A novel adaptive filter with a heart-rate-based reference signal for esophageal pressure signal denoising.

Esophageal pressure (Peso) is one of the most common and minimally invasive methods used to assess the respiratory and lung mechanics in patients receiving mechanical ventilation. However, the Peso measurement is contaminated by cardiogenic oscillations (CGOs), which cannot be easily eliminated in real-time. The field of study dealing with the elimination of CGO from Peso signals is still in the early stages of its development. In this study, we present an adaptive filtering-based method by constructing a reference signal based on the heart rate and sine function to remove CGOs in real-time. The proposed technique is tested using clinical data acquired from 20 patients admitted to the intensive care unit. Lung compliance ( QUOTE ) and esophageal pressure swings (△Pes) are used to evaluate the performance and efficiency of the proposed technique. The CGO can be efficiently suppressed when the constructional reference signal contains the fundamental, and second and third harmonic frequencies of the heart rate signal. The analysis of the data of 8 patients with controlled mechanical ventilation reveals that the standard deviation/mean of the QUOTE is reduced by 28.4-79.2% without changing the QUOTE and the △Pes measurement is more accurate, with the use of our proposed technique. The proposed technique can effectively eliminate the CGOs from the measured Peso signals in real-time without requiring additional equipment to collect the reference signal.

Functionalized cellulose nanofibrils based supramolecular system-assisted molding enabled strong, antibacterial chitosan bioplastics.

Bioplastics are considered as potential alternatives to non-renewable and non-biodegradable petroleum-based plastics. Inspired by ionic and amphiphilic properties of mussel protein, we proposed a versatile and facile strategy for the fabrication of a high-performance chitosan (CS) composite film. This technique incorporates a cationic hyperbranched polyamide (QHB) and a supramolecular system based on the lignosulphonate (LS)-functionalized cellulose nanofibrils (CNF) (LS@CNF) hybrids. The cationic QHB was synthesized by a one-step process from hyperbranched polyamide and quaternary ammonium salt. Meanwhile, the functional LS@CNF hybrids act as a well-dispersed and rigid cross-linked domain in CS matrix. Owing to the interconnected hyperbranched and enhanced supramolecular network, the toughness and tensile strength of the CS/QHB/LS@CNF film simultaneously increased to 19.1 MJ/m3 and 50.4 MPa, 170.2 % and 72.6 % higher than the pristine CS film. Additionally, the functional QHB/LS@CNF hybrids endow the films with superior antibacterial activity, water resistance, UV shielding, and thermal stability. This bioinspired strategy provides a novel and sustainable method for the production of multifunctional CS films.

Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case-control study.

BACKGROUND: The mortality of extensively drug-resistant Gram-negative (XDR GN) bacilli-induced ventilator-associated pneumonia (VAP) is extremely high. The purpose of this study was to compare the efficacy and safety of inhaled (IH) plus intravenous (IV) polymyxin B versus IV polymyxin B in XDR GN bacilli VAP patients. METHODS: A retrospective multi-center observational cohort study was performed at eight ICUs between January 1st 2018, and January 1st 2020 in China. Data from all patients treated with polymyxin B for a microbiologically confirmed VAP were analyzed. The primary endpoint was the clinical cure of VAP. The favorable clinical outcome, microbiological outcome, VAP-related mortality and all-cause mortality during hospitalization, and side effects related with polymyxin B were secondary endpoints. Favorable clinical outcome included clinical cure or clinical improvement. RESULTS: 151 patients and 46 patients were treated with IV polymyxin B and IH plus IV polymyxin B, respectively. XDR Klebsiella pneumoniae was the main isolated pathogen (n = 83, 42.1%). After matching on age (± 5 years), gender, septic shock, and Apache II score (± 4 points) when polymyxin B was started, 132 patients were included. 44 patients received simultaneous IH plus IV polymyxin B and 88 patients received IV polymyxin B. The rates of clinical cure (43.2% vs 27.3%, p = 0.066), bacterial eradication (36.4% vs 23.9%, p = 0.132) as well as VAP-related mortality (27.3% vs 34.1%, p = 0.428), all-cause mortality (34.1% vs 42.0%, p = 0.378) did not show any significant difference between the two groups. However, IH plus IV polymyxin B therapy was associated with improved favorable clinical outcome (77.3% vs 58.0%, p = 0.029). Patients in the different subgroups (admitted with medical etiology, infected with XDR K. pneumoniae, without bacteremia, with immunosuppressive status) were with odd ratios (ORs) in favor of the combined therapy. No patient required polymyxin B discontinuation due to adverse events. Additional use of IH polymyxin B (aOR 2.63, 95% CI 1.06, 6.66, p = 0.037) was an independent factor associated with favorable clinical outcome. CONCLUSIONS: The addition of low-dose IH polymyxin B to low-dose IV polymyxin B did not provide efficient clinical cure and bacterial eradication in VAP caused by XDR GN bacilli. Keypoints Additional use of IH polymyxin B was the sole independent risk factor of favorable clinical outcome. Patients in the different subgroups were with HRs substantially favoring additional use of IH polymyxin B. No patients required polymyxin B discontinuation due to adverse events.

Peripheral blood circular RNA hsa_circ_0082688-hsa_circ_0008675 can be used as a candidate biomarker of systemic lupus erythematosus with renal involvement.

OBJECTIVES: This research aimed to investigate the level of peripheral blood circular RNAs (circRNAs) from systemic lupus erythematosus (SLE) patients with renal involvement (SLE+RI) to identify novel biomarkers for SLE+RI screening. METHODS: circRNAs expression in peripheral blood from 3 SLE+RI patients, 3 SLE patients without renal involvement (SLE-RI) and 3 healthy controls (HC) were performed by microarray. All upregulated expressed circRNAs coming from "circBase" between the three groups were determined by real time-quantitative polymerase chain reaction (qRT-PCR) in SLE+RI, SLE-RI, HC, neprhritis without SLE (NWS) and rheumatoid arthritis (RA) patients. The diagnostic value of these circRNAs for SLE+RI was evaluated by receiver operating characteristic (ROC) curve. A 15-day follow-up was evaluated in 7 newly diagnosed SLE+RI patients to investigate the level change of these circRNAs after treatment. RESULTS: We confirmed that the level of hsa_circ_0082688, hsa_circ_0082689 and hsa_circ_0008675 were significantly elevated in SLE+RI patients with respect to the SLE-RI, RA, NWS patients and the HC. The level of hsa_circ_0082688, hsa_circ_0082689 and hsa_circ_0008675 were associated with C4, anti-dsDNA, anti-nucleosome. The level of hsa_circ_0008675 was associated with C3, and the level of hsa_circ_0082688 and hsa_circ_0008675 were associated with treatment. ROC curve analysis suggested that hsa_circ_0082688-hsa_circ_0008675 had significant value in the diagnosis of new-onset SLE+RI patients than the controls (new-onset SLE-RI patients, RA patients, NWS patients and HC) with an area under the curve of 0.925, sensitivity of 79.17% and specificity of 96.64%. CONCLUSIONS: This study suggests that peripheral blood hsa_circ_0082688-hsa_circ_0008675 level in SLE+RI patients is upregulated and may also serve as a potential biomarker for SLE+RI patient diagnosis and treatment.

[The mechanism of inhibition by ginkgolide B on interleukin-8 production induced by 4-hydroxynonenal in bronchial epithelial cells].

OBJECTIVE: 4-Hydroxynonenal (4-HNE) can increase the synthesis of interleukin-8 (IL-8) in bronchial epithelium cells (16HBE). This study was to explore the role of ginkgolide B in inhibiting the synthesis of IL-8 induced by 4-HNE in 16HBE. METHODS: The experiments were divided into 3 groups: a group treated with 4-HNE (10 micromol/L), a group treated with ginkgolide B (100 micromol/L) + 4-HNE (10 micromol/L), and a control group. IL-8 and IL-8 mRNA were measured after 4-HNE (or serum-free medium) stimulation for 0.5, 2, 4, 8, 12 hours. The phosphorylation of ERK1/2, JNK, p38MAPK and the combining activity of AP-1 after 4-HNE stimulation for 0.5, 2, 4, 8, 12 hours were all examined. IL-8 and the combining activity of AP-1 were measured after the 16HBE were pre-incubated with 50 micromol/L PD98059 (MEK1 inhibitor) for 2 hours before 4-HNE stimulation. The combining activity of AP-1 in 10 micromol/L 4-HNE, 100 micromol/L ginkgolide B + 10 micromol/L 4-HNE, and the control groups were all measured by EMSA. RESULTS: The level of IL-8 in 10 micromol/L 4-HNE, 100 micromol/L ginkgolide B + 10 micromol/L 4-HNE, the control groups after 4-HNE stimulating for 4 h were (98.3 +/- 4.2), (88.2 +/- 5.3), (65.3 +/- 6. 2) and (116.5 +/- 5.6), (102.8 +/- 4.7), (63.7 +/- 6.6) microg/L for 12 h. The level of IL-8 and IL-8 mRNA after 4-HNE stimulation in the ginkgolide B + 4-HNE group were lower than those in the 4-HNE group while higher than those in the control groups. The level of phosphorylation of ERK1 in the 4-HNE group at 0.5, 2, 4, 8, 12 hours were higher than those in the control groups (t = 2.83 - 14.03, P < 0.05). The AP-1 combining activity in the 4-HNE group, the ginkgolide B + 4-HNE group, PD98059 + 4-HNE group, and the control group were significantly different (F = 21.49 - 194.16, P < 0.01). The expression of IL-8 and the AP-1 combining activity in groups of pre-incubated with PD98059 2 hours before 4-HNE stimulation were lower than that without PD98059. The combining activity of AP-1 in the ginkgolide B + 4-HNE group was decreased as compared to the 4-HNE groups. CONCLUSION: 4-HNE increased the expression of Interleukin-8 in bronchial epithelium cells, via increasing the transcription activities of AP-1 by ERK1 cell signal transduction pathways. Ginkgolide B inhibited synthesis of IL-8 by blocking ERK1-AP1 transduction pathways.

[Effect of allitridum on expression of the gamma-glutamyl-cysteine synthetase in rat lung epithelial L2 cells].

OBJECTIVE: To study the effects of allitridum on the antioxidative capability of rat lung epithelial L2 cells (CCL-149 cell line) by observing the changes of glutathione (GSH), malondialdehyde (MDA) content, and the expressing level of gamma-glutamyl-cysteine synthetase (gamma-GCS) protein. METHODS: The cell viability of CCL-149 cells treated with allitridum was detected by MTT assay. CCL-149 cells were incubated with 0, 0.1, 1.0, 5.0 microg/ml of allitridum for 6, 12, 24, 48 h. After treatment, GSH content and MDA formation were measured by spectrophotometric assay, and the gamma-GCS protein was semi-quantified by Western blot. RESULTS: Allitridum (0.1, 1.0, 5.0 microg/ml) showed no side effects on cell growth (P > 0.05). Treatment with allitridum increased GSH levels and decreased MDA formation in CCL-149, the most significant time being incubation at 24 h. The GSH content were (13.34 +/- 0.62), (27.67 +/- 2.39), (29.54 +/- 0.71), (30.25 +/- 1.05) mg/g prot, and the MDA content were (1.25 +/- 0.08), (0.90 +/- 0.06), (0.84 +/- 0.06), (0.81 +/- 0.02) nmol/mg prot when CCL-149 cells were treatment with 0, 0.1, 1.0, 5.0 microg/ml of allitridum for 24 h, respectively. The effect showed no dose dependent effects (P > 0.05). After 6, 12, 24 h incubation, the expression of gamma-GCS protein was increased as compared to the control cells (t = 2.82 - 9.92, P < 0.05). CONCLUSION: Allitidum may increase the antioxidative ability of CCL-149 cells by increasing the expression of gamma-GCS protein and the content of GSH.

[Effects of benzo(a)pyrene on the expression of gamma-glutamate-cysteine ligase: a primary study with rat alveolar epithelial cells].

OBJECTIVE: To study the effect of benzo(a)pyrene [B(a)P] on the expression of gamma-glutamate-cysteine ligase (gamma-GCS) in rat alveolar epithelium cells (CCL-149 cell line). METHODS: Rat alveolar cells of the line CCL-149 were cultured and exposed to B(a)P of the concentrations of 0, 100, 500, and 5000 microg/L respectively for 24, 36, 48, and 72 hours respectively. Then the A values was measured to observe the influence of B(a)P on the growth of the CCL-149 cells. Another CCL-149 cells were exposed to B(a)P of the concentration of 200 microg/L for 6 h, then the nuclear protein was extracted. Electrophoretic mobility shift assays (EMSA) and antibody supershift assay were used to observe the specific binding of aryl hydrocarbon receptor nuclear translocator (ARNT) to the E-box element. CCL-149 cells were cultured to 95% confluent and transfected with GCLC-luc and GCLC-delE-box-luc for 6 h, exposed to B(a)P of different concentrations (2, 20, and 200 microg/L) for 2, 6, 12, or 24 h, then the cells were harvested and the luciferase activity was measured. Cells treated with DMSO were used as negative control group. RESULTS: B(a)P of the concentrations over 5000 microg/L significantly influenced the growth of the CCL-149 cells (all P < 0.01). Treated with B(a)P induced binding of AHR/ARNT to E-box element was significantly increased by treatment of B(a)P. Treatment of B(a)P of different concentrations at different time points did not significantly influence the luciferase activity (all P > 0.05). CONCLUSION: B(a)P induces the binding of ARNT to the E-box element on the gamma-GCS gene, but this interaction between E-box and ARNT seems not to have effect on the gene expression of gamma-GCS.