Regioselective super-assembly of Prussian blue analogue.

The construction of high-asymmetrical structures demonstrates significant potential in improving the functionality and distinctness of nanomaterials, but remains a considerable challenge. Herein, we develop a one-pot method to fabricate regioselective super-assembly of Prussian blue analogue (PBA) -- a PBA anisotropic structure (PBA-AS) decorated with epitaxial modules--using a step-by-step epitaxial growth on a rapidly self-assembled cubic substrate guided by thiocyanuric acid (TCA) molecules. The epitaxial growth units manifest as diverse geometric shapes, which are predominantly concentrated on the {100}, {111}, or {100}+{111} crystal plane of the cubic substrate. The crystal plane and morphology of epitaxial module can be regulated by changing the TCA concentration and reaction temperature, enabling a high level of controllability over specific assembly sites and structures. To illustrate the advantage of the asymmetrical structure, phosphated PBA-AS demonstrates improved performance in the oxygen evolution reaction compared to simple phosphated PBA nanocube. This method offers valuable insights for designing asymmetrical nanomaterials with intricate architectures and versatile functionalities.

Rapid Construction of Double Crystalline Prussian Blue Analogue Hetero-Superstructure.

The controllable construction of complex metal-organic coordination polymers (CPs) merits untold scientific and technological potential, yet remains a grand challenge of one-step construction and modulating simultaneously valence states of metals and topological morphology. Here, a thiocyanuric acid (TCA)-triggered strategy is presented to one-step rapid synthesis a double-crystalline Prussian blue analogue hetero-superstructure (PBA-hs) that comprises a Co3[Fe(CN)6]2 cube overcoated with a KCo[Fe(CN)6] shell, followed by eight self-assembled small cubes on vertices. Unlike common directing surfactants, TCA not only acts as a trigger for the fast growth of KCo[Fe(CN)6] on the Co3[Fe(CN)6]2 phase resulting in a PBA-on-PBA hetero-superstructure, but also serves as a flange-like bridge between them. By combining experiments with simulations, a deprotonation-induced electron transfer (DIET) mechanism is proposed for formation of second phase in PBA-hs, differing from thermally and photo-induced electron transfer processes. To prove utility, the calcined PBA-hs exhibits enhanced oxygen evolution reaction performance. This work provides a new method to design of novel CPs for enriching chemistry and material science. This work offers a practical approach to design novel CPs for enriching chemistry and material science.

Multifunctional Luminescent 3D Ln-MOFs with High Sensitivity for Trace Detection of Micronutrients.

The synthesis of two versatile fluorescent metal-organic frameworks (MOFs), [Eu(4-NCP)(1,4-bdc)]n·0.5H2O (1) and [Eu(4-NCP)(4,4'-bpdc)]n·0.75H2O (2) (HNCP = 2-(4-carboxyphenyl)imidazo(4,5-f)-(1,10)phenanthroline, 1,4-H2bdc = benzene-1,4-dicarboxylic acid, 4,4'-H2bpdc = 4,4'-biphenyldicarboxylic acid), was carried out using a hydrothermal method. These MOFs were characterized through various advanced technologies to determine their structural information. The results indicate that both MOFs exhibited 3D network structures with specific topologies. Furthermore, these MOFs demonstrated exceptional thermal stabilities and adsorption capabilities. Additionally, complex 2 was utilized for studying the fluorescence sensing properties of various micronutrients including metal ions, nitro aromatic compounds, and biological small molecules. Notably, complex 2 showed promising potential as a multifunctional sensor for selectively detecting Fe3+, nitrobenzene, and ascorbic acid in aqueous solutions through fluorescence quenching with low limits of detection (LODs ∼ 10-7 M) and high quenching constants (Ksv ∼ 103 M-1). Moreover, the detection mechanism of complex 2 was further investigated by using experimental methods and DFT calculations.

Regulation of Na+-K+-ATPase leads to disturbances of isoproterenol-induced cardiac dysfunction via interference of Ca2+-dependent cardiac metabolism.

Reductions in Na+-K+-ATPase (NKA) activity and expression are often observed in the progress of various reason-induced heart failure (HF). However, NKA α1 mutation or knockdown cannot cause spontaneous heart disease. Whether the abnormal NKA α1 directly contributes to HF pathogenesis remains unknown. Here, we challenge NKA α1+/- mice with isoproterenol to evaluate the role of NKA α1 haploinsufficiency in isoproterenol (ISO)-induced cardiac dysfunction. Genetic knockdown of NKA α1 accelerated ISO-induced cardiac cell hypertrophy, heart fibrosis, and dysfunction. Further studies revealed decreased Krebs cycle, fatty acid oxidation, and mitochondrial OXPHOS in the hearts of NKA α1+/- mice challenged with ISO. In ISO-treated conditions, inhibition of NKA elevated cytosolic Na+, further reduced mitochondrial Ca2+ via mNCE, and then finally down-regulated cardiac cell energy metabolism. In addition, a supplement of DRm217 alleviated ISO-induced heart dysfunction, mitigated cardiac remodeling, and improved cytosolic Na+ and Ca2+ elevation and mitochondrial Ca2+ depression in the NKA α1+/- mouse model. The findings suggest that targeting NKA and mitochondria Ca2+ could be a promising strategy in the treatment of heart disease.

Oxygen Defect Engineering Promotes Synergy Between Adsorbate Evolution and Single Lattice Oxygen Mechanisms of OER in Transition Metal-Based (oxy)Hydroxide.

The oxygen evolution reaction (OER) activity of transition metal (TM)-based (oxy)hydroxide is dominated by the number and nature of surface active sites, which are generally considered to be TM atoms occupying less than half of surface sites, with most being inactive oxygen atoms. Herein, based on an in situ competing growth strategy of bimetallic ions and OH- ions, a facile one-step method is proposed to modulate oxygen defects in NiFe-layered double hydroxide (NiFe-LDH)/FeOOH heterostructure, which may trigger the single lattice oxygen mechanism (sLOM). Interestingly, by only varying the addition of H2 O2 , one can simultaneously regulate the concentration of oxygen defects, the valence of metal sites, and the ratio of components. The proper oxygen defects promote synergy between the adsorbate evolution mechanism (AEM, metal redox chemistry) and sLOM (oxygen redox chemistry) of OER in NiFe-based (oxy)hydroxide, practically maximizing the use of surface TM and oxygen atoms as active sites. Consequently, the optimal NiFe-LDH/FeOOH heterostructure outperforms the reported non-noble OER catalysts in electrocatalytic activity, with an overpotential of 177 mV to deliver a current density of 20 mA cm-2 and high stability. The novel strategy exemplifies a facile and versatile approach to designing highly active TM-LDH-based OER electrocatalysts for energy and environmental applications.

Comparison of ventilation techniques for compensation of mask leakage using a ventilator and a regular full-face mask: A bench study.

Background: The use of noninvasive ventilation (NIV) during and after extubation is common. We designed this study to determine the optimal strategy to compensate for mask leaks and achieve effective ventilation during NIV by comparing commonly used operating room ventilator systems and a regular facemask. Methods: We tested four operating room ventilator systems (Dägger Zeus, Dägger Apollo, Dägger Fabius Tiro, and General Electric Healthcare Carestation 650) on a lung model with normal compliance and airway resistance and evaluated pressure control ventilation (PCV), volume control ventilation (VCV), and AutoFlow mode (VAF). We set the O2 flow at 10 L/min and the maximal flow at 13, 16, or 26 L/min. We simulated five leak levels, from no leak to over 40 L/min (I to V levels), using customized T-pieces placed between the lung model and the breathing circuit. We recorded the expired tidal volume (Vte) from the lung model and peak inspiratory pressure via two flow/pressure sensors that were placed distally and proximally to the T-pieces. Results: 1. Comparison of four ventilators: with any given ventilation mode, an increase in leak level caused a decrease in Vte. With PCV, only Zeus produced Vte larger than 150 ml at leak level V. 2. Effect of ventilation mode on Vte: across all four ventilators, PCV resulted in a higher Vte than VCV and VAF (P < 0.01). PCV mode with all ventilators at leak level II provided Vte values that were equal to or greater than those obtained with no leak. 3. Effect of O2 flow on Vte Using PCV mode: only Carestation 650 Vte at leak level II during PCV were significantly greater with 16 L/min O2 flow compared with 10 L/min O2 flow (P < 0.01). 4. Actual leak: increasing the O2 flow from 10 L/min to the maximum O2 flow dramatically increased the real leak with all 4 ventilators at any fixed leak level (P < 0.01). 5. Preset PIP vs. actual PIP with PCV: at low preset PIP and leak levels such as leak II and III, the discrepancy between preset PIP and actual PIP was small. The disparity between the preset and actual PIP grew when the target PIP and the leak level were raised. Conclusion: For NIV using a mask, the ventilator is preferred whose Pressure generator is Turbine, the PCV mode is preferred in the ventilation mode and the oxygen flow is set to 10 L/min or maximum oxygen flow.

Propofol suppresses OGD/R-induced ferroptosis in neurons by inhibiting the HIF-1α/YTHDF1/BECN1 axis.

BACKGROUND: Ischemia/reperfusion (I/R) is a pathological process that causes severe damage. Propofol is known to alleviate I/R-related injury; however, the exact function and underlying mechanisms are not fully understood. METHODS: Using an oxygen glucose deprivation/re-oxygenation (OGD/R) method, an in vitro I/R injury model was induced. The cell viability and the level of Fe2+, glutathione synthetase (GSH), and malondialdehyde (MDA) were evaluated using kits. Luciferase reporter gene assay, chromatin immunoprecipitation, and RNA immunoprecipitation (RIP) were used to verify the interaction between molecules. The m6A level of BECN1 mRNA was determined through methylated RIP. RESULTS: Propofol-treated OGD/R models showed reduced levels of Fe2+ and MDA, while the cell viability and the level of GSH increased. Propofol inhibited ferroptosis by down-regulating HIF-1α in OGD/R-treated HT22 cells. HIF-1α is bound to the promoter region of YTHDF1 to promote its transcription, and YTHDF1 promoted ferroptosis by stabilizing the mRNA of BECN1. The suppressive effect of propofol on OGD/R-induced ferroptosis was reversed by the overexpression of YTHDF1. CONCLUSIONS: Our study revealed that the HIF-1α/YTHDF1/BECN1 axis in OGD/R-treated HT22 cells promotes ferroptosis, and administration of propofol can inhibit this axis to avoid cell death. This study provides a novel insight for the neuroprotective function of propofol.

Controllable preparation of Ti3C2Tx/Ag composite as SERS substrate for ultrasensitive detection of 4-nitrobenzenethiol.

Currently, metal carbonitride (MXene) has been identified as a hot research topic in the research area of surface-enhanced Raman scattering (SERS). In this study, Ti3C2Tx/Ag composite was fabricated as SERS substrate with different Ag contents. The fabricated Ti3C2Tx/Ag composites show good SERS behavior by detecting 4-Nitrobenzenethiol (4-NBT) probe molecules. Through calculation, the SERS enhancement factor (EF) of the Ti3C2Tx/Ag substrate was as high as 4.15 × 106. It is worth noting that the detection limit of 4-NBT probe molecules can be achieved ultralow concentration of 10-11 M. In this system, electromagnetic enhancement mechanism and chemical enhancement mechanism have synergistic effects on SERS phenomenon. Meanwhile, the Ti3C2Tx/Ag composite substrate exhibited good SERS reproducibility. In addition, the SERS detection signal hardly changed after 6 months of natural standing, and the substrate showed good stability. This work suggests that the Ti3C2Tx/Ag substrate could be used as a sensitivity SERS sensor for practical application, and could be applied in the field of environmental monitoring.

A General Strategy for Synthesis of Binary Transition Metal Phosphides Hollow Sandwich Heterostructures.

The hollow sandwich core-shell micro-nanomaterials are widely used in materials, chemistry, and medicine, but their fabrication, particularly for transition metal phosphides (TMPs), remains a great challenge. Herein, a general synthesis strategy is presented for binary TMPs hollow sandwich heterostructures with vertically interconnected nanosheets on the inside and outside surfaces of polyhedron FeCoPx /C, demonstrated by a variety of transition metals (including Co, Fe, Cd, Mn, Cu, Cr, and Ni). Density functional theory (DFT) calculation reveals the process and universal mechanism of layered double hydroxide (LDH) growth on Prussian blue analog (PBA) surface in detail for the first time, which provides the theoretical foundations for feasibility and rationality of the synthesis strategy. This unique structure exhibits a vertical nanosheet-shell-vertical nanosheet configuration combining the advantages of sandwich, hollow and vertical heterostructures, effectively achieving their synergistic effect. As a proof-of-concept of their applications, the CoNiPx @FeCoPx /C@CoNiPx hollow sandwich polyhedron architectures (representative samples) show excellent catalytic performance for the oxygen evolution reaction (OER) in alkaline electrolytes. This work provides a general method for constructing hollow-sandwich micro-nanostructures, which provides more ideas and directions for design of micro-nano materials with special geometric topology.

iTRAQ-Based Quantitative Proteomic Analysis of Arthrobacter simplex in Response to Cortisone Acetate and Its Mutants with Improved Δ1-Dehydrogenation Efficiency.

Arthrobacter simplex is extensively used for cortisone acetate (CA) biotransformation in industry, but the Δ1-dehydrogenation molecular fundamental remains unclear. Herein, the comparative proteome revealed several proteins with the potential role in this reaction, which were mainly involved in lipid or amino acid transport and metabolism, energy production and conversion, steroid degradation, and transporter. The influences of six proteins were further confirmed, where pps, MceGA, yrbE4AA, yrbE4BA, and hyp2 showed positive impacts, while hyp1 exhibited a negative effect. Additionally, KsdD5 behaved as the best catalytic enzyme. By the combined manipulation in multiple genes under the control of a stronger promoter, an optimal strain with better catalytic enzyme activity, substrate transportation, and cell stress tolerance was created. After biotechnology optimization, the production peak and productivity were, respectively, boosted by 4.1- and 4.0-fold relative to the initial level. Our work broadens the understanding of the Δ1-dehydrogenation mechanism, also providing effective strategies for excellent steroid-transforming strains.

Measurement of exhaled breath temperature in patients under general anesthesia: A feasibility study.

The aim of the present study was to investigate the respiratory parameters that influence the exhaled breath temperature (EBT) and the feasibility of using the latter to monitor the core temperature under general endotracheal anesthesia. A total of 20 patients undergoing abdominal surgery were included in the present study. At the first stage of the experiment, the respiratory rate was adjusted, while the other respiratory parameters [tidal volume, inspiratory and expiratory time ratio (TI:TE), and positive end expiratory pressure (PEEP)] were maintained at a constant level. At the second stage, the tidal volume was adjusted, while the other respiratory parameters were maintained at a constant level. At the third stage, the TI:TE was adjusted, while the other parameters were maintained at a constant level. At the fourth stage, PEEP was adjusted, while the other parameters were maintained at a constant level. In each experiment, the EBT, the maximum temperature of exhaled air in each min, the inhaled air temperature and the nasopharyngeal temperature (T nose) were recorded every min. During the first stage of the experiment, no significant difference was noted in the EBT at different levels of respiratory rate. During the second, third and fourth stage, no significant difference was noted in the EBT at different tidal volumes, TI:TE and PEEP, respectively. The EBT was significantly correlated with the T nose. Overall, the present study demonstrated that the EBT of patients undergoing abdominal surgery under general endotracheal anesthesia was not affected by the examined respiratory parameters and that it could be considered a feasible method of monitoring core temperature.

Directional Charge Transfer Channels in a Monolithically Integrated Electrode for Photoassisted Overall Water Splitting.

Photoelectrocatalytic performance of a system is fundamentally determined by the full absorption of sunlight and high utilization of photoexcited carriers, but efficiency of the latter is largely limited by inefficient charge transfer from the absorber to reactive sites. Here, we propose to construct directional charge transfer channels in a monolithically integrated electrode, taking carbon dots/carbon nitride (CCN) nanotubes and FeOOH/FeCo layered double hydroxide (FFC) nanosheets as a representative, to boost the photoassisted overall water splitting performance. Detailed experimental investigations and DFT calculations demonstrate that the interfacial C-O-Fe bonds between CCN and FFC act as charge transfer channels, facilitating the directional migration of the photogenerated carriers between CCN and FFC surfaces. Moreover, the in situ oxidized Fe/Co species by photogenerated holes trigger lattice oxygen activation, realizing the construction of the Fe-Co dual-site as the catalytic center and efficiently lowering the barrier energy for water oxidation. As a result, the CCN@FFC electrode shows multiple functionalities in photoelectrocatalysis: only a low overpotential of 68 mV, 182 mV, and 1.435 V is required to deliver 10 mA cm-2 current densities for the photoassisted HER, OER, and overall water splitting, respectively. This directional charge transfer modulation strategy may facilitate the design of highly active and cost-effective multifunctional catalysts for energy conversion and storage.

Tailored FTO/Ag/ZIF-8 structure as SERS substrate for ultrasensitive detection.

In this work, a series of F-doped SnO2/Ag/zeolite imidazole framework (FTO/Ag/ZIF-8) sandwich structure have been successfully fabricated via a magnetic sputtering method and serve as surface-enhanced Raman scattering (SERS) substrate. The magnetic sputtering time of Ag was adjusted to obtain the optimal SERS substrate. The commonly used 4-mercaptobenzoic acid (4-MBA) molecules was selected for the SERS experiment. When the sputtering time of Ag nanoparticles (NPs) was 120 s, the FTO/Ag/ZIF-8 substrate showed the maximum SERS performance. In the system, the electromagnetic mechanism (EM) and charge-transfer (CT) enhancement mechanism have synergistic effect on the SERS phenomenon. Ag NPs was used to generate electromagnetic hot spots, which was beneficial to the EM mechanism. ZIF-8 could adsorb and capture more 4-MBA probe molecules to the hotspots. At the same time, CT happened between Ag, ZIF-8, and 4-MBA probe molecules, which was attribute to the CM mechanism. The enhancement factor (EF) of the composite SERS substrate was as high as 7.67 × 106. The detection limit of the substrate can reach 10-9 M of 4-MBA probe molecules. Moreover, the SERS templates showed good stability, the SERS signals almost unchanged after naturally kept for 6 months. Besides, due to the high sensitivity and good stability of the substrates, this work might broaden the potential practical application of SERS.

Influence of obstructive sleep apnoea on coronary artery disease in a Chinese population.

OBJECTIVE: This study aimed to investigate the correlation between obstructive sleep apnoea (OSA) and the severity of coronary artery disease (CAD) assessed by angiography. METHODS: This prospective study screened 273 patients diagnosed with CAD by coronary angiography. The severity of CAD was assessed by SYNTAX score. A total of 255 subjects were enrolled of whom 161 were diagnosed with OSA, with an apnoea-hypopnoea index ≥5/hour. Ninety-four CAD patients without OSA were used as controls. The relationship between OSA and CAD was analysed by multiple linear regression. RESULTS: The prevalence of OSA in CAD patients was 63.1%. The prevalences of single-vessel, two-vessel, and three-vessel disease were similar in the two groups. However, CAD was significantly more severe in patients with OSA, measured by SYNTAX score, than in those without OSA. OSA was independently associated with CAD after adjusting for traditional risk factors. CONCLUSIONS: OSA is relatively common among patients with CAD in China. The independent association between OSA and CAD, even after adjusting for traditional confounders, suggests that OSA should be taken into account when considering the risk factors for CAD. The present findings highlight the important adverse influence of OSA on the severity of CAD.

Facile fabrication of PS/Cu2S/Ag sandwich structure as SERS substrate for ultra-sensitive detection.

In this work, a serials of PS(polystyrene)/Cu2S/Ag sandwich substrates were successfully constructed using the magnetic sputtering method by adjusting the Ag sputtering time (0 min, 2 min, 4 min, 6 min, 8 min and 10 min) and used as the surface-enhanced Raman scattering (SERS) substrates. When the Ag sputtering time was 6 min, the strongest SERS signal was observed. The optimized SERS substrate has strong SERS activity on 4-mercaptobenzoic acid (4-MBA), the minimum detection limit was 10-13 M and the enhancement factor was as high as 4.7 × 107. In addition, the SERS signals were highly reproducible with small standard deviation. The SERS enhancement mechanism of the PS/Cu2S/Ag system was attributed to the synergistic effect of the chemical mechanism and the electromagnetic enhancement mechanism. This strategy has find a new way for manufacturing SERS activity sensor with high sensitivity and reproducibility.

Propofol Protects Against Hepatic Ischemia Reperfusion Injury via Inhibiting Bnip3-Mediated Oxidative Stress.

Propofol (PRO) protects against hepatic ischemia/reperfusion (I/R) injury. Bnip3 is involved in the I/R-induced injury. This study investigated whether the effect of PRO on hepatic hypoxia/reoxygenation (H/R) injury was realized through regulating Bnip3. After establishing a hepatic ischemia reperfusion (I/R ) injury model in mice, the serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined by an automatic biochemical analyzer. The histopathology and apoptosis of liver tissues were detected by hematoxylin-eosin and TUNEL staining. After the H/R liver cells were cultured and treated with PRO, the viability, apoptosis, reactive oxygen species (ROS) production, and the levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), TNF-α, and IL-6 were detected by MTT, flow cytometry, colorimetry, and ELISA. The expressions of Bnip3 and apoptosis-related factors in I/R mouse liver tissues and H/R cells were determined by immunohistochemical assay, immunofluorescence, Western blot, or RT-qPCR. PRO ameliorated the abnormal histopathology, reduced cell apoptosis and the levels of AST, ALT, Bnip3, Cleaved Caspase-3, and Bax, but upregulated the Bcl-2 level in the liver tissues of I/R mice. In H/R liver cells, PRO promoted the cell viability, downregulated the levels of LDH, MDA, TNF-α, IL-6, and reduced ROS production. Moreover, PRO promoted the downregulated expressions of cytosolic Bnip3, total Bni3p, Cleaved Caspase-3, and Bax and upregulated the Bcl-2 level. siBnip3 reversed the effect of H/R on the liver cells, and its overexpression also reversed the effect of PRO on H/R-induced liver cells. PRO protects against hepatic I/R injury via inhibiting Bnip3.

Rapid Synthesis of Large-Size Fe2O3 Nanoparticle Decorated NiO Nanosheets via Electrochemical Exfoliation for Enhanced Oxygen Evolution Electrocatalysis.

A novel nonprecious Fe2O3 nanoparticle decorated NiO nanosheet (Fe2O3 NPs@NiO NSs) composite has been obtained by a rapid one-pot electrochemical exfoliation method and can be used as an efficient oxygen evolution reaction (OER) catalyst. In the nanocomposite, the Fe2O3 NPs are uniformly anchored on the ultrathin graphene-like NiO nanosheets. At the same time, we also studied the influence of the Fe/Ni molar ratio on the morphology and catalytic activity. The Fe2O3 NPs@NiO NSs nanocomposite possessed a high BET surface area (194.1 m2 g-1), which is very conducive to the charge/mass transfer of electrolyte ions and O2. Owing to the unique two-dimensional (2D) heterostructures and rational Fe content, the as-prepared Fe2O3 NPs@NiO NSs show high catalytic performance, a low overpotential at 10 mA cm-2 (221 mV), a small Tafel slope (53.4 mV dec-1), and 2000 cycle and 20 h long-term durability. The introduction of Fe2O3 NPs is beneficial to accelerating charge transport, increasing the electrochemically active surface area (ECSA), and thus improving the release of oxygen bubbles from the electrode surface.

Refractive index sensor based on etched eccentric core few-mode fiber dual-mode interferometer.

A compact and high sensitivity refractive index (RI) sensor has been theoretically and experimentally demonstrated based on dual-mode interferometer (DMI) in an eccentric core few-mode fiber (ECFMF). The DMI is fabricated by fusion splicing a piece of ECFMF etched by hydrofluoric acid (HF) and two single mode fibers (SMFs) with a lateral-offset. The interference is formed by LP01 and LP11 modes in the eccentric core of ECFMF. The etched ECFMF-DMI based on core-core mode interference exhibits a higher RI sensitivity than the DMI based on core-cladding mode interference. The sensitivity reaches up to 2565.2 nm/RIU around the RI of 1.4. Both of the etched and unetched ECFMF-DMIs have low temperature sensitivities of 9.6 pm/°C and 33.1 pm/°C, respectively. The etched ECFMF-DMI based on the core-core mode interference possesses tremendous superiority for RI measurement due to its high RI sensitivity and low temperature cross, therefore the proposed sensor has great potentials in chemical and biological fields.

Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.

To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.

Effects of different ventilation strategies on exhaled nitric oxide in geriatric abdominal surgery.

Exhaled nitric oxide (eNO) has been suggested to be a marker of small airway injury. We investigated the effects of different ventilation strategies on eNO. Sixty-nine patients who received elective open abdominal surgery under general anesthesia with more than 2 h of surgery duration were randomly divided into three groups: high tidal volume of 10-12 ml kg(-1) predicted body weight (PBW) with zero end-expiratory pressure (ZEEP) (high VT + ZEEP group); low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O positive end-expiratory pressure (PEEP) (low VT + PEEP group); and low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O PEEP and recruitment maneuvers (low VT + PEEP + RMs group). eNO, respiratory system compliance (Crs), oxygenation index, inflammatory mediators tumor necrosis factor-alpha (TNF-α), interleukin-1ß (IL-1ß), IL-8, prostaglandin E2 (PGE2) and PGF2a as well as pulmonary function were measured during the perioperative period. The postoperative eNO decreased in 78.3% of patients in the high VT + ZEEP group and low VT + PEEP group, and increased in 56.5% of patients in the low VT + PEEP + RMs group (P = 0.016). The Crs level in the high VT + ZEEP group significantly decreased with time but significantly increased in the low VT + PEEP + RMs group (P < 0.05). The oxygenation index, inflammatory mediators and pulmonary function did not statistically differ among the three groups. Compared with the low VT + PEEP + RMs group, the decreasing rate of postoperative eNO in the high VT + ZEEP and low VT + PEEP groups was higher, which may imply small airway injury during geriatric abdominal surgery.