The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis.

OBJECTIVES: To assess the impact of analgosedation on mortality and delirium in critically ill patients. RESEARCH METHODOLOGY: A systematic review and meta-analysis was conducted to identify studies through Pubmed, Cochrane Library, Embase and Web of Science published from June 2017 to July 2018. Only articles published in English were considered. The Cochrane Collaboration Risk of Bias Tool was used to evaluate the methodological quality of randomised trials, while Newcastle-Ottawa Scale (NOS) was used for cohort studies. RESULTS: Seventeen eligible studies were identified, including 2298 patients (1170 in the experimental group and 1128 in the control group). Varying analgesics and sedatives were investigated, showing a high clinical heterogeneity. Analgosedation significantly decreased the ICU mortality rate when compared to conventional analgesia and sedation [odds ratio (OR) 0.72, 95%CI 0.53-0.97; P = 0.03]. No significant difference was demonstrated in 28-day/hospital mortality rate [OR 0.91, 95%CI 0.70-1.18; P = 0.48] or in the incidence of delirium [OR 1.06, 95%CI 0.78-1.45; P = 0.70]. However, subgroup analysis of trials indicated a significant increase in the delirium rate (OR: 1.88, 95%CI 1.14-3.10, p = 0.01). CONCLUSION: The ICU mortality was decreased by implementing analgosedation, but the hospital mortality and the delirium rates were not. Because of the absence of higher quality study designs, clinical heterogeneity and inclusion of small number of studies, the analysis results must be cautiously interpreted.

Poplar calcineurin B-like proteins PtCBL10A and PtCBL10B regulate shoot salt tolerance through interaction with PtSOS2 in the vacuolar membrane.

The calcineurin B-like protein (CBL) family represents a unique group of calcium sensors in plants. In Arabidopsis, CBL10 functions as a shoot-specific regulator in salt tolerance. We have identified two CBL10 homologs, PtCBL10A and PtCBL10B, from the poplar (Populus trichocarpa) genome. While PtCBL10A was ubiquitously expressed at low levels, PtCBL10B was preferentially expressed in the green-aerial tissues of poplar. Both PtCBL10A and PtCBL10B were targeted to the tonoplast and expression of either one in the Arabidopsis cbl10 mutant could rescue its shoot salt-sensitive phenotype. Like PtSOS3, both PtCBL10s physically interacted with the salt-tolerance component PtSOS2. But in contrast to the SOS3-SOS2 complex at the plasma membrane, the PtCBL10-SOS2 interaction was primarily associated with vacuolar compartments. Furthermore, overexpression of either PtCBL10A or PtCBL10B conferred salt tolerance on transgenic poplar plants by maintaining ion homeostasis in shoot tissues under salinity stress. These results not only suggest a crucial role of PtCBL10s in shoot responses to salt toxicity in poplar, but also provide a molecular basis for genetic engineering of salt-tolerant tree species.

Overexpression of G10H and ORCA3 in the hairy roots of Catharanthus roseus improves catharanthine production.

A number of genes that function in the terpenoid indole alkaloids (TIAs) biosynthesis pathway have been identified in Catharanthus roseus. Except for the geraniol 10-hydroxylase (G10H) gene, which encodes a cytochrome P450 monooxygenase, several of these genes are up-regulated by ORCA3, a jasmonate-responsive APETALA2 (AP2)-domain transcript factor. In this study, the G10H gene was transformed independently, or co-transformed with ORCA3 into C. roseus, using Agrobacterium rhizogenes MSU440. Hairy root clones expressing the G10H gene alone, or both the G10H and ORCA3 genes, were obtained. Alkaloid accumulation level analyses showed that all transgenic clones accumulated more catharanthine, with the highest accumulation level in the transgenic clone OG12 (6.5-fold higher than that of the non-expression clone). Following treatment with ABA, accumulation of catharanthine reached 1.96 mg/g DW in the transgenic clone OG12. The expression levels of TIAs biosynthesis genes in transgenic and non-transgenic clones were also investigated.