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Identification of risk factors for antibiotic treatment failure is urgently needed in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Here we investigated the relationship between sputum microbiome and clinical outcome of choice of initial antibiotics during hospitalization of AECOPD patients. Sputum samples of 41 AECOPD patients and 26 healthy controls were collected from Guangzhou Medical University, China. Samples were processed for 16S rRNA gene-based microbiome profiling. Thirty patients recovered with initial antibiotic treatment (antibiotic success or AS), while 11 patients showed poor outcome (antibiotic failure or AF). Substantial differences in microbiome were observed in AF versus AS patients and healthy controls. There was significantly decreased alpha diversity and increased relative abundances of Pseudomonas, Achromobacter, Stenotrophomonas and Ralstonia in AF patients. Conversely, Prevotella, Peptostreptococcus, Leptotrichia and Selenomonas were depleted. The prevalence of Selenomonas was markedly reduced in AF versus AS patients (9.1 % versus 60.0 %, P = 0.004). The AF patients with similar microbiome profiles in general responded well to the same new antibiotics in the adjusted therapy, indicating sputum microbiome may help guide the adjustment of antibiotics. Random forest analysis identified five microbiome operational taxonomic units together with C-reactive protein, procalcitonin and blood neutrophil count showing best predictability for antibiotic treatment outcome (area under curve 0.885). Functional inference revealed an enrichment of microbial genes in xenobiotic metabolism and antimicrobial resistance in AF patients, whereas genes in DNA repair and amino acid metabolism were depleted. Sputum microbiome may determine the clinical outcome of initial antibiotic treatment and be considered in the risk management of antibiotics in AECOPD.
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Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Hospitalização , Pulmão/microbiologia , Microbiota , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Escarro/microbiologia , Idoso , Antibacterianos/efeitos adversos , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Pacientes Internados , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/microbiologia , Ribotipagem , Resultado do TratamentoRESUMO
AIMS: To understand how decisions are made to transfer dying patients home from critical care units. BACKGROUND: Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. DESIGN: Integrative review. DATA SOURCES: Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. REVIEW METHODS: An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. RESULTS: The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. CONCLUSION: The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home.
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Cuidados Críticos , Tomada de Decisões , Serviços de Assistência Domiciliar , Unidades Hospitalares , Transferência de Pacientes , Assistência Terminal , Continuidade da Assistência ao Paciente , Feminino , Humanos , MasculinoRESUMO
Semiconducting carbon nanotubes (s-CNTs) have emerged as a promising alternative to traditional silicon for ultrascaled field-effect transistors (FETs), owing to their exceptional properties. Aligned s-CNTs (A-CNTs) are particularly favored for practical applications due to their ability to provide higher driving current and lower contact resistance compared with individual s-CNTs or random networks. Achieving high-semiconducting-purity A-CNTs typically involves conjugated polymer wrapping for selective separation of s-CNTs, followed by self-assembly techniques. However, the presence of the polymer wrapper on A-CNTs can adversely impact electrical contact, gating efficiency, carrier transport, and device-to-device variations, necessitating its complete removal. While various methods have been explored for polymer removal, accurately characterizing the extent of removal remains a challenge. Traditional techniques such as absorption spectroscopy and X-ray photoelectron spectroscopy (XPS) may not accurately depict the remaining polymer content on A-CNTs due to their inherent detection limits. Consequently, the performance of FETs based on pure polymer-wrapper-free A-CNTs is unclear. In this study, we present an approach for preparing high-semiconducting-purity and polymer-wrapper-free A-CNTs using poly[(9,9-dioctylfluorenyl-2,7-dinitrilomethine)-(9,9-dioctylfluorenyl-2,7-dimethine)] (PFO-N-PFO), a degradable polymer, in conjunction with a modified dimension-limited self-alignment process (m-DLSA). Comprehensive transmission electron microscopy (TEM) characterizations, complemented by absorption and XPS characterizations, provide robust evidence of the successful near-complete removal of the polymer wrapper via a cleaning procedure involving acidic degradation, hot solvent rinsing, and vacuum annealing. Furthermore, top-gated FETs based on these high-semiconducting-purity and polymer-wrapper-free A-CNTs exhibit good performance metrics, including an on-current (Ion) of 2.2 mA/µm, peak transconductance (gm) of 1.1 mS/µm, low contact resistance (Rc) of 191 Ω·µm, and negligible hysteresis, representing a significant advancement in the CNT-based FET technology.
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The upper and lower respiratory tract may share microbiome because they are directly continuous, and the nasal microbiome contributes partially to the composition of the lung microbiome. But little is known about the upper and lower airway microbiome of early postoperative lung transplant recipients (LTRs). Using 16S rRNA gene sequencing, we compared paired nasal swab (NS) and bronchoalveolar lavage fluid (BALF) microbiome from 17 early postoperative LTRs. The microbiome between the two compartments were significantly different in Shannon diversity and beta diversity. Four and eight core NS-associated and BALF-associated microbiome were identified, respectively. NS samples harbored more Corynebacterium, Acinetobacter, and Pseudomonas, while BALF contained more Ralstonia, Stenotrophomonas, Enterococcus, and Pedobacter. The within-subject dissimilarity was higher than the between-subject dissimilarity, indicating a greater impact of sampling sites than sampling individuals on microbial difference. There were both difference and homogeneity between NS and BALF microbiome in early postoperative LTRs. High levels of pathogens were detected in both samples, suggesting that both of them can reflect the diseases characteristics of transplanted lung. The differences between upper and lower airway microbiome mainly come from sampling sites instead of sampling individuals. IMPORTANCE: Lung transplantation is the only therapeutic option for patients with end-stage lung disease, but its outcome is much worse than other solid organ transplants. Little is known about the NS and BALF microbiome of early postoperative LTRs. Here, we compared paired samples of the nasal and lung microbiome from 17 early postoperative LTRs and showed both difference and homogeneity between the two samples. Most of the "core" microbiome in both NS and BALF samples were recognized respiratory pathogens, suggesting that both samples can reflect the diseases characteristics of transplanted lung. We also found that the differences between upper and lower airway microbiome in early postoperative LTRs mainly come from sampling sites instead of sampling individuals.
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Bactérias , Líquido da Lavagem Broncoalveolar , Transplante de Pulmão , Microbiota , RNA Ribossômico 16S , Transplantados , Transplante de Pulmão/efeitos adversos , Humanos , Microbiota/genética , Líquido da Lavagem Broncoalveolar/microbiologia , Masculino , Feminino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Bactérias/classificação , Bactérias/isolamento & purificação , Bactérias/genética , Adulto , Pulmão/microbiologia , Período Pós-Operatório , Idoso , Sistema Respiratório/microbiologiaRESUMO
BACKGROUND: Comfort is a primary patient objective and central to patient experience, and thus, maximising comfort is a universal goal for healthcare. However, comfort is a complex concept that is difficult to operationalise and evaluate, resulting in a lack of scientific and standardised comfort care practices. The Comfort Theory developed by Kolcaba has been the most widely known for its systematisation and projection and most of the global publications regarding comfort care were based on this theory. To develop international guidance on theory-informed comfort care, a better understanding about the evidence on the effects of interventions guided by the Comfort Theory is needed. OBJECTIVES: To map and present the available evidence on the effects of interventions underpinned by Kolcaba's Comfort theory in healthcare settings. METHODS: The mapping review will follow Campbell Evidence and Gap Maps guideline and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Protocols guidelines. An intervention-outcome framework has been developed based on Comfort Theory and the classification of pharmacological and non-pharmacological interventions via consultation with stakeholders. Eleven electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, AMED, Cochrane Library, JBI Library of Systematic Reviews, Web of Science, Scopus, CNKI and Wan Fang) and grey literature sources (Google Scholar, Baidu Scholar and The Comfort Line) will be searched for primary studies and systematic reviews between 1991 and 2023 written in English and Chinese as the papers regarding Comfort Theory were first published in 1991. Additional studies will be identified by reference list review of included studies. Key authors will be contacted for unpublished or ongoing studies. Two independent reviewers will screen and extract data using piloted forms with discrepancies resolved by discussion with a third reviewer. A matrix map with filters of study characteristics will be generated and presented through software of EPPI-Mapper and NVivo. DISCUSSION: More informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Findings from the evidence and gap map will present the existing evidence base for researchers, practitioners and policy-makers and inform further research as well as clinical practices aiming at patients' comfort enhancement.
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Garantia da Qualidade dos Cuidados de Saúde , Adulto , Humanos , Bases de Dados Factuais , Resultado do TratamentoRESUMO
OBJECTIVES: To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. DESIGN: A constructivist qualitative study. SETTING: One hospitals intensive care unit in Southeast China. METHODS: Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. FINDINGS: A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. CONCLUSION: The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members' needs when the patient has been transferred and dies at home in mainland China. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.1.
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Unidades de Terapia Intensiva , Assistência Terminal , Adulto , Humanos , Família , Pesquisa Qualitativa , Estado Terminal , Tomada de DecisõesRESUMO
Introduction: A rare pathogen of Infective Endocarditis (IE), the Abiotrophia defectiva, has been known to trigger life-threatening complications. The case discussed here is of a teenager with brain infarction and subarachnoid hemorrhage caused by IE due to A. defectiva. Case report: A 15-year-old girl with movement disorders involving the left limbs and intermittent fevers was admitted to the hospital. A head CT scan revealed cerebral infarction in the right basal ganglia and subarachnoid hemorrhage. Moreover, vegetation on the mitral valve were confirmed by echocardiography. The blood cultures were found to be positive for Gram-positive streptococcus and identified by Vitek mass spectrometry as A. defectiva. She was prescribed vancomycin antibacterial therapy and underwent a surgical mitral valve replacement. Conclusion: This case is suggestive of the fact that A. defectiva is a rare but crucial pathogen of IE-associated stroke. Obtaining early blood cultures and using microbial mass spectrometry could help achieve an accurate diagnosis. Moreover, reasonable anti-infective medications and surgical interventions need to be combined to avoid and/or manage severe complications.
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An aligned semiconducting carbon nanotube (A-CNT) array has been considered an excellent channel material to construct high-performance field-effect transistors (FETs) and integrated circuits (ICs). The purification and assembly processes to prepare a semiconducting A-CNT array require conjugated polymers, introducing stubborn residual polymers and stress at the interface between A-CNTs and substrate, which inevitably affects the fabrication and performance of the FETs. In this work, we develop a process to refresh the Si/SiO2 substrate surface underneath the A-CNT film by wet etching to clean the residual polymers and release the stress. Top-gated A-CNT FETs fabricated with this process show significant performance improvement especially in terms of saturation on-current, peak transconductance, hysteresis, and subthreshold swing. These improvements are attributed to the increase in carrier mobility from 1025 to 1374 cm2/Vs by 34% after the substrate surface refreshing process. Representative 200 nm gate-length A-CNT FETs exhibit an on-current of 1.42 mA/µm and a peak transconductance of 1.06 mS/µm at a drain-to-source bias of 1 V, subthreshold swing (SS) of 105 mV/dec, and negligible hysteresis and drain-induced barrier lowering (DIBL) of 5 mV/V.
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In the centrosymmetric title compound, [Cu(2)(C(10)H(8)O(4))Cl(2)(C(10)H(8)N(2))(2)(H(2)O)(2)]·2H(2)O, the Cu(II) atom is five-coordinated in a distorted square-pyramidal geometry by two N atoms from a chelating 2,2'-bipyridine ligand, one O atom from a 1,4-phenyl-enediacetate ligand, one Cl atom and one water mol-ecule. The 1,4-phenyl-enediacetate ligand, lying on an inversion center, bridges two Cu(II) atoms. In the crystal, O-Hâ¯O and O-Hâ¯Cl hydrogen bonds and π-π inter-actions between the pyridine rings [centroid-centroid distance = 3.740â (5)â Å] link the complex mol-ecules and uncoordinated water mol-ecules into a three-dimensional network.
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In the title compound, [CoCl(C(10)H(7)N(3)S)(2)]Cl·2H(2)O, the Co(II) atom is five-coordinated by four N atoms from two chelating 2-(1,3-thia-zol-4-yl)-1H-benzimidazole ligands and one Cl atom in a distorted trigonal-bipyramidal geometry. In the crystal, N-Hâ¯O and O-Hâ¯Cl hydrogen bonds and π-π inter-actions between the thia-zole, imidazole and benzene rings [centroid-to-centroid distances 3.546â (2), 3.683â (2) and 3.714â (2)â Å] link the complex cations, chloride anions and uncoordinating water mol-ecules into a three-dimensional network.
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Background: Both sodium-glucose co-transporter-2 (SGLT-2) inhibitors and angiotensin receptor-neprilysin inhibitor (ARNI) were recommended to treat heart failure with reduced ejection fraction (HFrEF). However, no trial was conducted to assess the efficacy and safety of the combined therapy of SGLT-2 inhibitors and ARNI in patients with HFrEF. Methods: We performed a meta-analysis of the prespecified subgroups from DAPA-HF and EMPEROR-Reduced trials. The primary endpoint was the composite risk of cardiovascular death or hospitalization for heart failure. The risk of cardiovascular death, all-cause death, a composite of serious adverse renal outcomes, and volume depletion were also estimated. Results: The risk of the composite of cardiovascular death or hospitalization for heart failure was reduced in combined therapy of SGLT-2 inhibitors and ARNI, compared with ARNI monotherapy (RR.68, 95% CI.53 to.85, P = 0.001). When compared with SGLT-2 inhibitors monotherapy, the events of cardiovascular death (RR.64, 95% CI.46 to 0.87, P = 0.005) and all-cause death (RR.72, 95% CI.55 to.94, P = 0.01) were significantly less in combined therapy, accompanied by elevated incidence of volume depletion (RR 1.55, 95% CI 1.22 to 1.96, P = 0.0003). Conclusion: Combined therapy has additional benefits over monotherapy in patients with HFrEF, however, it is accompanied by a possibly higher risk of volume depletion.
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High-density semiconducting aligned carbon nanotube (A-CNT) arrays have been demonstrated with wafer-scale preparation of materials and have shown high performance in P-type field-effect transistors (FETs) and great potential for applications in future digital integrated circuits (ICs). However, high-performance N-type FETs (N-FETs) have not yet been implemented with A-CNTs, making development of complementary metal-oxide-semiconductor (CMOS) technology, a necessary component for modern digital ICs, impossible. In this work, we reveal the mechanism hindering the realization of A-CNT N-FETs contacted by low-work-function metals and develop corresponding solutions to promote the performance of N-FETs to that of P-type FETs (P-FETs). The fabricated scandium (Sc)-contacted A-CNT N-FET with a 100 nm gate length exhibits an on-state current (Ion) of 800 µA/µm and a peak transconductance (gm) of 250 µS/µm, representing the highest performance of CNT-based N-FETs to date. Moreover, CMOS technology has been developed to realize N- and P-FETs with symmetric high performance based on A-CNTs. The fabricated A-CNT CMOS FETs show electron and hole mobilities of 325 and 241 cm2 V-1 s-1, respectively, which are slightly higher than the corresponding values of Si CMOS transistors. Our scalable fabrication of A-CNT CMOS FETs with comparable electronic performance to Si CMOS will promote the application of CNT-based electronics in digital ICs.
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Infection and rejection are the two most common complications after lung transplantation (LT) and are associated with increased morbidity and mortality. We aimed to examine the association between the airway microbiota and infection and rejection in lung transplant recipients (LTRs). Here, we collected 181 sputum samples (event-free, n = 47; infection, n = 103; rejection, n = 31) from 59 LTRs, and performed 16S rRNA gene sequencing to analyze the airway microbiota. A significantly different airway microbiota was observed among event-free, infection and rejection recipients, including microbial diversity and community composition. Nineteen differential taxa were identified by linear discriminant analysis (LDA) effect size (LEfSe), with 6 bacterial genera, Actinomyces, Rothia, Abiotrophia, Neisseria, Prevotella, and Leptotrichia enriched in LTRs with rejection. Random forest analyses indicated that the combination of the 6 genera and procalcitonin (PCT) and T-lymphocyte levels showed area under the curve (AUC) values of 0.898, 0.919 and 0.895 to differentiate between event-free and infection recipients, event-free and rejection recipients, and infection and rejection recipients, respectively. In conclusion, our study compared the airway microbiota between LTRs with infection and acute rejection. The airway microbiota, especially combined with PCT and T-lymphocyte levels, showed satisfactory predictive efficiency in discriminating among clinically stable recipients and those with infection and acute rejection, suggesting that the airway microbiota can be a potential indicator to differentiate between infection and acute rejection after LT. IMPORTANCE Survival after LT is limited compared with other solid organ transplantations mainly due to infection- and rejection-related complications. Differentiating infection from rejection is one of the most important challenges to face after LT. Recently, the airway microbiota has been reported to be associated with either infection or rejection of LTRs. However, fewer studies have investigated the relationship between airway microbiota together with infection and rejection of LTRs. Here, we conducted an airway microbial study of LTRs and analyzed the airway microbiota together with infection, acute rejection, and clinically stable recipients. We found different airway microbiota between infection and acute rejection and identify several genera associated with each outcome and constructed a model that incorporates airway microbiota and clinical parameters to predict outcome. This study highlighted that the airway microbiota was a potential indicator to differentiate between infection and acute rejection after LT.
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Transplante de Pulmão , Microbiota , Humanos , Pulmão , Transplante de Pulmão/efeitos adversos , RNA Ribossômico 16S/genética , TransplantadosRESUMO
PURPOSE: To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS: A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS: Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS: Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Cuidados Críticos , Unidades de Terapia Intensiva , China , HumanosRESUMO
Despite the importance of the therapeutic relationship on nursing practice, the literature regarding teaching and learning therapeutic relationship is limited. This paper discussed how an undergraduate nursing student learned therapeutic relationship in an acute care setting. Narrative inquiry was applied as a research methodology. The student's reflection served as the narrative in this paper. Collaboratively, researchers conducted data analysis, common themes were drawn, and a summative narrative was presented. Based on the student's narrative, a three-dimensional model, including practical knowledge, theory, and reflection, has been created as our summative narrative. This model suggests that, to facilitate a learning process on creating therapeutic nurse-patient relationship, practical knowledge is the foundation, theory is a leading guide, and constant reflection is a learning tool which transforms learning into a reflective and meaningful experience. To promote learning on therapeutic relationship, nurse educators should emphasize the importance of both practical knowledge and theory. Constant reflection as a learning tool should be encouraged and embedded in nursing curriculum. Diverse approaches of reflection should be promoted.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Docentes de Enfermagem , Humanos , Aprendizagem , NarraçãoRESUMO
Carbon nanotube (CNT) field-effect transistor (FET)-based biosensors have shown great potential for ultrasensitive biomarker detection, but challenges remain, which include unsatisfactory sensitivity, difficulty in stable functionalization, incompatibility with scalable fabrication, and nonuniform performance. Here, we describe ultrasensitive, label-free, and stable FET biosensors built on polymer-sorted high-purity semiconducting CNT films with wafer-scale fabrication and high uniformity. With a floating gate (FG) structure using an ultrathin Y2O3 high-κ dielectric layer, the CNT FET biosensors show amplified response and improved sensitivity compared with those sensors without Y2O3, which is attributed to the chemical gate-coupling effect dominating the sensor response. The CNT FG-FETs are modified to selectively detect specific disease biomarkers, namely, DNA sequences and microvesicles, with theoretical record detection limits as low as 60 aM and 6 particles/mL, respectively. Furthermore, the biosensors exhibit highly uniform performance over the 4 in. wafer as well as superior bias stress stability. The FG CNT FET biosensors could be extended as a universal biosensor platform for the ultrasensitive detection of multiple biological molecules and applied in highly integrated and multiplexed all CNT-FET-based sensor architectures.
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Técnicas Biossensoriais , Nanotubos de Carbono , Polímeros , Transistores EletrônicosRESUMO
Stimuli-responsive nanoparticles (NPs), so-called "smart" NPs, possess great potentials in drug delivery. Presently, the intelligence of smart NPs is mainly based on their chemical or physical changes to stimuli, which are usually "mechanical" and fundamentally different from biological intelligence. Inspired by mitochondria (MT), a biosmart nanoparticle with microenvironment targeting and self-adaptive capacity (MTSNP) was fabricated for ischemic tissue repair. The nanoparticles were designed as shell@circular DNA@shell@core. The double shells were like the two-layered membranes of MT, the melatonin-loaded cores corresponded to the MT matrix, and the circular DNA corresponded to MTDNA. In function, melatonin-loaded cores simulated the cell-protective mechanism of MT, which naturally synthesized melatonin to resist ischemia, while circular DNA was constructed to mimic the biological oxygen-sensing mechanism, synthesizing VEGF for vascularization according to oxygen level, like the ATP supply by MT according to microenvironment demand. At the acute stage of ischemia, melatonin was rapidly released from MTSNP to scavenge reactive oxygen species and activated melatonin receptor I on MT to prevent cytochrome c release, which would activate apoptosis. During the chronic stage, circular DNA could sense hypoxia and actively secrete VEGF for revascularization as a response. Importantly, circular DNA could also receive feedback of revascularization and shut down VEGF secretion as an adverse response. Then, the therapeutic potentials of the MTSNP were verified in myocardial ischemia by the multimodality of the methods. Such nanoparticles may represent a promising intelligent nanodrug system.
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Melatonina , Nanopartículas , Preparações Farmacêuticas , Sistemas de Liberação de Medicamentos , Humanos , Isquemia , MitocôndriasRESUMO
Dysbiotic airway microbiota play important roles in the inflammatory progression of asthma, and exploration of airway microbial interactions further elucidates asthma pathogenesis. However, little is known regarding the airway bacterial-fungal interactions in asthma patients. We conducted a cross-sectional survey of the sputum bacterial and fungal microbiota from 116 clinically stable asthma patients and 29 healthy controls using 16S rRNA gene and ITS1 sequencing. Compared with healthy individuals, asthma patients exhibited a significantly altered microbiota and increased bacterial and fungal alpha diversities in the airway. Microbial genera Moraxella, Capnocytophaga, and Ralstonia (bacteria) and Schizophyllum, Candida, and Phialemoniopsis (fungi) were more abundant in the asthma airways, while Rothia, Veillonella and Leptotrichia (bacteria) and Meyerozyma (fungus) were increased in healthy controls. The Moraxellaceae family and their genus Moraxella were significantly enriched in asthma patients compared with healthy controls (80.5-fold, P = 0.007 and 314.7-fold, P = 0.027, respectively). Moreover, Moraxellaceae, along with Schizophyllum, Candida, and Aspergillus (fungal genera), were positively associated with fungal alpha diversity. Correlation networks revealed 3 fungal genera (Schizophyllum, Candida, and Aspergillus) as important airway microbes in asthma that showed positive correlations with each other and multiple co-exclusions with other common microbiota. Moraxellaceae members were positively associated with asthma-enriched fungal taxa but negatively related to several healthy-enriched bacterial taxa. Collectively, our findings revealed an altered microbiota and complex microbial interactions in the airways of asthma patients. The Moraxellaceae family and their genus Moraxella, along with 3 important fungal taxa, showed significant interactions with the airway microbiota, providing potential insights into the novel pathogenic mechanisms of asthma.
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OBJECTIVE: To understand the occurrence and development of adolescent students' type 2 diabetes mellitus (T2DM) by researching the characteristics of the adolescent students' impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) effected by overweight or obesity. METHODS: From May to November 2007, 3856 middle school students aged 11 to 18 years old in Dongguan city were enrolled in the study. Overweight or obesity (b/Ob) depended on three indexes: the national unified school-age children and adolescent students' body mass index (BMI) and the temporary screening classification standard II established by the Working Group on Obesity in China, BP > or = 140/90 mm Hg (1mm Hg = 0.133 kPa) and fasting capillary whole glucose which was greater than or equal to 5.6 mmol/L. The fasting capillary whole glucose was screened by blood glucose meter from fingertips. Students who had any abnormal indexes were brought into this study. On basis of voluntary principle, blood lipid, fasting blood glucose (FPG) and 2-hour postprandial blood glucose (2 h PG), fasting insulin (FIns) of 368 male and 326 female students who conformed to these conditions were measured using their venous blood. By temporary BMI standard II, they were divided into overweight group (b) and obesity group (Ob). Data of different age groups (11 to 14; 15 to 18 years old) was analyzed. RESULTS: The BMI, low density lipoprotein cholesterol (LDL-C), insulin resistance index (IR), IFG and IGT of the same age stage in two groups were compared. The BMI value was (22.1 +/- 2.4) kg/m2, LDL-C was (2.38 +/- 0.65) mmol/L, IR was 1.15 +/- 0.58 and the detection rates of IFG and IGT were 3.5% and 1.4% respectively in female students aged 11 to 14 years old in b group. In Ob group, BMI value was (24.4 +/- 3.9) kg/m2, LDL-C was (2.70 +/- 0.73) mmol/L, IR was 1.36 +/- 0.67 and the detection rates of IFG and IGT were 14.6% and 6.3% respectively. t or chi2 values of two groups which were compared were 4.83, 2.45, 2.10, 7.41 and 7.99 (P < 0.01 or P < 0.05). BMI value was (25.8 +/- 3.1) kg/m2, LDL-C was (2.35 +/- 0.62) mmol/L, IR was 1.14 +/- 0.64 and the detection rates of IFG and IGT were 3.1% and 4.1% respectively in 15 to 18 years old in b group. In Ob group, BMI value was (28.0 +/- 4.3) kg/m2, LDL-C was (2.69 +/- 0.69) mmol/L, IR was 1.43 +/- 0.84 and the detection rates of IFG and IGT were 12.8% and 15.4% respectively. t or chi2 values of two groups which were compared were 3.33, 2.79, 1.87, 4.75 and 5.17 (P < 0.01 or P < 0.05). BMI value was (22.4 +/- 2.3) kg/m2, LDL-C was (2.36 +/- 0.67) mmol/L, IR was 1.19 +/- 0.65 and the detection rates of IFG and IGT were 3.6% and 1.8% respectively in male students of 11 to 14 years old in b group. In Ob group, BMI value was (24.6 +/- 4.2) kg/m2, LDL-C was (2.68 +/- 0.71) mmol/L, IR was 1.44 +/- 0.89 and the detection rates of IFG and IGT were 13.3% and 9.4% respectively. t or chi2 values of two groups which were compared were 4.85, 2.72, 2.19, 6.75 and 6.76 (P < 0.01 or P < 0.05). BMI value was (26.4 +/- 2.8) kg/m2, LDL-C was (2.35 +/- 0.70) mmol/L, IR was 1.24 +/- 0.68 and the detection rates of IFG and IGT were 4.7% and 5.6% respectively in 15 to 18 years old in b group. In Ob group, BMI value was (28.2 +/- 4.8) kg/m2, LDL-C was (2.71 +/- 0.73) mmol/L, IR was 1.50 +/- 0.95 and the detection rates of IFG and IGT were 17.9% and 17.9% respectively. t or chi2 values of two groups which were compared were 2.80, 2.69, 1.84, 6.68 and 6.27 (P < 0.01 or P < 0.05). The male students' FPG of 11 to 14 years old in b group was (4.88 +/- 0.76) mmol/L and FPG of Ob group was (5.09 +/- 0.80) mmol/L. Two groups were compared and t = 1.84 (P < 0.05). The statistical differences were all observed. We compared different age stages and found that the male students' 2-hour PG of 11 to 14 years old in Ob group was (5.13 +/- 1.18) mmol/L and the 2-hour PG of 15 to 18 years old was (5.36 +/- 1.24) mmol/L. Two groups were compared and t = 1.78 (P < 0.05) near the adults value. Male students' IGT of 11 to 14 years old (b/Ob) had 8 positive cases and the positive detection rate was 3.6%. IGT of 15 to 18 years old (b/Ob) had 13 positive cases and the positive detection rate was 8.9%. Two age stages were compared and chi2 = 6.86 (P < 0.01). Female students' IGT of 11 to 14 years old (b/Ob) had 5 positive cases and the positive detection rate was 2.6%. IGT of 15 to 18 years old (b/Ob) had 10 positive cases and the positive detection rate was 7.4%. Two age stages were compared and chi2 = 4.02 (P < 0.05). All had statistical significance. The high IGT incidence rate of b/Ob group's male and female students was in the stage of 15 - 18 years old. Male students were more obvious. CONCLUSION: T2DM prevention among adolescent students should start with body overweight control. Meanwhile, the adolescent students with high risk factors should be screened regularly and early measures should be taken to prevent the impaired glucose regulation (IFG, IGT) transforming into T2DM.
Assuntos
Glicemia/metabolismo , Síndrome Metabólica/sangue , Obesidade/sangue , Sobrepeso/sangue , Adolescente , Índice de Massa Corporal , Criança , China , LDL-Colesterol , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Intolerância à Glucose , Humanos , Resistência à Insulina , Lipídeos/sangue , MasculinoRESUMO
The skin microbiome plays important roles in the pathogenesis and development of acne. We aimed to investigate the facial skin microbiome of acne and microbiome differences related to different grades of acne. Skin swabs from nine healthy controls and 67 acne patients were collected, and the skin microbiomes were analyzed using 16S rRNA gene sequencing. Compared with healthy controls, acne patients harbored significantly altered skin microbiomes. The skin microbiomes of patients with grade 1-3 acne were similar, but patients with grade 4 acne showed a significantly different skin microbiome compared with grade 1-3 acne, including increased alpha diversity and increased proportions of four Gram-negative bacteria (Faecalibacterium, Klebsiella, Odoribacter and Bacteroides). In conclusion, acne patients harbored an altered skin microbiome, and more significant dysbiosis was found in patients with grade 4 acne (severe acne). Our findings may provide evidence for the pathogenic mechanisms of acne and microbial-based strategies to avoid and treat acne, especially grade 4 acne.