[Respiratory drive in acute respiratory distress syndrome: evaluation and control].

Acute respiratory distress syndrome (ARDS) is a common critical disease, which often leads to poor prognosis in critically ill patients. The excessive respiratory drive in ARDS is related to lung injury. Control of excessive respiratory drive is helpful to reduce lung injury and mortality of ARDS. The mechanisms of abnormal increase in respiratory drive in ARDS include hypoxemia, hypercapnia, stretch reflex caused by alveolar collapse and inflammatory stimulation. Respiratory drive should be evaluated by clinical manifestations, physiological parameters and respiratory mechanics indexes. It is particularly important to make individual therapy strategies according to the evaluation of respiratory drive. Analgesia and sedation combined with muscle relaxation, high positive end-expiratory pressure (PEEP) and prone position can be used to control excess respiratory drive. This article reviews the evaluation and management of excess respiratory drive in ARDS patients.

Analysis of associations of FBXL19-AS1 with occurrence, development and prognosis of acute pancreatitis.

OBJECTIVE: The aim of the study was to explore the association between F-box and leucine-rich repeat protein 19-antisense ribonucleic acid 1 (FBXL19-AS1) and acute pancreatitis (AP) and its role in prognostic evaluation. PATIENTS AND METHODS: According to the severity of AP, the patients were classified into mild group, moderate-severe group, and severe group, and the expression of FBXL19-AS1 was compared among the three groups. The associations of FBXL19-AS1 with Atlanta classification, computed tomography severity index (CTSI), acute physiology and chronic health evaluation (APACHE) II score, bedside index for severity in acute pancreatitis (BISAP) and Ranson score were analyzed. The optimal cut-off point of severe hyperlipidemia-induced AP was predicted by the receiver operating characteristic (ROC) curves. Then, the incidence rates of local and systemic complications were compared among AP patients with different levels of FBXL19-AS1. After overexpression of FBXL19-AS1 in AP cells, the quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) results showed that significantly upregulated the mRNA level of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), and IL-6. The opposite results were obtained after the knockdown of FBXL19-AS1 in cells. RESULTS: There were no statistical differences in the basic data among the three groups. The FBXL19-AS1 level was increased in severe group than the moderate-severe group and mild group. The area under the curve (AUC) of FBXL19-AS1 in predicting severe AP was 0.9177 (p<0.001). According to the Spearman correlation analysis, the FBXL19-AS1 level had significant positive correlations with the predictive scores of AP severity. The incidence rate of shock, liver dysfunction, and pancreatic necrotic tissue infection was significantly higher in FBXL19-AS1 high-expression group than that in FBXL19-AS1 low-expression group. FBXL19-AS1 could promote the upregulation of inflammatory indexes. CONCLUSIONS: FBXL19-AS1 is highly expressed in the serum of AP patients, and it is positively correlated with the severity of AP. FBXL19-AS1 mediates the inflammatory response and promotes the occurrence and development of pancreatitis, harming the prognosis of patients.