Long-term exposure to PM2.5 and its components is associated with elevated blood pressure and hypertension prevalence: Evidence from rural adults.

INTRODUCTION: The toxicity of fine particulate matter (PM2.5) is determined by its components, while the evidence regarding associations of PM2.5 components with blood pressure (BP) is limited, especially in rural areas. OBJECTIVES: This study aimed to explore the associations of PM2.5 and its chemical components with systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), mean artery pressure (MAP) levels and hypertension prevalence, and to identify key components in Chinese rural areas. METHODS: 39,211 adults from the Henan Rural Cohort were included during 2015-2017. Different periods of PM2.5 and chemical components were estimated by hybrid satellite model. The single-pollutant, component-PM2.5 model, component-residual model and component-proportion model were applied to explore the associations of pollutants with BP levels and hypertension prevalence. Exposure-response (E-R) relationships, stratified analyses and sensitivity analyses were used to explore these associations further. RESULTS: 12,826 (32.71%) were identified with hypertension. For each 1 µg/m3 increase of pollutants, the adjusted odds ratio (OR) for hypertension prevalence was 1.03 for PM2.5 mass, 1.40 for BC, 1.16 for NH4+, 1.08 for NO3-, 1.17 for OM, 1.12 for SO42- and 1.25 for SOIL in the single-pollutant model. BC and SOIL were statistically significant in the component-PM2.5 model, component-residual model and component-proportion model. Similarly, associations of these pollutants with elevated BP levels were also found in aforementioned four models. These pollutants produced a stronger association with SBP than DBP, PP and MAP. Most of associations were non-linear in E-R relationships. The groups of older, the men, with lower per capita monthly income, lower educational level and higher BMI were more vulnerable to these pollutants in stratified analyses. The results remained stable in sensitivity analyses. CONCLUSION: Long-term exposure to PM2.5 and its components, especially BC and SOIL, was associated with elevated BP and hypertension prevalence in rural adults, and decreasing pollutants may provide additional benefits.

A Novel Scale to Assess Humidification during Noninvasive Ventilation: A Prospective Observational Study.

Objective: To develop a novel scale to assess humidification during noninvasive ventilation (NIV). Methods: This study was performed in an ICU of a teaching hospital. Three ICU practitioners with more than 10 years of clinical experience developed an oral humidification scale with a range of 1-4 points. Each studied the current literature on humidification and examined 50 images of mouths of NIV patients with different levels of humidification. Then, through discussion, a consensus scale was developed. Next, 10 practitioners and 33 NIV patients were recruited to validate the scale. Finally, the patients rated the dryness of their mouths using the 1-4 visual scale just after the practitioners' assessment. Talking and discussion were forbidden during the assessment, and the scorers were blinded to each other. Results: We performed 36 assessments in 33 NIV patients. Three patients were assessed twice each more than 2 days apart. The interitem correlation coefficients between the 10 practitioners ranged from 0.748 to 0.917. Fleiss's kappa statistic was 0.516, indicating moderate agreement among practitioners. Of the 33 patients, 5 (15%) were unable to make an assessment using the 1-4 visual scale. Among the remainder, 55.7% provided scores that matched those given by the practitioners; 13.7% of scores were 1 point higher than that rated by the practitioners, and 20.7% were 1 point lower. Only 10% were beyond a 1-point difference. The kappa coefficient was 0.483 between patients and practitioners. Conclusions: The oral humidification scale showed moderate agreement between practitioners. It was also highly accurate in reflecting the level of humidification assessed by patients.

Weak cough is associated with increased mortality in COPD patients with scheduled extubation: a two-year follow-up study.

BACKGROUND: Cough strength is associated with short-term outcome in patients with scheduled extubation who successfully complete a spontaneous breathing trial (SBT). However, the long-term outcome is unclear. METHODS: This was a prospective observational study performed in a respiratory ICU of a teaching hospital. COPD patients who successfully completed a SBT were candidates. We enrolled the case who assessed the cough strength by cough peak flow (CPF) or semiquantitative cough strength score (SCSS, ranging from 0 = weak to 5 = strong). Patients were followed up to two years by phone every 3 months. RESULTS: A total of 215 patients were enrolled in current study. Among them, CPF and SCSS were measured in 214 and 208 cases, respectively. Strong cough was associated with a 16% decrease in the risk of two-year mortality (adjusted hazard ratio [HR] 0.84, 95%CI: 0.78-0.91) per 10 L/min increment of CPF. When it was tested by SCSS, decrease in the risk of two-year mortality per unit increment was 27% (adjusted HR 0.73, 95%CI: 0.62-0.86). Similar results were confirmed in the discharged patients. In all patients, the two-year mortality was 75%, 53%, and 38% in patients with CPF < 60, 60-90, and > 90 L/min; and 85%, 70%, and 40% in patients with SCSS of 0-1, 2-3, and 4-5, respectively. Similar trend was found among the discharged patients whether it was assessed by CPF or SCSS. CONCLUSIONS: In COPD patients, weak cough is associated with increased two-year mortality after a scheduled extubation. It provides objective information to caregivers to improve decision-making process during hospitalization and after discharge.

Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study.

BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. METHODS: This study was performed in four hospitals of China from January to March 2020. We retrospectively enrolled 23 and 13 COVID-19 patients who used HFNC and NIV as first-line therapy, respectively. RESULTS: Among the 23 patients who used HFNC as first-line therapy, 10 experienced HFNC failure and used NIV as rescue therapy. Among the 13 patients who used NIV as first-line therapy, one (8%) used HFNC as rescue therapy due to NIV intolerance. The duration of HFNC + NIV (median 7.1, IQR: 3.5-12.2 vs. 7.3, IQR: 5.3-10.0 days), intubation rate (17% vs. 15%) and mortality (4% vs. 8%) did not differ between patients who used HFNC and NIV as first-line therapy. In total cohorts, 6 (17%) patients received intubation. Time from initiation of HFNC or NIV to intubation was 8.4 days (IQR: 4.4-18.5). And the time from initiation of HFNC or NIV to termination in patients without intubation was 7.1 days (IQR: 3.9-10.3). Among all the patients, C-reactive protein was independently associated with intubation (OR = 1.04, 95% CI: 1.01-1.07). In addition, no medical staff got nosocomial infection who participated in HFNC and NIV management. CONCLUSIONS: In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. And no medical staff got nosocomial infection during this study.

Identification of Potential Metabolite Markers for Middle-Aged Patients with Post-Stroke Depression Using Urine Metabolomics.

BACKGROUND: Post-stroke depression (PSD) is one of the most common complications in stroke survivors. But, there are still no objective methods to diagnose PSD. This study aims to identify potential biomarkers for diagnosing PSD in middle-aged stroke survivors. METHODS: Middle-aged subjects aged 30 to 59 years (92 PSD patients and 89 stroke survivors without depression) were included in this study. Urinary metabolites were detected by gas chromatography-mass spectrometry (GC-MS). Differential urinary metabolites and potential biomarkers were screened by applying statistical analysis. RESULTS: The different urinary metabolic phenotypes between PSD patients and stroke survivors without depression were identified. A total of 12 differential urinary metabolites were accurately identified by using orthogonal partial least-squares-discriminant analysis. After analyzing those 12 differential urinary metabolites by step-wise logistic regression analysis, only seven metabolites (palmitic acid, hydroxylamine, myristic acid, glyceric acid, lactic acid, tyrosine and azelaic acid) were finally selected as potential biomarkers for diagnosing PSD in middle-aged stroke survivors. A panel consisting of these potential biomarkers could effectively diagnose middle-aged PSD patients. CONCLUSION: Urinary metabolic profiles were different between middle-aged PSD patients and stroke survivors without depression. Our results would be helpful in future for developing an objective method to diagnose PSD in middle-aged stroke survivors.

Head-To-Head Comparison of Treatment Failure and Costs among COPD Patients Who Used Noninvasive Ventilation in the Ward versus in the ICU: A Propensity-Matched Cohort Study.

Background: Head-to-head comparison of treatment failure and costs among chronic obstruct pulmonary disease (COPD) patients who used noninvasive ventilation (NIV) in the ward versus in the ICU is lacking. Methods: This retrospective study was performed in a department of respiratory and critical care medicine in a teaching hospital. COPD patients who used NIV in the respiratory ward or respiratory ICU were screened. We enrolled patients with PaCO2 more than 45 mmHg and pH less than 7.35 before the use of NIV. Results: We enrolled 83 patients who initiated NIV in the ward and 319 patients in the ICU. Only 5 (6%) patients in the ward were required to transfer to ICU for intensive care. The vital signs were worse but improved faster within 24 h of NIV among patients in the ICU than those in the ward. The NIV failure, hospital mortality, and the length of stay in hospital did not differ between the two groups. However, the duration of NIV was shorter (median 4.0 vs. 6.1 days, p < 0.01) and hospital costs were higher (median 4638 vs. 3093 $USD, p < 0.01) among patients in the ICU than those in the ward. After propensity matching, 42 patients were left in each group, and the baseline data were comparable between the two groups. The findings in the overall cohort were confirmed again in the propensity-matched cohort. Conclusions: Among COPD patients, the use of NIV in the ward leads to longer duration of NIV, but lower hospital costs, and similar NIV failure and mortality compared with those in the ICU.

Novel osteogenic growth peptide C-terminal pentapeptide grafted poly(d,l-lactic acid) improves the proliferation and differentiation of osteoblasts: The potential bone regenerative biomaterial.

Poly(d,l-lactic acid) (PDLLA) is widely used for bone regenerative engineering, because of its proven biocompatibility and biodegradability. However, the major limitation of PDLLA is its cell recognition and low hydrophilicity. The objective of this study was to develop a novel bioactive poly(d,l-lactic acid) tethered with osteogenic growth peptide (OGP), which has been confirmed as one of the important growth factors related to bone repair/regeneration. The biomimetic material modification methods were utilized that maleic anhydride-modified poly(d,l-lactic acid) (MPLA) as raw material, the active C-terminal pentapeptide OGP(10-14) were covalently grafted onto the side chain of MPLA through amide reaction using 1­ethyl­3­(3­dimethyl aminopropyl) carbodiimide hydrochloride (EDC) and N­hydroxysuccinimide (NHS) as the condensing agent to produce a new biopolymer (OGP(10-14)-MPLA). The OGP(10-14)-MPLA were further characterized with the Fourier transform infrared spectrometry, amino acid analyzer, elementary analysis, X-ray photoelectron spectroscopy. The results revealed that OGP(10-14) was successfully modified MPLA and its coupling efficiency was 12.40%. The data from both contact angle and water absorption showed the better hydrophilicity of OGP(10-14)-MPLA, compared with MPLA. Also, we found that OGP(10-14)-MPLA could improve the proliferation, differentiation, and mineralization of osteoblasts, indicating that the novel OGP(10-14)-MPLA has the better biocompatibility and is more osteoinductive. In conclusion, the OGP(10-14) modified MPLA have the potential for bone regenerative engineering.

The size of zinc oxide nanoparticles controls its toxicity through impairing autophagic flux in A549 lung epithelial cells.

Zinc oxide nanoparticles (ZnONPs) widely used in various products, have been concerned with its impact on human health, in particular, on the risk of pulmonary toxicity. Our previous study indicated that ZnONPs could harness autophagy and impair the autophagic flux, which was positively linked to ZnONPs-induced toxicity. The objective of this study was to investigate whether ZnONPs-induced impairment of autophagic flux and cell death in lung epithelial cells is related to the size of ZnONPs. We demonstrate that ZnONPs with the average size of 50 nm could induce toxic effects in A549 lung epithelial cells, including accumulation of autophagosomes (the elevation of LC3B-II/LC3B-I ratio), impaired autophagic flux (the increase of p62 expression), the release of intracellular zinc ions (the increase of FluoZin-3 signal and ZnT1 mRNA expression), mitochondrial damage (the decrease of TMRE signal), lysosomal dysfunction (the aberrant expression of LAMP-2), oxidative stress (the increase of DCFH-DA signal and HO-1 expression) and cell death. Interestingly, ZnONPs with the average size of 200 nm failed to induce autophagy-mediated toxicity. Taken together, our results indicate that the size of ZnONPs is closely correlated with its toxicity, which is probably mediated by induction of impaired autophagic flux. This finding provides an insight into better understating of ZnONPs-associated toxicity, and mitigating the risk to humans and allowing the safer application.

Noninvasive ventilation failure in pneumonia patients ≥65years old: The role of cough strength.

PURPOSE: To explore the association between cough strength and outcomes in elderly patients who received noninvasive ventilation (NIV) due to acute respiratory failure caused by pneumonia. MATERIALS AND METHODS: We enrolled patients ≥65years old with acute respiratory failure caused by pneumonia. Just before NIV treatment, cough strength was assessed on a cough-strength scale graded from 0 to 5. Patients graded 0-2 were defined as having no/weak coughs and those graded 3-5 were defined as having moderate/strong coughs. RESULTS: We enrolled 349 patients in this study. The prevalence of no/weak cough was 24% (84/349). Moderate/strong cough patients had lower NIV failure (92/265 [34.7%] vs. 67/84 [79.8%], p<0.01) and lower hospital mortality (85/265 [32.1%] vs. 60/84 [71.4%], p<0.01) than no/weak cough patients. In multivariate logistic regression analysis, we also found that no/weak cough was an independent risk factor for NIV failure (odds ratio=13.83, 95% confidence interval: 6.01-31.81) and death in hospital (odds ratio=4.41, 95% confidence interval: 2.49-7.81). CONCLUSIONS: In pneumonia patients ≥65years old, no/weak cough is associated with NIV failure and death in hospital. NIV must be used only with caution in no/weak cough patients.