Driving pressure-guided ventilation improves homogeneity in lung gas distribution for gynecological laparoscopy: a randomized controlled trial.

To investigate whether driving pressure-guided ventilation could contribute to a more homogeneous distribution in the lung for gynecological laparoscopy. Chinese patients were randomized, after pneumoperitoneum, to receive either positive end expiratory pressure (PEEP) of 5 cm H2O (control group), or individualized PEEP producing the lowest driving pressure (titration group). Ventilation homogeneity is quantified as the global inhomogeneity (GI) index based on electrical impedance tomography, with a lower index implying more homogeneous ventilation. The perioperative arterial oxygenation index and respiratory system mechanics were also recorded. Blood samples were collected for lung injury biomarkers including interleukin-10, neutrophil elastase, and Clara Cell protein-16. A total of 48 patients were included for analysis. We observed a significant increase in the GI index immediately after tracheal extubation compared to preinduction in the control group (p = 0.040) but not in the titration group (p = 0.279). Furthermore, the GI index was obviously lower in the titration group than in the control group [0.390 (0.066) vs 0.460 (0.074), p = 0.0012]. The oxygenation index and respiratory compliance were significantly higher in the titration group than in the control group. No significant differences in biomarkers or hemodynamics were detected between the two groups. Driving pressure-guided PEEP led to more homogeneous ventilation, as well as improved gas exchange and respiratory compliance for patients undergoing gynecological laparoscopy.Trial Registration: ClinicalTrials.gov NCT04374162; first registration on 05/05/2020.

Evaluation of the Diagnostic and Prognostic Value of CSF Presepsin Levels in Patients with Postneurosurgical Ventriculitis/Meningitis.

AIM: To evaluate the diagnostic and prognostic value of CSF presepsin levels in patients with postneurosurgical ventriculitis/meningitis (PNVM). METHODS: We conducted a case-control study to achieve our aims. First, we prospectively enrolled patients who had undergone neurosurgery in Beijing Tiantan Hospital from June to November 2020 and measured the CSF levels of 8 biomarkers, including presepsin and other meningitis biomarkers. The diagnostic and prognostic accuracies of presepsin levels were evaluated by determining the values for the area under the receiver operating characteristic curve (AUC). RESULTS: Two hundred thirty-nine patients were enrolled in this study; 34 were diagnosed with confirmed ventriculitis/meningitis (cVM), 138 were classified as probable ventriculitis/meningitis (pVM), and the others were rejected ventriculitis/meningitis (rVM). Presepsin levels effectively diagnose cVM and predict the outcomes of patients with PNVM, with thresholds of 1257.4 pg/mL and 1276.2 pg/mL and AUCs of 0.746 and 0.825, respectively. Furthermore, a joint analysis with CSF lactate (C-Lac) levels shows that the AUCs of the two markers increased to 0.856 and 0.872, respectively. CONCLUSION: The rapid diagnosis and prediction of the clinical outcome is important in neurosurgery. CSF presepsin levels are an impressive diagnostic and prognostic biomarker for meningitis, and when combined with C-Lac, they indeed improve the diagnostic and predictive efficiency of PNVM.

Downregulation of miR-196b Promotes Glioma Cell Sensitivity to Temozolomide Chemotherapy and Radiotherapy.

Human glioma is the most common type of primary brain tumor. The survival rate of people with a malignant glioma is extremely low, primarily due to a lack of effective treatments. We previously reported that miR-196b expression is upregulated in glioblastoma tissues and overexpression of miR-196b is associated with poor prognosis. miR-196b acts as an oncogene by enhancing cellular proliferation and increasing the expression of E2F1, which plays an important role in the PI3K/AKT signaling pathway. In the present study, we explored the effects of miR-196b expression on glioma cells and characterized the relationship between miR-196b expression and the PI3K/AKT signaling pathway. We found that downregulation of miR-196b decreased the proliferation of U87 and U251 glioma cells. When anti-miR-196b and radiotherapy were used together, cellular proliferation decreased, whereas apoptosis and caspase 3/7activity, an indicator of apoptosis, increased. Meanwhile, downregulation of miR-196b remarkably inhibited glioma cell growth and colony formation when concurrent with temozolomide administration. Further studies demonstrated that neither upregulation nor downregulation of miR-196b markedly changed the protein expression levels of downstream molecules in the PI3K/AKT signaling pathway in cellular experiments. Therefore, whether miR-196b plays a role by activating the PI3K/AKT signaling pathway has not yet been determined. Together, our findings indicate that downregulation of miR-196b increased glioma cell sensitivity to temozolomide chemotherapy and radiotherapy and may be a valuable target when treating malignant gliomas. However, further studies are required to accurately characterize the mechanism by which miR-196b elicits its pivotal role.

Association of anti-gangliosides antibodies and anti-CMV antibodies in Guillain-Barré syndrome.

INTRODUCTION: Numerous types of infection were closely related to GBS, mainly including Campylobacter jejuni, Cytomegalovirus, which may lead to the production of anti-gangliosides antibodies (AGA). Currently, although there are increased studies on the AGA and a few studies of anti-CMV antibodies in GBS, the association between them remains poorly documented. Therefore, our research aims to analyze the correlation of anti-CMV antibodies and AGA in GBS. METHODS: A total of 29 patients with GBS were enrolled in this study. The CMV antibodies were tested by the electrochemiluminescence immunoassay "ECLIA" (Roche Diagnostics GmbH). The serum gangliosides were determined by The EUROLINE test kit. RESULTS: Of the 29 patients with GBS, 9 (31%) were AGA-seropositive, in which 22 were CMV-IgG positive in CSF at the same time, but all 29 samples were CMV-IgM negative in both serum and CSF. In the AGA-positive group, the rate of both serum and CSF positive was 87.5% (7/8), higher than 50% (7/14) of the negative group, although no statistical significance was found. In addition, we found that there was a trend of higher ratio of men, a younger age onset, less frequent preceding infection, a higher level of CSF proteins, and less frequent cranial nerve deficits, although the data did not reach a statistical significance. CONCLUSION: In spite of no statistical significance association was found between serum AGA and CMV-IgG in serum and CSF. However, we found that there was a trend of high positive rate of both serum and CSF-CMV-IgG in AGA-positive than the negative group. So we should further expand the sample size to analyze the association between AGA and CMV or other neurotropic virus antibodies in various diseases, to observe whether they could be serological marker of these diseases (especially GBS) or the underlying pathogenesis.