[Value of high-flow oxygen therapy after weaning for successful extubation of critical ill patients with mechanical ventilation].

OBJECTIVE: To investigate the value of high-flow oxygen therapy after weaning in successful extubation of critically ill patients with mechanical ventilation. METHODS: A retrospective study was conducted. The weaned patients who were older than 18 years old and underwent mechanical ventilation for the first time due to cerebrovascular accidents, surgical operations, cardiovascular diseases, and pneumonia admitted to the department of critical care medicine of Zhejiang Hospital from January 2018 to June 2020 were enrolled. Among the patients, 40 cases received high-flow oxygen therapy after weaning, and 37 cases received Venturi combined with the humidifier. The patient's gender, age, primary disease, severity score, duration of mechanical ventilation before weaning, heart rate (HR), blood pressure, pulse oxygen saturation (SpO2) at 0, 6, 12, 18, and 24 hours after weaning, and pH value, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) at 6, 12, 18, and 24 hours after weaning, the rate of performing mechanical ventilation after weaning, extubation time after weaning, and the rate of reintubation after extubation for 72 hours were collected. RESULTS: There was no significant difference in baseline data such as gender, age, primary disease, severity score, and duration of mechanical ventilation before weaning between the two groups. After weaning, the vital signs of the two groups were stable, and there was no significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP) or SpO2 at each time point between the two groups. After weaning, the pH of arterial blood gas analysis in the two groups and the fluctuations of PaO2 and PaCO2 in the high-flow group were not obvious. In the Venturi group, PaO2 gradually decreased after weaning, PaCO2 increased significantly at 12 hours, and slowly decreased after 12 hours. The PaO2 from 6 hours and PaCO2 from 12 hours in the high-flow group were significantly lower than those in the Venturi group, and continued to 24 hours [PaO2 (mmHg, 1 mmHg ≈ 0.133 kPa): 112.34±38.25 vs. 156.76±68.44 at 6 hours, 110.92±38.66 vs. 150.64±59.07 at 12 hours, 111.12±36.77 vs. 141.30±39.05 at 18 hours, 110.82±39.37 vs. 139.65±41.50 at 24 hours; PaCO2 (mmHg): 41.30±7.51 vs. 47.42±7.54 at 12 hours, 40.97±6.98 vs. 45.83±8.63 at 18 hours, 40.10±7.06 vs. 46.14±9.15 at 24 hours, all P < 0.01]. The rate of performed mechanical ventilation after weaning and the rate of reintubation after extubation for 72 hours in the high-flow group were significantly lower than those in the Venturi group [17.5% (7/40) vs. 40.5% (15/37), 6.2% (2/32) vs. 31.8% (7/22), both P < 0.05], and the extubation time after weaning was significantly shorter than that in the Venturi group (hours: 22.43±11.72 vs. 28.07±10.42, P < 0.05). CONCLUSIONS: Using high-flow oxygen therapy to the extubation process of critically ill mechanical ventilation patients can reduce the incidence of carbon dioxide retention and the rate of performed mechanical ventilation after weaning, shorten the extubation time after weaning, and reduce the rate of reintubation after extubation for 72 hours.

CCL21 Facilitates Chemoresistance and Cancer Stem Cell-Like Properties of Colorectal Cancer Cells through AKT/GSK-3ß/Snail Signals.

Some evidence indicated that chemoresistance associates with the acquisition of cancer stem-like properties. Recent studies suggested that chemokines can promote the chemoresistance and stem cell properties in various cancer cells, while the underling mechanism is still not completely illustrated. In our study, we found that CCL21 can upregulate the expression of P-glycoprotein (P-gp) and stem cell property markers such as Bmi-1, Nanog, and OCT-4 in colorectal cancer (CRC) HCT116 cells and then improve the cell survival rate and mammosphere formation. Our results suggested that Snail was crucial for CCL21-mediated chemoresistance and cancer stem cell property in CRC cells. Further, we observed that CCL21 treatment increased the protein but not mRNA levels of Snail, which suggested that CCL21 upregulates Snail via posttranscriptional ways. The downstream signals AKT/GSK-3ß mediated CCL21 induced the upregulation of Snail due to the fact that CCL21 treatment can obviously phosphorylate both AKT and GSK-3ß. The inhibitor of PI3K/Akt, LY294002 significantly abolished CCL21 induced chemoresistance and mammosphere formation of HCT116 cells. Collectively, our results in the present study revealed that CCL21 can facilitate chemoresistance and stem cell property of CRC cells via the upregulation of P-gp, Bmi-1, Nanog, and OCT-4 through AKT/GSK-3ß/Snail signals, which suggested a potential therapeutic approach to CRC patients.

Distal foot coverage with reverse dorsal pedal neurocutaneous flaps.

Various types of neurocutaneous flaps have been used for extremity reconstructions. However, the application of this technique to the dorsum of the foot has not been reported previously. The aim of this article is to evaluate the attempts and clinical results from dorsal pedal neurocutaneous flap procedures. Harvesting of these flaps included the medial, intermediate and lateral dorsal cutaneous nerves, the deep peroneal nerve and the nutrient arteries of these nerves. The vascular anatomy of these flaps was studied before the clinical usage of the procedure. From 2003 to 2008, 30 patients with skin defects and bone exposure of the dorsum of the distal foot were treated with 39 dorsal pedal neurocutaneous flaps in our centre. The flaps in this series ranged from 3.5 to 7.0 cm in width and 4.0 to 10.0 cm in length. Totally, 35 flaps healed uneventfully. One showed partial loss at the distal edge, and three survived entirely following continuous massage. The postoperative contour of the flaps was acceptable. The reverse dorsal pedal neurocutaneous flap has proved effective and convenient for coverage of minor- to medium-sized defects in the distal foot.