Transtracheal ultrasound for confirmation of endotracheal tube placement in the intensive care unit: a systematic review and meta-analysis.

OBJECTIVE: The major objective of this review was to compare the diagnostic accuracy of ultrasound in confirming tracheal intubation to the standard methods of confirmation in the intensive care unit (ICU). MATERIALS AND METHODS: This systematic review and meta-analysis of observational studies was conducted from inception to July 2022. We included studies that compared the diagnostic accuracy of ultrasound-detected tracheal intubation to that of the gold standard diagnostic technique performed in adult patients who underwent tracheal intubation as part of any procedure. We searched the following electronic databases for published studies: PubMed, EMBASE, Cochrane Central, and Web of Science. Risk of bias was assessed using a standard procedure based on the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The results were analyzed using the RevMan or Meta-Disc software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Five studies that included 344 patients met the inclusion criteria. Pooled sensitivity was 0.96 (95% confidence interval (CI) (0.92-0.98) and 1.00 (95% CI: 0.97-1.00), respectively. Furthermore, the diagnostic odds ratio of ultrasonography was 311.25 (95% CI: 63.77-1,519.22), which was confirmed by a summary receiver operating characteristic curve with an area under the curve of 0.98. CONCLUSIONS: Ultrasonography has high sensitivity and specificity, is a valuable adjunct for confirming tracheal intubation in the ICU and should be performed when capnography is unavailable or unreliable.

The diagnostic values of lung ultrasound for ARDS.

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is a critical disease commonly found in many clinical cases, with a mortality rate of approximately 50%. Early diagnosis and intervention are important for improving ARDS prognosis. In this study, the applications of lung ultrasound in ARDS diagnosis and assessment are reviewed to clarify its key clinical values and application prospects. MATERIALS AND METHODS: According to the standard diagnosis of ARDS based on the Berlin definition, CXR or CT examination should be conducted. However, both the blurred images of the former, as well as the inconvenience and high risks of the latter, impose restrictions on their application in critically ill patients. RESULTS: Lung ultrasound was shown to improve safety, effectiveness, lacked radiation, can be performed bedside, and offers dynamic functionality. CONCLUSIONS: It may be a suitable approach to replace or complement traditional imaging examinations with lung ultrasound.

Diagnostic accuracy of ultrasonography for detecting gastric tube placement: an updated meta-analysis.

OBJECTIVE: This study aimed at reviewing the diagnostic accuracy of ultrasonography for detecting correct nasogastric tube placement compared with X-ray imaging as the reference standard. MATERIALS AND METHODS: This was a systematic review and meta-analysis of observational studies published between 1961 and 2022. We included studies that compared the diagnostic accuracy of ultrasound detection for nasogastric tube placement with that of X-ray imaging in adult patients who were undergoing nasogastric tube placement for any reason. We searched for published studies in the following electronic databases: Cochrane Library, PubMed, EMBASE, and Web of Science. The risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The results were analyzed using RevMan or Meta-Disc software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Fourteen studies met our inclusion criteria. Overall, 1,812 patients were included in these studies. The results included a pooled sensitivity of 0.96 (95% confidence interval [CI] 0.94-0.97), specificity of 0.91 (95% CI 0.85-0.96), positive likelihood ratio of 5.08 (95% CI 1.49-17.39), and negative likelihood ratio of 0.08 (95% CI 0.06-0.10). This was confirmed through a summary receiver operating characteristic curve, which showed that the area under the curve was 0.96. CONCLUSIONS: We found evidence about validity of ultrasound as an efficient method for verifying nasogastric tube placement, although there is insufficient evidence to suggest that it can be used as a diagnostic tool for incorrect gastric tube placement.

[Analysis of the social support and related factors of the elderly in the elderly activity centers in Macao, Hong Kong and Guangzhou].

Research participants were recruited at 16 elderly activity centers among three cities in Macao, Hong Kong and Guangzhou. A total of 324 people were surveyed, with women ≥ 55 years old and men ≥ 60 years old; There were 90, 100 and 134 in Macao, Hong Kong and Guangzhou respectively. The median (P(25), P(75)) score of the social support rating scale (SSRS) for the elderly was 30 (25, 38) for Macao, 24 (20, 29) for Hong Kong and 30 (26, 37) for Guangzhou respectively. The elderly in Macao and Guangzhou had a higher proportion of the SSRS in the middle and high groups (85.20%, 84.50%) when compared to the elderly in Hong Kong (62.10%) (P<0.05). The city, marital status, and personal well-being index are related to SSRS scores.

[Analysis of relationship between personal wellbeing index and related factors in the elderly aged 55 or above, who visit the day care centers in Macao, Hong Kong and Guangzhou].

Objective: To investigate the personal wellbeing index (PWI) among elderly aged 55 and above from the elderly day care centers in Macao, Hong Kong and Guangzhou, and associated factors. Methods: We used convenient sampling to select participants from 16 elderly day care centers in Macao, Hong Kong and Guangzhou. Inclusion criteria were: females aged 55 or above, males 60 or above, the participants who were conscious and clearly understood the questionnaire. Informed consent form was signed by the participants. A total of 324 elderly participated in the study: 90 from Macao, 100 from Hong Kong, and 134 from Guangzhou. Close-end questionnaire was used to collect demographic information and PWI inventory (Cantonese version) was used to assess the PWI scores. Comparison in the PWI scores difference was conducted. Multiple regression method was used to analyze factors associated with PWI. Results: The PWI was 7.3±1.9 (Macao: 7.7±1.9, Hong Kong: 7.2±1.7, Guangzhou: 7.0±1.9) (F=3.32, P=0.037). The multiple regression analysis showed that comparing to those who did exercised 3 times or less, or single/devoiced/separated, or had no education, the elderly who did exercised 4 times or more per week or married/widowed, or received education in primary school or above had higher PWI scores. The beta values (95%CI) were 0.82 (95% CI: 0.31-1.34), 1.03 (95% CI: 0.12-1.94), 0.51 (95% CI: 0.04-0.99) respectively. Conclusion: The elderly participants aged 55 or above who went to elderly day care centers in three cities had higher PWI score generally. Marital status, participate in sufficient physical activity and advanced education level were significant related to PWI.

Integrative genomics identifies YY1AP1 as an oncogenic driver in EpCAM(+) AFP(+) hepatocellular carcinoma.

Identification of key drivers and new therapeutic targets is important given the poor prognosis for hepatocellular carcinoma (HCC) patients, particularly those ineligible for surgical resection or liver transplant. However, the approach to identify such driver genes is facing significant challenges due to the genomically heterogenous nature of HCC. Here we tested whether the integrative genomic profiling of a well-defined HCC subset that is classified by an extreme EpCAM(+) AFP(+) gene expression signature and associated with poor prognosis, all attributes of a stem cell-like phenotype, could uncover survival-related driver genes in HCC. Following transcriptomic analysis of the well-defined HCC cases, a Gene Set Enrichment Analysis coupled with genomic copy number alteration assessment revealed that YY1-associated protein 1 (YY1AP1) is a critical oncoprotein specifically activated in EpCAM(+) AFP(+) HCC. YY1AP1 silencing eliminates oncogene addiction by altering the chromatin landscape and triggering massive apoptosis in vitro and tumor suppression in vivo. YY1AP1 expression promotes HCC proliferation and is required for the maintenance of stem cell features. We revealed that YY1AP1 cooperates with YY1 to alter the chromatin landscape and activate transcription of stemness regulators. Thus YY1AP1 may serve as a key molecular target for EpCAM(+) AFP(+) HCC subtype. Our results demonstrate the feasibility and power of a new strategy by utilizing well-defined patient samples and integrative genomics to uncover critical pathways linked to HCC subtypes with prognostic impact.

Removal of dimethyl sulfide by the combination of non-thermal plasma and biological process.

A bench scale system integrated with a non-thermal plasma (NTP) and a biotricking filtration (BTF) unit for the treatment of gases containing dimethyl sulfide (DMS) was investigated. DMS removal efficiency in the integrated system was up to 96%. Bacterial communities in the BTF were assessed by PCR-DGGE, which play the dominant role in the biological processes of metabolism, sulfur oxidation, sulfate-reducing and carbon oxidation. The addition of ozone from NTP made microbial community in BTF more complicated and active for DMS removal. The NTP oxidize DMS to simple compounds such as methanol and carbonyl sulfide; the intermediate organic products and DMS are further oxidized to sulfate, carbon dioxide, water vapors by biological degradation. These results show that NTP-BTF is achievable and open new possibilities for applying the integrated with NTP and BTF to odour gas treatment.

Light absorption engineering of hydrogenated nanocrystalline silicon by femtosecond laser.

The light absorption coefficient of hydrogenated nanocrystalline silicon has been engineered to have a Gaussian distribution by means of absorption modification using a femtosecond laser. The absorption-modified sample exhibits a significant absorption enhancement of up to ∼700%, and the strong absorption does not depend on the incident light. We propose a model responsible for this interesting behavior. In addition, we present an optical limiter constructed through this absorption engineering method.

Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method.

BACKGROUND: Abdominal drainage is a standard procedure after hepatectomy, but this practice has been challenged recently. METHODS: Between September 2004 and March 2005, 120 consecutive patients who had undergone hepatic resection by the same surgical team were randomly allocated into drainage and no drainage groups (60 in each group). Patient characteristics, preoperative liver function, presence of cirrhosis, resection-related factors and postoperative complications were compared between the two groups. RESULTS: The groups were comparable in terms of demographics, indications for surgery, preoperative liver function test results, presence of cirrhosis, extent of hepatectomy, intraoperative blood loss and requirement for blood transfusion. Symptomatic subphrenic collection and pleural effusion occurred in four patients (7 per cent) who had abdominal drainage and three (5 per cent) who did not. Local wound complications occurred in 17 (28 per cent) and two (3 per cent) patients respectively (P < 0.001). The postoperative hospital stay was similar in the two groups. Multivariate analysis indicated that the presence of cirrhosis and abdominal drainage were independently related to the development of postoperative wound complications. CONCLUSION: Routine abdominal drainage is unnecessary after elective hepatectomy using the crushing clamp method.

HTPAP gene on chromosome 8p is a candidate metastasis suppressor for human hepatocellular carcinoma.

Our previous studies suggested that chromosome 8p deletion is associated with metastasis of hepatocellular carcinoma (HCC), in which some novel metastasis suppressor genes might be harbored. The present study aimed to identify the metastatic suppressor gene(s). A cDNA chip was constructed with the expressed sequence tags (ESTs) from chromosome 8p and used to compare the difference of expression profiling between the MHCC97-H and MHCC97-L cell lines with different metastatic potentials and similar genetic backgrounds. In all, 10 ESTs were significantly downregulated in MHCC97-H cell line with higher metastatic potential. One full-length gene, HTPAP (phosphatidic acid phosphatase type 2 domain containing 1B), was identified at chromosome 8p12. Sequencing and bioinformatic analyses revealed that HTPAP has 826 bp and encodes a putative protein of 175 amino acids with a transmembrane segment at the NH2 terminus, two protein kinase C phosphorylation site and one tyrosine kinase phosphorylation site. Its expression level in metastatic tumor tissues was much lower than that of primary HCC tissues. Both in vitro and in vivo assays suggested that HTPAP could suppress the invasion and metastasis of HCC. These suggested that HTPAP is a novel metastatic suppressor gene for HCC. The mechanism of the effect of HTPAP on HCC metastasis is not clear yet and deserves further investigation.

Self-seeded multiwavelength Brillouin-erbium fiber laser.

We propose and demonstrate a self-seeded multiwavelength Brillouin-erbium fiber laser with an internally self-excited Brillouin pump, which is achieved by incorporation of a length of single-mode fiber together with a Sagnac loop mirror into a fiber ring cavity. In this simple scheme the Brillouin pump is self-excited in the fiber ring cavity and then used to seed the Brillouin multiwavelength comb in the single-mode fiber. Stable generation of more than 120 Brillouin Stokes wavelengths with relatively uniform amplitudes is demonstrated with this scheme. It is also shown that such a self-seeded Brillouin laser has good stability and repeatability.

Conformationally restricted and conformationally defined tyramine analogues as inhibitors of phenylethanolamine N-methyltransferase.

In a search for a selective inhibitor for the epinephrine synthesizing enzyme phenylethanolamine N-methyltransferase (PNMT; EC 2.1.1.28), phenolic 2-aminotetralins (12-15 as conformationally restricted analogues of tyramine) and phenolic benzobicyclo[3.2.1]octylamines (22-24 as conformationally defined analogues of tyramine) were used to gain information about the binding interactions of the catecholic hydroxyl groups in the natural substrate norepinephrine at the active site of PNMT. In addition, these analogues provided information about the effects of conformational flexibility on active-site interaction of the aminoethyl side chain in phenolic phenylethylamines that may aid in learning the manner in which norepinephrine binds at the active site of PNMT. Analogues 22-24 were synthesized by a nine-step sequence, in which a Friedel-Crafts type intramolecular cyclization was the key step in the construction of the benzobicyclo[3.2.1]octane skeleton. p-Tyramine (10, Ki = 294 microM) was more potent than phenylethylamine (1, Ki = 854 microM) but m-tyramine (9, Ki = 1250 microM) was less potent than phenylethylamine as an inhibitor of PNMT. Similarly, in the conformationally restricted and conformationally defined tyramine analogues (12-15 and 22-24, respectively), the analogues with the p-tyramine moiety (14, Ki = 4.7 microM; 23, Ki = 111 microM) bind to PNMT better than do the corresponding unsubstituted compounds (16, Ki = 6.8 microM; 25, Ki = 206 microM) while the analogues with the m-tyramine moiety (13, 15, 22, and 24) have a lower binding affinity than do 16 and 25. The greatly enhanced activity of the phenolic 2-aminotetralins (12-15) compared with m- and p-tyramine (9 and 10, respectively) is likely due to the restriction of the side-chain conformation. The conformationally defined analogues 22-24 were less active than the conformationally restricted ones, 12-15, although the low-energy half-chair conformation of 2-aminotetralin is defined in 22-24. The reduced activity of 22-24 compared with the activity of 12-15 is probably due to the steric hindrance from the extra bridging atoms in binding to PNMT. The interaction of the p-hydroxyl group of the tyramine moiety may involve hydrogen bonding since the corresponding methyl ethers show a greatly reduced affinity for the active site of PNMT (Ki = 34 and 389 microM for methoxy analogues 28 and 35, compared to Ki = 4.7 and 111 microM for the corresponding phenolic analogues 14 and 23).

Stereochemical aspects of phenylethanolamine analogues as substrates of phenylethanolamine N-methyltransferase.

Phenylethylamines and phenylethanolamines represent two major classes of ligands for the epinephrine synthesizing enzyme, phenylethanolamine N-methyltransferase (PNMT;EC 2.1.1.28). Phenylethylamines are usually competitive inhibitors and the isomers with the relative configuration as in (2S)-amphetamine (1) and (2S)-2-aminotetralin (3) are better inhibitors than their enantiomers. Phenylethanolamines are usually substrates of PNMT and the enzyme prefers the 1R isomers, such as (1R)-phenylethanolamine (5), in this class. Optically active norephedrines (7 and 8), norpseudoephedrines (9 and 10), and 2-amino-1-tetralols (13-16) were used to study the stereochemical requirements of phenylethanolamines for PNMT active site binding. Although the norephedrines (7 and 8) and the norpseudoephedrines (9 and 10) were poorer ligands for PNMT than were the 2-amino-1-tetralols (13-16), (1R,2S)-(-)-norephedrine (7) showed some activity as a PNMT substrate (Km = 1310 microM, Vmax = 0.22, 100 x Vmax/Km = 0.017). In the 2-amino-1-tetralols (13-16), the isomers with the 2S configuration (13 and 15) showed higher affinity to PNMT (13, Km = 4.5 microM; 15, Ki = 4.6 microM) and those with the 1R configuration (13 and 16) were substrates for the PNMT-catalyzed methyl transfer (13, Km = 4.5 microM, Vmax = 0.16, 100 x Vmax/Km = 3.6; 16, Km = 195 microM, Vmax = 0.12, 100 x Vmax/Km = 0.062); the combination of 1R and 2S configurations, such as in (1R,2S)-2-amino-1-tetralol (13), was required for a good substrate. These stereochemical requirements derived from the norephedrines (7 and 8), the norpseudoephedrines (9 and 10), and the 2-amino-1-tetralols (13-16) complement those for phenylethylamines (1-4) and for phenylethanolamines (5 and 6) and strongly suggest that phenylethylamine inhibitors bind to PNMT in the same orientation as do phenylethanolamine substrates.