Prophylactic noninvasive positive pressure ventilation in the weaning of difficult-weaning tracheotomy patients.

BACKGROUND: Prophylactic noninvasive positive pressure ventilation (NPPV) reduces reintubation in endotracheal intubation patients. However, the efficacy of using the prophylactic NPPV in the weaning of tracheotomy patients is unclear. METHODS: We performed prophylactic NPPV in 11 tracheotomy patients who passed a spontaneous breathing trial (SBT), removed the tracheotomy tube, and closed the incision (intervention group). We matched another 11 tracheotomy patients who also passed an SBT but weaning and removing of tracheotomy tube were managed as conventional methods (control group). RESULTS: Patients in the control group had reinstitution of mechanical ventilation 36 times after the initial SBT success. Compared with the control group, the interventional group had fewer weaning days (3.0±2.1 vs. 11.3±9.2, P=0.01) from initial SBT success to successful weaning and shorter intensive care unit (ICU) length of stay (11.6±4.2 vs. 20.3±11.6, P=0.03) after initial SBT success. The interventional group had lower nosocomial pneumonia rates after initial SBT success (0/11 vs. 2/11), lower ICU mortality (0/11 vs. 2/11), lower hospital mortality (0/11 vs. 3/11), and higher successful weaning rate (11/11 vs. 8/11), but it didn't reach significant difference. Also, there was no significant difference between groups in total duration of ventilation (25.5±13.3 vs. 34.7±24.2 days), hospital stay after initial SBT success (24.0±22.3 vs. 37.4±31.3 days), total ICU stay (35.7±15.3 vs. 45.0±29.5 days), and total hospital stay (48.7±33.1 vs. 68.6±52.6 days). CONCLUSIONS: Prophylactic NPPV may be useful to accelerate weaning, and shorten ICU stay after initial SBT success in tracheotomy patients.

Rapamycin-eluting Single and Double Stenting on Serum Markers in Coronary Bifurcation Lesions.

The objective of study was to compare effects of rapamycin-eluting single and double stenting on serum markers like high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in patients with coronary bifurcation lesions. It was an experimental study carried out from April 2016 to July 2017. One hundred and twenty-six patients were divided into two equal groups according to different treatment regimens. Group A was treated with rapamycin-eluting single stenting and group B with rapamycin-eluting double stenting. Three months after operation, hs-CRP, TNF-α, IL-6, IL-8 and MCP-1 levels in group B were lower than those in group A (p=0.010, p <0.001, p <0.001, p <0.001 and p <0.001, respectively). After one year of follow-up, rate of intrasegmental restenosis of branch vessels was higher in group A than in group B (p=0.011). Compared with rapamycin-eluting single stenting, rapamycin-eluting double stenting may regulate more effectively the above serum markers levels, reduce the incidence of intrasegmental restenosis of branch vessels.

Piezo1 induced apoptosis of type II pneumocytes during ARDS.

OBJECTIVE: The mechanisms of lung injury in acute respiratory distress syndrome (ARDS) are not well understood.Piezo1 was recently identified as a mechanotransduction protein. The present study found the expression of Piezo1 in type II pneumocytes and investigated its role in mediating ARDS-related lung injury. METHODS: Sprague-Dawley rats were used to establish an ARDS model, the expression of Piezo1,lung injuries, apoptosis as well as calcium influx were assessed. RESULTS: Piezo1 was expressed in type II pneumocytes as shown by immunofluorescence staining and expression was increased in the ARDS model. Knockdown of Piezo1 reduced apoptosis which was related to the elevation of Bcl-2.Calcium influx played a vital role in Piezo1-induced apoptosis. CONCLUSION: Piezo1 was expressed in type II pneumocytes. Mechanical stretch of alveoli during ARDS induced activation of the Piezo1 channel,which resulted in calcium influx. The increased intracellular Ca2+ induced the apoptosis of type II pneumocytes, which may be related to the Bcl-2 pathway.

A big-five personality model-based study of empathy behaviors in clinical nurses.

Empathy is the capacity to understand or feel what another person is experiencing from within the other person's frame of reference. Many studies have shown that enhancement of nurses' empathy capability can promote a good nurse-patient relationship. However, little research investigates the strategies to improve nurses' empathy abilities. This study investigated the characteristics of nurses' personality trait and empathy and explore the correlation between nurses' empathy and personality. A total of 471 nurses participated in this study. This study found that empathy was positively associated with conscientiousness and agreeableness, negatively associated with neuroticism. The personality traits were able to explain 37.5% of the overall variation in empathy capability, while agreeableness and conscientiousness tendency were significantly associated with empathy capability in nurses. Big five personality trait theory is a pretty good model to predict the empathy level of nurses, which could also play a positive role in improving the empathy ability, managing the satisfaction of patients and provision of quality and safe care customized to patients' needs and preferences. In addition, training programs emphasizing emotions, psychology and healthy personality should be strengthened to promote nurses' empathy.

Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials.

BACKGROUND: High tibial osteotomy (HTO) is an effective surgical technique that can stop or inhibit progression of knee osteoarthritis (OA) and avoid or postpone the need for knee arthroplasty. This meta-analysis determined whether opening-wedge high tibial osteotomy (OWHTO) was superior to closing-wedge high tibial osteotomy (CWHTO) in treatment of unicompartmental OA. METHODS: Databases (PubMed, Embase, Web of Science, Cochrane Library and Google) were searched from the time of their establishment to 1st August 2018 for randomized controlled trials (RCTs) comparing OWHTO and CWHTO in patients with unicompartmental OA. The Cochrane risk of bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. RESULTS: Nine RCTs (599 participants) were included in this meta-analysis. The pooled results showed that there were no significant differences between OWHTO and CWHTO VAS knee pain scores, HSS knee scores, walking distances or hip-knee-ankle (HKA) angles (P > 0.05). Furthermore, there were no significant differences between the two groups in complication and survival rates (p > 0.05). Nevertheless, there was a significantly greater tibial slope angle in OWHTO patients (P < 0.00001). CONCLUSION: CWHTO reduced the inclination of the tibial plateau, whereas OWHTO increased the posterior tilt, and these factors should be considered in the specific need of an individual patient when choosing the type of osteotomy. Therefore, we are unable to conclude which method is superior.

Characteristics of Subjects Who Failed a 120-Minute Spontaneous Breathing Trial.

BACKGROUND: The objective of this work was to identify the unique characteristics of patients who experienced success in a 30-min spontaneous breathing trial (SBT) but failed at 120 min. METHODS: Patients who had received mechanical ventilation for >24 h were eligible for inclusion in this study. The SBT was performed by 7 cm H2O of pressure support with zero PEEP. After a successful 120-min SBT, weaning from mechanical ventilation was performed. Data were collected at 30 and 120 min or at the failure of the SBT. All patients who successfully completed a 30-min SBT were enrolled. RESULTS: We enrolled 352 subjects in this study. Of these, 311 subjects (88.4%) directly completed a 120-min SBT (success group), and 41 subjects (11.6%) passed the test for at least 30 min but failed before 120 min (failure group). In data collected before the SBT, presence of chronic cardiopulmonary disease, number of previous SBT attempts before 30-min SBT success, age, and PaCO2 were independently associated with 120-min SBT failure. A scale was developed that used these 4 variables. The failure rate was low in subjects with ≤2 points (3%) but significantly higher in subjects with >2 points (46%). In data collected at the 30-min SBT, PaCO2 , rapid shallow breathing index, ΔPaO2 /FIO2 , Δbreathing frequency, and ΔpH were independently associated with 120-min SBT failure. These 5 variables were then used to develop another scale to predict SBT success. Similar to the previous score, the failure rate was low in subjects with ≤2 points (1%) and significantly higher in subjects with >2 points (55%). CONCLUSIONS: This study highlights differences between subjects who completed a 120-min SBT and those who succeeded at 30 min but failed by 120 min. In subjects with a score >2 points, reflecting a greater risk of SBT failure, a 120-min SBT may be required.

Nrf2 regulates the inflammatory response, including heme oxygenase-1 induction, by mycoplasma pneumoniae lipid-associated membrane proteins in THP-1 cells.

A series of inflammatory responses caused by Mycoplasma pneumoniae largely depend on the lipid-associated membrane proteins (LAMPs). Nuclear factor E2-related factor 2 (Nrf2), a transcription factor, is considered to be a critical modulator of inflammatory responses and cellular redox homeostasis. Monocytes play an important role in the invasion and immunity to resist pathogens. Here, we investigated the role of Nrf2 in the anti-inflammatory response stimulated by LAMPs using the human monocyte cell line THP-1. LAMPs were shown to affect the localization of Nrf2, and the levels of reactive oxygen species and inflammatory reactants, including nitric oxide (NO), prostaglandin E2 (PGE2) and cytokines (IL-6, IL-8), were highly elevated in LAMP-stimulated Nrf2-silenced THP-1 cells. Moreover, LAMPs induced the levels of mRNA and the expression of heme oxygenase-1 (HO-1). In summary, our results demonstrated that LAMPs cause nuclear translocation of Nrf2, which further suppresses the expression of inflammatory reactants in THP-1 cells.

Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure.

BACKGROUND Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV). MATERIAL AND METHODS This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups. RESULTS Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172-1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303-2.374, p<0.05) were independent predictive factors for NIPPV treatment failure. CONCLUSIONS NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome.

Association between interleukin 10 gene -1082 A/G polymorphism and the risk of type 2 diabetes mellitus: a meta-analysis of 4250 subjects.

Increasing evidence suggests that interleukin 10 (IL 10) gene -1082 A/G (rsl800896) polymorphism may be associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the results are inconsistent. The aim of this study is to analyze the association between this variant and the T2DM risk by meta-analysis. PubMed, Embase, Web of Science, and Google Scholar were searched from January 1, 1989 to February 17, 2012, as well as hand searching of the references of identified articles were performed. All the statistical tests were performed using Stata 11.0. Seven case-control studies were identified, covering a total of 1879 T2DM cases and 2371 controls. The results showed evidence of significant association between IL 10 gene -1082 A/G polymorphism and T2DM risk (for G/G+G/A vs. A/A: OR=1.21, 95% CI=1.05-1.40, p=0.010, p=0.040 after Bonferroni testing). In the subgroup analysis by ethnicity, no significant association was found between IL 10 gene -1082 A/G polymorphism and T2DM risk in Europeans. In summary, results from this meta-analysis provide evidence that IL 10 gene -1082 G allele is associated with increased risk of T2DM.

Association between the interleukin-6 gene -572 C/G polymorphism and the risk of type 2 diabetes mellitus: a meta-analysis of 11,681 subjects.

The association between the interleukin-6 (IL-6) gene -572 C/G (rs1800796) polymorphism and type 2 diabetes mellitus (T2DM) risk remains controversial. Thus, we performed this meta-analysis by searching PubMed, Embase, Web of Science, CBMdisc and CNKI databases until January 30, 2012. In addition, hand searching of the references of identified articles was performed. A total of 10 case-control studies including 11,681 subjects were selected to evaluate the possible association. Our results showed evidence for significant association between the IL-6 gene -572 C/G polymorphism and T2DM risk (for G allele vs. C allele: odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.09-1.52, P = 0.002, P = 0.008 after Bonferroni testing; for G/G vs. C/C: OR = 1.89, 95% CI = 1.51-2.37, P < 0.00001, P < 0.00004 after Bonferroni testing; for GG vs. G/C + C/C: OR = 1.75, 95% CI = 1.20-2.56, P = 0.004, P = 0.016 after Bonferroni testing; for G/G + G/C vs. C/C: OR = 1.32, 95% CI = 1.11-1.57, P = 0.001, P = 0.004 after Bonferroni testing). In addition, similar results were obtained in the subgroup analysis based on ethnicity. In summary, the present meta-analysis suggests a significant association between the IL-6 gene -572 G allele and increased risk of T2DM.

Association between interleukin-8 gene -251 T/A polymorphism and the risk of peptic ulcer disease: a meta-analysis.

It remains controversial regarding the association between interleukin-8 (IL-8) gene -251 T/A polymorphism and peptic ulcer disease (PUD) risk. Thus, a large-scale meta-analysis evaluating the precise association between this gene variant and PUD risk is required. We searched the PubMed, Embase, Web of Science, and Google Scholar until April 25, 2012. Additionally, hand searching of the references of identified articles were performed. All the statistical tests were performed using Stata 11.0. A total of eight studies (3105 subjects) were included in this meta-analysis. Overall, no significant association was found between IL-8 gene -251 T/A polymorphism and PUD risk (for A allele vs. T allele: OR = 1.17, 95% CI = 0.97-1.41, p = 0.094; for A/A vs. T/T: OR = 1.33, 95% CI = 0.94-1.90, p = 0.108; for A/A vs. A/T+T/T: OR = 1.22, 95% CI =0.97-1.52, p = 0.083; for A/A+A/T vs. T/T: OR = 1.26, 95% CI = 0.95-1.67, p = 0.113). However, in the subgroup analyses by ethnicity, H. pylori infection and the subtype of PUD, significant associations were found between IL-8 gene -251 T/A polymorphism and PUD risk in Asians, H. pylori+, duodenal ulcer disease (DUD) and gastric ulcer disease (GUD), respectively. In summary, the present meta-analysis suggests that IL-8 gene -251 T/A polymorphism is associated with increased PUD risk among Asians, and especially for the subgroups of H. pylori+, DUD and GUD.

The lack of association between interleukin-6 gene -174 G/C polymorphism and the risk of type 1 diabetes mellitus: a meta-analysis of 18,152 subjects.

Epidemiological studies have evaluated the association between interleukin-6 (IL-6) gene -174 G/C polymorphism and type 1 diabetes mellitus (T1DM) risk, but results of different studies have been inconsistent. The present meta-analysis was therefore designed to clarify these controversies. PubMed, Embase and Web of Science were searched from the first available year to March 25, 2012, as well as hand searching of the references of identified articles were performed. All studies investigating the association between IL-6 gene -174 G/C polymorphism and T1DM risk were included. Data analyses were carried out by Review Manager 5.1.2 and Stata 11.0. Seven studies were included in the final meta-analysis, covering a total of 9697 T1DM cases and 8455 controls. The results showed no evidence for significant association between IL-6 gene -174 G/C polymorphism and T1DM risk (for C/C+C/G vs. G/G: OR=1.30, 95% CI=0.84-2.00, p=0.24; for C/C vs. C/G+G/G: OR=1.10, 95% CI=0.75-1.60, p=0.63; for C/C vs. G/G: OR=1.34, 95% CI=0.75-2.42, p=0.33; for C allele vs. G allele: OR=1.16, 95% CI=0.88-1.53, p=0.30). In addition, the similar results were obtained in the subgroup analysis based on ethnicity. In summary, the present meta-analysis suggests that IL-6 gene -174 G/C polymorphism is not associated with T1DM risk. However, due to the small sample size in most of the included studies and the selection bias existed in some studies, the results should be interpreted with caution.

Associations between interleukin-6 gene -174 C/G and -572 C/G polymorphisms and the risk of gastric cancer: a meta-analysis.

BACKGROUND AND OBJECTIVES: Epidemiological studies have evaluated the associations between interleukin-6 (IL-6) gene -174 C/G (rs1800795) and -572 C/G (rs1800796) polymorphisms and gastric cancer (GC) risk, but results and conclusions remain controversial. In order to derive a more precise estimation of the associations, we performed this meta-analysis. METHODS: A meta-analysis was conducted to estimate the associations between IL-6 gene -174 C/G and -572 C/G polymorphisms and GC risk. RESULTS: Nine articles involving 13 studies were included in the final meta-analysis, covering a total of 1,581 GC cases and 2,563 controls. For IL-6 gene -174 C/G polymorphism, nine studies were combined showing no evidence for associations between IL-6 gene -174 C/G polymorphism and GC risk. For IL-6 gene -572 C/G polymorphism, four studies were combined. There was also lack of evidence for significant association between IL-6 gene -572 C/G polymorphism and GC risk. In addition, the similar results were obtained in the subgroup analyses and cumulative meta-analysis. CONCLUSIONS: The present meta-analysis suggests that IL-6 gene -174 C/G and -572 C/G polymorphisms are not associated with GC risk. However, due to the small subjects included in analysis and the selection bias in some studies, the results should be interpreted with caution.

Association between interleukin-10 gene -592 C/A polymorphism and the risk of type 2 diabetes mellitus: a meta-analysis of 5320 subjects.

Increasing evidence suggests that interleukin-10 (IL-10) gene -592 C/A polymorphism may be associated with an increased risk of type 2 diabetes mellitus (T2DM). To provide a quantitative assessment of the association between this variant and risk of T2DM, we performed this meta-analysis. Systematic searches of electronic databases PubMed, Embase, Web of Science, CBMdisc and CNKI, as well as hand searching of the references of identified articles were performed. A total of 2698 T2DM cases and 2622 controls in seven case-control studies were included in this meta-analysis. The results showed no evidence for significant association between IL-10 gene -592 C/A polymorphism and T2DM risk (for A allele vs. C allele: OR=0.94, 95% CI=0.69-1.29, p=0.69; for A/A vs. C/C: OR=0.88, 95% CI=0.39-1.98, p=0.75; for A/A vs. A/C+C/C: OR=1.04, 95% CI=0.59-1.82, p=0.89; for A/A+A/C vs. C/C: OR=1.11, 95% CI=0.73-1.69, p=0.61). In addition, the similar results were obtained in the subgroup analysis based on the ethnicity. In summary, results from this meta-analysis suggest that the IL-10 gene -592 C/A polymorphism is not associated with T2DM risk.

Association between interleukin-6 gene -174 G/C polymorphism and the risk of coronary heart disease: a meta-analysis of 20 studies including 9619 cases and 10,919 controls.

Interleukin-6 (IL-6) gene -174 G/C polymorphism has been reported to be associated with coronary heart disease (CHD), but the results remain inconclusive. The present meta-analysis was therefore designed to clarify these controversies. This meta-analysis was performed by searching PubMed, Embase and Web of Science databases. A total of 20 studies including 9619 CHD cases and 10,919 controls were combined showing no evidence of association between IL-6 gene -174 G/C polymorphism and CHD risk (for C/C+C/G vs. G/G: OR=1.10, 95% CI=0.99-1.22, p=0.07; for C/C vs. C/G+G/G: OR=1.08, 95% CI=0.93-1.24, p=0.33; for C/C vs. G/G: OR=1.16, 95% CI=0.97-1.39, p=0.11; for C allele vs. G allele: OR=1.10, 95% CI=1.00-1.21, p=0.06). Moreover, we also did not find significant association between IL-6 gene -174 G/C polymorphism and myocardial infarction (MI) risk. However, in the subgroup analysis by ethnicity, significant association was found among Asians (for C/C+C/G vs. G/G: OR=1.35, 95% CI=1.05-1.63, p=0.02). In summary, the present meta-analysis suggests that IL-6 gene -174 G/C polymorphism is associated with increased CHD risk among Asians. However, due to the small subjects included in the subgroup analysis of Asians, the results should be interpreted with caution.

Association between tumor necrosis factor-alpha gene -308A/G polymorphism and the risk of acute pancreatitis: a meta-analysis.

BACKGROUND: Epidemiologic studies have evaluated the association between tumor necrosis factor-alpha (TNF-α) gene -308A/G polymorphism and the risk of acute pancreatitis (AP), but the results are inconsistent. In order to derive a more precise estimation of the associations, a meta-analysis was performed. MATERIALS AND METHODS: Systematic searches of electronic databases PubMed, Embase, and Web of Science, as well as hand searching of the references of identified articles, were performed. All case-control studies investigating the association between TNF-α gene -308A/G polymorphism and AP risk were included. The association was assessed by odds ratio (OR) with 95% confidence intervals (CIs). Publication bias was analyzed by Begg's funnel plot and Egger's regression test. RESULTS: The initial search revealed 818 potentially eligible studies. Having read the title, abstract, or full text, we included six relevant studies in the final meta-analysis, which contained 1,006 AP cases and 782 controls. Overall, no significant association was found between TNF-α gene -308A/G polymorphism and AP risk when all studies were pooled into the meta-analysis (for A/A+A/G versus G/G: OR = 1.03, 95% CI = 0.83-1.28, P = 0.79; for A/A versus A/G+G/G: OR = 0.97, 95% CI = 0.65-1.45, P = 0.87; for A/A versus G/G: OR = 1.23, 95% CI = 0.79-1.91, P = 0.37; for A allele versus G allele: OR = 0.99, 95% CI = 0.83-1.18, P = 0.90). In addition, the similar results were obtained in the subgroup analysis based on the ethnicity and subtype of AP. CONCLUSIONS: The present meta-analysis reveals that the TNF-α gene -308A/G polymorphism is not associated with AP risk. However, due to the small number of subjects included in analysis and the selection bias in some studies, the results should be interpreted with caution.