[Analysis of clinical and pathological features of chronic hepatitis B combined with metabolic-associated fatty liver disease].

Objective: To analyze the clinical and histopathological features of patients with chronic hepatitis B (CHB) combined with metabolic-associated fatty liver disease (MAFLD). Methods: Clinical data of 529 cases who had liver biopsies at the First Affiliated Hospital of Zhengzhou University between January 2015 and October 2021 were collected. Among them were 290 cases with CHB, 155 cases with CHB combined with MAFLD, and 84 cases with MAFLD. Three groups of patients clinical data, including general information, biochemical indicators, FibroScan indicators, viral load, and histopathology, were analyzed. A binary logistic regression analysis was used to explore the factors influencing MAFLD in patients with CHB. Results: (1) Age, male status, proportion of hypertension and diabetes, body mass index, fasting blood glucose, γ-glutamyl transpeptidase, low-density lipoprotein, cholesterol, triglycerides, uric acid, creatinine, and the controlled attenuation parameter for hepatic steatosis were higher in CHB combined with MAFLD than in CHB patient groups. In contrast, the high-density lipoprotein, HBeAg positivity rate, viral load level, and liver fibrosis grade (S stage) were lower in CHB patients, and the differences were statistically significant (P < 0.05). (2) Alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, triglycerides, uric acid, creatinine, and the controlled attenuation parameter for hepatic steatosis in CHB combined with the MAFLD were lower than those in MAFLD patient groups, while high-density lipoprotein was higher than that of MAFLD patients, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the grade of liver inflammation and fibrosis (GS stage) between the two groups (P > 0.05). Binary multivariate logistic regression analysis showed that overweight/obesity, triglycerides, low-density lipoprotein, the controlled attenuation parameter for hepatic steatosis, and HBeAg positivity were independent influencing factors for MAFLD in CHB patients. Conclusion: Patients with CHB combined with metabolic disorders are prone to developing MAFLD, and there is a certain correlation between HBV viral factors, the degree of liver fibrosis, and the fatty degeneration of hepatocytes.

In vitro and in vivo effectiveness of a novel injectable calcitonin-loaded collagen/ceramic bone substitute.

This study aimed to evaluate the effectiveness of a novel calcitonin-loaded calcium phosphate composite bone cement in vitro and in vivo. The novel composite bone cements were composed of NuROs injectable bone graft substitute, type I collagen, and/or salmon calcitonin. The setting time, porosity, wettability, compressive strength, compressive modulus, and crystallographic structures of cement specimens were determined. Degradation rate, calcitonin release rate, and osteoinductivity were assessed in vitro. In addition, osteogenic effect was examined in a rabbit model of femoral defect. The results revealed that addition of collagen/calcitonin did not substantially alter physical properties and degradation rate of bone cement specimens. Calcitonin was released into culture medium in a two-phase manner. Osteogenic effect of conditioned medium derived from calcitonin containing bone cement was observed. Finally, de novo bone growth and bone mineralization across the bone defect area were observed in rabbits after implantation of composite bone cement specimens. In conclusion, this novel calcitonin-loaded composite calcium phosphate bone cement exhibits biocompatibility, bioresorbability, osteoinductivity, and osteoconductivity, which may be suitable for clinical use.

[Propensity-matched comparison of laparoscopic and open radical cystectomy for female patients with bladder cancer].

OBJECTIVE: To compare the perioperative and oncologic outcomes of female patients receiving laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). METHODS: Retrospective review of 91 consecutive female patients with urothelial carcinoma of bladder undergoing radical cystectomy at a single academic institution from 2006 to 2017. Those female patients received open radical cystectomy were matched to the patients who underwent laparoscopic radical cystectomy by using propensity score matching in 1 ∶1 ratio. The matching factors included age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, pathologic stage and pathologic nodal stage. The perioperation and oncology characteristics were compared, and Kaplan-Meier method was used to analyze the overall survival (OS), cancer specific survival (CSS) and progression-free survival (PFS) estimates. Finally, we did a sensitive analysis by using multivariable COX regression of all the patients, adjusting for the matching factors. RESULTS: There were 65 ORC and 26 LRC patients identified in this cohort with urothelial carcinoma of bladder, the median follow-up time was 38 months (interquartile range 18-69). The age (P<0.001) and ASA scores (P=0.018) were less for LRC before being matched. There were 22 LRC and 22 ORC patients matching successfully. Before being matched, the estimate blood loss (P=0.005), transfusion rate (P<0.001) and total complications rate (P=0.015) were less for LRC, and the lymph nodes yield was greater for LRC, but there were no differences in OS (P=0.698), CSS (P=0.942) and PFS (P=0.837) between the two groups. After being matched, the estimate blood loss (P=0.009), transfusion rate (P=0.001) and total complications rate (P=0.040) were less for LRC, but there was no difference in the lymph nodes yield. Besides, there were no statistic differences in OS (P=0.432), CSS (P=0.429) and PFS (P=0.284) between the two groups. In addition, in multivariable COX regression analysis, surgical approaches (LRC/ORC) were not found to be a predictor of OS (HR 1.134, 95%CI 0.335-3.835, P=0.839), CSS (HR 1.051, 95%CI 0.234-4.719, P=0.949) and PFS (HR 0.538, 95%CI 0.138-2.095, P=0.371) of the female patients with urothelial carcinoma of bladder. CONCLUSION: It is advantageous for laparoscopic radical cystectomy in terms of estimating blood loss, transfusion rate and complication rate. But there was no evidence that laparoscopic radical cystectomy for female patients with bladder cancer had a better oncologic prognosis than open radical cystectomy from this study.

Estimation of Lung Volume in Normal Population Using MSCT.

OBJECTIVES: To estimate lung volume in normal population by a combination of multi-slice spiral CT and Pulmo software. METHODS: Scans of the lung were performed on 45 normal individuals using Emotion 16-slice spiral CT and Pulmo software. A measurement instrument of work station was used to measure the vertical diameter of left and right lungs, the maximum anteroposterior and transverse diameters at the layers of apex pulmonis 1 cm below, arcus aortae, subcarinal and diaphragmatic dome, and the lung volume. Regression analysis was performed on normal lung volume and each measured parameter by SPSS 20.0 and an optimal model was selected. RESULTS: The goodness of fit between the best curvilinear equations of the normal bilateral lung volumes was 0.981. The goodness of fit between the curvilinear equations of the normal bilateral lung volume and the product of the vertical diameter and the maximum transverse diameter of diaphragmatic dome were 0.977 and 0.972, respectively. Fifteen cases were selected to make a retrospective test on the 3 models. No significant difference was found between the estimated and measured with Pulmo software lung volumes. CONCLUSIONS: The normal lung volume before injury can be estimated by the curvilinear equations established in this study. The percentage of lung compression can be measured based on the volume of compressed lung, which can provide a reference for the identification of lung compression degree.

[5-HT(2A) receptor/protein kinase C pathway in mediating long-term facilitation of carotid sinus nerve discharge in chronic intermittent hypoxia rats].

Objective: To explore the role of 5-HT(2A)R/PKC pathway in mediating long-term facilitation (LTF) of carotid sinus nerve (CSN) discharge in chronic intermittent hypoxia (CIH) rats. Methods: With number table, 24 adult SD rats were randomly divided into saline control group (group A, n=6), 5-HT(2A)R antagonist (ketanserin) group (group B, n=6), PKC inhibitor (PKC θ-pseudosubstrate) group (group C, n=6) and combined ketanserin with PKC θ-pseudosubstrate group (group D, n=6). All rats were placed into the animal chambers for CIH treatment, 8 h per day (from 9: 00 to 17: 00) for 4 consecutive weeks. 28 days later, 5 min × 3 times of stimulation with acute intermittent hypoxia (AIH) were given, after that, stable CSN discharge activities were recorded and compared before and after intravenous injection of saline (group A), ketanserin (group B), PKC θ-pseudosubstrate (group C) or ketanserin + PKC θ-pseudosubstrate (group D), respectively. Results: There were no significant difference in the baseline (before AIH stimulation) average peak amplitude of CSN discharge among the four groups (P>0.05). In group A, the amplitude of CSN discharge at 30 min and 60 min after AIH were (5.01 ± 0.53) µV and (4.95 ± 0.34) µV respectively, which were significantly higher than that before AIH (P<0.01). The results implied that the CSN LTF could be induced by AIH in CIH pre-treatment rats. In group B, the amplitude of CSN discharge at 30 min and 60 min after AIH were (3.79 ± 0.42) µV and (3.73 ± 0.46) µV, respectively, which were still significantly higher than that before AIH (P<0.01), showing that carotid sinus nerve LTF couldn't be completely blocked by 5-HT(2A)R antagonist in rats. After injection of PKC θ-pseudosubstrate or ketanserin + PKC θ-pseudosubstrate in group C or D, there were no significant differences in CSN discharge amplitude before and after AIH (P>0.01), suggesting that inhibition of PKC alone or 5-HT(2A)R/PKC pathway could completely block the LTF of CSN. Conclusion: 5-HT(2A)R/PKC pathway was involved in mediating long-term facilitation of carotid sinus nerve discharge in CIH rats.

Cisplatin induces apoptosis of hepatocellular carcinoma LM3 cells via down-regulation of XIAP.

OBJECTIVE: Cisplatin is an important anti-cancer drug. However, the molecular mechanism of cisplatin on inhibition of the proliferation of liver cancer cells is unclear. Thus, we aimed to investigate the regulatory role of cisplatin on the growth and apoptosis of hepatoma LM3 cells. MATERIALS AND METHODS: LM3 cells were treated with cisplatin (2 µmol/L) for 48 h. MTT assay, flow cytometry, and caspase-3 activity assay were used to detect the growth, proliferation and apoptosis of LM3 cells. Western blot was applied to detect the expression of the inhibitor of apoptosis protein, XIAP. siRNA was used to knockdown the level of XIAP followed by cisplatin (2 µmol/L) treatment, and then the apoptosis of LM3 cells was measured. RESULTS: The treatment of cisplatin significantly inhibited the growth but induced the apoptosis of LM3 cells. Cisplatin also downregulated the expression of XIAP. The downregulation of XIAP by using siRNA enhanced the apoptosis of LM3 cells induced by cisplatin. CONCLUSIONS: Downregulation of XIAP enhanced the proapoptotic effect of cisplatin on LM3 cells, suggesting that XIAP might be used as a potential target in the treatment of liver cancer.

[Expression of renal PLA2R in patients with idiopathic membranous nephropathy and its relationship with the curative effect of immunotherapy].

OBJECTIVE: To detect the expression of renal M-type phospholipase A2 receptor (PLA2R) in patients with idiopathic membranous nephropathy (IMN), and to explore the relationship between renal PLA2R and the curative effect of immunotherapy. METHODS: A total of 56 patients who were diagnosed as IMN from January 2012 to June 2014 in the department of nephrology in First People's Hospital, Shanghai Jiaotong University, were included in this study. The expression of renal PLA2R was detected by immumofluorescence assay. The IMN patients were treated with corticosteroids and cyclophosphamide, and the relationship between renal PLA2R and the curative effect of immunotherapy was observed. RESULTS: The ratio of PLA2R related IMN (renal PLA2R-positive) patients was 71.4%(40/56). The recovery conditions in proteinuria and serum albumin were better in the non-PLA2R related IMN group since 6 months after the treatment (P<0.05). The overall response rate in PLA2R related IMN group was 58.3%, 62.5% and 62.5% after 6, 9, 12 months, respectively. However, the overall response rate in non-PLA2R related IMN group almost reached 100% after treatment for 6 months. Compared with PLA2R related IMN group, the time which patients reached complete remission was significantly shorter in the non-PLA2R related IMN group [(5.4±3.5) vs (10.5±1.6) months, P<0.05]. CONCLUSIONS: Detection of renal PLA2R can be helpful to diagnose IMN. Non-PLA2R related IMN patients usually have a better curative effect of immunotherapy and a shorter time to onset of efficacy.

MiR-324-5p inhibits proliferation of glioma by target regulation of GLI1.

OBJECTIVES: To study the effects of the miR-324-5p on the glioma cells proliferation via the targeted regulation of the glioma-associated oncogene 1. METHODS: The luciferase reporter gene was used to test whether the glioma-associated oncogene 1 was the target of the miR-324-5p microRNA. The glioma-associated oncogene 1 expression was detected by Western blot. The proliferation and cell cycle were evaluated by MTT assay and flow cytometry. RESULTS: The glioma-associated oncogene 1 is a target of the miR-324-5p. An over-expressed miR-324-5p could reduce the cell survival rate and increase the G1/G0 phase rate in the glioma cell lines. CONCLUSIONS: The miR-324-5p can inhibit proliferation of the glioma cells via the targeted regulation of the glioma-associated oncogene 1.

Investigation on the suitability of the International Association of Diabetes and Pregnancy Study Group diagnostic criteria for gestational diabetes mellitus in China.

The aim of this study was to compare pregnancy outcomes of Chinese women diagnosed with gestational hyperglycaemia by the well-established American Diabetes Association (ADA) criteria, with those women meeting the newer criteria established by International Association of Diabetes and Pregnancy Study Groups (IADPSG). The study subjects consisted of 6,201 pregnant Chinese women with a singleton pregnancy who had received prenatal care and delivered between December 2008 and December 2011. Women who were screened positive with 1 h glucose load of ≥ 7.8 mmol/l underwent a diagnostic 3 h oral glucose tolerance test. Gestational hyperglycaemia was diagnosed using the ADA criteria and re-diagnosed according to the IADPSG criteria. The correlation between the incidences of adverse pregnant outcomes with gestational hyperglycaemia was analysed. In total, 570 patients (9.19% of 6,201) met the ADA criteria and 676 (10.90% of 6,201) met the IADPSG criteria. The 518 patients who met both standards showed a reduced caesarean section rate, as compared with 158 patients who only met the IADPSG standard and received no intervention (71.2% vs 79.7%, p < 0.05). The IADPSG-only group also had a higher rate of macrosomia and pre-eclampsia than the control group. The IADPSG criteria identified a group of women previously classified as normal according to the ADA criteria, but revealing poor pregnancy outcomes and requiring management. Therefore, we conclude that the IADPSG criteria are more suitable for the diagnosis of gestational hyperglycaemia in China.

IADPSG criteria for diagnosing gestational diabetes mellitus and predicting adverse pregnancy outcomes.

OBJECTIVE: To evaluate the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria versus the American Diabetes Association (ADA) criteria for diagnosing gestational diabetes mellitus (GDM) in China. STUDY DESIGN: Overall, 3083 women with a singleton pregnancy underwent a 75-g, 2-h oral glucose tolerance test between 24 and 28 weeks of pregnancy, and both IADPSG and ADA criteria were used for GDM diagnosis. Adverse pregnancy outcomes (APOs), including preterm birth, required Cesarean section, preeclampsia, macrosomia and low birth weight, were recorded and analyzed. RESULT: IADPSG and ADA criteria diagnosed 19.9% and 7.98% of women with GDM, respectively (P<0.001). IADPSG criteria has a stronger capacity of predicting APOs than ADA criteria (odds ratio (OR)=1.84, 95% confidence interval (CI): 1.52-2.25 for IADPSG, and OR=1.54, 95% CI: 1.16-2.05 for ADA). CONCLUSION: IADPSG criteria increase GDM diagnosis by almost twofold. GDM diagnosed by IADPSG criteria is more associated with APOs, although the economic impact needs further evaluation.

Differences in H3K4 trimethylation in in vivo and in vitro fertilization mouse preimplantation embryos.

Trimethylation of lysine 4 at histone 3 (H3K4me3) is considered a marker of active transcription; it plays an important role in transcription reprogramming efficiency. We compared the levels of H3K4me3 in mouse preimplantation embryos from MII stage oocytes produced by in vivo and in vitro fertilization (IVF) using immunofluorescence histochemistry. IVF embryos were further treated with trichostatin A (a histione deacetylase inhibitor) to investigate the effect of histone acetylation on H3K4me3. We found higher levels of H3K4me3 in MII stage oocytes in metaphase chromosomes. The pattern of H3K4 trimethylation of in vivo embryos from zygote to blastocyst stages was similar to that of IVF embryos; however, the concentration of H3K4me3 was significantly higher in the in vivo fertilization embryos. The levels of H3K4me3 in the trichostatin A-treated groups were also significantly increased. We conclude that culture condition and environmental changes can cause histone modification and that the effect of these environmental conditions on epigenetic changes should be taken into consideration.

Astragaloside IV synergizes with ferulic acid to inhibit renal tubulointerstitial fibrosis in rats with obstructive nephropathy.

BACKGROUND AND PURPOSE: The combination of Chinese herbs, Astragali Radix and Angelicae Sinensis Radix, could alleviate renal interstitial fibrosis. Astragaloside IV (AS-IV) and ferulic acid (FA) are the two major active constituents in this combination. In this study, we employed rats with unilateral ureteral obstruction to determine whether AS-IV and FA have the same renoprotective effects and investigated the mechanisms of this action. EXPERIMENTAL APPROACH: Renal pathological changes were evaluated after treatment with AS-IV, FA or AS-IV + FA (AF) for 10 days. Meanwhile, the expression of transforming growth factor ß(1) (TGF-ß(1) ), fibronectin, α-smooth muscle actin (α-SMA), phosphorylation of c-Jun NH(2) -terminal kinase (p-JNK) and nitric oxide (NO) production in kidney were determined. The expressions of fibronectin, α-SMA, mitogen-activated protein kinases [JNK, extracellular signal-regulated kinases (ERK), P38] in TGF-ß(1) -treated NRK-49F cells or interleukin-1-treated HK-2 cells after AS-IV, FA or AF were assessed. KEY RESULTS: AF alleviated the infiltration of mononuclear cells, tubular atrophy and interstitial fibrosis; reduced the expression of fibronectin, α-SMA, TGF-ß(1) and p-JNK; and dramatically increased the production of NO in obstructed kidneys. Neither AS-IV nor FA alone improved renal damage, but both increased NO production. AF inhibited α-SMA and fibronectin expression in NRK-49F or HK-2 cells. Furthermore, AF significantly inhibited IL-1ß-induced JNK phosphorylation, without affecting ERK or P38 phosphorylation. Neither AS-IV nor FA alone had any effect on the cells. CONCLUSIONS AND IMPLICATIONS: AS-IV synergizes with FA to alleviate renal tubulointerstitial fibrosis; this was associated with inhibition of tubular epithelial-mesenchymal transdifferentiation (EMT) and fibroblast activation, as well as an increase in NO production in the kidney.

CT-guided percutaneous neurolytic celiac plexus block technique.

Up to now, the studies in the world have demonstrated that CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is an invaluable therapeutic modality in the treatment of refractory abdominal pain caused by cancer. Its efficacy of pain relief varied in reported studies. The main technical considerations which would affect the analgesic effects on abdominal pain included the patients' cooperation, needle entry approaches, combined use of blocking approaches, localization of the target area, dosage of the blocker, and so on. A success of PNCPB depends greatly on close cooperation with patients. The patient should be educated about the purpose and steps of the procedure, and trained of breathing in and breathing hold. The needle entry can be divided into the posterior approach and the anterior approach. The former one is the most commonly used in clinical practice, but the latter one is rarely used except in the cases that the posterior approach becomes technically difficult. Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia. The needle entry site, insertion course, and depth should be preselected and simulated on CT monitor prior to the procedure in order to ensure an accurate and safe celiac plexus block. The magnitude of analgesic effect is closely related to the degree of degeneration and necrosis of the celiac plexus. Maximally filling with blocker in the retropancreatic space is an indication of sufficient blocking. We also provided an overview of indications and contraindications, preoperative preparations, complications and its treatment of PNCPB.

Comparative study of barnidipine and felodipine in Chinese patients with essential hypertension.

This study evaluated the efficacy and safety of barnidipine for the treatment of mild-to-moderate essential hypertension in Chinese patients. A total of 131 patients were randomized to receive either barnidipine (10 -15 mg) or felodipine (5 - 10 mg) once daily for 4 weeks. Both drugs reduced blood pressure significantly, with > or = 87% of patients obtaining a marked or moderate effect. The mean +/- SD reductions in systolic and diastolic blood pressure were 19.2 +/- 13.6 and 14.4 +/- 7.0 mmHg, respectively, for barnidipine treatment, and 20.3 +/- 11.3 and 14.7 +/- 7.7 mmHg, respectively, for felodipine treatment. There were no significant differences between the two drugs in terms of anti-hypertensive effect, heart rate, laboratory test results or incidence of adverse events. More patients taking felodipine experienced palpitations, but this difference was not statistically significant. Barnidipine is as efficacious and safe as felodipine in the treatment of essential hypertension in Chinese patients.

New aristolochic acid, aristololactam and renal cytotoxic constituents from the stem and leaves of Aristolochia contorta.

Two novel phenanthrene derivatives, aristololactam IVa (1) and 9-hydroxy aristolochic acid I (2) were isolated from the stem and leaves of Anstolochia contorta Bunge, together with 17 known compounds (3-19). The structures of these compounds were determined by spectroscopic analysis. The phenanthrenes obtained were tested for cytotoxicity against renal proximal tubular epithelial cell line (HK-2). Aristololactam IVa and 7-methoxy aristololactam IV were found to have strong cytotoxic activity against HK-2 cells with a potency similar to or even stronger than those of aristolochic acid I and aristololactam I.

[Changes in respiratory and circulatory function during sequential invasive-noninvasive mechanical ventilation].

OBJECTIVE: To investigate the change of respiratory and circulatory function in COPD during sequential invasive-noninvasive mechanical ventilation. METHODS: 12 COPD patients with type II respiratory failure were ventilated via endotracheal intubation. When pulmonary infection was under control (the appearance of "PIC Window"), all patients were extubated and received mask ventilation. The parameters of hemodynamics oxygenation and esophageal pressure were measured during endotracheal ventilation and mask ventilation (3 hrs after extubation). RESULTS: The change of respiratory and circulatory parameters were not significantly different between invasive mechanical ventilation and noninvasive mechanical ventilation (P > 0.05). CONCLUSION: The respiratory and circulatory function of COPD patients remained stable during sequential invasive-noninvasive mechanical ventilation.

The LG3 module of laminin-5 harbors a binding site for integrin alpha3beta1 that promotes cell adhesion, spreading, and migration.

Laminins are a family of extracellular matrix glycoproteins involved in cell adhesion and migration. A major obstacle to understanding their structure-function relationships is the lack of small laminin domains capable of replicating integrin-binding, cell-adhesive, and migratory functions of the intact molecule. Here, we show that the recombinant LG3 (rLG3) module (26 kDa) of laminin-5 (Ln-5) alpha(3) chain replicated key Ln-5 activities. rLG3 but not rLG1 or rLG2 supported cell adhesion and migration of at least two distinct cell lines, in an integrin alpha(3)beta(1)-dependent manner. Cell adhesion to rLG3 was regulated by divalent cations and accompanied by cell spreading and tyrosine phosphorylation of FAK focal adhesion kinase. The integrin binding activity of rLG3 was confirmed by rLG3 affinity chromatography of detergent cell lysates, which resulted in specific purification of integrin alpha(3)beta(1). To our knowledge, this is the first report directly demonstrating that a recombinant laminin LG module is an active domain capable of supporting integrin-dependent cell adhesion and migration.

A new stabilised form of isobenzofuran, rack-mounted on an alicyclophane.

New stable, crystalline isobenzofurans 9a and 9b linked through the 1,3-positions and incorporated into alicyclophanes have been prepared from the related furanoalicyclophane 5 in three steps (i) addition of benzyne or 4,5-bis(trimethylsilyl)benzyne (ii) hydrogenation of the pi-bond (iii) ejection of ethylene by flash vacuum pyrolysis, and shown to yet retain high 1,3-diene character and form adducts with dienophiles, e.g. dimethyl acetylenedicarboxylate or N-methyl maleimide; the corresponding off-rack 1,3-dimethylisobenzofurans were too unstable for isolation.

Efficacy of continuous tracheal gas insufflation in spontaneously breathing canine with acute lung injury.

OBJECTIVE: To investigate the effects of continuous tracheal gas insufflation (CTGI) combined with biphasic intermittent positive airway pressure (BIPAP) ventilation on dogs with spontaneous breathing. METHODS: Eight canine models with oleic acid induced lung injury and spontaneous breathing were ventilated in a random order by Evita 2 (Drager Inc., Germany) in modes of BIPAP (BIPAP group) and BIPAP with CTGI flow rate of 3, 6 and 9 L/min (T3, T6 and T9 groups), respectively. The setting parameters of BIPAP were fiction of inspired oxygen 60%, inspiratory to expiratory ratio 1:1, respiratory rate 20 and positive end expiratory pressure 5 cm H2O. Arterial and mixed venous blood gas, lung mechanics, systemic and pulmonary hemodynamics status were monitored at the same level of PaCO2 obtained by adjusting peak inspiratory pressure of BIPAP. RESULTS: Peak inspiratory pressure in the T6 group (14 +/- 4 cm H2O) and in the T9 group (11 +/- 3 cm H2O) were significantly lower than that of BIPAP (20 +/- 5 cm H2O, P < 0.01), but there was no significant difference among the T3, T6 and T9 groups or between the T3 and BIPAP groups. PaO2, mean artery blood pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, cardiac output, oxygen delivery and oxygen consumption all remained unchanged in four different conditions. CONCLUSIONS: Using BIPAP combined with CTGI does not cause asynchrony between ventilator and spontaneous breathing, but significantly decreases airway pressure with no influence on hemodynamics and oxygenation. Therefore, BIPAP with CTGI may be a useful support technique, especially in cases where the airway pressure should be limited.