Epidemiology and issues of NIV-treated AECOPD patients with hypercapnic respiratory failure in Shanghai: A multicentre retrospective survey.

OBJECTIVE: To investigate the epidemiology, clinical features, treatment and outcome of Noninvasive ventilation (NIV)-treated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in secondary hospitals of Shanghai. METHOD: Relying on Shanghai alliances for respiratory diseases, a retrospective observational study was performed in 34 secondary hospitals of Shanghai. The AECOPD patients treated with NIV and admitted to the respiratory department or respiratory intensive care unit were recruited between December 1, 2016, and November 30, 2017. RESULTS: There were 555 patients finally recruited in this study. The age was 75.8 ± 9.6 years old and 380 patients (68.5%) were male. 70.5% of all patients had respiratory acidosis (pH <7.35). 55.3% of all patients received nebulised bronchodilator and 77.7% were treated with systemic or inhaled corticosteroids during hospitalisation. 525 patients (94.6%) recovered successfully and the mortality was 3.2%. The hospitalisation was 15.3 ± 6.7 days and hospital expenses were 22 911 ± 13 595 RMB. Inadequate and nonstandard drug treatments were the most important problems during management. CONCLUSION: The NIV can be successfully used for AECOP patients in local hospitals of Shanghai, but accompanied by high costs and long hospital stays. However, the treatments for exacerbation and stable COPD patients are still insufficient.

Determination of 17ß-estradiol by surface-enhanced Raman spectroscopy merged with hybridization chain reaction amplification on Au@Ag core-shell nanoparticles.

The authors describe an aptamer-based assay for 17ß-estradiol. It relies on the combined use of surface enhanced Raman scattering (SERS) and hybridization chain reaction (HCR). The aptamer against 17ß-estradiol is applied as the recognition probes, and this results in excellent specificity. Specific recognition of target 17ß-estradiol induce the freedom of DNA 2, which will open the stem-loop structure of probe 1 on the Au@Ag and form the partial dsDNA structure. With the nicking enzyme, the partial dsDNA will be hydrolyzed and the reside ssDNA on Au@Ag will form a small stem-loop structure. With the help of the other probe 2 modified Au@Ag and pre-immobilized probe 3 on the well of the microplate, an enzyme-free HCR can occur and tremendous Au@Ag can be assembled along the formed dsDNA in HCR, which can act as the excellent substrate for Raman measurement and greatly amplify the Raman signal of R6G on the Au@Ag. Afterwards, the key factor, ratio between probe 2-Au@Ag (P2) and probe1-Au@Ag (P1), affects the detection sensitivity is systematically optimized for the best sensing performance. The SERS signal of R6G, best measured at 1651 cm-1, increases linearly in the wide range from 1 pM to 10 nM. The detection limit can be as low as 0.1 pM. Graphical abstract Schematic presentation of an aptamer-based surface enhanced Raman scattering method for accurate detection of 17ß-estradiol, which is integrated with hybridization chain reaction for signal amplification and sensitivity improvement.

Efficacy of sequential three-step empirical therapy for chronic cough.

BACKGROUND: Empirical three-step therapy has been proved in just one hospital. This study aimed to demonstrate applicability of the sequential empirical three-step therapy for chronic cough in different clinical settings. METHODS: Sequential empirical three-step therapy was given to patients with chronic cough in one tertiary and three secondary care respiratory clinics. Recruiters were initially treated with methoxyphenamine compound as the first-step therapy, followed by corticosteroids as the second-step therapy and the combination of a proton-pump inhibitor and a prokinetic agent as the third-step therapy. The efficacy of the therapy was verified according to the changes in cough symptom score between pre- and post-treatment, and compared among the different clinics. RESULTS: In total 155 patients in one tertiary clinic and 193 patients in secondary care clinics were recruited. The total dropout ratio is significantly higher in the secondary care clinics than that in the tertiary clinic (9.3% versus 3.2%, p = 0.023). The therapeutic success rate for cough was 38.7% at first-step therapy, 32.3% at second-step therapy and 20.0% at third-step therapy in the tertiary clinic, and comparable to corresponding 49.7%, 31.1% and 4.1% in secondary care clinics. Furthermore, the overall cough resolution rate was not significantly different (91.0% versus 85.0%, p = 0.091). However, the efficacy of the third-step therapy is much higher (20.0% versus 4.1%, p = 0.001) in the tertiary clinic than in the secondary care clinics. CONCLUSIONS: Sequential empirical three-step therapy is universally efficacious and useful for management of chronic cough in different clinical settings.

Colorimetric Integrated PCR Protocol for Rapid Detection of Vibrio parahaemolyticus.

Rapid detection of pathogens is of great significance for food safety and disease diagnosis. A new colorimetric method for rapid and easy detection of Vibrio parahaemolyticus (V. parahaemolyticus or Vp) has been developed in this research. A specific sequence was designed and integrated with the forward primer for molecular detection of Vp. This specific sequence was tested and treated as the horseradish peroxidase (HRP)-mimicking DNAzyme and could be amplified during the polymerase chain reaction (PCR) process. The products of PCR including the sequence of HRP-mimicking DNAzyme could produce the distinguished color in the presence of catalysis substrates. The optical signal of the catalysis reaction, which is in a linear relationship with the initial template of Vp, could be determined with the naked eye or measured with Ultraviolet-visible (UV-vis) for qualitative and quantitative detections, respectively. Based on the optical signal intensity, rapid and easy detection of Vp was successfully achieved with satisfied sensitivity and specificity. Furthermore, the detection of tdh, trh, tlh and toxR virulence genes of two Vp species (Vp 33847 and Vp 17802) were all performed successfully with this developed colorimetric integrated PCR protocol, which demonstrated potential applicability for the rapid detection of other bacteria.

Effectiveness of Inspiratory Termination Synchrony with Automatic Cycling During Noninvasive Pressure Support Ventilation.

BACKGROUND Pressure support ventilation (PSV) is a standard method for non-invasive home ventilation. A bench study was designed to compare the effectiveness of patient-ventilator inspiratory termination synchronization with automated and conventional triggering in various respiratory mechanics models. MATERIAL AND METHODS Two ventilators, the Respironics V60 and Curative Flexo ST 30, connected to a Hans Rudolph Series 1101 lung simulator, were evaluated using settings that simulate lung mechanics in patients with chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), or normal lungs. Ventilators were operated with automated (Auto-Trak) or conventional high-, moderate-, and low-sensitivity flow-cycling software algorithms, 5 cmH2O or 15 cmH2O pressure support, 5 cmH2O positive end-expiratory pressure (PEEP), and an air leak of 25-28 L/min. RESULTS Both ventilators adapted to the system leak without requiring adjustment of triggering settings. In all simulated lung conditions, automated cycling resulted in shorter triggering delay times (<100 ms) and lower triggering pressure-time product (PTPt) values. Tidal volumes (VT) increased with lower conventional cycling sensitivity level. In the COPD model, automated cycling had higher leak volumes and shorter cycling delay times than in conventional cycling. Asynchronous events were rare. Inspiratory time (Tinsp), peak expiratory flow (PEF), and cycling off delay time (Cdelay) increased as a result of reduction in conventional cycling sensitivity level. In the ARDS and normal adult lung models, premature cycling was frequent at the high-sensitive cycling level. CONCLUSIONS Overall, the Auto-Trak protocol showed better patient-machine cycling synchronization than conventional triggering. This was evident by shorter triggering time delays and lower PTPt.

Performance characteristics of seven bilevel mechanical ventilators in pressure-support mode with different cycling criteria: a comparative bench study.

BACKGROUND: Pressure support ventilation from a bilevel device is a standard technique for non-invasive home ventilation. A bench study was designed to compare the performance and patient-ventilator synchronization of 7 bilevel ventilators, in the presence of system leaks. MATERIAL/METHODS: Ventilators were connected to a Hans Rudolph Series 1101 lung simulator (compliance, 50 mL/cmH2O; expiratory resistance, 20 cmH2O/L/s; respiratory rate, 15 breaths/min; inspiratory time, 1.0 s). All ventilators were set at 15 cmH2O pressure support and 5 cmH2O positive end-expiratory pressure. Tests were conducted at 2 system leaks (12-15 and 25-28 L/min). The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time, and workload. RESULTS: The Breas Vivo30 could not synchronize with the simulator (frequent auto-triggering) at a leak of 25-28 L/min, but provided stable assisted ventilation when the leak was 12-15 L/min. Missed efforts and back-up ventilation occurred for the Weinmann VENTImotion and Airox Smartair Plus, requiring adjustment of trigger effort. All ventilators had a short trigger delay time (<200 ms), but significant differences between devices were found in triggering workload, pressurization appearance, tidal volume, and peak inspiratory flow. Premature cycling was frequent when the inspiratory termination criteria were at the highest sensitivity. Cycling synchronization was considerably improved by modifying expiratory triggering sensitivity settings, when available. CONCLUSIONS: Performance and triggering workload varied significantly between bilevel ventilators, possibly due to software algorithm differences. Adjusting the cycling criteria settings can alter the shape of the inspiratory phase and peak expiratory flow, and improve patient-ventilator synchrony.

[Effect on inspiratory cycling-off synchronization with different expiratory trigger sensitivity level during pressure-support ventilation: a lung model study].

OBJECTIVE: To compare the inspiratory cycling-off synchronization with different expiratory trigger sensitivity (ETS) setting during noninvasive pressure support ventilation (PSV) under the conditions of system leak. METHODS: Ventilators were connected to a lung model (Hans Rudolph Series1101 simulator). And its mechanics was set in two models of obstructive and restrictive ventilatory dysfunction. All ventilators were set at 15 cmH2O (1 cmH2O = 0.098 kPa) pressure support and 5 cmH2O positive end-expiratory pressure (PEEP). Tests were conducted at the level of air leaks (24-28 L/min). Cycling delay time, tidal volume and airflow were collected. RESULTS: Compared with Curative Flexo ST 30 with the ETS setting at the most sensitive level, the use of digital Auto-Trak(TM) system (Respironics Synchrony) was associated with milder delay cycling ((68.9 ± 13.3) vs (121.4 ± 13.2) ms, P < 0.05) in obstructive condition. The tidal volume (VT), inspiratory time (TI vent) and peak expiratory flow (PEF) increased after adjusting the ETS level. Premature cycling was detected in restrictive condition with both ventilators. Peak inspiratory flow (PIF) and PEF significantly increased as VT and TI vent decreased. Delay cycling ((64.3 ± 15.3) ms) was present in Flexo ST 30 when ETS was at most insensitive level. CONCLUSIONS: There are significant differences in performances and cycling-off in obstructive and restrictive conditions among 2 bilevel ventilators. And it may be due to the software of algorithm. Modifications of ETS can affect the ventilatory parameters to improve patient-ventilator synchrony in the presence of air leaks. The Auto-Trak system during PSV show similar results and better synchronzation compared with conventional adjustments.

MiRNA synergistic network construction and enrichment analysis for common target genes in small-cell lung cancer.

BACKGROUND: Small-cell lung cancer (also known as SCLC) is an aggressive form and untreated patients generally die within about 3 months. To obtain further insight into mechanism underlying malignancy with this cancer, an miRNA synergistic regulatory network was constructed and analyzed in the present study. METHOD: A miRNA microarray dataset was downloaded from the NCBI GEO database (GSE27435). A total of 546 miRNAs were identified to be expressed in SCLC cells. Then a miRNA synergistic network was constructed, and the included miRNAs mapped to the network. Topology analysis was also performed to analyze the properties of the synergistic network. Consequently, we could identified constitutive modules. Further, common target genes of each module were identified with CFinder. Finally, enrichment analysis was performed for target genes. RESULTS: In this study, a miRNA synergistic network with 464 miRNAs and 2981 edges was constructed. According to the topology analysis, the topological properties between the networks constructed by LC related miRNAs and LC unrelated miRNAs were significantly different. Moreover, a module cilque0 could be identified in our network using CFinder. The module included three miRNAs (hsa-let-7c, hsa-let-7b and hsa-let-7d). In addition, several genes were found which were predicted to be common targets of cilque0. The enrichment analysis demonstrated that these target genes were enriched in MAPK signaling pathways. CONCLUSIONS: Although limitations exist in the current data, the results uncovered here are important for understanding the key roles of miRNAs in SCLC. However, further validation is required since our results were based on microarray data derived from a small sample size.