Similarities and Differences of Vascular Calcification in Diabetes and Chronic Kidney Disease.

Presently, the mechanism of occurrence and development of vascular calcification (VC) is not fully understood; a range of evidence suggests a positive association between diabetes mellitus (DM) and VC. Furthermore, the increasing burden of central vascular disease in patients with chronic kidney disease (CKD) may be due, at least in part, to VC. In this review, we will review recent advances in the mechanisms of VC in the context of CKD and diabetes. The study further unveiled that VC is induced through the stimulation of pro-inflammatory factors, which in turn impairs endothelial function and triggers similar mechanisms in both disease contexts. Notably, hyperglycemia was identified as the distinctive mechanism driving calcification in DM. Conversely, in CKD, calcification is facilitated by mechanisms including mineral metabolism imbalance and the presence of uremic toxins. Additionally, we underscore the significance of investigating vascular alterations and newly identified molecular pathways as potential avenues for therapeutic intervention.

Acute diquat poisoning case with multiorgan failure and a literature review: A case report.

BACKGROUND: With the withdrawal of paraquat from the market, diquat is widely used, so the treatment of diquat poisoning has become one of the focuses of emergency poisoning diagnosis and treatment. CASE SUMMARY: We studied the case of a 17-year-old male patient who drank 200 mL (20 g/100 mL) of diquat solution two hours before arriving at the hospital. Despite the use of treatments such as gastric lavage, hemoperfusion, continuous hemodialysis, glucocorticoids, and organ support, the patient's condition rapidly progressed to multiorgan failure, and he died 23.5 h after admission. CONCLUSION: We summarized the clinical characteristics and treatment strategies of diquat poisoning through this case and performed a literature review to provide a basis and direction for clinical treatment.

Amantadine-associated delirium in patients with maintenance dialysis: Insomnia-associated recovery and uneven seasonal distribution.

Amantadine hydrochloride is a risky drug for triggering delirium in dialysis patients; however, it is often administered casually. Furthermore, little is known regarding the recovery and prognosis of dialysis patients with amantadine-associated delirium. Data of this retrospective cohort study were collected from a local hospital database for hospitalizations between January 2011 and December 2020. Patients were divided into 2 cohorts: early recovery (recovery within 14 days) and delayed recovery (recovery more than 14 days). The cases were analyzed together with the intermonth temperature using descriptive statistics. A Kaplan-Meier survival curve and binary logistic regression were applied for the analyses of prognoses and factors. A total of 57 patients were included in this study. The most common symptoms were hallucinations (45.61%) and muscle tremors (43.86%). Early recovery was observed in 63.16% of the patients. Only 3.51% of the cases occurred in local summer (June, July, and August). Better prognoses for survival (hazard ratio [HR] = 0.066, 95% confidence interval [95% CI] = 0.021-0.212) and hospitalization costs (7968.42 ± 3438.43 CNY vs 12852.38 ± 9361.13 CNY, P = .031) were observed in patients with early recovery than in those with delayed recovery. In the multivariate logistic regression adjusted by 1:1 propensity score matching, delayed recovery was independently caused by insomnia (P = .022, = 10.119, 95% CI = 1.403-72.990) and avoided in patients with urine volume over 300 mL (P = .029, = 0.018, 95% CI = 0.006-0.621). The increment (per 100 mg) of cumulative dose (P = .190, = 1.588, 95% CI = 0.395-3.172) tended to be a risk of delayed recovery. The area under curve of the receiver operating characteristic curve was 0.867, with a sensitivity of 90.5% and a specificity of 82.4% at the cutoff point (cutoff = 0.432). For amantadine-associated delirium in dialysis patients with uneven seasonal distribution, early recovery with better prognosis should be the aim of treatment by giving priority to the remedy of insomnia.

Potential therapeutic value of melatonin in diabetic nephropathy: improvement beyond anti-oxidative stress.

Diabetic nephropathy (DN) is a common complication of diabetes, and it is also the main cause of chronic renal failure. Physiological/pathological changes mediated by high glucose are the main factors causing injury of DN, including the enhancement of polyol pathway, the accumulation of advanced glycation products (AGEs), and the activation of protein kinase C (PKC) and transforming growth factor-ß (TGF-ß) signals. In addition, the abnormal activation of renin-angiotensin system (RAS) and oxidative stress are also involved. Melatonin is a physiological hormone mainly secreted by the pineal gland which has been proved to be related to diabetes. Studies have shown that exogenous melatonin intervention can reduce blood glucose and alleviate high glucose mediated pathological damage. At the same time, melatonin also has a strong antioxidant effect, and can inhibit the activation of RAS. Therefore, it is of great significance to explore the therapeutic effect and value of melatonin on DN.

A plant immune protein fights against cancer.

Altered global miRNA abundance is closely related to the occurrence of cancer. Recently, Qi et al. discovered that abnormal 1-nucleotide (nt)-shorter miRNA isoforms are widely accumulated in different human tumors. Ectopic expression of the plant immune protein RNA-dependent RNA polymerase (RDR)-1 can achieve a broad-spectrum antitumor effect by rescuing miRNA defects in cancer cells.

Multi-objective winter wheat irrigation strategies optimization based on coupling AquaCrop-OSPy and NSGA-III: A case study in Yangling, China.

The contradiction between crop water requirements and water supplies in Guanzhong Plain of Northwest China restricts the production of local winter wheat. The optimization of irrigation strategies considering multiple-objectives is of great significance to alleviate water crisis and sustainability of winter wheat production. This paper considered three typical hydrological years (dry year, normal year, and wet year), and a simulation optimization model coupling AquaCrop and NSGA-III was developed using Python language. The multi-objective optimization problem considered four objectives: (1) maximize crop yield (Y), (2) minimize irrigation water (IW), (3) maximize irrigation water productivity (IWP), and (4) maximize water use efficiency (WUE). The TOPSIS-Entropy method was then adopted for decision-making based on the Pareto fronts which were generated by multi-objective optimization, thus facilitating the optimization of the irrigation strategies. The results show that AquaCrop model could accurately simulate the growth process of winter wheat in the study area, the relative error is acceptable. The R2 of canopy cover (CC) is 0.75 and 0.61, and above ground biomass production (B) is 0.94 and 0.93, respectively. In the Pareto fronts, the difference between the maximum and minimum yield of winter wheat is 9.48 %, reflecting the diversity of multi-objective optimization results. According to the analysis results of this paper, the performance of different irrigation scenarios in each typical year varies greatly. The performance of the optimization in dry years is significantly better than that in normal years and wet years. The optimization of irrigation strategies and comparison of different scenarios play a positive role in improving the local water use efficiency, the winter wheat yield, as well as the sustainable development level of water resources.

[Responses of solar-induced chlorophyll fluorescence to meteorological drought across the Loess Plateau, China.] / é»„åœŸé«˜åŽŸæ¤è¢«æ—¥å ‰è¯±å¯¼å¶ç»¿ç´ è§å ‰å¯¹æ°”è±¡å¹²æ—±çš„å“åº”.

With the intensification of climate change, the frequency, duration and scope of drought have become more and more serious. Exploring the responses of plant photosynthesis to drought and the impacts of meteorological factors on photosynthesis is of great significance to the dealing with drought stress. Solar-induced chlorophyll fluorescence (SIF) based on remote sensing has the potential for early monitoring and accurate assessment of regional vege-tation photosynthesis under drought conditions. Based on the spaceborne SIF information and the standardized precipitation evapotranspiration index (SPEI), we investigated the responses of vegetation photosynthesis to drought and the influence of meteorological factors in the growing season (April to October) of the Loess Plateau during 2001-2017. The results showed that about 87.8% of total areas of the Loess Plateau had a significant positive correlation between SIF and SPEI. Vegetation photosynthesis in semi-arid area was more sensitive to drought and less sensitive in semi-humid area. Different vegetation types had different photosynthetic responses to drought. Grassland had the highest sensitivity to drought with three to four months SPEI time-scale, while forest had the lowest sensiti-vity with three to ten months SPEI time-scale. There was a significant correlation between meteorological factors and SIF. Temperature and precipitation were the most important factors affecting vegetation photosynthesis on the Loess Plateau. Photosynthetically active radiation showed a similar controlling strength to temperature. The impacts of drought and meteorological factors on vegetation photosynthesis were largely determined by differences in drought resistance among ecosystem types and climate regions.

Building social resilience in North Korea can mitigate the impacts of climate change on food security.

Adaptation based on social resilience is proposed as an effective measure to mitigate hunger and avoid food shocks caused by climate change. But these have not been investigated comprehensively in climate-sensitive regions. North Korea (NK) and its neighbours, South Korea and China, represent three economic levels that provide us with examples for examining climatic risk and quantifying the contribution of social resilience to rice production. Here our data-driven estimates show that climatic factors determined rice biomass changes in NK from 2000 to 2017, and climate extremes triggered reductions in production in 2000 and 2007. If no action is taken, NK will face a higher climatic risk (with continuous high-temperature heatwaves and precipitation extremes) by the 2080s under a high-emissions scenario, when rice biomass and production are expected to decrease by 20.2% and 14.4%, respectively, thereby potentially increasing hunger in NK. Social resilience (agricultural inputs and population development for South Korea; resource use for China) mitigated climate shocks in the past 20 years (2000-2019), even transforming adverse effects into benefits. However, this effect was not significant in NK. Moreover, the contribution of social resilience to food production in the undeveloped region (15.2%) was far below the contribution observed in the developed and developing regions (83.0% and 86.1%, respectively). These findings highlight the importance of social resilience to mitigate the adverse effects of climate change on food security and human hunger and provide necessary quantitative information.

ANGPTL8 in metabolic homeostasis: more friend than foe?

ANGPTL8 is an important cytokine, which is significantly increased in type 2 diabetes mellitus (T2DM), obesity and metabolic syndrome. Many studies have shown that ANGPTL8 can be used as a bio-marker of these metabolic disorders related diseases, and the baseline ANGPTL8 level has also been found to be positively correlated with retinopathy and all-cause mortality in patients with T2DM. This may be related to the inhibition of lipoprotein lipase activity and the reduction of circulating triglyceride (TG) clearance by ANGPTL8. Consistently, inhibition of ANGPTL8 seems to prevent or improve atherosclerosis. However, it is puzzling that ANGPTL8 seems to have a directing function for TG uptake in peripheral tissues; that is, ANGPTL8 specifically enhances the reserve and buffering function of white adipose tissue, which may alleviate the ectopic lipid accumulation to a certain extent. Furthermore, ANGPTL8 can improve insulin sensitivity and inhibit hepatic glucose production. These contradictory results lead to different opinions on the role of ANGPTL8 in metabolic disorders. In this paper, the correlation between ANGPTL8 and metabolic diseases, the regulation of ANGPTL8 and the physiological role of ANGPTL8 in the process of glucose and lipid metabolism were summarized, and the physiological/pathological significance of ANGPTL8 in the process of metabolic disorder was discussed.

Sources of uncertainty for wheat yield projections under future climate are site-specific.

Understanding sources of uncertainty in climate-crop modelling is critical for informing adaptation strategies for cropping systems. An understanding of the major sources of uncertainty in yield change is needed to develop strategies to reduce the total uncertainty. Here, we simulated rain-fed wheat cropping at four representative locations in China and Australia using eight crop models, 32 global climate models (GCMs) and two climate downscaling methods, to investigate sources of uncertainty in yield response to climate change. We partitioned the total uncertainty into sources caused by GCMs, crop models, climate scenarios and the interactions between these three. Generally, the contributions to uncertainty were broadly similar in the two downscaling methods. The dominant source of uncertainty is GCMs in Australia, whereas in China it is crop models. This difference is largely due to uncertainty in GCM-projected future rainfall change across locations. Our findings highlight the site-specific sources of uncertainty, which should be one step towards understanding uncertainties for more robust climate-crop modelling.

Syntheses, structures, magnetism and electrocatalytic oxygen evolution for four cobalt, manganese and copper complexes with dinuclear, 1D and 3D structures.

Four 3-(tetrazol-5-yl)-5-(pyrid-2-yl)-1,2,4-triazole (H2TPT) based complexes of [Co2(TPT)2(H2O)2] (1), [Mn2(TPT)2(H2O)2] (2), [Mn(TPT)(H2O)2]n (3) and [Cu(TPT)]n (4) have been solvothermally synthesized and structurally characterized by X-ray single-crystal diffraction analysis. Complexes 1 and 2 display isostructural dinuclear structures, while complex 3 exhibits a 1D zigzag chain structure. The structural difference for 2 and 3 may be caused by 100 and 160 °C temperature-controlled conditions. Complex 4 is a 3D framework structure in which the Cu2+ ion is in square pyramid coordination geometry. Complexes 1-4 display good thermal stability evaluated by thermogravimetric analysis. Complexes 1 and 4 show very strong antiferromagnetic interactions. The electrocatalytic oxygen evolution of complexes 1-4 was tested under neutral conditions, which revealed that the four complexes possess electrocatalytic oxygen evolution activity. Complex 1 exhibits a current density of 10.0 mA cm-2 at a potential of 2.00 V (vs. RHE), presenting 50-fold improvement in specific activity over the glassy carbon electrode.

Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China.

BACKGROUND: For emergency department (ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism (VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software. RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses (response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no significant differences were found with respect to job (doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years (n=83) scored significantly higher on the questionnaire than those under 5 years (n=91) (95.75 vs. 79.97, P=0.039). There was a significant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime. CONCLUSION: Our survey has shown deficiencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events (including VTE).

A novel model for hourly PM2.5 concentration prediction based on CART and EELM.

Hourly PM2.5 concentrations have multiple change patterns. For hourly PM2.5 concentration prediction, it is beneficial to split the whole dataset into several subsets with similar properties and to train a local prediction model for each subset. However, the methods based on local models need to solve the global-local duality. In this study, a novel prediction model based on classification and regression tree (CART) and ensemble extreme learning machine (EELM) methods is developed to split the dataset into subsets in a hierarchical fashion and build a prediction model for each leaf. Firstly, CART is used to split the dataset by constructing a shallow hierarchical regression tree. Then at each node of the tree, EELM models are built using the training samples of the node, and hidden neuron numbers are selected to minimize validation errors respectively on the leaves of a sub-tree that takes the node as the root. Finally, for each leaf of the tree, a global and several local EELMs on the path from the root to the leaf are compared, and the one with the smallest validation error on the leaf is chosen. The meteorological data of Yancheng urban area and the air pollutant concentration data from City Monitoring Centre are used to evaluate the method developed. The experimental results demonstrate that the method developed addresses the global-local duality, having better performance than global models including random forest (RF), v-support vector regression (v-SVR) and EELM, and other local models based on season and k-means clustering. The new model has improved the capability of treating multiple change patterns.

Estimating the potential yield and ETc of winter wheat across Huang-Huai-Hai Plain in the future with the modified DSSAT model.

The DSSAT model, integrated the calibrated Hargreaves ET model and dynamic crop coefficient, was run with the generated weather data by SDSM4.2 and CanESM2 to predict the potential yield and crop water requirement (ETC) of winter wheat in the Huang-Huai-Hai Plain in China under RCP4.5 and RCP8.5 scenarios. The results showed that the spatial distribution of potential yield in the future under RCP4.5 and RCP8.5 were similar, characterized by an increasing trend from the northwest inland to the southeast coast. The spatial distribution of ETC decreased gradually from the Shandong Peninsula to the surrounding area, and the minimum ETC was observed in the southern part of Huang-Huai-Hai Plain. The potential yield, ETC, and effective precipitation during winter wheat growing seasons might increase in the future under RCP4.5, while irrigation water requirements (IWR) would decrease. Under RCP8.5, the effective precipitation during the wheat growing seasons decreased first and then increased. However, the potential yield, ETC, and IWR of winter wheat increased first and then decreased. This study can provide some scientific evidence to mitigate the negative effects of climate change on agricultural production and water use in the Huang-Huai-Hai Plain.

A new salicylaldehyde-based azo dye and its two lanthanide(iii) complexes displaying slow magnetic relaxation.

A new salicylaldehyde-based azo dye 5-azotriazolyl-3-methoxysalicylaldehyde (H2TMSA) and its two Ln3+ complexes {[Ln(HTMSA)3(H2O)2][Ln(HTMSA)3(DMF)(H2O)]}·15H2O (Ln = Dy(1) and Tb(2)) have been synthesized and characterized by IR, Raman, 1H NMR and single-crystal X-ray diffraction techniques. H2TMSA shows an azo form in acidic (pH < 5.05) and strong basic (pH > 12.41) conditions, and a pH-dependent azo-hydrazone tautomerism in the range of pH 5.05 to 12.41, which is demonstrated by the time-dependent density functional theory (TD-DFT) calculations. Single-crystal X-ray diffraction reveals that 1 and 2 are isostructural complexes in which the Ln3+ ions are surrounded by six oxygen atoms from three dichelate HTMSA- ligands and two oxygen atoms from two solvent molecules forming a distorted square-antiprismatic geometry. Complex 1 shows distinct slow magnetic relaxation under a zero dc field, while 2 displays field-induced slow magnetic relaxation. Ab initio calculations were performed on the two complexes to understand their magnetic anisotropy and their different magnetic dynamics.

The role of mitofilin in left ventricular hypertrophy in hemodialysis patients.

Left ventricular hypertrophy (LVH) is a common abnormality in hemodialysis (HD) patients. Mitochondrial dysfunction contributes to the progression of LVH. As an inner mitochondrial membrane structural protein, mitofilin plays a key role in maintaining mitochondrial structure and function. The aim of this study was to investigate the relationship between mitofilin and LVH in HD patients. A total of 98 HD patients and 32 healthy controls were included in the study. Serum N-terminal proBNP (NT-proBNP), endothelin-1 (ET-1), and atrial natriuretic peptide (ANP) were examined. The protein level of mitofilin and the mitochondrial DNA (mtDNA) copy number were estimated in peripheral blood mononuclear cells (PBMCs). The left ventricle mass index (LVMI) was evaluated in all participants, and the interaction between these variables and the LVMI was assessed. The LVMI was positively correlated with the NT-proBNP, ET-1, and ANP levels, and it was negatively correlated with mtDNA copy number and mitofilin levels. Multiple regression analysis showed that the NT-proBNP, ET-1, and ANP levels as well as mitofilin levels and mtDNA copy number were associated with the LVMI. Although further research of these associations is needed, this result suggests that LVH may affect the levels of mitofilin in HD patients.

The efficacy of initial ventilation strategy for adult immunocompromised patients with severe acute hypoxemic respiratory failure: study protocol for a multicentre randomized controlled trial (VENIM).

BACKGROUND: Acute respiratory failure (ARF) is still one of the most severe complications in immunocompromised patients. Our previous systematic review showed noninvasive mechanical ventilation (NIV) reduced mortality, length of hospitalization and ICU stay in AIDS/hematological malignancy patients with relatively less severe ARF, compared to invasive mechanical ventilation (IMV). However, this systematic review was based on 13 observational studies and the quality of evidence was low to moderate. The efficacy of NIV in more severe ARF and in patients with other causes of immunodeficiency is still unclear. We aim to determine the efficacy of the initial ventilation strategy in managing ARF in immunocompromised patients stratified by different disease severity and causes of immunodeficiency, and explore predictors for failure of NIV. METHODS AND ANALYSIS: The VENIM is a multicentre randomized controlled trial (RCT) comparing the effects of NIV compared with IMV in adult immunocompromised patients with severe hypoxemic ARF. Patients who meet the indications for both forms of ventilatory support will be included. Primary outcome will be 30-day all-cause mortality. Secondary outcomes will include in-hospital mortality, length of stay in hospital, improvement of oxygenation, nosocomial infections, seven-day organ failure, adverse events of intervention, et al. Subgroups with different disease severity and causes of immunodeficiency will also be analyzed. DISCUSSION: VENIM is the first randomized controlled trial aiming at assessing the efficacy of initial ventilation strategy in treating moderate and severe acute respiratory failure in immunocompromised patients. The result of this RCT may help doctors with their ventilation decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02983851 . Registered 2 September 2016.

Efficacy of non-invasive ventilation and oxygen therapy on immunocompromised patients with acute hypoxaemic respiratory failure: protocol for a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: The number of immunocompromised patients has increased in recent years. Acute respiratory failure is a common complication leading to intensive care unit (ICU) admission and high mortality among such patients. The use of non-invasive ventilation (NIV) or oxygen therapy among these patients remains controversial, according to the inconsistent results of several randomised clinical trials (RCTs). This meta-analysis aims to evaluate whether NIV or oxygen therapy is the more appropriate initial oxygenation strategy for the immunocompromised patients with acute respiratory failure. METHOD: We will search all the RCTs that compared the efficacy of NIV and oxygen therapy on immunocompromised adult patients with acute hypoxaemic respiratory failure on the major databases (Cochrane Library, MEDLINE, EMBASE, Web of Science and others), conference proceedings and grey literature. Eligible RCTs will be included in accordance with the pre-specified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation system. Data will be extracted with a standardised form and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2 statistic and the source of which will be investigated. Publication bias will be identified with the funnel plot. ETHICS AND DISSEMINATION: Ethical approval is not required since it is not carried out in humans. The systematic review will be published in peer-reviewed journals and disseminated extensively through conferences.

Effect of Hypoxia on the Differentiation and the Self-Renewal of Metanephrogenic Mesenchymal Stem Cells.

Hypoxia is an important and influential factor in development. The embryonic kidney is exposed to a hypoxic environment throughout its development. The Wnt/ß-catenin pathway plays vital roles in the differentiation and self-renewal of metanephrogenic mesenchymal stem cells (MMSCs) from which the kidney is derived. Thus, we hypothesized that hypoxia can regulate the differentiation and pluripotency of MMSCs through the Wnt/ß-catenin pathway. To test this hypothesis, MMSCs from rats at embryonic day 18.5 were cultured in normoxic (21% O2) and hypoxic (1% O2) conditions. The effects of hypoxia on differentiation, stemness, proliferation, and apoptosis of cultured MMSCs and on the activity of the Wnt/ß-catenin pathway were tested. Our results revealed that the hypoxic condition increased the number of epithelial cells (E-cadherin+ or CK18+) as well the expression of markers of renal tubule epithelia cells (CDH6, Aqp1, and OPN), decreased the number and proliferation of stem cells (SIX-2+ or CITED1+), and induced apoptosis. Additionally, hypoxia reduced the expression of Wnt4 as well as its downstream molecules ß-catenin, LEF-1, and Axin2. Activation of the Wnt/ß-catenin pathway by LiCl or BIO modified the effects of hypoxia on the differentiation and self-renewal of MMSCs. Thus, we concluded that hypoxia induces the differentiation and inhibits the self-renewal of MMSCs by inhibiting the Wnt/ß-catenin pathway. The observations further our understanding of the effects of hypoxia on kidney.

Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis.

BACKGROUND: To determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients. METHODS: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted. RESULTS: Thirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay. CONCLUSIONS: The overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.