[Clinical research progress in non-invasive positive pressure ventilation in 2023].

Non-invasive positive pressure ventilation (NPPV) is a widely used method of providing respiratory support in a variety of clinical settings, including emergency departments, general wards, and intensive care units. The relevant research articles on NPPV published between 1st October 2022 and 30th September 2023 were retrieved from Medline and reviewed. In the management of acute respiratory failure (ARF) associated with COVID-19, studies have highlighted the significant influence of regional economic status on the choice of respiratory support strategies. It has been observed that NPPV is more suitable for patients with mild to moderate acute respiratory distress syndrome (ARDS) than for those with severe ARDS, as the latter group has an increased risk of delayed intubation. In addition, patients with severe dyspnea tended to benefit more from NPPV compared with high flow nasal cannula (HFNC) and conventional oxygen therapy, with a reduced risk of self-induced lung injury. For non-COVID-19-related ARF, research shows no significant differences in mortality and intubation rates between HFNC and NPPV in patients with hypercapnic ARF. The updated HACOR score and ROX score have been validated to have a high predictive value for clinical outcomes in patients receiving NPPV for hypoxemic ARF. With regard to weaning from invasive mechanical ventilation, immediate application of NPPV after extubation showed a lower mortality rate compared to continued invasive weaning. Moreover, NPPV with active humidification significantly decreased the reintubation rate within 7 days after extubation compared with HFNC. The choice between using NPPV and HFNC should be based on the specific etiology of the patient's condition. The potential effect of noninvasive high-frequency oscillatory ventilation on CO2 clearance was also investigated.

[Clinical update in non-invasive positive pressure ventilation for respiratory failure in 2022].

In this article, we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure(ARF)/chronic respiratory failure(CRF) between 1st October 2021 and 30th September 2022 through Medline, and reviewed the important advances. Three prospective randomized controlled studies related to the efficacy and safety of NPPV and/or high-flow nasal cannula oxygen therapy (HFNC) on patients with COVID-19 with ARF were reported, showing that NPPV (including continuous positive airway pressure and bilevel positive airway pressure) was able to reduce the intubation rate, but the efficacy of HFNC was contradictory. In addition, progress has been made in outcome prediction models for ARF treated with NPPV, NPPV-related cardiac arrest, and the impact of human-machine interface on NPPV treatment outcomes. The effects of NPPV as preoxygenation method before intubation was reported to be able to reduce severe desaturation during intubation, especially in obese population. The use of NPPV in extubated patients resulting in reduced reintubation rate was also studied. With regard to long-term home application of NPPV, five indicators of successful initiation were proposed, but the success rate was low in clinical practice. Some reports showed that psychological support could improve the adherence to NPPV. The results of these studies contributed to the rational selection and optimal application of NPPV in clinical practice.

[The prevalence and risk factors of diabetic peripheral artery disease in Chinese communities].

Objective: To investigate the prevalence and risk factors of diabetic peripheral artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM) managed in primary health care in China. Methods: A total of 2 528 T2DM patients were selected using a two-stage cluster random sampling method based on the baseline survey of the "China Diabetic Foot Prevention Model Project." The study was conducted in 2015 among T2DM patients in 8 primary healthcare centers in Changshu county and Jiang'an district of Wuhan, China. Data collection methods included a questionnaire, body measurement, and blood glucose detection. The Ankle-Brachial Index (ABI) is the most widely used noninvasive vascular test. A binary logistic regression model was used to analyze the influence factors. Results: The prevalence of PAD was 11.2% among the diabetic patients managed in primary health care in the two cities. The prevalence of PAD under 55 years old, 55- years old, 65- years old, and ≥75 years old were 7.8%, 6.0%, 12.9% and 22.5%, respectively. Multivariate stepwise logistic regression identified influence factors included older age, higher education level, smoking, drinking, postprandial glucose uncontrol, and prior myocardial infarction or angina. Compared to age <55 years, the odds ratio for PAD were 0.74 for 55- years (95%CI: 0.43-1.28), 1.72 for 65- years (95%CI: 1.05-2.81), 3.56 for 75 years and above (95%CI: 2.07-6.11), respectively. Compared to patients with education in primary school and below, the odds ratio was 1.37 (95%CI: 0.97-1.94), 2.48 (95%CI: 1.73-3.55), 1.99 (95%CI: 1.26-3.13) for those with education levels of junior high school, senior high school, and college, respectively. Current smoking (OR=1.49, 95%CI: 1.02-2.17), current drinking (OR=0.45, 95%CI: 0.28-0.71), postprandial glucose uncontrol (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.72, 95%CI: 1.22-2.43), and prior myocardial infarction or angina (OR=2.32, 95%CI: 1.50-3.61) were influencing factors of PAD. Conclusions: Despite the high prevalence of PAD in diabetes managed in primary health care; multiple risk factors are not effectively aware of and under control. It is urgent to promote ABI screening and standardized management for diabetes, especially in primary health care.

[Clinical research progress in non-invasive positive pressure ventilation from 2020 to 2021].

Non-invasive positive pressure ventilation (NPPV), an essential respiratory support method, is widely used in acute/chronic respiratory failure and assisting rehabilitation in patients with chronic obstructive pulmonary disease (COPD). We searched the relevant research articles about NPPV published from 1st October 2020 to 30th September 2021 through Medline. Researches focusing on the clinical application and viral transmission protection during high-flow nasal cannula oxygen and NPPV in COVID-19, were mainly retrospective and of small sample size. It demonstrated that high-flow nasal cannula oxygen and NPPV might reduce intubation rates when treating patients with mild-to-moderate respiratory failure, but the risk of delayed intubation should draw particular precaution. When using NPPV in non-COVID-19-related de novo acute respiratory failure, diaphragm thickening fraction and tidal change of esophageal pressure were validated to predict the treatment outcome. In addition, some studies explored the compliance and related influencing factors associated with the treatment effects of early NPPV initiation on amyotrophic lateral sclerosis patients and the effects of NPPV on dynamic hyperinflation during exercise in COPD patients. Furthermore, the effectiveness of neurally adjusted ventilatory assist ventilation and a novel communication device optimizing the use of NPPV were also investigated and outlined.

Synergistic effects ofα-Fe2O3nanoparticles and Fe-doping on gas-sensing performance of NiO nanowires and interface mechanism.

High surface area nickel oxide nanowires (NiO NWs), Fe-doped NiO NWs andα-Fe2O3/Fe-doped NiO NWs were synthesized with nanocasting pathway, and then the morphology, microstructure and components of all samples were characterized with XRD, TEM, EDS, UV-vis spectra and nitrogen adsorption-desorption isotherms. Owing to the uniform mesoporous template, all samples with the same diameter exhibit the similar mesoporous-structures. The loadedα-Fe2O3nanoparticles should exist in mesoporous channels between Fe-doped NiO NWs to form heterogeneous contact at the interface of n-typeα-Fe2O3nanoparticles and p-type NiO NWs. The gas-sensing results indicate that Fe-dopant andα-Fe2O3-loading both improve the gas-sensing performance of NiO NWs sensors.α-Fe2O3/Fe-doped NiO NWs sensors presented the highest response to 100 ppm ethanol gas (55.264) compared with Fe-doped NiO NWs (24.617) and NiO NWs sensors (3.189). The donor Fe-dopant increases the ground state resistance and the absorbed oxygen content in air.α-Fe2O3nanoparticles in electron depletion region result in the increasing resistance in ethanol gas and decreasing resistance in air. In this way,α-Fe2O3/Fe-doped NiO NWs sensor presents the excellent gas-sensing performance due to the formation of heterogeneous contact at the interface.

Associations of OSAHS complicated by cerebral infarction with intestinal flora, inflammatory factors, homocysteine and adiponectin expression.

OBJECTIVE: The aim of this study was to investigate the associations between obstructive sleep apnea hypopnea syndrome (OSAHS) complicated by cerebral infarction and intestinal flora, inflammatory factors, homocysteine, and adiponectin expression. PATIENTS AND METHODS: A total of 30 healthy volunteers (control group), 28 patients with simple cerebral infarction (cerebral infarction group) and 28 patients with OSAHS complicated by cerebral infarction (OSAHS + cerebral infarction group) were enrolled as research objects. The fecal bacterial DNA of research objects was extracted and subject to 16S ribosomal ribonucleic acid sequencing. Furthermore, the levels of inflammatory factors, homocysteine and adiponectin in the peripheral blood were detected. RESULTS: Compared with control group, cerebral infarction group exhibited significantly higher levels of interleukin-4 (IL-4), tumor necrosis factor-beta (TNF-ß), IL-1ß and C-reactive protein (CRP) (p<0.05). However, the levels of TNF-ß, IL-1ß and CRP in OSAHS + cerebral infarction group were notably higher than those in cerebral infarction group (p<0.05). The levels of myeloperoxidase (MPO) and malondialdehyde (MDA) were remarkably higher in cerebral infarction group than those in the control group (p<0.05). However, they were significantly higher in OSAHS + cerebral infarction group than cerebral infarction group (p<0.05). Compared with control group, cerebral infarction group exerted a noticeably higher level of homocysteine (p<0.05). However, homocysteine level was markedly higher in OSAHS + cerebral infarction group than that in cerebral infarction group (p<0.05). Adiponectin level was significantly lower in cerebral infarction group than that in the control group (p<0.05). Meanwhile, it was evidently lower in OSAHS + cerebral infarction group than that in the cerebral infarction group (p<0.05). Control group had the highest abundance of Actinobacteria, and cerebral infarction group exhibited the highest abundance of Coriobacteriales, Vagococcus, Sphingobacteriales and Adlercreutzia. However, OSAHS + cerebral infarction group exhibited the highest abundance of Bifidobacterium, Parascardovia, Metascardovia and Anaerostipes caccae. There was a strong positive correlation between Proteobacterium and Ruminococcus (r=0.9, p=0.000) and between Firmicutes and Bacteroidetes (r=0.72, p=0.004). However, there was a significant negative correlation between Firmicutes and Enterobacteriales (r=-0.45, p=0.009). CONCLUSIONS: OSAHS complicated by cerebral infarction is significantly associated with intestinal flora, inflammatory factors, homocysteine and adiponectin expression.

Parecoxib prevents nucleus pulposus cells apoptosis by suppressing endoplasmic reticulum stress.

OBJECTIVE: Intervertebral disc degeneration (IVDD) is the main cause of spine diseases, and apoptosis of nucleus pulposus (NP) cells is an important risk factor for the degeneration of intervertebral discs. Endoplasmic reticulum (ER) stress is involved in multiple apoptosis processes. This study investigated whether the specific COX-2 inhibitor parecoxib can inhibit NP cell apoptosis induced by ER stress. PATIENTS AND METHODS: Human NP cells were isolated from the disc tissue collected from IVDD patients. We used IL-1ß to establish an NP cell degenerated model. Degenerated levels were detected by the analysis of cell viability, collagen II, collagen X, aggrecan, TNF-α, IL-6, and MMP-13 expression. ER stress status was examined by GRP78 and CHOP expression. Apoptosis level was mainly indicated by the positive apoptotic cells and caspase-12 expression. CHOP-plasmid transfection was performed to overexpress the CHOP protein level. RESULTS: IL-1ß could induce the decrease of viability, collagen Ⅱ, aggrecan, but an increase of collagen X, TNF-α, IL-6, and MMP-13 in NP cells, as well as the upregulation of GRP78/PERK/caspase-12 and apoptosis level, which could be inhibited by parecoxib. Parecoxib could also suppress CHOP caused by COX-2 upregulation and apoptosis in NP cells. CONCLUSIONS: Parecoxib is a safe and efficient COX-2 inhibitor to NP cells, which could prevent NP cells apoptosis by suppressing ER stress.

[Prevalence and risk factors of diabetic peripheral neuropathy in Chinese communities].

Objective: To investigate the prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients under community management programs. Methods: A cross-sectional study was conducted on T2DM patients in eight communities in Wuhan and Changshu cities. Data would included questionnaire, body measurement, blood testing and clinical examination. The criterion of diabetic peripheral neuropathy was under the combination of symptoms with five physical examinations. Binary logistic regression model was used to analyze the influential factors. Results: The overall prevalence of peripheral neuropathy was 71.2% among the diabetic patients who were managed in primary care health services in the two cities. The binary logistic regression method identified older age (≥60 years, OR=2.39, 95%CI:1.95-2.94), longer diabetic duration (≥10 years, OR=1.25, 95%CI: 1.02-1.54), and worse postprandial glucose control (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.65, 95%CI:1.33-2.04) (all P<0.05) as risk factors for the presence of diabetic peripheral neuropathy, while higher education level was protective factor (compared to patients with education levels of primary school or below, OR=0.52, 95%CI: 0.41-0.66; OR=0.59, 95%CI: 0.44-0.79; OR=0.64, 95%CI: 0.44-0.94 for those with education levels of junior high school, senior high school, and college, respectively). Conclusions: High rates of diabetic peripheral neuropathy among T2DM patients suggested the urgent need for early screening and standardized management at the community levels. It is necessary to promote appropriate screening techniques and methods to identify the peripheral neuropathy, in the primary health service institutions.

[Prognostic value of lymphocyte-to-monocyte ratio in angioimmunoblastic T cell lymphoma].

Objective: To evaluate the prognostic value of lymphocyte-to-monocyte ratio (LMR) in angioimmunoblastic T cell lymphoma (AITL). Methods: Data of 64 patients diagnosed as AITL at the First Affiliated Hospital of Nanjing Medical University between June 2009 and July 2017, were analyzed retrospectively. Receiver Operator Characteristic (ROC) curve was used to calculate the cutoff value of LMR to divide this cohort of patients into high and low LMR groups. Characteristics between groups were compared by Pearson Chi-square or Fisher exact tests. Kaplan-Meier method and Cox regression were performed to probe prognostic factors associated with progression-free survival (PFS) and overall survival (OS). Results: A total of 64 cases [39 cases male and 25 ones female with the median age of 63 (29-89) years old] were enrolled. The cutoff value of LMR was 3.07. Patients with low LMR showed inferior PFS (9 months vs 13 months, P=0.044) and OS (16 months vs not reached, P=0.014), respectively than those without low LMR during a median follow-up of 33 months (5 to 103 months). Multivariate analysis showed that low LMR was an independent prognostic factor associated with poor outcomes (HR=0.48, 95% CI 0.26-0.92 for PFS, P=0.027; HR=0.38, 95% CI 0.18-0.82 for OS, P=0.013, respectively). Subgroup analysis showed that patients with low LMR and under the situation of high score of Prognostic Index for peripheral T-cell lymphoma, Unspecified (PIT) (2-4) had shorter PFS and OS (P=0.013 and P=0.031, respectively). But in low score of PIT (0-1) group, low LMR seemed to play almost no effects on PFS and OS (P=0.949 and P=0.238, respectively). Conclusions: The disease risk status of patients could be initially assessed according to PIT score and LMR level. Low LMR was demonstrated to be able to predict poor outcome in AITL.

[Survey on burden of disease attributable to low fruit intake among Chinese people aged 15 years old and above between 1990 and 2013].

Objective: To analyze the burden of disease attributable to low fruit intake among Chinese population aged ≥15 years old between 1990 and 2013. Methods: We used data from the 2013 Global Burden of Disease Burden of Disease Study to study the situation in China. The population attributable fraction was calculated to estimate and compare the death and disability-adjusted life years (DALY) attributed to low fruit intake between 1990 and 2013 in China (excluded Taiwan, China). An average world population age structure of the period 2000-2025 was adopted to calculate age-standardized rates. Results: Deaths attributable to low fruit intake accounted for 11.02% of all death in 2013, which were higher than it in 1990 (10.38%). In 2013, the number of deaths attributed to low fruit intake in China increased to 1 046 500 from 793 800 in 1990. From 1990-2013, the age-standardized death rate attributable to low fruit intake decreased from 113.04/100 000 to 79.80/100 000. DALYs caused by low fruit intake increased from 18.346 5 million in 1990 to 21.296 7 million in 2013. Compared with 1990, the age-standardized DALY rate attributed to low fruit intake decreased by 34.67%. In 2013, the top three provinces with the highest burden of disease attributed to low fruits intake were Tibet, Guizhou and Xinjiang provinces, with standardized DALY rate at 2 612.53/100 000, 2 281.85/100 000 and 2 198.22/100 000, respectively. Compared with the results in 1990, the standardized DALY attributed to low fruits intake decreased, especially in Tianjin, where decreased by 63.61%; followed by Aomen, Zhejiang, Shanghai and Beijing, where decreased by 59.74%, 59.53%, 56.64% and 53.88%, respectively. Conclusion: Compared with the situation in 1990, the burden of disease attributable to low fruit intake decreased in 2013, but the situation is still serious, especially in Tibet, Guizhou and Xinjiang provinces, where the burden decreased comparatively slowly.

Preoperative NLR and PLR in the middle or lower ESCC patients with radical operation.

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) had been analysed in many kind of tumours, but its role of predict the oesophageal squamous cell carcinoma (ESCC) patients' prognosis was not reach a consensus. Relationship between NLR, PLR and ESCC located in the middle or lower segment was evaluated. 317 patients with ESCC who underwent attempted curative oesophagectomy were analysed in this study. 157 and 98 patients had elevated NLR and PLR respectively (NLR >3.3 and PLR >150). The median overall survival time (OS) and disease-free survival (DFS) was 34.1 and 19.2 months respectively. Multivariate analysis found PLR >150 (P = 0.018, HR 1.426, 95%CI 1.063-1.912) accompanied by male, lymphatic metastases, tumour size more than 3 cm, tumour located at middle segment and poor differentiation were associated with significantly worse DFS. Meanwhile, gender, lymphatic metastases, tumour location and differentiation along with PLR >150 (P = 0.003, HR 1.595, 95% CI 1.172-2.170) and NLR>3.3 (P = 0.039, HR 1.367, 95% CI 1.015-1.840) were all independent prognostic factors for OS. Preoperative NLR and PLR might be used as predictive factors in patients with ESCC. For DFS, elevated PLR compared to NLR may have an advantage to indicate poor prognosis.

Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients.

BACKGROUND: Neuropathic pain after nerve injury is severe and intractable, and current drug and non-drug therapies offer very limited pain relief. Hyperbaric oxygen (HBO 2) has been clinically used for protection of the nervous system after acute injury. We investigated whether HBO 2 treatment could prevent and/or attenuate neuropathic pain in animals and in patients. METHODS: Mechanical allodynia and thermal hyperalgesia and neurochemical alterations of neuropathic pain were analysed in male, adult, Sprague-Dawley rats with sciatic nerve injury. Clinical trials were conducted in patients with idiopathic trigeminal neuralgia. RESULTS: Repetitive HBO 2 treatment [a combination of pressure at 3 atmosphere absolute (ATA) and pure oxygen] greatly inhibited behavioural signs of neuropathic pain manifested as thermal hyperalgesia and mechanical allodynia. Such an HBO 2 treatment also inhibited nerve injury-induced induction of c-Fos and activation of astrocytes and increased phosphorylation of NR2B receptor and the subsequent Ca 2+-dependent signals in rats. Neither high pressure (up to 3 ATA) nor pure oxygen alone resulted in analgesic effect. In clinical trials, one course of HBO 2 therapy (10 consecutive days) produced a rapid-onset, dose-dependent and long-lasting analgesic effects evidenced by the decreased doses of carbamazepine required for keeping patient pain at a minimum and decreased scores of visual analogue scales, which was used for patient's self-evaluation. CONCLUSIONS: These findings support that HBO 2 therapy is an effective approach for treating neuropathic pain in both animals and human beings and suggest that neural protection, anti-inflammation and inhibition of nerve injury-induced altered neural activity may contribute to the analgesic effect of HBO 2 therapy.