PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis / Evaluación sistemática y metaanálisis de la estrategia eit para la titulación Peep en pacientes con sdra

Objective To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients. Design A systematic review and meta-analysis. Setting 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed. Participants Randomized clinical trials patients with ARDS. Main variables PaO2/FiO2-ratio and respiratory system compliance. Intervension The quality of the studies was assessed with the Cochrane risk and bias tool. Results 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO2/FiO2 ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364−0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD −0.085, (95% CI −0.342 to 0.172)]. Conclusions The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo-controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS (AU)

Objetivo Para determinar qué método de valoración de la presión espirfinal positiva (PEEP) es más útil, y para establecer una base de evidencia para el impacto clínico de la tomode impedeléctrica (EIT) basada en el ajuste individual de PEEP que parece ser un método prometedor para optimizar la PEEP en pacientes con síndrome de dificultad respiraguda (ARDS). Diseño Una revisión sistemática y metanálisis. Ámbito Se realizaron 4 bases de datos (PUBMED, EMBASE, Web Of Science y Cochrane Library) de 1980 a diciembre de 2020. Participantes Ensayos clínicos aleatorizados de pacientes con SDRA. Variables principals PaO2/FiO2 ratio y compatibilidad respiratoria. Intervención La calidad de los estudios se evaluó con la Cochrane risk and bias tool. Resultados Ocho ensayos, incluyendo un total de 222 participantes, fueron elegibles para el análisis. El análisis de ≥ eta demuestra una configuración individual significativamente basada en MEITPpara pacientes que reciben una mayor proporción EE2/P PiO2en comparación con otras estrategias de titulación FOPEEP SMD CI. La estrategia de titulación de PEEP derivada del tie no aumentó significativamente el cumplimiento del sistema respiren comparación con otras estrategias de titulación de PEEP, [7 ensayos, 202 pacientes, DME -0,085, (IC del 95%: −0,342−0,172)]. Conclusiones Los beneficios de la valoración de la PEEP con EIT en los resultados clínicos de SDRA en ensayos controlados con placebo probablemente sean el resultado de la ventilación regional visible del EIT. Estos hallazgos ofrecen a los médicos y a las partes interesadas una evaluación integral y evidencia de alta calidad para la seguridad y eficacia de la configuración individual de PEEP basada en EIT como una opción superior para los pacientes que se someten a SDRA (AU)

Characterization of Bacillus spp. isolated from the intestines of Rhynchocypris lagowskii as a potential probiotic and their effects on fish pathogens.

Probiotics sourced from fish intestinal microbiota have a merit over other bacterial sources due to colonization ability and effective time. This study aimed to evaluate the bacilli isolated from the Rhynchocypris lagowskii intestines and their validity as a probiotic. Three isolates were selected (LSG 2-5, LSG 3-7, and LSG 3-8) and defined by morphological and 16S rRNA analysis as Bacillus velezensis, Bacillus aryabhattai, and Bacillus mojavensis, respectively. Results showed the strain tolerant abilities to gastrointestinal fluid, bile salt, pH, and temperature expotures. Additionally, all bacterial strains showed anti-pathogenic activity against at least four strains out of six tested pathogen strains (Staphylococcus aureus, Aeromonas hydrophila, Escherichia coli, Aeromonas veronii, Edwardsiella, and Aeromonas sobria). The bacterial strains also showed a high percentage of co-aggregation activity, more than 70%, with Aer. hydrophile, Staph. epidermidis, and Klebsiella aerogenes. At the same time, the results of competition, rejection, and substitution activity with Aer. hydrophila and Aer. veronii indicated the ability of the isolated strains to reduce the adhesion of pathogens to mucin. All strains showed safety properties, non-hemolytic, and sensitivity characteristics for most of tested antibiotics. In vivo test after injecting these strains into fish at various concentrations showed no side effects in the internal or external organs of fish compared to controls, proving that this is safe for these fish. Furthermore, the three strains produced lipase, amylase, and protease enzymes. The strains also showed bile salt hydrolase activity and biofilm formation, allowing them to tolerate stressful conditions. Conclusion: Based on these strains characteristics and features, they could be considered a promising candidate probiotic and can be used as an anti-pathogenic, especially in aquaculture.

Effect of Bacillus amyloliquefaciens LSG2-8 on the intestinal barrier function of Amur minnow (Rhynchocypris lagowskii).

Probiotics are widely used in aquaculture. This article aims to study the effect of Bacillus amyloliquefaciens LSG2-8 on the intestinal barrier function of Rhynchocypris lagowskii. B. amyloliquefaciens LSG2-8 were added to R. lagowskii basal diets (CK) as additives at four concentrations: 1.0 × 106 (D-6), 1.0 × 107 (D-7), 1.0 × 108 (D-8) and 1.0 × 109 (D-9) CFU g-1 by dry weight of basal diet. After a 56-day feeding experiment, the activities of intestinal digestive enzymes and immunity-related enzymes of R. lagowskii on group D-6, D-7, D-8 and D-9 diet were significantly higher than the control (P < 0.05). In molecular experiments, the authors found that the levels of TGF-ß mRNA, IL-10 mRNA, ZO-1 mRNA and claudin-3 mRNA in group D-8 R. lagowskii were significantly higher (P < 0.05) than those of the control and other groups. Furthermore, the levels of IL-1ß and IL-8 mRNA of R. lagowskii on group D-6, D-7, D-8 and D-9 diet were significantly lower than those of the control (P < 0.05). In addition, the authors found that B. amyloliquefaciens LSG2-8 can regulate the intestinal flora balance and improve the intestinal structure of R. lagowskii. In conclusion, B. amyloliquefaciens LSG2-8 can improve the intestinal barrier function of R. lagowskii and can be used as a feed additive in aquaculture.

PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis.

OBJECTIVE: To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients. DESIGN: A systematic review and meta-analysis. SETTING: 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed. PARTICIPANTS: Randomized clinical trials patients with ARDS. MAIN VARIABLES: PaO2/FiO2-ratio and respiratory system compliance. INTERVENSION: The quality of the studies was assessed with the Cochrane risk and bias tool. RESULTS: 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO2/FiO2 ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364-0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD -0.085, (95% CI -0.342 to 0.172)]. CONCLUSIONS: The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo-controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS.

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis.

Background: To explore the surgical outcomes between patients with perforated and non-perforated neonatal necrotizing enterocolitis (NEC) and identify indications for surgical intervention. Methods: The surgical outcomes of 271 children with NEC admitted to the Seventh Medical Center of Chinese PLA General Hospital between August 2009 and August 2020 were retrospectively analyzed. The patients were divided into the non-perforated and perforated groups. The preoperative factors, including gestational age, birth weight, intrauterine infection, cholestasis, platelet change, white blood cell count, and C-reactive protein level were compared between the two groups, along with postoperative factors including infection status, complications, enteral and parenteral nutrition time, ICU time, ventilator use time, and intestinal necrosis length. Bell staging was performed for the two groups and the mortality of different Bell stages was explored. The risk of death and predisposing factors of patients with NEC were analyzed. Results: In total, 271 children undergoing surgery were included in this study. A total of 188 children were observed without perforation, including 57 deaths (30.3%), and 83 children with perforation, including 24 deaths (28.9%). Preoperative cholestasis and time from NEC diagnosis to surgery were significantly different between the two groups (P < 0.05). Postoperative factors, including parenteral nutrition time (32 [3-94] days vs. 23 [1-53] days), enteral nutrition time (27 [0-86] days vs. 18 [0-81] days), NICU time (44 [5-125] days vs. 29 [1-92] days), and length of intestinal necrosis (15 [0-92] cm vs. 10 [2-70] cm), were significant. The mortality rate of patients with Bell stage IIIA was higher than that of patients with Bell stage IIIB. A total of 81 patients had 30-day postoperative mortality (57 non-perforated cases). Multivariate Cox regression analysis showed that non-perforation was a poor prognostic factor for survival outcome (hazard ratio 2.288, 95% confidence interval [1.329-3.940], P = 0.003). Conclusions: Preterm infants in the non-perforated group had more serious complications and had a longer recovery time after surgery. Bell staging is not accurate in diagnosing severe NEC that needs surgical intervention.

The effect of adding Bacillus amyloliquefaciens LSG2-8 in diets on the growth, immune function, antioxidant capacity, and disease resistance of Rhynchocypris lagowskii.

The purpose of this study was to investigate the effect of Bacillus amyloliquefaciens LSG2-8 on the growth performance, immune function, antioxidant capacity, and disease resistance of Rhynchocypris lagowskii. Fish were fed with the feed containing five levels such as 0, 1.0 × 106, 1.0 × 107, 1.0 × 108, and 1.0 × 109 CFU/g of the B. amyloliquefaciens LSG2-8 for 56 days. After 56 days of feeding, twenty four fish were randomly selected to test various growth, immune and antioxidant parameters. Ten fish were challenged with Aeromonas hydrophila for 14 days; the mortality rate was recorded 14 days after infection. The results showed that B. amyloliquefaciens LSG2-8 could significantly increase the growth parameters of R. lagowskii's, such as final body weight, weight gain rate, specific growth rate, and feed efficiency (p < 0.05). Further examination revealed the activity of antioxidant enzymes, Nrf-2 mRNA, and Keap-1 mRNA gene expression in the intestine and liver, and the serum immune index of R. lagowskii in the 1.0 × 108 CFU/g were all significantly higher compared to the other groups. Furthermore, fish fed a diet supplemented with B. amyloliquefaciens LSG2-8 had a significantly lower (p < 0.05) post-challenge mortality rate than the control fish. In summary, the research results showed that B. amyloliquefaciens LSG2-8 could improve the growth performance, immune function, antioxidant capacity, and disease resistance of R. lagowskii and be used in aquaculture.

Slippery Antifouling Polysiloxane-Polyurea Surfaces with Matrix Self-Healing and Lubricant Self-Replenishing.

The inferior mechanical properties and the difficulty in repairing damaged substrates and lubricant films of slippery liquid-infused porous surfaces significantly hampered their practical applications. To solve this problem, we fabricated a polysiloxane-polyurea slippery elastomer with lubricant self-replenishing and matrix self-healing properties by encapsulating silicone oil into the thermoplastic elastomers. By optimizing the chemical compositions and molecular interactions, the obtained slippery elastomer exhibits unique mechanical properties with a maximum breaking strength of 0.12 MPa, elongation of 1600%, and self-healing efficiency of 98%. Moreover, the lubricant stored in the capsule of the slippery elastomer can be controlled released under mechanical stimulation, further realizing surfaces' self-lubricating and liquid manipulation switching between slippery and pinning states. Furthermore, the textile-reinforced slippery elastomer with superior mechanical strength also exhibited liquid repellency, anti-biofouling, and drag reduction properties. Therefore, this textile-reinforced omniphobic surface with high mechanical property, matrix self-healing, and lubricant self-replenishing property shows a broad application prospect in surface protection, underwater antifouling, and drag reduction.

Liquid-repellent and self-repairing lubricant-grafted surfaces constructed by thiol-ene click chemistry using activated hollow silica as the lubricant reservoir.

The development of robust, stain-resistant, and self-healing liquid-repellent surfaces is a common aspiration of both consumer and industrial applications, but the existing methods suffer from limitations, such as complicated procedures, weak mechanical durability and substrate dependency. In this work, a lubricant-grafted slippery surface (LGSS) was prepared by grafting vinyl-terminated polydimethylsiloxane (Vi-PDMS) onto various substrates coated with sulfhydryl-modified hollow mesoporous silica (SH-HMS) through a thiol-ene click reaction. The uniform and intact lubricant layer can effectively decrease the absorption of the polysaccharide and protein, exhibiting superior antifouling properties. Notably, the hollow structure of SH-HMS could significantly increase the oil grafting capacity of the slippery surface from 0.013 g/cm2 to 0.027 g/cm2 compared with the surface constructed by solid silica. By virtue of the strong covalent bond forces between the lubricant oil and surfaces, the obtained LGSS exhibited robust liquid repellency when subjected to high/low temperature, ultraviolet irradiation and water impact. Moreover, the liquid-repellent LGSS exhibited good self-repairing performance owing to the directional migration of the Vi-PDMS chain segment from the hollow capsule to the surface through the mesoporous channels under heating treatment. Therefore, such a newly developed strategy for constructing liquid-repellent coatings on various substrates with self-repairing properties has the potential to promote the advancement of interfacial antifouling materials and exhibit tremendous potential for consumer and industrial applications.

Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study.

BACKGROUND: Measuring optic nerve sheath diameter (ONSD), an indicator to predict intracranial hypertension, is noninvasive and convenient, but the reliability of ONSD needs to be improved. Instead of using ONSD alone, this study aimed to evaluate the reliability of the ratio of ONSD to eyeball transverse diameter (ONSD/ETD) in predicting intracranial hypertension in traumatic brain injury (TBI) patients. METHODS: We performed a prospective study on patients admitted to the Surgery Intensive Care Unit. The included 52 adults underwent craniotomy for TBI between March 2017 and September 2018. The ONSD and ETD of each eyeball were measured by ultrasound and computed tomography (CT) scan within 24 h after a fiber optic probe was placed into lateral ventricle. Intracranial pressure (ICP) > 20 mmHg was regarded as intracranial hypertension. The correlations between invasive ICP and ultrasound-ONSD/ETD ratio, ultrasound-ONSD, CT-ONSD/ETD ratio, and CT-ONSD were each analyzed separately. RESULTS: Ultrasound measurement was successfully performed in 94% (n = 49) of cases, and ultrasound and CT measurement were performed in 48% (n = 25) of cases. The correlation efficiencies between ultrasound-ONSD/ETD ratio, ultrasound-ONSD, CT-ONSD/ETD ratio, and ICP were 0.613, 0.498, and 0.688, respectively (P < 0.05). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the ultrasound-ONSD/ETD ratio and CT-ONSD/ETD ratio were 0.920 (95% CI 0.877-0.964) and 0.896 (95% CI 0.856-0.931), respectively. The corresponding threshold values were 0.25 (sensitivity of 90%, specificity of 82.3%) and 0.25 (sensitivity of 85.7%, specificity of 83.3%), respectively. CONCLUSION: The ratio of ONSD to ETD tested by ultrasound may be a reliable indicator for predicting intracranial hypertension in TBI patients.

Mimicking from Rose Petal to Lotus Leaf: Biomimetic Multiscale Hierarchical Particles with Tunable Water Adhesion.

Water-droplet adhesions of the coatings constructed by all-polymer multiscale hierarchical particles (MHPs) were finely adjusted within the range from highly adhesive to self-cleanable. The MHPs were synthesized via thermal-induced polymerization of the reactants absorbed into self-made hollow reactors and in situ capping of nanocomplexes onto the reactors' shell simultaneously. The dynamic wettability of the prepared MHPs was tuned between water-droplet sliding and water-droplet adhering by simply controlling the type of capped nanocomplexes. Water-adhesive force changed in the range from 31.28 to 89.34 µN. In addition, the raspberry-like particles (MHPs without nanocomplex capping) were used to construct superhydrophobic rose-petal-like surface with a high water-adhesive force, which can be applied in microdroplet transportation without loss. The MHPs with appropriate nanocomplex capping were used to fabricate superhydrophobic lotus-leaf-like fabric, exhibiting excellent antifouling property and superior mechanical stability. We believe that the prepared superhydrophobic MHPs with diverse water-adhesive forces are promising in potential academic research and industrial applications.

Combination of plasma white blood cell count, platelet count and C-reactive protein level for identifying surgical necrotizing enterocolitis in preterm infants without pneumoperitoneum.

PURPOSE: To evaluate whether plasma white blood cell count (WBC), platelet count (PLT), and C-reactive protein level (CRP) can be used to differentiate surgical necrotizing enterocolitis (NEC) from medical NEC. METHODS: Preterm infants admitted between January 1, 2011 and July 31, 2015 were stratified by the need of surgery as surgical NEC (n = 41) and medical NEC (n = 43). The values of WBC, PLT and CRP were collected at time before NEC occurred (T0), at onset of NEC (T1) and when surgical assessment was required (T2). Patients admitted between August 1, 2015 and March 1, 2018 (n = 53) were collected for further verification. RESULTS: Variables identified in logistic regression analysis predicting surgical NEC were WBC and PLT at T2 (WBC2 and PLT2). The predictive probability of surgery (P) could be calculated by the equation [Formula: see text]. The area under curve of P was 0.84 and the ideal cutoff value was 0.55, with sensitivity and specificity of 85 and 81%, respectively. This cutoff value got an sensitivity of 80% and specificity of 79% in the verification group. CONCLUSION: Combination of WBC and PLT can effectively differentiate surgical NEC from medical NEC infants when surgical assessment was required.

Therapeutic effects of fibroblast growth factor-10 on hyperoxia-induced bronchopulmonary dysplasia in neonatal mice.

The survival rate of preterm neonates increases significantly with the development of neonatal care and comprehensive treatment, but more and more high-risk preterm neonates suffer from bronchopulmonary dysplasia (BPD). Currently, there is no effective treatment for BPD, thus it is still a major cause of disability and mortality in neonates. Thus, it is imperative to investigate the pathogenesis and treatment of BPD in depth. Fibroblast growth factor-10 (FGF-10) is a paracrine growth factor binding its receptors (FGFR1 and FGFR2) to regulate a lot of biological processes. FGF-10, with mitotic and chemotactic activities, plays an important role in histogenesis during embryonic stage. It can prevent and attenuate mechanical or infection induced inflammation in lung. Results showed lung FGF-10 expression reduced significantly in neonatal mice with BPD, and exogenous FGF-10 was able to promote the growth of pulmonary mesenchymal stem cells and alveolar epithelial cells type II and reduce the expression of pro-inflammatory cytokines. We preliminarily explored the relationship between FGF-10 and NF-κB in this animal model and found FGF-10 could inhibit NF-κB p65 expression as a feedback. Thus, to investigate the protective effects of FGF-10 on hyperoxia induced BPD in neonatal mice will provide a new strategy for the treatment of BPD.

Morphological differences between the aneurysmal and normal artery in patients with internal carotid-posterior communicating artery aneurysm.

The aim of this study was to identify image-based morphological parameters that correlated with the formation of internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysms. Morphological parameters obtained from 3-dimensional digital subtraction angiography (3D-DSA) were evaluated from nine patients with ICA-PcomA aneurysms, including the diameter of the ICA (Dica) and PcomA (Dpcom), the angle between the ICA and the origin of the PcomA (Apcom), and the angle between the ophthalmic and communicating segments of the ICA (Aica). Measurements were performed on both sides of each patient. Parameters were analyzed with a paired-samples t-test for significance. In additional, receiver operating characteristic (ROC) analysis was performed on the significant parameter. Statistically significant differences were found between the aneurysmal (45.28±29.07°) and control sides (79.22±17.83°) for Apcom (p=0.020). In the ROC analysis, the area under the curve value of Apcom was 0.852, and the threshold for optimal sensitivity and specificity was 52.25°. Therefore, the Apcom parameter was correlated with the formation of an ICA-PcomA aneurysm, and seems to be a promising morphological parameter for risk assessment of aneurysm formation.