Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

PURPOSE

To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.

METHODS

In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO2:FiO2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q1, Q3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher's exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.

RESULTS

Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively (p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003).

CONCLUSION

The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.

Thiamine ameliorates metabolic disorders induced by a long-term high-concentrate diet and promotes rumen epithelial development in goats

Data indicate that dietary thiamine supplementation can partly alleviate rumen epithelium inflammation and barrier function in goats fed a high-concentrate diet. The current work aimed to explore whether thiamine promotes rumen epithelium development by regulating carbohydrate metabolism during a long period of feeding high levels of concentrate. For the experiment, 24 female Boer goats (35.62 ± 2.4 kg of body weight) in parity 1 or 2 were allocated to 3 groups (8 goats per replicate) receiving a low-concentrate diet (concentrate:forage 30:70), a high-concentrate diet (HC; concentrate:forage 70:30), or a high-concentrate diet (concentrate:forage 70:30) supplemented with 200 mg of thiamine/kg of dry matter intake (HCT; concentrate:forage 70:30). On the last day of 12 wk, rumen fluid and blood samples were collected to measure ruminal parameters, endotoxin lipopolysaccharide, and blood inflammatory cytokines. Goats were slaughtered to collect ruminal tissue to determine differential metabolites, enzyme activities, and gene expression. Liquid chromatography-tandem mass spectrometry analysis revealed that the HCT group had significantly increased concentrations of d-glucose 6-phosphate, d-fructose 6-phosphate, glyceraldehyde 3-phosphate, thiamine pyrophosphate, oxaloacetate, acetyl-CoA, succinyl-CoA, sedoheptulose 7-phosphate, ribose 5-phosphate, and NADPH compared with the HC group. The pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and transketolase enzyme activities in the rumen epithelium of the HCT group were higher than those in the HC group. The plasma total antioxidant capacity values for the HCT group were greater than those for the HC group. The rumen epithelium ATP content in the HCT group was higher than that in the HC group. Compared with the HCT group, the HC group had a lower mRNA abundance of CCND1, CCNA2, CDK2, CDK4, CDK6, BCL2, PI3K, and AKT1. Taken together, the results suggest that dietary thiamine supplementation could ameliorate disorders in the tricarboxylic acid cycle and the pentose phosphate pathway induced by a long-term high-concentrate diet and could promote rumen epithelial growth.

[Subcutaneous sparganosis: a case report]

This case report presents the diagnosis and treatment of a case with subcutaneous sparganosis.

[Clinical analysis of adult Philadelphia chromosome-positive acute lymphoblastic leukemia with p16 gene deletion]

目的

探讨p16基因缺失在成人Ph染色体阳性急性淋巴细胞白血病（Ph⁺ ALL）中的临床意义。

方法

回顾性分析80例Ph⁺ALL伴p16基因缺失患者的临床特征、免疫表型、细胞遗传学、分子生物学改变及其预后。

结果

31.3% Ph⁺ALL患者合并p16基因缺失；p16基因缺失组与非缺失组相比，初诊时高白细胞计数（WBC≥30×10⁹/L）更常见，高表达CD20，更易出现附加染色体异常，其中以累及7、8、19号染色体以及der（22）较为常见；两组诱导缓解率比较差异无统计学意义（P=0.033），p16基因缺失组患者治疗3个疗程后获BCR-ABL融合基因主要分子学反应（MMR）率和完全分子学反应（CMR）率均明显低于非缺失组（P值分别为0.034和0.036），且复发率明显高于非缺失组（P=0.033）；p16基因缺失组使用伊马替尼联合化疗者和使用达沙替尼联合化疗者的MMR、CMR率及复发率差异均无统计学意义（P值均>0.05）；p16基因缺失组患者3年总体生存（OS）率及无病生存（DFS）率分别为37.1%和12.4%，显著低于非缺失组的54.1%和45.9%（P值分别为0.037和0.026）；25例p16基因缺失患者中14例行异基因造血干细胞移植（allo-HSCT），其中位OS时间为21个月，明显长于非移植组患者的12个月（P=0.030）。

结论

成人Ph⁺ALL伴p16基因缺失患者预后相对较差，二代酪氨酸激酶抑制剂不能明显改善其疗效，但allo-HSCT能够改善部分患者的生存，明确p16基因缺失状态对于评估预后和指导临床治疗有重要意义。

[Clinical significance of cytogenetic monitoring in chronic myeloid leukemia]

Objective: To analyze the association of cytogenetic abnormalities with the prognosis of chronic myeloid leukemia (CML) patients in tyrosine kinase inhibitors (TKI) era. Methods: Karyotype analysis of chromosome G-banding was carried out in 387 newly diagnosed CML patients by short-term culture of bone marrow cells. The correlation of cytogenetic abnormalities and CML progression was explored in combination with ABL tyrosine point mutations. Result: Of 387 patients with positive BCR-ABL fusion gene assayed by fluorescence in situ hybridization (FISH) technique, 94.1% (364/387) patients were Ph positive and 5.9% (23/387) Ph negative; 320 patients (87.9%) had a translocation t (9;22) (q34;q11) and 5 (1.4%) a variant translocation t (v;22) . Additional cytogenetic aberrations (ACA) at diagnosis were found in 10.7% (39/387) Ph(+) patients, major route ACA in 22 (56.4%) cases and minor route ACA in 15 (38.5%) cases and 2 patients (5.1%) lacked the Y chromosome (-Y) ; 23.4% (71/303) patients occurred ACA during TKI treatment and the most frequent abnormalities were abnormal chromosome numbersd, which were likely associated with high proportion of disease progression (χ(2)=168.21, P<0.001) and ABL tyrosine point mutations (χ(2)=29.04, P<0.001) . Newly diagnosed CML-CP patients with t (9;22) (q34;q11) had a longer event-free survival (EFS) and disease-free survival (DFS) rates than that of patients with ACA (P=0.037; P=0.003) , while the overall survival (OS) had no significant differences (P=0.209) . As for CML-CP patients that occurred ACA during TKI therapy would have a marked low OS, EFS and DFS (all P<0.001) compared with no ACA occurred patients. Survival of advanced patients that occurred ACA were dramatically reduced. Conclusion: ACA often emerged during the disease progress in CML patients, regular and timely detection of chromosomes karyotype and ABL tyrosine point mutations during TKI treatment was important for therapeutic evaluation, progress and prognosis of CML.

[Epidemiological characteristics of stroke in 16 provinces of China]

Epidemiological survey was conducted, according to diagnostic standard from WHO-MONICA project, on stroke events in 16 provinces of China. There were significant differences in geographical distribution of morbidity and mortality of stroke events. The morbidity and mortality were higher in northern China than in southern China (P < 0.001). The differences of morbidity varied from 11 to 14 times. The morbidity and mortality were higher in man than in woman (P < 0.01 or P < 0.05) and were higher in rural areas than in cities. The geographical differences in the morbidity and mortality for stroke may be related to many factors, and may be in parallel with the hypertension prevalence rate, which was higher in northern China than in Southern China. The age of patients with stroke was younger in northern China than in southern China (P < 0.01). The frequency of cerebral hemorrhage was higher in southern China than in northern China.

[Epidemiological characteristic of stroke in 1985-1989, Beijing]

We analyzed the data on stroke surveillance from 1985 to 1989 in Beijing. The results showed the annual average incidence rate was 189/100,000 and the first incidence rate was 134/100,000 in the population aged 25-74. The age standardized rates for both of them were 223/100,000 and 158/100,000 respectively. The incidence rate for male was 1.5 times as high as that for female. The incidence rate in rural area was 1.3 times as high as that in urban area. The incidence rates increased with age. The seasonal distribution of stroke incidence showed that it was the highest in winter and the lowest in summer. The trend of incidence from 1985 to 1989 was relatively steady. It is urgent to conduct the prevention of cerebrovascular disease (CVD) in Beijing.

[Urinary Tamm-Horsfall protein coating of free cells and its clinical diagnostic significance]

The origin of free cells in urine is difficult to determine in the absence of cellular casts. Using fluorescein-conjugated antibody to human Tamm-Horsfall protein (THP), it examines THP coating of free cells in urine (THP-CFC), that could be distinguished between renal parenchymal disease (RPD) and lower urinary tract disease (LUTD). We had examined THP-CFC in urine of the patients with all kinds of RPD, renal or ureteral stone (RUS) and LUTD. The percentage of THP-CFCs was 0% in healthy volunteers (n = 34), 0-8% in LUTD group (n = 14), 86.3% in glomerulonephritis and SLE nephritis group (n = 29), 80.8% in chronic intertitial nephritis group (n = 26), 0-10% in RUS group (n = 14). The research results suggest that the percentage of THP-CFCs between the RPD and LUTD or RUS had a significant difference. The presence of THP-CFC in RPD and its absence in LUTD suggests that this simple test may be of use in differentiating RPD from LUTD.

Synthesis and bioactivities of new LHRH antagonists containing a novel unnatural amino acids at position five

Synthesis and bioactivities of new antagonists of luteinizing hormone releasing hormone (LHRH) with novel unnatural amino acids at position five are reported. Most of them showed some antiovulatory activity at 0.5 microgram/rat and two of them inhibited ovulation completely at 1 microgram/rat using saline as vehicle.

Antagonists of luteinizing hormone releasing hormone with novel unnatural amino acids at position six

Five new antagonists of luteinizing hormone releasing hormone (LHRH) containing novel unnatural amino acids at position six are reported. They are very effective in the rat antiovulatory assay. Using saline as vehicle, antagonist-[N-Ac-D-2-Nal1, D-4-Cl-Phe2, D-3-Pal3, Arg5, D-A26, D-Ala10]-LHRH inhibited ovulation completely at 1 micrograms/rat and three of the other antagonists showed some antiovulatory activity at 0.5 micrograms/rat.

Characteristics of immobilized aminoacylase from Aspergillus oryzae on macroporous copolymers

Aminoacylase from Aspergillus oryzae was adsorbed on functionallized macroporous copolymers where the enzyme showed excellent catalyzing activity and operation stability. Various factors which effect the activity of the immobilized aminoacylase such as temperature, pH and ionic strength were investigated. The continuous operation of the enzyme immobilized on macroporous copolymers was compared with that of the enzyme immobilized on DEAE-Sephadex.