Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial

OBJECTIVE

To compare reintubation rates after planned extubation and unplanned extubation (UE) in patients in neonatal intensive care units (NICUs), to analyse risk factors for reintubation after UE and to compare outcomes in patients with and without UE.

DESIGN

Prospective, observational study nested in a randomised controlled trial (SEPREVEN/Study on Epidemiology and PRevention of adverse EVEnts in Neonates). Outcomes were expected to be independent of the intervention tested.

SETTING

12 NICUs in France with a 20-month follow-up, starting November 2015.

PATIENTS

n=2280 patients with a NICU stay >2 days, postmenstrual age ≤42 weeks on admission.

INTERVENTIONS/EXPOSURE

Characteristics of UE (context, timing, sedative administration in the preceding 6 hours, weaning from ventilation at time of UE) and patients.

MAIN OUTCOME MEASURES

Healthcare professional-reported UE rates, reintubation/timing after extubation, duration of mechanical ventilation, mortality and bronchopulmonary dysplasia (BPD).

RESULTS

There were 162 episodes of UE (139 patients, median gestational age (IQR) 27.3 (25.6-31.7) weeks). Cumulative reintubation rates within 24 hours and 7 days of UE were, respectively, 50.0% and 57.5%, compared with 5.5% and 12.3% after a planned extubation. Independent risk factors for reintubation within 7 days included absence of weaning at the time of UE (HR, 95% CI) and sedatives in the preceding 6 hours (HR 1.93, 95% CI 1.04 to 3.60). Mortality at discharge did not differ between patients with planned extubation or UE. UE was associated with a higher risk of BPD.

CONCLUSION

In the SEPREVEN trial, reintubation followed UE in 58% of the cases, compared with 12% after planned extubation.

TRIAL REGISTRATION NUMBER

NCT02598609.

An educational programme in neonatal intensive care units (SEPREVEN): a stepped-wedge, cluster-randomised controlled trial

BACKGROUND

Patients in neonatal intensive care units (NICUs) are at high risk of adverse events. The effects of medical and paramedical education programmes to reduce these have not yet been assessed.

METHODS

In this multicentre, stepped-wedge, cluster-randomised controlled trial done in France, we randomly assigned 12 NICUs to three clusters of four units. Eligible neonates were inpatients in a participating unit for at least 2 days, with a postmenstrual age of 42 weeks or less on admission. Each cluster followed a 4-month multifaceted programme including education about root-cause analysis and care bundles. The primary outcome was the rate of adverse events per 1000 patient-days, measured with a retrospective trigger-tool based chart review masked to allocation of randomly selected files. Analyses used mixed-effects Poisson modelling that adjusted for time. This trial is registered with ClinicalTrials.gov, NCT02598609.

FINDINGS

Between Nov 23, 2015, and Nov 2, 2017, event rates were analysed for 3454 patients of these 12 NICUs for 65 830 patient-days. The event rate per 1000 patient-days reduced significantly from the control to the intervention period (33·9 vs 22·6; incidence rate ratio 0·67; 95% CI 0·50-0·88; p=0·0048).

INTERPRETATION

A multiprofessional safety-promoting programme in NICUs reduced the rate of adverse events and severe and preventable adverse events in highly vulnerable patients. This programme could significantly improve care offered to critically ill neonates.

FUNDING

Solidarity and Health Ministry, France.

p53 Induces skin aging by depleting Blimp1+ sebaceous gland cells

p53 is an important inducer of organismal aging. However, its roles in the aging of skin remain unclear. Here we show that mice with chronic activation of p53 develop an aging phenotype in the skin associated with a reduction of subcutaneous fat and loss of sebaceous gland (SG). The reduction in the fat layer may result from the decrease of mammalian TOR complex 1 (mTORC1) activity accompanied by elevated expression of energy expenditure genes, and possibly as compensatory effects, leading to the elevation of peroxisome proliferator-activated receptor (PPAR)γ, an inducer of sebocyte differentiation. In addition, Blimp1(+) sebocytes become depleted concomitantly with an increase in cellular senescence, which can be reversed by PPARγ antagonist (BADGE) treatment. Therefore, our results indicate that p53-mediated aging of the skin involves not only thinning through the loss of subdermal fat, but also xerosis or drying of the skin through declining sebaceous gland activity.

Application of natural and synthetic polyamines as growth regulators to improve the freezing tolerance of winter wheat (Triticum aestivum L.)

Wheat cultivars were grown as soil culture under normal growth conditions. Twoweek- old seedlings were exposed to 4°C for 6 h and then transferred to −12°C for 24 h in the dark. Twenty-four hours before freezing stress, some of the plants were sprayed with aqueous solutions of spermine, spermidine, putrescine, 1,3-diaminopropane (1,3-DAP) and diethylenetriamine (DETA). The data showed that freezing stress caused a decrease in the fresh weight, chlorophyll content and plant survival rate, accompanied by a simultaneous accumulation of free proline and the enhanced leakage of electrolytes. Preliminary treatment with polyamines caused a decline in electrolyte leakage and a considerable augmentation in proline quantity, indicating that the compounds are capable of preventing frost injury. Additionally, the foliar application of polyamines retarded the destruction of chlorophyll, and lessened fresh weight losses due to freezing stress. The synthetic triamine DETA was the most effective, having the most pronounced action in all the experiments, followed by the tetraamine spermine. The application of polyamines to wheat crops could be a promising approach for improving plant growth under unfavourable growth conditions, including freezing temperatures. The results demonstrate that treatment with polyamines could protect winter wheat by reducing the stress injuries caused by subzero temperatures.

Simultaneous copper, cobalt and phenol removal from aqueous solutions by alternating biosorption and biodegradation

A strategy for removal of heavy metals and phenol from wastewaters is proposed. It involves consecutive cation biosorption by fungi, phenol biodegradation by the yeast association Candida sp. 2326 + Candida sp. 2327 and regeneration. Copper and cobalt removal from aqueous solutions containing 80-120 mg/L phenol by biosorption, using Rhizopus archizus cells immobilized onto poly (vinyl alcohol), was investigated by conducting a series of batch experiments. The removal efficiencies were 81% for Cu and 5% for Co. The residual concentrations of Cu (1.9 mg/L) and of Co (9.5 mg/L) did not change the biodegradation dynamics of phenol. A quantitative biodegradation of 120 mg/L phenol proceeded within 22 h. After biodegradation of phenol, the removal efficiencies achieved by biosorption after regeneration were 90% for Cu and 44% for Co. It was found that copper and cobalt form positively charged complexes with phenol. This complex formation hinders the retention of Cu and Co by the biosorbent and reduces the uptake of their cations.

Biosorption of copper(II) and cadmium(II) from aqueous solutions by free and immobilized biomass of Aspergillus niger

This study investigates the ability of Aspergillus niger resting cells entrapped into poly(vinyl alcohol) (PVA) network to remove Cu(II) and Cd(II) from single ions solutions. The performance of free and immobilized biosorbent was evaluated by equilibrium and kinetic studies. The PVA-immobilized fungal biosorbent removed Cu(II) and Cd(II) rapidly and efficiently with maximum metal removal capacities of 34.13 mg/g and 60.24 mg/g, respectively. These values of heavy metal uptake at equilibrium were higher than the amount of Cu(II) and Cd(II) removal by free biomass (17.60 mg/g and 69.44 mg/g, respectively). Biosorption equilibrium data were best described by Langmuir isotherm model. The biosorption kinetics followed the pseudo-second order model and intraparticle diffusion equation. The results obtained suggest that the immobilized biosorbent holds great potential for wastewater treatment applications.

Cd (II) stress response during the growth of Aspergillus niger B 77

AIMS

To investigate the relationship between growth, heavy metal ions uptake and participation of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in the protection of Aspergillus niger B 77 against cadmium stress.

METHODS AND RESULTS

The stress response of the model fungal strain, under conditions of a wide range of Cd (II) ion concentrations, was investigated by determining the biomass formation, protein biosynthesis, SOD and CAT activities and heavy metal uptake in growing cells. Exposure to heavy metal ions induced an increase in protein content, heavy metal uptake and SOD activity, and a heavy decrease in CAT activity.

CONCLUSION

The results obtained indicated that the tolerance of A. niger to Cd (II) was correlated with the heavy metal uptake, reactive oxygen species generation in the cells and the efficiency of antioxidative defence system.

SIGNIFICANCE AND IMPACT OF THE STUDY

Evidence is provided for the possibility that oxidative stress plays a major role in the effect of Cd (II) ions on A. niger. These data could offer useful information when creating new strategies and methodological improvements for bioremediation with the participation of fungi.

Neuronal nitric oxide synthase immunopositive neurons in cat vestibular complex: a light and electron microscopic study

Nitric oxide is a unique neurotransmitter, which participates in many physiological and pathological processes in the organism. Nevertheless, there are little data about the neuronal nitric oxide synthase immunoreactivity (nNOS-ir) in the vestibular complex of a cat. In this respect, the aims of this study were to: (1) demonstrate nNOS-ir in the neurons and fibers, from all major and accessory vestibular nuclei; (2) describe their light microscopic morphology and distribution; (3) investigate and analyze the ultrastructure of the NOS I-immunopositive neurons, fibers, and synaptic boutons. For demonstration of the nNOS-ir, the peroxidase-antiperoxidase-diaminobenzidin method was applied. Immunopositive for nNOS neurons and fibers were present in all major and accessory vestibular nuclei. On the light microscope level, the immunopositive neurons were different in shape and size. According to the latter, they were divided into four groups--small (with diameter less than 15 microm), medium-sized (with diameter from 15 to 30 microm), large type I (with diameter from 30 to 40 microm), and large type II (with diameter greater than 40 microm). On the electron microscope level, the immunoproduct was observed in neurons, dendrites, and terminal boutons. According to the ultrastructural features, the neurons were divided into three groups--small (with diameter less than 15 microm), medium-sized (with diameter from 15 to 30 microm), and large (with diameter greater than 30 microm). At least two types of nNOS-ir synaptic boutons were easily distinguished. As a conclusion, we hope that this study will contribute to a better understanding of the functioning of the vestibular complex in cat and that some of the data presented could be extrapolated to other mammals, including human.

Effect of cadmium and copper on the production of citric acid by Aspergillus niger

Copper and cadmium inhibited the growth as well as citric acid production (depending on the heavy metal concentrations) by citric-acid-producing Aspergillus niger. Activity of citrate synthase was connected with citrate synthesis in the absence as well as in the presence of heavy metals. The activity of aconitase, and both NAD- and NADP-isocitrate dehydrogenases was strongly inhibited by copper. The contents of DNA and proteins in the cells decreased but the contents of lipids and polysaccharides increased considerably in the presence of both heavy metals.

Antiviral activity of cholesteryl esters of cinnamic acid derivatives

Cholesteryl 3",4"-dimethoxycinnamate (7) and a new synthesized o-coumaroyl ester of 3 beta-(2'-hydroxyethoxy)-cholest-5-en (13) exhibited a marked activity against poliovirus type 1 (Mahoney). Compound 7 showed an approximately 20-fold greater selectivity in its antiviral activity than compound 13. These compounds were selected from thirteen steryl esters of cinnamic acid derivatives through an in vitro antiviral screening against viruses belonging to taxonomic groups with causative agents of important human infectious diseases to which chemotherapy is indicated, i.e. Picornaviridae, Orthomyxoviridae, Paramyxoviridae and Herpesviridae.