Safety and efficacy of a novel double-lumen tracheal tube in neonates with RDS: A prospective cohort study

BackgroundThe purpose of this study was to assess the safety and efficacy of a new double-lumen tracheal tube for neonates, with a conventional tracheal tube as a control.MethodNewborns with respiratory distress syndrome (RDS) requiring endotracheal intubation admitted to the tertiary neonatal intensive care unit (NICU) of Qujing Maternal and Child Healthcare Hospital in Yunnan Province between March 2021 and May 2022 were enrolled in this prospective cohort study. Outcome indicators related to effectiveness included mainly the number of intubations, duration of ventilation, duration of oxygenation, and length of stay; safety indicators included any clinical adverse effects during and after intubation. Appropriate stratified and subgroup analyses were performed according to the purpose of intubation, gestational age, and whether the drug was administered via endotracheal tube.ResultA total of 101 neonates were included and divided into two groups based on the choice of tracheal tube: the conventional (n = 50) and new (n = 51) tracheal tube groups. There was no statistical difference between the two groups in terms of adverse effects during and after intubation (p > 0.05). In neonates who were mechanically ventilated without endotracheal surfactant therapy or newborns receiving InSurE technique followed by non-invasive ventilation, no significant differences were found between the two groups regarding any of the efficacy indicators (p > 0.05). However, for neonates on invasive mechanical ventilation, the new tracheal tube allowed for a significant reduction in the duration of mechanical ventilation (96.50[74.00, 144.00] vs. 121.00[96.00, 196.50] hours, p = 0.037) and total ventilation (205.71 ± 80.24 vs. 277.56 ± 117.84 h, p = 0.027), when used as a route for endotracheal drug delivery. Further analysis was performed according to gestational age for newborns requiring intratracheal surfactant administration during mechanical ventilation, and the data showed that for preterm infants, the new tracheal tube not only shortened the duration of mechanical ventilation (101.75 ± 39.72 vs. 155.50 ± 51.49 h, p = 0.026) and total ventilation (216.00 ± 81.60 vs. 351.50 ± 113.79 h, p = 0.010), but also demonstrated significant advantages in reducing the duration of oxygen therapy (9.75 ± 6.02 vs. 17.33 ± 8.43 days, p = 0.042); however, there was no statistical difference in efficacy outcomes between the two groups in full-term infants (p > 0.05).ConclusionThe efficacy and safety of this new tracheal tube are promising in neonates with RDS, especially those requiring surfactant administration via a tracheal tube during mechanical ventilation. Given the limitations of this study, however, the clinical feasibility of this catheter needs to be further confirmed in prospective randomized trials with larger sample sizes.Clinical Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=12207

Sex-specific associations of the endocrine-disrupting chemicals with serum neurofilament light chain among US adults

Objective: Endocrine-disrupting chemicals (EDCs) can interfere with endocrine function and lead to neurological damage. Neurofilament light chain (NfL) is a protein released into the blood after neuroaxonal damage, and it has become a dependable biomarker for neurological conditions. The study aimed to investigate the associations between single or combined EDCs exposure and serum NfL levels in adults. Methods: The 1372 participants included in the study were from the 2013–2014 National Health and Nutrition Examination Survey. Due to the difference in types of EDCs, participants were divided into two populations. Multiple linear regression models were used to assess the association between 32 EDCs and NfL. The least absolute shrinkage and selection operator regression model was used for EDCs selection and the weighted quantile sum (WQS) regression was used for examining the association of EDCs mixture with NfL and identify the predominant exposure. Results: Levels of urinary bisphenol S, mono(2-ethylhexyl) phthalate, dibutyl phosphate, glyphosate, and 3,5,6-trichloropyridinol were positively associated with serum NfL levels, while benzophenone-3, methylparaben, and propylparaben showed negative associations. In the WQS regression model, the changes of NfL were 0.154 (95 % CI: 0.014–0.294) and 0.164 (95 % CI: 0.033–0.296) for each quartile increase in WQS index of EDCs mixture in the two populations, respectively. Analysis of the subgroup with gender stratification suggested that the association between EDCs mixture and NfL was only significant in men. The positive mixture β was 0.219 (95 % CI: 0.056–0.380) and 0.257 (95 % CI: 0.082–0.433) in the two population, respectively. Conclusion: The study suggested a potential association between single or combined exposure to EDCs and NfL levels. High-level EDCs exposure might be associated with more severe neurological damage, particularly in men

Factors That Influence Compliance to Long-Term Remote Ischemic Conditioning Treatment in Patients With Ischemic Stroke

Objectives: To investigate the treatment compliance of patients with ischemic stroke to remote ischemic conditioning (RIC) and to determine the factors that influence compliance.Methods: We conducted a retrospective study of patients with ischemic stroke who were treated with RIC. Treatment compliance was determined and analyzed in patients who had received 1 year of RIC training. Factors that influenced patient compliance were also determined using univariate and multivariate regression analyses.Results: Between March 2017 and February 2018, 91 patients were recruited into this study. The mean (±SD) age was 57.98 ± 10.76 years, and 78 (85.7%) patients were male. The baseline Kolcaba comfort scale of patients with good compliance scores were higher than those with poor compliance. The scores of the four dimensions in the scale and the total score are as follows: physiological dimensions, 15.0 (12.0,17.0) vs 17.0 (13.0,19.0); psychological dimensions, 30.0 (25.0,34.0) vs 31.0 (27.0,35.0); sociological dimensions, 20.0 (18.0,24.0) vs 21.0 (18.0,23.0); environmental dimensions, 19.0 (12.0,24.0) vs 20.0 (17.0,22.0); and total points, 82.0 (69.0,94.0) vs 91.0 (78.0,98.0). the differences between the groups were significant (p &amp;lt; 0.05), except for the sociological dimensions. A history of hypertension, number of follow-ups, and the physiological, psychological, and environmental dimensions of the comfort scale were related to patient compliance, out of which the number of follow-ups (Adjusted OR = 2.498, 95% confidence interval (CI) 1.257–4.964) and the physiological discomfort (Adjusted OR = 1.128, 95% CI 1.029–1.236) independently influenced compliance (p &amp;lt; 0.05).Conclusion: In patients with ischemic cerebrovascular disease who were treated with RIC, the number of follow-up visits and physiological discomfort associated with RIC treatment independently influenced patient compliance. Further studies are needed to investigate the RIC protocols and their corresponding nursing models.</jats:p

Abstract WP444: Influencing Factors on the Compliance in Ischemic Stroke Patients Treated With Remote Ischemic Conditioning

Objectives: To investigate the treatment compliance of remote ischemic conditioning in patients with ischemic stroke, and determine its associated influencing factors. Methods: A retrospective survey of ischemic stroke patients treated with remote ischemic conditioning was conducted. Treatment compliance was obtained and analysed in patients with one-year training of remote ischemic conditioning. The influencing factors on patients’ compliance were determined by univariate and multivariate regression analysis. Results: The history of hypertension, the number of follow-ups, and the physiological, psychological and environmental dimensions of the comfort scale were related to patient compliance, out of which the number of follow-ups and physiological comfort were independent influencing factors of compliance (P&lt;0.05). Conclusion: In future researches, if we can comprehensively consider the patient’s efficacy, comfort, compliance and other factors, choose the optimal treatment dose, and improve the RIC nursing process accordingly, then this will provide the basis for clinical implementation and scientific research of RIC. </jats:p

Predicting prognosis in patients with stroke treated with intravenous alteplase through the 24‐h trajectory of blood pressure changes

Abstract Blood pressure (BP) monitored within 24 h from the beginning of intravenous thrombolysis (IVT) with alteplase, is one of the important factors affecting the prognosis of patients with acute ischemic stroke (AIS). This study aimed to explore longitudinal BP trajectory patterns and determine their association with stroke prognosis after thrombolysis. From November 2018 to September 2019, a total of 391 patients were enrolled consecutively during the study period, and 353 patients were ultimately analyzed. Five systolic (SBP) and four diastolic blood pressure (DBP) trajectory subgroups were identified. The regression analysis showed that when compared with the rapidly moderate stable group, the continuous fluctuation‐very high level SBP group (odds ratio [OR]: 2.743, 95% confidence interval [CI]: 1.008–7.467) was associated with early neurological deterioration (END). Both the rapid drop‐high level SBP (OR: 0.448, 95% CI: 0.219–0.919) and DBP groups (OR: 0.399, 95% CI: 0.219–0.727) were associated with early neurological improvement (ENI). Moreover, there was a U‐shaped correlation between the OR value of SBP trajectory group and favorable outcome (the modified Rankin Scale [mRS] score 0–2) at 3 months: the slow drop‐low level SBP group represent a well‐established unfavorable outcome risk factor (OR:5.239, 95% CI: 1.271–21.595), and extremely high SBP—the continuous fluctuation‐very high level SBP group, are equally associated with elevated unfavorable outcome risk (OR:3.797, 95% CI: 1.486–9.697). The continuous fluctuation‐very high level DBP group was statistically significant in mRS (OR: 3.387, CI: 1.185–9.683). The BP trajectory groups show varying clinical features and risk of neurological dysfunction. The findings may help identify potential candidates for clinical BP monitoring, control, and specialized care

Abstract TP390: The Prognosis of Adverse Stroke Outcomes on the Post IV Alteplase Ischemic Stroke Patients: A Trajectory Groups of 24-Hour Systolic Blood Pressure (SBP) Measurement

Background: To explore whether longitudinal 24-hour SBP trajectory patterns after thrombolysis could predict the risk of adverse stroke outcome. Methods: The total of 362 ischemic stroke patients, were selected with onset of within 4.5 hours and underwent intravenous(IV) thrombolysis with alteplase(rt-PA). Group-based trajectory models to identify SBP subgroups were used. The demographics, medical history, laboratory test results and the stroke outcome including early neurological deterioration (END), early neurological improvement (ENI), hemorrhage, Barthel index(BI), the modified Rankin Scale (mRS) score, recurrent stroke at 3 months after stroke were collected. Results: The stroke patients with IV thrombolysis were classified into six SBP trajectory groups: admission SBP, antihypertensive drugs before thrombolysis, history of hypertension, stroke, hemoglobin, glucose, and triglycerides. There was no difference in the incidence of hemorrhage, END, and recurrent stroke. The results of logistic analysis,when compared with the moderate-stable SBP group, there was a negative correlation between the risk of ENI and SBP trajectory patterns (OR=0.32; 95%CI: 0.15 to 0.67) , and the “J” correlation between the risk of the mRS score(OR=0.31; 95%CI: 1.50 to 7.30). Conclusion: The findings potentially help identify candidates for clinical blood pressure observation, blood pressure control and nursing care and management. </jats:p

New insights into DEHP-induced inflammatory injury in chicken spleen: ROS/TLR4/MyD88 pathway and apoptosis/necroptosis-M1 polarization crosstalk

The environmental endocrine disruptor di(2-ethylhexyl) phthalate (DEHP) is a plasticiser used in large quantities in plastics and is hazardous to the health of humans and various animals. DEHP can be immunotoxic to the spleen through oxidative stress. Still, the role of splenic macrophage polarization in lymphocyte apoptosis and necroptosis, whether they interact with each other, and the mechanism of the effect on splenic inflammatory injury are unknown. In this study, based on the construction of a time-and dose-dependent model of DEHP-exposed chicken spleen, chicken lymphoma cell (MSB-1) and chicken macrophage (HD11) models were established to investigate the mechanism of apoptosis/necroptosis-M1 polarization crosstalk in DEHP-induced toxicity in chicken spleen injury. The results showed that DEHP exposure activated the ROS/TLR4/MyD88 pathway, up-regulated the expression of chemokines, induced macrophage M1 polarization, caused apoptosis and necroptosis in lymphocytes and inflicted inflammatory damage to the spleen, however, these effects could be alleviated by NAC. DEHP exposure of the HD11/MSB-1 cell co-culture system showed that M1 polarization promoted apoptosis and necroptosis and vice versa. In conclusion, DEHP exposure is involved in mediating the crosstalk between apoptosis/necroptosis and M1 polarization through the activation of the ROS/TLR4/MyD88 pathway, which in turn exacerbates inflammatory injury in the chicken spleen

Low-intensity pulsed ultrasound inhibits fibroblast-like synoviocyte proliferation and reduces synovial fibrosis by regulating Wnt/β-catenin signaling

Objective: Synovial fibrosis is a characteristic symptom of osteoarthritis (OA), which is closely associated with joint pain and stiffness. Previous studies have reported that low-intensity pulsed ultrasound (LIPUS) can alleviate cartilage degradation in OA. However, the functions and mechanisms of LIPUS in OA synovial fibrosis are still unknown. Methods: The destabilization of the medial meniscus (DMM) mouse model of OA was established in C57 male mice and fibroblast-like synoviocytes (FLS) were isolated from synovial tissue of OA patients. The knee joint diameter, Masson's trichrome (MT) and Hematoxylin-eosin (HE) staining were used to evaluate synovial fibrosis and hyperplasia. The Immunohistochemistry (IHC) staining was performed to detected the expression of synovial fibrosis makers and the activation of Wnt/β-catenin signaling in vivo. FLS were treated with TGF-β1 to serve as an in vitro model of synovial fibrosis, Wnt3a was used to activate the Wnt/β-catenin signaling in cells. Cell proliferation was detected by using EdU assay, cell viability was performed by CCK8 assay. The protein levels of α-SMA, CTGF, Col Ⅰ, β-catenin, active β-catenin, c-Myc and cyclin D1 were examined by western blot and immunofluorescence staining. Results: Two weeks after the LIPUS treatment, the synovial fibrosis, synovial hyperplasia and synoviocyte proliferation in the DMM model were significantly decreased. In vitro, LIPUS directly inhibited the TGF-β1-induced fibrotic response and proliferation of FLS. Meanwhile, LIPUS suppressed Wnt/β-catenin signaling in the synovium of DMM mice and cultured FLS. More importantly, we found that the synovial fibrosis makers, Wnt/β-catenin pathway downstream proteins and FLS proliferation were significantly decreased in Wnt3a-stimulated FLS following LIPUS treatment. Conclusions: Our results present a novel role of LIPUS in OA-related synovial fibrosis, which is associated with its ability to repress Wnt/β-catenin signaling in FLS. The translational potential of this article: This study provides new insight into the clinical application of LIPUS as a therapeutic option to manage synovial fibrosis in OA