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Alternative Therapies in Health and... Apr 2024Extremely premature infants (EPIs) are those less than 32 weeks of gestational age. Preterm birth is the leading cause of neonatal death and poor prognosis, accounting...
BACKGROUND
Extremely premature infants (EPIs) are those less than 32 weeks of gestational age. Preterm birth is the leading cause of neonatal death and poor prognosis, accounting for 25% of neonatal deaths, with extremely premature births accounting for 50% of all premature deaths. Continuous quality improvement (CQI) improves patient outcomes by changing and optimizing clinical practice including increasing participation of neonatologists in prenatal consultation, maintenance of normal body temperature in preterm infants, early use of pulmonary surfactant, reduction of mechanical ventilation time and intensive breastfeeding to reduce clinically avoidable adverse events.
OBJECTIVE
The risk of death and disability is high for very preterm infants, with a mortality rate of 30-50% and a risk of at least 20-50% for survivors. This study aimed to investigate the effect of CQI on the incidence of complications and treatment outcomes in very preterm infants.
DESIGN
This was a retrospective study.
SETTING
This study was conducted in the Maternal and Child Health Hospital of Hubei Province.
PARTICIPANTS
A total of 140 EPIs born in our hospital and transferred to the neonatal intensive care unit between August 1, 2020, and July 31, 2022, were enrolled. The EPIs were divided into two groups: before improvement (n=79, 56.4%) and after improvement (n=61, 43.6%) according to the week of birth, and the gestational age ranged from 26 weeks to 26 weeks 6 days into the 26 weeks group.
INTERVENTIONS
From August 2021, the hospital implemented the CQI method, which included neonatologists' participation in consultations before birth, the care of a professionally trained resuscitation team after birth, and the introduction of transport heating tanks and ventilators during transport.
PRIMARY OUTCOME MEASURES
(1) Apgar score (2) body weight (3) duration of invasive ventilation (4) length of stay (5) treatment expense (6) incidence of complications and (7) survival rate of EPIs.
RESULTS
The application of CQI methods resulted in significant improvements in body weight (1305 g vs 1404 g) and duration of invasive ventilation (4.64 d vs 7.40 d) in EPIs (P = .036 and P = .040), reduced the time of invasive mechanical ventilation decreased significantly, from 7.4 days to 4.64 days (P < .01), increased the median temperature of newborn infants (36.2°C vs 35.7°C) (P = 0), increased the proportion of newborn infants with a temperature greater than 36°C (67.2% vs 35.4%) (P < .001), reduced the incidence of complications in EPIs (32.79% vs 45.57%) (P < .05).
CONCLUSION
The application of the CQI approach significantly increases the body temperature, improves the incidence of complications of EPIs, and is conducive to the survival of EPIs. Our study may provide a clinical reference for management of EPIs.
PubMed: 38607199
DOI: No ID Found -
Nan Fang Yi Ke Da Xue Xue Bao = Journal... Mar 2024To evaluate the effect of esketamine combined with distal limb ischemic preconditioning (LIP) for lung protection in elderly patients undergoing thoracoscopic radical... (Randomized Controlled Trial)
Randomized Controlled Trial
[Lung-protective effect of esketamine combined with distal limb ischemic preconditioning in elderly patients undergoing thoracoscopic radical surgery for lung cancer: a randomized controlled trial in 160 cases].
OBJECTIVE
To evaluate the effect of esketamine combined with distal limb ischemic preconditioning (LIP) for lung protection in elderly patients undergoing thoracoscopic radical surgery for lung cancer.
METHODS
This randomized trial was conducted in 160 patients undergoing elective thoracoscopic surgery for lung cancer, who were randomized into control group (with saline injection and sham LIP), esketamine group, LIP group, and esketamine + LIP group (=40). Before anesthesia induction, according to the grouping, the patients received an intravenous injection with 0.5 mg/kg esketamine or 10 ml saline (in control group). LIP was induced by applying a tourniquet 1-2 cm above the popliteal fossa in the left lower limb to block the blood flow for 5 min for 3 times at the interval of 5 min, and sham LIP was performed by applying the tourniquet without pressurization for 30 min. Oxygenation index (OI) and alveolar-arterial PO difference (A-aDO) were calculated before induction (T0), at 30 min (T0.5) and 1 h (T1) of one-lung ventilation (OLV), and at 1 h after two-lung ventilation (T3). Serum levels of SP-D, CC-16 and TNF-α were measured by ELISA at T0, T1, T2 (2 h of OLV), T3, and 24 h after the operation (T4). The length of hospital stay and postoperative pulmonary complications of the patients were recorded.
RESULTS
Compared with those in the control group, the patients in the other 3 groups had significantly lower CC-16, SP-D and TNF- levels, shorter hospital stay, and lower incidences of lung infection and lung atelectasis (all < 0.05). Serum CC-16, SP-D and TNF-α levels, hospital stay, incidences of complications were significantly lower or shorter in the combined treatment group than in esketamine group and LIP group (all < 0.05).
CONCLUSION
In elderly patients undergoing thoracoscopic radical surgery for lung cancer, treatment with esketamine combined with LIP can alleviate acute lung injury by enhancing anti-inflammatory response to shorten postoperative hospital stay, reduce lung complications and promote the patients' recovery.
Topics: Humans; Aged; Lung Neoplasms; Tumor Necrosis Factor-alpha; Pulmonary Surfactant-Associated Protein D; Lung; Thoracoscopy; One-Lung Ventilation; Postoperative Complications; Ischemic Preconditioning; Ketamine
PubMed: 38597439
DOI: 10.12122/j.issn.1673-4254.2024.03.09 -
Frontiers in Immunology 2024SARS coronavirus 2 (SARS-CoV-2) infects human angiotensin-converting enzyme 2 (hACE2)-expressing lung epithelial cells through its spike (S) protein. The S protein is...
INTRODUCTION
SARS coronavirus 2 (SARS-CoV-2) infects human angiotensin-converting enzyme 2 (hACE2)-expressing lung epithelial cells through its spike (S) protein. The S protein is highly glycosylated and could be a target for lectins. Surfactant protein A (SP-A) is a collagen-containing C-type lectin, expressed by mucosal epithelial cells and mediates its antiviral activities by binding to viral glycoproteins.
OBJECTIVE
This study examined the mechanistic role of human SP-A in SARS-CoV-2 infectivity and lung injury and .
RESULTS
Human SP-A can bind both SARS-CoV-2 S protein and hACE2 in a dose-dependent manner (p<0.01). Pre-incubation of SARS-CoV-2 (Delta) with human SP-A inhibited virus binding and entry and reduced viral load in human lung epithelial cells, evidenced by the dose-dependent decrease in viral RNA, nucleocapsid protein (NP), and titer (p<0.01). We observed significant weight loss, increased viral burden, and mortality rate, and more severe lung injury in SARS-CoV-2 infected hACE2/SP-A KO mice (SP-A deficient mice with hACE2 transgene) compared to infected hACE2/mSP-A (K18) and hACE2/hSP-A1 (6A) mice (with both hACE2 and human SP-A1 transgenes) 6 Days Post-infection (DPI). Furthermore, increased SP-A level was observed in the saliva of COVID-19 patients compared to healthy controls (p<0.05), but severe COVID-19 patients had relatively lower SP-A levels than moderate COVID-19 patients (p<0.05).
DISCUSSION
Collectively, human SP-A attenuates SARS-CoV-2-induced acute lung injury (ALI) by directly binding to the S protein and hACE2, and inhibiting its infectivity; and SP-A level in the saliva of COVID-19 patients might serve as a biomarker for COVID-19 severity.
Topics: Animals; Humans; Mice; Acute Lung Injury; COVID-19; Disease Models, Animal; Lectins, C-Type; Pulmonary Surfactant-Associated Protein A; SARS-CoV-2; Spike Glycoprotein, Coronavirus
PubMed: 38596675
DOI: 10.3389/fimmu.2024.1370511 -
Molecular Therapy. Methods & Clinical... Jun 2024Pulmonary macrophage transplantation (PMT) is a gene and cell transplantation approach in development as therapy for hereditary pulmonary alveolar proteinosis (hPAP), a...
Pulmonary macrophage transplantation (PMT) is a gene and cell transplantation approach in development as therapy for hereditary pulmonary alveolar proteinosis (hPAP), a surfactant accumulation disorder caused by mutations in (and murine homologs). We conducted a toxicology study of PMT of gene-corrected macrophages (mGM-RαMϕs) or saline-control intervention in or wild-type (WT) mice including single ascending dose and repeat ascending dose studies evaluating safety, tolerability, pharmacokinetics, and pharmacodynamics. Lentiviral-mediated cDNA transfer restored GM-CSF signaling in mGM-RαMϕs. Following PMT, mGM-RαMϕs engrafted, remained within the lungs, and did not undergo uncontrolled proliferation or result in bronchospasm, pulmonary function abnormalities, pulmonary or systemic inflammation, anti-transgene product antibodies, or pulmonary fibrosis. Aggressive male fighting caused a similarly low rate of serious adverse events in saline- and PMT-treated mice. Transient, minor pulmonary neutrophilia and exacerbation of pre-existing hPAP-related lymphocytosis were observed 14 days after PMT of the safety margin dose but not the target dose (5,000,000 or 500,000 mGM-RαMϕs, respectively) and only in mice but not in WT mice. PMT reduced lung disease severity in mice. Results indicate PMT of mGM-RαMϕs was safe, well tolerated, and therapeutically efficacious in mice, and established a no adverse effect level and 10-fold safety margin.
PubMed: 38596536
DOI: 10.1016/j.omtm.2024.101213 -
JPMA. the Journal of the Pakistan... Mar 2024To review the association of surfactant protein-D with type 2 diabetes mellitus, infections, oxidative stress and inflammation, and the changes in oxidative stress...
OBJECTIVE
To review the association of surfactant protein-D with type 2 diabetes mellitus, infections, oxidative stress and inflammation, and the changes in oxidative stress markers in type 2 diabetes mellitus.
METHODS
The systematic review was conducted from April to September 2022, and comprised search on PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar databases for relevant studies published in English language between January 1, 2000, and June 30, 2022. The search was updated in September 2022. After transferring literature to Mendeley, relevant data was extracted from the included studies. Quality assessment for eligible studies was done using Joanna Briggs Institute Critical Appraisal Checklist. Quality of evidences was assessed by using Grading of Recommendations Assessment, Development and Evaluation tool.
RESULTS
Of the 203 studies identified, 18(8.9%) were analysed; 16(89%) with humans and 2(11%) with animals as subjects There were 5 (31.25%) studies for SP-D, of which 4 (80%) studies reported lower surfactant protein-D in type 2 diabetes mellitus cases than controls. Its significant negative association with glycated haemoglobin was reported by 1(20%) study and 2(40%) studies with fasting blood glucose levels. Higher surfactant protein-D in type 2 diabetes mellitus cases and its positive association with glycated haemoglobin was reported by 1(20%) study. Recurrent infections were frequent in type 2 diabetes mellitus patients. Malondialdehyde level was higher and superoxide dismutase activity was lower in type 2 diabetes mellitus cases, reflecting oxidative stress. Animal studies also showed that reactive oxygen species generating from hypochlorous acid during oxidative stress promoted the formation of non-disulfide linkages in surfactant protein-D structure, resulting in its decreased functionality.
CONCLUSION
Surfactant protein-D, oxidative stress, inflammation and infections were found to be linked to each other for pathogenesis of infections in type 2 diabetes mellitus.
Topics: Animals; Humans; Blood Glucose; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Inflammation; Oxidative Stress; Pulmonary Surfactant-Associated Protein D; Surface-Active Agents
PubMed: 38591293
DOI: 10.47391/JPMA.9977 -
Cureus Mar 2024Background The use of volume-targeted ventilation (VTV) in neonatology has been introduced in the last decade. This study was performed to determine the impact of...
A Retrospective Cohort Study of the Impact of Implementing Volume-Targeted Compared to Pressure-Limited Ventilation in a Single-Center, Level III Neonatal Intensive Care Unit in Oman.
Background The use of volume-targeted ventilation (VTV) in neonatology has been introduced in the last decade. This study was performed to determine the impact of clinical implementation of volume-targeted conventional mechanical ventilation using the volume guarantee mode in mechanical ventilation of all neonates needing mechanical ventilation compared to pressure-limited ventilation (PLV) modes. The mortality rate, duration of mechanical ventilation, and bronchopulmonary dysplasia were the primary outcomes of the study. Methodology This retrospective cohort study was conducted at a level III-VI neonatal intensive care unit (NICU) within a tertiary academic hospital in Oman. All intubated neonates admitted to the NICU within two time periods, i.e., the PLV cohort: January 2011 to December 2013 (three years), and the VTV cohort: January 2017 to December 2019 (three years), were eligible for inclusion in the study. Neonates were excluded if they had multiple congenital anomalies, tracheostomy, and those with a Do Not Resuscitate status. A predetermined data set was collected retrospectively from electronic records. The PLV and VTV cohorts were compared, and SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results A total of 290 neonates were included (PLV: n = 138, and VTV: n = 152). The two cohorts were statistically similar in their baseline characteristics, including gestational age, birth weight, Apgar scores, indications for mechanical ventilation, age at intubation, need for surfactant therapy, and age at extubation. The VTV cohort had a significantly lower mortality rate (n (%) = 10 (6.6%) vs. 21 (15.3%), p = 0.02). An insignificant trend of lower duration of ventilation was observed in the VTV cohort (34.5 vs. 50.5 hours, p = 0.24). There was no significant difference in bronchopulmonary dysplasia (16 (21.3%) vs. 12 (17.8%), p = 0.18). VTV was associated with a significant reduction in pulmonary hemorrhage (1 (0.7%) vs. 8 (5.7%), p = 0.04), episodes of hypocapnia (2 vs. 3/patient, p = 0.04), and episodes of hypercapnia (0 vs 1/patient, p = 0.04). Conclusions The implementation of VTV in clinical practice in our level III-VI NICU was associated with significant advantages, including reduction in mortality, pulmonary hemorrhage, and episodes of hypercapnia and hypocapnia. A large prospective, randomized, and multicenter trial is recommended to confirm these findings.
PubMed: 38586699
DOI: 10.7759/cureus.55731 -
American Journal of Translational... 2024To explore the potential effect of ultrasound-guided stellate ganglion block (SGB) on lung protection for patients undergoing one-lung ventilation (OLV).
OBJECTIVE
To explore the potential effect of ultrasound-guided stellate ganglion block (SGB) on lung protection for patients undergoing one-lung ventilation (OLV).
METHODS
A total of 123 patients undergoing elective one-lung ventilation surgery were selected as research subjects in this prospective study. These patients were randomly divided into the SGB group, control group and blank group on average. Stellate ganglion block was carried out in the SGB and control groups. Patients in the SGB group were injected with 6 ml mixture of 0.25% ropivacaine hydrochloride and 1% lidocaine hydrochloride, while those in the control group were injected with 6 mL of 0.9% saline. Punctures weren't performed for patients in the blank group. The same induction and maintenance of general anesthesia was adopted for all three groups. Hemodynamics, respiratory parameters and arterial blood gas analysis were recorded after entering the operation room (T0), pre-OLV (T1), 30 min after OLV (T2), 60 min after OLV (T3), at the end of surgery (T4), and 30 min after extubation (T5). Oxygenation index (OI), pulmonary shunt fraction (Qs/Qt) and pH value were compared at different time points. Intravenous serum was collected at T0, T3 and T5 for the detection of surfactant proteins A (SP-A), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels, respectively. The complications related to SGB after surgery and the postoperative pulmonary complications within 72 h were recorded.
RESULTS
At T1, T2, and T3, MAP level in SGB group was lower than that in blank and control groups (P<0.05). At T2, and T3, SGB group had lower hear rate (HR), peak airway pressure (P) and tidal volume (TV) than blank and control groups (all P<0.05). From T2 to T5, SGB group had higher OI but lower Qs/Qt than blank and control groups (both P<0.05). At T3 and T5, SGB group had lower SP-A, IL-6, and MDA levels but higher IL-10 and SOD levels than blank and control groups (all P<0.05). There was one case of hypoxemia in the blank group within 72 h after surgery.
CONCLUSION
Ultrasound-guided SGB has lung-protective effects on patients undergoing OLV, which significantly improves patients' OI, reduces intrapulmonary shunts, declines ventilator-induced lung damage, and inhibits inflammatory response as well as oxidative stress (China Clinical Trial Registry, registration number ChiCTR2000033385, https://www.chictr.org.cn).
PubMed: 38586109
DOI: 10.62347/UFZF5671 -
BioRxiv : the Preprint Server For... Mar 2024Protein cysteine thiols undergo reversible -acylation via a thioester linkage in vivo. -palmitoylation, modification by C16:0 fatty acid, is a common -acylation that...
Protein cysteine thiols undergo reversible -acylation via a thioester linkage in vivo. -palmitoylation, modification by C16:0 fatty acid, is a common -acylation that mediates protein-membrane and protein-protein interactions critical to an array of biological processes, from homeostatic lung surfactant function to cellular transformation. The most widely used -acylation assays, including acyl-biotin exchange (ABE) and acyl resin-assisted capture (Acyl-RAC), utilize blocking of free Cys thiols, hydroxylamine-dependent cleavage of the thioester and subsequent labeling of nascent thiol. ABE and Acyl-RAC have enabled both the proteome-wide identification of -palmitoylation sites and basic biochemical studies. Yet, these assays generally utilize hundreds of micrograms to milligrams of input material and require numerous reagent removal and washing steps, making them laborious and ill-suited for high throughput and low input applications. To overcome this, we devised "Acyl-Trap", a suspension trap-based assay that utilizes a thiol-reactive quartz to enable buffer exchange and hydroxylamine-mediated -acyl enrichment from 20-50 micrograms of input protein. The method is compatible with protein-level detection of Sacylated proteins as well as -acyl site-based identification and quantification using on-quartz isobaric (tandem mass tag) labeling and LC-MS/MS. Also described are conditions for long-term hydroxylamine storage, which further expedites the assay and minimizes waste. More generally, Acyl-Trap serves as a proof-of-concept for PTM-tailored suspension traps suitable for both traditional intact protein detection and chemoproteomic workflows.
PubMed: 38585928
DOI: 10.1101/2024.03.23.586403 -
Experimental Biology and Medicine... 2024Regulatory T cells (Tregs) constitute a specialized subset of T cells with dual immunoregulatory and modulatory functions. Recent studies have reported that Tregs...
Regulatory T cells (Tregs) constitute a specialized subset of T cells with dual immunoregulatory and modulatory functions. Recent studies have reported that Tregs mediate immune responses and regulate the development and repair processes in non-lymphoid tissues, including bone and cardiac muscle. Additionally, Tregs facilitate the repair and regeneration of damaged lung tissues. However, limited studies have examined the role of Tregs in pulmonary development. This study aimed to evaluate the role of Tregs in pulmonary development by investigating the dynamic alterations in Tregs and their hallmark cellular factor Forkhead box P3 (Foxp3) at various stages of murine lung development and establishing a murine model of anti-CD25 antibody-induced Treg depletion. During the early stages of murine lung development, especially the canalicular and saccular stages, the levels of Treg abundance and expression of Foxp3 and transforming growth factor-β (TGF-β) were upregulated. This coincided with the proliferation period of alveolar epithelial cells and vascular endothelial cells, indicating an adaptation to the dynamic lung developmental processes. Furthermore, the depletion of Tregs disrupted lung tissue morphology and downregulated lung development-related factors, such as surfactant protein C (SFTPC), vascular endothelial growth factor A (VEGFA) and platelet endothelial cell adhesion molecule-1 (PECAM1/CD31). These findings suggest that Tregs promote murine lung development.
Topics: Mice; Animals; T-Lymphocytes, Regulatory; Vascular Endothelial Growth Factor A; Endothelial Cells; Lung; Forkhead Transcription Factors
PubMed: 38577707
DOI: 10.3389/ebm.2024.10040 -
Prilozi (Makedonska Akademija Na... Mar 2024Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns...
Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns between January 2021 and July 2022 at the University Clinic for Gynecology and Obstetrics, Skopje. Up to date criteria for HIE/RDS for term and for preterm infants as well for the severity of HIE/RDS were used in a comprehensive analysis of cranial ultrasonography, neurological status, neonatal infections, Apgar score, bradycardia and hypotension, X-ray of the lungs, FiO2, acid-base status, assisted ventilation and use of surfactant. Three groups were created: HIE with RDS (42 babies), HIE without RDS (30 babies) and RDS without HIE in 38 neonates. All newborns with severe (third) degree of HIE died. Intracranial bleeding was found in 35.7% in the first group and 30% in the second group, and in the third group in 53.3%. The need for surfactant in the HIE group with RDS is 59.5%, and in the RDS group without HIE 84.2%. DIC associated with sepsis was found in 13.1-50% in those groups. In newborns with HIE and bradycardia, the probability of having RDS was on average 3.2 times higher than in those without bradycardia. The application of the surfactant significantly improved the pH, pO2, pCO2, BE and chest X-ray in children with RDS. An Apgar score less than 6 at the fifth minute increases the risk of RDS by 3 times. The metabolic acidosis in the first 24 hours increases the risk of death by 23.6 times. The combination of HIE/ RDS significantly worsens the disease outcome. The use of scoring systems improved the early detection of high risk babies and initiation of early treatment increased the chances for survival without disabilities.
Topics: Infant; Pregnancy; Female; Child; Infant, Newborn; Humans; Infant, Premature; Hypoxia-Ischemia, Brain; Bradycardia; Respiratory Distress Syndrome, Newborn; Pulmonary Surfactants; Surface-Active Agents
PubMed: 38575384
DOI: 10.2478/prilozi-2024-0003