Oxygen

氧气
  • 文章类型: Case Reports
    药物相关的颌骨坏死(MRONJ)可能是一种使人衰弱的并发症,可在服用或正在服用抗吸收(包括双膦酸盐)或抗血管生成药物的患者中出现,导致可见的骨头或瘘管持续八周以上,没有任何放疗史。该临床病例旨在描述使用blue®m口服凝胶的局部活性氧疗法治疗MRONJ。一名63岁的女性患者,通过口服每周服用阿仑膦酸钠(70毫克)四年,在#46区域表现出不适和植入物运动,然后接受了植入物的手术提取。三个月后,患者返回并被诊断为MRONJ。最初,进行了常规治疗,包括手术清创和抗生素治疗,但没有成功。植入物拔除后六个月,患者仍有骨坏死的临床体征。然后通过局部施用用blue®m口服凝胶填充整个插座。指示患者每8小时继续向该区域施用凝胶,持续15天。在这段时间之后,病人回来了,观察到伤口处于愈合过程中,有上皮化组织的存在,没有骨暴露。2年临床随访显示病灶已完全愈合,安装了新的植入物。骨整合期之后,最后的假体被放置。患者仍在临床随访中。因此,可以得出结论,在该临床病例中应用blue®m口服凝胶有助于骨坏死病变的恢复。
    Medication-related osteonecrosis of the jaw (MRONJ) can be a debilitating complication that can arise in patients who took or are taking antiresorptive (including bisphosphonates) or antiangiogenic agents, leading to visible bone or a fistula that continues for more than eight weeks, without any history of radiotherapy. This clinical case aimed to describe the treatment of MRONJ with topical active oxygen therapy using blue®m oral gel. A 63-year-old female patient that had been taking weekly sodium alendronate (70 mg) for four years by oral via, presented discomfort and implant movement in the #46 region, by that underwent surgical extraction of the implant. After three months the patient returned and was diagnosed with MRONJ. Initially, conventional therapies were performed, including surgical debridement and antibiotic therapy, but without success. The patient still had clinical signs of osteonecrosis six months after the implant extraction. The entire socket was then filled with blue®m oral gel by topical application. The patient was instructed to continue applying the gel to the region every 8 hours for 15 days. After this period, the patient returned, and it was observed that the wound was in the healing process, with the presence of epithelialized tissue and without bone exposure. The 2-year clinical follow-up showed the lesion had healed entirely, and a new implant was installed. After the osseointegration period, the final prosthesis was placed. The patient remains under clinical follow-up. Therefore, it can be concluded that the application of blue®m oral gel in this clinical case assisted in the recovery of the osteonecrosis lesion.
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  • 文章类型: Journal Article
    目的:在放疗的基础上,对缺氧膀胱癌患者进行缺氧修饰,但是没有生物标志物来识别缺氧肿瘤患者。我们,在这里,旨在在源自肌肉浸润性膀胱癌(MIBC)的异种移植物中实施氧增强MRI(OE-MRI),用于未来的缺氧生物标志物发现工作;并生成基因表达数据用于未来的生物标志物发现。
    方法:接种HT1376MIBC细胞的雌性CD-1裸鼠的侧腹。对具有小(300mm3)或大(700mm3)肿瘤的小鼠进行成像,在Agilant7T16cm口径磁体中注入吡莫硝唑1h后,使用动态MPRAGE采集的T2-TurboRARE序列与BrukerAvanceIII控制台连接。采集动态损坏梯度的回波图像5分钟,含0.1mmol/kgGd-DOTA(Dotarem,Guerbet,UK)在60s(1ml/min)后注射。匹配动态对比增强(DCE)-MRI和OE-MRI扫描的体素大小和视野。在DCE-MRI扫描中被认为灌注有显著对比后增强(p<0.05)的体素和组织被进一步分成pOxyE(常氧)和pOxyR(低氧)区域。在液氮中收获肿瘤,切片,提取RNA并使用Clarioms微阵列分析转录组。
    结果:成像的缺氧区域在较大与较小的肿瘤中更大。已知的缺氧诱导基因和24基因膀胱癌缺氧评分在吡莫硝唑高与低区域中的表达较高:CA9(p=0.012)和SLC2A1(p=0.012),表明预期的转录组学行为。
    结论:OE-MRI在MIBC来源的异种移植物中成功实施。来自低氧和非低氧异种移植区域的转录组数据将对未来的研究有用。
    OBJECTIVE: Patients with hypoxic bladder cancer benefit from hypoxia modification added to radiotherapy, but no biomarkers exist to identify patients with hypoxic tumours. We, herein, aimed to implement oxygen-enhanced MRI (OE-MRI) in xenografts derived from muscle-invasive bladder cancer (MIBC) for future hypoxia biomarker discovery work; and generate gene expression data for future biomarker discovery.
    METHODS: The flanks of female CD-1 nude mice inoculated with HT1376 MIBC cells. Mice with small (300 mm3) or large (700 mm3) tumours were imaged, breathing air then 100% O2, 1 h post injection with pimonidazole in an Agilant 7T 16cm bore magnet interfaced to a Bruker Avance III console with a T2-TurboRARE sequence using a dynamic MPRAGE acquisition. Dynamic Spoiled Gradient Recalled Echo images were acquired for 5 min, with 0.1mmol/kg Gd-DOTA (Dotarem, Guerbet, UK) injected after 60 s (1 ml/min). Voxel size and field of view of dynamic contrast enhanced (DCE)-MRI and OE-MRI scans were matched. The voxels considered as perfused with significant post-contrast enhancement (p<0.05) in DCE-MRI scans and tissue were further split into pOxyE (normoxic) and pOxyR (hypoxic) regions. Tumours harvested in liquid N2, sectioned, RNA was extracted and transcriptomes analysed using Clariom S microarrays.
    RESULTS: Imaged hypoxic regions were greater in the larger versus smaller tumour. Expression of known hypoxia-inducible genes and a 24 gene bladder cancer hypoxia score were higher in pimonidazole-high versus -low regions: CA9 (p=0.012) and SLC2A1 (p=0.012) demonstrating expected transcriptomic behaviour.
    CONCLUSIONS: OE-MRI was successfully implemented in MIBC-derived xenografts. Transcriptomic data derived from hypoxic and non-hypoxic xenograft regions will be useful for future studies.
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  • 文章类型: Journal Article
    化学需氧量(COD)的测量在污水处理过程中非常重要。COD值在一定程度上反映了污水处理的效果和趋势,但是获得准确的数据需要很高的成本和劳动强度。TO1解决这个问题,提出了一种基于卷积神经网络-双向长短期记忆网络-注意力机制(CNN-BiLSTM-attention)算法的COD在线软测量方法。首先,通过分析厌氧-缺氧-氧化(A2O)废水处理过程中好氧池阶段的机理,初步确定了输入变量的选择范围,并对采集的样本数据集进行相关性分析。最后,pH值,溶解氧(DO),电导率(EC),和水温(T)被确定为COD软测量预测的输入变量。然后,基于CNN的特征提取能力和BiLSTM能够捕获时间序列数据中的后向和前向依赖的优势,结合可以为关键数据分配更高权重的注意力机制,建立了CNN-BiLSTM-Attention算法模型对A2O污水处理过程好氧区出水COD进行软测量。同时,均方根误差(RMSE),平均绝对误差(MAE),平均绝对百分比误差(MAPE)和决定系数(R2)三个指标用于评估模型,结果表明,该模型能够准确预测COD值,具有较高的准确性。同时,与CNN-LSTM-Attention等模型相比,CNN-BiLSTM,CNN-LSTM,LSTM,RNN,BP,SVM,XGBoost,和RF等。,结果表明,CNN-BiLSTM注意力模型表现最好,证明了算法模型的优越性。Wilcoxon符号秩检验表明CNN-BiLSTM-注意力模型与其他模型之间存在显著差异。
    The measurement of chemical oxygen demand (COD) is very important in the process of sewage treatment. The value of COD reflects the effectiveness and trend of sewage treatment to a certain extent, but obtaining accurate data requires high cost and labor intensity. To1 solve this problem, this paper proposes an online soft measurement method for COD based on Convolutional Neural Network-Bidirectional Long Short-Term Memory Network-Attention Mechanism (CNN-BiLSTM-Attention) algorithm. Firstly, by analyzing the mechanism of the aerobic tank stage in the Anaerobic-Anoxic-Oxic (A2O) wastewater treatment process, the selection range of input variables was preliminarily determined, and the collected sample dataset was subjected to correlation analysis. Finally, pH, dissolved oxygen (DO), electrical conductivity (EC), and water temperature (T) were determined as input variables for soft measurement prediction of COD.Then, based on the feature extraction ability of CNN and the advantage that BiLSTM is able to capture the backward and forward dependencies in time series data, combined with the attention mechanism that can assign higher weights to the key data, a CNN-BiLSTM-Attention algorithm model was established to soft measure COD in the effluent from the aerobic zone of the A2O wastewater treatment process. At the same time, root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and coefficient of determination (R2) were utilized Three indicators were used to evaluate the model, and the results showed that the model can accurately predict the value of COD and has a high accuracy. At the same time, compared with models such as CNN-LSTM-Attention, CNN-BiLSTM, CNN-LSTM, LSTM, RNN, BP, SVM, XGBoost, and RF etc., the results showed that the CNN-BiLSTM Attention model performed the best, proving the superiority of the algorithm model.The Wilcoxon signed-rank test indicates significant differences between the CNN-BiLSTM-Attention model and other models.
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  • 文章类型: Journal Article
    缺氧(OD)是一种危重症,可导致脑损伤甚至死亡。目前的缺氧管理方法的有效性有限。积雪草(CA),以其神经保护特性而闻名,为OD治疗提供了潜在的替代方案。
    本研究旨在研究缺氧条件下CA对斑马鱼幼虫脑源性神经营养因子(BDNF)和囊泡谷氨酸转运蛋白1(VGLUT1)表达的神经保护作用。
    斑马鱼胚胎接受低氧水平(1.5mg/l)受精后0-2小时(hpf),直到受精后3天(dpf),模拟OD的早期阶段。随后的治疗涉及不同浓度的CA(1.25-5µg/ml),直至受精后9天。使用PCR方法测量BDNF和VGLUT1的表达水平。使用双向方差分析进行统计分析,以评估CA对在缺氧条件下3和9dpf的斑马鱼幼虫中BDNF和VGLUT1表达的影响。
    CA显著影响OD下BDNF和VGLUT1的表达(p<0.001)。在经历OD并用CA处理的斑马鱼幼虫中观察到BDNF表达的增加(p<0.001)和VGLUT1的减少(p<0.01)。在3dpf和9dpf的斑马鱼幼虫中,BDNF和VGLUT1表达在年龄变化中在治疗组中没有显着差异(p>0.05)。2.5µg/ml的CA浓度可有效增强BDNF并降低3-9dpf斑马鱼幼虫的VGLUT1。
    CA显示出作为神经保护剂的潜力,在OD条件下调节增加的BDNF表达和降低的VGLUT1。这些发现为进一步开发缺氧疗法奠定了基础。
    UNASSIGNED: Oxygen deprivation (OD) is a critical condition that can lead to brain damage and even death. Current hypoxia management approaches are limited in effectiveness. Centella asiatica (CA), known for its neuroprotective properties, offers a potential alternative for OD treatment.
    UNASSIGNED: This study aims to investigate the neuroprotective effects of CA on the expression of brain-derived neurotrophic factor (BDNF) and vesicular glutamate transporter 1 (VGLUT1) in zebrafish larvae under oxygen-deficient conditions.
    UNASSIGNED: Zebrafish embryos were subjected to low oxygen levels (1.5 mg/l) 0-2 hours post-fertilization (hpf) until 3 days post-fertilization (dpf), simulating the early stages of OD. Subsequent treatment involved varying concentrations of CA (1.25-5 µg/ml) up to 9 days post-fertilization. The expression levels of BDNF and VGLUT1 were measured using PCR methods. Statistical analysis was conducted using a two-way analysis of variance to evaluate the impact of CA on the expression of BDNF and VGLUT1 in zebrafish larvae aged 3 and 9 dpf in oxygen-deprived conditions.
    UNASSIGNED: CA significantly influenced the expression of BDNF and VGLUT1 under OD (p < 0.001). An increase in BDNF expression (p < 0.001) and a decrease in VGLUT1 (p < 0.01) were observed in zebrafish larvae experiencing OD and treated with CA. There was no significant difference in BDNF and VGLUT1 expression across age variations in zebrafish larvae at 3 dpf and 9 dpf in the treatment groups (p > 0.05). CA concentration of 2.5 µg/ml effectively enhanced BDNF and reduced VGLUT1 in 3-9 dpf zebrafish larvae.
    UNASSIGNED: CA demonstrates potential as a neuroprotective agent, modulating increased BDNF expression and reduced VGLUT1 under OD conditions. These findings lay a foundation for further research in developing therapies for oxygen deficiency.
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  • 文章类型: Journal Article
    背景:氧气面罩的安装会影响其性能,例如氧合或CO2消除。手术间EcoLite™成人高浓度氧气面罩(EcoLite带水库,手术间,英国)的开发是为了提供合身的。这项研究的目的是评估与常规面罩相比,具有储层的EcoLite的性能。
    方法:本研究纳入10名健康志愿者。以不同的氧气流速(5、8、10、12和15L/min)向患者提供带有储液器和常规面罩的EcoLite。通过经鼻插入的中咽处的采样管测量吸气O2的分数(FIOO2)和吸气CO2的分压(PICOO2)。
    结果:具有储层的EcoLite的FIO2明显高于对照储层掩模。然而,带有水库的EcoLite中的PICO2明显高于对照水库面罩中的PICO2,尤其是当氧气流量较低时。
    结论:具有储库的EcoLite在健康志愿者中提供了改善的氧合和比常规储库面罩更好的贴合性。然而,带有水库的EcoLite可能会在低氧流量下导致更高的二氧化碳再呼吸。
    BACKGROUND: The fitting of oxygen mask affects the performance of it such as oxygenation or CO₂ elimination. The intersurgical EcoLite™ adult high-concentration oxygen mask (EcoLite with a reservoir, Intersurgical, UK) was developed to give well-fitting. The purpose of this study is to evaluate the performance of EcoLite with a reservoir compared to the conventional mask.
    METHODS: Ten healthy volunteers were included in this study. EcoLite with a reservoir and conventional mask were given to patients at different oxygen flow rates (5, 8, 10, 12, and 15 L/min). Fraction of inspiratory O₂ (FIO₂) and partial pressure of inspiratory CO₂ (PICO₂) were measured by a sampling tube at the middle pharynx inserted via nose.
    RESULTS: The EcoLite with a reservoir had a significantly higher FIO₂ than the control reservoir mask. However, the PICO₂ was significantly higher in the EcoLite with a reservoir than in the control reservoir mask, especially when the oxygen flow rate was low.
    CONCLUSIONS: The EcoLite with a reservoir provided improved oxygenation and a better fit than the conventional reservoir masks in healthy volunteers. However, the EcoLite with a reservoir might cause higher CO₂ rebreathing at low oxygen flow rates.
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  • 文章类型: Journal Article
    由各种植物分泌的黄素和铁载体,缺铁条件下的真菌和细菌在环境中铁的生物地球化学循环中起着重要作用。尽管在缺氧条件下黄素和铁载体介导的Fe(III)还原和溶解的机制已被广泛研究,这些化合物在含氧条件下对Fe(II)氧化的影响尚不清楚。在这项研究中,我们研究了在存在核黄素(氧化(RBF)和还原(RBFH2))和去铁胺B(DFOB)作为代表性黄素和铁载体的情况下,在pH5〜7下,氧气在pH5〜7下氧化Fe(II)(17.8μM)的动力学。分别。结果表明,添加RBF/RBFH2或DFOB可显着加速O2对Fe(II)水溶液的氧化。例如,在pH6时,当添加10μMRBFH2时,Fe(II)的氧化速率提高了20〜70倍。加速Fe(II)氧化的机理与RBFH2,RBF和DFOB的氧化还原反应性和络合能力有关。虽然RBFH2不容易络合Fe(II)/Fe(III),它可以激活O2并产生活性氧,然后迅速氧化Fe(II)。相比之下,RBF和DFOB都不还原O2,但与Fe(II)反应形成RBF/DFOB络合的Fe(II),这反过来又加速了Fe(II)的氧化。此外,Fe(II)-DFOB络合物的较低标准还原电位,与Fe(II)-RBF络合物相比,与Fe(II)-DFOB络合物的较高氧化速率常数相关。我们的研究揭示了黄素和铁载体的催化作用,这可能有助于在氧-缺氧界面处的Fe(II)/Fe(III)循环。
    Flavins and siderophores secreted by various plants, fungi and bacteria under iron (Fe) deficient conditions play important roles in the biogeochemical cycling of Fe in the environment. Although the mechanisms of flavin and siderophore mediated Fe(III) reduction and dissolution under anoxic conditions have been widely studied, the influence of these compounds on Fe(II) oxidation under oxic conditions is still unclear. In this study, we investigated the kinetics of aqueous Fe(II) (17.8 μM) oxidation by O2 at pH 5‒7 in the presence of riboflavin (oxidized (RBF) and reduced (RBFH2)) and desferrioxamine B (DFOB) as representative flavins and siderophores, respectively. Results showed that the addition of RBF/RBFH2 or DFOB markedly accelerates the oxidation of aqueous Fe(II) by O2. For instance, at pH 6, the rate of Fe(II) oxidation was enhanced 20‒70 times when 10 μM RBFH2 was added. The mechanisms responsible for the accelerated Fe(II) oxidation are related to the redox reactivity and complexation ability of RBFH2, RBF and DFOB. While RBFH2 does not readily complex Fe(II)/Fe(III), it can activate O2 and generate reactive oxygen species, which then rapidly oxidize Fe(II). In contrast, both RBF and DFOB do not reduce O2 but react with Fe(II) to form RBF/DFOB-complexed Fe(II), which in turn accelerates Fe(II) oxidation. Furthermore, the lower standard reduction potential of the Fe(II)-DFOB complex, compared to the Fe(II)-RBF complex, correlates with a higher oxidation rate constant for the Fe(II)-DFOB complex. Our study reveals an overlooked catalytic role of flavins and siderophores that may contribute to Fe(II)/Fe(III) cycling at oxic-anoxic interfaces.
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  • 文章类型: Journal Article
    内皮功能障碍降低运动肢体血流量(BF)和肌肉氧合。急性补充L-瓜氨酸(CIT)可改善运动过程中的肌肉组织氧饱和度指数(TSI)和脱氧血红蛋白(HHb)。尽管CIT改善高血压女性的内皮功能(血流介导的扩张[FMD]),CIT对运动BF和肌肉氧合(TSI)和提取(HHb)的影响尚不清楚。我们检查了CIT(10克/天)和安慰剂4周对血压(BP)的影响,动脉血管舒张(口蹄疫,BF,和血管电导[VC]),22名绝经后高血压妇女在休息和运动时的前臂肌肉氧合(TSI和HHb)。与安慰剂相比,CIT显着(p<0.05)增加FMD(Δ-0.7±0.6%vs.Δ1.6±0.7%)和降低的主动脉收缩压(Δ3±5与Δ-4±6mmHg)在休息和改善运动BF(Δ17±12与Δ48±16mL/min),VC(Δ-21±9与Δ41±14mL/mmHg/min),TSI(Δ-0.84±0.58%与Δ1.61±0.46%),和HHb(Δ1.03±0.69vs.Δ=2.76±0.77μM)。运动过程中运动BF和VC与改善FMD和TSI呈正相关(均p<0.05)。CIT通过增加绝经后高血压妇女的内皮功能改善运动动脉血管舒张和肌肉氧合。
    Endothelial dysfunction decreases exercise limb blood flow (BF) and muscle oxygenation. Acute L-Citrulline supplementation (CIT) improves muscle tissue oxygen saturation index (TSI) and deoxygenated hemoglobin (HHb) during exercise. Although CIT improves endothelial function (flow-mediated dilation [FMD]) in hypertensive women, the impact of CIT on exercise BF and muscle oxygenation (TSI) and extraction (HHb) are unknown. We examined the effects of CIT (10 g/day) and a placebo for 4 weeks on blood pressure (BP), arterial vasodilation (FMD, BF, and vascular conductance [VC]), and forearm muscle oxygenation (TSI and HHb) at rest and during exercise in 22 hypertensive postmenopausal women. Compared to the placebo, CIT significantly (p < 0.05) increased FMD (Δ-0.7 ± 0.6% vs. Δ1.6 ± 0.7%) and reduced aortic systolic BP (Δ3 ± 5 vs. Δ-4 ± 6 mmHg) at rest and improved exercise BF (Δ17 ± 12 vs. Δ48 ± 16 mL/min), VC (Δ-21 ± 9 vs. Δ41 ± 14 mL/mmHg/min), TSI (Δ-0.84 ± 0.58% vs. Δ1.61 ± 0.46%), and HHb (Δ1.03 ± 0.69 vs. Δ-2.76 ± 0.77 μM). Exercise BF and VC were positively correlated with improved FMD and TSI during exercise (all p < 0.05). CIT improved exercise artery vasodilation and muscle oxygenation via increased endothelial function in hypertensive postmenopausal women.
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  • 文章类型: Journal Article
    背景与目的:胚胎和胎儿在生理低氧环境下发育,血管形成是由HIF-1,VEGF,和β-肾上腺素系统.在动物中,β3-肾上腺素受体(β3-ARs),缺氧上调,有利于全球胎儿健康,以至于大多数与早产相关的疾病被认为是由早熟β3-AR下调引起或加重的,由于过早暴露于相对高氧的环境。在动物中,目前正在研究β3-AR药理学激动作用作为一种可能的新的治疗机会来抵消氧诱导的损害。我们的目标是将动物获得的知识转化为人类。最近,我们已经证明,胎儿从妊娠中期到近期逐渐变得更加低氧,但是从第33-34周开始,氧合逐渐增加,直到出生。本文旨在描述一种临床研究方案,评估HIF-1、β3-ARs的表达水平,血管内皮生长因子在宫内和出生后受到氧气的调节,以类似于动物的方式。材料与方法:在前瞻性中,非营利组织,单中心观察性研究将纳入100例早产儿(A组)和100例足月新生儿(B组).我们将收集脐带血样本(T0)并测量HIF-1,β3-ARs的RNA表达水平,和VEGF通过数字PCR。在早产中,我们还将在48-72小时(T1)测量基因表达,14天(T2),和30天(T3)的生活和40±3周的月经后年龄(T4),不管生命的哪一天。我们将比较A组(T0)与B组(T0),并确定从A组中的系列样本获得的值与患者的临床数据之间的任何相关性。我们的方案已获得托斯卡纳地区临床研究儿科伦理委员会的批准(编号291/2022)。预期结果:观察到在婴儿中,HIF-1/β3-ARs/VEGF轴显示与动物相似的调节,提示β3-ARs也能促进人类胎儿健康.
    Background and Objective: The embryo and the fetus develop in a physiologically hypoxic environment, where vascularization is sustained by HIF-1, VEGF, and the β-adrenergic system. In animals, β3-adrenoceptors (β3-ARs), up-regulated by hypoxia, favor global fetal wellness to such an extent that most diseases related to prematurity are hypothesized to be induced or aggravated by a precocious β3-AR down-regulation, due to premature exposure to a relatively hyperoxic environment. In animals, β3-AR pharmacological agonism is currently investigated as a possible new therapeutic opportunity to counteract oxygen-induced damages. Our goal is to translate the knowledge acquired in animals to humans. Recently, we have demonstrated that fetuses become progressively more hypoxemic from mid-gestation to near-term, but starting from the 33rd-34th week, oxygenation progressively increases until birth. The present paper aims to describe a clinical research protocol, evaluating whether the expression level of HIF-1, β3-ARs, and VEGF is modulated by oxygen during intrauterine and postnatal life, in a similar way to animals. Materials and Methods: In a prospective, non-profit, single-center observational study we will enroll 100 preterm (group A) and 100 full-term newborns (group B). We will collect cord blood samples (T0) and measure the RNA expression level of HIF-1, β3-ARs, and VEGF by digital PCR. In preterms, we will also measure gene expression at 48-72h (T1), 14 days (T2), and 30 days (T3) of life and at 40 ± 3 weeks of post-menstrual age (T4), regardless of the day of life. We will compare group A (T0) vs. group B (T0) and identify any correlations between the values obtained from serial samples in group A and the clinical data of the patients. Our protocol has been approved by the Pediatric Ethical Committee for Clinical Research of the Tuscany region (number 291/2022). Expected Results: The observation that in infants, the HIF-1/β3-ARs/VEGF axis shows similar modulation to that of animals could suggest that β3-ARs also promote fetal well-being in humans.
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  • 文章类型: Journal Article
    急性低氧性呼吸衰竭(ARF)是住院的常见原因。高流量鼻氧(HFNO)越来越多地用作ARF患者的一线治疗,包括医疗病房。提供HFNO时,临床指导至关重要,和卫生服务使用当地卫生指导文件(LHGD)来实现这一目标。尚不清楚LHGD医院对HFNO的病房管理有何建议。这项研究检查了澳大利亚医院LHGD关于基于病房的HFNO管理的内容,以确定可能影响安全分娩的内容。2022年5月2日进行了范围审查,并于2024年1月29日进行了更新,以确定在澳大利亚两个州的医疗病房中向患有ARF的成年人提供HFNO的公立医院。提取并分析了有关HFNO起始的数据,监测,保养和断奶,和临床恶化的管理。在包括LHGD的26个中,五份文件引用了澳大利亚氧气指南。20个LHGD没有定义低氧血症的阈值水平,建议使用HFNO而不是常规氧疗。13在使用HFNO时没有提供目标氧饱和度范围。关于病房中最大吸入氧气水平和流速的建议各不相同。八个LHGD没有指定任何系统来识别和管理恶化的患者。五个LHGD没有为HFNO的断奶患者提供指导。在澳大利亚医院中,对于成人ARF患者的HFNO护理,LHGD存在很大差异。这些发现对高质量的交付,医院的安全临床护理。
    Acute hypoxemic respiratory failure (ARF) is a common cause for hospital admission. High-flow nasal oxygen (HFNO) is increasingly used as a first-line treatment for patients with ARF, including in medical wards. Clinical guidance is crucial when providing HFNO, and health services use local health guidance documents (LHGDs) to achieve this. It is unknown what hospital LHGDs recommend regarding ward administration of HFNO. This study examined Australian hospitals\' LHGDs regarding ward-based HFNO administration to determine content that may affect safe delivery. A scoping review was undertaken on 2 May 2022 and updated on 29 January 2024 to identify public hospitals\' LHGDs regarding delivery of HFNO to adults with ARF in medical wards in two Australian states. Data were extracted and analysed regarding HFNO initiation, monitoring, maintenance and weaning, and management of clinical deterioration. Of the twenty-six included LHGDs, five documents referenced Australian Oxygen Guidelines. Twenty LHGDs did not define a threshold level of hypoxaemia where HFNO use was recommended over conventional oxygen therapy. Thirteen did not provide target oxygen saturation ranges whilst utilising HFNO. Recommendations varied regarding maximal levels of inspired oxygen and flow rates in the medical ward. Eight LHGDs did not specify any system to identify and manage deteriorating patients. Five LHGDs did not provide guidance for weaning patients from HFNO. There was substantial variation in the LHGDs regarding HFNO care for adult patients with ARF in Australian hospitals. These findings have implications for the delivery of high-quality, safe clinical care in hospitals.
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  • 文章类型: Journal Article
    流行病学数据表明,中度高氧血症可能与创伤性脑损伤后预后改善有关。在一个潜在的,长期随机调查,14例成人急性硬膜下血肿复苏合并出血性休克(ASDH+HS),人类大小的猪,靶向高氧血症(200 Epidemiological data suggest that moderate hyperoxemia may be associated with an improved outcome after traumatic brain injury. In a prospective, randomized investigation of long-term, resuscitated acute subdural hematoma plus hemorrhagic shock (ASDH + HS) in 14 adult, human-sized pigs, targeted hyperoxemia (200 < PaO2 < 250 mmHg vs. normoxemia 80 < PaO2 < 120 mmHg) coincided with improved neurological function. Since brain perfusion, oxygenation and metabolism did not differ, this post hoc study analyzed the available material for the effects of targeted hyperoxemia on cerebral tissue markers of oxidative/nitrosative stress (nitrotyrosine expression), blood-brain barrier integrity (extravascular albumin accumulation) and fluid homeostasis (oxytocin, its receptor and the H2S-producing enzymes cystathionine-β-synthase and cystathionine-γ-lyase). After 2 h of ASDH + HS (0.1 mL/kgBW autologous blood injected into the subdural space and passive removal of 30% of the blood volume), animals were resuscitated for up to 53 h by re-transfusion of shed blood, noradrenaline infusion to maintain cerebral perfusion pressure at baseline levels and hyper-/normoxemia during the first 24 h. Immediate postmortem, bi-hemispheric (i.e., blood-injected and contra-lateral) prefrontal cortex specimens from the base of the sulci underwent immunohistochemistry (% positive tissue staining) analysis of oxidative/nitrosative stress, blood-brain barrier integrity and fluid homeostasis. None of these tissue markers explained any differences in hyperoxemia-related neurological function. Likewise, hyperoxemia exerted no deleterious effects.
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