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Background: Noninvasive ventilation (NIV) is commonly used to treat patients with acute cardiogenic pulmonary edema (ACPE), but the findings of a recent large clinical trial suggest that NIV may be less effective for ACPE than previously thought. Purpose: To provide an estimate of the effect of NIV on clinical outcomes in patients with ACPE that incorporates recent trial evidence and explore ways to interpret that evidence in the context of preceding evidence that favors NIV. Data Sources: PubMed and EMBASE from 1966 to December 2009, Cochrane Central Register of Controlled Trials and conference proceedings through December 2009, and reference lists, without language restriction. Study Selection: Randomized trials that compared continuous positive airway pressure and bilevel ventilation with standard therapy or each other. Data Extraction: Two independent reviewers extracted data. Outcomes examined were mortality, intubation rate, and incidence of new myocardial infarction (MI). Data Synthesis: Compared with standard therapy, continuous positive airway pressure reduced mortality (relative risk [RR], 0.64 [95% CI, 0.44 to 0.92]) and need for intubation (RR, 0.44 [CI, 0.32 to 0.60]) but not incidence of new MI (RR, 1.07 [CI, 0.84 to 1.37]). The effect was more prominent in trials in which myocardial ischemia or infarction caused ACPE in higher proportions of patients (RR, 0.92 [CI, 0.76 to 1.10] when 10% of patients had ischemia or MI vs. 0.43 [CI, 0.17 to 1.07] when 50% had ischemia or MI). Bilevel ventilation reduced the need for intubation (RR, 0.54 [CI, 0.33 to 0.86]) but did not reduce mortality or new MI. No differences were detected between continuous positive airway pressure and bilevel ventilation on any clinical outcomes for which they were directly compared. Limitations: The quality of the evidence base was limited. Definitions, cause, and severity of ACPE differed among the trials, as did patient characteristics and clinical settings. Conclusion: Although a recent large trial contradicts results from previous studies, the evidence in aggregate still supports the use of NIV for patients with ACPE. Continuous positive airway pressure reduces mortality more in patients with ACPE secondary to acute myocardial ischemia or infarction. Primary Funding Source: None.

ABSTRACTExtracellular vesicles (EVs) can be released from gram-positive bacteria and would participate in the delivery of bacterial toxins. Streptococcus pyogenes(group A Streptococcus, GAS) is one of the most common pathogens of monomicrobial necrotizing fasciitis. Spontaneous inactivating mutation in the CovR/CovS two-component regulatory system is related to the increase of EVs production via an unknown mechanism. This study aimed to investigate whether the CovR/CovS-regulated RopB, the transcriptional regulator of GAS exoproteins, would participate in regulating EVs production. Results showed that the size, morphology, and number of EVs released from the wild-type strain and the ropBmutant were similar, suggesting RopB is not involved in controlling EVs production. Nonetheless, RopB-regulated SpeB protease degrades streptolysin O and bacterial proteins in EVs. Although SpeB has crucial roles in modulating protein composition in EVs, the SpeB-positive EVs failed to trigger HaCaT keratinocytes pyroptosis, suggesting that EVs did not deliver SpeB into keratinocytes or the amount of SpeB in EVs was not sufficient to trigger cell pyroptosis. Finally, we identified that EV-associated enolase was resistant to SpeB degradation, and therefore could be utilized as the internal control protein for verifying SLO degradation. This study revealed that RopB would participate in modulating protein composition in EVs via SpeB-dependent protein degradation and suggested that enolase is a potential internal marker for studying GAS EVs.

Asphalt concrete is an insulating material. Conductive materials are added to asphalt concrete in order that improving the conductivity. Conductive asphalt concrete (CAC) has become a promising method to snow melting and self-monitoring. In this study, the piezoresistance of CAC which can be improved the conductivity through graphite are analyzed. Based on the interparticle separation and bitumen film-thickness of graphite particle, a model has been developed to predict the piezoresistance under the applied stress. The influences of applied stress, graphite diameter, graphite volume fraction, compressive modulus on the piezoresistance are interpreted through laboratory experiments. Both the numerical and experimental results show that the theoretical data obtained from the model are found to agree with the experimental ones fairly well. In addition, it was found that all these parameters influence the piezoresistance by altering the change process of interparticle separation of graphite.

Decreased functional capacity and reduced cardiac function were the main symptoms in patients with heart failure (HF) and the incidence increases with advanced age. The guidelines recommend that exercise training should be considered for medically stable HF outpatients. Studies have confirmed that exercise can improve functional capacity, prognosis, and reduced hospitalization rates; however, very few studies have investigated the elderly. It is not clear whether exercise could be feasible in elderly HF. The aim of this study was to evaluate the effect of the 6-month heart failure post-acute care program focused on home-based cardiac telerehabilitation (HCTR) on functional capacity, cardiac function, and readmission rates in HF patients.A prospective longitudinal study was conducted. Study duration was from January 2018 to December 2019. HF patients with a left ventricular ejection fraction <40% and age ≧65 years were included and divided into intervention (n = 40) and control group (n = 41). We arranged a 6-month heart failure post-acute care program that included outpatient cardiac rehabilitation and home exercise for the intervention group. The response to home exercise was followed by telemonitor. The exercise parameters were recorded on the HF health management mobile application system platform by each patient and daily transmission to hospital’s cloud database as HCTR, usual care program for the control group. Information such as general data, laboratory data, six-minute walk test, cardiac function, and admission record was collected from all patients.Eighty one patients between the ages of 65 and 92 completed the study. The mean age was 73.3 ± 5.0 and 75.6 ± 6.0 years in control and intervention group, respectively. The intervention group showed a statistically significant improvement in functional capacity, percentage change in the of six-minute walk distance (51.2% vs 17.7%, P< .05, 95% confidence interval −45.9 to −6.3). Left ventricular ejection fraction increased by 7.7%, which corresponds to 25.6% in relative terms (P< .05, 95% confidence interval −7.8 to −0.5). The readmission rate was 4.6% in the intervention group.Six months of post-acute HF focused on HCTR programs was safe, improved functional capacity, cardiac function, and decreased readmission rate in elderly patients with HF patients.

Aims: Total flavonoids of Oxytropisfalcata bunge (FOFB) from plants medicine have anti-inflammatory and anti-fibrotic activities. The present study was to investigate the effect of FOFB on the expression of MCP-1/TNF-α/IL-1β and ICAM-1 proteins in rats with idiopathic pulmonary fibrosis(IPF). Methods: Fifty rats model with IPF was established by a single intratracheal instillation of bleomycin (BLM 5 mg/kg). And 10 rats were taken as the control group without any treatment. After 14 days, model rats were administered the same volume with low dose(100 mg/kg), middle dose (200 mg/kg) and high dose (400 mg/kg) of FOFB, with prednisone acetate tablet (20 mg/kg, PAT group) as the positive drug. The remaining two groups were given the same volume of normal saline once a day for 28 consecutive days. Subsequently, pathological analysis by HE and Masson staining and ultrastructure by transmission electron microscopy were performed. The expressions of cytokines including MCP-1, TNF-α, IL-1β and ICAM-1 were determined by real-time PCR and immunohistochemical staining. Results: Compared with the blank group, severe inflammation and fibrosis were found in the BLM group; The mRNA levels of MCP-1, TNF-α, IL-1β and ICAM-1 were significantly increased in the model group. However, middle or high dose of FOFB and PAT group could significantly decrease infiltration of inflammatory cells, degree of fibrosis, and expression of inflammatory cytokines levels. Conclusion: FOFB can attenuate BLM-induced IPF via inhibiting inflammatory response, reducing inflammatory infiltration, and improving the degree of fibrosis. The mechanism may be related to the inhibition the expression of MCP-1, TNF-α, IL-1β and ICAM-1 proteins.

Cardiovascular disease (CVD) is one of the major causes to claim millions of lives all across the globe every year. While the chances of CVD increase with age, it can also occur in any age group of people, both male and female. Despite all efforts and tremendous accomplishments in the precaution and treatment of CVD, its detection at an early stage is still a big challenge for scientists in this present modern world. Here, NT-pro BNP plays a crucial role in acute congestive heart failure since it is biologically inactive, binds better with its receptors and has a longer half-life than any other, making it an ideal biomarker. The detection method is based upon the ligand-receptor interaction, also called as immunoassay, which can be successfully detected with the use of High Electron Mobility Transistors (HEMTs) with short duration pulse applied at the gate electrode. With its unique characteristic features like good electrical property, chemical stability, biocompatibility, thermal stability and low power consumption HEMT sensors also have been used in several other applications like ion-sensing, pH sensing, gas sensing, etc. Therefore, the detection method becomes simple, fast, convenient and cost effective.