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Objective: This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. Methods: Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. Results: We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I 2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I 2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = −2.42 days; 95% CI = −4.71-0.12; P = 0.04; I 2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = −1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). Conclusion: Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP. [ABSTRACT FROM AUTHOR]

Elevation plays a pivotal role in modulating hydroclimatic dynamics, changing vegetation activity and shaping vegetation distribution patterns in alpine regions. Nevertheless, a conspicuous knowledge gap persists regarding the interaction between climate drivers on vegetation activity. In this study, we investigated the spatio-temporal patterns of the Normalized Difference Vegetation Index (NDVI), a proxy for vegetation activity, and examined its interactions with temperature (T) and precipitation (P) along elevational gradient (EG) in the Alpine and Sub-alpine Woodlands of Southwest China (ASWSC) during 2001–2018. We found that approximately 24% vegetation in ASWSC exhibited significant greening trend, as a result of regional warming and slight wetting during the study period. The greening and browning rates were both elevational asymmetric, with higher rates at lower elevations. We also illustrated an alternating domination of T - P on vegetation activity along EG. This suggested a roughly antagonistic effect between the two drivers within the whole vegetation elevation range except for a synergistic effect in the sub-alpine forests zone between 2300 - 4200 m. The antagonistic effect tended to be more pronounced in warm and dry years, while the synergistic effect was more evident in cold and wet years. Specifically for different vegetation types, we found an insignificant T - P interactive effect along EG in indigenous evergreen needleleaf forest (ENF) and evergreen broadleaf forest (EBF), in contrast to the significant synergistic effect in the regenerated deciduous broadleaf forest (DBF) and mixed forest (MF) and antagonistic effect in shrubland and grassland types. In summary, our study revealed alternating-dominant effects of temperature and precipitation on vegetation activity along EG. These findings will deepen our understanding of vegetation resistance and resilience to climate change and eventually contribute to establishing a scientific foundation for effective ecosystem management and conservation practices in alpine region. • The greening and browning rates were both elevational asymmetric, with higher rates at lower elevations. • Alternating domination of temperature - precipitation on vegetation activity along elevational gradients. • Antagonistic effect of T and P was enhanced in warm and dry years, synergistic effect was enhanced in cold and wet years. [ABSTRACT FROM AUTHOR]

The fundamental role of covert spatial attention is to enhance the processing of attended items while simultaneously ignoring irrelevant items. However, relatively little is known about how brain electrophysiological activities associated with target selection and distractor suppression are involved as they develop and become fully functional. The current study aimed to identify the neurophysiological bases of the development of covert spatial attention, focusing on electroencephalographic (EEG) markers of attentional selection (N2pc) and suppression (PD). EEG data were collected from healthy young adults and typically developing children (9–15 years old) as they searched for a shape singleton target in either the absence or the presence of a salient‐but‐irrelevant color singleton distractor. The ERP results showed that a lateral shape target elicited a smaller N2pc in children compared with adults regardless of whether a distractor was present or not. Moreover, the target‐elicited N2pc was always followed by a similar positivity in both age groups. Counterintuitively, a lateral salient‐but‐irrelevant distractor elicited a large PD in children with low behavioral accuracy, whereas high‐accuracy children exhibited a small and "adult‐like" PD. More importantly, we found no evidence for a correlation between the target‐elicited N2pc and the distractor‐elicited PD in either age group. Our results provide neurophysiological evidence for the developmental differences between target selection and distractor suppression. Compared with adults, 9–15‐year‐old children deploy insufficient attentional selection resources to targets but use "adult‐like" or even more attentional suppression resources to resist irrelevant distractors. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=NhWapx0d75I Using a visual search paradigm, we found that, compared with adults, 9–15‐year‐old children deployed insufficient attentional selection resources to targets but used "adult‐like" or even more attentional suppression resources to resist irrelevant distractors. [ABSTRACT FROM AUTHOR]

Stroke is one of the major causes of disability and death worldwide. The lack of effective medical treatment for stroke heightens the need for new therapeutic targets. In this study, we obtained two microarray data sets from the Gene Expression Omnibus (GEO) database and identified differential genes (DEGs) between MCAO and control groups. Then, enrichment analysis of the DEGs was performed using DAVID and Metascape. The results show 27 DEGs shared between the two datasets. The functional enrichment analysis showed that these genes are mainly enriched in immune response, complement and coagulation cascades, apoptotic processes. The four hub genes (C1qc, Fcgr2b, C1qb, and Cd14) were screened out using the Cytoscape. Next, real-time PCR and Western blot analysis showed that expression of C1q and CD14 increased at 14 days after tMCAO. Furthermore, we took eight small molecule compounds with the lowest score using Cmap and studied their background characteristics. These results are built on a meta-analysis of data, which are generally accessible from the online space. Finally, we evaluated the protective effect of the rolipram through behavior tests after tMCAO, and results showed that the rolipram significantly attenuated neurobehavioral dysfunction at 14 days after brain ischemia. The present results provide novel insights into the biological process and potential therapeutic drugs involved in stroke.

The aim of this study was to evaluate the effect of modifying the cuff on preventing ventilator-associated pneumonia (VAP). PubMed, Embase and Cochrane Library were systematically searched from inception to April 2022, for randomised controlled trials (RCTs) that compared the effect of a new type of cuff intubation with traditional cuff intubation on VAP incidence and intensive-care unit (ICU) mortality in mechanically ventilated patients. Nine RCTs with 1937 patients were finally evaluated. The pooled results for the incidence of VAP showed that the modified cuff significantly decreased the morbidity of VAP compared with the traditional cuff (relative ratio (RR) = 0.73, 95% confidence interval (CI) 0.56-0.95, p = 0.02). The subgroup analysis revealed that polyurethane (PU) cuff (RR = 0.82, 95% CI 0.46-1.48, p = 0.52), conical cuff (RR = 0.97, 95% CI 0.73-1.28, p = 0.82) and PU-conical cuff (RR = 1.36, 95% CI 0.85-2.18, p = 0.20) did not decrease the incidence of VAP. Moreover, the improved cuff combined with subglottic secretion drainage (SSD) could significantly reduce the VAP incidence (RR = 0.58, 95% CI 0.44-0.77, p = 0.0001). In terms of ICU mortality, there was no statistically significant difference (RR = 0.83, 95% CI 0.68-1.02, p = 0.08) between the two groups. The modified cuff is superior to the traditional cuff in VAP prevention. In particular, the modified cuff combined with subglottic secretion drainage has more advantages. Key Words: Ventilator-associated pneumonia, Intubation, Endotracheal cuff, Intensive care unit, Meta-analysis.

Background: In the past few decades, liver disease has gradually become one of the major causes of death and illness worldwide. Hepatitis is one of the most common liver diseases in China. There have been intermittent and epidemic outbreaks of hepatitis worldwide, with a tendency toward cyclical recurrences. This periodicity poses challenges to epidemic prevention and control., Objective: In this study, we aimed to investigate the relationship between the periodic characteristics of the hepatitis epidemic and local meteorological elements in Guangdong, China, which is a representative province with the largest population and gross domestic product in China., Methods: Time series data sets from January 2013 to December 2020 for 4 notifiable infectious diseases caused by hepatitis viruses (ie, hepatitis A, B, C, and E viruses) and monthly data of meteorological elements (ie, temperature, precipitation, and humidity) were used in this study. Power spectrum analysis was conducted on time series data, and correlation and regression analyses were performed to assess the relationship between the epidemics and meteorological elements., Results: The 4 hepatitis epidemics showed clear periodic phenomena in the 8-year data set in connection with meteorological elements. Based on the correlation analysis, temperature demonstrated the strongest correlation with hepatitis A, B, and C epidemics, while humidity was most significantly associated with the hepatitis E epidemic. Regression analysis revealed a positive and significant coefficient between temperature and hepatitis A, B, and C epidemics in Guangdong, while humidity had a strong and significant association with the hepatitis E epidemic, and its relationship with temperature was relatively weak., Conclusions: These findings provide a better understanding of the mechanisms underlying different hepatitis epidemics and their connection to meteorological factors. This understanding can help guide local governments in predicting and preparing for future epidemics based on weather patterns and potentially aid in the development of effective prevention measures and policies., (©Xixi Zhao, Meijia Li, Naem Haihambo, Xinni Wang, Bin Wang, Meirong Sun, Mingrou Guo, Chuanliang Han. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 15.06.2023.)