Abstract
Background
An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous ...cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC.
Methods
We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation.
Results
We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 25% vs 69/301 23%; odds ratio OR 1.13; 95% confidence interval CI .77–1.67. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion RP 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio HR 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean DTM 0.02; 95% CI −.05 to .08, cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38).
Conclusions
Maintaining CPC through an automated electronic device did not reduce VARI incidence.
Clinical Trial Registration
NCT02966392.
The results of this randomised controlled trial demonstrate that continuous endotracheal cuff pressure control using an electronic automated device does not reduce the occurrence of ventilator-associated respiratory infection (VARI) in intubated patients compared with intermittent control.
We report a superspreading event of severe acute respiratory syndrome coronavirus 2 infection initiated at a bar in Vietnam with evidence of symptomatic and asymptomatic transmission, based on ...ministry of health reports, patient interviews, and whole-genome sequence analysis. Crowds in enclosed indoor settings with poor ventilation may be considered at high risk for transmission.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Targeted therapy with tyrosine kinase inhibitors (TKI) provides survival benefits to a majority of patients with non-small cell lung cancer (NSCLC). However, resistance to TKI almost always develops ...after treatment. Although genetic and epigenetic alterations have each been shown to drive resistance to TKI in cell line models, clinical evidence for their contribution in the acquisition of resistance remains limited. Here, we employed liquid biopsy for simultaneous analysis of genetic and epigenetic changes in 122 Vietnamese NSCLC patients undergoing TKI therapy and displaying acquired resistance. We detected multiple profiles of resistance mutations in 51 patients (41.8%). Of those, genetic alterations in EGFR, particularly EGFR amplification (n = 6), showed pronounced genome instability and genome-wide hypomethylation. Interestingly, the level of hypomethylation was associated with the duration of response to TKI treatment. We also detected hypermethylation in regulatory regions of Homeobox genes which are known to be involved in tumor differentiation. In contrast, such changes were not observed in cases with MET (n = 4) and HER2 (n = 4) amplification. Thus, our study showed that liquid biopsy could provide important insights into the heterogeneity of TKI resistance mechanisms in NSCLC patients, providing essential information for prediction of resistance and selection of subsequent treatment.
In this study, biochar derived from spent coffee grounds (SCGB) was used to adsorb norfloxacin (NOR) in water. The biochar properties were interpreted by analysis of the specific surface area, ...morphology, structure, thermal stability, and functional groups. The impacts of pH, NOR, and ion's present on SCGB performance were examined. The NOR adsorption mode of SCGB is best suited to the Langmuir model (R2 = 0.974) with maximum absorption capacity (69.8 mg g−1). By using a Response Surface Method (RSM), optimal adsorption was also found at pH of 6.26, NOR of 24.69 mg L−1, and SCGB of 1.32 g L−1. Compared with biochars derived from agriculture such as corn stalks, willow branches, potato stem, reed stalks, cauliflower roots, wheat straw, the NOR adsorption capacity of SCGB was 2–30 times higher, but less than 3–4 times for biochars made from Salix mongolica, luffa sponge and polydopamine microspheres. These findings reveal that spent coffee grounds biochar could effectively remove NOR from aqueous solutions. Approaching biochar derived from coffee grounds would be a promising eco-friendly solution because it utilizes solid waste, saves costs, and creates adsorbents to deal with emerging pollutants like antibiotics.
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•Norfloxacin was removed using biochar derived from spent coffee grounds (SCGB).•pH significantly influenced the Norfloxacin (NOR) adsorption of the SCGB.•Based on Langmuir model, the maximum absorption capacity was 69.8 mg g−1 at pH 6.•The adsorption process was optimized by using the response surface methodology.•Optimal adsorption conditions were achieved at pH of 6.26 and SCGB of 1.32 g L−1.
•Simple liquid-phase exfoliated method to fabricate few-layered MoS2 nanosheets.•Significant NO2 sensing performance of the sensor based on exfoliated MoS2 compared to that based on bulk MoS2.•The ...sensor based on the exfoliated MoS2 nanosheets indicates the highest response of about 8 times to 5 ppm at RT.•The exfoliated MoS2 nanosheet sensor shows good NO2 selectivity, ultra-low detection limit, good short- and long-term stability.
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Gas sensors based on the bulk MoS2 and exfoliated MoS2 nanosheets, were fabricated by the probe ultrasonic vibration followed by the drop-casting method. The sensing performance of the sensor based on the exfoliated MoS2 was much higher than that based on the bulk MoS2. The exfoliated MoS2 sensor showed highest gas response of approximately eight times to 5 ppm NO2 at room temperature. This fabricated sensor showed a good NO2 selectivity, ultra-low detection limit, and good short- and long-term stability.
Features such as surface-to-volume ratio, sensitive surface, and bandgap vary with the number of material layers of semiconductor two-dimensional transition metal dichalcogenides with superior responsivity at room temperature (RT) and their possible application as flexible electronic devices. Herein, a significant enhancement of NO2 gas sensing properties of few-layered MoS2 nanosheets exfoliated from bulk MoS2 through a simple sonication probe was reported. The gas responses of the sensor based on the exfoliated MoS2 nanosheets to 0.5–5 ppm NO2 at RT were as high as 5.3–8 times. At RT, the humidity effect to the performance of the exfoliated MoS2 sensor was insignificant. The exfoliated MoS2 sensor also exhibited an ultra-low detection limit of 27 ppb, excellent selectivity, and reliable long-term stability within 8 weeks, which are crucial for future application of the sensor in practical devices. The NO2 sensing mechanism of the exfoliated MoS2 nanosheets was discussed in detail.
Background. Trypanosoma is a genus of unicellular parasitic flagellate protozoa. Trypanosoma brucei species and Trypanosoma cruzi are the major agents of human trypanosomiasis; other Trypanosoma ...species can cause human disease, but are rare. In March 2015, a 38-year-old woman presented to a healthcare facility in southern Vietnam with fever, headache, and arthralgia. Microscopic examination of blood revealed infection with Trypanosoma. Methods. Microscopic observation, polymerase chain reaction (PCR) amplification of blood samples, and serological testing were performed to identify the infecting species. The patient's blood was screened for the trypanocidal protein apolipoprotein L1 (APOL1), and a field investigation was performed to identify the zoonotic source. Results. PCR amplification and serological testing identified the infecting species as Trypanosoma evansi. Despite relapsing 6 weeks after completing amphotericin B therapy, the patient made a complete recovery after 5 weeks of suramin. The patient was found to have 2 wild-type APOL1 alleles and a normal serum APOL1 concentration. After responsive animal sampling in the presumed location of exposure, cattle and/or buffalo were determined to be the most likely source of the infection, with 14 of 30 (47%) animal blood samples testing PCR positive for T. evansi. Conclusions. We report the first laboratory-confirmed case of T. evansi in a previously healthy individual without APOL1 deficiency, potentially contracted via a wound while butchering raw beef, and successfully treated with suramin. A linked epidemiological investigation revealed widespread and previously unidentified burden of T. evansi in local cattle, highlighting the need for surveillance of this infection in animals and the possibility of further human cases.
The selective detection and classification of NH3 and H2S gases with H2S gas interference based on conventional SnO2 thin film sensors is still the main problem. In this work, three layers of ...SnO2/Pt/WO3 nanofilms with different WO3 thicknesses (50, 80, 140, and 260 nm) were fabricated using the sputtering technique. The WO3 top layer were used as a gas filter to further improve the selectivity of sensors. The effect of WO3 thickness on the (NH3, H2, and H2S) gas-sensing properties of the sensors was investigated. At the optimal WO3 thickness of 140 nm, the gas responses of SnO2/Pt/WO3 sensors toward NH3 and H2 gases were slightly lower than those of Pt/SnO2 sensor film, and the gas response of SnO2/Pt/WO3 sensor films to H2S gas was almost negligible. The calcification of NH3 and H2 gases was effectively conducted by machine learning algorithms. These evidences manifested that SnO2/Pt/WO3 sensor films are suitable for the actual NH3 detection of NH3 and H2S gases.
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•The three layers of the SnO2/Pt/WO3 nanofilms based-gas sensor have been developed.•The SnO2/Pt/WO3 nanofilms can detect NH3 and H2 gases at low concentrations.•The classification of NH3 and H2 gases is made by machine learning algorithms.•The cross-response of sensors to interfering gas such as H2S were almost eliminated.•The gas filter mechanism was explained by the molecular size of the tested gases.
In this work, a feasible one-pot approach to synthesize manganese oxide/graphene composites, the so-called plasma-enhanced electrochemical exfoliation process (PE3P), has been developed. Herein, a ...composite of graphene decorated with manganese oxide nanoparticles was prepared via PE3P from a KMnO4 solution and graphite electrode under a voltage of 70 V in an ambient environment. By controlling the initial KMnO4 concentration, we obtained distinct MnO2/graphene samples. The prepared samples were characterized by scanning electron microscopy, transmission electron microscopy, x-ray diffraction, x-ray photoelectron spectroscopy, and Raman spectroscopy. The electrochemical measurements of the MnO2/graphene composites revealed that the specific capacitance of the samples is approximately 320 F g-1 at a scan rate of 10 mV s-1, which is comparably very high for manganese oxide/carbon-based supercapacitor electrode materials. Considering the simple, low-cost, one-step and environmentally friendly preparation, our approach has the potential to be used for the fabrication of MnO2/graphene composites as the electrode materials of supercapacitors.
This study aimed to elucidate virus, host and environmental dynamics of Vietnamese H5 highly pathogenic avian influenza viruses (HPAIVs) during 2014-2017. Epidemiologically, H5 HPAIVs were frequently ...detected in apparently healthy domestic and Muscovy ducks and therefore these are preferred species for H5 HPAIV detection in active surveillance. Virologically, clade 2.3.2.1c and 2.3.4.4 H5 HPAIVs were predominant and exhibited distinct phylogeographic evolution. Clade 2.3.2.1c viruses clustered phylogenetically in North, Central and South regions, whilst clade 2.3.4.4 viruses only detected in North and Central regions formed small groups. These viruses underwent diverse reassortment with existence of at least 12 genotypes and retained typical avian-specific motifs. These H5 HPAIVs exhibited large antigenic distance from progenitor viruses and commercial vaccines currently used in poultry. Bayesian phylodynamic analysis inferred that clade 2.3.2.1c viruses detected during 2014-2017 were likely descended from homologous clade viruses imported to Vietnam previously and/or preexisting Chinese viruses during 2012-2013. Vietnamese clade 2.3.4.4 viruses closely shared genetic traits with contemporary foreign spillovers, suggesting that there existed multiple transboundary virus dispersals to Vietnam. This study provides insights into the evolution of Vietnamese H5 HPAIVs and highlights the necessity of strengthening control measures such as, preventive surveillance and poultry vaccination.
This review presents a robust strategy to design photosensitizers (PSs) for various species. Photodynamic therapy (PDT) is a photochemical-based treatment approach that involves the use of light ...combined with a light-activated chemical, referred to as a PS. Attractively, PDT is one of the alternatives to conventional cancer treatment due to its noninvasive nature, high cure rates, and low side effects. PSs play an important factor in photoinduced reactive oxygen species (ROS) generation. Although the concept of photosensitizer-based photodynamic therapy has been widely adopted for clinical trials and bioimaging, until now, to our surprise, there has been no relevant review article on rational designs of organic PSs for PDT. Furthermore, most of published review articles in PDT focused on nanomaterials and nanotechnology based on traditional PSs. Therefore, this review aimed at reporting recent strategies to develop innovative organic photosensitizers for enhanced photodynamic therapy, with each example described in detail instead of providing only a general overview, as is typically done in previous reviews of PDT, to provide intuitive, vivid, and specific insights to the readers.
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