OBJECTIVE To explore the effect of comprehensive interventions to pulmonary rehabilitation on preven-tion of ventilator-associated pneumonia(VAP)in elderly patients undergoing long-term mechanical ventilation.METHODS A total of 154 elderly patients(aged no less than 80 years old)who received long-term me-chanical ventilation(no less than 21 days)in the Second Medical Center of Chinese PLA General Hospital from Nov.2018 to Dec.2024 were recruited as the research subjects and were randomly divided into the comprehen-sive intervention group with 77 cases(routine nursing plus comprehensive interventions to pulmonary rehabilita-tion)and the routine nursing group with 77 cases.RESULTS The incidence of VAP was 12.31％in the comprehen-sive intervention group,30.65％in the routine nursing group(P=0.009);the off-ventilator oxyhemoglobin satu-ration was(92.29±5.78)％in the comprehensive intervention group at the end of observation period,(88.84±4.70)％in the routine nursing group(P＜0.001);the diaphragmatic thickening ratio was(36.78±16.06)％in the comprehensive intervention group,(25.02±19.97)％in the routine nursing group(P＜0.001);the 24-hour ex-pectoration volume was(94.68±26.65)ml in the comprehensive intervention group,(64.61±15.16)ml in the routine nursing group(P＜0.001);all the above indexes were improved.The result of multivariate logistic regres-sion analysis showed that no interventions to pulmonary rehabilitation(OR=2.763,95％CI:1.061 to 7.195)and mechanical ventilation(OR=1.107,95％CI:1.033 to 1.186)were the risk factors for VAP(P＜0.05).CONCLUSIONS The comprehensive interventions to pulmonary rehabilitation can remarkably improve the respira-tory function of the elderly patients undergoing mechanical ventilation and reduce the incidence of VAP.The ex-tension of mechanical ventilation may increase the risk of VAP.

OBJECTIVE To explore the effect of comprehensive interventions to pulmonary rehabilitation on preven-tion of ventilator-associated pneumonia(VAP)in elderly patients undergoing long-term mechanical ventilation.METHODS A total of 154 elderly patients(aged no less than 80 years old)who received long-term me-chanical ventilation(no less than 21 days)in the Second Medical Center of Chinese PLA General Hospital from Nov.2018 to Dec.2024 were recruited as the research subjects and were randomly divided into the comprehen-sive intervention group with 77 cases(routine nursing plus comprehensive interventions to pulmonary rehabilita-tion)and the routine nursing group with 77 cases.RESULTS The incidence of VAP was 12.31％in the comprehen-sive intervention group,30.65％in the routine nursing group(P=0.009);the off-ventilator oxyhemoglobin satu-ration was(92.29±5.78)％in the comprehensive intervention group at the end of observation period,(88.84±4.70)％in the routine nursing group(P＜0.001);the diaphragmatic thickening ratio was(36.78±16.06)％in the comprehensive intervention group,(25.02±19.97)％in the routine nursing group(P＜0.001);the 24-hour ex-pectoration volume was(94.68±26.65)ml in the comprehensive intervention group,(64.61±15.16)ml in the routine nursing group(P＜0.001);all the above indexes were improved.The result of multivariate logistic regres-sion analysis showed that no interventions to pulmonary rehabilitation(OR=2.763,95％CI:1.061 to 7.195)and mechanical ventilation(OR=1.107,95％CI:1.033 to 1.186)were the risk factors for VAP(P＜0.05).CONCLUSIONS The comprehensive interventions to pulmonary rehabilitation can remarkably improve the respira-tory function of the elderly patients undergoing mechanical ventilation and reduce the incidence of VAP.The ex-tension of mechanical ventilation may increase the risk of VAP.

Currently the main treatment of acute myeloid leukemia (AML) is chemotherapy combining hematopoietic stem cell transplantation. However, the unbearable side effect of chemotherapy and the high risk of life-threatening infections and disease relapse following hematopoietic stem cell transplantation restrict its application in clinical practice. Thus, there is an urgent need to develop alternative therapeutic tactics with significant efficacy and attenuated adverse effects. Here, we revealed that umbilical cord-derived mesenchymal stem cells (UC-MSC) efficiently induced AML cell differentiation by shuttling the neutrophil elastase (NE)-packaged extracellular vesicles (EVs) into AML cells. Interestingly, the generation and release of NE-packaged EVs could be dramatically increased by vitamin D receptor (VDR) activation in UC-MSC. Chemical activation of VDR by using its agonist 1α,25-dihydroxyvitamin D3 efficiently enhanced the pro-differentiation capacity of UC-MSC and then alleviated malignant burden in AML mouse model. Based on these discoveries, to evade the risk of hypercalcemia, we synthetized and identified sw-22, a novel non-steroidal VDR agonist, which exerted a synergistic pro-differentiation function with UC-MSC on mitigating the progress of AML. Collectively, our findings provided a non-gene editing MSC-based therapeutic regimen to overcome the differentiation blockade in AML.