Objective To investigate the impact of lower inspiratory peak flow rates on airway peak pressure when using a ventilator to maintain respiratory function during the advanced life support phase of in-hospital cardiopulmonary resuscitation(CPR).Methods A prospective study was conducted,30 patients who underwent CPR for more than 20 minutes admitted to Lishui Municipal Central Hospital between September 2021 and December 2023 were enrolled as the study subjects.Volume controlled ventilation(VCV)with a descending flow waveform was used,while other preset parameters remained unchanged.Airway peak pressure was measured at different peak flow rates(55,50,45,and 40 L/min).The influence of varying flow rates on peak pressure was analyzed.Results During CPR,patients were in a continuous state of chest compressions.When the ventilator parameters were set conventionally,alarms for high airway pressure,low tidal volume(VT),and high respiratory rate often occurred,which affected the effectiveness of ventilatory support.There was a significant variation in airway peak pressure among different patients.As the peak flow rate increased from 40 L/min to 55 L/min,the airway peak pressure gradually increased.During the process of reducing the peak flow rate,the pulse oxygen saturation(SpO2)of all patients remained stable without significant changes.The 40 L/min group had significantly lower peak pressures than the 50 and 55 L/min groups,whereas the 55 L/min group had significantly higher pressures than all others[cmH2O(1 cmH2O≈0.098 kPa):41.20±9.06 vs.47.90±9.04 and 53.70±7.96,all P<0.05].When comparing patients with peak flow rates of 40 L/min and 50 L/min,as well as 45 L/min and 55 L/min,the average airway peak pressure increased significantly with each 10 L/min increment in inspiratory peak flow rate.However,the SpO2 remained essentially unchanged or slightly increased as the peak flow rate decreased.There were no statistically significant differences in SpO2 among patients at different peak flow rate levels.When the peak flow rate was set at 55,50,45,and 40 L/min,the proportions of patients with airway peak pressure>40 cmH2O were 100.0%,83.3%,63.3%,and 53.3%,respectively.Among them,the proportions of patients with airway peak pressure>50 cmH2O were 66.7%,40.0%,16.6%,and 16.6%,respectively.As the peak flow rate decreased,the proportion of patients with airway peak pressure>40 cmH2O gradually decreased.If the peak flow rate was set at 45 L/min or lower,the number of patients with airway peak pressure>50 cmH2O during CPR was less than 50.0%of the total number of cases.Conclusions During mechanical ventilation in CPR,using volume-controlled ventilation(VCV)mode with a decelerating waveform,improper peak flow rate settings can easily trigger high airway pressure alarms and result in low tidal volume(VT),leading to poor synchrony between the ventilator and the patient.Compared to peak flow rates of 55 L/min and above,selecting an inspiratory peak flow rate of 40 L/min and setting the high-pressure alarm at 50 cmH2O is suitable for the mechanical ventilation needs of most patients and does not affect oxygenation levels.This is a more appropriate choice.

Objective To investigate the impact of lower inspiratory peak flow rates on airway peak pressure when using a ventilator to maintain respiratory function during the advanced life support phase of in-hospital cardiopulmonary resuscitation(CPR).Methods A prospective study was conducted,30 patients who underwent CPR for more than 20 minutes admitted to Lishui Municipal Central Hospital between September 2021 and December 2023 were enrolled as the study subjects.Volume controlled ventilation(VCV)with a descending flow waveform was used,while other preset parameters remained unchanged.Airway peak pressure was measured at different peak flow rates(55,50,45,and 40 L/min).The influence of varying flow rates on peak pressure was analyzed.Results During CPR,patients were in a continuous state of chest compressions.When the ventilator parameters were set conventionally,alarms for high airway pressure,low tidal volume(VT),and high respiratory rate often occurred,which affected the effectiveness of ventilatory support.There was a significant variation in airway peak pressure among different patients.As the peak flow rate increased from 40 L/min to 55 L/min,the airway peak pressure gradually increased.During the process of reducing the peak flow rate,the pulse oxygen saturation(SpO2)of all patients remained stable without significant changes.The 40 L/min group had significantly lower peak pressures than the 50 and 55 L/min groups,whereas the 55 L/min group had significantly higher pressures than all others[cmH2O(1 cmH2O≈0.098 kPa):41.20±9.06 vs.47.90±9.04 and 53.70±7.96,all P<0.05].When comparing patients with peak flow rates of 40 L/min and 50 L/min,as well as 45 L/min and 55 L/min,the average airway peak pressure increased significantly with each 10 L/min increment in inspiratory peak flow rate.However,the SpO2 remained essentially unchanged or slightly increased as the peak flow rate decreased.There were no statistically significant differences in SpO2 among patients at different peak flow rate levels.When the peak flow rate was set at 55,50,45,and 40 L/min,the proportions of patients with airway peak pressure>40 cmH2O were 100.0%,83.3%,63.3%,and 53.3%,respectively.Among them,the proportions of patients with airway peak pressure>50 cmH2O were 66.7%,40.0%,16.6%,and 16.6%,respectively.As the peak flow rate decreased,the proportion of patients with airway peak pressure>40 cmH2O gradually decreased.If the peak flow rate was set at 45 L/min or lower,the number of patients with airway peak pressure>50 cmH2O during CPR was less than 50.0%of the total number of cases.Conclusions During mechanical ventilation in CPR,using volume-controlled ventilation(VCV)mode with a decelerating waveform,improper peak flow rate settings can easily trigger high airway pressure alarms and result in low tidal volume(VT),leading to poor synchrony between the ventilator and the patient.Compared to peak flow rates of 55 L/min and above,selecting an inspiratory peak flow rate of 40 L/min and setting the high-pressure alarm at 50 cmH2O is suitable for the mechanical ventilation needs of most patients and does not affect oxygenation levels.This is a more appropriate choice.

Objective To investigate the protective effect of apigenin on renal tubular epithelial cells(HK-2)induced by hyperglycemia and its potential mechanism.Methods HK-2 cells were incubated with d-glucose to establish an in vitro diabetic nephropathy model.Cell viability,apoptosis and oxidative stress were assessed.The mRNA levels of nuclear factor erythroid-2 related factor 2(Nrf2),heme oxygenase-1(HO-1)and epoxy chloropropane Kelch sample related protein-1(Keap1)were measured by quantitative real-time-PCR(q-PCR).Western blot analysis was performed to measure the protein expression of Nrf2.Results In HK-2 cells,high glucose decreased cell viability in a concentration-and time-dependent manner.Apigenin improved the viability of HK-2 cells under high glucose stress,reduced apoptosis and proinflammatory cytokine production,and inhibited the oxidative stress.Apigenin increased mRNA expression of Nrf2 and HO-1,increased expression of Nrf2 protein and reduced the mRNA level of Keap1.Inhibition of Nrf2 using small interfering RNA(siRNA)abolished the protective effects of apigenin on HK-2 cells under high glucose stress.Conclusion Apigenin treatment can alleviate the damage of HK-2 cells under high glucose stress,and exert the anti-oxidation and anti-inflammation effects through Keap1-Nrf2-ARE pathway.

Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri‑buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.
Adult ; Aged ; Aged, 80 and over ; COVID-19/complications* ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/therapy* ; SARS-CoV-2

OBJECTIVE:To systematically review the efficacy and safety of insulin glargine versus premixed insulin in treat-ment of type 2 diabetes,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,CJFD, Wanfang Database and VIP Database,the randomized controlled trials(RCT)about the efficacy and safety of premixed insulin ver-sus insulin glargine in the treatment of type 2 diabetes were collected. Meta-analysis was performed by using Rev Man 5.0 statistics software after extracting data and evaluating quality by modified Jadad. RESULTS:A total of 10 RCTs were enrolled,involving 1 655 patients. Results of Meta-analysis showed that insulin glargine was better than premixed insulin on reducing glycated hemoglobin [M=-0.41,95% CI(-0.64,-0.18),P<0.001] and fasting blood glucose [MD=-0.51,95% CI(-0.99,-0.02),P=0.04], there were significantly differences between 2 groups,and there were no significantly differences in reducing 2 h postprandial blood glucose [MD=-0.56,95% CI(-1.21,0.09),P=0.09] and body mass index [MD=-0.52,95% CI(-1.52,0.48),P=0.31];the incidence of hypoglycemia in insulin glargine group was significantly lower than premixed insulin,there were significantly differ-ences between 2 groups [RR=0.65,95%CI(0.46,0.90),P=0.01]. CONCLUSIONS:The efficacy and safety of insulin glargine are better than premixed insulin in the treatment of type 2 diabetes.

Objective: To investigate the efifcacy of supplemental walking training in patients with coronary artery disease (CAD) combining heart failure (HF) under routine medication.
Methods: A total of 80 patients with CAD combining HF were randomly divided into 2 groups: Exercise group,n=40 including 25 male and 15 female at (61.2 ± 9.8) years of age, the patients received additional six-minute walking exercise training based on routine medication and Control group,n=40 including 26 male and 14 female at (58.1 ± 10.9) years of age, the patients received routine medication. All patients were treated for 3 months. Plasma levels of BNP and general conditions at before and after the treatment were compared between 2 groups.
Results:①After 3 months treatment, both groups had signiifcantly improved LVESD, LVEDD, LVEF, plasma levels of BNP and six-minute walk test (except LVESD and LVEDD in Control group), allP<0.05.②Compared with Control group, Exercise group showed obviously improved LVEF, plasma level of BNP and six-minute walk test, allP<0.05.
Conclusion: Walking training may increase the exercise tolerance, which is beneifcial to recover the cardiac function in patients with CAD combining HF in addition to routine medication .