Lower Respiration Rates Research Articles

A big data analysis of fever threshold and vital sign characteristics using tympanic temperature in hospitalized patients

This study aimed to analyze vital sign characteristics of adult patients admitted at the Tertiary Hospital, and to define fever threshold and average body temperature by examining the tympanic temperatures of all patients. Retrospective medical data were extracted from 9195 patients aged > 21 years admitted to a tertiary hospital for elective surgeries between 2016 and 2020. Data regarding the patients’ vital signs during their hospital stay, including tympanic body temperature, heart rate, and respiratory rate, were analyzed according to age, sex, and circadian rhythm. A normal-distribution graph was obtained when all the body temperature results were aligned. The average body temperature measured was 36.91 ± 0.45 °C (average ± standard deviation), indicating a potential fever threshold of 37.81 °C. When the participants were divided into age groups, the average temperature, heart rate, and respiratory rate exhibited parabolic trends. Patients in their 60s exhibited the lowest average temperature (36.88 °C), whereas those in their 50s had the lowest average heart rate (75.82/min) and lowest respiratory rate (19.08/min). Heart rate and respiratory rate tended to increase in elderly people older than 81 years. The average body temperature was greater in women than in men (36.94 ± 0.42 °C vs. 36.89 ± 0.47 °C), while the average heart (75.53 ± 10.04/min vs. 77.31 ± 11.52/min) and respiratory rates (19.13 ± 1.39/min vs. 19.29 ± 2.24/min) were lower in women than in men respectively. According to the time of measurement, the average temperature and heart rate appeared to follow a sinusoidal pattern, suggesting that the circadian rhythm was highest at 1 a.m. and lowest at 8 a.m. Tympanic temperature is a convenient measurement method preferred in hospital settings because it is noninvasive and easier to measure compared to other body parts. To develop an improved device and measurement method in the future, it is necessary to analyze tympanic temperature big data and compare it with past vital sign data or biometric information from other body parts.

Melatonin treatment maintains the quality properties and storability of carambola fruit by modulating energy metabolism

The influences of 150 μmol/L melatonin treatment on the quality properties, storability, and energy metabolism in carambola fruit were explored. The results showed that, compared to the control, melatonin treatment significantly retained higher rate of commercially acceptable fruit, and retarded the development of fruit browning and yellowing. Additionally, melatonin treatment displayed higher levels of chromaticity L⁎ and h° values, titratable acid, total soluble solids, total soluble sugars, sucrose, and vitamin C, but lower respiration rate, chromaticity a⁎ and b⁎ values, and reducing sugar content. Moreover, melatonin treatment presented higher levels of ATP, ADP, and energy charge, as well as higher activities of H+-ATPase, Mg2+-ATPase, and Ca2+-ATPase in the membranes of vacuole, mitochondria, and plasma, thereby reducing the damage to cell membranes. These results will provide a scientific basis and practical guidance for melatonin to maintain the quality properties and storability, and to prolong the shelf life of postharvest carambola fruit.

Trends in mortality from lower respiratory infections in children under 14 years, 1990–2019: An analysis of the Global Burden of Disease Study 2019

BackgroundLower respiratory infections (LRIs) remain a leading cause of mortality among children, yet previous studies have primarily focused on children under 5 years of age as a whole, with limited research on more specific age groups. This study aimed to analyze the trends in mortality associated with lower respiratory infections (LRIs) among children under 14 years of age from 1990 to 2019, with particular attention to regional and age-specific disparities. MethodsWe collected annual lower respiratory infection (LRI) deaths and mortality rates for six age groups of children under 14 years from 1990 to 2019 using data from GBD 2019. Estimated annual percentage changes (EAPCs) were calculated by fitting a linear regression model to quantify temporal trends. Additionally, EAPCs for 12 risk factors by Socio-Demographic Index（SDI） and age group were calculated to assess their impact on changes in LRI mortality. ResultsGlobally, LRI-related deaths among children under 14 years decreased by 68.81 %, from 2,290,115 (95 % UI 2,001,328 to 2,687,160) in 1990 to 714,315 (95 % UI 588,975 to 875,975) in 2019. The most substantial reduction was observed in East Asia, with an EAPC of −9.68 (95 % CI -9.98 to −9.38). The highest mortality occurred in the 28–364 days age group, with significant risk factors including child wasting (26.81 %), household air pollution from solid fuels (16.14 %), and low birth weight (10.15 %). In the low and lower-middle SDI regions, there was an upward trend in mortality due to ambient particulate pollution among children aged 10–14 years. ConclusionDespite a significant global decline in LRI mortality among children under 14 years from 1990 to 2019, regional disparities persist. Addressing these inequalities and considering the developmental stages of children are crucial for further reducing child mortality rates.

Predictors of Poor Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Admitted to the Emergency Department With COVID-19: A Prospective Study.

Objectives Long-term consequences of COVID-19 in the post-pandemic era are still being investigated. Despite the growing data on COVID-19, there remains a lack of information regarding predictors of poor outcomes among chronic obstructive pulmonary disease (COPD) patients with COVID-19. Methods A single-center prospective cohort study was conducted with a total of 172 adult COPD patients with COVID-19 pneumonia included. Univariable and multivariable analyses were conducted to define independent factors associated with ICU admission, need for mechanical ventilation, or all-cause mortality in 30 days following COVID-19 pneumonia. receiver operating characteristic (ROC) analyses evaluated the diagnostic performance of the independent predictors. Results Out of all the patients, 73 (42.4%) experienced poor outcomes. Lower forced expiratory volume in the first second (FEV1) (OR= 0.949, p= 0.004), higher radiological severity score (OR= 1.15, p= 0.004), and lower respiratory rate oxygenation (ROX) index (OR= 0.867, p<0.001) were independently associated with poor outcomes.ROX index was found a better predictor of poor outcome than oxygen saturation (SaO2)/fraction of inspired oxygen (FiO2) and partial pressure of oxygen (PaO2)/FiO2 ratio (area under the curve (AUC)=0.80 vs. 0.73, p=0.01; AUC= 0. 80 vs. 0.63 p=0.001). A significant decline in FEV1 values compared to baseline values was observed (55.9 ±12.9 vs. 62.1±10.0; p<0.001). Conclusion Lower baseline FEV1, higher COVID-19 radiological severity score, and lower ROX index are strongly associated with poor outcomes in COPD patients with COVID-19.

Preserving refrigeration and shelf life quality of hardy kiwifruit (Actinidia arguta) with alginate oligosaccharides preharvest application.

Alginate oligosaccharide (AOS) is a bioactive carbohydrate known for its preservation properties. However, the efficacy of preharvest AOS treatment in maintaining the postharvest quality of hardy kiwifruit (Actinidia arguta) has not been previously reported. This study explores the effects of preharvest AOS treatment (80mg L-1) on A. arguta fruit, assessing visual quality, physiological attributes, aroma, and antioxidant capacity during refrigeration and shelf life. Results showed that AOS treatment maintained higher lightness, chroma, firmness, and antioxidant levels (total phenolics, flavonoids, ascorbic acid, and glutathione), along with antioxidant enzyme activities (peroxidase, catalase, and ascorbate peroxidase). Specifically, AOS-treated fruit had 9% higher chroma and double the firmness after 60 days of refrigeration. AOS treatment reduced ripening and senescence, with 25% lower soluble solids content, 22% lower respiration rate, 30% lower ethylene production, and 35% lower malondialdehyde content. Electronic nose analysis indicated that AOS treatment suppressed changes in fruit aroma and off-odor development, maintaining significantly higher quality during the shelf life period. These findings demonstrate the effectiveness of AOS as a sustainable method to extend shelf life and preserve the quality of A. arguta fruit, enhancing its market value and consumer appeal. PRACTICAL APPLICATION: The research on using alginate oligosaccharides (AOS) for preharvest treatment of hardy kiwifruit (Actinidia arguta) has practical applications in the food industry. By extending the shelf life and preserving the quality of the fruit during storage, this method can help reduce postharvest losses and improve the market value and consumer appeal of A. arguta fruit. This sustainable preservation technique offers an eco-friendly alternative to traditional methods, enhancing the freshness and nutritional quality of the fruit available to consumers.

Growth, Morphology and Respiratory Cost Responses to Salinity in the Mangrove Plant Rhizophora Stylosa Depend on Growth Temperature.

Mangrove plants, which have evolved to inhabit tidal flats, may adjust their physiological and morphological traits to optimize their growth in saline habitats. Furthermore, the confined distribution of mangroves within warm regions suggests that warm temperature is advantageous to their growth in saline environments. We analyzed growth, morphology and respiratory responses to moderate salinity and temperature in a mangrove species, Rhizophora stylosa. The growth of R. stylosa was accelerated in moderate salinity compared with its growth in fresh water. Under warm conditions, the increased growth is accompanied by increased specific leaf area (SLA) and specific root length. Low temperature resulted in a low relative growth rate due to a low leaf area ratio and small SLA, regardless of salinity. Salinity lowered the ratio of the amounts of alternative oxidase to cytochrome c oxidase in the mitochondrial respiratory chain in leaves. Salinity enhanced the leaf respiration rate for maintenance, but under warm conditions this enhancement was compensated by a low leaf respiration rate for growth. In contrast, salinity enhanced overall leaf respiration rates at low temperature. Our results indicate that under moderate saline conditions R. stylosa leaves require warm temperatures to grow with a high rate of resource acquisition without enhancing respiratory cost.

The Effects of a Three-Stair Positioning Pillow Used for Preterm Infants on Physiologic Parameters and Sleep-Wakefulness Status: Randomized Controlled Trial.

It is important to provide the necessary sleep for the growth of preterm infants in the neonatal intensive care unit. The purpose of this study was to determine the effect of 3-stair positioning pillows (TSPPs) developed for preterm infants with postnatal age 28 to 35weeks on physiologic parameters and sleep-wakefulness status. This research was conducted as a randomized controlled experimental study. The CONSORT flowchart was used in the implementation of the randomized controlled trial. The preterm infants in the experimental group were placed in the prone position with TSPPs, whereas the preterm infants in the control group were followed in the routine prone position given in the neonatal intensive care unit. Preterm infants were followed for a total of 3hours. The sample of the study consisted of 60 preterm infants (experiment group=30; control group=30) who were hospitalized in the neonatal intensive care unit and met the selection criteria. Compared with the infants in the control group, the preterm infants in the experimental group were determined to have significantly lower heart rates, higher oxygen saturations, lower respiratory rates, longer sleep durations, and shorter wakefulness times (P <.001). It was found that positioning preterm infants using TSPP had positive effects on physiological parameters (heart rate, oxygen saturation, and respiratory rate) and sleep-wakefulness status in favor of the experimental group. It is recommended to use a TSPP that supports the prone position to improve the physiologic parameters and sleep-wakefulness status of preterm infants in the neonatal intensive care unit. Larger studies need to be conducted utilizing longer follow-up protocols. Examining the effectiveness of TSPPs with different positioning materials in preterm infants is needed.

Clinical phenotype of ARDS based on K-means cluster analysis: A study from the eICU database

PurposeTo explore the characteristics of the clinical phenotype of ARDS based on Machine Learning. MethodsThis is a study on Machine Learning. Screened cases of acute respiratory distress syndrome (ARDS) in the eICU database collected basic information in the cases and clinical data on the Day 1, Day 3, and Day 7 after the diagnosis of ARDS, respectively. Using the Calinski-Harabasz criterion, Gap Statistic, and Silhouette Coefficient, we determine the optimal clustering number k value. By the K-means cluster analysis to derive clinical phenotype, we analyzed the data collected within the first 24 h. We compared it with the survival of cases under the Berlin standard classification, and also examined the phenotypic conversion within the first 24 h, on day 3, and on day 7 after the diagnosis of ARDS. ResultsWe collected 5054 cases and derived three clinical phenotypes using K-means cluster analysis. Phenotype-I is characterized by fewer abnormal laboratory indicators, higher oxygen partial pressure, oxygenation index, APACHE IV score, systolic and diastolic blood pressure, and lower respiratory rate and heart rate. Phenotype-II is characterized by elevated white blood cell count, blood glucose, creatinine, temperature, heart rate, and respiratory rate. Phenotype-III is characterized by elevated age, partial pressure of carbon dioxide, bicarbonate, GCS score, albumin. The differences in ICU length of stay and in-hospital mortality were significantly different between the three phenotypes (P < 0.05), with phenotype I having the lowest in-hospital mortality (10 %) and phenotype II having the highest (31.8 %). To compare the survival analysis of ARDS patients classified by phenotype and those classified according to Berlin criteria. The results showed that the differences in survival between phenotypes were statistically significant (P < 0.05) under phenotypic classification. ConclusionsThe clinical classification of ARDS based on K-means clustering analysis is beneficial for further identifying ARDS patients with different characteristics. Compared to the Berlin standard, the new clinical classification of ARDS provides a clearer display of the survival status of different types of patients, which helps to predict patient prognosis.

Cardiorespiratory Assessment of Preterm and Near Term Neonates on Nasal Continuous Positive Airway Pressure (CPAP) in Different Body Positions

Abstract Background The use of continuous positive airway pressure (CPAP) is one of the recommended interventions to reduce morbidity and mortality in preterm infants. The effect of body position is directly associated with clinical conditions and factors related to respiratory assistance. Aim and Objectives To evaluate the effect of different body positions on different cardiac, respiratory parameters for preterm and near term neonates with respiratory distress treated with CPAP. Patients and Methods This one arm clinical observational study was conducted on 81 preterm and near term neonates who had respiratory distress, placed on nasal CPAP. They were placed in prone, supine, left lateral and right lateral position, each for 90 minutes. The neonate was kept in each position for 30 minutes (washout period), then was observed clinically and monitored for respiratory rate, heart rate, oxygen saturation. Also, using electrical cardiometry cardiac output, stroke volume and index of contractility (ICON) level were monitored for 60 minutes, recorded at intervals of 10 minutes then the average was taken. Results Respiratory rate was significantly decreased (p-value &amp;lt; 0.001) in prone position 42.65 ±5.03(breath/min), compared to 45.41±7.73(breath/min)in supine position, 45.2±5.39(breath/min) in left lateral position, 45.23±5.32(breath/min) in right lateral position. Oxygen saturation was significantly increased (p-value &amp;lt;0.001) in prone position 97.3%±1.6% compared to 95.8±1.5% in supine position, 94.9%±1.6% in left lateral position, 95±1.5% in right lateral position, while there was no statistically significant difference as regard heart rate (p-value 0.64). As regards cardiometry parameters, cardiac output and stroke volume were highly significantly increased(p- value 0.019, &amp;lt;0.001 respectively) in prone position; that cardiac output was 0.41 ± 0.13 (l/min) in prone position versus0.38± 0.14 (l/min) in supine and right lateral positions, 38± 0.13 (l/min) in left lateral position, stroke volume was 3.02 ± 1.03(ml) in prone position versus 2.67 ± 0.87(ml) in supine position, 2.72 ± 0.94 (ml) in left lateral position, 2.74 ± 1.07(ml) in right lateral position. Conclusion Neonates on nasal CPAP in prone position had the highest oxygen saturation, lowest respiratory rate, highest stroke volume and cardiac output, further researches are needed on a greater scale.

Evaluation of Postharvest Quality of Fresh Kesum Leaves (Persicaria minor) during Storage in Different Temperatures and Packaging

Persicaria minor, locally known as kesum, is an herb synonym in Southeast Asia as a food flavor enhancer and seasoning for Eastern delicacies. Kesum leaves are quickly wilted, shrink, and lose moisture once harvested. This study aimed to determine optimum parameters: storage temperature and suitable packaging to maintain the freshness and quality of kesum and prolong the storage life. This study consisted of two activities: determining the best storage temperature and determining suitable packaging. For the first activity, kesum leaves were harvested manually from matured plants, transported to a packinghouse, sorted, cleaned, packed, and sealed in polyethylene (PE) 0.04mm before being stored at different temperatures, which were 5°C, 8°C, 10°C and 13°C, while for the second activity, kesum leaves were packed and sealed in different packaging: polyethylene (PE) 0.04mm and polypropylene (PP) 0.04mm and stored at 5°C. The postharvest quality of all samples and treatments (weight, moisture content, pH, total titratable acidity, total soluble solids, respiration rate of the leaves, total phenolic content, and leaf color values) was measured and recorded weekly throughout the storage period. The study's results found that storing fresh kesum leaves at 5°C temperature and in PE 0.04mm packaging can delay the senescence and maintain the quality and postharvest attributes for up to 35 days, as shown in lower respiration rate, maintain the pH, total titratable acidity, total soluble solids and color of the leaves, and show higher total phenolic content for up to 35 days of storage compared to storing in temperature of 8°C, 10°C, and 13°C and PP 0.04mm packaging.

Shelf-life extension of pomegranate arils using banana powder-based nanocomposite coatings functionalized with cellulose nanofiber and zinc-oxide nanoparticles

ABSTRACT This study explored a novel nanocomposite comprising banana powder (BP), cellulose nanofiber (CNF), and 0.6% zinc oxide nanoparticles (ZnO NPs). The treatment involved immersing arils in the respective nanocomposite coatings for 4 min, followed by air-drying at room temperature (25°C) and subsequent storage in polyethylene terephthalate punnets at 4°C and 85% relative humidity for 21 d. Results demonstrated that the nanocomposites significantly (p < .05) reduced total plate and yeast counts, delayed colour and texture degradation, and decreased weight loss and respiration rates while maintaining levels of total soluble solids and titratable acidity compared to the control (water) and standard BP/CNF treatment. The BP/CNF/ZnO-PPW was more effective as it displayed a lower respiration rate (50 mL CO2 kg−1 h −1), weight loss (0.4%), and maintained higher firmness (12.4 N) compared to the control treatment. Overall, the nanocomposite treatments with ZnO NPs resulted in a 6-day shelf-life extension, offering a promising solution through nanotechnology applications.

Modified R-GLIM Score Is a Good Prognostic Tool to Predict a Long-Term Prognosis in Poor Conditioned Elderly Patients with Aspiration Pneumonia, a Pilot Study.

While prognostic guidelines for pneumonia have widely allowed clinicians to treat patients, poor prognostic factors for 1- or 2-year survival times have never been mentioned to our knowledge. We conducted this retrospective study to evaluate whether malnutrition according to the GLIM criteria is a poor prognostic factor for 1- or 2-year survival among patients with aspiration pneumonia. All patients with community-onset aspiration pneumonia who were admitted to Aichi Medical University and had intervention from our nutrition support team (NST) in 2019 and 2020 were enrolled in this study. A total of 56 patients were enrolled in the study. The mean age was 86 ± 6.5 and 25 (45%) were male. Thirty-one patients died during this observational period. Comparing the survival and death group, higher respiratory rate (RR) and malnutrition were seen more frequently in the death group than in the survival group. Then, the patients were divided into the following three groups: those with an RR ≥ 22 and malnutrition, those with malnutrition, and a control group [patients who were not malnourished and had a low RR (<22)]. Comparing the three groups, patients with an RR ≥ 22 and malnutrition had significantly shorter overall survival times (OSs) than those in the other groups (p = 0.009 by Log-Rank test) for 1-year prognosis. The result of 2-year prognosis displayed a statistical significance that was the same as that for 1-year prognosis (p = 0.004 by Log-Rank test). The Cox hazard regression model showed that a higher RR was an independent poor prognostic factor for 1- and 2-year survival among aspiration pneumonia patients. This pilot study showed that combined scores of higher RR and malnutrition according to the GLIM criteria (modified R-GLIM score) was an independent poor prognostic factor for 1 or 2-year survival among super-elderly patients (aged over 80 years) with aspiration pneumonia.

Controlled atmosphere as cold chain support for extending postharvest life in cabbage

Postharvest management of cabbage relies on high-intensity cooling to control postharvest physiology, minimising quality loss despite incurring significant energy and environmental costs. As an alternative, we hypothesised that controlled atmosphere (CA) could allow increased storage temperature by supporting physiological regulation, while maintaining quality and reducing energy demand. This study examined the effect CA (1.5 kPa CO2 and 6 kPa O2) at 5 or 10 °C on cabbage quality, with the aim of proposing a more sustainable and resilient supply chain. CA treatment was effective at reducing head respiration at higher temperature, with CA/10 °C treatment achieving lower respiration rates than Control/5 °C. Improved head colour retention and maintenance of stump quality were observed in cabbage under CA conditions. CA effects were seen also at a regulatory level; CA promoted an average of 25.4% reduction in abscisic acid accumulation potentially as part of a wider hypoxia stress response and was successful in decreasing expression of the senescence-coordinating transcription factor BoORE15. This finding was linked with a lower in downstream expression of pheophytinase and subtilisin protease. These results demonstrated that CA treatment fundamentally modified postharvest physiology in cabbage, which can be exploited to enable storage at warmer temperatures, contributing to supply chains with lower energy demand and its associated environmental benefits.

The Effects of Burst Steroid Therapy on Short-term Decongestion in Acute Heart Failure Patients With Pro-inflammatory Activation: A Post Hoc Analysis of the CORTAHF Randomized, Open-label, Pilot Trial

The effect of steroids on congestion in patients with acute heart failure (AHF) is not known. Patients with AHF, NT-proBNP levels > 1500 pg/mL and high-sensitivity C-reactive protein (hsCRP) levels > 20 mg/L were randomized to once-daily oral 40 mg prednisone for 7 days or usual care. In this post hoc analysis, congestion score was calculated on the basis of orthopnea, edema and rales (0 reflecting lack of congestion, and 9 maximal congestion) at each time point. Among 100 eligible patients randomized, those assigned to prednisone had a greater improvement in congestion score at day 31 (win odds for the prednisone group compared to usual care at day 31 was 1.77 (95% CI 1.17-2.84; P = 0.0066) in all patients and 2.41 (95% CI 1.37-5.05; P = 0.0016) in patients with IL-6 > 13 pg/mL at baseline. In patients with congestion scores ≥ 7 at baseline, the effects of prednisone therapy on the EQ-5D visual analog scale score were 4.30 (95% CI 0.77-7.83) points at day 7 and 5.40 (0.51-10.29) points at day 31, accompanied by lower heart rate and respiratory rate and higher oxygen saturation compared to usual care. In patients with AHF and inflammatory activation, 7-day steroid therapy was associated with reduction in signs of congestion up to day 31. These results need confirmation in larger studies examining potential effects of steroids on congestion, diuresis, fluid redistribution and vascular permeability as well as clinical effects in AHF.

Pharmacokinetics of Extended-release Buprenorphine and Clinical Efficacy for Postoperative Pain Management in the Domestic Ferret (Mustela putorius furo).

Buprenorphine hydrochloride (Bup-HCl) is a common injectable opioid analgesic. In ferrets, Bup-HCl must be administered every 8 to 12 h to maintain clinical efficacy. Extended-release analgesics offer multiple advantages, including reduced handling and injection frequency, improved compliance, and increased protection from end-of-dose failure. Although efficacy of extended-release buprenorphine formulations has been demonstrated in other species, their use in the domestic ferret has not been investigated. In this study, we evaluated the pharmacokinetics of a compounded polymeric formulation of buprenorphine (Bup-ER) and a pharmaceutical-grade, FDA-indexed liposomal suspension (Bup-XR). Two doses each of Bup-ER (0.12 and 0.2 mg/kg) and Bup-XR (0.2 and 0.6 mg/kg SC) were administered to young adult female ferrets and plasma concentrations were measured between 0 and 96 h (n = 4 animals per timepoint). All doses of both drugs achieved therapeutic plasma levels by 30 min. Furthermore, high-dose Bup-XR maintained therapeutic levels for 72 h, followed by high-dose Bup-ER (less than 48 h), low-dose Bup-XR (24 h), and low-dose Bup-ER (less than 24 h). In this study, we also developed a pain scoring system and utilized this to compare analgesic efficacy between single high-dose Bup-XR (0.6 mg/kg SC) and a standard postoperative course of Bup-HCl (0.02 mg/kg SC every 10 to 12 h for 8 doses) after ovariohysterectomy. Ferrets receiving Bup-XR had significantly lower respiratory rate and posture scores in the first 24 h postoperatively than did those that received Bup-HCl and were less likely to react to palpation of the surgical incision. Of note, ferrets that received high-dose Bup-ER had a significantly higher incidence of injection site reactions than ferrets that received Bup-HCl (P = 0.0137). This study demonstrates that a single dose of Bup-XR (0.6 mg/kg SC) is a safe and effective analgesic in female ferrets, with a duration of action up to 72 h and minimal side effects, offering a refinement to analgesia in this species.

Post-Laparotomy Pulmonary Complications in Blow Bottle versus Interdigital Breathing Technique: A Quasi-Experimental Study

Objective: To analyze the impact of interdigital versus blow-bottle breathing exercises on spirometry, pulse oximetry and respiratory rate in post-laparotomy patients. Study Design: Quasi-experimental study. Place and Duration of Study: Riphah College of Rehabilitation Sciences, Riphah International University and Capital Hospital, Islamabad, Pakistan, from Apr to Aug 2018. Methodology: This quasi experimental study recruited 27 post laparotomy patients, male and female, aged between 25-45 years. Along with conventional treatment for both groups, Group-A (n=14) received interdigital breathing exercises and Group-B (n=13) was given blow-bottle breathing therapy. Effect on spirometry, pulse oximetry tests and respiratory rate on Day 1, 3 and 6 were recorded. Results: On 6th Day post-laparotomy, interdigital group (Group A) showed significantly higher median and mean ranks for oxygen saturation (OS) (p&lt;0.001), rate of peek expiratory flow (p=0.000), forced expiratory volume (1 second) (p=0.018), forced vital capacity (p&lt;0.001) and lower respiratory rate (p&lt;0.001). Blow bottle breathing therapy revealed significantly higher mean for forced vital capacity (p=0.017), but was lower for Oxygen saturation (p&lt;0.001) and respiratory rate (p&lt;0.001). Conclusion: Our findings lead us to conclude that interdigital technique provides more benefit to post-laparotomy patient compared to blow bottle technique in effective management of pulmonary complications.

Involvement of BcNAC083 in 1-MCP-induced delayed yellowing of pak choi (Brassica rapa subsp. Chinensis) through the regulation of reactive oxygen species metabolism and inhibition of major chlorophyll catabolic genes

Leaf yellowing is a typical senescence feature in postharvest pak choi. Plant-specific NAC transcription factors (TFs) are crucial regulators of plant senescence. In this study, a senescence-related NAC TF, BcNAC083, was investigated to identify its transcriptional regulation effects on the yellowing of pak choi by treatment with 1-methylcyclopropene (1-MCP). Applying 5.0 µL L–1 1-MCP alleviated yellowing and maintained a low respiration rate, high chlorophyll content, and relatively complete chloroplast structure in pak choi during storage. However, 10 μL L–1 ethylene accelerated yellowing, as demonstrated by the higher respiration rate, lower chloroplast structural integrity and chlorophyll content. In contrast to ethylene treatment, 1-MCP suppressed the activity of the reactive oxygen species (ROS) metabolism-related enzymes superoxide dismutase (SOD), catalase (CAT), ascorbic peroxidase (APX), and lipoxygenase (LOX), and correspondingly reduced superoxide anion (O2·–), hydrogen peroxide (H2O2), and malondialdehyde (MDA) accumulation. 1-MCP treatment also suppressed the transcript levels of ROS metabolic genes, including BcRBOHC, BcRBOHD, BcSOD, BcCAT, BcAPX, and BcLOX, and inhibited the activity of the chlorophyll catabolic enzymes chlorophyllase (CLH), Mg-de-chelatase, and pheophytin pheophorbide hydrolase (PPH) and transcript levels of associated genes, including BcCLH1/2, BcPPH1/2, BcPAO, BcNYC1, BcSGR1/2, BcHCAR, BcRCCR, and BcCAO. The expression of BcNAC083 was probably induced by ROS and was downregulated by 1-MCP and upregulated by ethylene. Molecular biology experiments determined that BcNAC083 bound directly to and activated the promoters of the chlorophyll metabolism-related genes BcCLH1, BcPPH1, BcNYC1, and BcHCAR. Importantly, transient overexpression of BcNAC083 stimulated the endogenous genes (NbCLH1, NbPPH1, NbNYC1, and NbHCAR) expression in tobacco leaves, resulting in rapid chlorophyll breakdown and leaf degreening. Treatment with 1-MCP may alleviated the yellowing of pak choi by inhibiting ROS accumulation and the transcriptional regulation of BcNAC083, which had positive regulatory effects on major chlorophyll metabolic genes.

The Effect of Two Different Nasal Interfaces Used in Post-Extubation Non-Invasive Respiratory Support on Extubation Success in Newborns

Background: Non-invasive ventilation support is frequently used in newborns after extubation. The efficiency of non-invasive ventilation support is associated to type of nasal interface used. We aimed to investigate the effect of nasal interface type in our study on extubation success. Materials and Methods: We retrospectively evaluated a total of 105 term and preterm patients who were extubated to non-invasive ventilation. We divided the patients into two groups according to nasal interface type: RAM cannula or short binasal prongs (SBPs). We examined extubation failure between the two groups. Results: While 63 of the patients were in RAM cannula group, 42 of them were in SBPs group, and the demographic characteristics of the patients were similar. There was no statistically significant differen-ce in the extubation failure rates between the groups (RAM; %44.4 vs SBPs; %38.1, p=0.518). The Ram cannula group had a higher beginning median positive end-expiratory pressure value (7.0 vs 6.5 cmH2O, p=0.038; respectively) and a lower median respiratory rate (60 vs 62/minute, p=0.032; res-pectively) than the SBPs group. Conclusions: We believe that the easy-to-use RAM cannula can be used in selected patients, especially by setting the PEEP value approximately 1 cmH2O higher.

Monitoring Respiratory Rate Continuously Without Attaching a Sensor During a Challenging Ramped Protocol.

Respiratory rate (RR) is a crucial vital sign in patient monitoring and is often the best marker of the deterioration of a sick patient. It can be used to help diagnose numerous medical conditions and has been demonstrated to be an independent predictor of patient outcomes in various critical care settings and is incorporated in many clinical early warning scores. Here, we report on the performance of depth-camera-based system for the noncontact monitoring of RR during a ramped RR protocol. The ramped breathing protocol was developed specifically to test the relatively rapid changes in rates, which include clinically important low and high ranges of RRs. We performed a series of experimental runs with healthy volunteers who were instructed to breathe over a wide range of RRs, where the rates were ramped up from 4 breaths/min to 50 breaths/min then back down to 4 breaths/min in a series of ramped steps. Depth information was acquired from the scene and used to determine a respiratory rate (RRdepth), and this was compared to capnograph or spirometer respiratory rate reference (RRref). A total of 9,482 contemporaneous data pairs (RRdepth, RRref) were collected during the study for comparison. A Pearson correlation coefficient of 0.995 was achieved and a line of best fit given by RRdepth = 0.99 × RRref + 0.36 breaths/min. The overall root mean squared difference (RMSD) across the runs was 1.29 breaths/min with a corresponding bias of 0.16 breaths/min, respectively. The associated Bland-Altman analysis found limits of agreement of -2.45 and 2.75 breaths/min. When the data were subdivided according to low, medium, and high RRs, corresponding to ≤10, >10 to 20, and >20 breaths/min, the RMSD accuracies were found to be 0.94, 1.34, and 1.55 breaths/min, respectively. The technology performed well, exhibiting an RMSD accuracy well within our target of 3 breaths/min, both across the whole range and across each individual subrange. In summary, our results indicate the potential viability of continuous noncontact monitoring for the determination of RR over a clinically relevant range.

The need for assisted ventilation corroborates the effectiveness of antenatal corticosteroid therapy in preventing premature lamb mortality

In premature births, deficiency and/or inactivation of surfactant and incomplete development of lung occur, leading to pulmonary complications and greater need for ventilatory interventions. Prenatal corticosteroid therapy is used to improve neonatal lung function and, thus, may reduce mortality and lower incidence and severity of lung injury. Therefore, this study aimed to assess the need for ventilatory support in preterm lambs subjected or not to prenatal betamethasone treatment, and to evaluate the effectiveness on neonatal survival. Lambing was induced and 13 premature lambs were assigned to Corticosteroid Group (n = 8; lambs from ewes subjected previously to 0.5 mg/kg betamethasone, IM, at 133 days of pregnancy) and Control Group (n = 5; non-treated lambs). Lambs were evaluated for vitality, neurologic reflexes, vital functions and birth weight. Three ventilatory modalities were preconized for critical lambs, according to specific criteria: mask oxygen therapy, self-inflating bag with tracheal tube and mechanical ventilation. Non-treated lambs had lower vitality score, muscle tonus and respiratory rate compared to Corticosteroid Group. Ventilatory support was needed for 3 Control lambs and only 1 Corticosteroid neonate. Corticosteroid lamb required significant less time-frame between birth and onset of ventilatory assistance and remained under ventilation for a shorter time. Percentage of ventilated non-treated lambs correlated negatively with birth weight, muscle tone, heart and respiratory rate. In conclusion, antenatal betamethasone treatment reduces the need for ventilatory assistance in premature lambs. Additionally, mortality is low when a protocol for inducing pulmonary maturity (maternal corticosteroid therapy) and/or ventilatory interventions are employed, ensuring the survival of premature lambs.