The risk of bias in observational studies of exposures (ROBINS-E) tool: concerns arising from application to observational studies of exposures

Systematic reviews, which assess the risk of bias in included studies, are increasingly used to develop environmental hazard assessments and public health guidelines. These research areas typically rely on evi...

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Micro-robots powered by chemistry grasp and creep

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[ASAP] Cobalt-Catalyzed Electrophilic Aminations with Anthranils: An Expedient Route to Condensed Quinolines

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b11466

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[ASAP] Direct Synthesis of Crystalline Graphdiyne Analogue Based on Supramolecular Interactions

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b09945

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[ASAP] Chemical Requirement for Extracting Energetic Charge Carriers from Plasmonic Metal Nanoparticles to Perform Electron-Transfer Reactions

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b11949

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[ASAP] Extended Bis(anthraoxa)quinodimethanes with Nine and Ten Consecutively Fused Six-Membered Rings: Neutral Diradicaloids and Charged Diradical Dianions/Dications

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b10279

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[ASAP] Mechanical Deformation Distinguishes Tunneling Pathways in Molecular Junctions

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b11248

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[ASAP] Palladium-Catalyzed Dearomative -1,4-Diamination

Journal of the American Chemical Society

DOI: 10.1021/jacs.8b13030

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How a major AI conference is attempting to tackle its culture problem

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Egypt and Pakistan had highest rise in research output in 2018

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Daily briefing: Your final Nature Briefing of 2018 — and the science to look out for next year

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Peak Oxygen Uptake and Mortality in Cystic Fibrosis: Systematic Review and Meta-Analysis

BACKGROUND:Aerobic fitness, as measured by peak oxygen uptake (V̇O2 peak), correlates with survival in children and adults with cystic fibrosis (CF). We sought to evaluate the effects of V̇O2 peak on mortality rates in subjects with CF.METHODS:An online search in PubMed, Embase, LILACS, and SciELO databases was conducted, and cohort studies that assessed mortality rates after oxygen absorption measurements during a maximal exercise test were included. Data were extracted independently by 2 reviewers. The quality analysis of the selected articles was performed using the Newcastle-Ottawa scale. The main outcome evaluated was the mortality of subjects with CF. Whenever possible, and if appropriate, a random effect meta-analysis was performed.RESULTS:Six cohort studies were included in this systematic review including 551 subjects. Five studies were classified with high methodological quality. Two analyses were carried out to evaluate the influence of V̇O2 peak on mortality. Total difference standardized mean between V̇O2 peak averages in the survival or non-survival groups was −0.606 (95% CI = −0.993 to −0.219, P = .002). In addition, subjects with a lower V̇O2 peak had a significantly higher mortality risk (relative risk 4.896, 95% CI = 1.086 to 22.072, P = .039) in an 8-y follow-up period.CONCLUSION:Low levels of peak oxygen uptake are associated with an increase of 4.9 in the risk of mortality in subjects with CF. This indicates that V̇O2 could be an important follow-up variable to measure, in addition to FEV1.

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Improved Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia: Better Than Silver and Gold?

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Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal

BACKGROUND:Biofilm on the surface of endotracheal tubes (ETTs) is associated with ventilator-associated pneumonia. The use of silver-coated ETTs has been suggested to reduce the occurrence of ventilator-associated pneumonia by preventing biofilm formation. However, mucus accumulation can reduce the antibacterial activity of silver-coated ETTs by isolating bacterial colonies from the silver surface. We hypothesized that, in mechanically ventilated subjects, periodic removal of secretions through the use of a cleaning device would enhance the antimicrobial properties of silver-coated ETTs and thus reduce bacterial colonization.METHODS:Subjects were randomized to either standard suctioning (blind tracheal suctioning, control group) or blind tracheal suctioning plus cleaning maneuver every 8 h (treatment group). Tracheal aspirates were collected immediately before extubation for microbiological culture. After extubation, ETTs were collected for both cultural and non-cultural microbiological analysis and biofilm isolation.RESULTS:39 subjects expected to be ventilated for > 48 h were enrolled; 36 ETTs (18 control, 18 treatment) and 29 tracheal samples (15 control, 14 treatment) were collected. Among the ETTs positive for bacterial colonization (15 vs 9, P = .18), cleaning maneuvers did not reduce microbial load, shown as the decimal logarithm of colony-forming units (CFU) per mL (1.6 ± 1.2 vs 0.9 ± 1.2 logCFU/mL, P = .15). There was a trend toward decreased biofilm deposition (439.5 ± 29.0 vs 288.9 ± 157.7 mg, P = .09) in the treated ETTs. No significant differences were observed in the number of positive tracheal aspirates (13 vs 10, P = .39) or in the microbial load (4.8 ± 4.0 vs 4.2 ± 3.8 logCFU/mL, P = .70) of tracheal secretions. Finally, no differences in the microbial load of Gram-positive organisms, Gram-negative organisms, or yeasts were found between the ETTs and tracheal aspirates of the 2 groups.CONCLUSIONS:In 39 critically-ill subjects intubated with silver-coated ETTs, periodic cleaning maneuvers did not decrease bacterial colonization of the ETTs and did not lower respiratory tract colonization compared to the standard suctioning. (Clinicaltrials.gov registration NCT02120001.)

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Lung Ultrasound: Just B Lines?

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Physiotherapy and Weaning From Prolonged Mechanical Ventilation

BACKGROUND:Patients undergoing prolonged mechanical ventilation represent up to 15% of all patients requiring weaning from mechanical ventilation. Although recent guidelines have recommended including physiotherapy early during mechanical ventilation to speed the process of weaning, only indirect evidence supporting the use of physiotherapy is available for patients receiving prolonged mechanical ventilation. The aim of our study was to evaluate the effects of a physiotherapy program in subjects requiring prolonged mechanical ventilation and the correlates of successful weaning.METHODS:A retrospective analysis was performed on 1,313 consecutive patients admitted to a weaning unit over a 15-y period to be liberated from prolonged mechanical ventilation. Subjects underwent a program of intensive physiotherapy organized in 4 incremental steps (1–4) and were analyzed according to the steps achieved (> 2 steps or ≤ 2 steps). The rate of successful weaning was recorded, and possible predictors were considered. The 15-y period of observation was divided into 3 consecutive 5-y intervals.RESULTS:Out of 560 subjects undergoing final analysis, 349 (62.3%) were successfully weaned. The weaning success rate was significantly greater in subjects attaining > 2 steps than in subjects who attained ≤ 2 steps (72.1% vs 55.9%, respectively, odds ratio = 2.04, 95% CI = 1.42–2.96, P < .001). Stepwise logistic regression analysis showed that achievement of > 2 physiotherapy steps was the main predictor of successful weaning (odds ratio = 2.17, 95% CI = 1.48–3.23, P < .001). Underlying disease was also a predictor of successful weaning. The overall rate of successful weaning decreased, and the median duration of weaning increased, during the period of observation.CONCLUSIONS:Our data support the inclusion of physiotherapy in the management of patients requiring prolonged mechanical ventilation.

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Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

BACKGROUND:Prolonged endurance running may acutely reduce spirometric lung values. This study examined changes in spirometry before and immediately after prolonged endurance exercise (running and/or walking). Specifically, we examined potential factors that predict the presence of at least a 10% postexercise reduction in FEV1.METHODS:After institutional review board approval, recruitment occurred at a pre-race exposition, where informed consent was obtained. Pre-and post-race spirometry measurements were taken from 79 study subjects who competed in a half-marathon (n = 66) or a marathon (n = 13). Spirometry was performed 1–2 days before the marathon or half-marathon and 25 min after finish the race.RESULTS:We identified a subgroup of 23 subjects with a postexercise decrease in FEV1 of ≥10%. In this subgroup, the mean post-race values for FEV1, FVC, and peak expiratory flow were 19–24% lower than the pre-race values. In the 56 subjects with a change in FEV1 of <10%, the mean post-race changes in spirometry values were not >6%. There was no difference between the 2 groups in sex distribution or between subjects who completed the half-marathon or the full marathon. For every 1-y increase in age, the likelihood of developing a postexercise reduction in FEV1 of at least 10% decreased by nearly 10% (R2 = 0.15, P = .003).CONCLUSIONS:Exercise-induced bronchoconstriction (EIB) is the most probable explanation for the reduction in post-race FEV1. Prolonged endurance exercise reduced spirometric lung function by ∼20% in those with EIB. Age was the only predictor for EIB, and EIB did not affect the finish times among recreational runners and/or walkers.

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Early Mobilization of Patients on Mechanical Ventilation: Worth the Effort and Expense?

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Continuous Neuromuscular Blockade and Mortality in Subjects With Exacerbation of Idiopathic Interstitial Pneumonias

BACKGROUND:Exacerbation of idiopathic interstitial pneumonias (IIPs) requiring mechanical ventilation is associated with high mortality. However, evidence for the optimal management strategy in patients on mechanical ventilation for exacerbation of IIPs is scarce. This study aimed to evaluate the association between continuous rocuronium infusion and in-hospital mortality in patients with exacerbation of IIPs requiring mechanical ventilation.METHODS:The effect of continuous rocuronium infusion was retrospectively analyzed using data in the Japanese Diagnosis Procedure Combination in-patient database from July 2010 to March 2016. We compared 28-d mortality between the continuous rocuronium infusion group (intravenous doses of ≥ 150 mg/d) and the control group using 1:4 propensity score matching.RESULTS:We enrolled 4,925 subjects. Propensity score matching yielded 66 subjects in the rocuronium group and 264 subjects in the control group. There was no significant difference in 28-d mortality (rocuronium vs control, 52% vs 44%, P = .31) or in-hospital mortality (68% vs 61%, P = .28) between the 2 groups.CONCLUSIONS:Continuous rocuronium infusion was not significantly associated with decreased mortality in patients with exacerbation of IIPs requiring mechanical ventilation.

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Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study

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