EXTUBATE: A randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Respiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of respiratory support and to improve rates of successful extubation.</p> <p>Non-invasive respiratory support has been demonstrated to be less injurious to the premature lung. Standard practice is to use nasal continuous positive airway pressure (n-CPAP) following extubation to support the baby's breathing. Many clinicians also use nasal biphasic positive airway pressure (n-BiPAP) in efforts to improve rates of successful extubation. However, there is currently no evidence that this confers any advantage over conventional nasal continuous positive airway pressure.</p> <p>Methods</p> <p>We propose an unblinded multi-centre randomised trial comparing n-CPAP with n-BiPAP in babies born before 30 weeks' gestation and less than two weeks old. Babies with congenital abnormalities and severe intra-ventricular haemorrhage will be excluded. 540 babies admitted to neonatal centres in England will be randomised at the time of first extubation attempt. The primary aim of this study is to compare the rate of extubation failure within 48 hours following the first attempt at extubation. The secondary aims are to compare the effect of n-BiPAP and n-CPAP on the following outcomes:</p> <p>1. Maintenance of successful extubation for 7 days post extubation</p> <p>2. Oxygen requirement at 28 days of age and at 36 weeks' corrected gestational age</p> <p>3. Total days on ventilator, n-CPAP/n-BiPAP</p> <p>4. Number of ventilator days following first extubation attempt</p> <p>5. pH and partial pressure of carbon dioxide in the first post extubation blood gas</p> <p>6. Duration of hospital stay</p> <p>7. Rate of abdominal distension requiring cessation of feeds</p> <p>8. Rate of apnoea and bradycardia</p> <p>9. The age at transfer back to referral centre in days</p> <p>The trial will determine whether n-BiPAP is safe and superior to n-CPAP in preventing extubation failure in babies born before 30 weeks' gestation and less than two weeks old.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN18921778">ISRCTN18921778</a></p

Behavior disorders in children with significant refractive errors

Purpose To evaluate the frequency of behavioral disorders in children with significant refractive error and to compare the results with those of emmetropic children. Methods In this prospective, comparative study from January to September 2013, refractive errors of all 5�12-year-old children who referred to a general eye clinic were recorded. A validated Persian version of the Rutter A scale was filled out by the parents for the evaluation of the child's behavioral disorders. The Rutter A scale scores of children with significant refractive error were compared with those of emmetropic eyes. Student t test, Chi square test, and Fisher's exact test were used for analysis. Differences with a P value less than 0.05 were considered significant. Results One hundred eighty-three patients, including 101 patients with significant refractive error and 82 emmetropic subjects, were studied. Overall, 44 patients (24) had behavioral disorders, according to the Rutter A scale scores. Thirty patients (29.7) with significant refractive error and 14 emmetropic subjects (16.9) had behavioral disorders (P = 0.043). The prevalence of behavioral disorders were 37.5 in hyperopia, 35.7 in hyperopia-astigmatism, 21.4 in simple astigmatism, 16.7 in myopia-astigmatism, and 14.3 in myopia. Compared with emmetropic subjects, the prevalence of behavioral disorders was statistically significantly higher only in patients with hyperopia and hyperopia-astigmatism (P = 0.019 and P = 0.040). Conclusion The prevalence of behavioral disorders is higher in children with hyperopia and hyperopia-astigmatism. © 2016 Iranian Society of Ophthalmolog

A novel noninvasive approach for evaluating work of breathing indices in a developmental rat model using respiratory inductance plethysmography.

Pulmonary function testing (PFT) is an important component for evaluating the outcome of experimental rodent models of respiratory diseases. Respiratory inductance plethysmography (RIP) provides a noninvasive method of PFT requiring minimal cooperation. RIP measures work of breathing (WOB) indices including phase angle (Ф), percent rib cage (RC %), breaths per minute (BPM), and labored breathing index (LBI) on an iPad. The aim of this study was to evaluate the utility of a recently developed research instrument, pneuRIP, for evaluation of WOB indices in a developmental rat model. Sprague Dawley rats (2 months old) were commercially acquired and anaesthetised with isoflurane. The pneuRIP system uses two elastic bands: one band (RC) placed around the rib cage under the upper armpit and another band (AB) around the abdomen. The typical thoracoabdominal motion (TAM) plot showed the abdomen and rib cage motion in synchrony. The plots of phase angle and LBI as a function of data point number showed that values were within the range. The distribution for phase angle and LBI was within a narrow range. pneuRIP testing provided instantaneous PFT results. This study demonstrated the utility of RIP as a rapid, noninvasive approach for evaluating treatment interventions in the rodent model

Superficial and deep foveal avascular zone area measurement in healthy subjects using two different spectral domain optical coherence tomography angiography devices

Purpose: To compare the area of the foveal avascular zone (FAZ) in the superficial and deep retinal layers using two different spectral-domain optical coherence tomography angiography (OCTA) devices. Methods: A cross-sectional comparative study was conducted to obtain macular OCTA images from healthy subjects using Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA) and Spectralis HRA+OCTA (Heidelberg Engineering, Heidelberg, Germany). Two independent trained graders measured the FAZ area using automated slab segmentation. The FAZ area in the superficial and deep retinal layers were compared. Results: Twenty-three eyes of 23 subjects were included. The graders agreement was excellent (&gt;0.86) for all measurements. The mean FAZ area was significantly larger at the superficial retinal layer as compared to the deep retinal layer on both devices (0.31 ± 0.08 mm2 vs 0.26 ± 0.08 mm2 in Optovue and 0.55 ± 0.16 mm2 vs 0.36 ± 0.13 mm2 in Spectralis, both P &lt; 0.001). The mean FAZ area was significantly greater in the superficial and deep retinal layers using Spectralis as compared to Optovue measurements (P &lt; 0.001 for both comparisons). Conclusion: In contrast to previous reports, the FAZ area was larger in the superficial retina as compared to deep retinal layers using updated software versions. Measurements from different devices cannot be used interchangeably. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY KNOWLEDGE

Automated Generation of Itineraries in Recommender Systems for Tourism

Current recommender systems can support tourists in choosing travel products (accommodation, activities, means of transport, etc.), in planning long trips, and in profitably spending time in a specific geographical area such as a region (or a city). In the last case, the system should be able to construct itineraries suited to the tourist’s interests. In this paper, a method for generating tourist itineraries in knowledge-based recommender systems is proposed. The method is based on a theoretical model that defines space-time relations among items of intangible cultural heritage (called events) and on transitive closure computation (of the relations), that is able to construct chains of events. The proposed method has been implemented in the T-Path recommender system, that suggests itineraries of cultural events occurring in the Apulia region

Antimicrobial activity of apple cider vinegar against Escherichia coli, Staphylococcus aureus and Candida albicans; downregulating cytokine and microbial protein expression

The global escalation in antibiotic resistance cases means alternative antimicrobials are essential. The aim of this study was to investigate the antimicrobial capacity of apple cider vinegar (ACV) against E. coli, S. aureus and C. albicans. The minimum dilution of ACV required for growth inhibition varied for each microbial species. For C. albicans, a 1/2 ACV had the strongest effect, S. aureus, a 1/25 dilution ACV was required, whereas for E-coli cultures, a 1/50 ACV dilution was required (p < 0.05). Monocyte co-culture with microbes alongside ACV resulted in dose dependent downregulation of inflammatory cytokines (TNFα, IL-6). Results are expressed as percentage decreases in cytokine secretion comparing ACV treated with non-ACV treated monocytes cultured with E-coli (TNFα, 99.2%; IL-6, 98%), S. aureus (TNFα, 90%; IL-6, 83%) and C. albicans (TNFα, 83.3%; IL-6, 90.1%) respectively. Proteomic analyses of microbes demonstrated that ACV impaired cell integrity, organelles and protein expression. ACV treatment resulted in an absence in expression of DNA starvation protein, citrate synthase, isocitrate and malate dehydrogenases in E-coli; chaperone protein DNak and ftsz in S. aureus and pyruvate kinase, 6-phosphogluconate dehydrogenase, fructose bisphosphate were among the enzymes absent in C.albican cultures. The results demonstrate ACV has multiple antimicrobial potential with clinical therapeutic implications

Clinical practice: Noninvasive respiratory support in newborns

The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infants