Central Venous Oxygen Saturation as a Predictor of the Outcome of Weaning From Mechanical Ventilation

Weaning from mechanical ventilation represents a corner stone of management of critically ill patients. Successful weaning represents a great achievement in patient's critical course in the ICU. This makes the process of weaning one of the most difficult steps in ICU care, for those reason, such a study was done to create a new thinking about the predictors that facilitate patient weaning from mechanical ventilator. The aim of this study is to evaluate the central venous saturation as a predictor of the outcome of weaning from mechanical ventilation. Cohort, unicentric, clinical study research design was utilized in the current study. Sample consists of one hundred and twenty patients over a one year period, all patients passed the first SBT (spontaneous breathing trial) and weaned successfully from mechanical ventilation were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of re-intubation within 48 hrs. The weaning protocol evaluated hemodynamic, ventilation parameters, arterial and venous gases during mechanical ventilation (Immediately before T-tube trial), and at the 30th min of spontaneous breathing trial. Findings of this study show that re-intubation rate was 30%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >5% was an independent predictor of re-intubation, with odds ratio of 52.6 (95% confidence interval =16.34–169.42), a sensitivity of 87%, and a specificity of 90%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption. Results of the present study indicated that central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols. Keywords: Central Venous Saturation - Mechanical Ventilation - Extubation

Naturally Occurring Extracellular Matrix Scaffolds for Dermal Regeneration: Do They Really Need Cells?

The pronounced effect of extracellular matrix (ECM) scaffolds in supporting tissue regeneration is related mainly to their maintained 3D structure and their bioactive components. These decellularized matrix scaffolds could be revitalized before grafting via adding stem cells, fibroblasts, or keratinocytes to promote wound healing. We reviewed the online published literature in the last five years for the studies that performed ECM revitalization and discussed the results of these studies and the related literature. Eighteen articles met the search criteria. Twelve studies included adding cells to acellular dermal matrix (ADM), 3 studies were on small intestinal mucosa (SIS), one study was on urinary bladder matrix (UBM), one study was on amniotic membrane, and one study included both SIS and ADM loaded constructs. We believe that, in chronic and difficult-to-heal wounds, revitalizing the ECM scaffolds would be beneficial to overcome the defective host tissue interaction. This belief still has to be verified by high quality randomised clinical trials, which are still lacking in literature

Serum and urinary transforming growth factor beta 1 as biochemical markers in diabetic nephropathy patients

Diabetic nephropathy is a common complication of diabetes mellitus. Transforming growth factor beta 1 (TGF-β1) is considered to be one of the major cytokines involved in the regulation of extracellular matrix (ECM) synthesis and degradation. Discrepant results were reported for urine TGF-β1 in diabetic patients. The aim of the present study is to investigate urine and serum TGF-β1 in patients with type II diabetes with and without nephropathy. The study was performed on 72 patients with type II diabetes (26 macroalbuminuria, 27 microalbuminuria and 19 normoalbuminuria) together with 30 healthy subjects to serve as controls. Urinary and serum TGF-β1 and urine albumin were investigated by Elisa, plasma glucose, whole blood glycated hemoglobin, Urinary and serum total protein, creatinine, were determined by colorimetric methods. Urine and serum TGF-β1 were significantly increased in all diabetic groups being more pronounced in the macroalbuminuria group than micro and normoalbuminuria groups. Also urine total protein was increased, being more pronounced in macroalbuminuria group than other groups. Urinary and serum TGF-β1 showed high positive correlation with urinary total protein concentration in macro and microalbuminuria groups r = (0.9, 0.9, 0.8 and 0.89) respectively. The results revealed significant increase in Urinary and serum TGF-β1 and their concentrations in urine were parallel to urine proteins and albumin concentrations; urinary and serum TGF-β1 showed high positive correlation with urinary total protein, so it could be used as a marker with total protein and albumin to confirm the diabetic nephropathy in type II diabetic patients

The complete mitochondrial genome of Dendrophyllia minuscula (Cnidaria: Scleractinia) from the NEOM region of the Northern Red Sea

The scleractinian coral family Dendrophylliidae is a major component of shallow and deep-water coral ecosystems worldwide, but our knowledge on the evolutionary history of the family remains scarce. Here, we used ezRAD coupled with Illumina sequencing technology and reconstructed the complete mitochondrial genome of Dendrophyllia minuscula (GenBank accession number OL634845), from mesophotic depths in the Red Sea NEOM area. The mitochondrial genome of D. minuscula consisted of 19,054 bp, organized in 13 protein-coding genes, 2 rRNA genes, and 2 tRNA genes, in agreement with the Scleractinia typical mitogenome organization. This complete mitochondrial genome contributes toward a better knowledge of mesophotic and deep-water coral diversity and evolutionary history