Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Optimization of cultural conditions for production of chitinase by Bacillus laterosporous MML2270 isolated from rice rhizosphere soil

A total of 39 chitinolytic bacteria were isolated from 77 rhizosphere soil samples collected from different crop fields in Tamil Nadu state, India. Among them, a strain designated as MML2270, which produced highest chitinolytic activity in primary and secondary screening in colloidal chitin agar was selected and later identified as Bacillus laterosporous. The production of chitinase by B. laterosporous was optimized using different growth media, substrate concentrations, pH, temperature and incubationperiod. The maximum chitinase production was observed in yeast nitrogen based medium (YNB) amended with 0.3% colloidal chitin at pH 8.0 and 35°C after four days of inoculation. Under this optimized growth condition, B. laterosporous MML2270 produced a total chitinase activity of 59.05units/ml as against only 19.7 units/ml in the initial YNB medium stage, which is a three-fold increase

Theoretical studies of the spin states of macrocyclic aza-amido binuclear copper (II) complexes

The spin and charge excitation gaps and charge and spin density distributions have been studied in macrocyclic binuclear aza-amido copper (II) complexes employing a model Hamiltonian. The spin gaps depend on the σ-orbital occupancies, and for small gaps, the exchange integral between the σ orbitals of the bridging oxygen atoms, KOO, which is sensitive to geometry, determines the low-lying spin excitations. The singlet—singlet gaps also depend upon the σ-orbital occupancy but are weakly dependent upon KOO

Biradicals as ESR Probes of Conformations in Model \beta-turn Peptides

Electron spin-spin exchange interaction in biradicals has been examined for its potential usefulness in the conformational analysis of peptides in solution. Three peptides with high propensity to adopt \beta-turn conformations in solution, Boc-Cys-Pro-Xxx-Cys-NHMe (Xxx = Leu, 1; Xxx = Aib, 2; Xxx = Tyr, 3), have been modified into biradicals by spin labeling the thiols groups. Analysis of electron spin resonance spectra of these peptides in it variety of solvents and at different temperatures suggests that the population of folded conformations follows the order 2 > 1 > 3

Effect of vesicular arbuscular mycorrhizal fungus on the physiological and biochemical changes of five different tree seedlings grown under nursery conditions

The symbiotic association between certain plants and microorganisms plays an important role in soil fertilization, and improves their growth and mineral nutrition. The symbiotic association betweenvesicular arbuscular mycorrhizal (VAM) fungi and roots provides a significant contribution to plant nutrition and growth. VAM mycelium in soil results in greater efficiency of nutrient absorption particularly for slowly diffusing mineral ions, especially phosphorous. The present investigation aims at studying the effects of VAM fungi on the physiological changes of the selected tree seedlings viz.,Cassia siamea, Delonix regia, Erythrina variegata, Samanea saman and Sterculia foetida. The chlorophyll a, chlorophyll b, total chlorophyll, carotenoid, protein, nitrate, nitrogen, phosphorus andpotassium content increased in VAM fungus treated seedlings compared with non-mycorrhizal tree seedlings. The total soluble sugars and soluble starch contents in the leaves of all the selected treespecies in the present study showed a decrease in mycorrhizal seedlings than non-mycorrhizal seedlings

Diagrammatic valence bond studies on hemocyanin

The Diagrammatic Valence Bond studies on the active sites of hemocyanin, consisting of two Cu(I) ions and an oxygen molecule, are performed to find out the stable geometrical pattern and electronic structure. Different parameters used in this theoretical approach are taken from existing literature on high T-c superconductors. Attempts have been made to find out the differences in electronic structure of [Cu2O2](+2) and [Cu2O2N4](+2) as it is observed that coordination of nitrogen ligand do affect electronic structure i.e. spin excitation gaps and charge and spin density distribution. A comparison of our results with earlier theoretical results are also presented