Datasheet1_Dynamic arterial elastance as a predictor of arterial pressure response to norepinephrine weaning in mechanically ventilated patients with vasoplegic syndrome—a systematic review and meta-analysis.docx

IntroductionDuring the de-escalation phase of circulatory shock, norepinephrine weaning may induce diverse arterial pressure responses in patients with different vasomotor tones. Dynamic arterial elastance (Eadyn) has been extensively studied to predict the arterial pressure response to interventions. We conducted this meta-analysis to systematically assess the predictive performance of Eadyn for the mean arterial pressure (MAP) response to norepinephrine weaning in mechanically ventilated patients with vasoplegic syndrome.Materials and methodsA systematic literature search was conducted on May 29, 2023 (updated on January 21, 2024), to identify relevant studies from electronic databases. The area under the hierarchical summary receiver operating characteristic curve (AUHSROC) was estimated as the primary measure of diagnostic accuracy because of the varied thresholds reported. Additionally, we observed the distribution of the cutoff values of Eadyn, while computing the optimal value and its corresponding 95% confidential interval (CI).ResultsA total of 5 prospective studies met eligibility, comprising 183 participants, of whom 67 (37%) were MAP responders. Eadyn possessed an excellent ability to predict the MAP response to norepinephrine weaning in patients with vasoplegic syndrome, with an AUHSROC of 0.93 (95% CI: 0.91–0.95), a pooled sensitivity of 0.94 (95% CI: 0.85–0.98), a pooled specificity of 0.73 (95% CI: 0.65–0.81), and a pooled diagnostic odds ratio of 32.4 (95% CI: 11.7–89.9). The cutoff values of Eadyn presented a nearly conically symmetrical distribution; the mean and median cutoff values were 0.89 (95% CI: 0.80–0.98) and 0.90 (95% CI: not estimable), respectively.ConclusionsThis meta-analysis with limited evidences demonstrates that Eadyn may be a reliable predictor of the MAP response to norepinephrine weaning in mechanically ventilated patients with vasoplegic syndrome.Systematic Review RegistrationPROSPERO CRD42023430362.</p

Structure of the <i>DgBRC1</i> genes.

<p>Coding sequences are shaded in black, introns in white, 5′ UTR and 3′ UTR in light grey. The two segments isolated from the cDNA were named as <i>DgBRC1-1</i> and <i>DgBRC1-2</i>. In <i>DgBRC1-2</i>, the alternative intron (intron I) is kept (indicated by dark grey box), which ended the protein later. Two copies coming from genomic DNA are shown. The termination codons are indicated by a triangle.</p

Elongation of two-bud stem segments and transcript levels of <i>DgBRC1</i> after PGR application.

<p>Bud position was recorded basipetally. Stem segments containing bud 3 and bud 4 were used as plant materials for PGR application. The elongation dynamics of bud 3 (A to C) and bud 4 (D to F) 10 days after application of PGR are presented. Figures G to I indicate the transcript levels of <i>DgBRC1</i> 4 hours after application of PGR. There were three groups of PGR treatments: left, 5 µM NAA and NPA applied; middle, 5 µM BAP applied; right, 5 µM NAA and BAP applied together. Stem segments without any PGR were served as the control. Node 3 and node 4 were collected 4 h after treatment for <i>DgBRC1</i> transcript analysis. Data were means ± SE. For lateral branches outgrowth, n = 8. For gene expression, results are means of three biological replicates analyzed by real-time PCR, with 10 plants for each replicate; letters indicate significant differences between different PGR applications at α = 0.05. PGR application: NAA on apical sides (NAA-A), NPA on basal sides (NPA-B), BAP on apical or basal sides (BAP-A, BAP-B), NAA and BAP on apical sides (NAA+BAP-A), NAA on apical sides and BAP on basal sides (NAA−A+BAP-B).</p

Transcript levels of <i>DgBRC1</i> after decapitation and at different planting densities.

<p>(A) <i>DgBRC1</i> transcript levels in node 1+2 and node 3+4 were analyzed 0 h, 1 h, 6 h, 24 h and 48 h after decapitation by real-time PCR. Bud position was recorded basipetally. (B) <i>DgBRC1</i> transcript levels at density 1(1 plant per 729 cm³) and density 9 (9 plants per 729 cm³). Results are means of three biological replicates with 10 plants for each replicate.</p

Phenotype of 35S::DgBRC1 of WT and <i>brc1-1</i> Aribidopsis plants.

<p>(A) Shoot branching phenotypes of WT and <i>brc1-1</i>with and without the 35S::DgBRC1 variant 1 construct. (B) Primary rosette and cauline branch number of WT, <i>brc1-1</i> and 35S::DgBRC1 lines. All plants were grown with long days under the same conditions and recorded at 10 days after anthesis, the number of the primary rosette and cauline branches longer than 3 mm were recorded. Data are means ± SE; n = 16. Letters indicate significant differences between them at α = 0.05.</p

Transcript levels of <i>DgBRC1</i> in different tissues.

<p>Total transcript levels of <i>DgBRC1</i> in different tissues were analyzed by real-time PCR. Bud position was recorded basipetally. Error bars indicate SE from three biological replicates consisting of 10 plants for each replicate. Abbreviations are SA, shoot apex; RT, root; ST, stem; LF, leaf; N1, node 1; N2, node 2; N3, node 3; N4, node 4.</p

<i>DgIPT3</i> transcript patterns in nodes 3 and 4 after NAA and GR24 treatments.

<p>There were four treatments, including intact plants, control, NAA-A, GR24-B. Plant materials and experiment procedures were prepared as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0061717#pone-0061717-g007" target="_blank">Figure 7</a>. Nodes 3 and node 4 were collected 6 h after treatment for analysis of <i>DgIPT3</i> transcript levels. Total RNA was subject to quantitative real-time PCR. Results are means of quantitative PCR analyses from three biological replicates, with 10 plants for each replicate; letters indicate significant differences between treatments at α = 0.05. PGRs applied in assays: NAA on apical sides (NAA-A), GR24 on basal sides (GR24-B).</p

Subcellular localization of DgBRC1 alleles.

<p>DgBRC1-1-GFP (A), DgBRC1-2-GFP (B), DgBRC1-1Δ17-GFP (C) and C-terminal sequences of three proteins (D) are shown. Images A, B, C, the bright-field, GFP fluorescence, and merged images of the same onion epidermal cells are presented from left to right respectively. DgBRC1-1-GFP localized in nuclei (A), while DgBRC1-2 -GFP localized in nuclei and plasma membranes (B). DgBRC1-1Δ17-GFP accumulated in nuclei and plasma membranes in 5 of 25 cells (C), whereas the others accumulated in nuclei (data not shown). The C-terminal sequences of DgBRC1-1, DgBRC1-2, DgBRC1-1?17 are shown in D, the extra 17 amion acids in DgBRC1-1 and the mutated 17 amino acids in DgBRC1-1Δ17 are both underlined.</p

Extracellular ATP levels in <i>P. euphratica</i> cells under NaCl stress.

<p>Time courses of ATP release in response to high NaCl (200 mM), in the presence or absence of P2 receptor antagonists (suramin or PPADS, 300 μΜ) or an ATP trap (H-G system, 50 mM glucose and 100 units/mL hexokinase). Bars represent the means from five independent experiments and whiskers represent the error of the mean.</p

Schematic model shows proposed eATP signals that mediate the NaCl stress response in <i>P. euphratica</i> cells.

<p>The top line (PM = double line) indicates the molecules involved in the osmotic sensor and associated responses to salt stress. The bottom line (PM = double line) indicates the molecules involved in the ionic sensor and associated responses to salt stress (see text for details). These sensors are separated in this diagram for clarity, but they are not expected to be relegated to separate compartments on the cell membrane.</p