Specific roles of gut microbes in COVID‐19 progression are critical. However, the circumstantial mechanism remains elusive. In this study, shotgun metagenomic or metatranscriptomic sequencing was performed on fecal samples collected from 13 COVID‐19 patients and controls. We analyzed the structure of gut microbiota, identified the characteristic bacteria, and selected biomarkers. Further, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations were employed to correlate the taxon alterations and corresponding functions. The gut microbiota of COVID‐19 patients was characterized by the enrichment of opportunistic pathogens and depletion of commensals. The abundance of Bacteroides spp. displayed an inverse relationship with COVID‐19 severity, whereas Actinomyces oris , Escherichia coli , and Streptococcus parasanguini were positively correlated with disease severity. The genes encoding oxidoreductase were significantly enriched in gut microbiome of COVID‐19 group. KEGG annotation indicated that the expression of ABC transporter was upregulated, while the synthesis pathway of butyrate was aberrantly reduced. Furthermore, increased metabolism of lipopolysaccharide, polyketide sugar, sphingolipids, and neutral amino acids were found. These results suggested the gut microbiome of COVID‐19 patients was in a state of oxidative stress. Healthy gut microbiota may enhance antiviral defenses via butyrate metabolism, whereas the accumulation of opportunistic and inflammatory bacteria may exacerbate COVID‐19 progression.
Innovation and green are the directions to promote the circular economy and environmental sustainability at the corporate level. This paper examines the impact of environmental regulation (pollution charge) on green technology innovation and the mediating role of corporate environmental responsibility. Our results indicate that: (1) Environmental regulations stimulate manufacturing enterprises’ environmental responsibility and green technology innovation. It is worth noting that corporate environmental responsibility strengthens the relationship between environmental regulation and green technology innovation. (2) Further investigation reveals that R&D expenditure and environmental investment have greatly strengthened the positive effect of environmental regulation on green technology innovation. (3) With more detailed disclosure about enterprises’ environment-related information, the more outstanding stimulation effects of environmental regulation. Discussions on the features of enterprise location have revealed that, if the goal of environmental protection is set too high or if the fiscal decentralization is too strong, implementation of environmental regulation would not achieve desirable results. Accordingly, we need to optimize the collection of environmental taxes, strengthen the enterprises’ environmental responsibility, and increase investment in R&D and environment protection. Meanwhile, the execution of environmental regulation should also take into account the institutional environment and governance features of the enterprise locations.
Combining baseline and stimulated BIS may help detect deep sedation in mechanically ventilated patients.
BackgroundAccurate measurement of esophageal pressure (Pes) depends on proper filling of the balloon. Esophageal wall elastance (Ees) may also influence the measurement. We examined the estimation of balloon-surrounding elastance in a bench model and investigated a simplified calibrating procedure of Pes in a balloon with relatively small volume.MethodsThe Cooper balloon catheter (geometric volume of 2.8 ml) was used in the present study. The balloon was progressively inflated in different gas-tight glass chambers with different inner volumes. Chamber elastance was measured by the fitting of chamber pressure and balloon volume. Balloon pressure-volume (P-V) curves were obtained, and the slope of the intermediate linear section was defined as the estimated chamber elastance. Balloon volume tests were also performed in 40 patients under controlled ventilation. The slope of the intermediate linear section on the end-expiratory esophageal P-V curve was calculated as the Ees. The balloon volume with the largest Pes tidal swing was defined as the best volume. Pressure generated by the esophageal wall during balloon inflation (Pew) was estimated as the product of Ees and best volume. Because the clinical intermediate linear section enclosed filling volume of 0.6 to 1.4 ml in each of the patient, we simplified the estimation of Ees by only using parameters at these two filling volumes.ResultsIn the bench experiment, bias (lower and upper limits of agreement) was 0.5 (0.2 to 0.8) cmH2O/ml between the estimated and measured chamber elastance. The intermediate linear section on the clinical and bench P-V curves resembled each other. Median (interquartile range) Ees was 3.3 (2.5–4.1) cmH2O/ml. Clinical best volume was 1.0 (0.8–1.2) ml and ranged from 0.6 to 1.4 ml. Estimated Pew at the best volume was 2.8 (2.5–3.5) cmH2O with a maximum value of 5.2 cmH2O. Compared with the conventional method, bias (lower and upper limits of agreement) of Ees estimated by the simple method was − 0.1 (− 0.7 to 0.6) cmH2O/ml.ConclusionsThe slope of the intermediate linear section on the balloon P-V curve correlated with the balloon-surrounding elastance. The estimation of Ees and calibration of Pes were feasible for a small-volume-balloon.Trial registrationIdentifier NCT02976844. Retrospectively registered on 29 November 2016.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0488-6) contains supplementary material, which is available to authorized users.
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