Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index

BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern.The Wei nasal jet tube(WNJT)is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel.The available evidence indicates that with a low oxygen flow,compared with nasal cannula,the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation.To date,there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used.AIM To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index.METHODS This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation.Patients were randomized into one of two groups to receive either the WNJT(WNJT group,n=147)or the nasal cannula(nasal cannula group,n=144)for supplemental oxygen at a 5-L/min flow during gastroscopy.The lowest SpO2 during gastroscopy was recorded.The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy.RESULTS The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group(P=0.000).The lowest median SpO2 during gastroscopy was significantly higher(98%;interquartile range,97-99)in the WNJT group than in the nasal cannula group(96%;interquartile range,93-98).Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment.The two groups were comparable in terms of the satisfaction of physicians,anesthetists and patients.CONCLUSION With a moderate oxygen flow,the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs,but causing slight epistaxis in a few patients.

Prospective, randomized comparison of two supplemental oxygen methods during gastro-scopy with propofol mono-sedation in obese patients

BACKGROUND Hypoxemia is a common complication in obese patients during gastroscopy with sedation.The Wei nasal jet tube(WNJT)is a new special nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channels.The aim of this study was to compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.AIM To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.METHODS A total of 103 obese patients with a body mass index of 30 kg/m2 or more undergoing elective gastroscopy under propofol mono-sedation were randomly assigned to receive supplemental oxygen at 5 L/min through either a WNJT(WNJT group,n=51)or a nasal cannula(nasal cannula group,n=52).The lowest pulse oxygen saturation(SpO2)and mild and severe hypoxemia during gastroscopy were recorded.The primary outcome was the incidence of hypoxemia.RESULTS The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula group.The incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula group.Other than a higher incidence of epistaxis in the WNJT group,the occurrence of adverse events was similar between the devices.While neither device demonstrated a statistically significant difference in satisfaction among patients,the WNJT did result in improved satisfaction among anesthetists and physicians.CONCLUSION During gastroscopy with propofol mono-sedation in obese patients,the WNJT,when compared with a nasal cannula for supplemental oxygen,can significantly reduce the occurrence of hypoxemia and improve both arterial oxygenation and satisfaction among anesthetists and physicians.The use of the WNJT may,however,lead to epistaxis in a few patients.In view of this clinically acceptable risk-benefit ratio,the WNJT may be recommended as an alternative tool for supplemental oxygen for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in obese patients.

Effective nanotherapeutic approach for metastatic breast cancer treatment by supplemental oxygenation and imaging-guided phototherapy

Metastasis remains the primary cause for mortality of breast cancer.Despite advances in current therapeutic agents,patients with metastatic breast cancer still have poor prognoses.Tumor hypoxia,a key microenvironment factor,is emerging as an attractive target to prevent metastasis and is also involved with resistance to phototherapy.Here,we show an effective nanotherapeutic approach based on manganese dioxide-coated polydopamine nanocarriers to trigger robust anti-tumor and anti-metastasis responses against metastatic breast cancer by supplemental oxygenation and multimodal imaging-guided phototherapies.In cancer cells,the produced oxygen by the developed nanoplatform decreases the expression of hypoxia-inducible factors 1 a to inhibit tumor metastasis,and enhances the efficacy of photodynamic therapy.This nanotherapeutic approach enables the combined photodynamic/photothermal treatments with great inhibition on cell migration and invasion in vitro.Moreover,the nanotherapeutics effectively suppresses primary tumor progress and inhibits lung metastasis in v ivo in a breast cancer mouse model with satisfying biosafety.This study suggests that the tumor hypoxia-targeting nanotherapeutics have great potential for preventing and treating metastatic cancers.

Oxygen administration in the care of neonates： a double-edged sword

Objective To evaluate the use of oxygen in neonates in the past, present and future Data sources The data are mainly from Pubmed with relevant published articles from the 1940s to the present with some information gathered from web searches.Study selection Studies evaluating the use of oxygen in premature and term infants through history with original milestone articles included.Results There are still many unknowns about the proper use of oxygen in preterm and term infants but many studies suggest that both liberal use （resulting in a blood oxygen saturation of greater than 94%） as well as restrictive use （resulting in a blood oxygen saturation of less than 80%-85%） are detrimental and have long term consequences on the infant.Conclusions Definitive studies evaluating the appropriate concentration and duration of supplemental oxygen are ongoing and will help in the management of term and preterm infants requiring oxygen.

An Activatable Nanoenzyme Reactor for Coenhanced Chemodynamic and Starving Therapy Against Tumor Hypoxia and Antioxidant Defense System

It is critical to improve the efficiency of cancer therapy with minimized side effects.Chemodynamic therapy(CDT)is a tumor therapeutic strategy designed to generate abundant reactive oxygen species(ROS)at tumor sites through a Fenton or Fenton-like reaction.Recently,this developing scheme has demonstrated an incredible promise for tumor therapy.The process involved could induce cell death without the input of external energy,and this could only occur via the conversion of hydrogen peroxide(H_(2)O_(2))to hydroxyl radicals(·OH).Although Fenton or Fenton-like reactions are being exploited for CDT,along with an application of oxidation reactions to supplement H_(2)O_(2),it has been proven that in cancer cells,the high levels of the existing antioxidants could suppress CDT via·OH depletion,and,unfortunately,tumor hypoxia also inhibits the oxidation reactions.Herein,the authors aimed to fabricate an activatable nanoenzyme reactor(NER)to solve this challenge.Fluorescent reporters(FRs)and bioenzyme glucose oxidase(GOX)were coassembled on nanozyme MnO_(2) nanosheets,which was enwrapped by the tumor-targeting material,hyaluronic acid(HA).NER was internalized explicitly by cancer cells through ligand/receptor recognitionmediated endocytosis,followed by intracellular hyaluronidase(HAase)-dependent activation.As a result,the oxygen level was improved,and the antioxidants were depleted,leading to the promotion of glucose consumption and an increase in·OH level.Thus,the NER exhibited multiple effects to induce coenhanced,chemodynamic and starving therapy against tumor hypoxia and antioxidant defense system to achieve a favorable targeted tumor therapeutic,via these rigorously highly effective,and targeted biochemical reactions both in an in vitro cultured cancer cells systemor in an in vivo mice tumor model.