TASK DEFINITION: In this task, you are given a passage which has a question and the context. You have to generate an answer to the question based on the information present in the context.
PROBLEM: Context: The use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n\u2009=\u2009284) treated with either continuous or intermittent control of endotracheal tube cuff pressure.', 'We performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent endotracheal tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI).', 'We found a lower incidence of VAP with the continuous (n\u2009=\u2009150) than with the intermittent (n\u2009=\u2009134) pressure control system (22.0% versus 11.2%; p\u2009=\u20090.02). MLRA showed that the continuous pressure control system (OR\u2009=\u20090.45; 95% CI\u2009=\u20090.22-0.89; p\u2009=\u20090.02) and the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) (OR\u2009=\u20090.39; 95% CI\u2009=\u20090.19-0.84; p\u2009=\u20090.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR\u2009=\u20090.45; 95% CI\u2009=\u20090.24-0.84; p\u2009=\u20090.01) and the use of an endotracheal tube incorporating a lumen for SSD (HR\u2009=\u20090.29; 95% CI\u2009=\u20090.15-0.56; p\u2009<\u20090.001) were protective factors against VAP. However, the interaction between type of endotracheal cuff pressure control system (continuous or intermittent) and endotracheal tube (with or without SSD) was not statistically significant in MLRA (OR\u2009=\u20090.41; 95% CI\u2009=\u20090.07-2.37; p\u2009=\u20090.32) or in Cox analysis (HR\u2009=\u20090.35; 95% CI\u2009=\u20090.06-1.84; p\u2009=\u20090.21).\Question: Does continuous endotracheal tube cuff pressure control system protect against ventilator-associated pneumonia?

SOLUTION: The use of a continuous endotracheal cuff pressure control system and/or an endotracheal tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.

PROBLEM: Context: Animal data show that low protein intake in pregnancy programs higher offspring blood pressure, but similar data in humans are limited. We examined the associations of first and second trimester maternal protein intake with offspring blood pressure (BP) at the age of six months.', 'In a prospective US cohort study, called Project Viva, pregnant women completed validated semi-quantitative food-frequency questionnaires (FFQ) to measure gestational protein intake. Among 947 mother-offspring pairs with first trimester dietary data and 910 pairs with second trimester data, we measured systolic blood pressure (SBP) up to five times with an automated device in the offspring at the age of six months. Controlling for blood pressure measurement conditions, maternal and infant characteristics, we examined the effect of energy-adjusted maternal protein intake on infant SBP using multivariable mixed effects models.', 'Mean daily second trimester maternal protein intake was 17.6% of energy (mean 2111 kcal/day). First trimester nutrient intakes were similar. Mean SBP at age 6 months was 90.0 mm Hg (SD 12.9). Consistent with prior reports, adjusted SBP was 1.94 mm Hg lower [95% confidence interval (CI) -3.45 to -0.42] for each kg increase in birth weight. However, we did not find an association between maternal protein intake and infant SBP. After adjusting for covariates, the effect estimates were 0.14 mm Hg (95% CI 20.12 to 20.40) for a 1% increase in energy from protein during the second trimester, and 20.01 mm Hg (95% CI 20.24 to -0.23) for a 1% increase in energy from protein in the first trimester.\Question: Is maternal protein intake associated with infant blood pressure?

SOLUTION: Variation in maternal total protein intake during pregnancy does not appear to program offspring blood pressure.

PROBLEM: Context: The aim of the study was to analyze John Cunningham virus (JCV) serology in natalizumab-treated patients over time and assess whether they are influenced by natalizumab treatment.', 'German (n = 1,921; 525 longitudinally) and French (n = 1,259; 711 longitudinally) patients were assessed for JCV serology alongside their therapy with natalizumab.', 'JCV serostatus changed in 69 of 525 longitudinally followed German patients (13.1%) over 14.8 months. Seroconversion according to serostatus was seen in 43 of 339 initially JCV- German patients (12.7% in 14.8 months; 10.3% per year) and 41 of 243 initially JCV- French patients (16.9% in 24 months; 8.5% per year). JCV index values could be reproduced (R (2) = 0.89) with the caveat of 8 of 50 samples (16%) being set into different risk categories between 2 assessments. Index values of JCV+ patients rose over time (p = 0.009) but not because of aging. Treatment with natalizumab was associated with a 15.9% increase of value in JCV+ patients in 14.8 months (12.9% per year).\Question: Is therapy with natalizumab associated with high JCV seroconversion and rising JCV index values?

SOLUTION:
JCV seroconversion and index values may be influenced by treatment with natalizumab. It is therefore important to monitor patients' JCV serology but also to incorporate additional risk factors into the progressive multifocal leukoencephalopathy risk stratification.