Patients suffering from tissue ischemia, who would greatly benefit from angiogenesis-promoting therapies such as hypoxia preconditioned blood-derived secretomes commonly receive oral anticoagulation (OA) and/or have diabetes mellitus (DM). In this study, we investigated the effect of OA administration on the in vitro angiogenic potential of hypoxia preconditioned plasma (HPP) and serum (HPS), prepared from nondiabetic/diabetic subjects who did not receive OA (n = 5) or were treated with acetylsalicylic acid (ASA, n = 8), ASA + clopidogrel (n = 10), or nonvitamin K antagonist oral anticoagulants (n = 7) for longer than six months. The effect of DM was differentially assessed by comparing HPP/HPS obtained from nondiabetic (n = 8) and diabetic (n = 16) subjects who had not received OA in the past six months. The concentration of key proangiogenic (vascular endothelial growth factor or VEGF) and antiangiogenic (thrombospondin-1 or TSP-1 and platelet factor-4 or PF-4) protein factors in HPP/HPS was analyzed via ELISA, while their ability to induce microvessel formations was examined in endothelial cell cultures. We found that OA use significantly reduced VEGF levels in HPP, but not HPS, compared to non-OA controls. While HPP and HPS TSP-1 levels remained largely unchanged as a result of OA usage, HPS PF-4 levels were significantly reduced in samples obtained from OA-treated subjects. Neither OA administration nor DM appeared to significantly reduce the ability of HPP or HPS to induce microvessel formations in vitro. These findings indicate that OA administration does not limit the angiogenic potential of hypoxia preconditioned blood-derived secretomes, and therefore, it does not prohibit the application of these therapies for supporting tissue vascularization and wound healing in healthy or diabetic subjects.

Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement. This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.

Respiratory function monitors (RFMs) can provide real-time data including expiratory tidal volumes and interface leak during delivery room (DR) neonatal resuscitation. However, concerns have been raised within previous randomised controlled trials and systematic reviews that effectuating RFMs routinely for DR resuscitation is limited by lack of comprehensive staff training. The International Liaison Committee on Resuscitation have also recently declared a knowledge gap in terms of the training required to be competent in utilising an RFM during neonatal resuscitation. We conducted an experiment with thirteen medical students who had no prior resuscitation experience to see if visual feedback from an RFM could improve mask leak when ventilating an extremely preterm manikin. Following a brief training session with hands-on practice, 260 breaths were analysed and median mask leak improved from 45% (IQR 25-62%) during the first breath to 0% (IQR 0-1%) by the twentieth and final breath. The median expiratory tidal volume was 3.6 mL (IQR 3.4-3.8 mL) and remained stable. This manikin experiment has demonstrated that even a short and experiential training session with an RFM for participants with no prior resuscitation training can be effective in reducing mask leak.