Comparison of clinical characteristics and outcomes of infants with moderate and severe acute respiratory distress syndrome diagnosed according to baseline oxygenation index / 中国小儿急救医学

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Evaluation and management of application of antibiotics in PICU / 中国小儿急救医学

Antibiotics are the most commonly used medicines in PICU.For children with severe infection, it is very important to ensure the curative effect of patients and reduce the adverse effects of antibiotic abuse through reasonable empirical initial use of antibiotics, timely evaluation and regulation, and appropriate course of antibiotic treatment.This review discussed several main problems of clinical application of antibiotics in PICU, in order to help clinicians in PICU improve the evaluation and management of antibiotics use.

Analgesic efficacy and safety of remifentanil for postoperative congenital heart children / 中国小儿急救医学

Objective To evaluate the efficacy and safety of remifentanil (RF) for analgesia of post-operative children with congenital heart disease in pediatric intensive care unit.Methods A total of 250 patients were enrolled and divided into 5 groups by random numerical table method.Patients in group RF1, RF2,RF3,SF and M was treated with at the doses of reminfentanil 1-3 μg/(kg·h),3-6 μg/(kg·h), 6-9 μg/(kg·h),sufentanil 0.08 μg/(kg·h) and morphine 20 μg/(kg·h) respectively.All the analgesias were given intravenously with midazolam 2 μg / ( kg·min) for sedative.We recorded the faces pain scale, Ramsay,vital signs(mean arterial pressure,heart rate),blood gas analysis,cortisol,ventilation time,times of contemporary sedation drugs and incidence of side effects in 24 hours after operation(1 h,4 h,8 h,12 h,24 h).Results The analgesic satisfaction in group M were lower than those in the other four groups at 1 h,4 h (P＜0.05),and the analgesic satisfaction in group RF3 were higher than those in group RF1 and RF2 at 1 h, 4 h,8 h(P＜0.05).Compared with group M and SF,group RF1,group RF2 and group RF3 had a more sta-ble hemodynamics (mean arterial pressure,heart rate).The times of contemporary sedative in group M were maximum among the 5 groups.The incidence of low blood pressure in group M was higher than those in the other four groups(P=0.06),while the incidence of respiratory depression in group RF3 was the most(P=0.06).There were also no significant differences in blood gas analysis,cortisol and ventilation time among each group.Conclusion The efficacy of remifentanil is superior to morphine.Compared with sufentanil and morphine,remifentanil has less influence on hemodynamics. We recommend the dose of remifentanil 3-6 μg/(kg·h),compound with midazolam 2 μg/(kg·min),which is more reliable and durable.

Effect and significance of tetrandrine on expression of Rho/Rho kinase in fetal lung of congenital diaphragmatic hernia rats / 重庆医学

Objective To investigate the effect and significance of the traditional Chinese medicine tetrandrine(TET) prenatal intervention on the expression of RhoA protein and Rho kinase ROCK1 in the fetal lung of congenital diaphragmatic hernia (CDH) rat model.Methods SD female rats with 9.5 d of gestation were randomly divided into the control group,CDH group and TET group.The CDH group and TET intervention group were administered with nitrofen by gavage for establishing CDH model.The TET intervention was given on 16.5 d of gestation.The fetal rat lungs were taken by cesarean section on 21.5 d of gestation and the lung weight/body ratio(Lw/Bw) was measured.The lung development and small pulmonary arterial morphologic changes in HE staining in all groups were observed with microscopy.The protein expression of RhoA and Rho kinase ROCK1were respectively examined by immunohistochemistry and Western blot.Results In the CDH group,the lungs had obvious maldevelopment and the fetal lung development in the TET group was close to that in the control group.The lung development indicators of Lw/Bw,PAA％,and lung vascular remodeling indicators of lumen area and vascular total area ratio(LA％) in the CDH group were significantly lower than those in the control group(2.11±0.36 vs.4.24±0.31;33.60±3.12 vs.58.81 ±2.92;38.58±2.15 vs.61.20±3.23,P＜0.05),the indicators of Lw/Bw.PAA％ and LA％ after TET intervention were significantly improved compared with the CDH group(3.61±0.24 vs.2.11±0.36;42.46±3.68 vs.33.60±3.12;56.07±3.32 vs.38.58±2.15,all P ＜0.05);the ratio of small pulmonary artery wall thickness to vascular external diameter (WT％) and the medium thickness percentage (MT％) in CDH group were significantly higher than those in the control group(26.64±2.41 vs.13.50±1.45 and 25.98±2.79 vs.16.47±2.07,P＜0.05),WT％ and MT％ in the TET group were obviously lower than those in the CDH group (16.02±2.35 vs.26.64± 2.41 and 17.96 ± 1.95 vs.25.98 ± 2.79,P＜0.05).The immunohistochemistry and Western blot detection indicated that the expressions of RhoA and ROCK1 from low to high were the control group ＜TET group ＜ CDH group.Conclusion Pulmonary hypoplasia and lung vascular remodeling exist in fetal rats with CDH and Rho/Rho kinase signaling pathway may be involved in the process.Prenatally giving TET may play the lung protective effect by regulating the Rho/Rho signal pathway.

Application of improved regional citrate anticoagulation in child hemofiltration / 重庆医学

Objective To investigate the application of citrate injected by dialysis pump in regional citrate anticoagulation (RCA) for child continuous hemofiltration(CHF). Methods The clinical data of 49 children patients with RCA-CHF with citrate anticoagulation in ICU of the Affiliated Children's Hospital of Chongqing Medical University from September 2015 to January 2017 were retrospectively analyzed. All cases were divided into the traditional group(20 cases) for conducting RCA-CHF treatment and improved group(29 cases,dialysis pump injection of citric acid) for conducting RCA-CHF under CHF mode. The occurence situation of common complications such as infusion pump bubble alarming, blood undesirable collection, bleeding and coagulation, and complications such as filter lifetime and citrate anticoagulation were observed. Results The bubble alarming and filter lifetime had statistical difference between the two groups(P<0.05). The biochemical indicators before and after treatment, and Na+ , iCa2+ , TCa2+/iCa2+ and HCO3- before and after treatment had statistical difference between the two groups. But Na+ , iCa2+ , TCa2+ /iCa2+and HCO3- before and after treatment had no statistical difference between the improved group and traditional group(P>0.05). Conclusion The improved technology of dialysis pumps instead of citrate pumps can more safely and more effectively use in child RCA-CHF treatment.

Antifungal agents and treatment options in children with invasive fungal disease / 中国小儿急救医学

Invasive fungal disease( IFD)in children can be life-threatening. Because of no differenti-al clinical manifestations,the early treatment is difficult. In this paper,according to the relevant literatures and clinical practices in recent years,we reviewed the commonly used antifungal drugs and the choices of treat-ment of invasive fungal disease in children.

Clinical progress of early enteral nutrition in critically ill children / 中国小儿急救医学

Most crit call y ill children have severe stress,the metabolic changes are speic fic and com-plex.Enternal nutritio n and early enternal nutrition can maintenance the nutrition metabolism andp rotect the intestinal mucosal bar ier na d digestive fnu ction.It also improve the perufs ion of tissue,regulate the immune, and significantly reduce the infection and the incidence of multiple organ dysfunction syndrome,reduce the occurrence of infection,so as to improve the rp ognosi .It has broad prospects for cliniacl application.Early enteral nutrition is the focus of this ap per,in order to provide some reference for the treatment of critci ally ill chli dren.

Definition and common etiology of acute liver failure in children / 中国小儿急救医学

Acute liver failure (ALF)in children is life-threatening clinical syndrome.There is an obvious difference between children and adults in the definition of ALF.The etiologies of ALF in children are related to virus infection,inherited metabolic diseases and drug intoxication.But in the infants,the etiological factors are significantly different to the elder children in ALF.The definition and etiology of ALF in children are reviewed in the paper.

Environmental control and nosocomial infections in pediatric intensive care unit / 中国小儿急救医学

Nosocomial infections take a tremendous impact to patients and curative activities in PICU.The occuring and developing of nosocomial infections are in close relation to the different internal and external environments of the patients.The incidence rate of nosocomial infections can be effectively reduced by the control of environmental factors in timely and reasonably.This paper reviewed the related internal and external environment factors and control measures in PICU nosocomial infections.

Oxidative stress and bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia( BPD),a serious disease in premature infant,obviously reduces the quality of life in the survivors.The etiological factors and pathological mechanism of BPD are very complicated.BPD caused by hyperoxia is associated with imbalance between the ability of antioxidation and the oxidation in body.There is a very close relationship between oxidative stress and inflammatory reaction,which influence each other and play a critical role in the development of BPD.Reactive oxygen species as a second message regulate many nuclear factors related to the proliferation and apoptosis of cells,which probably are the important mechanisms that oxygen stresses promote the development of BPD from gene level.The intervention of prevention and treatment in BPD are still at the exploration stage.This paper summarizes the intrinsic link between oxidative stress induced by high concentration oxygen and BPD,and the prevention and treatment in BPD by antioxidant.

Iatrogenic anemia in intensive care unit / 中国小儿急救医学

Acute and chronic anemias are frequently seen in patients of ICU.Besides the underlying diseases,anemia can also be induced by the examination and treatment.In this paper,the reasons of iatrogenic anemia were analyzed.On the base of the essential diagnosis and treatment,it is helpful to improve the prognosis of ICU patients by strengthening the administration of blood collection.The risk of iatrogenic anemia could be minimized by making a reasonable project of blood transfusion.

Modulatory effects of nebulized nitric oxide donor on inflammatory response in newborn piglets with acute respiratory distress syndrome / 中国小儿急救医学

Objective To investigate modulatory effects of Neb-SNP on inflammatory response and to explore the protection mechanisms of Neb-SNP in newborn piglets with ARDS. Methods Forty-five neonatal swines were randomly divided into five groups:group A (controlled group ,n = 9), group B (physiological saline group,n =9),group C (Neb-SNP 1 mg/ml,0. 9% NaCl, n = 9), group D (Neb-SNP 5 mg/ml,0. 9% NaCl, n = 9) and group E (Neb-SNP 10 mg/ml,0. 9% NaCl, n = 9). The pathological changes and activity of NF-κB in the lung tissue ,TNF-α ,IL-10 and IL-12 concentrations in serum at 30 minutes,60 minutes and 120 minutes after aerosol inhalation were observed. Results Activity of NF-κB and serum concentrations of TNF-α and IL-12 in the Neb-SNP treated group were lower than group B(P ＜0. 05) ,and serum IL-l0 concentration was obviously higher in the Neb-SNP group(P ＜0. 05). With an increase of Neb-SNP concentration,activity of NF-κB and serum concentrations of TNF-α and IL-12 were obviously increased, while serum concentrations of IL-10 was increased in group D and group E than that of group C (P ＜ 0. 05).Conclusion Inhalation of Neb-SNP reduced lung injury induced ARDS through lowering NF-κB activity and inhibiting expression of harmful inflammatory cytokines.

Effects of Matrine on STAT1, STAT3, CTGF, PDGF expression in fetal glomerular mesangial cells under lipopolysaccharide / 临床儿科杂志

Objectives To determine the effects of Matrine (Ma) on signal transducers and activators of transcription (STAT) 1, 3, connective tissue growth factor (CTGF) and platelet -derived growth factor (PDGF) in glomerular mesangial cells (MC) induced by lipopolysaccharide (LPS), and to explore the protective mechanisms of Ma. Methods Ma were added to cultured glomerular mesangial cells which were exposed to LPS for 12, 24 and 48 hours. Real time polymerase chain reaction were used to determine STAT1, 3, CTGF, PDGF mRNA, The protein expression of STATI, 3 and p-STAT1, 3 were observed by Western blot. Results Compared with the control group, MC proliferation of the LPS group (10μg/ml) significantly increased, which were suppressed in the Ma (320 μg/ml) group (P < 0.01) at 12, 24, 48 hours. The expression of STAT1, 3, CTGF, PDGF mRNA and the levels of p-STAT1 , p-STAT3 protein was significantly increased in MC under LPS medium at 12, 24, 48 hours, which were obviously lower in Ma group than those of the LPS group, especially at 24, 48 hours. Conclusions The protective mechanisms of Matrine is considered to down-regulate the expression of STAT1, 3, CTGF and PDGF.

Effect of oxymatrine on the expression of p-STAT3 and PIAS3 in human mesangial cells / 中华肾脏病杂志

Objective To study the effect of oxymatrine on p-STAT3 and PIAS3 signaling molecule and it's mRNA expression in the proliferation of the human mesangial cells (HMCs) induced by lipopolysaccharide(LPS) and to explore their relationship. Methods HMCs were divided into three groups: control group, LPS group and oxymatrine group. HMC proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay. Type Ⅳ collagen in the supernatants of the cultured HMCs was detected by ELISA at 12, 24, 48 hours respectively. At the same time, the protein and mRNA expressions of p-STAT3 and PIAS3 were measured by Western blot and real-time quantitative RT-PCR. Results The cell proliferation, the mRNA and protein expression of type Ⅳ collagen, p-STAT3 in LPS group were increased compared with the control group (P<0.01), but they were decreased in oxymatrine group (P < 0.01). The expressions of protein and mRNA of PIAS3 in LPS group were decreased significantly compared with control group (P<0.01), but they were increased in oxymatrine group (P<0.01). Conclusion Oxymatrine can down-regulate the expression of p-STAT3 and up-regulate the expression of PIAS3, which plays an important role in the process of LPS-induced HMCs proliferation.

Oxymatrine suppresses p-STAT1/PIAS1 signaling in LPS-induced human mesangial cells proliferation / 第三军医大学学报

Objective To observe the effect of oxymatrine(OM) on the expressions of p-STAT1 and PIAS1 signaling molecules at protein and mRNA levels in the proliferation of the human mesangial cells(HMC) induced by lipopolysaccharide(LPS) and explore the relationship between them.Methods HMCs were primarily cultured from a 4-month-old aborted human fetus(with informed consent and approved by the Ethics Committee of Lanzhou University),and then divided into 3 groups,that is,control group,LPS group(10 ng/ml) and OM group(LPS 10 ng/ml and OM 320 mg/L).After cultured for 12,24 and 48 h respectively,HMC proliferation were analyzed by methyl thiazolyl tetrazolium(MTT) assay and type Ⅳ collagen in the supernatants were detected by ELISA.At the same time points,the cells lysates were collected for the mRNA and protein expressions of p-STAT1 and PIAS1 by real-time quantitative RT-PCR and Western blot analysis.Results The cell proliferation of LPS group was faster and the type Ⅳ collagen protein was increased more than the control group(P