Progress in the treatment of chronic spontaneous urticaria: insights from the changes in the understanding of its pathogenesis / 中华皮肤科杂志

Mast cells, autoantibodies, inflammatory cells, coagulation cascade, complement system and nervous system are all involved in the complex pathogenesis of chronic spontaneous urticaria (CSU) , while mast cells play a pivotal role in it. With deeper understanding of the pathogenesis of CSU, cutting-edge therapeutic methods are gradually being used in clinical practice. Nowadays, pharmacotherapyeutic studies are more focused on accurately modulating the pathological state of mast cells. This review summarizes recent advances in the pathogenesis of and medicines for CSU.

Effect of prone position management on preventing ventilator-associated pneumonia in children with congenital heart disease complicated with acute respiratory distress syndrome / 中国实用护理杂志

Objective:To develop a prone position management program and evaluate its effectiveness in preventing ventilator-associated pneumonia (VAP) in children with congenital heart disease combined with acute respiratory distress syndrome, in order to provide experience for clinical application.Methods:This was a quasi-experimental study. Convenient sampling method was used to select children with congenital heart defect who underwent mechanical ventilation in the Cardiothoracic Surgical Care Unit of Shanghai Children′s Medical Center, Shanghai Jiao Tong University, School of Medicine from June 2018 to December 2021 as the study subjects. The control group consisted of 80 hospitalized children from June 2018 to December 2019. They were used general nursing interventions to prevent VAP. The 42 hospitalized children from January 2020 to December 2021 were the intervention group, who usd the prone position management program on the basis of the control group. The differences in the incidence of VAP, duration of mechanical ventilation, duration of ICU stay, oxygenation index and the incidence of adverse events between the two groups were compared.Results:The incidence of VAP and mechanical ventilation duration in the intervention group were 4.8% (2/42) and 67.50 (55.00/101.50), which were lower than 35.0% (28/80) and 92.50 (68.00/142.00) of the control group, and the differences were statistically significant ( χ2=11.98, Z=3.40, both P<0.01). And the trend of increasing oxygenation index with the intervention group was better than the control group ( F=8.38, P<0.05). There was no statistical difference in the incidence of adverse events between the two groups (all P>0.05). Conclusions:The application of prone ventilation program with congenital heart disease children complicated with acute respiratory distress syndrome is safe and can significantly improve the oxygenation index, shorten the duration of mechanical ventilation and reduce the incidence of VAP.

Stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts / 中华胸心血管外科杂志

Objective Patients with single-ventricle physiology pose a wide variety of therapeutic challenges.Pulmonary artery or anastomosis stenosis in single-ventricle physiology will have only subtle hemodynamic derangements due to the lack of the pumping chamber to force blood across the stenosis.This study aimed to evaluate the feasibility and usefulness of the stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts.Methods Retrospective analysis of 8 implanted stents between March 2014 and January 2015 in Shanghai Children's Medical Center.Transthoracic echocardiography,chest roentgenography and electrocardiography were carried out as follow-up studies at the second day after operation and 1,3,6,12 months after the procedure.Results In all of eight patients (6 males and 2 females),5 cases were post-Glenn operation and 3 cases were post-Fontan operation.The median age was 6.6 years (range 4.0-8.5 years).The median weight was 19.5 kg(range 13.8-25.6 kg).9 stents were implanted successfully in all patient,6 in left pulmonary arteries,2 in right pulmonary arteries and 1 in anastomosis.All stents were placed in the target lesion without any complication.The diameter of the narrowed segment improved from (3.63 ± 2.06) mm to (7.89 ± 1.62) mm (P ＜ 0.01).During follow-up no other complication occurred except thrombus in one patient because of discontinuation anticoagulation.Conclusion Branch pulmonary arterial stenosis in single-ventricle patients may often be underestimated due to the low pressure venous system and/or the development of venovenous collaterals bypassing and decompressing the pulmonary circuit.In these patients,even mild stenosis should be treated aggressively,especially in the presence of pleural effusions,pericardial effusions,protein-losing enteropathy and low-output states.Stent implantation is an effective method of treating branch pulmonary artery stenosis.

Initial experience with the new Pul-Stent in treating postoperative branch pulmonary artery stenosis / 中华儿科杂志

<p><b>OBJECTIVE</b>The Pul-stent is a new cobalt alloys stent, specially licensed for pulmonary artery stenosis. The aim of this study was to investigate the value of the stent implantation as the treatment of postoperative pulmonary artery stenosis.</p><p><b>METHOD</b>Clinical practice was carried out to evaluate effectiveness, safety and maneuverability of Pul-stent in the defined clinical setting. Transthoracic echocardiography, chest roentgenography and electrocardiography were carried out as follow-up studies at 1 and 3 months after procedures.</p><p><b>RESULT</b>Ten patients (7 males and 3 females) received Pul-stent implantation in left or right pulmonary arteries (9 stents in left and 1 stent in right). For 9 cases transcatheter stent implantation was performed and in I case hybrid procedure. The median age was 7. 9 years (range 3. 4 - 13. 7 years). The median weight was 22. 3 kg (range 13 - 32 kg). Among them 6 cases were post surgical repair of tetralogy of Fallot, 2 cases were after Fontan procedures, 1 patient was post surgical repair of pulmonary atresia with ventricular septal defect, and 1 patient had stenosis at Glenn pathway. The pressure gradient at the stenosis decreased from (31. 6 ± 10. 2) mmHg(1 mmHg =0. 133 kPa) to (7. 3 ± 10. 3) mmHg, and the diameter of the narrowest segment increased from (4. 0 ± 2. 3) mm to (9. 6 ± 2. 7) mm, the right ventricle to aortic pressure ratio decreased from 0. 54 to 0. 36, all of these improvements were statistically significant (t = 3. 9, -9. 7, 4. 5; P =0. 008, 0. 000, 0. 004). The total procedure time ranged from 55 to 220 min (median 117 min) , and the fluoroscopy time ranged from 9 to 67 min (median 26 min). There were 2 cases of post-stenting pneumorrhagia. No stent fracture, stent malposition and other severe complications were observed. Initial follow-up of 1 and 3-months showed good results with maintenance of improved caliber of the stented vessel, and the gradient across the stenosis area measured by echocardiography was (32. 0 ± 14. 6) mmHg after 3 months. Compared with before stentifng ((40.6 ± 15. 2) mmHg) and 1 month later ((30. 6 ± 13. 6) mmHg), the difference was not statistically significant (t =2. 2,1. 76; P =0. 07, 0. 10).</p><p><b>CONCLUSION</b>Pul-Stent tracking and delivery was excellent, the initial experience has shown that Pul-stent implantation was effective and safe in treating post-operative branch pulmonary artery stenosis. Further follow-up study should be conducted to make sure whether those good results would be kept constant.</p>