Mechanisms mediating the inhibitory effects of quercetin against phthalates-induced testicular oxidative damage in rats / 南方医科大学学报

OBJECTIVE@#To explore the mechanism underlying the inhibitory effect of quercetin against testicular oxidative damage induced by a mixture of 3 commonly used phthalates (MPEs) in rats.@*METHODS@#Forty male Sprague-Dawley rats were randomly divided into control group, MPEs exposure group, and MPEs with low-, median- and high-dose quercetin treatment groups. For MPEs exposure, the rats were subjected to intragastric administration of MPEs at the daily dose of 900 mg/kg for 30 consecutive days; Quercetin treatments were administered in the same manner at the daily dose of 10, 30, and 90 mg/kg. After the treatments, serum levels of testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and testicular malondialdeyhde (MDA), catalase (CAT) and superoxide dismutase (SOD) were detected, and testicular pathologies of the rats were observed with HE staining. The expressions of nuclear factor-E2-related factor 2 (Nrf2), Kelch-like ECH2 associated protein 1 (Keap1) and heme oxygenase 1 (HO-1) in the testis were detected using immunofluorescence assay and Western blotting.@*RESULTS@#Compared with the control group, the rats with MPEs exposure showed significant reductions of the anogenital distance, weight of the testis and epididymis, and the coefficients of the testis and epididymis with lowered serum testosterone, LH and FSH levels (P < 0.05). Testicular histological examination revealed atrophy of the seminiferous tubules, spermatogenic arrest, and hyperplasia of the Leydig cells in MPEs-exposed rats. MPEs exposure also caused significant increments of testicular Nrf2, MDA, SOD, CAT and HO-1 expressions and lowered testicular Keap1 expression (P < 0.05). Treatment with quercetin at the median and high doses significantly ameliorated the pathological changes induced by MPEs exposure (P < 0.05).@*CONCLUSION@#Quercetin treatment inhibits MPEs-induced oxidative testicular damage in rats possibly by direct scavenging of free radicals to lower testicular oxidative stress and restore the regulation of the Nrf2 signaling pathway.

REGEN-COV Antibody Cocktail in Outpatients with Covid-19

BackgroundContinued SARS-CoV-2 infections and COVID-19-related hospitalizations highlight the need for effective anti-viral treatments in the outpatient setting. In a descriptive interim analysis of the phase 1/2 portion of a double-blind phase 1/2/3 trial in COVID-19 outpatients conducted between June 16, 2020 and September 4, 2020, REGEN-COV(R) (casirivimab plus imdevimab) antibody combination reduced SARS-CoV-2 viral load versus placebo. MethodsThis final phase 1/2 analysis comprises 799 outpatients, including 275 from the previous descriptive analysis (group-1) and 524 from phase 2 (group-2). Patients were randomized (1:1:1) to placebo, REGEN-COV 2400mg, or REGEN-COV 8000mg. Prespecified hierarchical analyses of virologic endpoints were performed in group-2. The proportion of patients with [≥]1 COVID-19-related medically attended visit (MAV) through day 29 was assessed in group-1+2. Efficacy was assessed in patients confirmed SARS-CoV-2-positive by baseline nasopharyngeal RT-qPCR. Safety was assessed in all treated patients. ResultsData from 799 outpatients enrolled from June 16, 2020 to September 23, 2020 are reported. Time-weighted average daily reduction in viral load through day 7 was significantly greater in the REGEN-COV combined 2400mg+8000mg group versus placebo in patients with baseline viral load >107 copies/mL (prespecified primary endpoint): -0.68 log10 copies/ml (95% CI, -0.94 to -0.41; P<.0001). This reduction was - 0.73 (P<.0001) and -0.36 (P=.0003) log10 copies/mL in serum antibody-negative patients and in the overall population, respectively. REGEN-COV reduced the proportion of patients with [≥]1 COVID-19-related MAV versus placebo (2.8% [12/434] REGEN-COV combined dose group versus 6.5% [15/231] placebo; P=.024; relative risk reduction [RRR]=57%); in patients with [≥]1 risk factor for hospitalization, the treatment effect was more pronounced (RRR=71%). Adverse events were similar across groups. ConclusionsIn COVID-19 outpatients enrolled prior to the widespread circulation of delta and omicron variants, treatment with REGEN-COV significantly reduced viral load and COVID-19-related MAVs.

REGEN-COV Antibody Cocktail Clinical Outcomes Study in Covid-19 Outpatients

BackgroundREGEN-COV antibody cocktail (casirivimab with imdevimab) rapidly reduced viral load and decreased medically-attended visits in the phase 1/2 portion of this trial; REGEN-COV, retains activity in vitro against emerging SARS-CoV-2 variants of concern. MethodsThe phase 3 portion of this adaptive, randomized, master protocol, included 4,057 Covid-19 outpatients with one or more risk factors for severe disease. Patients were randomized to a single treatment of intravenous placebo, or various doses of REGEN-COV, and followed for 28 days. The prespecified hierarchical analysis first compared REGEN-COV 2400mg dose vs concurrent placebo, then compared the 1200mg dose vs concurrent placebo, for endpoints assessing risk of hospitalization or death, and time to symptom resolution. Safety was evaluated in all treated patients. ResultsBoth REGEN-COV 2400mg and 1200mg significantly reduced Covid-19-related hospitalization or all-cause death compared to placebo (71.3% reduction [1.3% vs 4.6%; p<0.0001] and 70.4% reduction [1.0% vs 3.2%; p=0.0024], respectively). The median time to resolution of Covid-19 symptoms was 4 days shorter in both dose arms vs placebo (10 vs 14 days; p<0.0001). Efficacy of REGEN-COV was consistent across subgroups, including patients who were SARS-CoV-2 serum antibody-positive at baseline. REGEN-COV more rapidly reduced viral load than placebo. Serious adverse events occurred more frequently in the placebo group (4.0%) than in the 1200mg (1.1%) and 2400mg (1.3%) groups and grade [≥]2 infusion-related reactions were infrequent (<0.3% in all groups). ConclusionsTreatment with REGEN-COV was well-tolerated and significantly reduced Covid-19-related hospitalization or all-cause death, rapidly resolved symptoms, and reduced viral load. (Funded by Regeneron Pharmaceuticals and the Biomedical and Advanced Research and Development Authority of the Department of Health and Human Services; ClinicalTrials.gov number, NCT04425629.)

Analysis of 24-hour ambulatory blood pressure monitoring in the assessment of high blood pressure medication in elderly patients / 中华老年医学杂志

Objective To evaluate the value of ambulatory blood pressure monitoring in evaluating hypertension status and the efficacy of antihypertensive medication in hypertension patients.Methods We retrospectively collected data from 236 elderly hypertensive patients at our hospital from July 2016 to June 2017 and analyzed the blood pressure characteristics of patients under 24 h ambulatory blood pressure monitoring and the effects of different types of antihypertensive medication.Results Of 236 patients with high blood pressure,80.1％ had both higher systolic blood pressure and higher diastolic blood pressure;about 90.0％ had blood pressure load greater than 40.0％;blood pressure in 57.6％ of patients reached its peak both in the morning and in the afternoon;a majority (58.9％)showed a non dipper circadian pattern.After antihypertensive drug treatment,the blood pressure indicators significantly improved(P ＜0.05).Common antihypertensive drugs included calcium antagonists,angiotensin converting enzyme inhibitors (ACEI),angiotensin receptor blockers (ARB),diuretics,beta blockers,and combination drugs.Conclusions 24 h ambulatory blood pressure monitoring can provide comprehensive blood pressure data,help achieve accurate assessment of blood pressure status,and may be used in the evaluation of antihypertensive drug treatment.

Four cases of acute respiratory distress syndrome patients transported with veno-venous extracorporeal membrane oxygenation / 中华儿科杂志

Objective@#To retrospectively review 4 cases diagnosed with pediatric acute respiratory distress syndrome (ARDS) who were transported with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) from April 2016 to March 2017.@*Methods@#Four patients were transported to Bayi Children's Hospital Afflicted to the PLA Army General Hospital, with V-V ECMO. Their vital signs, blood-gas analysis and chest X-ray before and after transportation were compared. The length of ECMO, pediatric intensive care unit (PICU) stay and hospitalization, and the prognosis were analyzed.@*Results@#All the four cases were transported to our hospital successfully from distances between 1 000 km to 1 210 km. The 4 cases were 4 to 6 years old with the body weight of 19 to 35 kg, of whom 3 were boys and 1 was girl. The catheters were inserted in the right jugular vein and femoral vein. The vital signs and blood-gas analysis after transportation did not change significantly compared to baseline. The length of ECMO for the four patients were 48, 754, 157 and 438 hours. They stayed in the PICU for 10, 32, 14 and 19 days, respectively. At last, 2 of them were successfully discharged from hospital without any complications; however, the other 2 died of multiple organ failure.@*Conclusion@#Transporting ARDS patients with a satisfactory cardiac function under VV-ECMO by an experienced ECMO team is safe.

Outcome of pediatric extracorporeal membrane oxygenation in a single center / 中华儿科杂志

Objective@#To investigate the application and outcome of pediatric extracorporeal membrane oxygenation (ECMO) in a single center.@*Methods@#The clinical data of 52 pediatric patients with cardiopulmonary failure received ECMO support in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of PLA were collected from January 2012 to October 2016. All patients were divided into two stages by time. January 2012 to December 2014 was stage one. January 2015 to October 2016 was stage two. A retrospective analysis was done for these patients between two stages. In addition, all clinical data were compared with the data of extracorporeal life support organization (ELSO). The constituent ratio differences in different groups were tested by chi square test.@*Results@#In 52 cases, there were 40 boys and 12 girls, aging from 1 day to 7 years, weighing from 2 to 20 kg. There were 35 cases who successfully weaned from ECMO (67%), and 25 cases were able to be discharged alive (48%). In stage one, there were 24 ECMO cases, 18 boys and 6 girls. There were 15 cases successfully weaned from ECMO (63%). Nine patients survived until discharge (38%). Complications were found in 15 cases during ECMO support (63%). In stage two, there were 28 ECMO cases, 22 were boys and 6 were girls. There were 20 cases successfully weaned from ECMO (71%). Sixteen patients survived until discharge (57%). Complications were found in 12 cases during ECMO support (43%). There was no significant difference in survival rates between two stages. However, the neonatal survival rate was higher in stage two than in stage one (71% (12/28) vs. 31% (5/24), χ2=5.107, P=0.038). The proportion of respiratory support was higher in stage two than in stage one (50% (14/28) vs. 21% (5/24), χ2=4.741, P=0.029), while the proportion of extracorporeal cardiopulmonary resuscitation (ECPR) decreased significantly (21% (6/28) vs. 67% (16/24), χ2=10.835, P=0.001). Application of peritoneal dialysis treatment in stage two was higher (6 vs. 0 cases, χ2=8.097, P=0.025). Mortality of ECMO was still higher than that of ELSO (48% (25/52) vs. 62% (34 655/55 886), χ2=4.281, P<0.05). The constituent ratio of different types of support varied between ECMO and ELSO patients (χ2=19.562, P<0.001).@*Conclusions@#ECMO technology can provide effective support for severe cardiopulmonary failure in critically ill children. Due to the multidisciplinary nature of ECMO technology, the complexity and characteristics of pediatric patients, it takes long time to improve ECMO management and prognosis.

Clinical analyses of twelve children with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation / 中国小儿急救医学

Objective To summarize the clinical experience of extrocorporeal membrane oxygena-tion(ECMO) in the treatment of pediatric acute respiratory distress syndrome (ARDS). Methods A retro-spective analysis of children with ARDS who were hospitalized for different causes and received the treatment of ECMO from October 2012 to November 2017 was performed. The clinical conditions and prognostic fac-tors in the course of their disease were compared. Results In 12 cases of ARDS,9 cases (75％ ) had severe pneumonia,2 cases (16. 67％ ) had lung tumor resection and 1 case ( 8. 33％ ) had bronchial foreign body. Seven cases (58. 3％ ) chose VA-ECMO,5 (41. 7％ ) cases chose VV-ECMO. The average duration of ECMO was (225. 03 ± 214. 75) h. With the positive treatment of ECMO,heart rate,mixed venous oxygen saturation and central venous pressure all improved significantly(P < 0. 05),and there was no obvious abnor-mal changes in MAP and lactic acid(P > 0. 05). Arterial oxygen partial pressure,arterial carbon dioxide par-tial pressure,oxygenation index and P/ F were significantly improved after the ECMO support(P < 0. 05). Ppeak,Paw and PEEP after evacuation of ECMO were significantly lower than those before treatment (P <0. 05). Ten cases (83. 33％ ) were successfully removed,8 cases (66. 67％ ) were saved, and 4 cases (33. 33％ ) died. During the ECMO treatment,9 cases (75％ ) had complications,including 8 cases of bleed-ing at the intubation site,3 cases of gastrointestinal hemorrhage,2 cases of hemolysis,1 case of infection,2 cases of acute kidney injury,2 cases of neurological symptoms,1 case of multiple organ dysfunction syn-drome. Conclusion Pediatric ARDS is critical and the mortality rate is high. ECMO should be used as soon as possible when the lung is potentially regained and other treatments are ineffective,so that the lung could be fully rescued to gain time and opportunity for clinical treatment.

Prognostic value of dynamic monitoring of RUNX1-RUNX1T1 transcript in pediatric acute myeloid leukemia / 中华血液学杂志

Objective@#To investigate the prognostic value of dynamic monitoring of RUNX1-RUNX1T1 transcript in pediatric patients with t (8;21) acute myeloid leukemia (AML) .@*Methods@#The clinical features and RUNX1-RUNX1T1 transcript levels of 55 pediatric t (8;21) AML patients, newly diagnosed from Jan. 2010 to Apr. 2016, were analyzed retrospectively. The relationship between the minimal residual disease (MRD) and prognosis was analysed by dynamic monitoring of RUNX1-RUNX1T1 transcript levels using real-time quantitative PCR (RQ-PCR) technology.@*Results@#The RUNX1-RUNX1T1 transcript levels in bone marrow cells at diagnosis was not related to relapse. After one course of induction therapy, patients with a more than 2 Log reduction of RUNX1-RUNX1T1 transcript levels (>2 Log) had lower 5 years cumulative incidence of relapse (CIR) [ (24.3±8.4) % vs (52.6±9.7) %, χ2=9.046, P=0.003], relapse-free survival (RFS) [ (71.6±12.7) % vs (48.1±13.2) %, χ2=5.814, P=0.016], and better overall survival (OS) [ (76.9±12.5) % vs (48.9±14.7) %, χ2=6.346, P=0.012], compared to patients with a less than 2 Log reduction (a<2 Log) . Multivariate Cox survival analysis suggested that a>2 Log reduction in RUNX1-RUNX1T1 transcript levels after a course of induction therapy was an independent prognostic factor for RFS (HR=0.263, 95%CI 0.081-0.851, P=0.026) and OS (HR=0.214, 95% CI 0.057-0.808, P=0.023) . During consolidation therapy and follow-up period, molecular relapse of 16 cases and hematologic relapse of 13 cases were identified by continuous dynamic monitoring of RUNX1-RUNX1T1 transcript levels, with a median interval of 4.0 (1.5-5.8) months from the molecular relapse to hematologic relapse. 2 cases of molecular relapse who received timely allogeneic hematopoietic stem cell transplantation did not experience hematologic relapse.@*Conclusion@#Dynamic monitoring RUNX1-RUNX1T1 transcript levels by RQ-PCR technique can subdivide patients into relatively low and high risk group, early screen patients at high risk of relapse and provide a scientific basis for precision stratification and risk-adapted therapy for pediatric t (8;21) AML children.

Correlation of vitamin A deficiency with hemoglobin level and respiratory tract infection in children / 临床儿科杂志

Objectives To explore the nutritional status of vitamin A in healthy children and children with respiratory infection symptoms, and its correlation with hemoglobin levels. Methods Health children who lived in Beijing for over half year during December 2014 to August 2015 were included. Serum retinol and peripheral blood hemoglobin were measured. The relationship of vitamin A nutritional status with age, respiratory tract infection and anemia were analyzed. Results A total of 1742 children (1056 males and 686 females) with a median age of 3.1 years (6 months~17 years) were enrolled. 202 children had respiratory tract infection and 1540 children didn't have respiratory tract infection when visiting. The median serum retinol level was 0.29 mg/L (0.25~0.33 mg/L) in all children. The level of retinol in children with respiratory tract symptoms was significantly lower than that in children without respiratory symptoms (P<0.001). The prevalence of subclinical vitamin A deficiency and suspected subclinical deficiency were 5.8% and 47.9% respectively. The prevalence of both the subclinical and suspected subclinical vitamin A deficiency ratios were >50% in children under 9-year-old. The prevalence of subclinical vitamin A deficiency and suspected subclinical deficiency among different age groups were statistically different (P<0.001). The incidence of anemia in subclinical vitamin A deficiency, suspected subclinical deficiency children and normal children were 3.9%, 8.7%, and 10.8% respectively, and The differences were statistically significant (P<0.01). Serum retinol and hemoglobin concentrations were positively correlated with age (r=0.179 or 0.571, P all < 0.001). Furthermore, serum retinol was positively correlated with the concentration of hemoglobin (r=0.244, P<0.001). Conclusions Serum retinol level in children with respiratory infection is lower than that in healthy children. Vitamin A deficiency was associated with anemia.

Correlation of vitamin A deficiency with hemoglobin level and respiratory tract infection in children / 临床儿科杂志

Objectives To explore the nutritional status of vitamin A in healthy children and children with respiratory infection symptoms, and its correlation with hemoglobin levels. Methods Health children who lived in Beijing for over half year during December 2014 to August 2015 were included. Serum retinol and peripheral blood hemoglobin were measured. The relationship of vitamin A nutritional status with age, respiratory tract infection and anemia were analyzed. Results A total of 1742 children (1056 males and 686 females) with a median age of 3.1 years (6 months~17 years) were enrolled. 202 children had respiratory tract infection and 1540 children didn't have respiratory tract infection when visiting. The median serum retinol level was 0.29 mg/L (0.25~0.33 mg/L) in all children. The level of retinol in children with respiratory tract symptoms was significantly lower than that in children without respiratory symptoms (P<0.001). The prevalence of subclinical vitamin A deficiency and suspected subclinical deficiency were 5.8% and 47.9% respectively. The prevalence of both the subclinical and suspected subclinical vitamin A deficiency ratios were >50% in children under 9-year-old. The prevalence of subclinical vitamin A deficiency and suspected subclinical deficiency among different age groups were statistically different (P<0.001). The incidence of anemia in subclinical vitamin A deficiency, suspected subclinical deficiency children and normal children were 3.9%, 8.7%, and 10.8% respectively, and The differences were statistically significant (P<0.01). Serum retinol and hemoglobin concentrations were positively correlated with age (r=0.179 or 0.571, P all < 0.001). Furthermore, serum retinol was positively correlated with the concentration of hemoglobin (r=0.244, P<0.001). Conclusions Serum retinol level in children with respiratory infection is lower than that in healthy children. Vitamin A deficiency was associated with anemia.

Treatment of 21 pediatric patients with pulmonary artery sling combined with tracheal stenosis / 中国小儿急救医学

Objective Total 21 pulmonary artery sling( PA sling)combined with tracheal stenosis children who received treatment in our hospital were reviewed. The feasibility of treatment strategy including left pulmonary artery( LPA)re-implantation without tracheoplasty was discussed in this study. Methods From April 2009 to November 2015,a total of 21 pediatric patients received surgical treatment due to PA sling with tracheal stenosis. Six patients received LPA re-implantation and trachea intervention simultaneously. The other 15 patients received LPA re-implantation alone to relieve the trachea compression without tracheoplasty. The postoperative strategy including early extubation and CPAP ventilation was employed in PICU. Results A total of 21 PA sling with tracheal stenosis children who underwent surgical treatment in our hospital were recruited. There were 9 females and 12 males. Ages of these children were from 1 months to 10 years old,and body weights were from 2. 9 kg to 25. 0 kg. Five patients needed mechanical ventilation for severe respiratory symptoms preoperatively. Six patients received LPA re-implantation and tracheal interven-tion simultaneously. Among them,3 patients received slide tracheoplasty,and one was discharged after recov-ery. The remaining 3 patients received tracheal stent implantation,but finally died. The survival rate was 16. 7% in these patients. Fifteen patients received LPA re-implantation alone,and slide tracheoplasty was per-formed in 2 patients for extubation failure who finally died of air leakage. The survival rate of 15 patients who received LPA re-implantation alone was 86. 7%. Conclusion The strategy in LPA re-implantation alone to relieve the trachea compression without tracheoplasty and early extubation and CPAP ventilation postoperative may be an ideal treatment for the pediatric patients with PLA sling combined with tracheal stenosis.

The muscle activation patterns of lower limb during stair climbing at different backpack load.

Stair climbing under backpack load condition is a challenging task. Understanding muscle activation patterns of lower limb during stair climbing with load furthers our understanding of the factors involved in joint pathology and the effects of treatment. At the same time, stair climbing under backpack load requires adjustments of muscle activations and increases joint moment compared to level walking, which with muscle activation patterns are altered as a result of using an assistive technology, such as a wearable exoskeleton leg for human walking power augmentation. Therefore, the aim of this study was to analyze lower limb muscles during stair climbing under different backpack load. Nine healthy volunteers ascended a four-step staircase at different backpack load (0 kg, 10 kg, 20 kg, 30 kg). Electromyographic (EMG) signals were recorded from four lower limb muscles (gastrocnemius, tibialis anterior, hamstring, rectus femoris). The results showed that muscle activation amplitudes of lower limb increase with increasing load during stair climbing, the maximum RMS of gastrocnemius are greater than tibialis anterior, hamstring and rectus femoris whether stair climbing or level walking under the same load condition. However, the maximum RMS of hamstring are smaller than gastrocnemius, tibialis anterior and rectus femoris. The study of muscle activation under different backpack load during stair climbing can be used to design biomechanism and explore intelligent control based on EMG for a wearable exoskeleton leg for human walking power augmentation.

Effect of castration on miR-301a expression in a mouse xenograft model of human prostate cancer / 中华泌尿外科杂志

Objective To investigate the changes of miR-301a and its host gene expression SKA2 in LNCaP prostate cancer xenografts in the castrated nude mice.Methods LNCaP cells were inoculated subcutaneously in nude mice to establish xenograft models of human prostate cancer.When the tumor volume grew to 200 mm3,the nude mice were randomly divided into the following 4 groups(n =6): 2 groups of nude mice to surgical castration,the other 2 groups of mice as control groups.The growth of those xnografts in nude mice was observed weekly and a growth curve of the xenografts was drawn.A point time during the process of tumor-regressing was selected when a group of castrated nude mice and a group of control mice were killed(the first time).The other 2 groups nude mice were continued to be observed.Another point time in the process of tumor re-growth,the rest castrated nude mice and control mice were killed(the second time).The tumors were weighted and the inhibitory rate was calculated.MiR-301a and SKA2 expression were detected by real-time PCR.Results The growth of the xenografts gradually decreased in LNCaP xenografts in nude mice after castration.After 13 days,the xenografls sizes decreased to(62.5 ±21.5)mm3 and tumor inhibitory rate was 59.8％(t =-3.895,P =0.018)in castration group of nude mice.At the 17th day after castration,tumor volume reached the minimum,and then gradually increased.At the 41st day after castration,tumor volumes in castration group increased to(364.5 ±97.3)mm3 and the tumor inhibitory rate was 62.2％(t =-7.017,P =0.002).MiR-301a and SKA2 in the first time of xenografts from the castrated group were both significantly lower than those of the control group(0.65-fold and 0.50-fold,respectively).However,their expressions in the second time of xenografts from the castrated group increased and were consistent with the control group(P ＞ 0.05).Conclusions Castration could turn prostate cancer xenografts from androgen-dependent into androgen-independent.There could be a close correlation between the characteristic of prostate cancer androgen-dependent and the expressions of miR-301 a and host gene SKA2.

The application of continuous blood purification in children with severe sepsis and regulation on the inflammatory factor of interleukin-6 and tumor necrosis factor-α / 中国小儿急救医学

Objective To evaluate the clinical effect of continuous blood purification (CBP) in treatment of children with severe sepsis,and analyze the changes of severity of illness and inflammatory factors,which can provide the proof for treatment of children with severe sepsis.Methods Twenty cases with severe sepsis admitted to pediatric intensive care unit of Bayi Children's Hosptial Affiliated to General Hospital of Beijing Military Commond from Aug 2008 to May 2011 were treated with CBP.The mean arterial blood pressure,boost dosages,urine output,arterial blood gases,and oxygenation index were collected before CBP and 12,24,48 hours after CBP treatment.The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were determined by enzyme-linked immunosorbent assay.Pediatric critical illness scores were assessed before and 48 h after CBP treatment.Results After the treatment of CBP,16 children were clinical improvement,2 died,2 abandoned the treatment.CBP was effective in the treatment by rising the mean arterial blood pressure (P ＜ 0.01),decreasing the dosages of dopamine and epinephrine (P ＜ 0.01),increasing urine output(P ＜ 0.01).The value of pH and base excess returned to normal basically.The levels of IL-6 and TNF-α were(706.90 ± 275.95) ng/L,(989.67 ± 386.33) ng/L before the CBP.The levels of IL-6 and TNF-α decreased to (162.59 ± 63.47) ng/L,(439.08 ± 159.37) ng/L at 48 h after CBP treatment (P ＜0.01).The pediatric critical illness scores were 67.59 ± 25.02 and 87.05 ± 32.81 before CBP and at 48 h after CBP,which showed significant difference (P ＜ 0.01).Conclusion The treatment of CBP can remove inflammatory factors in children with severe sepsis and improve the severity of illness.

Application of flexible fiberoptic bronchoscopy for the critical patients with severe respiratory diseases in PICU / 中国小儿急救医学

Objective To explore the role of flexible fiberoptic bronchoscope(FFB) in the critical patients with severe respiratory diseases of PICU.Methods One hundred and eighty-nine cases of severe respiratory diseases had undergone FFB from Jul 2010 to Jan 2011.One hundred and fifty-seven (83.06％) cases were less than 3 years.FFB examinations were made through nose (226 times) and endotracheal intubation (25 times).Bronchoscopic lavage for bacterial culture was performed by injecting normal saline solution (NSS) via a syringe into the working channel of FFB.Results Of all 189 cases,bacteria were isolated from 80 cases (42.3％) for bacterial culture of bronchoscopic lavage fluid,which included G-bacilli in 51 cases,G + cocci in 21 cases,and fungi in 8 cases.Six cases with tracheobronchial foreign bodies and 31 cases with respiratory tract anatomical abnormalities were found through FFB.Forty cases of severe pneumonia complicated with respiratory failure underwent bronchoscopic lavage,which were effective in 35 cases,and ineffective in 5 cases.In 20 cases of severe pneumonia atelectasis,pulmonary reexpansion were found in 16 cases by bronchoscopic lavage,atomization inhalation,and systemic administration,4 cases improved.Tracheobronchial foreign bodies were removed in all 6 cases by FFB.During FFB,bradycardia was found in 1 cases.There was no FFBrelated death.Conclusion FFB is safe for severe patients with respiratory diseases in PICU.FFB play important role in diagnosis and treatment for children in PICU,including feasible intervention under bronchoscopy.