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Objectives: To investigate whether the levels of interleukin 1ß (IL-1ß), interferon γ (IFN-γ), tumor necrosis factor α (TNF-α) in children with Kawasaki disease (KD) are correlated with coronary artery lesion (CAL) and resistance to intravenous immunoglobulin (IVIG) treatment. Methods: A total of 216 children in line with KD diagnostic criteria were continuously included as subjects, and 50 healthy children at the same period were selected as the control group, and their levels of IL-1ß, IFN-γ, and TNF-α were detected. Results: Subjects were subdivided according to the presence or absence of CAL: 42 cases (19.4%) of 216 children with KD developed CAL and were subdivided into the CAL group, while 174 (80.6%) of those who did not develop CAL were subdivided into the NCAL group. The levels of IL-1ß, IFN-γ, and TNF-α in the CAL group and the NCAL group were higher than those in the control group (P<0.05), and the levels of those in the CAL group were higher than those in the NCAL group (P<0.05). Subjects were subdivided according to the effect of IVIG treatment: 194 cases (89.8%) of 216 children with KD had a good control of inflammation after the initial IVIG treatment, and were considered to have IVIG-sensitive KD and divided into the IVIG-sensitive group; 22 cases (10.2%) could not get good control of inflammation after the initial IVIG treatment, and were considered to have IVIG-resistant KD and divided into the IVIG-resistant group. The levels of IL-1ß, IFN-γ, and TNF-α in the IVIG-sensitive group and the IVIG-resistant group were higher than those in the control group; The levels of IL-1ß, IFN-γ, and TNF-α in the IVIG-resistant group were higher than those in the IVIG-sensitive group (P<0.05), while the fever time of the IVIG-sensitive group was lower than that of the IVIG-resistant group (P<0.05). Conclusion: Children with KD may experience changes in IL-1ß, IFN-γ, and TNF-α levels in the acute phase. Such a significant increase in levels may be a risk factor for CAL and resistance to IVIG treatment in children with KD, while the prolonged fever time is a risk factor for resistance to IVIG treatment in children with KD.
RESUMEN
OBJECTIVES: To evaluate the sedative and analgesic effects of dexmedetomidine combined with propofol intravenous anesthesia in laparoscopic day surgery in pediatric urology. METHODS: Eighty male children with cryptorchidism and hydrocele who underwent laparoscopic daytime surgery in our hospital from January 2019 to January 2021 were selected and randomly divided into two groups: the experimental group and the control group. Children in the experimental group ranged in age from 5.7 to 11.3, with an average of 8.52±2.17 years old, while those in the control group ranged in age from 5.3 to 12.0, with an average of 8.60±2.07 years old. There were 12 cases of cryptorchidism and 28 cases of hydrocele in the experimental group, and 14 cases of cryptorchidism and 26 cases of hydrocele in the control group. Children in the control group received conventional propofol intravenous combined anesthesia, while those in the experimental group were given dexmedetomidine (2-5 ug/kg) intranasally on the basis of conventional propofol intravenous anesthesia. The anesthetic effect, analgesic effect, serum levels of inflammatory cytokines before and after surgery and adverse drug reactions in the two groups were compared and analyzed. RESULTS: The awakening time, extubation time and retention time in the resuscitation room of the experimental group were shorter than those of the control group, with a statistically significant difference (P<0.05); The VAS pain scores of the experimental group were significantly lower than those of the control group at 15minutes, 12hour and 24hour after awakening, with a statistically significant difference (P<0.05). In addition, the levels of TNF-a, CRP, IL-6 and other inflammatory factors in the control group were significantly higher compared with those in the experimental group 24h after surgery, with a statistical significance (TNF-a, P=0.02; CRP, P=0.00; IL-6, P=0.03); The incidence of adverse drug reactions in the experimental group was 17.5%, while that in the control group was 12.5%, which was not statistically significant (P=0.53). CONCLUSION: Dexmedetomidine combined with intravenous propofol anesthesia may be helpful to shorten the extubation time, the recovery time and the stay time in the anesthesia resuscative room, improve the analgesic effect, and may reduce the inflammatory response and the expression of serum inflammatory cytokines, with no significant increase in side effects.
RESUMEN
OBJECTIVE: To determine the expression levels and clinical significance of serum N-terminal pro-brain natriuretic peptide (NT-proBNP), hydrogen sulfide (H2S) and interleukin-6 (IL-6) in children with Kawasaki disease (KD). STUDY DESIGN: Descriptive comparative study. PLACE AND DURATION OF STUDY: Department of Pediatric Medicine, Baoding Children's Hospital, from July 2017 to July 2018. METHODOLOGY: Ninety-five KD children were chosen as the case group, and were classified into CAL group (23 patients) and NCAL group (72 patients, according to the presence of a coronary artery lesion (CAL). Forty-six non-KD children with an upper respiratory infection in the same time period were chosen as the control group. Electrochemiluminescence method was used to detect serum NT-proBNP levels. The spectrophotometer method was used to test H2S levels, and an enzyme-linked immunosorbent assay was used to test serum IL-6 levels and to analyse the correlation. RESULTS: In the acute phase and recovery phase, serum NT-proBNP and IL-6 levels were higher in the case group than the control group, while H2S levels were lower than those in the control group (p<0.001). In both the acute and recovery phases, serum NT-proBNP and IL-6 levels were higher in the CAL group than in the NCAL group, while H2S levels were lower than those in the NCAL group (p<0.001). CONCLUSION: NT-proBNP and IL-6 levels rise and the H2S level decreases in the blood of KD children, indicating that these indicators may participate in the pathogenesis of KD and that their levels are related to CAL occurrence and the vascular inflammatory response.
