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Severe COVID-19 cases often progress to life-threatening conditions such as acute respiratory distress syndrome (ARDS), sepsis, and multiple organ dysfunction syndrome (MODS). Gelsolin (GSN), an actin-binding protein with anti-inflammatory and immunomodulatory properties, is a promising therapeutic target for severe COVID-19. Plasma GSN levels are significantly decreased in critical illnesses, including COVID-19, correlating with dysregulated immune responses and poor outcomes. GSN supplementation may mitigate acute lung injury, ARDS, and sepsis, which share pathophysiological features with severe COVID-19, by scavenging actin, modulating cytokine production, enhancing macrophage phagocytosis, and stabilizing the alveolar-capillary barrier. Preliminary data indicate that recombinant human plasma GSN improves oxygenation and lung function in severe COVID-19 patients with ARDS. Although further research is needed to optimize GSN therapy, current evidence supports its potential to mitigate severe consequences of COVID-19 and improve patient outcomes. This review provides a comprehensive analysis of the biological characteristics, mechanisms, and therapeutic value of GSN in severe COVID-19.
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BACKGROUND: This multicenter prospective, randomized controlled clinical trial compared the clinical performance of supraglottic airway device (SAD) BlockBusterTM and laryngeal mask airway (LMA) Supreme for airway maintenance in anesthetized, paralyzed adult patients. METHODS: A total of 651 adult patients scheduled for elective surgery in 13 hospitals were randomly allocated into BlockBuster group (n = 351) or Supreme group (n = 300). The primary outcome was oropharyngeal leak pressure (OLP). Duration and ease of insertion, fiberscopic view of positioning, airway manipulations, and complications were also assessed. RESULTS: The OLP was significantly higher in BlockBuster group compared with Supreme group (29.9 ± 4.2 cmH2O vs 27.4 ± 4.3 cmH2O, p < 0.001). Success rate of insertion at the first attempt (90.2% vs 85.1%, p = 0.027), rate of optimal fiberscopic view (p = 0.002) and satisfactory positioning of SAD (p < 0.001) were significantly increased in BlockBuster group. CONCLUSIONS: Both SAD BlockBusterTM and LMA Supreme are safe, effective, and easy-to-use devices for airway maintenance in anesthetized, paralyzed adult patients, but the SAD BlockBusterTM is superior to LMA Supreme in terms of OLP, success rate at the first attempt, and fiber-optic view of positioning. TRIAL REGISTRATION: The trial is registered at www.chictr.org.cn (ChiCTR-ONC-16009105).
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Máscaras Laríngeas , Adulto , Humanos , Estudos Prospectivos , Tecnologia de Fibra Óptica , OrofaringeRESUMO
DNA-RNA hybrid (DRH) duplexes play essential roles during the replication of DNA and the reverse transcription of RNA viruses, and their flexibility is important for their biological functions. Recent experiments indicated that A-form RNA and B-form DNA have a strikingly different flexibility in stretching and twist-stretch coupling, and the structural flexibility of DRH duplex is of great interest, especially in stretching and twist-stretch coupling. In this work, we performed microsecond all-atom molecular dynamics simulations with new AMBER force fields to characterize the structural flexibility of DRH duplex in stretching and twist-stretch coupling. We have calculated all the helical parameters, stretch modulus, and twist-stretch coupling parameters for the DRH duplex. First, our analyses on structure suggest that the DRH duplex exhibits an intermediate conformation between A- and B-forms and closer to A-form, which can be attributed to the stronger rigidity of the RNA strand than the DNA strand. Second, our calculations show that the DRH duplex has the stretch modulus of 834 ± 34 pN and a very weak twist-stretch coupling. Our quantitative analyses indicate that, compared with DNA and RNA duplexes, the different flexibility of the DRH duplex in stretching and twist-stretch coupling is mainly attributed to its apparently different basepair inclination in the helical structure.
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Pareamento de Bases , DNA de Forma B/química , Simulação de Dinâmica Molecular , RNA/química , Conformação de Ácido NucleicoRESUMO
Objective To investigate the effect of intravenous dexmedetomidine injection(1 µg/kg)on the intubating conditions after inhalation induction with sevoflurane 8% and nitrous oxide(N2O)50% in children. Methods Totally 122 patients aged 4-10 years with an American Society of Anesthesiologists physical statusâ undergoing elective plastic surgery under general anesthesia were randomly divided to dexmedetomidine group(intraveneously injected with dexmedetomidine 1µg/kg)and control group(injected with normal saline)by using the random sampling table.On arrival of the operating room,anesthesia was induced with sevoflurane 8% and N2O 50% in oxygen 50%.When the patient became unconscious,the intravenous cannula 24# was inserted on the dorsum of hand.One minute later,laryngoscopy and tracheal intubation were performed.The intubating conditions were assessed by the scoring system in the previous study. Results The rates of acceptable conditions were 97% and 90% in dexmedetomidine group and in control group(P=0.143),and the rates of excellent conditions were 82% and 67%(P=0.04),respectively.In dexmedetomidine group,there were no signifi-cant differences of mean arterial presser and heart rate between the time-point of before intubation and the time-point of immediately after intubation.Conclusion Intravenous bolus of dexmedetomidine(1 µg/kg)can effectively improve the intubating conditions after inhalation induction of sevoflurane 8% and N2O 50% in children and make the hemodynamics more stable during tracheal intubation.
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Anestésicos Inalatórios/uso terapêutico , Dexmedetomidina/uso terapêutico , Intubação Intratraqueal , Sevoflurano/uso terapêutico , Anestésicos Inalatórios/administração & dosagem , Criança , Pré-Escolar , Dexmedetomidina/administração & dosagem , Procedimentos Cirúrgicos Eletivos , Hemodinâmica , Humanos , Sevoflurano/administração & dosagemRESUMO
Objective To compare two spray administration of intranasal dexmedetomidine (DEX) doses for premedication in children. Methods In this prospective,randomized,double-blind study,41 children aged 3-6 years were enrolled. Children were assigned to receive either spray administration of intranasal DEX 1 µg/kg (Group D1) or 2 µg/kg (Group D2). The Ramsay Sedation Scale scores were evaluated at 5 min intervals. Sedation status at separation from patient was also evaluated. Heart rate (HR) and saturation of peripheral oxygen (SpO2) were recorded before and every 15 min after drug administration. Results The median sedation onset time was 30 min and 20 min in group D1 and group D2,respectively. Compared with the children in group D1,those in group D2 were significantly more sedated when they were separated from their parents (61.9% vs. 95.0%,respectively)(χ2=5.549,P=0.010). In Group D2,the HR decreased by 15.8% (t=2.415,P=0.021) 30 min after the spray administration of intranasal DEX. Compared with the baseline values,there was no significant difference in both groups in terms of SpO2(t=-1.426,P=0.162;t=-1.096,P=0.280)and HR in group D1 (t=-0.299,P=0.767) 30 min after the spray administration of intranasal DEX. Conclusion Spray administration of intranasal DEX 2 µg/kg provides superior sedation in children.
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Administração Intranasal , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Anestesia/métodos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Oxigênio/análise , Estudos ProspectivosRESUMO
Objective To observe the effects of two different intranasal dexmedetomidine doses as premedication on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. Methods Children aged 3-6 years, of American Society of Anesthesiologists physical status 1, and scheduled for plastic surgery were enrolled in this study. Children were assigned to receive either spray administration of intranasal dexmedetomidine 1 µg/kg (group D1, n=21) or 2 µg/kg (group D2, n=20) approximately 30 minutes before anesthesia. Anesthesia was induced with sevoflurane up to 8% in 100% O2, with fresh gas flow set to 6 L/min. After the pupil fixed to the middle position, sevoflurane dial setting was reduced to 5% and fresh gas flow reduced to 3 L/min. The endtidal sevofluran (ETsevo) concentration for laryngeal mask airway insertion sustained for 10 minutes after vein intubation, which was determined according to the Dixon's up and down method. The initial endtidal sevoflurane concentration in each group was set at 2%. ETsevo was increased/decreased (1:1.2) in the next patient according to the response to laryngeal mask airway insertion. Bispectral index, mask acceptance, all response to laryngeal mask airway insertion, and ETsevo of laryngeal mask airway insertion of children were recorded. Results The bispectral index value was 77.4±3.6 in group D2, which was significantly lower than that (87.4±1.9) in group D1 when children entered operation room (P<0.05). Mask acceptance was 76.2% in group D1 and 90.0% in group D2. The EC50 of sevoflurane for laryngeal mask airway insertion was 1.09% (95% CI=0.89%-1.28%) in group D2, which was lower than 1.59% (95% CI=1.41%-1.78%) in group D1 (P<0.05). Conclusion Compared with the dose of 1 µg/kg, spray administration of intranasal dexmedetomidine 2 µg/kg as premedication can reduce the sevoflurane EC50 for successful laryngeal mask airway placement in children.
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Anestésicos Inalatórios/administração & dosagem , Dexmedetomidina/administração & dosagem , Máscaras Laríngeas , Éteres Metílicos/administração & dosagem , Administração Intranasal , Anestesia , Criança , Pré-Escolar , Humanos , SevofluranoRESUMO
OBJECTIVE: To compare the clinical effectiveness of fiberoptic bronchoscope (FOB)-guided intubation through the Cookgas intubating laryngeal airway(CILA)and the Fastrach intubating laryngeal mask airway (FT-LMA) in the management of anticipated difficult airways. METHODS: Sixty patients with all three difficult intubation criterion (thyromental distance<60 mm, interincisor distance<35 mm, and Mallampati class 3 or 4) undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group (n=30) and FT-LMA group (n=30). After anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with FOB-guided intubation through CILA or FT-LMA. The success of the intubating laryngeal airway(ILA)insertion and FOB-guided intubation, the number of attempts, and the duration of the successful attempt were recorded. RESULTS: The ILA was inserted successfully in 30 patients from CILA group and 27 patients from FT-LMA group. Three failed cases in FT-LMA group were inserted successfully with CILA. In CILA group, the first FOB-guided intubation attempt succeeded in 26 patients, and 4 cases were intubated at the second attempt. In 27 patients of FT-LMA group, 20 cases were intubated successfully at the first attempt, 4 cases at the second attempt, and 3 cases failed; of these three failed patients, two patients were intubated smoothly with FOB through CILA at the first attempt, one was intubated by FOB via CILA at the second attempt. The duration of FT-LMA insertion [(35.3±12.8)s] was significantly longer when compared with CILA [(23.9±17.5)s] (P<0.05). However, the duration of FOB-guided intubation through CILA and FT-LMA [(48.6±13.5)s vs.(53.2±14.2)s] and the time of ILA removal [(40.4±10.2)s vs. (38.5±11.3)s] were not significantly different between these two groups (P>0.05). The adverse events during and after intubtion were not significantly different between these two groups. CONCLUSIONS: FOB-guided intubation through CILA and FT-LMA is safe and feasible for the management of anticipated difficult airways. However, in patients with severe scar contracture of face and neck and those with huge expander in neck, the CILA insertion and FOB-guided intubation via CILA is superior to FT-LMA.
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Manuseio das Vias Aéreas/métodos , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Adolescente , Adulto , Anestesia Geral , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To observe the effectiveness of conscious sedation with midazolam, propofol and sufentanil for patients in plastic surgery. METHODS: 81 patients, scheduled for plastic surgery, were randomly selected to receive conscious sedation with midazolam 0.05 mg x kg(-1) and sufentanil 0.1 microg x kg(-1) intravenously, following by a continuous infusion of midazolam-propofol-sufentanil combination (midazolam 5 mg + propofol 200 mg + sufentanil 10 microg, a total of 23 ml). The initial infusion rate was 0.2 ml x kg(-1) x h(-1), and was adjusted (in 20% of initial infusion rate increment) to maintain OAA/S score as 11 during the operation. The patients' vital signs, discomfort and level of sedation were evaluated at 5 to 10 min intervals until the end of the surgery. The complications (i. e. anoxemia, apnea, restlessness, nausea and vomiting), anesthesia duration and drug consumption were recorded. The drug infusion was discontinued at 5 - 10 min before the end of the surgical procedure. On the first postoperative day, patients were asked to rate their satisfaction with the anesthetic management and whether they would choose to receive the same anesthetic technique if necessary in the future. RESULTS: The OAA/S score decreased from 20.0 +/- 0 to 11.9 +/- 2.6 after midazolam and sufentanil IV (P < 0.05), and was maintained as 10.5-11.1 during the procedure. At the end of the procedure, the OAA/S score returned to 16.0 +/- 2.2, which was also lower significantly compared with baseline value (P < 0.05). The induction of sedation produced a significant decrease in SBP and DBP (P < 0.05) and no significant changes in heart rate (P > 0.05). At the end of the procedure, SBP, DBP and HR returned to the baseline value. The anoxemia happened in 11 cases, apnea in 5 cases and restlessness in 2. No nausea and vomiting occurred. The anesthesia duration and consumption of midazolam, propofol and sufentanil were (101.1 +/- 42.5) min, (8.4 +/- 3.7) mg, (189.1 +/- 88.7) mg and (18.2 +/- 5.6) microg respectively. In an interview on the first postoperative day, 96% (78/ 81) of the patients were satisfied with their anesthesia and were willing to receive the same anesthetic technique if necessary in the future. CONCLUSION: Conscious sedation with midazolam, propofol and sufentanil is an effective anesthetic technique for patients in plastic surgery.
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Sedação Consciente/métodos , Cirurgia Plástica , Adolescente , Adulto , Feminino , Humanos , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Propofol/administração & dosagem , Sufentanil/administração & dosagem , Adulto JovemRESUMO
OBJECTIVE: To evaluate the feasibility of the fibreoptic intubating laryngeal mask airway (LMA) CTrach (CTrach) in anticipated difficult airway caused by face and neck scar contracture. METHODS: Totally 33 patients undergoing selective face and neck scar plastic surgery and requiring general anesthesia were enrolled in our study. After anesthesia induction, the CTrach was inserted and the viewer was attached, which allowed fibreoptic visualization of the larynx before and during passage of the tracheal tube through the vocal cords. The duration and the success rates of CTrach insertion, tracheal intubation, and CTrach removal were recorded. The view of glottis on viewer and the adjusting maneuvers for improving the laryngeal view were recorded. Noninvasive blood pressures and heart rates were recorded before and after anesthesia induction and at CTrach insertion, tracheal intubation, and CTrach removal. RESULTS: The CTrach was successfully inserted in all patients, among whom 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, while partial view and no view of glottis were shown in 8 and 15 patients, respectively. The good view of glottis was achieved by adjusting manoeuvres. Tracheal intubation via the CTrach was successful in 27 patients at the first attempt and in 6 patients at the second attempt. Hemodynamic changes during the performance with the CTrach were minimal. CONCLUSIONS: The CTrach can be easily inserted, with clear view and high success rate of tracheal intubation. Therefore, it is an effective way to resolve difficulty intubation caused by face and neck scar contracture.
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Cicatriz/cirurgia , Tecnologia de Fibra Óptica/métodos , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Pescoço , Adolescente , Adulto , Cicatriz/complicações , Contratura/etiologia , Contratura/cirurgia , Face , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To observe the clinical effectiveness of inductions and tracheal intubating conditions with 3% sevoflurane and different doses of remifentanil without muscle relaxant in children. METHODS: Totally 120 peadiatric patients (aged 4-10 years, American Society of Anesthesiologists grade I for inhalational induction) were randomly allocated into group I (remifentanil 1 microg/kg), group II (remifentanil 2 microg/kg), group III (remifentanil 3 microg/kg), and control group (vecuronium bromide 0.1 mg/kg). After inhalational induction with 3% sevoflurane and 60% nitrous oxide in 40% oxygen for 2 minutes, remifentanil 1 microg/kg, 2 microg/ kg, and 3 microg/kg were intravenously injected over 1 minute into patients in group I , group II, and group III, respectively. After remifentanil administration and manual ventilation for 1 minute, the trachea was intubated. In the control group, 2 minutes after intravenous administration of vecuronium bromide 0.1 mg/kg, tracheal intubation was attempted. Agitation, intubating satisfactoriness, and the circulation changes after tracheal intubation and anesthesia induction were observed. RESULTS: In these four groups, agitation occurred in 37.5% of patients during sevoflurane induction. Satisfactory intubation rate was 70.0% in group I, 86.7% in group II, 90.0% in group III, and 93.3% in the control group. Compared with the control group, the impact of tracheal intubation on the circulatory system was smaller in group I , II , and III. CONCLUSIONS: Induction with 3% sevoflurane combined with remifentanil can be smoothly performed, followed by the successful tracheal intubation. The intubating conditions are more satisfactory with 3% sevoflurane combined with remifentanil 2 microg/kg or 3 microg/kg.