姜黄素对哮喘大鼠肺内胶原沉积、结缔组织生长因子表达及气道重构的影响

目的:通过观察姜黄素对哮喘大鼠肺内胶原沉积、结缔组织生长因子(connective tissue growth factor,CTGF)表达的影响,探讨姜黄素对哮喘气道重构的治疗作用。方法:36只雄性SD大鼠随机分为正常对照组(A组)、哮喘模型组(B组)、姜黄素治疗组(C组)各12只,采用卵蛋白致敏大鼠哮喘模型,观察3组动物哮喘发作症状、胶原沉积情况及SABC免疫组化法检测CTGF在肺组织的表达变化。结果:B组大鼠哮喘发作症状明显重于C组,A组无症状。B组支气管黏膜下、血管壁及周围、肺泡壁、肺间质均有胶原大量沉积,C组胶原沉积程度明显轻于B组。A组胶原沉积不明显。免疫组化发现B组CTGF表达最强,C组较弱,A组微弱表达。结论:姜黄素可抑制哮喘大鼠肺组织的胶原沉积,在延缓气道重建中起重要作用,其作用机制可能是通过抑制CTGF的表达来实现。     

Attention‐network specific alterations of structural connectivity in the undamaged white matter in acute neglect

Visual neglect results from dysfunction within the spatial attention network. The structural connectivity in undamaged brain tissue in neglect has barely been investigated until now. In the present study, we explored the microstructural white matter characteristics of the contralesional hemisphere in relation to neglect severity and recovery in acute stroke patients. We compared age‐matched healthy subjects and three groups of acute stroke patients (9 ± 0.5 days after stroke): (i) patients with nonrecovered neglect (n = 12); (ii) patients with rapid recovery from initial neglect (within the first week post‐stroke, n = 7), (iii) stroke patients without neglect (n = 17). We analyzed the differences between groups in grey and white matter density and fractional anisotropy (FA) and used fiber tracking to identify the affected fibers. Patients with nonrecovered neglect differed from those with rapid recovery by FA‐reduction in the left inferior parietal lobe. Fibers passing through this region connect the left‐hemispheric analogues of the ventral attention system. Compared with healthy subjects, neglect patients with persisting neglect had FA‐reduction in the left superior parietal lobe, optic radiation, and left corpus callosum/cingulum. Fibers passing through these regions connect centers of the left dorsal attention system. FA‐reduction in the identified regions correlated with neglect severity. The study shows for the first time white matter changes within the spatial attention system remote from the lesion and correlating with the extent and persistence of neglect. The data support the concept of neglect as disintegration within the whole attention system and illustrate the dynamics of structural‐functional correlates in acute stroke. Hum Brain Mapp 35:4678–4692, 2014. © 2014 Wiley Periodicals, Inc .     

小儿呼吸道异物影像表现的探讨

目的评价各种影像检查在小儿呼吸道异物中的价值,提高小儿呼吸道异物的诊断水平。方法本院近5年收治小儿呼吸道异物56例。回顾性评价影像检查方法,分析不同类型不同部分的影像表现。结果声门附近异物7例,5例可见异物的直接征象。气管异物14例,均可见两肺不同程度的肺气肿,透视下11例可见心脏反常大小,5例可见异物在气管内的上下移动。右支气管异物22例,左支气管异物13例。30例患者可见明确的肺气肿伴纵隔摆动。全部病例最后作了喉镜或支气管镜检查。取出不同种类的异物包括金属类2例,动物骨骼6例,花生23例,各种瓜子17例,水果、蔬菜5例,其他3例。影像诊断正确51例(91.1%),误漏诊5例(8.9%)。结论照片加透视检查,必要时辅以CT冠状位扫描,全面认识不透X线异物的各种间接征象,可以显著提高诊断符合率。     

Traumatic brain injury: initial resuscitation and transfer

Traumatic brain injury (TBI) is common and carries a high morbidity and mortality. Initial management of the traumatic brain injury patient is directed toward preventing and limiting secondary brain injury while facilitating rapid transport to an appropriate facility capable of providing definitive neurocritical care. During resuscitation of the TBI patient, management is directed at correcting and maintaining mean arterial pressure (MAP), blood glucose, PaO₂ and PaCO₂ within their normal ranges. After the initial resuscitation, management is directed at limiting secondary damage to the brain that occurs in response to inflammatory changes, expanding haematomas, cellular swelling, seizures, and systemic complications such as haemodynamic or pulmonary changes, fever and pain. The transport of critically ill brain injured patients carries inherent risks. Although both intrahospital and interhospital transport must comply with regulations, patient safety is enhanced during transport by establishing an organised, efficient process supported by appropriate equipment and personnel. This review examines the evidence base for the initial resuscitation and transfer of head-injured patients.     

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

Background: Vascular calcification significantly increases the rates of cardiovascular mortality in hemodialysis (HD) patients. Abnormalities in mineral metabolism may play a role in the pathogenesis of arterial calcification. Whether patients treated with non-calcium-based phosphate binders had reduced aortic vascular calcification compared to those treated with calcium-based phosphate binders is still unclear. Methods: We searched multiple databases for studies published through August 2013 that evaluated the effects of non-calcium-based phosphate binders (NCBP) versus calcium-based phosphate binders (CBP) on cardiovascular calcification and bone remodeling among dialysis patients. We summarized test performance characteristics with the use of forest plots, fixed and random effects models, and Egger regression test. Results: Eighteen eligible randomized controlled trials totaling 3676 patients were included. Meta-analysis results showed NCBP could significantly attenuate the progression of coronary artery calcification than CBP (WMD: ?144.62, 95% CI: ?285.62 to ?3.63). The serum calcium levels significant lower in NCPB group than in CPB groups (WMD: ?0.26, 95% CI: ?0.37 to ?0.14), but the serum iPTH levels were significantly higher in NCPB groups (WMD: 57.1, 95% CI: 13.42 to 100.78). The osteoid volume and osteoblast numbers were significant higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers). The Egger regression test also showed no potential publication bias (p?=?0.725). Conclusions: Based on available data, NCBPs have equally effective with CBPs for serum phosphate control. But there was significantly lower incidence of coronary artery calcification and a significant higher bone formatting rate in NCBP groups than in CBP groups. So we recommend NCBPs as phosphate binders for HD patients.     

Topical interleukin-8 antibody attracts leukocytes in a piglet lavage model

Objective Acute respiratory distress syndrome (ARDS) in young infants is linked with a pulmonary inflammatory response part of which are increased interleukin-8 (IL-8) levels and migration of polymorphonuclear leukocytes (PMNL) into lung tissue. A topical application of an antibody against IL-8 might therefore decrease PMNL migration and improve lung function.Design Randomized, controlled, prospective animal study.Setting Research laboratory of a university childrens hospital.Subjects and interventions Anesthetized, mechanically ventilated newborn piglets (n=22) underwent repeated airway lavage to remove surfactant and to induce lung inflammation. Piglets then received either surfactant alone (S, n=8), or a topical antibody against IL-8 admixed to surfactant (S+IL-8, n=8), or an air bolus injection (control, n=6).Measurements and results After 6 h of mechanical ventilation following intervention, oxygenation [S 169±51 (SD) vs S+IL-8 139±61 mmHg] and lung function (compliance: S 1.3±0.4 vs S+IL-8 0.9±0.4 ml/cmH₂O/kg; extra-vascular lung-water: S 27±9 vs S+IL-8 52±28 ml/kg) were worse in the S+IL-8 group because reactive IL-8 production [S 810 (median, range 447–2323] vs S+IL-8 3485 (628–16180) pg/ml; P<0.05) with facilitated migration of PMNL into lung tissue occurred. Moreover, antibody application caused augmented chemotactic potency of IL-8 [linear regression of migrated PMNL and IL-8 levels: S r²=0.30 (P=ns) vs S+IL-8 r²=0.89 (P=0.0002)].Conclusion Topical anti-IL-8 treatment after lung injury increases IL-8 production, PMNL migration, and worsens lung function in our piglet lavage model. This effect is in contrast to current literature using pre-lung injury treatment protocols. Our data do not support anti-IL-8 treatment in young infants with ARDS.Financial support: supported by Hübner-Stiftung im Stifterverband, Essen; and Deutsche Forschungsgemeinschaft, Bonn, grant KR 1863/1-1     

Airway management in pediatric patients at referring hospitals compared to a receiving tertiary pediatric ICU

Objective

To describe the current practice of pediatric airway management at referring hospitals and the associated adverse events compared to a receiving tertiary pediatric ICU.

Method

Retrospective chart and transport record review of all emergency critical care transports to our Pediatric ICU over 3 years. Data regarding tracheal intubation procedure, pre-defined adverse Tracheal Intubation Associated Events (TIAEs), and airway events before, during, and after the inter-hospital transport were collected using a standard National Emergency Airway Registry for children (NEAR4KIDS) definition. Tracheal intubation outcomes were compared to in-hospital P ICU intubations.

Results

253/1489 (17%) of critical care transports had airway management, all by tracheal intubation. The most common condition was seizure (34%), followed by pulmonary/lower airway disease (16%). 49 (19%) had TIAEs; the most common event was mainstem bronchial intubation (13%). Incidence of TIAEs was similar to PICU (p = 0.69). Thirteen had an inappropriate tracheal tube position upon PICU arrival, but none experienced accidental extubation during transport. An uncuffed tracheal tube was used in 108/172 (63%) of patients < 8 years, significantly higher than PICU (20%, p < 0.0001). 124 (49%) were extubated within 24 h, 153 (60%) within 48 h. Two patients had the tracheal tube changed to cuffed from uncuffed due to air leak.

Conclusion

Provider reported adverse TIAEs are common during airway management in children requiring critical care transport, but not higher compared to PICU intubations. Most inter-hospital transport patients are intubated with an uncuffed tracheal tube. Subsequent tracheal tube change from uncuffed to cuffed tube is rarely required.     

非确定性人工气道湿化法降低脑卒中舌后坠患者肺部感染的效果研究

目的探讨脑卒中舌后坠患者非确定性人工气道(口咽通气道下)湿化的方法及临床应用效果。方法选择应用口咽通气道的脑卒中舌后坠呼吸困难患者60例,随机分为观察组和对照组各30例,观察组采取经口咽通气道内径孔道持续湿化法;对照组应用五官科喉头喷雾器间歇湿化法。观察两组患者痰液湿化效果、吸痰次数、痰痂的形成、气道黏膜损伤以及肺部感染情况。结果湿化第3、7天观察组痰液湿化效果满意率优于对照组、肺部感染率低于对照组,差异有统计学意义(P0.05);湿化第7天观察组痰痂的形成、气道黏膜的损伤低于对照组,差异有统计学意义(P0.05);湿化第3、7天观察组吸痰次数明显低于对照组,差异有明显统计学意义(P0.01)。结论脑卒中舌后坠患者采用非确定性人工气道持续湿化法,湿化效果满意,可减少吸痰次数、痰痂的形成以及气道黏膜的损伤,有效降低患者肺部感染的发生率。     

特殊类型呼吸道异物取出术的围手术期护理

目的探讨特殊类型呼吸道异物取出术的围手术期护理特点。方法分析69例特殊类型呼吸道异物患者的临床资料,总结特殊类型呼吸道异物围手术期的病情观察与护理要点。结果45例在全麻下经支气管镜通过声门取出异物,24例经气管切开取出异物。经支气管镜取出异物的45例患者中43例治愈,另有2例在通过声门时异物滑脱,发生异物变位,因呼吸衰竭死亡。经气管切开取出异物的24例患者经治疗和护理后全部治愈。总治愈率为97.1%。结论做好心理护理,严密观察病情动态变化,完善术前准备,保持气道通畅,注意并发症的发生,是特殊类型呼吸道异物治疗成功的重要保证。     

不同剂量卡维地洛对急性心肌梗死大鼠左室重构及血流动力学的影响

目的比较不同剂量卡维地洛对大鼠急性心肌梗死(AMI)后左室重构及血流动力学的影响。方法选取AMI术后存活的SD大鼠随机分为AMI组、卡维地洛大剂量组[30mg/(kg.d)]、卡维地洛小剂量组[2mg/(kg.d)]。给药6周后用导管法行血流动力学测定和心脏组织病理分析。另设正常对照组及假手术组。结果与假手术组比,AMI组左室舒张末压(LVEDP)、各心室重量均显著增加,左室内压最大收缩和舒张速率(±dp/dtmax)显著降低。与AMI组比,大、小剂量卡维地洛组的LVEDP、心室重量均显著降低,±dp/dtmax显著升高。与卡维地洛大剂量组比,小剂量组LVEDP及左心室重量下降更明显。结论卡维地洛疗能有效抑制大鼠AMI左室重构并改善血流动力学,且小剂量卡维地洛组疗效优于大剂量组。