Therapeutic potential of ciclesonide inhalation for COVID-19 pneumonia: Report of three cases

No specific and effective anti-viral treatment has been approved for COVID-19 so far. Systemic corticosteroid has been sometimes administered to severe infectious diseases combined with the specific treatment. However, as lack of the specific anti-SARS-CoV-2 drug, systemic steroid treatment has not been recommended for COVID-19. We report here three cases of the COVID-19 pneumonia successfully treated with ciclesonide inhalation. Rationale of the treatment is to mitigate the local inflammation with inhaled steroid that stays in the lung and to inhibit proliferation of the virus by antiviral activity. Larger and further studies are warranted to confirm the result of these cases.     

无创吸入式麻醉精准肺野照射装置在小鼠肺损伤研究中的应用

目的 探索小鼠放射性肺损伤模型中大批量、快速、低成本实现全肺野精准照射的有效方法,普及这一重要放射生物学模型在多领域的应用。方法 采用8~10周龄C57BL6雌性小鼠,使用micro-CT三维重建图像进行肺部解剖学参数测量并确定放射野范围（n=12）。结合标准化胸腔暴露及固定、无创通气麻醉等手段建立"一体化"麻醉、固定、定位装置,借助常规医用直线加速器完成批量小鼠精准肺野照射。结果 小鼠CT图像三维重建后在冠状位与矢狀位图像上确定肺结构的解剖位置与尺寸平均值。并进一步根据小鼠呼吸频率及幅度确定受呼吸频率影响的肺野上界、中线和下界,并将测量值标记于专门设计的肺野照射装置用来指导实际操作。本装置大致可分为小鼠固定架和麻醉通气系统两部分构成。固定架用以安置每排10只小鼠用弹力栓妥善固定暴露胸腔。照射中通过麻醉面罩全程给予异氟烷混合气体,确保实验过程中小鼠处于深度麻醉以及均匀呼吸动度。结论 本研究设计的集麻醉、固定、定位为一体的"弹匣式"小鼠肺野照射装置,可显著增加胸部放射实验的准确性、简易性、安全性、稳定性和高效性。大幅减低实验成本和对高端辐照设备的依赖,具有一定的实际应用及推广价值。     

Multi-walled carbon nanotube-induced inhalation toxicity: Recognizing nano bis-demethoxy curcumin analog as an ameliorating candidate

Human beings and ecosystems are being possibly exposed to CNTs, as there is a rise in global production rate of carbon nanotubes (CNTs). This may affect the health of humans and increases the environmental risk. We have already reported the pulmonary toxicity due to the inhalation of MWCNTs. We claim that a compound with anti-inflammatory and antioxidant activity may ameliorate the CNT-induced toxic effect. With this view, we have investigated the ameliorative effect of intravenously-administered nano bis-demethoxy curcumin analog (NBDMCA) against MWCNTs-induced inhalation toxicity by examining the lung histopathology for inflammatory cell dynamics, pulmonary remodeling and estimating the inflammatory biomarkers in the broncho-alveolar lavage fluid. We observed that NBDMCA could ameliorate the injury as evidenced by the decline in the levels of markers of inflammation, cell damage, and the histopathological changes induced by MWCNTs. We conclude that NBDMCA may be used to reduce the risk of MWCNTs-induced inhalation toxicity.     

氧化亚氮镇静复合神经阻滞麻醉在小儿埋伏牙拔除术中的应用

目的:观察氧化亚氮(N2O,笑气)镇静复合神经阻滞麻醉用于小儿埋伏牙拔除术的临床效果。方法:对64例应用氧化亚氮镇静复合神经阻滞麻醉拔除埋伏牙的小儿进行临床研究,测定笑气吸入前、后及手术中的心率(HR)、血压(BP)和脉搏血氧饱和度(SpO2),并进行Ramsay镇静评分,采用t检验数据进行统计学处理。结果:64例小儿均顺利完成拔牙术;吸入前、后和手术中心率、舒张压及脉搏氧相比,P>0.05;吸入前收缩压与吸入后收缩压、吸入前收缩压与术中收缩压相比,P<0.01;而吸入后收缩压与术中收缩压相比P>0.05;吸入前、后和手术中的Ramsay镇静评分相比,P>0.05。结论:氧化亚氮镇静复合神经阻滞麻醉具有很好的镇静作用,对于解除需拔除埋伏牙小儿的恐惧心理有良好的效果。     

布地奈德雾化吸入治疗小儿支原体肺炎的疗效及胸部CT表现变化观察

目的探究布地奈德雾化吸入治疗小儿支原体肺炎疗效并观察胸部CT表现变化。方法回顾性分析我院2015年2月至2019年2月收治的300例小儿支原体肺炎临床与影像学资料,依据患儿治疗方式不同将接受阿奇霉素序贯治疗的患儿纳入对照组(n=143),在对照组基础上加用布地奈德雾化吸入纳入观察组(n=157)。比较两组患儿治疗效果,治疗前后免疫功能与肺功能变化以及胸部CT表现。结果观察组患儿治疗总有效率(96.18%)显著高于对照组患儿(87.41%);治疗后两组患儿IgM、IgA较治疗前下降,而IgG水平较治疗前上升,治疗前后两组患儿免疫功能指标比较差异具有统计学意义(P<0.05),治疗后观察组患儿IgM、IgA、IgG水平显著低于对照组(P<0.05);两组患儿治疗后PEF、FVC、FEV1与PEF25等肺功能指标均明显改善,观察组患儿治疗后上述指标均显著高于对照组(P<0.05);治疗前两组患儿各种胸部CT表现差异不显著(χ²=1.69,P>0.05),治疗后观察组2例(1.27%)患儿有大片实变影,1例(0.64%)患儿还存在散在斑点或者片状影,3例(1.91%)患儿磨玻璃影,而对照组存在大片实变影、散在斑点或者片状影、磨玻璃影、斑点或者片状实变影患儿分别5例(3.50%)、3例(7.14%)、6例(14.29%)、4例(9.52%)。结论小儿支原体肺炎使用布地奈德雾化吸入治疗效果较好,胸部CT各种表现可以用于患儿病情诊断与疗效评价。     

普米克令舒雾化吸入治疗小儿急性感染性喉炎的疗效观察

目的探讨普米克令舒雾化吸入治疗小儿急性感染性喉炎的有效方式及临床价值。方法把2011年3月～2012年8月接受住院治疗且满足急性感染性喉炎确诊条件的92例患儿划分为甲乙两个小组,甲组接受常规治疗,乙组采用普米克令舒进行治疗。结果甲组无效13例（28．26％）,有效23例（50．00％）,显效10例（21．73％）,总有效率为71．74％。乙组无效1例（2．17％）,有效12例（26．09％）,显效33例（71．74％）,总有效率97．87％。两组治疗总有效率之间差异显著（P〈0．05）。乙组患儿采用普米克令舒进行治疗,声嘶、发热、吸气性呼吸困难、吸气性喉鸣及犬吠样咳嗽等症状消失时间较甲组有显著的减少（P〈0．05）。结论普米克令舒雾化吸人治疗小儿急性感染喉炎起效快、疗效显著,应值得推广使用。     

Effects of inhalational bronchodilator treatment during noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations

Purpose

To study the effects of withdrawing noninvasive ventilation (NIV) used during acute exacerbation of chronic obstructive pulmonary disease for the delivery of aerosolized medications on physiologic parameters and dyspnea sensation.

Methods

We measured accessory muscle use, dyspnea sensation, heart rate (HR), respiratory rate (RR), blood pressure (BP), and arterial blood gases during NIV, 10 minutes after cessation of NIV (with oxygen), after nebulization with salbutamol (5 mg) and ipratropium (500 μg), and again, on restitution of NIV.

Results

We studied 19 patients (3 women; mean [±SD] age, 72 [± 9] years) with a mean postbronchodilator forced expiratory volume in 1 second 40% (±12) of predicted. Baseline RR (23/min), HR (98/min), BP (121/62 mm Hg), Spo₂ (95%), pH (7.31 [±0.06]), Paco₂ (65 [±12] mm Hg), and Borg score (1.8 [±0.43]) were recorded. There were no significant changes in physiologic parameters and oxygenation between NIV and nebulization periods. The only physiologic changes observed were increase in systolic BP (SBP, P = .012) and HR (P = .003) after nebulization. However, significant decrease in oxygen saturation (P = .009) and increase in SBP (P = nonsignificant) were observed between NIV and oxygenation phases.

Conclusion

Short-term cessation of NIV for nebulization treatment did not result in distress, discomfort, or physiologic instabilities. The only detectable changes were increase in SBP and HR, probably due to the systemic adrenergic effects of salbutamol.     

七氟醚吸入与异丙酚静脉麻醉在小儿疝气手术中的应用效果及对心率和血压水平的影响分析

目的探讨小儿疝气手术中七氟醚吸入与异丙酚静脉麻醉的应用效果及对心率、血压水平的影响。方法选取2019年1月至2021年1月于本院接受疝气手术的90例患儿作为研究对象,按照随机数字表法分为两组,每组45例。对照组应用异丙酚静脉麻醉,观察组应用七氟醚吸入麻醉,比较两组手术前后心率与血压水平、苏醒时间、血氧饱和度及应激反应情况。结果术后,观察组心率与血压水平均低于对照组(P<0.05),观察组去甲肾上腺素、肾素和肾上腺素水平均低于对照组(P<0.05),观察组苏醒时间短于对照组(P<0.05),观察组血氧饱和度高于对照组(P<0.05)。结论七氟醚吸入麻醉在小儿疝气手术中的应用效果优于异丙酚静脉麻醉,可加快苏醒速度,降低患者的心率与血压水平,提高血氧饱和度,且无明显的应激反应,临床应用价值较高。     

异氟醚和七氟醚对肺癌根治术患者血清E-selectin、ICAM-1、MMP-2、MMP-9表达的影响

目的评价异氟醚和七氟醚吸入麻醉对肺癌根治术患者血清E-选择素(E-selectin)、内皮细胞间黏附分子(ICAM)-1、基质金属蛋白酶(MMP)-2、MMP-9浓度变化的影响。方法择期行肺癌根治术患者60例,年龄43~68岁,ASAⅠ或Ⅱ级。采用随机数字表法,将患者随机均分为两组:异氟醚(I组)和七氟醚组(S组)。两组患者气管插管后吸入1.7%~2.3%异氟醚或2.5%~3.4%七氟醚,维持I组异氟醚呼气末浓度为1.5~2.0 MAC、S组七氟醚呼气末浓度维持在1.5~2.0 MAC至术毕。于麻醉诱导前5min(T0)、手术开始后1h(T1)、手术开始后2h(T2)和术后1h(T3)时采集静脉血样,酶联免疫吸附法测定血清E-selectin、ICAM-1、MMP-2、MMP-9表达。结果与T0时比较,T1~T3时I组血清E-selectin、ICAM-1、MMP-2、MMP-9表达明显增加(P0.05),T2、T3时S组血清E-selectin、ICAM-1、MMP-2、MMP-9表达明显降低(P0.05)。T1~T3时S组血清E-selectin、ICAM-1、MMP-2、MMP-9表达明显低于I组(P0.05)。结论七氟醚能抑制肺癌根治术患者血清E-selectin、ICAM-1、MMP-2、MMP-9的表达。