ObjectiveTo discuss the values of fiber bronchoscopy with three-way laryngeal mask airway continuous ventilation in 1-6 month old infants with oxygen-dependent respiratory diseases.MethodsFrom January 2010 to May 2011, 29 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent conventional ifber bronchoscope and 148 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent ifber bronchoscopy with three-way laryngeal mask airway continuous ventilation were enrolled in control and treatment groups respectively. The success rate of ifber bronchoscope and the incidence rate of complications were compared between two groups.ResultsIn the treatment group, the success rate of ifber bronchoscope was 89.2% which was signiifcantly higher than 58.6% in the control group and the rate of laryngeal edema was 9.1% which was signiifcantly lower than 35.3% in the control group. The rates of endotracheal intu-bation ventilation and postoperative hemorrhage were lower than those in the control group, but the difference was not statistical ly signiifcant.ConclusionFiber bronchoscopy with three-way laryngeal mask airway continuous ventilation is superior to the traditional ifber bronchoscope in 1-6 month old infants with oxygen dependent respiratory system diseases.

Objective To explore the application value of pulse indicator continuous cardiac output (PiCCO) monitoring in the fluid management of children with acute respiratory distress syndrome (ARDS).Methods Thirty-two children with ARDS admitted to Pediatric Intensive Care Unit(PICU) of Zhengzhou Children's Hospital,from April 2013 to April 2016,were divided into intervention group (15 cases) and control group (17 cases) by adopting random number table method.Fluid management of intervention group by PiCCO,control group by central venous pressure,the 2 groups' oxygenation index (OI),acute lung injury score,mechanical ventilation time and 28 days mortality were statistically compared.The categorical data were analyzed by using SPSS 11.0 software,and the t test was used for the measurement data.The categorical data and mortality comparison were analyzed by adopting x2 test.The difference was statistically significant at P ＜ 0.05.Results After 3 days of mechanical ventilation,the changes of OI in the intervention group were significantly higher than those in the control group [(175.0 ±-43.7) mmHg vs.(143.0 ± 42.8) mmHg (1 mmHg =0.133 kPa),t =2.090 0,P ＜ 0.05].The intervention group was significantly shorter than the control group [(10.45 ± 3.12) d vs.(12.63 ± 2.87) d,t =2.058 7,P ＜ 0.05].There was no significant difference between 2 groups in acute lung injury score,PICU length of stay and 28 days mortality (all P ＞ 0.05).Conclusions PiCCO monitoring and guidance in the fluid management of pediatric ARDS can improve oxygenation after 3 days,reduce mechanical ventilation time,but can not significantly reduce the 28-day mortality.

Objective To investigate the effect of dexmedetomidine on 5- HT- induced constrictions of isolated human intrapulmonary arteries and explore the mechanisms. Methods Lung tissue was obtained from patients undergoing surgery for lung carcinoma. Intrapulmonary arteries were dissected and cut into rings, which were mounted in a Multi Myograph system to determine the effect of dexmedetomidine (0.3-3 nmol/L) on 5-HT-induced vasoconstractions. The influences of the endothelium removal and various drugs including L-NAME, yohimbine and indomethacin were tested on the effects of dexmedetomidine. Results Dexmedetomidine (0.1-100 nmol/L) did not obviously affect the resting tension of endothelium-intact human intrapulmonary arteries. 5- HT induced concentration- dependent contraction in endothelium- intact intrapulmonary arteries[pD2:6.11 ± 0.05, Emax:(102.10 ± 1.96)%]. In the rings with intact endothelium, dexmedetomidine (0.3-3 nmol/L) significantly attenuated the Emax and pD2 of 5-HT-induced vasoconstriction[pD2:5.94±0.03, Emax:(79.96±1.31)%]. 5-HT also induced concentration-dependent contraction in endothelium-denuded intrapulmonary arteries [pD2: 6.10 ± 0.07, Emax:(107.40 ± 3.20)%]. Dexmedetomidine produced no significant effects on the rings with denuded endothelium. The effects of dexmedetomidine on 5-HT-induced vasoconstriction was suppressed by L-NAME and yohimbine, but not by indomethacin. Conclusion Dexmedetomidine can inhibit 5-HT-induced vasoconstriction of isolated human intrapulmonary arteries probably throughα2-adrenergic acceptor and NO released from the endothelium.

Objective To investigate the effect of dexmedetomidine on 5- HT- induced constrictions of isolated human intrapulmonary arteries and explore the mechanisms. Methods Lung tissue was obtained from patients undergoing surgery for lung carcinoma. Intrapulmonary arteries were dissected and cut into rings, which were mounted in a Multi Myograph system to determine the effect of dexmedetomidine (0.3-3 nmol/L) on 5-HT-induced vasoconstractions. The influences of the endothelium removal and various drugs including L-NAME, yohimbine and indomethacin were tested on the effects of dexmedetomidine. Results Dexmedetomidine (0.1-100 nmol/L) did not obviously affect the resting tension of endothelium-intact human intrapulmonary arteries. 5- HT induced concentration- dependent contraction in endothelium- intact intrapulmonary arteries[pD2:6.11 ± 0.05, Emax:(102.10 ± 1.96)%]. In the rings with intact endothelium, dexmedetomidine (0.3-3 nmol/L) significantly attenuated the Emax and pD2 of 5-HT-induced vasoconstriction[pD2:5.94±0.03, Emax:(79.96±1.31)%]. 5-HT also induced concentration-dependent contraction in endothelium-denuded intrapulmonary arteries [pD2: 6.10 ± 0.07, Emax:(107.40 ± 3.20)%]. Dexmedetomidine produced no significant effects on the rings with denuded endothelium. The effects of dexmedetomidine on 5-HT-induced vasoconstriction was suppressed by L-NAME and yohimbine, but not by indomethacin. Conclusion Dexmedetomidine can inhibit 5-HT-induced vasoconstriction of isolated human intrapulmonary arteries probably throughα2-adrenergic acceptor and NO released from the endothelium.

Objective To explore the effect of thrombelastography in sepsis and septic shock with disseminated intravascular coagulation (DIC) condition in children.Methods Ninety-one cases of children admitted to the Pediatric Intensive Care Unit,Zhengzhou Children's Hospital between January 2013 and December 2016 were enrolled in this study.Fifty-eight cases of sepsis,17 cases of severe sepsis and 16 cases of septic shock (including 7 cases DIC and 9 cases non-DIC) were included in 91 cases of children.After admission,they were given conventional treatment according to their condition of illness,such as expansion of rehydration,applying vascular active drags,anti-infection,mechanical ventilation,maintaining internal environment,nutrition support,etc.Thrombelastography of all the patients were detected for 6 hours after admission.The test indexes included blood coagulation reaction time (R),blood clot formation time (K) and blood clot formation rate (alpha),maximum width (MA),coagulation index (CI),etc.And pediatric critical illness scores(PCIS) were also evaluated for 6 hours after admission.Results With the progression of sepsis severity,R value,K value increased dramatically (F =3.629,4.237,all P ＜ 0.05),alpha angle,MA value,CI value decreased (F =32.631,19.938,10.849,all P ＜ 0.05);R value,K value and PCIS scores showed a significant positive correlation (r =0.591,0.827,all P ＜ 0.05),alpha angle,MA value,CI and PCIS scores showed a significant negative correlation (r =-0.793,-0.827,-0.839,all P ＜ 0.05).R and K values in DIC group were significantly greater than the values of non-DIC group (t =4.381,2.613,all P ＜ 0.05),alpha angle was less than that of DIC group obviously (t =5.627,P ＜ 0.05).In DIC group MA and CI levels were significantly less than those of non-DIC group (t =5.416,2.951,all P ＜ 0.05).R value,K value,alpha Angle,MA,CI levels between the dead and surviving patients in the septic shock group had no significant difference (all P ＞ 0.05).Conclusions TEG has a great significance in evaluating severity of children with sepsis.It can also guide clinical assessment in children with septic shock DIC so as to give accurate effective intervention and improve the rescue success rate and the prognosis.

Objective To determine the effect of resveratrol on constrictions of isolated human intrapulmonary arteries and its mechanisms. Methods Intrapulmonary arteries (1-1.5 mm in diameter) were dissected and cut into rings (1.8-2.0 mm in length) under microscope, and were then mounted in a Multi Myograph system. The rings were stimulated with 100 nmol/L U46619, 30 nmol/L endothelin-1, or 60 mmol/L KCl to produce sustained contraction of the intrapulmonary arteries, after which resveratrol was applied cumulatively. Endothelium denudation, L-NAME and indomethecin were used to investigate the effect of resveratrol on constrictions of the isolated arteries, suing DMSO as the control. Results Resveratrol induced concentration-dependent relaxations in endothelium-intact rings that contracted in response to stimulations with U46619, ET-1 and KCl, with pD2 of 3.82 ± 0.20, 3.84 ± 0.57, and 3.68 ± 0.27, Emax of (99.58 ± 0.83)%, 100%, and (99.65 ± 0.98)%, respectively. Treatment of the arterial rings with the eNOS inhibitor L-NAME, but not with indomethecin or endothelium denudation, obviously affected the relaxant effects of resveratrol. Conclusion Resveratrol can concentration-dependently produce relaxant effect on human intrapulmonary arteries independent of the endothelium possibly by promoting synthesis and release of NO.

Objective To determine the effect of resveratrol on constrictions of isolated human intrapulmonary arteries and its mechanisms. Methods Intrapulmonary arteries (1-1.5 mm in diameter) were dissected and cut into rings (1.8-2.0 mm in length) under microscope, and were then mounted in a Multi Myograph system. The rings were stimulated with 100 nmol/L U46619, 30 nmol/L endothelin-1, or 60 mmol/L KCl to produce sustained contraction of the intrapulmonary arteries, after which resveratrol was applied cumulatively. Endothelium denudation, L-NAME and indomethecin were used to investigate the effect of resveratrol on constrictions of the isolated arteries, suing DMSO as the control. Results Resveratrol induced concentration-dependent relaxations in endothelium-intact rings that contracted in response to stimulations with U46619, ET-1 and KCl, with pD2 of 3.82 ± 0.20, 3.84 ± 0.57, and 3.68 ± 0.27, Emax of (99.58 ± 0.83)%, 100%, and (99.65 ± 0.98)%, respectively. Treatment of the arterial rings with the eNOS inhibitor L-NAME, but not with indomethecin or endothelium denudation, obviously affected the relaxant effects of resveratrol. Conclusion Resveratrol can concentration-dependently produce relaxant effect on human intrapulmonary arteries independent of the endothelium possibly by promoting synthesis and release of NO.

Despite the complex vascular effects of dexmedetomidine (DEX), its actions on human pulmonary resistance arteries remain unknown. The present study tested the hypothesis that DEX inhibits vascular tension in human pulmonary arteries through the endothelial nitric oxide synthase (eNOS) mediated production of nitric oxide (NO). Pulmonary artery segments were obtained from 62 patients who underwent lung resection. The direct effects of DEX on human pulmonary artery tension and changes in vascular tension were determined by isometric force measurements recorded on a myograph. Arterial contractions caused by increasing concentrations of serotonin with DEX in the presence or absence of L-NAME (endothelial nitric oxide synthase inhibitor), yohimbine (α2-adrenoceptor antagonist) and indomethacin (cyclooxygenase inhibitor) as antagonists were also measured. DEX had no effect on endothelium-intact pulmonary arteries, whereas at concentrations of 10⁻⁸~10⁻⁶ mol/L, it elicited contractions in endothelium-denuded pulmonary arteries. DEX (0.3, 1, or 3×10⁻⁹ mmol/L) inhibited serotonin-induced contraction in arteries with intact endothelium in a dose-dependent manner. L-NAME and yohimbine abolished DEX-induced inhibition, whereas indomethacin had no effect. No inhibitory effect was observed in endothelium-denuded pulmonary arteries. DEX-induced inhibition of vasoconstriction in human pulmonary arteries is mediated by NO production induced by the activation of endothelial α₂-adrenoceptor and nitric oxide synthase.
Arteries ; Dexmedetomidine* ; Endothelium ; Humans ; Indomethacin ; Lung ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type III* ; Pulmonary Artery ; Serotonin ; Vasoconstriction* ; Yohimbine

OBJECTIVETo investigate the effect of dexmedetomidine on 5-HT-induced constrictions of isolated human intrapulmonary arteries and explore the mechanisms.

METHODSLung tissue was obtained from patients undergoing surgery for lung carcinoma. Intrapulmonary arteries were dissected and cut into rings, which were mounted in a Multi Myograph system to determine the effect of dexmedetomidine (0.3-3 nmol/L) on 5-HT-induced vasoconstrictions. The influences of the endothelium removal and various drugs including L-NAME, yohimbine and indomethacin were tested on the effects of dexmedetomidine.

RESULTSDexmedetomidine (0.1-100 nmol/L) did not obviously affect the resting tension of endothelium-intact human intrapulmonary arteries. 5-HT induced concentration-dependent contraction in endothelium-intact intrapulmonary arteries [pD2: 6.11∓0.05, Emax: (102.10∓1.96)%]. In the rings with intact endothelium, dexmedetomidine (0.3-3 nmol/L) significantly attenuated the Emax and pD2 of 5-HT-induced vasoconstriction [pD2: 5.94∓0.03, Emax: (79.96∓1.31)%]. 5-HT also induced concentration-dependent contraction in endothelium-denuded intrapulmonary arteries [pD2: 6.10∓0.07, Emax: (107.40∓3.20)%]. Dexmedetomidine produced no significant effects on the rings with denuded endothelium. The effects of dexmedetomidine on 5-HT-induced vasoconstriction was suppressed by L-NAME and yohimbine, but not by indomethacin.

CONCLUSIONDexmedetomidine can inhibit 5-HT-induced vasoconstriction of isolated human intrapulmonary arteries probably through α2-adrenergic acceptor and NO released from the endothelium.

Adult ; Aged ; Dexmedetomidine ; pharmacology ; Female ; Humans ; In Vitro Techniques ; Male ; Middle Aged ; Pulmonary Artery ; drug effects ; Serotonin ; pharmacology ; Vasoconstriction ; drug effects

Transfusion-related acute lung injury (TRALI) is an acute and fatal complication of blood product transfusion.TRALI is a syndrome, which diagnosed by the basis of clinical signs.The pathogenesis of TRALI is unclear and the hypothesis of two-hit model is generally accepted.At present, there is no specific treatment for TRALI.Treatment of the patient with TRALI is mainly supportive.The rational transfusions can avoid the occurrence of TRALI.The incidence of TRALI has been decreased by making the mainly measure of avoiding transfusions of plasma from multiparous female donors.