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Effect of budesonide on NK-1 receptor expression in asthmatic rat airway smooth muscle cell

Chinese Pediatric Emergency Medicine.2009;16(6):558-560. doi:10.3760/cma.j.issn.1673-4912.2009.06.017

Objective To investigate the effect of budesonide on NK-1 receptor expression in airway smooth muscle cell (ASMC). Methods According to the random method,45 wistar rats were divided into three groups: asthmatic group, budesonide treatment group and control group. Aerosolize ovalbumin was used to make asthmatic rat model. Budesonide treatment group were given budesonide after inhaled ovalbumin. On day 21 .primary rat ASMC culture was conducted. The fourth cell passage and purified ASMC was collected for RT-PCR. The content of NK-1R was determined by real-time quantitative PCR. Data were expressed as mean±standard error (SE). The ANOVE Tukey test was carried out by using SPSS17.0 software and P＜0. 05 was considered significant. Results As compared with that of asthmatic group(1.1687±0.1356),NK-1R mRNA in therapy group( 1.0820 ±0. 1146) decreased significantly (P ＜0.05) ,but remained still higher than that of control group(1.034 7±0.2503) (P＜0. 05). Conclusion NK-1R may be involved in the pathogenesis of asthma. Budesonide may down-regulate the expression of the NK-1R mRNA in the airway smooth muscle cell, which may inhibit inflammation in asthmatic attacks.

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Hand ,foot and mouth disease in mainland China: an update on epidemic situation, diagnosis and treatment

Suyun QIAN

Chinese Pediatric Emergency Medicine.2011;18(1):1-3. doi:10.3760/cma.j.issn.1673-4912.2011.01.001

Hand,foot and mouth disease has become more widespread in mainland China in recent years and has shown an increasing trend in the annual prevalence, which has attracted considerable attention as a major public health problem. Enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) are major pathogens. Ninety-five percent of severe patients and death cases were younger than 3 years old. Unfortunately,there is no effective anti-enteroviral drug for hand, foot and mouth disease, therefore symptomatic treatment and supportive care remain as the mainstream therapy. Intravenous immunoglobulin (IVIG) is expected to be used in recent clinical trials, but its efficacy remains to be seen. Glucocorticoid therapy is still controversial in critical cases. EV71 vaccine is under development; however, it takes time to launch a mass vaccination. Multidisciplinary prospective, multicentral study is essential to control the spread of hand, foot and mouth disease and to tackle the problems of diagnosis and treatment.

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The expression changes of MMP-9 and TIMP-1 in the brain of neonatal rats with hypoxic-ischemic brain damage(HIBD)

Ying ZHANG ; Guilan CHU

Chinese Pediatric Emergency Medicine.2009;16(3):266-268. doi:10.3760/cma.j.issn.1673-4912.2009.03.021

Objective To explore the mechanism of hypoxic-ischemic brain damage(HIBD) and provide new ideas for clinical treatment of hypoxic-iscbemic encephalopathy.Methods Neonatal 7-day-old Wistar rats were randomly divided into sham-operation control group,HIBD 6 h,12 h,24 h,48 h and 72 h groups(n =6 per group).The model of HIBD was induced by unilateral carotid ligation followed by timed exposure to 8% oxygen.The expression of MMP-9 mRNA and TIMP-1 mRNA in brain tissue of neonatal rats was measured by Real-time Q-PCR method.Results (1) The ligatod brainhemisphere of HIBD groups showed obvious edema from 12 h to 48 h after hypoxia -ischemia in the neonatal rats.(2) The expression of MMP-9 mRNA was very low in the sham-operation control group,but in HIBD groups,it began to increase at 6 h,and reached a peak at 24 h,then gradually decreased,but still maintained at high level at 72 h(P＜0.01).(3) The expression of TIMP-1 mRNA was aslo very low in the sham-operation control group.But in HIBD group,it increased slightly at 6 h,12 h and 24 h,compared to the sham-operation control group,each group was statistically significant(P＜0.05),with no significant difference among the three groups(P＞0.05),then decreased at 48 h and 72 h,but with no significant difference from sham-operation control group (P＞ 0.05).(4) The ratio of MMP-9 mRNA/TIMP-1 mRNA was normal in the sham-operation control group and HIBD 6 h group,it began to increase at 12 h,and reached a peak at 48 h,then gradually decreased,but still maintained at high level at 72 h(P ＜0.01).Conclusion Hypoxia-ischemia increases the expression of MMP-9 mRNA in brain tissue of nenatal rats,and the imbalance in the expression of MMP-9 mRNA and TIMP-1 mRNA possibly is one cause of brain edema induced by HIBD.

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The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Chenguang ZHAO ; Yubin WU ; Ping ZHOU

Chinese Pediatric Emergency Medicine.2009;16(3):260-262. doi:10.3760/cma.j.issn.1673-4912.2009.03.019

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.

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Stereological study of the effects of Doxycycline on hyperoxic lung injury In neonatal rats

Jin ZHANG ; Qi FENG

Chinese Pediatric Emergency Medicine.2009;16(3):256-259. doi:10.3760/cma.j.issn.1673-4912.2009.03.018

Objective To explore the influence and potential protective effects of non-specific panMetrix Metalloproteinases(MMPs) inhibitor Doxycycline on hyperoxic lung injury and lung development in neonatal rats.Methods Neonatal SD rats were divided into 4 groups randomly within 12 hours after birth:air with normal saline(AN),air with doxycycline(AD),hyperoxia with normal saline(ON),and hyperoxia with doxycycline group(OD).Hyperoxia groups(ON and OD) were exposed to ≥90% O2.Doxycycline 20 mg/kg or equal volume of 0.9% saline(Doxycycline concentration 2 mg/ml) was administered by gastric gavage,twice daily from day 1 to experimental day,but it didn't exceed 14 days.Stereological study was carried out at day 1,3,7,14 and 21 after birth.Results Enlarged mean alveolar area was noted both in hyperoxia and Doxycycline groups.OD group had larger star volume than ON group on day 14.Except ON group,all other groups had increased alveolar septum and the condition was worsened by hyperoxia with Doxycycline.The percentage of collagen in lung parenchymal tissue in ON group increased persistently.This increasing trend was stopped in OD group on day 14,and collagen percentage had no significantly difference between OD and AN groups on day 14 and 21.Conclusion Both hyperoxia and Doxycycline influence neonatal lung development,percentage of coUgen in lung parenchymai can be reduced by Doxycycline in hyperoxic lung injury.

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Effect of recruitment maneuver on pulmonary surfactant in young piglets with acute lung injury

Yu WANG ; Zhujin LU ; Yi YANG

Chinese Pediatric Emergency Medicine.2009;16(3):249-252. doi:10.3760/cma.j.issn.1673-4912.2009.03.016

Objective To investigate the effect of recruitment maneuver(RM) on surfactant proteins in young piglets with acute lung injury and the possible mechanisms of lung recruitment after RM.Methods The piglet model of ALI was established by lipopolysaccharide intravenous injection,12 male piglets were randomly divided into two groups:conventional ventilation group(control group) and RM with low tidal volume group(RM group).After 8 hours of ventilation,mRNA expression of surfactant protein-A(SP-A),SP-B,SP-C,SP-D in the piglet lungs were determined by real time PCR and SP-A protein distribution was assessed by immunohistochemistry.Biochemical analyses of TP,total phospholipids(TPL),DSPC were conducted as well.SP-A levels in bronchoalveolar lavage fluid(BALF) and plasma were measured by enzymelinked immunosorbent assay(ELISA).Results As compared with control group,RM group had higher expression of SP-A,SP-B,SP-C and SP-D.SP-A average gray values of control group and RM group were 97.8±6.4 and 106.3±8.5,and there was significant difference(P＜0.01).RM group showed significant increase of TPL,DSPC and DSPC/TP.The concentration of SP-A in BALF was higher in RM group than that of the control group,however,SP-A plasma level was lower in RM group than that of the control group.Conclusion RM can increase suffactant protein expression in ALI animals,alleviate surfactant protein dysfunction and regulate the concentration of SP-A,which may improve alveolar recruitment following the RM and alleviate ventilator-induced lung injury.

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Effect of low molecular heparin calcium on Henoch-Schonlein purpura and Preventive Henoch-Schonlein purpura nephritis

Yumei LI ; Zhongbin TAO ; Li JIANG

Chinese Pediatric Emergency Medicine.2009;16(3):237-239. doi:10.3760/cma.j.issn.1673-4912.2009.03.011

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.

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Therapeutic effect of inhaled Iloprost on pediatric pulmonary hypertension after congenital heart disease operation

Yan HE ; Yinglong LIU ; Xu WANG

Chinese Pediatric Emergency Medicine.2009;16(3):231-233. doi:10.3760/cma.j.issn.1673-4912.2009.03.009

Objective To study the therapeutic effects of inhaled iloprost on pediatric pulmonary hypertension after congenital heart disease operation and to investigate the mechanisms of iloprost.Methods Thirteen 10 min every time,every 4 hours for 48 h after the surgery.We used the 24 h cardiac monitoring and ultrasonic cardiography for hemodynamical monitoring.We examined the blood cAMP and cGMP by ELISA assay.Results The patients were(17.88±12.56) months old with average weight of(9.29±3.59) kg.The right atrial pressure,systolic pulmonary arterial pressure,systolic pulmonary arterial pressure/systolic blood pressure were(11.5±1.41)mm Hg,(61.64±13.6) mm Hg and 0.66±0.16 before the treatment and they were(9.88±1.88) mm Hg,(47.67±12.18) mm Hg and 0.52±0.15 at the time point of 20 min after the treatment.For all the three parameters,there were significant differences before and after treatment.The effect of iloprost continues to 120 min later.The cAMP level was(335.75±127.31) μg/L before iloprost inhalation and increased to(519.68±148.54)μg/L at the time point of 20 min after inhaling iloprost,showing a significant difference(P＜0.01).Blood pressure,cGMP level and ventilator parameters showed no notable difference before and after the treatment.Conclusion Inhaled iloprost significantly improves pulmonary hemodynamics in children with pulmonary hypertension after congenital heart disease operation,which might be achieved by increasing the blood cAMP.However,systemic blood pressure and respiratory function keep unaffected after iloprost inhalation.

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Effect of lung protective-ventilation strategy on outcome of children with acute respiratory distress syndrome

Diqi ZHU ; Ying WANG

Chinese Pediatric Emergency Medicine.2009;16(3):222-224. doi:10.3760/cma.j.issn.1673-4912.2009.03.006

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.

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Recognition and experience in diagnosis and treatment of severe hand, foot and mouth disease

Chunfeng LIU

Chinese Pediatric Emergency Medicine.2011;18(1):4-7. doi:10.3760/cma.j.issn.1673-4912.2011.01.002

Severe hand,foot and mouth disease has emerged as the important threat to lives of children in China in recent years. Enterovirus especially EV 71 is neurotropic pathogen, can cause encephalitis,brainstem encephalitis, which are considered to be related to some severe complications such as pulmonary edema and cardiovascular failure. Autonomic nervous system dysregulation and secondary excessive catecholamine release are thought to be the main mechanism. The key measures for decreasing mortality include optimal ventilatory and cardiovascular support as well as prevention of further brain injuries. The guideline should be used with cautions and clinical practice should be based on patient's conditions.

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