Background: This study aimed to investigate the effects of dexmedetomidine (Dex) on hemodynamics and organ protection in congenital heart disease (CHD) children who underwent open-heart surgery under cryogenic cardiopulmonary bypass. Methods: Ninety children were randomly allocated to group C (0.9% saline 0.2 μg/kg/hour), group D1 (Dex 0.2 μg/kg/hour), and group D2 (Dex 0.4 μg/kg/hour) (n = 30 per group). All participants received fentanyl, propofol and 1% sevoflurane for anesthesia induction. Hemodynamic data were measured from T0 (before the induction) to T7 (30 minutes after extubation). The difference of arterial internal jugular vein bulbar oxygen difference and cerebral oxygen extraction ratio were calculated according to Fick formula. Enzyme-linked immunosorbent assay was performed to detect the serum myocardial, brain and kidney injury markers. The incidence of acute kidney injury (AKI) was calculated by serum creatinine level. Tracheal extubation time, postoperative pain score and emergence agitation score were also recorded. Results: Compared with group C, group D1, and D2 exhibited reduction in hemodynamic parameters, myocardial and brain injury indicators, and tracheal extubation time. There were no significant differences in blood urea nitrogen and neutrophil gelatinase-associated lipocalin or incidence of AKI among the 3 groups. Besides, the incidence of tachycardia, nausea, vomiting and moderate agitation, and the FLACC scale in group D1 and D2 were lower than those in group C. Moreover, Dex 0.4 g/kg/hour could further reduce the dosage of fentanyl and dopamine compared with Dex 0.2 g/kg/hour. Conclusions: Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.
Acute lung injury (ALI) is a pneumonic response characterized by neutrophil infiltration. Macrophage efferocytosis is the process whereby macrophages remove apoptotic cells, and is required for ALI inflammation to subside. The glycoprotein ulinastatin (UTI) has an anti-inflammatory effect during the acute stages of ALI, but its effect on efferocytosis and the subinflammatory stage of ALI is unclear. Extracellular signal-regulated kinase 5 (ERK5) is a key protein in efferocytosis, and we thus hypothesized that it may be activated by UTI to regulate efferocytosis and the resolution of pneumonia. To test this hypothesis, here we monitored phagocytosis of macrophages through in vivo and in vitro experiments. Pulmonary edema, neutrophil infiltration, protein exudation, and inflammatory factor regression were observed on days 1, 3, 5, and 7 in vivo. RAW264.7 cells were pretreated with different concentrations of UTI and ERK5 inhibitors, and the expression of tyrosine-protein kinase Mer (Mer) protein on macrophage membrane was detected. UTI increased the phagocytosis of apoptotic neutrophils by macrophages in vitro and in vivo, and promoted the resolution of pneumonia. The protein expression of ERK5 and Mer increased with UTI concentration, while the expression of Mer was down-regulated by ERK5 inhibitors. Therefore, our results suggest that UTI enhances efferocytosis and reduces lung inflammation and injury through the ERK5/Mer signaling pathway, which may be one of the targets of UTI in the treatment of lung injury.Acute lung injury (ALI) is a critical clinical illness of common occurrence and is a pneumonic reaction characterized by neutrophil infiltration [1]. The pathophysiological process of ALI can be roughly divided into the acute inflammatory stage and the subsiding inflammatory stage. In the subsiding phase of inflammation, macrophages directly engulf and clear apoptotic neutrophils to repair damaged tissues, a process called efferocytosis, which promotes the recovery of lung epithelial and endothelial functions and the reconstruction of lung tissue structure. If apoptotic cells are not cleared in time, many intracellular danger signaling molecules are released by secondary cell necrosis, which further hinders tissue repair. Therefore, promoting the regression of pneumonia will shorten the pathophysiological process of ALI and reduce lung injury [2,3].Ulinastatin (UTI), a commonly used drug in clinical practice, is an endogenous molecule with actions against infectious pathogens and its pharmacological Abbreviations ALI, acute lung injury; ERK5, extracellular signalregulated kinase 5; Mer, tyrosine-protein kinase Mer; UTI, ulinastatin.
The incidence of malignant tumors diagnosed during pregnancy is increasing, often ascribed to the recently recognized trend that many women are postponing childbirth. Although early diagnosis is optimal for both mothers and fetuses, the diagnosis of malignant tumors during pregnancy is often delayed until an advanced stage, because generalized symptoms of pregnancy and malignancy may overlap, such as shortness of breath, chest or abdominal discomfort. The study patient was 21 years old, and 31 weeks-pregnant when she was diagnosed with primary tracheal adenoid cystic carcinoma (ACC). The patient initially presented with dyspnea and decreased blood oxygen saturation and underwent a cesarean section on the first night of hospitalization, resulting from fetal distress. This case report intended to investigate potential barriers to the timely diagnosis of tracheal ACC and consider optimal management strategies when it is diagnosed during pregnancy.
Swan-Ganz pulmonary artery catheters enable continuous assessment of cardiac blood flow, left heart pressures, and oxygen delivery and consumption, with an uninterrupted view of cardiac function to facilitate proactive decisions in the most complex patients. However, complications of Swan-Ganz catheters have been continuously reported in clinical practice. Therefore, it is imperative to focus on prevention and treatment of Swan-Ganz catheter complications. This case presents successful management of an unusual complication, retrieval of a kinked thermal filament of a Swan-Ganz catheter in a 32-year-old male patient following liver transplantation. To our knowledge, this is the first reported case of a kinked thermal filament of a Swan-Ganz catheter. When the Swan-Ganz catheter was found to be difficult to withdraw, CT revealed that the Swan-Ganz catheter was kinked at the level of clavicle. Under X-ray guidance, the central venous catheter was first removed, followed by removal of the percutaneous introducer sheath, and finally the Swan-Ganz catheter was successfully withdrawn. This case report provides a successful procedure for the removal of the kinked Swan-Ganz catheter, and perspectives on the overall management, such as the possible need for CT examination when difficulty is encountered withdrawing a Swan-Ganz catheter.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.