Background: The investigation of mesenchymal stromal cell (MSC)-conditioned medium or extracellular vesicles (exosomes or microvesicles) as a remedy for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) has become a fast-growing field in recent years. Our purpose was to conduct a meta-analysis to investigate the efficacy of MSC-derived therapies (MDTs) for ALI/ARDS in animal models.Methods: A meta-analysis of MDTs for ALI/ARDS in animal trials was performed. PubMed and EMBASE were searched to screen relevant preclinical trials with a predetermined search strategy.Results: A total of 17 studies that compared MDT with the ALI control group were included in our study. The pooled result derived from the comparison of the two groups suggested that MDT could significantly reduce the lung injury score (standardized mean difference (SMD) = -4.02, 95% CI [- 5.28, -2.23], P < 0.0001) and improve animal survival (OR = -6.45, 95% CI [2.78, 14.97], P <0.0001). MDT mitigated the infiltration of neutrophils in alveoli (SMD = -3.38, 95% CI [-4.58, -2.18], P < 0.00001). MDT also reduced the wet-dry weight ratio of the lung (SMD = -2.34, 95% CI [-3.42, -1.26], P< 0.0001) and the total protein in BALF (SMD = -2.23, 95% CI [-3.07, -1.40], P < 0.00001). Furthermore, MDT was found to downregulate proinflammatory mediators such as IL-1, IL-6 and TNF-a and to upregulate anti-inflammatory mediators such as IL-10.Conclusion: MDT reduces lung injury and improves survival in animal ARDS models since it can ameliorate lung permeability, decrease inflammatory cell infiltration, downregulate proinflammatory mediators, and upregulate anti-inflammatory mediators. However, more animal studies and human trials are needed for further investigation.

Background Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which are particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema, and successively progresses to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important in the treatment process. Methods We reviewed young patients with severe HFMD, caused by EV71, and who had been successfully treated in our department. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve the clinical outcomes. Results After analysis, the findings were that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or reduce the number of cases which needed mechanical ventilation, it did reduce the incidence of fluid overload (p=0.085) and shortened the days of mechanical ventilation (p=0.028). After effective treatment, PiCCO monitoring showed that the cardiac index (CI) increased gradually(p<0.0001), whereas the pulse (P, p<0.0001), the extra vascular lung water index (EVLWI, p<0.0001), the global end diastolic volume index (GEDVI, p=0.0043), and the systemic vascular resistance index (SVRI, p<0.0001) all decreased gradually. Conclusion Our study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has potential clinical benefits, such as reducing fluid overload and duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

Background The investigation of Mesenchymal stromal cells (MSC) conditioned medium or extracellular vesicles (exosomes or microvesicles) for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a fast growing field in recent years. Our purpose is to investigate these MSC’s derived therapies’ (MDT) efficacy for ARDS in animal models by meta-analysis.Methods Meta-analysis of MDT for ALI/ARDS in animal trials. PubMed and EMBASE were searched to screen relevant preclinical trials with a pre-specified search strategy. Results A total of 17 studies were included in our studies. Compared the control group, the pooled result suggested that MDT can reduce lung injury score (mean = -4.02, 95% CI [- 5.28, - 2.23], P <0.0001) and improve survival (OR = -6.45, 95% CI [2.78, 14.97], P <0.0001) significantly. MDT mitigated the infiltration of neutrophils in alveoli (mean = -1.35, 95% CI [-1.69, -1.02], P <0.0001). Also, MDT reduced the wet to dry weight ratio of lung (mean = -2.65, 95% CI [-3.99, -1.31], P= 0.0001) and total protein in BALF (mean = -1.29, 95% CI [-1.63, -0.96], P <0.0001). Furthermore, MDT was found to down-regulate pro-inflammatory mediators such as IL-1, IL-6 and TNF-a, and up-regulate anti-inflammatory mediators such as IL-10.Conclusion MDT reduced lung injury and improved survival in animal ARDS models as it can ameliorate the lungs’ permeability, decrease inflammatory cells infiltration, down-regulate pro-inflammatory mediators and up-regulate anti-inflammatory mediators. However, more animal studies and human trials are needed for further investigation.

Background Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which are particularly common in preschool children. Severe HFMD is prone to pulmonary edema, and successively progresses to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important in the treatment process. Methods We reviewed young patients with severe HFMD, caused by EV71, and who had been successfully treated in our department. A total of 20 patients met the inclusion criteria. Some cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group and the control group. The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve the clinical outcomes. Results After analysis, the findings were that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or reduce the number of cases which needed mechanical ventilation, it did reduce the incidence of fluid overload and shortened the days of mechanical ventilation. After effective treatment, PiCCO monitoring showed that the cardiac index (CI) increased gradually(p<0.0001), whereas the pulse (P, p<0.0001), the extra vascular lung water index (EVLWI, p<0.0001), the global end diastolic volume index (GEDVI, p=0.0043), and the systemic vascular resistance index (SVRI, p<0.0001) all decreased gradually. ConclusionOur study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has potential clinical benefits which can reduce fluid overload(p=0.085) and duration of mechanical ventilation(p=0.028). However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.