慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素。方法采用病例对照研究方法,选取2015-05～2018-05该院呼吸内科住院的COPD合并IPA的住院患者24例为病例组,以年龄为匹配因素(±2岁),按1∶2的比例选取同期住院的COPD患者48例为对照组,采用条件Logistic回归分析对COPD合并IPA的危险因素进行分析。结果单因素分析结果显示COPD频繁急性加重、糖尿病、慢性肾功能不全、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的危险因素(P0.10);采用条件Logistic分析,糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素(OR=7.384,6.681,32.354,P0.05)。结论糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素。     

慢阻肺患者继发肺部真菌感染的危险因素及其痰培养结果分析

目的分析慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的危险因素及其痰培养结果。方法回顾性分析41例COPD继发肺部真菌感染的患者(研究组)和60例未发生肺部真菌感染的COPD患者(对照组)的临床资料,比较研究组的病原菌构成及耐药情况;通过多因素Logistic回归分析COPD患者继发肺部真菌感染的危险因素。结果研究组检出324株真菌,以白色念珠菌较常见(占63.58%)。分离菌对两性霉素B的耐药率较低(1.46%),而白色念珠菌对氟康唑等其它4种抗真菌药物的耐药性为1.46%~3.88%。研究组患者的年龄,合并肺源性心脏病、糖尿病、呼吸衰竭及机械通气的比例,抗菌药物和激素使用时间、ICU住院时间及血清白蛋白水平与对照组比较差异均有统计学意义(P0.05);多因素Logistic回归分析显示:高龄,合并肺源性心脏病、糖尿病、呼吸衰竭,机械通气,长期使用抗菌药物和激素及ICU住院时间长均是COPD患者继发肺部真菌感染的危险因素(P0.05),而血清白蛋白增高是COPD患者继发肺部真菌感染的保护性因素(P0.05)。结论 COPD患者继发肺部感染的真菌以白色念珠菌多见,两性霉素B治疗COPD继发肺部真菌感染的耐药率低。COPD患者发生继发肺部真菌感染的危险因素涉及高龄,合并肺源性心脏病、糖尿病、呼吸衰竭等多个方面。临床上应重视对上述危险因素的干预,提高真菌性肺炎的防治效果。     

血清糖类抗原125在慢性阻塞性肺疾病合并慢性肺源性心脏病的临床意义

目的:探讨血清糖类抗原125(CA125)在慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病患者血清中的表达水平及其临床意义。方法:将研究对象分为两组:COPD合并慢性肺源性心脏病组(294例),和单纯COPD组(234例)。收集所有研究对象的临床资料,进行超声心动图检查,并测定肿瘤标志物的血清学水平。结果:与单纯COPD组相比,COPD合并慢性肺源性心脏病组患者的血清CA125较单纯COPD组显著升高(P0.05);而其它肺瘤标志物(癌胚抗原、鳞状上皮细胞癌抗原、血清骨胶素和胃泌素释放肽前体)在两组之间比较,差异无统计学意义(P0.05)。结论:血清CA125可能被用于判断COPD是否合并慢性肺源性心脏病的一个血清学指标。     

生脉注射液对COPD合并慢性肺源性心脏病患者的影响

目的探讨生脉注射液对COPD合并慢性肺源性心脏病患者的影响。方法分析我院收治的40例慢性阻塞性肺疾病合并慢性肺源性心脏病患者的临床资料。结果在肺通气功能、血气分析、6分钟步行距离等方面,治疗后两组患者均得到了不同程度的改善,治疗前后的差异具有统计学意义(P<0.05);在心肺功能改善程度方面,生脉组优于对照组,二者相比差异具有统计学意义(P<0.05);在右心室流出道和内径变化方面,生脉组患者有所改善,而对照组患者没有发生显著变化,二者相比差异具有统计学意义(P<0.05)。结论生脉注射液对慢性阻塞性肺疾病合并慢性肺源性心脏病患者肺通气功能、心肺功能、右心室流出道等具有明显的改善作用,能够促进患者运动耐受能力的显著提升。     

纳洛酮联合无创机械通气治疗慢性阻塞性肺疾病合并早期肺性脑病22例

慢性阻塞性肺疾病(COPD)合并肺性脑病是由于呼吸功能衰竭导致缺氧、二氧化碳潴留,进而引起一系列精神障碍和神经系统症状的[1].肺性脑病作为慢性肺源性心脏病的严重并发症,预后差、病死率高.本文采用纳洛酮联合无创机械通气治疗COPD合并早期肺性脑病观察临床疗效.     

慢性阻塞性肺疾病合并肺结核的临床特征及危险因素分析

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺结核的临床特征,分析其危险因素。 方法选择陆军军医大学第二附属医院呼吸与危重症医学中心2016年1月至2018年12月所有COPD患者1 210例,选择同期单纯COPD患者22例,观察COPD合并肺结核的临床特征,同时应用多因素Logistic回归分析COPD合并肺结核的危险因素。 结果所有COPD患者中,COPD合并肺结核患者120例,其患病率为9.91%,而其病死率为1.67%。在COPD合并肺结核中,合并其他疾病主要为肺癌、肺部感染、肺源性心脏病、高血压、冠心病、呼吸衰竭、糖尿病,患病率分别为20%、18.33%、17.50%、15.83%、12.5%、12.5%、5.83%;在相关因素分析,结果显示COPD合并肺结核组在每年急性加重次数上显著多于对照组(P<0.05),两组间在性别比例、年龄、病程、吸烟比例以及吸烟时间上无统计学差异(P>0.05)。在多因素Logistic回归分析中,病程(>10年)、急性加重次数(>2次/年)、低蛋白血症是COPD合并肺结核的危险因素,OR值分别为8.455、45.607、14.990。 结论COPD合并肺结核后易合并其他疾病,增大其诊断和治疗的难度,及早关注其危险因素对其治疗和预后有临床意义。     

糖尿病对慢性阻塞性肺疾病患者肺功能影响的相关性研究

目的观察糖尿病对于慢性阻塞性肺疾病(COPD)患者肺功能及血气分析情况的影响。方法回顾性分析2015年1月—2016年12月间在该院诊治的慢性阻塞性肺疾病(COPD)患者80例,根据有无合并糖尿病,分为试验组及对照组,通过肺功能检测及血气分析,测量VC、FVC、FEV1、FEV1/FVC、PEF、弥散量DLCO与比弥散量DLCO/PRED等肺功能指标,并进行组间比较,分析严重程度之间的差异。结果试验组肺功能指标显著低于对照组。试验组的疾病严重程度也高于对照组患者,差异有统计学意义(P0.05)。结论慢性阻塞性肺疾病(COPD)患者合并糖尿病时,其的肺功能受损情况更严重,COPD合并糖尿病时肺通气功能和弥散功能都可受损。     

侵袭性肺曲霉病的临床特点及其危险因素分析

目的探讨侵袭性肺曲霉病(IPA)的临床特点并分析其危险因素,为早期发现IPA提供临床依据。方法回顾性分析安徽医科大学第一附属医院在2014年8月至2017年8月出院诊断80例IPA患者(包括确诊20例)作为感染组,按1:1配对原则,选取同期同病区并有发热和/或伴呼吸道症状的非IPA患者80例作为对照组。比较两组的临床症状和体征、胸部CT表现、相关实验室检查结果和基础疾病,应用单因素、多因素条件Logistic回归分析,找出IPA感染发生的危险因素。结果两组均可出现发热、咳嗽和肺湿啰音等症状和体征,IPA患者胸部CT可有曲霉球、空洞、新月征和晕轮征等相对特异性表现,且易合并糖尿病和慢性阻塞性肺疾病。广谱抗生素应用、长期及大剂量糖皮质激素应用、低蛋白血症、免疫抑制剂应用、合并慢性阻塞性肺疾病、糖尿病、多次住院、粒细胞缺乏是侵袭性肺曲霉病的危险因素(P0.05);多因素条件Logistic回归分析显示长期应用糖皮质激素、多次住院、合并慢性阻塞性肺疾病和粒细胞缺乏是IPA的独立危险因素(P0.05)。结论接受长期糖皮质激素治疗及多次住院、合并慢性阻塞性肺疾病、粒细胞缺乏患者是IPA感染的独立危险因素,应引起临床重视。     

肺康复治疗对稳定期慢性阻塞性肺疾病病人的疗效分析

目的观察肺康复治疗对稳定期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的效果。方法测定以下肢训练为主的社区康复治疗前后患者的FEV1(第一秒用力呼气量占预计值百分比)、6 min步行距离、呼吸困难评分(Borg评分)、年人均急性发作次数、年人均住院次数。结果肺康复治疗前后的FEV1、6 min步行距离、Borg评分明显好于治疗前(P0.05),年COPD急性发作次数及住院次数治疗前后有统计学意义。结论肺康复治疗可改善COPD患者的呼吸功能,减少年均急性发作次数及住院次数。     

慢性阻塞性肺疾病发生变应性支气管肺曲霉病危险因素分析

目的 探讨慢性阻塞性肺疾病(COPD,简称慢阻肺)发生变应性支气管肺曲霉病(ABPA)的危险因素,为早期诊断和预防该病提供依据.方法 选取郑州大学第一附属医院2015年8月至2020年8月收治的慢阻肺合并ABPA患者36例作为病例组,按1:2选取同时段入院、性别相同、年龄差不超过5岁的COPD未合并ABPA患者72例纳...     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.