支气管哮喘与支气管热成形术

支气管热成形术是近年来新出现的一项用于治疗药物治疗效果不理想的重症哮喘的方法,它的原理是通过热能减少支气管平滑肌,减轻气道痉挛。美国进行了大量动物实验、临床前试验和临床试验皆证明了该方法是有效和安全的。该治疗技术已得到美国FDA认可,并逐步在全世界推广。     

支气管热成形术治疗重症支气管哮喘的有效性和安全性研究

背景和目的:支气管热成形术(bronchial thermoplasty,BT)是一种新的支气管镜介入性治疗支气管哮喘(简称哮喘)的方法,通过在气道壁控制应用温热热能以减少哮喘患者气道平滑肌数量.该研究目的是评估BT对那些虽经过高剂量吸入糖皮质激素(ICS)和长效β2-受体激动剂(LABA)治疗,但仍有症状的重症哮喘患者的有效性和安全性.     

支气管肺泡灌洗氨溴索治疗支气管扩张并感染的效果分析

目的 探讨支气管肺泡灌洗氨溴索治疗支气管扩张并感染的疗效.方法 将120例支气管扩张并感染患者随机分为用氨溴索灌洗的治疗组60例和用生理盐水灌洗的对照组60例,均每3天灌洗1次,连续3次,于治疗前及治疗2周做肺功能和胸部CT检查.结果 治疗组疗效明显优于对照组（P＜0.01）,与对照组相比PEF、FVC及FEV1均明显改善（P＜0.05）,住院时间明显缩短（P＜0.05）.结论 支气管肺泡灌洗氨溴索治疗支气管扩张并感染是一种很好的治疗手段.     

支气管结核微波介入治疗的临床研究

目的观察微波介入治疗支气管结核的有效性和安全性.方法 92例住院支气管结核患者随机分成治疗组、对照组.治疗组应用微波介入治疗;对照组予局部药物注入治疗.结果 治疗组9月后痰菌阴转率及肺不张治愈率均达到100%,X线胸片病灶有效率88.1%,电子支气管镜复查病变支气管总有效率85.7%,明显高于对照组,疗效较好.结论 通过电子支气管镜微波介入治疗支气管结核是一种安全、有效的方法.     

支气管灌洗术在支气管扩张症治疗中的作用

目的 分析支气管灌洗术在支气管扩张症治疗中的效果.方法 选取82例支气管扩张症者予以支气管灌洗术作为观察组,再抽取予以抗生素等常规治疗的80例支气管扩张症者对比作为对照组;观察、分析两组临床疗效等.结果 观察组近期疗效（总有效率86.59%）、远期效果（82.93%）,均高于对照组;且观察组临床症状、体征消失或改善时间和抗生素应用时间和住院时间较对照组缩短（P〈0.05）.结论 支气管灌洗术在支气管扩张症治疗中应用效果显著且起效迅速.     

支气管肺泡灌洗治疗支气管张合并感染的临床研究

目的 观察对支气管扩张合并肺部感染患者经纤支镜支气管肺泡灌洗治疗的临床疗效.方法 将48例支气管扩张合并肺部感染患者随机分为灌洗组及埘照组,灌洗组26例,对照组22例,均在全身应用抗菌药物及祛痰药的基础上,灌洗组在生命体征监护下进行床旁纤支镜吸痰及支气管肺泡灌洗术治疗,对照组体位引流排痰.分析比较两组临床表现、化验和影像学变化以评价肺部感染控制情况.结果 纤支镜支气管肺泡灌洗治疗后较治疗前动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)明显提高,治疗后动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)灌洗组较对照组明显增高,灌洗组有效率明显高于对照组.灌洗组显效10例,好转12例,有效率为85%;对照组显效5例,好转9例,有效率为64%,两组有效率比较,P<0.05.无气胸及严重气道内出血等并发症.结论 经纤支镜支气管肺泡灌洗是治疗支气管扩张合并肺部感染的有效方法.     

053 CCL趋化因子和支气管哮喘

气道嗜酸粒细胞增多是支气管哮喘的一个特征.嗜酸粒细胞通过释放毒性蛋白酶、脂质调节因子和氧自由基引起组织损伤.趋化因子的发现以及该细胞因子超家族的某些成员可能参与嗜酸粒细胞的聚集,为支气管哮喘的治疗提供了一条新的途径.     

支气管哮喘靶向治疗的新进展

支气管哮喘靶向治疗是目前支气管哮喘治疗的一个新的方向,应用特异性抗体阻断气道炎症过程的某些环节.日前许多新的靶向治疗方法止处于临床试验的不同时期,本文就抗体靶向治疗的现状作一综述.     

支气管黏液表皮样癌的诊治(附1例报告及文献复习)

目的 总结支气管黏液表皮样癌的临床诊治经验.方法 分析我科收治的1例支气管黏液表皮样癌患者的临床资料并复习相关文献.结果 该患者术后随访半年未见复发及转移,结合文献资料,支气管黏液表皮样癌为低度恶性肿瘤.结论 手术是治疗支气管黏液表皮样癌的首选方法.     

成人气管性支气管2例报告并文献复习

目的 提高对成人气管性支气管疾病的认识和诊断水平.方法 对2例成人气管性支气管的临床资料进行回顾性分析,分析其临床特征及电子支气管镜检查在诊断和治疗方面的作用.结果 该2例患者因肺部占位性病变行电子支气管镜检查,发现伴有气管性支气管,予电子支气管镜下活检占位组织后,气管性支气管未予处理.结论 气管性支气管是少见的气道先天发育异常,目前国内成人报告病例极少,随着介入肺脏病学及医学影像学的发展,其检出率日益增多,若无临床症状可不予特殊处理.     

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.     

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.     

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.     

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.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.