变应性鼻炎的药物治疗策略

变应性鼻炎(allergic rhinitis,AR)是耳鼻咽喉科常见的疾病,也是重要的变态反应性疾病之一.全球AR患者超过5亿,我国大陆地区AR的患病率为4％～38％[1].AR在给患者生活质量造成严重影响的同时,亦给社会带来沉重的经济负担[2].     

载顺铂磁性纳米药物在小鼠体内的组织分布

 目的 研究海藻酸钠改性载顺铂磁性纳米药物的组织分布特征。方法 昆明小鼠84只,随机分为实验组和对照组,分别按顺铂剂量10 mg·kg-1从尾静脉推注载顺铂磁性纳米药物或顺铂0.2 mL,于给药后1,2,4,10 h,1,3,7 d,分7个时间点各处死实验组和对照组一组小鼠（6只）,取出小鼠的心、肝、脾、肺、肾组织,经强酸湿法消化后在原子吸收光谱仪上测定各组织样本中铂的浓度。结果 给药后7个不同时间点磁性顺铂在各组织中的浓度均明显高于顺铂（P<0.001）,7 d后实验组中肝、脾、肾组织中磁性顺铂的浓度分别为（8.31±1.92 ）、（24.23±6.02）、（3.02±0.74） μg·g-1,而对照组中顺铂分别只有（1.47±0.64）、0、（1.62±0.38） μg·g-1。结论 一次性给药后海藻酸钠改性载顺铂磁性纳米药物在小鼠体内的分布与顺铂不同,前者主要分布于肝、脾,并在组织中维持较长时间,后者主要分布于肝、肾,较快从组织中被清除。     

不同麻醉方式对儿童腹腔镜疝囊高位结扎术应激反应的影响

目的探讨两种麻醉方法对儿童腹腔镜疝高位结扎术（lapamscopic hernia sac high ligation）应激反应的影响。方法ASAⅠ-Ⅱ级择期行腹股疝疝囊高位结扎术患儿60例,年龄6—12岁,随机分为硬膜外麻醉组（E组）和单纯气管内全麻组（G组）各30例。检测术中不同时点血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）浓度并观察平均动脉压（MAP）和心率（HR）的变化。结果E组各时点Cor、NE、E、ACHT浓度无明显变化（P〉0．05）,G组气腹后上述各指标较气腹前明显增高（P〈0．05）且显著高于E组同时点（P〈0．05）（见表2）;E组气腹后平均动脉压及心率变化无统计学意义（P〉0．05）,而G组的则显著升高（P〈0．05）;两组患儿气腹10min后PaC02均显著增加（P〈0．05）,停气腹后渐恢复至正常,血PH值则变化不明显。结论硬膜外麻醉复合基础麻醉相对于单纯气管内全麻更能有效抑制儿童腹股疝疝囊高位结扎术的应激反应。     

腹腔镜右半结肠癌扩大切除术意义的纷争

随着全结肠系膜切除(CME)及扩大淋巴结清扫(D3)理念在结肠癌手术中的推广,CME及D3淋巴结清扫上取得了良好的肿瘤学和手术结果,提高生存率及无病生存率,降低局部复发率。CME手术与直肠癌术中直肠系膜全切除相似,是切除肿瘤引流区域的所有淋巴、血管和神经组织以及完整的肠系膜,腹膜和包围的筋膜。而D3淋巴结清扫也是基于相似的原则。但是,目前有证据表明CME和D3淋巴结清扫的预后获益受限于方法缺陷和一些潜在的混杂因素,需要大宗病例的前瞻随机对照临床实验进一步验证。     

Mental Health Multimorbidity among Caregivers of Older Adults During the COVID-19 Epidemic

ObjectiveTo investigate mental health status and associated factors among caregivers of older adults during the COVID-19 epidemic in China.MethodsFrom March 1 to 31, 2020, 916 caregivers of older adults participated in an online cross-sectional survey on the prevalence of anxiety, depression, and sleep problems. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was administered to measure anxiety symptoms, the two-item Patient Health Questionnaire (PHQ-2) was used to assess depressive symptoms, and a self-developed questionnaire was used to assess sleep quality and duration. Six questions about COVID-19-related experiences were used to assess community-level infection contact and the level of exposure to media information. The prevalence rates of anxiety, depression and sleep problems were computed. The Wald χ² were applied to compare the differences between subgroups. Multiple logistic regression analyses were performed to investigate factors associated with anxiety, depression, sleep problems, and multimorbidity.ResultsThe prevalence rates of anxiety, depression, and sleep problems were 46.8%, 29.8%, and 10.8%, respectively. Approximately 263 participants (28.7%) presented with two or more mental health problems. Being female (OR, 2.254; 95% CI, 1.510–3.363), having community-level COVID-19 contact (OR, 1.856; 95% CI, 1.189–2.898), and having a mental disorder (OR, 3.610; 95% CI, 1.644–7.930) were associated with increased risk of multimorbidity among caregivers. Caregivers who preferred positive information (OR, 0.652; 95% CI, 0.472–0.899) had reduced risk of multimorbidity.ConclusionAnxiety and depression were common among caregivers of older adults during the COVID-19 epidemic. Being female and having community-level COVID-19 contact were independent risk factors for experiencing multiple mental health problems. Preexisting mental disorders increased the risk of multimorbidity among caregivers, while enhanced access to positive media information decreased the risk of multimorbidity.     

Tumoral indoleamine 2,3-dioxygenase expression predicts poor outcome in laryngeal squamous cell carcinoma

The development of laryngeal squamous cell carcinomas (LSCC) is strongly influenced by the host immune system. Indoleamine 2,3-dioxygenase (IDO) can promote and maintain an immunosuppressive microenvironment which can impede the efficacy of anticancer responses. The purpose of the current study is to investigate the prognostic value of intratumoral IDO expression in LSCC. The expression of IDO protein was retrospectively assessed by immunohistochemistry in 187 LSCC patients. The potential association of tumor IDO expression with clinical parameters and tumor-infiltrating lymphocytes (TILs) was analyzed separately. Survival curves were estimated by the Kaplan–Meier method, and differences between groups were determined by log-rank test. Multivariate logistic regression analysis was performed to determine the independent factors associated with survival. Based on the evaluation score, 90 carcinomas (48.1 %) were identified with high IDO expression and 97 carcinomas (51.9 %) showed low expression. Tumor IDO expression was not associated with clinical stage, presence of metastases, and other clinicopathological parameters. Also, high IDO expression was not correlated with tumor-infiltrating CD3⁺ and CD8⁺ TILs. Instead it was positively related with the density of FOXP3⁺ Tregs. Furthermore, multivariate analysis identified a significant association of overall survival and disease-free survival with tumor IDO status. IDO high expression represents a significant negative prognostic factor in patients with LSCC. Current results provide further support for using IDO as an immunotherapeutic target in LSCC. The precise role of tumoral IDO in human LSCC remains to be elucidated in the future.     

Mechanisms for T cell tolerance induced with granulocyte colony-stimulating factor

Granulocyte colony-stimulating factor (G-CSF) has been widely accepted as a mediator of T cell tolerance. The immune modulatory effect of G-CSF on T cells is believed to be mediated exclusively through other effector cells, such as monocytes, tolerogenic dendritic cells (DC), and myeloid-derived suppressor cells. Recent advances confirmed the direct effects of G-CSF in inducing immune tolerance of T cells through the G-CSF-G-CSF receptor pathway and related molecular mechanisms. This review aims to summarize the findings associated with the direct and indirect mechanisms for T cell tolerance induced with G-CSF. The role of G-CSF in preventing graft-versus-host disease (GVHD) and in treating autoimmune diseases (ADs) is also discussed. It is conceivable that G-CSF and immune cell compositions, such as tolerogenic DC and CD4⁺CD25⁺Foxp3⁺ T cells, modulated by G-CSF could become an integral part of the immunomodulatory therapies against GVHD and ADs in the future.