Does pulse lavage reduce hip hemiarthroplasty infection rates?

This paper reports a prospective randomized trial involving four hospitals in the south of England, in which every hemiarthroplasty (American Association of Anaesthetists grade IV and above) was randomized to one of two limbs. In the first group, the patients received a 2-L pulse lavage normal saline washout; in the second group, they received a 2-L normal saline washout via a jug or a syringe. All wounds were reviewed during their time in hospital up to 30 days post surgery or discharge (using criteria from the Nosocomial Infection National Surveillance Survey). Any re-admissions for infection were recorded. The pulse lavage group had a significantly lower total infection rate and, specifically, a decreased 'joint space' or deep infection rate.     

The effect of high and low pressure pulsatile lavage on soft tissue and cortical blood flow: a canine segmental humerus fracture model

Objective To determine the effect of high pressure pulsatile lavage (HPPL) and low pressure pulsatile lavage (LPPL) on cortical and soft tissue blood flow in a canine humerus segmental fracture model. Design Midshaft humeral osteotomies to create a 2-cm segment of diaphyseal bone were performed on bilateral canine humeri. Each osteotomy site was irrigated using either high pressure (n = 6) or low pressure (n = 5) pulsatile lavage prior to stabilization with a 5-mm steinman pin. Perfusion of cortical bone, periosteum, and biceps muscle was measured using Laser Doppler Flowmetry during four intraoperative intervals: pre-osteotomy, post-osteotomy, post-lavage, and post-nailing. Results Following osteotomy, a significant drop occurred in cortical perfusion (HPPL P = 0.049, LPPL P = 0.021) and in periosteal flow (HPPL P = 0.019, LPPL P = 0.012). Following irrigation there was no significant decrease in blood flow in either group for muscle (HPPL P = 0.249, LPPL P = 0.41), periosteum (HPPL P = 0.381, LPPL P = 0.402), or cortex (HPPL P = 0.398, LPPL P = 0.352) measurements. There was no significant difference between irrigation groups in post-lavage perfusion values for muscle (P = 0.326), periosteum (P = 0.452), and cortex (P = 0.464). Cortical perfusion decreased significantly post-nailing (HPPL P = 0.027, LPPL P = 0.047). Measurements did not differ significantly between groups at any other time interval. Conclusion Although previous work has demonstrated an association between HPPL and detrimental structural changes in bone, this study demonstrates that HPPL does not adversely affect cortical or soft tissue blood flow acutely. Further, LPPL offers no acute benefit to cortical or soft tissue perfusion.     

Intracellular Th1/Th2 balance of pulmonary CD4(+) T cells in patients with active interstitial pneumonia evaluated by serum KL-6

The balance between CD4⁺ T helper (Th1) lymphocytes producing interferon-γ or Interleukin-4 (Th2) in the lungs may vary among diseases and during the progression of interstitial pneumonia (IP). Both idiopathic pulmonary fibrosis (IPF) and collagen vascular diseases (CVD) are associated with IP, but the clinical course and the response to treatment are different. Since Th1 or Th2 modulating drugs have been proven to alter the lymphocyte balance in vitro, it is important to elucidate the Th1/Th2 profile in patients with active IP. Bronchoalveolar lavage (BAL) was performed in patients who had IPF (n = 12) or CVD (n = 12) with IP, as well as in patients who had bronchoectasis and bronchopneumonia (n = 12). The CVD patients had rheumatoid arthritis (n = 6), Sjogren's syndrome (n = 2), dermatomyositis (n = 1), progressive systemic sclerosis (n = 2), and CREST syndrome (n = 1) as the underlying diseases. IP activity was evaluated by measuring serum KL-6, which is a clinically useful indicator for IP. The Th1/ Th2 balance and the CD4⁺/CD8⁺ ratio were determined for lymphocytes obtained from BAL by flow cytometric analysis. In IPF patients, the CD4⁺/CD8⁺ ratio was lower than in CVD patients. IPF patients showed Th2 dominance and CVD patients showed Th1 dominance when IP was active as evaluated by the serum KL-6 level. These data indicated that the Th1/Th2 balance of CD4⁺ T cells in the BAL differs between active IPF and CVD, even though KL-6 is elevated in both diseases. Therefore, the Th1/Th2 profile should be investigated to determine the use of Th1/Th2 modulator therapy for active IP with elevation of KL-6.     

纤维支气管镜灌洗治疗顽固性肺部感染研究

目的探讨经纤维支气管镜吸痰及灌洗治疗难治性肺部感染的临床疗效。方法选择难治性肺部感染的患者92例,随机选择55例（实验组）给予纤维支气管镜吸痰及灌洗治疗,另37例（对照组）未予气管镜吸痰灌洗。两组患者其他治疗措施均基本相同。结果实验组有49例感染控制,控制时间是（1n4±23）d,对照组有29例感染控制,感染控制时间（146±3．1）d。实验组肺部感染控制率显著高于对照组（P〈0.05）,而控制感染平均时间显著短于对照组（P〈0．05）。结论经纤维支气管吸痰及灌洗能有效治疗难治性肺部感染,且无严重并发症。     

分段肺泡灌洗与全肺灌洗治疗肺泡蛋白沉着症患者效果的比较

目的通过对分段肺泡灌洗和全肺灌洗治疗肺泡蛋白沉着症（pulmonaryalveolarproteinosis,PAP）患者的疗效及安全性比较,以寻找PAP最有效的治疗方法。方法选取2002年1月～2012年3月昆明市第一人民医院呼吸二科住院的16例PAP患者,分为分段肺泡灌洗（segmentalbronchoalveolarlavage,SBL）和全肺灌洗（wholelunglavage,WLL）治疗组。其中SBL治疗组7例．WLL治疗组9例。比较两组灌洗液量、灌洗液回收率、术中及术后并发症方面的差异,以及术后1个月两组在肺功能的一氧化碳弥散量（DLCO）、第一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大通气量（MVV）实测值占预计值百分比、氧分压（VaO：）、氧饱和度（SaO：）、Borg呼吸困难评分、6min步行试验、胸部高分辨率CT（HRCT）上病灶吸收方面的差异。结果WLL治疗组灌洗液人量、回收率明显高于SBL治疗组,差异有统计学意义（P〈0．05）。术中两组均未出现并发症,且术后两组在出现并发症方面无差异（P〉0．05）。术后1个月在改善患者肺功能（DLCO％、FEVI％、FVC％、MVV％）、Pa02、SaO2、Borg呼吸困难评分、6min步行试验、胸部HRCT病灶吸收方面WLL治疗组均优于SBL组,差异均有统计学意义（P〈0．05）。结论WLL较SBL治疗PAP的疗效好．值得在临床推广。     

支气管肺泡灌洗液中（1，3）-β-D葡聚糖检测对儿童侵袭性肺真菌病的诊断价值

【目的】探讨支气管肺泡灌洗液（BALF）中（1,3）-β-D-葡聚糖（BG）水平检测（G试验）对儿童侵袭性肺真菌病（IPFI）的诊断价值。【方法】选择本院收治的135例患儿,其中IPFI组34例、单纯肺炎组53例、非感染组48例,对所有入选患儿进行纤维支气管镜检查,留取BALF,同时采血行血清G试验。【结果】IPFI组BALF中BG水平和血清BG水平分别为（121．0士65．93）ng／L（23．29士20．49）ng／L,均明显高于单纯肺炎组（27．6士10．35）ng／L、（9．8±7．62）ng／L和非感染组（10．0±6．25）ng／L、（5．0±5．12）ng／L,其差异有统计学意义（P〈0．05）;IPFI组BALF中BG水平明显高于同组血清BG水平,其差异有统计学意义（P〈0．05）;BALF样本G试验用于诊断IPFI的最佳临界值是42．02ng／L,其灵敏度和特异度均明显高于血清G试验检测。【结论】BALF样本G试验诊断IPFI较血清标本具有更高的灵敏度和特异度,且在区分单纯肺炎和真菌感染方面可能比血清G试验更有优势,可减少IPFI的误诊、漏诊,为抗真菌药物的使用提供依据。     

纤维支气管镜治疗创伤后肺部感染的疗效观察

目的探讨纤维支气管镜治疗严重创伤及术后合并肺部感染的疗效。方法选取符合要求的34例严重创伤及术后合并肺部感染的患者,在常规抗感染治疗基础上用纤维支气管镜吸痰、冲洗、灌洗,并留取分泌物做细菌培养。结果全部病例临床症状、血常规、影像学检查结果明显改善。结论纤维支气管镜治疗严重创伤及术后合并肺部感染疗效确切,值得临床推广应用。     

Overview of CF lung pathophysiology

Defects of the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) protein affect the homeostasis of chloride, bicarbonate, sodium, and water in the airway surface liquid, influencing the mucus composition and viscosity, which induces a severe condition of infection and inflammation along the whole life of CF patients. The introduction of CFTR modulators, novel drugs directly intervening to rescue the function of CFTR protein, opens a new era of experimental research. The review summarizes the most recent advancements to understand the characteristics of the infective and inflammatory pathology of CF lungs.     

CD8+ T cells induced by adenovirus-vectored vaccine are capable of preventing establishment of latent murine γ-herpesvirus 68 infection

CD8+ T cells are known to control infections, but their role in preventing latent infection from establishing has not been thoroughly investigated.We hypothesized that a potent CD8+ T cell response patrolling the mucosal viral entry points could kill the first infected cells and thereby abrogate the infection before latency is established.To investigate this, replication deficient adenovirus serotype 5 vectors encoding murine γ-herpesvirus-68 CD8+ T cell epitopes linked to the T cell adjuvant Invariant chain, were developed. We show that intranasal vaccination of mice reduces the risk of establishment of latent infection from multiple intranasal ID50 challenges with murine γ-herpesvirus-68 by 81% per exposure at 14 days post vaccination. Protection waned over time, but immune responses were extended by heterologous prime-boost vaccination applied simultaneously intramuscularly and intranasally, and animals vaccinated 66 days prior to challenge showed a strong trend of long-term protection.Our data provides evidence that CD8+ T cells are able to protect against establishment of latent infection. Although the protective efficacy is difficult to maintain over time, this proof-of-concept study suggests a role for a CD8+ T cell arm in future vaccine strategies against latent human viral infections caused by pathogens such as HIV and multiple herpes virus.     

电子支气管镜灌洗治疗支原体肺炎伴肺不张患儿的临床效果

目的对支原体肺炎(MPP)伴有肺不张患儿实行电子支气管镜灌洗治疗,观察其临床疗效。方法以某院2018年3月至2019年9月收治的120例MPP伴有肺不张患儿为研究对象,按照随机数表法将其分为对照组与观察组,对照组行常规治疗,观察组在常规治疗基础上行电子支气管镜灌洗治疗,比较两组治疗第3天、1周后治疗转归情况。结果观察组治疗第3天肺复张有效率为93.3%,对照组为25.0%,观察组明显优于对照组,差异有统计学意义,P<0.05。治疗1周后,观察组总有效率为98.3%,对照组为61.7%,观察组明显优于对照组,差异有统计学意义,P<0.05。结论采用电子支气管镜灌洗治疗支原体肺炎伴肺不张患儿,可准确观察其病情状态,促进肺复张。