1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理

总结1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理经验。护理要点包括：组建多学科肺康复管理团队,实施个性化呼吸支持与降阶梯序贯氧疗护理,精准廓清呼吸道,开展一体化的早期肺功能康复锻炼。经过多学科团队合作,患者入院后第12天撤离呼吸机,第17天拔除气管插管,第20天下床活动,第37天顺利出院,随访6个月,患者恢复良好。     

治伤巴布剂对大鼠急性软组织损伤模型P38MAPK、AKT信号通路的影响＊

目的 观察治伤巴布剂对急性软组织损伤（acute soft tissue injury， ASTI）模型p38丝裂原活化蛋白激酶（mitogen-activated protein kinase，MAPK）、丝/苏氨酸蛋白激酶（AKT）信号通路的影响，探讨治伤巴布剂干预ASTI的可能作用机制。方法 将40只雄性SD大鼠按照随机数字表法分为正常对照组、模型对照组、治伤巴布剂组、p38MAPK信号通路抑制剂组、AKT信号通路抑制剂组，每组8只。除正常对照组外，其余四组均予以左侧后肢小腿ASTI造模。造模成功后，治伤巴布剂组于标记部位立即予治伤巴布剂（修剪成1.5x3cm大小）外敷，并用胶布固定；其余四组均予等剂量赋形剂（修剪成1.5×3 cm大小）外敷处理，胶布固定；持续外敷，共持续24 h。p38MAPK信号通路抑制剂组在造模前30 min予腹腔注射p38MAPK信号通路抑制剂SB203580（400 μg/kg/天）1次；AKT信号通路抑制剂组在造模前30 min予腹腔注射AKT信号通路抑制剂perifosine（20 mg/kg/天）1次。分别于0（造模前）、2h、4h、8h、12h、24h测量受伤小腿肌肉处的周长，并计算肌肉肿胀率（muscle swelling rate，MSR）。24 h药物干预结束后，采用颈椎脱臼法处死大鼠。后将左侧后肢小腿损伤中心部位进行取材，分成三份。一部分用于观察组织病理学形态变化；一部分用于逆转录聚合酶链反应（RT-PCR）检测核因子-κB（nuclear factor kappa-B，NF-κB）p65 mRNA、肿瘤坏死因子-α（TNF-α）mRNA、白细胞介素-1β（IL-1β）mRNA表达水平；剩下部分用酶联免疫吸附试验（ELISA）法检测骨骼肌组织TNF-α、IL-1β含量水平及蛋白质免疫印迹（Western-blot）法测定p38MAPK、AKT、NF-κB p65、核因子抑制蛋白α（inhibitor kappa B alpha， IκBα）表达水平。结果 与正常对照组相比，模型对照组MSR显著增加（P<0.01）；病理形态学上，骨骼肌组织可见大面积肌细胞排列紊乱，肌细胞变性坏死，间质内可见红细胞聚集及大量炎症细胞浸润；骨骼肌组织TNF-α、IL-1β含量水平显著升高（P<0.01）；磷酸化p38MAPK（p-p38）/总p38MAPK（t-p38），磷酸化-AKT（p-AKT）/总-AKT（t-AKT）明显升高（P<0.01），NF-κB p65及NF-κB p65mRNA表达水平明显升高（P<0.01）。与模型对照组相比，治伤巴布剂组MSR在治疗第8 h、12 h、24 h显著下降（P<0.01），且在治疗第24 h，其MSR较p38MAPK、AKT信号通路抑制剂组下降更明显（P<0.05）；病理学评分显著下降（P<0.01），且较p38MAPK、AKT信号通路抑制剂组下降更显著（P<0.05）；骨骼肌组织TNF-α、IL-1β含量水平明显下降（P<0.01），且较p38MAPK、AKT信号通路抑制剂组更显著（P<0.05）；p-p38/t-p38及p-AKT/t-AKT明显下降（P<0.01），NF-κB p65及NF-κB p65 mRNA表达水平显著下降（P<0.01），且较p38MAPK、AKT信号通路抑制剂组在降低NF-κB p65及NF-κB p65 mRNA相对表达值方面更显著（P<0.01）。结论 治伤巴布剂可能同时对p38MAPK、AKT信号通路产生了一定的抑制作用，引起NF-κB活性下调，NF-κB p65蛋白的表达下调，进而引起骨骼肌组织TNF-α、IL-1β炎性细胞因子含量水平下调，减轻ASTI炎症反应，从而改善ASTI。     

术前SCC与CYFRA21-1在肺鳞癌患者表达上调及临床意义

目的 分析术前SCC、CYFRA21-1与肺鳞癌临床病理特征、预后之间的关系。方法 收集2017年3月~2018年4月在云南省肿瘤医院确诊的肺鳞癌患者100例为观察组，确诊为肺良性肿瘤患者90名为肺良性肿瘤组、以及正常人群90名为健康人群组。通过电化学发光法对SCC、CYFRA21-1两种指标进行检测。检测SCC、CYFRA21-1含量，分析在肺鳞癌中表达的临床意义。结果 SCC、CYFRA21-1在肺鳞癌中比在肺良性肿瘤、健康人群中含量要高，差异有统计学意义（P＜0.001），并且敏感性均高于其他两组；男性患者的SCC、CYFRA21-1含量高于女性患者，差异具有统计学意义（P＜0.05）；SCC、CYFRA21-1含量在年龄≥60岁的含量高于＜60岁患者，差异无统计学意义（P＞0.05）；有吸烟史患者的SCC含量高于无吸烟史患者，差异无统计学意义（P＞0.05）。CYFRA21-1在吸烟史患者中高表达，差异有统计学意义（P＜0.05）；SCC、CYFRA21-1在有淋巴结转移、远处转移、肿瘤直径≥5 cm、病理分期为晚期时高表达，差异具有统计学意义（P＜0.05）；SCC、CYFRA21-1阳性患者OS、PFS比阴性患者短；SCC、CYFRA21-1两者之间呈正相关,相关系数（r）为0.630。结论 SCC、CYFRA21-1在肺鳞癌中表达上调；SCC、CYFRA21-1与性别之间存在某种内在联系；SCC、CYFRA21-1与肺鳞癌的TNM分期呈正相关；SCC、CYFRA21-1阳性患者OS、PFS比阴性患者短；SCC、CYFRA21-1两者之间呈正相关,相关系数（r）为0.630。     

Survival effects of time to surgery for Stage I lung cancer: A population-based study

ObjectivesTo examine the impact of time to surgery (TTS) on survival among patients with stage I non-small cell lung cancer (NSCLC).MethodsAll patients in the Canadian province of Ontario with stage I NSCLC from 2007 to 2017 were included. A logistic regression identified the predictors of TTS and a flexible parametric model estimated survival rates based on TTS.ResultsOver the study period, 6428 patients with stage I NSCLC undergoing surgical resection were identified, of which 62.5% had TTS >28 days. Less than half these patients (40.8%) underwent open resection, with 19.3% undergoing open sublobar and 21.5% undergoing open lobectomy. Adenocarcinoma and squamous cell carcinoma tumors accounted for 33.3% and 22.0% of cases, respectively. The majority (85.6%) of patients lived in urban areas within 50 km of a regional cancer center (76.9%). Variables that predicted TTS >28 days include age and extent of resection. After adjustment for VATS vs. open resection, age, sex, frailty, year of diagnosis, histology of tumor, and extent of resection, the hazard ratio for TTS >28 days was 1.26 (95%CI:1.13–1.40), indicating a 26% increased risk of all-cause mortality (p < 0.0001). The highest 5-year survival was observed for patients with stage I disease undergoing resection within 28 days.ConclusionsThe present study found age and extent of resection to be associated with increased TTS. Importantly, patients with TTS >28 days had reduced long-term survival.     

Lactobacillus delbrueckii UFV-H2b20 increases IFN-γ production and CD39+CD73+ Treg cell numbers in lungs,and protects mice against experimental allergic asthma

Asthma is a disorder characterized by airflow obstruction, inflammation, declining airway function, bronchial hyperresponsiveness and tissue remodelling. Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. The use of probiotics is becoming increasingly studied and recent evidence has suggested that it may provide therapeutic benefits in asthma and other diseases. Lactobacillus delbrueckii UFV-H2b20 fulfils all the requirements to be classified as probiotic. Previous studies have already shown the ability of L. delbrueckii UFV-H2b20 to stimulate the immune system. Our objective was to evaluate the protective effects of L. delbrueckii UFV-H2b20 in experimental allergic asthma. We used a murine model of ovalbumin-induced allergic airway inflammation to mimic allergic asthma. Oral treatment with L. delbrueckii UFV-H2b20 improves respiratory parameters and inhibits the inflammatory response in the lungs by decreasing the numbers of inflammatory monocytes, eosinophils and alveolar macrophages, as well as IgE levels. Treatment increased the IFN-γ/IL-4 cytokine ratio. Levels of IL-10 in the lungs were also increased in treated animals. Our results also showed that the probiotic administration increases the number of CD39⁺CD73⁺ T regulatory lymphocytes in the lung, suggesting a role for purinergic signals in the regulation of inflammation promoted by the treatment. Understanding the mechanisms of modulation of the immune system by probiotics could allow the development of probiotic preparations that are safe and have a direct action. Our results suggest that oral administration of L. delbrueckii UFV-H2b20 could be helpful to treat chronic inflammatory airway diseases, such as asthma.     

Tuberculosis during lung cancer treatment-A case series

This study aimed to clarify the characteristics of patients with lung cancer undergoing treatment until the onset of tuberculosis. Between 2005 and 2019, patients who were admitted to Tokyo National Hospital due to tuberculosis during lung cancer treatment were examined retrospectively. There were 42 patients, and detailed medical information was obtained in 39 patients. The median age of the 39 patients were 75 years (range: 47–92 years), of which 33 were males and 36 were Japanese Baby Boomers or older. Regarding risk factors for developing tuberculosis, smoking was noted in 34 cases, oral corticosteroid use in 13, and previous tuberculosis in six. Thirty-seven patients had one risk factor and 19 had two or more risk factors, but diagnosis of latent tuberculosis infection (LTBI) was obtained in only one patients, and none had received LTBI treatment. The first-line treatment for lung cancer was resection in 13 cases, chemoradiotherapy in 6, chemotherapy in 10, radiation therapy in 3, laser therapy in 1, and best supportive care (BSC) alone in 6. At tuberculosis onset, BSC accounted for 17 cases, but other situations were considerably existed such as anticancer medication (12 cases), and observation after lung cancer treatment (10 cases). Tuberculosis occurred in various situations in elderly patients with lung cancer. It is critical to actively evaluate the risk of tuberculosis and consider LTBI screening and treatment.     

Forensic pathological characteristics of explosion trauma in confined space terrorist mass fatalities classified with a 3-dimensional model

BackgroundExplosion fatalities are the severest type of violent crimes. These involve the use of explosive devices in terrorist like activities in confined spaces in civilian or military settings, with mass number of people present all around. A stark dearth of literature for the forensic interpretation of such catastrophes is astonishing.PurposeCharacterization of the pattern of the multitude of injuries in explosions in confined spaces as guide for investigations and growth of literature on this entity.MethodologyA review of the archives of the forensic examinations of mass fatalities due to an explosion in a metro car was undertaken. It was combined with the reconstruction of the events by developing a three-dimensional model of this incident that involved seventeen fatalities.ResultsAll the decedents showed differential pattern of fatal injuries under the influence of damaging explosion factors (DEFs). The causative forces were characterized as gas-detonation (in all the cases), damaging effect by shock waves (59% of the cases), and impact of fragmentation and collision of the body (thrown off) with nearby objects. Traumatic effect due to shrapnel as well as blunt force was noted in 82% of the cases. Gross destruction of head due to combined effect of gas-detonation and fragmentation was seen in 29% of the cases.ConclusionAn interpretation of the nature and pattern of injuries in confined space explosions can help to estimate the location of deceased/s with respect to the epicenter and the type of DEFs.