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.     

The effect of ethanol or long-time reaction on the diatom test in water samples using sodium hypochlorite

BackgroundThe diatom test method using sodium hypochlorite (NaClO) was equivalent to the conventional method in water samples. However, the method using NaClO was inferior to the conventional method in lung samples, in which ethanol was used and the reaction with NaClO was longer compared with the method in water samples. Using water samples, we aimed to clarify whether these differences affect the diatom test result.Materials and methodsThirteen water samples from natural water sources were each divided into four parts corresponding to four (2 × 2) digestion methods: 3 “digestion” vs. 1 “digestion” and with ethanol vs. without ethanol. After the base-2 logarithmic transformation, the diatom counts were analyzed using three-way analysis of variance (ANOVA); factor 1 was “digestion times,” factor 2 was “ethanol,” and factor 3 was “sample number,” and the interaction between factors 1 and 2 was also analyzed.ResultsThe geometric means of the diatoms from the 3 “digestion” with ethanol method, the 3 “digestion” without ethanol method, the 1 “digestion” with ethanol method, and the 1 “digestion” without ethanol method were 373.5, 551.8, 436.6, and 522.0, respectively. ANOVA showed a significant difference in factor 2 (P = 1.7 × 10^-4). There was no significant difference in factor 1 (P = 0.46), and no significant interaction between factors 1 and 2 (P = 0.13).ConclusionEthanol may decrease the diatom count in the diatom test using NaClO. In contrast, the diatom frustules do not dissolve through three-times digestion using NaClO.     

关节镜清理术联合透明质酸钠治疗膝骨性关节炎的效果

目的探讨关节镜清理术联合透明质酸钠治疗膝骨性关节炎患者的效果。方法100例膝骨性关节炎患者随机分为两组各50例,对照组采用关节镜清理术治疗,实验组采用关节镜清理术联合透明质酸钠治疗,比较两组的关节液炎性因子水平、膝关节功能以及疼痛情况。结果治疗后,实验组的TNF-α、IL-6、IL-8水平均显著低于对照组(P<0.05)。治疗1个月、3个月、6个月后,实验组的Lysholm评分均显著高于对照组,VAS评分均显著低于对照组(P<0.05)。结论关节镜清理术联合透明质酸钠治疗膝骨性关节炎可降低患者关节液炎性因子水平,改善膝关节功能,减轻疼痛。     

Four cases of sodium nitrite suicidal ingestion: A new trend and a relevant Forensic Pathology and Toxicology challenge

Sodium nitrite (NaNO₂) is an inorganic compound commonly used as a food additive, antifreeze admixture, and fertilizer. Its toxicity mechanism is mainly represented by the oxidation of ferrous iron to ferric iron of one of the four heme structures in haemoglobin with the onset of methaemoglobin. The mechanism of death by sodium nitrite toxicity is severe hypoxia. We present four cases of suicidal sodium nitrite ingestion that closely occurred within a two months-period. Self-poisoning with sodium nitrite actually represents an increasing trend in nitrates’ related deaths. In order to reach a precise diagnosis of NaNO₂ intoxication, a complete toxicological analysis should be carried out including not only MetHb blood levels but also nitrites and nitrites in standard or alternative matrices as a routine procedure. Autopsy should be carefully performed to detect common indicators of hypoxia or more rarely evident typical by themselves-non specific signs of sodium nitrite toxicity. Suicidal manner of death should be carefully considered when circumstantial data support that ingestion of large amounts of NaNO₂ occurred as a consequence of a self-injurious behaviour. Relevant informations include victim’s previous Internet or book researches about paths to follow to commit suicide with sodium nitrate, employment and past medical history, with strong regard to psychiatric diseases as well as eventual taking psycotropic drugs.Finally, an accurate integration of autoptic and toxicological results with circumstantial data is necessary to make correct diagnosis of death due to acute respiratory failure secondary to suicidal sodium nitrite ingestion.     

绝经后妇女骨关节炎合并骨质疏松三联治疗的临床观察

目的探讨绝经后妇女骨关节炎合并骨质疏松三联治疗的临床效果。方法选取2017年4月至2018年3月在我院治疗的64例绝经后骨关节炎合并骨质疏松患者进行研究,按照简单随机法将患者分为对照组、观察组,对照组予以非甾体类药物(NSAID)+玻璃酸钠治疗,观察组予以NSAID+玻璃酸钠+依降钙素治疗。比较两组患者的治疗效果及治疗前后VAS评分、Lysholm膝关节评分、WOMAC评分、腰骨密度值变化。结果对照组患者治疗有效率为78.13%,观察组治疗有效率为93.75%,观察组患者治疗有效率高于对照组(P0.05)。两组患者治疗后骨密度高于治疗前(P0.05);而在治疗后3个月、6个月,观察组患者骨密度高于对照组(P0.05)。两组患者治疗后VAS评分、Lysholm膝关节评分、WOMAC评分低于治疗前(P0.05);而在治疗后3个月、6个月,观察组患者VAS评分、Lysholm膝关节评分、WOMAC评分均低于对照组(P0.05)。结论 NSAID、玻璃酸钠、依降钙素联合应用于绝经后妇女骨关节炎合并骨质疏松治疗,不仅可提高治疗效果,改善膝关节功能,还能提高活动度及患者生活质量,应用于临床可起到积极作用。     

发作性睡病的药物治疗进展

发作性睡病是致残性白天睡眠增多的最常见原因之一，其治疗旨在减少白天睡眠增多和猝倒，改善夜间睡眠紊乱、睡眠瘫痪及与睡眠有关的幻觉。2019年，组胺H3受体拮抗剂替洛利生（Pitolisant）和多巴胺及去甲肾上腺素再摄取抑制剂索利氨酯（Solriamfetol）分别在欧盟和美国上市，前者具有促醒和抗猝倒作用，后者也有促醒作用，且戒断症状和滥用的发生率更低。目前，控释型羟丁酸钠（FT218）、低钠型羟丁酸盐（JZP-258）、选择性去甲肾上腺素再摄取抑制剂（瑞波西汀，又称AXS-12）以及莫达非尼联合氟卡尼制剂（THN102）等药物仍在开发和测试中，均可作为治疗发作性睡病相关白天睡眠增多和猝倒的潜在药物。本文重点介绍这些最近研发的发作性睡病治疗药物。     

Pediatric bowel preparation: Sodium picosulfate,magnesium oxide,citric acid vs polyethylene glycol,a randomized trial

BACKGROUND Bowel preparation in children can be challenging.AIM To describe the efficacy, safety, and tolerability of sodium picosulfate, magnesium oxide, and citric acid(SPMC) bowel preparation in children.METHODS Phase 3, randomized, assessor-blinded, multicenter study of low-volume, divided dose SPMC enrolled children 9-16 years undergoing elective colonoscopy. Participants 9-12 years were randomized 1:1:1 to SPMC ? dose × 2, SPMC 1 dose × 2, or polyethylene glycol(PEG). Participants 13-16 years were randomized 1:1 to SPMC 1 dose × 2 or PEG. PEG-based bowel preparations were administered per local protocol. Primary efficacy endpoint for quality of bowel preparation was responders(rating of ‘excellent' or ‘good') by modified Aronchick Scale. Secondary efficacy endpoint was participant's tolerability and satisfaction from a 7-item questionnaire. Safety assessments included adverse events(AEs) and laboratory evaluations.RESULTS 78 participants were randomized, 48 were 9-12 years, 30 were 13-16 years. For the primary efficacy endpoint in 9-12 years, 50.0%, 87.5%, and 81.3% were responders for SPMC ? dose × 2, SPMC 1 dose × 2, and PEG groups, respectively. Responder rates for 13-16 years were 81.3% for SPMC 1 dose × 2 and 85.7% for PEG. Overall, 43.8% of participants receiving SPMC 1 dose × 2 reported it was ‘very easy' or ‘easy' to drink, compared with 20.0% receiving PEG. Treatment-emergent AEs were reported by 45.5% of participants receiving SPMC 1 dose × 2 and 63.0% receiving PEG.CONCLUSION SPMC was an efficacious and safe for bowel preparation in children 9-16 years, with comparable efficacy to PEG. Tolerability for SPMC was higher compared to PEG.     

角膜内皮移植术后早期玻璃酸钠对泪膜及角膜上皮细胞再生的作用

目的　研究1 g·L^-1和3 g·L^-1玻璃酸钠（hyaluronate，HA）滴眼液对角膜内皮移植术后早期泪膜及角膜上皮细胞再生的作用。方法　选择2017年9月至2018年2月在北京大学第三医院行角膜内皮移植术的患者60例（60眼），随机分成1 g·L^-1HA组和3 g·L^-1HA组，每组各30例，观察标准干眼评估问卷（SPEED）评分、结膜角膜染色评分（OSS）、泪膜破裂时间（TBUT）、角膜上皮缺损范围，进行激光共聚焦显微镜检查。比较不同时间点组间、组内各指标差异。结果　SPEED评分:各时间点两组间比较差异均无统计学意义（均为P>0.05）。组内比较:两组组内术后7 d、14 d、28 d均低于前一时间点（均为P=0.000），余相邻时间点两两比较差异均无统计学意义（均为P>0.05）。TBUT:术后7 d、14 d、28 d 3 g·L^-1HA组均显著高于1 g·L^-1HA组（均为P<0.05），而术前组间差异不显著；组内比较:1 g·L^-1 HA组后一时间点较前一时间点、3 g·L^-1HA组术后7 d较术前均显著延长(均为P<0.05)，而3 g·L^-1HA组术后14 d、28 d与前一时间点差异均无统计学意义（均为P>0.05）。 OSS评分:术前及术后1 d、3 d两组间比较差异均无统计学意义（均为P>0.05），术后7 d、14 d、28 d 3 g·L^-1HA组均显著低于1 g·L^-1HA组（均为P<0.05）；组内比较:两组术后1 d OSS评分均显著高于术前（均为P=0.000），其余时间点两组均低于前一时间点（均为P=0.000）。角膜上皮缺损范围:术后1 d 两组间比较差异均无统计学意义（均为P>0.05），术后3 d、7 d 两组间比较，以及两组组内与前一时间点比较差异均有统计学意义（均为P<0.05）。角膜基底细胞密度:术前、术后28 d两组间比较，以及1 g·L^-1HA组组内术前与术后28 d比较差异均无统计学意义（均为P>0.05），而3 g·L^-1 HA组术后28 d显著低于术前（P=0.002）。结论　HA可以有效改善角膜内皮移植术后早期泪膜状态并促进角膜上皮细胞再生，存在浓度依赖性。     

嘌呤配体P2X门控离子通道型受体7及其下游分子在痛风性关节炎中作用机制的研究进展

目前随着痛风性关节炎的发病率逐年上升,对该病炎性反应及疼痛机制的研究越来越多,该病主要由尿酸盐沉积及ATP刺激P2X7R、Nod样受体蛋白3、NEK7表达诱导炎性反应递质成熟与分泌所致,但具体机制尚不明确。现对P2X7R、NLRP3、NEK7的国内外研究进展进行综述,以探讨GA炎性反应及疼痛的发病机制,为防治GA提供新思路与治疗靶点。