CIRCULATING CATECHOLAMINES IN ASTHMA

Summary Circulating catecholamines are not abnormally elevated in asthmatics. The normal circadian fall in circulating adrenaline at night may contribute to nocturnal wheezing by facilitating release of bronchoconstrictor mast cell mediators. Asthmatics who develop exercise-induced wheezing show an impaired catecholamine response to exercise which may facilitate mediator release during exercise. Endogenous catecholamines in asthma may therefore play a modulatory role on the release of mast cell mediators.     

DRUGS AFFECTING THE LEUKOTRIENE PATHWAY IN ASTHMA

SUMMARY Drugs affecting the leukotriene pathway are emerging as a new class of asthma treatment — the first for more than 20 years. Development of these leukotriene antagonists should lead to greater understanding of the underlying processes in asthma and may result in a safe, oral, anti-asthmatic drug to benefit particular groups of asthmatic patients.     

A COMPARISON OF BECLOMETHASONE DIPROPIONATE AND BUDESONIDE IN THE TREATMENT OF ASTHMA

Several reports have claimed that beclomethasone dipropionate (BDP) and budesonide (BUD) differ with regard to therapeutic efficacy and associated adverse effects, based either upon clinical data, or upon theoretical considerations. Although long-term comparisons are lacking, the consensus of numerous studies is that these drugs are of equivalent therapeutic efficacy. Assessment of pharmacological data suggests that beclomethasone 17-monopropionate (17-BMP), the active bronchial metabolite of BDP, has a greater glucocorticoid receptor affinity than BUD and thus theoretical claims for greater efficacy of BUD based on comparison with the receptor affinity of unchanged BDP are inaccurate. Similarly, clinical experience has not revealed any significant differences between the adverse effect profiles of BDP and BUD, in terms of adrenal suppression, changes in bone metabolism and growth, or cataract formation. Critical examination reveals that those reports describing differences in efficacy or safety profile between the two drugs have study design flaws which may undermine the validity of their conclusions. Current evidence indicates that, in terms of therapeutic efficacy and safety profile, BDP and BUD are effectively indistinguishable.     

咪喹莫特治疗支气管哮喘的动物实验研究

目的 :研究咪喹莫特治疗支气管哮喘的疗效及可能的机制。方法 :建立豚鼠哮喘模型 ,随机分为 :①对照组 (哮喘组 ) ;②咪喹莫特吸入组 ;③咪喹莫特灌胃组 ;④咪喹莫特外用组 ;⑤安慰剂组。治疗 2周后 ,支气管肺泡灌洗液 (BALF)及肺组织 ,分别测定外周血IgE ,支气管肺泡灌洗液 (BALF)细胞计数、分类 ,计数肺组织切片 0 1～ 0 3mm范围的支气管壁嗜酸性粒细胞 (EOS)、淋巴细胞 (L)数。结果 :咪喹莫特治疗组外周血IgE值 ,BALF细胞计数、EOS分类及 0 1～ 0 3mm支气管周围EOS计数、L计数与对照组间或安慰剂组间有统计学意义 (P <0 0 5 ) ,而BALFL分类百分比 ,治疗组与对照组间或安慰剂组间无统计学意义。咪喹莫特治疗组间IgE值、BALF计数、EOS分类、支气管旁EOS计数、L计数方差分析均有统计学意义。 结论 :咪喹莫特能显著减轻支气管肺周围的炎性细胞的浸润 (主要表现为下调EOS与L数、EOS百分率和IgE)。咪喹莫特吸入可能是治疗支气管哮喘的一种新方法。     

重症哮喘两种血清前炎症细胞因子水平的研究

目的：探讨白细胞介素－8（IL－8）、肿瘤坏死因子（TNF－α）在哮喘中的意义。方法：用双抗体夹心ELISA法测定30例重症哮喘病人血清IL－8和TNF－α水平。结果：重症哮喘病人血清IL－8和TNF－α水平显著高于健康人和哮喘缓解期病人（P＜0．01），而缓解期与健康对照两组间比较无显著差异（P＞0．05）。血清IL－8、TNF－α与末稍血中嗜酸性粒细胞（EC）水平呈正相关（P＜0．01）。重症哮喘病人EC水平升高，缓解期亦明显高于健康对照组（P＜0．05）。结论：血清IL－8和TNF－α参与哮喘发作的过程，并且与气道炎症反应及变态反应有关，阻断它们的过度效应，对防治哮喘发作有益。     

哮喘患者血浆内皮素测定及其临床意义

应用放射免疫方法测定了27例哮喘发作、18例哮喘缓解状态患者血浆内皮素浓度，并与42例正常人进行比较。结果表明，哮喘发作患者血浆内皮素浓度明显高于正常人及哮喘缓解状态者（P值分别为P＜0．01与P＜0．05），而哮喘缓解组与正常对照组间无显著性差异（P＞0．05）。提示血浆内皮素浓度与哮喘发作有关，可能是哮喘发作的中间介质。     

基层医院临床护士职业防护相关问题调查

目的了解护理人员的护理安全以及职业防护相关问题,为制定医务人员职业防护提供依据。方法通过现场调查和问卷调查方法,对本医院200名护士掰折医用玻璃安瓿所致损伤相关问题进行了调查。结果在所调查的200名护士中,有47.28%的护士徒手掰折玻璃安瓿;有78.65%的护士被玻璃安瓿划伤手。另外,有98.02%的护士要求使用安全掰折玻璃安瓿的器具。结论徒手掰折玻璃安瓿对护士手损伤率较高,存在医院感染和其他不安全隐患,使用专门掰折玻璃安瓿的器具和严格消毒安瓿是主要防护措施。     

EXERCISE-INDUCED ASTHMA

Exercise maintained for approximately eight minutes resultsin a fall in F.E.V.¹ a rise in airway resistance, and impairedgas distribution in asthmatic subjects. These effects are usuallymaximal within 15 minutes after cessation of exercise and recoverytakes place over the next 30 minutes. Measurement of airway resistance before and after exercise innormal subjects suggests that the same mechanism is operatingin them. Hyperventilation stimulated by the inhalation of carbon dioxidehas failed to produce a similar effect. Chlorpromazine, atropine, mepyramine maleate, and hydrocortisoneadministered before exercise have failed to block the effectbut adrenaline has succeeded. It has been possible in a few subjects to lessen the effectof exercise by repeated exercise on the same day and we interpretthis as pointing towards the depletion of a bronchoconstrictorsubstance released in the earlier periods. The possible substancesare discussed.     

HYPOCHLORHYDRIA IN ASTHMA: WITH SPECIAL REFERENCE TO THE AGE INCIDENCE

1. Fractional test meals were carried out on 109 asthmatic patients.Low free acidity was found in 51.5 per cent, and low total acidin 41.2 per per cent, of cases. Excess mucus and increased combinedacidity were also present in many cases. 2. Hypochlorhydria was found to be most common in asthmaticchildren under 15, and less so in young adults: it again becamemore common in those nearing middle age. 3. It would appear that gastric acidity does not remain thesame throughout life in allergic individuals, but tends to increasein a certain percentage of cases about puberty. 4. Female asthmatics from 15 years of age upwards. showed ahigher percentage of hypochlorhydria than males of the sameage. Before 15 years of age there was practically no differencein the sex incidence. 5. Sensitivity, as shown by skin tests, bore no apparent relationshipto the hypochlorhydria. 6. Repetition of the analyses after treatment showed definitechange in 59 per cent, of cases. Improvement in gastric acidityin originally hypochlorhydric cases coincided with clinicalimprovement. 7. The probable factors in the causation of hypochlorhydriahave been discussed.     

传染科护理人员职业暴露与防护措施补遗

目的探讨传染科护理人员职业暴露的致伤原因及风险因素,提出防护对策和暴露发生后的处理措施,以降低事故发生率及其影响。方法结合传染科的特殊性质,进一步分析职业暴露的危险因素,从传染科的特殊环境、手污染、锐器伤、化学物质以及心理、社会因素等方面进行深入分析。结果制定出了加强安全防护知识学习提高风险意识,加强病区及护理装备硬件建设和业务技术培训,做好预防接种,明确锐器伤处理流程,提高护理人员生理心理的调节能力等具有针对性的职业暴露防护措施。结论切实可行的防护措施和暴露发生后及时有效的处理流程在最大程度上预防和降低了传染科护理人员的职业暴露和暴露后的感染。     

氯吡格雷对支气管哮喘小鼠脑源性神经营养因子影响

目的观察氯吡格雷对支气管哮喘小鼠血浆中脑源性神经营养因子（BDNF）的影响。方法雌性BALB/c小鼠共30只,随机分为阴性对照组（对照组）、哮喘模型组（模型组）和氯吡格雷干预组（干预组）。用酶联免疫吸附试验检测富血小板血浆中BDNF含量。结果对照组、模型组、干预组富血小板血浆BDNF水平分别为（6.11±2.34）、（26.67±7.59）（、6.28±2.63）μg/L,模型组较对照组增高,干预组较模型组降低,差异有显著性（F=28.62,q=11.34、10.56,P〈0.01）;对照组、模型组及干预组肺泡灌洗液嗜酸性粒细胞分别占（5.64±1.86）%（、24.62±2.66）%（、7.32±2.02）%,哮喘组较对照组增高,干预组较模型组降低,差异有显著性（F=25.14,q=10.39、9.62,P〈0.01）。结论支气管哮喘小鼠血浆BDNF水平增高,经氯吡格雷干预后降低。     

普米克令舒雾化吸入治疗儿童咳嗽变异性哮喘的效果

目的观察普米克令舒雾化吸入治疗儿童咳嗽变异性哮喘的效果。方法选择25例咳嗽变异性哮喘病儿,应用普米克令舒雾化吸入治疗7周。观察期内由病儿家长记录病儿日间和夜间咳嗽症状,于治疗前及治疗后1、3、5、7周随访,计算日、夜间咳嗽情况均分。结果治疗后日、夜间咳嗽情况均分较治疗前明显改善,差异有显著性（F=6．966、18．137,q=3．310～17．351,P〈0．05）。结论应用压缩雾化泵雾化吸入普米克令舒混悬液治疗幼龄儿童（≤5岁）咳嗽变异性哮喘效果显著。     

供应室医护人员职业危害防护现状调查

目的了解供应室护理人员对职业危害的防护知识与技能,做好职业防护。方法通过问卷调查方式,对石家庄市5所三级甲等医院消毒供应中心部分护士进行职业危害防护现状调查。结果供应室护士对锐器伤、辐射伤、粉尘和噪声等物理损伤因素危害的答案正确率相对偏低,而对化学消毒剂、污染物品等生物因子危害则得分较高。供应室护士对职业危害的认知水平及防护技能与其学历呈正相关。结论该市三级甲等医院供应室护理人员对职业危害的认知水平普遍较高,防护技能有待提高。     

不同剂量甲基强的松龙治疗重症哮喘的效果

目的评价不同剂量甲基强的松龙（甲强龙）治疗重症哮喘的效果。方法将60例重症哮喘病人随机分为A、B组,分别静脉应用甲强龙40、60mg,均为每8h注射1次,平均治疗3～5d,观察两组病人的临床疗效、肺功能改善及并发症情况。结果两组治疗前后最大呼气流量、用力肺活量、一秒钟用力呼气容积差异有显著性（t=10．74～19．65,P均〈0．01）;两组间治疗效果比较差异无显著性（H=0．068,P〉0．05）;B组并发症明显多于A组,差异有显著性（x^2=11．52,P〈0．05）。结论甲强龙40mg,每8h注射1次治疗重症哮喘病人较为适宜。