肺孢子虫肺炎大鼠支气管肺泡灌洗液酶含量变化及大蒜素治疗对其影响

目的 研究卡氏肺孢子虫肺炎(PCP)大鼠支气管肺泡灌洗液(BALF)酶含量变化以及大蒜素治疗对其影响。 方法 用地塞米松连续肌肉注射Wistar大鼠， 诱导建立PCP大鼠模型。诱导第3、6、9周分别于后腿肌肉深部注射大蒜素治疗（10 mg/kg， 1次/d， 连续5 d）。同时设甲氧苄氨嘧啶(TMP)?鄄磺胺甲基异噁唑(SMZ)治疗对照组(SMZ/TMP组)、 PCP模型对照组和空白对照组。 于最后1次治疗3 d后处死大鼠， 无菌收集BALF， 测定谷草转氨酶(AST)、 谷丙转氨酶(ALT)、 胆碱脂酶(CHE)、 碱性磷酸酶(ALP)、 乳酸脱氢酶(LDH)、 肌酸激酶(CK)及其同工酶(CKMB)、 a?鄄羟丁酸脱氢酶(HBDH)、 a?鄄L?鄄岩藻糖甘酶(AFU)、 5′-核苷酸酶(5′NT)及腺苷脱氨酶(ADA)含量。 结果 PCP模型组ALP含量［（573.41 ± 350.63） U/L］显著高于空白对照组［（210.56 ± 114.41） U/L］（q=4.682， P<0.01）、 大蒜素治疗组［（392.07 ± 217.57） U/L］（q=3.851， P<0.05）以及SMZ/TMP组［（325.21 ± 180.65） U/L］（q=4.380， P<0.01）。 CK、 CKMB及5′NT含量， PCP模型对照组［依次为948.94 ± 403.43、 489.47 ± 254.46及（6.76 ± 3.11） U/L］显著高于空白对照组［426.22 ± 319.00、 213.33 ± 144.54及（3.22 ± 1.20） U/L］（q=4.696， 3.784， 3.812， P<0.05）。AST、 ALT、 CHE、 LDH、 HBDH、 AFU及ADA含量， 4组之间差异均无统计学意义(F=1.852， 0.958， 2.470， 1.423， 1.178， 1.342， 0.611， P>0.05)。 结论 PCP大鼠BALF中ALP、 CK、 CKMB及5′NT含量显著升高, 大蒜素治疗可使ALP含量显著降低。     

纤维支气管镜肺泡灌洗治疗重症肺部感染的临床研究

目的评价经纤维支气管镜肺泡灌洗治疗重症肺部感染的临床效果及安全性。方法 68例重症肺部感染分为二组,对照组：常规抗感染、综合治疗,共33例,治疗组：常规抗感染、综合治疗加纤维支气管镜肺泡灌洗治疗,共35例。结果治疗组35例显效28例（80.0%）,有效5例（14.3%）,无效2例（5.7%）,总有效率为94.3%。对照组33例,显效15例（45.5%）,有效9例（24.2%）,无效9例（27.3%）,总有效率为72.7%,两组对比均有显著性差异（P〈0.05）,治疗组病例在咳嗽、咳痰、发热时间、住院天数均短于对照组,无严重并发症发生。结论经纤维支气管镜肺泡灌洗是治疗重症肺部感染的安全有效治疗方法。     

支气管扩张症合并支气管哮喘患者支气管肺泡灌洗液病原菌培养及药敏状况研究

目的 探讨支气管肺泡灌洗液(bronchoalveolar lavage fluids,BALF)病原菌培养及药敏试验在支气管扩张症合并支气管哮喘治疗中的临床应用价值.方法 选择90例支气管扩张症合并支气管哮喘的住院患者,收集其BALF标本进行病原菌培养及药敏试验.结果 90例患者病原菌检出阳性55例(61.1％),共57株.革兰阴性杆菌54株(94.7％),以铜绿假单胞菌为主,鲍曼不动杆菌次之;真菌2株(3.5％),为曲霉菌;革兰阳性球菌1株(1.8％),为金黄色葡萄球菌.混合菌感染2例,为鲍曼不动杆菌合并金黄色葡萄球菌1例、施氏假单胞菌合并铜绿假单胞菌1例.药敏试验发现,53株革兰阴性杆菌对妥布霉素、头孢哌酮舒巴坦、亚胺培南最敏感,对头孢噻肟、复方新诺明、左旋左氧氟沙星耐药性最高;嗜麦芽寡养食单胞菌对左旋左氧氟沙星、米诺环素及复方新诺明100％敏感;曲霉菌对两性霉素B、伊曲康唑、伏立康唑100％敏感;革兰阳性球菌只检出1株,药敏结果代表性不强,未给予深入研究.结论 支气管扩张症合并支气管哮喘患者BALF病原菌培养出细菌以革兰阴性杆菌为主,真菌感染率亦显现,革兰阳性球菌少;2种或2种以上混合细菌感染虽然占少数,但混合菌感染的出现说明各病原菌对多种抗菌药物的耐药性可能增加;药敏结果对临床治疗支气管扩张症合并支气管哮喘有重要指导意义;BALF取样部位针对性强,提供结果较可靠,培养阳性率高,临床应用价值较大;通过肺泡灌洗将有助于支气管扩张症的感染性分泌物清除,改善患者支气管阻塞,降低局部病原菌数量和浓度,有助于改善其喘息症状,并有助于控制感染.     

Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial

OBJECTIVE:

To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used.

METHODS:

This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures.

RESULTS:

The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively).

CONCLUSIONS:

In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures.     

低分子肝素对老年重症肺炎患者预后的影响

目的探讨低分子肝素抗凝治疗对老年重症肺炎预后的影响。方法选取2018年1月至2019年1月入住北京世纪坛医院呼吸与危重症医学科重症监护病房(RICU)的年龄≥65岁的重症肺炎患者100例,利用随机数字表分为两组,对照组给予常规治疗,试验组在常规治疗基础上加用低分子肝素4000 U皮下注射,每日1次,治疗14 d。分别于治疗前及治疗第3、7、14天比较两组患者急性生理和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血气分析、凝血指标、D二聚体、血常规、C反应蛋白、降钙素原,以及28天死亡率、出血率、深静脉血栓形成率。结果治疗前,两组患者的基本资料和APACHEⅡ评分差异无统计学差异(P>0.05)。治疗第3天,两组患者的APACHEⅡ评分、D二聚体、白细胞、中性粒细胞百分比和C反应蛋白水平无显著差异。治疗第7天、14天,试验组的上述指标显著低于对照组(P<0.05)。血气分析显示,仅在治疗第14天,试验组乳酸水平显著低于对照组(P<0.05)。治疗期间,两组患者凝血指标和降钙素原差异均无统计学意义(P>0.05)。试验组的28天平均死亡率为8%,显著低于对照组(24%,P<0.05)。两组患者出血发生率无显著差异(P>0.05)。试验组深静脉血栓形成率显著低于对照组(P<0.05)。结论临床上对老年重症肺炎患者应用低分子肝素辅助治疗,可减少APACHEⅡ评分,降低28天死亡率,减少医院内深静脉血栓的发生。     

Combining Micro-Raman Spectroscopy and Scanning Electron Microscopy Mapping: A Stony Meteorite Study

Meteorite characterisation represents a privileged and unique opportunity to increase our knowledge about the materials composing the Universe and, particularly, the Proto Solar System. Moreover, meteorites studies evolve contextually with the development of analytical technologies. In the present paper, the results from an unclassified stony meteorite (chondrite) characterisation have been reported on the basis of the innovative analytical protocol presented here. Advanced Mapping by micro-Raman Spectroscopy and Scanning Electron Microscopy equipped with Energy Dispersive Spectroscopy have been combined to disclose molecular and elemental features on the same regions sample at a micrometric resolution. Thanks to their non-destructive properties, the mapping tools of both instruments have been applied to single chondrules analysis and the best match between the mineralogical information and the chemical composition has been obtained. This combined approach proved to be highly suitable in disclosing the crystallinity features of the phases, with in-depth spatial and morphological details too.     

细粒棘球绦虫生殖器官形态学的光镜和电镜研究

应用光镜和电镜对细粒棘球绦虫生殖器官的形态学进行了观察。结果发现该虫是以虫体之间的异体交配为主要生殖方式；自体受精只是在未能实现异体交配时的一种补充行为，虫体阴道的结构有利于异体交配和有效生殖过程的完成。子宫壁及其内侧枝的结构对虫卵生长发育具有重要的意义。虫卵的增殖可引起孕节内其它组织和器官的萎缩和退化。生殖孔周围的触觉乳头，除具有感觉功能外，可能还有分泌性信息素和具有性信息受体，以引起虫体之间的     

我国七种白蛉咽甲的超微结构研究

目的研究不同地域的7种白蛉(白蛉属5种,司蛉属2种)咽甲内侧壁的超微结构.方法采用扫描电子显微镜进行咽甲超微结构的分析.结果白蛉咽甲的内侧壁由一些齿形结构和横嵴组成,齿形结构和横嵴的形状、数目以及排列方式在各蛉种间表现不同.结论不同种属的白蛉咽甲在超微结构上有明显的差异,可为蛉种鉴定提供形态学依据.     

可溶性髓细胞表达触发受体1对肺炎诊断价值的初步评价

目的 探讨可溶性髓细胞表达触发受体1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)在感染性肺炎诊断中的价值及意义.方法 应用固相酶联免疫吸附试验法检测42例感染性肺炎(简称肺炎)患者(重症肺炎27例,非重症肺炎患者15例)、19例非感染性间质性肺炎(简称间质性肺炎)患者和9名健康人(正常对照组)支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)及血浆中sTREM-1、肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)、IL-6的水平.结果①重症肺炎组及非重症肺炎组BALF中sTREM-1水平均高于正常对照组,(50.27±18.73)ng/L,(42.83±15.49)ng/Lvs(20.58±6.92)ng/L(P值均<0.01);间质性肺炎组BALF中sTREM-1水平[(22.77±5.90)ng/L]与正常对照组差异无统计学意义.②重症肺炎组血浆sTREM-1水平明显高于非重症肺炎组.(76.36±36.06)ng/L vs(19.46±7.73)ng/L(P<0.01);非重症肺炎组血浆sTREM-1水平高于间质性肺炎组及正常对照组,(19.46±7.73)ng/L vs(3.42±1.89)ng/L,(3.53±1.53)ng/L(P值均<0.01).③BALF及血浆中TNF-α、IL-6水平均表现为重症肺炎组高于非重症肺炎组及间质性肺炎组(P值均<0.01);非重症肺炎组及间质性肺炎组均高于正常对照组(P值均<0.05).BALF中IL-1β水平在重症肺炎组、非重症肺炎组及问质性肺炎组均高于正常对照组(P<0.05或P<0.01).结论 sTREM-1可以作为感染性肺炎有意义的辅助诊断指标,并有可能协助判断感染的严重程度.     

Epidemiology of the Rhinovirus (RV) in African and Southeast Asian Children: A Case-Control Pneumonia Etiology Study

Rhinovirus (RV) is commonly detected in asymptomatic children; hence, its pathogenicity during childhood pneumonia remains controversial. We evaluated RV epidemiology in HIV-uninfected children hospitalized with clinical pneumonia and among community controls. PERCH was a case-control study that enrolled children (1–59 months) hospitalized with severe and very severe pneumonia per World Health Organization clinical criteria and age-frequency-matched community controls in seven countries. Nasopharyngeal/oropharyngeal swabs were collected for all participants, combined, and tested for RV and 18 other respiratory viruses using the Fast Track multiplex real-time PCR assay. RV detection was more common among cases (24%) than controls (21%) (aOR = 1.5, 95%CI:1.3–1.6). This association was driven by the children aged 12–59 months, where 28% of cases vs. 18% of controls were RV-positive (aOR = 2.1, 95%CI:1.8–2.5). Wheezing was 1.8-fold (aOR 95%CI:1.4–2.2) more prevalent among pneumonia cases who were RV-positive vs. RV-negative. Of the RV-positive cases, 13% had a higher probability (>75%) that RV was the cause of their pneumonia based on the PERCH integrated etiology analysis; 99% of these cases occurred in children over 12 months in Bangladesh. RV was commonly identified in both cases and controls and was significantly associated with severe pneumonia status among children over 12 months of age, particularly those in Bangladesh. RV-positive pneumonia was associated with wheezing.     

Direct Characterization of the Relation between the Mechanical Response and Microstructure Evolution in Aluminum by Transmission Electron Microscopy In Situ Straining

Transmission electron microscopy in situ straining experiments of Al single crystals with different initial lattice defect densities have been performed. The as-focused ion beam (FIB)-processed pillar sample contained a high density of prismatic dislocation loops with the <111> Burgers vector, while the post-annealed specimen had an almost defect-free microstructure. In both specimens, plastic deformation occurred with repetitive stress drops (∆σ). The stress drops were accompanied by certain dislocation motions, suggesting the dislocation avalanche phenomenon. ∆σ for the as-FIB Al pillar sample was smaller than that for the post-annealed Al sample. This can be considered to be because of the interaction of gliding dislocations with immobile prismatic dislocation loops introduced by the FIB. The reloading process after stress reduction was dominated by elastic behavior because the slope of the load–displacement curve for reloading was close to the Young’s modulus of Al. Microplasticity was observed during the load-recovery process, suggesting that microyielding and a dislocation avalanche repeatedly occurred, leading to intermittent plasticity as an elementary step of macroplastic deformation.     

我国七种白蛉咽甲的超微结构研究

目的　研究不同地域的7种白蛉 (白蛉属5种,司蛉属2种)咽甲内侧壁的超微结构。　方法　采用扫描电子显微镜进行咽甲超微结构的分析。　结果　白蛉咽甲的内侧壁由一些齿形结构和横嵴组成 ,齿形结构和横嵴的形状、数目以及排列方式在各蛉种间表现不同。　结论　不同种属的白蛉咽甲在超微结构上有明显的差异 ,可为蛉种鉴定提供形态学依据     

Factors Associated with Pneumocystis jirovecii Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study

Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Methods This single-center retrospective cohort study included consecutive patients with RA who received MTX for at least one year. The study population was divided into PCP and non-PCP groups, depending on the development of PCP, and their characteristics were compared. We excluded patients who received biologic disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase inhibitors, and anti-PCP drugs for prophylaxis. Results Thirteen patients developed PCP, and 333 did not develop PCP. At the initiation of MTX therapy, the PCP group had lower serum albumin levels, a higher frequency of pulmonary disease and administration of DMARDs, and received a higher dosage of prednisolone (PSL) than the non-PCP group. A multivariate Cox regression analysis revealed that the concomitant use of PSL [hazard ratio (HR) 5.50, p=0.003], other DMARDs (HR 5.98, p=0.002), and serum albumin <3.5 mg/dL (HR 4.30, p=0.01) were risk factors for the development of PCP during MTX therapy. Patients with these risk factors had a significantly higher cumulative probability of developing PCP than patients who lacked these risk factors. Conclusion Clinicians should pay close attention to patients with RA who possess risk factors for the development of PCP during MTX therapy.     

Effect of Electrocautery on Endothelial Integrity of the Internal Thoracic Artery: Ultrastructural Analysis with Transmission Electron Microscopy

The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting.Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson''s trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA.In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04).The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.