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急性缺血性脑卒中是由于脑血流突然中断而导致脑组织缺血、坏死的一种严重危害人类健康的疾病.近年来在尽早开通闭塞的脑血管,特别是在使用重组组织型纤溶酶原激活剂进行溶栓治疗方面取得了很大进展,然而在世界范围内卒中仍然是导致死亡和残疾的主要原因.并且由于溶栓治疗的时间窗过于狭窄,只有极少部分的患者能从中受益,因此迫切需要寻求一种新的、不受时间限制的方法来治疗脑卒中.     

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编者按:近年有不少新型免疫抑制剂问世,如吗替麦考酚酯、来氟米特、他克莫司及西罗莫司等,除来氟米特外,上述各药均是先用于器官移植抗免疫排斥反应,而后才扩展至内科免疫介导性疾病包括某些肾脏病治疗.     

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炎症性肠病(inflammatory bowel disease,IBD)是一种慢性非特异性肠道炎症性疾病,主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD).其发病机制十分复杂,尚未完全阐明.     

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甲状腺癌是一种内分泌系统中最常见的恶性肿瘤,在全身各种恶性肿瘤中约占1%~2%。其发病率随年龄增大而升高,女性较男性高出约2~3倍。甲状腺癌按病理类型分为乳头状腺癌、滤泡状腺癌、未分化癌和髄样癌。其中乳头状癌和滤泡状癌由于分化程度较高,又被称为分化型甲状腺癌(differe     

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原发性肾病综合征作为一种免疫性疾病,1985年前一直采用肾上腺皮质激素和细胞毒性药物进行治疗,1985年起环孢素A开始应用于原发性肾病综合征治疗,对激素依赖、耐受和复发型肾病综合征取得了良好疗效.     

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系统性红斑狼疮(SLE)肾脏受累多,成人60%合并肾脏受累,儿童及青少年合并肾脏受累达80%.患者常因狼疮性肾炎反复发作,迁延不愈而进展为终末期肾脏疾病(ESRD).     

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??Abstract??Since glucocorticoids have anti-inflammatory??anti-allergic??anti-toxins??anti-shock and immunosuppressive effects??they have been widely used in the treatment of respiratory diseases.Based on the guidelines for the clinical application of glucocorticoids developed by the Ministry of Health in 2011??with reference to the recent guidelines home and aboard??this paper focused on the treatment principle and treatment method of glucocorticoid in bronchial asthma??idiopathic interstitial pneumonia??allergic bronchopulmonary aspergillosis??sarcoidosis??chronic obstructive pulmonary disease and eosinophilic bronchitis and other respiratory diseases in the hope of regulating reasonable clinical application of glucocorticoid in respiratory diseases and reducing adverse reactions.     

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??Abstract??The application of glucocorticoids is a double-edged sword in the treatment of infectious diseases.Glucocorticoid shouldn’t be used in general or mild infections in principle.For shock??multiple system organ failure caused by serious infections??or for a particular target??the use of glucocorticoids may improve the prognosis and reduce certain impairments.Glucocorticoids are commonly used in severe hand foot and mouth disease(HFMD)??severe viral pneumonia??certain types of tuberculosis??orchitis complicated with brucellosis or mumps??shock caused by a variety of severe infections and so on.The timing of medication??dosage??course of treatment and side effects should be paid attention to.     

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氨基水杨酸盐(aminosalicylates)用于炎症性肠病(inflammatory bowel disease,IBD)的治疗已有50余年的历史,可追溯到20世纪40年代.当时,Nana Svartz在欧洲著名的Karolinska研究所将一抗生素(磺胺吡啶)与水杨酸(5-氨基水杨酸,5-aminosalicylic acid,5-ASA)结合成水杨酸偶氮磺胺吡啶(salicylazosulfapyridine,SASP)后,成功送达关节周围滑液中,并注意到在其治疗类风湿关节炎、发挥抗菌(当时认为系链球菌感染而致关节炎)与抗炎作用的同时,合并的结肠炎也得到改善,从而被用于IBD的治疗,这是溃疡性结肠炎治疗进展的重大里程碑[1-2].     

Prone position reduces lung stress and strain in severe acute respiratory distress syndrome.

The present authors hypothesised that in severe acute respiratory distress syndrome (ARDS), pronation may reduce ventilator-induced overall stress (i.e. transpulmonary pressure (P(L))) and strain of lung parenchyma (i.e. tidal volume (V(T))/end-expiratory lung volume (EELV) ratio), which constitute major ventilator-induced lung injury determinants. The authors sought to determine whether potential pronation benefits are maintained in post-prone semirecumbent (SR(PP)) posture under pressure-volume curve-dependent optimisation of positive end-expiratory pressure (PEEP). A total of 10 anesthetised/paralysed, mechanically ventilated (V(T) = 9.0+/-0.9 mL.kg(-1) predicted body weight; flow = 0.91+/-0.04 L.s(-1); PEEP = 9.4+/-1.3 cmH(2)O) patients with early/severe ARDS were studied in pre-prone semirecumbent (SR(BAS)), prone, and SR(PP) positions. Partitioned respiratory mechanics were determined during iso-flow (0.91 L.s(-1)) experiments (V(T) varied within 0.2-1.0 L), along with haemodynamics, gas exchange, and EELV. Compared with SR(BAS), pronation/SR(PP) resulted in reduced peak/plateau P(L) at V(T)s> or =0.6 L; static lung elastance and additional lung resistance decreased and chest wall elastance (in prone position) increased; EELV increased (23-33%); V(T)/EELV decreased (27-33%); arterial oxygen tension/inspiratory oxygen fraction and arterial carbon dioxide tension improved (21-43/10-14%, respectively), and shunt fraction/physiological dead space decreased (21-50/20-47%, respectively). In early/severe acute respiratory distress syndrome, pronation under positive end-expiratory pressure optimisation may reduce ventilator-induced lung injury risk. Pronation benefits may be maintained in post-prone semirecumbent position.     

Acute lung injury and acute respiratory distress syndrome. The clinical syndrome

Acute lung injury (ALI) is a syndrome of severe acute respiratory failure defined by a constellation of clinical criteria. The exact incidence of ALI is not known, but it generally occurs in the setting of acute severe illness. The course of ALI after onset is quite variable, but outcome is associated with risk factor, age, and comorbidity. Survival from this syndrome has improved over time. Survivors often are impaired after hospital discharge but tend to improve over time; however, ALI does confer a significant additional burden on survivors with regard to pulmonary function and health-related quality of life.     

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??Abstract??Recruitment maneuver (RM) plays a key role in the treatment of acute respiratory distress syndrome.Assessment of lung recruitability may reach a good compromise between improvement of oxygenation and reduction of ventilation-induced lung injury.Lung imaging and functional assessment are two main methods to evaluate alveolar recruitment.CT remains the gold standard in the assessment of lung recruitablity.Although P-V curve and lung ultrasound can provide evidences of alveolar recruitment at bedside??the two methods can’t provide information of lung hyperinflation.Electrical impedace tomography allows bedside assessment of tidal recruitment in dependent and nondependent regions.In addition to assessment of lung recruitablity??PET/CT can also evaluate the lung inflammation during RM.Further research is required for bedside assessment of lung hyperinflation combining alveolar recruitment.     

Mechanical ventilation in acute lung injury and acute respiratory distress syndrome

Mechanical ventilation provides life-sustaining support for most patients with acute lung injury and acute respiratory distress syndrome; however, traditional approaches to mechanical ventilation may cause ventilator-associated lung injury, which could exacerbate or perpetuate respiratory failure caused initially by conditions such as pneumonia, sepsis, and trauma. This article reviews the theory, laboratory data, and results of recent clinical trials that suggest that modified ventilator strategies can reduce ventilator-associated lung injury and improve clinical outcomes.     

Hemodynamic monitoring in acute lung injury and acute respiratory distress syndrome

Hemodynamic monitoring of critically ill patients, especially those who have ALI or ARDS, is a widely practiced compilation of techniques that largely have not been demonstrated to improve patient outcomes. Indeed, some techniques, such as use of the PAC, may actually be harmful. It seems unlikely that monitoring devices themselves are unreasonably risky to use. Rather it seems more likely that operator errors in gathering and interpreting hemodynamic data and in selecting the appropriate treatment strategies are the culprits. There is promise that ongoing clinical trials and better provider education will soon result in evidence-based recommendations for monitoring the circulation in this patient population.     

Radiological imaging in acute lung injury and acute respiratory distress syndrome

Computed tomography (CT) has been utilized to study acute respiratory distress syndrome (ARDS) since the middle 1980s, when it revealed the inhomogeneous pattern of the lung lesion. Its advantages rely on the strict correlation between CT density and the lung physical density, allowing a quantification of lung compartments with different degrees of aeration. By CT scans, ARDS lung appeared to be "small" rather than "stiff," leading to the "baby lung" concept. The regional analysis revealed that this appearance derives from an evenly distributed lung edema, which tends, because of gravitational forces, to lie predominantly in the most dependent regions, leading to alveolar collapse. New data suggest that such a "sponge lung" is made by a "core," consolidated, lung portion, from which, through an inflammatory reaction, lung edema will spread, determining the collapsed and recruitable lung portion. The amount of recruitable lung varies among ARDS patients. This knowledge is necessary for a rational positive end-expiratory pressure (PEEP) setting because the amount of tissue maintained aerated by PEEP is closely associated with the amount of recruitable lung. CT scans may also help to diagnose ARDS because CT provides a good estimate of the high-permeability lung edema, the characteristic lesion of this syndrome.