经面罩机械通气治疗慢性阻塞性肺疾病呼吸衰竭患者的回顾性分析

目的 评价经面罩机械通气(FMMV)治疗慢性阻塞性肺疾病(COPD)呼吸衰竭患的疗效及影响因素；比较FMMV与人工气道机械通气(ETMV)的效果和效率。方法 (1)根据呼吸机和面罩的性能、连接方式、通气方法分为初期、中期、完善期和推广期，比较FMMV的效果和副作用。(2)选择进行FMMV，以符合建立人工气道条件的患与ETMV比较。结果 FMMV患占总机械通气(MV)患的比例、FMMV的有效率、住院患的总有效率逐期上升，4期分别为48％(11／23)、79％(15／19)、85％(29／34)、91％(223／246)；46％(5／11)、67％(10／15)、83％(24／29)、89％(198／223)；71％(35／49)、71％(20／28)、81％(34／42)、88％(234／266)。鼻梁部糜烂和胃胀气的比例逐期下降，4期分别为27％(3／11)、13％(2／15)、7％(2／29)、2％(4／223)、46％(5／11)、40％(6／15)、21％(6／29)、5％(11／223)。与ETMV比较，FMMV患的机械通气时间、住院时间缩短，呼吸机相关性肺炎的发生率下降，住院患的有效率升高。结论 技术因素、呼吸机和面罩性能是影响FMMV效果的主要因素，FMMV可用于大部分COPD呼吸衰竭患，且较ETMV有更好的效果和更高的效率，ETMV是FMMV的必要补充。     

结核分枝杆菌持留状态体内外模型的建立与检测

目的建立体内外结核分枝杆菌持留状态模型，检测在不同条件和化疗阶段中结核分枝杆菌持留菌，探讨其与化学治疗的关系。方法应用低氧培养、定量逆转录聚合酶链反应测定结核分枝杆菌异柠檬酸裂解酶（ICL）、小分子热休克蛋白（Acr）及85B蛋白的mRNA表达变化的方法检测体内外模型中结核分枝杆菌持留菌。结果体外及动物模型中均存在结核分枝杆菌低氧培养阳性，体外模型中结核分枝杆菌ICLmRNA和Acr蛋白mRNA在低氧条件下表达逐渐增加，4d时显著增加，其对数值分别为（5．3±0．9）和（6．4±1．6）拷贝／ml，而85BmRNA在有氧条件下明显增加，10d时的对数值为（6．1±0．9）拷贝／ml，在低氧条件下无明显变化。在小鼠感染与治疗模型中，ICLmRNA在感染的2周和4周均有表达，在治疗4周后下降；AermRNA在感染4周及治疗4周不表达或表达很少，治疗8和10周表达量增加，10周的对数值为（6．2±1．7）拷贝／ml，治疗12周直至停药后4周仍有表达，停药4周的对数值为（3．0±1．6）拷贝／ml；而85B蛋白mRNA则在治疗前高表达，对数值为（6．4±1．1）拷贝／ml，随着治疗时间延长而逐渐降低，治疗12周时测定值为阴性。结论成功建立了结核分枝杆菌持留状态的体外及动物模型，ICLmRNA、Acr蛋白mRNA高表达可作为持留菌存在的标志，应用液体低氧培养并联合mRNA检测有可能检测到结核分枝杆菌持留菌。     

A controlled crossover human volunteer study of the in vivo filtration efficacy of a high-efficiency particulate air-filtering oxygen mask

Nosocomial airborne disease transmission can be important in some epidemics. An oxygen mask incorporating a high-efficiency particulate (HEPA) filter may reduce the chance of inhaling airborne particles. In a randomized controlled crossover volunteer study, the median ratio of ambient:intramask 0.02 to 1-μ particles was significantly higher for the HEPA oxygen mask than for a Hudson-type mask (P < .001), and was ≥100 in 59%-64% of subjects. The use of HEPA masks may protect patients receiving supplementary oxygen against airborne pathogens.     

A pilot study on the use of the humanized anti-interleukin-2 receptor antibody daclizumab in active ulcerative colitis

OBJECTIVES: Medical therapy of refractory ulcerative colitis (UC) is associated with long-term side effects of cyclosporine and steroids. Because cyclosporine acts by inhibiting interleukin-2 (IL-2) production, we studied the efficacy and safety of humanized anti-IL2 receptor (CD25) antibodies daclizumab for refractory UC in an open label pilot study. METHODS: Ten patients with chronically active UC received daclizumab, 1 mg/kg i.v. twice with a 4-wk interval. Clinical, endoscopic, and histological evaluation was scored at regular intervals. CD25 immunohistochemistry was followed in mucosal biopsies. The primary study endpoint was clinical improvement at wk 8. RESULTS: Nine of 10 patients completed the study. The median clinical activity score decreased from a median of 8 (95% CI = 7.2-9.2) at baseline to 3.5 (95% CI = 1.4-4.9) at wk 8 (p < 0.005). Endoscopic scores were significantly decreased at wk 8 (wk 0: 8, 95% CI = 6.3-8.5; wk 8: 5.0, 95% CI = 2.6-6.3; p < 0.01). Mucosal biopsies showed a significant decrease in CD25+ cells, and there was a trend toward lower histology scores at wk 8. Quality of life as assessed by the Inflammatory Bowel Disease Questionnaire increased after therapy (baseline: 131, 95% CI = 119-178; wk 8: 169; 95% CI = 124-216, p < 0.05). Nausea was most frequently reported as an adverse event, but always in patients that were concomitantly started on azathioprine. CONCLUSIONS: The anti-IL-2R antibody daclizumab was safe and well tolerated in acute UC. Patients experienced clinical benefit along with signs of endoscopic improvement, but further controlled trials are needed to determine the therapeutic benefit of this compound.     

A pilot study of the immune response to whole inactivated avian influenza H7N1 virus vaccine in mice

Background Highly pathogenic avian influenza (HPAI) outbreaks in domestic poultry bring humans into close contact with new influenza subtypes and represent a threat to human health. In 1999, an HPAI outbreak of H7N1 virus occurred in domestic poultry in Italy, and a wild‐type virus isolate from this outbreak was chosen as a pandemic vaccine candidate. Objectives We conducted a pilot study to investigate the kinetics of the humoral immune response induced after immunisation with an egg grown whole inactivated H7N1 virus vaccine in BALB/c mice. Methods Mice were vaccinated with one or two doses of H7N1 vaccine (15 μg total protein) to investigate the influenza specific antibody secreting cell (IS‐ASC) and serum antibody responses. Results After the first dose of vaccine, only IgM IS‐ASC were detected in the spleen and bone marrow, whereas IgG, IgA and IgM IS‐ASC were found after the second dose. Low antibody titres were detected after the first immunisation, whilst the second dose of vaccine significantly boosted the HI (range 128–512), neutralising and IgG antibody titres. The IgG subclass response was dominated by IgG2a indicating a dominant Th1 response after the first vaccination, whereas a more mixed Th1/Th2 profile was observed after the second dose. Conclusions This pilot study shows the value of using a number of immunological methods to evaluate the quality of the immune response to potential pandemic candidate vaccines.     

Effects of concomitant use of hydrogen water and photobiomodulation on Parkinson disease: A pilot study

Background:Parkinson disease (PD), the second most common neurodegenerative disease, has no cure or applicable disease-modifying approach, only symptomatic therapy. Oxidative stress and mitochondrial dysfunction play key roles in PD pathophysiology. Animal studies have demonstrated that photobiomodulation (PBM) may enhance mitochondrial function and boost adenosine triphosphate production, thus alleviating PD symptoms; however, this process can cause increased reactive oxygen species (ROS) production. Molecular hydrogen (H₂) is a potent and possibly therapeutic antioxidant that can mitigate the effect of ROS. PBM targeting the brainstem may facilitate neuronal activity, and the concomitant H₂ may clear additional ROS produced by PBM. Therefore, this study aimed to determine the safety and effectiveness of PBM + H₂ in patients with PD.Methods:We included 18 patients with PD (age 30–80 years) who were at Hoehn and Yahr stages II-III. All the participants received daily PBM + H₂ therapy for 2 weeks. The adverse event and the Unified Parkinson Disease Rating Scale (UPDRS) scores were recorded.Results:We noted that the UPDRS scores began significantly decreasing from the first week, and this improvement persisted until the end of therapy. Moreover, no adverse event was recorded. After 1 week of therapy cessation, UPDRS scores slightly increased but the improvement remained significant compared with the baseline.Conclusion:This novel, proof-of-concept study demonstrated that PBM+H₂ therapy is safe and reduces disease severity. A larger-scaled clinical trial is warranted to completely investigate the effects of PBM + H₂ therapy on PD.     

A pilot study to investigate the feasibility and cardiac effects of pegylated liposomal doxorubicin (PL-DOX) as adjuvant therapy in medically fit elderly breast cancer patients

In this pilot study, we examined the feasibility and toxicity in 16 elderly women age > or =65 receiving six cycles of pegylated liposomal doxorubicin (PL-DOX) cyclophosphamide as adjuvant chemotherapy for breast cancer. An extensive cardiologic assessment was also performed including echocardiographic Doppler-based strain rate imaging (SRI), a promising new sensitive technique to assess cardiac function. All but one patient finished the six planned cycles without major dose reductions or delay, and with limited serious toxicity showing the feasibility of this regimen. Significant decreases in radial strain and strain rate were found after six cycles of treatment while left ventricle ejection fraction remained unchanged. SRI may be a useful tool in the follow-up of elderly patients treated with anthracyclines, allowing early initiation of preventive measures in order to prevent further irreversible cardiac damage.     

A pilot study of the short-term use of simvastatin in sickle cell disease: effects on markers of vascular dysfunction

Sickle cell disease (SCD) is characterized by progressive vascular injury and its pathophysiology is strikingly similar to that of atherosclerosis. Statins decrease inflammation and improve endothelial function in cardiovascular disease, but their effect in SCD is not known. In this pilot study, we examined the safety and effect of short-term simvastatin on biomarkers of vascular dysfunction in SCD. We treated 26 SCD patients with simvastatin, 20 or 40 mg/d, for 21 d. Plasma nitric oxide metabolites (NOx), C-reactive protein (CRP), interleukin-6 (IL-6), vascular cell adhesion molecule-1 (VCAM-1), tissue factor (TF) and vascular endothelial growth factor (VEGF) were analyzed and responses to simvastatin were compared between the two treatment groups. Simvastatin increased NOx levels by 23% in the low-dose (P =0·01) and 106% in the moderate-dose (P =0·01) groups, and by 52% overall (P=0·0008). CRP decreased similarly in both dose groups and by 68% overall (P =0·02). Levels of IL-6 decreased by 50% (P=0·04) and 71% (P<0·05) in the low- and moderate-dose groups, respectively. Simvastatin had no effect on VEGF, VCAM1 or TF. Simvastatin was well-tolerated and safe. Our preliminary findings showing a dose-related effect of simvastatin on levels of NOx, CRP and IL-6 suggest a potential therapeutic role for simvastatin in SCD.     

双水平正压通气与面罩大流量吸氧早期治疗老年急性心源性肺水肿对比研究

目的对比研究双水平正压通气（BiPAP）与面罩大流量吸氧（MASK）早期治疗老年急性心源性肺水肿（ACPE）的临床结果.方法对68例接受BiPAP治疗与26例接受MASK治疗的老年ACPE患者进行回顾性对比研究,统计分析自入院时BiPAP/MASK治疗前和治疗2 h后呼吸频率（RR）、心率（HR）、平均动脉压（MAP）、血气指标的变化及住院期治疗终点结果.结果与MASK组比较,BiPAP组治疗2 h后,患者临床症状与体征的改善明显、迅速,其SaO2、PaO2显著升高,HR、RR及MAP显著下降（组间及组内治疗前后比较均P＜0.01）,住院期的气管插管率、肺部感染并发率及病死率均显著降低（P＜0.05或P＜0.01）.结论BiPAP能更迅速、有效地缓解老年ACPE患者临床症状与体征,改善气体交换,降低心脏后负荷,减少住院期气管插管率、肺部感染并发率及病死率,可作为老年ACPE患者的首选治疗.     

A pilot study of the accuracy of onsite immunoassay urinalysis of illicit drug use in seriously mentally ill outpatients

Objectives: This pilot study investigated the accuracy of onsite immunoassay urinalysis of illicit drug use in 42 outpatients with co-occurring substance use disorders and serious mental illness. Methods: Up to 40 urine samples were submitted by each participant as part of a larger study investigating the efficacy of contingency management in persons with co-occurring disorders. Each sample was analyzed for the presence of amphetamine, methamphetamine, cocaine, marijuana, and opiates or their metabolites using onsite qualitative immunoassays. One onsite urinalysis was randomly selected from each participant for confirmatory gas chromatography–mass spectrometry (GC–MS) analyses. Results: Agreement between immunoassay and GC–MS was calculated. Agreement was high, with 98% agreement for amphetamine, methamphetamine, opiate, and marijuana. Agreement for cocaine was 93%. Conclusions: Results of this pilot study support the use of onsite immunoassay screening cups as an assessment and outcome measure in adults with serious mental illness. Scientific significance: Data suggest that onsite urinalysis screenings may be a helpful assessment tool for measuring clinical and research outcomes.