脓毒症肺损伤相关信号转导通路研究进展

脓毒症是由宿主对感染反应失调引起的危及生命的器官功能障碍,作为人体重要器官,肺脏极易在脓毒症时发生损伤,导致急性呼吸窘迫综合征(ARDS)的发生。脓毒症引起的 ARDS发病机制非常复杂,其确切发病机制尚不完全清楚,涉及多个信号通路被激活。本文主要综述目前研究较多的信号通路在脓毒症相关急性肺损伤(ALI)/ARDS中的作用及机制,分析信号通路不同蛋白质和基因之间的相互作用,以及不同信号通路之间的关联性,以期为探寻脓毒症相关肺损伤治疗靶点提供一定理论基础。     

中、西医对急性肺损伤/急性呼吸窘迫综合征的认识及展望

背景 急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)由肺内外多种病因引起,其发病机制复杂,病死率高. 目的 文章拟将中、西医两方面对ALI/ARDS的研究作一浅显的对比回顾c内容 综合相关文献,西医和中医无论在病理机制还是治疗方面都各有研究,其中既有相通之处又各成体系. 趋向 为中西医结合治疗ALI/ARDS提供新的线索.     

lncRNA在ALI/ARDS中潜在治疗靶点及调控机制的研究进展

长链非编码RNA(lncRNA)通过调节炎症反应、氧化应激和免疫应答等途径参与急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的发展。通过研究lncRNA在ALI/ARDS的表达变化以及其作用机制, 能更好地理解疾病的发生和发展过程。文章收集近三年为主的研究报道, 对lncRNA在ALI/ARDS中调控基因表达的作用机制、分子调控机制进行综述。概括了lncRNA在表观遗传水平、转录水平和转录后水平调控基因表达, 参与介导细胞凋亡、细胞焦亡、细胞自噬、核因子-κB(NF-κB)信号通路激活和巨噬细胞激活等, 旨在对lncRNA在ALI/ARDS发生、发展中的作用机制进行综述和展望, 探索lncRNA的治疗潜力, 为临床应用提供更多潜在的治疗靶点。     

转化生长因子-β信号通路在急性肺损伤纤维化中作用的研究进展

背景急性肺损伤(acute lung injury,ALI)是临床常见的急危重症。研究表明,转化生长因子-β(transforming growth factor-β,TGF-β)信号通路在其发生发展中扮演着重要角色。目的分析总结TGF-β信号通路与肺损伤纤维化的相关性及作用机制的文献资料。内容描述了TGF-β的生物学...     

高迁移率族蛋白1和急性肺损伤

背景 高迁移率族蛋白1(high mobility group box protein 1,HMGB1)是一种非组蛋白染色体结合蛋白,进化上高度保守.HMGB1广泛存在于细胞核内,在核内作为DNA分子伴侣,被释放至细胞外将发挥促炎作用.急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是全身性炎症的肺部表现,特征为血管通透性增高致组织水肿、器官功能障碍.越来越多的研究证实细胞外的HMGB1能够通过促进NF-κB核转位和显著增加促炎因子释放引起ALI和致死性的炎症反应.目的 阐述HMGB1和ALI之间的关系以及HMGB1在治疗ALI中的研究现况,为临床治疗ALI提供新的靶点.内容 重点回顾有关HMGB1在ALI发病中的作用、HMGB1抑制剂在改善ALI中作用的研究.趋向 HMGB1抑制剂可以改善ALI结局,在治疗ALI中具有广阔前景.     

DNA甲基化在脓毒症急性肺损伤中的研究进展

DNA甲基化是表观遗传学的修饰方式之一, 在基因表达调控和细胞分化过程中发挥重要作用。肺是脓毒症时最容易受损害的器官, 脓毒症急性肺损伤(acute lung injury, ALI)严重威胁患者生命安全, 其机制尚不完全明确。目前已对DNA甲基化在肺损伤发病过程中的作用进行了大量研究, 文章在简要介绍DNA甲基化原理和脓毒症ALI机制的基础上, 就DNA甲基化与脓毒症ALI时的炎症反应、肺血管屏障破坏、免疫紊乱的关系以及DNA甲基化转移酶抑制剂对脓毒症ALI治疗效果的研究进行综述, 以期对脓毒症ALI的发病机制及防治研究起到一定的启示作用。     

血管内皮细胞生长因子在急性肺损伤中的作用

急性肺损伤(acute lurg injury,ALI)和急性呼吸窘迫综合征(acute respiratory distressyndrome,ARDS)的特征性病理改变为肺毛细血管通透性增高所致的肺水肿,血管内皮细胞生长因子能抗血管内皮细胞凋亡并增加血管通透性,可能在ALI和ARDS的病理过程中起到重要作用.现对血管内皮细胞生长因子在ALI中的作用进行综述,旨在为ALI和ARDS的治疗提供新的思路.     

程序性细胞死亡方式在急性肺损伤/急性呼吸窘迫综合征发病机制中的研究进展

急性肺损伤(acute lung injury, ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)是一种危及生命的肺部疾病, 其临床特征为严重的低氧血症和呼吸困难。程序性细胞死亡方式在ALI/ARDS发病机制中的研究日益成为热点。程序性细胞死亡是由基因决定的细胞主动死亡方式, 除常见的凋亡、焦亡等方式外, 近年来铁死亡、坏死性凋亡、NETosis等方式逐一被发现。文章通过介绍铁死亡、坏死性凋亡、NETosis等方式在ALI/ARDS中的研究进展, 总结不同程序性细胞死亡方式在不同ALI模型中的调控机制, 为靶向治疗ALI/ARDS提供更多理论依据。     

急性肺损伤/急性呼吸窘迫综合征液体治疗策略

背景 高通透性肺水肿是急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)的基本病理生理特征,其程度与ALI/ARDS的预后密切相关.目的 对ALI/ARDS患者合理的液体管理,有助于改善ALI/ARDS患者的肺水肿,降低该病病死率.内容 回顾了ALI/ARDS液体治疗策略探索过程中存在争议的问题(如限制性或开放性的液体治疗策略及治疗液体种类的选择),总结了该领域近年来的研究进展(如ALI/ARDS病程不同阶段的差异化治疗及液体治疗的监测指标).趋向 今后将进一步探索该病在不同的病理生理状态下特异性的液体治疗方法,寻求高效敏感的监测指标,指导液体治疗策略的选择和调整.     

机械通气相关性肺损伤中α7烟碱型乙酰胆碱受体的作用和机制

背景 机械通气是治疗急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的必要措施,但同时又增加了机械通气相关性肺损伤(ventilation-induced lung injury,VILI)的发病率.而胆碱能抗炎通路是近年来发现的一种通过传出迷走神经来抑制炎症的神经-内分泌抗炎途径,其主要通过α7烟碱型乙酰胆碱受体(α7 nicotinic acetylcholine receptors type,α7nAChR)发挥作用. 目的 对α7nAChR在VILI中的作用和机制的研究进展进行回顾和总结. 内容 共4部分:①VILI研究现状与共识;②胆碱能抗炎通路的研究进展;③α7nAChR在VILI中的具体机制;④归纳总结. 趋向α7nAChR在VILI中的作用和机制错综复杂,弄清这些复杂的信号转导机制对于揭示VILI的发生机制和预防VILI的发生具有临床意义.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.