过敏所致急性纤维素性机化性肺炎的诊治经验及文献复习

急性纤维素性机化性肺炎是一种罕见类型的间质性肺疾病,其病因及相关发病机制尚不明确,国内外关于此项疾病的研究及报道较少,亦无明确的诊断标准与规范的治疗方案。报道多为感染或药物不良反应相关,对过敏所致的此类疾病报道罕见,本文总结了成功诊治的一例此类患者相关诊疗经过,并做相关文献复习,以提高对该疾病的认识,避免误诊漏诊,同时提供一治疗方案供临床参考。     

Anti‐inflammatory effects of haptoglobin on LPS‐stimulated macrophages: Role of HMGB1 signaling and implications in chronic wound healing

Nonhealing wounds possess elevated numbers of pro‐inflammatory M1 macrophages, which fail to transition to anti‐inflammatory M2 phenotypes that promote healing. Hemoglobin (Hb) and haptoglobin (Hp) proteins, when complexed (Hb‐Hp), can elicit M2‐like macrophages through the heme oxygenase‐1 (HO‐1) pathway. Despite the fact that nonhealing wounds are chronically inflamed, previous studies have focused on non‐inflammatory systems, and do not thoroughly compare the effects of complexed vs individual proteins. We aimed to investigate the effect of Hb/Hp treatments on macrophage phenotype in an inflammatory, lipopolysaccharide (LPS)‐stimulated environment, similar to chronic wounds. Human M1 macrophages were cultured in vitro and stimulated with LPS. Concurrently, Hp, Hb, or Hb‐Hp complexes were delivered. The next day, 27 proteins related to inflammation were measured in the supernatants. Hp treatment decreased a majority of inflammatory factors, Hb increased many, and Hb‐Hp had intermediate trends, indicating that Hp attenuated overall inflammation to the greatest extent. From this data, Ingenuity Pathway Analysis software identified high motility group box 1 (HMGB1) as a key canonical pathway—strongly down‐regulated from Hp, strongly up‐regulated from Hb, and slightly activated from Hb‐Hp. HMGB1 measurements in macrophage supernatants confirmed this trend. In vivo results in diabetic mice with biopsy punch wounds demonstrated accelerated wound closure with Hp treatment, and delayed wound closure with Hb treatment. This work specifically studied Hb/Hp effects on macrophages in a highly inflammatory environment relevant to chronic wound healing. Results show that Hp—and not Hb‐Hp, which is known to be superior in noninflammatory conditions—reduces inflammation in LPS‐stimulated macrophages, and HMGB1 signaling is also implicated. Overall, Hp treatment on M1 macrophages in vitro reduced the inflammatory secretion profile, and also exhibited benefits in in silico and in vivo wound‐healing models.     

Batch to batch optimal control based on multiinput multioutput adaptive hinging hyperplanes prediction and Kalman filter correction

A batch to batch optimal control strategy based on multiinput multioutput adaptive hinging hyperplanes (MIMO AHH) prediction and Kalman filter correction is proposed for the products quality control of the batch process. The model of AHH is one kind of piecewise linear models and is extended to the MIMO case in this article. The MIMO AHH is then used to develop the predictive model of the batch process. Due to the model-plant mismatch and unknown disturbances, the optimal control policy calculated based on the MIMO AHH predictive model may not be optimal when applied to the true process. The Kalman filter is then utilized to correct the predictions of the current batch by considering the information of former batches. The effectiveness of the proposed strategy is verified through the simulation of a styrene batch polymerization reactor.     

Numerical modeling and simulations of type B aortic dissection treated by stent-grafts with different oversizing ratios

Retrograde type A dissection after thoracic endovascular aortic repair has been a major drawback of endovascular treatment. This study investigated the biomechanical mechanism of stent-graft-induced new lesions after implantation and analyzed the relationship between radial force and spring-back force of the stent-graft when it was implanted virtually under different oversizing ratios. Based on the computed tomography angiography images, a three-dimensional geometric model of a patient-specific aortic dissection was established. The stent was designed in CAD software and the stent-graft implantation procedure under different oversizing ratios was simulated in the finite element analysis software. Implantation simulations were performed six times for each stent-graft model under 0%, 3%, 6%, 9%, 12%, and 15% oversizing ratios and the peak stress of the aorta was compared among groups. It was observed that the peak stress of the aorta was located where the proximal bare stent interacted with aortic wall and its value was increased by 62.2% from 0% to 15% oversizing ratio. The conclusions are reached that the long-term higher stress in the aortic wall may lead to the emergence of new lesions in these areas, and the radial force plays a key role in the formation of a new entry in the real aorta model.     

Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome. It is curable by excision of the causative tumor. However, a few cases may persist or relapse after tumor resection. We aimed to investigate the rate of these events and related factors. We retrospectively studied TIO patients treated with surgery in a tertiary hospital. TIO was established based on a pathologic examination or the reversion of hypophosphatemia. Refractory TIO patients consisted of those with nonremission or recurrent hypophosphatemia after surgery. A total of 230 patients were confirmed as having TIO. After primary surgery, 26 (11.3%) cases persisted, and 16 (7.0%) cases recurred. The overall refractory rate was 18.3%. The median time of recurrence was 33 months. Compared with patients in the recovery group, patients in the refractory group were more likely to be female (59.5% versus 41.0%, p = .029) and have a lower serum phosphate level (0.44 ± 0.13 versus 0.50 ± 0.11 mmol/L, p = .002). The refractory rate was lowest in head/neck tumors (7.5%) and highest in spine tumors (77.8%). Regarding the tissue involved of tumor location, the refractory rate was higher in tumors involving bone than tumors involving soft tissue (32.7% versus 7.0%, p < .001). The outcomes of malignant tumors were worse than those of benign tumors (p < .001): nonremission rate, 21.4% versus 9.7%; recurrence rate, 28.6% versus 6.5%. In the multivariate regression analysis, female sex, spine tumors, bone tissue-involved tumors, malignancy, and low preoperation serum phosphorus levels were identified as risk factors for refractory outcomes. High preoperative fibroblast growth factor 23 (FGF23) levels were also associated with refractory after adjusting for involving tissue and tumor malignancy. In summary, we are the first to report the rate and clinical characteristics of refractory TIO in a large cohort. For patients with multiple risk factors, especially spine tumors, clinical practitioners should be aware of a poor surgical prognosis. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.     

Trends in emergency department utilization following common operations in New York State, 2005–2014

Surgical Endoscopy - ED overutilization is a leading cause of increased healthcare costs and a key target for healthcare reform. ED utilization patterns following common operative procedures are...     

三级甲等综合医院护士情域能力及影响因素研究

目的调查贵州省三级甲等综合医院临床护士情域能力现状并探讨影响因素,为采取干预措施提高情域能力提供参考。方法采用护士情域能力评价量表对贵州省9个州市45个临床科室的1 823名临床护士进行调查。结果临床护士情域能力评价量表总得分、专业信念感知能力、专业内涵领悟能力、专业价值评价能力、专业价值内化能力得分分别为108.61±22.53、21.71±4.82、30.34±6.43、26.48±5.51、30.08±6.72。护士年龄、岗位、最高学历、是否门急诊片区及离异是临床护士情域能力的主要影响因素(P0.05,P0.01)。结论贵州省三级甲等综合医院临床护士情域能力处于较高水平,可制定针对性干预措施加强对低年资、无职务、学历较低、门急诊片区、离异护士情域能力的培训。