布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果评价

目的 观察布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果。方法 参照随机数字表法,将2017年7月—2019年6月在某医院接受急诊治疗的40例重症支气管哮喘患者分为两组,每组各20例。对照组患者采用布地奈德治疗,观察组在对照组基础上联合福莫特罗干粉剂治疗。两组患者均治疗1个月,观察两组C反应蛋白(CRP)、血常规水平及肺功能指标[第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FCV)比值(FEV1/FCV)和最大呼气流量(PEF)]。结果 治疗期间对照组患者夜间睡眠时憋醒次数为(13.55±3.25)次,观察组患者夜间睡眠时憋醒次数为(5.25±0.95)次;组间相比,差异有统计学意义(t=10.962,P<0.05);治疗后,观察组CRP、白细胞计数、嗜酸性粒细胞比率、淋巴细胞比率分别为:(12.36±1.43)mg/L、(6.31±1.05)×109/L、(4.82±2.03)%、(20.06±2.48)%,均低于对照组的(15.98±1.95)mg/L、(8.59±1.34)×109/L、(6.79±2.68)%、(25.09±3.12)%,(t值分别为6.695、5.990、2.621、5.644,P值均<0.05);治疗后,观察组FEV1、PEF及FEV1/FCV水平分别为:(2.51±0.70)L、(3.28±0.75)L/s、(75.38±8.49)%,均高于对照组(2.02±0.52)L、(2.76±0.66)L/s、(62.63±6.89)%,(t 值分别为2.513、2.328、5.215,P值均<0.05)。结论 布地奈德联合福莫特罗干粉剂在急诊重症支气管哮喘患者的治疗中效果较好,能有效改善CRP及血常规水平,提高肺功能。     

Intratracheal administration of recombinant adenovirus containing IL-18 gene in treatment of experimental metastatic lung carcinoma

Objective: To study the treatment of experimental metastatic lung carcinoma by intratracheal injection of IL-18 gene recombinant adenovirus. Methods: (1)The mouse IL-18 mRNA was detected by RT-PCR, and the concentration of 1L-18 and associated cytokines in lung lavages and blood were determined by ELISA at different time points after intratracheal injection of IL-18 recombinant adenovirus. (2)The lung metastasis nodes, mouse survival periods and survival rates were evaluated. NK activity and CTL activity were determined by 51Cr 4 h release method. Results: (1)IL-18 mRNA was detectable in lung tissue 6 h after intratracheal use of IL-18 recombinant adenovirus, and the concentration of IL-18 in lung lavage was higher than that in peripheral blood. Neither IL-18 mRNA nor IL-18 was detectable in control group. (2) Intmtmcheal use of IL-18 recombinant adenovirus resulted in increased CTL and NK activity, longer survival time and higher survival rates compared with the control group, showing significant therapeutic effect on experimental lung metastasis. Conclusion: Intratracheal use of adenovirus vector containing IL-18 gene has therapeutic effect on the lung metastasis, denoting that gene therapy of lung diseases could be applied through airway directly with recombinant adenovirus.     

前列腺素E1治疗老年慢性肺心病急性期的疗效观察

OBJECTIVE: To investigate the effects of prostaglandin E1 (PGE1) in the treatment of chronic pulmonary heart disease in the elderlys at the acute stage. METHODS: Forty cases of chronic pulmonary heart disease at the acute stage were treated with PGE1 at the dosage of 100 micrograms.d-1 for 7 days by intravenous drop, other 40 patients with the same disease were treated without PGE1, and 20 healthy subjects were selected as controls. The level of plasma D-dimer and serum fibrin degradation products (FDP), and blood PaO2 and PaCO2 were determined. The patients' symptoms and signs were observed before and after the treatment. RESULTS: The levels of plasma D-dimer and serum FDP were significantly increased (P < 0.01) in both the PGE1 group and the control group (no PGE1) compared to the healthy subjects. In PGE1 and no PGE1 groups the levels of plasma D-dimer and serum FDP were significantly decreased (P < 0.01) after the treatment. The level of PaO2 was increased and there was no significant difference (P > 0.05) between the two groups, but the level of PaCO2 was significantly decreased (P < 0.01) in both PGE1 and no PGE1 groups, but the decreasing in the PGE1 group was lower than that in the no PGE1 group. The symptoms and signs in PGE1 group were more markedly improved than those in the no PGE1 group. CONCLUSIONS: PGE1 is effective in the treatment of chronic pulmonary heart disease in old people at the acute stage.     

纤维支气管镜在儿科呼吸系统疾病中的诊治作用

目的：探讨成人纤维支气管镜（纤支镜）在小儿呼吸系统疾病中的应用价值。方法：对107例用成人纤支镜检查的患儿的诊治结果进行分析。结果：107例均获病因诊断;21例支气管异物患者有17例成功取出异物;22例应用纤支镜进行了局部灌洗。结论：成人纤支镜BF系列各型可用于不同年龄的儿童,有助于儿科疾病的诊断;对异物的钳取安全有效;对炎症、手术后和吸入异物所致肺不张的治疗可靠,在小儿纤支镜尚未普遍开展的情况下,成人纤支镜可应急或代替使用。     

The role of bDMARDs in idiopathic inflammatory myopathies: A systematic literature review

Idiopathic inflammatory myopathies (IIM) are a group of different conditions typically affecting striate muscle, lung, joints, skin and gastrointestinal tract. Treatment typically relies on glucocorticoids and synthetic immunosuppressants, but the occurrence of refractory, difficult to treat, manifestations, may require more aggressive treatment, borrowed from other autoimmune diseases, including biologic disease modifying drugs (bDMARDs). In this regard, we conducted a systemic literature review in order to depict the current evidence about the use of bDMARDs in IIM. A total of 78 papers, published during the last 21 years, were retrieved. The majority of patients was treated with TNF-α inhibitors, whose effectiveness was assessed particularly in recalcitrant striate muscle, skin and joints involvement. Rituximab, whose evidence is supported by a large number of real-life studies and trials, seems to be an excellent option in case of ILD and anti-synthetase syndrome, while Tocilizumab, despite not meeting primary and secondary endpoints in a recently published clinical trial, proved its effectiveness in rapidly progressing ILD. Similarly, Abatacept, studied in a phase IIb clinical trial with conflicting evidence, was reported to be effective in some case reports of refractory dermatomyositis. Less data exist for anti-IL1 and anti-IL23 agents, which were employed particularly for inclusion body myositis and severe skin disease, respectively. This study provides an organ-focused assessment of bDMARDs in IIM, which display encouraging results in the treatment of refractory subsets of disease.     

Circulating and skin biopsy-present cytokines related to the pathogenesis of cutaneous lupus erythematosus

Cutaneous lupus erythematosus (CLE) is a common disease that may appear as a separate entity from systemic lupus erythematosus (SLE), precede SLE development, or occur as a manifestation of this systemic disease. It has a complex pathophysiology that involves genetic, environmental, and immune-mediated factors creating a self-amplification pro-inflammatory cycle. CLE is characterized by prominent type I interferons (IFNs) inflammation which are considered as the first precursors of the inflammatory cascade generated within the pathophysiology of CLE. TNF-α enhances the production of antibodies through the activation of B cells, and favors the expression of surface nuclear antigens on keratinocytes. UV light exposure favors keratinocyte apoptosis or necroptosis, which results in the release of multiple proinflammatory cytokines, including IL-6, IL-1α, IL-1β, TNF-α, IFNs, and CXCL10. Serum levels of IL-17 are elevated in patients with ACLE, SCLE, and DLE. Evidence suggests IL-22 plays a role primarily in tissue repair rather than in inflammation. High expression of BAFF and its receptors have been found in lesioned keratinocytes of patients with CLE, and patients with CLE have lower serum levels of the regulatory cytokines TGF-β and IL-10. The chemokines CXCL9 and CXCL10 (CXCR3 ligands) have an increased expression among these patients, and their expression is correlated with IFNs levels. CXCR3 ligands recruit cytotoxic type I cells through this receptor, further supporting the death of keratinocytes via necroptosis with the subsequent release of eNAs perpetuating the inflammatory cycle. Interface dermatitis is characterized by the presence of CXCR3-positive lymphocytes. This review describes the leading cytokines and chemokines present in the circulation and skin that play a fundamental role in the pathogenesis of CLE.     

Exosomes as biomarkers and therapeutic delivery for autoimmune diseases: Opportunities and challenges

Exosomes are spherical lipid bilayer vesicles composed of lipids, proteins and nucleic acids that deliver signaling molecules through a vesicular transport system to regulate the function and morphology of target cells, thereby involving in a variety of biological processes, such as cell apoptosis or proliferation, and cytokine production. In the past decades, there are emerging evidence that exosomes play pivotal roles in the pathological mechanisms of several autoimmune diseases (ADs), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), type 1 diabetes mellitus (T1DM), Sjogren's syndrome (SS), multiple sclerosis (MS), inflammatory bowel disease (IBD). systemic sclerosis (SSc), etc. Several publications have shown that exosomes are involved in the pathogenesis of ADs mainly through intercellular communication and by influencing the response of immune cells. The level of exosomes and the expression of nucleic acids can reflect the degree of disease progression and are excellent biomarkers for ADs. In addition, exosomes have the potential to be used as drug carriers thanks to their biocompatibility and stability. In this review, we briefly summarized the current researches regarding the biological functions of exosomes in ADs, and provided an insight into the potential of exosomes as biomarkers and therapeutic delivery for these diseases.     

First-line treatment of advanced non-small-cell lung cancer with docetaxel and cisplatin: A multicenter phase II study

Purpose: To evaluate the efficacy and safety of the docetaxel-cisplatin combination in patients with advanced non-small-cell lung cancer (NSCLC).Patients and methods: Chemotherapy-naïve patients with histologically confirmed, measurable stage IIIB or IV NSCLC, a World Health Organization (WHO) performance status of 0–2 and adequate bone marrow, renal, hepatic and cardiac function were eligible for the study. Patients received docetaxel (100 mg/m²) as an one-hour infusion on day 1 and cisplatin (80 mg/m²) as a 30-min infusion with appropriate hydration on day 2. Granulocyte colony-stimulating factor (G-CSF; 150 µg/m² , SC) was given on days 3 to 13. Treatment was repeated every three weeks.Results: Fifty-three patients were enrolled (28 with stage IIIB and 25 with stage IV). One complete and 23 partial responses were observed (overall response rate (OR): 45%; 95% CI: 34.1%–61.8%). The response rate was 57% and 32% in patients with stages IIIB and IV disease (P = NS). The median time to progression was 36 weeks and the median survival 48 weeks; the one-year survival was 48%. Grade 3–4 neutropenia occurred in 23 patients, 15 of whom were hospitalized for neutropenic fever; two patients died of sepsis. Grade 2 neurotoxicity was observed in six patients and grade 3 in five patients; grade 3 fatigue occurred in seven patients, grade 3–4 mucositis in four patients and grade 3–4 diarrhea in six patients. Mild allergic reactions and oedema were observed in five and four patients, respectively. The median dose intensity was 30 mg/m² /week for docetaxel and 24 mg/m² /week for cisplatin, corresponding to 91% and 89% of the specified protocol doses, respectively.Conclusions: The docetaxel–cisplatin combination is an active regimen in advanced NSCLC, but hematologic toxicity remains high despite the prophylactic use of G-CSF.     

Bioengineered muscle constructs and tissue-based therapy for cardiac disease

Bioengineering of contractile muscle tissues and organs for disease treatment is currently in the preclinical experimental stage of development. Cell biology over the last several decades has primarily focused on breaking down tissues and cells to smaller and smaller components to understand their functioning at the molecular level. We are just beginning to understand how to reassemble these components back into larger functional units. The merging of the fields of traditional engineering, biomaterials, cell biology, and computer science will lead to the ex vivo engineering tissues and organs for many cardiovascular applications in the future. For pediatric cardiology, bioengineered contractile tissues may serve as force generating cardiac patches, heart valve papillary muscle substitutes, or as living therapeutic protein delivery ‘devices’ when bioengineered from genetically engineered muscle cells.