62例咽旁间隙肿瘤临床分析

目的：探讨咽旁间隙肿瘤的诊断和治疗方法及熟悉咽旁间隙解剖与肿瘤关系。方法：回顾性分析62例咽旁间隙肿瘤的临床资料。结果：咽旁间隙肿瘤中病理类型较多,但以神经鞘膜肿瘤比例较大,占41.9%,混合瘤22.6%,畸胎瘤、错构瘤、脊索瘤、恶性淋巴瘤及脑膜瘤等共占35.5%。进行以颈侧入路为主的4种手术入路,2例肿瘤复发（1例神经鞘膜瘤,1例转移癌）,再次手术治愈,其余均一次性手术治愈。结论：咽旁间隙肿瘤临床表现复杂,病理类型多样,肿瘤预后较好。其诊断较难,除症状体征外,CT、MRI及B超对咽旁间隙肿瘤的诊断有重要价值。手术径路是根据患者体征、影像学特征结合肿瘤位置、大小及性质而最终确定。颈侧入路为主要手术途径,气管切开为预防窒息措施。     

双颌板磁力矫正器治疗阻塞性睡眠呼吸暂停综合征临床观察

目的探讨双颌板磁力矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)治疗效果。方法对确诊为OSAS的患者口腔内配戴双颌磁力矫治器,并在配戴前后用CT扫描观察患者上气道截面积的变化。结果观察组19例上气道截面积均有增大,最小值从0.80cm2增加到1.71cm2;口咽上部平均值由1.05cm2增加到1.92cm2。结论口腔双颌板磁力矫治器是治疗OSAS的有效方法。     

经鼻持续气道正压通气对肺表面活性物质治疗新生儿呼吸窘迫综合征效果的影响

目的 探讨不同时间点应用经鼻持续气道正压通气(nCPAP)对肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(RDS)效果的影响.方法 对湖北科技学院附属第一医院于2013年1月-2016年6月收治的RDS 100例的临床资料进行回顾性分析.根据应用nCPAP时间分为≤2h组38例、2～4h组41例、≥4 h组21例.观察3组治疗前后动脉血气变化、治疗3、7d的机械通气率及并发症发生情况.结果 3组给药24 h后吸入氧浓度(FiO2)和二氧化碳分压(PaCO2)低于给药前,pH和氧分压(PaO2)高于给药前,且2～4h组改善情况优于≤2h组和≥4h组;给药2h后,2～4h组FiO2低于≤2h组和≥4 h组,≥4h组PaO2均高于≤2h组和2～4h组(P＜0.05);治疗3d2～4h组需机械通气率低于≤2h组和≥4 h组(P＜0.05);支气管肺发育不良发病率≤2h组高于2～4h组和≥4h组(P＜0.05).结论 早期给予nCPAP对PS治疗RDS效果明显,可改善预后,在发病2～4h应用效果最佳.     

CpG寡脱氧核苷酸对慢性哮喘小鼠模型气道炎症的预防作用

目的研究含非甲基化的胞嘧啶-磷酸-鸟嘌呤（CpG）寡脱氧核苷酸（CpG-oligodeoxynueleotides,CpG- ODN）能否预防或减轻慢性哮喘小鼠气道炎症的发生。方法40只雌性C57BL／6小鼠随机均分为4组,A组（慢性哮喘组）、B组（CpG-ODN干预组）和C组（GpC-ODN对照组）分别腹腔注射卵蛋白致敏,然后用卵蛋白雾化吸入激发以制作慢性哮喘模型,D组（生理盐水对照组）用生理盐水进行致敏和激发。B组在致敏同时（d1, d14）和激发阶段（每2周1次）分别给予60μg／mLCpG-ODN腹腔注射,共6次。C组将CpG替换为鸟嘌呤-磷酸-胞嘧啶（GpC）作为对照。在末次激发24 h后,取血测嗜酸粒细胞（eosinophil,EOS）数,血清IgE、IgG1和IgG2α;收集支气管肺泡灌洗液（bronehoalveolar lavage fluid,BALF）作细胞分类计数;测定肺组织中白介素-4 （interleukin-4,IL-4）、白介素-13（interleukin-13,IL-13）和γ-干扰素的mRNA（interferon-γ,IFN-γ）表达量;以及肺组织病理学检查。结果A组外周血EOS数[（89±10）×10^4／mL]、血清IgE值[（279±53）ng／mL）、IgG1（A值2．151±0．628）、IgG2α（A值0．772±0．245）、BALF中EPS（6．3±1．3）]×10^5／mL）及百分比[（18．1±3．0）％]较D组明显增高（P〈0．01）;且肺组织中IL-4、IL-13和IFN-γ等细胞因子mRNA表达量[（分别为（5．72±3．89）×10^-2、（9．45±5．91）×10^-2和（3．23±1．69）×10^-2）]也明显高于D组（P〈0．05）。用CpG-ODN干预后（B组）,除IgG2α（A值1．186±0．414）和IFNγmRNA表达量[（18．91±9．85）×10^-2]增高外（P〈0．05）,其余指标均低于A组（P〈0．05）。C组的上述各指标与A组相比差异均无显著性（P〉0．05）。结论CpG- ODN对小剂量OVA反复激发所致的慢性气道炎症有一定的预防作用。     

The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta‐analysis of echocardiographic studies

Current evidence on the effects of continuous positive airway pressure (CPAP) on cardiac mechanics in patients with obstructive sleep apnea (OSA) is based on a few single studies. The authors investigated this topic through a meta‐analysis of speckle tracking echocardiography (STE) studies that provided data on left ventricular (LV) and right ventricular (RV) mechanics as assessed by global longitudinal strain (GLS). The PubMed, OVID‐MEDLINE, and Cochrane library databases were systematically analyzed to search English‐language review papers published from inception to January 31, 2022. Studies were identified by crossing the following terms: “obstructive sleep apnea”, “sleep quality”, “sleep disordered breathing”, “continuous positive airway pressure therapy”, “noninvasive ventilation”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “left ventricular mechanics”, “right ventricular mechanics”, “echocardiography” and “STE echocardiography”. The meta‐analysis, including a total of 337 patients with OSA from nine studies (follow‐up 2–24 months) showed a significant GLS improvement in both LV and RV after CPAP, standard mean difference (SMD) being 0.51±0.08, CI:0.36–0.66, p = .0001 and 0.28±0.07, CI:0.15–0.42, p = .0001), respectively. Corresponding SMD values for LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) were 0.20±0.06, CI:0.08–0.33, p = .001 and 0.08±0.06, CI: ‐0.04/0.20, p = .21. Our meta‐analysis suggests that: I) CPAP treatment exerts beneficial effects on biventricular function in patients with OSA; II) the assessment of cardiac mechanics by STE should be routinely recommended for monitoring cardiac function in this setting, due to limitations of conventional echocardiography in evaluating biventricular performance.     

A comparative study of the efficacy and safety of high-flow nasal cannula and nasal continuous positive airway pressure in neonatal respiratory distress syndrome: A protocol for systematic review and meta-analysis

Background:When it comes to preterm newborns, respiratory distress syndrome (RDS) is the most frequent respiratory condition. Despite the fact that it is well acknowledged that preterm delivery plays a significant role, the causes of lung damage are still not completely understood. In newborns with extremely low birth weight and neonatal RDS, nasal continuous positive airway pressure has been suggested as the first respiratory assistance for spontaneous breathing. In the current research, we aim to carry out a meta-analysis to assess the effectiveness and safety of high-flow nasal cannula (HFNC) and non-invasive continuous positive airway pressure (nCPAP) in patients with neonatal respiratory distress syndrome (NRDS).Methods:We intend to search the following databases: PubMed, EMBASE, Cochrane Library, Wanfang database, China National Knowledge Infrastructure (CNKI), and Google Scholar, starting from their initial publication until February 2022, to identify randomized controlled trials comparing HFNC to nCPAP in patients with NRDS. The suitable papers will be chosen by 2 writers who will work independently of one another. Using the Cochrane updated technique for risk of bias, each included article will be subjected to an independent data extraction process by the 2 writers who will then independently evaluate the risk of bias. Consequently, a third author will be asked to address any discrepancies that may arise between the writers. It will be necessary to pool the data and do a meta-analysis with the help of the RevMan 5.3 software.Results:In this study, the effectiveness and safety of HFNC will be compared with those of nCPAP in patients with NRDS.Conclusion:If the results of this research are confirmed, they may serve as a summary of the most recent data for non-invasive respiratory assistance in NRDS.Ethics and dissemination:The study will require ethical approval.Registration number:DOI 10.17605/OSF.IO/BKSQ5     

咽异物感伴有咽喉反流患者抗反流治疗的临床观察

目的 观察抗反流治疗对咽异物感伴有咽喉反流的临床疗效。 方法 将门诊以咽异物感自评超过3分,患病1个月以上的患者,进行反流症状指数量表(RSI)及反流临床表现量表(RFS)评分,对RSI超过13分及RFS超过7分的患者进行抗反流治疗,以能持续治疗8周以上为有效观察对象,共104例。分析入组患者反流各症状发生率、反流临床表现各体征发生率,并进行疗效评定。 结果 104例咽异物感患者多有反流症状清嗓动作(92/104,88.46%),主要反流体征为后连合肥厚(97/104,93.27%),红斑/充血(89/104,85.57%),喉内黏稠分泌物(87/104,83.65%),喉室阻塞(73/104,70.19%)等,经抗反流治疗,有效61例,有效率为58.65%;RSI治疗前后比较,差异有统计学意义(t=1.975,P<0.05);RFS治疗前后比较,差异无统计学意义(t=1.258,P>0.05)。 结论 咽异物感伴反流症状的患者,通过反流治疗是有效的。对于有咽异物感的患者,经过长期治疗效果不明显,应考虑是否有咽喉反流的可能。     

咽部异物感患者的高分辨率食管测压结果分析

目的：分析咽部异物感患者的高分辨率食管测压芝加哥分型分布情况,以及食管上、下括约肌的压力变化等食管动力学的特点。方法对21例咽部异物感患者（均排除咽喉部器质性疾病）进行高分辨率食管压力检测,以芝加哥分型为标准,分析食管动力学观察指标,包括食管上括约肌（upper esophageal sphincter ,UES）静息压、食管下括约肌（lower esophageal sphincter ,LES）静息压、远端收缩积分（distal contractile integral ,DCI）、4s完整松弛压（integrated relaxation pressure ,4s IRP）及远端潜伏期（distal latency ,DL）。结果21例患者中,10例（47．62％）为食管正常蠕动,4例为食管小缺损弱蠕动,6例为食管大缺损弱蠕动,1例为食管频发无蠕动;1例U ES平均静息压高于正常值上限,3例平均静息压低于正常值下限,其余均在正常范围内,U ES静息压的总体分布为65．20（44．25,123．05）mmHg ;21例患者的DCI、IRP4s、DL值均在正常范围,8例（38．1％）患者存在食管下括约肌静息压低于正常值,余均正常。结论咽部异物感可能与食管蠕动能力减弱及食管下括约肌压力降低相关。     

阻塞性睡眠呼吸暂停综合征患者上呼吸道的CT研究

目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者和正常人的上呼吸道CT资料的差异。方法 :对经多导睡眠监测 (PSG)确诊的OSAS患者和年龄性别相近的正常成年人各 5 3例 ,采用螺旋CT对上呼吸道进行连续扫描 ,测量并比较两组间有关数据。结果 :OSAS组软腭后区、悬雍垂区和舌后区的横截面积均明显小于对照组 ;左右径在所测量的 4个平面中均明显短于对照组 ;而前后径的比较除悬雍垂区以外 ,两组间差异均不明显 ;前后径 /左右径比值在会厌后区差异不显著 ,其余 3个区域差异明显 ;咽后壁的软组织厚度比较软腭后区和悬雍垂区差异明显 ,咽侧壁的软组织厚度比较 ,4个测量平面差异均显著 ,软腭后区咽侧脂肪面积比较差异不显著。结论 :上呼吸道的解剖性狭窄是OSAS的主要发病原因之一 ,造成上呼吸道解剖性狭窄的主要原因是咽侧壁软组织的明显增厚并导致气道左右径的缩短     

L-454,560, a potent and selective PDE4 inhibitor with in vivo efficacy in animal models of asthma and cognition

Type 4 phosphodiesterases (PDE4) inhibitors are emerging therapeutics in the treatment of a number of chronic disorders including asthma, chronic obstructive pulmonary disease (COPD) and cognitive disorders. This study delineates the preclinical profile of L-454,560, which is a potent, competitive and preferential inhibitor of PDE4A, 4B, and 4D with IC50 values of 1.6, 0.5 and 1.2 nM, respectively. In contrast to the exclusive binding of cilomilast and the preferential binding of roflumilast to the PDE4 holoenzyme state (Mg2+-bound form), L-454,560 binds to both the apo-(Mg2+-free) and holoenzyme states of PDE4. The intrinsic enzyme potency for PDE4 inhibition by L-454,560 also results in an effective blockade of LPS-induced TNFalpha formation in whole blood (IC50 = 161 nM) and is comparable to the human whole blood potency of roflumilast. The cytokine profile of inhibition of L-454,560 is mainly a Th1 profile with significant inhibition of IFNgamma and no detectable inhibition of IL-13 formation up to 1 microM. L-454,560 was also found to be efficacious in two models of airway hyper-reactivity, the ovalbumin (OVA) sensitized and challenged guinea pig and the ascaris sensitized sheep model. Furthermore, L-454560 was also effective in improving performance in the delayed matching to position (DMTP) version of the Morris watermaze, at a dose removed from that associated with potential emesis. Therefore, L-454,560 is a novel PDE4 inhibitor with an overall in vivo efficacy profile at least comparable to roflumilast and clearly superior to cilomilast.