全反式维甲酸治疗对大鼠肺气肿动脉血气变化的研究

目的观察研究不同浓度全反式维甲酸（ATRA）对猪胰蛋白酶（PPE）构建的大鼠肺气肿动脉血气变化的情况。方法 60只Wistar大鼠随机分为对照组（N）和模型组（E）,棉籽油组（C）,小剂量ATRA治疗组（L）,中剂量ATRA治疗组（M）,大剂量ATRA治疗组（H）,每组各10只,一次性气管内注入PPE构建大鼠肺气肿模型后,用大、中、小剂量ATRA和棉籽油注入大鼠腹腔内进行治疗。30天后测量大鼠体重,动脉血气分析。结果 L组大鼠动脉血气分析较E组有显著改善（P〈0.05）,接近N组水平;C、M、H组动脉血气未见明显效果,且有缺氧明显趋势。结论低剂量ATRA治疗大鼠肺气肿对改善动脉血气具有较好的效果。     

Normal expiratory flow rate and lung volumes in patients with combined emphysema and interstitial lung disease: a case series and literature review

Pulmonary function tests in patients with idiopathic pulmonary fibrosis characteristically show a restrictive pattern including small lung volumes and increased expiratory flow rates resulting from a reduction in pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. When the diseases coexist, pulmonary volumes are compensated, and a smaller than expected reduction or even normal lung volumes can be found. The present report describes 10 patients with progressive breathlessness, three of whom experienced severe limitation in their quality of life. All patients showed lung interstitial involvement and emphysema on computed tomography scan of the chest. The 10 patients showed normal spirometry and lung volumes with severe compromise of gas exchange. Normal lung volumes do not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.     

木瓜蛋白酶及胰蛋白酶所致大鼠肺气肿模型的差异及对比

目的研究木瓜蛋白酶及胰蛋白酶所致大鼠肺气肿模型的差异。方法采用猪胰蛋白酶和木瓜蛋白酶气管内滴注的方法,将体质量170～220 g的60只SPF级SD大鼠随机分为正常对照组(A组),猪胰蛋白酶组（B组）,木瓜蛋白酶组（C组）,各20只,B组、C组气管内分别滴入猪胰蛋白酶1 U/g、5％木瓜蛋白酶0.001 ml/kg造模...     

Bronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping

Chronic obstructive pulmonary disease (COPD) is common and has significant morbidity and mortality as the fourth leading cause of death in the United States. In many patients, particularly those with emphysema, COPD is characterized by markedly increased residual volume contributing to exertional dyspnea. Current therapies have limited efficacy. Surgical resection of diseased areas of the lung to reduce residual volume was effective in identified subgroups but also had significant mortality in and suboptimal cost effectiveness. Lung-volume reduction, using bronchoscopic techniques, has shown substantial benefits in a broader patient population with less morbidity and mortality. This review is meant to spread the awareness about bronchoscopic lung-volume reduction and to promote its consideration and early referral for patients with advanced COPD and emphysema frequently encountered by both primary care physicians and specialists. A search was conducted on PubMed (MEDLINE), EMbase, and Cochrane library for original studies, using the following keywords: “lung-volume reduction.” “endobronchial valves,” “intrabronchial valves,” “bronchoscopic lung-volume reduction,” and “endoscopic lung-volume reduction.” We included reports from systematic reviews, narrative reviews, clinical trials, and observational studies. Two reviewers evaluated potential references. A total of 27 references were included in our review. Included studies report experience in the diagnosis and bronchoscopic treatment for emphysema; case reports and non-English or non-Spanish studies were excluded.     

α1-抗胰蛋白酶缺乏症误诊一例并文献复习

目的分析α1-抗胰蛋白酶（alpha-1 antitrypsin,α1-AT）缺乏症的误诊原因及诊治经过,以提高对本病的认识。方法对我院收治1例α1-AT缺乏症的临床资料进行回顾性分析并结合相关文献进行复习。结果本例因反复乏力、食欲缺乏、尿黄伴胸闷、气促3年,再发2个月就诊,外院曾误诊为不明原因肝硬化、气胸、肺大泡,多次予护肝、抗感染等综合治疗,病情反复。后结合胸部CT、肝脏CT及肝脏穿刺活检,明确诊断为α1-AT缺乏症,予护肝、抗感染、利尿、提高白蛋白含量、补充血浆等综合治疗,病情好转出院。结论α1-AT缺乏症比较罕见,对临床出现不明原因的肝脏损害和（或）肺气肿患者应想到本病可能,及时行肝脏穿刺活检及光学显微镜、电子显微镜、高碘酸希夫（PAS）染色等检查,以及早诊断并治疗。     

抑制β2肾上腺素受体过度激活对被动吸烟大鼠肺组织病理改变的影响

目的 使用β肾上腺素受体阻断剂抑制被动吸烟大鼠动物模型β2肾上腺素受体的过度激活,观察其肺功能、小气道病理发肺气肿改变.方法 雄性SD大鼠随机分为正常对照组(9只),吸烟组(8只)和吸烟+β肾上腺素受体阻断剂干预组(简称吸烟+干预组,8只).对各组进行肺功能测定,同时测定小气道病理评分和平均肺泡线性间隔.结果 吸烟+干...     

Urinary tract infections: what's new?

PURPOSE: This review provides practicing urologists with important basic information about urinary tract infections (UTIs) that can be applied to everyday clinical problems. MATERIALS AND METHODS: A review is presented of provocative and controversial concepts in the current literature. RESULTS: Bacterial virulence mechanisms are critical for overcoming the normal host defenses. Increasing antimicrobial resistance of uropathogens has led to reconsideration of traditional treatment recommendations in many areas. For effective patient management the first issue is to define complicating urological factors. Managing complicated urinary tract infections, particularly in urology, is determined by clinical experience to define the pertinent anatomy and to determine the optimal interventions. New clinical data are summarized on UTIs in long-term care patients, behavioral risks for UTI in healthy women and anatomical differences associated with an increased risk for UTI. The rationale is presented for UTI prophylaxis using cranberry juice, immunization and bacterial interference. Current treatment trends for UTI include empiric therapy (without urine culture and sensitivity testing), short-course therapy, patient-administered (self-start) therapy and outpatient therapy for uncomplicated pyelonephritis. CONCLUSIONS: Recommendations for treating patients with UTIs have changed based on basic science and clinical experience.     

The sonographic appearance of acute focal pyelonephritis 8 years experience

AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation. The reported sonographic appearances of AFP are varied but are typically described as being echopoor. The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details. MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP. The study group consisted of 13 women and four men (mean age 20 years). Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen. RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two. An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria. CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity. Our data would suggest that areas of increased echogenicity are more common. There is no discernible correlation with clinical findings.