肺心合剂对肺心病急性发作期大鼠血流动力学及ET-1的影响

目的：探讨肺心合剂治疗肺心病急性发作期的部分作用机制。方法：将66只雄性Wistar大鼠随机分为正常对照组、MCT组、硝苯吡啶(Nif)组及肺心合剂低、中、高剂量治疗组，分别于造模后14d灌胃相应药物，连续用药8d。采用改良右心导管术测定肺血流动力学参数，以非平衡法测定静脉血浆ET-1水平；处死大鼠后，称量肺湿重(wW)、右心室自由壁(RV)重和左心室及室间隔(LV S)重，计算右心肥厚指数(RV／LV S)。结果：肺心合剂各剂量组及Nif组大鼠的MPAP、wW、RV／LV S及血浆ET-1水平均明显降低，以肺心合剂高剂量组效果最好。结论：肺心合剂能有效降低肺动脉高压，改善心功能，其作用机制可能与降低血浆ET-1水平有关。     

以肺痹论治类风湿关节炎肺间质纤维化

类风湿关节炎肺间质纤维化中医目前没有系统的认识,临床多将其归为中医肺痹一证进行论治,从前人经验中总结出其病因病机,认为本病是由痹证日久,肺气损伤,外邪侵袭造成的,以风寒湿等外邪痹阻日久,肺肾两虚,痰瘀毒阻于肺络为基本病机,在治疗上主张以补肺纳肾,祛痰化瘀解毒通络为总原则,临床疗效较好。     

以激素为对照的口服中药治疗肺间质纤维化的系统评价

目的：评价口服中药治疗肺间质纤维化的疗效和安全性。方法：计算机检索CNKI、VIP、CBM、PubMed和万方数据库等资源,收集以激素为对照的口服中药治疗肺间质纤维化的临床随机对照试验,按 Cochrane 系统评价方法,对纳入研究进行方法学质量评价,并采用 RevMan 5.2 软件进行 Meta 分析。结果：符合纳入标准的研究共22项（1 338例）。Meta分析结果显示：与激素比较,口服中药可提高治疗肺间质纤维化的有效率[RR=1.29,95%CI（1.16,1.42）,P<0.000 01];缓解咳嗽[MD=-0.57,95%CI（-0.83,-0.30）,P<0.000 1]、喘息[MD=-0.67,95%CI（-1.20,-0.14）,P=0.01]、气短[MD=-0.45,95%CI（-0.65,-0.25）,P<0.000 1]等症状;改善肺部Velcro啰音[MD=-0.49,95%CI（-0.73,-0.25）,P<0.000 1];提高用力肺活量（FVC）[SMD=0.37,95%CI（0.16,0.58）,P=0.000 7]、第一秒用力呼气量百分率（FEV1%）[MD=6.63,95%CI（1.67,11.60）,P=0.009]、动脉血氧分压（PaO2）[MD=4.87,95%CI（2.74,7.01）,P<0.000 01];减少肺部再感染次数[RR=0.75,95%CI（0.67,0.84）,P<0.000 01]。结论：口服中药较激素治疗肺间质纤维化具有一定的优势,但由于本系统评价纳入研究的方法学质量偏低,影响了结论的可靠性,该结论尚需更高质量、多中心、大样本的临床随机双盲对照试验加以证实。     

基于肺络理论论治肺结节病

随着肺结节病发病率及检出率的逐年上升,肺结节病逐渐引起各界的关注及重视,对肺结节病CT随访期进行有效的干预治疗,延缓进展,控制生长,以致消除结节,是现代医学面临的关键问题。从肺络论治肺结节病,着手于肺络之内涵、结构、生理特点等,进而探究肺络虚损是肺结节病的病理基础、肺络-气机失调是肺结节病发生的病理环节、肺络-气郁痰瘀停聚是肺结节病的重要病理演变、肺络郁闭是肺结节病的基本病机。最终,立足于中医络病理论的优势,提出通络法论治肺结节病,以期为临床论治肺结节打开新的诊疗思路,提供新的理论认识。     

滇重楼丛枝菌根与次生代谢产物甾体皂苷的关系初探

目的:考察滇重楼根际丛枝菌根真菌的侵染率、孢子密度与其次生代谢产物甾体皂苷含量的相关性。方法:采用Phillips和Hayman染色法挑选滇重楼丛枝菌根,采用Gendemann湿筛倾析法获得AMF孢子并进行计数。同时,采用HPLC测定滇重楼中4种甾体皂苷(重楼皂苷Ⅰ,Ⅱ,Ⅵ,Ⅶ)的含量。结果:滇重楼根际丛枝菌根真菌侵染率与其孢子密度呈显著的正相关,而侵染率、孢子密度与其根茎总甾体皂苷含量呈一定的正相关。结论:丛枝菌根真菌是影响滇重楼活性成分含量的重要因素。     

肺栓塞中医证型分析与西医分类的相关性研究

目的探讨肺栓塞中医证型分析结果与西医分类关联。方法本次选取肺栓塞患者80例,均为我院呼吸内科2013年5月—2015年5月收治,依据西医分类划为3个组别,即A组:急性广泛型30例;B组:急性亚广泛型40例;C组:伴肺动脉高压型10例。并行中医辨证分型,分析与西医分类间的相关性。结果 80例中,气虚水停型6例,占7.5%;气虚血瘀型28例,占35%;痰浊阻肺型20例,占25%;阳气暴脱型26例,占30%。阳气暴脱型血糖高于其他证型,脉压低于其他证型(P0.05),其他组间比较无差异(P0.05)。气虚血瘀型C组占86.7%,痰浊阻肺B组占50%;阳气暴脱A组占72%,与同证型其他比较均有统计学差异(P0.05)。结论临床显性肺栓塞中,阳气暴脱、痰浊阻肺、气虚血瘀为主要证型,气虚血瘀型多见于慢性肺栓塞,痰浊阻肺型以急性亚广泛性肺栓塞为主,阳气暴脱型以急性广泛性肺栓塞为主,分析证型,可对肺栓塞的病程急缓、程度间接反映。     

Diagnosis and treatment of the invasive extension of bacteria (cellulitis) from chronic wounds utilising point‐of‐care fluorescence imaging

Early diagnosis of wound‐related cellulitis is challenging as many classical signs and symptoms of infection (erythema, pain, tenderness, or fever) may be absent. In addition, other conditions (ie, chronic stasis dermatitis) may present with similar clinical findings. Point‐of‐care fluorescence imaging detects elevated bacterial burden in and around wounds with high sensitivity. This prospective observational study examined the impact of incorporating fluorescence imaging into standard care for diagnosis and management of wound‐related cellulitis. Two hundred thirty‐six patients visiting an outpatient wound care centre between January 2020 and April 2021 were included in this study. Patients underwent routine fluorescence scans for bacteria (range: 1‐48 scans/patient). Wound‐related cellulitis was diagnosed in 6.4% (15/236) of patients. In these patients, fluorescence scans showed an irregular pattern of red (bacterial) fluorescence extending beyond the wound bed and periwound that could not be removed through cleansing or debridement, indicating the invasive extension of bacteria (wound‐related cellulitis). Point‐of‐care identification facilitated rapid initiation of treatments (source control and antibiotics, when warranted) that resolved the fluorescence. No patients had worsening of cellulitis requiring intravenous antibiotics and/or hospitalisation. These findings demonstrate the utility of point‐of‐care fluorescence imaging for efficient detection and proactive, targeted management of wound‐related cellulitis.     

Value of combined detection of serum amyloid A,C-reactive protein and procalcitonin in differential diagnosis of respiratory tract infection in children of China

ObjectiveTo explore the diagnostic value of combined detection of serum amyloid A (SAA), C-reactive protein (CRP) and procalcitonin (PCT) in children with bacteria or non-bacterial respiratory tract infection.Methods200 children with respiratory tract infections diagnosed in our hospital were included in the study. According to the results of the aetiological examination, they were divided into bacterial infection group and non-bacterial infection group. At the same time, 100 healthy children admitted to the hospital for physical examination during the same period were selected as the healthy subjects control group. Changes in serum SAA, PCT and CRP in three groups were compared. Comparison of a positive rate of the single index and combined detection were performed. Children with bacterial infections were treated with conventional antibiotics. The changes in serum SAA, PCT and CRP in the infection group before and after treatment were compared. The efficacy of SAA, PCT and CRP alone and in combination was compared.ResultsThe serum SAA, PCT and CRP levels in the bacterial infection group were higher than those in the non-bacterial infection group and healthy children, and the differences were statistically significant. The positive detection rates and combined detection rates of serum SAA, PCT and CRP in the bacterial infection group were higher than those in the non-bacterial infection group and the healthy subject''s control group. After conventional antibiotic treatment, serum SAA, PCT and CR levels in children with bacterial infection were significantly decreased.ConclusionThe combined detection based on SAA, CRP and PCT can effectively identify and diagnose respiratory tract infection in children, providing a certain reference for the promotion of the diagnostic scheme.

Key messages

• Serum SAA, PCT and CRP were highly expressed in children with respiratory tract infection, and the expression level was the highest in children with bacterial pneumonia.
• The combined detection of serum SAA, CRP and PCT indicators have higher diagnostic efficiency and can effectively make a differential diagnosis of respiratory tract infection in children.

     

螺旋CT三维重建诊断肺动静脉畸形的价值

目的评价螺旋CT三维重建在肺动静脉畸形诊断中的价值。方法对10例临床怀疑为肺动静脉畸形的病人进行了螺旋CT检查,依据采集的薄层扫描数据(0.75mm～1mm)进行了三维图像重建,沿不同的旋转轴观察重建的肺动静脉血管与瘤体的空间解剖关系,确定病变的供血动脉和引流静脉。结果全部病例均清楚地显示了瘤体形态、大小、位置和供应动脉、引流静脉,可以对肺动静脉畸形作出明确诊断。其中9例经数年多次随访证实,1例经手术病理证实。结论螺旋CT三维多种重建可清楚地显示肺动静脉畸形的供血动脉和引流静脉,从而可无创性诊断本病并作为随访手段。     

Clinical outcomes of coronavirus disease 2019 and seasonal influenza in patients with hematological disorders: a retrospective study

Objective: The differences in clinical outcomes in hospitalized patients with hematological disorders (HD) who developed either coronavirus disease 2019 (COVID-19) or seasonal influenza (SI) are not fully understood. To examine these differences, we retrospectively analyzed the baseline characteristics and clinical outcomes of hospitalized patients with HD admitted from 2016 to 2021.Patients and Methods: Patients with HD who developed COVID-19 (in the past 1 year) (n=21) or SI (in the past 5 years) (n=23) in the Department of Hematology/Oncology, Asahikawa Kosei General Hospital were evaluated.Results: The median ages of the patients with HD with either COVID-19 or SI were 80 and 68 years, respectively (P=0.03). The groups showed no significant differences in sex ratio, body mass index, or Eastern Cooperative Oncology Group performance status. In the COVID-19 and SI groups, the most common primary diseases were diffuse large B-cell lymphoma (43%) and multiple myeloma (39%), respectively. The median numbers of days of oxygen administration (8 vs. 0 days), quarantine (25 vs. 6 days), and hospitalization (72 vs. 21 days) were significantly higher in HD patients with COVID-19 than those in HD patients with SI (all P<0.001). The overall 90-day survival of patients with HD and COVID-19 was significantly shorter than that of patients with HD and SI (P=0.019). Moreover, patients with HD and COVID-19 had a higher risk of in-hospital mortality (43% vs. 9%; odds ratio, 7.50; 95% confidence interval, 1.26–82.4; P=0.01) compared to patients with HD and SI.Conclusion: Patients with HD and COVID-19 required longer periods of in-hospital medical and showed poorer survival than those with SI. During the COVID-19 pandemic, hematologists should closely monitor the condition of patients with COVID-19 to closely monitor their condition to prevent deaths.