上气道咳嗽综合征中西医诊疗概述

上气道咳嗽综合征是慢性咳嗽的一种常见病因,临床表现多为咳嗽、咳痰、咽喉部有滴流感,西医治疗原则是病因治疗,对症治疗.中医辩证论治具有不可替代的优势。对上气道咳嗽综合征的病因、发病机制、诊断及治疗做一概述。     

Soy biodiesel emissions have reduced inflammatory effects compared to diesel emissions in healthy and allergic mice

Abstract

Toxicity of exhaust from combustion of petroleum diesel (B0), soy-based biodiesel (B100), or a 20% biodiesel/80% petrodiesel mix (B20) was compared in healthy and house dust mite (HDM)-allergic mice. Fuel emissions were diluted to target fine particulate matter (PM_2.5) concentrations of 50, 150, or 500?μg/m³. Studies in healthy mice showed greater levels of neutrophils and MIP-2 in bronchoalveolar lavage (BAL) fluid 2?h after a single 4-h exposure to B0 compared with mice exposed to B20 or B100. No consistent differences in BAL cells and biochemistry, or hematological parameters, were observed after 5?d or 4 weeks of exposure to any of the emissions. Air-exposed HDM-allergic mice had significantly increased responsiveness to methacholine aerosol challenge compared with non-allergic mice. Exposure to any of the emissions for 4 weeks did not further increase responsiveness in either non-allergic or HDM-allergic mice, and few parameters of allergic inflammation in BAL fluid were altered. Lung and nasal pathology were not significantly different among B0-, B20-, or B100-exposed groups. In HDM-allergic mice, exposure to B0, but not B20 or B100, significantly increased resting peribronchiolar lymph node cell proliferation and production of T_H2 cytokines (IL-4, IL-5, and IL-13) and IL-17 in comparison with air-exposed allergic mice. These results suggest that diesel exhaust at a relatively high concentration (500?μg/m³) can induce inflammation acutely in healthy mice and exacerbate some components of allergic responses, while comparable concentrations of B20 or B100 soy biodiesel fuels did not elicit responses different from those caused by air exposure alone.     

Acute upper airway obstruction secondary to late presentation of a massive oropharyngeal arteriovenous malformation

The case of a 65 year-old man with a massive oropharyngeal arteriovenous malformation, with acute deterioration and airway compromise, is presented. Optimal airway management was deemed to be fiberoptic intubation without sedative drugs.     

Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D3

BACKGROUND: Antimicrobial peptides (AMPs) such as cathelicidins contribute to initial defense of the airway against inhaled pathogens. Recent studies have shown that the hormonally active form of vitamin D(3), 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) up-regulates AMP gene expression in several established cell lines. Furthermore, serum levels of vitamin D are often deficient in cystic fibrosis (CF) patients. METHODS: We investigated the effect of 1,25(OH)(2)D(3) on AMP mRNA levels in primary cultures of normal human bronchial epithelial (NHBE) cells by real-time PCR, and protein levels by Western blot. Antimicrobial activity of airway surface fluid from these cells was measured by in vitro assay against laboratory strains of bacteria. RESULTS: Treatment of NHBE cells with 1,25(OH)(2)D(3) (10(-8)M), resulted in a 10-fold up-regulation of cathelicidin mRNA levels after 12 h, which was augmented 2-fold with co-incubation of 1 mM Calcium. Moreover, 1,25(OH)(2)D(3) induced antimicrobial activity against the airway pathogens Bordetella bronchiseptica and Pseudomonas aeruginosa. 1,25(OH)(2)D(3) induced cathelicidin mRNA expression equally in both normal and CF bronchial epithelial cells. CONCLUSIONS: Elucidation of the effect of 1,25(OH)(2)D(3) on cathelicidin expression in NHBE cells and CF bronchial epithelial cells will aid in the development of novel therapeutic agents for treatment of airway infections in CF.     

呼吸机相关性肺炎防治措施的研究进展

呼吸机相关性肺炎是目前发病率最高的院内感染之一,是导致患者住院时间延长、治疗费用增加及院内感染死亡的主要原因。本文对近年来有关呼吸机相关性肺炎的气道及呼吸机环路的管理、选择性消化道去污染和口腔去污染、胃肠营养及管理、增强机体免疫力药物的应用、控制外源性感染等方面的研究进展进行综述,旨在寻找减少内源性和外源性感染的方法,以降低呼吸机相关性肺炎的发生率和病死率。     

A comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants

Background: The Truview EVO2 laryngoscope is a recently introduced device with a unique blade that provides a wide and magnified laryngeal view at 46° anterior refracted angle. An infant blade of the laryngoscope has recently become available. Aims and objectives: The aim of the study was to compare the Truview infant EVO2 laryngoscope with the Miller straight blade laryngoscope in order to determine whether the Truview EVO2 laryngoscope provided an improved laryngeal view at laryngoscopy and also to assess the time taken for intubation with the two devices. Materials and methods: In this prospective randomized study, 60 neonates and infants of either sex undergoing surgery under general anesthesia were enrolled and divided into two groups: endotracheal intubation using a Truview infant blade (Group I) or with a Miller blade number 0 (Group II). The view of the glottis at laryngoscopy, time to intubation and the number of attempts required for intubation were recorded. Results: The average time for laryngoscopy in Group I was 18.18 s and in Group II was 16.30 s, which though not significant clinically, is statistically significant (P = 0.002). While eight patients (26.6%) had Cormack and Lehane grade 2 view on laryngoscopy in Group II, only two patients (6.6%) had such a view in Group 1 (P = 0.039). The number of attempts at laryngoscopy was comparable in the two groups. Conclusion: In this study, we found that in neonates and infants, the tracheal intubation using Truview infant EVO2 blade took almost as much time as miller blade and provided improved laryngoscopic view as compared to the Miller blade.     

Role of the extracellular signal-regulated kinase 1/2 signaling pathway in the process of thrombin-promoting airway remodeling in ovalbumin-allergic rats

Abstract

Context: Although it is recognized that thrombin plays a key role in airway remodeling during chronic asthma. In a previous study, we have proved that thrombin promotes airway remodeling via PAR-1 in OVA-allergic rats, but little is known about intracellular signaling pathway involved in the event.

Objective: In this study, we intend to explore the impact of pERK1/2 signaling pathway on the process of thrombin-induced airway remodeling in OVA-allergic rats.

Materials and methods: A rat model of chronic asthma was set up by systemic sensitization and repeated challenge to OVA. The doses of thrombin, recombinant hirudin, PAR-1 inhibitor ER-112780-06, and pERK1/2 inhibitor PD98059 varied for different groups. The expression of pERK1/2 was analyzed by western blot and RT-PCR. Secretion of TGF-β1 and IL-6 was detected by ELISA.

Results: The expression of pERK1/2 was higher in the airway of asthmatic rats than those of normal rats, and was significantly increased by thrombin treatment but decreased by thrombin-inhibitor treatment. Airway remodeling was enhanced by thrombin but weakened by pERK1/2 inhibitor. Expression of growth factors and IL-6 in asthmatic rats was significantly increased by thrombin treatment and decreased by thrombin-inhibitor treatment and pERK1/2 inhibitor treatment.

Conclusion: These results suggest that ERK1/2 signaling pathway may play an important role in the process of thrombin-promoting airway remodeling in OVA-allergic rats, and pERK1/2 inhibitor effectively inhibits the process.