喜炎平雾化吸入治疗急性脑卒中患者肺部感染的临床研究

目的：探讨喜炎平雾化吸入治疗急性脑卒中患者肺部感染的疗效。方法收集2011年2月－2013年3月急性脑卒中患者肺部感染者63例,按病历尾号将患者随机分为2组,对照组31例在常规治疗基础上配合抗感染、化痰药物治疗;治疗组32例在对照组治疗基础上,配合雾化吸入喜炎平治疗。2组均治疗7d为1个疗程,共治疗2个疗程。比较患者症状、体征消失时间和炎性指标改化情况。结果治疗组总有效率为93.75%（30/32）,对照组为74.19%（23/31）,2组比较差异有统计学意义（χ2＝4.510,P＝0.034）。治疗组咳嗽痰多[(5.94±1.25)d 比(6.73±1.48)d;t＝2.292,P＝0.025]、发热[(2.72±0.11)d 比(3.25±0.18)d;t＝12.046,P＝0.001]、肺部啰音[(5.22±1.15)d比(7.21±1.21)d;t＝6.693,P＝0.001]、呼吸困难[(1.17±0.49)d 比(2.82±0.61)d;t＝11.855,P＝0.001]等症状、体征的消失时间均短于对照组。治疗组治疗后白细胞计数[(2.55±1.02)×109/L 比(3.91±1.25)×109/L;t＝4.738,P＜0.01]、中性粒细胞比例[(4.92±1.32)%比(6.25±1.16)%;t＝4.738,P＜0.01]、淋巴细胞比例[(58.62±6.15)%比(65.94±6.17)%;t＝4.716,P＜0.01]均较对照组降低（P均＜0.01）。结论喜炎平雾化吸入可缩短急性脑卒中后肺部感染患者症状、体征时间,提高疗效。     

^99mTc—DTPA雾化吸入检测肺泡清除功能及初步分析

为探讨检测肺泡清除功能的方法以及肺泡清除功能变化的可能机理，应用９９ｍＴｃＤＴＰＡ雾化吸入２～３分钟后，启动γ相机连续动态采集３０分钟，以前５分钟的曲线斜率为Ｋ１，５分钟后的曲线斜率为Ｋ２。结果：正常对照组的时间放射性曲线为单室模型曲线，Ｙ＝Ａｅ－ｋｔ，在半对数坐标上为近似斜线，Ｋ１＝（９０８±４７９）×１０－３，Ｋ２＝（７３５±３２５）×１０－３（ｘ±ｓ）；吸烟、甲亢和哮喘组的Ｋ１、Ｋ２均高于正常（ｔ值３１６４～１０２３０，Ｐ＜００１），为双室或三室以上的多室模型曲线。结果表明：上肺与中肺的Ｋ１有显著差异，Ｋ１是一个灵敏指标。各病变组呼吸膜改变的主要原因是肺泡上皮或毛细血管内皮受损所致。     

Assessment of increased sampling pump flow rates in a disposable,inhalable aerosol sampler

A newly designed, low-cost, disposable inhalable aerosol sampler was developed to assess workers personal exposure to inhalable particles. This sampler was originally designed to operate at 10 L/min to increase sample mass and, therefore, improve analytical detection limits for filter-based methods. Computational fluid dynamics modeling revealed that sampler performance (relative to aerosol inhalability criteria) would not differ substantially at sampler flows of 2 and 10 L/min. With this in mind, the newly designed inhalable aerosol sampler was tested in a wind tunnel, simultaneously, at flows of 2 and 10 L/min flow. A mannequin was equipped with 6 sampler/pump assemblies (three pumps operated at 2 L/min and three pumps at 10 L/min) inside a wind tunnel, operated at 0.2 m/s, which has been shown to be a typical indoor workplace wind speed. In separate tests, four different particle sizes were injected to determine if the sampler's performance with the new 10 L/min flow rate significantly differed to that at 2 L/min. A comparison between inhalable mass concentrations using a Wilcoxon signed rank test found no significant difference in the concentration of particles sampled at 10 and 2 L/min for all particle sizes tested. Our results suggest that this new aerosol sampler is a versatile tool that can improve exposure assessment capabilities for the practicing industrial hygienist by improving the limit of detection and allowing for shorting sampling times.     

Experimental evaluation of aerosol mitigation strategies in large open-plan dental clinics

BackgroundAerosols are generated routinely during patient care in dentistry. Managing exposure risk requires understanding characteristics of aerosols created during procedures such as those performed using high-speed drills that operate at 200,000 revolutions per minute.MethodsA trained dentist performed drilling procedures on a manikin’s incisors (teeth nos. 8 and 9) using a high-speed drill and high-volume evacuator. The authors used high-speed imaging to visualize the formation and transport of aerosol clouds and particle sampling to measure aerosol concentration and size distribution at several locations. The authors studied several aerosol mitigation strategies.ResultsAerosols produced during high-speed drilling were erratic and yielded high concentrations that were at least an order of magnitude above baseline. High-speed imaging showed aerosols initially travelled at 1 m per second. Owing to erratic behavior of aerosols, supplemental suction was not effective at collecting all aerosols; however, barriers were effective.ConclusionsBarriers are the most effective mitigation strategy. Other methods studied have limitations and risks. To the authors’ knowledge, this article presents the first characterization of aerosols generated during high-speed drilling by a dentist.Practical ImplicationsWith thorough preoperative planning and the use of this investigation’s findings about effectiveness of mitigation strategies as a guide, dental offices may be able to return to prepandemic productivity.     

Comparison of 1 mg and 5 mg sodium cromoglycate metered dose inhalers in the treatment of asthma: A 12-week double-blind,parallel group trial

Summary

A double-blind, parallel group trial of a 1?mg sodium cromoglycate metered dose inhaler, a 5?mg formulation and a placebo aerosol was undertaken in 139 asthmatic patients with extrinsic allergic asthma. None of the patients had previously been treated with sodium cromoglycate and few (15%)were familiar with the use of a pressurized aerosol device. Each test treatment was taken at a dose of 2 ‘puffs’ 4-times per day for a period of 12 weeks. Response to treatment was assessed by analysis of symptom scores, medication usage and 3-times daily home measurements of PEFR recorded on diary cards, and by assessment of asthma severity and lung function in the clinic at the beginning and end of a 2-week baseline period and at intervals of 3 weeks throughout the trial. Analysis of patient-generated data (symptom scores and PEFR)demonstrated statistically significant differences in favour of each active treatment compared with placebo treatment. Clinic assessments of asthma severity and the investigator's opinion of treatment also showed the superiority of each sodium cromoglycate treatment regimen over placebo. These differences were statistically significant after 9 weeks (high dose)and 12 weeks (both doses). No statistically significant differences were demonstrated between the two active treatment groups in the clinic assessments of asthma severity, or in the home or clinic measurements of PEFR. There was, however; a consistent trend in favour of the higher dose formulation with respect to diary card symptom scores. In general, improvement in the low-dose sodium cromoglycate treatment group was slower than in the high-dose group suggesting an advantage for the 5?mg sodium cromoglycate inhaler in terms of onset of therapeutic response. The results indicate that sodium cromoglycate administered by pressurized aerosol at a dose of 2×1?mg or 2×5?mg 4-times daily is effective in the treatment of asthma and suggest that the higher dose formulation may provide more rapid control of symptoms.     

Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol

ObjectiveThe TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants.MethodThe TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations.ConclusionThe comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.     

Evaluation of Granulated Lactose as a Carrier for Dry Powder Inhaler Formulations 2: Effect of Drugs and Drug Loading

Previously, granulated lactose carriers were shown to improve uniformity and aerosolization of a low-dose model drug. In the present study, the blending uniformity and aerosol dispersion performance were assessed for 2 model drugs salbutamol sulfate (SS) and rifampicin (RIF), blended at high loadings (10% or 30% drug) with granulated lactose carriers. The model drug powders differed in particle size distribution, morphology, density, and surface energies. Content uniformity of RIF blends was better than that of SS. Aerosolization studies showed that all blend formulations had acceptable emitted fractions (>70%). The SS blends showed low induction-port deposition (6%-10%) compared to RIF (5%-30%). This difference was greater at high flow rates. At 90 L/min, the low induction port deposition of SS blends allowed high fine particle fraction (FPF) of 73%-81%, whereas the FPF of the RIF blends was around 43%-45% with higher induction port deposition. However, SS blends exhibited strong flow rate–dependent performance. Increasing the flow rate from 30 L/min to 90 L/min increased SS FPF from approximately 20% to 80%. Conversely, RIF blends were flow rate and drug loading independent. It was concluded that the aerosolization of high drug–loaded dry powder inhaler formulations using granulated lactose, particularly flow rate dependency, varies with active pharmaceutical ingredient properties.     

Six-month therapy with aerosolized interferon-gamma for refractory multidrug-resistant pulmonary tuberculosis

The aim of this study was to investigate the adjuvant effects of interferon-gamma (IFN-gamma) inhalation therapy for six months in the treatment of refractory multidrug-resistant pulmonary tuberculosis (MDR-TB). Aerosolized IFN-gamma was given to six MDRTB patients with persistent positive smears and cultures despite long-term medical treatment. The patients received aerosolized two million international units of IFN-gamma three times a week for 6 months while they continued on identical antituberculous chemotherapy. Before IFN-gamma inhalation therapy, the patients received a median of 6.5 (range, 4 to 7) antituberculous drugs for median duration of 29 months (range,7 to 76). After IFN-gamma inhalation therapy, sputum smears remained persistently positive in all patients throughout the study period. Sputum cultures were transiently negative at the 4th month in two patients, but became positive again at the end of 6 months of IFN-gamma therapy. Five patients had radiological improvement including three patients who showed a decrease in the size of the cavitary lesions. Resectional surgery could be performed in one patient in whom substantial clinical and radiological improvement was noted after IFN-gamma inhalation therapy. These results suggest that IFN-gamma inhalation therapy may be effective for some cases of refractory MDR-TB who are otherwise not responding to conventional therapy.