支气管肺泡灌洗加抗菌药物灌注治疗难治性肺部感染的临床疗效观察

目的观察支气管肺泡灌洗(BAL)加抗菌药物灌注治疗难治性肺部感染的临床疗效。方法 240例难治性肺部感染患者随机分为对照组和治疗组,对照组予常规抗感染治疗,治疗组在对照组的基础上,行BAL加抗菌药物灌注。结果治疗组总有效率为95.00%,对照组总有效率为63.33%,两组相比差异有统计学意义(P<0.05)。结论 BAL加抗菌药物灌注治疗难治性肺部感染安全有效,值得临床推广。     

Recognition of intoxication by alcohol counselors

Recent studies have found that police officers, bartenders, social drinkers, and trained interviewers are often unable to recognize when others are intoxicated. The present two studies were conducted to evaluate: (a) the recognition ability of alcohol counselors compared to mental health counselors, and (b) the recognition ability of less-experienced versus more-experienced alcohol counselors. Subjects viewed four videotapes of a 21-year-old male engaged in simulated counseling interviews after he was given drinks containing alcohol to achive one of four target Blood Alcohol Level (BAL) goals: .00%, .05%, .10%, .15%. Results indicated that alcohol counselors were not uniformly more accurate than mental health therapists, nor were more-experienced alcohol counselors uniformly more accurate than less-experienced alcohol councelors at recognizing intoxication or estimating BAL. In addition, subjects generally understimated the target's sober-intoxicated status and BAL when he was given alcohol, but almost every subject recognized that the target was at least moderately intoxicated when his BAL was .15%.     

特发性肺纤维化患者肺灌洗液炎症细胞化学发光检测的意义

本文采用3-氨基邻苯二甲酰肼增强化学发光(CL)的方法检测8例特发性肺纤维化(IPE)患者和10例正常对照的肺灌洗液(BAL)全细胞的CL。IPF患者BAL细胞的自发发光显著高于对照(P<0.01),而其刺激发光竟高达对照的11倍(P<0.001),说明IPF患者肺组织的炎症细胞释放大量的反应性氧中间物(ROI),后者可能是造成肺损害的原因。此外还对5例IPF患者接受激素治疗前后BAL细胞的CL进行了比较,3例接受激素后临床明显好转,其BAL细胞的CL较治疗前显著下降(P<0.05),2例治疗后无好转的患者其BAL的CL与治疗前相比无显著性变化(P>0.05)。本文以化学发光的方法研究和探讨了特发性肺纤维化的发病机制。     

Bilateral vagotomy or atropine pre-treatment reduces experimental diesel-soot induced lung inflammation

To investigate the role of the vagus nerve in acute inflammatory and cardiorespiratory responses to diesel particulate (DP) in the rat airway, we measured changes in respiration, blood pressure and neutrophils in lungs of urethane anesthetized Wistar rats 6-h post-instillation of DP (500 microg) and studied the effect of mid-cervical vagotomy or atropine (1 mg kg(-1)) pre-treatment. In conscious rats, we investigated DP, with and without atropine pre-treatment. DP increased neutrophil level in BAL (bronchoalveolar lavage) fluid from intact anesthetized rats to 2.5+/-0.7x10(6) cells (n=8), compared with saline instillation (0.3+/-0.1x10(6), n=7; P<0.05). Vagotomy reduced DP neutrophilia to 0.8+/-0.2x10(6) cells (n=8; P<0.05 vs. intact); atropine reduced DP-induced neutrophilia to 0.3+/-0.2x10(6) (n=4; P<0.05). In conscious rats, DP neutrophilia of 8.5+/-1.8x10(6), n=4, was reduced by pre-treatment with atropine to 2.2+/-1.2x10(6) cells, n=3. Hyperventilation occurred 6 h after DP in anesthetized rats with intact vagi, but not in bilaterally vagotomized or atropine pre-treated animals and was abolished by vagotomy (P<0.05, paired test). There were no significant differences in the other variables (mean blood pressure, heart rate and heart rate variability) measured before and 360 min after DP. In conclusion, DP activates a pro-inflammatory vago-vagal reflex which is reduced by atropine. Muscarinic ACh receptors in the rat lung are involved in DP-induced neutrophilia, and hence muscarinic antagonists may reduce airway and/or cardiovascular inflammation evoked by inhaled atmospheric DP in susceptible individuals.     

Biochemical markers in oncology. Part I: molecular basis. Part II: clinical uses

The investigation of the molecular mechanisms involved in carcinogenesis and tumor progression has led to the development of numerous biochemical markers. Biochemical markers may serve for early prediction of tumor recurrence, progression and development of metastases including bone metastases and for prediction of response to therapy. Tumor antigens have been used for more than a decade and although they have shown promising clinical results, their sensitivity and specificity remain limited. A lot of knowledge on the key molecules which control cell cycle, apoptosis and angiogenesis has been acquired during recent years, but their clinical value remains uncertain. Molecular markers which are linked to malignant transformation may provide a non-surgical therapeutic approach by targeting these molecules through gene therapy or antisense molecules. Because of the complexity of the physiopathogical processes involved in tumorogenesis and metastases, we first provide a review on the molecular basis of the various tumor markers and then discuss their potential clinical utility for the major cancers. The review of the current literature indicates that at the exception of a few examples, such as the use of Her-2 to predict response of the targeted Herceptin therapy, no single marker is sensitive and specific enough to perform an accurate diagnosis, predict disease progression or response to treatment. A combination of different biochemical and imaging markers appears to be the most promising strategy to monitor patients with cancer.     

Efficacy of various dithiol compounds in acute As2O3 poisoning in mice

The efficacy ofdl-dimercaptopropanol (British Anti-Lewisite, BAL),dl-dimercaptopropanesulfonate (DMPS), and meso-dimercaptosuccinic acid (DMS A) was compared in reducing the acute As₂O₃ toxicity in mice. Mice were treated with a single equimolar dose of a dithiol compound (0.7 mmol/kg i.p.) 0.5 or 30 min after the s.c. injection of various doses of As₂O₃. Both DMPS and DMSA were significantly (p<0.05) more effective in mice treated 0.5 min after the poisoning if compared to BAL on an equimolar level. The highest potency ratio (PR) (LD50 with treatment/LD5o without treatment) was found in animals injected with DMSA (PR=8.6). The corresponding value for DMPS was 4.2, and for BAL 2.1, respectively. In animals treated 30 min after poisoning the efficacy of DMPS (PR = 2.6) was similar to the efficacy of DMSA 2.4, both being only slightly superior to BAL 2.O. DMPS and DMSA were found to be much less toxic than BAL. The LD₅₀ of arsenic was 0.057 mmol/kg. The efficacy of BAL, DMPS, and DMSA in reducing the tissue content of arsenic following acute As₂O₃ poisoning was investigated in mice (n=6/group) and guinea pigs (n=3-4/group). The animals were injected s.c. with 0.043 mmol/kg As₂O₃ (containing a tracer dose of⁷⁴As(III)). Thirty minutes later the antidotes were administered A were more effective in reducing the arsenic content of tissues than BAL. Moreover, BAL caused accumulation of the toxicant in the brain. It is concluded that the recommendation of BAL as drug of choice in acute arsenic poisoning needs to be carefully re-evaluated.     

Liver antioxidant and plasma immune responses in juvenile golden grey mullet (Liza aurata) exposed to dispersed crude oil

Dispersants are often used after oil spills. To evaluate the environmental cost of this operation in nearshore habitats, the experimental approach conducted in this study exposed juvenile golden grey mullets (Liza aurata) for 48 h to chemically dispersed oil (simulating, in vivo, dispersant application), to dispersant alone in seawater (as an internal control of chemically dispersed oil), to mechanically dispersed oil (simulating, in vivo, natural dispersion), to the water-soluble fraction of oil (simulating, in vivo, an oil slick confinement response technique) and to seawater alone (control condition). Biomarkers such as fluorescence of biliary polycyclic aromatic hydrocarbon (PAH) metabolites, total glutathione liver content, EROD (7-ethoxy-resorufin-O-deethylase) activity, liver antioxidant enzyme activities, liver lipid peroxidation and an innate immune parameter (haemolytic activity of the alternative complement pathway) were measured to assess the toxicity of dispersant application. Significant responses of PAH metabolites and total glutathione content of liver to chemically dispersed oil were found, when compared to water-soluble fraction of oil. As was suggested in other studies, these results highlight that priority must be given to oil slick confinement instead of dispersant application. However, since the same patterns of biomarker responses were observed for both chemically and mechanically dispersed oil, the results also suggest that dispersant application is no more toxic than the natural dispersion occurring in nearshore areas (due to, e.g. waves). The results of this study must, nevertheless, be interpreted cautiously since other components of nearshore habitats must be considered to establish a framework for dispersant use in nearshore areas.     

Secretion of a chemotactic factor for neutrophils and eosinophils by alveolar macrophages from asthmatic patients

The studies presented in this article demonstrate the release of an IgE-dependent chemotactic factor for polymorphonuclear neutrophils (PMN) and eosinophils by alveolar macrophages (AMs) from normal subjects (n = 15) and allergic asthmatic patients (n = 15). A 60-minute incubation of normal AMs previously sensitized by 20% nonheated allergic sera with anti-human IgE antibody or the related allergen induced the release of a chemotactic activity (CA) for PMN and eosinophils in culture supernatants. When AMs were obtained from asthmatic patients, direct incubation with anti-IgE or the related allergen induced the same CA, whereas incubation with an unrelated allergen failed to produce CA (neutrophil CA after addition of anti-IgE, 22.5 +/- 3.5 cells per high power field; with related allergen, 15.8 +/- 3.6; with unrelated allergen, 0.7 +/- 1.8; p less than 0.0001). A partial characterization of the neutrophil chemotactic factor was carried out. Enzymatic treatment by trypsin or carboxypeptidase or by heating (56 degrees C for 3 hr) failed to abolish the neutrophil CA. After gel filtration the greater part of the neutrophil CA (80%) was recovered among low-molecular-weight components (300 to 1300 daltons). A preliminary deactivation of PMN by leukotriene B4 suppressed the CA of AM supernatants. These results indicate that IgE-dependent stimulation of AMs produces a neutrophil and eosinophil CA, present in a low-molecular-weight fraction possibly related to leukotrienes, and emphasizes the role of AMs in inflammatory lung processes during allergic asthma.     

BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭临床观察

目的:探讨支气管肺泡灌洗(BAL)联合无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并II型呼吸衰竭的临床效果。方法:选取我中心2011年1月至2013年1月间出诊送到同一家医院且收治的COPD合并II型呼吸衰竭的患者86例,随机分为观察组与对照组,观察组在常规治疗的基础上应用BAL联合NIPPV治疗,对照组单独采用NIPPV治疗,对比两组患者血气指标、心率、平均动脉压、APACHE II评分变化及不良反应发生情况。结果:两组患者治疗后Pa CO2均较治疗前显著下降,治疗前后比较差异有统计学意义(P<0.05);观察组患者治疗后Pa CO2下降较对照组更加迅速,组间比较差异有统计学意义(P<0.05);且观察组患者在治疗后24h、48h Pa O2均显著高于对照组,组间比较差异有统计学意义(P<0.05);且观察组患者气管插管率显著低于对照组,组间比较差异有统计学意义(P<0.05);两组患者心率、平均动脉压治疗24h后比较无统计学差异(P>0.05)。结论:BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭能有效的降低患者Pa CO2,提高Pa O2,可迅速缓解患者呼吸衰竭症状,是治疗COPD合并II型呼吸衰竭的有效治疗方案。