肺曲霉菌病诊治进展

肺曲霉菌病是曲霉菌侵入肺组织所引起的深部真菌感染性疾病,以烟曲菌为主要致病菌.主要发病于免疫缺陷患者,其临床表现无特异性,确诊依赖病理检查.早期诊断困难,治疗效果差,病死率高.近年来,该病在诊断和治疗上取得了很大的进展,现将其综述如下.     

12例确诊肺曲霉菌病临床分析

目的 通过对12例确诊肺曲霉菌病患者的临床特征、宿主因素、CT特点、诊断及治疗的回顾性分析,以提高早期诊断和治疗水平.方法 采用回顾性研究,查阅2004年1月-2011年9月新疆医科大学第一附属医院病历资料,收集肺曲霉菌病确诊病历相关资料,制作调查表格.结果 12例患者中侵袭性肺曲霉病2例,均有宿主因素,临床特征以发热、呼吸急促为主,胸部CT主要表现为结节、实变、斑片及空洞影,1例出现新月征,1例支气管镜下取痰曲霉菌属培养阳性,1例肺组织病理检查阳性,1例抗真菌治疗有效,1例死亡;寄生性肺曲霉菌病10例,8例有肺部基础疾病,临床症状以咯血多见,胸部CT表现结节8例,团块、空洞、斑片各2例,晕轮征、新月征各1例;9例行手术治疗,其中6例在术前未被考虑肺曲霉菌病;术后电话随访7例,治愈6例.结论 肺曲霉菌病临床特征不典型,痰检阳性率低,早期不易诊断,另外部分患者因病情危重不能耐受手术或气管镜检查;其早期诊断方法有待进一步探讨.     

Ursolic acid ameliorates autoimmune arthritis via suppression of Th17 and B cell differentiation

Aim:

Ursolic acid (UA) is a pentacyclic triterpenoid found in most plant species, which has been shown anti-inflammatory and anti-oxidative activities. In this study, we examined the effects of UA on collagen-induced arthritis (CIA) in mice, and to identify the mechanisms underlying the effects.

Methods:

CIA was induced in mice. Two weeks later, the mice were treated with UA (150 mg/kg, ip, 3 times per week) for 4 weeks. The expression of cytokines and oxidative stress markers in joint tissues was measured with immunohistochemistry. The numbers of CD4⁺IL-17⁺, CD4⁺CD25⁺Foxp3⁺ and pSTAT3 cells in spleens were determined using confocal immunostaining or flowcytometric analyses. Serum antibody levels and B cell-associated marker mRNAs were analyzed with ELISAs and qRT-PCR, respectively. CD4⁺ T cells and CD19⁺ B cells were purified from mice spleens for in vitro studies.

Results:

UA treatment significantly reduced the incidence and severity of CIA-induced arthritis, accompanied by decreased expression of proinflammatory cytokines (TNF-α, IL-1β, IL-6, IL-21 and IL-17) and oxidative stress markers (nitrotyrosine and iNOS) in arthritic joints. In CIA mice, UA treatment significantly decreased the number of Th17 cells, while increased the number of Treg cells in the spleens, which was consistent with decreased expression of pSTAT3, along with IL-17 and RORγt in the splenocytes. In addition, UA treatment significantly reduced the serum CII-specific IgG levels in CIA mice. The inhibitory effects of UA on Th17 cells were confirmed in an in vitro model of Th17 differentiation. Furthermore, UA dose-dependently suppressed the expression of B cell-associated markers Bcl-6, Blimp1 and AID mRNAs in purified CD19⁺ B cells pretreated with IL-21 or LPS in vitro.

Conclusion:

UA treatment significantly ameliorates CIA in mice via suppression of Th17 and differentiation. By targeting pathogenic Th17 cells and autoantibody production, UA may be useful for the treatment of autoimmune arthritis and other Th17-related diseases.     

大鼠肝缺血再灌注损伤肝核因子-κB、髓过氧化物酶、组织因子与凝血功能紊乱

肝缺血再灌注（IR）过程中，白细胞和细胞因子等不仅参与了肝组织炎症反应，而且极易引起凝血功能的紊乱。组织因子（TF）是一种跨膜糖蛋白，是凝血过程的启动因子，在炎症介质和内毒素等的刺激下，血管内皮细胞和单核细胞及巨噬细胞可表达TF。研究证实，核因子-κB（NF-κB）在肝IR损伤中发挥着重要作用。现旨在探讨肝I／R损伤中肝组织的炎性浸润与所引起的血液凝血功能失常之间的关系。     

下颌骨骨折病例回顾性分析研究

目的：研究下颌骨骨折的发生特点。方法：对我院自1986年至2000年间收治的206例下颌骨骨折住院患者的性别、年龄、致伤原因，骨折部位、骨折合并伤及治疗方法进行分析。结果：下颌骨骨折男性明显多于女性，20－39岁为高发年龄；交通事故为主要致伤原因；骨折部位以颏部最多；34．95％的伤员有面中部骨折、颅脑和四肢等处的合并伤；非手术治疗的颌间牵引复位固定为本组病例的主要治疗手段。近年来，坚固内固定在下颌骨骨折治疗中的应用取得了形态和功能均较满意的效果。结论：男性及20－39岁青壮年为下颌骨骨折高发人群。90年代以来，下颌骨骨折患者明显增多。交通事故是主要致伤原因。坚固内固定是目前治疗下颌骨骨折的较好办法。     

Vitapex糊剂根尖诱导成形的临床研究

目的:观察Vitapex根管糊剂在根尖诱导成形术中的疗效。方法:将86例共计94颗牙根未完全发育完成的年轻恒牙随机分为两组,治疗组48颗,对照组46颗,分别用Vitapex糊剂和氢氧化钙糊剂进行根尖诱导成形,术后3年随访并比较其疗效。结果:治疗有效率氢氧化钙组为76.09%,Vitapex糊剂组为93.75%,两组疗效比较差异有显著性意义(p<0.05)。结论:Vitapex根管糊剂在年轻恒牙根尖诱导成形中疗效满意,可推广使用。     

封闭式负压引流和传统切开引流在颌面间隙感染中的效果比较

目的:探讨封闭式负压引流和传统切开引流在治疗颌面间隙感染中的效果差异.方法:选择2017年2月—2019年8月收治的颌面部间隙感染患者139例,采用随机区组方式分为负压组69例(封闭式负压引流)和传统组70例(传统切开引流);比较2组的视觉模拟疼痛量表(VAS)评分、血清降钙素原(PCT)、C反应蛋白(CRP)变化,治...     

颊脂垫在口腔软组织缺损修复中的应用

目的:评价颊脂垫在口腔软组织缺损修复中的效果。方法:17例口腔不同部位肿瘤切除后,应用颊脂垫瓣修复软组织缺损并进行回顾性分析。结果:颊脂垫在组织缺损区愈合良好,未见并发症的发生,3～4周即可见上皮覆盖,组织缺损被修复。结论:颊脂垫瓣修复口腔软组织缺损,方法简单、易行,效果满意,值得推广。