支气管激发试验在儿童哮喘治疗中的意义

目的通过随访支气管哮喘患儿肺功能及气道反应性,了解哮喘患儿的症状/肺功能与气道炎症之间的关系,为哮喘规范治疗提供依据.方法对32例7～14岁、规范吸入糖皮质激素（ICS）治疗的支气管哮喘患儿的进行肺功能、组胺激发试验检查,评估患儿症状/肺功能与气道反应性的关系.结果经过规范治疗,非发作期的一秒用力呼气容积（FEV1）、25%和50%肺活量用力呼气流速（FEF25和FEF50）占预计值的百分比在吸入治疗后比治疗前的有显著改善（P＜0.01）;FEV1在治疗3个月后完全恢复正常;而小气道通气功能异常要到1年才完全恢复;气道高反应性治疗前后也有显著改善（P＜0.01）,但2年后组胺激发试验阳性率仍达72%,均为轻度气道高反应.结论哮喘缓解期,虽然症状消失,肺功能检测接近正常,但大部分患儿组胺激发试验持续阳性,说明气道炎症持续存在.定期复查肺功能及支气管激发试验是指导临床治疗的有效指标.     

常规肺通气功能检测在儿童支气管哮喘诊疗中的作用

目的探讨在儿童支气管哮喘诊疗中应用常规肺通气功能检测的临床意义。方法选取2017年1月～2018年6月我院接收的60例哮喘患儿,依据哮喘急性发作时病情严重程度结合肺功能,将患儿分为轻度32例,中度20例,重度8例,缓解期患儿为哮喘急性期经药物规范治疗后病情控制的患儿,统计急性期、缓解期哮喘患儿肺通气功能指标之间的差异,以及不同病情患儿肺功能指标实测值与预计值差异。结果哮喘急性期肺功能损害表现为小气道中重度异常,大气道轻中度异常;在大气道功能指标上,急性发作组FVC、FEV1、PEF均较缓解期组明显要低(P <0.05);在小气道功能指标上,急性发作组各项指标亦较缓解期组明显要低(P <0.05);急性期重度哮喘患儿肺功能各项指标较轻度、中度哮喘发作患儿明显减低,中度哮喘患儿PEF较轻度组明显减低(P <0.05)。结论肺通气功能检测对于哮喘的病情评估及指导治疗具有重要作用,应常规定期检测。     

343例支气管哮喘患者的气道反应性分析

目的了解支气管哮喘患者的气道反应性,为临床诊治提供依据。方法对343例临床诊断为支气管哮喘的患者进行支气管激发试验,对其阳性率、可疑阳性率及阴性率进行统计,并对三者的FEV1下降率进行分析。结果 343例支气管哮喘患者有61%具有气道高反应性(AHR)。三组病例的平均FEV1下降率之间差异具有统计学意义。结论气道反应性测定可作为支气管哮喘诊断、病情、预后评估及治疗方案选择的一个重要条件,但并非唯一。有许多因素可影响支气管激发试验的测定结果,其间尚有许多的工作要做。     

晚发支气管哮喘与慢性阻塞性肺疾病肺功能及气道反应性比较

目的分析晚发支气管哮喘与慢性阻塞性肺疾病(COPD)肺功能及气道反应性。方法选取晚发支气管哮喘(晚发哮喘组)与慢性阻塞性肺疾病(慢性阻塞性肺疾病组)患者各55例,并检测两组患者的肺功能指标以及气道反应性。结果两组患者的最大呼气流量(PEF)、1秒用力呼气容积(FEV1)、最大呼气中段流量(MMEF)、气道阻力(Raw)1、Raw2对比,差异有统计学意义(P<0.05)。结论肺功能检查以及气道反应性检测均可用于鉴别诊断晚发支气管哮喘与慢性阻塞性肺疾病,准确性较高,可指导后期临床治疗,应用价值显著。     

哮喘缓解期气道粘膜中肥大细胞超微结构变化

对12例具有气道高反应性的哮喘缓解期患者和4例气道反应性正常的健康人进行纤支镜检查,并分别在三级支气管水平取粘膜活检,透射电镜下观察,对肥大细胞分泌颗粒做形态定量学测定。结果显示,哮喘缓解期气道粘膜中肥大细胞仍处于慢性持续性释放介质状态,释放颗粒数与气道反应性之间无明显相关(r=0.5519)。     

阻塞性睡眠呼吸暂停综合征与气道反应性关系的研究

目的　探讨阻塞性睡眠呼吸暂停综合征(OSAS)是否存在气道高反应性及其临床意义。方法　抽取到我科进行呼吸监测的患者92例进行肺功能FEV1、支气管舒张试验的测定,并进行临床评估,以AHI≥5次/小时将92例分为OSAS组和对照组,进行比较分析。结果　OSAS组FEV1低于对照组(P <0 . 0 5 ) ;FEV1用支气管扩张剂前后改变率高于对照组(P <0. 0 5 ) ;且OSAS组合并哮喘的人数高于对照组。结论　OSAS患者存在肺功能减退及气道高反应性,哮喘发病人数增高。临床上除积极治疗OSAS外,加用支气管扩张剂、降低气道高反应性的药物可能对保护肺功能、降低哮喘的发生率有重要的意义。     

晚发支气管哮喘与慢性阻塞性肺疾病肺功能及气道反应对比分析

目的对比分析晚发支气管哮喘与慢性阻塞性肺疾病肺功能及气道反应。方法晚发支气管哮喘与慢性阻塞性肺疾病患者各30例。检测两组患者的肺功能指标:1秒钟用力呼气容积(FEV1.0)、最大呼气流量(PEF)、最大呼气中段流量(MMEF)、气道阻力(Raw)、残气容积/肺总量(RV/TLC)。通过潮气量法测定气道反应性,醋甲胆碱(Mch)作为激发试剂。结果与晚发支气管哮喘患者相比,慢性阻塞性肺疾病患者的1秒钟用力呼气容积(FEV1.0)和最大呼气中段流量(MMEF)较低,而气道阻力(Raw)增高,P<0.05,有统计学意义;支气管激发实验后,慢性阻塞性肺疾病患者气道阻力(Raw)没有明显变化,而晚发支气管哮喘患者气道阻力(Raw)变化非常明显,这些都表明,与慢性阻塞性肺疾病患者相比,晚发支气管哮喘患者气道可逆性增高,P<0.05,有统计学意义。结论肺功能检查与气道反应性测定,对晚发支气管哮喘与慢性阻塞性肺疾病的诊断和鉴别诊断非常重要,值得临床推广。     

支气管激发试验在不典型哮喘中的诊断价值

目的探讨支气管激发试验在不典型哮喘中的诊断价值及意义。方法对147例不典型哮喘患者用肺功能仪测定基础肺功能及吸入不同剂量组胺后的肺功能,同时对PEF、FEV1、MMEF同步进行测定,观察三者的变化。结果147例患者支气管激发试验阳性62例(42.2%),可疑阳性31例(21.1%),正常54例(36.7%)。所有患者均顺利完成检查。阳性组结果提示MMEF下降与FEV1下降呈明显相关性,且MMEF下降的幅度大于FEV1的改变;可疑阳性组MMEF与FEV1亦呈同步下降,下降值均≥20%,幅度也大于FEV1;正常组MMEF与FEV1也有很好的同步性,且MMEF激发前后所测值(-x±s)P<0.05具有统计学意义。结论对临床高度怀疑哮喘而基础肺功能正常的病人,首选支气管激发试验以便作出早期诊断。     

肺功能检查在咳嗽变异性哮喘患者诊断中的应用

目的探讨肺功能检测在咳嗽变异性哮喘诊断的应用价值。方法对2010年2月至2011年7月我院收治的70例反复咳嗽患者行肺通气功能及气道反应性测定。结果 70例患者中,肺功能异常者有32例,占45.71%,支气管舒张试验阳性总例数26例,占37.14%,男女两组阳性率无显著差异。经过对反复咳嗽的患者进行支气管舒张试验及结合临床治疗效果,最后确诊咳嗽变异型哮喘23例,其阳性率32.86%。结论对反复咳嗽患者进行肺通气功能及气道反应性测定,可准确诊断咳嗽变异型哮喘(CVA),有利于反复咳嗽病因的早期诊断。     

晚发支气管哮喘与慢性阻塞性肺疾病肺功能及气道反应性比较

目的：分析晚发支气管哮喘与慢性阻塞性肺疾病肺功能及气道反应性。方法选取本院2012年8月~2013年4月收治的54例晚发支气管哮喘患者与慢性阻塞性肺疾病患者,每组各27例,对两组患者的肺功能指标进行检测,主要包括1 s用力呼气容积（FEV1.0）、气道阻力（Raw）、最大呼气中断流量（MMEF）、最大呼气流量（PEF）以及残气容积/肺容量（RV/TLC）等。运用潮气量法对气道反应性进行测定,将醋甲胆碱作为激发试剂。结果慢性阻塞性肺疾病患者的MMEF、FEV1.0低于晚发支气管哮喘患者（P〈0.05）;晚发支气管哮喘患者的气道可逆性高于慢性阻塞性肺疾病患者（P〈0.05）。结论对晚发支气管哮喘患者与慢性阻塞性肺疾病患者的肺功能进行检查,对气道反应性进行测定,能够提高诊断准确性和鉴别力,值得推广。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.