呼出气一氧化氮水平对变应性哮喘的诊断价值

目的:评估呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)水平对变应性哮喘的诊断价值。方法:选择2015年8月至2016年9月在复旦大学附属中山医院呼吸科就诊的新诊断或未经规范治疗的哮喘患者147例。将患者分为变应性哮喘组(n=107)和非变应性哮喘组(n=40)。在规范化治疗前,进行FeNO、肺功能、血清总IgE等检测。采用受试者工作特征曲线(ROC)评价FeNO对变应性哮喘的诊断价值。结果:变应性哮喘组FeNO水平和血清总IgE值均明显高于非变应性哮喘组(P0.05),两组第1秒用力呼气容积占预计值百分比(FEV_1%pred)、用力呼气量占用力肺活量比值(FEV_1/FVC)和用力肺活量占预计值百分比(FVC%pred)差异均无统计学意义。变应性哮喘组中FeNO水平与血清总IgE正相关(r=0.298,P0.001),而与FEV_1%pred、FEV_1/FVC、FVC%pred无相关性;非变应性哮喘组FeNO水平与上述四项指标均无相关性。变应性哮喘组支气管舒张试验阳性与阴性的患者间FeNO水平差异无统计学意义。FeNO诊断变应性哮喘的ROC曲线下面积为0.971,最佳阈值为40.05ppb(1ppb=1μL/m~3),灵敏度为96.3%,特异度为85.0%。结论:新诊断或未规范治疗的变应性哮喘患者的FeNO水平升高,与血清总IgE值正相关;当FeNO40.05ppb时,变应性哮喘可能性大。     

非哮喘患者呼出气一氧化氮异常与肺通气功能情况分析

目的探讨非哮喘患者呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)异常与肺通气功能指标的关系。方法FeNO异常的非哮喘患者333例,根据FeNO值分为轻微异常组(FeNO:26~49ppb)93例,轻度异常组(FeNO:50~79ppb)82例,中度异常组(FeNO:80~100ppb)74例和重度异常组(FeNO100ppb)84例。检测4组患者肺通气功能指标第1秒用力呼气容积(forced expiratory volume in one second,FEV_1)、用力呼出50%肺活量的瞬间流量(forced expiratory flow at 50%of forced vital capacity exhaled,FEF_(50))和用力呼出75%肺活量的瞬间流量(forced expiratory flow at 75%of FVC exhaled,FEF_(75)),比较4组肺通气功能减退率及FEV_1、FEF_(50)和FEF_(75)。结果4组患者FEV_1比较差异无统计学意义(P0.05);重度异常组FEF_(50)和FEF_(75)[(66.62±29.37)%pred、(64.92±29.77)%pred]低于轻微异常组[(80.96±26.88)%pred、(86.04±24.70)%pred]和轻度异常组[(75.63±36.22)%pred、(76.26±35.67)%pred](P0.05),中度异常组[(72.96±28.63)%pred、(71.19±29.48)%pred]低于轻微异常组(P0.05);重度异常组肺通气功能减退率(61.9%)明显高于中度异常组(47.3%)、轻度异常组(37.8%)和轻微异常组(35.5%)(P0.05),中度异常组高于轻度异常组、轻微异常组(P0.05),轻度异常组高于轻微异常组(P0.05)。结论与肺通气功能指标FEV_1、FEF_(50)和FEF_(75)相比,FeNO对患者气道受损情况和程度的判断较灵敏。     

呼出气一氧化氮检测在小儿支气管哮喘早期诊断及病情评估中的应用

目的探讨呼出气一氧化氮(FeNO)对早期诊断小儿支气管哮喘及病情评估的应用价值。方法前瞻性选取130例支气管哮喘患儿作为研究对象,将90例急性发作期患儿纳入急性期组,将40例缓解期患儿纳入缓解期组,并将急性期组患儿按病情程度的不同分为轻度组(n=32)、中度组(n=35)和重度组(n=23)。比较急性期组和缓解期组、不同病情程度急性期患儿的FeNO、最大呼气流量占预计值百分比(PEF%)、第1秒用力呼气量占预计值百分比(FEV_1%)和免疫球蛋白E(IgE)水平,并采用Pearson法分析FeNO与PEF%、FEV_1%、IgE水平的相关性。结果急性期组FeNO(68. 30±9. 21) ppb、IgE(279. 32±78. 05) k U/L分别高于缓解期组(39. 27±5. 38) ppb、(185. 70±52. 36) k U/L,而PEF%(73. 50±9. 85)%、FEV_1%(78. 53±9. 76)%分别低于缓解期组(89. 65±6. 53)%、(90. 12±6. 74)%,差异均有统计学意义(P 0. 05);轻度组、中度组和重度组患儿FeNO、PEF%、FEV_1%、IgE组间两两比较,差异有统计学意义(P 0. 05)。Pearson法分析显示,急性期支气管哮喘患儿FeNO与PEF%、FEV_1%呈显著负相关(r=-0. 827、-0. 793,P 0. 05),与血清IgE呈显著正相关(r=0. 780,P 0. 05)。结论支气管哮喘患儿急性期FeNO异常升高,且与肺功能指标PEF%、FEV_1%和血清IgE有显著相关性,可为临床早期诊断支气管哮喘和评估病情提供重要依据。     

中央和外周气道一氧化氮测定在哮喘诊断中的应用

目的 通过分析中央气道一氧化氮(FeNO)、外周气道一氧化氮(Ca NO)和肺功能之间的关系,探讨FeNO和Ca NO在哮喘诊断中的临床应用价值。方法 以承德医学院附属医院2020年1月至2022年4月同时行FeNO、Ca NO、肺功能检测的患者为研究对象,分为哮喘组、慢阻肺组和对照组,分析三组患者FeNO、Ca NO与肺功能指标的关系,应用受试者操作特征曲线和配对设计资料χ²检验分析FeNO和CaNO在哮喘诊断方面的价值。结果 共纳入308例为研究对象,其中哮喘组患者130例,慢阻肺组患者102例,对照组患者76例。三组患者比较,哮喘组患者FeNO[(55.14±34.64)ppb]水平高于慢阻肺组患者[(19.56±7.93)ppb]和对照组患者[(18.93±7.93)ppb],组间差异有统计学意义(P<0.01),但后两组患者比较差异无统计学意义(P>0.05)。三组患者比较,CaNO和肺功能各指标组间差异均有统计学意义(P<0.05)。FeNO与CaNO呈正相关(r=0.363,P<0.001)。FeNO与年龄、25%肺活量时的最...     

血清尿酸与哮喘急性发作严重程度及肺功能的相关性

目的探讨哮喘急性发作患者血清尿酸水平与病情严重程度及肺功能的关系。方法哮喘急性发作患者126例(观察组),其中轻度和中度患者88例为非危重组,重度和危重度患者38例为危重组,于入院时检测血清尿酸水平,行肺功能检查记录用力肺活量(forced vital capacity,FVC)占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(percentage of forced expiratory volume in one second of the predicted value,FEV_1%pred)、呼气峰流量占预计值百分比(percentage of peak expiratory flow of the predicted values,PEF%pred),并与126例同期体检健康者(对照组)进行比较;采用Pearson相关分析哮喘急性发作患者血清尿酸水平与肺功能的相关性;绘制ROC曲线评价血清尿酸对哮喘急性发作重度和危重度的诊断价值。结果观察组血清尿酸水平[(353.96±61.27)μmol/L]高于对照组[(275.63±53.86)μmol/L],FVC%pred[(72.5±17.6)%]、FEV_1%pred[(69.5±16.9)%]、PEF%pred[(72.1±19.8)%]低于对照组[(86.3±9.1)%、(89.1±8.3)%、(85.9±7.6)%](P0.05);危重组血清尿酸水平[(395.08±73.49)μmol/L]高于非危重组[(335.59±58.73)μmol/L],FVC%pred[(54.5±12.0)%]、FEV_1%pred[(45.4±12.7)%]、PEF%pred[(60.3±20.2)%]低于非危重组[(81.3±15.3)%、(79.8±17.5)%、(84.4±18.3)%](P0.05);哮喘急性发作患者血清尿酸水平与病情严重程度呈正相关(r=0.63,P=0.002),与FVC%pred(r=-0.49,P=0.012)、FEV_1%pred(r=-0.41,P=0.029)和PEF%pred(r=-0.58,P=0.036)均呈负相关;血清尿酸以379.5μmol/L为最佳截断值,诊断哮喘急性发作重度和危重度的AUC为0.829(95%CI:0.743～0.916,P0.001),灵敏度为73.7%,特异度为85.2%。结论哮喘急性发作患者血清尿酸水平与病情严重程度、肺功能密切相关,可作为评价哮喘急性发作及严重程度的生物标志物。     

呼出气一氧化氮浓度评估糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘的临床疗效

目的:评价呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)浓度对糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘疗效的应用价值。方法:收集156例确诊的咳嗽变异性哮喘患儿,随机分为实验组和对照组各78例,实验组采用糖皮质激素和白三烯受体拮抗剂联合治疗的方法,而对照组只使用糖皮质激素治疗,观察两组患者的临床疗效、肺功能改善情况、炎症因子表达水平、不良反应,分析FeNO浓度与FEV_1%pred的关系。结果:实验组和对照组的在临床疗效、临床症状缓解时间、肺功能情况、炎症因子表达方面差异有统计学意义(P0.05),在不良反应方面两组差异无统计学意义(P0.05)。FeNO浓度与FEV_1%pred存在显著的负相关(r=.0.9491,95%CI=.0.9627～.0.9307,P0.001),FeNO浓度与PAQLQ量表评分也存在显著的负相关(r=.0.9313,95%CI=.0.9495～.0.9069,P0.001)。FeNO评估FEV_1%pred(%) ROC曲线:AUC=0.807,95%CI=0.735～0.878,P0.001。约登指数=0.633,FeNO诊断CVA的最佳截断值为40.5μg/L,敏感度90%,特异度73.3%,阳性预测值93.6%,阴性预测值62.9%。结论:糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘的效果显著,监测治疗前后的FeNO浓度可以评估肺功能的改善情况。     

血清ECP、CRP和FeNO联合检测在支气管哮喘诊治中的应用

目的探讨血清嗜酸性粒细胞阳离子蛋白(ECP)、C反应蛋白(CRP)和呼出气一氧化氮(FeNO)联合检测在支气管哮喘诊治中的应用。方法选取2014年10月至2016年10月唐山市协和医院接诊的50例支气管哮喘患者作为研究对象,并选择同期在该院接受体检的50例健康人员作为对照组。使用酶联免疫吸附试验法检测血清ECP、CRP的表达,使用FeNO检测仪检测FeNO水平。比较支气管哮喘组和对照组血清ECP、CRP、FeNO的表达,并比较不同病情程度支气管哮喘患者血清ECP、CRP、FeNO的表达;支气管哮喘组在接受3个月的对症治疗后,比较不同疗效结果患者血清ECP、CRP、FeNO的表达。结果支气管哮喘组血清ECP、CRP、FeNO水平[(15.86±1.47)ng/L、(4.87±0.52)mg/L、(61.23±11.52)ppb]均明显比对照组高[(6.62±0.63)ng/L、(1.04±0.23)mg/L、(23.58±3.40)ppb],差异有统计学意义(P0.05);急性发作期支气管哮喘患者血清ECP、CRP、FeNO[(18.56±1.85)ng/L、(5.74±0.70)mg/L、(66.93±10.62)ppb]明显比缓解期患者高[(12.34±1.47)ng/L、(3.69±0.37)mg/L、(54.54±8.02)ppb],差异有统计学意义(P0.05);支气管哮喘患者在治疗3个月后,临床控制28例,部分控制18例,未控制4例,临床控制组血清ECP、CRP和FeNO明显低于部分控制组及未控制组,差异有统计学意义(P0.05)。结论通过联合检测支气管哮喘患者血清ECP、CRP、FeNO的表达有助于了解疾病严重程度,在疾病的早期诊治中具有积极意义。     

呼出气一氧化氮评估慢性阻塞性肺疾病患者气道炎症临床研究

目的探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)在评估慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者气道慢性炎症及糖皮质激素治疗效果中的价值。方法 COPD患者101例,依据慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease,GOLD)分级分为轻度组9例、中度组35例、重度组36例、极重度组21例,同期25例体检健康者为对照组,检测并比较其FeNO水平;比较合并哮喘(32例)与未合并哮喘(69例),应用糖皮质激素(57例)与未应用糖皮质激素(44例),从未吸烟(42例)与未戒烟(23例)及已戒烟(36例)COPD患者FeNO增高率。结果COPD组患者FeNO水平[(15.51±13.23)ppb]明显高于对照组[(11.20±8.30)ppb](P0.05);COPD轻度组[(12.6±8.2)ppb]、中度组[(17.5±12.1)ppb]、重度组[(15.7±11.5)ppb]、极重度组[(13.0±7.6)ppb]FeNO水平比较差异无统计学意义(P0.05);合并哮喘者FeNO增高率(21.9%)明显高于未合并哮喘者(7.2%)(P0.05);未应用糖皮质激素治疗者FeNO增高率(20.5%)明显高于应用糖皮质激素治疗者(5.3%)(P0.05);从未吸烟、未戒烟、已戒烟者FeNO增高率比较差异无统计学意义(P0.05)。结论 FeNO可较好反映Th2介导的气道慢性炎症,有助于评价糖皮质激素治疗效果,可能有助于COPD合并支气管哮喘重叠综合征的诊断。     

支气管哮喘患者肺通气功能与呼出气一氧化氮浓度的关系

目的探讨支气管哮喘患者肺通气功能与呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)浓度的关系。方法 457例支气管哮喘患者,根据肺通气功能减退程度分为轻度阻塞组205例,中度阻塞组166例,重度阻塞组86例。3组均行FeNO检测,其中FeNO正常(FeNO≤25 ppb) 126例,FeNO轻度异常(FeNO 26～49 ppb) 133例,FeNO中重度异常(FeNO≥50 ppb) 198例。比较轻、中、重度阻塞组用力肺活量(forced vital capacity, FVC)占预计值百分比(FVC%_(pred))、第一秒用力呼气容积(forced expiratory volume in one second, FEV_1)占预计值百分比(FEV_1%_(pred))和FEV_1/FVC比值;比较轻、中、重度阻塞组FeNO正常、轻度异常、中重度异常者比率;采用Pearson相关分析重度阻塞组FeNO浓度与FEV_1%_(pred)的相关性。结果轻度阻塞组FVC%_(pred)、FEV_1%_(pred)和FEV_1/FVC值均高于中度阻塞组和重度阻塞组,中度阻塞组高于重度阻塞组(P0.05)。轻、中度阻塞组FeNO中重度异常比率(50.7%、41.6%)高于FeNO轻度异常比率(26.3%、31.3%)和FeNO正常比率(23.0%、27.1%),FeNO轻度异常比率高于FeNO正常比率(P0.05);重度阻塞组FeNO中重度异常比率(29.1%)低于FeNO轻度异常比率(31.4%)和FeNO正常比率(39.5%),轻度异常比率低于正常比率(P0.05)。FeNO中重度异常组FeNO浓度与FEV_1%_(pred)呈正相关(r=0.147,P=0.038)。结论支气管哮喘患者肺通气功能轻、中度阻塞时FeNO正常、轻度异常和中重度异常比率依次增高,重度阻塞时依次降低。     

呼出气一氧化氮对哮喘的诊断作用及与过敏原sIgE的关系

目的探讨呼出气一氧化氮(FeNO)对哮喘的诊断作用及与过敏原特异性IgE抗体(sIgE)的关系。方法选取2017年8月至2019年8月收治的98例疑似哮喘患儿进行观察,收集所有患儿的临床特征指标,检测肺功能及FeNO浓度,分析FeNO对哮喘的诊断作用及其与过敏原sIgE的关系。结果哮喘组的FeNO水平高于非哮喘组(P<0.05)。血清过敏原sIgE阳性患儿的Fe NO水平高于阴性患儿(P<0.05)。经Pearson相关性分析得出,FeNO水平与血清过敏原sIgE、血清总IgE和血清过敏原种类呈显著正相关(r=0.703、0.624、0.719,P<0.05)。结论FeNO在哮喘中具有一定的诊断价值,与过敏原sIgE存在显著的相关性,可为临床诊断与治疗哮喘提供有利参考依据。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."