慢性鼻窦炎患者嗅觉障碍的危险因素探讨及其对患者心理健康和生存质量的影响

摘要 目的：探讨慢性鼻窦炎患者嗅觉障碍的危险因素及其对患者心理健康和生存质量的影响。方法：选取2017年9月~2020年9月期间首都医科大学附属北京同仁医院收治的120例慢性鼻窦炎患者进行嗅觉功能测试。统计嗅觉功能障碍患者的发生率，并依据嗅觉功能测试情况将患者分为嗅觉障碍组（n=64）和嗅觉正常组（n=56）。对两组患者的基础资料、临床资料、心理健康状况和生存质量等进行比较分析，采用单因素分析慢性鼻窦炎患者嗅觉障碍发生的影响因素，多因素Logistic回归分析慢性鼻窦炎患者嗅觉障碍发生的危险因素。结果：经嗅觉功能测试结果统计，120例患者中有64例患者出现嗅觉功能障碍，嗅觉障碍患病率为53.33%，其中男性有36例（56.25%），女性有28例（43.75%）；嗅觉下降46例(38.33%)、失嗅18例(15.00%)。单因素分析显示：鼻内镜手术史、伴鼻息肉、哮喘病史、嗜酸粒细胞比例、鼻内镜Lund-Kennedy评分是慢性鼻窦炎嗅觉障碍发生的影响因素(均P<0.05)。多因素Logistic回归分析表明：鼻内镜手术史、伴鼻息肉、哮喘病史、嗜酸粒细胞比例>5%、鼻内镜Lund-Kennedy评分≥2分是慢性鼻窦炎嗅觉障碍发生的独立危险因素。嗅觉正常组的焦虑自评量表（SAS）、抑郁自评量表（SDS）评分均低于嗅觉障碍组（P<0.05）。嗅觉正常组生活质量简表（SF-36）各维度评分均高于嗅觉障碍组（P<0.05）。结论：慢性鼻窦炎患者的嗅觉障碍发生率较高，鼻内镜手术史、伴鼻息肉、哮喘病史、嗜酸粒细胞比例>5%、Lund-Kennedy评分≥2分是影响患者嗅觉障碍发生的危险因素。同时嗅觉障碍还会引起患者抑郁焦虑等不良情绪，降低患者的生活质量。     

通窍鼻炎片联合克拉霉素对慢性鼻窦炎患者嗅觉功能、鼻黏液纤毛传输速度及血清炎性因子的影响

目的:探讨通窍鼻炎片联合克拉霉素对慢性鼻窦炎患者嗅觉功能、鼻黏液纤毛传输速度及血清炎性因子的影响。方法:于2017年11月~2020年6月期间,选取我院门诊收治的慢性鼻窦炎患者86例。根据入院序号奇偶性将患者分为对照组和观察组,各43例。对照组采用克拉霉素治疗,观察组采用通窍鼻炎片联合克拉霉素治疗,均治疗4周。对比两组疗效、临床症状评分、嗅觉功能、鼻黏液纤毛传输速度及血清炎性因子,记录两组不良反应发生情况。结果:观察组的临床总有效率高于对照组(P<0.05)。两组治疗4周后T&T主观嗅觉测试法分级均较治疗前改善,且观察组的改善效果优于对照组(P<0.05)。两组不良反应发生率对比无明显差异(P>0.05)。治疗4周后,两组鼻黏膜纤毛输送率(MTR)和鼻黏膜纤毛清除率(MCC)均较治疗前升高,且观察组高于对照组(P<0.05)。治疗4周后,两组血清白介素-5(IL-5)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均较治疗前降低,且观察组低于对照组(P<0.05)。治疗4周后,观察组鼻塞、头晕头痛、鼻漏、嗅觉下降、流涕、喷嚏症状评分低于对照组(P<0.05)。结论:通窍鼻炎片联合克拉霉素治疗慢性鼻窦炎患者疗效显著,可有效改善患者嗅觉功能及鼻黏液纤毛传输速度,缓解临床症状并降低机体炎性因子水平,且安全性较好。     

儿童过敏性结膜炎与变应性鼻炎的相关性及鼻眼联合防治效果分析

目的：探讨儿童过敏性结膜炎与变应性鼻炎的相关性研究及鼻眼联合防治的临床效果。方法：回顾性分析300 例儿童过敏性 结膜炎与310 例儿童变应性鼻炎患者的临床资料,对儿童过敏性结膜炎与变应性鼻炎的相关性进行分析后将所有患儿随机均分 为对照组与观察组,对照组采用常规点眼的方法进行治疗,观察组则采用鼻朗喷鼻联合人工泪液点眼进行治疗。比较两组临床疗 效及不良反应情况。结果：（1）300 例过敏性结膜炎患儿中,50 例（16.67%）并发变应性鼻炎;310 例变应性鼻炎患儿中,59 例 （19.03%）并发过敏性结膜炎（P＞0.05）;（2）109 例同时并发两种疾病患儿中,均进行眼结膜与鼻粘膜的刮片检查嗜酸性粒细胞, 其中60 例（55.05%）结膜刮片与67 例（61.47%）鼻粘膜刮片检测到嗜酸性粒细胞（P＞0.05）;（3）两组治疗前后BUT 及角膜荧光素 染色评分、症状评分、临床总有效率比较差异明显（P＜0.05）。结论：儿童过敏性结膜炎与变应性鼻炎具有一定的相关性;鼻朗喷鼻 联合人工泪液点眼治疗儿童合并变应性鼻炎的临床疗效显著。     

慢性鼻病中乏氧诱导因子与5-脂加氧酶表达变化及其与疾病严重程度关系研究

摘要 目的：探究慢性鼻病中乏氧诱导因子（HIF-1α）与5-脂加氧酶（5-LOX）表达变化及其与疾病严重程度关系。方法：选取我院2019年7月-2020年11月期间收治的75例慢性鼻病患者作为研究对象;其中鼻息肉25例,变态反应性鼻炎25例,鼻窦炎25例;同期选择30例经鼻中隔偏曲矫正下鼻甲成形术患者的下鼻甲黏膜组织设为对照组。比较四组患者乏氧诱导因子与5-脂加氧酶蛋白及mRNA水平;并分析在不同鼻部疾病中,HIF-1α、5-LOX的相关性。结果：鼻息肉组、变态反应性鼻炎组、鼻窦炎组患者HIF-1α、5-LOX表达水平高于对照组（P<0.05）;鼻息肉组、变态反应性鼻炎组、鼻窦炎组患者HIF-1α、5-LOX表达水平比较无统计学意义（P>0.05）。鼻息肉组、变态反应性鼻炎组、鼻窦炎组患者HIF-1α、5-LOX mRNA表达水平高于对照组（P<0.05）;鼻息肉组、变态反应性鼻炎组、鼻窦炎组患者HIF-1α、5-LOX mRNA表达水平比较无统计学意义（P>0.05）。Parman相关分析,在不同鼻部疾病中,HIF-1α蛋白表达与5-LOX蛋白表达呈正相关（P<0.05）。结论：在慢性鼻病（鼻息肉、变态反应性鼻炎、鼻窦炎）中,HIF-1α、5-LOX表达水平显著升高,且在慢性疾病发展中可能相互促进、互相影响。     

综合护理干预在支气管哮喘合并过敏性鼻炎中的临床应用效果

目的评价综合护理干预在支气管哮喘合并过敏性鼻炎中的临床应用效果。方法选取2014~2016年我院收治的60例支气管哮喘合并过敏性鼻炎患者,按随机法分为观察组和对照组各30例,观察组采取综合护理干预,对照组采取常规护理干预,比较两组的临床效果及护理满意度情况。结果观察组的临床治疗总有效率为96.67%,对照组为66.67%,组间比较差异有统计学意义(P0.05);观察组患者的护理满意度为93.33%,对照组为70%,两组比较差异有显著统计学意义(P0.05)。结论支气管哮喘合并过敏性鼻炎患者实施综合护理干预,可提高患者的临床效果及护理满意度,值得推广应用。     

鼻窦内镜术治疗鼻窦炎合并鼻息肉的疗效及对鼻腔通气和嗅觉功能的影响

目的:探讨鼻窦内镜术治疗鼻窦炎合并鼻息肉的临床疗效及对鼻腔通气和嗅觉功能的影响。方法:选取2014年1月至2016年6月我院收治的鼻窦炎合并鼻息肉患者80例。根据随机数字表法分为观察组和对照组,各40例。对照组给予传统摘除术治疗,观察组则行鼻窦内镜术治疗。比较两组临床疗效以及治疗前、治疗后3个月症状评分、鼻气道总阻力、嗅觉功能评分。结果:观察组治疗总有效率为95.00%,显著高于对照组的77.50%(P0.05)。治疗前两组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分比较无统计学差异(P0.05),治疗后3个月两组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分均低于治疗前,且观察组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分低于对照组(P0.05)。治疗前两组患者鼻气道总阻力、嗅觉功能评分比较无统计学差异(P0.05),治疗后3个月两组患者鼻气道总阻力、嗅觉功能评分均低于治疗前,且观察组低于对照组(均P0.05)。结论:鼻窦内镜术治疗鼻窦炎合并鼻息肉有利于改善患者临床症状,促进患者嗅觉功能以及鼻腔通气的恢复,是治疗鼻窦炎合并鼻息肉的有效方法。     

鼻窦内窥镜手术联合糖皮质激素治疗慢性鼻-鼻窦炎患者疗效分析

目的探讨鼻窦内窥镜手术联合糖皮质激素治疗慢性鼻-鼻窦炎患者的临床疗效。方法将我院收治的121例慢性鼻-鼻窦炎患者随机分为两组,其中对照组60例行单纯鼻窦内窥镜手术,观察组61例联合糖皮质激素治疗,观察比较两组患者的临床疗效、鼻黏液纤毛清除功能。结果观察组的治疗总有效率为96.72%显著高于对照组的86.67%,差异有统计学意义(P0.05);治疗后,观察组的TNF-α、IL-6、IL-8、Hs-CRP水平均较对照组显著降低,差异均有统计学意义(P0.05);而且观察组患者的糖精清除时间亦显著低于对照组(P0.05),黏液纤毛清除速率、黏液纤毛清除速度均较对照组显著降低(P0.05)。结论鼻窦内窥镜手术联合糖皮质激素治疗慢性鼻-鼻窦炎的疗效显著,能显著降低各项炎性因子水平,促进鼻黏液纤毛功能恢复,预后较好,值得临床推广。     

趋化因子CCL-18 在慢性鼻- 鼻窦炎中的表达及意义

目的:分析趋化因子CCL-18在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜的表达差异,探讨CCL-18在慢性鼻-鼻窦炎中的表达及意义。方法:采用苏木精-伊红染色(HE),Masson染色及过碘酸-雪夫(PAS)染色对慢性鼻-鼻窦炎组织进行病理分析。采用Western blot检测CCL-18蛋白水平在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜组织中的表达差异。结果:CCL-18蛋白水平在伴鼻息肉和不伴有鼻息肉慢性鼻窦炎均较正常鼻黏膜组织中显著上调(P<0.05)。CCL-18蛋白水平在嗜酸性粒细胞慢性鼻窦炎的表达水平明显高于非嗜酸性粒细胞慢性鼻窦炎(P<0.05)。腺体型,纤维炎症型及水肿型慢性鼻-鼻窦炎中CCL-18表达水平均高于正常鼻黏膜,以水肿型表达最为显著(P<0.05)。结论:CCL-18在嗜酸性粒细胞和水肿型慢性鼻窦炎中高度表达,提示CCL-18可能参与慢性鼻-鼻窦炎中嗜酸性粒细胞的浸润这一基本病理过程。     

鼻内镜下鼻窦炎合并中鼻甲外侧壁切除术的临床疗效观察

目的:探讨鼻内镜下行鼻窦炎手术同时行中鼻甲外侧壁切除的疗效。方法:选择本院2009年6月至2013年7月的行鼻内镜下鼻窦炎手术的慢性鼻窦炎患者160例,随机分为观察组和对照组.对照组行单纯的鼻窦炎开放手术,观察组在对照组治疗的基础上行中鼻甲外侧壁切除术。比较两组术后临床疗效、换药平均次数、SNOT-20评分及不良反应等。结果:对照组术后平均换药次数显著高于观察组(P0.05);对照组治疗总有效率为72.50%,显著低于观察组92.50%,差异具有统计学意义(P0.01);两组治疗前SNOT-20评分比较无统计学差异(P0.05),治疗后SNOT-20评分,组内比较均低于治疗前(P0.05);观察组治疗后SNOT-20总分显著低于对照组(P0.05);两组不良反应发生率无显著差异(P0.05)。结论:鼻内镜下鼻窦炎手术中实施中鼻甲外侧壁切除的临床疗效显著,既不破坏鼻腔解剖结构,又保证了中鼻道的宽大,安全性较高,值得在临床推广应用。     

同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的疗效对比研究

摘要 目的：探讨同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的临床疗效。方法：回顾性分析本院2017年1月至2019年10月期间收治的76例慢性泪囊炎合并慢性鼻-鼻窦炎患者的临床资料,根据手术方式分为A组和B组,各38例。A组行分期手术（鼻腔鼻窦病变处理控制鼻腔鼻窦炎症后再行鼻内镜下泪囊鼻腔造孔术）。B组行同期手术（处理鼻腔鼻窦病变后立即行鼻内镜下泪囊鼻腔造孔术）,比较两组围术期指标、临床疗效、术后并发症发生情况,采用慢性泪囊炎生活质量量表（DQOLS）评价患者术前和术后6个月时的生活质量。结果：B组总有效率为94.74 %（36/38）,A组总有效率为92.11 %（35/38）,两组总有效率比较无明显差异（P>0.05）;B组术后并发症总发生率为13.16 %（5/38）,与A组的10.53 %（4/38）比较无明显差异（P>0.05）。两组患者术后6个月时的DQOLS各维度评分和总分均较术前升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）。B组患者住院总费用少于A组,住院时间、手术时间均短于A组（P<0.05）,两组术中出血量比较无明显差异（P>0.05）。结论：同期手术与分期手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎患者具有相当的临床疗效和安全性,且对患者生活质量的改善程度亦无明显差异,但前者能够缩短手术时间、住院时间及减少住院费用。     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Synthesis and antimicrobial studies of hydrazone derivatives of 4-[3-(2,4-difluorophenyl)-4-formyl-1H-pyrazol-1-yl]benzoic acid and 4-[3-(3,4-difluorophenyl)-4-formyl-1H-pyrazol-1-yl]benzoic acid

Microbial resistance to antibiotics is an unresolved global concern, which needs urgent and coordinated action. One of the guidelines of the Centers for Disease Control and Preventions (CDC) to combat antibiotic resistance is the development of new antibiotics to treat drug-resistant bacteria. In our effort to find new antibiotics, we report the synthesis and antimicrobial studies of 30 new pyrazole derivatives. These novel molecules have been synthesized by using readily available starting materials and benign reaction conditions. Some of these molecules have shown activity with MIC values as low as 0.78?µg/mL against four bacterial strains; Staphylococcus aureus, methicillin-resistant S. aureus, Bacillus subtilis, and Acinetobacter baumannii. Furthermore, active molecules are non-toxic to mammalian cell line.

     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Novel compounds with potent CDK9 inhibitory activity for the treatment of myeloma

Cyclin-dependent kinases (CDKs) and Polo-like kinases (PLKs) play key role in the regulation of the cell cycle. The aim of our study was originally the further development of our recently discovered polo-like kinase 1 (PLK1) inhibitors. A series of new 2,4-disubstituted pyrimidine derivatives were synthesized around the original hit, but their PLK1 inhibitory activity was very poor. However the novel compounds showed nanomolar CDK9 inhibitory activity and very good antiproliferative effect on multiple myeloma cell lines (RPMI-8226).