急性心肌梗死合并肺部感染患者多药耐药菌分布特征及心肌酶谱指标与炎性因子的关系分析

目的:分析急性心肌梗死合并肺部感染患者多药耐药菌分布特征及炎性因子与心肌酶谱指标的关系。方法:选择2015年2月~2018年10月期间中国人民解放军联勤保障部队第940医院收治的67例急性心肌梗死合并肺部感染患者作为感染组,选取同期收治的60例单纯急性心肌梗死患者作为未感染组,分析感染组多药耐药菌的分布及其耐药性,比较两组炎性因子与心肌酶谱指标水平,采用Pearson相关性分析感染组患者炎性因子与心肌酶谱指标的相关性。结果:67例患者痰培养标本中共分离出136株病原菌,其中有64株属于多药耐药菌,多药耐药菌中革兰阴性菌38株,占59.37%,革兰阳性菌26株,占40.63%。其中主要革兰阴性菌对哌拉西林/舒巴坦、头孢哌酮/舒巴坦、阿米卡星、美罗培南、亚胺培南等较为敏感,主要革兰阳性菌对替考拉宁、万古霉素、利福平等较为敏感。感染组患者白细胞介素-6(IL-6)、乳酸脱氢酶(LDH)、促血管生成素-2(Ang-2)、肌酸激酶(CK)、肿瘤坏死因子-α(TNF-α)、谷草转氨酶(AST)、肌酸激酶同工酶(CKMB)水平均高于未感染组患者(P0.05)。经Pearson相关性分析可得,感染组患者血清IL-6、Ang-2、TNF-α水平与AST、LDH、CK、CK-MB水平均呈正相关(P0.05)。结论:急性心肌梗死合并肺部感染患者心肌酶谱与炎性因子水平关系密切,有助于判断患者病情严重程度,且急性心肌梗死合并肺部感染患者多药耐药现象较为严重,临床应针对病原菌合理选取抗菌药物。     

肺脏超声对新生儿呼吸窘迫综合征的诊断价值及肺超声评分的评估价值分析

目的:探讨肺脏超声对新生儿呼吸窘迫综合征(NRDS)的诊断价值,并分析肺超声评分的临床应用价值。方法:本研究选择2017年5月至2018年5月于我院确诊的NRDS患儿45例作为观察组,选择同期于我院就诊的非肺病患儿45例作为对照组,所有患儿均行肺脏超声检查。分析NRDS患儿肺脏超声特征性征象,比较肺脏超声对两组患儿各种征象的检出率,分析肺脏超声对NRDS的诊断价值,比较两组肺超声评分。结果:NRDS患儿全部存在肺实质征象,超声下肺组织回声呈肝样伴支气管充气征,轻度的NRDS患儿于肺脏超声下表现为局灶性的肺实质,且支气管充气征不明显;重度的NRDS患儿于肺脏超声下表现为肺实质范围的进一步扩大,且支气管充气征随病情的加重而愈发明显。观察组肺实质、胸膜线异常、A线消失、弥漫性肺水肿、支气管充气征等征象的检出率显著高于对照组(P0.05),两组B线存在征象的检出率比较无统计学差异(P0.05)。肺实质、胸膜线异常和A线消失三种特征征象同时存在时对NRDS诊断的灵敏度和特异性均为100.00%,肺实质、胸膜线异常和支气管充气征三种特征征象同时存在时对NRDS诊断的灵敏度为80.00%,特异性为100.00%。观察组双肺、左肺、右肺、双侧肺、双肺底肺超声评分均高于对照组(P0.05)。结论:肺脏超声对NRDS的诊断价值较高,且肺超声评分可以评估NRDS患儿的病情严重程度,有助于指导患儿的治疗。     

血清PCT、IL-17与CRP在AECOPD合并肺动脉高压患者中的表达及诊断价值

目的:探讨降钙素原(PCT),白介素17(IL-17)与C反应蛋白(CRP)在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压患者外周血中的表达水平,探究联合检测的诊断价值。方法:收集2015年8月至2017年2月我院收治的AECOPD患者120例,纳入研究患者根据是否合并肺动脉高压分为分为单纯AECOPD组60例及AECOPD合并肺动脉高压(AECOPD+PH)组60例,另选取20例健康志愿者作为对照组。采用化学发光法检测PCT水平,双抗夹心酶联免疫吸附试验法(ELISA)检测IL-17水平及生化分析仪检测CRP水平,采用受试者工作特征曲线(ROC)评估PCT,IL-17与CRP对AECOPD合并肺动脉高压的诊断价值。结果:AECOPD+PH组及AECOPD组的PCT,IL-17,CRP水平较健康对照组均明显升高,而AECOPD+PH组的各指标水平也均高于单纯AECOPD组,差异均有统计学意义(P0.05)。通过Pearson相关性分析发现,AECOPD合并肺动脉高压的PCT与IL-17之间存在表达正相关性(r=0.733,P0.05),PCT与CRP表达存在正相关性(r=0.817,P0.05)。此外,针对AECOPD合并肺动脉高压的诊断中PCT的ROC曲线下面积为0.83,IL-17为0.71,CRP为0.77,联合三者的ROC曲线下面积为0.94。结论:PCT、IL-17和CRP可能与AECOPD患者肺动脉高压的形成有关,各指标存在一定的相关性,联合以上三项生物学指标对诊断AECOPD合并肺动脉高压患者具有一定的临床参考价值。     

Ablation-index guided versus conventional contact-force guided ablation in pulmonary vein isolation – Systematic review and meta-analysis

BackgroundContact-force sensing catheter is widely used for catheter ablation, however, it did not take account of radiofrequency power. Ablation index (AI) is a novel marker incorporating contact force-time-power, was shown to be reliable in predicting lesion size and depth for radiofrequency delivery. We aimed to assess the latest evidence on ablation index guided procedure versus conventional ablation procedure.MethodsWe performed a comprehensive search on topic that assesses ablation index guided procedure versus conventional procedures from inception up until February 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov.ResultsA total of 1727 subjects from five studies were included. 12 months’ incidence of AF/AT/AFL was lower in ablation index guided with an OR of 0.35 [0.17, 0.73], p = 0.005; I² 58%. Upon sensitivity analysis by removing a study, heterogeneity decreased to 0% with OR of 0.26 [0.15, 0.46], p < 0.001. First-pass isolation has a pooled OR of 11.29 [4.68, 27.20], p < 0.001; I² 58%. Pooled OR for acute pulmonary vein reconnection was 0.43 [0.29, 0.64], p < 0.001; I² 46%. AI group has a shorter fluoroscopy time of MD -1.62 [-2.62, ?0.62] minutes, p = 0.001; I² 51% and total ablation time MD -9.96 [-17.16, ?2.76] minutes, p < 0.001; I² 95%. Total procedural time and complication rate were similar.ConclusionAblation index guided procedure resulted in a significantly lower incidence of AF/AT/AFL, shorter fluoroscopy time, and total ablation time. First-pass isolation was higher in AI group and acute PVR was lower in AI group. Ablation-index guided procedure has a similar safety profile to conventional ablation.     

三维肺部图像中疑似肺结节结构的自动提取

本文提出了一种肺部CT图像三维数据中自动提取疑似结节区域的方法。首先结合阈值分割、种子填充等方法,在三维体数据上分割出肺实质。进而利用改进的模糊C均值聚类,提取出结节及具有结节特征的血管、支气管等感兴趣区域。该工作对感兴趣区域的特征提取有重要意义,是早期肺癌计算机辅助诊断重要的一步。     

A bioactive foam reactor for the removal of volatile organic compounds: system performance and model development

A bioactive foam reactor (BFR), a novel bioreactor operated using surfactant foams and suspended microorganisms for the treatment of gaseous toluene, was investigated to characterize its performance with respect to the mass transfer and biodegradation rates. The BFR system consisted of two reactors in series; a foam column for toluene mass transfer using fine bubbles and a cell reservoir where suspended microorganisms actively biodegraded toluene. In this study, a series of short-term experiments demonstrated that the BFR could achieve stable removal performance and a high elimination capacity (EC) for toluene at 100.3 g/m³/h. A numerical model, combining mass balance equations for the mass transfer and subsequent biodegradation, resulted in reasonable agreement with the experimental findings. At an inlet toluene concentration of 100 ppm_v, the toluene concentration in the liquid phase remained extremely low, indicating that the microbial activity was not hindered in the BFR system. However, the experimental and model prediction results showed that the actual mass of toluene transferred into the liquid phase was not closely balanced with the amount of toluene biodegraded in the BFR used in this study. Consequently, methods, such as increasing the effective volume of the foam column or the mass transfer coefficient, need to be implemented to achieve higher toluene EC and better BFR performance.     

急性加重期慢性阻塞性肺疾病患者痰色评分与肺部微生物和病情严重程度的相关性CSCD

目的 探讨急性加重期慢性阻塞性肺疾病患者痰色评分与肺部微生物、病情严重程度的相关性。方法 选择2018年3月至2019年9月我院收治的122例急性加重期慢性阻塞性肺疾病患者,根据其痰色评分分为1~2分组(n=30)与3~4分组(n=92),比较两组患者肺部微生物分布、病情严重程度分布、慢性阻塞性肺疾病评估测试(CAT)评分、白细胞(WBC)水平、C反应蛋白(CRP)水平,分析急性加重期慢性阻塞性肺疾病患者痰色评分与肺部微生物、病情严重程度的相关性。结果 3~4分组患者肺部肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎链球菌、草绿色链球菌、白假丝酵母、酵母样真菌、丝状真菌检出率与1~2分组比较差异无统计学意义(均P>0.05)。3~4分组患者鲍曼不动杆菌检出率显著高于1~2分组(P<0.05)。3~4分组患者病情严重程度分布与1~2分组比较差异有统计学意义(P<0.05)。3~4分组患者CAT评分、WBC水平、CRP水平均显著高于1~2分组(均P<0.05)。急性加重期慢性阻塞性肺疾病患者痰色评分与肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎链球菌、草绿色链球菌、白假丝酵母、酵母样真菌、丝状真菌检出率无显著相关性(均P>0.05),而与鲍曼不动杆菌检出率、CAT评分、WBC水平、CRP水平、病情严重程度呈显著相关性(均P<0.05)。结论 痰色评分与急性加重期慢性阻塞性肺疾病患者肺部微生物和病情严重程度关系密切,有望成为临床评价该类患者肺部微生物分布及病情严重程度的方法之一。     

Genetic models with reduced penetrance related to the Y chromosome

Classical statistical genetics models of a quantitative trait depending on an autosomal gene indicate that father-to-daughter and mother-to-son correlations should be the same. If phenotypes are not sex-dependent, father-to-son and mother-to-daughter correlations also share this common value. On the other hand, if the gene is sex-linked, then the father-to-son correlation is zero. Such models do not explain genetic variation in pulmonary artery pressure (PAP) of cattle--important because cattle with high PAP are known to develop brisket disease, pulmonary heart disease, and congestive heart failure when taken to high altitudes. Data on 966 calves at a ranch in Colorado showed positive correlation (0.2) between sire PAP and male calf PAP but slightly negative correlation (-0.01) between sire PAP and female calf PAP; the dam-to-male calf and dam-to-female calf correlations are both about 0.1. The model presented here postulates an autosomal gene with reduced penetrance (i.e., the trait may remain at a normal level even when the genotype suggests abnormality) and that, in males, the rate of penetrance is related to an abnormality in the Y chromosome and is therefore passed on from father to son. Then under plausible selective breeding assumptions, the pairwise correlation between fathers and daughters can become zero or negative. Explicit formulas are computed for the model covariances, and numerical computations indicate that plausible parameter values can be chosen for the model.     

Perturbation of DPPC bilayers by high concentrations of pulmonary surfactant protein SP-B

Deuterium (²H) NMR has been used to observe perturbation of dipalmitoylphosphatidylcholine (DPPC) bilayers by the pulmonary surfactant protein B (SP-B) at concentrations up to 17% (w/w). Previous ²H NMR studies of DPPC/dipalmitoylphosphatidylglycerol (DPPG) (7:3) bilayers containing up to 11% (w/w) SP-B and DPPC bilayers containing up to 11% (w/w) synthetic SP-B indicated a slight effect on bilayer chain order and a more substantial effect on motions that contribute to decay of quadrupole echoes obtained from bilayers of deuterated DPPC. This is consistent with the perturbation of headgroup-deuterated DPPC reported here for bilayers containing 6 and 9% (w/w) SP-B. For the higher concentrations of SP-B investigated in the present work, ²H NMR spectra of DPPC deuterated in both the headgroup and chain display a prominent narrow component consistent with fast, large amplitude reorientation of some labeled lipid. Similar spectral perturbations have been reported for bilayers in the presence of the antibiotic polypeptide nisin. The observation of large amplitude lipid reorientation at high SP-B concentration could indicate that SP-B can induce regions of high bilayer curvature and thus provides some insight into local interaction of SP-B with DPPC. Such local interactions may be relevant to the formation, in vitro and in vivo, of tubular myelin, a unique structure found in extracellular pulmonary surfactant, and to the delivery of surfactant material to films at the air–water interface.Abbreviations DPPC 1,2-dipalmitoyl-sn-glycero-3-phosphocholine - DPPG 1,2-dipalmitoyl-sn-glycero-3-phosphoglycerol - DPPC-d₆₂ 1,2-perdeuterodipalmitoyl-sn-glycero-3-phosphocholine - DPPC-d₄ 1,2-dipalmitoyl-sn-glycero-3-phospho-(, perdeutero)-choline     

Enhancing effect of dietary cholesterol and inhibitory effect of pravastatin on allergic pulmonary inflammation

To elucidate the link between the intake of animal fat and asthma, a murine model was developed to examine the effect of dietary cholesterol on pulmonary allergic inflammation. Male C57BL6 mice were fed either a control diet or a diet supplemented with 2% cholesterol. Following sensitization and inhalation exposure to ovalbumin, the bronchoalveolar lavage fluid of mice in the cholesterol group contained higher numbers of eosinophils and elevated levels of IL-5, PGE₂, and MCP-1. In addition, dietary cholesterol also resulted in elevated production of IL-4 and IFN- by lymphocytes isolated from the lungs. These inflammatory indicators were all significantly correlated with serum cholesterol levels. In contrast to the effect of dietary cholesterol, adding pravastatin to the drinking water significantly reduced eosinophil infiltration and the levels of IL-5, PGE₂ and MCP-1 in lavage fluid. Although dietary cholesterol did not alter baseline IL-12 in the lungs, in mice challenged with ovalbumin the IL-12 levels were reduced in the cholesterol group and elevated significantly in the pravastatin group. The results suggest that dietary cholesterol might enhance pulmonary allergic inflammation, possibly involving both nonspecific inflammatory processes and lymphocyte activities.