镍钛形状记忆合金环抱器内固定术对多发性肋骨骨折患者术后疼痛、呼吸功能及肺部感染的影响

目的:探讨多发性肋骨骨折患者采用镍钛形状记忆合金环抱器内固定术治疗的临床效果。方法:选取2016年1月-2018年1月期间我院收治的97例多发性肋骨骨折患者。按照不同的治疗方法将患者分为对照组(n=47)和研究组(n=50),对照组患者给予胸部护板外固定术,研究组患者给予镍钛形状记忆合金环抱器内固定术。比较两组患者术后7 d的临床疗效,比较两组术前、术后7 d疼痛程度及呼吸功能情况,记录两组术后并发症发生情况。结果:研究组患者治疗后总有效率为92.00%(46/50),高于对照组患者的76.60%(36/47)(P0.05)。两组患者术后7 d视觉疼痛模拟评分量表(VAS)评分均较术前降低,且研究组低于对照组(P0.05)。两组患者术后7 d最大自主通气量占预计值百分比(MVV%)较术前升高,且研究组高于对照组(P0.05);两组患者术后7 d第1秒用力呼气肺活量占预计值百分比(FEV1%)比较无差异(P0.05)。研究组患者术后并发症总发生率8.00%(4/50),低于对照组的23.40%(11/47)(P0.05)。结论:多发性肋骨骨折经镍钛形状记忆合金环抱器内固定术治疗安全、有效,可明显减轻患者术后疼痛及改善呼吸功能,临床应用价值较高。     

呼吸窘迫综合征早产儿血清VA、PCT、TNF-α及CRP水平的表达及临床意义

目的:探讨呼吸窘迫综合征(RDS)早产儿血清维生素A(VA)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平的表达及临床意义。方法:选取2015年2月～2018年5月期间青岛市妇女儿童医院收治的90例RDS早产儿纳入观察组,根据RDS分级将观察组分为轻度组48例,中重度组42例。另选取同期于本院出生的非RDS早产儿35例作为对照组。根据血清VA水平将125例早产儿分为VA缺乏组(n=72),亚临床VA缺乏组(n=36),正常组(n=17)。比较观察组与对照组、轻度组与中重度组早产儿血清VA、PCT、TNF-α及CRP水平,比较不同血清VA水平早产儿的RDS发病情况,分析观察组早产儿血清VA与PCT、TNF-α及CRP水平的相关性。结果:观察组早产儿血清VA水平明显低于对照组(P0.05),而观察组早产儿血清PCT、TNF-α、CRP明显高于对照组(P0.05)。中重度组早产儿血清VA水平与轻度组比较差异无统计学意义(P0.05),而中重度组早产儿血清PCT、TNF-α、CRP水平明显高于轻度组(P0.05)。随着血清VA水平的升高,RDS发病率逐渐降低,组间比较差异有统计学意义(P0.05)。Pearson相关性分析显示,观察组早产儿血清VA与PCT、TNF-α及CRP水平无显著相关性(P0.05)。结论:RDS早产儿血清VA与PCT、TNF-α及CRP水平均存在明显异常,但四者无明显相关性,血清VA相对较低者更易发生RDS,临床可通过及时干预VA水平以降低RDS的发生风险。     

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。     

有创无创序贯通气对急性呼吸衰竭患者血糖水平及预后的影响

目的:探讨有创无创序贯通气和有创机械通气对急性呼吸衰竭患者血糖水平及预后的影响。方法:选取我院重症医学科2012年3月至2017年10月收治的急性呼吸衰竭患者81例,按照通气方式不同分为两组,对照组(41例)采用单纯有创机械通气治疗,观察组(40例)采用有创-无创序贯通气治疗。比较两组患者的血糖水平、临床指标、治疗时间和临床转归情况。结果:两组患者治疗后血糖水平均较治疗前显著升高(P0.05),而观察组血糖水平显著低于对照组(P0.05);对照组拔管时和观察组通气3h后患者的动脉血二氧化碳分压(PaCO---_2)、动脉血氧分压(PaO_2)、收缩压(SBP)和心率(HR)对比无显著性差异(P0.05);观察组的通气时间、住院时间与对照组相比均较短(P0.05),撤机成功率高于对照组(P0.05),再插管率、呼吸机相关肺炎(VAP)和死亡率均显著低于对照组(P0.05)。结论:有创无创序贯通气急性呼吸衰竭患者血糖水平较低,治疗时间较短,且再插管率、VAP和死亡率较小,显著改善患者预后。     

Estimation of Respiratory Nasal Pressure and Flow Rate Signals Using Different Respiratory Sound Features

BackgroundRespiratory sounds are associated with the flow rate, nasal flow pressure, and physical characteristics of airways. In this study, we aimed to develop the flow rate and nasal flow pressure estimation models for the clinical application, and find out the optimal feature set for estimation to achieve the optimal model performance.MethodsRespiratory sounds and flow rate were acquired from nine healthy volunteers. Respiratory sounds and nasal flow pressure were acquired from twenty-three healthy volunteers. Four types of respiratory sound features were extracted for flow rate and nasal flow pressure estimation using different estimation models. Effects of estimations using these features were evaluated using Bland-Altman analysis, estimation error, and respiratory sound feature calculation time. Besides, expiratory and inspiratory phases divided estimation errors were compared with united estimation errors.ResultsThe personalized logarithm model was selected as the optimal flow rate estimation model. Respiratory nasal flow pressure estimation based on this model was also performed. For the four different respiratory sound features, there is no statistically significant difference in flow rate and pressure estimation errors. LogEnvelope was, therefore, chosen as the optimal feature because of the lowest computational cost. In addition, for any type of respiratory sound feature, no statistically significant difference was observed between divided and united estimation errors (flow rate and pressure).ConclusionRespiratory flow rate and nasal flow pressure can be estimated accurately using respiratory sound features. Expiratory and inspiratory phases united estimation using respiratory sounds is a more reasonable estimation method than divided estimation. LogEnvelope can be used for this united respiratory flow rate and nasal flow pressure estimation with minimum computational cost and acceptable estimation error.     

Development of mRNA vaccines against respiratory syncytial virus (RSV)

Respiratory syncytial virus (RSV) is a single-stranded negative-sense RNA virus that is the primary etiologic pathogen of bronchitis and pneumonia in infants and the elderly. Currently, no preventative vaccine has been approved for RSV infection. However, advances in the characterization, and structural resolution, of the RSV surface fusion glycoprotein have revolutionized RSV vaccine development by providing a new target for preventive interventions. In general, six different approaches have been adopted in the development of preventative RSV therapeutics, namely, particle-based vaccines, vector-based vaccines, live-attenuated or chimeric vaccines, subunit vaccines, mRNA vaccines, and monoclonal antibodies. Among these preventive interventions, MVA-BN-RSV, RSVpreF3, RSVpreF, Ad26. RSV.preF, nirsevimab, clesrovimab and mRNA-1345 is being tested in phase 3 clinical trials, and displays the most promising in infant or elderly populations. Accompanied by the huge success of mRNA vaccines in COVID-19, mRNA vaccines have been rapidly developed, with many having entered clinical studies, in which they have demonstrated encouraging results and acceptable safety profiles. In fact, Moderna has received FDA approval, granting fast-track designation for an investigational single-dose mRNA-1345 vaccine against RSV in adults over 60 years of age. Hence, mRNA vaccines may represent a new, more successful, chapter in the continued battle to develop effective preventative measures against RSV. This review discusses the structure, life cycle, and brief history of RSV, while also presenting the current advancements in RSV preventatives, with a focus on the latest progress in RSV mRNA vaccine development. Finally, future prospects for this field are presented.     

Metagenomic Analysis Reveals A Possible Association Between Respiratory Infection and Periodontitis

Periodontitis is an inflammatory disease that is characterized by progressive destruction of the periodontium and causes tooth loss in adults. Periodontitis is known to be associated with dysbiosis of the oral microflora, which is often linked to various diseases. However, the complexity of plaque microbial communities of periodontitis, antibiotic resistance, and enhanced virulence make this disease difficult to treat. In this study, using metagenomic shotgun sequencing, we investigated the etiology, antibiotic resistance genes (ARGs), and virulence genes (VirGs) of periodontitis. We revealed a significant shift in the composition of oral microbiota as well as several functional pathways that were represented significantly more abundantly in periodontitis patients than in controls. In addition, we observed several positively selected ARGs and VirGs with the Ka/Ks ratio > 1 by analyzing our data and a previous periodontitis dataset, indicating that ARGs and VirGs in oral microbiota may be subjected to positive selection. Moreover, 5 of 12 positively selected ARGs and VirGs in periodontitis patients were found in the genomes of respiratory tract pathogens. Of note, 91.8% of the background VirGs with at least one non-synonymous single-nucleotide polymorphism for natural selection were also from respiratory tract pathogens. These observations suggest a potential association between periodontitis and respiratory infection at the gene level. Our study enriches the knowledge of pathogens and functional pathways as well as the positive selection of antibiotic resistance and pathogen virulence in periodontitis patients, and provides evidence at the gene level for an association between periodontitis and respiratory infection.     

磷脂酶D和炎症的关系

磷脂酶Ｄ（ＰＬＤ）广泛存在于动物组织细胞中,并受各种胞外信号调节。其主要底物为磷脂酰胆碱（ＰＣ）。ＰＬＣ引起的ＰＣ水解是细胞内重要的信号转导途径。越来越多的证据表明ＰＬＤ和炎症有密切的关系。本文主要介绍ＰＬＤ在呼吸爆发、脱颗粒及花生四烯酸（ＡＡ）释放等方面的研究进展。     

Assembly of the phagocyte NADPH oxidase

Stimulated phagocytes undergo a burst in respiration whereby molecular oxygen is converted to superoxide anion through the action of an NADPH-dependent oxidase. The multicomponent phagocyte oxidase is unassembled and inactive in resting cells but assembles at the plasma or phagosomal membrane upon phagocyte activation. Oxidase components include flavocytochrome b₅₅₈, an integral membrane heterodimer comprised of gp91phox and p22phox, and three cytosolic proteins, p47phox, p67phox, and Rac1 or Rac2, depending on the species and phagocytic cell. In a sense, the phagocyte oxidase is spatially regulated, with critical elements segregated in the membrane and cytosol but ready to undergo nearly immediate assembly and activation in response to stimulation. To achieve such spatial regulation, the individual components in the resting phagocyte adopt conformations that mask potentially interactive structural domains that might mediate productive intermolecular associations and oxidase assembly. In response to stimulation, post-translational modifications of the oxidase components release these constraints and thereby render potential interfaces accessible and interactive, resulting in translocation of the cytosolic elements to the membrane where the functional oxidase is assembled and active. This review summarizes data on the structural features of the phagocyte oxidase components and on the agonist-dependent conformational rearrangements that contribute to oxidase assembly and activation.     

Triphenyltin enhances the neutrophilic differentiation of promyelocytic HL-60 cells

Triphenyltin (TPT) is an environmental endocrine disruptor and toxic substance, but little information is available on its immunological effects. To assess the effect of TPT on leukocyte differentiation, we investigated its effect on the neutrophilic differentiation of HL-60 cells induced by dimethyl sulfoxide and granulocyte colony-stimulating factor (G-CSF) for 6 days. At a low concentration, 10(-7)M, TPT increased superoxide production by differentiated HL-60 cells stimulated with opsonized zymosan (OZ) by about 45% and increased expression of CD18, a component of the OZ-receptor, by about 90%. Real-time PCR analysis revealed that TPT augmented the expression not only of CD18 but also of components of superoxide-generating NADPH-oxidase, p47phox, 2.7-fold, and p67phox, 2.0-fold, and of granulocyte colony-stimulating factor receptor (G-CSFR), 3.0-fold, whereas various other endocrine disruptors, including parathion, vinclozolin, and bisphenol A, had no such enhancing effects. The results of a DNA macroarray analysis showed that TPT enhanced the expression of G-CSFR and certain other neutrophil functional proteins, including CD14 and myeloid leukemia cell differentiation protein (MCL-1), and that TPT induced a decrease in expression of LC-PTP, leukocyte protein-tyrosine phosphatase, to about half the control level. The TPT-dependent suppression of LC-PTP was confirmed by real-time PCR analysis, and the results of immunoblotting indicated that TPT enhances the expression of myeloid specific tyrosine kinase hck by about 30% at the protein level, and this together with the reduction of LC-PTP may enhance tyrosine phosphorylation, in turn resulting in enhancement of superoxide production. These findings suggest that TPT may have an enhancing effect on the neutrophilic maturation of leukocytes.