Biomarkers of some pulmonary diseases in exhaled breath

Analysis of various biomarkers in exhaled breath allows completely non-invasive monitoring of inflammation and oxidative stress in the respiratory tract in inflammatory lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), bronchiectasis and interstitial lung diseases. The technique is simple to perform, may be repeated frequently, and can be applied to children, including neonates, and patients with severe disease in whom more invasive procedures are not possible. Several volatile chemicals can be measured in the breath (nitric oxide, carbon monoxide, ammonia), and many non-volatile molecules (mediators, oxidation and nitration products, proteins) may be measured in exhaled breath condensate. Exhaled breath analysis may be used to quantify inflammation and oxidative stress in the respiratory tract, in differential diagnosis of airway disease and in the monitoring of therapy. Most progress has been made with exhaled nitric oxide (NO), which is increased in atopic asthma, is correlated with other inflammatory indices and is reduced by treatment with corticosteroids and antileukotrienes, but not (β₂-agonists. In contrast, exhaled NO is normal in COPD, reduced in CF and diagnostically low in primary ciliary dyskinesia. Exhaled carbon monoxide (CO) is increased in asthma, COPD and CF. Increased concentrations of 8-isoprostane, hydrogen peroxide, nitrite and 3-nitrotyrosine are found in exhaled breath condensate in inflammatory lung diseases. Furthermore, increased levels of lipid mediators are found in these diseases, with a differential pattern depending on the nature of the disease process. In the future it is likely that smaller and more sensitive analysers will extend the discriminatory value of exhaled breath analysis and that these techniques may be available to diagnose and monitor respiratory diseases in the general practice and home setting.     

Effect of melatonin on cholestatic oxidative stress under constant light exposure

This study was designed to evaluate the effect of melatonin on cholestatic oxidative stress under constant light exposure. Cholestasis was induced by double ligature and section of the extra-hepatic bile duct. Melatonin was injected i.p.(1000 microg kg(-1) day(-1)). Malondialdehyde, reduced glutathione, catalase, superoxide dismutase, glutathione reductase, peroxidase and transferase were determined in liver. After bile-duct obstruction and under constant light exposure, an increase in malondialdehyde (p < 0.05) and a slight decrease in reduced glutathione were seen. Enzyme activity, with the exception of glutathione reductase, had significantly diminished. After melatonin administration, malondialdehyde fell (p < 0.001), whereas there was an increase in reduced glutathione (p < 0.0001) compared with untreated controls. Constant light exposure was associated with an increase in hepatic oxidative stress. Treatment with melatonin decreased lipid peroxide synthesis, and permitted a recovery of both reduced glutathione and scavenger enzyme activity.     

经鼻高流量氧疗对阻塞性睡眠呼吸暂停综合征患者的临床疗效研究

目的:探讨经鼻高流量氧疗对阻塞性睡眠呼吸暂停综合征患者的临床疗效。方法:选择2013年7月至2017年7月我院接诊的80例急阻塞性睡眠呼吸暂停综合征患者进行研究,通过随机数表法分为观察组(n=45)和对照组(n=35)。观察组采用经鼻高流量氧疗进行治疗,对照组采用无创正压通气进行治疗,比较两组临床疗效、夜间呼吸暂停时间、呼吸暂停低通气指数(AHI)、总睡眠时间、醒觉时间、血氧饱和度、治疗前后血压、高敏C反应蛋白(hs-CRP)、低密度脂蛋白(LDL)、总胆固醇(TC)水平及生活质量评分的变化。结果:观察组患者治疗后有效率为88.89%,显著高于对照组(71.43%,P0.05)。治疗后,观察组夜间最低血氧饱和度、总睡眠时间、醒觉时间、生活质量评分均明显高于对照组,AHI、收缩压、舒张压、平均动脉压、血清hs-CRP、LDL以及TC水平均显著低于对照组(P0.05)。结论:经鼻高流量氧疗用于阻塞性睡眠呼吸暂停综合征患者的临床疗效明显优于无创正压通气进行治疗,其可显著改善患者的临床症状,提高患者的生活质量。     

3D patient-specific numerical modeling of the soft palate considering adhesion from the tongue

Collapse of the soft palate in the upper airway contributes to obstructive sleeping apnea (OSA). In this study, we investigate the influence of the adhesion from the tongue on the soft palate global response. This is achieved using a cohesive zone finite element approach. A traction-separation law is determined to describe the adhesion effect from the surface tension of the lining liquid between the soft palate and the tongue. According to pull-off experimental tests of human lining liquid from the oral surface of the soft palate, the corresponding cohesive properties, including the critical normal traction stress and the failure separation displacement, are obtained. The 3D patient-specific soft palate geometry is accounted for, based on one specific patient’s computed tomography (CT) images. The calculation results show that influence of the adhesion from the tongue surface on the global response of the soft palate depends on the length ratio between the cohesive length and the soft palate length. When the length of the cohesive zone is smaller than half of the soft palate length, the adhesion’s influence is negligible. When the adhesion length is larger than 70 percent of soft palate length, the adhesion force contributes to preventing the soft palate from collapsing towards to the pharynx wall, i.e. the closing pressure is more negative than in the no adhesion case. These results may provide useful information to the clinical treatment of OSA patients.     

Importance of Mast Cell Prss31/Transmembrane Tryptase/Tryptase-γ in Lung Function and Experimental Chronic Obstructive Pulmonary Disease and Colitis

Protease serine member S31 (Prss31)/transmembrane tryptase/tryptase-γ is a mast cell (MC)-restricted protease of unknown function that is retained on the outer leaflet of the plasma membrane when MCs are activated. We determined the nucleotide sequences of the Prss31 gene in different mouse strains and then used a Cre/loxP homologous recombination approach to create a novel Prss31^−/− C57BL/6 mouse line. The resulting animals exhibited no obvious developmental abnormality, contained normal numbers of granulated MCs in their tissues, and did not compensate for their loss of the membrane tryptase by increasing their expression of other granule proteases. When Prss31-null MCs were activated with a calcium ionophore or by their high affinity IgE receptors, they degranulated in a pattern similar to that of WT MCs. Prss31-null mice had increased baseline airway reactivity to methacholine but markedly reduced experimental chronic obstructive pulmonary disease and colitis, thereby indicating both beneficial and adverse functional roles for the tryptase. In a cigarette smoke-induced model of chronic obstructive pulmonary disease, WT mice had more pulmonary macrophages, higher histopathology scores, and more fibrosis in their small airways than similarly treated Prss31-null mice. In a dextran sodium sulfate-induced acute colitis model, WT mice lost more weight, had higher histopathology scores, and contained more Cxcl-2 and IL-6 mRNA in their colons than similarly treated Prss31-null mice. The accumulated data raise the possibility that inhibitors of this membrane tryptase may provide additional therapeutic benefit in the treatment of humans with these MC-dependent inflammatory diseases.     

茵栀黄口服液联合布拉酵母 对新生儿黄疸的治疗

目的探讨茵栀黄口服液联合布拉酵母治疗新生儿黄疸的效果。方法回顾性分析2012年5月至2016年2月我院收治的108例新生儿黄疸患儿的临床资料,根据治疗方法的不同将患儿分为对照组(50例)和观察组(58例)。两组患儿均给予蓝光处理,对照组同时给予布拉酵母治疗,观察组在对照组的基础上联用茵栀黄口服液进行治疗。比较两组患儿凝血指数、血气指标、生化指标及治疗效果。结果观察组患儿治疗后有效率高于对照组(98.28%vs 90.00%,χ~2=24.92,P0.05)。观察组患儿治疗后PaCO_2、pH、BE及Ca~(2+)和Mg~(2+)水平均低于对照组,差异有统计学意义(均P0.05)。观察组患儿治疗后PT、APTT、FIB、TT异常发生率与对照组比较差异无统计学意义(均P0.05)。观察组患儿治疗后血清总胆红素水平低于对照组,住院时间及黄疸消退时间均短于对照组,差异有统计学意义(均P0.05)。结论茵栀黄口服液联合布拉酵母治疗新生儿黄疸效果显著,能够明显缩短黄疸消退时间,改善血气分析指标及生化指标水平,安全有效。     

内镜下逆行胰胆管造影置放胆道支架治疗恶性梗阻性 黄疸98 例疗效分析

目的:探讨内镜下逆行胰胆管造影置放胆道支架对恶性胆道梗阻的疗效及并发症的防治。方法:选择2008年2月至2011年9月我院收治的无法手术切除或不愿手术的恶性胆道梗阻患者98例,通过放置内置支架引流观察其操作成功率、支架通畅期和退黄效果、并发症发生情况及其防治效果和患者生存期等。结果:98例患者中有88例成功通过置入胆道内置引流管,成功率为89.8%,并发症发生率为11.22%,所有成功患者术后1周黄疸明显减退,支架平均通畅期137天,患者平均生存期为163天。结论:行胆道内置支架引流创伤小,并发症少,通畅性能好,可持久有效地控制黄疸,有效缓解病情,改善全身情况,明显延长恶性胆道梗阻患者的生存期。     

Hsp70/nitric oxide relationship in apoptotic modulation during obstructive nephropathy

The functional integrity of the kidney depends on normal development as well as on physiological cell turnover. Apoptosis induction is essential for these mechanisms. Multiple mechanisms are unleashed during obstructive nephropathy, one of the most complex being programmed cell death that leads to renal tubular atrophy and tubular loss. This review will focus on the interaction of nitric oxide and Hsp70 and on the regulation of renal antiapoptotic and protective oxidative stress responses.     

茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸的临床研究

目的:探讨茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸的临床疗效和安全性。方法:选择2016年9月-2018年3月我院收治的胆汁淤积性黄疸儿童94例,按随机抽签方式分为对照组及观察组,每组47例。对照组给予熊去氧胆酸胶囊治疗,观察组在对照组基础上给予茵栀黄口服液治疗,比较两组患儿治疗前后血清胆红素水平、肝功能及免疫指标水平的变化及不良反应的发生情况。结果:治疗后,两组总胆红素(Total Bilirubin,TBil)、直接胆红素(Direct Bilirubin,DBil)、谷丙转氨酶(Alanine transaminase,ALT)、谷草转氨酶(Aspartate aminotransferase,AST)、碱性磷酸酶(Alkaline phosphatase,ALP)、谷氨酰转肽酶(Glutamyl transpeptidase,GGT)、CD8~+水平均较治疗前显著下降(P0.05),且观察组TBil、DBil、ALT、AST、ALP、GGT、CD8~+水平均显著低于对照组[(86.29±11.07)μmol/L vs.(132.75±16.53)μmol/L、(53.47±6.71)μmol/L vs.(86.72±9.09)μmol/L、(76.53±8.60) U/L vs.(127.05±11.79) U/L、(138.59±12.14) U/L vs.(160.08±15.82) U/L、(206.88±79.04) U/L vs.(270.40±68.19) U/L、(223.04±89.59) U/L vs.(280.62±96.17) U/L、(22.80±3.79)%vs.(26.52±4.30)%](P0.05)。治疗后,两组CD4~+、CD4~+/CD8~+均较治疗前显著上升(P0.05),且观察组CD4~+、CD4~+/CD8~+[(38.91±7.20)%、(1.69±0.55)]均显著高于对照组[(34.67±6.26)%、(1.31±0.49)](P0.05)。治疗期间,两组患儿均没有出现相关不良反应。结论:茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸患儿可有效改善其胆红素水平及肝功能,且具有一定的免疫调节作用。