老年慢性阻塞性肺疾病患者和坠积性肺炎患者肺内病原菌比较及感染影响因素分析

目的对比老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者和坠积性肺炎患者肺内一般病原菌和多重耐药菌的分布,同时分析COPD患者和坠积性肺炎患者多重耐药菌感染的影响因素。方法对入选COPD患者和坠积性肺炎患者下呼吸道痰标本进行培养和鉴定,对比两组患者病原菌以及多重耐药菌的检出率,同时比较两组患者性别、年龄、住院时间、糖尿病病史、有创机械通气治疗和留置尿管等因素对多重耐药菌感染的影响。结果 COPD患者革兰阴性菌的检出率(48.39%)显著低于坠积性肺炎患者(66.13%),COPD患者真菌的检出率(11.06%)显著高于坠积性肺炎患者(2.42%)。两组患者检出的多重耐药菌均以产超广谱β-内酰胺酶肠杆菌科细菌、耐甲氧西林金黄色葡萄球菌和多重耐药/泛耐药铜绿假单胞菌为主。COPD患者中感染多重耐药菌患者的年龄和住院时间显著高于非感染患者;坠积性肺炎患者中感染多重耐药菌患者的住院时间、机械通气治疗率和留置尿管使用率显著高于非感染患者。结论影响老年COPD患者和坠积性肺炎患者多重耐药菌感染的因素有区别,应有针对性地应用抗生素以减少多重耐药菌的感染。     

幽门螺杆菌根除治疗对慢性胃炎患者肠道菌群的影响及其与血清hsCRP水平的相关性

目的探究幽门螺杆菌(H.pylori)根除治疗对慢性胃炎患者肠道菌群的影响及其与血清超敏C反应蛋白(hsCRP)水平的相关性。方法选择2018年5月至2019年5月我院收治的87例慢性胃炎患者为研究对象,所有患者均采用枸橼酸铋钾胶囊+雷贝拉唑钠肠溶胶囊+克拉霉素片+阿莫西林克拉维酸钾片进行幽门螺杆菌根除治疗,评价所有患者治疗后临床疗效、H.pylori根除率,比较所有患者治疗前后临床症状积分,肠道肠球菌、葡萄球菌、肠杆菌、乳杆菌、双歧杆菌数量及血清hsCRP水平,采用Pearson相关分析所有患者治疗后肠道菌群数量与血清hsCRP水平的相关性。结果入选患者临床治疗有效率为95.40%,H.pylori根除率为90.80%。患者治疗后腹胀、嗳气、腹痛、纳差评分显著低于治疗前(均P<0.05)。治疗后患者肠道肠球菌、葡萄球菌数量显著高于治疗前,而肠杆菌、乳杆菌、双歧杆菌数量显著低于治疗前(均P<0.05)。患者治疗后血清hsCRP水平显著低于治疗前(P<0.05)。患者治疗后肠道肠球菌、葡萄球菌、乳杆菌、肠杆菌、双歧杆菌数量与血清hsCRP水平无显著相关性(均P>0.05)。结论H.pylori根除治疗能有效改善慢性胃炎患者临床症状,提高H.pylori根除率,降低血清hsCRP水平,但会造成患者肠道菌群失调,且肠道菌群数量与血清hsCRP水平无显著相关性。     

微生态制剂联合莫西沙星序贯疗法对老年慢性阻塞性肺疾病合并下呼吸道感染患者肠道菌群及免疫功能的影响

目的探究微生态制剂联合莫西沙星序贯疗法对老年慢性阻塞性肺疾病(COPD)合并下呼吸道感染患者肠道菌群及免疫功能的影响。方法选取2016年2月到2019年2月我院收治的98例老年COPD合并下呼吸道感染患者为研究对象,按照随机数字表法分为观察组和对照组各49例。对照组患者采用莫西沙星序贯法进行治疗。观察组患者采用微生态制剂联合莫西沙星治疗。检测两组患者下呼吸道感染病原菌及肠道微生物变化,T淋巴细胞亚群(CD4⁺细胞,CD8⁺细胞,CD4⁺/CD8⁺)水平,并评价患者临床效果和并发症情况。结果治疗后两组患者CAT评分(8.23±3.64、10.41±4.08)和mMRC评分(1.35±0.82、1.77±0.61)均低于治疗前(23.01±4.47、22.87±5.26、2.79±0.54、3.04±0.74),且观察组下降幅度大于对照组,差异具有统计学意义(均P<0.05)。治疗后两组患者下呼吸道感染主要病原菌中肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌检出率均低于治疗前,但组间比较差异无统计学意义(均P>0.05)。治疗后两组患者肠道双歧杆菌、嗜酸乳杆菌、粪肠球菌数量均高于治疗前,大肠埃希菌数量均低于治疗前,且观察组改善情况优于对照组,差异有统计学意义(均P<0.05)。治疗后两组患者CD4⁺细胞、CD4⁺/CD8⁺均高于治疗前,且观察组高于对照组,差异有统计学意义(均P<0.05)。CD8⁺细胞数量治疗前后及组间比较差异无统计学意义(均P>0.05)。治疗后观察组患者腹胀(18.4%)、胃潴留(20.4%)发生率均低于对照组(36.7%、38.8%),差异有统计学意义(均P<0.05)。两组患者应激性溃疡发生率(20.4%、24.5%)差异无统计学意义(P>0.05)。结论微生态制剂联合莫西沙星序贯疗法治疗老年COPD合并下呼吸道感染能促进患者肠道微生态平衡,调节免疫功能,进而改善患者病情。     

蚓激酶在慢性乙型肝炎治疗中的潜在作用

纤连蛋白(FN)是参与乙型肝炎病毒感染和肝脏纤维化的重要分子。 蚓激酶(LK)是从赤子爱胜蚓(Eisenia foetide)中提取的一组蛋白水解同工酶,能水解纤维蛋白治疗凝血相关疾病。 从这组同工酶中分离纯化出单一活性成分,在体外可降解纤连蛋白,被命名为蚯蚓纤连蛋白水解酶(EFNase)。 然而,LK 能否预防乙型肝炎病毒感染以及缓解因乙型肝炎导致的肝脏损伤等问题还不清楚。本研究以人肝癌细胞系HepG2.2.15为细胞模型,观察LK 对乙型肝炎表面抗原(HBsAg)或 FN 水平的影响;以 C57BL / 6J-HBV 转基因小鼠为动物模型,探讨 LK 对小鼠血清中 HBsAg、FN、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平及肝脏病理改变的影响。结果表明,LK 在体内外均能抑制HBsAg 的生成,降低血清和肝脏FN。与生理盐水处理组相比,LK 改善了肝脏的状态。这些数据为理解LK 作为治疗乙型肝炎的潜在有效药物的治疗作用提供了有价值的信息。     

Reliability of surface electromyography for the gluteus medius muscle during gait in people with and without chronic nonspecific low back pain

The purpose of this study was to determine the intratester reliability of surface electromyography (EMG) assessment of the gluteus medius muscle in healthy people and people with chronic nonspecific low back pain (CNLBP) during barefoot walking. Gluteus medius muscle activity was measured twice in 40 people without and 30 people with CNLBP approximately 7 days apart. Walking gluteus medius muscle activity was normalised to maximal voluntary isometric contractions during side-lying hip abduction with manual resistance. Good intratester reliability (ICC > 0.75) was found for mean, peak, and peak to peak amplitude for healthy people. Only mean amplitude demonstrated good intratester reliability in those with CNLBP. Peak amplitude and peak to peak amplitude of the gluteus medius muscle of those with CNLBP, and the time of peak amplitude in both groups, demonstrated moderate reliability (ICC ranged from 0.50 to 0.58). Moderate to large standard error of measurement and minimal detectable change values were reported for outcome measurements. These results suggest that potentially large levels of random error can occur between sessions. Future research can build on this study for those with pathology and attempt to establish change values for EMG that are clinically meaningful.     

扶正活血祛瘀法治疗慢性足底溃疡的临床疗效观察

目的观察扶正活血祛瘀法治疗慢性足底溃疡的临床疗效。方法采用四妙勇安汤加减内服,红萝卜加马齿苋煎液浸泡外洗溃疡处,外敷呋喃西林纱布保护伤口的综合治疗方法。结果36例中治愈27例,占75．0％;好转6例,占16．7％;无效3例,占8．3％．姑论以扶正活血祛痰法内服为主,结合红萝卜加马齿苋煎液浸泡外洗与呋喃西林纱布外敷治疗慢性足底溃疡有较好的临床疗效．     

益生菌抑制肠道慢性炎症及维持肠道稳态的研究进展

益生菌在维护健康和预防疾病方面起着重要作用。近30年来,人们对益生菌的特性、分类、分布与营养等方面的研究很多,特别是益生菌抑制肠道慢性炎症及维持肠道稳态方面的作用引起了国内外学者的广泛关注。近几年来,随着分子生物学技术的迅速发展,关于益生菌抑制肠道慢性炎症及维持肠道稳态方面的作用机制成为当前研究的热点,并取得了一定的成果。本文目的在于对益生菌抑制肠道慢性炎症及维持肠道稳态的作用进行分析。     

Asymmetrical myocardial expression of natriuretic peptides in pacing-induced heart failure

High-frequency pacing of the left ventricle (LV) free wall causes a dyssynchronous pattern of contraction that leads to progressive heart failure (HF) with pronounced differences in regional contractility. Aim of this study was to evaluate possible changes in brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) mRNA expression in the anterior/anterior lateral region (pacing site, PS) as compared to the infero-septal region (opposite site, OS) and to explore possible association between the contractiling pattern and biomarker expression. Cardiac tissue was collected from minipigs with pacing-induced HF (n = 8) and without (control, n = 6). The samples were selectively harvested from the anterior left ventricular (LV) wall, PS, and from an area remote to the pacing-site, OS. BNP and CNP mRNA expression was evaluated by semi-quantitative polymerase chain reaction (PCR). A significant difference in BNP expression was found in the PS between HF animals and controls (BNP/GAPDH: 0.65 ± 0.11 vs. 0.35 ± 0.04, p = 0.02), but not in the OS (BNP/GAPDH: 0.36 ± 0.05, ns vs. controls). CNP expression was not different compared to controls, although higher levels were observed in the PS and in the OS with respect to the controls (CNP/GAPDH: controls 0.089 ± 0.036, PS 0.289 ± 0.23, OS 0.54 ± 0.16). This finding was in tune with an increase of CNP tissue concentration (controls: 0.69 ± 0.13; PS = 1.56 ± 0.19; OS = 1.70 ± 0.42 pg/mg protein; p = 0.039 controls vs. OS). Higher BNP mRNA expression in the PS is consistent with a reduction in contractile function in this region, while higher CNP mRNA expression in the OS suggests the presence of concomitant endothelial dysfunction in the remote region.     

Modulating human aging and age-associated diseases

Population aging is progressing rapidly in many industrialized countries. The United States population aged 65 and over is expected to double in size within the next 25 years. In sedentary people eating Western diets aging is associated with the development of serious chronic diseases, including type 2 diabetes mellitus, cancer and cardiovascular diseases. About 80% of adults over 65 years of age have at least one chronic disease, and 50% have at least two chronic diseases. These chronic diseases are the most important cause of illness and mortality burden, and they have become the leading driver of healthcare costs, constituting an important burden for our society. Data from epidemiological studies and clinical trials indicate that many age-associated chronic diseases can be prevented, and even reversed, with the implementation of healthy lifestyle interventions. Several recent studies suggest that more drastic interventions (i.e. calorie restriction without malnutrition and moderate protein restriction with adequate nutrition) may have additional beneficial effects on several metabolic and hormonal factors that are implicated in the biology of aging itself. Additional studies are needed to understand the complex interactions of factors that regulate aging and age-associated chronic disease.