鼻窦炎鼻内窥镜围手术期的中西医结合治疗临床分析

目的：观察中西医结合疗法在鼻窦炎鼻内窥镜围手术期的临床疗效。方法：按随机数字表法将符合标准的108例患者分为观察组和对照组,观察组58例,对照组50例。对照组采用常规西医处理,观察组在对照组基础上加用鼻渊舒口服液治疗。结果：观察组术中出血量少于对照组,2组比较,出血量≤50mL差异有显著性意义（P〈0．05）。观察组痊愈30例,痊愈率51．72％,总有效率91．38％。对照组痊愈14例,痊愈率28．00％,总有效率78．00％。2组比较,痊愈率和总有效率差异均有显著性意义（P〈0．05）。结论：鼻窦炎鼻内窥镜围手术期采取中西医结合治疗疗效优于单纯西医治疗。     

Shufeng Jiedu,a promising herbal therapy for moderate COVID-19:Antiviral and anti-inflammatory properties,pathways of bioactive compounds,and a clinical real-world pragmatic study

BackgroundShufeng Jiedu capsules (SFJDC), a patented herbal drug composed of eight medicinal plants, is used for the treatment of different viral respiratory tract infectious diseases. Based on its antiviral, anti-inflammatory and immunoregulatory activity in acute lung injury, SFJDC might be a promising candidate for the treatment of COVID-19.PurposeTo evaluate the antiviral and anti-inflammatory properties and to discover the mechanism of action of SFJDC as a potential drug for the treatment of COVID-19. Furthermore, the study should determine the clinical effectiveness of SFJDC for the treatment of COVID-19.DesignWe analyzed the antiviral and anti-inflammatory effects of SFJDC in a HCoV-229E mouse model on lung index, virus load in the lung, the release of cytokines, and on T- and B-lymphocytes. The mechanism of action was further investigated by network analysis. Additionally, we investigated data from a clinical pragmatic real-world study for patients with confirmed COVID-19, to evaluate the clinical effect of SFJDC and to determine the best time to start the treatment.ResultsSFJDC significantly reduced the virus load in the lung of HCoV-229E mice (from 1109.29 ± 696.75 to 0 ± 0 copies/ml), decreased inflammatory factors IL-6, IL-10, TNF-α, and IFN-γ in the lung, and increased the amount of CD4⁺ and CD8⁺ cells in the blood compared to the model group. Network analysis revealed that SFJDC reduces the activity of NFκB via several signaling pathways. Quercetin, wogonin, and polydatin bind directly to the main protease (M^pro) of SARS-CoV-2.Clinical data showed that SFJDC, added to standard antiviral therapy (AVD), significantly reduced the clinical recovery time of COVID-19 and fatigue (from 3.55 ± 4.09 to 1.19 ± 2.28 days) as well as cough (from 5.67 ± 5.64 to 3.47 ± 3.75) days compared to AVD alone. SFJDC therapy was significantly more effective when used within the first 8 days after the onset of symptoms.ConclusionSFJDC might be a promising drug for the treatment of COVID-19, but large-scale randomized, double-blinded, placebo-controlled clinical trials are needed to complement the real-world evidence. It might be beneficial to start SFJDC treatment as early as possible in suspected cases of COVID-19.     

Previous Helicobacter pylori infection–induced atrophic gastritis: A distinct disease entity in an understudied population without a history of eradication

Individuals with chronic atrophic gastritis who are negative for active H. pylori infection with no history of eradication therapy have been identified in clinical practice. By excluding false‐negative and autoimmune gastritis cases, it can be surmised that most of these patients have experienced unintentional eradication of H. pylori after antibiotic treatment for other infectious disease, unreported successful eradication, or H. pylori that spontaneously disappeared. These patients are considered to have previous H. pylori infection–induced atrophic gastritis. In this work, we define these cases based on the following criteria: absence of previous H. pylori eradication; atrophic changes on endoscopy or histologic confirmation of glandular atrophy; negative for a current H. pylori infection diagnosed in the absence of proton‐pump inhibitors or antibiotics; and absence of localized corpus atrophy, positivity for autoantibodies, or characteristic histologic findings suggestive of autoimmune gastritis. The risk of developing gastric cancer depends on the atrophic grade. The reported rate of developing gastric cancer is 0.31%‐0.62% per year for successfully eradicated severely atrophic cases (pathophysiologically equal to unintentionally eradicated cases and unreported eradicated cases), and 0.53%‐0.87% per year for spontaneously resolved cases due to severe atrophy. Therefore, for previous H. pylori infection–induced atrophic gastritis cases, we recommend endoscopic surveillance every 3 years for high‐risk patients, including those with endoscopically severe atrophy or intestinal metaplasia. Because of the difficulty involved in the endoscopic diagnosis of gastric cancer in cases of previous infection, appropriate monitoring of the high‐risk subgroup of this understudied population is especially important.     

等离子低温射频消融术联合鼻内镜对慢性鼻窦炎患者嗅觉功能及血清炎症介质的影响

目的:探讨等离子低温射频消融术联合鼻内镜对慢性鼻窦炎(CRS)患者嗅觉功能及血清炎症介质的影响。方法:选取2016年3月～2018年7月期间我院收治的CRS患者127例,根据手术方式的不同将患者分为A组(n=62,鼻内镜手术)和B组(n=65,等离子低温射频消融术联合鼻内镜手术),术后随访1年,比较两组患者临床疗效、症状评分、嗅觉功能、血清炎症介质及并发症情况。结果:B组术后1年的临床总有效率为87.69%(57/65),高于A组的72.58%(45/62)(P0.05);术后3个月B组的嗅觉功能分布优于A组(P0.05);两组患者术后3个月鼻塞、头面部胀痛、流脓涕、鼻涕倒流、头痛等症状评分均降低,且B组低于A组(P0.05)。两组患者术后1周血清白介素-5(IL-5)、白介素-17(IL-17)以及肿瘤坏死因子-α(TNF-α)均降低,且B组低于A组(P0.05)。两组术后并发症发生率比较无差异(P0.05)。结论:CRS在鼻内镜的基础上联合等离子低温射频消融术治疗的疗效显著,能够有效改善患者嗅觉功能和临床症状,抑制机体炎性反应的同时不增加并发症发生率。     

Dissection of Hexosyl- and Sialyltransferase Domains in the Bifunctional Capsule Polymerases from Neisseria meningitidis W and Y Defines a New Sialyltransferase Family

Crucial virulence determinants of disease causing Neisseria meningitidis species are their extracellular polysaccharide capsules. In the serogroups W and Y, these are heteropolymers of the repeating units (→6)-α-d-Gal-(1→4)-α-Neu5Ac-(2→)_n in NmW and (→6)-α-d-Glc-(1→4)-α-Neu5Ac-(2→)_n in NmY. The capsule polymerases, SiaD_W and SiaD_Y, which synthesize these highly unusual polymers, are composed of two predicted GT-B fold domains separated by a large stretch of amino acids (aa 399–762). We recently showed that residues critical to the hexosyl- and sialyltransferase activity are found in the predicted N-terminal (aa 1–398) and C-terminal (aa 763–1037) GT-B fold domains, respectively. Here we use a mutational approach and synthetic fluorescent substrates to define the boundaries of the hexosyl- and sialyltransferase domains. Our results reveal that the active sialyltransferase domain extends well beyond the predicted C-terminal GT-B domain and defines a new glycosyltransferase family, GT97, in CAZy (Carbohydrate-Active enZYmes Database).     

Murine Endoscopy for In Vivo Multimodal Imaging of Carcinogenesis and Assessment of Intestinal Wound Healing and Inflammation

Mouse models are widely used to study pathogenesis of human diseases and to evaluate diagnostic procedures as well as therapeutic interventions preclinically. However, valid assessment of pathological alterations often requires histological analysis, and when performed ex vivo, necessitates death of the animal. Therefore in conventional experimental settings, intra-individual follow-up examinations are rarely possible. Thus, development of murine endoscopy in live mice enables investigators for the first time to both directly visualize the gastrointestinal mucosa and also repeat the procedure to monitor for alterations. Numerous applications for in vivo murine endoscopy exist, including studying intestinal inflammation or wound healing, obtaining mucosal biopsies repeatedly, and to locally administer diagnostic or therapeutic agents using miniature injection catheters. Most recently, molecular imaging has extended diagnostic imaging modalities allowing specific detection of distinct target molecules using specific photoprobes. In conclusion, murine endoscopy has emerged as a novel cutting-edge technology for diagnostic experimental in vivo imaging and may significantly impact on preclinical research in various fields.     

Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis

Background: Barium radiographic studies have suggested the importance of evaluating areae gastricae pattern for the diagnosis of gastritis. Significance of endoscopic appearance of areae gastricae in the diagnosis of chronic atrophic fundic gastritis (CAFG) was investigated by image‐enhanced endoscopy. Materials and Methods: Endoscopic images of the corpus lesser curvature were studied in 50 patients with CAFG. Extent of CAFG was evaluated with autofluorescence imaging endoscopy. The areae gastricae pattern was evaluated with 0.2% indigo carmine chromoendoscopy. Micro‐mucosal structure was examined with magnifying chromoendoscopy and narrow band imaging. Results: In patients with small extent of CAFG, polygonal areae gastricae separated by a narrow intervening part of areae gastricae was observed, whereas in patients with wide extent of CAFG, the size of the areae gastricae decreased and the width of the intervening part of areae gastricae increased (p < 0.001). Most areae gastricae showed a foveola‐type micro‐mucosal structure (82.7%), while intervening part of areae gastricae had a groove‐type structure (98.0%, p < 0.001). Groove‐type mucosa had a higher grade of atrophy (p < 0.001) and intestinal metaplasia (p < 0.001) compared with foveola type. Conclusions: As extent of CAFG widened, multifocal groove‐type mucosa that had high‐grade atrophy and intestinal metaplasia developed among areae gastricae and increased along the intervening part of areae gastricae. Our observations facilitate our understanding of the development and progression of CAFG.     

放大内镜对结节性胃炎的诊断价值

随着内镜技术的发展,放大内镜在临床中的应用尤为受到重视,并越来越多运用于临床诊断。目前新型的放大内镜可清晰显示消化道粘膜腺管开口和微细血管等细微结构的变化,从而,发现和诊断普通内镜难以发现的一些早期病变,特别是早期恶性肿瘤及其癌前病变。近年来在放大内镜检查中加上染色对比技术及窄带成像等技术,使放大内镜的运用得到进一步拓展。本文就放大内镜对结节性胃炎及其相关病变的诊断价值作一综述。     

扶正化瘀胶囊对鼠血吸虫肝纤维化的作用及机制探讨

目的:研究扶正化瘀胶囊对实验性血吸虫病肝纤维化的影响,探讨其相关作用机制。方法:70只昆明小鼠分为正常对照组(A)、模型组(B)、吡喹酮组(C)、INF-γ组(D)、扶正化瘀胶囊低剂量组(E)、中剂量组(F)、高剂量组(G),采用日本血吸虫尾蚴30条/只攻击感染小鼠建立血吸虫性肝纤维化模型。第6周用吡喹酮驱虫治疗后予扶正化瘀胶囊干预,第14周末观察血清透明质酸、层粘连蛋白、III型前胶原、IV型胶原水平,HE染色观察肝脏病理改变及虫卵结节变化,免疫组化检测PDGF-BB和I、III型胶原的表达。结果:扶正化瘀胶囊各剂量组肝脏病理损伤减轻,虫卵肉芽肿面积和数量明显减小;血清HA、LN、PC-III、C-IV水平显著下降(P<0.05);肝组织I、III型胶原和PDGF-BB表达明显低于模型组(P<0.05)。结论:扶正化瘀胶囊具有抗血吸虫性肝纤维化作用,降低肝组织PDGF-BB的表达可能是其抗纤维化作用机制之一。