特发性肺纤维化一例及有关文献复习

目的探讨特发性肺纤维化的病理学特征。方法对1例特发性肺纤维化进行活检及镜下观察,同时复习相关文献。结果该例特发性肺纤维化的组织学改变符合特发性间质性肺炎的病理特征。结论特发性肺纤维化是临床较少见的疾病,属于特发性间质性肺炎,病理特点是光镜下呈典型的UIP结构。根据该病例的组织学特征,结合临床病史及胸部影像学资料可以作出诊断。     

原发性闭角型青光眼的临床表现及治疗

随着社会经济的发展和医疗水平的进步,我国呈现人口老龄化趋势,随之青光眼发病率也逐年增长。青光眼分为原发性、先天性及继发性,本文先叙述了原发性闭角型青光眼的基本知识,如分类及发病因素,然后结合医学实践中治疗的临床表现,详细列举了患者的发病特征及治疗阶段,最后对治疗手段加以叙述,并重点介绍了药物手术结合治疗青光眼的治疗方法及效果,旨在为原发性闭角型青光眼的治疗提供第一手资料。     

特发性肺纤维化药物治疗进展

特发性肺纤维化是一种致残率和死亡率双高的肺部疾病的最终转归。其发病隐匿,机制不明,死亡率超过一般癌症。因此,寻求积极有效的药物至关重要。本文将对IPF治疗药物进行回顾与总结,为今后的临床治疗提供参考资料。     

胃和小肠间质瘤16例的治疗体会

目的总结胃肠间质瘤(GIST)患者的诊断和治疗经验。方法回顾性分析2003年10月至2009年10月手术治疗GIST16例的临床资料。结果GIST常以腹痛、胃肠道出血、腹部肿块及肠梗阻为首发症状。全组良性12例、交界性1例、恶性3例,良性及交界性患者均无复发,无围手术期死亡,全组术后均未行放、化疗,术后6～26个月死亡3例。结论对于有腹痛、胃肠道出血、腹部肿块及肠梗阻的患者,可选择胃肠镜、全胃肠道造影、B超、CT、MRI检查,必要时剖腹探查。GIST好发于中老年人,部位以胃及小肠最多见。肿瘤的大小、转移是GIST恶性的重要指标,确诊有赖于病理形态学检查与免疫组化的结合。完整的局部手术切除是最有效的治疗手段。     

成人特发性巨结肠的特点与外科治疗

目的探讨成人特发性巨结肠的发生原因、临床特点和手术处理方法。方法对2006年1月至2008年4月援坦桑尼亚塔宝拉Kitete医院收治的成人特发性巨结肠38例临床资料进行回顾性分析。结果男25例,女13例,年龄18～68岁。合并乙状结肠扭转30例,肠坏死8例,中毒性休克5例。38例均有不同程度的腹痛、腹胀和肛门停止排气排便,11例有恶心呕吐。结论成人特发性巨结肠是以高度腹胀为主的肠梗阻表现,术中行全结肠灌洗,行巨结肠一期切除吻合安全可行。     

脑弥漫性轴索损伤临床表现及治疗观察

目的探讨脑弥漫性轴索损伤(DAI)的临床表现及治疗观察。方法回顾性分析我院64例脑弥漫性轴索损伤患者的临床资料。结果本组病例治疗6个月后GOS评分为良好12例(18.75%)、中残13例(20.31%)、重残9例(14.06%)、植物生存7例(10.93%)、死亡23例(35.93%)。结论脑弥漫性轴索损伤病死率高;意识障碍是其典型临床表现。其诊断MRI检查优于CT;积极合理的治疗能提高脑弥漫性轴索损伤患者的生存率。     

老年人厌氧菌性肺炎86例分析及治疗对策

目的分析老年人厌氧菌性肺炎临床特点及病原菌分布,探讨治疗方案。方法回顾性分析我院2009年1月至2010年12月收治的102例厌氧菌性肺炎老年患者的临床资料。结果老年厌氧菌性肺炎患者通常伴有基础病症,临床多表现为发热、咳嗽、咳痰;肺部检查有啰音,胸部X线检查可见斑点状云片。常见致病菌为革兰氏阴、阳性菌。通过痰培养实验和药敏试验选择相关抗生素,通过治疗后治愈52例,好转35例,无效15例(10例死亡)。结论老年人厌氧菌性肺炎临床表现不典型,应提高确诊率,根据相关检查制定治疗方案,减少死亡率。     

胃肠道间质瘤的诊断及预后探讨

目的探讨胃肠道间质瘤的诊断及预后相关因素。方法采用S-P免疫组化方法标记42例消化道及腹腔胃肠道间质瘤(GISTS)。结果42例GISTS中Des(+)4例(9.5%),SMA(+)14例(33%),Actin(+)12例(28.6%),CD34(+)36例(85.7%),CD117(+)40例(95.2%),S-100(+)12例(28.6%),Ki-67(+)22例(52.4%),bcl-2(+)28例(66.7%)。结论GISTS的诊断CD117阳性率高于CD34,但在诊断中应两者结合以提高诊断率;肿瘤的大小及核分裂的多少是判断良恶性的重要指标,而所有间质瘤具有潜在恶性。     

沐舒坦协同抗生素治疗小儿感染性肺炎

沐舒坦与抗生素协同治疗小儿感染性肺炎,可升高抗生素在肺组织的浓度,提高了抗生素的疗效。沐舒坦是治疗小儿感染性肺炎的有效药物,具有价格便宜、易使用、不良反应少等优点,是治疗小儿感染性肺炎的一种重要药物。     

沐舒坦治疗新生儿吸入性肺炎的疗效观察

目的观察沐舒坦治疗新生儿吸入性肺炎的疗效。方法将我科2007年1月至2009年6月收治疗的136例新生儿吸入性肺炎随机平均分为治疗组和对照组,治疗组在常规治疗的同时加用沐舒坦治疗。结果治疗组显效54例,有效14例,无效为0,总有效率为100%。对照组显效为12例,有效为20例,无效为36例,总有效率为47.06%。结论使用沐舒坦治疗新生儿吸入性肺炎能在短期内改善患儿临床症状,疗效肯定,值得临床推广。     

Lung Microbiome in Idiopathic Pulmonary Fibrosis and Other Interstitial Lung Diseases

Interstitial lung diseases represent a heterogeneous and wide group of diseases in which factors leading to disease initiation and progression are not fully understood. Recent evidence suggests that the lung microbiome might influence the pathogenesis and progression of interstitial lung diseases. In recent years, the utilization of culture-independent methodologies has allowed the identification of complex and dynamic communities of microbes, in patients with interstitial lung diseases. However, the potential mechanisms by which these changes may drive disease pathogenesis and progression are largely unknown. The aim of this review is to discuss the role of the altered lung microbiome in several interstitial lung diseases. Untangling the host–microbiome interaction in the lung and airway of interstitial lung disease patients is a research priority. Thus, lung dysbiosis is a potentially treatable trait across several interstitial lung diseases, and its proper characterization and treatment might be crucial to change the natural history of these diseases and improve outcomes.     

MMP-7 and fcDNA Serum Levels in Early NSCLC and Idiopathic Interstitial Pneumonia: Preliminary Study

A non-invasive test to facilitate the diagnosis of non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis (IPF) is still not available and represents an important goal. Forty-eight patients with stage I NSCLC, 45 with IPF, 30 with other idiopathic interstitial pneumonias (IIPs) including idiopathic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (HP), 35 with diffuse non-malignant disease and 30 healthy donors were enrolled onto the study. Free circulating (fc)DNA and MMP-7 levels were evaluated by Real Time PCR and ELISA, respectively. Median fcDNA levels were similar in NSCLC (127 ng/mL, range 23.6–345 ng/mL) and IPF (106 ng/mL, range 22–224 ng/mL) patients, and significantly lower in IIPs patients, in individuals with other diseases and in healthy donors (p < 0.05). Conversely, median MMP-7 values were significantly higher in IPF patients (9.10 ng/mL, range 3.88–19.72 ng/mL) than in those with NSCLC (6.31 ng/mL, range 3.38–16.36 ng/mL; p < 0.0001), NSIP (6.50 ng/mL, range 1.50–22.47 ng/mL; p = 0.007), other diseases (5.41 ng/mL, range 1.78–15.91, p < 0.0001) or healthy donors (4.35 ng/mL, range 2.45–7.23; p < 0.0001). Serum MMP-7 levels seem to be capable of distinguishing IPF patients from those with any other lung disease. fcDNA levels were similar in NSCLC and IPF patients, confirming its potential role as a biomarker, albeit non-specific, for the differential diagnosis of NSCLC.     

Role of Arachidonic Acid and Its Metabolites in the Biological and Clinical Manifestations of Idiopathic Nephrotic Syndrome

Studies concerning the role of arachidonic acid (AA) and its metabolites in kidney disease are scarce, and this applies in particular to idiopathic nephrotic syndrome (INS). INS is one of the most frequent glomerular diseases in childhood; it is characterized by T-lymphocyte dysfunction, alterations of pro- and anti-coagulant factor levels, and increased platelet count and aggregation, leading to thrombophilia. AA and its metabolites are involved in several biological processes. Herein, we describe the main fields where they may play a significant role, particularly as it pertains to their effects on the kidney and the mechanisms underlying INS. AA and its metabolites influence cell membrane fluidity and permeability, modulate platelet activity and coagulation, regulate lymphocyte activity and inflammation, preserve the permeability of the glomerular barrier, influence podocyte physiology, and play a role in renal fibrosis. We also provide suggestions regarding dietary measures that are able to prevent an imbalance between arachidonic acid and its parental compound linoleic acid, in order to counteract the inflammatory state which characterizes numerous kidney diseases. On this basis, studies of AA in kidney disease appear as an important field to explore, with possible relevant results at the biological, dietary, and pharmacological level, in the final perspective for AA to modulate INS clinical manifestations.     

23例主动脉夹层的临床分析

目的探讨主动脉夹层的临床特征,以积累经验,提高诊治率。方法对我院收治的23例主动脉夹层患者的临床资料进行回顾性分析。结果本组23例患者中误诊11例,误诊率44.00%;16例好转出院(69.57%),7例死亡(30.43%)。结论主动脉夹层患者的症状和体征表现多样,临床较易误诊,早期正确诊断和治疗对预后很关键。     

Fibrotic Idiopathic Interstitial Lung Disease: The Molecular and Cellular Key Players

Interstitial lung diseases (ILDs) that are known as diffuse parenchymal lung diseases (DPLDs) lead to the damage of alveolar epithelium and lung parenchyma, culminating in inflammation and widespread fibrosis. ILDs that account for more than 200 different pathologies can be divided into two groups: ILDs that have a known cause and those where the cause is unknown, classified as idiopathic interstitial pneumonia (IIP). IIPs include idiopathic pulmonary fibrosis (IPF), non-specific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP) known also as bronchiolitis obliterans organizing pneumonia (BOOP), acute interstitial pneumonia (AIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and lymphocytic interstitial pneumonia (LIP). In this review, our aim is to describe the pathogenic mechanisms that lead to the onset and progression of the different IIPs, starting from IPF as the most studied, in order to find both the common and standalone molecular and cellular key players among them. Finally, a deeper molecular and cellular characterization of different interstitial lung diseases without a known cause would contribute to giving a more accurate diagnosis to the patients, which would translate to a more effective treatment decision.     

Sirolimus Suppresses Phosphorylation of Cofilin and Reduces Interstitial Septal Thickness in Sporadic Lymphangioleiomyomatosis

Sporadic lymphangioleiomyomatosis (S-LAM) is a rare lung disease characterized by the proliferation of smooth muscle-like LAM cells and progressive cystic destruction. Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has a proven efficacy in patients with LAM. However, the therapeutic mechanisms of sirolimus in LAM remain unclear. We aimed to evaluate sirolimus-related lung parenchymal changes and the potential effect in LAM cells and modulating pathological cystic destruction. Lung specimens were examined for histopathological changes by HMB45 staining and compared the LAM patients treated with and without sirolimus. We detected the overexpression of mTOR, HMB45, and phosphorylation of cofilin (p-cofilin) in LAM patients. Sirolimus showed efficacy in patients with LAM, who exhibited a reduced expression of mTOR and p-cofilin as well as reduced interstitial septal thickness. In addition, sirolimus suppresses mTOR and p-cofilin, thus suppressing the migration and proliferation of LAM cells isolated from the patient’s lung tissue. This study demonstrates that interstitial septal thickness, as determined by histological structural analysis. Sirolimus effectively reduced the expression of p-cofilin and interstitial septal thickness, which may be a novel mechanism by sirolimus. Moreover, we develop a new method to isolate and culture the LAM cell, which can test the possibility of medication in vitro and impact this current study has on the LAM field. The development of approaches to interfere with mTOR-cofilin1-actin signaling may result in an option for S-LAM therapy.     

心脏内平滑肌病的临床特点及外科治疗

目的总结心脏内平滑肌瘤病(intracardiac leiomyomatosis,ICL)的临床特点及外科治疗经验。方法回顾分析1999年1月至2009年1月新乡医学院第一附属医院收治的5例心脏内平滑肌瘤病患者的临床资料。结果 5例患者均为女性,有明显心慌、胸闷、晕厥或静脉栓塞等症状。影像学检查在右房及下腔静脉发现瘤栓。其中4例有子宫肌瘤手术史,1例入院后B超检查发现子宫肌瘤。5例患者均接受手术治疗,其中1例行单纯心房内瘤体切除,半年后病变复发,再次手术后死于多器官功能衰竭。4例经胸腹联合切口行分期根治术,一期完整切除右房及下腔静脉内所有瘤体,6～9个月后由妇产科行二期手术治疗原发病灶,随访2年,心脏及下腔静脉内均无肿瘤复发,无明显临床症状。结论心脏平滑肌瘤临床发病率低,手术是最主要的治疗方法,彻底切净肿瘤是成功治疗的关键。     

益生菌联合美沙拉嗪对炎症性肠病治疗的临床研究

目的探讨益生菌联合美沙拉嗪对炎症性肠病治疗的临床研究。方法采用回顾性分析的方法,分析我院收治的60例炎症性肠病的患者临床资料,依据治疗方式不同,分为观察组(30例)和对照组(30例),观察其临床疗效。结果观察组结肠镜检查总有效率、临床疗效均明显高于对照组,P<0.05,差异均有统计学意义。观察组腹痛、腹泻、恶心、纳差、皮疹等不良反应的发生率均明显低于对照组,P<0.05,差异有统计学意义。结论益生菌联合美沙拉嗪对炎症性肠病治疗的临床疗效明显,安全性高,值得临床推广使用。