• 【呼吸道合胞病毒细支气管炎后3个月,嗜酸性粒细胞来源的神经毒素水平是反复性喘息的预测生物标志物。】 复制标题 收藏 收藏
    DOI:10.3109/1354750X.2013.773078 复制DOI
    作者列表:Kim CK,Seo JK,Ban SH,Fujisawa T,Kim DW,Callaway Z
    BACKGROUND & AIMS: OBJECTIVE:To determine whether eosinophil-derived neurotoxin (EDN) is a predictive marker of recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis. METHODS:EDN levels and recurrent wheezing episodes were serially measured in 200 infants hospitalized with RSV bronchiolitis. RESULTS:Serum EDN levels at 3 months correlated significantly with total wheezing episodes at 12 months in the RSV-PLC (n  = 71; r = 0.720, p < 0.0001) and RSV-MONT groups (n = 79; r = 0.531, p < 0.001). Positive predictive value of 3-mo EDN level for total wheezing episodes was 57%; negative predictive value, 76%; sensitivity, 72%; specificity, 62%. CONCLUSION:EDN levels have predictive value for the development of recurrent wheezing post-RSV bronchiolitis.
    背景与目标: 目的:确定嗜酸性粒细胞源性神经毒素(EDN)是否是呼吸道合胞病毒(RSV)细支气管炎反复喘息发作的预测指标。
    方法:连续测量200例RSV细支气管炎住院婴儿的EDN水平和反复喘息发作。
    结果:RSV-PLC(n = 71; r = 0.720,p <0.0001)和RSV-MONT组(n = 79; r = 0.531,p)在3个月时的血清EDN水平与12个月时总的喘息发作显着相关<0.001)。 EDN水平3个月对总的喘息发作的阳性预测值为57%;阴性预测值,占76%;敏感度为72%;特异性为62%。
    结论:EDN水平对RSV后细支气管炎复发性喘息的发生具有预测价值。
  • 【伊洛前列素与阿司匹林治疗闭塞性血栓血管炎的严重肢体缺血的试验。 TAO研究。】 复制标题 收藏 收藏
    DOI:10.1016/0140-6736(90)90346-7 复制DOI
    作者列表:Fiessinger JN,Schäfer M
    BACKGROUND & AIMS: :152 patients with thromboangiitis obliterans (Buerger's disease) and pain from critical leg ischaemia were randomly allocated to receive iloprost, a chemically stable prostacyclin analogue, or low-dose aspirin, for 28 days in a double-blind trial. On review, 19 patients did not fulfil the stringent entry criteria. Of the other 133 patients, 98 also had leg ulcers. After 21-28 days, 58 (85%) of 68 iloprost-treated patients showed ulcer healing or relief of ischaemic pain, compared with 11 (17%) of 65 in the aspirin-treated group. 43 (63%) on iloprost treatment had complete relief of pain, compared with 18 (28%) on aspirin. Ulcers healed completely in 18 of 52 (35%) who received iloprost compared with 6 of 46 (13%) who received aspirin. 6 months after the start of treatment, the response rate was 45 of 51 (88%) patients treated with iloprost compared with 12 of 44 (21%) patients treated with aspirin.
    背景与目标: 在双盲试验中,将152名患有闭塞性血栓性血管炎(Buerger病)和因严重下肢缺血的疼痛的患者随机分配接受伊洛前列素(伊洛前列素),伊洛前列素是一种化学稳定的前列环素类似物或小剂量阿司匹林。经复查,有19名患者不符合严格的入院标准。在其他133名患者中,有98名还患有腿部溃疡。 21-28天后,接受伊洛前列素治疗的68位患者中有58位(85%)溃疡愈合或减轻了缺血性疼痛,而阿司匹林治疗组的65位中有11位(17%)。伊洛前列素治疗组中有43(63%)名患者完全缓解了疼痛,而阿司匹林治疗组中只有18(28%)名。接受伊洛前列素的52名患者中有18名(35%)的溃疡完全治愈,而接受阿司匹林的46名患者中有6名(13%)的溃疡得到了完全治愈。在开始治疗后的6个月,伊洛前列素治疗的51例患者中有45例(88%)有效率,而阿司匹林治疗的44例患者中有12例(21%)有效率。
  • 【白细胞介素8与呼吸道合胞病毒毛细支气管炎的关联:系统评价和荟萃分析。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Peng L,Meng F,Liu Y,Zhang L
    BACKGROUND & AIMS: :Infants with the respiratory syncytial virus (RSV) and human rhinovirus respiratory infection (HRV) produce inflammatory interleukins (ILs) in the respiratory epithelium. The aim of this study was to evaluate the levels of interleukin-8 in RSV negative and RSV positive patients. This study search was conducted without a time limit until 2020 through the databases of PubMed, Wiley, Springer, ScienceDirect and Google Scholar search engines, by two researchers independently. The random-effects model was used to compare of interleukin-8 in RSV negative vs. RSV positive patients, using Revman software version 5 meta-analysis software. Totally, 921 patients were evaluated (207 RSV-negative and 714 RSV-positive). The mean concentration of IL8 in RSV positive patients was 15.02 pg/ml (95% CI: 13.68- 16.35%).  According to the meta-analysis results, the standardized mean difference (SMD) of IL8 concentration between RSV-positive and negative patients was 6.31 pg/ml) (95% confidence interval: 2.50- 10.13%). subtotal analysis of the IL8 laboratory assessment method revealed that there was no significant SMD deference in the studies that have used chemiluminescence (P=0.21). while IL8 concentrations were significantly higher in RSV positives in ELISA and Magnetic bead-based assays (P<0.05).  It appears that RSV positive patients may have greater levels of IL8 than RSV negative ones; whereas the synthesis of IL8 tends to be more secreted into the nasopharyngeal space; whereas the evaluation approach can also affect the results.
    背景与目标: :患有呼吸道合胞病毒(RSV)和人鼻病毒性呼吸道感染(HRV)的婴儿在呼吸道上皮中产生炎性白介素(ILs)。这项研究的目的是评估RSV阴性和RSV阳性患者中白细胞介素8的水平。这项研究的搜索是在没有时间限制的情况下进行的,直到2020年,由两名研究人员独立地通过PubMed,Wiley,Springer,ScienceDirect和Google Scholar搜索引擎的数据库进行了搜索。使用Revman软件版本5荟萃分析软件,使用随机效应模型比较RSV阴性和RSV阳性患者的白细胞介素8。总共评估了921例患者(207例RSV阴性和714例RSV阳性)。 RSV阳性患者中IL8的平均浓度为15.02 pg / ml(95%CI:13.68-16.35%)。根据荟萃分析结果,RSV阳性和阴性患者之间IL8浓度的标准平均差(SMD)为6.31 pg / ml(95%置信区间:2.50-10.13%)。 IL8实验室评估方法的小计分析显示,在使用化学发光的研究中,没有明显的SMD依赖(P = 0.21)。在ELISA和基于磁珠的检测中,RSV阳性的IL8浓度显着较高(P <0.05)。看来RSV阳性患者的IL8水平可能高于RSV阴性患者;而IL8的合成往往更多地分泌到鼻咽空间;而评估方法也会影响结果。
  • 【在急性儿科环境中进行的治疗性对话干预措施对由呼吸道合胞病毒(RSV)引起的毛细支气管炎患儿的家庭有影响吗?】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2702.2012.04330.x 复制DOI
    作者列表:Kamban SW,Svavarsdottir EK
    BACKGROUND & AIMS: AIMS AND OBJECTIVES:To measure the benefit of a short-family therapeutic conversation (STC) intervention in an acute paediatric unit. BACKGROUND:Studies of children with bronchiolitis caused by respiratory syncytial virus (RSV) have shown that this virus may have an impact on their respiratory system in the form of a wheezing disorder, asthma and even allergy during their childhood. Studies of the parents of these children indicate that they experience distress, vulnerability and anxiety through the illness period and therefore need support from healthcare professionals. However, little is known about what intervention is of most benefit for these parents. DESIGN:Quasi-experimental. METHOD:Data were collected from a convenience sample from February throughout April 2009 at an acute unit at a children's hospital in Iceland. Parents of infants diagnosed with bronchiolitis caused by RSV were invited to attend. In total, there are 41 participants: 21 in the intervention group (n = 21) and 20 in the control group (n = 20). Parents in both groups answered questionnaires about perceived support and family expressive functioning both before the intervention and on an average of 11 days after the intervention. RESULTS:The main findings showed that mothers in the intervention group perceive significantly higher support after the intervention compared with the control group. The findings also showed a significant difference between the genders (mothers and fathers) in the intervention group. The mothers perceived higher cognitive support than the fathers. CONCLUSIONS:Despite the often chaotic environment in an acute care setting, the research findings give paediatric nurses reason to conclude that a STC intervention benefits mothers of infants with bronchiolitis caused by RSV. RELEVANCE TO CLINICAL PRACTICE:A STC intervention offered by a nurse within an acute paediatric unit can support families in handling the illness experience.
    背景与目标: 目的和目的:评估急性小儿科的短期家庭治疗性对话(STC)干预的益处。
    背景:由呼吸道合胞病毒(RSV)引起的毛细支气管炎患儿的研究表明,该病毒可能以童年时期的喘息性疾病,哮喘甚至过敏等形式影响其呼吸系统。对这些孩子的父母的研究表明,他们在患病期间会感到困扰,脆弱和焦虑,因此需要医疗保健专业人员的支持。但是,对于哪种干预对这些父母最大的益处知之甚少。
    设计:准实验。
    方法:数据是从2009年2月至2009年4月在冰岛一家儿童医院的急诊室的便民样本中收集的。邀请被诊断为RSV引起的毛细支气管炎的婴儿的父母参加。总共有41位参与者:干预组21位(n = 21),对照组20位(n = 20)。两组父母均回答了有关干预前和干预后平均11天的感知支持和家庭表达功能的问卷。
    结果:主要研究结果表明,干预组的母亲在接受干预后的支持率明显高于对照组。研究结果还表明,干预组的性别(母亲和父亲)之间存在显着差异。母亲比父亲感觉到更高的认知支持。
    结论:尽管急性护理环境中经常出现混乱的环境,但研究发现使儿科护士有理由得出结论,STC干预有益于由RSV引起的毛细支气管炎婴儿。
    与临床实践的关系:急性儿科内的护士提供的STC干预可以支持家庭处理疾病经历。
  • 5 Bronchiolitis. 复制标题 收藏 收藏

    【细支气管炎。】 复制标题 收藏 收藏
    DOI:10.1016/S0140-6736(06)69077-6 复制DOI
    作者列表:Smyth RL,Openshaw PJ
    BACKGROUND & AIMS: :Bronchiolitis is a distressing, potentially life-threatening respiratory condition that affects young babies. Around 2-3% of all infants younger than 1 year are admitted to hospital with bronchiolitis, usually during the seasonal epidemic. The majority of these infants are infected with respiratory syncytial virus and all have an intense inflammatory response in their airways. Although most infants recover, they have an increased risk of recurrent wheezing. Although bronchiolitis is common, little is known about what causes infants to be susceptible. Diagnostic interventions have little effect on clinical outcome, and apart from supportive measures, there is no specific treatment. Bronchiolitis therefore presents an intriguing clinical conundrum and a major challenge to researchers. High quality clinical studies are needed to clarify assessment of disease severity and criteria for hospital admission, particularly the use of pulse oximetry and chest radiography. Careful mapping of the inflammatory pathways in the pathogenesis of bronchiolitis should lead to development of new therapies to alleviate symptoms.
    背景与目标: 毛细支气管炎是一种令人痛苦的,可能威胁生命的呼吸道疾病,会影响年幼的婴儿。通常在季节性流行期间,约有2-3%的1岁以下婴儿入院患有毛细支气管炎。这些婴儿中的大多数感染了呼吸道合胞病毒,并且它们的呼吸道均具有强烈的炎症反应。尽管大多数婴儿都能康复,但他们反复发作喘息的风险增加。尽管毛细支气管炎很常见,但对导致婴儿易感的原因知之甚少。诊断干预措施对临床结果影响不大,除支持性措施外,尚无特异性治疗方法。因此,毛细支气管炎给临床研究人员带来了有趣的难题和重大挑战。需要高质量的临床研究来阐明疾病严重程度和入院标准的评估,尤其是脉搏血氧饱和度和胸部X线摄片的使用。在细支气管炎发病机理中仔细绘制炎症途径的图谱应导致开发新的缓解症状的疗法。
  • 6 HIGH-FLOW THERAPY FOR BRONCHIOLITIS. 复制标题 收藏 收藏

    【支气管炎的高流量治疗。】 复制标题 收藏 收藏
    DOI:10.1111/jpc.14761 复制DOI
    作者列表:Del Villar-Guerra P,Medina A,Gutiérrez M,Modesto I Alapont V
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【阿奇霉素可降低闭塞性细支气管炎综合征患者的气道中性粒细胞减少和白细胞介素8的水平。】 复制标题 收藏 收藏
    DOI:10.1164/rccm.200601-071OC 复制DOI
    作者列表:Verleden GM,Vanaudenaerde BM,Dupont LJ,Van Raemdonck DE
    BACKGROUND & AIMS: RATIONALE:Bronchiolitis obliterans syndrome (BOS) remains the leading cause of death after lung transplantation. Treatment is difficult, although azithromycin has recently been shown to improve FEV(1). The exact mechanism of action is unclear. HYPOTHESES:(1) Azithromycin reduces airway neutrophilia and interleukin (IL)-8 and (2) airway neutrophilia predicts the improvement in FEV(1). METHODS:Fourteen lung transplant patients with BOS (between BOS 0-p and BOS 3) were treated with azithromycin, in addition to their current immunosuppressive treatment. Before and 3 mo after azithromycin was introduced, bronchoscopy with bronchoalveolar lavage (BAL) was performed for cell differentiation and to measure IL-8 and IL-17 mRNA ratios. RESULTS:The FEV(1) increased from 2.36 (+/- 0.82 L) to 2.67 L (+/- 0.85 L; p = 0.007), whereas the percentage of BAL neutrophilia decreased from 35.1 (+/- 35.7%) to 5.7% (+/- 6.5%; p = 0.0024). There were six responders to azithromycin (with an FEV(1) increase of > 10%) and eight nonresponders. Using categorical univariate linear regression analysis, the main significant differences in characteristics between responders and nonresponders were the initial BAL neutrophilia (p < 0.0001), IL-8 mRNA ratio (p = 0.0009), and the postoperative day at which azithromycin was started (p = 0.036). There was a significant correlation between the initial percentage of BAL neutrophilia and the changes in FEV(1) after 3 mo (r = 0.79, p = 0.0019). CONCLUSION:Azithromycin significantly reduces airway neutrophilia and IL-8 mRNA in patients with BOS. Responders have a significantly higher BAL neutrophilia and IL-8 compared with nonresponders and had commenced treatment earlier after transplantation. BAL neutrophilia can be used as a predictor for the FEV(1) response to azithromycin.
    背景与目标: 理由:闭塞性细支气管炎综合征(BOS)仍然是肺移植后死亡的主要原因。尽管最近已证明阿奇霉素可改善FEV(1),但治疗困难。确切的作用机理尚不清楚。
    假设:(1)阿奇霉素可减少气道中性粒细胞增多和白介素(IL)-8,(2)气道中性粒细胞减少可预测FEV(1)。
    方法:除了目前的免疫抑制治疗外,还用阿奇霉素治疗了14例BOS 0-p和BOS 3之间的BOS肺移植患者。在引入阿奇霉素之前和之后3个月,用支气管肺泡灌洗液(BAL)进行支气管镜检查以区分细胞并测量IL-8和IL-17 mRNA的比例。
    结果:FEV(1)从2.36(/-0.82 L)增加到2.67 L(/-0.85 L; p = 0.007),而BAL中性粒细胞的百分比从35.1(/-35.7%)降低到5.7%(/ -6.5%; p = 0.0024)。阿奇霉素有6名反应者(FEV(1)升高> 10%)和8名无反应者。使用分类单变量线性回归分析,反应者和非反应者之间的主要特征差异是初始BAL中性粒细胞增多(p <0.0001),IL-8 mRNA比(p = 0.0009)和阿奇霉素开始的术后天数(p = 0.036)。 BAL中性粒细胞的初始百分比与3个月后FEV(1)的变化之间存在显着相关性(r = 0.79,p = 0.0019)。
    结论:阿奇霉素可显着降低BOS患者气道中性粒细胞和IL-8 mRNA的表达。与无反应者相比,有反应者的BAL中性粒细胞和IL-8明显更高,并且在移植后更早开始治疗。 BAL中性粒细胞增多症可用作FEV(1)对阿奇霉素反应的预测因子。
  • 【CXCR3及其配体在闭塞性细支气管炎的鼠模型中:调节和功能。】 复制标题 收藏 收藏
    DOI:10.4049/jimmunol.176.11.7087 复制DOI
    作者列表:Medoff BD,Wain JC,Seung E,Jackobek R,Means TK,Ginns LC,Farber JM,Luster AD
    BACKGROUND & AIMS: :Lung transplantation remains the only effective therapy for patients with end-stage lung disease, but survival is limited by the development of obliterative bronchiolitis (OB). The chemokine receptor CXCR3 and two of its ligands, CXCL9 and CXCL10, have been identified as important mediators of OB. However, the relative contribution of CXCL9 and CXCL10 to the development of OB and the mechanism of regulation of these chemokines has not been well defined. In this study, we demonstrate that CXCL9 and CXCL10 are up-regulated in unique patterns following tracheal transplantation in mice. In these experiments, CXCL9 expression peaked 7 days posttransplant, while CXCL10 expression peaked at 1 day and then again 7 days posttransplant. Expression of CXCL10 was also up-regulated in a novel murine model of lung ischemia, and in bronchoalveolar lavage fluid taken from human lungs 24 h after lung transplantation. In further analysis, we found that 3 h after transplantation CXCL10 is donor tissue derived and not dependent on IFN-gamma or STAT1, while 24 h after transplantation CXCL10 is from recipient tissue and regulated by IFN-gamma and STAT1. Expression of both CXCL9 and CXCL10 7 days posttransplant is regulated by IFN-gamma and STAT1. Finally, we demonstrate that deletion of CXCR3 in recipients reduces airway obliteration. However, deletion of either CXCL9 or CXCL10 did not affect airway obliteration. These data show that in this murine model of obliterative bronchiolitis, these chemokines are differentially regulated following transplantation, and that deletion of either chemokine alone does not affect the development of airway obliteration.
    背景与目标: :肺移植仍然是终末期肺部疾病患者的唯一有效疗法,但存活率因闭塞性细支气管炎(OB)的发展而受到限制。趋化因子受体CXCR3及其两个配体CXCL9和CXCL10被确定为OB的重要介体。但是,CXCL9和CXCL10对OB发育的相对贡献以及这些趋化因子的调节机制尚未明确。在这项研究中,我们证明小鼠气管移植后,CXCL9和CXCL10以独特的模式上调。在这些实验中,CXCL9表达在移植后7天达到峰值,而CXCL10表达在移植后1天达到峰值,然后在移植后7天再次达到峰值。 CXCL10的表达在新型小鼠肺缺血模型中以及在肺移植后24小时取自人肺的支气管肺泡灌洗液中也上调。在进一步的分析中,我们发现移植后3小时CXCL10是来自供体组织,而不依赖于IFN-γ或STAT1,而移植后24小时CXCL10来自受体组织,并受IFN-γ和STAT1调节。移植后7天CXCL9和CXCL10的表达均受IFN-γ和STAT1的调节。最后,我们证明了受体中CXCR3的缺失减少了气道闭塞。但是,删除CXCL9或CXCL10不会影响气道闭塞。这些数据表明,在这种小鼠的闭塞性细支气管炎模型中,这些趋化因子在移植后受到不同的调节,并且单独删除任一趋化因子均不会影响气道闭塞的发展。
  • 【低氧性细支气管炎婴儿的鼻腔室内空气流量高。】 复制标题 收藏 收藏
    DOI:10.3389/fped.2019.00426 复制DOI
    作者列表:Franklin D,Babl FE,Gibbons K,Pham TMT,Hasan N,Schlapbach LJ,Oakley E,Craig S,Furyk J,Neutze J,Moloney S,Gavranich J,Shirkhedkar P,Kapoor V,Grew S,Fraser JF,Dalziel S,Schibler A,PARIS and PREDICT.
    BACKGROUND & AIMS: :Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. Trial registration: ACTRN12615001305516.
    背景与目标: 背景:毛细支气管炎是婴儿住院的最常见原因,三分之一由于低氧血症而需要氧疗。尚不清楚通过鼻腔高流量的室内空气处理低氧血症性毛细支气管炎婴儿的比例及其结果。目的和背景:在最近的一项多中心随机对照试验中,评估分配给高流量治疗的细支气管炎婴儿亚组鼻腔高流量在室内空气中的作用。患者和干预措施:如果饱和度≥85%,则首先使用室内空气高流量治疗分配给该试验高流量臂的婴儿。随后,如果氧饱和度未增加到≥92%,则添加氧并滴定FiO2以增加氧饱和度。在此计划的子研究中,将仅在整个住院期间使用高流量室内空气治疗的婴儿与接受标准氧气或高流量氧气的婴儿进行了比较。比较基线特征,住院时间和氧疗时间。研究结果:根据方案分析,仅在住院期间,630名婴儿中有64名(10%)使用高流量的室内空气开始留在室内。这些高流量室内空气的婴儿平均年龄较大,到医院就诊时出现中度低氧血症。他们的呼吸支持时间和住院时间也明显缩短。在多变量分析中无法确定入学前因素。结论:在一小部分低氧血症的毛细支气管炎婴儿中,仅在室内空气中高流量可逆转低氧血症。试用注册:ACTRN12615001305516。
  • 【对住院的病毒性毛细支气管炎婴儿进行高渗盐/肾上腺素治疗可减少住院时间:2年。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Tal G,Cesar K,Oron A,Houri S,Ballin A,Mandelberg A
    BACKGROUND & AIMS: BACKGROUND:We recently published preliminary evidence on the effectiveness of hypertonic saline in infants with viral bronchiolitis. OBJECTIVE:To further establish the efficacy of nebulized hypertonic saline in these infants. METHODS:In a continuing, second-year randomized, doubleblind controlled trial, an additional 41 infants (age 2.6 +/- 1 months) hospitalized with viral bronchiolitis were recruited during the winter of 2001-2002. The infants received inhalation of 1.5 mg epinephrine dissolved either in 4 ml normal (0.9%) saline (Group I, n=20) or 4 ml hypertonic (3%) saline (Group II, n=22). The therapy was repeated three times daily until discharge. Pooling our 2 years of experience (2000-2002), a total of 93 hospitalized infants with viral bronchiolitis were recruited; 45 were assigned to Group I and 48 to Group II. RESULTS:The clinical scores at baseline were 7.6 +/- 0.7 for Group I vs. 7.4 +/- 1.3 for Group II (P = NS). However, the clinical scores at days 1 and 2 after inhalation differed significantly between the two groups, invariably favoring Group II: 7 +/- 1 vs. 6.25 +/- 1.1 (P< 0.05), 6.45 +/- 1 vs. 5.35 +/- 1.35 (P< 0.05), respectively. Adding aerosolized 3% saline to 1.5 mg epinephrine reduced the hospitalization stay from 3.5 +/- 1.7 days in Group I to 2.6 +/- 1.4 in Group II (P< 0.05). The pooled data of both years revealed that adding 3% saline to the inhalation mixture decreased hospitalization stay from 3.6 +/- 1.6 to 2.8 +/- 1.3 days (P< 0.05). CONCLUSIONS:This second-year experience and our 2 year pooled data analysis strengthen the evidence that the combination of 3% saline/1.5 mg epinephrine benefits hospitalized infants with viral bronchiolitis.
    背景与目标: 背景:我们最近发表了有关高渗盐水对病毒性毛细支气管炎婴儿的有效性的初步证据。
    目的:进一步确定雾化高渗盐水对这些婴儿的疗效。
    方法:在一项持续的第二年随机双盲对照试验中,在2001-2002年冬季另外招募了41例病毒性毛细支气管炎住院婴儿(年龄2.6 /-1个月)。婴儿吸入1.5 mg肾上腺素,溶于4 ml生理盐水(0.9%)(I组,n = 20)或4 ml高渗(3%)盐水(II组,n = 22)。每天重复治疗3次直至出院。总结我们2年的经验(2000-2002年),共招募了93例住院治疗的病毒性毛细支气管炎婴儿。 I组分配了45个,II组分配了48个。
    结果:第一组的基线临床评分为7.6 /-0.7,第二组为7.4 /-1.3(P = NS)。然而,两组在吸入后第1天和第2天的临床评分差异显着,无一例外地倾向于第二组:7 /-1 vs. 6.25 /-1.1(P <0.05),6.45 /-1 vs. 5.35 /-1.35 (P <0.05)。在1.5 mg肾上腺素中添加3%气雾剂可使住院时间从I组的3.5 /-1.7天减少至II组的2.6 /-1.4(P <0.05)。两年的汇总数据显示,向吸入混合物中添加3%的盐水可使住院时间从3.6 /-1.6天减少到2.8 /-1.3天(P <0.05)。
    结论:这第二年的经验和我们两年的汇总数据分析,进一步证明了3%生理盐水/1.5 mg肾上腺素的组合有益于住院的病毒性毛细支气管炎婴儿。
  • 【广泛性干性龟头炎(BXO),累及前尿道和阴囊。】 复制标题 收藏 收藏
    DOI:10.1007/s11255-006-0100-8 复制DOI
    作者列表:Singh I,Ansari MS
    BACKGROUND & AIMS: :We describe an unusual case of balanitis xerotica obliterans (BXO) involving the entire anterior urethra and the scrotum that had presented as a palpable nodular scrotal mass with obstructive voiding symptoms in middle aged man. He was managed by a staged urethroplasty. We report the first such case of BXO involving the scrotum resulting in a nodular mass that has not been described and reported till date.
    背景与目标: :我们描述了一个不寻常的干性龟头炎(BXO),累及整个前尿道和阴囊,在中年人中表现为明显的结节性阴囊肿块,并伴有阻塞性排尿症状。他接受了分期的尿道成形术治疗。我们报告了第一例此类涉及阴囊的BXO病例,结节性肿块至今尚未得到描述和报道。
  • 12 Bronchiolitis and Bronchiolar Disorders. 复制标题 收藏 收藏

    【细支气管炎和支气管疾病。】 复制标题 收藏 收藏
    DOI:10.1055/s-0039-3402728 复制DOI
    作者列表:Ravaglia C,Poletti V
    BACKGROUND & AIMS: :Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung transplant allograft rejection, graft versus host disease in allogeneic stem cell recipients, neuroendocrine cell hyperplasia, infections, drug toxicity (e.g., penicillamine, busulfan), inhalation injury (e.g., cigarette smoke, nylon flock, mineral dusts, hard metals, Sauropus androgynous); idiopathic, common variable immunodeficiency disorder, and a host of other disorders or insults. The spectrum of bronchiolar disorders is wide, ranging from asymptomatic to fatal obliterative bronchiolitis. In this review, we discuss the salient clinical, radiographic, and histological features of these diverse bronchiolar disorders, and discuss a management approach.
    背景与目标: :细支气管是非软骨小气道,其内径为2 mm或更小,位于大约第八代纯气导气道(膜性细支气管),末端细支气管(无肺泡的最小气道)和呼吸性细支气管(与细支气管直接连通)肺泡管,直径在0.5 mm或更小范围内。支气管损伤,炎症和纤维化可能发生在多种疾病中,包括结缔组织疾病,炎性肠疾病,同种异体干细胞受体的肺移植排斥,同种异体干细胞接受者的移植物抗宿主病,神经内分泌细胞增生,感染,药物毒性(例如青霉素,白消安) ),吸入性伤害(例如,香烟烟雾,尼龙绒,矿物粉尘,硬质金属,蜥脚类雌雄同体);特发性,常见的可变免疫缺陷疾病,以及许多其他疾病或侮辱。细支气管疾病的范围很广,从无症状到致命的闭塞性细支气管炎。在这篇综述中,我们讨论了这些不同的细支气管疾病的显着临床,影像学和组织学特征,并讨论了一种治疗方法。
  • 【在患有闭塞性细支气管炎的类风湿关节炎患者中成功进行肺移植。】 复制标题 收藏 收藏
    DOI:10.1080/03009742.2020.1727006 复制DOI
    作者列表:Bozovic G,Larsson H,Wuttge DM,Håkansson M,Hansson L,Ingemansson R,Brunnström H,Andréasson K
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【成人闭塞性细支气管炎的计算机断层扫描。】 复制标题 收藏 收藏
    DOI:10.1016/s0009-9260(05)80142-4 复制DOI
    作者列表:Sweatman MC,Millar AB,Strickland B,Turner-Warwick M
    BACKGROUND & AIMS: :Fifteen adults with obliterative bronchiolitis (OB) were investigated with computed tomography (CT). CT was considered to be abnormal in 13/15 patients (87%) showing widespread areas of increased attenuation of a patchy nature and variable proportion. CT revealed more extensive changes than the chest radiograph or bronchogram. It is a non-invasive well-tolerated and easily repeatable technique and may have an important role in the radiological evaluation of adults with OB.
    背景与目标: :对十五例成人闭塞性毛细支气管炎(OB)进行了计算机断层扫描(CT)研究。在13/15例患者中,CT被认为是异常的(87%),显示出斑块性质和比例可变的衰减增加的广泛区域。 CT显示比胸部X光片或支气管造影更广泛的变化。它是一种无创且耐受性强且易于重复的技术,在成人OB的放射学评估中可能具有重要作用。
  • 【患有闭塞性细支气管炎综合征的肺移植受者的革兰氏阴性感染和支气管扩张。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1322619 复制DOI
    作者列表:Hayes D Jr,Weiland A,Kirkby S,Galantowicz M,McConnell PI,Tobias JD
    BACKGROUND & AIMS: BACKGROUND:Bronchiolitis obliterans syndrome (BOS) after lung transplantation manifests as a gradual decline in forced expiratory volume in 1 second. Bronchiectasis is often seen but occurs at variable rates with the underlying pathogenesis being unclear. OBJECTIVE:We completed a study to determine whether lower airway infection with gram-negative bacilli was associated with the development of bronchiectasis in lung transplant recipients with BOS. METHODS:A retrospective review of 17 lung transplant recipients (age: 28 ± 7 years, range: 13 to 40 years) in a patient population transplanted for cystic fibrosis (CF) 82% (14/17), bronchiolitis obliterans 12% (2/17), and sarcoidosis 6% (1/17) was completed. Each patient completed pulmonary function testing and underwent annual computed tomographic imaging of the chest for surveillance posttransplant at a single transplant center. RESULTS:Bronchiectasis was present in 70% (12/17) of patients whereas 94% (16/17) of patients had varying severity of BOS: 1 (n = 7), 2 (n = 3), and 3 (n = 6). All 12 patients with bronchiectasis had an allograft gram-negative rod infection and 92% (11/12) of them had BOS. CONCLUSIONS:The presence of bronchiectasis in lung transplant recipients with BOS was associated with a gram-negative bacterial airway infection of the allograft in a small cohort of predominately lung transplant recipients with CF.
    背景与目标: 背景:肺移植后闭塞性细支气管炎综合征(BOS)表现为强迫呼气量在1秒内逐渐下降。支气管扩张常见,但发生率可变,其潜在发病机制尚不清楚。
    目的:我们完成了一项研究,以确定在接受BOS的肺移植受者中,革兰氏阴性细菌的下呼吸道感染是否与支气管扩张有关。
    方法:回顾性分析17例肺移植受者(年龄:28±7岁,范围:13至40岁),该患者群体因囊性纤维化(CF)移植了82%(14/17),闭塞性细支气管炎12%(2 / 17),结节病6%(1/17)完成了。每位患者均完成了肺功能测试,并在单个移植中心接受了每年的胸部X线计算机断层扫描成像,以监测移植后的情况。
    结果:70%(12/17)的患者存在支气管扩张,而94%(16/17)的BOS严重程度各不相同:1(n = 7),2(n = 3)和3(n = 6)。所有12例支气管扩张患者均具有同种异体革兰氏阴性杆感染,其中92%(11/12)患有BOS。
    结论:BOS肺移植受者中支气管扩张的存在与同种异体移植物的革兰氏阴性细菌气道感染有关,这是一小部分以CF为主的肺移植受者。

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