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Spirometric Changes during Pregnancy in Cystic Fibrosis Patients 认领
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作者 Clay Wu Gloria Wu +2 位作者 Lynn Fukushima Adupa P. Rao Ahmet Baydur 《呼吸病期刊(英文)》 2021年第1期19-25,共7页
<b>Rationale:</b><span style="font-family:""><span style="font-family:Verdana;"> Survival and longevity in patients with cystic fibrosis (CF) have improved with new tre... <b>Rationale:</b><span style="font-family:""><span style="font-family:Verdana;"> Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p < 0.043 and 9.3%, p < 0.013, respectively). No statistically significant differences amongst spirometric values were observed, however, when adjusted for BMI and age over the entire time course. FEV1 and FVC recovered to baseline six months and one year following delivery, respectively. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution o 展开更多
关键词 Pulmonary Cystic Fibrosis Pregnant Women SPIROMETRY Respiratory Physiological Phenomena
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CT双输入模型低剂量容积灌注成像对肺孤立性炎性假瘤的诊断价值 认领
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作者 郝永 颜林军 +1 位作者 刘如焕 郭成伟 《临床误诊误治》 2021年第1期71-76,共6页
目的探讨CT双输入模型低剂量容积灌注成像对肺孤立性炎性假瘤的诊断价值。方法选取经手术或穿刺病理检查证实的肺孤立性、直径范围2.0~5.0 cm炎性假瘤22例和周围型肺癌38例,均行CT双输入模型低剂量容积灌注成像,分析肺孤立性炎性假瘤和... 目的探讨CT双输入模型低剂量容积灌注成像对肺孤立性炎性假瘤的诊断价值。方法选取经手术或穿刺病理检查证实的肺孤立性、直径范围2.0~5.0 cm炎性假瘤22例和周围型肺癌38例,均行CT双输入模型低剂量容积灌注成像,分析肺孤立性炎性假瘤和周围型肺癌血供情况,比较二者强化达峰时间(TTP)和灌注参数肺动脉血流量(PF)、支气管动脉血流量(BF)、灌注指数(PI),并应用受试者工作特征(ROC)曲线分析TTP和灌注参数鉴别诊断肺孤立性炎性假瘤与周围型肺癌的价值。结果肺孤立性炎性假瘤由肺动脉和支气管动脉较均衡供血,PF(50.71±19.02)ml/min,BF(42.13±21.27)ml/min,二者比较差异无统计学意义(P>0.05);PI(44.04±10.49)%。周围型肺癌由肺动脉和支气管动脉双重供血,PF(68.67±34.75)ml/min高于BF(48.26±24.31)ml/min,差异有统计学意义(P<0.05);PI(54.50±15.74)%。肺孤立性炎性假瘤患者TTP短于周围型肺癌患者,PF和PI低于周围型肺癌患者,差异有统计学意义(P<0.05或P<0.01)。TTP鉴别诊断肺孤立性炎性假瘤与周围型肺癌的曲线下面积(AUC)为0.93,诊断价值较高,当TTP 18.06 s作为预测肺良恶性结节的临界值时,敏感度为97.6%,特异度为92.3%;PF和PI鉴别诊断肺孤立性炎性假瘤与周围型肺癌的AUC分别为0.71和0.70,诊断价值中等。结论CT双输入模型低剂量容积灌注成像TTP有助于提高肺孤立性炎性假瘤与周围型肺癌的鉴别诊断价值。 展开更多
关键词 浆细胞肉芽肿 灌注成像 强化达峰时间 肺动脉灌注量 支气管动脉灌注量 灌注指数
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Right-heart contrast echocardiography reveals missed patent ductus arteriosus in a postpartum woman with pulmonary embolism: A case report 认领
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作者 Jin-Ling Chen Dan-E Mei +1 位作者 Cai-Gui Yu Zhi-Yu Zhao 《世界临床病例杂志》 SCIE 2021年第3期639-643,共5页
BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and in... BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and interpreted logically,RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.CASE SUMMARY A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress.Two years prior,she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography.While the latter showed no sign of pulmonary artery embolism,the former showed pulmonary artery hypertension,moderate insufficiency,and mild stenosis of the aortic valve.RHCE showed microbubbles appearing in the left ventricle,slightly delayed after rightheart filling with microbubbles;no microbubbles appeared in the left atrium and microbubbles’appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles.Conventional echocardiography was re-performed,and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles.The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.CONCLUSION RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus. 展开更多
关键词 Right heart contrast echocardiography Computed tomography angiography Patent ductus arteriosus Pulmonary embolism Pulmonary artery hypertension Case report
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Acute Respiratory Distress Syndrome Following Anaphylactic Shock—“A Deadly Duel”—Case Report and Literature Review 认领
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作者 Ungamandadige P. M. Fernando Malmee P. Dharmawardhane +3 位作者 Nishanthan Subramaniam Srisothinathan Nimalan Kukulagoda U. I. S. Gunathilake Baththirange M. Munasinghe 《麻醉学期刊(英文)》 2021年第2期33-38,共6页
A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms... A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms of anaphylaxis or interestingly, the treatment itself;adrenaline, majority of the latter being related to administration of supra-therapeutic doses. According to our clinical experience, the possibility of ARDS should be considered in <span>patients who develop unexplainable hypoxaemia following anaphylactic</span><span> shock. </span><span>This case report discusses the pathophysiology of ARDS both in anaphylaxis and following epinephrine treatment and key aspects of management of ARDS with </span><span>a </span><span>main focus on the role of high flow oxygen, diuretics and anxiolytics. </span><span>T</span><span>he </span><span>importance of avoiding drug administration errors is also highlighted.</span> 展开更多
关键词 Acute Respiratory Distress Syndrome (ARDS) ANAPHYLAXIS Epinephrine/Adrenaline Pulmonary Edema
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慢性血栓栓塞性肺动脉高压患者SPECT/CT肺灌注体积及视觉评分与血流动力学参数的相关性研究 认领
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作者 侯鹏 林巳焱 +10 位作者 王敏 陈芃灏 易婧薇 李宇翔 黄大勇 林杰龙 林峰丞 郭文亮 解承鑫 洪城 王欣璐 《中华核医学与分子影像杂志》 CAS 北大核心 2021年第2期82-87,共6页
目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者肺灌注SPECT/CT显像肺灌注体积及视觉评分与右心导管血流动力学参数的相关性。方法回顾性分析2015年3月至2019年7月间广州医科大学附属第一医院51例连续CTEPH患者的资料,其中男17例,女34例... 目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者肺灌注SPECT/CT显像肺灌注体积及视觉评分与右心导管血流动力学参数的相关性。方法回顾性分析2015年3月至2019年7月间广州医科大学附属第一医院51例连续CTEPH患者的资料,其中男17例,女34例,年龄(59±12)岁。所有患者均行肺灌注SPECT/CT显像及右心导管检查。应用不同百分比阈值(15%~85%)分割法计算肺灌注体积。参照Begic三分法对肺灌注SPECT/CT图像进行视觉评分。收集右心导管检查血液动力学参数[肺动脉收缩压(PASP)、舒张压(PADP)及平均压(mPAP)、肺小动脉楔压(PAWP)、肺血管阻力(PVR)、心输出量(CO)、心指数(CI)等],并采用Spearman相关分析评价肺灌注体积、视觉评分和右心导管血流动力学参数间的相关性。结果在30%~70%阈值下,双肺灌注体积与mPAP间存在相关性(rs值:-0.414~-0.302,均P<0.05)。其中40%和45%阈值下双肺灌注体积与mPAP间呈中等负相关(rs值:-0.414和-0.412,均P<0.05)。40%阈值下双肺灌注体积与PASP、PADP呈中等负相关(rs值:-0.402和-0.440,均P<0.05),与PVR呈弱的负相关(rs=-0.352,P<0.05)。视觉评分与PADP间存在弱的正相关(rs=0.311,P<0.05),余右心导管参数与视觉评分间无相关性(rs值:-0.201~0.275,均P>0.05)。结论肺灌注SPECT/CT显像中基于阈值分割的肺灌注体积参数可较准确反映肺动脉压力等血流动力学状态,可用于评估CTEPH患者病情严重程度。 展开更多
关键词 高血压 肺性 肺栓塞 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 99m锝聚集白蛋白
Imaging findings of primary pulmonary synovial sarcoma with secondary distant metastases:A case report 认领
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作者 Rui Li Xin Teng +2 位作者 Wei-Hong Han Yan Li Qing-Wei Liu 《世界临床病例杂志》 SCIE 2021年第8期1893-1900,共8页
BACKGROUND Synovial sarcoma(SS)accounting for 6%-10%of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs.Primary pulmonary SS(PPSS)is rare and has a poor prognosis.Case... BACKGROUND Synovial sarcoma(SS)accounting for 6%-10%of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs.Primary pulmonary SS(PPSS)is rare and has a poor prognosis.Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports.We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology,and shared valuable information on PPSS.CASE SUMMARY A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung.The results of a hemogram,erythrocyte sedimentation rate(ESR)and tumor markers were all within the normal range,tuberculin skin test(5 TU PPD)was negative(-).Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe.Thoracoscopic-assisted wedge resection of the right upper lobe of the lung,right upper lobe resection and lymph node dissection were performed.Nine months after surgery,ultrasound examination showed multiple metastases on the chest wall and kidney.CONCLUSION PPSS is a rare malignant lung tumor with strong invasiveness,early distant metastasis and poor prognosis.There are very few imaging reports.PPSS is often manifested as irregular tumor and calcification,and the metastases have extremely low echo on ultrasonography.Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement,manifested as“fast forward and fast regression”. 展开更多
关键词 Primary pulmonary synovial sarcoma Imaging findings Contrast-enhanced ultrasound Secondary distant metastases Computed tomography Case report
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肺动脉高压三尖瓣反流压差与血脑钠肽前体及并发心力衰竭的关系 认领
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作者 高蓉 于玮慧 +1 位作者 凌卫明 焉高亮 《安徽医药》 CAS 2021年第2期349-352,共4页
目的探讨肺动脉高压三尖瓣反流压差与血清脑钠肽前体(PRO-BNP)及并发心力衰竭的关系。方法选取2016年2月至2018年11月无锡市精神卫生中心收治的肺动脉高压病人87例(疾病组),另选取同期体检健康者79例(健康组),均采用多普勒超声心动图检... 目的探讨肺动脉高压三尖瓣反流压差与血清脑钠肽前体(PRO-BNP)及并发心力衰竭的关系。方法选取2016年2月至2018年11月无锡市精神卫生中心收治的肺动脉高压病人87例(疾病组),另选取同期体检健康者79例(健康组),均采用多普勒超声心动图检测三尖瓣反流压差及采用电化学发光法测定血清PRO-BNP水平,分析三尖瓣反流压差与血清PRO-BNP水平的关系;另根据病人是否并发心力衰竭情况将疾病组分为心衰组与无心衰组,对比两组三尖瓣反流压差、血清PRO-BNP水平,并采用logistic回归分析法分析其与心衰的关系。结果疾病组三尖瓣反流压差及血清PRO-BNP水平分别为(52.17±6.58)mmHg、(619.72±113.47)ng/L,健康组分别为(21.09±4.51)mmHg、(194.37±41.26)ng/L,疾病组均高于健康组,差异有统计学意义(P<0.05);经Pearson相关性分析,疾病组三尖瓣反流压差与血清PRO-BNP水平呈显著正相关(r=0.643,P<0.05);87例肺动脉高压病人中共有26例伴发心力衰竭,心力衰竭并发率为29.89%(26/57);心衰组三尖瓣反流压差及血清PRO-BNP水平分别为(60.15±6.23)mmHg、(698.79±115.08)ng/L,无心衰组分别为(48.77±5.87)mmHg、(586.02±109.21)ng/L,心衰组均高于无心衰组,差异有统计学意义(P<0.05);经logistic回归分析法分析,三尖瓣反流压差>50 mmHg及血清PRO-BNP>600 ng/L均是肺动脉高压病人伴发心力衰竭的危险因素(OR=3.146、2.737,P<0.05)。结论肺动脉高压病人三尖瓣反流压差明显增大,血清PRO-BNP水平明显升高,此二者呈显著正相关,且三尖瓣反流压差可作为预测心衰的一项重要指标。 展开更多
关键词 高血压 肺性 三尖瓣反流压差 脑钠肽前体 心力衰竭
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Acute cor pulmonale in patients with acute respiratory distress syndrome:A comprehensive review 认领
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作者 Kay Choong See 《世界重症医学杂志》 2021年第2期35-42,共8页
Acute respiratory distress syndrome(ARDS)-related acute cor pulmonale(ACP)is found in 8%-50%of all patients with ARDS,and is associated with adverse hemodynamic and survival outcomes.ARDS-related ACP is an echocardiog... Acute respiratory distress syndrome(ARDS)-related acute cor pulmonale(ACP)is found in 8%-50%of all patients with ARDS,and is associated with adverse hemodynamic and survival outcomes.ARDS-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia,which connote simultaneous diastolic(volume)and systolic(pressure)overload respectively.Risk factors include pneumonia,hypercapnia,hypoxemia,high airway pressures and concomitant pulmonary disease.Current evidence suggests that ARDS-related ACP is amenable to multimodal treatments including ventilator adjustment(aiming for arterial partial pressure of carbon dioxide<60 mmHg,plateau pressure<27 cmH2O,driving pressure<17 cmH2O),prone positioning,fluid balance optimization and pharmacotherapy.Further research is required to elucidate the optimal frequency and duration of routine bedside echocardiography screening for ARDS-related ACP,to more clearly delineate the diagnostic role of transthoracic echocardiography relative to transesophageal echocardiography,and to validate current and novel therapies. 展开更多
关键词 CORONAVIRUS Critical care ECHOCARDIOGRAPHY HYPERTENSION PULMONARY Respiratory distress syndrome ADULT Ventricular dysfunction RIGHT
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耐多药/广泛耐药肺结核并发2型糖尿病患者耐药特征分析 认领
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作者 胡卫华 金龙 初乃惠 《中国防痨杂志》 CAS 2021年第1期26-30,共5页
目的了解并分析耐多药/广泛耐药肺结核并发2型糖尿病患者的耐药特征。方法搜集黑龙江省传染病防治院耐药病区2018年6月至2020年6月收治的经结核分枝杆菌培养及药物敏感性试验(简称"药敏试验")确诊的耐多药/广泛耐药肺结核患者... 目的了解并分析耐多药/广泛耐药肺结核并发2型糖尿病患者的耐药特征。方法搜集黑龙江省传染病防治院耐药病区2018年6月至2020年6月收治的经结核分枝杆菌培养及药物敏感性试验(简称"药敏试验")确诊的耐多药/广泛耐药肺结核患者233例,其中并发2型糖尿病者84例(简称"并发糖尿病组"),未并发糖尿病者149例(简称"未并发糖尿病组")。对两组患者的肺结核初复治情况、所耐药品数量、耐药谱进行分析,采用SPSS 18.0软件进行统计学分析,组间计数资料"构成比或率"的比较采用χ^(2)检验,以P<0.05为差异有统计学意义。结果并发糖尿病组初治肺结核26例,占比为30.95%(26/84);未并发糖尿病组初治肺结核16例,占比为10.74%(16/149),两组比较差异有统计学意义(χ^(2)=14.854,P<0.01)。在所耐药品数量上,并发糖尿病组与未并发糖尿病组比较,耐异烟肼与利福平的构成比分别为10.71%(9/84)、7.39%(11/149),耐3种药品的构成比分别为28.57%(24/84)、24.16%(36/149),耐4种药品的构成比分别为19.05%(16/84)、24.83%(37/149),耐5种药品的构成比分别为17.86%(15/84)、19.46%(29/149),耐6种及以上药品的构成比分别为23.81%(20/84)、24.16%(36/149);两组间差异均无统计学意义(χ^(2)值分别为0.759、0.546、1.023、2.063、0.882,P值分别为0.383、0.460、0.312、0.151、0.348)。在耐药谱方面,并发糖尿病组与未并发糖尿病组比较,异烟肼与利福平耐药的比率分别为10.71%(9/84)、7.40%(11/149),氟喹诺酮类药品耐药的比率分别为29.76%(25/84)、29.53%(44/149),抗结核药品二线注射剂耐药的比率分别为4.76%(4/84)、6.71%(10/149),异烟肼与利福平+氟喹诺酮类药品+抗结核药品二线注射剂同时耐药的比率分别为8.33%(7/84)、13.42%(20/149),两组间差异均无统计学意义(χ^(2)值分别为0.760、0.009、0.361、1.358,P值分别为0.383、0.926、0.548、0.244)。结论耐多药/广泛耐药肺结核并发2型糖尿病患� 展开更多
关键词 结核 结核 抗多种药物性 糖尿病 2型 共病现象 耐药特征 数据说明 统计
肺超声评分预测新生儿呼吸窘迫综合征合并支气管肺发育不良的临床价值 认领
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作者 卫晶丽 李敏 +2 位作者 李娜 何欢 刘百灵 《临床超声医学杂志》 2021年第1期45-48,共4页
目的探讨肺超声评分预测新生儿发生呼吸窘迫综合征(NRDS)合并支气管肺发育不良(BPD)的临床价值。方法选取我院收治的158例NRDS患儿,均行肺部超声检查,计算肺超声评分,并收集患儿一般临床资料。依据是否合并BPD将其分为BPD组71例和非BPD... 目的探讨肺超声评分预测新生儿发生呼吸窘迫综合征(NRDS)合并支气管肺发育不良(BPD)的临床价值。方法选取我院收治的158例NRDS患儿,均行肺部超声检查,计算肺超声评分,并收集患儿一般临床资料。依据是否合并BPD将其分为BPD组71例和非BPD组87例,比较两组患儿肺超声评分和临床资料的差异。绘制受试者工作特征(ROC)曲线分析肺超声评分预测NRDS合并BPD的诊断效能,探讨肺超声评分与不同治疗方式间的相关性。结果两组患儿在胎龄、出生体质量、住院时间、持续气道正压呼吸时间、机械通气时间、Apgar评分比较,差异均有统计学意义(均P<0.05);在性别、双胎数、常规氧疗时间、宫内感染及新生儿肺炎发生率方面比较,差异均无统计学意义。BPD组肺超声评分为(39.15±4.26)分,高于非BPD组(26.23±5.89)分,差异有统计学意义(P<0.001)。肺超声评分预测新生儿NRDS合并BPD的曲线下面积为0.832,以37分为截断值,其诊断敏感性78.0%,特异性89.0%,阳性预测值86.7%,阴性预测值74.5%。患儿肺超声评分与采用的呼吸治疗方式呈正相关(r=0.47,P<0.05)。结论肺超声评分有助于预测NRDS患儿是否合并BPD,为其进行合理的诊断治疗提供较可靠的影像依据。 展开更多
关键词 超声检查 新生儿 呼吸窘迫综合征 支气管肺发育不良
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糖尿病住院患者并发肺结核的临床特征分析 认领
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作者 曾剑锋 杨敏 +4 位作者 唐芳 朱惠敏 陈涛 邓国防 张培泽 《中国防痨杂志》 CAS 2021年第1期31-35,共5页
目的了解糖尿病(包括1型、2型糖尿病患者)住院患者并发肺结核的发病率,以及对结核病活动状态的相关性进行分析。方法回顾性分析2018年1月至2019年12月我院患糖尿病住院的2648例患者常规胸部影像学检查资料及临床资料,计算糖尿病患者并... 目的了解糖尿病(包括1型、2型糖尿病患者)住院患者并发肺结核的发病率,以及对结核病活动状态的相关性进行分析。方法回顾性分析2018年1月至2019年12月我院患糖尿病住院的2648例患者常规胸部影像学检查资料及临床资料,计算糖尿病患者并发肺结核的发病率,比较活动性与非活动性肺结核患者的基本情况,以及糖化血红蛋白(HbA1c)水平、糖尿病治疗情况。结果 2648例糖尿病患者中,2585例患者无肺结核证据,占97.62%(2585/2648);31例患者并发活动性肺结核,占1.17%(31/2648);32例患者并发非活动性肺结核,占1.21%(32/2648);活动性、非活动性肺结核均以男性为主,分别占90.32%(28/31)、84.38%(27/32);活动性肺结核患者的平均年龄为(51.16±13.06)岁,非活动性肺结核患者的平均年龄为(61.78±12.88)岁,二组比较差异有统计学意义(t=-3.236,P=0.002);活动性肺结核患者的HbA1c水平检测平均为(9.18±2.85)%,非活动性肺结核患者平均为(8.05±1.69)%,二组比较差异无统计学意义(t=1.884,P=0.070)。结论糖尿病住院患者并发肺结核的比例高,以男性多见,应重视糖尿病住院患者的肺结核筛查和随访;血糖控制水平与糖尿病患者肺结核活动状态的相关性尚需进一步证实。 展开更多
关键词 糖尿病 结核 共病现象 疾病特征 发病率 数据说明 统计 回顾性研究
利用宏基因组测序确诊肺结核及非结核分枝杆菌肺病各一例报道并文献复习 认领
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作者 马潇枭 高宝安 +1 位作者 牟干 刘玲 《实用心脑肺血管病杂志》 2021年第1期122-127,共6页
结核分枝杆菌及非结核分枝杆菌(NTM)同属分枝杆菌属,致病机制及临床表现类似,传统病原微生物技术因检测周期长、敏感度低、阳性率低等局限性常难以对菌种进行精准鉴别,导致临床误诊、漏诊及治疗延误。近年来,基于二代测序的宏基因组测序... 结核分枝杆菌及非结核分枝杆菌(NTM)同属分枝杆菌属,致病机制及临床表现类似,传统病原微生物技术因检测周期长、敏感度低、阳性率低等局限性常难以对菌种进行精准鉴别,导致临床误诊、漏诊及治疗延误。近年来,基于二代测序的宏基因组测序(mNGS)以其高通量、覆盖度广、速度快、灵敏度高、不依赖传统分离培养、无需特异性引物等优点在病原微生物鉴定中展现了独特的优势,同时也成为一种鉴定结核分枝杆菌复合群及NTM的重要补充手段。本文报道宜昌市中心人民医院借助mNGS确诊的1例结核分枝杆菌及NTM混合感染引起的肺结核患者及1例NTM感染引起的NTM肺病患者的诊疗经过,并进行相关文献复习,以提高临床对这两种疾病的认识及鉴别诊断水平,同时提升临床工作者对mNGS在复杂感染性疾病病原微生物鉴定中应用的认识。 展开更多
关键词 结核 结核分枝杆菌 非结核分枝杆菌 宏基因组 病例报告
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Chronic myelomonocytic leukemia-associated pulmonary alveolar proteinosis:A case report and review of literature 认领
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作者 Can Chen Xi-Lian Huang +2 位作者 Da-Quan Gao Yi-Wei Li Shen-Xian Qian 《世界临床病例杂志》 SCIE 2021年第5期1156-1167,共12页
BACKGROUND Pulmonary alveolar proteinosis(PAP)is a rare condition that can cause progressive symptoms including dyspnea,cough and respiratory insufficiency.Secondary PAP is generally associated with hematological mali... BACKGROUND Pulmonary alveolar proteinosis(PAP)is a rare condition that can cause progressive symptoms including dyspnea,cough and respiratory insufficiency.Secondary PAP is generally associated with hematological malignancies including chronic myelomonocytic leukemia(CMML).To the best of our knowledge,this is the first reported case of PAP occurring secondary to CMML.CASE SUMMARY We report the case of a 63-year-old male who presented with a recurrent cough and gradually progressive dyspnea in the absence of fever.Based upon clinical symptoms,computed tomography findings,bone marrow aspiration,flow cytometry studies and cytogenetic analyses,the patient was diagnosed with PAP secondary to CMML.He underwent whole lung lavage in March 2016 to alleviate his dyspnea,after which he began combined chemotherapeutic treatment with decitabine and cytarabine.The patient died in January 2020 as a consequence of severe pulmonary infection.CONCLUSION This case offers insight regarding the mechanistic basis for PAP secondary to CMML and highlights potential risk factors. 展开更多
关键词 Pulmonary alveolar proteinosis Chronic myelomonocytic leukemia DIAGNOSIS TREATMENT PROGNOSIS Case report
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Sericin microparticles enveloped with metal-organic networks as a pulmonary targeting delivery system for intra-tracheally treating metastatic lung cancer 认领
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作者 Jia Liu Yan Deng +6 位作者 Daan Fu Ye Yuan Qilin Li Lin Shi Guobin Wang Zheng Wang Lin Wang 《生物活性材料》 SCIE 2021年第1期273-284,共12页
Chemotherapy is one of the major approaches for the treatment of metastatic lung cancer.However,systemic chemotherapy is limited by poor therapeutic efficiency and severe toxic side effects,due to the extremely low de... Chemotherapy is one of the major approaches for the treatment of metastatic lung cancer.However,systemic chemotherapy is limited by poor therapeutic efficiency and severe toxic side effects,due to the extremely low delivery efficacy and non-specificity of anticancer drugs.Herein,we report a sericin microparticles enveloped with metal-organic networks as a pulmonary delivery system for treating lung metastasis of breast cancer in an animal model.The sericin microparticles(SMPs)were prepared using water in oil(w/o)emulsification method.After doxorubicin(DOX)loading,tannic acid(TA)/ferric irons(Fe3+)based metal organic networks(MON)were coated on the particles to obtain DOX-loaded microparticles(DOX@SMPs-MON).The SMPs-MON with good biocompatibility could effectively encapsulate DOX and sustainably unload cargos in a pH-dependent manner.The DOX-loaded microparticles could be uptaken by 4T1 cells,and effectively kill the cancer cells.In vivo,DOX@SMPs-MON was deposited in the lungs and remained for over 5 days after pulmonary administration.In contrast to conventional DOX treatment that did not show significantly inhibitory effects on lung metastatic tumor,DOX@SMPs-MON markedly decreased the number and size of metastatic nodules in lungs,and the lung weight and appearance were similar to those of healthy mice.In summary,the sericin microparticles with MON wrapping might be a promising pulmonary delivery system for treating lung metastatic cancer. 展开更多
关键词 Sericin microparticles Pulmonary delivery system Metal organic networks DOXORUBICIN Metastatic lung cancer
2014-2018年杭州市肺结核患者的耐药情况及其影响因素分析 认领
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作者 范大鹏 岳永宁 +4 位作者 张艳 陈园园 鲍志坚 朱敏 蔡龙 《中国防痨杂志》 CAS 2021年第1期72-79,共8页
目的分析2014—2018年杭州市肺结核患者对一线抗结核药品的耐药特征及其影响因素,为杭州市防治耐药结核病提供科学依据。方法收集2014—2018年浙江省中西医结合医院结核病诊疗中心就诊的杭州市全部常住人口中的活动性肺结核患者,共12 85... 目的分析2014—2018年杭州市肺结核患者对一线抗结核药品的耐药特征及其影响因素,为杭州市防治耐药结核病提供科学依据。方法收集2014—2018年浙江省中西医结合医院结核病诊疗中心就诊的杭州市全部常住人口中的活动性肺结核患者,共12 851例,纳入结核分枝杆菌培养阳性且对一线抗结核药品药物敏感性试验(简称"药敏试验")信息全面的3807例患者。通过国家结核病信息管理系统和结核病实验室信息系统(laboratory information system,LIS)收集所有患者的性别、年龄、户籍、职业、治疗分类(初治和复治)、肺部有无空洞、患者来源及现居住地、结核分枝杆菌培养及药敏试验结果。运用单因素和多因素非条件logistic回归分析的方法研究杭州市耐药肺结核患者耐药特征及其影响因素。结果 3807株菌株中,907株(23.82%)对4种一线抗结核药品耐药,耐药顺位依次为异烟肼(18.57%,707例)、链霉素(18.41%,701例)、利福平(12.03%,458例)、乙胺丁醇(6.41%,244例);所有患者的耐多药率和多耐药率分别为11.11%(423/3807)和4.44%(169/3807)。2014—2018年不同年份肺结核患者耐药率分别为22.87%(185/809)、25.55%(198/775)、25.60%(181/707)、23.04%(188/816)、22.14%(155/700),差异无统计学意义(χ_(趋势)^(2)=4.275,P=0.370);耐多药率分别为11.12%(90/809)、13.16%(102/775)、11.88%(84/707)、11.40%(93/816)、7.71%(54/700),差异有统计学意义(χ_(趋势)^(2)=11.276,P=0.024)。多因素条件logistic回归分析显示,相对于男性和初治患者,女性和复治肺结核患者是发生耐药的危险因素[OR(95%CI)=1.308(1.111~1.540);OR(95%CI)=4.281(3.498~5.238)];相对于下沙区,居住在其他6个区的结核病患者发生耐药的可能性较大,萧山区和富阳区的风险更高[OR(95%CI)=4.400(2.559~7.565);OR(95%CI)=3.803(2.037~7.098)]。相对于男性、<40岁、初治患者,女性、≥40岁、复治的肺结核患者是产生耐多药的危险因素[OR(95%CI 展开更多
关键词 结核 结核 抗多种药物性 数据说明 统计 因素分析 统计学 小地区分析
浙江省常山县“移动结核门诊”服务在结核病防控中的实施效果评价 认领
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作者 刘文峰 周琳 +3 位作者 徐天亮 易槐明 王勇 王谦信 《中国防痨杂志》 CAS 2021年第1期100-102,共3页
通过描述性研究,对比分析"移动结核门诊"服务前4年(2013—2016年)(简称"实施前")和后3年(2017—2019年)(简称"实施后")常山县患者发现和治疗管理等指标。实施前后计数资料的比较采用χ^(2)检验,以P<0... 通过描述性研究,对比分析"移动结核门诊"服务前4年(2013—2016年)(简称"实施前")和后3年(2017—2019年)(简称"实施后")常山县患者发现和治疗管理等指标。实施前后计数资料的比较采用χ^(2)检验,以P<0.05为差异有统计学意义。结果显示实施后共服务患者146例、263例次。结核病患者登记发病率由实施前的118.31/10万(1144/966 944)下降至实施后的99.25/10万(746/751 611),差异有统计学意义(χ^(2)=13.54,P=0.000);病原学阳性患者治愈率由实施前的87.47%(363/415)上升到实施后的94.12%(336/357),差异有统计学意义(χ^(2)=9.91,P=0.002);病原学阴性患者完成疗程率由实施前的88.89%(648/729)上升到实施后的93.83%(365/389),差异有统计学意义(χ^(2)=7.28,P=0.007);曾经中断治疗结核病患者的治疗成功率由实施前的52.14%(122/234)上升到实施后的93.15%(136/146),差异有统计学意义(χ^(2)=69.38,P=0.000)。结论 "移动结核门诊"服务实施后提高了常山县结核病患者管理的质量,为进一步改善结核病防治管理模式提供了依据和参考。 展开更多
关键词 结核 移动结核门诊 门诊医疗 卫生服务管理 对比研究 数据说明 统计
微小RNA-194-5p与cullin4A在肺结核病人中的表达及意义 认领
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作者 闫书娜 马腾 +2 位作者 李国锋 李金洲 曾俊风 《安徽医药》 CAS 2021年第3期489-493,共5页
目的探讨微小RNA-194-5p(miR-194-5p)与泛素连接酶cullin4A(CUL4A)在肺结核病人中的表达及其意义。方法选取2016年12月至2018年12月中国平煤神马集团职业病防治院结核病病人为研究对象,确诊为肺结核病人50例作为肺结核组,潜伏结核感染病... 目的探讨微小RNA-194-5p(miR-194-5p)与泛素连接酶cullin4A(CUL4A)在肺结核病人中的表达及其意义。方法选取2016年12月至2018年12月中国平煤神马集团职业病防治院结核病病人为研究对象,确诊为肺结核病人50例作为肺结核组,潜伏结核感染病人50例作为潜伏结核感染组,同期该院体检健康者50例作为对照组。实时荧光定量逆转录聚合酶链反应(qRT-PCR)检测miR-194-5p、CUL4A mRNA、鸟苷酸结合蛋白5(GBP5)mRNA的表达;酶联免疫吸附测定(ELISA)检测可溶性Tim-3(sTim-3)、可溶性Gal-9(sGal-9)水平;采用Pearson相关性分析检验肺结核病人miR-194-5p、CUL4A表达量与GBP5、sTim-3、sGal-9的相关性。结核分枝杆菌(Mtb)感染人巨噬细胞系U937,ELISA检测白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平。蛋白质印迹法(Western blotting)检测Wnt/β-连环素(Wnt/β-catenin)信号通路相关蛋白T细胞因子(TCF)、糖原合成酶激酶-3(GSK-3β)、β-catenin表达量。结果与对照组相比,潜伏结核感染组与肺结核组病人血清miR-194-5p、GBP5 mRNA的表达水平升高(P<0.05),其中miR-194-5p:(1.01±0.23)比(2.32±0.53)比(3.35±0.20),sTim-3、sGal-9水平升高(P<0.05),CUL4A mRNA的表达水平显著降低[(1.03±0.11)比(0.73±0.12)比(0.41±0.15),P<0.05],潜伏结核感染组与肺结核组各指标间相比差异有统计学意义(P<0.05);miR-194-5p与CUL4A呈负相关(r=-0.421,P<0.001),miR-194-5p与GBP5、sTim-3、sGal-9呈正相关(P<0.05);Mtb感染细胞后,IL-6、TNF-α的表达水平升高(P<0.05),TCF、GSK-3β、β-catenin表达量升高(P<0.05)。结论miR-194-5p在肺结核病人中表达上调,CUL4A表达下调,二者可能参与肺结核发生及发展过程。 展开更多
关键词 结核 结核分枝杆菌 微小RNA-194-5p 泛素蛋白连接酶类 cullin4A 炎症
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Role of various imbalances centered on alveolar epithelial cell/fibroblast apoptosis imbalance in the pathogenesis of idiopathic pulmonary fibrosis 认领
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作者 Qing Wang Zhao-Liang Xie +3 位作者 Qi Wu Zhi-Xian Jin Chao Yang Jing Feng 《中华医学杂志:英文版》 SCIE CAS 2021年第3期261-274,共14页
There have been recent extensive studies and rapid advancement on the pathogenesis underlying idiopathic pulmonary fibrosis(IPF),and intricate pathogenesis of IPF has been suggested.The purpose of this study was to cl... There have been recent extensive studies and rapid advancement on the pathogenesis underlying idiopathic pulmonary fibrosis(IPF),and intricate pathogenesis of IPF has been suggested.The purpose of this study was to clarify the logical relationship between these mechanisms.An extensive search was undertaken of the PubMed using the following keywords:"etiology,""pathogenesis,""alveolar epithelial cell(AEC),""fibroblast,""lymphocyte,""macrophage,""epigenomics,""histone,"acetylation,""methylation,""endoplasmic reticulum stress,""mitochondrial dysfunction,""telomerase,""proteases,""plasminogen,""epithelial-mesenchymal transition,""oxidative stress,""inflammation,""apoptosis,"and"idiopathic pulmonary fibrosis."This search covered relevant research articles published up to April 30,2020.Original articles,reviews,and other articles were searched and reviewed for content;240 highly relevant studies were obtained after screening.IPF is likely the result of complex interactions between environmental,genetic,and epigenetic factors:environmental exposures affect epigenetic marks;epigenetic processes translate environmental exposures into the regulation of chromatin;epigenetic processes shape gene expression profiles;in turn,an individual’s genetic background determines epigenetic marks;finally,these genetic and epigenetic factors act in concert to dysregulate gene expression in IPF lung tissue.The pathogenesis of IPF involves various imbalances including endoplasmic reticulum,telomere length homeostasis,mitochondrial dysfunction,oxidant/antioxidant imbalance,Th1/Th2 imbalance,M1-M2 polarization of macrophages,protease/antiprotease imbalance,and plasminogen activation/inhibition imbalance.These affect each other,promote each other,and ultimately promote AEC/fibroblast apoptosis imbalance directly or indirectly.Excessive AEC apoptosis and impaired apoptosis of fibroblasts contribute to fibrosis.IPF is likely the result of complex interactions between environmental,genetic,and epigenetic factors.The pathogenesis of IPF involve 展开更多
关键词 Alveolar epithelial cell APOPTOSIS Idiopathic pulmonary fibrosis FIBROBLAST PATHOGENESIS
肺结核误诊为支原体肺炎六例报告 认领
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作者 熊鑫 刘领 +1 位作者 周荣荣 薛兵 《临床误诊误治》 2021年第1期9-12,共4页
目的探讨肺结核误诊为支原体肺炎的原因及防范措施。方法回顾性分析曾误诊为支原体肺炎的肺结核6例的临床资料。结果6例均曾误诊为支原体肺炎,误诊时间9 d~2个月。临床表现为发热4例(咳黄白色黏痰2例,伴畏寒、咳嗽、痰中带血1例,干咳、... 目的探讨肺结核误诊为支原体肺炎的原因及防范措施。方法回顾性分析曾误诊为支原体肺炎的肺结核6例的临床资料。结果6例均曾误诊为支原体肺炎,误诊时间9 d~2个月。临床表现为发热4例(咳黄白色黏痰2例,伴畏寒、咳嗽、痰中带血1例,干咳、咽痛1例),干咳、气短1例,咳嗽、咳痰伴头痛、头晕、胸闷1例。胸部CT检查示病变位于右肺下叶3例,左肺下叶1例,双肺弥漫病变1例,右肺多发病变1例;表现为小斑片渗出和小叶中心结节影3例(合并实变1例),实变合并磨玻璃影2例(合并小叶中心结节及支气管气相各1例),实变、呈“树芽征”和小叶间隔增厚1例。经气管镜下肺泡灌洗液抗酸染色及痰涂片抗酸染色阳性确诊各3例,确诊后予抗结核治疗,电话随访6个月,4例已完全治愈,2例治疗中,胸部CT检查提示病灶已明显吸收。结论肺结核临床及影像学表现多样,迷惑性极强,当遇到胸部CT多种表现同时存在及抗支原体治疗效果不佳的支原体肺炎患者时,应考虑到肺结核可能,若患者无痰或痰涂片抗酸染色多次阴性可行气管镜检查,以减少误漏诊。 展开更多
关键词 肺炎 支原体 误诊 结核 痰涂片抗酸染色 气管镜检查
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Mononeuropathy multiplex associated with systemic vasculitis:A case report 认领
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作者 Hyun Jun Chae Jung Woo Kim +2 位作者 Yae Lim Lee Jeong Hwan Park Sang Yoon Lee 《世界临床病例杂志》 SCIE 2021年第7期1741-1747,共7页
BACKGROUND Vasculitis,a systemic disorder with inflammation of blood vessel walls,can develop broad spectrum of signs and symptoms according to involvement of various organs,and therefore,early diagnosis of vasculitis... BACKGROUND Vasculitis,a systemic disorder with inflammation of blood vessel walls,can develop broad spectrum of signs and symptoms according to involvement of various organs,and therefore,early diagnosis of vasculitis is challenging.We herein describe a patient who developed a special case of systemic vasculitis with mononeuropathy multiplex,rectal perforation and antiphospholipid syndrome(APS)presented with pulmonary embolism.CASE SUMMARY A 61-year-old woman visited hospital with complaints of myalgia and occasional fever.She was initially diagnosed as proctitis and treated with antibiotics,however,there was no improvement.In addition,she also complained right foot drop with hypesthesia,and left 2^(nd) and 3^(rd) finger tingling sensation.She underwent nerve conduction study for evaluation,and it revealed sensorimotor polyneuropathy in the left arm and bilateral legs.Subsequent sural nerve biopsy strongly suggested vasculitic neuropathy.Based on nerve biopsy and clinical manifestation,she was diagnosed with vasculitis and treated with immunosuppressive therapy.During treatment,sudden rectal perforation and pulmonary thromboembolism occurred,and further laboratory study suggested probable concomitant APS.Emergency Hartmann operation was performed for rectal perforation,and anti-coagulation therapy was started for APS.After few cycles of immunosuppressive therapy,tingling sensation and weakness in her hand and foot had been partially recovered and vasculitis was considered to be stationary.CONCLUSION Vasculitis can be presented with a variety of signs and symptoms,therefore,clinicians should always consider the possibility of diagnosis. 展开更多
关键词 Systemic Vasculitis Peripheral nervous system diseases MONONEUROPATHIES Antiphospholipid syndrome Pulmonary embolism Case report
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