Objective:To compare and analyze the difference of oxygen-driven nebulization therapy for inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in different periods.Methods:A total of 180 patients with AECOPD who were hospitalized in the general ward of the Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, from January 1, 2016 to December 31, 2016 and from January 1, 2019 to December 31, 2019 were selected.They were divided into two groups according to the year of hospitalization.A retrospective study method was used to compare the use ratio of oxygen-driven nebulization, the composition ratio, use ratio and dosage of combined nebulization drugs in the two groups, and to compare the average hospitalization days of the two groups.Results:There were differences in the total oxygen-driven nebulization ratio, combined nebulization drug composition, ipratropium bromide, acetylcysteine use ratio, and acetylcysteine dosage (all P<0.05). There was no difference in the ratio and dosage of budesonide and salbutamol, and the dosage of ipratropium bromide (all P>0.05), but there was significant difference in the average hospital stay between the two groups ( Z=2.51, P<0.05). Conclusions:Oxygen-driven nebulization therapy has been paid more and more attention in AECOPD inpatients, mainly multi-drug nebulization.Ipratropium bromide and acetylcysteine use ratio has been increased significantly, the average hospital stay in 2019 is shorter than that in 2016 may be related to multi-drug nebulization therapy.

目的 比较不同剂量去甲万古霉素治疗老年肺部感染患者的血药谷浓度.方法 将34例老年肺部感染患者按给药剂量分为对照组11例和试验组23例.对照组给予去甲万古霉素每次0.4 g,q12 h,静脉输注;试验组给予去甲万古霉素每次0.4 g,q8 h,静脉输注.2组患者均治疗4～20 d.比较2组患者的临床疗效、去甲万古霉素稳态血药谷浓度和血药谷浓度分布范围,以及药物不良反应的发生情况.结果 治疗后,试验组和对照组的有效率分别为60.87％(14例/23例)和100.00％(11例/11例),平均血药谷浓度分别为(16.13±8.55)和(9.78±5.04)μg·mL-1,差异均有统计学意义(均P<0.05).试验组和对照组的血药谷浓度分别为波动于1.18～32.40和1.58～20.64μg·mL-1.对照组发生的药物不良反应以肾功能损伤伴发热为主,试验组发生的药物不良反应以肾功能损伤、皮疹和胃肠道反应为主.试验组和对照组的总药物不良反应发生率分别为17.39％和9.09％,差异无统计学意义(P>0.05).结论 老年肺部感染患者用去甲万古霉素静脉治疗时,血药谷浓度个体差异大,应尽量选择较小的有效剂量进行治疗.

Lung cancer is a major health challenge worldwide. Gefitinib, a tyrosine kinase inhibitor (TKI), is the common therapeutic drug used in advanced non-small-cell lung cancer (NSCLC). However, it is eventually bound to face the problem of acquired drug resistance. In this work, we investigated the role of lncRNA MITA1 in the acquisition of gefitinib resistance in NSCLC and uncovered the possible underlying molecular mechanism of the same. Experiments were carried out using the HCC827 and HCC827GR cells. These were transfected with pcDNA-MITA1 or si-MITA1 and treated with gefitinib. Subsequently, lncRNA MITA1 mediated effect on cell viability and apoptosis were studied using the MTT and flow cytometry assays. Furthermore, using qRT-PCR, Western blotting, and immunofluorescence assays, the regulatory association between lncRNA MITA1 and markers of autophagy (LC3, Beclin-1, and p62) were examined by estimating their cellular protein levels. Also, these results were verified in the presence of an autophagy inhibitor bafilomycin A1. We found that MITA1 was highly upregulated in the gefitinib-resistant NSCLC cells, indicating the regulatory role of MITA1 in gefitinib resistance. Mechanistically, upregulated MITA1 led to gefitinib resistance by suppressing apoptosis, increasing cell viability, and inducing autophagy. Furthermore, these results were true when tested in the presence of bafilomycin A1. Our results suggest that MITA1 by inducing autophagy could be a key regulator of gefitinib resistance in NSCLC.

Objective To improve understandings of clinical characteristics of tracheobronchomegaly (TBM) and reduce risks of missed diagnosis in clinical practice.Methods A case of TBM admitted to Beijing Tiantan Hospital was reported and 20 cases previously published in domestic literatures were reviewed.Results Of the total 21 involved patients,20 cases were male with an average age of 54 years old.The most common clinical symptoms and physical signs were cough (95.24％),sputum (95.24 ％),shortness of breath (57.14 ％),bronchial rale and/or wheezing (65.67 ％).Featured imaging changes by chest CT scan were dilatation of the trachea and mainstem bronchi (100.00％),bronchiectasis (42.86 ％),tracheal diverticulosis (14.29 ％),and pulmonary bulla (23.81％).The average diameter of trachea in 18 patients was 36.1 mm,while the average diameters of left and right mainstem bronchus in 12 patients were 25.2 mm and 25.0 mm,respectively.The further analysis showed the diameter of trachea was not associated with age (r =-0.147,P =0.560) or disease duration of patients (r =0.337,P =0.201).Among 13 patients with bronchoscopy,increased tracheal diameter (100.00％),diverticulosis (46.15％) and trachea dysfunction (30.77％) were observed.There was no correlation between the diameter of trachea and trachea dysfunction (x 2 =0.213,P =0.644).No patient was treated by trachea stent therapy to sustain their airway stabilization.One patient died of severe infection.Conclusions TBM is more common in male patients without specific clinical manifestations.The diagnosis of TBM is mainly based on measurement of trachea diameter.Bronchoscopy can facilitate early diagnosis of TBM and direct verification of tracheobronchomalacia.

人的一生可能并不坚强,甚至会非常脆弱,而在此短暂的过程中,游戏和闲暇会帮助我们度过岁月中那些脆弱甚至无聊的日子,而台湾作家傅佩荣的散文<麻将的趣味>就呈现了在脆弱的人生中,麻将这种游戏所带来的不可替代的人生趣味和处世哲学.

目的研究多肿瘤标志物蛋白芯片检测方法对肺部恶性肿瘤的诊断价值.方法同期住院患者分为三组:肺癌组(78例)、肺部良性病变组(118例)、对照组(68例),用多肿瘤标志物蛋白芯片检测系统测定血清中12种肿瘤标志物的水平.结果癌胚抗原(CEA)、糖原125(CA125)、铁蛋白(Fer)和糖原242(CA242)的血清水平肺癌组明显高于肺部良性病变组和对照组,其他各项肿瘤标志物的血清水平和检测阳性率各组间差异均无统计学意义.CEA、CA125、Fer和CA242检测诊断肺癌的灵敏度分别为41.0%、35.9%、26.9%、17.9%,特异度分别为89.8%、86.0%、86.6%、95.7%.12种肿瘤标志物中单项检测阳性诊断肺癌的敏感度和特异度分别为57.7%和72.0%,二项阳性为32.19%和88.7%,三项阳性为24.4%和96.8%,四项阳性为15.4%和98.9%.结论多肿瘤标志物蛋白芯片检测方法对肺癌诊断的阳性率较高,当三项以上同时阳性时虽然敏感度下降,但特异度可高达96.8%,对于初步判断病灶的恶性性质有一定的帮助.

Objective To evaluate the efficacy and safety of domestic cefepime in the treatment of patients with lower respiratory tract infections. Methods A randomized, double-blind, parallel controlled trial tract was conducted. Imported cefepime was as the controlled drug. Results The clinical cure rates in the trial and control groups were 52.63 % and 38.10%. The efficacy rates and the bacterial clearance rates in the trial group were all 100%, while in the controled group were 85.71 % and 92.31%. The adverse reaction rate in the trial group was 10.00 %, while in the control group was 9.09%. The difference of clinical effects, the bacterial clearance rates and adverse reaction rates between the two groups were no statistically significant. Conclusion It suggested that domestic cefepime is an effective and safe drug for lower respiratory tract infections.

慢性阻塞性肺疾病是呼吸系统疾病中一种常见病和多发病.在世界上,COPD居当前死亡原因的第四位,据世界卫生组织预测到2020年将成为世界疾病经济负担的第五位.在我国北部及中部农村,COPD的发病率很高,约为3%.因此,COPD是一种严重危害人民健康的重要的慢性呼吸系统疾病.为规范COPD的诊断和治疗,1995年欧美等国相继制定了"慢性阻塞性肺疾病(COPD)诊治指南",我国于 1997年也制定了 "慢性阻塞性肺疾病(COPD)诊治规范(草案)".2000年,美国国立心肺血管研究所和世界卫生组织组织多国有关专家进一步制定了"慢性阻塞性肺疾病防治全球创议(GOLD)",就COPD的定义、机制、诊断及治疗进行了全面阐述.参照GOLD的有关内容,在1997年我国<草案>的基础上,中华医学会呼吸病学分会结合我国的实际情况同时也为与国际对本病的认识接轨,于2002年进一步制定了<慢性阻塞性肺疾病诊治指南>.本文就近年来COPD诊治现状作简要介绍.

To evaluate the curative effect and safety of levofloxacin and ceftriaxone in aged patients with bacterial lower-respiratory infection. Fiftysix aged patients with bacterial lower-respiratory infection were randomly divided into test group (27 cases) and control group (29 cases). Patients of test group were treated with levofloxacin, 200mg iv drip/d; patients of control group with ceftriaxone, 2g iv drip/d. The overall effective rate and side effect rate of two group were 85.18%, 7.4% and 89.66%, 4.16% respectively, there was no statistical difference between two groups (P>0.05). Levofloxacin and ceftriaxone have similar curative effect and safety in the treatment of aged patients with bacterial lower-respiratory infections.

对42例医院获得性耐甲氧西林金黄色葡萄球菌(MRSA)下呼吸道感染病人临床资料进行分析.结果显示:病人主要来自神经外科ICU和神经外科病房;感染与手术、气管切开、呼吸机使用、糖皮质激素应用、多种抗生素使用及病情严重程度密切相关.提示:MRSA具有多重耐药性,且易与G阴性杆菌形成混合感染,治疗困难,患者病死率高.

司帕沙星(SPFX)是国产新型喹诺酮类药物,具有高效、广谱、速效的抗菌作用. 高效--仅千分之几微克的药物浓度即可杀灭一些革兰氏阴性菌.

比较头孢三嗪、头孢布烯序贯疗法与单用头孢三嗪静脉治疗34例中、重度下呼吸道感染的临床疗效和治疗费用.结果显示:序贯组(A组)临床总有效率为88.24%,单用头孢三嗪组(B组)临床总有效率为88.24%,2组间无显著性差异(P＞0.05);总医疗费用序贯组为(2 165.36±539.78)元,单用头孢三嗪组为(2 698.14±765.84)元,2组间具有显著性差异(P＜0.05).结果提示序贯疗法与单独静脉治疗具有相同的临床疗效,但显著降低了医疗费用.