BACKGROUND:Benign airway stenosis (BAS) involves progressive pathological narrowing of the trachea and main bronchi, causing clinically significant respiratory impairment that can advance to life-threatening obstruction. While fibrosis arises from dysregulated immune-stromal crosstalk, the specific cellular and molecular drivers of BAS remain poorly understood. METHODS:We conducted single-cell RNA sequencing on clinical specimens representing the BAS spectrum normal airway, granulation tissue, and fibroproliferative tissue. Integrated bioinformatic analyses delineated cellular heterogeneity, intercellular communication, and differentiation trajectories. Spatial validation of key subsets was performed using multiplex immunofluorescence. Functional assessment of the PROS1-AXL axis involved treating primary human airway granulation fibroblasts (PHAGF) isolated from BAS patients with either conditioned medium from RANKL-stimulated THP-1 macrophages or recombinant PROS1, followed by inhibition with the AXL-specific antagonist R428. In parallel, an in vivo mouse model of BAS was used to evaluate the therapeutic efficacy of R428. RESULTS:Transcriptomic analysis revealed substantial remodeling of the BAS microenvironment, marked by epithelial depletion and expansion of stromal and immune compartments. We identified a novel macrophage subset co-expressing CTSK and SLC9B2, specifically enriched in granulation tissue. Communication analysis demonstrated selective PROS1-AXL signaling between CTSK+ macrophages and CD82+ fibroblasts. Pseudotemporal analysis positioned this crosstalk upstream of myofibroblast differentiation. Multiplex immunofluorescence confirmed CTSK+ macrophage localization in human BAS granulation tissue. In vitro, conditioned medium from RANKL-primed THP-1 macrophages promoted fibroblast activation in PHAGF cells through the PROS1-AXL axis, an effect that was attenuated by AXL inhibition with R428. Furthermore, Western blot analysis revealed that PROS1-AXL signaling activated the AKT/GSK3β pathway in PHAGF cells. In vivo, systemic administration of R428 in a BAS mouse model significantly reduced fibrotic remodeling, as evidenced by decreased granulation tissue hyperplasia, collagen deposition, and improved survival compared to vehicle-treated controls. Furthermore, TNFSF11 on CD82+ fibroblasts may bind TNFRSF11A on CTSK+ macrophage precursors to drive their differentiation. CONCLUSION:This work defines a pro-fibrotic cellular module in BAS CTSK+ macrophages and CD82+ fibroblasts interacting via PROS1-AXL and establishes a rationale for targeting this pathway, supported by both patient-relevant primary cell and in vivo evidence, to disrupt fibrosis and mitigate recurrence.

Acquired digestive-respiratory tract fistulas occur with abnormal communication between the respiratory tract and digestive tract caused by a variety of benign or malignant diseases, leading to the alimentary canal contents in the respiratory tract. Although various departments have been actively exploring advanced fistula closure techniques, including surgical methods and multimodal therapy, some of which have gotten good clinical effects, there are few large-scale evidence-based medical data to guide clinical diagnosis and treatment. The guidelines update the etiology, classification, pathogenesis, diagnosis, and management of acquired digestive-respiratory tract fistulas. It has been proved that the implantation of the respiratory and digestive stent is the most important and best treatment for acquired digestive-respiratory tract fistulas. The guidelines conduct an in-depth review of the current evidence and introduce in detail the selection of stents, implantation methods, postoperative management and efficacy evaluation.

BackgroundNocardia is a ubiquitous soil saprophyte transmitted through airborne or direct cutaneous inoculation routes. Although Nocardia is more common in immunocompromised patients, Nocardia may also arise in apparently immunocompetent patients. Case presentationWe report a rare case of Nocardia infection presenting as a large mediastinal mass in an immunocompetent ceramic worker. A 54-year-old man with no previous history of immune dysfunction, a ceramic worker by profession, was referred and admitted to our hospital because of a persistent fever for 19 days. Chest CT showed a large middle mediastinal mass. However, conventional anti-infective treatment was ineffective. Under the guidance of the Virtual bronchoscopic navigation (VBN) system, he underwent Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The purulent exudate obtained by EBUS-TBNA was further identified as Nocardia by weak acid-fast and metagenomic next-generation sequencing (mNGS). He was subsequently treated with intravenous imipenem/amikacin, switched to intravenous imipenem and oral trimethoprim/sulfamethoxazole, and the clinical symptoms were significantly improved. ConclusionsEven in immunocompetent patients, Nocardiosis cannot be excluded. For the public, especially soil contact workers, precautions should be taken to avoid Nocardia infection from occupational exposure. This rare case may provide a diagnosis and treatment reference for clinicians.

Background: The management of prolonged air leakage (PAL) is a significant clinical challenge, particularly for patients who are unfit for surgical treatment. The use of endoscopic interventions with occlusive devices have been reported previously; however, local availability and cost may represent potential hurdles, especially in developing countries. In this study, we present a conical endobronchial plug of our design and evaluated the efficacy of making use of that in the treatment of PAL as a novel method. Methods: This retrospective study included a total of 23 patients with PAL who were not suitable for surgery and underwent bronchial occlusion using customized plugs. The responsible bronchi were identified by the balloon occlusion test or by end-tidal carbon dioxide detection. In each case, the plug was grasped at the knot of the tip with forceps and then inserted into the target bronchus with a flexible bronchoscope. Results: Of the 23 patients with intractable pneumothorax, 1 to 3 plugs (median =1) were successfully inserted into the affected bronchi of each patient for bronchial occlusion. Air leakage showed complete cessation in 13 patients (56.5%) and reduction in seven patients (30.4%). A total of 20 patients (87.0%) experienced successful removal of the drainage tube following plug occlusion or presented with additional pleurodesis. Complications included expectoration of the plug (n=1) and fever (n=1); no other severe complications were observed. Conclusions: Bronchial occlusion using customized endobronchial plugs appears to be an effective and simple option for the management of PAL in patients who are not suitable for surgery, especially in developing countries, as the customized plug is a cost-effective alternative.

Background. High-flow nasal cannula (HFNC) can be used in stable chronic obstructive pulmonary disease (COPD) patients, but the effect of HFNC on clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still uncertain. Methods. We searched electronic literature databases for randomized controlled trials (RCTs) comparing HFNC with noninvasive ventilation (NIV) in hypercapnic patients with AECOPD. The primary endpoint of this meta-analysis was PaCO2, PaO2, and SpO2. The secondary outcomes were the respiratory rate, mortality, complications, and intubation rate. Results. We included 7 RCTs with a total of 481 patients. There were no significant differences on measures of PaCO2 (MD = −0.42, 95%CI −3.60 to 2.75, Z = 0.26, and P = 0.79), PaO2 (MD = −1.36, 95%CI −4.69 to 1.97, Z = 0.80, and P = 0.42), and SpO2 (MD = −0.78, 95%CI −1.67 to 0.11, Z = 1.72, P = 0.08) between the HFNC group and the NIV group. There was no significant difference in measures of the mortality and intubation rate between the HFNC group (OR = 0.72, 95%CI 0.30 to 1.69, Z = 0.76, and P = 0.44) and the NIV group (OR = 2.38, 95%CI 0.49 to 11.50, Z = 1.08, and P = 0.28), respectively. But the respiratory rate in the HFNC group was lower than that in the NIV group (MD = −1.13, 95%CI −2.13 to −0.14, Z = 2.23, and P = 0.03), and fewer complications were found in the HFNC group (OR = 0.26, 95%CI 0.14 to 0.47, Z = 4.46, and P < 0.00001). Conclusion. NIV was noninferior to HFNC in decreasing PaCO2 and increasing PaO2 and SpO2. Similarly, the mortality and intubation rate was similar among the two groups. The respiratory rate and complications were inferior in the AECOPD group treated with HFNC.

Purpose: Surgical bullectomy is the standard treatment of giant emphysematous bulla (GEB). However, bronchoscopic treatment should be considered as an alternative approach for patients who are unfit for surgical treatment. The study aimed to evaluate the clinical efficacy of endobronchial occlusion for the treatment of GEB using silicone plugs. Methods: This retrospective study recruited four patients with GEB who were unsuitable for surgery. Preoperative planning was performed using high-resolution computed tomography and a virtual bronchoscopic navigation system. Customized silicone plugs were then placed in the target airway via bronchoscopy to cause GEB regression and atelectasis. Results: All procedures were completed successfully in four patients. Three months after the procedures, compared with baseline, increases in the mean forced expiratory volume in 1 s (from 1.20 L/s to 1.33 L/s), forced vital capacity (from 2.63 L to 2.90 L), diffusion lung capacity for carbon monoxide (from 29% to 41% of the predicted value) and 6-minute walking test (from 412 m to 474 m) were observed. Additionally, the mean total lung capacity (from 6.80 L to 6.35 L), residual volume (from 3.97 L to 3.52 L), and St. George’s Respiratory Questionnaire scores (from 67 to 45) were all lower than baseline data. Conclusion: Our preliminary results demonstrated that the endobronchial placement of silicone plugs could be a low-cost, safe, and effective choice for the treatment of GEB in surgically unfit patients.

Pulmonary rehabilitation (PR) is an essential method for Acute exacerbation in chronic obstructive pulmonary disease (AECOPD) recovery. We perform a meta-analysis to compare early PR with usual care. A literature search was performed through these databases: PubMed, MEDLINE database, Google Scholar, Cochrane, Embase from inception to July 2021. Eligible trials were clinical randomized controlled trials comparing the effects of early PR and usual care in AECOPD patients. The primary endpoint of this meta-analysis was FEV1% predicted, 6-min walk test (6MWD), modified Medical Research Council (mMRC) and George Respiratory Questionnaire-total (SGRQ-total). The secondary outcomes were borg dyspnea score, short-form 36 health survey questionnaire physical (SF-36 physical) and SF-36 mental. We included 13 RCTs with a total of 866 patients. There were no significant effects of the PR group on measures of FEV1% predicted (MD = 0.50, 95%CI -1.43 to 2.44, Z = 0.51, p = 0.61), borg dyspnea score (MD = -0.88, 95%CI -1.89 to 0.13, Z = 1.71, p = 0.09) and SF-36 mental (MD = 4.34, 95%CI -1.64 to 10.32, Z = 1.42, p = 0.16) compared with usual care. PR group achieved better 6MWD (MD = 97.58, 95%CI 17.21 to 177.96, Z = 2.38, p = 0.02), mMRC (MD = -0.36, 95%CI -0.52 to -0.21, Z = 4.56, p < 0.00001), SGRQ-total (MD= -9.67, 95%CI -16.23 to -3.11, Z = 2.89, p = 0.004) and SF-36 physical (MD = 4.98, 95%CI 0.60 to 9.35, Z = 2.23, p = 0.03) compared with usual care group. Early PR in AECOPD patients would lead to better 6MWD, mMRC, SGRQ-total and SF-36 physical. But there were no significant effects of the PR group on measures of FEV1% predicted, borg dyspnea score and SF-36 mental.

Purpose: Surgical bullectomy is the standard treatment of giant emphysematous bulla (GEB). However, bronchoscopic treatment should be considered as an alternative approach for patients who are unfit for surgical treatment. The study aimed to evaluate the clinical efficacy of endobronchial occlusion for the treatment of GEB using silicone plugs.Methods: This retrospective study recruited four patients with GEB who were unsuitable for surgery. Preoperative planning was performed using high-resolution computed tomography and a virtual bronchoscopic navigation system. Customized silicone plugs were then placed in the target airway via bronchoscopy to cause GEB regression and atelectasis.Results: All procedures were completed successfully in four patients. Three months after the procedures, compared with baseline, increases in the mean forced expiratory volume in 1 s (from 1.20 L/s to 1.33 L/s), forced vital capacity (from 2.63 L to 2.90 L), diffusion lung capacity for carbon monoxide (from 29% to 41% of the predicted value) and 6-minute walking test (from 412 m to 474 m) were observed. Additionally, the mean total lung capacity (from 6.80 L to 6.35 L), residual volume (from 3.97 L to 3.52 L), and St. George's Respiratory Questionnaire scores (from 67 to 45) were all lower than baseline data.Conclusion: Our preliminary results demonstrated that the endobronchial placement of silicone plugs could be a low-cost, safe, and effective choice for the treatment of GEB in surgically unfit patients.

目的 探究酸性氧化电位水对ICU物体表面多重耐药定植菌的抑菌效果.方法 选取2019年4月—2021年3月福建医科大学附属第二医院ICU的360个物体为研究对象,分别使用酸性氧化电位水、1000 mg/L含氯消毒剂擦拭,对比抑菌和消毒效果.结果 物体表面用酸性氧化电位水擦拭后4 h、8 h抑菌率比含氯消毒剂高,差异显著(P<0.05).酸性氧化电位水擦拭后4 h物体表面消毒合格率为95.56％、8 h后为41.94％,分别高于含氯消毒剂的91.94％和30.28％,差异显著(P<0.05).两种消毒剂对涂有MRSA的物体抑菌率均为100％,组间无统计学差异(P>0.05).2组消毒成本主要包含材料及人工成本,提示酸性氧化电位水成本(0.81元)较含氯消毒液(1.17元)低.结论 ICU物体表面应用酸性氧化电位水擦拭,能有效清除多重耐药定植菌,且较其他消毒剂相比成本较低,达到良好的抑菌效果.

目的:探讨早产儿医院感染的发生情况及危险因素,为医院感染的预防控制提供依据.方法:调查2019年1月—2020年12月入住该院新生儿病房早产儿的医院感染发生情况,分析相关危险因素及干预措施.结果:共调查778例早产儿,发生医院感染34例,感染率为4.37％;感染部位以下呼吸道和菌血症为主,分别占28.95％和23.68％;感染患儿共检出病原菌29株,其中革兰阴性菌23株,占79.31％,革兰阳性菌5株,占17.24％,真菌1株,占3.45％.胎龄、出生体重、机械通气、PICC/脐静脉置管、应用抗菌药物时间、住院天数是早产儿发生医院感染的危险因素(P<0.001).结论:早产儿发生医院感染的危险因素相对较多,应针对性开展监测、采取干预措施,减少不必要的侵入性操作、合理使用抗菌药物、缩短住院时间等有利于减少早产儿医院感染的发生.

新冠肺炎传染性强、波及范围广,临床医院作为收治患者的前线,存在医务人员感染及院内传播的风险.本文结合综合医院新冠肺炎防控经验,从建立医院感染风险防控体系、制定动态防护和主动监测措施、加强防护物资管理等方面探讨新冠肺炎流行期间医院感染防控的实践与体会.

目的:探讨医院获得性肺炎(HAP)患者感染多重耐药菌(MDRO)的危险因素,为临床感染防治提供参考.方法:选取2019年4月-2021年3月福建医科大学附属第二医院所有确诊为HAP的患者共395例作为研究对象,根据HAP患者的痰、支气管肺泡灌洗液等相关标本的培养结果,将感染MDRO的患者列为病例组(n=231),感染非MDRO(包括无细菌感染)的患者列为对照组(n=164),统计两组性别等研究因素并进行单因素分析,再对上述差异有统计学意义的指标进一步进行多因素Logistic回归方程分析.结果:395例HAP患者生物标本共检出病原菌387株,其中MDRO共231株,占总菌株的59.69％.病原菌分布以革兰阴性菌为主,主要为鲍曼不动杆菌占比23.58％,其次分别为铜绿假单胞菌占18.91％,肺炎克雷伯菌占16.32％等;主要的革兰阳性菌包括金黄色葡萄球菌占10.36％,肺炎链球菌占9.33％,粪肠球菌占8.03％.病例组与对照组年龄、是否合并肺部基础疾病、是否有抗生素使用史、是否有动静脉置管、气管切开、留置胃管等侵入性操作史等因素比较,差异有统计学意义(P<0.05);经过Logistic回归分析HAP患者感染MDRO的危险因素包括合并肺部基础疾病、有抗生素使用史、有动静脉置管、气管切开、留置胃管等侵入性操作史.结论:合并肺部基础疾病、有抗生素使用史、有动静脉置管、气管切开、留置胃管等侵入性操作史是HAP患者感染MDRO的独立危险因素.

目的:探讨长链非编码RNA(lncRNA)LINC01503对肺癌细胞活力、迁移和侵袭的影响及其作用机制.方法:将人肺癌H1299细胞分为si-NC组(转染si-NC)、si-LINC01503组(转染si-LINC01503)、pcDNA组(转染pcDNA)、pcDNA-LINC01503组(转染pcDNA-LINC01503)、miR-NC组(转染miR-NC)、miR-335-5p组(转染miR-335-5p mimics)、si-LINC01503+anti-miR-NC组(共转染si-LINC01503和anti-miR-NC)、si-LINC01503+anti-miR-335-5p组(共转染si-LINC01503和anti-miR-335-5p)、miR-NC+WT-LINC01503组(共转染miR-NC和WT-LINC01503)、miR-NC+MUT-LINC01503组(共转染miR-NC和MUT-LINC01503)、miR-335-5p+WT-LINC01503组(共转染miR-335-5p和WT-LINC01503)和miR-335-5p+MUT-LINC01503组(共转染miR-335-5p和MUT-LINC01503).采用RT-qPCR检测miR-335-5p和LINC01503的表达水平;Western blot检测蛋白表达;MTT法检测细胞活力;Transwell法检测细胞迁移和侵袭能力的变化;双萤光素酶报告基因实验验证LINC01503与miR-335-5p的靶向关系.结果:与正常肺组织相比,肺癌组织中LINC01503表达水平显著升高,miR-335-5p表达水平显著降低(P<0.05);与Ⅰ/Ⅱ期阶段相比,Ⅲ/Ⅳ期肺癌组织中LINC01503表达水平显著升高,miR-335-5p表达水平显著降低(P<0.05);LINC01503高表达的患者短期生存率显著低于LINC01503低表达的患者(P<0.05).与正常支气管上皮细胞系BEAS-2B相比,肺癌细胞系H1299、A549和SPC-A-1中miR-335-5p的表达水平显著降低,LINC01503的表达水平显著升高(P<0.05);过表达miR-335-5p、抑制LINC01503表达均可抑制H1299细胞的活力、迁移和侵袭,抑制细胞周期蛋白D1(cyclin D1)、基质金属蛋白酶2(MMP-2)和MMP-9蛋白的表达(P<0.05).LINC01503靶向调控miR-335-5p的表达,干扰miR-335-5p表达能逆转抑制LINC01503表达对H1299细胞活力、迁移和侵袭的抑制作用.结论:抑制lncRNA LINC01503表达可抑制肺癌细胞的活力、迁移和侵袭,其机制可能与靶向调控miR-335-5p有关.

INTRODUCTION:Low-concentration oxygen is an established way for the treatment of chronic obstructive pulmonary disease (COPD) with Type II respiratory failure. Hypercapnia can complicate both COPD exacerbations and stable COPD. Treating with noninvasive ventilation (NIV) can reduce carbon dioxide tension in arterial (PaCO2 ) in hypercapnic COPD. As an open system, high-flow nasal cannula oxygen (HFNC) is easy to tolerate and use. More researches are needed to focus on how HFNC is used to treat COPD patients with hypercapnic respiratory failure.METHODS:The Cochrane Library, Medline, EMBASE, and CINAHL database were retrieved from inception to October 2019. Eligible trials were clinical randomized controlled trials comparing the effects of HFNC and conventional oxygen on hypercapnic COPD patients. Two researchers assessed the quality of each study and extracted the data into RevMan 5.3 independently. The primary outcome was PaCO2 and the secondary outcome was PaO2 .RESULTS:Four RCTs with 329 patients were included. The research results indicated that PaCO2 in the HFNC group was similar to the conventional oxygen group. No significant difference were observed in PaCO2 (MD -0.98, CI: -2.67 to 0.71, Z = 1.14, p = 0.25) and PaO2 (MD -0.72, CI: -6.99 to 5.55, Z = 0.23, p = 0.82) between the HFNC group and conventional oxygen group.CONCLUSIONS:Our meta-analysis showed no difference in PO2 and PCO2 between the HFNC and conventional oxygen. But we should treat this conclusion with caution because the number of studies and participants is small and, there is heterogeneity in the PaO2 and PCO2 measurements between stable and AECOPD.

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is an independent risk factor for hypertension (HTN). The oral microbiota plays a pathophysiological role in cardiovascular diseases; however, there are few reports directly investigating and identifying the organisms involved in OSAHS-related HTN. Therefore, this study aimed to identify those organisms. We obtained 139 oral samples and determined the microbiome composition using pyrosequencing and bioinformatic analyses of the 16S rRNA. We examined the fasting levels of cytokines and homocysteine in all participants and analyzed the correlations between the oral microbiota and homocysteine levels. We determined the molecular mechanism underlying HTN by investigating the genetic composition of the strains in the blood. We detected higher relative abundances of Porphyromonas and Aggregatibacter and elevated proinflammatory cytokines in patients with OSAHS of varying severity compared with individuals without OSAHS; however, the two organisms were not measured in the blood samples from all participants. High levels of specific Porphyromonas bacteria were detected in patients with OSAHS with and without HTN, whereas the relative abundance of Aggregatibacter was negatively correlated with the homocysteine level. The receiver operating characteristic curve analysis of controls and patients with OSAHS resulted in area under the curve values of 0.759 and 0.641 for patients with OSAHS with or without HTN, respectively. We found that the predictive function of oral microbiota was different in patients with OSAHS with and without HTN. However, there was no direct invasion by the two organisms causing endothelial cell injury, leading to speculation regarding the other mechanisms that may lead to HTN. Elucidating the differences in the oral microbiome will help us understand the pathogenesis of OSAHS-related HTN.

目的 比较产和非产超广谱β内酰胺酶(ESBLs)肺炎克雷伯杆菌(KP)的医院及社区感染患者的临床分布特征及菌株耐药性差异,为临床诊疗提供依据.方法 采用回顾性调查的方法,收集2017年1月1日至2018年6月30日在我院检出KP感染菌株的患者临床特征和耐药情况,运用卡方检验或Fisher确切概率法比较产和非产ESBLs-KP的分布及耐药性差异.结果 共检出KP感染菌株334株,产ESBLs-KP的检出率为24.85％(83/334).医院与社区感染的产ESBLs-KP检出率差异无统计学意义(31.25％ vs.22.27％,x2=2.955,P=0.086).产ESBLs-KP的检出率女性高于男性,差异有统计学意义(32.32％ vs.21.70％,x2=4.208,P=0.040).产ESBLs-KP在＜18岁、18～45岁、45～60岁和≥60岁各组的检出率差异均无统计学意义.KP感染部位的前三位依次均为下呼吸道、泌尿道、菌血症.医院感染产ESBLs-KP在各部位、各科室的分布均无明显差异.社区感染产ESBLs-KP在各部位、各科室的分布均有明显差异,其中感染部位前两位为泌尿道(37.74％)、皮肤软组织(30.77％);感染科室前两位为泌尿外科(40.00％)、呼吸内科(38.10％).产ESBLs-KP比非产ESBLs-KP对16种抗生素的耐药率较高,其差异有统计学意义(P＜0.05);产ESBLs-KP与非产ESBLs-KP的医院和社区感染对常见抗生素的耐药率差异均无统计学意义(P＞0.05).结论 医院和社区感染产ESBLs-KP的检出率和耐药率均较高,应加强临床抗菌药物使用管理,对产ESBLs-KP感染病例实时监控.对女性和社区泌尿道感染KP等患者,应提高警惕,加强院感防控,减少交叉感染.

目的 探讨维生素D受体(Vitamin D receptor,VDR)基因甲基化对泌尿外科患者泌尿道医院感染的影响,为泌尿道医院感染的防控提出新的思路.方法 选择2017年1月-2018年12月于福建医科大学附属第二医院泌尿外科住院治疗的患者454例为研究对象,根据泌尿道医院感染情况分为感染组186例和未感染组268例.采用高分辨率熔解曲线(High-resolution melting,HRM)法检测外周血VDR基因甲基化水平;分析患者性别、年龄、住院天数、泌尿道插管等情况,归纳泌尿外科患者泌尿道医院感染的影响因素及VDR基因甲基化对泌尿道感染的影响.结果 感染组患者共检出菌株161株,其中革兰阴性菌119株占73.91,革兰阳性菌33株占20.50％,真菌9株占5.39％,以大肠埃希菌、屎肠球菌、肺炎克雷伯菌、铜绿假单胞菌为主.不同检出菌的熔解温度(melting temperature,Tm)差异有统计学意义(P＜0.05),革兰阴性菌的Tm值高于革兰阳性菌和真菌(P＜0.05),而革兰阳性菌的Tm值与真菌差异无统计学意义(P=0.407).感染组的Tm值为(70 20±020)℃低于对照组(P＜0.001),感染组VDR基因甲基化程度低于对照组.多因素分析经调整人口学因素后,住院天数、泌尿道插管、联用抗菌药物是泌尿外科患者泌尿道医院感染的影响因素;VDR基因甲基化水平是泌尿道医院感染的保护因素(P＜0.001).结论 VDR基因甲基化水平较高是泌尿道医院感染的保护因素,VDR基因甲基化在医院感染过程中发挥重要作用.

目的 综合评价X线修复交错互补基因3(XRCC3)基因rs861539位点多态性与肺癌预后的关联性.方法 计算机检索Pubmed、CBM、CNKI、万方数据库和VIP数据库,搜集国内外有关rs861539位点多态性与肺癌预后的研究,检索时限均为建库至2017年1月3日.由2位研究者独立进行文献筛选、数据提取及文献质量评价后,采用Stata 12.0软件进行Meta分析.结果 共纳入12篇文献,累计3 603例非小细胞肺癌患者.Meta分析结果显示:XRCC3基因rs861539位点多态性与肺癌总生存期长短无统计学关联(TT vs CC:合并HR=1.10,95％CI:0.72～1.67;CT vs CC:合并HR=1.04,95％CI:0.81～1.34;TT+CT vs CC:合并HR=1.04,95％CI:0.90～ 1.20).结论 尚不能认为rs861539位点多态性与肺癌预后有关,受文献数量和质量限制,该结论需更多研究予以验证.

Intermittent hypoxia and sleep fragmentation are critical pathophysiological processes involved in obstructive sleep apnea/hypopnea syndrome (OSAHS). These manifestation independently affect similar brain regions and contribute to OSAHS-related comorbidities that are known to be related to the host gut alteration microbiota. We hypothesized that microbiota disruption influences the pathophysiological processes of OSAHS through a microbiota–gut–brain axis. Thus, we aim to survey enterotypes and polysomnographic data of OSAHS patients. Subjects were diagnosed by polysomnography, from whom fecal samples were obtained and analyzed for the microbiome composition by variable regions 3–4 of 16S rRNA pyrosequencing and bioinformatic analyses. We examined blood cytokines level of all subjects. Three enterotypes Bacteroides (n=73), Ruminococcus (n=14), and Prevotella (n=26) were identified. Central apnea indices, mixed apnea indices, N1 sleep stage, mean apnea–hypopnea duration, and arousal indices were increased in apnea–hypopnea indices (AHI) ≥15 patients with the Prevotella enterotype. However, for AHI<15 subjects, obstructive apnea indices and systolic blood pressure were significantly observed in Ruminococcus and Prevotella enterotypes, respectively. The present study indicates the possibility of pathophysiological interplay between enterotypes and sleep structure disruption in sleep apnea through a microbiota–gut–brain axis and offers some new insight toward the pathogenesis of OSAHS.Importance Intermittent hypoxia (IH) and sleep fragmentation (SF) are hallmarks of are the predominant mechanism underlying obstructive sleep apnea/hypopnea syndrome (OSAHS). Moreover, IH and SF of pathophysiological roles in the gut microbiota dysbiosis in OSAHS have been demonstrated. We hypothesized that gut microbiota disruption may cross-talk the brain function via microbiota–gut–brain axis. Indeed, we observed central apnea indices and other parameters of disturbances during sleep were significantly elevated in AHI≥15 patients with the Prevotella enterotype. This enterotype prone to endotoxin production, driving systemic inflammation, ultimately contributes to OSAHS-linked comorbidities. Vice versa, increasing the arousal index leads to systemic inflammatory changes and accompanies metabolic dysfunction. We highlight that the possibility that the microbiota–gut–brain axis operates a bidirectional effect on the development of OSAHS pathology.

Gut microbiota alterations manifest as intermittent hypoxia and fragmented sleep, thereby mimicking obstructive sleep apnea-hypopnea syndrome (OSAHS). Here, we sought to perform the first direct survey of gut microbial dysbiosis over a range of apnea-hypopnea indices (AHI) among patients with OSAHS. We obtained fecal samples from 93 patients with OSAHS [5 < AHI ≤ 15 (n=40), 15 < AHI ≤ 30 (n=23), and AHI ≥ 30 (n=30)] and 20 controls (AHI ≤ 5) and determined the microbiome composition via 16S rRNA pyrosequencing and bioinformatics analysis of variable regions 3-4. We measured fasting levels of homocysteine (HCY), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). Results revealed gut microbial dysbiosis in several patients with varying severities of OSAHS, reliably separating them from controls with a receiver operating characteristic-area under the curve (ROC-AUC) of 0.789. Functional analysis in the microbiomes of patients revealed alterations; additionally, decreased in short-chain fatty acid (SCFA)-producing bacteria and increased pathogens, accompanied by elevated levels of IL-6. Lactobacillus levels correlated with HCY levels. Stratification analysis revealed that the Ruminococcus enterotype posed the highest risk for patients with OSAHS. Our results show that the presence of an altered microbiome is associated with HCY among OSAHS patients. These changes in the levels of SCFA affect the levels of pathogens that play a pathophysiological role in OSAHS and related metabolic comorbidities.