Bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. Concomitant problems, such as pulmonary infection and respiratory failure, are typically the main contributors to mortality from BPF because of improper contact between the bronchial and pleural cavity. We present the case of a 75-year-old male patient with a history of right upper lobe lung cancer resection who developed complex BPFs. Following appropriate antibiotic therapy and chest tube drainage, we treated the fistulas using endobronchial valve EBV placement and local argon gas spray stimulation. Bronchoscopic treatment is the preferred method for patients who cannot tolerate a second surgery because it can help to maximize their quality of life. Our treatment method may be a useful reference for treating complex BPF.

Objective To investigate the clinical value of IFN-γ and IL-27 levels in cerebrospinal fluid（CSF） for diagnosis of acute meningitis. Methods CSF samples were collected from 150 patients with suspected meningitis who were admitted to Shaoxing People’s Hospital from January 2015 to December 2020, including 65 cases of viral encephalitis（VE）, 28 cases of bacterial meningitis（BM）, 23 cases of tuberculous meningitis（TBM）, 12 cases of cryptococcal meningitis（CM）, and 22 non-meningitis cases（control group）. The CSF levels of WBC, protein, adenosine deaminase（ADA）, glucose, chloride, IFN-γ and IL-27 were detected and compared among groups. Multivariate logistic regression analysis was used to identify the independent influencing factors for VE, BM, TBM and CM, and ROC curve analysis was used to evaluate the diagnostic efficacy of these factors for various types of acute meningitis. Results Except chloride, there were statistically significant differences in the other 6 indexes of cerebrospinal fluid in 5 groups（all P＜0.05）. Multivariate logistic regression analysis showed that CSF WBC, protein, ADA and IFN-γ levels were independent influencing factors for TBM（all P＜0.05）. CSF protein,ADA and IL-27 levels were independent influencing factors for CM（all P＜0.05）. No independent influencing factors were found for VE and BM. ROC analysis showed that the AUC, sensitivity, and specificity of IFN-γ or IFN-γ in combination with other 3 indicators for diagnosis of TBM were 0.933, 0.957, 0.843 and 0.944, 0.957, 0.772, respectively. AUC, sensitivity, and specificity of CSF IL-27 or IL-27 in combination with protein and ADA for diagnosis of CM were 0.838, 0.573, 0.935 and 0.844, 0.833,0.341, respectively（all P＜0.05）. Conclusion CSF IFN-γ combined with WBC, protein and ADA has a high diagnostic value for TBM, and CSF IL-27 combined with protein and ADA has a certain diagnostic value for CM.

目的 探讨肺腺癌(LUAD)伴恶性胸腔积液患者胸水细胞蜡块中电导钙激活钾离子通道蛋白(KCa3.1)的表达及其意义.方法 利用GEPIA、Kaplan-Meier plotter数据库分析KCa3.1在肺腺癌组织中的表达情况及其与肿瘤分期、总生存期(OS)的关系.选取2019年6月1日至2021年6月30日绍兴市人民医院收治的LUAD伴恶性胸腔积液患者72例,应用免疫组化法检测胸水细胞蜡块KCa3.1表达,分析其与临床特征及预后的关系.结果 生物信息学分析和临床资料分析提示,LUAD患者KCa3.1表达水平明显高于正常肺组织(P＜0.05),KCa3.1高表达和低表达患者性别、年龄、吸烟情况、T分期、N分期、肺外转移情况、表皮生长因子受体基因突变情况比较差异均无统计学意义(均P＞0.05),KCa3.1高表达患者OS低于低表达患者(P＜0.05).结论 KCa3.1在LUAD患者中高表达,且与不良预后有关,提示KCa3.1可作为LUAD患者诊断和预后判断的潜在靶点.

目的 探讨虚拟导航(VBN)联合径向超声(EBUS)引导下经支气管镜肺活检(TBLB)在早期周围型肺癌诊断中的应用价值.方法 回顾性分析2016年6月至2019年9月于绍兴市人民医院呼吸内科住院或门诊就诊、胸部CT高度怀疑为周围型肺癌的患者188例,根据操作设备不同,分为经支气管镜肺活检组(TBLB组)、径向超声组(EBUS+TBLB组)及虚拟导航联合径向超声组(VBN+EBUS+TBLB组),评估三种不同检查方法的诊断阳性率、安全性,以及EBUS组及VBN+EBUS组操作时间.结果 TBLB组、EBUS组及VBN+EBUS组三组患者的诊断率分别为32.2％、64.3％及67.1％,差异有统计学意义(P<0.05),特别是直径为2～3 cm的病灶差异更为明显.亚组分析显示,诊断率与病变肺叶无关,VBN能明显缩短操作时间,超声探头在病灶内部或紧邻病灶诊断率高.结论 在TBLB的基础上联合VBN及EBUS在不增加并发症的情况下能大大提高周围型肺癌诊断的阳性率.

目的 探讨早期综合肺康复对脱机后慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者的疗效及心理状态的影响.方法 选取2017年5月至2018年12月因AECOPD合并II型呼吸衰竭、肺性脑病在绍兴市人民医院呼吸重症监护室经气管插管等治疗脱机后转入呼吸内科的患者63例,采用随机数字表法分为康复组32例和常规组31例,常规组予常规的抗菌药物、支气管扩张剂、糖皮质激素等治疗,康复组是在常规治疗基础上配合肺康复锻炼,随访3个月后比较两组患者肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)占预计值比值(FEV1％pred)、FEV1/FVC比值]、6 min步行距离(6 MWD)、慢性阻塞性肺疾病自我评估测试(CAT)评分、呼吸困难指数(mMRC)评分、BODE指数的变化,并采用抑郁自评量表(SDS)评估两组患者精神状态的变化.结果 最终两组患者均有29例获得全部随访.经过3个月的康复锻炼,康复组患者FVC、FEV1％pred、FEV1/FVC比值、6 MWD均明显高于常规组,而CAT评分、mMRC评分、BODE指数及SDS评分均明显低于常规组,差异均有统计学意义(均P<0.05).结论 对于AECOPD合并肺性脑病经机械通气等治疗脱机后的患者尽早进行综合肺康复是可行的,能够缓解临床症状,提高患者运动能力,改善心理状态.

Abstract The PITX gene family of transcription factors have been reported to regulate the development of multiple organs. This study was designed to investigate the role of PITXs in lung adenocarcinoma (LUAD). In this study, the transcriptional levels of the 3 identified PITXs in patients with LUAD were examined using the gene expression profiling interactive analysis interactive web server. Meanwhile, the immunohistochemical data of the 3 PITXs were obtained in the Human Protein Atlas website, and western blotting was additionally conducted for further verification. Moreover, the association between the levels of PITXs and the stage plot as well as overall survival of patients with LUAD was analyzed. We found that the mRNA and protein levels of PITX1 and PITX2 were higher in LUAD tissues than those in normal lung tissues, while those of PITX3 displayed no significant differences. Additionally, PITX1 and PITX3 were found to be significantly associated with the stage of LUAD. The Kaplan-Meier Plot showed that the high level of PITX1 conferred a better overall survival of patients with LUAD while the high level of PITX3 was associated with poor prognosis. Our study implied that PITX1 and PITX3 are potential targets of precision therapy for patients with LUAD while PITX1 and PITX2 are regarded as novel biomarkers for the diagnosis of LUAD.

原发性气管支气管良性肿瘤在临床上较为少见,包括脂肪瘤、错构瘤、血管瘤、乳头状瘤、平滑肌瘤、神经纤维瘤、涎腺混合瘤及软骨瘤等,但临床症状、体征及影像学改变缺乏特异性,常被误诊和漏诊.气管支气管脂肪瘤是一种极为少见的良性肿瘤,而发生在气管的脂肪瘤就更为少见.本文结合最近收治的一例气管脂肪瘤病例并复习国内外文献,总结其临床特点,提高临床医生对该病的认识程度,寻求合理的治疗方案.

目的 分析老年稳定期慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者呼出气冷凝液(EBC)及血清可溶性髓样细胞触发受体-1(sTREM-1)水平及其与肺动脉压之间的相关性.方法 选择2017年6月～2018年5月在我院呼吸科门诊及住院确诊的老年稳定期COPD患者132例,以肺动脉压力水平为分界,分为单纯COPD组、轻度PH组和中重度PH组,测定三组患者的EBC及血清sTREM-1水平,并分析其与PH的相关性.结果 轻度PH组、中重度PH组患者EBC及血清sTREM-1、超敏C反应蛋白(hs-CRP)水平高于单纯COPD组(P<0.05);中重度PH组患者EBC及血清sTREM-1、hs-CRP水平高于轻度PH组(P<0.05);EBC及血清sTREM-1、hs-CRP水平与COPD患者的PH严重程度呈正相关(P<0.05).结论 EBC中sTREM-1可能与COPD患者PH形成有关,EBC中sTREM-1可在一定程度上反映肺动脉压水平.

肺癌是世界上发病率和病死率最高的恶性肿瘤[1].而肺炎型肺癌(PTCL)是肺癌的一种特殊表现形式,因其与肺炎的影像学表现极为相似,且咳嗽、咳痰、胸痛、咯血及呼吸困难等临床症状无特异性,常被误诊及漏诊.现笔者对浙江省绍兴市人民医院呼吸内科最近收治的2例PTCL患者的临床资料结合相关文献进行回顾性分析,以提高对PTCL的诊治水平.现报道如下.

目的:探讨细胞自噬对多西环素调控脂多糖(LPS)刺激巨噬细胞引发炎症反应的影响及其分子机制.方法:利用LPS刺激人单核/巨噬细胞系THP-1建立炎症反应细胞模型,用多西环素进行干预.通过测定细胞培养上清液中肿瘤坏死因子 α(TNF-α)和白细胞介素8(IL-8)等细胞因子评估炎症水平;通过Western blot法检测LC3B、核因子 κB(NF-κB)和磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)等蛋白水平评估细胞自噬水平及对炎症细胞信号通路的影响.利用3-甲基腺嘌呤(3-MA)和雷帕霉素分别抑制和促进细胞自噬,研究自噬对多西环素调控LPS刺激THP-1细胞炎症因子水平的影响.结果:LPS刺激THP-1细胞诱导细胞因子TNF-α 及IL-8快速释放,12 h左右达到峰值;多西环素有效地抑制了LPS诱导的细胞因子产生(P<0.05).多西环素增加了LPS诱导的THP-1细胞自噬水平,且多西环素本身是一种自噬诱导剂.LPS上调p-mTOR蛋白水平,而多西环素抑制p-mTOR的蛋白水平,提示多西环素通过mTOR依赖的途径而LPS通过非mTOR依赖的途径诱导自噬.进一步研究显示,联用LPS、雷帕霉素及多西环素抑制了NF-κB的蛋白水平,雷帕霉素增加了多西环素对细胞因子生成的抑制;反之,自噬抑制剂3-MA减弱了多西环素对NF-κB的抑制效应,同时减弱了多西环素对炎症因子生成的抑制效应.结论:自噬参与多西环素调控LPS刺激单核/巨噬细胞引起的炎症反应.

1 病历摘要 患者,男性,30岁,因"反复咳嗽咳痰8月余,再发伴发热3天"于2017年6月14日入院.患者于8个月前无明显诱因下出现咳嗽,咳少量白痰,感胸部不适,右侧卧位时明显,曾到当地医院就诊,予抗感染治疗(具体不详),症状仍有,咳痰有所减少.

Kartagener综合征(KS)是一种罕见的常染色体隐性遗传性疾病,由支气管扩张、慢性鼻窦炎、内脏反位三联征组成[1],称为完全性KS,缺少慢性鼻窦炎称为不完全性KS[2].

目的 探讨腹部创伤患者腹腔引流液可溶性髓系细胞触发受体-1(sTREM-1)的表达及其对腹部创伤后脓毒症的诊断价值.方法 将本院ICU收治的65例腹部创伤患者作为病例组,18例胃大部切除术(择期手术)后患者作为对照组,分别检测两组患者入ICU后0、24、48、72 h腹腔引流液sTREM-1、血清sTREM-1、前降钙素(PCT)和C反应蛋白(CRP)浓度,评价上述指标对创伤后脓毒症的早期诊断价值.结果 创伤组腹腔引流液sTREM-1、血清sTREM-1、PCT和CRP浓度明显高于对照组(P<0.05).创伤组中并发脓毒症组腹腔引流液sTREM-1、血清sTREM-1、PCT和CRP浓度明显高于未并发脓毒症组(P<0.05),腹腔引流液sTREM-1诊断创伤后脓毒症的敏感性82.5%,特异性84.0%,ROC曲线下面积0.885,明显优于血清sTREM-1、PCT及CRP(P<0.05).结论 腹腔引流液sTREM-1对腹部创伤后脓毒症的早期诊断有重要价值.

Objective To investigate the expression of soluble triggering receptors expressed on myeloid cells-1 ( sTREM-1 ) in intraperitoneal drainage fluid of patients with abdorminal trauma and its predictive value for post-traumatic sepsis. Methods A total of 80 abdominal trauma patients were served as the trauma group and 25 patients treated with subtotal gastrectomy as the control group.Intraperitoneal drainage fluid sTREM-1,serum sTREM-1,procalcitonin (PCT) and C-reactive protein (CRP)at 0,24,48,72 hours after admission were determined in two groups for assessing their value in early prediction of post-traumatic sepsis. Results The levels of drainage fluid sTREM-1,serum sTREM-1,PCT and CRP in the trauma group were significantly higher than those in the control group (P ＜ 0.05 ).Drainage fluid sTREM-1 showed the area under the receiver operating characteristic (ROC) curve,sensitivity and specificity for 0.84,77％,and 83％ in the prediction of post-traumatic sepsis,which was superior to the serum sTREM-1,PCT and CRP. Conclusion Intraperitoneal drainage fluid sTREM-1 has high accuracy in predicting the sepsis in abdominal trauma patients.

创伤脓毒症是由严重创伤患者合并严重感染所致,是创伤患者晚期死亡的重要原因之一[1].机体在严重创伤、脓毒症等应激状态下可出现应激性高血糖,后者可通过多种途径直接或间接损伤血管内皮细胞(vascular endothelial cells,VEC),使内皮细胞合成、释放的多种活性物质比例失调,导致血管舒缩功能障碍,最终导致机体创口愈合不良、感染和脏器功能不全的发生率增高,患者的病死率增加.近年来,强化胰岛素治疗(intensive insulin therapy,IIT)是在重症医学科中被逐步推广使用的血糖控制措施,在降低患者病死率方面有着显著效果[2],同时IIT的内皮保护作用也可能对创伤患者预后有益.

<正>脓毒症是严重创(烧)伤、休克、外科大手术后常见的并发症,可进一步发展为脓毒性休克、多器官功能障碍综合征(multiple organ dysfunction syn-drome,MODS)。近年来,脓毒症的基础和临床研究取得了较大进展,在整体、器官、细胞、分子等水平研

AIM:To investigate the effects of intensive insulin therapy on the prognosis and serum vWF,ET-1,NO levels in patients with sepsis. METHODS:Ninety patients were randomly assigned to intensive insulin therapy group and conventional insulin therapy group,serum von Willebrand factor(vWF),endothelin-1(ET-1) and nitric oxide(NO) of the two groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle(ELISA) before treatment and the next 3 d,7 d after treatment.At the same time we observed the two groups of patients with the days of hospitalized in ICU,number of days for using mechanical ventilation,the last day of APACHE II score in ICU and incidence rate of hypoglycemia and 28 d mortality.RESULTS:Compared with conventional insulin therapy group,vWF,TM and ET-1 levels in intensive insulin therapy group were significantly decreased(P0.05),NO were significantly higher(P0.05);and the days of hospitalized in ICU,number of day for using mechanical ventilation,the last day of APACHE II score in ICU,28-d mortality were significantly decreased(P 0.05)in intensive insulin therapy group,and incidence rate of hypoglycemia of two group had no difference(P0.05).CONCLUSION:Intensive insulin therapy in patients with sepsis can reduce serum vWF,ET-1 levels and elevate NO levels,at the same time can reduce the case-fatality rate of patients,improve the prognosis.

Objective To investigate the effects of intensive insulin therapy on the functions of vascullar endothelial cells in septic patients. Methods One hundred and twenty septic patients were randomly assigned to intensive insulin therapy 1 ,intensive insulin therapy 2 and conventional insulin therapy, serum von Willebrand factor (vWF),thrombomodulin protein(TM),endothelin-1 (ET-1) and nitric oxide(NO) of the three groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle (ELISA) before treatment and the next 3 d,7 d after treatment. At the same time we observed the three groups of patients with 28-d mortality, the days of hospitalized in ICU, number of days for using mechanical ventilation, △ APACHE Ⅱ score and △MODS score. Results After treatment of 3 days,vWF was (142.57 ± 10.07)%, (137.32 ±9.66)% and (138. 32 ± 8. 80) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, vWF was (126.27 ±10.49) %, (116. 55 ± 9. 36) % and (120.72 ± 9. 53) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, TM was (6. 87 ± 1.62) μg/L, (5.95 ± 1.60) μg/L and (6. 17 ± 1.33) μg/L in the CIT, IIT1and IIT2 group, respectively. After treatment of 7 days, TM was (4. 55 ± 1.48) μg/L, (3.35 ± 0.94) μg/L and(3. 87 ± 1.20) μg/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, ET-1 was (61.27 ±9. 20) ng/L, (55.97 ± 9.03) ng/L and (57. 37 ± 7. 70) ng/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, TM was (43. 12 ± 6. 17) ng/L, (33.77 ± 6. 20) ng/L and (35.95 ± 5.73) ng/L in the CIT, IIT1and IIT2 group, respectively. Compared with conventional insulin therapy, vWF, TM and ET-1 were significantly decreased (P ＜ 0.05), NO were significantly higher (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups had no significant difference (P ＞ 0.05). In the CIT, IIT1 and IIT2 groups respectively, the mortality at 28 days were 20.0%, 12. 5 % and 45.0%, the days of hospitalized in ICU were (9.50 ± 3. 70) d, (7. 72 ± 3.29) d and (8.02 ±2. 90) d, number of day for using mechanical ventilation were (8. 92 ± 3.79) d, (7.23 ± 3. 32) d and (7. 37 ±3. 29) d, △ APACHE Ⅱ score were 8. 87 ± 3.46,7. 20 ± 2. 81 and 7.42 ± 3. 18, △ MODS score were 4. 15 ± 2. 15,3.20 ± 1.48 and 3.32 ± 1.74, with significant differences (P ＜ 0.05). These indices were significantly decreased (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups also had no significant differences (P ＞ 0.05). Conclusions Intensive insulin therapy on patients with sepsis has a protective effect of vascular endothelial cells, and the blood glucose controlled in the 6. 6 - 8. 3 mmol/L can significantly decrease the incidence of hypoglycemia, and intensive insulin therapy can also significantly improve the prognosis of patients with sepsis.

目的 探讨连续性血液净化(CBP)对严重脓毒症患者Toll样受体及炎症介质的影响.方法 30例严重脓毒症患者随机分成常规治疗组和CBP治疗组,每组15例;另选15名健康志愿者为对照组.在治疗的不同时间点,检测单核细胞Toll样受体-2(TLR2)和TLR4的蛋白表达及血清TNF-α、IL-6、IL-10的浓度.结果 严重脓毒症患者TLR2/4的蛋白表达及TNF-α、IL-6、IL-10的浓度水平,均明显高于健康对照组(均P＜0.05).CBP可下调TLR2/4的蛋的表达及TNF-α、IL-6的浓度水平(P＜0.05).结论 CBP通过下调TLR2/4的蛋白表达,抑制过于亢进的非特异性免疫反应;通过降低血清炎症介质的浓度,使促炎和抗炎反应达到相对平衡.