The dynamic changes of pulmonary ventilation and gas exchange were common in pulmonary pathophysiology.Although related detection methods as chest X-ray, CT, magnetic resonance imaging (MRI) had certain effect in the evaluation and treatment of pulmonary diseases, which can′t still fully assess the function of pulmonary ventilation, pulmonary interstitial oxygen absorption, gas exchange, etc., especially having certain limitations in the diagnosis for local lesions.However, hyperpolarized 129Xe MRI uniquely images technology characterised by non-invasiveness and no ionizing radiation.Meanwhile, It has not only a unique application role for chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, ect., but also a good practical value for expressing pulmonary ventilation, evaluating airway microstructure, exploring gas exchange, and assessing local pulmonary lesion.This article reviews the application of hyperpolarized 129Xe MRI uniquely images in pulmonary diseases.

迄今为止,脓毒症在医学界仍然是一个难题.研究表明,脓毒症早期促炎和抗炎共同发生,高病死率与后期免疫抑制有关.大量研究显示,程序性死亡受体-1(PD-1)和白细胞介素-35(IL-35)在脓毒症中起着免疫调控的作用,脓毒症发生时PD-1和IL-35的升高可以引起免疫抑制,而通过PD-1和IL-35调节免疫抑制可以降低死亡率.基于此,本文主要对PD-1和IL-35与脓毒症免疫抑制的关系、发生机制以及治疗现状进行综述,以期为脓毒症的诊疗提供理论基础.

吸入治疗是呼吸系统疾病治疗的基础.氦氧混合气作为一种低密度、雷诺系数偏低、使气体通过气道趋于层流的可吸入性气体,自19世纪30年代起作为非药物治疗方式,其主要应用于呼吸系统疾病的治疗,具有减少呼吸做功、提高扩散率、改善分钟通气量,促进气溶胶输送、改善通气分布、提高二氧化碳清除等特性,治疗效果受到广泛关注.本文对氦氧混合气在慢性阻塞性肺疾病、支气管哮喘、急性呼吸窘迫综合征、肺康复等成人呼吸系统疾病中的应用作以简单综述.

评估容量反应性可准确了解患者心脏前负荷功能,合理对其进行容量管理,避免盲目补液,指导容量治疗方向,帮助患者改善预后.现将近年来通过超声测量评估机械通气患者容量反应性的一些指标,如:下腔静脉直径变化、上腔静脉直径变化、颈内静脉直径变化、锁骨下静脉直径变化、颈动脉峰流速变异度、肱动脉峰流速变异度及脾多普勒阻力指数,综述如下.

Objective To investigate the value of integrative weaning index (IWI) on weaning from mechanical ventilation. Methods The PubMed, Web of Science, EMbase, CNKI, WangFang Databases were searched for IWI diagnostic accuracy on weaning from mechanical ventilation up to October 2018. Two reviewers independently screened the literatures based on the inclusion and exclusion criteria. The methodological quality of included studies was assessed by QUADAS-2. Data were analyzed by Meta-DiSc software. Results Five studies involving 783 patients were included. The summary estimates for IWI diagnostic accuracy on weaning from mechanical ventilation included: sensitivity 0.95 (95%CI: 0.90-0.99), specificity 0.81 (95%CI: 0.68-0.94), positive likelihood ratio 4.46 (95%CI: 1.98~10.07), negative likelihood ratio 0.08 (95%CI: 0.03-0.19), diagnosis odds ratio 60.34 (95%CI: 16.54-220.05), and the area under the curve of SROC was 0.9466. Conclusion IWI can improve the diagnostic accuracy on weaning from mechanical ventilation. Key words: Integrative weaning indexl; Mechanical ventilation; Weaning; Meta-analysis