目的:在新型冠状病毒肺炎(COVID-19)疫情爆发的早期阶段,通过优化氧疗资源的措施,使所有患者得到合适的氧疗,观察对患者病情的改善和预后的影响.方法:观察对象为COVID-19确诊患者,共有127例患者入组.以优化氧疗措施的实施日期为分界点,各取前后15 d内入院的患者(患者相对最多的时间段).将患者分为两组:(1)优化氧疗措施前入院的患者,这些患者无论轻重,主要通过中心供氧系统供氧,共52例;(2)优化氧疗措施后入院的患者,这些患者分为轻症、普通、重症和危重症患者,轻症患者予以中心供氧系统吸氧,普通患者予以家用制氧机吸氧,重症患者予以氧气筒吸氧,危重症患者予以机械通气,共75例.观察指标为生命体征、血常规和凝血功能、心脏、肝脏和肾脏功能等指标,同时观察对住院时间和死亡率的影响.结果:两组患者的基本临床资料比较无统计学的差异.优化氧疗措施后入院的患者生命体征得到改善,尤其是血氧饱和度(SpO2)明显好转(P<0.01).凝血功能紊乱减轻,表现为D-二聚体升高减轻(P<0.01).患者的炎症反应得到一定程度的抑制,表现为C反应蛋白(CRP)的降低(P<0.05).经过对年龄、性别和病情危重程度等危险因素的调整,优化氧疗后患者死亡率明显下降(P<0.01).结论:在COVID-19疫情大规模爆发期间,尽快使氧疗资源优化是重要的措施,使所有患者得到尽可能有效的氧疗,从而提高氧合而改善患者病情及其预后.

目的 评价重组人血管内皮抑制素联合长春瑞滨+顺铂方案(NPE)治疗晚期非小细胞肺癌(NSCLC)的疗效和安全性.方法 使用计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、ClinicalTrials、中国知网、万方数据库及维普等数据平台,检索时间为自建库至2020年9月,收集NPE与长春瑞滨+顺铂方案(NP)方案治疗晚期NSCLC的随机对照试验(RCTs),由两名研究者独立提取文献信息及评价纳入研究偏倚,采用RevMan5.3.0软件进行Meta分析.结果 共纳入23项前瞻性临床研究,合计1806例晚期NSCLC患者;Meta分析结果显示,NPE方案治疗晚期NSCLC的客观有效率(RR=1.76,95％CI:1.53～2.02,P<0.00001)、临床受益率[RR=1.21,95％CI:1.14～1.28,P<0.00001)以及治疗前后血清癌胚抗原(carcinoembryonic antigen,CEA)水平下降程度(MD=7.65,95％CI:3.17～12.12,P=0.0008)均高于NP方案;两方案在白细胞下降、血小板下降、胃肠道反应、肝功能损害的不良反应方面比较差异均无统计学意义(P>0.05),但是,NPE方案的心脏毒性发生风险高于NP方案(RR=2.52,95％CI:1.44～4.43,P=0.001).结论 与晚期NSCLC患者的NP治疗方案相比,NPE方案能提高治疗的客观有效率和临床受益率,且不良反应可耐受,值得进一步临床应用.

目的:观察二氧化硫(SO2)衍生物亚硫酸钠和亚硫酸氢钠对支气管上皮细胞NLRP3炎症小体活化的影响.方法:使用不同浓度的SO2衍生物作用于支气管上皮细胞16HBE,通过流式细胞术检测细胞内活性氧簇(ROS)的生成,Western blot检测细胞内NLRP3和caspase-1 p20蛋白水平,ELISA检测细胞上清中白细胞介素1β(IL-1β)的分泌水平,结合细胞毒性实验(MTT)确定2 mmol/L为SO2衍生物的实验浓度.采用RNA干扰技术沉默16HEB细胞NLRP3基因及ROS清除剂N-乙酰半胱氨酸(NAC)预处理16HBE细胞,通过流式细胞术检测细胞内ROS,Western blot和ELISA分别检测NLRP3和caspase-1 p20蛋白表达及IL-1β分泌水平.结果:与对照组比较,2 mmol/L和4 mmol/L SO2衍生物组细胞内ROS水平、NLRP3和caspase-1 p20蛋白表达及细胞上清液中IL-1β水平明显升高(P<0.05).与2 mmol/L SO2衍生物组比较,NLRP3 siRNA组细胞内的NLRP3和caspase-1 p20蛋白水平明显降低(P<0.05),且细胞上清液中IL-1β的浓度明显下降(P<0.05),ROS无明显变化;NAC组NLRP3和caspase-1 p20蛋白水平及IL-1β浓度均明显下降(P<0.05).结论:SO2衍生物激活支气管上皮细胞NLRP3炎症小体,促进IL-1β生成.

肺鳞状细胞癌是恶性程度较高的一种肺癌,以生长迅速,易向周围组织侵犯,较早出现转移为特点.患者多以咳嗽,咯血症状为主,致命性大咯血罕见.国内外因肺癌侵犯肺内血管导致致命性大咯血病例鲜有报道.现就本院呼吸科1例此类病例进行报道.

目的 探讨新生儿细菌性肺炎外周血自然杀伤细胞和淋巴细胞亚群与病程进展的关联.方法 选择2017年1月-2019年1月深圳市盐田区人民医院收治的细菌性肺炎新生儿80例为研究对象纳入观察组,另选同期健康体检新生儿50例为对照组.观察组患者、对照组入选者入院时分别采集空腹静脉血,用流式细胞仪检测自然杀伤细胞、淋巴细胞亚群等细胞水平,并进行组间比较.采用Pearson相关性检验对患儿的外周血自然杀伤细胞与淋巴细胞亚群的相关性进行分析探讨.结果 观察组患者的自然杀伤细胞包括CD1C、CD56+、CD59+等细胞水平均低于对照组,观察组内急性期患儿的CD16+、CD56+、CD59+细胞水平均低于恢复期患儿,三组间比较差异有统计学意义(P＜0.05).观察组患者的CD3+、CD4+、CD4+/CD8+水平低于对照组,CD8+水平高于对照组;观察组内急性期患儿的CD3+、CD4+、CD4+/CD8+水平低于恢复期患儿,CD8+水平高于恢复期患儿,三组间比较差异有统计学意义(P＜0.05).经Pearson相关性分析,CD16+、CD56+、CD59+与CD3+、CD4+呈正相关性,与CD8+呈负相关性.结论 细菌性肺炎新生儿体内的免疫系统紊乱,外周血自然杀伤细胞和淋巴细胞亚群的变化与疾病的进展及恢复有密切关联.因此,通过对细菌感染性肺炎患儿进行免疫功能的监测,对于疾病的进展、疗效评估有参考价值.

AIM:To investigate the expression of FIZZ1 ( found in inflammatory zone 1) in the lung tissues from smoking-induced chronic obstructive pulmonary disease (COPD) rats and to explore the potential role of FIZZ1 in air-way remodeling in COPD. METHODS:The male Wistar rats (n=70) were used in the study. The rats were randomly di-vided into COPD group and control group. The rat model of COPD was established by inhaling cigarette smoke alone. HE staining was used to observe the pathological changes of the lung tissues for firming the successful modeling. The protein ex-pression of FIZZ1 in the lung tissues at different time points was determined by immunohistochemistry and Western blot. The inflammatory cells in bronchoalveolar lavage fluid (BALF) were counted. The concentrations of interleukin 4 (IL-4) and tumor necrosis factor α (TNF-α) in both BALF and serum were measured by ELISA. RESULTS:HE staining showed that the inflammatory response was chronic in the lung tissues of model group at 20th week and gradually showed pathologi-cal features of COPD. The results of immunohistochemistry and Western blot showed that in the model group, FIZZ1 protein expression was significantly increased (P<0. 05). Total number of inflammatory cells in BALF in the cigarette smoked rats was significantly higher from 4th week (P<0. 05). Within a certain range, compared with the control group, the concen-trations of inflammatory cytokines IL-4 and TNF-α in both BALF and serum were increased in the model group ( P <0.05). CONCLUSIONS:FIZZ1 may be involved in the occurrence and development of COPD with the mechanism of causing infiltration of inflammatory cells and secretion of cytokines.

目的 探讨阿莫西林克拉维酸钾和头孢他啶治疗新生儿肺炎的效果及其对肠道微生态的影响.方法 60例新生儿肺炎患儿,按照随机数字法分为对照1组、对照2组和研究组,各20例.对照1组予以阿莫西林克拉维酸钾治疗,对照2组予以头孢他啶治疗,研究组予以阿莫西林克拉维酸钾联合头孢他啶治疗.比较三组患儿临床疗效、治愈时间以及肠道各种益生菌数目.结果 研究组治愈率(80.00％)与对照1组(75.00％)、对照2组(85.00％)比较,差异无统计学意义(P>0.05).研究组治愈时间(5.32±1.31)d与对照1组(5.39±1.62)d、对照2组(5.42±1.37)d比较,差异无统计学意义(P>0.05).研究组肠道各种益生菌数目均显著低于对照1组、对照2组,差异有统计学意义(P<0.05).结论 阿莫西林克拉维酸钾和头孢他啶联合用药及单独用药治疗新生儿肺炎效果类似,但联合用药对肠道菌群影响更大.

Objective To compare the effect of synchronized intermittent positive pressure ventilation (SIPPV) with that of synchronized intermittent mandatory ventilation (SIMV) at the same level of parameters on the cardiac function in premature infants with hyaline membrane disease (HMD).Methods One hundred premature infants with HMD admitted in Department of Neonatology,Shenzhen People's Hospital from March 2013 to March 2015 were randomized into SIPPV group (50 cases) and SIMV group (50 cases).Both groups were treated with invasive mechanical ventilation,with the Maquet SERVO-i respirator produced in Sweden,appropriate tracheal catheter and the same level of parameters,but different ventilation mode,SIPPV group adopted SIPPV mode,SIMV group adopted SIMV mode.Other 50 healthy premature infants with matched sex,gestational age,mode of delivery and birth weight were selected as the control group.The mean airway pressure (MAP),tidal volume (VT),respiratory rate (RR),blood pressure,pH value,carbon dioxide (PCO2),oxygen partial pressure (PO2) of the SIPPV and SIMV groups were recorded.In all groups,color Doppler echocardiography was used to determine the indexes for evaluating left ventricular pump blood function,including left ventricular ejection fraction (LVEF),left ventricular fractional shortening (LVFS),left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),stroke volume (SV),heart rate (HR),and cardiac output (CO),and to measure the blood flow velocity at the valve orifices,covering peak flow rate at the aortic valve orifice (AV),and peak flow rate at the pulmonary valve orifice (PV),mitral ratio of early to late diastolic filling velocities (M-E/A) and tricuspid ratio of early to late ventricular filling velocities (T-E/A).Results MAP and VT in the SIMV group were lower than those in the SIPPV group (P ＜ 0.05).Blood pressure,pH value,PCO2,PO2 between SIPPV group and SIMV group had no significant difference (P ＞0.05).RR in the SIMV group was lower than that in the SIPPV group (P ＜0.05).LVEF,LVFS,LVEDV,LVESV,SV,CO,AV,M-E/A among the three groups did not differ significantly (P ＞ 0.05).Notable differences in HR,PV,T-E/A were found among the three groups (P ＜ 0.05).Compared with the control group,the SIPPV group had higher HR but lower PV and T-E/A (P ＜ 0.05).SIMV group had lower HR but higher PV and T-E/A than the SIPPV group did (P ＜ 0.05).And it had lower PV and T-E/A than the control group did (P ＜ 0.05).MAP and VT were negatively correlated with PV and T-E/A in both the SIPPV group and SIMV group (P ＜ 0.05).Conclusion Right ventricular diastolic function and PV decreased in both the SIPPV and SIMV groups at the same level of parameters,but they decreased more in the former group;while left ventricular pump function and diastolic function in both groups had no obvious changes.

Objective To analyze the clinical features,prevention and control measures,treatment and prognosis of catheter - related hansenula anomala fungemia occurring in neonatal intensive care unit( NICU). Methods We made a retrospective analysis of the clinical data of 5 neonates with catheter - related hansenula anomala fungemia occuring in NICU of Shenzhen People' s Hospital from September to October in 2013. Clinical manifestation,laboratory examination results and imageological examination results were recorded,and drug sensitivity test and strain identification were conducted. Results The 5 newborns were all very low birth weight infant and were all administrated with PICC for more than 2 weeks,and partial parenteral nutrition was given to several of the newborns. The 5 newborns all had fever,3 had accelerated heart rate,1 had poor response,3 had cyanosis and apnea,and 3 had shortness of breath. Leukopenia occurred in 2 newborns,thrombocytopenia occurred in 1 newborn,elevation of CRP occurred in 1 newborn,new nidus in lung was found in one newborn. The 5 newborns all had normal results of cerebrospinal fluid examination. The fungus showed sensitivity to fluconazole. The catheters were timely removed in all the 5 cases,and intravenous drip of fluconazole was administrated by 12 mg·kg - 1 ·d - 1 ,after which all the 5 newborns were cured. During the one - year follow - up,obvious abnormality was not noted in the 5 newborns. By improving health education,health management and hand hygiene,nosocomial fungal invasive infection on longer occurred in the NICU. Conclusion Catheter - related hansenula anomala fungemia is rare and has similar clinical features with common fungemia. The disease could be prevented and controlled,and fluconazole has good therapeutic effect and prognosis.

Objective To investigate tbe effect and nursing experience of TCM Reyanbao for external application for treating non-dialy-sis cbronic renal disease. Methods Totally 46 patients from July 2012 to December 2013 in tbe bospital witb cbronic renal disease were selected and performed retrospective analysis. Tbey were randomly divided into tbe control group and tbe observation group,40 cases in eacb group. Tbe control group were given tbe conventional treatment,tbe observation group were given TCM Reyanbao for ex-ternal application on tbe basis of tbe control group. Observe tbe improvement of symptoms,signs and mental states of tbe two groups. Results Tbe total effective rate in tbe observation group was 95. 65%,wbicb was obviously bigber tban 86. 96% in tbe control group( P < 0. 05). Tbe SAS and SDS scores of tbe observation group was obviously lower tban tbose of tbe control group( P < 0. 05), witb better nursing satisfaction. Conclusion TCM Reyanbao for external application in treating cbronic renal disease bas tbe effect of slowing tbe progression of tbe disease and is wortby of clinical promotion.

目的：探讨持续非卧床腹膜透析（C A PD ）患者的营养状况与护理要点。方法选取我院2010年5月～2013年5月收治的30例CAPD患者作为研究对象，对患者进行营养状况评价、人体测量、生化指标检测及半定量SGA评分四项评定，统计分析患者的营养状况，并基于评估结果进行护理干预，观察护理效果。结果半定量SGA评分23例，占76．7％患者存在不同程度的营养不良；营养生化指标检测10例，占33．3％患者营养不良；人体测量16例，占53．3％患者营养不良。护理后23例患者营养状况明显改善，护理满意度达92．4％。结论 CAPD患者营养不良发生率较高，应结合膳食营养与CAPD患者营养状况之间的关系对其进行科学的营养指导与护理。

Objective To explore the value of serum procalcitonin ( PCT) detection in differential diagnosis of intracranial infection in children. Methods A total of 95 children with intracranial infection admitted to department of pediatrics during May 2011 and May 2013 were divided into acute bacterial meningitis group ( bacteria group, n=46 ) and viral encephalitis (virus group, n=49). The changes of leukocyte counts of cerebrospinal fluid (CSF), protein quantification and serum PCT level were compared in the two groups before and after treatment, and the distribution and positive detection rate at different concentration levels of serum PCT were also compared between the two groups. Results Before the treatment, there were significant differences between the two groups in leukocyte counts of CSF, protein quantification and serum PCT level (P<0. 01);but there were no significant differences between the two groups in leu-kocyte counts of CSF and protein quantification after the treatment (P>0. 05), while there was significant difference in serum PCT level between the two groups (P<0. 01);there were no significant differences in the indexes in virus group before and after the treatment (P>0. 05), but there were significant differences in the indexes in bacteria group before and after the treatment (P<0. 05). The difference in detection distribution at different concentration levels of serum PCT in the two groups was statistically significant (Z=6. 71, P=0. 000);and the positive detection rate of serum PCT was 18. 4% in virus group and 80. 4% in bacteria group respectively, and the difference was also statistically significant (χ2 =35. 60, P=0. 000). Conclusion Serum PCT is an important index in differential diagnosis of acute bacterial meningitis and viral encephalitis and the method of serum PCT test is simple, quick and clinically worthy.

Objective To observe the dynamic expression changes of microRNA(miR)-146a and miR-29 in neonatal rats with acute lung injury (ALI) induced by lipopolysaccharide (LPS),and to explore their influence on ALI.Methods Totally 80 newborn rats aged 7 days were randomly assigned into the LPS group and control group.Intraperitoneal injection of endotoxin(5 mg/kg) was done to establish neonatal rat model of ALI in the LPS group.Rats in the control group were intraperitoneally injected with 0.1 mL 9 g/L saline.Lung tissue and blood specimens from newborn rats were taken at 6 hours,1 day,3 days and 7 days after treatment.Lung pathological changes were observed,and the levels of serum tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay.The relative expressions of lung tissues miR-146a and miR-29a were determined by reverse transcription-polymerase chain reaction.Results The lung tissue hematoxylin-eosin staining indicated ALI in the LPS group.Compared with the control group,the levels of serum TNF-α and lung tissue miR-146a showed high expression (P ＜ 0.05),while the miR-29a was significantly reduced (P ＜ 0.05).Conclusions Differential expressions of miR-146a and miR-29a have an important role in neonatal rat ALI.The key targets may provide new targets for early clinical diagnosis and treatment of ALI,as well as research and development of new medicine.

本文对我国上市公司1993年至2010年高管更换进行了研究,分析了高管更换产生的原因及其导致的经济后果,提出了相关对策建议,以期为改善我国公司治理提供参考。

目的 探讨人脐带间充质干细胞(hUCMSCs)对新生大鼠肺纤维化细胞因子水平的影响,为慢性肺部疾病临床防治提供新思路.方法 32只新生SD大鼠随机分4组(n=8):磷酸盐缓冲液(PBS)对照组(Ⅰ组)、hUCMSCs组(Ⅱ组)、博莱霉素对照组(Ⅲ组)、博莱霉素+hUCMSCs组(Ⅳ组).Ⅲ、Ⅳ组用博莱霉素腹腔注射5 mg/kg×5 d,进行肺纤维化造模.同时Ⅰ、Ⅱ组予等体积PBS腹腔注射.Ⅱ、Ⅳ组在新生鼠7 d腹腔注射(1×106) hUCMSCs,Ⅰ、Ⅲ组注射等体积PBS.30 d取时大鼠肺组织行HE染色,辐射状肺泡计数(RAC),羟脯氨酸(HYP)含量测定,荧光定量PCR测定细胞因子TNF-α、IL-6、IL-13、角化生长因子(KGF)的mRNA表达水平.结果 Ⅲ组肺泡呈发育不良,肺纤维化改变,HYP升高,各细胞因子mRNA水平升高,RAC减少.Ⅳ组病理损伤程度减轻,HYP降低,RAC增加,KGF mRNA表达降低,差异有统计学意义(P＜0.05).Ⅰ、Ⅱ组未见明显病理改变,HYP、RAC和各细胞因子mRNA水平差异无统计学意义(P＞0.05).结论 hUCMSCs具有拮抗肺纤维化作用,其机制可能部分通过旁分泌KGF,保护正常肺发育而实现的.hUCMSCs调节肺内促炎因子(TNF-α、IL-6)/抗炎因子(IL-13)间的平衡在炎症晚期不是主要保护机制.

欧盟对华光伏产品采取反倾销、反补贴的措施引起国内外的广泛关注,我国有关部门也对欧盟此举采取了相应的应对措施。贸易战并不能达到互利共赢的效果,最终只会两败俱伤。本文重点分析欧盟内部的决策与调查程序,以期从法律层面出发,寻找更优的应对策略,以更好地应对今后可能面临的贸易摩擦。

Aim:To explore the distribution and expression of Resistin like molecule beta in lungs from patients with chronic obstructive pulmonary disease(COPD).Methods: According to the latest COPD diagnostic criteria,19 patients with lung cancer underwent pneumonectomy were divided into COPD group(10 cases) and normal lung function group(9 cases).Pathomorphological changes of the lung tissues were observed by routine H.E dyeing.The expression of RELMβ in the lung tissues was identified by immunohistochemistry and western blot.Results: The RELMβ protein in COPD group(2.657±0.387)was significantly higher than that in non-COPD group(0.386±0.072)(P0.05).The correlation analysis showed that RELMβ was negatively correlated with FEV1/FVC% and FEV1/pre%,but positively correlated with smoking index(P0.05).Conclusion:The results suggest that RELMβ may participate and promote in the occurrence and development of chronic obstructive pulmonary disease.

BACKGROUND:A series of studies have found that mesenchymal stem cells play an important role in the prevention and cure of acute lung injury in adult animals. <br> OBJECTIVE:To further validate the effects of human umbilical cord mesenchymal stem cells on endotoxin-induced acute lung injury in newborn rats. <br> METHODS:Total y 120 newborn rats aged 7 days were randomly assigned to three groups. Intraperitoneal injection of 3 mg/kg endotoxin was done to establish neonatal rat model of acute lung injury in the model and stem cellgroup. Rats in the normal saline group were intraperitoneal y injected with 0.1 mL normal saline. After 30 minutes of modeling, the rats in the stem cellgroup were subjected to intraperitoneal injection of 0.1 mL human umbilical cord mesenchymal stem cells (1×106). The same volume of normal saline was administered in the normal saline and model groups. Lung tissue and blood specimens from newborn rats were taken at 6 hours, 1 day, 2 days, 4 days, and 7 days after treatment to observe lung pathological changes and detect levels of serum tumor necrosis factor-alpha and interleukin-10 as wel as myeloperoxidase activity in the lung tissue. <br> RESULTS AND CONCLUSION:The lung hematoxylin-eosin staining and myeloperoxidase activity indicated acute lung injury in the model group. At 4 and 7 days after modeling, the severity of lung injury in the stem cellgroup was lighter than that in the model group. Compared with the model group, the interleukin-10 level was&nbsp;significantly increased in the stem cellgroup, while the level of tumor necrosis factor-alpha was significantly reduced (P<0.05). These findings suggest that human umbilical cord mesenchymal stem cells transplanted into newborn rats with acute lung injury can reduce lung inflammation, and the main mechanism may be that human umbilical cord mesenchymal stem cells can balance anti-inflammatory and pro-inflammatory factors and reduce lung injury through immune regulation.

国家审计与国家治理已成为当今研究和讨论的热点。本文探讨了国家治理视角下国家审计的本质、审计目标和对象、所发挥的作用,以期对国家治理视角下的国家审计有全面、深刻的认识与理解。最后,本文提出了完善国家治理视角下的国家审计的对策建议,以期为国家审计部门提供参考。