Objective:To explore the pathogenesis and acupuncture treatment effects of neutrophil homing and extracellular trapping net in rats with ventilator-associated pneumonia (VAP).Methods:Thirty Sprague-Dawley rats were divided into a control group, a model group, an acupuncture group, an acupuncture + CXCR4 inhibitor group, and an acupuncture + neutrophil extracellular traps (NETs) inhibitor group, with six rats in each group. Rats in the control group were only exposed to the trachea and kept spontaneous breathing. In the model group, the trachea was exposed and Klebsiella pneumoniae was injected into the trachea after anesthesia. After 72 hours, the rats were intubated and connected with a small animal ventilator. High tidal volume ventilation was performed 2-3 times every 30 minutes for five hours daily for two days. Rats in the acupuncture group were treated with acupuncture after 30 minutes of successful modeling. Rats in the acupuncture + CXCR4 inhibitor group were intraperitoneally injected with CXCR4 inhibitor at a dose of 2.5 mg/kg based on body weight half an hour before bacterial injection on the first day. Rats in the acupuncture + NETs inhibitor group received intrathecal injection of NETs inhibitor at a dose of 0.8 μM/290-340 g based on body weight in 0.5-1.0 h before mechanical ventilation. Flow cytometry was used to detect the neutrophil trends in lung tissue, hematoxylin-eosin (HE) staining to observe the lung tissue pathology, and immunohistochemical staining to observe the citrullinated histone H3 (Cit-H3) and myeloperoxidase (MPO) expression levels.Results:The expression level of CD11b + CD62L in the control group, model group, acupuncture group and acupuncture + CXCR4 inhibitor group was significantly different (F = 25.150, P < 0.001). Further pairwise comparison showed that the expression level of CD62L + CD11b in the model group was significantly higher than that in the control group (P < 0.05). Compared with the model group, the expression level of CD62L + CD11b in the acupuncture + CXCR4 inhibitor group was significantly decreased (P < 0.05). HE staining showed that there was no obvious congestion, hemorrhage, edema, and neutrophil infiltration in the lung tissue of rats in the control group. Rats in the model group had obvious edema, hyperemia, and hemorrhage, with a large number of infiltrating inflammatory cells. The congestion and edema of alveoli and airway mucosa were reduced, and the infiltration of inflammatory cells was decreased in the acupuncture group. The congestion and edema of alveoli and airway mucosa and the infiltration of inflammatory cells were significantly reduced in the acupuncture + NETs inhibitor group. The lung injury score and the expression levels of Cit-H3 and MPO in the control group, model group, acupuncture group and acupuncture + NETs inhibitor group were compared, and their differences were statistically significant (F = 51.723, 227.370, 570.097; all P < 0.001). Further pairwise comparison showed that compared with the control group, the expression levels of Cit-H3 and MPO in the model group were significantly increased, and the inflammatory infiltration of lung tissue was more severe (all P < 0.05). Compared with the model group, the expression levels of Cit-H3 and MPO in the acupuncture group and acupuncture + NETs inhibitor group were significantly decreased, and the inflammatory infiltration in lung tissue was significantly reduced, especially in the acupuncture + NETs inhibitor group (all P < 0.05).Conclusions:There are neutrophil homing and excessive formation of NETs in rats with VAP. Acupuncture has no obvious inhibitory effect on neutrophil homing, but it can inhibit the excessive formation of NETs by regulating the expression of Cit-H3 and MPO, thereby reducing the inflammatory response. At the same time, acupuncture combined with CXCR4 inhibitor can significantly improve the homing of neutrophils, and their combination of NETs inhibitor has a more significant regulatory effect on NETs and a stronger improvement effect on the inflammatory response of lung tissue.

目的 探讨表面活性蛋白-A(surfactant protein-A,SP-A)在重症肺炎大鼠模型血清、肺、结肠组织中的变化规律.方法 将60只SD健康雄性大鼠随机分为对照组和重症肺炎组,分别在造模成功后即刻、12 h、24 h、36 h、48 h处死大鼠并留取血液、支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)、肺组织、肠组织标本.通过酶联免疫吸附(ELISA)方法检测血液和BLAF中SP-A和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α);蛋白质印迹法(Western blot)、免疫荧光和HE染色检测肺、肠组织中SP-A和TNF-α的表达.结果 与对照组比较,重症肺炎组各时间段BALF中的SP-A降低,而血清SP-A和TNF-α升高(P<0.05);与对照组比较,重症肺炎组各时间段肺组织SP-A表达降低,肠组织SP-A在建模后12 h短暂升高,在12 h后降低(P<0.05);而肺、肠组织中TNF-α的表达较对照组均升高(P<0.05);HE染色可见重症肺炎组肺、肠组织损伤呈逐渐加重趋势,肺组织损伤程度大于肠组织.结论 SP-A不仅可评价血气屏障的完整性,也可判断肠黏膜损伤程度,通过检测血清中SP-A的变化可早期判断重症肺炎的病情进展.

目的 观察解毒化痰平喘汤对重症肺炎患者氧化应激反应的影响.方法 收集60例重症肺炎病例,随机分为对照组与试验组各30例.对照组给予常规西医治疗,试验组在常规西医治疗基础上加用解毒化痰平喘汤治疗.检测两组治疗前后肺泡灌洗液中肺泡巨噬细胞内过氧化物酶6(PRDX6)蛋白表达及血过氧化脂质(LPO)水平,检测谷胱甘肽过氧化物酶(GSH-Px活性)变化.结果 1)解毒化痰平喘汤可增加肺泡巨噬细胞内PRDX6蛋白表达,降低LPO水平,增加GSH-Px活性,减轻重症肺炎患者氧化应激反应.2)解毒化痰平喘汤可减少急性生理学与慢性健康状况评分Ⅱ评分,降低血乳酸、C反应蛋白、降钙素原水平,提示其对肺炎严重程度及预后的改善.结论 解毒化痰平喘汤可改善重症肺炎患者氧化应激反应.

目的 观察改良隔药饼灸治疗急性肠胃炎的效果并探讨其作用机制.方法 94例患者随机分为观察组与对照组,观察组采用改良隔药饼灸"塔灸".对照组采用传统隔药饼灸.通过对比治疗起效时间、患者皮肤温度变化、烫伤发生率评价改良隔药饼灸治疗急性肠胃炎的临床疗效.结果 两组治疗后主要证候积分均明显降低(P＜0.05),观察组降低程度明显优于对照组(P＜0.05).观察组温度时间上升较快,在5 min内皮温即感觉微热,到15 min时即达到最佳温度体验温热,且治疗全程皮肤感觉温热舒适.观察组治疗过程感觉皮肤温度反应时间分布均优于对照组(均P＜ 0.05).观察组治疗反应起效快、持续时间长、效率高.观察组烫伤发生率0.00％,低于对照组的4.26％ (P＜ 0.05).两组治疗后VAS评分均低于治疗前(P＜0.05).两组治疗后总有效率、VAS评分、疼痛缓解时间、止泻时间比较,差别均不大(P＞0.05).结论 "塔灸"操作简便,温度可控,可保证有效治疗时间,减少烫伤发生率;改良隔药饼灸治疗急性肠胃炎与传统隔药饼灸疗效类似,具有较好疗效,患者易于接受.

目的 在三级甲等中医院,构建急诊-发热门诊-感染病房一体化运行机制,形成具有中医特色的防控体系,对突发公共卫生事件中的应急能力、资源整合、运营效果进行分析.方法 从部门一体化、团队一体化、专业一体化、中医治疗体系、医院感染管理5个方面,科学整合医疗资源,构建"平战结合"、具有中医特色的医疗防控体系.结果 通过对在构建前、后100例发热患者候诊时间、就诊完成时间、确诊时间、应急反应时间、中医治疗比例等几个方面进行比较,一体化模式明显优于普通模式(P＜ 0.05或P＜0.01).结论 急诊-发热门诊-感染病房一体化运行模式是一种高效、资源集中、节约运行成本、急救应急能力强效,体现中医特色的运行模式.

近年来,随着器官移植、肿瘤化放疗、结缔组织疾病的糖皮质激素等免疫抑制剂治疗的广泛开展,免疫缺陷患者呈现不断增加和累积趋势.而这些患者中,严重的呼吸道感染是免疫缺陷患者入住ICU的主要原因,同时也是免疫缺陷患者最主要的致死原因[1].此类患者呼吸系统感染有病情重、发展快、病原菌复杂、治疗效果差、病死率高等特点,给临床在诊疗过程中造成了巨大的困扰.

目的 观察补肺益肾贴对呼吸机依赖患者痰液肺表面活性物质相关蛋白-A(SP-A)含量的影响,探索SP-A在导致呼吸机依赖中可能的机制.方法 将重庆市中医院符合呼吸机依赖患者52例,随机分为实验组与对照组.实验组在西医常规治疗基础上加用补肺益肾贴外用治疗7d,对照组单纯采用西医常规治疗,留取各组入组当天、第3天、第7天的痰液标本,检测两组患者痰液中SP-A水平,记录氧合指数、脱机时间、28 d死亡率及每日按需吸痰频率.结果 1)实验组痰液中SP-A水平随治疗时间延长呈递增趋势,差异有统计学意义(P＜0.05);对照组痰液中SP-A水平前后无明显变化(P＞0.05);两组入组第3、7天SP-A含量进行组间比较,实验组较对照组改善明显(P＜0.05).2)两组治疗后,患者氧合情况均有不同程度改善,但两组组间比较,实验组较对照组改善明显(P＜0.05).3)两组患者脱机时间及28 d死亡率差异无统计学意义(P＞0.05).结论 外用补肺益肾贴敷能增加呼吸机依赖患者肺内SP-A的分泌,对患者氧合情况有一定改善作用,能减少肺内痰液的分泌,但其对脱机时间及28 d死亡率无影响.

Objective To explore the effect of ambroxol hydrochloride combined with budesonide on the airway inflammation and lung oxidative stress in allergized rats.Methods Forty cases of clean health level SD male rats were randomly divided into blank control group,model group,positive control group and test group,10 rats in each group.Except blank control group,the rats of other groups were treated with ovalbumin to build the asthma model.Model group was intraperitoneally injected 10％ ovalbumin 1 mL on 1,8 d,and 1％ ovalbumin was inhaled on 15 d,once a day for 0.5 h,till the rats appear abdominal muscle contraction,nodding and so on.Positive control group was inhaled 0.02％ budesonide 30 min before nebulization for 1 h before nebulization.The test group was intraperitoneal injected ambroxol hydrochloride 60 mg · kg-1 at 25 min before inhalation of budesonide on the basis of positive control group.Each group were intervention for 10 weeks.The numbers of lymphocytes and eosinophils in bronchoalveolar lavage fluid of rats in each group were measured by cell counting method.The airway histopathological and morphological changes were observed by hematoxylin-eosin (HE) staining.Colorimetric method was used to detect the levels of oxidative stress in lungs of each group.Results The percentages of eosinophils in blank control group,model group,positive control group and test group were (1.29 ±0.41)％,(81.44 ±5.15)％,(37.51 ±5.38)％,(20.14±4.65)％,the percentages of lymphocytes were (4.01 ± 0.87) ％,(17.38-± 2.99) ％,(11.59 ± 2.01) ％,(7.96 ± 1.43) ％.The difference betweent test group and model group and positive control group was statistically significant (P ＜0.01).HE staining showed that the most obvious pathological changes in model group,followed by positive control group.The levels of glutathione (GSH) in lung tissue of blank control group,model group,positive control group and test group were (1.54±0.15),(0.53 ±0.18),(0.79 ±0.09),(1.15 ±0.11) μmol · L-1,and reactive oxygen species (ROS) were (1643 ±163),(4986 ±195),(3619 ± 184) and (2348 ± 171) U mg-1 pro.The GSH,ROS in test group and positive control group had significant difference (P ＜ 0.01).Conclusion Ambroxol hydrochloride combined with budesonide can relieve the airway inflammation and lung oxidative stress in rats with asthma,which can be used for the treatment of acute asthma attacks.

Objective To explore the mechanism by which peroxisome proliferators-activated receptor-γ (PPAR γ) upregulates miR-16 and inhibits inflammatory response in sepsis.Methods Real-time PCR was used to investigate the expression of PPAR γand miR-16 in peripheral blood monocytes of patients with sepsis and healthy subjects,and the correlation between PPAR γand miR-16 was analyzed.THP-1 and RAW246.7 cells were treated with the PPAR γagonist RGZ,PPAR γsiRNA or a mir-16 inhibitor (antagomir16),and the changes in the expressions of miR-16 and its target gene IKKα were detected using real-time PCR and Western blotting.The cells were transfected with luciferase reporter gene plasmid containing the miR-16 promoter region followed by treatment with RGZ or the PPAR γ antagonist GW9662,and luciferase reporter assay was performed to detect the changes in the reporter gene activity.In cells treated with RGZ followed then by LPS,the expression levels of the inflammatory factors tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) were detected using ELISA.In a mouse model of LPS-induced sepsis,following treatment with RGZ with or without antagomir-16 pretreatment,the expression of miR-16 in peripheral blood monocytes was detected with real-time PCR,and the expression of TNFα and IL-6 were determined using ELISA.Results The expressions of PPAR γ and miR-16 in peripheral blood monocytes were significantly reduced in patients with sepsis (P ＜ 0.05).In THP-1 and RAW246.7 cells,the activation of PPAR γ obviously increased the expression of miR-16 by enhancing the transcriptional activity of miR16 promoter and consequently inhibited the expression of IKKα,the target gene of miR-16 (P ＜ 0.05).PPAR γ inhibited production of TNFα and IL-6 in the inflammatory cells by increasing the expression of miR-16 (P ＜ 0.05).Treatment with PPAR γsignificantly decreased the serum levels of TNFα and IL-6 in mouse models of LPS-induced sepsis (P ＜ 0.05).Conclusion Activation of PPAR γ inhibits the expression of inflammatory cytokines in inflammatory cells and suppresses inflammatory response in septic mice by upregulating miR-16.

Objective:To observe the effect of combined selection of Yuan point and Luo point and Bushen Yishou Capsule on serum homocysteine level,intelligent damage,dysuria and TCM syndrome score in patients with cerebral infarction and urinary incontinence.Methods:120 patients with cerebral infarction and limb dysplasia were randomly divided into 3 groups according to the random number table method.On the basis of routine treatment and nursing care,the acupuncture treatment group followed the principle of combined selection of Yuan point and Luo point with acupuncture treatment.Bushen Yishou Capsule were given 0.6 grams of Bushen Yishou Capsule orally,3 times a day;the combined group was treated with combined selection of Yuan point and Luo point combined with oral Bushen Yishou Capsule.Before and after treatment,serum homocysteine levels,Hasegawa dementia score (HDS),dysuria (including B-ultrasonography residual urine,urinary dynamic changes)and TCM syndrome scores were observed in three groups.Results:The levels of homocysteine,Hasegawa dementia scale (HDS),B-ultrasonography residual urine,urinary kinetics and TCM score were significantly improved in the three groups (P＜ 0.01).There was no significant difference between the acupuncture treatment group and Bushen Yishou Capsule group (P＞ 0.05).The improvement of the indexes in the combined group was better than that in the acupuncture group and the drug group (P＜ 0.01).Conclusion:The combined selection of Yuan point and Luo point combined with Bushen Yishou Capsule can improve the serum homocysteine level,the Hasegawa Dementia Scale(HDS) score,the urinary obstruction and the TCM syndrome score.

目的 观察抗组胺药物、5-羟色胺受体阻滞剂及β-内啡肽拮抗剂治疗肝胆疾病所致皮肤瘙痒症的临床疗效及与相关瘙痒介质的关系.方法 将肝胆疾病所致皮肤瘙痒症患者90例随机分为3组各30例,分别予以氯雷他定片、纳洛酮和格拉司琼治疗,观察治疗前后瘙痒症状评分及瘙痒程度直观模拟评分(IS)变化情况;分析患者组胺、5-羟色胺、β-内啡肽的变化与瘙痒症状评分变化的相关性.结果 使用3种药物治疗后患者瘙痒症状积分及IS积分均有明显下降;组胺降低与瘙痒症状积分下降呈正相关,5-羟色胺及β-内啡肽的降低与瘙痒症状积分下降无关.结论 5-羟色胺受体阻滞剂格拉司琼及β-内啡肽拮抗剂纳洛酮治疗肝胆疾病所致皮肤瘙痒症有效.

目的 研究膳食纤维肠内营养对伴有高血糖危重症患者免疫功能及炎性因子的影响.方法 将46例伴有高血糖危重症患者随机分为2组,分别给予标准肠内营养组(对照组)和膳食纤维肠内营养组(研究组),每组23例,治疗10d.观察两组患者治疗前后外周血T细胞亚群CD3、CD4、CD8百分比及CD4/CD8比值以及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)、白细胞介素-10 (IL-10)水平.结果 研究组治疗后CD3、CD4百分比及CD4/CD8比值均较治疗前升高(P＜0.05),但CD8的变化无统计学意义(P＞0.05);对照组治疗前后T细胞亚群的变化无统计学意义(P＞0.05).两组治疗后TNF-α及IL-6水平下降(P＜0.05),且研究组IL-6及TNF-α水平低于对照组(P＜0.05).治疗前后两组IL-10水平变化无统计学意义(P＞0.05).结论 膳食纤维肠内营养支持治疗较标准肠内营养能增强伴有高血糖危重症患者机体的免疫功能,减轻炎症反应,从而有利于改善预后.