【摘要翻译】 一 氧化氮合酶( NOS) -2( NOS-2) 的诱导和一氧化氮产物增加是过敏性气道疾病的共同特征。严重哮喘与气道S-亚硝基硫醇减少相关。S-亚硝基硫醇是NO的生化产物, 可通过促炎症转录因子NF-κB 的S-亚硝基化抑制炎症反应。因此, 重建气道S-亚硝基硫醇对治疗可能有益。我们对此假设在以卵清蛋白诱导的过敏性炎症大鼠模型中进行验证。未使用或使用卵清蛋白致敏的动物均在卵清蛋白激发前于气管内灌注S-亚硝基谷胱甘肽( GSNO;50 μl, 10 mM) , 并在48 h 以后进行分析。GSNO 给药增加了肺组织S-亚硝基硫醇水平。与对照组比, GSNO 降低了卵清蛋白致敏动物NF-κB 的活性, 但对支气管肺泡灌洗细胞总数、分类计数及杯状细胞化生标记物均无显著影响。GSNO给药也改变了HIF-1 的活性, 导致未致敏大鼠HIF-1 活化,但抑制卵清蛋白致敏大鼠的HIF-1 活性。我们使用NOS-2基因敲除小鼠来评价内源性一氧化氮合成酶-2 在调节NF-κB和( 或) HIF-1 活性及气道过敏性炎症的作用。尽管在NOS-2 基因敲除小鼠中卵清蛋白诱导的NF-κB 活力轻度增高, 这与支气管肺泡灌洗中性粒细胞轻度增加有关, 其他的过敏性炎症指标和HIF-1 活性在NOS-2 基因敲除及野生型小鼠之间却无明显相差。总体来说, 我们的研究表明GSNO灌注能抑制气道过敏性炎症中NF-κB 活性, 但是并不能显著地影响大部分炎症及杯状细胞化生指标, 这样可能因为对其他信号通道( 比如HIF-1) 的影响而限制了它的治疗价值。【述评】 GSNO 是近年哮喘治疗研究的热点。既往的研究发现GSNO 在哮喘治疗中有一定前景。本研究却发现GSNO 气管内滴注虽能抑制过敏性气道炎症中NF-κB 活性,但并不能显著抑制气道炎症反应及杯状细胞化生这两个哮喘关键病理改变, 可能与GSNO 同时影响了HIF-1 等其他信号通路有关。该研究表明GSNO 对哮喘气道炎症治疗效果有限, 同时表明哮喘气道炎症调控机制较为复杂, 治疗药物的设计需考虑多种信号通路对哮喘气道炎症的影响。
ObjectivesTo detect expressions of trefoil factor 1 (TFF1) and TFF3 in the mice with acute allergic airway disease (AAD) after different interventions, and explore primitively the effect of recombinant TFF3 on airway inflammation and mucous secretion.MethodsForty BALB/c mice were randomly divided into 5 groups, each group with 8 mice, ie. a normal saline control group (group A), an AAD group (group B), a budesonide intervention group (group C), a recombinant TFF3 intervention group (group D), and a budesonide+recombinant TFF3 intervention group (group D). The BALB/c mice were sensitized and challenged with ovalbumin to induce AAD. Lung tissue sections were stained with hematoxylin-eosin staining for assessment of airway inflammation, and immunohistochemistry was used for detecting TFF1/TFF3 expression in the airway. Alcian blue stain was applied to determine mucous secretion.ResultsAirway inflammation score and airway mucous secretion: Group B was significantly more than group A (P<0.01); Group C was less than group B (P<0.05), and there was no significant difference between group D and group B (P>0.05); There was no significant difference between group C and group E (P>0.05). Expression of TFFs: TFF1 and TFF3 were expressed in epithelial cells, goblet cells and submucosal gland cells of bronchi and bronchioles in all groups; The expressions of TFF1 and TFF3 in group B were significantly higher than those in group A (P<0.01), while the expressions of TFF1 and TFF3 in group C were lower than those in group B (P<0.05). TFF1 expression in airway epithelium was positively correlated with inflammatory score (r=0.876, P=0.000) and mucin expression (r=0.807, P=0.000). TFF3 level was positively correlated with inflammatory score (r=0.654, P=0.006) and mucin expression (r=0.666, P=0.005).ConclusionsOvalbumin-induced acute allergic airway inflammation significantly increases TFF1/TFF3 expression. Intranasal TFF3 treatment may not influence airway inflammation and mucus secretion. Inhaled corticosteroids to some extent inhibit expressions of TFF1 and TFF3, simultaneously suppress airway inflammation and mucus secretion in the mouse model of acute AAD .
Objective To propose the terminology of acoustic hypersensitivity, and investigate its clinical features and relationship with tinnitus. Methods A total of 214 patients with acoustic hypersensitivity or tinnitus as their first chief complaint were recruited and studied between January 2014 to January 2016. Detailed information of clinical manifestations, accompanying symptoms and related medical history were collected in the patients with acoustic hypersensitivity. Patients were instructed to complete the Hyperacusis Questionnaire and the Self-rating Anxiety Scale. The Tinnitus Evaluation Questionnaire was used to evaluate tinnitus severity in patients with tinnitus. Results Among the patients with acoustic hypersensitivity as their first chief complaint, 93.3% had tinnitus; 47.3% of the patients with tinnitus as their first chief complaint had acoustic hypersensitivity and the prevalence of acoustic hypersensitivity increased as the tinnitus severity increased. In terms of onset of the two symptoms, simultaneous acoustic hypersensitivity and tinnitus occurred in 55.1% of the patients, acoustic hypersensitivity occurred after tinnitus in 34.7% of the patients, and acoustic hypersensitivity occurred before tinnitus in 10.2% of the patients. Most patients with acoustic hypersensitivity as the first chief complaint felt uncomfortable to any sounds that are louder than usual. The main manifestations included feeling disturbed, echoing in the ear or head, ear fullness or pain. Discomfort in 68.6% of the patients disappeared when there was no environmental sound. It was found that hearing loss, ear fullness, vertigo, and anxiety were usually present in patients with acoustic hypersensitivity, and 28.6% of the patients with acoustic hypersensitivity had a history of noise exposure. Conclusions Acoustic hypersensitivity occurs together with tinnitus for the majority of time, which shows a close relationship between these two symptoms. However, acoustic hypersensitivity shows different clinical manifestations from tinnitus. It is important to unify the terminology and standardize the concept of acoustic hypersensitivity among clinicians. It is also critical to conduct more clinical research in terms of diagnosing and evaluating acoustic hypersensitivity.
Objective To investigate the clinical significance of the level of serum amylase and serum IgA and total IgE in henoch-schonlein purpura patients with gastrointestinal involvement (also known as "Henoch purpura "). Methods Levels of serum amylase and serum IgA and total IgE in henoch-schonlein purpura patients with or without abdominal pain or patients with acute abdominal pain were compared. Results The average level (180.3 ± 15.8 IU) of serum amylase of Henoch purpura patients was significantly higher than HSP patients without abdominal pain and acute abdominal pain patients (F=32.214, P=0.009); Ratio of cases of increased level of serum IgA in henoch purpura abdomen patients was 44.2%, and there was no significant difference with HSP patients without abdominal pain. But ratio of two groups was respectively higher than the acute abdominal pain patients group (χ2=13.73, P=0.001); Ratio of cases of increased level of serum IgE in Henoch purpura abdomen patients accounted for 40.4%, but there was no significant difference among the three group (χ2=1.80，P=0.41). Conclusion Levels of serum amylase increase and serum IgA increase conduce to diagnose HSP patients with the onset of abdominal pain, and serum total IgE has little significance.
Objective To investigate the status of nurses’ cognition of skin test for β-lactam antibiotics in tertiary hospitals in China and its influencing factors. Methods The nurses in the eastern and western regions were selected by stratified sampling and convenient sampling between March and May 2023. A multi-center survey was conducted with the help of the questionnaire star platform using the “Questionnaire on the Cognitive Status of β-lactam Antibiotics Skin Test” developed by the “Guidelines for β-lactam Antibiotics Skin Test (2021 Edition)” issued by the National Health Commission of the reference country. Results A total of 89 tertiary hospitals were surveyed. Among them, there were 27 in the eastern regions and 62 in the western regions; There were 64 comprehensive hospitals and 25 specialized hospitals. A total of 4 241 nurses were included. Among them, 4 151 were females and 90 were males. The scores of nurses’ cognition of skin test of β-lactam antibiotics were (61.47±16.27). The survey results showed that the accuracy rate ranges from 15.52% to 88.98%. Only no routine skin test before cephalosporin administration, judgment of skin test results, and infusion device replacement after allergy were greater than 80%. The results of the logistic regression analysis showed that the nurses with professional titles and antimicrobial management training in the past 2 years were independent influencing factors of nurses’ cognition of skin test of β-lactam antibiotics (P<0.001). Conclusions At present, nurses in tertiary hospitals in China still have insufficient knowledge of skin test of β-lactam antibiotics. It is suggested that hospitals should form corresponding hospital skin test of β-lactam antibiotics standards in combination with guidelines and strengthen training for nurses in this regard, so as to improve nurses’ correct cognition and implementation of skin test of β-lactam antibiotics.
Objective To investigate the clinical features of hypersensitivity pneumonitis and misdiagnosis causes. Methods The morbidity, misdiagnosis, progression, treatment, recovery, relapse and experience of treatment of a case with hypersensitivity pneumonitis was retrospectively analyzed. Results Patients with hypersensitivity pneumonitis usually have a contact history of organic dust, and clinical manifestations are nonspecific. Chest radiography shows wandering pattern of multiple reticular or patchy infiltration shadows. Lung function tests showrestricted ventilation and impaired diffusion. Blood eosinophil is usually normal. Lymphocyte and sedimentation antibody in serum and bronchoalveolar lavage fluid may still be normal. Pathohistology is complicated, with a progression from acute inflammation to chronic fibrosis. Systemic steroid should be prescribed as soon as possible. Antigen avoidance should be emphasized. Conclusions Clinical symptoms of hypersensitivity pneumonitis is atypical, which may be easily misdiagnosed. The contact history, clinical features, chest radiography, laboratory examination and pathological changes should all be considered in such cases.