急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）是指心源性以外的各种肺内外致病因素导致的原发或继发的急性、进行性呼吸衰竭，其病理改变主要表现为肺上皮及内皮细胞的损伤、炎性浸润和透明膜形成，并伴有肺间质纤维化。临床表现为以呼吸窘迫、顽固性低氧血症和非心源性肺水肿为特征的一种急性进行性呼吸困难。采用常规的治疗难以纠正其低氧血症，死亡率高达60%，严重威胁人们的生命健康[1]。自1967年Ashbaugh及其同事首次描述ALI/ARDS以来，医学研究者进行了大量关于ALI/ARDS发病机制及病理生理学的基础及临床研究，但是迄今ALI/ARDS的发病机理仍未完全阐明。近年来越来越多的研究提示凋亡因子（Fas/Fas配体，即Fas/FasL）介导的细胞凋亡在ALI/ARDS的发生发展过程中有着十分重要的作用[2，3]。本文就Fas/FasL的生物学特性及其在ALI/ARDS发病机制中的作用作一综述。
Influenza A is an acute infectious respiratory disease caused by influenza A virus, with typical signs and symptoms of upper and / or lower respiratory tract involvement, and symptoms of systemic disease such as fever, headache, myalgia and fatigue. Although it is a self-limited disease in the general population, it is associated with increased morbidity and mortality in some high-risk populations and often leads serious complications, such as severe acute lung injury, acute respiratory distress syndrome, as well as other extrapulmonary injuries. The exploration of the mechanisms of lung injury caused by influenza A infection could be helpful to understand the pathogenic mechanisms of other viral pneumonias, such as coronavirus disease 2019.
In recent years, with the wide application of metagenomics next-generation sequencing, more and more rare pathogens have been detected in our clinical work, including non-tuberculous Mycobacterium, Corynebacterium, Fusarium, Cryptococcus pneumoniae, human herpes virus, torque teno virus, parvovirus, Tropheryma whipplei, Bartonella, Chlamydia psittaci, etc. It is difficult to determine whether these rare pathogens are clinically significant and need treatment. This article puts forward some suggestions and discussions on the diagnosis and treatment of pulmonary infections with some rare pathogens.
目的：调查6个短串联重复（short tandem repeat，STR）基因座在中国四川成都汉族人群中的基因频率分布。方法：应用四色荧光标记引物复合扩增技术对260名成都汉族无关个体的血样6个STR基因座进行多态性研究。结果：在四川成都汉族人群中6个STR基因座个体识别机率PD为0.796～0.913，杂合度HO为0.627～0.796，多态信息含量PIC为0.57～0.75。6个STR基因座PD总值为0.999 995 97。所有基因座经卡方检验符合Hard-Weinberg平衡。结论：上述6个STR基因座在成都汉族人群中等位基因分布较好，个体识别率高，适合法医个体识别和亲子鉴定。
Community-acquired pneumonia (CAP) is still a common disease that seriously affects people’s health. It is of great clinical significance for proper anti-infective therapy to identify the characteristics and changes of the pathogens. Along with the accelerated process of aging population, increased use of immunosuppression agents, and increased morbidity of malignant tumor and underlying diseases, the pathogenic spectrum of patients with CAP varies as well. This article reviews the important pathogenic changes of CAP in recent years.
Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.
ObjectiveTo evaluate the efficacy of aerosolized aminoglycoside antibiotics in patients with ventilator-associated pneumonia (VAP) by meta-analysis.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, VIP and Wanfang Data for the Chinese and English literature on aerosolized aminoglycoside antibiotics for VAP until May, 2018. After data extraction and quality evaluation, RevMan 5.2 software was performed for meta-analysis.ResultsA total of 9 randomized controlled trials and a total of 543 patients were included in this study. Compared with patients treated with non-atomized inhaled aminoglycoside antibiotics, meta-analysis showed that aerosol inhalation of amikacin significantly improved the clinical cure rate of patients with VAP ［odds ratio (OR)=2.37, 95% confidence interval (CI) (1.50, 3.75), P=0.000 2］, nebulized tobramycin ［OR=2.30, 95%CI (0.92, 5.78), P=0.08］ and two or more antibiotics ［OR=2.00, 95%CI (0.62, 6.46), P=0.25］ had no significant effect on the clinical cure rate of patients with VAP; aerosolized aminoglycoside antibiotics had no significant effect on mortality of patients ［OR=1.17, 95%CI (0.66, 2.07), P=0.59］ and tracheal spasm rate ［OR=2.39, 95%CI (0.94, 6.11), P=0.07］ and renal dysfunction rate ［OR=0.62, 95%CI (0.32, 1.21), P=0.16］ in patients with VAP.ConclusionInhalation of amikacin can significantly improve the clinical cure rate of patients with VAP, but it can not reduce the mortality rate of patients; the safety of aerosolized aminoglycoside antibiotics is good, and the risk of tracheal spasm and renal function damage in patients with VAP is not increased.
Bronchiectasis is a heterogeneous disease characterized by abnormal expansion of the bronchi, manifested by cough, sputum, and recurring lung infections. As one of the common fungi of lung infection, aspergillus can not only appear as the outcome of the disease in bronchiectasis, but also as an inducement to participate in the disease progression, and ultimately complicate the course of bronchiectasis. This article describes the susceptibility factors and pathogenic mechanisms of aspergillus in bronchiectasis, and further introduces the diagnosis and treatment status of bronchiectasis combined with aspergillus infection, aiming to clarify the effect of aspergillus infection on bronchiectasis and provide new thinking directions for its clinical diagnosis and treatment.
Sarcoidosis is a multi-organ inflammatory disorder characterized by the presence of non-caseating granulomas primarily affecting the lungs. The pathogenesis of sarcoidosis has not been fully clarified. In recent years, studies have suggested that a variety of pathogen infections, including Mycobacterium tuberculosis, Propionibacterium acnes, fungi, viruses, may be related to the occurrence and progression of sarcoidosis. This article reviews the researches on sarcoidosis and pathogen infection, aiming to explore the potential role of pathogen infection in the pathogenesis of sarcoidosis and provide another direction for the treatment of sarcoidosis.
The common cold is the most common acute respiratory infectious disease, with a high incidence and widespread susceptibility. Most common colds are self-limited but can lead to serious social and economic burdens. In recent years, the symptoms of common cold patients have been complex and diverse, and some patients can develop serious complications, even threatening their lives. The Anti-infection Committee, Emergency Doctor Branch of Chinese Medical Doctor Association has developed the Practice Guidelines for the Diagnosis and Management of Common Cold in Adults, 2023, which explored 15 important issues related to clinical practice. This article provides a detailed and comprehensive interpretation of the guideline, in order to better understand the diagnosis and treatment of adult common cold and serve clinical practice.