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。
ObjectiveTo systematically review the efficacy and safety of N-acetylcysteine (NAC) for patients with idiopathic pulmonary fibrosis (IPF). MethodsWe electronically searched PubMed, EMbase, The Cochrane Library (Issue 2, 2014), CNKI, WanFang Data and VIP databases from the date of establishment to February 2014 for all randomized controlled trials (RCTs) on the use of NAC in patients with IPF. Manual search in relevant journals were also performed. The data extraction and quality assessment of included RCTs were conducted by two reviewers independently. Then, meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 13 RCTs involving 713 patients were included. The results of meta-analysis indicated that the NAC group was better than the control group in clinical effectiveness (RR=1.34, 95%CI 1.19 to 1.51, P < 0.000 1). After treatment, the lung function was also improved in the NAC group than in the control group in the following index:PaO2 (MD=6.06, 95%CI 3.79 to 8.32, P < 0.000 01), vital capacity (VC) (%) (MD=4.79, 95%CI 0.35 to 9.24, P=0.03) and diffusing capacity of carbon monoxide (Dlco) (%) (MD=5.74, 95%CI 2.67 to 8.81, P=0.000 2). However, no significant difference was found between groups in total lung capacity (TLC) (%) (MD=5.56, 95%CI-1.73 to 12.86, P=0.14). No serious or frequently-happened adverse effect was reported in the NAC group. ConclusionThe current evidence suggests that NAC in long term use could improve clinical conditions, PaO2 and lung function of IPF patients, with less adverse effects.
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.