Acute lung injury/acute respiratory distress syndrome （ALI/ARDS）, which manifests as non-cardiogcnic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or ind...Acute lung injury/acute respiratory distress syndrome （ALI/ARDS）, which manifests as non-cardiogcnic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/ARDS, include the ventilatory, pharmacological, as well as cell therapies.展开更多
Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition t...Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ALI.Currently,there are limited treatment options available beyond conservative respiratory support.However,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service.In this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.展开更多
背景中医药治疗脓毒症性急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的疗效确切,但大多数已发表的临床试验设计中缺乏标准、统一的结局指标,造成同类研究结果难以合并、对比,无法产生高质量的循证证据指导临床决策。目的分析2017—2022...背景中医药治疗脓毒症性急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的疗效确切,但大多数已发表的临床试验设计中缺乏标准、统一的结局指标,造成同类研究结果难以合并、对比,无法产生高质量的循证证据指导临床决策。目的分析2017—2022年中医药治疗脓毒症性ALI/ARDS临床试验结局指标的使用情况。方法检索中国知网(CNKI)、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library数据库中有关脓毒症性ALI或ARDS的随机对照试验,其中干预组措施为中医药联合其他药物或常规治疗方案,对照组不做限制。采用Cochrane研发的ROB.2工具进行文献质量评价并总结结局指标分类情况。结果经筛选后纳入39篇文献,其中文献偏倚风险评估为低风险1篇(2.56%),高风险3篇(7.69%),可能存在风险35篇(89.74%)。5篇(12.82%)文献结局指标报告质量评分≥5分,为结局指标报告完整。共报告106种结局指标,累计使用443次,包括理化检测(55种,51.89%)、中医症状/证候(2种,1.89%)、症状/体征(13种,12.26%)、远期预后(19种,17.92%)、生活质量(7种,6.60%)、安全性事件(8种,7.55%)和经济学评估(2种,1.89%)。使用率>50%的结局指标有4个,分别是氧合指数(82.05%)、急性生理与慢性健康状况评分系统Ⅱ(58.97%)、机械通气时间(51.28%)和白介素6(51.28%)。21篇文献使用有效率和/或中医证候疗效的复合结局指标,包括总有效率12次,中医证候积分8次和中医症状疗效6次。由于各结局指标差异较大,对106种指标进行合并和依次归类,最终总结出3个大类,分别为:整体评价指标(36种,33.96%)、共性指标(36种,33.96%)及不同关注重点指标(34种,32.08%)。结论目前中医药治疗脓毒症性ALI/ARDS临床试验结局指标的选择尚不规范,主要表现为主次结局指标区分不明确、复合结局指标标准不统一、轻视终点指标、缺少随访数据和中医特色指标等。未来应构建脓毒症性ALI/ARDS的中医药核心结局指标集,推动中医药的高质量发展。展开更多
Objective:To observe the effects of electroacupuncture(EA)pretreatment on M1 polarization of alveolar macrophages(AMs)in rats with acute lung injury(ALI)induced by lipopolysaccharide(LPS),and to explore the potential ...Objective:To observe the effects of electroacupuncture(EA)pretreatment on M1 polarization of alveolar macrophages(AMs)in rats with acute lung injury(ALI)induced by lipopolysaccharide(LPS),and to explore the potential protective mechanism of EA.Methods:Forty Sprague-Dawley rats were randomly divided into a normal group,a model group,and three groups of EA pretreatment[including a Chize(LU5)group,a Zusanli(ST36)group and a Chize(LU5)plus Zusanli(ST36)group],with eight rats in each group.The model rats of ALI were established by instilling LPS[2 mg/(kg·bw)]into the trachea of rats for 3 h.The rats in each EA pretreatment group were pretreated with EA for 30 min per day at the corresponding bilateral acupoints 6 d before instilling LPS.Three hours after modeling,the pulmonary function of the rats was tested,and the lung tissue was taken to calculate the ratio of lung wet weight to dry weight(W/D).The pathological lung changes and the injury score were observed by hematoxylin-eosin staining.The contents of tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and myeloperoxidase(MPO)in rat's bronchoalveolar lavage fluid(BALF)were detected by enzyme-linked immunosorbent assay.The mRNA and protein expression levels of M1 macrophage markers clusters of differentiation 86(CD86),inducible nitric oxide synthase(iNOS),and its signaling pathway factor Toll-like receptor(TLR)4,and nuclear factor-κB(NF-κB)p65 in the alveoli were detected by fluorescence quantitative polymerase chain reaction and Western blot,respectively.Results:After being induced by LPS,the pulmonary function of the model rats showed that the forced expiratory volume in 0.1 s(FEV0.1),forced expiratory volume in 0.3 s(FEV0.3),and their respective ratios of FEV to forced vital capacity(FVC)(including FEV0.1/FVC and FEV0.3/FVC)were significantly decreased(P<0.01),while the W/D of lung tissue was increased(P<0.01).The score of lung injury was significantly higher(P<0.01).The contents of TNF-α,IL-1β,and MPO in the BALF and the mRNA and protein expression levels of CD86,iNOS,TLR4,and NF-κB p65 in the lung tissue were significantly increased(P<0.01).After EA pretreatment,the FEV0.1,FEV0.3,FEV0.1/FVC,and FEV0.3/FVC were significantly increased,the lung injury score decreased significantly,and the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs and proteins in the alveoli decreased significantly(P<0.05 or P<0.01).Compared with the other two single acupoint groups,the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs in the alveoli in the Chize(LU5)plus Zusanli(ST36)group were significantly lower(P<0.01).Conclusion:EA pretreatment at Chize(LU5)and Zusanli(ST36)can inhibit inflammation and reduce pulmonary injury in ALI rats induced by LPS.The effect of the combination of Chize(LU5)and Zusanli(ST36)is better than that of using these two acupoints separately,and its mechanism may be related to the inhibition of AMs'M1 polarization by down-regulation TLR4/NF-κB signaling pathway.展开更多
文摘Acute lung injury/acute respiratory distress syndrome （ALI/ARDS）, which manifests as non-cardiogcnic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/ARDS, include the ventilatory, pharmacological, as well as cell therapies.
文摘Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ALI.Currently,there are limited treatment options available beyond conservative respiratory support.However,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service.In this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.
文摘背景中医药治疗脓毒症性急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的疗效确切,但大多数已发表的临床试验设计中缺乏标准、统一的结局指标,造成同类研究结果难以合并、对比,无法产生高质量的循证证据指导临床决策。目的分析2017—2022年中医药治疗脓毒症性ALI/ARDS临床试验结局指标的使用情况。方法检索中国知网(CNKI)、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library数据库中有关脓毒症性ALI或ARDS的随机对照试验,其中干预组措施为中医药联合其他药物或常规治疗方案,对照组不做限制。采用Cochrane研发的ROB.2工具进行文献质量评价并总结结局指标分类情况。结果经筛选后纳入39篇文献,其中文献偏倚风险评估为低风险1篇(2.56%),高风险3篇(7.69%),可能存在风险35篇(89.74%)。5篇(12.82%)文献结局指标报告质量评分≥5分,为结局指标报告完整。共报告106种结局指标,累计使用443次,包括理化检测(55种,51.89%)、中医症状/证候(2种,1.89%)、症状/体征(13种,12.26%)、远期预后(19种,17.92%)、生活质量(7种,6.60%)、安全性事件(8种,7.55%)和经济学评估(2种,1.89%)。使用率>50%的结局指标有4个,分别是氧合指数(82.05%)、急性生理与慢性健康状况评分系统Ⅱ(58.97%)、机械通气时间(51.28%)和白介素6(51.28%)。21篇文献使用有效率和/或中医证候疗效的复合结局指标,包括总有效率12次,中医证候积分8次和中医症状疗效6次。由于各结局指标差异较大,对106种指标进行合并和依次归类,最终总结出3个大类,分别为:整体评价指标(36种,33.96%)、共性指标(36种,33.96%)及不同关注重点指标(34种,32.08%)。结论目前中医药治疗脓毒症性ALI/ARDS临床试验结局指标的选择尚不规范,主要表现为主次结局指标区分不明确、复合结局指标标准不统一、轻视终点指标、缺少随访数据和中医特色指标等。未来应构建脓毒症性ALI/ARDS的中医药核心结局指标集,推动中医药的高质量发展。
文摘Objective:To observe the effects of electroacupuncture(EA)pretreatment on M1 polarization of alveolar macrophages(AMs)in rats with acute lung injury(ALI)induced by lipopolysaccharide(LPS),and to explore the potential protective mechanism of EA.Methods:Forty Sprague-Dawley rats were randomly divided into a normal group,a model group,and three groups of EA pretreatment[including a Chize(LU5)group,a Zusanli(ST36)group and a Chize(LU5)plus Zusanli(ST36)group],with eight rats in each group.The model rats of ALI were established by instilling LPS[2 mg/(kg·bw)]into the trachea of rats for 3 h.The rats in each EA pretreatment group were pretreated with EA for 30 min per day at the corresponding bilateral acupoints 6 d before instilling LPS.Three hours after modeling,the pulmonary function of the rats was tested,and the lung tissue was taken to calculate the ratio of lung wet weight to dry weight(W/D).The pathological lung changes and the injury score were observed by hematoxylin-eosin staining.The contents of tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and myeloperoxidase(MPO)in rat's bronchoalveolar lavage fluid(BALF)were detected by enzyme-linked immunosorbent assay.The mRNA and protein expression levels of M1 macrophage markers clusters of differentiation 86(CD86),inducible nitric oxide synthase(iNOS),and its signaling pathway factor Toll-like receptor(TLR)4,and nuclear factor-κB(NF-κB)p65 in the alveoli were detected by fluorescence quantitative polymerase chain reaction and Western blot,respectively.Results:After being induced by LPS,the pulmonary function of the model rats showed that the forced expiratory volume in 0.1 s(FEV0.1),forced expiratory volume in 0.3 s(FEV0.3),and their respective ratios of FEV to forced vital capacity(FVC)(including FEV0.1/FVC and FEV0.3/FVC)were significantly decreased(P<0.01),while the W/D of lung tissue was increased(P<0.01).The score of lung injury was significantly higher(P<0.01).The contents of TNF-α,IL-1β,and MPO in the BALF and the mRNA and protein expression levels of CD86,iNOS,TLR4,and NF-κB p65 in the lung tissue were significantly increased(P<0.01).After EA pretreatment,the FEV0.1,FEV0.3,FEV0.1/FVC,and FEV0.3/FVC were significantly increased,the lung injury score decreased significantly,and the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs and proteins in the alveoli decreased significantly(P<0.05 or P<0.01).Compared with the other two single acupoint groups,the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs in the alveoli in the Chize(LU5)plus Zusanli(ST36)group were significantly lower(P<0.01).Conclusion:EA pretreatment at Chize(LU5)and Zusanli(ST36)can inhibit inflammation and reduce pulmonary injury in ALI rats induced by LPS.The effect of the combination of Chize(LU5)and Zusanli(ST36)is better than that of using these two acupoints separately,and its mechanism may be related to the inhibition of AMs'M1 polarization by down-regulation TLR4/NF-κB signaling pathway.
