儿童重症监护室呼吸机相关肺炎影响因素及其护理

目的:探讨儿童重症监护室(PICU)呼吸机相关肺炎的影响因素,以加强预防和控制。方法:对机械通气中发生呼吸机相关肺炎63例患儿进行Logistic回归分析,并进行统计分析。结果:185例机械通气患儿中,发生呼吸机相关肺炎的为63例,发生率为34.1%。主要影响因素有应用抗生素使用情况、留置胃管、定时翻身、口腔护理、通气时间及药物应用等。结论:VAP发生与多种因素有关,其防治要采取综合措施。

大鼠放射性肺损伤模型的动态病理学观察

目的:建立放射性肺损伤大鼠模型,动态观察放射性肺损伤的病理学变化。方法:采用6 MV X射线单次30 Gy照射,建立大鼠半胸放射性肺损伤动物模型,完全随机分为正常对照组1组、照射组5组(每组5只)。在照射后第1、7、14、28和56天处死1只正常对照组大鼠和1组照射组大鼠,行电镜、HE染色比较观察各组肺组织病理学变化。正常对照组及照射后第1天组大鼠部分肺组织行凋亡指数测定。结果:放射性肺损伤的病理变化过程大致经过急性炎症、增生和纤维化3个时期,电镜观察各个时间点均可见凋亡的Ⅱ型肺泡上皮细胞。照射后第1天的细胞凋亡指数明显高于正常对照组,差异有统计学意义,P<0.001。结论:放射性肺损伤的病理改变是一个动态发展的过程,Ⅱ型肺泡上皮细胞凋亡在放射性肺损伤的发生、发展中可能发挥了重要的作用。

隐孔菌多糖对脂多糖诱导人肺上皮细胞生成单核细胞趋化蛋白-1的作用

目的:研究隐孔菌多糖(CP)对脂多糖(LPS)诱导人肺上皮细胞株A549生成单核细胞趋化蛋白-1(MCP-1)的影响。方法:在有或无CP条件下用LPS诱导A549细胞株,分别采用ELISA和RT-PCR法,测定MCP-1蛋白浓度和MCP-1 mRNA的表达。结果:LPS 1000μg/L诱导A549细胞24 h明显增加MCP-1的生成。CP 100μg/L或地塞米松1μmol/L对A549细胞株的生长和活力无明显影响。CP 100μg/L或地塞米松1μmol/L能明显抑制LPS诱导A549细胞株的MCP-1蛋白含量和mRNA的表达。结论:结果证明,CP能调节MCP-1的生成,可能是其抗肺部炎症的作用机制之一。

ICR小鼠吸烟诱导肺部炎症模型的建立及其特征

目的:观察ICR小鼠对急性吸烟暴露的敏感性,建立ICR小鼠急性吸烟引起肺损伤的模型。方法:小鼠每天被动吸烟3次,一次暴露两支,持续20min,分别急性吸烟0d、1d、3d、7d,观察小鼠肺组织的支气管肺泡灌洗液(BALF)细胞计数及分类计数、肺组织干湿重比,肺组织病理切片炎症情况、肺组织TNF-α含量、MMP-12含量,MPO活性,评价该品系小鼠对吸烟的耐受性与敏感性和适宜的暴露时间。结果:随着吸烟天数的增加,肺干湿重比、白细胞计数、MPO、MMP-12均呈时间依赖性上升(P<0.01),以3d为最高。TNF-α吸烟1d即明显升高,吸烟7d时仍持续高水平。结论:ICR小鼠急性吸烟3d为急性炎症的高峰,之后迁延进入慢性炎症,本品系对于吸烟暴露的耐受性与敏感性均较佳,为急性吸烟建模的良好模型。

Pathophysiology of pulmonary complications of acute pancreatitis

Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia, acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids, chemoattractants such as tumor necrsosis factor （TNF）- alpha, interleukin （IL）-1, IL-6, IL-8, fMet-leu-phe （a bacterial wall product）, nitric oxide, substance P, and macrophage inhlbitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

Associated factors of professional identity among nursing undergraduates during COVID-19:A cross-sectional study

Objectives Professional identity plays an important role in the long-term development of nurses,and it will change when public health emergency occurs.The objective of this study is to investigate the factors associated with the professional identity of nursing undergraduates in the epidemic of COVID-19.Methods A cross-sectional survey design with convenience sampling was used.A total of 3,875 nursing undergraduates were recruited from seven universities across China from March to April 2020.A general information questionnaire was used to collect students’information,and the Professional Identity Questionnaire for Nurse Students was used to survey their professional identity during the early and later stages of the first wave of the COVID-19 epidemic.Results The score of professional identity in the later stage(59.49±12.41)was higher than that in the early stage(56.96±12.61).The stepwise regression indicated that several factors were associated with professional identity,including gender,residential area,major,impact of the epidemic on intention to work after graduation,reasons for choosing nursing major and students’scores of professional identity in early stage.Conclusions Nursing educators can utilize the positive impact of responding to public health emergencies to increase the professional identity of students.Meanwhile,educators should give those students with lower professional identity more targeted education to cultivate their professional identity after the occurrence of public health emergencies.

Relationship between Chlamydia pneumoniae infection and occurrence of bronchial asthma

Objective: To study the relationship between Chlamydia pneumoniae (C. pneumoniae) infection and asthma exacerbation. Methods: A prospective study of C. pneumoniae infection was conducted in 75 patients with asthma and 63 patients with respiratory tract infection, and 100 blood donors served as controls. The presence of infection was convinced by the polymerase chain reaction and direct immunofluorescence assay for C. pneumoniae DNA from throat swab specimens and micro-immunofluorescence testing for C. pneu-moniae-specific IgG, IgM and IgA antibodies. Results: Prevalence of specific IgG in asthma patients (81. 3%) was higher than that of the blood donors (68. 0%, P<0. 05) and was not significantly different from respiratory tract infection patients (68. 0%, P>0. 05). The acute C. pneumoniae infection rate of symptomatic asthma patients (59. 4%) was markedly higher than that of respiratory tract infection patients (34. 9% , P<0. 05). The average titer of C. pneumoniae IgG instead of IgA in asthma patients (48. 38±6. 94) was significantly higher than respiratory tract infection patients (24. 70±8. 77, P<0. 05). Other pathogens were identified in 12 of 21 (57. 1%) asthma patients with C. pneumoniae. The symptoms of 7 asthma patients with C. pneumoniae infection were improved through antibiotic treatment. Conclusion: The findings suggest a possible role of C. pneumoniae infection in asthma.

Network Pharmacology Approach to Investigate the Preventive Mechanism of Hunan Expert Group Recommended Chinese Medicine Prevention No.2 Prescription Against COVID-19

Objective To explore the possible preventive mechanism of Hunan expert group recommended Chinese medicine prescription of No.2(Pre-No.2)against coronavirus disease 2019(COVID-19)by network pharmacology method.Methods The target proteins of effective components and active compounds in Pre-No.2 were screened by searching the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).A component-target-disease interaction network of Pre-No.2 was constructed by Cytoscape 3.7.2,gene ontology(GO)analysis,and Kyoto encyclopedia of genes and genomes(KEGG)analysis of target protein pathway by DAVID.Results A total of 163 compounds and 278 target protein targets in Pre-No.2 were collected from the TCMSP database.Kaempferol,wogonin,7-methoxy-2-methyl isoflavone,formononetin,isorhamnetin,and licochalcone A were the most frequent targets in the regulatory network.GO enrichment analysis showed that Pre-No.2 regulated response to virus,viral processes,humoral immune responses,defense responses to virus and viral entry into host cells.KEGG enrichment analysis showed that the formula regulated the NF-κB signaling pathway,B cell receptor signaling pathway,viral carcinogenesis,T cell signaling pathway and FcγR-mediated phagocytosis signaling pathway.Conclusions Pre-No.2 may play a preventive role against COVID-19 through regulation of the Toll-like signaling,T cell signaling,B cell signaling and other signaling pathways.It may regulate the immune system to protect against anti-influenza virus.

Network pharmacology and molecular docking analysis on molecular targets and mechanism prediction of Huanglian Jiedu Decoction in the treatment of COVID-19

Objective To investigate and predict the molecular targets and mechanism of Huanglian Jiedu Decoction(黄连解毒汤,HLJDD)in the treatment of Corona Virus Disease 2019(COV-ID-19)through network pharmacology and molecular docking analysis.Methods The chemical constituents and action targets of HLJDD were retrieved on Tradi-tional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),SymMap v2,Encyclopedia of Traditional Chinese Medicine(ETCM),a High-throughput Ex-periment-and Reference-guided Database of Traditional Chinese Medicine(HERB),and Tra-ditional Chinese Medicine Integrated Database(TCMID).UniProt and GeneCards were used to query the target genes that corresponding to the active compounds,and then a compound-target network was constructed using Cytoscape 3.7.2.Gene Ontology(GO)database was used to annotate GO functions.Kyoto Encyclopedia of Genes and Genomes(KEGG)was used to predict the possible mechanisms of active compounds.The Database for Annotation,Visu-alization and Integrated Discovery(DAVID)was used to analysis the tissue enrichment.The main active compounds in HLJDD are molecularly docked with their corresponding related targets.Results Seventy-six compounds were screened and 458 corresponding targets in the network were obtained.Gene annotation showed that the targets were involved mainly in 1953 biolo-gical processes.884 signaling pathways was enriched,involving signaling by interleukins,cy-tokine signaling in immune system,generic transcription pathway,and RNA polymerase II transcription.The targets mainly distributed in the lung,liver,and placenta,involving a vari-ety of immune cells,such as T cells and B cells.The molecular docking results showed that core compounds such as wogonin,berberine,and baicalein had high affinity with tumor nec-rosis factor(TNF),insulin(INS),and tumor protein 53(TP53).Conclusion The active compounds in HLJDD may have a therapeutic effect on COVID-19 through regulating multiple signal pathways by targeting genes such as vascular endothelial growth factor A(VEGFA),INS,interleukin-6(IL-6),TNF,caspase-3,TP53,and mitogen-activ-ated protein kinase 3(MAPK3).

呈节段性改变的大叶性肺炎伴心肌酶异常19例临床分析

目的 探讨呈节段性改变的大叶性肺炎病理及部位分型并分析其心肌酶异常的临床意义.方法 对本院呈节段性改变的大叶性肺炎伴心肌酶异常19例患儿影像学特点及心肌酶检测结果进行分析.结果 19例患儿影像学检查肺实变以肺段为单位单一或多肺段或有跨叶的多肺段受累为特征;血清LDH、α-HBDH同时增高者17例,占89.5%,治疗前后比较差异有统计学意义（P〈0.01）.结论 肺炎支原体肺炎（MP）等非典型致病微生物感染所致呈节段性改变的大叶性肺炎以＂节段性肺炎＂命名可区别于肺炎球菌等典型致病微生物所致的典型大叶性肺炎;而LDH、α-HBDH增高可作为心肌损害诊断指标.

儿童支原体肺炎临床表现与年龄、性别的关系

目的探讨儿童支原体肺炎（MPP）的I临床表现与年龄、性别的关系。方法对1110例经ELISA法检测血清支原体（MP）抗体结合PCR法确诊的病例的临床资料进行回顾性分析。结果1110例患儿中男598例，女512例，男女比例2．08：1，平均年龄（7．3±3．3）岁，其中婴幼儿190例，学龄前期550例。学龄期210例，青春期150例，临床表现婴幼儿期MPP起病相对较急，咳痰、喘息症状明显，肺部干性哕音多，体温相对较低，平均热程短，学龄组儿童多表现为高热，干咳症状重，肺部体征轻，平均发热时间长，MPP肺部X线小叶实质性浸润学龄前组和学龄组明显多于婴幼儿组，肺外侵犯消化系统损伤学龄期组少于其他组，心脏、肾脏、皮肤损害各组间无明显差异，胸膜受累主要见于学龄期和青春期组，性别与临床表现差异无统计学意义。结论儿童支原体肺炎临床表现与年龄有一定关系，临床医生应根据不同年龄特点给予相应的诊断、治疗。