Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature,absence of radiation exposure,widespread availability,prompt results,high accuracy,and repeatability at the bedside.The diaphragm is a crucial respiratory muscle.Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients.In this editorial,we comment on an article,retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023.The study found that the diaphragm thickening fraction,an index from diaphragm ultrasound,can better predict the outcome of non-invasive ventilation in patients with AECOPD.The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged.Diaphragmatic dysfunction diagnosed with ultrasound is asso-ciated with prolonged mechanical ventilation and weaning times and higher mortality.

Western blotting in the diagnosis of duodenal-biliary and pancreaticobiliary refluxes in biliary diseases

BACKGROUND: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases. METHODS: An oral radionuclide (99)mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five subgroups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases. RESULTS: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P<0.001). The amylase and trypsin-1 tests also showed consistency in diagnosing pancreaticobiliary reflux (P<0.001). Amylase and lipase levels within gall and ductal bile were strongly correlated (P<0.05). In the common bile duct pigment stone group, the EK and trypsin-1 positive rates were found to be insignificant (P>0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (P<0.05). CONCLUSIONS: Western blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas:A case report

Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall.A 38-year- old man was admitted to the hospital for abdominal pain and vomiting after food intake.The diagnosis of acute pancreatitis was initially suspected.Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which,small cysts(diameter,less than 1 cm)were present in the vicinity of pancreatic head. The head of pancreas appeared enlarged(63 mm×42 mm) and hypoechoic.Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation,as well as 4 cm long stenosis of the second portion of the duodenum.CT examination revealed multiple cysts located in an enlarged,thickened duodenal wall with moderate to strong post-contrast enhancement.We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound(EUS).Endoscopic ultrasound(EUS)revealed circular stenosis from the duodenal bulb onwards.A twenty megahertz mini-prope examination further showed diffuse(intramural)infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa.Patient was successfully surgically treated and pancreatoduodenectomy was performed.The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas. Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall,with intralumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.

Neural Respiratory Drive Measured Using Surface Electromyography of Diaphragm as a Physiological Biomarker to Predict Hospitalization of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Background: Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi?electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients. Methods: COPD patients visiting the outpatient department due to acute exacerbation were enrolled in this study. All patients who were subjected to EMGdi and classical parameters such as spirometry parameters, arterial blood gas analysis, COPD assessment test (CAT) score, and the modified early warning score (MEWS) in outpatient department, would be treated effectively in the outpatient or inpatient settings according to the Global Initiative for Chronic Obstructive Lung Disease guideline. When the acute exacerbation of the patients was managed, all the examination above would be repeated. Results: We compared the relationships of admission?to?discharge changes (Δ) in the normalized value of the EMGdi, including the change of the percentage of maximal EMGdi (ΔEMGdi%max) and the change of the ratio of minute ventilation to the percentage of maximal EMGdi (ΔVE/EMGdi%max) with the changes of classical parameters. There was a significant positive association between ΔEMGdi%max and ΔCAT,ΔPaCO2, and ΔpH. The change (Δ) of EMGdi%max was negatively correlated with ΔPaO2/FiO2 in the course of the treatment of AECOPD. Compared with the classical parameters including forced expiratory volume in 1 s, MEWS, PaO2/FiO2, the EMGdi%max (odds ratio 1.143, 95% confidence interval 1.004–1.300) has a higher sensitivity when detecting the early exacerbation and enables to predict the admission of hospital in the whole cohort. Conclusions: The changes of surface EMGdi parameters had a direct correlation with classical measures in the whole cohort of AECOPD. The measurement of NRD by surface EMGdi represents a practical physiological biomarker, which may be helpful in detecting patients who should be hospitalized timely.

超声测量膈肌运动参数联合BODE指数预测慢性阻塞性肺疾病急性加重

目的观察超声测量膈肌运动参数联合BODE指数预测慢性阻塞性肺疾病(COPD)急性加重的价值。方法回顾性纳入80例COPD患者并分为稳定组(n=45)与急性加重组(n=35),以超声测量平静呼吸(QB)下膈肌移动度(DE QB)及用力呼吸(DB)下DE DB。比较组间一般资料、超声所测膈肌运动参数及BODE指数等;采用logistic回归分析筛选可用于预测COPD病情急性加重的独立因素,以受试者工作特征(ROC)曲线及其曲线下面积(AUC)评价单一膈肌运动超声参数、BODE指数及其联合预测COPD急性加重的效能。结果相比稳定组,急性加重组BMI及BODE指数评分均较高(P均<0.05),DE QB较大而DE DB较小(P均<0.05)。DE DB及BODE指数为COPD急性加重的独立预测因素;DE DB增大提示COPD急性加重风险降低[OR(95%CI)=0.673(0.493,0.918),P<0.05],而BODE指数增大提示风险增加[OR(95%CI)=3.678(1.061,12.746),P<0.05];二者单一预测的AUC分别为0.788、0.799,其联合预测的AUC为0.979,显著高于单一预测(P均<0.05)。结论超声测量膈肌运动参数可用于评估COPD患者膈肌功能;DE DB联合BODE指数预测COPD急性加重的效能较好。

Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Spontaneous intramural duodenal hematoma in type 2B von Willebrand disease

Intramural duodenal hematoma is a rare cause of a proximal gastrointestinal tract obstruction.Presentation of intramural duodenal hematoma most often occurs following blunt abdominal trauma in children,but spontaneous non-traumatic cases have been linked to anticoagulant therapy,pancreatitis,malignancy,vasculitis and endoscopy.We report an unusual case of spontaneous intramural duodenal hematoma presenting as an intestinal obstruction associated with acute pancreatitis in a patient with established von Willebrand disease,type 2B.The patient presented with abrupt onset of abdominal pain,nausea,and vomiting.Computed tomography imaging identified an intramural duodenal mass consistent with blood measuring 4.7 cm×8.7 cm in the second portion of the duodenum abutting on the head of the pancreas.Serum lipase was 3828 units/L.Patient was managed conservatively with bowel rest,continuous nasogastric decompression,total parenteral nutrition,recombinant factorⅧ(humateP)and transfusion.Symptoms resolved over the course of the hospitalization.This case highlights an important complication of an inherited coagulopathy.

Evolution of nonspecific duodenal lymphocytosis over 2 years of follow-up

AIM: To assess the evolution of duodenal lymphocytosis(DL), a condition characterized by increased intraepithelial lymphocytes(IELs), over 2 years of follow-up.METHODS: Consecutive patients undergoing upper endoscopy/histology for abdominal pain, diarrhea, weight loss, weakness or other extraintestinal features compatible with celiac disease(CD) were included. Evaluation of IELs infiltrate in duodenal biopsy sampleswas carried out by CD3-immunohistochemistry and expressed as number of positive cells/100 enterocytes. Diagnostic agreement on the IELs count was tested by calculating the weighted k coefficient. All patients underwent serological detection of autoantibodies associated with CD: Ig G and Ig A anti-tissue transglutaminase and endomysium. Each patient underwent further investigations to clarify the origin of DL at baseline and/or in the course of 2 years of follow-up every six months. Autoimmune thyroiditis, intestinal infections, parasitic diseases, bacterial intestinal overgrowth, hypolactasia and wheat allergy were detected. Colonoscopy and enteric magnetic resonance i m a g i n g w e r e p e r f o r m e d w h e n n e c e s s a r y. R i s k factors affecting the final diagnosis were detected by multinomial logistic regression and expressed as OR.RESULTS: Eighty-five patients(16 males, 69 females, aged 34.1 ± 12.5 years) were followed up for a mean period of 21.7 ± 11.7 mo. At baseline, endoscopy/duodenal biopsy, CD3 immunohistochemistry revealed: > 25 IELs/100 enterocytes in 22 subjects, 15-25 IELs in 37 and < 15 IELs in 26. They all had negative serum anti-transglutaminase and anti-endomysium, whilst 5 showed Ig G anti-gliadin positivity. In the course of follow-up, 23 developed CD seropositivity and gluten sensitivity(GS) was identified in 19. Other diagnoses were: 5 Helicobacter pylori infections, 4 jejunal Crohn's disease, 1 lymphocytic colitis and 1 systemic sclerosis. The disease in the remaining 32 patients was classified as irritable bowel syndrome because of the lack of diagnostic evidence. At multivariate analysis, the evolution towards CD was associated with an IELs infiltrate > 25(OR = 1640.4) or 15-25(OR = 16.95), human leukocyte antigen(HLA) DQ2/8(OR = 140.85) or DQA1*0501(OR = 15.36), diarrhea(OR = 5.56) and weakness(OR = 11.57). GS was associated with IELs 15-25(OR = 28.59), autoimmune thyroiditis(OR = 87.63), folate deficiency(OR = 48.53) and diarrhea(OR = 54.87).CONCLUSION: DL may have a multifactorial origin but the IELs infiltrate and HLA are strong predictive factors for CD development and a clinical diagnosis of GS.

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

Acute duodenal Crohn's disease successfully managed with low-speed elemental diet infusion via nasogastric tube:A case report

Duodenal Crohn＇s disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn＇s disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn＇s disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin （IL）-1β, IL-6, IL-8, and tumor necrosis factor-α levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available ElentalTM, which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h （usual speed, 100 mL/h）. After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, lowspeed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn＇s disease.

Duodenitis in Systemic Autoimmune Diseases: Pathologist Perspective

Aims: To study the histomorphology of duodenitis associated with systemic autoimmune diseases with clinicopathologic correlation. Patients and Methods: This is a descriptive prospective study. Fifteen patients of autoimmune diseases with duodenitis were included. Informed consent was taken. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes were counted, inflammatory cells in lamina propria—lymphocytes, neutrophils, eosinophils, epithelioid cells. Statistical analysis was done using IBM-SPSS software version 21. Results: Fifteen cases of duodenitis associated with autoimmune diseases included 6 patients of systemic lupus erythematosus (SLE), 5 of rheumatoid arthritis, one each of ankylosing spondylitis, systemic sclerosis, dermatomyositis and seronegative reactive arthritis. All these cases were serologically proven. Only 3 (20%) patients had mild villous blunting. Six patients (46.7%) had increased IEL counts. The range of IELs was 8 - 30, mean ± SD was 14 ± 7.6. Range of villous tip IELs was 0 - 8 with mean ± SD of 3.45 ± 2.56. Six patients (46.7%) had increased IEL counts but only 3 patients (20%) had increased villous tip IELs. All patients had moderate increase in lymphoplasmacytic infiltrate in lamina propria. Eosinophils in lamina propria were increased in 46.7% cases.? Conclusion: One of the causes for malabsorptive conditions in adult population in South India is found to be duodenitis associated with autoimmune conditions. We conclude that a combination of clinical, serological, endoscopic and histopathologic features is crucial in arriving at a correct diagnosis.

Endoscopic management of intramural spontaneous duodenal hematoma:A case report

BACKGROUND Intramural duodenal hematoma is a rare condition described for the first time in 1838.This condition is usually associated with blunt abdominal trauma in children.Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases,coagulation disorders,malignancy,collagenosis,peptic ulcers,vasculitis and upper endoscopy procedures.In adults the most common risk factor reported is anticoagulation therapy.The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding.CASE SUMMARY The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™stent(Boston Scientific Corp.,Marlborough,MA,United States).CONCLUSION Endoscopic lumen-apposing metal stent Hot AXIOS™stent is a safe and feasible treatment of duodenal intramural hematoma in our case.

体外膈肌起搏器联合间歇式训练在慢性阻塞性肺疾病急性加重期患者肺康复中的应用

目的探讨体外膈肌起搏器联合间歇式训练在慢性阻塞性肺疾病急性加重期(AECOPD)患者肺康复中的应用价值。方法选取2019年2月至2022年2月南京市第一医院呼吸内科门诊或急诊收治的100例AECOPD患者,采用随机数字表法将其分为对照组和试验组,各50例。对照组采用间歇式训练干预,试验组采用体外膈肌起搏器联合间歇式训练,两组均持续接受干预到出院,出院时进行效果评价。对两组膈肌功能、肺功能进行比较。结果干预后,两组膈肌活动度、膈肌增厚分数高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。干预后,两组第1秒用力呼气量(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC水平高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。结论采用体外膈肌起搏器联合间歇式训练干预AECOPD患者能显著改善膈肌功能,促进肺功能康复。

床旁超声膈肌功能评估对慢性阻塞性肺疾病机械通气撤机的预测价值

目的:研究分析床旁超声膈肌功能评估对慢性阻塞性肺疾病(COPD)机械通气撤机的预测价值。方法:选取2022年4月—2023年6月凉山彝族自治州第一人民医院行机械通气的60例患者作为研究对象,在符合临床撤机条件后进行2 h自主呼吸试验(SBT)。试验结束后采用床旁超声对患者进行评估,按照撤机结果分为参照组(撤机失败,n=28)和试验组(撤机成功,n=32)。比较两组行SBT 30 min后吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)、膈肌增厚指数(DTF)、右侧膈肌移位距离(DD)、浅快呼吸指数(RSBI)及膈肌浅快呼吸指数(D-RSBI)等床旁超声膈肌功能评估相关参数,并应用受试者工作特征曲线(ROC)分析床旁超声功能评估相关参数在COPD机械通气患者撤机指导中应用效能。结果:两组行SBT 30 min后DTei、DTee比较,差异无统计学意义(P>0.05);试验组行SBT 30 min后DTF高于参照组,DD长于参照组,差异有统计学意义(P<0.05)。试验组行SBT 30 min后RSBI、D-RSBI低于参照组,差异有统计学意义(P<0.05)。曲线下面积(AUC)≥0.7时,表示预测价值良好,DTF、DD、RSBI、D-RSBI均对撤机有较好的预测价值,其AUC依次为0.840、0.749、0.876、0.804;同时,DTF敏感度高于DD、RSBI、D-RSBI。结论:床旁超声膈肌功能评估获取DTF、RSBI及D-RSBI等参数在COPD撤机指导中应用效能良好,可为临床成功撤机提供良好预测价值。

胃食管反流病的外科治疗

胃食管反流病(GERD)是一种常见的消化系统疾病,全球发病率约为13%。目前主要的手术方式包括360°的Nissen折叠术、270°的Toupet折叠术和180°的Dor折叠术。虽然Nissen术在远期效果上优于其他方法,但其术后吞咽困难发生率较高。在选择手术时,需要根据食管动力学检查和pH值进行个体化决策。手术不仅要修复解剖结构,还需恢复功能,包括恢复腹段食管长度和膈肌脚与脊柱的斜度。重建胃食管阀瓣和膈食管筋膜有助于优化手术效果并防止术后并发症发生。考虑到GERD涉及的生理和心理状态变化,个体化治疗是改善症状和提升生活质量的关键。

慢性阻塞性肺疾病并发膈肌疲劳的中西医研究进展

慢性阻塞性肺疾病(COPD)膈肌疲劳是常见病症,当膈肌疲劳时,其收缩力和耐力都会下降,导致呼吸困难、气短等症状。长期的膈肌的疲劳会造成膈肌的损伤从而严重影响患者生活质量。西医研究显示,COPD患者膈肌功能异常,病理改变与膈肌疲劳有关。目前治疗以药物和呼吸康复为主,效果有限。中医认为病机为肺脾肾虚弱、气血不足、痰湿阻络,治疗以补益肺脾肾、化痰通络为主。运用针灸、中药等可增强膈肌功能。本文从发病原因、发生机制和相关治疗这三个方面展开讨论COPD膈肌疲劳的研究进展,以期为加强中西医学合作,为COPD膈肌疲劳的研究治疗提供新的思路和依据。

1例环状胰腺合并十二指肠膜式狭窄超声表现

患儿男,14个月,间断性餐后呕吐胃内容物1年;产前检查无明显异常,外院诊断为“牛奶蛋白过敏”,更换奶粉后症状稍缓解;半年前添加辅食后呕吐加重,伴便秘、腹胀。查体:腹部膨隆,叩诊呈鼓音。实验室检查未见明显异常。

抗组织转谷氨酰胺酶IgA抗体滴度和HLA-DQ分型在1型糖尿病合并乳糜泻诊断中作用

目的探讨抗组织转谷氨酰胺酶IgA(IgA-抗tTG)抗体滴度以及人类白细胞抗原(HLA)-DQ分型对1型糖尿病(T1DM)合并乳糜泻(CD)发生的预测价值。方法选取2019年11月到2023年11月在内分泌科就诊的所有<18岁的T1DM患儿和同期体检的健康儿童作为研究对象,进行相关血清学分析及CD相关的HLA等位基因(DQ 2、DQ 8)检测。IgA-抗tTG抗体阳性患儿均行十二指肠病理活检。分析IgA-抗tTG滴度和Marsh分期之间相关性,采用ROC曲线评价IgA-抗tTG预测CD的诊断价值。结果纳入577例T1DM患儿,其中女性314例(54.4%),中位年龄10.0(5.0~16.0)岁。对照组150例,女性72例(48.0%),中位年龄9.5(6.0~17.0)岁。T1DM患儿中77例(13.3%)IgA-抗tTG抗体反应呈阳性(>18 IU/L),其中60例(77.6%)十二指肠组织病理学检查阳性,Marsh 2期19例,Marsh 3a期4例,Marsh 3 b期18例,Marsh 3 c期19例,均诊断为CD;余17例十二指肠组织病理学检查阴性,经过其他检查最终被确诊为小麦过敏或麸质敏感。46例IgA-抗tTG抗体阴性但仍存在谷胶依赖症状的T1DM组患儿也进行十二指肠病理活检,其中21例病理结果符合Marsh 2期或3期,同样诊断为CD。总计81例T1DM患儿确诊为合并CD。Spearman相关性分析显示81例T1DM合并CD患儿的IgA-抗tTG抗体水平与其Marsh分期之间呈显著正相关(r_(s)=0.76,P<0.001)。IgA-抗tTG抗体滴度预测CD阳性的ROC曲线下面积(AUC)为0.83(95%CI:0.72~0.93);IgA-抗tTG抗体滴度最佳截断值为87.65 IU/L,其预测CD的灵敏度为83.19%,特异度为92.20%。对照组血清IgA-抗tTG抗体反应均阴性。有CD与无CD的T1DM组之间HLA-DQ分型分布差异无统计学意义(P>0.05)。结论IgA-抗tTG抗体滴度在T1DM患儿合并CD诊断中具有一定价值,HLA基因分型可能作为血清抗体检测结果的辅助筛查手段。

COPD患者不同卧位及膈肌功能状态对机械通气效果的影响

目的探讨慢性阻塞性肺疾病(COPD)患者有益于机械通气的最佳体位,为临床护理提供实证依据。方法方便抽取120例住院机械通气的COPD患者,采取床旁超声测量平卧位、30°、40°、60°4种卧位膈肌功能状态机械通气效果的参数。结果4种卧位膈肌活动度差异有统计学意义(均P<0.05),其中30~40°卧位膈肌活动度较佳;不同卧位机械通气中,卧位角度越小气道顺应性越好,吸气阻力越高,呼气阻力越低(均P<0.05);卧位角度越小,支持压力越低,通气效果更佳(均P<0.05)。结论COPD患者不同卧位膈肌功能状态及机械通气效果存在明显的趋势变化,一般情况下建议选取30~40°卧位行机械通气。