Prenatal diagnosis,prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) can be associated with genetic or structural anomalies with poor prognosis. In isolated cases, survival is dependent on the degree of lung hypoplasia and liver position. Cases should be referred in utero to tertiary care centers familiar with this condition both for prediction of outcome as well as timed delivery. The best validated prognostic indicator is the lung area to head circumference ratio. Ultrasound is used to measure the lung area of the index case, which is then expressed as a proportion of what is expected normally (observed/expected LHR). When O/E LHR is < 25% survival chances are < 15%. Prenatal intervention, aiming to stimulate lung growth, can be achieved by temporary fetal endoscopic tracheal occlusion (FETO). A balloon is percutaneously inserted into the trachea at 26–28 weeks, and reversal of occlusion is planned at 34 weeks. Growing experience has demonstrated the feasibility and safety of the technique with a survival rate of about 50%. The lung response to, and outcome after FETO, is dependent on pre-existing lung size as well gestational age at birth. Early data show that FETO does not increase morbidity in survivors, when compared to historical controls. Several trials are currently under design. Copyright © 2008 John Wiley & Sons, Ltd.     

甲醛暴露时间延长加剧小鼠哮喘模型肺氧化损伤并促进IL-17表达

为了探究不同暴露时间甲醛对小鼠哮喘模型肺氧化应激及IL-17表达的影响,用浓度为3.0 mg·m~(-3)的甲醛气体吸入染毒,同时将48只雄性Balb/c小鼠随机分为6组:(1)对照组(生理盐水组);(2)ovalbumin(OVA)致敏组;(3)0.5 h甲醛+OVA组;(4)1h甲醛+OVA组;(5)1.5 h甲醛+OVA组;(6)2 h甲醛+OVA组,以不同时间长度进行甲醛暴露,连续35 d。OVA致敏组、0.5 h甲醛+OVA组、1 h甲醛+OVA组、1.5 h甲醛+OVA组、2 h甲醛+OVA组均在第11、18及25天腹腔注射OVA致敏液(5 mg OVA+175 mg Al(OH)_3+30 mL生理盐水),第29~35天(共计1周)进行1%OVA雾化(30 min·d~(-1)),每日1次,诱发哮喘。第36天进行以下操作:取肺组织测定肺系数并制作肺匀浆,检测肺组织中活性氧自由基(ROS)、丙二醛(MDA)和还原型谷胱甘肽(GSH)的含量,并采用ELISA法检测肺组织中IL-17的水平。同时,采用HE染色法观察小鼠肺部气道的病理学变化。结果显示,在浓度为3.0 mg·m~(-3)的甲醛气体吸入染毒条件下,与对照组相比,1.5 h甲醛+OVA染毒组、2 h甲醛+OVA染毒组ROS、MDA、IL-17含量上升,具有统计学意义(P0.01)。同时,随着暴露时间长度的增加,小鼠肺部气道出现明显病理学变化。综上所述,每天2 h甲醛+OVA染毒能对小鼠肺造成损伤并恶化OVA对小鼠肺的损伤,产生炎症反应,并通过氧化应激反应介导。     

学龄儿童呼吸系统疾病、症状影响因素研究

用非条件 Logistic回归分析方法研究空气污染对学龄儿童呼吸系统疾病、症状的影响。结果表明 ,控制年龄、性别、父亲和母亲受教育水平、住房结构、家庭烹饪燃料、厨房抽风设备、被动吸烟等因素 ,污染区儿童因呼吸系统疾病住院、患支气管炎和出现喘息症状的危险性分别是相对清洁区的 1 .6、1 .5和 1 .2倍 ;不感冒咳嗽或不感冒咳痰的发生与室外空气污染水平的关系均不明显 ;家庭烹饪使用不洁燃料、厨房通风不良、被动吸烟使喘息症状的发生机会增加 (尤其是厨房的通风状况不良 )     

Prenatal interventions for fetal lung lesions

The widespread availability of high resolution ultrasound equipment and almost universal routine anatomy scanning in all pregnant women in the developed world has lead to increased detection of abnormalities in the fetal thorax. Already in the 1980s, large pleural effusions and significant macrocystic lesions in the fetus were easily detected on ultrasound. However, smaller lung tumours were often missed. Nowadays, fetal medicine centres receive many referrals for evaluation of fetal lung lesions, of which the most common are congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Almost invariably, both the parents and the referring physicians experience anxiety after detection of large lung masses in the fetus. However, the vast majority of the currently detected fetal lung lesions have an excellent prognosis without the need for prenatal intervention. In the small group of fetuses in which the prognosis is poor, almost exclusively those with concomitant fetal hydrops and cardiac failure, several options for fetal therapy exist, often with a more than 50% survival rate. Indications, techniques, complications and outcomes of these interventions will be described in this review. Copyright © 2011 John Wiley & Sons, Ltd.     

高原地区672例尘肺患者死因分析

为了探讨高原地区尘肺患者死因特点及其规律,对青海省1955—2005年间诊断的2 942例尘肺患者有关资料进行了回顾性收集,并采用SPSS10.0软件进行统计分析。结果显示,青海省共有7种尘肺,其中矽肺和煤工尘肺占尘肺总数的93.88%。至2005年底,共有672例已死亡,尘肺病死率为22.84%。尘肺患者死亡年龄集中在40~49岁、50~59岁、60~岁组,占整个死亡总数的92.26%。平均死亡年龄为60.24岁,并且随着年代的推移而延长。尘肺患者平均寿命损失为15年。对死因分析后发现,前3位死因依次为:肺心病、尘肺和肺结核。探讨、分析及研究的结果表明,高原地区尘肺患者的首位死因为肺心病,提示在今后高原地区尘肺病防治工作中应加以重视。     

The effect of a systemic arteriovenous fistula on the pulmonary arterial blood pressure in the fetal sheep

In order to investigate whether systemic arteriovenous fistula occurring during the fetal period could induce pulmonary hypertension at birth, a fistula was surgically created between the carotid artery and jugular vein of fetal lambs at 120 days' gestation. Mean pressures in the left pulmonary artery, aorta, atrium and ventricles were measured at birth in seven experimental animals and in five control animals. Mean left pulmonary pressure was significantly higher in the lambs with fistula as compared with the control group, suggesting that prenatal occurrence of systemic arteriovenous fistula may induce fetal pulmonary hypertension. The present study provides a new animal model that could be relevant for the study of mechanisms regulating pulmonary vascular tone in the perinatal period. Copyright © 2002 John Wiley & Sons, Ltd.     

室内空气污染对慢性阻塞性肺部疾病的影响

为了探讨室内空气污染与慢性阻塞性肺部疾病(COPD)的关系,对云南省宣威县使用不同生活燃料、年龄≥40岁的农民10892人进行了COPD及其症状的现患率调查,同时测定了调查对象的最大呼气流速(PEF).结果表明,不同燃料造成的室内空气污染对COPD及其症状和最大呼气流速的作用顺序依次为有烟煤>无烟煤>柴.在调整了年龄、性别、吸烟和改灶年限等因素后发现,使用有烟煤和使用无烟煤的人群患COPD的危险性分别是使用柴的4.63倍和1.55倍.改灶年限越长,COPD及其症状的现患率越低,最大呼气流速越高.室内燃煤空气污染是影响宣威慢性阻塞性肺部疾病(COPD)的主要危险因素,改炉改灶对控制COPD及其症状的现患水平,改善肺功能具有积极的作用.     

氧化石墨烯和多环芳烃与肺表面活性物质间的相互作用

为阐明氧化石墨烯与多环芳烃这一复合污染体系与肺表面活性物质（PS）的作用,考察了各组分之间的作用方式及效应,并对作用机制进行分析.结果表明,PS及其组分对多环芳烃有增溶作用,增溶能力依次为萘 < 苊 < 苯并（a）蒽;氧化石墨烯对多环芳烃和PS有一定的吸附作用,且多环芳烃和PS存在竞争吸附,入肺后PS及其组分占据多环芳烃的吸附位点而负载于氧化石墨烯表面;多环芳烃在PS及其组分增溶作用下在氧化石墨烯表面解析,毒性增强;DPPC由竞争吸附产生的解析效果尤为显著,当苯并（a）蒽的加入量到0.6mg/L时,DPPC于GO上吸附量减少了28.92mg/g;同时,多环芳烃和PS均会促使氧化石墨烯团聚,粒径增大3倍以上;C=C键的增多和化学键转化产生的作用力影响了氧化石墨烯的稳定性.本研究为复合污染对肺的潜在毒性效应及肺风险评估提供了一定的理论支撑.