Bloodletting Puncture at Hand Twelve Jing-Well Points Relieves Brain Edema after Severe Traumatic Brain Injury in Rats via Inhibiting MAPK Signaling Pathway

Objective:To investigate whether blood-brain barrier(BBB)served a key role in the edema-relief effect of bloodletting puncture at hand twelve Jing-well points(HTWP)in traumatic brain injury(TBI)and the potential molecular signaling pathways.Methods:Adult male Sprague-Dawley rats were assigned to the shamoperated(sham),TBI,and bloodletting puncture(bloodletting)groups(n=24 per group)using a randomized number table.The TBI model rats were induced by cortical contusion and then bloodletting puncture were performed at HTWP twice a day for 2 days.The neurological function and cerebral edema were evaluated by modified neurological severity score(mNSS),cerebral water content,magnetic resonance imaging and hematoxylin and eosin staining.Cerebral blood flow was measured by laser speckles.The protein levels of aquaporin 4(AQP4),matrix metalloproteinases 9(MMP9)and mitogen-activated protein kinase pathway(MAPK)signaling were detected by immunofluorescence staining and Western blot.Results:Compared with TBI group,bloodletting puncture improved neurological function at 24 and 48 h,alleviated cerebral edema at 48 h,and reduced the permeability of BBB induced by TBI(all P<0.05).The AQP4 and MMP9 which would disrupt the integrity of BBB were downregulated by bloodletting puncture(P<0.05 or P<0.01).In addition,the extracellular signal-regulated kinase(ERK)and p38 signaling pathways were inhibited by bloodletting puncture(P<0.05).Conclusions:Bloodletting puncture at HTWP might play a significant role in protecting BBB through regulating the expressions of MMP9 and AQP4 as well as corresponding regulatory upstream ERK and p38 signaling pathways.Therefore,bloodletting puncture at HTWP may be a promising therapeutic strategy for TBI-induced cerebral edema.     

如何学好药理学

药理学是研究药物与机体相互作用、作用机制及规律的科学,是连接基础医学与临床医学、医学与药学的一门重要课程.许多学生在初次学习药理学时,认为药理学不好学,内容复杂、抽象,药物种类较多,抓不住重点,难以记忆,不知道怎样学习药理学,现就这些问题谈谈学习药理学的方法.     

昆虫抗冻蛋白及其在医学领域中的应用

抗冻蛋白(antifreeze protein,AFP)是一类结构多样的蛋白质,具有热滞效应(thermal hysteresis,TH,降低冰点而不改变熔点)和重结晶抑制效应(recrystalization inhabition,RI).通过非共价吸附抑制机制吸附到冰核表面,限制冰晶生长和抑制冰晶重结晶,从而保护有机体免受结冰引起的伤害.由于抗冻蛋白具有阻止冰晶生长而不破坏细胞的特点,因而利用抗冻蛋白在低温中长期保存各种细胞、组织和器官,特别在器官移植中可能具有很好的应用前景.     

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection （DSWI） following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males （73.7%） and 5 females （26.3%）, aged 55±13 （18-78） years. According to the Pairolero classification of infected median sternotomies, 3 （15.8%） patients were type II, and the other 16 （84.2%） were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients （78.9%）, bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients （21.0%） needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients （10.5%） presented with subcutaneous infection, and 3 patients （15.8%） had hematoma. They recovered following local debridement and medication. 17 patients （89.5%） were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.     

植皮区域局限性皮肤松弛症1例

病人,女,81岁.40年前在工作时双上肢不慎被火烧伤,当年在大连化工厂医院烧伤科给予取自体腹部皮肤行前臂植皮术,术后植皮区域皮肤成活修复良好.4年前无明显诱因双侧前臂植皮区域肤色逐渐变深,无意中发现皮肤明显松弛,无不适感.近3个月自觉植皮区域疼痛不适,局部无红肿等,轻微牵拉皮肤时疼痛明显.自发病起4年皮损未见扩大.患者既往体健,否认家族有类似病患者.     

对症喝汤好处多

夏季多喝汤不仅能调节口味,补充体液,增强食欲,而且能防病抗病,对健康有益. 日常人们常喝的汤有荤、素两大类.荤汤有鸡汤、肉汤、骨头汤、鱼汤、蛋花汤等,素汤有海带汤、豆腐汤、紫菜汤、番茄汤、冬瓜汤和米汤等.无论是荤汤还是素汤,都应根据各人的喜好与口味来选料烹制,加之"对症喝汤",就可达到抗衰治病、清热解毒的"汤疗"效果.     

维生素B1和维生素B12肌注致过敏性休克1例报告

1 临床资料 患者,男,23岁,因左下肢疼痛20 d来医院就诊.询问病史:患者2 d前在上级医院诊断为坐骨神经痛.既往健康,无药物过敏史.门诊当日给予维生素B1 100 mg,维生素B12 250靏肌注,用药约5 min时患者感到头晕、胸闷、呼吸困难、寒战,面色苍白,脉搏105次·min-1,血压80/50 mmHg,考虑为药物所致过敏性休克,立即给予平卧,氧气吸入,肾上腺素1 mg肌注,地塞米松10 mg静注,5 min后患者恢复正常.     

第16届欧洲呼吸学会年会会议纪要

第16届欧洲呼吸学会年会(The European Respiratory Society 16th Annual Congress)于2006年9月1日～6日在德国慕尼黑市国际会议中心(ICM)召开,来自100多个国家和地区的16 888名代表参加了会议,大会共收到论文5277篇,接收论文4221篇,其中来自中国(包括香港、澳门和台湾)84篇(图1).现将会议内容扼要介绍如下.     

POCT的信息管理

POCT是在医疗条件下,由非实验室的卫生保健人员,在实验室的质控指导下,于病人身边进行的检验。它广泛适用于医院(如外科,儿科)、监护病房、急救单位、保险公司、社区医疗、家庭保健网络等领域。当今,POCT在全球方兴未艾,据调查,现今已有10%的诊断实验是在POCT仪器上完成的,究其原因,无非是POCT兼具医学上的有效性及经济两个方面的优势。当然,随着POCT设备的投放不断增加,使用范围不断拓展,POCT的管理问题也日益凸现,本文将对POCT实施中的信息管理的若干问题进行初步探讨。     

重型急性胰腺炎并发急性肺损伤的诊治（附23例报告）

目的：探讨重型急性胰腺炎（SAP）并发急性肺损伤（ALI）的诊治方法。方法：对23例SAP并发ALI患者的资料进行回顾性分析。结果：SAP并发ALI发生率为59％,经机械通气及生长抑素等综合治疗,多器官功能障碍综合征发生率为21．9％,ALI治愈率为91．3％,结论：ALI是SAP早期最常见的并发症,根据预警指标警惕ALI的发生是避免漏误诊的关键,早期合理应用呼吸机及生长抑素是主要的综合治疗措施。     

脓毒性急性肾损伤和急性肺损伤的分子机制及治疗新进展

严重脓毒症患者常并发急性肾损伤(AKI)和急性肺损伤(ALI),使患者病死率显著增高,存活者也可能会患有慢性肾脏疾病或肺功能障碍。脓毒症并发AKI和ALI时,肾和肺是否能够相互影响及如何更好地治疗,目前并没有深入研究。尽管脓毒症及其诱发的多器官功能障碍已被研究很多年,但潜在的调控机制还未明确。文章对脓毒性AKI和ALI的细胞和分子病因及其相互作用和治疗进展进行了综述。     

Ventilatory management of acute lung injury and acute respiratory distress syndrome

Context  The acute lung injury and acute respiratory distress syndrome are critical illnesses associated with significant morbidity and mortality. Mechanical ventilation is the cornerstone of supportive therapy. However, despite several important advances, the optimal strategy for ventilation and adjunctive therapies for patients with acute lung injury and acute respiratory distress syndrome is still evolving. Evidence Acquisition  To identify reports of invasive ventilatory and adjunctive therapies in adult patients with acute lung injury and acute respiratory distress syndrome, we performed a systematic English-language literature search of MEDLINE (1966-2005) using the Medical Subject Heading respiratory distress syndrome, adult, and related text words, with emphasis on randomized controlled trials and meta-analyses. EMBASE and the Cochrane Central Register of Controlled Trials were similarly searched. The search yielded 1357 potential articles of which 53 were relevant to the study objectives and considered in this review. Evidence Synthesis  There is strong evidence to support the use of volume- and pressure-limited lung-protective ventilation in adult patients with acute lung injury and acute respiratory distress syndrome. The benefit of increased levels of positive end-expiratory pressure and recruitment maneuvers is uncertain and is being further evaluated in ongoing trials. Existing randomized controlled trials of alternative ventilation modes, such as high-frequency oscillation and adjunctive therapies, including inhaled nitric oxide and prone positioning demonstrate no significant survival advantage. However, they may have a role as rescue therapy for patients with acute respiratory distress syndrome with refractory life-threatening hypoxemia. Conclusions  Volume- and pressure-limited ventilation strategies should be used in managing adult acute lung injury and acute respiratory distress syndrome patients. Further research is needed to identify barriers to widespread adoption of this strategy, as well as the role of alternative ventilation modes and adjunctive therapies.      

急性混合型高脂血症对急性心肌梗死面积的影响及其机制探讨

目的:探讨急性混合型高脂血症对急性心肌梗死面积的影响及机制.方法:将53只Sprague-Dawley(SD)大鼠分为3组:对照组(n=15)静脉注射0.9%(质量分数)生理盐水1.0mL,低剂量组(n=17)和高剂量组(n=21)分别静脉注射10%(质量分数)Triton WR-1339溶液0.5mL和1.0mL.给药24 h后建立急性心肌梗死模型.测定给药前、给药24h血脂水平和血清脂蛋白相关磷脂酶A2 (lipoprotein-associated phospholipase A2,Lp-PLA2)的活性,并观察急性心肌梗死24h后各组大鼠心肌梗死面积.结果:与给药前相比,低剂量组血浆总胆固醇(total cholesterol,子酱TC)和甘油三酯(triglycerides, TG)浓度[分别为(6.92±1.48)mmol/L和(11.76±2.76)mmol/L]均明显升高(P<0.01),高剂量组升高更为明显[分别为(11.91±0.87)mmol/L和(33.97±5.85)mmol/L].两组血浆低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)浓度也较给药前升高(P<0.05),但血浆高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C)浓度较给药前明显降低(P<0.01).另外,给药24h后3组SD大鼠的血清Lp-PLA2的活性组间比较以及与给药前相比差异均无统计学意义(P>0.05).大鼠心肌梗死面积在低剂量组和高剂量组分别为(55.2±3.1)%和(51.4±8.3)%,两组间差异无统计学意义(P=0.336),但与对照组[(37.0±4.2)%]相比均明显增加(P<0.001).结论:急性混合型高脂血症能增加大鼠急性心肌梗死面积,Lp-PLA2在该过程中的作用还有待进一步探讨.     

急性药物性肝炎与急性乙型肝炎临床病理特征的比较

目的总结急性药物性肝炎（acutedrug-inducedhepatitis,ADIH）与急性乙型病毒性肝炎（acutehepatitisB,AHB）的临床及病理学特点。方法选取临床确诊并经肝穿刺病理证实的ADIH患者128例、AHB患者5l例。所有切片均行HE染色、D—PAS染色及CK7免疫组化染色。镜下观察各种染色结果,结合临床资料进行分析。结果ADIH女性多见（71．9％）,AHB男性多见（66．7％）,差异有统计学意义（P=0．000）。ADIH组年龄明显大于AHB组f（42．85±13．07）岁VS．（35．12±9．96）岁,P=0．000]。AHB组丙氨酸氨基转移酶（ALT）为（1287．56±1072．00）U／L,白蛋白（ALB）为（42．23±4．14）g／L,均明显高于ADIH组f（798．60±777．20）U／L和（38．78±5．19）g／L],差异有统计学意义（P=0．001,P=0．000）,其余生化指标差异无统计学意义。肝组织病理,ADIH的嗜酸性粒细胞计数（3．85±4．11）个／HPF,凋亡小体计数（2．52±3．26）个,均显著高于AHB（P=0．000,P=0．010）;ADIH的肝细胞坏死程度、汇管区炎症程度及细胆管反应增生均较AHB为重（P=0．000）,AHB比ADIH更易发生脂肪变性（39．2％VS．21．1％,P=0．013）。结论ADIH女性更多见,发病年龄偏大;组织学表现为肝实质坏死明显、汇管区炎症较重、细胆管增生显著、凋亡小体多见、组织内嗜酸性粒细胞数量多等特点．可作为与AHB的鉴别要点。