脑外伤与心电图异常关系的分析

目的:分析脑外伤患者脑伤情况与心电图异常率之间的关系.方法:选择同一时间段内住院治疗的161例脑外伤患者,比较、分析不同损伤程度、部位的脑伤患者心电图异常率,以及随着治疗心电图异常的恢复情况.结果:共出现心电图异常83例(51.55%),以各种心律失常、T波及ST段改变、左室高电压等最为常见.Glasgow评分越低、脑...     

维持性血液滤过治疗心脏手术后急性肾损伤

目的探讨持续性血液滤过（CVVH）对心脏手术后急性肾损伤（acute kidney injury，AKI）的治疗作用。方法回顾性分析12例心脏手术后AKI患者采用CVVH治疗的临床资料。结果11例存活，1例死亡。存活患者心率及平均动脉压在CVVH过程中波动于正常范围，血肌酐、尿素氮、血钾水平在治疗后显著下降，肾功能均恢复正常。结论CVVH是救治心脏手术后AKI患者的有效手段，此结果仍需扩大样本进一步研究。     

Acute thermal injury of the esophagus

Acute thermal injury to the esophagus has not been reported previously in the radiographic literature. We present a case of a young adult who developed an intramura blister that ultimately communicated with the esophageal lumen. A double-contrast esophagogram outlined the resulting mucosal flap. A brief review of other injuries to the esophagus is included.     

血必净治疗爆炸致兔ALI及细胞因子调节作用的实验研究

目的 探讨不同剂量血必净(Xue Bi Jing,XBJ)治疗对爆炸致兔急性肺损伤(ALI)细胞因子调节作用的研究。方法 选取兔40只,随机分为5组,每组8只:设正常组为A组、设模型组为B组、设低、中、高剂量XBJ干预组分别为C组、D组和E组。采用空气爆炸致兔胸部,制作ALI模型。建模后4h、24h后采样,选取实验兔血清、支气管肺泡灌洗液(BALF),用ELISA方法测定血清和BALF中TNF-α、IL-6、IL-10的含量,选肺作病理学和肺干/湿重比(W/D)检查。结果 测定W/D、TNF-α、IL-6、IL-10中研究发现B组与A组比较显著升高(P0.05),而C、D、E组与B组比较显著降低(P0.05),且以E组降低最明显(P0.05);B组病理研究显示可见肺间质、肺泡明显水肿,肺泡断裂破坏,腔内大量红细胞、炎性细胞渗出集聚为明显,D、E组比B组明显减少(P0.05)。结论 不同浓度XBJ治疗爆炸致兔ALI显著减轻,以大剂量XBJ干预效果最好,可以抑制TNF-α、IL-6表达和促进IL-10升高,对细胞因子有调节作用,对肺有保护作用。     

Effect of a neutrophil elastase inhibitor on ventilator-induced lung injury in rats

Objective

We hypothesized that pretreatment with sivelestat therapy could attenuate ventilator-induced lung injury (VILI) and lung inflammation in a rat model.

Methods

The neutrophil elastase inhibitor was administered intraperitoneally 30 min before and at the initiation of ventilation. The rats were categorized as (I) sham group; (II) VILI group; (III) sivelestat group; (IV) early sivelestat group. Wet-to-dry weight ratio, bronchoalveolar lavage fluid (BALF) neutrophil and protein, tissue malondialdehyde (MDA) and histologic VILI scores were investigated.

Results

The ratio of wet-to-dry weight, BALF neutrophil and protein, tissue MDA and VILI scores were significantly increased in the VILI group compared to the sham group [3.85±0.32 vs. 9.05±1.02, P<0.001; (0.89±0.93)×10⁴ vs. (7.67±1.41)×10⁴ cells/mL, P<0.001; 2.34±0.47 vs. 23.01±3.96 mg/mL, P<0.001; 14.43±1.01 vs. 36.56±5.45 nmol/mg protein, P<0.001; 3.78±0.67 vs. 7.00±1.41, P<0.001]. This increase was attenuated in the early sivelestat group compared with the sivelestat group [wet-to-dry ratio: 6.76±2.01 vs. 7.39±0.32, P=0.032; BALF neutrophil: (5.56±1.13)×10⁴ vs. (3.89±1.05)×10⁴ cells/mL, P=0.021; BALF protein: 15.57±2.32 vs. 18.38±2.00 mg/mL, P=0.024; tissue MDA: 29.16±3.01 vs. 26.31±2.58, P=0.049; VILI scores: 6.33±1.41 vs. 5.00±0.50, P=0.024].

Conclusions

Pretreatment with a neutrophil elastase inhibitor attenuates VILI in a rat model.     

Leflunomide-related lung injury in patients with rheumatoid arthritis: imaging features

Imaging findings of 26 cases of leflunomide (Arava)-related acute lung injury were analyzed. Thirteen cases had pre-existing interstitial pulmonary disease on chest X-ray or computed tomography. The main features of clinically determined leflunomide-induced acute lung injury were similar to those caused by other drugs: diffuse or widespread patchy ground-glass opacities and/or consolidation, frequently accompanied by septal thickening and intralobular reticular opacities. We categorized these findings into four patterns: diffuse alveolar damage (DAD), acute eosinophilic pneumonia, hyperreaction, and cryptogenic organizing pneumonia. The DAD group had a higher mortality rate, but statistically not a significant one. It is impossible to exclude infectious disease such as pneumocystis carinii pneumonia based on imaging findings, and detailed correlation of imaging findings with clinical and laboratory findings is essential in order to make a correct diagnosis.     

早期气管切开联合过度通气在重型颅脑损伤中的临床应用价值

目的探讨早期气管切开联合轻~中度过度通气在治疗重型颅脑损伤（sTBI）中的临床应用价值。方法将80例sTBI患者（GCS评分3~8分）随机分为观察组和对照组各40例。观察组患者入院后24 h内行经皮气管切开并呼吸机短时间内维持轻~中度过度通气（HV）,监测呼气末二氧化碳分压（PetCO2）,使PetCO2维持在27~32 mmHg,30 min/次,4次/d（Q6h）,持续7 d。对照组患者入院后持续面罩中流量供氧,出现呼吸衰竭时再行经皮气管切开及机械通气（未进行过度通气）。全部80例患者均予防治感染、脱水降颅压、脑保护、营养支持等对症支持治疗（有手术指征者及时行手术治疗）,连续观察患者伤后第1~7天颅内压（ICP）的变化,所有病例于伤后6个月时根据GOS评估法判断疗效,分为良好、中残、重残、植物生存和死亡。结果观察组经过轻~中度过度通气后能使sTBI患者的ICP迅速下降,与对照组比较差异有统计学意义（P〈0.O1）。观察组与对照组患者半年后预后在良好、中残、重残、植物生存方面比较差异有统计学意义（P〈0.05）,病死率比较差异无统计学意义（P〉0.05）。结论早期气管切开联合轻~中度过度通气在治疗sTBI中有利于降低颅内压,改善重症患者伤后6个月的生存质量。     

柴茵丹参汤治疗利福平肝损伤的实验研究

[目的]观察柴茵丹参汤对大鼠利福平(RFP)肝损伤的治疗作用,并探讨其机制.[方法]RFP灌胃21 d诱导大鼠肝损伤模型,柴茵丹参汤、甘利欣、护肝片分别治疗14 d后,检测血清丙氨酸氨基转移酶(ALT)活性、血清和肝组织丙二醛(MDA)水平、肝组织病理变化及超微结构.[结果]柴茵丹参汤、甘利欣、护肝片可在不同程度上降低ALT活性(P＜0.01,＜0.05,＜0.01);柴茵丹参汤、护肝片可明显减少血清和肝组织MDA水平(P＜0.01,＜0.01,＜0.05,＜0.05),而甘利欣效果稍差(P＜0.05);3种药物可减轻肝组织细胞水肿、脂肪变性及点状坏死;柴茵丹参汤可减轻肝细胞线粒体肿胀、内质网扩张,减少凋亡的肝细胞数量,甘利欣、护肝片也可减轻肝细胞超微结构改变,但脂肪代谢异常.[结论]柴茵丹参汤对RFP肝损伤有一定的治疗作用.     

Acute kidney injury after transcatheter aortic valve implantation

Even though experience and techniques have constantly improved over the last years, peri- and postprocedural complications in high risk TAVI-collectives remain a major issue affecting outcome and survival. Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI) and effects outcome and survival. However, the definition of AKI in published studies dealing with the phenomenon of AKI after TAVI varies widely and lacks standardization. This Review aims to present an overview over the current literature concerning AKI after TAVI with regard to the definition of AKI, the impact of AKI on mortality and potential risk factors for renal impairment after TAVI.     

射频消融术的射频电流对心肌损伤的临床研究

目的：研究射频消融术(RFCA)患术后不同时间血清心肌酶浓度变化及肌酸激酶同功酶(CK—MB)与RFCA诸因素的关系。探讨RFCA对心肌的损伤程度。方法：采用酶连续检测法，分别测定40例阵发性室上性心动过速(PSV丁)患RFCA术前及术后即刻，6、12、24小时血清肌酸激酶(CK)，肌酸激酶同功酶(CK—MB)及天冬氨酸氨基转氨酶(AS丁)的浓度。结果：RFCA患CK，CK—MB，AS丁均于术后即刻升高，术后6小时达到峰值．12小时下降，24小时除CK外，均恢复正常(P均＜0．05)。经相关分析表明CK。MB活性变化的峰值升高程度与消融时间，平均功率及累计能量均无线性关系(r＝0．14，r＝0．19，r＝0．27，P均＞0．05)，而与消融靶点个数高度正相关(r＝0．84，P＜0．001)，与消融次数也有显关系(r＝0．52，P＜0．01)。结论：RFCA对心肌组织确有不同程度的损伤，但持续时间短，损伤轻，恢复快。这提示RFCA系安全有效的治疗快速心律失常的方法。     

脊髓损伤治疗干预对细胞自噬及凋亡影响的相关研究进展

脊髓损伤是脊柱外科常见的严重疾患之一,其治疗一直是世界性难题。脊髓损伤后继发性损伤所引起的后果更严重,细胞自噬与凋亡在其调控过程中起重要作用。该文对近年来脊髓损伤治疗干预对细胞自噬及凋亡影响的相关研究进展作一综述。     

动脉损伤后基质金属蛋白酶-3的变化

目的　观察基质金属蛋白酶 3(MMP 3)在动脉球囊损伤后的动态变化 ,探讨MMP 3在再狭窄形成中的作用。方法　建立大鼠腹主动脉球囊损伤模型 ,设立对照组 ,术后第 3d、7d、14d、2 1d、2 8d取材检验 ,应用免疫组织化学法观察MMP 3在血管壁的表达情况。结果　球囊损伤组MMP 3于术后第 3d表达增加 (1 73± 0 2 3) % ,14d达高峰(19 30± 0 32 ) % ,以后逐渐减弱 ;与对照组比较 ,球囊损伤组各时间点均有统计学差异。结论　MMP 3于动脉球囊损伤术后合成、分泌增多 ,在早期再狭窄形成过程中发挥作用     

An experimental study of the treatment of liver injury with InLine RFA

Background: The liver is the most frequently injured abdominal organ after blunt injury; sometimes it may be very difficult to achieve haemostasis. In this study we examined the use of InLine radiofrequency ablation (RFA) for the coagulation and haemostasis of simulated liver injury. Materials and methods: Six pigs were tested in this study. We created two types of grade III to IV liver injury: peripheral and central. Then treatment with InLine RFA was compared to conventional diathermy and suture. A total of 32 surgeries were performed: peripheral injury (12 InLine versus 6 diathermy + suture); central injury (8 InLine versus 6 diathermy + suture). Results: The reduction of blood loss was 63.88% in peripheral injury and 53.57% in central injury, respectively. There were significant differences in both types of injuries as regards blood loss (p<0.05) and blood loss per cm² (p <0.05). Conclusions: InLine RFA is efficacious in treating liver injuries in pigs and may have a significant potential for some human liver injuries.     

Resveratrol inhibits cell apoptosis by suppressing long noncoding RNA (lncRNA) XLOC_014869 during lipopolysaccharide-induced acute lung injury in rats

BackgroundAcute lung injury (ALI) is a common clinical complication with a high mortality rate. Resveratrol (Res) has been shown to protect against ALI, but the role of long noncoding RNAs (lncRNAs) in this process is still unclear.MethodsMale rats (n=20) aged 7–8 weeks were randomly divided into four groups: control, lipopolysaccharide (LPS), LPS + Res, and LPS + dexamethasone (Dexa). Intragastric administration of Res (0.5 mg/kg) or Dexa (1.5 mg/kg) was performed 1 h before intraperitoneal injection of LPS (5 mg/kg). Lung tissue, serum, and bronchoalveolar lavage fluid were sampled 6 h after LPS treatment for inflammatory factor detection, pathological detection, lncRNA sequencing and bioinformatical analysis, and TdT-mediated dUTP Nick-End Labeling. Quantitative real time polymerase chain reaction and western blotting were used to verify the sequencing results. LPS, Res, and RNA interference were used in rat alveolar epithelial cells experiments to confirm the protective of Res/lncRNA against ALI.ResultsRes pretreatment inhibited lung injury and the increase of inflammatory cytokines induced by LPS. The differentially expressed lncRNAs and mRNAs (P<0.05 and |fold change| >2) were mainly involved in the signaling pathway of immunity, infection, signaling molecules and interactions. Among the lncRNAs and mRNAs, 26 mRNAs and 23 lncRNAs had high levels in lungs treated with LPS but decreased with Res, and 17 mRNAs and 27 lncRNAs were at lower levels in lungs treated with LPS but increased with Res. lncRNA and adjacent mRNA analysis showed that lncRNAs XLOC_014869 and the adjacent gene Fos, and the possible downstream genes Jun and Faslg were increased by LPS, but these changes were attenuated by Res. Pretreatment with Res reduced LPS-induced lung tissue apoptosis. Similarly, Res treatment and knockdown of lncRNA XLOC_014869 reduced LPS-induced apoptosis and the levels of Fos, c-Jun, and Fas-L.ConclusionsRes can inhibit the increase of lncRNAs XLOC_014869 caused by LPS stimulation and inhibit lung cell apoptosis. These effects may be due to lncRNA XLOC_014869 mediation of the pro-apoptotic factors (Fos, c-Jun, and Fas-L).     

复方黄根对四氯化碳所致大鼠慢性肝损伤的保护作用

[目的]研究复方黄根对大鼠慢性肝损伤的保护作用及可能机制.[方法]制备大鼠四氯化碳(CCl4)慢性肝损伤模型,观察复方黄根对肝损伤大鼠血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)活性,总蛋白(TP)、清蛋白(Alb)和羟脯氨酸(Hyp)水平的变化以及肝组织匀浆超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平的影响,放免法检测透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)水平,免疫组化法测肝组织转化生长因子-β1(TGF-β1)的表达,并观察肝组织病理学改变.[结果]复方黄根可显著降低CCl4所致大鼠慢性肝损伤血清中ALT、AST、HA、PⅢP、Hyp水平,升高血清中Alb、TP水平;升高肝组织中SOD、GSH-Px的活性,并可降低MDA的水平;免疫组化结果表明复方黄根能抑制TGF-β1表达;病理观察结果能减轻慢性肝损伤的肝脏损伤程度.[结论]复方黄根有明显的保肝和抗肝纤维化作用,其作用机制可能与抗脂质过氧化和抑制肝组织TGF-β1的表达有关.     

Edaravone suppresses postoperative reperfusion injury in rat lower extremity: An immunohistological study

PURPOSE

The present study evaluated whether the free radical scavenger edaravone (Radicut [Mitsubishi Pharma Co, Japan]) can suppress lower extremity postoperative reperfusion injury by evaluating muscle cell viability with immunohistological stain (cytochrome c oxidase stain).

METHODS

Eight Lewis male rats (460 g to 510 g) were divided into two groups. In the control group, postoperative reperfusion injury models were created by clamping the bilateral common femoral arteries for 5 h and then releasing. In the other group, 9.0 mg/kg of edaravone was administered before clamping the bilateral common femoral arteries. After 5 h of reperfusion, the bilateral triceps muscles in both groups were stained with cytochrome c oxidase stain (each n=4 × 2). The positive areas of cytochrome c oxidase stain were measured and compared, using computerized densitometry (National Institutes of Health Image program, version 1.61).

RESULTS

In the control group, the lower triceps muscles were not stained with cytochrome c oxidase. In the edaravone group, the lower triceps muscles were strongly stained with cytochrome c oxidase. The positive areas of cytochrome c oxidase stain were significantly greater in the edaravone group (133,000±12,000 μ²/mm², P<0.01) compared with the control group (8000±1300 μ²/mm²).

CONCLUSION

The present study suggests that the preoperative administration of 9.0 mg/kg of edaravone may suppress postoperative reperfusion injury in a rat model.     

670例药物性肝损害分析

目的探讨药物性肝损害的病因、临床特点及预后,为防治提供参考。方法选取670例诊断为药物性肝损害的住院患者,对其用药史、临床表现、肝功能及预后等进行回顾性分析。结果引起药物性肝病的前三位药物分别为抗肿瘤药物(18.8%)、中草药(13.3%)、抗结核药(12.5%);临床表现多为恶心、呕吐、乏力、纳差等非特异性症状。肝损害以肝细胞损害型最为常见,占420例(62.7%)。药物性肝损害患者的预后较好,其中治愈和好转率达82.7%。结论引起药物性肝病的药物种类繁多,由于药物性肝病临床表现无特异性,易误诊及漏诊,在有基础肝病者中更为常见,因此临床医师应提高对本病的认识,并应加大相关研究力度,重在预防和早期诊治。     

Drug-induced hypersensitivity syndrome associated with reactivation of human herpesvirus 6 presenting with severe hepatic injury

Little is known about the pathophysiology of liver complication seen in drug-induced hypersensitivity syndrome (DIHS). We describe herein a 32-year-old Japanese man with DIHS due to salazosulfapyridine (SASP) associated with reactivation of human herpesvirus 6 (HHV-6) presenting with severe acute hepatic injury. The patient, with a 1-year history of ulcerative colitis (UC), presented with high fever and abnormally elevated liver enzymes. Six weeks prior to his symptoms, prednisolone (PSL) and SASP had been started because of UC aggravation. Besides fever and liver dysfunction, the appearance of atypical lymphocytes together with eosinophils and generalized erythematous maculopapular skin rash developed sequentially, and a diagnosis of DIHS was established. Despite cessation of SASP and increased dose of PSL, his initial abnormalities continued, and biphasic second alanine aminotransferase (ALT) flare with deep jaundice worsened. Based on the significant increase in the titer of HHV-6 IgG antibodies at the second peak of ALT level without HHV-6 IgM antibody elevation, strongly suggesting reactivation of the virus, HHV-6 was first considered to directly contribute to the deterioration of liver function. However, extensive histological analysis of the liver led to the realization that the cause of the DIHS liver injury was essentially drug-related hepatotoxicity induced by SASP, causing wide-ranging damage to both the hepatocytes and cholangiocytes.