静吸复合麻醉对特重度烧伤患者凝血功能障碍的影响

目的收集特重度烧伤(总TBSA50%以上或三度TBSA20%以上或伴有严重并发症者)患者围术期凝血指标(APTT、PT、FIB、DD和PLT)，分析静吸复合麻醉对患者凝血功能的影响及其临床意义。 方法选取近3年内蒙古医科大学第三附属医院烧伤外科收治的特重度烧伤患者148例，根据入院14 d内的预后分为死亡组和生存组，生存组男性129例，女性9例；年龄24~59岁，平均(43.30±12.90)岁。死亡组男性8例，女性2例；年龄26~63岁，平均(46.19±15.41)岁。收集入院时(T0)，术前(早晨入手术室前，T1)，术毕(送至PACU未拔除气管导管前，T2)及术后2 d(T3)4个时间点的凝血指标，比较两组凝血指标动态差异。 结果死亡组休克期输液量、累计血浆、红细胞输入量显著高于生存组(P<0.01)。T0时，生存组的FIB(1.78±0.32)显著高于死亡组(1.26±0.07)(P<0.05)；T2时，两组APTT、PT均显著缩短(P<0.05)，生存组的FIB(3.86±0.40)显著高于死亡组(2.45±1.02)(P<0.05)；T3时，死亡组PLT显著低于生存组(P<0.01)。 结论特重度烧伤患者在围手术期易出现高凝状态，并且这可能导致患者死亡。静吸复合麻醉和围术期大量液体复苏会促进患者的高凝状态。     

Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection

Cerebral ventricular infection(CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques(NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery(NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade I(n = 3), Grade II(n = 13), Grade III(n = 10), and Grade IV(n = 6) CVI. The three patients with grade I CVI underwent one NES,the 23 patients with grade II/III CVI underwent two NESs, and patients with grade IV CVI underwent two(n = 3) or three(n = 3) NESs.The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures.Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus,18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6-to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.     

Control the fate of human umbilical cord mesenchymal stem cells with dual‐enzymatically cross‐linked gelatin hydrogels for potential applications in nerve regeneration

Stem‐cell‐based therapy is a promising strategy to treat challenging neurological diseases, while its application is hindered primarily by the low viability and uncontrolled differentiation of stem cell. Hydrogel can be properly engineered to share similar characteristics with the target tissue, thus promoting cell viability and directing cell differentiation. In this study, we proposed a new dual‐enzymatically cross‐linked and injectable gelatin hydrogel for regulating survival, proliferation, and differentiation of human umbilical cord mesenchymal stem cells (hUC‐MSCs) in a three‐dimensional matrix. This injectable gelatin hydrogel was formed by oxidative coupling of gelatin–hydroxyphenyl acid conjugates catalyzed by hydrogen horseradish peroxidase (HRP) and choline oxidase (ChOx). Modulus and H₂O₂ release can be well controlled by ChOx activity. Results from calcein‐AM/PI staining and Ki67 immunofluorescence tests demonstrated that the survival and proliferation behavior of hUC‐MSCs were highly enhanced in HRP_1UChOx_0.25U hydrogel with lower modulus and less H₂O₂ release compared with other groups. Attractively, the expression of neuron‐specific markers β‐III tubulin, neurofilament light chain (NFL), and synapsin‐1 was significantly increased in HRP_1UChOx_0.25U hydrogel as well. Additionally, in vitro hemolysis test and in vivo HE staining data highlighted the good biocompatibility. Undoubtedly, this injectable gelatin hydrogel's ability to control hUC‐MSCs' fate holds enormous potentials in nervous disorders' therapy and nerve regeneration.     

颅脑创伤术后非感染性发热的原因分析与处理

目的分析颅脑创伤（TBI）开颅术后非感染性发热的原因，探讨其诊治措施。 方法收集广州医科大学附属第六医院脑外科自2016年5月至2019年7月行TBI开颅术后非感染性发热的23例患者的病例资料，对其发热原因及相应临床特点进行分析。 结果TBI开颅术后23例患者出现非感染性发热，其中吸收热3例，中枢性发热3例，植物神经功能紊乱2例，无菌性脑膜炎7例，皮下积液2例，假性囊肿1例，脑脊液漏3例，药物源性发热2例，经治疗后好转。 结论TBI开颅术后非感染性发热的原因复杂，应针对不同原因采取个体化的治疗措施。     

临床医学专业“5+3”一体化本科全程导师制创新人才培养的实践与探索

以培养创新型人才为目标，大连医科大学制定实施了“5+3”创新人才培养改革方案，以导师制培养为载体，在医学本科教育全过程中，制定分阶段创新能力培养体系，涵盖课程、讲座、实验设计、论文等基本科研能力训练，强化本科生科研能力培养。通过对首届“5+3”学生阶段性培养成果的统计学分析发现，“5+3”学生发表中文期刊、SCI，主持国家级创新项目、省级创新项目的比例均显著高于普通5年制学生，差异具有统计学意义（P<0.05）。虽然实施过程中存在一些问题和不足，但以导师制为核心的科研基础训练对提高学生科研思维和创新能力效果显著，对培养医学创新型人才具有可实施性。     

丝棉木种子化学成分及其抗肿瘤活性

目的 研究丝棉木Euonymus maackii Rupr.种子的化学成分及其抗肿瘤活性.方法 丝棉木种子95%乙醇提取物乙酸乙酯部位采用硅胶、D101、反相HPLC进行分离纯化,根据理化性质及波谱数据鉴定所得化合物的结构.MTT法测定其抗肿瘤活性.结果 从中分离得到10个化合物,分别鉴定为1β-甲基正丁酰氧基-2β-苯甲酰氧基-4α-羟基-6α-呋喃酰氧基-9β,12-二乙酰氧基-β-二氢沉香呋喃(1)、6α,9β,12-三乙酰氧基-1β,2β,8β-三苯甲酰氧基-β-二氢沉香呋喃(2)、6α,9β,12-三乙酰氧基-1β,8β-二苯甲酰氧基-2β-正己酰氧基-β-二氢沉香呋喃(3)、6α,9β,12-三乙酰氧基-1β,8β-二苯甲酰氧基-2β-正辛酰氧基-β-二氢沉香呋喃(4)、6α,9β,12-三乙酰氧基-1β,8β-二苯甲酰氧基-2β-正癸酰氧基-β-二氢沉香呋喃(5)、卫矛羰碱(6)、6α,12-二乙酸基-1β,9α-二乙酸(β-呋喃羧氧基)-4α-羟基-2β-2-甲基丁酯-β-二氢沉香呋喃(7)、6α,9β,12-三乙酰氧基-1β,8β-二苯甲酰氧基-2β-羟基-β-二氢沉香呋喃(8)、6α,12-二乙酸基-1β,9 α-二乙酸(β-呋喃羧氧基)-4α-羟基-1β-2-甲基丁酯-β-二氢沉香呋喃(9)、6α,9β,12-四乙酰氧基-1β,8β-二苯甲酰氧基-β-二氢沉香呋喃(10).化合物6对Hela细胞有明显的抑制作用,IC50为9.76 μg/mL.结论 化合物1为新化合物.化合物6有一定的抗肿瘤活性.