Survival, hemodynamics, and tissue oxygenation after head trauma

BACKGROUND: The aims of this study were to describe the early time course of hemodynamic and tissue perfusion and oxygenation patterns in survivors and nonsurvivors after head injury; to suggest physiologic mechanisms responsible for the observed patterns; and to evaluate postinjury parameters that might be useful for treatment. The hypothesis was that reduced hemodynamics and tissue oxygenation and reduced arterial oxygen saturation affect outcomes. STUDY DESIGN: Sixty patients with head trauma were noninvasively monitored on arrival in the emergency department to assess the temporal hemodynamic patterns associated with head injury; patients who were brain dead were excluded because they have very different hemodynamic patterns. Cardiac index, mean arterial pressure, and heart rate were monitored to assess cardiac function, pulse oximetry to reflect changes in pulmonary function, and transcutaneous oxygen and carbon dioxide to reflect tissue perfusion function. Patients were stratified by inhospital survival outcomes, the Glasgow Coma Scale, and the presence or absence of associated somatic injuries. RESULTS: When all head injured patients were considered together, the predominant findings were high cardiac index, hypertension, mild tachycardia, normal pulmonary function, and reduced tissue oxygenation. The subset of survivors and those with high Glasgow Coma Scale had greater than normal cardiac index responses (4.02 +/- 0.01 (SEM) L/min/m2, p < 0.01 versus normal) and better tissue oxygenation (217 +/- 2 mmHg PtcO2/FiO2) than nonsurvivors (70 +/- 3 mmHg, p < 0.01) and those with low Glasgow Coma Scale (160 +/- 2, p < 0.05). Patterns of patients with associated somatic injuries were similar to those with isolated head injury. CONCLUSIONS: The study suggested that survivors' cardiac index, tissue oxygenation, and arterial oxygen saturation may be considered as markers of resuscitation. Nonsurvivors of head injury had normal blood flow with reduced tissue oxygenation that might have contributed to unfavorable outcomes.     

Bilateral monosymptomatic optic neuritis following Mycoplasma pneumoniae infection: A case report and literature review

Herein, we report the clinical findings, treatment choice, and clinical course of a rare case of Mycoplasma pneumoniae (M. pneumoniae) infection with the sole manifestation of optic neuritis (ON). To the best of our knowledge, this is the first case presenting monosymptomatic visual loss without papillitis, neurological symptoms, and abnormal findings on brain imaging. Related articles about ON after M. pneumoniae infection were reviewed to summarize the clinical presentation, possible mechanisms, clinical survey, treatment, and prognosis of this condition. We propose that a Mycoplasma profile is necessary in children who present with ON, especially when this condition is accompanied by prodromal symptoms of the respiratory tract infection.     

银杏叶提取物对氧诱导视网膜病新生鼠视网膜血管形态和密度的影响

目的探讨银杏叶提取物(金纳多)对氧诱导早产儿视网膜病变(ROP)新生鼠视网膜血管形态和密度的影响。方法将48只SD新生鼠随机分为对照组、模型组、治疗组各16只,模型组与治疗组建立波动氧诱导的新生鼠ROP模型,治疗组于造模第7天开始予以金纳多50mg/(kg·d)腹腔注射7天。各组分别于第14天和第19天随机抽取8只新生鼠,一侧眼球采用视网膜铺片ADP酶染色,观察视网膜血管形态改变,另一侧眼球行组织切片HE染色,观察并计数突破视网膜内界膜的血管内皮细胞核数目。结果视网膜铺片ADP酶染色显示,第14天和第19天时,模型组较对照组血管主干变细、形态异常,而治疗组血管形态和密度较模型组明显好转。HE染色显示模型组第14天和第19天视网膜各层细胞排列紊乱;第19天突破内界膜的细胞核数对照组、模型组、治疗组分别为(5.0±2.1)、(34.6±5.3)、(12.6±3.4),模型组高于对照组和治疗组,差异均有统计学意义(P<0.001)。结论高幅度氧浓度波动可成功构建ROP动物模型。金纳多在氧诱导视网膜病变新生鼠模型中对视网膜发挥保护作用。     

阿帕替尼联合艾瑞卡对NSCLC患者免疫细胞表面分子表达的影响

目的分析阿帕替尼联合艾瑞卡对非小细胞肺癌患者免疫细胞表面分子表达的影响,并免疫细胞表面分子与临床预后的相关性。 方法采用巢式对照研究法,以确诊为晚期非小细胞肺癌为研究起点,将接受放化疗+阿帕替尼靶向治疗的病例作为阿帕替尼组35例,将与阿帕替尼组基线资料相匹配的接受放化疗+阿帕替尼+艾瑞卡的病例作为阿帕艾瑞组30例。观察阿帕替尼组和阿帕艾瑞组临床预后情况(总生存月数)及血清免疫指标(CD4⁺ T细胞、Treg细胞及表面分子CD39⁺、PD-1⁺)表达情况,并采用生存时间Kaplan-Meier曲线分析CD39、PD-1表达对临床预后的影响。 结果阿帕艾瑞组平均总生存时间(8.57±1.34)个月长于阿帕替尼组(6.70±0.54)个月,P<0.05。与治疗前比较,治疗后阿帕替尼组和阿帕艾瑞组的CD4⁺ CD39⁺、CD4⁺ PD-1⁺表达水平均下降,但阿帕艾瑞组的CD4⁺ CD39⁺、CD4⁺ PD-1⁺表达水平下降幅度高于阿帕替尼组(P<0.05)。与治疗前比较,治疗后阿帕替尼组和阿帕艾瑞组的Treg+CD39⁺、Treg+PD-1⁺表达水平均下降,但阿帕艾瑞组的Treg+CD39⁺、Treg+PD-1⁺表达水平下降幅度高于阿帕替尼组(P<0.05)。CD39阳性表达病例的平均总生存时间(5.48±0.34)个月短于CD39阴性表达病例(9.61±1.28)个月(P<0.05)。PD-1阳性表达病例的平均总生存时间(5.44±0.28)个月短于PD-1阴性表达病例(9.89±1.19)个月(P<0.05)。 结论与阿帕替尼辅助放化疗方案比较,阿帕替尼联合艾瑞卡辅助放化疗可获取到更佳总生存时间收益,可改善非小细胞肺癌患者免疫相关细胞CD39、PD-1蛋白的表达,可能与艾瑞卡的恢复机体抗肿瘤免疫力有关。     

Th1/Th2类细胞因子在非小细胞肺癌中的作用探讨

目的探讨CD8 T细胞分泌的Th1/Th2类细胞因子在非小细胞肺癌中的作用。方法将具有完整分期(Ⅰ、Ⅱ、Ⅲ、Ⅳ期)的非小细胞肺癌患者与正常对照组随机各抽取35例,对其CD8 T细胞及其分泌的Th1类细胞因子Interferon-γ(IFN-γ)、Interleukin-2(IL-2)和Th2类细胞因子IL-4的变化进行流式细胞术检查并进行Spearman分析。结果正常对照组、Ⅰ、Ⅱ、Ⅲ、Ⅳ期肺癌中CD8 T细胞表达IFN-γ占CD8 T细胞百分比分别为(61.71±11.41)%、(59.83±11.32)%、(46.28±9.54)%、(35.16±7.51)%和(28.57±5.82)%;IL-2百分比分别为(63.22±12.01)%、(65.28±12.52)%、(54.27±9.78)%、(46.81±7.86)%和(35.24±6.84)%;IL-4百分比分别为(30.59±4.84)%、(31.52±4.97)%、(42.28±6.38)%、(53.37±8.61)%和(67.58±10.88)%;与Ⅰ、Ⅱ期肺癌相比,Ⅲ、Ⅳ期肺癌CD8 T细胞表达Th1类细胞因子IFN-γ、IL-2占CD8 T细胞的百分比下降,表达Th2类细胞因子IL-4占CD8 T细胞的百分比升高,有统计学意义(P值均<0.01)。经Spearman相关分析发现肺癌的分期与CD8 T细胞表达Th1类细胞因子IL-2、IFN-γ占CD8 T细胞的百分比呈负相关,秩相关系数分别为rS=-0.5124;rS=-0.4862;rS=-0.4327。而与CD8 T细胞表达Th2类细胞因子IL-4占CD8 T细胞的百分比呈正相关,秩相关系数分别为rS=0.5056。结论晚期肺癌患者Th1/Th2类细胞免疫功能失平衡,Th1类细胞免疫功能下降。     

保存前后滤除WBC的RBC悬液质量的对比性研究

目的探讨保存前后滤除WBC(滤白)的RBC悬液质量的变化,为临床选择滤白时机提供参考依据。方法对4℃保存5d的悬浮RBC 20袋(每袋2U)用血库型滤器滤白作为保存后滤白组(A组),由血站滤白的少白悬浮RBC 20袋(每袋2U)作为保存前滤白组(B组);分别在第7天、第14天、第21天、第28天和第35天测定两组血细胞指标、炎性细胞因子水平。结果 B组血浆游离血红蛋白(FHb)在第14天明显升高,K+浓度在21d显著升高,且二者浓度随保存时间的延长而增加(P<0.05);A组炎性细胞因子(IL-1、IL-6、IL-8、TNF-α)水平在滤白后第21天时才明显升高,与B组比较差异有统计学意义(P<0.05);A、B两组回收率差异无统计学意义(P>0.05)。结论保存前后滤白都能达到很好的滤除效果,但不同的滤白贮存方式对血液的质量产生不同的效果,为临床选择不同的滤白RBC提供了实验依据。     

老年人贫血病因学研究进展

人的年龄超过60岁,即步入老年期[1].贫血是老年人群患病率很高的一种疾病.老年人贫血的诊断标准应比中青年相应降低,当血红蛋白＜110g/L时可诊断为贫血[2].国外有研究报道:贫血患病率随着年龄的增加而增高,男性略高于女性,黑人比白人更明显[3].美国65岁及以上老年人贫血患病率分别为男性11.0%、女性10.2%[4].     

A novel nano-structured porous polycaprolactone scaffold improves hyaline cartilage repair in a rabbit model compared to a collagen type I/III scaffold: in vitro and in vivo studies

Purpose

To develop a nano-structured porous polycaprolactone (NSP-PCL) scaffold and compare the articular cartilage repair potential with that of a commercially available collagen type I/III (Chondro-Gide^®) scaffold.

Methods

By combining rapid prototyping and thermally induced phase separation, the NSP-PCL scaffold was produced for matrix-assisted autologous chondrocyte implantation. Lyophilizing a water–dioxane–PCL solution created micro and nano-pores. In vitro: The scaffolds were seeded with rabbit chondrocytes and cultured in hypoxia for 6 days. qRT–PCR was performed using primers for sox9, aggrecan, collagen type 1 and 2. In vivo: 15 New Zealand White Rabbits received bilateral osteochondral defects in the femoral intercondylar grooves. Autologous chondrocytes were harvested 4 weeks prior to surgery. There were 3 treatment groups: (1) NSP-PCL scaffold without cells. (2) The Chondro-Gide^® scaffold with autologous chondrocytes and (3) NSP-PCL scaffold with autologous chondrocytes. Observation period was 13 weeks. Histological evaluation was made using the O’Driscoll score.

Results

In vitro: The expressions of sox9 and aggrecan were higher in the NSP-PCL scaffold, while expression of collagen 1 was lower compared to the Chondro-Gide^® scaffold. In vivo: Both NSP-PCL scaffolds with and without cells scored significantly higher than the Chondro-Gide^® scaffold when looking at the structural integrity and the surface regularity of the repair tissue. No differences were found between the NSP-PCL scaffold with and without cells.

Conclusion

The NSP-PCL scaffold demonstrated higher in vitro expression of chondrogenic markers and had higher in vivo histological scores compared to the Chondro-Gide^® scaffold. The improved chondrocytic differentiation can potentially produce more hyaline cartilage during clinical cartilage repair. It appears to be a suitable cell-free implant for hyaline cartilage repair and could provide a less costly and more effective treatment option than the Chondro-Gide^® scaffold with cells.     

滤过手术中丝裂霉素C不同用法的疗效分析

目的 比较青光眼滤过手术中丝裂霉素C（MMC）结膜瓣下与巩膜瓣下两种应用方法的降压效果和并发症的发生情况。方法 132眼接受滤过手术的原发性青光眼随机分为对照组和MMC组，再将应用MMC（0．4mg／ml，3min）的66眼分成结膜瓣下（MMC-A）组和巩膜瓣下（MMC-B）组。观察1年内3组患者手术后的眼压、视力和手术并发症。结果 MMC组与对照组相比眼压下降差异有统计学意义（P〈0．05），功能性滤过泡形成率71．21％，手术成功率达75．76％，而两组手术并发症无显著性差异。MMC两组病人的降压效果和并发症的差异无统计学意义。结论 MMC作为滤过性手术辅助药物，可增加手术成功率，而且无严重并发症。MMC放置在结膜瓣下和巩膜瓣下效果相似，但放置在结膜瓣下可能会减少对眼内组织的毒性。     

红毛五加多糖对四氧化碳肝损伤保护作用机理探讨

目的：研究红毛五加多糖（AGP）对四氯化碳（CCl4)肝损伤保护作用机理。方法：采用大鼠CCl4肝损伤模型进行实验。结果：AGP能明显降低CCl4肝损伤大鼠的肝MDA，提高肝GSH和细胞色素P－450含量及GSH－Px活性。结论：AGP对CCl4引起的急性肝损伤保护作用机制可能与其清除自由基，抑制脂质过氧化及诱导肝药酶有关。