目的 研究不同剂量液体复苏对失血性休克大鼠肠损伤及肠黏膜通透性的影响.方法 将72只SD大鼠随机分成4组(n=18):高剂量液体复苏组(HLR组)、中剂量液体复苏组(MLR组)、低剂量液体复苏组(LLR组)及未复苏组(Sham组),前3组的液体复苏剂量分别为45、30和15 mL/(kg·h).复苏后检测所有大鼠肠黏膜的通透性.于复苏后24、48及72 h,均分别抽取6只大鼠检测动脉血中乳酸和静脉血中肿瘤坏死因子-α(TNF-α)的水平,测量肠湿/干重比,进行小肠组织病理学检查并评分.结果 复苏后,HLR组的肠黏膜通透性高于其余3组(P＜0.05).复苏3～8 h内,Sham组的所有大鼠均死亡,而其余3组大鼠均存活.术后24 h时LLR组的乳酸水平低于其余2组(P＜0.05);HLR组的TNF-α水平在术后24、48及72 h均高于其余2组(P＜0.05),在48 h时,LLR组低于MLR组(P＜0.05);术后24 h时,LLR组的肠湿/干重比最低,HLR组最高(P＜0.05).HE染色结果显示,3组大鼠肠黏膜损伤严重程度均随时间好转,但在48和72 h时,LLR组的肠绒毛基本正常.结论 复苏剂量为15 mL/(kg·h)的限制性液体复苏能降低失血性休克大鼠术后早期酸中毒的程度和TNF-α的释放,降低肠黏膜通透性,减轻对肠道的损伤.

BACKGROUND:Thyrotrophin,insulin or insulin-like growth factor play important roles in development,differentiation,heterogenic expression and function production of thyroid cells.Thus,this study simulated thyroid in vivo embryogenesis,and gradually added above-mentioned stimulating factor to further induce bone marrow mesenchymal stem cells(BMSCs).OBJECTIVE:To investigate the feasibility of differentiation of the adult BMSCs into thyroid cells under specific circumstances in vitro.METHODS:BMSCs were isolated by the density gradient method.BMSCs were induced with thyrotrophin and insulin.Morphological changes were observed by the inverted optical microscope and transmission electron microscopy.Immune fluorescence detection method was used to differentiate adult BMSCs.RESULTS AND CONCLUSION:On day 3 following culture in the induction group,BMSC morphology changed from spindle to round,ellipse or triangle,grew irregularly,with clear boundary.On day 8,adherent embryo became flat.On day 7,differentiated cells expressed thyroid cell gene TSHr.On day 9,differentiated cell markers TTF-1 expression was detected in thyroid cells.Results suggested that BMSCs can be induced to differentiate into thyroid cells in vitro and are ideal seed cells in the study of tissue engineering treatment of thyroid diseases.

BACKGROUND: Under certain conditions, rat bone marrow mesenchymal stem cells (BMSCs) can be induced to differentiate into thyroid cells. OBJECTIVE: To establish the method to in vitro induce the differentiation of rat BMSCs into thyroid cells. METHODS: BMSCs were separated using density gradient method, and induced with thyroid-stimulating hormone and insulin. A group without any induced materials was used as parallel control. Morphology changes were observed with inverted optical microscope and transmission electron microscopy, immune fluorescence detection method was applied for BMSCs differentiation. RESULTS AND CONCLUSION: Thyroid cell-specific gene expression such as TSHr could be seen in cultured cells after 7 days; thyroid cell-differentiated cell markers TTF-1 expression was detected after 9 days; no change in the control group. BMSCs can be induced to differentiate into thyroid cells based on morphology and biological examination.

患者男,49岁.因上腹部疼痛伴巩膜黄染,尿黄半个月入院.肝功能Child B级.AFP＞1210μg/L.B超及CT检查示肝右叶及尾状叶略低密度软组织影,包块突向肝门部,肝内胆管、胆总管扩张.增强扫描动脉期包块中度强化,门静脉期及延迟期病灶密度明显低于肝实质,脾明显增大,脾门区及胃底见曲张血管团.有乙型病毒性肝炎病史10年.诊断为原发性肝癌伴胆管癌栓,肝硬化.

奥美拉唑是一种新型强力胃酸分泌抑制剂,临床用于治疗胃酸相关性疾病.近年来国内有文献报道其不良反应,现摘要如下.

头孢他啶为第3代头孢菌素类抗生素,临床应用广泛,近年来国内有文献报道其不良反应,现摘要如下.

> 2000年至2005年青岛3家医院收治52例局部进展期结肠直肠癌累及泌尿道患者,42例资料完整,现总结报告如下。1.对象与方法:42例中,22例为乙状结肠癌(Dukes B期19例;Dukes C 期3例),14例为直肠癌(Dukes B 期12例;Dukes C 期2例),6例为结肠直肠癌盆腔内局部复发。所有患者均累及泌尿道,年龄28～81岁,平均59岁;随访0.05～6.8年,中位时间45个月,随访率81%(34/42)。切除肿

头孢曲松钠为第三代头孢菌素类药物,其抗菌谱广临床应用广泛, 近年来国内有文献报道其不良反应,现摘要如下. 1 过敏反应 女,33岁.因剖腹产并阑尾切除术后给予头孢曲松钠2.0 g+生理盐水250 ml静滴 ,用药后患者出现全身多处皮肤瘙痒,予对症治疗,症状略微缓解,次日继用本品,滴后仍有皮肤瘙痒,改用抗生素后,皮肤瘙痒自行消失[1].

对近年来文献报道药物合用所致不良反应摘要如下. 1 阿昔洛韦+头孢曲松致肾损害 男,19岁.因流行性腮腺炎给予阿昔洛韦1 g和头孢曲松1 g静滴,1次/d,第4次用药后出现剧烈呕吐,胸闷,腰部胀痛,继发少尿.查肾功能:BUN 8.45 mmol/L,Cr 157.1 μmol/L,UA 495.3 μmol/L.给予保肾对症治疗,症状逐渐缓解,本例阿昔洛韦剂量偏大,且与头孢曲松合用,加重了肾损害,提示两药应避免合用[1].

1 左氧氟沙星 女,63岁.因系统性红斑狼疮给予盐酸左氧氟沙星注射液0.4 g+5%葡萄糖液250 ml静滴,5 min后出现头晕、恶心、口唇严重肿胀不能张嘴,双眼睑水肿不能睁眼,两侧面部水肿明显,视力模糊,即停药,给予对症治疗,3 d后面部水肿减轻,5 d后症状完全消失[1].

1 病例报告 例1:男,28岁.发热、心悸3 d入院.查体:T 38.5 ℃,BP 100/70 mm Hg,结膜轻度充血水肿,心界不大,心率不齐,心电图提示频繁交界性早搏,血WBC 6.7×109/L,中性0.65,PLT 120×109/L,肾功正常,尿蛋白(+),疑病毒性心肌炎.次日患者血压下降,右侧胸部腋下见散在出血点,HFRS抗体阳性,诊断肾综合征出血热(HFRS)治愈出院.