目的:探讨miR-19a通过调节PTEN在肝癌中有抑制肝癌细胞的作用.方法:分析miR-19a表达与肝癌临床病理特征以及预后的关系;用RT-PCR的方法检测miR-19a基因在100例肝癌组织、相应的癌旁组织以及肝癌细胞HepG2中的表达;Western Blot检测PTEN及其下游通路蛋白的表达.采用双荧光素报告基因验证miR-19a对PTEN的靶向调控作用.结果:在肝癌患者中,低表达的miR-19a与较小的肿瘤体积(P＜0.05)、较低的TNM分级(P＜0.05)相关;此外,与Mut-PTEN转染的细胞相比,miR-19a抑制剂和WT-PTEN-3'UTR共转染可明显促进萤光素酶活性(P＜0.05).结论:miR-19a在肝癌中表达升高,且低表达的miR-19a可以通过上调PTEN表达进一步抑制肝癌细胞的增殖.其具有重要的应用前景和临床应用价值.

目的:研究脂氧素A4对横纹肌溶解大鼠横纹肌的保护作用及机制.方法:SD大鼠45只,随机分为3组,每组15只,包括正常对照组、模型组(肌注50％甘油10 mL/kg)、脂氧素A4组(模型组基础上加1 μg/kg脂氧素A4腹腔注射).72 h后取大鼠下肢肌肉标本进行病理检查,Western Blot法检测肌组织核转录因子(NF)-κB的蛋白表达.同时检测血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平.结果:模型组TNF-α、IL-6水平分别为(214.03±15.52)pg/mL 和(131.92±6.31)pg/mL,而正常对照组分别为(61.36±4.96)pg/mL 和(48.52±4.00)pg/mL,差异均有统计学意义(P＜0.05),表明模型制备成功;和脂氧素A4组[分别为(93.78±5.25)pg/mL、(67.28±6.23)pg/mL]相比较,差异也有统计学意义(P＜0.05).与模型组比较,脂氧素A4组肌组织NF-κB表达明显下降(P＜0.05),病理切片中横纹肌组织损伤显著减少.结论:脂氧素A4可减少横纹肌溶解大鼠血浆IL-6和TNF- 的释放,抑制肌组织NF-κB蛋白的表达,从而对横纹肌溶解的大鼠的横纹肌起到保护作用.

目的 探讨非创伤性胸痛的临床特点及病因.方法 选取2016年7月及2017年10月武汉大学中南医院急救中心接诊的非创伤性胸痛2例,观察临床特点,并分析病因及发病机制.结果 不同病因的非创伤性胸痛病人胸痛位置、胸痛程度、胸痛时间、影像资料和实验室检查均不同,2例病人在采取相应对症治疗后,均治愈出院.结论 不同病因形成的以胸痛为主诉的非创伤性胸痛病人的临床特点各不相同,在诊疗过程中应根据病人的不同临床特点,给予及时准确治疗.

Objective:To study the immune regulation effect of Lipoxin A4 (LXA4) on CD4+ T ceils and the protective effect on germ cells in testicular ischemia and reperfusion injury in rats.Methods:Forty rats were randomly divided into 4 groups:sham group(A);testicular torsion group(B);torsion/detorsion (T/D) group(C),T/D plus LXA4-pretreated group(D).Biochemical analysis (IFN-γ,IL-2,IL-4,IL-10,MDA,SOD and GPx in the testes),apoptosis assessment of germ cells,and morphologic evaluation were carried out after orchiectomies.Results:Compared with group A,the levels of proinflammatory cytokines (IFN-γ,IL-2) and MDA were significantly increased in the testes (P＜0.05),and the levels of SOD and GPx were decreased after testicular torsion.Compared with B and C,the levels of IL-4,IL-10 and tissue SOD/GPx were significantly increased (P＜0.05) in group D,while IFN-y,IL-2 and MDA levels were significantly decreased.In addition,the AI (apoptosis index) values of group D was significantly lower than group B and C (P＜0.05),whereas Johnsen score was significantly increased (P＜0.05).Furthermore,swollen mitochondria with degenerated cristae and enlarged intercellular spaces were observed under transmission electron microscopy in group D.Conclusion:LXA4 can regulate cytokine secretion of CD4+ T cells and reduce the inflammation injure to germ cells,thus protecting reproductive function in testieular ischemia-reperfusion in rats.

目的:探讨急诊外科患者数量的多少是否影响电子病历的使用.方法:以2014-11-2015-04在我院急诊外科就诊的患者为A组,2015-05-2015-10就诊的患者为B组,2组时间内接诊医师无人事、人员数量变动,均为8名医师;对每位接诊医师在A组及B组所接诊患者的数量,电子病历使用率,患者等待医生看诊总时间和收入院患者的总体等待入院时间进行对比分析.结果:A组内单个医师接诊患者量为(2 256±124)例,B组为(3036±195)例,2组差异有统计意义(t=7.82,P＜0.05).A组电子病历完成率为(94.5±2.3)％,B组电子病历完成率为(94.0±1.3)％,2组差异无统计学意义.A组患者等待就诊时间为(12.2±2.1) min,B组为(13.2±1.7) min,2组差异无统计学意义.A组收住院患者住院时间为(77.2±8.8) min,B组为(72.8±5.9) min,2组差异无统计学意义.结论:急诊外科患者的数量并不影响结构化电子病历的使用,也不影响患者的等待时间和入院时间,应大力推行电子病历的使用.

Objective To investigate the effects of the unbalance of CD4+T cell subgroups on germ cell apoptosis during rat testicular torsion. Methods Male SD rats were randomly divided into three groups and there were 10 rats in each group. For rats in sham operation group, they served as the control;For rats in left unilateral testicular torsion group, their left testes were rotated 720 degree for 2 hours;For rats in left testicular torsion reset group, their testes were reseted after 2 hours testicular torsion. At 24 hours after operation, levels of serum cytokines IFN-γ, IL-12, IL-4 and IL-10 were measured by ELISA. Germ cell apoptosis index in left testes of the rats was determined by TUNEL. Results Compared with that of the sham operation group, the levels of Th1 type cytokines were significantly increased in torsion and detorsion groups(P<0.05). The levels of Th2 type cytokines such as IL-4, IL-10 were obviously lower in torsion and detorsion groups than that in sham operation group (P<0.05). CD4+T cell subgroups was unbalance during testicular torsion in rats. The apoptosis index of germ cells was significantly higher in torsion and detorsion groups than that of sham operation group. Conclusion CD4+T cell subgroups is unbalance in ischemia reperfusion injury in rat testis, which may be associated with germ cell apoptosis.

Objective To investigate a reproducible model of severe crush injury (CI) in rats.Methods A total of 50 clean grade male SD rats were randomly (random number) divided into 5 groups.Both hindlimbs of anesthetized rats were compressed by blocks weighing 3.5 kg,for 6 hours and followed by 3 hours of reperfusion on a specially notched device (group SP,n =10),ordinary compression (group NM,n =10) and simple control (group SHAM,n =10).Arterial tension,serum lactate,and potassium (K+),serum myoglobin (MB),aspartate transferase (AST) and alanine transferase (ALT),BUN and Cr were measured at 10 minutes after cannulaton,and 3 hours after release from compression.Muscles and kidneys were evaluated morphologically.Group D and E were treated in the same way and were observed for 72 h to get the survival rate of the NM group and the specially notched compression group.The SPSS 17.0 statistical software was used for statistical analysis,repeated-measures ANOVA analysis for the differences between groups,Kaplan Meier-estimator for survival analysis.Results The Specially notched compression produced a greater increase in serum lactate (F =39.626,P ＜ 0.05),AST (F =24.965,P ＜ 0.05),ALT (F =19.096,P＜0.05),BUN (F=7.938,P＜0.05),CR (F=14.787,P＜0.05) and MB (F=16.840,P ＜0.05) by the end of experiment than NM group and simple control group.The direct cellular damage and ischemia-reperfusion injury were found under microscope.In crush injury caused by specially notched compression there was acute tubular necrosis found at 24 hours after injury.Mortality rate in the NM group was 20％,whereas mortality rate reached 90％ in rats with specially notched compression (P ＜0.05).Conclusions It successfully developed a severe crush injury model in experimental rats,suggesting it is worthwhile to popularization.

Retrospective analysis was conducted for the results of first-aid competitions so as to understand the present status of how emergency doctors of Hubei Province grasp the skills and consciousnesses of cervical immobilization.From 6 out of 19 teams,38 participating doctors from grade 3A hospitals provided patient cervical immobilization while 2 teams offered no cervical protection.It is necessary to intensify the skills and consciousnesses of cervical immobilization in clinical practice.

目的:探讨Th1/Th2淋巴细胞偏移对大鼠睾丸缺血再灌注损伤的影响。方法:SD雄性大鼠30只,随机分成假手术组、睾丸扭转组、扭转复位组,每组10只,通过建立左侧睾丸扭转和复位动物模型,在手术后24h分别取材,ELISA方法检测血清IFN-γ、IL-12、IL-4、IL-10水平,TUNEL法检测各组手术侧睾丸生殖细胞凋亡指数。结果:与假手术组相比,扭转组和扭转复位组与Th1细胞相关的细胞因子水平升高明显（P＜0.05）,Th2细胞相关的细胞因子水平下降（P＜0.05）,生殖细胞凋亡指数增加。结论:在大鼠睾丸缺血再灌注损伤过程中Th1/Th2淋巴细胞偏移与生殖细胞凋亡存在相关性。

Aim of the Study The aim of the study was to evaluate the effects of bolus infusion of hypertonic hydroxyethyl starches (HHESs) and continuous infusion of hypertonic saline (HTS) in the early resuscitation in crush syndrome. Methods A rat model of crush injury was established. Rats were randomly divided into five groups: (1) HHES group, (2) HTS group, (3) volume resuscitation group, (4) normal resuscitation (NR) group, and (5) sham group. Blood samples were collected 6 h after the crush period for biochemical evaluation. Blood pressure was monitored throughout this experiment. Muscles and kidneys were evaluated morphologically 24 h after reperfusion. Twenty rats in each group were taken for survival observation for 72 h. Results Compared with the NR and HTS groups, the HHES group had significantly increased the survival rate 72 h after release (P < 0.05). In the first 2 h after release, mean arterial blood pressure in the HHES group was significantly higher than in HTS, volume resuscitation, and NR groups (respectively, P < 0.05). Animals that received HHES infusion showed a better acid-base balance and renal function. However, there was no significant difference in survival rate between the HTS and NR groups. Furthermore, animals in the HTS group showed a bad acid-base balance and a higher serum sodium level. Conclusions Bolus infusion of HHES combined with normal saline could be an effective therapy for crush syndrome in the early resuscitation period. However, continuous HTS injection was not seemed to be a suitable choice particularly in the absence of monitoring equipment for serum irons or blood gases (institutional protocol no. ZN5R20110016).

A novel method is proposed to prepare magnetic gold electrodes for DNA targets detection. This magnetic gold electrode displayed excellent performance such as low internal resistance, good electrical conductivity, easy to capture and enrich probe-magnetic beads onto the electrode surface, and robust and simple to operate. It was successfully utilized for direct capture and sensitive detection of DNA targets by using Methylene Blue (MB) as an electrochemical indicator.

Objective To evaluate the effects of nursing pathway applied to emergency patients with acute cerebrovascular diseases. Methods A total of 286 cases with acute cerebrovascular diseases who attended emergency clinic from September 2007 to December 2008 were treated as the control group and 309 patients from January 2009 to June 2010 as the observation group.The control group received conventional nursing procedures for emergency rescue,and clinical pathway was employed for the observation group to standardize rescue process. Results There were statistically significant differences in rescue time,and patients satisfaction between the two groups(P<0.01 for both). Conclusion Implement of nursing pathway for emergency patients with acute cerebrovascular diseases,can effectively improve rescue efficiency,survival rate,and patient satisfaction.

目的 比较并探讨创伤患者长途转运过程中给予药物镇痛治疗的效果.方法 选取2011年1月到2012年5月长途转运至我院的36例创伤患者为治疗组,在转运途中给予小剂量间断静脉注射吗啡行镇痛治疗;对照组为2009年1月到2010年12月长途转运至我院的28例未给予药物镇痛治疗的患者.通过比较患者转院开始和到达我院时的疼痛评分差值,评价患者疼痛缓解程度.结果 治疗组与对照组的患者转运到我院时疼痛评分差值有统计学意义(P<0.05),治疗组患者的疼痛得到明显缓解.结论 在长途转运创伤患者时,给予小剂量间断静脉注射吗啡行镇痛治疗,能明显缓解患者的疼痛.

>急性阑尾炎是腹部外科中最常见的急腹症,适时进行阑尾切除术是较佳的治疗方法。然而,在急诊外科遇到的急性阑尾炎由于特殊原因,不能立即手术者不是少数。但是,在进行保守治疗的时候可能出现腹痛加剧,而又必须手术治疗。阑尾炎的病理变化是一个渐进的过程,在部分早期单纯性炎症阶段时,一旦炎症吸收消退,阑尾能恢复正常,也可不再复发,可行非手术治疗;若急性阑尾炎转为化脓、坏疽、穿孑L阶段,非手术治疗有引起弥漫性腹膜炎风险,应尽早手术治疗。所以,如果能预计急性阑尾炎的病理分型,那么对急性阑尾炎的治疗将非常有帮助。本文对2008-2009年武汉大学中南医院收

目的探讨应用床旁超声诊断大白兔气胸模型的价值。方法应用针刺注射气体法建立大白兔气胸动物模型,应用超声和床旁仰卧位X片进行检查,以CT结果为标准比较二者的价值。结果 41只大白兔动物模型中,22只CT证明产生气胸,超声诊断19只,床旁仰卧位X片诊断9只。超声诊断假阳性率1只,CT证实为皮下气肿,超声诊断的敏感性、阴性预测值为86%,86%(19/22和1 8/21)、特异性为95%(18/19),阳性预测值为95%(19/20);仰卧位X片诊断的敏感性41%(9/22)、特异性为100%(19/19),阳性预测值为100%(9/9)、阴性预测值为59%(19/32)。结论超声对针刺注射气体法建立的大白兔气胸的诊断价值高于仰卧位X片,与CT诊断的无显著性差异。

Objective To evaluate the efficacy of multiple injection of morphine combined with phloroglucinol in the treatment of renal colic. Methods One hundred and twenty patients with severe renal colic were equally divided into three groups by random digits table,with 40 cases each group. The group A was administrated with physiological saline 100 ml and phloroglucinol 80 mg intervenous drop infusion combined with morphine 9 mg intravenous injection fractionated into three times, and the group B was administrated with physiological saline 100 ml and phloroglucinol 80 mg intervenous drop infusion,and the group C was administrated with physiological saline 100 ml intervenous drop infusion and morphine 9 mg intravenous injection fractionated into three times. At 10,20 and 40 min after administration, the antalgic efficacy of three groups were analyzed as well as the side effect. Results At 20 min and 40 min both of the total efficacy rates in group A[82.5%(33/40),95.0%(38/40)] were higher than those in group B [62.5%(25/40),80.0%(32/40)] and group C [60.0%(24/40),77.5%(31/40)] (P＜ 0.05),and the colic-exclusion rate in group A was also higher than that in group B and group C (P ＜ 0.05). The difference of the efficacy rates in group A in these two time-points had no statistical significance (P ＞0.05). No increased pain occurred in group A except 1 case of vomiting. Conclusion Multiple injection of morphine combined with phloroglucinol is quick, effective and safe in the early treatment of renal colic.

目前我国存在多种院前急救模式~([1]).为了能够更好地完成院前急救的急、救、转三方面的任务,即以最快的速度到达患者身边,并进行针对性的救治,然后再迅速转运到医疗机构,武汉大学中南医院于2007年10月借鉴法国院前急救模式,组建了依托于综合医院急救科,专业化的,用于医院间陆路急救转运急危重患者228例,取得良好效果,现报道如下。

目的:探讨阴茎锐器损伤的急诊治疗方式。方法:对我院23例阴茎锐器损伤患者急诊手术治疗并随访1～6个月等相关资料进行总结。结果:23例患者术后7d拆线,伤口甲级愈合,无并发症发生。结论:阴茎锐器损伤及时有效的治疗对保持尿道连续性和保护阴茎勃起功能至关重要。

目的:观察654-2和吗啡静脉滴注对急诊肾绞痛患者的镇痛效果;。方法:选择武汉大学中南医院急诊就诊的肾绞痛患者1536例,自然分成2组,A组为2008年12月31日以前的患者,静脉应用654-2,B组为2009年以来患者,静脉应用吗啡,用药后不同时间点行疼痛程度评分,观察疼痛缓解的程度及不良反应。结果:B组患者3min后疼痛开始缓解,约6min疼痛明显减轻,10min基本缓解,无明显严重不良反应;A组患者20min时疼痛才开始缓解,约30min时疼痛缓解明显,部分患者出现急性尿潴留。2组比较差异有统计学意义。结论:肾绞痛患者静脉滴注吗啡镇痛迅速,起效快,无尿潴留副反应,是一种良好的镇痛方式。