目的:探讨多学科团队(MDT)医疗管理模式在紧急建设的亚定点医院的应用价值.方法:在新冠肺炎疫情期间,根据援沪的不同医疗队内医生的专业分布和临床工作能力,选取涵盖心内科、呼吸与危重症医学科、感染科、重症医学科等专业具有高级职称的医师,组建MDT医疗救治专家组.灵活应用局部整体结合、舱内舱外结合、线上线下结合、中医西医结合、前方后方结合的工作方式对重点患者进行研讨.结果:在收治的3 293例感染新冠病毒的患者中,MDT研讨评估为重型/危重型患者及高危人群者329例,其中92例(27.96%)患者病情得到控制最终解除隔离,237例患者因不具备处理条件或病情控制不佳,转出至定点医院.结论:在合理选择专家、创新工作方式的基础上,将MDT医疗管理模式应用于新冠肺炎此类突发重大公共卫生事件,有利于保证患者的医疗安全.

方舱医院具有组装快、功能全、机动性强的特点,能够有效缓解突发公共卫生事件早期医疗资源紧张的状况,在国内外应对新冠疫情中取得了积极成效.本文通过梳理国内外应对突发新冠肺炎疫情时关于方舱医院人力资源配置中存在的问题,结合国内方舱医院的管理实际,从病区管理模式、灵活设定床护比、建立人力资源信息共享平台、应用信息技术手段、建立临时党支部、鼓励志愿者服务等6个方面提出优化人力资源配置的对策及建议.

肾穿刺出血是肾活检常见并发症,多表现为显微镜下血尿、肉眼血尿和包膜下血肿,少部分表现为出血性休克.选择性肾动脉造影栓塞是肾活检术后严重出血的首选治疗方式.我们报道1例选择性肾动脉造影检查假阴性,采用超声引导下血肿区域聚桂醇注射成功止血的病例,为肾活检出血提供一种新的止血方式.

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.

Objective To investigate the expression of transient receptor potential melastatin 8 (TRPM8) in osteosarcoma tissues and HOS cells and the possible effect of TRPM8 on the proliferation and motility of H-OS cells.Methods 8 osteosarcoma specimens were collected from patients who did not receive any preoperative chemotherapy or radiotherapy, with 8 osteochondroma specimens also collected as control.And then the immunohistochemistry analysis was performed to examine the expression of TRPM8.As the human bone marrow mesenchymal stem cells (BMSCs) being normal control, Western blotting was used to investigate the expression of TRPM8 in HOS cells.After knockdown of TRPM8 by using the small interfering RNA targeted on TRPM8 gene, the proliferation and motility of HOS cells were checked by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) assay and scratch assay.Western blotting was used to investigate the change of proliferation and motility related proteins.Results The expression of TRPM8 in osteosarcoma tissues was obviously up-regulated when compared with osteochondroma tissues, since 6 in 8 of osteosarcoma tissues present high level expression of TRPM8 and however 1 in 8 of osteochondroma tissues present high level expression of TRPM8.Compared with BMSCs cells, the expression of TRPM8 in HOS cells was significantly up-regulated and it was almost 3 times as much.Knockdown of TRPM8 can inhibit the proliferation and motility of HOS cells.Knockdown of TRPM8 can induce G0/Gt arrest which maybe through the downregulation of Cyclin D1 and cyclin-dependent kinases 4 (CDK4);besides its negative influences on the phosphorylation of focal adhesion kinase (FAK) and the expression of matrix metalloproteinase (MMP)-2 may account for the inhibition of cell motility.Conclusion The expression of TRPM8 in osteosarcoma tissues and HOS ells were significantly up-regulated when compared with osteochondroma tissues and human BMSCs separately.Downregulation of TRPM8 in HOS cells significantly suppressed the proliferation and motility of HOS cells.Therefore, TRPM8 is worthy further investigation for its potential as a clinical biomarker and therapeutic target in osteosarcoma.

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.

目的 探讨应用远端蒂指掌侧固有动脉背侧支皮瓣修复指端皮肤软组织缺损并骨外露术式的临床应用效果. 方法 2009年3月至2010年5月,采用远端蒂指掌侧固有动脉背侧支皮瓣急诊修复外伤性指端皮肤及软组织缺损17例,手术皮瓣以远节指间关节平面与指侧正中线交汇处的指掌侧固有动脉背侧支发出点为旋转点,切取面积1.0 cm×1.5 cm ～ 1.8 cm×2.2 cm,蒂长0.8 ～ 1.7 cm,转位90°～ 120°覆盖指端. 结果 全部皮瓣均完全成活.随访3～6个月,手指外形均良好而不臃肿,痛、温觉逐步恢复,其中8例术中能够找到神经残端修整后与皮瓣指掌侧固有神经背侧支吻合者两点辨别觉达6～8mm,平均6.5 mm. 结论 以远端蒂指掌侧固有动脉背侧支皮瓣转位一期修复手2～5指的指端皮肤及软组织缺损,操作简单,血供可靠,临床效果满意.

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.