Thrombelastography (TEG) has been used to monitor the coagulation function of patients since it was first described in 1948 and has been repeatedly recommended in the guidelines.This article shows the reader the assay and its clinical application.This article focuses on evidence that supports the use of TEG in the emergen cy department.

Objective To investigate the effects of hypoxic cultured bone marrow mesenchymal stem cells (BMSCs) on changes of cytokines in paraquat-induced acute lung injury in rats.Methods BMSCs were isolated from SD rats and divided into normoxic culture group(20%O2) and hypoxic culture group(5%O2).The proliferation and determination were observed and compared between the both groups.Sixty SD rats were randomly divided into four groups: a PQ group, a normoxic cultured BMSCs treatment group, ahypoxic culturedBMSCs treatment group and a normal control group.The rats′ survival time were calculated during 14 days after PQ injections in each group.At the same time, the levels of Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX) in plasma were detected.Results ①The BMSCs cultured under hypoxic condition appeared differentiation partly.But most of the cells remained the characteristics of BMSCs, and the stability was good.②Compared with the normoxic cultured BMSCs, the proliferation of the hypoxic cultured BMSCs increased markedly (P≤0.05), and the numbers of colony formation increased significantly (P≤0.01).③Compared with PQ group, the rats were all alive within 14 days in normoxic cultured BMSCs treatment group and hypoxic cultured BMSCs treatment group.④Compared with normoxic cultured BMSCs treatment group during 7 days after PQ Poisoning, the levels of IL-1β and TNF-α in plasma in hypoxic cultured BMSCs treatment group were decreased significantly (P≤0.01), the levels of MDA in plasma decreased markedly (P≤0.05), and the activities of SOD, GSH-PX in plasma increased obviously (P≤0.05).Conclusion The hypoxic cultured BMSCs are more adapt to clinical pathological physiological environment than the cells cultured in normoxia, which have stronger ability of inhibiting inflammatory mediator levels, scavenging free radical and resisting lipid peroxidation injury.

目的:探讨损伤控制性复苏(DCR)方案配合等比例成分输血治疗多发伤并发创伤性凝血病(ATC)疗效.方法:选取2014-03-2015-03我院急诊创伤抢救室收治的ATC患者48例,治疗均采用DCR方案,治疗过程中患者输注浓缩红细胞(CRBC)和新鲜冰冻血浆(FFP)剂量不同,把其中CRBC和FFP按照1:1及2:1输注的患者进行研究分析.将患者分为2组,A组按照1:1比例输注,B组按照2:1输注.回顾分析患者入院后第1、2、3天血红蛋白(Hb)、凝血酶原时间(PT)、国际化标准比率(INR)、纤维蛋白原(FIB)水平、血压、中心静脉压(CVP)水平.结果:2组患者在入院后的第1天的Hb组间比较,差异无统计学意义(P＞0.05),第1天与第2、3天Hb之间差异有统计学意义(P＜0.05),入院第1天,2组患者的PT、INR、FIB比较,差异无统计学意义(P＞0.05),各指标之间在第1天与第2、3天之间的比较差异有统计学意义(P＜0.05).入院后第2、3天A组PT、INR、FIB、血压、CVP优于对照组(P＜0.05).在救治多发伤并发ATC患者时,等比例成分输血可维持相同Hb及血凝目标值而节约红细胞(RBC)的输注,从经济学角度A组较B组人均治疗费少.结论:DCR方案配合等比例成分输血对多发伤并发ATC具有较好疗效.

目的 探讨损伤严重程度评分(injury severity score,ISS)在重度创伤患者病情中的评估作用与预后相关性.方法 回顾性分析2011年1月-2013年5月我科救治的较重多发创伤1556例临床资料,比较ISS≥50的重度创伤患者(99例)与16≤ISS＜ 50严重创伤患者(1457例)在致伤机制、入院前情况、住院治疗情况及治疗结果等方面的差异.结果 ISS≥50组摩托车致伤者显著高于ISS评分＜50组.ISS≥50组平均损伤3.8个部位,ISS＜ 50组平均损伤2.3个部位(P＜0.05).在ISS≥50组胸部联合下肢损伤和胸部联合脊髓损伤发生率高于ISS＜ 50组(P＜0.05).入院前的休克、意识障碍以及实施气管插管、心肺复苏和两次转诊患者的比例,ISS≥50组均高于ISS＜ 50组P＜0.05),多器官衰竭发生率在ISS≥50组显著高于ISS＜ 50组(P＜0.05).ISS≥50组接受手术台数、住ICU时间、气管插管时间均高于ISS＜ 50组(P＜0.05).ISS＞ 50组住院日平均73 d,病死率32.3％,诊断为重型颅脑损伤并伴严重的感觉运动功能障碍的患者经治疗获得中等以上好转.ISS＜ 50组住院日平均49 d,病死率12.3％,两组比较差异有统计学意义(P＜0.05).结论 影响重度多发伤预后的因素较多,ISS可作为评估损伤严重程度和预后的可靠工具,但并不能准确预测多发伤患者的最终治疗结果,即使是ISS评分＞50患者经过及时系统的治疗也会有较好预后.

Objective To understand the relevant circumstances and issues of clinical ventilator application of hospitals upper than or equal to second-class in China' s northwest. It provides a reference for developing a long-term training program for local ventilator operators. Methods Trainees(all from Northwest of China) were collected from Non-invasive ventilator training courses which is hold by department of pulmonary and critical care medicine,Xijing Hospital in December,2012. We adopt the form of the questionnaire in this survey. Results Finally,81 qualified questionnaires were collected. Respondents were composed of upper first-class hospital(45. 5%),middle first-class hospital(11. 3%),upper second-class hospital(39. 5%)and middle second-class hospital(3. 7%). ① Operator of Adjusting ventilator: Doctors take on this work(70%); Nurses take on this work(1. 2%). Both of doctors and nurses take this work(24. 6%);② Knowledge of mechanical ventilation(MV) : The purpose of using MV only to meet the families' request(14. 8%); doctors thought using MV just could retard the disease in short-term,but in long-term,it is meaningless(38. 2%); doctors thought MV was expensive,and the overall results was so poor(20. 9%);doctors thought using MV increased the opportunity of breathing pain(4. 9%); doctors thought use the breathing machines in early time,can improve the patients' condition(80. 2%); ③ Complication of using Non-invasive ventilation(according to the experience of the respondents,from high to low) : the incidence followed by expectoration unfavorable(70. 3%); abdominal distension(58%); aspiration(25. 9%); facial pressure ulcers(24. 7%); unstable blood pressure(8. 6%); pneumothorax(12. 3%); ④ Sedation of using Non-invasive ventilation: 8. 6% routinely given sedation,11. 1% for most of the time sedation,25. 9%occasionally sedation,38. 3% never. ⑤ The confusion of non-invasive ventilator: operator was not clear about the structure and principle of the ventilator(61. 7%); operator was not grasp the exact indications and timing of using non-invasive ventilator(67. 9%); operator was not sure of the parameter adjustment(75. 3%); operator was unclear of the non-invasive ventilation principle of carbon dioxide emitted(53. 1%). Conclusions Most of the ventilator operators of hospitals upper than or equal to second-class of China' s Northwest regions could recognize the important role of ventilator in respiratory failure curing,but they lack of the knowledge about the structure and principle of the ventilator,parameter adjustment and so on. And there were higher level of complications during the non-invasive ventilation clinically. The information will provide an important reference of the ventilator operator training program development locally.

Objective:To study the effect of CPC material with different pore sizes on cell proliferation.Methods:Primary cul-tured rat bone mesenchymal stem cells were used in the present study.Three kinds of CPC scaffolds with different pore sizes(200-300μm,300-450μm,450-600μm) were divided into three groups.Micro-CT was used to analyze the average pore size and porosity.The three kinds of CPC material were placed in 24-well plates and 5×104 cells were incubated per-well.The cells were har-vested 1,4,7,14 and 21 days after the incubation,and then use the PicoGreen dsDNA Quantitation Reagent kit to test the cell proliferation on the three group of scaffolds.The cell morphology and cell condition were observed by scanning electron microscope.Results:The pore sizes of CPC material used in this study were interconnected.Porosity of the three groups was greater than 68% with the average pore size of 235μm,422μm and 505μm,respectively.The amount of cell in the 3 groups has no significant in day 1.In the 4th day the amount of cell in the 450-600μm group more than that of B and C groups.The number of cell necrosis in A group was significantly more than that of B and C groups.In the 7th day,increase of the pore size,the amount of cell increased gradually.In the 14th and 21th day,the amount of cell in 200-300μm group was significantly less than that the other two groups.Conclusion:The pore size may affect cell proliferation.Along with the increase of the spore size,cell adhesion rate increased gradually.The present study provides the founda-tion for further study on the effect of aperture structure on cell viability.

MicroRNAs(miRNAs) have emerged as a new dimension of gene regulation in recent years.These endogenous noncoding RNAs are 22 nucleotides.They regulate protein translation and mRNA stability.Pathogenesis of osteoporosis is closely with the defective differentiation of mesenchymal stem cells.Recendy,it has been found that miRNAs play a crucial role in the self-renewal and differentiation of MSCs,while the accurate regulatory mechanisms have not been completely elucidated.Further studying the role of miRNAs in MSCs and comprehensively understanding the mechanism underlying MSCs differentiation are important to diagnosis and treatment of osteoporosis.