目的:探讨芹菜素对大鼠脑外伤(TBI)的保护作用及其机制.方法:72只雄性SD大鼠被随机分为对照组(24只)、TBI组(24只)和TBI+芹菜素组(24只),采用Feeney法自由落体打击装置建立大鼠TBI模型,TBI+芹菜素组在造模后每天腹腔注射芹菜素(40 mg/kg),持续3 d.取大鼠伤侧皮层,免疫组化检测神经微丝中链蛋白(NF-M)、胶质纤维酸性蛋白(GFAP)及离子钙接头蛋白抗体-1(Iba-1)的表达;Western blot检测紧密连接相关蛋白Claudin-5、ZO-1、Occludin-1的表达;伊文斯蓝及脑组织含水量检测血脑屏障通透性情况;ELISA检测炎症因子肿瘤坏死因子(TNF-a)、白细胞介素1β(IL-1β)和白细胞介素6(IL-6)的水平,利用丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)检测氧化应激水平.结果:与对照组相比,TBI组大鼠皮层中NF-M、GFAP、Iba-1、TNF-α、IL-1β、IL-6、MDA的表达均升高(均P＜0.05);伊文斯蓝及脑组织含水量均增加(均 P＜0.05);Claudin-5、ZO-1、Occludin-1、SOD、CAT 及 GSH-Px 的表达均降低(均 P＜0.05).与 TBI 组相比,TBI+芹菜素组NF-M、GFAP、Iba-1、TNF-α、IL-1β、IL-6、MDA的表达均降低(均P＜0.05);伊文斯蓝及脑组织含水量均减少(均 P＜0.05);Claudin-5、ZO-1、Occludin-1、SOD、CAT 及 GSH-Px 的表达均升高(均 P＜0.05).结论:芹菜素通过抑制胶质细胞活性,降低体内的炎症及氧化应激水平,保护血脑屏障,减轻大鼠TBI后的神经损伤.

目的 分析目标导向液体治疗重症胸部创伤并创伤性休克的临床效果.方法 70例重症胸部创伤并创伤性休克患者,按随机数字表法分为观察组与对照组,每组35例.观察组采用目标导向液体复苏治疗方案,对照组采用开放式液体复苏治疗方案.观察2组在不同液体复苏治疗后的平均动脉压(MAP)、心脏指数(CI)和每搏变异度(SVV)及补液量,并观察急诊手术后2组凝血功能指标凝血酶原时间(PT)及活化部分凝血酶时间(APTT)、核心体温、pH值,比较2组治疗总效率、并发症发生率及伤口恢复时间.结果 2组患者经过不同液体复苏治疗后,两组MAP比较差异无统计学意义(P>0.05),而观察组SVV和补液量低于、CI高于对照组(P<0.05).观察组患者凝血功能指标PT及APTT优于对照组(P<0.05),但2组核心体温及pH值比较差异无统计学意义(P>0.05).观察组总有效率为85.71％,高于对照组的60.00％(P<0.05);术后观察组并发症发生率为17.14％(其中2例炎症反应,1例ARDS,3例术口渗血),对照组并发症发生率为45.71％(其中4例炎症反应,2例MODS,3例ARDS,7例术口渗血),观察组并发症发生率低于对照组(P<0.05).术后伤口恢复时间观察组短于对照组(P<0.05).结论 通过对重症胸部创伤并创伤性休克患者采取目标导向液体复苏治疗措施,可有效增强临床治疗效率,改善凝血功能,缩短伤口恢复时间,减少并发症,为患者预后恢复创造良好条件,具有临床意义.

目的 探讨影像归档和通信系统(PACS)多窗联合阅片在急诊空腔脏器穿孔诊断中的应用效果.方法 回顾性分析的58例空腔脏器穿孔患者的腹部X线和CT影像资料.通过PACS阅片,比较单独X线、单独常规CT(仅包括腹窗)、联合阅片(X线、CT腹窗、CT纵隔窗)诊断空腔脏器穿孔的准确性.结果 立位腹部X线诊断空腔脏器穿孔准确率为41.38％(24/58),常规CT诊断空腔脏器穿孔准确率为65.52％(38/58),联合阅片诊断空腔脏器穿孔准确率为86.21％(50/58);联合阅片诊断准确率高于单独X线或常规CT检查,而常规CT诊断准确率高于X线(均P<0.05).结论 PACS系统多窗联合阅片有助于提高急诊空腔脏器穿孔的诊断准确率.

"注册前住院医师"作为住院医师规范化培训过程中特殊参培人群,其执业资质应得到认证,并以此来调动其积极性,充分锻炼和提高其临床能力;"岗位胜任力"为导向的培训模式是缩短住院医师现况与临床实际需求之间差距的可行方法,尝试该种模式对"注册前住院医师"进行培训,可使其在掌握和提高医学专业知识及临床技能的同时具备更高层次的良好的职业素养及合格的岗位胜任力.

Objective To investigate the therapeutical effect of triptolide (TP) on subarachnoid hemorrhage (SAH) in rats and its underlying mechanisms.Methods Endovascular perforation technique was used to establish SAH models.TP was used to treat SAH rats by intraperitoneal injection.Rats were randomly divided into control group,SAH 3 d group,SAH 3 d + DMSO group and SAH 3 d + TP group.Pathologic change was observed in rat cortex by HE staining.Cell apoptosis was evaluated by TUNEL assay.Iba-1 considered as microglia marker was assessed by immunohistochemistry.The levels of inflammatory factors including IL-6,IL-1 β and TNF-o were detected by ELISA.Results Compared with control group,pathologic changes,such as cell edema,nuclear pyknosis were more obviously;the number of apoptosis cell,the expression of Iba-1 and the level of inflammatory factors including IL-6,IL-1β and TNF-α were all increased in the cortex of SAH 3 d group,SAH 3 d + DMSO group and SAH 3 d + TP group (P ＜ 0.05).There were no significant differences in pathologic changes,the number of apoptosis cells,the expression of Iba-1 and the levels of inflammatory cytokines in the brain cortex between SAH 3 d group and SAH 3 d + DMSO group (P ＞ 0.05).Compared with SAH 3 d group and SAH 3 d + DMSO group,pathologic changes were alleviated,and the number of apoptosis cells,the expression of Iba-1 and the levels of inflammatory cytokines including IL-6,IL-1β and TNF-α were all decreased in the brain cortex in SAH 3 d + TP group.Conclusion TP could alleviate the pathologic changes,reduce the cell apoptosis and inhibit the microglia activation in rat brain cortex after SAH,and the neuroprotective effect of TP might be associated with the decreased levels of inflammatory cytokines.