• 【急性鼠皮肤切口伤口的微循环显示出血管功能的时空变化。】 复制标题 收藏 收藏
    DOI:10.1111/j.1743-6109.2006.00142.x 复制DOI
    作者列表:Bluff JE,O'Ceallaigh S,O'Kane S,Ferguson MW,Ireland G
    BACKGROUND & AIMS: :A mouse perfusion model using fluorescently labeled dextran has been developed to investigate the functionality of blood vessels during cutaneous wound healing. By immunostaining cryostat sections of perfused wounds with antibodies that identify vessels, we were able to assess their functionality. There was an increase in the proportion of CD31(+)-perfused vessels in all wound regions with time, although the vessels of the wound margins and superficial granulation tissue (GT) took the longest to become perfused. More than 50% of the latter vessels were not perfused at 10 days postwounding. This is consistent with the growth of functional vessels from the wound base proceeding to the more superficial GT. The CD34 marker was expressed by a subpopulation of CD31(+) vessels. However, in contrast to CD31(+) vessels, the functionality of CD34(+) vessels did not change significantly with time and 50-75% of CD34(+) vessels in the GT and wound margins were nonfunctional. This might be explained either by apoptosis of the CD34(+) vessels or the loss of the marker with time. This study has important implications for assays of wound-healing angiogenesis based on histology and immunohistochemical markers for vessels, because vessel functionality differs both spatially and temporally during wound healing.
    背景与目标: : 已经开发了使用荧光标记的葡聚糖的小鼠灌注模型,以研究皮肤伤口愈合过程中血管的功能。通过用识别血管的抗体对灌注伤口的低温恒温器切片进行免疫染色,我们能够评估其功能。尽管伤口边缘和浅表肉芽组织 (GT) 的血管灌注时间最长,但所有伤口区域中CD31 () 灌注血管的比例随时间增加。超过50% 的后一种血管在伤后10天没有灌注。这与从伤口基部到更浅表的GT的功能性血管的生长是一致的。CD34标记由CD31 () 血管的亚群表达。然而,与CD31(+) 血管相反,CD34(+) 血管的功能没有随时间显着变化,并且GT和伤口边缘中的50-75% CD34(+) 血管无功能。这可以通过CD34 () 血管的凋亡或标记物随时间的丢失来解释。这项研究对基于血管的组织学和免疫组织化学标记的伤口愈合血管生成测定具有重要意义,因为在伤口愈合过程中,血管功能在空间和时间上均不同。
  • 【含咖啡因补充剂对力量,肌肉耐力和无氧能力的急性影响。】 复制标题 收藏 收藏
    DOI:10.1519/18285.1 复制DOI
    作者列表:Beck TW,Housh TJ,Schmidt RJ,Johnson GO,Housh DJ,Coburn JW,Malek MH
    BACKGROUND & AIMS: :The purpose of this study was to examine the acute effects of a caffeine-containing supplement on upper- and lower-body strength and muscular endurance as well as anaerobic capabilities. Thirty-seven resistance-trained men (mean +/- SD, age: 21 +/- 2 years) volunteered to participate in this study. On the first laboratory visit, the subjects performed 2 Wingate Anaerobic Tests (WAnTs) to determine peak power (PP) and mean power (MP), as well as tests for 1 repetition maximum (1RM), dynamic constant external resistance strength, and muscular endurance (TOTV; total volume of weight lifted during an endurance test with 80% of the 1RM) on the bilateral leg extension (LE) and free-weight bench press (BP) exercises. Following a minimum of 48 hours of rest, the subjects returned to the laboratory for the second testing session and were randomly assigned to 1 of 2 groups: a supplement group (SUPP; n = 17), which ingested a caffeine-containing supplement, or a placebo group (PLAC; n = 20), which ingested a cellulose placebo. One hour after ingesting either the caffeine-containing supplement or the placebo, the subjects performed 2 WAnTs and were tested for 1RM strength and muscular endurance on the LE and BP exercises. The results indicated that there was a significant (p < 0.05) increase in BP 1RM for the SUPP group, but not for the PLAC group. The caffeine-containing supplement had no effect, however, on LE 1RM, LE TOTV, BP TOTV, PP, and MP. Thus, the caffeine-containing supplement may be an effective supplement for increasing upper-body strength and, therefore, could be useful for competitive and recreational athletes who perform resistance training.
    背景与目标: : 这项研究的目的是检查含咖啡因补充剂对上半身和下半身力量,肌肉耐力以及无氧能力的急性影响。37名接受过抵抗训练的男性 (平均/- SD,年龄: 21/- 2岁) 自愿参加了这项研究。在第一次实验室访问时,受试者进行了2次Wingate厌氧测试 (想要) 以确定峰值功率 (PP) 和平均功率 (MP),以及1次重复最大值 (1RM),动态恒定外阻力强度和肌肉耐力 (TOTV; 在双侧腿部伸展 (LE) 和自由重量卧推 (BP) 练习的耐力测试中,重量的总体积为1RM的80%。休息至少48小时后,受试者返回实验室进行第二次测试,并被随机分配到2组中的1组: 补充剂组 (SUPP; n = 17),摄入含咖啡因补充剂,或安慰剂组 (PLAC; n = 20),摄入纤维素安慰剂。摄入含咖啡因补充剂或安慰剂一小时后,受试者进行了2次想要,并在LE和BP锻炼中测试了1RM力量和肌肉耐力。结果表明,SUPP组的BP 1RM显着增加 (p <0.05),而PLAC组则没有。但是,含咖啡因的补充剂对LE 1RM,LE TOTV,BP TOTV,PP和MP没有影响。因此,含咖啡因的补充剂可能是增加上身力量的有效补充剂,因此对于进行阻力训练的竞技和休闲运动员可能有用。
  • 【循环内毒素是损伤后全身炎症反应综合征的诱因吗?】 复制标题 收藏 收藏
    DOI:10.1097/00000658-199705000-00010 复制DOI
    作者列表:Kelly JL,O'Sullivan C,O'Riordain M,O'Riordain D,Lyons A,Doherty J,Mannick JA,Rodrick ML
    BACKGROUND & AIMS: OBJECTIVE:Patients with severe traumatic or burn injury and a mouse model of burn injury were studied early after injury to determine the relation of plasma endotoxin (lipopolysaccharide [LPS]) to the production of proinflammatory cytokines and subsequent resistance to infection.

    SUMMARY BACKGROUND DATA:Elevated levels of plasma LPS have been reported in patients after serious injury. It has been suggested that circulating LPS may be a trigger for increased proinflammatory cytokine production and may play a role in the septic syndromes seen in a substantial portion of such patients. Yet, despite multiple reports of leakage of LPS from the gut and bacterial translocation after injury in animal models, there is little direct evidence linking circulating LPS with production of inflammatory mediators.

    METHODS:The authors studied serial samples of peripheral blood from 10 patients with 25% to 50% surface area burns and 8 trauma patients (injury Severity Score, 25-57). Patients were compared with 18 healthy volunteers. The study was focused on the first 10 days after injury before the onset of sepsis or the systemic inflammatory response syndrome. Plasma samples were assayed for LPS, and adherent cells from the blood were studied for basal and LPS-stimulated production of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6). The correlation of increased plasma LPS with TNF-alpha production was studied as was the association of increased plasma LPS and increased TNF-alpha production with subsequent septic complications. We also studied a mouse model of 25% burn injury. Burn mice were compared with sham burn control subjects. Plasma samples were assayed at serial intervals for LPS, and adherent cells from the spleens were studied for basal- and LPS-stimulated production of TNF-alpha, IL-1 beta, and IL-6. Expression of the messenger RNAs for IL-1 beta and TNF-alpha also was measured. The relation of increased TNF-alpha production with mortality from a septic challenge, cecal ligation and puncture (CLP), was determined. Finally, the effect of administration of LPS to normal mice on subsequent mortality after CLP and on TNF-alpha production was studied.

    RESULTS:Elevated plasma LPS (> 1 pg/mL) was seen in 11 of the 18 patients within 10 days of injury and in no normal control subjects. In this period, patients as compared with control subjects showed increased stimulated production of TNF-alpha, IL-1 beta, and IL-6. Increased TNF-alpha production was not correlated with elevated plasma LPS in the same patients. Neither increased plasma LPS nor increased TNF-alpha production early after injury was correlated with subsequent development of systemic inflammatory response syndrome or sepsis in the patients. Burn mice, as compared with sham burn control subjects, showed elevated plasma LPS levels chiefly in the first 3 days after injury. Increased stimulated production of proinflammatory cytokines by adherent splenocytes from the burn mice also was seen at multiple intervals after injury and did not correlate with mortality from CLP. Increased production of TNF-alpha and IL-1 beta was associated with increased expression of messenger RNAs for these cytokines. Finally, two doses of 1 ng LPS administered 24 hours apart to normal mice had no effect on mortality from CLP performed 7 days later nor on the production of TNF-alpha at the time of CLP.

    CONCLUSIONS:These findings call into question the idea that circulating LPS is the trigger for increased proinflammatory cytokine production, systemic inflammatory response syndrome, and septic complications in injured patients.

    背景与目标: 目标 : 严重创伤或烧伤患者和烧伤小鼠模型在损伤后早期进行了研究,以确定血浆内毒素 (脂多糖 [LPS]) 与促炎细胞因子的产生以及随后对感染的抵抗力之间的关系。
    摘要背景数据 : 据报道,严重损伤后患者血浆LPS水平升高。已经提出,循环LPS可能是促炎性细胞因子产生增加的触发因素,并且可能在此类患者的大部分脓毒症综合征中起作用。然而,尽管有多份动物模型中LPS从肠道泄漏和细菌移位的报道,但几乎没有直接证据将循环LPS与炎症介质的产生联系起来。
    方法 : 作者研究了10例25% 至50% 表面积烧伤患者和8例创伤患者的外周血系列样本 (损伤严重程度评分,25-57)。将患者与18名健康志愿者进行比较。该研究的重点是败血症或全身性炎症反应综合征发作前的受伤后10天。测定血浆样品中的LPS,并研究血液中的贴壁细胞的基础和LPS刺激的肿瘤坏死因子-α (TNF-α),interleukin-1 β (IL-1 β) 和interleukin-6 (IL-6) 的产生。研究了血浆LPS增加与TNF-α 产生的相关性,以及血浆LPS增加和TNF-α 产生增加与随后的败血症并发症的关联。我们还研究了25% 烧伤的小鼠模型。将烧伤小鼠与假烧伤对照组进行比较。以连续间隔测定血浆样品中的LPS,并研究来自脾脏的贴壁细胞的基础和LPS刺激的TNF-α,IL-1 β 和IL-6的产生。还测量了IL-1 β 和TNF-α 的信使rna的表达。确定了TNF-α 产生增加与败血性攻击,盲肠结扎和穿刺 (CLP) 造成的死亡率之间的关系。最后,研究了向正常小鼠施用LPS对CLP后后续死亡率和TNF-α 产生的影响。
    结果 : 18例患者中有11例在受伤后10天内发现血浆LPS升高 (> 1 pg/mL),而没有正常对照。在此期间,与对照组相比,患者表现出TNF-α,IL-1 β 和IL-6的刺激产生增加。在同一患者中,TNF-α 产生的增加与血浆LPS升高无关。损伤后早期血浆LPS的增加和TNF-α 的产生均与患者全身炎症反应综合征或败血症的后续发展无关。与假烧伤对照组相比,烧伤小鼠的血浆LPS水平主要在受伤后的前3天升高。烧伤小鼠的粘附脾细胞刺激促炎细胞的产生也在受伤后的多个间隔内增加,并且与CLP的死亡率无关。TNF-α 和IL-1 β 的产生增加与这些细胞因子的信使rna的表达增加有关。最后,对正常小鼠相隔24小时施用两次1 ng LPS对7天后进行的CLP的死亡率没有影响,也没有对CLP时TNF-α 的产生影响。
    结论 : 这些发现使人们质疑循环LPS是导致受伤患者促炎性细胞因子产生增加,全身性炎症反应综合征和败血症并发症的诱因。
  • 【[人型支原体。急性肾盂肾炎的罕见病原体]。】 复制标题 收藏 收藏
    DOI:10.1055/s-2008-1047651 复制DOI
    作者列表:Küchle C,Abele-Horn M,Menninger M,Held E,Heesemann J
    BACKGROUND & AIMS: HISTORY AND CLINICAL FINDINGS:A 23-year-old woman was admitted with typical signs of an acute urinary tract infection: fever, pain on tapping over both renal areas and in both flanks, urgency and dysuria. She had a history of renal colic with spontaneous passage of a renal stone.

    INVESTIGATIONS:There was marked leukocytosis and raised C-reactive protein, leukocyturia and haematuria, but no nitrites or protein in the urine. All blood and urine cultures were sterile and renal ultrasound was unremarkable.

    DIAGNOSIS, TREATMENT AND COURSE:As signs and laboratory data indicated acute pyelonephritis (PN) she was treated with gyrase inhibiting antibiotics. But while symptoms improved, fever, leukocyturia and haematuria continued; no micro-organism could be demonstrated. Mycoplasma was therefore considered as a rare cause of PN. Special urine cultures then grew M. hominis, > 10(5) organisms/ml. On the basis of sensitivity tests doxycycline was administered. All symptoms quickly improved and all inflammation parameters and urine sediments became normal.

    CONCLUSION:In rare instances M. hominis may be isolated as the causative organism of PN. If, in cases with appropriate symptoms, routine tests fail to demonstrate the causative agent, M. hominis should be included in the differential diagnosis.

    背景与目标: 病史和临床发现 : 一名23岁的女性入院时出现了急性尿路感染的典型症状: 发热,在两个肾脏区域和两侧的拍打疼痛,尿急和排尿困难。她有肾绞痛病史,并自发通过肾结石。
    调查 : 白细胞增多,C反应蛋白升高,白细胞增多和血尿,但尿液中没有亚硝酸盐或蛋白质。所有血液和尿液培养物均无菌,肾脏超声检查无异常。
    诊断,治疗和病程 : 由于体征和实验室数据表明,她接受了gyrase治疗。抑制抗生素。但是,尽管症状有所改善,发热,白细胞减少和血尿仍在继续; 无法证明微生物。支原体因此被认为是PN的罕见原因。然后,特殊的尿液培养物长出了人型M.,> 10(5) 个生物/ml。根据敏感性测试,给予强力霉素。所有症状都迅速改善,所有炎症参数和尿沉淀物都恢复正常。
    结论 : 在极少数情况下,可能会分离出原始人作为PN的致病生物。如果在具有适当症状的情况下,常规检查未能证明病原体,则应将人M。人的鉴别诊断疾病包括在内。
  • 【急性肝衰竭的辅助部分原位肝移植。】 复制标题 收藏 收藏
    DOI:10.1016/s0168-8278(97)80109-2 复制DOI
    作者列表:Pereira SP,McCarthy M,Ellis AJ,Wendon J,Portmann B,Rela M,Heaton N,Williams R
    BACKGROUND & AIMS: BACKGROUND/AIMS:Auxiliary partial orthotopic liver transplantation holds potential advantages over conventional orthotopic liver transplantation, but experience with the technique in acute liver failure is limited.

    METHODS:We describe our initial experience in seven patients (4 men, 3 women; mean age 28, range 14-35 years) with acute liver failure (paracetamol 3, non A-E 2, autoimmune 1, Ecstasy 1) who fulfilled criteria for emergency transplantation. Preoperatively, the median international normalised ratio was seven (range 3.4-15), with a creatinine of 123 microM (51-389 microM) and bilirubin 320 microM (61-572 microM). The reasons for performing an auxiliary transplant were the patients' young age and stable preoperative condition (n = 5), or a significant psychiatric history precluding conventional transplantation (n = 2).

    RESULTS:All patients received blood group-matched left (n = 2) or right (n = 5) auxiliary grafts. Median duration of surgery was 8.5 h (7.3-10 h), with blood loss of 8.3 litres (4.6-14.6 litres). Post-transplant, the international normalised ratio and aspartate aminotransferase fell progressively in all patients, with median values at day 7 of 1.4 (1.0-2.4) and 108 IU/1 (78-910 IU/1). Three patients died from sepsis within the first postoperative month. At 2 weeks, four of six patients had partial regeneration of the native liver, which became complete in two of the survivors by 1 year.

    CONCLUSIONS:Although patient selection remains poorly defined, auxiliary partial orthotopic liver transplantation in acute liver failure is technically feasible and, in some patients, allows native liver regeneration and eventual immunosuppression withdrawal.

    背景与目标: 背景/目的 : 辅助部分原位肝移植比常规原位肝移植具有潜在的优势,但在急性肝衰竭方面的技术经验有限。
    方法 : 我们描述了7例急性肝衰竭 (扑热息痛3,非A-E 2,自身免疫性1,摇头丸1) 符合标准的患者 (4名男性,3名女性; 平均年龄28岁,范围14-35岁) 的初步经验。紧急移植。术前,国际标准化比率中位数为7 (范围3.4-15),肌酐为123微米 (51-389微米),胆红素320微米 (61-572微米)。进行辅助移植的原因是患者的年龄较小且术前状况稳定 (n = 5),或者有明显的精神病史而无法进行常规移植 (n = 2)。
    结果 : 所有患者均接受了血型匹配的左 (n = 2) 或右 (n = 5) 辅助移植物。手术的中位持续时间为8.5小时 (7.3-10小时),失血量为8.3升 (4.6-14.6升)。移植后,所有患者的国际标准化比率和天冬氨酸转氨酶均逐渐下降,在1.4第7天 (1.0-2.4) 和108 IU/1 (78-910 IU/1) 的中位数。术后第一个月内有3名患者死于败血症。在2周时,六名患者中有四名患者的天然肝脏部分再生,其中两名幸存者在1年内完全再生。
    结论 : 尽管患者选择的定义仍然很差,在急性肝衰竭中进行辅助部分原位肝移植在技术上是可行的,并且在某些患者中,允许天然肝脏再生并最终退出免疫抑制。
  • 【通过血管内超声记录不稳定型心绞痛和急性心肌梗死中冠状动脉小动脉粥样硬化斑块上的血栓。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9149(97)00199-9 复制DOI
    作者列表:Birnbaum Y,Luo H,Fishbein MC,Samuels B,Siegel RJ
    BACKGROUND & AIMS: Rupture of atheromatous plaques leading to acute coronary syndromes usually occur in lipid-reach and well-developed coronary lesions. We describe 2 unusual patients with acute coronary syndromes in whom there was angiographic and intravascular ultrasound evidence of an intraluminal thrombus overlying a small, nonocclusive plaque in an enlarged coronary artery.

    背景与目标: 导致急性冠状动脉综合征的动脉粥样硬化斑块破裂通常发生在脂质到达和发达的冠状动脉病变中。我们描述了2例不寻常的急性冠状动脉综合征患者,其中有血管造影和血管内超声证据表明腔内血栓覆盖了扩大的冠状动脉中的一个小的非闭塞斑块。
  • 【比较基于相机的99mTc-MAG3和24小时肌酐清除率评估肾功能。】 复制标题 收藏 收藏
    DOI:10.2214/AJR.05.1025 复制DOI
    作者列表:Esteves FP,Halkar RK,Issa MM,Grant S,Taylor A
    BACKGROUND & AIMS: OBJECTIVE:The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based technetium-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of kidney function. MATERIALS AND METHODS:Data were obtained from a retrospective analysis of 28 patients with varying degrees of kidney dysfunction and 85 subjects evaluated for kidney donation. The MAG3 clearance was calculated using a camera-based technique without blood or urine sampling. The creatinine clearance was measured using the plasma creatinine and a 24-hour urine collection. The MAG3 and creatinine clearances were corrected for body surface area, and clearance values in healthy subjects and patients were compared using the paired Student's t test. The linear association between the MAG3 and creatinine clearances was expressed by Pearson's correlation coefficient. RESULTS:The mean MAG3 clearance in the potential kidney donors was 321 +/- 95 mL/min/1.73 m2 (95% CI, 171-546 mL/min/1.73 m2), significantly higher than the mean creatinine clearance of 152 +/- 51 mL/min/1.73 m2 (79-278 mL/min/1.73 m2, p < 0.001). The mean MAG3 clearance in patients was 153 +/- 70 mL/min/1.73 m2 (32-316 mL/min/1.73 m2) and was also significantly higher than the mean creatinine clearance of 74 +/- 36 mL/min/1.73 m2 (21-138 mL/min/1.73 m2, p < 0.001). The ratio of the mean creatinine clearance to the mean MAG3 clearance was essentially the same for volunteers and patients, 0.47 and 0.48, respectively. The Pearson's correlation between the MAG3 and creatinine clearances was 0.80 (0.72-0.86). CONCLUSION:The camera-based 99mTc-MAG3 clearance correlates well with the 24-hour creatinine clearance and can provide a simple and convenient index of kidney function.
    背景与目标:
  • 【烧伤和内脏损伤合并爆炸伤后腹壁全层损失的成功治疗。】 复制标题 收藏 收藏
    DOI:10.1097/01.BCR.0000238090.70355.6D 复制DOI
    作者列表:Başaran O,Karaarslan P,Sakalloğlu AE,Kesik E,Karakayalý H,Haberal M
    BACKGROUND & AIMS: :A 29-year-old man was admitted to our institution 10 days after he had undergone an urgent exploratory laparotomy at a local army hospital after a terrorist bombing attack. On admission, deep second-degree and third-degree burns involving 25% of the upper and lower extremities were present, together with a 25 x 10-cm abdominal full-thickness blast injury defect on the left side, an infected eviscerated midline incision, and a colostomy on the right side of the abdomen. The patient underwent a second laparotomy, at which time the intraabdominal abscess was drained, and the abdominal cavity was irrigated with saline. A jejunal perforation was found and sutured. The abdominal cavity was left open and covered with a Bogota bag for temporary closure. On postburn day 18, the patient underwent débridment and grafting of the third-degree burns to the left and right arm and right lower extremities. After several débridment sessions (postburn days 16, 18, 20, 22, and 24), an abdominal skin release and reapproximation were performed (postburn day 26). On postburn day 36, split-thickness skin grafts were placed directly on the granulated tissue of the intestines and on a defect in the left flank and iliac regions. Postoperatively, the patient did well. He was discharged on postburn day 78 with all wounds well healed. In our opinion, temporary closure followed by direct application of meshed split-thickness skin grafts to exposed abdominal viscera represents a simple method of reconstruction that can be safely performed, with minimal risk, on critically ill patients.
    背景与目标: : 一名29岁的男子在恐怖爆炸袭击后在当地一家军队医院接受紧急剖腹探查术10天后被送入我们的机构。入院时,出现了涉及上下肢25% 的深二度和三度烧伤,左侧有25x10 cm的腹部全层爆炸伤缺损,感染的内脏中线切口,以及腹部右侧的结肠造口术。患者接受了第二次剖腹手术,此时引流了腹腔内脓肿,并用盐水冲洗了腹腔。发现空肠穿孔并缝合。腹腔保持开放状态,并用波哥大袋覆盖,以暂时关闭。在烧伤后第18天,患者接受了三度烧伤的移植,并将其移植到左,右臂和右下肢。经过几次缓解 (烧伤后第16、18、20、22和24天) 后,进行了腹部皮肤释放和重新逼近 (烧伤后第26天)。在烧伤后的第36天,将厚度分开的皮肤移植物直接放置在肠的颗粒状组织以及左侧和ili区的缺损处。术后,患者表现良好。他在烧伤后第78天出院,所有伤口均愈合良好。在我们看来,暂时封闭,然后直接将网状厚度的皮肤移植物应用到暴露的腹部内脏上,代表了一种简单的重建方法,可以对危重病人安全地进行,风险最小。
  • 【肾脏能起到肺的作用吗?家兔缺血肾脏逆行灌注过程中的全身氧合和肾脏保存。】 复制标题 收藏 收藏
    DOI:10.1111/j.1464-410X.2006.06257.x 复制DOI
    作者列表:Humphreys MR,Ereth MH,Sebo TJ,Slezak JM,Dong Y,Blute ML,Gettman MT
    BACKGROUND & AIMS: OBJECTIVE:To investigate renal preservation by a novel method of perfusion using an oxygenated perfluorocarbon (PFC) emulsion via retrograde access to the kidney, as preserving renal function during urological surgery has been elusive, and the recognized technique of nephron-sparing surgery has increased its application and practice in modern urology. MATERIALS AND METHODS:After institutional review and approval, 30 New Zealand White rabbits were studied. In a solitary kidney model, each rabbit had the ureter catheterized before 40 min of renal artery occlusion. Each rabbit was randomized to one retrograde perfusion group, i.e. sham, normothermic PFC, chilled PFC, normothermic saline, and chilled saline. The rabbits were maintained for 2 weeks, during which renal function, urine output, systemic blood gases, weight and serum creatinine level were measured. After death, the kidneys were individually examined and graded by one renal pathologist unaware of the treatment. RESULTS:The rabbits treated with retrograde PFC perfusion (normothermic and chilled) had less change in their creatinine clearance, at 3.6 and 4.0 mL/min per kg, than the sham group, at 7.8 mL/min per kg, while also having significantly higher systemic venous oxygenation, at 26.3 and 10.0 mmHg, than the sham group, at 0.2 mmHg. Normothermic and chilled perfusion with PFC was also associated with less histological evidence of ischaemic damage, with mean (sd) scores of 13.0 (13.5) and 8.7 (4.5), respectively, than in the sham group, at 33.3 (16.8), while favourably matching the contralateral control kidney group, at 5.5 (2.3). The rabbits treated with saline retrograde perfusion also had better outcomes than the sham cohort. There were no adverse effects in any of the study arms or with the use of PFC. CONCLUSION:Retrograde oxygen delivery to the kidney through the urinary collecting system was successful in this pilot study. Renal function, laboratory and histological data indicate a trend towards renal preservation and even systemic oxygenation in the experimental groups compared with the sham rabbits, with no adverse effects attributed to this technique.
    背景与目标:
  • 【在急性护理环境中,护士在照顾病态肥胖患者时面临的挑战。】 复制标题 收藏 收藏
    DOI:10.1016/j.soard.2005.06.003 复制DOI
    作者列表:Drake D,Dutton K,Engelke M,McAuliffe M,Rose MA
    BACKGROUND & AIMS: BACKGROUND:Despite increasing numbers of morbidly obese patients admitted to acute care facilities for surgery or treatment of nonsurgical conditions, there is little evidence of the problems nurses face in providing care to these patients. Anecdotal evidence suggests that the care of these patients is more demanding than the care of nonobese patients. The objective of this study was to describe nurses' perceptions of the challenges that they face when caring for morbidly obese patients. METHODS:Focus groups of nurses from a tertiary care facility were convened. A trained facilitator posed questions to the group concerning various aspects of care for morbidly obese patients. Comments of respondents were categorized using NVIVO software. RESULTS:Nurses reported concerns about the increased staffing needs required for care of these patients and the particular challenges of the physical care. Concerns also included the availability, placement, and use of specialized equipment. Room size and the absence of some equipment were also problematic. Finally, nurses perceived safety issues, both for themselves and their patients. CONCLUSIONS:Morbidly obese patients in the acute care setting require specialized nursing care in terms of techniques, levels of staffing required, and the use of specialized equipment.
    背景与目标:
  • 【穿孔素介导的急性心肌炎心肌损伤。】 复制标题 收藏 收藏
    DOI:10.1016/0140-6736(90)92486-2 复制DOI
    作者列表:Young LH,Joag SV,Zheng LM,Lee CP,Lee YS,Young JD
    BACKGROUND & AIMS: :Endomyocardial specimens were obtained from 7 patients with acute myocarditis. Immunohistochemical examination of the mononuclear infiltrate showed mainly cytotoxic T lymphocytes and natural killer cells. Perforin (a pore-forming protein found in cytotoxic lymphocytes) was identified in this myocardial lymphocytic infiltrate and electron microscopy showed myocardial cell damage that may have been associated with these perforin containing lymphocytes. The results indicate that in acute idiopathic and viral myocarditis, myocardial damage may be due to the action of perforin-secreting lymphocytes.
    背景与目标: : 从7例急性心肌炎患者中获得心内膜心肌标本。对单核浸润的免疫组织化学检查显示主要是细胞毒性T淋巴细胞和自然杀伤细胞。在这种心肌淋巴细胞浸润中鉴定出穿孔素 (一种在细胞毒性淋巴细胞中发现的成孔蛋白),电子显微镜显示心肌细胞损伤可能与这些含有穿孔素的淋巴细胞有关。结果表明,在急性特发性和病毒性心肌炎中,心肌损伤可能是由于穿孔素分泌淋巴细胞的作用所致。
  • 【压力限制通气期间持续气管气吹入对急性肺损伤家兔肺表面活性物质的影响。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Zhu GF,Zhang W,Zong H,Liang Y
    BACKGROUND & AIMS: BACKGROUND:Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (V(T)) while maintaining constant partial arterial CO2 pressure (PaCO(2)). We hypothesised that TGI limited peak inspiratory pressure (PIP) and V(T) and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI). METHODS:ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n = 8 for each group), and subsequently ventilated with limited PIP and V(T) to maintain PaCO(2) within 35 to 45 mmHg for 4 hours. Physiological dead space to V(T) ratio (V(D)/V(T)), dynamic respiratory compliance (Cdyn) and partial arterial O(2) pressure (PaO(2)) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (V(V)), myeloperoxidase and interleukin (IL)-8. RESULTS:TGI resulted in significant (P < 0.05 or P < 0.01) decrease in PIP [(22.4 +/- 1.8) cmH2O vs (29.5 +/- 1.1) cmH2O], V(T) [(6.9 +/- 1.3) ml/kg vs (9.8 +/- 1.11) ml/kg], V(D)/V(T) [(32 +/- 5)% vs (46 +/- 2)%], TP [(109 +/- 22) mg/kg vs (187 +/- 25) mg/kg], SA/LA (2.5 +/- 0.4 vs 5.4 +/- 0.7), myeloperoxidase [(6.2 +/- 0.5) U/g tissue vs (12.3 +/- 0.8) U/g tissue] and IL-8 [(987 +/- 106) ng/g tissue vs (24 +/- 3) mN/m] of BALF, and significant (P < 0.05) increase in Cdyn [(0.47 +/- 0.02) ml.cmH2O(-1).kg(-1) vs (0.31 +/- 0.02) ml.cmH2O(-1).kg(-1)], PaO(2) [(175 +/- 24) mmHg vs (135 +/- 26) mmHg], TPL/TP (52 +/- 8 vs 33 +/- 11) and Vv (0.65 +/- 0.05 vs 0.44 +/- 0.07) as compared with CMV. CONCLUSIONS:In this animal model of ALI, TGI decreased ventilatory requirements (PIP, V(T) and V(D)/V(T)), resulted in more favourable alveolar pulmonary surfactant composition and function and less severity of lung injury than CMV. TGI in combination with pressure limited ventilation may be a lung protective strategy for ALI.
    背景与目标:
  • 【儿童急性囊尾性脑膜炎: 对吡喹酮的反应。】 复制标题 收藏 收藏
    DOI:10.1080/02724936.1997.11747856 复制DOI
    作者列表:Visudhiphan P,Chiemchanya S
    BACKGROUND & AIMS: :Acute purulent meningitis as a manifestation of cerebral cysticercosis is uncommon. We report two children aged 12 months and 3 years who presented with clinical signs of acute meningitis and whose initial cerebrospinal fluid (CSF), except for negative culture, was typical of purulent meningitis. However, eosinophils were present in subsequent examinations of the CSF and the haemagglutination titre for cysticercus rose. Praziquantel was given to both children with dramatic improvement in clinical and CSF findings.
    背景与目标: : 急性化脓性脑膜炎作为脑囊虫病的表现并不常见。我们报告了两名年龄分别为12个月和3岁的儿童,他们表现出急性脑膜炎的临床症状,除阴性培养外,其初始脑脊液 (CSF) 是化脓性脑膜炎的典型表现。然而,在随后的CSF检查中存在嗜酸性粒细胞,并且囊尾蚴的血凝滴度上升。对两名临床和CSF表现均显着改善的儿童均给予吡喹酮。
  • 【肾源性干细胞隔离与鉴定。】 复制标题 收藏 收藏
    DOI:10.1681/ASN.2006030275 复制DOI
    作者列表:Gupta S,Verfaillie C,Chmielewski D,Kren S,Eidman K,Connaire J,Heremans Y,Lund T,Blackstad M,Jiang Y,Luttun A,Rosenberg ME
    BACKGROUND & AIMS: :Acute kidney injury is followed by regeneration of damaged renal tubular epithelial cells. The purpose of this study was to test the hypothesis that renal stem cells exist in the adult kidney and participate in the repair process. A unique population of cells that behave in a manner that is consistent with a renal stem cell were isolated from rat kidneys and were termed multipotent renal progenitor cells (MRPC). Features of these cells include spindle-shaped morphology; self-renewal for >200 population doublings without evidence for senescence; normal karyotype and DNA analysis; and expression of vimentin, CD90 (thy1.1), Pax-2, and Oct4 but not cytokeratin, MHC class I or II, or other markers of more differentiated cells. MRPC exhibit plasticity that is demonstrated by the ability of the cells to be induced to express endothelial, hepatocyte, and neural markers by reverse transcriptase-PCR and immunohistochemistry. The cells can differentiate into renal tubules when injected under the capsule of an uninjured kidney or intra-arterially after renal ischemia-reperfusion injury. Oct4 expression was seen in some tubular cells in the adult kidney, suggesting these cells may be candidate renal stem cells. It is proposed that MRPC participate in the regenerative response of the kidney to acute injury.
    背景与目标: : 急性肾损伤后,受损的肾小管上皮细胞再生。目的检验肾干细胞存在于成人肾脏并参与修复过程的假说。从大鼠肾脏中分离出一种独特的细胞群,其行为方式与肾干细胞一致,被称为多能肾祖细胞 (MRPC)。这些细胞的特征包括梭形形态;> 200种群倍增的自我更新,没有衰老的证据; 正常的核型和DNA分析; 波形蛋白,CD90 (thy1.1),Pax-2和10月4的表达,而不是细胞角蛋白,MHC I或II类,或更多分化细胞的其他标记。MRPC表现出可塑性,通过逆转录酶PCR和免疫组织化学诱导细胞表达内皮,肝细胞和神经标志物的能力证明了这种可塑性。当在未受伤的肾脏的胶囊下注射或在肾缺血再灌注损伤后动脉内注射时,细胞可以分化为肾小管。在成人肾脏的某些肾小管细胞中观察到10月4的表达,表明这些细胞可能是候选的肾干细胞。建议MRPC参与肾脏对急性损伤的再生反应。
  • 【两肾一夹高血压中白细胞浸润和ICAM-1表达。】 复制标题 收藏 收藏
    DOI:10.1093/ndt/12.5.899 复制DOI
    作者列表:Haller H,Park JK,Dragun D,Lippoldt A,Luft FC
    BACKGROUND & AIMS: How an increase in blood pressure, in and of itself, induces hypertensive nephrosclerosis is unclear. In an earlier study we found that leukocyte infiltration, proximal tubular cell proliferation, matrix deposition and interstitial fibrosis occur in the unclipped kidney of 2 K 1 C Goldblatt hypertensive rats. In this study we tested the hypothesis that the cell surface adhesion molecule ICAM-1 is expressed on the vascular endothelium and tubular epithelium of unclipped kidneys at 4 weeks. As a positive control, we examined the clipped kidney as well. We found that systolic blood pressure was significantly elevated in renovascular hypertensive rats compared to sham-operated controls after 4 weeks (198 +/- 5 mmHg vs 121 +/- 2 mmHg, P < 0.001). Furthermore, quantitative (densitometry) measurements showed that ICAM-1 expression on vascular endothelium and on tubular cells was significantly increased in unclipped kidneys compared to controls (P < 0.05). The same was true for monocyte and granulocyte infiltration (P < 0.05). These same variables were even more prominent in the clipped kidneys, compared to unclipped and control kidneys (P < 0.05). Our data show that ICAM-1 is expressed in unclipped kidneys exposed to hypertension as well as in clipped kidneys exposed to ischemia. We suggest that mechanical injury induced by increased blood pressure is responsible for an inflammatory adhesion molecule-mediated response and concomitant renal injury.

    背景与目标: 目前尚不清楚血压本身的升高如何引起高血压肾硬化。在较早的研究中,我们发现2 K 1 C Goldblatt高血压大鼠的未夹肾中发生白细胞浸润,近端肾小管细胞增殖,基质沉积和间质纤维化。在这项研究中,我们测试了以下假设: 细胞表面粘附分子ICAM-1在4周时在未夹住的肾脏的血管内皮和肾小管上皮上表达。作为阳性对照,我们也检查了截断的肾脏。我们发现,与假手术对照组相比,肾血管性高血压大鼠的收缩压在4周后显着升高 (198/- 5 mmHg vs 121/- 2 mmHg,P <0.001)。此外,定量 (密度测定法) 测量显示,与对照组相比,未夹住的肾脏在血管内皮和肾小管细胞上的ICAM-1表达显着增加 (P <0.05)。单核细胞和粒细胞浸润也是如此 (P <0.05)。与未夹肾和对照肾相比,这些相同的变量在夹肾中更为突出 (P <0.05)。我们的数据显示,ICAM-1在暴露于高血压的未夹肾以及暴露于缺血的夹肾中表达。我们建议由血压升高引起的机械损伤是炎症粘附分子介导的反应和伴随的肾损伤的原因。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录