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PROSPECTIVE STUDIES OF GASTRIC-SECRETION IN TRAUMA PATIENTS

AMERICAN JOURNAL OF SURGERY 1976年第1期131卷 78-85页

作者： STREMPLE, JF UNIV PITTSBURGH SCH MEDDEPT SURGPITTSBURGHPA

Patients who had cranial injuries and those who were less severely injured had a normal gastric acid output. Pepsin output decreased throughout the first 72 hours after trauma. Gastric juice protein output was slightly increased. Gastric mucosal cell renewal as estimated by gastric juice DNA was increased. Patients who were more severely injured and those with intra-abdominal trauma had markedly increased gastric acid, pepsin, and protein output after increased gastric mucosal cell exfoliation but a relatively decreased gastric mucosal cell renewal between 36 and 72 hours after trauma. It is concluded that the gastric mucosa must be protected by antacids and/or gastric aspiration before 24 hours after trauma and continued through at least 72 hours. This study supports the importance of acid-pepsin damage during gastric mucosal cell exfoliation and decreased renewal in trauma patients and indicates the timing and value of prophylactic treatment.

关键词：胃液/代谢胃黏膜/代谢胃黏膜/病理学胃泌素类/血液胃泌素类/代谢胃蛋白酶A/代谢通透性分泌率时间因素创伤和损伤/病理生理学青少年成年人老年人女(雌)性人类男(雄)性中年人

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TRACKING RESPIRATORY THERAPY IN TRAUMA PATIENT

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AMERICAN JOURNAL OF SURGERY 1975年第3期129卷 255-258页

作者： GOLDFARB, MA CIUREJ, TF MCASLAN, TC SACCO, WJ WEINSTEIN, MA COWLEY, RA EDGEWOOD ARSENAL BIOPHYS DIV BIOMED LAB ABERDEEN PROVING GROUND MD USA MARYLAND INST EMERG MED BALTIMORE MD USA

The respiratory index (RI), P(AaDO 2 ) PaO 2 , was investigated in a retrospective study of 177 intubated patients treated at the Maryland Institute for Emergency Medicine. An RI of 0.1 to 0.37 is normal. Patients with an RI of 2 or greater were intubated. Those patients who reached an RI of 6 or more had an associated 12 per cent probability of survival. The RI reflects the presence of pulmonary shunting in a variety of circumstances including atelectasis, pulmonary contusion, and pulmonary emboli. A nomogram that allows the course of the patient with respiratory problems to be followed is described. Movement along the same isobars or between isobars can be followed by plotting the PaO2 against the FIO2 . Thus, the rationale and effect of respiratory therapeutic manipulations may be recorded graphically.

关键词：急症概率预后呼吸呼吸人工呼吸功能试验/方法呼吸功能不全/死亡率回顾性研究创伤和损伤/死亡率创伤和损伤/病理生理学成年人人类中年人

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Long-term sound conditioning enhances cochlear sensitivity

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JOURNAL OF NEUROPHYSIOLOGY 1999年第2期82卷 863-873页

作者： Kujawa, SG Liberman, MC Harvard Univ Sch Med Dept Otol & Laryngol Boston MA 02114 USA Massachusetts Eye & Ear Infirm Eaton Peabody Lab Boston MA 02114 USA

Sound conditioning, by chronic exposure to moderate-level sound, can protect the inner ear (reduce threshold shifts and hair cell damage) from subsequent high-level sound exposure. To investigate the mechanisms underlying this protective effect, the present study focuses on the physiological changes brought on by the conditioning exposure itself. In our guinea-pig model, 6-h daily conditioning exposure to an octave-band noise at 85 dB SPL reduces the permanent threshold shifts (PTSs) from a subsequent 4-h traumatic exposure to the same noise band at 109 dB SPL, as assessed by both compound action potentials (CAPs) and distortion product otoacoustic emissions (DPOAEs). The frequency region of maximum threshold protection is approximately one-half octave above the upper frequency cutoff of the exposure band. Protection is also evident in the magnitude of suprathreshold CAPs and DPOAEs, where effects are more robust and extend to higher frequencies than those evident at or near threshold. The conditioning exposure also enhanced cochlear sensitivity, when evaluated at the same postconditioning time at which the traumatic exposure would be delivered in a protection study. Response enhancements were seen in both threshold and suprathreshold CAPs and DPOAEs. The frequency dependence of the enhancement effects differed, however, by these two metrics. For CAPs, effects were maximum in the same frequency reg lon as those most protected by the conditioning. For DPOAEs, enhancements were shifted to lower frequencies. The conditioning exposure also enhanced both ipsilaterally and contralaterally evoked olivocochlear (OC) reflex strength, as assessed using DPOAEs. The frequency and level dependence of the reflex enhancements were consistent with changes seen in sound-evoked discharge rates in OC fibers after conditioning. However, comparison with the frequency range and magnitude of conditioning-related protection suggests that the protection cannot be completely explained by amp

关键词：声刺激动作电位/生理学耳蜗/生理学条件反射经典/生理学橄榄核/生理学耳声发射自发性/生理学时间因素创伤和损伤/病理生理学动物女(雌)性豚鼠男(雄)性

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Initiators and propagators of the metabolic response to injury

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WORLD JOURNAL OF SURGERY 2000年第6期24卷 624-629页

作者： Hill, AG Africa Inland Church Kijabe Hosp Dept Surg Kijabe Kenya

Injury produces tissue hypoperfusion and subsequent reperfusion, afferent neural activity, and immune and vascular endothelial activation. These, in turn, set up a cascade of events coordinated by the central nervous system and at the level of individual tissues such as the liver, gut, and skeletal muscle. They are mediated by a complex array of neutrophil and macrophage products, The changes result in hypermetabolism, lypolysis, lysis of skeletal muscle and visceral protein, and expanded extracellular fluid with consequent organ failure.

关键词：细胞因子类/代谢白细胞介素类/代谢肠/病理生理学活性氧/代谢肿瘤坏死因子α/生理学创伤和损伤/代谢创伤和损伤/病理生理学动物人类

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The lateral impaction of the shoulder

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INTERNATIONAL ORTHOPAEDICS 1999年第5期23卷 302-307页

作者： Scarlat, MM Cuny, C Goldberg, BA Harryman, DT Matsen, FA Ctr Hosp Gen Serv Chirurg Orthoped & Traumatol F-83407 Hyeres Les Palmiers France

17 patients had radiographic demonstration of injury to the clavicle, scapula and ribs from an impact delivered to the lateral shoulder. The study included 13 males and 4 females whose ages ranged from 18 to 83 years (average 45 years). Most injuries were sustained in falls or motor vehicle accidents. Analysis of these cases suggests a biomechanical hypothesis concerning the transmission of the impact forces within the shoulder girdle. According to this hypothesis, the impaction force applied to the lateral shoulder is transmitted from outside inward following two paths. The anterior and superior path passes through the acromio-clavicular joint, the clavicle, the costo-clavicular joint and the sterno-clavicular joint. The posterior and inferior path is transmitted within the gleno-humeral joint, the scapula and the scapulo-thoracic joint. Major impacting force is required to disrupt the anterior and posterior arches of the shoulder girdle. When both of these supporting structures are damaged, the patient is at risk for more serious injuries, including disruption of the thorax, shoulder joint, brachial plexus and neck.

关键词：意外跌倒事故交通创伤和损伤/病理生理学青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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CARDIAC-OUTPUT DETERMINATIONS IN SURGICAL PATIENTS

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SURGICAL CLINICS OF NORTH AMERICA 1975年第3期55卷 521-529页

作者： TIETJEN, GW GUMP, FE KINNEY, JM COLUMBIA UNIV COLL PHYS & SURG DEPT SURG NEW YORK NY 10027 USA

The availability of cardiac output measurements has aided the physician in diagnosing and treating critically ill patients. An understanding of the indications and limitations of the various methods available — Fick,... 详细信息

关键词：心排血量/方法指示剂稀释技术监测生理学肺心病/病理生理学休克出血性/病理生理学外科手术温度创伤和损伤/病理生理学动物人类

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Wound healing associated with severe surgical illness

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WORLD JOURNAL OF SURGERY 2000年第6期24卷 648-654页

作者： Clark, MA Plank, LD Hill, GL Univ Auckland Auckland Hosp Dept Surg Auckland 1003 New Zealand

Severe injury or infection is associated with a hypermetabolic response that, when excessive, results in impaired wound healing and as a consequence increased morbidity and mortality, The objective examination of wound healing in humans is difficult and generally requires the use of models. Evidence is accumulating that nutritional and growth factors play important roles in improving the wound healing response, particularly after thermal injury and uncomplicated major surgery. The septic patient represents the biggest challenge to those seeking to optimize wound healing capacity. Advances in molecular biology have provided promising therapies in experimental studies of wound healing that await clinical investigation.

关键词：生长物质/生理学营养状况脓毒症/病理生理学外科手术肿瘤坏死因子α/生理学伤口愈合/生理学创伤和损伤/病理生理学人类

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Can we produce a human corneal equivalent by tissue engineering?

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PROGRESS IN RETINAL AND EYE RESEARCH 2000年第5期19卷 497-527页

作者： Germain, L Carrier, P Auger, FA Salesse, C Guérin, SL Lab Organogenese Expt Quebec City PQ G1S 4L8 Canada Univ Laval Dept Chirurg Ste Foy PQ G1K 7P4 Canada CHU Laval Ctr Rech Unite Rech Ophtalmol Quebec City PQ G1V 4G2 Canada CHU Laval Ctr Rech Mol Endocrinol Lab Quebec City PQ G1V 4G2 Canada

Tissue engineering is progressing rapidly. Bioengineered substitutes are already available for experimental applications and some clinical purposes such as skin replacement. This review focuses on the development of reconstructed human cornea in vitro by tissue engineering. Key elements to consider in the corneal reconstruction, such as the source for epithelial cells and keratocytes. are discussed and the various steps of production are presented. Since one application of this human model is ro obtain a better understanding of corneal wound healing, the mechanisms of this phenomenon as well as the function played both by membrane-bound integrins and components from the extracellular matrix have also been addressed. The analysis of integrins by immunohistofluorescence labelling of our reconstructed human cornea revealed that beta(1), alpha(3), alpha(5), and alpha(6) integrin subunits were expressed but alpha(4) was not. Laminin. type VII collagen and fibronectin were also detected. Finally, the future challenges of corneal reconstruction by tissue engineering are discussed and the tremendous applications of such tissue produced in vitro for experimental as well as clinical purposes are considered, (C) 2000 Elsevier Science Ltd. All rights reserved.

关键词：生物医学工程角膜/损伤角膜/代谢细胞外基质/代谢整合素类/代谢伤口愈合创伤和损伤/病理生理学人类

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PAI-1 gene expression is regionally induced in wounded epithelial cell monolayers and required for injury repair

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JOURNAL OF CELLULAR PHYSIOLOGY 2000年第2期182卷 269-280页

作者： Providence, KM Kutz, SM Staiano-Coico, L Higgins, PJ Albany Med Coll Program Mol & Cell Biol Albany NY 12208 USA Cornell Univ Weill Med Coll Dept Surg New York NY USA

Induced expression of plasminogen activator inhibitor type-1 (PAI-1), a major negative regulator of pericellular plasmin generation, accompanies wound repair in vitro and in vivo. Since transcriptional control of the PAI-1 gene is superimposed on a growth state-dependent program of cell activation (Kutz et al., 1997, J Cell Physiol 170:8-18), it was important to define potentially functional relationships between PAI-1 synthesis and subpopulations of cells that emerge during the process of injury repair in T2 renal epithelial cells. Specific cohorts of migratory and proliferating cells induced in response to monolayer trauma were spatially as well as temporally distinct. Migrating cells did not divide in the initial 12 to 20 h postinjury. After 24 h, S-phase cells were generally restricted to a region 1 to 2 mm from, and parallel to, the wound edge. Proliferation of wound bed cells occurred subsequent to wound closure, whereas the distal contact-inhibited monolayer remained generally quiescent. Hydroxyurea blockade indicated, however, that proliferation (most likely of cells immediately behind the motile "tongue") was necessary for maintenance of cell-to-cell cohesiveness in the advancing front, although the ability to migrate was independent of proliferation. PAI-1 mRNA expression was rapidly up-regulated in response to wounding with inductive kinetics approximating that of serum-stimulated cultures. Differential harvesting of T2 cell subpopulations, based on proximity to the injury site, prior to Northern assessments of PAI-1 mRNA abundance indicated that PAI-1 transcripts were restricted to cells immediately bordering the wound or actively migrating and not expressed by cells in the distal contact-inhibited monolayer regions. Such cell location-specific distribution of PAI-1-producing cells was confirmed by immunocytochemistry. PAI-1 synthesis in cells that locomoted into the wound field continued until injury closure. Down-regulation of PAI-1 synthesis and matri

关键词：细胞系上皮细胞/生理学基因表达/生理学肾/损伤动力学纤溶酶原激活物抑制物1/遗传学伤口愈合/生理学创伤和损伤/遗传学创伤和损伤/病理生理学动物大鼠

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Systemic responses to trauma

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BRITISH MEDICAL BULLETIN 1999年第4期55卷 726-743页

作者： Foex, BA Univ Manchester Hope Hosp Salford M6 8HD Lancs England

The systemic responses to trauma can be divided into cardiovascular, immunological, and metabolic. The cardiovascular responses are seen immediately after a traumatic insult. The pattern of response depends on whether the insult is mainly haemorrhagic, tissue damage, or a combination of the two. The response may be quite different for penetrating vascular trauma, compared with a crush injury to a limb. The immunological, or inflammatory, consequences of trauma usually become apparent several hours or days after the initial insult, although it is increasingly clear that they may be triggered by the very early cardiovascular changes. These have been implicated in the development of multiple organ failure. The metabolic responses are of greatest importance in the longer term: after successful resuscitation and after the definitive treatment of the patient's injuries. The metabolic responses need to be taken into account during the recovery from treatment and during the rehabilitation of the patient.

关键词：心血管系统/病理生理学细胞因子类/代谢出血/病理生理学炎症/病理生理学多器官功能衰竭/病因学局部血流/生理学创伤和损伤/并发症创伤和损伤/免疫学创伤和损伤/病理生理学动物人类

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