The effect of x-rays on the rickettsiostatic activity of streptomycin,aureomycin, and penicillin

The effect of x-rays on the rickettsiostatic activity of streptomycin, penicillin and aureomycin in the embryonate egg was investigated. Only a slight reversal of the rickettsiostatic action of 5 mg. of streptomycin occurred in embryonate eggs given 100 r of x-rays at 4 days of incubation, whereas complete reversal occurred in those given 1000 r. Groups of eggs irradiated with intermediate doses of x-rays showed a graded response. The rickettsiostatic activity of 5 mg. (1660 Oxford units/mg.) of penicillin or of 5 mg. of aureomycin was not reversed by doses of x-rays ranging from 100 to 1000 r. 500 r of x-rays reversed the rickettsiostatic activity of 2 mg., 4 mg., 8 mg., or 16 mg. of streptomycin per egg in proportion to the amount of streptomycin injected. The rickettsiostatic activity of 2 mg. of streptomycin was completely reversed and the activity of 16 mg. only partially reversed. Reversal of the rickettsiostatic activity of streptomycin by x-rays was observed when radiation was given up to 6 days after the injection of the antibiotic into 7-day-old embryos. Reversal of the rickettsiostatic activity of 4 mg. of streptomycin could be detected when the antibiotic was injected 3 days after 500 r of x-radiation. Explanations of the observed phenomena are discussed in terms of biochemical and biophysical alterations of the cells of the host.     

心肌组织超声背向散射参数临床应用研究

本文报道了２０例陈旧性心梗（ＯＭＩ）、３３例扩张型心肌病（ＤＣＭ）、５６例高血压病（ＨＴ）、１２例肥厚型心肌病（ＨＣＭ）患者和正常对照组４０例心肌超声背向散射参数检查结果。正常组各节段心肌平均ＩＢ％相近，ＣＶＩＢ略有差异。ＯＭＩ梗塞灶、ＤＣＭ和出现并发症的ＨＴ患者（１９／５６）心肌平均ＩＢ％均增大，ＣＶＩＢ均减低或ＩＢＳ曲线形态异常，无并发症的ＥＴＨ患者ＩＢ％、ＣＶＩＢ无显著改变。ＨＣＭ患者ＩＶＳ的ＩＢ％增大，ＣＶＩＢ减低，ＩＶＳ左室侧１／２心肌ＣＶＩＢ大于右室侧１／２；ＬＶＰＷ的ＩＢ％和ＣＶＩＢ与正常组无显著差异。     

贵要静脉营养血管远端蒂复合瓣的解剖学特征

背景:前臂皮神经营养血管皮瓣特别适宜手部远端的组织缺损修复,所以了解贵要静脉远端的营养血管及与邻近骨、皮和前臂内侧皮神经的血供关系对临床上前臂皮神经营养血管远端蒂复合瓣的设计有重要意义。目的:研究前臂尺侧缘远端的动脉穿支,为前臂尺侧缘贵要静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计:单一样本实验。单位:解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心。材料:实验于2004-05/10在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。研究材料为30侧动脉灌注红色乳胶成人上肢标本(由南京军区福州总医院军区骨科研究所临床解剖学研究中心提供)。方法:将30侧成人上肢标本,以尺骨茎突为观测标志点进行显微解剖。主要观察指标:重点观察:①前臂尺侧缘远端的动脉穿支来源。②动脉穿支与贵要静脉远端的营养血管。③营养血管与邻近骨、皮和前臂内侧皮神经的血供关系。④贵要静脉的浅深交通支。结果:①前臂尺侧缘远端的动脉穿支来自:尺动脉的皮支5～9支,外径(0.7±0.3)mm,尺动脉腕上皮支1～3支,外径(0.6±0.3)mm。在尺骨茎突上方6.0～16.0cm,骨间前动脉发骨皮穿支二三支,骨间后动脉发骨皮穿支1～3支,二者外径在0.4～1.2mm,分布尺骨中下段骨膜及相应区域的皮肤。②上述动脉穿支均发皮支、筋膜支、骨膜支、贵要静脉和皮神经营养血管支,形成贵要静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂尺侧缘远端的动脉穿支是贵要静脉营养血管的来源,营养血管与邻近的骨、皮和前臂内侧皮神经的营养血管同源,是设计贵要静脉营养血管远端蒂复合瓣的解剖学基础。以尺动脉腕上皮支为蒂的远端蒂复合瓣,旋转轴点可达腕关节平面,用于转位修复手部远处的组织缺损。     

Biogenesis of the mycobacterial cell wall and the site of action of ethambutol.

The effect of ethambutol (EMB) is primarily on polymerization steps in the biosynthesis of the arabinan component of cell wall arabinogalactan (AG) of Mycobacterium smegmatis. Inhibition of the synthesis of the arabinan of lipoarabinomannan (LAM) occurred later, and thus in the cases of AG and LAM, the polymerization of D-arabinofuranose apparently involves separate pathways. While the synthesis of these arabinans was normal in an EMB-resistant isogeneic strain, the addition of EMB to the resistant strain resulted in partial inhibition of the synthesis of the arabinan of LAM and the emergence of a novel, truncated form of LAM, indicating partial susceptibility of the resistant gene(s) and providing a new intermediate in the LAM biosynthetic sequence. A consequence of inhibition of AG arabinan biosynthesis is the lack of new sites for mycolate attachment and thus the channeling of mycolate residues into a variety of free lipids which then accumulate. The primary biochemical effects of EMB can be explained by postulating separate AG and LAM pathways catalyzed by a variety of extramembranous arabinosyl transferases with various degrees of sensitivity to EMB.     

Industrial nursing. Functions within the basic health unit

The Law of Prevention of Risks at Work marked an important point of flexion in the tie sanitary professions the field of the labor health. This work will mark the objective to locate to the Industrial Nursing (a company nursing assistant) in a context near the reality. For it, it will be equipped with legal content, and those articles of the Law of Prevention of Risks at Work will be mentioned and of the Regulations for Prevention Services, that establishes the guidelines of performance of the professionals of the Basic Unit of Health (Industrial Medicina and the company nursing assistant) Also will mention the objectives of the First draft of Law of the Reformation of Normative Marco of the Law of Prevention of Risks at Work, consequence of the alarming data of sinisterness and labor accidental.     

Pathogenesis of steatorrhea in chronic diseases of the small intestine

Altogether 150 patients with chronic enteritis and celiac disease with a history of resection of a part of the ileum were examined. It was established that in patients with chronic enteritis, of importance for the pathogenesis of steatorrhea was the deficiency of bile acids during digestion because of hypokinesia of the gallbladder and partial deconjugation of bile acids in the presence of bacterial dissemination of the small intestine. During celiac disease, steatorrhea was caused by the decreased enzymatic function of the pancreas, asynchronism of the food and bile supply to the intestinal lumen, disorders of absorption of lipolysis products. In patients with large resection of the ileum, steatorrhea was associated with abnormality of the enterohepatic circulation of bile acids, bacterial dissemination of the small intestine and reduction of the absorption surface. A schedule of differentiated therapy is offered.     

The secretory phospholipase A2 and transport of lipids by lipoproteins in patients with the risk of cardio-vascular pathology (the system "score") of lower and average degree. The diagnostic significance of the test

The clinical and pathomorphologic data demonstrate that the most frequent cause of cardiac infarction is the formation of "soft" atheromatosis plaques in the intima of arteries. Their rupture results in thrombosis of coronary arteries. The plaques are characterized by higher content of triglycerides. On the basis of the research data, it is possible to validly consider that the detection of secretary phospholipase content A2 conjugated with lipoproteins is the test of systemic inflammatory response. This response is formed under atherosclerosis in vivo as a feedback to the accumulation in the intercellular medium of the endogenic flogogens (initiators of biological reaction of inflammation)--lipoproteins of lower density subclass A. Their utilization in the intima, as a pool of local interstitial tissue, by the resident macrophagocytes transformed from monocytes result in the formation of doth soft and disposed to laceration atheromatosis plaques and the atherothrombosis of coronary arteries and rarer of carotids. Concurrently, the increase of lipoproteins content in blood plasma is supposed to be the test of proliferation of cells in vivo, the smooth muscle cells of medium in particular. The simultaneous detection of content of secretory associated with lipoproteins phospholipase A2 and lipoprotein (a) can be considered as a valid risk factor of atherosclerosis and atherothrombosis--atheromatosis of intima of arteries with the formation of "soft" plaques in the intima, their laceration and thrombosis of coronary arteries and clinical presentation of cardiac infarction. The diagnostic triad of formation of soft plaques in the intima can be composed of the higher level of triglycerides, the content of protein of phospholipase A2 and lipoprotein (a).     

Current data on curarization

The knowledge of the mechanism of action of neuromuscular blocking agents has improved together with the better understanding of the physiology of the neuromuscular junction at the molecular and cellular levels. The main action of competitive neuromuscular relaxants is the blockade of the acetylcholine binding site of the acetylcholine receptor when the latter is its inactive-closed conformation. Owing to the high margin of safety of the neuromuscular transmission, the blockade of an important fraction (75-90%) of acetylcholine receptors is necessary to cause a decrease in muscle strength. An other mechanism of action of competitive agents is the blockade of presynaptic secretion of acetylcholine during repetitive stimulations which may explain the phenomenon of train of four fade or of tetanic fade.     

彩色多普勒超声对开角型青光眼的血流动力学研究及临床意义

目的了解开角型青光眼视神经的血液供应情况。方法用彩色多普勒超声检测开角型青光眼和正常眼眼动脉、视网膜中央动脉和睫状后动脉的收缩期峰值血流速度、舒张末期血流速度、时间平均血流速度、阻力指数和搏动指数。结果在两者之中眼动脉和睫状后动脉的收缩期峰值血流速度差异无显著性（Ｐ＞０．０５）,舒张末期血流速度、时间平均血流速度、阻力指数、搏动指数差异有显著性意义（Ｐ＜０．００１）。视网膜中央动脉的多项血流动力学指标差异有显著性意义（Ｐ＜０．００１）。结论开角型青光眼的视神经存在缺血因素。     

溃疡性结肠炎患者周围血中性粒细胞凋亡和Bcl-2基因的表达

目的　观察溃疡性结肠炎 (UC)患者周围血中性粒细胞 (PMN)凋亡及Bcl 2基因表达的变化。方法　采用流式细胞术检测 18例UC患者周围血PMN凋亡及Bcl 2基因的表达。结果　活动期UC患者PMN凋亡率明显低于健康人对照组和缓解期UC患者 (P <0 .0 1) ,Bcl 2基因的表达明显高于对照组和缓解期患者 (P <0 .0 1)。缓解期UC患者PMN凋亡率与对照组无差别 ,但Bcl 2基因的表达与正常人对照组比较差别有显著性意义 (P <0 .0 1)。不同病情活动期UC患者PMN凋亡及Bcl 2的表达有显著性差异 (P <0 .0 1或P <0 .0 5 )。结论　活动期UC患者周围血PMN凋亡延迟 ,且与病情及疗效密切相关。PMNBcl 2基因表达上调可能是其凋亡延迟的重要分子机制之一。     

Co-trimoxazole impairs colonization resistance in healthy volunteers.

The influence of co-trimoxazole on colonization resistance of the bowel was investigated in six healthy volunteers, by measuring the numbers of indigenous aerobic flora and of a co-trimoxazole resistant challenge strain of Klebsiella pneumoniae. Impairment of colonization resistance of the bowel was shown by a significant increase in the numbers of yeasts in the faeces of five of six volunteers, by a significant increase in the numbers of Gram-negative bacilli in the faeces of two of six volunteers, and by facilitation of colonization of the bowel by the challenge strain in all volunteers. Impairment of colonization resistance of the mouth was shown by the development of glossitis caused by Candida albicans in two volunteers, and by a significant increase in the numbers of yeasts in mouth washings from four volunteers. It is concluded that co-trimoxazole impairs colonization resistance of the gastro-intestinal tract.     

三维肛管直肠腔内超声对出口梗阻性便秘患者的诊断意义

目的应用三维肛管直肠腔内超声（3D-endoanal ultrasound）方法对出口梗阻性便秘患者进行图像分析,以期提高对出口梗阻性便秘患者的临床诊断认识。方法回顾性分析采用三维肛管直肠腔内超声（B—K2050）检查对60例出口梗阻性便秘患者进行图像采集。结果直肠前突32例,直肠黏膜内套叠46例,耻骨直肠肌肥厚痉挛13例,肠疝23例,其中直肠前突合并直肠黏膜内套叠28例,合并肠疝11例;耻骨直肠肌肥厚痉挛合并直肠黏膜内套叠7例;直肠黏膜内套叠合并肠疝19例。结论三维肛管直肠腔内超声检查方法对出口梗阻性便秘患者有临床诊断意义。     

中国医学科学院北京协和医院陈敏章消化内镜中心和首家全国（消化科）内镜诊疗技术培训基地通过现场验收评价

中国医学科学院、中国协和医科大学党委书记、北京协和医院院长刘谦教授；医院党委书记常务副院长鲁重美教授；医院副院长、《中华肝胆外科杂志》副总编赵玉沛教授；著名消化内镜专家、前卫生部部长陈敏章教授的夫人李家熙研究员；国际消化内镜协会副主席、亚太消化内镜协会主席曹世植教授；中华医学会消化内镜分会主任委员、     

品管圈活动降低PICC出院患者并发症发生率的应用效果

目的 探讨品管圈活动对PICC带管出院患者并发症发生率的影响效果.方法 选取2015年4~10月PICC带管出院患者86例由QCC小组进行管理作为观察组,2014年8月~2015年3月PICC带管出院患者78例由责任护士常规随访护理作为对照组,比较两组患者出院期间导管维护依从性及并发症发生率.结果 实验组患者出院期间维护依从性提高(P<0.05),导管并发症发生率低于对照组患者(P<0.05).结论 开展品管圈活动,有效提高延伸护理服务质量,降低患者院外带管并发症发生率,值得临床上推广应用.     

抑癌基因DPC4蛋白在大肠癌组织中缺失表达及临床意义研究

目的探讨抑癌基因DPC4（deletedinpancreaticcancerlocus4）蛋白在大肠癌组织中的缺失表达特征及临床意义，阐明DPC4蛋白缺失表达与大肠癌发生的关系。方法采用免疫组化（SP法）检测50例大肠癌组织、癌旁组织及正常大肠组织中DPC4的表达，以20例正常大肠组织作为对照分析。结果50例大肠癌组织中DPC4阳性率为32％，癌旁组织中DPC4阳性率为34％，正常大肠组织DPC4阳性率100％，癌和癌旁的DPC4表达与正常大肠组织DPC4表达的差异有统计学意义（P〈0．01）。大肠癌组织中DPC4蛋白表达随着病理组织学分化程度下降而降低，淋巴结转移组DPC4的阳性表达低于淋巴结无转移组，但差异无统计学意义。结论DPC4蛋白表达缺失是大肠癌的发生发展的重要因素之一。     

The intensity of processes of lipoperoxidation and antioxidant defense in patients with recurrent viral herpes infection

The article discusses some parameters of free radical metabolism of lymphocytes of blood plasma in 65 patients with recurrent virus herpes infection in course of disease. It is established that in patients occurs increasing of both of level of malonic dialdehyde and functional activity of neutrophils in blood plasma. On the background of these alterations, compensatory increase of activity of such antioxidant enzymes as ceruloplasmin and catalase is noted. The intensity of stationary derangement of free radical oxidation and antioxidant defense under recurrent virus herpes infection depended on the period of disease and severity of pathologic process.     

The ethics of nursing care and 'the ethic of care'

Recent discussions concerning the ethics of nursing care have gained added impetus from articulations of die so-called 'ethic of carersquo; in moral philosophy. This paper addresses the question of recognizing and elaborating the ethics of nursing care by exploring the problems and the possibilities of diese intersecting discourses. In the first part of the paper it is argued that appropriation of 'the ethic of care' by nursing theorists as the central value of nursing, in contradistinction to other moral values such as beneficence or justice, runs the risk of reinforcing the conventional approaches to ethics that 'the ethic of care' seeks to overturn. Central to 'the ethic of care' is the recognition that caring entails a focus on the particularities and context of the relationships in which it is expressed. Accordingly die application of a unitary concept of care to the context of nursing relations may seriously distort dieir diverse and complex-specific ediical possibilities. The dynamic complexity of nursing ethics may be more adequately understood by working through an array of specific examples of nursing practice highlighting the differences and similarities between them and other ethical practices of care. Experience of a set of examples in this way will draw attention to the multiplicity, ambiguity, and particularity of the ethics of nursing while facilitating the ability to recognize how other practices may or may not be understood as examples of ediical nursing care. In the second part of the paper a beginning is made on this project by addressing the work of several different theorists of care who have examined different practices of nursing from the overlapping perspectives of nurses, patients and the socio-historical construction of their relationships.     

长骨溶骨型骨巨细胞瘤与溶骨型骨肉瘤的X线鉴别诊断

目的：探讨长骨溶骨型骨巨细胞瘤及溶骨型骨肉瘤的X线特征。材料与方法：比较分析经手术及病理证实的22例长骨溶骨型骨巨细胞瘤与30例长骨溶骨型骨肉瘤的X线征像。结果：长骨溶骨型骨巨细胞瘤均有不同程度的骨端松质骨破坏,破坏形态均趋于类球状,10例侵及关节面,局限性骨膜反应4例;长骨溶骨型骨肉瘤26例为干骺端松质骨破坏,4例为骨端松质骨破坏,破坏形态呈不规则片状,3例侵及关节面,30例皆有程度不一的骨膜反应,其中出现Codman’s三角者16例。结论：长骨溶骨型骨巨细胞瘤的X线特征为骨端松质骨类球状破坏;溶骨型骨肉瘤的X线特征为干骺端松质骨不规则片状破坏,伴有程度不一的骨膜反应。     

Control of breathing during mechanical ventilation: who is the boss?

Over the past decade, concepts of control of breathing have increasingly moved from being theoretical concepts to "real world" applied science. The purpose of this review is to examine the basics of control of breathing, discuss the bidirectional relationship between control of breathing and mechanical ventilation, and critically assess the application of this knowledge at the patient's bedside. The principles of control of breathing remain under-represented in the training curriculum of respiratory therapists and pulmonologists, whereas the day-to-day bedside application of the principles of control of breathing continues to suffer from a lack of outcomes-based research in the intensive care unit. In contrast, the bedside application of the principles of control of breathing to ambulatory subjects with sleep-disordered breathing has out-stripped that in critically ill patients. The evolution of newer technologies, faster real-time computing abilities, and miniaturization of ventilator technology can bring the concepts of control of breathing to the bedside and benefit the critically ill patient. However, market forces, lack of scientific data, lack of research funding, and regulatory obstacles need to be surmounted.     

昆明市45所医院污水消毒情况调查

为了解昆明市各医院排放污水的消毒情况,通过取样检测和现场调查,对该市45所医院的污水消毒情况进行了调查。结果,有6所医院无污水消毒设施,污水直接排放。36所医院污水消毒检测总合格率为55.6%;有84.6%的医院使用次氯酸钠消毒污水。医院污水消毒不严格和过量使用含氯消毒剂现象较普遍。结论,本市医院污水消毒合格率仅有55.6%,尚有部分医院污水不消毒;必须建设完善的医院污水消毒设施,加强监督监测力度,确保医院污水排放安全。