内毒素血症时肺动脉和胸主动脉内一氧化氮合酶表达的比较

目的 观察内毒素血症时肺动脉和胸主动脉中诱导型一氧化氮合(iNOS)基因和蛋白表达的时间依从性变化。方法 48只Wistar大鼠350－450g，雌雄兼备，随机均分成对照组（C组），3h组，8h组和48h组。对照组腹腔内注射2ml生理盐水，余各实验组腹腔内注射脂多糖（LPS）4mg/kg，溶于2ml生理盐水，分别在LPS腹腔内注射后3h,8h和48h颈椎脱臼法处死大鼠取肺动脉和胸主动脉，RT－PR和Western blot法测定各组肺动脉和胸主动脉中iNOS的mRNA和蛋白表达。结果 LPS注射后大鼠肺动脉中iNOS的mRNA和蛋白表达逐渐上升，8h达到高峰，48h恢复到LPS注射前水平；胸主动脉中iNOS的蛋白表达3h即达峰值，以后逐渐下降，48h恢复到LPS注射前水平。LPS注射后3h和8h大鼠iNOS的mRNA及蛋白表达水平肺动脉比胸主动脉高。结论 内毒素大鼠的肺动脉和胸主动脉中iNOS的mRNA和蛋白的表达呈现时间依从性变化，iNOS的mRNA和蛋白表达峰值胸主动脉早于肺动脉，肺动脉中iNOS的mRNA和蛋白表达程度高于胸主动脉。     

大鼠骨骼肌缺血再灌注时血红素氧合酶-1的表达

目的：观察大鼠缺血再灌注时骨骼肌中血红素氧合酶－1（HO－1）表达的变化，方法：夹闭大鼠股动脉造成下肢缺血模型，分别采集假手术（S）组，单纯缺血（I）4小时组及缺血4小时再灌注（R）2、4、8、16和24小时组的比目鱼肌，检测其组织学和丙二醛（MDA）含量变化，通过Northern印迹、Western印迹及免疫组织化学分析，观察HO－1表达的变化。结果：S组和I组未见HO－1mRNA表达；R2组可见其表达信号，且随着再灌注时间延长表达信号逐渐增强，到R8组时达到高峰，之后渐减弱，R24组时已消失。蛋白表达的变化与mRNA变化基本一致，免疫组织化学显示，R组HO－1阳性信号主要出现在骨骼肌细胞浆内，S组和I组均未见阳性信号。与S组相比，R各组MDA含量显著增高（P＜0．05），但R8组较R4组显著减低（P＜0．05）。结论：肢缺血再灌注可诱发骨骼肌HO－1的表达，其表达可能具有保护作用。     

烫伤延迟复苏大鼠组织白细胞介素18mRNA表达的变化

目的 探讨烫伤延迟复苏后不同组织白细胞介素18（IL－18）mRNA的动态表达规律。方法 采用大鼠TBSAⅢ度烫伤延迟复苏模型,54只大鼠随机分为正常对照组、烫伤延迟复苏组、选择性消化道脱污染（SDD）预防组,分别在伤前及伤后2、8、16、24h,采用逆转录聚合酶链式反应,检测肠、肺、肝、肾等组织IL－18 mRNA含量。结果 烫伤延迟复苏后体循环内毒素水平显升高,8、24h达高峰（P＜0．01）,给予SDD预防治疗可显降低内毒素峰值（P＜0．05）;另一方面,烫伤后2h,肺、肝、肾等组织IL－18 mRNA含量表达较伤前值有显升高,烫伤后8h达高峰（P＜0．01）,且一直持续至伤后24h,给予SDD预防后可不同程度抑制IL－18 mRNA的表达（P＜0．05－0．01）。相关分析显示,体循环内毒素水平同肠、肺、肝组织IL－18 mRNA呈显正相关（r值分别为0．298、0．290、0．365,P＜0．05－0．01）。结论 肠、肺、肝、肾等组织IL－18 mRNA表达在烫伤早期即显增多,并呈逐渐升高的趋势,创伤后内毒素血症对机体多种组织IL－18 mRNA基因表达具有重要影响。     

芪归合剂拮抗地塞米松对肾病综合征大鼠生长的抑制作用

目的 观察芪归合剂对地塞米松治疗的肾病综合征大鼠（NS鼠）生长障碍的作用及其可能的机制。方法 制备大鼠阿霉素NS模型，设正常对照组，NS模型组，芪归治疗组，激素治疗组和激素芪归治疗组。测量各组鼠的身长，体重，尿蛋白和血白蛋白水平。以放射免疫法和免疫放射法测各组血，尿胰岛样生长因子（IGF）－1和IGF结合蛋白（BP）－3水平。用RT－PCR法检测肝IGF－1mRNA,IGFBP-3 mRNA表达水平。结果 NS模型组体重增长，身长增长，血IGF－1，IGFBP－3低于正常组，尿IGF－1高于正常组（P＜0．01或P＜0．05）；肝IGF－1mRNA表达与正常组无差异，而IGFBP-3 mRNA表达低于正常组（P＜0．01）。激素治疗组的体重增长，身长增长，血IGF－1和IGFBP－3水平，肝IGF－1mRNA,IGFBP-3 mRNA表达水平低于模型组（P＜0．01或P＜0．05）。芪归治疗组的身长增长，体重增长，血清IGF－1，IGFBP－3水平，肝IGF－1mRNA,IGFBP-3 mRNA表达水平高于模型组（P＜0．01或P＜0．05）。激素芪归组的身长增长，体重增长，血清IGF－1，IGFBP－3水平，肝IGF－1mRNA,IGFBP-3 mRNA表达水平高于激素治疗组（P＜0．01或P＜0．05）。结论 芪归合剂可能是通过增加地塞米松治疗的NS鼠肝IGF－1mRNA,IGFBP-3 mRNA的表达水平而部分拮抗地塞米松对NS鼠生长的抑制作用。     

七氟烷诱导大鼠海马HO－1基因表达信号转导通路的研究

目的：探讨七氟烷诱导大鼠海马血红素氧合酶－1（NO－1）表达的信号转导通路。 方法：40只Wistar大鼠随机分为5组（n=8）：正常培养组（C组）、0．6MAC七氟烷组（s组）．0．6MAC七氟烷＋SB203580组（SB组）、0．6MAC七氟烷＋U-0126组（u组）、0．6MAC七氟烷＋SP600125（SP组）。C组大鼠正常喂养。S组大鼠吸入0．6MAC七氟烷60min后继续培养24h。SB组、U组和SP组在大鼠吸入0．6MAC七氟烷时分别腹腔注100mg／kg SB203580、100mg／kg U-0126或1mg／kg SP600125后同S组处理。检测大鼠海马组织中HO－1－mRNA和磷酸化ERK1／2（p^ERK1／2）、磷酸化P^38（PP^38）．磷酸化JNK（P^JNK）、磷酸化HO-1（P^HO-1）蛋白的表达。 结果：与C组比较，S组大鼠海马HO-1～mRNA的表达增加（P〈0．05），p^ERK1／2（P〈0．05），PP38（P〈0．05）和HO^-1（p〈0.05）蛋白表达增加。与S组比较，SB组大鼠海马HO^-1 -mRNA的表达减少（P〈0．05），PP^38（p〈0．05）和PHO^-1（P〈0．05）蛋白表达减少，P^ERK1／2（p〈0．05）和P^JNK（p〈0．05）蛋白表达变化不明显（P〉0．05）。与S组比较，U组大鼠海马HO^-1-mRNA的表达减少（p〈0．05），P^ERK1／2（P〈0．05）和PHO^-1（P〈-．05）蛋白表达减少．PP^38（p〉0．05）和P^JNK（p〉0．05）蛋白表达变化不明显。与S组比较，SP组大鼠海马HO^-1-mRNA的表达变化不明显（p〉0．05），p^JNK蛋白表达减少（P〈0．01）．P^ERK1／2（p〉0．05），PP^38（p〉0.05）和PHO^-1（P〉0．05）蛋白表达变化不明显。 结论：七氟烷通过^ERK1／2和P^38信号转导通路诱导大鼠海马HO－1－mRNA的表达。     

七氟醚对内毒素诱导大鼠肺组织氧化应激反应的影响

目的 探讨七氟醚对内毒素（LPS）诱导大鼠肺组织氧化应激反应的影响。方法Wistar大鼠48只，体重200-290g，随机分为4组（n=12）：对照组（C组）、LPS组（L组）、1．0MAC七氟醚组（S1L组）和1．5MAC七氟醚组（S2L组）。各组大鼠腹腔注射异戊巴比妥钠100mg／kg，麻醉后机械通气。维持呼气末二氧化碳分压在35～45mmHg。L组股静脉注射LPS5mg／kg，C组给予生理盐水1．2ml，S1L组、S2L组注射LPS后分别吸入1．0MAC、1．5MAC七氟醚4h。吸入七氟醚后4h处死大鼠，测定肺组织超氧化物超歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）、总一氧化氮合酶（tNOS）水平、诱导型一氧化氮合酶（iNOS）活性及iNOS mRNA、蛋白表达。结果 与C组比较，L组肺组织SOD活性下降，MDA、NO、tNOS水平、iNOS活性及iNOS mRNA及蛋白表达均升高（P〈0．01）；与L组比较，S1L组、S2L组肺组织SOD活性升高，MDA、NO、tNOS水平及iNOS mRNA及蛋白表达降低（P〈0．05）；S1L组与S2L组上述各项指标比较差异无统计学意义（P〉0．05）。结论 吸入1．0MAC和1．5MAC七氟醚4h可减轻LPS诱导肺组织氧化应激反应。     

异丙酚或氯胺酮对内毒素性急性肺损伤大鼠肺小动脉BMP-2表达的影响

目的评价异丙酚或氯胺酮对内毒素（LPS）性急性肺损伤大鼠肺小动脉骨形态构建蛋白-2（BMP-2）表达的影响。方法雌性Wistar大鼠60只，体重220—260g，6—7周龄。随机分为6组，每组10只。对照组（C组）：1．5h内经股静脉输注生理盐水5ml；LPS组（L组）：1h内输注生理盐水3ml，然后30min内输注内毒素1mg／kg（溶于2ml生理盐水中）；异丙酚20mg／kg＋LPS组（P1组）、异丙酚50mg／kg＋LPS组（P2组）、氯胺酮20mg／kg＋LPS组（K1组）、氯胺酮50mg／kg＋LPS组（K组）1h内经股静脉分别输注不同剂量的药物，然后30min内输注LPS1mg／kg（溶于2ml生理盐水中）。输注完毕后72b断头处死大鼠。RT-PCR法测定肺小动脉BMP-2mRNA、BaxmRNA表达。免疫组织化学法、Western blot测定肺小动脉BMP-2、Bax、Bcl-2表达。显微成像分析系统测量肺小动脉中膜厚度。结果各组肺小动脉BMP-2、Bax、Bcl-2均有表达。与C组比较，其余组BMP-2、Bax蛋白水平和mRNA表达降低，Bcl-2水平升高（P〈0．05或0．01）。与L组比较，异丙酚或氯胺酮使BMP-2、Bax蛋白水平及mRNA表达升高，Bcl-2水平降低（P〈0．05）。各组肺小动脉中膜厚度较C组增加（P〈0．05）；异丙酚或氯胺酮减轻了肺小动脉中膜的增厚（P〈0．05）。结论异丙酚或氯胺酮可以抑制大鼠LPS致急性肺损伤肺血管的重建，其机制可能与BMP-2、Bax基因表达上调，Bcl-2基因表达下调有关。     

复方丹参注射液对体外循环后大鼠肺组织Bcl-2和Bax表达的影响

目的探讨复方丹参注射液对体外循环（CPB）后大鼠肺组织凋亡调控基因Bcl-2和Bax表达的影响。方法成年健康雄性SD大鼠24只,年龄12～16周龄,体重400～450 g,随机分为3组（n=8）：对照组、CPB组和丹参组。对照组行假手术,CPB组和丹参组建立体外循环,丹参组在停机前5 min经储血器加入复方丹参注射液1 ml/kg。CPB结束后60 min取肺组织提取总RNA,用RT-PCR方法测定凋亡调控基因Bcl-2、Bax的mRNA表达。取肺组织用多聚甲醛固定,制作石蜡切片,用免疫组织化学方法测定肺组织中Bcl-2、Bax的蛋白表达。结果与对照组相比,CPB组和丹参组肺组织Bcl-2和Bax的mRNA和蛋白表达均增加（P＜0．05或0．01）,CPB组Bax/Bcl-2比值升高（P＜0．05）。与CPB组相比,丹参组肺组织Bax的mRNA表达及Bax/Bcl-2比值均降低（P＜0．05）,肺组织Bcl-2蛋白表达增高,Bax蛋白表达降低（P＜0．01）。结论体外循环可上调凋亡调控基因的表达,复方丹参注射液能下调促凋亡基因Bax的表达,抑制大鼠肺组织的细胞凋亡因而可减轻肺损伤。     

硝普钠对内毒素致大鼠急性肺损伤保护作用的机制

目的 研究外源性一氧化氮（NO）供体一硝普钠对内毒索（LPS）致大鼠急性肺损伤（Au）保护作用的机制。方法 32只Wistar大鼠随机分为4组（n=8），假手术组（S组）、内毒素组（LPS组）、HO-1诱导剂氯化高铁血红素预处理组（HM组）和硝普钠治疗组（SNP组）。采用气管内滴入750μg／kg（溶于300ml生理盐水中）LPS建立大鼠ALI模型，HM组在给LPS前12h腹腔注射氯化高铁血红素40μmol／kg，SNP组将LPS与硝普钠（25μg／kg）同时滴入气管。滴人LPS后8h处死大鼠，测定肺组织湿／干重比（W／D）、丙二醛（MDA）含量、诱导型血红素加氧酶（HO-1）、诱导型一氧化氮合酶（iNOS）蛋白表达及支气管肺泡灌洗液（BALF）蛋白浓度，并观察肺组织病理变化。结果 与S组比较，LPS组、HM组、SNP组肺组织iNOS、HO-1蛋白表达均增强，LPS组、HM组肺组织W／D及MDA含量增加，LPS组BALF蛋白浓度增加；与LPS组比较，HM组和SNP组肺组织iNOS蛋白表达减弱，肺组织HO-1蛋白表达增强，肺组织W／D、MDA含量及BALF蛋白浓度降低（P〈0．05或0．01）。SNP及HM组肺组织病理损伤程度明显轻于LPS组。结论 硝普钠可通过诱导HO-1进而抑制iNOS／NO，减轻LPS所致ALI．     

脓毒症大鼠多器官高迁移率族蛋白B1基因表达的信号机制与意义

目的探讨Janus激酶／信号转导和转录激活因子（JAK／STAT）通路对盲肠结扎穿孔术（CLP）所致脓毒症大鼠多器官高迁移率族蛋白B1（HMGBl）基因表达的影响及其意义。方法采用CLP模型,大鼠随机分为正常对照组（10只）、假手术组（10只）、CLP组（60只）、JAK2抑制剂AG490干预组（24只）、STAT抑制剂雷帕霉素（RPM）干预组（24只）。留取肝、肺、肾、肠组织测定HMGB1mRNA表达和STAT1／3的DNA结合活性。结果CLP后,肝、肺、肾、肠组织中STATl在脓毒症早期即迅速活化,6-12h后活化达高峰。肝、肺组织中STAT3的活化特点与STAT1相似,但相对较弱;在肾、肠组织中未探测到STAT3的活化。同时,CLP组除肾组织HMGB1mRNA表达改变不明显外,肝、肺、肠组织其表达均明显增强（P＜0．05或P＜0．01）。AG490早期处理后24—48h,肝、肠组织HMGB1mRNA表达显著低于CLP组（P＜0．05或P＜0．01）;RPM干预组肝、肺、肠组织HMGB1mRNA表达均呈现不同程度地抑制,其中以肺组织下降幅度尤为明显。结论严重腹腔感染可导致机体主要脏器JAK／STAT通路迅速活化,该信号途径参与了HMGB1mRNA的表达调控过程。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。