环磷酸腺苷葡胺对心脏瓣膜置换术患者心肌缺血/再灌注损伤心肌保护作用的研究

目的：研究环磷酸腺苷葡胺（M-cAMP）对体外循环下换瓣手术患者心肌缺血/再灌注损伤的保护作用。方法：选择30例在体外循环下行换瓣手术的患者,随机分为M-cAMP组（A组）和对照组（B组）,A组入预充液中经转机进入体内;测定切皮前（T0）、主动脉开放后5min（T1）、术毕（T2）、术后6h（T3）和术后18h（T4）血浆CK-MB、TNF-α、SOD、MDA含量。结果：两组血浆中SOD均明显下降,以对照组更为明显（P〈0.05）,血浆CK-MB、TNF-α、MDA含量较术前上升,以对照组为明显（P〈0.05）。结论：M-cAMP可保护缺血/再灌注损伤心肌SOD活性,减少心肌细胞MDA产生,有效保护心肌功能。     

脓毒症大鼠肝脏组织Toll样受体4和髓样分化蛋白-2基因表达的变化规律

目的探讨脓毒疗人鼠肝脏组织内毒素复合受体—Toll样受体4（TLR4）／髓样分化蛋白-2（MD-2）mRNA的表达变化，研究其与肝脏组织肿瘤坏死因子-α（TNF—α）mRNA表达的父系。方法腹腔注射内毒素（LPS）5mg／kg制作大鼠脓毒症模型。动物分为正常对照组（20只）及内毒素注射后1h、2h、6h组（各20只）．检测肝脏组织TLR4／MD-2以及TNF-α mRNA的表达。结果LPS注射后1h，TLR4／MD-2及TNF-α mRNA表达开始升高并达高峰．伤后2～6h逐渐下降，各时间点的表达量均显著高于对照组（P〈0．01）．TLR4与MD-2 mRNA的表达呈明显正相关（P〈0．05）．且分别与TNF—α mRNA的表达呈显著正相关（P〈0．05）。结论LPS可迅速上调肝脏组织TLR4／MD-2的基闪表达并诱导早期炎症细胞因子TNF-α的基因表达。脓毒症时TLR4识别LPS是可能以TLR4／MD-2复合体的形式完成的．且在识别过程中MD-2是TLR4必需的作用分子。     

阿托伐他汀通过PPARα信号通路抑制老年大鼠心肌TNF—α的表达

目的观察阻断过氧化物酶体增殖物激活物受体仪（PPARα）信号通路对阿托伐他汀抑制老年大鼠心肌肿瘤坏死因子-α（TNF-α）表达作用的影响。方法分离培养24个月龄大鼠的心肌细胞,将培养的细胞分为空白对照组、溶剂对照组、阿托伐他汀组、PPAR拮抗剂GW6471＋阿托伐他汀组。各组细胞分别加入细胞培养液、二甲基亚砜、阿托伐他汀、阿托伐他汀＋GW6471处理。分别用RT—PCR和Western blot方法检测各组大鼠心肌细胞的TNF-α mRNA表达水平和蛋白含量。结果（1）与空白对照组相比,溶剂对照组细胞的TNF-α mRNA表达水平和蛋白含量均无显著差异（P〉0．05）;（2）与空白对照组相比,阿托伐他汀组的TNF—α mRNA表达水平和蛋白含量均显著降低（P〈0．01）;（3）GW6471＋阿托伐他汀组的TNF-α mRNA表达水平及蛋白含量均显著高于阿托伐他汀组（P〈0．05）,但仍低于空白对照组（P〈0．05）。结论阿托伐他汀可通过激活PPARα信号通路来抑制老年大鼠心肌细胞炎性因子TNF-α表达。     

氯胺酮对体外循环诱导外周血单核细胞NF-κB及TNF-α表达的影响

目的：观察氯胺酮对体外循环（CPB）诱导外周血单核细胞（PBMCs）中核因子-κB（NF-κB）和肿瘤坏死因子（TNF-α）表达的影响。方法：选择先天性室间隔缺损心脏病需行体外循环心脏直视手术患儿20例，随机双盲分为对照组和氯胺酮组，每组10例。氯胺酮组在CPB开始时立即给予1mg／kg氯胺酮。采用Western blot和RT-PCR测定CPB前（T0）、CPB 30min（T1）、停CPB后1h（T2）、停CPB后4h（T3），PBMCs中NF-κB P65及TNF-α mRNA的表达。结果：两组PBMCs NF-κB P65和TNF-α mRNA表达水平在T2、T3时均有不同程度升高，但在T2、T3时氯胺酮组的表达水平显著低于对照组。结论：氯胺酮对CPB诱导的PBMCs NF-κB和TNF-α表达具有一定的抑制作用。     

蜂毒肽MP-1对内毒素血症小鼠急性肺损伤保护作用的研究

目的探讨蜂毒肽MP-1对内毒素血症（ETM）小鼠急性肺损伤的保护作用。方法尾静脉注射内毒素（LPS）5mg/kg制备ETM小鼠模型。动物随机分为正常对照组（n=8）、ETM组（n=48）和MP-1治疗组（n=48,注射LPS的同时注射MP-1 3mg/kg）。ETM组和MP-1组分别于注射LPS后2、6、12、24、48、72h处死动物,采集血浆和肺组织标本,动态比浊法鲎试验检测各时相点血浆LPS水平,ELISA法检测血浆TNF-α和IL-6水平,real-ti me RT-PCR检测肺组织Toll样受体4（TLR4）、TNF-α和IL-6 mRNA表达,分光光度法检测肺组织髓过氧化物酶（MPO）活性,并观察伤后12h肺组织的病理变化。结果ETM小鼠伤后2-48h血浆LPS、TNF-α和IL-6水平显著增高（P〈0.01）,肺组织TLR4、TNF-α、IL-6 mRNA表达和MPO活性也明显增强（P〈0.05或P〈0.01）。MP-1治疗可不同程度降低血浆LPS和各细胞因子水平（P〈0.05或P〈0.01）,抑制肺组织相关基因表达及减低MPO活性（P〈0.05或P〈0.01）,并可减轻肺组织的病理损伤。结论MP-1可能通过中和LPS,减少LPS诱导的炎症介质的合成与释放,进而减轻炎症介质对肺组织的损伤。     

白藜芦醇对重症急性胰腺炎大鼠腹腔巨噬细胞功能的影响

目的：探讨腹腔巨噬细胞（PM）在大鼠重症急性胰腺炎（SAP）中的作用,并观察白藜芦醇（Res）对SAP大鼠PM功能的影响。方法：36只大鼠随机分为假手术（SO）组、SAP组和Res组3组。制模后4、12h剖杀大鼠。分离PM并培养24h。RT—PCR法检测PM中肿瘤坏死因子-α（TNF-α）mRNA和白介素-1β（IL-1β）mRNA的表达;酶联免疫吸附法（EUSA）检测细胞培养液及血清中TNF-α和IL-1β的水平。取胰腺组织行HE染色及病理学评分。结果：与SAP组比较,Res组胰腺损伤程度明显减轻;SAP组PM中TNF—mnRNA和IL—1βmRNA的表达、细胞培养液及血清中TNF-α和IL-1β水平均高于SO组（P〈0．001）;与SAP组比较,Res组PM中TNF-αmRNA和1L-1βLRNA的表达、细胞培养液及血清中TNF-α和IL-1β水平明显下降（P〈0．001）,但仍高于SO组（P〈0．05）。结论：PM在SAP发病机制中起非常重要的作用;Res能显著减轻SAP时胰腺组织损伤,其机制与抑制PM功能,从而抑制TNF-α和IL-1β的分泌有关。     

腺苷蛋氨酸对酒精性肝损伤大鼠HHcy和TNF-α的影响

目的 观察S-腺苷蛋氨酸（S-adenosylmethionine,SAM）对酒精性肝损伤大鼠的防治作用及机制。方法 48只SD大鼠随机分为4组（每组12只）：对照组、模型组、腺苷蛋氨酸低、高剂量组。除对照组外,其余三组给予酒精、鱼油灌胃配合高脂饮食构建酒精性肝损伤大鼠模型,造模4周后腹腔注射SAM,第8周处死全部大鼠。测定血浆总同型半胱氨酸（total plasma homocysteine,tH-cy）、血清丙氨酸转移酶（ALT）、肝匀浆丙二醛（MDA）和还原型谷胱甘肽（GSH）含量,并应用半定量逆转录聚合酶链反应（RT-PCR）法检测大鼠肝组织TNF-α mRNA水平。结果 与对照组比较,模型组大鼠tHcy、ALT、MDA含量均明显升高（P＜0．01）;GSH水平降低（P〈O．01）;大鼠肝组织TNF-α mRNA表达明显增强（P〈O．01）。与模型组比较,SAM治疗组ALT、MDA明显降低（P〈O．05）;GSH含量升高（P〈O．01）;肝组织内TNF-α-mRNA水平明显降低（P〈O．01）;但血浆tHcy水平无显著变化（P〉O．05）。结论 SAM可明显改善大鼠酒精性肝损伤,其机制可能与其降低肝组织脂质过氧化、抑制肝内TNF-α表达有关,SAM对血浆tHcy水平无显著影响。     

马来酸桂哌齐特对骨胳肌缺血-再灌注损伤的保护作用与机制研究

目的探讨马来酸桂哌齐特对骨胳肌缺血再灌注损伤的保护作用及其机制。方法♂Wistar大鼠56只，随机分为假手术组（s组）、缺血再灌注组（I／R组）、马来酸桂哌齐特组（T组），检测骨骼肌腺苷含量和肿瘤坏死因子（TNF）-α基因转录水平，观察骨骼肌线粒体超微结构变化。结果I／R组缺血后20min骨骼肌腺苷含量显著升高，缺血2h和再灌注后1h明显回降，T组缺血后20min骨骼肌腺苷含量与I／R组无显著差异，但在缺血2h和再灌注后1h分别显著高于I／R组（P〈0．01）。I／R组再灌注1h骨骼肌TNF-α基因转录水平显著升高，T组显著低于I／R组（P〈0．01）。T组骨骼肌线粒体损伤明显轻于I／R组。结论马来酸桂哌齐特能够通过增加腺苷含量和抑制炎症反应，减轻骨骼肌缺血-再灌注损伤。     

外源性硫化氢对大鼠肢体爆炸伤后继发性肺损伤的作用

目的观察外源性硫化氢（H2S）对大鼠肢体爆炸伤后继发性肺损伤的作用，探讨H2S在肢体爆炸伤后继发性肺损伤防治中的临床应用价值。方法采用大鼠肢体爆炸伤模型，动物随机分为3组（n=8／组）：正常对照组（Ⅰ）、单纯致伤组（Ⅱ）和致伤＋外源性H2S组（Ⅲ）；伤后6小时取标本。测定血浆和肺组织肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-10（IL-10）浓度，肺组织髓过氧化物酶（MPO）活性和丙二醛（MDA）浓度；观察肺脏病理学变化。结果致伤后6小时大鼠血浆和肺组织TNF-α、IL-6、IL-10浓度和肺组织MDA浓度及MPO活性显著升高（P〈0．01，VSI），肺充血、水肿和炎细胞浸润明显；给予硫氢化钠（NaHS）处理后伤鼠血浆和肺组织TNF-α、IL-6、IL-10和肺组织MDA浓度及MPO活性显著降低（P〈0．05，vsⅡ），肺充血、水肿和炎细胞浸润程度较单纯致伤鼠明显减轻。结论肢体爆炸伤可引起大鼠严重的继发性肺损伤；而早期给予外源性H2S可明显抑制肺脏炎性损伤和氧化损伤，减轻肺充血、水肿和炎细胞浸润程度，从而减轻继发性肺损伤。     

阿托伐他汀对2型糖尿病大鼠心肌NF-κB、TNF-α表达的影响

目的探讨NF-κB及TNFα-在2型糖尿病大鼠心肌中的表达及阿托伐他汀的干预作用。方法60只SD大鼠分为对照组、糖尿病组和阿托伐他汀组,每组20只,后两组用小剂量链脲佐菌素(STZ)制备2型糖尿病大鼠模型。阿托伐他汀组给予阿托伐他汀20mg/(kg.d)灌胃12周。用放免法检测各组大鼠血浆及心肌TNFα-,光镜下观察心肌结构。RT-PCR方法检测心肌组织中NFκ-B及TNFα-的mRNA表达水平,免疫组化法检测其蛋白表达。结果光镜下可见对照组大鼠心肌细胞排列整齐、致密,结构清晰,细胞核呈卵圆形,糖尿病组大鼠心肌细胞排列紊乱、扭曲,间质有炎症细胞聚集,阿托伐他汀组心肌细胞排列趋于整齐,结构接近正常。糖尿病组大鼠血浆和心肌中TNFα-浓度较对照组明显升高(P<0.01),且心肌组织中NFκ-B和TNF-αmRNA及蛋白表达较对照组明显增加(P<0.01)。给药12周后,阿托伐他汀组NFκ-B、TNF-αmRNA及蛋白表达较糖尿病组明显降低(P<0.01)。结论阿托伐他汀可抑制2型糖尿病大鼠心肌组织中NFκ-B及TNFα-的表达,对2型糖尿病心肌病具有一定防治作用。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.