Release of melanotroph- and corticotroph-type proopiomelanocortin derivatives into blood after administration of corticotropin-releasing hormone in patients with septic shock without adrenocortical insufficiency

The aim of the study was to assess the adequacy of pituitary function by determining the plasma concentrations of corticotroph-type (corticotropin, beta-endorphin immunoreactive material [beta-END IRM], authentic beta-END, and beta-lipotropin IRM) as well as melanotroph-type (alpha-melanocyte-stimulating hormone [alpha-MSH] and N-acetyl-beta-END [Nac-beta-END] IRM) proopiomelanocortin (POMC) derivatives in patients under septic shock upon administration of corticotropin-releasing hormone (CRH). The objectives were to assess whether an insufficient release of corticotroph- or melanotroph-type POMC derivatives from the pituitary into the cardiovascular compartment correlates with the 28-day mortality rate. Seventeen patients with septic shock but without adrenocortical insufficiency and 16 healthy volunteers were enrolled in the study, and CRH stimulation tests were performed with an i.v. bolus injection of 100 microg human CRH. After treatment with CRH, plasma concentrations of corticotroph-type POMC derivatives increased in survivors and nonsurvivors, melanotroph-type POMC derivatives such as alpha-MSH or Nac-beta-END IRM increased only in survivors in contrast to nonsurvivors. The release of alpha-MSH and Nac-beta-END IRM was suppressed by dexamethasone in survivors but not in nonsurvivors. In patients with septic shock, the response of the pituitary to CRH stimulation in terms of alpha-MSH or Nac-beta-END IRM release was impaired in nonsurvivors compared with survivors or controls. Reduced responses of alpha-MSH or Nac-beta-END IRM to CRH and the invalid suppression by dexamethasone reflect a state of dysfunction of the melanotroph-type POMC system in nonsurvivors. Considering anticytokine and anti-inflammatory effects of alpha-MSH, this dysfunction may increase the risk of death in patients with septic shock.     

人体蛞蝓假寄生1例

患者女性,50岁,黑龙江省七台河市新兴煤矿面包厂工人。2006年11月25日早饭后自觉腹胀,持续1d,因无食欲未再进食。次日清晨,患者呕吐活虫20余条,从中捡出7条置于小瓶中,来哈尔滨医科大学附属第二医院就诊。经胃肠钡餐造影,未见异物。经本教研室鉴定,7条虫体为蛞蝓(Li     

建立猪血管内皮细胞对人血清适应的模型及其评估

目的:观察人免疫球蛋白G、免疫球蛋白M和正常人AB型血清诱导猪血管内皮细胞适应状态的效果。方法:实验于2002-05/2003-02在解放军第四军医大学分子生物学实验室完成。①正常人AB型血清和猪血清制备:取健康AB血型成年人血,每次50mL,置于干燥管内,垂直静置6h,3000r/min离心10min,取上清。操作4℃条件下进行,以保证补体的活性。获得血清于-20℃保存备用,用前0.22μm滤膜过滤除菌。猪血清制备同上。②猪血管内皮细胞培养、纯化及鉴定:取体质量3kg实验用乳猪,自左侧髂总动脉向心侧插入大隐静脉导管20cm,注射肝素500U后持续滴注含肝素抗生素盐水(肝素1×105U/L,青霉素4×107U/L),取腹主动脉和胸主动脉,以4℃含肝素抗生素盐水冲洗管腔和外膜后注入37℃预热的10g/LⅠ型胶原酶,消化5min后收集消化液,以1000r/min离心5min,收集细胞放于CO2孵箱内培养并传代,第3代以后不再使用抗生素。在光学显微镜下观察细胞生长形态,进行培养细胞类型的鉴定。③正常人血清对猪血管内皮细胞溶解试验:将猪血管内皮细胞制成浓度5×106L-1的细胞悬液,接种于96孔培养板,每孔200μL,培养至第4天细胞基本铺满培养板底部后加入含正常人AB型血清的培养液,终浓度分别为5%、10%、25%、40%,以相应浓度猪血清为对照,每组各取3孔。放入37℃孵箱内孵育2h后以四唑盐比色试验测各孔的吸光度值。④猪血管内皮细胞对人血清适应模型的建立及评估:培养猪血管内皮细胞,分别以免疫球蛋白G、免疫球蛋白M和低浓度正常人AB型血清诱导猪血管内皮细胞6d,以四唑盐比色法检测细胞存活率,并以免疫组化方法检测其血红素氧合酶1表达的情况。结果:①接种细胞形态呈圆形、三角形或短梭形,胞体丰满、胞浆均匀、核仁清晰。部分细胞呈团块样,大部分细胞为单细胞分布,其间混杂有少许血细胞,说明培养细胞为血管内皮细胞,无明显杂细胞污染。②在25%的正常人AB型血清作用下,猪血管内皮细胞的存活率为(71±22)%。与对照组相比较,100mg/L免疫球蛋白M和5%、10%正常人AB型血清诱导猪血管内皮细胞存活率分别为(81±31)%,(93±25)%,(90±42)%。③诱导后猪血管内皮细胞胞浆内血红素氧合酶1的表达明显增加。结论:100mg/L免疫球蛋白M和正常人AB型血清能够诱导猪血管内皮细胞的适应,后者效果更为明显。     

3T3-L1脂肪细胞分化不同阶段抵抗素表达的变化

目的:抵抗素具有直接对抗胰岛素作用,观察3T3-L1脂肪细胞分化不同阶段过程中抵抗素mRNA和蛋白表达的变化。方法:实验于2006-03/10在郑州大学第一附属医院完成。3T3-L1前脂肪细胞由武汉同济医院儿科馈赠。①将3T3-L1前脂肪细胞接种于培养瓶,加入含体积分数为0.1小牛血清的高糖DMEM培养液,在37℃、体积分数为0.05的CO2条件下培养。待细胞融合2d后,加入体积分数为0.1小牛血清的高糖DMEM培养液培养(含0.5mmol/L3-异丁基-1-甲基黄嘌呤、5mg/L胰岛素、1μmol/L地塞米松),诱导3T3-L1前脂肪细胞分化成熟。②分别于诱导分化的第2,4,6,8天采集细胞,采用反转录-聚合酶链反应检测脂肪细胞抵抗素mRNA的表达,以免疫印迹分析方法检测脂肪细胞抵抗素蛋白的表达。结果:①3T3-L1前脂肪细胞分化的形态学变化:诱导分化前细胞呈梭形,胞浆中无脂滴,表现为成纤维细胞样的前脂肪细胞形态,待完全汇合后处于生长停滞期;诱导分化第2天细胞变圆;第4天时细胞变大,变圆,胞浆有少量脂滴出现;第6天脂滴明显增多;至第8天更多的脂滴积累,形成典型的“戒环”样结构。②抵抗素mRNA在3T3-L1脂肪细胞分化不同阶段表达的变化:3T3-L1脂肪细胞抵抗素mRNA在分化的第2,4,6,8天吸光度值分别为0.16±0.03,0.37±0.07,0.63±0.11和0.96±0.17,相邻两时间点比较抵抗素mRNA的表达差异均有显著性意义(P均<0.01)。③抵抗素蛋白在3T3-L1脂肪细胞分化不同阶段表达的变化:3T3-L1脂肪细胞抵抗素蛋白在分化的第2,4,6,8天吸光度值分别为28942.5±1392.7,59326.7±2954.3,107821.6±4325.1和173656.5±8356.7,相邻两时间点比较抵抗素蛋白的表达差异均有显著性意义(P均<0.01)。结论:抵抗素mRNA及蛋白在脂肪细胞分化成熟过程中表达逐渐升高。     

石河子大学及石河子市3所不同性质高中在校学生症状自评量表测试结果比较

目的:调查石河子市在校学生的心理健康状况。方法:本调查于2006-06完成。随机抽取石河子市二中、农八师高级中学和石河子市五中3所高中每个年级1个班,共计536名学生;于石河子大学理工类、文史类和艺术类各选取1个专业,农学院和医学院本科2005～2003级的全部少数民族学生,共计564名学生。其中男生493名,女生607名,少数民族学生243名。应用症状自评量表,对纳入学生的心理健康进行评定。本量表9个因子分别为:躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执及精神病性。以任意1项因子分≥3分认为有心理问题发生。结果:共发放调查问卷1100份,收回有效问卷964份。①石河子市964名在校学生中有心理问题的160名(16.59%)。②石河子市在校学生各因子分均大于中国常模,差异有显著性意义(P<0.01)。男女生抑郁和恐怖因子2个因子得分比较,差异有显著性意义(P<0.01),其他各因子和心理健康总分均未出现明显差异(P>0.05)。③大学生总均分明显高于高中生。高中生阳性均分,躯体化,强迫,恐怖和敌对性因子分与大学生比较,差异不明显(P>0.05),其余各项均明显低于大学生,差异有显著性意义(P<0.05)。④不同专业学生强迫、人际敏感、恐怖和阳性项目均分比较,差异不明显(P>0.05),其余6个因子得分比较,差异均有显著性意义(P<0.05)。结论:石河子市在校学生心理素质方面基础较薄弱,学校应有针对性地开展心理健康教育。     

Provisional stenting in the real world: results in 1058 consecutive patients undergoing percutaneous coronary angioplasty

OBJECTIVE: To study a strategy of aggressive coronary balloon angioplasty with provisional stenting in allcomers. In randomized trials, stenting has improved the outcome of patients undergoing coronary intervention. However, whether these results hold up in clinical practice is largely unknown. Furthermore, the results of balloon angioplasty have also improved dramatically. It is therefore essential to evaluate the current results of balloon angioplasty and to assess whether stents are required in all patients. METHODS: The authors prospectively studied the occurrence of death, myocardial infarction (MI) and target lesion revascularization (TLR) of a large consecutive group of patients undergoing aggressive balloon angioplasty with provisional stenting. None of the patients received a platelet glycoprotein IIb/IIIa receptor blocker. The results were compared with the outcome of routine stenting in recent randomized trials. RESULTS: Angioplasty was performed in 1058 patients of whom 369 (34.9%) received a stent. The angiographic success rate was 98.9%. During hospital stay, 4.8% of the patients suffered any cardiac event. At one-year follow-up, death occurred in 1.1%, MI in 3.3%, TLR in 12.4% and any event in 16.7% of the patients. Event-free survival at one-year was 82.3%. These results compare favorably with routine stenting in recent trials. CONCLUSIONS: Aggressive balloon angioplasty with provisional stenting yields excellent results in a general patient population.