老年急性化脓性胆囊炎是临床常见的危重胆道感染,病情重,进展快,容易出现胆囊穿孔、感染性休克等严重并发症,对于超高龄、不能语言交流的老年患者,因临床症状不典型,待明确诊断时病情已较重,因此,对于反复发热、感染灶不明确的高龄患者,及时行肝胆超声检查,及早发现并干预,能有效控制病情进展.空军特色医学中心近期收治2例急性化脓性胆囊炎的超高龄患者,分析其发病及治疗特点,从而提高对该病的认识及诊治.

The mechanism involved in the effects of positive acceleration adaptive training (PAAT) on gastric ischemia-reperfusion injury (GI-RI) has not been fully characterized. The aim of the present study was to investigate the effects of PAAT in attenuating GI-RI in a rat model. The inflammatory factor and caspase-3 levels were measured using ELISA kits. A western blot assay was used to analyze tumor necrosis factor-α (TNF)-α, tumor necrosis factor receptor 1 (TNFR1), tumor necrosis factor-related apoptosis inducing ligand (TRAIL), death receptor (DR) 4, DR5, cyclooxygenase (COX)-2, COX-1 and prostaglandin E2 (PGE2) protein expression levels. It was revealed that PAAT could alleviate GI-RI and inflammatory factor levels in a rat model. PAAT suppressed TNF-α and TNFR1 protein expression levels, inhibited TRAIL, DR4, DR5, COX-2 and PGE2 protein expression levels; however, it did not have an effect on COX-1 protein expression in the model of GI-RI. The data indicated that the effects of PAAT attenuated GI-RI through the downregulation of COX-2 and PGE2 expression.

Objective To provide reference and theoretical basis for the medical care in retired military cadres by analyzing the physical examination results of 3247 cases.Methods A total of 3247 cadres retired from army who took physical examination in our hospital from March 2014 to March 2016 were enrolled in this study .They were 2684 males and 563 females, and at an age of 75.0 ±13.8 (50-95) years.According to their age , they were divided into 50-59, 60-69, 70-79 and 80 -95 years groups (n=374, 1184, 1547 and 142).The results of physical examination , medical examination and laboratory test were collected and analyzed.Results Compared with other aged group , the 80-95 years group had higher ratios of females , more comorbidities of coronary heart disease, diabetes and hyperuricemia, higher proportion of medication, and lower 25-(OH)D3 level (P<0.05).Abdominal ultrasound results showed that fatty liver , hepatic cyst , gallbladder polyps , gallbladder stones and kidney stones were more common in the 80-95 years old group (P<0.05).Chest X-ray filming indicated there were more images of increased pulmonary markings , thoracic vertebra degeneration , obsolete pulmonary tuberculosis , pulmonary interstitial changes , arteriosclerosis , pulmonary emphysema , pulmonary patchy shadow and adhesion of the pleural cavity in the 80-95 years old group (P<0.05).Electrocardiogram indicated there were more images of ischemic change , bundle branch block ,sinus arrhythmia ,myocardial infarction ,left ventricular hypertrophy , premature contraction, atrial ventricular block in the 80 -95 years group ( P <0.05).At the same time, the incidence rates of mammary hyperplasia and uterine fibroids were higher in the females from the 60-69 years group , and those of prostate hypertrophy , prostatic calculus and prostatic calcification were common in the males of the 80 -95 years group ( P<0.05 ) .Conclusion The abnormality rates of medical examination results are quite high in the retired cadres .So, pertinent health guidance should be carried out and related risk factors should be monitored and controlled for the senile patients , so as to get benefits from early discovery and active intervention.More attention should be paid to the health care in those aged 80-95 years.

Objective To systematically evaluate the effectiveness and safety of probiotics combined with bismuth-containing quadruple therapy for eradication of Helicobacter pylori. Methods The databases including PubMed, SCIE, EMbase, Biosis Previews, ELSEVIER, Science Direct, Springer Link, the Cochrane Library, CBM, VIP, WanFang Data and CNKI were searched to collect randomized controlled trials (RCT) before July 2016. Data extraction and quality assessment were performed by 2 independent reviewers. Meta analyses were conducted using RevMan 5.3 software. Results A total of 11 studies involving 1589 participants were included. According to intention-to-treat (ITT) analysis, H.pylori eradication rate in experimental group was 90.5%and 82.1% in control group with significant difference (OR=2.13, 95% CI: 1.58 - 2.88, P < 0.001). The incidences of adverse reaction in experimental group was 13.9% and 27.5% in control group with significant difference (OR=0.42, 95% CI: 0.30 - 0.59, P < 0.001). Conclusion Current evidence indicates that probiotics combined with bismuth-containing quadruple therapy can improve eradication rate of Helicobacter pylori and reduce the incidences of adverse reaction.

目的：探讨军队离退休老干部心电图的变化规律。方法按照年龄的差异将3247例军队离退休老干部分为四个年龄组，即中年组（50～59岁）374名、低龄老年组（60～69岁）1184名、中龄老年组（70～79岁）1547名和高龄老年组（80～95岁）142名，均行常规12导联心电图检查，并对心电图异常情况进行统计分析。结果3247例中正常心电图286例，异常心电图2961例，军队离退休老干部的心电图异常情况为缺血性改变76.67％（2270／2961）、束支传导阻滞58.76％（1740／2961）、窦性心律失常53.56％（1586／2961）、心肌梗死47.15％（1396／2961）、左心室肥厚30.63％（907／2961）、各种期前收缩25.13％（744／2961）和房室传导阻滞21.65％（641／2961）等，四个年龄组的心电图异常情况比较均有非常显著性差异（χ2＝75.42，P＜0.01）。结论应尽早行心电图检查，对早期发现、诊断和治疗心血管疾病具有重要意义。

目的 分析正加速度(+Gz)暴露下大鼠外周血D-乳酸及二胺氧化酶(DAO)含量的变化,探讨+Gz暴露对大鼠肠黏膜通透性的影响及机制.方法 32只雄性SD大鼠随机分成4组,每组8只,分别标记为A组(正常对照组)、B组(+5 Gz组)、C组(+10 Gz组)、D组(重复暴露组).采用动物离心机模拟+Gz暴露,B、C组大鼠分别以+5和+10 Gz暴露5min,D组大鼠重复暴露于+5Gz 1.5min,+10 Gz 2 min,+5Gz 1.5min,除A组外,其他各组大鼠每日暴露1次,持续5d.实验结束后次日麻醉大鼠,取大鼠肠黏膜标本及外周血清,镜下观察大鼠肠道组织病理学特点,并检测各组大鼠血清D-乳酸及DAO水平.结果 除A组外,其他各组大鼠小肠组织肉眼及光镜下观察均有损伤,损伤程度D组＞C组＞B组;与A组比较,其他各组大鼠血清D-乳酸及DAO水平均明显升高(P＜0.05),血清D-乳酸水平C组低于D组(P＜0.01);血清DAO水平B组低于C组和D组(P＜0.05).结论 +Gz暴露可增加大鼠肠道黏膜通透性,破坏大鼠肠道机械屏障,损伤程度与+Gz暴露值有关.

目的 探讨正加速度适应性训练对大鼠胃黏膜损伤指数及PGE2含量的影响.方法 40只雄性SD大鼠随机分为5组,每组8只,分别标记为A、B、C、D、E组.A组为空白对照组;B组大鼠每天+5 Gz值暴露5 min,连续暴露5d;C组大鼠每天+10 Gz值暴露5 min,连续暴露5d;D组大鼠适应性训练(+4 Gz值每天暴露3 min,连续暴露5 d)后+5 Gz值每天暴露5 min,连续暴露5d;E组大鼠适应性训练(+4 Gz值每天暴露3 min,连续暴露5 d)后+10 Gz值每天暴露5 min,连续暴露5d.实试验结束后肉眼观察胃黏膜损伤情况,计算损伤指数(lesion index,LI),ELISA法检测胃黏膜PGE2的含量.结果 肉眼观察,除A组外,其余各组胃黏膜均可见不同程度损伤.C组损伤指数(5.625±1.767)高于B组(1.750±0.707).适应性训练后,D组损伤指数(0.875±0.641)低于B组(1.750±0.707),E组损伤指数(2.250±1.035)低于C组(5.625±1.767),差异有统计学意义(P＜0.05).C组PGE2含量[(24.598±6.017) pg/ml]低于B组[(60.468±9.697) pg/ml],适应性训练后,E组PGE2含量[(46.165±13.996) pg/ml]高于C组的[(24.598±6.017) pg/ml](P＜0.05).结论 低速正加速度适应性训练可减轻高速正加速度带来的胃黏膜损伤,其机制与胃黏膜内PGE2分泌增多有关.

Objective To explore the effect of positive acceleration (+Gz) on immune barrier of intestinal mucosa in rats. Methods Thirty two male SD rats were randomly divided into 4 groups (8 each): Group A (control group), Group B (+5Gz group), Group C (+10Gz group) and Group D (repeated exposure group). The animal centrifuge was used to simulate the exposure of acceleration. Group A was no disposed. +5Gz group and +10Gz group were subjected to centrifugal force of +5Gz and +10Gz respectively for 5min; repeated exposure group was continuously exposed to 1.5min under +5Gz value, 2min under +10Gz value and 1.5min under +5Gz. All groups were exposed to the respective acceleration once daily for 5 days. The damage of intestinal mucosa was observed by light microscopy after the experiment was finished, and the content of sIgA in intestinal mucosa was detected by ELISA. Results Except for group A, intestinal mucosal injury was observed in the other three groups. Group D was shown as the most serious one, followed by group C and group B. Compared with group A, the level of sIgA was significantly lower in other three groups (P<0.05). The level of sIgA in group C was significantly lower than that in group B (P<0.05) and higher than that in group D (P<0.05). Conclusion +Gz exposure can result in intestinal injury and weaken the function of immune barrier of intestinal mucosa in rats. DOI: 10.11855/j.issn.0577-7402.2016.10.14

目的 系统评价奥曲肽联合泮托拉唑治疗急性非静脉曲张性上消化道出血(acute non-variceal upper gastrointestinal bleed-ing,ANVUGIB)的疗效.方法 计算机检索Pubmed、EBSCO、Springer、Ovid、ScienceDirect、SCIE、Wiley、CBM、VIP、CNKI和WanFangData,查找有关应用奥曲肽联合泮托拉唑治疗非静脉曲张性上消化道出血的随机对照试验(RCT),并检索纳入文献的参考文献,检索时限均为建库至2015年2月.由2名评价者独立选择试验、提取资料和评估方法学质量,采用RevMan 5.3软件进行Meta分析.结果 最终纳入23个研究,共2 239例受试者(试验组1 153例,对照组1 086例).Meta分析结果显示:奥曲肽联合泮托拉唑治疗在以下方面均优于常规治疗或单用二者之一,差异有统计学意义:总有效率(OR =4.92,95％ CI:3.69 ～6.56,P＜0.00001)、止血时间(MD=-8.17,95％CI:-9.82～-6.15,P＜0.00001)、输血量(MD=-0.81,95％CI:-1.18～-0.44,P＜0.00001)、胃液pH值(MD=0.83,95％CI:0.45～1.21,P＜0.0001);在不良反应发生率方面,两组差异无统计学意义(OR=1.20,95％ CI:0.37 ～ 3.94,P=0.76).结论 奥曲肽联合泮托拉唑治疗优于常规治疗或二者之一治疗,且不良反应少,适合在临床上推广使用.

Objective To study the effects of positive acceleration adaptive training on the expression of COX -1 mRNA and COX-2 mRNA in gastric mucosa.Methods 40 male SD rats were randomly divided into 5 groups:A, B,C,D and E.Group A was the control group,and did not undergo any treatment .Group B was exposed to +5 Gz for 5 minutes per day over 5 consecutive days.Group C was exposed to +10 Gz for 5 minutes per day over 5 con-secutive days.Group D was exposed to +4 Gz for 3 minutes per day over 5 consecutive days and +5 Gz for 5 mi-nutes per day over another 5 consecutive days.Group E was exposed to +4 Gz for 3 minutes per day over 5 consec-utive days and +10 Gz for 5 minutes per day over another 5 consecutive days.The damage to the gastric mucosa was then observed with the naked eye and under the microscope .The 6-Keto-PGF1α content in gastric mucosa was detected by ELISA.The expression of COX-1 mRNA and COX-2 mRNA was assessed with RT-PCR method.Re-sults The content of 6-Keto-PGF1αwas significantly lower in group B than in group A and in group C than group A (P <0.05).After adaptive training, the content of 6-Keto-PGF1αwas significantly higher in group D than in group B and in group E than group C (P <0.05).There was no significant difference on the expression of COX -1 mRNA in all groups.The expression of COX-2 mRNA was significantly higher in group B than in group A and in group C than group B and group A (P <0.05).After adaptive training,the expression of COX-2 mRNA was significantly higher in group D than in group B and in group E than group C .The content of 6-Keto-PGF1α and the expression-COX-1 mRNA,and the expression of COX-2 mRNA, had no significant correlation (P <0.05).Conclusion A-daptive training can significantly reduce the gastric mucosal damage caused by high +Gz value,and its mechanism is related to the increase in PGI 2 content and expression of COX-2 mRNA.

目的 观察正加速度(+Gz)暴露对大鼠肠黏膜机械屏障及免疫屏障的损伤,探讨谷氨酰胺(Glutamine,Gin)对损伤的修复作用.方法 24只雄性SD大鼠随机分成3组,每组8只,分别标记为A组(对照组)、B组(+ 10 Gz组)、C组(+10 Gz +Gln组).采用动物离心机模拟+Gz暴露,B组大鼠以+10Gz值旋转5 min,每日暴露1次,持续5d,C组训练方法同B组,训练前灌服用生理盐水配置的Gin溶液.实验结束后次日麻醉大鼠,取大鼠肠黏膜标本及外周血清,镜下观察大鼠肠道组织形态特点,并检测各组大鼠血清D-乳酸、二胺氧化酶(DAO)水平以及用酶联免疫吸附测定肠黏膜分泌型免疫球蛋白A (sIgA)含量.结果 A组大鼠小肠组织无明显损伤;B组+Gz暴露后的小肠组织损伤最严重;C组小肠组织损伤程度不及B组.与A组相比,B组大鼠血清D-乳酸、DAO水平明显升高(P＜0.01),sIgA水平明显降低(P＜0.01);C组大鼠血清D-乳酸、DAO水平高于A组(P＜0.05),但sIgA水平与A组相比差异无统计学意义.B组大鼠血清D-乳酸、DAO水平高于C组(P＜0.05),sIgA水平明显低于C组(P＜0.01).结论 + Gz暴露可增加大鼠肠道黏膜通透性,破坏大鼠肠道屏障.加速度暴露过程中补充Gin,对屏障损伤有较好的修复作用.

Stroke, either ischemic or hemorrhagic, is the leading cause of death and morbidity worldwide. Identifying the risk factors is a prerequisite step for stroke prevention and treatment. It is believed that a major portion of the currently unidentified risk factors is of genetic origin. Consistent with this idea, numerous potential risk alleles for stroke have been reported, however, the genetic evidence so far is not conclusive. The major goal of this review is to update the current knowledge about the genetic predisposition to the common multifactorial stroke, and to provide a bird's-eye view of this fast moving field. We selectively review and meta-analyze the related English literatures in public domain (PubMed) from 2000 onward, including the original reports and meta-analyses, to evaluate the genetic risk factors of common multifactorial stroke. The results indicated that we reviewed and meta-analyzed original reports and existing meta-analyses that studied the genetic predisposition to the common multifactorial stroke. Some original reports and meta-analyses were specific for ischemic stroke and others were for hemorrhagic stroke only. We also evaluated the major evolving issues in this field and discussed the future directions. In conclusion, strong evidences suggest that genetic risk factors contribute to common multifactorial stroke, and many genetic risk genes have been implicated in the literatures. However, not a single risk allele has been conclusively approved.

目的探讨+Gz条件下实验性胃溃疡大鼠胃黏膜降钙素基因相关肽mRNA（calcitonin gene-related peptide-mRNA,CGRPmRNA）表达和血清一氧化氮（NO）、内皮素（endothelin,ET）的变化情况及其影响溃疡愈合的相关机制。方法选择雄性SD大鼠40只随机分成4组:正常对照组（A组）、胃溃疡模型组（B组）、模型+5 Gz暴露组（C组）、模型+10 Gz暴露组（D组）。对B、C、D组大鼠采用Okabe方法建立胃溃疡模型,造模3 d后+Gz处理大鼠,A组不做处理,B组地面捆绑5 min,C组+5 Gz旋转5 min,D组+10 Gz旋转5 min,隔日1次,共4次。1周后麻醉大鼠并固定,采集血液及胃黏膜组织标本,用荧光定量RT-PCR法测定胃黏膜CGRP-mRNA含量,运用比色法测定血清中NO含量,放免法测定血清中ET含量。结果胃黏膜CGRP-mRNA的含量:B组较A组升高,差异有统计学意义（P＜0.05）;胃溃疡大鼠经+Gz处理后,B组＞C组＞D组（P＜0.05）,但C组仍明显高于A组（P＜0.05）;血清中NO含量:B组＜A组,C组＞D组＞B组,差异均有统计学意义（P＜0.05）;血清中ET含量:B组＞A组,C组＜D组＜B组,差异均有统计学意义（P＜0.05）。结论 +Gz暴露导致胃黏膜CGRP-mRNA及血清NO、ET发生规律性变化,导致胃黏膜血流改变,从而影响溃疡愈合,可能低+Gz有利于机体产生生理代偿能力,促进溃疡愈合,而高+Gz会加重机体损伤。

目的：研究正加速度（＋Gz）适应性训练对大鼠胃黏膜前列环素（prostacyclin,PGI2）、血栓素A2（thromboxane A2,TXA2）含量及TXA2/PGI2比值变化的影响.方法：40只♂SD大鼠随机分为5组,每组8只,分别标记为为A、B、C、D、E组.A组大鼠为空白对照,不做处理,B组大鼠＋5 Gz值暴露5 min,1次/d,连续暴露5 d,C组大鼠＋10 Gz值暴露5 min,1次/d,连续暴露5 d,D组大鼠适应性训练（即＋4 Gz值暴露3 min,1次/d,连续暴露5 d）后＋5 Gz值暴露5 min,1次/d,连续暴露5 d,E组大鼠适应性训练（即＋4 Gz值暴露3 min,1次/d,连续暴露5 d）后＋10 Gz值暴露5 min,1次/d,连续暴露5 d.试验结束后肉眼和光学显微镜下观察胃黏膜损伤情况,计算损伤指数,ELISA法检测胃黏膜内TXB2、6-酮-前列腺素F1？（6-keto-prostaglandin F1？,6-K-PGF1？）的含量,并计算TXB2/6-K-PGF1？的比值.结果：肉眼和光学显微镜下观察,除A组外,其余各组胃黏膜均有损伤,D组损伤轻于B组,E组损伤轻于C组.适应性训练后,D组损伤指数小于B组（0.875±0.641 vs 1.750±0.707,P〈0.05）,E组损伤指数小于C组（2.250±1.035 vs 5.625±1.767,P〈0.05）;D组TXB2低于B组（159.588 pg/m L±36.216 pg/m L vs251.018 pg/m L±50.845 pg/m L,P〈0.01）,E组TXB2低于C组（150.476 pg/m L±48.589p g/m L v s 331.538 p g/m L±79.102 p g/m L,P〈0.01）;D组6-K-P G F1？高于B组（72.242p g/m L±12.413 p g/m L vs 52.015 p g/m L±11.827 pg/m L,P〈0.01）,E组6-K-PGF1？高于C组（87.426 pg/m L±15.833 pg/m L vs 44.726pg/m L±18.867 pg/m L,P〈0.01）;D组TXB2/6-K-PGF1？比值小于B组（2.283±0.705 vs 5.128±1.788,P〈0.01）,E组TXB2/6-K-P G F1？比值小于C组（2.250±1.035 vs 8.599±4.157,P〈0.01）.结论：适应性训练可明显减轻持续＋Gz暴露带来的胃黏膜损伤,其机制与PGI2含量升高、TXA2含量降低以及TXA2/P G I2比值降低有关.

目的：探讨子宫恶性肿瘤PET/CT的表现与诊断价值。方法2012年8月至2013年12月选择在我院进行诊治的子宫肿瘤患者80例，都进行子宫恶性肿瘤PET/CT与手术病理分析。结果PET/CT检查判断良性肿瘤67例，恶性肿瘤13例；而病理判断为良性肿瘤68例，恶性肿瘤12例；为此子宫恶性肿瘤的PET/CT检查敏感性与特异性分别为98.5%和100.0%。结论子宫恶性肿瘤PET/CT的表现具有较高的灵敏度、特异性，并具有一次即可完成体部扫描的特点，值得推广应用。