化学、生物、放射和核(CBRN)威胁可能造成大规模伤亡,是战场防御的重点内容.CBRN武器医学防护学是军队医学院校学员的必修课程.该文介绍了野战演练中防化医学课程设立的以防护姿态通过污染区、操作防化装备、化学攻击后的现场救援和化学污染伤员早期救治4个模块的训练内容,以及将各模块整合到全功能性演习中的实施过程;讨论了在野外军事医学综合演习过程中模块化设计的思路和学员借此训练应建立的防化医学核心意识.模块化训练可为CBRN防御医学野战演练的有效实施提供新的借鉴.

诺维乔克类(Novichoks)化合物是G类和V类神经性毒剂的衍生物,被称为第三代神经性毒剂,具有不易侦检和不易治疗的特点.根据目前已有的数据显示,该类化合物作为新一代的神经性毒剂,与G类和V类神经性毒剂在结构上有一定的相似性,均含有P=O双键,但其结构比G类和V类神经性毒剂的结构更为复杂.复杂的结构和效应关系决定了它们更易与乙酰胆碱酯酶发生作用,形成的中毒酶更易老化,因此其毒性更大.Novichoks化合物中毒后除表现出胆碱能神经系统功能紊乱的症状,还可能伴有难治性的迟发性神经毒性症状,目前尚无针对Novichoks化合物的特效抗毒药物.但这类化合物最近在英国的使用暗示了它们对人类的巨大危险性,关于Novichoks化合物的特效抗毒药物的研究势在必行.因此,本文对其结构、理化性质、中毒机制、临床表现和可能的防治方法等进行了综述,希望能增进人们对于Novichoks化合物的了解,促使开发针对这类化合物的新型抗毒特效药物以及侦检、防护和洗消的策略.

Objective:To construct a performance appraisal index system for the full-time scientific research personnel in general hospitals.Methods:Appraisal indexes and weight coefficients are determined by Documentary Analysis, Delphi Method and Analytic Hierarchy Process.Results:Weight coefficients of performance appraisal index system for the full-time scientific research personnel are determined after 3 rounds of expert consultation by using Analytic Hierarchy Process and calculating weight coefficients of evaluation indexes and combined weight coefficients.Conclusions:This system can introduce new evaluation methods for human resource management in general hospitals, help to evaluate the research capacity and work performance of full-time scientific research personnel comprehensively, and improve the evaluation system for full-time scientific research personnel.

Interleukin-1β (IL-1β) is important for the pathological process of heatstroke (HS), although little is known regarding the main source of the IL-1β produced during the early stage of HS. In this study, heat stress led splenic lymphocytes to death with generation of inflammatory cytokines. The same phenomenon also occurs in animal models of heatshock. We observed that the death of splenic lymphocytes was identified to be pyroptosis. In addition, splenic lymphocyte pyroptosis can be induced by hyperpyrexia in a time- and temperature-dependent manner with NLR pyrin domain containing 3 (NLRP3) inflammasome activation. An NLRP3 inhibitor (MCC950) and a caspase-1 inhibitor (ac-YVAD-cmk) were used to confirm the role of the NLRP3/caspase-1 pathway in pyroptosis. With heat stress, levels of mitochondrial reactive oxygen species (mtROS) in splenic lymphocytes would significantly increase. Accordingly, the use of mtROS scavenger (Mito-TEMPO) could reduce the occurrence of pyroptosis and the activation of the NLRP3 inflammasome in vitro. In animal models of heatshock, Mito-TEMPO can inhibit activation of the NLRP3/caspase-1 pathway. Taken together, our data suggest that activation of the NLRP3 inflammasome mediates hyperpyrexia-induced pyroptosis in splenic lymphocytes. Perhaps one of the important initiators of pyroptosis is mtROS. Our data have elucidated a new molecular mechanism of IL-1β overexpression in the early stage of HS, providing a new strategy for IL-1β-targeted therapy in future clinical treatments for HS.

目的 肝损伤是重症中暑的常见并发症,是导致患者死亡的直接原因.本研究拟探讨红景天苷(salidroside,Sal)对热射病小鼠急性肝损伤的保护作用及其可能机制.方法 动物实验部分,将40只ICR (institute of cancer research)小鼠随机分为空白对照组、Sal对照组、热射病组、Sal干预组.苏木精-伊红染色法(hematoxylin-eosin staining,HE)染色后观察小鼠肝脏损伤的程度.检测肝功能指标丙氨酸氨基转移酶(alanine aminotransferase,ALT)和天冬氨酸氨基转移酶(aspartate aminotransferase,AST)的改变.体外实验部分,分离和培养库普弗细胞(Kupffer cells,KCs),以不同终浓度(80 μmol/L、160 μmol/L及320 μmol/L)的Sal预处理KCs 24 h,43℃±0.5℃热应激2h.MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide]比色法检测细胞存活率.采用相应的试剂盒测定各组细胞上清液中乳酸脱氢酶(lactate dehydrogenase,LDH)、丙二醛(malonaldehyde,MDA)、肿瘤坏死因子-α (tumor necrosis factor-alpha,TNF-α)和高迁移率族蛋白1(high mobility group box 1,HMGB1)释放量.采用实时聚合酶链反应(real-time polymerase chain reaction,real-time PCR)评估HMGB1的mRNA表达.应用细胞核/细胞质提取试剂盒提取细胞核和细胞质蛋白,Western印迹法观察HMGB1从细胞核向细胞质转移的变化.结果 本实验条件下,动物实验部分,与空白对照组、Sal对照组相比,热射病小鼠肝脏病理损伤主要表现为肝细胞肿胀、透明或水样变性,伴随肝功能指标ALT和AST的明显升高;与热射病组相比,Sal干预能够缓解其肝细胞肿胀、透明或水样变性等病理改变并降低热射病小鼠血清ALT和AST水平.细胞实验部分,热刺激可诱导KCs上清液中LDH、MDA以及TNF-α释放,而随着Sal剂量的增加,可显著抑制热应激诱导的LDH、MDA以及TNF-α释放,提高细胞的存活率.且Sal显著抑制热应激诱导的HMGB1表达和分泌,以及HMGB1从细胞核向细胞质的易位.结论 Sal保护热射病小鼠肝损伤,可能是通过其抑制KCs的HMGB1表达和分泌,以及HMGB1从细胞核向细胞质的易位发挥作用.

Background Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). We developed a novel systemic inflammation score (SIS) based on integration of biomarkers used routinely in clinical settings. We aim to explore the association between SIS and AF. Methods A matched case-control study with 376 pairs of AF cases and controls was performed using a propensity score matching system. The SIS was developed by integrating albumin (ALB), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio (LMR). Univariate and multivariate analyses were performed to examine the association of each marker and SIS with AF. Results The conditional multivariate logistic regression analysis showed that elevated levels of ALB and LMR were significantly associated with decreased risk of AF with an OR of 0.74 (95% CI: 0.65, 0.85) and 0.73 (95% CI: 0.64, 0.83), respectively. Patients with elevated SIS had a significantly higher risk of AF. Compared to the patients with SIS equal to 1, the patients with SIS equal to 3 and 4 had an OR of 2.16 (95% CI: 1.40 3.32), and 2.55 (95% CI: 1.66, 3.92), respectively. The SIS was positively correlated with left atrial diameter and right atrial diameter in patients with AF. Conclusions In conclusion, this study provides further clinical epidemiological evidence that systemic inflammatory status was correlated with AF. The SIS, as an index to evaluate the intensity of systemic inflammatory status, could be useful for early prediction of AF development and understanding of AF mechanism.

Regeneration of the corpus spongiosum helps prevent complications following urethral reconstruction, but currently there is a lack of effective therapeutic methods in clinic. In previous studies, we fabricated a fusion protein collagen-binding domain (CBD)-basic fibroblast growth factor (bFGF) that specifically binds to and releases from collagen biomaterials. We demonstrated that CBD-bFGF could promote angiogenesis and tissue regeneration in vivo. In this study, we established a beagle model with extensive urethral defects, and reconstructed the defects with collagen biomaterials that were unmodified or modified with CBD-bFGF. The results demonstrate that CBD-bFGF promotes corpus spongiosum regeneration resulting in improved outcomes following urethral reconstruction. Modifying collagen biomaterials with CBD-bFGF may represent an effective strategy for urethral substitution in urethral reconstruction.

Extensive urethral defects have a serious impact on quality of life, and treatment is challenging. A shortage of material for reconstruction is a key limitation. Improving the properties of biomaterials and making them suitable for urethral reconstruction will be helpful. Previously, we constructed a fusion protein, collagen-binding VEGF (CBD-VEGF), which can bind to collagen scaffold, stimulate cell proliferation, and promote angiogenesis and tissue regeneration. We proposed that CBD-VEGF could improve the performance of collagen in reconstruction of extensive urethral defects. Our results showed that collagen scaffolds modified with CBD-VEGF could promote urethral tissue regeneration and improve the function of the neo-urethra in a beagle extensive urethral defect model. Thus, modifying biomaterials with bioactive factors provides an alternative strategy for the production of suitable biomaterials for urethral reconstruction.

Objective To study the intervention effect of oxygen-reuptake on cardiac functions of anoxic dogs by self-reflection method.Methods Six male hybrid dogs were used in the present study.The dogs were anaesthetized with pentobarbital sodium and were fixed on the operating tables.The catheterizations of trachea,left ventricle and femoral artery were performed.The dogs first inhaled normal air followed by mixture of oxygen and nitrogen and then inhaled normal air again.Records were taken at 60min,30min,10min before hypoxia and 10 min,30 min,60min at hypoxia and 10 min,30 min,60min at oxygen-reuptake.The bio-signals of heart rate(HR),left ventricle systolic pressure(LVSP) and +dp/dtmax were recorded.Arterial partial pressure of oxygen(PaO2) and arterial partial pressure of carbon dioxide(PaCO2) were analyzed by automatic blood gas system.Results Heart rates of dogs were increased gradually by inhaling the mixture of oxygen and nitrogen.LVSP,however,experienced a process of increase at 10 min and 30min and decrease at 60min.Decreased PaO2 and increased PaCO2 were observed during the inhalation of anoxic air.Conclusion Anoxic air inhalation could affect the cardiac functions of the dogs and oxygen-reuptake could ameliorate these changes.

Objective To study the effects of acute hypoxia and sodium cyanide(NaCN) intoxication on electrocardiogram signals and AST,ALT in blood serum of dogs.Methods Eighteen dogs were randomly divided into normoxic and hypoxic groups.Endotracheal intubation was taken after anesthesia and ECG electrodes were placed.The dogs in normoxic group breathed the air while those in hypoxia group inhaled nitrogen-oxygen mixture in proportion as 81.8% : 18.2%.NaCN in a dose of 3.6 mg/kg was injected subcutaneously to dogs in hypoxia group one hour after the operation.Glutamic-oxalacetic transaminease(AST),glutamic-pyruvic transaminase(ALT) and electrocardiogram signals of PPd,PQd and QRSd were recorded and analyzed respectively at 0,10,20,30 and 50 min after intoxication.Results Acute hypoxia can significantly affect ALT and PQd while sodium cyanide can change AST、ALT,PPd and PQd,However,all of the changes were enhanced by the combination of hypoxia and sodium cyanide intoxication.Conclusion Acute hypoxia and sodium cyanide intoxication could produce combined effects on cadiac function in dogs.

芥子气是一种糜烂性化学毒剂,能作用于眼、呼吸系统、皮肤和骨髓等组织器官,导致急性损伤且遗留远后损伤效应.目前尚无针对芥子气中毒的特效解毒药,仅采取对症和支持疗法.

Objective To study the effects of NaCN poisoning on cardiac function in acute hypoxia dogs.Methods 18 dogs were randomly divided into normoxic control group and hypoxic group.Endotracheal intubation and left ventricular catheterization were taken after anesthesia in both groups.The normoxic control group breathed the air while the hypoxia group inhaled oxygen-nitrogen mixture.One hour after the operation,NaCN was subcutaneously injected into the back of the dog in a dosage of 3.6 mg/kg.Heart rate(HR),left ventricular systolic pressure(LVSP) and left ventricular pressure maximum upstroke velocity(+dp/dtmax) were recorded at 0,10,20,30 and 50 min.Blood samples were drawn at the same time for Lactate Dehydrogenase(LDH),creatine kinase(CK),and creatine kinase-MB(CK-MB) detection.Results The HR slowed down and +dp/dtmax was decreased while the LVSP and the contents of three cardiac enzymes were increased after NaCN poisoning in normoxic control group.The same trend of these indicators was observed in the hypoxic group but the time of change was shorter and the rates of these changes also increased.Conclusion Acute hypoxia can strengthened cyanide intoxication in cardiac function.

目的 研究抗缺氧复方Ⅰ号(简称复方Ⅰ号)和抗缺氧复方Ⅱ号(简称复方Ⅱ号)药物对缺氧复合NaCN中毒犬心脏血流动力学及心率的影响.方法 健康四川杂种犬12只,随机均分为平原组、高原组、复方Ⅰ号组和复方Ⅱ号组,复方Ⅰ号组和复方Ⅱ号组在术前分别喂服复方Ⅰ号和复方Ⅱ号药物,1次/d,连续10 d.各组犬只麻醉后施行气管和左侧颈总动脉插管术,术后静待30 min.平原组在常规实验室内进行实验;高原组、复方Ⅰ号组和复方Ⅱ号组分别通气吸入N2 -O2混合气体(模拟海拔4000 m).各组背部皮下注射NaCN(3.0 mg/kg),记录中毒前60 min(-60)、中毒前0 min(0)、中毒后10、30、50、80、120 min各时点左心室收缩压峰值(mLVSP)、左心室压力上升最大速率(+dp/dtmax)和心率(HR).结果 与高原组比较,复方Ⅰ号组、复方Ⅱ号组犬NaCN中毒后,心脏各项指标变化明显.结论 抗缺氧复方Ⅰ号和抗缺氧复方Ⅱ号药物能够有效减小高原急性缺氧犬NaCN中毒后的心脏功能损害;两药的作用特点虽有所不同,但未发现两药在抗缺氧效果上的差异.

Modularized teaching was applied to chemical defense course in annual military maneuver.Four main modules were set up according to the disciplinary requirements for military exercise: passing through the chemical contaminated area,establishing a field treatment station,rescuing chemical wounds on site and using of individual protective equipment for chemicals.The conduction of modularized teaching is described and discussed.

Objective To study the effects of combined hypoxia and sodium cyanide(NaCN)intoxication on the phospholipids in rats' BALF and lung tissues.Methods Seventy two male SD rats were randomly divided into 2 groups:the hypobaric hypoxia group(HH)in 4000m altitude and the normoxia non-hypoxia group(NH)in 308m altitude.The animals for the experiment of hypoxia were processed in a artificial hypobaric chamber to simulate the designated high altitude hypoxia(4000m,61kPa).Sodium cyanide(NaCN)was injected subcutaneously to the rats in the both groups in a dosage of 3.6mg/kg.The animals were killed immediately at the time points of 0,0.5,1.0,2.0,4.0 and 6.0h.Bronchoalveolar lavage fluid(BALF)and lung tissues were prepared at the same time.The weight ratios of lung/body and dry/wet of lung tissue were measured and the phospholipids content was determined with a biochemistry method.Results Non-hypoxia and hypobaric hypoxia produced a significant increasing effect on the phospholipids content in the rats BALF and the weight ratios of lung/body and dry/wet of lung tissue.Phospholipids content in the lung tissue of the rats,however,was obviously decreased.Acute hypobaric hypoxia and sodium cyanide intoxication produced a more significant increasing effect on the phospholipids content in the rats BALF and the weight ratios of lung/body and dry/wet of lung tissue.All the changes of the parameters mentioned above were further increased by the treatment of sodium cyanide injection.Conclusion Hypoxia and sodium cyanide intoxication may induce a combined injury effect on animal lung tissues.

Objective To approach the effects of combination with plateau(altitude 4000m) hypoxia and sodium cyanide(NaCN) on the heart function of rats.Methods 108 rats were randomized into 2 groups:plain(altitude 308m) NaCN intoxication(PL) and combination with plateau hypoxia and NaCN intoxication(PH) groups.PH rats were pre-treated with plateau hypoxia for 72 hours in plateau hypoxia cabin(simulating altitude 4000m),12 rats of them were percutanously injected with NaCN(3.6mg/kg) to induce NaCN intoxication.Mean arterial blood pressure(mAP),electrocardiogram(ECG).And then 36 rats′ hearts of them were extirpated for determination of cytochrome C oxidation enzyme(cyt-c) activity.Others 60 rats were used examination of pathematology.Results To compare the plain environment,the haemodynamics and the ECG of rats had obviously change induced by NaCN intoxication under the plateau hypoxia environment,even had significant difference(P<0.01) and had difficultly recover.cardiac muscle tissues pathological section also finded analogous result.Conclusion The condition of combination with plateau hypoxia and NaCN brings about recombination effect that results to the more severe consequence to body,and the more critical cardiac function disorder.It implies we should search difference prevention and remedy measure.

Objective To approach the effects of combined plateau hypoxia due to high altitude and sodium cyanide(NaCN)intoxication on the heart function of rats.Methods 84 healthy male SD rats were randomly divided into 2 groups:only NaCN intoxication in plain areas(altitude 308m)(PL group)and combined high altitude(altitude 4 000m)hypoxia and NaCN intoxication(PH group).Rats in PH group were pre-treated with hypoxia for 72h in a plateau hypoxia cabin(simulating altitude 4 000m).12 rats of PH group were anesthetized.NaCN in a dosage of 3.6mg/kg was subcutaneously injected into the back of rats.At the time points of-10min,0min,10min,20min,30min,40min,50min,60min and 90min after NaCN injection,the left ventricular systolic pressure(mLVSP),+dP/dtmax and heart rate(HR)were recorded by physiological functions signal processing system RM6240.The arterial blood were taken from the other 72 rats for myocardium zymogram detection(including AST,LDH,CK,CK-MB)at the time points of 0h,0.5h,1h,2h,4h and 6h after NaCN injection.Results Compared with the PL group,the mLVSP,+dP/dtmax,and HR changed obviously(P<0.01)in the rats in PH group with the influences of plateau environment,and these changes were difficult to recover,meanwhile the myocardium zymogram of rats in PH group showed significant changes accordingly.The most distinguish changes were on LDH that was in accordance with the lack of oxygen in hypoxia circumstance.Conclusion The condition of combined hypoxia and NaCN intoxication would bring about more severe consequence to body,and impair the cardiac function acutely.Search for effective measures for prevention and therapy is necessary for the treatment.

Objective To study the effects of combined plateau hypoxia and sodium cyanide on NOS activity and NO concentration.Methods Seventy-two male SD rats were randomly divided into two groups:plain(308 m) group(n=36) and plateau(4 000 m) group(n=36).After 3.6 mg/kg NaCN subcutaneous injection the activity of NOS and the concentration of NO of rat liver were determined at the time point of 0(contrd group),0.5,1,2,4 and 6 h.Results In both plain group and plateau group,NaCN administration produced the decrease of total NOS activity and the increase of iNOS activity of rats liver.The activity of iNOS in plain group increased more significantly than that in plateau group.NO concentration of plain group reached a peak value at 1 h.However,the NO concentration of plateau group increased at the time point of 30 min,and then decreased.Conclusion Plateau hypoxia combined NaCN intoxication may inhibit NO production of liver.

Objective Utilizing cervical part whiplash injury animal model,to explore the traumatic condition of cervical whiplash injury of different drawing acceleration and to afford the important experimental evidence for the studies of whiplash injury occurrence mechanism,safe protect and remedy measures.Methods Based on the actual occurrence process of cervical whiplash injury,the new-style occurring equipment of cervical whiplash injury was designed,and a dog model of cervical whiplash injury at the various drawing acceleration was built.Combining with a series of measures,including combined behavioral score(CBS) and neuro patholoical general light microscope observing,magnetic resonance imaging(MRI) and examining anatomical lesion of cervical part subcutaneous tissue,muscle,soft tissue and lungs through macroscopic observation,to observe injury traits of cervical part and to investigate the relationships between degree of injury and drawing acceleration.Results The conventional light microscope examining of the cervical spinal cord pathological section could discover the change of the pathological damage.It was shown the function feature of the cervical spinal cord injury in the praxiology.Which suggested the nerve conduction of cervical spinal cord had suffer lesion.Conclusion The home-made cervical part whiplash injury vulnerating equipment can do better to simulate the movement condition of occupants′ head and neck of different drawing acceleration in the motor vehicle rear-impact.After injury,the cervical spinal cord suffers different degree trauma.

目的:验证自行设计的颈部挥鞭伤仿真发生装置的可操作性及稳定性,通过模拟实验分析颈部挥鞭伤的伤情特点以及损伤程度和牵引加速度之间的关系.方法:实验于2003-09/2004-05在第三军医大学新建的实车碰撞实验室完成.选取健康成年杂种犬21只,随机分为4组:重度伤组、中度伤组、轻度伤组各6只,分别施加(40±1.5)g,(25±1.5)g,(15±1.5)g的牵引加速度;对照组3只,用于检查正常颈段脊髓的病理切片.采用自行设计的颈部挥鞭伤仿真发生装置,建立犬颈部挥鞭伤的实验模型,通过联合行为评分(分为五级:0级:弛缓性瘫痪;1级:肌紧张和膀胱控制失调;2级:受伤后肢的负重作用;3级:表现为1或2个后肢跛行;4级:能短时间行走、跑,不能走直行路线;5级:正常,完全恢复)对实验犬的运动、感觉、反射以及肢体动作协调等脊髓功能进行综合评定.检测伤前和伤后皮质体感诱发电位和运动诱发电位的变化以及损伤程度.结果:实验纳入21只犬全部进入结果分析,中途无脱落.①颈部挥鞭伤仿真发生装置的建立:此装置可以根据落锤重量和下落高度差的调节产生比较稳定、不同大小的牵引力和牵引加速度,能较好的模拟汽车追尾碰撞中乘员的头颈部运动特点,可用于仿真汽车追尾碰撞过程中颈部挥鞭伤的发生过程.②行为学观测(联合行为评分):不同的加速度组其损伤的程度不同.重度伤组、中度伤组和轻度伤组在致伤后各时相点沣的评分均小于正常值(5分),且3组评分依次递增.③皮质体感诱发电位的变化:伤后即刻重度伤组出现了波形基本消失,没有明显的NPN波形.与各自伤前比较,中度伤组和轻度伤组伤后即刻的N1,P1波均明显升高[(37.2±2.7),(12.4±1.3)μV;(58.9±3.1),(48.6±2.0)μV;(18.2±2.1),(12.4±2.0)μV;(55.5:±2.0),(48.7±2.3)μV,P均＜0.01].与重度伤组伤后24 h比较,中度伤组和轻度伤组的N1,P1波均明显降低[(21.4±1.4),(17.9±1.9),(17.0±2.5)μV,P均＜0.01;(53.9±4.8),(51.7±4.4),(51.5±8.4)μV,P均＞0.05].④运动诱发电位的变化:伤后即刻重度伤组出现了波形基本消失,没有明显的NPN波形.与各自伤前比较,中度伤组和轻度伤组伤后即刻的N1,P1波均明显升高[(20.5±2.5),(7.7±0.8)μV;(25.85±1.4),(17.8±2.6)μV;(12.1±1.9),(7.85±1.3)μV;(22.6±1.7),(17.6±2.0)μV,P均＜0.01].与重度伤组伤后24 h比较,中度伤组和轻度伤组的N1,P1波均明显降低[(18.5±2.5),(13.1±3.9),(8.75±0.7)μV,P均＜0.01;(21.7±2.4),(19.7±1.8),(19.8±2.3)μV,P均＜0.05].⑤脊髓C4～7段病变情况:大体观察除了重度伤组出现颈部皮下出血,肺部出血水肿外,其余组皆无异常.光镜检测下重度伤组可见神经元数量较少,绝大多数发生变性、坏死,中度伤组可见大部分的神经元变性,轻度伤组形态基本正常. 结论:自制的颈部挥鞭伤致伤装置能较好地模拟汽车追尾碰撞中乘员的头颈部运动特点,可用于仿真汽车追尾碰撞过程中颈部挥鞭伤的发生过程.对犬施加的致伤牵引加速度越大,则引起犬的颈段脊髓损伤程度也越严重.