大鼠头颅侧向旋转致脑弥漫性轴索损伤的NF68免疫组化形态学观察

目的探讨大鼠头颅侧向旋转后脑弥漫性轴索损伤(DAI)的形态学改变。方法大鼠12只,随机均分为损伤后30min、2h、24h及对照组,制作头颅侧向旋转脑DAI模型。脑矢状切片经用小鼠抗神经纤维丝(NF)蛋白NF68亚单位的血清、免疫组化ABC法与DAB+H2O2显色技术等处理。选延髓部分,薄片间包埋,光镜定位,阳性区超薄切片,电镜观察。结果伤后30min光镜下延髓轴索迂曲肿胀;电镜下髓鞘轻度分离,轴浆NF结构紊乱。伤后2～24h,轴索破坏随时间渐重,光镜下轴索明显肿胀、断裂并形成轴缩球;电镜下髓鞘显著分离,局部断裂,线粒体空泡变并移向周边,部分胞浆溶解。和正常对照比,伤后轴索轴浆NF68染色也明显增强;伴随轴索结构的变化,NF68阳性轴索染色强度和数量逐步递增。结论大鼠头颅侧向旋转后脑神经轴索内NF蛋白的NF68亚单位免疫活性显著增强,引起NF结构紊乱,终致轴索肿胀、断裂并形成轴缩球。     

重型颅脑损伤的神经轴索形态改变与病理机制研究

为探讨重型颅脑损伤的发生机制,将大鼠制成脑弥漫性轴索损伤(DAI)模型和Mamarou自由落体致伤模型.对DAI鼠脑行小鼠抗神经纤维丝(NF)蛋白NF68亚单位和HSP70免疫组化检测,延髓部分行电镜观察;对落体致伤鼠脑左顶叶皮层行HE和HSP70检测.结果发现,DAI大鼠伤后30min延髓轴索纡曲肿胀,髓鞘轻度分离,轴浆NF结构紊乱;伤后2h～24h,轴索破坏渐重并形成轴缩球;髓鞘局部断裂,线粒体空泡变,部分胞浆溶解,NF68染色强度也渐增强.两组的HSP70的变化趋势一致,均在伤后3h开始表达,24h达高峰,72h下降.该结果说明DAI可引起NF结构破坏,缺血和缺氧等因素诱发了HSP产生.     

大鼠头颅侧向旋转致脑弥漫性轴索损伤的NF68免疫组分形态学观察

目的 探讨大鼠头颅侧向旋转后脑弥漫性轴索损伤（DAI）的形态学改变。方法 大鼠12只,随机均分为损伤后30min、2h、24h及对照组,制作头颅侧向旋转脑DAI模型。脑矢状切片经用小鼠抗神经纤维丝（NF）蛋白NF68亚单位的血清、免疫组经ABC法与DAB＋H2O2显色技术等处理。选延髓部分,薄片间包埋,光镜定位,阳性区超薄切片,电镜观察。结果 伤后30技术等处理。选延髓部分,薄片间包埋,光镜定位,阳性区超薄切片,电镜观察。结果 伤后30min光镜下延髓轴索迂曲肿胀;电镜下髓鞘轻度分离,轴浆NF结构紊乱。伤后2－24h ,轴索破坏随时间渐重,光镜下轴索明显肿胀、断裂并形成轴缩球;电镜下髓鞘显著分离,局部断裂,线粒体空泡变并移向周边,部分胞浆溶解。和正常对照比,伤后轴浆NF68染色也明显增强;伴随轴索结构的变化,NF68阳性轴索染色强度和数量逐步递增。结论 大鼠头颅侧向旋转后脑神经轴索内NF蛋白的NF68亚单位免疫活性显著增强,引起NF结构紊乱,终致轴索肿胀、断裂并形成轴缩球。     

β淀粉样前体蛋白在弥漫性轴索损伤后早期的变化

目的探讨β淀粉样前体蛋白（β-APP）在弥漫性轴索损伤（DAI）后早期的变化规律及其临床价值。方法按组织学改进的Marmarou等的自由落体法建立弥漫性脑轴索损伤模型,将SD大鼠21只分为损伤组和对照组,损伤组大鼠于伤后不同时间点灌注、取材,随后行常规HE染色法观察神经细胞损伤情况,免疫组化检测β淀粉样前体蛋白在神经元的表达。对照组仅行头皮切开。结果大鼠伤后主要临床表现为意识障碍、呼吸抑制和抽搐。损伤大鼠脑组织大体病理学检查见皮层、胼胝体、脑干等部位的脑挫伤灶。在DAI后半小时始,脑组织内各结构逐渐出现β-APP阳性表达,在伤后24h达高峰,伤后24h轴索断裂征象最为常见。结论成功复制了自由落体致大鼠弥漫性轴索损伤模型。DAI形成是一个渐进过程。轴索损伤常见部位在脑干、胼胝体和大脑皮层。β-APP在弥漫性轴索损伤早期即有增加,增加趋势呈波动性,β-APP作为反应蛋白有望用于检测早期弥漫性轴索损伤。     

大鼠弥漫性轴索损伤后Fos蛋白表达的研究

目的观察大鼠弥漫性轴索损伤(DAI)后不同时间Fos蛋白在脑皮质、脑干的表达,进一步阐明脑损伤后弥漫轴索损伤的发生机制。方法45只大鼠随机分为两组,正常对照组(5只)和损伤组(40只)。损伤组复制Marmarou DAI模型,通过免疫组织化学方法,观察伤后不同时间脑皮质、脑干神经元Fos蛋白表达。结果外伤后0.5 h Fos蛋白表达开始增加,1d达到高峰,以后逐渐下降,12 d后基本消失。与正常对照组相比,损伤组伤后0.5、1、4、12 h、1、4 d Fos阳性神经元数明显增多(P<0.01)。结论DAI的形成和发展与伤后的时间存在明显相关关系。     

脑干枪弹伤的超微结构研究

目的 观察脑干枪弹伤的形态学变化。方法 切取2例头部枪弹伤死亡后25min的脑干，对中服与服桥被盖部和延脑第四脑深部组织做电镜观察。结果 中脑枪弹伤波及整个脑干及小脑；脑干枪弹伤超微结构见烧灼伤和冲击、压力伤两种，其特点是广泛性神经轴索损伤重，神经元损伤轻；轴索烧灼伤呈现轴索水肿，髓鞘、轴浆及其线性体浓缩、变形；冲击、压力伤呈现轴突扭曲、变形、融合、挤压、缺损、破裂致轴浆内容物外流或缺失、错位、神经微丝与微管偏向轴索一侧等。结论 网状结构严重广泛性神经轴索损伤与对机体的致命性有着重要关系。     

周围神经损伤后高压氧治疗的病理观察

为了观察高压氧对神经损伤后的治疗作用,80只大鼠用于此实验,实验组40只,对照组40只。用无齿蚊式钳造成右侧坐骨神经轴索断裂伤,伤后实验组行高压氧治疗。术后2～8周活杀取材行Roger法染色观察轴索再生;Loyez法染色观察髓鞘再生及透射电镜观察超微结构。结果表明实验组神经纤维再生明显优于对照组。提示:高压氧能促进神经间质水肿的吸收,改善组织缺氧状态;高压氧能加速雪旺氏细胞的增生,促进神经纤维的再生。     

脑弥漫性轴索损伤的CT诊断

弥漫性轴索损伤（DAI）是头部加速运动引起的脑白质轴索广泛性损伤。我们报告18例脑弥漫性轴索损伤，提出DAI的CT诊断标准；大脑皮髓质交界处、基底地内囊区域、胼胝体、脑干或小脑一个或多个直径≤2cm的出血灶和／或脑室内出血，无明显颅内血肿和挫裂伤；或CT仅提示急性弥漫性脑肿胀，蛛网膜下腔出血，但伤后原发性持久昏迷，无脑缺氧情况。在384例急性脑外伤中，CT诊断DAI18例。对DAI的发病机理、CT表现的病理基础及诊断标准、CT表现与临床的关系进行了讨论。     

弥漫性轴索损伤磁敏感加权成像的实验研究

目的:用磁敏感加权成像(SWI)观察大鼠弥漫性轴索损伤(DAI)后的变化规律。方法:采用液压颅脑损伤模型制备32只DAI的SD大鼠模型,并于模型制作前、DAI后6h和24h分别进行常规磁共振成像和SWI成像(GE 3.0T超导磁共振成像仪)。比较各序列图像上DAI病灶检出数,在各时间点SWI图像上测量双侧皮髓质交界处感兴趣区(ROI)的相位弧度值,并分析其变化规律。结果:SWI对DAI病灶的检出率显著高于常规的MRI序列(P<0.05)。伤后6h,骨窗侧出血灶相位弧度值较致伤前变为负值;对侧相位值升高,差异有统计学意义(P<0.05),伤后24h,DAI鼠出血灶部位的相位弧度值较伤后6h相位弧度值变化差异无统计学意义(P>0.05);结论:磁敏感加权成像(SWI)检出弥漫性轴索损伤病灶的敏感性高于常规MRI序列,相位弧度值的变化反映了DAI的宏观变化过程,其变化规律与顺磁性物质有关。     

大鼠弥漫性轴突损伤早期淀粉样前体蛋白(β-APP)表达的实验研究

目的 观察大鼠弥漫性轴突损伤（DAI）早期脑内各部位淀粉样前体蛋白（β-APP）表达的变化。方法 应用瞬间旋转致伤装置使16只SD大鼠发生DAI，并于伤后3h、6h分批处死（每时间点8只），另取8只大鼠作为正常对照，在24h后处死。取各组大鼠脑标本进行免疫组织化学观察，检查损伤后早期不同时间皮质下白质、海马、胼胝体、脑干区域的病理学改变。各部位（胼胝体、海马、脑干）的切片在显微镜下（200倍）进行半定量分析。结果 损伤后3h，大脑皮质下白质、胼胝体和脑干β-APP呈弱阳性表达；损伤后6h，轴突局部免疫反应阳性较前明显增强，范围增大，半定量分析显示，胼胝体、海马、脑干的免疫反应均强于3h组。结论 β-APP在DAI早期（伤后3h）即有明确表达，并呈逐渐增强趋势，可作为DAI早期的标志物。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).