补阳还五汤对大鼠局灶性脑缺血损伤的长期保护作用

目的：观察补阳还五汤对大鼠脑缺血损伤后感觉运动功能和脑损伤的长期影响。 方法：实验于2005-06／08在浙江中医学院实验动物中心完成。①取33只健康雄性SD大鼠，随机分为3组：补阳还五汤组（n=12）、缺血组（n=11）和假手术组（n=10）。前2组采用线栓法诱导大鼠大脑中动脉阻塞模型：假手术组只分离血管，不插栓线。补阳还五汤组：从缺血前7天开始按13.3g/kg剂量灌服补阳还五汤水煎剂（补阳还五汤处方来源于《医林改错》，成分：黄芪120g，当归6g，川芎4．5g，赤芍4．5g，地龙3g，红花3g，桃仁3g，药材购自浙江中医学院附属门诊部并经鉴定，煎2次，40min／次，合并后浓缩为含生药2g／mL），持续到缺血后14d，1次／d；其余各组同时灌等量生理盐水，干预时间同补阳还五汤组。②通过肢体放置实验[包括7个步骤。评分标准：正常，2分；延迟（2s）和／或不完全，1分；不反应，0分]在缺血后1-7，10，14，21和28d评价前后肢对触觉和本体感觉的反应。通过横木行走实验（用噪音刺激大鼠跨过横木。评分标准：大鼠不能呆在横木上，0分；大鼠能呆在横木上但不动，1分；大鼠试图跨过横木但摔下，2分；大鼠跨过横木．但损伤的后肢滑落次数超过50％，3分；超过1次但不到50％，4分；仪滑落1次，5分；顺利通过，6分）评价运动的协调和整合缺损。通过祜胶揭除实验（评分标准：1分为≤10s；2分为10-19s；3分为20-29s：4分为30-39s；5分为40-49s；6分为50～59s；7分为≥60s）评价躯体感觉功能。2块同面积的医用胶布分别贴在两前肢腕部腹侧面作为触觉刺激，记录大鼠揭除胶布的潜伏期.③缺血后第29天处死大鼠，取脑，冠状冰冻切片，采用甲苯胺蓝染色测定梗死体积。④肢体放置和横木行走实验结果差异比较采用非参数Mann-Whitney U检验，黏胶揭除实验结果和梗死体积差异比较采用单因素方差分析。 结果：大鼠33只均进入结果分析。①肢体放置实验评分：缺血后1—10，14，21，28d缺血组明显低于假手术组（u=0-9，P〈0．01）。补阳还五汤组大鼠在缺血后1～7，10，14d明显高于缺血组（u=4．5-35，P〈0．05-0．01）。②横木行走实验评分：缺血后1～7d缺血组明显低于假手术组（u=0-10，P〈0．05～0．01）。缺血后1～3d补阳还五汤组明显高于缺血组（u=26．5～31，P〈0．05）。③黏胶揭除实验评分：缺血后1，7，14，21，28d缺血组明显高于假手术组（t=2．56～21．91，P〈0．05-0．01）。缺血后1，7，14，21d补阳还五汤组明显低于缺血组（t=2．36-3．88，P〈0．05-0．01）。④脑梗死体积：缺血后29d，补阳还五汤组明显小于缺血组[（9．5&;#177;25），（123&;#177;22）mm^3，t=2．75，P〈0．05]。 结论：补阳还五汤能显著改善脑缺血大鼠长期感觉运动功能，减轻脑损伤。     

补阳还五汤对大鼠脑缺血后蛋白激酶B1和c-Jun氨基末端激酶1/2表达的影响

目的探讨补阳还五汤对脑缺血后大鼠蛋白激酶B1（AKT1）和c-Jun氨基末端激酶1/2（JNK1/2）的影响。方法将48只SD大鼠按随机数字表法分为正常对照组、假手术组、模型组、补阳还五汤组,每组12只。采用大脑中动脉闭塞法（MCAO）建立右侧局灶性脑缺血大鼠模型。补阳还五汤组大鼠于术后2h起灌服补阳还五汤（主要由生黄芪120g、当归6g、赤芍4.5g、川芎3g、西红花3g、桃仁3g、广地龙3g组成）14.2 g/kg,每日1次,连续7 d。其他各组动物均给予等体积生理盐水。于第7日处死大鼠,取脑组织,采用逆转录-聚合酶链反应（RT-PCR）测定AKT1 mRNA表达,采用免疫组化法检测JNK1/2蛋白表达。结果与正常对照组和假手术组比较,模型组AKT1 mRNA表达量〔吸光度（A）值〕明显降低（0.48±0.08比0.63±0.11、0.61±0.09,均P＜0.05）,JNK1/2阳性细胞数（个/mm2）明显增多（34.13±4.57比16.15±1.09、16.23±2.05,均P＜0.05）;与模型组比较,补阳还五汤组脑组织中AKT1 mRNA表达（0.93±0.11）和JNK1/2阳性细胞数（45.04±5.68）明显增加,差异均有统计学意义（P＜0.05或P＜0.01）。结论补阳还五汤可上调缺血脑组织AKT1 mRNA和JNK1/2阳性细胞数表达,是其脑保护作用机制之一。     

补阳还五汤对大鼠局灶性脑缺血后神经干细胞影响的初步研究

目的：观察中药补阳还五汤对大鼠局灶性脑缺血后内源性神经干细胞(neural stem cells，NSC)反应的影响探讨其可能机制。．方法：84只雄性SD大鼠随机分为假手术组、模型组、补阳还五汤组，采用线栓法复制大鼠脑缺血模型，分别给予不同处理，于术后12h，1，3，5，7d处死动物，运用免疫组织化学方法检测脑缺血后各组NSC的激活。另取5只大鼠为正常对照组。结果：正常大鼠脑组织中存在少量NSC，主要分布在皮质区；脑缺血后，NSC增殖，以皮质、缺血周围区增加明显，健侧海马区可见NSC激活；1d开始增多，5d达高峰，模型组1，3，5，7dNSC数分别为(10．3&;#177;1．3)，(14．2&;#177;1．7)，(18．3&;#177;1．2)，(16．4&;#177;1．6)个，补阳还五汤则分别为(10．8&;#177;1．1)，(15．4&;#177;1．4)，(23．5&;#177;1．1)，(22．0&;#177;1．4)个，两组比较NSC数在5，7d时间点差异有非常显著性意义(P&;lt;0．01)。’结论：局灶性脑缺血后，NSC激活、增殖。补阳还五汤能促进NSC的增殖。     

活血化瘀类方剂对局灶性脑缺血损伤的作用比较

目的：探讨活血化瘀类方剂血府逐瘀汤、通窍活血汤、补阳还五汤、桃红四物汤对脑缺血损伤的保护作用。方法：检测大鼠大脑中动脉缺血后3，6h脑组织匀浆及血清超氧化物歧化酶(superoxide dismutase，SOD)，丙二醛，一氧化氮，Na^+-K^+ ATP酶的变化及活血化瘀4古方对其影响并比较4种古方抗脑缺血损伤的作用。结果：血府逐瘀汤、通窍活血汤、补阳还五汤能提高脑缺血损伤大鼠SOD，Na^+-K^+ ATP酶的活性，降低丙二醛、一氧化氮的含量(P&;lt;0．05，0．01)，其作用补阳还五汤比通窍活血汤、血府逐瘀汤强(P&;lt;0．05，0．01)。病理损伤程度：血府逐瘀汤，通窍活血汤组和补阳还五汤组大鼠脑组织病理损伤与对照组比较均较轻，补阳还五汤组(通窍活血汤组(血府逐瘀汤组。结论：补阳还五汤、通窍活血汤、血府逐瘀汤有抗脑缺血损伤作用，对缺血大鼠脑有保护作用。以补阳还五汤作用最强，通窍活血汤次之，血府逐瘀汤较弱。     

补阳还五汤对脑出血大鼠脑内Flt-1和Flk-1蛋白表达的影响

目的：探讨补阳还五汤对脑出血大鼠脑内血管内皮生长因子受体VEGFR-1（Flt-1）和VEGFR-2（Flk-1）蛋白表达的影响。方法：SD大鼠90只，分为3组各30只，模型组及补阳还五汤组（中药组）采用Ⅶ型胶原酶诱导大鼠脑出血模型，假手术组（对照组）作为正常对照。术后中药组用补阳还五汤灌胃。3组均采用Westernblot法分析脑内Flt-1和Flk-1蛋白表达。结果：对照组未见Flt-1和Flk-1蛋白表达；模型组造模后1dFlt-1和Flk-1开始表达，持续增高至21d；中药组补阳还五汤干预后7、14及2ld时Flt-1和Flk-1蛋白表达均高于模型组（P〈0．01），Flt-1于21d达高峰，Flk-于14d达高峰（均P％0．01）。结论：补阳还五汤能增强脑出血大鼠脑Flt-1和Flk-1蛋白表达，以促进脑组织修复。     

补阳还五汤对大鼠局灶性脑缺血后神经干细胞影响的初步研究

目的:观察中药补阳还五汤对大鼠局灶性脑缺血后内源性神经干细胞(neuralstemcells,NSC)反应的影响探讨其可能机制。方法:84只雄性SD大鼠随机分为假手术组、模型组、补阳还五汤组,采用线栓法复制大鼠脑缺血模型,分别给予不同处理,于术后12h,1,3,5,7d处死动物,运用免疫组织化学方法检测脑缺血后各组NSC的激活。另取5只大鼠为正常对照组。结果:正常大鼠脑组织中存在少量NSC,主要分布在皮质区;脑缺血后,NSC增殖,以皮质、缺血周围区增加明显,健侧海马区可见NSC激活;1d开始增多,5d达高峰,模型组1,3,5,7dNSC数分别为(10.3±1.3),(14.2±1.7),(18.3±1.2),(16.4±1.6)个,补阳还五汤则分别为(10.8±1.1),(15.4±1.4),(23.5±1.1),(22.0±1.4)个,两组比较NSC数在5,7d时间点差异有非常显著性意义(P<0.01)。结论:局灶性脑缺血后,NSC激活、增殖,补阳还五汤能促进NSC的增殖。     

补阳还五汤对沙土鼠脑缺血后迟发性神经元坏死脑？…

目的：研究补阳还五汤抗脑缺血后迟发性神经元坏死（ＤＮＮ）作用与一氧化氮（ＮＯ）和一氧化氮合酶（ＮＯＳ）的关系。方法：采用沙土鼠双侧颈总动脉夹闭脑缺血－再灌注模型,于再灌注后４８小时取前脑皮质测定ＮＯ和ＮＯＳ。结果：缺血－再灌注后４８小时脑组织ＮＯ含量和ＮＯＳ活性降低。腹腔注射补阳还五汤可增加缺血－再灌注４８小时后脑组织ＮＯ含量,提高ＮＯＳ活性。结论：脑缺血后ＤＮＮ与及脑内ＮＯ的生成减少有一定的关系     

补阳还五汤对大鼠脑缺血后白细胞介素-1β和肿瘤坏死因子-α表达的影响

目的 探讨补阳还五汤对脑缺血后大鼠脑组织白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)表达的影响.方法 按随机数字表法将SD大鼠分为正常对照组、假手术组、模型组、补阳还五汤组,后3组再按给药后1、3和7 d分为亚组,每组5只.采用大脑中动脉闭塞法(MCAO)建立右侧局灶性脑缺血大鼠模型;补阳还五汤组于术后2 h起灌服补阳还五汤10 ml/kg(14.2 g/kg)、每日1次.分别于相应时间点处死大鼠后取脑组织,采用酶联免疫吸附法(ELISA)和逆转录-聚合酶链反应(RT-PCR)测定IL-1β和TNF-α的蛋白及mRNA表达.结果 正常对照组和假手术组有低水平的IL-1β和TNF-α蛋白及mRNA表达.模型组IL-1β、TNF-α蛋白及mRNA表达于给药后1 d开始升高,IL-1β蛋白及mRNA表达在3 d时达高峰后开始下降,TNF-α蛋白及mRNA表达于7 d达高峰.与模型组比较,补阳还五汤组给药后1、3和7 d脑组织中IL-1β和TNF-α蛋白及mRNA表达均明显下降[IL-1β蛋白(ng/L),1 d:90.290±8.693比102.556±13.934,3 d:129.632±11.050比150.117±8.552,7 d:66.185±9.020比91.362±9.901;TNF-α蛋白(ng/L),1 d:210.341±19.247比236.887±20.137,3 d:267.503±21.006比322.659±15.068,7 d:299.637±17.717比386.678±16.297;IL-1β mRNA,1 d:0.54±0.09比0.64±0.11,3 d:0.80±0.06比0.89±0.07,7 d:0.70±0.09比0.78±0.08;TNF-α mRNA,1 d:0.64±0.09比0.73±0.11,3 d:0.74±0.13比0.85±0.07,7 d:0.82±0.07比0.93±0.08],差异均有统计学意义(P＜0.05或P＜0.01).结论 补阳还五汤可能通过下调缺血脑组织IL-1β和TNF-α的蛋白及mRNA表达来调控炎症因子的释放,从而起到脑保护作用.     

补阳还五汤预处理对脑缺血再灌注损伤沙鼠VEGF和Ang-1表达的影响

目的探讨补阳还五汤预处理对局灶性脑缺血再灌注沙鼠脑组织血管内皮生长因子(VEGF)和血管生成素-1(Ang-1)表达的干预作用。方法 45只雄性长爪沙鼠随机分为假手术组、脑缺血模型组、补阳还五汤预处理组,每组15只。采用线栓法制作脑缺血再灌注损伤模型。2,3,5一氧化三苯基四氮唑(TTC)染色法显示脑梗死区域,免疫组化法检测脑组织VEGF和Ang-1的表达。结果 TTC染色显示模型组及补阳还五汤预处理组均出现白色梗死灶,位于颞顶叶皮质和纹状体,补阳还五汤组脑梗死体积较模型组明显减小(P<0.05);免疫组化结果显示,补阳还五汤预处理组VEGF和Ang-1表达较模型组均显著上升(P<0.01)。结论补阳还五汤预处理可通过上调脑缺血后VEGF和Ang-1的表达,促进缺血区脑组织的血管新生。     

补阳还五汤对脑缺血大鼠经侧脑室移植神经干细胞存活和分化的影响

目的 探讨补阳还五汤对大鼠脑内移植神经干细胞(NSCs)治疗局灶性脑缺血的影响.方法 分离培养新生大鼠海马NSCs,用5-溴-2-脱氧尿嘧啶核苷(BrdU)进行标记.采用大脑中动脉线栓法复制脑缺血模型;将实验大鼠随机分为模型组、空白移植组、单纯移植组和移植加中药组,移植组大鼠术后3 d向脑室注射10 μl NSCs细胞悬液,空白移植组则注射等量生理盐水.于移植前及移植后7、14、28 d观察神经功能评分,相应时间点处死大鼠后用免疫组化法检测移植细胞存活情况,用荧光双标记免疫组化法检测BrdU和神经丝蛋白200(NF200)双阳性细胞数.结果 单纯移植组大鼠神经功能明显得到恢复,在14 d和28 d与模型组比较差异有统计学意义(P均<0.05);移植加中药组则提前到7 d(P均<0.05);模型组与空白移植组比较神经功能评分差异无统计学意义.镜下观察NSCs能移行至缺血部位并存活,移植加中药组存活和新生细胞在14 d和28 d与单纯移植组比较差异有统计学意义(P<0.05或P<0.01).结论 联合使用补阳还五汤能促进脑缺血后移植NSCs的存活,提高新生神经元数量,促进神经功能的恢复.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.