重度放烧复合伤大鼠创面处理的实验研究

本文用不同方法对重度放烧复台伤大鼠创面进行了处理。结果显示, 伤后24小时植自体皮、异体皮或伍加输血时, 30天活存率和胸腺及脾细胞功能的恢复程度, 均显著高于对照组, 也高于单给Zn(SD)₂保痴或AgSD及zn(sD)₂保痂植皮组。但伤后7天植皮的动物25天内全部死亡。伤后1天, 痂下和内脏均未捡出细菌, 3～15天, 对照组内脏检出率随痴下增加而升高, 但24小时植皮组仅创面检出2例。这说明伤后24小时切痂植皮时效果最好, 主要因及早消除创面, 使感染减轻、免疫功能改善而有利于提高疗效。但极期应严禁切痂植皮。     

骨髓移植前输血对不同剂量全身照射大鼠的影响

本文以8～12Gy γ线孵射大鼠,观察了照射前输血对BMT的影响。输血+BMT组于照后7～10天WBC数上升者占97%,而FMT组占85%。两组于BMT后10、30和100天分批活杀取BMC染色体分析均见供体型细胞。9～11Gy照射时,见输血+BMT组90天活存率(72%)显著高于BMT组(41%)。8Gy照射前输血时,BMT和IBMT+植皮的两组30天活存率均为1 00%,90天活存率分别为93%和5%。移植的皮肤20天开始长毛,30天全部长毛,180天仍然蹙康。这些结果表明:BMT前输血有提高BMC植入和移植面耐受性的作用;BMT和BMT+植皮前输血效果一致;辐射量8～11Gy TBI移植显效,11Gy组差。并讨论了照前输血BMT的显效特点。     

放射损伤、烧伤及放烧复合伤大鼠几种免疫功能的变化

本文研究了放射损伤(6Gy)、烧伤(15%Ⅲ^。)及放烧复合伤大鼠几种免疫功能的变化特点。放射组于伤后24～72小时胸腺及脾细胞受抑程度最重；7天开始恢复。烧伤组胸腺细胞受抑程度明显低于放射组, 且恢复快。复合伤组效应特点如下：(1)与放射组相比, 胸腺细胞受抑深。恢复慢;(2)脾细胞受抑过程与放射组相似, 但早期(24～77小时)脾细胞受抑程窒明显重于放射组;(3)复合伤后期, T_H细胞的恢复水平低于放射组;(4)复合伤后24小时切痂植皮有助于胸腺和脾细胞功能恢复。结果表明。复合伤后免疫功能受抑制和恢复慢, 与烧伤创面有关。     

放射损伤和复合烧伤恢复期贫血发生的原因

本实验使用520只大鼠, 分别给以⁶⁰Coγ线照射, 凝固汽油燃烧背部皮肤及两种损伤的复合, 经过简易治疗使动物进入恢复期。于伤后30天将各组活存的贫血动物予以活杀进行各项检查, 探讨放射损伤及复合烧伤恢复期贫血发生的原因。结果表明, 大鼠重度放射损伤及复合重度烧伤, 活存动物贫血发生率蘧着放射损伤破复含烧伤伤情的加重而增高, 放烧组明显高于对应的单放组。单烧组贫血率发生较低、在恢复期红系祖细胞生成的抑制, 骨髓基质细胞损伤修复的延缓以及红细胞可能在脾脏破坏的增多等因素与贫血发生有密切的关系。     

大鼠高原严重烧伤后早期小肠损伤的病理变化及复方红景天参芪花粉对其保护作用

目的：探讨高海拔地区(3480m)大鼠严重烧伤(30％Ⅲ度)后小肠病理变化以及复方红景天参芪花粉对其影响;方法：建立高原烧伤大鼠模型,156只大鼠随机分为烧伤试验组(72只),烧伤对照组(72只),正常组(12只),试验组伤前灌胃给药,其余给盐水。伤后3h、6h、12h、24h、48h和72h等6个时相点剖腹取出小肠一段,10％福尔马林固定,常规石蜡包埋切片,陋染色;结果：烧伤对照组伤后3h即出现小肠粘膜充血水肿,伤后6h～24h肠粘膜细胞变性。纹状缘消失,继而上皮细胞糜烂,但病变极少累及粘膜下层,伤后48h～72h上述病变更趋明显,固有膜内可见出血灶,粘膜下充血水肿。烧伤试验组：伤后3h小肠粘膜有轻度水肿,伤后6h～24h固有膜内少许粒细胞、淋巴细胞浸润,粘膜上皮未见明显变性糜烂。伤后48h～72h肠粘膜充血水肿减轻;结论：复方红景天参芪花粉制剂对大鼠高原严重烧伤后的小肠损害有显著的保护作用。     

放烧复合伤植皮对创面细菌侵入性感染的影响

本文研究了大鼠受6Gy全身照射复合15%Ⅱ度烧伤后24h切痂移植自体瘦对其创面细菌侵入性感染的影响．伤后24h,对照组细菌仅限于痂上和痂内．3天已侵入痂下;7～15天细菌大量繁殖．菌量均大于1×10⁵cfu／g,内脏细菌感染发生率随痂下菌量增加而升高,而植皮组随创面菌量减少而降低．结果表明,放烧复合伤早期切痂植皮封闭剖面有减少或防止痂下感染及侵入性感染的作用．     

大鼠高原严重烧伤后早期心肌损伤的病理变化及复方红景天参芪花粉对其保护作用

目的：探讨高海拔地区(海拔3480m)大鼠严重烧伤(30％Ⅲ度)后心肌病理变化及复方红景天参芪花粉对其影响；方法：建立烧伤模型，156只大鼠随机分为烧伤试验组(72只)，烧伤对照组(72只)，正常组(12)只，试验组伤前灌胃给药，其余给盐水；伤后3h、6h、12h、24h、48h、72h6个时相点剖腹取心脏，10％福尔马林固定，常规石蜡包埋切片，脏染色；结果：烧伤对照组伤后3小时心肌间质增宽，充血，伤后6h～24h心肌纤维可见颗粒变性，并可见“波浪纤维”；伤后48h～72h心肌仍持续出现灶性凝固性坏死和溶解坏死，少量肌纤维断裂；烧伤试验组：伤后3h心肌问质轻度水肿，伤后6h～24h心肌纤维仅有部分颗粒变性，未见空泡变性；伤后48h～72h，仍有间质充血水肿，未见肌纤维断裂：结论：复方红景天参芪花粉对大鼠高原严重烧伤后的心肌损害有显著保护作用。     

高原复合冲击伤伤情特点的研究

目的探讨猪高原复合冲击伤的伤情特点。方法将30只猪分为5组,每组各6只,于海拔3 500m处分别复制单纯冲击伤、15%体表面积Ⅱ°烧伤、一侧后肢高速弹片伤、烧冲复合伤和弹冲复合伤模型。用PCB公司生产的压力传感器测定冲击波的物理参数,观察伤后28小时动物活存情况和大体形态学改变。结果单纯烧伤组和单纯弹片伤组动物全部活存,均未见明显形态学改变。单纯冲击伤组可见中度肺出血和轻度肠道浆膜下出血,且动物均全部存活。烧冲复合伤组和弹冲复合伤组肺出血加重,半数动物(3/6)为重度肺出血,同时伴中度肺水肿,肠道未见加重效应。烧冲复合伤组2只动物分别于伤后16、10小时死亡,弹冲复合伤组1只动物于伤后3小时死亡。结论高原复合冲击伤与单纯冲击伤相比,具有伤情更重,死亡率更高的特点,加重效应的器官主要为肺脏,加重的程度大致为一个等级。     

Bcl-2基因转染胰岛细胞移植的实验研究

目的探讨Bcl-2基因转染胰岛细胞同种移植治疗糖尿病大鼠的效果。方法腺病毒介导胰岛细胞的Bcl-2基因转染,以表达Bcl-2的胰岛细胞经门静脉肝内移植治疗链脲菌素诱导的糖尿病大鼠。通过观察受体大鼠的血糖变化和组织学改变来了解排斥反应和移植物的功能。结果胰岛细胞植入后48h内,基因转染组和未转染组糖尿病大鼠血糖均有明显下降。与未转染组比较,基因转染组大鼠移植物存活有效时间明显延长(16·4±4·3天vs6·8±2·2天,P<0·05),移植部位可见到结构和功能完好的胰岛细胞,局部炎性反应也明显减轻。结论胰岛细胞的Bcl-2基因转染对移植物的存活和功能有保护作用。     

氧自由基-线粒体信号通路在Edaravone治疗创伤性脑创伤中的作用

目的 探讨创伤性脑损伤(traumatic brain injury,TBI)后在抗氧化剂Edaravone干预下大鼠大脑皮质凋亡相关蛋白表达改变情况并探讨氧自由基-线粒体信号通路在Edaravone治疗创伤性脑创伤中的作用.方法 成年雄性SD大鼠180只随机分为TBI组、Edaravone治疗组和对照组.每组设伤后1,3,6,24,48,72 h 6个时相点.Edaravone治疗组给予Edaravone(10 mg/kg),对照组、TBI组给予等量等渗盐水.HE染色观察大鼠TBI后皮层神经元的病理改变.免疫组化和TUNEL法以及硫代巴比妥酸缩合法观察不同时相点大鼠皮层Cyt-c、Bcl-2和Bax的表达情况,细胞凋亡和丙二醛(MDA)变化情况.结果 HE染色可见创伤后6 h大脑皮质出现散在变性坏死神经元,伤后24 h达高峰.Edaravone治疗组伤后6 h即可检测到自由基中间产物丙二醛(MDA)的升高,与对照组相比,48 h达高峰.与TBI组相比,MDA含量各时相点均降低,其中在24,48和72 h差异有统计学意义(P＜0.05).与对照组相比,TBI组Cytc阳性细胞免疫反应6 h增强,24 h达高峰,在3,6,24,48和72 h差异有统计学意义(P＜0.05).与TBI组相比,Edaravone治疗组Ctyc阳性细胞免疫反应在24,48和72 h降低.Bcl-2表达在伤后应激性增高,于3 h达高峰,以后逐渐下降.Bax在伤后表达逐渐增高,于48 h达高峰,Bax/Bcl-2于48 h达高峰.TBI后,TUNEL阳性细胞数逐渐增多,24 h以前以TUNEL Ⅰ型细胞为主,24 h后以Ⅱ型细胞为主,并于48 h达高峰.结论 大鼠TBI后皮质神经细胞死亡存在坏死和凋亡两种方式,以凋亡为主.氧自由基-线粒体是TBI后神经细胞凋亡的信号转导通路中的一条.Edaravone对TBI有治疗作用.     

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     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.