汉防己甲素抑制鼠角膜新生血管VEGF、TGF-β的实验研究

目的探讨汉防己甲素（tetrandrine,Tet）对大鼠角膜新生血管（corneal neovascularization,CNV）中血管内皮生长因子（vascular endothelial growth factor,VEGF）与转化生长因子-β（transforminggrowthfactor,TGF-β）表达的影响。方法碱烧伤法制作大鼠角膜新生血管模型,采用裂隙灯照相和免疫组化等方法,分别观察Tet组与其他对照组模型大鼠角膜新生血管每天的生长状况及检测各组模型大鼠角膜中VEGF和TGF-β在各时期的表达情况。结果 Tet组模型大鼠角膜新生血管及VEGF和TGF-β的表达情况均较对照组有显著变化。结论 Tet能有效抑制碱烧伤诱发的大鼠角膜新生血管,同时降低新生血管中VEGF和TGF-β的表达。     

大肠癌组织血管内皮生长因子及其受体的表达与肿瘤血管生成的关系

为探讨血管内皮生长因子（VEGF）及其受体（KDR）的表达与人大肠癌组织血管生成的关系，采用免疫组织化学SABC法观察了68例人大肠癌组织中的VEGF及KDR的定位与分布，并对血管进行染色及计数。结果显示，68例大肠癌组织中VEGF表达阳性率为55．9％（38／68），阳性物质阳性物质主要位于肿瘤细胞胞膜及胞浆；KDR表达阳性率为45．6％（31／68），既可位于癌组织及癌组织旁的血管内皮细胞，又可位于肿瘤细胞胞膜及胞浆。VEGF表达与大肠癌Dukes分期密切相关。VEGF表达阳性大肠癌组织的微血管密度（MVD）显著高于VEGF表达阴性者（P＜0．01），而且随着VEGF表达强度的增强，癌组织内微血管密度明显增加（P＜0．01）。结果提示，大肠癌细胞分泌的VEGF既可以旁分泌的形式促进肿瘤血管的生成，也可能存在着自分泌形式；VEGF与大肠癌的生长、浸润和转移密切相关，是大肠癌主要的血管新生诱导因子之一，可促进大肠癌的血管生成。     

尾悬吊模拟失重大鼠肺组织VEGF mRNA的研究

为研究尾悬吊模拟失重大鼠肺组织血管内皮生长因子（VEGF）mRNA的变化，采用尾悬吊模拟失重，分为悬吊7天和21天及相应同步对照共4组，每组10只健康雄性SD大鼠，并采用原位杂交技术检测肺组织的VEGF mRNA表达情况。发现同正常对照组相比，7天尾悬吊模拟失重大鼠肺组织VEGF mRNA的表达水平明显增高（P＜0．05），且21天悬吊组模拟失重大鼠肺组织VEGF mRNA的表达水平仍较高（P＜0．05），但同7天悬吊组相比增高程度已明显降低。提示在模拟失重条件下肺组织VEGF的表达水平增高。     

乙型肝炎肝组织血管内皮生长因子的表达变化

目的研究血管内皮生长因子（VEGF）表达与乙型肝炎（HB）肝血管增生及肝纤维化的关系.方法从人肝组织提取VEGF总RNA,经RT-PCR扩增取得VEGF mRNA基因探针,对160例HB肝组织（HB组）及10例正常肝组织（对照组）的VEGF mRNA作了定位观察,同时对VEGF表达变化进行了检测.结果原位杂交显示,对照组VEGF mRNA阴性.HB组VEGF mRNA定位于肝窦、狄氏腔及扩张的肝窦周围肝细胞胞质;而VEGF则有胞质、膜窦、窦内皮3种形态,其表达强度、分布范围与HB分级分期、肝血管炎症、破坏、阻塞、增生及纤维化呈同步关系,不同肝病变之间差异显著（P＜0.01）.结论肝组织VEGF表达增强可促进肝血管生成及肝窦毛细血管化.     

拮抗血管内皮生长因子对骨折愈合影响的实验研究

为探讨拮抗血管内皮生长因子（VEGF）对骨折愈合的影响，制作兔左桡骨中段骨折模型，给实验组动物在3周内应用VEGF多克隆抗体（400ng腹腔注射，每3天1次），分别于伤后1、3、5、8周摄骨折部位X线片，并取骨折端标本脱钙进行光镜及电镜观察。结果显示，实验组动物伤后初期骨细胞坏死增多，虽然伤后72h骨折端成纤维细胞出现增生现象，但1－5周骨折端均有灶性坏死出现，3周时骨折部位血管生成明显减少，电镜下发现骨折端成纤维细胞和成骨细胞细胞器存在变性，伤后第8周骨折端以纤维组织连接为主。X线片上见骨不连样改变。提示骨折端VEGF表达障碍可能是导致骨不连的重要原因之一。     

管内皮抑制素对125I近距离照射裸鼠肺癌移植瘤的增敏效应研究

目的 探讨重组人血管内皮抑制素对125I粒子植入治疗裸鼠肺癌移植瘤模型的辐射增敏效应。 方法 建立裸鼠移植瘤模型,随机分成对照组（A组）、125I植入组（B组）、重组人血管内皮抑制素组（C组）和125I植入联合重组人血管内皮抑制素组（D组）,每组20只。移植瘤直径达2 cm时行125I粒子植入,处方剂量20 Gy,采用治疗计划系统计算移植瘤的体积及接受剂量。按每只裸鼠每天给予20 mg/kg重组人血管内皮抑制素,连续给药14 d,观察并记录肿瘤生长的速度和瘤体体积的变化,分别于第15、30天时处死裸鼠,并通过免疫组化方法检测血管内皮生长因子（VEGF）的表达和微血管密度（MVD）,通过RT-PCR分别检测各组肿瘤组织中αvβ3 mRNA水平。 结果 第15、30天时,D组的重量抑瘤率和体积抑瘤率与B、C组相比明显增加,差异有统计学意义,B组和D组第30天时的重量抑瘤率和体积抑瘤率均较第15天时明显增加,差异有统计学意义。免疫组化结果显示,第15、30天时,D组与A、B、C组VEGF、MVD差异均有统计学意义,其中,C组与A、B组VEGF、MVD差异有统计学意义,C组第30天时的VEGF表达水平和MVD较第15天时增加,差异有统计学意义。RT-PCR结果显示,第15、30天时,与A组相比,B组αvβ3 mRNA的表达有所增加,并随时间的延长增加更明显,差异有统计学意义,而C组和D组αvβ3 mRNA的表达下降,差异有统计学意义。 结论 重组人血管内皮抑制素对肺癌移植瘤的近距离辐射增敏作用明确,VEGF、MVD、αvβ3 mRNA的表达变化是其重要机制。     

移植成血管基因修饰MSCs改善心肌梗死大鼠左室血流动力学参数的研究

目的探讨大鼠心肌梗死模型缺血心肌局部移植血管内皮生长因子（vascular endothelial growth factor,VEGF）修饰的骨髓间充质干细胞（mesenchymal stem cells,MSCs）对左室血流动力学参数的影响。方法 Percoll液密度梯度离心法分离、贴壁培养Wistar近交系大鼠MSCs,真核表达载体pcDNA3.1（-）/hVEGF165转染MSCs。30只Wistar近交系大鼠随机均分为转染组（MSCs/VEGF组）、对照组（MSCs组）、无血清培养基组（DMEM组）。结扎前降支建立急性心肌梗死模型后在梗死区边缘区行5×106（40μl）细胞移植,DMEM组行等量培养基注射。移植前细胞行CM-DiI标记。移植1个月后行心脏B超测量EF值,经右侧颈内动脉左室内置管测量如下血流动力学参数：心率（heart rate,HR）、左室收缩末压（left ventricularend-systolic pressure,LVESP）、左室舒张末压（left ventricular end-diastolic pressure,LVEDP）、最大左室内压上升速率（＋dp/dtmax）、最大左室内压下降速率（-dp/dtmax）。大体标本组织行HE、Masson染色。结果培养的MSCs呈典型贴壁生长成纤维细胞样外观,CM-DiI能近100%标记MSCs。移植后1个月MSCs/VEGF组较其余两组LVEF、LVESP、LVEDP、＋dp/dtmax、-dp/dtmax值有显著性差异（P〈0.05）,大体标本HE、Masson染色染色病理变化亦明显优于其余两组。结论大鼠心肌梗死模型梗死心肌局部移植VEGF基因转染MSCs能显著改善左室血流动力学参数,进而改善心脏功能。     

腺病毒介导的VEGF-B基因促血管内皮细胞增殖作用的研究

为观察腺癌毒素介导的血管内皮细胞生长因子B（VEGF－B）基因体外转染对血管内皮细胞的促增殖作用，构建编码人VEGF－B基因的复制缺陷的重组腺病毒载体，体外转染鼠主动脉血管内皮细胞（RAECs），应用RT－PCR和Western blot检测外源VEGF－B的表达，应用四唑盐（MTT）观察转染后RAECs的增殖。结果发现，RAECs可有效地被重组腺病毒载体感染，并能成功转录和表达VEGF－B基因和蛋白，在转染后细胞培养上清中检测到VEGF－B蛋白的表达，对RAECs有显著促增殖作用。提示重组腺病毒载体介导的人VEGF－B基因有血管新生作用，可用于缺血性心脏病的治疗。     

人参皂苷Rg1对急性心肌梗死后VEGF和HIF-1α的作用

目的研究人参皂苷Rg1，对急性心肌梗死（AMI）后血管新生的影响及其作用机制。方法建立Wistar大鼠急性心肌梗死模型，104只大鼠分为假手术组、急性心肌梗死对照组、人参皂苷Rg1低剂量治疗组（1mg／kg）和高剂量治疗组（5mg／kg），于术后3、7、10、14天测定梗死区微血管密度，RT-PCR法检测梗死区心肌组织血管内皮生长因子（VEGF）和缺氧诱导因子1α（HIF-1α）mRNA，免疫组化法检测VFGF在梗死区内的表达。结果梗死区的血管生成数量稳定持续的增加，治疗组显著高于对照组（P〈0．01）；心肌梗死后VEGF、HIF-1α mRNA表达随缺血时间的延长（3、7、10天组）有增高趋势，治疗组明显升高（P〈0．01），14天时VEGF的增长出现停止或下降，而HIF-1α继续升高；假手术组VEGF表达明显低于各手术组。结论严重缺血可刺激心肌组织产生大量的VEGF、HIF-1α，其对缺血心肌起保护作用，人参皂苷Rg1可通过增加其表达而刺激心肌梗死区的血管生成和侧支循环建立。     

血管内皮生长因子转染放疗组织的研究

目的 用血管内皮生长因子基因转染的方法恢复放疗损伤区组织血管生成能力。方法以^60Co-γ射线照射大鼠右后肢，每次每只大鼠吸收剂量为2Gy，总吸收剂量为30Gy。照射结束后第1天，将重组质粒pcDNA／VEGF165转染大鼠右后肢照射区肌肉组织细胞，每次每只大鼠转染质粒200μg，共治疗2次，间隔2周，治疗结束后行VEGF165mRNA、VEGF蛋白、血管染色体视学图像分析及血管超微结构观察等检查。结果经重组质粒pcDNA3/VEGF165转染后，照射区组织VEGF165 mRNA及VEGF蛋白均明显增高，微血管密度、平均截面积、平均管径均达到正常组织水平，血管超微结构基本恢复正常。结论VEGF基因转染不仅有效地修复了组织血管放射损伤，而且还能恢复其血管生成能力，为临床应用提供了实验基础。     

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.     

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.     

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.