低剂量电离辐射对大鼠海马新生神经元树突生长发育的抑制作用

目的 观察电离辐射对幼年大鼠海马齿状回新生神经元树突生长发育的影响。方法 SD大鼠按随机数字表法分为照射组(20只)和健康对照组(20只),照射组给予单次2 Gy全脑照射。所有大鼠均予海马区立体定向注射反转录病毒标记新生神经元,免疫荧光染色观察照射后不同时间新生神经元树突形态的变化。结果 与健康对照组相比,照射组在照射后2周和4周新生神经元树突总长度、最长树突的长度均显著减少(t=3.10、2.07、2.94、4.02,P<0.05),神经元分支数在照射后2周显著减少(t=2.23,P<0.05)。照射后4周,海马区新生神经元数量显著降低(t=8.43,P<0.05)。结论 低剂量电离辐射可抑制幼年大鼠海马齿状回新生神经元的生长发育,这可能是射线致海马依赖的认知功能障碍发生的机制之一。     

獐牙菜苦苷对放射性肺损伤的防护作用

目的 探讨獐牙菜苦苷对电离辐射所致肺损伤的防护作用和机制。方法 实验将人支气管上皮细胞(Beas-2B)和人胚肺成纤维细胞(HELF)分为对照组、10 Gy X射线照射组、照射+獐牙菜苦苷组,检测獐牙菜苦苷对 X射线照射后的影响。检测射线暴露后细胞的乳酸脱氢酶(LDH)释放量、细胞的增殖情况、DNA损伤水平、活性氧(ROS)水平、脂质过氧化物水平、铁离子水平、铁死亡相关蛋白SLC7A11(xCT)及谷胱甘肽过氧化物酶(GPX4)含量变化。为了验证獐牙菜苦苷在体内对放射性肺损伤是否具有防护作用,建立放射性肺损伤小鼠模型,将C57BL/6J雄性小鼠分为对照组、照射组、照射+獐牙菜苦苷组,每组5只,对小鼠胸部进行15 Gy X射线照射,照射后30 d收集小鼠肺组织及血清。观察受照小鼠肺组织病理变化、肺组织氧化应激水平及肺组织中γ-H2AX、GPX4含量变化和炎性因子水平变化。结果 与照射组相比,照射+獐牙菜苦苷组(130 μmol/l)细胞的增殖率及克隆形成率明显上升(Beas-2B:t=5.50~5.92,P＜0.05;HELF:t=3.79~5.51,P＜0.05);LDH释放率、ROS含量、脂质过氧化物水平及铁离子含量显著降低(Beas-2B:t=3.00~16.99,P＜0.05;HELF:t=4.10~10.97,P＜0.05)。DNA损伤水平显著下降(Beas-2B:t=5.69~8.27,P＜0.05;HELF:t=3.44~14.77,P＜0.05)。xCT和GPX4蛋白表达发生上调(Beas-2B:t=2.90~3.27,P＜0.05;HELF:t=3.01~7.07,P＜0.05)。体内实验中,与照射组相比,獐牙菜苦苷预处理可有效提升小鼠肺组织中GSH和GPX4含量(t=2.31~2.65,P＜0.05),降低MDA和γ-H2AX含量(t=2.71~4.19,P＜0.05),同时降低小鼠血清中IL-6及IL-1β水平(t=3.16~4.56,P＜0.05)。结论 獐牙菜苦苷可以通过降低电离辐射诱导的DNA损伤和氧化应激水平,从而对电离辐射引起的肺损伤发挥防护作用,为研发新型放射性肺损伤防护剂提供思路。     

大鼠放射性脑损伤模型中Ca、Fe、Cu、Zn、Mg含量的变化及MgSO4的保护作用

目的 观察全脑照射后大鼠脑组织含水量、微血管损伤及海马组织中Ca、Mg、Cu、Fe、Zn含量的动态变化,探讨这些元素在放射性脑损伤(RBI)发病机制中的作用。方法 用随机数字表法将大鼠分为空白组、防护组(400 mg/kg体重腹腔注射10%MgSO₄溶液+单次全脑20 Gy电子束照射)和照射组(400 mg/kg体重腹腔注射生理盐水+单次全脑20 Gy电子束照射),每组18只,每个时间点3只。用干-湿重法测定脑组织含水量(BWC),HE染色观察脑组织微血管损伤程度,应用电感耦合等离子体发射光谱仪,定量分析大鼠脑放射性损伤后不同时间海马组织中Ca、Mg、Cu、Fe、Zn元素含量的动态变化。结果 照射组在照后7、14、30 d与空白组相比,脑含水量升高(t=-3.21、-2.11、2.82,P<0.05),防护组在照后7、14、30 d低于照射组(t=2.84、4.33、1.90,P<0.05)。RBI模型中出现微血管栓塞,防护组较照射组减轻。照射组Ca含量在照后各时间点及Fe含量在照后1、3、7 d与空白组相比含量升高(t=11.41、6.81、14.03、17.17、6.89、9.12和5.43、5.66、3.60,P<0.05),且照射组Ca含量在照后各时间点较防护组增加(t=5.35、5.28、11.02、14.26、5.68、9.10,P<0.05);照射组Cu含量在照后1、7、14、60 d及Zn含量在照后1、7、14、30、60 d低于空白组(t=4.24、3.76、4.76、3.86和5.25、4.78、26.53、6.67、11.37,P<0.05),防护组Cu含量在照后各时间点低于照射组(t=4.23、3.57、4.01、4.73、3.78、3.44,P<0.05),Zn含量在照后14 d高于照射组(t=6.21,P<0.05);照射组Mg含量在照后7 d降低(t=5.85,P<0.05)。结论 RBI模型中Ca、Fe、Cu、Zn含量失衡,补充MgSO₄可以纠正Ca、Fe、Cu、Zn含量的失衡,并可以减轻放射性脑损伤。     

电针穴位对受辐照小鼠认知功能和学习记忆的影响

目的 观察电针百会、风府和双侧肾俞穴位对射线照射模型小鼠认知及空间学习记忆能力的影响。方法 100只30 d龄C57BL/6J小鼠按随机数字表法分成对照组、模型组(4、8和16 Gy)、电针非穴位组(4、8和16 Gy)、电针穴位组(4、8和16 Gy),每组10只。不同剂量射线照射(4、8和16 Gy)建立小鼠放射性脑辐射损伤模型,电针治疗3个疗程。测定小鼠体重进行一般状况评价,旷场实验测试小鼠认知功能,Morris水迷宫实验测试空间学习记忆能力。结果 照后7和14 d,与对照组比较,模型组(8和16 Gy)小鼠体重明显减少(t=2.917、9.650、3.043、2.882,P<0.05);与模型组(8和16 Gy)比较,电针穴位组小鼠体重明显增加(t=6.602、5.409、19.660、2.975,P<0.05)。在旷场实验中,与对照组比较,模型组(8和16 Gy)小鼠垂直运动和水平运动次数显著减少(t=2.183、2.119、2.369、2.231,P<0.05);与模型组(8和16 Gy)和电针非穴位组(8和16 Gy)小鼠比较,电针穴位组小鼠垂直运动和水平运动显著性增加(t=8.914、2.727、4.325、4.178,P<0.05;t=4.030、3.014、2.150、4.771,P<0.05)。Morris水迷宫实验中,与对照组比较,在测试第3天,模型组(4 Gy)小鼠潜伏期明显延长,而穿越靶象限次数减少(t=4.544、3.422, P<0.05);与模型组(4 Gy)及电针非穴位组(4 Gy)比较,电针穴位组(4 Gy)潜伏期显著缩短(t=2.877、3.001,P<0.05)。与对照组比较,在测试第2、3天,模型组(8和16 Gy)小鼠潜伏期显著延长(t=2.544、3.706、3.796、7.934, P<0.05),穿越次数减少(t=2.120、2.393,P<0.05),模型组(8 Gy)停留时间减少(t=2.543, P<0.05)。与模型组(8和16 Gy)和电针非穴位组(8和16 Gy)小鼠比较,电针穴位组小鼠潜伏期显著缩短(与模型组比较:t=5.404、7.869、4.104、15.590, P<0.05;与电针非穴位组比较:t=2.938、7.955、6.566、10.350,P<0.05),而穿越靶象限次数和停留时间仅电针穴位组(8 Gy)显著增加(与模型组比较:t=2.673、2.613,P<0.05;与电针非穴位组比较:t=3.345、2.179,P<0.05)。结论 8 Gy以上射线照射可建立脑辐射损伤模型,电针(百会、风府和双侧肾俞)能够显著改善模型小鼠认知能力及空间学习记忆能力。     

PI3K/Akt信号通路与肝星状细胞活化的关系及其在放射性肝纤维化中的作用

目的 探讨磷脂酰肌醇3激酶-蛋白激酶B(PI3K/Akt)信号通路与肝星状细胞(HSC)活化的关系及其在放射性肝纤维化中的作用。方法 6 MV X射线照射,联合PI3K/Akt信号通路特异性抑制剂处理HSC,分为空白对照组、抑制剂组、10 Gy照射组、10 Gy+抑制剂组、20 Gy照射组和20 Gy+抑制剂组。检测各组的细胞凋亡率、细胞上清液转化生长因子β1(TGF-β1)浓度、平滑肌肌动蛋白(α-SMA)的mRNA表达量和磷酸化蛋白激酶B(p-Akt)的表达量。结果 与空白对照组相比,10 和20 Gy照射组细胞的凋亡率随照射剂量的增加而增加(t=8.43、11.63,P<0.05);与10 和20 Gy照射组比较,分别加抑制剂后细胞的凋亡率降低(t=8.09、4.88,P<0.05)。与10 Gy照射组比较,20 Gy照射组TGF-β1、α-SMA、p-Akt的量增加(t=6.91、7.80、9.28,P<0.05),10 Gy+抑制剂组TGF-β1、α-SMA、p-Akt的量降低(t=6.17、15.11、10.34,P<0.05)。与20 Gy照射组比较,20 Gy+抑制剂组TGF-β1、α-SMA、p-Akt的量同样降低(t=10.04、6.85、23.84,P<0.05)。结论 X射线通过激活PI3K/Akt信号通路使HSC活化,导致放射性肝纤维化的发生。     

氮氧自由基化合物对60Co γ射线致BALB/c小鼠辐射损伤的防护作用

目的 观察氮氧自由基化合物NHCOCH3-TEMPO对雄性BALB/c小鼠电离辐射损伤的防护效果。方法 将120只雄性BALB/c小鼠按随机数字表法分成4和7 Gy照射组,每组60只,每组再按随机数字表法分成6组,每组10只,分别为生理盐水对照组、生理盐水照射组、低剂量TEMPO照射组、中剂量TEMPO照射组、高剂量TEMPO照射组和阳性对照(WR-2721)组。⁶⁰Co γ射线照射前0.5 h动物腹腔注射防护药物,剂量分别为:WR-2721组200 mg/kg、低、中、高剂量TEMPO组分别为100、200和400 mg/kg、生理盐水对照组和生理盐水照射组给予等量生理盐水。4 Gy全身照射组用于观察小鼠照后8和15 d骨髓有核细胞数、骨髓DNA含量和外周血象的变化;7 Gy全身照射用于观察小鼠照后30 d生存率。结果 4 Gy照射后,TEMPO预处理组小鼠骨髓有核细胞计数、骨髓DNA含量较生理盐水照射组均明显增加(t=2.53~6.13,P<0.05);中剂量TEMPO预处理组小鼠外周血白细胞数较生理盐水照射组明显增加(t=4.34,P<0.05),但外周血红细胞数与生理盐水照射组相比,差异无统计学意义。7 Gy照射后,低剂量TEMPO预处理组小鼠30 d存活率较生理盐水照射组明显增加(χ²=5.934,P<0.05)。结论 氮氧自由基化合物NHCOCH3-TEMPO对雄性BALB/c小鼠γ射线辐射损伤有一定的防护作用。     

电离辐射对小鼠胸腺Th17细胞相关细胞因子的影响

目的 通过研究电离辐射对小鼠胸腺Th17细胞相关细胞因子的影响,探讨高、低剂量辐射诱导不同的免疫效应中Th17细胞功能。方法 将健康ICR小鼠按随机数字表法分为健康对照组、低剂量照射组(0.05、0.075 Gy)和高剂量照射组(0.5、1.0、2.0、4.0 Gy)探讨剂量-效应关系,用X射线深部治疗机进行不同剂量的全身照射,于照射后24 h处死。同时,探讨时间-效应关系,即分为健康对照组、低剂量照射组(0.075 Gy)和高剂量照射组(2.0 Gy),于照射后12、24、48 h处死,取胸腺组织制备成组织匀浆,ELISA法检测小鼠胸腺细胞中白介素-17a(IL-17a)与白介素-21(IL-21)的浓度。结果 在时间-效应结果中,与健康对照组相比,0.075 Gy照射组胸腺细胞IL-17a和IL-21分泌量呈下降趋势,其分泌量于48 h降到最低(t=3.85、4.73,P<0.05);而2.0 Gy照射组均呈大幅度上升趋势,其分泌量在48 h达到最高(t=-6.74、-6.19,P<0.05);在剂量-效应结果中,与健康对照组相比,较低剂量照射组胸腺细胞IL-17a与IL-21分泌量下降,在0.05 Gy最低(t=8.39、16.45,P<0.05);较高剂量照射组胸腺细胞的分泌量上升,在4.0 Gy时升至最高(t=-15.60、-18.62,P<0.05)。结论 高剂量辐射可以诱导小鼠胸腺细胞IL-17a与IL-21分泌量的增加,而低剂量辐射使其下降,表明Th17细胞相关的细胞因子在低剂量辐射诱导的免疫功能增强效应和高剂量辐射诱导免疫抑制效应中起着重要的作用。     

维生素D对不同剂量X射线照射小鼠免疫功能的保护作用

目的 观察维生素D对不同剂量X射线照射小鼠免疫功能的影响。方法 将小鼠采用随机数字表法分为5组:健康对照组、2 Gy和5 Gy照射组、2 Gy+药物(维生素D)组和5 Gy+药物(维生素D)组。给药组小鼠在不同剂量X射线照射后,连续7 d腹腔注射6 IU维生素D[1,25(OH)₂D₃]/g体重,于给药后第8天,5组小鼠均处死。测定小鼠体重、胸腺和脾脏指数,ConA诱导的脾脏T淋巴细胞增殖能力,ELISA法检测脾细胞IL-2的分泌量。结果 与健康对照组相比,2和5 Gy照射组小鼠脾脏T淋巴细胞增殖能力、脾细胞IL-2的分泌量均显著降低(F=36.20、7.13,P<0.05);与2 Gy照射组相比,2 Gy+药物组小鼠胸腺指数、脾脏指数、脾脏T淋巴细胞增殖能力均显著增高(t=-2.54、-2.24、-2.84,P<0.05);与5 Gy照射组相比,5 Gy+药物组小鼠的胸腺指数、脾细胞IL-2的分泌量显著增高(t=-5.02、-2.64,P<0.05)。结论 维生素D能够改善受照小鼠的免疫功能,但随照射剂量增大,改善作用减弱。     

电离辐射对大鼠海马区神经发生及TrkA和TrkB表达的影响

目的 探讨电离辐射对大鼠海马区神经发生以及TrkA、TrkB蛋白表达的影响。方法 将56只SD大鼠按随机数字表法分为照射组（28只）和健康对照组（28只）,照射组给予单次10 Gy全脑照射。分别于照后1、3 d,2周以及1个月取海马组织,应用免疫荧光染色观察神经元增殖变化,Golgi染色观察海马树突棘形态变化,Western blot及RT-PCR分别检测TrkA、TrkB蛋白及RNA水平变化。结果 与健康对照组比较,免疫荧光染色显示照射组双皮质素（DCX）数量明显减少（t=6.49,P<0.05）。照射组海马树突棘明显减少,且树突棘的形态变化明显。与健康对照组相比,照后不同时间照射组TrkA蛋白表达明显升高（t=2.64、3.06、4.80、2.64, P<0.05）,而TrkB的表达则显著下降（t=4.59、3.06、2.81、2.57, P<0.05）;TrkA mRNA表达水平明显升高（t=4.57、3.06、5.39、5.86, P<0.05）,TrkB的表达显著下降（t=14.87、11.69、4.98,P<0.05）。结论 作为神经生长因子、脑源性神经因子重要的下游信号通路分子,全脑照射后TrkA、TrkB的表达变化,可能在电离辐射所致海马神经发生损伤中发挥重要作用。     

X射线照射对原代培养海马神经元突起生长的作用

目的 探讨X射线照射对离体培养原代海马神经元突起生长的作用。方法 采用离体的方式培养原代海马神经元,分别给予0、2、4、8、10和12 Gy剂量照射,在照射后第1天和第3天,采用MTT法检测电离辐射对原代海马神经元死亡的影响,免疫荧光染色检测电离辐射对原代海马神经元神经突起的影响。结果 在照射后第1天和第3天,随着剂量的增加,海马神经元细胞死亡增多,差异有统计学意义(F=123.068、43.370,P<0.05),但4、8、10和12 Gy照射组间差异无统计学意义(P>0.05)。不同剂量照射后第1天,神经突起长度、总树突分支长度(TDBL)差异均有统计学意义(F=9.169、7.856,P<0.05),照后第3天神经突起长度、TDBL和总树突分支点数(TDBTN)差异均有统计学意义(F=23.797、6.565、6.021,P<0.05)。结论 X射线照射对离体培养的原代海马神经元突起的生长具有抑制作用。     

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.     

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.     

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).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

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.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.