大鼠肝区照射后肝纤维化过程的动态观察

６０Ｃｏγ射线照射１３０只大鼠肝区，于照后０．５，１，２，３，６，９及１２个月分批活杀，通过光镜（常规及多种特染）、共焦激光扫描显微镜、电镜及图像分析，动态观察了照后肝纤维化的过程。结果表明：３０Ｇｙ组动物在照后１年内逐渐发生了放射性肝纤维化病变，可将其分为４个阶段即急性放射性肝炎期、肝纤维化前期、肝纤维化期及肝硬化期。在肝纤维化发生过程中，胶原及网状纤维含量增加；成纤维细胞增多；肝细胞浆内糖原颗粒含量进行性减少；肥大细胞增多并见脱颗粒；贮脂细胞增多，其荧光强度增强。作者并对放射性肝纤维化的形成机理进行了探讨。     

实验性肝纤维化肝内Ⅰ、Ⅲ型胶原及PⅢP的免疫组化研究

利用免疫组化ＡＢＣ法研究正常及ＣＣｌ４实验性肝纤维化大鼠肝内，Ⅰ、Ⅲ型胶原及ＰⅢＰ的分布，并对部分切片进行了图像定量分析。结果表明在正常肝脏，Ⅰ、Ⅲ型胶原在分布上一致，ＰⅢＰ在汇管区显著少于Ⅰ、Ⅲ型胶原（Ｐ＜０．００１），在肝窦周围显著多于Ⅰ、Ⅲ型胶原（Ｐ＜０．０１，Ｐ＜０．０５），提示汇管区以成熟胶原为主，在肝窦周围以新合成胶原为主。在肝纤维化时，胶原纤维分布于变性、坏死的肝细胞之间，呈“干枝挂果”样，肝窦周围的胶原随着纤维化的进展而减少。纤维隔来源于非实质细胞，肝细胞可能不参与胶原合成。     

巨噬细胞和MMP-9对肺成纤维细胞增生及合成Ⅳ型胶原的作用

目的探讨放射性肺纤维化早期启动的发生机制。方法灌洗收集经^60Coγ射线照射后的Wistar大鼠肺泡巨噬细胞制备条件培养液，刺激培养的人肺成纤维细胞增生，用MTT法检测细胞增生活力，Western blot检测细胞合成Ⅳ型胶原含量的改变，酶谱分析检测细胞基质金属蛋白酶-9的活性。结果经条件培养液刺激后，人肺成纤维细胞的增殖活力明显增加，在48～72h之内作用明显HLF合成Ⅳ型胶原增多，12h达高峰，随后有所下降；12h后基质金属蛋白酶．9活性开始增高，于48h达高峰，72h开始下降。结论20Gy^60Coγ射线能刺激AM分泌某些细胞因子促进肺间质成纤维细胞增生及合成Ⅳ型胶原，与此同时后者能激活基质金属蛋白酶-9，降解增多的Co Ⅳ，参与肺损伤早期的重建过程。     

Ⅳ型胶原、MMPs和TIMPs在放射性肺损伤重建中的作用

目的探讨Ⅳ型胶原、基质金属蛋白酶（MMPs）及其组织基质金属蛋白酶抑制剂（TIMPs）在放射性肺损伤早期重建中的作用。方法用20研Gy^60Coγ射线照射大鼠右胸部，建立放射性肺损伤模型，1、2、4周后分别取材；用实时荧光定量PCR和免疫组织化学方法，从基因表达和蛋白质合成水平结合图像分析对肺组织Ⅳ型胶原、MMP-2、MMP-9、TIMP-1和TIMP-2 mRNA进行定量分析。结果实时定量PCR基因检测：Ⅳ型胶原表达于1周时升高，2周时下降；MMP-2在2周时达高峰，与Ⅳ型胶原成相反变化趋势；MMP-9呈明显的升高、下降、再升高趋势，与Ⅳ型胶原变化趋势相同；TIMP-1表达较低，各时间点之间无明显差异；TIMP-2呈现略升高、降低、升高趋势，与MMP-2表达相反。免疫组化-图像分析：肺组织Ⅳ型胶原含量于1周即明显增加，2周开始下降；MMP-2在2周时下降，随后升高，后期与Ⅳ型胶原呈相反趋势；MMP-9变化趋势同Ⅳ型胶原，但程度明显高于后者；TIMP-1于2周时轻度升高，与MMP-9趋势相反。结论Ⅳ型胶原、MMP-2和MMP-9及其组织抑制物参与放射性肺损伤早期的无效重建过程，MMP-2和MMP-9具有降解Ⅳ型胶原作用；Ⅳ型胶原降解障碍可能与肺纤维化启动有一定关系。     

纤维连接蛋白和层粘连蛋白在大鼠放射性肺损伤中的…

用光镜，电镜及免疫组织化方法，动态观察了大鼠经胸部照射３０Ｇｙ后肺组织内纤维连接蛋白和层粘连蛋白的变化。结果显示，照射组大鼠肺组织内ＦＮ、ＬＮ分布紊乱，ＦＮ含量在病变早期较明显增多，而病变后期则逐渐减少；ＬＮ在各期均有不同程度增加。提示，ＦＮ主要参与放射性肺损伤早期病变的发生发展；ＬＮ参与肺损伤病变的全过程。     

纤维连接蛋白和层粘连蛋白在大鼠放射性肺损伤中的变化

用光镜、电镜及免疫组化方法，动态观察了大鼠经胸部照射３０Ｇｙ后肺组织内纤维连接蛋白（ＦＮ）和层粘连蛋白（ＬＮ）的变化。结果显示，照射组大鼠肺组织内ＦＮ、ＬＮ分布紊乱，ＦＮ含量在病变早期较明显增多，而病变后期则逐渐减少；ＬＮ在各期均有不同程度增加。提示，ＦＮ主要参与放射性肺损伤早期病变的发生发展；ＬＮ参与肺损伤病变的全过程。     

自身免疫性肝炎患者肝组织纤维化机制的研究

目的 探讨自身免疫性肝炎(AIH)肝纤维化的机制。方法 以突触素(SYN)标记36例AIH患者肝穿刺标本的肝星状细胞(HSC),采用免疫组化方法检测HSC、Ⅰ型胶原(ColD、Ⅳ型胶原(ColⅣ)及膜型基质金属蛋白酶1(MT-MMP-1)的表达,原位分子杂交方法(ISH)检测MT-MMP-1 mRNA及组织型金属蛋白酶1(TIMP-1)mRNA的表达。结果 36例AIH肝组织内SYN阳性HSC主要分布于汇管区、细胞纤维间隔及肝小叶炎症活动部位,尤其活动性界面炎部位往往呈聚集性分布,周围易见胶原纤维沉积,SYN阳性HSC数量与AIH肝组织活动指数(HAl,Knodell)呈正相关关系。ColⅠ、ColⅣ的表达量随AIH肝纤维化程度的增加而增加。ColⅣ主要分布于活动性炎症区域并随塌陷窦壁呈聚集性分布,ColⅠ主要见于纤维间隔及汇管区内,为S5～6期(Knodell)AIH肝组织内主要的细胞外基质(ECM)成分。MT-MMP-1及其mRNA阳性细胞主要见于汇管区周围界面炎及细胞纤维间隔边缘部位间质细胞内,周围少部分肝细胞亦呈阳性表达。MT-MMP-1及其mRNA表达与AIH肝组织HAI密切相关,且随AIH肝纤维化分期而增强,于S4～5期(Knodell)表达量最高,其后有所下降。AIH肝组织内TIMP-1的表达随肝纤维化的进展大致呈递增趋势。结论 AIH免疫损伤致反复持续性活动性炎症引起HSC的大量活化、增殖,进而引起ECM的沉积可能是AIH肝纤维化发生和进展的重要原因之一;MT-MMP-1引起ColⅣ的降解,改变HSC周围的微环境而诱导HSC的激活可能是HSC活化、增殖的机制之一;AIHECM的降解水平相对低下可能是AIH肝纤维化进展的另一重要机制。此外,本实验结果显示,SYN是研究肝纤维化组织内HSC的一个较好的标志物。     

复方鳖甲软肝片对酒精性肝纤维化狄氏间隙胶原沉积的影响

目的　研究复方鳖甲软肝片 (FFBJRGP)对酒精性肝纤维化大鼠肝血窦周围胶原沉积的影响。方法　采用“白酒 -植物油-吡唑”混合液灌胃配合饲喂高脂饲料法复制大鼠酒精性肝纤维化模型。采用高、中、低 3个剂量的FFBJRGP对肝纤维化大鼠进行治疗。取材后 ,采用肝组织样本前处理水解法检测各组大鼠肝组织羟脯氨酸含量 ;用放免分析法检测各组大鼠血清中Ⅳ型胶原 (CⅣ)和层黏连蛋白 (LN)含量 ;大鼠肝组织石蜡切片 ,Mallory、天狼星红染色 ,图像分析 ,显示胶原分布及含量。结果　酒精性肝纤维化大鼠肝组织内羟脯氨酸含量 ,血清中CⅣ和LN水平均显著升高 (P<0 0 1) ;中、低剂量FFBJRGP治疗后 ,羟脯氨酸含量、血清中CⅣ和LN水平呈下降趋势 (P <0 0 5或P<0 0 1) ;酒精性肝纤维化大鼠肝窦Disse间隙胶原大量沉积 ,中央静脉周围及肝小叶Ⅲ区的肝窦内以Ⅰ型胶原为主 ;FFBJRGP治疗后 ,肝窦内、中央静脉周围胶原明显减少 ,肝窦内胶原类型由Ⅰ型向Ⅲ型转化。结论　FFBJRGP可有效抑制肝血窦基底膜胶原的合成和沉积 ,促进胶原由幼稚向成熟型转化 ,从而有效阻滞肝纤维化的进程     

肥大细胞在放射性肝纤维化中的改变与作用的研究

１３０只大鼠经６０Ｃｏγ射线１０，３０，５０，６０Ｇｙ单次照射右腹部肝区，于照后０．５，１，２，３，６，９，１２个月分批活杀，通过光镜、电镜及图像分析，定性、定量地观察了肥大细胞（ＭＣ）在放射性肝纤维化中的变化规律．结果表明：３０Ｇｙ组动物肝脏发生了典型的慢性纤维化病变，其病变呈进行性发展，其中ＭＣ于照后１～２个月即见增多，胞体变大，尤以３～９个月为显著，并见脱颗粒现象．且ＭＣ增多和变大的高峰期恰与肝内结缔组织增生明显期相平行，而照后１２个月，纤维组织胶原化时，ＭＣ则趋于减少．表明ＭＣ参与了放射性肝纤维化的形成过程。最后，本文作者对其可能促进或直接参与放射性肝纤维化的形成机理等作了探讨．     

钆塞酸二钠增强MRI评估肝纤维化的研究进展

肝纤维化主要的病理生理机制是由于病毒性肝炎、酒精性脂肪肝、非酒精性脂肪肝等因素刺激肝细胞,引起肝窦毛细血管化以及胶原、蛋白多糖等大分子在细胞外基质的合成增多,从而导致纤维结缔组织增生[1].肝纤维化发生的早期阶段是可控、可逆的,晚期阶段不仅逆转的可能性极低,而且与门脉高压和肝细胞肝癌的发生密切相关[2].     

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.