坐骨神经高速弹丸震荡伤后腰段脊髓病理改变

目的　研究坐骨神经高速弹丸震荡伤后腰段脊髓的病理改变。方法　火器伤组致伤靶点为兔右后肢外侧坐骨神经体表投影线中点 ,切割伤组在同一水平切断右坐骨神经 ,分别在光电镜下观察伤后 1天、3天 ,1周、2周、4周、12周时腰段脊髓的病理改变。结果　火器伤组可见腰段脊髓有小出血灶、神经元水肿、空泡样变、运动神经元数量减少等变化 ,切割伤组则未见这些病理改变。结论　火器伤组腰段脊髓损伤较切割伤组重 ,运动神经元存活数量显著减少     

不同损伤条件下CIDE-B的变化与神经元凋亡的关系

目的通过对周围神经火器伤和切割伤CIDE-B基因及蛋白的表达检测，并与神经细胞的凋亡进行对比，探讨CIDE-B的变化与神经元凋亡的关系。方法113只大耳白兔随机分为火器伤组、切割伤组、正常对照组。在伤后不同时相点取材，以RT-PCR法检测CIDE-B mRNA表达水平，原位杂交检测CIDE-B mRNA的形态学分布，Western blot检测CIDE-B的蛋白水平。结果神经损伤后脊髓内CIDE-B mRNA表达增强。火器伤组增加的幅度较大，第1天开始增加，7d达到峰值，持续到2周，4周回落；切割伤组表达增加延迟，幅度也小。蛋白水平的变化与此相一致。正常对照组脊髓组织有少量的CIDE-B mRNA表达，分布于脊髓神经元细胞胞浆内。结论周围神经损伤后脊髓神经元CIDE-B在mRNA、蛋白水平的表达均增强，组织学分布在脊髓灰质内，火器性损伤改变更加明显。     

兔坐骨神经高速弹丸震荡伤后腰段脊髓运动神经元及胶质细胞凋亡规律

目的：探讨坐骨神经高速弹丸震荡伤后腰段脊髓运动神经元及胶质细胞凋亡规律。方法：65只大耳白兔分为正常对照组，高速弹丸震荡伤组（震荡伤组）和功能伤组，震荡伤组致伤靶点为兔右大腿外侧坐骨神经体表投影线中点，切割伤组在同一水平切断右坐骨神经，应用DNA电泳，原位末端标记法（TUNEL）染色和流式细胞仪进行细胞凋亡定性定量检测。结果：震荡伤组伤后2周运动神经元数明显减少，伤后1，2周，可见TUNEL阳性运动神经元及胶质细胞，DNA电泳出现凋亡梯形带，流式细胞仪检测可见亚二倍体峰，震荡伤组伤后1，2周，细胞凋亡百分比分别为10．6％和26．4％，切割伤组仅在4周时有少量阳性运动神经元，结论：与切割伤组比较，震荡伤组细胞凋亡发生早，数量多，凋亡是坐骨神经高速弹丸震荡伤后运动神经元数量减少的主要机制。     

胸腰段脊髓火器贯通伤后Bcl-2基因的早期表达

目的 建立家猪胸腰段脊髓火器贯通伤模型和改良Allen打击伤后全瘫模型,观察伤后Bcl-2基因的早期表达。方法 实验动物随机分为3组,其中火器贯通伤组（G组）9只,在全麻状态下制作胸腰段（L1～L2）脊髓火器伤模型;打击伤组（A组）9只,L1节段脊髓行改良Allen打击;对照组（C组）2只,仅予麻醉不致伤。于伤后1、3、6小时和距伤点不同距离处取材,进行Bcl-2蛋白的免疫组化染色。结果 两组脊髓损伤后6小时出现Bcl-2蛋白的表达增加,A组仅在伤点和近伤段处变化,而G组波及中伤段及远段伤。结论 细胞凋亡基因Bcl-2在脊髓损伤中的表达有一定的时空性,在脊髓损伤后6小时,出现Bcl-2基因蛋白表达增加。G组波及范围较A组更为广泛。     

神经元尼氏染色法在坐骨神经损伤研究中的应用

目的探讨神经元尼氏染色法在外周神经损伤研究中的应用.方法建立坐骨神经切断损伤模型,脊髓L4-6腰膨大连续石蜡切片,焦油紫尼氏染色的方法.结果坐骨神经切断损伤后,脊髓L4-6腰膨大前角外侧大、中型神经元较正常对照组数量减少,存活率下降,细胞轮廓不清,尼氏体模糊.结论焦油紫染色显示尼氏体的方法适用于坐骨神经损伤时脊髓腰膨大前角神经元的形态学研究.     

火器性周围神经间接伤对伤口愈合的影响

以高、低速投射物致伤犬肢体为实验模型，在观察火器性坐骨神经间接损伤的形态学基础上，对伤道组织内参与伤口愈合的神经递质的第二信使环核苷酸的变化以及胆碱酯酶的活性进行动态观察，探讨上述变化与火器伤伤口愈合的关系。实验发现肢体火器伤时，伤道外坐骨神经结构发生明显损伤，以髓鞘劈裂、轴索裸露、神经微丝减少为特征，高速投射物组明显重于低速投射物伤组。同时伤后６小时至１０天，高速组伤道组织ｃＧＭＰ含量以及胆碱酯酶活性均低于低速组。伤后高速组伤道肉芽组织内标志伤口愈合程度的羟脯氨酸含量低于低速组。实验结果提示肢体火器伤时周围神经间接伤与投射物速度有关，周围神经损伤尤其是神经细胞骨架损伤导致神经递质以及胆硷酯酶活性代谢紊乱是影响火器伤伤口愈合的重要因素。因此肢体火器伤时改善周围神经功能，纠正神经递质代谢紊乱是促进伤口愈合的重要措施。     

大鼠坐骨神经损伤后脊髓组织中Caspase 3、Bcl-xl表达变化的实验研究

目的：探讨大鼠坐骨神经损伤后脊髓组织中Caspase3、Bcl-xl的表达变化以及与脊髓神经细胞凋亡的关系。为进一步研究坐标神经损伤后的神经再生提供依据。方法：成年Wistar大鼠96只,随机分为对照组（12只）和实验组（84只）,实验组大鼠切除右侧长约6mm的坐骨神经,分为伤后3d和1,2,3,4,5,6周组,采用Caspase3、Bcl-xl免疫组化检测大鼠脊髓组织Caspase3、Bcl-xl表达变化,测定Caspase3的活性;采用流式细胞仪AnnexinⅤ/PI双标检测和原位末端脱氧核苷酸转移酶介导的生物素脱氧尿嘧啶核苷酸缺口末端标记法（TUNEL）检测脊髓细胞凋亡情况。结果Caspase3、Bcl-xl免疫组化阳性反应主要位于灰质神经元细胞,高表达区在前角。伤后1周实验组伤侧脊髓组织中Caspase3表达轻度升高,2－4周显著升高,5周后下降,伤后1－3周脊髓Bcl-xl表达减弱,4周后明显升高,高水平持续到伤后6周;伤后2－4周在鼠伤侧脊髓有较多TNEL阳性标记细胞;伤后3d伤侧Caspase3活性荧光值开始升高,1－3周明显升高,4周逐渐下降;流式细胞仪检测,伤后1周伤侧脊髓凋亡细胞开始增加,2,3周为高峰,4周伤侧凋亡细胞逐渐减少。实验组末伤侧与对照组比较,各项检查差异无显著性意义。结论：Caspase3的活化是细胞凋亡的早期生化。与细胞凋亡的形态学表现相互关系;Bcl-xl对减轻大鼠坐骨神经损伤后脊髓组织细胞凋亡有重要作用,及早识别细胞凋亡的早期特征,对促进神经再生具有重要意义。     

延迟氟桂嗪、尼莫地平处理支持大鼠坐骨神经元存活

目的：观察、比较氟桂嗪与尼莫地平对慢性退变中神经元的保护作用。方法：21只生后2d新生大鼠，切断右侧坐骨神经作为实验侧，左侧为正常对照侧。术后第5天，氟桂嗪组皮下注射氟桂嗪(25μg／g体重)，尼莫地平组皮下注射尼莫地平(20μg／g体重)，对照组注射等量溶剂，连续14d，然后取L4-6脊髓，在光镜下观察并计数脊髓前角神经元。结果：在神经元慢性退变过程中，氟桂嗪组与尼莫地平组可以分别平均支持78．3％和58．1％神经元存活，统计学上以前者占优势，且两者与对照组相比(存活53．2％)差异显著。氟桂嗪组实验侧脊髓前角神经元核团改变较小，其胞体萎缩程度较轻。结论：氟桂嗪与尼莫地平对慢性退变过程中神经元均有保护作用，而氟桂嗪的保护作用更显著。     

大鼠坐骨神经损伤对背根节GDNF表达的影响

目的应用免疫组化技术观察大鼠坐骨神经条件性损伤对相应背根节及坐骨神经胶质细胞源性神经营养因子(glial cell line-derived neurotrophic factor,GDNF)表达的影响,以探讨GDNF对损伤神经元的作用.方法 45只成年雌性Wistar大鼠随机分为3组:A组(N=5)正常对照组,B组(N=20)坐骨神经压榨伤组,C组(N=20)坐骨神经切断/结扎组;B、C两组按存活期不同再各分为4个亚组,每组5例.大鼠分别于伤后3天、2周、1个月、2个月处死,取材L5节段损伤侧背根节及损伤坐骨神经的远近节段,免疫组化染色观测GDNF表达.结果 (1)正常背根节细胞GDNF表达主要分布于小神经元,少数为大神经元.(2)坐骨神经损伤促使同侧背根节神经元GDNF表达显著增强,伤后2周达到高峰;B组背根节细胞GDNF表达在伤后1个月时轻度下调,伤后2个月恢复为对照组水平.C组背根节细胞GDNF表达保持高水平,并至观察后期2个月.(3)坐骨神经损伤同时诱导背根节卫星细胞及坐骨神经雪旺氏细胞GDNF表达显著增强,其中远端坐骨神经GDNF表达强于近端.B组这些细胞的阳性表达持续至伤后2周,C组伤后1个月时其表达仍显著.结论 GDNF是参与损伤初级感觉神经元反应的重要因子,并可能对正常及受损背根节细胞发挥营养作用.     

犬颅脑枪弹伤后局部脑组织c-fos基因表达

目的　探讨犬颅脑枪弹伤后c -fos基因表达及其变化规律 ,为进一步了解火器性颅脑损伤的机制提供实验基础。　方法　以德国小口径步枪子弹致伤犬颅脑贯通伤模型为对象 ,采用免疫组化法检测对照组脑组织及伤后不同时间弹道挫伤区、震荡区及脑干神经元中c -fos基因的表达。　结果　对照组脑皮层神经元中c -fos基因呈弱表达 ,弹道挫伤区、震荡区及脑干神经元中c-fos基因表达于伤后 30min开始增加 ,2h达到高峰 ,3h逐渐下降 ,且c -fos基因表达在弹道震荡区较挫伤区更为明显 (P <0 .0 5 )。　结论　犬脑组织弹道挫伤区、震荡区及脑干神经元中c-fos基因表达是对损伤刺激的早期反应 ,其表达可能是由Leao播散性抑制引起 ,并与细胞内外信号转导和细胞凋亡有关。     

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.