E-64-D对大鼠脊髓缺血再灌注损伤中钙蛋白酶表达的抑制作用

目的观察脊髓缺血再灌注损伤后钙蛋白酶特异性抑制剂E-64-D对脊髓组织中钙蛋白酶表达和活性的抑制作用。方法纯种雄性成年SD大鼠，夹闭右肾动脉分支下方腹主动脉30min，造成动物脊髓缺血再灌注损伤，静脉应用E-64-D，观察再灌注后3、24、72h和7d钙蛋白酶Ⅰ的表达和68-KDNFP的降解。结果脊髓再灌注损伤后3h，出现钙蛋白酶Ⅰ阳性细胞，72h最明显。68000NFP的降解产物在再灌注损伤后3h出现，并在72h后达到高峰。应用E-64-D后，钙蛋白酶Ⅰ的表达和68-KDNFP的降解得到抑制，差异有统计学意义（P〈0．01）。结论脊髓再灌注损伤后应用E-64-D，对脊髓中68-KDNFP降解具有明显保护作用。     

甲基强的松龙对大鼠脊髓缺血再灌注损伤后钙蛋白酶表达的影响

目的观察大鼠脊髓缺血再灌注损伤后应用甲基强的松龙(MP)对脊髓组织钙蛋白酶表达的影响.方法用纯种雄性成年SD大鼠,夹闭右肾动脉分支下腹主动脉30min后恢复血供,缺血再灌注组(损伤组)不作任何治疗,造成动物脊髓缺血再灌注损伤模型,治疗组于恢复血供后即刻静脉应用MP(治疗组),观察再灌注后3h、24h、72h和7d时脊髓损伤节段钙蛋白酶Ⅰ的表达以及钙蛋白酶特异性底物68-KD NFP的降解.结果脊髓再灌注后3h出现钙蛋白酶Ⅰ阳性细胞和68-KD NFP的降解产物,随着时间的延长,阳性细胞数目逐渐增多,染色深度逐渐增加,再灌注后72h最明显,MP治疗组较损伤组明显降低(P＜0.01).结论脊髓再灌注损伤后静脉应用MP可以减少大鼠脊髓中calpain-Ⅰ阳性细胞的表达,对细胞骨架蛋白68-KD NFP具有明显保护作用.证实MP可以抑制钙蛋白酶的表达,可能是MP对脊髓损伤治疗的另一种机理.     

钙蛋白酶抑制剂对缺血再灌注损伤脊髓的保护作用

目的 观察大鼠脊髓缺血再灌注损伤后应用钙蛋白酶特异性抑制剂E-64-D,对脊髓神经细胞组织学改变和凋亡的影响及对大鼠后肢运动功能的保护作用.方法 选用纯种雄性成年SD大鼠106只,夹闭右肾动脉分支下腹主动脉30 min,再灌注即刻静脉应用钙蛋白酶特异性抑制剂E-64-D,观察再灌注后3、24、72 h和7 d脊髓损伤节段神经细胞的凋亡及再灌注后24、72h组织病理学改变;对再灌注后72 h的大鼠后肢功能进行评分.结果 脊髓缺血再灌注24 h开始出现神经细胞凋亡现象,脊髓组织出现病理学改变,神经元死亡,胶质细胞增生.应用E-64-D后,凋亡现象和细胞坏死得到抑制,差异有统计学意义(P<0.01).再灌注后72 h后肢功能也得到一定程度的保护.结论 脊髓再灌注损伤后静脉应用E-64-D治疗,可以明显抑制脊髓神经细胞的凋亡,有利于神经元的存活,损伤后3 d大鼠后肢运动功能得到一定程度的改善.     

选择性钙蛋白酶抑制剂E-64-d对大鼠急性脊髓损伤的作用

[目的]利用急性脊髓损伤SD大鼠动物模型,探讨E-64-d在脊髓损伤修复过程中的作用机制。[方法]制作大鼠脊髓损伤模型,将大鼠随机分为5组:对照组;单纯损伤组;E-64-d治疗组;MP治疗组;MP与E-64-d联合治疗组。给与钙蛋白酶抑制剂E-64-d和/或甲基强的松龙(MP)腹腔注射。分别应用TUNEL法检测神经细胞的凋亡水平。免疫组化测定各时间点Calpain1与GFAP的表达变化;每天同一时间对大鼠进行后肢运动功能BBB评分及感觉功能评分。[结果]TUNEL检测显示,治疗组神经元细胞凋亡减少,Caspase-3的活性均减弱。损伤后脊髓组织中Calpain 1活性增加,应用E-64-d治疗后得到抑制。损伤后3 d Calpain 1和GFAP的表达增强,但治疗组显著低于损伤组。BBB运动功能评分显示,治疗组大鼠的运动功能得到增强,结果具有统计学意义。进一步实验结果显示,联合使用E-64-d和甲基强的松龙(MP)的效果要好于单独使用E-64-d或MP。[结论]E-64-d具有减轻急性大鼠脊髓损伤的作用,其与MP联合使用效果更加明显,Calpain抑制剂具有治疗脊髓损伤的潜力。     

缺血预处理对鼠后肢缺血再灌注下脊髓腰骶膨大运动神经元的保护作用

[目的]对大鼠一侧后肢的缺血再灌注损伤行不同条件缺血预处理,观察脊髓腰骶膨大处运动神经元超微结构的变化,探讨其保护作用.[方法]通过血管夹暂时阻断大鼠左侧髂总、髂内和髂外动脉,建立大鼠后肢缺血模型.以缺血6h再灌注2h和12 h分为A、B两组,预处理方式为缺血10 min血液复流10 min,按无预处理、预处理1次、无时间间隔预处理2、3次,分成A0、A1、A2、A3;B0、B1、B2、B3组.取材腰骶膨大处脊髓灰质前角,光镜及透射电镜下观察不同条件预处理对缺血再灌注损伤中脊髓前角超微结构变化.[结果]组织形态观察结果显示A0组缺血再灌注损伤后神经元细胞减少,核溶解消失,损伤明显,预处理后神经元细胞增多,可见部分细胞核存在;B0组缺血再灌注损伤后神经元细胞大部分坏死溶解,预处理后坏死溶解现象减轻.超微结构观察显示A0和B0组脊髓前角神经兀细胞不同程度核周器扩张损伤,出现内质网扩张、大量线粒体空泡以及核膜溶解消失.预处理后损伤程度有所减轻,叠加预处理后损伤进一步减轻.[结论]缺血预处理能减轻大鼠肢体缺血再灌注下脊髓腰骶膨大运动神经元的损伤,对脊髓具有保护作用.反复3次预处理产生的保护作用优于2次预处理及1次预处理.     

氢饱和生理盐水对兔脊髓缺血再灌注损伤的神经保护作用

目的 研究氢气对脊髓缺血再灌注损伤的保护作用及其潜在机制。方法 新西兰兔随机分为3组：对照组、脊髓缺血再灌注损伤组和氢水治疗组。对照组仅接受暴露,无脊髓缺血再灌注损伤;缺血再灌注组动物采用ZIVIN法建立脊髓缺血再灌注损伤模型,造成脊髓腰骶段缺血35 min 后行再灌注;氢水治疗组动物在再灌注前5 min腹腔注射饱和氢盐水（5 mL/kg）,再灌注后8 h重复注射。不同时间点检测后肢运动功能。术后72 h取脊髓进行HE染色、TUNEL染色、氧化-抗氧化指标检测及ELISA检测细胞因子。结果 含氢生理盐水治疗能显著改善动物神经功能、抑制脊髓神经元凋亡、抑制氧化应激、改善抗氧化能力,同时降低炎症相关细胞因子,从而发挥脊髓保护作用。结论 腹腔注射含氢生理盐水通过抗氧化和抗炎对脊髓缺血再灌注损伤发挥保护作用。     

肢体缺血预处理对兔颈髓慢性缺血后再灌注损伤的影响

目的：探讨肢体缺血预处理对兔颈髓慢性缺血后再灌注损伤的影响及其机制。方法：建立兔颈髓慢性压迫损伤模型，随机分为实验组和对照组。实验组在脊髓减压再灌注前给予肢体缺血预处理，对照组不做预处理。两组兔在减压前和减压后2h、8h、24h，7d、21d分别进行后肢神经功能评分。在减压后即刻、0．5h、1h和以上时间点分别进行脊髓血流测定。处死动物取脊髓(C1～T1)进行组织病理学检查。结果：实验组于再灌注8h后神经功能评分明显好于对照组。实验组脊髓组织丙二醛含量于再灌注8h后显著低于对照组。两组再灌注后脊髓血流均显著下降，实验组优于对照组。病理学检查示对照组神经元呈缺血改变，白质水肿、脱髓鞘；实验组病理改变轻微。实验组热休克蛋白70表达阳性，对照组为阴性。结论：肢体缺血预处理对脊髓慢性缺血后的再灌注损伤具有明显保护作用。     

钙蛋白酶与肝移植缺血再灌注损伤关系的实验研究

目的 探讨大鼠肝在不同冷缺血期、复温期及再灌注期钙蛋白酶活性变化，以及钙蛋白酶抑制剂对离体灌注肝功能及原位肝移植大鼠生存的影响。方法 SD大鼠。共5个实验部分：（1）冷缺血实验；（2）冷缺血后复温实验；（3）冷缺血后再灌注实验；（4）钙蛋白酶抑制剂实验；（5）原位肝移植实验。结果 冷缺血12h始，肝组织中钙蛋白酶活力明显增加，并随着冷缺血时间的延长而逐渐明显增加（P＜0.01）。冷缺血复温30min始，肝组织中钙蛋白酶活力明显增加，并随着复温时间延长而逐渐明显增加（P＜0.01）。肝组织冷缺血0和12h再灌注60min钙蛋白酶明显增加（P＜0.05）。钙蛋白酶抑制剂明显增加（P＜0.05）。而冷缺血24h再灌注30min钙蛋白酶便明显增加（P＜0.05）。钙蛋白酶抑制剂可明显地降低离体灌注肝AST水平及增加胆汁量（分别P＜0.01）。结论 肝移植冷缺血期、复温期及再灌注期钙蛋白酶均明显增高，钙蛋白酶抑制剂可明显地改善移植肝功能。     

甘草酸二铵对大鼠脊髓缺血再灌注损伤后运动神经元Caspase-3表达的影响

目的:观察甘草酸二铵(DG)对大鼠脊髓缺血再灌注损伤后脊髓前角运动神经元Caspase-3表达的影响.方法:60只大鼠随机分为3组,每组20只.两组采用手术夹闭大鼠左右肾动脉之间的腹主动脉30min致脊髓缺血,然后松开再灌注,其中一组在缺血前10min舌下静脉注射DG 20mg/kg(DG干预组),一组仅造成脊髓缺血损伤(损伤组);另一组打开腹腔后即关腹,不进行缺血再灌注(正常对照组).分别于术后3、24、72、168h处死大鼠取腰段脊髓行免疫组化染色,观察脊髓前角Caspase-3光密度变化情况;、168h处死动物前先采用Behrmann 5点评分法评定大鼠后肢功能.结果:损伤组与干预组72h时后肢功能评分分别为4.2±0.45分、5.8±1.1分:168h时分别为5±0分、6.2±1.3分,两组相同时间比较有显著性差异.Caspase-3表达位于脊髓前角运动神经元胞浆.术后3、24、72、168h,正常对照组前角运动神经元的平均光密度为0.13±0.04、0.15±0.06、0.13±0.06、0.15±0.06,损伤组为0.18±0.04、0.18±0.03、0.20±0.04、0.20±0.05,DG干预组为0.17±0.06、0.15±0.02、0.16±0.04、0.15±0.02,损伤组各时间点与对照比较均有显著性差异,DG干预组在24、72、168h与损伤组比较差异有显著性.结论:DG可下调凋亡信号转导通路中Caspase-3的表达水平,从而抑制脊髓前角神经元凋亡的发生.     

预防使用大剂量甲基强的松龙对大鼠急性脊髓损伤的神经保护作用

目的研究预防使用大剂量甲基强的松龙对急性脊髓损伤大鼠的神经功能保护作用方法采用Allen重物打击模型，动物随机分为三组：对照组；脊髓损伤组；预防使用大剂量甲基强的松龙组。分别在脊髓损伤后24h、72h进行神经功能评分(Tarlov评分障碍率、Molt斜板功能障碍率)、脊髓病理形态学及超微结构观察、神经中丝(NF)及胶质纤维酸性蛋白(GFAP)观察、结果预防使用大剂量MP可明显改善损伤脊髓的病理形态及超微结构；脊髓损伤后72h大鼠神经功能评分明显提高；显著提高NF的表达、抑制GFAP的表达．结论预防使用大剂量甲基强的松龙对大鼠急性脊髓损伤有神经保护作用     

Lisfranc injuries: Incidence,mechanisms of injury and predictors of instability

BackgroundIn Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries.MethodsEighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined.ResultsThe incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person–years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036).ConclusionThe incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.Level of EvidenceLevel III, cross-sectional study.     

Penetrating Neck Injury: A Case Report and Review of Management

Penetrating neck injury constitutes 5–10 % of all cases seen in the emergency room. As surgeons we must be prepared to manage these cases. After stabilizing the general condition of the patient the neck injuries are assessed. Management has changed from routine exploration to selective exploration. Injury to aerodigestive tract and vessels are commonly seen.     

Snowboarding injuries: Comparison of injuries in snowboarders and skiers

To clarify the characteristics of injuries occurring in snowboarding accidents, we compared, injuries in 138 snowboarders and 128 skiers (aged 15–35 years), injured at the “H” Ski Resort. In the snowboarder group, injuries to the upper extremities, particularly the wrist joint, were more frequent, whereas injuries to the lower extremities, particularly the knee joint, were less frequent. As for the type of injury, fractures were more frequent in snowboarders, while sprains and ligament injuries were less frequent. Fractures, sprains of the wrist joint, and contusions of the shoulder were more frequent in snowboarders, with sprains of the knee joint and the thumb were being less frequent. The duration of sporting activity was significantly longer in snowboarders. Injuries to snowboarders occurred more often while they were traveling at “reckless speed” on moderate slopes. There were no significant differences in skill levels between the two groups. Differences between the snow boarders' and skiers' boots and differences in sliding on boards and on skis are believed to have contributed to the differences in their injuries. Our analysis indicates that it is necessary to create slopes that are safe and enjoyable for board riders as well as skiers. Lessons are also recommended so that snowboarders learn the proper technique, and understand the general principles of slope safety; the potential for injury would thus be reduced.     

Treatment and outcome of traumatic biliary injuries in children

Background/Purpose

Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome.

Methods

We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002–2012.

Results

Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4–15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage.

Conclusion

Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections.     

手部逆行皮肤撕脱伤的显微外科修复

目的探讨手部皮肤逆行撕脱伤的修复方法。方法应用显微外科技术通过吻合浅静脉，修复手部皮肤撕脱伤11例。结果皮肤全部成活者8例，2例手掌心有少部分皮肤坏死，1例手背撕脱皮瓣近心端皮肤部分坏死，给予游离植皮后成活。术后随访6个月～2年，患手外形美观，皮肤质地柔软，耐磨能力强，基本恢复了原来的功能。结论应用显微外科技术吻合浅静脉修复手部皮肤逆行撕脱伤可取得较好的效果，手术适应证的把握，高质量的血管吻合，积极的术后康复是手术成功的关键。     

Penetrating ballistic-like frontal brain injury caused by a metallic rod

Summary  Penetrating non-missile intracranial injuries caused by metallic foreign bodies are very rare among the civilian population. We present a unique instance of a severe, high-energy, penetrating orbitocranial injury caused by a solid metallic rod that corresponded to the spray valve lever handle of a kitchen sink pre-rinse spray tap, which was fractured and projected at high speed for an unknown reason. To our knowledge, this is the first report of a high-energy, penetrating brain injury caused by such an object. After careful radiological evaluation of the shape and position of the foreign object, a combined right frontal craniotomy and supraorbital osteotomy was performed in order to achieve safe removal of the metal bar. Successful surgical treatment of an orbitocranial injury caused by a similar object has not previously been reported.