内大鼠毒素休克肠粘膜免疫功能的改变及意义

目的:探讨内毒素休克后大鼠肠粘膜免疫功能的改变及意义.方法:健康Wistar大鼠81只,随机取9只为实验前基础值组,余72只按腹腔注射的药物不同,分成对照组(生理盐水),休克组(精制内毒素 5mg/kg),每组9只,各组于实验后0、2、6和24 h分别检测肠粘膜及血浆中sIgA、TNF-α、IL-1β含量和肠粘膜上皮内淋巴细胞增殖活力.结果:内毒素休克组肠粘膜、血浆内sIgA含量较对照组显著下降;TNF-α、IL-1β含量较对照组显著升高,分别于注射后2 h、6 h达峰值(P＜0.05),上述指标在血浆中的变化滞后于肠粘膜的变化;同时肠粘膜上皮内淋巴细胞(T、B细胞)增殖活力较对照组显著下降(P＜0.05).结论:内毒素休克后肠粘膜免疫功能呈双向性变化,肠粘膜局部免疫功能的紊乱可能是引起整个机体免疫功能的紊乱的原因之一.     

醒脑静注射液对内毒素休克兔肠的保护作用

目的 探讨醒脑静注射液对兔内毒素休克时肠功能的保护作用.方法 日本大耳白兔54只,随机分为正常对照组6只、LPS组24只（每个亚组6只）、LPS＋XNJ组24只（每个亚组6只）.用耳缘静脉推注LPS（2.4mg/kg）复制兔内毒素休克模型,用耳缘静脉推注醒脑静注射液（0.5mL/kg）治疗.于Oh、1h、2h、3h取肠黏膜及血用ELISA法检测肠黏膜和血浆,TNF-а、sIgA的含量.结果 sIgA的变化：LPS组各时间点的肠黏膜sIgA浓度与正常对照组比明显下降（P〈0.05）,而LPS＋XNJ组各时间点的slgA与LPS组比显著升高（P〈0.05）.INS组各时间点的血浆slgA浓度与正常对照组比明显下降（P〈0.05）,LPS＋XNJ组从2h开始显著高于LPS组（P〈0.05） TNF-а的变化：LPS组肠黏膜及血浆的TNF-а浓度与正常对照组比明显升高（P〈0.05） LPS＋XNJ组与LPS组比显著降低（P〈0.05）.结论 醒脑静注射液对内毒素休克时家兔肠黏膜有保护作用.     

乌司他丁对缺血再灌注损伤大鼠肠黏膜免疫功能的影响

目的：探讨乌司他丁（ulinastafin，UTI）对缺血再灌注（IR）损伤大鼠肠黏膜免疫屏障的保护作用及机制。方法：采用大鼠小肠缺血45min再灌注模型，治疗组于再灌注5min内尾静脉缓慢注射UTI。于再灌注后2h用免疫放射法测定血清、肠黏膜组织中分泌型免疫球蛋白A（sIgA）的含量；四甲基偶氮唑盐微量酶反应比色法（MTr）测定Peyer＇s淋巴结（pp）、上皮内淋巴细胞（IEL）和固有层淋巴细胞（LPL）增殖活力。结果：肠IR后血清和肠黏膜中sIgA含量下降，淋巴细胞增殖活性下降（P〈0．01）；不同剂量的UTI治疗组均能逆转IR后sIgA含量下降和淋巴细胞增殖活性下降，差异有显著意义（P〈0．01），而不同剂量UTI治疗组间各项指标也有显著差异（P〈0．05）。结论：乌司他丁（UTI）可参与调节肠道相关淋巴细胞免疫功能，对缺血再灌注损伤肠道免疫屏障具有保护作用。     

γ射线照射对兔眼损伤效应的实验研究

目的 观察胰高血糖素样肽－2对放射损伤小鼠小肠肠粘膜屏障和消化吸收功能恢复的影响。方法 昆明种小鼠经8Gy^60Coγ射线全身性一次照射后随机分为放射损伤对照组和胰高血糖素样肽－2处理组，设1、3、5d3个时相点，检测肠通透性、血浆内毒素含量、葡萄糖吸收能力及肠上皮蔗糖酶和乳糖酶活性变化。结果 8Gy ^60Coγ射线照射后1、3、5d肠通透性和葡萄糖吸收能力、蔗糖酶、乳糖酶活性分别显著高于和低于正常对照组（P＜0．01或P＜0．05），血浆内毒素含量在1、3d时显著高于正常对照组（P＜0．01或P＜0．05）；胰高血糖素样肽－2处理组肠通透性、血浆内毒素含量、葡萄糖吸收能力和蔗糖酶、乳糖酶活性分别在3d和5d时恢复正常。结论 胰高血糖素样肽－2可促进放射损伤小鼠肠粘膜屏障和消化吸收功能的恢复。     

小肠屏障功能监测的实验研究

目的 通过对创伤后小肠屏障功能几种监测方法的对比分析,试图找到一种适合临床推广的快速敏感的监测方法。方法 北京地区雄性成年山羊32只,随机分为创伤性失血性休克组（H组,n＝6）,创伤内毒素血症组（E组,n＝6）和创伤失血再灌注复合内毒素组（M组,n＝20）,模拟临床创伤、缺血再灌注（I／R）、感染脓毒症的实验模型。同时监测二胺氧化酶（DAO）、肠粘膜下pH（(pHi)和尿乳果糖／甘露醇比值,并参照血浆内毒素（LPS）、TNF和病理形态学结果进行对比分析。结果 创伤和失血性休克后当日血浆DAO活性可呈一过性升高,M组在输入内毒素后再度升高呈双峰型,H组术后第一天开始DAO渐趋下降,E组自手术当日开始逐渐升高。M组L／M较E组增显著;创伤、休克末和输内毒素后小肠pHi持续降低。血浆DAO的变化与L／M和肠粘膜pHi的变化呈高度相关（r=0.951和－0．553,P＜0．01－0．05）,三种肠功能指标与 浆LPS和TNF的变化高度相关,并与病理形态学变化相一致。结论 创伤缺血再灌流,单纯输内毒素均可导致肠屏障功能损伤,这种损伤是短暂和可逆的;创伤缺血再灌注流复合内毒素血症对肠屏障功能的损伤程度明显加重;DAO活性、L／M和肠pHi均能敏感地反映出创伤肠屏障功能损伤程度和逆转情况,但以DAO法更快速敏感,且能反应出肠上皮修复情况,又不平加病人痛苦,适于临床推广。     

卡托普利对失血性休克兔肠道细菌内毒素移位的影响

目的：研究卡托普利对失血性休克兔肠道细菌内毒素移位的影响。方法：新西兰白兔30只随机分为空白对照组、失血休克组、药物治疗组，分别于休克前（S0）、治疗起点（S1）及再灌注1h（REP1）、2h（REP2）、4h（REP3）、6h（REP4）、8h（REP5）、12h（REP6）取肠黏膜静脉血做细菌培养，同时于上述时间点测定肠黏膜静脉血内毒素浓度。结果：休克组与再灌注4h后细菌培养阳性率及肠系膜静脉血内毒素浓度与对照组相比升高显著；治疗组应用卡托普利后，细菌培养及肠系膜静脉血内毒素浓度与休克组相比明显较低。结论：失血性休克早期应用卡托普利能明显防止肠道细菌内毒素的移位。     

谷氨酰胺颗粒剂对严重创伤患者疗效及安全性的临床评价

目的 观察口服谷氨酰胺颗粒剂对严重创伤患者体内谷氨酰胺缺乏的治疗作用及可能发生的不良反应。方法 将受试患者随机分为对照组和治疗组。治疗组口服谷氨酰胺颗粒剂；对照组口服同等剂量的安慰剂。比较两组的蛋白质代谢、肠粘膜受损程度、免疫功能、肝肾功能。结果 治疗组血浆谷氨酰胺含量与用药前和对照组相比明显增加（P＜0.05)，而对照组用药后无明显变化。肠道受损程度明显减轻，治疗组二胺氧化酶活性、内毒素含量及肠粘膜通透性较用药前及对照组明显下降（P＜0.05-0.01)，血浆内毒素的变化则不明显（P＞0.05)。治疗组血浆蛋白、白介素－2水平显著高于用药前（P＜0.05)，尿氮含量明显低于对照组（P＜0.01)。结论 服用谷氨酰胺颗粒剂能显著提高血浆谷氨酰胺含量，对严重创伤患者谷氨酰胺缺乏的治疗是安全、有效的。     

大肠癌术后肠道粘膜免疫功能的改变

目的探讨大肠癌手术前后肠道粘膜免疫功能的变化，评估常规大肠癌手术对患者肠道粘膜免疫功能的影响．了解术后使用肠道益生菌制剂治疗肠道粘膜免疫功能紊乱的疗效。方法将大肠癌患者随机分为两组（实验组和对照组）。对照组：患者常规实施大肠癌根治术；实验组：患者常规实施大肠癌根治术，并于手术后可以进食起开始补充肠道益生菌制剂。两组均于术前，术后第一次排便，排便后5天，术后1月，4次抽静脉血检测血清CRP及TNF-α的含量，同时留取粪便检测分泌型免疫球蛋白（SIgA）含量。结果①两组患者术后第一次粪便SIgA含量与术前相比均明显减少（P〈0．05），术后第二次粪便SIgA含量较术后第一次并未明显增多（P〉0．05），实验组术后1月粪便SIgA含量较术后第一、二次明显升高，且明显高于对照组愀0．05）；②两组患者术后第一次血清TNF-α含量较术前明显升高（P〈0．05），术后第二次较术后第一次血清TNF-α含量有所降低（P〈0．05），术后第三次血清TNF-α含量实验组较对照组明显降低（P〈0．05）；③两组患者血清CRP术后第一次较术前均明显升高（P〈0．05），术后第二次较第一次明显降低（P〈0．05），术后第三次较第二次也明显降低（P〈0．05），但实验组与对照组比较，实验组降低更明显（P〈0．05）。结论④大肠癌患者手术后肠道粘膜免疫功能明显降低。②大肠癌患者术后粪便SIgA水平下降，应用肠道益生菌制剂短期内对升高SIgA效果不明显，但长期应用可显著升高SIgA水平。③大肠癌患者术后血清TNF-α和CRP水平显著升高，应用肠道益生菌制剂后可显著降低。     

抗大肠杆菌免疫卵黄球蛋白对大鼠放射性肠炎的防护作用

目的：观察抗大肠杆菌卵黄免疫球蛋白（IgY)对大鼠放射性肠炎的防护作用。方法：将30只大鼠随机分为正常对照组（A组），照射对照组（B组）和IgY保护组（C组），大鼠全腹照射1000cGy。C组自照射前1d开始灌服IgY.4d后处死大鼠观察肠道细菌移位情况，血中内毒素水平及小肠粘膜病理形态学改变，结果：A组无细菌移位，B组细菌移位最为明显（96．7％），C组细菌移位（13．3％），远不及B组明显；A组内毒素含量极低（0．001EU/ml)，B组内毒素含量明显升高（0．829EU/ml),C组内毒素含量（0．249EU/ml)明显低于B组；A组肠粘膜正常，B组肠粘膜绒毛水肿，炎性细胞浸润，部分上皮细胞脱落，C组绒毛轻度水肿，未见明显细胞脱落。结论：全腹照射能明显损伤小肠粘膜，引起细菌移位和内毒素血症，抗大肠杆菌IgY能明显减轻射线对小肠粘膜的损伤。     

腹部创伤感染时胃肠粘膜屏障损害的实验研究

目的：探讨腹部创伤感染时胃肠粘膜屏障损害过程及其发病机制．方法：在盲肠结扎加穿孔（ＣＬＰ）模型上，进行胃肠粘膜电位（ＰＤ）、血流量，肠粘膜通透性，血浆内毒素和血小板活化因子（ＰＡＦ）含量测定以及荧光标记菌示踪和组织形态学等观察．结果：腹腔感染大鼠胃肠粘膜ＰＤ和血流量显著降低；肠粘膜通透性和血浆内毒素水平显著升高；肠道荧光标记菌大量移位于肠外器官．血ＰＡＦ水平也显著升高，且与胃肠粘膜损害程度呈一致性相关．而应用ＰＡＦ拮抗剂ＷＥＢ２１７０治疗能明显减轻胃肠粘膜病理损害和降低肠道细菌移位率．结论：腹部创伤后腹腔感染时胃肠粘膜屏障出现广泛损伤和肠源性感染发生，而ＰＡＦ是导致这一病理生理改变的重要因素之一．     

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.