高原和平原慢性肾衰竭患者红细胞相关指标比较分析

目的:探讨高原和平原慢性肾衰竭患者血红蛋白的差异,为高原慢性肾衰竭诊治提供参考依据。方法:同期检测西藏军区总医院(高原组,n=80)和重庆新桥医院肾内科(平原组,n=80)慢性肾衰竭患者血红蛋白(Hb)、血细胞比容(HCT)、红细胞计数(RBC)、红细胞平均体积(MCV)及红细胞平均血红蛋白浓度(MCHC)等指标。根据血清肌酐浓度将患者分为4期。结果:两组各期患者均为20例。随肾功能不全程度加重,高原患者和平原患者一样,Hb、HCT及RBC均逐渐降低。高原组代偿期、氮质血症期和肾功能衰竭期患者Hb、HCT及RBC均高于同期平原组,但在尿毒症期两组患者无明显差异。高原组患者MCV明显高于平原组,呈现大细胞性贫血。结论:高原慢性肾衰竭早中期贫血程度要轻于平原患者,终末期无明显差别;且为大细胞性贫血。     

汉族人群移居高原后其心脏结构、心功能和肺动脉压等变化的研究

目的：研究汉族人群移居高原后其心脏结构、心功能、肺动脉压变化。方法：随机选取从内地平原移居至西藏高原多年（移居高原时间：28．88年±9．76年）的汉族人群,经病史及相关检查排除其他原因引起疾病共67例为移居高原组,并随机选取内地平原健康者61例为平原对照组。分别检测其心脏结构、心脏功能、肺动脉压和瓣膜口血流速度等指标,并进行统计分析探讨高原心血管适应问题。结果：移居高原组右心房、右心室和左心房内径;肺动脉收缩压、肺动脉内径、右肺动脉内径,均显著大于平原对照组（P〈0．001）,而且移居高原组内肺动脉收缩压与右心房、右心室内径存在正相关关系（r=0．370,P=0．011;r=0．403,P=0．005）。移居高原组左室射血分数显著高于平原对照组（P=0．018）、而心脏指数明显低于平原对照组（P=0．036）、每搏输出量和心输出量值两组无明显差异。移居高原组二尖瓣舒张期血流E峰、二尖瓣舒张期血流A峰、三尖瓣舒张期血流E峰、三尖瓣舒张期血流A峰均明显高于平原对照组（P=0．000）。结论：本研究表明,汉族人群移居高原多年后其心脏结构、心功能、肺动脉压、瓣口血流速度等指标均发生了显著的高原适应性变化;而且研究表明移居高原者心脏增大与肺动脉收缩压升高之间存在关联。     

高原与平原肺心病右室功能的超声改变与血清ET-1的关系

目的：检测不同海拔高度下肺心病患者右心室功能与血清ET-1水平变化的相关性。方法：将肺心病患者根据海拔分为高原组和平原组,采用彩色多普勒超声心动图对右心室前壁厚度、右室流出道宽度等指标进行测量比较。血清ET含量利用放射免疫技术进行测定。结果：高原组肺动脉瓣a波消失、右室前壁增厚和左右肺动脉宽度出现频率显著高于平原组（P〈0.01）;右室流出道增宽、室间隔增宽率高原组高于平原组（P〈0.05）;平均肺动脉压也高于平原组（P〈0.05）;高原组血清ET-1含量也显著高于平原组,并与肺动脉压存在一定的正相关。结论：高原肺心病右心病变较平原组严重,其与血清ET-1的水平变化有明显的相关性。     

高原与平原下肢深静脉血栓患者的护理效果比较分析

目的比较高原与平原下肢深静脉血栓患者的治疗、护理效果。方法选择41例高原下肢深静脉血栓患者和同期收治的38例平原下肢深静脉血栓患者,对两组患者进行针对性治疗和精心护理,并对药物使用剂量、疗效及并发症对比分析。结果 72例患者病情明显好转,7例患者症状缓解不明显。高原组中出现4例并发症,平原组中出现2例并发症,对症治疗后,症状均缓解。高原组有效37例（90.2%）,平原组有效35例（92.1%）。但高原组在使用抗凝药物达到目标值的剂量上是平原组的1.3～1.5倍,两组在疗效及并发症的发生上无显著差异（P〉0.05）。结论高原下肢深静脉血栓的治疗和护理策略与平原患者相同,只是在使用抗凝药物治疗上,高原患者使用抗凝药物治疗需要达到目标值是平原患者剂量的1.3～1.5倍,针对性治疗可以显著提高疗效,减少并发症的发生。     

高原地区慢性肺心病患者心电图改变的临床分析

目的:探讨高原地区慢性肺心病患者心电图改变的特点,评价心电图对该病诊断与治疗的临床价值。方法:对世居海拔(2 700~3 200)m的78例肺心病患者(高原组)及世居平原海拔400m的80例肺心病患者(平原组)常规心电图检查并进行心电图改变对比。结果:1肺心病患者心电图有典型改变特征;2平原组与高原组慢性肺源性心脏病心电图改变相比较,仅右心室肥厚,肢导联低电压,有显著性差异(P<0.05),其余指标均无显著性差异(P>0.05)。结论:1肺心病与心电图异常改变具有明显相关性,是临床诊断、治疗肺心病的重要指标之一;2高原肺心病患者与平原肺心病患者心电图改变有相似性,但部分改变差异有显著性。     

缺氧对健康成人甲状腺功能的影响

目的:探讨高原低氧环境对健康成人血清甲状腺激素的影响。方法:应用放射性免疫分析法(RIA)测定90例新兵在平原地区及高原地区血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺素(TSH)水平变化。结果:高原组血清T3、T4含量明显低于平原组,而TSH略高于平原组,但无统计学意义。结论:缺氧可导致甲状腺功能减退。     

高原与平原中青年冠心病患者冠脉病变与危险因素的比较

目的 探讨高原中青年冠心病患者冠状动脉病变情况和危险因素.方法 纳入经冠脉造影确诊的128例高原和同期收治的85例平原中青年（年龄≤50岁）冠心病患者,对两组患者的冠脉病变情况和心血管危险因素进行比较分析.结果 两组中青年冠心病患者均以男性为多,前降支受累率最高,侧支循环少见.高原组冠脉多支（≥2支）病变比例较平原组显著增加（P＜0.05）,冠脉中重度狭窄和闭塞病变的比例也较平原组显著增加（P＜0.05或P＜0.01）.高原组高血压、血脂异常和血糖异常的比例均显著高于平原组（P＜0.05或P＜0.01）;平原组肥胖和精神抑郁的比例显著高于高原组（P＜0.05或P＜0.01）;两组患者的性别构成比、吸烟史和家族史无显著差异.结论 高原中青年冠心病患者比平原患者合并高血压和糖脂异常的比例更高,且冠脉多支病变和重度狭窄的比例也更高.     

缺氧复合氰化钠中毒对大鼠脑组织单胺类神经递质含量的影响

目的观察缺氧复合氰化钠(NaCN)中毒对大鼠脑组织单胺类神经递质含量的影响。方法128只雄性SD大鼠随机分为平原组和高原组,每组64只。平原组大鼠在常规实验室内处理,高原组于模拟海拔4 000m的高原低压舱内连续缺氧暴露3d,每天23.5h。高原组和平原组大鼠分别在模拟高原条件和平原条件下经腹腔注射NaCN 3.6mg/kg,于中毒0、0.5、2、6h麻醉取脑,冰上分离海马和纹状体组织,离心提取组织内蛋白质。HPLC法测定大鼠脑纹状体和海马组织多巴胺(DA)、去甲肾上腺素(NE)和5-羟色胺(5-HT)含量。结果平原组大鼠NaCN中毒0.5、2、6h脑纹状体和海马组织的DA、NE和5-HT含量与中毒0h比较变化不明显。高原组大鼠脑纹状体DA、NE、5-HT含量和海马组织NE、5-HT含量在NaCN中毒2h或6h与0h比较均显著下降。与平原组比较,高原组纹状体DA、NE、5-HT和海马组织NE、5-HT含量均明显降低(P<0.05或0.01)。结论高原缺氧后脑组织单胺类神经递质含量明显降低,而氰化物中毒可进一步加剧这一改变。     

亚高原地区大、小鼠生化指标正常参考值实验研究

目的 探讨亚高原地区SD大鼠和KM小鼠血液生化指标变化规律,确立参考值.方法 将2w龄SD大鼠和KM小鼠各60只,按饲养地区分为亚高原组(海拔1890 m)和平原组(海拔540 m),分别于4、6、10 w龄时检测血液生化指标,比较两组肝功能、肾功能、血脂及血糖的差异.结果 取得亚高原地区不同周龄、不同性别SD大鼠和KM小鼠的血液生化指标均值.亚高原组的肝功能指标普遍高于平原组,以谷丙转氨酶、谷草转氨酶、白蛋白的改变为主(P＜0.05);亚高原组肾功能指标也高于平原组(P＜0.05),特别是习服时间越长,改变越明显;亚高原组血脂指标高于平原组(P＜0.05);除平原组雄性KM小鼠血糖(GLU)高于亚高原组(P＜0.05)外,其余亚高原组大、小鼠GLU均高于平原组(P＜0.05).结论 建立了亚高原地区不同周龄、不同性别SD大鼠和KM小鼠的血液生化指标数据库,为该地区生物医学研究奠定了基础,也为亚高原地区KM小鼠和SD大鼠标准化鉴定和质量控制提供了可靠依据.     

久居高原的老人返回平原后环核苷酸变化的初步研究

本研究以放射免疫法检测了久居高原后返回平原的老人、中年人的cAMP、cGMP的血浆含量。以海拔2260m人群、作为高原对照组;以苏州地区人群,作为平原对照组。结果显示:①中度高原人cAMP与cGMP含量较平原人下降,cAMP/cGMP比值仍维持平原人水平(p>0.05),两地区老人的cAMP/cGMP比值均较中年组有所下降,但无统计学意义(P>0.05),提示:中度高原人环核苷酸呈低水平调控,缺氧是导致环核苷酸下降的重要原因;②返回平原的老人,cAMP、cGMP均增加,但以cGMP增高为主,cAMP/cGMP比值下降,和返回平原的中年组相比有显著性差异(P>0.05)。表明环核苷酸失衡,机体整个代谢加强,从而促进细胞增繁、异化率增高,细胞的免疫水平下降等,并对机体产生不利后果。     

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.