低温环境下放射性与火器复合伤后细菌学改变的研究

目的观察低温环境下放射性与火器复合伤(下称放火器复合伤)后伤道及血液细菌学变化特点,为其临床救治提供理论依据。方法以30只新西兰大白兔制备低温放火器复合伤动物模型,分别于致伤后0、4、8、16、24、48 h进行实验动物体温变化动态观察,伤道及血液中的细菌定性培养及菌群种类分析。结果低温放火器复合伤动物体温伤后明显升高,伤后4 h平均体温达(39.47±0.39)℃,体温变化趋势非常显著。伤后4 h,伤道局部分泌物中细菌为表面菌群,伤后8 h检测到肠道菌群。血液中出现细菌的时间为伤后8 h,既有表面菌群,又有肠道菌群。结论低温放火器复合伤后体温升高明显,细菌感染较严重,细菌入血时间早,肠道细菌容易入血,处理应尽早清创,早期合理使用广谱抗生素。     

低温环境放火器复合伤细菌感染的实验研究

目的：探讨低温放火器复合伤感染的发生特点。方法：将健康兔随机分为低温放火器复合伤（HFR）组和低温火器伤（HF）组，于致伤后0、4、8、16、24h进行体温、伤道和血液细菌学的检测。结果：HFR组伤后体温持续明显升高，伤道细菌数明显上升，在对应时间点较HF组升高显著（P〈0．05，P〈0．01），2组分别于8和24h出现肠道菌群且细菌入血，细菌数达感染临界值。结论：低温放火器复合伤后细菌生长繁殖快，感染时限缩短且严重，应早期彻底清创，合理使用广谱抗生素。     

TNF-α在腹部火器伤肠管穿透后肝损伤机制中的作用

目的：探讨TNF-α在腹部火器伤肠管穿透后肝损伤中的作用。方法：健康长白仔猪42头随机等分为对照组和伤后1、2、4、8、12和24h组，实验组建立腹部火器伤肠管穿透模型后，用免疫组化及图像分析法检测各组肝内TNF-α的表达，同时应用TUNEL法测定肝细胞凋亡和血清中ALT水平变化情况，在光镜下观察各组肝脏组织学变化。结果：伤后各组肝内TNF-α表达均明显高于对照组，并于伤后2h和12h出现2个高峰（P〈0．05）。伤后各组出现逐渐加重的肝细胞水肿、变性、坏死，肝细胞凋亡指数和血清ALT水平也在伤后明显升高，并于伤后2h和12h出现2个高峰（P〈0．05）。结论：腹部火器伤肠管穿透后肝内TNF-α表达增多，与肝细胞凋亡、肝脏结构和功能损伤基本一致，TNF-α可能诱导了腹部火器伤肠穿孔后继发性肝损伤的发生。     

TNF-α在沙漠干热环境下猪腹部肠管火器伤后肝组织中的表达

目的探讨沙漠干热环境下猪腹部肠管火器伤后肝脏组织TNF-α的表达和肝功能的变化。方法沙漠干热环境组和常温环境组健康长白仔猪各42头随机等分为对照组和伤后1、2、4、8、12 h和24 h组,实验组建立腹部火器伤肠管穿透模型后,用免疫组化及图像分析法测定各组肝脏组织内TNF-α的表达,同时测定血清中AST水平。结果伤后各组肝组织TNF-α表达明显高于对照组,沙漠干热环境组于伤后2 h和8 h出现2个高峰;常温环境组于伤后2 h和12 h出现2个高峰。血清AST水平于伤后显著增高,并于伤后2 h出现第1个高峰,沙漠干热环境组和常温环境组分别于伤后8 h和12 h出现第2个高峰。结论沙漠干热环境下腹部肠管火器伤后肝脏TNF-α的表达增加并与AST的变化趋势一致,而且峰值较常温组提前出现,提示TNF-α在腹部肠管火器伤后肝损伤过程中可能起重要作用。     

环氧化酶-2在腹部肠管火器伤后肝组织中的表达及意义

目的:探讨环氧化酶-2(COX-2)在腹部肠管火器伤后肝组织中表达的变化及其意义。方法:健康长白仔猪42头随机等分为对照组和腹部肠管火器伤后1、2、4、8、12和24 h实验组。建立腹部肠管火器伤模型后,用免疫组化图像分析法测定各组肝组织COX-2的表达,同时测定血清ALT、AST水平,在光镜下观察各组肝脏组织学变化。结果:伤后各组肝组织COX-2表达明显高于对照组(P<0.05),并于伤后2 h和12 h出现2个高峰。伤后各组出现逐渐加重的肝细胞水肿、变性、坏死,血清ALT、AST水平在伤后也明显升高,也于伤后2 h和12 h出现2个高峰。相关分析表明,伤后肝组织COX-2与血清ALT、AST水平均呈正相关(r值分别为0.850、0.757,P<0.05)。结论:腹部肠管火器伤后肝组织COX-2表达增强,与肝脏结构和功能损伤基本一致,COX-2在腹部肠管火器伤后继发性肝损伤中具有重要意义。     

常温环境下腹部火器伤肠管穿透后猪肝脏功能和形态的变化

目的:观察常温环境下猪腹部火器伤肠管穿透后肝脏功能和形态的变化。方法:健康长白仔猪42头随机等分为对照组和伤后1、2、4、8、12和24 h组,实验组建立腹部火器伤肠管穿透模型后,分别测定伤后1、2、4、8、12和24 h各组动物血清中ALT、AST水平,并与对照组比较。对照组麻醉,但不建立火器伤模型。在光镜下观察各组肝脏组织学变化,电镜下观察肝脏超微结构改变。结果:伤后各组血清ALT、AST水平均高于对照组,并于伤后2 h和12 h出现2个高峰(P<0.01)。伤后1、2、4 h组出现逐渐加重的肝细胞水肿、变性,伤后8、12、24 h组出现逐渐加重的肝细胞点状坏死、灶状坏死、炎细胞浸润和肝细胞超微结构损伤。对照组光镜下未见明显的损伤性变化。结论:腹部火器伤肠管穿透导致肝脏出现功能和形态的损伤性变化,随着伤后时间的延长而加重。     

NF-κB在腹部火器伤肠管穿透后肺损伤中的变化及意义

目的探讨NF-κB在腹部火器伤肠管穿透后肺损伤中的变化及意义。方法健康长白仔猪42头随机等分为对照组和伤后1、2、4、8、12 h和24 h组,实验组建立腹部火器伤肠管穿透模型后,用免疫组化图像分析法测定各组肺组织NF-κB表达,在光镜下观察各组肺脏组织学变化,电镜下观察肺脏超微结构改变。结果 伤后各组肺组织NF-κB表达明显高于对照组,并于伤后1~8 h内快速上升,在8h出现高峰(P<0.05)。伤后各组逐渐出现肺泡腔变窄,肺泡壁增厚;肺充血,肺间质水肿。电镜下4、8、12、24 h组逐渐出现线粒体肿胀、溶解。结论腹部火器伤肠管穿透后肺组织NF-κB表达活性增强,与肺脏组织病理损伤基本一致,NF-κB在腹部火器伤肠管穿透后继发性肺损伤中具有重要意义。     

TNF-α和IL-6在腹部肠管火器伤后血清中的变化

目的探讨腹部肠管火器伤后血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)的动态变化规律,为寻找有效的细胞因子拮抗剂来减轻腹部火器伤后机体的损伤以促进机体康复提供理论依据。方法健康长白仔猪42头随机等分为对照组、伤后1、2、4、8、12 h和24 h组,每组6只,实验各组建立猪腹部肠管火器伤模型后,采用双抗体夹心ELISA法测定各组动物血清TNF-α、IL-6水平。结果实验组各组动物血清TNF-α、IL-6水平均明显高于对照组(P<0.05),TNF-α在伤后12 h为(94.36±10.18)ng/L,IL-6在伤后12 h为(1 218.35±74.00)ng/L,二者均于伤后12 h达到高峰。结论TNF-α、IL-6参与了腹部肠管火器伤后机体的病理生理过程,可能是引起腹部肠管火器伤后多器官功能障碍综合征(MODS)的重要因素之一。     

猪腹部火器伤肠管穿透后NF-κB在心脏中的表达及其意义

目的探讨NF-κB在腹部火器伤肠管穿透后心脏中的变化及意义。方法健康长白仔猪42头随机等分为对照组和伤后1、2、4、8、12 h和24 h组,实验组建立腹部火器伤肠管穿透模型后,用免疫组化图像分析法测定各组心肌组织NF-κB活性,同时测定血清中LDH、CK-MB水平,在光镜下观察各组心脏组织学变化,电镜下观察心脏超微结构改变。结果伤后各组心脏NF-κB表达明显高于对照组。伤后各组血清LDH、CK-MB水平均高于对照组。伤后8、12、24 h组光镜下出现逐渐加重的心肌细胞水肿、变性;电镜下4、8、12、24 h组出现逐渐的线粒体肿胀、溶解;对照组光、电镜下未见明显的损伤性变化。相关分析表明,伤后心肌组织NF-κB表达与血清LDH、CK-MB水平均呈正相关(r值分别为0.968、0.957,P<0.05)。结论腹部火器伤肠管穿透后心肌组织内NF-κB活性增强;NF-κB在腹部火器伤肠管穿透后继发性心脏损伤中具有重要意义。     

沙漠干热环境下猪腹部肠管火器伤后肝组织核因子-κB的表达

目的 探讨沙漠干热环境下猪腹部肠管火器伤后肝脏组织核因子-κB(NF-κB)的表达和肝功能的变化.方法 沙漠干热环境组和常温环境组健康长白仔猪各42头随机等分为对照组和伤后1、2、4、8、12小时和24小时组,实验组建立腹部火器伤肠管穿透模型后,用免疫组化图像分析法测定各组肝脏组织内NF-κB的表达,同时测定血清中谷丙转氨酶(ALT)水平.结果 伤后各组肝组织NF-κB表达明显高于对照组,沙漠干热环境组于伤后1小时和4小时出现2个高峰;常温环境组于伤后1小时和8小时出现2个高峰.血清ALT水平于伤后显著增高,并于伤后2小时出现第1个高峰,沙漠干热环境组和常温环境组分别于伤后8小时和12小时出现第2个高峰.结论 沙漠干热环境下腹部肠管火器伤后肝脏NF-κB的表达增加并伴随肝功能损伤,而且峰值较常温组提前出现,提示腹部肠管火器伤后靶向NF-κB的干预治疗在沙漠干热环境下应及早进行.     

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.     

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.     

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).     

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.