嗅鞘细胞移植治疗脊髓截瘫110例

目的用嗅鞘细胞移植法试治脊髓截瘫,探讨该方法是否有助于脊髓损伤神经功能的恢复.方法取胚胎嗅球,消化成单个嗅鞘细胞后,培养2～3周,然后将其移植到脊髓损伤部位的上下处.结果嗅鞘细胞移植后6个月、1年和2年随访,75例患者的脊髓功能均有不同程度的改善,且呈现继续改善趋势.结论嗅鞘细胞移植有助于脊髓损伤患者脊髓神经功能的恢复.     

嗅鞘细胞移植治疗多发性硬化的初步分析附1例报告

目的 开展嗅鞘细胞移植治疗脊髓多发性硬化的临床试验研究，探讨其对多发性硬化脊髓神经功能的改善效果。方法 取胚胎嗅球，消化成单个嗅鞘细胞后，培养2周，然后将其移植到脊髓病变部位的上下处。报告1例移植患者：女，33岁，四肢及躯干进行性无力，感觉减退2年。采用上述细胞行脊髓移植。术前和术后4周使用美国脊髓损伤协会国际评价系统进行疗效评价。结果 嗅鞘细胞移植后4周，患者的脊髓功能有改善，美国脊髓损伤协会评分运动总分由术前2增加到4分；轻触觉总分由4增到6分；痛觉由21增至24分。经0．5年电话随访呈继续改善趋势。结论 嗅鞘细胞移植能改善多发性硬化患者的脊髓神经功能。长期效果有待进一步评价。     

急性脊髓炎后遗截瘫行嗅鞘细胞移植术的临床效果观察

目的开展嗅鞘细胞移植治疗急性脊髓炎的临床试验研究,探讨其对急性脊髓炎脊髓神经功能的改善效果。方法取胚胎嗅球,消化成单个嗅鞘细胞后,培养2～3周,然后将其移植到脊髓病变部位的上下处。术前和术后2周使用美国脊髓损伤委员会国际评价系统进行疗效评价。结果嗅鞘细胞移植后2周,患者的脊髓功能有改善。运用美国脊髓损伤委员会运动国际评价系统总分评价,病例1由术前50增加到52分,轻触觉总分由64增到76分,痛觉由64增至80分;病例2由术前40分增加到53分,轻触觉总分由38增到48分,痛觉由38增至43分。经0．5年电话随访呈继续改善趋势。结论嗅鞘细胞移植能改善急性脊髓炎患者的脊髓神经功能,长期效果有待进一步评价。     

嗅鞘细胞促使脊髓挫裂伤后神经再生和功能恢复的研究

目的：研究嗅鞘细胞在脊髓挫裂损伤后不同时期植入能是否帮助轴突再生、穿过瘢痕和神经功能恢复。方法：用NYU打击器制造Log Evans Hooded大鼠的脊髓挫裂损伤模型,在伤后即刻和二周后植入嗅鞘细胞,采用BBB方法做行为学观察三个月,经运动皮层注入神经示踪剂（BDA）后行组织化学研究。结果：部分大鼠鞘细胞植入后比对照组的神经功能恢复好,组织学发现这些神经功能恢复好（BBB分数＞10）的大鼠,再生神经轴突能穿过损伤瘢痕区到达损伤下段。结论：嗅鞘细胞在脊髓挫裂损伤后即刻和二周后植入均能帮助轴突再生、穿过瘢痕和神经功能恢复。     

脑源性神经营养因子基因转染嗅鞘细胞移植修复脊髓损伤的观察

目的观察BDNF基因转染的嗅鞘细胞（OECs）对脊髓损伤的修复作用。方法制作大鼠脊髓损伤模型,随机分为无OFCs移植组（6只）、非转染OECs移植组（6只）和转染OECs移植组（8只）,利用免疫组化、逆行示踪及顺行示踪技术对脊髓横断损伤区及其上位、下位脊髓不同平面进行观察。结果移植后12周在局部注射区仍可以见到预标记的OECs,免疫组化观察到脊髓损伤区有BDNF的表达。逆行示踪法在损伤平面头侧的脊髓、脑干和皮质中观察到示踪剂。顺行示踪法在脊髓损伤区可以见到再生的神经纤维通过。无嗅鞘细胞移植组及非转染嗅鞘细胞移植组损伤平面头侧的脊髓、脑干和皮质中未观察到示踪剂,脊髓损伤区内亦未见有再生神经纤维长入。结论移植BDNF转染的OECs可促进损伤的中枢神经轴突存活和再生,较单纯应用OECs能更好地促进脊髓损伤修复。     

嗅鞘细胞移植对创伤性脑损伤大鼠神经功能和突触密度的影响

目的 研究嗅鞘细胞(olfactory ensheathing cells,OECs)移植对创伤性脑损伤(traumatic brain injuries,TBI)大鼠神经生理功能恢复的影响及其作用机制.方法 成年SD大鼠以随机数字表法分为假手术组、自由落体致大脑运动皮质区脑挫伤组、脑损伤后嗅鞘细胞移植组.先制备大鼠TBI模型.体外培养、纯化并鉴定嗅鞘细胞后将其移植入损伤脑组织周围.术后14 d对各组大鼠进行感觉诱发电位(CSEP)和运动诱发电位(MEP)神经电生理检测后,取损伤处及其邻近脑组织以突触素抗体免疫组化染色显示各组突触数量变化.用单因素方差分析进行统计学分析.结果 体外培养的细胞经鉴定为嗅鞘细胞,移植入损伤脑组织后14 d,嗅鞘细胞移植组的CSEP和MEP较单纯损伤组明显改善.且突触数量增多.结论 嗅鞘细胞移植可促进脑损伤大鼠神经生理功能恢复,并增加突触数量,为临床应用嗅鞘细胞治疗脑外伤提供了重要的实验证据.     

雌激素影响急性大鼠脊髓损伤后细胞凋亡的相关性实验研究

目的在建立大鼠脊髓损伤模型基础上,观察不同时间点雌激素对脊髓胶质细胞,神经元凋亡的影响,以期为临床急性脊髓损伤的治疗提供理论依据。方法健康成年大鼠72只,随机分为两组,其中单纯损伤组（单纯打击损伤）36只,雌激素组（手术加雌激素）36只。脊髓损伤动物模型的制备：用自制Allen打击器25gcm致伤力撞击脊髓,制成脊髓损伤动物模型。雌激素组每日肌注雌激素（100μg／kg）直至处死,单纯损伤组仍每日肌注生理盐水0．5ml直至处死。组织切片的制备：脊髓损伤后1d、3d、5d、8d、14d、21d共6个时间段分批处死动物。4％多聚甲醛心肌灌注固定24h,切取每只大鼠T5～T13节段脊髓组织,常规制成切片,给于Bcl－2检测,TUNEL原位末端标记,检测大鼠脊髓损伤后细胞凋亡的情况。脊髓损伤后2周给予Gale评分及斜板维持试验。结果Bcl－2蛋白检测：在脊髓损伤后的第1天,脊髓组织即开始较高表达Bel－2蛋白。单纯损伤组Bcl－2高峰发生在损伤后3天,而雌激素组伤后8天达到高峰,此时Bcl－2蛋白不仅表达在神经细胞中,更多的在胶质细胞中大量表达,且此状态一直维持到伤后14天才开始下降,伤后21天仅少量表达（P〈0．05）。TUNEL原位标记检测：单纯损伤组24小时已出现不少阳性细胞,以胶质细胞为主．3～8天达到高峰,此后逐渐回落,但21天时仍有阳性细胞,应用雌激素治疗后,凋亡细胞明显减少（P〈0．05）。脊髓损伤后2周Gale评分及斜板维持率雌激素组优于单纯损伤组（P〈0．01）。结论雌激素在脊髓损伤中通过改善微循环,促进Bcl－2蛋白的表达,清除氧自由基,抗氧化作用能够抑制脊髓损伤早期神经细胞和胶质细胞的凋亡,从而减轻脊髓继发性损伤．促进脊髓神经功能的恢复。所以脊髓损伤后早期应用雌激素配合其它药物阻止神经细胞和胶质细胞的凋亡可能有助于减轻脊髓损伤的损害程度,促进脊髓神经功能的恢复,为SCI的治疗提供一个新的途径。     

髓鞘碱性蛋白徽基因修饰雪旺细胞移植对大鼠脊髓损伤后生长相关蛋白—43表达的影响

目的：研究pSVPoMcat微基因修饰雪旺细胞（Schwann cell,SC)对大鼠脊髓损伤（spinal cord injury,SCI)后神经生长相关蛋白－43（growth associated protein-43,GAP-43)表达的影响。方法：采用120只大鼠脊髓半横切损伤模型，随机分为三组：pSVPoMcat微基因修饰SC移植组（A组），单纯SC移植组（B）组，损伤对照组（C组）。应用免疫细胞化学方法动态观察SCI后GAP－43的表达，同时采用联合行为记分（CBS）观察大鼠神经功能恢复情况。结果：SCI损伤后1周，A，B，C三组间GAP－43表达差异无显著性意义；SCI后2，4，8周，三组间表达顺序为A＞B＞C，差异有显著性意义（P＜0．05）。其间A组在2周时达到最高峰，此后逐渐下降，12周时A，B，C三组间差异无显著性意义。A组大鼠神经功能恢复最好。结论；pWVPoMcat微基因修饰SC移植有促进SCI后GAP－43表达和大鼠神经功能恢复的作用。     

前路减压固定植骨融合治疗胸腰椎骨折合并脊髓损伤前路减压固定植骨融合治疗胸腰椎骨折合并脊髓损伤

目的 探讨经前路椎体切除减压固定植骨融合治疗胸腰椎骨折合并脊髓损伤的疗效。方法 通过对自1985年1月至2002年6月采用前路减压固定植骨融合治疗537例胸腰椎骨折合并脊髓损伤患者临床资料分析，以及248例患者的随访结果比较，观察其神经功能恢复和局部脊柱的稳定性。结果 573例患者术后均无神经功能损害加重。出院时神经功能改善情况：93例无神经损伤者，术后功能良好；新鲜骨折合并不全瘫患者275例中，240例有1～3级恢复；107例陈旧性骨折患者术后神经功能均有不同程度改善；62例全瘫患者，仅5例感觉有部分恢复。248例随访中，26例全瘫患者仅4例部分浅感觉恢复，204例不全瘫患者均有不同程度的神经功能改善。全部患者X线片显示植骨均已融合，有4例出现断钉，但无临床症状。结论对来自椎管前方压迫的胸腰椎骨折合并脊髓损伤，前路减压手术具有减压彻底、神经功能改善率高、Ⅰ期固定融合成功率高、脊柱稳定性好等优点，是治疗胸腰椎骨折合并脊髓损伤的有效方法。     

前路减压手术治疗晚期脊髓损伤的初步报告

目的 探讨前路减压手术治疗晚期脊髓损伤的手术指征和时限。方法 晚期脊髓损伤伴脊髓压迫症患者56例,由受伤至本次手术的时间为0．5～31年,平均3．6年。脊柱骨折部位：颈4～胸1为19例,胸2～胸9为9例,胸11～胸2为28例。瘫痪程度：完全瘫痪46例,不全瘫10例。所有患者均行脊髓前路减压术,脊柱失稳者同时行内固定手术。结果 术后影像学检查证实所有患者完全去除脊髓腹侧压迫,恢复椎管直径。随访20d～6个月(平均30d),53例(有效率94．6％)获得不同程度脊髓功能改善,表现为肢体痉挛减轻、泌汗功能改善、根性疼痛减轻、感觉平面下移、肌力增加、肛周感觉部分恢复以及排尿功能改善。结论 ①脊髓前路减压能准确、彻底地解除脊髓腹侧之压迫,改善晚期脊髓损伤包括全瘫患者同一平面神经根和脊髓长束的功能。脊髓、神经受压时间长短在临床上只具有相对意义,不是影响手术治疗效果的主要因素。②晚期前路减压的手术指征应放宽,凡影像学检查证实脊髓腹侧存在压迫和(或)严重后突畸形者均应彻底减压。③减压时应注意保持和恢复脊柱的稳定性,必要时内固定。     

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.