预处理对高原大鼠肝脏缺血再灌注损伤的防护作用

目的 :探讨丹参、地塞米松、L -精氨酸、维拉帕米在肝脏缺血预处理 (IPC)过程中的作用 ;方法 :在原位灌流的大鼠肝脏缺血再灌注模型上 ,经尾静脉注射丹参、地塞米松、L -精氨酸和维拉帕米 ,检测上述药物在IPC中的疗效 ;结果 :药物预处理组与对照组比较 ,药物预处理可阻止血清谷丙转氨酶 (ALT ,U/L) 1 3 7.7± 1 5.6、1 4 2 .6± 1 5.9、1 4 6.3±1 3 .7、1 4 2 .8± 1 5.7与 1 74.7± 2 3 .9;谷草转氨酶 ( (AST ,U/L) 2 63 .1± 2 3 .5、2 56.8± 2 8.7、2 72 .5± 2 2 .5、3 2 9.3± 3 6.5与 3 40 .2± 3 8.3 ;乳酸脱氢酶 (LDH ,U/L) 1 2 0 6± 1 3 7、1 2 96±1 1 8、1 2 2 0± 1 2 7、1 2 76± 1 2 3与 2 568± 1 53及脂质过氧化物 (MDA ,mmol/L) 2 9.7± 5.4、2 7.6± 4.5、2 7.8± 4.7、2 7.6± 5.7与 3 8.7± 7.6水平升高 (P <0 .0 1 ) ;而使超氧化歧化酶(SOD ,mu/L) 95.1± 1 0 .2、92 .4± 1 1 .4、92 .4± 1 0 .5、95.3± 1 0 .8与 73 .7± 5.4;一氧化氮(NO ,mmol/L) 81 .5± 7.9、86.4± 9.4、88.3± 9.6、76.3± 8.6与 64.2± 6.8保持在较高水平 (P <0 .0 1 ) ;药物预处理组肝脏病理改变程度明显轻于缺血再灌注组 ,但维拉帕米不如丹参、地塞米松、L -精氨酸的疗效 (P <0 .0 5) ;结论 :药物预     

丙泊酚对兔肝脏缺血后再灌注损伤的保护作用

目的探讨丙泊酚对兔肝脏缺血后再灌注损伤的影响。方法将实验兔随机分为拟手术组(S组),肝脏缺血后再灌注组(IR组),及微量泵连续静脉输注丙泊酚[10mg/(kg.h)]组(PRO组),IR组和PRO组将入肝血流阻断25min后再灌注120min,然后观察不同时相丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转氨酶(AST)、乳酸脱氢酶(LDH)的变化,检测肝组织超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量。结果IR组、PRO组再灌注120min后肝功能均有损害,而IR组的ALT,AST,LDH均高于PRO组;PRO组肝脏组织MDA浓度低于IR组(P<0.05),PRO组的SOD浓度高于IR组(P<0.05)。结论肝脏缺血后再灌注可使大量氧自由基释放,它在肝损伤中发挥重要作用,丙泊酚可抑制再灌注后的过度氧化反应,减轻肝组织损伤。     

大麻二酚对大鼠非酒精性脂肪肝的治疗作用及机制

目的 观察大麻二酚(CBD)对蛋氨酸/胆碱缺乏饲料(MCD)诱导的大鼠非酒精性脂肪肝(NASH)的治疗作用并探讨其分子机制.方法 63只成年雄性SD大鼠随机分为对照组(给予正常饲料)、MCD组(给予MCD喂养)和MCD+CBD组[给予MCD,同时给予2mg/(kg·d)CBD腹腔注射].10周后,组织染色法观察大鼠肝脏病理变化及纤维化情况,采用全自动生物化学分析仪检测血清丙氨酸转氨酶(AST)、天冬氨酸转氨酶(ALT)水平,生化试剂盒检测肝脏中胆固醇和甘油三酯水平,Western blotting法观察肝细胞自噬活性的变化.结果 MCD喂养的大鼠给予CBD后,肝脏的病理改变明显减轻(4.7±1.1 vs.2.2±0.5,P<0.05),血清ALT(214.5±54.1U/L vs.92.1±36.0U/L,P<0.05)和AST(175.9±55.2U/L vs.70.8±24.9U/L,P<0.05)水平明显下降,肝脏/体重比(%)降低(4.2±0.6 vs.3.1±0.6,P<0.05),肝脏中胆固醇(182.4±42.7mmol/mg protein vs.101.0±33.8mmol/mg protein,P<0.05)和甘油三酯(71.4±12.5mmol/mg protein vs.38.7±11.1mmol/mg protein,P<0.05)含量减少;肝脏的纤维化程度降低(1.4%±0.4%vs.0.8%±0.3%,P<0.05),Ⅰ型α1胶原(Col1A1)mRNA水平明显下降(2.9±0.4 vs.1.6±0.3,P<0.05).CBD治疗后,MCD大鼠肝脏中Ⅱ型微管相关蛋白1轻链3(LC3-Ⅱ)/LC3-Ⅰ比值增加(37.1±10.8 vs.71.2±17.1,P<0.05),可溶性死骨片1(p62)蛋白水平降低(202.4±40.9 vs.125.8±32.7,P<0.05).结论 CBD减轻了MCD诱导的大鼠NASH症状,CBD对肝细胞自噬流的促进可能是其肝脏保护作用的机制之一.     

复方葡萄籽提取物对乙醇及四氯化碳肝损伤的影响

目的：探讨复方葡萄籽提取物（GSE）对化学性肝损伤的预防和治疗作用。方法：用小鼠建造四氯化碳肝损伤和乙醇肝损伤模型，观察乙醇灌胃前预先给予复方GSE及乙醇或四氯化碳灌胃后再给予复方GSE后小鼠血清谷丙转氨酶（ALT），肝细胞超氧化物歧化酶（SOD）、谷光甘肽（GSH）、丙二醛（MDA）。结果：预先给予GSE可增强SOD活性，防止乙醇导致的肝GSH减少，有效降低小鼠血清ALT和肝细胞MDA上升程度，在乙醇或四氯化碳灌胃后再给予复方GSE，也可降低小鼠血清中ALT和肝细胞脂质过氧化产物。结论：复方GSE对乙醇肝损伤有预防和治疗作用。对四氯化碳肝损伤也有一定治疗作用。     

婴儿肝炎综合征ALT、r—GT、AFP水平检测的临床意义

我科自1988年以来对收治的 24例婴儿肝炎综合征(婴肝)患儿检测其血清谷丙转氨酶(ALT)、r-谷氨酰转肽酶(r-GT)、甲胎蛋白(AFP)水平,并对该三种酶的临床意义以及与预后的关系加以观察及探讨.一、一般资料:男16例,女8例.年龄<28天3例,l～2月17例,2～3月4例.皮肤黄染24例,肝大24例,脾大7例,粪色浅或发白19例、B超检查24例均未发现胆道系统明显异常.二、转归:治愈18例,好转2例,无变化3例,死亡1例.三、实验资料与结果:24例人院首次ALT、r-GT、AFP均值分别为:59.17±9.25U、109.17±9.40U、314.58±150.23μg/L(我院正常值分别为:<40U、<50U、0～30μg/L).此三项酶活力均高于正常值.治疗前后ALT、r-GT、AFP值对照观察,只有ALT值下降有显著性差异(P<0.05),而r—GT、AFP值无显著性差异.详见表1.     

氢气生理盐水对大鼠肝缺血再灌注后氧化应激损伤的保护作用

目的研究氢气生理盐水(Hydrogen-rich saline,HS)抑制氧化应激,减轻大鼠肝缺血再灌注损伤(IRI)的作用。方法将32只雄性Wistar大鼠随机分为假手术组(sham)、肝缺血再灌注组(IR)、生理盐水处理组(IR+NS)和氢气生理盐水处理组(IR+HS),制作70%大鼠肝脏缺血再灌注模型,术后12h处死大鼠,检测各组大鼠血清丙氨酸转氨酶(AIR)和天冬氨酸转氨酶(AST)水平;取肝组织观察其病理学变化,并观察肝组织内超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽(GSH)变化。结果与IR+NS组相比较,术后IR+HS组肝组织病理损伤情况明显改善,血清AIR及AST值较低(P<0.05),肝组织MDA水平明显下降(P<0.05),SOD活性和GSH含量明显上升(P<0.05)。结论 HS能减轻大鼠肝IRI,其机制可能与抑制肝缺血再灌注后氧化应激反应有关。     

黄芩苷对异烟肼和利福平肝损害小鼠的保护作用

目的 观察黄芩苷对异烟肼和利福平肝毒性的保护作用。方法 分别测定血清谷丙转氨酶(ALT)的活性，肝匀浆中谷胱甘肽(GSH)及脂质过氧化物丙二醛(MDA)的含量，肝微粒体中细胞色素P450及其亚型2E1的活性。结果 黄芩苷可对抗异烟肼和利福平合用引起的肝指数、血清ALT水平、肝匀浆中的MDA含量、以及细胞色素P4502E1活性的升高，调节细胞色素P=450的水平，增加肝匀浆中GSH含量；病理组织学检查黄芩苷能明显减轻肝细胞的变性和坏死。结论 黄芩苷对两药合用肝毒性的保护作用不仅与清除自由基、抑制肝细胞膜的脂质过氧化反应有关，而且还与抑制细胞色素P4502E1活性有关。     

血清钾、钠联合肝转氨酶在钝性肝损伤中的临床价值研究

目的探讨血清钾、钠联合肝转氨酶在钝性肝损伤中的临床应用价值。方法回顾性分析2003年10月—2016年4月福州总医院收治的202例钝性肝脾损伤患者的临床资料。按是否存在肝损伤分为肝损伤组101例,无肝损伤组即脾损伤组101例;按肝损伤程度分为轻度肝损伤组53例,严重肝损伤组48例。检测两组血清钾(K~+)、血清钠(Na~+)、谷丙转氨酶(ALT)、谷草转氨酶(AST)的值,通过Logistic回归建立回归模型,绘制受试者工作特征曲线(ROC曲线)并计算曲线下面积(AUC)以评价单独及联合指标检测的诊断价值。通过ROC曲线确定ALT、AST在肝损伤中的最佳阈值及血清K~+、Na~+、ALT、AST在严重肝损伤中的最佳阈值。结果肝损伤与无肝损伤组血清K~+、Na~+、ALT、AST水平四种指标的差异有统计学意义(P0.01);轻度与严重肝损伤组四种指标水平的差异有统计学意义(P0.01)。对于判断闭合性腹部损伤是否合并肝损伤,联合指标检测的AUC大于单独检测的AUC,但差异无统计学意义(P0.05);ALT单独和联合检测对肝损伤和非肝损伤的预测率分别为89.1%、94.1%;ALT单独判断肝损伤的敏感度和特异度分别为92.1%、93.1%,而联合检测则分别为93.1%、93.1%。对于判断钝性肝损伤是否为严重肝损伤,联合检测的AUC大于单独检测的AUC,且差异有统计学意义(P=0.043);ALT单独检测对轻度肝损伤和严重肝损伤的预测率分别为79.2%、58.3%,而联合则分别为81.1%、70.8%;ALT单独检测判断严重肝损伤的敏感度和特异度分别为83.3%、54.7%,而联合则分别为66.7%、94.3%。通过ROC曲线评估得出ALT、AST在肝损伤中的最佳阈值分别为57.55U/L、59.2U/L;血清K~+、Na~+、ALT、AST在严重肝损伤中的最佳阈值分别为3.685mmol/L、142.55mmol/L、171.50U/L、364.00U/L。血清K~+和Na~+水平在轻度和严重肝损伤组呈负相关(P=0.005,r=-0.382;P=0.001,r=-0.494),且在严重肝损伤中最为明显。结论肝转氨酶升高与肝损伤密切相关;肝功能联合电解质检测对临床鉴别钝性肝损伤是否为严重肝损伤有较高的准确性、预测性和特异度,可作为临床早期鉴别的一种初步有效的手段之一,从而为其治疗提供有力的证据。     

己酮可可碱对重度失血性休克大鼠肝脏缺血再灌注后氧自由基的影响

目的探讨已酮可可碱(PTX)对重度失血性休克大鼠肝脏缺血再灌注后氧自由基的影响。方法 48只SD大鼠随机分为4组(n=12):对照组(C组)、单纯休克组(NR组)、乳酸林格液复苏组(LR组)及乳酸林格液联合PTX(25mg/kg)复苏组(LRPTX组)。采用改良Wiggers法制备失血性休克动物模型,分别于休克前(Ts)、处死前(Td)取静脉血检测谷丙转氨酶(ALT)及谷草转氨酶(AST)含量。NR组在休克后即刻、其余组在复苏后4h处死大鼠取肝组织测定过氧化物歧化酶(SOD)活性,丙二醛(MDA)含量,诱导型一氧化氮合酶(iNOS)及NF-κB蛋白表达情况。电镜及光镜下观察各组大鼠肝组织病理变化。结果与C组比较,NR组、LR组和LRPTX组Td时间点静脉血中AST及ALT水平均明显升高(P<0.05);肝组织MDAi、NOS含量明显升高,NF-κB蛋白表达增加,SOD活性降低(P<0.05)。肝组织病理学损伤明显。与LR组比较,LRPTX组静脉血中AST、ALT、MDAi、NOS含量均明显下降,NF-κB蛋白表达减少,SOD活性升高(P<0.05),肝组织病理学损伤减轻。结论 PTX可减少肝脏iNOS生成,抑制NF-κB活化,减少肝脏氧自由基生成,提高SOD活性,降低肝缺血再灌注损伤。     

普拉克索在减轻小鼠肝缺血再灌注损伤中应用

目的探讨普拉克索(PPX)对小鼠缺血再灌注(I/R)后肝损伤的影响及机制。方法选择健康、雄性C57BL/6小鼠40只,随机分为4组:Sham+DMSO组、Sham+PPX组、I/R+DMSO组、I/R+PPX组,每组各10只。Sham组小鼠仅接受中线开腹、游离肝十二指肠韧带及关腹操作;I/R通过Pringle法诱导肝缺血再灌注模型。DMSO和PPX(1 mg/kg)均在术前30 min腹腔注射。再灌注3、6、24 h后检测血清谷丙转氨酶/谷草转氨酶(ALT/AST)水平,观察肝形态学变化;TUNEL染色了解肝细胞凋亡情况;通过试剂盒检测肝氧化应激指标MDA、HNE、SOD水平;使用Clark氧电极法检测肝线粒体功能指标RCR、ADP/O;检测肝ATP水平。结果与I/R+DMSO组比较,I/R+PPX组小鼠肝功能损伤指标ALT/AST水平显著降低(P<0.01),HE染色显示,I/R+PPX组小鼠肝细胞肿胀、排列紊乱、内皮细胞结构完整性破坏情况有明显改善(P<0.01);而从肝细胞凋亡统计情况可以看出,I/R+PPX组细胞凋亡数量减少(P<0.01);同时,I/R后的氧化应激指标水平较I/R+DMSO组显著减轻(P<0.05);I/R+PPX组肝线粒体功能水平及ATP生成水平较I/R+DMSO组显著提高(P<0.05)。结论 PPX能够保护肝线粒体功能,并进一步减轻肝的I/R损伤。     

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.