不同深低温停循环方法对脑组织ATP酶的影响

目的：观察深低温停循环对脑组织ATP酶活力及结构的影响。方法：18只实验犬随机分为3组，深低温停循环（DHCA）组，DHCA＋逆行脑灌注（RCP）组，DHCA＋顺行间断脑灌注（IACP）组。降温至18℃后停循环90min，在停循环前、后及再循环后留取血液标本作ATP酶活力和乳酸含量测定。手术结束时取海马组织作透射电镜检查。结果：停循环后，DHCA和RCP组ATP酶活力值显著降低，乳酸含量显著升高；IACP组ATP酶活力值无显著差异，乳酸含量仅在停循环后45min时显著升高。结论：DHCA时间较长时，脑组织会发生缺血缺氧性损伤；RCP对脑组织有保护作用，但易发生神经细胞水肿；IACP的脑保护效果较为理想。     

亚低温脑保护的研究和应用

亚低温脑保护的研究和应用朱诚江基尧早在５０年代，人们就将深低温（体温降至２７～２８℃以上）应用于心血管直视手术，以保护脑和其他重要脏器．但由于深低温易发生室颤和凝血功能障碍，增加患者死亡率，已很少被临床医师所采用，目前仅被选择性用于某些复杂的心血管直...     

深低温对全脑缺血大鼠海马代谢型谷氨酸受体3型表达的影响

深低温对全脑缺血性损伤的保护作用已经被大量的动物实验和临床实践证实，对深低温脑保护机制的研究一直是国内外学术界关注的热点.笔者在前期工作中以基因芯片技术初步筛选出了可能与深低温脑保护作用相关的基因.代谢型谷氨酸受体3型（mGluR3）是其中一个。笔者进一步以实时荧光定量RT—PCR技术研究深低温对全脑缺血大鼠海马mGluR3表达的影响，并探讨其在深低温脑保护机制中的作用.     

左旋精氨酸对复苏犬缺血缺氧性脑损害的影响

目的 利用犬停循环(CA)复苏模型,研究深低温及NO前体-左旋精氨酸(L-arg)对复苏犬脑氧代谢及超微结构的影响.方法 健康成年杂种犬10只,随机分为L-arg预处理组和对照组,每组5只.按临床方法建立体外循环转流降温至鼻咽温18℃停循环,90min后恢复体外循环复苏.分别于CA前30min、CA 0min、CA 45min、CA 90min、复苏后60min抽取颈静脉、颈动脉血测算颈静脉血氧饱和度(SjvO2).取脑皮质透射电镜观察脑超微结构改变.处死后测脑皮质含水量.结果 停循环后SjvO2逐步降低,至CA 90min达最低值,复苏后回升.停循环期L-arg预处理组SjvO2高于对照组(P＜0.001).复苏后L-arg预处理组脑皮质超微结构改变轻于对照组,脑组织含水量亦低于对照组(P＜0.05).结论 深低温可改善停循环后脑氧供需平衡,对缺血缺氧性脑损害有保护作用,L-arg预处理有利于停循环后脑复苏治疗.     

深低温“假死”救治失血性休克动物模型建立

目的探讨应用深低温"假死"方法救治失血性休克的可行性。方法对8只小型巴马香猪行颈总动脉和颈内静脉插管,建立体外循环;转流降低直肠温至15℃时,暂停循环90 min后恢复体外循环并复温;待直肠温恢复到术前水平后,脱离体外循环,呼吸机辅助呼吸直至脱离呼吸机;观察实验猪血流动力学指标及存活情况。结果本组8只实验猪心脏均自动复跳并能够脱离呼吸机,脱机后2 h内血流动力学稳定。1只实验猪脱离体外循环后死于循环障碍。结论应用深低温"假死"救治猪失血性休克安全、有效,为外伤或战伤后心脏和大血管损伤的救治提供了实验基础。     

便携式体外生命支持系统在失血性休克猪模型中应用

目的探讨便携式体外生命支持系统在失血性休克救治中的有效性与安全性。方法以小型巴马猪为实验对象,体质量(46.0±5.2)kg,共12只,雄性,建立失血性休克模型,肝素化后转流,应用低温脏器保护液逐步降温至15℃并停止循环。将动物随机分为两组:A组停循环时间为90 min;B组停循环时间为120 min,每组各6只。分别记录操作前后心率、平均动脉压、呼吸、体温、末梢氧饱和度及神经系统评分等。结果 A组死亡0只,存活6只(100%);B组死亡3只,存活3只(50%);两组存活率比较,差异有统计学意义(P<0.05)。术后1 d神经系统评分,A组明显高于B组(P<0.05);两组术后7 d比较,差异无统计学意义(P>0.05)。结论在失血性休克动物模型救治中,便携式体外生命支持系统可诱导深低温(15℃)水平停循环90 min,保证实验动物存活及神经系统功能正常,安全有效。     

应用苯妥英钠后急性低压缺氧条件下大鼠脑单胺递质的变化

目的探讨苯妥英钠（Ｄｉｐｈｅｎｙｌｈｙｄａｎｔｏｉｎ，ＤＰＨ）在急性缺氧条件下的脑保护作用。方法给大鼠应用ＤＰＨ，用荧光分光法检测其在低压舱模拟升空７．５ｋｍ后１ｈ、２ｈ的脑匀浆单胺递质含量，同时观察脑细胞形态学改变。结果ＤＰＨ实验组在缺氧１ｈ及２ｈ时脑多巴胺和５－羟色胺含量升高（Ｐ＜０．０５），而脑去甲肾上腺素在缺氧１ｈ时降低（Ｐ＜０．０５），缺氧２ｈ恢复正常。电镜形态学观察，低压缺氧条件下对照组大鼠脑细胞水肿，线粒体嵴严重缺失，细胞核明显变形；应用ＤＰＨ的实验组细胞形态基本正常。结论给大鼠应用苯妥英钠后，在急性缺氧条件下，动物脑单胺递质含量的变化可能与缺氧适应或耐受的形成有关。     

可控性大鼠急性脑局部缺血模型的建立及CT灌注成像与病理学评价

目的 建立稳定、可控的脑局部缺血动物模型，并通过CT灌注成像和病理学方法对其进行评价。方法 雄性Wistar大鼠28只，随机分为4组(假手术组、脑梗死15min组、脑梗死30min、再灌注1h组及低灌注6h组)，每组7只鼠。在激光多普勒血流仪监测下采用改良的线栓法制作可控性脑局部缺血动物模型。利用CT灌注成像对各组动物模型的缺血状态进行观察，并与光学显微镜、电子显微镜结果以及红四氮唑(TTC)染色标本对照。结果 脑梗死15min组在激光多普勒血流仪监测下将局部脑血流量(rCBF)控制为5％～22％，CT灌注成像显示7只大鼠局部脑血流量均下降，TIC染色呈浅红色，未见明确梗死病灶，病理学检查显示部分神经元变性和星形细胞肿胀。脑梗死30min再灌注1h组在激光多普勒血流仪监测下将rCBF控制为4％～23％，病理学检查显示7只大鼠脑缺血灶内星形细胞肿胀明显，可见大量神经元变性，标本TTC染色所示的白色梗死区与CT灌注成像异常区域一致。在低灌注6h组，由于rCBF下降程度较小(为38％～55％)，病理学显示7只大鼠星形细胞肿胀明显而神经元变性轻微，TTC染色未见明确梗死病灶。假手术组7只大鼠均未见上述各种异常表现。结论 可控性大鼠急性脑局部缺血模型稳定可靠，能模拟出不同灌注程度的缺血状态，除了可用于脑梗死的研究外，更适用于脑梗死前期的急性脑局部缺血的研究。功能CT灌注成像是评价急性脑局部缺血模型的1种准确、敏感的方法。     

左心辅助对急性左心衰犬心肌c-fos mRNA的影响

目的：探讨自制气动左心辅助泵对辅助急性左心衰实验犬后c—fos mRNA表达的影响。方法：20只实验犬随机分为3组：辅助组（A组，n=9）、心衰组（B组，n=9）和对照组（C组，n=2）。A组：急性左心衰后行左心辅助循环；B组：心衰形成后不进行左心辅助；C组：开胸后未行处理。于术后6h将动物处死，用RT—PCR方法检测心肌组织c—fosmRNA的表达。结果：对照组无c—fosmRNA表达，辅助组心肌组织有少量c—fos mRNA表达，心衰组心肌组织c—fos mRNA表达较辅助组显著增加（P〈0．01）。结论：自制气动左心辅助泵抑制了心肌缺血后c—fos mRNA的表达，保护心肌细胞并抑制了继发性损害的发生，是左心辅助改善心衰可能的作用机理。     

飞行变压性眩晕动物模型的建立

目的建立变压性眩晕的动物模型，观察前庭功能和前庭终器形态学的变化。方法20只健康豚鼠描记前庭功能后随机分成4组，每组各5只动物。A组行右鼓膜造孔，B组行左咽鼓管阻塞，C组行右鼓膜造孔并左咽鼓管阻塞，D组为对照组。实验组动物建模后和对照组动物置于低压舱内，反复升降3次，观察动物躯体反应和自发性眼震，出舱后即刻复查前庭功能，最后行前庭终器的形态学观察。结果①在低压舱上升时，实验组动物均出现了前庭躯体异常反应；15只动物中有12只（A组3只，B组4只，C组5只）出现了快相向左的水平性眼震，持续数十余秒到数分钟；出舱后即刻复查前庭功能，A组正弦摆动实验4只动物左右向眼震不对称比大于正常，B组和C组正弦摆动实验和旋转急停实验5只动物不对称比均大于正常。②光镜和透射电镜显示实验组动物前庭终器毛细胞胞浆及线粒体空泡样变，扫描电镜示毛细胞纤毛局限性倒伏、缺失（C组最明显，B组于A组和C组之间）。结论双侧中耳不平衡压力及中耳相对高压，引起了前庭功能变化和前庭终器的形态学改变。本设计可作为深入研究变压性眩晕的动物模型。     

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.