S-亚硝基谷胱甘肽对舱室内大鼠颅脑爆炸伤后继发性脑损伤的作用

目的观察S-亚硝基谷胱甘肽(GSNO)在舱室内大鼠颅脑爆炸伤后继发性脑损伤中的作用,探讨其在舱室颅脑爆炸伤防治中的临床应用价值。方法 88只SD大鼠完全随机分为正常对照组(n=8)、单纯致伤组(n=40)和致伤+GSNO治疗组(n=40);采用二硝基重氮酚(DDNP)纸质点爆源在模拟装甲舱室爆炸,建立颅脑爆炸伤模型。伤后1、6、12、24、48小时取标本。测定脑组织中肿瘤坏子因子-α(TNF-α)、白介素-1β(IL-1β)浓度;丙二醛(MDA)浓度及超氧化物岐化酶(SOD)活性;观察脑组织病理学变化。结果致伤组伤后1小时脑组织TNFα-、IL-1β、MDA浓度均明显升高(P0.01),伤后12小时升高达峰值(P0.01),伤后48小时脑组织TNF-α、IL-1β浓度仍显著高于正常对照组(P0.01)。致伤组伤后1小时脑组织SOD活性即显著降低(P0.01),致伤后12小时降低至最低值(P0.01),伤后48小时仍低于正常值。致伤组脑血管内皮细胞肿胀、脑水肿、神经元变性、坏死明显;给予GSNO治疗后各时间点脑组织TNF-α、IL-1β、MDA浓度均较致伤组明显降低,SOD活性明显增高(P0.01或P0.05)。治疗组脑水肿、神经元变性、坏死等表现均较单纯致伤组轻。结论舱室颅脑爆炸伤后可导致大鼠严重的继发性脑损伤;而早期给予GSNO可明显减轻脑组织炎性损伤和氧化损伤,减轻脑水肿及神经元变性、坏死,从而减轻继发性脑损伤。     

大鼠急性颅脑损伤后脑微循环变化的实验研究

目的研究大鼠急性颅脑损伤后脑微循环的改变,以找出影响颅脑损伤与恢复的变化规律.方法 100只大鼠随机分为5组,自由落体致大鼠脑损伤,伤后30分钟、3小时、24小时、168小时取材,研究脑微血管形态学变化,并用核磁共振波谱法分析颅脑损伤局部脑组织代谢的变化.结果大鼠脑损伤后10分钟～24小时大脑皮层微血管减少,并有“微无血管区”,微血管内可见微血栓形成;血脑屏障(BBB)通透性增加,出现脑水肿,颅脑损伤后伤区脑组织乳酸含量于伤后3小时显著增高(P＜0.01),伤后24小时仍然明显高于正常值.胆碱于伤后3小时明显升高,24小时达高峰(P＜0.01).N-乙酰门冬氨酸含量自伤后3小时明显降低,伤后24～168小时仍然显著低于正常值(P＜0.01).谷氨酸自伤后30分钟开始明显降低,3小时降至最低水平(P＜0.01).结论实验结果提示,颅脑损伤后微循环障碍是引起早期脑缺氧,产生外伤性脑水肿的重要病理基础,救治重型颅脑损伤要重视防治早期脑微循环障碍,纠正脑缺血、缺氧.     

亚低温对大鼠脑损伤后脑组织炎性反应的影响

目的探讨颅脑外伤后早期应用亚低温治疗对脑组织炎性反应的影响。方法采用Feeney自由落体改良模型,设定对照组、颅脑外伤模型组及亚低温组,每组再根据伤后不同生存时间随分为3个亚组。取伤灶脑组织检测髓过氧化酶(MPO)活性,做细胞间黏附子-1(ICAM-1)免疫组化染色,光镜下计数ICAM-1阳性血管数。结果亚低温组各时间点伤灶区ICAM-1阳性血管数明显低于颅脑外伤模型相应时间点(P<0.01)。亚低温组各时间点MPO活性均明显低于颅脑外伤模型组相应时间点(P<0.01)。结论亚低温治疗能明显减少伤灶区白细胞浸润及ICAM-1的表达,有助于改善颅脑外伤后脑组织炎性反应引起的继发性脑损伤。     

大鼠颅脑液压损伤后脑组织内Na^＋—K^＋—ATP酶活性的变化

目的：测定大鼠颅脑液压损伤后脑组织内Ｎａ＋－Ｋ＋－ＡＴＰ酶活性，探讨其在继发性脑损伤中的作用。方法：利用大鼠颅脑液压损伤模型，在致伤后６小时测定脑组织含水量、脑组织内Ｎａ＋－Ｋ＋－ＡＴＰ酶活性。结果：脑损伤６小时后，损伤侧脑组织内含水量明显增加（Ｐ＜０．０５），Ｎａ＋－Ｋ＋－ＡＴＰ酶活性明显下降（Ｐ＜０．０５）；而未损伤侧脑组织含水量和脑内Ｎａ＋－Ｋ＋－ＡＴＰ酶活性均无显著改变（Ｐ＞０．０５）。结论：脑损伤后脑组织内Ｎａ＋－Ｋ＋－ＡＴＰ酶活性下降是继发性脑损害发生和发展的重要因素之一。     

创伤性脑损伤后脑组织核因子-κB和基质金属蛋白酶-9的表达

目的 研究创伤性脑损伤（TBI）后损伤区脑组织核因子κB（NF-κB）和基质金属蛋白酶-9（MMP-9）的表达,探讨其在继发性脑损害中的作用机制。方法 采用自由落体撞击法造成大鼠右侧顶叶脑挫裂伤,Wistar大鼠随机分为对照组、伤后3、12、24、72小时和7天组。采用EMSA测定NF-κB的活性,免疫组化测定MMP-9的表达。结果 TBI后NF-κB的活性和MMP-9的表达逐渐增强,至伤后72小时达高峰,伤后7大仍保持任较高水平。NF-κB和MMP-9任表达时相和强度上呈正相关关系。MMP-9表达阳性细胞包括血管内皮细胞、神经胶质细胞和少数神经元细胞及侵入的中性粒细胞。结论 TBI可引起损伤区脑组织NF-κB活性和MMP-9的表达明显增强,可能在脑组织的继发性损害中起重要作用。     

外源性硫化氢对大鼠肢体爆炸伤后继发性肺损伤的作用

目的 观察外源性硫化氢(H2S)对大鼠肢体爆炸伤后继发性肺损伤的作用,探讨H2S在肢体爆炸伤后继发性肺损伤防治中的临床应用价值.方法 采用大鼠肢体爆炸伤模型,动物随机分为3组(n=8/组):正常对照组(Ⅰ)、单纯致伤组(Ⅱ)和致伤 外源性H2S组(Ⅲ);伤后6小时取标本.测定血浆和肺组织肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)浓度,肺组织髓过氧化物酶(MPO)活性和丙二醛(MDA)浓度;观察肺脏病理学变化.结果 致伤后6小时大鼠血浆和肺组织TNF-α、IL-6、IL-10浓度和肺组织MDA浓度及MPO活性显著升高(P<0.01,vs Ⅰ),肺充血、水肿和炎细胞浸润明显;给予硫氢化钠(NaHS)处理后伤鼠血浆和肺组织TNF-α、IL-6、IL-10和肺组织MDA浓度及MPO活性显著降低(P<0.05,vs Ⅱ),肺充血、水肿和炎细胞浸润程度较单纯致伤鼠明显减轻.结论 肢体爆炸伤可引起大鼠严重的继发性肺损伤;而早期给予外源性H2S可明显抑制肺脏炎性损伤和氧化损伤,减轻肺充血、水肿和炎细胞浸润程度,从而减轻继发性肺损伤.     

外源性硫化氢对大鼠肢体爆炸伤后继发性肺损伤的作用

目的观察外源性硫化氢（H2S）对大鼠肢体爆炸伤后继发性肺损伤的作用，探讨H2S在肢体爆炸伤后继发性肺损伤防治中的临床应用价值。方法采用大鼠肢体爆炸伤模型，动物随机分为3组（n=8／组）：正常对照组（Ⅰ）、单纯致伤组（Ⅱ）和致伤＋外源性H2S组（Ⅲ）；伤后6小时取标本。测定血浆和肺组织肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-10（IL-10）浓度，肺组织髓过氧化物酶（MPO）活性和丙二醛（MDA）浓度；观察肺脏病理学变化。结果致伤后6小时大鼠血浆和肺组织TNF-α、IL-6、IL-10浓度和肺组织MDA浓度及MPO活性显著升高（P〈0．01，VSI），肺充血、水肿和炎细胞浸润明显；给予硫氢化钠（NaHS）处理后伤鼠血浆和肺组织TNF-α、IL-6、IL-10和肺组织MDA浓度及MPO活性显著降低（P〈0．05，vsⅡ），肺充血、水肿和炎细胞浸润程度较单纯致伤鼠明显减轻。结论肢体爆炸伤可引起大鼠严重的继发性肺损伤；而早期给予外源性H2S可明显抑制肺脏炎性损伤和氧化损伤，减轻肺充血、水肿和炎细胞浸润程度，从而减轻继发性肺损伤。     

镧示踪法观察大鼠颅脑损伤后血脑屏障形态学变化

目的：颅脑损伤后血脑屏障（ｂｌｏｏｄ－ｂｒａｉｎｂａｒｒｉｅｒ，ＢＢＢ）通透性的变化，是导致外伤性脑水肿的最直接的因素．研究脑ＢＢＢ改变对探讨颅脑损伤脑水肿发生发展过程有重要意义．方法：本实验采用镧示踪法观察大鼠脑损伤后ＢＢＢ超微结构的变化，同时定量检测了伤区脑组织脑水肿发展过程．结果：研究发现伤后１０分钟组，已可见ＢＢＢ开放，伤后２４～４８小时组渗出最为严重，伤后７天组ＢＢＢ功能尚未完全恢复．颅脑损伤后伤区脑组织伊文氏蓝（ｅｖａｎｓｂｌｕｅ，ＥＢ）含量及伤区脑组织含水量的变化过程与ＢＢＢ的改变相一致．结论：对颅脑损伤后脑水肿的治疗应从早期开始，并持续１周以上．     

创伤性脑损伤后脑组织c-fos表达及细胞凋亡

目的研究创伤性脑损伤（TBI）后脑组织c-fos表达及神经细胞凋亡,探讨神经细胞凋亡在脑继发性损害中的作用,及c-fos基因表达与凋亡的关系。方法雄性Wistar大鼠,随机分为假手术对照组和脑创伤后3、12、24、72小时和7天组,采用自由落体撞击致重型颅脑损伤。应用TUNEL法检测神经细胞凋亡,免疫组化法观测c-fos的表达。结果TBI后3小时创伤组各组脑组织即出现c-fos表达和神经细胞凋亡,随伤后时间逐渐增强,至伤后72小时达高峰,伤后7天仍有明显的c-fos表达和神经细胞凋亡。其分布区域为脑挫伤区、挫伤周围皮质和海马,累及细胞类型包括神经元和胶质细胞。c-fos表达与神经细胞凋亡在时序空间分布上基本一致,两者呈正相关。结论创伤性脑损伤可引起脑组织明显的c-fos表达和神经细胞凋亡,c-fos表达增加在神经细胞凋亡和修复中可能起重要作用。     

GM1在流体冲击致大鼠脑损伤后对谷氨酸受体变化的作用

目的探讨大鼠急性脑损伤后神经书苷脂Monosialotetrahexosylganglioside（GMI）对谷氨酸受体活性变化的作用。方法采用成年雄性Wistar大鼠左颅顶液压冲击伤模型，受体放射配基结合分析法（RBA）测量双侧海马谷氨酸受体（GluR）活性，干-湿重法测量双侧脑组织水含量。结果大鼠脑损伤后GMI能显著降低伤后脑水含量的升高；抑制伤后早期GluR的最大结合量（Bmax）的增高和平衡解离常数（KD）降低，后期未发生Bmax降低和KD升高，与伤前水平基本相同；且假损伤动物GM1组与对照组或生理盐水组间GluR活性的比较，无显著差异（P＞0．05）。结论早期应用GMI能有效地拮抗GluR滥用性激活导致的兴奋性毒性，从而有效阻止脑水肿以及继发性脑损伤的发生，同时GM1对正常脑组织中GluR的活性无影响，因此具有临床应用价值。     

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.