严重烧伤后肾功能与损伤机制的研究进展

严重烧伤后可造成全身许多脏器的损伤,其中肾脏组织损伤是较早出现的并发症。有些属可逆性损伤,有些为不可逆损伤。烧伤后大量体液自创面外渗造成低血容量性休克,由此引发的缺血、缺氧性损害及失控性炎症反应是严重烧伤后多脏器损害的主要因素。作为全身性损伤的一部分。肾组织损伤的发生与多种细胞因子、嘌呤池耗竭、自由基的生成增多和清除能力减弱、能量代谢障碍、钙离子稳态失衡、微血管损伤和白细胞学说、细胞内酸中毒、细胞凋亡和坏死等多种因素的作用有关。本文通过文献回顾,综述近几年来其相关研究进展。     

MEBT/MEBO治愈重度黄磷烧伤12例体会

作者采用MEBT／MEBO救治12例重度黄磷烧伤,均获成功。认为重度黄磷烧伤由于热力损伤、化学损伤与中毒并存,救治过程中必须重视内排外治,药刀并用和早期防治内脏并发症。其重．或放在治疗诱发多脏器损害（MODS）的诱因上,力争使受损衰竭器官对治疗措施反应敏感,是救治成功的关键。     

烧伤早期脏器损害发病机制的探讨

烧伤后脏器损害是当前烧伤主要的死亡原因，其发病机制的尚未完全阐明。本研究认为其本质是缺血缺氧性损害；血液灌流不足与肠源性感染是其主要发病因素；失控性炎症反应是其基本病理生理变化；血管内皮细胞起关键作用。改善早期复苏方案，应用延迟性速补液可改善脏器血液灌流，应用早期肠道营养能减轻肠道损害，有助于防止肠源性感染；伤后尽快一次切除大部分焦痂能减轻失控炎症反应，降低内脏并发症的发生率。     

一次性大面积切痂防治烧伤早期脏器损害的临床研究

目的：探讨一次性大面积切痂防治烧伤早期脏器损害的作用及机制．方法：大面积烧伤病人６０例，分为一次切痂组（３５例）和常规分次切痂组（２５例）．一次性切痂组病人在漂浮导管监测下将Ⅲ度焦痂一次性全切除，同时观察血流动力和氧合指标、血浆内毒素和肿瘤坏死因子（ＴＮＦ）含量，以及病人血清对体外培养的内皮细胞的损伤作用．结果：与常规切痂组比较，一次性切痂组脏器损害和多器官功能障碍综合征（ＭＯＤＳ）的发生率均显著减少，治愈率显著提高．血浆内毒素和ＴＮＦ及内皮细胞培养液中乳酸脱氢酶（ＬＤＨ）和６－酮－ＰＧＦ１α含量明显下降；培养的内皮细胞基本维持原有形态和排列．结论：一次性大面积切痂通过遏制全身炎症反应综合征和减轻内皮细胞损伤，可有效地防治烧伤早期脏器损害和ＭＯＤＳ．     

腹部空腔脏器损伤的外科处理

在腹部创伤中腹部空腔脏器损伤的比例并不高,但由于空腔脏器破损后其内容物造成腹腔污染,再加上部分空腔脏器损伤病情隐匿,且常常合并其他部位或脏器损伤,早期诊断困难,容易漏诊。而一旦误诊或漏诊,后续均可能引起严重的并发症和极差的预后。因此对腹部空腔脏器损伤早期快速诊断,及时正确地处理是改善预后的关键。损害控制外科理念适用于各种创伤的救治,在腹部空腔脏器损伤的救治过程中也要始终贯穿这一理念。     

烧伤后多器官功能衰竭84例分析

我们对84例烧伤后合并多器官功能衰竭（MSOF）的病例进行了回顾性分析，资料显示MSOF与烧伤程度，休克及吸入性损伤和重度感染有密切关系。迟发型中肾脏是首发脏器，与休克、感染因素有直接关系。速发型与吸入性损伤有关，其首发器官为肺脏，但肾功能同时或随即出现损害，且更严重。受累脏器愈多，则死亡率愈高。本文对防治对策提出了六点预防及治疗意见。     

严重烧伤早期中性粒细胞在肝脏中的聚集机制及参与肝脏损害的 …

目的 研究中性粒然肝脏中的聚集，滞留机制及参与肝细胞损伤的作用。方法 应用生物力学技术，流式细胞技术等方法，观察了烧伤病人血清对培养人肝细胞和肝窦内皮细胞间粘附力，以及Ｐ－选择素及镜粘发子－１（ＩＣＡＭ－１）在两种细胞中表达情况的影响。结果 （１）严重烧伤后早期中性粒细胞在肝脏中有聚集；（２）肝细胞和中性粒细胞在烧伤血清作用下粘附力以２小时为最强；（３）肝细胞正常情况下无Ｐ－选择素和ＩＣＡＭ－１表     

严重烧伤后早期大鼠肝脏细胞粘附分子1和白介素6的表达

目的：观察严重烧伤早期大鼠肝脏细胞粘附分子1(Intercellular adhesion molecule—1，ICAM—1)、白细胞介素6(Intedeukin6，IL—6)在不同时间点的表达及早期病理变化，为阐明烧伤早期肝脏损伤机制及为伤后早期损伤的防治打下基础。方法：(1)光镜和电镜观察大鼠在烧伤后早期(5min至72h)肝脏的病理变化。(2)免疫组织化学、原位杂交和图橡分析技术对伤后不同时间点肝脏ICAM—1进行染色和分析。(3)免疫组织化学、原位杂交和图像分析技术对伤后不同时间点肝脏IL—6进行染色和分析。结果：(1)伤后早期主要病理变化为出血、充血和水肿；电镜显示：肝脏毛细血管内皮细胞受损。(2)伤后30min，免疫组化和原位杂交显示ICAM—1、IL—6表达增强；伤后2h～24h明显增强，呈阳性或强阳性；伤后72h，表达逐渐减弱。结论：伤后早期肝脏的损伤可能与内皮细胞损伤有关，I-CAM—1、IL—6在伤后早期肝脏损害机制中占有重要地位。     

346例瓦斯爆炸烧伤伤情特点

目的研究瓦斯爆炸烧伤伤情特点，以求提高治愈率。方法通过临床资料回顾性观察，进行分析研究。结果本组患者TBSA为（26±11）％，Ⅲ度伤为（10±5）％；复合伤中吸人性损伤和CO中毒发生率分别为98．8％、51．4％，伤后早期出现精神症状237例；事故现场CO含量在2％-3％以上时，烧伤程度和复合伤明显增加；死亡45例，其中21例（47％）合并多脏器功能衰竭。结论瓦斯爆炸烧伤为烧伤的一种特殊类型；吸人性损伤、CO中毒和早期精神症状是瓦斯爆炸烧伤重要临床特点；伤情越重。并发症越多。     

髓过氧化物酶在严重烧伤后早期心肌损伤中的变化规律及意义

目的：观察心肌髓过氧化物酶（MPO）在严重烧伤后大鼠中的变化规律，并探讨其与烧伤早期心肌损伤的关系。方法：采用大鼠20% TBSAⅢ度烧伤模型，动物随机分为正常对照组及烧伤组。检测各组心肌组织MPO含量及血清CK-MB、心肌肌钙蛋白T（cTn-T）含量的动态变化。结果：烧伤后2小时心肌MPO及血清cTn-T水平明显增高，至伤后镐、72小时仍保持高水平，而血清CK-MB于伤后4小时方明显升高，至伤后24、48小时已表现出下降趋势，至72小时己接近正常水平。相关分析显示，心肌MPO水平升高与血清cTn-T水平呈正相关。结论：心肌组织MPO水平的显著增高与心肌损害的水平密切相关，表明中性粒细胞在心脏组织中的长时间聚集可能与大面积烧伤后早期的心脏损害有密切关系；同时利用心肌组织MPO水平的检测有助于研究预防烧伤后早期心肌损害的有效治疗方法。     

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.