医用多糖止血愈合海绵皮肤止血和愈创作用的实验研究

目的探讨医用多糖止血愈合海绵对家兔皮肤创面的止血和愈创作用。方法采用家兔耳皮肤出血模型和家兔背部皮肤愈创模型,分别予以医用多糖止血愈合海绵(HA)、羧甲基纤维素(CMC)、明胶海绵(GS)和医用纱布(MG)进行创面外敷,观察敷料的止血时间、失血量及创面愈合情况。结果在兔耳皮肤出血模型中,HA组、CMC组、GS组的止血效果优于MG组,其中前三者的比较中CMC组失血量少于HA组或GS组。在家兔皮肤愈创实验中,HA组及CMC组的创面收缩率均快于相同时间点的GS组及MG组,且创面愈合时间明显缩短。结论医用多糖止血愈合海绵、羧甲基纤维素敷料在家兔皮肤创面止血效果确切,与明胶海绵相似,同时可提供湿性愈合环境加速创面愈合。     

PAA-CS超吸水海绵应用于喂服华法林大鼠拔牙创模型的止血效果

 目的 探讨PAA-CS超吸水海绵应用于口腔拔牙创的优势。方法 建立对照组(A组)SD大鼠拔牙创模型和华法林组(B组)SD大鼠凝血功能异常拔牙创模型,以纱布棉球做阴性对照对拔牙创进行止血,比较PAA-CS超吸水海绵与纱布棉球的止血效果。结果 B组凝血酶原时间(s)较A组显著延长[(19.73±2.74)vs(10.04±0.95),P<0.05],INR值增大(3.49 vs 1)。A、B两组中,PAA-CS超吸水海绵止血时间均少于纱布棉球,差异有统计学意义(P<0.05);A组止血后无继发出血;B组应用纱布棉球止血后有4只继发出血。结论 成功建立了因喂服华法林而导致凝血功能异常的大鼠拔牙创模型,PAA-CS超吸水海绵的止血效果明显优于纱布棉球。     

血余炭纳米纤维膜止血作用的实验研究

目的探讨血余炭纳米纤维膜的止血作用。方法采用静电纺丝技术制备一种新型载药止血材料血余炭 纳米纤维膜。制作家兔耳缘静脉与肝脏创面出血模型,采用巴马小型猪建立肝脏、脾脏创伤出血模型,分别用医用纱布、吸 收性明胶海绵及血余炭纳米纤维膜进行止血,通过观察止血时间、出血量、组织病理学变化等指标,评价血余炭纳米纤维膜 的止血效果。结果与医用纱布组和明胶海绵组比较,血余炭纳米纤维膜组显著缩短家兔耳静脉与肝脏创面止血时间（P 〈 0.05, P 〈0.01）,明显减少肝脏创面出血量（P 〈0.05, P 〈0.01）。巴马小型猪出血模型血余炭纳米纤维膜组肝脏、脾脏出 血时间明显缩短,出血量显著减少,与明胶海绵组比较差异具有统计学意义（P 〈0.05）。组织学观察,血余炭纳米纤维膜止 血处理的肝、脾创面组织除伴有轻度的充血外,未见有明显的出血、坏死或结节状增生等病理学改变。结论动物实验结果 表明血余炭纳米纤维膜具有较好的止血作用,止血效果显著优于明胶海绵和医用纱布,是一种良好的止血材料。     

医用多糖止血愈合海绵对小型猪股动脉出血模型的止血作用研究

目的 研究医用多糖止血愈合海绵(MP)在小型猪股动脉出血模型中的止血作用.方法 采用小型猪32只制作股动脉出血模型后随机分为4组(n=8),分别采用MP、羧甲基纤维素(CMC)、明胶海绵(GS)和医用纱布(MG)进行创面外敷止血,观察各组的止血时间、失血量及小型猪生命体征.结果 建立小型猪股动脉出血模型后,各组动物平均动脉压无明显差异.MP组、CMC组、GS组的止血时间及失血量均明显低于MG组(P＜0.01),且CMC组的止血效果优于MP组和GS组,而MP组和GS组的止血效果相似.结论 MP、CMC敷料对小型猪股动脉止血效果确切,与GS相似或略优于GS.     

几种止血材料对兔实质脏器创伤止血性能的比较

目的评价明胶海绵、可吸收止血纱布、复合生物海绵和速效止血粉对兔肝、脾损伤的止血效果及周围组织反应。方法将正常状态下和肝素抗凝后的兔的肝和脾脏前端约1.0cm长的组织剪去,建立实质脏器活性出血模型,分别用不同的止血材料压敷创面,考察两种状态下创面的出血时间和出血量,取与敷料接触的肝组织进行病理分析。结果在正常状态下,明胶海绵、复合生物海绵、止血纱布和速效止血粉对肝损伤的止血时间分别为（6.28±1.45）min（、6.19±1.04）min（、5.09±1.03）min和（4.07±0.84）min,与普通纱布对照组（9.89±0.75）min相比差异有显著性意义（P〈0.01）;肝素抗凝后,各组的止血时间明显延长,特别是明胶海绵和止血纱布组。病理结果表明速效止血粉对肝创面组织造成热损伤。结论复合海绵和速效止血粉显示出较明胶海绵和止血纱布更好的止血效果,尤其是在肝素抗凝的情况下。但鉴于速效止血粉的热损伤和不易于清除,应限用于威胁生命的急救止血。     

复合海绵及载药复合海绵止血性能研究

目的 评价复合海绵及其载药后对兔肝、脾创面的局部止血性能.方法 采用复合交联、冷冻干燥得到复合海绵;将其浸入一定浓度的氨甲环酸中,冻干得载药复合海绵.在兔肝、脾损伤创面,分别敷用复合海绵和载药复合海绵,观察正常情况下和肝素抗凝后兔肝、脾创面的出血时间及出血量,并与可吸收性明胶海绵和壳聚糖海绵比较.结果 正常情况下,复合海绵的止血时间和出血量较明胶海绵组和壳聚糖海绵组缩短或减少(P＜0.05,0.01);在肝素抗凝后,明胶海绵止血时间明显延长,而壳聚糖海绵和复合海绵的变化并不明显.载药复合海绵与复合海绵相比,在正常状态下止血性能有明显提高,但在凝血功能障碍时止血性能没有显著变化,且止血性能与载药量不呈线性关系.结论 复合海绵和载氨甲环酸复合海绵较明胶海绵止血性能明显提高,尤其是在凝血功能障碍时.

Abstract：

Objective To evaluate the hemostatic efficacy of complex sponge and drug-loaded complex sponge on hepatic and splenic wounds in rabbits. Methods Complex sponge was prepared by means of cross-linking and lyophilization. Then, the sponge was immersed into the tranexamic acid solution and lyophilized to obtain the drug-loaded sponge. The complex sponge and drug-loaded complex sponge were respectively used on the hepatic and splenic wounds of rabbits to observe the bleeding time and blood loss under normal and liquemine anticoagulation respectively. The gelatin sponge and the chitosan sponge were used as controls. Results Under normal condition, the hemostatic time and blood loss of the complex sponge was decreased obviously compared with the gelatin sponge ( P＜ 0. 01 ) and compared with the chitosan sponge ( P ＜ 0. 05 ). Posterior to liquemine anticoagulation, the hemostatic time was increased obviously in the gelatin sponge but showed no difference for the chitosan sponge and the complex sponge. Compared with complex sponge, the hemostatic efficacy of the tranexamic acid-loaded complex sponge was improved markedly for normal rabbits. While the hemostatic efficacy showed no significant change for rabbits with coagulation disorders, when there was no linear relationship between the hemostatic efficacy and the content of tranexamic acid. Conclusions The hemostatic efficacy of the complex sponge and the drug-loaded complex sponge surpass obviously that of the gelatin sponge, especially for the rabbits with coagulation disorders.     

羧化多糖可吸收止血纱对兔肝、脾创面的止血效果评估

目的评估羧化多糖可吸收止血纱(其编号为NWL-K)对兔肝、脾创面的止血效果。方法60只新西兰兔按随机数字表法分为两组,每组30只,分别建立肝和脾创面出血模型;两组模型再根据使用止血材料的品种,分成普通纱布组、速即纱组和NWL-K组,每组10只。采用造模出血量和切除肝组织重量评估模型稳定性。脾脏出血模型按压3 min后每隔(30±5)s以及肝脏出血模型按压30 s后每隔(20±5)s分析各组止血时间和止血评分,观察创口与纱布的黏合情况。结果各肝脏、脾模型组造模时出血量比较,差异无统计学意义(P>0.05),造模时肝脏组织切除重量比较,差异均无统计学意义(P>0.05),说明模型造模稳定,对之后的止血实验不产生影响。在脾脏创面出血模型止血时间上,NWL-K组[210(180,248)s]、速即纱组[255(233,300)s]分别与普通纱布组[465(383,660)s]比较差异有统计学意义(P<0.05),NWL-K组相较于速即纱组止血时间更短(P<0.05)。在肝脏创面出血模型止血时间上,NWL-K组[70(70,95)s]、速即纱组[90(85,110)s]分别与普通纱布组[250(225,290)s]比较差异有统计学意义(P<0.05)。脾脏模型各观察时间点速即纱组、NWL-K组止血评分下降快于普通纱布组差异有统计学意义(P<0.05),180 s时NWL-K组和速即纱组比较,差异有统计学意义(P<0.05)。肝脏模型50,70,90 s时速即纱组、NWL-K组止血评分下降快于普通纱布组差异有统计学意义(P<0.05)。30,110,130 s时普通纱布组与NWL-K组比较,差异有统计学意义(P<0.05)。NWL-K吸水性和周围组织黏合性均优于普通纱布和速即纱。结论对于肝、脾出血创面,与其他类型纱布比较,应用NWL-K能有效缩短止血时间,减少出血量;NWL-K吸水性强,与创口黏合稳固。     

小麦蛋白膜的体外生物相容性研究

目的 研究小麦蛋白的体外生物相容性,探索其用作生物医用材料的潜在可能.方法 以聚乳酸膜s为对照,进行了细胞相容性试验(包括浸提液细胞毒性试验和细胞直接接触试验)和血液相容性试验(包括溶血试验、血小板粘附试验和动态凝血时间试验).结果 小麦蛋白膜浸提液细胞毒性评价合格;大鼠成骨样细胞Ros17/2.8在小麦蛋白膜上的粘附...     

经脾动脉行明胶海绵与碘化油栓塞治疗脾功能亢进的对照研究

目的探讨经脾动脉行明胶海绵和碘化油栓塞治疗肝硬化脾功能亢进(脾亢)的疗效与并发症,为临床治疗肝硬化脾亢栓塞剂的选择提供依据。方法回顾性分析40例肝硬化脾功能亢进患者行经脾动脉明胶海绵栓塞和39例行经脾动脉碘化油栓塞治疗的临床资料,观察两组患者外周血三系细胞改善和并发症以及复发情况。结果两组患者的脾脏体积回缩、血红蛋白、白细胞和血小板计数差异无显著性(P>0.05),但碘化油栓塞组患者6个月后有部分病例出现血小板再次减少,明胶海绵栓塞组术后并发症发生率高于碘化油栓塞组(P<0.05),碘化油栓塞组肝、胃肠道毒性分级均较明胶海绵栓塞组低。结论对高龄、肝功能差、腹水较多、凝血功能严重障碍、肝硬化门脉高压明显的患者可行经脾动脉碘化油栓塞治疗脾亢。     

腹腔镜输卵管妊娠保守手术中3种止血方法的疗效比较分析

 目的 评价腹腔镜下输卵管妊娠保守手术中创面电凝止血、缝合止血、缝合联合输卵管系膜注射垂体后叶素止血的疗效及优缺点.方法 回顾分析我院2006-08至2009-08收治输卵管妊娠实施腹腔镜下保守手术,其中腹腔镜输卵管妊娠保守手术创面电凝止血118例(A组)、创面缝合止血113例(B组)、创面缝合联合输卵管系膜注射垂体后叶素止血108例(C组)的临床资料(手术时间、术中出血量及术后输卵管通畅率).结果 C组手术时间为(31.21±3.65)min,手术时间最短,A组次之,为(36.13±2.82) min,B组最长,为(59.23±2.78) min.A组与B组、C组与B组间差异有统计学意义(P＜0.05),A组与C组间差异无统计学意义(P ＞0.05).A组与B组术中出血量差异无统计学意义(P ＞0.05),但明显多于C组(P ＜0.05).术后3个月造影患侧输卵管通畅率B组与C组间差异无统计学意义(P ＞0.05),B组、C组与A组间差异有统计学意义(P ＜0.05).持续性异位妊娠发生率3组间差异无统计学意义(P ＞0.05).结论 腹腔镜输卵管妊娠保守手术中的创面缝合联合输卵管系膜注射垂体后叶素止血法具有术中出血少,术野清晰,缩短手术时间,术后输卵管通畅率高的特点.     

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.