已酮可可碱对脾切除大鼠内毒素血症的干预作用

目的与方法：通过动态观察已酮可可碱干预处理脾切除后大鼠内毒素血症时肝及肺组织TNA－α水平及肝、肺组织TNF－αmRNA表达的变化,探讨PTX对无脾动物脓毒症的保护作用及机制。结果：内毒素攻击后无脾动物肝肺组织TNF－α水平、TNF－αmRNA的表达及肺组织髓过氧化物酶水平均较有脾动物显著升高（P＜0．05）,PTX预处理可显著抑制这种增高（P＜0．05）。结论：PTX通过下调肝肺组织TNF－αmRNA的表达,减少组织中TNF－α浓度对脾切除后凶险性感染（OPSI）的防治及脓毒症的治疗可能有益。     

抗肿瘤坏死因子单抗对内毒素血症大鼠急性肺损伤的保护作用

目的：观察肿瘤坏死因子(TNF-α)在内毒素血症大鼠急性肺损伤中的作用及抗肿瘤坏死因子单抗(TNF-α McAb)的保护效应。方法：静脉注射法造成内毒素血症肺损伤模型，内毒素注射前、后应用anti-TNF-α McAb控制TNF-α含量，ELISA法检测肺匀浆液中TNF-α含量，用组织病理学检查及肺体指数评价肺损伤程度。结果：(1)内毒素组肺匀浆液中TNF-α含量及肺体指数均明显高于对照组，P＜0．01，肺损伤程度严重；(2)内毒素注射前半小时应用anti-TNF-α McAb从可完全避免肺匀浆液中TNF-α含量和肺体指数的升高，与对照组无显著差异，P＞0．05；(3)内毒素注射前5min应用anti-TNF-α McAb可部分避免肺匀浆液中TNF-α含量及肺体指数的升高，肺损伤程度减轻；(4)内毒素注射后0．5h应用mnti-TNF-α McAb则肺匀浆液中TNF-α含量及肺体指数均显著高于对照组，P＜0．01，肺损伤程度重。结论：TNF-α是内毒素肺损伤的重要介导因子；内毒素注射之前使用anti-TNF-α McAb可完全预防或部分减轻内毒素肺损伤。     

蜂毒肽MP-1对内毒素血症小鼠急性肺损伤保护作用的研究

目的探讨蜂毒肽MP-1对内毒素血症（ETM）小鼠急性肺损伤的保护作用。方法尾静脉注射内毒素（LPS）5mg/kg制备ETM小鼠模型。动物随机分为正常对照组（n=8）、ETM组（n=48）和MP-1治疗组（n=48,注射LPS的同时注射MP-1 3mg/kg）。ETM组和MP-1组分别于注射LPS后2、6、12、24、48、72h处死动物,采集血浆和肺组织标本,动态比浊法鲎试验检测各时相点血浆LPS水平,ELISA法检测血浆TNF-α和IL-6水平,real-ti me RT-PCR检测肺组织Toll样受体4（TLR4）、TNF-α和IL-6 mRNA表达,分光光度法检测肺组织髓过氧化物酶（MPO）活性,并观察伤后12h肺组织的病理变化。结果ETM小鼠伤后2-48h血浆LPS、TNF-α和IL-6水平显著增高（P〈0.01）,肺组织TLR4、TNF-α、IL-6 mRNA表达和MPO活性也明显增强（P〈0.05或P〈0.01）。MP-1治疗可不同程度降低血浆LPS和各细胞因子水平（P〈0.05或P〈0.01）,抑制肺组织相关基因表达及减低MPO活性（P〈0.05或P〈0.01）,并可减轻肺组织的病理损伤。结论MP-1可能通过中和LPS,减少LPS诱导的炎症介质的合成与释放,进而减轻炎症介质对肺组织的损伤。     

脓毒症大鼠肝脏组织Toll样受体4和髓样分化蛋白-2基因表达的变化规律

目的探讨脓毒疗人鼠肝脏组织内毒素复合受体—Toll样受体4（TLR4）／髓样分化蛋白-2（MD-2）mRNA的表达变化，研究其与肝脏组织肿瘤坏死因子-α（TNF—α）mRNA表达的父系。方法腹腔注射内毒素（LPS）5mg／kg制作大鼠脓毒症模型。动物分为正常对照组（20只）及内毒素注射后1h、2h、6h组（各20只）．检测肝脏组织TLR4／MD-2以及TNF-α mRNA的表达。结果LPS注射后1h，TLR4／MD-2及TNF-α mRNA表达开始升高并达高峰．伤后2～6h逐渐下降，各时间点的表达量均显著高于对照组（P〈0．01）．TLR4与MD-2 mRNA的表达呈明显正相关（P〈0．05）．且分别与TNF—α mRNA的表达呈显著正相关（P〈0．05）。结论LPS可迅速上调肝脏组织TLR4／MD-2的基闪表达并诱导早期炎症细胞因子TNF-α的基因表达。脓毒症时TLR4识别LPS是可能以TLR4／MD-2复合体的形式完成的．且在识别过程中MD-2是TLR4必需的作用分子。     

急性肺损伤大鼠TNF-α、IL-1β、IL-1ra mRNA的表达及药物干预

目的观察急性肺损伤(ALI)大鼠肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-1受体拮抗剂（IL-1ra）mRNA的动态表达及白介素-10(IL-10)、地塞米松(Dex)对TNF-α、IL-1β、IL-1ra的干预作用。方法气道内滴注内毒素(LPS)10mg／k建立大鼠ALI模型。72只雄性SD大鼠随机分为对照组、损伤组、LPS加IL-10组、LPS加Dex组，每组18只(2、6、24h各6只)。采用RTPCR方法检测肺组织TNF-α、IL-1β及IL-1ra mRNA的表达水平，光镜下观察肺组织病理改变。结果损伤组肺组织TN-α mRNA表达2h达高峰，随后迅速下降；IL-βmRNA表达2h显著升高，6h达高峰，随后迅速下降；IL-1ra mRNA表达6h开始升高，且为峰值，24h仍高于对照组。IL-10及Dex可明显抑制肺组织TNF-α及IL-1βmRNA的表达，但对IL-1ra mRNA表达无明显影响。肺组织病理检查见IL-10组、Dex组的肺损伤较损伤组明显减轻。结论急性肺损伤时，TNF-α及IL-1βmRNA表达明显早于IL-1ra mRNA，提示ALI早期存在炎症介质／抗炎介质失衡。IL-10、Dex可明显抑制TNF-α及IL-1βmRNA的表达，但不影响IL-1ra mRNA的表达，这有利于炎症介质／抗炎介质平衡的重建，减轻大鼠ALI。     

脂多糖结合蛋白对内毒素急性肺损伤大鼠肺巨噬细胞TLR4信号通路的影响

为研究脂多糖结合蛋白（LBP）对内毒素（LPS）急性肺损伤大鼠TLR4肺巨噬细胞信号通路的影响，探讨LBP对LPS炎症反应增敏作用的部分机制，运用RT-PCR和ELISA方法分别检测LBP对LPS刺激后大鼠肺巨噬细胞IL-1β、IL-18mRNA表达与TNF-α分泌量的作用，同时用RT-PCR与Western blot检测其TLR4mRNA与蛋白的表达水平。结果显示，LBP显著增加LPS刺激后大鼠肺巨噬细胞TNF-α的分泌和IL-1β、IL-18mRNA的表达，同时也增加TLR4的mRNA与蛋白表达水平，而LBP多抗能阻断上述作用。说明LBP可增强由TLR4介导的LPS信号跨膜转导功能，这可能是LBP对LPS起增敏作用的重要分子机制之一。     

内毒素及其增敏系统在烫伤后金葡菌脓毒症中的改变及意义

利用大鼠20％体表面积Ⅲ度烫伤复合金葡菌攻击致脓毒症模型，探讨内毒素及其增敏系统－脂多糖结合蛋白（LBP）和脂多糖受体CD14在G＋菌脓毒症中的变化规律及其与机体过度炎症反应的关系。70只Wistar大鼠随机分为正常对照组（10只），烫伤对照组（10只）和烫伤脓毒症组（50只），检测动物心，肝，肺，肾等组织中LBP，CD14和TNF－α mRNA表达的改变，同时测定组织和血浆内毒素水平，小肠组织二氨氧化酶（DAO）的活性及病理形态学改变，结果显示，烫伤合并金葡菌感染后动物小肠组织DAO活性显著降低，并且至感染后24h仍处于较低水平，同时血浆内毒素水平明显升高，于金葡菌攻击后2h达峰值（P＜0．05），6h则迅速恢复至正常范围，心，肝，肺，肾等组织中LBP，CD14和TNF－α，mRNA表达广泛上调，至24h仍维持于较高水平，肝脏LBP mRNA与肝组织TNF－α基因表达的改变呈显著正相关，提示烫伤后金葡菌感染可导致肠源性内毒素移位和内毒素增敏系统LBP，CD14表达广泛上调，后者作为金葡菌致病因子和内毒素的共同受体对金葡菌脓毒症的发生，发展可能具有促进作用。     

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，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。     

完整迷走神经刺激对肝细胞炎症反应及细胞因子信号转导抑制因子mRNA表达的影响

目的 观察完整迷走神经刺激(IVNS)对肝细胞炎症反应及细胞因子信号转导抑制因子(SOCS)mRNA的影响.方法 以内毒素血症为全身炎症反应模型.80只SD大鼠随机分为内毒素组、迷走神经刺激组、假手术组和对照组.每组在注射前、注射后2,4,6 h共4个时相点,检测肝组织TNF-α、IL-10水平变化;RT-PCR法检测肝组织SOCS1、SOCS3 mRNA表达.结果 注射LPS后,肝组织TNF-α、IL-10水平升高,其中注射后4 h TNF-α高于注射后2,6 h(P＜0.01,P＜0.05).在LPS注射后的各时相点,迷走神经刺激组TNF-α浓度显著低于内毒素组(P(0.05).注射后4,6 h迷走神经刺激组IL-10水平显著高于注射后2 h水平(P＜0.01),且高于内毒素组(P＜0.05).注射后4 h,LPS组SOCS1、SOCS3 mRNA表达显著高于对照组及假手术组(P＜0.01);迷走神经刺激组SOCS3 mRNA水平高于内毒素组(P＜0.01).结论 IVNS能抑制肝脏炎症反应,其抗炎机制涉及SOCS信号转导途径.     

地塞米松对海水淹溺性肺损伤兔肺组织炎症反应的抑制作用

目的了解地塞米松对海水淹溺性肺损伤兔肺组织炎症反应的影响。方法机械通气的麻醉新西兰兔随机分成对照组（CG）和地塞米松治疗组（DG），每组12只。CG兔的气管内灌注4ml／kg体重海水，DG兔在CG的基础上静注1mg／kg地塞米松。取部分右下肺行常规病理学检查。分别用RT-PCR和ELISA检测肺组织中TNF-α、IL-1β和IL-8的mRNA表达及蛋白含量。结果病理学观察显示CG的肺组织内有大量的炎性细胞浸润，肺泡腔内有出血及透明膜形成。DG的上述改变轻于CG。DG肺组织内TNF-α、IL-1β和IL-8的mRNA表达及蛋白含量显著低于CG（P〈0．05）。结论地塞米松治疗可抑制海水淹溺性肺损伤兔肺组织TNF-α、IL-1β和IL-8的表达，减轻肺组织内炎症反应。     

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.