35%TBSA Ⅲ度烫伤大鼠肠内补液时葡萄糖电解质液的吸收效率研究

目的观察35% TBSA Ⅲ度烫伤早期肠内补液时电解质和水的吸收效率变化,了解葡萄糖对小肠吸收电解质溶液的影响。方法雄性Wistar大鼠30只,20%乌拉坦(100mg/kg)肌注麻醉后,行十二指肠和回肠插管,与输液泵相连。将林格液或葡萄糖-林格液作为灌流液置于37℃恒温水浴箱中,通过输液泵控制流速进行肠内补液并形成肠内灌流环路(灌流液-十二指肠插管-十二指肠-回肠-回肠插管-灌流液)。实验动物随机分为假烫补林格液组(假烫LR组)、烫伤补林格液组(烫伤LR组)和烫伤补葡萄糖-林格液组(烫伤LR/G组,林格氏液中加入20g/L的葡萄糖粉),每组10只。烫伤组采用沸水法(100℃,15s)造成35%TBSA Ⅲ度烫伤。各组于烫伤后0.5h按1/2Parkland公式量和速率(2ml.1%TBSA-1.kg-1)进行肠内补液,测定肠道对水分和Na 的吸收速率。伤后4h处死动物测定血Na 浓度和血细胞比容。结果与假烫LR组比较,两烫伤组小肠对水和Na 的吸收以及血Na 浓度均显著降低(P<0.01),血细胞比容显著增高(P<0.01),伤后3h烫伤LR组水和Na 的吸收效率仅为伤前的29.7%和34.5%。烫伤LR/G组对水和Na 的吸收优于烫伤LR组,从伤后2h起差别显著(P<0.05);伤后4h烫伤LR/G组血细胞比容显著低于烫伤LR组(P<0.05),但两组血Na 浓度无显著差异(P>0.05)。结论大鼠35% TBSA Ⅲ度烫伤早期小肠对水和电解质液的吸收效率显著降低,肠内补液时葡萄糖-电解质液的吸收效率和扩容效果优于单纯电解质溶液。     

肠内输入与静脉输入高渗盐葡萄糖溶液复苏犬烧伤休克的疗效比较

目的比较肠道和静脉两种途径应用高渗盐糖溶液(HEGS)对烧伤早期休克复苏的疗效。方法采用Beagle犬35%TBSA三度烧伤模型,随机分为烧伤不复苏组(对照组)、静脉高渗盐糖补液组(静脉补液组)和胃肠高渗盐糖补液组(胃肠补液组),后两组于伤后0.5h分别通过静脉和肠道给予1.8%HEGS,8h补液总量为1ml/(kg·1% TBSA),匀速输入,测定三组平均动脉压(MAP)、心排量指数(CI)、血容量(PV)及血浆钠离子浓度的变化。结果三组的MAP均先升高后下降(P<0.05),静脉和胃肠补液组比较无显著性差异(P>0.05),但均显著高于对照组(P<0.01);对照组的CI和PV在烧伤后持续降低(P<0.01),静脉和胃肠补液组则是先降低(P<0.05),复苏后上升,两组比较无显著性差异(P>0.05),但与对照组比较均显著升高(P<0.01);对照组血浆钠离子浓度平稳(P>0.05),静脉和胃肠补液组复苏后升高(P<0.05),三组比较,静脉补液组最高,胃肠补液组次之,对照组最低(P<0.05)。结论在35%TBSA三度烧伤早期休克的复苏中,采用肠道途径输入高渗盐糖溶液可以达到与静脉途径相似的提高心排量、补充血容量、维持血浆渗透压的效果。     

高渗氯化钠葡萄糖溶液对烧伤休克犬早期补液量及肺血管通透性的影响

目的比较应用1.8%的高渗氯化钠葡萄糖溶液(HEGS)和0.9%的等渗氯化钠葡萄糖溶液(IEGS)进行烧伤早期抗休克治疗对补液量及肺血管通透性的影响。方法采用Beagle犬35%TBSAⅢ度烧伤模型,随机分为高渗盐糖溶液复苏组(H组)、等渗盐糖溶液复苏组(Ⅰ组)和对照组(C组)。分别于伤前及伤后0.5、1、2、4、6、8、24h测血管外肺水(EVLW)、肺血管通透性指数(PVPI),全身血浆容量(PV)及血浆渗透压(OPP),伤后24h处死,取肺脏测量含水量。结果H组从伤后3～4h开始,EVLW、PVPI显著低于Ⅰ组(P<0.05或P<0.01);H组肺脏含水量明显低于I组(P<0.05);H组从伤后2h开始OPP明显高于Ⅰ组(P<0.05或P<0.01);H组和I组PV无明显差别(P>0.05),但伤后2h开始均高于C组(P<0.01)。结论HEGS进行烧伤早期复苏,能减少补液量,降低肺血管通透性,减轻肺脏水肿程度。其复苏效果优于IEGS。     

卡巴胆碱对烫伤大鼠肠内补液时肠黏膜血流量、Na+-K+-ATP酶活性和水通道蛋白-1表达的影响

目的研究卡巴胆碱对烫伤早期大鼠肠内补液时肠黏膜血流量(IMBF)、Na -K -ATP酶活性和水通道蛋白-1(AQP1)表达的影响。方法雄性Wistar大鼠50只,随机分为假烫组、单烫组、肠内卡巴胆碱组、肠内补液组和肠内补液 卡巴胆碱组,每组10只。大鼠经35% TBSA Ⅲ度烫伤后,麻醉状态下进行十二指肠和回肠插管,与输液泵相连形成闭合回路进行小肠补液(灌流)。肠内补液时于烫伤后0.5h开始灌注葡萄糖-电解质溶液,灌注液总量为2ml/(kg.1% TBSA),于3.5h内在智能输液泵控制下匀速输入。卡巴胆碱(60μg/kg)于烫伤后0.5h肠内注射。伤后4h用激光多普勒血流仪测定IMBF,然后处死动物,取肠组织进行Na -K -ATP酶活性和AQP1免疫组化测定。结果IMBF、Na -K -ATP酶活性和AQP1表达肠内卡巴胆碱组和肠内补液组均显著高于单烫组(P<0.01),但低于肠内补液 卡巴胆碱组(P<0.05)。结论35%TBSAⅢ度烫伤肠内补液时给予卡巴胆碱能增加肠黏膜血流量和Na -K -ATP酶活性,促进AQP1表达,有助于肠道对口服液体的吸收。     

卡巴胆碱对50%TBSA烧伤犬口服补液时组织灌流和脏器功能的影响

显著升高,IMBF显著减少;CAR组PgCO2低于口服补液组,IMBF高于口服补液组,且伤后72h均未恢复至伤前水平.两组伤后血浆ALT、Cr、CK-MB、DAO水平均明显高于伤前(P<0.01),且CAR组均明显低于u服补液组(P<0.01),但伤后72h仍显著高于伤前.口服补液组和CAR组72h死亡率分别为50%(3/6)和33%(2/6).结论 50%TBSA烧伤口服补液伍用CAR能显著改善组织灌流和脏器功能,提高口服液体复苏的疗效.     

烧伤合并海水浸泡伤早期补液实验研究

目的：探讨犬烧伤合并海水浸泡伤早期抗休克补液的方法，为人同类伤的早期补液复苏提供依据。方法：将实验犬随机分为A、B、C三组，分别于伤后3h给予补充高张液、等张液、低张液抗休克治疗，观察24h内血浆渗透压、电解质、酸碱平衡变化情况及病死率。结果：三组伤后均有高渗性脱水、代谢性酸中毒和低氧血症等发生。分别经不同补液方法抗休克后，B及C组中大多得到纠正，而A组于补液后病情更加严重。A组病死率为90％，B及C组均为10%（P〈0．01）。结论：重度烧伤合并海水泡伤后使用高张液抗休克，会加重水、电解质和酸碱平衡紊乱。     

丁酸钠对严重烫伤大鼠小肠黏膜血流量和微血管通透性的影响

 目的 探讨丁酸钠(sodium butyrate,BTR)对严重烫伤大鼠小肠黏膜血流量和微血管通透性的影响。方法 雄性SD大鼠48只,体重240~260 g,随机分为假烫组、烫伤组和丁酸钠组,每组16只。烫伤组和丁酸钠组采用沸水烫伤背部15 s、腹部8 s,造成50%总体表面积(TBSA)Ⅲ度烫伤;假烫组采用37 ℃温水浸泡相同部位及时间。于烫伤后立即腹腔注射丁酸钠(400 mg/kg)或等体积生理盐水。烫伤后3 h和6 h测定小肠黏膜血流量;检测血浆二胺氧化酶(DAO)活性;取小肠组织检测含水率及微血管通透性。结果 假烫组大鼠小肠黏膜血流量丰富,血浆DAO活性正常,小肠微血管通透性和含水率为正常水平。大鼠严重烫伤后,小肠黏膜血流量迅速降低,DAO活性显著增强,小肠微血管通透性和含水率明显增高。烫伤后3 h,丁酸钠组与烫伤组比较,小肠组织微血管通透性[(4.26±0.98)μg/ml vs (5.53±1.31)μg/ml]、含水率[(63.67±3.35)% vs (74.32±3.74)%]、血浆DAO[(43.76±9.34)U/L vs (73.29±11.34) U/L]均显著降低,小肠黏膜血流量明显升高[(67.21±9.47)BPU vs (55.18±10.48)BPU](均P<0.05)。烫伤后6 h,丁酸钠组与烫伤组比较,小肠微血管通透性[(6.89±1.12)μg/ml vs (8.92±1.69) μg/ml]、含水率[(68.45±4.52)% vs (80.76±3.94)%]、血浆DAO[(47.59±10.71)U/L vs (89.87±11.93) U/L]均明显降低,小肠黏膜血流量明显升高[(47.77±8.93)BPU vs (25.64±7.42)BPU](均P<0.05)。结论 丁酸钠能增加严重烫伤大鼠小肠黏膜血流量,降低小肠微血管内皮通透性和组织水肿,对小肠组织具有保护作用。
     

口服丙酮酸盐-糖液对50％TBSA 烧伤休克犬循环血容量和血乳酸水平的影响

目的：研究烧伤休克犬口服丙酮酸盐-糖液对循环血容量和血乳酸水平的影响。方法24只Beagle犬施行颈总动脉和颈外静脉置管及胃造口手术后24h,采用凝固汽油燃烧法造成50％总体表面积（TBSA）Ⅲ度烧伤;将实验动物随机分为3组：单纯烧伤组（NR组,n＝8,伤后不补液）、NaHCO3盐-糖口服补液组（OH组,n＝8）和丙酮酸盐-糖口服补液组（OP组,n＝8）。口服补液组于伤后30min根据Parkland公式经胃造口分别输注NaHCO3-葡萄糖电解质液或丙酮酸盐-葡萄糖电解质液。在动物清醒状态下测定平均动脉压（ MAP）、循环血浆容量（ PV）、左心室内压最大变化速率（ dp／dtmax）、血乳酸浓度、动脉血pH值、PaO2。结果各组动物的血流动力学等指标（ MAP、PV、dp／dtmax、动脉pH值、血乳酸浓度、PaO2）于致伤后均降低;NR组各项指标持续恶化,直至死亡;口服补液组各指标逐渐恢复,OP组显著优于OH组（ P＜0.05）。结论50％TBSA烧伤犬口服补液时,丙酮酸盐-糖液改善MAP、PV、dp／dtmax、动脉pH值、血乳酸浓度、PaO2的效果显著优于常用的NaHCO3盐-糖液。     

维生素C对烫伤休克大鼠肠内补液时肠组织氧自由基损伤的影响

目的研究维生素C对烫伤休克大鼠肠内补液时肠组织氧自由基损伤的影响。方法雄性Wistar大鼠40只,20%乌拉坦(100mg/kg)肌注麻醉后,采用沸水法(100℃,15s)造成35% TBSA Ⅲ度烫伤,行十二指肠和空肠置管。随机分为单烫组(S组)、葡萄糖-电解质溶液(GES)组、VC组和GES/VC组,每组10只,GES组和GES/VC组大鼠在烫伤后30min将GES经十二指肠置管处匀速泵入,前4h按1/2Parkland公式量和速率(2ml.1%TBSA-1.kg-1)补液,VC组和GES/VC组大鼠在伤后30min将VC(250mg/kg)单独或溶于GES中注入十二指肠。伤后4h处死大鼠,取空肠组织测定丙二醛(MDA)含量及黄嘌呤氧化酶(XOD)、髓过氧化物酶(MPO)活性,并用干湿重法测定肠组织含水率(GW)。结果与S组比较,GES组MDA含量明显增高(P<0.05),而XOD、MPO活性两组比较无显著差异;VC组和GES/VC组上述指标与S组和GES组比较均显著降低(P<0.05)。GES组GW(83.1%±2.4%)显著高于S组(78.8%±2.5%,P<0.05),且二者均明显高于VC组(72.4%±1.2%)和GES/VC组(68.9%±2.1%,P<0.05)。结论VC能减轻烫伤休克大鼠肠内补液时的缺血再灌注损伤和肠组织水肿。     

早期口服补液对35%TBSA烧伤犬血流动力学和后期脏器功能的影响

目的研究35% TBSA烧伤休克早期口服补液对血流动力学、脏器功能和伤后5d预后的影响。方法成年雄性Beagle犬18只,体重11.0±0.5kg,先期无菌手术行动静脉置管术监测血流动力学和肠黏膜血流量(IMBF),24h后用速效药丙泊酚作10min短时麻醉,凝固汽油燃烧造成35%TBSAⅢ度烧伤,随机分为不补液组、口服补液组和静脉补液组,每组6只。伤后第1个24h不补液组无治疗,口服补液组和静脉补液组于伤后30min分别胃内输注葡萄糖-电解质溶液和静脉滴注乳酸林格液,补液量为4ml/(kg.1% TBSA),前8h补一半,后16h补另一半。伤后24h起各组动物均实施静脉补液,伤后第4天起实施静脉营养支持。分别于伤前和伤后第2、4、8、24、48、72、120h测定动物清醒状态下的平均动脉压(MAP)、心输出量(CO)、IMBF以及血中丙氨酸转氨酶(ALT)、肌酐(Cr)和磷酸肌酸激酶同工酶(CK-MB)水平,并统计三组动物的5d死亡率。结果各组动物伤后MAP、CO和IMBF均下降,但MAP在伤后4h已恢复至伤前水平,之后各组间MAP均无统计学差异(P>0.05);伤后24h内口服补液组CO和IMBF均高于不补液组(P<0.05),但低于静脉补液组(P<0.05),24h后各组间血流动力学无统计学差异(P>0.05),各组IMBF恢复均较CO滞后。伤后各组血浆ALT、Cr和CK-MB水平均不同程度升高,伤后72h内口服补液组ALT和CK-MB低于不补液组(P<0.05),但高于静脉补液组(P<0.05);口服补液组Cr在4、8、24h时点低于不补液组但高于静脉补液组(P<0.05)。不补液组伤后5d内死亡率为33.3%(2/6),口服补液组和静脉补液组死亡率均为0。结论35%TBSA烧伤后早期口服葡萄糖-电解质溶液复苏效果虽略差于静脉补液,但相比不治疗组仍能显著改善血流动力学和保护脏器功能,减少早期死亡率,有望成为战争或灾害时早期静脉复苏的替代方法。     

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.