大鼠中度脊髓损伤后两种后肢行为学评估标准的比较研究

目的 对大鼠中度脊髓损伤后两种后肢行为学评估标准进行评价.方法 24 只雄性 Wistar 大鼠随机分为假手术组和损伤组.损伤组采用Allen's打击法制作脊髓损伤模型,假手术组仅行椎板切除术.术后1、3、7、14、21天分别采用Tarlov评分和BBB(basso,beattie and bresnahan)评分对两组大鼠后肢运动功能恢复情况进行评估.结果 两组大鼠BBB评分值在伤后各时间点差异均非常显著(P<0.01),Tarlov评分值在伤后各时间点有显著性差异(P<0.05),但只在 1、3、7天时差异才非常显著(P<0.01);评分值按百分制换算后,假手术组大鼠两组评分值之间的一致性较好,仅在伤后7天时有显著性差异(P<0.05),损伤组大鼠两组评分值之间的差异较大,伤后1、3、7天时差异非常显著(P<0.01).结论 BBB评分的敏感性和区分度优于Tarlov评分,能更准确、客观地反映大鼠中度脊髓损伤后运动功能恢复情况.     

丙戊酸对大鼠脊髓损伤后Caspase-3及C-fos表达的影响

目的探讨丙戊酸（VPA）对大鼠脊髓损伤（SCI）后Caspase-3及c-fos表达的影响。方法 60只雄性sD大鼠随机分为3组：假手术组（C组）、损伤组（SCI组）和丙戊酸保护组（VPA组）。采用改良的Allen法制作脊髓损伤动物模型。VPA组术后即刻及其后每12h皮下注射VPA300mg／kg;C组和SCI组在相应时间点注射等体积的生理盐水。伤后6h,每组取5只大鼠处死取材,每组其余大鼠分别在伤后24、48、72h取5只先行后肢运动功能BBB评分,随后处死取材。通过免疫组化法检测Caspase-3及c-fos的表达。结果 BBB评分显示,C组运动功能未受影响,VPA组的BBB评分均高于SCI组,两者相比在伤后48h和72h差异有显著性（P〈0．05）。与C组相比,SCI组和VPA组的Caspase-3表达在各时间点均明显增加（P〈0．05）,而VPA组的增加低于SCI组（P〈0．05）;与C组相比,SCI组和VPA组的c—fos表达在伤后6、24、48h明显增加（P〈0．05）,而VPA组的增加也低于SCI组（P〈0．05）。结论VPA可能通过抑制Caspase-3和e．fos表达,从而对SCI发挥保护作用。     

真皮多能干细胞移植治疗大鼠脊髓损伤的实验研究

目的：观察真皮多能干细胞（dMSCs）移植对脊髓损伤大鼠运动功能的修复作用。方法：32只SD大鼠在L4水平制成脊髓全横断损伤模型，并随机分为真皮多能干细胞移植组（A组）及损伤对照组（B组），每组10只大鼠。伤后1w，移植组于伤处移植大鼠真皮多能干细胞（dMSCs），而对照组仅注射等量PBS。分别于移植后1d、1w、8w、12w对两组大鼠进行动物行为学（BBB）评分和脊髓诱发电位（SEP和MEP）检测，并于移植后12w进行损伤脊髓的大体观察和组织学检测。结果：BBB评分4w以后组间比较差异有统计学意义（P〈0．05），移植组明显高于对照组（P〈0．05）；SEP和MEP潜伏期和波幅值在8、12w后组间比较差异有统计学意义（P〈0．05）；移植后12w，移植组损伤脊髓结构的修复明显优于对照组。结论：移植治疗脊髓损伤，能明显改善其运动功能和神经形态，dMSC对脊髓损伤大鼠有治疗作用。     

胰岛素对脊髓损伤后血管内皮生长因子的表达及血管再生的影响

目的 观察胰岛素对大鼠急性脊髓损伤后血管内皮生长因子（VEGF）表达及微血管再生的影响,探讨胰岛素在改善脊髓损伤微循环方面可能的作用。方法 60只SD大鼠随机分为损伤对照组和胰岛素治疗组,建立脊髓损伤（SCI）模型;术后采用斜板试验和改良的Tadov评分对大鼠急性脊髓损伤后的功能评估;采用免疫组织化学（S-P法）观察脊髓VEGF、微血管密度（MVD）的表达变化,并进行比较分析。结果 术后各时相斜板试验和改良的Tarlov评分,胰岛素治疗组明显高于对照组;胰岛素治疗绀各时相点VEGF的阳性表达均明显高于对照组;伤后14天,胰岛素组MVD计数明显增多,毛细血管密度增加,两组差异有统计学意义（P〈0．05,P〈0．01）。结论 胰岛素可增强脊髓损伤后VEGF的表达,促进微血管再生,改善微循环。     

兔坐骨神经牵拉伤MTR值与肢体功能的相关分析

目的：探讨兔坐骨神经急性牵拉伤后不同时间点牵拉远段神经磁化传递率（MTR）与肢体功能的相关关系。方法：选取20只新西兰大白兔,右后肢为损伤侧,建立坐骨神经牵拉伤模型;左后肢为假手术侧。随机将实验兔分为两组,A组（n=12）于术前1天、术后1和3天以及1、2、4、6和8周分别行双侧后肢磁化传递MRI扫描,测量牵拉远段神经及假手术侧神经的MTR值;同时对实验兔的肢体功能进行展趾反射和改良Tarlov评分,分析术后1～8周MTR值与肢体功能的相关性;B组（n=8）于上述各时间点进行病理学检查。结果：牵拉远段神经的MTR值于损伤后1天明显降低,2周时达最低值,4～8周逐渐升高至正常水平,各时间点MTR值与假手术侧相比差异均有统计学意义（P〈O．05）。牵拉伤后1天兔展趾反射及Tarlov评分降至最低;伤后1天～1周评分保持较低水平;伤后2～8周评分逐渐增高、肢体功能逐渐恢复。伤后1～8周牵拉远段神经MTR值与肢体功能评分呈正相关（r=0．638,P％0．01）。病理检查显示术后1周神经开始退变,2周时髓鞘退变最显著,4周后开始恢复。结论：牵拉远段神经的MTR值与肢体功能评分呈正相关,提示MTR值可用于监测伤后神经功能退变及再生的情况。     

细胞外三磷酸腺苷对大鼠脊髓损伤后微管相关蛋白-2表达及运动功能恢复的影响

目的 研究细胞外三磷酸腺苷（ATP）对大鼠脊髓损伤后微管相关蛋白-2（MAP-2）表达运动功能恢复的影响。方法 健康成年Wistar大鼠66只，随机取6只作为正常对照组，余60只制作成脊髓打击伤动物模型，随机分为两组：A组（ATP组）和B组（对照组），每组30只大鼠。伤后1，3，7，14，28d取材，应用免疫组织化学方法观察MAP-2的表达，采用计算机图像分析系统，进行定量分析；并用改良的Tarlov评分观察大鼠脊髓损伤后运动功能的恢复情况。结果脊髓损伤后14d和28d，A组大鼠MAP-2的表达明显强于B组（P＜0．05）；损伤后14d和28d，A组大鼠改良Tarlov评分明显大于B组（P＜0．05）．结论细胞外ATP能促进大鼠损伤脊髓表达MAP-2，并能促进大鼠脊髓损伤后运动功能的恢复。     

咯利普兰治疗脊髓损伤的实验研究

目的研究咯利普兰对SD大鼠脊髓神经丝蛋白（NF）、突触素（SYP）表达变化和运动功能的影响，探讨咯利普兰治疗脊髓损伤的可行性。方法SD成年雌性大鼠30只，体重220±20g，随机分成3组：即假损伤组；脊髓挫伤组（SCI组）及咯利普兰（ROL）组，用改良的Allen装置造成T12脊髓节段挫裂伤。在手术前及术后每天对大鼠进行BBB评分。手术后，脊髓挫伤后以0．4μmol·kg^-1·h^-1计算24小时ROL总量，分4次腹腔注射（每次间隔6h），持续10天。所有动物在伤后4周处死。术后置于25．5℃的温室内（以电暖气升温）。以4％多聚甲醛固定液灌注固定大鼠，取损伤节段上、下长约0．5cm脊髓入4％多聚甲醛后同定、修块、沉底。连续冰冻切片，片厚25μm，间隔取片后分别以抗神经丝蛋白、突触素抗体行免疫组化ABC染色。在光学显微镜下观察各组NF、SYP在SD大鼠脊髓的表达分布情况，进行统计学分析。结果ROL组轴突数目明娃多于SCI组，但仍低于似损伤组，差异显著（P〈0．05）。相应损伤节段SYP灰度值比较中，ROL组SYP灰度值明显低于SCI组．差异显著（P〈0．01）。SCI组、ROL组所有动物在术后第1天BBB评分为0。SCI后4周ROL组较SCI组神经学功能均显著提高，差异具有显著性（P〈0.05）。结论咯利普兰在脊髓损伤中后期明显促进其损伤后的再生，具有中远期疗效。     

高压氧对大鼠脊髓损伤后炎症因子的影响

目的 观察高压氧对大鼠脊髓损伤后外周血中炎症细胞因子及其运动功能恢复的影响。方法采用改良Allen’s法制作大鼠脊髓损伤模型。75只SD大鼠,随机分为三组：假手术组（n=15）,对照组（n=30）和高压氧组（n=30）。分别于治疗后4h、12h、1d、3d及5d时间点,利用BBB评分法对大鼠进行运动功能评分,同时应用放射免疫检测技术测定各时间点大鼠外周血中TNF-α、IL-6、IL-8及IL-10的含量。结果对照组和高压氧组的各炎性细胞因子水平,较假手术组均有不同程度升高（P〈0．05）;高压氧组BBB评分较对照组升高（P＜0．05）;高压氧组外周血中上述炎性细胞因子在各时间点均较对照组降低（P＜0．01）。结论高压氧可抑制外周血中炎性细胞活性,降低各炎性细胞因子水平,促进损伤恢复,具有保护受损脊髓组织的作用。     

转TrkC基因神经干细胞移植对脊髓损伤的治疗作用

目的 研究转酪氨酸激酶C（tyrosine kinase C，TrkC）基因神经干细胞（neural stem cells，NSCs）移植治疗脊髓损伤的作用。方法 60只SD大鼠随机分成正常对照组（A组）、脊髓半切组（B组）、NSCs移植组（C组）、NSCs移植＋神经营养素（NT）-3局部使用（D）组、转TrkC基WNSCs移植组（E组）和转TrkC基因NSCs移植＋NT-3局部使用组（F组），每组10只。脊髓损伤后第9天进行细胞移植。各组大鼠在细胞移植后2个月，行体感诱发电位（SEP）和运动诱发电位（MEP）检查以及脊髓运动功能（BBB）评分。结果 细胞移植后2个月SEP和MEP发生潜伏期和峰峰波幅以及右后肢BBB评分的恢复均以下组最佳，与其他各组比较，差异有统计学意义（P＜ 0．05，0．01）。结论在局部给予的NT-3作用下，转TrkC基因NSCs能较好地促进损伤脊髓功能的恢复。     

骨髓间充质干细胞移植治疗大鼠脊髓损伤的抗凋亡机制

目的探讨骨髓间充质干细胞（BMSCs）移植治疗大鼠脊髓损伤的潜在抗凋亡机制。方法成年雄性SD大鼠48只，随机分为对照组、模型组、治疗组，每组16只。模型组、治疗组采用改良Allen法建立大鼠下胸段脊髓损伤模型。造模后7d，于L4～L5间隙蛛网膜下腔向对照组及治疗组注射BMSCs，模型组注射同体积Hank缓冲液。术后评估大鼠后肢运动功能。以原位末端标记法（TUNEL）检测神经细胞凋亡，免疫组织化学染色法检测Bax、Bcl-2的表达。结果BMSCs移植后，治疗组动物后肢运动功能持续恢复。移植后14d，模型组TUNEL阳性细胞数量高于对照组和治疗组（P〈0．01），治疗组亦高于对照组（P〈0．01）；模型组Bax阳性细胞表达多于对照组和治疗组（P〈0．01），治疗组Bax阳性细胞表达多于对照组（P〈0.01），Bcl-2阳性细胞表达各组间差异无统计学意义（P〉0．05）。移植后28d，各组TUNEL阳性细胞数量均减少，模型组仍然高于对照组和治疗组，但差异无统计学意义（P〉0.05）；各组Bax阳性细胞表达减少，各组间比较，差异无统计学意义（P〉0．05），Bcl-2阳性细胞表达变化不明显。结论BMSCs移植可改善脊髓损伤大鼠后肢运动功能，减少神经细胞凋亡，具有潜在抗凋亡作用，这一作用可能通过下调凋亡调控蛋白Bax表达而实现。     

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.