10戈瑞γ线照射所致狗的肠型放射病

本文观察了10戈瑞⁶⁰Coγ线照射所致狗的肠型放射病的临床特点。实验结果表明, 肠型放射病病情危重, 发展快, 死亡早, 9只狗均在照后8～6天(平均4天)内死亡, 照后胃肠症状极为严重, 所有实验动物均出现频繁的呕吐、严重的腹泻(血水便), 早期拒食, 脱水和电解质紊乱, 造血损伤比骨髓型更为严重, 肠套迭发生率高, 9只狗中有8只发生套迭I病程虽有分期, 但很不明显。肠型放射病狗的死亡原因主要有;脱水和电解质紊乱, 机体中毒、肠套迭、肾上腺出血和心力衰竭。     

肠型放射病的实验治疗研究

本实验用27只杂种狗全身照射⁶⁰Coγ线9～12Gy,全部发生肠型放射病。6只狗给予自身骨髓移植和对症治疗,10只狗只给予对症治疗,11只狗作为对照不给任何治疗。后两组动物均在照后8～11天间死亡,未见造血恢复。7只对症治疗动物胃肠损伤有恢复。在6只骨髓移植动物中,2只死于照后15天,3只活存超过30天,胃肠和造血损伤均恢复,1只狗已活存4年多。实验结果表明,骨髓移植和症治疗联合应用是治疗肠型放射病的有效措施。     

急性放射病及其复合伤的并发症-肠套迭

562例急性放射病与放射复合烧伤、冲击伤死亡狗共发生肠套迭23例(4.09%),全部出现在骨髓型和肠型病例,未见于脑型与射线下死亡者。治疗组动物的肠套迭发生率达6.36%(14/220例),而效应组为2.63%(9/342例);单纯放射病时肠套迭的发生率为0.61%(1/164例),复合烧伤或复合烧伤、冲击伤时为4.49%(8/178例);骨髓型放射病时肠套迭的发生率为7.11%(17/239例),较肠型者2.34%(6/256例)显著增高。肠套迭最早见于照后23.5小时,最迟23.9天死亡狗,平均11.96±5.64天,以照后第二、三周发生率较高。肠套迭病例的照射剂量在137—4965拉德之间,其中265—1500拉德最多见。狗单纯放射病时并发肠套迭的照射阈剂量为660拉德,放烧复合伤时为265拉德,放烧冲复合伤时为137拉德。23例肠套迭中见单套迭(20例)和多套迭两种,后者包括双套迭(2例)和三套迭(1例)。小肠套迭(空空肠套迭和回回肠套迭)约占61%,回结肠套迭约占17%,十二指肠胃套迭约9%,多发型约13%。依据肠套迭病理变化,可分为单纯型(5例)、水肿型(1例)和坏死型(17例)。三型可能是肠套迭局部病变由轻到重依次发展的过程。肠套迭局部粘膜坏死、静脉淤滞、水肿、纤维素渗出、出血,并发细菌感染。其特点是上述病变较临床上肠套迭更多见,更严重;病变部位缺乏炎细胞反应。     

胎肝细胞移植治疗小儿医疗性重度骨髓型急性放射病两例报告

两例重型B一地中海贫血患儿,经环磷酰胺40mg/kg治疗2天后,分别以6.4,6.6Gyγ线全身均匀照射,发生了医疗性重度骨髓型急性放射病。照后4天内使用胎肝移植(FLT)分别移植了4和8个胎肝的细胞悬液,有核细胞总数为17.7×10⁹与15.9×10⁹,辅以抗感染抗出血等垒身支持治疗。两例患儿胎肝造血干细胞均获得了暂时性植活,没有发生严重的移植物抗宿主病(GVHD).虽然胎肝移植后2～3个月均逐渐恢复了重型β-地中海贫血的自身造血,但却成功地治愈了两例患儿的医疗性重度骨髓型急性放射病。术后至今已分别为21和19个月,一般情况良好。     

两例极重度骨髓型放射病肺组织病变的病理学对比观察及分析

目的对比观察不同吸收剂量、不同存活时间对极重度骨髓型放射病肺组织病变发生发展的影响.方法分别于病人死亡后从肺脏取材,每个尸检病例从不同部位取材数块,10%甲醛固定,石蜡包埋,病理组织切片,分别行HE和Gimsa染色,光学显微镜观察和分析.结果极重度骨髓型伴轻度肠型放射病尸检病例（107号）肺内主要病变为肺组织大面积坏死伴广泛性曲霉菌感染;另一极重度骨髓型放射病尸检病例（108号）肺内主要病变为广泛性卡氏肺孢子虫感染,虫体充满肺泡腔,肺泡间隔增宽,成纤维细胞活跃增生伴胶原纤维形成.结论放射病抢救治疗过程中肺内容易继发霉菌或卡氏肺孢子虫感染,可能与病人的呼吸衰竭和早期死亡有直接关系;极重度骨髓型放射病人的存活时间超过2个月,早期肺纤维化过程开始启动.     

狗脑型、肠型和骨體型放射病小肠粘膜病变的比较

小肠是辐射敏感器官,照射后小肠粘膜迅速发生破坏。关于脑型、肠型、骨髓型放射病时小肠粘膜的病变规律,迄今缺少系统的资料。本文从病理方面比较了三种类型放射病时小肠粘膜损伤和修复的基本过程,着重探讨肠型放射病小肠的病变特点。     

D-高雌酚酮-3-醋酸酯对急性放射病的防治

D-高雎酚酮-3-醋酸酯(D-homoestrone-3-acetate)是由雌酚酮衍生而来的化合物.对小鼠急性放射病有一定的预防作用.对260和300拉德照射狗的急性放射病有明显的治疗作用,分别可提高活存率60.8%(p<0.05)和52.2%(p<0.001).对正常狗的白细胞有明显的升高作用,有减轻受照射动物(小鼠和狗)白细胞下降的作用.该药雌活力低,约为炔雌醇的1/1,000.毒副作用小,目前已用于临床.实验证明炔雎醇对致死量照射的动物有较好的防治作用⁽¹⁾,经临床试用该药有明显的升白作用⁽²⁾,但副作用也较严重.主要表现为恶心和女性化.为了克服该药的缺点,同时又保持其防治效果,我们进行了本实验研究.     

3例中度骨髓型急性放射病照后8年医学随访观察

2000年2月27日, 成都某⁶⁰Co 辐照场发生一起3人同时受到γ射线意外照射事故, 造成3例中度骨髓型急性放射病。     

严重急性呼吸综合征不同时间死亡患者的病理变化及其特征

目的系统观察6例严重急性呼吸综合征(SARS)不同时间死亡患者近30个脏器的病理变化，探讨其病理发生发展过程及病变和病原体特点。方法采用光镜、透射电镜、组织化学和部分免疫组织化学方法观察各脏器的病理变化。结果①重症SARS死亡患者早期基本病变为以肺和免疫器官(脾、淋巴结、黏膜淋巴组织)为主的全身各脏器发生不同程度的实质细胞变性、凋亡和坏死等变质性改变和肺水肿、透明膜形成及出血等为主的血循环障碍；中后期则以肺上皮坏死脱落和问质纤维增生伴早期纤维化及免疫器官进行性萎缩等病变为主，再次证实肺和免疫器官为主要靶器官；②肺脏病变经历急性渗漏性炎症期(发病后2周内，主要病变为严重的弥漫性肺水肿和透明膜形成)、肺泡上皮坏死脱落伴增生机化性炎症期(发病后3～4周)和纤维增生伴早期纤维化期(发病后5～6周)，具有广泛性、速发性、进行性和阶段性、多样性等特点；③在重症SARS死亡患者中，脾和淋巴结等免疫器官发生严重的破坏和广泛出血，脾小体和淋巴滤泡极度萎缩，淋巴细胞迅速发生凋亡和坏死，T、B淋巴细胞数量极度减少，免疫功能极度低下，其病变同样具有广泛性、速发性和持续性等特点；④证实主要病原体为新型冠状病毒，衣原体样颗粒也是致病病原体之一，同时于肺和脾观察到性质未明的长杆棒状结构，于肺脏中观察到球菌菌团。结论重症SARS死亡尸检标本中，病原体具有多样性，其中冠状病毒累及全身多个器官、多种细胞，引起病毒血症；全身各脏器均发生不同程度病变，肺和淋巴组织为主要靶器官；肺脏病变呈进行性发展，经历3个阶段，于4～6周即发生纤维增生和早期纤维化；淋巴器官萎缩呈持续性、进行性发展，免疫功能长期低下。     

大鼠实验性脑震荡的病变规律和神经细胞凋亡研究

采用Wistar大鼠复制脑震荡动物模型，于伤后1，3，7，14及30天活杀取脑组织，经光镜，电镜和原位末端标记等技术研究脑震荡的病变规律及神经细胞凋亡情况。结果显示，100g砝码于1m处撞击大鼠头部可复制大鼠脑震荡的模型，其基本病变为脑血管扩张，淤血，出血，脑组织水肿，神经元变性，凋亡和坏死，尼氏体减少甚至消失。伤后1－3天，脑组织呈点状坏死，周围组织疏松，单核及泡沫样细胞增多，神经元变性，凋亡和坏死。7天脑水肿达高，海马锥体细胞减少，呈极度缺血性改变，14－30天内仍见血管扩张，淤血，可见出血，水肿好转。原位末端标记显示，伤后1天见凋亡细胞增多，3天数量达高峰，伤后30天凋亡的神经元持续存在。结果显示，脑震荡以血液循环障碍和实质细胞变性，凋亡和坏死为主要病理改变；神经细胞凋亡是脑震荡神经元迟发性损害的主要形式之一。     

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.