超声作用下CTGF-siRNA对大鼠肝纤维化基因治疗的实验研究

目的探讨利用超声微泡造影剂介导携带结缔组织生长因子-小干扰RNA(CTGF-siRNA)真核表达质粒转染大鼠肝细胞的有效性。方法 (1)构建CTGF-siRNA真核表达质粒;(2)将40只实验大鼠随机分为7组:正常组,实验对照组,CTGF-siRNA质粒组,超声联合微泡组,超声联合微泡介导基因低、中、高剂量组;(3)建立肝纤维化模型,基因治疗4周后处死大鼠,超声及病理切片HE染色评价肝纤维化程度,masson染色观察胶原纤维含量,反转录-聚合酶链反应(RT-PCR)检测肝组织中CTGF、Ⅰ型和Ⅲ型胶原的mRNA表达。结果 (1)CTGF-siRNA基因治疗后超声及病理切片显示干预组纤维化程度降低;(2)masson染色显示超声介导微泡基因组胶原纤维含量表达量随着剂量增高而降低(P<0.05);(3)RT-PCR显示超声介导微泡基因组CTGF、Ⅰ型和Ⅲ型胶原的mRNA表达明显低于其他组,且随着质粒剂量增大而减少(P<0.05)。结论超声微泡作用下CTGF-siRNA基因能特异地作用于靶位点,有效抑制肝纤维化进程,提高对肝纤维化干预的特异度。     

超声辐照微泡介导肝细胞生长因子基因逆转大鼠肝纤维化

目的 探讨超声辐照载肝细胞生长因子(hepatocyte growth factor,HGF)基因的超声微泡造影剂逆转大鼠肝纤维化的可行性. 方法 将成模后的40只Wistar大鼠随机分为5组,即(1)超声+载基因超声微泡造影剂组(HGF+ US/MB),(2)超声+单纯质粒组(HGF+ US),(3)质粒+超声微泡造影剂组(HGF+MB),(4)单纯质粒组(HGF),(5)单纯模型组(MA).经股静脉注入超声微泡造影剂,同时超声基因转染治疗仪辐照肝区,辐照条件为300 kHz,2 W/cm2,辐照10 s,间隔10 s,共20 min.于超声辐照后14 d行磁共振弥散加权成像(diffusion weighted imaging,DWI)检查;然后处死各组大鼠,取肝组织HE染色,观察肝纤维化恢复情况;Western Blot检测HGF蛋白在大鼠肝脏中的表达. 结果 HGF+ US/MB组的表观弥散系数(apparent diffusion coefficient,ADC)值明显高于其他各组;相反地,指数表观弥散系数(exponential apparent diffusion coefficient,EADC)低于其他各组;病理组织片可见HGF+ US/MB组汇管区纤维结缔组织增生,但肝小叶结构完整,其余各组纤维组织增生程度强于HGF+US/MB组.同时,HGF+US/MB组的HGF蛋白的表达均高于其他各组(P＜0.05). 结论 超声靶向破坏微泡能够介导HGF基因在肝组织内高效表达,并产生抗纤维化效应,为肝纤维化的基因治疗提供一种新的基因转移途径.     

超声作用下微泡携肝细胞生长因子治疗大鼠肝纤维化的实验研究

目的 探讨超声作用下微泡携肝细胞生长因子(HGF)对大鼠肝纤维化的治疗效果。方法 构建真核表达质粒pMD18-T/HGF;将实验大鼠随机分为5组：正常组、模型组、低剂量组、中剂量组、高剂量组。建立肝纤维化模型,治疗14 d后处死大鼠,取血行检测丙氨酸转氨酶(ALT)评价肝功能,病理切片HE染色评价纤维化程度,免疫组化SABC法观察HGF蛋白,RT-PCR检测HGF mRNA。结果 治疗组治疗后血清肝功能优于模型组(P＜0.05),低剂量组与正常组间差异有统计学意义(P＜0.05),中、高剂量组与正常组间差异无统计学意义(P＞0.05)。病理切片示治疗组纤维化减轻;免疫组化见各治疗组HGF阳性表达,表达量随治疗剂量增高而增大(P＜0.05)。RT-PCR示各治疗组HGF mRNA表达高于模型组,且随治疗剂量的增大而增高(P＜0.05)。结论 超声作用下微泡携HGF可以有效抑制肝纤维化进程,其治疗效果在一定范围内随着治疗剂量的增大而增强。     

肝纤维化大鼠骨代谢及其调控激素的改变

目的:研究肝纤维化大鼠骨代谢及其调控激素的改变。方法:20只大鼠分为2组,一组以四氯化碳肌注建立肝纤维化大鼠模型,另一组为正常对照组。分别测定2组的肝功能[丙氨酸氨基转移酶(alanineaminotmnsferase,ALT)、天门冬氨酸氨基转移酶(as—partameaminotransferase,AST)、总胆红素(totalbilirubin,TB)、总蛋白(serumtotalprotein,TP)、白蛋Lh/球蛋白(A/G)、γ谷氨酰转移酶(γ-glutamyltransferase,γ-GT)];股骨和腰椎骨密度(bonemineraldensity,BMD);骨代谢指标及其调控激素[血清钙、尿钙、25羟基维生素D3[25(OH)VitD3]、甲状旁腺激素(parathyroidhormone,PTH)、尿吡啶酚/肌酐(urinarypyridinoline/ereatinine,Pyd/Cr)]。结果:肝纤维化大鼠与正常对照组相比,股骨和腰椎骨密度下降,但无显著差异[0.149±0.014vs0.151±0.006g/cm2,P>0.05;0.139±0.012vs0.146±0.007g/cm2,P>0.05];血清25(OH)VitD3无显著差异[18.97±1.52vs18.20±1.03ng/ml,P>0.05];尿Pyd/Cr则显著升高[0.13±0.04vs0.08±0.02nm/μmol,P<0.01]。相关性分析显示,腰椎骨密度与血清A/G呈正相关(r=0.586,P<0.01),而与尿Pyd/Cr呈负相关(r=-0.512,P<0.05)。结论:肝纤维化大鼠骨吸收加强。     

下颌骨牵引成骨过程中基因干预对牵引区转化生长因子β1表达的影响

背景:局部基因治疗能促进牵引区新骨的生成,但关于基因治疗后对局部生长因子表达的影响目前尚不清楚。目的:观察电穿孔介导的基因治疗对兔下颌骨牵引成骨过程中转化生长因子β1表达的影响。方法:新西兰大白兔双侧下颌骨截骨后3d开始下颌骨牵引,0.8mm/d,连续牵引7d后,随机分为5组,分别在牵引区注射2μg(0.1g/L)重组质粒pIRES-hVEGF165-hBMP2、pIRES-hBMP2、pIRES-hVEGF165、空质粒pIRES及相同剂量的生理盐水。之后施加电穿孔刺激。结果与结论:免疫组织化学染色发现转化生长因子β1主要在细胞胞浆中表达,给药7d时骨端骨细胞、编织骨痂骨细胞、骨痂表面成骨细胞呈转化生长因子β1染色阳性;14d时新生成的编织骨痂骨细胞、骨痂表面成骨细胞、肉芽组织中的间质细胞、单核巨细胞、多核巨细胞转化生长因子β1染色阳性;28d时转化生长因子β1阳性细胞明显减少。其中注射重组质粒pIRES-hVEGF165-hBMP2、pIRES-hBMP2、pIRES-hVEGF165后转化生长因子β1的表达明显多于注射空质粒pIRES及生理盐水(P<0.05或P<0.01)。说明基因治疗能促进转化生长因子β1的表达,促进牵引区细胞基质的形成和新骨生成。     

血管内皮生长因子基因诱导脑梗死大鼠热休克蛋白70变化与其梗死体积的关系

目的:观察血管内皮生长因子165基因治疗大鼠脑梗死前后热休克蛋白70表达的变化,进一步研究热休克蛋白70在脑梗死中的神经保护作用。方法:实验于2003-03/2004-03在郧阳医学院附属太和医院神经科学研究所完成。选择雌性Wistar大鼠40只,常规饲养观察1周后,随机分为正常对照组5只,不造模,余35只造模后分为假手术组5只,单纯梗死组10只,空载质粒对照组10只,血管内皮生长因子基因治疗组10只。采用改进的线栓法制成Wistar大鼠永久性大脑中动脉闭塞模型,空载质粒对照组和血管内皮生长因子基因治疗组用50μL微量进样器进针约3.5mm,分别注入5μL空载质粒和质粒载体与血管内皮生长因子165基因构成的重组DNA到梗死区,7d后断头取脑。用热休克蛋白70免疫组化染色的方法显示脑中的热休克蛋白70的表达情况;用苏木精-伊红染色显示梗死区,用图像分析仪测定梗死面积。结果:40只大鼠全部进入结果分析。①热休克蛋白70的着色部位在神经细胞的细胞浆和细胞膜,黄褐色细胞即为阳性细胞。②热休克蛋白70的表达:正常对照组与假手术组基本相似犤(3.00±0.89)个/高倍视野,(6.31±0.63)个/高倍视野,(P>0.05)犦,单纯梗死组与空载质粒对照组基本相似犤(23.98±3.25)个/高倍视野,(23.31±2.77)个/高倍视野,(P>0.05)犦,单纯梗死组比正常对     

拉米夫定联合重组乙肝疫苗治疗慢性乙型肝炎疗效观察

目的:研究拉米夫定联合重组乙肝疫苗(rHBV)治疗慢性乙型肝炎的疗效和肝脏纤维化指标改变。方法:慢性乙型肝炎31例,给予口服拉米夫定100mg/d加肌注rHBV10μg,1次/15d,12个月,动态观察服药0,6,12个月肝功能,乙肝五项,HBV-DNA定量,血清肝纤维化指标透明质酸(HA),层粘蛋白(LN),型前胶原(PC)和型胶原(C)的变化。结果:拉米夫定加乙肝疫苗治疗12个月,可显著抑制HBV-DNA(copy/L)复制(5.13×109±3.03×105vs8.01×105±3.89×103,P<0.01),使大多数患者肝功能(nkat/L,ALT:1597±807vs450±203;AST:1687±617vs398±230)恢复正常(P<0.01)。结论:拉米夫定加rHBV是治疗慢性乙型肝炎的一种较为有效的方法。     

不同病因心脏病患者心肌纤维化间质胶原及血清指标变化对心功能的影响

目的:观察不同病因心肌纤维化间质胶原的变化,评价血清细胞外基质(extracellularmatrix,ECM)对心肌纤维化状况的价值。方法:选取20例风湿性心脏病(风心病),7例扩张型心肌病(扩心病),10例先天性心脏病(先心病)患者心肌标本进行心肌间质Ⅰ,Ⅲ型胶原染色,5例正常心肌标本作对照,图像分析计算胶原容积分数(collagenvolumefraction,CVF);测定患者组(n=37)与正常对照组(n=20)血清I型前胶原(procollagenI,PCI)、III型前胶原(procollagenⅢ,PCⅢ)、纤联蛋白、透明质酸的含量,并和纤维化面积作相关分析。结果:①风心病、扩心病、先心病患者CVF分别为20.37±8.32,18.34±2.84,12.13±3.26,与正常心肌(5.47±1.68)比较,差异有显著性意义(t=-4.172～-10.642,P<0.01)。②实验组患者血清中ECM成分(μg/L),风心病组(PCI:64.24±21.28,PCIII:118.43±36.32,纤联蛋白:116.77±16.65,透明质酸:118.29±37.69),扩心病组(PCI:60.56±19.58,PCIII:128.32±40.21,纤联蛋白:115.66±15.36,透明质酸:122.78±35.72),均较正常对照组(PCI:49.08±14.54,PCIII:70.28±15.34,纤联蛋白:82.68±13.60,透明质酸:65.73±18.22)明显增高,差异有显著性意义(t=-6.462～-11.426,P<0.05);血清ECM各成分水平与心肌纤维化面积呈正相关。结论:不     

外源Smad7转染肝星状细胞及对转化生长因子β1和Ⅰ、Ⅲ型胶原mRNA表达的影响

背景:Smad7是转化生长因子β信号转导途径的主要抑制性蛋白,具有抗纤维化的作用.目的:构建并鉴定大鼠Srnad7真核表达质粒,观察外源Smad7可否有效转染肝星状细胞T6,并进一步研究其对转化生长因子β及Ⅰ、Ⅲ型胶原mRNA表达水平的影响.设计、地点:基因重组及细胞观察实验,于新疆石河子大学医学院第一附属医院完成.材料:pcDNA3.1(+)质粒为课题组保留;大肠杆菌DH5a系石河子大学医学院新疆地方与民族高发病教育部重点实验室所赠;肝星状细胞T6细胞由中国医学科学院肿瘤医院肿瘤研究所提供品.方法:采用基因重组技术将Smad7cDNA插入真核表达载体pcDNA3.1(+),构建大鼠Smad7真核表达质粒.脂质体介导转染肝星状细胞T6细胞,分为正常对照、空质粒及转染组,G418筛选,挑取阳性细胞.主要观察指标:反转录-聚合酶链反应法检测各组中Smad7、转化生长因子β及Ⅰ、Ⅲ型胶原mRNA的表达水平.结果:酶切和测序结果证实Smad7真核表达质粒构建成功.Smad7转染组与正常对照组、空质粒组比较:Smad7 mRNA 达显著增加(P<0.01);转化生长因子β、Ⅰ型胶原mRNA表达减少(P<0.01);Ⅲ型胶原mRNA表达差异无显著性意义(P>0.05).正常对照组、空质粒组smad7、转化生长因子β及Ⅰ、Ⅲ型胶原mRNA表达差异无显著性意义(P值均>0.05).结论:大鼠Smad7真核表达质粒构建成功,外源Srnad7转染肝星状细胞T6细胞后可有效表达,并能降低转化生长因子β及Ⅰ型胶原mRNA表达水平.     

水通道蛋白4基因干预对大鼠脑缺血再灌注损伤后血脑屏障形态及功能的影响

目的:探讨水通道蛋白(aquaporin,AQP)4水平的变化对大鼠血脑屏障结构和功能的影响,以寻找防治血脑屏障损伤的新靶点。方法:应用自行构建的含AQP4基因的真核表达质粒,在大鼠脑内进行预先转染,正向调控大鼠脑内AQP4的表达水平,观察其对正常大鼠以及缺血再灌注损伤后血脑屏障对伊文思蓝(EB)的通透率和紧密连接蛋白(ZO-1)表达水平的影响。实验分正常健康组、AQP4基因干预(实验质粒)组和基因干预对照(对照质粒)组。结果:①AQP4水平的升高并不影响正常大鼠血脑屏障对EB的通透率以及ZO-1的表达水平。②预先升高AQP4水平可明显加剧缺血再灌注损伤后血脑屏障对EB的通透率,再灌注12h实验质粒组的伤侧皮质及皮质下血脑屏障对EB的通透率分别为(74.10±9.64),(100.72±7.63)μg/g,对照质粒组相应部位的通透率分别为(48.11±7.34),(66.72±7.70)μg/g,再灌注24h实验质粒组的伤侧皮质及皮质下血脑屏障对EB的通透率分别为(100.90±2.63),(127.71±7.80)μg/g,对照质粒组相应部位的通透率分别为(60.39±2.54)μg/g,(99.71±5.10)μg/g;同时降低ZO-1的表达水平,再灌注12,24h实验质粒组伤侧半球ZO-1表达评分分别为2.13±0.69,0.33±0.24,对照质粒组相应时间相应部位的评分分别为2.60±0.49,1.00±0.33。结论:①正常生理状态     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.