脊髓型减压病大鼠脊髓组织内NGF和Trk A的蛋白表达

目的 观察大鼠脊髓减压病后脊髓组织内神经生长因子（NGF）及其受体酪氨酸激酶A（Trk A）蛋白表达随疾病进程的变化过程，探讨减压病脊髓损伤后自身的神经保护机制。方法 采用1.0MPa暴露5.5min后极快速减压的方法制备SD大鼠脊髓减压病模型，在出舱0，6，24，48，72h应用免疫组织化学染色和半定量图象分析方法检测脊髓组织NGF及其受体Trk A的蛋白表达。结果 极快速减压后6h开始有少量NGF和Trk A蛋白表达，在24h表达明显增强并达到高峰，此后Trk A表达逐渐减弱，NGF表达直到72h仍比基础值明显增加。结论减压病脊髓损伤诱导了脊髓神经元和胶质细胞的NGF及其受体的合成，提示脊髓型减压病在损伤神经组织的同时也激活了自身的神经保护机制，通过Trk A受体途径NGF可能在保护受损神经细胞中起作用。     

低温预处理对大鼠脊髓内牵拉后脊髓神经细胞凋亡及神经功能的影响

目的 探讨局部低温预处理对大鼠脊髓内牵拉型脊髓损伤病理形态学改变、神经细胞凋亡和神经功能的影响。方法 将80只4个月龄SD大鼠随机分为低温预处理组（A组）和对照组（B组），建立大鼠脊髓内牵拉型脊髓损伤模型，于损伤后2，4，8，24，48，72h和7d评估脊髓损伤后大鼠运动功能，用HE染色观察损伤脊髓组织病理变化，原位末端标记（TUNEL）法标记凋亡细胞。结果 HE染色镜检显示A组脊髓组织病理学改变明显轻于B组。A、B两组运动功能评分和神经细胞凋亡指数比较，差异有统计学意义（P〈0．05或0．01）。结论 低温预处理可明显减轻大鼠脊髓内牵拉型脊髓损伤早期病理形态学损伤，抑制细胞凋亡，有助于神经功能的恢复。     

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。     

高压氧对实验性减压病兔脊髓bFGF表达的影响

目的探讨实验性减压病兔脊髓bFGF的改变及高压氧对其影响。方法实验家兔随机分为7组：正常组、减压病3h组、减压病3d组、高压氧3h组、高压氧3d组、常氧高压氮3h组、常氧高压氮3d组。采用快速减压方法制备减压病模型，用免疫组织化学方法检测胸髓及腰髓中bFGF表达。结果（1）快速减压后各组bFGF表达均较正常组增加（P〈0．01），3h组之间无差异（P〉0．05）；（2）减压病3d组较3h组bFGF表达显著增高（P〈0．01），高压氧3d组较3h组显著降低（P〈0．01），常氧高压氮3d组较3h组有所降低（P〈0．05）；（3）高压氧3d组与常氧高压氮3d组均较减压病3d组显著降低（P〈0．01），高压氧3d组较常氧高压氮3d组降低（P〈0．05）。结论减压病脊髓损伤后bFGF表达增加；高压氧和常氧高压氮对减压病脊髓损伤起保护作用，高压氧效果优于常氧高压氮。     

雌激素影响急性大鼠脊髓损伤后细胞凋亡的相关性实验研究

目的在建立大鼠脊髓损伤模型基础上,观察不同时间点雌激素对脊髓胶质细胞,神经元凋亡的影响,以期为临床急性脊髓损伤的治疗提供理论依据。方法健康成年大鼠72只,随机分为两组,其中单纯损伤组（单纯打击损伤）36只,雌激素组（手术加雌激素）36只。脊髓损伤动物模型的制备：用自制Allen打击器25gcm致伤力撞击脊髓,制成脊髓损伤动物模型。雌激素组每日肌注雌激素（100μg／kg）直至处死,单纯损伤组仍每日肌注生理盐水0．5ml直至处死。组织切片的制备：脊髓损伤后1d、3d、5d、8d、14d、21d共6个时间段分批处死动物。4％多聚甲醛心肌灌注固定24h,切取每只大鼠T5～T13节段脊髓组织,常规制成切片,给于Bcl－2检测,TUNEL原位末端标记,检测大鼠脊髓损伤后细胞凋亡的情况。脊髓损伤后2周给予Gale评分及斜板维持试验。结果Bcl－2蛋白检测：在脊髓损伤后的第1天,脊髓组织即开始较高表达Bel－2蛋白。单纯损伤组Bcl－2高峰发生在损伤后3天,而雌激素组伤后8天达到高峰,此时Bcl－2蛋白不仅表达在神经细胞中,更多的在胶质细胞中大量表达,且此状态一直维持到伤后14天才开始下降,伤后21天仅少量表达（P〈0．05）。TUNEL原位标记检测：单纯损伤组24小时已出现不少阳性细胞,以胶质细胞为主．3～8天达到高峰,此后逐渐回落,但21天时仍有阳性细胞,应用雌激素治疗后,凋亡细胞明显减少（P〈0．05）。脊髓损伤后2周Gale评分及斜板维持率雌激素组优于单纯损伤组（P〈0．01）。结论雌激素在脊髓损伤中通过改善微循环,促进Bcl－2蛋白的表达,清除氧自由基,抗氧化作用能够抑制脊髓损伤早期神经细胞和胶质细胞的凋亡,从而减轻脊髓继发性损伤．促进脊髓神经功能的恢复。所以脊髓损伤后早期应用雌激素配合其它药物阻止神经细胞和胶质细胞的凋亡可能有助于减轻脊髓损伤的损害程度,促进脊髓神经功能的恢复,为SCI的治疗提供一个新的途径。     

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。     

依达拉奉对实验性急性脊髓损伤后细胞凋亡的影响

目的观察依达拉奉（MCI-186）对脊髓损伤后神经细胞凋亡的影响。方法选择SD雄性大鼠40只,随机分成对照组和MCI-186组,均采用改良的Allen打击（WD）法制成150gcf（克厘米势能）中度急性脊髓损伤模型,术后实验组给予MCI-186,3mg/kg对照组给予等量生理盐水。分别于术后6h、12h、24h、72h、7d处死动物取材,采用流式细胞仪检测损伤段脊髓细胞凋亡的情况。结果对照组和MCI-186组均发现凋亡细胞,均在1d达到高峰,但MCI-186组凋亡细胞比率显著低于对照组（P〈0．05）。结论MCI-186通过有效地清除氧自由基,可明显抑制急性脊髓损伤后的脂质过氧化反应及降低神经细胞的凋亡,从而达到保护其神经组织的作用。     

细菌脂多糖、脂蛋白和DNA体内协同致病作用观察

目的观察细菌脂多糖（lipopolysaccharide，LPS）、脂蛋白（bacterial lipoprotein，BLP）及其DNA[鸟嘌呤二核苷酸（CpG）寡核苷酸（oligonueleoetide），CpG—ODN]的体内协同致病作用。方法147只小鼠随机分为等渗盐水对照组、单纯LPS组、单纯CpG—ODN组、单纯BLP组、LPS＋BLP组、LPS＋CpG—ODN组和LPS＋BLP＋CpG—ODN组，尾静脉注射给药，观察小鼠死亡率及血清肿瘤坏死因子（TNF）-α水平。结果注射后12，24，48h，二联组的死亡率显著高于单独给药组（P〈0．05或P〈0．01）；三联给药组各时相点死亡率显著高于二联组（P〈0．05）。单独给药后6h，TNF—α水平均显著高于对照组（P〈0．05），12，24h与对照组比较，差异无统计学意义。二联组与单因素组和对照组比较，6，12h血TNF—α均明显升高，差异有统计学意义（P〈0．05）。三者联合刺激时，6，12h血TNF-α与二联组比较，差异有统计学意义（P〈0．05），至24h仍显著高于对照组（P〈0．05）．结论细菌LPS、细菌脂蛋白和细菌DNA不仅自身存在一定的致病能力，而且三者间具有明显的协同效应，特别是三者联合给药时作用最强。     

异丙酚对大鼠脊髓损伤后诱导型一氧化氮合酶表达的影响

目的 探讨异丙酚对大鼠急性压迫性脊髓损伤后诱导型一氧化氮合酶（iNOS）表达的影响。方法 采用改良Allen’s打击法制备急性脊髓压迫性损伤模型。雄性SD大鼠74只,随机分为正常组（n=4）、脊髓损伤后异丙酚干预组（n=35）和生理盐水对照组（n=35）,采用免疫组化和Western blot法检测脊髓损伤后不同时间点（1h、3h、8h、1d、3d、7d、14d）脊髓组织中iNOS蛋白的表达。结果 与生理盐水对照组比较,异丙酚干预组大鼠损伤后脊髓组织iNOS表达明显降低,差异有统计学意义（P〈0．05或0．01）。结论 异丙酚可通过抑制iNOS蛋白表达对大鼠急性脊髓损伤起保护作用。     

α-硫辛酸对糖尿病大鼠认知能力的影响

目的检测α-硫辛酸对糖尿病大鼠认知能力的影响情况,探讨α-硫辛酸对糖尿病大鼠学习与记忆影响的机制。方法Wistar大鼠共30只,随机分成3组,对照组10只,治疗组10只,糖尿病组10只。糖尿病大鼠模型用链佐菌素（STZ）制模。12周后,Morris水迷宫测试其学习记忆能力,western blotting检测各组NF—kB蛋白水平表达,TUNEL法检测大鼠海马神经元凋亡情况。结果糖尿病组大鼠学习成绩降低（P〈0．05）,TUNEL阳性细胞增多（P〈0．05）,NF-kB蛋白水平表达增加（P〈0．05）,甜硫辛酸治疗组大鼠较糖尿病组学习成绩升高（P〈0．05）,TUNEL阳性细胞减少（P〈0．05）,NF-kB蛋白水平表达减少（P〈0．05）。结论NF-kB蛋白的表达增高可能与糖尿病大鼠海马神经元凋亡及认知功能障碍有关。α-硫辛酸可能通过降低NF-kB的表达,从而对糖尿病大鼠学习与记忆障碍有一定程度的改善。     

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.     

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).     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme