鼻咽癌颈部淋巴结转移的CT表现

目的 探讨鼻咽癌颈部淋巴结转移的CT表现.方法 回顾性分析经穿刺活检、放射治疗后CT片对比证实的212例鼻咽癌颈部淋巴结转移病例的CT表现.结果 212例病例中,Ⅱ区144例,Ⅲ区8例,未见单独Ⅳ、Ⅴ、Ⅵ、Ⅶ区淋巴结转移病例,Ⅱ区合并其他区淋巴结转移者60例.单侧淋巴结转移74例,双侧淋巴结转移138例.转移淋巴结呈均匀强化64例,呈不均匀强化者148例.152例转移淋巴结均为圆形, 42例转移淋巴结部分有融合,18例病例可见椭圆形转移淋巴结.结论 鼻咽癌颈部淋巴结转移是自上向下发展的,这与鼻咽部淋巴引流方向有关.     

甲状腺癌颈部转移性淋巴结的CT表现

目的研究甲状腺癌颈部淋巴结转移的CT表现。方法18例经手术或活组织检查证实的甲状腺癌颈淋巴结转移患者，包括17例腺癌和1例鳞状细胞癌均经CT平扫和增强扫描。对所有患者颈淋巴结转移的CT表现作回顾性分析。结果CT增强扫描显示，所有患者颈淋巴结转移表现为明显均匀强化，其强化程度与正常血管及甲状腺相接近。其中，8例伴有淋巴结内细颗粒状钙化。转移性淋巴结主要分布于Ⅵ和Ⅶ区，其次为Ⅱ、Ⅲ、Ⅳ区。结论增强CT上所显示的明显均匀强化和部分伴有淋巴结内钙化是诊断甲状腺癌颈淋巴结转移的有意义特征。     

喉癌颈部淋巴结转移的CT影像及其病理基础

目的探讨喉癌颈部淋巴结转移的CT影像及其病理基础,确立淋巴结转移的CT诊断标准。材料与方法20例声门上型喉癌患者,先行CT扫描,将手术切取的颈部廓清标本制成病理大切片,然后进行对照研究。分别以淋巴结短直径0.5、1.0及1.5cm为淋巴结转移的假设诊断标准,根据诊断试验计算CT诊断淋巴结移转移的准确度。结果共有22侧颈部转移,38个转移淋巴结,根据三种不同诊断标准,CT诊断的准确度分别为81％、90％及71％,喉癌颈部淋巴结转移分为四个阶段;转移早期,发展期,完全癌变期及破溃融合期。结论CT诊断淋巴结转移优于临床触诊,淋巴结转移的CT诊断标准以淋巴结短直径1.0cm较合理,CT影像有与转移淋巴结各期相对应的影像表现。     

基于美国肿瘤放射治疗协会颈部淋巴结分区标准的转移性淋巴结影像分析

目的 :探讨基于美国肿瘤放射治疗协会(RTOG)颈部淋巴结分区标准的转移性淋巴结分布与原发恶性肿瘤的相关性,为临床治疗及预后评估提供依据。方法:回顾性分析经手术病理证实的154例原发肿瘤颈部淋巴结转移患者的影像资料,分析颈部转移性淋巴结的分布特点及其与原发肿瘤的相关性。结果:颈部转移性淋巴结的分布特点与其原发肿瘤的来源有明显相关性。多数头颈部原发恶性肿瘤可发生颈部淋巴结转移,其中以Ⅱb区最常见,Ⅱa区、Ⅲ区也是常见的转移部位,Ⅰ区受累少见。结论:颈部转移性淋巴结分区与其原发恶性肿瘤的淋巴引流部位密切相关。RTOG颈部淋巴结分区对判断颈部转移性淋巴结原发恶性肿瘤来源有重要参考价值。     

血管内皮因子和一氧化氮酶表达在声门上喉癌患者治疗中的临床意义

目的:探讨早期诊断声门上型喉癌颈淋巴结转移,指导临床选择性进行颈颈淋巴结清扫术.方法:应用免疫组化染色检测血管内皮因子(VEGF)和Ⅱ型一氧化氮酶(NOS2)的表达,回顾性的分析42例声门上癌的病例资料.结果:VEGF和NOS2的表达与声门上癌颈淋巴结转移呈正相关.结论:VEGF和NOS2的表达结果可指导临床对NO病例应用选择性颈淋巴结清扫术.     

舌癌颈部淋巴结转移的分布规律临床研究

目的探讨舌鳞状细胞癌的颈部淋巴结转移分布规律,为舌癌颈淋巴结清扫术式的选择提供参考依据。方法对1996—2004年手术治疗的137例舌癌患者临床资料回顾性研究,并进行Cox回归分析及spe姗n等级相关分析。结果本组137例病例中,经病理证实有淋巴结转移pN（＋）76例,颈淋巴结转移率55．47％,其中颈淋巴结转移受累区域为Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ,其中Ⅱ区最高;Cox分析显示,T分期、N分期、颈淋巴结转移最低受累区域、淋巴结包膜外侵犯为影响患者预后的独立因素;pN（-）和pN（＋）中颈淋巴结转移最低受累区域Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ的5年生存率分别为46．15％、46．88％、41．18％、0．00％、0．00％（P〈0．01）。结论舌癌颈淋巴结转移是影响患者生存的一个重要因素,且舌癌颈淋巴结转移最常见于Ⅰ、Ⅱ、Ⅲ区,临床颈淋巴结转移阴性（CN0）患者可选择包括Ⅰ、Ⅱ、Ⅲ区的区域性清扫,可有助于提高颈部控制率和改善患者生存质量。     

恶性淋巴瘤和头颈部鳞癌颈部受累淋巴结的CT与病理比较

目的 探讨增强CT对恶性淋巴瘤颈部淋巴结的诊断价值，并与鳞癌转移性淋巴结比较，以提高其诊断与鉴别诊断的准确性。方法 回顾性分析经组织学诊断的恶性淋巴瘤累及颈淋巴结者56例和鳞癌颈部淋巴结转移者66例的增强CT所见，并对两者进行比较。恶性淋巴瘤男44例，女12例；年龄9－75岁（中位年龄42岁）。鳞癌男51例，女15例，年龄16－76岁（中位年龄48岁）。将CT表现分为4型进行分析对比，Ⅰ型：密度均匀，强化程度近等于肌肉；Ⅱ型：不均匀强化结节，明显高于肌肉；Ⅲ型：边缘强化，中央低密度（明显低于肌肉）；Ⅳ型：薄环状强化，中央相对低密度（近于或略低于肌肉）。结果 恶性淋巴瘤颈部淋巴结增强CT表现多种多样，可多种表现并存（27/56,48.2%)。与转移性鳞癌相比，Ⅰ型、Ⅳ型几乎仅见于恶性淋巴瘤，出现率分别为83.9%(47/56)、26.8%(15/56)，鳞癌仅为3.0%(2/66)、1.5%(1/66)；而Ⅱ型多见于鳞癌转移，出现率为47.0%(31/66)，淋巴瘤仅为14.3%(8/56)；Ⅲ型二者均常见，淋巴瘤为37.5%(21/56)，鳞癌为78.8%(52/66)，更多见于鳞癌转移（P＜0.001)。结论 恶性淋巴瘤颈部淋巴结增强CT表现多种多样，多为双侧、多发、密度均匀近等于肌肉的淋巴结肿大，有或无强化的薄环状包膜；淋巴结呈厚薄不一的周边强化、中央低密度在未行治疗的淋巴瘤中亦非少见，应注意与转移性鳞癌鉴别。     

X线、CT诊断喉癌的临床价值

目的：探讨喉癌的X线与CT表现及其对喉癌诊断的临床价值。方法：对经手术和病理证实的20例喉癌作回顾性分析。结果：声门上癌8例，声门癌6例，跨声门癌6例，其中5例累及会厌前间隙和喉旁间隙，3例侵犯前联合，18例有颈淋巴结转移。结论：CT在诊断喉癌及其浸润范围上较准确，优于X线检查。     

常规超声特征联合增强CT检查甲状腺乳头状癌颈部淋巴结转移临床应用

目的 探讨常规超声特征联合增强CT检查甲状腺乳头状癌颈部淋巴结转移中的临床应用。方法 选取甲状腺乳头状癌患者60例，常规超声特征联合增强CT检查作为观察组，单纯CT检查作为CT对照组，单纯超声检查作为对照组，每组的患者均为20例，分析三种方法在甲状腺乳头状癌颈部淋巴结转移中影像表现特征。结果 观察组、CT对照组、对照组的Ⅰ区转移颈部淋巴结的诊断阳性率分别是83.76%、72.07%、72.87%。观察组的Ⅰ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。观察组、CT对照组、对照组的Ⅱ、Ⅲ、Ⅳ区转移颈部淋巴结的诊断阳性率分别是87.50%、70.55%、82.69%。观察组的Ⅱ、Ⅲ、Ⅳ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。观察组、CT对照组、对照组的Ⅴ、Ⅵ区转移颈部淋巴结的诊断阳性率分别是92.31%、72.00%、76.79%。观察组的Ⅴ、Ⅵ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。结论 常规超声特征联合增强CT可显著提高单项CT检查对甲状腺乳头状癌颈部淋巴结转移诊断的准确性。     

基于 RTOG 分区的颈部淋巴结转移CT 及 MR分析

目的：探讨颈部转移淋巴结分布与其原发肿瘤的相关性,以及其CT、MR影像表现特点,旨在提高病变诊断的准确率。方法搜集经手术或穿刺病理证实的126例原发肿瘤颈部转移淋巴结患者C T和（或）M RI资料,分析颈部转移淋巴结分布与其原发肿瘤的相关性,以及其影像学表现。结果多数头颈部原发肿瘤均可转移到Ⅱb区,Ⅱa区及Ⅲ区也是常见的转移部位。颈部转移淋巴结分布与其原发肿瘤的来源有较大的相关性。结论颈部转移淋巴结分布与其原发肿瘤的淋巴引流区域相关,颈部淋巴结RT OG分区对判断颈部淋巴结转移的原发肿瘤来源具有重要的价值。     

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.