超声引导下射频消融甲状腺实性结节的临床应用价值

目的探讨超声引导下射频消融(RFA)甲状腺实性结节的方法、疗效及安全性。方法超声引导下对43例甲状腺结节患者58枚实性结节行射频消融治疗,术后采用常规超声及超声造影随访观察结节的大小、血供及并发症的发生情况。结果术后超声随访结节的体积较治疗前不同程度缩小(P<0.05),血流信号减少或消失,术后即刻超声造影显示53枚结节无增强,完全消融率为91.38%。术中难忍受的疼痛11例,放射性头痛3例,停止消融疼痛即可缓解。喉返神经损伤2例,经治疗声音恢复正常;1例术后即刻声音减低,未处理持续2h声音自行恢复。结论超声引导下射频消融治疗甲状腺实性结节效果显著,并发症少、安全性高、无手术疤痕,值得临床进一步推广应用。     

超声引导下行甲状腺囊实性结节热消融术的方法及疗效

目的 研究经超声引导下行甲状腺囊实性结节热消融术的疗效.方法 选取2017年4月至2018年6月在浙江省肿瘤医院就诊甲状腺结节患者65例,对共70枚囊性部分占40％～80％的甲状腺囊实混合性结节行超声引导下微波消融(MWA)或射频消融(RFA)术治疗.术后统计患者结节大小变化,计算手术前后结节体积,得出结节的体积缩小率...     

超声弹性成像应变率比值法在微波消融治疗甲状腺良性结节中应用

目的探讨超声弹性成像应变率比值法在微波消融(MA)治疗甲状腺良性结节中的应用价值。方法选取2017年8—12月于北部战区总医院行超声引导下MA治疗的19例甲状腺良性结节患者为研究对象。本组患者共41枚病灶,其中,结节性甲状腺肿38例、甲状腺腺瘤3例,于消融前、消融后1、3、6个月分别接受超声弹性成像应变率比值法(SR)诊断。观察消融效果,比较结节性甲状腺肿与甲状腺腺瘤病灶消融前后的甲状腺结节体积变化及SR值变化情况。结果 41枚甲状腺结节治疗后1、3、6个月治疗有效率分别为61. 0%(25/41)、90. 2%(37/41)及97. 6%(40/41),随着恢复时间的延长,治疗有效率显著增高,差异有统计学意义(P <0. 05)。术后1、3、6个月,结节性甲状腺肿及甲状腺腺瘤的体积缩小率逐渐增加,甲状腺腺瘤的结节体积逐渐减小,但差异无统计学意义(P> 0. 05);结节性甲状腺肿与甲状腺腺瘤体积缩小率比较,差异均无统计学意义(P> 0. 05)。在消融后1、3、6个月,结节性甲状腺肿与甲状腺腺瘤的SR值比较,差异无统计学意义(P>0. 05)。结论超声弹性成像SR技术可识别坏死后消融灶与周围正常组织的硬度差异,可评价甲状腺良性结节MA治疗后恢复的效果,对促进微波消融手术的发展具有一定意义。     

超声引导下射频消融治疗甲状腺峡部微小乳头状癌的安全性和有效性

目的 评估超声引导下射频消融(RFA)治疗甲状腺峡部微小乳头状癌(PTMC)的安全性和有效性.资料与方法 回顾性分析行RFA的65例PTMC患者的治疗结果,术前均获得明确病理结果,术后1、3、6、12、18个月行超声及超声造影(CEUS)随访,观察凝固性坏死区体积,计算体积缩小率(VRR).结果 术后1、3、6、12、...     

超声评价体系在良性甲状腺结节微波消融治疗中的应用价值研究

目的对不同超声特征的甲状腺结节微波消融治疗疗效进行分类总结,探讨超声评价体系在良性甲状腺结节微波消融治疗中的应用价值。方法随访观察207名良性甲状腺结节患者共351枚结节微波消融治疗术前及术后不同时段的超声特征:结节大小(最大径及体积),边界,类型,血流分级,弹性分级,应变率比值,是否合并钙化,分析以上超声特征在评价微波消融治疗良性甲状腺结节中的应用价值。结果结节的最大径及体积,血流分级,弹性分级,应变率比值等指标术后与术前比较均有显著统计学差异(P0.001)。术前最大径2cm(含)以下及体积4ml(含)以下,术前血流等级低的结节术后体积缩小更明显(P0.05),而结节的边界清晰与否,类型,有无钙化及弹性分级等超声指标组内比较,其术后1年的体积缩小率无显著统计学差异(P0.05)。结论结节的最大径、体积与血流分级是重要的术前评估指标。术前弹性分级可作为短期疗效评估的参考指标。超声评价体系在良性甲状腺结节微波消融治疗中术前临床评估,术后疗效评价及随访中有重要指导价值。     

超声引导下微波消融治疗压迫性甲状腺实性良性结节的近期疗效观察

目的探讨经超声引导下经皮微波消融术治疗压迫性甲状腺实性良性结节的近期疗效。方法回顾性分析2016年1月～2018年1月经穿刺活检证实为甲状腺实性良性结节的患者146例(最大直径均≥3cm),共163个病灶,所有患者均在超声引导下接受微波消融治疗,定期随访并记录术后的症状评分、美容评分及体积缩小率、甲状腺功能,观察术后并发症及残留情况。结果 146例共163个结节均成功完成微波消融治疗术。术后患者的症状评分、美容评分均显著下降,体积缩小率逐渐升高。术前与术后甲状腺功能指标无统计学意义(P0.05)。术后仅有1例出现疼痛,并于1周后出现声音嘶哑,未经特殊处理症状好转并恢复正常。结论超声引导下经皮微波消融术治疗压迫性甲状腺实性良性结节的近期疗效确切,安全性高、并发症少、症状问题得到明显改善,值得在临床应用中推广。     

超声造影与二维超声在微波消融乳腺良性结节的应用比较

目的比较超声造影(contrast-enhanced ultrasound, CEUS)和二维超声(two-dimensional ultrasound, 2DUS)在引导微波消融(microwave ablation, MWA)治疗乳腺良性结节中的应用价值。方法回顾性分析我院2016年1月～2018年3月经MWA治疗乳腺结节的患者60例。根据引导方式分为超声造影组(CEUS组)30例和二维超声组(2DUS组)30例。评估两组患者术中及术后1、6、12个月的疗效。结果术中,CEUS组发现8个结节需补充治疗,2DUS组41个结节被彻底消融。术后1个月,MRI显示CEUS组43个结节完全凝固坏死,2DUS组检测到5个结节需补充治疗。术后1、 6、12个月,CEUS组和2DUS组乳腺结节体积较治疗前均明显缩小(P0.05),且术后12个月,CEUS组的结节体积又明显小于同时期的2DUS组;术后6、12个月CEUS组的临床有效率明显高于同时期的2DUS组(P0.05)。结论 CEUS在MWA治疗乳腺良性结节中能精准确定病灶位置、大小及血流分布,准确评价消融效果及时补充治疗,完全消融乳腺结节。     

超声引导下热消融治疗甲状腺乳头状癌术后颈部转移性淋巴结的疗效分析

【摘要】 目的 研究超声引导下热消融治疗甲状腺乳头状癌术后复发性颈部转移性淋巴结的安全性及疗效。 方法 纳入曾行全甲状腺切除术的甲状腺乳头癌患者31例,共计62枚颈部转移性淋巴结（经细针穿刺细胞学证实）。热消融治疗包括射频消融28例（共计57枚淋巴结）及微波消融3例（共计5枚淋巴结）。31例患者于术前、术后行常规超声检查及超声造影检查。随访包括常规超声、超声造影、甲状腺功能及必要的细针穿刺细胞学检查。结果 31例患者均成功治愈,无明显并发症,热消融后超声造影显示消融淋巴结无增强。平均随访27（12,70）个月,无证据显示消融部位淋巴结复发。有3例患者出现消融部位以外的颈部淋巴结转移（经术后病理证实）。随访显示消融后淋巴结均出现体积收缩,其中9枚淋巴结完全消失,32枚淋巴结体积收缩50%及以上,21枚淋巴结收缩50%以下。在末次随访评估中,31例患者中19例的甲状腺球蛋白水平降低。结论 超声引导下热消融治疗甲状腺乳头状癌术后复发性颈部转移性淋巴结是一种安全、有效的治疗方法。     

多模态超声评价经皮微波消融治疗乳腺良性肿瘤的疗效

【摘要】 目的 利用多模态超声评估经皮穿刺微波消融（MWA）治疗乳腺良性肿瘤的疗效。方法 收集2018年1月到2020年1月青海省人民医院住院治疗的35例乳腺多发良性肿瘤患者病例信息，共计75个结节。患者全部接受超声引导下经皮MWA治疗，术前，术后3、6、12个月复查乳腺二维超声、超声造影、超声弹性成像，计算多模态超声下肿瘤直径、体积、缩小率及硬度变化，综合评价患者预后及复发等。结果 35例患者共计75个结节平均直径约（1.98±1.10） cm，均完成精准消融（完全消融率100%），平均消融治疗时间（35.3±21.1） min，平均住院时间（3+1） d，术前、后多模态超声下患者乳腺病灶直径、体积均较术前明显减小（P＜0.05）有统计学意义，随访期间结节缩小率减低（P＜0.05）有统计学意义，术后超声造影均无对比剂灌注，弹性成像显示结节硬度增加，随访期间硬度逐渐减低至结节消失，消融前后多模态超声图像对比评估，表明MWA均达彻底性，术后可出现疼痛及皮肤灼伤等并发症，经对症处理后恢复。结论 多模态超声评估经皮MWA治疗乳腺良性肿瘤的效果显著，多模态超声在介入治疗领域具有可靠的应用价值。     

超声引导下微波消融治疗甲状腺良性腺瘤的体积缩小率与消融时间的相关性研究

目的：探讨超声引导下甲状腺良性腺瘤微波消融治疗后体积缩小率与消融时间的相关性。方法：收集75例甲状腺良性结节微波消融患者，术后1、3、6个月及1年复查并记录消融区体积，计算相应体积缩小率，并分析体积缩小率与单位体积消融时间的相关性。结果：①根据疗效判定，分为治愈、有效、好转、无效4组，分别两两比较单位体积消融时间，除好转组与失败组外，其他各组之间差异均有统计学意义（均P<0.05）；②消融术后体积缩小率与单位体积消融时间呈负相关，随着消融时间缩短，结节体积缩小率增大。结论：超声引导下微波消融治疗甲状腺良性腺瘤疗效确切，并发症发生率低。在甲状腺良性腺瘤消融完全的情况下，有效控制消融时间，可提高肿瘤体积缩小率。     

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.