急性缺血性脑卒中支架取栓首次成功再灌注的影响因素分析

目的 探讨前循环急性缺血性脑卒中(AIS)患者支架取栓术首次成功再灌注(FPR)的影响因素.方法 回顾性分析2018年1月至2020年3月在南京医科大学第一附属医院接受Solitaire AB支架取栓治疗的前循环AIS患者临床资料.根据首次支架取栓后闭塞血管再通程度是否达到改良溶栓治疗脑梗死(mTICI)血流分级2c/...     

动脉溶栓与机械碎栓联合动脉溶栓的对比分析

目的 比较两种不同动脉溶栓方法治疗超早期脑梗死患者的疗效,探讨哪种方法更有益于开通血管.方法 收集2009年10月- 2011年5月55例脑梗死急性期并行超早期介入治疗患者,其中25例(联合治疗组)采用机械碎栓联合尿激酶进行动脉内溶栓治疗,30例(尿激酶组)采用尿激酶进行单纯动脉内溶栓治疗.术后观察患者闭塞血管再通和神经功能障碍恢复情况,并比较分析两种动脉溶栓方法的疗效.结果 联合治疗组患者血管再通23例,成功再通率为92%(23/25),尿激酶组患者则为18例,再通成功率仅为60%(18/30).术后平均NIHSS(脑卒中量表)及ADL(日常活动量表)评分联合治疗组(1 h 分别为8.6 ± 2.5和20.0 ± 4.6;24 h分别为9.0 ± 1.8和17.0 ± 2.5)改善程度明显优于尿激酶组(1 h分别为7.5 ± 2.0和28.0 ± 3.5;24 h分别为8.1 ± 2.0和24.0 ± 2.1),两组间差异有统计学意义(P ＜ 0.05).尿激酶用量及溶栓时间联合治疗组分别为(36.8 ± 8.4)万u和(35.3 ± 11.6)min,尿激酶组分别为(50.4 ± 15.3)万u和(55.7 ± 13.3)min,前者低于后者,两组间差异有统计学意义(P ＜ 0.05).结论 超早期应用动脉内机械碎栓联合动脉溶栓治疗急性脑梗死的疗效优于单纯动脉溶栓.     

急性缺血性卒中Solitaire AB支架取栓术后颅内出血并发症分析

目的 探讨急性缺血性卒中(AIS)患者接受Solitaire AB支架取栓术后颅内出血并发症的影响因素.方法 收集2015年6月至2016年10月采用Solitaire AB支架取栓术治疗的32例AIS患者临床资料.分析 取栓术后发生颅内出血性转化(HT)并发症患者基本资料,并与国内外相关研究进行对比分析.结果32例AIS患者取栓手术均成功,术后病死率为9.4％(3/32).3例术后发生症状性颅内HT,其中1例为前循环动脉闭塞,2例为后循环动脉闭塞,HT发生率为9.4％(3/32).2例保守治疗,1例行经脑室钻孔外引流并植入储液囊,最终2例因HT死亡,1例经保守治疗恢复良好.HT死亡患者占所有死亡患者比例为2/3.结论 颅内HT是AIS取栓手术致命性并发症.临床实践中应严格把握取栓手术适应证,术中精细操作,规范围术期管理,以降低出血并发症发生率.     

补救性支架植入治疗急性缺血性脑卒中13例北大核心CSCD

目的探讨支架植入作为补救性措施治疗急性缺血性脑卒中的有效性与安全性。方法回顾性分析13例大脑前循环大血管闭塞发病8 h内并接受补救性支架植入治疗的急性缺血性脑卒中患者临床资料。所有患者治疗前均经其它再通术式(静脉溶栓、动脉溶栓、Penumbra装置吸栓、Solitaire支架取栓)未果。根据脑梗死溶栓(TICI)治疗后血流分级评价血管再通,记录围手术期出血及梗死并发症。根据美国国立卫生研究院卒中量表(NIHSS)评分评价术后1周神经功能改善情况。根据改良Rankin量表(m RS)评分评价术后3个月预后指标。结果 13例接受补救性治疗患者共植入支架16枚,支架植入前采用Solitaire可回收支架取栓10例,Penumbra装置吸栓3例,经静脉尿激酶溶栓1例,经动脉尿激酶溶栓1例。12例(92.3%)患者闭塞血管部分或全部再通(TICI≥2B/3)。NIHSS评分由术前平均(16.15±5.81)分改善为术后1周平均(8.08±5.61)分,差异有统计学意义(P<0.05)。术后3个月,7例(53.8%)预后良好(m RS≤2),2例死亡。术后发生颅内出血2例,手术相关栓塞3例。结论颅内支架植入术作为不同组合药物溶栓治疗急性缺血性脑卒中患者血管再通的补救性措施,安全有效。     

不同卒中分型急性基底动脉闭塞机械取栓临床研究

【摘要】 目的 比较不同卒中分型急性基底动脉闭塞（BAO）患者机械取栓的临床疗效和安全性。 方法 回顾性纳入2017年4月至2019年4月在苏州大学附属第一医院总院接受机械取栓治疗的29例急性BAO患者。采用中间导管联合Solitaire FR支架行机械取栓,评价急性BAO机械取栓可行性、血管再通率、90 d预后良好率和手术相关并发症。结果 29例急性BAO患者中TOAST分型为心源性脑栓塞（CE）型19例（CE组）,大动脉粥样硬化性脑卒中（LAA）型9例（LAA组）,病因不明栓塞1例。26例（89.7%）闭塞血管成功再通（mTICI分级2b/3级）,其中CE组、LAA组分别为17例（89.5%）、8例（88.9%）（P＞0.05）,病因不明1例。CE组、LAA组患者发病至医院就诊时间分别为（203.6±99.2） min、（353.8±210.8） min（P＜0.05）,分别有2例、3例接受补救性支架植入（P＞0.05）,取栓次数分别为（1.6±0.9）次、（2.0±1.4）次（P＞0.05）。术后90 d预后良好率（改良Rankin量表评分≤2分）为48.3%（14/29）,其中CE组、LAA组分别为52.6%（10/19）、33.3%（3/9）（P＞0.05）,病因不明1例恢复良好。手术相关并发症包括异位栓塞、出血转化。 结论 机械取栓治疗急性BAO安全可行。CE患者和LAA患者90 d预后良好率无差异,但CE患者发病至医院就诊时间较短于LAA患者。     

Solitaire AB型支架用于急性脑动脉闭塞取栓术31例

目的探讨Solitaire AB型支架用于急性脑动脉闭塞动脉取栓术的效果及安全性。方法 2010年5月至2011年5月采用Solitaire AB型支架用于急性脑动脉闭塞的动脉取栓术,共31例,其中颈内动脉闭塞6例,大脑中动脉闭塞12例,基底动脉闭塞9例,合并大脑中动脉及基底动脉闭塞1例,颈内动脉末段合并大脑中动脉闭塞3例。回顾性分析其即时取栓效果,术后出血情况,并比较其随访90 d时的MRS评分情况。结果大脑中动脉和基底动脉闭塞患者均成功再通,颈内动脉有6例(6/9)获再通。12例患者因为再通后仍存在管腔狭窄而放置支架。术后颅内出血4例(12.9%),死亡8例(25.8%)。在死亡患者中,5例责任动脉在颈内动脉,3例在基底动脉。从发病到获得再通时间超过8 h者8例,其中死亡2例,均为颈内动脉闭塞患者。90 d随访患者中,出院MRS评分预后良好(<2)的有15例(48.4%)。结论用Solitaire AB型支架进行动脉取栓对于大脑中动脉及基底动脉闭塞患者能获得较高的再通率,改善临床结局,但对颈内动脉闭塞患者效果不理想,再通率低,死亡率高。     

静脉溶栓桥接Solitaire支架取栓治疗急性缺血性脑卒中的效果分析

目的探讨静脉溶栓桥接Solitaire支架取栓开通颅内闭塞大血管的疗效。 方法回顾我院2014年6月—2015年10月采用桥接模式接受血管内治疗的15例急性缺血性脑卒中患者资料。分析大血管开通情况,术中、术后并发症发生情况,早期神经功能改善情况以及随访90 d时mRS情况。 结果15例患者中,大脑中动脉闭塞9例,颈内动脉颅内段合并大脑中动脉闭塞2例,椎基底动脉系统闭塞4例。所有患者大血管均获得开通。2例患者出现颅内出血,1例为颞叶出血、1例为丘脑出血。死亡2例。入院NIHSS评分(14.83±5.65)与3天后NIHSS评分(6.82±5.53)比较,差异有统计学意义。90 d随访临床结果优良患者9例(mRS<2)。 结论静脉溶栓桥接Solitaire支架动脉取栓能使大血管获得较好的再通率,显著改善急性缺血性脑卒中患者的预后。     

CDT联合血管成形术治疗髂动脉闭塞症的研究

目的评价导管接触溶栓(catheter-directed thrombolysis,CDT)联合血管成形术在髂动脉闭塞症治疗中的疗效。方法选取髂动脉闭塞症患者58例,分为直接腔内治疗组(介入组) 28例和CDT联合血管成形术组(溶栓组) 30例。评估溶栓组CDT溶栓效果及安全性,观察两组术后有效性及安全性。对比观察支架植入率、随访期间术后通畅率。结果两组手术成功率100%,术后ABI均明显升高。介入组、溶栓组术后支架植入率分别为96.4%(27/28)、73.3%(22/30),支架平均长度分别为(11.7±1.2) cm、(7.6±2.9) cm,随访1年术后通畅率分别为78.6%、93.3%,两两比较P 0.05,差异有统计学意义。溶栓组溶栓后血管病变段长度明显缩短,溶栓总有效率93.33%,无严重出血事件发生。结论 CDT联合血管成形术在髂动脉闭塞症治疗中具有显著的减容作用、减少支架的植入,提高术后通畅率。     

机械性血管再通治疗超时间窗急性缺血性脑卒中患者11例

目的 探讨影像导引下机械性血管再通治疗超时间窗急性缺血性脑卒中患者的安全性和有效性.方法 收集2013年3月至2014年10月接受机械性血管再通治疗的急性缺血性脑卒中连续患者共91例,其中超时间窗并影像学检查显示有缺血半暗带患者11例(男9例,女2例;中位年龄59岁).观察11例患者术前、术后30 d美国国立卫生研究院卒中量表(NIHSS)评分变化,根据改良Rankin量表(mRS)评分评估术后90 d患者临床结果.结果 11例患者4条大脑中动脉、3条颈内动脉、4条椎基底动脉接受机械性血管再通治疗(单纯支架成形术10例,机械取栓联合支架成形术1例),血管再通治疗成功率为90.9％(10/11),术后30 d内再闭塞率为9.1％(1/11).术后90 d中位NIHSS评分为4分(0～12分),与术前中位评分11分(4～35分)相比均明显好转(P＜0.05);mRS评分0～2分患者由术前0例改善为术后90 d7例(63.6％,7/11).结论 影像导引下机械性血管再通治疗超时间窗急性缺血性脑卒中患者是安全有效的.     

颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例北大核心CSCD

目的探讨Penumbra抽吸系统联合Trevo取栓器治疗颅内大动脉急性闭塞的临床效果。方法收集2016年11月至12月采用ACETM取栓器联合Trevo可视性取栓支架机械取栓治疗的5例颅内大动脉急性梗死患者临床资料。其中前循环闭塞2例,后循环闭塞3例;平均(60.4±11.6)岁。术后观察患者取栓时间、闭塞血管再通和神经功能恢复情况。结果 5例患者穿刺-血管再通时间分别为29 min、32 min、35 min、33 min、30 min,平均(31.8±2.4)min;术中脑梗死溶栓(TICI)治疗后血流分级均达到3级;NIHSS评分由术前(11.0±7.4)分明显改善至术后24 h(4.2±1.1)分、7 d(1.8±1.3)分、30 d(0.9±0.6)分(P<0.05);改良Rankin量表(m RS)评分均为0~2分,且未发生颅内出血转化。结论 ACETM取栓器联合Trevo取栓支架机械取栓治疗颅内大动脉急性梗死,在取栓次数少、取栓时间短情况下,取得了最佳血管再通效果,临床预后良好。     

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.