2619例中老年人群高血压患者脉压与心电图异常的关系

目的　探讨中老年人群高血压患者脉压与心电图异常的关系。方法　 2 6 19例中老年人年度健康体检 ,测血压和心电图检查 ,并对其中 75 1例高血压患者进行分析。结果　高血压病人群心电图异常率与非高血压人群比较有显著性差异 (P <0 0 1) ;高血压人群中心电图异常者脉压差大于心电图正常者 ,具有统计学意义 (P <0 0 5 ) ;不同脉压水平 ,随着脉压差的增加心电图异常、收缩压增长 (P <0 0 1～ 0 0 0 1) ,而舒张压增加不明显 ;随着年龄的增加收缩压增高 ,舒张压反而降低 ,脉压差增大 ,心电图异常率逐渐增加 (P <0 0 0 1)。结论　高血压人群脉压与心电图改变有关 ,脉压应作为评价高血压危险度和降压效果的重要指标。     

24小时平均脉压和诊所脉压对高血压病患者左室结构的影响

目的　探讨并比较 2 4h平均脉压和诊所脉压对高血压病患者左室结构的影响。方法　选择4 33名初诊的轻 -中度高血压病患者 ,所有入选病例测量非同日 3次诊所血压 ,进行 2 4h动态血压监测和超声心动图检查。①根据 2 4h平均脉压水平分为 4组 ,即A组 :2 4hPP <4 0mmHg ;B组 :4 0mmHg≤ 2 4hPP <5 0mmHg ;C组 :5 0mmHg≤ 2 4hPP <6 0mmHg ;D组 :2 4hPP≥ 6 0mmHg。②根据诊所脉压水平分为 4组 ,即A组 :CPP <4 0mmHg ;B组 :4 0mmHg≤CPP <5 0mmHg ;C组 :5 0mmHg≤CPP <6 0mmHg ;D组 :CPP≥6 0mmHg。③根据左室重量指数 (leftventricularmassindex ,LVMI)分为左室肥厚组和无左室肥厚组。结果　 2 4h收缩压、2 4h平均脉压、诊所收缩压和诊所脉压均与LVMI显著相关 (r =0 .339、0 .2 79、0 .2 2 1、0 .15 5 ,P <0 .0 1) ,并且 2 4h血压参数与LVMI的相关性明显强于诊所血压参数 ;收缩压和脉压均表现为左室肥厚组显著高于无左室肥厚组 (P <0 .0 0 1) ,而舒张压在各组之间无显著性差异 (P >0 .0 5 ) ;与左室结构正常组比较 ,向心性肥厚组的平均年龄最大 (5 3.3± 8.7比 4 8.1± 8.6 ,P <0 .0 0 1) ,而且高血压病史最长 (72 .4±10 7.8比 32 .1± 5 5 .2 ,P <0 .0 1)。结论　脉压升高是高血压病患者左室肥厚及左室结     

老年高血压病患者脉压与靶器官损害的关系

目的　近年来研究表明脉压 (PP)也是心脑血管疾病发生和死亡的独立危险因素 ,其预测价值甚至大于收缩压 (SBP)、舒张压 (DBP)及平均脉压 (MAP) ,而老年高血压患者中以脉压增宽多见 ,目前研究多以未服药治疗的老年单纯收缩期高血压病患者为研究对象 ,为此本研究目的在于药物规则治疗下老年高血压病患者PP与心脏、大血管及肾脏等靶器官损害的关系 ,为临床更好地控制血压 ,防治靶器官损害提供依据。方法　用 2 4h动态血压仪监测 2 6 3例老年高血压病患者全天平均脉压 (ABPP) ,多普勒超声检查颈动脉粥样斑块发生率 (CAPR)、颈总动脉分叉处内膜 -中膜厚度 (IMT)及内经 (CAD)、左室重量指数 (LVMI)、左室舒张早期充盈峰值流速与心房收缩期充盈峰值流速比值 (E/A值 )、射血分数 (EF) ,生化测定内生肌酐清除率 (CcR)及 2 4小时尿微量白蛋白排泄量 (MAU)。评价不同ABPP值对心脏、颈动脉、肾脏结构或功能的影响。结果　老年高血压病患者PP≥ 6 0mmHg与PP <6 0mmHg比较 ,E/A值、EF和CcR均下降 (P <0 .0 5 ) ,而LVMI、CAD、CAPR、IMT、MAU升高 (P <0 .0 5 )。结论　本研究表明脉压增宽可降低老年高血压病患者心脏的收缩和舒张功能 ,导致左室负荷增大 ,使心肌发生重构 ,室壁增厚。脉压增宽也使反映大动脉顺应性的颈动     

中老年高血压患者脉压与靶器官损伤的关系

 目的探讨高血压病的脉压与血压、血压变异及靶器官损害的关系.方法对206例年龄大于50岁的高血压病住院患者,经动态血压监测和超声心动图的检查以及临床资料,分别按脉压≥50mmHg和＜50 mmHg进行分组,比较二组之间的动态血压参数,并对伴和不伴心、脑、肾等靶器官损害组中脉压≥50mmHg比例进行比较.结果高脉压组收缩压水平、白天血压变异明显高于低脉压组,而舒张压水平、夜间血压变异二组之间无差异,在伴靶器官损害的116例病例中,脉压≥50mmHg者占68.9%,明显高于脉压＜50mmHg者所占比例,也高于无靶器官损害组,后者仅42.2%.结论(1)中老年高血压患者脉压主要与收缩压升高有关;(2)脉压高的中老年高血压患者白天血压变异大;(3)脉压高与靶器官损伤呈明显的相关,其相关性可能与血压变异增加有关.     

高血压病人脉压与心脏几何结构的关系

目的　探讨高血压病人脉压与心脏几何结构的关系。方法　对 395例高血压病人进行诊所血压和 2 4h动态血压监测 ,同时采用超声心动图测定心脏结构。结果　不同年龄组间诊所脉压的差异有统计学意义 (P <0 0 5 ) ,随着年龄的增大 ,脉压逐渐增大 ,且≥6 0岁组的脉压明显高于其他年龄组 ,差异有统计学意义 (P <0 0 5 )。“非杓型”病人各时段的收缩压 /舒张压 (SBP/DBP)、平均动脉压(MAP)均明显高于“杓型”血压者 (P <0 0 1或P <0 0 5 )。年龄越大 ,“非杓型”血压病人的比例越大 ,而“杓型”血压者的比例减少。随着年龄的增大 ,左室肥厚的检出率有增大的趋势 ;随着脉压的增大 ,左室重量指数 (LVMI)、左室舒张末内径 (LVIDD)及室间隔厚度 (IVST)均升高 ,≥ 6 0mmHg组明显高于 4 0～ 5 9mmHg组 (P <0 0 5 ) ,更高于 <4 0mmHg组(P <0 0 5 )。随着脉压的增大 ,左室重构、向心性肥厚及离心性肥厚的百分比相应增加 ,且向心性肥厚的比例增加更明显 (占 32 6 % )。结论　高血压病人脉压对左室几何构型存在重要的影响。     

~(99)Tc~m-MIBI门控心肌显像测定局部室壁收缩增厚率对冠心病的诊断价值

目的　探讨心肌局部室壁收缩增厚率 (STR)与心肌局部室壁运动状态和冠状动脉 (简称冠脉 )狭窄程度间的关系及其临床意义。方法　对 34例冠心病 (CAD)患者和 8例正常受检者行静息99Tcm 甲氧基异丁基异腈 (MIBI)门控心肌断层显像。根据冠脉和左室造影所得冠脉狭窄程度和运动状态分组。取收缩末期和舒张末期图像计算STR值。结果　对照组和CAD无室壁运动异常组与室壁运动减弱组、无室壁运动组及矛盾运动组之间的STR值差异均有显著性 (P <0 .0 1或P <0 .0 5 ) ;对照组与冠脉轻度、中度、重度狭窄节段之间STR差异均有显著性 (P <0 .0 1或P <0 .0 5 ) ,且STR与该节段供血冠脉狭窄程度呈负相关 (r =- 0 .74,P <0 .0 1)。STR判定室壁运动异常的灵敏度为77 9% ,特异性为 90 .9% ;判断冠脉中度以上狭窄 (冠脉狭窄 >5 0 % )和重度狭窄 (冠脉狭窄 >80 % )的灵敏度分别为 5 3.8%和 73.4% ,特异性分别为 93.1%和 88.9%。结论　STR可比较准确地反映心肌局部室壁运动状态及局部供血冠脉的狭窄程度     

脉压对高血压病心血管事件预测的临床价值

目的:探讨脉压(PP)与高血压病心血管事件发生的关联性.方法:107例发生心血管事件患者列入研究组.131例单纯高血压患者列入对照组,对比所有患者个人及家庭病史、饮酒吸烟、身高体重情况,检测患者血压、血糖、高密度脂蛋白胆固醇(HDL-C)、甘油三脂(TG)、血清总胆固醇(TC)和PP值.结果:两组患者在年龄、病程、SBP、DBP和PP方面经统计学比较具有显著差异(P<0.05);研究组PP值在(60～80)mmHg间的患者比例(51.40%)明显高于其它取值范围(7.48%,28.04%,13.08%),60 mmHg患者的心血管疾病发生率最低(P<0.05).结论:临床将PP控制在60 mmHg以下对高血压患者较安全.     

超声观察脉压对高血压患者颈总动脉的影响

目的 :探讨超声观察脉压 (pulsepressure ,PP)对高血压患者颈总动脉 (commoncarotidanery,CCA)的不同类型斑块的发生情况和物理性状影响的方法。方法 :用二维高频超声 (B modehighfrequencyultrasond ,B IFUS)和M型超声 (M modeul trasond ,M US)观察 6 0例正常对照人群和 1 72例高血压患者 (80例脉压 <6 0mmHg和 92例脉压≥ 6 0mmHg)颈总动脉的不同类型斑块的发生情况、内中膜厚度、收缩期管径 (systolicdiameter,Ds)、舒张期管径 (diastolicdiameter,Dd) ,结合血压 ,计算颈总动脉的动脉硬化指数 (arterialsclerosisindex ,ASI)、动脉可扩张度 (arterialexpandingdegree ,AED)和周向扩张率。结果 :低脉压组和正常对照组比较、高脉压组和低脉压组比较 ,斑块的检出率明显增加 (P <0 0 5 ,P <0 0 1 ) ,中内膜明显增厚 (P <0 0 5 ,P<0 0 1 ) ,内径明显增加 (P <0 0 5 ,P <0 0 5 ) ,动脉硬化指数明显增加 (P <0 0 1 ,P <0 0 1 ) ,动脉可扩张度明显下降 (P <0 0 1 ,P <0 0 1 ) ,周向扩张率明显下降 (P <0 0 5 ,P <0 0 1 )。结论 :超声可显示脉压与高血压患者颈总动脉变化的关系 ,从而为高血压的防治提供帮助。     

冠状动脉造影对心房颤动患者的冠心病诊断价值

目的　用冠状动脉造影比较心房颤动 (房颤 )患者冠心病诊断的准确性 ,提高房颤患者冠心病诊断水平及临床价值。方法　 87例房颤患者包括阵发性房颤 5 6例、持续性房颤 31例 ,均行 18导联心电图、冠脉造影检查。对比心电图有缺血型ST T改变的阵发性房颤与持续性房颤患者的冠脉病变。通过房颤患者冠脉狭窄的分布 ,评价两者冠心病的诊断价值。冠脉狭窄 >5 0 %诊断冠心病。结果　① 87例心电图有缺血型ST T改变 36例 ,其中 ,阵发性房颤 2 0例 (5 5 .6 % ) ,冠脉造影示冠脉有不同程度狭窄者 12例(6 0 % ) ;持续性房颤 16例 (4 4.4 % ) ,冠脉造影示不同程度冠脉狭窄者 13例 (81.3% )。②房颤患者的冠脉狭窄的分布 :阵发性房颤 5 6例中冠脉造影正常者 4 4例 (78.6 % ) ;粥样硬化 8例 ;轻度狭窄 2例 ;中度狭窄及完全闭塞各 1例 ,计 12例 (12 .4 % )。持续性房颤 31例中冠脉造影正常者 3例 (9.7% ) ,有 18例 (5 8.1% )冠脉造影有不同程度狭窄 (粥样硬化、轻度狭窄各 10例、中度狭窄 4例、完全闭塞 3例、重度狭窄 1例 )而且多为 2、3支血管病变 ,两组比较有差异非常显著 (P <0 .0 1)。③冠脉造影对房颤冠心病的诊断价值 :阵发性房颤 5 6例中确诊为冠心病者 4例 (7.1% ) ;持续性房颤 31例中确诊冠心病者 18例 (5 8.     

冠脉造影术中血压升高患者血管内皮功能与冠脉狭窄的相关性

目的:探讨冠脉造影术中血压升高的非高血压患者血管内皮功能的变化与冠脉狭窄的相关性。方法:选择990例疑诊冠心病的非高血压患者,将冠脉造影术中血压≥140/90mmHg者分为观察组,而血压<140/90mmHg为对照组,测定一氧化氮(NO)、肱动脉介导的血管内皮功能(FMD)及血管性假血友病因子(vWF)和单核细胞趋化蛋白-1(MCP-1)。结果:1观察组狭窄>50%者显著高于对照组,而对照组冠脉造影正常者显著高于观察组。2观察组NO、FMD显著低于对照组,而vWF和MCP-1显著高于对照组。3随访3年,观察组诊断高血压者显著高于对照组。结论:对于冠脉造影术中血压升高的非高血压患者,其冠状动脉狭窄与内皮功能障碍有关,此类患者发展为高血压的风险显著升高。     

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.     

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).     

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.     

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）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.