合并肝静脉阻塞Budd－Chiari综合征的介入治疗研究

目的：根据合并肝静脉阻塞Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的血液动力学特征，研究该型Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的介入治疗方法。材料与方法：本组４例，临床主要症状为腹胀，肝肿大，胸腹壁静脉曲张，２例继发门脉高压。诊断经彩超、下腔静脉及肝静脉造影确诊。应用经颈静脉肝内门体静脉分流术Ｒｕｐｓ－１００肝穿装置行肝静脉开通术及ＰＴＡ。结果：４例肝静脉开通术及ＰＴＡ均获成功，３例为右肝静脉，１例为左肝静脉。肝静脉压力由术前的２．６７±０．４０ｋＰａ降至术后的１．２５±０．４０ｋＰａ。术后随访２０天～３个月，患者一般情况良好，未见术前症状复发。结论：对合并肝静脉阻塞的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征进行介入治疗，重要的是开通阻塞的肝静脉，解除因肝静脉回流受阻所至的淤血性肝硬化门脉高压，临床效果好。对合并下腔静脉阻塞侧枝循环建立好的，下腔静脉可不进行处理     

HAPC患者红细胞2,3—二磷酸甘油酸的变化和红细胞ATP酶的活性

目的：了解红细胞２，３－二磷酸甘油酸、红细胞膜ＡＴＰ酶在高原红细胞增多症（ＨＡＰＣ）的变化及二者关系。方法：ＨＡＰＣ患者２４例，正常对照１９例，分别测定红细胞２，３－二磷酸甘油酸，红细胞膜ＡＴＰ酶（Ｎａ＋－Ｋ＋－ＡＴＰ酶，Ｃａ２＋－Ｍｇ２＋－ＡＴＰ酶活性。结果：ＨＡＰＣ组及对照组红细胞２，３－二磷酸甘油分别为：３．２１ｍｍｏｌ／Ｌ±０．１３ｍｍｏｌ／Ｌ，４．８７ｍｍｏｌ／Ｌ±０．０７ｍｍｏｌ／Ｌ，（Ｐ＜０．０５）；Ｎａ＋－Ｋ＋－ＡＴＰ酶活性分别为：４．１±０．０１３λΒ／μｍｏｌ·ｈ－１·ｇ－１，７．４±０．１９λΒ／μｍｏｌ·ｈ－１·ｇ－１（Ｐ＜０．０１）；Ｃａ２＋－Ｍｇ２＋－ＡＴＰ酶活性分别为１５．１±１．７０λΒ／μｍｏｌ·ｈ－１·ｇ－１，２５．３±２．３１λΒμｍｏｌ·ｈ－１·ｇ－１（Ｐ＜０．０１）；相关分析显示：２，３－二磷酸甘油酸与Ｎａ＋－Ｋ＋－ＡＴＰ酶呈正相关（ｒ＋０．４８１７，Ｐ＜０．０１）与Ｃａ２＋－Ｍｇ２＋－ＡＴＰ酶呈正相关（ｒ＝０．４７８３，Ｐ＜０．０１）。结论：ＨＡＰＣ患者红细胞２，３－二磷酸甘油酸的减少，红细胞膜ＡＴＰ酶活力降低，反映机体缺氧状况，体细胞代谢异常     

神经节苷酯对低氧大鼠脑钙,钙调素及蛋白激酶Ⅱ的影响

观察了神经节苷酯对急性低氧组大鼠（Ａ组：模拟海拔７００ｍ，５ｈ；Ｂ组：给神经节苷酯）和常氧对照组大鼠（Ｃ组：常氧；Ｄ组：给神经节苷酯）脑组织Ｃａ￣（２＋）、钙调素（ＣａＭ）及ＣａＭ依赖性蛋白激酶Ⅱ（ＣａＭＰＫⅡ）活性的影响。用Ｆｕｒａ－２测得Ｃａ￣（２＋）水平分别为７２２．１±８１．２．６４０．６±７４．４、２５８。７±３９．２和２６３．８±４１．３ｎｍｏｌ／Ｌ，Ａ组明显高于常氧对照组（Ｐ＜０．０１）；Ｂ组明显低于Ａ组（Ｐ＜＜０．０５）。用流式细胞仪（ＦＡＣＳ）所测ＣａＭ平均荧光强度分别为４０．２±４．７、４４．３±４．８．４６．１±５．１和４５．９±５．０道；Ａ组明显低于常氧对照组。用同位素（ｒ￣（３２）－ＡＴＰ）液闪计数法所测ＣａＭＰＫⅡ活性分别为１８２．９±７．９、１９２．３±８．２、１９７．９±９．２和１９８．２±９．３ｐｍｏｌｐｉ．ｍｉｎ￣（－１）ｍｇ￣（－１）ｐｒｏｔｅｉｎ，Ａ组明显低于其它三组，急性低氧Ｂ组与常氧对照组比无明显差别。表明，低氧时神经节苷酯可以减少胞内Ｃａ￣（２＋）蓄积和稳定ＣａＭ和ＣａＭＫｉｎａｓｅⅡ的变化．     

^99mTc—ECD SPECT断层影像采血法和非采血法定量测定rCBF和C …

目的：应用＾９９ｍＴｃ－ＥＣＤ ＳＰＥＣＴ断层影像采血和非采血法定量测定ｒＣＢＦ和ＣＢＦ。材料和方法。正常对照组１５例,疾病组１０例;采血法用动脉化静脉血样求得血中＾９９ｍＴｃ－ＥＣＤ的浓度。非采血法用头颈平面像求得血中＾９９ｍＴｃ－ＥＣＤ浓度。结果;正常对照组采血法ｒＣＢＦ２５．０±４．０－５９．１±７．６１ｍｌ．ｍｉｎ＾－１．（１００ｇ）＾－１,ＣＢＦ４３．０±３．６ｍｌ．ｍｉｎ＾－１．（１０     

布洛芬控速－缓释制剂在肝功损害患者体内药动学研究

本文报告用改进的高效液相色谱法测定７名肝功损害患者自身交叉口服布洛芬混悬液及布洛芬控速──缓释制剂后的血药浓度，并计算药动学参数和相对生物利用度。布洛芬控速──缓释制剂体内表现为一级吸收的二室开放模型，其主要药动学参数为：ａ＝０．６７±０．１１ｈｒ－１，β＝０．０９１±０．０１ｈｒ－１，ｋ２１＝０．３４±０．０９ｈｒ－１，Ｋ１０＝０．１８±０．０３ｈｒ－１，Ｋ１２＝０．２３±０．０５ｈｒ－１，ｔ１／２（α）＝１．０６±０．１７ｈｒ，ｔ１／２（β）＝７．７４±０．７ｈｒ，Ｖβ＝２３．８±４．０Ｌ，ＡＵＣ＝１９０．６±２４．９ｕｇ·ｈｉｍｌ－１相对生物利用度Ｆ＝０．９７。     

Budd-Chiari综合征血管内支架治疗

目的：研究完全闭塞型及合并肝静脉病变的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征介入治疗方法和支架移位的防治。方法：１２例Ｂｕｄｄ－Ｃｈｉａｉｒ综合征，膜性狭窄７例，节段性病变５例，术前下腔静脉内径平均０．５６ｍｍ，平均静脉压３．２０±０．４６ｋＰａ。在球囊扩张的基础上置入了血管内支架。结果：技术操作全部成功，无严重并发症发生。临床症状及体征明显好转，治疗后下腔静脉直径平均达１９．８０ｍｍ，平均静脉压１．５０±０．４０ｋＰａ。经２－２３个月（平均１１．５个月）的随访，除１例因支架移位引起再狭窄外，其余下腔静脉血流均通畅，未出现再狭窄。结论：Ｂｕｄｄ－Ｃｈｉａｒｉ综合征血管内支架治疗，近期及中期疗效显著，是理想的治疗方法。     

氩激光小梁成形术治疗开角型青光眼

目的：介绍氩激光小梁成表术治疗开角型青光眼的方法与结果，方法；对１２例１９眼开角型青光眼包括原发开角型青光眼１１例，（其中外经流术后复发２例２眼）房角后退继发青光眼１例１眼行氩激光小梁成形术（ＡＬＴ），结果：治前眼压，３１．２１±２．２０ｍｍｇ，Ｃ值，０．１３±０．０２；治后经８～１８个月随诊眼压；１８．４２±４．１３ｍｍｇＣ值：０．１９±０．０３，统计学处理有显著意义，治疗前，后视力，视野对比无     

TIPSS治疗肝硬化门脉高压的应用研究

笔者报告了自１９９２年６月以来，应用ＴＩＰＳＳ治疗６２例肝硬化门脉高压（ＣＰＨ）的研究结果。６２例中，肝炎后ＣＰＨ３３例；酒精性ＣＰＨ３例；Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）４例，其余为原因不明者。在ＴＩＰＳＳ获得成功的６０例（９７％）中，应用国产Ｚ－ｓｔｅｎｔ者４６例。其中，并用食管胃底静脉硬化栓塞术（８ＥＥＶ）者３１例。ＴＩＰＳＳ后，门脉压平均下降１．３２±０．５１ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ＿２Ｏ）。病人的主要症状、体征得到有效控制或／和明显改善。未发生与技术操作有关的严重并发症。但出现肝性脑病者８例（１４％），术后经１～２５个月（平均９个月）的随访观察，肝内分流道发生阻塞者９例（１５％），７例获得再通。术后１～２０个月内死亡１０例。其中，３０天内死亡４例。笔者认为：（１）ＴＩＰＳＳ作为ＣＰＨ治疗的一个安全有效的新方法，既可作为应急性抢救措施，也可作为预防性治疗手段；其治疗对象既可以是酒精性ＣＰＨ，也可以是肝炎后ＣＰＨ及ＢＣＳ所致的瘀血性ＣＰＨ；（２）在实施限制性ＴＩＰＳＳ时，应把ＳＥＥＶ作为一个重要步骤。（３）与一般Ｚ－ｓｔｅｎｔ相比，螺旋式Ｚ－ｓｔｅｎｔ更适于在ＴＩＰＳＳ中应用。     

下体负压致兔意识丧失的监测

目的用下体负压（ＬＢＮＰ）技术建立兔意识丧失（ＬＯＣ）的模型，旨在找出一些切实可行的ＬＯＣ监测指标。方法按阶梯下降的方法，将８只兔暴露于不同的负压值下（－１．３３ｋＰａ、－２．６７ｋＰａ、－４．００ｋＰａ、－５．３３ｋＰａ和－６．６７ｋＰａ），每种负压值持续作用１ｍｉｎ，观察兔发生ＬＯＣ的动态过程，并记录有关生理指标。结果ＬＢＮＰ可致兔发生ＬＯＣ、ＥＥＧ拉平，但滞后于颈总动脉血流量（ＣＢＦ）降到零后３９．７５±６．４０ｓ；ＣＢＦ与动脉血压的变化关系密切（ｒ＝０．９７１，Ｐ＜０．０１），其直线回归方程为Ｑ＝１．４０ＢＰ－４．７２（Ｑ为ＣＢＦ，Ｑ＝０时，ＢＰ＝３．３７ｋＰａ）。结论可选用ＣＢＦ降为零作为发生ＬＯＣ的监测指标；以ＥＥＧ拉平作为监测指标，会夸大ＬＯＣ的病理损害性；离心机实验时，眼水平动脉血压降为０ｋＰａ似乎可代替ＣＢＦ作为ＬＯＣ的监测指标。     

优秀运动员的营养状况和改善途径

为了解我国优秀运动员当前的营养问题，我们于１９８７年和１９８９年冬训期间对国家集训队１１个项目的４３６名运动员进行了营养生化检测和评定，取得了４０００多个数据，主要结果如下：１．运动员的血红蛋白水平；男女分别是１５．２±０．８和１４．０±０．９ｇ／ｄＬ。血清总蛋白含量：男女分别为７．１±０．６和７．０±０．４ｇ／ｄＬ。运动员的贫血和低蛋白血症的检出率显著减少。运动员的蛋白质营养状况显著改善。２．运动员血清总胆固醇水平：男、女分别是２０２±３２和２０１±３０ｍｇ／ｄＬ，甘油三酯分别是８７．４±１４．２和８８．５±１３．４ｍｇ／ｄＬ。高血清胆固醇的检出率分别为３９．７％（＞２００ｍｇ／ｄＬ）、１９．４％（＞２２０ｍｇ／ｄＬ）和８．７％（＞２４０ｍｇ／ｄＬ）。血清甘油三酯＞１２０ｍｇ／ｄＬ者有８．８％。３．运动员中血清镁浓度低于２ｍｇ／ｄＬ的人数占检测总人数的４．４％，而且低血清镁者多数为游泳运动员。低血清锌和铜的检出率为１５－２０％。运动员中维生素Ｂ１和Ｂ２营养处于不足水平者分别占５１．３％和３２．２％。血清维生素Ａ不足的有２１％。维生素Ｃ营养良好。运动员的元素或维生素不足多数为边缘性（或亚临床）的缺乏水平。４?     

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.