125Ⅰ粒子近距离治疗前列腺癌临床应用

目的探讨经会阴超声引导放射性125Ⅰ粒子近距离治疗前列腺癌的近期疗效和并发症.方法32例前列腺癌患者实施经会阴超声引导放射性125Ⅰ粒子植入术,11例单纯粒子治疗,6例术前或术后配合外放疗.15例粒子植入术后加睾丸去势术.连续3次前列腺特异抗原(prostatespecific antigen,PSA)升高即为生物化学失败.结果14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为(52.14±54.61)ng/ml和(4.26±7.11)ng/ml,统计学处理差异有显著性(t=3.253,P=0.003),生物化学控制率为100%.12例去势术后复发患者125Ⅰ粒子植入治疗前和治疗后PSA分别为(15.14±20.80)ng/ml和(18.94±35.25)ng/ml(t=-0.307,P=0.764),统计学处理差异无显著性,生物化学控制率为75%.5例骨转移患者术前和术后PSA分别为(120.03±145.96)ng/ml和(75.53±84.84)ng/ml(t=0.527,P=0.621),统计学处理差异无显著性.125Ⅰ粒子单纯植入治疗34.62%患者无尿道副反应,Ⅰ～Ⅴ级尿道副反应发生率分别为38.46%、11.54%、11.54%、0和3.85%.125Ⅰ粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为16.67%、0、0和16.67%.Ⅰ级直肠副反应发生率为3.12%.3.12%患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺.结论超声引导经会阴放射性125Ⅰ粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

125I粒子近距离治疗前列腺癌临床应用

目的探讨经会阴超声引导放射性125Ⅰ粒子近距离治疗前列腺癌的近期疗效和并发症.方法32例前列腺癌患者实施经会阴超声引导放射性125Ⅰ粒子植入术,11例单纯粒子治疗,6例术前或术后配合外放疗.15例粒子植入术后加睾丸去势术.连续3次前列腺特异抗原(prostatespecific antigen,PSA)升高即为生物化学失败.结果14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为(52.14±54.61)ng/ml和(4.26±7.11)ng/ml,统计学处理差异有显著性(t=3.253,P=0.003),生物化学控制率为100%.12例去势术后复发患者125Ⅰ粒子植入治疗前和治疗后PSA分别为(15.14±20.80)ng/ml和(18.94±35.25)ng/ml(t=-0.307,P=0.764),统计学处理差异无显著性,生物化学控制率为75%.5例骨转移患者术前和术后PSA分别为(120.03±145.96)ng/ml和(75.53±84.84)ng/ml(t=0.527,P=0.621),统计学处理差异无显著性.125Ⅰ粒子单纯植入治疗34.62%患者无尿道副反应,Ⅰ～Ⅴ级尿道副反应发生率分别为38.46%、11.54%、11.54%、0和3.85%.125Ⅰ粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为16.67%、0、0和16.67%.Ⅰ级直肠副反应发生率为3.12%.3.12%患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺.结论超声引导经会阴放射性125Ⅰ粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

~(125)I粒子近距离治疗前列腺癌临床应用

目的　探讨经会阴超声引导放射性1 2 5I粒子近距离治疗前列腺癌的近期疗效和并发症。方法　 32例前列腺癌患者实施经会阴超声引导放射性1 2 5I粒子植入术 ,11例单纯粒子治疗 ,6例术前或术后配合外放疗。 15例粒子植入术后加睾丸去势术。连续 3次前列腺特异抗原 (prostatespecificantigen ,PSA)升高即为生物化学失败。结果　 14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为 (5 2 14± 5 4 6 1)ng ml和 (4 2 6± 7 11)ng ml,统计学处理差异有显著性 (t=3 2 5 3,P =0 0 0 3) ,生物化学控制率为 10 0 %。 12例去势术后复发患者1 2 5I粒子植入治疗前和治疗后PSA分别为 (15 14± 2 0 80 )ng ml和 (18 94± 35 2 5 )ng ml(t=- 0 30 7,P =0 76 4 ) ,统计学处理差异无显著性 ,生物化学控制率为 75 %。 5例骨转移患者术前和术后PSA分别为 (12 0 0 3± 14 5 96 )ng ml和(75 5 3± 84 84 )ng ml(t =0 5 2 7,P =0 6 2 1) ,统计学处理差异无显著性。1 2 5I粒子单纯植入治疗34 6 2 %患者无尿道副反应 ,Ⅰ～Ⅴ级尿道副反应发生率分别为 38 4 6 %、11 5 4 %、11 5 4 %、0和3 85 %。1 2 5I粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为 16 6 7%、0、0和 16 6 7%。Ⅰ级直肠副反应发生率为 3 12 %     

060经会阴植入125I粒子近距离治疗局限性前列腺癌

从1985～1996年,在阿姆斯特丹学术医疗中心,102例T1～T2N0期前列腺癌患者接受了经会阴植入125I粒子近距离治疗,其中T1c期4例,T2a期73例,T2b期25例.放疗前PSA平均17ng/ml.直肠超声引导下植入放射性粒子,前列腺平均容量31ml(15～48ml),平均植入49粒(29～74).前列腺周边剂量160Gy.直到1988年才有27例追加盆腔外照射40Gy,20d,2Gy/d.     

放射性125I粒子植入治疗头颈部肿瘤

目的 探讨超声或CT引导下放射性^125I粒子组织间植入治疗头颈部肿瘤的技术可行性和近期疗效。方法 40例头颈部癌和转移癌患者。4例采用全身麻醉，在CT引导下行^125I粒子植入术；36例采用局部麻醉，行超声引导下^125I粒子植入术。粒子针平行排列，间距1～1．5cm，原发肿瘤植入靶体积影像学边界外放lcm，转移瘤植入靶体积为影像学边界。粒子间距1cm。肿瘤周边匹配剂量（matched peripheral dose，MPD）90～145Gy，每颗粒子活度0．40～0．70mCi，每个病灶植入3～84颗粒子。5例患者术后1周加外放疗，每次200cGy，总剂量45～50Gy。术后24h拍头颈正侧位平片或CT，行质量验证。术后24～48h拍胸部x线片了解有无粒子移位或游走。结果 随访3～33月，10例舌癌3例完全缓解，3例部分缓解，3例稳定，1例进展；2例颈部淋巴结转移的患者经粒子治疗后完全缓解，局部控制率为60％，中位生存期11个月，1年和2年生存率分别为87．50％和35％。14例头颈部癌粒子治疗后，局部控制率为76．47％，中位生存期9个月，1年和2年生存率为66．08％和24％。16例头颈部转移癌粒子治疗后，局部控制率95．23％，中位生存期9个月，1年和2年生存率为54．55％和32．73％。没有1例发生严重的皮肤反应。结论 放射性^125I粒子粒子植入治疗头颈部癌疗效确切，尤其是为那些手术后或放疗复发患者提供了一种新的、可行的、安全和微创治疗手段。     

术中超声引导放射性125Ⅰ粒子植入治疗胰腺癌

目的探讨术中超声引导放射性^125I粒子组织间植入治疗胰腺癌的疗效。方法22例无法切除晚期胰腺癌患者11例先行胃肠或胆肠短路术，2例行支架植入术。术前根据CT扫描图像行治疗计划计算需要剂量、需要植入粒子活度和个数。^125I粒子活度为0．40～0．70mCi／颗，肿瘤匹配周边剂量（MPD）为65～145Gy。粒子针插植，间距1～1．5cm，边缘包括肿瘤外1～1．5cm。Mick枪植入^125I粒子。粒子间距1cm。5例患者术后4周加三维适形外放疗，2～3Gy／次，5次／周，总吸收剂量39～50Gy，1例加紫杉醇增敏，1次／周，60mg／次，共3次。5例患者术后加健择化疗2周期，每21天为1个周期。结果15例伴有上腹部疼痛患者，粒子治疗后有12例疼痛完全缓解，2例部分缓解，1例无明显缓解，有效率93．33％，平均显效时间2—3d。全组患者6例术后因复发而殛亡，复发率为27．27％。全组中位生存时间6个月，其中Ⅲ期中位生存时间8个月。50％患者死于远处转移。3例术后1个月复查时发现5颗粒子迁徙到肝脏。未见出血、感染、胰腺炎和胰瘘等并发症。结论放射性^125I粒子组织间植入治疗胰腺癌具有很好的姑息止疼疗效，部分局部晚期患者可获得长期生存，而且并发症发病率较低。     

经会阴植入~(125)I粒子近距离治疗局限性前列腺癌

从1985～1996年,在阿姆斯特丹学术医疗中心,102例T_1～T_2N_0期前列腺癌患者接受了经会阴植入~(125)I粒子近距离治疗,其中T_(1c)期4例,T_(2a)期73例,T_(2b)期25例。放疗前PSA平均17ng/ml。直肠超声引导下植入放射性粒子,前列腺平均容量31ml(15～48ml),平均植入49粒(29～74)。前列腺周边剂量160Gy。直到1988年才有27例追加盆腔外照射40Gy,20d,2Gy/d。结果:5年实际生存率77％,7年实际生存率63％。平均102个月。其中10人(9.5％)死于前列腺癌。5年、7年临床进展率分别为12％、17％。生化指标PSA显示5年、7年失败率分     

CT引导下125I粒子植入治疗复发性直肠癌的临床应用

目的探讨CT引导下^125I放射性粒子植入治疗胰腺癌技术的可行性和疗效。方法对40例不能手术切除的晚期胰腺癌患者作CT引导下植入^125I粒子治疗。术前采用治疗计划系统（TPS）重建胰腺肿瘤的三维立体图像,计算出植入的^125I粒子数目、空间分布和剂量分布率,在CT引导下将^125I粒子植入胰腺肿瘤内,采用^125I粒子活度为0．5～0．8mCi／颗,相隔1．0cm植入,避开血管和胰管等周围要脏器。放射性粒子的肿瘤匹配周边剂量（matched peripheral dose,MPD）为60～140Gy。中位植入粒子36颗（18～68颗）,术后即刻行CT扫描进行粒子质量验证。术后1周10例患者给予吉西他滨和5-Fu动脉灌注化疗,3～4个疗程。结果全组肿瘤平均直径为4．9cm。治疗后随访2～28个月,术后患者顽固性疼痛症状明显缓解（P〈0．05）,Karnofsky评分显著提高（P〈0．05）。平均术后2～5d疼痛开始缓解。术后2个月CT随访,肿瘤完全缓解（CR）3例,部分缓解（PR）20例,无变化（NC）14例,进展（PD）3例。总有效率（CR＋PR）为57．5％。全组中位生存时间为10．2个月。Ⅱ、Ⅲ、Ⅳ期粒了植入术后中位生存期分别为14．7、10．9及7．1个月;6个月和12个月累计生存率分别为100％、88％、62％和70％、41％、0。其中5例合并肝转移患者,则同时行动脉栓塞治疗。3例患者术后随访发现4颗粒了迁移到肝脏内。住随访过程中未见上消化道出血、胰腺炎、胰瘘及放射十牛肠炎等并发症。结论CT引导下植入^125I放射性粒子治疗胰腺癌,近期疗效确切,具有良好的止痛效果,是一种安全、有效、并发症发生率低的微创治疗方法,粒了治疗后联合化疗药物动脉灌注治疗,有望提高疗效,远期疗效尚待进一步随访和观察。     

125I粒子与缓释化疗粒子联合应用靶向治疗复发性直肠癌

目的 探讨应用放、化疗粒子联合植入法综合治疗复发性直肠癌的可行性、安全性及短期疗效。方法 自2001年12月至2005年12月,应用放、化疗粒子联合植入法综合治疗复发性直肠癌26例,均为直肠癌Mile＇s术后盆腔复发病人。在治疗计划指导下,交替植入氟尿嘧啶缓释化疗粒子和放射性125I粒子。放射性粒子的肿瘤匹配周边剂量（matched peripheral dose,MPD）为90～130Gy。平均每例使用^125Ⅰ粒子12粒,氟尿嘧啶600 mg。结果 26例病人手术均顺利完成,未发生出血、感染等并发症,经盆腔摄片证实放射性粒子的位置无变化。疼痛缓解率为88.9%（16/18）,平均疼痛缓解时间为5～10 d。于术后3～6个月CT复查肿瘤变化,提示瘤体不同程度缩小,其中2例完全缓解,19例部分缓解,4例稳定,局部控制率为81%。随访6～42个月,中位生存期为29个月,最长1例随访时间为术后42个月,现仍存活。1例术后6个月死于全身广泛转移。结论 放射性125I粒子和氟尿嘧啶缓释化疗粒子联合应用局部植入技术具有安全、微创及并发症发生率低的特点,是综合治疗复发性直肠癌较有效的手段之一。     

125I粒子植入联合内分泌治疗前列腺癌疗效观察

目的 回顾性分析¹²⁵I粒子植入联合内分泌治疗T₃N₀M₀期前列腺癌的疗效和不良反应。方法 临床分期为T₃N₀M₀前列腺癌患者22例,行经直肠超声引导¹²⁵I粒子植入联合内分泌治疗。靶区最小周边剂量为140~160 Gy,尿道剂量<400 Gy。中位粒子数74颗(26~90颗),中位粒子活度1.55×10⁷ Bq(1.30×10⁷~1.85×10⁷)Bq。11例行去势手术,11例行药物去势联合抗雄激素治疗。结果 22例患者均顺利完成粒子植入治疗。5年无生化失败生存率为70.6%,总生存率为81.8%。2例于粒子植入术后12个月出现生化失败,1例在术后90个月出现生化失败,重新给予内分泌治疗。粒子植入治疗后1级、2级尿道不良反应发生率分别为54.5%、9.1%,1级和2直肠不良反应发生率分别为22.7%和9.1%,1例出现4级直肠反应。结论 放射性¹²⁵I粒子植入联合内分泌治疗T₃N₀M₀期前列腺癌创伤小、疗效好,可以考虑应用于不愿接受外放疗的患者。     

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.