镍钛记忆合金气管支架治疗恶性气道狭窄

目的探讨气管支架置入术治疗恶性气管狭窄的方法及疗效。方法17例气道狭窄的患者采用气管支架置入治疗,13例支架放置后给予化学治疗配以放射治疗。结果17例气管、主支气管狭窄的患者放置18只支架,成功率100%。支架放置后所有患者呼吸困难即刻缓解,无术中并发症。随访1~11个月,支架无再狭窄及移位,12例于随访期间死亡,平均生存期3.5个月。结论镍钛记忆合金气管支架治疗恶性气道狭窄是一种安全、有效、简单快速的方法。     

内支架在气道狭窄中的临床应用

目的探讨内支架在气道狭窄中临床应用的价值。方法采用支架输送器经鼻腔放置记忆镍钛合金支架41例,1例经PTA球囊导管预扩张后放置。结果42例中放置气管支架24例,支气管支架11例,气管、支气管均放置支架7例,放置成功后,均立即解除了呼吸困难的症状,随访3～43个月,生存者支架无移位,呼吸通畅。结论采用输送器放置内支架治疗气道狭窄是一种安全有效的方法。     

国产镍钛支架治疗气道狭窄

目的　评价国产镍钛合金气管支架治疗气管支气管良恶性狭窄的疗效。方法　气管、支气管良恶性狭窄 13例。狭窄部位 :气管 5例、气管主支气管 6例 ,主支气管 2例。经纤支镜和X线合用共放置 15枚支架。结果　全部支架均放置成功 ,呼吸困难改善 ,死亡病例平均存活时间 11.4个月 ,1例仍存活。结论　经纤支镜和X线合用 ,植入国产镍钛合金支架是治疗气管支气管良恶性狭窄的有效方法     

纤支镜和X线联合导向下镍钛合金支架治疗重症恶性气道狭窄

目的评估纤支镜和X线联合导向下放置国产镍钛记忆合金支架治疗重症恶性气道狭窄的安全性及价值。方法12例重症恶性气道狭窄患者,气促评分3级3例,4级9例,在纤支镜和X线联合导向下放置国产镍钛记忆合金支架。结果放置1枚支架者11例,1例放置2枚支架。气促评分5例降为0级,7例降为1级,无严重并发症发生。术后3例接受放疗加静脉化疗,5例单纯放疗,1例单纯静脉化疗。随访1月~4年,除2例再次气道阻塞死亡外余未再出现呼吸困难。结论经纤支镜和X线联合导向下放置镍钛记忆合金支架具有操作简便、迅速、安全的特点,是治疗重症恶性气道狭窄的理想方法。     

全麻下单导丝引导Y型气道支架置入术治疗复杂气管疾病6例

目的：探讨在全身麻醉下采用单导丝引导Y型气道支架置入的方法和临床应用。方法接受气道Y型支架治疗复杂气管疾病患者6例,其中气管胸膜瘘1例,食管－气管瘘2例,气道复合型狭窄3例。全身麻醉后在DSA监视下对6例患者置入气道Y型支架。结果6例患者共置入Y型气道支架6枚,均为单导丝引导置入,其中1例支架右侧分支误入右肺上叶支气管内,余5例支架置入均一次获得成功。结论全麻下Y型气道支架置入术能有效封堵支气管残端胸膜瘘、左主支气管食管瘘,能快速有效解除气管隆突区复合性气道狭窄,近期疗效显著,手术安全、可靠,单导丝引导置入技术操作相对于双导丝引导置入技术操作简单、快速有效、值得推广应用。     

金属支架治疗大气道狭窄

目的　探讨气管支架成形术缓解大气道狭窄的方法、安全性和疗效。资料与方法　气管狭窄患者 32例 ,其中气管切开或插管后局部组织过度增生 7例 ,转移性肿瘤压迫气管 12例 ,多发性软骨炎引起气管塌陷 1例 ,肺癌 12例 ;单纯气管狭窄 2 8例 ,主支气管狭窄 1例 ,气管支气管同时有狭窄者 3例。术前均经CT检查及气管体层片证实气管、支气管狭窄。 13例术前用的卡因喷喉麻醉 ,19例在全身麻醉下置入支架。结果　 32例共放置 37枚气管支架 ,均一次置入成功 ,无操作失败 ,通气全部得到改善 ,手术成功率 10 0 %。 2例气管狭窄经置入支架后复发狭窄再次置入支架。 33枚置于气管 ,4枚置于主支气管。 1例狭窄严重仅容 4F导管通过 ,用球囊导管扩张至 12mm后置入支架 ;其余均直接置入支架。术后通气功能明显改善 ,无需吸氧 ,无明显胸痛、咯血等并发症。 1周后X线复查无支架移位 ,可见支架进一步扩张。 1例甲状腺癌支架置入术后 2周复发呼吸困难 ,CT扫描示支架内有新生物 ,经支架内放射治疗后症状消失。结论　气管内支架成形术方法简单、安全 ,缓解呼吸困难疗效迅速、确实 ,适合良恶性气道狭窄姑息治疗     

气管支架置入术治疗气管狭窄的护理体会

各种原因造成的气管、支气管重度狭窄及气管、支气管瘘，不能手术治疗的，通常放置气管内支架以解除气道狭窄，保持呼吸道通畅，改善通气状况，封闭瘘口等，提高患者的生活质量。气管狭窄的患者多病情危重，因此，护理工作对于手术的成功起到重要的作用。现结合我院收治的气管狭窄患者，总结护理体会如下。     

球囊扩张及内支架成形术治疗气管良恶性狭窄的临床应用

目的 评价X线监视下内支架成形术和球囊扩张术治疗良恶性气管狭窄的临床意义.方法 回顾分析45例气道狭窄患者,其中恶性气管狭窄37例,包括纵隔淋巴结转移14例、食管癌13例、肺癌4例、支气管腺癌3例、淋巴瘤2例、喉癌1例;良性气管狭窄8例,包括支气管内膜结核6例、胸骨后甲状腺腺瘤1例、气管插管后1例.对其中38例患者行气道内支架成形术,7例患者行球囊扩张术.所有操作均在X线透视下完成.结果 38例患者共放置53枚支架,除1例死于痰液窒息外,其他患者术后临床症状均即刻缓解,随访无支架移位;4例患者发生再狭窄,分别行再次内支架成形术和球囊扩张术.7例患者共行19次球囊扩张术,术后症状明显缓解,无复发.平均随访24.5个月(0～124个月),31例因疾病死亡,无与支架或球囊扩张相关死亡病例.结论 X线透视下行内支架成形术和球囊扩张术是治疗良恶性气管狭窄的安全、快速、有效方法.     

气管支架的临床应用

目的将气管支架应用于临床,治疗气管内外肿瘤或其他原因造成的气道狭窄,保持呼吸道通畅。方法采用部分覆以硅橡胶薄膜的不锈钢“Ｚ”形支架,运用带有导引鞘管的输送器放置支架。结果１９例均放置成功,立即解除了呼吸困难的症状,并阻挡癌肿向腔内生长,随访观察２～１０个月,生存者支架无移位,气道通畅。结论采用气管支架治疗气道狭窄是十分有效的方法     

气管支架置入术治疗重症气道狭窄的疗效与经验

目的总结气管支架置入术治疗重症气道狭窄的疗效和经验。方法各种原因引起的气管和主支气管狭窄患者13例。术前常规行高千伏胸部X线摄片和CT检查以了解气道狭窄的部位、形态和范围。狭窄段位于气管10例、右侧主支气管1例、左主支气管2例。在透视下将多功能导管配合超滑导丝经过声门进入气管,随后更换金属加强导丝并随导管越过狭窄段,将导丝留置于狭窄段远端,撤除导管,将装有支架的置入器沿导丝送至狭窄段,释放支架。结果全部支架均成功置入,技术成功率100%。术后所有患者呼吸困难症状明显改善,恶性肿瘤患者平均存活时间为6.2个月,1例良性气管狭窄患者随访5年仍无再狭窄。结论气管支架置入术是治疗重症气道狭窄的有效方法。     

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.