前瞻性心电门控技术在诊断先天性冠状动脉变异中的应用

目的:探讨64排128层CT前瞻性心电门控技术在诊断先天性冠状动脉变异中的应用。方法:收集60例心率70次/min的先天性冠状动脉变异患者,分为前瞻性心电门控组(观察组)和回顾性心电门控组(对照组),比较2组的成像质量和辐射剂量。结果:心率70次/min时,前瞻性心电门控组和回顾性心电门控组图像质量差异无统计学意义(χ2=0.001,P0.05)。二者的有效辐射剂量分别为(3.85±0.35)mSv、(8.79±0.72)mSv(t=-43.34,P0.05)。结论:64排128层CT前瞻性心电门控技术较回顾性心电门控技术辐射剂量显著降低,在患者心率70次/min时,图像质量较好,对冠状动脉变异的诊断具有较好的临床应用价值。     

256层CT前瞻与回顾性心电门控冠状动脉成像的应用研究

目的 通过256层CT前瞻性心电门控与回顾性心电门控冠状动脉成像的辐射剂量和成像质量等比较,探讨前瞻性心电门控CT冠状动脉成像的可行性.资料与方法 拟诊冠状动脉粥样硬化性心脏病(CHD)两组患者分别进行前瞻性和回顾性心电门控扫描,并采用最大密度投影(MIP)、容积再现(VR)、多平面重组(MPR)及曲面重组(CPR)多种重组技术显示各节段冠状动脉,图像质量根据对诊断影响分为优、良、差,并计算各自有效辐射剂量,进行统计学分析.结果 前瞻性组平均辐射剂量为(2.11±0.48)mSv,明显低于回顾性组的(9.15±1.59)mSv(P<0.01);前瞻性组冠状动脉节段图像质量优良及差者分别占96.7%(1259/1302)和3.3%(43/1302),与回顾性组的96.3%(1339/1390)和3.7%(51/1390)比较,差异无统计学意义.结论 256层CT前瞻性心电门控冠状动脉成像能以较低的辐射剂量取得优质图像,更适合CHD患者的早期筛查.     

256层CT前瞻性及回顾性心电门控冠状动脉成像质量和辐射剂量的初探

目的运用前瞻性心电门控与回顾性心电门控两种方法行冠状动脉CT成像,比较两者的成像质量与辐射剂量。资料与方法 70例疑似冠状动脉疾病的患者随机分为两组,前瞻性心电门控组和回顾性心电门控组,每组35例,两组心率均<70次/min,记录两组的成像质量和辐射剂量。结果前瞻性心电门控和回顾性心电门控两组冠状动脉成像质量评价差异无统计学意义(P>0.05);两组的有效剂量分别为(2.5±0.7)mSv和(9.6±1.7)mSv,差异有统计学意义(P<0.001),平均ED前瞻性心电门控组较回顾性心电门控组低74.4%。结论心率在一定范围内(﹤70次/min),256层前瞻性心电门控技术能够获得满足临床诊断需要的冠状动脉CTA图像,并有效地降低了辐射剂量。     

前瞻性心电门控技术在双源CT冠状动脉成像中的应用价值

目的:比较双源CT冠状动脉成像(CTCA)前瞻性心电门控与回顾性心电门控扫描的辐射剂量及图像质量。方法:以相同纳入标准,选取50例行前瞻性心电门控扫描的患者作为前瞻门控组,另选取50例行回顾性心电门控的患者作为回顾门控组。由两名CT医师分别对两组CTCA图像进行评估。记录并比较两组患者一般临床资料、辐射剂量及图像质量评分。结果:两组患者性别、年龄、体重指数、平均心率、心率波动、扫描范围差异均无统计学意义(P>0.05)。前瞻门控组有效辐射剂量(3.80±0.46)mSv,回顾门控组有效辐射剂量(20.64±3.14)mSv,两组差异具有统计学意义(P<0.001)。两组图像质量的差异无统计学意义(2=1.166,P=0.761)。结论:前瞻性心电门控较回顾性心电门控技术能够在保证图像质量的同时明显降低辐射剂量。     

双源CT自适应前瞻性心电门控冠状动脉造影:与传统冠状动脉造影对照

目的 评价双源CT(DSCT)自适应前瞻性心电门控CT冠状动脉成像(CTCA)对冠状动脉病变诊断的准确性和可行性.资料与方法选取同期行自适应前瞻性心电门控CTCA(扫描前心率低于75次/min)和传统冠状动脉造影(CAG)的30例连续患者作为研究对象.另选取同期行回顾性心电门控CTCA和CAG的45例连续患者作为对照.由两名CT医师和两名造影医师分别对CTCA和CAG图像进行评估.记录CTCA的图像质量和X线剂量.比较自适应前瞻性和回顾性心电门控CTCA的诊断准确性、X线剂量和图像质量.结果 对患者冠状动脉病变的诊断,自适应前瞻性和回顾性心电门控CTCA的差异无统计学意义,其敏感性分别为100%、97.4%(P=0.86),特异性分别为66.7%、100%(P=0.65);对分支冠状动脉病变的诊断,两者差异也无统计学意义,其敏感性分别为95.9%、91.1%(P=0.46),特异性分别为97.2%、97.0%(P=0.85);对节段冠状动脉病变的诊断,两者差异同样无统计学意义,其敏感性分别为90.5%、91.2%(P=0.92),特异性分别为98.4%、99.3%(P=0.35).自适应前瞻性心电门控CTCA的冠状动脉图像质量与回顾性心电门控CTCA类似(3.3±0.5与3.2±0.3;P:0.23).与回顾性心电门控CTCA比较,自适应前瞻性心电门控CTCA能降低71%的X线剂量[(3.1±1.3)mSv与(10.8±4.6)mSv,P＜0.01].结论 在心率低于75次/min、心律稳定的情况下,DSCT自适应前瞻性心电门控CTCA能获得与DSCT回顾性心电门控CTCA相同的诊断准确性,图像质量也无差别,而X线剂量却大大降低.     

双源 CT ECG 管电流调制技术在冠状动脉成像的临床应用

目的：与常规回顾性心电门控技术比较,探讨双源 CT ECG 管电流调制技术在冠状动脉成像的应用价值。方法200例冠心病患者随机等分为 ECG 管电流调制技术组(A 组)和常规回顾性心电门控技术组(B 组),A 组主要参数是根据患者不同心率设置不同的全剂量曝光时间窗。记录 A、B 组的成像质量和辐射剂量,主观评分采用χ2检验,客观评分及辐射剂量采用 t 检验。结果2组图像质量差异无统计学意义(χ2=2.125,t 噪声=-0.557,P >0.05);A 组和 B 组的有效辐射剂量(ED)分别为(3.30±0.40)mSv和(6.90±1.76)mSv,差异有统计学意义(t ED =-19.954,P <0.05),A 组比 B 组的辐射剂量降低52%。结论与常规回顾性心电门控技术比较,ECG 管电流调制技术保证图像质量的同时大幅降低辐射剂量,可作为冠状动脉成像的常规检查技术。     

双源CT冠状动脉扫描心电门控模式和管电压对辐射剂量与图像质量的影响

目的 探讨双源CT(DSCT)冠状动脉成像有效辐射剂量(ED)、图像质量与心电门控技术和扫描管电压(kV)的关系.方法 对101例(男42例,女59例,平均年龄60.2岁±10.8岁)DSCT冠状动脉血管成像的连续患者行回顾性研究,所有患者均未口服或静脉给予β受体阻滞剂、硝酸甘油等控制心率和扩张血管药物.本组根据前瞻性心电门控(44例)和回顾性心电门控(57例)(组1),以及扫描电压100 kV(43例)和120 kV(58例)(组2)分成2组,对组1、2的图像质量(1～4分)和有效辐射剂量(mSv)分别进行组间对比研究.组间计量资料采用t检验,计数资料采用χ2检验.P<0.05为有统计学差异.结果 本组仅1例因扫描过程中出现心律失常导致检查失败(技术成功率99%).组1前瞻门控组和回顾门控组冠状动脉图像质量平均分分别为3.3±0.5和3.3±0.3(P>0.05),图像噪音分别为(20.9±5.1) HU和(23.9±6.5) HU(P0.05),图像噪音分别为(25.2±7.0) HU和(20.6±4.5) HU(P<0.001).结论 在不降低双源CT冠状动脉检查成功率和图像质量的情况下,采用前瞻性心电门控和100 kV管电压扫描,能够显著降低患者的有效辐射剂量.     

64排螺旋CT冠状动脉成像的前瞻性与回顾性心电门控技术的图像质量及辐射剂量的比较研究

目的 研究前瞻性心电门控触发(prospective ECG-triggering)与回顾性心电门控(retrosp-ective ECG gating)两种技术方法行冠状动脉CTA检查时,对冠状动脉图像质量及辐射剂量的比较.方法 33名疑似冠状动脉疾病的患者分两组进行对比研究.前瞻组16例为前瞻性心电门控成像,心率小于65次/min;回顾组17例为回顾性心电门控成像,心率小于75次/min.记录两组的辐射剂量并统计分析,同时进行图像质量评价.结果 两组图像质量比较,差异无统计学意义(P0.05).前瞻性心电门控冠状动脉CTA的平均DLP 234.4 mGy·cm,占回顾性心电门控冠状动脉CTA的平均DLP 974.4 mGy·cm的24.1%.前瞻性心电门控冠状动脉CTA的患者的平均有效剂量为3.2 mSy,回顾心电门控冠状动脉CTA患者的为13.6 mSv,降低76.47%.结论 64排螺旋CT在前瞻性心电门控冠状动脉CTA与回顾性心电门控冠状动脉CTA比较可以获得相似的图像质量,可大幅降低患者的有效剂量对于不能接受高辐射剂量且心率较低的受检人群具有重要的临床价值.     

前瞻性心电门控扫描在冠脉支架随访中的应用

目的探讨前瞻性心电门控扫描在冠状动脉支架随访中的可行性。方法 77例冠状动脉支架植入术后患者行冠状动脉CT血管成像检查,按照心率不同分为两组,分别采用回顾性心电门控及前瞻性心电门控扫描。比较两组图像支架内及支架近端的CT值、噪声、信噪比(SNR)、支架内CT值净增比(SAIR)、图像质量主观评分及辐射剂量。定量数据表示为平均数±标准差。结果回顾性心电门控组的心率快于前瞻性心电门控组(P 0. 05)。两组图像支架内及支架近端的CT值、噪声、信噪比(SNR)、支架内CT值净增比(SAIR)以及图像质量主观评分差异均无统计学意义(P0. 05)。前瞻性心电门控组辐射剂量显著降低,平均有效辐射剂量为(2. 40±0. 99) m Sv,组间差异具有统计学意义(P 0. 05)。结论对于冠脉支架植入术后的患者,前瞻性心电门控扫描方案在降低辐射剂量的同时,可获得满意的图像质量。     

64排螺旋CT冠状动脉成像的前瞻性与回顾性心电门控技术的图像质量及辐射剂量的比较研究

目的 研究前瞻性心电门控触发(prospective ECG-triggering)与回顾性心电门控(retrosp-ective ECG gating)两种技术方法行冠状动脉CTA检查时,对冠状动脉图像质量及辐射剂量的比较.方法 33名疑似冠状动脉疾病的患者分两组进行对比研究.前瞻组16例为前瞻性心电门控成像,心率小于65次/min;回顾组17例为回顾性心电门控成像,心率小于75次/min.记录两组的辐射剂量并统计分析,同时进行图像质量评价.结果 两组图像质量比较,差异无统计学意义(P0.05).前瞻性心电门控冠状动脉CTA的平均DLP 234.4 mGy·cm,占回顾性心电门控冠状动脉CTA的平均DLP 974.4 mGy·cm的24.1%.前瞻性心电门控冠状动脉CTA的患者的平均有效剂量为3.2 mSy,回顾心电门控冠状动脉CTA患者的为13.6 mSv,降低76.47%.结论 64排螺旋CT在前瞻性心电门控冠状动脉CTA与回顾性心电门控冠状动脉CTA比较可以获得相似的图像质量,可大幅降低患者的有效剂量对于不能接受高辐射剂量且心率较低的受检人群具有重要的临床价值.     

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.