经皮胆道支架联合近距内放疗治疗不能手术切除的肝门胆管癌

目的 探讨经皮胆道支架联合近距内放疗治疗不能手术切除的肝门胆管癌的可行性、安全性和有效性,以及联合治疗对患者黄疸复发和生存期的影响.方法 对2014年2月-2015年12月上海仁济医院肿瘤介入科收治的21例不能手术切除而接受经皮胆道支架联合近距内放疗的肝门胆管癌患者及该院同期单纯胆道引流或金属裸支架植入的患者28例进行回顾性分析.观察手术成功率、退黄效果及术后并发症发生率,比较两组患者生存期和黄疸复发时间的差异.结果 21例联合治疗患者共植入金属裸支架32枚,放射性12I粒子580颗,手术成功率100％,治疗有效率85.7％,术后早期并发症发生率9.5％,无手术相关死亡发生.联合治疗组患者术后中位黄疸复发时间为344 d而单纯胆道引流或金属裸支架植入患者的中位黄疸复发时间为193 d(P=0.035).联合治疗组患者中位生存期387 d明显长于单纯胆道引流或金属裸支架植入患者的256 d(P=0.022).结论 经皮胆道支架联合近距离内放疗作为不能手术切除的肝门胆管癌患者的姑息治疗方案安全有效可行,联合治疗能够推迟肝门胆管癌患者的黄疸复发及延长生存期.     

金属内支架治疗恶性梗阻性黄疸的临床研究：附33例分析

目的：总结胆管金属内支架放置术的临床经验和疗效分析。材料与方法：恶性梗阻性黄疸患者３３例，男２３例，女１０例。胆管癌１６例，胰头癌２例，原发性肝癌２例，肝转移瘤３例，肝门淋巴结转移瘤压迫胆管１０例。本组共采用金属内支架行内引流３３例，共使用６种３８枚金属内支架。１２例支架放置术后加局部放射治疗和化学治疗（简称放、化疗）。结果：３３例采用经皮经肝穿刺置入胆管支架均获得成功，其中２９例一次性植入支架，４例先行胆汁引流术（ＰＴＢＤ）后再放置金属内支架；９例因胆管梗阻复杂，金属支架置入后仍保留引流导管，其中３例在置管１５～２００天后拔除引流管。２８例（８４．８５％）黄疸消退满意。本组中位生存期７个月，支架植入后加局部放、化疗组中位生存期１０个月。结论：胆管内金属支架治疗恶性梗阻性黄疸，可用于不能手术治疗的高位胆管梗阻，支架植入后加局部放、化疗可望提高远期疗效。     

胆道内支架引流术结合立体定向放射治疗恶性梗阻性黄疸

目的　评价经皮肝穿刺胆道内支架置入术配合立体定向适形放射治疗对恶性梗阻性黄疸的疗效。方法　 15例恶性梗阻性黄疸采用经皮肝穿刺法置入 19个金属内支架。支架置入后随即开始立体定向适形放射治疗。结果　 15例胆道支架植入术全部成功。随访 12个月以上。 3例分别在术后 3、4、11个月无黄疸死亡 ,其余均存活超过 1年。 1年生存率 80 %。结论　胆管癌在经皮肝穿刺胆道内支架置入术有效减黄之后 ,针对肿瘤实施先进的立体定向适形放射治疗能明显延长恶性梗阻性黄疸病人的生存期     

经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌

目的探讨经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌的疗效及安全性。方法 2005年10月—2007年1月对不愿意手术或不能手术治疗的21例肝门部胆管癌患者,给予经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗。肿瘤边缘剂量4～8Gy/次,隔日1次,总剂量为40～60 Gy,10～20 d完成。结果患者行经皮肝穿胆管内支架置入术后,血总胆红素及直接胆红素水平均有显著下降。治疗后1~3月复查,1例出现再梗阻,其余血胆红素水平基本上接近正常。肿瘤病灶CR 2例,PR 14例,PD 1例,SD 3例,总有效率(CR+PR)为80%。胆道支架植入术中及术后,出现血压下降4例,放疗不良反应以消化道反应多见,均为I~II度。患者中位生存期为14.5月,1、2年生存率分别为47.6%、14.2%。结论经皮肝穿胆管内支架置入术联合伽玛刀立体定向放射治疗是肝门部胆管癌的一种有效方法,并发症及不良反应少。     

经皮经肝胆管引流术治疗恶性梗阻性黄疸的疗效观察

目的探讨介入治疗恶性梗阻性黄疸的效果及价值。资料与方法回顾性分析恶性梗阻性黄疸患者资料146例,其中男84例,女62例,平均年龄(63±13)岁,所有患者均经辅助检查诊断为恶性胆管梗阻。先行经皮经肝胆管穿刺,随后置入引流管行胆管引流或置入胆管内支架;术后1周,37例行肝动脉化疗栓塞(TACE)。结果146例均成功穿刺并置入引流管(105例)和(或)置入支架(41例),成功率100%,术后129例患者黄疸症状好转,总有效率88.4%;胆管引流及支架引流前后总胆红素(TB)、血清丙氨酸转氨酶(ALT)、直接胆红素(DB)、血清碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)及血清白蛋白水平进行独立样本t检验,不同引流方法在减轻黄疸,改善肝功能,延长生存期方面差异有统计学意义(P<0.05);胆管支架减轻黄疸的幅度优于胆管引流,但黄疸缓解的比例组间无差异;单纯外引流组、内外引流组及胆管支架组的中位生存期分别为3.2个月、4.5个月及6.1个月,胆管支架组在生存期方面亦优于胆管引流。结论胆管引流/胆管支架对于缓解恶性梗阻性黄疸的症状和提高患者的生活质量具有重要价值,行TACE治疗可明显加快胆红素水平下降的幅度。     

胆管癌~(192)lr线源胆管腔内照射的经验

作者应用~(192)Ir源胆管内照射治疗3例胆管癌,将线源留置在前端为盲端的导管内,把此导管经皮经肝插入胆管内腔,~(192)Ir线源腔内照射剂量目前尚无最佳剂量标准,作者考虑到胆管癌对放疗敏感性低,采用距线源5mm处30Gy腔内照射及30Gy外部照射。对腔内照射的适应证尚无定论,Prempree等认为胆管癌小于1.5cm时只腔内照射,大于1.5cm则并用外照射。一般胆管癌发现时多为进行性癌,一般认为腔内照射并外照射者比单纯外照射平均生存期延长,并用腔内照射者平均生存月数为15个月,2年生存率为25%。单纯外照射平均生存     

The Clinical Observation of Interventional Therapy for Malignant Obstructive Jaundice

目的 探讨介入治疗恶性梗阻性黄疸的效果及价值.资料与方法 回顾性分析恶性梗阻性黄疸患者资料146例,其中男84例,女62例,平均年龄(63±13)岁,所有患者均经辅助检查诊断为恶性胆管梗阻.先行经皮经肝胆管穿刺,随后置入引流管行胆管引流或置入胆管内支架;术后1周,37例行肝动脉化疗栓塞(TACE).结果 146例均成功穿刺并置入引流管(105例)和(或)置人支架(41例),成功率100％,术后129例患者黄疸症状好转,总有效率88.4％;胆管引流及支架引流前后总胆红素(TB)、血清丙氨酸转氨酶(ALT)、直接胆红素(DB)、血清碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)及血清白蛋白水平进行独立样本t检验,不同引流方法在减轻黄疸,改善肝功能,延长生存期方面差异有统计学意义(P＜0.05);胆管支架减轻黄疸的幅度优于胆管引流,但黄疸缓解的比例组间无差异;单纯外引流组、内外引流组及胆管支架组的中位生存期分别为3.2个月、4.5个月及6.1个月,胆管支架组在生存期方面亦优于胆管引流.结论 胆管引流/胆管支架对于缓解恶性梗阻性黄疸的症状和提高患者的生活质量具有重要价值,行TACE治疗可明显加快胆红素水平下降的幅度.     

胆管癌性阻塞内支架术后再狭窄的介入治疗

目的　探讨胆管癌性阻塞内支架术后再狭窄的介入治疗方法及其疗效。方法　 12例胆管癌性阻塞性黄疸内支架术后胆管再狭窄患者 ,采用经皮经肝穿刺胆道引流术 (PTCD)加金属内支架置入术或结合局部持续性灌注化疗术及化疗性栓塞术 ,共使用 12枚金属内支架。结果　 12例采用经皮经肝穿刺置入金属胆道内支架均获得成功 ,均一次性置入支架。术后总胆红素、丙氨酸转氨酶、谷酰转肽酶、碱性磷酸酶均有明显下降。术后 12例患者黄疸消退满意。 3例黄疸消退 ,置入内支架术后 4周在DSA下行局部持续性灌注化疗术及化疗性栓塞术。结论　经皮胆管内金属支架再置入术是姑息性治疗胆管癌性阻塞性黄疸内支架术后胆管再狭窄的安全、有效方法 ,结合局部持续性动脉灌注化疗及化疗性栓塞术 ,能提高患者的生命质量及延长生存期     

经皮经肝胆管引流支架植入联合三维适形放射治疗恶性梗阻性黄疸48例分析

目的观察经皮肝胆管穿刺引流(PTCD)及胆管内支架置入术(PTBS)联合三维适形放疗(3D-CRT)治疗恶性梗阻性黄疸的疗效及应用价值。方法对48例恶性梗阻性黄疸患者行经皮肝胆管穿刺置管引流及胆管内支架植入,术后予3D-CRT,常规分割,总剂量DT 40～60 Gy/4～6周,观察近期疗效及生存率。结果 48例均引流成功,术前血清总胆红素(221.85±54.73)μmol/L,术后1、2及3周总胆红素分别下降为(129.68±23.58)、(88.29±15.70)和(48.58±11.61)μmol/L;经3D-CRT后肿瘤完全缓解3例,部分缓解36例,稳定9例,肿瘤总有效率81.3%;1、2年累积生存率分别是77.1%、37.5%;中位生存期18.5个月;无治疗相关的严重并发症。结论 PTBD+支架植入联合3D-CRT治疗恶性梗阻性黄疸是一种安全、有效的姑息性治疗方法,可以改善恶性肿瘤伴黄疸患者的临床症状,提高生存质量并延长生存时间。     

金属内支架治疗恶性梗阻性黄疸的临床研究

目的：总结胆总管金属内支架放置术的临床经验和疗效分析。材料和方法：恶性梗阻性黄疸患者１２例,男７例,女５例。胆管癌６例,胰头癌４例,肝转移瘤１例,肝门淋巴结转移瘤压迫胆管１例。本组共采用金属内支架行内引流１２例,共使用４种１４枚金属内支架。１２例支架放置术后加局部放射治疗和化学化疗。结果：１２例采用经皮经肝穿刺置入胆管支架获得成功,其中２例因病变范围较长,放置２枚支架。其中３例因胆管梗阻复杂,金属     

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.