^99Tc^m-双半胱氨酸利尿肾动态显像评价小儿先天性肾盂积水手术前后肾功能

目的探讨^99Tc^m-双半胱氨酸（EC）利尿。肾动态显像（DR）在小儿先天性肾盂积水手术前肾功能评价和术后随访中的临床价值。方法回顾性分析40例肾盂积水患儿的DR（常规方法中第15分钟注射呋塞米）,对患肾血流灌注率（BPR）及有效肾血浆流量（ERPF）、肾盂积水分度、肾图曲线和动态显像图进行手术前后的比较。符合正态分布数据间比较采用t检验,等级资料数据间比较采用非参数检验。结果（1）40只患肾的BPR术前为（34．05±11．07）％,术后为（40．04±8．56）％,平均提高5．99％（t=-5．13,P〈0．01）。患肾的ERPF术前为（57．81±34．32）ml／min,术后为（70．29±5．37）ml／min,平均提高12．48ml／min（t=-4．35,P〈0．01）。（2）40只患肾的。肾盂积水分度的平均秩和术前为47．21,术后为33．79（Z=-2．64,P〈0．01）。（3）随着积水程度的加重,患肾形态增大,肾实质变薄,肾内放射性缺损范围增大,对利尿试验的反应明显减弱直至无反应。（4）术前DR诊断肾盂输尿管连接处梗阻（UPJO）37例,输尿管膀胱入口处梗阻（UVJO）3例,术前梗阻的定位均为手术证实。结论DR是评价小儿先天性肾盂积水的一种可靠方法,能够准确反映病情、指导治疗,并监测手术疗效。     

SPECT肾动态显像在小儿先天性肾盂积水中的临床应用

目的探讨SPECT肾动态显像在诊断小儿先天性肾盂积水的价值.方法回顾性分析肾盂积水患儿30例,采用99mTc-DTPA肾动态显像方法,部分患儿静脉注射速尿,其中12例作手术前后比较.定量指标有高峰摄取率(PUR),肾血流灌注率(BPR),半排时间(T1/2)结果BPR随肾盂积水程度加重而明显下降,重度积水为16.8%±6.8%,中度积水为35.1%±6.9%,轻度积水为40.6%±9.2%.PUR在重度积水时为21.6%±12.9%.12例患儿手术后其中10例BPR明显升高,术后T1/2明显改善.结论SPECT可准确反映肾盂积水和肾功能受损程度,两者呈正相关,术后肾功能改善情况和应用速尿能正确判断集尿系统有无梗阻存在.     

小儿肾积水手术前后利尿性肾动态显像对比研究

目的探讨利尿性核素肾动态显像在小儿肾积水手术疗效评价和术后随访中的临床价值。方法回顾性分析49例肾积水患儿的利尿性肾动态显像(F15法,常规方法中第15 min注射呋塞米),对肾脏影像、单肾肾小球滤过率(SKGFR)及肾图曲线进行手术前后的比较。结果①以利尿性核素肾动态显像进行积水分类,术前轻、重度积水各9例,中度积水31例,均被手术证实。功能差的25例SKGFR术前为(26.99±13.85)ml·min-1,术后为(31.15±17.04)ml·min-1,平均提高4.16 ml·min-1。②术前完全梗阻30例,部分梗阻18例,无明显梗阻1例;术后部分梗阻12例,无明显梗阻37例,没有完全梗阻病例,术后梗阻改善明显(P<0.001)。③术前肾盂输尿管交界处梗阻(UPJO)47例,输尿管膀胱交界处梗阻(UVJO)2例,术前梗阻定位为手术证实。④综合梗阻和肾脏功能信息对患儿分类,术前最差型21例,较差型28例,无正常型;术后较差型15例,正常型34例,无最差型。手术前后患儿的构成类型差异有显著性(P<0.001)。结论利尿性核素肾动态显像是评价小儿肾积水的可靠方法,能准确反映手术疗效和疾病转归并指导治疗。     

急性单侧上尿路完全性梗阻的CT表现与其病理、生理学对照

目的：探讨急性完全性上尿路梗阻的影像表现与病理、生理的对应关系。材料与方法：收集我院一例有明确梗阻原因的急性上尿路完全性梗阻病历，并完善B超，静脉肾盂造影，CT双肾动态增强扫描，膀胱镜检，肾脏造漏术。结果：急性完全性上尿路梗阻影像表现有肾盂轻度扩张积水，肾实质弥漫性肿大，肾周漏尿，肾盂、输尿管内可见造影剂影等，一系列影像表现均与急性上尿路梗阻的病理、生理机制相关。     

儿童肾重复畸形99Tcm-EC肾动态显像

目的 评价^99Tc^m-双半胱氨酸（EC）肾动态显像（RDI）在儿童肾重复畸形诊断中的意义以及对选择手术方式的价值。方法 对20例肾重复畸形患儿行RDI、静脉肾盂造影（IVP）、B超等检查，分析肾重复畸形的RDI影像特征，并对3种检查结果进行比较，对14例手术切除的上半肾作临床病理分型：发育型、积水型、发育不良型。^99Tc^m-EC肾动态显像处理：反24min内图像叠加成1帧／2min连续影像，设置重复上半肾、同侧下半肾、对侧上半肾感兴趣区，获得其放射性计数率（D、L、C），以D／L或D／C中较小者为重复上半肾功能指标（D／N），并与病理分型比较，结果 肾重复畸形在RDI连续影像中有4种表现：上肾衡疏、上肾缺损、肾影增长、肾盂分离；RDI对合并输尿管囊肿检出率较高，并可检出部分输尿管扩张积水。RDI、B超、IVP对重复肾的检出率分别为73.1%、57.7%、73.1%，三者较为一致（P＞0.05）；RDI的灵敏度、特异性、准确性分别为73.1%、92.2%、80.0%。发育不良型的上肾D／N值均小于60％，发育型均大于60％。结论 肾重复畸形的^99Tc^m-EC肾动态显像有较好的诊断价值，可为临床术前判断是否保留上肾提供重要依据。     

儿童肾盂输尿管连接处梗阻介入治疗的疗效评估

目的 评价儿童先天性肾盂输尿管连接处梗阻介入治疗的近、远期疗效。资料与方法 33例先天性肾盂输尿管连接处梗阻患儿经皮肾造口施行球囊扩张输尿管成形术（1例植入支架）,而后结合影像学,尿动力学,肾功能检查以及临床症状等指标评价近、远期疗效。结果 术后近期肾盂压力较前显著下降,造影显示梗阻改善,肾功能指标恢复正常。1—7年随访临床症状消失27例（82％）;症状明显改善4例（12％）;2例（6％）症状无改善改行手术治疗。结论 介入治疗方法具有微创、体表无瘢痕等特点,对儿童先天性肾盂输尿管连接处梗阻的疗效稳定而持久。     

^99mTc—DTPA肾动态显像在小儿肾盂积水中的应用

目的探讨９９ｍＴｃＤＴＰＡ肾动态显像诊断小儿肾盂积水的临床价值。方法常规９９ｍＴｃＤＴＰＡ肾动态显像方法，１５分钟后静脉注射速尿，共检查肾盂积水患儿４５例，其中７例作手术前后比较。定量分析指标包括：肾血流灌注率（ＢＰＲ），高峰摄取率（ＰＵＲ），半排泄时间（Ｔ１／２）。结果①ＢＰＲ随积水程度加重而明显下降，重度积水为１６８％±６８％，中度积水为３５１％±６９％，轻度积水为４０６％±９２％。ＰＵＲ在重度积水时为２１６％±１２９％。②７例患儿中６例术后ＢＰＲ明显升高。术前、术后Ｔ１／２分别为４１３±２０４和２２９±１１９分钟。术后Ｔ１／２明显改善。结论①ＢＰＲ可正确反映肾盂积水和肾功能受损程度，两者呈正相关；②术后肾功能改善情况和速尿介入能正确判断集尿系统有无梗阻存在     

磁共振尿路造影在小儿泌尿系梗阻诊断中的价值

目的 探讨磁共振尿路造影(MRU)技术在小儿泌尿系梗阻诊断中的价值. 方法 65例上尿路梗阻患儿行静脉肾盂造影(IVP)、B超及MRU检查,MRU检查应用快速自旋回波重T_2WI序列.对照MRU与手术结果,比较MRU与IVP、BUS在上尿路梗阻诊断中的价值. 结果 MRU诊断肾盂输尿管连接部狭窄36例,重复肾3例(其中误诊1例),原发性巨输尿管症9例,输尿管膀胱入口狭窄4例,输尿管末端囊肿3例,孤立肾2例,肾结石5例,神经性膀胱2例,先天性肾发育不良1例.MRU对上尿路梗阻的诊断正确率为98.5%(64/65),优于IVP及B超(P＜0.05). 结论 MRU是诊断小儿上尿路梗阻的可靠方法.     

双J管在离断式肾盂成形术治疗肾盂输尿管连接部梗阻中的应用

目的探讨离断式肾盂成形术治疗肾盂输尿管连接部梗阻及使用双J管的经验和体会。方法2006年9月－2010年3月对68例先天性。肾盂输尿管连接部梗阻引起的肾积水患儿应用Aderson—Hynes离断式肾盂成形术治疗,术中均放置双J管作支架和引流。结果68例术后7d出院,65例术后1—2个月经尿道膀胱镜顺利完整取出双J管,3例提前取出。随访3—36个月,复查B超及静脉肾盂造影（IVU）显示,患肾形态有缩小,肾实质厚度增加,造影检查时见吻合口以远输尿管显影,排泄通畅。结论离断式肾盂成形术治疗先天性肾盂输尿管连接部梗阻,术中放置双J管作支架和引流,临床效果确切。     

MRU对小儿先天性肾积水的临床应用研究

目的:探讨泌尿系统水成像(MRU)技术对小儿先天性肾积水的临床应用价值。方法:回顾性分析52例手术证实为先天性肾积水的小儿MR图像。所有患儿均行冠状位MRU及兴趣区轴位T2WI序列检查。结果:52例患儿中,肾盂输尿管连接部狭窄35例,原发性巨输尿管4例,重复肾盂输尿管畸形7例,输尿管末端囊肿2例,肾发育不全或异位肾4例。手术中所见与MRU图像表现基本一致。结论:MRU能够无放射线、无需对比剂、多角度、直观显示小儿肾脏积水和/或合并其它泌尿系畸形。     

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.