^89SrCl2与^153Sm-乙二胺四亚甲基膦酸治疗骨转移癌的对比研究

目的对比研究^89SrCl2和^153Sm-乙二胺四亚甲基膦酸（^153Sm-EDTMP）治疗骨转移癌疗效。方法120例骨转移患者随机分为SOSrCl2治疗组和^153Sm-EDTMP治疗组,分别为69例和51例,^89SrCl2剂量为1．11-2．22MBq／kg,^153Sm-EDTMP剂量为25．9～37．0MBq／kg,3-6月复查SPECT,对止痛效果、转移灶变化及不良反应进行比较分析。结果^89SrCl2组总有效率、显效、有效、无效分别为92．8％、69．6％、23．3％、7．2％;^153Sm-EDTMP组的总有效率、显效、有效、无效分别为94．2％、66．7％、27．5％、5．8％,两组比较的差异无统计学意义（χ^2=4．98,P〉0．05）;^89SrCl2治疗组骨转移病灶Ⅰ级（变淡,缩小或消失,无新增病灶出现）为56．5％,^153Sm-EDTMP组为54．9％,两组比较的差异无统计学意义（χ^2=4．81,P〉0．05）;骨髓抑制情况（白细胞和血小板中任一项降低）分别为40．8％和59．2％,两组比较的差异有统计学意义（r=7．45,P〈0．05）。结论^153sm-EDTMP和^89SrCl2控制乳腺癌、前列腺癌及大多数肺癌骨转移疼痛有效,可根据经济条件选择相应药物。^89SrCl2疗效持久,相对骨髓抑制较小,更安全可靠,可作为早期骨转移患者的首选药物。     

局部放疗联合89Sr治疗骨转移癌的疗效观察

目的评价局部放疗配合放射性核素^89Sr治疗骨转移癌的疗放，分析单纯放疗单纯核素^89Sr治疗及联合治疗的副作用。方法观察60例确诊为骨转移癌的患者，分为3组，每组20例。局部放疗（A组），采用6MV直线加速器外照射给予吸收剂量30—60Gy，2—4周，局部放疗＋^89Sr治疗（B组），单纯^89Sr治疗（C组）放射性核素^89Sr静脉内注射3—4mCi。结果治疗后B组骨痛缓解，原发灶改善明显好于A、C组；新增疼痛部位及转移灶均少于A、C组（P〈0．05）。治疗后血液学的毒性3组差异统计学意义（P〉0．05）。结论局部放疗配合^89Sr治疗骨转移癌有较好的疗效，提示对单发性骨转移患者的压痛明显部位给予局部外照射止痛效果明显，对多发骨转移且病灶相距较近的给予放疗联合^89Sr治疗效果安全可靠，对全身性多发性骨转移者采用单纯放射性核素^89Sr治疗对于止痛和控制骨转移有一定疗效。     

骨转移癌治疗药物^153SmEDTMP辐射剂量研究

^153Rm-EDTMP(乙二胺甲甲撑膦酸）是一种可望用于骨转移癌缓解治疗的放射性药物，注入示踪量^153Sm-EDTMP，准确计算离红骨髓的吸收剂量，是建立安全，有效的骨转移癌治疗方案的重要组成部分，本介绍了计算吸收剂量的一般原理和方法，并综述了近期在^153Sm-EDTMP辐射剂量及其效应方面的研究进展。     

99Tcm-MDP骨显像在肺癌骨转移疗效观察中的应用

目的：应用99Tcm-MDP骨显像对肺癌骨转移患者的治疗效果进行分析，观察其疗效差异。方法：对178例肺癌患者，在系统治疗前均行99Tcm亚甲基二膦酸盐（99Tcm-MDP）全身骨显像；85例骨显像阳性患者，单纯放疗40例。综合治疗（放疗同期化疗）45例，在治疗后2月复查骨显像．用统计学方法分析显像结果，对肺癌骨转移的治疗效果进行评价。结果：①单纯放疗组完全缓解（CR）5例，部分缓解（PR）12例，有效率（CR＋PR）为42．5％；综合治疗组分别为7例。17例，53．3％。两组比较有效牢无显著性差异（P〉0.05）。②综合治疗组中腺癌骨转移病灶有效率45%（9／20）；小细胞癌为80％（12／15）；鳞癌则为30％（3／10）。三种病理类型肺癌骨转移灶综合治疗的有效率差异有显著性（P〈0.05）。其中小细胞癌较腺癌、鳞癌骨转移灶疗效好（P均〈0．05）。③接受综合治疗的患者骨显像共有近期疗效可评价者258个病灶，其中胸部、脊椎、骨盆、四肢和颅骨分别为145个（56．20％）。57个（22．09％），34个（13．18％）。22个（8．53％）。复查骨显像有效率分别为65．52％（95／145）、63．16％（36／57）、58．82％（20／34）、54．55％（12／22），无显著性差异（P〉0．05）。结论：单纯放疗和放化疗联合均可有效治疗骨转移。不同病理类型患者应用综合治疗后效果有差异．而不同部位之问疗效无差异。应用99Tcm-MDP骨显像可对肺癌骨转移疗效进行较好观察。     

烟酰胺和碳合氧增敏89Sr治疗多发性骨转移癌的临床研究

目的评价烟酰胺和碳合氧（Carbogen）增敏^89Sr治疗多发性骨转移癌的作用、骨痛的缓解及毒副反应。方法97例恶性肿瘤多发性骨转移患者随机分为4组：烟酰胺＋Carbogen＋^89Sr治疗组（A组）；烟酰胺＋^89Sr治疗组（B组）；Carbogen＋^89Sr治疗组（C组）；^89Sr治疗组（D组）。^89SrCl2治疗采用1．48-2．22MBq／kg，静脉注射。注射^89Sr前1h开始给予烟酰胺，6g／d，分3次口服，连服5d。首次口服烟酰胺后开始吸入Carbogen（95％O2＋5％CO2）气体，6L／min，10min，每日1次，连续5d。结果A组治疗后骨痛的缓解及生活质量较B组、C组及D组有效率高（91．7％、77．3％、76．0％和69．2％），且A组与D组比较差异有统计学意义（P=0．048）。治疗后3个月复发性骨转移癌全身骨显像反应，各组之间差异无统计学意义。各组病人治疗后均有Ⅰ-Ⅱ度骨髓抑制，各组之间差异无统计学意义。结论烟酰胺＋Carbogen＋^89Sr治疗多发性骨转移癌，对骨痛的缓解及生活质量的改善有更好的疗效，且未增加^89Sr的治疗毒性反应。     

^153Sm—EDTMP显像测定骨摄取率在个体化治疗剂量计算中的应用

目的 探讨^153Sm-乙二胺四甲撑膦酸（EDTMP）全身显像法在个体化给药剂量计算中的价值。方法 对20例骨转移癌患者进行^153Sm-EDTMP显像,计算骨摄取率,并与尿液收集法进行比较。结果 显像法与尿液收集法所测得的骨摄取率之间具有很好的相关性（r=0.93)。根据显像法计算的骨摄取率,给药剂量为1．40－2．27GBq(平均1．90GBq),骨髓吸收剂量为1．37－1．43Gy(平均1．40Gy)。按标准体重计算,则应给予的剂量为1．75－2．41GBq（平均2．18GBq),骨髓吸收剂量为1．37－2．27Gy(平均1．63Gy)。两种方法给药剂量之间差异有显著性（t=4.075,P=0.001),同髓吸收剂量差异也有显著性（t=4.030,P=0.001)。结论 骨转移癌患者治疗剂量按^153Sm-EDTMP显像法测定的骨摄取率进行个体化给药,在达到治疗目的同时,还可避免发生骨髓毒性反应,具有重要的临床价值。     

He-Ne激光静脉内照射加骨膦治疗骨转移癌性疼痛的探讨——附50例分析

为了提高治疗骨转移癌疼痛的效果，我们采用骨膦和骨膦加Ｈｅ－Ｎｅ激光静脉内照射治疗骨转移癌疼痛病人５０例。单纯骨膦治疗组总有效率为６８％（１５／２２），显著缓解率为１４％（３／２２）；激光加骨膦综合治疗组总有效率为９６％（２７／２８），显著缓解率为５７％（１６／２８），两组疗效有非常显著性差异（Ｐ＜０．０１）。说明骨膦加Ｈｅ－Ｎｅ激光静脉内照射能较好地缓解疼痛。     

153Sm-EDTMP致血液学毒性的多因素分析

目的 探讨^153Sm-乙二胺四甲撑膦酸（^153Sm-EDTMP）治疗导致白细胞、血小板降低发生的相关因素。方法 回顾性地整理206例^153Sm-EDTMP治疗后患者的资料，运用Logistic回归对数据进行单因素和多因素分析，对有意义的指标进行分析。结果 单因素分析结果表明：^153Sm-EDTMP治疗后，血液学毒性的发生与患者的年龄、骨转移灶数目、治疗前化疗史、同时进行外放疗、治疗次数有关；多因素分析结果显示，治疗前化疗史、同时进行外放疗、治疗次数等因素与血液学毒性产生与否有关；治疗前靠药物维持正常血象者也易出现血液学毒性。结论 ^153Sm-EDTMP治疗后血液学毒性的发生与几个因素有关，对有这些因素的患者，应特别注意治疗后血象的变化。     

经肝动脉灌注^131 I-HAblSF（ab’）2治疗肝癌合并门静脉癌栓疗效分析

目的探讨经肝动脉灌注^131 I-HAbl8F（ab’）2治疗肝癌合并门脉癌栓的价值。方法8例合并门脉癌栓的晚期肝癌患者行经肝动脉超选择灌注^131 I-HAbl8F（ab＇）2临床治疗性试验，剂量：0．75mCi／kg。分析症状、卡氏评分、肝功能、AFP及肿瘤CT等影像变化，随访近期疗效。结果7例疼痛患者中，3例症状缓解。3例卡氏评分增加、4例稳定。6例AFP异常患者治疗后3例下降。全组病例用药后肝功能损害均无明显加重。1例无明显症状的弥漫型肝癌患者治疗后病灶减少；余7例中，瘤体增大5例、缩小2例，其中，PR2例，临床有效率28．6％。本组1例1年随访时生存。结论经肝动脉灌注0．75mCi／kg ^131 I-HAbl8F（ab＇）2对合并门脉癌栓的肝癌患者肝功影响小，对门脉分支癌栓患者有较好的疗效。     

153Sm-羟乙基乙二胺三甲撑膦酸(HEDTMP)的动物实验研究

目的：初步探讨^153Sm-羧乙基乙二胺三甲撑膦酸（HEDTMP）的生物学性能。方法：分别以^99Tc^m-亚甲基二膦酸盐（MDP）和^153Sm-乙二胺四甲基膦酸（EDTMP）作对照，进行^153Sm-HEDTMP新西兰兔、Wistar大鼠骨显像和昆明小白鼠体内分布实验。结果：①^153Sm-HEDTMP动物骨显像提示有较高的骨摄取，颅骨、脊柱、四肢显示清晰，与^99Tc^m-MDP及^153Sm-EDTMP的骨显像效果相似。②^153Sm-HEDTMP有快速的血清除与骨摄取，注射后330min骨摄取为19.13％ID/g，3h为24.54％ID/g，24h为18.95％ID/g；示踪剂主要经肾脏排泄，非靶脏器放射性残留低。③^153Sm-HEDTMP的骨摄取和靶/非靶比值比^153Sm-EDTMP高。结论：^153Sm-HEDTMP显示出良好的生物学性能，有解雇成为新的放射性骨治疗剂。     

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.