冠心病患者PTCA术前后核素心脏显像结果对比分析

目的　应用99Tcm 甲氧基异丁基异腈心肌灌注断层显像及心室显像随访经皮冠状动脉腔内成形术 (PTCA)及支架置入术后的效果。方法　患者在成功的PTCA及支架置入术前及随访期进行负荷 /静息或静息 /含硝酸甘油心肌灌注断层显像及心室显像检查。结果　 44例患者在术前及术后平均 11.4个月进行了心肌灌注断层显像 ,其中 40例患者进行了心室显像。结果显示 ,术后患者心肌缺血及不可逆缺损节段数减少 ,分别为 2 .5± 0 .4与 1.5± 0 .3(P =0 .0 6 )及 3.5± 0 .5与 2 .3± 0 .4(P <0 .0 5 ) ;左室射血分数、高峰射血率及高峰充盈率无明显变化 ,运动低下节段数有所下降 ,但未达到统计学差异。结论　成功的PTCA及支架置入术后心肌缺血明显改善 ,左室功能无明显变化 ,部分节段运动改善     

卡维地洛治疗扩张型心肌病心力衰竭的疗效观察

目的　观察卡维地洛对扩张型心肌病 (DCM)心力衰竭 (CHF)的临床疗效。方法　 6 0例DCM并心力衰竭患者在利尿剂、洋地黄、ACEI及硝酸盐制剂治疗的基础上 ,随机分为卡维地洛治疗组及常规治疗组 (每组 30例 )。治疗前及 4月启用超声心动图测左室缩短分数 (FS) ,射血分数 (EF)、左室舒张末内径 (LVDD)、室间隔厚度 (IVS)和左室后壁厚度 (LVPW)。结果　治疗 4月后 ,两组心功能明显改善。卡维地洛组LVDD[6 1.5± 6 .6与 6 7.3± 6 .2 ,P <0 .0 5 ]、EF[4 8± 9.7与 4 0 .3± 6 .2 ,P <0 .0 5 ]、D/T[4 .1± 0 .7与 4 .6± 0 .5 ,P <0 .0 5 ]显著改善。结论　卡维地洛能显著改善DCM心力衰竭心功能及心肌重构     

美托洛尔改善扩张性心肌病心力衰竭的临床研究

目的　观察美托洛尔对扩张性心肌病(DCM)、心力衰竭的临床疗效。方法　 3 0例DCM伴心力衰竭患者在利尿、A CEI、洋地黄及硝酸盐制剂治疗的基础上 ,随机分为美托洛尔组及常规治疗组 (每组 1 5例 )。治疗前及治疗 4个月后启用超声心动图测定左室缩短分数 (FS) ,射血分数 (EF) ,左室舒张末内径 (LVDD) ,室间隔厚度 (LVS)和左室后壁厚度 (LVPW)。结果　治疗 4个月后两组心功能明显改善。美托洛尔组心功能改善较常规组更明显 ;美托洛尔组与常规组LVDD分别为61 .5± 6.5与 67.2± 6.1 ,P <0 .0 5 ,EF分别为 48.± 9.3与 40 .3±60 3 ,P <0 .0 5 ,D/T分别为 4.1± 0 .7与 4.6± 0 .5 ,P <0 .0 5。LVDD ,D/T ,LVPW美托洛尔组治疗后与治疗前以及与常规组治疗后相比改善显著 (P <0 .0 5 )。结论　美托洛尔能显著改善DCM心力衰竭心功能及逆转心肌重构。     

99 Tcm-MIBI与99Tcm-MDP骨显像诊断 骨良恶性病变的比较

目的　对比分析99Tcm 甲氧基异丁基异腈 (MIBI)和99Tcm 亚甲基二膦酸盐 (MDP)对骨良恶性病变的诊断价值和疗效评估。方法　 6 1例临床拟诊骨良恶性病变患者分别进行 2项骨显像 ,其中 6例恶性肿瘤患者分别进行化疗前后显像。显像后均经手术、病理检查对比分析。结果　99Tcm MIBI显像 :73 %恶性肿瘤病灶肉眼见中、高度MIBI浓聚 ,6 0 %良性病灶肉眼未见MIBI聚集。恶性病灶部位与对侧正常组织放射性计数比值 (L C)即99Tcm MIBI摄取比值 (3 0 8± 1 6 7)明显高于良性病灶(1 36± 0 6 4) ,P <0 0 1。99Tcm MDP显像 :大多数恶性或良性病灶肉眼见中、高度MDP浓聚 ,但恶性病灶99Tcm MDPL C(3 76± 1 37)与良性病灶L C(3 10± 1 0 5 )比较差异无显著性 (P >0 0 5 )。化疗可以抑制99Tcm MIBI摄取 ,99Tcm MIBI摄取程度与99Tcm MDP比较能较好反应治疗效果。结论　99Tcm MIBI对鉴别诊断良恶性骨病和评估疗效有较好的应用价值 ,与99Tcm MDP显像联合应用可更全面地提供信息     

双核素门控心肌断层显像对心肌缺血的诊断价值

目的　提高心肌断层显像技术对冠心病诊断的准确性和实用性。方法　采用双核素门控心肌断层显像对 10 3例受检者进行检查 ,患者分为冠心病组 (3 7例 )和非冠心病组 (66例 )。静息注射2 0 1Tl和运动高峰注入99Tcm 甲氧基异丁基异腈 (MIBI) ,40min后一次性进行门控双能峰断层采集。分析比较运动和静息的断层图像 ,以及室壁运动、心肌灌注、室壁增厚度和区域射血分数值等 4个功能图像和左室功能参数 :左室射血分数、舒张末期容积和收缩末期容积 (LVEF、EDV和ESV) ,并以不同角度的“双网图”分析各心壁运动情况。有 3 8例在 2周内进行冠状动脉造影。结果　冠心病组检查阳性 94.6% (3 5 / 3 7例 ) ,阴性 5 .4% (2 / 3 7例 ) ;非冠心病组中检查阳性 10 .6% (7/ 66例 ) ,阴性89.4% (5 9/ 66例 )。冠心病组中双核素门控心肌断层显像提示心肌缺血共 48个节段 ,其中有 3 2个在功能图像上出现室壁运动下降和 (或 )区域LVEF值降低 (66.7% )。冠心病组LVEF(% ) ,EDV(mL)和ESV(mL)分别为 5 2 .3 3± 16.2 6,70 .45± 2 8.12和 3 3 .3 5± 18.86,非冠心病组分别为 61.76± 9.3 8,60 .45± 18.18和 2 3 .3 0± 11.0 9,两组之间比较P <0 .0 1(t=2 .96) ,P <0 .0 5 (t =2 .5 5 ) ,P <0 .0 5 (t =2 .67)。其中 3 8例与冠状     

99Tcm-枸橼酸盐和99Tcm(Ⅴ)-DMSA显像诊断急性化脓性骨关节炎

目的　探讨99Tcm 枸橼酸盐和99Tcm(Ⅴ ) 二巯基丁二酸 (DMSA)显像对急性化脓性骨关节炎的诊断价值。方法　 17例急性化脓性骨关节炎患者和 19例非化脓性骨关节病患者分别行99Tcm 亚甲基二膦酸盐 (MDP)、99Tcm 枸橼酸盐和99Tcm(Ⅴ ) DMSA显像 ,行半定量分析。结果　 3种显像剂在急性化脓性骨关节炎病灶处均有明显趋骨性浓集 ;非化脓性骨关节病病灶处99Tcm MDP和99Tcm(Ⅴ ) DMSA有明显趋骨性浓集 ,99Tcm 枸橼酸盐仅有轻度趋骨性浓集 ,后者还可见周围软组织放射性浓集。半定量分析示 ,急性化脓性骨关节炎99Tcm 枸橼酸盐显像靶与非靶组织 (L N)比值 (2 30 0± 0 0 94 )明显高于非化脓性骨关节病 (1 2 98± 0 0 5 4 ,P <0 0 1) ;99Tcm(Ⅴ ) DMSA显像L N比值分别为 3 4 95±0 180和 3 0 91± 0 0 91,差异无显著性 (P >0 0 5 )。结论　联合应用99Tcm 枸橼酸盐和99Tcm(Ⅴ ) DMSA或99Tcm MDP显像能无创地评估骨组织炎症的病理生理状态。99Tcm 枸橼酸盐显像可显示骨组织炎症累及范围 ,而后两者可显示炎症所致骨组织代谢增高范围。     

定量门控~(99)Tc~m-tetrofosmin心肌显像测量左室功能

目的　探讨定量门控 (QG) 99Tcm tetrofosmin心肌显像测量左室功能的临床应用价值。方法　 74例受试者进行了门控99Tcm tetrofosmin心肌显像 ,采用QGSPECT专用分析程序全自动测量左室功能。其中 36例同时进行静息门控心室显像 ,以比较两种方法测量左室功能的相关性。结果　①74例99Tcm tetrofosminQGSPECT全自动定量测定左室功能均获成功。②QGSPECT全自动测量 36例受试者的静息左室射血分数 (LVEF)、舒张末期容积 (EDV)、收缩末期容积 (ESV)分别与静息门控心室显像计算结果显著正相关 (r分别为 0 .85 9,0 .914,0 .95 0 ,P均 <0 .0 0 1) ,重复性好。③心肌缺血组 (n =2 8)静息LVEF与对照组 (n =2 3)比较差异无显著性 ,而心肌梗死组 (n =9)静息LVEF明显低于对照组 (t=6 .33,P <0 .0 0 1)。结论　定量门控心肌显像99Tcm tetrofosmin能准确评价左室功能     

~(99)Tc~m-MIBI心肌灌注断层显像在急诊治疗急性心肌梗死中的作用

目的　比较直接冠状动脉 (简称冠脉 )内支架置入和静脉溶栓疗法在急性心肌梗死(AMI)治疗中的效果。方法　 42例急诊入院AMI患者 ,随机分为冠脉内支架组 2 3例 ,静脉溶栓组 19例。两组患者均于梗塞相关动脉 (IRA)再通治疗前和后行99Tcm 甲氧基异丁基异晴 (MIBI)心肌SPECT显像。将左室心肌分为 2 0个节段 ,并对心肌摄取99Tcm MIBI的程度进行打分 ,分别计算治疗前心肌显像的总积分 (SBS)、治疗后心肌显像的总积分 (SAS)和两者相减的积分 (SDS)。结果　直接冠脉内支架组与溶栓组比较 :SBS为 41 3± 9 8和 39 4± 7 9(t=1 2 ,P >0 0 5 ) ,SAS为 17 8± 6 4和 2 7 3±6 7(t=5 8,P <0 0 1) ,SDS为 2 4 5± 4 2和 12 2± 2 3(t =7 3,P <0 0 1)。在冠脉内支架组的总共46 0个心肌节段中 ,IRA再通治疗前有 193个 3分和 4分节段 ,治疗后有 10 6个改善至 0分 (5 4 9% )。在溶栓组的总共 380个心肌节段中 ,溶栓前有 149个 3分和 4分节段 ,溶栓后有 6 1个节段改善至 0分(4 0 9% ) ,两组间的完全改善率差异有极显著性 (P =0 0 14)。结论　在AMI的急诊治疗中 ,直接冠脉内支架置入的疗效明显优于静脉溶栓疗法 ;99Tcm MIBI心肌SPECT显像可对AMI患者IRA再通治疗疗效进行可靠的无创性评价。     

葡萄糖负荷对细菌性兔骨关节炎动物模型摄取99Tcm(Ⅴ)-DMSA及其生物分布的影响

目的　探讨葡萄糖负荷影响99Tcm(Ⅴ ) 二巯基丁二酸 (DMSA)在细菌性骨关节炎症处浓集的可能机制。方法　自制细菌性兔骨关节炎动物模型 ,葡萄糖负荷下分别用感兴趣区技术和百分注射量分析法 ,分析葡萄糖负荷对99Tcm(Ⅴ ) DMSA生物分布及骨关节炎症处摄取和滞留99Tcm(Ⅴ ) DMSA的影响。结果　葡萄糖负荷对99Tcm(Ⅴ) DMSA全身生物分布没有明显影响 ,明显提高细菌性骨关节炎症区99Tcm(Ⅴ ) DMSA摄取水平 ,其 6h患侧与健侧比值 :显像分析法为对照组 2 882± 0 52 5,实验组 3 487± 0 53 5(P <0 0 5) ;百分注射量分析法为对照组 3 153± 0 3 3 4 ,实验组 5 0 71± 1 780 (P <0 0 5)。结论　葡萄糖负荷可提高骨组织炎症区99Tcm(Ⅴ ) DMSA摄取水平     

AMI患者直接与择期PTCA术后心肌活性及左室功能的研究

目的　比较直接与择期经皮冠状动脉腔内成形术 (PTCA)对急性心肌梗死 (AMI)后患者心肌活性及左室功能的影响。方法　采用双探头符合线路SPECT ,分别对 2 4例经直接PTCA治疗 (直接PTCA组 )和 2 2例经择期PTCA治疗 (择期PTCA组 )的AMI患者于PTCA术后 10～ 2 0d进行99Tcm 甲氧基异丁基异腈 (MIBI)门控心肌断层显像 ,并在 1周内完成心肌1 8F 脱氧葡萄糖 (FDG)符合线路显像。将MIBI摄取明显减低或无摄取而FDG摄取明显改善的心肌节段判定为存活心肌。结果　直接PTCA组与择期PTCA组的心肌灌注减低节段分别为 16 .2 % (35 2 16个 )和 2 8.3% (5 6 198个 ) ,2组比较差异有显著性 (χ2 =8.8,P <0 .0 1) ;存活心肌节段分别为 77.1% (2 7 35个 )和 5 3.6 % (30 5 6个 ) ,2组比较差异有极显著性 (χ2 =18.4 ,P <0 .0 0 1) ;左室射血分数 (LVEF)分别为 (6 5 .4± 9.8) %和 (5 1.2±10 .3) % ,2组比较差异有显著性 (t=2 .5 ,P <0 .0 5 )。结论　直接PTCA能更有效地增加心肌血流灌注 ,并可更多地挽救AMI患者的存活心肌和保护心脏功能。     

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.     

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.     

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）