对缺氧代谢敏感的鼠心肌线粒体膜99Tcm-MIBI特异性结合蛋白的研究

目的　探讨99Tcm 甲氧基异丁基异腈 (MIBI)心肌线粒体非膜电位依赖性结合机制。方法　分离SD大鼠心肌线粒体片段和制作心肌超薄切片。用薄层层析法 (TLC)和SDS聚丙酰胺凝胶电泳法 (SDS PAGE)分析99Tcm MIBI特异性结合蛋白。采用有氧 缺氧 再给氧程序分析99Tc MIBI对心肌摄取和清除99Tcm MIBI的影响。结果　在TLC上可见 2个结合99Tcm MIBI计数峰。其中之一Kd 值为 (5 8± 1 7)nmol/L ,Bmax值为 (11 5± 3 1)pmol/mg蛋白质。此结合能被 2 0 μmol/L99Tc MIBI持久替代 ,被 5 0 μmol/L环孢素A短暂替代。在SDS PAGE上展现出 3个99Tcm MIBI标记蛋白质 ,相对分子质量分别为 4 3× 10 4、2 3× 10 4和 1 0× 10 4。未结合的游离99Tcm MIBI仅为 1 6%。 15 μmol/L99Tc MIBI明显加速心肌清除99Tcm MIBI,而不影响其摄取。缺氧代谢也能促进心肌清除99Tcm MIBI,但与99Tc MIBI有协同作用。结论　鼠心肌线粒体膜存在 1种对缺氧代谢敏感的99Tcm MIBI特异性结合蛋白 ,该蛋白质至少包括 2种亲和力和功能不同的蛋白质亚基     

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     

~(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。     

运动99Tcm-MIBI心肌显像左室暂时性扩大诊断冠状动脉病变的价值

目的　探讨定量分析运动99Tcm 甲氧基异丁基异腈 (MIBI)心肌显像左室暂时性扩大诊断冠状动脉 (简称冠脉 ) 3支病变的价值。方法　 76例拟诊冠心病患者 ,平均年龄 (6 1± 8 3)岁。间隔1个月内完成运动 静息99Tcm MIBI心肌断层显像和冠脉造影检查。根据心肌短轴断层影像直径方向剖面曲线 2个峰值点间的距离计算左心腔面积 (LVD) ,以运动 /静息LVD比值 (LVDR)作为判断左心腔暂时性扩大的指标。结果　冠脉造影正常组、冠脉 1支病变、2支病变和 3支病变组LVDR平均值分别为 1 0 1± 0 0 5、1 0 2± 0 0 5、1 0 5± 0 0 4和 1 13± 0 0 6。 76例拟诊冠心病患者中左室暂时性扩大者 2 1例 ,其中 ,有冠脉 3支病变者 19例 (90 % )。LVDR值诊断冠脉 3支病变的灵敏度和特异性分别为 82 %和 94% ,常规分析方法分别为 5 0 %和 91%。其灵敏度显著高于常规分析方法 (χ2 =4 96 ,P <0 0 5 ) ,特异性差异无显著性 (χ2 =1 31,P >0 0 5 ) ,2种分析方法结合 ,灵敏度进一步提高 ,而特异性无显著下降。结论　定量分析运动99Tcm MIBI心肌显像左心腔暂时性扩大可提高其诊断冠脉 3支病变的灵敏度 ,不降低其特异性 ,LVDR值是诊断冠脉 3支病变的 1个新的有用指标。     

~(99)Tc~m-MIBI和电子束CT测定左室射血分数结果比较

方法 :用 99Tcm -甲氧基异丁基异腈 ( MIBI)和电子束 CT检查了 2 5例初次患左室有 Q波前壁急性心肌梗死病人。按 99Tcm- MIBI心肌灌注显像结果 ,梗死心肌占左室心肌重量的 ( 30± 2 1) %。检查在梗死发生后 9± 6天进行 ,两法相隔平均 1.0天。其中 14例做过 2次检查 ,共有 39对结果可供比较。99Tcm - MIBI首次通过法核素心血管造影取时间活性曲线 ,删除最初和最末一个心动周期计数 ,取中间 6个心动周期的计数进行平均值计算。电子束 CT用 Imtron C- 10 0扫描仪 ,每秒 17帧 ,平均每例取 9± 1个横轴切面 ,切面厚度为0 .8cm ,切面间…     

99TCm-MIBI联合67Ga心肌显像诊断小儿病毒性心肌炎

目的　探讨99Tcm 甲氧基异丁基异腈 (MIBI)心肌灌注显像联合6 7Ga心肌显像诊断小儿病毒性心肌炎 (VMC)的价值。方法　 78例VMC患儿 ,其中急性期 (<6个月 ) 4 5例 ,慢性期 (>6个月) 33例 ,分别行99Tcm MIBI心肌灌注显像和6 7Ga心肌显像。结果　 4 5例急性期患儿中 31例(6 8 9% ) 99Tcm MIBI心肌灌注显像出现不同程度的放射性分布异常 ,38例 (84 4 % ) 6 7Ga心肌显像示心脏部位异常放射性浓聚 ;33例慢性期患儿中 2 3例 (6 9 7% ) 99Tcm MIBI心肌灌注显像阳性 ,6 7Ga心肌显像仅10例 (30 3% )阳性。急性期两者结果差异无显著性 (P >0 0 5 ) ;慢性期两者差异有显著性 (P <0 0 5 )。结论　99Tcm MIBI心肌灌注显像联合6 7Ga心肌显像对诊断小儿VMC及观察病情演变有较高价值。     

心肌显像剂[99Tcm(CO)3(MIBI)3]+和99Tcm-MIBI药理实验对比研究

目的对心肌显像剂羰基99Tcm-甲氧基异丁基异腈(MIBI)([99Tcm(CO)3(MIBI)3]+)和99Tcm-MIBI进行动物药理对比研究.方法制备[99Tcm(CO)3(MIBI)3]+注射液,放化纯85%.实验犬3只,每次静脉注射剂量555 MBq,通过动态采集、全身显像和采集血样,获得药代动力学参数、体内生物分布、靶/非靶比值和药效学结果.结果 [99Tcm(CO)3(MIBI)3]+符合一次静脉给药的药代动力学二室模型,快相清除半衰期T(α)1/2=(1.33±0.12) min,慢相清除半衰期T(β)1/2=(102.33±25.58) min,总清除速率(CL)=(401.33±73.51) mL/h.心、肝、肺时间-放射性曲线显示[99Tcm(CO)3(MIBI)3]+肝摄取曲线幅度低于心肌曲线,而99Tcm-MIBI肝曲线明显高于心肌曲线.10、30、60、90和120 min[99Tcm-(CO)3(MIBI)3]+在心、肺、肝百分注射剂量(%ID)与99Tcm-MIBI比较,前者心肌摄取较高,肺本底较低,肝摄取低.[99Tcm(CO)3(MIBI)3]+心/肺和心/肝比值均高于99Tcm-MIBI,差异有显著性,P均<0.01.静脉注射[99Tcm(CO)3(MIBI)3]+后10～120 min均可获得清晰的心肌图像,肝胆排泄较快,肝内放射性较低,左室下壁不受肝影影响,无需脂餐促进肝胆排泄.结论 [99Tcm(CO)3(MIBI)3]+有望成为一种新的心肌灌注显像剂.     

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。     

~(99)Tc~m-MIBI运动心肌显像评价冠心病PTCA术后再狭窄

目的　拟用非创伤性方法评价冠心病经皮冠状动脉腔内成形术 (PTCA)术后冠状动脉(简称冠脉 )再狭窄。方法　对PTCA治疗后 1～ 2 4个月的 45例冠心病患者 ,静脉注射99Tcm 甲氧基异丁基异腈 (MIBI) ,观察其心肌血流灌注情况 ,结合其他临床参数 ,利用t检验、Spearman相关分析和Logistic分析等多因素评价PTCA术后再狭窄。结果　①未出现再狭窄组和再狭窄组比较 ,追踪时间、术后冠脉造影积分、术后心肌显像积分差异有显著性 ,分别为 (17.2± 7.3)和 (11.4± 7.3)个月、(8.1± 11.5 )和 (19.6± 2 0 .7)分、(0 .4± 0 .7)和 (1.0± 0 .6 )分 (P <0 .0 5 ) ;②术后冠脉造影积分与术前冠脉造影积分、术后胸痛症状和术后心肌显像积分呈显著正相关 (P <0 .0 1) ;③术后心肌显像积分和术后胸痛是预示PTCA术后再狭窄的独立危险因素。结论　99Tcm MIBISPECT运动心肌显像可为非创伤性判断PTCA术后再狭窄提供较可靠的指标。     

99Tcm-octreotide显像在乳腺癌诊断中的应用

目的　探讨99Tcm 奥曲肽 (octreotide)显像对乳腺癌诊断的临床价值。方法　 36例乳腺肿块患者 ,据手术及病理检查结果分为乳腺癌组 (19例 )和乳腺良性病变组 (17例 )。术前分次进行乳腺99Tcm octreotide及99Tcm 甲氧基异丁基异腈 (MIBI)显像 ,行定性及半定量 [放射性摄取比值 (UR)测定 ]分析。结果　99Tcm octreotide显像对乳腺癌诊断的灵敏度 (6 8 4 %)低于99Tcm MIBI (94 7%,P <0 0 5 ) ,特异性 (10 0 %)明显高于99Tcm MIBI(76 5 %,P <0 0 5 ) ,准确性 (83 3%)与99Tcm MIBI (86 1%)差异无显著性 (P >0 0 5 )。联合99Tcm octreotide与99Tcm MIBI显像特异性高 (10 0 %) ,但准确性(80 6 %)无明显变化 (P >0 0 5 )。结论　99Tcm octreotide显像对乳腺癌诊断特异性高 ,准确性与99Tcm MIBI显像无明显差别。     

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.