153 Sm-柠檬酸-羟基磷灰石滑膜切除术治疗类风湿关节炎膝关节积液

目的观察^153Sm-柠檬酸-羟基磷灰石（HA）滑膜切除术治疗类风湿关节炎（RA）持续性膝关节积液的疗效和安全性.方法常规抗风湿药物治疗无效的RA患者43例,共67个持续性积液的膝关节,行^153Sm-柠檬酸-HA滑膜切除术,观察其疗效和不良反应.结果注射后24 h 8例患者关节外放射性泄漏占注射总量的百分比均＜1%.随访至治疗后3、6、12、24和36个月,总有效率分别为65.7%、85.1%、77.6%、64.2%和56.7%.随访至36个月时,治疗有效的关节复发率为33.3%.治疗有效的关节表现为肿痛缓解,积液量减少,滑膜厚度减小,关节功能活动改善.不良反应主要为一过性关节肿痛加重.结论^153Sm-柠檬酸-HA滑膜切除术治疗RA持续性膝关节积液短期、中期疗效及安全性较好.     

153Sm-HA用于关节滑膜切除的实验研究

目的 探讨^153Sm-柠檬酸．羟基磷灰石(HA)对抗原诱导关节炎动物模型兔关节滑膜切除的价值。方法 30只新西兰大白兔随机分为正常对照组(A组)，抗原诱导关节炎^153Sm-HA未治疗组(B组)及治疗组(C、D组)，用核素显像方法检测其关节腔内注射^153Sm-HA后关节内滞留率及生物学分布，并进行组织病理学观察。结果 A组与C组注射^153Sm-HA后3、6d关节腔内滞留率分别为97．7％、93．5％和98．4％、95．1％；A组和C组3和6d关节外漏出率分别为0．17、0．31％ID／g和0．065、0．0912％：ID／g。组织病理学检查示治疗组较未治疗组滑膜炎症明显好转。结论 ^153Sm-HA滑膜切除术漏出率低，在关节内能均匀分布，与炎性滑膜组织亲和力强，安全性高，可有效治疗慢性滑膜性关节炎。     

关节镜下滑膜切除术治疗膝滑膜结核的临床分析

目的：探讨关节镜下滑膜切除术治疗膝滑膜结核的疗效。方法：对我院1990年1月至2003年7月的23例膝关节滑膜结核的患者在关节镜下行滑膜切除术并取组织送病理检查。结果：术后经随访16—36个月，患者功能恢复良好，症状消失，优良率达到96．3％。结论：关节镜下滑膜切除术治疗膝关节滑膜结核是一种安全有效的治疗方法。     

超声检测类风湿关节炎膝关节滑膜改变及其血流的临床应用价值

目的：通过观察类风湿关节炎（rheumatoid arthritis ,RA ）膝关节滑膜病变的超声声像图表现,分析滑膜病变超声检查结果与RA活动度的相关性,探讨超声检查RA膝关节滑膜病变的临床应用价值。方法对38例RA患者患侧膝关节和20例正常对照者双侧膝关节行超声检查,根据DAS28评分结果将RA患者分组,分别对比各组与对照组的滑膜厚度,髌上囊积液;分析RA组超声检测结果与DAS28评分之间的相关性。结果 RA组滑膜厚度较对照组明显增厚,髌上囊积液明显增多（ P ＜0．05）。RA组膝关节滑膜厚度、关节积液及滑膜内血流信号分级与RA患者DAS28评分之间存在一定的相关性（ P ＜0．05）。结论超声检查对RA膝关节滑膜病变具有一定的的诊断价值,与DAS28评分的相关性较好,可以作为评估RA膝关节滑膜病变常规检查方法之一。     

类风湿性关节炎的研究进展

类风湿性关节炎（Rheumatoid Arthrits．RA）是以关节滑膜慢性炎症为主的自身免疫性疾病，能引起关节肿痛。继而导致软骨破坏，关节间隙变窄，晚期关节畸形，最终出现不同程度的残疾。根据统计表明，RA在全世界均有发病，平均发病率为1％。而我国患病率为0．3％-0．4％。苫未及时诊治，70％患者2年后可致残．平均寿命缩短10～15年。在临床上为了防止和减缓关节的破坏和改善患者的长期患病状况，在过去的几卜年里都是趋向于应用改善疾病的抗风湿药物（disease—modifying anti—rheumatic drugs，DMARDs），得到了很好的疗效.     

153Sm-EDTMP治疗多发性骨转移癌的临床观察

目的 评价放射性核素^153Sm-2乙二胺四甲基膦酸（^153Sm-EDTMP）治疗骨转移癌的疗效及其对造血功能的影响。方法 静脉注射^153Sm-EDTMP，每次0．5-1．5mCi／kg体重。观察治疗前、后患者的生活质量、病灶及血细胞的变化。结果 患者疼痛完全缓解率（CR）32．5％（13／40）；部分缓解率（PR）50％（20／40）；疾病进展（PD）17．5％（7／40）；总有效率82．5％。单一应用^153Sm-EDTMP，剂量≤1mCi的患者。对造血功能影响较小，一般于治疗后4周基本恢复。剂量〉1mCi或与化疗联合应用的患者，对造血功能影响较大，需用G-CSF或输血（包括脐血）治疗，约治疗后6周才能恢复。结论 ①^153Sm-EDTMP是比较理想的治疗多发性骨转移癌的放射性核素之一，具有控制病情发展、消除骨转移灶，改善患者生活质量的作用；②^153Sm-EDTMP治疗后可使患者血象一过性降低。剂量〉1mCi，连续治疗2次以上者可诱发全血减少；③脐血有恢复射线所致的造血功能损伤的作用。     

膝关节类风湿关节炎的MRI

目的：评估MRI对膝关节类风湿关节炎（RA）各种病变的显示能力及其对临床诊治的意义。材料和方法：对24例RA患者的41个膝关节进行多种序列MR成像，分析其MR表现。结果：所有膝关节均发现存在不同程度MR异常改变（100％）。主要影像学表现包括滑膜增生与血管翳形成、关节囊积液、关节软骨与骨质受侵破坏、半月板与韧带异常、Guo窝囊肿及皮下结节形成等。MR尚能通过血管翳的信号和强化程度判断疾病是否处于活动期。结论：MRI能直接显示膝关节RA不同时期的各种病变。根据MRI表现进行分期不仅可为临床提供诊断依据，还可辅助临床选择适当的治疗方案。     

关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的短期临床疗效分析

目的：探讨关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的短期临床疗效。方法自2007年1月～2011年1月对7例弥漫型色素沉着绒毛结节性滑膜炎患者进行了全滑膜切除术,并进行了2～5年的临床随访。结果7例患者均完全获得随访,平均随访时间32月。6例患者术后症状、功能得以明显改善,1例患者术后2月出现复发,再次进行关节镜下全滑膜切除术,术后联合局部放疗,截止末次随访为止,未见复发。 Ly－sholm关节功能评分由术前（41．21±12．32）分提高到（83．25±5．10）分（P＜0．05）,较术前关节功能评分具有显著性差异。结论关节镜治疗弥漫型色素沉着绒毛结节性滑膜炎损伤少、恢复快,复发率低,短期临床疗效满意。     

超微超顺磁性氧化铁粒子增强MRI监测兔抗原诱导性膝关节炎的初步研究

目的探索超微超顺磁性氧化铁粒子（USPIO）增强MRI监测兔抗原诱导性膝关节炎的可行性及理想成像序列。方法9只雌性新西兰大白兔，后腿右膝关节（简称右膝关节）腔注入甲基化小牛血清蛋白（mBSA）0．5ml（2mg／ml）诱导关节炎模型，后腿左膝关节（简称左膝关节）作为对照。另选3只制成假模型组。模型成功后9～28d（平均21．3d）经静脉注入USPIO（0．3ml／kg），分别于增强前、增强后24h行MRI扫描，其中2只于48、72h再行MRI扫描。扫描方案包括T1WI、FSE T2WI、短时反转恢复（STIR）序列及梯度回波（GRE）T2^＊ WI。测量USPIO增强前后滑膜的信噪比（SNR）及SNR变化（△SNR），行配对t检验，并与病理结果相对照。结果9只大白兔右膝均成功诱导关节炎模型，病理显示滑膜增生，血管翳形成，有大量吞噬USPIO的滑膜巨噬细胞浸润；MRI示滑膜增厚，厚度为（2．07±0．97）mm；关节囊积液。注射USPIO后24h，T1WI信号升高[△SNR为（41．91±27．94）％]，T2WI和T2^＊ WI信号下降[△SNR分别为（-34．92±11．77）％和（-57．24±16．05）％]，各序列增强前后SNR差异有统计学意义（P〈0．05）。注射后48h，信号强度开始恢复，72h信号基本同增强前。模型组左膝关节及假模型组双膝关节滑膜正常，关节囊无明显积液。结论滑膜巨噬细胞吞噬氧化铁粒子是引起USPIO增强MRI信号改变的基础，GRE序列是反映USPIO增强效应的敏感序列。     

强直性脊柱炎核素关节显像

目的 探讨^99Tc^m-人免疫球蛋白（HIgG)与99Tc^m-亚甲基二膦酸盐（MDP）关节显像在强直性脊柱炎（AS）中的应用价值。方法 对经确诊的21例AS和18例活动期类风湿关节炎（RA）患者行^99Tc^m-HIgG全身显像，其中12例AS患者行^99Tc^m-MDP显像。结果 ①21例AS患者中20例^99Tc^m-HIgG显像示骶髂关节异常放射性增高；44个有临床症状或体征的外周关节中，32个显像异常，临床符合率75％，无一例累及手部小关节。②18例活动期RA患者^99Tcm-HIgG显像均有手部关节的异常改变，无一例累及骶髂关节。③12例AS患者^99Tc^m-HIgG与^99Tc^m-MDP显像比较显示：前者有11例骶髂关节异常放射性分布增高，而后者显像异常仅7例。31个临床累及的外周关节中，^99Tc^m-HIgG显像阳性24个，^99Tc^m-MDP显像异常16个，与临床符合率分别为77．4％和51．6％，差异有显著性（P＜0．025）。结论 ^99Tc^m-HIgG显像能较^99Tc^m-MDP显像更为准确地探测AS患者病变关节的炎症改变，帮助临床早期明确诊断。     

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.     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme