~(99)Tc~m-P53运动/静息门控心肌灌注显像TID比值在X综合征患者临床价值

目的采用99Tcm-P53运动/静息门控心肌灌注显像计算左心腔短暂性缺血性扩张(TID)比值的正常值,并探讨对X综合征患者内膜下缺血的诊断价值。方法 X综合征组52例,冠状动脉造影或冠脉CT正常,而有典型的劳力性心绞痛症状;健康对照组由58例健康成年人组成,无糖尿病、高血压。均行核素99Tcm-P53运动/静息门控心肌灌注显像。采用西门子QGS软件对图像进行定量分析,计算TID比值。结果 X综合征组中TID比值为1.19±0.30,对照组中TID比值为0.79±0.19。以1.20为TID比值的正常上限值,X综合征患者内膜下缺血的检出率为61.2%。结论以TID比值1.20为正常截断值,是发现X综合征患者内膜下缺血的有效方法,补充并扩展了心肌灌注显像现有结果,是一种方便有效的指标。     

心肌显像联合冠状动脉造影及组织学检查在评价Ad-HGF治疗猪心肌梗死疗效中的价值

目的探讨心肌静息显像联合冠状动脉造影及组织学检查在评价重组腺病毒-肝细胞生长因子（Ad—HGF）治疗猪实验性心肌梗死中的价值。方法低、中、高剂量Ad—HGF治疗组[Ad-HGF剂量依次为10^8，4×10^8，5×10^9空斑形成单位（PFU）／点；均分10点注射]，生理盐水对照组及空白对照组小型猪各5头，分别于治疗前后行静息心肌显像及冠状动脉造影，并于治疗后行组织学检查。结果空白对照组及生理盐水对照组治疗前后心肌灌注及Rentrop评分无明显变化。各Ad-HGF治疗组治疗后心肌灌注及Rentrop评分较治疗前改善，低、中、高剂量组治疗前后冠状动脉左回旋支（LCX）供血节段得分分别为7．8±1．3和16．4±1．1（低），8．2±1．6和17．6±0．9（中），8．4±1．5和19．0±0．7（高）；各组治疗前后LCX供血区域Rentrop评分分别为0．80±0．16和1．66±0．15（低），0．94±0．11和2．16±0．11]（中），0．90±0．22和2．22±0．19（高）。3组治疗前后数据比较差异均有统计学意义（P〈0．01）。各Ad-HGF治疗组及空白对照组治疗后血管数量明显多于生理盐水对照组。结论用心肌静息显像联合冠状动脉造影及组织学检查评价Ad-HGF治疗猪心肌梗死的疗效有价值。     

门控~（99m）Tc－MIBI心肌断层显像诊断多支冠状动脉病变和心肌缺血

目的：评价门控心肌显像诊断冠心病（ＣＡＤ）的临床意义。方法：对３２例ＣＡＤ患者的９９ｍＴｃ—甲氧基异丁基异腈（ＭＩＢＩ）门控。非门控心肌断层显像和冠状动脉造影进行了比较，以及对４０例ＣＡＤ患者的门控与常规潘生丁─静息心肌断层显像也作了比较。结果：１．门控与非门控显像法诊断ＣＡＤ的灵敏度和特异性无差别，但前者对检测病变冠状动脉和诊断多支冠状动脉病变性ＣＡＤ的灵敏度高于后者，而特异性无差别。２．射血分数（ＥＦ）值显著影响非门控图像的病变显示。３．与非门控显像比较，门控显像能观察到更多的再分布节段和较少的无再分布节段。静息门控心肌显像除发现较多的灌注异常外，还观察到了许多单纯收缩功能受损节段。后者虽然可判断８４％的灌注再分布节段，但特异性不高。结论：门控心肌断层显像对诊断ＣＡＤ无优势，但对诊断ＥＦ值较高的或多支冠状动脉病变性ＣＡＤ、检测病变冠状动脉和心肌缺血有一定价值。     

负荷-静息心肌灌注显像对老年人冠心病的诊断价值

目的探讨负荷-静息心肌灌注显像对老年人冠心病的诊断价值。方法205例疑诊冠心病的老年患者[≥60（67±5）岁],行^99Tc^m-甲氧基异丁基异腈（MIBI）负荷-静息心肌灌注显像（运动负荷185例,药物负荷20例）和冠状动脉造影检查,排除曾行经皮冠状动脉介入治疗（PCI）及冠状动脉旁路移植术（CABG）者。以冠状动脉造影为“金标准”,评价负荷-静息心肌灌注显像诊断老年冠心病的灵敏度、特异性和准确性。采用SPSS 15．0软件对数据行χ^2检验。结果以冠状动脉管腔狭窄〉50％作为诊断标准,205例患者中冠状动脉造影阳性57例（28％）,其中单支病变30例,双支病变19例,三支病变8例。冠状动脉造影结果阳性的患者中核素负荷-静息心肌灌注显像异常者36例;冠状动脉造影阴性148例（72％）患者中,负荷-静息心肌灌注显像正常者135例。对照冠状动脉造影结果,负荷-静息心肌灌注显像对老年人冠心病总的诊断灵敏度63％（36／57）,特异性91％（135／148）,准确性83％（171／205）;对单支、双支以及三支病变的诊断灵敏度分别为57％（17／30）、58％（11／19）和8／8。行运动负荷显像患者185例,按照运动试验是否达到目标心率分为2组：组1运动试验高峰心率达到目标心率,共53例（29％）;组2运动试验高峰心率未达到目标心率,共132例（71％）。2组心肌灌注显像诊断冠心病的灵敏度分别为81％（13／16）和58％（22／38）。组1诊断灵敏度高于组2,但经χ^2检验,两者之间差异无统计学意义（χ^2=2．69,P=0．1）。结论负荷-静息心肌灌注显像是诊断老年人冠心病的可靠方法;当运动负荷达到目标心率时,核素心肌灌注显像诊断冠心病的灵敏度较高。     

门控心肌SPECT显像三种定量分析软件测定左心室容积和射血分数的比较

目的研究定量门控心肌断层显像（QGS）、爱莫瑞心脏工具箱（ECToolbox）和四维模型心肌断层显像（4D-MSPECT）3种定量分析软件所测左心室射血分数（LVEF）、舒张末期容积（EDV）和收缩末期容积（ESV）的相关性以及与左心室造影之间的相关性。方法临床疑诊或确诊冠心病患者212例均行99^Tc^m-MIBI门控心肌SPECT显像，并分别以QGS、ECToolbox和4D-MSPECT软件处理得LVEF1、EDV1、ESV1。其中106例患者行左心室造影，分别测得LVEF2、EDV2、ESV2。比较3种软件之间及其与左心室造影之间的相关性。结果3种软件所测LVEF1、EDV1、ESV1的相关性好，所测LVEF1值的r值为0．89～0．91（P均〈0．001），EDV1、ESV1值的r值为0．97～0．98（P均〈0．001）。对于LVEF1和EDV1，QGS、ECToolbox、4D-MSPECT所测值间的差异具有统计学意义（P〈0．001）。QGS所测值[LVEF1：（59．2±11．4）％、EDV1：（88．8±35．5）ml]低于4D-MSPECT所测值[LVEF1：（64．2±12．6）％、EDV1：（98．1±39．5）ml]，4D—MSPECT所测值又低于ECToolbox所测值[LVEF1：（68．3±12．8）％、EDV1：（108．2±39．0）ml]；而对于ESV1，QGS[（39．0±27．0）ml]、ECToolbox[（37．9±31．4）ml]与4D—MSPECT[（38．7±31．3）ml]所测值之间差异无统计学意义（P=0．92）。门控心肌SPECT显像与左心室造影所测LVEF2、EDV2、ESV2的相关性好，r值分别为0．70～0．80，0．57～0．61和0．87—0．89（P均〈0．001）。结论3种门控SPECT定量分析软件所测值之间及与左心室造影的相关性均较好。     

蒽环类抗肿瘤药化疗患者心肌99Tcm-MIBI清除率变化

目的探讨用蒽环类抗肿瘤药（ATC）化疗患者心99^Tc^m-MIBI清除率变化及其在ATC心脏毒性监测中的价值。方法14例接受ATC化疗的患者化疗前和化疗第6周期后1周行99^Tc^m-MIBI静态平面及门控SPECT显像。比较化疗前后99^Tc^m-MIBI早期与晚期清除率及左心室射血分数（LVEF）的差异。结果ATC治疗患者化疗前早期及晚期心肌99^Tc^m-MIBI清除率分别为（17．92±5．86）％和（17．05±5．17）％，化疗后为（21．27±7．14）％和（19．67±6．41）％，化疗前后相比差异均有统计学意义（t值分别为-2．611，-2．824，P均〈0．05）。化疗前后LVEF变化差异无统计学意义（t=1．719，P〉0．05）。结论ATC化疗患者心肌99^Tc^m-MIBI清除率的变化有助于监测ATC所致的心肌损害，且其早于LVEF的改变。     

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。     

门控^99mTc—MIBI心肌断层显像诊断多支冠状动脉病变和心肌缺血

目的：评价门控心肌显像诊断冠心病（ＣＡＤ）的临床意义。方法：对３２例ＣＡＤ患者的＾９９ｍＴｃ－甲氨基异丁基异腈（ＭＩＢＩ）门控、非门控心肌断层显像和冠状动脉造影进行了比较，以及对４０例ＣＡＤ患者的门控与常规潘生丁－静息心肌断层显像也作了比较。结果：１．门控与非门控显像法诊断ＣＡＤ的灵敏度和特异性无差别，但前者对检测病变冠状动脉和诊断多支冠状动脉病变性ＣＡＤ的灵敏度高于后者，而特异性无差别。２．射血     

SPECT／CT显像评价“功能相关冠状动脉病变”的价值

目的探讨SPECT／CT显像评价“功能相关冠状动脉（简称冠脉）病变”的可行性及临床价值。方法40例可疑或确诊冠心病患者同机完成^99Tcm-甲氧基异丁基异腈（MIBI）负荷／静息心肌灌注断层显像和冠脉CT造影（CTCA）。负荷／静息心肌灌注显像采用标准二日法,首日行腺苷负荷心肌灌注显像,次日行静息心肌灌注显像及CTCA。腺苷按患者体质量以0．84mg·kg^-1·min^-1经静脉泵匀速给药,CTCA使用标准自动对比剂跟踪扫描程序完成。通过专用融合软件将心肌血流灌注与冠脉三维成像图融合,评价心肌缺血与冠脉病变的相关关系,确定“功能相关冠脉病变”。结果40例患者,CTCA正常20例,异常20例;120支冠脉中共检出33支病变血管,累及左前降支15支,左回旋支9支,右冠脉9支。心肌灌注显像正常22例,心肌缺血和（或）心肌梗死18例。SPECT心肌灌注和CTCA融合图像显示供血区心肌血流灌注正常且无狭窄冠脉占总的无狭窄冠脉的92．47％（86／93）,狭窄〈75％的冠脉中,其供血区心肌缺血或梗死的阳性率占42．86％（6／14,例）,狭窄〉75％或闭塞冠脉中,其供血区心肌缺血的阳性率占92．31％（12／13,例）。120支冠状动脉中20．83％（25／120,支）的病变冠脉为“功能相关冠脉病变”,检测出27例患者中25．93％（7／27,例）有无狭窄病变的冠脉导致心肌缺血;使15．38％（2／13,例）冠脉病变患者免除有创性诊断检查;指导对42．86％（6／14,例）的狭窄〈75％冠脉行药物治疗或冠脉血管重建术治疗;为1支狭窄〉75％的冠脉无需行血管重建术提供依据。结论SPECT／CT心肌灌注和CTCA融合显像可确定“功能相关冠脉病变”,可提供综合信息诊断冠心病和指导治疗。     

低负荷201Tl/静息99Tcm-MIBI双核素心肌断层显像诊断冠心病

目的探讨低负荷-再分布201Tl/静息99Tcm-甲氧基异丁基异腈(MIBI)双核素心肌断层显像在冠心病诊断中的临床价值.方法对101例临床怀疑有冠心病的患者进行低剂量多巴酚丁胺负荷-再分布201Tl/静息99Tcm-MIBI同时心肌断层显像,图像断层重建后进行定量靶心图测定,并与正常数据进行对照,由2位以上有经验的核医学科医师进行图像分析.断层显像后2周内101例患者均行冠状动脉造影,其中54例冠状动脉造影正常,26例有1支动脉病变,15例有2支动脉病变,6例有3支动脉病变.结果①多巴酚丁胺负荷试验,每节段负荷时间维持约2 min,负荷后心率仅达到目标心率的(72±17)%.②以动脉狭窄>50%作为冠心病的判断标准,低负荷-再分布201Tl/静息99Tcm-MIBI同时心肌断层显像法诊断冠心病的灵敏度、特异性、准确性分别为93.62%、85.19%和89.11%.③对狭窄动脉检出率由高到低依次为左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA),其灵敏度、特异性、准确性分别为91.89%、82.81%、86.14%;80.00%、82.72%、82.18%和76.47%、82.14%、81.19%.④74支病变冠状动脉中21支为不可逆性放射性缺损,53支为可逆性放射性再分布.⑤53支可逆性放射性再分布的病变动脉中,8支负荷201Tl显像和静息99Tcm-MIBI显像示放射性稀疏缺损,而再分布或再注射201Tl显像见放射性填充,提示存在"冬眠心肌".结论在较低多巴酚丁胺负荷状态下,负荷-再分布201Tl/静息99Tcm-MIBI同时心肌断层显像法仍是一种有效的诊断冠心病及检出病变冠状动脉的方法.     

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）