支气管肺癌栓塞化疗：明胶海绵与碘油

目的比较研究明胶海绵和碘油在支气管肺癌栓塞化疗术中的应用价值.材料和方法135例支气管肺癌,腺癌52例,鳞癌76例,小细胞肺癌7例.选择性支气管动脉插管造影确认肿瘤血供,分别在支气管动脉干或超选择肿瘤血管支内行明胶海绵栓塞化疗术或碘油栓塞化疗术.结果明胶海绵组85例,均在支气管动脉主干栓塞,伴23例共干的肋间动脉同时栓塞.碘油组50例,肿瘤血管支内栓塞41例,9例支气管动脉干栓塞者有3例共干肋间动脉.碘油组的有效率(CR+PR率)显著高于明胶海绵组(76%55.3%,p＜0.05).碘油组并发症包括脊髓缺血症状、肋间动脉缺血症状和肺动脉栓塞症状,发生率也显著高于明胶海绵组(12%2.4%,p＜0.05),后者仅出现肋间动脉缺血症状,上述并发症经治疗后缓解.选择性肿瘤血管内化疗栓塞者无并发症发生.结论碘油栓塞化疗术治疗支气管肺癌的近期疗效优于明胶海绵栓塞化疗术.明胶海绵栓塞化疗术较安全,碘油化疗栓塞术宜在超选择性肿瘤血管插管的基础上谨慎施行.     

支气管动脉栓塞术并发症分析

目的　研究支气管动脉栓塞术并发症及其相关因素。方法　 1 61例患者 ,大咯血 2 6例 ,支气管肺癌 1 35例。行选择性支气管动脉插管造影确认病变血供 ,分别在支气管动脉干或支气管动脉分支超选择插管下行栓塞术或栓塞化疗术 ,栓塞物质为明胶海绵颗粒、PVA和碘油。结果　并发症发生率 6 .2 % ,包括脊髓缺血 (1 .2 2 % )、肋间动脉缺血 (3 .7% )、肺动脉栓塞 (1 .2 % )。脊髓缺血和肋间动脉缺血均发生在支气管动脉主干栓塞者。脊髓缺血见于PVA组和碘油组 ,肺动脉栓塞见于碘油组 ,而肋间动脉缺血在各栓塞物质组均有发生。结论　支气管动脉栓塞术宜谨慎施行 ,使用同轴导管技术超选择性插管值得推荐 ,明胶海绵颗粒是相对安全的栓塞物质     

非小细胞肺癌栓塞化疗术并发症分析

目的回顾分析非小细胞肺癌栓塞化疗术的并发症及其相关因素。方法非小细胞肺癌135例,行选择性支气管动脉插管造影确认病变血供,分别在支气管动脉主干或超选择性支气管动脉分支行灌注化疗加栓塞术。灌注化疗方案为三联药物:卡铂300mg,丝裂霉素10～20mg或表阿霉素40～60mg,5-FU1000mg。栓塞材料为明胶海绵颗粒或碘油。结果并发症发生率5.9%,包括脊髓缺血1例(0.7%)、肋间动脉缺血5例(3.7%)、肺动脉栓塞2例(1.5%)。经治疗后均于1～4周内缓解。脊髓缺血和肋间动脉缺血均发生在支气管动脉主干栓塞者。脊髓缺血和肺动脉栓塞仅见于碘油组,而肋间动脉缺血在明胶海绵颗粒组也有发生。结论支气管动脉栓塞术宜谨慎施行,超选择性支气管动脉插管及明胶海绵颗粒栓塞相对安全。     

DSA引导下肋间动脉栓塞法分度建立犬脊髓缺血模型及扩散加权成像初步研究

目的 采用DSA引导下肋间动脉栓塞法分度建立犬脊髓缺血模型并进行磁共振扩散成像（DWI）的初步应用。方法 9只犬采用完全随机分组法分为3组，按照不同配比的碘油栓塞剂栓塞犬9-11肋间动脉，观察其神经功能、病理变化，并在1.5T磁共振仪进行常规MRI和DWI。结果 除1例栓塞失败外，余均成功建模。轻度组（3例）损伤较轻，肌力3-5级之间，有一定恢复性，病灶范围2个椎体左右，中度组（3例）均表现截瘫，肌力0-1级，伴大小便失禁，病灶范围在3-4个椎体间；重度组（2例）均截瘫，肌力0级，大小便失禁，病灶范围〉4个椎体。常规MRI和DWI均表现为病灶高信号。结论 采用不同配比的碘油栓塞剂可以分度建立犬脊髓缺血模型，并可以在1．5T磁共振仪进行DWI，为进一步脊髓缺血研究奠定了基础。     

介入法犬股骨头坏死模型制作

目的 应用介入方法建立犬股骨头坏死模型.方法 9只成年杂种犬全麻后,分别通过股动脉Seldinger法穿刺插管,超选一侧股骨头供血动脉行平阳霉素灌注及明胶海绵栓塞处理,建立股骨头缺血坏死模型,对侧股骨头作对照.模型犬随机分为3组,每组3只,分别于栓塞术后2、4、6周处死.所有犬均于栓塞术前及术后每周行双侧髋关节MRI扫描,栓塞术前、术后即刻、处死前行双侧股骨头供血动脉DSA造影检查,最后一次造影结束处死动物,取双侧股骨头标本送病理学观察.结果 9只犬均造模成功,术后所有栓塞动脉造影复查均未见再通.造模侧股骨头在术后2周出现早期病理学改变.术后4周MRI显示股骨头坏死异常信号,病理切片出现不同程度骨细胞及骨小梁坏死,术后6周病理切片可见坏死后增生及修复反应.结论 本法能成功制作出犬股骨头坏死模型,具有创伤小、造模方法简单、成模时间短、动物死亡率低等优点,是一种比较理想的造模方式.     

碘油与不同栓塞剂组合对子宫肌瘤疗效的影响

目的研究以碘油为主组合不同栓塞剂型治疗子宫肌瘤的疗效。方法36例子宫肌瘤患者,随机分为3组,采用与碘油不同栓塞剂组合,行双侧子宫动脉栓塞(UAE)治疗。Ⅰ组碘油 无水乙醇;Ⅱ组碘油 平阳霉素;Ⅲ组碘油 平阳霉素 无水乙醇 明胶海绵粒。术后随访观察月经恢复情况、瘤体大小、有无并发症发生等。结果Ⅰ、Ⅱ、Ⅲ3组UAE治疗后,子宫肌瘤缩小>50%分别为3、4、8例,Ⅰ、Ⅱ组间无显著性差异(P>0.05);Ⅰ、Ⅱ组与Ⅲ3组之间有显著性差异(P<0.05);Ⅰ、Ⅱ、Ⅲ3组间并发症发生率无统计学差异(P>0.05)。结论碘油与无水乙醇、平阳霉素、明胶海绵粒联合栓塞子宫肌瘤其疗效优于其它组合剂型。     

选择性椎体供血动脉栓塞的动物实验研究

目的 通过对实验犬进行选择性椎体供血动脉栓塞的研究，旨在建立椎体急性缺血模型以及探讨影响栓塞结果的因素，为临床更好地实施脊柱肿瘤术前动脉栓塞提供理论依据。方法 用明胶海绵对12只实验犬分别行单节段和多节段选择性腰动脉造影和栓塞，栓塞后1－7d内观察后肢功能情况、靶节段椎体、脊髓MRI表现和病理改变。结果 栓塞单节段（双侧）或多节段腰动脉者均引起椎体不同程度的缺血、坏死改变。栓塞单根腰动脉者，不管靶动脉是否发出根髓动脉其靶椎体未见明显变化和未发生瘫痪；栓塞多节段腰动脉者有1只犬发生不全。在栓塞单节段以上腰动脉的脊柱节段水平可背部肌肉发生不同程度的缺血坏死表现。结论 （1）选择性动脉栓塞可用于椎体急性缺血模型的制作，为椎体缺血性病变的实验性诊断和治疗研究提供可能。（2）单节段动脉栓塞难于使整个椎体缺血坏死。（3）多节段动脉栓塞时有可能引起并发症，特别是栓塞范围内存在根髓动脉时。（4）在作选择性脊柱动脉检塞时，必要时应行保护性栓塞。     

综合应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤的临床研究

目的探讨应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤的临床效果.方法对36例子宫肌瘤进行选择性双侧子宫动脉栓塞灌注碘油、PVA、明胶海绵,随访3～20个月,平均9个月,观察术后症状缓解情况,子宫缩小和肌瘤缩小程度.结果36例右侧股动脉穿刺操作全部成功.子宫肌瘤动脉造影,表现为子宫动脉明显增粗、迂曲、分支增多、子宫增大、肿瘤染色灶明显.栓塞后肌瘤染色灶明显消失,栓塞剂加用抗生素,术后反应(发热、疼痛、呕吐)明显减轻,子宫肌瘤缩小率46.3%～91.7%,其中肌瘤缩小50%以上占86.6%,性激素术前、术后无明显差异.结论综合应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤是非手术治疗的良好方法.     

自制碘油混合乳剂肝癌的联合化疗及栓塞的疗效分析

目的 :观察自制碘油混合乳剂经肝动脉栓塞术 (TAE)对中晚期肝癌的疗效和肝功能指标变化 ,并与常规TAE的疗效对比。方法 :79例中、晚肝癌分常规组和对照组经股动脉途径插管进行周期性治疗 ,灌注化疗物药 :AMD +5 FU +MMC +CDDP +羟基喜树碱 ,并进行碘油明胶海绵栓塞 ,常规组 :超液化碘油 +明胶海绵 ,对照组 :超液化碘油、阿霉素、5 氟脲嘧啶、无水酒精抽吸乳化 +明胶海绵 ;治疗前后检测血清ALT、AST水平 ,并随访生存期。结果 :治疗后 6个月、12个月、18个月生存率对照组 (10 0 %、76 .9%、6 4 .1% )较常规组 (82 .5 %、5 7.5 %、30 % )有明显增高 (P <0 .0 5 ) ,治疗后两组血清ALT、AST水平无显著差异 (P >0 .0 5 )。结论 :使用自制碘油混合乳剂经股动脉途径插管进行周期性栓塞治疗中晚期肝癌 ,可有效地提高患者的生存期。     

可取出式动脉滤器在颈动脉血管成形术中脑保护效率的动物实验研究

目的制作犬颈内动脉的选择性灌注模型,验证可取出式动脉滤器对犬脑的保护效率.方法健康杂种犬12只,随机分为滤器组及对照组.以明胶海绵栓塞颈外动脉,制作犬颈内动脉的选择性灌注模型.滤器组每只犬于颈总动脉内滤器近侧注入1m×1mm×1mm大小的血栓5个,对照组犬则不用滤器,直接注入栓子.术后观察动物神经系统功能改变情况,术后24h行犬脑MR检查,术后7d将犬脑取出、固定,行大体病理检查.结果栓子注入后血管造影,对照组犬中,5只显示颈内动脉分支闭塞,滤器组犬均未见颈内动脉栓塞表现.对照组犬中,5只术中出现对侧肢体及颈部强直,其中2只在注入栓子后于术中死亡;滤器组犬中,2只术后出现栓塞对侧肢体轻瘫,12～24h后症状消失.对照组犬中,4只术后MR显示栓塞侧大面积脑梗死;滤器组犬中,除1只犬术后MR显示术侧外囊点状梗死灶外,其余5只犬术后MR显示正常.术后大体病理表现与MR结果相符.结论动脉滤器对约1mm大小的较大栓子有令人满意的捕获能力,能有效防止严重脑梗死并发症的发生.但此种动脉滤器对小于1mm的栓子的捕获能力尚待进一步研究.     

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）