肺癌早期胸膜转移的螺旋CT检查

目的 评价螺旋CT检查肺癌早期胸膜转移与其手术病理分级、解剖分布部位关系。资料与方法 回顾分析43例经手术病理确诊原发肺癌胸膜转移的CT表现,并将其与手术病理表现作对照研究。结果 43例中合并胸腔积液8例,手术病理分为Ⅰ级25例、Ⅱ级13例、Ⅲ级5例。术前CT仅诊断5例Ⅲ级,3例Ⅱ级。而CT实际显示胸膜转移结节28例,检出率为65．1％（28／43）,其Ⅰ、Ⅱ、Ⅲ级CT检出率分别为40％（10／25）、100％（13／13）、100％（5／5）,叶间胸膜、膈胸膜、肋胸膜、纵隔胸膜转移CT检出率分别为100％（12／12）、45．5％（10／22）、56．5％（13／23）、70％（14／20）。结论 CT能准确诊断中晚期胸膜转移,CT检出早期胸膜转移与其分级及分布的胸膜解剖部位密切相关,对Ⅰ级转移有明显局限性,显示叶间胸膜病灶最敏感,对膈胸膜、肋胸膜敏感性较差。     

无显性胸水的肺癌胸膜播种性转移:影像学检出和诊断

目的提高对无显性胸水的肺癌胸膜播种性转移的影像学检出和诊断水平。方法对12例无明显胸水征象而经手术和病理证实有胸膜播种性转移的肺癌病例的胸部平片、普通CT和高分辨率CT(HRCT)等影像学表现进行回顾性分析;并结合文献比较上述各种影像学手段对此种肺癌胸膜播种性转移的检出和诊断价值。结果本组12例肺癌胸膜播种性转移中,胸部平片、CT和HRCT对其检出率分别为8.3%、58.3%和91.7%。HRCT对肋胸膜和纵隔胸膜转移检出率为54.5%,对叶间胸膜转移的检出率为85.7%。胸壁胸膜播种性转移的HRCT表现有:(1)胸膜面毛糙和棘状小突起;(2)胸膜面凹凸不平;(3)胸膜面散在2~3 mm大小结节;(4)胸膜面5~10 mm左右圆形或半圆形结节;(5)胸膜面正常。叶间胸膜播种性转移的HRCT表现有:(1)叶间胸膜均匀增厚;(2)叶间胸膜不均匀增厚;(3)叶间胸膜上散在2~3 mm结节;(4)2~3 mm结节与增厚的叶间胸膜一起构成串珠状改变;(5)叶间裂附近成堆或散在2~3 mm结节,酷似位于肺实质内。结论HRCT是检出和诊断肺癌胸膜播种性转移的最佳影像学技术。     

原发性肺癌胸内转移及直接侵犯征象的CT探讨

目的:探讨原发性肺癌胸内转移及直接侵犯的病理特点和CT诊断价值.方法:回顾性分析经手术、支气管镜检查、穿刺活检及病理证实的原发性肺癌且CT检查已有胸内转移及直接侵犯的254例患者的CT表现.结果:254例中:①淋巴结转移123例(48.42%),胸膜转移81例(31.88%),肺内转移55例(21.65%),胸壁转移14例(5.51%);②直接侵犯:纵隔51例(20.69%),胸壁21例(8.22%),心包心脏9例(3.54%).CT诊断肺内、胸壁转移和纵膈、胸壁、心包心脏直接侵犯敏感度、特异度、符合率均较高,而诊断淋巴结、胸膜转移特异度、诊断符合率较低.结论:原发性肺癌胸内转移最多见的为淋巴结转移,其次为胸膜转移和肺内转移.CT可以综合评价原发性肺癌的胸内转移及直接侵犯情况,对临床制订治疗方案具有重要的参考价值.     

小细胞肺癌的CT表现分类及其价值

【摘要】目的：探讨小细胞肺癌（SCLC）的特征性CT表现。方法：回顾性分析143例小细胞肺癌（SCLC）患者的胸部CT图像,根据肿块位置、淋巴结及纵隔侵犯情况等对SCLC进行分型。Ⅰ型,仅肺门肿块;Ⅱ型,肺门肿块伴同侧纵隔淋巴结增大,肿块与淋巴结分界清晰（Ⅱa）或不清晰（Ⅱb）;Ⅲ型,肺门肿块伴双侧纵隔淋巴结增大 ,肿块与同侧淋巴结分界清晰（Ⅲa）、不清晰（Ⅲb）或与双侧淋巴结融合（Ⅲc）;Ⅳ型,周围型肿块。结果：143例中Ⅰ型20例（13.99%）,Ⅱ型46例（32.10%）,Ⅲ型57例（39.86%）,Ⅳ型20例（13.99%）。Ⅳ型肿块可见分叶（n=11）、毛刺征（n=13）和胸膜相连或胸膜牵拉（n=19）。合并支气管狭窄/阻塞134例;血管侵犯110例（76.9%）,包括主、叶肺动脉（PA）及上腔静脉（SVC）;胸腔积液和（或）胸膜结节或增厚71例;肺实质受累124例（86.7%）,包括邻近肺实变/结节（n=77）、血行播散（n=52）、淋巴道播散（n=96）、阻塞性肺炎（n=56）和阻塞性肺不张（n=38）。合并慢支、肺气肿100例（69.9%）。结论：小细胞肺癌的CT征象有一定特征性,对其CT表现进行分型有助于病变的早期诊断。     

螺旋CT与CD44v6表达在肺癌诊断及分期中的价值

目的:探讨CT扫描与CD44v6表达分析在肺癌诊断及分期中的意义。方法:应用螺旋CT增强扫描对32例肺癌进行术前分期,且把CT诊断结果与组织病理对照;其中对28例手术病例的组织标本行CD44v6表达分析。同时观察同期20例手术切除的肺良性肿块组织检测CD44v6表达作为对照。结果:CT扫描对肺癌T分期准确度84.4%,N分期准确度58.8%,M分期准确度100%,综合TNM分期准确度75%。肺癌组织中CD44v6表达阳性率为53.6%,明显高于肺良性肿块组织(χ2=9.744,P<0.01)。Ⅲ期肺癌的CD44v6表达阳性率明显高于Ⅰ、Ⅱ期肺癌组织(χ2=15.68,P<0.001)。CD44v6表达判断淋巴结转移优于CT扫描。结论:应用螺旋CT增强扫描结合CD44v6表达分析有利于提高肺癌诊断及分期准确度,从而使临床能更好的制定最佳治疗方案。     

CT在恶性胸膜间皮瘤诊断中的价值

目的探讨CT在恶性胸膜间皮瘤诊断中的价值。资料与方法回顾分析9年来我院经手术或/和病理证实的42例恶性胸膜间皮瘤患者的CT资料,并与12例手术所见作比较。结果结节状或肿块状胸膜增厚(97.6%)是胸膜间皮瘤最常见的CT表现,有诊断性的表现为胸膜增厚>1cm(59.5%),环状胸膜增厚(41.5%),病变累及纵隔胸膜(92.9%)或叶间裂(69.0%),病变侵犯周围胸壁或/和肋骨、纵隔、心包、膈肌等邻近组织或器官(65.9%),1例呈胸内巨大肿块,42.9%病例可见纵隔或/和肺门淋巴结肿大。在CT和手术所见的比较中,CT准确检出了13处(65%)对周围组织或器官的侵犯,漏诊7处(35%)。结论CT在恶性胸膜间皮瘤的诊断、分期上有重要价值,是治疗前的标准诊断方法。     

螺旋CT诊断胸膜斑的临床价值

目的：研究胸膜斑的螺旋CT表现,提高诊断和鉴别诊断水平。材料和方法：回顾性分析与石棉粉尘密切接触的42例胸膜斑的螺旋CT表现。结果：42例中,螺旋CT发现胸膜斑407个,其中透明型/非钙化型胸膜斑250个、钙化型胸膜斑36个和混合型胸膜斑121个;单侧10例、双侧32例;单发胸膜斑5例,多发胸膜斑37例;最大胸膜斑长4.2cm,厚1.2cm;胸膜斑的形状多种多样;钙化型和混合型胸膜斑内可见不同形态的钙化;胸膜斑多位于中、下胸部前或后外侧胸壁,肋骨下方28例（66.7%）,侵犯双侧膈顶10例,心包4例,合并肺纤维化4例,6例增强扫描胸膜斑未见增强;肺尖和肋膈角不受累。正确诊断42例,正确诊断率100%。结论：螺旋CT能清晰地显示胸膜斑的部位、分布、范围、形态、大小、密度及其毗邻关系,结合石棉粉尘接触史,能与其他胸膜增厚病变鉴别,明确诊断。对胸膜斑/石棉肺,螺旋CT是最佳的影像学检查方法。     

PET/CT显像在肺癌诊断及分期中的初步应用

目的　探讨PET CT显像用于肺癌诊断及分期的价值。方法　肺癌患者4 6例,其中初诊者35例,治疗后者11例。所有患者皆行1 8F 脱氧葡萄糖(FDG)PET CT显像。图像经图像融合后,进行PET CT融合图像、PET图像和CT图像帧对帧对比分析。结果　①35例肺癌初诊者,肺癌病灶PET CT检出灵敏度10 0 % ,除1例肺泡癌呈双肺弥漫性浓聚外,其他皆表现为结节状或团块状病灶,病灶直径介于0 8～9 4cm ,标准摄取值为4 6±1 94。PET所见高代谢病灶与CT所见占位性病变位置及形态基本匹配。PET CT在病灶定性、边界确定、显示病灶对周围组织的侵犯及在区分肺癌与肺不张、阻塞性肺炎、胸腔积液方面优于单纯PET和CT。11例肺癌治疗后患者中,9例双肺未见恶性肿瘤存在,另2例PET CT发现双肺转移。②在转移灶的检出方面,PET CT优于单纯PET和CT ,灵敏度分别为95 2 %、90 4 %、73 8%。PET和CT对病灶的检出有互补性,PET在小淋巴结转移灶、胸膜转移、骨转移和肾上腺转移检出及定性方面优于CT ,而CT对肺内小转移灶检出优于PET。结论　PET CT显像在肺癌诊断和分期方面优于单纯CT和PET。     

胸膜凹陷征在孤立性肺结节MSCT诊断中的价值

目的:评价胸膜凹陷征在孤立性肺结节定性诊断中的价值。方法:回顾性分析经手术、病理或临床随访证实的60例周围型肺癌和40例良性结节的MSCT资料,并行MPR、VR、SSD等显示结节与胸膜之间关系的影像表现。结果:胸膜凹陷发生于肺肋胸膜面46例,纵隔面11例,膈面22例,叶间胸膜面13例,壁胸膜与叶间胸膜同时发生8例。图像后处理技术对胸膜凹陷征的检出率均显著高于轴位图像(P0.05)。周围型肺癌典型胸膜凹陷征和伴相关结节切迹的出现例数显著高于良性结节组(P0.05);良性结节粗线影和伴胸膜粘连增厚的检出例数高于周围型肺癌(P0.05)。结论:MSCT图像后处理显示胸膜凹陷征对孤立性肺结节的定性诊断具有指导意义。     

胸部CT影像学特征对肺腺癌亚实性结节脏层胸膜侵犯的预测价值

【摘要】目的：探讨胸部CT影像学特征在肺腺癌亚实性结节（SSN）脏层胸膜侵犯（VPI）中的临床预测价值。方法：回顾性收集2016年5月-2021年12月在本院经手术切除和病理确诊为肺腺癌SSN的患者103例。男34例，女69例，年龄25～82岁，平均（58.5±10.2）岁。病理组织学诊断结果VPI阳性组19例（18.45%），VPI阴性组84例（81.55%）。记录患者的年龄、性别等临床资料。所有患者术前均行胸部CT检查。阅读CT影像学征象，包括位置、径线、密度、分叶征、毛刺征及胸膜凹陷征等。结节与胸膜关系（NPR）分为四种亚型：Ⅰ型，1条线相连；Ⅱ型，多条线相连；Ⅲ型，窄基底相贴；Ⅳ型，宽基底相贴。单因素分析比较VPI阳性组和阴性组在临床和CT影像学特征间的差异，将单因素分析差异有统计学意义的指标纳入多因素Logistic回归分析，通过受试者操作特征（ROC）曲线建立预测模型。结果：103例患者包括非实性结节49例（47.57%）和部分实性结节54例（52.43%）。VPI阳性组和阴性组的性别和年龄差异无统计学意义（P=0.883、0.151）。非实性结节VPI发生率为8.16%（4/49），低于部分实性结节27.78%（15/54），差异有统计学意义（P=0.01）。NPR四种亚型发生VPI的比例分别为Ⅰ型6.82%（3/44）、Ⅱ型15.00%（3/20）、Ⅲ型28.00%（7/25）和Ⅳ型42.86%（6/14），差异具有统计学意义（P=0.011）。结节密度和NPR分型是预测肺腺癌SSN的VPI状态的独立危险因素。ROC结果显示，结节密度诊断VPI的曲线下面积（AUC）为0.663，敏感度为78.9%，特异度为53.6 %；NPR分型诊断VPI的AUC为0.726，敏感度为68.4%，特异度为69.0%；两者联合诊断VPI的AUC为0.804，敏感度为73.7%，特异度为70.2%。结论：肺腺癌亚实性结节的CT影像学特征有助于脏层胸膜侵犯的术前评估，结节密度和结节与胸膜关系分型是预测脏层胸膜侵犯的独立危险因素。     

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）