冠状动脉内尿激酶联合替罗非班治疗急性心肌梗死的疗效分析

目的 观察在急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗术(PCI)中,冠状动脉(冠脉)内应用尿激酶联合替罗非班治疗富含血栓病变的安全性和疗效.方法 回顾性分析85例行急诊PCI术AMI患者住院和随访资料,7例患者造影发现其梗死相关动脉(IRA)内血栓负荷明显,对这部分患者冠脉内联合应用尿激酶和替罗非班,术后观察患者TIMI血流分级和心肌灌注,住院期间药物不良反应,住院期间以及随访期主要不良心血管事件(MACE)和心脏彩色多普勒超声.结果 用药后患者冠脉内血栓负荷明显减轻甚至消失,前向血流恢复至TIMI 2～3级,支架植入后未发生"无复流"或"慢血流"现象,住院期间无MACE事件、严重出血事件发生,3～9个月随访亦未发生MACE事件,患者心脏彩超提示左室功能良好,取得了较好的临床疗效.结论 对于富含血栓病变的AMI患者,在急诊PCI中冠脉内联合应用尿激酶和替罗非班安全有效.     

高危急性冠脉综合征急诊介入治疗150例分析

目的　通过分析急诊经皮冠状动脉介入治疗 (PCI)对高危急性冠脉综合征 (ACS)的疗效 ,探讨急诊PCI对高危ACS的策略。方法　入选 2 0 0 1年 12月 7日至 2 0 0 4年 8月 2 2日来院的高危ACS(ST抬高的急性心肌梗死和非ST抬高的急性心肌梗死共 15 0例。发病时间在 2 4h内 ,从发病到来院时间 <6h ,6～ 12h和 12～ 2 4小时的比例分别为 6 0 %、2 5 %和 15 %。行急诊冠状动脉造影 (CAG)和急诊PCI,并随访观察。结果　 15 0例入选患者均行急诊冠脉造影 ,14 3例行急诊PCI,其中直接植入支架 6 0例 ,PTCA后植入支架 80例 ,仅行PTCA 3例。 4例延迟植入支架 ,3例早期病变。梗死相关血管 (IRA)前向血流达到TIMIⅢ级为 99.3%。单支病变 双支病变、3支病变和早期病变分别占 2 8% 4 6 % 2 4 %和 2 %。从来院到导管室时间平均 5 0min ,从进导管室到梗死血管开通时间平均 1h。术中发生慢血流2 1例 ,经冠脉内给药好转 ,无血流 1例 ,治疗无效 ,术后急性闭塞 2例 ,分别再次PCI和IABP治疗好转。IABP治疗 12例 ,1例无效。院内死亡 7例 ,其中术中无血流 1例 ,术中心源性休克 1例 ,术中室颤 1例 ,术后室颤 1例 ,术后顽固心衰 2例 ,术后心脏破裂 1例 ,病死率 4 .7%。 14 3例随访 ,随访时间为 30～ 993d ,出现心绞痛 3例 ,心力衰竭 3     

直接经皮冠脉成形术治疗急性心肌梗死住院死亡原因探讨

目的　探讨直接经皮冠脉成形术 (PCI)治疗心肌梗死 (AMI)住院期间死亡原因。方法　按入选标准对连续入院的 2 35例AMI患者行直接PCI,记录住院期间病死率、死亡原因及相关因素。结果　 15例患者住院期间死亡 ,住院总病死率为 6 .4 % ,心脏性病死率为 6 .0 %。直接死亡原因包括心脏破裂 5例 (33.3% ) ,室颤 5例 (33.3% ) ,泵衰竭 4例 (2 6 .7% ) ,脑卒中死亡 1例 (6 .7% )。心脏破裂患者中继发于再次心肌梗死者 1例。所有室颤患者均为继发性 ,继发于再次心肌梗死的室颤 2例 ,继发于不稳定性心绞痛 2例 ,继发于左室衰竭 1例 ;1例为迟发性室颤 (PCI后 2周 )。泵衰竭患者中 ,心源性休克 3例 ,左室衰竭 1例。结论　直接PCI治疗AMI患者住院期间病死率为 6 .4 % ,心脏破裂、室颤和泵衰竭是主要的死亡原因 ,术后严重心肌缺血和心力衰竭是重要诱因     

直接冠状动脉内支架术对无再流现象的影响

目的　评价冠心病患者冠状动脉 (冠脉 )内直接支架术对术后无再流的影响。方法　包括 12 7例接受直接冠脉内支架术患者 (直接支架组 )和一般情况匹配的 12 7例球囊扩张后行冠脉支架术患者 (常规支架组 ) ,比较两组的一般情况、冠脉造影及介入治疗即刻和临床随访结果。结果　直接支架组患者冠脉狭窄程度较轻(82 %± 6 %和 87%± 11% ,P <0 .0 5 ) ,支架植入术最终扩张压力明显增高 [(15± 5 )atm和 (12± 3)atm ,P<0 .0 5 ],5例 (4 % )支架植入后发生无血流 (常规支架组 6例 ,11% ,P =0 .14 )。随访期两组严重心脏不良事件发生率无明显差异 ;亚组分析显示无血流组患者预后显著较正常血流者差 (严重心脏不良事件发生率 :5 0 %和 8% ,P <0 .0 0 1)。结论　急性心肌梗死患者冠脉内直接支架或常规支架术对术后无血流现象的发生无明显影响 ;介入治疗后发生无血流现象患者预后较差。     

改良T型药物洗脱支架置入术治疗冠状动脉分叉病变

目的评估改良T型支架置入术结合雷帕霉素洗脱支架CypherTM在冠状动脉(冠脉)分叉病变介入治疗中的应用。方法30例冠脉造影显示真性分叉病变患者,应用改良T型支架置入法在冠脉主支和分支内分别置入CypherTM支架,并行对吻球囊扩张术。观察术后即刻成功率和住院期、随访期不良事件发生率。结果30例中,即刻手术成功28例(93%),19例(63%)行对吻球囊扩张术。1例左前降支和第一对角支分叉病变发生急性血栓形成,导致对角支血流TIMI0～1级和急性前间壁心肌梗死;另1例对吻球囊扩张术后对角支开口残余狭窄40%,但无任何临床症状。30例平均临床随访(11±5)个月,无不良事件发生,9例(30%)于术后(10±3)个月行冠脉造影复查,无支架内和节段内再狭窄。结论改良T型支架置入术结合药物洗脱支架在冠脉分叉病变介入治疗中安全可行。     

急性心肌梗死急诊介入治疗的临床观察

目的：观察急诊冠脉介入治疗(PCI)的疗效及安全性。方法：选择我科急诊收治的急性心肌梗死(心梗)患者116例进行急诊PCI，其中急性前壁、前间壁心梗68例，急性下壁心梗46例，急性前壁并下壁心梗2例；合并严重低血压或心源性休克12例，依Grenuzig’s法行PCI，必要时置入冠脉内支架。结果：本组急诊冠脉造影显示多支病变者66例，单支病变50例。73支前降支、44支右冠及8支回旋支靶血管行PCI；38例二处以上同时行PCI。成功109例，失败7例；94例患者同时植入支架117枚。1例未能通过病变。术后院内死亡4人，其中3例死于心衰、休克，1例死于室颤。随访2-93月大多数临床症状改善。结论：急性心肌梗死急诊介入治疗是一项恢复冠脉血流最直接、最有效的手段。对高危的心梗患者尤应加强围手术期的观察、处理，可降低急性心肌梗死的死亡率。     

经桡动脉途径无保护冠状动脉左主干分叉病变介入治疗

 目的 探讨经桡动脉途径PCI在无保护左主干分叉病变中治疗的可行性和疗效.方法 回顾性分析我院无保护左主干分叉病变择期行PCI的患者22例,21例置入药物洗脱支架,单支架置入7例,双支架置入14例,14例置入双支架的患者均成功进行对吻球囊扩张,1例系支架术后再狭窄,单纯行切割球囊成形术.术后每15 d或1个月门诊复查1次,3～9个月行冠状动脉造影复查.结果 22例PCI均取得成功,术后达TIMI 3级血流,住院期间主要不良心脏事件1例(4.55%),冠状动脉造影复查显示支架内再狭窄2例(10.53%),1例再次行PCI术.术后平均随访(16.86±6.90)个月,随访期内死亡1例.结论 经桡动脉径路无保护左主干分叉病变PCI即刻成功率高,有较好的近、中期疗效.     

晶碳微膜烤瓷支架治疗冠心病的临床观察

目的　探讨晶碳微膜烤瓷支架 (SORIN冠脉支架 )在冠心病介入治疗中的安全性 ,特别是防止支架内血栓的有效性 ,及降低再狭窄发生率的作用。方法　共 1 0例患者 ,其中急性心肌梗死 (AMI)6例 ,不稳定心绞痛 (UAP) 4例。急诊直接PCI 8例、补救PCI 2例。共涉及病变血管 1 2支、病变 1 3处。选择支架直径与靶血管直径之比为 1 .0～ 1 .1∶1。从较低压力开始扩张 ,直至残存狭窄 <5 %。结果　共用晶碳微膜烤瓷支架 1 3枚 ,术后病变血管均达到前向TIMIIII级血流 ,术后抗凝。随访 4～ 1 8个月 ,平均(1 1 .6± 5 .7)个月 ,全部患者在随访期内无心血管事件的发生。结论　烤瓷支架在其金属表面覆着一层晶碳微膜 ,隔离了金属与血液及组织 ,可降低急性血栓的发生率 ,同时再狭窄率也相应降低 ,但其确切疗效还有待循证医学研究     

急诊经皮冠脉介入普通支架和药物洗脱支架随机对照观察

目的观察急性心肌梗死(AMI)患者经皮冠脉介入(PCI)时应用药物洗脱支架的疗效及安全性。方法采用前瞻性随机对照方法,将AMI患者随机分为普通支架组(CrofelexTheca支架组,C组),进口药物洗脱支架组(Taxus组,T组),国产药物洗脱支架组(Firebird组,F组),每组计划入选各20例,急诊PCI术时仅处理梗死相关动脉。观察住院期间、6个月心血管疾病死亡,再梗死,再住院,靶血管再血管化等情况。结果最终C组、T组、F组各入选15,18,16例,发病至手术时间:C组(6.67±3.26)h,T组(6.22±3.77)h,F组(6.44±3.69)h;靶血管特征为:C组血管直径≥3.0mm占80%,T组≥3.0mm占72.2%,F组≥3.0mm占81.3%;C组植入支架15枚,T组21枚,F组16枚,手术成功率均为100%。三组住院其间均无心血管性疾病死亡,再梗死、靶血管再血管化;6个月随访中亦无心血管性疾病死亡、再梗死、靶血管再血管化,C组、F组各有1例因为心功能不全再入院。结论急诊PCI中应用药物洗脱支架,包括国产药物洗脱支架Firebird安全可靠,疗效明确;但样本量小,还有待进一步大样本,多中心的临床研究来证实。     

直接PCI治疗急性心肌梗死出现“无血流”的剖析

目的　探讨直接经皮冠脉介入治疗 (PCI)治疗急性心肌梗死 (AMI)出现“无血流”(no flow ,NF)的发生率和临床意义。方法　 99例连续行直接PCI的AMI患者根据冠脉造影中有无NF现象分为NF组 (18例 )非NF组 (81例 ) ,计算NF的发生率 ,分析两组一般临床特征、blush分级、ST段抬高的变化、磷酸肌酸激酶的峰值 (CPK)、心功能和心血管事件的发生率。结果　NF组 18例患者 ,占所有直接PCI患者的 18.2 % ,既往心梗史、糖尿病、前壁梗死和多支血管病变的发生率方面明显增加 (P <0 .0 5 )。NF组blush分级和ST段抬高下降≥ 5 0 %者显著减少 ,CPK显著增加 [(32 38± 10 0 8)和 (2 4 5 1±112 4 ) ,P <0 .0 5 ],LVEF显著降低 [(0 .38± 0 .11)和 (0 .6 3+0 .10 ) ,P <0 .0 1];NF组总死亡率较非NF组有增加趋势 ,但无显著统计学意义 ;非致死性心衰 (2 1.4 %和 4 .8% ,P <0 .0 5 )和复合终点事件(4 2 .9%和 18.5 % ,P <0 .0 5 )的发生率无论住院期间还是随访 1年均明显增加 ,而两组在不稳定性心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡的发生率方面无显著降低 [(0 .5 8±0 .14 )和 (0 .6 3± 0 .10 ) ,P >0 .0 5 )。结论　直接PCI治疗AMI过程中NF的发生率为 18.2 % ;出现NF者心肌微循环灌注不良 ,梗死     

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.     

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.     

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).     

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.