动眼神经及相关动脉MRI与薄层断面解剖学研究

目的研究动眼神经及其相关动脉的正常表现和相互关系,获得正常MR影像和断层解剖资料。方法在多平面重建图像上测量动眼神经的最佳显示角度及脑池段长度,并在该图像、塑化切片、源图像及最大信号强度投影图像上观察动眼神经与基底动脉(BA)、大脑后动脉(PCA)、小脑上动脉(PCA)及后交通动脉(PCoA)的关系。结果薄片断面上动眼神经和动脉节段性显示,与MRI有良好的对应关系,动眼神经脑池段长（14.07±2.15）mm,与脑干背侧连线夹角（69.68±7.15)°,与正中矢状面夹角左右分别为（24.44±4.64）°、（24.44±5.06）°。年龄越大BA发生偏移例数越多,多数PCA和SCA与动眼神经紧贴,少数使神经受压,PCoA仅胚胎型与神经紧贴或使之受压。结论MRI能够显示动眼神经脑池段的走行、形态及动脉与神经的关系,是评价动眼神经与毗邻动脉的准确的影像学技术。     

脑池段展神经及相关动脉MRI与解剖断层标本的对比研究

目的：研究展神经及相关动脉的正常表现和相互关系，获得正常MRI和断层解剖资料。方法：在MR三维积极干预稳态（3D—CISS）序列的多平面重组图像上观察57名正常体检者的展神经解剖特点及其与小脑前下动脉（AICA）等血管的关系，其中20名同时行时间飞跃（TOF）序列血管成像。将正常体检者的展神经成像结果与尸体断层切片及头颅标本3D—CISS序列成像结果进行对照。结果：（1）展神经在斜横断面、斜矢状面重组图像上以96．5％（110／114）的几率清楚显示，冠状面重组图像上以94．7％（108／114）的几率清楚显示；20名体检者的3D—TOF序列重组图像上不能清楚显示展神经。（2）103支展神经从桥脑延髓沟发出，7支从紧靠桥脑延髓沟的脑桥表面发出；显示的展神经全部以1支神经根丝连于脑干；面神经丘显示几率为100％（114／114），Dorello管的显示几率为95．6％（109／114）。（3）AICA是显示率最高的动脉，74．7％（71／95）的AICA与展神经接触。（4）将正常体检者的展神经成像结果与尸体3D—CISSMRI及断层切片标本所显示的展神经相对照，显示具有良好的对应关系。结论：3D—CISSMRI可以显示展神经及相关动脉血管的解剖特点；面神经丘和Dorello管是识别展神经的重要解剖标志。     

展神经3D-FIESTA MRI表现

目的:探讨3D-FIESTA序列磁共振水成像(MRH)对脑池段展神经及毗邻血管解剖关系的显示效果和诊断价值.方法:30例患者(60侧)采用3.0T MR机行横轴面及斜矢状面FIESTA序列MRI检查.结果:展神经在横轴面和斜矢状面图像上的显示率均为93.3％.在展神经与血管关系中,小脑前下动脉(AICA)显示率最高.5...     

Ⅲ、Ⅴ、Ⅵ、Ⅶ-Ⅷ脑神经显示角度的MRI测量研究

目的：以脑干为参照对不同年龄段脑神经的走行规律进行研究，获得正常数据标准。资料与方法：对140例和60例正常人按年龄、性别进行分组，以3D－FLASH序列完成正常人脑干MR薄层扫描，同时采用MPR后处理技术完整显示动眼神经、三叉神经、外展神经、面神经－前庭蜗神经脑池段，并测量横断面和矢状面最佳显示角度。结果：MPR后处理技术可对脑神经脑池段全程显示，脑神经横断面最佳显示角度与年龄有一定的关系，随年龄的增大脑神经与脑干背侧连线的夹角逐渐变小。矢状面最佳显示角度与年龄、性别无相关性。结论：在作动眼神经及三叉神经、外展神经、面神经－前庭蜗神经横断面成像和／或重建时应该考虑到年龄因素的影响。     

经鼻腔穿刺行翼管神经封闭的应用解剖

根据经鼻腔穿刺施行翼管神经封闭的需要,对8个尸体头颅及50个颅骨进行了解剖和观测.结果表明:穿刺针经过的途径为鼻孔内侧缘下端、中鼻道、中鼻甲后端、中鼻道粘膜、蝶腭孔、翼管神经(翼管前口).穿刺深度为58.6±3.9mm.穿刺针与法兰克福平面的夹角为22°18′±3°24′.穿刺针与正中矢状面的夹角为13°48′±2°42′.鼻腔底面与法兰克福平面的夹角为2°±3°48′.     

正常脑池段后组脑神经及相关动脉MRI与断层标本解剖的对比研究

目的获得正常人脑池段后组脑神经及相关动脉血管的MRI和断层解剖资料。方法对59名正常体检者进行三维（3D）积极干预稳态（3D-CISS）序列扫描、多平面重组（MPR）成像，其中22名同时行3D-时间飞跃法（TOF）脑干区血管成像。对这些受检者脑池段后组脑神经的走行和神经血管位置关系进行显示，并将脑池段后组脑神经MRI结果与5具尸体脑断层切片、尸体脑3D-CISS结果进行对照分析。结果（1）显示概率：59名正常体检者脑池段舌咽、迷走、副复合体神经在斜横断面、斜矢状面重组图像上分别以100％（118／118）、99％（117／118）的概率清晰显示；舌下神经在斜横断面、斜矢状面重组图像上分别以90％（106／118）、91％（107／118）的概率清晰显示；3D-TOF序列成像不能清晰显示后组脑神经。（2）神经走行显示：59名正常体检者的双侧舌咽、迷走、副复合体神经均从橄榄后沟发出，自上而下依次为舌咽、迷走、副神经；颈静脉孔为舌咽、迷走、副复合体神经出现的标志层面；45％（53／118）的舌咽、迷走、副神经呈分离平行状走行，55％（65／118）三者呈聚拢状走行；舌下神经从延髓前外侧沟出延髓，舌下神经管为舌下神经出现的标志层面。（3）3D-CISS序列MR影像：椎动脉（VA）是显示率较高的动脉，72％（85／118）的VA与后组脑神经无接触；28％（33／118）的VA与后组脑神经接触。（4）将脑池段后组脑神经成像结果与尸体3D-CISSMRI、断层切片标本进行对照，显示良好的对应关系。结论3D-CISS MRI可以清晰显示脑池段后组脑神经及相关动脉血管。     

标准型主动脉弓分支开口位置的MSCT测量

目的:测量标准型主动脉弓分支的最佳显示角度,旨在为临床工作提供帮助。方法:按照入组标准搜集211例标准型主动脉弓患者的颈部MSCT血管成像资料,将显示两血管最小间距的层面确定为各个分支的最佳观测平面,测量其与矢状面的夹角。结果:头臂干动脉和左颈总动脉最佳观测平面与矢状面之间的夹角最大值为120.7°,最小值为14.6°,平均71.47°±2.16°,无年龄及性别差异;显示左颈总动脉和左锁骨下动脉间距的平面与矢状面之间的夹角最大值为96.6°,最小值为3.6°,平均30.82°±1.62°,无年龄及性别差异。结论:MSCT对主动脉弓的解剖观察可为显示主动脉分支开口提供最佳观测位置。     

膝关节后外侧结构的解剖与MRI研究

目的 改进膝关节后外侧结构MRI定位方法，提高后外侧结构损伤的诊断准确率。方法 解剖膝关节标本，辨认后外侧各结构起止点及走行，明确它们之间的解剖关系。以注水的输液器缝合标记各结构进行MRI扫描，测量各结构在矢状面和冠状面上与腓骨颈长轴之间的夹角。按照这些角度定位扫描正常膝关节，观察各结构在MRI中完整显示的情况。结果 （1）测得矢状面上腓侧副韧带和胴肌腱关节囊内部分与腓骨颈长轴的夹角分别为（11．5±1.7）°和（39．5±6，4）°冠状面上胴肌腱关节囊外部分和胴腓韧带与腓骨颈长轴夹角为（39.5±3．9）°和（31．9±3．9）°。（2）腓侧副韧带在11°后斜冠状位1个层面上完整显示占90％，胴肌腱关节囊内部分在40°后斜冠状位1个层面上完整显示占80％，胭肌腱关节囊外部分在内斜40°矢状位1个层面上完整显示占90％，胭腓韧带在外斜30°矢状位1个层面上完整显示占90％。此外，胴腓韧带在11°后斜冠状位1个层面上完整显示的占75％，股二头肌腱和髂胫束在常规冠状面均能够很好显示.结论 选择完整显示腓骨茎突和腓骨颈的冠状面和矢状面为基准面，按照后外侧各结构与腓骨颈长轴所呈角度进行定位，层厚2mm的MR扫描能很好地显示膝关节后外侧解剖结构。     

视神经CT检查技术

目的　研究视神经CT检查技术。资料与方法　 (1)重建 2 0例既往普通正常眼眶的视神经矢状面 ,测量视神经与OM线 (orbitomeatalbaseline)夹角 ,计算此夹角平均值。 (2 )以OM线为基线扫描线 ,扫描架向足侧倾斜至此夹角的角度 ,对 2 0例志愿者行眼球极度仰视的视神经薄层扫描 ,其间眼球保持极度仰视。结果　 (1)测得既往视神经与OM线平均夹角为 2 0°。 (2 )用OM 2 0°线 (扫描架自OM线向足侧倾斜 2 0°)薄层扫描 2 0例志愿者的 4 0只视神经 ,有 38只视神经全程清楚显示 ,占 95 % (38/ 4 0 )。结论　以OM 2 0°线为基线 ,眼球极度上旋薄层扫描 ,能够在同一层面上全程显示视神经     

原发性三叉神经痛:三叉神经微观结构与神经脑桥夹角的相关性

【摘要】目的：探讨原发性三叉神经痛患者（PTN）三叉神经的微观结构改变与三叉神经-脑桥夹角之间的相关性。方法：将25例经微血管减压术（MVD）证实存在神经血管压迫（NVC）的单侧PTN患者和25例健康志愿者（对照组）纳入本研究，两组受试者均采用3D-FIESTA及DTI序列行MRI扫描，测量双侧三叉神经脑池段的长度、三叉神经-脑桥夹角、桥小脑角池横截面积以及NVC部位的扩散参数（FA、ADC）值，并分别对神经-脑桥夹角与扩散参数值及二者与视觉模拟评分（VAS）和病程等临床指标进行相关性分析。结果：PTN组患侧神经-脑桥夹角明显小于健侧和对照组［患侧：(39.11±5.76)°，健侧：(49.00±7.59)°，对照组：(45.20±5.76)°；F=15.26，P<0.001］；且当责任血管为小脑上动脉（SCA）时，患侧神经-脑桥夹角显著小于其它责任血管时的夹角［SCA：(36.69±4.90)°，非SCA：(43.42±4.65)°；U=156.5，P=0.002］。与健侧及对照组比较，患侧桥小脑角池的横截面积和脑池段神经长度的差异均无统计学意义（P>0.05），患侧三叉神经的FA值明显减小、ADC值明显增加（P均>0.05）。患侧神经-脑桥夹角与FA值呈正相关（r=0.56，P<0.01），与ADC值呈负相关（r=－0.62，P<0.01）；FA值与VAS评分呈负相关（r=－0.53，P<0.01）。结论：三叉神经与脑桥的夹角可作PTN的临床诊断指标之一，FA值亦可作为一种评估PTN患者临床症状严重程度的指标。     

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.