CT引导下经皮穿刺胸腺乙醇消融疗法治疗重症肌无力

目的：评价CT引导下经皮穿刺胸腺乙醇消融疗法对重症肌无力（MG）的治疗价值。材料和方法：31例MG，男13例，女18例，年龄10－54岁，平均34岁。均根据典型的病史、体征、新斯的明试验和肌电图表现等作出诊断。按Osseerman分型：Ⅰ型19例、Ⅲ型7例、Ⅳ型5例。胸腺增生25例，小胸腺瘤5例，正常胸腺1例，均经穿刺活检证实。取胸骨旁为穿刺点，用22G穿刺针在CT引导下穿入胸腺，分次注射无水乙醇，直到胸腺瘤或整个增生、正常胸腺充满乙醇为止。结果：治疗后即刻CT扫描，示胸腺内充满高密度影（乙醇混含对比剂），3－4 周CT复查，25例胸腺增生和1例正常胸腺坏死，5例小胸腺瘤坏死。31例MG胸腺乙醇消融治疗后3个月CT复查，胸腺上下径、前后径与治疗前比较分别缩小了59．2％，68．6％，73．2％。30例MG于治疗后2天内部见效，其中23例在治疗后眼睑即能明显睁开。治疗后随访4年，显著好转23例，好转7例，无效1例。结论：CT引导下经皮穿刺胸腺乙醇消融疗法对MG具有确切疗效，安全易行，并发症少，是可供选择的微创治疗方法。     

CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效

 目的 探讨CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效。方法 选择2013-03至2015-03在CT引导下经皮微波消融治疗26例不能手术切除的巨块型肺癌患者,所有病例诊断均经术前穿刺病理证实,其中鳞癌18例,腺癌7例,腺鳞癌1例。术后即刻、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,分别于术前与术后1个月采用KPS评分评价患者生存质量,随访时间为12个月。结果 26例32次微波手术均获得成功,其中6例于术后1周行二次微波消融手术。微波消融治疗结束后即刻行CT增强扫描,其中CA 5例(19.2%),PA19例(73.1%),SD 2例(7.7%),总体有效率为92.3%。所有患者瘤体负荷显著减轻,治疗前KPS评分为78.23±11.54,治疗后1个月KPS评分为85.13±10.22(t=-2.282,P＜0.05);消融术前肿瘤最大径为(10.4±1.3)cm,消融术后3、6、12个月肿瘤最大径分别为(7.6±2.4)cm、(6.2±2.8)cm 和(5.7±2.5)cm,与术前比较,差异有统计学意义(F=21.482,P＜0.05)。结论 CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌是一种安全、微创、减瘤效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步研究。     

CT引导置管引流治疗单发性腹膜后脓肿

目的探讨单发性腹膜后脓肿CT引导下经皮穿刺置管引流治疗的疗效。方法回顾性总结采用CT引导下经皮穿刺引流治疗的13例腹膜后单发性脓肿,脓肿位于胰尾部4例,胰头旁3例,肾周间隙3例,肾后间隙2例,腰大肌旁1例;脓肿最大径3.5～8.0cm。结果8例患者行1次穿刺引流,3例行2次穿刺引流,2例行3次穿刺引流。13例患者平均引流16d,经过临床、超声及CT随访未发现残存感染灶或复发。结论CT引导下经皮穿刺引流治疗腹膜后脓肿疗效确切、创伤小。     

冷循环微波消融术治疗肺恶性肿瘤的临床疗效分析

目的:探讨CT引导下经皮穿刺冷循环微波消融术治疗肺恶性肿瘤的疗效。方法:收集24例行经皮穿刺微波消融术治疗的肺恶性肿瘤患者的病历资料,按RECIST1.1版标准对其疗效进行评估,并随访6个月。结果:24例共29个病灶成功进行微波消融治疗,术后6个月有效缓解率为70.8%(17/24),总体获益率为83.3%(20/24)。消融术后3 d内出现气胸9例(37.5%),胸腔积液7例(29.2%),咯血3例(12.5%),肺部感染1例(4.2%),消融后综合征9例(37.5%)。结论:CT引导下经皮穿刺微波消融术治疗肺恶性肿瘤安全有效,有利于提高患者的生存质量。     

重症肌无力89例临床分析

目的 总结重症肌无力临床治疗经验。方法 分析89倒重症肌无力临床资料，其中药物治疗75例。合并胸腺瘸者行胸腺瘸切除术14倒。结果 药物治疗缓解11例。好转60例，无效4例。总有效率92％；手术治疗术后稳定缓解4例。药物缓解8例，无效2例。结论 重症肌无力是自身免疫性疾病，治疗包括药物治疗和手术治疗。本组病例治疗以药物为主，应用激素中剂量冲击小剂量维持疗法。联合抗胆碱酯酶药物治疗重症肌无力是有效的；伴有胸腺瘸者行胸腺切除术，胸腺切除术是治疗重症肌无力的有效手段。     

经皮穿刺胆囊引流治疗急性重症胆囊炎的临床疗效

目的：探讨CT引导下经皮穿刺胆囊引流术治疗急性重症胆囊炎的临床疗效。 方法：于2014年月—2016年6月,对我院22例急性重症胆囊炎患者行经皮穿刺胆囊引流术,其中19例经皮经肝穿刺引流,3例经腹腔穿刺引流。 结果：所有22例患者均一次性完成穿刺引流,技术成功率100%。21例患者术后72 h内患者的腹痛、腹胀、高热等症状明显缓解,血常规检查中白细胞及中性粒细胞计数10 d内恢复正常。1例患者合并重症肺炎术后第2天死亡。14例患者术后3～6周拔管,7例患者长期带管生存。 结论：CT引导下经皮穿刺胆囊引流治疗急性重症胆囊炎操作简单、创伤小、安全有效,值得临床推广应用。     

重症肌无力39例的外科治疗

目的:总结重症肌无力采取胸腺瘤及胸腺增生切除术治疗经验,探讨重症肌无力合并胸腺瘤及胸腺增生的外科治疗。方法:对39例重症肌无力合并胸腺瘤及胸腺增生的外科治疗方法。结果:全组除死亡4例,2例死于肌无力危象,2例死于成人呼吸窘迫综合症外,其余31例随访1~6年,手术效果好。结论:重症肌无力是一种自身免疫性疾病,胸腺被认为是参与发病的重要组织,胸腺切除是治疗重症肌无力的有效方法,如能尽早手术治疗,将能获得较好的疗效。     

重症肌无力伴胸腺瘤38例病理与临床分析

重症肌无力（myasthenia gravis,MG）是一种主要累及神经肌肉接头处突触后膜乙酰胆碱受体的自身免疫性疾病,10%～15%患者伴有胸腺瘤。胸腺瘤的类型、临床分期与MG的发生、发展及转归具有一定关系。笔者将38例伴胸腺瘤MG的病理改变、临床分型、分期和术后并发肌无力危象     

CT引导下介入治疗肾囊肿的临床应用

目的探讨CT引导下穿刺硬化剂治疗肾囊肿的方法及疗效。方法经B超或CT诊断的78例84个肾囊肿在CT定位下经皮穿刺抽吸,行无水乙醇反复冲洗法硬化剂治疗,用18~22 G穿刺针抽吸,注入99.7%无水乙醇,注射量为抽出囊液量的25%~30%。术后每隔3个月复查,随访其疗效。结果其中79个囊肿一次穿刺成功,随访3个月~1年,复查见51例54个囊肿消失,22例24个囊肿缩小,4例4个囊肿未见缩小。有效率95.2%,消失率64.2%,无严重并发症。结论CT引导下经皮穿刺硬化剂治疗肾囊肿是一种安全、有效的治疗方法,具有较高的临床实用价值。     

胸腺切除治疗重症肌无力53例

目的　探讨胸腺切除对重症肌无力的疗效。方法　对 1990年— 2 0 0 2年间手术治疗的 5 3例重症肌无力患者的临床资料和随访结果进行总结 ,并分析其预后因素。结果　疗效按Monden标准评价 ,缓解 14例 ( 2 6 4%) ,改善 2 4例 ( 4 5 3 %) ,无变化 9例 ( 17 0 %) ,恶化 6例( 11 3 %,其中死亡 2例 ) ,总有效率 (缓解 +改善 ) 71 7%。结论　胸腺切除术是治疗重症肌无力的有效方法 ,对重症肌无力病人应及早手术治疗。     

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.     

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）     

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.