基于体素的形态测量学方法研究屈光参差性弱视患儿的相关区域脑结构

目的 利用基于体素的形态测量学(VBM)分析屈光参差性弱视患者全脑灰、白质体积变化.方法 采用1.5 TMR扫描仪对12例屈光参差性弱视患儿和年龄、性别相匹配的12名正常志愿者行3D快速扰相梯度回波(FSPGR)序列的全脑扫描.原始数据用统计参数图(SPM)5软件进行处理.结果 与正常对照组相比,弱视组脑灰质体积减少的脑区包括右侧楔叶、双侧枕中下回、右侧额中回、左侧颞中回、右侧颞上回、右侧楔前叶、右侧中扣带回(差异脑区体素＞ 10个).弱视组脑灰质体积增多的脑区包括右侧小脑半球、右侧海马旁回、左侧中央前回、左侧额上回(差异脑区体素＞ 10个).与对照组比较,弱视组脑白质体积减少的脑区包括双侧视放射区、双侧内囊,以右侧为著(差异脑区体素＞10).未见弱视组脑白质体积增多的脑区.结论 运用VBM方法可分析屈光参差性弱视患者全脑灰、白质体积变化,有助于从形态学的角度阐述屈光参差性弱视的可能神经机制.     

肌萎缩侧索硬化症基于体素的形态测量扩散张量分析

目的 利用基于体素的形态测量学(VBM)及基于体素的扩散张量分析评价肌萎缩侧索硬化症(ALS)患者的脑灰质、白质体积及各向异性分数(FA)值的改变.方法 选取39例确诊或拟诊为ALS的患者(ALS组)及39名健康成年人(对照组)进行常规MR扫描及神经心理学评估,并采集3D快速扰相梯度回波(fast spoiled gradient echo,FSPGR)序列T_1WI和DTI数据.对3D T_1结构像进行配准、分割、平滑后,采用VBM分析,计算分割后的脑灰质、白质及脑脊液的体积.选取76名健康志愿者进行DTI,对原始图像进行后处理,制作FA模版,将ALS组和对照组受试者的FA图配准在所创建的FA模版上,测量FA值.统计方法采用协方差分析,因性别完全匹配,故对于VBM,年龄及全脑总体积作为协变量,而对于基于体素的扩散张量分析,仅年龄作为协变量,P＜0.01(未校正),相连像素＞20个的脑区为有差异的脑区.结果 全脑体积分析显示两组受试者的全脑灰质体积、全脑白质体积、全脑体积及脑灰质分数之间差异无统计学意义,但ALS患者的白质分数(0.29±0.02)小于健康对照组(0.30±0.02)(P=0.003).与健康对照组比较,ALS患者局部灰质体积减少脑区主要位于双侧额上回及中央前回,右侧额中回及颞中、下回,左侧枕上回、楔叶及左侧岛叶,ALS患者局部白质体积减少脑区主要位于胼胝体膝部,双侧额内侧回、旁中央小叶及岛叶,右侧额上回及额中回、左侧中央后回.ALS患者双侧扣带回及海马旁回FA值较对照组减低.结论 ALS并不是单纯的运动神经元病,是一种多系统受累的疾病,基于体素的扩散张量分析对于怀疑认知功能障碍的患者海马旁回及扣带回白质FA值变化的检出具有一定的潜在价值.     

VBM-DARTEL法观察带状疱疹后遗神经痛患者脑灰质体积的形态学改变

目的 观察带状疱疹后遗神经痛(PHN)患者全脑灰质形态学改变,探讨其形态学改变与PHN患者视觉模拟评分(VAS)及病程之间的相关性.方法 对17例PHN患者及17例正常对照的3D T1WI结构图像进行预处理,采用VBM-DARTEL法比较2组分割后的脑灰质体积,并分析脑灰质体积改变与PH患者VAS及病程之间的相关性.结果 相对于正常对照组,PHN患者脑灰质体积减小的脑区包括:双侧眶额区(眶回及直回)、左侧额下回、左侧岛叶、左侧尾状核、右侧扣带回、左侧颞上回、左侧楔叶、双侧小脑前后叶;PHN患者脑灰质体积增加的脑区包括:双侧额上回、左侧额中回、小脑蚓部、脑桥;PHN组两侧半球脑灰质体积改变不对称(左侧>右侧);PHN患者脑灰质体积异常脑区与VAS及病程之间均无相关性.结论 VBM-DARTEL法揭示PHN患者存在广泛脑灰质体积异常,这些改变可能在疼痛的形成及慢性状态维持中发挥重要作用.     

不同分期肺腺癌患者大脑静息葡萄糖代谢改变研究

目的 探讨无脑部转移的不同分期肺腺癌患者大脑静息葡萄糖代谢改变特点及其关系。 方法 回顾性分析120例组织学确诊为原发性肺腺癌患者的全身18F-FDG PET/CT检查资料, 其中Ⅰ期患者为28例、Ⅱ期29例、Ⅲ期31例和Ⅳ期32例。50名健康体检者为对照组, 分析Ⅰ、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者脑葡萄糖代谢改变, 并比较4组之间脑代谢改变的差异。 结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者PET脑显像均表现区域性脑代谢减低, Ⅰ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回(体素数为681), Ⅱ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回(体素数为1258), Ⅲ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回、右侧顶下小叶(体素数为1810), Ⅳ期累及脑区为左侧额上中回、右侧颞上中下回、左侧颞上中下回、右侧顶下小叶、左侧前扣带回及右侧岛回(体素数为2910)。4组患者脑代谢减低区体素值差异具有统计学意义(F=25.444, P=0.0001), 且随分期增加异常代谢脑区范围逐渐增大。 结论 肺腺癌患者脑代谢减低区涉及多个与精神情感有关的功能脑区, 且其脑代谢改变与肿瘤分期具有一定相关性。     

慢性阻塞性肺部疾病早期脑部灰、白质VBM及DTI研究

目的运用基于体素形态学分析(voxel-based morphometry, VBM)及弥散张量成像(diffusion tensor imaging, DTI)技术探讨慢性阻塞性肺气肿(chronic obstructive pulmonary disease, COPD)患者慢性缺氧所致的脑灰、白质结构病理变化。方法收集COPD患者30例及年龄相匹配的正常志愿者30例。所有入组者均运用Philips 3.0T MR进行T_2、FLair,DTI及全脑3D-T_1WI。运用VBM8软件处理,得到全脑灰质密度数据参数图。利用Philips工作站处理DTI信息,勾画出长联络纤维。以VBM结果所得灰质减少区为种子勾画弓状纤维,测量白质纤维束的FA、ADC值。一般资料及FA、ADC计数资料对比均应用SPSS 17.0进行t检验统计分析。结果 VBM结果显示,COPD患者组对比正常组,全脑多个区域灰质密度减小,包括右侧颞下回、右侧额眶回、左侧海马旁回、右侧颞极、双侧尾状核、双侧前运动皮层、左侧缘上回、右侧岛叶。DTI测量示:双侧尾状核FA值,右侧岛叶,双侧皮质脊髓束、左侧扣带束、左侧勾束FA降低,P0.005。结论 COPD患者脑区存在多个灰、白质区域异常,提示COPD患者在常规MRI未出现异常情况下已有微观脑结构改变。VBM及DTI技术可检测疾病早期脑结构病理改变,对临床评估有一定意义。     

先天性耳聋患者脑基于体素的形态测量学研究

目的应用基于体素的形态测量学方法(VBM)研究先天性耳聋患者的灰质和白质变化情况。资料与方法对18例先天性耳聋患者和22名健康自愿者全脑进行三维磁共振成像数据采集,应用(diffeomorphic anatom-ical registration through exponential lie algebra,DARTEL)对灰质和白质进行VBM分析。以簇体积>100个体素,且P<0.001为差异有统计学意义。结果与健康自愿者相比,耳聋患者灰质体积增大的脑区为左侧颞横回和双侧小脑(P<0.001);灰质体积减小的脑区为双侧楔回、左侧梭状回和右侧中央前回(P<0.001);白质体积减小的脑区为双侧前扣带回、左侧胼胝体、左侧舌回和右侧额中回(P<0.001)。结论先天性耳聋患者灰质和白质发生改变,反映了脑可塑性重组及患者使用手语交流导致脑结构发生的改变。     

遗忘型轻度认知损害的全脑灰质基于体素的MRI形态分析

目的：利用优化基于体素的MRI形态分析（voxel-based morphometry,VBM）,研究遗忘型轻度认知损害（amnestic mild cognitive impairment,aMCI）和正常老年人的脑灰质体积变化。方法：选取aMCl患者20例和正常老年对照18例,MRI排除脑内其他病变,然后行高分辨率三维T1WI扫描。应用优化VBM方法处理数据,将脑组织分割成灰质、白质和脑脊液,最后应用两样本t检验比较两组被试灰质体积改变。结果：VBM结果显示与正常老年对照组比较,aMCI患者组双侧额颞叶出现广泛的灰质体积减少,具体脑区为右侧海马钩回、双侧额下回、双侧额中回、右侧额上回、双颞叶额中回、左侧颞下回、左侧颞上回、右侧顶上小叶、左侧枕中回等结构灰质体积小于对照组,差异有统计学意义（P〈0.001）。结论：VBM方法可显示aMCl患者全脑灰质萎缩情况,对临床早期诊断aMCl患者有重要价值,具有广阔的临床应用前景。     

帕金森病认知障碍患者脑结构的体素形态学研究

目的：分析帕金森病(PD)患者脑灰质异常区域及分布特征,探寻与轻度认知障碍(MCI)有关的脑结构变化。方法采用基于体素的形态学测量(VBM)方法,对20例伴 PD-MCI 患者、17例无轻度认知障碍 PD(PD-nMCI)患者及20例正常对照组(NC)的3组3D-T1 WI 脑容积数据进行处理统计,得到3组全脑灰质图像。结果与 NC 组相比,PD-nMCI 组脑灰质体积异常减少的脑区包括：右侧梭状回、右颞中下回、右钩回及左侧颞上回。与 PD-nMCI 组相比,PD-MCI 组脑灰质体积异常减少的脑区包括：两侧额叶(两额中下回、左侧中央前回)、颞叶(右颞中回、左颞上回)、岛叶、右枕叶(右楔叶、舌回)、右后扣带回。结论PD-nMCI 患者灰质体积的缺失相对局限,随认知障碍的出现、发展,缺失脑区的范围逐渐扩大,其中两侧额叶中下回、左侧中央前回的体积缺失与 PD 患者的 MCI 关系密切。     

特发性全身性癫痫患者脑灰质结构基于体素的形态学测量的研究

目的 运用基于体素的形态学测量(VBM)方法分析特发性全身性癫痫患者(IGE)和正常人全脑灰质体积的差异.方法采用GE 3.0T HDX 超导型磁共振扫描仪对28例IGE患者和25例正常对照进行全脑高分辨解剖像扫描.在Matlab 7.0平台上采用SPM5软件包对图像进行处理.采用双样本t检验,将P< 0.005、像素簇大小＞200个体素的脑区作为有统计学差异的脑区.结果 与正常对照相比,IGE患者显示双侧大脑半球广泛脑区的灰质体积减少,包括双侧扣带回、双侧额中回、右侧额上回、右侧额叶直回、右楔叶、左侧尾状核头;与正常对照相比IGE患者灰质体积增加的脑区包括左侧颞上回、左侧屏状核、右侧豆状核.结论 VBM能揭示IGE患者存在广泛脑区灰质密度异常,灰质密度减低脑区多与认知功能相关,是引起癫痫患者认知功能下降的原因之一.     

基于体素的形态学测量无常规MR异常的颞叶癫痫的灰质改变

目的 利用基于体素的形态学分析(voxel-based optimized morphometry,VBM)及基于统计参数图的个体脑结构分析(individual brain atlases using SPM,IBASPM)软件,分析无常规MR异常的颞叶癫痫患者全脑灰质结构的改变.方法 对30例颞叶癫痫患者及40例正常健康志愿者行全脑扫描,扫描序列为磁化快速梯度回波(magnetization prepared rapid gradient echo,MPRAGE)扫描序列,获得高分辨T1WI图像,数据分析采用以SPM5(statistical parametric mapping 5)软件包为基础的VBM及IBASPM技术进行处理,利用SPSS16.0分别进行统计学分析.结果 通过比较,VBM显示颞叶癫痫患者双侧扣带前回、右侧扣带中回、左侧丘脑、双侧中央后回、左侧中央前回、左侧颞上回及右侧颞下回不同程度的灰质体素值减少,癫痫组灰质总体积明显小于对照组,有显著性差异(P<0.05).癫痫组的双侧扣带前回、右侧扣带中回、左侧颞上回及右侧颞下回灰质体素值均小于对照组相应脑区,差异有统计学意义(P<0.05),癫痫组的左侧丘脑、双侧中央后回、左侧中央前回灰质体素值与对照组无显著性差异(P>0.05).结论 利用VBM及IBASPM技术,说明无常规MR异常的颞叶癫痫灰质总体积明显减小,并显示局灶性灰质体素值改变的脑区,提示了病变的主要部位,为临床精确治疗提供信息.     

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）