经皮开窗术治疗主动脉夹层引起的缺血

目的 评价经皮开窗术治疗主动脉夹层引起的内脏及下肢缺血。方法 6例主动夹层并发内脏及下肢缺血患者行经皮开窗术，所有患者皆是Stanford B型夹层，累及的血管有肾动脉（3条）、肠系膜动脉（1条）和下肢动脉（6条）。4例行单纯经皮开窗术，1例行开窗及左肾动脉支架置入治疗，1例行开窗及腹主动脉和双侧髂总动脉支架置入治疗。1例患者于开窗后1个月行支架移植物复合体（stent—graft）腔内隔绝术。结果 所有6例患者血管重建均成功，其中4例缺血症状消失，2例明显减轻。随访4～12个月，平均7．6个月，1例患者术后3个月死于主动脉破裂出血，余5例仍存活。无严重的手术相关并发症。结论 经皮开窗术或经皮开窗结合支架置入是1种安全、有效的治疗主动脉夹层引起的内脏及下肢缺血的方法。     

经皮内膜瓣开窗术及内支架置入术治疗主动脉夹层（附一例报告及文献复习）

目的 探讨经皮主动脉夹层内膜瓣开窗术（FIF）及内支架（ES）置入术治疗主动脉夹层的临床应用价值。方法 男,54岁,DeBakey III b型主动脉夹层,内膜瓣破裂口位于降主动脉,腹主动脉及右髂动脉真腔变窄,最窄处内径仅为3mm,经股动脉行主动脉夹层FIF及ES置入术,共置入ES4枚。结果 腹主动脉真腔及其各分支血流基本得到恢复,初步观察最狭窄处内径增至12．3mm,病人症状完全消失,结论 经皮主动脉夹层FIF及ES置入术治疗主动脉夹层具有损伤性小,并发症少,疗效显著等特点,因此,可作为治疗某些主动脉夹层珠安全有效的首选方法。     

胸、腹主动脉病变的血管内治疗

目的探讨胸、腹主动脉病变不同血管内治疗方法的临床疗效。方法7例患者,其中DebakeyⅢ型主动脉夹层5例(4例行一体式支架腔内隔绝术,1例行内膜瓣开窗术);DebakeyⅢ型主动脉夹层外院外科人造血管置换术后降主动脉假性动脉瘤形成1例(行一体式支架腔内隔绝术);肾动脉开口以下腹主动脉瘤1例(行分体式支架腔内隔绝术)。结果5例一体式支架腔内隔绝术均获成功,2例出现Ⅰ型内漏,1例经球囊扩张后内漏消失,1例30 min后内漏减少,未处理;1例内膜瓣开窗术后患者双下肢缺血症状消失;1例分体式支架腔内隔绝术后造影提示动脉瘤消失,无内漏发生。结论应用血管内支架移植物或内膜瓣开窗术治疗胸、腹主动脉病变安全有效,其中分体式支架的临床应用具有更好的前景。     

主动脉夹层的低创伤性治疗

血流障碍、主动脉破裂和动脉瘤形成是主动脉夹层的并发症,目前的治疗方法就是针对这些并发症。直到不久前,主动脉夹层的缺血性并发症几乎只能外科治疗。分支血管血流障碍患者的手术操作困难,且手术死亡率为２５％～５１％;危急的肾缺血或肠缺血患者手术死亡率可达７０％以上。近来,随着新的经皮枝术的发展,介入放射学可以借助球囊开窗术、支架植入术或溶栓术治疗这些缺血症。经皮治疗的死亡率为０％～２５％。假腔近侧入口的持续性开放可以导致假腔破裂或动脉瘤形成。为了预防这些并发症,近来用加膜的支架．移植物来闭塞近侧入口。介…     

StanfordB型胸主动脉夹层动脉瘤合并肾缺血的诊治（附3例报告）

为探讨合并肾缺血的StanfordB型胸主动脉夹层动脉瘤的诊断和处理,分析1996年1月至2000年4月收治的StanfordB胸主动脉夹层动脉瘤29例,其中合并肾缺血3例,为急性期2例,慢性期1例。急性期1例发病后第3天死亡,中1例同时合并肾缺血或双下肢缺血,经夹层隔膜开窗术缓解;慢性期1例腔内隔绝术治愈夹层后肾缺血自行缓解。提示合并肾缺血的StanfordB胸主动脉夹层动脉姑息性转流手术有助于缓解症状,提高生存率;对于慢性StanfordB胸主动脉夹层动脉瘤合并肾缺血的患者,腔内隔绝术在治愈夹层动态瘤的同时恢复了真腔供血,肾缺血可同时治愈。     

主动脉狭窄和(或)闭塞性病变综合性介入治疗的临床观察

目的 对主动脉狭窄和(或)闭塞性病变(ASO)的综合介入治疗进行疗效观察与评价。方法 本组23例ASO(狭窄性病变14例，闭塞性病变9例)均分别应用经皮主动脉闭塞穿通术、经导管局部溶栓术、经皮腔内血管成形术(PTA)、血管内支架(ES)置入术及经皮主动脉夹层内膜瓣开窗术(FIF)等进行了综合介入治疗。结果 23例ASO的治疗成功率为96．7％。其中，14例主动脉狭窄性病变的治疗成功率为92.9％(1例主动脉破裂死亡)。9例腹主动脉完全闭塞的治疗成功率为100．0％。23例ASO中行血管内支架置入术11例(狭窄4例，闭塞7例)，成功率为100．0％。1例主动脉夹层所致主-髂动脉狭窄行血管内支架置入术并用FIF获得成功。其余12例仅采用局部溶栓术和(或)PTA治疗，成功率为91．7％。术后除1例死亡外，其余22例中，术后症状完全消失者18例，症状改善者4例。目前平均随访31．0个月(1～113个月)，其中1例于随访48个月后失访；1例于治疗后2个月因出现主动脉再狭窄及右下肢缺血坏死而截肢；1例于治疗后18个月死于胸主动脉夹层破裂；19例随访至今，症状无复发。结论 综合应用多种血管介入技术治疗ASO可获得满意的临床效果。     

椎动脉夹层的影像诊断及血管内介入治疗(附19例报告)

目的总结椎动脉夹层的影像诊断和评价血管内介入治疗方案的选择与效果。方法回顾性分析19例椎动脉夹层的影像学特点(CTA、DSA)。采用血管内介入椎动脉夹层19例:颅外段椎动脉夹层所致血管狭窄行支架成形术3例,颅内段夹层动脉瘤累及小脑下后动脉(PICA)采取支架结合弹簧圈栓塞4例,PICA位于夹层动脉瘤以远采取夹层动脉瘤及近端载瘤动脉闭塞12例。结果颅外段椎动脉夹层表现为血管腔狭窄、内膜瓣,颅内段椎动脉夹层的影像特点CTA表现为动脉瘤样扩张、壁内血肿等,DSA为珠线征、瘤样扩张等。术后造影:单纯支架置入病例狭窄消失;支架结合弹簧圈治疗病例动脉瘤腔消失,载瘤动脉通畅;血管闭塞病例显示椎动脉夹层均完全闭塞。术中未发生死亡、破裂出血及其它严重并发症,术后随访3-36个月,未发生再出血及缺血等并发症。结论 DSA及CT、CTA椎动脉夹层具有诊断价值;夹层动脉瘤的准确诊断对于介入治疗方案的选择至关重要;血管内介入治疗椎动脉夹层安全、有效、效果良好。     

3D打印在复杂主动脉疾病个体化腔内治疗中的应用价值

【摘要】目的：探讨3D打印技术在复杂主动脉疾病个体化腔内治疗中的应用价值。方法：搜集3例复杂主动脉病变,包括病变邻近主动脉弓远端的Stanford B型主动脉夹层（病例1）,病变累及升主动脉但原发破口位于降主动脉的逆撕Stanford A型主动脉夹层（病例2）和解剖迂曲的肾动脉下型腹主动脉瘤（病例3）。通过3D打印模型制定个体化腔内治疗方案。结果：根据3D打印模型制定个体化手术方案,病例1行左锁骨下动脉+左颈总动脉开窗,病例2行单纯腔内修复,病例3行腔内隔绝术;3例患者术中造影均显示无内漏,开窗血管血流通畅,无支架移位、截瘫、神经系统并发症发生。术后随访1年,3例均无内漏,假腔或瘤体血栓机化,无主动脉相关事件发生。结论：3D打印技术有助于复杂主动脉疾病最优化、个体化腔内治疗方案的制定,临床应用前景广泛。     

主动脉夹层的介入治疗

主动脉夹层是最常见的侵及主动脉的致命疾病 ,其发生率是破裂性主动脉瘤的 2倍。主动脉夹层也可隐匿发生 ,发病高峰年龄在 60～ 70岁 ,男性更易罹患 ,高血压是常见的诱发因素。多年来本病在临床上一直缺乏安全有效的治疗手段。近年来随着介入放射学的发展 ,国外有人报道应用介入治疗的方法 ,即主动脉夹层内膜瓣开窗术 (ｆｅｎｅｓｔｒａｔｉｏｎｏｆｉｎｔｉ ｍａｌｆｌａｐ ,ＦＩＦ)及人造血管内覆膜支架置入术 (ｅｎｄｏｖａｓｃｕｌａｒｓｔｅｎｔ ｇｒａｆｔ,ＥＳＧ)对其进行治疗 ,获得了较好的临床效果[1] 。笔者就其病因、分型、介入…     

逆行性A型主动脉夹层腔内隔绝治疗效果观察

目的 观察逆行性A型主动脉夹层的腔内隔绝治疗效果，探讨逆行性A型主动脉夹层腔内隔绝治疗的策略。方法 选取湖南中医药大学第一附属医院2016年10月至2020年11月近端内膜破口位于降主动脉的逆行性A型主动脉夹层患者19例，行主动脉覆膜支架植入术，并于术后1周、3个月、半年、1年随访观察治疗效果。结果 全组随访无一例患者死亡，2例患者支架近端主动脉弓部出现局限性溃疡，2例出现升主动脉夹层，1例支架远端出现夹层，其余14例患者均恢复良好，无相关并发症。结论 近端内膜破口位于降主动脉的逆行性A型主动脉夹层患者，经保守治疗后择期行腔内隔绝手术的治疗策略近中期效果理想。     

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.