川芎嗪对急性心肌梗死急诊冠状动脉介入治疗后"心肌无复流"的影响

目的 利用SPECT心肌灌注显像观察川芎嗪对急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)后患者心肌微循环的影响,以探讨"心肌无复流"治疗的新途径.方法 行PCI的AMI患者82例,分为川芎嗪组(治疗组,40例)和对照组(42例).受检患者分别于梗死相关血管(IRA)再通即刻、川芎嗪治疗24 h内及第15天分别注射99Tcm-tetrofosmin 555、1110和740 MBq,1 h后用SPECT行门控静息心肌灌注显像.用Cequal和Qgspect软件分别处理,得到3个断面断层图像及左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV).并分别计算心肌显像总积分.结果 治疗组与对照组PCI后即刻LVEF(%)(47.5±7.1和48.4±8.6)、LVEDV(ml)(91.1±24.5和89.1±23.4)、LVESV(ml)(48.7±16.4和45.9±16.7)和心肌显像积分(7.8±2.9和7.5±3.1)差异无显著性(P＞0.05);PCI后24 h内,治疗组LVEF(%)(43.5±8.0)较对照组(44.7±8.3)减少更为明显(P＜0.05),而LVEDV(ml)(93.5±24.9和99.2±24.8)、LVESV(ml)(52.9±16.1和54.5±14.4)呈增加趋势,2组间差异无显著性(P＞0.05);PCI后15 d,治疗组与对照组比较,LVEF(%)(45.5±6.9和45.6±7.6)、LVEDV(ml)(92.8±24.9和99.9±22.3)及LVESV(ml)(51.2±17.0和54.8±16.1)均明显改善(P＜0.05).治疗组与对照组PCI后24 h内及15 d心肌显像积分比较,治疗组积分减少更为明显(4.5±2.6,3.0±2.5和6.0±2.6,4.2±2.7;P＜0.05).结论 SPECT心肌灌注显像能准确反映川芎嗪对"心肌无复流"的改善.     

远端血管保护装置在急性ST段抬高心梗中的应用

目的 评价远端血管保护装置(DPD)在急性ST段抬高心梗中的应用价值.方法 回顾性分析2004年1月1日-2005年12月31日第四军医大学西京医院心内科收治的267例急性Sr段抬高心梗患者行急诊FCI的相关临床资料.其中常规PCI(对照组)169例,PCI术中使用DPD(实验组)98例.比较两组术中无复流发生率、心肌梗死溶栓治疗(TIMI)3级血流比例、术后ST段回降率、住院死亡率、术后1周左室射血分数(LVEF)等指标.结果 DPD组无复流发生率、TIMI 3级血流比例、术后ST段回降率分别为3.06%(3例)、93.88%(92例)、94.90%(93例),对照组分别为13.61%(23例)、77.51%(131例)、84.02%(142例),两组比较差异显著(P<0.05).两组间住院期间死亡率、术后1周LVEF比较无显著性差异.结论 在急性ST段抬高心梗急诊PCI术中应用DPD能明显减少无复流发生率,改善TIMI血流,而对住院死亡率、PCI术后近期心功能改善的影响有待进一步研究.     

经皮冠状动脉介入治疗中血栓抽吸导管的应用

目的 探讨经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）中出现无复流或慢复流时应用血栓抽吸导管的安全性和有效性.方法 选择行PCI时发生无复流或慢复流患者56例,随机分为抽吸组26例和对照组30例,抽吸组除常规处理外立即使用血栓抽吸导管,分析比较两组术后TIMI分级、TIMI心肌灌注（TMP）分级、心肌酶谱、ST-T改变、LVEF及随访30 d的主要心血管不良事件（main adverse cardiovascular event,MACE）发生率.结果 抽吸组TIMI及TMP分级,心肌酶谱及LVEF均优于对照组,出现缺血性ST段抬高的患者数少于对照组,差异均有统计学意义（P〈0.05）;但MACE在两组间无统计学差异（P＞0.05）.结论 PCI时出现无复流或慢复流时应用血栓抽吸导管有助于改善罪犯血管远端的心肌灌注及术后心功能,减轻慢复流或无复流对心肌的损伤.     

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.     

SPECT心肌灌注显像对急性心肌梗死急诊PCI的近期疗效评估

目的 :探讨单光子发射型计算机断层 (singlephotonemissioncomputedtomography ,SPECT)心肌灌注显像评估急性心肌梗死 (AMI)急诊经皮冠脉介入治疗 (PCI)后的心肌灌注状况的价值。方法 :采用99mTc tetrofosmin(P5 3)SPECT心肌灌注显像对 10 9例急诊PCI治疗的AMI患者评估心肌灌注情况 ,并记录 6个月心脏事件发生率。结果 :SPECT显示无复流 (no reflow ,NR)组 2 0例 ,有复流组 85例 ,两组在心梗史、糖尿病和多支血管病变的差异有显著性意义 (P <0 .0 5 )。NR组总死亡率较非NR组有增加趋势 ,但差异无显著性意义 ;非致死性心衰和复合终点事件的发生率无论住院期间还是随访 6个月差异均有显著性意义 (P <0 0 5 )。结论 :SPECT心肌灌注显像可对AMI患者梗死相关血管 (IRA)再通治疗疗效进行可靠的无创性评价 ,NR者预示心肌微循环灌注不良 ,心功能差 ,近中期预后差。     

依那普利联合卡维地洛治疗无症状性心力衰竭的研究

目的 :观察依那普利联合卡维地洛对无症状心力衰竭患者心室重塑和心功能进展的影响。方法 :4 7例未经治疗的无症状性心力衰竭患者 ,随机分为治疗组 (依那普利 卡维地洛 )和对照组 (安慰剂 )治疗 12个月 ,治疗前后分别进行心功能 (NYHA)分级评估 ,并应用超声心动图测量左室射血分数 (LVEF)、左室收缩末期容积 (LVESV)和左室舒张末期容积 (LVEDV)。结果 :治疗组有 95 8%的患者心功能仍为Ⅰ级 ,对照组只有 6 8 2 %的患者心功能为Ⅰ级 (P <0 0 5 ) ;LVEF治疗组从 37 7%上升到 4 8 5 % (P <0 0 5 ) ,而对照组从 38 3%下降至 33 4 % (P <0 0 5 ) ,治疗组与对照组相比有显著性差异 (P <0 0 1) ;治疗组LVESV、LVEDV较治疗前明显下降 (P <0 0 5 ) ,对照组LVESV、LVEDV继续恶化 ,但与治疗前相比无显著性差异 (P >0 0 5 )。结论 :依那普利与卡维地洛联合治疗能抑制无症状心衰患者的心室重塑 ,提高左室射血分数 ,延缓无症状心衰的进展 ,降低心衰住院率。     

急性心肌梗死急诊经皮冠状动脉介入治疗近期疗效观察

目的　探讨直接经皮冠状动脉 (冠脉 )介入治疗 (PCI)对急性心肌梗死 (AMI)的疗效。方法　 6 3例AMI患者在发病 12h内接受梗死相关血管急诊PCI ,随访 1～ 14个月。结果　 6 3例患者中6 1例 (96 .8% )介入治疗获得成功。 3例行经皮冠脉腔内成形术 (PTCA) ,5 8例置入支架。全部获得TIMI 3级血流灌注。 5例发生无血流现象 ,行冠脉内尿激酶溶栓血流改善。 5例在术中发生室速、室颤 ,4例及时除颤转复窦性心律 ,1例死亡。 5例心原性休克患者有 2例住院期死亡。随访期主要事件发生率 17% (5 / 6 0 ) ,其中 2例猝死 ,1例再梗死 ,再次接受PCI成功 ,1例接受择期CABG。 1例因支架内再狭窄行再次PCI。结论　直接PCI治疗AMI可有效地使梗死相关冠脉再通 ,成功率高 ,住院病死率低 ,近期预后良好     

发病时间对选择性经皮冠脉腔内成形术围术期左室功能的影响

 为观察冠心病发病时间对选择性PTCA围术期左室功能的影响,应用二维超声心动图(2DE),对成功地实施选择性经皮冠脉腔内成形术(FIVA)的25例患者,动态观察其围术期左室射血分数(LVEF)、每搏量(SV)、左室舒张末容积(LVEDV)及左室收缩末容积(LVESV)的演变.发现发病≤2 a者围术期LVEF增加(P<0.05),LVEDV及LVESV缩小(分别P<0.05及P<0.01),SV无变化(P>0.05);发病>2 a者虽有LVEDV及LVESV减少(均P<0.05),但LVEF及SV无变化(均P>0.05).提示较早实施选择性PTCA者左室功能改善较明显;反映左室功能改善的2DE指标中,LVEDV及LVESV较LVEF及SV敏感.     

小剂量尿激酶联合合贝爽冠状动脉内注射对PCI无再流现象疗效的临床评价

目的:探讨冠状动脉内注射小剂量尿激酶+合贝爽对经皮冠状动脉介入治疗(PCI)中梗死相关动脉(IRA)无再流现象的临床疗效。方法:对460例急性冠脉综合征患者实施PCI,其中急性心肌梗死150例,PCI术中38例出现IRA的无再流;不稳定型心绞痛310例,7例出现无再流。45例病人随机分为2组,小剂量尿激酶+合贝爽组24例,交替给予尿激酶及合贝爽冠脉内注射,尿激酶总量20万U,合贝爽总量2 mg;合贝爽组21例,给予合贝爽冠脉内注射,总量2 mg。结果:小剂量尿激酶+合贝爽组24例心肌梗死溶栓治疗(Thrombolysis inMyocardial Infarction,即TIMI)血流明显改善,P<0.005;合贝爽组21例TIMI血流亦明显改善,P<0.005。对4例TIMI血流Ⅰ级者继续给予尿激酶10-20万U推注后,TIMI血流Ⅲ级者3例,TIMI血流Ⅱ级者1例,术后24h死亡2例,静点多巴胺1周维持血压1例。两组相比,术后TIMI血流改善以小剂量尿激酶+合贝爽组更为显著,P<0.005。结论:无再流现象与IRA远端的冠脉微血栓形成及痉挛均有关,PCI中给予冠脉内小剂量尿激酶+合贝爽安全有效。     

冠状动脉内注射替罗非班治疗冠状动脉介入中无复流的疗效观察

目的观察冠状动脉内注射替罗非班对冠状动脉介入(PCI)术中无复流的疗效。方法 21例PCI中出现无复流患者,冠脉内注入替罗非班注射液12μg/kg负荷量,0.15μg/(kg·min)静脉维持36h,比较给药前与冠脉内给药后10min冠状动脉造影的校正后的计帧数(CTFC)、TIMI血流分级。结果给药前与给药后校正后的计帧数(CTFC)由(62.42±11.60)帧降至(28.62±8.60)帧,前后比较差异有统计学意义(P<0.01);给药前后TIMI血流变化比较,显效13例(61.9%),有效7例(33.3%),总有效率达95.2%。结论冠状动脉内注射替罗非班治疗PCI术中无复流现象有效。     

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.