严重急性呼吸综合征康复者髋、膝关节骨坏死与激素治疗的关系

目的了解严重急性呼吸综合征（SARS）康复者下肢骨缺血与激素治疗的关系。资料与方法对来自广州市5所医院的148例SARS康复医务人员下肢骨包括双侧髋关节及膝关节进行MRI检查。148例中42例未使用激素治疗,106例使用不同剂量的激素治疗。MRI检查分为筛查与详查。筛查包括T1WI及短反转时间反转恢复序列（STIR）冠状位成像。筛查有阳性发现者则进行详查,在筛查的基础上加用横断位、冠状位T2WI及STIR成像。结果42例未使用激素治疗者未发现下肢骨坏死。106例使用激素治疗康复者中,共发现8例骨缺血改变,其中1例为双侧股骨头缺血坏死,2例为单侧股骨头缺血坏死,1例为双侧股骨头、胫骨髁及单侧股骨髁缺血坏死,1例单侧股骨髁缺血坏死,1例单侧股骨颈骨梗死并钙化,2例双侧股骨、胫骨骨髓水肿。多因素Logistic回归分析显示激素累积剂量是骨缺血性坏死最重要的危险因素（P=0．001）。结论使用激素治疗的SARS康复者中,少数发生下肢骨缺血坏死,而激素累积剂量与骨缺血性坏死关系密切。     

SARS和肾移植患者大剂量应用激素后发生缺血性股骨头坏死的比较

目的对SARS和同种异体肾移植术（下称肾移植）两组患者接受糖皮质激素治疗后缺血性股骨头坏死的发生率进行比较,并分析其差异原因,探讨糖皮质激素及其他因素在缺血性股骨头坏死发生中的作用。方法对67例SARS和59例肾移植术后患者的资料进行回顾性分析,主要包括：双侧髋关节MRI、激素用药情况（累积剂量、单次最大剂量和用药时间）、体重、负重指数、最低动脉血氧分压和辅助通气情况。结果缺血性股骨头坏死发生率SARS组为23．9％（16／67）,肾移植组为6．8％（4／59）,两组比较差异显著（P〈0．05）;两组间静脉注射甲泼尼龙累积剂量无显著性差异（P〉0．05）,肾移植组口服泼尼松累积剂量、甲泼尼龙单次最大剂量、激素用药时间及最低动脉血氧分压均大于SARS组（P〈0．01）。结论静脉大剂量使用激素是SARS和肾移植术后发生缺血性股骨头坏死的基础因素之一,急性期缺氧、病毒侵犯和免疫反应等其他因素可能与缺血性股骨头坏死发病有关。     

SARS患者骨缺血性坏死的MRI检查

目的 分析严重急性呼吸综合征(SARS)患者发生骨缺血性坏死的MRI表现特点。资料与方法 搜集44例SARS患者在接受激素治疗3个月后进行骨关节MRI随访检查的资料进行分析。结果 44例患者中有10例在MRI上发现骨缺血性坏死改变，受累部位包括股骨头、股骨髁、肱骨头、胫骨平台、跟骨和股骨干。病变的中央区信号近似脂肪信号，边缘区呈线样低信号，可见典型的“双线征”。结论 SARS患者在接受大剂量激素治疗后引起骨缺血性坏死是不可忽视的问题。MRI是SARS患者骨缺血性坏死随访筛选检查的一种有效方法。     

SARS康复患者骨坏死改变的MRI筛查

目的　探讨SARS康复患者骨缺血坏死的患病率 ,及其与激素使用的关系。方法　对76例SARS康复患者进行双髋和双膝关节MR扫描。其中男 17例 ,女 5 9例。在治疗SARS时 8例未使用激素 ,其余 6 8例均使用了激素治疗 ,其中 30例有确切激素用量、疗程。对患者全身骨关节症状进行问卷调查。由高年资医生阅读MR图像 ,诊断有无骨缺血坏死改变。对骨缺血坏死患病率、激素用量和症状等参数进行统计学分析。结果　 (1)SARS康复患者股骨头和股骨髁部位出现的骨缺血坏死及骨髓内骨梗死的MRI表现符合临床诊断骨缺血坏死者的MRI典型表现。 (2 ) 8例未用过激素的SARS康复患者无一例出现骨缺血坏死改变 ,而 6 8例使用激素患者中 2 5例出现骨缺血坏死改变 ,两组比较差异有显著性意义 (P <0 0 5 )。 2 5例中有 2 0例累及双侧髋或 (和 )膝关节。骨缺血坏死改变累及股骨头 32个 ,股骨髁 2 6个 ,股骨、胫骨骨髓坏死 6处。在 30例有确切激素用量患者中 ,有骨缺血坏死表现的患者 13例 ,其使用激素总量的中位数为 35 70mg、每日最大用量的中位数为 2 5 0mg、激素使用时间的中位为数 2 3d ,均大于无骨缺血坏死组 (17例 ) ,相应中位数分别为 2 5 6 0mg、2 4 0mg和 2 2d。两组之间 3个参数经秩和检验差异无显著性意义 (P值均 >0 0 5 )     

MRI观察SARS患者激素治疗后骨缺血性坏死改变

目的 使用MRI观察SARS患者激素治疗后骨缺血性改变。方法 采用MRI对23例SARS患者激素治疗后的髋关节、下肢、肩、腰椎等部位进行38次扫描，其中7例病人加做X线平片检查。结果 MRI显示：(1)骨缺血坏死31个部位，其中股骨头28个(Ⅰ期16个，Ⅱ期8个，Ⅲ期4个)；右胫骨平台下坏死1个；左右肱骨头各1个关节面下小斑片状坏死。(2)骨梗死，1例重型SARS患者(双侧股骨头坏死Ⅲ期、左肱骨头坏死)出现多处骨梗死(双侧股骨、双侧胫骨、双侧跟骨、双侧距骨)。(3)骨髓水肿48个部位，其中43个髋关节，3个胫骨平台下和2个肱骨头下骨干。(4)髋关节腔积液16个，9个膝关节内发现轻度积液。X线平片无阳性发现。结论 SARS患者在长时间大剂量使用激素治疗后，股骨头及其他部位骨骼发生缺血性病变比率高。骨骼病变的转归尚需做进一步的深入研究。     

严重急性呼吸综合征康复患者骨坏死与骨髓转化的MRI研究

目的 采用MRI观察严重急性呼吸综合征（SARS）康复患者骨缺血坏死和股骨骨髓转化,分析SARS骨坏死的MRI特征及骨髓转化的意义。资料与方法 112例SAPS患者行股骨MRI检查,检查序列为SE T1WI及短时间反转恢复序列（STIR）。骨髓转化系数（MCI）值为T1WI干骺端信号强度与大转子信号强度的比值。结果 112例SAPS患者中23例发生骨坏死,双侧股骨头坏死13例,双侧股骨头坏死合并双侧股骨干远端骨梗死1例,单侧股骨头坏死2例,干骺端骨坏死6例,双侧膝关节骨坏死1例,MRI显示坏死区均含黄骨髓。21例无骨髓水肿的骨坏死患者MCI值高于年龄相似的无骨坏死患者,差异具有显著意义（P〈0．05）,两组激素的总量及日平均量差异显著（P〈0．05）。结论 SAPS康复患者骨坏死发生于黄骨髓含量高的部位,MCI对骨坏死的预测有重要意义。     

激素所致罕见部位骨坏死影像学分析

目的 探讨SARS恢复期患者罕见部位骨坏死影像学表现及原因。方法 采用平片、0．5T MR机，对2003年6～8月间复查的41例SARS恢复期患者四肢骨骼进行检查，分析影像学检查结果及其与应用激素的相关性；检查距最初使用激素的平均时间为88．2d(67～106d)；平均激素(甲基泼尼松龙)最大用量392(320～480)mg；平均持续用药时间为47．2(30～70)d。结果 MRI显示5例罕见部位骨坏死病变共累及11个部位。3例双侧肱骨头坏死，其中1例合并右侧坐骨坏死；1例右侧腕舟骨坏死；1例双侧跟骨坏死合并右侧距骨坏死。主要MRI表现为各部位的不规则异常信号病灶。平片仅显示1例右侧坐骨坏死。结论 SARS恢复期患者骨坏死早期发现需做MR扫描，而且是多部位扫描，激素用量、时间及患者对激素的敏感性和个体差异是骨坏死的重要原因。     

有机氟吸入康复患者股骨头缺血性坏死的MRI筛查

目的:探讨有机氟吸入患者股骨头缺血坏死的患病率及其激素使用的关系。方法:对31例有机氟吸入男性患者进行双髋MR检查。在治疗时,8例未使用激素,其余23例均使用了激素治疗,均有激素用量及疗程。对股骨头缺血性坏死患病率、激素用量和症状等参数进行统计学分析。结果:8例未使用激素的有机氟吸入康复患者无1例出现股骨头缺血性坏死,而23例使用激素患者中10例出现股骨头缺血性坏死,两组比较差异有显著性意义(P<0.05)。10例中9例累及双侧股骨头,1例累及一侧股骨头。在10例股骨头缺血性坏死中,其激素总量的中位数为3570mg、每日最大用量的中位数250mg、激素使用时间的中位数为23天,均大于无股骨头缺血坏死组(13例),相应中位数分别为2560mg、240mg和22天。两组之间3个参数经秩和检验差异无显著性意义(P值均>0.05)。31例中,22例出现各种骨关节症状,主要症状是多个关节疼痛。15例累及1个以上的关节,7例只累及1个部位。累及的关节分别为髋关节12例、膝关节10例、腰椎10例、肩关节7例及腕关节2例。8例未使用激素的患者中7例主诉有多个关节疼痛症状,在23例使用激素者15例主诉有关节疼痛症状。两组之间无显著性意义(P>0.05)。其中10例MRI发现有股骨头坏死征象的患者中9例有症状,而21例MRI未见异常的患者中,13例有症状。两组之间差异无显著性意义(P>0.05)。结论:MRI筛查能够早期发现股骨头缺血坏死改变;在使用激素治疗的有机氟吸入康复患者中MRI筛查发现股骨头缺血坏死发生率较高;有机氟吸入康复患者多数出现全身关节疼痛症状,其原因尚待研究。     

早期股骨头缺血性坏死的综合影像诊断

目的：探讨股骨头缺血性坏死的早期X线平片、CT、MRI诊断价值。方法：对20例Ficat分期标准0～Ⅱa期股骨头缺血性坏死患者行X线平片、CT、MRI检查。结果：20例早期股骨头缺血性坏死中X线平片仅发现Ⅱa期病变3个,阳性率15％。CT发现0～Ⅱa期病变13个．阳性率65％。MRI发现0～Ⅱa期病变20例，阳性率100％。结论：MRI诊断早期股骨头缺血性坏死的敏感性最高，CT次之，X线平片最差。     

股骨头缺血性坏死的MRI表现

目的：探讨常规MRI平扫及增强扫描对股骨头缺血性坏死的诊断价值。方法：对30例确诊为股骨头缺血性坏死患者进行常规MRI平扫检查（共51个缺血性坏死股骨头）、其中10例加做增强MRI检查（共15个缺血性坏死股骨头）。结果：按股骨头缺血性坏死MRI分期,I期见于13个股骨头,Ⅱ期见于19个股骨头,Ⅲ期见于8个股骨头,Ⅳ期见于11个股骨头。增强MRI强化表现为：无强化（n=2）;轻微强化为主（n=10）和强化较明显（n=3）。骨髓水肿10例。髋关节积液48例。结论：常规MRI与增强MRI检查相结合可更好的反映病理改变过程,评估组织活性,有利于临床医师判断病程分期,选择治疗方案。     

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.