脑动静脉畸形出血的相关血管构筑学研究（附80例分析）

目的：探讨DSA的超选择造影显示畸形血管闭构筑学与脑AVM的关系,以期预测脑AVM出血的危险性。方法：血管内栓塞治疗的脑AVM80例,栓塞材料为不同长度5/0的手术丝线、IBCA和NBCA。单因素、多因素回归分析。结果：（1）出血风险评估;术前年平均出血率2.18%,栓塞治疗后年平均出血率2.02%,与术前比较无明显差异。（2）单因素分析结果：对出血危险有显著性影响的因素依次是：引流静脉支数、AVM位置、合并动脉瘤、AVM大小、供应动脉类型及年龄。出血危险与供血动脉支数、静脉引流形式和合并静脉瘤无相关性,多因素回归分析结果：静脉引流支数越少危险性越大。位于基底节、后颅凹的AVM,合并动脉瘤的AVM出血危险性亦大。结论：①单支引流静脉、位于脑深部基底节或后颅凹以及合并动脉瘤的AVM最易破裂出血。AVM出血的影响因素还有AVM大小、供血动脉类型和年龄,②血管内栓塞治疗不能有效地防止AVM的再出血,除非病灶完全消失。     

脑动静脉畸形供血方式与栓塞的关系研究

目的探讨脑动静脉畸形供血方式与栓塞的关系。方法回顾性分析12 4例4 0 0次超选择性微导管造影所显示的脑动静脉畸形的供血方式及其栓塞后并发症的发生率。结果4 0 0次微导管超选择性造影显示终末型供血方式2 92次,占73% ,穿枝型供血方式2 8次,占7% ,动静脉直接交通型36次,占9%。畸形血管团内伴有动脉瘤2 4例,占6 %。畸形血管团内含有静脉瘤或引流静脉呈瘤样扩张者2 0例,占5 %。除穿枝型供血方式16例未行栓塞外,余者栓塞后无严重并发症发生。结论了解脑动静脉畸形供血方式便可知道能否安全的进行栓塞,而测定脑动静脉畸形的动静脉循环时间可指导栓塞用胶的配制浓度。     

髓内血管畸形的血管构筑学及栓塞治疗

目的：探讨髓内动静脉畸形（AVM）的血管构型、血管内栓塞的指征及栓塞治疗的效果。方法：15例患者均有不同程度的肢体瘫痪、感觉障碍、括约肌功能障碍行DSA检查和栓塞治疗。栓塞材料选用PVA颗粒及丝线段。结果：15例中,球型3例,幼稚型12例;球型AVM均为单支动脉供血;幼稚型AVM为多支动脉供血,其中7例为2支供血动脉,5例有3支以上供血动脉,2例伴有动静脉瘘（AVF）;15例患者经27例次栓塞治疗,根据栓塞前后脊髓功能评价,痊愈2例,显效3例,好转6例,4例无变化,无1例加重。经6个月－5年随访,症状较栓塞前改善者4例;栓塞后症状维持者2例;栓塞后症状再次反复者7例,再次行栓塞治疗;失得2例。结论：髓内AVM应栓塞畸形血管团,减轻静脉压力,减少出血机会;血管内栓塞治疗脊髓血管畸形是一种创伤小、安全性高、有效的治疗方法。     

椎管内血管畸形的血管造影诊断与血管内介入治疗

目的:探讨椎管内血管畸形的血管造影诊断与血管内介入治疗效果。方法:回顾性分析66例椎管内血管畸形的选择性动脉造影与栓塞治疗资料。结果:66例椎管内血管畸形的血管造影表现为隐匿性髓内血管畸形者6例,余60例均能显示病变的范围、血供情况及其特征。12例髓内动静脉畸形、17例硬脊膜动静脉瘘和9例髓周动静脉瘘接受了栓塞治疗,其愈显率分别为58.3%、64.7%和66.7%。所有栓塞病例均无严重并发症发生。结论:经选择性血管造影确诊后行栓塞治疗是椎管内血管畸形安全有效的治疗手段。     

出血性脑动静脉畸形的影像特点与血管内治疗

目的：探讨以出血发病的脑动静脉畸形的影像学特点与血管内治疗的技术操作。方法：经脑CT或MRI确认为脑实质内出血的56例病例，经DSA全脑血管造影证实为脑动静脉畸形(AVM)，根据AVM病灶的特点，行经血管内超选择应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗。结果：56例在1-3次栓塞后，36例病灶完全消除；1例因AVM中有新生的动脉瘤及1例术后1年发生出血而行第2次栓塞治愈，1例在接受X-刀治疗后3个月再次出血，经手术后痊愈。结论：AVM病灶内或病灶旁存在动脉瘤和动脉囊样扩张、引流静脉细小和脑室内生长的AVM是引起脑出血的主要原因，而在栓塞中优先处理动脉瘤样病变对防止脑出血有重要意义。     

50%乙醇栓塞治疗儿童YakesⅣ型动静脉畸形

目的 探讨50%乙醇经微导管栓塞治疗儿童YakesⅣ型动静脉畸形（AVM）的安全性和有效性。方法 回顾性分析7例YakesⅣ型AVM患儿的临床资料，局部直接穿刺病变失败后，采用微导管超选病变供血动脉推注50%乙醇，观察疗效、不良反应和并发症。结果 7例患儿均成功实施超选择性AVM栓塞术，共进行了24次栓塞。2例出现皮肤水疱，5例出现局部肿胀，未出现皮肤坏死、神经损伤等严重并发症。术后随访6～12个月，病变消退率为50%～80%,7例治疗效果达到好转。结论 50%乙醇经微导管栓塞治疗儿童YakesⅣ型AVM安全有效，为局部直接穿刺失败的患者提供了补救治疗方式。     

脊髓血管畸形血管内治疗的疗效评价

目的：观察通过血管内栓塞治疗脊髓血管畸形疗效。材料和方法：8例脊髓血管畸形中髓内AVM 5例，髓周AVF 3例。颈段1例．胸段4例(球型2例．幼稚型3例)。髓周]AVF 3例均位于圆锥马尾部．其中Ⅱ型1例，Ⅲ型2例．8例均作病灶栓塞。保留供血动脉4例，供血动脉完全闭塞4例。结果：症状和体征均有不同程度的改善。无并发症．随访2—24个月，髓周AVF疗效明显优于髓内AVM。结论：血管内栓塞治疗脊髓血管畸形，尤其对Ⅱ型和Ⅲ型髓周AVF不失为有效的治疗方法，     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。     

肢体和颅面部血管畸形的血管造影诊断及介入治疗

目的 探讨肢体和颅面部血管畸形的血管造影诊断及介入治疗的临床价值.资料与方法 56例肢体和颅面部血管畸形患者,颅面部14例,上肢18例,下肢24例.先行血管造影,了解病变部位、累及范围、供血动脉、引流静脉及侧支循环情况.然后行栓塞治疗,超选择插管至病变供血动脉内,根据病变性质、造影表现、插管的具体位置及治疗目的 ,选择不同种类、大小的栓塞剂及栓塞方法.对四肢近端局限性动静脉瘘患者置入带膜支架封堵瘘口.结果 56例患者通过选择性动脉造影均明确诊断,其中44例表现为动静脉畸形,供血动脉与引流静脉之间有明显迂曲扩张畸形血管团;12例表现为动静脉瘘.23例行介人治疗,其中21例栓塞后临床症状和体征均有不同程度的缓解,表现为局部包块缩小,血管杂音减轻或消失,心脏功能改善等,2例带膜支架置入后血管杂音消失.随访4～48个月,除2例臀部血管畸形患者栓塞后1年左右又出现临床症状而接受相应治疗外,其余患者均未出现明显临床症状.结论 经导管动脉造影是肢体和颅面部血管畸形的可靠诊断方法;介入治疗血管畸形创伤小、安全、有效,并发症少.     

25例脊髓动静脉畸形治疗

目的　探讨脊髓髓内动静脉畸形的栓塞方法。方法　 2 5例脊髓髓内血管畸形患者 ,均行血管内栓塞治疗 ,早期 4例在肋间动脉或腰动脉直接注射硬脑膜颗粒或PVA等 ,近期 9例将微导管插至供血动脉远端以PVA栓塞 ,1例先以NBCA栓塞供血动脉上的动脉瘤 ,再以Embosphere栓塞AVM。 7例以NBCA栓塞。 5例直接手术切除病灶 ,2例栓塞联合手术治疗。结果　 2 0例栓塞后造影证实 12例几乎完全栓塞 ,8例为大部分栓塞 ,经半年～ 2年随访 ,16例临床症状均有不同程度改善 ,4例临床症状无明显变化 ,均未出现出血症状。结论　对于髓内幼稚型和不能手术的团块型AVM ,血管内栓塞治疗为首选治疗。     

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.