白芨粉栓塞门静脉制备犬门脉高压症模型的实验研究

选用成年、健康杂种犬15只,术前经超声多普勒测量门静脉血流量,个体间采用自身对照。经开腹术穿刺门静脉测压,分次注入白芨粉混悬液,使门脉压升高至3.43 kPa(35 cmH_2O)以上,术后10天、20天,60天重复注射白芨液,术后100天犬门脉血流动力学出现如下变化:门脉压力由术前1.59±0.26 kPa增至3.09±0.49 kPa(31.52±4.97 cmH_2O)。胃镜及病理切片证实食管下段粘膜静脉曲张形成,汇管区出现纤维化。门静脉血流量由术前449.41±84.12 ml/min增至565.72±105.93 ml/min。白芨粉无任何毒性,注入血管可产生确切的人工血栓。制备犬门脉高压症模型简单,存活率高,周期短,可望用于基础及临床研究。     

经颈静脉肝内门腔分流术治疗复杂型Budd-Chiari综合征

目的　探讨和评价经颈静脉肝内门腔静脉分流术（TIPS）治疗复杂型Budd-Chiari综合征（BCS）并门脉高压的临床应用价值。方法　患者男4例，女1例，平均年龄33岁，均有不同程度的食管胃底静脉曲张，4例有上消化道出血史，2例伴有腹水。经下腔静脉相当于右肝静脉开口部进针穿刺门脉行TIPS治疗。结果　5例均获成功。门脉压力由术前平均（4.7±1.3）kPa降至（3.5±1.5）kPa（1kPa=7.5mmHg）。术后24h1例死于心肺衰竭；术后3周1例死于肝功能衰竭。另3例平均随访64个月，肝功能均正常。2例于术后6、9个月均有分流道狭窄，并行二次介入治疗。结论　TIPS是解决复杂型BCS伴门脉高压的一种安全有效的治疗方法。     

TIPSS术＋食道胃底静脉曲张栓塞术前后门静脉压力的变化

目的观测肝硬化门静脉高压患者行经颈内静脉肝内门体分流术（transjugular intrahepatic portosystemic stent shunt,TIPSS）＋食道胃底静脉曲张栓塞术前后门静脉压力的变化,进而探讨TIPSS＋食道胃底静脉曲张栓塞术在治疗肝硬化门静脉高压中的作用。方法对20例因肝硬化所致门静脉高压患者行经颈内静脉肝内门体分流术＋食道胃底静脉曲张栓塞术,在术前、术后分别用直接法测定门静脉主干压力,比较术前、术后压力的变化。结果术前本组肝硬化门脉高压患者的门静脉压力为（41.46±4.89）cmH2O、术后为（25.65±5.73）cmH2O,差异有显著性（P〈0.001）。术前、术后压力差为（15.82±3.12）cmH2O,术后较术前门静脉压力平均下降38.13%。结论 TIPSS＋食道胃底曲张静脉栓塞术可显著降低肝硬化门脉高压患者的门静脉压力,在治疗肝硬化门脉高压症中有重要的应用价值。     

经颈内静脉肝内门体分流术治疗肝硬化门脉高压140例分析

目的探讨经颈内静脉肝内门体分流术（TIPS）治疗肝硬化门脉高压的疗效及安全性。方法回顾性分析140例经TIPS治疗肝硬化门脉高压患者的临床资料,记录术前术后门静脉压力、门静脉和脾静脉直径、食道胃底静脉、腹水的变化,观察术后肝性脑病、复发出血、支架再狭窄等并发症。结果手术成功率及即刻止血率100%,门静脉压力术前（44.7±3.5）cmH2O,术后（23.6±3.8）cmH2O（P<0.01）,门静脉主干直径术前（1.64±0.035）cm,术后（1.27±0.047）cm（P<0.01）,脾静脉直径术前（1.26±0.027）cm,术后（0.95±0.023）cm（P<0.01）。肝性脑病发生率13.6%（19/140）,腹水好转率89%（65/73）,术后12个月复发再出血8.6%（12/140）,支架再狭窄15.7%（22/140）。结论 TIPS是治疗肝硬化门脉高压的有效方法,能有效降低门静脉压力,控制上消化道出血。     

TIPS术治疗肝硬化门脉高压症患者围手术期护理

目的探讨TIPS治疗肝硬化门脉高压症患者的护理措施。方法对320例肝硬化门脉高压症患者行TIPS术的术前、术中和术后护理进行总结分析。结果 318例患者成功置入支架,建立有效分流通道,1例腹腔出血死亡,1例门脉破损,外科行门脉修补。结论 TIPS术是治疗肝硬化门脉高压患者安全有效的方法,充分的术前准备,术中密切的配合,术后病情及并发症的观察十分重要,可有效提高患者的生存质量。     

经颈静脉肝内门体分流术治疗门脉高压症

目的 经颈静脉肝内门体分流术(Transjugular Intrahepatic Portosytemic stent shunt,Tipss)治疗门脉高压症和消化道出血的临床疗效观察。方法 对7例肝硬化并发门脉高压症患者行Tipss,检测门脉压和门静脉及脾静脉内径的变化。结果 Tipss的成功率为85.7％(6/7),门脉压(cmH_2O)24.83±2.137(P<0.01,vs术前的43.33±2.733),提示Tipss能有效地降低门脉压;门静脉主干及脾静脉内径(cm)分别为0.98±0.098,0.80±0.064(P<0.01,vs术前的1.48±0.073,1.23±0.028),进一步说明了门脉压的降低。近期有效率及急症出血控制率为100％,肝性脑病的发生率为16.7％,其发生与分流的血管有关,左肝静脉与门脉左支分流者较右肝静脉与门脉右支及门脉主干分流者低。12月内支架狭窄、闭塞2例(2/4),18月内闭塞1例(1/2),发生再出血2例(2/6),随访6-24月无死亡。结论 Tipss是一种有效降低门脉压、控制食管、胃底静脉曲张破裂出血的新技术,对于急症出血的疗效优佳,但是,中远期分流道易发生狭窄和阻塞,其疗效有待进一步提高。     

CT影像导引预穿刺塑形在TIPS术中的应用北大核心CSCD

目的探讨CT影像导引下预穿刺塑形在经颈静脉肝内门体分流术(TIPS)中的应用价值。方法回顾性分析2019年1月至2021年6月在莆田市第一医院接受TIPS术治疗的56例肝硬化伴上消化道出血患者临床资料。借助术前CT影像显示的肝静脉和门静脉,设计肝静脉穿刺点(A点)、穿刺角度和方向、预期穿刺的门静脉靶点(B点),精确测量A、B点三维距离,并对穿刺针进行塑形。记录术中门静脉穿刺次数,观察术中和术后相关并发症。结果56例患者穿刺次数为(1.68±1.32)次。穿刺1次成功40例(71.4%),2次成功8例(14.3%),4次成功2例(3.6%),4次仍未成功6例(10.7%),其中4例联合门静脉间接造影后穿刺成功,2例门静脉海绵样变患者结合经皮经肝门静脉穿刺并置入定位导管后穿刺成功。56例手术均取得成功,其中49例(87.5%)联合胃冠状静脉栓塞术。经肝右静脉穿刺50例(89.3%),经肝中静脉穿刺6例(10.7%);穿刺门静脉右支47例(83.9%),穿刺门静脉左支9例(16.1%)。门静脉压由术前(39.46±7.09)cmH_(2)O(1 cmH_(2)O=0.098 kPa)改善至术后(24.95±3.41)cmH_(2)O(t=17.726,P<0.01);门体静脉压差由术前(28.25±5.50)cmH_(2)O改善至术后(16.13±4.32)cmH_(2)O(t=20.017,P<0.01)。未发生腹腔出血等严重并发症。结论借助CT影像对TIPS穿刺针进行预穿刺塑形,穿刺成功率较高,值得临床推广应用。     

TIPSS治疗肝硬化门脉高压症的临床应用

报告了12例应用 TIPSS 并 SEEV 治疗 CPH 合并上消道出血的临床研究结果。技术成功率91.7%。分流道为10mm。门脉平均压力由术前的43.2±5.3cmH_2O,降至术后的26.8±3.4cmH_2O。术后随访6～12月。分流道狭窄1例。3个月内死亡3例。初步结果表明:1.TIPSS 是治疗 CPH 合并消化道出血的新的有效的方法,近中期疗效满意。2.TIPSS 同时行 SEEV 对减少再出血,预防食管静脉破裂出血是非常有效的。3.支架以 Wall-stent 为最佳。4.对曾有过肝性脑病,肝功能差者,要加强预防性治疗措施。     

经颈静脉途径肝内门体分流术的临床应用

报告120例 TIPSS 治疗的中期随访结果,探讨影响疗效的因素。120例全部有中度以上食管-胃底静脉曲张。术后随访方法有 US、内镜或/和食管钡餐、肝功能及血管造影等。结果:111例成功,技术成功率为92.5%。建立分流后门脉压力从术前的40.5±4.5cmH_2O(1cmH_2O=0.098kPa)降至23.5±3.5cmH_2O 术后2周 Doppler 超声显示分流道流速峰值为106±68cm/s,脾、门静脉血流速度较术前增加50%以上。术后4～6个月内死亡9例。分流道狭窄或闭塞22例,占随访病例的25.0%。再通成功12例。随访病例的通畅率:首次通畅率为75.0%,第二次处理后的累计通畅率为88.5%。结论:TIPSS 的技术成功率高,降低门脉压及即刻止血可靠,但术后分流道狭窄、阻塞的发生率较高,以 Z 型支架组尤为突出,因而强调术后应定期随访,以及早发现、处理分流道异常。TIPSS 后肝功能衰竭主要见于 Child C 级患者。     

门脉高压症出血组与未出血组门静脉压力的对照研究

目的：探讨经皮经肝穿刺测量门静脉压力来评估曲张的食管胃底静脉发生出血风险的可行性及判断出血风险的门静脉压力参考值、是否行预防性经颈内静脉肝内门体分流术(TIPSS)的门静脉压力参考值。方法临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张自发性出血患者在行 TIPSS 及经皮经肝食管胃底静脉曲张栓塞术中测量门静脉的压力;对临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张未发生出血的患者在行预防性 TIPSS 及经皮经肝穿刺测量门静脉压力;对2组间的门静脉的压力进行比较。结果肝硬化门脉高压症出血组门静脉压力为(41.97±5.12)cmH 2 O,未出血组压力为(33.44±7.79)cmH 2 O,2组间差异有统计学意义(P <0.001);门静脉压力>37.45 cmH 2 O 可作为行预防性 TIPSS 的参考依据之一。结论通过经皮经肝穿刺测量门静脉的压力,可评估乙肝后肝硬化食管胃底静脉曲张发生出血的风险,通过经皮经肝穿刺门静脉压力测量可作为是否对乙肝后肝硬化食管胃底静脉曲张尚未发生出血的患者行预防性 TIPSS 的参考依据。     

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.