FFR CT诊断冠心病的初步应用体会

目的初步探究基于CT血管成像的无创血流储备分数（FFR_CT）与传统有创血流储备分数（FFR）相比在冠心病病人心肌缺血诊断方面的应用价值。方法纳入2017年2月-12月于我院接受冠状动脉CT血管成像（CCTA）检查且后续1周内完成冠状动脉造影（ICA）及FFR检查的可疑或确诊冠心病的病人20例,其中男13例,女7例,平均年龄（64.72±8.01）岁。对病人CCTA影像采用简化一维cFFR软件进行FFR_CT值测定,以有创性FFR结果作为金标准,分析比较FFR_CT对冠心病病人心肌缺血诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度。绘制受试者操作特征（ROC）曲线,比较FFR_CT与CCTA的诊断准确性。采用Pearson相关性检验及Bland-Altman方法比较FFR_CT与FFR的诊断相关性及一致性。结果以病变为分析单位,FFR_CT与CCTA诊断敏感度、特异度、阳性预测值、阴性预测值、准确度分别为93.5%、86.2%、87.9%、92.6%、90.0%及83.9%、79.3%、82.1%、81.2%、81.7%。FFR_CT和CCTA的ROC曲线下面积分别为0.960及0.892。FFR_CT与FFR诊断一致性及相关性良好（r=0.973,P<0.001）。结论FFR_CT对于冠心病病人心肌缺血诊断具有良好的临床应用价值。     

基于机器学习的FFRCT对冠状动脉功能性狭窄的诊断准确性研究

目的以有创性冠状动脉血流储备分数（FFR）为金标准,探讨不同区间内基于机器深度学习的CT冠状动脉血流储备分数（FFR_CT）对冠状动脉功能性狭窄的诊断准确性。方法?回顾性收集先后行冠状动脉CT血管成像（CCTA）及FFR检查的病人125例（162处病变）,年龄42.0~88.0岁,平均（61.0±8.2）岁,男79例,女46例。两项检查时间间隔≤2周。在CCTA影像上获得病变直径狭窄程度,采用西门子cFFR原型软件（cFFR,version3.0.0）计算FFR_CT数值。以FFR≤0.8为具有血流动力学意义的狭窄,绘制FFR_CT及CCTA的受试者操作特征曲线,获得曲线下面积（AUC）。并计算两种方法的敏感度、特异度、阳性预测值、阴性预测值及准确度。结果FFR_CT及CCTA对于诊断功能性狭窄的AUC分别为0.85、0.76（P<0.05）。基于病人水平分析,CCTA和FFR_CT的诊断敏感度、特异度、准确度分别为77.6%、69.7%、76.8%和85.7%、78.9%和86.1%。当FFR_CT数值≤0.69、0.7~0.8、0.81~0.89、≥0.9时,FFR_CT诊断功能性狭窄的准确度分别为86.4%、61.2%、88.6%、98.2%。结论以FFR为金标准,FFR_CT数值在0.7~0.8之外的病变结果具有良好的诊断准确性,而数值在0.7~0.8区域内的病变诊断准确性欠佳。     

基于机器学习方法研究造成缺血特异性狭窄的斑块特征

目的 利用机器学习（ML）方法探讨定量、定性的冠状动脉斑块特征以及血流动力学参数对缺血特异性狭窄血管的影响。 材料与方法 回顾性分析同时行冠状动脉CT血管成像（CCTA）、有创冠状动脉造影（ICA）及FFR测量的255例病人共328支血管的临床及影像资料。以FFR≤0.80作为提示病变特异性缺血的指标,依据FFR值将纳入血管分为非缺血组（FFR>0.80）和缺血组（FFR≤0.80）。测量所有纳入斑块的CCTA参数,包括斑块的定量、定性特征以及血流动力学参数。采用LogitBoost算法建立随机森林模型,通过信息增益排序方法自动选择特征。分类准确度、敏感度以及f1值（分类准确度与敏感度的调和平均值）用以评价随机森林模型对造成缺血特异性狭窄斑块的预测价值,并计算受试者操作特征（ROC）曲线下面积。采用十折分层交叉验证法计算模型的总体分类准确度。 结果 应用ML方法得出,血流动力学参数FFR_CT、ΔFFR_CT是预测缺血特异性狭窄最重要的2个特征,其次是斑块的定量、定性特征,包括脂质斑块体积、斑块弯曲、斑块不规则、非钙化斑块体积、狭窄程度、纤维斑块体积和管腔体积。在排序前10的特征中有9个是CCTA相关参数,只有1个临床参数。采用随机森林模型预测缺血特异性狭窄的分类准确度为0.940,敏感度为0.940,f1值为0.940;预测缺血特异性狭窄的 ROC曲线下面积为0.992,模型的总体分类准确度为0.921±0.047。 结论 ML方法能够很好地预测引起心肌缺血的冠状动脉特异性狭窄病变的斑块特征。     

基于CCTA对胸痛病人高危斑块成分及血流动力学特征的研究

目的 基于冠状动脉CT血管成像（CCTA）研究伴高危斑块的胸痛病人其斑块成分特征及血流动力学特征。方法 回顾性纳入行CCTA且于2个月内行有创冠状动脉造影检查的43例冠心病病人,男30例,女13例,平均年龄（60.8±8.7）岁。依据病人是否存在高危斑块及胸痛将病人分为2组,组1同时存在胸痛和至少1个高危斑块特征（23例）,组2仅有胸痛或高危斑块特征任意一项（20例）。测量斑块成分特征参数[斑块总体积、钙化斑块体积、纤维斑块体积、脂质斑块体积占比（脂质斑块%）、脂质斑块面积、最小管腔面积、偏心指数]和血流动力学特征参数[基于CCTA的血流储备分数（FFR_CT）,斑块近、远端FFR_CT差值（△FFR_CT）]。采用Mann-Whitney U检验或独立样本t检验比较2组间参数的差异。利用约登指数计算斑块成分特征及血流动力学特征判断高危斑块合并胸痛的临界值,采用受试者操作特征（ROC）曲线分析计算其临界值的敏感度、特异度以及曲线下面积（AUC）。结果 组1的脂质斑块%、脂质斑块面积均高于组2（均P<0.05）,FFR_CT值低于组2（P<0.05）,2组间其他斑块成分特征参数及△FFR_CT差异均无统计学意义（均P>0.05）。分析脂质斑块%、脂质斑块面积及FFR_CT 特征参数的诊断能力,FFR_CT的临界值为0.82时的敏感度最高（61%）、特异度最低（85%）,AUC最高（0.80）。结论 采用CCTA分析高危斑块中脂质斑块成分特征并进行FFR_CT测量,可作为评估高危斑块合并胸痛病人的有效辅助手段,为临床治疗决策提供依据。     

AI在CCTA诊断冠状动脉狭窄中的准确性及应用价值

目的:探讨人工智能(AI)在冠状动脉CT血管成像(CCTA)中诊断冠状动脉狭窄的准确性及应用价值。方法:收集2019年4月至10月110例同时行CCTA及有创冠状动脉造影(ICA)病人的影像资料,110例共1484段血管纳入评价范围。狭窄程度分为无狭窄、轻度狭容(<50%)、中度狭(50%~70%)重度狭窄(>70%).AI软件自动对CCTA图像进行重建及计算分析。以ICA结果为金标准,计算AI在CCTA中诊断冠状动脉狭容的敏感度、特异度、阳性预测值及阴性预测值。对AI与ICA结果进行Kappa值一致性检验。结果:①AI检出冠状动脉狭窄的敏感度、特异度、阳性预测值及阴性预测值分别为92.97%.97.91%,88.53%,96.36%,准确性为93.60%,AI与ICA检出冠状动脉狭窄一致性好(Kappa值0.86).②AI诊断冠状动脉狭窄程度准确性为66.13%,与ICA一致性一般(Kappa值0.58)。诊断轻度狭窄准确性较高,诊断中重度狭窄特异度较高。结论:AI在CCTA中对冠状动脉狭窄节段的检出及诊断轻度狭窄具有较高准确性,诊断中重度狭窄特异度较高,可作为医师辅助诊断手段.     

冠状动脉管腔内对比度衰减梯度对钙化斑块诊断价值的研究

目的：以侵入性冠状动脉造影（ICA）为金标准,评价冠状动脉CT血管成像（CCTA）时管腔内对比度衰减梯度（TAG）诊断钙化斑块所致冠状动脉狭窄的价值。方法：回顾性分析78例冠状动脉有钙化斑块的患者,共112支血管,所有患者均做了CCTA （采用320排容积CT）和ICA检查。以血管为单位,计算TAG;并以CCTA目测法评价钙化斑块处管腔的狭窄程度。以ICA结果将狭窄程度分为轻度组（<50%）、中度组（50%～69%）和重度组（≥70%）。比较TAG在3组间的差异;计算并对比分析TAG、CCTA和TAG+CCTA诊断钙化斑块处狭窄程度的灵敏度、特异度、阳性预测值、阴性预测值和ROC曲线下面积。结果：轻度组85支,中度组40支,重度组14支。3组的TAG分别为-14.400±7.024、-27.307±6.222和-37.325±11.187,3组间有显著性差异（P<0.001）。判断中度及以上狭窄时,TAG的灵敏度和特异度为94.44%和81.03%,TAG、CCTA和TAG+CCTA的ROC曲线下面积分别为0.930、0.579和0.934,其中TAG与CCTA (P<...     

基于冠状动脉CT血管成像的狭窄率与斑块特征联合分析对提高CT诊断心肌缺血效能的价值

目的:探究冠状动脉CTA（CCTA）诊断的狭窄程度与斑块特征联合应用对冠状动脉缺血病变的诊断效能。方法:2018年11月至2020年3月,在全国5家临床试验中心纳入疑诊或已知冠心病并拟行冠状动脉造影（ICA）的患者,所有患者于1周内依次行CCTA、ICA及血流储备分数（FFR）检查。测量并收集所有病变血管的斑块特征,包...     

基于深度学习的FFRCT在可疑冠心病病人中的应用

目的 探讨基于深度学习的CT血流储备分数（FFR_CT）在可疑冠心病病人中应用的可行性,分析缺血性病变（FFR_CT≤0.80）的预测因素及对治疗决策的影响。方法 回顾性纳入因疑似冠心病行冠状动脉CT血管成像（CCTA）的病人292例,其中男187例,女105例,平均年龄（65.8±10.3）岁。利用CCTA影像将狭窄程度分为轻度 （≥25%且<50%）、中度（≥50%且<70%）和重度（≥70%且<99%）。采用基于深度学习的FFR_CT软件对病人的CCTA数据进行测量。根据FFR_CT数值范围将病人分为阳性组（FFR_CT≤0.80,102例）和阴性组（FFR_CT>0.80,190例）。2组病人的一般资料、CCTA上的血管特征及血运重建,以及基于FFR_CT与CCTA制定的治疗策略的比较采用Mann-Whitney U 检验、t检验及卡方检验。采用Logistic回归分析FFR_CT≤0.80的独立预测因素。结果 阳性组病人的年龄更大,男性更多,高血压、糖尿病和吸烟的比例均高于阴性组（均P<0.05）。阳性组较阴性组病人更多的表现为中重度狭窄（分别为80.4%和28.4%）,更多的病人行血运重建术（分别为56.8%和11.1%）,均P<0.05。74例病人（25.3%）基于FFR_CT的结果治疗决策发生改变。多因素Logsitic回归分析显示,高血压（OR=2.245）、糖尿病（OR=2.238）及中重度狭窄（OR=8.837）是FFR_CT≤0.80的独立预测因素（均P<0.05）。结论 基于深度学习的FFR_CT技术在可疑冠心病病人中的应用是可行的,高血压、糖尿病及中重度狭窄是FFR_CT≤0.80的独立预测因素,FFR_CT可能影响病人的治疗决策。     

CT管腔内对比度衰减梯度及改良校正的管腔内对比度衰减梯度对冠状动脉功能性狭窄的诊断初探

目的探讨并比较CT管腔内对比度衰减梯度(TAG)和改良校正的管腔内对比度衰减梯度(MTAG-CCO)对冠状动脉功能性狭窄的诊断价值。方法收集2016年2月～2017年8月来我院就诊并有意愿行CCTA及FFR检查的冠心病患者。将所有冠状动脉分为无功能性狭窄组(FFR0.80)和功能性狭窄组(FFR≤0.80);记录每支冠状动脉的TAG、MTAG-CCO及FFR值,比较两组间TAG、MTAG-CCO,并计算TAG、TAG-CCO、CCTA及TAG+CCTA及MTAG-CCO+CCTA对功能性狭窄的灵敏度、特异度,阳性预测值和阴性预测值。结果纳入35例患者(37支冠状动脉)。无功能性狭窄组和功能性狭窄组(-15.39±2.250 vs-19.87±2.054)HU/10mm的TAG之间不存在显著性差异(P=0.1561),MTAG-CCO(-0.02521±0.001867 vs-0.03260±0.002369)/10mm之间存在显著性差异(P=0.0179)。单独CCTA的敏感度、特异度、阳性预测值和阴性预测值分别为50.0%,17.6%,41.7%和23.1%;TAG分别为55.0%,11.8%,42.3%和18.2%;MTAG-CCO分别为15.0%,41.2%,23.1%和29.2%;TAG+CCTA分别为90.0%,5.9%,52.9%和33.3%;MTAG-CCO+CCTA分别为50.0%,52.9%,55.6%和47.4%。结论 MTAG-CCO较TAG有进一步区别冠状动脉功能性狭窄的可能性;MTAG-CCO+CCTA的敏感度、特异度均较高。     

基于CCTA的ΔCT-FFR对重度钙化冠状动脉功能学评估的临床价值分析

目的 探讨基于冠状动脉计算机断层扫描血管成像(CCTA)的血流储备分数(CT-FFR)和冠状动脉病变最严重狭窄处的近端与远端CT-FFR测量差值(ΔCT-FFR)对重度钙化冠状动脉功能学评估诊断效能的临床价值。方法 收集2018年1月-2019年6月解放军总医院心血管内科收治住院的107例冠心病(CAD)患者的149支血管进行回顾性分析。所有患者住院期间依次进行CCTA、CT-FFR、侵入性冠状动脉造影(ICA)和有创血流储备分数(FFR)检查。以单支冠状动脉钙化积分(CACS)≥100判断为血管水平的重度钙化,根据CACS水平将冠状动脉分为CACS≥100组(n=56)和CACS<100组(n=93)。以FFR≤0.8作为诊断冠状动脉血流动力学异常的“金标准”,ΔCT-FFR定义为冠状动脉病变最严重狭窄处近端与远端CTFFR的测量差值。采用Pearson相关和Bland-Altman图评估血管水平CT-FFR与FFR值的相关性和一致性。通过ΔCT-FFR校正CT-FFR的检测结果,使用Delong检验比较不同诊断方法间受试者工作特征曲线(ROC)的曲线下面积(AUC),在血管水...     

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.