氧甲吡嗪在糖尿病患者18F-FDG心肌代谢显像中的作用

目的评价氧甲吡嗪(商品名乐脂平)对改善糖尿病患者心肌18F-脱氧葡萄糖(FDG)摄取的作用.方法107例糖尿病患者进行心肌99Tcm-甲氧基异丁基异腈(MIBI)/18F-FDG双核素同时采集(DISA)SPECT显像,其中65例以口服葡萄糖法进行DISA显像(A组),42例为口服氧甲吡嗪(250 mg×2)加口服葡萄糖法显像(B组).另有8例单纯用口服葡萄糖法图像质量差,而再行另一次口服氧甲吡嗪(250 mg×2)加口服葡萄糖法显像.由2位核医学科医师独立评判图像质量(O～3分法,O分为心肌不摄取18F-FDG,1分为心肌少量摄取,2分为心肌摄取,3分为摄取极佳);定量分析心肌与心腔内放射性计数比值(M/B),心脏与肝脏(H/Li)及心脏与右肺中段最大放射性计数比值(H/L).结果A、B组患者的临床情况相似,18F-FDG注射前血糖浓度没有差别.B组患者没有出现明显副作用.图像质量评分A组为2.3±0.9,B组为2.8±0.7(P=0.013).口服氧甲吡嗪后,图像达3分的比率明显增加(55.3%比79.5%,P＜0.001).8例进行2次显像的患者,服用氧甲吡嗪后,图像评分由0.50±0.27增加到1.75±0.31(P=0.009),M/B(分别为1.41±0.31和1.98±0.88,P=0.008)和H/L(分别为0.98±0.18和1.58±0.41,P=0.046)均有明显增加.结论氧甲吡嗪可明显改善糖尿病患者心肌18F-FDG显像的图像质量.     

多巴酚丁胺负荷用于猪缺血心肌18F-FDG代谢显像的价值

目的 探讨多巴酚丁胺负荷情况下实验猪缺血心肌对18F-脱氧葡萄糖(FDG)的摄取情况.方法 15头中华小型猪,于冠状动脉左前降支近中段放置动脉环,造成慢性冠状动脉狭窄.分别在静息和多巴酚丁胺负荷试验时,进行99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注和18F-FDG心肌代谢SPECT显像.99Tcm-MIBI心肌血流灌注图像用17段4分法进行半定量分析,通过测量心肌短轴感兴趣区(ROI)放射性计数,对缺损的可逆程度进行定量分析.18F-FDG心肌代谢图像分析通过在原始投影数据上勾画ROI,计算心脏与肝脏的平均放射性比值(H/Li)、心脏与右肺尖的平均放射性比值(H/L).所有实验猪均行冠状动脉造影检查.结果 冠状动脉造影发现,所有实验猪的冠状动脉左前降支狭窄均大于50%.99Tcm-MIBI药物负荷和静息显像时的心肌血流灌注半定量评分分别为(9.5±8.3)和(8.3±8.4)分,两者差异有显著性(P＜0.05).缺损可逆程度比值为1.17±0.14.18F-FDG图像分析发现在静息情况下,H/Li比值为1.06±0.10,H/L比值为1.40±0.18;而在多巴酚丁胺负荷情况下,心脏对18F-FDG的摄取相对增加H/Li比值为1.25±0.15(P＜0.0001),与缺血可逆程度呈明显正相关(r=0.64,P=0.007),H/L比值为1.77±0.33(P=0.001),与缺血可逆程度呈明显正相关(r=0.51,P＜0.05).结论多巴酚丁胺负荷可使缺血心肌增加对18F-FDG的摄取.     

骨显像对强直性脊柱炎的早期诊断价值

目的研究放射性核素骨显像对强直性脊柱炎(AS)早期诊断的价值.方法早期与可疑AS患者和对照组均行全身、局部及断层骨显像,测定骶髂关节/骶骨(SI/S)的放射性比值.结果早期与可疑AS患者的SI/S比值分别为1.53±0.11和1.57±0.10,与对照组(1.21±0.10)比较,差异均有显著性(t分别为11.9和15.0,P均<0.01).全身骨显像显示的5例AS患者腰椎及外周关节的病变X线平片均未能发现;AS患者椎骨断层显像可准确判断病变位置,还可发现平面显像不能显示或可疑的椎骨异常浓聚灶.结论放射性核素骨显像测定SI/S比值发现早期AS较X线平片灵敏;全身骨显像及断层显像对了解AS病变部位有明显优势.     

双时相18F-FDG符合线路显像在肿瘤良恶性鉴别诊断中的应用

目的评价双时相18F-脱氧葡萄糖(FDG)符合线路显像在肿瘤良恶性鉴别诊断中的应用价值.方法对100例临床拟诊为恶性肿瘤的患者,静脉注射18F-FDG 185～370 MBq后40～65min和100～140 min,采用Philips IREX三探头符合线路SPECT仪分别行早期和延迟显像.测定2次显像病灶(L)和对侧正常组织(B)的感兴趣区(ROI)放射性计数,并计算L/B比值和L/B变化率(△L/B).结果最后经病理检查或临床随访证实恶性肿瘤75例,良性病变25例.恶性肿瘤组早期显像L/B比值为3.62±2.07,延迟显像为5.67±3.20,△L/B为(57.59±31.91)%;良性病变组2次显像的L/B比值分别为2.47±1.53(早期)和2.72±1.93(延迟),△L/B为(7.23±23.14)%.以△L/B＞30%作为良恶性病变鉴别诊断的阈值,灵敏度为97.3%,特异性为92.0%,准确性为96.0%.结论恶性肿瘤延迟显像L/B比值的增高幅度明显大于良性病变,且双时相符合线路显像方法简便、实用,能提高18F-FDG符合线路显像鉴别良恶性病变的灵敏度、特异性和准确性,有较高的临床应用价值.     

99Tcm-HL91乏氧显像在鼻咽癌治疗中的应用

目的探讨99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)SPECT/CT乏氧断层显像在鼻咽癌(NPC)治疗中的临床应用价值.方法38例NPC患者按常规进行鼻咽、颈部99Tcm-HL91断层显像;并对病灶的靶/非靶组织放射性比值(T/N)进行半定量分析;其中16例NPC患者在放疗前、后均行99Tcm-HL91乏氧显像;同时对16例患者按乏氧靶区调整放疗剂量,行后程三维适形放疗(3DCRT).结果NPC患者乏氧断层显像检查阳性率约为82%;99Tcm-HL91乏氧显像对NPC诊断的灵敏度、特异性、准确性分别为82%、78%、87%;放疗前鼻咽、颈部乏氧病灶的T/N分别为2.37±1.13、2.17±1.08,两者比较差异无显著性(P＞0.05).16例NPC患者在放疗前、后NPC病灶的T/N平均值分别为2.21±1.05、1.29±0.39,两者比较差异有显著性(P＜0.001);NPC病灶的乏氧状态与其对放疗的响应密切相关,相关系数r为0.532,P＜0.01.NPC 3DCRT的近期疗效优于常规放疗,肿瘤局部控制率较高,急性放射毒性较轻.结论99Tcm-HL91乏氧显像可监测NPC病灶的乏氧状态,指导NPC的3DCRT;NPC乏氧靶区3DCRT可提高其放疗疗效,减轻急性放射毒性.     

冠心病患者PTCA术前后核素心脏显像结果对比分析

目的　应用99Tcm 甲氧基异丁基异腈心肌灌注断层显像及心室显像随访经皮冠状动脉腔内成形术 (PTCA)及支架置入术后的效果。方法　患者在成功的PTCA及支架置入术前及随访期进行负荷 /静息或静息 /含硝酸甘油心肌灌注断层显像及心室显像检查。结果　 44例患者在术前及术后平均 11.4个月进行了心肌灌注断层显像 ,其中 40例患者进行了心室显像。结果显示 ,术后患者心肌缺血及不可逆缺损节段数减少 ,分别为 2 .5± 0 .4与 1.5± 0 .3(P =0 .0 6 )及 3.5± 0 .5与 2 .3± 0 .4(P <0 .0 5 ) ;左室射血分数、高峰射血率及高峰充盈率无明显变化 ,运动低下节段数有所下降 ,但未达到统计学差异。结论　成功的PTCA及支架置入术后心肌缺血明显改善 ,左室功能无明显变化 ,部分节段运动改善     

右侧位显像在鉴别下(后)壁心肌放射性减低中的应用

目的评价右侧位显像在鉴别诊断下(后)壁心肌放射性减低中的价值.方法155例常规仰卧位99Tcm-甲氧基异丁基异腈(MIBI)心肌显像受检者中,45例同时加做右侧卧位显像,其中包括冠心病低发人群38例,下(后)壁心肌梗死患者7例.探头仍然为右前斜45°旋转到左后斜45°,采集32帧.心肌显像定性判读由3位医师共同进行,并用极座标靶心图定量分析心肌计数.结果155例受检者中,仰卧位心肌显像时有32.9%(51/155例)出现下(后)壁心肌放射性减低,其中冠心病低发人群62.7%(32/51例),此32例受检者右侧位显像时下(后)壁放射性计数均明显改善(100%,32/32例),由仰卧位时的72.3±7.1提高到83.6±7.8(P<0.01).但右侧位显像时有31.3%(10/32例,1例在心尖,9例在前壁)出现了仰卧位时未出现的放射性减低区.7例下(后)壁心肌梗死患者右侧位显像下(后)壁放射性与仰卧位比较均无改善,其中1例减低更加明显.6例仰卧位显像下(后)壁放射性无明显减低的冠心病低发者中,4例右侧位显像下(后)壁放射性变化不明显,2例仅轻度增加.结论常规仰卧位心肌显像发现下(后)壁放射性减低,加做右侧位显像能明显提高冠心病诊断的准确性,但可在前壁或心尖出现新的伪像,故不能取代常规仰卧位显像.     

早期帕金森病中多巴胺转运体的显像及其与D2受体显像比较

目的了解早期帕金森病患者大脑内多巴胺转运体及多巴胺D2受体的变化情况.材料和方法7例早期帕金森病患者和7例正常人进行大脑123I-βCIT/SPECT显像;其中5例进行123I-βIBZM/SPECT显像.计算纹状体与小脑的放射性比值,分析双侧纹状体中β-CIT和IBZM的特异性摄取.结果7例患者症状对侧和症状同侧纹状体18小时的β-CIT特异性摄取指数为2.3±0.4和4.1±0.3,纹状体的非对称指数为23.3±6.8;其中5例患者症状对侧和症状同侧纹状体的123I-IBZM特异性摄取指数分别为1.8±0.2和1.7±0.2,非对称指数为2.0±0.1.结论早期帕金森病患者双侧纹状体中多巴胺转运体的丢失比D2受体的变化更早,更明显.     

~(99m)TC-MIBI心肌灌注显像在小儿病毒性心肌炎中的应用价值

目的：观察病毒性心肌炎患儿的心肌ＳＰＥＣＴ 显像特点,及心肌灌注显像在病毒性心肌炎（ＶＭＣ） 的诊断和治疗中的作用。材料和方法：对临床诊断为ＶＭＣ 的８９ 例患者进行心肌灌注显像,并与心电图、超声心动图、聚合酶链反应（ＰＣＲ） 等进行比较。结果：８９ 例患儿中有４５ 例（５０ ．５６ ％ ） 心肌显像出现不同程度的放射性分布异常区,有２０ 例出现单节段放射性减低,１９ 例多节段出现放射性分布异常,６ 例呈花斑样改变。２ 例患者在治疗后进行随访,其治疗后显像结果比治疗前有明显好转。结论：ＳＰＥＣＴ 心肌灌注显像有助于对病毒性心肌炎的诊断,对治疗疗效评价有一定的临床价值。     

~(99m)TC—MIBI心肌断层显像对心肌炎的诊断意义

本文用~(99m)TC—MIBI心肌显像对10例正常人,25例心肌炎病人的心肌断层、靶心图半定量分析结果进行了探讨,认为心肌显像对心肌炎的诊断有较高的灵敏度,阳性率达88％。心肌炎病人的图像特点为弥漫性或局限性“花斑”样放射性减低。运动试验与静息时图像大致相同,放射性减低程度无明显变化。心肌炎病人的半定量分析示,与正常人图像相比,其放射性减低约1～3个色阶。故~(99m)TC—MIBI心肌断层显像可为心肌炎的病人提供心肌受损的范围、程度。为临床治疗及预后的估价提供有意义的参考价值。     

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.