多层螺旋CT血管成像对胰腺癌侵犯胰周血管的表现及可切除性评价

目的：评价多层螺旋CT血管成像（MSCTA）检查对胰腺癌侵犯胰周主要血管的影像表现及手术可切除性评价。方法：使用16层螺旋CT对胰腺癌患者扫描后,进行动脉期和门脉期胰周主要血管CTA三维成像。以三维图像为主,结合原始图像对胰周血管是否受累进行判别及评价,并与手术对照。结果：51例手术病例与手术结果比较,术前MSCTA判断不能切除的21例中手术均无法切除,术前MSCTA判断能切除的30例中手术结果能切除28例,2例误判,判断符合率为93%。结论：MSCTA对于胰腺癌术前可切除性评估具有重要的临床意义。     

多层螺旋CT对胰腺癌周围血管侵犯及肿瘤可切除性的术前评估

【摘要】目的：探讨术前CT对胰腺癌周围血管侵犯和肿瘤可切除性的评估价值。方法：回顾性分析经病理证实的98例胰腺癌的CT多期增强表现,根据其胰周血管侵犯情况及胰腺癌可切除标准,将所有病例分为可切除组、潜在可切除组和不可切除组。以手术及病理结果作为金标准,评价CT对胰腺癌周围血管的诊断效能及肿瘤可切除性的诊断符合率。结果：98例胰腺癌中,术前CT诊断可切除组37例,潜在可切除组38例,不可切除组23例。与手术及病理结果对照,CT对胰周动脉受侵的诊断符合率、敏感度、特异度分别为92.2%、89.9%、92.8%;对胰周静脉受侵的诊断符合率、敏感度、特异度分别为96.9%、95.6%、97.3%。术前CT对可切除组、潜在可切除组、不可切除组的诊断符合率分别为为97.3%、86.8%、91.3%。结论：CT多期增强扫描对胰腺癌周围血管受侵情况的评估具有重要价值,有利于术前评估肿瘤的可切除性。     

低场MRI对胰腺癌胰周血管受累的评估

目的　探讨低场MRI对于胰腺癌胰周血管受累评估的准确性及其临床价值和限度。方法　对 5 5例胰腺癌病例进行MR扫描 ,预测评估胰周血管受侵情况 ,并与手术结果进行比较。结果　 5 5例中 ,5 0例 ( 91% )术前得以正确诊断。血管未受累预测准确性 86% ,血管受累预测准确性 93 %。结论　低场MRI对于判断胰周血管是否受侵很有价值 ,但MRI分级Ⅰa级和Ⅰb级对于指导临床工作尚存在局限性     

16层螺旋CT兼容性血管成像对胰腺癌胰周主要血管侵犯的诊断价值

目的探讨16层螺旋CT兼容性血管成像对胰腺癌胰周主要血管侵犯的诊断及其价值。方法对48例胰腺癌患者采用MSCT肝脏兼容性双期增强扫描方式,以多平面容积重建(MPVR)、容积重建(VR)血管成像技术,行胰周主要动脉、门静脉血管成像,并多角度观察胰周主要动脉、静脉血管的侵犯情况。结果胰腺癌胰周毗邻的动脉主干受侵30例,主要静脉受侵41例,胰周血管受侵的表现特征:1肿瘤压迫侵蚀局部血管弧形变扁,边缘轻度不规则;2血管僵直管腔狭窄变细,边缘毛糙或锯齿状改变;3孤立性或非孤立性脾静脉阻塞;4胰周侧支循环血管扩张迂曲;5胰周区域性门静脉高压。结论 MSCTA、CTPV对胰腺癌胰周主要血管侵犯的准确诊断和不可切除性评估提供较为可靠的依据。     

螺旋CT三期增强扫描及后处理对胰腺癌的诊断及术前分期的价值

目的 探讨螺旋CT三期增强扫描及后处理对胰腺癌的诊断价值及手术可切除性的评估.方法 回顾分析41例胰腺癌的螺旋CT三期增强及后处理图像资料,分析肿瘤的部位、大小、强化特征和胰周血管是否受侵等,并与手术结果对照.结果 胰腺癌灶在胰腺期较门脉期强化程度低,病灶与正常胰腺组织问密度差别大,病变显示清晰;与手术结果对比,螺旋CT三期增强及后处理对胰周动脉受侵评价的准确度为80.7%,对转移评价的准确度为75.8%.结论 螺旋CT三期增强及后处理对胰腺癌的诊断有重要价值,有助于术前治疗方案的选择和可切除性的评估.     

胰腺癌血管侵犯的不同CT诊断标准的研究

目的:研究胰腺癌血管侵犯的不同CT诊断标准的优劣。材料和方法:回顾性收集我院经多层螺旋CT三期动态增强扫描并经手术病理证实为胰腺导管细胞癌的36例患者。CT轴位图像结合CTA(以MIP和VR方法重建)以及多平面重建(MPR)分别对这些血管以Loyer和Lu血管分级CT标准进行分级,并和手术结果进行对照,分别作出受试者工作特性曲线(ROC),比较曲线下面积的差异。另外,运用Lu的CT诊断标准分别评价胰周动脉和静脉受侵的准确性、灵敏度、特异度、阳性预测值、阴性预测值、Youden指数,研究Lu的CT诊断标准对动静脉分级的差异。结果:Loyer和Lu的CT诊断标准所得的灵敏度、特异度分别为84.5%、86.0%、81.4%、91.8%,两个诊断标准的ROC曲线下面积分别为0.886、0.912,经统计学检验无明显差异。应用Lu的CT诊断标准,胰周动静脉受侵的阳性预测值分别为57.1%和71.0%。结论:分别以Loyer和Lu血管分级CT标准对胰腺癌胰周血管侵犯进行分级,两者的诊断价值相同,Lu的CT诊断标准的最佳诊断分界点应在90°-180°之间,此外,它对胰周动脉的价值要比静脉差。     

能谱CT对胰腺癌可切除性的评估

目的 探讨能谱CT成像对胰腺癌术前可切除性评估的临床应用价值.方法 对46例经手术病理证实的胰腺癌患者进行能谱CT扫描.应用能谱CT综合评价癌肿与周围主要血管、脏器的关系及肝脏、腹腔淋巴结转移情况.结果 能谱CT术前正确判断8例存在肝转移,11例存在淋巴结转移.经统计学分析,能谱CT评估动脉受侵的特异性为98.9％,敏感性为95.2％;评估静脉受侵的特异性为100％,敏感性为90.6％;判断总体血管受侵的特异性为99.2％,敏感性为93.5％.结论 能谱CT可准确判断胰腺癌是否发生肝转移和淋巴结转移,并可提高对胰周血管是否受侵判断的特异性和敏感性.     

多层螺旋CT对评价胰腺癌可切除性的作用

目的 探讨多层螺旋CT评价胰腺癌的可切除性，并与手术比较。方法 使用TOSHIBA Aquilion16层螺旋CT，对67例临床胰腺癌患者行动态增强CT扫描，判断胰腺病变大小，评价及判别胰周血管是否受累，观察肝脏及腹膜后淋巴结是否转移，判别胰腺癌的影像学可切除性，结合手术及病理结果，进行统计学分析。结果 CT增强扫描判断胰腺癌可切除性的敏感性72．72％，特异性98．21％。通过卡方检验，x^2=1．000，P〉0．05，胰腺癌可切除性的术前CT判断与外科手术判断在统计学上没有差异。结论 CT判断胰腺癌可切除性对选择手术方式具有前瞻性指导意义。     

胰周血管受胰腺癌侵犯程度常被影像学低估的原因分析

目的 探讨胰周血管受侵程度被影像学低估的原因.方法 收集经手术病理证实或临床治疗证实的胰腺癌无远处转移患者76例,均行术前螺旋CT增强扫描,其中66例行MRI增强扫描并行三维血管重建,显示胰腺癌对周围血管的侵犯程度,把肿瘤对血管的侵犯程度分为0级、1级、2级、3级、4级.对术前评价可切除病例中的受侵犯的血管进行术中探查,并与手术结果对照.结果 39例中的138支血管受肿瘤侵犯达2级或以上,放弃手术,另37例术前评估有手术切除可能性,术中25例做了胰腺根治性切除,12例由于术前低估了1支或多支血管的受侵程度,仅做了肿块切除或姑息性治疗.此12例中有16支动脉血管及21支静脉血管受侵程度被低估,术中综合评估3级、4级的血管手术均无法切除,术中综合评估0级、1级的血管手术均顺利切除,评估为2级的血管受术者水平的影响而有部分切除.结论 术前用多层螺旋CT及MRI多期增强扫描并进行三维血管重建,评估动、静脉时使用不同的时像、不同的判定标准,可准确反映胰周血管受侵程度的准确信息.     

128层螺旋CT双期增强扫描对胰腺癌诊断价值的分析

目的:探讨胰腺癌的128层螺旋CT表现及对临床手术的指导价值.方法:回顾性分析了29例经病理证实的胰腺癌双期扫描的CT征像,评估手术价值.结果:胰腺癌的CT表现具有一定特征性,并可通过胰周血管受累情况及远处转移情况对胰腺癌手术可切除性进行评价.结论:128层螺旋CT双期扫描能清楚显示胰腺癌的大小及与周围血管之间的关系,可作为诊断胰腺癌的首选方法,术前评估对胰腺癌的外科治疗具有重要的指导意义.     

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.     

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.     

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).     

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.