Budd-Chiari综合征的介入治疗

目的：研究和评价Ｂｕｄｄ－Ｃｈｉａｒｉ（ＢＣＳ）综合征的介入治疗结果。材料与方法：对２３例各型ＢＣＳ患者在Ｂ超及透视监视下采用闭塞部位穿刺，球囊扩张及支撑架技术进行治疗。结果：２２例成功，无严重手术并发症，术后患者症状明显缓解，腔静脉压差由２．４±１．１ｋＰａ降为０．７±０．２ｋＰａ，肝静脉压差的２．８±０．９ｋＰａ和为０．５±０．３ｋＰａ，经过６个月－４年随访，通畅率８２％，复发病例经再次治疗均     

节段性狭窄闭塞Budd－Chiari综合征的介入治疗

目的：研究节段性狭窄闭塞Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的治疗方法和如何提高其疗效。材料与方法：本组１２例，男１１例，女１例，年龄１９～５０岁，病程２月～２５年。全部病例均经彩色超声多普勒和下腔静脉造影确诊，其中下腔静脉肝段闭塞１０例，狭窄２例，狭窄闭塞长度２～１５．５ｃｍ，平均５．６ｃｍ。对完全闭塞者应用Ｂｒｏｃｋｅｎｂｒｏｕｇｈ穿刺针行闭塞段穿通术，尔后行ＰＴＡ及血管内支架置入。结果：１０例下腔静脉节段性闭塞行穿通术，ＰＴＡ及血管内支架置入均获成功；２例节段性狭窄行ＰＴＡ成功，但在１～１．５个月后发生再狭窄，经再次ＰＴＡ及血管内支架置入也获较好效果。术前后下腔静脉压力由２．８６６±０．４００ｋＰａ降至１．５３４±０．４００ｋＰａ。术后患者腹胀减轻，肝脏回缩变软，下肢水肿及静脉曲张减轻。随访１．５～２６个月，平均８．５个月，经彩超检查下腔静脉均保持通畅，仅２例发现内支架略有塌陷，但临床症状和体征比术前也有明显改善。结论：对下腔静脉节段性狭窄闭塞的介入治疗，单行ＰＴＡ容易发生再狭窄，同时置入血管内支架可防止再狭窄的发生。对下腔静脉节段性闭塞穿通术有一定难度和风险，作者强调要熟练掌握Ｂｒｏｃｋｅｎｂｒｏｕｇｈ穿刺     

Budd-Chiari综合征血管内支架治疗

目的：研究完全闭塞型及合并肝静脉病变的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征介入治疗方法和支架移位的防治。方法：１２例Ｂｕｄｄ－Ｃｈｉａｉｒ综合征，膜性狭窄７例，节段性病变５例，术前下腔静脉内径平均０．５６ｍｍ，平均静脉压３．２０±０．４６ｋＰａ。在球囊扩张的基础上置入了血管内支架。结果：技术操作全部成功，无严重并发症发生。临床症状及体征明显好转，治疗后下腔静脉直径平均达１９．８０ｍｍ，平均静脉压１．５０±０．４０ｋＰａ。经２－２３个月（平均１１．５个月）的随访，除１例因支架移位引起再狭窄外，其余下腔静脉血流均通畅，未出现再狭窄。结论：Ｂｕｄｄ－Ｃｈｉａｒｉ综合征血管内支架治疗，近期及中期疗效显著，是理想的治疗方法。     

下腔静脉阻塞类型和病程对PTA治疗的影响

下腔静脉阻塞类型和病程对ＰＴＡ 治疗的影响目的　评价单纯ＰＴＡ 对治疗肝段下腔静脉阻塞综合征的长期疗效和相关因素分析。方法　１９９３～１９９７ 年间,１６ 例肝段下腔静脉阻塞患者实施下腔静脉血管成形术。术前对所有患者进行病史调查,常规临床体验,超声及下腔静脉造影,造影结果按Ｓｕｇｉｕｒａ 法分类。术后随访分为Ａ 组（ 症状复发组） 和Ｂ组（症状未复发组） 。结果　１６ 例患者中,Ａ 组７ 例,Ｂ 组９ 例,术前平均病程分别为（７ ．７１ ±３．０４） 年（４ ～１２ 年） 和（２．３３ ±１ ．５） 年（１ ～５ 年）。主要临床表现为腹胀,肝脾大,双下肢及胸腹壁静脉曲张。下腔静脉造影Ｓｕｒｇｉｕｒａ 分类：Ａ组：Ⅰａ、Ⅰｂ 、Ⅲ型各１ 例,Ⅱ型４ 例（ 肝静脉开放２ 例,闭塞５ 例）。Ｂ组：Ⅰａ、Ⅲ型各３ 例,Ⅰｂ 型２ 例,未能归类１ 例（肝静脉开放６ 例,闭塞３ 例） 。１６ 例ＰＴＡ 均获成功,除１ 例术后发生右髂股静脉血形成并发轻度的肺栓塞外,无其它并发症发生。Ａ 组症状复发平均时间（２２ ．５７ ±１２ ．８５）个月。Ｂ组无症状复发平均时间（４１．５５ ±６．２）１ 个月。结论：ＰＴＡ 对病程短,至少有１支肝静脉开放的下腔静脉梗阻患者有较好的长期     

大鼠肌皮神经感觉纤维在脊髓胶状质内的投射

应用酸性磷酸酶法，定量研究肌皮神经感觉纤维在胶状质内的投射，结果为投射节段Ｃ４下段至Ｃ６上段，长度（３．０９±０．０６）ｍｍ。横向投射区集中在胶状质内侧半２～３区的范围至１～３区，Ｃ４（０．５６２±０．０１５）ｍｍ２、Ｃ５（０．５９２±０．０１）ｍｍ２、Ｃ６（０．５４３±０．０１８）ｍｍ２三者间无显著性差异（Ｐ＞０．０５）。     

合并肝静脉阻塞Budd－Chiari综合征的介入治疗研究

目的：根据合并肝静脉阻塞Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的血液动力学特征，研究该型Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的介入治疗方法。材料与方法：本组４例，临床主要症状为腹胀，肝肿大，胸腹壁静脉曲张，２例继发门脉高压。诊断经彩超、下腔静脉及肝静脉造影确诊。应用经颈静脉肝内门体静脉分流术Ｒｕｐｓ－１００肝穿装置行肝静脉开通术及ＰＴＡ。结果：４例肝静脉开通术及ＰＴＡ均获成功，３例为右肝静脉，１例为左肝静脉。肝静脉压力由术前的２．６７±０．４０ｋＰａ降至术后的１．２５±０．４０ｋＰａ。术后随访２０天～３个月，患者一般情况良好，未见术前症状复发。结论：对合并肝静脉阻塞的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征进行介入治疗，重要的是开通阻塞的肝静脉，解除因肝静脉回流受阻所至的淤血性肝硬化门脉高压，临床效果好。对合并下腔静脉阻塞侧枝循环建立好的，下腔静脉可不进行处理     

血栓形成性Budd—Chiari综合征的腔内支架成形治疗

目的　探讨Ｂｕｄｄ—Ｃｈｉａｒｉ综合征血栓形成性下腔静脉闭塞的介入治疗方法。材料和方法　１０例下腔静脉血栓性闭塞患者,病变长度２～１３ｃｍ,介入治疗前给予１～２周以上抗凝,溶栓治疗。下腔静脉再通采用Ｒｕｐｓ—１００型肝内穿刺针的金属鞘及其保护套管,再通后行球囊导管扩张并植入内支架。结果　１０例患者行下腔静脉再通、扩张和支架植入获得成功。患者平均下腔静脉压由术前的３．４２±０．６６ｋＰａ降至术后的１．９０±０．４１ｋＰａ。术中和术后无肺动脉栓塞和其他并发症发生。术后患者症状和体征于２周后明显改善或消失。随访３～２８个月显示经开通的下腔静脉均保持通畅,无再狭窄及血栓形成发生。结论　下腔静脉介入治疗前１～２周给予良好的抗凝治疗．是预防术中血栓脱落致肺梗塞的最佳措施。自膨胀式内支架有支撑和固定血栓的作用,植入时应覆盖闭塞段全程。     

节段性狭窄闭塞Budd-Chiari综合征介入治疗的临床评价

目的：评价应用穿通术、ＰＴＡ、内支架（ｓｔｅｎｔ）置入及溶栓术治疗节段性狭窄闭塞Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）的临床效果。方法：本组２４例，其中节段性狭窄１４例，闭塞１０例，大部分并有肝静脉不同程度阻塞，下腔静脉血栓形成２例。应用Ｂｒｏｃｋｅｎｂｒｏｕｇｈ穿刺针行下腔静脉闭塞段穿通术，ＰＴＡ和内支架置入；应用Ｒｕｐｓ－１００开通阻塞的肝静脉。结果：２４例下腔静脉均开通成功，同时开通１１支肝静脉，下腔静脉压力平均由术前的３．１４ｋＰａ降至１．１５ｋＰａ，肝静脉压力由术前的２．７５ｋＰａ降至１．９１ｋＰａ。平均随访１３．５个月，２例发生轻度下腔静脉狭窄，但临床症状也有明显改善。结论：在ＢＣＳ介入治疗中，ＰＴＡ应视为首选方法，但对治疗效果不好，尤其是节段性病变应置入内支架，对合并肝静脉阻塞和血栓的要做相应的介入治疗，可明显提高临床效果。术后抗凝治疗是维持开通血管长期通畅的重要手段。     

B超监测卵泡的临床应用

随着医疗技术的发展,超声在临床上已得到广泛的应用。本文简述了超声监测卵泡在排卵障碍性不孕症的诊疗及避孕方法的监测中的应用和前景。１与Ｂ超监测有关的基础理论１．１正常月经周期中［１］,Ｂ超监测时间是在下次月经预算日的前１２～１６天或１１～１７天,每天且次,共５～７次,排卵前４～５天卵泡增长速度为 ２．０±１．９ｍｍ／ｄ,排卵前卵泡的最大直径平均为 ２３±２．０ｍｍ。在超促排治疗不孕症中［２］,卵泡平均增长速度为１．５～２．５ｍｍ／ｄ,卵泡发育成熟的时间为１２．９±１．８天,排卵时间为 １４．４±１．…     

血管内支架置入术治疗节段性Budd－Chiari综合征的临床观察（附12例报告）

作者报告了采用自张式金属血管内支架（ＥＭＳ）置入术对１２例节段性Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ｓＣＳ）患者进行治疗的临床结果。其中肝后段下腔静脉节段性阻塞型９例；节段性狭窄型３例。术后患者主要临床症状及体征消失或明显改善，下腔静脉平均压力由术前３．４０±０．６０ｋＰａ降为１．７４±０．３５ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）。２例于术后复查了血管造影，１例于术后第６个月时虽有管腔内膜增生，但该段下腔静脉依然通畅；另１例于术后３０个月时，病变段出现狭窄，经球囊导管成形术（ＰＴＡ）并置入另一组ＥＭＳ后，管腔再度获得通畅。其余１０例术后随访８～２８个月（平均１５个月）无症状再发生。作者认为ＥＭＳ置入术是治疗节段性ＢＣＳ的有效方法，可提高临床治疗效果，降低单纯ＰＴＡ治疗术后再狭窄闭塞发生率。     

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.