应用介入技术行犬盆腔分离灌注中顺铂的药动学研究

目的研究犬盆腔分离灌注中顺铂的药动学。方法11只犬行盆腔分离灌注,测灌注区及非灌注区静脉血顺铂浓度,作药动学分析。结果盆腔最大血药浓度为(30.3±2.4)μg/ml,体循环最大血药浓度为(4.8±0.4)μg/ml。灌注区与非灌注区曲线下面积比为8.0±1.8。结论应用介入技术行盆腔分离灌注可以明显的提高灌注区血药浓度,降低非灌注区血药浓度。创伤小,技术相对简单,是治疗盆腔肿瘤可供选择的一种方法。     

肝脏隔离灌注化疗治疗原发性肝癌

经肝动脉灌注化疗在肝癌的治疗中发挥着重要作用,但如何进一步提高治疗效果备受关注.肝脏隔离灌注化疗随着介入放射学的发展渐受重视,就肝脏隔离灌注化疗的历史背景、方法、动物实验及初步的临床应用进行综述.     

兔肝VX2移植瘤介入性热化疗方法的实验研究

目的研究2种经动脉热灌注化疗方法对兔肝VX2移植瘤的热化协同效率。方法30只新西兰大白兔建立肝VX2肿瘤模型。经股动脉插管,导管头置于兔肝动脉,DSA证实肿瘤供血动脉后,分3组(每组10只),分别给予常温100 ml盐水 阿霉素(ADM)灌注、60℃热生理盐水100 ml 阿霉素连续灌注、60℃热生理盐水100 ml 阿霉素间歇灌注。灌注过程中,测量60℃热灌注组肿瘤组织内43～45℃持续时间,灌注后即时检测各组肿瘤组织内阿霉素浓度。结果阿霉素浓度：60℃间歇灌注组为(17.622±1.368)μg/ml,60℃连续灌注组为(12.013±2.237)μg/ml,常温灌注组为(11.519±1.225)μg/ml。60℃间歇灌注组与60℃连续灌注组比P＜0.05,60℃连续灌注组与常温灌注组比P＞0.05；43～45℃持续时间：60℃间歇性灌注组为(11.3±3.3)min,60℃连续灌注组为(4.1±2.7)min,60℃间歇灌注组比60℃连续灌注组高近3倍。60℃2组兔的呼吸、心率、体温变化无明显差异。结论经动脉间歇热灌注化疗方法是一种更有效的介入热化疗方法。     

肝脏隔离灌注化疗治疗原发性肝癌

经肝动脉灌注化疗在肝癌的治疗中发挥着重要作用。但如何进一步提高治疗效果备受关注，肝脏隔离灌注化疗随着介入放射学的发展渐受重视，就肝脏隔离灌注化疗的历史背景。方法，动物实验及初步的临床应用进行综述。     

肝脏CT灌注成像技术及其在肝硬化中的初步应用

目的　采用单层CT动态成像测定肝脏血流量 ,探讨CT灌注成像测定肝血流量的技术原理。资料与方法　 15例经临床及实验室、B超检查诊断为肝硬化患者 ,其中ChildB级者 10例 ,ChildC级者 5例。对照组为 13例无肝脏疾病者。所有患者均选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线计算肝脏血流量各参数。结果　正常组肝动脉灌注量 (HAP)为 0 .2 82 3± 0 .0 96 9ml·min-1·ml-1,门静脉灌注量 (PVP)为 (1.1788± 0 .4 0 0 4 )ml·min-1·ml-1,总肝血流量 (THBF)为 (1.4 5 6 3± 0 .4 4 39)ml·min-1·ml-1,肝动脉灌注指数 (HPI)为 (19.73± 5 .81) %。肝硬化时PVP为 (0 .6 12 1± 0 .2 5 4 4 )ml·min-1·ml-1,较正常组降低 ;THBF也减低 ,为 (0 .84 2 6± 0 .32 4 2 )ml·min-1·ml-1。肝硬化患者的HPI较正常组略有升高 ,为 (2 7.16±12 .75 ) % ,但无统计学差异 (P =0 .0 6 5 )。结论　肝脏CT灌注成像可定量测定肝脏血流量参数     

MSCT灌注在肝纤维化早期诊断中的应用价值研究

目的 探讨多层螺旋CT(MSCT)肝脏灌注成像在肝纤维化早期诊断中的应用价值.资料与方法 28例接受MSCT肝脏灌注成像检查,其中6名为无明显肝脏疾病的自愿者(正常对照组),22例经肝脏穿刺活检证实为肝纤维化.根据Ishak评分系统及是否需要抗病毒治疗分为两组:10例为轻度肝纤维化患者,不需抗病毒药物治疗(轻度肝纤维化组),12例为显著肝纤维化患者,需行抗病毒治疗(显著肝纤维化组).计算各组的各项灌注指标并进行组间比较.结果 从正常对照组、轻度肝纤维化组到显著肝纤维化组,肝动脉分数(HAF)呈升高趋势,其平均HAF值分别为(17.09±3.43)%、(19.92±6.01)%和(21.32±7.47)%,平均通过时间(MTT)则有所降低,三组的MTT值分别为(13.49±1.02)s、(12.35±1.31)s和(12.19±3.33)s.正常对照组、轻度肝纤维化组和显著肝纤维化组的平均血流量(BF)值分别为(102.75±32.76)ml·100 g-1·min-1、(114.54±25.81)ml·100 g-1·min-1和(111.98±19.81)ml·100 g-1·min-1;平均血容量(BV)值分别为(15.97±7.59)ml/100 g、(17.07±2.94)ml/100 g和(16.42±5.53)ml/100 g.各组平均HAF、MTT、BF及BV值的差异无统计学意义(P>0.05).结论 MSCT肝脏灌注可用于各项肝脏血流灌注参数的定量测量,部分灌注参数值的变化对肝纤维化分期具有一定程度的参考价值.但目前尚不能有效地进行肝纤维化的早期诊断.     

慢性终末期肝病肝移植后肝脏血流动力学的CT灌注成像评价

目的　通过对比慢性终末期肝病在肝移植后与正常人群肝脏灌注参数的差异 ,评价CT灌注成像在肝移植术后肝脏血流动力学的价值。进一步了解慢性终末期肝病肝移植后血流动力学变化的规律。资料与方法　通过单层螺旋CT测得 9例慢性终末期肝病肝移植后 (术后 12～ 2 0d)和 13例正常人群的肝脏灌注参数 (肝动脉灌注量、门静脉灌注量、总灌注量以及肝动脉灌注指数 )。并统计分析两组数据之间的差异。结果　肝移植组和对照组的灌注参数分别是 :肝动脉灌注量 :(0 .3831± 0 .175 4 )ml·min-1·ml-1和 (0 .2 82 7± 0 .0 971)ml·min-1·ml-1;门静脉灌注量 :(1.5 76 3± 0 .4 5 4 0 )ml·min-1·ml-1和 (1.1885± 0 .3899)ml·min-1·ml-1;肝总灌注量 :(1.95 94± 0 .5 72 7)ml·min-1·ml-1和 (1.4 712± 0 .4 4 5 1)ml·min-1·ml-1;肝动脉灌注指数 :HIP 19.5 1%和 18.97%。对比对照组 ,肝移植组门静脉和总灌注量明显上升 (P =0 .0 4 4和 0 .0 36 )。结论　在慢性终末期肝病肝移植后早期 ,门静脉和总灌注量呈现明显上升趋势。肝动脉灌注量变化不明显 ,但其个体间变化增大 ,提示在术后早期肝动脉灌注量存在不稳定的变化过程。     

CT灌注成像对肝硬化血流动力学的临床研究

目的　采用单层CT动态成像测定肝脏血流量 ,研究肝硬化程度与肝脏血流量动态变化的关系。方法　对 2 7例肝硬化患者及 13例对照者选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线 ,计算肝脏血流量各参数。结果　正常组肝动脉灌注量为 (0 2 82 3± 0 0 96 9)ml·min-1·ml-1,门静脉灌注量为 (1 1788± 0 4 0 0 4 )ml·min-1·ml-1,总肝血流量为 (1 4 5 6 3± 0 4 4 39)ml·min-1·ml-1,肝动脉灌注指数为 (19 73± 5 81) %。肝硬化程度不同时 ,肝动脉灌注量、门静脉灌注量、肝脏总血流量及肝动脉灌注指数变化间差异存在显著性意义。ChildA、B级患者肝动脉灌注量 [(0 16 85± 0 10 6 8)ml·min-1·ml-1,(0 192 1± 0 0 986 )ml·min-1·ml-1]降低 ,而ChildC级患者肝动脉灌注量 [(0 30 72± 0 114 5 )ml·min-1·ml-1]比ChildA、B级患者增加 ,肝动脉灌注指数 [(37 4 8± 16 6 5 ) % ]也增加。ChildB、C级患者门静脉灌注量 [(0 6 331± 0 2 0 70 )ml·min-1·ml-1,(0 5 70 2± 0 35 6 2 )ml·min-1·ml-1]及总肝血流量 [(0 82 5 2± 0 2 95 2 )ml·min-1·ml-1,(0 8774± 0 4 118)ml·min-1·ml-1]下降。结论　肝脏CT灌注成像可定量测     

多层螺旋CT肝脏灌注测量在肝硬化中的初步应用

目的探讨多层螺旋CT肝脏灌注测量在肝硬化中的应用价值。资料与方法37例接受多层螺旋CT肝脏灌注测量。20例无明显肝脏疾患的志愿者(正常组),17例肝硬化患者(肝硬化组),再按其肝硬化程度分为两组:9例为轻中度肝硬化(轻中度肝硬化组),8例为重度失代偿肝硬化(重度失代偿组)。计算各例的各项灌流指标并进行组间比较。结果(1)肝硬化组与正常组相比,门静脉灌流量(HPP)、门静脉灌流指数(PPI)明显减低[HPP:(0.49±0.19)ml·min-1·ml-1与(0.60±0.16)ml·min-1·ml-1,P=0.045;PPI:0.58±0.14与0.67±0.06,P=0.015],门静脉与肝动脉灌流比率(HPP/HAP)亦明显减低(1.63±0.87与2.12±0.65,P=0.04),肝动脉灌注指数(HPI)升高(0.42±0.14与0.33±0.06,P=0.015),提示肝硬化时HPP减少,门静脉血流在肝脏血供中的比例减少,而动脉的灌流比重增加;(2)重度失代偿组肝硬化HAP较轻中度组明显升高[分别为(0.48±0.16)ml·min-1·ml-1与(0.25±0.07)ml·min-1·ml-1,P=0.002],HPI亦明显升高(分别为0.54±0.10与0.32±0.07,P=0.0001),PPI则明显降低(分别为0.46±0.10与0.68±0.07,P=0.0001),提示不同程度肝硬化其灌注指标存在差异,灌注改变与肝硬化程度有关。结论肝脏CT灌注测量可以反映肝硬化的血流灌注改变,灌注值的变化也能够提示肝硬化的程度。     

中晚期肝癌的综合介入治疗

目的　探讨肝动脉栓塞化疗术 (TAE)、经皮穿刺注射无水酒精 (PEI)和肝动脉灌注化疗药物术 (TAI) 3种方法联合治疗中晚期肝细胞癌的临床效果。方法　常规肝动脉栓塞化疗术、肝动脉灌注化疗药物术 ,透视或CT定位经皮穿刺多点注射无水酒精。结果　随访 1～ 3年 ,1、2、3年生存率分别为6 0 .3% ,2 8.6 % ,17.3%。结论　运用 3种介入方法治疗中晚期肝癌有明显临床效果     

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.