64层螺旋CT对先天性心脏病的诊断价值

目的：探讨64层CT增强扫描及后处理技术对先天性心脏病（CHD）的诊断价值。方法：分析52例经手术证实的CHD患者的64层CT、心脏超声（TTE）和X线心血管造影（CAG）检查资料。结果：手术证实心内外畸形共142处,其中心内畸形54处,MSCT漏诊4处,TTE漏诊2处,CAG漏诊2处,MSCT、TTE和CAG对心内畸形诊断符合率分别为92.6%、96.3%和96.3%,3者差异无显著性意义（P=0.769,P〉0.05）;心脏大血管连接部及心外血管畸形88处,MSCT误诊或漏诊4处,TTE误诊或漏诊24处,CAG误诊或漏诊4处,MSCT、TTE和CAG对心外畸形诊断符合率分别为95.5%、72.7%和95.5%,MSCT、CAG诊断符合率明显高于TTE（P=0.004,P〈0.05）。结论：64层CT能客观清晰地显示CHD的病理解剖形态,对心脏大血管连接部及大血管畸形的诊断明显优于TTE,在CHD的无创性检查中具有较高的诊断价值。     

64层螺旋CT诊断复杂先天性心脏病的临床价值

目的 探讨64层螺旋CT(64SCT)对比增强及后处理技术对复杂先天性心脏病(CCHD)的诊断价值.方法 39例CCHD手术前均行经胸心脏二维超声(TTE)检查和648CT对比增强扫描检查,其中CT扫描时有8例采用心电门控技术.手术后按心内畸形、心脏大血管连接部畸形及大血管部分畸形分别统计CT及TTE 2种检查方法及有否使用心电门控技术的诊断正确率,并使用SPSS13.0版软件包对结果行χ~2检验.结果 手术证实畸形共102处,其中心脏部分畸形47处,CT和TTE的诊断准确率分别为85.1%和95.7%,2种检查的诊断正确性差异无显著性意义(χ~2=2.68,P>0.05);心脏大血管连接部分及大血管部分畸形共计55处,CT和TTE的诊断准确率分别为98.2%和78.2%,64SCT诊断正确率明显高于TTE(χ~2=14.64,P<0.01).未使用和使用心电门控在定性诊断准确性差异上无显著意义(χ~2=1.84,P>0.05),但采用心电门控技术CT扫描图像更清晰.结论 64CT对CCHD的检查具有较高的诊断价值.扫描时是否采用心电门控技术对CCHD的定性诊断无明显统计学差别.     

多层螺旋CT在小儿复杂先天性心脏病诊断中的应用

目的　探讨多层螺旋CT(MSCT)对小儿复杂先天性心脏病 (简称先心病 )的诊断价值。方法　MSCT对比增强心脏检查 4 8例 ,原始图像在工作站经多平面 (MPR)、最大密度投影 (MIP)、容积再现 (VR)及表面阴影成像 (SSD)法重建。 4 8例作心脏超声 (US)对照 ,2 1例作X线心血管造影 (CAG)对照。所有病例均经手术证实。结果　手术证实畸形共 174处 ,MSCT总的诊断敏感度 97 1%、特异度 99 4 %、准确度 95 9%。其中 ,心脏部分畸形 5 7处 ,MSCT漏诊 4处 ,US误诊 2处 ,CAG漏诊 1处 ,3种检查的诊断准确率差异无显著性意义 (χ2 =0 86 ,P >0 0 5 )。心脏大血管连接部分及大血管部分畸形共计 117处 ,MSCT、US、CAG诊断准确率分别为 97 4 %、76 9%、92 7% ,MSCT(χ2 =2 2 0 2 ,P <0 0 1)及CAG(χ2 =4 90 ,P <0 0 5 )诊断准确率明显高于US ,MSCT与CAG诊断准确率差异无显著性意义 (χ2 =0 80 ,P >0 0 5 )。MSCT与US联合可提高诊断准确率至 99 4 %。结论MSCT对小儿复杂先心病畸形的检出优于US ,MSCT与US联合可提高对小儿先心病诊断的准确率。MSCT可作为CAG的补充 ,有时甚至可取代CAG。     

低剂量CT心血管造影对成人先心病诊断的价值

目的通过图像质量评价和诊断评价,探讨低剂量CT心脏大血管造影(CCTA)对成人先天性心脏病(CCHD)诊断的价值。方法 143位CCHD阳性患者和7位CCHD阴性患者采用MSCT进行低剂量CCTA检查。计算有效辐射剂量。对成像质量进行主、客观评价;以经胸超声(TTE)为对照,进行诊断评价。结果平均有效剂量为(5.95±0.28)mSv。图像信噪比(SNR)为11.31±2.92。CTA和TTE诊断心内畸形的准确度分别为90.4%,96.8%(P=0.152);诊断心外大血管连接畸形的准确度分别为94.1%,80.4%(P=0.022);诊断心外大血畸形的准确度分别为100%,68.7%(P=0.000)。结论低剂量心脏大血管造影的图像质量能够满足CCHD诊断的要求。     

先天性心脏病复杂畸形的影像学诊断

目的：探讨多层螺旋CT、超声心动图以及心血管造影三种影像学方法在先天性心脏病复杂畸形诊断中的优选应用。方法：对50例患有先天性心脏病复杂畸形的患者术前均行多层螺旋CT、超声心动图以及心血管造影检查,检查后行心脏外科手术治疗,以手术后所得到的诊断结果为对照,并计算其诊断的准确率。将三种检查方法所得到的诊断准确率分别进行统计学分析。结果：手术证实畸形共149处,其中心内畸形66处,心外畸形83处。多层螺旋CT（MSCT）、超声心动图（UCG）和心血管造影（CAG）对心内畸形诊断的准确率分别为97.0%、100%和98.5%,三者诊断准确率差异无显著性意义（χ^2.098,P〉0.05）;MSCT、UCG和CAG对心外畸形诊断准确率分别为92.8%、78.3%和97.6%,MSCT和CAG诊断准确率明显高于UCG（χ^21.58,P〈0.01和χ^2.08,P〈0.05）,MSCT与CAG之间诊断率差异无显著性意义（χ^2.37,P〉0.05）。MSCT与UCG联合可提高诊断准确率至98.7%。结论：MSCT在心外血管结构的显示上较UCG有优势,而UCG对心内结构的评价更准确;MSCT与UCG的联合应用可提高小儿先天性心脏病诊断准确率;但对显示体-肺侧支,肺血管特别是外围血管的发育,测量心脏及大动脉内压力等,目前仍需依靠有创性的心血管造影。     

64层螺旋CT多种后处理技术诊断复杂型先天性心脏病的价值

目的 评价64层螺旋CT多种后处理技术对复杂型先天性心脏病(complex congenital heart disease,CCHD)的诊断价值.资料与方法 20例CCHD患者原始多层螺旋CT(MSCT)对比增强图像,根据不同心率采用不同扇区重组方法,获取最满意的图像,并将原始图像在工作站行多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)重组.比较分析多种影像后处理技术对CCHD的检测和诊断价值.结果 手术或多种影像学方法(血管造影或者心脏超声)检查证实心脏畸形共70处,其中心脏部分畸形为27处,MPR、MIP、VR的诊断准确率分别为96.3%、81.5%、3.7%,3种技术对心脏部分畸形的诊断准确率差异具有统计学意义(X2=55.8941,P<0.05).心脏与大血管连接部分畸形共计25处,VR、MIP、MPR的诊断准确率分别为36.0%、96.0%、92.0%,3种技术对心脏与大血管连接部分畸形的诊断准确率差异具有统计学意义(X2=29.7462,P<0.05);心脏大血管部分畸形18处,VR、MPR、MIP的诊断准确率分别为94.4%、83.3%、83.3%.结论 64层螺旋CT多种后处理技术联合应用能直观地显示心脏病理解剖结构,可为临床术前评估和术式选择提供影像学信息.     

多层螺旋CT在右室双出口诊断中的应用价值

目的：探讨多层螺旋CT（MSCT）在右室双出口诊断中的应用价值。方法：75例经临床、X线片、心脏超声（UCG）拟诊为右室双出口的再行MSCT检查,采用心脏节段分析法分析内脏心房位、心室袢、大动脉关系,另外,观察室间隔缺损部位、有无肺动脉狭窄、主动脉异常及其它并发畸形,并将CT结果与手术结果进行对照。结果：75例手术证实右室双出口中,MSCT定性诊断正确73例,误诊2例。75例均有室间隔缺损。肺动脉高压10例,肺动脉狭窄53例,心脏大血管连接部分及心外并发畸形共72处,小房间隔缺损或卵圆孔未闭漏诊4处。结论：MSCT对右室双出口的解剖诊断及分型具有重要价值。观察心脏大血管连接部分及心外大血管畸形有明显优势,能显示冠状动脉情况。     

64层螺旋CT诊断复杂先天性心脏病及与超声心动图和手术对照

目的探讨64层螺旋CT对复杂先天性心脏病(简称复杂先心病)的诊断价值。资料与方法对25例复杂先心病患者的心脏CT和超声心动图(TTE)进行回顾性分析,并与手术结果对照。全部病例均经手术证实。结果25例患者中手术证实畸形79处,64层螺旋CT与TTE诊断的准确率分别为96%和73%。其中,心脏部分畸形29处,64层螺旋CT漏误诊2处,TTE漏误诊4处,两种检查的诊断准确率差异无统计学意义。心脏-大血管连接部及大血管部分畸形50处,64层螺旋CT漏误诊1处,TTE漏误诊17处,两种检查的诊断准确率差异有统计学意义。结论64层螺旋CT在复杂先心病诊断中畸形的检出率优于TTE,诊断准确率达96%,特别是对主动脉、肺动脉及肺静脉畸形的显示具有明显优势。     

320排CT在先天性心脏病诊断中的应用

目的:探讨320排CT对先天性心脏病的临床诊断价值。方法:回顾性分析15例先天性心脏病患者的320排CT扫描资料,并与经胸超声心动图(TTE)及手术结果进行对照研究。结果:15例经手术证实的心内外结构异常共72个,其中心内结构异常27个,心外结构异常45个。320排CT、TTE对心内畸形的诊断符合率分别为96.3%(26/27)和92.6%(25/27),差异无显著性意义(χ2=2.982,P>0.05)。320排CT对心脏大血管连接部位畸形及心外大血管畸形的诊断符合率[100%(45/45)]明显高于TTE[53.3%(24/45)],差异有显著性意义(χ2=31.28,P<0.05)。320排CT及TTE对先心病总的诊断符合率分别为98.6%和68.0%,差异有显著性意义(χ2=28.09,P<0.05)。结论:320排CT对心外大血管结构异常的检出显著优于TTE,对心内结构异常的检出也有良好的效果,320排CT结合TTE可显著提高对小儿先心病的诊断准确性。     

心血管造影、磁共振成像与经胸超声对先天性胸内大血管畸形的诊断价值比较

目的比较心血管造影(CAG)、磁共振成像(MRI)、经胸超声(TTE)对先天性胸内大血管畸形(CAITGV)的诊断价值。方法对沈阳军区总医院1993—1998年期间132例经手术证实的CAITGV病人的MRI,TTE,CAG的诊断结果进行分析。结果132例患者经手术证实有98例共119处畸形,包括主动脉瓣上狭窄(2处),先天性主动脉窦瘤破裂(13处)、主动脉弓离断(7处)、主动脉弓缩窄(15处)、主动脉弓闭锁(2处)、动脉导管未闭(54处)、主肺动脉隔缺损(4处)、完全性肺静脉异位引流(9处)、冠状动脉心室瘘(13处)。MRI诊断的灵敏度为97.5%,特异度为97.1%;TTE诊断的灵敏度为83.2%,特异度为100%;CAG诊断的灵敏度为98.1%,特异度为100%。MRI对CAITGV的灵敏度优于TTE(P<0.05),而与CAG相当(P>0.05)。MRI在主动脉弓畸形、完全性肺静脉异位引流等畸形的细节解剖显示上可以弥补CAG和TTE的不足。结论MRI可以清晰地显示各种CAITGV病理解剖及其畸形部位,若辅以TTE检查,可以作为一种可靠、实用的无创性方法,能补充CAG检查的不足,对主动脉弓离断、主动脉弓缩窄、主动脉弓闭锁、完全性肺静脉异位引流等可取代有创性的CAG检查。因此MRI可作为各种CAITGV术前诊断的首选检查方法。     

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.