冠状动脉狭窄的多层螺旋CT诊断

目的 旨在评价多层螺旋CT（MDCT）诊断冠状动脉（简称冠脉）狭窄的可行性和准确性。方法 65名患者行冠脉MDCT造影（MDCTA），扫描数据在回顾性心电门控下重建。有32例同时接受选择性冠脉造影（SCA）。分析CT图像质量，并与SCA比较，评价MDCTA诊断50％以上狭窄的准确性。结果 心率70次／min以下患者CT图像质量明显优于心率70次／min以上组（W＝539，P＜0．0001）。32例MDCTA图像与相应SCA比较，MDCTA诊断50％以上狭窄的敏感度、特异率、阴性预测值和准确度分别为95％、80％、89％和90％。结论 MDCT对冠脉能够高质量成像并可较准确诊断冠脉狭窄。     

定量评估64层螺旋CT血管成像与DSA显示冠状动脉狭窄的能力和可靠性

目的定量评估64层螺旋CT（MSCT）与DSA2种成像方法显示冠状动脉狭窄及支架内再狭窄的能力和可靠性。方法应用心脏动态体模，设定心率为0、50、70、90次／min，对内径3mm的模拟冠状动脉（内设25％、50％、75％3段狭窄）及内径4mm的模拟带支架冠状动脉（支架段内设50％、75％2段狭窄）分别进行MSCT与DSA成像，将MSCT与DSA对应数据进行分析。结果（1）MSCT对25％、50％、75％3段狭窄的平均测量值为（30．0±1．4）％、（49．5±1．3）％、（72．9±3．9）％（P值分别为0．005、0．531、0．369）；DSA分别为（24．8±2．0）％、（48．2±2．1）％、（75．3±2．4）％（P值分别为0．883、0．180、0．796）。（2）MSCT图像伪影随心率增快而增加，心率≥70次／min影响变明显；DSA不受心率影响，所有心率下都可清晰地显示狭窄程度，无伪影。（3）MSCT与DSA测量血管狭窄程度有较好的相关性（r=0．995，P=0．000）。（4）MSCT可同时显示支架及支架内狭窄，但显示支架内狭窄能力有限，对50％狭窄分别显示为（46．4±4．5）％（心率为0）和（43．6±5．7）％（心率为50次／min），与标准值（50％）相比，差异有统计学意义（P〈0．05）。DSA可清晰显示支架内狭窄，但不能很好显示支架形态。结论（1）MSCT与DSA评价冠状动脉狭窄结果可靠，MSCT受心率的影响大，时间分辨率有待提高，作为排除性诊断有很高的临床应用价值；MSCT对于支架内再狭窄的判断尚有一定局限性，但在管径较粗和低心率条件下评价支架内再狭窄有一定价值。     

64层容积CT冠状动脉成像技术及影响因素的分析

目的探讨64层容积CT冠状动脉成像技术及影响图像质量的因素。资料与方法对254例患者进行64层容积CT心脏扫描,以容积再现（VR）、最大密度投影（MIP）和曲面重组（CPR）等技术行冠状动脉三维成像．以心率≤60次／min、61～69次／min、70～75次／min及≥76次／min分为4组评价图像质量,分析其影响因素。结果（1）心率≤60次／min、61～69次／min、70～75次／min3组间冠状动脉成像优良率差异无统计学意义;（2）心率≤75次／min组出现差片的概率明显低于心率≥76次／min组（P＜0．05）．优等片的概率明显高于心率≥76次／min组（P＜0．05）;（3）影响冠状动脉管腔评价的技术性因素主要是扫描过程中发生心率、心律变化或对比剂延迟时间不当等造成的移动伪影、血管错位和边缘模糊;非技术性因素为冠状动脉管壁的弥漫性钙化导致的高密度及其伪影。结论影响64层容积CT冠状动脉成像质量的主要因素是心率或心律的变化、延迟时间不当和广泛钙化。适当控制心率,避免心律不齐的发生可明显改善冠状动脉的成像质量,提高可评估率。     

前门控在256层螺旋CT冠脉成像中应用的探讨

目的通过分析冠脉CTA图像质量及辐射量探讨前门控对冠心病的临床应用价值。方法选取行冠脉CTA检查患者500例,心率≤70次／min者124例;心率〉70次／min者376例,前者随机分为前后门控两组,后者均为后门控扫描。结果心率≤70次／min者,前后门控两组图像质量评分分别为4．14±0．87和4．15±0．83,差异无统计学意义（P〉O．05）;有效辐射量分别为（1．89±0．57）mSv和（15．01±4．13）mSv,差异有统计学意义（P〈0．05）。心率〉70次／min者：71～85次／min者优质图像所在R—R间期百分比具有不确定性;心率〉85次／rain者100％在40％～50％R—R间期。结论心率≤70次／min时,前后门控冠脉成像图像质量具有一致性,前门控明显降低了辐射量;心率〉70次／min者也可以应用前门控技术扫描。     

双源CT冠状动脉成像的初步研究

目的初步探讨无需口服控制心率药物准备的双源CT冠状动脉成像的扫描技术和图像质量。方法对215例临床怀疑冠心病或冠状动脉早期病变患者进行无需口服控制心率药物准备的双源CT冠状动脉成像。扫描步骤包括平扫和增强扫描。用平扫图像行冠状动脉钙化积分，用增强扫描图像行多平面重组（MPR）、最大密度投影（MIP）及容积再现技术（VRT）重组。总结双源CT冠状动脉成像的扫描技术和后处理方法。将图像质量分为3级，按冠状动脉分段标准评价各个节段的图像质量。结果215例患者钙化积分值中位数为82．2（2．3～1827．9）。增强扫描平均心率为（80．6±15．3）（57～139）次／min，尽可能使冠状动脉良好显示的后处理方法有：（1）多个时相筛选法；（2）2个或多个时相补充法；（3）早搏去除法和心律不齐移位法。共评价3026个冠状动脉节段，其中图像质量为1级者占97．5％（2951／3026），2级者占2．0％（62／3026），为3级者占0．5％（13／3026）；图像质量为2级和3级的节段多由于呼吸伪影所致。215例患者共91例冠状动脉各节段均未见斑块或狭窄，共诊断〈50％冠状动脉狭窄节段112个，≥50％冠状动脉狭窄节段213个。结论双源CT冠状动脉成像在无需口服控制心率药物准备的情况下可获得非常好的冠状动脉各节段图像，心率不再是影响图像质量的关键因素，通过单时相或多时相重组可良好显示冠状动脉主干及分支。     

64层螺旋CT冠状动脉成像诊断冠状动脉狭窄的初步探讨

目的：探讨64层螺旋CT（MSCT）冠状动脉成像对冠状动脉狭窄的诊断价值。方法：53例冠心病患者同期均行64层螺旋CT冠状动脉成像和常规冠状动脉造影（CCA）,以CCA的诊断结果作为金标准,采用美国心脏协会冠状动脉改良分段法,分析745个冠状动脉节段MSCT图像质量及对冠状动脉狭窄的显示情况,得出有意义病变（冠状动脉狭窄率≥500%）MSCT诊断的正确性,并分析钙化对其影响。结果：587个冠状动脉节段图像可以满足诊断要求,158个节段因运动伪影（27个节段）或管壁严重钙化（131个节段）无法进行血管评价。MSCT诊断冠状动脉狭窄的敏感度为93．4％、特异度为97．9％、阳性预测值为93．9％、阴性预测值为97．7％。钙化积分≥1000的患者,MSCT诊断冠状动脉狭窄的特异度、敏感度、阳性预测值、阴性预测值分别为74％、82％、68％、96％。结论：64层螺旋CT冠状动脉成像是一种快速、安全、无创的检查方法,与常规冠状动脉造影检查结果有较好的一致性,可以作为临床怀疑冠心病患者的首选检查方法。     

多层螺旋CT冠状动脉成像质量及对冠状动脉病变诊断准确性的评价

目的探讨64层螺旋CT（MDCT）冠状动脉成像的图像质量及诊断冠状动脉病变的准确性。方法105例患者（包括高心率、冠状动脉钙化及肥胖病例，但除外房颤病例）作MDCT冠状动脉成像，并与常规冠状动脉造影对照。分析MDCT图像质量及对冠状动脉病灶的显示情况。结果每例均对冠状动脉的13个节段进行分析（共1365个节段）。1144个节段能满足管腔评价，221个节段因钙化严重（153个节段）或运动伪影（68个节段）无法满足管腔评价。105例中钙化积分中位数为154（范围0～1983）；87例钙化积分〈1000，中位数105（范围0～994）；18例钙化积分≥1000，中位数1477（范围1115-1983）。MDCT发现≥50％狭窄总的敏感度、特异度、阳性预测值、阴性预测值分别为85．7％、97．9％、93．0％、95．5％。当评价局限在钙化积分〈1000的患者时，MDCT发现≥50％狭窄的敏感度、特异度、阳性预测值、阴性预测值分别为96．0％、98．9％、95．3％、99．0％。临床正确诊断率（发现或排除至少1个有意义病灶）为92．4％（97／105）。结论对非选择性病例，MDCT可提供高诊断准确性的冠状动脉图像。     

冠状动脉狭窄的16层螺旋CT造影检查

目的以常规X线冠状动脉造影为标准,评价16层螺旋CT（MSCT）无创性检查冠状动脉及诊断冠状动脉狭窄的价值。资料与方法65例临床初诊为冠心病,无冠状动脉成形术和搭桥术史的患者,在冠状动脉16层MSCT造影检查后,回顾性重建心电门控轴位图像,并采用容积成像（VR）、多平面重建（MPR）、曲面MPR、最大密度投影（MIP）等后处理方法,对所有冠状动脉及其分支进行重建,统计可供临床评价的、管径≥1．5mm的冠状动脉段,以选择性冠状动脉造影（SCA）为标准,对比分析MSCT诊断冠状动脉显著性狭窄（管腔平均直径缩小超过50％）的准确性。其中8例在检查前心率超过80次／min的患者使用了B受体阻滞剂。结果93％的冠状动脉节段和94％的冠状动脉主干可供评价,不能评价的主要原因分别为：心脏运动伪影（58％）,致密钙化（28％）和管腔显影不良（14％）。除外不能评价的冠状动脉,按节段和主干分类,MSCT诊断冠状动脉显著性狭窄的敏感性和特异性分别达到92％、98％和95％、97％。结论无需常规使用B受体阻滞剂,16层MSCT冠状动脉造影即可获得较好的图像质量用于诊断冠状动脉狭窄,是一种值得临床医师信赖的检查冠状动脉有无狭窄的非创伤性方法。     

冠状动脉钙化对64层螺旋CT诊断冠状动脉狭窄的影响

目的探讨64层螺旋CT（MSCT）诊断伴钙化斑块的冠状动脉狭窄的正确性。方法60例患者同期行64层MSCT冠状动脉扫描和常规冠状动脉造影（CCA）。用MSCT的平扫图像行钙化积分测定，以CCA结果为金标准，得出64层MSCT诊断有意义病变（冠状动脉狭窄率≥50％）的正确性，并分析钙化对诊断正确性的影响。结果分析797个可以诊断的冠状动脉节段，得出MSCT诊断的敏感性为96％（174／182），特异性为98％（601／615），阳性预测值为93％（174／188），阴性预测值为99％（601／609）。对于钙化积分≥100分（Agatston评分）的冠状动脉节段，MSCT诊断的特异性为63％（12／19），阳性预测值为81％（30／37）。结论对于冠状动脉无钙化或者轻度钙化者，64层MSCT可作为诊断冠心病的可靠手段应用于临床。对于严重钙化者，其诊断的特异性和阳性预测值明显下降。     

服用硝酸甘油对多层螺旋CT冠状动脉成像的影响

目的：探讨通过服用硝酸甘油提高多层螺旋CT（MSCT）冠状动脉成像显影质量的可行性。方法：选服用与不服用硝酸甘油患者各30例，用16层MSCT扫描，对比2组患者冠状动脉13个节段显影的差异。并将服用硝酸甘油患者中10例进行了DSA选择性冠状动脉成像的图像进行对比。结果：（1）2组在冠状动脉13个血管节段中，右冠状动脉（第1、2、3段）、左主干（第5段）、左前降支（第6、7段）、左旋支（第11段）可评价血管例数相同（均为30例）；后降支和左室后支（第4段，X^2=8．007，P=0．004）、左前降支（第8段，X^2=8．571，P=0．003）、第1对角支（第9段，X^2=6．667，P=0．010）、第2对角支（第10段，X^2=38．400，P=0．000）、钝圆支（第12段，X^2=12．000，P=0．001）、左旋支（第13段，X^2=10．335，P=0．001）的显影差异有统计学意义。（2）服用硝酸甘油MSCT冠状动脉成像10例与选择性冠状动脉成像初步对比，严重的钙化和运动伪影影响狭窄的准确性，轻度钙化或无钙化和无运动伪影时，MSCT冠状动脉成像与DSA冠状动脉成像结果吻合。结论：使用硝酸甘油可提高MSCT冠状动脉成像的显影质量。     

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.