脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾总结 2 4 0例脑动静脉畸形 (AVM)中合并动脉瘤 5 1例的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析研究造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;1 6例供血动脉动脉瘤 ,1 1例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月后第 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标     

脑动静脉畸形出血的相关血管构筑学研究（附80例分析）

目的：探讨DSA的超选择造影显示畸形血管闭构筑学与脑AVM的关系,以期预测脑AVM出血的危险性。方法：血管内栓塞治疗的脑AVM80例,栓塞材料为不同长度5/0的手术丝线、IBCA和NBCA。单因素、多因素回归分析。结果：（1）出血风险评估;术前年平均出血率2.18%,栓塞治疗后年平均出血率2.02%,与术前比较无明显差异。（2）单因素分析结果：对出血危险有显著性影响的因素依次是：引流静脉支数、AVM位置、合并动脉瘤、AVM大小、供应动脉类型及年龄。出血危险与供血动脉支数、静脉引流形式和合并静脉瘤无相关性,多因素回归分析结果：静脉引流支数越少危险性越大。位于基底节、后颅凹的AVM,合并动脉瘤的AVM出血危险性亦大。结论：①单支引流静脉、位于脑深部基底节或后颅凹以及合并动脉瘤的AVM最易破裂出血。AVM出血的影响因素还有AVM大小、供血动脉类型和年龄,②血管内栓塞治疗不能有效地防止AVM的再出血,除非病灶完全消失。     

脑动静脉畸形的DSA血管构筑学及其栓塞治疗

目的：探讨脑动静脉畸形（AVM）的血管构筑特征及血管内栓塞治疗的疗效。方法：采用Seldinger技术及微导管技术超选择性脑执AVM供血动脉造影及血管内栓塞。结果：脑AVM血管结构上分为终末型供血方式,穿支型供血方式及混合式。可伴有动脉瘤或静脉结构异常。本组栓塞治疗技术成功率97.5%,AVM完全消失,解剖治愈11例,AVM畸形血管团大部分消失,其减少大于80%4例,减少50%～80例,小于50%9例。随访6个月至5年,效果满意。结论：超选择性造影可正确指导栓塞治疗。血管内栓塞治疗脑AVM是一种安全、可靠、有效方法。     

出血性脑动静脉畸形的影像特点与血管内治疗

目的：探讨以出血发病的脑动静脉畸形的影像学特点与血管内治疗的技术操作。方法：经脑CT或MRI确认为脑实质内出血的56例病例，经DSA全脑血管造影证实为脑动静脉畸形(AVM)，根据AVM病灶的特点，行经血管内超选择应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗。结果：56例在1-3次栓塞后，36例病灶完全消除；1例因AVM中有新生的动脉瘤及1例术后1年发生出血而行第2次栓塞治愈，1例在接受X-刀治疗后3个月再次出血，经手术后痊愈。结论：AVM病灶内或病灶旁存在动脉瘤和动脉囊样扩张、引流静脉细小和脑室内生长的AVM是引起脑出血的主要原因，而在栓塞中优先处理动脉瘤样病变对防止脑出血有重要意义。     

后天性脑静脉干壁动静脉畸形

硬脑膜动静脉畸形(DAVMs)主要发生于静脉窦附近,罕见累及脑静脉干(大脑内静脉与大脑大静脉)。作者报道4例直接位于脑静脉干(VG)壁的DAVMs。例1,15岁男性。CT扫描示VG扩大。儿月后患者左侧偏瘫,意识衰退,再次CT扫描见脑室内出血。血管造影示小脑上蚓部动静脉畸形(AVM),血供来自左小脑前上、下动脉。小脑上蚓部静脉为AVM的直接引流静脉,并引流到扩大的VG。直窦有血栓形成,造影剂经海马静脉逆流到颞下静脉和右横窦。随着病变恢复,从小脑左侧前上动脉栓塞AVM。栓塞后,AVM减小75%。并且,扩大VG内自发形成部分血栓。手术     

颅内椎动脉夹层动脉瘤介入治疗个体因素分析

目的 总结介入栓塞治疗颅内椎动脉夹层动脉瘤(IVADA)影像和临床效果,探讨个体化治疗策略.方法 回顾性分析2011年至2015年郑州大学第一附属医院分别采用单纯弹簧圈栓塞、夹层动脉瘤及载瘤动脉闭塞、支架辅助弹簧圈栓塞和覆膜支架植入术治疗的24例IVADA患者资料、治疗经过及临床疗效,探讨不同动脉瘤介入治疗时须考虑的个体化因素.结果 24例IVADA患者介入治疗均获成功:动脉瘤和载瘤动脉闭塞5例,弹簧圈栓塞动脉瘤1例,支架辅助弹栓塞动脉瘤16例,覆膜支架植入2例.术后临床随访平均11个月(5～29个月),所有患者症状明显减轻或消失,无新发出血.12例获脑血管造影随访,11例夹层动脉瘤不显影,1例复发,再次介入治疗.结论 介入栓塞术治疗IVADA安全有效,须结合夹层动脉瘤是否破裂及相关临床症状、是否位于优势侧椎动脉及对侧椎动脉情况、动脉瘤形态及是否累及小脑后下动脉制定个体化治疗方案.     

髓内血管畸形的血管构筑学及栓塞治疗

目的：探讨髓内动静脉畸形（AVM）的血管构型、血管内栓塞的指征及栓塞治疗的效果。方法：15例患者均有不同程度的肢体瘫痪、感觉障碍、括约肌功能障碍行DSA检查和栓塞治疗。栓塞材料选用PVA颗粒及丝线段。结果：15例中,球型3例,幼稚型12例;球型AVM均为单支动脉供血;幼稚型AVM为多支动脉供血,其中7例为2支供血动脉,5例有3支以上供血动脉,2例伴有动静脉瘘（AVF）;15例患者经27例次栓塞治疗,根据栓塞前后脊髓功能评价,痊愈2例,显效3例,好转6例,4例无变化,无1例加重。经6个月－5年随访,症状较栓塞前改善者4例;栓塞后症状维持者2例;栓塞后症状再次反复者7例,再次行栓塞治疗;失得2例。结论：髓内AVM应栓塞畸形血管团,减轻静脉压力,减少出血机会;血管内栓塞治疗脊髓血管畸形是一种创伤小、安全性高、有效的治疗方法。     

双能量CT对脑动静脉畸形相关出血危险因素诊断价值

目的:探讨双能量CT在颅内动静脉畸形中的诊断价值。方法:回顾性分析64例颅内动静脉畸形(AVM)患者的双能量CT影像资料,结合患者的临床资料分析出血与非出血患者的双能量CT诊断结果的差异。采用Cox回归模型分析出血患者的相关危险因素。结果:单因素卡方分析表明脑AVM出血与其生长部位、大小、引流静脉类型、数目、供血动脉类型、是否合并动脉瘤相关(χ2值分别为0.0746、10.397、7.729、8.592、7.801、6.178,P<0.05)。利用Cox风险回归模型筛选相关危险因素为生长部位、引流静脉类型、是否合并动脉瘤,相对危险度分别为1.418、4.106和5.398。结论:脑AVM出血密切相关的危险因素是AVM生长部位、引流静脉类型、是否合并动脉瘤。应用双能量CT在颅内动静畸形中诊断中具有较好的诊断价值。     

脑动静脉畸形介入治疗并发症的观察与护理

目的：探讨脑动静脉畸形（AVM）栓塞治疗并发症的观察与护理。方法：回顾性分析152例脑动静脉畸形介入治疗术中并发症的发生,总结护理观察经验。结果：AVM位于额顶叶87例、顶枕叶34例、颞顶叶17例、基底节区7例、小脑半球7例。畸形团直径小于3cm的56例,3~6cm的72例,大于6cm的24例。注射Onyx栓塞脑动静脉畸形,畸形团完全栓塞42例,畸形团栓塞80%以上62例,畸形团栓塞50%~80%34例,畸形团栓塞50%以下14例。术中并发症：2例栓塞术中发生粘管;8例栓塞术后出现肢体偏瘫,由于护理观察及时,经解痉、降低颅内压、促进微循环供血等治疗好转;1例脑出血急症开颅清除血肿,肢体留有偏瘫。其余病例无严重并发症。结论：术前充分准备,术中预见性观察与处理对保证栓塞的疗效,减少并发症的发生具有重要的意义。     

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.     

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.     

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.     

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）