颅脑外伤后视神经蛛网膜下腔扩张与颅内压增高的MRI相关性研究

目的:探讨颅脑外伤患者眶内段视神经蛛网膜下腔扩张与颅内压增高的关系。方法:14例颅脑外伤并颅内压增高及蛛网膜下腔出血患者,在伤后2d内进行MRI检查,并在斜冠状位重T2加权图像上测量视神经球后4mm、10mm、16mm处蛛网膜下腔的外径,MRI检查结束后4h内进行腰穿,在施放脑脊液前测量脑脊液压力。经保守治疗6～14d,临床症状明显好转后,再重复一次MRI检查及腰穿脑脊液压力测定,对所得数据进行统计分析。结果:14例颅脑外伤并急性颅内压增高患者,首次检查脑脊液压力为2.31±0.24kPa,视神经眶内段前、中、后各测量点蛛网膜下腔的外径(左右侧平均值)分别为6.5±0.5mm、5.5±0.5mm、4.9±0.5mm,由前向后逐渐变窄(P<0.01)。经保守治疗好转后,脑脊液压力降低为1.75±0.21kPa,此时各测量点蛛网膜下腔外径分别为4.2±1.0mm、3.6±0.9mm、3.2±0.7mm,较首次检查明显变窄(P<0.01)。前、中、后各测量点的蛛网膜下腔的外径与脑脊液压力的相关系数分别为0.864、0.858、0.837(P<0.01)。结论:眶内段视神经蛛网膜下腔扩张程度与颅内压呈显著的正相关关系,可作为临床评价颅脑损伤患者颅内压增高程度的定量指标。     

眶内段视神经蛛网膜下腔扩张的MRI表现及临床意义

目的 :探讨眶内段视神经蛛网膜下腔扩张的MRI表现并评价其临床意义。方法 :回顾性分析 5 6例眶内段视神经蛛网膜下腔扩张的MRI图像。结果 :5 6例包括颅脑肿瘤 2 4例、颅脑外伤 11例、颅内出血 11例、颅内炎症 1例、脑积水 5例及良性颅内高压 4例。双侧眶内段视神经蛛网膜下腔扩张 5 5例 ,单侧扩张 1例。T2 WI等信号视神经周围扩张的蛛网膜下腔呈高信号影 ,在横轴位上呈“双轨征” ,在冠状位上呈“环形征”。眶内段视神经中点处蛛网膜下腔外径宽度为5 9mm± 0 .9mm。 34例肿瘤切除术后或内科治疗后复查 ,9例视神经蛛网膜下腔宽度无明显变化 ,7例扩张程度明显减轻 ,18例恢复正常。结论 :眶内段视神经蛛网膜下腔扩张提示颅内压增高 ,可作为临床评价颅内压增高的重要影像学依据。     

HASTE序列在静脉窦血栓患者视神经测量上的应用

目的应用HASTE序列测量视神经眶内段直径并探讨显示视神经的最佳MRI扫描方案。方法对经临床确诊的20例静脉窦血栓患者和20例正常对照组行球后视神经MRI检查,取球后3mm、9mm、15mm处眶内视神经直径、蛛网膜腔外径、径线比、蛛网膜腔面积应用独立样本t检验比较分析,并用Pearson相关分析与临床病程和BMI指数的相关性。结果 20例静脉窦血栓患者与相匹配正常对照组眶内段视神经直径、蛛网膜腔外径、蛛网膜腔面积差异均无统计学意义(P0.05),其径线比P=0.0160.05,差异具有统计学意义;径线比与临床病程、BMI指数无明显相关。结论HASTE序列能够准确显示视神经及蛛网膜下腔,获得视神经眶内段直径,为早期诊断视神经病变提供客观依据,为颅内静脉窦血栓患者视神经损伤提供影像支持。     

MRI与解剖对比研究:视神经-眼平面脑外段视神经的表现

目的:评价正常成人视神经-眼平面(NOP)视交叉以外段颅神经的MRI表现并与尸解测量结果对照,建立正常标准.方法:随机选择正常成人志愿者100例,采用GE 1.5T MRI echo speed plus超导型磁共振成像仪及相控阵头线圈,成像序列包括自旋回波T1加权成像(SE-T1WI),自旋回波T2加权成像(SE-T2WI)和脂肪抑制序列(fs-TSE-T2WI);扫描方位以NOP平面为基准扫描.对20例无眼部疾患的成年尸体以NOP平面为中心进行轴位断层解锯.分别测量两组视神经眼球后神经膨大段直径、眶内段视神经直径、长度,管内段视神经直径及该段视神经起始至同侧视交叉的长度,后者与眶内段视神经长度之和即代表颅外段视神经的长度.结果:NOP平面上,正常人眼球后神经膨大段直径为4.2±0.56mm,眶内段直径为3.1±0.45mm、长度为24.6±2.88mm,管内段视神经直径为3.2±0.49mm,至同侧视交叉的长度为18.7±2.40mm,颅外段视神经的长度为43.3±3.83mm;尸解上述部位指标依次为3.9±0.30mm、3.8±0.40mm、23.9±3.00mm、3.4±0.39mm、17.4±1.37mm、41.2±3.00mm.统计分析,正常成人组内性别和年龄、双侧视神经之间无显著差异,正常人组和尸解组眶内段视神经、管内段视神经直径存在差异(P=0.000和P=0.021,均小于0.05).正常成人组与尸解组的其余四项测量结果差异无显著性(P>0.05).结论:NOP平面评价视神经有很大优势,MRI可以很好显示视神经的形态,是研究其解剖和疾病的有效检查手段;但是MRI的部分视神经数据与尸解数据还存在差异.     

正常成人眼外肌的CT测量

目的用CT测量成人眼外肌正常解剖径线。材料与方法分别测量100例和80例冠状和横轴CT扫描双眼内、外、上、下直肌及上斜肌横径和高径。对用两种方法所测数值进行统计学分析和比较。结果正常成人六条眼外肌横径和高径平均值为内直肌4±0.7mm、10.7±1.0mm;外直肌3.7±1.0mm、10.0±1.0mm;上直肌9.6±1.0mm、3.9±0.9mm;下直肌8.8±1.0mm、4.4±0.8mm;上斜肌2.5±0.4mm、5.5±0.8mm。下斜肌高径2.6±0.4mm。视神经最大横径5.6±0.8mm。眼眶外侧壁与矢状面夹角47.5±4.8°。结论CT扫描对眼外肌的测量准确、全面且直观。横轴CT对眼外直肌横径的测量较为准确。     

100例正常人脑底动脉直径的MR血管成像测量

目的　测量并建立国人正常脑底动脉直径磁共振血管成像 (MRA)正常值。方法　常规MR检查脑实质及脑动脉三维时间飞越法 ( 3DTOF)MRA检查脑底动脉表现无异常者 10 0例 ,其中男5 3例 ,女 47例 ,年龄 4～ 75岁 ,平均 45 8岁 ;≤ 14岁者 12例 ,>14岁者 88例。采用投影仪放大胶片间接测量法测量各脑动脉直径 ,分析其左右侧、年龄和性别上的差异性 ,并统计出各动脉直径的正常参考值。结果　各脑动脉直径测量值为 :眼动脉 (OphA)男为 ( 0 8± 0 2 )mm ,女为 ( 0 9± 0 2 )mm ;颈内动脉 (ICA)C2段男为 ( 3 0± 0 3)mm(≤ 14岁 )和 ( 3 5± 0 6 )mm( >14岁 ) ,女为 ( 2 8± 0 6 )mm(≤14岁 )和 ( 3 1± 0 5 )mm( >14岁 ) ;ICAC4段男为 ( 4 3± 0 6 )mm ,女为 ( 3 9± 0 6 )mm ;大脑前动脉(ACA)A1段男为 ( 2 1± 0 4)mm ,女为 ( 2 1± 0 4)mm ;前交通动脉 (ACoA)男为 ( 1 4± 0 4)mm ,女为( 1 3± 0 4)mm ;大脑中动脉 (MCA)M1段男为 ( 2 7± 0 4)mm ,女为 ( 2 6± 0 4)mm ;基底动脉 (BA)男为 ( 2 9± 0 5 )mm ,女为 ( 2 8± 0 4)mm ;大脑后动脉 (PCA)P1段男左为 ( 2 1± 0 5 )mm、右为 ( 2 0±0 5 )mm ,女左为 ( 2 0± 0 3)mm、右为 ( 1 9± 0 3)mm ;PCAP2段男为 ( 1 8± 0 4)mm     

成人正常眼眶结构的CT测量

目的　建立正常成人CT轴位扫描眼外肌的直径标准、眼外肌群直径总和与颧骨间距比值及眼球的正常位置。方法　从10 0例正常成人共 2 0 0个眼球结构中 ,在轴位CT上分别测量眼外肌的直径、颧骨间距、从颧骨间平面到眼球后缘的距离、球后至眶尖的距离及视神经鞘的宽度 ,同时分析眼外肌群直径总和与颧骨间距的比值。结果　眼外肌正常直径范围 :内直肌 2 .7～ 5 .2mm ,平均 4.0mm。外直肌 1.8～ 4.9mm ,平均 3.4mm。下直肌 5 .4～ 9.1mm ,平均 7.8mm。上直肌群 6 .7～ 10 .2mm ,平均 8.5mm。视神经鞘为 3.1～ 5 .6mm ,平均 4.4mm。眼球后缘正常位置为颧骨间线后 8.7mm(范围 5 .4～ 11.9mm) ,球后至眶尖 33mm(范围 2 4～ 42mm) ,眼外肌总和与眶骨间距比值为 0 .2 3(范围 0 .19～ 0 .2 6 )。结论　CT测量眼眶结构简便易行 ,并检出测量的参考层面标准     

正常成人肝脏背向散射积分超声组织定征测定

目的 :测定正常成人肝组织超声背向散射积分 (IBS)值 ,以期为临床诊断与鉴别诊断肝脏弥漫性病变提供参考。方法 :应用HP5 5 0 0彩色超声仪 ,将 75例受试者分为三个年龄组 :Ⅰ组 4 0岁以下 ,Ⅱ组 4 0～ 5 9岁 ,Ⅲ组 6 0岁以上 ;分别检测每位受检者肝脏的近场、中场、远场IBS值。结果 :正常成人不同年龄组不同部位肝组织IBS测值分别是 :Ⅰ组 :近场 ( 2 2 .0 7± 3.6 2 )dB、中场 ( 18.91± 5 .0 0 )dB、远场 ( 13.5 5± 3.2 0 )dB ;Ⅱ组 :近场 ( 2 3.98± 2 .78)dB、中场 ( 2 2 .35± 4 .32 )dB、远场 ( 15 .34± 2 .90 )dB ;Ⅲ组 :近场 ( 2 9.5 0± 2 .70 )dB、中场 ( 2 4 .4 9± 3.0 6 )dB、远场 ( 17.81± 3.30 )dB。不同年龄组肝脏相应部位IBS值比较 :Ⅰ组与Ⅱ组对比 ,Ⅱ组与Ⅲ组对比均存在差异 (P <0 .0 5 ) ;正常成人肝脏不同取样部位IBS值比较 :近场与中场对比、中场与远场对比均存在显著差异 (P <0 .0 1) (正常成人IBS测值近场 2 5 .0± 4 .6 1dB ,中场 2 1.4 9± 4 .98dB ,远场 14 .0 5± 3.2 9dB)。结论 :正常成人肝组织IBS值随年龄的增加而增大 ,且从近场→中场→远场 ,IBS值逐渐减小。     

经肝后段下腔静脉建立肝内门腔分流的CT研究

目的　分析肝后段下腔静脉 (RHSIVC)、肝内门静脉的影像学解剖关系 ,为经肝后段下腔静脉途径建立肝内门腔分流 (TRSIIPS)提供形态学依据。资料与方法　分析 2 2 6例肝硬化患者上腹部增强CT图像 ,分别测量肝后段下腔静脉的长度 ,计算周围肝实质包绕RHSIVC的范围 ,以及与距门脉分叉部 1cm的肝内门脉左 (LPV)、右支(RPV)及门脉分叉部 (BPV)同层面的RHSIVC中心至上述部位的距离 ,并计算及比较经肝后段下腔静脉顺行性 (股静脉途径 )、逆行性 (颈静脉途径 )至LPV、RPV、BPV的穿刺深度和角度。数据采用配对t检验。结果　 2 2 6例患者肝后段下腔静脉平均长度为 6 4 .4 6mm± 12 .5 0mm(39～ 130mm)。 5 4 .2 %～ 98.9%RHSIVC管腔被周围肝实质所包绕 ,从肝后段下腔静脉至LPV、RPV、BPV顺行性穿刺的深度及角度分别为 4 3.86mm± 10 .91mm、32 .4 0mm± 9.4 6mm、2 7.96mm±9.0 8mm和 4 2 .88°± 10 .6 9°、4 8.4 9°± 14 .0 2°、5 6 .0 5°± 13.92°;而逆行性穿刺的深度和角度分别为4 4 .18mm± 9.98mm、4 9.4 0mm± 10 .80mm、5 4 .10mm± 10 .338mm和 4 2 .82°± 12 .4 3°、2 9.14°± 10 .15°、2 5 .0 4°± 8.75°。顺行性及逆行性穿刺RPV、BPV的深度及角度有显著性差异 (P <0 .0 5 )。结论　肝后段下     

胶质细胞源性神经营养因子对大鼠脊髓损伤后前角神经元的保护作用

目的　研究胶质细胞源性神经营养因子 (GDNF)对大鼠脊髓损伤后前角运动神经元的保护作用。　方法　雄性SD大鼠 4 5只随机分为等渗盐水组、GDNF组、神经生长因子 (NGF)组 ,每组 15只 ,采用改良Nystr¨om法后路压迫大鼠胸段脊髓模型 ,经蛛网膜下腔局部注射GDNF(1μg μl,10 μg d) 1周。伤后 1,2 ,4周应用尼氏染色、酶组织化学染色方法观察前角运动神经元存活数目及胆碱酯酶 (CHE)和酸性磷酸酶 (ACP)的变化。　结果　脊髓损伤后第 1,2周 ,GDNF组前角运动神经元存活数目 [(2 1.4± 3.8,2 0 .7± 3.6 )个 前角视野 ]明显多于等渗盐水对照组的 (17.3± 2 .8,16 .5± 3.0 )个 前角视野 (P <0 .0 1) ;GDNF组前角运动神经元中CHE灰度值 (6 5 .2± 2 3.8,98.7±31.6 )低于等渗盐水组 (94 .5± 35 .2 ,12 5 .6± 4 1.6 ) (P <0 .0 1) ;ACP灰度值 (74 .2± 2 5 .7,6 8.6±30 .6 )高于等渗盐水组 (5 8.5± 18.2 ,4 9.6± 2 1.6 ) (P <0 .0 1)。　结论　外源性GDNF能保护脊髓不完全性损伤后引起的运动神经元损害。     

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）