介入性完全性血运重建对冠状动脉多支病变患者长期预后的影响

目的 比较单支和多支冠状动脉病变患者经皮冠状动脉介入术(PCI)后的远期预后以及实施完全性或不完全性血运重建对后者长期临床疗效的影响. 资料与方法 959例冠心病患者行选择性冠状动脉内支架置入术,其中单支病变组(single-vessel disease,SVD)362例,多支病变完全性血运重建组(complete revascularization,CR)291 例,多支病变不完全性血运重建组(incomplete revascularization,IR)306例,对比分析3组患者PCI手术后2.5年随访结果. 结果 与CR组比较,IR组患者中冠状动脉病变严重程度、3支病变比例、左主干病变、分叉病变数量均高 (P＜0.05) ,病变数目少而平均置入支架数多(P＜0.05).SVD组冠状动脉病变平均狭窄程度重而植入支架长度和直径均小于另两组(P＜0.05).IR组再发心绞痛(P＜0.05)、再次血运重建比例(P＜0.01)和MACE事件发生率(P＜0.05)均显著高于另两组. 结论 通过行PCI术实现完全性血运重建的多支冠状动脉病变患者长期预后效果与单支病变者类似,优于不完全性血运重建者.     

导引导丝操作托盘在经皮冠状动脉介入治疗中的应用

目的 探讨自制经皮冠状动脉腔内成形术(PTCA)导引导丝操作托盘,在经皮冠状动脉介入治疗(PCI)中的应用价值.方法 40例患者随机分为实验组(使用导丝操作托盘,n=20)和对照组(采用传统方法操作导丝,n=20),两组PCI术均在局部麻醉下进行.观察评价两组术中导丝缠绕次数、手术操作区域手术单污染程度及导丝操作舒适便利程度.结果 实验组导丝缠绕次数、手术操作区域手术单污染程度明显少于对照组(P＜0.05).实验组术中操作导丝舒适便利程度优于对照组(P＜0.05).结论 PCI术中应用自制导引导丝操作托盘,可有效地避免导丝相互缠绕,降低手术区域手术单污染程度.     

应用PTCA导丝经桡动脉环冠状动脉造影

目的 研究应用经皮腔内冠状动脉成形术（percutaneous transluminal coronary angioplasty,PTCA）导丝经桡动脉环完成冠状动脉造影的可行性.方法 2012-01至2012-12我院行经桡动脉冠状动脉造影2600例,对超滑导丝推送困难或遇到阻力者通过造影导管行桡动脉或上肢动脉造影,对发现的桡动脉环随机分为两组,PTCA导丝组改用PTCA导丝尝试通过桡动脉环完成冠脉造影,改股动脉组直接改为股动脉入路行冠脉造影,比较两组成功率、操作时间、放射线剂量（dose area product,DAP）、造影剂用量情况等.结果 经桡动脉造影确认桡动脉环52例,两组患者完成冠脉造影成功率差异无统计学意义（92％ vs 100％,P=0.15）,PTCA导丝组操作时间、放射线剂量高于改股动脉组[（922.8±124.2）s vs（699.2±99.5）s,P＜0.001; （27288.1±6420.2）mGy/cm2 vs （22711.9±4850.4）mGy/cm2,P ＜0.05],造影剂用量差异无统计学意义[（49.5±5.9） mlvs （45.1±6.2）ml,P＞0.05].结论 经桡动脉造影遇到桡动脉环时通过改用PTCA导丝仍可顺利完成冠脉造影,一定程度增加操作时间及放射线剂量.     

多导丝斑块挤压结合双腔微导管在复杂慢性冠状动脉闭塞病变介入治疗中的应用

目的 观察冠状动脉慢性完全闭塞(CTO)经皮冠状动脉介入治疗(PCI)术中球囊难以通过靶病变时应用双腔微导管辅助多导丝斑块挤压技术开通的有效性和安全性.方法 回顾性分析2016年9月至2018年4月在解放军第九八○医院成功接受PCI治疗的280例冠状动脉CTO患者临床资料.根据导丝通过病变闭塞段后最小球囊是否能通过分成...     

伴多支血管病变超高龄急性冠状动脉综合征患者不同介入策略疗效观察

目的 评价经皮冠状动脉介入治疗(PCI)中完全血运重建对伴发多支血管病变超高龄(＞80岁)急性冠状动脉综合征患者的安全性和有效性.方法 2012年9月至2014年9月82例经冠状动脉造影证实为多支血管病变并入院接受PCI术治疗的80岁以上急性冠状动脉综合征患者入选本研究,其中45例仅作罪犯血管血运重建,37例作完全血运重建.观察记录两组患者临床特征、住院期间和1年随访期间主要心血管不良事件(MACE)如全因死亡、心绞痛复发和心肌缺血再次血运重建等,以及对比剂肾病发生率.结果 两组患者年龄、性别、吸烟史、伴高血压病、伴糖尿病、伴高脂血症、脑卒中史和既往PCI史无明显差异.完全血运重建组和罪犯血管血运重建组患者对比剂肾病发生率分别为8.1％(3/37)、13.3％(6/45),差异无统计学意义(P=0.457);MACE发生率分别为8.1％(3/37)、40.0％(18/45),差异有统计学意义(P=-0.022),其中心绞痛复发率分别为2.7％(1/37)、20.0％(9/45)(P=0.041).结论 伴发多支血管病变超高龄(＞80岁)急性冠状动脉综合征患者接受PCI术完全重建血运治疗是安全、有效的.     

血管内超声指导介入治疗冠状动脉分叉病变临床研究

目的探讨血管内超声（IVUS）对冠状动脉真性分叉病变介入治疗的指导作用及对远期预后的影响。方法选取2010年4月至2014年1月接受双支架治疗的冠状动脉分叉病变患者62例,随机分为IVUS组（32例）和冠状动脉造影组（30例）,比较两组冠状动脉主支和分支近端和远端最小管腔直径（MLD）、最小管腔横截面积（MLA）、参照管腔直径（RLD）及病变长度、植入支架直径和长度,并记录术后12个月支架内血栓、靶病变血运重建（TLR）、主要不良心血管事件（MACE）。结果 IVUS组主支和分支MLD 高于冠状动脉造影组（P＞0.05）,MLA、RLD、植入支架直径和长度均高于冠状动脉造影组（P＜0.05）,IVUS组支架内血栓、TLR、MACE发生率均低于冠状动脉造影组（P＞0.05）。结论 IVUS指导经皮冠脉介入治疗（PCI）双支架植入治疗冠状动脉分叉病变,有助于优化支架植入,改善PCI远期预后。     

双低MSCT技术对非肥胖患者门脉成像的临床研究

目的:探讨联合应用低管电压和低对比剂方案用于非肥胖患者门静脉成像(MSCTP)的可行性.方法:纳入接受MSCTP、体质量指数≤25 kg/m2的患者160例,采用数字法随机分为2组,每组80例.常规组管电压为120 kVp,对比剂用量为1.2 mL/kg,双低组管电压为80 kVp,对比剂用量为1.0 mL/kg.采用独立样本t检验比较各组CT剂量容积指数(CTDIvol)、有效管电流(mAs)、剂量长度乘积(DLP)、有效辐射剂量(ED)和对比剂用量、肝实质CT值(CTH)、门静脉CT值(CTp)、图像噪声(SD)、肝实质SNR(SNRH)、门静脉与肝实质CNR(CNRp)的差异;采用秩和检验比较两组图像评分.采用Kappa检验两位医师评分结果一致性.结果:双低组CTDIvol[(4.59±1.03) mGy]低于常规组CTDIvol[(7.50±1.45) mGy(P＜0.05)],均有统计学差异;双低组ED[(1.71±0.50) mSv]低于常规组[(2.75±0.67) mSv(P＜0.05)];双低组平均辐射剂量比常规组减少了1.05 mSv,减少38.09％;双低组图像质量评分(3.93±0.88)高于常规组[(3.33±0.81),有统计学差异(P＜0.05)];双低组CTH和CTp分别为(126.74±30.59)和(223.78±45.85) HU均明显高于常规组(95.60±15.89)和(161.47±25.37) HU,差异有统计学意义(P＜0.05);双低组SD(24.61±2.77) HU高于常规组(1.65±3.38) HU,P＜0.05],双低组SNRH为(5.20±1.24) HU低于常规组SNRH(7.00±2.44) HU,差异有统计学差异(P＜0.05),但是双低组门静脉与肝实质CNRp为(4.33±0.97) HU与常规组(4.67±1.44) HU比较差异无统计学意义(P＞0.05);双低组平均对比剂用量为(66.56±2.48) mL显著低于常规组[(80.48±2.97) mL(P＜0.05)],双低组平均造影剂用量较常规组减少17.30％.结论:采用80 kVp低管电压结合低剂量和对比剂方案对非肥胖患者进行MSCTP能降低辐射剂量和对比剂用量并进一步提高图像质量.     

经皮冠状动脉腔内成形术17例报告

本文报道17例经皮冠状动脉腔内成形术(PTCA),其中A型病变7例,B型10例,病变形态:向心性8例,偏心性3例,完全闭塞6例。术后14例残存狭窄<20％,临床症状减轻,心电图明显改善,成功率82.3％,失败3例,均为导丝、球囊未能通过狭窄区。完全闭塞6例中5例经溶栓 PTCA术获得成功,其中2例再通后出现再灌注心律失常,1例出现夹层。1例双支病变者采用双球囊技术后出现边支闭塞。认为在PTCA成功后不要立即撤出导丝,严密观察心电图及患者变化,一旦出现急性闭塞或内膜严重撕裂一夹层时,可重复进行球囊扩张或植入支架,确保患者安全。     

经桡动脉途径无保护冠状动脉左主干分叉病变介入治疗

 目的 探讨经桡动脉途径PCI在无保护左主干分叉病变中治疗的可行性和疗效.方法 回顾性分析我院无保护左主干分叉病变择期行PCI的患者22例,21例置入药物洗脱支架,单支架置入7例,双支架置入14例,14例置入双支架的患者均成功进行对吻球囊扩张,1例系支架术后再狭窄,单纯行切割球囊成形术.术后每15 d或1个月门诊复查1次,3～9个月行冠状动脉造影复查.结果 22例PCI均取得成功,术后达TIMI 3级血流,住院期间主要不良心脏事件1例(4.55%),冠状动脉造影复查显示支架内再狭窄2例(10.53%),1例再次行PCI术.术后平均随访(16.86±6.90)个月,随访期内死亡1例.结论 经桡动脉径路无保护左主干分叉病变PCI即刻成功率高,有较好的近、中期疗效.     

自然呼吸下小剂量对比剂CTPA诊断肺动脉栓塞

目的:评估自然呼吸状态下小剂量对比剂CT肺动脉成像(CTPA)的可行性及诊断肺动脉栓塞的价值.方法:64例临床怀疑肺动脉栓塞的患者行CTPA检查,按随机表分为A、B两组:A组(n=32),自然呼吸状态下扫描,管电压100kV,螺距3.2,对比剂为碘海醇(350 mg I/mL)25 mL;B组(n=32),常规扫描模式,管电压120 kV,螺距2.2,对比剂为碘帕醇(370 mg I/mL).测量各级肺动脉CT值、标准差(SD)、上腔静脉CT值;计算肺动脉主干及双下肺动脉基底支信噪比(SNR)、对比噪声比(CNR);记录对比剂用量、容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)、有效辐射剂量(ED),并进行统计学分析.结果:两组肺动脉各级分支CT值及两下肺动脉基底支SD值、SNR差异均无统计学意义(P＞0.05).A组肺动脉主干、左右肺动脉SD值高于B组,差异均有统计学意义(P＜0.05);A、B两组肺动脉主干SNR、CNR及左右下肺动脉基底支CNR差异均有统计学意义(P＜0.05).A组上腔静脉CT值[(469.93±196.22) HU]、对比剂用量(25.00mL)明显低于B组[(870.72±426.87)HU、(49.47±7.56)mL],差异有统计学意义(P＜0.01);A组CTDIvol、DLP、ED较B组明显减低[(2.81±3.86) vs (5.65±1.14),P=0.000;(86.25±0.40) vs (163.63±39.00),P=0.000;(1.21±0.18)mSv vs (2.29±0.55)mSv,P=0.000],差异均有统计学意义(P＜0.05).两组共检出肺动脉栓塞24例(A组11例,B组13例),两组间阳性显示率差异无统计学意义(P＞0.05);两组上腔静脉线束硬化伪影显示率(A组9例,B组19例)差异有统计学意义(P＜0.05).结论:自然呼吸状态下小对比剂用量CTPA检查图像质量可满足诊断要求,可减少上腔静脉线束硬化伪影,降低对比剂用量及辐射剂量.     

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.     

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.