咯血患者支气管动脉栓塞治疗后复发原因分析

目的:探讨咯血患者支气管动脉栓塞(BAE)术后咯血复发的原因及预防措施.方法:632例咯血患者接受支气管动脉栓塞术,进行分阶段疗效追踪,全部病例随访12～14个月,复发病例通过再次手术,确定咯血的复发原因.结果:632例中有114例咯血复发,复发的原因主要有病变血管漏栓(3例)、肺循环供血(2例)、病变血管再通(32例)、侧支循环形成(55例)和原发病进展(54例).采用合理的栓塞技术和栓塞物质组合联合栓塞,寻找所有可能对病变区域供血的血管(支气管动脉、肋间动脉、胸廓内动脉、食管固有动脉、膈动脉等)并予以栓塞,并积极的治疗原发病是预防咯血复发的主要措施.结论:充分认识患者支气管动脉栓塞术后咯血原因对降低复发率有重要的意义.     

支气管动脉栓塞治疗大咯血的远期疗效分析

目的 探讨支气管动脉栓塞术治疗大咯血的远期疗效及影响疗效的因素.方法 对89例肺结核、5例肺癌、2例支气管扩张症所致大咯血共96例患者行支气管动脉栓塞术治疗,术后进行为期1～6年的追踪观察,对咯血有无复发、复发的时间、复发的原因、相应的治疗及效果进行了统计,采用生存分析的寿命表法对咯血控制率进行分析.结果 94例(97.9%)成功施行了支气管动脉栓塞术,术后即刻停止咯血.术后30 d、90 d、1年及2年的咯血控制率分别为93.6%(88/94)、86.2%(81/94)、81.9(77/94)及78.7%(74/94).术后30 d内咯血复发9例,复发的主要原因是漏栓和血管再通.30 d后咯血复发5例,90 d后复发2例,复发的主要原因与非支气管动脉体循环侧支循环形成、肺内病灶进展以及继发感染有关.结论 支气管动脉栓塞术在治疗肺结核咯血时疗效确切.防止漏栓、加主干双重栓塞、注重治疗病因、预防感染有助于提高支气管动脉栓塞术治疗大咯血的远期疗效.     

儿童咯血介入栓塞治疗后复发8例

【摘要】 目的 分析儿童咯血经导管支气管动脉栓塞术（BAE）后复发的原因,为预防复发提供支持。方法 回顾性分析2014年6月至2018年6月46例咯血患儿经BAE治疗后复发的8例临床资料,通过支气管动脉再次造影综合分析复发原因。结果 BAE术后8例咯血复发患儿再次造影发现,复发咯血由原责任血管再通所致2例,异常供血支气管动脉遗漏栓塞所致2例,病灶新生侧支循环供血动脉建立所致3例,血管变异超选失败所致1例。二次BAE治疗后随访6个月至3年。7例患儿未再出现咯血症状,1例再次出现咯血,给予外科右肺下叶切除后治愈。结论 BAE可有效治疗咯血,完全栓塞是关键。但术中造影应仔细,避免遗漏,再通和新发动脉也值得注意,是咯血复发原因之一。     

大咯血介入治疗术后复发原因与对策

目的：探讨顽固性大咯血介入治疗术后复发原因及处理措施。方法：对36例大咯血介入治疗术后复发出血患者行CT平扫、CTA及DsA检查,寻找出血责任血管,分析复发原因,并通过栓塞（PVA／明胶海绵）一药物灌注（垂体后叶素）一再栓塞（弹簧圈）的过程,再次行永久性栓塞治疗,并观察疗效。结果：36例患者CT及CTA示基础病变进展1l例、血管漏栓10例、栓塞血管再通8例、非支气管性体动脉（NBSA）参与供血18例、侧枝形成5例、支气管动脉一肺动脉瘘2例,其中有两种或两种以上情况同时存在13例。DsA示出血责任血管55支,其中支气管动脉（BA）31支,NBSA20支,肺动脉（PA）4支,36例再次介入栓塞后即刻止血32例（32／36）。结论：对顽固性咯血患者肺部病因治疗是防止栓塞后复发出血的重要因素,寻找出血责任血管是全面、永久栓塞治疗的关键,栓塞材料的选择和方法是提高成功率的基础。     

咯血患者导管栓塞治疗后复发的原因分析

目的 探讨经导管支气管动脉栓塞(TBAE)治疗大咯血后复发的原因及预防措施。资料与方法 56例咯血患者接受TBAE治疗，其中支气管扩张38例，肺结核7例，肺癌6例，肺切除术后咯血4例，支气管动静脉畸形1例。咯血量150～700ml。56例共栓塞靶血管79支，其中单纯使用明胶海绵颗粒(GSP)栓塞41例，使用GSP 丝线线段栓塞4例，使用GSP 无水乙醇栓塞3例，使用GSP 聚乙烯醇(PVA)栓塞4例，单纯使用PVA栓塞4例。所有病例随访1年以上，对有咯血复发的病例均重复行DSA及栓塞治疗。结果 56例患者TBAE后30min～4h咯血均完全停止，但栓塞后1周、1个月、6个月和1年分别有7例(12．5％)、10例(17．9％)、12例(21．4％)和13例(23．2％)复发。复发的原因包括支气管动脉再通(5例)、支气管动脉漏栓(3例)、非支气管动脉供血(3例)和原发病进展(2例)。采用长效栓塞剂联合栓塞，寻找多支支气管动脉及参与供血的膈动脉、肋间动脉、胸廓内动脉等非支气管动脉并予以栓塞，积极治疗原发病是预防咯血复发的主要措施。结论 认识咯血患者栓塞后复发的原因对预防复发具有重要意义。     

经导管支气管动脉栓塞在治疗咯血中的临床应用

目的:探讨经导管支气管动脉栓塞术(transcatheter bronchial arterial embolization,TBAE)治疗大咯血的临床应用价值。方法:56例咯血患者接受TBAE治疗,其中支气管扩张38例,肺结核7例,肺癌6例,肺切除术后4例,支气管动静脉畸形1例。咯血量约150~700mL。56例共栓塞靶血管79条,其中单纯使用明胶海绵颗粒(GSP)栓塞41例,使用GSP+丝线线段栓塞4例,使用GSP加无水乙醇栓塞3例,使用GSP+聚乙烯醇(PVA)颗粒栓塞4例,单纯使用PVA栓塞4例。患者随访1年以上,复发患者均重复行DSA及栓塞治疗。结果:56例患者TBAE术后30min~4h咯血均完全停止,但栓塞后1周、1个月、6个月和1年分别有7例(12.5%)、10例(17.9%)、12例(21.4%)和13例(23.2%)复发。复发的原因包括支气管动脉再通5例、支气管动脉漏栓3例、非支气管动脉供血3例和原发病2例,再次栓塞后停止出血。结论:TBAE是治疗大咯血的安全有效方法,即使复发,再次栓塞仍是可行的。     

合并支气管动脉-肺循环瘘大咯血的介入治疗

目的 探讨大咯血患者合并支气管动脉-肺循环瘘介入栓塞治疗策略及临床疗效. 资料与方法 66例大咯血患者经DSA检查显示20例合并支气管动脉-肺循环瘘,采用长效栓塞剂PVA和丝线对靶血管进行栓塞治疗,部分辅以明胶海绵颗粒(条). 结果 16例1周内咯血消失,4例首次治疗无效者均为病变广泛分流量大或主干血管细小扭曲,1例病变血管栓塞不全,3例1～3天复发再次造影显示瘘口完全或部分再通,栓塞后2例仍咯血改行手术治疗.术后5个月及11个月复发各1例,首次治疗有效率80%,1年内复发率26.3%. 结论 介入栓塞治疗合并支气管动脉-肺循环瘘的大咯血安全、有效,但主干血管细小扭曲及病变广泛分流量大者瘘口易早期再通复发咯血.     

温度敏感型液体栓塞剂经支气管动脉栓塞治疗咯血的短期疗效及安全性分析

目的 评价温度敏感型液体栓塞剂治疗咯血的安全性及疗效。方法 选取我科采用温度敏感型液体栓塞剂治疗22例咯血患者的临床资料及随访结果，患者平均随访时间为(4.27±2.16)月。结果 所有患者均成功实施支气管动脉栓塞，术后3日临床治愈+显效率为90.91%,有效率为100%。随访期1例患者因责任血管漏栓致咯血复发，再次栓塞后咯血显著缓解。所有患者随访至今未发现严重不良事件。结论 温度敏感型液体栓塞剂经支气管动脉栓塞治疗咯血安全可行，初步临床疗效较满意，具有较大的临床应用潜力。     

非肿瘤性咯血二次支气管动脉栓塞治疗效果及预后因素分析

【摘要】 目的 评价二次支气管动脉栓塞术（BAE）治疗非肿瘤性咯血的安全性、有效性及预后影响因素。方法 收集2015年1月至2020年10月于南京医科大学第一附属医院接受二次BAE治疗的33例非肿瘤性咯血患者临床资料,分析二次BAE治疗复发性咯血的安全性、有效性及预后影响因素。结果 33例患者中肺部基础疾病为支气管扩张20例,肺结核后遗症13例;咯血病史中位时间为4.5年。二次BAE造影结果显示复发原因分别为靶血管再通（21/33,63.6%）、新生侧支循环（9/33,27.3%）、漏栓血管（3/33,9.1%）。二次BAE技术成功率和临床成功率均为100%,术后未出现手术相关严重并发症。术后中位随访时间2.8年,有19例患者咯血复发,术后1个月、1年、3年、5年累计咯血复发率分别为12.3%、35.7%、61.8%、71.4%。Cox回归分析结果显示,二次BAE术后咯血复发的独立危险因素是病灶存在非支气管性体动脉（NBSA）供血（HR=2.81,95%CI=1.07～7.40,P=0.036）。结论 二次BAE治疗非肿瘤性咯血安全有效。病灶存在NBSA供血为影响二次栓塞疗效的独立危险因素。     

支气管动脉栓塞术治疗大咯血的疗效研究

目的：探讨支气管动脉栓塞术治疗急症大咯血的近远期疗效及术后咯血复发、影响该治疗技术疗效的主要原因。方法：对57例大咯血患者行支气管动脉栓塞术治疗。57例中,支气管扩张症20例,肺结核31例,肺癌6例。术后随访3～18个月,观察疗效。结果：即刻止血48例（84．2％）,术后咯血完全停止;7例咯血明显减少,经内科保守治疗2—5天后咯血停止;2例咯血减少不明显,经二次栓塞治疗后咯血停止。2例肺结核患者及1例肺癌患者术后因病情进展,分别于6个月、9个月后再次咯血,经再次栓塞治疗后咯血停止。结论：支气管动脉栓塞术治疗急症大咯血创伤小,止血迅速安全,近远期疗效确切,有效控制原发病可降低咯血复发率。     

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.