成人原发性甲状腺功能减退症的脑血流灌注显像特征

目的 观察成人原发性甲状腺功能减退症(甲减)患者局部脑血流(rCBF)显像特点,以探索甲减致脑中枢神经系统损害的机制.方法 对15例正常对照组及45例甲减患者分别进行了脑SPECT显像.结果 45例成人甲减患者rCBF减低为91.11%(41/45例),正常为8.89%.20%的甲减患者脑血流灌注出现弥漫性减低,71.11%的患者出现局灶性减低.病变累及的部位主要是颞叶和额叶,其中额叶异常18例(56.25%);颞叶异常31例(96.88%);顶叶异常9例(28.13%);枕叶异常5例(15.63%),基底节异常11例(34.38%).临床甲减组双侧额叶、颞叶、顶叶、基底节及右侧枕叶rCBF明显低于对照组(P《0.01或0.05).亚临床甲减组双侧颞叶、左侧额叶及左侧基底节rCBF也明显低于对照组(P《0.01或0.05).甲减组的额叶、颞叶R/L比值与对照组比较有显著差异(P《0.01).结论 成人原发性甲减患者存在不同程度的脑血流灌注减低,这与其引起的神经精神方面症状可能密切相关,并对指导临床治疗有积极意义.     

低剂量CT血流灌注成像对阿尔茨海默病的诊断价值

目的 评价低剂量CT血流灌注成像对阿尔茨海默病(Alzheimer's disease,AD)的诊断价值.方法 根据临床诊断标准随机选择52例AD和30例健康对照组.对他们进行低剂量血流灌注扫描(CTPI),并在工作站上进行处理,生成伪彩图及进行灌注参数测量,灌注参数包括脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)、平均通过时间(mean transit time,MTT)和达峰时间(time to peak,TTP).选择双侧额叶皮质、双侧颞叶皮质、双侧海马、双侧基底节区域进行测量.结果 健康对照组的双侧额叶、颞叶、基底节和海马CBV、CBF值明显高于AD组,而AD组上述部位的MTT和TTP明显大于健康对照组,有统计学意义(P＜0.05).结论 AD患者伴有微循环障碍和缺血改变.低剂量CT灌注对AD的诊断有一定意义.     

脑血流灌注显像对脑缺氧后遗症患者大网膜移植术后的评价

脑血流灌注显像对脑缺氧后遗症患者大网膜移植术后的评价李劲松傅宏亮吴靖川顾振辉施海虹吴伟烈徐顺清刘鸣华续明附表对照组与５例双侧大网膜移植术脑缺氧症患者脑血流灌注显像半定量分析（％，ｘ±ｓ）比较组别例数左半球额叶颞叶顶叶枕叶基底节正常组１００９６±０?..     

AD型与非AD型变性痴呆大脑葡萄糖代谢的SPM分析

目的 探讨阿尔茨海默病(AD)型与非AD型变性痴呆患者的大脑葡萄糖代谢特征.方法 对23例AD患者、24例非AD型变性痴呆[包括9例帕金森病痴呆(PDD)、7例额颞痴呆(FTD)及8例路易体痴呆(DLB)]患者及40名健康对照者进行静息状态下的18F-脱氧葡萄糖(FDG)PET脑显像.结果 采用统计参数图(SPM)法进行基于体素水平分析.结果 (1)AD组:AD患者大脑葡萄糖代谢较对照组减低的脑区包括双侧颞-顶联合皮质区、额叶、楔前叶及后扣带回等部位.(2)非AD型变性痴呆组:FTD组大脑葡萄糖代谢较对照组减低的脑区包括双侧额叶、顶叶、岛叶、扣带回及左侧楔前叶、右侧皮质下结构等部位,以双侧额叶及皮质下结构为著;PDD组大脑葡萄糖代谢较对照组减低的脑区包括双侧额叶、颞-顶联合皮质区及皮质下结构,如基底节、丘脑等部位;DLB组大脑葡萄糖代谢较对照组减低的脑区包括双侧枕叶、楔前叶、额叶、顶叶及左侧前扣带回、右侧颞叶及皮质下结构如基底节、丘脑等部位,以双侧颞-顶-枕叶联合皮质区为著.结论 AD型与非AD型变性痴呆的大脑葡萄糖代谢特征不同,18F-FDG PET脑显像可为临床诊断及鉴别诊断神经变性痴呆提供依据.     

动脉自旋标记在评估甲状腺功能亢进患者脑血流灌注情况中的应用研究

目的探索动脉自旋标记(arterial spin labeling,ASL)在研究甲状腺功能亢进患者脑灌注情况的可行性并分析其与健康人群在脑灌注上的差异。方法收集年龄、性别、文化程度相匹配的17名甲亢患者(实验组)和16名健康志愿者(对照组)行常规颅脑磁共振检查及三维假连续式动脉自旋标记(three dimensional pseudocontinuous ASL,3D-p CASL)序列检查,测量实验组与对照组各脑区的脑血流量值(cerebral blood flow,CBF)。结果甲亢患者双侧额叶、颞叶、枕叶、基底节区及海马区的CBF较健康对照者减低(P均0.05,其中,双侧额叶、枕叶、左侧基底节区、右侧颞叶、右侧海马区P0.01)。右侧额叶CBF与促甲状腺激素(thyroid stimulating hormone,TSH)浓度呈正相关(r=0.7820,P0.05);诸脑区CBF与游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及游离甲状腺素(free thyroxine,FT4)浓度无明显相关性;诸脑区CBF与促甲状腺素受体(thyrotropin receptor antibody,TRAb)浓度无明显相关性;右侧基底节区、右侧顶叶、左侧顶叶CBF与病程长短呈正相关(r=0.7576、r=0.7576、r=0.8257,P均0.05)。结论利用ASL评估甲亢患者脑灌注情况具有可行性。其双侧额叶、颞叶、枕叶、基底节区及海马区存在明显低灌注;右侧额叶灌注对血清TSH水平敏感;右侧基底节区、右侧顶叶、左侧顶叶灌注情况对病程时间长短敏感。     

不同程度阿尔茨海默病PET脑代谢减低的SPM研究

目的 以统计参数图(SPM)为方法、其输出的脑代谢减低范围大小为指标,探讨不同程度阿尔茨海默病(AD)患者PET显像脑葡萄糖代谢减低区的大小和范围.方法 AD组27例,均符合精神障碍诊断和统计工作手册(DSM-Ⅳ-R)中的AD诊断标准,行简易智能量表(MMSE)检查.根据MMSE评分将AD组分为轻度、中度和重度组,每组各9例.对照组9名,均为健康体格检查者.所有受检者静脉注射18F-脱氧葡萄糖(FDG)后行PET三维脑显像.在Matlab 6.5平台上,用SPM2软件对得到的PET图像进行预处理,设P值阈值为0.001,将全部AD患者以及轻、中、重度3个AD患者组分别与对照组进行组间统计分析.结果 与对照组比较,AD组于双侧顶叶、颞叶、额叶及扣带回出现代谢减低区,以k值(即满足P值要求的每一"块"异常脑区的像素值)为指标测量,轻度组减低区k值为929,其中额叶减低区k值为174;中度组k值为6743,额叶减低区k值为2712;重度组k值为24 678,额叶减低区k值为4981.脑白质及脑内灰质核团未见代谢减低.结论 使用SPM,以k值为指标,可对不同程度AD患者脑代谢减低区大小进行评价.随痴呆程度加重,受累脑区范围增加,额叶晚期受累严重.     

CT灌注成像对非卒中型烟雾病血流动力学的分析

目的：分析非卒中型烟雾病(MMD)患者脑血流动力学改变特点。方法对12例颅脑 CT 平扫未发现病变,经 DSA 证实的 MMD 患者(病例组)和10例正常成人(对照组)行多排螺旋 CT 灌注成像(CTPI),计算出2组样本相对应脑解剖部位血流动力学参数,对比分析所得数值的统计学意义。结果病例组不同部位脑组织各血流灌注参数差异均有显著统计学意义(P =0.000);对照组不同部位脑组织各血流灌注参数差异均无统计学意义(P >0.05)。病例组额叶、颞叶、顶叶及基底节区脑血容量(rCBV)明显高于对照组(P <0.01);病例组额叶脑血流量(rCBF)低于对照组(P <0.05);病例组额叶、颞叶、顶叶对比剂平均通过时间(MTT)及额叶对比剂峰值时间(TTP)较对照组延长(P <0.05)。结论CTPI 可以定量地反映脑组织的血流动力学改变,对评价尚未出现脑组织形态学变化的 MMD 患者脑循环障碍具有重要价值。     

Alzheimer病与轻度认知功能障碍的脑SPECT显像

目的探讨脑SPECT显像对阿尔茨海默病（AD）和轻度认知功能障碍（MCI）的早期诊断及预后判定价值。方法对33例AD、17例MCI患者和12例认知正常者进行SPECT检查及随访研究。结果AD组典型表现是双侧颞顶叶低灌注，在颞叶、顶叶、额叶、丘脑和扣带回血流灌注均明显低于MCI和认知正常组（P〈0．05）；MCI组仅在颞叶血流灌注明显低于认知正常组（P〈0．05）。不稳定型MCI组扣带回血流灌注明显低于稳定型MCI组（P〈0．05）。结论SPECT显像可为早期诊断AD和MCI提供客观评定脑功能的指标，对MCI预后判定有重要价值。     

五例艾滋病患者~(99)Tc~m-ECD脑SPECT显像

目的　观察艾滋病 (AIDS)患者局部脑血流 (rCBF)的变化。方法　对 5例男性AIDS患者 (IV期 )进行了99Tcm 双半胱乙酯 (ECD)脑血流灌注显像 ,半定量测定rCBF。 16例性别、年龄匹配的健康者作正常对照。结果　 1例有痴呆临床表现的AIDS患者存在双侧额、顶、颞叶和基底节及左侧丘脑rCBF低灌注 ,4例无痴呆临床表现的AIDS患者亦出现双侧额、顶叶rCBF低灌注。AIDS组患者双侧额、顶、颞叶、基底节和丘脑以及直回和桥脑rCBF明显低于对照组。结论　AIDS患者存在脑皮层和皮层下rCBF减少     

~(18)F-FDGPET显像诊断老年性痴呆初步研究

目的　探讨18F 脱氧葡萄糖 (FDG)PET显像诊断老年性痴呆 (AD)的影像特征和诊断标准。方法　静脉注射18F FDG后行脑断层显像 ,获得顶叶、颞叶、额叶单位面积放射性计数与小脑计数的比值 ,以此作为半定量指标。结果　 12例正常人可见大脑皮质各叶、基底神经节、丘脑及小脑放射性分布均匀对称。 12例AD影像分为 3种 :双侧顶叶放射性减低 5例 ,双侧颞顶叶减低 4例 ,单侧颞顶叶减低 3例。半定量分析显示AD患者顶颞叶代谢显著低于正常人 ,并与痴呆程度相关。 11例非AD痴呆影像也分 3种 :多发性非对称性放射性减低 8例 ,双侧颞顶叶伴其他多灶性放射性减低 2例 ,显像正常 1例。MRI检查 10例AD可见颞叶、杏仁核、海马体积缩小 ;2例轻度AD虽有代谢减低 ,但MRI未见海马体积缩小。 10例非AD痴呆MRI可见脑内陈旧出血、梗死、软化灶等病灶 ,而这些表现AD患者未见到。结论　在MRI除外脑内结构损害病灶基础上 ,18F FDGPET发现双侧或单侧顶叶或颞顶叶代谢减低可诊断AD ;半定量分析有助于痴呆程度的评价。     

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.