脉压对脑梗死患者颈总动脉影响的超声观察

目的:使用超声技术观察脉压对脑梗死患者颈总动脉的不同类型斑块的发生情况和物理形状的影响。方法:用二维高频超声和M型超声观察A组187例脑梗死患者颈总动脉的不同类型斑块的发生情况、内中膜厚度、收缩期管径、舒张期管径,结合血压,计算颈总动脉的动脉硬化指数、动脉可扩张度和周向扩张率,并与B组232例非脑梗死者比较。结果:脑梗死组和对照组及各分组之间比较,脑梗死组中PP≥60mmHg组与血压正常组比较、PP<60mmHg组与血压正常组比较,斑块的检出率增加,中内膜增厚,内径增加,动脉硬化指数增加,动脉可扩张度下降,周向扩张率明显下降。脑梗死组中PP≥60mmHg组与血压正常组比较,这种变化更明显。脑梗死组中内膜普遍达到有病理学意义的增厚(大于1mm)。结论:高脉压型高血压在脑梗死的发病机制中有重要的作用。如果超声发现高脉压的高血压患者颈总动脉中内膜增厚,检出斑块,内径明显增加,动脉硬化指数明显增加,动脉可扩张度明显下降,周向扩张率明显下降,则高度提示脑梗死的可能,从而为脑梗死的防治提供帮助。     

老年原发性高血压患者动态脉压与颈动脉粥样硬化相关性研究

目的:探讨老年原发性高血压患者动态脉压与颈动脉粥样硬化间的关系。方法:根据动态全天平均脉压将100例老年原发性高血压患者分为两组。所有患者均经超声检测颈总动脉、颈内动脉和颈外动脉分叉处的内膜中层厚度、血管内径,并计算斑块发生率。以颈总动脉最大内膜中层厚度(IMT max)作为评价颈动脉粥样硬化程度的指标。结果:脉压差大于60mmHg的患者颈总动脉内径、颈总动脉最大内膜中层厚度、颈动脉斑块发生率明显高于脉压差为40~60mmHg患者(P<0.05)。Pearson相关分析显示,平均脉压、平均收缩压及病程与颈总动脉最大内膜中层厚度呈明显正相关(r分别为0.410、0.217、0.247,P<0.05),而平均舒张压与颈总动脉最大内膜中层厚度呈负相关(r=-0.404,P<0.01)。结论:老年原发性高血压患者脉压差与颈动脉粥样硬化斑块和内中膜厚度相关,脉压差可能参与动脉粥样硬化的形成和发展。     

多普勒超声应用于高血压患者中检测其颈动脉、血脂意义

目的探讨多普勒超声应用于高血压患者中检测其颈动脉、血脂的意义。方法选取2014年4月~2016年12月于医院治疗的66例高血压患者作为本次研究观察组,另选取同期于医院健康体检的正常健康人群32例为对照组。采用彩色多普勒超声检测两组颈总动脉和颈内动脉内径、颈动脉内-中膜厚度(IMT)及斑块,检测两组颈动脉血流动力学指标及血脂水平。结果观察组患者颈动脉内径明显高于对照组,IMT厚度明显大于对照组,斑块检出率明显高于对照组,P0.05。观察组患者颈总动脉和颈内动脉收缩期PSV和SR明显低于对照组,而RI明显大于对照组,P0.05。随血压级数增加,颈动脉厚度IMT、斑块检出率及RI逐渐增加,而PSV和SR逐渐降低,高血压各亚组间比较,P0.05。观察组患者与对照组胆固醇和甘油三酯水平相比较,P0.05。结论临床通过采用彩色多普勒超声检测高血压患者颈动脉硬化程度来判断其是否出现动脉硬化,为临床及时干预提供参考。     

高血压病人脉压与心脏几何结构的关系

目的　探讨高血压病人脉压与心脏几何结构的关系。方法　对 395例高血压病人进行诊所血压和 2 4h动态血压监测 ,同时采用超声心动图测定心脏结构。结果　不同年龄组间诊所脉压的差异有统计学意义 (P <0 0 5 ) ,随着年龄的增大 ,脉压逐渐增大 ,且≥6 0岁组的脉压明显高于其他年龄组 ,差异有统计学意义 (P <0 0 5 )。“非杓型”病人各时段的收缩压 /舒张压 (SBP/DBP)、平均动脉压(MAP)均明显高于“杓型”血压者 (P <0 0 1或P <0 0 5 )。年龄越大 ,“非杓型”血压病人的比例越大 ,而“杓型”血压者的比例减少。随着年龄的增大 ,左室肥厚的检出率有增大的趋势 ;随着脉压的增大 ,左室重量指数 (LVMI)、左室舒张末内径 (LVIDD)及室间隔厚度 (IVST)均升高 ,≥ 6 0mmHg组明显高于 4 0～ 5 9mmHg组 (P <0 0 5 ) ,更高于 <4 0mmHg组(P <0 0 5 )。随着脉压的增大 ,左室重构、向心性肥厚及离心性肥厚的百分比相应增加 ,且向心性肥厚的比例增加更明显 (占 32 6 % )。结论　高血压病人脉压对左室几何构型存在重要的影响。     

132例中青年缺血性脑卒中颈动脉硬化危险因素分析

目的探讨中青年缺血性脑卒中颈部动脉硬化危险因素。方法对132例缺血性脑卒中患者行颈动脉彩色多普勒超声检查和危险因素进行回顾性分析,分别检查颈总动脉、颈总动脉窦部及颈内外动脉。结果 132例中有89例颈动脉检出粥样硬化斑块,检出率67.42%,颈动脉单纯内膜增厚41例,检出率46.06%。斑块形成48例,约占89例颈部动脉硬化53.93%。结论原发性高血压、脂肪肝、吸烟、血糖异常等是中青年缺血性脑卒中颈部动脉硬化得主要危险因素。     

高血压患者脉压水平与冠脉狭窄的关系

目的　探讨高血压患者脉压 (PP)水平与冠脉狭窄的关系。方法　回顾性分析 336例因胸痛住院接受冠脉造影且规则接受药物治疗下高血压病患者的脉压与冠脉狭窄的相关性。结果　①随着收缩压增高和舒张压的下降 ,脉压逐渐增大 ,冠状动脉狭窄级别、狭窄≥ 75 %血管支数和狭窄≥ 75 %的例数均明显增加 (P <0 .0 1)。②高血压病患者严重冠脉狭窄 (≥ 75 % )的发生与年龄、高血压病程和脉压相关 (P <0 .0 1) ,但与患者平均动脉压似无相关 (p >0 .0 5 )。③Logistic回归分析显示 ,PP与高血压病患者严重冠脉狭窄 (≥ 75 % )发生存在明显的相关性 ,PP每增加 10mmHg ,冠心病发生率增加 32 % (95 %CI :1.2 5～ 1.39,P <0 .0 0 0 1) ;在对年龄和高血压病程进行调整后 ,PP每增加 10mmHg仍显示增加冠心病发生率 2 1% (95 %CI:1.15～ 1.2 7,P <0 .0 0 0 1)。在其他血压参数中 ,收缩压 (SBP)同样与冠心病的发生密切相关。结论　高血压患者脉压水平与冠脉狭窄呈正相关关系 ,在降压治疗的同时 ,应缩小增大的脉压。     

高血压患者血浆同型半胱氨酸水平与颈动脉硬化及性别的关系

目的探讨高血压患者颈动脉硬化及性别与血浆同型半胱氨酸(Hcy)的关系。方法选择高血压患者216例,根据颈动脉超声分为正常组、颈动脉硬化组和斑块组,斑块组又分为稳定斑块组和不稳定斑块组,采用彩色多普勒超声仪检测颈动脉内膜中层厚度(IMT)及斑块,同时测定血Hcy。结果正常组、颈动脉硬化组和斑块组血Hcy蛋氨酸和半胱氨酸代谢中间产物差异有统计学意义;不稳定斑块组和稳定斑块血Hcy差异有统计学意义(P<0.01);男性高血压患者血浆Hcy水平高于女性患者(P<0.01)。结论高血压患者血Hcy与动脉硬化程度、斑块稳定性及性别密切相关。     

超声在乳腺癌化疗患者颈动脉粥样硬化诊断中应用

目的探讨超声在乳腺癌化疗患者颈动脉粥样硬化诊断中的应用价值。方法选取自2016年1月至2019年1月在北部战区总医院就诊的120例进行化疗的女性乳腺癌患者为观察组,另选取同期于我院就诊的未患乳腺癌的120例女性为常规组,再根据年龄分别将两组患者分为青年组(20～40岁)、中年组(40～60岁)和老年组(60～80岁) 3个亚组,每个亚组各40例。经颈动脉超声检查,比较两组研究对象中同一年龄组的颈动脉内中膜厚度(IMT)、动脉粥样斑块检出率,以及检出斑块的位置、数量。结果观察组的中年组颈动脉IMT增厚发生率明显高于常规组的中年组,差异有统计学意义(P <0. 05);观察组的青年组及老年组颈动脉IMT增厚发生率高于常规组的青年组及老年组,但差异无统计学意义(P> 0. 05)。观察组的青年组、中年组颈动脉粥样斑块检出率明显高于常规组的青年组、中年组,差异有统计学意义(P <0. 05);观察组老年组颈动脉粥样斑块检出率高于常规组老年组,但差异无统计学意义(P> 0. 05)。观察组共检出颈动脉粥样斑块245块,常规组共检测出89块。观察组中青年组、中年组、老年组检出的平均颈动脉粥样斑块数量均多于常规组对应的各亚组,组间比较,差异均有统计学意义(P <0. 05)。观察组与常规组检出的位于颈总动脉分叉处、颈内动脉起始处及颈总动脉的斑块比例比较,差异均无统计学意义(P> 0. 05)。结论超声是颈动脉粥样斑块的有效检查方式,通过超声评价颈动脉IMT及粥样斑块情况,可以发现早期亚临床动脉硬化,积极干预治疗,可预防动脉粥样硬化的并发症的发生,提高乳腺癌患者的存活率及生存质量。     

老年高血压病患者脉压与靶器官损害的关系

目的　近年来研究表明脉压 (PP)也是心脑血管疾病发生和死亡的独立危险因素 ,其预测价值甚至大于收缩压 (SBP)、舒张压 (DBP)及平均脉压 (MAP) ,而老年高血压患者中以脉压增宽多见 ,目前研究多以未服药治疗的老年单纯收缩期高血压病患者为研究对象 ,为此本研究目的在于药物规则治疗下老年高血压病患者PP与心脏、大血管及肾脏等靶器官损害的关系 ,为临床更好地控制血压 ,防治靶器官损害提供依据。方法　用 2 4h动态血压仪监测 2 6 3例老年高血压病患者全天平均脉压 (ABPP) ,多普勒超声检查颈动脉粥样斑块发生率 (CAPR)、颈总动脉分叉处内膜 -中膜厚度 (IMT)及内经 (CAD)、左室重量指数 (LVMI)、左室舒张早期充盈峰值流速与心房收缩期充盈峰值流速比值 (E/A值 )、射血分数 (EF) ,生化测定内生肌酐清除率 (CcR)及 2 4小时尿微量白蛋白排泄量 (MAU)。评价不同ABPP值对心脏、颈动脉、肾脏结构或功能的影响。结果　老年高血压病患者PP≥ 6 0mmHg与PP <6 0mmHg比较 ,E/A值、EF和CcR均下降 (P <0 .0 5 ) ,而LVMI、CAD、CAPR、IMT、MAU升高 (P <0 .0 5 )。结论　本研究表明脉压增宽可降低老年高血压病患者心脏的收缩和舒张功能 ,导致左室负荷增大 ,使心肌发生重构 ,室壁增厚。脉压增宽也使反映大动脉顺应性的颈动     

冠心病患者颈动脉粥样硬化与内皮舒张功能的超声检测及临床意义

目的　探讨颈动脉粥样硬化病变的发生与冠心病的关系 ,研究冠心病患者内皮功能的变化。方法　应用高频超声检测 1 2 0例住院接受冠脉造影患者的颈动脉内中膜厚度 (IMT)及粥样硬化斑块 ,同时检测肱动脉血流介导和硝酸甘油 (GTN)引起的舒张反应。结果　根据冠状动脉造影结果将 1 2 0例患者分为冠心病组 (90例)和对照组 (30例 ) ,冠心病组IMT明显大于对照组 ,但不同病变支数的冠心病患者之间无差异。冠心病组颈动脉硬化斑块的检出率 (以分叉部为最高 ,其次为颈总动脉和颈内动脉 )明显高于对照组 ,且与冠脉病变的严重程度有关。总胆固醇、低密度脂蛋白、胆固醇水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。冠心病组的肱动脉基础内径略大于对照组 ,但差异无统计学意义 (P >0 0 5 )。冠心病组由血流介导和硝酸甘油引起的肱动脉舒张反应均明显低于对照组(P <0 0 1 )。结论　颈动脉粥样硬化严重程度与冠心病发生呈正相关。颈动脉超声检测对冠心病有一定的预测价值。颈动脉超声及血管内皮功能检查不仅可能为早期发现、预防和治疗冠心病提供依据 ,还可能作为监测和评估病情变化的指标     

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.