131I对Graves病可溶性细胞凋亡蛋白Fas的影响

目的 探讨131I治疗对Graves病(GD)患者循环血可溶性细胞凋亡相关蛋白Fas(sFas)的影响.方法 采用酶联免疫吸附试验(ELISA)和放射免疫分析法(RIA)分别检测52例GD患者131I治疗前及治疗后30、90和180 d血清sFas和甲状腺激素水平,并进行相关性分析,30例年龄与性别相匹配的健康者作为正常对照.结果 GD患者血清sFas水平(2.48±1.05)ng/ml显著高于对照组(1.34±0.41)ng/ml(P＜0.01);131I治疗180 d后,甲状腺功能恢复正常,症状缓解,sFas水平逐渐下降,但仍高于对照组(P＜0.05);血清sFas与促甲状腺激素受体抗体(TRAb)呈正相关,与FT3、FT4和TSH没有相关性.结论 GD患者体内存在sFas异常表达,131I治疗能有效抑制GD患者自身免疫,其治疗前后循环血sFas的动态变化可能与GD发病与转归的病理生理过程有关.     

Graves病治疗前后细胞因子水平的变化

目的　探讨1 31 I和抗甲状腺药物 (ATD)治疗对Graves病 (GD)患者血清细胞因子水平及免疫功能的不同影响。方法　用放射免疫分析法检测 87例接受ATD治疗、14 6例接受1 31 I治疗的GD患者治疗前及治疗后 30 ,6 0 ,180和 36 0d外周血清白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、肿瘤坏死因子 (TNF α)浓度变化 ,并与血清FT3、FT4 、促甲状腺激素 (TSH)进行相关性分析。结果　GD患者血清IL 6、TNF α水平显著高于对照组 (P <0 0 1) ,IL 2显著低于对照组 (P <0 0 1) ;血清IL 6与TNF α水平呈正相关 (P <0 0 5 ) ,与IL 2、FT3、FT4 、TSH水平无相关性 ;1 31 I治疗与ATD治疗对GD患者血清细胞因子的影响程度不一致。结论　1 31 I和ATD治疗可影响血清细胞因子的表达。多种细胞因子水平变化与病程和治疗结果密切相关。     

可溶性细胞间粘附分子-1放射免疫分析法

目的　建立血清可溶性细胞间粘附分子 1(sICAM 1)放射免疫分析法 (RIA)并用于Gra ves病 (GD)的临床检测。方法　用sICAM 1免疫家兔 ,制备多抗 ,建立sICAM 1RIA法。测定对照组4 0 0例 ,治疗前GD患者 312例 ,抗甲状腺药物治疗后甲状腺功能 (简称甲功 )恢复正常的GD患者 4 4 5例 ,单纯性甲状腺肿大患者 5 6例 ,1 31 I治疗前后 36例 ,抗甲状腺药物治疗前后 93例 ,甲状腺次全切除前后GD患者 6例 ,GD停药复发患者 5 2例的血清sICAM 1。结果　sICAM 1RIA灵敏度为 6 6 5 3μg L ;特异性 :非特异结合 <8% ;精密度 :批内低、中、高值变异分别为 4 2 5 %、4 35 %、3 99% (n =6 ) ,批间变异分别为 5 5 5 %、2 82 %、3 4 8% (n =6 ) ;准确性 :回收率平均为 10 0 88%。sICAM 1正常值范围 ( x± 2s) :(16 8 4 3± 72 4 6 ) μg L。治疗前GD组、抗甲状腺药物治疗后甲功恢复正常的GD组血清sICAM 1均明显高于对照组 (P <0 0 1) ,单纯性甲状腺肿大患者组与对照组差异无显著性 (P >0 0 5 ) ;治疗前GD组明显高于抗甲状腺药物治疗后甲功恢复正常的GD组 (P <0 0 5 ) ;GD患者在甲状腺次全切除后、1 31 I及抗甲状腺药物治疗后血清sICAM 1均明显低于治疗前 (P <0 0 5 ) ;GD停药复发患者组血清sICAM 1明显高于甲功恢复正     

心力衰竭患者血浆肾上腺髓质素和升压素的变化

为探讨肾上腺髓质素(ADM)和肾上腺升压素 (ADT)在充血性心力衰竭 (CHF)发展中的变化及其临床意义 ,采用特异性放射免疫法检测 45例CHF患者治疗前后ADM和ADT血浆浓度。结果显示 ,治疗前心功能Ⅱ、Ⅲ级组患者ADM血浆浓度分别为 5 1 46±4 5 2pg/ml、70 3 9± 3 2 2 pg/ml,ADT为 2 9 98± 1 13 pg/ml、3 3 45± 0 91pg/ml,与对照组的ADM ( 2 4 12± 1 5 9pg/ml)、ADT( 2 4 89±2 19pg/ml)比较差异有显著性意义(P <0 0 5 ) ;心功能Ⅳ级组ADM和ADT浓度分别为 3 6 3 3± 2 17pg/ml和 2 0 71±0 75 pg/ml,明显低于Ⅱ、Ⅲ级组和对照组(P <0 0 5 )。治疗后 ,Ⅱ、Ⅲ级组ADM和Ⅲ级组ADT浓度较治疗前明显降低 (P <0 0 5 ) ,余各组ADM和ADT浓度与治疗前比较差异无显著性意义。提示ADM和ADT在CHF不同阶段发生调节紊乱 ,共同参与了心衰的发展过程 ,可作为心衰患者心功能的一项评价指标     

Tg升高131I显像阴性的甲状腺癌患者131I疗效评价

目的　评价甲状腺球蛋白 (Tg)升高但1 31 I全身显像 (WBI)未见局部1 31 I浓聚的分化型甲状腺癌患者1 31 I治疗的疗效。方法　经甲状腺次全切除术后常规1 31 I去除残余甲状腺组织的分化型甲状腺癌患者 2 6例 ,血清Tg升高 ,WBI未见局部放射性浓聚。分为试验组 16例 ,行 3 .7～ 7.4GBq1 31 I治疗 ;对照组 10例 ,Tg升高但未行1 31 I治疗。分别随访监测Tg水平变化。结果　随访半年后试验组Tg由( 2 1.3± 13 .7) μg L明显降至 ( 10 .8± 4.7) μg L(t=2 .43 8,P <0 .0 5 ) ,对照组Tg则明显增高 (t=2 .672 ,P <0 .0 5 ) ,由 ( 18.9± 11.6) μg L增至 ( 2 9.8± 15 .3 ) μg L。 结论　Tg升高而WBI未见局部放射性浓聚的分化型甲状腺癌患者应密切随访 ,当Tg大于 10 μg L时应常规行1 31 I治疗     

经皮二尖瓣球囊扩张术对内皮素及其他内分泌激素的影响

目的　探讨风湿性心脏病二尖瓣狭窄患者在行经皮二尖瓣球囊扩张术 (PBMV)前后内皮素 (ET)以及其他内分泌激素变化的意义。方法　 14例风湿性心脏病二尖瓣狭窄患者作PBMV的前后测定血浆ET、心钠素 (ANF)、肾素 (PRA)、血管紧张素Ⅱ (AⅡ )以及血流动力学参数。结果　在PBMV前血浆ET(16 1.94± 5 0 .6 1) pg/ml[术后为 (80 .4 0± 19.13)pg/ml,P <0 .0 0 1];ANF(2 39.34± 87.0 0 )pg/ml[术后为 (10 5 .0 0±4 1.4 6 )pg/ml,P <0 .0 1];PRA(3.2 7± 1.0 5 )pg/ml[术后为 (1.38± 0 .78)ng/ml,P <0 .0 1];AⅡ (16 1.2 6± 36 .4 5 4 ) pg/ml[术后为 (89.4 4± 2 3.70 )pg/ml,P <0 .0 0 1],均较手术前明显降低 ,但仍显著高于对照。PBMV后ET的变化 (ΔET)与左房压 (ΔLAP)、二尖瓣跨压差 (ΔMPG)、二尖瓣面积 (ΔMAV)以及峰值流速 (ΔPV)变化有显著相关性。结论　本研究证实PBMV扩大瓣口面积使LAP下降 ,ET等其他内分泌激素含量随之下降 ,两者有显著相关性     

131I治疗自主功能亢进性甲状腺腺瘤的疗效观察

自主功能亢进性甲状腺腺瘤又称甲状腺毒性腺瘤 ,与Graves病不同。13 1I治疗本病具有安全、有效、简便、无痛苦的特点。笔者自 1996年以来采用13 1I治疗甲状腺毒性腺瘤 43例 ,现报道如下。一、资料与方法1 临床资料。对 1996年 1月～ 2 0 0 2年 1月经FT3 、FT4 、TSH测定、甲状腺核素显像、B超等检查确诊为单发性甲状腺毒性腺瘤的 43例患者行13 1I治疗 ,其中男 15例 ,女 2 8例 ,年龄 3 8～ 75(55 3±9 5)岁。患者FT3 6 9～ 18 3 (10 6± 3 1)pmol L(正常参考值 3 5～ 6 5pmol L) ,FT42 7 1～ 74 8(45 2± 11 6)pmol L(正常参考值 …     

131Ⅰ治疗非Graves'甲状腺功能亢进及非毒性甲状腺肿后诱发Graves'病

~(131)I治疗非Graves’甲亢及非毒性甲状腺肿后数月,少部分患者体内出现促甲状腺激素受体抗体并诱发Graves’病(GD),发病率在0．05%～5%之间。其发病机制假说有通过自身免疫反应介导等。通过监测体内甲状腺自身抗体水平变化、甲状腺显像,可以预测~(131)I治疗后GD的发生。其治疗方法有抗甲状腺药物治疗、再次放射性~(131)I治疗、手术治疗。     

低吸131I率甲亢患者131I治疗疗效评价

笔者探讨了低吸1 31 I率甲状腺功能亢进症患者 (简称甲亢 ) 1 31 I治疗的疗效 ,现报道如下。一、资料与方法1 研究对象。甲亢患者 31例 ,男 11例 ,女 2 0例 ,平均年龄 (38 1± 14 5 )岁。其中 3例为初诊患者 ,7例为第 2次1 31 I治疗患者 ,17例为抗甲状腺药物 (ATD)治疗无效者 ,2例用过碘油治疗 ,1例服用过海藻多元片 ,1例曾给予质量分数95 %酒精甲状腺内多点注射治疗。入选标准以吸1 31 I率低于 4 0 %。考虑到放射性测量统计涨落 ,1例吸1 31 I率为 4 0 2 %也纳入本研究。其中 3例吸1 31 I率 <30 % ,平均 (35 9± 5 1) %。有 7例伴吸…     

他巴唑对Graves病131I治疗后碘代谢的影响

目的　观察他巴唑对Graves病 (GD)患者体内13 1I代谢的影响。方法　 15 8例首次接受13 1I治疗的GD患者随机分为 3组 ,0组 6 8例 ,13 1I治疗后未服他巴唑治疗 ;Ⅰ组 5 2例 ,13 1I治疗后 2 4h开始服他巴唑 15mg/d ;Ⅱ组 38例 ,13 1I治疗后 2 4h开始服他巴唑 30mg/d。13 1I治疗后动态测定GD患者甲状腺和尿中放射性 ,观察他巴唑及其剂量对体内碘代谢的影响。结果　13 1I治疗后 3组患者不同时间甲状腺部位照射量率均呈持续下降趋势 ,但差异无显著性 (P >0 0 5 )。 3组患者尿中放射性计数均于服13 1I后 2 4h内最高 ,2 4～ 4 8h内下降 ,4 8h后 (服他巴唑 2 4h后 )Ⅰ、Ⅱ组患者均呈上升趋势 ,其发生率与 0组比较差异有显著性 (P <0 0 1)。Ⅰ组和Ⅱ组升降率比较无明显差异 (P >0 0 5 )。结论　GD患者13 1I治疗后 2 4h不宜加用抗甲状腺药物治疗 ,要依据病情适时使用。     

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.