放射性肺损伤

放射性肺损伤是胸部肿瘤放射治疗引起的并发症,一般有两种表现形式,早期急性放射性肺炎和后期放射性纤维化.发病机理研究主要为病理学观察,归纳起来主要有分子生物学机制、肺Ⅱ型上皮细胞损伤、血管内皮细胞受损和自由基等.损伤的发生与照射野、放射剂量、分割方式等有关.总照射剂量低于36GY无放射性肺炎发生,低于40GY无纤维化发生.其病理改变随着照射后时间延长逐渐加重,肺泡是主要受损部位.基本病变为肺充血、水肿、肺间质增厚纤维化.CT、X线是临床最常用检查方法,表现为毛玻璃样斑片状高密度影, 与正常组织分界清.放射性肺损伤不可逆转,预防比治疗更为重要.本文综述了近几年放射性肺损伤各方面研究进展.     

弥漫性肺周边疾患:用高分辨力 CT 观察

作者对15例弥漫性肺周边疾患进行高分辨力CT 扫描(HRCT),并以一般照片及组织学作为对照。所有病人在HRCT 上显示肺大泡、蜂窝样间质纤维化以及小的肉芽肿都比一般X 线片清楚。6例慢性原发性肺纤维化之胸片表现为两肺底网状索条样影,支气管镜活检为肺泡壁增厚、间质纤维化。HRCT 中4例两上肺野胸膜下可见增大之肺泡,从5mm 到10mm。有的融合成更大的肺泡,全部病人之两下肺野边缘有不规则索条状密度增加,似含有小蜂窝状气泡。3例过敏性肺炎治愈期之胸片呈轻度毛玻璃状高密度影,HRCT 上呈散在边缘清楚     

肝移植术后巨细胞病毒肺炎的高分辨率CT表现

目的 探讨肝移植术后巨细胞病毒(CMV)肺炎的高分辨率CT(HRCT)表现,提高对其认识水平.方法 回顾性分析11例肝移植术后CMV肺炎的HRCT表现.结果 毛玻璃影10例,多发结节8例,斑片状实变影4例.所有病例见到多种形态病灶共同存在:毛玻璃影与多发结节4例,毛玻璃影与实变影3例,实变影与多发结节1例,毛玻璃影、实变影与多发结节三者共同存在3例.所有病变均累及双肺,9例病灶分布于肺内外带,仅分布于外带和内带各3例.病变累及下叶11例,累及中叶与上叶分别为10例、9例.4例胸膜增厚,3例少量胸腔积液和1例少量心包积液.所有病例均未见到肺门及纵隔肿大淋巴结.结论 肝移植术后CMV肺炎的HRCT表现主要为双肺混合存在的毛玻璃影、多发结节及斑片实变影,这些征象可作为诊断肝移植术后CMV肺炎的重要依据.     

肺泡蛋白沉积症胸部高分辨率CT诊断

目的 探讨高分辨率CT(HRCT)对肺泡蛋白沉积症(PAP)的诊断价值.方法 回顾性分析6例确诊的PAP患者胸部CT表现与相应病理学改变.结果 在HRCT上,6 例患者在不同层面可见磨玻璃影,4例表现为两肺斑片状磨玻璃影与周围肺组织分界清楚,呈地图样改变,3例因肺小叶间隔增厚交织成铺路石样改变,3例可见肺泡实变融合成密度较高的斑片状阴影.3例患者活检肺组织在光镜下显示肺泡腔内充满大量块状或颗粒状嗜伊红物质,PAS染色阳性,AB染色阴性,其中1例肺泡间隔正常,2例肺泡间隔增宽,可见成纤维细胞增生和胶原沉积.结论 PAP的胸部HRCT表现与病理改变一致,具有一定的特征性,对提高本病的诊断具有重要价值.     

特发性肺含铁血黄素沉着症的影像学表现及其与肺功能改变的相关性分析

目的分析特发性肺含铁血黄素沉着症(IPH)的影像学表现及其高分辨率CT(HRCT)表现与肺功能改变的相关性。方法回顾性分析15例IPH的影像学表现和临床资料。结果X线平片:毛玻璃样阴影9例;渗出影10例;网格状阴影7例;结节影6例。HRCT:支气管血管束改变12例;毛玻璃影12例;渗出影11例;结节影8例;小叶间隔增厚9例。HRCT上毛玻璃样阴影与肺功能的相关性分析:r=0.5394,P=0.134。HRCT上小叶间隔增厚与肺功能的相关性分析:r=0.9633,P=0.0001。结论HRCT对于病灶的显示较平片佳。小叶间隔的增厚程度与肺功能改变呈正相关,能预测肺功能的损害程度。     

盐酸博莱霉素致大鼠肺纤维化动物模型HRCT的评价

目的 评价高分辨率CT(HRCT)对盐酸博莱霉素致大鼠肺纤维化动物模型的诊断及鉴别诊断价值,探讨能应用于放射影像学研究的肺纤维化动物模型。方法 雄性SD大鼠60只,其中50只经气管滴注盐酸博莱霉素,10只经气管滴注等体积的生理盐水。28天后平行观察大鼠HRCT征象,行HRCT-病理对照研究。结果 经气管一次性滴注盐酸博莱霉素的大鼠均出现了纤维化病变,HRCT可见肺实变、结节影、血管支气管束异常、胸膜增厚、交界面不规则、磨玻璃样密度影等,部分可见蜂窝肺,病理切片对照显示肺组织纤维性增生。结论 HRCT方法适于诊断活体动物肺纤维化,该方法方便、准确、可靠,具有良好的可重复性。     

肺间质性疾病的HRCT表现及相关病理研究

目的：分析肺间质性疾病的HRCT表现及其与病理学的关系。方法：38例经手术病理证实的肺间质纤维化患者和疾病对照组14例分别行HRCT扫描、组织病理学检查（包括HE、Masson氏三色染色）及免疫组化。结果：早期组中肺小叶间隔增厚81.25%，肺内渗出毛玻璃影18.75%，肺内小结节影66.67%，胸膜下曲线12.5%；中、晚期组中肺小叶间隔纡曲、僵直、变形85.71%，支气管血管束纡曲、僵直35.71%，范围较广的肺气肿32.14%，蜂窝肺28.57%，胸膜增厚39.29％。结论：HRCT是一种安全、反映准确、无创性的诊断ILD的手段，经与病理对照、毛玻璃影、小叶间隔增厚，肺内小结节影、网状影和胸膜下曲线是ILD早期征象；而肺小叶间隔纡曲、僵直、变形，支气管血管束纡曲、僵直，范围较广的肺气肿及蜂窝肺是中、晚期的征象。     

外源性类脂肺炎中的碎石路样表现:CT与病理的关系

外源性类脂肺炎少见,多因吸入食物中的矿物、植物或动物油,对比剂及油性药物所致。作者报道了3例,均有因鼻炎用油剂滴鼻史。2例病人的胸片示两肺有模糊影,在薄层CT上有两侧斑片状,边缘清楚的毛玻璃影并重叠有增粗的小叶间隔;1例病人的胸片示右下肺实变,在薄层CT上有右肺基底部毛玻璃影并有网影重叠。3例均形成碎石路样表现。病理检查显示,毛玻璃影和增厚的肺小叶间隔代表扩张的肺泡壁和间质,其内含有大量充满脂质的巨噬细胞,并伴有类脂物沉积,炎症细胞浸润和     

间质性肺疾病的HRCT表现及相关病理

目的:分析间质性肺疾病(ILD)的HRCT表现及与普通病理学和免疫病理学表现的关系。方法:19例经手术病理证实的肺间质纤维化病人和7例正常对照分别行HRCT扫描,组织病理学检查(包括HE、Masson氏三色染色)及免疫组化,分析其HRCT表现及相关病理学表现的关系。结果:ILD的HRCT基本征象及分期有其相应镜下病理表现,bFGF、TGF-β1、TNF-α与肺小叶间隔增粗、肺内渗出毛玻璃影、小叶核增粗、肺内异常线影及肺内小结节等HRCT征象中有较强的相关性。结论:HRCT是一种安全、有效、无创性的诊断ILD的手段,肺小叶间隔增粗、肺内渗出毛玻璃影、小叶核增粗、肺内异常线影及肺内小结节是间质性肺疾病较为可靠的HRCT征象。     

原发性干燥综合征胸部病变的HRCT表现

目的 探讨原发干燥综合征(PSS)胸部病变的高分辨率CT(HRCT)表现. 资料与方法 22例PSS患者均行HRCT检查.观察11种较常见的HRCT征象的分布情况. 结果 毛玻璃影13例(59.1%)、实质结节12例(54.5%)及支气管扩张11例(50%)是最多见的3种征象.其他征象有支气管壁增厚6例(27.3%)、肺气肿3例(13.6%)、薄壁囊肿6例(27.3%)、小叶间隔增厚9例(40.9%)、蜂窝肺6例(27.3%)、马赛克灌注7例(31.8%)及胸膜病变6例(27.3%).其中实质结节以中下叶多见,支气管壁增厚及支气管扩张以中心分布为主,小叶间隔增厚以两下肺多发. 结论 PSS胸部异常主要表现为气道和间质的病变,HRCT能很好地显示这些病理征象.     

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.