烟雾病的DSA分析研究

目的:提高对烟雾病的理解和认识。方法:对19例证实为烟雾病病人的脑血管造影片(包括双侧颈动脉造影及单侧椎动脉造影)按狭窄及闭塞部位,脑底异常血管网,和脑内、外侧支循环进行分析。结果:38 例次颈动脉造影,除4 例显示正常外,均发现不同程度颈内动脉系统病变,此外,脑膜中动脉病变见14 例次,颞浅动脉病变见7例次。19 例单侧椎动脉造影见大脑后动脉病变12例(19侧),伴基底动脉病变5例,同时伴椎动脉病变3 例。所有病例均可见各种形式侧支循环的形成。结论:烟雾病为脑底动脉进行性狭窄或闭塞伴广泛侧支循环形成的疾病,它的血管病变不仅累及颈内动脉系统,椎- 基底动脉系统及颈外动脉系统亦可累及     

64层CTA在成人烟雾病诊断中的应用

目的:探讨64层CTA在成人烟雾病诊断中的应用价值。方法:回顾性分析13例烟雾病患者的临床及影像资料。患者均行64层脑CTA检查,在HPXW 6600工作站上行VR、MPR、MIP、CPR。结果:64层CTA均能清晰显示发生狭窄、闭塞的颈内动脉、后循环、脑底异常血管网、侧支血管情况,其中双侧颈内动脉闭塞或狭窄7例,单侧颈内动脉狭窄或闭塞3例,双侧大脑中动脉狭窄或闭塞2例,单侧大脑中动脉狭窄或闭塞1例。结论:64层CT利用后处理技术可以清晰显示闭塞及狭窄血管、颅底异常血管网,为诊断烟雾病提供了重要的参考依据。     

256层CTA对下肢动脉不同部位闭塞侧支循环的评价

目的应用256层CT血管成像(CTA)探讨下肢动脉不同部位闭塞侧支循环的特征及临床应用价值。方法对43例下肢动脉闭塞患者临床资料进行回顾性分析,所有病例行下肢动脉CTA检查,利用多种后处理技术观察下肢动脉闭塞的部位,观察相应血管侧支循环形成情况,并与DSA进行比较。结果 43例下肢动脉不同部位闭塞侧支循环途径包括:腹壁动脉(14例)、旋髂浅动脉(14例)、腰动脉(6例)、股深动脉(13例)、膝关节支(16例)、穿支动脉(10例),CTA对其显示率分别为100%、100%、67%、100%、69%、30%;DSA显示率分别为100%、100%、83%、100%、88%、80%。结论 256层CTA能清晰显示下肢动脉不同部位闭塞的侧支循环形成情况,为下肢动脉闭塞症患者治疗方式的选择和预后判断具有肯定的临床应用价值。     

320层CT动态容积扫描对烟雾病侧支循环的评价

目的 探讨320层CT动态容积扫描技术在烟雾病侧支循环诊断中的应用价值.方法 搜集23例经临床、影像综合诊断为烟雾病患者的320层CT扫描图像,并结合病史、DSA检查等进行回顾性分析.结果 23例烟雾病患者320层CT动态容积扫描时表现为单侧或双侧颈内动脉颅内段及大脑前、中动脉狭窄或闭塞,颅底动脉环处见细小、杂乱、迂曲代偿血管网.烟雾病侧支循环途径包括willis环(6例)、眼动脉(4例)、颅底烟雾动脉(23例)、软脑膜吻合动脉(4例)、颈外动脉分支(9例)等.结论 320层CT动态容积扫描技术能显示烟雾病患者侧支循环情况,特别能良好显示来源于颈外动脉的侧支循环,具有肯定的临床应用价值.     

16排螺旋CT血管造影诊断烟雾病的临床价值探讨

目的 探讨16排螺旋CT血管造影(CTA)对烟雾病的诊断价值.方法 回顾性分析24例烟雾病病例,其中男性10例,女性14例,年龄16～71岁.对病例患者进行颅脑CT平扫及CTA检查,应用容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)技术进行图像后处理.结果 平扫CT表现为15例患者颅内若干部位呈见出血灶.7例出现梗死灶,8例出现脑萎缩,2例正常.CTA显示18例患者双侧颈内动脉终末段血管闭塞或狭窄,双侧大脑前、中动脉局部或全程显示不清,其走行区及周围见较多细小侧支循环血管影,6例患者单侧颈内动脉狭窄,单侧大脑前及中动脉显示不清.18例见较为典型的颅底动脉环周围纤细、烟雾状迂曲血管,3例烟雾状血管较少显示,3例VR重建血管网显示效果一般,但是,经过调整VR透明值,便得以清楚显示血管网.VR重建技术对于显示病变血管与其周围结构的位置关系效果显著,显示侧支和细小血管效果不如MIP和MPR.结论 通过CTA可较为清晰地显示颅底异常的脑血管网,颅内颈内动脉末端及大脑前、中、后动脉近端有不同程度的狭窄、闭塞的特征.在诊疗烟雾病过程时采用16排螺旋CT血管造影具有很重要的临床价值,同时可为临床诊治和预后评判提供可靠依据.     

16层CT血管造影在诊断烟雾病中的应用价值

目的：探讨16层CT血管造影（16SCTA）在诊断烟雾病中的应用价值。方法23例烟雾病患者均行16层CT平扫和16SCTA检查,图像后处理采用多平面重组（MPR）、容积再现（VR）和最大密度投影（MIP）。其中5例同时行数字减影血管造影（DSA）检查。结果16层CT平扫显示脑梗死8例,脑出血7例,脑出血合并脑梗死6例,脑实质未见异常2例。16SCTA均清晰显示发生狭窄、闭塞的颈内动脉、Willis环血管近侧端,以及明显增多、扩张的脑底部侧支血管影,其中双侧颈内动脉闭塞8例,单侧大脑中动脉闭塞13例,单侧颈内动脉闭塞伴同侧大脑后动脉狭窄2例。侧支血管表现为相应血管及其分支的粗大、增多、迂曲。5例DSA表现与16SCTA结果一致。结论16SCTA可以清晰显示烟雾病病变血管的特点,检查方法简单、快捷,可为临床诊疗提供重要的诊断依据。     

成人烟雾病27例多层螺旋CT征象分析

目的分析成人烟雾病的CT平扫及CT血管造影(CTA)特征,旨在提高对烟雾病的认识。方法 27例烟雾病患者均行CT平扫和CTA检查,在ADW4.3工作站上做容积再现(VR)、最大密度投影(MIP)和多平面容积重建(MPVR)。结果本组病例均为成人,年龄为21～67岁,平均44.3岁。缺血型9例,其中3例表现为多发病灶,1例显示软化灶,脑萎缩3例,脑实质无明显异常2例;出血性脑卒中18例,脑实质区出血7例,脑室出血6例,脑实质并脑室出血4例,蛛网膜下腔出血1例。CTA均清晰显示发生狭窄、闭塞的颈内动脉、Willis环血管近侧端以及明显增多、扩张的脑底部侧支血管影,其中双侧颈内动脉狭窄、闭塞12例,单侧2例,双侧大脑中动脉狭窄、闭塞9例,单侧3例,双侧大脑前、中动脉A1、M1段不同程度狭窄、闭塞1例。侧支血管表现为相应血管及其分支粗大、增多,迂曲延长。结论 CTA可显示烟雾病患者脑血管的病理特点,CT平扫可显示合并脑梗塞及出血。     

成人烟雾病颅内出血部位及原因的MSCTA分析

目的:通过多层螺旋CT血管成像(MSCTA)探讨成人烟雾病(MMD)颅内出血的部位及原因。方法:搜集30例年龄>30岁的出血性MMD患者的临床及MSCTA资料并进行回顾性分析。结果:本组患者中脑叶出血6例,丘脑、基底节区出血15例,脑室内出血5例,蛛网膜下腔出血4例。MSCTA表现为①本组患者颈内动脉分叉以上均有不同程度的狭窄闭塞:双侧大脑中动脉狭窄闭塞20例,单侧10例;双侧大脑前动脉狭窄闭塞25例,单侧3例;双侧大脑后动脉狭窄闭塞7例,单侧3例;双侧颞浅动脉狭窄2例,单侧3例。②脑底动脉环、基底节区及病变血管周围异常增生血管网形成28例。③侧支代偿供血:大脑后动脉扩张形成软脑膜吻合支代偿22例;前交通动脉增粗,由健侧代偿供血10例;眼动脉扩张5例;颈外动脉分支动脉扩张形成穿膜支与颅内软脑膜动脉吻合8例。④合并脑动脉瘤形成11例。⑤脑出血与侧支循环的关系:15例丘脑、基底节区出血及5例脑室出血患者均见异常增生血管网;6例脑叶出血患者见软脑膜侧支代偿丰富,其中1例枕叶出血与大脑后动脉瘤破裂有关。结论:MMD出血以丘脑、基底节区及脑室出血多见。异常增生血管、扩张的侧支代偿动脉及动脉瘤破裂是脑出血的主要原因。     

64层螺旋CT血管成像诊断椎动脉起源异常

目的 分析椎动脉起源异常的64层CT血管成像(CTA)表现,提高对该血管变异的认识.方法 回顾性分析135例经64层CTA诊断为椎动脉起源异常病人的影像学资料,分析椎动脉起源异常的发生率,起始血管及部位、起源异常椎动脉的行径及其合并症.结果 2757例行头颈64层CTA检查的病人中椎动脉起源异常的发生率为4.9%(135例病人136支椎动脉),其中左侧椎动脉起源异常133支(4.8%),右侧椎动脉起源异常3支;左侧椎动脉起源异常中,129支起源于主动脉弓,2例为重复畸形,1支起源于左侧颈内动脉,1支起于左锁骨下动脉根部.3支右侧椎动脉起源异常中,2支起自右侧颈总动脉,1支起源于头臂干.37例病人合并椎动脉行径异常(进入第4、5和7椎间孔);28支异常起源的椎动脉发育不良;5支起源异常椎动脉的远端游离(未与对侧椎动脉汇合);3例合并椎动脉-基底动脉成窗畸形,1例合并对侧椎动脉瘤.结论 64层CTA能清晰、快速、无创、准确地诊断椎动脉起源变异.     

VCT对头颈部血管狭窄与闭塞的诊断价值

目的 探讨64排螺旋CT(VCT)头颈部血管成像对头颈部血管慢性狭窄性病变的临床诊断价值.资料与方法 对62例可疑头颈部血管慢性狭窄性病变的患者应用CT血管成像(CTA)技术行头颈动脉成像检查,观察两侧椎动脉(VA)、颈内动脉(ICA)以及大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA).对所有图像行曲面重组(CPR)、容积再现(VR)、最大密度投影(MIP)及多平面重组(MPR)处理.结果 62例中头颈部CTA未见异常19例,发现血管异常43例.其中VA狭窄18支,闭塞7支;ICA狭窄30支,闭塞7支;ACA和MCA狭窄11支,闭塞2支,PCA发育不良2支.烟雾病2例,脑内动静脉畸形2例.血管起源变异4例.结论 VCT头颈部血管成像能准确显示头颈部血管正常解剖与异常改变,二维与三维图像相结合对头颈部血管狭窄或闭塞诊断和治疗方案的制定具有指导意义.     

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.