经皮支架植入术治疗主动脉缩窄的疗效及安全性

目的　评估经皮支架植入术治疗主动脉缩窄的疗效方法　 5例 (男性 3例 ,年龄 33± 9岁 )胸主动脉缩窄患者行经皮主动脉球囊成型术支架植入术。结果　各例支架植入后即刻压力阶差显著减低 (8± 2mmHg ,比较术前 73± 6mmHg ,P <0 .0 0 1)。平均随访 2 7± 12月各例无需多种药物治疗但血压控制良好 (15 2± 7/ 91± 5mmHg ,比较术前 2 0 1± 8/ 12 0± 8mmHg ,P <0 .0 0 1) ,无不良事件发生。 结论　经皮支架植入术治疗主动脉缩窄安全可行 ,且对患者血压控制具有长期疗效     

经皮上腔静脉成型术治疗上腔静脉阻塞综合征

目的　探讨经皮上腔静脉支架成型术治疗上腔静脉阻塞综合征的方法及临床价值。方法　上腔静脉阻塞综合征患者 1 5例 ,包括肺癌伴纵隔淋巴结转移 1 0例 ,非霍奇金淋巴瘤 3例 ,食管癌伴纵隔淋巴结转移 2例 ,均先行右锁骨下静脉或肘静脉穿刺插管至阻塞上段作造影、测压 ,显示阻塞的部位、程度、侧支循环及有无血栓等情况 ,再经右侧股静脉穿刺入路置放上腔静脉支架。结果　 1 5例患者均 1次成功地植入上腔静脉支架 ,1例患者因狭窄范围超过 1 0cm而导入 2枚支架 ,其余均置入 1枚支架。术后造影显示血流恢复通畅 ,手术前后梗阻远端测压从术前的 (30 .5± 2 .3)cmH2 O降到术后的 (8.8±1 .5 )cmH2 O(均为卧位测压 ) ,差异有显著性 (P <0 .0 1 )。术后造影侧支静脉不再显影 ,上腔静脉阻塞症状明显改善 ,随访 6个月 ,除 1例患者因合并血栓经局部溶栓、球囊扩张治疗后症状改善 ,其余患者均无阻塞症状复发。结论　经皮上腔静脉成型术创伤小、恢复快、疗效确切 ,是治疗上腔静脉阻塞综合征的有效方法。     

肿瘤所致下腔静脉狭窄及阻塞的介入性开通治疗

目的　探讨肿瘤所致下腔静脉狭窄及阻塞的介入性开通治疗的疗效及术后处理。方法5 3例肿瘤性下腔静脉狭窄病人 ,有完整随访资料。先用导丝通过狭窄段或潜在的缝隙行球囊扩张后 ,置入支架 ,造影并测量下腔静脉压。结果　 5 3例中 5 0例开通成功 ,3例因导丝无法通过完全阻塞的下腔静脉而失败。 2例因狭窄段超过 10cm而置入 2个支架 ,其余病人均置入 1个支架。开通后下腔静脉压由术前 (2 8 6 6± 4 0 8)cmH2 O (1cmH2 O =0 0 98kPa)降至 (17 6 5± 4 18)cmH2 O ,经t检验 ,开通前后下腔静脉压变化具有非常显著性差异 (t=3 2 6 1,P <0 0 1)。 5 0例置入支架的病例中 48例下腔静脉狭窄或阻塞所致的临床症状及体征在 3～ 5d内消失或部分消失。 1例术中发生肺梗死 ,未出现其他严重并发症 ,平均随访 13 5个月 ,46例仍保持通畅。结论　支架置入治疗肿瘤性下腔静脉狭窄是一种安全有效的方法     

国产前列腺内支架的临床应用及并发症探讨

目的 :探讨国产前列腺内支架治疗前列腺增生引起的排尿困难的临床疗效及并发症。方法 :42例前列腺增生引起的排尿困难的患者 ,植入 46枚前列腺内支架。支架均为国产镍钛记忆合金编织而成。结果 :42例均一次植入成功 ,36例植入支架后立即自行排尿 ,5例因前列腺增生过大前列腺尿道部过长或支架位置不理想 ,植入一个支架后 ,排尿仍有困难 ,再次植入第二个支架后 ,立即自行排尿 ,但 2例出现长期尿失禁 ;1例伴有糖尿病的患者 ,植入支架 1周后排尿困难未改善 ,而进行外科手术治疗。 36例生活质量评估 (QOL)从术前 6min降到术后 0～ 3min ,其中 2 9例术后随访6～ 2 1个月 ,国际前列腺症状评分 (IPSS)术前 (2 7.49± 4 .2 1 )ml/s,术后 (6 .89± 3 .76)ml/s(P <0 .0 0 1 ) ,最大尿流率术前(1 .78± 3 .89)ml/s,术后 (1 3 .91± 3 .56)ml/s(P <0 .0 0 1 )。结论 :国产前列腺内支架治疗良性前列腺增生引起的排尿困难 ,是一种安全、可靠的治疗方法     

支架联合125I粒子条植入治疗肝癌所致下腔静脉恶性梗阻20例

目的 评估支架联合125I粒子条植入治疗下腔静脉(IVC)恶性梗阻的临床疗效.方法 选取20例IVC恶性梗阻患者,行IVC支架联合125I粒子条植入,术前术后分别对IVC梗阻长度、内径,右心房与梗阻段远端压差及患者临床梗阻症状积分进行统计分析.术后每2个月采用CT、彩色多普勒超声或者IVC造影对患者IVC通畅情况进行随访.结果 20例患者共植入26枚支架及40根粒子条,手术均一次性获得成功,未发生与手术相关严重并发症.IVC梗阻长度为(6.82±2.21) cm,狭窄段内径由(0.50±0.27) cm扩张至(1.55±0.33) cm.右心房与梗阻远端压差由术前(16.28± 1.26) mmHg降至术后(5.90± 1.86) mmHg,患者临床梗阻症状积分由术前4～5分(中位值4分)下降至术后0～2分(中位值0分).随访2～26个月,支架通畅率为90％.结论 支架联合125I粒子条植入治疗下腔静脉恶性梗阻安全有效,为临床提供了一种新的姑息性治疗手段.     

下腔静脉恶性梗阻的介入治疗

目的　评价采用国产金属Z形自膨胀式支架治疗下腔静脉恶性梗阻的疗效。方法78例晚期肝癌伴有下腔静脉梗阻的患者入选本研究 ,其中原发性肝癌 6 6例、转移性肝癌 12例 ,患者中男 6 6例、女 12例 ,平均年龄 (5 0 45± 11 81)岁 (年龄范围 2 0～ 78岁 )。术前所有患者均行CT、MRI或彩色超声 (以下简称彩超 )检查 ,提示下腔静脉梗阻存在 ,同时对患者的梗阻症状进行记分。经下腔静脉造影证实狭窄及其程度 ,并在狭窄段放置国产金属Z形自膨胀式支架。术前、术后分别对患者下腔静脉狭窄段内径、患者的梗阻症状积分进行比较 ,统计学处理采用配对秩和检验。术后每 2个月采用CT、彩超或下腔静脉造影对患者下腔静脉的通畅情况进行随访。结果　 78例患者下腔静脉狭窄段长度为 1 5～ 18 5cm(中位值为 7 2cm) ,共 94个支架放置于患者下腔静脉狭窄段内 ,体内支架长度为7 5～ 2 0 0cm(中位值为 10 0cm)。支架释放成功率为 98%。除 1例患者于术后第 2天出现支架内急性血栓形成外 ,其余患者术后无严重的并发症发生。下腔静脉狭窄段内径由术前 0～ 0 5cm(中位值为 0 2cm)扩张至术后 0 3～ 1 6cm(中位值为 1 0cm) (Z =- 5 4 36 5 ,P <0 0 0 0 1) ,两者差异有非常显著性意义。患者梗阻症状积分由术前的 4～ 5分 (中位值     

卡维地洛和美托洛尔治疗急性心肌梗死伴心功能不全对比研究

目的　比较卡维地洛和美托洛尔治疗急性心肌梗死 (AMI)伴心功能不全患者的疗效和安全性。方法　 82例AMI伴左心室收缩功能减退患者以 2 :1随机分为卡维地洛组 (5 4例 )和美托洛尔组(2 8例 )。测定治疗前后临床心功能分级、血压、心率、左心室功能及肾功能和血糖、血脂水平。结果　治疗后 ,卡维地洛组的收缩压、舒张压和心率分别从 (12 6± 2 2 )mmHg ,(77± 10 )mmHg和 (75± 10 )次 min下降至 (12 2± 16 )mmHg(P <0 .0 1) ,(74± 9)mmHg(P <0 .0 5 )和 (6 9± 6 )次 min(P <0 .0 1)。美托洛尔组的心率从 (79± 7)次 min下降至 (71± 7)次 min(P <0 .0 1) ,但收缩压 [(12 9± 17)mmHg和 (12 9± 13)mmHg]和舒张压 [(79± 8)mmHg和 (77± 10 )mmHg]无显著变化。卡维地洛和美托洛尔治疗后 ,NYHA心功能分级分别从 2 .7和 2 .8改善为 2 .0 (P =0 .0 0 1)和 2 .2 (P <0 .0 0 1)。两组左心室射血分数增高 (从 0 .4 4± 0 .0 9和 0 .4 5± 0 .0 7增加至 0 .5 2± 0 .0 9和 0 .5 1± 0 .0 8,P均 <0 .0 5 ) ,收缩末期容量降低 (从 5 9± 2 8ml和 5 4± 2 1ml降低至 5 3± 2 2ml和 4 9± 15 ,P均 <0 .0 5 )。卡维地洛组的血糖、总胆固醇 (TC)和低密度脂蛋白胆固醇 (LDL C)从 7.5mmol L ,4 .6mmol L和 3.0mmol L     

下腔静脉膜性阻塞症介入治疗的疗效随访观察

1　资料与方法1 1　临床资料　 1988年 6月～ 2 0 0 0年 12月采用介入疗法对 6 8例下腔静脉膜性阻塞病人进行了治疗。男 46例 ,女 2 2例 ,年龄 16～ 6 0岁 ,平均 36岁。病程 3个月～ 12年。完全性膜阻塞 19例 ,不完全性膜阻塞 (膜上存有孔隙 ) 49例 ,膜厚 1～ 5ｍｍ。1 2　治疗方法　采用Ｉｎｏｕｅ球囊导管进行成形治疗。不全性膜阻塞 ,先经膜上的孔隙插入导丝 ,然后引入球囊导管进行破膜成形治疗 ;完全性膜阻塞 ,则需先用房间隔穿刺针穿膜 ,建立人工孔道后引进导丝和球囊导管 ,再行成形治疗。44例施行单纯球囊导管成形术 (ＰＴＡ) ;2 4例…     

可回收支架治疗下腔静脉阻塞合并血栓形成的中期疗效

目的 观察可回收支架治疗下腔静脉阻塞(BCS)合并血栓形成的中期疗效.方法 8例下腔静脉合并血栓BCS,采用术中抗凝溶栓治疗后,行钝性破膜小球囊预扩张后植入可回收支架,最后使用大球囊充分扩张闭塞膜.术后给予抗凝溶栓治疗,待血栓消失后经颈内静脉将可回收支架取出.其中下腔静脉节段性闭塞合并血栓患者同时置入"Z"型支架.术后用彩色多普勒随访疗效.结果 8例患者均成功实施了介入治疗,血栓均在短期内消失,可回收支架顺利取出,术中未发生肺动脉栓塞和其他并发症.彩色多普勒超声随访3～12个月,2例下腔静脉狭窄,余6例可回收支架置入部位未见血栓形成、局部再狭窄及管壁增厚等情况发生.结论 使用可同收支架治疗下腔静脉阻塞合并血栓形成疗效满意.     

肝癌伴下腔静脉癌栓行TACE联合下腔静脉放射性支架或裸支架治疗的对照研究

目的 探讨TACE联合下腔静脉放射性支架植入治疗肝细胞肝癌伴下腔静脉癌栓的安全性及有效性.方法 对61例肝细胞肝癌伴下腔静脉癌栓患者的资料行回顾性分析,放射性支架采用125I粒子条捆载裸支架的方法,共对33例患者采用此方法(A组),28例患者植入裸支架(B组).采用倾向性评分匹配(propensity score matching)对原数据进行后随机化分析以减少选择性偏倚,对两组患者的生存期,症状缓解率及不良反应进行对照分析.结果 两组患者术后不良反应发生率相仿,均采用内科对症处理.A组患者较B组显示更长的生存期优势,A组中位生存时间(203.0±28.1)d,B组(93.0±24.3)d(P=0.006),倾向性评分匹配后(24对)A组(200±31)d,B组(66.0±23) d(P=0.019),A组水肿缓解率97.0％,B组为96.4％,多因素分析显示放射性支架植入与肿瘤客观有效率为患者预后好的独立性影响因素.结论 TACE联合放射性支架植入对治疗肝细胞肝癌伴下腔静脉癌栓安全有效,可能延长患者生存时间.     

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.     

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.     

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）