部分脾栓塞治疗难治性原发血小板减少性紫癜

目的：探讨ＰＳＥ治疗难治性原发血小板减少性紫癜的临床应用价值。方法：对６２例经内科治疗无效的ＲＩＴＰ，采用Ｓｅｌｄｉｎｇｅｒ′ｓ法，经股动脉穿刺，脾动脉置管，注射明胶海绵作部分脾栓塞治疗，以期提高患者周围血小板计数，治愈或减轻出血症状。结果：本组６２例ＲＩＴＰ经ＰＳＥ治疗后，获ＣＲ３９例（６２．９％）；ＰＲ１３例（２１．０％）；总有效率８３．９％。１年后复查，复发率２９．０％。结论：ＰＳＥ治疗ＲＩＴＰ与脾切除无显著性差异（Ｐ＞０．０５），可作为脾切除的替代手术。     

晚期宫颈癌血管内介入治疗的临床研究

目的 采用超选择性子宫动脉化疗栓塞治疗２８例晚期宫颈癌,探讨其疗效及并发症。材料与方法 治疗组２８例采用超选择子宫动脉化疗栓塞治疗,对照组３２例采用常规全身静脉化疗。结果 超选择性子宫动脉化疗栓塞治疗组完全有效（ＣＲ）＋部分有效（ＰＲ）为９２．９％（２６／２８）,全身静脉化疗组ＣＲ＋ＰＲ为３１．３％（１０／３２）,两组比较Ｐ〈０．０１。治疗组１０例获Ⅱ期手术切除。结论 采用超选择子宫动脉化疗检塞是     

替尼泊苷为主的联合方案治疗难治性复发性急性白血病的疗效及多药耐药基因的表达

用替尼泊苷（威猛，ＶＭ－２６）为主的联合方案治疗了３０例难治性复发性急性白血病并用链亲和素胶体金原位杂交（ＩＳＨ－ＳＡＧ）研究了多药耐药基因（ｍｄｒ－１）表达对疗效的影响。３０例病人中完全缓解１５例（ＣＲ），部分缓解（ＰＲ）５例，ＣＲ率５０．０％，有效率６６．７％。２１例检测了ｍｄｒ－１基因表达，其中ｍｄｒ－１阳性者７１．４％，阴性者２８．６％。ｍｄｒ－１阳性组ＣＲ率２６．７％，阴性组ＣＲ率８３．３％（Ｐ＜０．０５）。１５例ｍｄｒ－１基因阳性病人中，加用环孢素Ａ逆转治疗者的ＣＲ率５０％，未用逆转治疗者的ＣＲ率１２．５％。     

髂内动脉化疗栓塞治疗盆腔晚期癌肿

对５８例进展期或复发性盆腔恶性肿瘤施行了双侧髂内动脉灌注化疗，并在灌注后分别用微球和明胶海绵碎块做了栓塞。绝大部分患者的出血、腹水、患部疼痛等症状得以缓解。微球组２１例显示完全有效（ＣＲ）２例，部分有效（ＰＲ）１３例，轻微有效（ＭＲ）５例，无效（ＮＣ）１例。１年生存率２８．６％（６／２１），半年生存率７６．２％（１６／２１）。化疗栓塞后并发症有下肢肌力减退和感觉异常，臀部疼痛和红斑等。除１例微球栓塞后出现下肢严重的运动和感觉障碍外，其余患者均在短期内恢复正常。明胶海绵栓塞后无严重并发症发生。     

部分性脾栓塞术的质量控制

目的探寻术中较准确地控制脾栓塞程度的方法。方法回顾性地分析９０例部分性脾栓塞（ｐａｒｔｉａｌｓｐｌｅｎｉｃｅｍｂｏｌｉｚａｔｉｏｎ，ＰＳＥ）术患者栓塞前、后的脾动脉造影表现，总结出大小为１ｍｍ×１ｍｍ×１ｍｍ明胶海绵颗粒数（Ｇ）、内径约１ｍｍ脾内动脉支数（Ａ）与栓塞程度（Ｅｅ）的关系。以此为依据对２４例脾亢患者进行前瞻性研究，栓塞（Ｅ）前先根据Ｅｅ预期、Ａ值确定明胶海绵用量，行ＰＳＥ术后，比较Ｅｅ实际与Ｅｅ预期的偏差。结果Ｇ、Ａ与Ｅ（Ｅｅ×１００）的关系为Ｇ＝（Ｅ－１１．４５）Ａ／５０．７９。运用本公式可确定栓塞剂用量，从而控制Ｅｅ，９５％偏差范围将控制在－５．８％～６．８％。结论根据预期栓塞程度与脾内动脉分支数确定明胶海绵颗粒用量，从而控制栓塞程度是一种简便可靠的定量脾栓塞法     

明胶海绵在部分性脾栓塞中的应用

目的探讨明胶海绵在部分性脾栓塞中应用方法及价值。方法75例脾亢患者，根据导管位置，采用不同大小的明胶海绵行部分性脾栓塞治疗，栓塞范围50％～70％。结果75例，脾动脉主干用明胶海绵条栓塞8例，脾动脉远端用明胶海绵颗粒栓塞21例，脾中下极动脉用明胶海绵粉末加脾动脉远端明胶海绵颗粒栓塞20例，脾中下极动脉明胶海绵粉末栓塞26例。栓塞成功率100％，脾亢缓解率100％，无异位栓塞并发症发生。结论根据导管头端位置选用不同大小明胶海绵作栓塞剂，安全有效，栓塞成功率高，可避免或减少异位栓塞并发症。     

动脉灌注化疗并栓塞治疗中晚期恶性肿瘤935例临床疗效及并发 …

目的：为总结动脉灌注化疗合并栓塞治疗各种恶性肿瘤的临床疗效以及并发症发生的原因。材料与方法：采用回性临床总结过去６年中９３５例各种中晚期肿瘤，并进行支经疗药物灌注２７１５例闪，肿瘤供血动脉栓塞６７５例次，所用化疗药物一般２－３联，所用栓塞霁眯４０％碘化油５－２０ｍｌ以及明胶海绵碎屑。结果：９３５例病人ＣＲ１１３例，ＰＲ２０１例，ＭＲ２８８例，ＳＤ２４１例，ＰＤ９２例，总有效率（ＣＲ＋ＰＲ＋ＭＲ）为     

21d头低位卧床中几种体液调节激素的变化

目的观察卧床模拟失重所致血浆肾素活性（ＰＲＡ）、醛固酮（Ａｌｄ）及前列腺素（ＰＧＩ２）的变化和ＬＢＮＰ对抗措施对上述激素的影响。方法１２名健康男性志愿者进行了２１ｄＨＤＴ－６°卧床实验。被试者年龄２３．７±５．０岁,随机等分为对照组（ＣＯＮ）和下体负压（ＬＢＮＰ）组。ＬＢＮＰ组在卧床最后一周进行下体负压锻炼（－３０ｍｍＨｇ,１ｈ／ｄ）。卧床前、卧床第２、４、１１天及卧床结束日清晨分别抽取肘静脉血。结果与卧床前相比,Ａｌｄ在第２天显著下降（ＣＯＮ－３０％,Ｐ＜０．０５;ＬＢＮＰ－３８％,Ｐ＜０．０１）,在第１１天显著上升（ＣＯＮ＋３０％,Ｐ＜０．０５;ＬＢＮＰ＋４８％,Ｐ＜０．０１）。ＰＲＡ在第４天达到峰值（Ｐ＜０．０５）,第２２天回落到低于对照水平。ＰＧＩ２在ＨＤＴ过程中均高于对照水平。对照组在第２２天增加＋２６０％（Ｐ＜０．０１）,ＬＢＮＰ组在第１１天,第２２天分别升高１４９％,１０２％（Ｐ＜０．０５）。采用ＬＢＮＰ对抗措施后,ＰＲＡ,Ａｌｄ在两组间无明显差别,ＰＧＩ２在ＬＢＮＰ组未进一步升高。结论２１ｄ头低位卧床导致ＰＲＡ、Ａｌｄ的一过性升高及ＰＧＩ２持续性升高。     

尾部悬吊大鼠不同部位动脉血管内皮细胞几何形状与排列的变化

目的探讨模拟失重对动脉血管内皮细胞几何形状与排列的影响。方法采用ｅｎｆａｃｅ小皮贴片技术观察了尾部悬吊４周（ＳＵＳ－４）、悬吊４周后恢复１周（ＲＥＣ－１）及对照（ＣＯＮ）大鼠后肢和头颈部动脉血管内皮的形态学改变。结果股动脉：与ＣＯＮ比较，ＳＵＳ－４组内皮细胞的平均长度（Ｌ）降低１０％（Ｐ＜０．０１），平均宽度（Ｗ）增大４５％（Ｐ＜０．０１），平均宽／长之比（Ｗ／Ｌ）增大６５％（Ｐ＜０．０１），细胞更趋于圆形，内皮细胞的数目（Ｎ）无明显改变（Ｐ＞０．０５）；ＲＥＣ－１组Ｌ、Ｗ、Ｗ／Ｌ已基本恢复。颈总动脉：其变化趋势与股动脉相反。与ＣＯＮ比较，ＳＵＳ－４组内皮细胞的Ｌ增加１０％（Ｐ＜０．０５），Ｗ降低２４％（Ｐ＜０．０１），平均宽／长之比减小３１％（Ｐ＜０．０１），细胞更趋于梭形，Ｎ变化不明显（Ｐ＞０．０５）；ＲＥＣ－１组Ｌ、Ｗ、Ｗ／Ｌ已基本恢复。结论上述内皮细胞这些变化进一步表明，模拟失重大鼠头颈部的血流量增大，而后肢的血流量降低。     

MEBO在外阴白色病变CO2激光术后的应用

ＣＯ２激光联合ＭＥＢＯ治疗外阴白色病变５０例，旨在探索提高其疗效的方法，结果治疗１个疗程后总有效率９０％，复发率１０％。同时，分别用单纯ＣＯ２激光治疗（Ｂ且）及药物治疗（Ｃ组）５０例进行对照，总有效率分别为７０％及６４％，复发率１３％及１５％，ＣＯ２激光联合ＭＥＢＯ疗效明显优于其他两组（Ｐ〈０．０１），且复发率明显降低（Ｐ〈０．０５）。有效率高，复发率低，无明显瘢痕及毒副作用，消肿止痛，止痒快等特     

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.