多体素^1H MRS测定正常脑组织不同区域的代谢物分布

目的: 测定正常人脑组织不同部位代谢物浓度、计算其比值.材料和方法: 用多体素磁共振质子波谱PRESS序列测定100例正常脑组织的额叶、颞叶、顶叶、枕叶、基底节区和小脑代谢物浓度,观察NAA、Cho、Cr的波峰特点,计算和分析NAA/Cr、Cho/Cr、NAA/Cho的比值.结果: 正常脑实质的1H波谱Levene方差分析显示额叶、颞叶、顶叶、枕叶、基底节区和小脑的NAA/Cr(P<0.000)和NAA/Cho(P=0.001)有显著差异,Cho/Cr在上述各部位的浓度无显著差异(P=0.068).进一步用Bonferroni方差分析比较各组间显著差异性显示小脑NAA/Cr低于额叶、顶叶、枕叶的NAA/Cr(P值分别<0.05,<0.01,<0.05),小脑NAA/Cho低于顶叶、枕叶的NAA/Cho(P均<0.01),而额叶、颞叶、顶叶、枕叶、基底节区之间NAA/Cr、NAA/Cho无显著差异.结论: 多体素1H MRS可以测定NAA/Cr、Cho/Cr、NAA/Cho浓度比值,不同解剖部位代谢物浓度不尽相同,为颅脑代谢异常提供参考标准.     

小儿正常小脑半球组织~1H-MRS研究

目的:测定和计算0～7岁小儿正常小脑半球组织代谢物比值,并观察各比值随年龄变化规律。方法:应用多体素2D1H-MRS点分辨波谱(PRESS)序列测定70例0～7岁小儿正常小脑半球组织的双侧灰质及白质区代谢物浓度,按年龄分为0-1岁,1-2岁,2-3岁,3-5岁,5-7岁五组,计算和分析NAA/Cr、Cho/Cr、NAA/Cho的比值。结果:正常小脑灰质区在各年龄组间NAA/Cho(P=0.0143)和NAA/Cr(P=0.0050);白质区的NAA/Cho和NAA/Cr均P<0.001;灰质和白质区的Cho/Cr(P=0.1195,P>0.05);灰质和白质区NAA/Cho值与年龄呈正相关(P<0.001,P<0.0001);NAA/Cr值与年龄呈正相关(P=0.0004,P<0.0001);灰质区Cho/Cr与年龄呈负相关(P=0.038),白质区与年龄呈负相关(P=0.568>0.05)。结论:0～7岁小儿正常小脑半球灰、白质的代谢物比值在不同年龄组会不同,灰质和白质区NAA/Cho、NAA/Cr值随年龄增长逐渐升高,而灰质区Cho/Cr值逐渐减小,白质区无明显变化,临床上应用MRS要考虑其年龄和部位的因素。     

外伤性脑损伤脑桥快速波谱成像研究

目的探讨颅脑外伤(TBI)所致脑桥代谢物变化规律及其与预后的关系。方法对34例TBI患者行快速波谱成像(TSI),获得NAA/Cr、Cho/Cr、Cho/NAA值,并与16例正常志愿者(对照组)进行对比。将TBI组根据格拉斯哥预后评分分为预后良好、中等、差3组,比较不同组间代谢物水平差别。结果 TBI组34例脑桥NAA/Cr、Cho/Cr、Cho/NAA均值分别为2.51±0.73、2.56±0.67、1.05±0.29;对照组16例NAA/Cr、Cho/Cr、Cho/NAA均值分别为2.70±0.37、1.92±0.09、0.72±0.08。两组间NAA/Cr均值差异无统计学意义(P=0.235),两组间Cho/Cr、Cho/NAA均值差异有显著统计学意义(P值均=0.000)。NAA/Cr在预后差组(2.15±0.56)与预后中等组(2.73±0.58)之间、预后差与预后良好组(2.98±0.90)间差异有统计学意义(P值分别为0.036、0.007)。Cho/Cr 3组之间差异无统计学意义。Cho/NAA在预后差组(1.22±0.31)与预后良好组(0.80±0.15)之间差异有统计学意义(P=0.001)。结论 TSI适合TBI脑桥MRS检测,TBI患者脑桥Cho/Cr和Cho/NAA较正常人升高,而NAA/Cr和Cho/NAA比值对TBI预后判断较有意义。     

卒中后抑郁患者小脑磁共振波谱成像改变的临床研究

目的 应用氢质子磁共振波谱成像(1H-MRS)技术,探讨卒中后抑郁(PSD)患者小脑代谢的改变及其与抑郁严重程度的关系.方法 以卒中患者作为研究对象,回顾性收集人口学、个人疾病史和生活方式的数据,对40例卒中患者及20例健康志愿者进行自评抑郁量表(SDS)和汉密尔顿抑郁量表(HAMD)评分.根据评分结果,将卒中患者分为卒中后抑郁(PSD)组和卒中后无抑郁(CONT)组.对PSD组、CONT组和正常对照(NORM)组进行T1WI、T2WI、DWI及1H-MRS检查,评估脑梗死体积和脑白质病变部位及严重程度,测定小脑半球N-乙酰天冬氨酸(NAA)/肌酸(Cr)、胆碱复合物(Cho)/Cr、Cho/NAA比值,并分析卒中后小脑代谢改变与HAMD评分间的关系.结果 CONT组双侧小脑NAA/Cr、Cho/Cr、Cho/NAA比值与NORM组比较差异均无统计学意义(P＞0.05).与NORM组和CONT组比较,PSD组病灶对侧小脑Cho/Cr、Cho/NAA比值均较高(P＜0.05),病灶同侧小脑Cho/Cr、Cho/NAA比值差异无统计学意义(P＞0.05),而双侧小脑NAA/Cr比值差异无统计学意义(P＞0.05).PSD组家庭APGAR问卷评分、ARWMC总分、发病14d时NIHSS评分、病灶对侧小脑Cho/Cr和Cho/NAA比值与CONT组比较差异有统计学意义(P＜0.05).多重线性回归分析显示,病灶对侧小脑Cho/Cr、Cho/NAA比值与HAMD评分具有相关性(P＜0.05).结论 小脑可能参与了卒中后抑郁的发生.     

儿童抽动秽语综合征患者双侧壳核容积与代谢改变的MR研究

目的:采用MR容积分析及MRS对比研究儿童抽动-秽语综合征(TS)患者双侧壳核的容积与代谢改变及其相关性,探讨TS患者的病理生理机制.方法:搜集18例儿童TS患者(TS组)及18例年龄性别相匹配的健康志愿者(对照组),用容积分析软件对TS患者及正常对照组双侧壳核进行容积测量,采用单体素氢质子MRS对TS患者及对照组壳核进行数据采集和分析,根据峰下面积大小分别计算NAA/Cr、Cho/Cr值.将测得的NAA/Cr值与壳核的容积进行相关性分析.结果:TS组(左侧壳核:NAA/Cr=1.17±0.15,Cho/Cr=0.81±0.13;右侧壳核:NAA/Cr=1.09±0.09,Cho/Cr=0.78±0.17)与对照组(左侧壳核:NAA/Cr=1.43±0.03,Cho/Cr=0.70±0.12;右侧壳核:NAA/Cr=1.39±0.06,Cho/Cr=0.75±0.10)相比,TS患者双侧壳核NAA/Cr明显减低,差异具有统计学意义(P均＜0.05),两组间两侧Cho/Cr差异均无统计学意义(P均＞0.05).TS组和对照组左侧与右侧NAA/Cr、Cho/Cr差异均无统计学意义(P＞0.05).TS组与对照组双侧壳核容积差异无统计学意义(左:t=0.536,P＞0.05;右:t=1.758,P＞0.05).TS组和对照组左侧与右侧壳核容积差异均无统计学意义(TS组:t=1.501,P＞0.05;对照组:t=0.481,P＞0.05).TS组和对照组双侧壳核NAA/Cr值与容积大小均无相关性(P＞0.05).结论:壳核可能参与了儿童TS患者的病理生理过程,MRS比容积测量对TS患者的壳核的改变更敏感.     

原发性单侧症状帕金森病磁共振氢质子谱研究

目的:探讨磁共振氢质子谱(1H-MRS)对原发性单侧起病帕金森病的诊断价值。方法:未经治疗的原发单侧症状PD患者50例为PD组,健康人42名为对照组。两组分别予以双侧壳核MRS检查,由仪器自带软件自动计算得双侧壳核代谢物比值:NAA/Cr,Cho/Cr,NAA/Cho。结果:PD组患者其症状对侧壳核NAA/cr比值分别较同侧及健康对照组双侧壳核相应比值均值明显下降(分别为1.23±0.22,1.38±0.33,1.33±0.16;t=2.616,P=0.01和t=2.324,P=0.02),而其NAA/Cho、Cho/Cr比值较同侧及对照组相应比值均值无显著差异。症状同侧壳核NAA/cr、NAA/Cho、Cho/Cr较对照组无明显差异。结论:原发性单侧症状PD其症状的对侧壳核早期就可能存在神经元的缺失或胶质增生,提示壳核磁共振波谱分析可为早期PD的临床诊断提供较为可靠的客观依据。     

单侧颞叶癫病人双侧基底节区多体素MRS研究

目的采用多体素MRS探讨单侧颞叶癫(TLE)病人双侧基底节区代谢物改变。方法选取根据临床发作症状和脑电图综合诊断的左侧TLE病人10例,右侧TLE病人10例,正常志愿者10例纳入研究。所有TLE病人均进行利物浦性发作严重程度量表2.0(LSSS 2.0)评估,采用Simens 3.0 T超导MR设备进行多体素1H-MRS数据采集,对称性测量双侧尾状核头、豆状核和丘脑的N-乙酰天门冬氨酸(NAA)、乙酰胆碱(Cho)、肌酸(Cr)含量,计算各兴趣区NAA/Cr和Cho/Cr比值并进行统计学分析,将代谢物比值与LSSS 2.0评分进行Pearson相关分析。结果左侧TLE组双侧丘脑NAA/Cr比值分别为1.92±0.15(左)和2.02±0.26(右),右侧TLE组双侧丘脑NAA/Cr比值分别为2.19±0.16(左)和1.79±0.16(右),均明显低于对照组[2.37±0.14(左)和2.36±0.10(右),P0.05]。右侧TLE组,其致灶同侧丘脑的NAA/Cr比值较对侧丘脑要低(P0.05)。TLE组致灶同侧丘脑NAA/Cr比值与LSSS 2.0评分呈负相关(左侧r=-0.667;右侧r=-0.643,均P0.05)。结论单侧TLE病人存在双侧丘脑神经元丢失和/或功能障碍,且致灶同侧丘脑NAA/Cr比值与LSSS 2.0评分可以一致性反映近期性发作严重程度。     

急性CO中毒与正常人海马体1HMRS对照研究

目的:采用氢质子磁共振波谱成像(1 H-MRS)测量急性一氧化碳中毒(ACOP)患者与正常人海马区代谢物浓度(氮-乙酰天门冬氨酸NAA、胆碱Cho和肌酸Cr)并比较两组的差异.方法:所有受试者分为两组,ACOP组56例,平均年龄(48.9±10.9)岁;对照组27例,平均年龄(49.2±12.5)岁.所有病例均行两侧海马区MRS检查,记录两侧海马区NAA/Cr、Cho/Cr值,采用两个独立样本t检验比较对照组及ACOP组海马体部代谢物比值的差异.结果:ACOP组NAA/Cr值为1.014±0.683,对照组NAA/Cr值为1.697±0.711,差异有统计学意义(P=0.000).ACOP组Cho/Cr值为1.181±0.389,对照组Cho/Cr值为1.148±0.367,差异无统计学意义(P=0.602).结论:采用1 H-MRS可以准确反映ACOP患者海马区代谢物差异,为评估病情的严重性与早期诊断提供影像学支持.     

1H-MRS在原发性中枢神经系统淋巴瘤与高级别胶质瘤鉴别诊断中的价值

目的 探讨单体素不同回波时间(TE =30 ms/135 ms)和多体素长回波(TE=135 ms) MRS在原发性神经系统淋巴瘤(PCNSL)与高级别胶质瘤(HGG)鉴别诊断中的价值.方法 回顾性分析19例PCNSL(13例经病理证实,6例经诊断性治疗确诊)和22例HGG(均经病理证实)患者影像资料.19例PCNSL均行单体素短和长回波MRS检查,其中15例行多体素长回波MRS检查.22例HGG均行单体素短和长回波MRS及多体素长回波MRS检查.分析不同TE时间单体素MRS在瘤体中的不同代谢物相对比值,同时分析多体素长回波MRS在瘤体及瘤周中的不同代谢物相对比值.结果 单体素短回波MRS的Cho/Cr和NAA/Cr在PCNSL与HGG的鉴别诊断中差异均有统计学意义(P＜0.05);Cho/NAA和(Lac+ Lip)/Cr在两者的鉴别诊断中差异均无统计学意义(P＞0.05).单体素长回波MRS的Cho/Cr、NAA/Cr和Cho/NAA在两者的鉴别诊断中差异均有统计学意义(P＜0.05).多体素长回波MRS瘤体的Cho/Cr、NAA/Cr和Cho/NAA在两者的鉴别诊断中差异均无统计学意义(P＞0.05);瘤周的Cho/Cr、NAA/Cr和Cho/NAA在两者的鉴别诊断中差异均无统计学意义(P＞0.05).结论 单体素MRS代谢物是鉴别诊断PCNSL与HGG的有效指标,多体素长回波MRS鉴别诊断价值有限.     

脑小血管病丘脑的1H-MRS成像特点及其与认知功能相关性研究

目的 探讨脑小血管病(CSVD)患者丘脑的代谢变化特点,了解其与认知障碍间的关系.方法 采用蒙特利尔认知评估量表(MoCA)对34例CSVD患者和26例志愿者进行认知功能测评,通过单体素氢质子磁共振波谱(1H-MRS)技术对所有研究对象两侧丘脑N-乙酰基天门冬氨酸(NAA)、胆碱化合物(Cho)、磷酸肌酸(Cr)的含量进行检测,记录NAA/Cr、Cho/Cr比值.比较2组间两侧丘脑NAA/Cr、Cho/Cr比值的差异,并对CSVD组内两侧丘脑NAA/Cr、Cho/Cr比值与MoCA总评分及各子项评分进行相关性分析.结果 ①CSVD组MoCA总评分、视空间与执行能力、记忆、注意力、语言评分均低于对照组,差异有统计学意义(P<0.05);②CSVD组两侧丘脑NAA/Cr比值较对照组降低(左侧1.57±0.18、1.68±0.17、t=2.46、P=0.02;右侧1.66±0.21、1.78±0.19、t=2.23、P=0.03),差异有统计学意义(P<0.05);组间两侧丘脑Cho/Cr比值无明显差异(P>0.05);③CSVD组内,两侧丘脑NAA/Cr比值与MoCA总评分(左r=0.83,右r=0.79, P<0.05)、视空间与执行能力(左r=0.65,右r=0.46,P<0.05)、记忆(左r=0.59,右r=0.50, P<0.05)、注意力(左r=0.42,右r=0.52,P<0.05)、语言(左r=0.52,右r=0.41,P<0.05)、抽象(左r=0.47,右r=0.40,P<0.05)、定向力(左r=0.48,右r=0.42,P<0.05)评分均呈正相关(P<0.05),Cho/Cr比值与MoCA总评分及各子项评分无明显相关性(P>0.05).结论 CSVD患者丘脑存在神经元损伤或功能降低,这种代谢异常可能与患者广泛的认知损害相关.     

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.