光束均匀化后Nd:YAG激光对离体人前列腺组织的生物效应

目的 探讨光束均匀化后Nd:YAG激光对离体人前列腺实质的生物学效应及其降低激光治疗良性前列腺增生(BPH)复发率的可行性.方法 离体BPH标本30例,随机分为均匀化组和非均匀化组,各15例.均匀化组,Nd:YAG激光(波长0.53 μm,功率20 W,光斑直径3 mm)经过反射镜后照射BHP标本;非均匀化组Nd:YAG激光(功率15 W)直径照射BPH标本.照射后第20、40、60、80、100和120秒,测量照射点及相距1、2 mm处BPH标本表面温度.结果 激光光束进行均匀化处理之后,辐照区域内光子能量密度趋于均匀,从而使辐照区域的前列腺组织温度变化更加均匀.结论 光束均匀化后Nd:YAG激光对离体人前列腺的处理更彻底,有可能降低现有激光治疗BPH后的复发率.     

Nd：YAG激光照射对非酸蚀的充填材料与牙体窝洞界面密合度的影响

目的探讨Nd∶YAG激光照射对3种常用牙体充填材料与牙体窝洞界面密合度的影响.方法将牙体标本随机分为3组.每组设激光照射组和对照组,其中激光照射组依照射功率分2 W、3 W、8 W组,共计4小组,每组9颗牙.激光照射组在常规充填材料后,分别用不同功率的激光沿窝洞边缘作扫描式照射.常规制备电镜标本,扫描电镜观察.结果银汞合金组,随激光功率的提高,牙体窝洞与充填材料界面的缝隙宽度减小愈明显,功率达8 W时,可引起银汞合金与牙体组织的接触面融合.激光照射各组与对照组比较,差异均有非常显著意义(P＜0.01),激光照射各组之间比较,2W、3W组之间差异无显著意义(P＞0.01),但这二组与8 W之间差异有非常显著意义(P＜0.001).玻璃离子组、FX粉组中,激光功率不同,达到的效果不同.2 W可使缝隙减小,3 W可使牙体组织与充填材料在界面发生融合.8 W功率照射缝隙加大.激光照射2 W、3 W组与对照组比较,差异有非常显著意义(P＜0.01),激光照射组之间比较,2 W组与8 W组及3 W组与8 W组之间差异有非常显著意义(P＜0.001).结论适宜功率的Nd∶YAG激光照射,对减少非酸蚀的3种常用牙体充填材料与牙齿窝洞界面微渗漏可能是一种有效方法.     

脉冲CO2激光消融离体人乳突骨组织的特性

目的 探讨脉冲CO2激光对离体人乳突骨组织的消融阈值及热损伤.方法 脉冲CO2激光功率从1 W逐渐增大到12W,频率为60 Hz,光斑直径为1.40mm.定点照射离体人乳突骨,利用连续组织切片、光学显微镜扫描电镜等检查手段对消融弹坑形态特征及其周围热损伤深度进行测量.结果 实验获得消融弹坑深度及周围热损伤深度随激光能量密度的变化关系,并确定脉冲CO2激光对离体人乳突骨组织的消融阈值为1.98～2.60 J/cm2.结论 本研究为临床提供具有参考意义的光剂量学基础数据,促进激光消融技术在耳外科领域中的应用.     

Nd∶YAG激光照射对非酸蚀的充填材料与牙体窝洞界面密合度的影响

目的　探讨Nd∶YAG激光照射对 3种常用牙体充填材料与牙体窝洞界面密合度的影响。方法　将牙体标本随机分为 3组。每组设激光照射组和对照组 ,其中激光照射组依照射功率分 2W、3W、8W组 ,共计 4小组 ,每组 9颗牙。激光照射组在常规充填材料后 ,分别用不同功率的激光沿窝洞边缘作扫描式照射。常规制备电镜标本 ,扫描电镜观察。结果　银汞合金组 ,随激光功率的提高 ,牙体窝洞与充填材料界面的缝隙宽度减小愈明显 ,功率达 8W时 ,可引起银汞合金与牙体组织的接触面融合。激光照射各组与对照组比较 ,差异均有非常显著意义 (P <0 0 1) ,激光照射各组之间比较 ,2W、3W组之间差异无显著意义 (P >0 0 1) ,但这二组与 8W之间差异有非常显著意义 (P <0 0 0 1)。玻璃离子组、FX粉组中 ,激光功率不同 ,达到的效果不同。 2W可使缝隙减小 ,3W可使牙体组织与充填材料在界面发生融合。 8W功率照射缝隙加大。激光照射2W、3W组与对照组比较 ,差异有非常显著意义 (P <0 0 1) ,激光照射组之间比较 ,2W组与 8W组及 3W组与 8W组之间差异有非常显著意义 (P <0 0 0 1)。结论　适宜功率的Nd∶YAG激光照射 ,对减少非酸蚀的 3种常用牙体充填材料与牙齿窝洞界面微渗漏可能是一种有效方法。     

Er,Cr∶YSGG激光照射对牙本质小管封闭作用的实验研究

目的观察 Er,Cr∶YSGG 激光对牙本质小管的封闭作用,探讨此激光治疗牙本质过敏症的可行性及其作用机制. 方法人新鲜离体牙制备 1.5 mm厚的牙本质片 24张.经 37%磷酸凝胶处理 10 s,制成牙本质过敏模型.随机分为 6组,每组 4张.第 1组不做任何处理,作为对照组;第 2～ 6组于无水条件下行 Er,Cr∶YSGG 激光照射,输出功率分别为 1、2、3、4和 6 W,照射时间 6 s.常规制备标本,扫描电镜下观察牙本质表面的形态变化. 结果 Er,Cr∶YSGG 激光照射后,随着输出功率的增加,牙本质表面出现不同的变化 1 W激光照射后不能封闭牙本质小管; 2和 3 W 激光照射后可见小管管腔缩窄,部分小管封闭; 4和 6 W激光照射后牙本质表面出现熔融、炭化等热损伤改变,可见凹坑及裂纹. 结论功率为 2和 3 W Er,Cr∶YSGG 激光照射时可起到较为理想的封闭牙本质小管的作用.在临床上有望用于治疗牙本质过敏症.     

Nd:YAG激光去除根管内碎屑的实验研究

为解决去除根管壁玷污层的难题，应用扫描电镜观察Ｎｄ∶ＹＡＧ激光根管内照射后根管壁的清洁程度。实验选用离体牙１４颗，随机分为对照组和实验组。对照组进行常规根管预备，实验组在常规根管预备后，应用５０ｍＪ１５Ｈｚ能量设置的Ｎｄ∶ＹＡＧ激光进行根管内照射，冲洗干燥后，所有实验牙进行扫描电镜观察。观察到激光照射后，根管壁表面大部分区域无不规则碎屑，玷污层消失，牙本质小管暴露，呈熔岩状；某些部位可见熔岩状改变与不规则碎屑同时存在；少部分区域与对照组结构相似。结果表明：激光根管内照射可大部分去除玷污层，大大提高根管壁的清洁度，有利于提高根管治疗成功率。     

1.34 μm Nd∶YAP激光照射后兔颈总动脉的形态学研究

目的探讨1.34 μm Nd∶YAP激光照射后兔颈总动脉的病理学改变及激光能量密度与血管损伤程度的关系.方法普通级新西兰白兔32只,2只为对照,不行激光照射,余30只分为透射电镜A组,光镜B1、B2、B3、B4组,每组6只;预置激光输出功率分别为5、10、5、10和5 W,照射距离分别为5、10、5、5和2.5 min,照射时间设定2 s,光纤发散角θ=17°,非接触式点状照射一侧兔颈总动脉.照射后即刻、1、3、7、14和21 d分别取照射靶区的血管组织,进行光镜和透射电镜观察.结果激光照射后1～3 d,血管组织损伤主要表现为程度不同的凝固性改变,损伤程度与激光能量密度呈正相关,出现附壁性血栓,管壁弹力纤维断裂挤压或碎裂成块状,排列无序;照射后7 d,管壁增厚,纤维组织增生.结论 1.34 μm Nd∶YAP激光照射后,血管组织损伤主要表现为凝固性改变,组织损伤程度与能量密度密切相关.     

超声引导经皮Nd:YAG激光肝组织光凝固术的基础研究

作者等采用Nd：YAG激光以2～5W输出功率，照射5～20分钟，对离体猪肝、狗肝进行了体外光凝固实验，并在超声引导下对犬、小型猪肝脏进行了经皮穿刺组织间光凝固的在体实验。激光照射中实时监测了受照组织的温度变化及其范围，观察了超声影像与肝组织改变的对应关系，对比了激光照射能量与肝组织温度变化、热损伤程度的关系。实验结果表明，超声引导下经皮Nd：YAG激光肝肿瘤凝固术是可行的，并为进一步的临床研究提供了有参考价值的实验数据。     

Nd∶YAG激光间质内热毁损犬和猪肝脏的实验研究

目的研究影响激光热毁损区的各种因素,包括"激光汽化兼热杀癌肿瘤理论模型"已考虑的近似简化条件、以及未考虑的复杂或可变因素,为激光手术安全操作提供参考依据.方法由理论模型计算Nd∶YAG激光功率为7 W(波长1 064 nm)、汽化空腔直径(mm)为4.40、5.40、6.40、7.40时所需的照射时间.将Nd∶YAG激光裸光纤插入活体和离体犬肝、离体猪肝(增加8.40 mm数据点)定时照射.照射后即刻沿光纤剖开标本,测量激光热毁损区域的大小,作统计学相关对比分析,建立线性回归方程.结果理论模型对汽化空腔大小的数值模拟结果在4.40～7.40 mm范围内与实验数据基本符合.能用汽化空腔理论值进一步估计空腔外围瞬态凝固区域长短径的平均值.对空腔或凝固区长短径均值的Pearson积矩相关分析表明,活体与离体犬肝对比P<0.05,离体犬肝与离体猪肝对比P<0.01.汽化空腔的形状还与光纤末端侧面透光区长短、照射前初温、肝组织各向异性等有关.结论根据数学方法选择激光的功率和作用时间来实施激光间质内热毁损某一确定范围的肝肿瘤病灶是可行的.影响汽化空腔形状的复杂或可变因素有多种,临床应用中需加以注意和利用.     

1.34μm Nd：YAP激光照射后兔颈总动脉的形态学研究

目的　探讨 1 3 4μmNd∶YAP激光照射后兔颈总动脉的病理学改变及激光能量密度与血管损伤程度的关系。方法　普通级新西兰白兔 3 2只 ,2只为对照 ,不行激光照射 ,余 3 0只分为透射电镜A组 ,光镜B1、B2、B3、B4组 ,每组 6只 ;预置激光输出功率分别为 5、10、5、10和 5W ,照射距离分别为 5、10、5、5和 2 5min ,照射时间设定 2s,光纤发散角θ =17°,非接触式点状照射一侧兔颈总动脉。照射后即刻、1、3、7、14和 2 1d分别取照射靶区的血管组织 ,进行光镜和透射电镜观察。结果　激光照射后 1～ 3d ,血管组织损伤主要表现为程度不同的凝固性改变 ,损伤程度与激光能量密度呈正相关 ,出现附壁性血栓 ,管壁弹力纤维断裂挤压或碎裂成块状 ,排列无序 ;照射后 7d ,管壁增厚 ,纤维组织增生。结论　 1 3 4μmNd∶YAP激光照射后 ,血管组织损伤主要表现为凝固性改变 ,组织损伤程度与能量密度密切相关     

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.