局部注射99Tcm(V)-DMSA检测口腔癌颈淋巴结转移

目的探讨局部注射正五价^99 Tc^m标记的二巯基丁二酸[^99 Tc^m（V）-DMSA]检测口腔癌颈部淋巴结转移灶的可行性，为制定合理的口腔癌颈淋巴清扫术式提供参考。方法原发口腔鳞状细胞癌患者30例，癌周分点注射^99 Tc^m（V）．DMSA，行头颈部断层和平面显像，寻找异常放射性浓聚区域，以ROI技术分析，将结果和术后病理检查结果比较。结果局部注射^99 Tc^m（V）．DMSA检测颈部淋巴结转移灶的灵敏度为84．6％（11／13），特异性为82．4％（14／17），准确性为83．3％（25／30）。结论癌周局部注射^99 Tc^m（V）-DMSA检测口腔癌颈淋巴结转移的灵敏度高，准确性好，操作简便。     

^99mTc（V）—DMSA骨显像诊断骨转移瘤的临床价值

目的：评价99mTc（V）－DMSA显像在骨转移瘤诊断中的意义。材料和方法：对91例疑骨转移瘤患者行99mTc（V）DMSA全身显像，并与99mTc-MDP全身骨显像及其它检查对比。结果：74例证实存在骨转移瘤者，99mTc．MDP骨显像均显示异常放射性浓聚，99mTc（V）-DMSA显像72例显示了与99mTc-MDP显像某些相同部位的放射性浓聚，2例99mTc（V）DMSA显像阴性。17例骨良性病变，99mTc－MDP骨显像显示轻度异常放射性浓聚，而99mTc（V）-DMSA显像却未见异常的放射性浓聚。结论：99mTc（V）－DMSA诊断骨转移瘤的特异性比99mTc-MDP骨显像高，在骨良恶性肿瘤鉴别诊断中具有重要的临床价值。     

MRI对高强度聚焦超声治疗骨肉瘤疗效的随访

目的评估MRI对高强度聚焦超声(high intensity focused ultrasound，HIFU)治疗骨肉瘤疗效随访的价值。方法前瞻性分析了经病理证实的16例骨肉瘤在HIFU治疗前后的MR平扫和多时相动态增强表现与诊断，并与^99m锝-亚甲基二磷酸盐(^99mTc-MDP)静态骨显像对照。结果MRI可正确判断14例骨肉瘤在HIFU治疗后的疗效。HIFU治疗前，16例骨肉瘤在T1WI上呈低信号、T2WI为混杂高信号，多时相动态扫描各期明显强化^99mTc—MDP骨显像显示瘤灶放射性异常浓聚。HIFU治疗后1～4周，瘤灶在T1WI上呈稍高信号、多时相动态扫描各期无强化、灭活区边缘见1条薄的强化带；^99mTc-MDP骨显像显示瘤灶的放射性异常浓聚消失。HIFU治疗后3～25个月，瘤灶逐渐缩小，T1WI上的信号缓慢下降。结论HIFU是一种有效局部治疗骨肉瘤的方法，MRI能准确评估HIFU治疗骨肉瘤的疗效。     

99Tcm标重组H-Annexin Ⅴ在动物血栓显像中的研究

目的 评价人膜联蛋白V（H—Annexin V）对血栓的亲和性，对^99Tc^m直接标记H—Annexin V与通过联肼尼克酰胺（HYNIC）螫合标记AnnexinV进行比较。方法 在3种不同的反应条件下，分别用^99Tc^m of直接标记AnnexinV、H—AnnexinV及HYNIC—AnnexinV，然后测定标记率、稳定性及对兔股动脉血栓模型进行γ显像，比较损伤侧（T，血栓）及对侧（NT）的放射性比值。结果 在还原剂足量的情况下，^99Tc^mO4^-直接标记H—Annexin V方法简便，反应条件易于控制，^99Tc^m-H—Annexin V标记率达95％以上，17h后测放化纯仍〉80％，血栓显像示动脉损伤处有明显的放射性浓聚，损伤处平均放射性计数为健侧放射性计数的3．714倍。结论 ^99Tc^m-H—AnnexinV与血栓具有很好的亲和力，标记率及稳定性高，标记方法较为简单。     

99Tcm-MDP SPECT/CT骨显像诊断恶性肿瘤骨转移的价值

目的探讨^99Tc^m-亚甲基二膦酸盐（MDP）SPECT／CT骨显像诊断恶性肿瘤骨转移的临床价值。方法73例恶性肿瘤或不明原因骨痛患者行^99Tc^m-MDP SPECT／CT全身骨平面和局部显像。获得全身骨平面、SPECT断层和CT图像及SPECT与CT融合图像后，结合病史、临床表现进行回顾性分析。结果SPECT／CT骨显像可提供精确的解剖定位，发现脊柱（31处）、肋骨（11处）、胸骨（4处）、锁骨（3处）、肩胛骨（1处）、骶骨（1处）、坐骨（3处）、骶髂关节（1处）和骨外（20处）有异常放射性浓聚灶。骨骼病变的性质与病灶部位有关，如病变累及椎体和（或）椎弓根，常提示肿瘤骨转移；累及椎小关节或椎体，呈“唇样”放射性浓聚，可考虑为良性病变。若平面显像呈“热区”，CT图像表现正常者，可考虑肿瘤骨转移。结论SPECT／CT骨显像诊断骨转移灶有较高临床价值。     

脑灌注显像剂99Tcm-MPBDA的研制与动物实验

目的 研制一种新的SPECT脑灌注显像剂。方法 将化学合成的N2S三齿配体2－巯基丙基－1,2－苯二胺（MPBDA）用^99Tc^m标记：25只昆明种小白鼠静脉注射100μL555-740kBq^99Tc^m-MPBDA进行体内生物分布实验;2只健康恒河猴（4－6kg)静脉快速注入218．3－333MBq^99Tc^mMPBDA或^99Tc^m双半胱乙脂（ECD）后分别即刻连续动态采集和给药后70min行全身显像和脑断层显像;2组小鼠和3只家兔分别进行了急性毒理和热原实验。结果 ^99Tc^m－MPBDA的产率和放化纯度分别大于95％和97％。小鼠体内分布实验结果表明^99Tc^m－MPBDA能在脑内浓聚并具有很好的脑滞留,血清除半衰期小于15min。猴脑动态血流灌注显像示注药后2min脑放射性达高峰,1h脑放射性占2min的83．0％,70min后入脑量高达2．76％ID,略低于^99Tc^m－ECD（2．9％ID）。断层显像可见大脑灰白质对比度好,影像轮廓较清晰。小鼠和兔子注射^99Tc^m－MPBDA后均无毒副反应。结论 研制的^99Tc^m－MPBDA具有^99Tc^m－ECD相近的脑血流灌注显像性能,用于活体安全可靠。     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

SPECT/CT融合显像对乳腺癌骨转移的诊断价值

目的 评价SPECT/CT融合显像对^99Tc^m-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值.方法 对^99Tc^m-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异.结果 ①210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个（39.0％）,良性病灶112个（53.3％）,诊断准确率为92.4％（194/210）,灵敏度为94.3％,特异度为91.1％,阳性预测值为88.2％,阴性预测值为95.7％.②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9％（94/97）,肋骨最低,为83.7％（36/43）,其差异有统计学意义（χ^2=7.81,P＜0.05）.结论 SPECT/CT同机融合显像能够对^99Tc^m-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低.     

强直性脊柱炎核素关节显像

目的 探讨^99Tc^m-人免疫球蛋白（HIgG)与99Tc^m-亚甲基二膦酸盐（MDP）关节显像在强直性脊柱炎（AS）中的应用价值。方法 对经确诊的21例AS和18例活动期类风湿关节炎（RA）患者行^99Tc^m-HIgG全身显像，其中12例AS患者行^99Tc^m-MDP显像。结果 ①21例AS患者中20例^99Tc^m-HIgG显像示骶髂关节异常放射性增高；44个有临床症状或体征的外周关节中，32个显像异常，临床符合率75％，无一例累及手部小关节。②18例活动期RA患者^99Tcm-HIgG显像均有手部关节的异常改变，无一例累及骶髂关节。③12例AS患者^99Tc^m-HIgG与^99Tc^m-MDP显像比较显示：前者有11例骶髂关节异常放射性分布增高，而后者显像异常仅7例。31个临床累及的外周关节中，^99Tc^m-HIgG显像阳性24个，^99Tc^m-MDP显像异常16个，与临床符合率分别为77．4％和51．6％，差异有显著性（P＜0．025）。结论 ^99Tc^m-HIgG显像能较^99Tc^m-MDP显像更为准确地探测AS患者病变关节的炎症改变，帮助临床早期明确诊断。     

10例颅内原发性恶性淋巴瘤18F-FDGPET显像及与MRI比较

目的 分析颅内原发性恶性淋巴瘤（IPML）^18F—FDG PET显像特征。方法 IPML10例，胶质母细胞瘤加例，脑转移瘤15例。分析各自的^18F—FDG PET显像，总结IPML病灶的分布、代谢特点以及病灶周围组织的^18F—FDG分布，计算并比较各组的肿瘤灶／对侧相应部位（T／CCR）放射性比值和肿瘤灶周围皮质／对侧相应部位皮质（TSC／CCRC）放射性比值。结果 10例IPML包括6例单病灶和4例多病灶，单病灶分布于皮质表面，多病灶多分布于脑中线和脑室周围。与对侧相应部位比较，9例病灶呈团块状^18F—FDG摄取明显增高，1例呈环形^18F—FDG浓聚。高代谢灶周围的皮质呈轻度或中度代谢减低；位于基底节和丘脑区域病灶周围未见代谢减低区。与胶质母细胞瘤和脑转移瘤比较，IPML对^18F—FDG摄取程度高于胶质母细胞瘤（P〈0．05），明显高于脑转移瘤（P〈0．01）。IPML病灶周围皮质对^18F—FDG摄取减低程度低于脑转移瘤（P〈0．05），明显低于胶质母细胞瘤（P〈0．01）。结论 IPML病灶呈明显代谢增高，对^18F—FDG摄取程度高于胶质母细胞瘤和脑转移瘤，病灶周围皮质对^18F—FDG摄取减低程度低于胶质母细胞瘤和脑转移瘤。     

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.