运动训练对发育期大鼠反复惊厥所致认知损害的干预及机制研究

目的:探讨发育期大鼠青霉素点燃致反复惊厥发作对学习记忆能力远期影响及踏转轮运动训练的干预效果及机制。方法:56只21日龄(PD21,下同)健康雄性SD大鼠随机分为单纯对照组(CONT1)10只,对照加运动训练组(CONT2)10只,单纯惊厥组(EXP1)及惊厥加运动训练组(EXP2),其中后两组共36只,均采用腹腔注射(ip)青霉素(4.5×106U·kg-1·d-1)连续6天,以制备惊厥模型。两组对照组同时给予同等剂量的生理盐水腹腔注射。将制备成功的20只惊厥模型进行随机分组,其中EXP1组10只,EXP2组10只。四组SD大鼠分别于PD39-PD43、PD61-PD64进行两次Morris水迷宫测试以检测各组大鼠的学习、记忆能力,其间于PD49-PD54对CONT2组和EXP2组进行踏转轮运动训练;免疫组织化学染色观察海马各区谷氨酸受体2(GluR-2)表达情况。结果:①第一次水迷宫测试,四组间逃避潜伏期存在显著性差异(F=5.56,P0.01),且两惊厥组潜伏期均明显长于两对照组(P0.05);空间搜索实验中,两惊厥组穿越原平台所在位置的次数明显少于两对照组(P0.05);②第二次水迷宫测试,经过运动训练的EXP2组的潜伏期明显短于EXP1组(q=4.37,P0.05);两惊厥组穿越原平台所在位置的次数仍明显少于两对照组(P0.05),且EXP1组与EXP2组间无明显差异(P0.05);③两惊厥组海马齿状回及CA3区GluR2阳性表达率均明显低于两对照组(P0.05)。结论:发育期青霉素诱发反复长程惊厥能够对学习和记忆功能产生远期的损害,可能与海马GluR2表达下调有关。运动训练能够明显改善反复惊厥所致的学习能力损害,而对记忆能力效果较差,可能与海马GluR2表达上调有关。     

3-甲基腺嘌呤对大鼠新生期惊厥致神经行为损伤的干预

目的 探讨大鼠新生期反复惊厥急性期应用自噬抑制剂3-甲基腺嘌呤(3-MA)对惊厥所致神经行为损伤的干预作用及机制。方法 实验在苏州大学衰老与神经疾病实验室进行。日龄6d(P6,下同)的Sprague-Dawley大鼠45只随机(随机数字法)分成三组,每组15只,惊厥组在P6吸入三氟乙醚诱导惊厥发作,持续30 min,连续6d;对照组同样操作但不吸入三氟乙醚;3-MA组惊厥前腹腔注射3 -MA(总量2μL),同样方法吸入三氟乙醚诱导惊厥,方法同惊厥组。三组大鼠于P12进行游泳行为评分测试大鼠神经运动发育,P17进行旷场实验,P43～P49行Morris水迷宫测试大鼠学习记忆功能,于PS0取海马组织,采用免疫印迹技术(Western blot)检测抗凋亡基因Bcl-2及自噬标记蛋白Beclin1的表达。各组行为学指标和蛋白水平采用方差分析进行统计。结果 惊厥后各组大鼠游泳行为测评,各项评分惊厥组明显低于对照组及3-MA组(P＜0.01),旷场实验显示惊厥组延迟时间[(13.33±6.69)8]较对照组[(7.11±2.37)8]和3-MA组[(9.91±4.23)s]显著延长,差异具有统计学意义(F=4.39,P＜0.05);Morris水迷宫测试RS组第4、5天逃避潜伏期较对照组和3-MA组明显延长(P＜0.05)。惊厥组海马Bcl-2表达水平(0.587±0.139)较对照组(0.782±0.083)及3-MA组(0.799±0.163)显著降低,差异具有统计学意义(F=4.71,P＜0.05)。各组Beclin1的表达差异无统计学意义(F =0.27,P＞0.05)。结论 3-MA能显著改善大鼠惊厥后神经行为损伤,并可能与上调海马抗凋亡基因Bcl-2表达有关。     

运动训练对新生期惊厥大鼠学习能力和海马ZnT1表达的远期影响

目的：探讨新生期大鼠单次长程或反复惊厥对学习能力和海马锌离子转运体1（ZnT1）表达的远期影响及运动训练的干预作用。方法：生后6d（用P6表示）的SD大鼠随机分成3组各12只。单次惊厥组（SS组）和反复惊厥组（RS组）在P6吸入三氟乙醚诱导惊厥发作,持续30min,SS组诱导P1,RS组连续P6;对照组同样操作但不吸入三氟乙醚。3组大鼠分别于P27-31、P58～61、P80-82进行3次Morris水迷宫测试,检测学习和记忆功能;同时在PS1～56对SS组和RS组进行踏转轮训练,30min,每天1次,连续P6。P82时行脑组织切片观察ZnT1在海马的表达。结果：①逃避潜伏期：各组各次逃避潜伏期均有逐渐缩短趋势,其中第1次水迷宫测试RS组P1～4潜伏期明显高于对照组（P〈0．05）,第5次各组差异不明显;第2次水迷宫RS组P1～2潜伏期较对照组仍显著延长（P〈0．05）,P3差异无显著性意义;第3次测试各组间差异不明显。②ZnT1原位杂交：RS组ZnT1 mRNA在海马表达明显高于对照组和SS组（P〈0．01）。结论：新生期反复长程惊厥能够对学习功能产生远期损害;而单次长程惊厥对学习能力无明显影响。早期运动训练能够改善反复惊厥所致的学习能力损害,这可能与海马ZnT1表达上调有关。     

不同运动方式对快速老化小鼠学习记忆能力的影响

目的:探讨不同运动方式对快速老化小鼠(SAMP8)学习记忆能力的影响。方法:3月龄SAMP8和抗快速老化(SAMR1)小鼠各30只随机分为跑笼运动组、技巧运动组和对照组。运动2个月后采用Morris水迷宫实验、跳台实验进行学习记忆能力评测。结果:Morris水迷宫结果显示,5月龄SAMP8与SAMR1比较,潜伏期延长(P0.01),穿越平台次数减少(P0.05)。跑笼运动组和技巧运动组较对照组潜伏期缩短(P0.05),穿越平台次数增多(P0.05)。跳台实验结果显示,5月龄SAMP8与SAMR1比较,第1天反应时间延长(P0.01),错误次数差异无显著性意义(P0.05);跑笼运动组和技巧运动组较对照组反应时间缩短(P0.05),错误次数减少(P0.05)。跑笼运动组较技巧运动组错误次数减少显著(P0.05)。第2天5月龄SAMP8与SAMR1比较潜伏期差异无显著性意义(P0.05),错误次数显著增多(P0.01)。跑笼运动组和技巧运动组潜伏期较对照组延长(P0.05),技巧运动组较对照组错误次数减少(P0.05)。结论:两种运动方式均能改善SAMP8小鼠空间学习记忆能力。在改善SAMP8小鼠条件反射学习记忆能力上,跑笼运动改善学习能力优于技巧运动,技巧运动改善记忆能力优于跑笼运动。     

有氧运动干预对衰老大鼠学习记忆能力及小脑生长相关蛋白-43表达的影响

目的:探讨衰老过程中进行有氧运动干预对大鼠学习记忆能力及小脑神经生长相关蛋白-43(growth associated protein-43,GAP-43)表达的影响。方法:45只成年雄性SD大鼠随机分为生理盐水对照组(Na组,n=15)、有氧运动干预组(S组,n=15)和衰老对照组(N组,n=15)。S组进行6周的衰老造模同时进行有氧运动干预,N组大鼠进行6周的衰老造模,Na组大鼠注射6周的生理盐水进行对照实验。三组大鼠造模结束后分别进行7天的Morris水迷宫实验测试大鼠的学习记忆能力,Morris水迷宫结束后24h内取大鼠的小脑,利用实时PCR法检测小脑内GAP-43 mRNA表达水平,Western-blotting法检测小脑GAP-43蛋白含量。结果:Morris水迷宫定位航线实验当中:第2天和第1天相比,第3天和第2天相比,Na组、N组和S组大鼠平均潜伏期均缩短且存在显著性差异(P0.01);第4天和第3天相比,N组大鼠平均潜伏期存在显著性差异(P0.01),Na组和S组平均潜伏期无显著性差异(P0.05);第5天和第4天相比,第6天和第5天相比,Na组、N组和S组大鼠平均潜伏期无显著性差异(P0.05)。Morris水迷宫空间探索实验结果显示:Na组和S组穿越原平台位置次数多于N组且存在显著性差异(P0.01)。实时PCR实验和Western-blotting结果显示:Na组和S组大鼠小脑内GAP-43表达量皆高于N组大鼠且存在显著性差异(P0.01)。结论:在衰老过程中进行有氧运动干预在一定程度上可以促进脑衰老大鼠的学习记忆能力和小脑内GAP-43的表达,这可能是有氧运动延缓脑衰老学习记忆能力下降的分子机制之一。     

运动训练对发育期惊厥性脑损伤大鼠搜寻策略及大脑皮质可塑性相关分子-1表达的影响

目的 将发育期大鼠制成青霉素诱发反复惊厥模型,探讨运动训练对实验大鼠水迷宫搜寻策略和脑皮质可塑性相关分子PRG-1表达的远期影响。 方法 采用随机数字表法将出生21d（P21）的SD大鼠分为空白对照组、训练对照组、单纯惊厥组及惊厥训练组。采用青霉素腹腔注射将单纯惊厥组及惊厥训练组大鼠制成反复惊厥动物模型;空白对照组、训练对照组则给予等量生理盐水腹腔注射。各组大鼠分别于P39～P43、P61～P64期间进行Morris水迷宫策略分析,检测大鼠学习及记忆功能。P49～P54期间训练对照组及惊厥训练组大鼠给予踏转轮训练,每天训练1次,每次训练30min,连续训练6d。待Morris水迷宫测试结束后（P66）采用荧光定量RT-PCR法观察各组大鼠可塑性相关基因-1（PRG-1）在大脑皮质中的表达。 结果 ①搜寻策略：各组大鼠边缘式搜寻比例均呈逐渐减少趋势,而趋向式和直线式搜寻比例均呈逐渐增加趋势。Ridit秩和检验显示第1次Morris水迷宫实验两惊厥组第2天及第4天成绩均明显落后于两对照组（P<0.05）;第2次水迷宫实验发现惊厥训练组第2天以后成绩明显提高,第4天时训练对照组及惊厥训练组成绩均明显优于单纯惊厥组（P<0.05）。②记忆实验：对各组大鼠搜寻策略进行Ridit秩和检验,发现第1次水迷宫测试两惊厥组成绩均明显落后于两对照组（P<0.05）;第2次水迷宫测试单纯惊厥组搜寻策略明显落后于其它组（P<0.05）,而惊厥训练组成绩显著提高,与训练对照组无显著差异。③RT-PCR：训练对照组、单纯惊厥组、惊厥训练组PRG-1表达均明显高于空白对照组（P<0.05）;此外惊厥训练组PRG-1表达较单纯惊厥组有降低趋势,但差异无统计学意义（P>0.05）。 结论 运动训练能显著改善发育期反复长程惊厥所致认知损伤,其治疗机制可能与调节脑皮质PRG-1表达有关。     

移植神经干细胞对血管性痴呆大鼠的行为学效应

目的:移植神经干细胞于血管性痴呆(vasculardementia,VD)大鼠海马,研究移植后大鼠的行为学疗效。方法:实验于2002-09/2003-12在解放军南京军区福州总医院实验动物中心进行。①利用无血清培养和单细胞克隆技术从新生大鼠脊髓分离具有单细胞克隆能力的细胞群并连续传代培养,获得大量克隆细胞。②永久性结扎大鼠双侧颈总动脉法建立VD模型,结扎后饲养30d,以Morris水迷宫定位航行试验和空间探索试验来检测大鼠的空间记忆能力。③利用脑立体定位技术将5-溴-2'-脱氧尿苷(BrdU)标记后的神经干细胞移植入VD大鼠海马内,饲养8周后以Morris水迷宫来检测大鼠的空间记忆能力。结果:神经干细胞移植后8周,假手术组平均逃避潜伏期为(25.61±3.21)s,痴呆组的平均逃避潜伏期为(53.42±8.26)s,两组比较差异有显著性意义(F=7.82,P<0.01),移植组平均逃避潜伏期(36.93±6.24)s,两组比较差异有显著性意义(F=8.23,P<0.01),移植组平均逃避潜伏期与假手术组相比差异无显著性意义(F=5.77,P>0.05)。痴呆组、移植组及假手术组大鼠在平台象限的平均滞留时间分别为(8.21±2.90),(11.82±3.08),(13.48±3.35)s,痴呆组、移植组比较差异有显著性意义(F=9.76,P<0.01),痴呆组、假手术组比较差异有显著性意义(F=10.21,P<0.01),假手术组、移植组     

运动训练对血管性痴呆大鼠认知障碍及长时程增强的影响

目的：探讨运动训练对大鼠空间学习、记忆能力和长时程增强（LTP）的影响。方法：选用Wistar雄性大鼠随机分成对照组5只，血管性痴呆组10只，血管性痴呆＋运动训练组10只。用电生理学方法检测在体海马CAI区LTP。用Morris水迷宫评价大鼠学习记忆能力。结果：血管性痴呆组大鼠水迷宫逃避潜伏期明显延长．血管性痴呆＋运动训练组大鼠较血管性痴呆组大鼠水迷宫隐匿平台逃避潜伏期缩短，但仍长于对照组（P〈0．05）。血管性痴呆组大鼠LTP诱导明显受到抑制，血管性痴呆＋运动训练组大鼠较血管性痴呆组大鼠LTP诱导明显改善．但仍比对照组差（P〈0．05）。结论：血管性痴呆大鼠学习记忆能力降低，LTP诱导障碍，运动训练可提高大鼠空间学习、记忆能力，增强LTP的形成．     

反复热性惊厥对大鼠行为运动及空间学习记忆的影响

背景热性惊厥脑损伤已经引起关注,但热性惊厥对行为运动及学习记忆影响的研究也是十分重要的.目的探讨热性惊厥对大鼠行为运动及空间学习记忆能力的影响.设计随机对照的实验研究.地点和材料实验在西安交通大学医学院实验动物中心完成.实验选用21日龄雄性SD大鼠60只,按随机数字法均分为热性惊厥组、发热对照组及正常对照组.干预45℃热水浴建立热性惊厥动物模型,定时浸浴2 min设立发热对照组.通过斜板试验、悬吊试验、旷场活动试验及Morris水迷宫检测大鼠行为运动及空间学习记忆能力变化.主要观察指标各组大鼠转体时间、悬吊时间、旷场活动性、逃逸潜伏期及搜寻策略比较.结果多次热性惊厥发作可使大鼠在斜板试验[热性惊厥组为(9.15±2.63)s,发热对照组为(5.32±2.11)s,正常对照组为(5.29±2.04)s,热性惊厥组和其他两组比较,差异有显著性意义(F=6.17,P＜0.01)],悬吊试验[热性惊厥组为(33.4±18.1)s,发热对照组为(50.1±20.3)s,正常对照组为(59.0±20.7)s,热性惊厥组与其他两组比较,差异在显著性意义(F=8.23,P＜0.01)],旷场活动试验[热性惊厥组为(5.07±2.04)分,发热对照组为(10.37±2.98)分,正常对照组为(13.22±2.26)分,热性惊厥组与其他两组比较,差异在显著性意义(F=7.42,P＜0.01)]中行为运动能力下降.在Morris水迷宫试验中,热性惊厥组逃逸潜伏期延长,平台所在区域内的游泳时间百分比降低以及穿过平台面积的次数减少.结论热性惊厥发作可损害大鼠的行为运动和空间学习记忆能力.     

运动训练对局灶性脑缺血大鼠学习记忆能力及弥散张量成像的影响

目的探讨运动训练对局灶性脑缺血大鼠学习记忆能力的影响,并运用弥散张量成像(DTI)参数分析运动训练后大鼠脑组织结构的变化。方法 24只SPF级雄性Sprague-Dawley大鼠随机分为假手术组(n=8)、自然恢复组(n=8)和运动训练组(n=8)。后两组根据Longa改良线拴法制备大鼠左侧大脑中动脉闭塞(MCAO)模型。运动训练组于术后24 h进行跑轮训练,共14 d。所有大鼠术后第15天进行Morris水迷宫测试。记录定位航行实验中三组大鼠到达平台的潜伏期,空间探索实验中三组大鼠第1次到达平台所在位置的潜伏期、边界时间百分比、边界距离百分比、平均速度及游泳路径。各组选取Longa评分相近的4只大鼠进行磁共振DTI扫描,测量脑缺血皮质及海马区域及对侧相应区域的部分各向异性(FA)、轴向扩散系数(λ‖)和径向扩散系数(λ⊥)。结果定位航行实验中,三组大鼠的潜伏期均随训练天数的增加呈下降趋势(P0.05)。自然恢复组大鼠各时间点潜伏期均大于假手术组(P0.05);运动训练组大鼠前3 d潜伏期大于假手术组(P0.05),第4、5天潜伏期与假手术组无显著性差异(P0.05),且小于自然恢复组(P0.05)。空间探索实验中,自然恢复组大鼠潜伏期、边界时间百分比及边界距离百分比均明显大于假手术组(Z2.627,P0.01),边界时间百分比及边界距离百分比大于运动训练组(Z2.521,P0.05)。三组大鼠平均速度无显著性差异(P0.05)。运动训练组和假手术组的游泳路径更优。假手术组大鼠左侧皮质感兴趣区FA及相对FA(r FA)均高于运动训练组和自然恢复组(P0.05),运动训练组大鼠左侧皮质感兴趣区FA及r FA稍高于自然恢复组,但无显著性差异(P0.05)。三组大鼠右侧大脑皮质感兴趣区FA无显著性差异(F=0.532,P=0.607)。假手术组大鼠左侧皮质感兴趣区λ⊥和λ‖及相对λ‖(rλ‖)和相对λ⊥(rλ⊥)均低于自然恢复组(P0.05)。运动训练组大鼠左侧皮质感兴趣区λ⊥和λ‖及rλ‖和rλ⊥与自然恢复组及假手术组相比均无显著性差异(P0.05)。三组大鼠右侧大脑皮质感兴趣区λ⊥和λ‖均无显著性差异(F1.030,P0.05)。三组大鼠双侧海马感兴趣区FA、λ‖及λ⊥及相对值均无显著性差异(F1.845,P0.05)。皮质感兴趣区r FA、rλ‖、rλ⊥及左侧λ⊥与空间探索实验中潜伏期相关(P0.05),其中rλ⊥与潜伏期相关性较高(r=0.761,P0.01)。结论适当的运动训练可改善局灶性脑缺血大鼠学习记忆能力,并可促进其皮质缺血区神经纤维损伤修复和减轻血管源性水肿。DTI参数中,皮质的r FA、rλ‖、rλ⊥及患侧皮质区λ⊥可能是大鼠局灶性脑缺血后认知功能恢复的有效预测指标,其中rλ⊥的预测价值更高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.