基于超声联合血清学指标的列线图模型早期预测乳腺癌术后化疗患者心脏毒性风险

目的应用列线图探讨超声联合血清学指标早期预测乳腺癌术后化疗患者的心脏毒性。方法前瞻性选取在我院乳腺外科经术后病理确诊的乳腺癌女性患者148例,所有患者均于术后2周接受化疗,根据化疗1年后是否发生左室射血分数(LVEF)下降超过10%,将患者分为毒性组与无毒性组。比较两组患者化疗前与化疗3周期常规超声心动图指标、血清学指标及二维斑点追踪(2D-STI)指标差值的差异。采用多因素COX回归筛选预测心脏毒性的指标并建立列线图预测患者出现心脏毒性的概率。绘制受试者工作特征(ROC)曲线分析各指标评估术后早期心脏毒性风险的价值。结果共随访148例患者,失访2例,余146例患者纳入研究,其中毒性组18例,无毒性组128例。多因素COX回归显示化疗前与化疗3周期高敏感性心肌肌钙蛋白I差值(Δhs-cTnI)、N末端B型利钠肽前体差值(ΔNT-proBNP)和整体纵向峰值应变差值(ΔGLS)是预测乳腺癌术后化疗患者心脏毒性的独立风险指标(HR=1.030、1.003、1.853,均P0.05)。基于Δhs-cTnI、ΔNT-proBNP和ΔGLS建立的列线图提示患者心脏毒性风险方面具有良好的辨别力(C-index=0.904)和校准度(χ~2=8.170,P=0.417,Hosmer-Lemeshow检验)。ROC曲线分析结果显示,列线图预测患者发生心脏毒性风险的曲线下面积最高,为0.904。结论ΔGLS联合Δhs-cTnI、ΔNT-proBNP绘制的列线图有助于早期评估乳腺癌术后化疗患者发生心脏毒性的风险。     

实时三维斑点追踪成像对乳腺癌化疗患者心脏毒性的早期预测价值分析

目的:探讨实时三维斑点追踪成像(RT3D-STI)对乳腺癌化疗患者心脏毒性的预测价值。方法:选取2016年1月—2019年4月本院住院并拟行术后化疗的120例乳腺癌术后患者作为研究组,所有患者均采取6个周期的AC化疗。从同期于本院进行体检的健康女性中随机选取120例作为对照组。研究组患者于化疗前、化疗3个周期后和化疗6个周期后的48 h内进行常规超声心动图及RT3D-STI监测。对照组均于签署知情同意书后接受常规超声心动图及RT3D-STI监测。比较对照组和研究组化疗前、化疗3个周期和6个周期的48 h内的超声心动图及RT3D-STI检查结果。Pearson相关法分析常规超声、RT3DSTI与药物剂量的相关性,绘制RT3D-STI预测蒽环类化疗患者心脏毒性的ROC曲线。结果:研究组化疗6个周期的Em、Em/Am低于化疗前、化疗3个周期和对照组(P<0.05)。对照组和研究组患者不同时间点的GRS、GCS、3D-LVEF的差异无统计学意义(P>0.05)。研究组患者化疗3个周期的GAS、GLS、LVtw、MCI低于化疗前、对照组(P<0.05);研究组化疗6个周期的GAS、GLS、LVtw、MCI低于化疗前、化疗3个周期、对照组(P<0.05)。Em和Em/Am与药物剂量无明显相关(P>0.05),GAS、GLS、LVtw、MCI与药物剂量呈负相关(P<0.05)。120例患者随访期间共22例(18.33%)患者出现心脏毒性。根据患者1年随访结果(出现心脏毒性=1、未出现心脏毒性=0)绘制RT3D-STI参数预测乳腺癌化疗患者心脏毒性的ROC曲线,结果显示MCI预测心脏毒性的ROC曲线下面积为0.864(95%CI:0.773~0.971),当截断值为-197.28时,敏感度和特异度分别为0.859、0.781;LVtw为0.842(95%CI:0.723~0.962),当截断值为10.87时,敏感度和特异度分别为0.828、0.797;GAS的ROC曲线下面积为0.804(95%CI:0.670~0.938),当截断值为-32.62时,敏感度和特异度分别为0.781、0.844;GLS的ROC曲线下面积为0.722(95%CI:0.562~0.883),当截断值为-16.76时,敏感度和特异度分别为0.734、0.875。结论:乳腺癌患者化疗期间积极检测RT3D-STI参数可早期预测蒽环类药物所致心脏毒性的发生风险,且是无创性检查,重复性高。     

复方丹参滴丸对乳腺癌化放疗心脏毒性的保护

乳腺癌已成为目前女性最常见的恶性肿瘤之一，对于Ⅱ、Ⅲ期的患者术后均需接受化疗，Ⅱ期中腋窝淋巴结≥4个的患者及Ⅲ期患者还需接受术后锁骨上区、胸壁的放疗。无论是术后化疗还是放疗对心脏均有一定的毒副作用，尤其是左侧乳腺癌接受术后放疗后，更易导致心脏毒性的出现。复方丹参滴丸能活血化瘀，改善心脏缺血。肌酸激酶同工酶（CK-MB）能否作为衡量心肌化放疗损伤的血清学指标尚不清楚。本研究观察复方丹参滴丸对左侧乳腺癌患者术后接受化放疗心脏毒性的保护作用，报道如下。     

乳腺癌术后蒽环类药物化疗致心脏毒性的早期监测

目的监测乳腺癌术后患者采用蒽环类药物化疗前、后心功能(心电图、超声心动图)及心脏生化标记物[B型利钠肽(BNP)、肌钙蛋白I(cTnI)]水平的变化,评价其对乳腺癌术后患者蒽环类药物化疗所致早期心脏毒性监测的临床价值。方法收集2014年12月至2016年12月就诊于宁夏医科大学总医院肿瘤医院的191例女性乳腺癌患者,术后均给予蒽环类药物化疗。所有患者均于化疗前及化疗1、4周期后行心电图、超声心动图检查及血清BNP及cTnI水平检测。对所得结果进行详细分析。结果191例乳腺癌术后患者蒽环类药物化疗1、4周期后的心电图异常发生率分别为32.46%、39.79%,比较常见的心电图异常为ST-T改变、窦性心动过缓/过速。乳腺癌术后患者应用蒽环类药物化疗前及化疗1、4周期后的E/A比值呈进行性降低,血清BNP水平呈进行性升高(P<0.01),而血清cTnI水平比较,差异无统计学意义(P>0.05)。结论心电图、超声心动图中E/A比值及血清BNP水平可以作为乳腺癌术后患者蒽环类药物化疗所致近期心脏毒性的监测指标,而cTnI能否作为发现早期心脏毒性的指标,需增加样本采集时间及扩大临床病例数进一步观察验证。     

斑点追踪技术检测乳腺癌术后化疗药物对心肌的毒性作用

目的 采用斑点追踪成像技术（STE）检测心肌应变及心脏扭转获得心肌综合指数（MCI）,探讨其对乳腺癌术后蒽环类药物化疗患者心肌毒性的临床检测价值。方法 选择2012年2月至2013年2月在同济大学附属东方医院肿瘤科就诊的33例女性乳腺癌术后辅助化疗患者纳入研究,并选择36名健康女性志愿者作为健康对照组。分别采集受试者在不同时点的常规超声心动图指标：左心室舒张末容积（EDV）、收缩末容积（ESV）、室间隔厚度（IVSTd）、左心室后壁厚度（PWTd）和左心室射血分数（LVEF）,并用体表面积标化获得左心室舒张末容积指数（EDVI）、左心室收缩期末容积指数（ESVI）。采用STE技术获得左心室整体纵向应变（GLS）、整体径向应变（GRS）、左心室旋转角度（LVtw）和MCI。利用受试者操作特性（ROC）曲线分析各指标对乳腺癌患者化疗后心脏毒性的临床价值。结果 化疗组患者在完整5个化疗周期结束后同化疗前基础状态和健康对照组比较发现：（1）三组间的常规超声心动图参数EDV、ESV、IVSTd、PWTd和LVEF比较,差异无统计学意义（F=1.35、2.04、1.28、2.34、2.16,P均＞0.05）,而三组间的ESVI和EDVI比较,差异有统计学意义（F=4.73、6.86,P均＜0.05）;（2）化疗组患者在完整5个化疗周期结束后ESVI和EDVI较化疗前基础状态和健康对照组减低,差异有统计学意义（同化疗前基础状态比较：t=6.10、5.13,同对照组比较：t=5.26、4.24,P均＜0.05）;（3）三组间的GRS比较,差异无统计学意义（F=1.23,P＞0.05）,而三组间的GLS、LVtw和MCI比较,差异有统计学意义（F=4.29、5.02、12.35,P均＜0.05）;（4）化疗组患者在完整5个化疗周期结束后GLS、LVtw和MCI均较化疗前基础状态和健康对照组减低,差异有统计学意义（同化疗前基础状态比较：t=5.33、13.94,同健康对照组比较：t=4.97、4.46、7.18,P均＜0.05）;（5）MCI曲线下面积为0.894,MCI以-265.7（%×度）为乳腺癌化疗患者的截断值时,其敏感度为82.6%,特异度为78.7%。结论 采用STE技术检测乳腺癌化疗患者所获得的MCI,将心肌应变和心脏扭转结合起来,对早期检测化疗药物的心脏毒性作用具有较高的临床参考价值。     

术前静脉期CT影像组学列线图预测喉鳞癌患者预后

目的：研究增强CT影像组学术前预测喉鳞癌术后复发的价值。方法：收集本院64例经术后病理证实为喉鳞癌的患者作为训练组;将TCGA数据库中下载的39例患者作为验证组,基于患者术前CT增强静脉期图像,利用3D-slicer软件提取喉鳞癌全域影像组学特征。在训练组中,应用单因素COX及LASSO回归确定复发相关的最佳组学特征,构建影像组学风险评分对喉鳞癌患者预后分层;基于多因素COX回归构建预测1年、3年无进展生存的列线图。采用受试者工作特征曲线（ROC）评估影像组学风险评分的诊断效能。最后采用相同阈值对验证组患者进行模型验证。结果：训练组确定4个影像组学特征与复发显著相关,构建影像组学评分模型,Kaplan-Meier曲线显示训练组和验证组低风险组（组学评分<0.7）无进展生存时间均显著长于高风险组（P<0.001,P=0.025）。多因素COX回归研究表明影像组学评分是喉鳞癌术后复发的独立危险因素。在训练组中列线图预测喉鳞癌患者三年术后无进展生存C指数为0.816,影像组学模型C指数为0.795。在验证组中列线图C指数为0.858,影像组学模型C指数为0.795。结论：基于术前...     

斑点追踪应变成像评价乳腺癌曲妥珠单抗化疗相关早期亚临床心脏毒性的价值

目的 应用二维斑点追踪成像（2D-STI）技术评估乳腺癌患者曲妥珠单抗化疗相关的左心室和右心室收缩功能的早期改变,探究其在评价化疗相关早期亚临床心脏毒性中的应用价值。 方法 回顾性分析我院确诊有明显病例分型并接受曲妥珠单抗化疗的乳腺癌患者89例,共3个化疗周期,一个化疗周期为3周。于化疗前基线水平（T0）、3个化疗周期（T1、T2、T3）分别行一次超声心动图检查,测量左心室和右心室常规超声参数,应用2D-STI测量左心室和右心室整体纵向峰值应变（LVGLS和RVGLS）。心脏毒性定义为左心室射血分数下降,且低于基线水平的10%。以化疗过程中出现心脏毒性为临床结局,应用Logistic回归和ROC曲线分析T1期各参数对化疗相关的早期亚临床心脏毒性的预测价值。结果22例（24.7%）患者在化疗周期中出现心脏毒性（心脏毒性组）,67例（75.3%）未发生心脏毒性（无心脏毒性组）。发生心脏毒性的患者,其T2期LVEF低于基线水平的18%,而LVGLS和RVGLS于T1期、T2期均显著低于基线水平。ROC曲线和Logistic回归分析表明T1期的RVGLS联合LVGLS是预测乳腺癌化疗相关早期亚临床心脏毒性的最佳指标,其诊断敏感性为98%,特异性为75%。结论 无明显左室射血分数降低的曲妥珠单抗化疗乳腺癌患者,其T1期LVGLS和RVGLS已经发生减低,2D-STI技术有助于早期发现化疗相关的亚临床心脏毒性。     

乳腺癌剪切波弹性成像与常规超声特征预测腋窝淋巴结转移及模型建立

目的 探讨乳腺癌原发灶剪切波弹性成像(SWE)定量参数和常规超声特征对腋窝淋巴结转移(ALNM)的预测价值,并与腋窝超声相结合构建术前列线图模型。方法 选取术前行SWE和常规超声检查的乳腺癌患者295例。回顾性分析原发灶及腋窝淋巴结超声特征,筛选与ALNM相关的独立危险因素,在此基础上构建列线图模型并评估预测价值。结果 乳腺癌原发灶边缘不光整、E_max及超声诊断ALNM阳性是预测ALNM的独立危险因素。在此基础上构建的列线图模型的曲线下面积(AUC)为0.842(95%CI:0.786～0.888),预测效能均优于单一指标,差异有统计学意义(P<0.05)。结论 乳腺癌原发灶SWE定量参数和常规超声特征可用于预测ALNM,与腋窝超声相结合构建的列线图模型在预测ALNM方面具有良好的价值。     

超声特征联合免疫组化构建列线图预测早期乳腺癌前哨淋巴结转移

目的 探讨联合原发病灶的超声特征及免疫组化指标构建列线图预测早期乳腺癌前哨淋巴结转移(SLNM)的临床意义.方法 回顾性纳入577例早期乳腺癌患者作为训练组及内部验证组,纳入183例早期乳腺癌患者作为外部验证组.分析原发灶超声特征及免疫组化特征,筛选预测早期乳腺癌SLNM的独立预测变量,基于上述独立预测变量绘制列线图,...     

基于多模态超声参数的列线图预测乳腺癌新辅助化疗后腋窝淋巴结病理完全缓解的价值

目的 基于多模态超声定量参数构建预测乳腺癌新辅助化疗(NAC)后腋窝淋巴结病理完全缓解(pCR)的列线图模型,探讨其临床应用价值。方法 选取在我院行NAC的乳腺癌患者150例,依据腋窝淋巴结是否pCR分为pCR组43例和非pCR组107例,比较两组二维超声、弹性成像和超声造影检查结果的差异。应用多因素二元Logistic回归分析筛选乳腺癌患者NAC后腋窝淋巴结pCR的独立影响因素,并构建列线图模型。绘制受试者工作特征(ROC)曲线分析模型的预测效能;采用校准曲线评价模型的拟合优度;临床决策曲线分析模型的临床适用性。结果 pCR组阻力指数(RI)、收缩期峰值流速(PSV)、搏动指数(PI)、AUC、最大径变化率均大于非pCR组,病灶最大径和弹性评分均小于非pCR组,差异均有统计学意义(均P<0.001)。多因素二元Logistic回归分析显示,RI是乳腺癌患者NAC后腋窝淋巴结pCR的独立保护因素(P<0.05),弹性评分是独立危险因素(P<0.05)。以RI和弹性评分构建预测乳腺癌患者NAC后腋窝淋巴结pCR的列线图模型,ROC曲线分析显示,该模型预测乳腺癌患者NAC...     

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.     

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.     

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.     

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.     

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.