胰岛素抗体对电化学发光免疫分析法测定血清胰岛素的影响

目的探讨胰岛素抗体(IA)对电化学发光免疫分析法(ECLIA)检测胰岛素的影响。方法放射免疫法检测糖尿病患者血清IA,IA结合率<5%组10例,IA结合率≥5%组53例。聚乙二醇(PEG)沉淀法去除IA,Roche E lecsys 2010测定胰岛素浓度。结果IA结合率<5%组和IA结合率5%~10%组PEG处理前后的胰岛素浓度、游离胰岛素/直接胰岛素比值、胰岛素浓度改变值差异均无统计学意义(P>0.05)。IA结合率10%~20%、20%~30%、>30%组PEG处理前后的胰岛素浓度、游离胰岛素/直接胰岛素比值、胰岛素浓度改变值差异有统计学意义(P<0.05)。IA结合率>10%时,IA结合率与游离胰岛素/直接胰岛素比值呈负相关(r=-0.729,P=0.000),与胰岛素浓度的改变值呈正相关(r=0.821,P=0.000)。结论IA结合率≤10%时,IA对ECLIA测定血清胰岛素浓度没有影响。IA结合率>10%时,IA使ECLIA测定胰岛素结果假性升高。     

血清胰岛素抗体对胰岛素测定的干扰及纠正方法

目的　测定正常人及糖尿病患者血清游离胰岛素 (freeimmunoreactive insulin ,F IRI)与免疫活性胰岛素 (immunoreactive insulin ,IRI)水平 ,探讨血中胰岛素抗体 (insulinantibodies,IA)对胰岛素测定的干扰及纠正方法。方法　采集正常人和糖尿病人血样 ,聚乙二醇 (PEG)预沉淀除去血清中IA和结合胰岛素 ,用12 5I 胰岛素和胰岛素分别行热、冷回收鉴定 ;采用RIA法分别测定样品IA、IRI和F IRI。结果　IA阳性血样的F IRI热回收率 (5 .87% )显著低于IA阴性者 (98.35 % ) (P <0 .0 1) ,而F IRI冷回收率在IA阴、阳性组间无差异 (P >0 .0 5 ) ;正常人及IA阴性的糖尿病患者 ,血清IRI与F IRI测定值无差异 (P >0 .0 5 ) ;IA阳性的糖尿病患者血清IRI高于F IRI测值 (P <0 .0 5 ) ,而且与餐后相比 ,空腹时IRI与F IRI二者的差异程度更明显 (P <0 .0 5 )。结论　血清内源性IA可干扰IRI放免测定 ,使测定值出现偏差。采用PEG对标本预沉淀后测定F IRI,可排除IA的干扰 ,对了解病情和指导用药有实际意义     

几种化学发光检测系统测定血清胰岛素的临床效果评价

目的探讨血清胰岛素临床测定结果在几种化学发光检测系统间的可比性和符合程度,并试图找到不受方法学影响,能够反映其动态变化规律的通用参数。方法选择40例做胰岛素释放试验的患者（均未使用外源性胰岛素治疗）,同时应用三种化学发光免疫分析系统,检测同一个体在口服葡萄糖耐量试验（OGTT）中各时间点血清胰岛素的浓度,并分别计算服糖后各时间点浓度与其空腹浓度的比值（简称比值）。结果 （1）血清胰岛素测定结果在任意两系统间的差异均有统计学意义（均P〈0.05）,且高度相关（r=0.914～0.993,均P=0.000）。（2）服糖后同一时间点胰岛素的上述比值在任意两系统间均显著相关（r=0.622～0.993,均为P〈0.05）,且差异均无统计学意义（均P〉0.05）。结论血清胰岛素测定结果在不同检测系统间差异很大,虽均具有很好的相关性,但不能互相通用。而在OGTT中,同一个体服糖后于同一时间点胰岛素浓度与其空腹浓度的比值在不同检测系统间的差异似乎并不显著,有望成为不同检测系统间互认的指标。     

重组人胰岛素治疗2型糖尿病免疫原性研究

目的探讨重组人胰岛素治疗2型糖尿病的免疫原性及其临床意义。方法应用放射免疫法检测179例重组人胰岛素治疗的2型糖尿病患者及429例未用胰岛素治疗的2型糖尿病患者胰岛素抗体（INS-Ab）的阳性率,并分析INS-Ab阳性患者的临床特征及其危险因素。结果 （1）重组人胰岛素治疗组中INS-Ab阳性率为36.31%,而未用重组人胰岛素组INS-Ab阳性率为0.23%,差异具有统计学意义（χ2=166.19,P=0.000）。（2）Logistic回归分析显示在应用重组人胰岛素的患者中INS-Ab阳性的危险因素分别为胰岛素治疗时间（OR=1.201,P=0.006）及糖尿病病程（OR=1.07,P=0.004）。应用重组人胰岛素半年以上、糖尿病病程5年以上并已接受重组人胰岛素治疗时,INS-Ab阳性率明显升高（P〈0.05）。重组人胰岛素治疗组中,INS-Ab阳性组HOMR-IR明显高于INS-Ab阴性组（18.48±21.58 vs.6.90±14.39,t=3.68,P=0.000）,高胰岛素血症组INS-Ab阳性率也明显高于无高胰岛素血症组（59.26%vs.20.99%,χ2=33.684,P=0.000）。（3）INS-Ab阳性患者空腹胰岛素及餐后2 h胰岛素水平均明显高于INS-Ab阴性者（P〈0.05）,低血糖发生次数明显高于阴性者（Z=-6.109,P=0.000）。（4）INS-Ab阳性组糖化血红蛋白达标率明显低于阴性组（χ2=4.422,P=0.035）。（5）诺和灵30R、甘舒林30R及优泌林30R胰岛素抗体阳性率分别为37.25%、38.46%、28.13%,差异无统计学意义（χ2=0.948,P=0.623）。结论 （1）重组人胰岛素治疗2型糖尿病仍具有免疫原性,在应用重组人胰岛素的患者中重组人胰岛素应用超过半年、低血糖频发、糖尿病病程5年以上的应及时检测INS-Ab。（2）已经使用重组人胰岛素的糖尿病患者也应常规查血清胰岛素水平,及时发现高胰岛素血症及免疫性胰岛素抵抗。（3）INS-Ab是胰岛素抵抗的危险因素,是影响糖尿病患者糖化血红蛋白达标率的因素之一。     

严重脓毒症患者胰岛素抵抗和胰岛素分泌功能的观察

目的探讨严重脓毒症患者入ICU后血糖、胰岛素浓度、胰岛素抵抗（IR）及胰岛素分泌功能的动态变化．与疾病的严重程度和预后的关系。方法选取严重脓毒症患者36例和正常对照20例,根据脓毒症后28d后的存活情况,分为生存组（n=20例）和死亡组（n=16）。回顾分析各组第1天、第28天空腹血糖（FBG）、胰岛素（FINS）浓度,使用稳态模式法（HOMA）计算胰岛素抵抗指数（HOMA—IR）及胰岛素分泌指数（HOMA-8）。结果严重脓毒症患者入组后第1天FBG、FINS浓度及HOMA—IR均明显高于对照组,HOMA—β明显低于对照组,差异均有统计学意义（t分别=7．46、5．64、7．07、6．73,P均〈0．05）。生存组与死亡组入组后第1天FBG、FINS浓度及HOMA—IR均高于对照组,而HOMA—β低于对照组,差异有统计学意义（t分别=5．13、4．43、5．49、4．70、6．85、3．60、5．02、8．96,P均〈0．05）;生存组第28天FBG、FINS浓度及HOMA—IR较第1天下降,而HOMA-β回升,差异均有统计学意义（t分别=3．71、2．72、4．06、2．47,P均〈0．05）;死亡组FBG和HOMA-IR高于生存组,HOMA—β低于生存组,差异有统计学意义（t分别=3．46、2．82、2．97,P均〈0．05）;而FINS浓度与生存组间差异无统计学意义（t=0．32,P〉0．05）。单个脏器功能不全患者FBG浓度、HOMA-β与对照组间比较,差异均无统计学意义（q分别=1．95、1．66,P均〉0．05）;多个脏器功能不全患者FBG、FINS浓度及HOMA—IR均高于对照组;而HOMA—β低于对照组,差异均有统计学意义（q分别=10．18、5．19、7．58、14．96,P均〈0．05）。APACHEⅡ评分与FBG、HOMA—IR呈正相关,与HOMA—β呈负相关,差异均有统计学意义（r分别=0．68、0．50、-0．66,P均〈0．05）。结论严重脓毒症患者存在IR,其中多脏器功能不全患者存在胰岛β细胞功能不全,FBG浓度、HOMA—IR及HOMA—β可作为判断严重脓毒症患者病情转归,预后的预警指标。     

胰岛素和胰岛素样生长因子Ⅰ对高糖条件下成骨细胞的影响

目的：观察胰岛素和胰岛素样生长因子Ⅰ在高浓度葡萄糖条件下对成骨细胞增殖和矿化的影响，探讨胰岛素和胰岛素样生长因子Ⅰ对糖尿病性骨质疏松和骨质减少治疗的作用。方法：实验于2004—07／2005-09在第四军医大学唐都医院感染病中心完成。健康新生24h内的SD仔鼠3只。①采用组织块培养法分离培养新生SD大鼠颅骨成骨细胞，分别给以不同葡萄糖浓度的培养液，即正常浓度葡萄糖（5．5mmol／L）和高浓度葡萄糖（25．5mmol／L）。在高糖条件下分别加人胰岛素（10^-6mmol／L）和胰岛素样生长因子Ⅰ（10^-7mmol／L）。所有实验分为四组：正常浓度葡萄糖组，高浓度葡萄糖组，高浓度葡萄糖＋胰岛素样生长因子Ⅰ组，高浓度葡萄糖＋胰岛素组。②MTT法检测不同培养条件对成骨细胞增殖的影响。③原子能吸收法检测钙离子吸收量和体外诱导骨结节的形成来评价成骨细胞的分化。结果：①MTT比色法显示连续培养5d，不同组吸光度值均成比例增加，与正常浓度葡萄糖相比，高浓度葡萄糖显著促进细胞的增殖，细胞生长率显著高于其他组。胰岛素和胰岛素样生长因子Ⅰ下调了高浓度葡萄糖导致的细胞增殖，除第1天以外，该两组细胞的生长率与正常浓度葡萄糖组的结果相似。②从第17天到第32天，各组的钙吸收量显著增加，但高糖组的钙吸收量明显低于其他组。胰岛素样生长因子Ⅰ组的钙吸收量高于胰岛素组，与正常浓度葡萄糖组的钙吸收量相比没有明显差别（P〉0．05）。在第32天，高糖组的骨结节数明显低于其他组，而且多数细胞仍处于增殖阶段，钙化的细胞很少。胰岛素样生长因子Ⅰ组的骨结节数多于胰岛素组（P〈0．05），少于正常葡萄糖组（P〉0．05）。结论：高浓度葡萄糖刺激成骨细胞增殖但抑制细胞矿化可能直接导致了糖尿病性骨病的病理改变；胰岛素和胰岛素样生长因子Ⅰ对其矿化的促进作用可能是治疗糖尿病性骨质减少和骨质疏松的机制之一。     

几种化学发光检测系统测定血清胰岛素和C-肽临床效果的评估

目的探讨不同化学发光检测系统测定血清胰岛素、C-肽临床结果间的可比性和符合程度,并试图找到不受方法学影响,能够反映两者动态变化规律的通用参数。方法选择40名做胰岛素和C-肽释放试验的患者（均未使用外源性胰岛素治疗）,同时应用三种化学发光免疫分析系统,检测同一个体在OGTT中各时间点血清胰岛素和C-肽的浓度,并分别计算两者在服糖后各时间点浓度与其空腹浓度的比值（简称比值）。结果①血清胰岛素或C-肽测定结果在任意两系统间的差异均非常显著（均为P〈0.001）,且高度相关（胰岛素：r=0.946-0.977;C-肽：r=0.959-0.996）。②服糖后同一时间点胰岛素的上述比值在任意两系统间均显著相关（均为P〈0.05）,且均无统计学差异（均为P〉0.05）,C-肽也可得到相似结果。③对于相同检测系统,同一时间点两者的上述比值间差异显著（P〈0.05）且C-肽的比值显著低于胰岛素。结论血清胰岛素或C-肽的测定结果在不同检测系统间差异很大,虽均具有很好的相关性,但不能互相通用。而在OGTT中,服糖后同一时间点两者浓度与各自空腹浓度的比值在不同检测系统间的差异似乎并不显著,有望成为不同检测系统间互认的指标。至于C-肽在反映胰腺β细胞功能的敏感度上显著低于胰岛素的问题,其临床应用尚有待进一步研究。     

预混赖脯胰岛素与甘精胰岛素比较治疗2型糖尿病效果的Meta分析

目的系统评价预混赖脯胰岛素与甘精胰岛素比较治疗2型糖尿病的疗效与安全性。方法计算机检索h e Cochrane Library（2013年第3期）、Pub Med、EMbase、临床试验注册库（Clinical Trials.gov）、CBM、CNKI和Wan Fang Data数据库,查找关于预混赖脯胰岛素与甘精胰岛素比较治疗2型糖尿病的临床疗效和安全性的随机对照试验（RCT）,检索时限均为从建库至2013年10月。由2名研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果共纳入13个RCT,合计4 557例患者。Meta分析结果显示：1预混组在降低糖化血红蛋白（Hb A1c）水平方面优于甘精组[平行试验：WMD=–0.18,95%CI（–0.33,–0.02）,P=0.03;交叉试验：WMD=–0.38,95%CI（–0.52,–0.24）,P〈0.000 01];2预混组在降低空腹血糖（FPG）水平方面不及甘精组[平行试验：WMD=0.82,95%CI（0.65,0.99）,P〈0.000 01;交叉试验：WMD=0.64,95%CI（0.26,1.02）,P=0.000 9];3预混组在控制体重方面效果不及甘精组[平行试验：WMD=0.93,95%CI（0.31,1.56）,P=0.003;交叉试验：WMD=0.74,95%CI（0.19,1.29）,P=0.009];4预混组低血糖发生率高于甘精组[平行试验：OR=1.27,95%CI（1.11,1.45）,P=0.000 6;交叉试验：OR=2.24,95%CI（1.45,3.46）,P=0.000 3]。结论对2型糖尿病患者而言,预混赖脯胰岛素与甘精胰岛素相比在临床疗效和安全性方面各有优势,临床实际工作中应根据患者具体情况选择合适的胰岛素。     

不同浓度胰岛素对体外培养新生鼠心肌细胞生长和增殖的影响

背景：小鼠高胰岛素血症模型研究发现，高胰岛素可引起心肌肥厚的发生。 目的：观察胰岛素对体外培养的新生鼠心肌细胞增殖和肥大的浓度效应。 设计、时间及地点：细胞学体外观察，于2006—01／2007-03在新乡医学院解剖学与组织胚胎学重点学科实验室完成。 材料：1—3d龄Wistar新生鼠20只，胰岛素为美国sigma公司产品。 方法：采用胰蛋白酶消化法和差速贴壁法体外分离培养和纯化新生鼠心室肌细胞，分别加入10^-8，10^-7，10^-6mol／L胰岛素处理48h，并设立空白对照组，细胞周期分析选取10^-7mol／L胰岛素组。 主要观察指标：显微测量细胞直径、细胞活力和细胞计数，免疫细胞化学染色观察心肌细胞中细胞周期素E的变化。 结果：各组心肌细胞活力均在90％以上。与空白对照组比较，10^-8，10^-7，10^-6mol／L胰岛素组心肌细胞长径和短径均显著增加（t=2．7815，P〈0．01）；10^-8，10^-7mol／L胰岛素组心肌细胞数目无明显变化（P〉0．05），10^-6mol／L胰岛素组心肌细胞数目显著下降（f=1．9762，P〈0．05）；10^-7mol／L胰岛素组心肌细胞内细胞周期素E阳性颗粒吸光度值明显下降（t=2．1743，P〈0．05），平均灰度值明显增加（t=-2．4587，P〈0．05）。 结论：10^-8～10^-6mol／L胰岛素具有促进新生鼠心肌细胞肥大的作用，但无法促进心肌细胞增殖。     

依那普利对高血压病患者胰岛素敏感性的影响

观察60例高血压病患者（EH组）和40例健康体检者（对照组）的血糖（SG）、血浆胰岛素浓度（IS）、胰岛素敏感性指数（ISI）及血脂水平。结果治疗后EH组空腹SG水平无差异（P〉0．05）,而IS浓度显著降低,ISI显著增高（P〈0．05）;TC和TG显著降低（P〈0．05,P〈0．01）,HDL—C明显增高（P〈0．05）。认为依那普利不仅具有良好的降压效果,而且可改善胰岛素敏感性和血脂代谢异常。     

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.