胃癌外体（exosome）内miRNA-1的检测分析

目的检测胃癌细胞系来源外体(exosome)及其胃癌组织和血清中exosome内miRNA-1的表达水平并分析其临床意义。方法采用实时荧光定量RT-PCR分别检测胃癌细胞系来源exosome、胃癌患者组织及血清exosome内miRNA-1的表达水平,分析其与临床资料相关性,并绘制ROC曲线进行效能分析。结果 miRNA-1在人胃癌细胞系MGC-803(6.51±0.41)和SGC-7901(14.81±1.30)中的含量明显高于胃上皮细胞系GES-1(1.05±0.25),差异有统计学意义(t分别为11.26、10.38,P均0.01);而MGC-803、SGC-7901细胞培养上清exosome内miRNA-1的表达水平(49.98±11.77和28.68±4.66)显著高于GES-1来源exosome(1.00±0.02)差异有统计学意义(t分别为4.162、5.942,P均0.01);25对胃癌组织标本中有18例癌组织miRNA-1表达上调,7例表达下调,胃癌组织[1.110(0.070,4.307)]平均表达水平高于癌旁组织[1.149(1.110,2.075)],差异有统计学意义(Z=-1.897,P0.05)。miRNA-1在胃癌患者血清exosome内的表达水平[4.130(0.151,12.720)]较体检健康者血清exosome内表达水平[0.704(0.077,7.243)]明显增高(Z=-2.407,P0.05),且与胃癌的淋巴结转移相关;胃癌患者血清exosome内miRNA-1的ROC曲线下面积(AUCROC)为0.723 0,95%可信区间(CI)为0.627 0~0.818 7,cut off值为2.39,敏感性为66%,特异性为68%。结论胃癌组织及其胃癌患者血清来源exosome内富含miRNA-1,有望成为新的胃癌诊断标志物。     

胃癌患者血清外泌体中DANCR表达及其临床意义

目的检测胃癌患者血清外泌体(exosome)中抗分化非编码RNA(DANCR)的表达水平并分析其临床应用价值。方法采用实时荧光定量RT-PCR检测胃癌细胞培养上清和胃癌患者血清exosome中DANCR表达水平,分析其与临床病理资料的相关性,绘制ROC曲线评价其诊断效能。结果 DANCR在人胃癌细胞系HGC-27中表达水平(4.43±0.37)明显高于胃黏膜上皮细胞(1.01±0.01),差异有统计学意义(P0.05)。HGC-27细胞培养上清exosome中DANCR表达水平(3.06±0.14)明显高于GES-1细胞(1.01±0.20),差异有统计学意义(P0.05)。DANCR在胃癌患者血清exosome中的平均含量[5.060(1.380,22.785)]较胃良性疾病患者[0.535(0.340,1.380)]和体检健康者[1.200(0.605,1.655)]明显升高(Z分别为-3.409,-4.229,P均0.01),且与肿瘤大小、TNM分期以及淋巴结转移相关。胃良性疾病患者与体检健康者相比,血清exosome中DANCR含量差异无统计学意义(Z=-1.308,P0.05)。胃癌患者血清exosome中DANCR的ROC曲线下面积(AUCROC)为0.777,95%可信区间(CI)为0.678~0.876,cut-off值2.50,敏感性为68.6%,特异性为84.4%。结论胃癌患者血清exosome中DANCR表达水平升高,有望成为胃癌诊断的新指标。     

胃癌患者血清LINC00978表达及其临床意义

目的检测胃癌患者血清中LINC00978表达水平,评估其表达水平与临床病理参数的关系,并探讨其临床诊断价值。方法实时荧光定量RT-PCR检测LINC00978在胃癌细胞、体检健康者、胃良性疾病及胃癌患者血清中的表达水平,分析其与胃癌患者临床病理参数的相关性,并用ROC曲线分析其诊断效能。结果 LINC00978在人胃癌细胞系MGC-803中的表达水平(18.88±1.15)明显高于胃黏膜上皮细胞(1.00±0.03),差异有统计学意义(t=-21.926,P0.05)。LINC00978在胃癌患者血清中的平均含量[3.525(1.385,8.954)]较胃良性疾病患者[0.419(0.258,1.369)]和体检健康者[0.814(0.351,2.510)]均明显升高(Z值分别为-4.834和-4.686;P均0.01),且与淋巴结转移、浸润深度和TNM分期相关(r分别为0.448、0.369和0.383,P均0.01);胃癌患者术后血清中LINC00978的表达水平[0.17(0.15,0.39)]较术前[0.98(0.59,1.61)]明显降低(Z=-5.731,P0.01)。与体检健康者相比,LINC00978在胃良性疾病患者血清中表达差异无统计学意义(Z=-1.693,P0.05)。胃癌患者血清LINC00978的ROC曲线下面积(AUCROC)为0.807,95%可信区间(CI)为0.723~0.882,当cut-off值为1.806时,其诊断胃癌的敏感性为71.4%,特异性为75.9%。结论 LINC00978在胃癌患者血清中呈高表达,且与淋巴结转移、浸润深度和TNM分期相关,有望成为潜在的胃癌诊断的生物学标志物。     

外周血清sCD163在肝硬化无创评估中的临床应用价值

目的定量检测肝硬化患者外周血清中可溶性CD163分子(s CD163)的表达水平,以探讨血清s CD163在肝硬化患者无创诊断及病程监测中的临床应用价值。方法收集肝硬化不同阶段患者外周血清41份及正常健康对照外周血清20份。采用酶联免疫吸附法(ELISA)定量检测肝硬化患者外周血清s CD163表达水平,并采用受试者工作曲线(ROC)分析其临床诊断价值。结果肝硬化患者外周血清s CD163水平明显高于健康对照组[(92.53±3.34)μg/L vs.(58.22±3.12)μg/L,P<0.01],且随着Child-Pugh A、B、C分级而增高[(76.99±4.46)μg/L vs.(99.69±4.04)μg/L vs.(112.90±3.59)μg/L,均P<0.05]。与患者病因、有无再出血、有无门脉血栓形成及有无合并肝细胞性肝癌等无关,而与是否合并腹水或自发性细菌性腹膜炎(SBP)相关。外周血清s CD163的ROC曲线下面积为0.901,以80.12μg/L作为临界点,其诊断肝硬化的灵敏度为73.2%,特异度为95%。有腹水肝硬化患者外周血清s CD163的ROC曲线下面积为0.795,s CD163>94.79μg/L预测肝硬化患者腹水生成的灵敏度和特异度分别为73.1%和80%。结论 s CD163作为巨噬细胞活化的标记物,在肝硬化患者外周血清中明显升高,且与肝硬化Child-Pugh分级有关,可作为肝硬化程度判断及病情监测的无创指标。血清s CD163水平与肝硬化相关并发症腹水和SBP的形成相关,提示其可能在肝硬化病程进展中发挥了一定的作用。     

血清胰岛素样生长因子1与E-钙黏蛋白在胃癌患者中的表达及临床意义

目的探讨胃癌患者血清胰岛素样生长因子1(insulin-like growth factor 1, IGF1)、E-钙黏蛋白(E-cadherin)水平变化及与预后的关系。方法胃癌患者158例为胃癌组,同期体检健康者158例为对照组,采用ELISA法检测2组血清IGF1、E-cadherin水平;分析血清IGF1、E-cadherin水平与胃癌临床病理特征的关系;ROC曲线分析血清IGF1、E-cadherin诊断胃癌的效能;随访5 a,比较不同血清IGF1、E-cadherin水平胃癌患者无进展生存期(progression-free survival, PFS)、总生存期(overall survival, OS),多因素Cox回归分析血清IGF1、E-cadherin对胃癌患者预后的影响。结果胃癌组血清IGF1[(102.83±10.22)μg/L]水平高于对照组[(46.48±8.94)μg/L],E-cadherin[(3.00±0.28)μg/L]水平低于对照组[(17.58±4.22)μg/L](P0.05);胃癌组血清IGF1高表达者肿瘤低分化比率(64.79%)、浸润深度T_3～T_4期比率(71.83%)、有淋巴结转移比率(67.61%)、TNMⅢ～Ⅳ期比率(70.42%)高于IGF1低表达者(44.83%、50.57%、42.53%、44.83%)(P0.05),E-cadherin高表达者浸润深度T_3～T_4期比率(46.75%)、有淋巴结转移比率(35.06%)、TNMⅢ～Ⅳ期比率(41.56%)低于E-cadherin低表达者(67.90%、71.60%、70.37%)(P0.05);血清IGF1以56.0μg/L为最佳截断值,诊断胃癌的AUC为0.798(95%CI:0.786～0.904,P0.001),灵敏度为82.5%,特异度为95.0%;血清E-cadherin以5.2μg/L为最佳截断值,诊断胃癌的AUC为0.838(95%CI:0.811～0.926,P0.001),灵敏度为85.0%,特异度为90.0%;随访5 a,血清IGF1高表达者中位PFS(21.0个月)、中位OS(25.0个月)均较IGF1低表达者(44.0、48.0个月)短(P0.05);血清E-cadherin高表达者中位PFS(29.5个月)、中位OS(39.5个月)较E-cadherin低表达者(17.5、23.0个月)长(P0.05);多因素Cox回归分析结果显示,血清IGF1高表达(HR=3.011, 95%CI:1.649～4.307,P=0.020)、E-cadherin低表达(HR=2.691,95%CI:1.870～3.551,P=0.026)是胃癌患者预后的危险因素。结论胃癌患者血清IGF1表达升高,E-cadherin表达下调,IGF1高表达,E-cadherin低表达提示预后不良。     

血清脂联素、分泌型黑色素瘤细胞黏附分子在2型糖尿病肾病中的表达及临床意义

目的 探讨2型糖尿病肾病(T2DN)患者血清脂联素(ADPN)、分泌型黑色素瘤细胞黏附分子(MCAM)的表达及临床意义。方法 选取海南西部中心医院2020年6月—2021年6月收治的180例T2DN患者作为T2DN组,根据患者尿白蛋白排泄率(UAER)将T2DN组分为轻度组(n=52)、中度组(n=66)、重度组(n=62),另外选取58例健康体检正常者为对照组,比较T2DN组中不同病情程度患者的ADPN、分泌型MCAM结果差异,并采用受试者工作特征(ROC)曲线分析血清ADPN和分泌型MCAM诊断T2DN的临床效能。结果 T2DN组血清ADPN表达水平为(10.67±1.21)μg/mL,低于对照组的(12.36±3.08)μg/mL,分泌型MCAM表达水平为(118.89±26.07)μg/L,高于对照组的(68.79±18.34)μg/L,差异有统计学意义(P<0.05)。中度组、重度组血清ADPN水平低于轻度组,重度组ADPN水平低于中度组,中度组、重度组分泌型MCAM水平高于轻度组,重度组MCAM水平高于中度组,差异有统计学意义(P<0.05)。ROC曲线显示,血...     

肿瘤标志物联合检测对小细胞肺癌的诊断价值

目的探讨血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、糖类抗原(carbohydrate antigen,CA)125、癌胚抗原(carcinoembryonic antigen,CEA)、非小细胞肺癌抗原(cytokeratin 19fragment,CYFRA21-1)联合检测对小细胞肺癌(small cell lung cancer,SCLC)的诊断价值。方法 SCLC患者51例(SCLC组)和同期体检健康者25例(对照组),采用电化学发光法检测2组血清NSE、CA125、CEA、CYFRA21-1、CA19-9、CA72-4水平,应用ROC曲线进行分析和评价。结果 SCLC组NSE[(60.22±19.62)μg/L]、CA125[(49.79±9.78)u/mL]、CEA[(6.46±1.02)μg/L]、CYFRA21-1[(3.95±0.85)μg/L]高于对照组[(13.47±4.41)μg/L、(11.49±3.32)u/mL、(1.93±0.75)μg/L、(2.14±0.64)μg/L],差异有统计学意义(P<0.01),SCLC组CA19-9[(15.28±4.39)u/mL]、CA72-4[(2.89±0.36)u/mL]与对照组[(8.42±1.03)u/mL、(1.82±0.41)u/mL]比较差异无统计学意义(P>0.05);血清NSE、CA125、CEA、CYFRA21-1在SCLC组的AUC分别为0.905、0.853、0.778、0.705;ROC曲线分析显示NSE、CA125、CEA、CYFRA21-1的临床诊断临界点分别为23.23μg/L、19.71 u/mL、2.64μg/L、3.24μg/L,单项检测时,NSE、CA125、CEA、CYFRA21-1的灵敏性分别为74.51%、64.71%、64.71%、50.98%,特异性分别为100.00%、96.00%、88.00%、92.00%,4项指标联合检测时灵敏性为94.12%,特异性为84.00%。结论血清NSE是诊断SCLC的一个较理想指标;检测血清NSE、CA125、CEA、CYFRA21-1水平对诊断SCLC有重要意义,4项联合检测灵敏度较单项检测升高,但特异性下降。     

胃癌患者血清生长分化因子15和胃癌抗原724检测及其临床价值探讨

目的探讨生长分化因子15(GDF15)和胃癌抗原724(CA724)在胃癌患者血清中的变化及临床意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA)检测30例胃癌患者血清中GDF15水平,同时用电化学发光法(ECL)测定血清CA724水平,并与32例胃良性病变患者和30例健康对照者进行比较。结果胃癌组患者血清GDF15和CA724水平分别为(1.58±0.53)ng/mL、(40.80±5.20)IU/mL,胃良性病变组患者血清GDF15和CA724水平分别为(0.26±0.11)ng/mL、(12.90±2.30)IU/mL,健康对照组GDF15和CA724水平分别为(0.17±0.08)ng/mL、(3.80±0.90)IU/mL,胃癌组患者血清GDF15和CA724水平显著高于胃良性病变组和健康对照组(P0.01)。血清GDF15水平与胃癌患者肿瘤大小、TNM分期、淋巴结转移密切相关(P0.05)。GDF15诊断胃癌灵敏度为83.3%,特异度为83.9%,受试者工作特征曲线下面积(AUC)为0.837;CA724诊断胃癌的灵敏度为90.0%,特异度为76.5%,AUC为0.886。GDF15和CA724联合检测时,AUC为0.920,显著高于单项检测。结论GDF15与胃癌的发生、发展有关,联合检测血清中GDF15和CA724有助于早期诊断胃癌,并判断患者预后。     

血清SOD水平检测对胃癌的诊断价值

目的探讨血清超氧化物歧化酶(SOD)水平检测对胃癌的诊断价值。方法选择该院2017年1月1日至2018年12月31日收治的50例初次确诊的胃癌患者作为胃癌组,选择同期50例健康体检者作为对照组。比较胃癌组与对照组血清SOD水平;比较早期胃癌与进展期胃癌患者血清SOD水平;应用受试者工作特征(ROC)曲线判断血清SOD水平检测在鉴别健康人群与胃癌患者中的价值。结果胃癌组血清SOD水平为(145.86±25.74)kU/L,明显低于对照组[(186.08±20.28)kU/L],差异有统计学意义(P<0.05);进展期胃癌患者血清SOD水平较早期胃癌患者明显降低,差异有统计学意义(P<0.05),但早期胃癌患者与健康体检者比较,差异无统计学意义(P>0.05);ROC曲线分析结果显示,血清SOD水平检测对胃癌具有诊断价值(曲线下面积为0.886,最佳临界值为174.50 kU/L,特异度为80%,灵敏度为90%)。结论胃癌患者血清SOD水平降低,且与病情严重程度有关,这提示SOD可能参与了胃癌的发展过程。血清SOD水平检测对胃癌具有一定诊断价值。     

血清白细胞介素-33及鳞状细胞癌抗原联合诊断宫颈癌的价值

目的探讨宫颈癌患者血清白细胞介素-33(interleukin-33, IL-33)、鳞状细胞癌抗原(squamous cell carcinoma antigen, SCCA)、癌胚抗原(carcinoembryonic antigen, CEA)、糖链抗原(carbohydrate antigen, CA)19-9和CA125水平变化,分析其相关性及血清IL-33联合SCCA诊断宫颈癌的价值。方法 224例宫颈癌患者(宫颈癌组),同期85例体检健康女性(对照组),检测2组血清IL-33、SCCA、CEA、CA19-9和CA125水平;分析血清IL-33水平与宫颈癌临床特征的关系;Pearson法分析血清IL-33与SCCA、CEA、CA19-9和CA125的相关性;绘制ROC曲线,分析血清IL-33联合SCCA诊断宫颈癌的效能。结果宫颈癌组血清IL-33[(284.13±35.74)μg/L]、SCCA[(12.31±1.98)μg/L]、CEA[(6.65±1.94)μg/L]、CA19-9[(48.92±6.34)u/mL]和CA125 [(45.97±12.27)u/mL]水平均高于对照组[(156.06±23.77)μg/L、(0.41±0.13)μg/L、(2.11±0.56)μg/L、(13.85±3.18)u/mL、(12.01±6.13)u/mL](P0.05);血清IL-33水平在Ⅱb～Ⅲ期宫颈癌患者[(320.41±34.78)μg/L]高于Ⅰ～Ⅱa期者[(261.93±23.81)μg/L](P0.05),在低、中、高分化者依次降低[(307.85±16.43)、(286.47±21.23)、(260.55±18.31)μg/L](P0.05),在鳞癌患者[(291.31±39.76)μg/L]和腺癌患者[(278.56±48.41)μg/L]比较差异无统计学意义(P0.05);宫颈癌患者血清IL-33水平与SCCA呈正相关(r=0.557,P=0.024),与CEA(r=0.736,P=0.421)、CA19-9(r=0.411,P=0.087)和CA125(r=0.621,P=0.319)无线性相关性;ROC曲线分析结果显示,血清IL-33以311.59μg/L为最佳截断值,诊断宫颈癌的AUC为0.837(95%CI:0.748～0.966,P0.001),灵敏度为85.4%,特异度为78.5%;血清SCCA以13.04μg/L为最佳截断值,诊断宫颈癌的AUC为0.745(95%CI:0.707～0.858,P0.001),灵敏度为85.2%,特异度为80.7%;血清IL-33联合SCCA诊断宫颈癌的AUC为0.919,灵敏度为94.2%,特异度为83.3%。结论宫颈癌患者血清IL-33、SCCA、CEA、CA19-9和CA125水平增高,血清IL-33与肿瘤临床分期、分化程度有关,与SCCA表达呈正相关,IL-33及SCCA联合检测对宫颈癌有较高的诊断价值。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.