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。     

运动训练对发育期大鼠反复惊厥所致远期认知损伤及海马Zn2+转运体-3表达的影响

目的观察运动训练对发育期大鼠反复惊厥所致远期认知损伤及海马Zn2+转运体3（ZnT-3）表达水平的影响。 方法将出生21 d的SD大鼠随机分成空白对照组、运动对照组、单纯惊厥组及惊厥运动组,每组10只。采用青霉素腹腔注射方法诱发单纯惊厥组及惊厥运动组大鼠反复惊厥,空白对照组及运动对照组大鼠则同期腹腔注射等量生理盐水,运动对照组和惊厥运动组于出生后48～53 d期间进行踏转轮训练。各组大鼠分别于出生后39～44 d及61～65 d期间进行Morris水迷宫测试,于出生后66 d时采用实时定量逆转录聚合酶链反应（RT-PCR）技术检测ZnT-3在海马中的表达情况。 结果①搜寻策略比较：各组大鼠边缘式搜寻比例均呈逐渐减少趋势,而趋向式及直线式搜寻比例均呈逐渐增加趋势。第1阶段Morris水迷宫测试发现两对照组成绩在第1天及第4天时均明显优于两惊厥组（均P<0.05）;第2阶段Morris水迷宫测试发现运动对照组及惊厥运动组搜寻策略成绩在第2天以后,均显著优于空白对照组及单纯惊厥组（P<0.05）。②记忆功能比较：在前、后2阶段Morris水迷宫测试中,两惊厥组大鼠穿越原平台所在区域的次数均明显少于两对照组（均P<0.05）,且单纯惊厥组与惊厥运动组间差异无统计学意义（P&rt;0.05）。③实时定量RT-PCR结果比较：惊厥运动组大鼠海马ZnT-3 mRNA表达水平均明显高于两对照组及单纯惊厥组（均P<0.05）。 结论青霉素诱发反复长程惊厥能导致发育期大鼠学习、记忆功能远期损伤,运动训练能明显改善受损学习功能,其治疗机制可能与上调海马ZnT-3表达水平有关。     

鸢尾素对新生大鼠高胆红素血症细胞凋亡的影响

摘要 目的：探究鸢尾素对新生大鼠高胆红素血症细胞凋亡的影响。 方法：将96只新生SD大鼠随机分为对照组（N组）和模型组（M组）,于7和10日龄腹腔注射胆红素溶液进行造模。造模成功后将M组随机分为T0组、T1组、T2组、T3组。T1、T2、T3组分别侧脑室注射40、60和80 μg/kg的鸢尾素溶液,余各组注射等量磷酸盐缓冲液溶液。侧脑室注射24h后,神经行为学、苏木精-伊红染色（Hematoxylin-Eosin staining,HE）、原位末端标记法（terminal-deoxynucleoitidyl transferase mediated nick end labeling,Tunel）检测海马区病理改变并统计凋亡率,Western Blot检测海马Bcl-2、Bax和Caspase-3蛋白相对表达量。 结果：侧脑室注射鸢尾素后。平面翻正反射：T3组所需时间少于T0、T1、T2组且多于N组（P<0.01）;负趋地性反射：T3组所需时间少于T0、T1、T2组（P<0.01,P<0.05）。HE染色：M组海马神经细胞核固缩、裂解,排列紊乱。T1、T2、T3组细胞形态等不同程度改善。Tunel染色：M组Tunel+细胞增多,布满视野;N组Tunel+细胞少,呈零星分布;T3组凋亡率低于T0、T1组（P<0.05）。Western Blot：各组Bcl-2蛋白相对表达量无显著性意义（P>0.05）;T0组Bax蛋白高于其余各组（P<0.05）,T3组低于T1组（P<0.05）;T0组Bcl-2/Bax值低于N、T3组（P<0.05）,T1、T2组均低于T3组（P<0.05）;T0组Caspase-3蛋白高于其余各组（P<0.05）,N组低于T1组（P<0.05）,T1组高于T3组（P<0.05）。 结论：鸢尾素可能通过减少Bax、Caspase-3蛋白表达,升高Bcl-2/Bax值来减轻神经细胞凋亡且与鸢尾素注射剂量相关。     

脉冲电磁场对去卵巢大鼠Runt相关转录因子2表达的影响

目的 观察脉冲电磁场(PEMFs)对去卵巢大鼠骨细胞Runt相关转录因子2(Runx2)表达的影响,并探讨PEMFs治疗骨质疏松可能的作用机制。 方法 将60只Sprague Dawley（SD）雌性大鼠按随机数字表法分成假手术对照组（Sham组）、去卵巢组（OVX组）、去卵巢+阿伦磷酸钠药物治疗组（ALN组）、去卵巢+脉冲电磁场治疗组（PEMFs组）,每组15只大鼠,按文献方法,Sham组切除双侧卵巢周围脂肪组织,其余各组大鼠切除双侧卵巢制成骨质疏松模型。手术结束后第30天,ALN组大鼠开始给予阿伦磷酸钠灌胃,PEMFs治疗组大鼠予以PEMFs治疗,Sham组和OVX组不干预。各组动物均于干预30d后采用腹腔注射戊巴比妥钠处死,取股骨行骨密度检测;采用Western bloting检测Runx2蛋白表达量;采用q-PCR检测Runx2 mRNA表达量。 结果 干预30d后,PEMFs组的骨密度值、Runx2蛋白表达水平和Runx2 mRNA表达水平较OVX组均有明显升高,差异有统计学意义（P<0.05）;但PEMFs组的骨密度值、Runx2蛋白表达水平和Runx2 mRNA表达水平与ALN组比较,组间差异均无统计学意义(P>0.05)。 结论 PEMFs可上调去卵巢SD雌性大鼠的Runx2蛋白和mRNA表达水平,可能是PEMFs治疗骨质疏松的机制之一。     

运动诱导甘丙肽分泌对2型糖尿病大鼠胰岛素敏感性的影响

目的：探讨运动后甘丙肽(GAL)分泌增加对2型糖尿病大鼠大鼠胰岛素敏感性的影响。方法：糖尿病大鼠随机分4组：安静对照组、运动对照组、安静用药组、运动用药组。安静对照组及运动对照组均腹腔注射生理盐水,安静用药组及运动用药组腹腔注射GAL。快速血糖仪测空腹血糖以计算胰岛素抵抗指数,Western Blot 法检测骨骼肌葡萄糖转运蛋白4（GLUT4）含量。结果：运动对照组与安静对照组以及运动用药组与安静用药组相比较,正糖钳的葡萄糖输注速率显著性增加（P<0.05）;安静用药组及运动用药组实验后比实验前血清胰岛素均显著增加（P<0.05）,安静用药组实验后比实验前胰岛素敏感指数有非常显著下降（P<0.01）;运动对照组比安静对照组骨骼肌GLUT4蛋白含量非常显著性提高（P<0.01）,运动用药组比安静用药组GLUT4蛋白含量显著性提高（P<0.05）。结论：运动诱导GAL浓度增加,可能主要依靠增加GLUT4膜转运量或提高GLUT4活性来提高胰岛素敏感性。     

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。     

脉冲电磁场对椎间盘退行性病变大鼠A2A腺苷受体及p38 MAPK信号通路的影响

目的 观察脉冲电磁场（PEMF）对椎间盘退行性病变（IDD）大鼠A2A腺苷受体（A2AR）及p38 MAPK信号通路的影响。 方法 采用随机数字表法将40只SD大鼠分为对照组、IDD模型组（简称模型组）、PEMF组和PEMF联合CGS-21680治疗组（简称观察组）。将模型组、PEMF组及观察组大鼠制成IDD动物模型，PEMF组于制模后给予PEMF干预，观察组则给予PEMF干预并注射A2AR激动剂CGS-21680。于造模8周后采用番红O-快绿染色评估各组大鼠椎间盘病理改变，同时检测各组大鼠椎间盘A2AR、环磷酸腺苷（cAMP）、蛋白激酶A(PKA)、半胱氨酸天冬氨酸蛋白水解酶-3（Caspase-3）、Ⅱ型胶原（Col-Ⅱ）、基质金属蛋白酶-3（MMP3）表达水平。 结果 模型组大鼠髓核组织皱缩，纤维成分及软骨细胞增多，观察组大鼠髓核形态基本趋于正常，纤维环完整无破裂。模型组椎间盘组织A2AR蛋白表达及mRNA水平均高于对照组，观察组A2AR蛋白表达及mRNA水平均显著高于其他各组（P<0.05）。PEMF组和观察组椎间盘cAMP含量及PKA mRNA表达均较模型组增高，且观察组与模型组间差异具有统计学意义（P<0.05）。模型组大鼠椎间盘p38 MAPK、p-p38 MAPK含量及p-p38 MAPK/p38 MAPK比值均显著高于对照组（P<0.05），PEMF组和观察组p38 MAPK、p-p38 MAPK蛋白含量及p-p38 MAPK/p38 MAPK比值均有不同程度降低，且观察组上述指标数值均显著低于模型组（P<0.05），p-p38 MAPK蛋白含量及p-p38 MAPK/p38 MAPK比值亦显著低于PEMF组（P<0.05）。模型组大鼠Caspase-3蛋白含量及mRNA表达均显著高于对照组，PEMF组及观察组上述指标含量均较模型组明显降低（P<0.05）。模型组大鼠MMP3含量较对照组显著升高，Col-Ⅱ含量则明显下降；PEMF组、观察组MMP3含量均较模型组降低，Col-Ⅱ表达均较模型组增高，并且观察组上述指标含量与模型组间差异均具有统计学意义（P<0.05）。 结论 炎性因子刺激能活化p38 MAPK信号通路并诱导细胞凋亡，这也是促进IDD大鼠病变的重要原因之一。PEMF联合A2AR激动剂干预能激活A2AR/cAMP/PKA信号通路，进而抑制p38 MAPK磷酸化，减少髓核细胞凋亡，缓解IDD损伤。     

丹参多酚酸盐及神经肽Y干预后癫痫大鼠海马神经肽Y的表达变化

目的探讨丹参多酚酸盐及神经肽Y（neuropeptide-Y,NPY）干预注射对海马NPY的表达影响研究。方法采用匹鲁卡品（PILO）诱发癫痫模型,随机分为NPY干预组、丹参多酚酸盐干预组、盐水干预组和对照组,观察各组大鼠的行为学改变,用免疫组织化学法标记显示各组大鼠脑内海马NPY的表达变化。结果在海马门区、CA3区、CA1区有NPY阳性细胞表达,生理盐水及丹参多酚酸盐干预组可见颗粒细胞中NPY的异位表达。干预方法不同,海马NPY阳性细胞数表达不同,生理盐水（NS）、丹参多酚酸盐干预组NPY阳性细胞数高于对照组,差异有统计学意义（P〈0.05）;丹参多酚酸盐组高于生理盐水干预组,差异有统计学意义（P〈0.05）。结论 NPY有抗癫痫作用。丹参多酚酸盐可以明显降低急性癫痫痉挛性大鼠的发作等级和发作时间,可能通过NPY的表达增高来发挥治疗作用。     

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。     

不同运动量对2型糖尿病大鼠肝脏Toll样受体4和核转录因子κ9-B表达的影响

目的探讨不同运动量对2型糖尿病大鼠肝脏Toll样受体4（TLR4）和核转录因子9-κB（NF9-κB）表达的影响。 方法将50只SD入选大鼠按随机数字表法分为对照组、糖尿病模型组（DM组）和糖尿病小运动量组(LIE组)、糖尿病中等运动量组(MIE组)、糖尿病大运动量组(HIE组),每组10只。对照组给予普通膳食,其余4组给予高脂高糖膳食并用小剂量链脲佐菌素（STZ）腹腔注射建立2型糖尿病大鼠模型,然后LIE组、MIE组和HIE组分别采用40%、70%和100%的力竭时间进行游泳训练,每日1次,每周6d,共运动干预6周。由于感染和游泳溺水等原因,运动干预结束后大鼠共存活41只,其中对照组10只,DM组8只,LIE组8只,MIE组8只,HIE组7只。运动干预结束后检测大鼠体重、肝重和空腹血糖,采用RT9-PCR技术测定肝脏TLR4和NF9-kB的mRNA表达,采用免疫组化技术测定肝脏TLR4和NF9-kB的蛋白表达。 结果①干预6周后,糖尿病模型各组（DM组、LIE组、MIE组、HIE组）大鼠的体重［（265.00±21.00）、（274.00±22.00）、（286.00±14.00）和（271.00±21.00）g］和肝重［（12.64±1.03）、（12.84±0.85）、（12.65±0.98）和（12.11±0.67）g］显著低于对照组［（567.00±26.00）g体重和（18.04±2.25）肝重g］,差异有统计学意义（P<0.05);而糖尿病模型各组大鼠的空腹血糖值［（29.51±3.48）、（23.64±2.39）、（15.45±1.36）和（25.54±2.48）mmol/L］显著高于对照组［（5.77±0.57）mmol/L］,差异亦有统计学意义（P<0.05）;与DM组比较,糖尿病模型各运动组的体重和肝重变化差异无统计学意义（P>0.05）,但各运动组的血糖有不同程度的降低,差异有统计学意义（P<0.05）;其中MIE组大鼠的空腹血糖值与HIE组和LIE组相比,降低最为显著,组间差异有统计学意义（P<0.05）。②干预6周后,糖尿病模型各组大鼠的肝脏TLR4和NF9-κB mRNA的表达明显高于对照组（P<0.05);与DM组比较,各运动组均出现不同程度的降低（P<0.05）;与HIE组和LIE组相比,MIE组降低最为显著,组间差异有统计学意义（P<0.05）。③干预6周后,对照组肝组织内TLR4和NF9-κB蛋白呈阴性或弱阳性表达,而糖尿病各组大鼠肝脏中TLR4和NF9-κB呈强阳性表达,且表达均明显高于对照组（P<0.05);DM组比较,TLR4和NF9-κB蛋白在各运动组中的表达出现不同程度的降低（P<0.05）;与HIE组和LIE组相比,MIE组降低最为显著（P<0.05）。 结论有氧运动能够降低2型糖尿病大鼠的血糖,减少肝脏TLR4和NF9-kB的mRNA及蛋白的表达;中等运动量组的干预效果明显优于小运动量组和大运动量组。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.