高浓度胰岛素对阿司匹林抑制的血小板中TXB2合成影响的研究

目的：探讨高浓度胰岛素是否影响阿司匹林抑制的血小板中TXB2合成。方法将制备的两组等体积的富含血小板血浆（PRP）分别加入浓度为30μU/ml和300μU/ml的胰岛素，37℃的环境下孵育3min，再次将上述两组的PRP分成等体积，分别用浓度为0、75μmol/L、150μmol/L和300μmol/L的阿司匹林处理，于37℃的环境下继续孵育30min，加入ADP 5min后，用吲哚美辛和柠檬酸葡萄糖封闭血小板反应；用血小板聚集仪检测各组的血小板最大聚集率，酶联免疫吸附法检测血小板中TXB2的含量。结果胰岛素300μU/mL组与30μU/mL组比较，前者可明显升高经阿司匹林作用后的血小板最大聚集率（P〈0.05），且明显增加血小板中TXB2的合成（P〈0.05）。结论高浓度胰岛素可减弱阿司匹林抑制的血小板TXB2合成作用。     

血清总胆红素与系统性红斑狼疮活动性的关系

目的探讨系统性红斑狼疮（SLE）患者血清中总胆红素（TBIL）水平与疾病活动程度的关系与意义。方法用重氮盐改良J-G法检测和比较分析54例SLE患者和50名健康人血清TBIL的水平。结果SLE患者组血清TBIL水平[（9．80±4．98）μmol／L]比健康对照组[（13．54±5．20）μmol／L]明显降低（P〈0．001）；经糖皮质激素治疗后血清TBIL浓度[（12．83±5．18）μmol／L]与治疗前[（5．79±3．73）μmol／L]相比，差异有显著意义（P〈0．001）；活动期SLE血清TBIL水平[（5．93±3．78）μmol／L]低于非活动期[（8．93±4．18）μmol／L（P〈0．05）；蛋白尿组[（6．64±3．56）μmol／L]低于非蛋白尿组[（9．30±4．36）μmol／L]（P〈0．05）；血管炎组[（6．32±4．31）μmol／L]和非血管炎组[（9．96±5．03）μmol／L]之间相比有明显显著意义（P〈0．001）。结论TBIL可能参与SLE的发病机制，TBIL的血清水平可作为反映SLE活动程度、肾脏损害以疾病进展或改善的指标。     

老年帕金森病患者血清同型半胱氨酸及血尿酸水平与认知功能障碍的相关性

目的探讨血清同型半胱氨酸（Hcy）和血尿酸（UA）的水平与帕金森病（PD）患者认知功能障碍的相关性。方法检测58例帕金森病患者和50例健康老人的血清同型半胱氨酸及血尿酸水平,采用简易精神状态检查（MMSE）量表对老年 PD 患者进行认知功能评分。结果老年帕金森病组的 Hcy 浓度[（25．89±3．01）μmol／L]显著高于健康老年组[（13．29±2．13）μmol／L]（P ＜0．01）;血尿酸水平显著低于健康老年组[（267．34±68．43）μmol／L 比（341．26±52．75）μmol／L,P ＜0．01],并且 PD 伴认知障碍组的 Hcy 浓度显著高于 PD 无认知障碍组[（29．54±4．35）μmol／L 比（20．78±3．17）μmol／L ,P ＜0．05],PD 伴认知障碍组的血尿酸水平显著低于 PD 无认知障碍组[（245．10±55．61）μmol／L 比（302．21±52．31）μmol／L ,P ＜0．05]。结论老年帕金森病患者会出现血清同型半胱氨酸水平升高及血尿酸水平的降低,其变化与程度认知功能障碍的发生有一定关联度。     

氯吡格雷抵抗的发生率、影响因素及干预策略研究

目的通过检测冠心病患者二磷酸腺苷（adenosine diphosphate,ADP）诱导的血小板聚集、血浆P选择素（CD62P）浓度及可溶性CD40配体（sCD40L）的浓度,了解氯吡格雷抵抗在冠心病患者的发生率及影响因素,探讨氯吡格雷抵抗的干预策略。方法130例受选对象在服用氯吡格雷75mg／d前、服药5天后,测定血小板聚集（platelet aggregation）、CD62P浓度及sCD40L的浓度。根据ADP诱导的血小板聚集降低程度分为氯吡格雷抵抗组和非氯吡格雷抵抗组。对氯吡格雷抵抗患者随机分为氯吡格雷剂量加倍（150mg／d）和维持原有剂量两组,5天后重复测定血小板聚集率、血浆CD62P浓度及sCD40L浓度。结果服用氯吡格雷5天后测得氯吡格雷抵抗的发生率分别为16．2％（ADP10μmol／L）和14．6％（ADP20μmol／L）。对氯吡格雷抵抗患者剂量加倍干预5天后测得剂量加倍组的血小板聚集为（8．1±3．1）Ω,较服氯前（10．9±3．6）Ω有所降低（P〈0．05）;维持剂量组的血小板聚集为（7．4±5．7）Ω,较服氟前（9．9±5．1）Ω有所降低,但差异无统计学意义（P〉0．05）。剂量加倍组中氯吡格雷抵抗患者由10例降低为3例（30．0％）,维持原剂量组中氯吡格雷抵抗患者由9例降低为5例（55．6％）。结论氯吡格雷的抗血小板作用存在时间和剂量依赖性。     

丹参酮ⅡA磺酸钠影响血管紧张素Ⅱ诱导心肌肥大及p-JNK和丝裂原活化蛋白激酶磷酸酶1的表达

目的：观察丹参酮ⅡA衍生物-丹参酮ⅡA磺酸钠对血管紧张素Ⅱ诱导的心肌肥大及p-JNK，丝裂原活化蛋白激酶磷酸酶1表达的影响。 方法：实验于2005-11／2006-03于华中科技大学同济医学院实验中心完成。取ld龄新生清洁级Wistar乳鼠10只。雌雄不拘，取心室肌组织分离培养新生大鼠心肌细胞，将细胞均匀地接种于6孔培养板，每孔2mL。第3天将培养的细胞分为5组，即对照组。血管紧张素Ⅱ组，丹参酮ⅡA磺酸钠2，10。50μmol／L组，分别给予相应药物。对照组给予生理盐水，其余各组均给予血管紧张素Ⅱμmol／L进行心肌细胞肥大诱导。在此基础上，丹参酮ⅡA磺酸钠2，10。50μmol／L组再分别给予相应浓度的丹参酮ⅡA磺酸钠，以上浓度为培养基内终浓度。采用考马斯亮蓝法测定心肌细胞蛋白含量；采用[^3H]亮氨酸掺入法测定蛋白合成速率作为心肌肥大指标；用Western-blot测定p-JNK，丝裂原活化蛋白激酶磷酸酶1表达。观察各组心肌细胞总蛋白质含量、[^3H]-亮氨酸掺入测定结果、p-JNK,MKP．1蛋白表达。 结果：①用刺激因素处理24h后，2。10，50μmol／L丹参酮ⅡA磺酸钠组总蛋白含量明显低于血管紧张素Ⅱ组[（65．38&;#177;1．26），（53．41&;#177;3．63），（48．42&;#177;2．61），（80．42&;#177;3．28）μg/孔，P〈0．05—0．011。②1μmol／L血管紧张素Ⅱ作用24h后，2，10，50μmol／L丹参酮ⅡA磺酸钠组心肌细胞合成速率显著低于血管紧张素Ⅱ组[（140．52&;#177;12．04）％，（120．58&;#177;8．72）％。（111．88&;#177;10．06）％，（163．04&;#177;11.38）％。P〈0．011。⑧1μmol／L血管紧张素Ⅱ作用24h后，2，10，50μmol／L丹参酮ⅡA磺酸钠组p—JNK蛋白表达显著低于血管紧张素Ⅱ组[（145．96&;#177;11．98）％，（133．04&;#177;6．54）％，（116．56&;#177;11．61）％，（167．04&;#177;12．72）％，P〈0．05—0．011。④丹参酮ⅡA磺酸钠（10μmol／L）显著上调丝裂原活化蛋白激酶磷酸酶1表达，在40min时达到高峰达（132．16&;#177;7．88）％，随后下降，在60，80min分别为（110．72&;#177;10．94）％。（104．32&;#177;9．55）％，（P〈0．01）。 结论：丹参酮ⅡA磺酸钠可以抑制血管紧张素Ⅱ诱导的心肌细胞肥大，机制可能与上调丝裂原活化蛋白激酶磷酸酶1表达。降低p-JNK表达有关。     

维持性血液透析患者血浆同型半胱氨酸水平及叶酸、维生素B12的干预效果

目的评价补充叶酸（FA）和维生素B12（VitB12）对维持性血液透析（MHD）患者血浆同型半胱氨酸（Hey）水平的影响。方法将61例MHD患者随机分为治疗组（30例）和非治疗组（31例）,治疗组给予FA15mg／d口服,VitB120．15mg／d肌注,疗程为8周。同时测定61例MHD患者和40名正常对照者血浆Hcy浓度和血清FA、VitB12水平。结果MHD患者血浆Hcy水平[（52．6±21．6）μmol／L]明显高于正常对照组[（10．1±3．6）μmol／L]（P〈0．001）。FA、VitB,2治疗8周后,治疗组MHD患者的血清VitB12[（638．9±229．0）ng／L]和FA水平[（17．7±4．6）μg/L）]明显高于非治疗组[（450．3±195．9）ng／L、（7．2±2．3）μg／L]（P〈0．001）,血浆Hcy水平[（28．8±5．5）μmol／L]低于非治疗组[（50．0±18．8）μmol／Lj（P〈0．001）。血浆Hey水平与叶酸、VitB。：水平均呈负相关。结论MHD患者普遍存在高Hcy血症。FA和VitB12能降低血浆Hcy浓度,对预防MHD患者心脑血管疾病的发生具有重要意义。     

苯并[a]芘与铅单独及联合作用对体外神经元存活率及胞核DNA损伤的影响

背景：苯并[a]芘对中枢神经和外周神经具有一定的损伤作用，苯并[a]芘与其他毒物联合神经毒作用的研究处于起始阶段。目的：应用分子生物学技术与神经元培养相结合的手段研究苯并[a]芘、铅单独及联合作用下对体外神经细胞的毒性及胞核DNA的损伤情况。设计：重复测量设计。单位：重庆医科大学劳动卫生教研室和华中科技大学同济医学院职业医学研究所热生物与分子毒理实验室。材料：实验于2003-06／09在华中科技大学同济医学院职业医学研究所热生物与分子毒理实验室完成，选择10只8日龄SD大鼠小脑组织制备原代细胞培养物，分10组培养，每组5个培养皿。按以下分组进行处理：①空白对照组。②溶剂对照组（等量二甲基亚砜＋肝微粒体酶混合物平行处理）。③低浓度铅染毒组（醋酸铅5μmol／L）。④高浓度铅染毒组（醋酸铅50μmol／L）。⑤低浓度苯并[a]芘染毒组（苯并[a]芘5μmol／L＋肝微粒体酶混合物）。⑥高浓度苯并[a]芘染毒组（苯并[a]芘50μmol／L＋肝微粒体酶混合物）。⑦低浓度铅＋低浓度苯并[a]芘联合染毒组。⑧低浓度铅＋高浓度苯并[a]芘联合染毒组。⑨高浓度铅＋低浓度苯并[a]芘联合染毒组。⑩高浓度铅＋高浓度苯并[a]芘联合染毒组。方法：染毒90min，胰酶消化法收集标本，椎虫蓝染色法检测各组细胞存活率；单细胞凝胶电泳法检测各组细胞胞核DNA的损伤情况。主要观察指标：苯并[a]芘、铅单独及联合染毒下体外神经细胞的存活率及胞核DNA的损伤率。结果：①两种浓度的苯并[a]芘、铅单独或联合染毒各组细胞存活率均低于对照组[染毒组为（44．14&;#177;4．80%～（82.40＋2．70）％，对照组为（88．44&;#177;2.53）％～（90．12&;#177;2.23％，P〈0．05～0．01]。②高浓度苯并[a]芘单独染毒组、低浓度铅＋高浓度苯并[a]芘染毒组、高浓度铅＋低浓度苯并[a]芘染毒组、高浓度铅＋高浓度苯并[a]芘染毒组胞核DNA损伤程度均高于对照组[63％（19／30），87％（26／30），80％（24/30），97％（29／30），13％（4／30），20％（6／30），P〈0．01]。结论：苯并[a]芘与铅均有一定的体外神经毒性，且二者有协同作用；苯并[a]芘损害体外培养神经元胞核DNA的能力大于铅。     

多样本分离血小板在ADVIA 2120血细胞分析仪血小板线性验证中的应用

目的分离血小板验证Bayer ADVIA 2120全自动血细胞分析仪的血小板线性范围。方法按IS015189的EP6-A要求,从250份样本中分离血小板对血小板线性范围进行验证。结果任意混合多样本分离血小板取得高浓度血小板,Bayer ADVIA 2120检测血小板批内和天间不精密度为3．0％和3．6％,携带污染率为0．02％,血小板在21～4918×10^9／L范围内呈一项次线性关系。结论可不分血型混合血浆,通过分离、浓缩取得高浓度血小板;Bayer ADVIA 2120全自动血细胞分析仪检测血小板精密,线性良好,线性范围宽,携带污染率低,是一台检测血小板性能良好的全自动血细胞分析仪。     

Na^＋／H^＋交换抑制剂HMA抑制低氧刺激的大鼠肺动脉平滑肌细胞增殖

目的：观察低氧培养对大鼠肺动脉平滑肌细胞增殖的影响。以及Na^＋／H^＋交换抑制剂HMA对此增殖效应的抑制作用。 方法：实验于2004-12／2005-06在第四军医大学病理生理学教研室完成。健康SD大鼠2只，分离培养肺动脉平滑肌细胞，选择3-6代生长良好的细胞在常氧（O2的体积分数为0．21）或低氧（O2的体积分数为0．02）条件下培养，并分别给予0．3，1，3和10μmol／L等不同浓度的HMA（n=8），采用噻唑蓝比色实验和测定细胞总蛋白含量的方法观察细胞增殖情况，同时光镜观察细胞形态并测定培养液上清乳酸脱氢酶活力以反映药物的非特异性细胞毒作用。 结果：实验所用细胞样本均进入结果分析。①体积分数为0．02氧浓度较体积分数为0．05氧浓度下培养的大鼠肺动脉平滑肌细胞生长曲线抬高，低氧刺激24h增殖达到高峰。②体积分数为0．05血清培养使此增殖效应更为显著[噻唑蓝光吸收值无血清常氧组（0．238&;#177;0．011），无血清低氧组（0．280&;#177;0加9），体积分数为0．05血清常氧组（0．313&;#177;0．013），体积分数为0．05血清低氧组（0．389&;#177;0．011）]。③HMA可以抑制增殖，显著降低噻唑蓝吸光度值[对照组（0．391&;#177;0．011），0．3μmol／L组（0．377&;#177;0．010），1μmol／L组（0．328&;#177;0．012），3μmol／L组（0．289&;#177;0．006），10μmol／L组（0．246&;#177;0．007）]。④细胞总蛋白含量也显著降低[对照组、0．3μmol／L组、1μmol／L组、3μmol／L组、10μmol／L组分别为（193．30&;#177;8．51）．（177．63&;#177;821），（166．84&;#177;9．48），（155．72&;#177;10.46）和（135．13&;#177;10．30）mnol／L]。⑤各浓度处理组细胞形态无改变，培养液上清乳酸脱氢酶活力也无明显变化[对照组、0．3μmol／L组、1μmol／L组、3μmol／L组、10μmol／L组分别为（212．23&;#177;8．44），（208．80&;#177;6．37），（209．79&;#177;7．12），（208．77&;#177;7．33），（215．42&;#177;7．81）U／L]，细胞无明显损伤。 结论：0．3-10μmol／L浓度的Na^＋／H^＋交换抑制剂HMA可以有效抑制低氧刺激的大鼠肺动脉平滑肌增殖，此作用不是非特异的细胞毒作用所致。     

药物防护电磁脉冲所致海马神经元损伤的可能性

背景：电磁脉冲照射可引起实验大鼠学习记忆能力下降，并可造成离体海马神经元的胞内钙超载，进而发生坏死和凋亡，物理屏蔽可减轻电磁辐射对实验动物的损伤，但缺乏在细胞模型上进行的药物防护研究。 目的：观察药物防护电磁脉冲致离体海马神经元损伤的可能性。 设计：随机对照动物实验。 单位：承德医学院基础部。材料：实验于2004—01／2005-01分别在军事医学科学院和承德医学院完成。实验动物选用Wistar乳鼠若干只。 方法：断头取脑分离海马组织，进行海马神经元原代培养与鉴定，原代培养的海马神经元经MK801（N-甲基-D-天冬氨酸受体拮抗剂）和尼非地平（L型钙离子通道阻断剂）预处理后进行电磁脉冲照射。电磁脉冲照射条件为6&;#215;10^4V／m，脉冲上升时间20ns，脉宽30μs，频率2．5脉冲／min，作用2min。将培养在特殊培养皿的细胞分为正常对照组、电磁脉冲照射组、MK801 20μmol／L组和MK80 120μmol／L＋尼非地平1μmol／L组。采用MTT法对细胞活力进行测定；FACS法检测细胞凋亡率；Fluo-3-AM荧光探针负载、激光共聚焦显微镜扫描测定神经元胞内游离钙离子浓度[Ca^2＋]i。 主要观察指标：各组细胞内钙超载、细胞活力、细胞调亡的情况比较。 结果：①电磁脉冲组在照射后即刻的[Ca^2＋]i荧光强度显著高于正常对照组，差异有显著性意义[（107．34&;#177;26．14），（54．93&;#177;16．08），P〈0．051；MK80 120μmol／L组比电磁脉冲照射组的[Ca^2＋]i荧光强度有所下降（81．29&;#177;19．96，P〈0．05），而MK801 20μmol／L＋尼非地平1μmol/L组的[Ca^2＋]i荧光强度呈进一步下降趋势（69．82&;#177;25．54，P〈0．05）。但两个给药组的[Ca^2＋]i荧光强度仍高于正常对照（P〈0．05）。②MK801 20μmol／L组和MK801 20μmol／L＋尼非地平1μmol／L组反映细胞增殖活力的吸光度值分别为0．25&;#177;0．06和0．27&;#177;0．07，明显高于电磁脉冲照射组（0．17&;#177;0．08，P〈0．05），但仍低于正常对照组（0．33&;#177;0．08，P〈0．05）。③电磁脉冲照射组在照后即刻的细胞凋亡率显著高于正常对照组，差异有显著性意义[（68．63&;#177;9．04）％，（20．14&;#177;4．34）％，P〈0．011；MK801 20μmol／L组比电磁脉冲照射组的细胞凋亡率有所下降（62．12&;#177;11．08）％。MK801 20μmol／L＋尼非地平1μmol／L组的细胞凋亡率呈进一步下降趋势[（53．69&;#177;13．60）％，P〈0．05）1，但两个给药组的细胞凋亡率仍高于正常对照组（P〈0．01）。 结论：MK801和尼非地平预处理可部分阻断电磁脉冲所致的海马神经元损伤；细胞内钙超载在电磁脉冲损伤机制中发挥重要作用。     

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.