电针刺复合丹参对缺血-再灌注心肌的保护作用

目的:观察电针刺和丹参对缺血-再灌注后心肌细胞热休克蛋白70(Hsp70)mRNA表达和体内多巴胺含量的影响,探讨电针刺和丹参之间的相互作用.方法:24只中国大耳白兔随机分为对照组(缺血-再灌注组)、电针刺组、丹参组和电针刺 丹参组4组,每组各6只.采用夹闭心脏冠状动脉前降支30 min后松解2 h制成缺血-再灌注模型.术中分别采取电针刺激和静脉给予丹参的处理.在缺血前、缺血30 min和再灌注2 h分别取静脉血测定血中多巴胺含量;取缺血区和非缺血区心肌组织用逆转录聚合酶链(PT-PCR)方法测定Hsp70 mRNA的表达;观察电针刺和丹参对Hsp70 mRNA表达及血中多巴胺含量的影响.结果:电针刺组和丹参组心肌Hsp70 mRNA的表达与对照组相比均有明显增加(P均<0.05),而血中多巴胺含量与对照组相比则均有明显的降低(P<0.05);与电针刺组和丹参组相比,电针刺 丹参组的变化则更为显著(P均<0.05).结论:电针刺和丹参对缺血-再灌注后心肌Hsp70 mRNA表达有显著的增强作用,能抑制缺血-再灌注后体内多巴胺含量的增加;并且电针刺和丹参之间有相互协同效应.     

电针刺复合丹参对缺血再灌注心肌的协同保护作用

背景：电针刺和丹参均具有防冶缺血再灌注损伤的作用，但当两者同用时是否可产生协同作用。目的：探讨电针刺和丹参对缺血再灌注后具有心肌保护作用的心肌细胞热休克蛋白70mRNA表达以及心肌损伤的标志多巴胺水平的影响，以及电针刺和丹参之间的相互作用。设计：两因素析因设计。单位：上海第二医科大学附属仁济医院麻醉科。材料：实验于2001-09／2002-12在仁济医院动物实验室进行。取康新西兰白兔24只，随机分为4组，每组6只：（!）缺血再灌注组。②电针组。③丹参组。④电针＋丹参组。方法：①缺血再灌注组：采用夹闭心脏冠状动脉前降支30min后松解2h制成缺血再灌注模型。②电针组：同前造模，在缺血前20min电针刺“内关”，“云门”，“列缺”，电压0．8V，频率3．0～4．0Hz。③丹参组：同前造模，缺血前静脉单次注射丹参1．5mg／kg，灌注前和灌注后分别单次注射丹参1．0ms／ks。④电针刺＋丹参组：同前造模，既电针又给药。在缺血前，缺血30min和再灌注2h分别取各组免静脉血测定血中多巴胺的含量；取缺血区和非缺血区心肌热休克蛋白70mRNA的表达通过反转录一聚合酶链反应方法测定。结果：经补充后24只兔进入结果分析。①心肌热休克蛋白70mRNA的表达：各组缺血再灌注后均较缺血前显著增加（P〈0．01），其他3组均高于缺血再灌注组（P〈0．05），电针＋丹参组高于电针组和丹参组（F=4．48，P〈0．05）。②多巴胺水平：各组缺血再灌注后均较缺血前显著升高（P〈0．01），其他3组缺血30min和再灌注2h时血中多巴胺水平显著低于缺血再灌注组（P〈0．05），电针＋丹参组低于电针组和丹参组（F=5．95，P〈0．05）。结论：①电针刺和丹参都能激发缺血再灌注后热休克蛋白70mRNA的表达，增强热休克蛋白70的蛋白稳定作用，减轻心肌损害。②电针刺和丹参能抑制缺血再灌注后体内多巴胺含量的增加，减少多巴胺介导的损伤，保护心肌。③电针刺和丹参之间有相互协同效应。     

电针刺复合丹参对缺血再灌注心肌的协同保护作用

背景电针刺和丹参均具有防治缺血再灌注损伤的作用,但当两者同用时是否可产生协同作用. 目的探讨电针剌和丹参对缺血再灌注后具有心肌保护作用的心肌细胞热休克蛋白70 mRNA表达以及心肌损伤的标志多巴胺水平的影响,以及电针刺和丹参之间的相互作用. 设计两因素析因设计. 单位上海第二医科大学附属仁济医院麻醉科. 材料实验于2001-09/2002-12在仁济医院动物实验室进行.取康新西兰白兔24只,随机分为4组,每组6只①缺血再灌注组.②电针组.③丹参组.④电针+丹参组. 方法①缺血再灌注组采用夹闭心脏冠状动脉前降支30 min后松解2 h制成缺血再灌注模型.②电针组同前造模,在缺血前20 min电针刺"内关","云门","列缺",电压0.8 V,频率3.0～4.0 Hz.③丹参组同前造模,缺血前静脉单次注射丹参1.5 mg/kg,灌注前和灌注后分别单次注射丹参1.0 mg/kg.④电针剌+丹参组同前造模,既电针又给药.在缺血前,缺血30 min和再灌注2 h分别取各组兔静脉血测定血中多巴胺的含量;取缺血区和非缺血区心肌热休克蛋白70 mRNA的表达通过反转录-聚合酶链反应方法测定.结果经补充后24只兔进入结果分析.①心肌热休克蛋白70 mRNA的表达各组缺血再灌注后均较缺血前显著增加(P＜0.01),其他3组均高于缺血再灌注组(P＜0.05),电针+丹参组高于电针组和丹参组(F=4.48,P＜0.05).②多巴胺水平各组缺血再灌注后均较缺血前显著升高(P＜0.01),其他3组缺血30 min和再灌注2 h时血中多巴胺水平显著低于缺血再灌注组(P＜0.05),电针+丹参组低于电针组和丹参组(F=5.95,P＜0.05). 结论①电针刺和丹参都能激发缺血再灌注后热休克蛋白70 mRNA的表达,增强热休克蛋白70的蛋白稳定作用,减轻心肌损害.②电针剌和丹参能抑制缺血再灌注后体内多巴胺含量的增加,,减少多巴胺介导的损伤,保护心肌.③电针刺和丹参之间有相互协同效应.     

电针合用尼卡地平对心肌再灌注损伤的协同保护作用

目的：观察电针合用尼卡地平对心肌缺血再灌注损伤后心肌炎症损害、线粒体受损程度的作用结果。方法：①实验于2002-12／2004-12在上海第二医科大学附属仁济医院动物实验中心完成。选用24只雄性新西兰白兔。24只新西兰白兔被随机分为4组：对照组、电针组、尼卡地平组、电针＋尼卡地平组，每组6只。②各组兔均结扎冠状动脉左前降支造成急性心肌缺血再灌注损伤动物模型。对照组：套扎冠状动脉左前降支30min，松开再灌注2h。电针组：静脉麻醉诱导完成后刺激内关（采用电针刺激仪，电针刺激频率为5Hz，缓慢调节输出强度到3V），约30min后开始肋骨切开，术中维持。尼卡地平组：冠状动脉左前降支结扎前10min至实验结束持续静脉注射尼卡地平【1μg/（kg&;#183;min）】。电针＋尼卡地平组：联合给予电针和尼卡地平，剂量和方法同电针组和尼卡地平组。（3）于冠状动脉结扎前即刻、灌注前即刻、灌注2h 3个时间点采用NAC-act法测定血浆的肌酸磷酸激酶水平。于再灌注2h采用化学发光法测定血浆白细胞介素8水平；采用高效液相色谱测定血浆肾上腺素和去甲肾上腺素水平；以Bradford方法定量线粒体蛋白浓度，放射免疫γ计数器测定1mL线粒体溶液γ记数。④每组内各时间点的肌酸磷酸激酶差异用单因素方差分析分析，各时间点两两比较用Dunnett’s检验（结扎前即刻作为控制时间点）。电针和尼卡地平对灌注2h血浆肌酸磷酸激酶，白细胞介素8，应激激素（肾上腺素和去甲肾上腺素）和^99Tc^m-甲氧基异丁基异腈的交互作用使用2&;#215;2析因分析，各组间差异用单因素方差分析并用LSD’s方法进行组间两两比较。结果：新西兰兔24只均进入结果分析。①血浆肌酸磷酸激酶水平：各组结扎前即刻均低于灌注前即刻和再灌注2h（P〈0．05），对照组、电针组、尼卡地平组再灌注2h明显高于电针＋尼卡地平组（P〈0．05），电针组和尼卡地平组再灌注2h明显低于对照组（P〈0．05）。②血浆白细胞介素8水平：电针组和电针＋尼卡地平组明显低于对照组和尼卡地平组（P〈0．05）。（3）血浆肾上腺素和去甲肾上腺素水平：电针组和电针＋尼卡地平组明显低于对照组和尼卡地平组（P〈0．05），尼卡地平组与对照组差异不明显。④心肌线粒体^99Tc^m-甲氧基异丁基异腈摄取率：电针＋尼卡地平组明显高于其他3组（P〈0．05）。电针组和尼卡地平组明显高于对照组（P〈0．05）。结论：①电针内关抑制应激激素和白细胞介素8的释放，减轻心肌缺血再灌注损伤炎症反应和线粒体损害程度。②电针合用尼卡地平对心肌保护有协同作用。     

电针合用尼卡地平对心肌再灌注损伤的协同保护作用

目的观察电针合用尼卡地平对心肌缺血再灌注损伤后心肌炎症损害、线粒体受损程度的作用结果。方法①实验于2002-12/2004-12在上海第二医科大学附属仁济医院动物实验中心完成。选用24只雄性新西兰白兔。24只新西兰白兔被随机分为4组对照组、电针组、尼卡地平组、电针+尼卡地平组,每组6只。②各组兔均结扎冠状动脉左前降支造成急性心肌缺血再灌注损伤动物模型。对照组套扎冠状动脉左前降支30m in,松开再灌注2h。电针组静脉麻醉诱导完成后刺激内关(采用电针刺激仪,电针刺激频率为5H z,缓慢调节输出强度到3V),约30m in后开始肋骨切开,术中维持。尼卡地平组冠状动脉左前降支结扎前10min至实验结束持续静脉注射尼卡地平[1μg/(kg·m in)]。电针+尼卡地平组联合给予电针和尼卡地平,剂量和方法同电针组和尼卡地平组。③于冠状动脉结扎前即刻、灌注前即刻、灌注2h3个时间点采用NAC-act法测定血浆的肌酸磷酸激酶水平。于再灌注2h采用化学发光法测定血浆白细胞介素8水平;采用高效液相色谱测定血浆肾上腺素和去甲肾上腺素水平;以Bradford方法定量线粒体蛋白浓度,放射免疫γ计数器测定1m L线粒体溶液γ记数。④每组内各时间点的肌酸磷酸激酶差异用单因素方差分析分析,各时间点两两比较用Dunnett’s检验(结扎前即刻作为控制时间点)。电针和尼卡地平对灌注2h血浆肌酸磷酸激酶,白细胞介素8,应激激素(肾上腺素和去甲肾上腺素)和99Tcm-甲氧基异丁基异腈的交互作用使用2×2析因分析,各组间差异用单因素方差分析并用LSD’s方法进行组间两两比较。结果新西兰兔24只均进入结果分析。①血浆肌酸磷酸激酶水平各组结扎前即刻均低于灌注前即刻和再灌注2h(P<0.05),对照组、电针组、尼卡地平组再灌注2h明显高于电针+尼卡地平组(P<0.05),电针组和尼卡地平组再灌注2h明显低于对照组(P<0.05)。②血浆白细胞介素8水平电针组和电针+尼卡地平组明显低于对照组和尼卡地平组(P<0.05)。③血浆肾上腺素和去甲肾上腺素水平电针组和电针+尼卡地平组明显低于对照组和尼卡地平组(P<0.05),尼卡地平组与对照组差异不明显。④心肌线粒体99Tcm-甲氧基异丁基异腈摄取率电针+尼卡地平组明显高于其他3组(P<0.05)。电针组和尼卡地平组明显高于对照组(P<0.05)。结论①电针内关抑制应激激素和白细胞介素8的释放,减轻心肌缺血再灌注损伤炎症反应和线粒体损害程度。②电针合用尼卡地平对心肌保护有协同作用。     

电针刺激辅助低温对猪缺血—再灌注损伤心肌功能的保护作用

目的：在猪心肌缺血－再灌注模型上观察电针刺激和低温对再灌注损伤心肌的保护作用。方法：18头小型狸建立急性心肌缺血模型,随机分为3组;对照组、针刺组和针刺加低温（34℃）组（n=6),于缺血前10分钟、缺轿20分钟和再灌注20、60分钟自左心耳取标本,应用Reagent试剂抽提组织总RNA,经逆转录聚合酶链反应（RT－PCR）扩增后,对HSP70mRNA进行定量,经静脉抽取样本,测定肌酸磷酸激酶及基同工酶（CPK、CPK－MB）,静脉血乳酸,超氧化物歧化酶（SOD）和丙二醛（MDA）。采用超声多普勒测定冠状动脉血液量（CAF）。结果①再灌20洲60分钟时,对照组SOD逐步降低（P＜0．01）,针刺组和地刺加低温组SOD值有升高趋势;对照组MDA明显高于针刺组和针刺加低温组。②组CPK,CPK－MB和血乳酸值均较对照组明显升高（P＜0．05和P＜0．01）,对照组的升高幅度明显大于针刺和针刺加低温组。③再灌注60分钟时对照组HSP70mRNA表达率低于针刺组和针刺加低温组。结论：电针刺激可拮抗缺血－再灌注造成的心肌损伤;针刺和低温对心肌保护有协同作用,其机制与抗氧化能力的增加以及HSP70的转录合成增强有关。     

尼卡地平联合异丙酚预处理对沙鼠缺血后再灌注神经细胞凋亡的影响

目的　探讨尼卡地平联合异丙酚预处理对缺血后再灌注神经细胞凋亡的影响 ,并检测经尼卡地平和异丙酚联合预处理后的沙土鼠脑组织中抑凋亡基因Bcl 2的表达。方法　采用夹闭沙土鼠双侧颈总动脉造成脑缺血模型。 5 0只健康成年沙土鼠随机分成五组 ,每组各 1 0只 :假手术对照组 (A组 ) ;脑缺血对照组 (B组 ) ,全脑缺血 5min后再灌注 72h ;尼卡地平预处理组 (C组 ) ;异丙酚预处理组 (D组 ) ;尼卡地平联合异丙酚预处理组 (E组 )。C、D、E三组缺血前 30min分别静脉给予尼卡地平 0 2mg/kg、腹腔注射异丙酚 1 0 0mg/kg以及两者同时联合处理 ,缺血 5min后分别再灌注 72h。实验终末 ,断头取脑 ,石蜡切片 ,采用DNA末端标记技术 (TUNEL法 )观察各组脑细胞凋亡的变化情况并采用免疫组化染色评定Bcl 2蛋白反应强度。结果　E组的凋亡细胞百分数明显低于其他各组 ,而Bcl 2蛋白免疫反应强度高于其它各组(P <0 0 5 )。结论　短暂性脑缺血再灌注后有细胞凋亡发生 ,脑缺血前经尼卡地平联合异丙酚预处理后 ,能明显减少细胞凋亡的发生 ,此与Bcl 2蛋白表达增强有关。     

超声微泡介导尼卡地平对大鼠缺血再灌注心肌细胞凋亡及相关基因表达的影响

目的探讨超声破坏微泡介导尼卡地平对大鼠急性缺血再灌注心肌细胞凋亡及相关基因Bcl-2,Bax表达的影响。方法60只SD大鼠随机分空白对照、假手术、缺血再灌注、尼卡地平、超声微泡、超声微泡介导尼卡地平六组。阻断左冠状动脉前降支40min,再灌注120min,建立在体急性心肌缺血再灌注模型。TUNEL法检测凋亡心肌细胞,SABC免疫组化法检测Bcl-2、Bax基因表达。结果缺血再灌注诱导心肌细胞凋亡,尼卡地平可减少其发生,上调Bcl-2基因表达,下调Bax基因表达,超声微泡介导可进一步减少凋亡发生。结论尼卡地平可上调Bcl-2并下调Bax基因表达,升高Bcl-2/Bax比值,显著减少缺血再灌注诱导心肌细胞凋亡,通过超声微泡介导,可增强尼卡地平抗凋亡作用。     

脑缺血/再灌注后缺血核心区皮质内MCP-1mRNA和蛋白质表达

目的　观察大鼠脑缺血 /再灌注后缺血核心区皮质内单核细胞趋化蛋白 (MCP) - 1mRNA和蛋白质表达情况。方法　用半定量的逆转录PCR(RT -PCR)法测定缺血 2h再灌注不同时间缺血核心区脑皮质内MCP - 1mRNA的表达 ,ELISA法测定MCP - 1含量的变化。结果　缺血核心区脑皮质内MCP - 1的mRNA表达于缺血 2h明显升高 ,再灌注后 16h达高峰(均值是缺血 2h组的 2 2倍 ,与缺血 2h组相比差异显著 ,P <0 0 1) ,此后仍维持较高水平的表达直至再灌注后 4 8h(与假手术组相比 ,P <0 0 5 ) ;MCP - 1含量于再灌注后 6h开始升高 (均值 2 2 5ng/g组织 ,是假手术组的 17 0倍 ,P <0 0 5 ) ,此后逐渐升高 ,4 8h达到高峰 (均值 110 9ng/g组织 ,是假手术组的 83 7倍 ,P <0 0 1)。结论　脑缺血 /再灌注后缺血核心区皮质内MCP - 1的mRNA和蛋白质表达均明显增加 ,提示MCP - 1在脑缺血 /再灌注损伤中发挥重要作用     

沙土鼠脑缺血后再灌注神经细胞凋亡与参附注射液联合尼卡地平预处理的影响

目的:检测经参附注射液和尼卡地平联合预处理后的沙土鼠脑组织中抑凋亡基因bcl-2的表达,探讨参附注射液联合尼卡地平预处理对脑缺血后再灌注神经细胞凋亡的影响。方法:实验于2005-07/09在河南大学麻醉与危重病医学研究所完成。50只健康成年沙土鼠随机分成5组,每组10只。①假手术对照组:只进行分离颈部血管,不夹闭双侧颈总动脉。②脑缺血对照组:夹闭沙土鼠双侧颈总动脉造成脑缺血模型。全脑缺血5min后再灌注72h。③尼卡地平预处理组:缺血前30min静脉给予尼卡地平0.2mg/kg。④参附注射液预处理组:缺血前30min腹腔注射参附注射液10mL/kg。参附注射液主要成份为人参皂甙和乌头碱,分别为红参和黑附片的提取物。⑤参附注射液联合尼卡地平预处理组:缺血前30min腹腔注射参附注射液10mL/kg,同时静脉给予尼卡地平0.2mg/kg。后3组缺血5min后分别再灌注72h。实验结束后快速断头取脑,石蜡切片,采用DNA末端标记技术(TUNEL法)观察各组脑细胞凋亡的变化情况并采用免疫组化染色评定bcl-2蛋白反应强度。结果:实验沙土鼠50只全部进入结果分析。①凋亡细胞所占比例:参附注射液联合尼卡地平组低于参附注射液组、尼卡地平组和脑缺血对照组,差异有显著性意义[(18.7±3.1)%,(42.4±3.6)%,(38.0±1.9)%,(72.4±2.2)%,P<0.05],参附注射液组和尼卡地平组相比差异无显著性意义(P>0.05)。②皮层细胞bcl-2蛋白免疫反应强度:参附注射液联合尼卡地平预处理组高于参附注射液预处理组、尼卡地平预处理组和脑缺血对照组,差异有显著性意义(2.70±0.39,1.30±0.78,1.70±0.33,0.90±0.54,P<0.05),参附注射液预处理组与尼卡地平预处理组相比,差异无显著性意义(P>0.05)。结论:脑缺血前经参附注射液联合尼卡地平预处理后,能明显减少细胞凋亡的发生,可能与bcl-2蛋白表达增强有关。     

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.     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.