外周血T淋巴细胞亚群和细胞因子在儿童肺炎支原体肺炎诊断中的意义

目的探讨外周血T淋巴细胞亚群(CD4~+、CD8~+T细胞)及细胞因子[白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子(TNF)-α]在儿童肺炎支原体肺炎(MPP)诊断中的意义。方法采用流式细胞仪和酶联免疫吸附试验(ELISA)分别检测153例MPP患儿(疾病组)和122例健康儿童(对照组)外周血CD4~+、CD8~+T细胞比例,IL-6、IL-8、IL-10和TNF-α水平,并对疾病组治疗前、治疗后及疾病组并发胸腔积液伴肺纤维化(纤维化组)与不伴有肺纤维化(非纤维化组)数据进行统计分析。结果疾病组治疗前外周血IL-6、IL-8、IL-10和TNF-ɑ水平及CD8~+T细胞比例均显著高于治疗后和对照组,CD4~+T细胞比例和CD4~+/CD8~+均低于治疗后和对照组,差异有统计学意义(P0.05)。疾病组治疗后外周血IL-6、IL-8、IL-10水平高于对照组,CD4~+、CD8~+T细胞比例低于对照组,差异有统计学意义(P0.05)。纤维化组外周血IL-6、IL-8、IL-10水平和CD8~+T细胞比例高于非纤维化组,CD4~+T细胞比例和CD4~+/CD8~+低于非纤维化组,差异有统计学意义(P0.05)。受试者工作特征曲线表明,IL-6和IL-8辅助诊断肺纤维化的敏感性和特异性较高,敏感性分别为100.0%和92.6%,特异性分别为95.6%和93.0%。结论联合检测外周血CD4~+、CD8~+、CD4~+/CD8~+比例及细胞因子IL-6、IL-8、IL-10和TNF-α水平有助于全面了解MPP患儿治疗前、后免疫功能的变化。外周血IL-6和IL-8最有助于MPP患儿肺纤维化的辅助诊断。     

早期小剂量糖皮质激素治疗对脓毒症休克患者T淋巴细胞亚群的影响分析

目的观察早期小剂量使用糖皮质激素在脓毒症休克治疗中的价值。方法选择2016年7月～2018年7月我院收治的62例脓毒症休克患者为研究对象,采用随机数表法分为两组各31例。对照组进行常规综合抗休克治疗,观察组在脓毒症休克后2d内予以糖皮质激素治疗。比较两组T淋巴细胞亚群状况、炎性指标水平[肿瘤坏死因子-α(TNF-α)、血清降钙元素(PCT)、白介素-6(IL-6)]。结果两组治疗后CD8+、TNF-α、PCT以及IL-6均下降,CD3+、CD4+以及CD4+/CD8+均提高,且观察组变幅大于对照组,差异有统计学意义(P0.05)。结论针对脓毒症休克患者,早期小剂量使用糖皮质激素治疗可改善机体免疫,减轻全身炎症反应,效果确切。     

再生障碍性贫血患者治疗前后免疫T细胞亚群和血清IL-8、IFN-γ、TNF-α水平变化研究

目的探讨再生障碍性贫血患者治疗前后免疫T细胞亚群和血清白细胞介素-8(IL-8)、γ-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)水平的变化。方法 80例再生障碍性贫血患者(研究组)及同期本院体检的32名健康志愿者(对照组),比较治疗前后研究组、对照组免疫T细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)、血清IL-8、IFN-γ、TNF-α水平变化,依据治疗6个月后研究组预后情况分为缓解组和未缓解组,比较两组免疫T细胞亚群和血清IL-8、IFN-γ、TNF-α水平,对再生障碍性贫血患者预后与免疫T细胞亚群和血清IL-8、IFN-γ、TNF-α水平进行相关性分析。结果研究组治疗前CD3~+、CD4~+、CD4~+/CD8~+低于治疗后及对照组,CD8~+、IL-8、IFN-γ、TNF-α高于治疗后及对照组;治疗后CD3~+、CD4~+、CD4~+/CD8~+低于对照组,CD8~+、IL-8、IFN-γ、TNF-α高于对照组(P0.05)。缓解组CD3~+、CD4~+、CD4~+/CD8~+高于未缓解组,CD8~+、IL-8、IFN-γ、TNF-α低于未缓解组(P0.05)。再生障碍性贫血患者预后与CD3~+、CD4~+呈正相关(P0.05),与CD8~+、IL-8、IFN-γ、TNF-α呈负相关(P0.05)。结论再生障碍性贫血患者治疗后可有效调节其免疫T细胞亚群和血清IL-8、IFN-γ、TNF-α水平,且免疫T细胞亚群和血清IL-8、IFN-γ、TNF-α水平变化与其预后存在相关性。     

外周血T淋巴细胞、VEG F、IL-6、IL-8、TNF-α在复方红豆杉胶囊辅助治疗卵巢癌疗效监测中的价值

目的探讨外周血T淋巴细胞亚群、血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)在复方红豆杉胶囊辅助治疗卵巢癌疗效监测中的价值。方法选择2012年3月至2014年4月于该院接受卵巢癌根治术治疗并配合术后化疗的44例卵巢癌患者作为对照组,选择2014年5月至2016年4月于该院接受复方红豆杉胶囊辅助治疗的44例卵巢癌患者作为观察组,比较两组治疗效果,检测治疗前后患者外周血T淋巴细胞亚群CD3+、CD4+、CD8+百分率及CD4+/CD8+的变化,测定患者治疗前后VEGF、IL-6、IL-8、TNF-α水平的变化,统计两组不良反应发生率。结果观察组总缓解率高于对照组(P0.05);治疗前,两组CD3+、CD4+、CD8+百分率及CD4+/CD8+,IL-6、IL-8、TNF-α、VEGF水平比较差异无统计学意义(P0.05),治疗后,观察组CD3+、CD4+百分率及CD4+/CD8+水平高于对照组,IL-6、IL-8、TNF-α、VEGF水平均低于对照组(P0.05);观察组Ⅰ～Ⅱ级胃肠道反应、血尿、白细胞计数减少发生率低于对照组(P0.05)。结论复方红豆杉胶囊在卵巢癌化疗中辅助应用有其增效减毒效应,可上调CD3+、CD4+百分率及CD4+/CD8+水平,下调IL-6、IL-8、TNF-α、VEGF水平,优化化疗效果,减轻不良反应。     

血必净注射液对社区获得性肺炎伴发急性肾损伤的疗效评价

目的 探讨血必净注射液对社区获得性肺炎(CAP)伴发急性肾损伤(AKI)患者的疗效和机制.方法 选择2009 年12 月至2012 年3月收治的CAP 患者,根据RIFLE(危险、损伤、衰竭、肾功能丧失、终末期肾病)诊断标准和肌酐(Cr)水平诊断是否伴发AKI,最终纳入CAP 伴发AKI 患者105 例,按随机原则分为对照组(50 例,给予常规治疗)和血必净组(55 例,在对照组基础上加用血必净注射液每日100 ml,疗程14 d).观察治疗前后两组患者白细胞计数(WBC)、尿素氮(BUN)、Cr、C- 蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-6、IL-10)、外周血T 淋巴细胞亚群和肺炎严重度指数(PSI)≥Ⅳ级、是否发展为严重脓毒症、是否入住重症监护病房(ICU)、机械通气、使用正性肌力药物支持的比例,以及住院时间和30 d 病死率的变化.结果 对照组和血必净组治疗前WBC、BUN、Cr、CRP、TNF-α、IL-6、IL-10、外周血T 淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+ 比值)比较差异均无统计学意义(均P 0.05).对照组和血必净组治疗后WBC、BUN、Cr、CRP、TNF-α、IL-6 均较治疗前明显下降,IL-10、CD3+、CD4+、CD4+/CD8+ 比值较治疗前明显升高,但以血必净组上述指标改善更显著〔WBC( ×109/L):9.5±1.9 12.5±1.7,BUN( mmol/L):5.62±2.10 比7.12±2.12,Cr( mol/L):61.70±18.56 比90.76±23.62,CRP(mg/L):123±32 比206±38,TNF-α(ng/L):38±12 比89±13,IL-6(ng/L):21±6 比37±12,IL-10(ng/L):168±45 比126±32,CD3+:53.5±8.2 比40.5±3.4,CD4+:45.9±3.2 比33.7±5.8,CD4+/CD8+:1.92±0.43 比1.58±0.42,均P ＜0.05〕,CD8+ 比较差异无统计学意义(P ＞0.05).血必净组治疗后PSI 评分≥Ⅳ级(14.5%)、发展为严重脓毒症(9.1%)、入住ICU( 16.4%)、需要机械通气(5.5%)和使用正性肌力药物支持(14.5%)患者的比例均低于对照组(分别为30.0%、20.0%、32.0%、24.0%、28.0%,均P ＜0.01),血必净组住院时间较对照组明显缩短(d:16±5 比20±4,P ＜0.05),30 d 病死率较对照组明显降低(15.4% 比32.0%,P ＜0.01).结论 血必净注射液可以保护CAP 伴发AKI 患者的肾功能并改善其预后,其机制可能是血必净抑制促炎因子的释放和增加抗炎因子的表达以及调节患者免疫功能有关.     

去白细胞红细胞输血对严重创伤患者免疫功能和炎症因子的影响

目的探讨白细胞过滤对严重创伤输血患者免疫功能和炎症因子的影响。方法选择147例创伤患者分为3组,第1组49例输入不含有白细胞的成分血液,第2组49例输入全血,第3组49例未输血,测定3组输血前、输血后1d、7d CD3+、CD4+、CD8+、CD4+/CD8+及细胞比例血清肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6水平。结果输去白红细胞患者在输血后7dCD3+、CD4+、CD8+、CD4+/CD8+与输血前无明显差异。输血后第7天,输去白红细胞患者的CD3+、CD4+、CD8+、CD4+/CD8+比输全血组明显升高(P 0.05)。3组患者在输血后1d血清TNF-α和IL-6比输血前明显升高(P 0.01),输血后7d逐渐下降。输血后第7天,第1组患者血清TNF-α和IL-6均高于输血前(P 0.01,P 0.05)。第2组患者血清TNF-α仍高于输血前(P 0.05),血清IL-6与输血前的差异无统计学意义(P0.05)。第1组输血后7d血清TNF-α和IL-6均高于第2组和第3组(P 0.05)。结论滤过白细胞的输血可以明显延缓血清TNF-α和IL-6的下降,对输血后患者的康复有重要意义。     

免疫调理治疗对脓毒症患者血CD4+CD25+T细胞的影响

目的 了解脓毒症患者外周血调节性T细胞(CD4+CD25+Tregs)比例水平及其与机体细胞免疫之间的关系,并探讨免疫调理治疗对其水平的影响.方法 选择滕州市中心人民医院住院治疗的脓毒症患者40例,随机分成治疗组和对照组,治疗组加用乌司他丁和胸腺肽α1作抗炎和免疫调节治疗,分别于治疗前和治疗后第3,第8天抽外周静脉血,检测T淋巴细胞亚群、CD4+CD25+Tregs,TNF-α,IL-6,IL-10水平,同时APACHEⅡ评分.结果 治疗前两组患者CD4+CD25+Tregs细胞水平明显升高,总淋巴细胞数、T细胞比例下降,其中以CD4+T细胞下降更明显,CD4+/CD8+明显下降,IL-6,TNF-αt水平升高;治疗后,两组患者CD4+C125+Tregs降低,总淋巴细胞数、CD4+/CD8+比值升高,APACHEⅡ评分和IL-6,TNF-αt水平均下降,治疗组改善更明显.结论 外周血CD4+CD25+Tregs细胞比例水平,可以作为评价机体免疫能力及预后新指标;联合应用胸腺肽α1和乌司他丁治疗脓毒症,可提高患者免疫力,显著降低APACHEⅡ评分、IL-6,TNF-α水平,改善患者病情.

Abstract：

Objective To investigate the percentage of CD4 + C125 +Tregs in peripheral blood of patients with sepsis and its effect on cell immunity so as to unravel the effect of immunomodulatory therapy on it. Method Fourty patients with sepsis in ICU were randomly (random number) divided into experimental group and control group . The patients of experimental group were treated with Ulinastatin and immunoregulation agent (Thymosin αl) as well. The blood specimens were collected just before treatment, 3 days and 8 days after treatment. The percentages of CD4 + CD25 + Tregs and lymphocyte subsets were detected by using FCM (flow cytometry), and TNF-α, IL-6 and IL-10 assayed by using ELISA, and APACHE Ⅱ scores were calculated. Results Before treatment, the percentage of CD4 + CD25 + Tregs increased, and the number of lymphocytes and the percentage of T lymphocytes decreased, especially the CD4 + T lymphocytes and CD4+/CD8+ decreased more markedly, and the levels of IL-6 and TNF-α increased. After treatment,the percentage of CD4+ CD25 + Tregs was decreased, the number of lymphocytes and CD4 +/CD8 + increased, and the levels of APACHE Ⅱ score, IL-6 and TNF-α decreased especially in the experimental group decreased more significantly (P ＜ 0. 05). Conclusions The percentage of CD4 + CD25+ Tregs in peripheral blood can reflect the immune status of patients with sepsis and become a novel indicator to estimate the progress of sepsis, and the immunity and prognosis of patients. Treating the patients with Thymosin αl and Ulinastatin can raise their immunity, decrease the levels of IL-6, TNF-α and APACHE Ⅱ score and improve their prognosis.     

大黄联合山莨菪碱对严重脓毒症患者免疫功能的影响

目的 探讨在严重脓毒症患者中联合应用大黄和山莨菪碱对免疫功能的影响.方法 将94例入选的严重脓毒症患者按随机原则分为4组.对照组(22例)采用常规治疗;大黄组(27例)在常规治疗基础上加用大黄;山莨菪碱组(24例)在常规治疗基础上加用山莨菪碱;联合组(21例)在常规治疗基础上同时给予大黄、山莨菪碱.检测治疗前及治疗后24、48、72 h心率(HR)、平均动脉压(MAP)、乳酸(Lac)以及肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、CD14+/人白细胞DR抗原(CD14+/HLA-DR)的变化.结果 4组治疗前后HR、MAP比较差异均无统计学意义(均P＞0.05),联合组治疗后72 h,血Lac (mmol/L)较对照组明显降低(1.08±0.80比2.83±1.25,P＜0.05).4组治疗前及治疗后24 h、48 h TNF-α(ng/L)、IL-6 (ng/L)、CD14+/ HLA-DR比较差异均无统计学意义(均P＞0.05);大黄组、山莨菪碱组、联合组治疗后72 h上述指标较治疗前均有所改善,且联合组较对照组改善更显著[TNF-α:22.05±4.73比29.23±6.40,IL-6:88.21±7.22比104.04±9.76,CD14+/ HLA-DR:(52.40±4.80)%比(32.40±4.12)%,均P＜0.05].结论 联合使用大黄及山莨菪碱能降低严重脓毒症患者炎症因子(TNF-α和IL-6)和Lac水平,提高CD14+/HLA-DR表达水平,改善患者的免疫功能.     

肠道病毒性脑炎儿童外周血NK细胞、T淋巴细胞亚群及相关细胞因子水平的变化

目的:探讨肠道病毒性脑炎(EVE)儿童外周血NK细胞、T淋巴细胞亚群及相关细胞因子水平变化及意义。方法:选取2015年10月至2017年10月河南省儿童医院神经科住院的EVE患儿136例为阳性组,对症治疗后根据预后情况分为预后良好组和预后不良组,以90例健康儿童为对照组。比较两组患儿T淋巴细胞亚群、 NK细胞及相关细胞因子的变化水平。结果:EVE组CD4~+T细胞、CD4~+/CD8~+比值及NK细胞水平均低于对照组,CD8~+T细胞水平高于对照组,差异有统计学意义(P0.05);EVE组IL-2水平低于对照组,IL-6、TNF-α水平高于对照组,差异均有统计学意义(P0.05)。136例EVE患儿,122例(89.71%)预后良好,14例(10.29%)预后不良。预后良好组CD4~+T细胞、CD4~+/CD8~+比值及NK细胞水平高于预后不良组,CD8~+T细胞水平低于预后不良组,差异均有统计学意义(P0.05);预后良好组IL-2水平高于预后不良组(P0.05),IL-6、TNF-α水平低于预后不良组,差异有统计学意义(P0.01)。结论:EVE患儿常伴免疫功能紊乱,IL-6、TNF-α水平升高,且预后不良者免疫功能紊乱更明显。     

抗感染联合乌司他丁治疗重症肺炎临床效果及对患者炎性因子、T淋巴细胞亚群影响

目的探讨抗感染联合乌司他丁治疗重症肺炎的临床效果及对患者炎性因子、T淋巴细胞亚群的影响。方法选取重症肺炎66例随机将其分为观察组和对照组两组各33例,观察组在常规治疗基础上采用抗感染联合乌司他丁注射液进行治疗,对照组在常规治疗基础上仅采用抗感染治疗,观察比较两组临床疗效、治疗前后外周血炎性因子水平和T淋巴细胞亚群情况以及不良反应发生情况。结果观察组总有效率为87. 88%,对照组总有效率为66. 67%,观察组明显高于对照组,差异有统计学意义(P 0. 05)。治疗后两组外周血白细胞介素(IL)-10、CD3+、CD4+水平及CD4+/CD8+均较治疗前明显升高,外周血IL-6、IL-8及肿瘤坏死因子α(TNF-α)水平均较治疗前显著下降,差异具有统计学意义(P 0. 05)。治疗后观察组外周血IL-10、CD3+、CD4+水平及CD4+/CD8+均较对照组升高,外周血IL-6、IL-8及TNF-α水平均较对照组降低,差异有统计学意义(P 0. 05)。治疗期间观察组不良反应总发生率9. 09%,对照组不良反应总发生率12. 12%,观察组不良反应总发生率低于对照组,但差异无统计学意义(P0. 05)。结论抗感染联合乌司他丁治疗重症肺炎临床效果显著,安全性较高,可能与抑制炎性因子释放及提高外周血T淋巴细胞亚群免疫功能相关。     

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.     

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.     

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.