HIV/AIDS合并慢性肝炎肝内静脉及脾静脉超声与CD4~+T淋巴细胞数相关性的研究

目的探讨HIV/AIDS合并慢性病毒性肝炎在CD4+T淋巴细胞计数不同免疫时期肝内静脉及脾静脉的超声改变。方法选择2010年1月-2013年10月50例合并HIV/AIDS慢性病毒性肝炎患者作为病例组,50例单纯性慢性病毒性肝炎患者作为对照组。观察病例组(按CD4+T淋巴细胞计数的不同免疫时期)与对照组肝内静脉及脾静脉的超声改变。结果病例组肝内静脉及脾静脉在不同CD4+T淋巴细胞计数的免疫时期有超声异常改变,主要表现在门静脉及脾静脉远端走行不清,内径增宽,血流速减慢,血流频谱起伏消失、平直;肝静脉远端走行不清,血流频谱低矮三相型、负相型、空窗消失。CD4+T细胞数>300/mm3组与对照组之间肝内静脉、脾静脉超声观察指标比较,差异无统计学意义(P>0.05);CD4+T细胞数100~200/mm3组的脾静脉内径、肝静脉血流频谱与对照组差异有统计学意义(P<0.05);CD4+T细胞数<100/mm3组除肝静脉走行异常发生率差异无统计学意义外(P>0.05),其余异常情况发生率与对照组比较差异均有统计学意义(P<0.05)。结论 HIV/AIDS合并慢性病毒性肝炎肝内静脉及脾静脉超声异常改变随着CD4+T细胞计数下降更为明显,综合考虑肝内静脉及脾静脉超声各项指标的变化有助于临床评估HIV/AIDS合并慢性病毒性肝炎的病情发展。     

司他夫定联合拉米夫定与奈韦拉平抗病毒方案治疗对艾滋病患者免疫功能的影响及其安全性分析

目的探讨司他夫定(D4T)+拉米夫定(3TC)+奈韦拉平(NVP)抗病毒方案治疗对艾滋病患者免疫功能的影响及其安全性。方法选取2014年1月至2016年1月期间符合抗病毒方案治疗标准且经D4T+3TC+NVP抗病毒方案治疗的艾滋病患者80例作为研究组,同期选取尚未达到抗病毒方案治疗标准的艾滋病患者80例作为对照组。比较两组免疫功能、HIV病毒载量与药物安全性的差异。结果治疗前,研究组CD4~+T淋巴细胞计数明显低于对照组(P0.05),治疗后,研究组CD4~+T淋巴细胞计数明显高于对照组与治疗前(P0.05),而对照组治疗前后CD4~+T淋巴细胞计数比较差异无统计学意义(P0.05)。治疗前,研究组HIV病毒载量明显高于对照组(P0.05),治疗后,研究组HIV病毒载量明显低于对照组与治疗前(P0.05),而对照组治疗前后HIV病毒载量检测结果比较,差异无统计学意义(P0.05)。研究组HIV病毒抑制率明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗期间发生胃肠道不适、头晕乏力、肝功能障碍、皮疹、周围神经损害、乳酸酸中毒、胰腺炎与脂肪分布异常等轻中度不良反应,并经对症处理后好转,无病死案例。结论 D4T+3TC+NVP抗病毒方案治疗艾滋病患者的临床疗效满意,有助于改善免疫功能,且药物安全性较高,值得临床推广应用。     

葛根总黄酮对实验性哮喘大鼠的预防效应

目的:探讨脾T淋巴细胞亚群在实验性大鼠哮喘模型中的表达,和葛根总黄酮对T淋巴细胞亚群及对实验性哮喘的预防作用。方法:实验于2003-03-01/04-02在解放军总医院实验动物中心完成。用卵蛋白致敏并激发建立了SD大鼠哮喘模型,32只大鼠随机分为4组,每组8只。为正常对照组、卵蛋白激发哮喘发作组、葛根总黄酮灌胃组、葛根总黄酮预防组,每组分别测定动脉血血气作为哮喘严重程度的缺氧评定指标,测定血液中白细胞介素4水平,同时采用流式细胞仪观察脾T细胞亚群的变化。结果:4组32只大鼠均进入结果分析。①各组大鼠血气结果:卵蛋白激发哮喘发作组动脉血氧分压低于正常对照组和葛根总黄酮灌胃组犤(4.24±2.20),(10.04±1.13),(9.68±1.35)kPa,P<0.01犦;卵蛋白激发哮喘发作组剩余碱低于正常对照组和葛根总黄酮灌胃组犤(1.82±1.31),(2.77±2.18),(2.67±2.18)mmol/L,P<0.01犦;卵蛋白激发哮喘发作组血氧饱和度低于正常对照组和葛根总黄酮灌胃组犤(51.8±35.9),(64.55±29.87),(62.51±40.31)%,P<0.05犦。②各组大鼠脾T淋巴细胞亚群变化:葛根总黄酮预防组CD4+低于卵蛋白激发哮喘发作组(13.19±3.33,18.37±1.98,P<0.01),葛根总黄酮预防组CD8+高于卵蛋白激发哮喘发作组(8.01±0.42,6.25±0.63,P<0.01),葛根总黄酮预防组CD4+/CD8+低于卵蛋白激发哮喘发作组(1.61±0.35,2.94±0.32,P<0.01)。③白细胞介素4:卵蛋白激发哮喘发作组为(85.2±12.3)ng/L,比正常对照组和葛根总黄酮预防组大鼠显著增高犤(3.3±0.7),(7.7±1.0)ng/L,P<0.01犦。结论:脾T淋巴细胞亚群的活化参与哮喘的发病过程,葛根总黄酮可以抑制免疫细胞T淋巴细胞的活化和过表达,可能通过恢复CD4+/CD8+比值,加强CD8+T淋巴细胞对CD4+T淋巴细胞的抑制作用,抑制嗜酸性粒细胞增生和IgE的合成从而阻断哮喘发病。     

慢性心力衰竭患者外周血Th17/Treg失衡的研究及意义

目的探讨慢性心力衰竭(CHF)患者外周血中Th17细胞、CD4+CD25+CD127-调节性T细胞(Treg)的变化及意义。方法 53例CHF患者按照NYHA心功能分级分为CHF1组(NYHA心功能Ⅰ~Ⅱ级,n=24)和CHF2组(NYHA心功能Ⅲ~Ⅳ级,n=29)。20例健康体检者作为对照组。采用流式细胞分析法检测外周血中Th17细胞、Treg细胞占CD4+T细胞的比例。结果 CHF1组和CHF2组患者外周血中Th17/CD4+T细胞的比例明显高于对照组(1.89±1.24 vs 0.51±0.35,3.35±1.78 vs 0.51±0.35;P<0.05;P<0.01),CHF2组亦明显高于CHF1组(3.35±1.78 vs 1.89±1.24,P<0.01);CHF1组和CHF2组患者外周血中Treg/CD4+T细胞的比例明显低于对照组(5.69±0.74 vs 7.89±1.66,3.31±0.98 vs 7.89±1.66;P<0.01;P<0.01),CHF2组亦明显低于CHF1组(3.31±0.98 vs 5.69±0.74,P<0.01);CHF1组和CHF2组患者Th17/Treg的比值明显高于对照组(0.35±0.17 vs 0.11±0.09,1.06±0.49 vs 0.11±0.09;P<0.05;P<0.01),CHF2组亦明显高于CHF1组(1.06±0.49 vs 0.35±0.17,P<0.01)。结论 CHF患者外周血中存在Th17/Treg失衡,且与心功能有一定关系,Th17/Treg失衡可能参与了CHF的发生发展。     

选择性5-羟色胺再摄取抑制剂艾司西肽普兰对血小板功能的影响

目的 观察选择性5-羟色胺再摄取抑制剂艾司西肽普兰对血小板功能的影响。方法 选取抑郁症患者61例,随机分为治疗组(艾司西酞普兰10 mg/日)和安慰剂对照组,测定治疗前后的血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板聚集率(PAR)、血小板膜糖蛋白CD62P和CD63表达。结果 治疗组在治疗前后的PLT(10⁹/L),MPV(fl),PDW(fl),PAR(%),CD62P(%)和CD63(%)分别为175.8±59.1 vs 169.1±60.5,11.8±1.2 vs 10.3±0.9,15.6±2.1 vs 16.7±1.9,60.1±11.5 vs 59.3±14.9,23.8±5.6 vs25.1±3.7,20.6±7.2 vs 22.4±4.7,对照组在治疗前后的PLT(10⁹/L),MPV(fl),PDW(fl),PAR(%),CD62P(%)和CD63(%)分别为198.6±76.5 vs 203.2±49.8,9.4±1.1 vs 10.2±0.8,12.5±1.8 vs 13.3±2.9,62.7±13.6 vs 66.4±10.7,27.9±7.1 vs 24.8±4.9,26.9±8.1 vs 24.1±6.4,差异均无统计学意义(均P>0.05)。结论 艾司西肽普兰对血小板功能无明显影响。     

围非小细胞肺癌手术期T细胞含量变化的研究

目的 通过分析非小细胞肺癌(non-small-cell carcinoma,NSCLC)患者外周血淋巴细胞Th1和Th2细胞水平,研究NSCLC患者术前术后T淋巴细胞亚群的变化,为临床上对NSCLC疾病的预防、诊断及治疗提供参考依据。方法 收集NSCLC患者(60名),健康体检者(60名)全血(EDTA抗凝处理),采用流式细胞术检测外周血淋巴细胞CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比以及Th1和Th2细胞水平,并且用血细胞分析仪检测其淋巴细胞绝对值。结果 NSCLC术前和正常对照组CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比(%)分别为58.40±10.27 vs 66.58±6.84,31.32±8.65 vs 39.40±6.43,34.23±8.00 vs 24.31±8.16,CD₄⁺/CD₈⁺比值为0.96±0.23 vs 1.58±0.23,差异均具有统计学意义(t=-6.726～14.916,P均<0.05)。NSCLC术后1～3天组和正常对照组CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比(%)分别为56.31±8.00 vs 66.58±6.84,27.72±7.55 vs 39.40±6.43,33.69±7.10 vs 24.31±8.16,CD₄⁺/CD₈⁺比值为0.87±0.31vs 1.58±0.23,差异均具有统计学意义(t=-6.720～14.367,P均<0.05)。与正常对照组相比,NSCLC术后4～7天组CD4⁺T细胞百分比(%)为33.23±4.13 vs 39.40±6.43,差异具有统计学意义(t=6.257,P<0.05)。在辅助性T细胞亚群中,NSCLC术前与正常对照组Th1,Th2细胞含量(×10/μl)分别为6.79±1.34 vs 12.52±3.56,4.82±0.51 vs 2.32±0.82,Th1/Th2比值为1.39±0.84 vs 5.36±1.42,差异均具有统计学意义(t=-20.087～18.630,P均<0.05)。NSCLC术后1～3天组与正常对照组Th1细胞含量(×10/μl)为8.86±1.52 vs 12.52±3.56,术后4～7天组与正常对照组Th1细胞含量(×10/μl)为7.02±1.27 vs 12.52±3.56,差异均具有统计学意义(t=7.339～11.275,P均<0.05)。结论 NSCLC患者免疫功能紊乱,表现在T淋巴细胞数和辅助性T细胞的数量减少,T细胞亚群失调,明显趋向Th2细胞; 另外可能在癌细胞的不断刺激下,细胞免疫功能亢进杀伤性T细胞增多,经过手术治疗后杀伤性T细胞开始降低。     

多器官功能障碍综合征患者外周血CD3+、CD4+、CD8+T淋巴细胞的变化

目的 观察多器官功能障碍综合征(MODS)患者外周血CD3+、CD4+、CD8+ T淋巴细胞的变化,并探讨其临床意义.方法 采用流式细胞仪检测35例MODS患者(MODS组)及20例健康体检者(健康对照组)外周血CD3+、CD4+、CD8+ T淋巴细胞计数.结果 MODS患者CD3+、CD4+ T淋巴细胞计数明显低于健康对照组(P均<0.01),两组CD8+ T淋巴细胞计数比较差异无统计学意义(P>0.05),故MODS组CD4+/CD8+ T淋巴细胞计数比值明显低于健康对照组(P<0.01).结论 MODS患者T淋巴细胞亚群发生变化,提示免疫失衡是MODS发生的重要因素.     

慢性乙型肝炎外周血T淋巴细胞亚群CD4+/CD25+和CD8+/CD28-的研究

目的 通过对慢性乙型肝炎患者外周血中CD4+/CD25+和CD8+/CD28-调节性淋巴细胞的分析,探讨其与慢性乙型肝炎患者临床状态的关系.方法 采用流式细胞技术多色荧光分析法,对280例慢性乙型肝炎患者、28例慢性病毒携带者以及22例健康体检者外周血中CD4+/CD25+和CD8+/CD28-淋巴细胞测定.结果 慢性病毒携带者外周血中CD4+/CD25+调节性淋巴细胞为(3.23±1.37)%,明显高于慢性乙型肝炎患者(1.85±1.38)%和正常健康对照(1.59±0.54)%(P＜0.05),但慢性乙型肝炎患者与正常健康对照差别无统计学意义(P＞0.05);而且HBeAg阴性慢性乙型肝炎(1.66±1.09)%与HBeAg阳性慢性乙型肝炎(1.96±1.43)%比较,差别无统计学意义(P＞0.05).慢性乙型肝炎患者和慢性病毒携带者外周血中CD8+CD28-调节性淋巴细胞分别为(79.53±16.07)和89.30±5.12)%,均明显高于正常健康对照(63.93±7.85)%(P＜0.05);另外,HBeAg阳性慢性乙型肝炎组(87.47±17.82)%,也明显高于HBeAg阴性慢性乙型肝炎组(64.90±15.26)%(P＜0.05).结论 慢性病毒携带者处于病毒携带状态可能与体内调节性淋巴胞CD4+/CD25+和CD8+/CD28-的升高有关.     

重组人粒细胞集落刺激因子动员对CD4+T淋巴细胞迁移和黏附功能的影响

目的探讨重组人粒细胞集落刺激因子(rhG-CSF)动员对CD4+T淋巴细胞表面分子CXCR4和淋巴细胞功能相关抗原1(LFA-1)所介导功能和相关信号机制的影响.方法在rhG-CSF动员前和动员后第5天抽取供者外周血,用三色荧光标记检测动员前后CD4+T淋巴细胞LFA-1和CXCR4的表达率,并应用免疫磁性分选法分离纯化CD4+T淋巴细胞,检测动员前后CD4+T淋巴细胞对基质细胞衍生因子1α(SDF-1α)的迁移能力和对细胞间黏附分子1(ICAM-1)的黏附能力.结果rhG-CSF动员前后CD4+T淋巴细胞的LFA-1(CD11a)和CXCR4表达率差异无统计学意义(P＞0.05),动员前后CD4+T细胞LFA-1表达率均为100%;动员前CD4+T淋巴细胞CXCR4表达率为(84.58±20.31)%,动员后为(81.23±22.46)%.动员前后CD4+T淋巴细胞向SDF-1α的4 h迁移率分别为(28.5±10.3)%和(31.2±8.9)%,差异无统计学意义(P＞0.05);动员前后CD4+T淋巴细胞在CD3单抗作用下对ICAM-1的黏附率分别为(85.59±14.21)%和(61.45±15.07)%,动员前显著高于动员后(P＜0.05).结论rhG-CSF动员不影响CD4+T淋巴细胞LFA-1和CXCR4的表达,但影响CD4+T淋巴细胞通过LFA-1对ICAM-1的黏附能力.     

超短波辅助治疗儿童大叶性支原体肺炎的疗效观察及对血清中炎性因子的影响

目的 观察超短波辅助治疗儿童大叶性支原体肺炎的疗效及对血清中肿瘤坏死因子-α（TNF-α）、白介素-6(IL-6)及T细胞亚群表达的影响。 方法 采用随机数字表法将80例大叶性支原体肺炎患儿分为观察组及对照组,每组40例。2组患儿均予以常规护理(对有发热症状患儿给予退热处理,有咳嗽、咳痰患儿给予止咳化痰等治疗)及阿奇霉素治疗,观察组在此基础上辅以超短波干预。于治疗1周后观察2组患儿病情改善情况;于治疗前、治疗1周后检测2组患儿血清中TNF-α、IL-6含量及T细胞亚群变化。 结果 治疗后观察组患儿总有效率（92.5% vs 75.0%）显著高于对照组水平（P<0.05）;并且观察组退热时间［(3.24±0.65)d vs (4.38±1.14)d］、止咳时间［(5.13±1.17)d vs (6.51±1.54)d］、肺部啰音消失时间［(6.32±1.61)d vs (7.85±2.01)d］、X线吸收时间［(10.82±2.17)d vs (12.38±2.73)d］、平均住院天数［(12.4±2.53)d vs (14.6±3.2)d］均较对照组明显缩短（P<0.05）;治疗后观察组血清中TNF-α［(50.46±15.03)pg/ml vs (65.32±16.57)pg/ml］、IL-6［(28.58±6.94)pg/ml vs ( 39.43±7.58) pg/ml］、CD8+T细胞百分比［(21.81±2.04)% vs (25.23±2.17)%］均较对照组明显降低（P<0.05）;CD4+T细胞百分比 ［(35.02±2.53)% vs (14.6±3.2)%］、CD4+/CD8+细胞比值［(1.49±0.31) vs ( 1.25±0.21)］均较对照组明显增高（P<0.05）。 结论 超短波联合阿奇霉素治疗儿童大叶性支原体肺炎临床疗效显著,其治疗机制可能与调节TNF-α、IL-6含量及T细胞亚群水平有关。     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.