家族性颅内动脉瘤的遗传学研究进展

颅内动脉瘤(intracranial aneurysm,IA)破裂引起的蛛网膜下腔出血常可致残、致命。IA存在家族聚集性, 这可能与遗传有关,相关基因突变在家族内聚集可能导致家族内成员的IA发病率增加。随着对家族性颅内动脉瘤 (familial intracranial aneurysms,FIAs)家系研究的深入,1p36,5q31,7q11,14q22,17cen,19q13,Xp22等染色体片段 都被发现可能与IA的发病相关。TNFRSF13B,ANRIL,SOX17,ADAMTS15,RNF213,LOXL2等基因的突变都可能导 致FIAs的发生。FIAs家系富集遗传学负荷,对其进行独立的遗传流行病学关联研究,能更经济有效地发现疾病相关基 因,进一步探明IA的发生、发展机制,为疾病的防治奠定基础。     

白细胞介素-1β基因多态性与颅内动脉瘤的关系

目的探讨白细胞介素-1β(IL-1β)基因多态性与颅内动脉瘤(IA)的相关性。方法用聚合酶链反应-限制性片段长度多态性技术对182例颅内动脉瘤患者(颅内动脉瘤组)和120例健康者(对照组)的IL-1β-511C/T的基因多态性进行分析,运用统计学方法分析基因与疾病的相关性。结果IL-1β-511C/T基因型的分布频率与对照组比较差异有显著性(P=0.016),IL-1β-511T等位基因频率为39.84%,对照组为28.75%,两组比较有统计学差异(P=0.005)。结论IL-1β-511C/T基因多态性与颅内动脉瘤的发病有一定关系,考虑T等位基因频率增高与颅内动脉瘤的发病有关。     

白细胞介素-1β基因多态性与颅内动脉瘤关系的研究

目的　探讨白细胞介素-1β(IL-1β)基因多态性与颅内动脉瘤(IA) 的相关性。方法　用聚合酶链反应-限制性片段长度多态性技术对182例颅内动脉瘤患者(颅内动脉瘤组) 和120 例健康者(对照组) 的IL-1β-511C/T的基因多态性进行分析，运用统计学方法分析基因与疾病的相关性。结果　IL-1β-511C/T基因型的分布频率与对照组比较差异有显著性（P =0.016）, IL-1β-511T等位基因频率为39.84% ,对照组为28.75%,两组比较有统计学差异(P=0.005)。结论　IL-1β-511C/T基因多态性与颅内动脉瘤的发病有一定关系,考虑T等位基因频率增高与颅内动脉瘤的发病有关。     

APOA基因多态性与颅内动脉瘤的相关性

目的研究APOA基因多态性与颅内动脉瘤发病的相关性.方法选择58例经全脑动脉造影证实为颅内动脉瘤的患者及健康对照组58例,采集血浆,提取淋巴细胞基因组DNA,采用多聚合酶链反应(PCR)结合非变性聚丙烯酰胺凝胶电泳(PAGE)检测APOA 5′调控区五核苷酸TTTTA重复序列(PNR)的基因多态性,运用统计学方法分析基因与疾病的相关性.结果两组人群共检出8种APOA PNR基因型和6种等位基因.动脉瘤组PNR-5等位基因频率和PNR 5/8基因型频率显著高于健康对照组(P＜0.05).PNR-9等位基因频率和PNR 8/9基因型频率显著低于健康对照组(P＜0.05).结论APOA PNR(TTTTA)拷贝数为5的等位基因可能与颅内动脉瘤发生呈正相关.     

对1008例颅内动脉瘤患者的回顾性分析

颅内动脉瘤是严重威胁患者健康的疾病.笔者系统回顾吉林大学第一临床医院神经外科2000年7月18日至2006年7月17日期间,所有确诊为"颅内动脉瘤"的出院患者共计1008人.其中984例为吉林省内患者,余为内蒙古及其他省区患者.现报告如下:     

同型半胱氨酸及蛋氨酸合成酶基因多态性与颅内动脉瘤的关系

目的 探讨同型半胱氨酸(Hcy)及其代谢关键酶蛋氨酸合成酶(methionine synthase,MS)基因多态性与颅内动脉瘤的关系.方法 采用化学发光技术检测76例颅内动脉瘤患者和77例健康成人的血浆Hcy水平,并利用聚合酶链式反应技术检测其MS基因多态性.结果 颅内动脉瘤组血浆Hcy水平为(16.14±6.72)...     

颅内动脉瘤血管内治疗现状

蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)占所有脑卒中的5%-10%,颅内动脉瘤(Intracranial aneurysm,IA)是SAH的主要病因(约占85%)。IA在脑血管疾病中,是仅次于脑血栓形成、高血压脑出血的危害人类健康的疾病。颅内动脉瘤是颅内动脉壁的囊性膨出,多因动脉壁局部薄弱和血流冲击形成,极易破裂出血。在普通人群中,未破裂的颅内动脉瘤的总患病率2%到3.2%之间,男女比例为1:2。首次破裂死亡率为20%-30%,再次破裂死亡率高达60%。SAH是最为危重的脑血管病,一旦发现IA应尽早积极处理,主要治疗方法是手术夹闭治疗和介入栓塞治疗。介入栓塞治疗经过数十年的发展,目前已经成为治疗急性颅内动脉瘤破裂出血的主要方法。本文拟对颅内动脉瘤血管内介入治疗现状进行综述。     

COL3A1基因与颅内动脉瘤Ⅲ型胶原蛋白稳定性的关系

目的 探讨COL3A1基因多态性与中国人汉族颅内动脉瘤散发病例Ⅲ型胶原蛋白稳定性的相关关系.方法 随机选择56例颅内动脉瘤散发病例和57例对照组,对照组为排除颅内动脉瘤并且不具备颅内动脉瘤发病的可能风险因素,不存在颅内动脉瘤家族史、蛛网膜下腔出血史及脑卒中个人史及家族史者,抽取研究对象的外周血,提取基因组DNA,扩增感兴趣的基因片段并测序,比较病例组和对照组之间COL3A1基因多态性出现的频率差异;然后再应用生物信息学的相关方法探讨多态性位点突变对Ⅲ型胶原蛋白稳定性的影响作用.结果 颅内动脉瘤和对照组rs1800255位点基因型及等位基因的差异均具有统计学意义;该位点突变导致的氨基酸替代可以导致COL3A1编码的多肽稳定性下降.结论 COL3A1基因的多态性位点rs1800255与中国人汉族颅内动脉瘤散发病例之间存在相关性,COL3A1基因是中国人汉族颅内动脉瘤散发病例的易感基因之一.     

颅内动脉瘤的遗传学研究进展

颅内动脉瘤是严重威胁人类生命健康的一种疾病,是造成自发性蛛网膜下腔出血的首位原因。遗传因素参与部分颅内动脉瘤的形成已经获得共识,而且动脉瘤常与某些遗传疾病伴发。但颅内动脉瘤形成的具体病因仍然是未知的,还没有确认单独的基因可以导致颅内动脉瘤的形成和破裂。现针对颅内动脉瘤的易感基因鉴定、候补基因分析及染色体基因座的连锁研究等遗传学方面的最新进展予以综述。     

我国颅内动脉瘤基础研究现状与展望

20世纪80年代,颅内动脉瘤（IA）的显微手术治疗取得了很大的进步,死亡率降到2％以下,成为颅底外科成功标志。但是动脉瘤破裂所致的蛛网膜下腔出血,由于其高死亡率和病残率,仍是困扰动脉瘤治疗的重要原因。尽管大量的流行病学调查发现吸烟、饮酒和高血压等因素是IA的危险因素,然而其病因目前仍不清楚。我国对IA病因学方面的基础研究始于上世纪90年代中期,从最初以形态学观察为主的单纯病理学研究,发展为以探求易感基因为目的的分子遗传学分析。现将近10年来对IA基础研究情况、目前存在问题及将来的发展方向阐述如下。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.