IL-10基因启动子-592A/C多态性与HBV感染预后的关系

摘 要 目的：探讨湖北汉族人白细胞介素-10（IL-10）基因启动子区-592位点单核苷酸多态性与乙型肝炎病毒（HBV）感染、转归的关系。方法：采用聚合酶链反应-限制性片段长度多态性分析（PCR-RFLP）方法，检测231例慢性HBV感染者（其中慢性乙型肝炎75例，无症状携带156例），165例HBV感染自愈者和135例正常对照者IL-10基因启动子区-592A/C位点基因型。结果：IL-10基因启动子区-592A/C位点基因型和等位基因在慢性HBV感染组、HBV感染自愈组和正常对照组之间的分布频率比较差异无显著性（P>0.05），在血清HBV-DNA<1×103copies/mL的慢性HBV感染者组和HBV-DNA≥1×103 copies/mL组之间的分布频率比较差异亦无显著性（P>0.05）；但IL-10基因启动子区-592位点AA基因型和A等位基因在慢性乙型肝炎组出现的频率明显高于HBV无症状携带组，两组之间分布比较差异有显著性（P<0.05）。结论：汉族人IL-10基因启动子区-592位点多态性可能与人群对HBV易感性及感染后的病毒血症水平无显著相关性，但该位点基因多态性与HBV感染后的肝脏炎症反应有关。≥≥≥≥≥     

IL-10-592位点基因多态性与儿童EV71脑炎易感性关系

目的研究白细胞介素10（IL-10）基因启动子区-592C/A（IL-10-592C/A）位点基因多态性与肠道病毒71（EV71）易感性的关系,探讨不同基因型对EV71感染患病风险的影响。方法运用多重高温连接酶检测反应技术,检测EV71感染病儿及对照儿童IL-10-592C/A位点的基因多态性。结果 EV71感染重症组病儿基因型AC＋AA、等位基因A频率的分布与轻症组病儿比较差异有显著性（χ2=9.071、18.143,P〈0.05）。结论 IL-10-592C/A位点等位基因A、基因型AC＋AA的病儿感染EV71后易发展为重症。IL-10-592C/A位点基因型CC和C等位基因为EV71感染后不易发展为重症的保护基因。     

黏病毒抗性蛋白A基因多态性与HBV感染转归的关系

目的 探讨干扰素诱导的黏病毒抗性蛋白A(MxA)基因单核苷酸多态性(SNP)对乙型肝炎病毒(HBV)感染自然转归的影响.方法 收集湖北地区160例HBV自限感染者和243例慢性HBV感染者的外周血标本,应用聚合酶链反应-限制性片段长度多态性分析方法,检测MxA启动子-88,-123位点基因型.结果 MxA启动子-88G/T位点基因型和等位基因在慢性HBV感染者和自限性感染者中的分布差异有高度显著性.HBV自限性感染者MxA启动子-88位点GG基因型和G等位基因频率分别为41.3%和62.8%,均较慢性感染者频率52.7%和74.9%低(P=0.025和P= 0.001),而TT基因型和T等位基因频率分别为15.6%和37.2%,均较慢性感染者频率2.9%和25.1%高(P=0.000和P= 0.001),比值比为6.24,95%可信限2.63～14.81.然而,MxA启动子-123位点不同基因型和等位基因在HBV自限性感染组和慢性感染组间的分布频率差异均无统计学意义(P＞0.05).结论 MxA启动子-88G/T位点多态性与HBV感染后的结局有关,其中TT基因型或T等位基因的存在可能有利于HBV感染后的清除.     

MxA启动子和elF-2a调节区2基因多态性对HBV感染自然转归的影响

目的探讨干扰素诱导的黏病毒抗性蛋白A(MxA)和真核细胞起始因子2a调节区2(elF-2a-reg2)基因的单核苷酸多态性(SNP)对乙型肝炎病毒(HBV)感染自然转归的影响。方法收集湖北地区160例HBV自限感染者和243例慢性HBV感染者的外周血标本,应用聚合酶链反应-限制性片段长度多态性分析方法,检测MxA启动子-88、-123位点及elF-2a-reg2基因型。结果 MxA启动子-88G/T位点基因型和等位基因在慢性HBV感染者和自限性感染者中的分布差异有统计学意义(P<0.05)。HBV自限性感染者MxA启动子-88位点GG基因型和G等位基因频率分别为41.3%、62.8%,均较慢性感染者频率52.7%、74.9%低(P=0.025和P=0.001),而TT基因型和T等位基因频率分别为15.6%、37.2%,均较慢性感染者频率2.9%、25.1%高(P=0.000和P=0.001),比值比为6.24,95%可信限2.63～14.81。然而,MxA启动子-123位点、elF-2a-reg2基因的不同基因型和等位基因在HBV自限性感染组和慢性感染组间的分布频率差异均无统计学意义(P>0.05)。结论 MxA启动子-88G/T位点多态性与HBV感染后的结局有关,其中TT基因型或T等位基因的存在可能有利于HBV感染后的清除。     

白细胞介素-18基因多态性与肺结核病易感性的关系

目的：通过病例-对照研究,探讨白细胞介素-18（IL-18）基因启动子区-607C/A、-137G/C位点单核苷酸多态性（SNP）与肺结核病的关系。方法：采用序列特异性引物PCR（PCR-SSP）及测序技术检测深圳地区汉族人群肺结核患者200例及健康对照者197例IL-18启动子区-607 C/A 、-137G/C位点多态性基因型。采用直接计数法计算各组基因型频率及等位基因频率,进行χ2 检验。以P值＜0.05为具有统计学意义。结果：肺结核患者IL-18启动子区-607位点A/A纯合子、A/C杂合子、C/C纯合子基因型频率分别为19.5%、55.0%、25.5% ;A、C等位基因频率分别为47.0%、53.0%。健康对照者A/A纯合子、A/C杂合子、C/C纯合子基因型频率分别为22.8%、46.7%、30.5%;A、C等位基因频率分别为46.2%、53.8%。两组人群-607位点基因型及等位基因分布无明显差异(P>0.05)。肺结核患者IL-18启动子区-137G/C位点C/C纯合子、C/G杂合子、G/G纯合子基因型频率分别为4.5%、18.5%、77.0%;C、G等位基因频率分别为13.8%、86.2%。健康对照者C/C纯合子、C/G杂合子、G/G纯合子基因型频率分别为5.6%、25.9%、68.5%;C、G等位基因频率分别为18.5%、81.5%。两组人群-137位点基因型分布无明显差异(P>0.05)。结论：IL-18启动子区-607、-137位点基因多态性与中国汉族人群肺结核病易感性无关。     

IL-10基因位点多态性与ACS的相关性分析

[目的]探讨急性冠脉综合征(ACS)与白介素-10(IL-10)基因位点4259A/G、-1082G/A、-592C/A、-819C/T多态性分布的相关性.[方法]选择2010年5月至2015年9月常州市溧阳人民医院心内科和武进人民医院心内科收治的ACS患者471例(观察组),选择同期两个医院心内科收治的197例非ACS者为对照组,采用基因测序技术检测所有标本IL-10基因型,分析其与ACS发病相关危险因素.[结果]两组在年龄、吸烟、合并糖尿病、血清TC、TG、LDL-C方面比较,差异均具有统计学意义(P<0.05).在两组研究对象中,IL-104259A/G位点仅发现AA一种基因型;但是在两组研究对象中发现IL-10-1082G/A位点上有GG、AG、AA三种基因型、IL-10-582C/A位点上有CC、AC和AA三种基因型、IL-10-819C/T位点上有CC、CT和TT三种基因型.与对照组作比较后,尚未发现各种基因型之间分布频率、等位基因分布频率有统计学差异;对每一种基因型行引起ACS发病传统危险因素多元Logistic回归分析显示IL-10基因-592C/A、-819C/T、-1082G/A基因型与ACS的发病无相关性.[结论]在常州地区心血管疾病住院患者IL-10基因4259A/G仅有AA一种基因型;IL-10基因-1082G/A、-592C/A、-819C/T具有多态性,但其多态性分布与本地区汉族人群ACS的发病无相关性.     

IL-18基因编码区105位点多态性及其血清含量相关性研究

目的了解白细胞介素-18(in terleuk ine-18,IL-18)基因编码区105A/C位点多态性在汉族人中的分布频率及其与血清IL-18含量间的关系。方法采用聚合酶链反应-限制性片段长度多态性分析(polym erase cha inreaction-restrictionfragm en t length polym orph ism,PCR-RFLP)的方法,对87例健康个体IL-18编码区105A/C位点基因多态性进行观察,同时检测血清IL-18水平,探讨其与基因型间的关系。结果健康汉族人IL-18编码区105A/C位点基因型以AA型最为多见,占64.4%,其次为AC型和CC型,分别为33.3%和2.3%;等位基因A和C频率分别为81.0%和19.0%。经等级资料和相关分析,IL-18基因编码区105位点A→C单核苷酸突变与血清IL-18含量呈正相关(χ2=6.29,P<0.05,r=0.311)。结论汉族人IL-18基因编码区105A/C位点多态性与其血清含量存在相关性,提示该位点多态性可能与个体在某些疾病遗传易感性方面有一定联系。     

白细胞介素6基因启动子-572 C/G多态性与心绞痛的相关性研究

目的探讨白细胞介素6(IL-6)基因启动子-572C/G多态性各等位基因及基因型在心绞痛患者中的分布频率,并分析其基因型及血清水平与心绞痛的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测121例心绞痛患者及140例对照者IL-6基因启动子-572C/G多态性,同时用ELISA法检测心绞痛和对照者血清IL-6水平。结果心绞痛组IL-6血清水平显著高于对照组(P<0.01),IL-6基因启动子-572C/G基因型频率和等位基因频率在心绞痛组和对照组间比较差异有显著性(P<0.05),等位基因频率的相对风险分析发现,G等位基因携带者患心绞痛的风险是C等位基因的1.665倍(OR=1.665,95%CI:1.089~2.544);结论IL-6基因启动子-572C/G多态性与心绞痛的发病具有相关性。     

脂联素基因启动子区-11377C／G单核苷酸多态性与中国北方汉族人2型糖尿病的关系

目的:分析脂联素基因启动子区-11377C/G(SNPs-11377C/G)单核苷酸多态性与中国北方汉族人2型糖尿病的关系。方法:选择2004/2005北京市和黑龙江哈尔滨地区的2型糖尿病流行病学调查资料中有糖尿病家族史,且相互间无亲缘关系的2型糖尿病患者348例,同时选择非糖尿病健康对照378例。所有研究对象均为汉族人,均签署了知情同意书。用聚合酶链反应-限制性片段长度多态方法鉴定脂联素基因启动子区SNPs-11377C/G的单核苷酸多态性。结果:726例研究对象均进入结果分析。①2型糖尿病组中CC,CG,GG基因型分别为171例(49.1%),151例(43.4%),26例(7.5%),正常对照组中CC,CG,GG基因型分别为180例(47.6%),173例(45.8%),25例(6.6%)。SNPs-11377C/G的基因型频率和等位基因频率在2型糖尿病组和正常对照组中的分布差异无显著性(P>0.05)。②SNPs-11377C/G的基因型频率和等位基因频率的分布性别差异也无显著性(P>0.05)。③SNPs-11377C/G不同基因型组中肥胖指标(体质量指数、腰围和腰臀比)的特征差异也无显著性(P>0.05)。结论:脂联素基因启动子区-11377C/G(rs266729)单核苷酸多态性与中国北方汉族人2型糖尿病无明显相关性。     

白细胞介素-18基因多态性与慢性乙型病毒性肝炎病毒感染关系的研究

目的 探讨白介素-18(IL-18)基因启动子区-137G/C(rs187238)和-607C/A(rs1946518)单核苷酸多态性(SNP)与慢性乙型病毒性肝炎(乙肝)病毒感染之间的关系。 方法 选取2007年3月至2010年10月期间就诊于桂林市疾病预防控制中心和桂林医学院附属医院的慢性乙肝患者作为病例组,共264例;另外选取同期在上述两个单位进行体检,均无慢性乙肝病史的健康者作为对照组,共300例。采用序列特异性引物-聚合酶链反应技术(SSP-PCR),检测上述二组研究对象IL-18基因启动子-137G/C(rs187238)、-607C/A(rs1946518)单核苷酸多态性位点基因型,分析病例组和对照组基因型和等位基因频率分布。 结果 病例组IL-18基因多态性位点rs1946518的基因型和等位基因的频率与对照组相比差异无统计学意义(P0.05)。但是,病例组IL-18基因SNP位点rs187238 G等位基因的频率高于对照组(OR=1.353,95%CI:1.009~1.815,P=0.043)。携带rs187238 GG基因型的患者发生慢性乙肝的风险较高(OR=1.629,95%CI:1.152~2.305,P=0.006)。分层分析发现,rs187238位点上GC基因型和C等位基因的频率与慢性乙肝的关联在乙肝e抗原(HBeAg)阳性组的患者中更加显著(P=0.022,P=0.011)。 结论 IL-18基因启动子区-137G/C(rs187238)多态性与慢性乙肝易感性具有相关性,而且,rs187238位点上GC基因型和C等位基因的频率与HBeAg阳性的慢性乙肝患者具有相关性。     

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.     

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.     

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.     

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.     

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.