中国丙型肝炎病毒基因型的进化树分析

目的了解丙型肝炎病毒的基因型在中国的分布,对各基因型做遗传进化树分析。方法分型方法按5′端非编码区(5′NCR)ABC程序酶切分型技术进行。应用BsrBⅠ、HaeⅡ、HinfⅠ、BstUⅠ、HaeⅢ等5种限制性内切酶,对HCV阳性血清进行分型研究。对1a、3b基因型进行HCVNS5bPCR,测序。对5′NCR和NS5b进行遗传进化树分析。结果测序结果证实中国存在HCV3b和1a型;进化树分析结果表明第86、98、123株样品与3bD49374相关,获美国NCBI的GenBank认证;第61株与HC J1D107491a型相关;5′NCR测序结果证实第16、62株与HC J82b型相关。结果表明中国存在着HCV1a、2b、3b型的感染。结论经过遗传进化树分析证实了ABC程序酶切分型技术可准确地检测1a～6aHCV基因型。     

NS5B区核酸序列测定的丙型肝炎病毒基因分型研究

目的了解昆明市丙型肝炎感染者HCV基因型分布特征。方法用RT-PCR法扩增40例HCVRNA阳性的患者血清样本丙型肝炎病毒NS5B区段,PCR产物纯化后进行测序分析,测序结果与参考序列共同构建系统进化树,得到丙型肝炎病毒基因型和基因亚型。结果丙型肝炎病毒NS5B区段基因序列的系统进化树分析能对丙型肝炎病毒感染者样本进行很好的分型;分型结果显示,昆明地区丙型肝炎病毒主要的基因型是3b型占45.0%,其次2a型占22.5%,1b型占20.0%,3a型占7.5%,6n型及6a型各占2.5%。结论构建丙型肝炎病毒NS5B区系统进化树分析能得到准确的HCV基因型和亚型;昆明地区的丙型肝炎病毒基因型以3型为主,其次2a、1b型,同时发现6型;昆明丙型肝炎感染者中HCV基因型分布更接近于中国香港和东南亚国家的丙型肝炎病毒基因分布。     

武汉地区丙型肝炎病毒基因型分布及其少见基因亚型系统进化树分析

目的研究武汉地区丙型肝炎病毒(HCV)基因型分布情况,构建HCV少见基因亚型系统进化树。方法收集武汉地区258例慢性丙型肝炎患者血浆样本,采用基于HCV非结构蛋白5B(NS5B)区的Sanger测序法对患者HCV进行基因分型,将HCV NS5B区测序结果与NCBI Genotyping tool中HCV基因型数据库进行比对,得到受检患者的HCV基因亚型,采用MEGA5.0软件对武汉地区HCV少见基因亚型进行系统进化树分析。结果 258例丙型肝炎患者样本均被成功分型,共检出6种基因亚型:1b型(71.32%)、2a型(20.16%)、6a型(3.49%)、3b型(2.71%)、3a型(1.16%)、1a型(1.16%)。武汉地区HCV少见基因亚型系统进化树被成功构建。结论武汉地区HCV优势基因亚型为1b型和2a型,6a型、3a型、3b型、1a型较少见。武汉地区3例3a型HCV可能由日本传入;大部分3b型HCV可能由越南传入,NO.379样本出现较大变异;6a型HCV可能由越南传入。     

河南地区慢性丙型肝炎患者丙型肝炎病毒基因型分布研究

目的调查河南地区慢性丙型肝炎患者丙型肝炎病毒(hepatitis C virus,HCV)基因型的分布特点。方法 106例慢性丙型肝炎患者的血清标本,采用反转录PCR扩增HCV NS5B区,产物直接测序,并构建进化树进行HCV基因分型。结果 106例患者中HCV分型阳性95例(89.6%),共检出7种基因型:1a、1b、2a、2b、3a、3b、6a,其中1a亚型1例(1.1%)、1b亚型56例(58.9%)、2a亚型18例(18.9%)、2b亚型1例(1.1%)、3a亚型6例(6.3%)、3b亚型2例(2.1%)、6a亚型11例(11.6%)。结论河南地区慢性丙型肝炎患者HCV基因型以1b型为主,其次为2a和6a型,基因型的分布呈现多样化。     

山东地区448例丙型肝炎患者HCV基因分型状况分析

目的研究丙型肝炎病毒(HCV)基因分型,了解山东地区丙型肝炎的基因分型情况。方法收集448例丙型肝炎患者的血清标本,采用焦磷酸测序法对HCV感染标本进行分型。结果 448例丙型肝炎患者共检出7种基因亚型,分别为1b型288例(64.28%)、2a型137例(30.57%)、1a型13例(2.90%)、3b型4例(0.90%)、3a型2例(0.45%)、6a型2例(0.45%)、1a1b型2例(0.45%);对HCV基因型与性别、年龄的关系进行分析显示无明显相关性;2013-2016年各基因型患病率分析结果显示无明显的变化趋势。结论山东地区HCV感染基因型以1b型为主,其次为2a型;HCV基因型分布与性别、年龄差异无统计学意义(P0.05),且近4年山东地区各基因型年患病率无明显变化趋势。     

中国HCV5′-非编码区复合酶切分型及其3b基因型序列分析

目的　研究中国丙型肝炎病毒 (HCV)不同基因型感染分布情况 ,并对 3b序列进行分析。方法　采用逆转录 聚合酶链反应 (RT PCR)技术扩增HCV5’NCR 1a、1b、2a、2b、3a、3b、4a、6a不同基因型的cDNA及 187份HCVRNA阳性样品中cDNA。A应用BHH (BsrBI、HaeⅡ、HinfI)复合内切酶消化 5′ NCRcDNA ,B应用BstUⅠ消化 ,C应用HaeⅢ消化 ,电泳检测片段大小。结果　 187例HCVRNA阳性患者ABC分型结果表明 ,1b型感染率占 6 7 38% ,2a型 12 30 % ,1b/ 2a型为5 88% ,3b型 5 35 % ,2b型 3 2 1% ,2a/ 2b、1b/ 2b型各为 2 14 % ,1a型 1 0 7,6a型 0 5 4 %。 3份 3b基因型 5’ NCRA T克隆测序结果表明 ,3株 3b型之间同源性为 99 5 4 %～ 10 0 %。其中chiKQ5 0与GI5 14 395 3a株为 96 2 8%与GI6 76 8773b株同源性为 98 6 % ,与 1a型为 93 4 9% ,与 1b型为94 88% ,与 2a型为 91 6 3% ,与 2b型为 89 30 % ,与 4a型为 95 35 % ,与 6a型为 93 4 % ,结论　研究结果表明该项分型技术既保证了RT PCR检测灵敏度 ,又具有良好的分型效果。提示 :该分型方法不仅适合中国HCV基因型检测 ,对亚洲及欧洲和非洲HCV分型研究也具有一定的参考价值     

基于丙型肝炎病毒NS5B基因序列分析的基因分型

目的：建立基于丙型肝炎病毒(HCV)NS5B基因序列分析的基因分型方法，对上海地区慢性丙型肝炎进行基因分型。方法：用HCVRNA实时荧光定量检测试剂盒对慢性丙型肝炎患血清标本的HCV RNA水平进行定量分析。用逆转录-聚合酶链反应(RT-PCR)和套式-PCR扩增HCV RNA阳性的41份标本的部分HCV NSSB区基因，PCR产物经回收、纯化后直接进行测序分析。从GenBank中下载25份不同基因型的HCV原型序列，用NSSB区222bp的基因片段构建系统进化树，对临床标本相应的HCVNS5B区序列进行分析。结果：基于HCVNS5B基因序列的系统进化树分析，可成功地对本组41份标本进行基因分型。分型结果显示，1b型占85．4％(35／41)，2a型占12．20％(5／41)，3a型占2．44％(1／41)。结论：基于HCVNSSB区基因序列的系统进化树分析是一种可靠和方便的HCV基因分型方法。上海地区的HCV基因型以1b型为主。     

湖北地区慢性丙型肝炎患者HCV基因分型结果分析

目的 应用基因测序技术检测分析湖北地区慢性丙型肝炎患者的HCV基因型及其分布特点。方法 收集2013年2月～2015年7月武汉大学人民医院感染科447例HCV-RNA阳性的慢性丙型肝炎患者血浆标本,通过Sanger测序法测定HCV基因的NS5B区基因序列,然后与NCBI genebank数据库中HCV基因型数据进行比对,分析患者HCV基因型。结果 研究检测的慢性丙型肝炎患者血浆中,共检测出11种HCV基因型,分别是1a,1b,2a,3a,3b,6a,6b,1b/2a混合型,1b/2k混合型,6a/1b混合型和6d/6k混合型。其中,HCV1a型为7例(1.57%),1b型325例(72.71%),2a型67例(14.99%),3a型7例(1.57%),3b型20例(4.47%),6a型14例(3.13%),6b型2例(0.45%),1b/2a混合型2例(0.45%),1b/2k型1例(0.22%),6a/1b混合型1例(0.22%)和6d/6k混合型1例(0.22%)。结论 湖北地区慢性丙型肝炎患者的HCV-RNA基因型以1b型为主,其次为2a型,亦可见其他型别,提示湖北地区HCV流行的基因型呈多样性。     

深度测序法在检测HCV不同基因型/亚型混合感染中的应用

目的将深度测序法用于HCV感染者中不同基因型/亚型混合感染的检测。方法 2例HCV RNA阳性血浆标本(标记为1和2号标本),以NS5B和E1编码区为目的基因,经RT-PCR扩增后做sanger核苷酸序列测定,对其做基因分型发现2个编码区的分型结果后,重复3次NS5B基因PCR扩增;合并3次PCR产物用Ion TorrentTM半导体测序仪做深度测序。获得的序列用Geneious软件的"The map to reference algorithm"和"De novo assembly"2种方法做序列分析和比对,并用Mega 5构建进化树。结果 sanger测序:1、2号标本NS5B基因分型均为1b,E1基因分型均为2a;深度测序:2个标本均为HCV 1b与2a混合感染,其中The map to reference algorithm(Geneious)方法显示,1号标本中1b占92.7%、2a占3.8%、没有比对到的序列(unused seq)占3.5%,2号标本相应为84.3%、5.4%,没有比对到的序列占10.3%;De novo assembly(Geneious)方法显示,1号标本中1b占96.3%、2a占3.7%,2号标本相应为94.1%、5.9%。结论深度测序技术可以精确地获得HCV混合感染的不同基因型/亚型信息,De novo assembly(Geneious)分析HCV的深度测序数据更为精确和直观。     

萍乡地区丙型肝炎基因分型

目的了解萍乡地区慢性丙型肝炎患者的HCV基因分型情况,为丙型肝炎病毒的诊断和治疗提供有力的依据。方法利用门诊及住院病人血清HCV抗体阳性标本,经荧光定量PCR检测HCV-RNA阳性的102例标本用基因芯片进行不同基因分型检测。结果检测HCV感染标本102例,共检出7种基因亚型,分别为1b,6,2a,1b+2a,1b+3a,3a和3b型,其中1b占72.6%,6型占8.8%,2a占7.8%,1b+2a占5.9%,1b+3a占2.9%,3a占1.0%,3b占1.0%。结论萍乡地区HCV基因型主要为1b与中国其它地区HCV基因型分布比较一致。     

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.     

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.     

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.