PCR-RFLP方法检测医学重要真菌的临床应用研究

目的：建立并应用PCR-RFLP技术区分临床重要真菌的方法，进行实验研究和临床应用。方法：首先根据医学真菌的18SrRNA基因合成了白色念珠菌、热带念珠菌、假热带念珠菌、近平滑念珠菌、解脂念珠菌、新型隐球菌、烟曲霉菌等9种真菌的通用引物；建立鉴定医学真菌的PCR-RFLP方法。通过用白色念珠菌感染大鼠，建立了白色念珠菌感染的实验动物模型。将建立的方法用于临床，并与血培养法和协同凝集试验法进行了比较。结果：PCR-RFLP法的灵敏度高于协同凝集试验和血培养法。经过一年多的临床应用，我们分别用PCR结合限制性内切酶鉴定技术、协同凝集试验法和血培养法检测了118例血液病、肿瘤和其他发热患者的血液标本。应用协同凝集试验（CoA）法检出真菌血症19例，阳性率为16.1%。应用PCR和限制性内切酶技术共有40例检出真菌血症，阳性率为33.9%；其中白色念珠菌血症占真菌血症的65.0%，热带念珠菌感染占17.5%，假热带念珠菌感染占10%，光滑念珠菌感染占5.0%，近平滑念珠菌感染占2.5%，为临床不明原因发热患者寻找病因、进行抗真菌治疗提供了参考依据。结论：该技术具有快速、敏感、不需放射性同位素等优点，而且准确性极高，有着较好的临床应用前景。此技术应用于临床将为血液病、肿瘤和免疫抑制患者的诊断和救治工作起到积极的作用。     

中国黑龙江斑点热立克次体和日本斑点热立克次体基因型和血清型的比较

中国黑龙江斑点热立克次体和日本斑点热立克次体先后被鉴定为斑点热群中的两个新种。通过采用微量免疫荧光方法和聚合酶链扩增／限制性内切酶片段长度多态性分析技术，对两株斑点热立克次体进行了比较。结果显示，黑龙江立克次体抗血清与日本株抗原无交叉反应，黑龙江立克次体抗原与日本株抗血清仅呈低滴度反应。同时采用获自主氏立克次体蛋白抗原Ｒｒ１９０序列的一对寡核苷酸序列作为引物扩增上述两株立克次体后，用限制性内切酶ＲｓａＩ消化扩增产物，其Ｒｒ１９０－ＲｓａＩ图谱说明，两株的酶切带的迁移率明显不同。     

人血小板生成素在大肠杆菌中的高效表达

目的：人血小板生成素（ＴＰＯ）在大肠杆菌中的高效表达。方法：利用ＰＣＲ技术,扩增出了（１－１７４个氨基酸的）人血小板生成素ｃＤＮＡ,并将其克隆到ｐＧＥＸ－１λＴ载体中,构建了融合蛋白表达质粒。重组子用限制性内切酶酶切鉴定。表达产物ＳＤＳ－聚丙烯胺凝胶电泳（ＳＤＳ－ＰＡＧＥ）。结果：限制性内切酶酶切鉴定表明重组子含有正确的（１－１７４氨基酸）ＴＰＯｃＤＮＡ片段;表达产物经ＳＤＳ－ＰＡＧＥ相对分子质量     

霍乱弧菌ctxAB融合基因的克隆及原核表达

目的构建霍乱毒素A亚基基因（ctxA）和B亚基基因（ctxB）的融合表达载体，并在原核系统表达，为霍乱毒素（CT）免疫原性的研究及其作为免疫佐剂的研究提供基础。方法以霍乱弧菌DNA为模板，利用重叠PCR技术，扩增出含有ctxA和ctxB的融合基因片段ctxAB，并与带有硫氧还蛋白（Trx）基因的高效原核表达质粒pET32a（＋）定向重组，构建重组质粒，转化大肠杆菌BL21（DE3）。经限制性核酸内切酶酶切鉴定、PCR和核酸序列分析后，以IPTG诱导表达TrxBB—CTAB融合蛋白，用SDS—PAGE及Western blot进行鉴定。结果限制性核酸内切酶酶切鉴定、PCR和核酸序列分析表明，扩增出了霍乱弧菌1158bp的ctxAB融合基因，成功构建了重组质粒pET—ctxAB，SDS—PAGE及Western blot分析显示重组质粒pET—ctxAB在原核系统中得到了高效融合表达。结论霍乱弧菌ctxA基因和ctxB基因通过重叠PCR成功地融合在一起，融合基因ctxAB在大肠杆菌中得到了高效表达。     

中国黑龙江省斑点热立克次体和日本斑点热立克次体基因…

中国黑龙江斑点热立克次体和日本斑点热立克次体先后被鉴定为斑点热群中的两个新种。通过采用微量免疫荧光广泛和聚合酶链扩增／限制性内切酶片段长度多态性分析技术，对两株斑点热立克次体进行了比较。结果显示，黑龙江立克次抗血清与日本株抗原无交叉反应，黑龙江立克次体抗原与日本株抗血清仅呈低滴度反应。     

PCR-RFLP技术在布氏菌鉴定与分型中的应用

目的 利用PCR-RFLP技术扩增7株布氏菌临床分离株16S RNA基因片段,为该菌的分子诊断学、遗传学和流行病学研究提供实验依据.方法 参考GenBank公布的布氏菌ATCC 25840标准株序列,设计针对该菌16S RNA保守区的特异性引物,从临床分离培养7株布氏菌,提取DNA并行16S RNA片段的PCR扩增.将PCR产物克隆至PGEM-T载体进行测序并选用合适的限制性内切酶进行RFLP分析,将分析结果用于临床株的同源性及变异位点的研究,并对感染患者的临床资料进行回顾性分析,研究不同布氏菌基因型与感染患者临床特征的相关性.结果 利用PCR扩增出的目的片段与预期一致,大小约为1500bp.测序及同源性分析表明,7株临床分离株之间存在98.88%的同源性和11个变异位点.RFLP结果将7株菌分为4个基因型,临床资料回顾性分析患者不同基因型与临床表现之间无明显联系.结论 利用PCR技术扩增布氏菌16S RNA基因片段可以实现对该菌的早期诊断,为布氏菌的分子遗传学和流行病学提供依据.     

PCR技术在鉴定阳性重组子中的应用

介绍了采用ＰＣＲ技术在人粒细胞集落刺激因子（ｈＧ－ＣＳＦ）、人促红细胞生成素及中国人γ－干扰素（ｈＩＦＮ－γ）ｃＤＮＡ重组质粒的构建过程中快速鉴定阳性重组子的方法。经ＰＣＲ扩增鉴定为阳性的重组子，提取质粒ＤＮＡ经重组位点相应的ＤＮＡ内切酶双酶切鉴定表明，全部含有插入片段。     

聚合酶链反应—酶谱法分型检测人疱疹病毒DNA方法的建立及应用研究

在疱疹病毒高度同源序列DNA聚合酶基因中设计一对引物，能对HSV－Ⅰ、HSV－Ⅱ、EBV和CMV4种疱疹病毒DNA进行扩增，继而用凝胶电泳和限制性内切酶BarnHⅠ或SmaⅠ酶切分析扩增产物进行鉴别，建立了能一次性分型检测上述4种病毒的POR－酶谱法。敏感性和特异性试验表明，灵敏度可测到1fgDNA，相当于6个病毒颗粒，且引物仅对4种疱疹病毒扩增。对影响PCR效果的有关因素如Mg2＋浓度、引物浓度、循环参数等进行了优化选择。用建立的PCR－酶谱法检测病毒性脑炎患者脑脊液和慢性宫颈炎患者宫颈分泌物中的疱疹病毒，取得较好结果。本方法的建立为疱疹病毒感染的临床早期准确诊断、药物疗效考核和流行病学研究等提供了有效的手段。     

用核糖体RNA ITS区序列寡核苷酸探针鉴定临床常见真菌

目的：建立一种快速鉴定临床常见真菌菌种的方法。方法:选取真菌核糖体RNA的ITS区为靶基因，设计通用引物和种特异性探针，将3个属的6种临床常见真菌(白色念珠茵、热带念珠茵、光滑念珠茵、新型隐球菌、烟曲霉和黄曲霉)的种特异性探针加尾后固定于硝酸纤维素膜上；用标记生物素的真菌通用引物扩增11种医学真菌DNA，产物与固定在膜上的探针杂交。结果：通用引物可以扩增所试11种医学重要真菌的DNA，扩增片段长度约为560bp。6种真菌扩增产物只与其对应的探针杂交。结论：此方法快速、简便、特异，适合常规实验室开展。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）