3种常用单核苷酸多态性检测方法的应用比较

目的：通过比较变性梯度凝胶电泳(denaturing gradient gel electrophoresis．DGGE)、单链构像多态性(single—stranded conformational polymorphism，SSCP)、限制性酶切检测单核苷酸多态性(single nucleotide polymorphism，SNP)的优缺点。为不同条件下选择最适合的SNP检测方法提供借鉴。方法：DGGE、限制性酶切检测150例大肠癌APEX基因第3外显子，SSCP检测第5外显子，最后结果经直接测序验证。结果：DGGE检测出17例异常泳动条带；测序结果证实该17例均存在1247A→G的SNP；SSCP检测到57例异常条带；经直接测序证实38例有2197T→G的SNP；PCR-限制性酶切结果与DGGE所测结果完全吻合。结论：DGGE检测结果无假阳性，重复性好，准确率高。而且可判断基因型；SSCP简便易行．但存在假阳性与假阴性，而且不能判断基因型；限制性酶切对SNP位点检测及基因分型均能进行较准确的判断。     

垂直变性梯度凝胶电泳在大肠癌APEX基因变异检测中的应用

目的探讨变性梯度凝胶电泳(denaturinggradientgelelectrophoresis,DGGE)在大肠癌APEX基因单核苷酸多态性(singlenucleotidepolymorphism,SNP)或基因突变筛选中的应用价值。方法对散发性大肠癌APEX基因5个外显子进行DGGE检测及DNA测序,分析DGGE带型和测序结果之间的关系。结果根据DGGE原理及实验观察结果,发现无论何种碱基改变,在DGGE胶上通常只可能呈现4种带型中的一种,本研究发现其中的3种。杂合子的特征是在变性胶的泳道上出现不同水平的4条带,纯合子呈单一条带;带有错配的DNA分子在凝胶上的位置总是落后于没有错配的分子;当碱基改变为A/T→G/C时,突变DNA分子泳动较快,其条带位于野生型分子之前,当碱基改变为G/C→A/T时,结果相反。结论对于一已知的SNP,利用DGGE带型可以判断SNP的基因型和等位基因频率而免去进一步测序工作;对突变检测而言,DGGE可预测碱基改变的类型,有利于对测序结果判读的准确性。     

肝癌相关基因单核苷酸多态性基因芯片制备与检测分析

目的　研制肝癌多种相关基因芯片 ,进行肝癌组织中基因编码区单核苷酸多态性(cSNP)检测分析研究。方法　选取定位于肝癌高频缺失区的基因 ,经NCBIdbSNP数据库查询 ,获得基因cSNP序列 ,且根据多态位点设计寡核苷酸探针 ,制备成含 2 5个肝癌相关基因的 4 8个cSNP芯片。并对 10例肝癌患者cSNP进行检测分析 ,而对 7例患者的部分检测结果用聚合酶链反应 单链构象多态性法 (PCR SSCP)和测序进行验证。结果　芯片检测的灵敏度为 6× 10 3 ng/ μl,检测重复率高于 95 83% ,随探针浓度降低 ,杂交信号逐渐减弱。 10份肝癌患者组织中 ,检测到半胱氨酸酶caspase9(rs2 30 894 1)C→T多态性和停泊蛋白DOK2 (rs2 2 4 2 2 4 1)T→G各 7份 ,表皮生长因子类似物EGFL3(rs94 7345 )A→G多态性、caspase9(rs2 30 8938)C→G多态性和磷酸甘油酸盐脱氢酶PHGDH(rs180 195 5 )T→A多态性各 6份 ,启动子结合因子E2F2 (rs32 18170 )G→A多态性 5份 ,DNA切除修复糖基化酶MUTYH(rs114 0 5 0 7)T→C和胞内蛋白BNIP3L(rs10 5 5 80 6 )G→T多态性 4份 ,肿瘤坏死因子家族成员TNFRSF1B (rs10 6 16 2 2 )T→G多态性 1份。经PCR SSCP检测 ,7例肝癌患者有多态性单链迁移率改变。选取有caspase9(rs2 30 894 1G)与 (rs2 30 894 1A)的样本分别连     

上海地区汉族健康人群PAF乙酰水解酶基因4号外显子275位点G/A单核苷酸多态性

目的了解血小板活化因子乙酰水解酶(PAF-AH)基因4号外显子275位点G/A位点单核苷酸多态性(SNP)在中国上海地区汉族健康人群中的分布及与其他种族比较的特点。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,对100名上海地区汉族健康者PAF-AH4号外显子275位点G/A位点的SNP进行了检测,计算其基因型和等位基因频率,并结合文献进行了不同种族间的分析比较。结果上海地区汉族健康人群GG基因型频率最高(88%),GA基因型次之(12%),未发现AA基因型。与英国人相比,上海地区汉族人群G等位基因频率较高。结论上海地区汉族健康人群G→A位点碱基突变率较低,其SNP与英国人相比分布存在明显差异。     

80例山西汉族先天性巨结肠症患儿RET基因单核苷酸多态性分析

目的研究80例山西汉族先天性巨结肠症(Hirschsprung disease,HSCR)患儿RET基因7、12、13、15号外显子的单核苷酸多态性(single nucleotides polymorphisms,SNPs)与HSCR发病的关系。方法通过测序及序列比对的方法,对山西省80例汉族散发性HSCR患者和80例汉族健康儿童进行RET基因外显子序列分析,比较基因多态性位点等位基因频率在两组的差异。结果 RET基因7号外显子A432A(GCA→GCG)位点存在多态性,病例组和对照组中该位点的等位基因分布频率存在显著性差异(χ2=5.668,P<0.05),风险等位基因为G等位基因,OR=3.05,95%可信区间为1.218～7.639;RET基因13号外显子L769L(CCT→CTA)位点存在多态性,病例组和对照组中该位点的等位基因分布频率存在显著差异(χ2=37.458,P<0.01),风险等位基因为G等位基因,OR=4.632,95%可信区间为2.832～7.577。7号外显子D489N(GAC→AAC),15号外显子S904S(TCC→TCG)存在多态位点,病例组与对照组中P>0.05,该位点与疾...     

高分辨率熔解曲线在ABO血型基因526位点单核苷酸多态性检测中的应用

目的建立高分辨率熔解(HRM)曲线检测ABO血型基因526位点单核苷酸多态性(SNP)的方法。方法随机提取35例待检血型标本的DNA,运用HRM曲线检测ABO血型基因526位点的SNP,通过PCR-DNA测序以及血型血清学试验验证HRM检测结果的准确性。结果 35例血型标本中,共检出526位点杂合子13例,纯合子22例。经测序分析和血清学试验验证13例G/C杂合中B型8例、AB型5例,22例CC纯合子中A型10例,O型12例。HRM法检测结果与测序结果及血清学结果相符。结论 HRM法是一种低成本、简便、准确的SNP检测技术,有望成为临床ABO血型基因分型的新方法。     

毛细管电泳联合激光诱导荧光技术检测结直肠癌hMLH1基因突变

目的　建立毛细管电泳 (CE)联合激光诱导荧光检测 (LIF)技术 ,分析单链构象多态性 (SSCP) ,检测人结直肠癌hMLH1基因点突变的方法。方法　PCR扩增 4 2例散发性结直肠癌患者与 2 0例健康志愿者外周血基因组DNAhMLH1基因 12外显子 ,采用CE LIF进行SSCP分析 ,对异常片段进行测序鉴定 ;研究不同筛分介质 (线性聚丙烯酰胺LPA)浓度、分离温度与分离电压对CE行为的影响。结果　 4 2例患者中有 4例 (9.5 2 % )突变 ,CE测序证实为T115 1A的杂合子点突变 ;2 0例健康志愿者未发现突变。较高浓度的LPA(4 %～ 6 % ) ,2 0℃分离温度与 9kV分离电压有助于单链DNA峰分离。结论　调整适宜的LPA浓度、分离温度与分离电压可提高CE分析SSCP的效率 ,应用CE LIF技术SSCP分析检测hMLH1基因点突变快速、高效、重复性好 ,适合临床大样本筛查     

散发性乳癌WIF-1基因启动子区多态性研究

目的探讨WIF-1基因启动子区rs58172684 A/G与rs2336433 C/T位点单核苷酸多态性与散发性乳癌发生的关系。方法采用等位基因特异性扩增（ASA）法对200例乳癌病人和200例正常对照者的WIF-1基因启动子区rs58172684 A/G与rs2336433 C/T位点单核苷酸多态性进行分析,PCR产物进行测序。结果乳癌病人WIF-1基因启动子区rs58172684 A/G与rs2336433 C/T位点基因型频率与正常对照者比较差异具有显著性（χ2=117.475、38.798,P〈0.001）;乳癌病人rs58172684 G等位基因频率显著高于正常对照者（χ2=11.620,P〈0.001）。rs58172684 A/G位点AA、AG、GG等3种基因型和rs2336433 C/T位点CC、CT、TT等3种基因型与年龄、病理分级、组织分型及淋巴结转移无关（P〉0.05）。结论乳癌病人WIF-1基因启动子区rs58172684 A/G与rs2336433 C/T单核苷酸多态性可能与散发性乳癌的发生相关,G等位基因可能为其发生的遗传危险因素。     

软骨发育不全患者的FGFR3基因诊断

目的建立软骨发育不全(ACH)患者的FGFR3基因检测方法。方法用PCR扩增和测序技术对临床上疑似ACH的14例患者的FGFR3基因突变进行测序。结果 FGFR3基因的外显子10测序结果显示,14例疑似ACH患者中10例检出FGFR3基因1138位G→A突变。对4例未检出突变的样本进行FGFR3基因的全部外显子测序,有2例样本检出FGFR3基因882位T→C杂合突变,最后确定其为已知的单核苷酸多态性(SNP)位点(rs2234909)。对4例样本中的1例进行了后续检查,证实该受检者不是ACH患者。结论 FGFR3基因的突变检测有助于疑似ACH患者的明确诊断,对遗传咨询具有重要意义。     

宁夏地区Graves'病与CTLA-4基因多态性相关性研究

目的 探讨细胞毒性T淋巴细胞相关抗原4(CLTA-4)基因多态性与宁夏人群Graves'病(GD)的相关性.方法 应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术分析61例GD患者和60名对照者的CTLA-4基因第一外显子(49)A/G位点和启动子(318)C/T位点多态性.结果 GD患者组与对照组之间CTLA-4基因SNP (49)A/G的基因型分布(χ 2=9.277,P＜0.05)及等位基因频率(χ 2= 10.831,P＜0.05)差异有统计学意义;SNP(318)C/T的基因型分布(χ 2= 0.446,P>0.05)及等位基因频率(χ 2= 0.489,P>0.05)差异无统计学意义.结论 CTLA-4基因第一外显子的(49)A/G位点的多态性与宁夏地区GD的发生可能相关.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.