两种进口试剂盒在福建汉族人群STR基因分型中的一致性验证及应用

目的确认PowerPlexFusion与GlobalFiler试剂盒基因分型结果的一致性。方法收集2 410名福建地区无关汉族个体血样并提取基因组DNA。采用PowerPlexFusion与GlobalFiler试剂盒检测个体的STR座位,观察20个重叠常染色体STR基因座及1个Y(DYS391)基因座分型结果的一致性。并比较分析这2个试剂盒在日本、韩国人群应用评价的结果。结果所有20个重叠常染色体STR基因座除D21S11、D22S1045和D5S818基因座观察到4例标本基因分型结果不一致外(占标本总数的0.17%),其他17个常染色体STR和DYS391基因分型结果均一致。2个试剂盒20个相同STR常染色体基因座基因型一致率为99.992%。2个试剂盒的杂合基因座峰高比例差异无统计学意义(P0.05)。结论 PowerPlexFusion与GlobalFiler试剂盒基因分型一致性较好,在需要确认是否为无效等位基因时可互为补充。     

手工与全自动核酸提取仪提取石蜡包埋组织DNA的比较

目的：比较手工与全自动核酸提取仪提取石蜡包埋组织DNA的浓度和纯度之间的差异,探讨不同提取方法、不同消化方式对DNA提取的影响。方法：选取27例中性福尔马林固定石蜡包埋组织标本,同一技师分别用手工提取与全自动核酸提取仪提取DNA的方法以及分别置于金属浴和恒温箱中消化,进行DNA提取。结果：使用金属浴对组织进行消化,手工提取DNA的浓度为107.1±30.1 ng/μL,全自动核酸提取仪提取DNA的浓度为39.1±16.5 ng/μL；使用恒温箱对组织进行消化,手工提取DNA的浓度为75.5±28.2 ng/μL,全自动核酸提取仪提取DNA的浓度为29.6±17.1 ng/μL,手工提取DNA的浓度均较高,差异有统计学意义(两者均为P<0.01)。手工提取和全自动DNA提取中,使用金属浴消化提取的DNA浓度均比使用恒温箱消化的高(107.1±30.1 VS 75.5±28.2,39.1±16.5 VS 29.6±17.1),差异有统计学意义(两者均为P<0.05)。不同提取方法及消化方式提取DNA的纯度无显著性差异。 结论：手工提取石蜡包埋组织DNA的浓度较高,使用金属浴消化组织提取DNA较恒温箱消化好,不同方式提取的DNA质量均满足分子病理检测需求。     

鄂西北及周边地区汉族人群D2S1338和D19S433基因座多态性分析与调查

目的 采集鄂西北及周边地区汉族人群无关个体血样,进行STR等位基因座D2S1338和D19S433多态性分析. 方法 应用chelex提取DNA,AmpFISTR Identifiler试剂盒扩增,毛细管电泳分型. 结果 在被检测的387位无关个体中等位基因座D2S1338和D19S433分别检出14和17个等位基因型以及两个等位基因的分布频率,基因座等位基因分布频率符合Hardy-Weinberg平衡. 结论 得到一些适合本地区应用的等位基因的频率,为以后司法物证鉴定工作提供参考.     

优化甲醛固定石蜡包埋组织DNA提取预处理对STR分型有效性的研究

目的通过对甲醛固定石蜡包埋组织（FFPET）DNA提取进行优化处理,确定满足FFPET样本进行短片段重复序列（STR）完整分型的条件。方法改变石蜡切片厚度、离心速率和时间、组织用量和消化液体积等参数提取FFPETDNA,并对提取的DNA样本进行常规STR扩增检验。结果优化方法处理后可以提取到较高质量DNA（1000bp）,经扩增均可以检出性别基因座（amelogenin）和15个以上STR基因座。结论 FFPET优化方法能够提高DNA提取的质量,适合STR分型研究。     

亲子鉴定中STR基因座来源不明突变的分析

目的 探讨亲子鉴定中STR基因座的等位基因突变来源不明的现象、原因及亲权指数计算.方法 采用Chelex-100法提取4385例家系样本DNA,经聚合酶链反应(PCR)扩增后,应用毛细管电泳分析STR基因座的等位基因分型.发生突变的STR基因座,分别采用Identifiler体系或Microreader 23sp ID...     

广东汉族人群21个常染色体STR基因座遗传多态性

目的调查研究广东汉族人群21个常染色体短串联重复序列(STR)基因座的遗传多态性。方法采用Expressmarker22STR荧光检测试剂盒,对618例广东汉族无关个体21个常染色体STR基因座(D18S51、FGA、D21S11、D8S1179、vWA、D13S317、D16S539、D7S820、TH01、D3S1358、D5S818、CSF1PO、D2S1338、D19S433、D12S223、D2S441、D10S1248、TPOX、D6S1043、PentaE、PentaD)和1个性别位点进行复合扩增,用AB3500分析仪进行基因分型,用Modified-Powerstates、Phylip3.695和Mega7.0软件进行法医遗传学参数统计分析及Hardy-Weinberg平衡检验、遗传距离计算、进化树绘制。结果广东汉族群体中共检出223个等位基因,各基因座分布均符合Hardy-Weinberg平衡定律(P>0.05),频率分布0.000 8-0.525 1;杂合度、个体识别力、多态信息含量等法医学参数显示,除TH01和TPOX基因座,其余STR基因座的均具有高度遗传多态性;群体进化树分析显示该人群与贵州汉族人群亲缘关系最近,与云南汉族人群亲缘关系最远。结论这21个常染色体STR基因座在广东汉族人群中具有较高的多态性和较好的个体识别能力,是较理想的遗传标记,能满足法医学个体识别和亲权鉴定的需要,所得到的数据可为广东汉族的群体遗传学研究提供依据。     

PCR反应体系中Mg2+浓度对从石蜡包埋组织中提取DNA进行PCR反应的影响

目的　探讨PCR反应体系中Mg2 浓度对从石蜡包埋组织中提取DNA进行PCR反应的影响。方法　从石蜡包埋组织中提取DNA ,PCR反应扩增甲状腺髓样癌RET基因第 13外显子 ,分析PCR反应体系中Mg2 浓度分别为1 5mmol L、2 0mmol L、2 5mmol L、3 0mmol L、4 0mmol L时PCR反应产物中目的基因含量及对PCR产物基因序列测定的影响。结果　 5种条件扩增的目的基因经纯化后DNA含量分别为 4 8ng μl(1 5mmol L)、2 6 6ng μl(2 0mmol L)、4 0 2ng μl(2 5mmol L)、38 5ng μl(3 0mmol L)、4 4 5ng μl(4 0mmol L) ;Mg2 浓度为 4 0mmol L时PCR产物电泳图见到多条非特异性条带 ;Mg2 浓度为 2 5mmol L时PCR产物直接测序反应曲线峰图背景噪音 (噪峰 )减小 ,信噪比 (信号 噪音 )增高。结论　从石蜡包埋组织中提取DNA行PCR反应 ,Mg2 浓度为 2 5mmol L时反应特异性强 ,PCR产物质量高。较高的Mg2 浓度可以增加PCR反应产量 ,但降低反应的特异性     

一种石蜡包埋组织DNA提取方法

从石蜡包埋组织中提取基因组DNA有一定的难度。Moerkerk证明福尔马林固定对DNA有降解作用[1]。传统的二甲苯脱蜡及苯酚氯仿抽提DNA,其弊端是过程长、对人有毒、得到的DNA量仅1～2ng。如何避免DNA分子损失,保持DNA相对完整和纯度值得探讨?本人经过5年摸索,建立了一种简便有效的石蜡包埋组织DNA的提取方法。其基本原理是:用蛋白酶K及SDS、TritonX-100在Tris、EDTA保护DNA的条件下,裂解细胞、消化蛋白质,使核蛋白解聚并使细胞内本身存在的DNA酶灭活,然后用NaI沉淀DNA,玻璃粉吸附DNA,离心去除杂质以及乙醇洗涤得到5～10μgD…     

从石蜡包埋的淋巴瘤组织提取DNA并定量检测EB病毒

目的 定量检测石蜡包埋的淋巴瘤组织中EB病毒（EBV）的表达，方法 对TES水浴DNA提取法进行了改良，从石蜡包埋的淋巴瘤组织中提取高质量的基因组DNA，以实时荧光定量PCR方法检测淋巴瘤组织EBV。结果在60例标本中平均提取DNA量为3．97ng（10／μm厚切片2片），86．7％（52／60）标本DNA的纯度（260nm／280nm）≥1．6，其中50％（30／60）淋巴瘤组织EBV呈阳性表达（10^0～10^6拷贝／ngDNA）。结论 采用改良TES水浴法能获取石蜡包埋组织中高质量基因组DNA，使用该新的实验技术可有效地利用现有的标本资源进行与疾病相关科学的研究。     

广东省佛山地区汉族人群15个STR基因座的遗传多态性

目的对广东省佛山地区汉族人群无血缘关系的个体的15个STR基因座（D8S1179、D21S11、D7S820、CSFIPO、D3S1358、D5S818、D13S317、D16S539、D2S1338、D19S433、vWA、D12S391、D18S51、D6S1043、FGA）的遗传多态性进行研究。方法采用Chelex-100法应用荧光标记复合扩增系统（AmpFISTR Sinofiler）和ABI 3100遗传分析仪对250例广东省佛山地区汉族无血缘关系的个体血样进行DNA多态性分析,并统计各基因座的群体遗传学参数。结果在佛山地区汉族人群中,15个STR基因座的基因型分布经x2检验符合Hard-Weinberg平衡（P〉0.05）。杂合度（H）值在0.727～0.880之间,匹配概率（pM）值在0.033～0.130之间,三联体非父排除率（PE）值在0.471～0.754之间,个体识别能力（PD）值在0.870～0.967之间,多态性信息含量（PIC）值在0.68～0.86之间;15个基因座累计个人识别概率（TPD）值为0.999999999999999999245。结论 15个STR基因座在广东省佛山地区汉族人群中有较高的多态性,AmpFISTR Sinofiler复合扩增系统对佛山汉族人群的身份识别和亲权鉴定以及DNA数据库建立具有较高的应用价值。     

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.