肝脂肪酶基因启动子250 G/A多态性与脑梗死的关系

目的探讨本地区汉族人肝脂肪酶(HL)基因启动子250 G/A多态性与脑梗死的关系.方法采用聚合酶链反应-限制性片段长度多态性技术检测71例脑梗死患者和69名正常老年汉族人HL启动子250 G/A基因多态性,探讨其对血脂、载脂蛋白水平的影响.结果脑梗死组A等位基因频率分布与正常老年组之间的差异无显著性,但脑梗死组的GG、GA和AA基因型频率分别为0.378 6、0.466 0和0.197 2,与正常老年组(0.405 8、0.536 2和0.058 0)相比,AA基因差异有显著性(P＜0.05);脑梗死组的高密度脂蛋白胆固醇[HDL-C,(1.17±0.32)mmol/L]、载脂蛋白A-Ⅰ[apoA-Ⅰ,(1.18±0.31)g/L]水平明显低于正常老年组[(1.36±0.22)mmol/L、(1.44±0.22)g/L];而脑梗死组的三酰甘油[TG,(1.57±0.60)mmol/L]、低密度脂蛋白胆固醇[LDL-C,(3.25±0.81)g/L]则明显高于正常老年组[(1.33±0.41)mmol/L、(2.72±0.82)g/L].脑梗死组(GA+AA)型的TG[(1.56±0.56)mmol/L]、HDL-C[(1.22±0.36)mmol/L]、LDL-C[(3.38±0.79)mmol/L]、apoA-Ⅰ[(1.19±0.34)g/L]水平与正常老年组的同基因型间差异有显著性(P＜0.05).结论在脑梗死患者中,HL启动子250 G/A基因多态性对TG、HDL-C、LDL-C、apoA-Ⅰ水平有一定影响,与脑梗死的发生相关.     

肝脂肪酶基因启动子250G/A多态性与脑梗死的关系

目的探讨本地区汉族人肝脂肪酶(HL)基因启动子250 G/A多态性与脑梗死的关系。方法采用聚合酶链反应-限制性片段长度多态性技术检测71例脑梗死患者和69名正常老年汉族人HL启动子250 G/A基因多态性,探讨其对血脂、载脂蛋白水平的影响。结果脑梗死组A等位基因频率分布与正常老年组之间的差异无显著性,但脑梗死组的GG、GA和AA基因型频率分别为0.378 6、0.466 0和0.197 2,与正常老年组(0.405 8、0.536 2和0.058 0)相比,AA基因差异有显著性(P<0.05);脑梗死组的高密度脂蛋白胆固醇[HDL-C,(1.17±0.32)mmol/L]、载脂蛋白A-Ⅰ[apoA-Ⅰ,(1.18±0.31)g/L]水平明显低于正常老年组[(1.36±0.22)mmol/L、(1.44±0.22)g/L];而脑梗死组的三酰甘油[TG,(1.57±0.60)mmol/L]、低密度脂蛋白胆固醇[LDL-C,(3.25±0.81)g/L]则明显高于正常老年组[(1.33±0.41)mmol/L、(2.72±0.82)g/L]。脑梗死组(GA AA)型的TG[(1.56±0.56)mmol/L]、HDL-C[(1.22±0.36)mmol/L]、LDL-C[(3.38±0.79)mmol/L]、apoA-Ⅰ[(1.19±0.34)g/L]水平与正常老年组的同基因型间差异有显著性(P<0.05)。结论在脑梗死患者中,HL启动子250 G/A基因多态性对TG、HDL-C、LDL-C、apoA-Ⅰ水平有一定影响,与脑梗死的发生相关。     

汉族人肝脂酶基因启动子-514C/T多态性与2型糖尿病合并冠心病的关系

目的探讨汉族人肝脂酶(HL)基因启动子-514C/T多态性与2型糖尿病合并冠心病的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)技术检测了114例2型糖尿病合并冠心病患者、127例2型糖尿病患者和106名健康对照组汉族人HL基因启动子-514C/T多态性基因型,探讨了其对血脂、脂蛋白和载脂蛋白水平的影响。结果糖尿病组与对照组HL基因启动子-514C/T多态性基因型和等位基因频率分布差异无统计学意义,糖尿病合并冠心病组的CT和TT基因型频率分布明显低于对照组(0.439比0.613,P<0.05),但是等位基因频率分布差异无统计学意义。3组研究对象中,HL基因启动子514-C/T多态性基因型和等位基因分布频率与性别、家族史、吸烟史及体重指数无明显关联性。当调整了性别、年龄、体重指数(BMI)、吸烟史、冠心病和高血压家族史等因素后,Spearman相关及线性回归分析显示,所有2型糖尿病患者(糖尿病组与糖尿病合并冠心病组)中,T等位基因与高密度脂蛋白胆固醇(HDLC)、载脂蛋白AⅠ(apoAⅠ)呈明显正相关;Logistic回归分析显示,T等位基因不是冠心病发生的独立危险因素。结论在2型糖尿病及其冠心病合并症中,HL基因启动子514C/T基因多态性对血脂水平有一定影响。CT和TT基因型分布频率     

汉族人肝脂酶基因启动子-514C/T多态性与冠心病的关系

目的:探讨汉族人肝脂酶(HL)基因启动子-514C/T多态性与冠心病的关系。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127例冠心病患者和100名对照组汉族人HL基因启动子-514C/T多态性基因型,探讨其对血脂、脂蛋白和载脂蛋白水平的影响。结果:冠心病组与对照组HL基因启动子-514C/T多态性基因型和等位基因频率分布差异无显著意义,与性别、家族史、吸烟史及体重指数无明显相关性。Spearman相关分析显示,不论健康对照组,还是冠心病组,T等位基因与各项血脂水平之间均无明显相关性。Logistic回归分析显示,T等位基因不是冠心病发生的独立危险因素。结论:此结果表明,不论健康对照组还是冠心病组,HL基因启动子-514C/T基因多态性与各种血脂水平之间无明显相关性,T等位基因不是冠心病发生的独立危险因素。     

肝脂酶启动子250 G/A多态性与血脂的关系

目的探讨各项血脂水平与肝脂酶(HL)启动子250 G/A基因多态性的关系。方法运用聚合酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP),对112例三酰甘油(TG)正常者和103例高TG者的HL启动子250 G/A基因多态性进行研究。结果发现HL启动子250 AA等位基因频率在高TG组为0.447 7明显高于正常TG组(0.263 4,P<0.05)。在总研究组发现AA型的TG、载脂蛋白B(ApoB)浓度明显高于GG型和GA型,而载脂蛋白A l(ApoA l)则明显降低(P<0.05)。按性别分层后发现AA型女性和男性的TG、低密度脂蛋白胆固醇(LDL-C)的浓度明显高于非AA型同性(P<0.05),而高密度脂蛋白胆固醇(HDL-C)、ApoA l浓度分别低于非AA型的同性(P<0.05)。经Logistic回归分析显示年龄、LDL-C、ApoB、AA型是危险因子,而HDL-C是保护因子。结论HL启动子250 G/A多态性与高TG血症的发生相关,并可影响血浆脂类的代谢,可能是高TG所致疾病的危险因素。     

肝脂酶启动子250G/A多态性与高密度脂蛋白胆固醇的关系

目的:探讨肝脂酶(HL)基因启动子250G/A多态性与高密度脂蛋白胆固醇(HDL-C)间的关系。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203例高HDL-C者和156名HDL-C水平正常对照者的HL基因启动子250G/A多态性基因型,并探讨其与血脂水平的关系。结果:高HDL-C组该位点的基因型和等位基因频率分布与对照组相比,差异均有统计学意义(P<0.05);高HDL-C组GA型的TG、TC、HDL-C、nonHDL-C明显高于对照组GA型(P<0.05);高HDL-C组AA型除载脂蛋白B100(ApoB100)外其他指标与对照组AA型相比,差异均有统计学意义(P<0.05),且TG、TC、HDL-C、nonHDL-C、LDL-C高于同组的GG型、GA型(P<0.05)。多元Logistic回归分析示TG、AA型与高HDL-C的发生有关(P     

高密度脂蛋白胆固醇与肝脂酶启动子514C/T多态性的关系

目的:探讨肝脂酶(HL)的基因启动子514C/T多态性与高密度脂蛋白胆固醇(HDL-C)间的关系。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203例高HDL-C患者和156名HDL-C正常对照者(对照组)的HL基因启动子514C/T多态性及其基因型,并探讨其与血脂水平的关系。结果:高HDL-C组HL基因启动子514C/T位点的基因型及等位基因频率分布与对照组相比,差异均无统计学意义(P>0.05)。再按TG与TC水平将高HDL-C组再分成2组进行观察,高HDL-C组1[TG≥1.70 mmol/L和(或)TC≥5.72 mmol/L]的等位基因型频率与对照组比较,差异有统计学意义(P<0.05),而高HDL-C组2(TG0.05)。高HDL-C组1中CC型者除载脂蛋白A1(ApoA1)及ApoA1/ApoB100外,其他血脂指标均明显高于同基因型的对照组(P<0.05)。经过多元逐步Logistic回归分析,结果显示三酰甘油(TG)、总胆固醇(TC)与高HDL-C的发生有关(P     

肝脂酶基因-250G/A多态性与脑梗死

目的:探讨上海汉族人群肝脂酶基因启动子250G/A(HL-250G/A)多态性与脑梗死的关系。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RELP)技术检测133例脑梗死患者和92名正常老年人HL-250G/A多态性基因型,并研究其对血脂水平的影响。结果:脑梗死组的基因型和等位基因频率分布与正常老年组相比,均有显著差异;在男性无突变型中,脑梗死组的高密度脂蛋白胆固醇水平比正常老年组低;在女性中,脑梗死组突变型的三酰甘油水平高于同组的无突变型和正常老年组的突变型,统计学上差异均存在显著性(P     

肝脂酶基因-763A/G多态性与混合型高脂血症的关系

目的探讨混合型高脂血症(CHL)与肝脂酶(HL)基因启动子763A/G多态性的关系。方法运用聚合酶链反应-限制性内切酶片段长度多态性技术(RCR-RFLP),对219名对照者和218例CHL患者的HL基因启动子763A/G多态性进行检测,并研究其对血脂水平的影响。结果总研究组的HL-763A/G多态性的AA、AG和GG基因型频率分别为0.315 5、0.493 6、0.190 8;A、G等位基因频率分别为0.562 3、0.437 7。在CHL组中除年龄、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-Ⅰ(apo A-Ⅰ),AA型的低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(apo B)及GG型的apo A-Ⅰ水平外,其余指标均与对照组同基因型之间差异有统计学意义(P<0.05);GG型的年龄明显低于AA型(P<0.05),apo A-Ⅰ水平明显高于AA型(P<0.05),而apo A-Ⅰ及apo A-Ⅰ/apo B水平明显高于AG型(P<0.05)。在CHL男性组中,除AA型HDL-C、GG型HDL-C、apo A-Ⅰ水平外,其余血脂水平均高于对照男性组(P<0.05),同样,在CHL女性组中,除GG型的H...     

混合型高脂血症与肝脂酶基因启动子250G/A多态性的关系

目的:探讨混合型高脂血症与肝脂酶基因启动子250G/A多态性的关系。方法:运用聚合酶链反应-限制性内切酶片段长度多态性技术,检测195名对照者和105例混合型高脂血症患者的肝脂酶(HL)基因启动子250G/A多态性,并研究其对血脂水平的影响。结果:混合型高脂血症组HL基因型和等位基因频率分布与对照组相比,均有显著差异(P＜0．05);GAvs GG,0R=1．446,95%CI:0．829～2．524;AA vs GG,OR=4．076,95% CI:2．068～8．035;A vs G, OR=1．978,95%CI:1．408～2．777。在混合型高脂血症组中除患者年龄和AA型载脂蛋白Al(Apo Al)水平外,其他基因型的各项指标均与对照组相同基因型有显著差异(P＜0．05)。混合型高脂血症组各基因型间的血脂指标均无差异(P＞0．05);而对照组AA型的TG水平明显高于GG型、GA型(P＜0．05),LDL-C水平则明显高于GG型(P＜0．05)。结论:HL基因启动子250G/A多态性与混合型高脂血症的发生相关,并可影响血浆脂类代谢。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.