白色念珠菌实时荧光定量聚合酶链反应检测体系的建立

目的建立白色念珠菌实时荧光定量聚合酶链反应(PCR)检测体系,实现白色念珠菌的早期、快速检测,为临床医生对白色念珠菌感染的诊断提供指导。方法使用白色念珠菌及其他真菌标准株,利用Primer Premier 5.0和Beacon Designer 7.7设计引物探针。同时对镁离子(Mg2+)、三磷酸脱氧核糖核苷酸(dNTP)、引物及探针浓度等参数进行优化,选出最佳反应体系,并验证反应体系的特异性、重复性,分析反应体系的最低检测限,对临床分离出的45例白色念珠菌进行检测。结果设计的引物探针仅能对白色念珠菌进行特异性扩增,反应体系不同底物浓度与Ct值之间成良好的线性关系,反应体系的最低检测限为5CFU/mL,且反应体系稳定性、重复性好,对临床分离菌株的检测阳性率为100%。结论成功设计了白色念珠菌特异性的引物探针,并建立了实时荧光定量PCR检测体系,能快速、准确地检出白色念珠菌。     

多重巢式PCR检测恶性疟和间日疟原虫

目的建立鉴别诊断恶性疟原虫(P.f)和间日疟原虫(P.v)的多重巢式PCR法。方法针对P.f、P.v 18S rRNA基因设计外引物和内引物,优化引物浓度与退火温度,建立可扩增出两种疟原虫基因片段的多重巢式PCR,并检测54例疑似疟疾临床标本,以镜检法为金标准评价敏感性和特异性等指标。结果该方法可扩增出162 bp(P.f)和112 bp(P.v)基因片段,并能检出混合感染。该方法检测P.f,敏感性为87.50%、特异性为63.33%;检测P.v,敏感性为69.23%、特异性为68.29%。结论所建立的多重巢式PCR方法能可靠诊断疟疾并鉴别虫种,敏感性高,在混合感染的诊断方面具有优越性。     

巢式聚合酶链式反应检测脑脊液标本中病原体的方法评价

目的探讨巢式聚合酶链式反应(PCR)检测脑脊液标本中病原体的可行性,为疾病的快速临床诊断提供参考。方法源自细菌16S rRNA基因序列设计的巢式PCR技术方法,包括2对引物,2次PCR扩增,第1对引物首次PCR扩增脑脊液标本提取的核酸DNA,第2对引物再次PCR扩增,其DNA模板为第1轮PCR扩增产物。将第2轮PCR扩增产物进行测序,对序列进行比对分析,从而确定感染的病原体。使用DNA微量分光光度测定布鲁氏菌纯菌核酸DNA,将DNA进行倍比稀释,用于巢式PCR敏感性测试。结果巢式PCR能够检测的最低限约为1个核酸DNA拷贝数。应用巢式PCR检测40份临床患者的脑脊液标本,扩增结果表明有37份标本获得约1 460 bp的预期扩增条带(不同细菌扩增片段有差异),测序比对结果显示,检出脑膜炎奈瑟菌7份、产碱假单胞菌1份、草假单胞菌22份、嗜麦芽窄食单胞菌2份、肺炎链球菌1份、未知细菌性病原体4份、未检出3份。结论巢式PCR能够快速检测与鉴定脑脊液标本中的细菌性病原体。     

TTV病毒检测方法的建立及在维吾尔族人群中的应用

目的建立TTV-DNA聚合酶链反应方法并应用于新疆地区不同人群TTV感染的检测。方法根据已报道的TTV基因序列(DDB）序列号：AB008394)．通过引物设计软件SQNCE和OLIGO在其ORF1区设计一对PCR引物,扩增产生一个315bp的扩增片段,产物经Bg1Ⅱ酶切分别产生一个219bp和96bp的酶切片段。结果用建立的PCR方法检测临床标本,在15例维吾尔族转氨酶升高的非甲～非庚型肝炎患血清标本中检测到6份TTVDNA阳性,表明新羞地区存在TTV感染．维吾尔旗人群中有较高的TTV感染率。结论我们建立的TTV DNA-PCR灵敏度高、特异性好,可用于各类人群TTV-DNA的检测。     

荧光定量聚合酶链反应检测杜克雷嗜血杆菌的实验研究及临床应用

目的：建立荧光定量聚合酶链反应(FQ-PCR)检测杜克雷嗜血杆菌(HD)的方法，并作临床应用评价。方法根据HD的基因库序列设计引物对2株参考株进行扩增，证实其特异性；再以10倍稀释不同浓度模板扩增测定其敏感度；同时检测76份生殖器溃疡处分泌物标本，每份标本同时作HD涂片和培养。结果：2株不同来源的HD参考株均出现特异性扩增片段，扩增片段大小为60bp；其敏感度为10拷贝／μ1。将FQPCR用于检测76例HD培养阴性的生殖器溃疡分泌物标本，结果4例阳性。结论：FQPCR是一种高灵敏度、高特异性和高精确性的检测生殖器溃疡标本中HD的实验诊断方法，可用于临床诊断HD感染。     

聚合酶链反应检测真菌感染的临床评价

用聚合酶链反应 (PCR)检测真菌 ,已有较多报道[1 2 ] ,我们也曾报道过初步研究[3 ] 。为给临床提供快速、灵敏、非创伤的真菌感染诊断方法 ,本文就采用真菌通用引物PCR检测真菌DNA的灵敏度、特异性、可检测真菌范围及临床适用性作进一步评价。1　材料和方法1 1　引物　真菌 18S亚基rRNA多拷贝基因的保守序列通用引物序列为 5′ ATTGGAGGGCAAGTCTGGTG 3′和 5′ CCGATCCCTAGTCGGCATAG 3′ ,扩增产物大小因真菌病原体而异 ,为 4 82～ 5 0 3bp[4] ,白色念珠菌为 4 90bp。由北京赛百盛生物工程公司合成。1 2　临床无菌性…     

两种念珠菌DNA探针的研制及应用

目的：制备两种念珠菌DNA探针并应用于临床诊断。方法：对聚合酶链反应扩增的白色念珠菌标准株的E03基因的125bp片段，用半抗原地高辛标记；合成仪合成的E03基因中25bp特异寡核苷酸，用生物素标记。检测两种探针显色敏感度，并与23株临床分离的白色念珠菌、热带念珠菌，近平滑念珠菌、克柔念珠菌、星形念珠菌及大肠埃希菌等细菌进行斑点杂交试验。结果：Dig-125bpDNA探针显色敏感度为0.01pg，仅与白色念珠菌杂交，且对临床分离株检测的结果与传统厚膜孢子鉴定法相符。Bio-25bpDNA探针显色敏感度为20pg，与白色念珠菌、近平滑念珠菌及星形念珠菌杂交。结论：Bio-25bp DNA探针可用于念珠菌初步鉴定，而Dig-125bp DNA探针可用于白色念珠菌的鉴定。     

巢式聚合酶链反应检测SEN病毒方法的建立

目的 建立用于SEN病毒（SENV）检测的巢式聚合酶链反应（nPCR）方法。方法 选择SENV各亚型间高度保守的5′端非编码区（5′－NCR）序列设计2对特异性引物，建立可同时检测SENV所有亚型的nPCR方法。对173例慢性乙型肝炎（CHB）患血清和96份正常人血清进行SENV检测，并随机选择3份PCR阳性产物进行克隆测序。结果 倍比稀释实验表明该方法的终检稀释度为10^3。PCR产物克隆测序结果显示：各分离株与Genbank收录的SENV序列相应区段同源性为95％－96％。CHB患SENV感染率为86．1％，正常人为85．1％，二差异无显性（χ^2=0.381,P=0.537)。结论 该方法敏感、特异且简便经济，适于开展SENV的流行病学研究。     

TaqMan-MGB探针实时荧光定量PCR快速检测光滑念珠菌

目的采用TaqMan-MGB探针作为检测信号,建立快速检测光滑念珠菌的实时荧光定量PCR方法。方法以光滑念珠菌核糖体RNA编码基因(rDNA)中的内转录间隔区2(ITS2)作为靶基因,设计特异性引物和TaqManMGB探针。在梯度光滑念珠菌纯菌液标本中评价所建方法灵敏度和重复性;在102株光滑念珠菌临床分离株、非光滑念珠菌的其他4种念珠菌临床分离株、7种细菌临床分离株和人基因组的DNA中评价所建方法特异度;并在模拟光滑念珠菌血症的血标本中初步探讨其临床应用价值。结果所建方法对光滑念珠菌纯菌液的检测下限为101 CFU/ml,相应的批内、批间变异系数(CV)分别为1.68%和2.84%。对102株光滑念珠菌临床分离株检出率为100%;对非光滑念珠菌无交叉反应,显示该方法特异性为100%。对模拟光滑念珠菌血症血标本的最低检测下限为101 CFU/ml。结论所建方法具有特异性和灵敏度高、重复性好的特性,适于临床上光滑念珠菌血症的快速检测。     

荧光定量聚合酶链反应检测常见致病真菌方法的建立

目的建立快速的检测临床致病真菌的荧光定量聚合酶链反应(PCR)方法。方法使用真菌的通用引物ITS86和ITS4,检测临床常见的致病性真菌,并观察检测方法的敏感性和特异性。结果建立的荧光定量PCR可以准确地检测念珠菌属、曲霉菌属和新型隐球菌等常见的致病真菌,白色念珠菌的敏感性为0.87fg,光滑念珠菌的敏感性为4.2fg,与细菌和人类基因组DNA以及病毒DNA均无交叉反应,根据融解曲线的Tm值可以进行菌种的初步鉴定。结论荧光定量PCR方法检测真菌的敏感性和特异性好,可以应用于临床进行快速检测。     

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.