因母亲14/21平衡易位导致的先天性愚型

本文报告一患儿染色体G带检查结果,其核型为46,XY,t(14:21)(14q~(ter)→14p~(11 )21p~(11)—21q~(ter)),确诊为14/21易位型21三体综合症。追溯患儿易位染色体形成原因,对患儿父母作染色体检查分析,其父核型为46,XY;其母则是45,XX,t(14:21)(14q~(ter)→14p~(11 21)p~(11)→21q~(ter)),证实其母为14/21平衡易位携带者,患儿易位染色体21三体为其母所传递。具有这样平衡易位核型的人,其子女患先天性愚型的危险比普通人群高70倍左右。因此,检出平衡易位对优生很有价值。     

罕见的染色体12;15号平衡易位携带遗传

先证者黄××,女,26岁,结婚三年,流产三次,每次均发生在孕2~+月,为查明流产原因,夫妇双方来遗传咨询。查体:夫妇双方表型正常,男方生殖器及精液常规检查均正常,先证者身高162cm,皮纹学、内外生殖器均正常.染色体检查:男方核型46,XY;先证者核型发现一条15号染色体长臂断裂易位到12号长像12号长臂的末端易位到15号,核型为46,XX,t(12;15)(12Pter→12q~(21)∷15q~(13)→15qter)(15Pter→15q~(13)∷12q~(21)→12qter)。家系调     

新发现t(6:16)平衡易位核型

在我室进行外周血淋巴细胞染色体检查507例中发现一例不育症患者染色体核型为t(6:16)平衡易位。经请医学遗传国家培训中心细胞遗传研究室夏家辉主任,李麓云副主任鉴定并查阅国内外资料未见有报导,属世界首报。现简要报告如下: 资料①患者××,编号477,男性,31岁,因结婚五年爱人不孕,1986年2月22日来我室就诊。患者发育正常,营养中等,身高169cm,体重60kg,表型正常,精液常规检查正常。染色体检查结果,经外周血淋巴细胞培养G显带核型分析发现为t(6:16)平衡易位。计数患者50个细胞,核型分析5个细胞,为46,XY,t(6:16)(6p~(ter)→6q~(21)::16p~(13)→16p~(ter),16q~(ter)→16p~1::6q~(21)→     

12对自然流产史夫妇外周血染色体分析

我科遗传咨询门诊随机地对具有自然流产史夫妇双方进行了外周血染色体检查,共12对夫妇24例,其中正常核型者19例,异常核型者5例。5例中,平衡易位者1例,核型为46,XY,t(5;15)(5qter→5p~(16)∷15q~(22)→15qter;15Pter→15P~(22)∷5p~(16)→5pter);属于所谓正常     

一家三代染色体t(4;9)平衡易位病例报告

我院产科优生咨询门诊于1983年1月17日对一位患有结缔组织病的孕妇进行外周血培养作G带检查,发现其染色体核型为:46,xx,-4-9+t(4P~(ter→cen→)4q~(35)∷9q~(22)→9g~(ter))+t(9P~(ter→cen→)9q~(22)∷4q~(35)→4q~(ter)),为此对其兄妹及上下代作家系调查,见其母、妹及子的染色体核型均与之相同,现作如下报告。     

Turner氏综合征3例实验室研究与临床分析

应用外用血染色体G显带、高分辨技术、中期X染色体复制技术和X小体检查,对有原发性闭经、体矮和性发育差的患者进行研究,确诊了部分缺失型、X等臂染色体型和X单体型Turner氏综合征,其核型分别为46,X,del(X)(p~(ter)→q~(13·1:));46,X,i(Xq);45,XO。说明应用现代细胞遗传学技术和临床研究对诊断Turner氏综合征有重要意义。     

一个遗传三代的9号染色体短臂三体型家系

先证者,检查号血909号,4岁半,由于有出血倾向于1981年12月来我院附一院血液室就诊,因体查中发现智力较差,在询问家族史时发现有两个舅舅智力亦差而转我遗传咨询门诊。外周血 G 显带染色体检查发现除两条正常的20号染色体外,尚有一条类似于20号,但形态略有差别的染色体。为了准确鉴定其核型,取其母,兄,大舅,二舅,二姨,四舅,外祖父,外祖母的外周血作了 G 显带染色体分析。结果,其外祖父染色体正常,其大舅,二舅具有先证者相同的异常染色体,其母,兄,二姨,四舅、外祖母为9号和22号染色体短臂相互易位型携带者,他(她)们的核型为:46,XY(XX),t(9,22)(P13;P12)。通过家系中携带者的检出与核型鉴定使我们确认其先证者及其大舅、二舅为9号染色体短臂部份三体型的患者,其核型为46,XY,-22, der(22),t(9;22)(p13;p12)。     

家族性染色体断裂易位热点

染色体结构畸变起源于染色体的断裂和变位重接。文献中尚未见到关于结构畸变染色体在上下代的遗传传递中与其他非同源染色体再次发生结构性重排的报道。我室曾发现一例核型为46,XY,-13, der(13),t(4;13),(13pter→13q34∶∶4q25→4q ter)(图1)的4q 部分三体型患儿(血273号),其父亲(血274号)、伯父(血456号)均为1/4染色体平衡易位携带者,核型为46,XY,t(1;4)(1p ter→1q43∶∶4q25→4q ter;4p ter→4q25∶∶1q43→1qt er)     

首报3例人类染色体异常核型

本室在149对反复性流产夫妇的染色体检查中发现了7例人类染色体异常核型,其中三例经查阅文献及专家鉴定认为属世界首报。核型Ⅰ:46,XX,t(1;13)(q~(22);q~(34)),该患者连续流产五胎,流产时间均在三个月内,其表型,月经周期、子宫发育均正常。家系调查发现其母曾漉产五胎,生产二胎,经染色体检查染色体核型与先证者相同。由此可见该患者的异常染色体可能为其母遗传。     

二代四例9号染色体臂间倒位报告

吴某,男,46岁,本人表型与智力正常,生三女均智力低下而作染色体核型分析。吴某为 46,xy,inv(9)(p~(13);q~(13)),其长女19岁、次女16岁、三女12岁染色体核型均为46,xx,inv(9)(p~(13);q~(13)),其妻表型及智力正常,其父母为姑舅结婚,吴某父亲染色体核型46,xy 正常。国外报道在新生儿调查中9号染色体臂间倒位发生率为0.95～1.2%。李麓云     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.