聚合酶链反应结合探针杂交检测幽门螺杆菌

建立特异，灵敏的聚合酶链反应结合长臂光敏生物素探针杂交检测幽门螺杆菌的方法。用ＰＣＲ产物直接克隆并测序，以含ＨＰ ＤＮＡ序列的重组质粒外源片段为探针。用细菌培养，单纯ＰＣＲ和ＰＣＲ结合杂交检测经胃镜诊断为慢性炎，胃溃疡，十二指肠球部溃疡的胃活检组织，唾液和粪便标本中的ＨＰ。     

聚合酶链反应检测幽门螺杆菌

本文应用与幽门螺杆菌染色体ＤＮＡ高保守区序列互补的引物对，建立聚合链反应检测技术，对２８种非ＨＰ菌及１６株ＨＰ进行检测，特异性１００％，敏感性达到能检出１ｐｇ染色体ＤＮＡ（相当于１００个菌细胞）水平，对３６例接受胃镜检查病人的胃活检组织进行检测，ＨＰ阳性率４７．２％（１７／３６），而对照方法中细菌培养ＨＰ阳性率３３．３％（１２／３６），快速尿素酶试验ＨＰ阳性４１．６％（１５／３６）。结果提示ＰＣＲ     

聚合酶链反应和尿素酶试验检测幽门螺杆菌

近年来随着大量研究资料表明,幽门螺杆菌（ＨＰ）与慢性胃炎、消化性溃疡及胃癌的发生均有着十分密切的关系［１、２］。目前检测 ＨＰ感染的方法较多,分为入侵性和非入侵性两类,如细菌涂片。培养,尿素酶试验（ＲＵＴ）,聚合酶链反应（ＰＣＲ）和血清ＨＰ抗体检测及１３Ｃ或１４Ｃ,尿素呼吸试验（ＵＢＴ）等。我们通过对２ １６例患者胃镜活检同部位粘膜标本,分别作ＰＣＲ反应和ＲＵＴ试验检测对照,以了解各自优缺点。１资料和方法 本组２１６例,男１３６例,女８０例,年龄１７～８２岁,平均５２．１岁。慢性萎缩性胃炎８２例,…     

竞争性定量聚合酶链反应检测幽门螺杆菌cagA基因

目的 建立竞争性聚合酶链反应（ＰＣＲ）定量检测幽门螺杆菌（Ｈｐ）细胞毒素相关蛋白基因Ａ（ｃａｇＡ）的方法。方法 以重组ＰＣＲ将乳糖操纵子中乳糖调节蛋白（ＬａｃＩ）的特异性结合序列（２１ｂｐ）插入ｃａｇＡ基因的一段序列（４００ｂｐ）中得到重组ｃａｇＡ基因片段（ｒｆｃａｇＡ）。体外克隆并表达谷胱甘肽转硫酶－ＬａｃＩ（ＧＳＴ－ＬａｃＩ）的融合蛋白,其一端具有ＣＳＴ活性,另一端可特异性地与ｒｆｃａｇＡ结合     

聚合酶链反应检测幽门螺旋杆菌

自从1983年Marshall和Warren报道胃粘膜活检标本中成功地分离出幽门螺杆菌（HelicobacterPylori，HP）以来，国内外学者对此进行了广泛深入的研究，在检测技术上有很大发展。分子生物学方法中的聚合酶链反应（PCR）技术为HP的快速检测提供了全新手段。本文对冒镜确诊的362例胃炎、胃十二指肠溃疡等病例作PCR技术确定HP检出率，并以病理检查作对照，结果报告如下。1材料与方法1．1材料：标本采自本院1995年3月～1997年10月经胃镜检查确诊的胃、十二指肠溃疡、各类胃炎及溃疡合并胃炎362例，每例在距幽门口5cm内钳取胃粘膜2份（每例检…     

多聚酶链反应检测幽门螺杆菌临床意义

多聚酶链反应检测幽门螺杆菌临床意义康黎（江西省波阳县人民医院，波阳３３３１００）幽门螺杆菌（ＨｅｌｉｃｏｂａｔｅｒＰｙｌｏｒｉ，ＨＰ）的检测方法有多种，包括细菌涂片、培养、尿素酶试验、血清学检查、１４Ｃ呼吸试验等都有一定的诊断价值，应用多聚酶链反应（...     

聚合酶链反应(PCR)检测幽门螺杆菌cag A基因

目的　探讨应用PCR直接测定胃粘膜标本中幽门螺杆菌cagA基因。方法　不需细菌培养 ,直接从胃粘膜标本中提取幽门螺杆菌DNA ,选择合适的引物及条件进行PCR ,通过琼脂糖电泳来确定标本中的cagA基因。结果　每例cagA阳性的标本在 191bp的位置有一条清晰的电泳带。 19例胃溃疡患者中cagA阳性 16例 ,阴性 3例。 15例健康人血清对照 ,cagA阳性 3例 ,阴性 12例。该法敏感性 84 .2 % ,特异性 80 %。同时进行快速尿素酶实验 ,发现 17例阳性标本中PCR方法 16例阳性 (94 .1% ) ,2例快速尿素酶实验阴性标本PCR阴性。二者没有显著差异 (χ2 =0 ,P >0 .0 5 )。结论　应用PCR直接测定胃粘膜标本中幽门螺杆菌cagA基因方法简单 ,快速 ,灵敏度和特异性较高。     

荧光定量聚合酶链反应检测唾液中幽门螺杆菌的研究

幽门螺杆菌 ( Hp)感染与胃炎、胃溃疡甚至胃肿瘤等的发病关系密切 ,国际癌研究协会已于 1 994年将 Hp感染列为人的 类致癌因子。检测 Hp感染发展迅速 ,然而其中大多属于有创性 ,荧光定量 -聚合酶链反应 ( FQ- PCR)法能从唾液中直接检测 Hp并具有无创、简便、可准确定量等优点。我们用 FQ- PCR法检测唾液中 Hp,对诊断儿童 Hp感染进行探讨。对象与方法一、研究对象　 1 999年 1 1月至 2 0 0 0年 8月我院门诊患儿 72 8例 ,男 40 5例 ,女 32 3例 ,年龄 3个月～ 1 4岁。其中 ,3个月～ 1岁 5例 ;1～ 3岁 2 8例 ;3～ 6岁 1 96例 ;6～ 1 0岁…     

聚合酶链反应法测定幽门螺杆菌的vacA基因型

以幽门螺杆菌ＤＮＡ为模板,采用聚合酶链反应设计了５个特异性寡核苷酸引物的一个共引物,分析检测了６２株幽门螺杆菌空泡形成细胞毒素基因Ｓ１ａ、Ｓ１ｂ、Ｍ１型和Ｍ２型,检测结果均为Ｓ１ａ／Ｍ２实验显示胃十二指肠疾病与空泡形成细胞毒素基因无相关关系。     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."     

Antimicrobial susceptibility testing of Mycobacteroides (Mycobacterium) abscessus complex,Mycolicibacterium (Mycobacterium) fortuitum,and Mycobacteroides (Mycobacterium) chelonae

The drug susceptibility of rapidly growing mycobacteria (RGM) varies among isolates. Treatment strategies similarly differ depending on the isolate, and for some, no clear strategy has been identified. This complicates clinical management of RGM. Following Clinical and Laboratory Standards Institute standard M24-A2, we assessed the susceptibility of 140 RGM isolates to 14 different antimicrobial drugs by measuring their minimal inhibitory concentrations (MICs). We also investigated the correlation of clarithromycin (CAM) MICs with the erm(41) and rrl gene mutations in the Mycobacteroides (Mycobacterium) abscessus complex, the rrl mutation in Mycobacteroides (Mycobacterium) chelonae, and the erm(39) mutation in Mycolicibacterium (Mycobacterium) fortuitum to determine the contribution of these mutations to CAM susceptibility. The five species and subspecies examined included 48 M. abscessus subsp. abscessus isolates (34.3%), 35 (25.0%) being M. abscessus subsp. massiliense, and two (1.4%) being M. abscessus subsp. bolletii. The M. abscessus complex accounted for 85 isolates (60.7%) in total, whereas 43 isolates (30.7%) were M. fortuitum, and 12 (8.6%) were M. chelonae. Our results demonstrated species-specific susceptibility to antimicrobials. In most cases, susceptibility to CAM could be predicted based on genetic pattern, but since one isolate did not fit that pattern, MIC values needed to be measured. Some isolates also exhibited rates of resistance to other drugs that differed from those previously reported in other locations, indicating that accurate identification of the bacterial isolate and use of the correct method for determining MIC are both important for the diagnosis of RGM.     

Brief history of quality movement in US healthcare

The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.