LTA基因单核苷酸多态位点与胃癌易感性的研究

目的通过对江西地区汉族胃癌患者和正常人群中淋巴毒素-α（LTA）基因单核苷酸多态（single nucleotide polymorphism,SNP）位点rs909253基因型的检测,探讨rs909253位点与胃癌患者易感性的关系。方法利用Sequenom-MassArray-IPLEX检测194例胃癌和250例对照LTA基因多态位点rs909253的基因分型,并利用非条件logistic回归对检测结果进行相关统计。结果 LTA rs909253多态位点GG、GA、AA三种基因型在胃癌的频率分别为26.4%、52.0%和21.6%,与对照组（35.6%、46.4%和18.0%）相比,统计学上无显著意义（χ2=4.403,P=0.111）;但胃癌组和正常组的等位基因频率分布差异临近显著,P值达0.059;对年龄和性别进行校正后,携带等位基因G的胃癌发病风险有所增加（OR=1.315,95%CI：1.001~1.728）。结论江西汉族人群胃癌的遗传易感性可能与LTA基因rs909253位点的单核苷酸多态性有关,G等位基因为其发病的危险因素。     

探讨MUC1基因多态性与胃癌遗传易感性的关系

目的：探讨 MUC1基因多态性与胃癌遗传易感性的关系。方法采用病例对照研究对150例胃癌患者（胃癌组）和150名健康查体正常者（对照组）的MUC1基因rs2070803单核苷酸多态性进行检测,并分析其与胃癌易感性之间的关系。结果 MUC1基因rs2070803位点3种基因型GG、GA、AA在胃癌病例组中频率分别为80.7%、16.0%和3.3%,而在对照组中分别为64.7%、32.0%和3.3%。与GG型比较,GA/AA型基因型者胃癌发生的危险性降低,OR值为0.439（0.259～0.742）。结论 MUC1基因rs2070803位点GG、GA基因型降低汉族人群的胃癌易感性。     

STAT4基因启动子区单核苷酸多态性与系统性红斑狼疮相关性研究

目的检测深圳地区汉族人群信号转导和转录活化因子4(STAT4)基因单核苷酸多态性(SNP),探讨其与系统性红斑狼疮遗传易感性之间的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,对74例SLE患者和95例正常对照STAT4基因启动子区rs16833431 A>G位点进行检测,计算其基因型和等位基因频率,并结合临床进行分析。结果 SLE患者STAT4 rs16833431位点基因型频率AA(16.2%)、AG(47.3%)、GG(36.5%),等位基因频率A(39.9%)、G(60.1%),与正常对照组基因型频率AA(16.8%)、AG(45.3%)、GG(37.9%)和等位基因频率A(39.5%)、G(60.5%)相比无统计学差异(P>0.05)。结论 STAT4基因rs l6833431 A>G位点多态性与深圳汉族人群SLE遗传易感性无相关性。     

DDB2单核苷酸多态位点rs830083CG变异与非吸烟人群肺癌易感性的关系

目的 分析DNA损伤结合蛋白2(DDB2)单核苷酸多态位点rs830083CG变异与非吸烟人群肺癌易感性的关系。方法 选择2020年3月至2021年3月收治的158例非吸烟肺癌患者为研究组，选择同期100例体检健康人群为对照组，检测DDB2基因单核苷酸多态性(SNP)位点rs830083多态性，采用非条件logistic回归模型分析DDB2基因多态性与非吸烟人群肺癌易感性的关系，并评估环境暴露因素与DDB2基因rs830083位点多态性的交互作用。结果 研究组和对照组DDB2基因rs830083位点CC、CG、GG基因型频率分别为36.08%、52.53%、11.39%和53.00%、39.00%、8.00%;C、G等位基因频率分别为62.34%、37.66%和75.50%、27.50%，差异均有统计学意义(P <0.05)。两组DDB2基因rs830083位点基因型分布，在显性模式下，差异有统计学意义(P <0.05)，在隐性模式下差异则无统计学意义(P> 0.05)。与CC基因型比较，CG+GG基因型与非吸烟人群肺癌易感性有关。相比于rs830083位点CC基因型...     

白细胞介素-18基因多态性与慢性乙型病毒性肝炎病毒感染关系的研究

目的 探讨白介素-18(IL-18)基因启动子区-137G/C(rs187238)和-607C/A(rs1946518)单核苷酸多态性(SNP)与慢性乙型病毒性肝炎(乙肝)病毒感染之间的关系。 方法 选取2007年3月至2010年10月期间就诊于桂林市疾病预防控制中心和桂林医学院附属医院的慢性乙肝患者作为病例组,共264例;另外选取同期在上述两个单位进行体检,均无慢性乙肝病史的健康者作为对照组,共300例。采用序列特异性引物-聚合酶链反应技术(SSP-PCR),检测上述二组研究对象IL-18基因启动子-137G/C(rs187238)、-607C/A(rs1946518)单核苷酸多态性位点基因型,分析病例组和对照组基因型和等位基因频率分布。 结果 病例组IL-18基因多态性位点rs1946518的基因型和等位基因的频率与对照组相比差异无统计学意义(P0.05)。但是,病例组IL-18基因SNP位点rs187238 G等位基因的频率高于对照组(OR=1.353,95%CI:1.009~1.815,P=0.043)。携带rs187238 GG基因型的患者发生慢性乙肝的风险较高(OR=1.629,95%CI:1.152~2.305,P=0.006)。分层分析发现,rs187238位点上GC基因型和C等位基因的频率与慢性乙肝的关联在乙肝e抗原(HBeAg)阳性组的患者中更加显著(P=0.022,P=0.011)。 结论 IL-18基因启动子区-137G/C(rs187238)多态性与慢性乙肝易感性具有相关性,而且,rs187238位点上GC基因型和C等位基因的频率与HBeAg阳性的慢性乙肝患者具有相关性。     

人类ErbB2转录因子1基因多态性与陕西汉族人群胃癌的关系研究

目的探讨人类ErbB2转录因子1(TOB1)基因多态性与陕西汉族人群胃癌之间的关系。方法选取320例胃癌患者为胃癌组,350例经胃镜检查及病理活检排除胃癌的门诊患者为对照组,对TOB1基因4个候选单核苷酸多态性(SNP)位点(rs61482741、rs34700818、rs12601477、rs4626)进行基因分型。分析TOB1基因候选SNP位点等位基因、基因型、显性模式和隐性模式频率与胃癌风险的关系;分析TOB1基因候选SNP位点连锁不平衡情况。结果胃癌组与对照组TOB1基因4个候选SNP位点基因分型结果均符合哈迪-温伯格平衡(P0.05)。TOB1基因易感位点包括内含子区域rs61482741位点G等位基因(P=0.011,OR=1.42,95%CI=1.15～1.78)、GG基因型(P=0.016,OR=1.91,95%CI=1.18～3.23)、显性模式GG+CG基因型(P=0.032,OR=1.44,95%CI=1.05～1.93)、隐性模式GG基因型(P=0.043,OR=1.68,95%CI=1.03～2.74);外显子区域rs4626位点G等位基因(P=0.006,OR=1.41,95%CI=1.16～1.76)、GG基因型(P=0.006,OR=1.85,95%CI=1.20～2.85)、显性模式GG+AG基因型(P=0.023,OR=1.53,95%CI=1.10～2.16)、隐性模式GG基因型(P=0.028,OR=1.56,95%CI=1.09～2.21);内含子区域rs34700818和rs12601477位点等位基因、基因型、显性模式和隐性模式频率在胃癌组与对照组间比较,差异均无统计学意义(P0.05)。结论TOB1基因内含子区域rs61482741和外显子区域rs4626位点可能是陕西汉族人群胃癌高风险易感基因位点。     

M型磷脂酶A_2受体和人类白细胞抗原基因单核苷酸多态性与维吾尔族特发性膜性肾病的相关性

目的探讨M型磷脂酶A_2受体(M-type phospholipase A_2receptor,PLA_2R)rs35771982和人类白细胞抗原(human leukocyte antigen DQα-chain 1,HLA-DQA1)rs2187668位点单核苷酸多态性与维吾尔族特发性膜性肾病(idiopathic membranous nephropathy,IMN)的相关性。方法 45例维吾尔族IMN患者为IMN组,45例同期维吾尔族体检健康者为对照组,采用直接测序法检测2组PLA_2R基因rs35771982、HLA-DQA1基因rs2187668位点单核苷酸多态性(single nucleotide polymorphism,SNP),比较2组基因型和等位基因频率;采用单因素logistic回归分析风险基因型。结果 IMN组PLA_2R基因rs35771982位点C等位基因频率(78.90%)明显高于对照组(40.00%)(P0.01);在显性模型下PLA_2R基因rs35771982位点携带CC基因型的患病风险为携带CG+GG基因型的7倍(OR=7.00,95%CI:2.74~17.87,P=0.000),隐性模型下携带GG基因型的患病风险为携带CC+CG基因型的0.13倍(OR=0.13,95%CI:0.04~0.44,P=0.000);IMN组PLA_2R基因rs35771982位点CC基因型血清肌酐[103.15(74.28,175.67)μmol/L]和24h尿蛋白[2.77(2.00,3.95)g]明显高于CG+GG基因型[73.70(58.87,106.65)μmol/L、1.90(1.39,2.75)g](P0.05),收缩压[(138.03±23.11)mmHg]高于CG+GG基因型[(123.13±15.05)mmHg],血清白蛋白[26.80(17.84,28.86)g/L]明显低于CG+GG基因型[29.96(25.67,36.64)g/L](P0.05);2组HLA-DQA1SNP rs2187668位点仅检测到GG基因型,未检测到GA、AA基因型。结论 PLA_2R基因rs35771982位点CC基因型和C等位基因是新疆维吾尔族IMN的易感基因,也是功能基因,其中CC基因型与尿蛋白定量呈正相关,与血清白蛋白水平呈负相关。     

TGFβ2基因单核苷酸多态性与扩张型心肌病的相关性研究

目的通过研究转化生长因子β2(TGFβ2)基因单核苷酸多态性与扩张型心肌病(DCM)的相关性,探讨DCM的免疫遗传学发病机制。方法从169例DCM患者(DCM组)和158例健康对照者(对照组)外周血中提取DNA,采用聚合酶链扩增反应-限制性片段长度多态性技术检测中国西南地区汉族人群DCM患者和健康对照者TGFβ2基因一个标签位点(rs6658835)单核苷酸多态性;用χ2检验比较DCM组与对照组之间基因型频率和等位基因频率的统计学差异。结果 DCM组与正常对照组基因型分布均符合Hardy-W e inberg平衡;与正常对照组相比,DCM患者组TGFβ2基因标签位点(rs6658835)GG+AG基因型和G等位基因频率明显增加,差异有统计学意义(分别为79.3%VS 62.7%和51.2%VS 39.6%,均P<0.01)。结论 TGFβ2基因rs6658835位点单核苷酸多态性与中国西南地区汉族人群DCM相关,TGFβ2基因多态性可能在DCM遗传易感性方面具有重要作用。     

乙醛脱氢酶2基因多态性及生活习惯与胃癌易感性的相关性分析

目的探讨乙醛脱氢酶2(ALDH2)基因多态性及不良生活习惯与胃癌易感性的相关性。方法采用基因芯片技术检测161例胃癌患者及150名体检正常者(正常对照组)ALDH2基因多态性,同时收集生活习惯资料(吸烟,饮酒,是否速饮速食、暴食,是否喜好热食、腌制食物、辛辣食物)。采用Logistic回归分析评价胃癌易感性的影响因素。结果胃癌组不良生活习惯比例均明显高于正常对照组(P0.05)。ALDH2基因多态性中GG基因型频率明显高于GA和AA基因型(P0.05),G等位基因频率明显高于A等位基因(P0.05);但男、女性之间GG、GA、AA基因型频率及G、A等位基因频率差异均无统计学意义(P0.05)。Logistic回归分析显示基因型[比值比(OR)=3.767,95%可信区间(CI)1.92~8.77]、等位基因(OR=3.200,95%CI 1.68~7.85)、不良生活习惯(OR=2.779,95%CI 0.85~5.82)和胃癌症状(OR=3.180,95%CI 0.99~6.72)为胃癌易感性的影响因素(P0.05)。结论不良的生活习惯及ALDH2基因多态性与胃癌易感性有关。     

PKCβ基因多态性与类风湿性关节炎患者遗传易感性及相关性

目的探讨蛋白激酶Cβ(PKCβ)基因多态性与类风湿性关节炎(RA)患者遗传易感性及疾病的相关性。方法选取确诊的RA患者400例(病例组),收集时间2013年1月至2016年1月,同期体检健康对象400例作为对照组。采用Taq Man探针基因分型技术检测两组对象PKCβ基因rs16972959位点的基因型,并分析不同基因型与RA患者各实验室指标、临床特征之间的关系。结果病例组患者的PKCβ基因rs16972959位点的基因型频率为GG 54.75%,GA 37.50%,AA 7.75%,对照组PKCβ基因rs16972959位点的基因型频率为GG 52.75%,GA 40.00%,AA 7.25%,两组间比较差异均无统计学意义(P0.05);病例组PKCβ基因rs16972959位点等位基因频率为G 73.50%,A 26.50%,对照组PKCβ基因rs16972959位点等位基因频率为G 72.50%,A 27.50%,两组间比较差异均无统计学意义(P0.05)。RA患者中RF阳性患者的AA基因型频率(9.51%)显著的高于RF阴性患者(2.11%)(P0.05);AA、GA基因型患者的关节肿胀数目、关节触痛数目均显著的高于GG患者(P0.05)。结论 PKCβ基因多态性与RA患者遗传易感性无明显的相关性,但是与RF因子阳性率、患者的临床表现具有一定的关系。     

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.     

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.     

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.     

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.