115例急性呼吸道感染患者FluA抗原快速检测与血清抗体对比研究

目的评价胶体金免疫层析（goldirnmunoehromatographicassay,GICA）快速检测甲型流感（influenzaA,FluA）病毒抗原的可行性,并调查部分呼吸科住院患者FluA感染及抗体水平。方法收集2009年09月16日至2011年02月01日期问在北京军区总医院呼吸科住院的115例患者鼻咽部分泌物标本,应用GICA法检测FluA病毒抗原,同时留取患者双份血清。以检测双份血清抗体的Hl法为“金标准”,对GICA法做出评价。结果①GICA法与HI法检测结果行一致性检验,Kappa值为0．628,配对）（2检验,差异无统计学意义（P〉0．05）;GICA法的敏感度为68．2％,特异度为93．5％,符合率为84．3％,误诊率为6．5％,漏诊率为31．8％,约登指数是0．617;②115例住院患者FluAHI法确诊病例共22例,FluA（新型H1N1）检出率为4．3％（5／115）,FluA（季节性H1N1）检出率为2．6％（3／115）,FIuA（季节性H3N2）检出率为6．1％（7／115）,FluA混合感染检出率为6．1％（7／115）。FluA（新型H1N1）检出时间主要集中在09年10月和11月,随后以混合感染形式与FluA（季节性H3N2和H1N1）散发存在。结论①与HI法相比,应用GICA法检测FluA抗原,敏感度略低,特异度较好,二者一致性较好,作为临床筛查FluA感染有一定价值;②初步印证WHO预计的2009年H1N1流感病毒会在未来数年内以季节性病毒的方式继续传播趋势。     

229例成人甲型流感患者临床特征分析

目的 分析229例确诊甲型流感(简称甲流)患者的临床特征.方法 我院发热门诊中489例较典型流感样症状患者取鼻、咽拭子送流感网络实验室行流感病毒实时聚合酶链式反应检测.结果 共检出甲流患者229例,其中非甲型H1N1流感患者178例,甲型H1N1流感患者51例,主要检出月份在2009年8-11月,患者从发病到就诊时间平...     

甲型流感病毒快速基因分型POCT方法的建立

目的建立一种无需核酸提取,直接检测鼻咽拭子中甲型流感病毒H1HA pdm09、H3HA亚型和季节性流感病毒H1HA non-pdm09的POCT快速分型方法。方法针对3种流感病毒的血凝素(hemagglutinin,HA)基因序列保守区设计高度特异性的引物和HyBeacon探针,同时以人类RNaseP基因作为内参。优化多重PCR反应条件,建立用熔解曲线分析甲型流感病毒基因分型的方法,并将其应用到ParaDNA核酸POCT检测仪,对50例甲型流感病毒抗原初筛阳性且经过实时荧光定量PCR检测的临床鼻咽拭子标本进行检测。结果该方法可在1.5 h内完成对3种甲型流感病毒亚型HA基因的特异性扩增和分型,与其他7种呼吸道病原微生物无交叉反应,其核酸检测下限为50 copies/μl。对临床50例甲型流感病毒抗原阳性的鼻咽拭子标本进行直接检测,检出H1HA pdm09阳性标本48例,H3HA阳性标本2例,未检出季节性流感H1HA nonpdm09阳性标本。结论基于HyBeacon探针和ParaDNA核酸POCT检测仪所建立的甲型流感病毒快速分型方法能同时检测H1HA pdm09、H3HA和季节性流感病毒H1HA non-pdm09。该方法无需核酸提取,操作简便,检测时间短,适于对甲型流感病毒抗原初筛阳性的鼻咽拭子开展现场基因分型检测,可为流感的诊治和防控提供及时快速的实验室依据。     

胶体金免疫层析法快速检测甲型流感病毒的可行性

我们应用胶体金免疫层析(GICA)法检测甲型流感病毒核心抗原,并用病毒分离培养法、RT-PCR法与对照进行验证,现将结果报道如下.     

流感快速检测的临床研究

目的 探讨快速诊断试纸条(GICA)法在快速诊断流感病毒感染中的可靠性.方法 应用GICA法和标准免疫荧光法检测呼吸科住院患者鼻咽部分泌物中的流感病毒A、B抗原.结果 GICA法检出流感病毒A、B抗原单一和混合阳性患者21例,26例次,免疫荧光法检出30例次,两种方法检测结果差异无统计学意义.结论 GICA是快速检测流感病毒的简捷的好方法.     

流感快速检测的临床研究

目的 探讨快速诊断试纸条(GICA)法在快速诊断流感病毒感染中的可靠性.方法 应用GICA法和标准免疫荧光法检测呼吸科住院患者鼻咽部分泌物中的流感病毒A、B抗原.结果 GICA法检出流感病毒A、B抗原单一和混合阳性患者21例,26例次,免疫荧光法检出30例次,两种方法检测结果差异无统计学意义.结论 GICA是快速检测流感病毒的简捷的好方法.     

甲型（H1N1）（2009）流感病毒三重RT-PCR快速检测方法的建立

目的建立一种早期快速检测甲型（H1N1）（2009）流感流行病毒株的方法。方法将2009年分离的甲型（H1N1）流感流行病毒株基因与以前的流感病毒株进行序列比对,找出其特异的基因序列,设计针对甲型（H1N1）（2009）流行株的血凝素（HA）、神经氨酸酶（NA）、核蛋白（NP）基因的三对特异引物,采用RT-PCR同时扩增三条目的片段,通过琼脂糖凝胶电泳进行检测。结果此方法对临床标本的阳性检出率为71%。结论采用三重PCR同时扩增甲型（H1N1）（2009）流感流行病毒的三段特异序列既缩短检测时间又提高了检测特异性,无交叉反应,是一种有效可行的快速检测甲型（H1N1）（2009）流感流行病毒株的方法。     

2009年广东省甲型流行性感冒暴发流行期间首株甲型H1N1流行性感冒病毒血凝素基因分析

目的 检测和分析2009年广东省甲型流行性感冒(流感)暴发流行期间首株甲型H1N1流感病毒血凝素(HA)基因.方法 对2009年广东省首例确诊的甲型H1N1流感患者的咽拭子进行病毒分离,取细胞培养上清液提取病毒核酸,采用HA基因的特异性引物进行RT-PCR,PCR产物进行克隆、测序和同源性分析.结果 获得2009年广东省首株甲型H1N1流感病毒的HA基因,大小为1710 bp,命名为A/GuangzhouSB/01/2009(H1N1)HA,GenBank登录号为GQ268003.与疫情发源地近期报告的277株甲型H1N1流感病毒的HA基因比对,同源性为99.0%～99.8%;其中与美国报告的病毒株的同源性高达99.8%,与患者发病前曾到美国旅游的流行病学史一致.与25株中国季节性甲型H1N1流感病毒的HA基因比对,同源性为72.3%～85.6%.结论 2009年广东省甲型流感暴发流行期间首株甲型H1N1流感病毒与目前流行的甲型H1N1流感病毒同源性高,与中国季节性甲型H1N1流感病毒同源性较低.     

不同引物检测甲型H1N1流感病毒的比较研究

目的筛选灵敏、特异的甲型H1N1流感病毒核酸检测方法。方法采用国家流感中心推荐的甲型流感病毒(H1N1)核酸引物和1对自行设计的引物,同时选择市售荧光定量PCR试剂盒,分别对不同浓度的流感病毒进行RT-PCR或荧光定量PCR扩增,比较其检测的灵敏度和特异性。结果荧光定量PCR检测H1N1病毒核酸的灵敏度为10-5(病毒稀释度),高于普通RT-PCR的灵敏度10-3~10-4;RT-PCR扩增甲型流感病毒(H1N1)核酸时,自行设计引物的灵敏度为10-4,高于中国CDC推荐引物的灵敏度10-3。2种引物的特异性一致。结论对于甲型(H1N1)流感病毒疑似样品的检测,荧光定量PCR是较灵敏的方法,但从成本和灵敏度两方面考虑,自行设计的引物更适合基层疾控机构采用。     

2009年广东省新型甲型H1N1流行性感冒病毒神经氨酸酶基因进化分析

目的 探讨2009年广东省新型甲型H1N1流行性感冒(流感)病毒神经氨酸酶(NA)基因的进化及NA基因编码蛋白抗原性、酶活性位点、糖基化位点变异情况.方法 从2009年广东省新型甲型H1N1流感患者中分离到病毒毒株共69株,提取病毒总RNA,RT-PCR扩增NA基因,并测序分析;同时从美国国立生物技术信息中心基因库检索获得 52株不同年代、不同地域甲型流感病毒NA基因序列,用MEGA 4.0软件进行基因进化分析和氨基酸序列分析.结果 2009年广东省新型甲型H1N1流感病毒NA基因与禽H5N1流感病毒同源性较高,为87.1%,潜在抗原位点氨基酸分布相同;所有毒株的酶活性中心位点高度保守;具有8个糖基化位点,其中5个位点有不同程度的氨基酸替换,但与2001年禽H5N1毒株的糖基化位点的氨基酸相同.结论 2009年广东省新型甲型H1N1流感病毒NA基因与禽H5N1流感病毒高度同源,与NA抑制剂的特异性结合位点未发生变化.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。