应用生物发光技术定量检测PCR扩增产物

目的　建立一种基于生物发光技术的定量检测PCR产物的方法 ,并用于HBV定量PCR检测。方法　首先利用ATP硫酰化酶 (ATPsulfurylase)将焦磷酸 (PPi)定量转化成ATP ,然后利用虫荧光素酶 (luciferase)系统发光检测ATP ,从而确定样品中PPi含量。利用 2次PCR法扩增HBVDNA目的片段 ,并进行回收纯化定量 ,以之作为阳性标准模板制作标准曲线。选择适当的循环次数扩增样品中HBVDNA ,利用化学发光法检测扩增产物中PPi的量 ,进而确定样品中HBVDNA模板的量。结果　当起始模板量为 (10～ 5 )× 10 5拷贝 ,循环次数为 2 5 ,发光值与起始模板浓度呈现良好的相关。检测 32份样品血清 ,其中 2 3例HBsAg(+)、HBeAg(+)、HBcAb(+)标本中HBVDNA平均含量为 1 6× 10 5拷贝 / μl,9例HBsAg(+)、HBeAg(- )、HBcAb(+)标本中HBVDNA平均含量为 5 6× 10 3 拷贝 / μl。结论　本方法是一种操作简便、灵敏度高的定量PCR方法     

影响抗-HIV弱阳性质控血清稳定性的几种因素探讨

目的探讨影响自制HIV抗体弱阳性质控血清稳定性的因素。方法用3种ELISA试剂检测不同条件处理的HIV抗体弱阳性质控血清。结果反复冻融10次对HIV质控血清的稳定性没有影响;长时间-20℃保存,PBS(含10%BSA,0.5mg/ml庆大霉素)稀释对稳定性无影响,阴性血清(含0.1%的叠氮钠)稀释在12个月后有沉淀物析出,稳定性受影响。结论PBS(含10%BSA,0.5mg/ml庆大霉素)稀释液配制的HIV抗体弱阳性质控血清能更长时间保持稳定。     

PCR-微流芯片检测HBV DNA在血液筛查中的初步应用

目的　探讨在血液筛查中检测HBVDNA的必要性及应用PCR 微流芯片检测献血者HBVDNA可运 行模式。方法用PCR 微流芯片检测已经过常规ELISA初、复检全项测定合格献血者的微量血清汇集池(5人 份×50μl)HBVDNA,再对阳性血清汇集池中的标本进行单份检测。用HBVDNA(-)的献血者血清系列稀释 HBVDNA标准质控血清,分别测定其含量,以确定该方法的灵敏度;分别检测37例HBeAg(+)、16例HCV RNA(+)、3例抗 HAVIgM(+)患者标本的HBVDNA,观察其特异性;再重复检测不同稀释度的HBVDNA标 准质控血清,以了解其批内、批间变异。结果　545份(分109个血清汇集池)无偿献血标本中有7份HBVDNA阳 性(1.28%)。PCR 微流芯片法检测HBVDNA敏感度为4.81×102拷贝/ml;HBeAg(+)患者的HBVDNA阳性 检出率为100%(37/37),而HCVRNA(+)、抗 HAVIgM(+)患者的HBVDNA全为阴性;批间、批内变异范围 分别为15.6%～40.2%、11.9%～30.6%。结论无偿献血者开展HBVDNA检测是必要的。PCR 微流芯片法 具有操作简便、快速、敏感度高、特异性强、重复性好等特点,把它应用于血液筛查中并利用混合标本检测HBV DNA是可行的,这将有助于进一步提高输血的安全性。     

HBsAg定性测定室内质控物浓度的选择

目的探讨定性ELISA测定的室内质控血清浓度的选择方法。方法根据系列HBsAg质控血清的浓度与其测定S／CO值的关系，得到线性回归直线方程Y=a＋bX及其相关系数r。选择计算得到的S／CO值减去3倍批间CV与该S／CO值的乘积仍大于1的质控物作为判断实验室测定重复性室内质控用。结果质控血清0～2ng／ml与其检测的S／CO值之间呈高度相关。1ng／ml质控血清可作为测定重复性使用，0．5ng／ml质控血清作为监测试剂下限使用。结论定性ELISA试剂本身的阴性、阳性对照只能检测其实验的有效性，无法监测灵敏性及测定下限的变化，必须使用弱阳性质控血清进行室内质控，并依据统计学直线回归与相关分析，科学地选用质控物浓度，保证实验的准确性。     

HBV-HCV-HIV三联荧光PCR检测的内标浓度选择研究

目的选择一个在乙型肝炎病毒-丙型肝炎病毒-人类免疫缺陷病毒(HBV-HCV-HIV)三联荧光PCR检测试验中既可有效监控假阴性结果出现,又对阳性结果影响最小的内标浓度。方法应用不同浓度的内标参入酶链聚合反应(PCR)反应,确定最佳内标参入量;并在适量内标浓度下,检测低浓度标本的阳性检出率。结果由内标浓度5拷贝/PCR、10拷贝/PCR、20拷贝/PCR、50拷贝/PCR、100拷贝/PCR 5个浓度中,优选出最适的内标浓度为20拷贝/PCR,此条件下,阴性标本的内标检出率为100%,检测灵敏度标本的阳性检出率与无内标样本差异无统计学意义。结论合适浓度的内标参与荧光PCR检测能有效地解决了每个标本的质控问题,指示反应体系(试剂耗材)与检测体系(仪器)的有效性。     

乙型肝炎病毒DNA荧光定量PCR的建立与应用

目的　建立血浆 (血清 )HBVDNA荧光定量PCR检测方法 ,探讨其临床应用价值。方法　用PUCm T载体和PCR纯化产物连接 ,转染DH5α菌 ,筛选阳性菌落 ,提取质粒 ,制作外标准品 ;在HBV基因组S区设计一对引物和TaqMan探针 ,严格优化反应物的组成和扩增条件 ,并对该方法进行评价。结果　建立的HBVDNA荧光定量PCR最低可检出 80 0拷贝 /ml;批内误差为 1 8%～ 6 5% ,批间误差为 2 6 %～ 9 1 % ;在 1 0 4 ～ 1 0 11拷贝 /ml之间与Ct值具有很好的线性 (Ct =- 1 .391 1ln(X) 4 1 .6 5,r =- 0 .9958) ;外周血HBVDNA临床定量检测发现 ,HBeAg阳性的 1 30例中 ,HBVDNA阳性率为 1 0 0 % ,含量为1 0 6 89± 1.6 9拷贝 /ml,抗HBe阳性的 96例中HBVDNA阳性率为 55 2 % ( 53/ 96 ) ,含量为 1 0 4 .0 9± 1.19拷贝 /ml;6 2例献血员未检出HBVDNA。乙肝临床治疗监测发现 ,外周血中HBVDNA含量检测可有效反映治疗效果 ,指导临床用药。结论　荧光定量PCR检测方法是一种相对准确、灵敏度高、特异性较强和较简便的HBVDNA定量检测技术 ,对乙肝诊断、指导临床用药和治疗监测方面具有实用价值     

7家ELISA法HBsAg诊断试剂的质量评价分析

目的对7家ELISA法HBsAg诊断试剂(国产5家进口2家)进行质量考核和分析,为实验室选择高质量试剂提供参考。方法应用临床科研血清盘、HBsAg弱阳性定值质控血清,对7家ELISA法HBsAg诊断试剂盒的灵敏度阴阳样总符合率以及亚型最低检出限进行质量评价分析。结果 7家试剂对HBsAg弱阳性0.2IU/mL定值质控血清、adr、adw亚型的最低检测限,检测的S/CO比值的差异很大;3国产试剂对ay血清型的出现漏检现象。结论 7家HBsAg ELISA诊断试剂的灵敏度总符合率均有较大的差异,实验室在选择试剂时应当进行考核,进口试剂相对质量较好。     

高血脂、肝素对乙型肝炎病毒DNA实时荧光定量PCR测定干扰机制的探讨

目的探讨高血脂、肝素对乙型肝炎病毒基因实时荧光定量PCR(HBVDNA-FQ-PCR)测定的干扰机制。方法将己经确诊的乙肝大三阳志愿者的高脂血和非脂血、肝素抗凝血和未抗凝血用实时荧光定量PCR做HBVDNA定量测定并同时做定性测定,另外将同一份乙肝大三阳标本五种不同浓度肝素抗凝,另一份不抗凝,然后分别用HBVDNA-FQ-PCR和琼脂糖凝胶电泳-溴乙锭显色法做HBVDNA定量和定性测定。结果5份非脂血和相应的高脂血HBVDNA定量结果有非常显著性差异(P<0.01),定性结果两者没有差异全部为阳性(5/5)。5份用1 500 U/ml肝素抗凝血HBVDNA定量结果都为0,定性结果都为阴性,而相应未抗凝血定量结果分别为6.35E 8,5.21E 6,7.05E 8,2.98E 7,6.33E 6,定性结果肝素抗凝和未抗凝标本都为阳性(5/5)。五种不同浓度肝素抗凝标本的HBVDNA定量结果,当肝素浓度大于1 000 U/ml时定量结果为0,肝素浓度小于100 U/ml对HBVDNA-FQ-PCR测定结果影响不大,相应的对照HBVDNA拷贝数为7.32 8E,不同浓度肝素抗凝标本的HBVDNA定性结果,当肝素浓度大于500 U/ml为阴性,小于100 U/ml为阳性。结论高血脂对HBVDNA实时荧光定量PCR的干扰机制主要是血液中的低密度脂肪(乳糜微粒等)对荧光的屏蔽或吸收作用,肝素对HBVDNA实时荧光定量PCR的干扰机制是肝素对Taq酶的抑制作用。     

用于PCR产物检测的液相杂交法的优化

目的　为了使液相交在检测更加灵敏、特异、快速。方法　通过改进杂交液的成分 ,选择最佳的探针浓度 ,使 5’端标记生物素的PCR扩增产物与 5’端标记地高辛的探针在PCR反应管中进行液相杂交 ,杂交条件为 :94℃ 10s冷却到 37℃ 10s即完成杂交。杂交后产物通过链霉素亲和素被固定在微孔表面 ,同时在含高浓度DMSO的杂交液中将非特异结合的探针解离 ,然后对被固定的特异杂交产物进行ELISA检测。结果　液相杂交的条件优化 :杂交液中DMSO浓度为 30 0ml/L ,探针浓度为 0 5 μmol/L ,杂交温度为 37℃。对 6 0bp～ 6 0 0bp的PCR产物的杂交特异性无明显差异 ,可以检测到 1× 10 4copy的PCR产物 ,对 10 0例乙型肝炎患者的血清进行检测 ,HBsAg( )、HBeAg( )、抗HBc( )的血清检出HBVDNA阳性为 10 0 % (30 / 30 ) ;HBsAg( )、抗HBe( )、抗HBc( )的血清检出HBVDNA阳性为 10 0 % (30 /30 ) ;HBsAg( )、抗HBe( )、抗HBc( )的血清检出HBVDNA阳性为 78 6 % (2 2 / 2 8) ;HBsAg( )、抗HBc( )的血清检出HBVDNA阳性为 6 6 7% (16 / 2 4 ) ,其余为阴性。结论　该液相杂交法操作简单、快速、灵敏、特异 ,适合临床实验室使用     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的疗效和安全性研究

目的评价一种国产阿德福韦酯用于治疗HBeAg阳性慢性乙型肝炎患者的疗效和安全性。方法采用多中心、随机、双盲、安慰剂对照的临床试验,选择HBeAg阳性的慢性乙型肝炎患者211例,按1∶1的比例随机分为阿德福韦酯组和拉米夫定组。完成12周治疗后均进入阿德福韦酯开放治疗期。完成12周和48周治疗时,检测血清HBVDNA及ALT水平。结果治疗12周时阿德福韦酯组（107例）血清HBVDNA水平平均下降2.94log10拷贝/ml,77.6%的受试者血清HBVDNA水平下降≥2log10拷贝/ml或血清HBVDNA≤104拷贝/ml,ALT均值下降76.9IU/L;而安慰剂组（104例）血清HBVDNA水平平均下降0.57log10拷贝/ml,血清HBVDNA水平下降≥2log10拷贝/ml或血清HBVDNA≤104拷贝/ml的受试者比例仅为13.5%,ALT均值下降20.9IU/L。两组血清HBVDNA水平下降值和血清ALT下降值比较,差异均有统计学意义（P〈0.05）。治疗48周时,阿德福韦酯组血清HBVDNA水平平均下降3.54log10拷贝/ml,ALT均值下降100.6IU/L;安慰剂组血清HBVDNA水平平均下降3.28log10拷贝/ml,ALT均值下降92.7IU/L;两组血清HBVDNA水平下降值和血清ALT下降值比较,差异无统计学意义（P〉0.05）。阿德福韦酯组不良事件发生率与安慰剂组相比,差异无统计学意义（P〉0.05）。结论阿德福韦酯治疗HBeAg阳性慢性乙型肝炎可在病毒学及生化学方面取得较好疗效,且安全性良好。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。