痴呆病人ApoE基因检测与多态性分析

目的研究痴呆病人与载旨蛋白Ｅ（ＡｐｏＥ）等位基因之间的关系。方法对３０例老年性痴呆（ＡＤ）患和２５例多发梗死性痴呆患的ＡｐｏＥ基因进行检测，确定基因型，计算基因频率，验证ＡｐｏＥ与ＡＤ的相关性。结果ＡＤ病人基因型以ε３／４最多，ε３／３型次之；血管性痴呆（ＶＤ）病人以ε３／３型最多，ε２／３次之；从等位基因频率看，ＡＤ病人及ＶＤ均以ε３型等位基因频率最高，ＡＤ病人ε４等位基因频率显高于ＶＤ病     

载脂蛋白E基因多态性检测技术的对比性研究

目的建立并比较载脂蛋白Ｅ（ＡｐｏＥ）基因多态性检测技术,为ＡｐｏＥ基因分型提供良好的方法。方法应用聚合酶链反应（ＰＣＲ）限制性片段长度多态性（ＲＦＬＰ）和ＰＣＲ单链构象多态性（ＳＳＣＰ）检测技术对１１０例患者及相同人数的正常人进行ＡｐｏＥ基因型检测和分析。结果应用ＲＦＬＰ、ＳＳＣＰ技术测得正常对照组：ε２／２（０,０．０２０）,ε３／３（０．７００,０．７６０）,ε４／４（０,０．０４０）,ε２／３（０．１００,０．０６０）,ε２／４（０,０．０２０）,ε３／４（０．２００,０．１００）,ε２（０．０５０,０．０６０）,ε３（０．８５０,０．８４０）,ε４（０．１００,０．１００）。经χ２检验,ＡｐｏＥ基因型频率和等位基因频率的差异无显著意义（Ｐ＞０．０５）。上两种检测技术与既往两种检测技术（ＩＥＦ,ＷｅｓｔｅｒｐＢｌｏｔｉｎｇ）的结果经χ２检验,其ＡｐｏＥ等位基因频率的差异也无显著意义（Ｐ＞０．０５）,均符合中国汉族人ＡｐｏＥ基因频率分布。结论ＰＣＲＲＦＬＰ方法是一种稳定可靠的ＡｐｏＥ基因多态性分析方法,多重ＰＣＲＳＳＣＰ技术更加简便有效,使ＡｐｏＥ基因多态性的研究更加完善。     

Alzheimer‘s disease患者载脂蛋白E多态性的检测

人类ＡｐｏＥ基因型存在多态性，这种多态性是老年性痴呆发病的易和危险因子之一，可为临床诊断提供重要的实验指标和信息。方法，本文采用ＰＣＲ－ＲＦＬＰ技术，Ｈｈａｌ酶切ＰＣＲ扩增产物后的片段经１０％ＰＡＧ电泳和４％琼脂糖电泳，分析了ＡｐｏＥ基因型。在此基础上，我们分析了４０名ＡＤ患者和３５名正常对照者。结果实验显示：ＡＤ组和正常对照组的ＡｐｏＥ基因型有显著的差异，且ＡＤ组中ε４等位基因明显高于对照组，分     

聚合酶链反应限制性片段长度多态性检测载脂蛋白E基因型

目的建立一种简便、准确、实用的人载脂蛋白Ｅ（ａｐｏＥ）基因型的检测方法。方法应用聚合酶链反应（ＰＣＲ）特异性扩增ａｐｏＥ基因含编码１１２位和１５８位氨基酸的基因序列，扩增产物用限制性内切酶ＨｈａⅠ酶切，聚丙烯酰胺凝胶电泳后，观察酶切位点的限制性片段长度多态性（ＲＦＩＰ）图谱。结果运用ＰＣＲ－ＲＦＬＰ法检测了１１３名健康人ａｐｏＥ基因型，频率分别为ε３／３６９．０％，ε３／２１６．８％，ε４／３１１．５％，ε４／２１．８％，ε４／４０．９％；ε２、ε３和ε４等位基因频率分别是９．３％、８３．２％和７．５％。结论该方法简单、快速、准确，对人体无害，适合于一般实验室开展及大规模人群调查     

载脂蛋白E多态性研究的方法学进展

人载脂蛋白Ｅ（ａｐｏＥ）具有明显的遗传多态性，三种常见的等位基因（ε２，ε３，ε４）分别编码三种主要异构体（Ｅ２，Ｅ３，Ｅ４）。ａｐｏＥ多态性不仅是心血管疾病的一种重要易患因素，而且与Ａｌｚｈｅｉｍｅｒ病及老化密切相关，目前国内外检测ａｐｏＥ多态性的方法主要有两类：一类以极低密度脂蛋白（ＶＬＤＬ）或血清为样品检测ａｐｏＥ蛋白表型，另一类以ＤＮＡ为样品检测ａｐｏＥ基因型，本文仅对ａｐｏＥ基因结构与多     

应用CPR检测载脂蛋白E表型

为探讨壮族人群载脂蛋白（ａｐｏＥ）基因与冠心病之间的内在联系，应用ＰＣＲ方法检测１５８例壮族健康人群和５３例临床确诊的壮族冠心病患者ａｐｏＥ表型和等位基因频率分布，结果健康人群等位基因频率分布是ε０．１０８，ε０．８１３，ε０．０７９，冠心病组为ε０．０７６、ε０．７９２、ε０．１３２。冠心病患者中Ｅ４／３频率明显高于健康人群（Ｐ〈０．０１），提示ε４可能是冠心病的遗传易患因子。     

载脂蛋白E外显子4基因多态性与Alzheimer‘s病

探讨了载脂蛋白Ｅ（ａｐｏＥ）外显子４基因多态性与Ａｌｚｈｅｉｍｅｒ‘ｓ病的关系。应用聚合酶链反应扩增ａｐｏＥ外显子４基因片段，对扩增片段用ＨｈａⅠ酶切消化后进行基因分型，并用ＤＮＡ测序技术对分型结果予以证实，Ａｌｚｈｅｉｍｅｒ’ｓ病组与年龄匹配对照组在ａｐｏＥ外显子４ε３／４基因型频率和ε４等位基因频率分布上的差异有显著性（ｘ＾２＝８．９１，Ｐ〈０．０５，Ｘ＾２＝９．４９，Ｐ〈０．０１），Ａｌｚｈ     

保定市中老年人群载脂蛋白E基因多态性与脑梗死遗传易感性关系的研究

目的检测并分析保定市中老年人群中载脂蛋白E（apoE）基因多态性,探讨apoE基因多态性与脑梗死遗传易感性的关系。方法采用聚合酶链式反应-限制性片段长度多态性（PCR—RFLP）技术,分析92例脑梗死患者和86例健康对照者apoE的3种等位基因ε2、ε3、ε4,做基因频率和基因型多态性分析。结果健康人群组apoE基因呈多态性,有6种基因型,即3种纯合子（ε2／2、ε3／3、ε4／4）和3种杂合子（ε2／3、ε3／4、ε2／4）。健康人群组apoE3种等位基因的基因频率分别为：ε25．8％、ε387．2％、ε47．0％;apoE基因型频率数为ε2／20、ε3／375．5％、ε4／41．2％、ε2／310．5％、ε2／42．3％、ε3／410．5％。脑梗死组apoE等位基因频率：ε24．3％、ε369．6％、ε426．1％;基因型频数：ε2／23％、ε3／342．3％、ε4／410．8％、ε2／311．9％、ε2／42％、ε3／430％。与健康人群组比较,脑梗死组ε3／3基因型频率较健康组明显降低,差异有统计学意义（P〈0．05）,ε4／4、ε3／4基因型频率较健康组明显升高,差异有统计学意义（P〈0．05）,ε2／2、ε2／3、ε2／4基因型频率较健康组差异无统计学意义（P〉0．05）。与健康组比较,脑梗死组ε3等位基因频率明显降低,差异有统计学意义（P〈0．05）,ε4等位基因频率明显升高,差异有统计学意义（P〈0．05）,ε2等位基因频率较健康组差异无统计学意义（P〉0．05）。结论保定市健康人群组apoEe3基因出现率最高,ε2和ε4频率较低,以ε3／3基因型最多,而ε2／2、ε4／4相对较少,脑梗死患者中ε3／3、ε2／3基因型频率较低,ε3对脑梗死可能具有保护作用。ε4等位基因频率在脑梗死患者中增高,ε4可能是脑梗死的易感因素和风险因素。     

早期复发性脑梗塞患者载脂蛋白E基因多态性分析

目的 探讨载脂蛋白E（apoE)基因多态性与早期脑梗塞复发的关系。方法 将年龄55－75岁之间脑梗塞患分为早期复发性脑梗塞与普通脑梗塞,和对照组三组分别以聚合酶链反应限制性片段长度分析法（PCR－RFLP）检测apoE基因型。结果 对照组apoE基因型以ε3／3最多,其次ε2／3,二组脑梗塞也以ε3／3最多,其次为ε3／4。二组病例ε3／4基因型、ε4等位基因频率均显高于对照组,尤以早期复发性脑梗塞组为突出,且其ε4等位基因频率明显高于普通脑梗塞组。结论 ApoEε4基因是脑梗塞的危险因素,并与脑梗塞早期复发有关。     

中国汉族健康群体多巴胺D1受体-48A／G基因多态性分布

目的：了解中国汉族健康群体多巴胺D1受体-48A／G基因的多态性。方法：随机收集2004—03／07武汉大学人民医院门诊体检中心健康汉族人188名，其中男112名，女76名。用聚合酶链反应-限制性片段长度多态性方法，分析限制性酶切位点-48A／G的多态分布。结果：188名健康人的测试结果进入分析。①多巴胺D1受体-48A／G基因型在中国汉族健康人群中的分布特点；以AA纯合子型最多见（0．71），AG杂合子型次之（0．28），GG纯合子型最为罕见（0．01）；等位基因频率的分布以A等位基因最多见（0．85），其次为G等位基因（0．15）。在男女性别之间，基因型频率（x^2=1.582，P〉0．05）相等位基因频率（x^2=0.606，P〉0．05）分布差异无显著性。②不同种族间多巴胺D1受体-48A／G基因型分布的比较；中国汉族健康群体多巴胺D1受体-48A／G等位基因的分布与高加索、德国及日本人群相比差异有显著性（P〈0．01）；在基因型的分布上，与日本人群也存在显著性差异（P〈0.01）。结论：中国汉族健康群体多巴胺D1受体-48A／G以AA纯合子基因型最多，等位基因频率的分布以A等位基因最多；在男女性间的基因型频率和等位基因频率分布无差异。中国汉族健康群体与高加索、德国及日本报道的人群多巴胺D1受体-48A／G等位基因分布和基因型的分布不同     

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.     

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.     

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.