白血病细胞p16基因突变分析

目的探讨ｐ１６基因突变在白血病发生中的作用及基因突变的机制。方法利用点突变检测仪、水平和垂直板电泳对ｐ１６基因的外显子１、外显子２的ＰＣＲ扩增产物作缺失和点突变分析。结果在白血病３５例临床标本中有２２例发生缺失突变，６例发生点突变，突变率约８０％。在２２例缺失突变病例中，有１０例为不完全缺失突变即有低于外显子５０９ｂｐ的扩增产物。结论ｐ１６基因含有“ＧＣ”ＤＮＡ重复顺序，易发生ＤＮＡ重组及易位和重排。在白血病发生中起重要作用     

少精不育患者的雄性激素受体基因突变分析

目的了解雄性激素受体（ＡＲ）基因突变对少精不育症发生所起的作用。方法利用聚合酶链反应技术（ＰＣＲ）对３０例少精不育患者精液标本的ＡＲ基因８个外显子分别进行扩增。扩增产物经琼脂糖凝胶电泳和聚丙烯胺的ＣＤＧＥ电泳分析,检测基因片段的插入,缺失和点突变。结果３０例患者中,外显子Ａ即基因转录激活区发生点突变３例,插入突变４例共７例,突变率为２３３％。外显子Ｈ发生缺失突变１例,约占３３％,外显子Ｇ处发生点突变１例,约占３３％,总突变率为３００％。结论雄性激素受体基因外显子Ａ即基因转录激活区的突变是造成少精不育的重要原因。     

非同位素方法检测卵巢癌组织p53基因的改变

为解决常规ＤＮＡ单链构象多态性分析（ＳＳＣＰ）使用放射性同位素及操作繁杂等问题，应用溴化乙锭（ＥＢ）染色的非同位素检测方法对１６例卵巢癌及５例正常胎盘组织中ｐ５３基因的第５、６外显子（Ｅｘｏｎ５、６）的聚合酶链反应（ＰＣＲ）扩增产物进行了分析，并结合ＤＮＡ测序技术进行验证。正常组织未发现异常，１６例卵巢癌ＳＳＣＰ分析显示３例异常，ＤＮＡ测序证实其中２例为核苷酸突变，１例为核苷酸插入。采用ＥＢ染色的     

少精不育患者的雌性激素受体基因突变分析

目的 了解雄性激素受体（ＡＲ）基因突变对少精不育症发生所起的作用。方法 利用聚合酶链反应技术（ＰＣＲ）对３０例少精不育患者精液标本的ＡＲ基因８个外显子分别进行扩增。扩增产物经琼脂糖凝胶电流和聚丙烯胺的ＣＤＧＥ电泳分析,检测基因片段的插入,缺失和点突变。结果 ３０例患者中,外显子Ａ即基因转录激活区发生点突变３例,插入突变４例共７例,突变率为２３．３％。外显子Ｈ发生缺失突变１例,约占３．３％,外显子Ｇ     

非同位素方法检测卵巢癌组织p53基因的改变

为解决常规ＤＮＡ单链构象多态性分析（ＳＳＣＰ）使用放射性同位素及操作繁杂等问题，应用溴化乙锭（ＥＢ）染色的非同位素检测方法对１６例卵巢癌及５例正常胎盘组织中ｐ５３基因的第５、６外显子（Ｅｘｏｎ５、６）的聚合酶链反应（ＰＣＲ）扩增产物进行了分析，并结合ＤＮＡ测序技术进行验证。正常组织未发现异常，１６例卵巢癌ＳＳＣＰ分析显示３例异常，ＤＮＡ测序证实其中２例为核苷酸突变，１例为核苷酸插入。采用ＥＢ染色的非同位素ＰＣＲ－ＳＳＣＰ，方法简便、省时、准确，具有良好的实用性和广泛的使用价值。     

非同位素银染单链构象多态性技术筛查葡萄糖激酶基因突变

目的建立银染单链构象多态性（ＳＳＣＰ）技术筛查葡萄糖激酶基因点突变。方法收集１０个ＮＩＤＤＭ家系的１１２例基因组（ＤＮＡ），经多聚合酶链反应（ＰＣＲ）扩增葡萄糖激酶基因第２～１０号外显子，ＳＳＣＰ电泳，硝酸银染色筛查点突变。结果发现３个家系，９例受试者第５，６号外显子出现异常ＤＮＡ片段条带，经顺序分析证实为第５号内含子１２位碱基Ｃ→Ｇ突变。结论非同位素ＳＳＣＰ技术是一种简便、经济、快速、准确和有效的筛查基因点突变的方法。     

非同位素银染单链构象多态性技术筛查葡萄糖激酶基因突变

目的 建立银染单链构象多态性（ＳＳＣＰ）技术筛查葡萄糖激酶基因点突变，方法 收集１０个ＮＩＤＤＭ家系的１１２例基因组（ＤＮＡ），经多聚合酶链反应（ＰＣＲ）扩增葡萄糖激酶基因第２～１０号外显子，ＳＳＣＰ电泳，硝酸银染色筛查点突变，结果 发现３个家系，９例受试者第５，６号外显子出现异常ＤＮＡ片段条带，经顺序分析证实为第５号内含子１２位碱基Ｃ→Ｇ突变，结论 非同位素ＳＳＣＰ技术是一种简便，经济，快速，准     

非缺失型HbH病基因突变类型的研究

采用选择性聚合酶链反应扩增技术及等位基因特异寡核苷酸探针斑点杂交，分析了１２例经血液学检测及基因图谱分析确认为非缺失型ＨｂＨ病的样品。结果显示，１２例非缺失型ＨｂＨ病样品中，ＨｂＣｏｎｓｔａｎｔＳｐｒｉｎｇ８例（６６．７％），Ｈｂ广西２例（１６．７％），２例为未知突变类型（１６．７％），对这２例未知样品的α＿２％基因外显子ＩＩＩ及其旁侧的突变热点区域进行了扩增、克隆和测序，结果发现这２例的α＿２基因密码子１２４均有ＴＣＣ→ＴＣＧ突变，其中１例的α＿２基因３＇非编码区第３６位碱基发生Ａ→Ｃ突变。     

抑癌基因p16在子宫颈癌中的检测研究

本文通过检测宫颈癌组织中的ｐ１６抑癌基因的突变，来探讨ｐ１６抑癌基因在宫颈癌发生、发展中的作用。选取２０例正常宫颈组织、２０例慢性宫炎组织、３０例宫颈癌组织，其中宫颈癌Ⅰ期７例、Ⅱ期１１例、Ⅲ期８例、Ⅳ期４例，在细胞分化程度上Ⅰ级６例，Ⅱ级１３例，Ⅲ级１１例，应用ＰＣＲ－ＳＳＣＰ技术检测抑癌基因ｐ１６外显因子α的突变。研究结果：正常宫颈组织和慢性宫颈炎组织均无ｐ１６基因突变，３０例原发宫颈癌组织有２例ｐ１６基因突变，分别为Ⅲ期１例，Ⅳ期１例，且细胞分化程度均为Ⅲ级。在宫颈癌中ｐ１６基因突变发生率为６．７％（２／３０），提示ｐ１６基因突变率可能随着宫颈癌的进展而增高与细胞分化程度呈负相关，说明Ｐ１６抑癌基因失活在宫颈癌发展中起着一定的作用。     

p16基因突变及表达与喉癌的相关性研究

目的　研究ｐ１６ 基因在喉癌发生过程中的表达及在喉癌诊断中的应用价值。方法　采用特异合成引物对ｐ１６ 基因的有关外显子进行ＰＣＲ 扩增，结合单链构象多态性技术，检测２９ 例喉癌手术标本中ｐ１６ 基因的突变，同时应用免疫组织化学方法观察其ｐ１６ 蛋白表达情况。结果　１１／２９ 的喉癌组织有ｐ１６ 基因第一、第二外显子的突变（ Ｐ＜ ０ ．０５） ，其中９／１１ 发生于喉癌Ⅲ、Ⅳ期；７／９ 伴颈淋巴结转移有者第一、第二外显子突变（ Ｐ＜ ０ ．０５） 。免疫组织化学法结果显示临床Ⅲ、Ⅳ期喉癌ｐ１６ 蛋白表达明显低于Ⅰ、Ⅱ期（ Ｐ＜ ０ ．０５） ，伴颈淋巴结转移组ｐ１６ 蛋白表达明显低于无颈淋巴结转移组（ Ｐ＜ ０ ．０５） 。结论　ｐ１６ 基因突变与喉癌的临床病程进展有关，在喉癌的诊断、判断预后及指导治疗上有重要意义。     

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.     

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.     

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.     

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.