16S rRNA基因芯片诊断新生儿败血症

目的建立16SrRNA基因加基因芯片检测新生儿败血症的诊断技术，以提高临床检测细菌的速度及准确性。方法对125例拟诊为败血症的新生儿血标本及部分脑脊液标本进行细菌16SrRNA基因及基因芯片检测．包括DNA提取、设计引物和探针、聚合酶链反应（PCR）扩增、基因芯片的制备、杂交、激光扫描与读片。结果125例中PCR检测血标本阳性64例，占51．2％；血培养阳性32例，占25．6％；非特异性指标41例，占32．8％，差异有统计学意义（P〈0．01）。若以血培养阳性和／或非特异指标至少两项阳性为诊断标准，PCR灵敏度为90．3％（56／62），特异度为87．3％（55／63），正确诊断指数为0．776。3例脑脊液标本中PCR阳性2例，培养阳性仅1例。对64例PCR阳性血标本进一步作基因芯片检测，结果通用探针均阳性。其中G^＋探针阳性60份。G探针阳性4份。30份PCR和血培养均阳性的标本中其探针菌株与血培养细菌阳性结果相符。2例脑脊液标本PCR阳性，基因芯片检测结果与培养结果相符。结论168 rRNA基因PCR加基因芯片杂交可为新生儿败血症提供早期、敏感的病原学诊断依据。     

基因芯片技术在常见肠道致病菌感染检测中的应用

目的 建立一种运用PCR结合基因芯片技术检测和鉴定引起腹泻的常见肠道致病菌方法.方法 根据生物信息学技术以细菌16S rDNA和23S rDNA序列设计各细菌的特异型探针和引物,在基因芯片制备基础上,通过对靶基因的扩增、杂交和对杂交结果的分析,对常见肠道致病菌的检测和鉴定效果进行评价,同时对临床采集100份腹泻患者粪便标本通过细菌培养结果,比较基因芯片技术的灵敏性和特异性.结果 100份临床粪便标本中,采用基因芯片技术共检出50份(50％)携带肠道致病菌;细菌培养鉴定出47份(47％)携带肠道致病菌,其中42份基因芯片与细菌培养结果一致,准确率为79.25％,与基因芯片比较差异无统计学意义(x2=5.28,P＞0.05).结论 我们所建立的基因芯片系统具有高通量和高准确性,可以作为临床鉴定细菌的一个重要的工具,而且适用于流行病学调查研究.     

基因芯片技术检测结核分枝杆菌利福平和异烟肼耐药性临床应用评价

目的评价基因芯片技术检测结核分枝杆菌利福平和异烟肼耐药性的临床应用效果。方法利用基因芯片技术对涂阳肺结核患者的痰标本和临床分离株进行利福平和异烟肼耐药基因位点检测,比较痰标本与菌株检测结果的差异;并以BACTEC MGIT 960药敏试验结果为对照评价基因芯片的检测性能。另外,通过对999株鉴定为结核分枝杆菌的临床分离菌株进行rpoB、katG和inhA基因耐药相关区域扩增产物测序,以验证基因芯片对核酸序列检测的准确性。结果在涂阳的1 108例标本中有100例经基因芯片菌种鉴定为非结核分枝杆菌。其余的1 008例痰标本基因芯片结果与BACTEC MGIT960培养阳性的菌株基因芯片结果比较仅有9例结果不一致,符合率为99.1%。以BACTEC MGIT960培养法药敏结果为对照,999株菌株基因芯片法检测利福平耐药性的符合率为98.1%,异烟肼的耐药性的符合率为94.5%。与DNA测序法相比,基因芯片法检测利福平和异烟肼耐药性的准确率分别为99.6%和99.8%。结论基因芯片技术能够快速、准确地进行结核分枝杆菌利福平和异烟肼的耐药性检测,并能直接用于痰标本检测。     

16SrRNA基因PCR加反相杂交技术检测细菌DNA

目的探讨聚合酶链反应（ＰＣＲ）加反相杂交技术在细菌ＤＮＡ检测中的应用。方法以１６ＳｒＲＮＡ基因为靶序列，设计引物及寡核苷酸探针，采用ＰＣＲ法加反相杂交检测标准菌株及临床标本细菌ＤＮＡ。结果对２０株不同标准菌株进行ＰＣＲ扩增，均出现３７１ｂｐ长度的ＤＮＡ片段，敏感性试验可检测出１０－１２ｇ的细菌ＤＮＡ，与人基因组及病毒无交叉反应；２２份血培养阳性标本及４份脑脊液培养阳性标本均扩增出３７１ｂｐ长度ＤＮＡ条带，反相杂交区分革兰阳性／阴性细菌与培养结果相符。结论１６ＳｒＲＮＡ基因ＰＣＲ加反相杂交技术检测细菌ＤＮＡ，具有敏感、快速、准确的特点，为细菌感染的临床诊断提供了科学的依据。     

一种快速检测患者血液标本猪链球菌方法的研究

目的建立一种快速检测患者血液标本中猪链球菌的方法。方法收集患者血液标本。提取细菌金基因组DNA；根据猪链球菌6个特异基因设计引物，采用PCR技术对这些基因进行检测，并对PCR扩增阳性的基因产物进行序列分析验证，并分析该方法诊断猪链球菌病的特异性和敏感性。结果取唾液链球菌等6种链球菌进行验证，该检测方法的特异性为100％。模拟标本（细菌含量〉10^3个／ml）的敏感性为100％，血培养阳性病人标本的敏感性为100％。通过对90份血培养阴性临床标本的检测，9份PCR结果阳性，序列分析结果证实扩增片段为目的基因。结论该方法灵敏、特异、快速。可直接用于患者血液标本的猪链球菌特异性基因的检测，为猪链球菌感染的早期诊断提供实验室依据。     

DNA测序与线性反向探针杂交法检测HBV P基因耐药突变的比较

目的建立和优化扩增慢性乙型肝炎患者血清HBV P基因的PCR方法,比较DNA测序法与线性反向探针杂交法检测HBV基因突变情况,并对耐药相关基因突变及其意义进行分析。方法采用巢式PCR法扩增93例慢性乙型肝炎患者血清HBV P基因反转录酶区,对PCR产物进行DNA测序,采用Bioedit6．0．5、Seqman TMⅡ、EditSeq TM和MegAlign软件分析结果;同时随机抽取40份血清进行线性反向探针杂交,比较两者的检测结果,并对11个已知耐药相关突变位点进行分析。结果在93份标本中DNA序列测定法检测到碱基突变113个,其中与LAM相关突变50份（53．78％）,与ADV相关突变6份（6．46％）,与LdT相关突变3份（3．23％）,与ETV相关突变3份（3．23％）;在40份血清中与线性反向探针杂交检测结果一致的突变为87．5％（35140）,氨基酸位点一致为98．0％（431／440）。此外,还检测到V84I、S85C、A181S、L229W、N238T等与耐药相关的突变位点。结论应用线性反向探针杂交检测虽然比较快捷,但其价格昂贵且只能检测已知常见的变异位点;建立在巢式PCR基础上的DNA序列测定法敏感性与线性反向探针杂交法相当,两者检测结果有较高的符合率,但似可检出更多的耐药相关突变。     

深圳地区未经治疗艾滋病患者蛋白酶和逆转录酶耐药基因变异检测

目的 了解广东省深圳地区部分未经治疗的AIDS患者蛋白酶和逆转录酶耐药基因变异的发生频率和类型。方法 收集深圳市45例未经治疗的AIDS患者血浆，用RT-PCR及套式PCR扩增HIV-1pol区蛋白酶基因全序列与逆转录酶基因部分序列，将反应产物直接进行序列测定，并分析耐药基因的突变情况。结果 从45份血浆标本中扩增出41份pol区基因并进行序列测定与分析，蛋白酶基因耐药的主要突变发生率为12．2％（5／41），次要突变发生率为100％（41／41）；逆转录酶基因的耐药基因突变发生率为39．0％（16／41）。对上述耐药基因突变的评分表明，对蛋白酶类药物的耐药率为9．8％（4／41）；对逆转录酶类药物的耐药率为19．5％（8／41）；有1份标本对蛋白酶抑制剂、2份标本对逆转录酶抑制剂潜在耐药。结论 深圳地区未经治疗的AIDS患者中存在HIV-1耐药株，但多数患者对现有抗病毒药物敏感。应用抗病毒治疗必须加强监测，保持较好的依从性，防止耐药性毒株的流行。     

16SrRNA基因序列分析用于诊断病原性细菌感染初步研究

目的建立一种可适用于多种病原菌检测的方法,以提高病原学诊断率,有利于传染病的病原学监测。方法细菌16SrRNA基因通用引物对直接从血液、尿液、脑脊液标本中提取的细菌DNA进行PCR扩增,并对16SrRNA基因扩增产物进行克隆和序列分析。结果检测了28份临床标本,16SrRNA基因序列分析与尿液细菌培养结果不完全吻合;血液和脑脊液的16SrRNA的检出率均高于细菌培养。结论16SrRNA基因检测分析和细菌培养均具有良好的诊断效果,而针对16SrRNA基因的PCR直接扩增核酸并进行序列分析可对分离培养阴性的标本进行有效的补充诊断,可检测到多种病原菌如肠球菌,大肠杆菌,表皮葡萄球菌,牛链球菌,猪链球菌,布鲁氏菌,表皮葡萄球菌和脑膜炎球菌等,为疾病的诊断提供良好的线索。     

利用基因芯片快速检测多种临床常见致病菌及其耐药性基因

目的快速、准确、灵敏地检测临床常见的致病菌及其耐药基因。方法采用基因芯片技术，利用细菌23S rRNA基因序列信息和某些耐药基因作为检测靶基因，设计针对不同菌属的寡核苷酸探针和耐药基因探针的基因芯片，聚合酶链反应（PCR）扩增并荧光标记目的DNA片段，通过杂交反应检测致病菌及其耐药基因。结果在理想状态下（检测试剂盒抽提的细菌基因组DNA）检测的结果与国内外文献报道的灵敏度相当（10^3～10^6细菌／ml），并在部分临床分离株、耐药标准菌株中进行验证，显示该方法有良好的特异性及可重复性。细菌种类能鉴别到种水平的有16种，能鉴别到属水平的有7类。覆盖了临床常见的多种病原菌，并且还可同期检测超广谱β内酰胺酶（ESBLs）基因耐药。结论DNA芯片检测具有快速、高特异性和高灵敏度的特点，是常规鉴定方法的一种有益补充。     

常见致病菌23S rRNA基因片段序列分析及其应用初探

目的通过临床常见致病菌23S rRNA基因序列差异的分析，探索建立可同时检测或鉴定多种细菌的分子生物学方法。方法对常见致病菌23S rRNA基因的一个多变区序列进行聚合酶链反应（PCR）扩增和测序分析，根据序列差异设计相应引物和探针，并采用PCR-凝胶电泳分析和PCR-反向杂交技术检测或鉴定临床常见致病菌。结果1.革兰阳性菌和革兰阴性菌间的23S rRNA基因序列存在较大差异，通过PCR扩增和凝胶电泳分析能快速区分待测菌株为革兰阳性菌抑或革兰阴性菌。2.不同菌种间亦存在一定差异，可通过PCR-反向杂交技术将细菌鉴定到种。结论.临床常见致病菌的23S rRNA基因之间存在可供细菌鉴定的序列差异，据此可望建立各种具有快速，灵敏，准确特点的分子生物学方法，为细菌感染的快速病原诊断提供客观依据。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.