ACE基因I/D多态性与原发性高血压和高血压性脑出血的关系

目的研究血管紧张素转换酶（ACE）基因插入/缺失（I/D）多态性的分布及其与原发性高血压（EH）、高血压性脑出血（CH）之间的关系。方法采用常规酚—氯仿抽提法提取外周血基因组DNA,PCR检测ACE基因I/D多态性基因型频率及等位基因频率。结果 EH、CH患者及健康对照者ACE基因DD基因型频率分别为17.95%、17.55%、6.45%;D等位基因的分布频率分别是45.51%、45.18%、33.06%。与健康对照比较,EH和CH患者间ACE基因DD基因型频率和D等位基因频率均显著增高（P〈0.05）,但EH和CH患者间无统计学差异。结论 ACE基因DD基因型和D等位基因可能是EH和CH的遗传易感基因。     

血管紧张素转换酶基因插入/缺失多态性检测方法的研究

目的 采用三条引物法进行力紧张素转换酶（ACE）基因分型检测,并与Rigat法进行比较,以探讨Rigat造成DD型分型的错判率,并用此方法检测了中国汉族人群中ACE基因I／D基因型的分布频率以及插入（I）／缺失（D）多态性与高血压病（EH）间的相关性。方法 EH患（EH组）206例,用上述两种方法进行ACE基因分型;正常血压组（NT组）156例以及核心家系25个共118例,三条引物法进行ACE基因分型。结果 EH组Rigat法得出的DD型比例较三条引物法高。与三条引物法相比较,Rigat法对DD型的错判率为13．04％。用三条引物法进行基因分型的结果如下：（1）在NT组,ACE各基因型的分布频率为Ⅱ型0．51,ID型0．41,DD型0．08。等位基因频率为：I0．71,D0．29。（2）25个EH家系所有成员的基因分型结果,完全符合孟德尔遗传规律。（3）EH与NT两组间基因型和等位基因频率无显性差异。结论 三条引物法1次完成ACE基因分型,有良好的特异性、准确性和重复性。     

血管紧张素转换酶基因I/D多态性及醛固酮合成酶基因T-344C多态性与蒙古族人群原发性高血压的相关性研究

目的研究血管紧张素转换酶（ACE）基因及醛固酮合成酶（CYP11B2）基因多态性与蒙古族原发性高血压（EH）的关系。方法应用PCR-RFLP技术检测98例EH患者与正常对照组108名健康受试者ACE基因第16内含子I/D多态性及CYP11B2基因T-344C多态性。结果①蒙古族人ACE基因I/D位点II、ID、DD基因型频率在EH组和正常对照组分别为0.44、0.38、0.18和0.42、0.32、0.26，差异无显著性（χ^2=1.693，P=0.192）；②I、D等位基因的频率分别为0.63、0.37和0.58、0.42，差异无显著性（χ^2=0.808，P=0.363）；③CYP11B2T-344C位点TT、TC、CC基因型的频率在EH组和正常对照组分别为0.46、0.44、0.09和0.37、0.54、0.09，两组之间差异无显著性（χ^2=0.005，P=0.945）。④T、C等位基因频率分别为0.69、0.31和0.64、0.36，差异无显著性（χ^2=0.928，P=0.335）；⑤同时分析CYP11B2基因T-344C基因型与ACE基因I/D基因型在蒙古族人群患EH方面无协同作用。结论ACE基因I/D位点及CYP11B2基因T-344C位点与蒙古族人群患EH无相关性。     

原发性高血压病患者血管紧张素转换酶的基因多态性分析

目的：采用三条引物法进行血管紧张素转换酶(ACE)基因分型，并与Rigat法进行比较，探讨ACE基因多态性与原发性高血压病(EH)之间的关系。方法：抽取外周血DNA，分别用三条引物法和Rigat法对128例EH患者进行ACE基因分型，并以150例正常人作对照组。结果：Rigat法对DD型的错判率为22．22％。正常血压人群ACE基因DD型、Ⅱ型、ID型分别有10、62、78例，占6．67％、41．33％、52％，Ⅰ和D的等位基因频率是67％、33％；原发性高血压病人群ACE基因DD型、Ⅱ型、ID型分别有14、47、67例，占10．94％、36．72％、52．34％，Ⅰ和D的等位基因频率是63％、37％。结论：ACE基因多态性与原发性高血压有一定关系。     

血管紧张素转化酶基因多态性在海南黎、汉族高血压人群的对比研究

目的研究血管紧张素转化酶(ACE)基因多态性在海南黎、汉族原发性高血压(EH)人群的频率分布差异.方法采用聚合酶链反应(PCR)方法,检测海南黎族111例EH患者(黎族组),106例汉族EH患者(汉族组)ACE基因多态性,观察DD、DI、Ⅱ基因型频率及等位基因频率,并对所有普通PCR定为DD型的样本进行插入特异性PCR检测,以减少误分型率.结果黎族组DD、DI、Ⅱ基因型频率分别为10.8%、37.8%、51.4%,D及Ⅰ等位基因频率分别为29.7%、70.3%;汉族组DD、DI、Ⅱ基因频率为16.0%、28.3%、55.7%,D及Ⅰ等位基因分别为30.2%、69.8%,2组比较,差异无统计学意义.结论ACE基因多态性不是海南黎族EH人群发病率不同于汉族人群的主要原因.     

血管紧张素转换酶基因多态性与非杓型高血压的关系

目的研究血管紧张素转换酶 ( ACE)基因插入 /缺失 ( I/ D)多态性与非杓型高血压 ( EH)的关系。方法　 1应用聚合酶链反应 ( PCR)方法扩增 5 0例正常人、99例高血压患者的 ACE基因上 2 87bp片段 ,根据插入 ( I)或 /缺失( D)来判断其多态性。 2高血压患者行 2 4h动态血压监测 ( ABPM) ,根据 ABPM结果分为杓型 EH组和非杓型 EH组。结果　 1非杓型组与健康对照组相比 ,其 D等位基因及 DD基因型显著升高。 2非杓型组与杓型组相比 ,其 D等位基因及 DD基因型显著升高。3杓型组与健康对照组相比 ,ACE基因型和等位基因频率无显著性差异。结论　ACE基因多态性与非杓型高血压有关联性 ,DD基因型提示可能与高血压昼夜节律改变有关     

ACE基因(I/D)多态性与家族性原发性高血压的关系

目的:探讨血管紧张素转换酶(ACE)基因插入/缺失(I/D)多态性与家族性原发性高血压(EH)的关系。方法:采用原位杂交荧光染色脱氧核糖核酸测序法,检测46例有家族史EH患者(有家族史EH组)及64例无家族史的EH患者(无家族史EH组)和43名健康人群(健康对照组)的ACE基因I/D多态性基因型频率及等位基因频率。结果:健康对照组、无家族史EH组及有家族史EH组患者ACE基因DD基因型频率分别是11.6%、32.3%、37.0%;D等位基因的分布频率分别是33.7%、52.3%、57.6%。和健康对照组比,无家族史EH组和有家族史EH组患者ACE基因DD基因型和D等位基因频率均明显升高(P<0.05或<0.01),但无家族史EH组和有家族史EH组患者间无统计学差异(P>0.05)。结论:ACE基因DD基因型和D等位基因可能是原发性高血压患者的遗传易感基因,而无家族史的高血压患者和有家族史的高血压患者两组基因构成比无差别。     

ACE基因、CYP11B2基因多态性联合分析与原发性高血压合并缺血性脑血管病的相关性研究

目的探讨血管紧张素转换酶（ACE）基因I／D多态性和醛固酮合酶（CYP11B2）基因-344T／C多态性联合分析与原发性高血压（EH）及合并缺血性脑血管病（ICVD）的关系。方法运用聚合酶链反应（PCR）、限制性片段长度多态性（RFLP）等技术检测正常对照（NE）组305例、单纯高血压（SEH）组324例和高血压合并缺血性脑血管病（ICVD）组297例的ACE、CYP11B2基因型，结合临床资料统计分析。结果ACE基因DD型及D等位基因频率在ICVD组显著高于NE组和SEH组（P〈0．0125），在SEH组与NE组问无显著差异；CYP11B2三种基因型在各组分布差异无显著性；ACE基因DD型＋CYP11B2基因TC／CC型分布在三组间有显著差异（P〈0．05），DD—TC／CC频率在ICVD组显著高于NE组和SEH组（P〈0．0125），在SEH组与NE组间差异无显著性；Logistic回归分析提示，年龄、体重指数（BMI）、血清总胆固醇（CHOL）、血糖（GLU）、基因联合DD—TC／CC是EH人群发生ICVD的独立危险因素，而ACE基因DD型未进入回归方程。结论ACE基因I／D多态性和CYP11B2基因-344T／C多态性与高血压无明显关系，但在高血压人群中，年龄、BMI、CHOL、GLU、ACE基因DD型＋CYP11B2基因TC／CC型可能是其发生ICVD的独立危险因素，ACE基因与CYP11B2基因可能存在协同作用。     

ACE基因I/D多态性与佳木斯地区汉族人群中老年原发性高血压的关系

目的 探讨佳木斯地区汉族中老年人群血管紧张素转换酶(ACE)基因的插入／缺失(L／D)多态性与原发性高血压(EH)的关系。方法 应用聚合酶链反应(PCR)、电泳分型等方法，检测佳木斯地区102例汉族人原发性高血压患者和107例正常对照组的ACE基因L／D多态性。结果 正常对照组及原发性高血压患者的ACE基因L／D多态性Ⅱ、ID、DD基因型频率分别为0．3925、0．4299、0．1776和0．4313、0．4118、0．1569，I、D等位基因分布频率分别为0．6074、0．3926和0．6372、0．3628，两组间无显著差异。结论 ACE基因L／D多态性可能与佳木斯地区汉族人原发性高血压病无关。     

昆明汉族ACE、AT1R基因多态性与2型糖尿病肾病的关系

运用聚合酶链反应（PCR）和PCR／Ddel酶切技术,检测110例DN患者[DN（＋）组]与74例2型糖尿病无肾病患者[DN（-）组]及56例正常对照人群ACE基因及AT,R基因多态性。结果（1）DN（-）组ACE—DD基因型和D等位基因频率与正常对照组比较无显著性差异（P〉0．05）;（2）DN组ACE基因DD基因型频率（56．4％）,D型等位基因频率（70．5％）较DN（-）组（21．6％,46．6％）均升高（P〈0．01）;（3）三组间AT1R基因的A1166C多态基因型频率和等位基因频率分布均无差异（P〉0．05）;（4）联合作用分析同时携带ACE纯合子缺失基因型（DD）和AT,R突变基因型（AC＋CC）者发生DN的危险较大,OR值为5．421。结论昆明地区汉族人ACE基因I／D多态性与2型DN发生有关,携带DD基因型和D型等位基因者是2型DN的易感人群。AT1R基因A1166C多态性与2型DN无关,但携带AC＋CC与DD基因型的个体有更高的患DN风险。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

改水、服硒、食用蓬灰防治大骨节病的效果观察

本实验应用改水、服硒、食用蓬灰等措施在大骨节病区对3～13岁儿童进行现场防治实验。用现患率、健康儿童新发率、X线痊愈率作为其判定指标。 通过四年的实验观察,现患率由1980年的46.40％下降到1984年的20.30％,有非常显著的差异。36名健康儿童连续四年观察未有新发病人,而对照组出现新发病例,取得了较好的防治效果。本文还对防治措施的作用进行了分析讨论。     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

A long-term surviving patient with cancer of papilla of Vater after local resection

We report successful local resection for cancer of papilla of Vater in an 86-year-old woman. She was referred to our hospital because of right hypochondralgia. Abdominal ultrasonography and computed tomography showed marked dilatation of the common bile duct (CBD). Endoscopic retrograde cholangiography disclosed a small shadow defect in the terminal of the dilated CBD. Biopsy of the papilla revealed well-to-moderately differentiated adenocarcinoma. Considering her extreme old age and keeping in mind her quality of life after the operation, and the finding that the tumor was localized within the papilla and highly differentiated, we performed local resection. In addition, the intrapancreatic portion of the CBD and part of the main pancreatic duct (MPD) were further resected to secure a negative margin, confirmed by frozen section. The MPD was reapproximated to the duodenal mucosa and a choledocho-duodenostomy was performed for CBD reconstruction. Histopathological examination showed the tumor was papillary adenocarcinoma, 10 × 15 mm in size; there was no invasion beyond the sphincter of Oddi, it had partly infiltrated the CBD, but had not invaded to the pancreas or duodenum. The patient's postoperative course was not eventful and she has had good quality of life for the past 6 years since the operation, without any evidence of recurrence. Although radical pancreaticoduodenectomy is now the standard procedure in patients with malignant tumor of the papilla of Vater, local resection is a reasonable alternative for high-risk patients with highly differentiated, apparently localized carcinomas.     

严重肺功能不全伴前列腺增生的临床治疗

目的探讨严重肺功能不全患者伴有前列腺增生的临床治疗。方法经尿道气化电切前列腺增生组织,测定患者肺功能及动脉血气分析。结果测定38例患者手术前后血气分析指标无显著差异(P>0.05);其中34例患者顺利通过围手术期,术后3例并发支气管肺炎,1例为肺不张。平均随访6月,无排尿梗阻症状。结论经尿道气化电切术适合治疗严重肺功能不全伴有前列腺增生患者。     

TIMP-1和TIMP-2在原发性肝癌生长、浸润及转移中的作用

目的：了解基质金属蛋白酶组织抑制因子-1(tissue inhibitou of metalloproteinase-1，TIMP-1)和基质金属蛋白酶组织抑制因子-2(TIMP-2)mRNA及相关抗原在肝癌组织中的定位和表达状态，探讨TIMP-1和TIMP-2在肝癌组织生长、浸润及转移中所起的作用。方法：以TIMP-1和TIMP-2探针及单克隆抗体（McAb）为试剂，采用原位杂交技术及免疫组织化学法检测原发性肝癌、肝高分化腺癌的肝组织中TIMP-1和TIMP-2mRNA及相关抗原的表达，并与10例正常肝组织做对照。结果：20例原发性肝癌患者的肝组织中TIMP-1和TIMP-1mRNA及相关抗原表达的阳性率为90%;9例肝高分化腺癌的腺癌组织中无TIMP-1和TIMP-2mRNA及相关抗原的表达；10例正常肝组织中TIMP-1和TIMP-2mRNA及相关抗原表达均为阴性；TIMP-1和TIMP-2mRNA及相关抗原阳性信号呈现为棕黄色颗粒状，分布在肝细胞浆内，未见细胞核着色；无论是原发性肝癌癌组织还是癌周组织中,TIMP-1的表达强于TIMP-2的表达，癌周组织中TIMP-1和TIMP-2mRNA和相关抗原的表达与肝组织病理改变相关，即肝硬化者表达强，慢性肝炎者表达弱，正常肝组织无表达。结论：原发性肝癌的癌组织中存在TIMP-1和TIMP-2mRNA及相关抗原的表达，其表达强度可能与原发性肝癌的分型有关，它可能通过抑制MMP的活性使ECM降解减少从而阻止癌细胞通过基底膜移出而抑制肝癌细胞向周围浸润及转移。     

Fatal cerebral edema following angiocardiography: a case report

We describe a case of fatal reaction to angiocardiography following investigation of tetralogy of Fallot. This happening has occurred only once in 8300 procedures in our laboratory. It was due to cerebral edema. Although a recognized, but very rare, hazard following injection of contrast material, we found no way in our case of either predicting the outcome or its possible recurrence.