204例登革热患者病原学特征分析

目的 分析204例登革病毒感染者的病毒血清型别分布及抗体产生特征,为研究登革热流行动态特征及临床诊治策略提供实验依据.方法 采集登革热患者急性期血清,应用实时荧光PCR检测登革病毒核酸及分型,ELISA法检测登革病毒特异性抗体IgG和IgM.结果 共检测204例标本,其中179例登革病毒核酸阳性,DENV-1型、DENV-2型及DENV-3型分别占97.2％ (174/179)、1.1％(2/174)及0.6％(1/174);DENV-1合并DENV-2型感染和DENV-1合并DENV-3型感染各1例.ELISA法结果显示IgM、IgG抗体阳性者分别为193例和47例,且IgG抗体阳性者的IgM抗体同为阳性,表明初次感染和二次感染分别为146例(75.6％,146/193)和47例(24.4％,47/193).结论 广州存在多种血清型流行及二次感染患者,提示今后广东省重症登革热的发生几率可能会有所增加,应引起重视.     

珠海口岸入境人员登革热病毒感染监测与结果分析

目的 掌握珠海口岸对来自东南亚登革热疫区的船员中登革热病毒感染情况,为做好登革热病毒监测和预防工作提供政策依据.方法 采用ELISA方法检测288名入境船员和83名对照组的血清登革病毒特异性抗体.结果 288名不同国籍入境船员中,登革病毒IgG抗体阳性者181例,阳性率为62.85%,东南亚七国201名船员中登革病毒感染者162名,感染率为80.60%,地区构成比为89.50%,并有8例IgM抗体阳性;而中国和韩国船员87名,感染者为19例,感染率为21.84%,地区构成比为10.50%,登革病毒感染有明显地区差别(P＜0.01).45名珠海地区健康体检者,登革病毒IgG抗体和IgM抗体均为阴性,而38例不明原因发热者IgG抗体阳性者4例,阳性率为10.53%,但IgM抗体阴性,为继往感染.结论 针对珠海口岸入境人员登革病毒感染者的流行病学特点,建立完善的入境人员登革热病监测和预报系统很有必要,应选择敏感度高的检测手段,以防止漏诊和登革热病例的输入.     

登革热病例病程中后期登革病毒带毒研究

目的 了解登革热病例在病程中后期血液和尿液标本中登革病毒的带毒情况。方法 连续采集4例登革热病患者的血液、尿液样本,提取病毒核酸,采用实时荧光RT-PCR方法对血凝块、血清、尿液标本分别进行病毒核酸检测并分型。结果 收集4例患者在住院期间及病情好转出院后的临床样本44份,采集时间为发病后6～60 d,有21份样本登革病毒核酸检测结果为阳性,检出率分别为血凝块100.00%(16/16)、血清6.25%(1/16)、尿液33.33%(4/12),均为登革病毒1型。结论 血凝块可作为登革病毒核酸检测的标本类型之一,能提高病程中、后期登革热疑似病例的实验室确诊率。     

输入性登革热的实验室诊断

目的通过实验室检测发现并确诊1例输入性登革热阳性病例。方法采用实时荧光(RT-PCR方法对病人血清进行检测,并对RT-PCR扩增产物进行核苷酸序列测定,检测结果使用BLAST进行比对;并采用间接ELISA法和捕获ELISA法分别检测登革热特异性抗体IgG、IgM。结果通过实时荧光RT-PCR方法检测出该病例呈登革热病毒核酸Ⅲ型阳性;对RT-PCR扩增产物进行序列比对,结果显示与登革病毒III型同源性很好;ELISA法检测登革热特异性抗体IgG、IgM均为阴性。结论通过实验室确诊,该病例为登革热阳性病例。     

中山市一起登革热局部爆发的流行病学调查

目的分析中山市2004年一起登革热爆发的流行病学特征,为制定登革热预防控制措施提供科学依据。方法按登革热诊断标准进行回顾性流行病学调查,使用登革热IgM/IgG快速免疫色谱测试卡对疑似病例血清进行登革热抗体检测,用C6/36细胞对急性期病人血清进行病毒分离。使用布雷图指数(BⅠ)法进行蚊媒密度调查。结果本次疫情流行历时36d,共发病37例,登革热抗体阳性37例,分离到登革Ⅰ型病毒4株。病例主要集中在城区城乡结合部,男性16例,女性21例,发病年龄最小6岁,最大63岁,其中10～39岁27例,占72.97%。疫情发生时布雷图指数67.0,经采取以快速杀灭成蚊和清除伊蚊孳生地为主的综合防治措施后,疫情很快得到控制。结论本次疫情是由I型登革病毒引起,因早期病例误诊,未及时发现传染源,导致疾病传播。快速灭蚊和清除伊蚊孳生地是控制疫情的有效措施。针对该市的流行因素,今后应继续加强各项控制措施的执行落实,加强可疑病例的监测和杀灭蚊媒的工作,扩大原因不明发热病人血常规监测范围,特别是曾发生疫情的乡镇社区卫生服务站。     

登革热病毒多重荧光PCR检测及基因分型方法的研究

目的 建立一种登革热病毒双靶基因多重荧光PCR检测方法,用于登革热病毒的实验室诊断和基因分型.方法 选取登革热病毒Ⅰ-Ⅳ型病毒保守区设计型特异性引物探针和通用型引物探针,评估多重荧光PCR检测方法的特异性、重复性和检测限;并对20份阳性样本进行检测.结果 20个登革热阳性核酸标本在通用型检测全部为阳性,特异性型别检测发现登革热病毒Ⅰ型10例、登革热病毒Ⅱ型3例、登革热病毒Ⅲ型3例、登革热病毒Ⅳ型4例;20名正常无症状人群标本提取的核酸和HIV、HCV和HEV通用型和特异性型别检测全部为阴性.梯度检测的变异系数均小于5％.对登革热Ⅰ-Ⅳ型病毒检测最低检测限达103 copies/ml.结论 本研究建立的登革热病毒双靶基因多重荧光PCR检测及分型方法具有特异性好、重复性好、快速易操作等优点,可用于登革热病毒的快速检测和基因分型鉴定.     

2012-2013年广州市发热伴血小板减少病例登革抗体监测结果分析

目的 分析2012-2013年广州市6家定点医院送检的发热伴血小板减少病例登革抗体检测结果,评估定点医院监测在登革热病例发现中的效应,以提高全市的登革热监测水平。方法 选取荔湾、越秀、天河、白云、黄埔和番禺区各1家二级以上医院,每周收集门诊发热伴血小板减少患者的血清标本,采用ELISA法检测登革病毒Ig M和Ig G抗体,阳性标本采用PCR法核酸检测和病毒型别确定。结果 1 871份监测血清标本中,Ig M阳性率为29.88%,Ig G阳性率为0.69%,Ig M和Ig G均阳性6.04%。对其中63份Ig M抗体阳性标本进行病毒核酸检测,型别测定为登革Ⅰ型4份,Ⅱ型1份,Ⅲ型10份,Ⅳ型12份,通用阳性36份。结合流行病学调查结果 ,552例(29.5%)确诊为登革热病例。结论 在发热伴血小板减少病例中开展登革抗体监测检出率较高,对此类患者及时开展登革病毒抗体检测,同时询问患者流行病学史、结合高热、头痛和皮疹等临床表现,可及时准确诊断发现登革热可能病例,有效提高了全市的病例监测水平。     

登革热疫点22年后的血清流行病学调查

目的了解曾发生登革热流行的旧疫区健康人群抗登革病毒的抗体水平及分布。方法在1986年曾爆发Ⅱ型登革热疫情的黄埔区鱼珠街一带,对2周内无临床症状的健康人群横断面采样,收集血清,ELISA法检测血清中抗登革病毒IgG抗体,并和非疫点健康人群抗登革病毒IgG抗体阳性率进行比较。RT—PCR法检测抗体阳性者血清中登革病毒。结果登革热疫点健康人群抗登革病毒IgG抗体阳性率为23.3％,非疫点健康人群抗登革病毒IgG抗体阳性率为3．8％,两者差异有统计学意义（P〈0．01）;登革热疫点人群抗体阳性率与年龄成正相关,0～20、21～30、31—40、41～50、51—60、61～70和70岁以上各年龄组的抗体阳性率分别为3．8％、5．8％、9．1％、26．5％、27．7％、32．5％和35．1％。30岁以下年龄组与31～40岁年龄组、31～d0岁年龄组与41～60岁年龄组、41-60岁年龄组与61岁年龄组间的抗登革病毒IgG抗体阳性率差异分别具有统计学意义（P〈0．05）。登革热疫点和非疫点15岁以下中小学生滤纸血样标本中均未检测到抗登革病毒IgG抗体。RT—PCR法未检测到抗体阳性者血清中有登革病毒。结论登革热疫点人群抗登革病毒IgG阳性率明显高于非疫点人群,疫点人群抗体阳性率随年龄增长而上升,提示登革热疫点在登革热疫情后,登革病毒可能在蚊媒体内存在低密度的循环。     

海南省2007年登革热血清学监测调查

目的为了解海南省登革热媒介带毒和人群抗体消长现状，预测本省登革热流行态势。方法在既往登革热高发地区儋州、临高和陵水3个地区采集健康居民静脉血697份，收集全省2007年疑似登革热发热病例278例，分别检测IgG和IgM抗体；同时采集既往登革热高发地区蚊媒标本28份进行病毒分离和核酸检测。结果697份健康居民静脉血中IgG抗体阳性率为0．4％，278例疑似登革热发热病例IgM抗体阳性率为5．40％，对采集的28份蚊子标本，进行病毒分离和核酸检测，结果均阴性。结论了解海南省登苹热高发地区和一般地区健康人群中登革热抗体阳性率的消长情况，揭示登革热传播媒介带毒率，以分析海南省登革热的流行趋势。     

2003年广州市登革1型病毒流行株的分离及NS2基因序列分析

目的对广州市区2003年仲夏—批疑似登革病毒感染的患进行确诊，并从基因水平分析流行株的可能来源。方法用免疫层析法(ICT)检测早期疑似患的DV—IgN和IgG抗体；同时用逆转录-聚合酶链反应(RT—PCR)、细胞培养病毒分离分别进行病原的分离和鉴定；对所分离到的毒株进行基因克隆、测序，并与国际参考株及国内流行株相应的序列进行同源性分析，结合患的流行病学资料推测本次流行株的可能来源。结果发病5d内患DV—IgM抗体阳性率为56．5％(13／23)，发病5～10d的患DV—IgM抗体阳性率为66．7％(16／24)；DV—IgG抗体无1例阳性。从18份发病5d内患的血标本中分离病毒7份，经RT—PCR和基因测序检测证实为DVI感染；用RT—PER检测30份早期患血标本，患的阳性率为83．3％(25／30)。基因序列分析表明，2003年流行株与登革1型病毒柬埔寨流行株及我国1997、1999年登革1型病毒流行株的同源性最高，分别为97％、97％、98％。所有患在发病前两个月均在广州市区某大院内居住，无输血史、无外出史。结论2003年广州登革热流行为登革1型病毒感染所致，推测广东可能存在登革1型病毒的疫源地。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.