血清胱抑素C水平与甲状腺功能关系的Meta分析

目的 系统评价血清胱抑素C (CysC)水平与甲状腺功能的关系,旨在为甲状腺疾病的预防和治疗提供循证医学证据.方法 计算机检索SinoMed、Embase、PubMed、知网和万方等数据库关于CysC水平与甲状腺功能相关性的研究,检索时间为自建库至2016年.由两名独立的研究人员根据纳入和排除标准筛选文献、提取研究数据.采用软件Stata12.0进行Meta分析.绘制森林图和漏斗图,行Begg's检验,进一步判定发表偏倚的可能性.结果 共纳入研究8个,患者520例.与对照组比较,①甲状腺功能亢进组的CysC水平明显增高,差异有统计学意义[WMD=0.32,95％ CI(0.27,0.36);Z =13.84,P＜0.001];②甲状腺功能减低组的CysC水平明显减低,差异有统计学意义[WMD=-0.12,95％ CI(-0.16,-0.09);Z =7.77,P＜0.001].纳入研究的漏斗图对称分布,Begg's检验,P值分别为0.13和0.26,提示研究间存在发表偏倚的可能性较小.结论 CysC水平与甲状腺功能关系密切相关.     

血清胱抑素C水平与早期高血压肾脏功能损伤关系的Meta分析

目的 系统评价血清胱抑素C(CysC)水平与早期高血压肾脏功能损伤的关系.方法 计算机检索SinoMed、ScienceDirect、Embase、Pubmed、知网和万方等数据库关于CysC与早期高血压肾脏功能损伤的病例对照试验,观察组为高血压早期组(尿蛋白阴性,肾小球滤过率在正常范围),对照组为同期体检的健康人群.检索时间自建库至2016年.以WMD及其95％ CI为效应性指标,采用Review Manager 5.3软件进行Meta分析.应用Statal2.0软件绘制漏斗图和敏感性分析图.结果 纳入研究7个,观察组患者377例,对照组样本量309例.Meta分析结果:与对照组比较,早期高血压组[SMD =0.14,95％ CI(0.07,0.21)]的CysC水平明显升高,差异具有统计学意义(Z=3.96,P＜0.005);纳入研究漏斗图呈对称分布,进一步行Begg's和Egger's检验,P值分别为0.45、0.79,提示研究间存在发表性偏倚的可能性小.敏感性分析图显示Meta分析结果稳定可靠.结论 CysC水平可作为早期高血压肾脏损伤的评价指标.     

中国人群脂联素基因+45T/G多态性与冠心病相关性的Meta分析

目的:对中国人apMl基因+45T/G多态性与冠心病相关性的研究进行Meta分析。方法:通过文献检索收集2009年12月以前完成或发表的中国人apMl基因+45T/G多态性与CHD相关性的病例对照研究,剔除不符合要求的文献。采用ReviewManager4.2软件进行Meta分析,根据各入选文献的同质性检验结果进行数据合并,计算总OR值。绘制漏斗图和Egger’s回归分析检验发表偏倚,并通过改变样本含量进行敏感性分析。结果:共纳入符合条件的8组研究,包括CHD患者1929例,对照1641例;Meta分析结果显示中国人apMl基因+45T/G多态性与CHD易感性无明显相关性(P0.05);发表偏倚和敏感性分析显示本次Meta分析结果稳定可靠。结论:尚无足够证据表明中国人apMl基因+45T/G多态性与CHD易感性相关。     

幽门螺杆菌感染与胃癌关系的系统评价

目的:探讨幽门螺杆菌(Helicobacter pylori,Hp)感染与胃癌的关系.方法:纳入22篇关于Hp感染与胃癌关系的文献,应用Review Manager 4.2软件进行Meta分析,计算合并优势比(odd ratio,OR)及OR值95%可信区间(confidence interval,CI),倒漏斗图法定性评价发表性偏倚.结果:Meta分析得出Hp感染与胃癌发病合并OR值为2.47(95 %CI为1.74～3.52,χ2 =144.18,P<0.01).本研究倒漏斗分析图形不对称,但经敏感性分析和计算失安全系数证明发表性偏倚的影响较小.结论:Hp感染是胃癌发生的危险因素.     

血清CA125水平与子宫内膜异位症关系的Meta分析

目的 系统评价血清CA125水平与子宫内膜异位症的关系.方法 计算机检索PubMed、Embase、WanFang、CNKI等数据库关于血清CA125水平与子宫内膜异位症关系的病例对照研究,搜索诸数据库自建库至2017年6月.按照纳入与排除标准筛选文献,应用Stata12.0软件进行Meta分析.结果 共纳入8个研究,1061例样本,其中观察组655例,对照组406例.剔除异质性较大的研究后Meta分析结果显示:与对照组比较,观察组的血清CA125水平[SMD=1.60,95% CI (1.27~1.92)]明显增高,差异有统计学意义(Z=9.69,P<0.005).结论 血清CA125水平与子宫内膜异位症关系密切,可作为临床评价的依据.     

机器人辅助与常规徒手开放椎弓根螺钉内固定的精确性与安全性的Meta分析

目的 使用Meta分析的方法分析比较机器人辅助和常规徒手开放椎弓根螺钉内固定的精确性和安全性.方法 计算机检索Pubmed、Embase、Cochrane library、中国生物医学文献(CBM)、万方、中国知网数据库(CNKI)中2016年12月1日前的文献.根据制定的纳入与排除标准,筛选合格文献并进行数据提取和质量评价.利用RevMan5.3软件进行Meta分析.对二分类数据采用相对危险度(RR)及95％置信区间(CI)表示效应差异.对连续型数据采用均数差(MD)或标准化均数差(SMD)表示效应差异.当P＜0.05,95％CI不含数值1时说明差异有统计学意义.结果 共纳入266例患者,包括机器人辅助138例、常规徒手开放128例;共置人螺钉1 200枚,包括机器人辅助608枚、常规徒手开放592枚.结果显示,根据Gertzbein-Robbins分级标准(A、B、C),机器人辅助和常规徒手开放方法之间的椎弓根螺钉置钉准确率差异无统计学意义,其中A(RR=1.07,95％CI:0.82,1.39,I2=46％,P=0.62)、B(RR=1.56,95％CI:0.86,2.82,I2=0％,P=0.14)、C(RR=0.91,95％CI:0.32,2.55,I2=0％,P=0.85).两组并发症发生率差异无统计学意义(RR=0.33,95％CI:0.05,2.17,I2=0％,P=0.25).两组螺钉修复率差异无统计学意义(RR=0.53,95％CI:0.10,2.90,I2=0％,P=0.47).两组手术时间差异有统计学意义(MD=20.90,95％CI:5.54,36.26,I2=15％,P=0.008).两组辐射曝光时间差异有统计学意义(SMD=-1.19,95％CI:-1.63,-0.75,I2=0％,P＜0.000 01).两组螺钉与关节面的距离差异有统计学意义(SMD=-1.15,95％CI:0.79,1.51,I2=16％,P＜0.000 01).结论 与常规徒手开放方法相比,目前的证据尚不能证实机器人辅助系统在椎弓根螺钉内固定的手术精确率与并发症发生率方面存在明显优势.脊柱手术机器人辅助系统作为新技术应用于脊柱外科手术具有深入开发的潜能.     

基质金属蛋白酶-9基因多态性与脑梗死相关性的Meta分析

目的评价基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)基因-1562CT多态性与脑梗死发病的相关性。方法对2015年10月前公开发表的关于脑梗死MMP-9基因-1562CT多态性的病例对照研究进行Meta分析。结果共纳入12个病例对照研究。Meta分析结果表明,MMP-9基因-1562CT多态性与脑梗死的发病相关,具有显著的统计学意义(显性遗传模型:OR=1.29,95%CI:1.12-1.48,P0.01;隐性遗传模型:OR=2.20,95%CI:1.55-3.12,P0.01)。敏感性分析显示结果稳定。倒漏斗图及Egger回归分析提示不存在发表性偏倚。结论 MMP-9基因-1562CT多态性与脑梗死发病相关,可能是脑梗死发病的危险因素。     

延续性护理对癌症患者焦虑抑郁情绪影响的Meta分析

目的 采用Meta分析评价延续性护理对癌症患者焦虑抑郁情绪的影响效果。方法 计算机检索2013年1月1日~2018年10月1日Cochrane、PubMed、EMBASE、CIANHL、CBM、CNKI、维普和万方数据库,收集延续性护理对癌症患者焦虑抑郁情绪影响的随机对照试验。由2名研究者独立筛选文献、提取资料、质量评价,应用RevMan5.3软件对纳入的文献进行Meta分析。结果 共纳入15项随机对照研究,1347例患者;Meta分析结果显示:与常规出院护理比较,采用延续性护理能降低癌症患者焦虑评分（SMD=1.14,P＜0.05）与抑郁评分（SMD=1.24,P＜0.05）。结论 延续性护理较常规出院护理能降低癌症患者焦虑抑郁评分。本次纳入研究文献数量以及质量存在一定局限性,尚需高质量的研究进一步验证。     

rs798766 C＞T多态性与膀胱癌易感性的Meta分析

目的 对rs798766 C>T多态性与膀胱癌易感性的关联进行Meta分析.方法 在Pubmed与百度学术数据库中检索相关病例对照研究,根据纳入与排除标准进行筛选.提取研究基本情况,提取或计算T等位基因比值比ORCT+TT vs.CC及其95 %可信区间,进行Meta分析.结果 共纳入9项病例对照研究,涉及10 647名膀胱癌患者与53 588名健康对照.Meta分析有显著异质性(I2=75 %,P<0.1),合并结果为1.34[1.19,1.51].亚组分析结果显示,亚洲人与白人的合并结果无显著差异(χ2=0.65,P=0.42).漏斗图对称,无发表偏倚.结论 rs798766 C>T多态性增加膀胱癌易感性.     

MTRR基因G66A多态性与冠心病相关性的Meta分析

目的探讨甲硫氨酸合成酶还原酶(methionine synthase reduetase,MTRR)基因C66A多态性与冠心病易感性的相关性。方法从数据库Pub Med、Medline、CNKI及Wan Fang Data网站上检索并收集相关人群MTRR基因G66A多态性与冠心病风险的病例-对照研究,检索时限截至2017年12月。按照纳入与排除标准筛选文献、提取资料并评价纳入研究的质量后,用Stata 12.0软件进行Meta分析、发表偏倚评估和敏感性分析。结果共获得14篇相关文献,7篇纳入研究。MTRR G66A基因多态性与冠心病易感性相关研究中,共有冠心病患者1212例,对照组777例。MTRR C66A基因多态性与冠心病相关性经Meta分析结果显示在5个遗传模型中只有隐性遗传模型提示MTRR基因多态性与心血管疾病发病风险的相关性具有统计学意义。等位基因模型(G vs.A:OR=0.84,95%CI=0.925-1.210,P=0.398;Pheterogeneity=0.001,I2=72.8%);纯合子模型(GG vs.AA:OR=0.87,95%CI=0.850-1.523,P=0.385;Pheterogeneity=0.001,I2=78.1%);杂合子模型(GA vs.AA:OR=0.98,95%CI=0.861-1.115,P=0.758;Pheterogeneity=0.007,I2=66.5%);显性遗传模型(GG+GA vs.AA:OR=0.1,95%CI=0.906-1.115,P=0.923;Pheterogeneity=0.001,I2=74.2%);隐性遗传模型(GG vs.AA+GA:OR=3.02,95%CI=1.095-1.531,P=0.003;Pheterogeneity=0.102,I2=43.3%)。结论 MTRR基因G66A多态性与冠心病易感性相关,暴露因素GG可能是冠心病易感的危险因素。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.