中华骨髓库造血干细胞捐献志愿者HLA基因分型中模棱两可结果解决方案的探讨

目的 探讨中华骨髓库造血干细胞捐献志愿者HLA基因分型中模棱两可结果的解决方案。方法 采用聚合酶链式反应(PCR)-测序分型技术(SBT)对20621名中华骨髓库供者的HLA-A、B、DRB1基因进行高分辨分型，并对其中的模棱两可分型结果进行精确分型。根据精确分型后的HLA等位基因频率计算模棱两可结果中真基因型的相...     

中国人群人类白细胞抗原A、B和DRB1基因测序分型中模棱两可等位基因的鉴别

背景:人类白细胞抗原基因测序分型中,当某些等位基因间的差异碱基位于测序范围外时,无法得到清晰的等位基因结果.目的:分析中国人群人类白细胞抗原A,B,DRB1基因测序分型中模棱两可等位基因的分布规律,探讨其在中华骨髓库大样本人类自细胞抗原A、B、DRB1基因的测序分型中的解决方案.设计、时间及地点:采用随机抽样方法对研究样本进行人类白细胞抗原A、B、DRB1基因的测序分型,并对其中的模棱两可等位基因进行验证性实验,于2006-01/2008-06在深圳市血液中心完成.材料:658名深圳骨髓库汉族供者乙二胺四乙酸盐抗凝血5 mL.方法:采用聚合酶链式反应-测序分型方法对658名深圳骨髓库供者的人类白细胞抗原A、B和DRB1基因进行高分辨分型,并采用针对相应位点的高分辨聚合酶链式反应-序列特异性引物方法对其中由于碱基差异位于检测区外而产生的模棱两可等位基因进行鉴别.主要观察指标:模棱两可等位基因的分布及确认.结果:658份标本中,人类白细胞抗原A、B和DRB1三个基因座的模棱两可等位基因分别为9个(2种)、140个(5种)、406个(8种),占等位基因总数的14.06%(565/3 948).高分辨聚合酶链式反应-序列特异性引物鉴定结果显示,中国报道的DRB1*1401被全部确认为DRB1*1454;12例B*0705/B*0706中,有1例被确认为B*0706,其他13种等位基因的鉴定结果分别为A*6801、A*7402、B*2705、B*3501、B*4402、B*5801、DRB1*0101、DRB1*0406、DRB1*0803、DRB1*1101、DRB1*1201、DRB1*1302和DRB1*1502.结论:在中华骨髓库大样本人类白细胞抗原基因的测序分型中可以应用直接鉴别的方法区分模棱两可等位基因,但在临床移植前的高分辨确认试验中则需要采用实验方法进行精确分型.     

等位基因频率在鉴别模棱两可HLA基因型中的应用价值分析

本研究探讨采用等位基因频率直接鉴别模棱两可HLA基因型的应用价值。应用聚合酶链式反应（PCR）-测序分型方法（SBT）对658名汉族供者HLA-A、B、DRB1基因进行测序分型，并分别采用PCR-序列特异性引物法（SSP）和杂合性歧义引物分离法（HAPRs）对其中的模棱两可标本进行精确分型，进而利用等位基因频率计算真基因型的相对概率并与真实结果进行比对。结果表明：222个HLA-A，238个HLA-B和107个HLA-DRB1基因的模棱两可标本中，真基因型的相对概率高于95％的比例分别为99．5％（221／222）、95．8％（228／238）和97．7％（104／107）；与PCR—SSP和HAPRs分型结果相比，3个基因座的吻合率分别为100％（222／222）、99．6％（237／238）和99．1％（106／107），仅有B％3501／5501和DRB1＊1201／1504不同，其相对概率值分别为40．3％和2．1％。结论：在大规模供者HLA基因的PCR—SBT分型中，应用等位基因频率直接鉴别模棱两可基因型的方法不仅具有较高的准确率和可信度，而且更加经济、简便、快捷，但在移植前供、患者HLA基因的确认试验中必须慎重应用。     

杂合性歧义引物分离法在解决人类白细胞抗原基因歧义分型结果中的应用

目的 评估杂合性歧义引物分离法(HARPs)在解决中国汉族人群人类白细胞抗原(HLA)基因歧义分型结果中的应用价值,并筛选合适的HARPs引物.方法 416名南方汉族个体的HLA-A、HLA-B、HLA-DRB1基因通过PCR-测序分型(PCR-SBT)方法进行基因分型,并采用美国Atria公司的HARPs引物对其中的歧义分型标本进行附加测序分型.结果 86.3%(132/153)的HLA-A、73.9%(130/176)的HLA-B和38-1%(85/223)的HLA-DRB1歧义分型标本可以通过HARPs方法有效解决;其中48.5%(64/132)的HLA-A、80.0%(104/130)的HLA-B和100.0%(85/85)的HLA-DRB1歧义分型标本只需要1种HAPRs引物,47.7%(63/132)的HLA-A、20.0%(26/130)的HLA-B需要同时使用2种HAPRs引物;3～6种HARPs引物可以解决90%以上的歧义分型标本.结论 HARPs可作为解决中国汉族人群HIM-A、HLA-B、HLA-DRB1基因SBT歧义分型结果的常规方法.     

流式磁珠反向SSO法HLA分型结果判读影响因素及解决对策的研究

目的研究流式磁珠反向SSO法HLA-A、B、DRB1分型结果判读中出现的常见问题,并提出相应的解决策略。方法对3 219名随机抽取的深圳市无关造血干细胞供者及组织配型患者的DNA采用流式磁珠反向SSO法进行HLA-A、B、DRB1低分辨基因分型,模棱两可结果用PCR-序列特异性引物(Sequence Specific Primer,SSP)法及PCR-SBT测序方法等方法复核确认。结果3 219份样本中发现有95份(95/3 219)28种类型的模棱两可结果,其中HLA-A位点有3(3/28)种,HLA-B位点有25(25/28)种,91.6%的模棱两可结果其样本的荧光值在阳性控制线上,本研究观察到的模棱两可结果通过基因频率分析、PCR-SSP法及PCR-SBT基因测序等方法得以定型。结论建立流式磁珠反向SSO法HLA-A、B、DRB1基因分型模棱两可结果解决策略,对提高HLA数据分析的速度和分型的准确性有重要的意义。     

基于UCLA DNA交换室间质评的HLA分型策略探讨

目的探讨提高HLA分型精准性的策略。方法采用聚合酶链反应-序列特异寡核苷酸探针技术、聚合酶链反应-测序分型方法和针对组特异性的序列特异性引物扩增和杂合性模棱两可引物分离法等方法对2009-2014年288份HLA质控品进行HLA低/中/高分辨分型并回报每期结果。结果 HLA分型精准性随着分型方法及试剂的改进更新不断提高,自2011年质控品高分辨提交比例升高至60.6%-94.1%;分型方法的限制性和等位基因指定性错误是导致质控中错检漏检的常见原因。288份质控品检出的等位基因中,仅HLA-A*26∶05、B*08∶12、B*53∶10不包含在美国组织相容性和免疫遗传协会常见及确认的等位基因表2.0内,且A、B、DRB1座位分别有8、22和14个等位基因不包含在中国CWD2.0表内。结论 HLA分型方法试剂的更新换代和实验室质控水平的提升是室间质评分辨度和符合率大幅提高的根本原因。样品因地域种族差异,常呈现出中国人少见或罕见的HLA表型或单体型,ASHI及中国CWD、单体型频率、罕见等位基因频率等群体性资料和生物信息学仍是极具参考价值的数据平台。     

中国人群HLA-DRB1＊1454等位基因和HLA-DRB1第3外显子鉴定意义

目的:在中国人群中鉴定人类白细胞抗原(human leukocyte antigen,HLA)DRB11454等位基因,分析供受者HLA-DRB1第3外显子DNA序列信息对器官移植、细胞移植及人类遗传学研究的重要现实意义.方法:应用聚合酶链反应-直接测序分型方法对58例等待造血干细胞移植供受者进行人类白细胞抗原测序分型,1 268例广东地区随机健康供者采用聚合酶链式反应-序列特异寡核苷酸探针反向杂交法进行HLA-DRB1中高分辨基因分型,部分模棱两可结果采用聚合酶链式反应-序列特异引物PCR-SSPHLA-DRB14高分辨方法分型法.结果:在1 268例广东地区随机健康人群中检出HLA-DRB11403,1406,1410,1412,1418,1425和1454等位基因,HLA-DRB1401/1434/1454等位基因模棱两可结果的8例样本被确认为HLA-DRB11454等位基因,DRB11454等位基因可能是广东人群最为常见的HLA-DRB114 基因. 中国人群HLA-DRB114第3外显子存在多态性.结论:中国人群HLA-DRB11454等位基因确认了DRB1等位基因第3外显子多态性的存在,进一步明确了开展中国汉族人群及少数民族HLA-DRB1第3外显子检测的意义.     

陕西地区10165例造血干细胞捐献者HLA-A／B／DRBl座位罕见等位基因确认与分析

本研究分析陕西地区2009-2012年度10165例造血干细胞捐献者HLA-A／B／DRBl分型中罕见等位基因的检出状况。应用PCR-SBT方法对10165陕西地区造血干细胞捐献者的HLA-A／B／DRBl进行分型。结果发现,在48例捐献者中确认罕见等位基因40种,其中在15个捐献者中确认的10种等住基因虽不包含在中华骨髓库的常见及确认等位基因表（common allelesandwelldoeumemedalleles,CWD）中,但已包含在美国免疫遗传协会的常见及确认的等位基因表中,分别是：A＊02：04、B＊07：10、B＊27：09、B＊35：11、B＊44：29、DRB1＊03：04、DRB1＊08：18、DRB1＊13：05、DRB1＊13：14、DRB1＊14：11,检出2例以上的罕见等位基因包括A＊68：24、B＊35：11、B＊44：29、DRB1＊03：04、DRB1＊08：18、DRB1＊13：05。本实验室从2005-2012年发现并被世界卫生组织人类白细胞抗原因子命名委员会命名的共21例新的HIA等位基因中,有些在多个实验室的多个个体被确认,现已有HLA-A＊02：90、HLA-B＊48：14、HLA-DRB1＊01：14被列入中华骨髓库的确认及常见等位基因表。结论：在实际工作中,对于发现的新等位基因要及时上报,对确认的罕见等位基因要记录统计,保证中华骨髓库HLA基因人群分布不断累积和多态性完整,给修正中国CWD表提供依据。在参照常见及确认等位基因表进行实验分析时,对于模棱两可样本含有已确认过的罕见等位基因时要慎重取舍,以避免错检或漏检发生,保证患者尤其是携带罕见等位基因的患者最大可能的找到匹配的供者。     

中国汉族群体中异基因造血干细胞移植前人类白细胞抗原的高分辨分型

目的：通过对异基因造血干细胞移植无关供受者对的人类白细胞抗原A．B．DRB1基因的序列分析，探讨中国汉族群体中异基因造血干细胞移植前人类白细胞抗原高分辨分型的必要性。方法：实验于2000—08／2004—03在深圳市血液中心完成。供者和受者114对的血样分别来源中华骨髓库和各移植医院，供者和受者均签署知情同意书。采用聚合酶链式反应-测序分型技术对114对中国汉族无关供受者间的人类白细胞抗原-A，B，DRB1等位基因进行序列分析，观察中国汉族无关供受者对间等位基因水平的配合率、各等位基因家族的配对分布和错配分布规律。某些位点的模棱两可结果，则通过相应位点的高分辨聚合酶链式反应-序列特异性引物分型试剂进行分离并确认最后结果。结果：①高分辨与低分辨分型结果比较：114对无关供受者对中，110对人类白细胞抗原-A，B，DRB1的聚合酶链式反应-测序分型结果与低分辨（等位基因星号后两位数）DNA分型结果相吻合，4对聚合酶链式反应．测序分型结果与低分辨结果不相符。②供受者间人类白细胞抗原-A，B，DRB1高分辨配对分类结果：39％的中国汉族供受者对完全配合，但61％的供受者间存在至少一个等位基因的错配。③供受者间人类白细胞抗原-A，B，DRB1等位基因家族配对分布结果：3个座位的错配率分别为A（23％），B（10％），DRB1（17％）；A和DRB1座位的错配比较集中，A座位仅见于A＊02，A＊11和A＊24家族，DRB1座位见于DRB1＊04，DRB1＊08，DRB1＊12，DRB1＊14和DRB1＊15家族；而B座位的错配则比较分散，比较高的是B＊35，B＊48，B＊61和B＊62。④供受者间人类白细胞抗原-A，B，DRB1错配等位基因组合结果：3个座位的错配等位基因组合呈现较高的多样性，比较常见的几种组合为A＊0201／0207，A＊1101／1102．A＊0201／0206，A＊0203／0207，B＊4002／4006，DRB1＊1201／1202和DRB1＊1501／1502。结论：中国汉族异基因造血干细胞移植无关供受者对的人类白细胞抗原等位基因配合率低且其分布具有一定规律和特殊性，在移植前有必要对无关供受者对进行人类白细胞抗原高分辨分型。     

PCR—SBT法HLA基因分型模棱两可结果的判读及解决对策

目的研究PCR—SBT法HLA基因分型结果判读中出现的模棱两可问题并提出解决策略。方法对306名随机抽取的组织配型患者的DNA采用PCR-序列特异性引物（Sequence Specific Primer,SSP）低分辨方法检测,同时采用PCR—SBT法进行HLA—A,B,DRB1高分辨基因分型。PCR—SBT法模棱两可结果用PCR—SSP高分辨方法复核确认。结果所有306例检测标本的高低分辨血清学抗原一致,经PCR—SBT基因测序方法检测有111份模棱两可结果,占36．3％（111／306）。其中HLA—A座位有30对等位基因存在模棱两可结果,占所有检测标本等位基因总数的3．3％;HLA—B座位有66对,占7．2％;HLA—DRB1座位有36对,占3．9％。所有模棱两可标本经PCR—SSP HLA基因高分辨分型试剂PCR—SSP等方法复核确认。结论针对PCR—SBT法进行HLA—A,B,DRB1高分辨基因分型模棱两可结果所建立的解决策略,对于提高HLA数据分型的速度和分型准确性有重要意义。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Racial differences in oxidative stress and inflammation: in vitro and in vivo

African American race is an independent risk factor for enhanced oxidative stress and inflammation. We sought to examine whether oxidative-stress and inflammatory markers that are typically measured in humans also differ by race in cell culture. We compared levels between African American and Caucasian young adults and then separately in human umbilical vein endothelial cells (HUVECs) from both races. We found heightened oxidative stress and inflammation in the African Americans both in vitro and in vivo. African American HUVECs showed higher nitric oxide (NO) levels (10.8 ± 0.4 vs. 8.8 ± 0.7 μmol/L/mg, p = 0.03), Interleukin-6 (IL-6) levels (61.7 ± 4.2 vs. 23.9 ± 9.0 pg/mg, p = 0.02), and lower superoxide dismutase activity (15.6 ± 3.3 vs. 25.4 ± 2.8 U/mg, p = 0.04), and also higher protein expression (p < 0.05) of NADPH oxidase subunit p47phox, isoforms NOX2 and NOX4, endothelial nitric oxide synthase (NOS), inducible NOS, as well as IL-6. African American adults had higher plasma protein carbonyls (1.1 ± 0.1 vs. 0.8 ± 0.1 nmol/mg, p = 0.01) and antioxidant capacity (2.3 ± 0.2 vs. 1.1 ± 0.3 mM, p = 0.01). These preliminary translational data demonstrate a racial difference in HUVECs much like that in humans, but should be interpreted with caution given its preliminary nature. It is known that racial differences exist in how humans respond to development and progression of disease, therefore these data suggest that ethnicity of cell model may be important to consider with in vitro clinical research.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.