MOTSA 和MTC MRA 对脑动静脉畸形的诊断价值

目的 分析脑ＡＶＭ的３Ｄ－ＴＯＦ ＭＲＡ结合ＭＯＴＳＡ（ｍｕｌｔｉｐｌｅ ｏｖｅｒｌａｐｐｉｎｇ ｔｈｉｎ ｓｌａｂ ａｃｑｕｉｓｉｔｉｏｎ）和ＭＴＣ（ｍａｇｎｅｔｉｚａｔｉｏｎ ｔｒａｎｓｆｅｒ ｃｏｎｔｒａｓｔ）的表现。探讨其诊断价值。方法 使用ＧＥｓｉｇｎａ ｅｃｈｏ ｓｐｅｅｄ １．５Ｔ超导ＭＲ机对１２０例ＡＶＭ患者分别行ＳＥ序列ＭＲＩ,３Ｄ－ＴＯＦＭＲＡ结合ＭＯＴＳＡ和ＭＴＣ检查。结果     

hGM-CSF基因在哺乳动物细胞中稳定转染表达质粒的构建和鉴定

目的：获得具有天然糖基化结构的重组人粒细胞巨噬细胞集落刺激因子（ｒｈＧＭ－ＣＳＦ）。方法：采用含ｓＲα启动子和新霉素抗性基因的真核细胞表达载体ｐＭＥｎｅｏ，接上ＸｈｏＩ接头，与ＸｈｏＩ酶切ｈＧＭ－ＣＳＦｃＤＮＡ片段连接，构建了可在哺乳动物细胞中稳定表达的ｐＭＥｎｅｏ－ｈＧＭ－ＣＳＦ质粒。结果：２２个ｐＭＥｎｅｏ重构载体克隆中，８个含有ｈＧＭ－ＣＳＦｃＤＮＡ片段，酶切鉴定插入方向为５个顺式，１个顺式串珠，２个反式。结论：将上述各式以ＤＥＡＥ法转染ＣＯＳ细胞，瞬时表达鉴定，用ＴＦ１细胞ＭＴＴ法测定培养液上清的ｈＧＭ－ＣＳＦ活性，顺式和顺式串珠培养上清活性为１×（１０３～１０４）Ｕ／ｍｌ，反式插入方向培养上清没有活性     

严重型再生障碍性贫血患者骨髓和外周血 HLA-DR~ T 细胞的变化及其淋巴细胞造血抑制活性的研究

目的：进一步阐明免疫紊乱在严重型再生障碍性贫血（ＳＡＡ）发病中的作用。方法：对１３例初诊ＳＡＡ、７例抗淋巴细胞球蛋白（ＡＬＧ）治疗后恢复期ＳＡＡ（ｒＳＡＡ）患者骨髓和外周血及对照组（包括９名骨髓对照和１１名外周血对照）的ＨＬＡ－ＤＲ＋Ｔ细胞进行检测，并对部分患者和对照组刺激的外周血去单核细胞的单个核细胞培养上清液（ＰＨＡ－ＬＹＣＭｓ）的造血活性进行检测。结果：初诊ＳＡＡ患者骨髓及外周血ＨＬＡ－ＤＲ＋Ｔ细胞显著高于对照组（Ｐ＜０．００１）；ＡＬＧ治疗后ｒＳＡＡ患者骨髓和外周血ＨＬＡ－ＤＲ＋Ｔ细胞较初诊ＳＡＡ下降，但仍高于对照组（Ｐ＜０．００１）；ＳＡＡ患者骨髓内ＨＬＡ－ＤＲ＋Ｔ细胞显著高于外周血（Ｐ＜０．００１）；与对照组比较，初诊的ＳＡＡ患者外周血ＰＨＡ－ＬＹＣＭｓ对正常骨髓ＢＦＵ－Ｅ和ＣＦＵ－ＧＭ具有显著的抑制作用（Ｐ＜０．００１），而ＡＬＧ治疗后ｒＳＡＡ患者ＰＨＡ－ＬＹＣＭｓ对正常骨髓ＢＦＵ－Ｅ和ＣＦＵ－ＧＭ的抑制作用明显减弱。结论：ＨＬＡ－ＤＲ＋Ｔ细胞在ＳＡＡ的发病中可能发挥重要的作用。     

载脂蛋白E PCR—RFLP分型的建立和评价

采用聚合酶链反应－限制性片段长度的多态性（ｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ－ｒｅｓｔｒｉｃｔｉｏｎｆｒａｇｍｅｎｔｌｅｎｇｈｔｐｏｌｙｍｏｒｐｈｉｓｍ，ＰＣＲ－ＲＦＬＰ）分析ａｐｏＥ的多态性，通过在引物５′端增加一段寡核苷酸，降低了扩增用二甲基亚砜（ＤＭＳＯ）的浓度，高效地扩增目标基因。运用限制性内切酶ＨｈａＩ内切编码精氨酸的核苷酸顺序ＧＣＧＣ，不能切割编码半胱氨酸的核苷酸顺序ＧＴＧ     

耐甲氧西林葡萄球菌四种检测方法的比较及临床应用

用ｍｅｃＡ基因检测法、琼脂筛选法、Ｅ试验和Ｋ－Ｂ纸片扩散法检测１００株临床分离的葡萄球菌甲氧西林耐药株（ＭＲＳ）,比较其阳性检出率,对其可靠性和临床实用性进行评估,结果：凡ｍｅｃＡ阳性葡萄球菌（６９／１００）其琼脂筛选法均为阳性,其中６７株苯唑西林ＭＩＣ大于４μｇ／ｍｌ,２株凝固酶阴性葡萄球菌（ＣＮＳ）为２μｇ／ｍｌ。在琼脂筛选法显示耐药的菌株（７３／１００）中,４株为ｍｅｃＡ阴性,且均检出β－内     

脑卒中患者转化生长因子与细胞黏附因子检测及分析

中华内科杂志，２０００，３９（５）：３０９－３１１． 对脑卒中患者（脑出血３０例，脑血栓３０例，男、女患者各占一半，年龄５７岁至７０岁）进行外周血转化生长因子（ＴＧＦ－β１）和细胞黏附因子（ｓＩＣＡＭ－１）水平的测定并对其进行分析，并以３０名健康献血员作为对照。结果脑出血患者外周血ＴＧＦ－β１民的水平为（１７±２）μｇ／Ｌ，对照组为（３７±５）μｇ／Ｌ（Ｐ＜０．０１），而ｓＩＣＡＭ－１水平分别为（５４７±８０）μｇ／Ｌ和（２４８±５４）μｇ／Ｌ（Ｐ＜０．０１）；脑血栓患者外周血ＴＧＦ－β１水平为…     

荧光信号引物PCR定量测定血清HCV—RNA的实验室评价

目的对Ａｍｐｌｉｓｅｎｓｏｒ荧光标记ＨＣＶ定量ＰＣＲ方法进行实验室考核。方法２８例抗ＨＣＶ（＋）、定性ＰＣＲ（＋）的血清标本，用于重复性测定；２０例健康人血清用于正常值测定；５例定性ＰＣＲ（＋）和５例定性ＰＣＲ（－）标本用于Ａｍｐｌｉｓｅｍｓｏｒ和ｂｒａｎｃｈ－ＤＮＡ两种方法的比较。结果孔间变异系数（ＣＶ）为 ２０．６％，操作者间ＣＶ为 ４３．８％，批内 ＣＶ为 ６１．９％，批间ＣＶ为８５．１％。２０例健康人血清测定值均小于最小检测浓度，即１０２拷贝／ｍｌ。用Ａｍｐｌｉｓｅｎｓｏｒ和ｂｒａｎｃｈ－ＤＮＡ两种方法对５ 例定性ＰＣＲ（－）标本测定，Ａｍｐｌｉｓｅｎｓｏｒ和ｂｒａｎｃｈ－ＤＮＡ均为阴性；对５ Ｎ定性ＰＣＲ（＋）标本测定，Ａｍｐｌｉｓｅｎｓｏｒ均为阳性，ＨＣＶ－ＲＮＡ的浓度为 ２． ５ × １０５拷贝 ／ｍｌ～ １． ７ ×１０６拷贝 ／ｍｌ， ｂｒａｎｃｈ－ＤＮＡ方法有 ２例未能检出。结论 Ａｍｐｌｉｓｅｎｓｏｒ ＨＣＶ定量 ＰＣＲ方法特异性和灵敏度均好，可用于临床疾病的研究和抗病毒药物疗效的评估。由于批内、批间变异系数较大，试验与操作均应严格规范。     

一种新的NADH-细胞色素b5还原酶基因点突变

目的　为了查明中国人遗传性高铁血红蛋白血症（ＲＣＭ） 患者的ＮＡＤＨ细胞色素ｂ５ 还原酶（ｂ５Ｒ） 基因突变类型,探讨ＲＣＭ 发生的分子机制。方法　从已报道的１ 例ＲＣＭⅠ型患者的外周血白细胞中提取ＲＮＡ,应用逆转录聚合酶链反应法（ＲＴＰＣＲ） 扩增了ｂ５ＲｃＤＮＡ（９２１ ｂｐ）,测定其ｂ５ＲｃＤＮＡ的全部编码序列。结果　ｂ５ＲｃＤＮＡ基因的第２０３ 位密码子存在（ＴＧＣ→ＴＡＣ）Ｃｙｓ→Ｔｙｒ 的错义突变。经基因组ＰＣＲ限制性片段长度多态性（ＲＦＬＰ） 分析证实该突变并非ＰＣＲ过程中的错配。结论　Ｃｙｓ２０３ →Ｔｙｒ 是ＲＣＭ 的一种新的基因突变类型     

JAKs—STATs信号传导途径与白血病

在急性非淋巴细胞白血病（ＡＮＬＬ）中，不同类型均可见ＪＡＫｓ和ＳＴＡＴｓ表达，但表达及活化种类不同，多未达成共识。急性淋巴细胞白血病（ＡＬＬ）中也有ＪＡＫｓ及ＳＴＡＴｓ表达及活化；慢性髓系白血病（ＣＭＬ）存在ＪＡＫ２的表达及ＳＴＡＴ５的活化，ＳＴＡＴｓ活化可能与ＣＭＬ发生密切相关。ＡＧ－４９０为ＪＡＫ激酶抑制剂，在体内外均可选择性阻断白血病细胞生长和诱导细胞程序死亡，对正常造血无影响。ＪＡＫｓ－Ｓ     

根据对危险的评估制定环氧乙烷残留量限度

根据对危险的评估制定环氧乙烷残留量限度［Ｐａｇｅ，ＥＦＪ．ＨｅａｌｔｈＩｎｄｕｓｔｒｙＭａｎｕｆａｃｔｕｒｅｓＡｓｓｏｃｉａｔｉｏｎ，Ｕ．Ｓ．Ａ．］国际标准组织（ＩＳＯ）的１９４技术委员会第１１工作组（ＴＣＩ９４／ＷＧ１１）已制定出环氧乙烷残留量国际...     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.