白介素13基因+1923C/T 及+2044G/A 多态性与支气管哮喘的相关性研究

目的：探讨白细胞介素13(IL-13)基因第3内含子+1923C/T 及第4外显子+2044G/A 多态性与哮喘的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)方法,检测100例哮喘患者和100例健康人群 IL-13基因+1923C/T 及+2044G/A 位点单核苷酸多态性,分析其基因型和等位基因分布频率。结果 IL-13+1923C/T 位点基因型 CC、CT 和 TT 在哮喘组分布频率为21.0%、41.0%和38.0%,对照组为41.0%、44.0%和15.0%。IL-13+2044G/A 位点基因型 GG、GA 和 AA 在哮喘组分布频率为51.0%、39.0%和10.0%,对照组为70.0%、25.0%和5.0%。IL-13+1923C/T 和+2044G/A 位点各基因型分布在两组间差异有统计学意义(χ2=16.54,P <0.01;χ2=7.71,P <0.05)。结论 IL-13基因+1923C/T 和+2044G/A 多态性与哮喘易感性相关,携带+1923T 或+2044A 等位基因的个体患哮喘的风险更大。     

鼻咽癌患者乙醛脱氢酶2基因G1510A突变及酶活性研究

目的研究乙醛脱氢酶2(ALDH2)基因第12外显子G1510A遗传多态性及ALDH活性与鼻咽癌(NPC)的关系。方法研究对象包括70例NPC患者和86例健康对照者。采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术结合琼脂糖凝胶电泳,研究受试者ALDH2基因G1510A多态性位点的基因型与等位基因分布;采用比色法测定研究对象血清ALDH总活性水平。结果病例组AA、GA和GG基因型频率分别为24.29%、30.00%和45.71%,A和G等位基因频率分别为39.29%和60.71%;对照组AA、GA和GG基因型频率分别为12.79%、25.58%和61.63%,A和G等位基因频率分别为25.58%和74.42%。病例组A等位基因频率高于对照组[相对危险度(OR)=1.88,95%可信区间(95%CI)=1.16～3.05,P<0.05],与GG基因型比较,AA和GA基因型NPC患病风险增加。在病例组与对照组之间,ALDH总活性无明显差异。结论 ALDH2基因G1510A变异可能与NPC患病风险存在相关性,有待加大样本量作进一步研究。     

白细胞介素17基因启动子区多态性与儿童哮喘易感性的相关性

【目的】探讨白细胞介素17(interleukin-17,IL-17)基因启动子区多态性与儿童支气管哮喘易感的相关性。【方法】选择128例小儿支气管哮喘患儿为哮喘组,158例健康儿童为对照组,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测白细胞介素17基因启动子区-152 G/A 多态性,分析其与儿童支气管哮喘易感的相关性。【结果】哮喘组 IL-17基因启动子区-152A 等位基因频率为50.8%,显著高于对照组42%,差异有统计学意义(P =0.038);哮喘组与对照组之间的 GG、GA 和 AA 等位基因型的分布差异有统计学意义(χ2=7.236,P <0.05),其中 AA 等位基因型在哮喘组中的频率显著高于对照组(29.7% vs 15.2%,P =0.023;OR=2.16,95% CI=1.11~4.2)。【结论】IL-17基因启动子区-152 G/A 多态性和儿童哮喘易感性之间具有相关性。     

IL-17基因多态性与支气管哮喘患儿血清TIgE、ECP的关系分析

目的分析白细胞介素(IL)-17基因多态性与支气管哮喘患儿血清总IgE(TIgE)、嗜酸性粒细胞阳离子蛋白(ECP)的关系。方法将该院2018年1—12月收治的60例哮喘患儿设为哮喘组,同期于该院行健康体检的60例健康儿童设为对照组,采用PCR-限制性片段长度多态性分析法检测2组IL-17基因多态性,采用免疫比浊法、酶联免疫吸附试验法分别检测其血清TIgE、ECP水平,比较2组IL-17基因多态性、TIgE和ECP水平及不同基因型、不同等位基因型患儿血清TIgE、ECP水平。结果哮喘组中IL-17A-152G/A位点中AA型基因频数频率、A等位基因频数频率,IL-17F 7488T/C位点中TT型基因频数频率、T等位基因频数频率,血清TIgE、ECP水平均显著高于对照组(P<0.05)。哮喘组IL-17A-152G/A位点AA型基因血清TIgE显著高于AG、GG型(P<0.05)。IL-17A-152G/A位点A等位基因携带患儿血清TIgE显著高于非A等位基因携带患儿(P<0.05)。哮喘组IL-17F 7488T/C位点不同基因型、等位基因携带者间血清TIgE、ECP与对照组比较,差异无统计学意义(P>0.05)。结论IL-17A-152G/A基因多态性与哮喘易感性有关,变异等位基因A携带患儿哮喘风险更高,尤其是突变纯合子AA基因型,野生型TT纯合子与哮喘也有一定关联性;且IL-17基因多态性虽与血清ECP均无明显关联,但血清ECP在哮喘患儿中仍明显高表达。     

TLR基因多态性与颅内动脉瘤发病相关性研究

目的 研究Toll样受体(TLR)相关基因rs121917864和rs37752902多态性与颅内动脉瘤(IA)发生之间的关系。方法 回顾性选择滨州市人民医院2018年12月至2020年12月收治的240例IA患者作为观察组,180名健康正常人群作为对照组。通过qRT-PCR检测对比IA患者及健康人群外周血中rs121917864和rs37752902基因分型及等位基因表达变化水平。结果 观察组TLR2基因rs121917864位点GG和AG基因型频率分别为72.50%和27.50%,A、G等位基因频率分别为13.75%和86.25%,对照组GG和AG基因型频率分别为67.00%和33.00%,A、G等位基因频率分别为17.00%和83.00%,基因型频率和等位基因频率差异均无统计学意义(P>0.05)。观察组TLR3基因rs37752902位点GG、AG和AA的基因型频率分别为10.00%、50.00%和40.00%,A、G等位基因频率分别为65.00%和35.00%,对照组GG、AG和AA基因型频率分别为5.00%、39.00%和56.00%,A、G等位基因频率分别为75.0...     

脑梗死与对氧磷酶1基因192G/A位点多态性的关系

目的:评估脑梗死患者对氧磷酶1(paraoxonase 1,PON1)的基因192G/A多态性与脑梗死间的关系。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法分析295例脑梗死患者(脑梗死组)及117名正常对照者(对照组)的PON1基因192G/A多态性。结果:PON1基因192G/A多态性在对照组和脑梗死组中的GG型、GA型和AA型基因型分布分别为36.75%、50.43%、12.82%和28.14%、50.85%、21.02%。G、A等位基因分布在对照组和脑梗死组中分别为61.97%、38.03%和53.56%、46.44%。经检验,PON1基因192G/A位点基因型频率在2组人群中的分布差异无统计学意义(P>0.05),而等位基因频率在2组人群中的分布差异有统计学意义(P     

湖北汉族人群RBP4基因多态性803G/A位点与T2DM的相关性研究

目的 调查湖北汉族人群中的视黄醇结合蛋白4(RBP4)基因多态性(-803G/A位点)分布情况,并探讨RBP4基因多态性(-803G/A位点)与2型糖尿病(T2DM)的相关性.方法 应用基因测序技术对湖北128例T2DM患者和131例正常人RBP4基因-803G/A位点进行研究,同时结合血糖、血脂水平来探讨两者之间的关系.结果 T2DM组中基因型分布为:GG型40.5%,AG+AA型59.5%;对照组中分布为:GG型62.3%,AG+AA型37.7%.T2DM组中等位基因频率A和G分别为36.2%和63.8%;对照组中分别为18.7%和81.3%.T2DM患者AA基因型频率和A等位基因频率均明显高于正常对照组(P＜0.05).与对照组比较,T2DM组中GG基因型血清TG与 Lp(a)水平差异均有统计学显著性意义(P＜0.01);AG基因型血清 Lp(a)水平差异有统计学显著性意义(P＜0.01).结论 湖北汉族人群中的RBP4基因-803G/A多态性可能与T2DM的发生相关.     

痛风性关节炎患者血清 IL-1β，TNF-ɑ，hs-CRP水平及与 IL-1β基因启动子区 rs2853550 A/G位点多态性相关性分析

目的　分析深圳地区痛风性关节炎（ gouty arthritis,GA）患者血清白细胞介素 -1β（interleukin-1β,IL-1β）、肿瘤坏死因子（ tumor necrosis factor,TNF-ɑ）、超敏 -C反应蛋白（ hypersensitive C-reactive protein,hs-CRP）水平及与 IL-1β基因启动子区 rs2853550 A/G位点多态性相关性。方法　收集 GA确诊患者 216例作为 GA组,同时选取 153例健康体检人群作为对照组。分别检测血清 IL-1β,TNF-ɑ及 hs-CRP水平,同时检测 IL-1β基因 rs2853550 A/G多态性。结果　GA组 IL-1β,TNF-ɑ及 hs-CRP水平分别为 5.16±1.02pg/ml,21.84±6.49pg/ml和 17.03±5.61mg/L,明显高于对照组（ 3.94±0.87pg/ml,3.50±1.16pg/ml及 2.14±0.73mg/L）,差异均有统计学意义（ t=4.217 3,20.510 4,23.274 5,均 P<0.05）。GA组 IL-1β基因 rs2853550 A/G位点 GG基因型和 G等位基因频率（ 75.93%和 83.56%）明显高于对照组（ 51.63%和 60.13%）,差异有统计学意义（ χ2=5.641 9,5.037 2,均 P<0.05）。GG基因型和 G等位基因患 GA的相对风险明显增加（ OR=7.092,95%CI:5.681~10.526和 OR=5.914,95％ CI:3.514～ 8.029）,而 AA基因型和 A等位基因患 GA的相对风险明显降低（ OR=0.731,95%CI:0.576～ 0.918和 OR=0.584,95％ CI:0.437~0.753）。GA组 GG基因型 IL-1β水平（5.42±1.12pg/ml）明显高于 GA基因型（ 4.51±0.67pg/ml）,而 GA基因型明显高于 AA基因型（ 4.04±0.29pg/ml）,不同基因型之间差异有统计学意义（ F=8.019 5,P=0.023 6）。经 Spearman相关性分析, GA组 IL-1β与 TNF-ɑ,hs-CRP水平呈正相关（ r=0.790 1,0.684 7,均 P<0.05）。结论　GA患者 IL-1β,TNF-ɑ及 hs-CRP水平明显升高,且存在一定相关性。同时 IL-1β基因启动子区 rs2853550 A/G位点呈多态性,其中 GG基因型可能与 GA发病具有一定的相关性。     

半胱氨酸蛋白酶抑制剂C基因G 73A位点的多态性与急性心肌梗死关系的探讨

目的探讨半胱氨酸蛋白酶抑制剂C（Cys C）基因外显子＋73G/A（简称G73A）位点变异与急性心肌梗死（AMI）的关系;同时观察池州地区汉族AMI患者血浆Cys C浓度的变化。方法采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）法分析112例AMI患者和110名健康对照者全血DNA中Cys C基因G73A位点变异的多态性分布情况,同时检测AMI组和对照组血浆Cys C浓度。结果AMI患者血浆Cys C浓度明显低于对照组（P〈0.05）。在AMI患者组中,G73A位点GG/GA/AA基因型频率分别为64.3%、28.6%和7.1%,G等位基因频率为78.6%;对照组G73A位点GG/GA/AA基因型频率分别为67.3%、28.3%和4.5%,G等位基因频率为81.4%,2组比较差异无统计学意义（P〉0.05）。结论Cys C水平的降低可能是AMI发病的危险因素之一;池州地区汉族AMI患者和正常人群中存在Cys C基因G73A位点变异的多态性,这个位点发生变异可能对AMI疾病的的发生不起主要作用。     

Cyclin D1基因多态性和儿童急性淋巴细胞性白血病相关性研究

目的 探讨细胞周期素 D1(Cyclin D1)基因A870G多态性和儿童急性淋巴细胞白血病之间的相关性.方法 应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)检测118例急性淋巴细胞白血病患儿(实验组)和160例健康儿童(对照组)的Cyclin D1 A870G基因型,比较两组基因型频率和等位基因频率.结果 实验组基因型频率为AA型30.51%、AG型50%、GG型19.49%,对照组基因型频率为AA型20.63%、Aa型47.5%、GG型31.67%,差异均有统计学意义(P<0.05).实验组等位基因A、G的分布频率依次为55.51%、44.49%,对照组等位基因A、G的分布频率依次为44.38%、55.62%,差异均有统计学意义(P<0.05).B细胞型患儿基因型频率为AA型50%、AG型41.67%、GG型8.33%,T细胞型患儿基因型频率为AA型25.53%、AG型52.13%、GG型22.34%,差异有统计学意义(P<0.05).结论 Cyclin D1基因A870G位点多态性与儿童急性淋巴细胞白血病发病的易感性存在相关性.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.