应用三联PCR技术产前诊断假性肥大型进行性肌营养不良的研究

目的通过对两例散发的BMD家系中的先证者和胎儿进行DMD基因和SRY基因分析,拟建立一种快速、准确、适用于临床的DMD/BMD的产前基因诊断方法。方法提取羊水细胞基因组DNA,通过检测SRY基因鉴定胎儿性别,以多重PCR方法对DMD基因缺失热区的18个外显子进行基因缺失的筛查,结合4对STR引物(内含子44、45、49、50)进行短串联重复序列多态性连锁分析(STR-PCR),分析结果经DNA测序验证。结果 SRY基因分析结果显示家系1胎儿为女性,家系2胎儿为男性,与超声诊断结果一致。两例BMD先证者均未检测到18个外显子的缺失,两家系的母亲及家系1的女性胎儿均为BMD基因STR-49位点杂合子,家系2的男性胎儿为BMD。同时发现了STR45、STR50的非常见基因型。结论应用SRY基因检测胎儿性别及多重PCR方法对DMD基因外显子缺失的检测,结合STR-PCR技术检出非缺失型携带者并行产前诊断,此三联PCR方法具有快速、简便、直观可靠的特点,特异性高,实验可操作性强,适用于临床推广应用。     

15例DMD/BMD外显子缺失与临床关系研究

目的：探讨Ｄｕｃｈｅｎｎｅ／Ｂｅｃｋｅｒ型进行性肌营养不良症（ＤＭＣ／ＢＭＤ）致病基因外显五缺失的分布特点及其与临床表现的。方法：利用９对引物以多技术，对临床诊断的ＤＭＤ／ＢＭＤ患者抗肌营养不良蛋白基因进行检测。结果：共发现１５例患者外显子缺失，主要分布在中央缺失热区和５＇端缺失热区，其中汉４５、１８号外显子缺失最多见，且缺失片段长度各异。结论：（１）外显子缺失的表达也受到个体差异的影响，呈高度的     

10个DMD/BMD家系的基因诊断及其中3个家系的产前基因诊断分析

目的：对杜氏／贝氏肌营养不良症（DMD／BMD）家系进行基因诊断和产前基因诊断。方法：抽提DMD家系成员外周血及胎儿羊水或脐静脉血全基因组DNA，采用PCR技术和聚丙稀酰胺凝胶银染法对DMD／BMD基因3端及基因内的45、50内含子的（CA）n短串联重复序列（STR）多态性进行连锁分析。 结果：结果显示，7个家系可提供遗传连锁诊断信息，完成了其中3个家系的产前基因诊断并出生了一例健康的男性婴儿；3个家系不能提供遗传连锁诊断信息。可诊断率达70％。 结论：STR多态连锁分析适用于常见缺失突变检测未发现缺失的DMD／BMD患者，是一种快速、有效、准确、易于普及的基因诊断方法，能有效地提高DMD／BMD家系基因诊断和产前基因诊断的可诊断率。     

一例假肥大型肌营养不良症患儿基因新突变报道和临床分析

目的对一例假肥大型肌营养不良（DMD/BMD）患儿发生的DMD基因突变（c.9760₉781dup22/p.Pro3261LeufsX5）进行报道,并对其临床表现进行分析。方法联合应用多重连接探针扩增技术（MLPA）和基因测序技术的方法,对DMD患儿进行DMD基因分析。结果 MLPA技术检测到患儿DMD基因67号外显子发生缺失突变,通过PCR技术、基因测序技术检测,证实患儿发生的是67号外显子的微小突变（c.9760₉781dup22/p.Pro3261LeufsX5）。结论 67号外显子的微小突变（c.9760₉781dup22/p.Pro3261LeufsX5）是一种新突变,此突变可能与DMD疾病发生及智力障碍表现相关。     

中国北方59个假肥大性肌营养不良家系中抗肌萎缩蛋白基因突变分析

目的 分析研究我国北方地区假肥大性肌营养不良[分为杜克肌营养不良(DMD)和贝克肌营养不良(BMD)]患者抗肌萎缩蛋白基因突变的类型,断裂点的分布,并为临床应用奠定基础.方法 采用多重连接探针扩增法(MLPA)检测59个来自北方地区DMD(51例)及BMD(8例)家系的男性患者及其父母的抗肌萎缩蛋白基因突变情况.结果 从59个DMD/BMD家系的59例DMD/BMD患者中,检测到33例外显子缺失,6例外显子重复和l例点突变;内含子44是最常见的断裂点(n=13,33.3%),内含子50和45为第二位(n=11,28.2%)和第三位(n=8,20.5%).并发现2例为Leiden数据库中未报道的新发突变,即D,149的2个位点的重复突变(外显子3～7和外显子44)和D165的点突变[5208del(A)].1例患者为中国人群中未见报道的外显子22缺失.19例患者用MLPA方法未检测到突变.结论 缺失突变主要发生在外显子45～50的中央热区,重复突变主要发生在基因的5'端,内含子44是中国北方人群DMD基因缺失最常见的断裂点.     

假肥大型肌营养不良症产前基因诊断的临床应用

目的 建立规范的假肥大型肌营养不良症(DMD/BMD)产前基因诊断程序。方法 利用DMD基因内18个缺失热点的PCR引物,6个DMD基因内(CA)n短重复序列(STR)引物以及性别决定基因SRY引物,多重聚合酶链反应检测羊水胎儿脱落细胞、先证者和双亲外周血有核细胞基因组DMD基因,通过胎儿性别确定、基因缺失检测和基因连锁分析确定胎儿DMD基因状态。结果 在4例先证者基因缺失家系的产前诊断中,2例男胎DMD基因缺失与先证者相同,1例女胎为基因缺失携带者,1例男胎未发现缺失;在4例有2个或2个以上患者又先证者未检出缺失的家系产前诊断中,发现获得风险染色体的男胎与女胎各1例,余1例女胎和1例男胎均未携带风险染色体。检测结果的可靠性经流产胚胎和已出生胎儿DNA分析、DMD临床症状监测得到部分证实。结论 胎儿性别基因诊断、DMD基因缺失检测结合基因连锁分析的方法,在严格控制检测范围、规范的检测程序和有效的质量控制下,能准确地对DMD／BMD进行产前基因诊断,是目前预防患儿出生最有效的实验室检测方法之一。     

DNA微阵列对进行性肌营养不良基因缺失检测的分析

背景：目前对Duchenne型肌营养不良(DMD)基因缺失的检测主要是Southem印迹或聚合酶链反应(PCR)的方法，在实际应用中有一定的局限性。DNA微阵列技术已广泛应用于基因突变的检测。目的：制备简易DNA微阵列检测DMD基因常见外显子缺失，作为一项新技术的方法学摸索，为开发更完善的DMD基因诊断芯片做准备。设计t非随机对照研究。地点和对象：5例患来自2000-01／2001—12解放军第四军医大学西京医院神经内科门诊，所有患均为男性。健康为患的父亲。方法：应用分子克隆的方法扩增DMD基因18个常见易缺失外显子片段，以此作为探针制备出简易DNA微阵列，对DMD患和健康对照的基因进行检测分析。主要观察指标：微阵列杂交结果；PCR结果。结果：应用简易DNA微阵列检测出4例DMD患具有不同程度的外显子缺失，其结果与PCR验证相符，对照满意。结论：DNA微阵列技术适用于DMD基因缺失检测，具有简便、高通量、灵敏等特点。     

MLPA技术对Duchenne肌营养不良症患者基因外显子缺失和重复的诊断价值

目的使用多重连接依赖探针扩增技术对Duchenne肌营养不良症和Becker肌营养不良症家系成员的DMD基因进行外显子缺失和重复检测,探讨多重连接依赖探针扩增技术对Duchenne肌营养不良症患者和Becker肌营养不良症患者的诊断价值。方法应用多重连接依赖探针扩增技术检测1个Duchenne肌营养不良症家系成员和1个Becker肌营养不良症家系成员DMD基因的全部外显子缺失和重复,对家系成员进行基因诊断。结果 Duchenne肌营养不良症家系患者是DMD基因外显子45~50缺失所致,Becker肌营养不良症家系患者是外显子3~4重复所致。两个家系中的患者致病基因携带者均得到明确诊断。结论在规范操作的条件下,多重连接依赖探针扩增技术检测的探针拷贝数可预示DMD基因的外显子缺失和重复,因此多重连接依赖探针扩增技术可作为临床对DMD基因外显子缺失和重复的首选检测方法。     

中国人DMD基因缺失检测多重PCR新体系的建立

目的 建立新的适合中国人DMD特征的多重PCR体系,提高缺失突变的检出率.方法 对经"一步到位"诊断程序和MLPA分析确定的355例缺失型DMD患者的缺失突变谱进行归纳总结,筛选出缺失高发的外显子区域,挑选代表性外显子,组装成扩增体系,优化多重PCR条件.结果 经过对355例缺失型DMD患者的突变谱分析后,总结出两套新的多重PCR体系.第一套检测体系分两组,检测10个外显子(外显子5、8、17、44.45、47、49、50、51和52),可检出92%(326/355)的缺失;第二套检测体系检测另外5个外显子(外显子12、19、35、43和54),可进一步检测到5%(17/355)的缺失.在后续22例DMD患者的检测验证中,所有患者的多重PCR结果均与MLPA结果吻合.结论 这两套新体系是在对355例中国缺失型DMD患者的缺失分析的基础上归纳而成,所涉及的DMD病例来源遍布全国,更适合于中国人群DMD患者缺失突变的检测.     

15例疑似假肥大性肌营养不良患儿遗传学分析

目的 分析进行性假肥大性肌营养不良（DMD）患儿的临床特点和基因变异情况,为临床诊断、治疗和遗传咨询提供参考。方法 对2019年7月—2021年7月河南科技大学第一附属医院15例疑似假肥大性肌营养不良患儿的临床特征进行回顾性分析,并采用多重连接探针扩增技术（MLPA）和全外显子组测序（WES）分析患儿的基因变异特点。对变异位点进行生物信息学分析。结果 15例患儿中,有14例存在DMD基因变异,其中12例为外显子区域大片段缺失,2例为点突变[c.2168+1G>T和c.9917＿9923del(p.Thr3306Serfs*22)]。检测到的DMD基因大片段缺失共涉及11个不同的区域,其中8个可引起抗肌萎缩蛋白可读框移码,2个可引起阅读框内整码缺失,1个缺失变异覆盖整个DMD基因。14例DMD基因变异患儿均有酶学异常增高、肌源性损伤等特征,被确诊为DMD。1例未检测到DMD基因变异的患儿存在LAMA2基因复合杂合变异[c.819+1G>A和c.1884G>A(p.Glu628Glu)],被诊断为肢带型肌营养不良（LGMD）。结论 临床需注意DMD、贝克肌营养不良（BMD...     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.