不同消化性疾病患者幽门螺杆菌毒力基因类型及意义研究

目的分析用不同消化性疾病来源的幽门螺杆菌(Hp)毒力基因的检测结果及其意义。方法收集该院胃镜室于2015年1月至2016年7月采集的628例患者胃活检标本,分离培养Hp,检测其携带的毒力基因,并探讨Hp与慢性萎缩性胃炎(CAG)、慢性浅表性胃炎(CSG)、消化性溃疡(PUD)的相关性。结果 628份胃活检标本中成功分离出214株Hp,选取其中172株提取DNA,发现Hp携带cagA、vacA、dupA、iceA、oipA、luxS多种毒力基因,其中vacA s1m1是CSG的危险因素,vacA s1m2与iceA1+/iceA2+提高PUD的发生率,dupA+提高十二指肠溃疡危险度。结论不同消化性疾病与Hp感染密切相关,dupA可考虑作为Hp致十二指肠溃疡的标记基因,vacA s1m2与iceA1+/iceA2+增加了发生PUD的危险性。     

小儿幽门螺杆菌cagA基因变异性探讨

本研究应用 3对不同引物 ,通过聚合酶链反应 (PCR)技术扩增具有细胞毒素相关基因 (cagA基因 )DNA ,检测浙江地区儿童感染幽门螺杆菌 (Hp)cagA基因阳性 (cagA+ )菌株阳性率 ,探讨cagA基因的变异性及其CagA蛋白表达情况。一、材料与方法1 研究对象 :2 0 0 0年 12月～ 2 0 0 1年 5月间经胃镜检查、组织活检证实为Hp感染患儿 5 0例 ,男 31例 ,女 19例 ,平均年龄 9岁 (范围 4～ 15岁 )。2 胃粘膜标本 :取距幽门孔 3cm内胃窦粘膜 3～ 4块 ,分别进行病理切片 ;快速尿素酶 (福建三强生物制品公司试剂 )试验 (RUT) ;荧光定量PCR检测HpUreA…     

PCR扩增16S rRNA基因检测幽门螺杆菌的特异性研究

为了评估 PCR扩增 1 6S r RNA基因检测幽门螺杆菌的特异性 ,对 Hp和非 Hp临床分离菌株、胃活检组织、胃黏液、大便、淋巴细胞及其它非胃组织进行了 Hp的检测。 49株 Hp均出现 1 0 9bp特异扩增条带 ,而 7株非 Hp菌株为阴性 ;77份胃活检组织中 ,细菌培养阳性 48份 ,PCR阳性 50份 ;550份吞线取样的胃黏液标本 PCR扩增 Hp阳性 2 61份 (47.5% ) ;2 0份淋巴细胞、2 0份大便、5份乳房组织、4份肌肉组织、7份肺组织、2份脾组织和 3份肝组织标本 ,PCR扩增均阴性。结果显示 ,PCR法扩增 1 6S r RNA基因有较高的特异性 ,可用于临床标本 Hp的检测。     

聚合酶链反应(PCR)检测幽门螺杆菌cag A基因

目的　探讨应用PCR直接测定胃粘膜标本中幽门螺杆菌cagA基因。方法　不需细菌培养 ,直接从胃粘膜标本中提取幽门螺杆菌DNA ,选择合适的引物及条件进行PCR ,通过琼脂糖电泳来确定标本中的cagA基因。结果　每例cagA阳性的标本在 191bp的位置有一条清晰的电泳带。 19例胃溃疡患者中cagA阳性 16例 ,阴性 3例。 15例健康人血清对照 ,cagA阳性 3例 ,阴性 12例。该法敏感性 84 .2 % ,特异性 80 %。同时进行快速尿素酶实验 ,发现 17例阳性标本中PCR方法 16例阳性 (94 .1% ) ,2例快速尿素酶实验阴性标本PCR阴性。二者没有显著差异 (χ2 =0 ,P >0 .0 5 )。结论　应用PCR直接测定胃粘膜标本中幽门螺杆菌cagA基因方法简单 ,快速 ,灵敏度和特异性较高。     

幽门螺杆菌感染与慢性胃病关系的检测分析

目的：了解消化性溃疡和慢性胃炎患者感染的幽门螺杆菌（Hp）cagA／vacA优势基因型及不同基因型Hp感染、混合感染与疾病的关系。方法：选择胃窦、胃体双份活检标本均培养出Hp的42例慢性胃炎（CG）和36例消化性溃疡（PU）患者作为研究对象，采用聚合酶链反应检测156份Hp分离株的cagA基因、vacA基因的信号区（s）和中间区（m）亚型，分析Hp基因型及多株Hp混合感染在CG和PU中的分布。部分优势基因型的扩增产物T—A克隆后进行核苷酸序列测定。结果：cagA基因的检测中，78例病人的胃窦标本中有？5例（96．2％）为cagA阳性，相应的胃体标本中，76例（97．4％）为cagA阳性，有1例（1．3％）患者胃窦、胃体检出cagA状态不一的Hp混合菌株。在胃窦标本的vacA基因分型中，sla／ml、sla／m2、sla／mlb、sla／mib—m．24种vacA基因型在78例患者中所占比例分别为6．4％（5／78）、55．1％（43／78）、26．9％（21／78）和1．3％（1／78），多株混合感染为3．8％（3／78）；而相应的胃体标本中，前述四种vacA基因型所占比例依次为6．4％（5／78）、53．8％（42／78）、25．6％（20／78）和3．8％（3／78），多株混合感染为5．1％（4／78）。c8gA＋sla／m2和cagA＋sla／mlb在胃窦标本中占51．3％（40／78）和26．9％（21／78），而在相应的胃体标本中占52．6％（41／78）和25．6％（20／78）。少量胃窦、胃体标本中vacA基因8区和m区不能分型，未发现8lb、82和mla型。联合胃窦、冒体标本分析，16例（20．5％）患者中检出不同基因型的多株Hp菌株，同一胃内多部位采样比单部位采样者有更高的混合感染检出率。HpcagA基因、vaeA基因型、cagA／vaeA基因组合及不同基因型菌株混合感染在CG和PU中的分布差异均无显著性（P〉0．05）。6株8h型Hp菌株的8区扩增产物与报道的ala型60190株核苷酸序列同源性为93．15—94．86％，4株n正型Hp菌株的m区扩增产物与报道的m2型87～203株核苷酸序列之间同源性为93．63—97．61％。结论：cagA＋sla／m2是本地区慢性胃炎或消化性溃疡中最主要的Hp菌株的优势基因型，其次为cagA＋sla／mlb，部分vacAsla／m2型优势分布菌株其核苷酸序列与国外报道的参考菌株比较有较高的同源性，部分患者同时感染不同基因型的多株Hp，但均与所致疾病类型和严重程度无密切相关。     

PC R 检测技术在幽门螺杆菌诊断检测中的应用探讨

目的探寻聚合酶联反应(PCR)检测技术在幽门螺杆菌(H .pylori ,Hp)检测中的应用.方法通过对该院消化内科疑是患胃或十二指肠溃疡、胃或胃窦炎、胃癌患者于胃镜下取其病变部位组织标本,进行 Hp分离培养、PCR体外扩增,患者同时做尿素酶试验、血清学抗体检查,将结果进行比较分析.结果170份病例标本中,分离培养67例、尿素酶试验82例、Hp抗体检查152例、PCR扩增144例阳性.阳性率分别为39.4%、48.2%、89.5%、84.7%.以细菌培养为金标准,则尿素酶试验、抗体检查、PCR灵敏度分别为88.1%、89.5%、98.5%,特异性分别为94.6%、77.4%、81.7%.这4种检测方法中,灵敏度最高的为PCR基因扩增法,其次为抗体检查和尿素酶试验;特异性最高的为尿素酶试验,其次为PCR扩增和抗体检查.结论 PCR试验特异性和灵敏度均较高,可以用作Hp感染的确诊、基因分型、流行病学调查、微量取材等的检查.     

上海崇明地区幽门螺杆菌cagA基因多态性与感染临床结局的关系

目的探讨上海崇明地区幽门螺杆菌（Helicobacter pylori,Hp）的cagA基因的多态性与感染临床结局的关系。方法采用PCR法检测100株临床分离株cagA基因亚型,获得东亚型和西方型2种基因型。分析cagA基因亚型与消化道疾病间的关系。结果100株Hp中72株检出cagA基因,其中81．9％为cagA基因东亚型,15．3％为西方型,2．8％为同时存在着2种基因型。胃癌与慢性萎缩性胃炎患者中cagA基因东亚型菌株均显著高于胃溃疡、十二指肠溃疡患者,而十二指肠溃疡cagA基因西方型菌株的比率显著高于其余4种疾病类型。结论本地区感染Hp以cagA基因东亚型为主,cagA基因东亚型菌株与胃癌、慢性萎缩性胃炎密切相关,而cagA基因西方型菌株与十二指肠溃疡密切相关。推测cagA基因多态性对由Hp引起的感染性疾病的发病机制可能起一定的作用。     

PCR扩增16SrDNA在幽门螺杆菌感染诊断中的运用

目的 探讨16SrDNA聚合酶链式反应 (PCR)在幽门螺杆菌(Hp)感染检查中的应用价值.方法 疑似慢性胃炎、胃及十二指肠溃疡患者于胃镜下取其病变部位组织活检标本,胃癌患者于术中取病变部位组织活检标本,进行Hp的分离培养、提取活检组织DNA进行16SrDNA PCR扩增和琼脂糖凝胶电泳,并将二者结果进行比较.结果 85例病例中,54例16SrDNA PCR阳性,阳性率为63.5%;34例Hp分离培养阳性,阳性率为40%.结论 两种检测方法阳性率相比较,PCR检查法明显优于分离培养法(P＜0.005).     

上海地区幽门螺杆菌对克拉霉素耐药的相关基因检测

目的通过荧光PCR熔解曲线方法直接检测临床样本中幽门螺杆菌(Hp)对克拉霉素耐药基因,了解上海地区Hp耐克拉霉素基因的分布特征,并为临床快速检测Hp对克拉霉素耐药性提供一种有效的方案。方法收集2017年9-12月复旦大学附属中山医院消化科就诊并接受胃镜检查的快速尿素酶试验Hp阳性患者的胃黏膜组织标本80份,使用荧光PCR熔解曲线法直接检测黏膜样本中Hp种特异性23S rRNA的区域并对扩增的核酸进行荧光标记,通过检测荧光变化绘制其熔解曲线,以确定Hp的23S rRNA突变情况;采用DNA测序技术直接检测标本中Hp克拉霉素23S rRNA耐药基因突变位点。并对两种方法的结果进行Kappa检验统计学比较。结果 80份胃黏膜组织标本使用荧光PCR熔解曲线法共检测69份Hp阳性,11份Hp阴性,阳性率为86.2%。在69份Hp阳性标本中24份标本存在23SrRNA第2142或2143位点的变异,突变率34.8%。使用DNA测序法共检测出64份Hp阳性,阳性率为80.0%。其中23例患者的标本检测到23S rDNA耐药基因的突变,突变率35.9%。两种方法检测Hp耐药基因突变的阳性符合率、阴性符合率和总符合率分别为87.0%、95.1%和92.2%,Kappa系数为0.829,两者一致性较好。结论上海地区克拉霉素耐药Hp菌株基因型以23S rRNA基因的A2143G突变占主导。荧光PCR熔解曲线法可直接检测胃黏膜活检组织中Hp及其23S rRNA突变基因,该方法结果准确可靠。     

西安地区幽门螺杆菌及其cagA基因与胃肠疾病的相关性

研究表明 ,幽门螺杆菌 (H pylori,Hp)是胃癌发生的启动因素之一[1] ,Hp毒素相关蛋白 (cagA)是Hp毒力的主要因素 ,与胃肠疾病密切相关[2 ] 。本研究采用细菌培养的方法对胃肠疾病患者胃粘膜标本中的Hp菌进行分离鉴定 ,并对Hp菌进行了cagA的检测 ,旨在探讨西安地区Hp及其cagA基因与胃肠疾病的关系。1　材料和方法1 1　标本来源　 2 5 9例胃粘膜标本取自西京医院接受胃镜检查的患者。每例患者取 4块组织 ,胃体 2块、胃窦 2块 ,同时送病理检查和培养。经病理检查证实 ,胃腺癌 97例 ,慢性浅表性胃炎 35例 ,伴肠上皮化生 2 9例 ,单纯萎缩性胃…     

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.