血浆miR-324-5p对单纯性先天性心脏病早期诊断的应用评估

目的：研究单纯性先天性心脏病（CHD）患者血浆中 miR-324-5p表达变化,评价其在 CHD诊断方面的临床应用价值。方法收集2012年6月～2013年2月76例CHD患儿及13例健康正常对照血清标本,应用 Real-time PCR检测血浆中miR-324-5p表达变化,通过受试者工作曲线（ROC）,评价血浆 miR-324-5p在 CHD诊断方面的临床应用价值。结果与正常对照相比,单纯性CHD患者外周血浆miR-324-5p表达升高（P＝0.032）;受试者工作曲线（ROC）分析显示,曲线下面积（AUC）为0.731,最佳诊断临界值为0.1161,敏感度为64.5％,特异度为84.6％。结论血浆 miR-324-5p作为CHD早期排除诊断的生物学标志物并具有一定的临床应用价值,但还需要与其它指标联合应用。     

重症急性胰腺炎患者外周血miR-22-3p和miR-324-5p水平及其对重症急性胰腺炎相关性急性肺损伤的诊断价值分析

目的检测miR-22-3p、miR-324-5p在重症急性胰腺炎(SAP)患者外周血中表达情况,探讨二者与SAP患者临床病理参数的关系及在SAP相关性急性肺损伤(ALI)诊断中的应用价值。方法回顾性收集2015年2月至2017年2月确诊并治疗的86例急性胰腺炎患者为研究对象,根据是否合并ALI分为合并ALI组(n=49)和未合并ALI组(n=37)。选取同期健康体检者45例作为健康对照组。实时荧光定量PCR(qRT-PCR)检测各受试者外周血miR-22-3p、miR-324-5p水平,并计算受试者工作曲线(ROC曲线)下面积(AUC)和对SAP诊断校能,观察上述指标与临床病理参数的相关性。结果健康对照者、未合并ALI、合并ALI的SAP患者外周血miR-22-3p水平逐渐升高、miR-324-5p水平逐渐降低,两两比较差异有统计学意义(P0.05)。检测外周血miR-22-3p、miR-324-5p水平诊断SAP疾病的AUC分别为:0.729、0.683,灵敏度分别为:57.41%、50.89%,特异度分别为:83.70%、78.61%。miR-22-3p、miR-324-5p表达与SAP患者CT分级、胸水情况、APACHEⅡ评分和是否并发ALI疾病有关(P0.05)。miR-22-3p、miR-324-5p水平诊断SAP合并ALI疾病的AUC分别为:0.791、0.748,灵敏度分别为:63.82%、58.90%,特异度分别为:83.91%、81.71%。COX比例风险模型分析结果显示,miR-22-3p、miR-324-5p水平、CT分级是影响SAP患者ALI发生风险的独立危险因素。结论 miR-22-3p在SAP患者外周血中高表达,miR-324-5p低表达,且在合并ALI患者和未合并ALI患者中存在明显差异,检测外周血miR-22-3p、miR-324-5p水平对SAP合并ALI疾病的诊断具有一定应用价值。     

冠状动脉粥样硬化性心脏病患者血清中miR-7-5p和PARP1水平与心功能的相关性研究

目的 探讨冠状动脉粥样硬化性心脏病(CHD)患者血清中miR-7-5p和聚腺苷二磷酸核糖聚合酶1(PARP1)水平及其与心功能的相关性。方法 前瞻性选取2020年5月至2021年5月上海交通大学医学院附属第九人民医院黄浦分院心脏科住院并经冠状动脉造影证实为CHD患者85例为CHD组。同时选取同期同院健康体检者85名为对照组。对两组研究对象的一般资料、血清中miR-7-5p和PARP1表达、心功能指标进行对比分析,并对不同心功能分级患者血清中miR-7-5p、PARP1水平及心功能指标进行对比,并分析miR-7-5p、PARP1与心功能指标的相关性。结果 CHD组体重指数、收缩压、空腹血糖、低密度脂蛋白胆固醇均高于对照组,高密度脂蛋白胆固醇低于对照组,差异均有统计学意义(P <0.05)。CHD组血清中miR-7-5p的相对表达量为0.37±0.06,明显低于对照组(1.01±0.12),血清中PARP1的相对表达量为1.84±0.25,显著高于对照组(0.63±0.06),差异均有统计学意义(P <0.05)。CHD组中LVESD、LVEDD为(45.68±4.23)、(7...     

LncRNA FoxD2-AS1靶向miR-324-5p对结肠癌SW480细胞增殖和迁移侵袭的影响

目的探讨长链非编码RNA(lncRNA) FoxD2-AS1是否通过靶向miR-324-5p影响结肠癌SW480细胞增殖、迁移和侵袭。方法 RT-qPCR检测人正常结肠黏膜上皮细胞株NCM460及结肠癌细胞株SW480、HCT116和HT29中FoxD2-AS1和miR-324-5p表达水平; MTT法检测FoxD2-AS1和miR-324-5p表达对结肠癌SW480细胞增殖活力的影响; Transwell小室实验检测FoxD2-AS1和miR-324-5p表达对结肠癌SW480细胞迁移和侵袭能力的影响;双荧光素酶报告基因实验检测FoxD2-AS1是否靶向miR-324-5p。结果与NCM460细胞相比,结肠癌各细胞株中FoxD2-AS1表达明显上调(P 0. 05),miR-324-5p表达明显下调(P 0. 05);双荧光素酶报告基因实验证实FoxD2-AS1靶向抑制miR-324-5p的表达; MTT和Transwell小室实验结果表明,干扰FOXD2-AS1和过表达miR-324-5p后结肠癌SW480细胞增殖活力均明显降低,细胞迁移和侵袭能力均明显减弱;与干扰FOXD2-AS1相比,同时干扰FOXD2-AS1和miR-324-5p后细胞增殖、迁移和侵袭能力明显增强(P 0. 05)。结论 lncRNA FOXD2-AS1通过靶向负调控miR-324-5p的表达影响结肠癌SW480细胞增殖、迁移和侵袭能力。     

血浆miR-31-5p和miR-134-5p对精神分裂症的诊断价值

目的检测精神分裂症(Schizophrenia,SZ)患者血浆中miR-31-5p和miR-134-5p的表达水平,并探讨两者对SZ的诊断价值。方法收集SZ患者、双相情感障碍(bipolar disorder,BPAD)患者和体检健康者血浆样本各90例。实时荧光定量PCR(qRT-PCR)检测3组血浆样本中miR-31-5p和miR-134-5p的表达水平,并进行统计学分析以验证差异表达的miR-31-5p和miR-134-5p,绘制ROC曲线,采用逐步Logistic回归分析miR-31-5p和miR-134-5p单独及其联合检测对SZ的诊断价值。结果miR-31-5p在SZ组、BPAD组和健康人对照组的差异有统计学意义(χ2=9.223,P0.05),组间两两比较结果表明,SZ组与健康人对照组miR-31-5p的表达差异有统计学意义(q=7.85,P0.05);miR-134-5p在3组间的差异亦有统计学意义(χ2=29.111,P0.05),组间两两比较结果表明,其在SZ组与健康人对照组、SZ组与BPAD组差异均统计学意义(q分别为20.40,23.18,P均0.05)。miR-31-5p诊断SZ的ROC曲线下面积(AUCROC)为0.617,敏感性73.3%,特异性54.4%;miR-134-5p诊断SZ的AUCROC为0.696,敏感性84.4%,特异性48.9%;二者联合预测变量PRE的AUCROC为0.695,敏感性84.4%,特异性48.9%。结论 miR-134-5p单独和联合miR-31-5p检测对SZ的诊断价值相当,且均优于单变量miR-31-5p。     

老年急性 ST 段抬高型心肌梗死患者血浆 miR-499-5p 表达水平对并发急性心力衰竭的预测价值

目的　探讨老年急性 ST 段抬高型心肌梗死（STEMI）患者血浆微小核糖核酸 -499-5p（miR-499-5p）水平对并发急性心力衰竭（AHF）的预测价值。方法　连续性收集 2019 年 1 月 ~12 月就诊于西安市第五医院的 135 例老年急性STEMI 患者纳入病例组,并根据发病 48h 内是否发生急性心力衰竭（AHF）将病例组分为 AHF 亚组和非 AHF 亚组。另随机选择同期在该院行健康体检的志愿者 50 例为对照组。采用实时荧光定量 PCR（RT-qPCR）法检测血浆 miR-499-5p 的相对表达水平。结果　病例组血浆 miR-499-5p 相对表达水平显著高于对照组（Z=10.434,P ＜ 0.001）。AHF 亚组血浆 miR-499-5p 相对表达水平显著高于非 AHF 亚组（Z=5.817,P ＜ 0.001）。病例组患者血浆 miR-499-5p 相对表达水平与 cTnI,CK-MB,BNP 和 Killip 分级均呈正相关关系（r=0.339,0.243,0.477,0.581,均 P ＜ 0.01）。多因素分析结果显示老年急性 STEMI 患者血浆 miR-499-5p 表达升高是并发 AHF 的独立危险因素（OR=3.192,P=0.011）。血浆miR-499-5p 预测 AHF 的 AUC 为 0.797（0.725,0.869）。结论　老年急性 STEMI 患者血浆 miR-499-5p 表达水平显著升高,可能是并发 AHF 的独立危险因素。     

血浆miR-107-5p、miR-210水平与脓毒症并发急性肾损伤患者肾功能、炎症指标及预后的关系

目的探讨血浆miR-107-5p、miR-210水平与脓毒症并发急性肾损伤(AKI)患者肾功能、炎症指标及预后的关系。方法选择2015年5月至2020年3月该院重症监护病房收治的210例脓毒症患者,其中86例并发AKI(AKI组),124例未并发AKI(NAKI组)。检测2组miR-107-5p、miR-210、肾功能指标[尿素氮(BUN)、血肌酐(Scr)、胱抑素C(Cys-C)]及炎症指标[C反应蛋白(CRP)、降钙素原(PCT)]水平。采用Pearson相关分析miR-107-5p、miR-210水平与BUN、Scr、Cys-C、CRP、PCT之间的相关性。采用Cox比例回归分析miR-107-5p、miR-210与脓毒症并发AKI患者预后的关系;采用受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)分析miR-107-5p、miR-210预测脓毒症并发AKI患者预后的价值。结果 AKI组miR-210、miR-107-5p、BUN、Scr、Cys-C、CRP、PCT水平高于NAKI组(P0.05);AKI组患者入院28d内死亡33例,存活53例,死亡患者miR-210、miR-107-5p、BUN、Scr、Cys-C、CRP、PCT水平高于存活患者(P0.05)。Pearson相关分析结果显示miR-210、miR-107-5p水平与BUN、Scr、Cys-C、CRP、PCT呈正相关(P0.05)。多因素Cox比例回归分析结果显示Cys-C、miR-210、miR-107-5p是脓毒症并发AKI患者死亡的危险因素(OR=2.252、2.149、2.115,P0.05)。ROC曲线显示,miR-107-5p、miR-210预测脓毒症并发AKI患者死亡的最佳临界值为6.91、7.03,AUC分别为0.878、0.814。结论脓毒症并发AKI患者血浆miR-107-5p、miR-210水平较未并发AKI患者明显增高,二者水平升高与肾损伤程度、炎性反应程度和不良预后相关,可以作为脓毒症并发AKI患者预后评估的辅助指标。     

上皮性卵巢癌组织中miR-506-3p及miR-532-5p的表达与临床病理特征及预后的相关研究

目的 探讨miR-506-3p及miR-532-5p在上皮性卵巢癌（epithelial ovarian cancer,EOC）组织中的表达及其对预后预测的意义。方法 选取2017年1月～2019年12月三亚市妇女儿童医院和三亚中心医院收治的118例EOC患者。检测EOC组织及正常组织中miR-506-3p及miR-532-5p表达水平。应用单因素及多因素COX回归模型分析EOC患者预后不良的危险因素。结果 EOC组织miR-506-3p(0.31±0.05)及miR-532-5p(0.24±0.03)表达水平低于正常组织（1.16±0.42,1.48±0.51）,差异有统计学意义（t=13.582,16.217,均P<0.001）。Kaplan-Meier生存分析显示,miR-506-3p及miR-532-5p低表达与EOC患者生存期短有关（P<0.001）。多因素分析显示,淋巴结转移[HR(95%CI)=1.840(1.137～4.105)],腹膜转移[HR(95%CI)=2.974(2.106～6.113)],miR-506-3p <0.45[HR(95%CI)...     

胃腺癌患者血浆中miR-199a-5p和miR-200c-3p的表达及其诊断和预后判断的价值

目的探讨胃腺癌病人血浆中miR-199a-5p、miR-200c-3p的表达及其诊断和预后判断的价值。方法选取2014年5月至2015年4月胃腺癌病人50例为观察组,同期入选体检健康者50例为研究对照,应用实时荧光定量PCR技术检测两组研究对照血浆中的miR-199a-5p和miR-200c-3p的表达水平情况;比较不同分化程度、淋巴结转移情况的胃腺癌病人的血浆中miR-199a-5p、miR-200c-3p表达水平。结果观察组的miR-199a-5p表达水平显著低于对照组,差异有统计学意义(P0.05);观察组的miR-200c-3p表达水平显著高于对照组,差异有统计学意义(P0.05);不同分化程度、淋巴结转移情况的胃腺癌病人的血浆miR-199a-5p、miR-200c-3p表达水平差异有统计学意义(P0.05)。结论胃腺癌病人血浆miR-199a-5p、miR-200c-3p表达水平与肿瘤分化程度、淋巴结转移情况密切相关,可用于评估胃腺癌的病情严重程度及预后。     

外周血miR-125b-5p和miR-155相对表达量对冠状动脉狭窄程度的预测价值

目的探讨冠心病患者外周血miR-125b-5p与miR-155相对表达量与冠状动脉病变程度的相关性及其对冠状动脉狭窄程度的预测价值。方法冠心病患者57例为冠心病组,体检健康者57例为对照组,采用实时荧光定量PCR法检测2组血浆miR-125b-5p和miR-155相对表达量,分析冠心病患者血浆miR-125b-5p和miR-155相对表达量与冠状动脉病变支数及最大狭窄程度的相关性;绘制ROC曲线,评估血浆miR-125b-5p和miR-155相对表达量对冠心病患者冠状动脉狭窄50%的预测价值。结果冠心病组患者血浆miR-125b-5p(0.81±0.10)和miR-155(0.64±0.09)相对表达量低于对照组(0.98±0.12、0.82±0.13)(P0.05);冠状动脉狭窄≥50%冠心病患者血浆miR-125b-5p(0.74±0.11)和miR-155(0.59±0.10)相对表达量低于狭窄50%冠心病患者(0.87±0.08、0.72±0.09)(P0.05)。冠心病患者血浆miR-125b-5p、miR-155相对表达量与冠状动脉病变支数(r=—0.643,P0.001;r=—0.669,P0.001)及最大狭窄程度(r=—0.718,P0.001;r=—0.728,P0.001)均呈负相关。当血浆miR-125b-5p相对表达量0.776、miR-155相对表达量0.641为最佳截断值时,预测冠心病患者冠状动脉狭窄≥50%的AUC分别为0.949(95%CI:0.892～0.982,P0.001)、0.907(95%CI:0.839～0.954,P0.001),敏感度分别为91.2%、79.4%,特异度分别为92.5%和92.5%。结论血浆miR-125b-5p和miR-155相对表达量与冠心病病变程度具有负相关性,对冠状动脉狭窄≥50%具有较好预测价值。     

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.