慢性乙型肝炎患者白细胞介素1β及白细胞介素1受体拮抗剂基因多态性分析

目的探讨白细胞介素1β(IL-1β)基因启动子区域-511C/T和白细胞介素1受体拮抗剂(IL-1RN)基因在慢性乙型肝炎及正常人群中的多态性,初步分析其基因型与慢性乙型肝炎的相关性.方法对190例慢性乙型肝炎患者和249例正常人IL-1β、IL-1RN基因进行PCR扩增,其中IL-1β基因用AvaI限制性内切酶对PCR产物进行消化,然后经琼脂糖凝胶电泳分别对IL-1β、IL-1 RN基因多态性进行分析.结果慢性乙型肝炎患者IL-1RN 1/2基因型和IL-1RN2等位基因频率均明显低于正常对照组(P<0.025,P<0.05).在乙型肝炎病毒(HBV) DNA水平不同的2组慢性乙型肝炎患者中,IL-1β基因启动子-511位点CC型分布差异有显著性(χ2=4.77,P<0.05).结论慢性乙型肝炎与IL-1β、IL-1RN基因的多态性有关,其中IL-1RN2等位基因可能对乙型肝炎病毒感染有保护作用,而IL-1β基因中的CC型可能对感染后HBV DNA的复制有抑制作用.     

慢性乙型肝炎患者白细胞介素1β及白细胞介素1受体拮抗剂基因多态性分析

目的　探讨白细胞介素 1β(IL 1β)基因启动子区域 5 11C/T和白细胞介素 1受体拮抗剂 (IL 1RN)基因在慢性乙型肝炎及正常人群中的多态性 ,初步分析其基因型与慢性乙型肝炎的相关性。方法　对 190例慢性乙型肝炎患者和 2 4 9例正常人IL 1β、IL 1RN基因进行PCR扩增 ,其中IL 1β基因用AvaI限制性内切酶对PCR产物进行消化 ,然后经琼脂糖凝胶电泳分别对IL 1β、IL 1RN基因多态性进行分析。 结果　慢性乙型肝炎患者IL 1RN 1/ 2基因型和IL 1RN 2等位基因频率均明显低于正常对照组 (P <0 .0 2 5 ,P <0 .0 5 )。在乙型肝炎病毒 (HBV)DNA水平不同的 2组慢性乙型肝炎患者中 ,IL 1β基因启动子 5 11位点CC型分布差异有显著性 (χ2=4 .77,P <0 .0 5 )。结论　慢性乙型肝炎与IL 1β、IL 1RN基因的多态性有关 ,其中IL 1RN 2等位基因可能对乙型肝炎病毒感染有保护作用 ,而IL 1β基因中的CC型可能对感染后HBVDNA的复制有抑制作用     

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。     

IL-10基因启动子区-592A/C位点多态性与HBV感染转归的关系

目的探讨汉族人白细胞介素-10(IL-10)基因启动子区-592位点单核苷酸多态性与乙型肝炎病毒(HBV)感染、转归的关系。方法采用聚合酶链反应-限制性片段长度多态性分析(PCR-RFLP)方法,检测231例HBV感染者,165例HBV感染康复者和135例正常对照者IL-10基因启动子区-592A/C位点基因型。结果IL-10基因启动子区-592A/C位点基因型和等位基因在HBV感染组、HBV感染康复组和正常对照组之间的分布频率比较差异无显著性(P>0.05),在血清HBV-DHA<1×103copies/ml的HBV感染者组和HBV-DHA≥1×103copies/ml组之间的分布频率比较差异亦无显著性(P>0.05);但IL-10基因启动子区-592A/C位点AA基因型和A等位基因在慢性乙型肝炎组出现的频率明显高于HBV无症状携带组,两组之间分布比较差异有显著性(P<0.05)。结论汉族人IL-10基因启动子区-592A/C位点多态性可能与人群对HBV易感性及感染后的病毒血症水平无显著相关性,但该位点基因多态性与HBV感染后的肝脏炎症反应有关。     

雌激素受体α基因Pvu Ⅱ多态性与膝关节骨关节炎的相关性研究

目的 探讨雌激素受体α基因PvuⅡ多态性(rs2234693)与膝关节骨关节炎的相关性。方法 对单核苷酸多态性(SNP) rs2234693进行病例-对照关联研究,共对1 953例受试者(1 033例病例组和920例对照组)进行基因分型。比较病例组和对照组的等位基因和基因型频率。结果 对病例组和对照组年龄、体重指数和性别进行校正后,显性模型(TT+TC vs. CC)差异有统计学意义(P<0.05)。与等位基因C相比,T等位基因频率也较高(P<0.05)。按膝关节骨关节炎严重程度分层,TT+TC基因型和T等位基因与轻度膝关节骨关节炎明显相关,但与重度膝关节骨关节炎无关。结论 雌激素受体α基因PvuⅡ多态性在早期膝骨关节炎的发病中具有重要意义。     

蛋白酶体α6亚单位基因1233A/T位点多态性与脑梗死的关系

目的探讨中国汉族人群中蛋白酶体α6亚单位(PSMA6)基因1233A/T(-1520C/T)位点的多态性与脑梗死的相关性。方法 2012年1月至2015年4月,选择脑梗死患者211例(病例组)和健康体检者201例(对照组),应用聚合酶链反应-限制性片段长度多态性分析(PCR-RFLP)检测PSMA6基因1233A/T位点单核苷酸多态性,并分析其基因型及等位基因频率在脑梗死患者和正常人群中的分布特点。结果两组CC、CT+TT基因型频率及C、T等位基因频率均无显著性差异(χ20.053, P 0.05)。性别分层后,无论男性、女性,两组CC、CT、TT基因型频率和C等位基因频率均无显著性差异(χ22.735, P 0.05)。结论 PSMA6基因1233A/T位点可能与脑梗死的发病无关。     

白细胞介素基因多态性与急性胰腺炎病情程度的关系

目的 观察白细胞介素-1β(IL-1β)和IL-6基因多态性,探讨其与急性胰腺炎(AP)病情严重程度的关系.方法 采用聚合酶链反应一限制性片段长度多态性(PCR-RFLP)分析技术检测74例AP患者[轻型急性胰腺炎(MAP)36例,重症急性胰腺炎(SAP)38例]及78例健康对照者的IL-1β基因511C/T和IL-6基因634C/G位点多态性;采用酶联免疫吸附法(ELISA)检测血浆IL-1β和IL-6的浓度;SAP按不同基因型分组,比较各组间病情程度评分.结果 AP组血浆IL-1β、IL-6浓度高于健康对照组[IL-1β:(13.16±2.82)ng/L比(6.21±1.57)ng/L;IL-6:(84.86±32.92)ng/L比(9.95±2.49)ng/L,P均＜0.053.AP患者中,IL-1β基因511位点不同基因型血浆IL-1β浓度差异无统计学意义,IL-6基因634位点C/G基因型血浆IL-6浓度高于C/C型[(97.23±35.49)ng/L比(72.14±24.55)ng/L,P＜0.053.IL-1β基因511位点和IL-6基因634位点基因型及等位基因频率分布在AP组和健康对照组间差异无统计学意义;SAP组IL-1β基因511位点T/T型及T等位基因分布频率高于MAP组(P均＜0.05).SAP患者中,IL-1β基因511位点C/T+T/T型和IL-6基因634位点C/G型具有较高的病情程度评分.结论 IL-1β基因511C/T和IL-6基因634C/G位点多态性可能与AP的病情加重有关.     

IL-10基因位点多态性与ACS的相关性分析

[目的]探讨急性冠脉综合征(ACS)与白介素-10(IL-10)基因位点4259A/G、-1082G/A、-592C/A、-819C/T多态性分布的相关性.[方法]选择2010年5月至2015年9月常州市溧阳人民医院心内科和武进人民医院心内科收治的ACS患者471例(观察组),选择同期两个医院心内科收治的197例非ACS者为对照组,采用基因测序技术检测所有标本IL-10基因型,分析其与ACS发病相关危险因素.[结果]两组在年龄、吸烟、合并糖尿病、血清TC、TG、LDL-C方面比较,差异均具有统计学意义(P<0.05).在两组研究对象中,IL-104259A/G位点仅发现AA一种基因型;但是在两组研究对象中发现IL-10-1082G/A位点上有GG、AG、AA三种基因型、IL-10-582C/A位点上有CC、AC和AA三种基因型、IL-10-819C/T位点上有CC、CT和TT三种基因型.与对照组作比较后,尚未发现各种基因型之间分布频率、等位基因分布频率有统计学差异;对每一种基因型行引起ACS发病传统危险因素多元Logistic回归分析显示IL-10基因-592C/A、-819C/T、-1082G/A基因型与ACS的发病无相关性.[结论]在常州地区心血管疾病住院患者IL-10基因4259A/G仅有AA一种基因型;IL-10基因-1082G/A、-592C/A、-819C/T具有多态性,但其多态性分布与本地区汉族人群ACS的发病无相关性.     

合肥地区不孕不育患者MTHFR基因多态性分析

目的 通过分析亚甲基四氢叶酸还原酶(MTHFR)基因C677T位点基因多态性,探讨合肥地区不孕不育与MTHFR基因C677T位点多态性的相关性。方法 采用实时荧光PCR技术,测定2995例不孕不育患者(疾病组)和1 122名正常育龄人群(对照组)全血样本中MTHFR基因C677T基因型。通过统计学分析,比较该地区不孕不育患者与正常育龄人群MTHFR C677T基因多态性分布差异。结果 检出MTHFR C677T多态性分别为CC、CT、TT 3种基因型,疾病组基因型分布频率依次为CC 26.44%、CT 48.05%、TT 25.51%,与对照组基因型分布频率(CC 37.17%、CT 46.79%、TT 16.04%)比较,差异有统计学意义(χ²=64.121,P<0.001)。疾病组MTHFR C677T等位基因分布频率与对照组比较,差异也有统计学意义,其中疾病组等位基因C的分布频率低于对照组,而等位基因T的分布频率则高于对照组(χ²=66.809,P<0.001)。等位基因T发生不孕不育的风险是C基因的1.507倍。含有等位基...     

白细胞介素-18启动子基因在云南基诺族、傣族、僾尼族人群中的遗传多态性

目的:分析云南省西双版纳地区基诺族、傣族和僾尼族人群白细胞介素-18(IL-18)启动子基因多态性的分布情况.方法:运用PCR-测序的方法检测三民族人群IL-18启动子G-137C、C-607A和G-656T位点基因型及等位基因频率.结果:(1)基诺族人群G-137C位点基因型与等位基因分布频率与其他两民族显著不同,差异有统计学意义(P值均为0.000).(2)C-607A与G-656T完全连锁,C-607A(G-656T),位点基因型与等位基因分布频率三民族人群相比均有统计学差异(均P<0.05).结论:IL-18启动子G-137C、C-607A和G656T多态性位点基因型和等位基因分布频率具有民族、种族差异.     

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.