冠心病家族史青少年载脂蛋白E、B的基因多态性

目的 探讨青少年载脂蛋白E(apolipoprotein E，apoE)、apoB基因多态性对冠心病的遗传易感性。方法 应用聚合酶链反应—限制性片段长度多态性技术，对244名健康汉族大学生(冠心病家族史阳性者109人，阴性者135人)的apoE、apoB XbaI、apoB 3’可变数目串联重复序列(variable number of tandem repeat ，VNTR)基因型进行分析。结果 阳性组的e4、x^ 、VNTR—B(hypervariable element，HVE＞38)等位基因频率显著高于阴性组(P＜0．05)，且与血总胆固醇、低密度脂蛋白—胆固醇、aPoBl00水平升高有显著相关(P＜0．05)。结论 apoE的e4、apoB Xba I的x^ 、apoB3’VNTR的VNTR—B可能为冠心病的重要遗传标记。     

Molecular cloning and expression of a novel alternative splice variant of BRDT gene

In this study, a human adult testis cDNA microarray was constructed and hybridized with (33)P-labeled human adult testis, embryo testis and sperm cDNA probes, respectively. A novel alternative splice variant of BRDT gene, named BRDT-NY, presumably involved in testicular function was cloned. It was expressed 3.96-fold more in human adult than embryo testis and also expressed in human spermatozoa. Similarly, RT-PCR revealed a differential expression pattern of this gene in human adult testes and fetal testes. The full length of BRDT-NY was 3438 bp and contained a 2883 bp open reading frame, encoding a 960-amino-acid protein. Sequence analysis showed that it has two bromodomains in N-terminal of the protein. Multiple tissue RT-PCR results showed that BRDT-NY was exclusively expressed in testis. mRNA expression of BRDT-NY gene was deleted in some azoospermic patients' testes. These experiments suggested that BRDT-NY gene may have an important role in the process of spermatogenesis and may be correlated with male infertility.     

中国狂犬病毒疫苗株（5aG）糖蛋白基因在痘苗病毒中的表达及免疫效果观察

将克隆到的中国狂犬病毒疫苗株（５ａＧ）的糖蛋白基因重组到痘苗病毒ＴＫ区，并在痘苗病毒Ｐ１１启动子的控制下，构建了狂犬－痘苗重组病毒（ＶＶａＧ）。经间接免疫荧光和Ｗｅｓｔｅｒｎ免疫印染证明，重组病毒ＶＶａＧ能良好地表达狂犬病毒糖蛋白，其分子量约为６６００。用ＶＶａＧ免疫小鼠，７ｄ便可诱生较高的狂犬病毒中和抗体，２１ｄ达４１６９，并能１００％保护狂犬病毒本毒株和国际标准攻击毒（ＣＶＳ）的致死量攻击。     

Large deformation three-dimensional image registration in image-guided radiation therapy

In this paper, we present and validate a framework, based on deformable image registration, for automatic processing of serial three-dimensional CT images used in image-guided radiation therapy. A major assumption in deformable image registration has been that, if two images are being registered, every point of one image corresponds appropriately to some point in the other. For intra-treatment images of the prostate, however, this assumption is violated by the variable presence of bowel gas. The framework presented here explicitly extends previous deformable image registration algorithms to accommodate such regions in the image for which no correspondence exists. We show how to use our registration technique as a tool for organ segmentation, and present a statistical analysis of this segmentation method, validating it by comparison with multiple human raters. We also show how the deformable registration technique can be used to determine the dosimetric effect of a given plan in the presence of non-rigid tissue motion. In addition to dose accumulation, we describe a method for estimating the biological effects of tissue motion using a linear-quadratic model. This work is described in the context of a prostate treatment protocol, but it is of general applicability.     

Murein lipoprotein is a critical outer membrane component involved in Salmonella enterica serovar typhimurium systemic infection

Lipopolysaccharide (LPS) and Braun (murein) lipoprotein (Lpp) are major components of the outer membrane of gram-negative enteric bacteria that function as potent stimulators of inflammatory and immune responses. In a previous paper, we provided evidence that two functional copies of the lipoprotein gene (lppA and lppB) located on the chromosome of Salmonella enterica serovar Typhimurium contributed to bacterial virulence. In this study, we characterized lppA and lppB single-knockout (SKO) mutants and compared them with an lpp double-knockout (DKO) mutant using in vitro and in vivo models. Compared to the lpp DKO mutant, which was nonmotile, the motility of the lpp SKO mutants was significantly increased (73 to 77%), although the level of motility did not reach the level of wild-type (WT) S. enterica serovar Typhimurium. Likewise, the cytotoxicity was also significantly increased when T84 human intestinal epithelial cells and RAW264.7 murine macrophages were infected with the lpp SKO mutants compared to the cytotoxicity when cells were infected with the lpp DKO mutant. The level of interleukin-8 (IL-8) in polarized T84 cells infected with the lppB SKO mutant was significantly higher (two- to threefold higher), reaching the level in cells infected with WT S. enterica serovar Typhimurium, than the level in host cells infected with the lppA SKO mutant. The lpp DKO mutant induced minimal levels of IL-8. Similarly, sera from mice infected with the lppB SKO mutant contained 4.5- to 10-fold-higher levels of tumor necrosis factor-alpha and IL-6; the levels of these cytokines were 1.7- to 3.0-fold greater in the lppA SKO mutant-infected mice than in animals challenged with the lpp DKO mutant. The increased cytokine levels observed with the lppB SKO mutant in mice correlated with greater tissue damage in the livers and spleens of these mice than in the organs of animals infected with the lppA SKO and lpp DKO mutants. Moreover, the lppB SKO mutant-infected mice had increased susceptibility to death. Since the lpp DKO mutant retained intact LPS, we constructed an S. enterica serovar Typhimurium triple-knockout (TKO) mutant in which the lppA and lppB genes were deleted from an existing msbB mutant (msbB encodes an enzyme required for the acylation of lipid A). Compared to the lpp DKO and msbB SKO mutants, the lpp-msbB TKO mutant was unable to induce cytotoxicity and to produce cytokines and chemokines in vitro and in vivo. These studies provided the first evidence of the relative contributions of Lpp and lipid A acylation to Salmonella pathogenesis.     

结直肠癌RAS、BRAF基因状态与临床病理特征的关系

目的分析中国人群结直肠癌患者中KRAS、NRAS及BRAF基因突变状态与临床病理特征之间的关系。方法回顾性分析2018年1月—2020年11月于福建省肿瘤医院接受治疗的370例结直肠癌患者的肿瘤组织标本,检测KRAS、NRAS、BRAF基因突变状态及MMR蛋白表达状态,分析基因突变状态与结直肠癌临床病理特征的关系。结果370例患者中存在KRAS基因突变155例(41.9%),NRAS基因突变19例(5.1%),BRAF基因突变40例(10.8%),其中1例患者突变类型为G469V,其他均为V600E突变。KRAS基因在女性、高中分化患者中突变率高(P<0.05)。NRAS基因突变多见于低分化、浸润型患者(P<0.05)。BRAF V600E突变在右半结肠癌、年龄小于50岁、低分化、浸润型、淋巴结及远处转移患者中的突变率高(P<0.05)。结论KRAS基因突变与性别、分化程度有关,NRAS基因突变与分化程度、肿瘤大体分类有关,BRAF基因V600E突变与肿瘤原发部位、年龄、分化程度、肿瘤大体分类、区域淋巴结及远处转移有关。对结直肠癌患者进行KRAS、NRAS及BRAF基因的检测,为了解中国患者热点基因突变分布情况和临床精准诊疗提供理论依据。     

产褥期乳腺炎影响因素分析

目的探讨导致产妇发生产褥期乳腺炎(PM)的影响因素。 方法选择2020年9月1日至12月31日,在成都市某三甲妇女儿童医院分娩,并进行产后42 d随访的1 162例产妇为研究对象。根据产妇产后42 d内是否发生PM,将其分为PM组(n＝103)与对照组(n＝1 059)。采用本研究自行设计的《产褥期乳腺炎相关影响因素调查问卷》(以下简称为《调查问卷》),联合《中国简式心理状态剖面图(POMS)量表》(以下简称为《POMS量表》),分别对2组产妇进行调查。《调查问卷》内容主要包括产妇一般人口学资料、妊娠及疾病、药物使用、母乳喂养、饮食及生活习惯等10个维度,共计50个条目。《POMS量表》包括心理焦虑等7个维度,共计40个条目。对2组产妇《调查问卷》条目及《POMS量表》评分,采用独立样本t检验、χ²检验及Fisher确切概率法等进行统计学比较。本研究遵循的程序符合病例收集医院医学伦理委员会要求,经过该伦理委员会批准[审批文号：科研伦审2021(29)],并与研究对象签署临床研究知情同意书。2组产妇的年龄等一般临床资料比较,差异无统计学意义(P>0.05)。 结果①本研究纳入产妇的PM发生率为8.9%(103/1 162),产后第3、4周PM发生率最高,分别为2.7%(31/1 162)与2.4%(28/1 162)。②本研究2组产妇围生期补充铁剂及口服益生菌占比,乳头皲裂程度、吸奶器使用时间及频率、乳头保护罩与乳头保护霜使用频率构成比,哺乳衔接姿势正确率,哺乳时乳房疼痛程度、哺乳内衣穿戴率等分别比较,差异均有统计学意义(P<0.05)。③PM组产妇《POMS量表》焦虑评分为(7.1±5.0)分,显著高于对照组的(5.3±4.1)分,并且差异有统计学意义(t＝-3.540、P＝0.001)。④将上述影响产妇发生PM的单因素分析中差异有统计学意义因素,并结合已有研究结果与临床经验,纳入10项影响因素,进行多因素非条件logistic回归分析结果显示,产妇围生期补充铁剂(OR＝3.351,95%CI：1.949~5.758,P<0.001),乳头皲裂(OR＝3.564,95%CI：1.909~6.654,P<0.001),吸奶器使用频率>1次/d(OR＝5.102,95%CI：1.047~24.876,P＝0.044),乳头保护霜使用频率>1次/d(OR＝2.147,95%CI：1.156~3.987,P＝0.016),哺乳衔接姿势不正确(OR＝2.311,95%CI：1.202~4.445,P＝0.012),穿戴不舒适哺乳内衣(OR＝2.322,95%CI：1.008~5.347,P＝0.048),不穿戴哺乳内衣(OR＝3.516,95%CI：1.821~6.789,P<0.001),焦虑评分高(OR＝1.073,95%CI：1.007~1.143,P＝0.029),均为导致产妇发生PM的独立危险因素;而围生期口服益生菌(OR＝0.110,95%CI：0.025~0.478,P＝0.003)是其独立保护因素。 结论通过制定临床干预措施,指导产褥期产妇纠正不正确行为,如围生期补充铁剂、吸奶器与乳头保护霜使用不当,哺乳内衣穿戴及哺乳行为不规范等,提倡产妇围生期口服益生菌,缓解产妇焦虑情绪,对预防产妇PM发生具有重要意义。     

预防维持性血液透析患者发生动静脉内瘘失功的护理对策

目的 探讨预防维持性血液透析患者发生动静脉内瘘失功的护理对策.方法 选取河南省某医院于2017年1月—2021年1月收治的60例维持性血液透析患者为研究对象.采用随机数字表法将患者分为对照组和观察组,每组30例.对照组患者给予常规护理干预.观察组患者给予针对性护理干预.比较2组患者干预前及干预6个月时焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、健康知识掌握情况及生活质量;比较2组患者干预6个月时并发症发生情况.结果 干预前,2组患者SAS及SDS评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者SAS及SDS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P＜0.05).干预前,2组患者健康知识掌握评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者健康知识评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P＜0.05).干预前,2组患者生活质量量表中躯体功能、认知功能及社会功能评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者生活质量量表中躯体功能、认知功能及社会功能评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P＜0.05).观察组患者并发症发生率低于对照组,差异有统计学意义(P＜0.05).观察组患者动静脉内瘘失功发生率低于对照组,差异有统计学意义(P＜0.05).结论 对维持性血液透析患者采用针对性护理措施可有效改善患者不良的心理状态,提高健康知识水平和生活质量,降低并发症发生率及动静脉内瘘失功发生率,进而提高患者透析质量.     

门诊医生工作站的设计与应用

门诊医生工作站是医院门诊信息系统的中心,对合理规划门诊业务流程起关键作用.在对现有医院门诊流程进行分析的基础上,介绍了自行开发的门诊医生工作站系统,着重阐述了系统的数据流程和设计思想,最后对系统的应用效果进行了介绍.     

Off-clamp Retroperitoneoscopic Tumour Evacuation for Sporadic Renal Angiomyolipomas with High RENAL Nephrometry Scores: A Novel Surgical Technique and Its Outcomes

BackgroundPartial nephrectomy or angioembolisation is commonly used for sporadic renal angiomyolipomas (RAMLs) with high RENAL scores, but there is a risk of reduced renal function, postoperative complications, and recurrence.ObjectiveTo describe a new technique for off-clamp laparoscopic evacuation of sporadic RAMLs with high RENAL scores that promotes maximal renal function maintenance and low postoperative complication and lesion recurrence rates.Design, setting, and participantsA retrospective cohort of patients undergoing off-clamp laparoscopic evacuation for sporadic RAMLs with RENAL scores ≥9 from January 2013 to June 2018 was included.Surgical procedureWe highlighted the curettage, suction, packing, and binding (CSPB) technique, a new off-clamp retroperitoneoscopic evacuation technique for sporadic RAMLs.MeasurementsDemographics, preoperative, intraoperative, and postoperative outcomes were assessed.Results and limitationsA total of 141 cases were included. The median (interquartile range [IQR]) tumour size was 7 (6.2–8.2) cm. The median (IQR) RENAL score was 10 (9–11). The median (IQR) operative time was 80 (65–125) min, with a median (IQR) estimated blood loss of 130 (90–362.5) ml. Conversion to neither open surgery nor standard laparoscopy occurred. The warm ischaemia time was zero for all cases. Postoperatively, 13 minor complications (Clavien grade 1) were recorded. No blood transfusions were reported. The glomerular filtration rate did not change significantly from preoperative period to 12-mo follow-up. Recurrence did not occur at the median follow-up period of 48 (36–60) mo. The retrospective design and lack of a control group are limitations of this study.ConclusionsOff-clamp retroperitoneoscopic tumour evacuation using the CSPB technique is feasible, safe, and effective for treating complex sporadic RAMLs.Patient summaryWe report a curettage, suction, packing, and binding technique for off-clamp retroperitoneoscopic evacuation of sporadic renal angiomyolipomas that leads to complete lesion clearance, excellent renal function preservation, and minimal perioperative complications.