血管紧张素转换酶基因多态性在脑血管病中作用及机制的初步研究

目的：探讨血管紧张素转换酶（ACE）基因多态性与脑梗死，高血压脑出血的关系。方法：应用PCR方法检测60例脑梗死患者，33例高血压性脑出血患者和62例健康才的ACE基因的缺失／插入多态性。结果：高血压性脑出血的DD基因型和D等位基因频率明显高于正常对照组，脑梗死组DD基因型和D等位基因频率与正常对照组比较有显著差异；尤其伴高血压的脑梗死患者，这种趋势更为明显。结论：ACE基因多态性和高血压脑血管病患者有关联性。DD基因型可能是伴高血压脑梗死，脑出血的易患因素。     

血管紧张素转换酶基因多态性及血清水平与脑梗死的关系

目的研究血管紧张素转换酶（ACE）基因多态性及血清ACE水平与脑梗死之间的相互关系及可能机制。方法对84例脑梗死患者和74例健康对照者用聚合酶链反应（PCR）技术和琼脂糖凝胶电泳法分别进行ACE基因插入／缺失（I／D）多态性测定。分析比较脑梗死组与健康对照组之间ACE基因多态性的分布差异。结果脑梗死组DD基因型频率（50％）和D等位基因频率（64％）与健康对照组（分别为28％、4600）比较增高,差异有统计学意义（分别为P〈0．01,P〈0．05）。ACE基因多态性与血清ACE水平有关,ACE水平依次为：DD型〉ID型〉Ⅱ型,三者相互之间差异有统计学意义（P〈0．01）。结论ACE基因多态性与血清ACE水平和脑梗死有关,其DD型基因和D等位基因是脑梗死的危险因素。     

广西汉族人血管紧张素转换酶I基因多态性与2型糖尿病肾病相关性研究

目的 探讨血管紧张素I转换酶（ACE）基因多态性与2型糖尿病肾病（DN）的关系。方法 应用多聚酶链反应（PCR）技术，对100例正常人、34例2型糖尿病肾病，52例2型糖尿病不伴DN的ACE基因插入／缺失（I／D）多态性进行检测。结果 2型DM肾病组DD基因型及D等位基因发生频率高于正常对照组及无DN组，2型DM肾病组Ⅱ基因型及I等位基因发生频率低于正常对照组及无DN组，均有显著意义P＜0．05。结论 ACE基因插入／缺失（I／D）多态性与2型糖尿病肾病易感性密切相关。     

ACE基因多态性及线粒体5178A／C基因型与心肌梗死的关系研究

[目的]探讨血管紧张素转换酶（ACE）基因插入／缺失（I／D）多态性及线粒体（mt）5178A／C基因型与心肌梗死的关系。[方法]采用PCR法检测心肌梗死患者84例及正常对照80例的ACEI／D多态性。采用PCR—RFLP方法检测心肌梗死患者84例及正常对照者80例的mr5178A／C基因型。并对结果进行统计学分析。[结果]在心肌梗死患者中，ACE基因的DD基因型频率及D等位基因频率显著高于正常对照组（均P〈0．05），DD与非DD及D与I的比数比（OR）分别为2．443（1．265—4．716）及1．703（1．098—2．638）。mt5178C等位基因频率也明显高于正常对照组（P=0．021），mt5178C与mt5178A的比数比为2．254（1．114—4．563）。[结论]ACE基因DD基因型及mt5178C与心肌梗死有关，可能是发生心肌梗死的重要危险因素。     

血管紧张素系统基因多态性与早发冠心病的相关性研究

目的探讨血管紧张素转换酶（ACE）和血管紧张素Ⅱ1型受体（AT1R）基因多态性与早发冠心病（CAD）的关系。方法用PCR法检测41例早发CAD和64例迟发CAD患者体细胞ACE基因插入／缺失（I／D）多态性和AT1R-A1166C基因多态性，并与50例健康者对照。结果105例CAD患者ACE的DD基因频率分布与对照组比较差异有显著性（P〈0．05）；早发和迟发CAD患者与对照组比较，D等位基因和DD基因频率显著高于对照组（P〈0．05）。早发CAD组AT1R的CC基因型和C等位基因频率与对照组相比差异有显著性（P=0．036，P=0．008）。联合基因多态分析，早发CAD合并ACE-DD＋AT1 R—CC基因型频率显著高于对照组（P=0．036）；迟发CAD合并ACE-DD＋AT1 R—CC基因型频率与对照组比较差异无显著性（P=0．206）。结论早发CAD组与ACE的DD基因频率和ATIR的A1166C基因频率分布相关，ACE-DD基因频率与AT1R—CC基因频率在早发CAD的发病中具有协同作用。     

妊娠高血压综合征患者血管紧张素转换酶基因多态性研究

目的探讨血管紧张素转换酶（ACE）基因插入／缺失多态性与妊娠高血压综合征（PIH）的关系。方法应用聚合酶链反应（PCR）检测92例PIH患者及85名正常妊娠者的ACE基因多态性。结果PIH组ACE基因3种基因型频率分别为DD型44．6％、ID型33．7％、Ⅱ型21．7％，对照组ACE基因3种基因型频率分别为DD型18．8％、ID型40．0％、Ⅱ型41．2％；两组的DD基因型及D等位基因频率比较差异有显著性（P〈0．05）。结论ACE基因的缺失多态性（DD）可能为妊高征发病的重要遗传因素之一。     

晚发性抑郁症与血管紧张素转化酶基因多态性关系研究

目的 探讨晚发性抑郁症（LOD）与血管紧张素转换酶（ACE）基因第16内含子中Alu重复序列的插入/缺失（Insertion/Deletion，I/D）多态性的关系。方法 入组183例60-86岁老年人，晚发性抑郁症组（93例，下称LOD组）和正常对照组（90例，下称对照组），用聚合酶链式反应（PCR）法进行ACE基因I/D多态性分型。结果LOD组和对照组间基因型频率及等位基因频率分布差异无显著（X^2=0.241，P=0.886；X^2=0.127，P=0.722），各基因型亚型患者在年龄、性别、发病次数、病程、HAMD评分、有无精神病性症状、有无自杀企图间差异无显著（P均〉0.05）。结论ACE基因I/D多态性与晚发性抑郁症无显著相关性。     

东莞市T2DM患者与健康人ACE基因多态性研究

目的研究血管紧张素转换酶基因插入（I）／缺失（D）多态性在东莞市T2DM患者与健康人中的分布。方法采用限制性片段长度多形态多聚酶链式反应（PCR—RFLP）技术对东莞市200例T2DM患者和93例健康者进行ACE基因内含子16插入／缺失（I／D）多态性检测。结果东莞市T2DM患者ACEDD、Ⅱ、ID基因型分布频率分别为8．5％、46．0％和45，5％．等位基因频率分别为I：68，8％、D：31．2％。健康对照组的频率分别为19．4％、35．5％和45，2％．等位基因频率分别为1：58，1％、D：41．9％。T2DM患者与健康对照组比较，I等位基因频率显著增高，而D等位基因频率显著降低（P％0，05）。结论ACE基因多态性是致T2DM的遗传危险因素之一。     

血管紧张素转换酶及其基因多态性（I／D）关系的初步研究

目的：探讨血管紧张素转换酶（ACE）与其基因的插入／缺失（I／D）多态性的相关性。方法：健康人对照组、慢性阻塞性肺部疾病（COPD）组、肺心病组各30例，用多聚酶链反应（PCR）检测各组中的ACE基因I／D多态性（分别有三种基因型DD、ID、Ⅱ），同时检测血清中的ACE（SACE）。结果：COPD组、肺心病组等位基因与健康人对照组比较有显著性差异（P＜0．01）。SACE水平与ACE基因型DD、ID、Ⅱ型有关，DD、ID的SACE值与Ⅱ的SACE值比较有显著性差异（P＜0．01）。     

ACE 基因 I/D 多态性与动脉血栓性脑梗死的关联性研究

目的研究血管紧张素转换酶（ACE）基因I/D多态位点与动脉血栓性脑梗死的关联性及相关机制。方法选取动脉血栓性脑梗死患者112例和年龄、性别匹配的对照组180例,采用PCR-AFLP技术对ACE基因I/D位点进行分型。 结果单因素分析提示病例组收缩压水平（138.1±19.7 mmHg）显著高于对照组（126.6±20.6 mmHg）（t=4.716,P<0.001）;病例组舒张压水平（88.9±10.1 mmHg）显著高于对照组（79.9±10.0 mmHg）（t=7.450,P<0.001）。病例组中ACE基因I/D位点D等位基因频率和DD基因型频率分布均显著高于对照组（等位基因:χ2=4.953,P=0.026; 基因型:χ2=6.303,P=0.043）。病例组和对照组中ACE基因I/D位点基因型DD携带者收缩压及舒张压水平显著高于基因型ID及II携带者。 结论ACE基因I/D位点等位基因D可能是汉族人群动脉血栓性脑梗死遗传易感基因。等位基因D可能通过升高个体血压的机制导致动脉血栓性脑梗死发生。       

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.