CALU(rs2307040)基因多态性与华法林稳定剂量的关系研究

目的:探讨CALU(rs2307040)基因型在中国汉族人群中的分布情况及其基因多态性与瓣膜置换术后华法林稳定剂量的相关性。方法:采用Snapshot技术检测226例研究对象CALU(rs2307040)位点基因型,研究其基因型及等位基因频率;比较其中176例瓣膜置换术患者基因多态性与华法林稳定剂量的相关性。结果:226例研究对象,CALU(rs2307040)位点基因型AA、AG和GG分别有0、40和186例,各占0%、17.7%和82.3%,A和G等位基因的频率分别为8.8%和91.2%;176例瓣膜置换术后患者服用华法林达稳定状态,AA型未检出,AG组与GG组比较,华法林日维持剂量、INR值和PT值均无显著统计学差异。结论:中国汉族人群CALU(rs2307040)基因多态性可能不是瓣膜置换术后华法林个体剂量差异的影响因素。     

新疆汉族GGCX基因rs11676382位点多态性与心房颤动的相关性研究

目的研究汉族GGCX基因rs11676382位点多态性与心房颤动(AF)的相关性。方法以200例汉族未服用华法林的心房颤动患者作为研究组,200例健康汉族患者作为对照组,所有患者均采集外周血提取基因组DNA,采用聚合酶链反应,限制性片段长度多态性技术(PCRRFLP)检查患者GGCX基因rs11676382多态性的基因型和等位基因频率分布,观察GGCX基因rs11676382多态性与心房颤动的关系。结果GGCX基因rs11676382位点在入选人群中的基因型及等位基因分别为CC、CG和GG型,其基因型频率在心房颤动组和对照组分别依次为82.5%、16.5%、1.0%和85.0%、0.5%、14.5%,分布趋势相同,差异无统计学意义(P0.05);C和G等位基因频率在心房颤动组和对照组分别为99.0%,1.0%和99.5%,0.5%,C和G等位基因频率在两组间的差异无统计学意义(P0.05)。结论 GGCX基因rs11676382多态性与未服用华法林的心房颤动无相关性。     

华法林相关基因SNPs在心脏瓣膜置换汉族患者中的分布调查

目的:探索心脏瓣膜置换的汉族患者中华法林相关基因SNPs的分布。方法:入选2012年至2013年上海市在中山医院行心脏瓣膜置换手术后,需长期服用华法林进行抗凝治疗的汉族患者110例,通过阅读文献筛选得到华法林相关基因及相应SNPs位点(CYP2C9 rs1799853 C/T、CYP2C9rs1057910 A/C、VKORC1 rs9923231 G/A、VKORC1 rs9934438 C/T、CYP4F2 rs2108622 C/T、GGCX rs12714145 A/G、EPHX1 rs1877724 C/T、EPHX1 rs2292566 A/G、EPHX1 rs4653436 A/G)。使用直接测序法检测SNPs,采用Hardy-Weinberg遗传平衡检验验证群体代表性。结果:CYP2C9基因rs1799853、rs1057910等位基因频率分别为0.45%、5.00%;VKORC1基因rs9923231、rs9934438等位基因频率均为91.36%;CYP4F2基因rs2108622等位基因频率为28.64%;GGCX基因rs12714145等位基因频率为33.18%;EPHX1基因rs1877724、rs2292566和rs4653436等位基因频率分别为30.00%、24.55%、26.36%。结论:探索华法林相关基因CYP2C9、VKORC1、CYP4F2、GGCX、EPHX1的9个SNPs的频率在行心脏瓣膜置换术的患者人群中的分布,对建立和实施华法林个体化治疗具有重要意义。     

云南汉族人群VKORC1￣1639A/G基因多态性与华法林抗凝治疗剂量的相关性研究

目的研究云南汉族人群维生素K环氧化物还原酶复合体亚单位1(VKORC1)-1639A/G基因多态性的分布及与其他民族间的差异,为临床应用华法林初始剂量及维持剂量提供分子遗传学依据,以提高病人应用华法林的依从性。方法采集300例心脏机械瓣膜置换术后服用华法林,INR值在1.5~3.0患者的外周血液,通过聚合酶链式反应(英简PCR)结合限制性片段长度多态性(英简RFLP)分析技术,评价VKORC1-1639 A/G基因的基因型。结果所有样本中,AA型为204例(占68%)、AG型为87例(占29%)、GG型为9例(占3%),等位基因A占82.5%,等位基因G占17.5%。所需华法林维持剂量GG型(4.83±1.15 mg/d)AG型(3.57±1.62mg/d)AA型(2.72±1.35)mg/d。此外,云南汉族人群VKORC1-1639A/G基因多态性分布在性别和年龄上无差异,但与高加索等欧美人群相比存在较大的差异,与VKORC1 1173 C/T及VKORC1 3730 A/G存在高度连锁不平衡。结论 VKORC1基因多态性是一项对华法林个体间用量之间的差异有所影响的重要遗传因素,其还能够对患者VKORC1-1639位点给予准确基因分型,可指导华法林个体化用药的治疗。     

中国汉族人群CYP2C9和VKORC1基因多态性对华法林用药的影响

目的 探讨中国汉族人群细胞色素氧化酶P450 2C9(CYP2C9)基因以及维生素K环氧化物还原酶复合体1(VKORC1)基因多态性对华法林用药的影响。方法 首先抽取无抗凝障碍的汉族人群受试者200例利用基因测序法进行CYP2C9 和VKORC1基因分型(正常对照组)。并收集临床使用华法林稳定维持剂量的汉族人群患者114例(服用华法林药物组),记录患者年龄、性别、身高、体质量以及体表面积等,检测基因型并结合体征差异及临床稳定剂量进行分析。结果 正常对照组的CYP2C9基因型检测有CYP2C9*1/*1型186例(93%),未发现CYP2C9*1/*2型,CYP2C9*1/*3型14例(7%); VKORC1-1639A/G基因型:AA型179例(89.5%),GA型21例(10.5%),未发现GG型(0.0%); 服用华法林药物组的CYP2C9*1/*1型104例(91.2%),CYP2C9*1/*3型10例(8.8%),CYP2C9*1/*1型患者华法林平均维持剂量高于CYP2C9*1/*3型患者[(2.13±0.83)mg/dvs(1.61±1.17)mg/d,P＜0.05]。VKORC1(-1639G＞A)基因型检测有102例患者为突变纯合子AA型(89.5%),12例患者为杂合子GA型(10.5%),未发现纯合子GG型患者,GA型患者华法林平均维持剂量明显高于AA型[(3.34±1.07)mg/d vs(1.63±0.45)mg/d,P＜0.01]。正常人群组与服用华法林药物组基因型在CYP2C9*3(1075C/A)(P=0.926)和VKORCl -1639A/G突变上的差异无统计学意义(P=0.812)。结论 中国汉族人群存在CYP2C9*3 A/C 和VKORC1-1639G/A 的基因多态性,且不同基因型患者间华法林用量存在差异。     

海南省黎族与汉族持续性心房颤动患者CYP2C9^*3基因多态性差异

目的:分析罹患持续性心房颤动的海南省黎族与汉族患者细胞色素P450酶2C9^*3(CYP2C9^*3)基因多态性分布,评估CYP2C9^*3基因多态性对患者稳定服用华法林剂量的影响。方法:选取2017年1月至2018年12月于海南医学院第二附属医院就诊的罹患持续性心房颤动的海南省黎族患者100例为研究组,同期海南医学院第二附属医院持续性心房颤动的汉族患者100例为对照组。记录两组研究对象的血清华法林浓度、国际标准化比率(international normalized ratio,INR)达标时间、华法林平均日剂量及总剂量;提取两组基因组DNA,采用扩增阻滞突变体系-聚合酶链式反应技术(amplification refractory mutation system,ARMS-PCR)对CYP2C9^*3基因位点进行基因分型。结果:研究组患者A/A与A/C基因型及等位基因A频率显著低于对照组(P<0.05),C/C基因型及C频率显著高于对照组(P<0.05)。两组不同基因型患者华法林稳定剂量及血清华法林浓度存在差异,均为A/A型最大(P<0.05),而A/C型与C/C型无差异(P>0.05);研究组A/A基因型患者华法林稳定剂量及血清华法林浓度低于对照组(P<0.05),但两组A/C与C/C基因型患者华法林稳定剂量及血清华法林浓度均无差异(P>0.05)。A/A基因型黎族持续性心房颤动患者的INR达标时间、华法林平均日剂量及总剂量最高,C/C基因型最低,A/C基因型次之(P<0.05)。结论:CYP2C9基因多态性与持续性心房颤动的海南省黎族患者稳定服用华法林剂量密切相关,C/C型CYP2C9基因持续性心房颤动的海南省黎族患者INR达标时间、华法林平均日剂量及总剂量更低。     

基质辅助激光解吸电离飞行时间质谱技术检测华法林代谢酶基因多态性

目的用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF-MS)技术建立检测人群中华法林代谢酶基因多态性的方法。方法选取2011年1月至2013年1月北京安贞医院心脏外科心脏机械瓣膜置换术后接受华法林抗凝治疗的患者10例,采集外周血,提取全血基因组DNA,用MALDI-TOF-MS技术检测10例患者华法林代谢酶基因CYP2C9*2(rs1799853)、CYP2C9*3(rs1057910)、CYP2C9*6(rs9332131)、VKORC1 CT(rs9923231)(-1639GA)、GGCX GC(rs11676382)的单核苷酸多态性(SNP)位点,并用Sanger测序法进行验证。结果用MALDI-TOF-MS技术可以同时完成10份标本3个华法林代谢酶基因5个SNP位点的检测。10名服华法林的心脏机械瓣膜置换术患者中,发现VKORC1-1639GA AG型2例,AA型8例,A等位基因频率为90%。未发现CYP2C9*2(rs1799853)、CYP2C9*3(rs1057910)、CYP2C9*6(rs9332131)和GGCX GC(rs11676382)突变。经与Sanger测序法比较,符合率为100%。结论成功建立MALDI-TOF-MS技术检测华法林代谢酶基因多态性的平台,该法具有高通量、快速、准确的特点,在个性化医疗上有较大的推广应用价值。     

换瓣术后华法林维持量与mEH ApoE基因多态性的相关性研究

目的探讨mEH基因T612C、A691G位点sNP及ApoE基因型在中国汉族人群中的分布,并探讨华法林维持剂量与其相关性。方法共选取52例换瓣术后患者以及68例健康汉族个体。瓣膜置换术后个体根据国际化标准比值（INR）控制在1．5～2．2,调整华法林维持剂量,采用PCR-RFLP技术检测ApoE基因型、Pyrosequencing法检测mEHT612C及A691GSNP。结果（1）在120个受测试人群中,mEHT612C等位基因频率分别为74．6％和25．4％;而mEHA691G分别为66．7％、33．3％,换瓣人群中mEHT612C的纯合子比杂合子和野生型的所需华法林剂量要高,分别为（5．5±2．9）mg／d、（4．8±2．2）mg／d、（4．0±2．6）mg／d,三者之间剂量比较有显著性差异（P〈0．05）。（2）在120个受测试人群中,ApoE基因型等位基因E2,E3,E4的频率分别为44．2％、35．8％、20．O％;换瓣人群中各基因型所需华法林的剂量分别为（4．5±2．7）mg／d、（4．7±2．4）mg／d、（4．4±2．6）mg／d,三者之间差异无统计学意义（P〉0．05）。结论mEH基因T612C、A691G位点SNP能解释部分个体之间华法林维持剂量的差异,ApoE基因型的差异不能解释华法林维持剂量的差异。     

基于口腔黏膜脱落细胞的CYP2C9 1075A/C多态性流行病学研究

目的探讨华法林剂量相关基因CYP2C9 1075A/C多态性在江西汉族人群中的流行病分布情况。方法收集上海交大医学院附属第九人民医院急诊科门诊及病房中常规口服华法林药物的江西汉族患者680例,口拭子无创刮取口腔脱落细胞,采用PCR-限制性片段长度多态性(PCR-RFLP)法检测CYP2C9 1075A/C,统计分析CYP2C9 1075A/C在汉族人群中的分布情况。结果在680例被检病例中,CYP2 C9基因有AA和AC两种基因型被发现,分布频率分别为89.71%和10.29%,等位基因A的频率为94.85%,等位基因C的频率为5.15%。讨论CYP2C9 1075A/C多态性在中国人群中存在比较广泛,临床使用华法林药物前,应常规对病人进行CYP2C9 1075A/C检测,合理调整华法林使用剂量。     

华法林药物遗传学基因CYP2C9和VKORC1单核苷酸多态性在广东汉族人群的分布研究

目的探讨细胞色素P450(cytochrome P450, CYP450)家族中CYP2C9的单核苷酸多态性(single nucleotide polymorphisms, SNP)位点rs1057910和rs1799853以及维生素K环氧化物还原酶复合物亚基1(vitamin K epoxide reductase complex subunit 1, VKORC1)的rs9923231 SNP位点在广东汉族的分布,为华法林(warfarin)个体化用药(personalized medicine)提供循证医学依据.方法利用Sequenom MassArray? iPLEX GOLD系统对215例广东地区人群的rs1057910,rs1799853和rs9923231三个位点进行基因分型,并分析各基因型分布频率.结果 rs1799853和rs9923231在广东汉族中无多态性分布,分别只有CC基因型和CT基因型.rs1057910在广东汉族中有两种基因型AA和AC,分布频率分别为0.921和0.079;等位基因A的频率为0.9605,C的频率为0.0395.结论在本研究中由于rs1799853和rs9923231在广东汉族中无多态性分布,基于本研究数据建议广东汉族华法林药物的检测位点应以rs1057910为主.     

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.     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."