正常大鼠脑CT灌注成像的可重复性研究

目的:评价多层螺旋CT灌注成像对正常大鼠脑血流动力学观测结果的可重复性.方法:分别对10只健康Wistar大鼠间隔2d进行CT灌注扫描,两组原始灌注数据由2名放射科医师分别进行5次后处理得出CBF、CBV和MTT值.分析观察者内和观察者间观测结果的可重复性,以及对同一组研究对象间隔2d两次检查结果的一致性.结果:多层螺旋CT对Wistar大鼠脑所采集的灌注原始数据在观察者内和观察者间观测结果均无统计学差别(P＞0.05),并具有很好的线性(CBF和CBV值)或等级(MTT值)正相关(P＜0.01).对同一组研究对象间隔2d的两次CT灌注成像结果也存在同样好的重复性.结论:多层螺旋CT灌注成像对于Wistar大鼠脑部血流动力学观测具有很高的精密度和准确性,完全适于小型动物模型脑部血流动力学的研究.     

基于供给侧视角的我国分级诊疗相关问题思考

自习近平总书记首次提出供给侧改革以来,“供给侧”作为经济改革新词逐渐在医疗领域也引起热议,继续推行分级诊疗制更有现实必要性。从医疗服务提供者和相关配套措施角度详细分析了我国分级诊疗供给侧存在的问题,并提出逐步剥离医院门诊服务、加大对基层的投入力度和加强不同医疗机构的协作的建议。     

Calcitonin-like peptide hormone (CT/DH) in the frontal ganglia as a feeding regulatory peptide of the silkworm,Bombyx mori

The frontal ganglion (FrG) in insects contributes to the modulation of feeding behavior via the regulation of foregut contraction and other neural networks. Profiling the peptides of the FrG is important to understand endocrine regulation of feeding behavior in insects. High-resolution spiral matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identified an ion peak, corresponding to calcitonin-like diuretic hormone 31 (CT/DH) in the FrG of silkworm Bombyx mori larvae. RT-PCR confirmed that CT/DH is expressed in the FrG, as are other peptide hormones, including allatoregulatory peptides. A feeding latency assay using synthetic CT/DH revealed that it increases the time to the initiation of feeding in a dose-dependent manner. These data indicate that CT/DH is a candidate regulatory peptide that modulates the feeding behavior of B. mori.     

胎盘发育过程中的表观遗传学改变及其相关疾病

胎盘介于胎儿与母体之间,是维持胎儿宫内生长发育的重要器官。在胎盘的正常发育过程中,子宫正常蜕膜化、滋养层细胞粘附与侵袭、胎盘血管生成与形成、胎盘印记基因表达都受到表观遗传修饰(如DNA甲基化、组蛋白修饰、非编码RNA等)的调控。研究已经证实环境因素如重金属、化合物、现代辅助生殖技术、营养物质均可导致胎盘上多种基因的表观遗传修饰异常。此外,胎盘基因表达存在性别差异也可能与表观遗传修饰有关。目前,在临床上可运用产前DNA甲基化水平分析技术检测异常的表观遗传修饰,并在疾病早期发现并做出诊断,从而为疾病预防及治疗提供依据。本文对胎盘正常发育过程中表观遗传修饰的调控及环境因素所致的胎盘基因表观遗传改变进行了综述,以期对胎盘相关疾病的诊断与治疗提供借鉴和参考。     

Strengthening the laboratory diagnosis of pathogenic Corynebacterium species in the Vaccine era

Over the last three decades, successful implementation of the diphtheria vaccination in the developed and developing countries has reduced the infections caused by the toxigenic strains of Corynebacterium diphtheriae, but a concomitant increase in the invasive infections due to the nontoxigenic strains was seen. In addition, the recent reports on the emergence of nontoxigenic toxin gene‐bearing strains, having the potential to revert back to toxigenic form poses a significant threat to human beings. Besides infections caused by C. diphtheriae, the emergence of the respiratory, cutaneous and invasive infections by related pathogenic Corynebacterium species like C. ulcerans and C. pseudotuberculosis, complicate the diagnosis and management of infection. These observations together with the widespread prevalence of diphtheria in the vaccine era, necessitates the strengthening of the epidemiological surveillance and laboratory diagnosis of the pathogen. This review provides the overview of the advantages and limitations of different molecular methods and the role of MALDI‐TOF in the laboratory diagnosis of Diphtheria. The contribution of next generation sequencing technology and different genotyping techniques in understanding the pathogenicity, transmission dynamics and epidemiology of the C. diphtheriae is discussed.     

Plasma levels and diagnostic utility of VEGF,MMP-2 and TIMP-2 in the diagnostics of breast cancer patients

Objective: We investigated plasma levels and diagnostic utility of vascular endothelial growth factor VEGF, matrix metalloproteinase-2 (MMP-2) and tissue inhibitors of metalloproteinase-2 (TIMP-2) in comparison to cancer antigen 15-3 (CA 15-3).

Methods: Plasma levels of tested parameters were determined using enzyme-linked immunosorbent assay (ELISA) while CA 15-3 with chemiluminescent microparticle immunoassay (CMIA).

Results: The plasma levels of VEGF, TIMP-2 showed significantly higher than CA 15-3 values of the diagnostic sensitivity, the predictive values of positive and negative test results (PPV, NPV) and the area under the receiver-operating characteristics (ROC) curve (AUC) in early stages of breast cancer (BC). The combined use of the tested parameters with CA 15-3 resulted in the increase in sensitivity, NPV and AUC, especially in the combination with VEGF (83%; 72%; 0.888) and TIMP-2 (83%; 72%; 0.894). The highest values were obtained for combination of all three parameters (93%; 85%; 0.923).

Conclusions: These findings suggest the usefulness of the tested parameters in the diagnosis of BC, especially VEGF and TIMP-2 with CA 15-3 in early stages of BC, which could be a new diagnostic panel.     

The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin

Purpose: In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase.

Materials and methods: In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model. Multivariable Cox regression modelling was used to estimate the predictive value of both biomarkers.

Results: In total, 178 (19%) cases had AMI. The AUC for hs-cTnT was 0.81. Adding copeptin increased the AUC to 0.85 (p?=?0.004) and the combined model allowed a prehospital rule-out of 45% of cases without AMI (negative predictive value, NPV 98%). Both biomarkers are highly predictive of outcome.

Conclusions: A future application of hs-cTnT and copeptin measurement, performed already in the prehospital phase, could potentially improve the prehospital diagnostic and prognostic classification of patients with a suspected AMI.     

Detection of Fomitiporia torreyae and Fulviformes umbrinellus by multiplex loop‐mediated isothermal amplification (mLAMP) for diagnosis of Japanese pear dwarf

Japanese pear dwarf, caused by the fungi Fomitiporia torreyae or Fulviformes umbrinellus, is one of the most important diseases affecting Japanese pear (Pyrus pyrifolia var. culta). To diagnose this disease, a multiplex loop‐mediated isothermal amplification (mLAMP) reaction using primer sets designed from the rDNA internal transcribed spacer (ITS) sequences of F. torreyae and F. umbrinellus was developed. The optimal conditions for simultaneous detection of the two pathogens were investigated. The best results were obtained at a reaction temperature of 65°C and a primer ratio of 1:1.5 (F. torreyae : F. umbrinellus). Fluorescently labelled mLAMP amplicons were precipitated using polyethyleneimine. As a result, multiplex detection was enabled by the fluorescent colour of precipitate under ultraviolet light. The detection limit of mLAMP was 100 fg of genomic DNA, which was 10 times more sensitive than the polymerase chain reaction (PCR) method. The mLAMP assay was applied to Japanese pear trunk samples from Aichi Prefecture, Japan, and the results were compared with those obtained using PCR. As a result, mLAMP was observed to be effective for the specific detection of F. torreyae or F. umbrinellus.     

精准医疗与结核病

精准医疗概念的提出开启了一个医学新时代,且在世界范围内引起了一场科技竞争。精准医疗的实质包括精准诊断和精准治疗,其具体内容,结合各国实际情况各不相同。对中国而言,慢性传染病特别是结核病造成了严重疾病负担,应作为重点研究对象,实际上该领域中各种形式的精准医疗已然展开。精准医疗作为一种新的理念,贯穿于结核病的研究和治疗中,势必对人类结束结核病的肆虐和消除结核病作出重大贡献。