不同病情急性呼吸窘迫综合征患者血清铁蛋白、血管生成素样蛋白4、降钙素原与白蛋白比值的变化及对预后的评估价值

摘要 目的：探讨不同病情急性呼吸窘迫综合征（ARDS）患者血清铁蛋白、血管生成素样蛋白4（ANGPTL4）、降钙素原与白蛋白比值（PAR）的变化及对预后的评估价值。方法：选取2019年3月至2022年6月四川大学华西第四医院重症医学科收治的109例ARDS患者,根据氧合指数（PaO₂/FiO₂）将患者分为轻度组（200 mmHg＜PaO₂/FiO₂≤300 mmHg,38例）、中度组（100 mmHg＜PaO₂/FiO₂≤200 mmHg,42例）、重度组（≤100 mmHg,29例）。检测所有ARDS患者血清铁蛋白、ANGPTL4水平及PAR,根据患者入院后28 d内生存状况将其分为存活组（69例）、死亡组（40例）。多因素Logistic回归分析ARDS患者入院后28 d内死亡的危险因素。受试者工作特征（ROC）曲线分析血清铁蛋白、ANGPTL4、PAR评估ARDS患者预后的预测价值。结果：重度组血清铁蛋白、ANGPTL4、降钙素原及PAR高于中度组和轻度组（P＜0.05）,血清白蛋白水平低于中度组和轻度组（P＜0.05）。死亡组血清铁蛋白、ANGPTL4、降钙素原及PAR高于存活组（P＜0.05）,血清白蛋白水平低于存活组（P＜0.05）。高SOFA评分、高PAR及血清铁蛋白、ANGPTL4水平升高是 ARDS患者入院28 d内死亡的危险因素（P＜0.05）。联合血清铁蛋白、ANGPTL4、PAR三项指标预测ARDS患者预后的曲线下面积为0.867,高于单独指标预测的0.775、0.727、0.776。结论：ARDS患者血清铁蛋白、ANGPTL4水平及PAR增高与病情加重以及预后不良有关,联合检测三项指标在ARDS患者预后评估中具有较高价值。     

玉肤解毒膏治疗结直肠癌患者卡培他滨化疗所致手足综合征的疗效观察

摘要 目的：观察玉肤解毒膏治疗结直肠癌患者卡培他滨化疗所致手足综合征的临床疗效,为临床提供合理治疗方案。方法：选择2021年月-2022年5月湖南省肿瘤医院门诊或住院部确诊为结直肠癌行含卡培他滨方案化疗所致手足综合征患者60例。所有患者采用抛掷硬币法分为玉肤解毒膏组和尿素软膏组,各30例。玉肤解毒膏组采用玉肤解毒膏治疗;尿素软膏组采用尿素软膏治疗,2组均连续治疗21 d。观察2组手足综合征分级改善情况、临床疗效、中医证候积分、疼痛视觉模拟评分（VAS）、手足皮肤反应生活质量量（HF-QoL）评分及焦虑自评量表（SAS）评分。结果：玉肤解毒膏组在降低手足综合征分级及提高治疗总有效率上均优于尿素软膏组（P＜0.05）;治疗后2组中医证候积分、VAS评分、HF-QoL评分及SAS评分较治疗前降低（P＜0.05）,且玉肤解毒膏组均低于尿素软膏组（P＜0.05）。结论：玉肤解毒膏治疗结直肠癌患者卡培他滨化疗所致手足综合征的临床疗效确切,可有效降低患者临床分级,降低中医证候积分、缓解疼痛症状,改善患者生活质量及焦虑状况,具有一定的临床应用价值。     

游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示,妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。     

原发性肾病综合征合并血栓栓塞的临床研究

摘要 目的：肺栓塞及下肢深静脉血栓是影响肾病综合征(Nephrotic Syndrome,NS)预后的重要因素,但在其发生率以及治疗方面仍存在争议。本文将通过回顾性的病例研究对NS患者中血栓栓塞事件的发生率、危险因素以及是否需要早期干预等问题进行探讨。方法：收集上海交通大学医学院附属新华医院肾内科2014年1-12月诊断为原发性NS患者,并同时收集患者基本临床信息,血栓检查结果以及NS相关血液及尿液检查结果等在内的临床资料,采用多种统计方法分析血栓发生率及其危险因素,并进一步讨论NS患者的预防性抗凝措施。结果：NS患者下肢静脉血栓或肺栓塞的发生率均为15.4%,两种血栓同时发生的概率为9.6%。NS患者血栓事件的发生率与D-二聚体、血浆白蛋白、病程、病理类型呈明显相关,且具有统计学意义。结论：NS患者血栓栓塞的发生率与D-二聚体、血浆白蛋白、病程、病理类型呈显著相关,膜性肾病患者血栓栓塞发生率最高。如NS患者合并高危因素,建议定期筛查,综合评估后预防性抗凝。     

L-Tryptophan: Biochemical,nutritional and pharmacological aspects

Summary Tryptophan is important both for protein synthesis and as a precursor of niacin, serotonin and other metabolites. Tryptophan is an unusual amino acid because of the complexity of its metabolism, the variety and importance of its metabolites, the number and diversity of the diseases it is involved in, and because of its use in purified form as a pharmacological agent. This review covers the metabolism of tryptophan, its presence in the diet, the disorders associated with low tryptophan levels due to low dietary intake, malabsorption, or high rates of metabolism, the therapeutic effects of tryptophan and the side effects of tryptophan when it is used as a drug including eosinophilia myalgia syndrome.     

非线性映射和聚类分析在中风病证候分类中的应用

本文用非线性映射和聚类分析方法,给出了中风病的四个类型,为中风病的证候分类提供了分析方法和信息．     

艾滋病合并隐球菌感染17例尸检材料的临床病理学研究

在１５１例艾滋病尸检材料中发现１７例合并隐球菌感染,均经病理学确诊,患者男１５名,女２名,平均４３．６岁。１２例发生脑膜炎、肺炎和淋巴结炎各７例,尚见脾（６例）、肾（５例）等器官受累。９例为播散性感染。病变为慢性肉牙肿性,其中见有隐球菌。本文描述隐球菌性脑膜炎、肺炎等临床病理学表现,并讨论其病变特征与病理诊断问题。     

A 19-kb CpG Island Associated with Single-minded Gene 2 in Down Syndrome Chromosomal Region

To help in isolating the genes involved in Down syndrome, wesought CpG islands in 4 Mb cosmid/PAC contigs spanning mostof the 21q.22.2 band using seven rare cutting enzymes. A strikingfeature was observed upstream of hSIM2 where at least 41 rare-cuttingsites were clustered within a 20-kb region. To investigate thestructure of the cluster, a cosmid containing hSIM2 was submittedto shotgun sequencing. Sequence analysis revealed that the clusterwas a long CpG island extending 19, 128 nucleotides which includesin the first and second exons of hSIM2. Taken together withour observation in which the CpG islands were concentrated within1.2 Mb around hSIM2, we propose that this region functions asan R-band, and the cluster provides a unique element for markingof DNA for the spatial and temporal expression of the hSIM2locus.     

The genomic sequence for Prader-Willi/Angelman syndromes' loci of human is apparently conserved in the great apes

Chromosomal changes through pericentric inversions play an important role in the origin of species. Certain pericentric inversions are too minute to be detected cytogenetically, thus hindering the complete reconstruction of hominoid phylogeny. The advent of the fluorescence in situ hybridization (FISH) technique has facilitated the identification of many chromosomal segments, even at the single gene level. Therefore the cosmid probe for Prader-Willi (PWS)/Angelman syndrome to the loci on human chromosome 15 [ql 1-12] is being used as a marker to highlight the complementary sequence in higher primates. We hybridized metaphase chromosomes of chimpanzee (PTR), gorilla (GGO), and orangutan (PPY) with this probe (Oncor) to characterize the chromosomal segments because the nature of these pericentric inversions remains relatively unknown. Our observations suggest that a pericentric inversion has occurred in chimpanzee chromosome (PTR 16) which corresponds to human chromosome 15 at PTR 16 band pl 112, while in gorilla (GGO 15) and orangutan (PPY 16) the bands q11-12 complemented to human chromosome 15 band q11-12. This approach has proven to be a better avenue to characterize the pericentric inversions which have apparently occurred during human evolution. Genetic divergence in the speciation process which occurs through chromosomal rearrangement needs to be reevaluated and further explored using newer techniques.Correspondence to: R.S. Verma