lncRNA RP11-86H7.1在川崎病诊断中的临床意义

目的：探讨lncRNA RP11-86H7.1在川崎病（KD）患者血清中的表达及其与临床病理特征及预后的关系。方法：筛选KD特异相关的循环lncRNA，分KD治疗前患儿组、KD治疗后患儿组、普通发热患儿组及健康儿童组，采用qPCR检测各组血清lncRNA RP11-86H7.1相对表达。分析血清lncRNA RP11-86H7.1相对表达与KD临床病理特征间关系；绘制ROC曲线，分析血清lncRNA RP11-86H7.1表达水平对KD的诊断效能。结果：KD急性患儿组血清lncRNA RP11-86H7.1相对表达量高于各对照组（P＜0.05）；年龄和性别比例与低表达组比较差异无统计学意义（P＞0.05）；qPCR发现lncRNA RP11-86H7.1在KD急性期患儿血清中表达水平明显高于KD恢复期、健康儿童及发热儿童组，差异均有统计学意义（P＜0.05）。结论：血清lncRNA RP11-86H7.1在KD患者中表达上调，其可作为KD早期诊断和评估预后的潜在的生物标志物。     

H型高血压患者舌面诊图像颜色特征参数分析＊

目的 分析H型高血压患者的舌面诊图像颜色参数特征，探讨H型高血压患者的舌诊、面诊变化规律。方法 运用上海中医药大学自行研制的Smart TCM-1型中医舌面一体仪，采集高血压患者舌面诊图像，提取特征参数，分析健康对照组、H型高血压组与非H型高血压组患者舌面颜色参数特征。结果 ①在舌色各项参数中，H型高血压组舌尖部R值、B值、V值均显著小于健康对照组（P < 0.01）；非H型高血压组舌尖部B值显著小于健康对照组（P < 0.01），S值较健康对照组显著增大（P < 0.05）；H型高血压组舌尖部R、V值均明显小于非H型高血压组（P < 0.05）。在舌苔各项参数中，H型高血压组舌中H值、V值均明显小于健康对照组（P < 0.05）；非H型高血压组舌中V值、舌右V值均显著小于健康对照组（P < 0.01）；H型高血压组舌中H值明显小于非H型高血压组（P < 0.05），右侧舌苔S值明显大于非H型高血压组（P < 0.05）。②H型高血压组面色参数鼻G值、下颌G值、口唇R值、口唇V值均明显小于健康对照组（P < 0.05）；非H型高血压组前额H值、目眶H值、脸颊H值、鼻H值、下颌H值、整体H值均明显大于健康对照组（P < 0.05）；H型高血压组前额H值、目眶G值、目眶H值、脸颊H值、鼻G值、鼻H值、下颌R值、下颌G值、下颌H值、下颌V值、口唇R值、口唇G值、口唇V值、整体R值、整体G值、整体H值、整体V值均明显小于非H型高血压组（P < 0.05）。结论 H型高血压患者苔色偏黄，以舌中部为主，且舌右侧黄苔积聚较明显；H型高血压患者面色为黄中带红，口唇、下颌部更为晦暗。H型高血压患者的舌、面诊特征参数的变化，与高血压病阳亢湿盛病机相符。     

附件炎性包块的诊断

附件炎性包块是指盆腔炎性疾病引起的附件区包块，多由性传播疾病的病原体（如淋病奈瑟菌和沙眼衣原体）感染引起，性生活活跃的年轻女性是高危人群。附件炎性包块会严重影响女性的生殖健康，故预防重于治疗。盆腔炎性疾病的临床表现差异较大，尚无敏感且特异的实验室检查指标，阴道超声诊断附件炎性包块的准确性较高，是临床常用的检查手段。     

血浊证的诊断标准与疗效评价

血浊理论是从整体观念出发,综合考虑医学、现代科学和社会发展的现状,遵循辨证论治的原则,提出的对疾病防治具有现实意义的一种全新理论。克服传统中医诊断没有定性定量的缺点,制定血浊证规范的证候诊断和临床疗效评价标准,将有效地丰富辨证论治的内容,增强辨证论治的依据,推进中医理论和临床的应用及发展。     

CA153联合CA199对良恶性腹腔积液的鉴别诊断价值

目的探讨腹腔积液中CA153联合CA199对良恶性腹腔积液的鉴别诊断价值。方法选择98例腹腔积液患者,经手术病理诊断为恶性腹腔积液者为观察组(48例),良性腹腔积液者为对照组(50例)。检测并比较2组患者腹腔积液中的CA153、CA199水平及CA153、CA199的阳性结果,分析CA153及CA155单用及联合应用对恶性腹腔积液的诊断效能。结果观察组腹腔积液中的CA153及CA199水平均明显高于对照组,P <0. 05。观察组CA153及CA199阳性率明显高于对照组,P <0. 05。CA153、CA199对恶性腹腔积液诊断的敏感性、特异性及准确性对比,差异无统计学意义(P> 0. 05);CA153+CA199的敏感性、特异性及准确性明显高于单项CA153及CA199(P <0. 05)。结论 CA153与CA199单项检测对恶性腹腔积液的诊断价值有限,CA153+CA199对恶性腹腔积液的诊断价值较高,值得临床推广应用。     

进展型脑梗死患者miRNA的表达水平及临床意义

目的探讨进展型脑梗死患者微小RNA(miRNA)的表达水平及临床意义。方法回顾性分析2016年7月至2018年7月期间我院收治的138例脑梗死患者病例资料。根据斯堪的那维亚卒中量表(SSS)将其分为对照组(稳定型脑梗死,82例)和观察组(进展型脑梗死,56例)。观察组患者按照高级中枢损伤严重程度评定标准(MESSS)评分为轻度进展(30例)、中度进展(17例)、重度进展(9例)三个亚组。对观察组出院两个月后进行预后随访,并将其分为预后不良组及预后良好组。分析进展型脑梗死患者miRNA的表达水平及临床意义。结果进展型脑梗死患者的miRNA-21、miRNA-223水平均显著高于稳定型脑梗死患者(P 0. 05); miRNA-21、miRNA-223的高表达均是进展型脑梗死的危险因素(P 0. 05),且进展型脑梗死的严重程度与血清miRNA-21、miRNA-223的表达水平均呈正相关(r=0. 834,P=0. 008;r=0. 896,P=0. 001)。预后不良组患者血清miRNA-21、miRNA-223表达水平显著高于预后良好组(P 0. 05);血清miRNA-21、miRNA-223表达水平预测进展型脑梗死预后的AUC面积分别为0. 805、0. 834,并分别得出截断值4. 45 (敏感度77. 14%,特异性82. 28%)、7. 06(敏感度82. 86%,特异性73. 42%)。结论进展型脑梗死患者miRNA-21、miRNA-223呈高表达,且其表达水平与脑梗死严重程度呈正相关,同时对预测进展型脑梗死预后均具有较高的敏感度和特异度,有可能成为一种早期诊断和预测进展型脑梗死生物标志物。     

Hacia el buen gobierno por la salud: incorporación de la diversidad de percepciones en salud urbana

ObjectiveTo analyse the similarities and differences in the discourse surrounding the conceptualisation of health and the perceived health assets and needs in the neighborhoods and city of Bilbao in a participatory process.MethodParticipatory workshops were held with professionals, neighbors and associated citizens. The differences in perceptions of the three content blocks were analysed on the basis of the health model referred, as well as the typologies —of a more individual or structural nature— of identified health needs and assets.ResultsThe conceptualisation of health from a biopsychosocial perspective was clearer among professionals, although both profiles pointed to the importance of its social determinants. The formulation of needs and assets in health by the neighbors was made from the impact on their daily life and from a position of users with respect to a service provider administration. Among the associated citizens and professionals, intermediate and structural determinants were more frequently mentioned, as well as issues related to the administration's scope of action.ConclusionsThe inclusion of the multiplicity and diversity of perceptions in planning is key to good local government for health. To address their contradictions, a commitment by governments to effectively incorporate citizen participation is needed.     

Molecular study of hypersensitivity to spores in adults and children from Castile & Leon

Introduction and objectivesBiological aerosols play a vital role in the interactions between the atmosphere, biosphere, climate and public health and fungal spores are a component with allergic importance.We constructed a database in Castile & Leon (Spain) and carry out molecular-level component-resolved diagnosis to complete the air quality study carried out since 2006 by our aerobiological network (RACYL) to aid clinical diagnosis and treatment.MethodsWe reviewed a database of 19,774 patients (adults and children) with allergic respiratory disease treated in our unit during the last 12 years. We also made a component-resolved diagnosis of the molecules involved in the pathology in a randomly selected population of 150 patients.ResultsThe dimeric glycoprotein Alt a1 from Alternaria is the most prevalent and most useful allergen in the diagnosis of patients with allergy to fungi in our area (94.4%), followed by enolase Alt a 6 (Alternaria), ribonuclease Asp f 1 of Aspergillus and mannitol dehydrogenase from Cla h 8 (Cladosporium).ConclusionsOur results have helped determine which spore molecules are most-closely associated with allergies. Molecular analysis will be useful to determine more accurate and useful immunotherapy in these patients.     

Congenital high airway obstruction syndrome (CHAOS): Natural history,prenatal management strategies,and outcomes at a single comprehensive fetal center

PurposeCongenital high airway obstruction syndrome (CHAOS) is a devastating fetal condition of complete airway discontinuity resulting in significant hydrops and extreme lung hyperplasia. It is universally fatal with survival reported only in the rare spontaneous fistulization or EXIT intervention (Ex Utero Intrapartum Treatment). Even in these cases, mortality remains high, and current investigations are targeting prenatal interventions. This report describes our experience with management and fetal interventions for CHAOS, including laser laryngotomy.MethodsWe retrospectively reviewed all patients diagnosed with CHAOS at a single academic institution between 2006 and 2017.ResultsFifteen patients were identified. Eight had obstruction at the trachea and seven at the larynx. In the laryngeal obstructions, three expired shortly after birth, and one survived after spontaneous fistulization and subsequent EXIT to tracheostomy. The remaining three underwent in-utero treatment with laser laryngotomy. One had preterm premature rupture of membranes (PPROM), delivered 3 days post-operatively, and died. Two underwent EXIT to tracheostomy with one surviving to discharge and is currently 2 years old.ConclusionOur study demonstrates the outcomes of a large series of patients diagnosed with CHAOS. While mortality remains high, options for fetal intervention are being explored to allow alterations in the prenatal natural history and improve postnatal outcomes.Type of StudyRetrospective Treatment Study.Level of EvidenceLevel IV.