C反应蛋白与白蛋白比值对川崎病早期丙种球蛋白抵抗的预测价值

目的 探讨C反应蛋白与白蛋白比值(CRP/ALB)对川崎病(KD)早期丙种球蛋白(IVIG)抵抗的预测价值。方法 将2020年1月至2023年6月成都医学院第一附属医院住院的118例病程≤5 d的KD患儿分为IVIG抵抗组和IVIG敏感组,分析患儿临床资料,采用多因素Logistic回归分析探究独立危险因素,ROC曲线探究CRP/ALB对KD患儿早期IVIG抵抗的预测价值。结果 IVIG抵抗组比IVIG敏感组有更高水平的白细胞计数(WBC)、CRP、CRP/ALB和更低水平的血红蛋白(HGB)。CRP/ALB升高和HGB降低是KD患儿早期IVIG抵抗的独立危险因素。CRP/ALB可预测KD患儿早期IVIG抵抗(AUC=0.664)。结论 CRP/ALB升高和HGB降低是KD患儿早期IVIG抵抗的独立危险因素,CRP/ALB可有效预测KD患儿早期IVIG抵抗。     

一种小鼠肠道纤维化模型建造的方法及评价

目的 探究一种使用酒精建造C57BL/6小鼠肠道纤维化模型的方法。方法 将6周龄C57BL/6小鼠根据不同酒精浓度分为正常对照组、50%乙醇组、三硝基苯磺酸(TNBS)/30%乙醇组、TNBS/50%乙醇组,采用灌肠液灌肠方式造模,每周灌肠1次,持续5周,第6周处死后取结直肠。整个实验期间观察小鼠生存状态、体重变化及生存率,每天进行小鼠疾病活跃指数(DAI)评价。固定包埋后,采用苏木精-伊红染色检测肠道黏膜以及腺体结构完整性;马森三色染色法检测小鼠肠道胶原沉积情况;免疫组织化学染色检测纤维化蛋白α-平滑肌肌动蛋白(α-SMA)的表达量。结果 与正常对照组比较,50%乙醇组、TNBS/30%乙醇组、TNBS/50%乙醇组的黏膜破损、腺体丢失比例、纤维化蛋白α-SMA表达明显高于正常对照组,并且50%乙醇组、TNBS/30%乙醇组、TNBS/50%乙醇组的DAI评分更高、胶原沉积更多,且TNBS/50%乙醇组高于TNBS/30%乙醇组,50%乙醇组与TNBS/30%乙醇组相近。结论 与正常组比较,50%乙醇组小鼠各时间点DAI评分均明显增高,整体纤维化程度与TNBS/30%乙醇组类似,单纯使用乙醇可以建造小鼠肠道的纤维化模型。     

Challenging surgical treatment of giant retroperitoneal liposarcoma: A case report

Liposarcoma is a rare malignant tumor type and surgical resection is the gold standard treatment. The present study reported on the case of a 51-year-old woman who presented with a mass in the left upper abdomen. Computed tomography revealed a 32-cm giant retroperitoneal liposarcoma. Complete tumor resection was performed without the removal of other organs. Postoperative pathological examination indicated retroperitoneal well-differentiated liposarcoma and immunohistochemistry revealed S-100(−), MDM2(+), vimentin(+), CDK4(+), p16(+) and STAT6(+) results. The patient recovered well after the surgery. Complete tumor resection during the first surgery is key to cure liposarcoma. The present case report will be helpful for clinical oncologists to fully understand giant retroperitoneal liposarcoma and treat it accordingly.     

Total body water/fat-free mass ratio as a valuable predictive parameter for mortality in maintenance hemodialysis patients

Hydration of fat-free mass (FFM), defined as the ratio of total body water (TBW) to FFM (TBW/FFM), is stable at 0.739 in adult mammals. However, an increase in the TBW/FFM ratio is common in hemodialysis (HD) patients. This study aimed to evaluate the determinants of TBW/FFM and investigate its predictive value for the prognosis of all-cause mortality in HD patients.We enrolled patients undergoing maintenance HD between July 2020 and May 2021. All patients were prospectively followed until death, HD dropout, or until the end of the study (November 1, 2021). A forward stepwise multivariable linear regression analyses was performed to test the independent relationship between TBW/FMM and other clinical variables. Receiver operating characteristic (ROC) analysis was used to discriminate the TBW/FFM with respect to 180-day mortality.Of the 106 patients, 42 had elevated TBW/FFM levels. Multiple linear regression analysis revealed that the TBW/FFM ratio was significantly associated with extracellular water (ECW)/TBW (standardized regression coefficient [β = 1.131, P < .001], phase angle (PhA) [β = 0.453, P < .001], and sex (β = 0.440, P < .001). We calculated the ROC curve (AUC) of TBW/FFM, ECW, ECW/TBW, and intracellular water (ICW) to compare the discriminatory capacities of these parameters in predicting 180-day mortality. The AUC for TBW/FFM (AUC = 0.849; 95% CI, 0.745–0.953) exhibited better discriminatory potential than ECW (AUC = 0.562; 0.410–0.714), although it had a similar predictive potential as the ECW/TBW ratio (AUC = 0.831; 0.731–0.932). High TBW/FFM can be used as a valuable prognostic index for predicting all-cause mortality in patients on HD.     

新型冠状病毒感染相关急性黄斑区神经视网膜病变的神经眼科特征

目的：总结新型冠状病毒(SARS-CoV-2)感染相关急性黄斑区神经视网膜病变(AMN)的神经眼科特征。

方法：纳入2022-12-27/2023-02-01就诊于西安市第一医院(西北大学附属第一医院)神经眼科并经相关检查确诊为AMN的患者8例(6例女性,2例男性)共14眼纳入本次研究。所有患者病前均有SARS-CoV-2感染史。收集患者的临床资料。纳入最佳矫正视力(BCVA)、非接触间接眼压测定、眼底彩色照相、近红外成像(IR)、频域光学相干断层扫描(SD-OCT)、OCT血流成像(OCTA)、眼底荧光素血管造影(FFA)、吲哚菁绿血管造影(ICGA)、视野、视觉诱发电位(VEP)和视网膜电流图(ERG)检查结果。对纳入患者的神经眼科特征进行分析总结。

结果：纳入的8例患者年龄20-43(平均30±6.63)岁。病前3-11(平均5±3.51)d有SARS-CoV-2感染史,8例患者中有6例在感染SARS-CoV-2的5 d内出现视觉症状。患者的临床表现为视力下降或视物遮挡感; 纳入患者的视力0.08-1.0; 视野缺损表现为中心、旁中心暗点或合并周边暗点。VEP可见P100或P2峰时延迟; ERG提示视网膜感光细胞 功能受损。在疾病早期,SARS-CoV-2感染相关AMN患者可能存在视力、视野和视网膜外层病变大小及形状可能不匹配的情况,并发现视力越低,VEP峰时越迟。

结论：除眼底多模影像,SARS-CoV-2感染相关AMN的神经眼科特征需要临床医师关注,视功能及电生理可以辅助临床更加全面评估患者及判断预后。     

拇指旋转撕脱性离断再植的临床研究

目的 探讨拇指旋转撕脱性离断再植的治疗方法和临床疗效.方法 23例拇指旋转撕脱患者,采用环指浅屈肌腱转位修复拇指屈曲功能,示指固有伸肌腱转位修复拇指伸指功能,环指桡侧指动脉神经修复拇指动脉神经,示指指背静脉修复拇指静脉.结果 术后拇指全部成活,随访0.5～2.0年,再植拇指外形正常,血运好,感觉功能和肌力良好.根据中华医学会手外科学会拇、手指再造功能评定试用标准,综合评价全部为优.结论 此型转位方法治疗拇指旋转性离断再植,术后功能恢复满意,是一种安全有效的手术方法.     

Nitrogen-doped graphene–poly(hydroxymethylated-3,4-ethylenedioxythiophene) nanocomposite electrochemical sensor for ultrasensitive determination of luteolin

An ultrasensitive luteolin electrochemical sensor was constructed by co-electropolymerization of nitrogen-doped graphene (N-GR) and hydroxymethylated-3,4-ethylenedioxythiophene (EDOT-MeOH) using cyclic voltammetry (CV). Because of the synergistic effects of the large surface area, superior electrical conductivity, and large amount of chemically active sites of N-GR together with the satisfactory water solubility and high conductivity of poly(hydroxymethylated-3,4-ethylenedioxythiophene) (PEDOT-MeOH), the N-GR–PEDOT-MeOH nanocomposite sensor exhibited high electrochemical sensitivity towards luteolin with a wide linear range of 0.005–10.06 μM and low detection limit of 0.05 nM. Satisfactory reproducibility, selectivity, and stability were exhibited by this electrochemical sensor. Additionally, the proposed sensor was employed for trace-level analysis of luteolin in actual samples of herbal medicines (thyme (Thymus vulgaris L.), honeysuckle (Lonicera japonica Thunb.), and Tibetan Duyiwei (Lamiophlomis rotata (Benth.) Kudo)) with satisfactory results.

A sensitive and selective electrochemical sensor was constructed by one-step co-electropolymerization of hydroxymethylated-3,4-ethylenedioxythiophene and nitrogen-doped graphene for the trace-level analysis of luteolin in Thymus vulgaris, Lonicera japonica, and Lamiophlomis rotata.     

维持性血液透析患者微炎症状态与胰岛素抵抗的关系

目的探讨尿毒症的微炎症状态及其与胰岛素抵抗的关系。方法测定55例尿毒症维持性血液透析(maintenance hemodialysis,MHD)患者及30例正常人慢性炎症指标血C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α),同时检测空腹胰岛素(FINS)、空腹血糖(FBS)、血脂及肾功能等指标,计算稳态模型胰岛素抵抗指数(Homa-IR)作为胰岛素抵抗指标。结果MHD组血CRP、IL-6、TNF-α分别为(5.08±2.53)mg/L、(127.6±104.1)ng/L、(1.63±0.64)μg/L,均高于对照组且差异有统计学意义(P<0.05～0.01)。MHD患者血CRP与Homa-IR、FINS、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)呈正相关(P<0.05～0.01)。结论MHD患者存在微炎症状态,炎症与胰岛素抵抗密切相关。     

孕妇仰卧位低血压综合征对新生儿神经行为发育的影响

目的探讨孕妇仰卧位低血压综合征的临床表现及其对胎儿宫内窘迫发生率、新生儿窒息发生率、新生儿神经行为发育的影响。方法对60例出现仰卧位低血压综合征的住院待产孕妇(研究组)与140例正常自然分娩产妇(对照组)的临床表现、胎儿宫内窘迫发生率分和新生儿窒息发生率及新生儿20项神经行为测定结果进行对比分析。结果研究组主要临床表现为仰卧5min～10min出现头晕、胸闷、恶心、呕吐、面色苍白、冷汗、脉搏细速、血压下降;同时出现胎心初为过速、胎动增强,后为胎心过缓、胎动减弱等症状。研究组胎儿宫内窘迫、新生儿窒息、羊水污染及脐血血气分析异常发生率均极显著高于对照组(P<0.01)。新生儿20项神经行为评分研究组38.33%总分≤35分,行为能力及主动肌张力因子分均显著低于对照组(P<0.05或0.01),被动肌张力因子分显著高于对照组(P<0.05)。结论仰卧位低血压综合征可引起孕妇低血容量休克,同时可导致胎儿宫内窘迫、新生儿窒息及新生儿神经行为发育异常等,临床要积极加以防治。