New advances of adiponectin in regulating obesity and related metabolic syndromes

Obesity and related metabolic syndromes have been recognized as important disease risks,in which the role of adipokines cannot be ignored.Adiponectin(ADP)is one of the key adipokines with various beneficial effects,including improving glucose and lipid metabolism,enhancing insulin sensitivity,reducing oxidative stress and inflammation,promoting ceramides degradation,and stimulating adipose tissue vascularity.Based on those,it can serve as a positive regulator in many metabolic syndromes,such as type 2 diabetes(T2D),cardiovascular diseases,non-alcoholic fatty liver disease(NAFLD),sarcopenia,neurodegenerative diseases,and certain cancers.Therefore,a promising therapeutic approach for treating various metabolic diseases may involve elevating ADP levels or activating ADP receptors.The modulation of ADP genes,multimerization,and secretion covers the main processes of ADP generation,providing a comprehensive orientation for the development of more appropriate therapeutic strategies.In order to have a deeper understanding of ADP,this paper will provide an all-encompassing review of ADP.

Predictors of survival in autoimmune liver disease overlap syndromes

BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.

Percutaneous Coronary Intervention in Acute Coronary Syndromes at the Mother-Child University Hospital Luxembourg in Bamako

Introduction: Acute coronary syndromes (ACS) are a diagnostic and therapeutic emergency. Objective: Studying the feasibility, difficulties and results of coronary angioplasty in acute coronary syndromes at the Luxembourg Mother-Child University Hospital in Bamako. Patients and Methods: Cross-sectional, descriptive study with prospective recruitment over 18 months from September 2020 to February 2022. All patients aged at least 18 years old admitted for SCA and having undergone PCI during the study period were included. Result: We collected 249 patients for SCA, of whom 160 underwent angioplasty, either an angioplasty/SCA ratio of 0.64. The average age of the patients was 59.54 ± 11.62 with extremes of 32 and 92 years. The age group of 45 to 65 years was the most representative. The predominance was male, sex ratio of 2.4. The main cardiovascular risk factors were high blood pressure (58.23%) and diabetes (45.78%). Persistent ST-segment elevation on the electrocardiogram was present in 71.48%. The treatment time was more than 12 hours after the first medical contact in 95.5%. The approach was radial in 96.5% of cases. Coronarography was pathological in 91.16% of our patients. The lesions were tri-truncular in 34.13% with the anterior inter ventricular as culprit artery in 72% of cases. The majority of patients (64%) had undergone angioplasty with implantation of an active stent. Angioplasty was performed successfully in 98% and per procedural mortality was 1.87%. Only 6.45% of ACS with ST elevation benefited from primary angioplasty. Conclusion: Percutaneous coronary intervention is performed routinely in our center with satisfactory results. Difficulties exist, related to the diagnostic delay of ACS and the high cost of angioplasty.

A Systematic Review of Cannabidiol Effects in Coronary Syndromes: Challenges to Clinical Translation

Background: Myocardial ischemia in addition to other several cardiac syndromes represent a pathological proinflammatory state alongside a complex cellular microenvironment that can be modified by using cannabinoids. Cannabidiol (CBD), a non-psychoactive compound of cannabis has been recently proposed as an immudomodulatory and cardioprotective drug. Objectives: In this systematic review we sought to clarify and summarize the clinical and preclinical evidence of potential benefit of the use of CBD in coronary syndromes. Methods: We conducted a systematic search and review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Review of Animal Data from Experimental Studies (CAMARADES) guidelines, in the electronic database from PubMed, Web of Science and Scopus up to April 2022 using predefined search terms. Pre-specified exclusion and inclusion criteria were considered, finally 11 articles were chosen to be included for this peer review. Results: Currently there are no good-quality clinical trials with the use of CBD in acute or chronic coronary syndromes. A total of 11 preclinical studies where prescreened and 5 demonstrated reproducible positive cardiovascular outcomes on in-vivo models treated with CBD. Mechanisms of CBD cardioprotection observed: 1) reduction in oxidative stress and inflammation, 2) activation of adenosine receptors and 3) increased expression of angiotensin type 2-receptor. Experimental models included ischemia/reperfusion injury, myocardial infarction, arrhythmias, and metabolic syndrome-like conditions. Conclusion: No clinical recommendation can be issued with the current evidence, on the use of CBD in acute and chronic coronary syndromes. Based on preclinical evidence, we considered there is enough evidence to propose the development of well-designed clinical trials that include CBD in the management of coronary syndromes.

The Distribution Pattern of Traditional Chinese Medicine Syndromes in Patients with Hyperlipidemia

Objective: Hyperlipidemia is a representative nutritional metabolic disease in clinic, which is easy to induce atherosclerotic cardiovascular and cerebrovascular diseases, with complex classification. Traditional Chinese Medicine (TCM) syndrome aims to reflect the characteristics of diseases and is the basic principle of TCM treatment of diseases. This study aimed to summarize the distribution pattern of TCM syndromes in patients with hyperlipidemia. Methods: The frequency, characteristics and distribution of all TCM syndromes of 1012 patients with hyperlipidemia were analyzed. Results: The main disease types determined by frequency of 1012 patients included hypertriglyceridemia combined with hypo high-density lipoprotein cholesterolemia (19.76%), hypo high-density lipoprotein cholesterolemia (18.58%), hypercholesterolemia (16.50%), mixed hyperlipidemia (16.40%), and hypertriglyceridemia (15.12%). The distribution of TCM syndromes, in order of frequency, was as follows: Qi-deficiency and blood stasis syndrome (23.52%), liver depression and spleen deficiency (9.88%), syndrome of qi stagnation and blood stasis (9.29%), phlegm stasis syndrome (7.41%), and syndrome of yang deficiency of spleen and kidney (6.92%). Conclusion: Qi-deficiency and blood stasis syndrome and liver depression and spleen deficiency are the most common TCM syndromes in patients with hyperlipidemia.

Progress of Triglyceride Glucose Index in Lesion Severity and Prognosis of Acute Coronary Syndromes

Background: In response to the escalating burden of cardiovascular diseases (CVDs) worldwide, exacerbated by lifestyle changes and socioeconomic shifts, acute coronary syndromes (ACS) stand out as a leading cause of morbidity and mortality. The pivotal role of insulin resistance in the pathogenesis of atherosclerosis, independent of traditional risk factors, has garnered significant interest. Objective: This review aims to synthesize the recent advancements in the utilization of the triglyceride glucose index (TyG index) as a biomarker for assessing the severity and predicting the prognosis of ACS lesions. Methods: A systematic search was conducted across PubMed, Embase, and Scopus databases, incorporating keywords such as “triglyceride glucose index”, “TyG index”, “acute coronary syndrome”, “cardiovascular disease”, “insulin resistance”, “coronary artery calcification”, “SYNTAX score”, “Gensini score”, and “major adverse cardiac events”. Studies were included from the inception of each database up to July 2024. Selection criteria encompassed observational studies, case-control studies, and randomized controlled trials, with a particular emphasis on evaluating the diagnostic and prognostic value of the TyG index in patients with acute coronary syndromes. Ultimately, 46 publications met the inclusion criteria. Data extraction and quality assessment were performed in accordance with established guidelines. Results: Evidence suggests that the TyG index, reflecting insulin resistance, blood glucose, and lipid levels, is significantly associated with lesion severity in ACS, including coronary artery calcification, SYNTAX score, and Gensini score. Moreover, it demonstrates predictive power for major adverse cardiovascular events, underscoring its potential as a valuable tool in clinical decision-making. Conclusion: The review highlights the emerging role of the TyG index in the assessment and prognosis of ACS, advocating for its incorporation into clinical practice as a complement to existing diagnostic modalities. However, the establishment of standardized reference ranges and further validation across diverse populations are warranted to refine its applicability in personalized medicine. The interdisciplinary approach is essential to advance our understanding of the complex interplay between insulin resistance and cardiovascular disease, paving the way for the development of more effective prevention and treatment strategies.

An overview on CV2/CRMP5 antibody-associated paraneoplastic neurological syndromes

Paraneoplastic neurological syndrome refers to certain malignant tumors that have affected the distant nervous system and caused corresponding dysfunction in the absence of tumor metastasis.Patients with this syndrome produce multiple antibodies,each targeting a different antigen and causing different symptoms and signs.The CV2/collapsin response mediator protein 5(CRMP5)antibody is a major antibody of this type.It damages the nervous system,which often manifests as limbic encephalitis,chorea,ocular manifestation,cerebellar ataxia,myelopathy,and peripheral neuropathy.Detecting CV2/CRMP5 antibody is crucial for the clinical diagnosis of paraneoplastic neurological syndrome,and anti-tumor and immunological therapies can help to alleviate symptoms and improve prognosis.However,because of the low incidence of this disease,few repo rts and no reviews have been published about it so far.This article intends to review the research on CV2/CRMP5antibody-associated paraneoplastic neurological syndrome and summarize its clinical features to help clinicians comprehensively understand the disease.Additionally,this review discusses the curre nt challenges that this disease poses,and the application prospects of new detection and diagnostic techniques in the field of paraneoplastic neurological syndrom e,including CV2/CRMP5-associated paraneoplastic neurological syndrome,in recent years.

Root structure syndromes of four families of monocots in the Middle Urals

The present article tests the following general assumption:plant taxa with different specializations towards mycorrhizal interactions should have different root syndromes.Roots of 61 species common in boreal zone were studied:16 species of Poaceae,24 species of Cyperaceae,14 species of Orchidaceae,and 7 species of Iridaceae.Using a fixed material of 5 individuals of each species,the following was determined:number of orders of branching roots;transverse dimensions of root,stele and cortex;number of primary xylem vessels and exodermis layers;length of root hairs;abundance of mycorrhiza.Species of each family had well-defined syndromes.Roots of Orchidaceae and Iridaceae were thick with a large stele and developed exodermis.Orchidaceae had no branching roots and had long root hairs.In Iridaceae,roots were branched,and root hairs were short.Roots of Poaceae and Cyperaceae were thin with a relatively thin stele.Root hairs were short in Poaceae and long in Cyperaceae.Our finding that root syndromes of four families of monocots differed is a new and unexpected discovery.The high specificity of root syndromes in Cyperaceae,Iridaceae,Poaceae,and Orchidaceae indicates that species of these families use different strategies to obtain water and soil nutrients.

Hereditary polyposis syndromes remain a challenging disease entity:Old dilemmas and new insights

In this editorial we present an overview and insights of the management of hereditary polyposis syndromes.The primary focus was on familial adenomatous polyposis,juvenile polyposis syndrome and Peutz-Jegher syndrome.Genetic testing has become increasingly available and is easier than ever to integrate into clinical practice.Furthermore,several genes have been added to the expanding list of genes associated with hereditary polyposis syndromes,allowing for precise diagnostics and tailored follow-up.Endoscopic evaluation of patients with hereditary polyposis syndromes is paramount in the surveillance strategies.Current endoscopic procedures include both diagnostic procedures and surveillance as well as therapeutic interventions.Recommendations for endoscopic procedures in the upper and lower gastrointestinal canal were described.Surgery is still a key component in the management of patients with hereditary polyposis syndromes.The increased cancer risk in these patients often render prophylactic procedures or intended curative procedures in the case of cancer development.Surgical interventions in the upper and lower gastrointestinal canal were described with relevant considerations.Development of chemopreventive medications is ongoing.Few drugs have been investigated,including nonsteroidal anti-inflammatory drugs.It has been demonstrated that cyclooxygenase-2 inhibitors may lower the number of polyps.Other medications are currently under investigation,but none have,to date,consistently been able to prevent development of disease.

Prognostic significance of identification of traditional Chinese medicine syndromes in colorectal cancer

Background:Traditional Chinese medicine(TCM)syndrome is the basic unit of TCM treatment,which help clinicians assess the disease progression and treatment preoperative of tumor patients.However,the prognostic significance of TCM syndrome is still unclear.This study aims to detect the differences in overall survival between different TCM syndrome and further develop a new nomogram with TCM syndrome for predicting overall survival in colorectal cancer.Methods:A total of 324 patients with colorectal cancer were enrolled and categorized into three groups based on TCM syndrome:deficiency,excess,and deficiency-excess.The prognosis of colorectal cancer patients with different TCM syndromes was evaluated using Kaplan-Meier analysis and Cox regression analysis.Results:The proportion of advanced stage and lymph metastasis in the patients with deficiency syndrome was higher,and the overall survival was shorter than other syndromes.Meanwhile,the TCM syndrome(P<0.001),tumor invasion depth(P<0.001),lymph metastasis(P=0.018),organic metastasis(P=0.005)and tumor node metastasis(TNM)stage(P=0.029)were the independent prognostic factor.Then,a new nomogram with TCM syndrome was established and assessed.324 colorectal cancer patients were randomly divided into training(n=215)and validation cohorts(n=109).A nomogram incorporating preoperative TCM syndrome,gender,age,T,N,and M status was developed,which had good discrimination and calibration.Conclusion:Taken together,our results indicated that TCM syndrome could assess the prognosis of colorectal cancer.The nomogram incorporating TCM syndromes and tumor information is helpful for risk stratification and prognostic predictions in colorectal cancer preoperatively.

Hereditary cancer syndromes

Hereditary cancer syndromes(HCSs)are arguably the most frequent category of Mendelian genetic diseases,as at least 2%of presumably healthy subjects carry highly-penetrant tumor-predisposing pathogenic variants(PVs).Hereditary breast-ovarian cancer and Lynch syndrome make the highest contribution to cancer morbidity;in addition,there are several dozen less frequent types of familial tumors.The development of the majority albeit not all hereditary malignancies involves two-hit mechanism,i.e.the somatic inactivation of the remaining copy of the affected gene.Earlier studies on cancer families suggested nearly fatal penetrance for the majority of HCS genes;however,population-based investigations and especially large-scale next-generation sequencing data sets demonstrate that the presence of some highly-penetrant PVs is often compatible with healthy status.Hereditary cancer research initially focused mainly on cancer detection and prevention.Recent studies identified multiple HCS-specific drug vulnerabilities,which translated into the development of highly efficient therapeutic options.

Epidemiological, Clinical and Angiographic Profile of Chronic Coronary Syndromes in the Catheterization Room. Single-Centre Study Carried Out in the Cardiology Department of the Chu Aristide Le Dantec in Dakar (Senegal)

Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1st, 2018 to December 31st, 2019) in the Cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclusion: Our study shows that screening for chronic coronary disease should be done especially in diabetics, elderly subjects and those with previous angioplasty taking into account symptoms and pretest probability to avoid unnecessary invasive procedures.

Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

BACKGROUND During the second wave of the coronavirus disease 2019(COVID-19)pandemic,a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extra-pulmonary organ dysfunction.AIM To describe the clinical and laboratory characteristics,outcomes,and management of these patients,and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory disorders.METHODS This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital,between May and August 2021,who fulfilled clearly defined inclusion and exclusion criteria.Outcome was assessed by a change in PaO_(2)/FiO_(2) ratio and levels of inflammatory markers before and after immunomodulation,duration of mechanical ventilation after starting treatment,and survival to discharge.RESULTS Five patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extrapulmonary organ dysfunction at a median interquartile range(IQR)duration of 32(23-35)d after the onset of symptoms.These patients had elevated inflammatory markers,required mechanical ventilation for 13(IQR 10-23)d,and responded to glucocorticoids and/or intravenous immunoglobulin.One patient died(20%).CONCLUSION This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome–Adults by the paucity of extrapulmonary organ involvement.The diagnosis can be considered in patients presenting with delayed respiratory worsening,that is not attributable to cardiac dysfunction,fluid overload or ongoing infections,and associated with an increase in systemic inflammatory markers like C-reactive protein,inteleukin-6 and ferritin.A good response to immunomodulation can be expected.This delayed inflammatory pulmonary syndrome may represent a distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection.

《内经》“关刺”联合“合谷刺”治疗不宁腿综合征疗效观察

目的 观察《内经》“关刺”联合“合谷刺”治疗不宁腿综合征(restless legs syndrome, RLS)的临床疗效。方法 将100例RLS患者随机分为治疗组(50例,脱落1例)和对照组(50例,脱落2例)。治疗组给予“关刺”联合“合谷刺”治疗,阳陵泉、膝关、丘墟采用关刺法,伏兔、丰隆、漏谷采用合谷刺法;对照组给予假针刺治疗。治疗前后采用国际RLS评定量表(international restless leg syndrome scale, IRLSS)评价患者不宁腿严重程度,采用RLS生活质量量表(RLS quality of Life, RLSQoL)评价患者生活质量,采用失眠严重指数量表(insomnia severity index, ISI)评价患者的睡眠情况,并比较两组临床疗效。结果 治疗组总有效率为91.8%,显著高于对照组的41.7%(P<0.01)。治疗后,治疗组IRLSS评分低于治疗前和对照组(P<0.01),治疗组RLSQoL评分高于治疗前和对照组(P<0.01),治疗组ISI评分低于治疗前和对照组(P<0.01)。对照组治疗前后各项评分比较,差异无统计学意义(P>0.05)。结论 《内经》“关刺”联合“合谷刺”可显著改善RLS患者临床症状,在中医学理论的指导下拓展了《内经》五刺法的临床应用。

术前静注艾司氯胺酮对腹腔镜结直肠癌根治术患者术后疲劳综合征的影响

目的评价术前静注艾司氯胺酮对腹腔镜结直肠癌根治术患者术后疲劳综合征(POFS)的影响。方法选择2021年6月至2022年7月择期行腹腔镜结直肠癌根治术患者62例,男41例,女21例,年龄34~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:艾司氯胺酮组(E组)和对照组(C组),每组31例。手术开始前5 min E组静脉注射艾司氯胺酮0.25 mg/kg(用生理盐水配成5 ml),C组静脉注射生理盐水5 ml。两组术后静脉镇痛方案相同。于麻醉诱导前10 min、术后即刻、12、24 h抽取颈内静脉血样,检测血清肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)浓度。于术前1 d、术后3、5、7 d进行简明围术期疲劳评定量表(ICFS-10)评分,记录POFS(ICFS-10评分>24分)发生情况。记录拔管时间、拔管后呛咳、苏醒期谵妄和躁动等不良反应、术后各系统并发症的发生情况、术后住院时间。结果与C组比较,E组术后即刻、术后12、24 h血清TNF-α浓度明显降低(P<0.05),SOD浓度明显升高(P<0.05);术后3、5、7 d ICFS-10评分、术后7 d POFS发生率明显降低(P<0.05)。两组拔管时间、拔管后呛咳、苏醒期谵妄和躁动、术后各系统并发症发生率、术后住院时间差异均无统计学意义。结论术前单次静脉注射艾司氯胺酮可降低腹腔镜结直肠癌根治术患者术后血清TNF-α、SOD浓度和POFS的发生率,未增加不良反应。

饲料中添加复合胆汁酸对皮质酮诱导的肉鸡脂肪肝综合征的缓解作用研究

[目的]本试验旨在探究饲料中添加胆汁酸(bile acid,BA)对皮质酮(corticosterone,CORT)诱导的肉鸡脂肪肝综合征的缓解作用。[方法]试验选取了120只1日龄雄性AA肉鸡,随机分为2组,分别饲喂基础日粮和含BA日粮。BA添加分为前期、中期、后期3个阶段,剂量依次递增。28日龄时,从基础日粮组中选取肉鸡20只,随机分为对照组(control,CON)、皮质酮处理组(CORT);从胆汁添加组中随机选取10只设为皮质酮+胆汁酸组(CORT+BA)。CON组颈部皮下注射乙醇PBS溶液(15%乙醇),CORT组和CORT+BA组注射4 mg·kg^(-1) CORT,连续注射7 d。肉鸡40日龄屠宰采样,记录器官与组织质量,采集血清和肝脏组织以测定生化指标、脂代谢相关基因和蛋白表达水平。[结果]饲料中添加BA可显著缓解由CORT处理引起的腹脂率升高及腿肌重降低(P<0.05)。生化测定结果表明,CORT处理显著降低了40日龄肉鸡血清中高密度脂蛋白(HDLC)水平、增加游离脂肪酸(NEFA)水平,而BA处理显著升高血清HDLC水平(P<0.05)。与CON组相比,CORT组肉鸡肝脏内甘油三酯(TG)水平显著升高(P<0.01),肝细胞内脂滴显著富集且出现空泡化现象,而BA处理可显著缓解肝脏内的TG沉积(P<0.01)。CORT处理显著上调肝脏中硬脂酰辅酶A去饱和酶(scd1)和乙酰辅酶A羧化酶(acc)基因表达水平(P<0.05),显著上调ACC和脂肪酸合成酶(FASN)蛋白表达水平(P<0.05),同时下调过氧化物增殖激活受体(PPARα)蛋白的表达水平(P<0.05);BA处理可显著逆转皮质酮引起的以上基因和蛋白表达变化,并显著增加肉毒碱棕榈酰基转移酶1A(cpt1a)基因表达水平,显著降低脂肪酸转位酶(CD36)蛋白表达水平(P<0.05)。[结论]日粮中添加胆汁酸可减少肝脏内甘油三酯合成,促进其分解,抑制肝细胞对脂肪酸的摄取,从而缓解皮质酮诱导的肉鸡脂肪肝综合征。

以假性Bartter综合征为主要表现的囊性纤维化患儿3例并文献复习

目的总结以假性Bartter综合征(pseudo-Bartter syndrome,PBS)为主要表现的囊性纤维化(cystic fibrosis,CF)(CF-PBS)患儿的临床特征和基因变异,以提高对CF-PBS的认识。方法回顾性分析2018年1月—2023年8月在湖南省儿童医院确诊的3例CF-PBS患儿的临床资料并文献复习。结果3例患儿均在婴儿期起病,入院后检验示低钠、低钾、低氯血症和代谢性碱中毒,基因检测示CFTR基因存在复合杂合变异,均诊断为CF。文献检索33例CF-PBS中国患儿,起病年龄和诊断年龄分别为1~36月龄、3~144月龄,伴有反复呼吸道感染或持续肺炎29例(88%)、营养不良26例(79%)、发育落后23例(70%)、胰腺炎或可疑胰腺外分泌功能不全18例(55%);c.2909G>A是CFTR基因最常见的变异位点,等位基因变异频率为23%(15/66)。结论CF早期无典型的呼吸道症状,对于反复出现的低钠、低钾、低氯血症和代谢性碱中毒的婴儿,特别是同时存在营养不良、发育落后,需警惕CF-PBS可能,应尽早进行CFTR基因检测协助诊断CF。

中医辨证治疗前庭性偏头痛的多中心前瞻性队列研究

目的:评价中医辨证治疗前庭性偏头痛的临床疗效,探讨中医辨证用药规律。方法:采用前瞻性队列研究方法,选取前庭性偏头痛患者197例,根据是否采用中医辨证治疗为暴露因素,分为中药组与西药组,分别为123例与74例。观察两组治疗第4、8、12周的眩晕复发率及相关结局指标。结果:治疗第4、8、12周,眩晕复发率中药组依次为14.9%、18.4%、29.7%,西药组依次为12.3%、32.8%、55.6%,其中第8、12周两组比较差异有统计学意义(P<0.05);治疗后第4周,眩晕残障量表评分(dizziness handicap inventory,DHI)、VAS评分改善情况西药组优于中药组,但差异无统计学意义(P>0.05),第8、12周DHI、VAS评分改善情况中药组均优于西药组(P<0.05);共收集门诊处方273首,涉及中药76味,使用频率前十位的中药依次为天麻、法半夏、柴胡、茯神、远志、茯苓、酸枣仁、煅龙骨、珍珠母、黄芩。结论:中医辨证治疗前庭性偏头痛在改善眩晕症状,控制眩晕复发方面优势明显,但起效速度方面不及西药治疗。临床用药以疏肝解郁、重镇安神为主,安神之法应贯穿治疗始终。

冠心病心血瘀阻证大鼠心肌组织代谢组学研究

目的研究冠心病心血瘀阻证大鼠心肌组织代谢产物谱,探讨其病证生物学基础。方法SD大鼠随机分为假手术组和模型组,采用冠状动脉左前降支结扎法制备冠心病心血瘀阻证大鼠模型,观察大鼠一般状态,检测舌象色度、心电图、心功能,HE染色、透射电镜观察心肌组织形态及超微结构,用超高效液相色谱-质谱技术检测心肌组织差异代谢物,并对代谢通路进行富集分析。结果与假手术组比较,模型组大鼠舌象色度R、G、B值均显著降低(P<0.05),心电图心率、ST段抬高幅度显著上升(P<0.05),左室射血分数、左室短轴缩短率显著下降(P<0.05),左室收缩末期内径、左室舒张末期内径显著上升(P<0.05);心肌组织结构模糊,有炎性细胞浸润,线粒体肿胀、破裂、溶解,嵴结构断裂减少。代谢组学共鉴定出29个假手术组与模型组差异显著的潜在生物标志物(7个上调、22个下调),主要富集于硫胺素代谢,精氨酸生物合成,嘌呤代谢,氨酰基-tRNA生物合成,丙氨酸、天冬氨酸和谷氨酸代谢,戊糖和葡萄糖醛酸相互转化,糖酵解/糖异生,缬氨酸、亮氨酸和异亮氨酸降解,三羧酸循环,丙酮酸代谢10条代谢通路。结论冠状动脉左前降支结扎法可较好地模拟冠心病心血瘀证病理过程,其病理机制涉及葡萄糖代谢、线粒体能量代谢、氨基酸代谢、蛋白质生物合成、嘌呤代谢等多层次代谢网络紊乱。

泉州地区艾滋病患者机会性感染现状及预后Nomogram预测模型的构建

目的通过对泉州地区艾滋病(AIDS)患者机会性感染现状、临床特点及其预后的影响因素分析,为AIDS机会性感染的科学预防和治疗提供一定依据。方法选取2017年1月—2022年1月于福建医科大学附属泉州第一医院确诊并接受住院治疗的172例AIDS合并机会性感染患者作为研究对象,收集患者一般资料和机会性感染情况,采用多变量Cox回归分析确定影响AIDS合并机会性感染患者预后的独立预测因子,将独立预测因素引入R软件,根据各因素回归系数绘制预后Nomogram模型。采用一致性指数(C-index)对该模型的区分度进行标定,利用校准图阐明Nomogram预测的预后与实际预后之间的关系,并采用决策曲线(DCA)对Nomogram模型的临床效用进行验证。结果172例AIDS合并机会性感染患者中,机会性感染共有8种,其中细菌性肺炎占比最高,达54.65%,其次为口腔白斑,占51.74%,肺孢子菌肺炎占43.60%,带状疱疹占28.49%,肺结核占21.51%,感染性腹泻占19.77%,中枢神经系统感染占12.79%,巨细胞病毒感染最低,仅占10.47%。男性明显多于女性,18~39岁人群居多。年龄、感染种数、基因型耐药、CD4+T淋巴细胞水平是AIDS合并机会性感染患者预后的影响因素。校准曲线及DCA显示Nomogram预测模型具有较好的预测能力和临床有效性,且精准区分度较好。结论年龄、感染种数、基因型耐药、CD4+T淋巴细胞水平等因素是影响AIDS合并机会性感染患者预后的主要因子,而构建Nomogram预测模型能发挥较好的临床预测能力和有效性,为临床早识别、早防控提供科学依据。