环状RNA在肺动脉高压中的研究进展

环状RNA是一种稳定、保守的凭借共价键首尾相连的闭合环状RNA，研究表明环状RNA和多种疾病的发生发展密切相关。肺动脉高压（PH）是一类以肺血管阻力进行性升高为特征的肺血管疾病，其发病机制尚不明确。近年来越来越多的研究提示环状RNA在PH的发生发展中可能扮演重要角色，为PH的诊断和治疗提供新线索。该文结合环状RNA在PH领域的研究现状，综述其在PH中的作用和机制。     

乳腺癌组织中环状RNA CDR1as及miR-483-5p表达特点及临床意义

目的 探讨乳腺癌组织中环状RNA CDR1as及miR-483-5p表达特点及临床意义。方法 选取2020年1月～2021年3月我院50例乳腺癌患者病理肿瘤样本作为实验组,配对的癌旁3cm正常乳腺组织样本50例作为对照组。通过原位分子杂交技术测量乳腺癌以及正常标本中环状RNA CDR1as及miR-483-5p的表达。结果 乳腺癌组织中环状RNA CDR1as表达高于正常组织,miR-483-5p表达低于正常组织（P<0.05）;RNA CDR1as高表达、miR-483-5p低表达患者生存率为46.15%,RNA CDR1as、miR-483-5p均低表达患者生存率为86.49%,Kaplan-Meier分析显示环状RNA CDR1as高表达、miR-483-5p低表达是患者预后不良的风险因素（Log Rank Cox=5.307,P=0.021）;单因素、多因素分析显示肿瘤大于5cm、TNM分期、淋巴结转移是影响环状RNA CDR1as及miR-483-5p在乳腺癌组织中表达水平的重要因素（P<0.05）。结论 乳腺癌组织中环状RNA CDR1as呈高表达,miR-48...     

环状RNA在糖尿病肾病中的研究进展

糖尿病肾病（DKD）是常见的糖尿病并发症之一，病理过程复杂，常涉及整个肾脏结构。环状RNA是一种共价闭合环状结构的非编码RNA，它们在各种生理和病理过程中发挥作用。在DKD病程中，环状RNA通过参与调控细胞周期、细胞分化及死亡，调节炎性因子释放与基质纤维蛋白表达等过程参与肾脏细胞损伤。该文介绍了环状RNA的结构与功能，并从肾脏细胞损伤角度对环状RNA在DKD中最新研究进展进行综述。     

Research progress of circular RNA in drug resistance of liver cancer北大核心CSCD

环状RNA是一类具有多生物学功能的新型非编码RNA,可参与肝癌的发生、发展、侵袭及转移等生物学过程,也可参与肝癌的耐药。该文综述了环状RNA在肝癌化疗耐药、靶向治疗耐药以及免疫治疗耐药中的作用及其机制,以期为解决肝癌耐药提供新思路。     

环状RNA的分类、特征、功能及在胃癌诊疗中的作用

环状RNA是一类通过反向剪接方式形成的具有稳定闭合环状的内源性非编码RNA分子,其具有稳定的结构和高度的保守性,这些是其在不同生物中发挥重要作用的基础.胃癌是起源于胃黏膜上皮的常见恶性肿瘤,具有发病率高、发病机制复杂等特点.目前研究已证实环状RNA可以作为miRNA海绵体、与蛋白质相互作用以及调节基因表达等功能,从而参...     

P波离散度与甲状腺功能亢进的相关研究进展

房颤是成年人中最常见的心率失常,而甲亢是阵发性和潜在的房颤发生的一个重要原因。目前国内外较多报道P波离散度(Pwave dispersion,PWD)可以作为房颤的预测因子,PWD增大与发生房颤紧密相关。心房颤动是最常见的心律失常之一,它可以引起很多临床问题,包括死亡、心力衰竭、血栓事件以及其他一些并发症。现将目前PWD与甲状腺功能亢进症的相关研究进展综述如下,为甲亢并发房颤的理论研究、预防、诊断和治疗提供参考依据。     

长链非编码RNA相关中药作用机制研究进展

中药是我国医药文化的瑰宝,有数千年的应用历史。然而,中药的作用机制尚未完全阐明,这在一定程度上限制了其临床应用。非编码RNA （nocoding RNA,ncRNA）是一类不能编码蛋白的转录体。几类ncRNA已被证实对疾病的发生和发展具有重要的调控作用,包括微小RNA、长链非编码RNA和环状RNA等。近年来,长链非编码RNA相关中药作用机制已成为研究热点。本文综述该领域研究进展,以期为中医药研究提供新思路。     

环状RNA在妇科恶性肿瘤中的研究进展

环状RNA(circRNA)是一种具有调节转录、RNA海绵、蛋白质支架(海绵)及翻译功能的非编码RNA。近几年随着研究的深入开展,研究人员认识到circRNA与疾病的病因,疗效和疾病转归有着紧密的联系,并且意识到其有成为疾病诊断标志物、精准治疗靶点以及预测未来疾病转归的潜力。本文通过对circRNA与常见妇科恶性肿瘤的关系最新研究进展做一综述。     

左房容积指数与射频消融术后房颤复发的关系

目的探讨左房容积指数(LAVI,Left atrial volume index)与射频消融术后房颤远期复发的关系。方法选择接受环肺静脉电隔离射频消融术的房颤患者118例,并根据术后第12个月体表心电图和24h动态心电图监测及临床随访结果,分为房颤复发组和无复发组。分析房颤射频消融术后房颤复发的预测因素。结果复发与无复发组在年龄、性别、病程、左室射血分数等方面无统计学差异,复发组的左房容积指数大于无复发组,Logistic多元回归分析显示LAVI为房颤复发的独立危险因素(P<0.01)。结论 LAVI是房颤复发的独立预测因素。     

微小RNA与心房颤动中心房重构关系的研究进展

心房颤动(简称房颤)是临床上最常见的持续性心律失常之一,有着很高的发病率和病死率,给人们带来了沉重的社会和经济负担。房颤的发病机制十分复杂,目前认为心房结构重构、电重构、钙离子稳态失调、氧化应激及炎症反应等一系列病理生理改变参与了房颤的发生与发展,其中关于心房的结构重构和电重构是研究人员关注的重点。近年来随着分子生物学的飞速发展,研究人员开始关注微小RNA(microRNA,miRNA)在房颤发病机制中发挥的作     

环状RNA在乳腺癌中的研究进展 #br#

环状 RNA（circRNAs）是一种具有闭环结构的非编码 RNA。近年来随着高通量测序技术和生物信息学的 快速发展,越来越多的 circRNA在肿瘤组织中被发现。研究表明,circRNA在细胞中可以通过微小 RNA（miRNA）海 绵或者与蛋白结合的机制,进而调控靶基因的转录及翻译,从而广泛参与细胞生长、分化、发育和凋亡在内的病理生 理过程,为相关疾病的预防、诊断和治疗提供新的方向。乳腺癌是女性最常见的恶性肿瘤,具有高度异质性,以肿瘤 分子生物学特征为基础的治疗靶点的确立已成为个体化精准治疗的关键。本文对 circRNA的形成机制、生物功能及 其对乳腺癌发生、发展和预后的影响进行综述。     

Primary and secondary prevention of atrial fibrillation with statins and polyunsaturated fatty acids: review of evidence and clinical relevance

Atrial fibrillation (AF) is an increasingly common arrhythmia that now stands at epidemic proportion, with more than 2.3 million people affected in the USA and over 4.5 million people affected in Western Europe. AF is an expression of underlying heart disease and is increasingly associated with hypertension, congestive heart failure, and ischemic heart disease. It is also a progressive disease secondary to continuous structural remodeling of the atria, which relates to AF itself, to changes associated with aging and to progression of the underlying heart disease. Traditionally, AF has been addressed only after it has already presented with pharmacological and nonpharmacological therapies designed for rhythm or rate control (secondary prevention). Although secondary prevention is the most feasible approach at present, the concept of primary prevention of AF with therapies aimed at preventing the development of substrate and correcting the risk factors for AF has emerged as a strategy, which is likely to produce a larger effect in the general population. Recent experiments provided new insights into AF pathophysiology, which generated background for new mechanism-based therapies. Agents targeting inflammation, oxidative injury, atrial myocyte metabolism, extracellular matrix remodeling, and fibrosis have theoretical advantages as novel therapeutic strategies. In this respect, drugs that are not traditionally antiarrhythmic such as angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, aldosterone antagonists, statins, and omega-3 polyunsaturated fatty acids have shown an antiarrhythmic potential in addition to any treatment effect on the underlying disease. These agents are thought to have an advantage of targeting both the occurrence and progression of the substrate for AF, thus, providing primary and secondary prevention of the arrhythmia. Although first experimental and hypothesis-generating small clinical studies or retrospective analyses have been encouraging, several larger, properly designed, prospective trials have not confirmed earlier observations. This review provides a contemporary evidence-based insight into the possible preventative and reverse remodeling role of statins and polyunsaturated fatty acids in AF.     

Atrial remodeling and novel pharmacological strategies for antiarrhythmic therapy in atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It can occur at any age, however, it becomes extremely common in the elderly, with a prevalence approaching more than 20% in patients older than 85 years. AF is associated with a wide range of cardiac and extra-cardiac complications and thereby contributes significantly to morbidity and mortality. Present therapeutic approaches to AF have major limitations, which have inspired substantial efforts to improve our understanding of the mechanisms underlying AF, with the premise that improved knowledge will lead to innovative and improved therapeutic approaches. Our understanding of AF pathophysiology has advanced significantly over the past 10 to 15 years through an increased awareness of the role of "atrial remodeling". Any persistent change in atrial structure or function constitutes atrial remodeling. Both rapid ectopic firing and reentry can maintain AF. Atrial remodeling has the potential to increase the likelihood of ectopic or reentrant activity through a multitude of potential mechanisms. The present paper reviews the main novel results on atrial tachycardia-induced electrical, structural and contractile remodeling focusing on the underlying pathophysiological and molecular basis of their occurrence. Special attention is paid to novel strategies and targets with therapeutic significance for atrial fibrillation.     

急性心肌梗死伴新发心房纤颤的临床分析

目的研究探讨急性心肌梗死（AMI）伴新发心房纤颤（AF）的临床特点。方法回顾性分析344例急性心肌梗死患者住院期间的资料,其中新发房颤患者53例（AF组）,未发生房颤者291例（NAF组）,AF组按新发AF持续时间分为AF1组23例（心肌梗死24h内发生AF者）,AF2组30例（心肌梗死24h后发生AF者）。比较AF组和NAF组之间的年龄、并发症、CK—MB峰值、心功能（Killp分级）、死亡率以及NAF组和AFl组、AF2组之间心肌梗死部位病变血管情况等因素的对比。结果AF组老年患者多于NAF组（P〈0．01）,AF伴有高血压病、糖尿病者高于NAF组（P〈0．01）,AF组CK—MB峰值、心力衰竭发生率、死亡率显著高于NAF组（P〈0．01）,AF组冠状动脉多支病变的发生率较NAF组高（P〈0．05）,AF1组下壁AMI发生率高于NAF组和AF2组（P〈0．05）,AF2组前壁AMI发生率高于AF1组（P〈0．05）。结论高龄、伴发高血压、糖尿病、梗死面积及多支血管病变是AMI并新发AF的危险因素,AF发生时间与AMI梗死部位相关,AMI并新发AF者严重并发症多,预后差,应给予早期积极干预。     

阵发性心房颤动的生物标记物

阵发性心房颤动(PAF)约占所有心房颤动(AF)的50％,PAF作为一种过渡性心律失常显著增加血栓栓塞事件风险,但并未引起足够重视.目前,PAF不再被视为良性病变实体,早期发现或预测PAF具有重要的临床意义.本文从电生理、分子及形态学三方面阐述PAF的生物标记物,以期对PAF的早期诊断和预测提供帮助.     

The role of the renin-angiotensin system in atrial fibrillation and the therapeutic effects of ACE-Is and ARBS

Atrial fibrillation (AF) is the most common rhythm disturbance in medical practice and represents a very expensive health problem. AF can be managed with the prevention of thromboembolism and either a rate control of rhythm strategy. As both strategies have important limitations, probably a preventative strategy in patients at risk of developing arrhythmia can be a more attractive option. The renin-angiotensin system (RAS) seems to be involved in the genesis of arrhythmia by the following two mechanisms: 1. the induction of atrial fibrosis and structural remodelling by mitogen-activated protein kinase (MAPK) expression and reduction of collagenase activity; 2. the induction of electrical remodelling by shortening of the atrial effective refractory period (AERP) and of the action potential duration. For these reasons it has been hypothesized that angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin-II receptor blockers (ARBs) may play a role in preventing AF recurrence. The aim of the present review was to analyse evidence supporting the usefulness of RAS inhibition in patients with AF in order to focus on which specific subset of patients it would most favour. After reviewing the literature, we conclude that, although many studies and meta-analysis have supported the advantage of RAS block in preventing AF recurrence, it is premature to recommend the use of ACE-Is and ARBs specifically for the prevention of AF. However we believe that as these drugs are safe and manageable, they should be considered the drugs of choice in patients with AF and coexisting clinical conditions such as hypertension, coronary disease, heart failure and diabetes mellitus.     

Guidelines for stroke prevention in patients with atrial fibrillation

Atrial fibrillation (AF) is a major independent risk factor for stroke. AF is most commonly associated with nonvalvular cardiovascular disease and is especially frequent among the elderly. The annual risk for stroke in patients with AF is approximately 5% with a wide range depending on the presence of additional risk factors. For patients who cannot successfully be converted and maintained in normal sinus rhythm (NSR), antithrombotic therapy is an effective method for preventing stroke. The 2 drugs which are indicated for stroke prophylaxis in patients with AF are warfarin and aspirin. For primary prevention, warfarin reduces the risk of stroke approximately 68%. Aspirin therapy is less effective, resulting in a 20 to 30% risk reduction. Combination therapy with aspirin and low intensity warfarin adjusted to an International Normalised Ratio (INR) of 1.2 to 1.5 has not been shown to be superior to standard intensity warfarin with a target INR of 2.0 to 3.0. In patients with AF and a prior history of stroke or transient ischaemic attack (TIA), the absolute risk reduction with warfarin is even greater because of the high risk of stroke in this population. In contrast, aspirin has not been shown to significantly reduce the risk of stroke in patients with AF when used for secondary prevention. When appropriately managed, warfarin is associated with a low risk of major bleeding. In controlled trials of highly selected patients, the annual rate of intracranial haemorrhage (ICH) with warfarin was approximately 0.3%. Studies have shown that specialty anticoagulation clinics can achieve similar low rates of major bleeding. However, these results cannot be extrapolated to the general population. Factors which have been identified as predictors of bleeding include advanced age, number of medications and most importantly, the intensity of anticoagulation. INR values above 4.0 have been associated with an increased risk of major bleeding while values below 2.0 have been associated with thrombosis. Slow careful dosage titration, regular laboratory monitoring and patient education can substantially reduce the risk of complications. In patients with AF, antithrombotic therapy has been shown to be cost effective. For high risk patients, warfarin is the most cost-effective therapy, provided the risks for bleeding are minimised. In contrast, aspirin is the most cost-effective agent for low risk patients. Current practice guidelines for stroke prophylaxis recommend warfarin (target INR 2.5: range 2.0 to 3.0) for AF patients at high risk for stroke including those over 75 years of age or younger patients with additional risk factors. Aspirin should be reserved for low risk patients or those unable to take warfarin. Although these recommendations are strongly supported by the clinical trial evidence, studies show that many patients are not receiving appropriate antithrombotic therapy. In particular, warfarin is underutilised in high risk elderly patients. Additional studies are needed to identify barriers that prevent implementation of the clinical trial findings into clinical practice.     

Angiotensin II receptor blockers in the prevention of atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia. While antiarrhythmic agents and electrical cardioversion are highly effective in restoring sinus rhythm, the results obtained in prevention of recurrences are disappointing. Recently, angiotensin II has been recognized as a key factor in atrial structural and electrical remodeling associated with AF. So there are several potential mechanisms by which inhibition of the renin-angiotensin-aldosterone system may reduce AF. In this review, we report the results of studies evaluating the effect of angiotensin II receptor blockers (ARBs) in various clinical settings (i.e., lone AF, hypertension, high-risk patients, congestive heart failure, secondary prevention). However, many of these studies are small and retrospective and have a limited follow-up; moreover, since AF is related to several causes, chiefly heart diseases, patients with different characteristics have often been enrolled. Thus, it is not surprising that the results obtained are frequently conflicting. With these limitations and considering only the results of larger studies with longer follow-up, ARBs are effective in preventing AF in patients with congestive heart failure or hypertension with left ventricular hypertrophy or coronary artery/cerebrovascular disease. In any case, the use of ARBs is not recommended at present in clinical practice to prevent AF.     

Evaluation and management of atrial fibrillation

Atrial fibrillation (AF) is the most common clinically encountered arrhythmia affecting 0.4% of the general population. Its prevalence increases with age, affecting more than 6% of people over 80 years of age. The annual risk of ischemic stroke in patients with lone AF is approximately 1.3%. This annual risk increases up to 10% -12% in patients with a prior stroke or transient ischemic attack. Randomized clinical trials (RCT) comparing adjusted-dose oral anticoagulation and placebo showed a risk reduction of 61% (95% CI 47% to 71%). The absolute risk reduction for stroke with oral anticoagulants is about 3% per year. Aspirin has been shown in meta-analyses to have on average a 20-25% relative risk reduction, and is inferior to oral anticoagulants. In high risk patients with AF warfarin is a class I ACC/AHA indication unless there is a contraindication for anticoagulation. Unfortunately, this therapy requires frequent monitoring with blood samples and the interaction with food and several medications makes its use difficult and sometimes unreliable. It requires strict patient compliance and its use is also linked to potentially serious bleeding complications. In clinical practice, less than 60% of patients who do not have contraindications to oral anticoagulation are actually receiving them. Additionally, of those that receive oral anticoagulation, less than 50% are consistently within therapeutic targets. As such, the "real world" efficacy of a strategy towards prescribing oral anticoagulants is likely significantly lower than that demonstrated in clinical trials. As such, the need to discover other methods of anticoagulation with oral bioavailability, predictable pharmacokinetics, and minimal interactions with diet and other pharmacological agents is imperative. Low molecular weight heparin has a more predictable bioavailability and a longer half-life, but its subcutaneous mode of administration and long-term risks, in particular, osteoporosis makes the chronic use of this medication non-feasible. Antiplatelet agents such as clopidogrel have proven efficacy and superiority compared to aspirin to prevent systemic vascular events in at-risk patient populations, but currently they do not play an important role in the prevention of AF related thromboembolic events. The ACTIVE study is a randomized trial comparing the combination of clopidogrel and aspirin therapy to oral anticoagulation with warfarin in patients with AF, and was unfortunately terminated prematurely by the data safety and monitoring board because of increased events in the antiplatelet arm. Direct thrombin inhibitors, such as ximelagatran, may be as effective as warfarin for stroke-risk reduction in patients with AF. No anticoagulation monitoring is needed and it has excellent bioavailability, with a twice-daily oral dose. Elevation of liver enzymes was an initial concern regarding the use of this new drug, which is not available for general use. Ongoing pharmacological research and future clinical trials may one day leave the "warfarin days" behind. Unfortunately, the new therapies that are being tested seem to be at least several years away from being available on a widespread basis. In this review, we discuss the underlying pathophysiology of AF and stroke. We also provide a comprehensive discussion regarding various available therapies to treat AF.