长链非编码RNA在风湿免疫病发病分子机制中的研究进展

长链非编码RNA(long non-coding RNA, lncRNA)是一类长度大于200个核苷酸且不具备蛋白编码功能的RNA。随着研究的进一步深入,lncRNA在生物学和人体发病过程中发挥的调控作用被发现。风湿免疫病是一系列机制复杂、影响多器官系统的自身免疫性疾病。近年来一些研究提示lncRNA通过多种途径参与调节多种风湿免疫病发病相关基因的表达,影响免疫系统多个环节的功能,影响该病的发病和进展。本文就lncRNA在风湿免疫病发病中分子机制的研究进展进行综述,为进一步研究提供参考。     

非酒精性脂肪性肝炎肝纤维化血清学无创诊断

由于肝活检的有创性和不足,非酒精性脂肪性肝炎（NASH）及其肝纤维化的无创诊断成为关注的热点。以血清学指标为基础的多参数模型公认为首选的NASH及肝纤维化的研究对象。本文阐述了各种特异性或非特异性血清学参数模型在NASH及肝纤维无创诊断中的应用现状。     

多靶区协同增强神经环路调控:思考与创新

运动功能损伤大多阻断或干扰运动神经传导通路。本团队创新设计的多靶区磁刺激（magnetic stimulation, MS）技术通过刺激皮层和神经根,激活人体中枢和外周神经系统,目前已在科研和临床探索中取得初步疗效。机制研究涉及神经元的激活、神经传导、损伤区微环境的调节和基因调控等。然而,如何使MS技术在临床康复中实现更精准有效的神经修复,是神经调控目前面临的瓶颈问题,可能需要从神经环路重建和任务导向训练去突破。本专题聚焦“神经再生调控与康复”,旨在将神经再生与神经调控的理念运用于临床的康复治疗中,并为探索康复效果的神经生物学机制提供有力依据。本述评将通过多靶区协同增强神经环路调控技术在神经环路重建中发挥的重要作用展开思考,建立更精准有效的MS创新技术与临床路径,以期推动神经调控的基础和临床应用研究。     

Transferrin receptor and ferritin-H are developmentally regulated in oligodendrocyte lineage cells

Iron is an essential trophic element that is required for cell viability and differentiation, especially in oligodendrocytes, which consume relatively high rates of energy to produce myelin. Multiple iron metabolism proteins are expressed in the brain including transferrin receptor and ferritin-H. However, it is still unknown whether they are developmentally regulated in oligodendrocyte lineage cells for myelination. Here, using an in vitro cultured differentiation model of oligodendrocytes, we found that both transferrin receptor and ferritin-H are significantly upregulated during oligodendrocyte maturation, implying the essential role of iron in the development of oligodendrocytes. Additional different doses of Fe3+ in the cultured medium did not affect oligodendrocyte precursor cell maturation or ferritin-H expression but decreased the expression of the transferrin receptor. These results indicate that upregulation of both transferrin receptor and ferritin-H contributes to maturation and myelination of oligodendrocyte precursor cells.     

中青年2型糖尿病患者窦性心率震荡的分析

目的探讨中青年初发2型糖尿病患者窦性心率震荡(HRT)的可能变化及其临床意义。方法选择初发室性期前收缩(VPB)的中青年2型糖尿病患者76例(糖尿病组),有VPB的健康人76例作为对照组。两组均行24h动态心电图(DCG)检查,分析单次VPB后HRT的初始值(TO)、斜率(TS)以及TO和TS异常的发生率。结果糖尿病组TO、TS值明显异常,与对照组比较均有显著性差异(p<0.01);糖尿病组TO及TS异常发生率分别为35.3%和38.2%,而对照组分别为7.9%和5.3%,糖尿病组TO、TS值异常率较对照组明显升高,差异有显著性意义(p<0.01)。结论初发青中年2型糖尿病患者HRT现象明显减弱,同时HRT异常率明显增高。临床上HRT可作为青中年初发2型糖尿病自主神经病变的预测指标。     

无需还纳的保护性回肠造口技术的再优化

目的探讨在既往经回肠壁无需还纳的保护性肠造口技术基础上优化为经回盲部无需还纳的保护性回肠造FI术的临床应用。方法先制作“组合引流装置”（“组合装置”）：根据回肠直径,先用合适型号的可降解吻合环置于避孕套内并予固定,剪去避孕套头端的储精囊．套内置人直径约0．8em、头端带侧孔的引流管,固定引流管于避孕套内。将原先切开回肠壁置人“组合装置”优化：在距回盲瓣5cm处回肠做2个距离约0．5cm的肠管环行荷包．并在对系膜缘和2个荷包缝线之间横向切开肠壁约半圈,置入“组合装置”,其远端从阑尾根部盲肠壁引出,将“组合装置”从右下腹Trocar孔引出腹腔外。结果2010年10月至2012年7月上海同济医院胃肠外科共完成17例超低位直肠癌保护性造口,其中6例应用优化前的经回肠壁无需还纳的保护性回肠造FI术（优化前组）,1l例采用优化后的经回盲部无需还纳的保护性回肠造FI术（优化后组）。所有患者术后低位吻合口愈合良好,引流管排粪顺畅。3—5周左右吻合环降解后顺利拔管。优化前组有1例患者在拔管前后出现肠鸣音亢进和轻度阵发性腹部绞痛等肠梗阻征象;而优化后组无一例出现肠梗阻。优化前组造瘘引流管拔除后的腹壁瘘FI愈合时间为5。36（平均9）d;优化后组则为3～7（平均5）d。结论再优化的经回盲部保护性回肠造FI技术拔管后腹壁造瘘口愈合时间明显缩短,且由于无需固定回肠,发生肠扭转和肠梗阻的概率也相应降低。     

孤立性眩晕型小脑梗死的误诊分析与早期识别

目的旨在探讨急性孤立性眩晕型小脑梗死的早期识别因子及误诊为前庭周围性眩晕的原因。方法通过回顾性分析55例表现为孤立性眩晕发作的急性小脑梗死及58例年龄基本相配前庭周围性眩晕患者的临床资料,分析漏诊和误诊的具体原因,比较分析急性小脑梗死与前庭周围性眩晕患者的临床特点与脑血管病危险因素,寻找早期识别急性小脑梗死的预测因子。结果 13例(23.64%)初诊时被误诊为前庭周围性眩晕者。36例(65.45%)没有步态检查记录,所有患者没有进行眼前庭反射检查,初诊时阳性体征(如眼球震颤、辨距不良及直线行走困难等)的发现率明显偏低。16例(29.09%)没有及时进行头部CT或MRI检查。小脑性眩晕的早期呕吐、头痛症状及眩晕间隙期步态障碍的发生率也明显高于周围性眩晕(P<0.05)。二项Logistic回归分析发现男性、Essen缺血性卒中风险评估(ESRS)>3分是预测急性小脑梗死的重要因子(P<0.05)。结论急性小脑梗死通常表现为孤立性眩晕症状,容易漏诊或误诊。病史询问不详尽、神经系统体格检查不彻底、忽视了神经影像学检查以及早期CT检查的不敏感性是容易漏诊或误诊的重要原因。ESRS>3分、早期出现呕吐或头痛、眩晕间隙期直线行走困难、前庭眼球反射正常对早期诊断小脑性急性孤立性眩晕有重要临床价值。     

Does the Bipolar Disorder-Associated CACNA1C Gene Confer Susceptibility to Schizophrenia in Han Chinese?

The gene coding for the calcium channel, voltage-dependent, L type, alpha 1C subunit (CACNA1C) has been reported to be associated with bipolar disorder (BD) in our previous study. Broad evidence suggests some degree of shared genetic susceptibility between BD and schizophrenia. In this study, we aimed to determine whether the BD-associated gene CACNA1C confers susceptibility to schizophrenia. The association was assessed using a cross section study of 696 schizophrenia patients and 1,114 matched control subjects of Han Chinese origin. Between-group comparisons of genotypic or allelic frequencies showed no statistically significant differences. CACNA1C is unlikely to play a major role in the pathophysiology of schizophrenia in Han Chinese. Further large-scale replication studies using a haplotype-tagging single-nucleotide polymorphism selection approach are required to obtain more conclusive results of any potential association.     

Exercise activities are impaired in maintenance dialysis patients and its correlative factors

Objective To investigate the exercise performance in maintenance dialysis patients, and analyze its correlative factors. Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled, with their baseline data and biochemical measurement being collected. The anthropometric indexes including arm circumference, triceps skinfold, waist circumference and hip circumference were detected. The exercise activity was assessed by hand grip test, timed up and go test (3mTUG) and five times sit-to-stand test (FTSST). Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG＞12 s). Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis. Results There were 121 patients enrolled: 62 on peritoneal dialysis and 59 on hemodialysis, 76 men and 45 women. Patients' average age was (61.6±13.0) years and median dialysis age was 31.7(12.3, 69.0) months. There was no statistical difference between fast group (n=80) and slow group (n=41) in gender, dialysis method, dialysis age, body mass index (BMI), arm muscle area (AMA), waist-hip ratio (WHR), hemoglobin (Hb) and total cholesterol (TC). Patients in fast group were younger, had higher serum albumin, prealbumin, serum phosphate and iPTH, and less prevalence of diabetes than those in slow group. In exercise activity, patients in fast group had better performance in handgrip, 3mTUG and FTSST (all P＜0.05). Univariate analysis showed that, handgrip was correlated with sex (male), AMA, BMI, age, diabetes, serum phosphorus and TC; scores in FTSST was correlated with age, BMI, diabetes, WHR, dialysis method, dialysis age, prealbumin and serum phosphorus; scores in 3mTUG was correlated with age, diabetes, WHR, dialysis method and dialysis age, prealbumin, serum phosphorus and iPTH (all P＜0.05). Multiple stepwise regression analysis showed that sex (male), age, AMA and diabetes were independently correlated with handgrip in dialysis patients (all P＜0.05); age, dialysis method, BMI and diabetes were independently correlated with scores in FTSST (all P＜0.05); age, dialysis method, diabetes and WHR were independently correlated with scores in 3mTUG (all P＜0.05). Conclusions The exercise performances of patients on maintenance dialysis are impaired. Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis. AMA is independently associated with upper limb movement, and dialysis method, BMI and WHR are independent factors associated with lower limb movement in dialysis patients.