代谢综合征与非酒精性脂肪肝临床特征的关系

目的:探讨代谢综合征(metabolic syndrome,MS)与非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)临床特征之间的相关性。方法:从我院2012年1月-2014年2月健康体检资料中抽选326例经超声确诊为NAFLD的患者,作为NAFLD组,并随机抽选335例无脂肪肝患者作为对照组;观察两组患者间的临床特征,并采用Logistic回归分析MS与NAFLD临床特征之间的相关性。结果:NAFLD组患者体重指数(BMI)、血压、丙氨酸氨基转移酶(ALT)、空腹血糖(FBG)、血尿酸(UA)、高密度脂蛋白(HDL-C)、甘油三酯(TG)、天冬氨酸氨基转移酶(AST)水平显著高于对照组(P0.05):两组间低密度脂蛋白(LDL-C)、总胆固醇(TC)比较无显著性(P0.05)。NAFLD组中MS、血脂及糖代谢异常、肥胖以及高血压的检出率明显高于对照组(P0.05)。经Logistic回归分析显示,NAFLD、BMI、TG、HDL-C、高血压及血糖是MS的独立危险因素。结论:NAFLD患者中存在MS的各种组分聚集特征,MS患病率明显升高,NAFLD是MS的独立危险因素之一,因此MS与NAFLD关系密切。     

肝细胞极性与膜蛋白分选的分子机制

肝细胞是高度特化的极性上皮细胞,细胞质膜蛋白的分选和极性转运对于肝细胞极性的建立与维持至关重要.首先,膜蛋白在内质网中合成,随后经高尔基体加工修饰,再由反面高尔基体进一步分选,最后通过膜泡运输等不同的机制分别转运到胆汁腔面或窦状隙面,行使其特殊的功能.近些年来,细胞内负责转运的细胞器和主要的分选信号已逐步被揭示.特别是循环内体也被证明参与了胆汁腔面和窦状隙面膜蛋白的极性分选和转运.肝细胞的极性一旦遭到破坏,将会引起胆汁分泌障碍以及其他肝脏功能的损伤,从而可能导致肝脏糖脂代谢紊乱,甚至丧失正常的生理功能.因此,深入研究肝脏细胞极性的形成与维持机制,将为多种肝脏疾病的预防和治疗寻找到新的方向和靶点,具有重要的理论和临床实践意义.     

Regulation and function of stimulus-induced phosphorylation of MeCP2

DNA methylation-dependent epigenetic regulation plays important roles in the development and function of the mammalian nervous system. MeCP2 is a key player in recognizing methylated DNA and interpreting the epigenetic information encoded in different DNA methylation patterns. Mutations in the MECP2 gene cause Rett syndrome, a devastating neurological disease that shares many features with autism. One interesting aspect of MeCP2 function is that it can be phosphorylated in response to diverse stimuli. Insights into the regulation and function of MeCP2 phosphorylation will help improve our understanding of how MeCP2 integrates environmental stimuli in neuronal nuclei to generate adaptive responses and may eventually lead to treatments for patients.     

The Cellular and Physiological Functions of the Lowe Syndrome Protein OCRL1

Phosphoinositide lipids play a key role in cellular physiology, participating in a wide array of cellular processes. Consequently, mutation of phosphoinositide‐metabolizing enzymes is responsible for a growing number of diseases in humans. Two related disorders, oculocerebrorenal syndrome of Lowe (OCRL) and Dent‐2 disease, are caused by mutation of the inositol 5‐phosphatase OCRL1. Here, we review recent advances in our understanding of OCRL1 function. OCRL1 appears to regulate many processes within the cell, most of which depend upon coordination of membrane dynamics with remodeling of the actin cytoskeleton. Recently developed animal models have managed to recapitulate features of Lowe syndrome and Dent‐2 disease, and revealed new insights into the underlying mechanisms of these disorders. The continued use of both cell‐based approaches and animal models will be key to fully unraveling OCRL1 function, how its loss leads to disease and, importantly, the development of therapeutics to treat patients.      

The current management of mycosis fungoides and Sézary syndrome and the role of radiotherapy: Principles and indications

Aim

To evaluate the current treatment of mycosis fungoides (MF) and Sézary syndrome (SS) focusing on the role of radiotherapy (RT), its principles and indications, and the perspectives of the novel irradiation technologies.

Background

MF and SS are rare lymphoproliferative diseases whose incidence is increasing. For a long time RT has been used as a single modality or in integrated treatment programs for these diseases.

Materials and methods

The latest systematic reviews, primary studies and new diagnostic and treatment guidelines on MF and SS were analyzed. Clinical outcomes together with the technical aspects and the role of RT were also evaluated.

Results

New data are available on pathogenesis, diagnostic criteria, classification and staging procedures for MF and SS and several local and systemic therapies are proposed. Localized RT can cure “minimal stage” MF while total skin electron beam irradiation (TSEI) may cure initial-stage disease and may offer important symptom relief (itch, erythroderma) in a more advanced setting. Despite its efficacy, RT is not largely used, mainly because of some technical difficulties but new RT technologies may be proposed to treat large skin surfaces.

Conclusions

New treatment programs offer good results, with median survival of more than 12 years in early-stage MF, but the median survival of 2.5 years or less in advanced stages is still a challenge. RT remains an option for all stages with a good cost/effectiveness ratio in a curative or palliative setting. New RT technologies can overcome some technical problems of treating large skin surfaces.     

肺水相关指数对重症烧伤并发急性呼吸窘迫综合征患者病情预后的评估价值

目的评价肺水相关指数对重症烧伤并发急性呼吸窘迫综合征(ARDS)患者严重程度、预后判断的价值。方法对31例重症烧伤并发ARDS患者,除记录一般临床资料及主要合并症外,均利用脉搏指示剂连续心输出量(PiCCO)监测仪监测,并记录置入PiCCO导管时的急性生理和慢性健康状况(APACHE)Ⅱ评分,置管后0、24、48、72h氧合指数,肺血管通透性指数(PVPI)和血管外肺水指数(EVLWI)值。根据28天预后分为存活组和死亡组,分析两组各指数之间的差异及其对预后的评估能力。结果纳入研究的31例患者中,28天内死亡21例(67.7%),吸入性损伤、脓毒血症是主要合并症及影响预后的主要因素。存活组患者置管后72h氧合指数高于死亡组,差异有统计学意义(P0.05);存活组患者置管后48、72hPVPI低于死亡组,差异有统计学意义(P0.05);存活组患者置管后24、48、72hEVLWI低于死亡组,差异有统计学意义(P0.05);且随着置管时间延长,氧合指数、PVPI、EVLWI均对预后评价准确性增加,置管后72h的氧合指数、PVPI、EVLWI值对预后的评价最佳,3个指数对预后评估价值差异无统计学意义(P0.05)。结论运用PiCCO监测仪对肺水相关指数连续监测对重症烧伤并发ARDS患者严重程度、预后评价具有重要临床意义。     

31例非获得性免疫缺陷综合征肺隐球菌病临床分析

目的通过研究非获得性免疫缺陷综合征肺隐球菌病的临床特点,提高医务人员对肺隐球菌病的认识,做到早期诊断和治疗。方法回顾性分析2001年1月至2011年12月在南京医科大学附属杭州市第一人民医院确诊的31例非获得性免疫缺陷综合征肺隐球菌病患者的性别、年龄分布、职业情况、伴随的基础疾病、临床症状、实验室检查、影像学特征、治疗方案及预后等各方面特点。结果肺隐球菌病发病年龄有年轻化趋势,临床特点及影像学表现缺乏特异性,极易误诊及漏诊。治疗方法及药物少,病程长。结论肺隐球菌病虽然临床表现缺乏特异性,但从病例分析结果来看诊治该病仍有一定规律可循,亟需提高对本病的认识,遇到疑似病例应行血乳胶凝集试验及肺活检或手术病理予以明确,药物治疗需要足够疗程。     

中东呼吸综合征冠状病毒假病毒系统的建立及其在中和抗体检测中的应用

目的:为了避免中东呼吸综合征冠状病毒(MERS-CoV)感染与中和试验中操作活病毒带来的生物安全隐患,构建只具有一次感染能力而无复制能力的MERS假病毒,建立MERS假病毒系统,并应用于中和抗体检测。方法:构建含有MERS-CoV S基因的重组质粒pcDNA3.1-MERS-S,与缺失Env基因、含有萤光素酶报告基因的HIV-1骨架质粒pNL4-3.Luc.RE共转染293T细胞,收获含有假病毒的上清;通过Western印迹、细胞感染实验和血清中和试验,确定是否包装出MERS假病毒,及是否能有效应用于细胞感染与中和试验。结果:MERS假病毒pMERS-S培养上清经Western印迹鉴定出相对分子质量为25×103的HIV-1 P24蛋白和相对分子质量为180×103的MERS-CoV S蛋白;与阴性对照假病毒pEnv-相比,pMERS-S能有效感染MERS-CoV敏感细胞系Huh-7,在感染细胞中产生荧光信号,感染细胞的假病毒量与产生的荧光信号呈明显的量效关系;在MERS假病毒中和试验中,pMERS-S能被MERS-CoV中和抗体中和而失去感染力,反映抗体对MERS-CoV的中和活性。结论:建立了不依赖于BSL-3高等级生物安全条件的MERS假病毒系统,并有效应用于中和抗体检测,为MERS-CoV疫苗、药物评价及病毒致病机制研究提供了良好的技术支撑手段。     

Repeatability of movement behaviour in a wild salmonid revealed by telemetry

Movement estimates derived from sub‐daily tracking of radio‐tagged bull trout Salvelinus confluentus on the Columbia River, British Columbia, Canada, were used to test whether interindividual variation in behaviour was repeatable among contexts, both short‐ and long‐term. Interindividual variation in S. confluentus behaviour was consistent across contexts. These findings emphasize the potential for telemetry as a tool in animal personality and temperament research.