Volume 134 · Issue 01 · 2021

成人潜伏性自身免疫性糖尿病（LADA）描述了发展为表型2型糖尿病（T2D）但具有胰岛自身免疫标志物的患者亚组。LADA是1型糖尿病（T1D）的一种亚型还是一种独特的疾病仍有争议。取决于种族，LADA在表型T2D中占约1.5%至14.2%。它是成人中诊断的最常见的自身免疫性糖尿病形式，患病率比成人发病的T1D高3.3至12.2倍。^[1]LADA的发病机制与典型的胰岛素依赖型糖尿病相似，是由环境因素和遗传易感性同时促成的。其特征是胰岛β细胞中的自身免疫和缓慢进行性损伤。LADA作为糖尿病的一个重要亚型，在临床实践中应予以认识、理解和适当管理。迄今为止，世界范围内越来越多的研究描述和更新了LADA的命名、诊断标准、临床特征、发病机制和治疗。了解拉达有一条漫长而曲折的道路。在这里，我们将讨论对旱地退化评估的不断扩大的理解，并更新关于旱地退化评估的最新证据。

中国快速老龄化的人口给麻醉师带来了严峻的挑战。老年患者的合并症和功能下降增加了脑部并发症的风险，这可能导致长期发病率和术后总体生活质量下降。^[1,2]因此，实施老年患者围手术期脑保护策略势在必行。

LAPTM4B它是一种原癌基因，在癌症的进展中起着重要作用，包括临床分期和病理分级。^[1]TheLAPTM4B基因编码溶酶体相关蛋白跨膜-4 β（LAPTM4B）蛋白和LAPTM4B是从肝细胞癌（HCC）克隆的。^[2]越来越多的证据表明LAPTM4B是一种新的癌基因，在许多人类实体瘤中过度表达。^[3]此外，LAPTM4B的上调与化疗耐药性以及不良的临床结果和预后相关。^[4,5]LAPTM4B还促进细胞存活、生长、增殖、转移、代谢应激耐受性和自噬。^[6]因此，LAPTM4B蛋白可以代表个体化治疗和肿瘤监测的优秀候选物。

1型糖尿病(T1D)是一种器官特异性自身免疫性疾病，伴有胰腺β-细胞的丢失，其特征是胰岛素水平降低和血糖升高。^[1]T1D的发病率在全球范围内每年以约2%~5%的速度增长，成为全球性的健康问题。^[2]据报道，维生素D（VD）缺乏是T1D发展的一个危险因素。^[3]最近的研究表明，补充VD可缓解T1D患者的疾病症状。然而，一些随机对照试验（RCT）证明了VD治疗的临床效果，但结果不一致。本文旨在评估补充VD治疗T1D的效果，这有助于开发T1D的辅助治疗。

1型糖尿病(T1DM)是一种自身免疫性疾病，其特征在于T细胞介导的胰腺β细胞的破坏，这导致几乎完全丧失合成胰岛素的能力。^[1]这种胰岛素缺乏导致失去调节血糖的能力，因此，外源性胰岛素给药对于患者控制血糖和降低相关慢性糖尿病并发症的发生率是必要的。^[2]此外，还检测到糖尿病和高血压之间存在正相关。^[3]

胰岛素治疗有许多皮肤改变和皮肤相关的不良反应，脂肪肥大（LH）是其中最常见的。^[1]LH的定义是胰岛素注射部位的肿瘤样肿块、可见且可触摸的脂肪组织。^[2]它可能是由重复胰岛素暴露的脂肪生成效应引起的。^[3,4]将胰岛素注射到具有LH的组织中会削弱胰岛素的生理功能，并导致过量的葡萄糖暴露、血糖可改变性和低血糖风险增加。^[5]不幸的是，关于胰岛素使用者中LH的病理生理学的信息有限。因此，需要报告患病率、临床后果和发病机制。

冠状病毒疾病2019（新冠肺炎）疫情最近使全球卫生服务面临越来越大的压力。对于已知新冠肺炎阳性或高度怀疑新冠肺炎感染的患者，尽管稳定的心血管疾病首选非手术治疗以减少暴露，但当主要问题危及生命且没有其他选择时，仍有必要进行紧急心脏手术。

China has experienced rapid urbanization in the past 30 years. We aimed to report blood cadmium level (BCL) in the rapidly urbanized Yangtze Plain of China, and explore the association between BCL and 25-hydroxyvitamin D (25(OH)D).

Our data source was the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) cross-sectional study (ChiCTR-ECS-14005052, www.chictr.org). We enrolled 3234 subjects from 12 villages in the Yangtze Plain. BCLs were measured by atomic absorption spectrometry. 25(OH)D was measured with a chemiluminescence assay.

A total of 2560 (79.2%) subjects were diagnosed with vitamin D deficiency. The median (interquartile range) BCL was 1.80 μg/L (0.60-3.42) for men and 1.40 μg/L (0.52-3.10) for women. In women, mean 25(OH)D concentrations were inversely associated with BCL (0.401, 95% confidence interval: -0.697 to -0.105 nmol/L lower with each doubling of the BCL) after adjustment for age, educational status, current smoking, body mass index, diabetes, and season. However, there was no significant difference in 25(OH)D across the BCL tertiles for men.

BCL in Chinese residents in the Yangtze Plain were much higher than that in developed countries. An inverse association between BCL and 25(OH)D was found in general Chinese women after multivariable adjustment. Future prospective cohort and animal studies are warranted to resolve the direction and temporality of these relationships, and to elucidate the exact mechanisms involved.

Urbanization in China is rapidly proceeding, but rural-to-urban migration and its association with overweight and obesity is not well studied. This study aimed to explore the age at arrival, duration of migration, and the corresponding association with overweight/obesity in Yi migrants in China.

A cross-sectional study was conducted in rural and urban areas in 2015 in Sichuan province, China. Demographic characteristics, lifestyle factors, and anthropometry were collected. General linear regression models were used to assess the effect of duration of migration (1-10, 11-20, 21-30, and >30 years) on body mass index (BMI). Multi-variable logistic regression was used to examine the association between duration of migration and overweight/obesity (BMI ≥ 25 kg/m²).

A total of 3056 Yi people (1894 Yi farmers and 1162 Yi migrants) aged 20 to 80 years were enrolled. After adjusting for age, sex, and other potential confounders, Yi migrants had 1.71 kg/m² (95% confidence interval [CI]: 1.36-2.06) higher BMI and a 2.13-fold (95% CI: 1.71-2.65) higher risk of overweight/obesity than Yi farmers. In Yi migrants, stratified by age at arrival, no significant association between duration of migration and overweight/obesity was observed in those who were 0 to 20 years old at arrival. In comparison, in migrants >20 years old at arrival, compared with the reference group (1-10 years), long-term migration (>30 years) was found to be associated with overweight/obesity after adjustment (odds ratio: 1.85, 95% CI: 1.04-3.29).

Yi migrants were observed to have greater risk of overweight/obesity than Yi farmers. In Yi migrants, the risk of overweight/obesity increased according to the duration of migration, especially in those who were older upon their arrival.

Patients with temporal lobe epilepsy (TLE) originating from different seizure onset zones had distinct electrophysiological characteristics and surgical outcomes. In this study, we aimed to investigate the relationship between the origin and prognosis of TLE, and the stereoelectroencephalography (SEEG) features.

Thirty patients with TLE, who underwent surgical treatment in our functional neurosurgery department from January 2016 to December 2017, were enrolled in this study. All patients underwent anterior temporal lobectomy after an invasive preoperative evaluation with SEEG. Depending on the epileptic focus location, patients were divided into those with medial temporal lobe seizures (MTLS) and those with lateral temporal lobe seizures (LTLS). The Engel classification was used to evaluate operation effectiveness, and the Kaplan-Meier analysis was used to detect seizure-free duration.

The mean follow-up time was 25.7 ± 4.8 months. Effectiveness was 63.3% for Engel I (n = 19), 13.3% for Engel II, 3.3% for Engel III, and 20.0% for Engel IV. According to the SEEG, 60.0% (n = 18) had MTLS, and 40.0% (n = 12) had LTLS. Compared with the MTLS group, the operation age of those with LTLS was significantly greater (26.9 ± 6.9 vs. 29.9 ± 12.5 years, t = -0.840, P = 0.009) with longer epilepsy duration (11.9 ± 6.0 vs. 17.9 ± 12.1 years, t = -1.801, P = 0.038). Patients with MTLS had a longer time interval between ictal onset to seizure (67.3 ± 59.1 s vs. 29.3 ± 24.4 s, t = 2.017, P = 0.008). The most common SEEG ictal pattern was a sharp/spike-wave rhythm in the MTLS group (55.6%) and low-voltage fast activity in the LTLS group (58.3%). Compared with the LTLS group, patients with MTLS had a more favorable prognosis (41.7% vs. 77.8%, P = 0.049). Post-operative recurrence was more likely to occur within three months after the operation for both groups, and there appeared to be a stable longterm outcome.

Patients with MTLS, who accounted for three-fifths of patients with TLE, showed a more favorable surgical outcome.

Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.

In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.

The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t= 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t= 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t= 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.

Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.

Previous studies have demonstrated that various circular RNAs are involved in the malignant proliferation of cancers, such as liver cancer, lung cancer, breast cancer, and others. The potential role of circular RNAs in glioblastoma, however, is still uncertain. In this study, we aimed to study the potential role of hsa_circ _01844 in glioblastoma.

Using reverse transcription-polymerase chain reaction (RT-PCR) method, hsa_circ_01844 expression was measured in five glioblastoma samples and five normal brain samples. To evaluate the potential function of hsa_circ_01844 in glioblastoma, hsa_circ_01844 was overexpressed in glioblastoma cell lines (U251 and U87 cells). Using these two cell lines, in vitro experiments including the flow cytometry assay, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay, Transwell assay, and cell apoptosis assay were performed to investigate the role of hsa_circ_01844 in glioblastoma. Student t test and one-way analysis of variance were used for statistical analysis.

The expression of circular RNA hsa_circ_01844 was lower in glioblastoma tissues when compared with the normal brain tissues by RT-PCR method (0.034 ± 0.036 vs. 1.630 ± 0.891, P < 0.001). Using two glioblastoma cell lines, we found that overexpression of hsa_circ_01844 in glioblastoma cells suppressed their proliferation, colony formation, migration, and increased the apoptotic rate compared with empty vector group and blank control group (all P < 0.05).

Hsa_circ_01844 shows decreased expression in glioblastoma and its overexpression induces apoptosis and inhibits proliferation, migration, and invasion of glioblastoma cells.

Mounting evidence, consistent with our previous study, showed that γ-aminobutyric acid type A receptor (GABAAR) played an indispensable role in airway inflammation and mucus hypersecretion in asthma. Monocyte chemotactic protein-inducing protein 1 (MCPIP1) was a key negative regulator of inflammation. Recent studies showed that inflammation was largely suppressed by enhanced MCPIP1 expression in many inflammatory diseases. However, the role and potential mechanism of MCPIP1 in airway inflammation and mucus hypersecretion in asthma were still not well studied. This study was to explore the role of MCPIP1 in asthmatic airway inflammation and mucus hypersecretion in both mice and BEAS-2B cells, and its potential mechanism.

In vivo, mice were sensitized and challenged by ovalbumin (OVA) to induce asthma. Airway inflammation and mucus secretion were analyzed. In vitro, BEAS-2B cells were chosen. Interleukin (IL)-13 was used to stimulate inflammation and mucus hypersecretion in cells. MCPIP1 Lentiviral vector (LA-MCPIP1) and plasmid-MCPIP1 were used to up-regulate MCPIP1 in lung and cells, respectively. MCP-1, thymic stromal lymphopoietin (TSLP), mucin 5AC (MUC5AC), MCPIP1, and GABAARβ2 expressions were measured in both lung and BEAS-2B cells. Immunofluorescence staining was performed to observe the expression of GABAARβ2 in cells.

MCPIP1 was up-regulated by LA-MCPIP1 (P < 0.001) and plasmid-MCPIP1 (P < 0.001) in lung and cells, respectively. OVA-induced airway inflammation and mucus hypersecretion, OVA-enhanced MCP-1, TSLP, MUC5AC, and GABAARβ2 expressions, and OVA-reduced MCPIP1 were significantly blunted by LA-MCPIP1 in mice (all P < 0.001). IL-13-enhanced MCP-1, TSLP, MUC5AC, and GABAARβ2 expressions, and IL-13-reduced MCPIP1 were markedly abrogated by plasmid-MCPIP1 in BEAS-2B cells (all P < 0.001).

The results of this study suggested that OVA and IL-13-induced airway inflammation and mucus hypersecretion were negatively regulated by MCPIP1 in both lung and BEAS-2B cells, involving GABAAR signaling pathway.

卵泡刺激素（FSH）分泌腺瘤（FSHoma）是一种相对罕见的促性腺瘤。^[1]育龄妇女本病的特征包括卵巢增大伴多发性囊肿、血清雌二醇水平正常至升高、FSH水平升高、黄体生成素（LH）水平降低、病因诱发的月经紊乱、不孕和卵巢过度刺激。肿瘤总是FSH免疫阳性，有时LH和催乳素(PRL)免疫阳性。

对孕妇外周血的无细胞DNA（cfDNA）进行测序已成功应用于胎儿染色体非整倍体的产前筛查，称为非侵入性产前筛查（NIPS）。^[1,2]随着大规模临床实践，人们认识到该方法的准确性和可靠性在很大程度上依赖于来自母体血浆的总cfDNA中存在的胎儿cfDNA的比例，称为胎儿分数。^[3]

2019冠状病毒病（COVID-19）大流行自爆发以来已影响全球超过2000万人，^[1]其中约19%预计进展为重度或危重疾病，构成死亡高危人群。^[2]不同地区报告的重症COVID-19病死率差异很大，从零到61.5%不等^[1,3]背后的原因仍不清楚。低病死率地区报告的重症病例管理数据非常有限。在这项研究中，我们描述了四川省重症新冠肺炎的临床特征、多策略管理和呼吸支持资源的使用情况，四川省所有患者的28天病死率为0.6%，重症病例为3.7%，远低于全球大多数研究报告的水平。

上皮性卵巢癌（EOC）是最常见的卵巢恶性肿瘤。2018年国际妇产科联合会（FIGO）指南推荐盆腔和主动脉旁淋巴结的选择性淋巴结切除术作为早期卵巢癌分期手术的一部分。^[1]2019年第1版国家综合癌症网络指南建议，EOC的手术治疗应包括至少至肠系膜下动脉水平的主动脉旁淋巴结，最好是肾血管水平。^[2]然而，这种根治性治疗显著增加了神经和血管损伤和术中失血的发生率，以及乳糜漏、淋巴漏和淋巴水肿的发生率。^[3]与术后乳糜漏相关的最重要的危险因素是术中淋巴管暴露不足。目前，卵巢癌手术中淋巴管造影的研究主要集中在前哨淋巴结（SLN）标测和通过术中乳糜管成像预防乳糜漏。在这项研究中，我们介绍了使用术前口服花生油识别腹主动脉区域乳糜管的经验，并探索了一种预防术后乳糜漏的新方法。

致编辑：全颈椎间盘置换（TDR）已被广泛用于治疗颈椎间盘退行性疾病（CDDD）。然而，许多研究报告了种植体相关并发症，包括种植体迁移、种植体下沉、异位骨化（HO）和前骨丢失（ABL）。ABL近年来受到了更多的关注；然而，这种现象仅在没有龙骨的颈椎人工椎间盘中被认识到，包括Bryan、Baguera-C、Discocerv和Mobi-C。^{[1,2,3,4,5,6]}因此，本研究的第一个目的是评估龙骨状人工椎间盘Prestige-LP颈椎间盘系统（Medtronic Sofamor Danek Inc.，Memphis，TN，USA）中ABL的发生率。

致编辑：Rosai-Dorfman病（RDD），又称窦组织细胞增生症伴巨大淋巴结病，是一种罕见的非朗格汉斯细胞组织细胞增生性疾病。RDD的特征是双侧颈部淋巴结肿大伴有结外受累，皮肤是最常见的受累器官。^[1]皮肤RDD（CRDD）仅影响皮肤而无全身症状，更为罕见。^[2]在此，我们报告了一名CRDD患者的皮肤镜和反射共聚焦显微镜（RCM）发现。

致编辑：一名1岁男孩因进行性线性头皮脱发到我科就诊，已持续1个月。体格检查发现位于头皮右顶叶和枕叶区域的环状脱发斑块，宽度约为1.5 cm[图1A].病灶光滑，无红斑或鳞屑。患者未出现其他不适。他的病史和家族史并不显著。实验室检查包括全血细胞计数、尿分析、肝肾功能、免疫球蛋白（Ig）、红细胞沉降率、抗双链DNA、抗Sm、抗Ro/SSA和抗La/SSB抗体测定均正常或阴性。C3成分为0.61 g/L（0.79-1.52 g/L），抗核抗体阳性（1：80）。秃顶区的组织病理学检查显示真皮深层和附件周围淋巴细胞和浆细胞浸润[图1B].在皮下组织中也观察到粘液沉积和淋巴细胞浸润。阿尔新蓝染色阳性。直接免疫荧光检查显示基底膜区没有IgG、IgA、IgM和C3沉积。根据临床表现和组织学特征，诊断为环状狼疮性脂膜炎。

致编辑：银屑病是一种多基因遗传背景下由T淋巴细胞介导的慢性炎症增生性疾病。^[1]而且，其发病机制尚不完全清楚。最近的研究表明，T细胞介导的免疫炎症在银屑病的病理生理学中起着关键作用，其最常见的下游介质白细胞介素（IL）-17是该病症中的主要效应细胞因子。司库奇尤单抗是一种高亲和力、完全人源化、G1 κ单克隆抗体，可同时阻断多种来源的IL-17A。^[2]在一项全球性、核心、III期试验中，司库奇尤单抗被证实可快速改善银屑病症状；然而，其在中国人群中使用的疗效仍然未知。本研究在中国人群中进行，为期16周，以探索司库奇尤单抗于2019年5月在临床环境中引入后的疗效和安全性。