XRCC1在胶质瘤中的表达及意义

目的分析XRCC1在脑胶质瘤,癌旁组织和正常组织中的表达情况。方法郑州大学第五附属医院神经外科2015-07—2016-03经手术切除的脑胶质瘤标本50例,按病理类型可分级,另取因高血压所导致的脑出血行正常脑组织切除减压患者标本10例为对照组。依次检测不同级别的脑胶质瘤和正常脑组织中XRCC1的表达情况,比较XRCC1在不同级别的脑胶质瘤和正常脑组织中以及在不同年龄及性别中的阳性率和相关性。结果低度恶性组胶质瘤(Ⅰ~Ⅱ级)XRCC1阳性率低于高度恶性组胶质瘤(Ⅲ~Ⅳ级),差异无统计学意义(P0.05);在10例正常脑组织标本中XRCC1表达总阳性率为0%。XRCC1在正常脑组织与胶质瘤组织表达有显著差异(P0.05);50例胶质瘤患者组织标本中XRCC1的表达与患者年龄、性别差异无统计学意义(P0.05)。结论 XRCC1在神经胶质瘤中的表达明显高于正常脑组织;XRCC1阳性率的表达与神经胶质瘤的恶性级别无相关性。     

人巨细胞病毒IE1-72蛋白在胶质瘤中的表达及临床意义

目的探讨人巨细胞病毒(HCMV)在脑胶质瘤中的表达,为揭示HCMV感染在胶质瘤中的作用提供理论依据。方法采用免疫组化方法检测HCMV立刻早期蛋白1-72(IE1-72)在不同级别脑胶质瘤的表达情况,并分析IE1-72蛋白表达情况和患者预后关系。结果在89例脑胶质瘤组织中,76. 4%细胞核和(或)细胞质中出现HCMV IE1-72蛋白阳性表达,其中75. 0%II级星形细胞瘤、70. 9%III级星形细胞瘤以及84. 6%胶质母细胞瘤组织中出现阳性表达,而在10例对照脑组织标本中没有发现HCMV IE1-72蛋白阳性表达。我们同时发现在不同级别脑胶质瘤中HCMV IE1-72蛋白表达差异性没有统计学意义,HCMV IE1-72蛋白表达水平与胶质瘤患者的PFS无相关性。结论HCMV IE1-72蛋白在脑胶质瘤中高表达,HCMV感染与胶质瘤的发生具有相关性,其发病机制仍需进一步研究。     

水通道蛋白4在脑胶质瘤患者脑内表达的研究

目的 观察水通道蛋白4(aquaporin-4,AQP4)在脑胶质瘤患者脑内的表达.方法 采用逆转录聚合酶链式反应(RT-PCR)和免疫组织化学技术,分析比较16例脑胶质瘤手术患者脑组织与12例正常脑组织标本AQP4的mRNA和蛋白的表达情况.结果 AQP4主要在脑内星形胶质细胞表达.脑胶质瘤患者脑组织AQP4的mRNA和蛋白的表达均显著高于正常对照组(P<0.01).AQP4在不同分级的胶质瘤中表达并不相同,在Ⅲ、Ⅳ级(32.5±6.5)表达要高于Ⅰ、Ⅱ级(21.6±4.9)(P<0.05).结论 AQP4参与了脑胶质瘤继发脑水肿的发生,是脑水肿产生的重要分子基础.     

Survivin、PTEN蛋白在脑星形细胞瘤中的表达及其相关性

目的 探讨Survivin、PTEN蛋白在脑星形细胞瘤中的表达及其相关性.方法 应用免疫组化SP法,检测65例脑星形细胞瘤患者的肿瘤标本中Survivin、PTEN蛋白的表达.结果 不同级别间的脑星形细胞瘤Survivin 蛋白的表达阳性率差异有统计学意义,Ⅱ级显著低于Ⅲ级与Ⅳ级(均P＜0.05);不同级别间PTEN蛋白表达的阳性率差异有统计学意义,Ⅱ级显著高于Ⅲ级与Ⅳ级(P＜0.05,P＜0.001);两者在脑星形细胞瘤中的表达呈负相关(r=-0.5367,P＝0.002).结论 Survivin、PTEN蛋白的表达与脑星形细胞瘤形成有关,抑癌基因PTEN的突变与Survivin基因的表达可能在星形细胞瘤的恶性进展中起协同作用.     

整合素β3和组织蛋白酶D在人脑胶质瘤中的表达及意义

目的研究人脑星形细胞瘤中整合素β3(Integrin-β3,Int-β3)和组织蛋白酶D(CathepsinD,CathD)的表达,探讨它们在星形细胞瘤侵袭性生长和恶性发展中的作用。方法采用免疫组织化学方法,对临床经过石蜡包埋的47例脑胶质瘤(Ⅰ-Ⅱ级24例,Ⅲ-Ⅳ级23例)和7例正常脑组织标本中Int-β3和CathD的表达进行定位和定性分析,利用计算机图像分析技术测定Int-β3和CathD染色的阳性面积率和平均光密度,并比较两者的相关性。结果Ⅲ-Ⅳ胶质瘤Int-β3和CathD表达水平明显高于Ⅰ-Ⅱ胶质瘤和正常脑组织(P<0.01);Ⅰ-Ⅱ胶质瘤CathD表达水平亦显著高于正常脑组织(P<0.05),但Int-β3表达在此两组间差异无显著性(P>0.05),Int-β3和CathD在胶质瘤中的表达呈显著正相关(r=0.59,P<0.01)。结论Int-β3和CathD的协同作用可能在人脑胶质瘤细胞侵袭性生长及恶性发展中起重要作用。     

星形细胞瘤中错配修复基因HMSH2蛋白表达的改变

目的探讨HMSH2与星形细胞瘤发生、发展及恶性程度的关系。方法应用免疫组化技术检测50例星形细胞瘤组织和10例正常脑组织标本中HMSH2蛋白的表达情况。结果正常脑组织、低级别星形细胞瘤、高级别星形细胞瘤中HMSH2蛋白缺失率分别为0、33.3%、65.2%。结论HMSH2蛋白缺失率与星形细胞瘤的病理分级和恶性程度有密切相关,可能在星形细胞瘤的发生、发展过程中起重要作用。     

端粒结合蛋白-1在脑胶质瘤中的表达及临床意义

目的探讨端粒结合蛋白-1(TRF-1)在不同级别脑胶质瘤及正常脑组织中的表达及其临床意义。方法选取58例脑胶质瘤和10例脑外伤内减压脑组织石蜡切片标本作为研究对象,应用免疫组化技术检测各组TRF1的表达水平,应用半定量法计算不同标本肿瘤细胞免疫标记的频率和强度积分。结果共58例不同级别胶质细胞瘤,其中低度恶性组(WHOⅠ、Ⅱ级)27例,高度恶性组(WHOⅢ、Ⅳ级)31例,10例脑外伤病人内减压脑组织作为正常对照。在所有胶质瘤组织及正常脑组织中均检测到TRF1表达,其中正常脑组织中TRF1表达高积分构成比90.00%,低度恶性胶质瘤组(WHOⅠ、Ⅱ级)的TRF1表达高积分构成比62.96%,高度恶性胶质瘤组(WHOⅢ、Ⅳ级)29.03%。统计分析发现,TRF1在不同级别胶质瘤中的表达与其恶性程度成负相关。结论在人脑胶质瘤和正常脑组织均有TRF1的广泛表达,其在不同级别脑胶质瘤中的表达水平与其恶性程度负相关,即随肿瘤的恶性程度的增高出现表达下调,TRF1可作为脑胶质瘤临床病理分级和恶性程度判断的参考指标。     

脑胶质瘤低氧诱导因子鄄1α的表达及其意义

目的探讨低氧诱导因子鄄1α在脑胶质瘤中的表达及其意义。方法60例脑胶质瘤标本中Ⅰ级11例(毛细胞型星形细胞瘤8例、脉络丛乳头状瘤2例、黏液乳头状型室管膜瘤1例);Ⅱ级20例(弥漫型星形细胞瘤11例、少突胶质细胞瘤5例、室管膜瘤2例、多形性黄色瘤型星形细胞瘤2例);Ⅲ级21例(间变性星形细胞瘤12例、间变性少突胶质细胞瘤6例、间变性室管膜瘤3例);Ⅳ级8例(均为胶质母细胞瘤)。采用免疫组织化学方法检测胶质瘤标本中低氧诱导因子鄄1α的表达变化,并与胶质瘤体积及患者年龄、性别进行统计学分析。结果(1)胶质瘤组织低氧诱导因子鄄1α表达呈阳性反应,主要位于细胞质和(或)细胞核,具有明显的异质性;肿瘤浸润边缘部的肿瘤细胞表达明显增强;而阴性对照标本和10例对照脑组织标本则无表达。胶质瘤组织中低氧诱导因子鄄1α阳性表达率为71.67%(43/60),其中Ⅰ级为27.27%(3/11),Ⅱ级70.00%(14/20),Ⅲ级85.71%(18/21),Ⅳ级100%(8/8)。高级别胶质瘤者低氧诱导因子鄄1α阳性表达率明显高于低级别者,不同级别间差异有高度统计学意义(χ2=15.907,P<0.01);表达强度与病理级别间呈高度正相关(rs=0.480,P<0.01)。(2)低氧诱导因子鄄1α表达与患者年龄、性别及原发肿瘤体积的大小等均无相关性(均P>0.05)。结论脑胶质瘤低氧诱导因子鄄1α的表达强弱与肿瘤病理分级相关。     

血管内皮生长因子与水孔蛋白4在胶质瘤及脑转移瘤中的表达及意义

目的 探讨血管内皮生长因子(VEGF)与水孔蛋白4(AQP4)在胶质瘤及脑转移瘤中的表达,并探讨两者与胶质瘤及脑转移瘤的组织病理学关系及在瘤周水肿形成过程中的作用.方法 选择福建医科大学附属第一医院神经外科自1999年至2001年手术切除并经病理检查证实的胶质瘤石蜡组织标本73例和脑转移瘤组织标本15例,并另取正常脑组织标本8例作为对照,应用免疫组织化学方法检测组织标本中VEGF与AOP4的表达.结果 正常脑组织中未见VEGF表达:高级别胶质瘤与低级别胶质瘤之间、低级别胶质瘤与正常脑组织之间、脑转移瘤与正常脑组织及低级别胶质瘤之间VEGF阳性表达比较差异有统计学意义(P<0.05),而脑转移瘤与高级别胶质瘤之间VEGF阳性表达比较差异无统计学意义(P>0.05).AQP4在所有组织标本中均有表达,正常脑组织与高级别胶质瘤、脑转移瘤之间,低级别胶质瘤与高级别胶质瘤、脑转移瘤之间AQP4阳性表达比较差异有统计学意义(P<0.05),而正常脑组织与低级别胶质瘤之间、脑转移瘤与高级别胶质瘤之间AQP4阳性表达比较差异无统计学意义(P>0.05).Spearman相关分析显示两者在胶质瘤及脑转移瘤组织中表达呈正相关关系(r=0.516,P<0.05).结论 VEGF与AQP4是参与形成肿瘤周围水肿的重要分子生物学因素,且两者可能存在某种协同作用.     

脾酪氨酸激酶在不同等级胶质瘤中的表达及其与周期素1水平的相关性

目的 探讨人脑胶质瘤中脾酪氨酸激酶(Syk)的表达及其与周期索1(CyclinDl)水平的相关性.方法 收集贵州航天医院神经外科自2005年1月至2010年1月间手术切除并经病理证实的脑胶质瘤标本46例,其中Ⅰ级13例,Ⅱ级9例,Ⅲ级5例,Ⅳ级胶质母细胞瘤19例.另取5例因脑创伤行内减压术患者的正常脑组织标本作为对照,RT-PCR检测脑组织标本Syk mRNA、CyclinD1 mRNA的表达并分析二者的相关性.结果 与正常脑组织比较,Ⅰ、Ⅱ、Ⅲ、Ⅳ级脑胶质细胞瘤标本Syk mRNA表达较低,CyclinDl mRNA表达较高,差异有统计学意义(P＜0.05),而且胶质瘤的病理级别越高,Syk mRNA的表达越低,CyclinDl mRNA表达较高,差异均有统计学意义(P＜0.05);胶质瘤中Syk与CyclinDl的表达呈负相关关系(r=-0.832,P=0.000).结论 Syk在脑胶质瘤中表达较低或缺失,提示其可能具有抑癌基因功能,其机制可能与下调胶质瘤中CyclinD1的表达有关.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.