脂蛋白脂酶基因和对氧磷酶1基因联合作用与脑梗死发病的相关性

目的 探讨脂蛋白脂酶(LPL)、对氧磷酶1(PONl)基因联合作用与脑梗死发病的相关性.方法 选取LPL基因2个SNP和PON1基因2个标签SNP,采用聚合酶链反应(PCR)和限制性片段长度多态性(RFLP)技术,对705例脑梗死患者和431例对照组人群进行检测,应用UNPHASED软件、等位基因条件分析的方法,分析基因的联合作用与脑梗死的相关性.结果 LPL基因rs328位点G等位基因分布在动脉粥样硬化性脑梗死组与对照组差异显著(x2=4.83,P=0.034,OR=1.47,95％CI=1.03～2.13);rs326位点G等位基因分布在动脉粥样硬化性脑梗死组与对照组差异显著(x2=3.597,P=0.047,OR=1.64,95％CI =1.12～1.84);PON1基因上的rs2299262位点与LPL基因上的rs328位点联合作用与脑梗死的发病具有相关性(x2=6.26,df =2,P=0.043).结论 LPL基因rs328位点G等位基因携带者患大动脉粥样硬化性脑梗死的风险高于非携带者.LPL基因rs326位点G等位基因携带者患大动脉粥样硬化性脑梗死的风险高于非携带者.PON1基因上的rs2299262位点与LPL基因上的rs328位点联合作用与脑梗死的发病具有相关性.     

NOS1基因多态性与腔隙性脑梗死相关性研究

目的:探讨神经元型一氧化氮合酶基因( NOS1)多态性与腔隙性脑梗死发病的关系。方法:本研究共纳入385例腔隙性脑梗死患者和313例对照组人群，以位于NOS1基因的rs9658281和rs2682820位点为遗传标记，采用聚合酶链式反应-限制性片断长度多态性(PCR-RFLP)技术检测NOS1基因的多态性。结果:Cocaphase 分析表明腔隙性脑梗死组rs9658281位点G等位基因频率较对照组显著增高(x2 =4.135，P=0.042，OR=1.422，95％ CI 1.013～1.997)，这种差异在女性患者更加明显(x2=9.522，P=0.002，OR=2.502，95％ CI 1.398～4.479)。卡方检验表明腔隙性脑梗死组rs9658281位点的GG基因型频率较对照组显著增高(x2=5.862，P=0.015，OR=1.579，95％ CI 1.091～2.286)，这种差异在女性更加明显(x2=13.641，P＜0.0001，OR=3.501，95％CI 1.800～6.810)。经过多因素回归分析调整了传统危险因素的影响后，两组间的差异仍有显著性(P=0.014)。腔隙性脑梗死组和对照组的rs2682820位点的基因型、等位基因频率差异无显著性（P＞0. 05）。结论:NOS1基因rs9658281位点G等位基因与腔隙性脑梗死的发病可能有关。     

文拉法辛临床疗效与γ-氨基丁酸β2受体基因的相关分析

目的 探索γ-氨基丁酸β2受体(GABRB2)基因多态性与五羟色胺-去甲肾上腺素重吸收抑制剂(Serotonin and Norepinephrine Reuptake Inhibitor,SNRI)文拉法辛抗抑郁疗效差异的相关性.方法 对151例抑郁症患者采用文拉法辛治疗6周,以治疗后17项汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)总分≤7为临床痊愈.检测5号染色体上的GABRB2基因的29个标签单核苷酸多态性(Single Nucleotide Polymorphisms,SNP)位点.运用Plink 1.07和Haploview 4.2软件进行29个SNP位点及其构成的单倍型与药物疗效的相关分析.结果 GABRB2基因的rs10071312 和 rs4426954位点的等位基因频率在痊愈组和非痊愈组之间的差异有统计学意义(均P=0.02),rs10071312位点的A等位基因携带者的治疗痊愈率高于G等位基因携带者(OR=4.43),而rs4426954位点的A等位基因携带者的治疗痊愈率低于G等位基因携带者(OR=0.44).有3种单倍型在痊愈组和非痊愈组之间的分布差异有统计学意义,分别是A-A-A-A-G-A (rs7724146-rs10051667-rs2964773-rs12153421-rs2962402-rs4426954,P=0.01),A-A-A-G-A(rs10051667-rs2964773-rs12153421-rs2962402-rs442695,P=0.02)和A-A-A-G-A-G (rs10051667-rs2964773-rs12153421-rs2962402-rs4426954-rs3816596,P=0.03).结论 GABRB2基因多态性可能与文拉法辛治疗的个体化差异有关联.     

精神分裂症患者多巴胺D1受体基因多态性与抗精神病药疗效的关系

目的:探讨精神分裂症患者多巴胺D1受体(DRD1)基因多态性与抗精神病药疗效的关系.方法:300例精神分裂症患者分别给予氯丙嗪(n=78)、利培酮(n=90)、氯氮平(n=132)单一治疗8周;以阳性与阴性症状量表(PANSS)评定疗效;以SNaPshot单核苷酸多态性(SNP)技术检测DRD1基因rs265981、rs4532、rs686和rs265976多态性. 结果:氯氮平总疗效有效组与无效组相比,rs265981基因型T/T、T/C、C/C及等位基因T、C的分布差异有统计学意义(x2=7.101,P=0.029;x2 =4.011,P=0.045);rs265976基因型A/A、A/C、C/C的分布差异有统计学意义(x2=7.124,P=0.028),但其等位基因A、C的分布差异无统计学意义(x2=3.54,P =0.06).氯丙嗪改善阳性症状有效组与无效组相比,rs686等位基因A、G的分布差异有统计学意义(x2=4.427,P=0.035),但其基因型A/A、A/G、G/G的分布差异无统计学意义(x2=3.842,P=0.146).氯氮平改善阴性症状有效组与无效组相比,rs265976基因型A/A、A/C、C/C的分布差异有统计学意义(x2 =5.999,P=0.05),而其等位基因A、C的分布差异无统计学意义(x2=1.051,P=0.305). 结论:DRD1基因rs265981、rs686和rs265976多态性可能对抗精神病药治疗精神分裂症的临床疗效有着重要影响.     

脑源性神经营养因子基因多态性与强迫症的关联研究

目的:探讨脑源性神经营养因子(BDNF)基因与强迫症(OCD)的关联性。方法:190例OCD患者和309个健康对照为研究对象,通过聚合酶链式反应与限制性片段长度多态性(PCR-RFLP)基因分型技术对BDNF基因标签单核苷酸多态性(SNP)位点rs6265进行基因分型。以耶鲁-布朗强迫量表(Y-BOCS)评定OCD患者的病情。结果:OCD组和对照组之间rs6265位点的基因型和等位基因频率分布差异无统计学意义(P>0.05)。在起病年龄和性别方面基因型和等位基因频率分布差异也无统计学意义(P>0.05)。结论:BDNF基因rs6265多态性与OCD可能没有关联。     

L型钙离子通道α1C亚基基因多态性与精神分裂症的相关性

目的探讨L型钙离子通道α1C亚基(calcium channel,voltage-dependent,L type,alpha 1C subunit,CACNA1C)基因多态性与精神分裂症的关系。方法纳入118例精神分裂症患者及122名对照,采用变性高效液相色谱法对其CACNA1C基因rs10848683、rs2238032、rs2299661位点进行基因分型,通过病历资料收集患者感知觉障碍、思维障碍、情感障碍和行为障碍等临床表现,采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评估患者症状。结果 rs2238032和rs2299661位点基因型和等位基因在患者组与对照组间分布有统计学差异(均P0.05),而rs10848683位点基因型和等位基因分布在组间无统计学差异(P0.05)。rs2238032位点TT基因型(OR=0.394)和rs2299661位点CG(OR=0.326)与精神分裂症的患病风险有关联(均P0.05)。rs10848683位点各基因型患者行为障碍分布有统计学差异(P0.05);rs2238032各基因型患者思维障碍、情感障碍和PANSS得分有统计学差异(均P0.05);rs2299661各基因型患者感知觉障碍、PANSS得分有统计学差异(均P0.05)。单体型分析示,CTC(OR=1.811)、CTG(OR=0.432)和TGC(OR=1.771)与精神分裂症关联有统计学意义(P0.05)。结论 CACNA1C基因多态性与精神分裂症及其临床表现有关联。     

CAMSAP1L1基因多态性与我国中部地区人群癫痫的相关性分析

目的 探讨我国中部地区汉族人群中CAMSAP1L1基因两个SNP位点rs6660197和rs2292096的多态性与癫痫遗传易感性的关系.方法 采取病例对照研究方法,分别选取157例癫痫患者,其中包括122例良性癫痫伴中央颞区棘波（BECT）和35例难治性癫痫（RE）患儿;选取160例正常体检儿童作为研究对象.利用PCR-RFLP的方法测定两个SNP位点多态性分布,并进行统计分析.结果 在所有患者中SNP位点（rs6660197）的基因型（CC,CT,TT）频率和等位基因C频率与对照组比较差异均有统计学意义（P＜0.05）;SNP位点（rs2292096）的基因型（AA,AG,GG）频率两组比较差异无统计意义（P＞0.05）.SNP位点（rs6660197）与我国中部地区汉族人群BECT的易感性相关（P=0.040）,CC为风险基因型,C等位基因为风险因子,与对照组比较OR =1.584,95％ CI：1.046～2.398,P=0.029.RE患者SNP位点（rs2292096）的基因型与对照组比较差异有统计学意义（P=0.028）,A等位基因为风险因子（OR=2.431,95％CI：1.265～4.134,P=0.010）,等位基因频率明显高于对照组（P=0.010）.结论 CAMSAP1L1基因SNP位点（rs6660197）与BECT的易感性相关,而SNP位点（rs2292096）与RE的易感性相关.     

脑源性神经营养因子基因多态性与广泛性焦虑症、强迫症的关联研究

目的 探讨脑源性神经营养因子(Brain-Derived Neurotrophic Factor,BDNF)基因与广泛性焦虑症(Generalizea-Anxiety Disorder,GAD)、强迫症(Obsessive-Compulsive Disorder,OCD)的关联性.方法 以上海及周边地区汉族人群108例GAD患者、148例OCD患者和94名健康对照为研究对象,通过TaqMan探针SNP基因分型技术对BDNF基因及基因上游10kb区域的标签单核苷酸多态性(Single nucleotide polyrmorphism,SNP)位点rs6265和rs11030101进行基因分型.同时以汉密尔顿焦虑量表(HAMA)和耶鲁-布朗强迫量表(Y-BOCS)分别评定GAD和OCD患者的病情.结果 GAD组和对照组之间rs6265位点和rs11030101位点的基因型和等位基因频率分布差异无统计学意义(P＞0.05),表明GAD与两个位点不存在关联.同样,也未见OCD与rs6265位点和rs11030101位点的基因型及等位基因存在关联(P＞0.05),GAD和OCD与上述两个位点的单倍型也未见关联(P＞0.05).在GAD组、OCD组内,上述位点的不同基因型组患者首次发病年龄、HAMA或Y-BOCS评分的差异均无统计学意义(P＞0.05).结论 不支持BDNF基因rs6265和rs11030101多态性与GAD或OCD相关.     

精神分裂症患者多巴胺D2受体基因多态性与利培酮治疗效应的关联分析

目的:探讨多巴胺D_2受体基因(DRD2)多态性与利培酮治疗精神分裂症临床疗效的关系。方法:纳入汉族精神分裂症患者304例(研究组)和汉族健康对照120名(对照组),研究组服用利培酮8周后以阳性与阴性症状量表(PANSS)评估疗效,同时检测两组DRD2基因rs6275、rs1801028和rs6277位点多态性。结果:rs6277位点在研究组和对照组中的等位基因频率与基因型频率的分布差异有统计学意义(χ~2=8.37,P=0.02)。研究组rs6275(F=15.52,P0.001)、rs1801028(F=19.74,P0.001)和rs6277(F=10.67,P0.001)位点不同基因型在PANSS总分减分率上差异均有统计学意义;同时rs1801028位点不同基因型在阴性症状减分率上差异有统计学意义(F=15.29,P0.001),rs6277位点在阳性症状减分率上差异有统计学意义(F=14.74,P0.001)。结论:DRD2基因rs6277位点多态性与精神分裂症易感性存在关联;不同DRD2基因型患者利培酮疗效可能存在差异。     

脑源性神经营养因子基因多态性与精神分裂症的关联研究

目的:探讨脑源性神经营养因子(BDNF)基因多态性与精神分裂症的关联性.方法:以111例精神分裂症发作期患者与362例正常对照为研究对象,通过TagMan探针单核苷酸多态性(SNP)基因分型技术对BDNF基因及基因上游10 kb区域的标签SNPs rs6265和rs11030101进行基因分型,比较各组间基因型、等位基...     

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”.