脑啡肽酶基因多态性与散发性阿尔茨海默病的关系研究

目的探讨脑啡肽酶(neprilysin,NEP)基因单核苷酸多态性与中国北方汉族散发性阿尔茨海默病(sporadic Alzheimer’s disease,SAD)的关系。方法临床确诊的99例中国北方汉族SAD患者及109例正常对照,提取外周血基因组DNA,聚合酶链反应-限制性片段长度多态性结合DNA直接测序法确定NEP基因rs989692位点及rs6776185位点基因型,分析上述两个位点单核苷酸多态性与AD的关系。结果 AD组和正常对照组NEP基因rs989692位点各等位基因频率及基因型分布无显著性差异(P>0.05);AD组NEP基因rs6776185位点A等位基因频率显著高于正常对照组(88.9%vs 81.2%,P=0.029),AA基因型频率显著高于正常对照组(80.8%vs 67.0%,P=0.024);携带A等位基因者,发生AD的风险是不携带A等位基因者的1.85倍(OR=1.85,95%CI 1.07~3.20);经载脂蛋白E基因(apolipoprotein E,Apo E)ε4等位基因及年龄分层比较,携带ε4基因及年龄<75岁组,AD组A等位基因及AA基因型分布频率仍明显高于正常对照组(P<0.05)。结论 NEP基因rs6776185位点A等位基因和AA基因型可能是中国北方汉族人群SAD的危险因素,可使AD发病年龄提前,并与Apo Eε4等位基因可能具有协同作用。     

心血管危险因子与广西汉族迟发性阿尔茨海默病之间的相关性研究

目的　研究心血管危险因子载脂蛋白 E( Apo E)、载脂蛋白 C- ( Apo C- )以及低密度脂蛋白受体相关蛋白 ( LRP)与汉族迟发性阿尔茨海默病 ( LOAD)之间的相关性。方法　应用 PCR-RFLP技术或直接通过 PCR方法 ,分析了 1 5 6例正常老年人、79例 LOAD Apo E、Apo C- 与 LRP基因型。结果　在 LOAD患者组和正常对照组中 ,Apo Eε4等位基因出现的频率分别为 1 7.7%、5 .7% ,其间差异有显著性 ( x2 =1 5 .75 0 ;P=0 .0 0 1 ,OR=3 .3 96,95 % CI =1 .80 8～ 6.3 79) ;Apo Eε3等位基因频率分别为 76.0 %、84% ,前者低于后者 ( x2 =4.43 9;P=0 .0 3 5 ,OR=1 .65 9,95 % CI =1 .0 3 3～ 2 .665 ) ;LRP、Apo C- 基因的基因型频率和等位基因频率在 LOAD与对照组之间差异无显著性 ( P >0 .0 5 )。结论　 Apo Eε4等位基因是 LOAD的遗传危险因子 ,Apo Eε3等位基因则可能有保护效应 ;此研究未能证明 Apo C- 基因变异和 LRP基因 C766T多态性与 LOAD有相关关系     

中国人载脂蛋白E基因多态性与脑梗死的Meta分析

目的探讨我国人群中载脂蛋白E基因多态性与脑梗死之间的相关性。方法使用Review Manager 5.2统计分析软件对已发表的载脂蛋白E基因多态性与脑梗死关系的相关研究进行分析。结果 ApoEε3/3、ApoEε2/3、ApoEε4/4、ApoEε3/4及ApoEε2/4基因型的OR值分别是0.55(95%CI为0.43~0.72)、0.81(95%CI为0.66~0.98)、2.72(95%CI为1.63~4.57)、2.25(95%CI为1.66~3.04)、1.70(95%CI为1.12~2.60);携带ε4等位基因、携带ε3等位基因发生脑梗死的风险是对照组的2.44倍(95%CI为1.84~3.22)、0.59倍(95%CI为0.46~0.75)。结论 ApoEε3/3、ApoEε2/3基因型及ε3等位基因可能是脑梗死的保护因素;ApoEε4/4、ApoEε3/4及ApoEε2/4基因型和ε4等位基因可能是脑梗死的危险及遗传易感因素。     

胰岛素样生长因子1、载脂蛋白酶E基因多态性与阿尔茨海默病关系的研究

目的探讨河南省汉族人群胰岛素样生长因子1(insulin like growth factor 1,IGF-1)基因rs972936位点多态性、载脂蛋白酶E(Apo E)基因多态性与阿尔茨海默病(Alzheimer’s disease,AD)之间的相关性。方法选取58例AD患者和126例年龄、性别相匹配的健康对照(ND)者为研究对象,柱层析法提取外周血基因组DNA,采用PCR和基因测序技术检测IGF-1基因rs972936位点及Apo E基因型多态分布,并进行对比分析。结果与ND组比较,AD组IGF-1基因rs972936位点3种基因型分布总体差异有统计学意义(χ~2=6.108,P=0.047),其中AD组中GG基因型的频率高于对照组(70.7%51.6%,χ~2=5.935,P=0.015),G等位基因频率明显高于健康对照组(χ~2=6.502,P=0.011);AD组Apo Eε4等位基因频率可能增加AD的患病风险(OR=2.872,95%CI 1.542~5.351)(P=0.001);Apo Eε4等位基因不影响IGF-1基因rs972936位点的基因型或等位基因的分布频率(P0.05)。结论 IGF-1基因rs972936位点多态性与河南汉族人群AD的发病可能有相关性,其中GG基因型、G等位基因可能是AD发病的独立于Apo Eε4等位基因的危险因素。Apo Eε4等位基因是散发性AD的主要危险因素。     

急性缺血性卒中ApoEε4等位基因与血脂和预后相关性研究

目的探讨急性缺血性卒中患者载脂蛋白E(Apo E)ε4等位基因与血脂水平及预后的关系。方法据Apo E基因分型和美国国立卫生研究院卒中量表(NIHSS)评分,将786例急性缺血性卒中患者分为携带Apo Eε4等位基因组和不携带Apo Eε4等位基因组,以及预后良好组(NIHSS评分≤10分)和预后不良组(NIHSS评分10分),分别采用单因素和前进法多因素Logistic回归分析筛查影响携带Apo Eε4等位基因急性缺血性卒中患者预后的不良因素。结果携带Apo Eε4等位基因组患者血清低密度脂蛋白胆固醇和载脂蛋白B表达水平高于不携带Apo Eε4等位基因组[(3.25±0.85)mmol/L对(3.00±0.83)mmol/L,P=0.008;(1.20±0.30)mmol/L对(1.09±0.25)mmol/L,P=0.000]。前进法多因素Logistic回归分析仅入院时NIHSS评分和出院时改良Rankin量表评分是影响急性缺血性卒中患者预后的主要危险因素(均P=0.000),而Apo Eε4等位基因并非其影响因素(P=0.343)。结论携带Apo Eε4等位基因的急性缺血性卒中患者血清低密度脂蛋白胆固醇和载脂蛋白B表达水平升高,但Apo Eε4等位基因并非预后不良的预测指标。     

FGF1基因启动子-1385A/G多态性与阿尔茨海默病的关联性研究

目的　探讨中国汉族人成纤维细胞生长因子 1(FGF1)基因启动子、载脂蛋白 E(Apo E)基因多态性与散发性阿尔茨海默病 (Sporadic Alzheimer’s disease,SAD)的相关情况。方法　应用 PCR- RFL P方法检测 4 1例患者和 4 3例正常人中 FGF1基因启动子和 Apo E基因多态性分布 ,并通过比值比 (OR)对这两种基因与 AD之间进行关联分析。结果　 FGF1基因启动子多态性 (- 1385 A/G)与 AD的发病风险显著相关 ;GG基因型与非 GG基因型的比值比 (OR) =3.15 ,95 % CI=1.0 8～ 5 .4 6。SAD患者与 Apo E基因的等位基因 ε4正关联 ,Apo Eε4与非 ε4的比值比 (OR) =4 .0 2 ,95 % CI=1.6 4～ 9.5 2。在 Apo Eε4中携带 FGF1GG基因型的 (OR) =15 .2 2 ,95 % CI=6 .6 8～4 0 .5 8。结论　 FGF1基因启动子 - 1385 A/G多态是 AD发病的遗传危险因素。     

中国人ApoE基因多态性与血管性痴呆关系的Meta分析

目的评价我国人群ApoE基因多态性与血管性痴呆的关系。方法对1996年1月至2011年5月公开发表的关于中国人血管性痴呆ApoE基因多态性的病例对照研究进行Meta分析。结果共纳入20个病例对照研究。Meta分析结果表明,中国人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为2.20[95%CI(1.81,2.66)];中国汉族人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为3.11[95%CI(2.06,4.69)]。结论载脂蛋白E基因多态性与中国人血管性痴呆相关,携带ε4等位基因的个体有发生血管性痴呆的倾向。     

ApoE基因多态性与阿尔茨海默病的相关性研究

目的 探讨阿尔茨海默病（Alzheimer disease,AD）与载脂蛋白E（ApoE）基因多态性的关系.方法 采用PCR-RFL P方法,对68例晚发型AD（LOAD）、54例早发型AD（EOAD）和168例对照组进行ApoE基因型测定,对AD患者的ApoE基因多态性进行相关分析.结果 两组人群ε3/ε3基因型比例最大,未发现ε2/ε2基因型.APOEε4携带者的频率在LOAD组中是52.5%（43/80）,对照组16.1%（27/168）,其差别有显著性（χ^2=36.2,P＜0.000 1,RR=5.76,95%CI=3.17-10.47）;APOEε4携带者的频率与EOAD呈显著性相关（X^2=6.11,P=0.013 5,RR=2.40,95%CI=1.18-4.86）.结论 ε4等位基因与LOAD、EOAD呈显著性相关,是AD的危险因素之一.     

原钙黏蛋白11X rs5984894基因多态性与迟发性阿尔茨海默病的相关性研究

目的：研究原钙黏蛋白11X（PCDH11X）rs5984894A/G基因多态性与迟发性阿尔茨海默病（AD）的相关性。方法：采用病例对照研究方法,应用聚合酶链反应限制性片段长度多态性（RCR-RFLP）技术检测355例迟发性AD患者和399名健康人的PCDH11X rs5984894的基因型及等位基因频率。应用卡方检验和Logistic回归分析其与AD的相关性。结果：AD组与对照组基因型及等位基因频率差异均无显著统计学意义（P〉0.05）,将样本按载脂蛋白Eε4及性别分层后,同样两组间的差异均无统计学意义（P〉0.05）。经Logistic回归分析去除混杂因素影响后,女性GG纯合子OR=2.90,95%CI=0.57-14.65。结论：中国北方汉族人群中PCDH11X rs5984894基因多态性可能不是迟发性AD发病的独立遗传因素,与迟发性AD的发病无关。     

蒙古族Alzheimer病患者载脂蛋白E基因多态性研究

目的探讨载脂蛋白E(ApoE)基因多态性与蒙古族Alzheimer病(AD)的关系。方法用聚合酶链反应及基因测序技术检测106例蒙古族AD患者和100名正常对照者的ApoE基因的基因型和等位基因频率,并进行比较。结果 AD组中有ApoEε4基因型频率(31.1%)显著高于正常对照组(17.0%)(χ2=5.591,P=0.018;OR=2.207,95%CI:1.136～4.289);ε4等位基因的频率显著高于正常对照组(χ2=4.27,P=0.039;OR=1.841,95%CI:1.026～3.304);两组ApoEε2、ε3等位基因频率的差异无统计学意义。结论ApoE基因ε4等位基因可能是蒙古族人群患AD的遗传性危险因素。     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.