甲状腺过氧化物酶基因c.2268dupT突变与甲状腺结节的相关性研究

目的 探讨先天性甲状腺功能减退症(先天性甲减)患者及其家系成员发生甲状腺结节与突变位点的关系.方法 58例先天性甲减患者入选,提取外周血白细胞基因组DNA,根据甲状腺功能及超声检查结果选择靶基因.PCR扩增甲状腺过氧化物酶(TPO)、双氧化酶2(DOUX2)、双氧化酶成熟因子2(DOUXA2)、促甲状腺激素受体(TSHR)、钠/碘协同转运体(NIS)基因的所有外显子,对纯化PCR产物进行测序.发现突变后对其家系成员进行筛查.患者及家系成员行甲状腺功能和99mTc甲状腺扫描或超声检查,然后分析5个基因的突变位点与甲状腺结节的关系.结果 16例先证者为复合杂合子或纯合子,其中10例为TPO基因突变,含c.2268dupT突变者6例.37例家系成员为杂合突变,其中TPO基因突变25例.TPO基因c.2268dupT突变先证者及杂合携带者共20例,其中12例并发甲状腺结节.与其他所有突变位点组相比,c.2268dupT突变组的甲状腺结节患病率较高,差异有统计学意义(x2=13.545,P ＜0.01).结论 TPO基因c.2268dupT突变为高频突变,该突变携带者发生甲状腺结节危险性较高.     

以肝肿大为主要表现的Ⅰa型糖原累积病家系研究分析

目的对一个以肝肿大为主要表现的Ⅰa型糖原累积病（GSD 1a）家系进行基因突变研究和分析。方法收集GSDⅠa患者家系资料和亲属外周血标本，PCR法扩增葡萄糖-6-磷酸酶（G-6-Pase）基因的5个外显子，并测序比对基因序列的变化。结果结合临床表现、肝组织学检查及家系分析，患者诊断明确。基因结构分析显示，患者p6-Pase基因5号外显子密码727G→T／1071C→A（A331E）复合突变。在其父辈家系中存在5号外显子727G→T杂合子突变，导致剪切点突变；其母辈家系中存在5号外显子1071C→A杂合子突变，导致第331位密码子编码的A转变为E。结论患者的祖父及外祖母为首发突变者。727G→T／1071C→A（A331E）复合突变是该家系发病的分子生物学基础。     

自身免疫性甲状腺病与促甲状腺激素受体基因突变的关系

自身免疫性甲状腺病（AITD）是一组器官特异性自身免疫疾病。主要包括Graves病（GD）、桥本甲状腺炎（HT）和原发性粘液性水肿。促甲状腺激素受体（TSHR）是AITD发病中重要的自身抗原，对其遗传变异的研究具重要意义。人类TSHR基因位于染色体14q31处，全长60kb，包括10个外显子和9个内含子，第1至9号外显子编码TSHR氨基酸膜外区的部分，跨膜区和膜内区部分由第10号外显子编码。研究表明，自主性功能性甲状腺腺瘤，遗传或散发性毒性甲状腺增生症，先天性甲减等多种甲关腺疾病与TSHR基因突变密切相关，对于Graves病和桥本甲状腺炎，这方面的研究较少。目前有G205C体细胞突变，C253A原始细胞突变的报道，但尚存争议。本研究初步探讨AITD与TSHR基因突变的关系。     

家族性高胆固醇血症低密度脂蛋白受体基因突变分析

目的:检测1例家族性高胆固醇血症(FH)先证者及其4代家系成员低密度脂蛋白受体(LDL-R)基因突变,探讨该家族FH可能发病分子机制.方法:收集先证者及其家系成员临床资料和基因组DNA,以基因组DNA为模板,用PCR方法扩增LDL-R基因的启动子和全部18个外显子,PCR产物进行限制性内切酶技术结合DNA测序,核苷酸序列分析结果与Gen Bank比对寻找突变;采用PCR-DNA测序技术检测apoB100基因R3500Q、R3531C和R3500W位点以及枯草溶菌素转化酶9(PCSK9)基因,以排除家族性apoB100缺陷症和PCSK9基因突变.结果:先证者及其部分家系成员第6号外显子发生Cys276X杂合无义突变,为半胱氨酸改变为提前终止密码子,使终止密码子在第276位提前出现,为致病性突变,国内尚无报道;另外,第15号外显子发生Arg744Arg同义突变.其母未发现上述突变,未检测出患者及其家系apoB100基因R3500Q、R3531C和R3500W突变以及枯草溶菌素转化酶9基因突变.结论:此患者及家系LDL-R基因存在Cys276X无义突变,可能是FH的致病突变,该突变是我国FH患者LDLR基因的一种新突变类型.     

一个中国大家系Brugada综合征相关基因SCN5A的突变位点检测

目的：研究一个中国大家系Brugada综合征相关基因SCN5A的突变情况。方法：收集一个Brugada家系（43例）的临床资料,采用聚合酶链反应及直接测序法对此家系进行SCN5A基因突变检测,同时对136名家系外健康对照者的该位点进行单链构象多态性（SSCP）分析。结果：在Brugada家系中发现了一个杂合变异,即SCN5A基因第12外显子上发现一个错义变异（A1685G）,导致代表组氨酸的558位密码子突变为精氨酸（H558R）。结论：在中国人Brugada综合征患者的SCN5A基因上发现了一个已经报道的错义多态位点（H558R）。     

新突变致复合杂合子家族性高胆固醇血症家系的基因检测

目的对临床诊断为遗传性高胆固醇血症纯合子患者所在家系成员的相关基因进行突变检测和分析,探讨该病的分子诊断方法和发病的可能分子机制。方法以该家系中3代共6人的基因组DNA为模板,用PCR对低密度脂蛋白受体（LDLR）基因的全部18个外显子和启动子以及载脂蛋白B-100（Apo B-100）基因3500-3531区域进行扩增,琼脂糖凝胶电泳鉴定后对PCR产物直接测序。测序结果与Gene Bank中该基因的正常序列对比找出突变,结合该家系成员临床表型证实突变。结果在ApoB-100的3500-3531区域未发现突变,而在先证者LDLR基因的第4外显子发现新的点突变685delA杂合性腺嘌呤缺失和386A〉G杂合错义突变,其父存在685delA杂合性腺嘌呤缺失,其母存在386A〉G杂合错义突变。结论证实家系先证者是存在LDLR突变的复合杂合子,发现的新的LDLR基因突变位点386A〉G和685delA分别来源于父系和母系的遗传,可能是该家系发病的分子基础。     

中国人A型胰岛素抵抗家系与胰岛素受体基因突变研究

目的探讨胰岛素受体基因突变在严重胰岛素抵抗综合征中的发病机制。方法采用PCR对一临床拟诊A型胰岛素抵抗综合征患者胰岛素受体的22个外显子进行扩增并直接测序,测得突变所在外显子后,将其一级亲属的相应外显子进行扩增并直接测序。结果先证者及其父亲均为胰岛素受体第20号外显子R1174W杂合错义突变,另发现先证者胰岛素受体3处外显子纯合同义突变及6处内含子变异。胰岛素受体第20号外显子R1174W杂合子突变引起胰岛素受体β亚基酪氨酸激酶活性下降和自身磷酸化缺陷。结论胰岛素受体第20号外显子R1174W杂合子突变是导致该家系先证者及其父亲严重胰岛素抵抗的主要原因,不排除环境因素及其它基因突变的合并存在造成临床表型差异的可能。     

胰岛素基因突变所致的永久性新生儿糖尿病误诊54年家系报道

报道一例55岁确诊的胰岛素基因（INS）杂合突变所致永久性新生儿糖尿病（PNDM）家系。先证者以“发现血糖升高54年,恶心、呕吐5 d”为主诉收入住院,结合临床资料及家族史拟诊为PNDM。收集先证者及其儿子的外周血进行全外显子高通量二代测序,先证者及其儿子在外显子区域检测到INS基因 c.G287A（p.C96Y）杂合...     

变异型克雅病毒转为感染新的人类基因型

据Medscape．com5月18日报道（原载BMJ 2006；332：1164-1165，1186-1188），到目前为止，英国报道的所有变异型克雅病临床病例在朊病毒蛋白基因密码子129位点上均为蛋氨酸纯合子（蛋氨酸，缬氨酸杂合子除外）。大规模分析结果表明，变异型克雅病蛋白中朊病毒基因阳性，其129位密码子缬氨酸突变为纯合子。     

Brugada综合征SCN5A基因的三个新突变

目的 研究Brugada综合征相关基因SCN5A突变情况。方法 以4例Brugada综合征患者和9例临床可疑Brugada综合征患者为研究对象,采用聚合酶链反应和双脱氧末端终止测序法对所有患者进行SCNSA基因扫描。对阳性结果者进行家系中其他成员的筛查。结果 在1个Brugada综合征家系发现两个杂合突变,即SCN5A基因第3外显子上发现一错义突变（G283A）,导致代表缬氨酸残基的第95位密码子突变为异亮氨酸残基（V95I）,第28外显子上也发现一错义突变（CA946T）,导致代表丙氨酸的第1649位密码子突变为缬氨酸（A1649V）。在1个临床可疑Brugada综合征家系发现一杂合突变,即SCN5A基因第28外显子缺失3个碱基（TCT）,导致代表苯丙氨酸残基的第1617位密码子缺失（delF1617）。结论 在Brugada综合征患者发现了3个SCN5A基因新突变（V95I、A1649V、delF1617）。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.