用短串联重复序列单体连锁分析进行肌营养不良症产前基因诊断

目的对２０个迪谢内／贝克肌营养不良症（ＤＭＤ／ＢＭＤ）家系进行产前基因诊断。方法应用多重聚合酶链反应（ｍＰＣＲ）和短串联重复序列（ＳＴＲ）多态单体连锁分析对２０个ＤＭＤ／ＢＭＤ家系的成员进行产前基因分析。结果１６个家系可提供充足的多态性信息，４个散发型家系不能提供多态性信息。１１例男性胎儿中，３例存在基因缺失，４例非缺失型男性胎儿的单体型与其携带者母亲相同，确定为ＤＭＤ胎儿。９例女性胎儿中５例继承了母亲的单体型，为致病基因携带者。５１例先证者母亲及其他女性血亲为杂合型。结论ＳＴＲ单体连锁分析快速、准确，基因组ＤＮＡ需要量小，可提供的信息量高，适合非缺失型ＤＭＤ／ＢＭＤ家系产前诊断的需要。同时选择ＤＭＤ基因两端和基因内４个位点进行连锁分析，可大大提高诊断的准确率     

联合应用PCR-SSCP、PCR-限制性酶切和连锁分析法对脊髓性肌萎缩症进行产前基因诊断

目的：建立脊髓性肌萎缩症（SMA）的基因诊断方法。并且应用于SMA的产前基因诊断。方法：应用聚合酶链反应（PCR）－单链构像多态性（SSCP）分析和PCR－限制性酶切分析法对运动神经元存活基因（SMNT）的第7外显子进行缺失检测;应用紧靠SMN基因的微卫星标记进行单体型连锁分析。结果：家系1的患者为两个SMNT基因的同源缺失,胎儿虽然未发现SMNT基因的同源缺失,但是从母亲那儿遗传了一条与患者相同的异常5号染色体,是SMA携带者;家系2的胎儿亦未发现SMNT基因的同源缺失,两家系先证者的母亲各生下了一名正常儿。结论：PCR－SSCP分析,PCR－限制性酶切和单体型连锁分析法是诊断SMA的有效方法,三者联合使用可以相互验证,互为补充,提高产前基因诊断的准确率成功率。     

肌酸转运载体缺乏一家系临床与遗传学分析

目的报道由SLC6A8基因突变导致肌酸转运载体缺乏(creatine transporter deficiency,CRTR-D)一家系的临床和遗传特点。方法对2018年9月山西省儿童医院神经内科收治的1例全面性发育迟缓伴癫痫患儿及家系进行临床分析与遗传学检查,分析其致病基因突变情况。结果先证者男性,3岁3个月,走路不稳,不会说话,频繁抽搐,尿肌酸/肌酐比值升高,磁共振波谱提示脑肌酸峰值降低。先证者舅舅与患儿症状相似,先证者母亲仅表现出学习困难,先证者父亲、姐姐及外祖父母均无症状。测序发现患儿SLC6A8基因(NM_005629)TTC缺失突变[c.1222_1224del(p.Phe408del)],诊断为X-连锁CRTR-D;患儿母亲及外祖母为杂合突变,患儿舅舅携带同样的半合子突变,先证者父亲、姐姐及外祖父未发现该突变。结论SLC6A8基因突变导致CRTR-D的病例家系中具有相同突变的2名女性携带者临床表现不一,存在表型变异,对研究CRTR-D基因型-表型相关性有重要意义。     

基于脐带血和短串联重复序列分析的脊髓小脑共济失调3型产前诊断

目的 探讨脊髓小脑共济失调3型(SCA3)的产前诊断方法 .方法 对1个SCA3家系女性先证者的胎儿进行产前检测,于妊娠20周抽取脐带血进行胎儿DNA提取,采用PCR和基于CEQ8000核酸分析仪的短串联重复序列分析技术进行SCA3基因CAG重复序列动态突变检测.结果 先证者SCA3基因CAG重复数目为31/75次,其配偶CAG重复数目为14/27次,胎儿CAG重复数目为14/31次,其中14次重复来自父亲,31次重复来自母亲的正常等位基因,符合孟德尔遗传规律.本次检测的胎儿携带患者的正常等位基因.胎儿出生后的检测结果 与产前检测完全相同.结论 通过脐带血和短串联重复序列分析技术检测SCA3基因CAG重复序列动态突变,可快速、可靠地进行SCA3产前诊断.     

一个2A型肢带型肌营养不良家系CAPN3基因的突变分析

目的对一个2A型肢带型肌营养不良(limb-girdle muscular dystrophy type 2A)家系进行CAPN3基因的致病突变分析。方法收集先证者及家系成员的外周血,提取DNA,应用全外显子测序技术对先证者进行致病基因检测,然后用Sanger测序技术对先证者家系成员进行突变位点的验证。结果全外显子测序发现先证者携带CAPN3基因c. 1194-9A G和c. 1437C T (p. ser479=)的复合杂合突变。Sanger测序验证先证者母亲为CAPN3基因c. 1194-9A G变异携带者。家系中其他患者均存在相同的复合杂合突变,其未发病的姐姐和女儿为CAPN3基因c. 1437C T (p. ser479=)变异携带者,先证者的女婿未检测到上述位点变异。结论 CAPN3基因c. 1194-9A G和c. 1437C T (p. ser479=)的复合杂合突变为该家系的致病原因。     

D uchenne 型肌营养不良家系的临床及分子遗传学研究

目的：探讨Duchenne型肌营养不良（DMD）家系的临床及分子遗传学特征。方法收集并分析我院收治的2个DMD家系临床资料和基因检测结果,并结合既往相关文献,回顾该病在临床表现、分子遗传学等方面的特点。结果DMD儿童期隐匿起病,进行性加重,以肌无力、肌萎缩为特点,可伴肌肉假性肥大,血清肌酶水平异常增高,肌电图呈肌源性损害,肌肉活检呈肌病特征。本文报道的2个家系经基因检测家系1先证者为DMD基因的第3～21号外显子缺失,家系2先证者则为第8、9外显子重复突变,2个家系中的先证者基因均为纯合突变,且其母亲均为致病基因的携带者,符合X染色体隐性遗传的规律。结论早期识别DMD的临床特征有助于提高该病的诊断水平,基因检测是一种确诊DMD快速、有效的方法。     

Duchenne/Becker肌营养不良症家系基因分析

目的　对 1 8个DMD BMD基因 1 31例成员进行基因分析。　　方法　采用多重聚合酶链反应(mPCR)和短串联重复序列 (STR)多态单体连锁分析。　　结果　 1 0例男性胎儿中 4例存在基因缺失 ,4例非缺失型男性胎儿单体型与其携带者母亲相同 ,确定为DMD胎儿。 8例女性胎儿中 4例继承了母亲的单体型 ,为致病基因携带者。 46例先证者母亲及其他女性血亲为杂合型。 5′CA ,MP1P和内含子 44,49这 4个位点的杂合率分别为 65 2 % ,47 8% ,80 4%和 93 5%。　　结论　同时选择DMD基因两端和基因内 4个CA或TTGA位点进行联合分析 ,可大大提高诊断的准确率。     

6q25.3缺失致Coffin-Siris综合征1型1例

总结1例6q25.3缺失致Coffin-Siris综合征1型患儿的临床资料及基因突变特点。患儿为7岁6个月女童, 有喂养困难、反复感染、语言及运动发育迟缓、智力低下、喉软骨发育不良等表现, 浓眉、牙齿稀疏、背部多毛, 伴多动及攻击性行为、癫痫发作、共济失调。先证者染色体核型分析未见异常;基因组拷贝数变异测序(CNV-seq)示染色体6q25.3区域存在约4.27 Mb杂合缺失, 包含ARID1B基因在内的17个基因, 其父母CNV-seq无异常。家系全外显子基因测序示先证者ARID1B基因第1～20外显子全部缺失, 父母为野生型。先证者临床症状较重, 单倍剂量不足是先证者的遗传学病因。     

双胎共患Wolf-Hirschhorn综合征一家系

目的分析Wolf-Hirschhorn综合征(WHS)的临床表现及基因特点, 提高对此病的诊断及鉴别诊断能力。方法观察2021年12月就诊于郑州大学第三附属医院的4p16.3区段微缺失所致的WHS先证者的临床特点、辅助检查, 对其进行家系全外显子测序(WES), 并对治疗反应及预后进行评估。结果先证者女性, 11月龄, 8月龄开始出现抽搐, 发作有热敏感及丛集性特点, 其同卵双胎姐姐有类似病史。体格检查:营养不良, 发育落后, 面容特殊, 前额突出、鼻梁宽、下颌小, 心前区可闻及全期3/6级杂音, P2亢进, 四肢肌张力低。家系WES及拷贝数变异(CNV)检测发现, 先证者染色体4p16.3区段存在1.99 Mb杂合缺失, 包含WHSC1(NSD2)、WHSC2(NEFLA)等基因, 先证者和姐姐基因组拷贝数变异测序(CNV-Seq)结果显示4p16.3区段分别存在1.97、1.92 Mb杂合缺失, 经定量聚合酶链反应家系分析, 该CNV来源为新发, 根据美国医学遗传学与基因组学学会制订的遗传变异分类标准与指南, 判定为致病性变异。先证者口服丙戊酸钠, 其姐姐先后口服丙戊酸钠、唑尼沙胺...     

MTMR13/SBF2基因复合杂合突变致腓骨肌萎缩症4B2型一家系临床表型及基因突变分析

目的探讨腓骨肌萎缩症4B2型(CMT4B2型)的临床表型和分子遗传学特征。方法一家系3例CMT4B2型患儿,采用目标区域捕获测序技术检测MTMR13/SBF2基因突变类型。结果例1(先证者)6年前出现双下肢无力,行走向前跨步,跑步速度较同班同学明显缓慢,随后症状逐渐加重,出现双手大小鱼际肌和骨间肌萎缩,双侧指关节不能伸直,双侧小腿肌萎缩,双侧马蹄内翻足和四肢腱反射减弱。例2(先证者之大弟)2年前出现双下肢无力,行走不稳,跑步和上楼梯较前明显缓慢,步态异常逐渐加重,足跟行走不能,双手大小鱼际肌萎缩,双侧小腿轻度肌萎缩,四肢腱反射减弱。例3(先证者之二弟)足跟行走困难,双手大小鱼际肌轻度肌萎缩,四肢腱反射减弱。基因检测显示,例1存在MTMR13/SBF2基因c.230GA(p.Gln77Arg)和c.1537CT(p.Gln513~*)复合杂合突变,其父携带c.230GA(p.Gln77Arg)杂合突变,其母携带c.1537CT(p.Gln513~*)杂合突变,例2和例3均存在与先证者相同的c.230GA(p.Gln77Arg)和c.1537CT(p.Gln513~*)复合杂合突变。3例患儿诊断明确为CMT4B2型,该家系明确诊断为CMT4B2型家系。予甲钴胺对症治疗,先证者马蹄内翻足明显,予石膏固定疗法予以纠正。结论 CMT4B2型是罕见且严重的进展型腓骨肌萎缩症,目前尚无有效治疗方法,对患者进行及时的基因检测以明确诊断,同时对患病家系积极开展遗传咨询,对于有生育要求的致病基因携带者还应结合产前基因诊断以避免患病胎儿的出生。对于家系中携带致病基因尚未出现临床症状或处于疾病早期的患者,应密切随访,采取积极治疗以尽可能延迟发病时间或指导患者进行正确的康复训练以预防弓形足、脊柱侧弯等畸形,从而提高生活质量。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.