CD40配体在重症肌无力发病机制中的作用探讨

目的　研究 CD4 0配体 (CD4 0 L)在重症肌无力 (MG)患者主要致病因素产生中的作用 ,从而探讨CD4 0 L 在 MG发病机制中的作用。方法　 MG急性期组 10例 ,MG非急性期组 15例 ,设健康对照组 16例。分离外周血单个核细胞 (PBMC) ,分组用植物血凝素 (PHA)和美洲商陆原 (PWM)刺激剂刺激进行单个核细胞培养 :(1)PHA组 :即用 PHA刺激。培养后收集上清检测 γ-干扰素 (IFN- γ)和白细胞介素 4 (IL- 4 ) ;(2 ) PWM组 :即用 PWM刺激。培养后收集上清检测抗乙酰胆碱受体抗体 (Ach Rab)和抗突触前膜受体抗体 (Psm Rab)。比较两组中抗CD4 0 L 单克隆抗体 (CD4 0 L m c Ab)干预与否的差异并与健康对照组比较。结果　无论 MG急性期组或 MG非急性期组 ,刺激后 Ach Rab、Psm Rab、IFN- γ和 IL- 4水平均比健康对照组显著增高 (P<0 .0 0 1)。MG急性期组 IFN- γ高于 MG非急性期组 (P<0 .0 5 ) ,MG非急性期组 IL- 4高于 MG急性期组 (P<0 .0 5 ) ,CD4 0 L mc Ab干预后 4种因素均基本降至健康对照组水平 (P>0 .0 5 )。结论　在 MG的发生、发展过程中 Th细胞亚类出现不平衡 ,CD4 0 -CD4 0 L 共刺激因子均起重要作用     

CD40配体在血清AChRab阳性和阴性重症肌无力发病机制中作用的探讨

目的 :研究CD40配体在血清阳性重症肌无力 (SPMG)和血清阴性重症肌无力 (SNMG)主要致病因素产生中的作用。结果 :无论SPMG或SNMG ,外周血单个核细胞体外培养后上清液中γ干扰素 (IFN γ)、白细胞介素 4(IL 4)、抗乙酰胆碱受体抗体 (AChRab)和抗突触前膜受体抗体 (Prsmab)均比健康对照组非常显著增高 (P =0 0 0 0 )。抗CD40L单克隆抗体 (anti CD40Lmonoclonalantibody ,CD40LMcAb)干预后 ,SPMG组与健康对照组的差异无统计学意义 (P >0 0 5 ) ,SNMG组只有PsmRab与健康对照组的差异无统计学意义 (P >0 0 5 ) ,而IFN γ、IL 4和AChRab的水平虽有所下降 ,但仍显著高于健康对照组 (P <0 0 5 )。结论 :SNMG的AChRab、IFN γ和IL 4可能还通过其他途径产生 ,存在其他发病机制。     

重症肌无力患者血清中可溶性CD40配体表达及临床意义

目的:研究重症肌无力(MG)患者血清中可溶性CD40配体(sCD40L)及抗乙酰胆碱受体抗体(AchRab)的水平,探讨sCD40L在MG发病中的作用。方法:研究对象为25例MG患者,分为急性期组13例,非急性期组12例,设正常对照组15例。取静脉血,分离血清,采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定血清中可溶性CD40配体及抗乙酰胆碱受体抗体(AchRab)的含量。结果:MG急性期组中sCD40L及AchRab的含量比非急性期组及正常对照组显著升高(P<0.01),非急性期组sCD40L及AchRab的含量比正常对照组显著升高(P<0.05)。各组sCD40L与AchRab均呈正相关。结论:sCD40L含量增高可能与MG发生和加重有关。     

重症肌无力患者末梢血Th1和Th2细胞内细胞因子的变化及意义

目的研究重症肌无力(MG)患者末梢血细胞因子及抗乙酰胆碱受体抗体(AchRab)水平,探讨细胞因子在MG发病中的作用。方法研究对象为17例MG患者,分为急性期组10例,非急性期组7例,设健康对照组15例。应用流式细胞术(FCM)测定末梢血产生各型细胞因子(CK)的CD4+T细胞%,采用酶联免疫吸附法(ELISA)测定血清中抗乙酰胆碱受体抗体(AchRab)。结果⑴MG患者急性期组和非急性期组IFN-γ+IL-4-CD4+T细胞%及AchRab的含量比健康对照组显著增多(P<0.05和P<0.001);⑵急性期组和非急性期组IFN-γ-IL-4+和IL-13+CD4+T细胞%比健康对照组显著减少(P<0.05);⑶IL-10+CD4+T细胞%各组之间无显著性差异;⑷各组IFN-γ+IL-4-CD4+T细胞%与AchRab均呈正相关。结论MG患者Th1和Th2细胞因子的平衡紊乱,Th1细胞因子IFN-γ对MG患者自身抗体的产生有促进作用。     

重症肌无力患者CD40配体表达的信号传导途径初步探讨

目的研究重症肌无力(MG)患者CD40配体(CD40L)的表达,探讨MG患者CD40L表达的信号传导途径.方法研究对象为急性期MG患者13例.分离血中单个核细胞,分组用刺激剂刺激进行单个核细胞培养(1)纯培养组不加任何刺激剂进行细胞培养;(2)PMA组用PMA和A23187刺激;(3)PHA组用PHA刺激;(4)BLM组加PKC抑制剂BLM后再加PHA刺激培养.培养后用流式细胞仪检测CD40L阳性细胞率及RT-PCR法检测单个核细胞CD40L mRNA表达.结果MG急性期BLM组CD40L阳性细胞率和CD40L mRNA与纯培养组差异无显著性(P＞0.05),而显著低于PMA组和PHA组(P＜0.01).结论在MG中,CD40L的表达可能依赖于PKC活性介导的T细胞活化途径.     

重症肌无力患者CD40配体mRNA表达的研究

目前一般认为 ,重症肌无力 (MG)是T细胞依赖的 ,抗乙酰胆碱受体抗体 (AchRab)介导的器官特异的自身免疫病。其发生与T细胞的异常活化有关。T细胞传递共刺激信号以活化B细胞 ,诱导B细胞产生病理性抗体[1 ] ,共刺激因子CD4 0 /CD4 0L参与活化过程中信号的传导[2 ,3] 。本研究拟检测MG患者急性期、非急性期外周血单个核细胞 (PBMC)CD4 0LmRNA的表达 ,以了解CD4 0L在MG发病中的作用。1　资料1 1　一般资料 :MG患者 2 5例 ,均为 2 0 0 0年 3月至 2 0 0 2年 3月在广西医科大学一附院神经内科病房及门诊就诊的患者 ,根据病史、体征、…     

重症肌无力患者血清可溶性Fas水平变化及其临床意义

目的探讨重症肌无力(MG)患者血清可溶性Fas(sFas)水平变化及其临床意义。方法采用流式细胞术及酶联免疫吸附法(ELISA)分别测定45例MG患者(MG组)及40例对照者(对照组)外周血T细胞亚群分布和血清sFas水平,并对其中24例MG患者应用糖皮质激素(GC)治疗前后的血清sFas水平进行比较。结果(1)MG组外周血中CD8 T细胞百分率为(21.50±2.21)%,明显低于对照组[(27.75±3.00)%](P<0.01);CD4 /CD8 比值(1.92±0.26)明显高于对照组(1.48±0.16)(P<0.01);血清sFas水平[(3542.06±706.23)pg/m l]显著高于对照组[(2568.18±562.48)pg/m l](P<0.01)。(2)MG组全身型血清sFas水平为(3914.23±804.81)pg/m l,极明显高于眼肌型[(2797.72±592.83)pg/m l](P<0.001);病情中、重度患者明显高于病情轻度者(均P<0.005);预后良好者[(3254.69±661.73)pg/m l]显著低于预后不良者[(4178.38±841.65)pg/m l](P<0.001)。(3)24例MG患者经GC治疗后sFas水平[(2864.59±617.43)pg/m l]较治疗前[(3539.67±705.92)pg/m l]极显著降低(P<0.001)。结论MG患者血清凋亡抑制因素sFas水平增高,并与MG类型、病情及预后相关;GC治疗可以改善MG患者的免疫功能。     

重症肌无力患者CD40配体高表达及其临床意义

目的:研究重症肌无力(MG)患者CD40配体(CD40L)的表达,探讨CD40L在MG中的作用。方法:25例MG患者,分为急性期组13例,非急性期组12例,设正常对照组15例。分离血中单个核细胞,分别培养并用不同刺激剂(PHA、PMA和A23187)刺激。培养前后用流式细胞仪检测CD40L阳性细胞率。结果:①MG急性期组CD40L阳性细胞率比正常对照组及非急性期组显著增高(均为P<0.01);②经PHA或PMA和A23187刺激后,非急性期组CD40L阳性细胞率也比正常对照组显著增高(P<0.01)。结论:CD40L的高表达与MG发生和加重有关。     

白细胞介素-7/CD127信号通路对重症肌无力患者CD8+T细胞的调控作用

目的研究重症肌无力(MG)患者白细胞介素-7(IL-7)/CD127信号通路对CD8+T细胞的调控作用。方法收集2017—2020年在南阳市中心医院神经内科就诊的初治MG患者57例(MG组), 同时入组健康对照者35名(健康对照组), 采集两组受试者的外周血分离血浆和外周血单个核细胞, 采用酶联免疫吸附试验(ELISA)检测血浆中IL-7和可溶型CD127水平, 用流式细胞术检测CD8+T细胞中膜型CD127的表达比例, 分析上述指标在不同性别和发病年龄、有无胸腺瘤、不同Osserman分型之间的差异及与定量重症肌无力(QMG)量表评分的相关性。纯化MG患者CD8+T细胞, 使用重组人IL-7(5 μg/L)刺激培养, 比较可溶型CD127和膜型CD127的水平变化, ELISA法检测培养上清中穿孔素、颗粒酶B、干扰素-γ、肿瘤坏死因子-α(TNF-α)水平;采用实时荧光定量聚合酶链反应法检测CD8+T细胞中免疫检查点分子mRNA表达量。结果 MG组血浆IL-7水平高于健康对照组[(293.4±74.7)pg/ml比(233.8±70.8)pg/ml, t=3.78, P<0.0...     

急性期Guillain-Barr(e)综合征患者人类肿瘤坏死因子样分子1A表达与T细胞分泌γ-干扰素水平的关系

目的 探讨人类肿瘤坏死因子样分子1A(hTL1A)在急性期Guillain-Barre综合征(GBS)中表达及其与T细胞分泌γ-干扰素(IFN-γ)水平的关系.方法 ①重组人可溶性hTL1A(rhsTL1A)免疫6周龄雌性Bal b/c小鼠,用人脐带静脉内皮细胞(HUVECs)以免疫荧光染色法鉴定rhsTL1A抗血清.②鉴定rhsTL1A的生物学活性:健康捐赠者外周血单个核细胞(PBMCs)接种于96孔板,设2 μg/ml植物血凝素(PHA)、2 μg/ml PHA+25 ng/ml rhsTL1A、2 μg/ml PHA+100 ng/mlrhsTL1A、2 μg/ml PHA+400 ng/ml rhsTL1A组,~3H-TdR掺入法检测T细胞增殖.③酶联免疫吸附(ELISA)法检测急性期GBS患儿血清中IFN-γ水平.④流式细胞术检测急性期GBS患儿外周血中CD_3~+ hTL1A~+ T/CD_3~+ T细胞的百分比.⑤分离急性期GBS患儿PBMCs,给予2 μg/ml PHA和400ng/ml rhsTL1 A,培养72 h后ELISA法检测IFN-γ水平.结果 ① rhsTL1A抗血清能够识别真核细胞HUVECs表达hTL1A.②T细胞增殖实验结果显示各组刺激指数(SI)均较对照组升高,400 ng/mlrhsTL1A组的SI最大(2.65).③急性期GBS患儿血清IFN9-γ水平[(102.25±22.17)pg/ml]较对照组[(28.75±1.31)pg/ml]显著升高(t=3.309,P<0.05).④急性期GBS患儿外周血中CD_3~+TL1A~+T/CD_3~+ T细胞比例(18.22%±1.83%)较健康对照组(5.17%±0.48%)显著增高(t=6.884,P<0.01).⑤健康对照组和急性期GBS组PBMCs经2 μmg/ml PHA和400 ng/ml rhsTL1A孵育后,IFN-γ分泌量[(43.56±4.41)pg/ml、(180.64±38.39)pg/ml]均显著增高(t=4.523、2.600,P<0.01、0.05),并且急性期GBS组的IFN-γ水平显著高于健康对照组(t=3.545,P<0.05).结论 ①400 ng/ml rhsTL1A能有效促进2μg/ml PHA活化的T细胞增殖,rhsTL1A具有生物学活性.②急性期GBS患儿外周血中活化T细胞表达hTL1A增加,可通过与其受体DR_3相互结合,促进IFN-γ的分泌.     

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.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.