Duchenne肌营养不良模型鼠骨髓移植后dystrophin的表达

目的　观察Duchenne型肌营养不良模型鼠 (mdx鼠 )不同成分骨髓细胞移植后dystrophin的表达。方法　用体外培养的C57BL雄鼠的骨髓细胞、骨髓悬浮细胞、骨髓基质细胞分别经鼠尾静脉注射到放疗后的mdx鼠体内 ,动态观察受体雌性mdx鼠骨骼肌dystrophin的表达 ,并取受体mdx雌鼠血 ,用聚合酶链反应进行Sry基因检测。结果　骨髓细胞、悬浮细胞、基质细胞移植后 1～ 2个月 ,较少肌纤维表达dystrophin(<1 % ) ,3～ 4个月分别约有 7%、6 %、4 %的肌纤维表达dystrophin。Sry基因检测均扩增出受体雌鼠Y染色体上 449bp的DNA片段 ,提示供体细胞在受体内存活。结论　骨髓细胞、悬浮细胞、基质细胞分别移植到mdx鼠体内后 ,mdx鼠骨骼肌均有dystrophin的表达     

骨髓移植治疗Duchenne型肌营养不良症模型鼠后dystrophin相关蛋白表达

目的观察骨髓移植治疗Duchenne型肌营养不良症(DMD)模型鼠—mdx鼠后，β-dystroglycan和α-sarcoglycan在肌膜上的表达情况。方法以正常C57鼠作为供体，以mdx鼠作为受体进行骨髓移植，在移植后2、4、6个月分别进行mdx鼠骨骼肌的β-dystroglycan和α-sarcoglycan免疫荧光染色，计算阳性细胞的荧光积分光密度，与C57鼠及未移植的mdx鼠进行比较。结果在骨髓移植后2、4、6个月mdx鼠骨骼肌肌膜上β-dystroglycan和α-sarcoglycan的表达量均有随时间的延长逐渐增加的趋势．至移植后6个月时，二者的表达量明显高于未治疗的mdx鼠。结论骨髓移植可使mdx鼠的dystrophin相关蛋白在病损骨骼肌细胞膜上表达增加．其对维持肌膜的稳定性、促进肌肉的恢复有重要意义。     

骨髓干细胞移植治疗Duchenne型肌营养不良鼠的实验研究

目的　研究骨髓干细胞移植治疗Duchenne型肌营养不良鼠 (mdx鼠 )的效果。方法　取 4～ 5周龄昆明鼠骨髓干细胞 ,体外培养 3d ,静脉移植到 7Gyγ射线预处理 7～ 8周龄mdx鼠体内。临床监测受体鼠移植物抗宿主病 (GVHD)表现 ,并对移植 12周mdx鼠的运动功能、肌电生理、dystrophin蛋白表达情况进行检测。 结果　 5只 7Gy剂量放疗mdx鼠 ,静脉移植 4 8× 10 6骨髓干细胞 ,3个月后 ,肌电图指标有了部分改善 ;10 %肌纤维表达了dystrophin蛋白。结论　静脉移植同种非同系鼠骨髓干细胞治疗mdx鼠有效 ,显示骨髓干细胞移植治疗DMD有着理想的前景。     

肌营养不良症模型鼠骨骼肌的组织病理学研究

目的　比较肌营养不良症模型 (mdx)鼠、C57鼠和Duchenne型肌营养不良症 (DMD)患者骨骼肌的组织病理学改变 ,以及dystrophin在肌细胞膜上的分布。方法　取mdx鼠、C57鼠和DMD患者骨骼肌作常规HE染色 ,比较其组织学改变 ;同时对mdx鼠、C57鼠骨骼肌作dystrophin的免疫组化染色 ,比较dystrophin在肌细胞膜上的分布。结果　mdx鼠骨骼肌肌纤维大小不等 ,轮廓变圆 ,肌间隙增宽 ,少量脂肪、结缔组织增生 ,细胞核中心移位增多 ,部分肌纤维变性坏死 ,而DMD患者骨骼肌的改变和mdx鼠基本一致。mdx鼠肌细胞膜缺乏完整环行棕色条带 ,而C57鼠则呈一完整环行棕色条带 ,提示mdx鼠dystrophin蛋白缺乏。结论　mdx鼠有类似于DMD患者的骨骼肌组织病理学改变     

Duchenne型肌营养不良症模型小鼠神经肌肉接头特征研究

目的观察Duchenne型肌营养不良症模型小鼠骨骼肌肌膜抗肌萎缩蛋白(dystrophin)表达变化和神经肌肉接头形态,分析其可能机制。方法 C57BL/6和mdx小鼠各8只,HE染色观察肌细胞组织学形态,免疫荧光染色检测腓肠肌肌膜dystrophin蛋白表达变化和神经肌肉接头形态。结果C57BL/6小鼠腓肠肌肌细胞大小基本一致,呈多角形,胞核位于细胞周边、极少数位于肌纤维中心;肌膜均匀表达dystrophin蛋白;神经肌肉接头形态完好。Mdx小鼠腓肠肌肌细胞大小不一致,呈圆形,部分胞核趋中心化;仅少量或个别肌细胞表达dystrophin蛋白;mdx种鼠突触后膜乙酰胆碱受体断裂成小片段,突触前膜神经末梢突起增多、变细,而mdx幼鼠神经肌肉接头形态与C57BL/6小鼠基本一致;mdx小鼠神经肌肉接头数目明显减少,突触前膜和突触后膜横截面积明显减小,肌细胞间神经轴突明显变细。结论Mdx小鼠骨骼肌肌膜dystrophin蛋白缺失并非导致神经肌肉接头改变的直接因素,可能与病情进展有关。     

不同放疗剂量对肌营养不良鼠骨髓干细胞移植的影响

目的　使用不同剂量γ射线对Duchenne型肌营养不良鼠 (mdx鼠 )照射 ,研究骨髓干细胞移植后mdx鼠缺失蛋白表达的情况。方法　将 18只 7～ 8周mdx鼠随机平均分为A、B、C 3组 ,依次给予 7Gy、7.5Gy、8Gyγ射线预处理 ;3天后行骨髓干细胞移植。移植骨髓干细胞取自 4～ 5周的C5 7BL/6鼠 ,体外培养 3d ,按 1 2× 10 7个细胞 /每只剂量移植给 3组预处理后的mdx鼠。连续观察受体鼠的移植物抗宿主病 (GVHD)程度 ;移植 12周后 ,检测受体鼠体内抗肌萎缩蛋白表达情况。结果　C组GVHD反应较明显 ;A、B、C 3组的股骨肌肌纤维dystrophin蛋白表达率分别为 8%、9%和 13 %。各组间缺失蛋白表达率有显著差异。结论　对 7～ 8周mdx鼠 ,给予不同剂量的γ射线预处理 ,骨髓干细胞移植后 ,8Gyγ射线表达最多 ,7Gy射线照射表达量最少 ;但 8Gyγ射线照射GVHD反应较明显。     

骨髓基质干细胞在肌营养不良模型鼠中的分布及移植途径对分布的影响

目的研究干细胞在mdx鼠体内较长时间的动态分布以及移植途径对它的影响。方法用3H-TdR掺入标记骨髓基质干细胞,用4×106个/只静脉及腹腔移植放疗mdx鼠各30只,在24h、48h、2周、1个月、2个月、4个月时间点处死小鼠,取血、心、肝、脾、肺、肾、肌、脑、骨髓消化测定放射计数,计算%ID/g值。结果①静脉移植的mdx鼠脑、骨髓在2周才达到它自身的最高水平,心肌、骨骼肌4个月时达到高峰;而每个时间点各器官含量相比早期基本是肺、肝、骨髓分布多,心肌、肌肉2个月后仅次于骨髓。②腹腔移植mdx鼠血、肺、肾、肝、脾脏、脑到达它各自的高峰比静脉注射均有不同时间延迟,早期还是在骨髓、肝、肺分布多,肌肉2个月后仅次于骨髓。③心、肌肉、脑、骨髓含量静脉移植比腹腔移植高,均具有显著的统计学意义(P<0.01)。结论干细胞移植mdx鼠后4个月达高峰,移植途径对干细胞的分布有影响,3H-TdR能长时间动态观察干细胞分布。     

Utrophin蛋白的分子生物学研究进展

Duchenne型肌营养不良（DMD）是一种X-连锁隐性遗传的肌肉变性病,是由Xp21上的抗肌萎缩蛋白（dystrophin）基因突变所致dystrophin蛋白缺乏引起的疾病.新生男婴DMD发生率大约是1/3500,患者肌无力发展迅速,11～13岁后完全不能行走,大部分在20岁左右死于周围性呼吸循环衰竭.由于utrophin蛋白与dystrophin蛋白有着结构的同源性和相似的功能,通过转基因方法使细胞表面utrophin蛋白水平提高2～3倍,可以使DMD模型动物mdx鼠肌肉的形态和功能得到修复,而这仅是正常肾组织utrophin蛋白水平的大约50%,肺的25%,被认为是基因治疗DMD的非常有希望的替代物.现将其分子生物学研究进展综述如下.     

mdx小鼠骨骼肌组织成肌、成脂、成骨基因的特异性表达**

背景：干细胞移植是治疗肌营养不良症的有效方法之一,但移植的干细胞在病理骨骼肌中成肌表达较低。 目的：通过比较mdx小鼠和C57小鼠的骨骼肌形态及成肌、成脂、成骨基因表达的差异,探讨mdx小鼠骨骼肌病理改变的可能机制。 方法：取mdx小鼠与C57小鼠的骨骼肌组织行冰冻切片,苏木精-伊红染色和Vonkossa染色观察两种小鼠肌肉组织的形态特征;提取mdx小鼠和C57小鼠骨骼肌组织总RNA,real-time PCR检测成肌、成脂、成骨相关基因的表达。 结果与结论：mdx小鼠骨骼肌有肌纤维坏死和再生,伴有轻度脂肪、纤维结缔组织增生,Vonkossa染色可见钙结节沉积,而C57小鼠的骨骼肌细胞形态清晰,核位于细胞周边。与C57小鼠比较,mdx小鼠肌肉组织成骨、成脂基因表达有不同程度的上调(P < 0.05),而成肌基因表达下调(P < 0.05)。dystrophin基因缺失及成肌基因表达下调、成骨和成脂基因上调是造成mdx小鼠肌肉组织变性坏死的原因。     

骨髓移植治疗Duchenne型肌营养不良症中骨髓细胞体内分布的实验研究

目的　探讨骨髓移植治疗肌营养不良症的早期骨髓细胞在体内的分布规律。方法　采用1 2 5I和99m Tc分别标记C5 7鼠的骨髓细胞和红细胞,将其静脉移植入放疗后的m dx鼠体内示踪,于4、12、2 4 h计算各器官内细胞特异性分布指数。用免疫荧光法对宿主骨骼肌的dystrophin检测。结果　骨髓细胞在移植后4 h以内随血流在体内均匀分布。在12 h时其在骨髓中的特异性分布指数明显增加(P<0 .0 5 ) ,而2 4 h时在病损骨骼肌中的特异性分布指数较正常骨骼肌明显增加(P<0 .0 5 ) ,并在2个月后宿主骨骼肌中表达了dystrophin。结论　骨髓移植后骨髓细胞有回巢现象和对病损骨骼肌有趋化现象,有利于靶器官的组织修复。该研究为骨髓移植后骨髓细胞早期能够定居在病损骨骼肌中并发挥修复功能提供了有力的实验依据。     

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.     

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.     

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.     

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.     

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.     

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.