强啡肽原基因和多巴胺D2受体基因与精神分裂症的关系研究

目的探讨甘肃省汉族人群强啡肽原（Prodynorphin,PDYN）基因和多巴胺D2受体（dopamine D2 receptor,DRD2）基因与精神分裂症遗传易感性的关系及其相互作用对精神分裂症的影响。方法采用聚合酶链反应-限制性片段长度多态性〈PCR—RFLP）技术检测128例精神分裂症患者和124例健康对照者PDYN基因启动子区68bp可变串联重复序列（variable number tandem repeat,VNTR）多态性及DRD2基因启动子区-141位胞嘧啶插入／缺失（-141C Ins／Del）多态性的基因型和等位基因的频率。结果精神分裂症患者PDYN等位基因和基因型频率与健康对照者没有显著不同;精神分裂症患者DRD2-141C Del等位基因的频率则显著低于健康对照者;在携带DRD2-141C Del等位基因的精神分裂症患者和健康对照者中,精神分裂症患者PDYN等位基因3的频率显著高于健康对照者。结论DRD2-141C Del等位基因的降低可能与精神分裂症的遗传易感性相关,单独的PDYN基因多态性不会改变精神分裂症的危险度,但是通过与DRD2—141C Del等位基因的上位相互作用可能与这种疾病的易感性相关。     

抑郁症与Nogo基因3'端未编码区CAA插入/缺失突变的关联研究

目的 探讨抑郁症与Nogo基因的3'端未编码区CAA Ins/Del(插入/缺失)突变的相关性.方法 应用聚合酶链反应(PCR)及聚丙烯酰胺凝胶电泳(PAGE)方法,检测321例抑郁症患者和250名健康对照Nogo基因的CAA Ins/Del基因突变分布,采用SHEsis软件分析该基因多态性与抑郁症的关系.结果 Nogo基因的3'端未编码区CAA Ins/Del突变的基因型和等位基因频率在患者组和对照组间的差异无统计学意义(χ2=2.01,P>0.05;χ2=0.31,P>0.05).结论 未发现Nogo基因的3'端未编码区CAA Ins/Del与抑郁症相关.     

多巴胺2受体基因TaqIA多态性与美沙酮维持治疗海洛因依赖患者心理症状相关性研究

目的研究昆明市美沙酮维持治疗A门诊接受美沙酮维持治疗的汉族海洛因依赖者多巴胺D2受体基因TaqIA多态性与接受美沙酮维持治疗海洛因依赖患者心理症状的相关性,探讨影响病人治疗效果的遗传因素。方法对81例接受美沙酮维持治疗的海洛因依赖者实施SCL-90测试,应用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）技术,检测多巴胺D2受体基因TaqIA基因多态,比较不同基因型与SCL-90各因子的关系。结果 A1＋组（A1/A1,A1/A2）与A1-组（A2/A2）SCL-90各因子分无显著性差异。结论D2受体基因TaqIA多态性与美沙酮维持治疗海洛因依赖患者心理症状可能不存在相关性。     

解偶联蛋白2基因-866G/A,Ala55Val及Ins/Del多态性对宁夏回族人群血清抗氧化物质含量的影响分析

目的以宁夏地区回族人群为研究对象,分析UCP2基因多态性对血清抗氧化物质含量的影响。方法收集宁夏地区回族正常人群及回族脑缺血患者外周血样本,提取外周血基因组DNA,采用聚合酶链反应-限制性片断长度多态性方法检测各样本UCP2基因-866G/A、Ala55Val及Ins/Del多态性,利用试剂盒检测血清抗氧化物质SOD、TAOC、GSH含量。结果宁夏地区回族健康人群中,UCP2基因-866位点GA基因型血清GSH值(125.78±4.55)U/L低于GG野生型基因型GSH值(130.35±10.68)U/L(P0.05);脑缺血患者中Ins/Del位点组Ins/Ins基因型血清GSH值(108.71±8.30)U/L低于Del/Del基因型血清GSH值(116.43±8.24)U/L(P0.05)。结论在一定条件下,UCP2基因-866G/A,Ins/Del多态性可能影响宁夏地区回族人群血清GSH值。     

河南汉族缺血性脑血管病患者半胱氨酸蛋白酶抑制因子Cystain C Rs2897119 (-177C/T)基因多态性检测

目的探讨半胱氨酸蛋白酶抑制因子Cystain C基因Rs2897119（-177C/T）与中国河南汉族人缺血性脑血管病的关系。方法运用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法 ,对185例缺血性脑血管病组（包括血栓性脑梗死、腔隙性脑梗死和短暂性脑缺血发作）和111例对照组进行Cystain C基因Rs2897119（-177C/T）多态性检测。结果病例组中Cystain C Rs2897119（-177C/T）基因型频率T/T、C/C、C/T分别为2.2%、81.6%、16.2%,T、C等位基因频率分别为10.3%、89.7%;对照组中Rs2897119基因型频率T/T、C/C、C/T分别为3.6%、79.3%、17.1%,T、C等位基因频率则分别为12.2%、87.8%。2组中Cystain C基因Rs2897119（-177C/T）野生型T/T与纯合子突变型C/C基因型频率差异无统计学意义（χ2=0.575,P=0.448）,野生型T/T与杂合子突变型C/C基因型频率差异无统计学意义（χ2=0.360,P=0.549）,2组中等位基因频率差异无统计学意义（χ2=0.508,P=0.476）。结论 CystainC基因Rs2897119（-177C/T）多态性可能与缺血性脑血管病没有明显关联,不是缺血性脑血管病的遗传影响因素。     

多巴胺D2受体TaqI A多态性与海洛因渴求程度的关联分析

目的探讨多巴胺D2受体TaqI A多态性与线索诱发海洛因渴求程度的关系.方法 380名海洛因依赖者接受环境诱发渴求实验,用PCR-RFLP技术检测DRD2受体TaqI A多态性,比较不同基因型与线索暴露前后渴求程度的关系. 结果强制戒毒被试者基因型与暴露前后渴求程度未见显示差异(P＞0.05).自愿戒断被试者基因型与诱发后渴求分值、暴露前后渴求分差值的差异有显著性(F=4.523,P=0.012;F=3.936,P=0.021),A1/A1基因型被试者暴露后渴求程度高于A2/A2(P=0.027,P=0.019)和A1/A2(P=0.032,P=0.035)被试者.三者基因型在成瘾、加量和海洛因使用时间差异上有显著性(P=0.014,P=0.001,P=0.004).A1/A1基因型个体成瘾时间和加量时间小于A2/A2(P=0.007,P=0.001)和A1/A2(P=0.023,P=0.001)基因型个体,但吸毒时间大于A1/A2(P=0.003)和A2/A2(P=0.002)基因型个体. 结论 DRD2受体基因TaqI A多态性可能与环境诱发海洛因渴求程度易感性和成瘾、加量及毒品使用时间有关,A2+(A2/A2,A1/A2)基因型可能在海洛因依赖中起保护作用,而A2-(A1/A1)基因型则可能具有促进作用.     

多巴胺D4受体基因与氯氮平临床疗效个体差异的关系

目的　探讨多巴胺D4受体基因第 3外显子 4 8bp可变重复序列多态性与氯氮平临床疗效个体差异的关系。方法　 81例精神分裂症患者单一服氯氮平治疗 6～ 8周 ,利用阳性与阴性症状量表 (PANSS)评定氯氮平的疗效。采用聚合酶链式反应 (PCR)、变性聚丙烯酰胺凝胶电泳结合银染技术 ,检测精神分裂症患者的基因型和等位基因频率。同时为排除氯氮平个体代谢能力的遗传差异带来的混淆 ,检测了每个患者的血清氯氮平浓度。结果　DRD4基因第 3外显子 4 8bp可变重复序列多态性的 5等位基因的纯合子基因型 (DRD4 5 / 5 )和 5等位基因 (DRD4 5 )的频率在氯氮平有效组和无效组之间有显著性差异。氯氮平治疗精神分裂症阳性症状、阴性症状的有效组和无效组间基因型及等位基因的频率相比无显著性差异。结论　氯氮平治疗精神分裂症的总疗效个体差异与DRD4基因第 3外显子 4 8bp可变重复序列相关 ,携带DRD4 5等位基因者和DRD4 5 / 5基因型者疗效好     

强迫症与5-羟色胺受体基因的关联研究

目的探讨北方汉族人群中5-HT2A、5-HT2C、5-HT1Dβ受体基因与强迫症(OCD)的相关性。方法采用聚合酶链反应-限制性片段长度多态技术测定225例强迫症患者和175名正常对照的5-HT2A-1438G/A、5-HT2CCys23Ser、5-HT1DβG861C多态性的基因型,根据强迫症的共病情况、发病年龄、临床表现将OCD划分亚型进行与5-羟色胺受体基因多态性的关联分析。结果OCD组5-HT1Dβ等位基因861C频率与对照组有显著性差异(2=4.39,P=0.04),而5-HT2A、5-HT2C2个位点基因型和等位基因及5-HT1Dβ基因型的频率与对照组之间差异无显著性(P>0.05);OCD共病其他精神障碍组5-HT1Dβ基因型与等位基因频率与对照组有显著性差异(2=7.12,P=0.03;2=7.56,P=0.006),而无共病组3个位点基因型与等位基因频率与对照组无显著性差异(P>0.05);早发OCD组5-HT2A基因型和等位基因频率与对照组有显著性差异(Х2=8.97,P=0.01;Х2=8.05,P=0.005);强迫思维合并强迫行为的患者5-HT2A基因型与等位基因频率与对照组有显著性差异(Х2=9.15,P=0.01;Х2=8.38,P=0.004)。结论5-HT2A-1438G/A多态性与强迫思维合并强迫行为的OCD亚型及早发型OCD的发病存在关联;5-HT1DβG861C多态性与共病其他精神障碍的OCD相关,有/无共病强迫症可能有不同的发病机制。     

Mu阿片受体多态性与海洛因依赖的关联研究

目的：探讨上海汉族人群中Mu阿片受体（OPRMI）基因A118G位点、C1031G位点多态性与海洛因依赖关联性。方法：采用病例对照研究,分别检测201名海洛因依赖者（依赖组）和249名健康对照（对照组）OPRMI基因A118G和C1031G位点基因型及等位基因频率,分析海洛因依赖者OPRMI受体基因多态与物质依赖的相关性。结果：A118G和C1031G位点多态性在依赖组和对照组间的分布差异无显著性;单体型分析两位点4种单体型均与海洛因依赖间无关联。结论：OPRMI基因A118G和C1031G位点与海洛因依赖无显著相关性。     

低密度脂蛋白受体相关蛋白基因3号外显子多态性与阿尔茨海默病的相关性研究

目的　探讨低密度脂蛋白受体相关蛋白 (LRP)基因 3号外显子多态性与阿尔茨海默病 (AD)的相关性。方法　应用PCR RFLP方法分析 42例患者和 40例正常对照的LRP基因 3号外显子的多态性。结果　AD患者LRP基因 3号外显子的C/C纯合子基因型频率及等位基因C频率均高于对照组 (χ2 =4 2 0 1 ,4 51 5 ,P <0 0 5) ,C/C纯合子发生AD的相对危险度是 2 71 0。结论　LRP基因 3号外显子多态性与AD关联是由于LRP基因C/C型在患者中过表达所致 ;LRP基因C/C型是AD患者发病的风险因子     

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.