STK40在脑胶质瘤中的表达及其临床意义的生信分析

目的 探讨丝氨酸/酸酸蛋白激酶40（STK40）在脑胶质瘤中的表达及其临床意义。方法 计算机检索GEPIA数据库,运用生物信息学方法分析STK40在胶质瘤组织及正常脑组织中的表达差异;同时,检索CGGA数据库中693例脑胶质瘤的基因信息及临床资料,运用Kaplan-Meier生存曲线分析STK40表达水平与脑胶质瘤生存预后的关系;采用多因素Cox比例回归风险模型分析脑胶质瘤生存预后的影响因素。结果 GEPIA数据库分析显示,胶质母细胞瘤组织STK40表达水平较正常脑组织明显增高（P<0.05）。STK40表达水平与胶质瘤病理级别呈正相关,随胶质瘤病理级别增高,STK40表达水平明显增高（P<0.0001）。多因素Cox风险比例回归模型分析结果显示,STK40高表达是脑胶质瘤生存预后不良的独立危险因素（P<0.05）。Kaplan-Meier生存曲线分析显示,STK40高表达组中位总生存期较低表达组明显缩短（P<0.0001）;而且STK40高表达明显降低胶质瘤放/化疗的效果（P<0.0001）。Pearson相关性分析显示,ERK下游产物SRF与STK40呈明显正相关（r=0.45;P<0.0001）,JNK下游产物ATF2与STK40表达水平呈明显负相关（r=-0.167;P<0.0001）。结论 胶质瘤STK40呈高表达,与病人生存预后不良有关,其作用机制可能与ERK/MAPK及JNK/MAPK信号通路有关。     

胶质母细胞瘤PPFIBP1的表达及其临床意义

目的 探讨PPFIA结合蛋白1(PPFIBP1)在胶质母细胞瘤中的表达及其与病人生存预后的关系。方法 选取2011年6月至2018年6月手术切除的胶质母细胞瘤116例,另选取颅脑损伤内减压术中切除的非肿瘤脑组织68例为对照,用免疫组化染色法检测PPFIBP1的表达。随访截止2021年6月,记录总生存期和无进展生存期。结果 胶质母细胞瘤组织PPFIBP1高表达率[67.24%(78/116)]明显高于对照组[17.65%(12/68);P<0.05]。多因素Cox回归分析显示,PPFIBP1高表达是胶质母细胞瘤病人总体生存预后和无进展生存预后不良的独立危险因素（P<0.05）。生存曲线分析显示,PPFIBP1高表达组中位总体生存期和中位无进展生存期较低表达组均明显缩短（P<0.05）。结论 PPFIBP1在胶质母细胞瘤中呈高表达,与病人不良生存预后有关。     

S100蛋白在儿童髓母细胞瘤组织中的表达及与预后的关系

目的 探讨S100蛋白在儿童髓母细胞瘤组织中的表达,分析与肿瘤临床特点之间的关系和对儿童髓母细胞瘤预后的影响.方法 应用免疫组化SP法检测S100蛋白在44例儿童髓母细胞瘤中的表达,并结合长期随访资料进行生存曲线分析.结果 S100阳性表达率为68.18%.S100表达与儿童髓母细胞瘤患者性别、年龄、有无侵犯四脑室、有...     

EGFR、PCNA、N-myc和P16基因蛋白产物在髓母细胞瘤中的表达

目的探讨EGFR、Nmyc、PCNA和P16基因在髓母细胞瘤发生中的作用,以及上述基因蛋白检测对髓母细胞瘤的诊断、病理分型和年龄的临床意义。方法用免疫组织化学LSAB法检测四种基因蛋白的产物在41例人脑髓母细胞瘤中的表达,分析与髓母细胞瘤病理分型和年龄间的关系。结果EGFR、Nmyc和PCNA蛋白在髓母细胞瘤中高度表达,P16蛋白有明显的缺失,分别为56.10%、60.98%、65.89%、58.54%。EGRF蛋白在两种主要病理类型中的表达差异有统计学意义(P<0.01),P16蛋白在两组不同年龄组间的差异有统计学意义(P<0.05)。结论上述四种基因在髓母细胞瘤的发生中可能起重要作用,EGFR和P16蛋白的检测对病理分型和预后判断有临床实际应用意义。     

儿童髓母细胞瘤中C—Jun和C—Fos表达与预后的关系

目的探讨C-Jun和C—Fos在儿童髓母细胞瘤中的表达及临床意义。方法回顾性分析84例经手术病理证实并获随访的儿童髓母细胞瘤临床病理资料，男46例，女38例，年龄6～12岁，按术后生存期3、5、10年，分为A、B、C三组，每组病例数各为42例、27例和15例。采用免疫组化S-P法检测患儿肿瘤组织中C-Jun和C-Fos的表达。使用spe踟m相关分析和COX回归模型作统计学处理。结果84例儿童髓母细胞瘤中，C-Jun和C—Fos阳性表达各71例（84．52％）和65例（77．38％），A、B、C三组中Cqun和C—Fos阳性表达率各为100％和97．6％,40．74％和77．78％、13．33％和20％，三者两两比较，差异均有统计学意义（P〈O．01）；Spearman相关分析显示，C-Jun和C—Fos的表达与患者的生存时间呈显著负相关，且二者表达具有协同性。COX回归模型分析显示，C-Jun和C—Fos是患儿预后的不良因素。结论儿童髓母细胞瘤中存在C-Jun和C-Fos的阳性表达，并与患儿预后呈负相关。     

不同放射敏感性胶质瘤中ATM蛋白、NF-κB表达及相关性研究

目的探讨ATM蛋白、NF-κB在不同放射敏感性胶质瘤中的表达及相互关系。方法应用免疫组织化学SABC法检测ATM蛋白、NF-κB在儿例髓母细胞瘤,12例室管膜瘤,17例少枝胶质细胞瘤,低级别(Ⅰ～Ⅱ级)及高级别星形细胞瘤(Ⅲ～Ⅳ级)各21例和5例正常脑组织中的表达。结果正常脑组织中均未见阳性表达。ATM蛋白、NF-κB在82例不同组织类型胶质瘤中的阳性表达率分别为32.9%、48.8%,二者阳性和阴性同时表达者分别为25.6%、36.5%;ATM蛋白在多形性胶质母细胞瘤表达率最高,在髓母细胞瘤和低级别星形细胞瘤表达较低,髓母细胞瘤中平均光密度值与其他各组均有显著性差异(P<0.05)。NF-κB表达率在髓母细胞瘤、室管膜瘤、少枝胶质细胞瘤、低及高级别星形细胞瘤、多形性胶质母细胞瘤中里依次上升趋势。结论ATM蛋白与NF-κB存在相关关系,它们的表达水平与胶质瘤的不同放射敏感性具有相关性。     

细胞黏附分子CD99在人髓母细胞瘤中的表达及意义

目的 探讨细胞黏附分子CD99在人髓母细胞瘤组织中的表达特点及其临床意义。方法 采用免疫组化法检测107例髓母细胞瘤及15例瘤旁正常脑组织标本中CD99的表达。所有病人均随访至死亡或截止至2013年12月，随访时间为12~80个月，利用Kaplan-Meier生存曲线进行生存分析。结果 髓母细胞瘤CD99阳性表达率（57.94%，62/107）明显高于瘤周正常脑组织（0%，0/15；P<0.05）。CD99的表达水平与病人性别、年龄、肿瘤的病理组织学分型和分子亚型均无明显相关性（P>0.05）。CD99的高表达与髓母细胞瘤病人的预后呈显著负相关（P<0.05）。结论 CD99高表达与髓母细胞瘤预后显著相关，可作为预后判断的指标及治疗髓母细胞瘤潜在的新靶点。     

成人髓母细胞瘤患者的预后影响因素分析

目的探讨成人髓母细胞瘤(MB)患者性别、肿瘤部位、免疫组化指标、是否全切、辅助放化疗等临床、病理因素对预后的影响。方法回顾性分析25例成人髓母细胞瘤患者的临床资料,并对患者的预后进行电话随访。使用Kaplan-Meier曲线和Log-rank检验进行生存分析,寻找影响预后的因素。结果本组患者中,男性14例(56.0%),女性11例(44.0%),平均年龄为(25.1±5.9)岁。其中,12例患者(48.0%)的肿瘤位于小脑内,13例患者(52.0%)肿瘤突入四脑室;20例患者(80.0%)实现了肿瘤全切;23例患者(92.0%)术后进行了放疗;13例患者(52.0%)术后行化疗。本组患者的5年无进展生存和整体生存率分别为(65.9±10.6)%和(67.5±15.6)%。辅助放疗(P<0.001)和突触素阳性表达(P=0.017)与较好的5年无进展生存相关。在术后行辅助放疗的基础上,再行辅助化疗并无确切疗效(P=0.202)。结论成人髓母细胞瘤患者术后行辅助放疗是必需的,是否行辅助化疗尚存争议。辅助放疗和突触素阳性表达与较好的预后相关。免疫组化指标对评估成人髓母细胞瘤患者的预后有价值。     

人脑胶质瘤FAM46A表达与病人预后的关系

目的 探讨人脑胶质瘤序列相似性家族46成员A(FAM46A)的表达与病人预后的关系。方法 收集2016年1月～2019年6月手术切除的人脑胶质瘤标本95例,取同期颅脑损伤减压术切除的非肿瘤脑组织42例为对照组。免疫组化染色检测FAM46A表达情况。胶质瘤病人术后随访2年。结果 胶质瘤组织FAM46A阳性表达率高于对照组（P<0.05）。多因素Cox回归分析显示FAM46A阳性表达是胶质瘤病人生存预后不良的独立危险因素（P<0.05）。生存曲线分析显示,FAM46A阳性表达组2年累积生存率明显低于FAM46A阴性表达组（P<0.05）。结论 脑胶质瘤FAM46A呈阳性表达,与病人预后不良有关。     

胶质母细胞瘤铜死亡相关lncRNA预后模型的构建

目的 采用生物信息学方法分析胶质母细胞瘤差异表达的铜死亡相关长链非编码RNA(lncRNA)并构建预后模型。方法 计算机检索TCGA数据库下载胶质母细胞瘤的RNA-seq数据及其临床信息,应用单因素Cox分析和LASSO回归筛选铜死亡相关lncRNA,并计算风险评分=基因系数×基因表达量,以风险评分中位数分为低风险组和高风险组;将胶质母细胞瘤样本随机分为测试组和训练组,再进行整合生物信息学分析。结果 共下载胶质母细胞瘤样本169例,对照样本5例,共表达分析发现791个铜死亡相关lncRNA,其中正相关lncRNA有753个,负相关lncRNA有38个。单因素Cox分析发现22个显著差异表达的lncRNA(P<0.05),LASSO回归分析筛选9个差异表达的lncRNA;多因素Cox回归分析显示风险评分增高是胶质母细胞瘤预后不良的独立危险因素（P<0.05）。生存曲线分析显示,无论是训练组,还是测试组,高风险组总体生存期和无进展生存期显著缩短（P<0.05）。ROC曲线分析显示模型对1、2、3年生存期具有良好的预测价值（P<0.05）,而且风险评分预测效能显著优于...     

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.