遗传性共济失调线粒体DNA 3243、8993点突变的研究

目的研究线粒体DNA点突变与遗传性共济失调(HA)的关系。方法采用聚合酶链反应方法,扩增26例HA患者和35例健康对照者的外周血白细胞线粒体DNA,用限制片断长度多态性分析法检测有无A3243G、T8993G或T8993C点突变。结果所有HA患者和健康对照者均未检测到线粒体DNA点A3243G、T8993G或T8993C点突变。结论线粒体DNAA3243G、T8993G或T8993C基因突变导致HA的可能性不大。     

浙江温岭帕金森病线粒体DNA基因突变与多态性研究

目的 研究温岭散发性帕金森病(PD)线粒体DNA(mtNDA)基因突变与国人散发性PD相关性.方法 对88例散发性PD患者和60例正常健康人的基因位点G1719A、G4580A、C7028T进行扩增,将其异常结果进行基因测序,确定基因突变发生位点.结果 在PD患者G1719A附近有4例1711(G→A)1738(A→G),3例1738(A→G),1例1664(G→A)突变；在G4580A附近有1例4476(A→G),1例4638(A→G),1例4651(→T)突变；在C7028T附近有1例6984(C→T),1例6979( G→C) 6984(C→T),3例7083(C→),4例6963(G→A),1例6910(C→A)突变,共发现11种突变类型,对照组无发现突变位点.结论 散发性PD患者存在线粒体基因位点突变,预示线粒体基因突变参与了PD的发病过程.     

Alzheimer病患者线粒体DNA点突变的研究

目的旨在观察Alzheimer病(Alzheimerdisease,AD)患者线粒体DNA(mitochondrialDNA,mtDNA)上点突变的情况,并探讨mtDNA点突变与AD发生的关联性。方法入组了111例AD患者作为AD组和性别/年龄与之相匹配的正常老人117名组成对照组,应用PCR-RFLP的方法对被研究对象mtDNA上分别位于第4336、5460和8021三个位置的点突变情况进行检测。结果第4336位置上的碱基未发现存在突变的现象。第8021位置上的碱基仅在正常老人组内检测到1例突变型,其余均为野生型。在第5460位置上对照组突变率为2.6%(3/117),AD老人组中突变率为6.3%(7/111),显著性检验χ2=1.902,P=0.168。结论在我国上海汉族人群中线粒体DNA上第4336位置上可能不存在点突变的现象,第8021位置上突变也很少发生,在第5460位置上的碱基可能出现A或T的点突变,但这种突变的发生可能与AD的发生无直接关联。     

脑梗死患者β纤维蛋白原-455G/A、-148C/T基因多态性和血浆纤维蛋白原水平研究

目的　探讨纤维蛋白原 (Fibrinogen,Fg) β基因启动子区 - 4 5 5 G/A、- 14 8C/T基因多态性频率分布和血浆 Fg水平的关系以及在脑梗死 (CI)中的作用。方法　用限制性片段长度多态性 (RFL P)分析基因频率分布 ,用 Clauss法分析血浆 Fg水平 ,对 CI组 (90例 )和健康人对照组 (10 2例 )进行研究。结果　 CI组和对照组 Fg水平分别为 3.5 5± 0 .94和 2 .6 7± 0 .78(P<0 .0 1)。等位基因 - 4 5 5 A、- 14 8T在对照组中的频率分别为 0 .186、0 .2 0 6 ,在 CI组中的频率分别是 0 .2 89、0 .30 6 ,两个多态性位点 - 4 5 5 G、- 14 8C或 - 4 5 5 A、- 14 8T分别紧密连锁 ,符合率超过 96 %。对照组和 CI组中 - 4 5 5 A等位基因携带者的 Fg水平均高于非携带者 ,分别为 3.4 4± 0 .6 7和2 .32± 0 .77(P<0 .0 1)、3.80± 0 .6 4和 3.31± 0 .97(P<0 .0 5 ) ;对照组和 CI组中 - 14 8T携带者的 Fg水平亦均高于非携带者 ,分别为 3.2 9± 0 .6 6和 2 .33± 0 .77(P<0 .0 1)、3.77± 0 .6 5和 3.31± 0 .97(P<0 .0 1)。结论　 Fg水平升高是 CI的危险因素 ;两对等位基因紧密连锁不平衡 ,- 4 5 5 A、- 14 8T等位基因与脑梗死无相关性 ;Fgβ- 4 5 5 G/A、- 14 8C/T多态性与血浆 Fg水平具相关性。     

5-羟色胺2A受体基因多态性与精神分裂症患者迟发性运动障碍的关联分析

目的　探讨5- 羟色胺2A( 5- HT2A)受体基因A 1 4 38G、T1 0 2C多态性与精神分裂症伴迟发性运动障碍(TD)的相关性。方法　先用异常不自主运动量表(AIMS)评定精神分裂症男性患者有无TD及其严重程度,有4 2例符合TD(AIMS总分≥3分)者和51例与TD组严格相匹配的非TD者入组,采用简明精神病评定量表(BPRS)评定精神症状,应用聚合酶链反应 限制性片段长度多态性方法分析5 HT2A受体基因的A 1 4 38G、T1 0 2C多态性位点的多态性。结果　①5- HT2A受体基因A 1 4 38G和T1 0 2C两位点多态性呈完全连锁不平衡,TD组与非TD组的两多态性位点的基因型总体分布无显著性差异( χ2 =4 37,v =2 ,P >0 . 0 5) ,在TD组有更高的C/A等位基因频率,与非TD组有显著性差异( χ2 =4 . 36 ,v =1 ,P <0. 0 5)。②不同基因型间的人口学和临床学资料(如:病程、服药总时间、日服抗精神病药物剂量、AIMS和BPRS的评分)间无显著性差异(P >0. 0 5)。结论　5 -HT2A受体基因的A 1 4 38G、T1 0 2C多态性可能与男性精神分裂症患者的TD相关联。     

多药耐药相关蛋白1基因多态性及蛋白表达与癫痫患者耐药机制关系的研究

目的探讨多药耐药相关蛋白1 (MRP1)基因G128C (rs41395947)、C218T (rs41494447)、G2168A(rs4148356)、G3173A(rs41410450)多态性及MRP1蛋白水平与癫痫耐药的关系,进一步探究MRP1基因多态性更易导致癫痫患者对哪种抗癫痫药物(AED)耐药。方法对2017年11月至2018年6月就诊于包头医学院第一附属医院门诊、病房和包头中心医院癫痫门诊,且诊断符合2014年国际抗癫痫联盟关于癫痫的诊断标准,均经视频脑电图及头颅MRI证实的31例耐药性癫痫患者和67例药物敏感性癫痫患者进行调查问卷。采用DNA测序的方法分别检测MRP1基因,从而分析其多态性分布情况,采用酶联免疫吸附(ELISA)测定的方法分别检测两组人群中MRP1蛋白的浓度,采用化学发光法检测癫痫患者卡马西平、丙戊酸钠的血药浓度。结果经DNA测序发现,AED耐药组和AED敏感组癫痫患者MRP1基因中第128位和第3173位未出现基因突变,第218位、2168位中存在单核苷酸多态性。MRP1的C218 T(rs41494447)突变5例,其中AED耐药组4例,ADE敏感组1例,C218T(rs41494447)多态性在AED耐药组与AED敏感组中的分布差异无统计学意义(P 0. 05)。MRP1的G2168A(rs4148356)突变9例,其中AED耐药组6例,ADE敏感组3例,G2168 A (rs4148356)多态性在AED耐药组与AED敏感组中的分布差异有统计学意义(P 0. 05); MRP1的2168位GA基因型在AED耐药组67%高于AED敏感组33%。MRP1蛋白水平测定结果:AED耐药组高于AED敏感组,差异有统计学意义(P 0. 05)。MRP1的2168位GA基因型患者的卡马西平、丙戊酸钠血药浓度低于GG基因型患者,差异有统计学意义(P 0. 05)。比较MRP1的C218T(rs41494447)、G2168A(rs4148356)不同基因型的MRP1浓度,差异无统计学意义(P 0. 05)。结论MRP1的G2168A (rs4148356)多态性可能是癫痫患者发生AEDs耐药的风险位点。MRP1基因的G128 C (rs41395947)、C218 T (rs41494447)、G3173 A (rs41410450)三个位点可能不是癫痫患者发生AEDs耐药的风险位点。MRP1蛋白高表达可能是引起癫痫患者耐药的一个因素。癫痫患者中存在MRP1的G2168A单核苷酸多态性者更易对卡马西平、丙戊酸钠耐药。耐药性癫痫患者MRP1基因218位点及2168位点突变可能不是引起MRP1蛋白高表达的原因。     

TAFI基因编码区的单核苷酸多态性与脑梗死的相关性探讨

目的　凝血酶激活的纤溶抑制物 (Thrombinactivatablefibrinolysisinhibitor ,TAFI)具有抑制纤维蛋白溶解的功能 ,它在止血中起重要的作用。TAFI的血浆浓度是受TAFI基因变异调节的 ,因此TAFI基因可能是脑梗死的候选基因之一。探讨TAFI基因单核苷酸的多态性与脑梗死的关系。方法　收集了 189例尸体检查的样本 ,其中包括 95例脑梗死和 94例的对照组。TAFI基因G5 0 5A和C10 4 0T的基因型是用PCR -RFLP(Restrictionfragmentlengthpolymorphism)法来分析。 结果　G5 0 5AandC10 4 0T的基因型频率分布是A5 0 5A 12 (6 % ) ,G5 0 5A 75 (4 0 % ) ,G5 0 5G 10 2 (5 4 % ) ;C10 4 0C 139(74 % ) ,C10 4 0T 4 5 (2 3% ) ,T10 4 0T 5 (3% )。在脑梗死组和对照组之间 ,这些基因型的分布没有显著性差别 (P >0 .0 5 )。结论　TAFI基因单核苷酸的多态性 (G5 0 5A和C10 4 0T)与脑梗死没有显著性相关。     

痴呆患者早老素-1基因第6号外显子突变研究

目的探讨痴呆患者早老素-1基因第6号外显子的突变特点。方法应用聚合酶链反应一单链构象多态性(PCR-SSCP)和DNA测序技术检测53例SAD患者、60例VD患者及90名健康老年人早老素-1基因第6号外显子。结果DNA测序在SSCP泳动异常标本中发现1123位点和1300位点发生错义突变，其中，SAD组2例在1123位点发生突变、2例在1300位点突变，VD组1例在1123位点发生突变；1123位点发生C→G突变(cys23Trp)，1300位点发生A→C突变(Asp 200Ala)。结论SAD患者存在早老素-1基因第6号外显子突变，本实验结果显示的2个突变位点均处在早老素蛋白的重要功能区，考虑此突变为病理性突变。     

散发性Alzheimer病与神经型尼古丁胆碱能受体α4α7基因多态性的关联研究

目的探讨散发性Alzheimer病(SAD)与神经型尼古丁胆碱能受体α4亚单位(CHRNA4)基因外显子3、α7亚单位(CHRNA7)基因内含子3、7基因多态性的关联关系。方法用聚合酶链式反应-变性梯度凝胶电泳(PCR-DGGE)和DNA测序技术分析23例SAD患者及30例正常人的CHRNA4基因外显子3基因序列和16例SAD患者及16例正常人CHRNA7基因全部外显子及其两侧的部分内含子基因序列。结果在CHRNA4基因外显子3上发现3个新的多态性位点C104T(2=8,41,P<0.05)、A136G(2=16.21,P<0.05);G169A(2=3.98,P<0.05)。研究结果显示3个多态位点在SAD组与对照组之间存在差异显著性。在CHRNA7基因上发现2个新的多态性位点内含子3G3133418C(2=4.571,P>0.05)、内含子7上117643+GTG三碱基插入突变(2=1.032,P>0.5)统计学结果该2个多态位点在SAD组与对照组之间无差异显著性。结论在CHRNA4基因外显子3上发现的3个新的多态性位点(GeneBank登录号为AY786507AY857199AY857197)与散发性Alzheimer病的发病可能存在相关关系。在CHRNA7基因上发现的2个新的多态性位点(GeneBank登录号为AY641830和AY641831)与散发性Alzheimer病的发病没有显著性的相关关系。因此CHRNA4基因外显子3多态性可能与散发性Alzheimer病发病有关联。     

精神分裂症攻击行为与5-HT2A受体基因多态性的关联研究

目的探讨精神分裂症患者的攻击行为与5-HT2A受体基因T102C和A1438G多态性的相关性。方法采用《修订版外显攻击行为量表》(MOAS)对精神分裂症患者进行评定,MAOS评分≥5分为研究组,MOAS≤4为对照组。并采用聚合酶链反应(PCR)和限制性片断长度多态性(RFLP)技术,检测103例伴发攻击行为精神分裂症(研究组)和99例非攻击行为精神分裂症患者(对照组)5-HT2A基因型,并分别比较两组5-HT2A受体基因T102C位点多态性和A1438G位点多态性差异。结果研究组和对照组T102C位点多态性的等位基因频率和基因型频率分布统计学均具有显著性差异(P0.01),研究组基因型T/T频率和等位基因T频率均高于对照组(χ2=10.126,P=0.006),(χ2=8.176,P=0.004);A1438G位点多态性基因型频率分布差异无统计学意义(P0.05),而等位基因频率分布差异具有统计学意义(P0.05),研究组等位基因A频率高于对照组。结论 5-HT2A受体基因T102C位点和A1438G位点的多态性与精神分裂症的攻击行为均具有相关性,其等位基因T和A可能增加患者攻击行为的风险。     

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.