Activating mutations in the KCNJ11 gene encoding the ATP-sensitive K+ channel subunit Kir6.2 are rare in clinically defined type 1 diabetes diagnosed before 2 years

We have recently shown that permanent neonatal diabetes can be caused by activating mutations in KCNJ11 that encode the Kir6.2 subunit of the beta-cell ATP-sensitive K(+) channel. Some of these patients were diagnosed after 3 months of age and presented with ketoacidosis and marked hyperglycemia, which could have been diagnosed as type 1 diabetes. We hypothesized that KCNJ11 mutations could present clinically as type 1 diabetes. We screened the KCNJ11 gene for mutations in 77 U.K. type 1 diabetic subjects diagnosed under the age of 2 years. One patient was found to be heterozygous for the missense mutation R201C. She had low birth weight, was diagnosed at 5 weeks, and did not have a high risk predisposing HLA genotype. A novel variant, R176C, was identified in one diabetic subject but did not cosegregate with diabetes within the family. In conclusion, we have shown that heterozygous activating mutations in the KCNJ11 gene are a rare cause of clinically defined type 1 diabetes diagnosed before 2 years. Although activating KCNJ11 mutations are rare in patients diagnosed with type 1 diabetes, the identification of a KCNJ11 mutation may have important treatment implications.     

A genome-wide scan in families with maturity-onset diabetes of the young: evidence for further genetic heterogeneity

Maturity-onset diabetes of the young (MODY) is a heterogeneous single gene disorder characterized by non-insulin-dependent diabetes, an early onset and autosomal dominant inheritance. Mutations in six genes have been shown to cause MODY. Approximately 15-20% of families fitting MODY criteria do not have mutations in any of the known genes. These families provide a rich resource for the identification of new MODY genes. This will potentially enable further dissection of clinical heterogeneity and bring new insights into mechanisms of beta-cell dysfunction. To facilitate the identification of novel MODY loci, we combined the results from three genome-wide scans on a total of 23 families fitting MODY criteria. We used both a strict parametric model of inheritance with heterogeneity and a model-free analysis. We did not identify any single novel locus but provided putative evidence for linkage to chromosomes 6 (nonparametric linkage [NPL]score 2.12 at 71 cM) and 10 (NPL score 1.88 at 169-175 cM), and to chromosomes 3 (heterogeneity LOD [HLOD] score 1.27 at 124 cM) and 5 (HLOD score 1.22 at 175 cM) in 14 more strictly defined families. Our results provide evidence for further heterogeneity in MODY.     

Etiological investigation of diabetes in young adults presenting with apparent type 2 diabetes

OBJECTIVE: Young adults with newly diagnosed apparent type 2 diabetes present the clinician with a wide differential diagnosis of possible etiology, including autoimmune and genetic causes as well as young-onset type 2 diabetes (YT2D). The characteristics of these groups have been described, but it is not known in which subjects investigation for etiology may be beneficial. RESEARCH DESIGN AND METHODS: A total of 268 unselected U.K. Caucasian subjects diagnosed at ages 18-45 years and not treated with permanent insulin for < or =6 months were studied. All subjects underwent clinical assessment and screening for GAD antibodies (GADA) and tyrosine phosphatase IA-2 antibodies (IA-2A). Screening for a common mutation in the hepatocyte nuclear factor-1 alpha (HNF-1 alpha) gene and the common mitochondrial mutation was performed in the antibody-negative subjects. Subjects without insulin resistance were selected for sequencing of the HNF-1 alpha gene. RESULTS: A specific etiology was defined in 11.6% of the 268 subjects and in 24.7% of the lean subjects. Twenty-six subjects (9.7%) were positive for a beta-cell antibody, one subject had familial partial lipodystrophy and the lamin A/C mutation R482W, and two subjects had the mitochondrial mutation A3243G. Two of 15 selected subjects had HNF-1 alpha mutations, the novel missense mutation A501T, and the previously reported R583Q. CONCLUSIONS: This unselected series shows that there is considerable heterogeneity in apparent YT2D. beta-Cell autoantibodies should be performed in all those presenting at ages 18-45 years. Genetic investigations can be targeted to phenotypically defined subjects. The finding of a specific etiology will allow individualization of management and give patients valuable information about their condition.     

刑事警察心理健康调查分析

①目的了解刑事警察的心理健康状况，为心理干预提供依据。②方法对济宁市刑警队员进行症状自评量表（Symptom Checklist 90．SCL-90）、焦虑自评量表（Self—rating Anxiety state，SAS）、抑郁自评量表（Self—rating Depression scale，SDS）评定。③结果济宁市刑警队员的SCL-90、SAS、SDS量表评分与全国常模相比存在显著性差异。④结论。刑事警察职业是一种特殊职业，该职业对队员的心理健康有显著的影响，这种影响随着从事刑警工作时间的不同而改变。     

黄芪注射液对肝纤维化大鼠模型肝细胞胶原及TGF-β_1表达的影响

目的探讨黄芪注射液抗肝纤维化及对TGF-β1、Col-Ⅰ表达的影响。方法将35只SD大鼠随机分为正常对照组、CCl4诱导肝纤维化模型组和黄芪干预组。至造模第10周,处死所有大鼠,采用PV免疫组化方法检测Col-Ⅰ在各组肝组织中的表达,ELISA法检测TGF-β1在各组血清中的表达。结果经CCl4诱导成功建立大鼠肝纤维化模型,随着肝纤维化程度的进展,肝组织中Col-Ⅰ和血清中TGF-β1表达明显增强。在正常对照组、黄芪干预组和肝纤维化模型组肝组织中Col-Ⅰ表达的平均光密度值分别为0.298、0.315、0.503,模型组与前两组比较差异均有显著性（P〈0.01）,而黄芪干预组与正常组肝组织比较差异无统计学意义（P〉0.05）。在正常对照组、黄芪干预组和肝纤维化模型组大鼠血清中TGF-β1表达含量分别为491.29pg/L、629.91pg/L、959.09pg/L,呈递增趋势。模型组与前两组比较差异均有显著性（P〈0.01）,黄芪干预组与正常组比较其表达含量无显著差异（P〉0.05）。结论黄芪注射液可以显著抑制实验性肝纤维化大鼠模型的肝纤维化,这种抑制作用可能与抑制I型胶原蛋白及TGF-β1的表达有关。     

Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: imaging with US and CT

Findings at neuroimaging in 100 consecutive infants treated with extracorporeal membrane oxygenation (ECMO) are presented. Imaging in these infants consisted of pretreatment cranial ultrasonography (US), daily US studies while on ECMO, and follow-up cranial computed tomography (CT) after treatment. There were findings of abnormalities in 43 patients. Thirty had intracranial bleeding, often of unusual extent and distribution. Thirteen additional infants had nonhemorrhagic abnormalities alone. Bleeding considered to be major was seen in 12% of infants. Large parenchymal hemorrhages and infarcts, cerebellar hemorrhages, and diffuse edema were the most significant abnormalities, with a 50% mortality (eight of 16 patients). No lateralization was noted with respect to distribution of bleeding sites or areas of nonhemorrhagic abnormalities. US was a sensitive but imperfect screening tool for intracranial abnormalities. Abnormalities missed with US included peripheral and small parenchymal lesions, subarachnoid hemorrhage, cerebral atrophy, and sagittal sinus thrombosis.     

The dangerousness of psychiatrists

Since psychosis occasionally leads to behaviour requiring constraint, psychiatrists are involved in decisions which may lead to loss of liberty. In some places and at some times psychiatrists and their predecessors have made those decisions unrestrained. This essay considers how we have used that power in the past, indicates some of the abuses extant now, recognises that there is no satisfying solution to the problems which exist and argues for the consistency of the legal system with all its limitations rather than the uncertain and unrestrained judgment of individual psychiatrists.