Journal of Heredity 200394(2)181–183 ó 2003 The American Genetic Association DOI 10.1093j

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《猪、鸡重要经济性状遗传的分子机制》

《猪、鸡重要经济性状遗传的分子机制》
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遗 付 HEREDITAS(Beijing) 2013
第 35卷
· 综 合 信 息·
《猪 、鸡 重 要 经 济 性 状 遗 传 的 分 子 机 制 》
作者 :李 宁 ISBN:9787030381897 定价:150 开本:16装帧:圆脊精装 页码:424 初版时间:9/1/2013
内容 介 绍 《猪 、鸡 重要经 济性状 遗传 的分子 机制 》介绍 了 973计 划项 目 “猪 、鸡重要 经济性 状遗 传的分 子机制 ” 的研 究成
果 。内容包 括 :猪 、鸡 生长发 育 的功能基 因组,猪 、鸡 品质性 状形成 的分 子机制 ,繁殖性 状形成 的遗 传机制 ,抗病 和抗 逆基 因 的克隆分 析,重要复 杂性状 的 比较 基 因组 ,表 观遗传 和 miRNA 影 响性状 形成 的机制,以及猪 、鸡重要 经济 性状 的分 子改 良。这些 重大科 学 问题 的 阐释和相关 功 能基 因组 学等 技术 的建立,将为 我国农业 动物 的高产 、优 质 、高效 发展 提供 遗传理 论和 高新技术 。 购 书 指 南 :
学 士 书 店 :http://www.xueshi.tom.c 科学 出版社 科学销 售 中心 联 系人 :周 文字 E·mail:zhouwenyu@mail.sciencep.corn

儿科病例--黑斑息肉病

儿科病例--黑斑息肉病

诊断
PJS的诊 断主 要 依 据 患 者病 史 、皮 肤 黏膜 色 素沉 着 等 临床 表现及 内镜下 或影 像学 发现 胃肠 道息 肉等证 据 。 • 对 于 胃与 大肠 的息 肉可 通过 胃十 二指肠 镜 及结肠 镜 进行 诊 断 ,并 可 在 内镜
下 取 活 检 行 病 理检 查 。 • 对 于 小 肠息 肉的诊 断 目前 主要 有 胶 囊 内镜 (CE)、CT小 肠 造 影 (CTE)、磁 共 振
临床表现
• 临床表 现 PJS患 者 的 临 床 表 现 主 要 包 括 皮 肤 黏 膜 色 素 沉 着 、消化道 多 发性息 肉及 肿瘤 易 感性 。
• 约 95% 的 PJS患 者 出现 皮肤 黏 膜 色素 沉 着 ,出生 时少 见 ,而多 于幼 年期 出现 ,典 型 的色 素 沉着 直 径 1~ 5mm,颜 色为 深 褐 色 ,多 分 布 于 眼 、耳 、口周 、肛 周 、颊 黏 膜及 四肢末 端 ,部 分色 素 沉 着 可 随 患 者年 龄 增 长 而 褪 色 。 目前 尚无研 究证 实 PJS患 者 的皮 肤黏 膜 色 素沉 着具 有恶 变倾 向 。
• PJS 患者 胃肠 道 息 肉的病 理类 型主要 为错 构 瘤性 息 肉。 胃 肠道 息 肉可 导致反 复发 作 的 肠 梗 阻 与肠 套 叠 ,使 得 患 者需 要 经历 多次 开腹 手术 与肠 段 切 除 。另外 ,胃肠 道 息 肉也 可 引起消 化 道 出血 ,长 此 以往导 致 缺 铁 性 贫 血 。
为 85.7% ,在 所 有 PJS患 者 中为 63.2% ,且 LKB1基 因启 动 序 列 的 甲基 化 可 能 与 胃肠 道 息 肉癌变 的发 生有 关 。 • WANG等 研 究 发 现 , LKB1是一 种 DNA损 伤 应 答 蛋 白 ,缺 乏 LKB1的肿 瘤 细胞 将对 基 于 DNA损伤 的放 疗及 阻碍 DNA修 复 的化 疗 (如 PARP抑制 剂 )更 为 敏感 ,这 可 能 为 PJS的治 疗 提 供 了新 方 向。 • KIM 等 认 为 ,STK11的突变与在不同部位出现的幽门腺黏液上皮异常增殖有着密切关联 。 总之 ,基 于上 述发 现 ,认 为 STK11/LKB1的突变与大部分遗传性PJS的发生有关,但除此以外是否有 其他基因参与PJS的发生,目前仍有待研究 。

单核苷酸多态性_环境因素与肝细胞肝癌遗传易感性的关系_纪龙

单核苷酸多态性_环境因素与肝细胞肝癌遗传易感性的关系_纪龙

文章编号:100028020(2009)022*******・综述・单核苷酸多态性、环境因素与肝细胞肝癌遗传易感性的关系纪龙综述 余红平审校广西医科大学公共卫生学院,南宁 530021摘要:肝细胞肝癌(HCC )的发生和演进是一个多基因、多因素的复杂过程,是遗传与环境因素相互作用的结果。

单核苷酸多态性(S NP )作为第三代遗传标记,充分反映了个体间的遗传差异,决定了个体对疾病的易感性,正成为肝癌遗传易感性研究的重要工具。

关键词:单核苷酸多态性 环境因素 肝细胞肝癌 遗传易感性 肝肿瘤中图分类号:R73517R73011 文献标识码:AR elationship of single nucleotide polymorphism ,environmental factors and the hereditary susceptibility of hepatocellular carcinomaJI Long ,YU H ongpingSchool of Public Health ,G uangxi Medical University ,Nanning 530021,ChinaAbstract :Resulting by the interaction between the hereditary factor and the environmental factor ,the occurrence anddevelopment of hepatocellular carcinoma (HCC )is a com plicated course with multi 2genes and multi 2factors.As the third genetic marker ,the single nucleotide polym orphism reflects the hereditary difference am ong individuals ,decides the susceptibility to disease and becomes an im portant tool to study the hereditary susceptibility of HCC.K ey w ords :single nucleotide polym orphism ,environmental factor ,hereditary susceptibility ,hepatocellular carcinoma基金项目:国家自然科学基金资助项目(N o.30660162);广西自然科学基金资助项目(N o.桂科攻0592007221);广西研究生教育创新计划资助项目(N o.2008105981004M189);广西大型仪器协作网测试补助(N o.529220072108)作者简介:纪龙,男,硕士研究生,助教,研究方向:慢性病流行病学,E 2mail :tsmcjl @ 肝细胞肝癌(HCC )是我国最常见的恶性肿瘤之一,死亡率为2014Π10万,严重威胁人们的生命健康。

巴氯芬临床应用研究进展

巴氯芬临床应用研究进展

巴氯芬临床应用研究进展世?界?临?床?药?物WRLDCLINICALDRUGS巴氯芬临床应用酮究进展复旦大学附属中山医院老年科,神经内科'.__????一.谢瑞满中枢性肌松剂巴氯芬在降低肌张力的神经康复治疗和减轻疼痛的治疗方面有独特效果,特别是在脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗中取得了明显疗效,且安全可靠.巴氯芬;脑卒中;疼痛10年来,中枢性肌松剂巴氯芬的临床应用得到很大进展,特别是在降低肌张力的神经康复治疗和减轻疼痛的治疗方面获得很多经验,例如在脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗中取得了明显疗效.近来有研究还发现,巴氯芬能够明显减少胃食管反流并改善其症状,有效缓解儿童肌张力障碍的症状,治疗中枢性顽固性呃逆和脊髓损伤后的排尿功能障碍.另外,巴氯芬鞘内注射疗法的临床应用,能够进一步提高临床疗效和随时调整药物用量,稳定治疗效果.本文对中枢性肌松剂巴氯芬在临床上的各种应用研究作一回顾3_.概述巴氯芬(baclofen,氯苯氨丁酸)为解痉药,是y-氨基丁酸(GABA)的衍生物,为作用于中枢神经系统脑和脊髓的骨骼肌松弛剂,镇静剂.本品通过激动GABA~B受体而使兴奋性氨基酸如谷氨酸,门冬氨酸的释放受到抑制,从而抑制单突触和多突触反射在中枢神经系统脑和脊髓的传递,从而起作者简介谢瑞满:神经科博士,教授,1999年作为NIH课题成员在哈佛医学院神经科任客座教授,博士后导师.从事神经眼耳科,行为神经科及人脑功能损伤研究.参加国家七五一十五脑卒中防治和康复攻关等课题.2001年获上海市老年学科带头人和优秀人才基金.世?界?临-床?药?物WIRLDCLINICALDRUGS到解痉作用.巴氯芬在胃肠道中吸收迅速而完全,脑脊液中活性物质浓度约为血浆中的1/8,血浆消除半衰期(f1,)平均为3~4小时,大部分巴氯芬以原型排出,在72小时内,摄入量中约75%经肾脏排出.与三环类抗抑郁药联用.巴氯芬作用增加,有可能引起肌张力过低.巴氯芬和降压药联用,可使降压作用加强,因此降压药的剂量应根据情况适当调整.帕金森病患者,同时接受较大剂量巴氯芬和左旋多巴/卡比多巴治疗,有个别报告引起精神错乱,幻想和激动不安. 作用机制巴氯芬的作用机制目前尚不清楚,一般认为,GABA在人体中枢神经系统脑和脊髓中含量很高,比脑内单胺类如儿茶酚胺,去甲肾上腺素,多巴胺等高出1000多倍,其中以中脑黑质和苍白球中含量最高, 脑内约有20%一40%的突触以GABA 为递质.GABA是中枢神经系统脑和脊髓中主要的抑制性递质,但它不能透过血脑屏障.GABA通过B碳原子接上对位氯苯基(B-chloropheny1) 即变为巴氯芬,从亲水性物质变为亲脂性,从而能透过血脑屏障.巴氯芬的主要作用是激动GABA的B受体,通过突触抑制兴奋性氨基酸如天门冬氨酸,谷氨酸的释放,并使神经元内K,Ca离子外流,产生超极化作用,降低单突触性与多突触性反射的传递,促使中间神经元活动的正常,减少oc运动神经元的活动,从而缓解锥体束受损引起的骨骼肌痉挛状态.降低肌张力,促进运动功能恢复【".脑卒中患者早期产生的兴奋性神经递质是有害的.因此应用巴氯芬治疗不仅能够降低脑卒中后的肌张力异常增高,并且可以减少兴奋性神经递质对神经元细胞的毒性.脊髓损伤患者经巴氯芬治疗后,肌电图检查显示F波振幅,时程,F/M显着减小,提示巴氯芬治疗能够降低oc 运动神经元活性,改变中间神经元的活性,对y运动神经元,Renshaw细胞活性影响不大.临床应用巴氯芬主要用于脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗.也能明显改善胃食管反流性疾病的症状,有效缓解儿童肌张力障碍,治疗中枢性顽固性呃逆和脊髓损伤后的排尿功能障碍.>))脑卒中后偏瘫脑卒中后肌张力增高是中枢神经系统受损引起的上运动神经元损害的特征,脑卒中后一般过程是:发病初出现肌张力丧失,无随意运动,而后联合反应运动,肌张力,反射及随意共同运动出现,之后随意共同运动为主,肌张力增加并至高峰,接着是共同运动减少,随意分离运动出现,肌张力开始下降,随后随意分离运动为主,肌张力下降至正常,最后随意分离运动充分,肌张力正常.肌张力过高不能及时降低,随意分离运动不能恢复,使精细技巧运动不能完成,引起挛缩,关节脱位及畸形,脑卒中后这种现象在我国极为常见,临床上一般要等到脑卒中后肌张力很高,如达到Ashworth评价的…,lV级时才给予降低肌张力的药物,并且剂量偏大.往往使正常药物作用难以发挥且不良反应明显.因此,正确合理应用降低肌张力的药物,防止肌张力异常增高.促使肌张力由低一高一正常顺序进行恢复.是临床治疗中实用和有效的方法.作者报道的脑卒中急性期巴氯芬治疗的前瞻性随机双盲对照临床研究,选择急性单侧半球脑卒中患者160例,随机分为2组,按双盲法给药,用药前,用药2周,4周观察肌力,肌张力,运动机能障碍及日常生活能力,统计分析后揭盲.结果显示,巴氯芬治疗组在肌张力,运动机能障碍评定方面较对照组有显着差异,表明巴氯芬有利于脑卒中患者的神经康复.有助于提高临床疗效,改善预后;而肌力和日常生活能力评定结果,未见差异.可能与巴氯芬药理作用机制以及对日常生活能力的影响等因素有关.研究提示,巴氯芬治疗确能防止脑卒中患者肌张力异常增高,提高临床疗效,改善预后.揭盲后显示,巴氯芬的世?界?临?床?药?物WRLDCLINICALDRUGS2006V01.27No.3用药剂量为每次2.5mg,一日2次起始,逐步增加剂量.至每次5~10mg.一日3次较为合适[.许多文献报道和我们的临床研究还发现.有些脑卒中患者应用巴氯芬后还有助于腱反射亢进的缓解和病理征的消失.临床上3~6个月的随访研究发现,应用巴氯芬治疗有助于脑卒中患者的长期神经康复,提高治疗效果,最终改善预后,防止肌肉挛缩,关节脱位及畸形发生[2I. )))脊髓损伤,多发性硬化症后的中枢痉挛性瘫痪Hattab[】对欧洲发表的关于巴氯芬治疗脊髓损伤,多发性硬化症后肌痉挛的280篇文献作了综述,并针对其中1531例患者进行了分析,发现患者用药后显着进步的为66%,中等进步的为12%,两者合计总有效率为78%.一项针对多发性硬化症患者的前瞻性随机双盲对照临床研究[5】发现,与地西泮比较,巴氯芬疗效更好,并且镇静作用较少见.国内相关研究结果显示,巴氯芬组的有效率为77.39%,显效率为29.57%,和国外文献报道的结果基本一致[.,.)))胃食管反流性疾病研究表明,巴氯芬能够减少胃食管反流性疾病患者餐后第一个3/J\ 时内的反流发生.短期研究选择28例伴或不伴轻度内镜下食管炎的胃食管反流性疾病患者为治疗组,以15例健康志愿者为对照组,进行食管胃48小时pH值监测,期间采用双盲的方式给予巴氯芬或安慰剂1天,结果发现,短期给予巴氯芬后,胃食管反流性疾病患者(尸之O.003)反流发生次数和pH值小于4的时间明显减少,给予巴氯芬后胃食管反流性疾病患者(P<O.001)胃pH值明显升高. 长期研究选择16例胄食管反流性疾病患者给予巴氯芬每次10mg,一日4次或安慰剂共4周,在治疗前,后进行24小时食道pH值监测和反流症状积分计算.研究发现,巴氯芬给药4周,所有胃食管反流性疾病患者的反流发生次数(P<O.OO3)和pH值小于4的时问(P<O.02)明显减少.巴氯芬治疗后症状积分明显改善(P<O.0007).提示巴氯芬治疗胃食管反流性疾病可能有效[.)))中枢性顽固性呃逆和神经性疼痛由于巴氯芬为神经传导抑制性递质的相似物,能同时抑制中枢神经系统单突触和多突触反射,可能使传人端高度极化,具有中枢神经系统抑制作用,因此可用于解除上运动神经元受损所致的痉挛状态.特别是屈肌痉挛及并发的疼痛,肌阵挛和肌肉震颤.有多组报道采用巴氯芬治疗各种中枢性疾病引起的顽固性呃逆,效果显着,其可能因上述抑制机制而达到止呃逆效果,具有起效快,不易复发,不良反应少的特点[引.自1980年巴氯芬首先用于治疗三叉神经痛以来,有许多研究表明巴氯芬能够治疗各种神经性疼痛,包括偏头痛的预防和治疗,反复发作的丛集性头痛的治疗,安全且耐受性好[们.)))脊髓损伤后的排尿功能障碍临床上.发生脊髓损伤患者,其膀胱尿道功能经常受到损害,所出现的排尿功能障碍主要类型是逼尿肌反射亢进,急迫性尿失禁,或逼尿肌无反射及低顺应性,溢出性尿失禁,给患者带来极大痛苦.有研究采用巴氯芬等治疗脊髓损伤后患者排尿功能障碍,选择主诉尿失禁,排尿困难或遗尿的脊髓损伤患者,以美国Life-TechJanusV型尿动力学检查仪检查其排尿功能障碍,对尿道横纹肌括约肌功能亢进者予以巴氯芬每次1Omg,一日3 次.表现为尿道横纹肌括约肌协同失调或痉挛,伴逼尿肌反射亢进属上运动神经元病变者,辅以托特罗定;伴逼尿肌无反射属下运动神经元病变者,辅以坦洛新及吡啶斯的明.多数患者症状均有明显改善,表现为恢复排尿,尿失禁及遗尿消失,尿线增粗和排尿次数减少等.巴氯芬是GABA的B受体激动剂,该受体兴奋在骶髓水平导致阴部神经核抑制,尿道横纹肌括约肌松弛,对尿道横纹肌括约肌功能亢进者有治疗作用.在桥脑,排尿中枢和贮尿中枢是分离而无神经联系的,而逼尿肌括约肌的协调在骶髓水平,对脊髓损伤患者无论是上或下运动神经元病变,保证逼尿肌压力处于安全水2006V o1.27No.3世?界?临?床-药?物WRLDCLINICALDRUGS平如小于40cmH.O,减少剩余尿极为重要.应适当采用辅助药物,减少出口阻力.巴氯芬的适应证包括失调性排尿,逼尿肌无力,导尿管依赖状态,神经性膀胱中有神经性梗阻存在和膀胱过动症合并出口过紧者【131.)))腰椎间盘突出症急性发作期腰椎问盘突出症以男性青壮年为最多,这与劳动强度大及外伤有关.由于腰骶部活动度大,故L4/5及L5/$1椎间盘突出发病率最高,一般发病时间短,急性期时症状,体征较严重,通常有腰肌痉挛,可发生一例甚至两侧腰肌痉挛,大部分伴脊柱侧弯畸形,脊柱侧弯的方向一般取决于髓核突出位置与神经根的关系.腰肌痉挛和脊柱畸形均属继发性,适应性改变,属痛性反应.在椎问盘突出治愈后,这些畸形会随之消失.传统治疗对本病有良好的效果,但对伴随的肌张力增高未予足够的重视.腰椎的稳定性依靠脊柱本身结构和与之相关联的肌肉系统维持,如果肌肉痉挛始终存在,必然引起肌力下降,致使腰椎间盘突出症迁延难愈和反复发作.研究发现,巴氯芬对痛性痉挛有明显缓解作用,患者应用后2,4,6周肌张力分别下降57.39%,71.30%和77.39%,大部分病例经2周治疗后可取得显着效果.巴氯芬是目前国内外首选的抗肌痉挛药物, 能缓解肌肉痉挛及因痉挛引起的疼痛.本品口服吸收良好,服药1周左右疗效最佳.有研究显示,100例腰椎间盘突出症急性发作期伴明显肌肉痉挛且行动障碍的患者,在进行传统康复治疗的同时,给予巴氯芬治疗,不但改善了肌痉挛,还促进了肌力平衡的恢复,显着提高了康复疗效.有患者服用较大剂量巴氯芬后出现嗜睡不良反应.但这恰恰对因疼痛而造成的夜不能寐有帮助.至今尚无本品引起严重不良反应的报道I.>))可卡因成瘾性加州大学洛杉矶分校Shoptaw博士进行的一项纳入70例吸毒者的研究显示,巴氯芬能够降低长期,大量吸毒者的毒瘾.研究中有半数吸毒者连续使用巴氯芬16周,并接受行为咨询;其余半数则服用安慰剂,也接受行为咨询.研究结束时的尿液毒品检测结果显示.使用巴氯芬的患者,其毒品使用量比安慰剂组要低.且长期,大量吸毒者功效尤为明显【].)))酒精成瘾性酒精能够促进大脑释放GABA,引起愉悦感,但过量的GABA会损害对肌肉的控制并降低反应速度,所以大脑会释放谷氨酸盐对其进行抑制.当谷氨酸盐水平很高却没有酒精存在的时候,人会出现易怒或其他不适症状.为了减轻这些感觉,大脑就会产生饮酒的冲动.随着更多的GABA和谷氨酸盐的释放,为了与之相适应,大脑细胞就会发生结构和功能的变化.当人戒酒时就会出现心理和身体上的各种痛苦. GABA也许是人想喝酒的原因.而谷氨酸盐则是人无法戒酒的原因. 这种物质在人脑学习中心扮演着重要的角色,其过量会对饮酒过程造成深刻的记忆,使人即使戒酒多年以后也会因为遇到某人,回到某地或者闻到酒精味而再次产生饮酒的欲望.这种诱导是戒酒者复饮的主要原因.有许多报道表明,巴氯芬有助于戒酒成功.巴黎的奥利维尔?阿梅森医生也是一个酗酒者,在1997—2004 年问.阿梅森因酗酒和心脏病发作多次被送进医院抢救.巴氯芬可以通过干预大脑中的神经回路来抑制对饮酒的欲望,阿梅森接受了9个月的巴氯芬治疗后,第一次没有了对酒精的渴望,即使与朋友在餐馆里,也不受别人饮酒的影1~[16,17].鞘内注射治疗鞘内巴氯芬注射法(1TBT)的优点是可使巴氯芬在脑脊液中的浓度高于口服给药的30倍,其药效相对明显,例如能够长期减低脑卒中后的痉挛性肌张力增高,显着改善闭锁综合征患者的运动功能,对成人脑外伤性或缺氧性痉挛患者有明显疗效,也可明显缓解中枢性疼痛.ITBT可以根据患者需求,通过电脑向植入腹部皮下的泵输入信息而随时调整每日用药量,必要时还可终止用药以避免或减少药物不良反应,也可使巴氯芬随脑脊液流至脊髓和脑.因此能使全身紧张状态松弛,包括颈,上肢,躯干和腿,从而减少患者痛苦,更好地改善功能[18,伯】. ITBT的缺点是患者有嗜睡,恶心,呕吐,头痛,肌肉无力等不良反应,也可出现视物模糊,语言不清等表现,绝大多数症状是暂时的或能通过改变用药剂量而改善,但剂量过大可致昏迷甚至死亡.Penn对7年中接受ITBT的62例患者进行了回顾分析,ITBT的手术过程并不复杂,术后泵植入部位感染或泵固定不好是可能造成手术失败或不得不将泵取出的主要原因.另外泵的电池使用年限,也是造成再次手术的原因.且泵的体积偏大[2o】. 随着技术的改进,ITBT将在临床逐步推广.总之,随着中枢性肌松剂巴氧芬的临床应用越来越广泛,其在降低脑和脊髓疾病引起的肌张力增高的神经康复治疗,以及减轻各种原因尤其是神经性病变所致的疼痛治疗方面获得了很多宝贵经验.另外,巴氯芬对有些临床治疗比较困难的疾病或症状,也显示出很好的效果.随着ITBT的逐步推广应用,以及医患对其药物特性的不断认识,我们相信中枢性肌松剂巴氯芬将会使更多的患者受益.参考文献1MilanovIG.Mechanismsofbaclofenactionon spasticity.ActaNeuroScand,1992,85(5):305-3102.谢瑞满,姚景莉.方定华,等.中风急性期巴氯芬治疗的双盲随机对照研究.国际中华神经精神医学杂志,2001,2(1):9-113.MeythalerJM.Guin?RenfroeS,BrunnerRC,eta1.Intrathecalbaolofenforspastichypertonia fromstroke.Stroke,2001,32(9):2099?21094.HattabJR.ReviewofEuropeanclinicaltrials withbaclofenIn:FeldmanRG,YoungRR,Kiella WP,eds.Spasticity:DisorderedMotorContro1. 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单克隆抗体药物治疗视神经脊髓炎谱系疾病的临床试验研究进展

单克隆抗体药物治疗视神经脊髓炎谱系疾病的临床试验研究进展

单克隆抗体药物治疗视神经脊髓炎谱系疾病的临床试验研究进展刘晔1,孟德旺2△,杨贵莉1,孙莉1摘要:视神经脊髓炎谱系疾病(NMOSD)是一种体液免疫介导的中枢神经系统自身免疫性疾病,以脊髓和视神经的炎性脱髓鞘病变为特征,可导致瘫痪和失明。

其治疗除传统的免疫抑制剂外,还有B细胞靶向的利妥昔单抗及伊比利珠单抗,抑制白细胞介素-6受体的托珠单抗和沙妥珠单抗,阻断补体介导的细胞毒性和继发性炎症的依库珠单抗等新型靶向药物。

就治疗NMOSD的单克隆抗体靶向药物的作用机制、疗效、不良反应及其研究进展予以综述。

关键词:视神经脊髓炎;水通道蛋白质4;抗体,单克隆;利妥昔单抗;临床试验;分子靶向治疗中图分类号:R744.52文献标志码:A DOI:10.11958/20211261Progress in clinical trials of monoclonal antibody therapy for neuromyelitisoptica pedigree diseasesLIU Ye1,MENG De-wang2△,YANG Gui-li1,SUN Li11Department of Neurology,Tianjin Medical University General Hospital,Tianjin Neurological Institute,Key Laboratory ofPost-trauma Neuro-repair and Regeneration in Central Nervous System,Ministry of Education;Tianjin Key Laboratory ofInjuries,Variations and Regeneration of Nervous System,Tianjin300052,China;2Department of Medical Record QualityControl,Tianjin Chest Hospital△Reviser E-mail:*********************Abstract:Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune disease of the central nervous system mediated by humoral immunity.It is characterized by inflammatory demyelination of the spinal cord and optic nerve,which may lead to paralysis and blindness.In addition to traditional immunosuppressants,more and more new drugs are used in the treatment of NMOSD,such as rituximab and inebilizumab targeting B cells,tocilizumab and satralizumab inhibiting interleukin-6receptor and eculizumab blocking complement mediated cytotoxicity and secondary inflammation.In recent years,the results of several randomized clinical trials of these monoclonal antibody drugs have been published.This paper will review the research progress of these targeted drugs in the treatment of NMOSD from the aspects of the mechanism of基金项目:国家自然科学基金青年项目(81601039);国家自然科学基金面上项目(82071389);天津市自然科学基金(20JCQNJC00460)作者单位:1天津医科大学总医院神经内科,天津市神经病学研究所,教育部“中枢神经系统创伤修复与再生”重点实验室,天津市“神经损伤变异与再生”重点实验室(邮编300052);2天津市胸科医院病案质检科作者简介:刘晔(1984),女,博士,助理研究员,主要从事视神经脊髓炎谱系疾病的研究和治疗。

科学引文索引(SCI)收录期刊

科学引文索引(SCI)收录期刊

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性别决定和伴性遗传(英文版)

性别决定和伴性遗传(英文版)
Inheritance Pattern
X-linked dominant diseases are usually inherited through the paternal line. Males with the disease gene will usually be affected by the disease, and their daughters will inherit the disease gene and may also be affected. Sons of affected males will also inherit the disease gene but usually show no symptoms.
Gender Determination and Sexually Associated Inher
目录
contents
sex determination Sexually inherited Sex chromosome abnormalities Gender and prevention and treatment of hereditary diseases
The impact of genetics and environment on gender
02
Sehromosome recessive genetic disease
X-linked Recessive Genetic Diseases: These diseases are caused by mutations in genes located on the X chromosome. Since males have only one X chromosome, they are more likely to be affected by these diseases than females, who have two X chromosomes copies. Some examples of X-linked recessive genetic diseases include Duchenne muscular dystrophy, hemophilia A, and red-green color blindness.

盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性

盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性

①南通瑞慈医院(扬州大学第四临床医学院) 江苏 南通 226001通信作者:徐孝华盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性唐美玲① 赵银梅① 徐孝华①【摘要】 目的:探讨盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性。

方法:选取2019年1月—2022年10月南通瑞慈医院收治的102例注意缺陷多动障碍患儿,依照随机数字表法分为常规组(n =51)和观察组(n =51),常规组采用盐酸托莫西汀胶囊治疗,观察组采用盐酸托莫西汀胶囊联合哌甲酯治疗,比较两组反应时间、漏报数,斯诺佩评估量表第四版(SNAP-Ⅳ)评分,临床疗效及不良反应发生率。

结果:治疗后,两组反应时间均缩短(P <0.05),且观察组短于常规组(P <0.05)。

治疗后,两组漏报数均减少(P <0.05),且观察组少于常规组(P <0.05)。

治疗后,两组患儿SNAP-Ⅳ评分均降低(P <0.05),且观察组低于常规组(P <0.05)。

观察组总有效率(92.16%)高于常规组(76.47%)(P <0.05)。

两组不良反应发生率比较,差异无统计学意义(P >0.05)。

结论:盐酸托莫西汀胶囊联合哌甲酯用于治疗注意缺陷多动障碍,能够改善临床症状,疗效显著,且安全可靠。

【关键词】 盐酸托莫西汀胶囊 哌甲酯 注意缺陷多动障碍 Efficacy and Safety of Tomoxetine Hydrochloride Capsules Combined with Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder/TANG Meiling, ZHAO Yinmei, XU Xiaohua. //Medical Innovation of China, 2023, 20(23): 010-013 [Abstract] Objective: To investigate the efficacy and safety of Tomoxetine Hydrochloride Capsules combined with Methylphenidate in the treatment of attention deficit hyperactivity disorder. Method: A total of 102 children with attention deficit hyperactivity disorder admitted to Nantong Rich Hospital from January 2019 to October 2022 were selected and divided into the conventional group (n =51) and the observation group (n =51) according to random number table method. The conventional group was treated with Tomoxetine Hydrochloride Capsules, while the observation group was treated with Tomoxetine Hydrochloride Capsules combined with Methylphenidate. The reaction time and number of omissions, Swanson Nolan and Pelham version Ⅳ scale (SNAP-Ⅳ) scores, clinical efficacy and incidence of adverse effects of the two groups were compared. Result: After treatment, the reaction time of both groups were shortened (P <0.05), and that of the observation group was shorter than that of the conventional group (P <0.05). After treatment, the number of omissions were decreased in both groups (P <0.05), and that of the observation group was lower than that of the conventional group (P <0.05). After treatment, the SNAP-Ⅳ scores were reduced in both groups (P <0.05), and that of the observation group was lower than that of the conventional group (P <0.05). The total effective rate in the observation group (92.16%) was higher than that in the conventional group (76.47%) (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion: Tomoxetine Hydrochloride Capsules combined with Methylphenidate can improve clinical symptoms in the treatment of attention deficit hyperactivity disorder, and the efficacy is significant, safe and reliable. [Key words] Tomoxetine Hydrochloride Capsules Methylphenidate Attention deficit hyperactivity disorder First-author's address: Nantong Rich Hospital, Nantong 226001, China doi:10.3969/j.issn.1674-4985.2023.23.003 注意缺陷多动障碍是由多种原因(主要是额叶及皮质下的功能发育问题)所致的一种儿童时期常见的,并以注意力缺陷和活动过度为主要特征的一组综合征。

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Programmed Cell Death and Hybrid IncompatibilityS.A.F RANK AND C.M.B ARRFrom the Department of Ecology and Evolutionary Biology,University of California,Irvine,CA92697-2525,USA.This research was supported by National Institutes of Health grant AI24424and National Science Foundation grant DEB-0089741. Address correspondence to S.A.Frank at the address above,or e-mail:safrank@.We propose a new theory to explain developmental aberrations in plant hybrids.In our theory,hybrid in-compatibilities arise from imbalances in the mechanisms that cause male sterility in hermaphroditic plants.Mitochondria often cause male sterility by killing the tapetal tissue that nurtures pollen mother cells.Recent evidence suggests that mitochondria destroy the tapetum by triggering standard pathways of programmed cell death.Some nuclear geno-types repress mitochondrial male sterility and restore pollen fertility.Normal regulation of tapetal development therefore arises from a delicate balance between the disruptive effects of mitochondria and the defensive countermeasures of the nuclear genes.In hybrids,incompatibilities between male-sterile mitochondria and nuclear restorers may frequently upset the regulatory control of programmed cell death, causing tapetal abnormalities and male sterility.We propose that hybrid misregulation of programmed cell death may also spill over into other tissues,explaining various developmental aberrations observed in hybrids.Natural populations with mitochondrial male sterility usually have two or more mitochondrial genotypes(Frank2000). Each mitochondrial genotype can be repressed by its own specific set of matching nuclear restorer genes,suggesting that each mitochondrial type causes male sterility in a biochemically different way.Distinct polymorphic sets of mitochondrial and nuclear genes coexist,each set with mitochondrial destruction of pollen production and match-ing nuclear repression of mitochondrial action.The matching mitochondrial and nuclear polymorphisms arise from the conflicting patterns of transmission between mitochondrial and nuclear genes(Frank2000).Mitochondria typically transmit only through seeds and not through pollen. Matrilineally transmitted mitochondria increase theirfitness by pollen abortion and enhanced seed production,whereas biparentally inherited nuclear genes favor a balance of pollen and seeds.The polymorphisms from this reproductive conflict are much like the matching polymorphisms of attack and defense that often occur in host-parasite systems.Morphological signs of tapetal deterioration have been observed in several male-sterile species.The maize mito-chondrial gene T-urf13expresses a protein that results in early tapetal degeneration soon after microspore meiosis (Schnable and Wise1998).In sunflower,the mitochondrial PET1gene causes tapetal degeneration soon after meiosis II (Schnable and Wise1998).Similar tapetal abnormalities arise in male-sterile petunia,wheat,sorghum,and other species (Laser and Lersten1972).Mitochondrial genes may cause tapetal degeneration through pathways of programmed cell death(PCD).Balk and Leaver(2001)provide the clearest study relating tapetal deterioration to PCD.In their study,they analyzed morphological and biochemical aspects of male sterility caused by the PET1-CMS cytoplasm in sunflower.They observed classical signs of PCD in tapetal tissues,including cell condensation,oligonucleosomal cleavage of nuclear DNA,separation of chromatin into delineated masses,and partial release of cytochrome c into the cytosol of tapetal cells before the major changes associated with PCD.These characteristics of PCD in tapetal tissue are similar to apoptosis in mammals.However,tapetal deterioration lacks two attributes of apoptosis:condensation of nuclei and deterioration of cells into structures called apoptotic bodies. Thus,following Balk and Leaver,we use PCD as a general term for the triggered and orderly killing of cells;we reserve apoptosis for the subset of PCD with characteristics that have so far only been observed in animals.Other studies have also suggested that PCD causes tapetal deterioration in mitochondrial male sterility.Induced pollen abortion in barley causes the tapetum and nearby tissue to digest its DNA intofixed size classes(Wang et al. 1999).Such DNA laddering is a hallmark of PCD(Danon et al.2000).Some authors have suggested that maize mitochondria carrying the T-urf13gene cause male sterility by inducing PCD in the tapetum,but this has not yet been demonstrated directly(Wu and Cheung2000).It has beenJournal of Heredity2003:94(2):181–183Ó2003The American Genetic Association DOI:10.1093/jhered/esg020181shown that,in the presence of a fungal toxin,maize mitochondria carrying the T-urf13gene experienced small ion leakage and a loss of membrane potential(Holden and Sze1987).These symptoms of mitochondrial deterioration appear to be caused by the formation of pores in the mitochondrial membrane(Wu and Cheung2000),a common feature of apoptosis in animals(Green and Reed1998).Different mitochondrial genotypes may trigger cell death in different ways by altering the complex regulatory cascade leading to PCD.Each male-sterile mitochondrial genotype has its own matching nuclear restorer genes.Thus,it appears that each mitochondrial pathway for interfering with the regulation of PCD can be blocked by a matching nuclear pathway that restores normal regulation.Normal regulation therefore arises from a delicate balance between the disrup-tive effects of mitochondria and the defensive counter-measures of the nuclear genes.Hybrid crosses often produce male-sterile progeny(Laser and Lersten1972;Schnable and Wise1998),suggesting that hybrid incompatibilities readily disrupt the delicate mito-chondrial–nuclear balance over the regulation of tapetal cell death.Such mitochondrial–nuclear imbalances may some-times disturb the regulation of cell death in other tissues, causing diverse hybrid aberrations associated with the mis-regulation of PCD.Many tissues,such as xylem and leaves, use PCD as part of their normal development(Pennell and Lamb1997).In addition,plant cells use PCD as a mechanism to limit pathogen growth at the site of infection(Pennell and Lamb1997).Therefore,misregulation of the PCD pathway could cause defects in tissues throughout the plant.Hybrids often have reducedfitness and developmental abnormalities(Burke and Arnold2001;Waldmann1999). However,we found surprisingly little detail in the literature about morphological and biochemical aberrations in plant hybrids.In our own work,we have observed aberrations of Nemophila menzesii when crossed between distant locations (Barr CM,unpublished data).The resulting progeny are stunted,have thickened and curled leaves,have aberrant petals and anthers,and make little or no pollen.Interestingly, N.menzesii has CMS,making it a good candidate species to analyze associations between CMS and PCD-induced aberrations in crosses between diverged populations.We have found one case that associates hybrid aberrations with PCD.Hybrids from crosses between Nicotiana suavolens and Nicotiana tabacum had developmental abnormalities of cellular death withtheclassicalmorphological and biochemical signatures of PCD(Yamada et al.2001).Nicotiana species have widespread male sterility(Nikova et al.1999).It is these sorts of hybrid abnormalities in Nicotiana and Nemophila that deserve closer attention.Perhaps there is a link between mitochondrial-nuclear imbalances arising from male sterility and hybrid aberrations in the regulation of PCD.Why should the normally tapetal-specific effects of PCD in male sterility occur in other tissues in hybrids?One explanation for tapetal problems in CMS plants is that tapetal tissue experiences exceptional demand for respiration and mitochondrial performance(Hanson1991).Thus,tapetal tissue is particularly sensitive to mitochondrial aberrations and is usually the only tissue that exceeds the threshold for showing signs of mitochondria-induced failure.If this quantitative explanation is correct,and hybrids have a lower threshold for expressing mitochondrial aberrations,then hybrids may express aberrant PCD in tissues other than the tapetum.Lower hybrid thresholds could arise from poorer physiological performance of hybrid tissues,rendering those tissues more susceptible to expressing aberrations normally masked in intraspecific crosses.Alternatively,Balk and Leaver(2001)present evidence in favor of tapetal PCD in male sterility arising from tightly regulated,tissue-specific expression of genes.In this case, misregulation of PCD in hybrids may arise from failure of the mechanisms that confine the CMS-induced expression of PCD to the tapetum.Such failure may occur because the genes involved in causing or suppressing CMS are likely to evolve exceptionally rapidly.We expect rapid evolution because CMS arises from a conflict between cytoplasmic and nuclear genes,and antagonistic coevolution often leads to rapid evolutionary change in other systems such as host-parasite interactions(Frank2002).Our idea about misregulation of PCD in hybrids calls for closer attention to the nature of hybrid aberrations in plants.ReferencesBalk J and Leaver CJ,2001.The PET1-CMS mitochondrial mutation in sunflower is associated with premature programmed cell death and cyto-chrome c release.Plant Cell13:1803–1818.Burke JM and Arnold ML,2001.Genetics and thefitness of hybrids.Annu Rev Genet35:31–52.Danon A,Delorme V,Mailhac N,and Gallois P,2000.Plant programmed cell death:a common way to die.Plant Physiol Biochem38:647–655. Frank SA,2000.Polymorphism of attack and defense.Trends Ecol Evol 15:167–171.Frank SA,2002.Immunology and evolution of infectious disease. Princeton:Princeton University Press.Green DR and Reed JC,1998.Mitochondria and apoptosis.Science281: 1309–1312.Hanson MR,1991.Plant mitochondrial mutations and male sterility.Annu Rev Genet25:461–486.Holden MJ and Sze H,1987.Dissipation of the membrane potential in susceptible corn mitochondria by the toxin of Helminthosporium maydis,race T,and toxin analogs.Plant Physiol84:670–676.Laser KD and Lersten NR,1972.Anatomy and cytology of microsporo-genesis in cytoplasmic male sterile angiosperms.Bot Rev38:425–454. Nikova V,Pundeva R,and Petkova A,1999.Nicotiana tabacum L.as a source of cytoplasmic male sterility in interspecific cross with N.alata Link&Otto. Euphytica107:9–12.Pennell RI and Lamb C,1997.Programmed cell death in plants.Plant Cell 9:1157–1168.Schnable PS and Wise RP,1998.The molecular basis of cytoplasmic male sterility and fertility restoration.Trends Plant Sci3:175–180. Waldmann P,1999.The effect of inbreeding and population hybridization on developmental instability in petals and leaves of the rare plant Silene diclinis(Caryophyllaceae).Heredity83:138–144.182Journal of Heredity2003:94(2)Wang M,Hoekstra S,van Bergen S,Lamers GEM,Oppedijk BJ,van der Heijden MW,de Priester W,and Schilperoort RA,1999.Apoptosis in developing anthers and the role of ABA in this process during androgenesis in Hordeum vulgare L.Plant Mol Biol39:489–501.Wu HM and Cheung AY,2000.Programmed cell death in plant reproduction.Plant Mol Biol44:267–281.Yamada T,Marubashi W,and Niwa M,2001.Facile induction of apoptosis into plant cells with temperature-sensitive lethality shown on interspecific hybrid from the cross Nicotiana suavolens3N.tabacum.Plant Cell Physiol42: 204–213.Received June27,2002Accepted December16,2002Corresponding Editor:James L.Hamrick183Brief Communications。

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