一种导致完全性雄激素不敏感综合征的AR基因移码突变的鉴定

目的 对1个男性假两性畸形完全性雄激素不敏感综合征的家系雄激素受体(androgen receptor,AR)基因进行突变检测,并分析其致病原因.方法 用PCR扩增及DNA测序等技术分析男性假两性畸形先证者候选基因AR的外显子及外显子内含子接头序列,根据检测到的突变位点情况,检测患者及其家系其他成员的相应DNA区段的碱基序列.结果 先证者及其家庭成员共3例患者均为AR基因1910delA的移码突变.其母亲为AR基因突变杂合子,是此疾病的携带者.该突变导致AR基因的N637I(AAU→AUC)、L638*(CTG→TGA)改变,导致AR蛋白283个氨基酸的截短.正常人群未发现该移码突变,该突变尚未见文献报道.结论 基因水平确定了该家系为AR基因突变引起的完全性雄激素不敏感综合征男性假两性畸形家系,同时发现了1种AR基因病理性新突变.     

应用多重连接依赖性探针扩增和变性高效液相色谱技术筛查Peutz-Jeghers综合征家系致病基因突变

目的 联合应用多重连接依赖性探针扩增(MLPA)和变性高效液相色谱(DHPLC)技术快速筛查Peutz-Jeghers综合征家系致病基因的突变.方法 收集家系成员的外周血,采用MLPA、PCR-DNA测序等方法分别检测了LKB基因大片段缺失、碱基突变、碱基插入和缺失.同时收集250名正常人外周血,PCR-DHPLC筛查验证突变位点在正常人群中的分布.生物信息学分析突变位点对编码蛋白质结构和功能的影响.结果 2名家系受累成员均携带LKB基因924G＞C点的突变,这一突变位点在家系正常人和正常人群中都不存在.突变导致位于功能结构域的第308位编码氨基酸由色氨酸变为半胱氨酸,变异蛋白质结构和功能发生改变.结论 c.924G＞C位点的突变是一种病理性胚系突变,编码氨基酸的改变(Trp308Cys)是此家系的致病性因素.     

一个迟发性耳聋家系的DFNA5基因变异分析

目的确定1个常染色体显性遗传性迟发性非综合征性耳聋(non-syndromic hearing loss,NSHL)家系的致病变异。方法收集先证者及其家系成员的临床资料,采集其外周血样,提取基因组DNA,应用核心家系全外显子组测序对先证者及其父母19396个基因的编码区及侧翼序列进行测序,寻找可能的致病变异。用Sanger测序法验证候选变异并对家系其他成员进行检测。结果发现先证者DFNA5基因第8内含子存在1个单碱基缺失杂合变异(c.1183+1delG p.?),该变异为父源性。结论应用核心家系全外显子组测序确定了1个迟发性NSHL家系的致病变异,为遗传咨询提供了依据。     

常染色体显性成人多囊肾病两家系PKD1、PKD2基因的突变鉴定

目的 鉴定两个常染色体显性成人多囊肾病家系的致病突变.方法 采用酚氯仿法提取家系成员及无亲缘关系的100名健康对照个体的外周血白细胞DNA,PCR扩增先证者致病基因PKD1、PKD2的所有外显子序列及其侧翼内含子剪切区域,直接测序确定DNA序列的变异.通过家系和正常对照的比较分析,对检测到的变异是否与疾病相关进行了初步探讨.结果 在两个家系中共检测到5个序列变异:PKD1:c.2469G＞A,PKD1:c.5014_5015 delAG,PKD1:c.10529C＞T,PKD2:c.568G＞A和PKD2:c.2020-1_2020 delAG.其中PKD1:c.2469G＞A和PKD2:c.2020-1_2020 delAG为新发现的变异.此外,检测到的移码突变和剪切突变未见于家系中健康成员及无亲缘关系的正常对照.结论 PKD1:c.5014_5015 delAG和PKD2:c.2020-1_2020 delAG分别为家系A和B的致病突变,且PKD2:c.2020-1_2020 delAG为先证者新发生的突变.     

OCA1患者TYR基因突变的生物信息学分析

目的对2例眼皮肤白化病患者及其家系进行了TYR基因分析,确定其分型和基因型,探讨基因突变对人TYR蛋白结构与功能的影响。方法PCR扩增外周血基因组DNA的TYR基因外显子和外显子-内含子交界区,以DNA序列测定技术检测先证者的TYR基因突变,以生物信息学手段对突变造成的致病性做出合理可能的解释。结果家系1的先证者为929 insC和W 400L突变复合杂合子,家系2中的先证者为G295X突变纯合子,其中G295X为国际上从未报道过的OCA1致病突变。用ClustalW、蛋白功能分析和二级结构分析均显示家系1中的两种突变和TYR蛋白功能与结构的改变相关。结论应用生物信息学分析方法对TYR基因突变的致病性做出一些合理可能的解释是可行的。     

ED1基因新突变导致无汗型外胚层发育不良

目的鉴定一个无汗型外胚层发育不良(HED)家系ED1基因的突变及探讨基因型与表型之间的关系,为该病的诊断,产前诊断及遗传咨询提供实验依据。方法对一个HED家系进行调查,临床资料收集及采集外周血,抽取基因组DNA;设计ED1基因外显子引物,行先证者DNA PCR扩增及序列测定,发现候选变异后对先证者的父母及120名匹配正常人进行突变位点序列分析;推导的该基因氨基酸序列(突变位点)用Clustal W软件进行多物种对比。结果先证者发现ED1基因c.158T>G(p.Leu53Arg)纯合突变,母亲为c.158T>G(p.Leu53Arg)杂合突变;先证者父亲及120例正常对照的序列分析结果未检测出相应位置突变。讨论 ED1基因突变检测是直接诊断HED有效手段之一,发现的c.158T>G(p.Leu53Arg)为新致病突变。     

1个中央轴空病家系RYR1基因的突变分析

目的 对一个常染色体显性遗传的中央轴空病(CCD)家系进行基因诊断,探讨家系中CCD患者可能的致病机制以及基因型与表现型的关系.方法 对先证者进行病史和家族史询问以及详细的临床检查.采集先证者及其家属的外周血样本,用PCR方法扩增理阿诺碱受体1(RYR1)基因C端突变热点区(外显子90-104)的编码序列,进行序列测定,与数据库中的参考序列进行比对分析.结果 先证者及其母亲、妹妹RYR1基因第102外显子均发生了第14690位碱基G到A的点突变,此突变会导致氨基酸改变,即G4897D,家系内正常成员以及家系外的50名正常对照均未发现该突变位点.结论 本实验所研究的家系中,RYR1基因第102外显子G14690A的杂合突变为致病基因,该基因突变可能导致不同的临床表现和病理改变.     

原发性肉碱缺乏症一家系的SLC22A5基因突变检测与产前诊断

目的对原发性肉碱缺乏症(PCD)病患者及一家系进行致病基因SLC22A5突变鉴定,为家系提供遗传咨询和产前诊断,同时研究c.394-1 GT突变所导致的SLC22A5基因剪接形式的改变。方法收集患者及父母的外周血标本,提取基因组DNA,采用Sanger法对家系中各成员进行SLC22A5基因的所有外显子进行测序,同时对发现的突变在100名正常对照中进行测序,以排除多态性位点;使用QIAGEN血液RNA提取试剂盒抽提患儿总RNA,通过RT-PCR和测序技术分析c DNA序列特征。对先证者母亲的羊水标本进行产前诊断。结果 Sanger法DNA测序检测出该家系中先证者为SLC22A5基因的两个杂合突变:c.394-1 GT,c.760CT(p.R254X),在100名正常对照中均未发现这两个位点的突变。先证者父亲、母亲分别携带SLC22A5基因c.394-1 GT、c.760 CT(p.R254X)杂合突变。先证者母亲的羊水标本的基因型与先证者一样。先证者的特定片段RT-PCR产物电泳时较非携带者的正常人多出一条小的亮带,经测序确认是由c.394-1 GT突变导致SLC22A5基因c DNA外显子2完整序列的缺失。结论 c.394-1 GT突变位点在国内外仅一例报道,本研究证实该突变的存在,同时证明该突变导致SLC22A5基因c DNA外显子2完整序列的缺失。这一发现丰富了SLC22A5基因突变谱,为原发性肉碱缺乏症(PCD)病的防治提供新的参考,Sanger测序等技术可为原发性肉碱缺乏症家系提供遗传咨询和产前诊断服务。     

眼皮肤白化病Ⅰ型产前基因诊断

目的对已生育过眼皮肤白化病Ⅰ型（oculocutaneous albinism type Ⅰ，OCA1）患儿的两个家系进行酪氨酸酶（tyrosinase，TYR）基因TYR的突变研究和产前基因诊断。方法应用PCR技术扩增TYR基因各外显子、外显子．内含子交界区及启动子区，直接以DNA序列测定技术分析先证者或其父母的基因突变，明确致病性突变后，检测胎儿TYR基因相应位点的DNA序列，获知胎儿的基因型。结果家系1的先证者为R278X和929insC突变复合杂合子；胎儿未获得这2种突变等位基因，基因型和表型均正常。家系2先证者的父母分别为IVS4＋3A→T和G253E突变的杂合子，胎儿只获得了父源性的IVS4＋3A→T突变等位基因，未获得母源性G253E突变等位基因，胎儿为表型正常的致病基因携带者。结论此为中国大陆首次真正意义上的OCA1产前基因诊断；应用上述基因分析方法进行OCA1产前基因诊断是可行的。     

三个Fabry病家系GLA基因突变与临床表型

目的 分析3个Fabry病家系GLA基因突变及其与临床表型的关系.方法 应用PCR结合DNA测序技术,检测先证者及相关成员GLA基因编码序列与剪切位点DNA序列变异,分析致病性突变与临床表型关系.结果 在家系1先证者GLA基因第5外显子中发现1个未经报道的错义突变c.797A＞C(D266A),家系2先证者GLA基因第5外显子中发现1个错义突变c.644A＞G(N215S),家系3先证者GLA基因第2外显子中发现1个无义突变c.355C＞T(Ql19X).家系1与家系3先证者主要表现为皮肤损害和慢性肾功能不全,家系2先证者临床则以肥厚性心肌病为特点.结论 首次发现的GLA基因c.797A＞C(D266A)突变是第266位密码子第6个被证实的错义突变,已报道的另5种突变均有致病性,在正常非相关对照中未发现该突变,提示GLA基因c.797A＞C突变很可能是该家系的致病原因.N215S和Q119X系首次发现于中国Fabry病家系的突变.GLA基因不同位点的突变具有较为显著的表型差异.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.