genetic mutations

基因突变
  • 文章类型: Journal Article
    先天性心脏病(CHD)包括影响心脏和主要血管的各种结构和功能异常。流行病学研究表明,冠心病患病率在全球范围内有所增加,这可以归因于诊断技术的进步。广泛的研究已经确定了大量的CHD相关基因,提供对这种病理状态的生化途径和分子机制的见解。在这次审查中,我们讨论了各种体外和体内CHD模型的优势和挑战,包括灵长类动物,犬科动物,非洲爪蛙,兔子,小鸡,老鼠,果蝇,斑马鱼,和诱导多能干细胞(iPSC)。灵长类动物与人类密切相关,但罕见且昂贵。犬类模型成本高,但在结构上与人类相当。非洲爪蛙是有利的,因为它们产生了许多胚胎,易于进行基因改造,心脏相似性兔子模仿人类生理学,但对基因控制具有挑战性。小鸡价格低廉,操作简单;然而,心脏事件可能因人而异。小鼠在生理上不同,同时在进化上接近和资源充足。果蝇的基因与人类相似,但心脏结构不同。斑马鱼有几个优点,包括人类的高基因保守性和生理心脏相似性,但与哺乳动物抗体的交叉反应性有限,基因复制,和用于反向遗传方法的有限胚胎干细胞。iPSCs具有基因编辑的潜力,但在2D结构和基因组稳定性方面面临挑战。CRISPR-Cas9允许基因校正,但需要很高的技术技能和资源。这些模型提供了有关心脏发育的宝贵知识,疾病模拟,和遗传因素的验证。这篇综述强调了各种模型在生物学特征方面的不同特征,容易患上特定的心脏病,用于诱发特定条件的方法,以及这些物种与人类的可比性。因此,选择合适的模型是基于研究目标,最终导致对疾病病理和治疗的理解增强。
    Congenital heart disease (CHD) encompasses a diverse range of structural and functional anomalies that affect the heart and the major blood vessels. Epidemiological studies have documented a global increase in CHD prevalence, which can be attributed to advancements in diagnostic technologies. Extensive research has identified a plethora of CHD-related genes, providing insights into the biochemical pathways and molecular mechanisms underlying this pathological state. In this review, we discuss the advantages and challenges of various In vitro and in vivo CHD models, including primates, canines, Xenopus frogs, rabbits, chicks, mice, Drosophila, zebrafish, and induced pluripotent stem cells (iPSCs). Primates are closely related to humans but are rare and expensive. Canine models are costly but structurally comparable to humans. Xenopus frogs are advantageous because of their generation of many embryos, ease of genetic modification, and cardiac similarity. Rabbits mimic human physiology but are challenging to genetically control. Chicks are inexpensive and simple to handle; however, cardiac events can vary among humans. Mice differ physiologically, while being evolutionarily close and well-resourced. Drosophila has genes similar to those of humans but different heart structures. Zebrafish have several advantages, including high gene conservation in humans and physiological cardiac similarities but limitations in cross-reactivity with mammalian antibodies, gene duplication, and limited embryonic stem cells for reverse genetic methods. iPSCs have the potential for gene editing, but face challenges in terms of 2D structure and genomic stability. CRISPR-Cas9 allows for genetic correction but requires high technical skills and resources. These models have provided valuable knowledge regarding cardiac development, disease simulation, and the verification of genetic factors. This review highlights the distinct features of various models with respect to their biological characteristics, vulnerability to developing specific heart diseases, approaches employed to induce particular conditions, and the comparability of these species to humans. Therefore, the selection of appropriate models is based on research objectives, ultimately leading to an enhanced comprehension of disease pathology and therapy.
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  • 文章类型: Journal Article
    目的:本研究的目的是比较基因突变,肿瘤突变负荷(TMB),以及分子靶向药物和免疫检查点抑制剂(ICIs)在头颈部粘膜黑色素瘤(HNMUM)以及皮肤黑色素瘤(SKM)和眼部黑色素瘤(OM)中的作用。
    方法:分析72例HNMUM患者的数据,包括带有SKM的366和带有OM的31,在日本国立癌症中心注册,癌症基因组学和高级治疗学中心(C-CAT),2019年6月至2023年10月。通过FoundationOneCDx下一代测序确定遗传改变和TMB。
    结果:HNMUM的前10个突变是RAD21(47.2%),NBN(45.8%),MYC(40.3%),LYN(31.9%),NRAS(29.1%),IRF4(23.6%),DAXX(22.2%),KIT(22.2%),NOTCH3(20.8%),和DDR1(19.4%),具有16.6±0.8(平均值±SEM)突变/个体。在SKM中,BRAF(p=0.04)突变与显著更好的预后相关。HNMUM的TMB值为5.7±2.1(平均值±SEM),SKM中的4.1±0.2,和3.4±0.9的OM,三组间无显著差异。对于HNMUM,远处转移患者的中位生存时间为803(95%置信区间:539-NA)天,SKM的1413(831-2172)天,OM为1138(438-NA)天。
    结论:HNMUM的前10个突变比SKM更接近OM。关于ICIs在疾病中的治疗效果,TMB值或生存率没有显着差异,这表明目前用ICIs治疗HNMUM是合适的。
    方法:3喉镜,2024.
    OBJECTIVE: The purpose of this study is to compare genetic mutations, tumor mutation burden (TMB), and the effects of molecular targeted drugs and immune checkpoint inhibitors (ICIs) in head and neck mucosal melanoma (HNMUM) with those in skin melanoma (SKM) and ocular melanoma (OM).
    METHODS: Data were analyzed for 72 consecutive patients with HNMUM, including 366 with SKM and 31 with OM, registered at the Japan National Cancer Center, Center for Cancer Genomics and Advanced Therapeutics (C-CAT) between June 2019 and October 2023. Genetic alterations and TMB were determined by FoundationOne CDx next-generation sequencing.
    RESULTS: The top 10 mutations in HNMUM were RAD21 (47.2%), NBN (45.8%), MYC (40.3%), LYN (31.9%), NRAS (29.1%), IRF4 (23.6%), DAXX (22.2%), KIT (22.2%), NOTCH3 (20.8%), and DDR1 (19.4%), with 16.6 ± 0.8 (mean ± SEM) mutations/individual. In SKM, BRAF (p = 0.04) mutation was associated with a significantly better prognosis. The TMB values were 5.7 ± 2.1 (mean ± SEM) in HNMUM, 4.1 ± 0.2 in SKM, and 3.4 ± 0.9 in OM, with no significant differences among the three groups. The median survival time for patients with distant metastases was 803 (95% confidence interval: 539-NA) days for HNMUM, 1413 (831-2172) days for SKM, and 1138 (438-NA) days for OM.
    CONCLUSIONS: The top 10 mutations in HNMUM are closer to those in OM than those in SKM. There was no significant difference in TMB values or survival rates with regard to the therapeutic effect of ICIs among the diseases, which suggests that current treatment of HNMUM with ICIs is appropriate.
    METHODS: 3 Laryngoscope, 2024.
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  • 文章类型: Journal Article
    胰腺癌,随着发病率的惊人上升,预计到2040年将成为第二致命的实体瘤,这凸显了对改进诊断和治疗策略的迫切需要。尽管医学上取得了进步,胰腺癌的5年生存率保持在14%左右,转移时进一步下降。这篇综述探讨了早期检测生物标志物的前景,个性化治疗,和疾病监测。基于基因突变的胰腺癌分子分型,基因表达,蛋白质标记指导治疗决策,有可能改善结果。目前正在进行大量研究不同策略的临床试验。靶向治疗,其中反对CLAUDIN18.2和抑制Claudin18.1的人表现出了希望。下一代测序(NGS)已成为胰腺肿瘤全面基因组分析的强大工具,揭示了驱动癌症进展的独特遗传改变。这使肿瘤学家能够针对特定的分子异常定制治疗方法。然而,挑战依然存在,包括对生物标志物指导疗法的认识和吸收有限。继续研究胰腺癌的分子机制对于开发更有效的治疗方法和提高患者生存率至关重要。
    Pancreatic cancer, with its alarming rising incidence, is predicted to become the second deadliest type of solid tumor by 2040, highlighting the urgent need for improved diagnostic and treatment strategies. Despite medical advancements, the five-year survival rate for pancreatic cancer remains about 14%, dropping further when metastasized. This review explores the promise of biomarkers for early detection, personalized treatment, and disease monitoring. Molecular classification of pancreatic cancer into subtypes based on genetic mutations, gene expression, and protein markers guides treatment decisions, potentially improving outcomes. A plethora of clinical trials investigating different strategies are currently ongoing. Targeted therapies, among which those against CLAUDIN 18.2 and inhibitors of Claudin 18.1, have shown promise. Next-generation sequencing (NGS) has emerged as a powerful tool for the comprehensive genomic analysis of pancreatic tumors, revealing unique genetic alterations that drive cancer progression. This allows oncologists to tailor therapies to target specific molecular abnormalities. However, challenges remain, including limited awareness and uptake of biomarker-guided therapies. Continued research into the molecular mechanisms of pancreatic cancer is essential for developing more effective treatments and improving patient survival rates.
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  • 文章类型: Journal Article
    目的:心房的个性化3D计算机模型在过去的一年中已被广泛实施,这是一种工具,可以帮助人们理解不同形式的心律失常的潜在机制。如心房颤动(AF)。同时,研究表明,在无症状患者中,作用于钾离子通道动力学的基因突变可诱发纤颤发作.这项研究旨在评估三种功能获得突变对房颤的影响和心房易感性-即KCNH2T895M,KCNH2T436M,和KCNE3-V17M-与AF爆发相关,使用具有真实壁厚和异质组织学特性的高度详细的3D心房模型。
    方法:通过重建房颤患者CT扫描的分段解剖结构,生成三维心房模型。Courtemanche人心房肌细胞模型的修改版本用于再现WT和三个突变细胞的电生理活性。使用具有两个S2基本周期长度(BCL)和11个耦合间隔的S1-S2协议在心房网格上的16个位置模拟异位灶(EF),以诱发心律失常。
    结果:3D水平的三个基因突变降低了APD90。KCNE3-V17M突变引起最高的缩短(RA和LA相对于WT为55%),其次是KCNH2T895M(在RA中为14%,在WT中为18%LA)和KCNH2T436M(在RA中为7%,在WT中为9%LA)。KCNE3-V17M突变导致67%的模拟病例和94%的异位病灶出现心律失常,在S2处BCL等于100ms。KCNH2T436M和KCNH2T895M突变以类似的方式增加了对AF的脆弱性,在7%的模拟条件下导致心律失常发作,在S2BCL设置为160ms。总的来说,产生的心律失常事件的60%发生在左心房。螺旋波,在KCNE3-V17M突变的存在下引起多个转子和无序的电模式,表现出7.6Hz的瞬时平均频率和1.12Hz的平均标准偏差。在KCNH2T436M和KCNH2T895M突变存在下诱导的滚动波显示出稳定性和规律性,瞬时平均频率在4.9-5.1Hz范围内,平均标准偏差在0.19-0.53Hz内。
    结论:KCNE3-V17M的致心律失常性,在个性化3D心脏模型上研究并证明KCNH2T895M和KCNH2T436M突变。根据对心房电生理特性的影响,证明了这三种基因突变以不同的方式增加了心房组织对AF易感底物形成的易感性。
    OBJECTIVE: Personalized 3D computer models of atria have been extensively implemented in the last yearsas a tool to facilitate the understanding of the mechanisms underlying different forms of arrhythmia, such as atrial fibrillation (AF). Meanwhile, genetic mutations acting on potassium channel dynamics were demonstrated to induce fibrillatory episodes in asymptomatic patients. This research study aims at assessing the effects and the atrial susceptibility to AF of three gain-of-function mutations - namely, KCNH2 T895M, KCNH2 T436M, and KCNE3-V17M - associated with AF outbreaks, using highly detailed 3D atrial models with realistic wall thickness and heterogenous histological properties.
    METHODS: The 3D atrial model was generated by reconstructing segmented anatomical structures from CT scans of an AF patient. Modified versions of the Courtemanche human atrial myocyte model were used to reproduce the electrophysiological activity of the WT and of the three mutant cells. Ectopic foci (EF) were simulated in sixteen locations across the atrial mesh using an S1-S2 protocol with two S2 basic cycle lengths (BCL) and eleven coupling intervals in order to induce arrhythmias.
    RESULTS: The three genetic mutations at 3D level reduced the APD90. The KCNE3-V17M mutation provoked the highest shortening (55 % in RA and LA with respect to WT), followed by KCNH2 T895M (14 % in RA and 18 % LA with respect to WT)and KCNH2 T436M (7 % in RA and 9 % LA with respect to WT). The KCNE3-V17M mutation led to arrhythmia in 67 % of the cases simulated and in 94 % of ectopic foci considered, at S2 BCL equal to 100 ms. The KCNH2 T436M and KCNH2 T895M mutations increased the vulnerability to AF in a similar way, leading to arrhythmic episodes in 7 % of the simulated conditions, at S2 BCL set to 160 ms. Overall, 60 % of the arrhythmic events generated arise in the left atrium. Spiral waves, multiple rotors and disordered electrical pattern were elicited in the presence of the KCNE3-V17M mutation, exhibiting an instantaneous mean frequency of 7.6 Hz with a mean standard deviation of 1.12 Hz. The scroll waves induced in the presence of the KCNH2 T436M and KCNH2 T895M mutations showed steadiness and regularity with an instantaneous mean frequencies in the range of 4.9 - 5.1 Hz and a mean standard deviation within 0.19 - 0.53 Hz.
    CONCLUSIONS: The pro-arrhythmogenicity of the KCNE3-V17M, KCNH2 T895M and KCNH2 T436M mutations was studied and proved on personalized 3D cardiac models. The three genetic mutations were demonstrated to increase the predisposition of atrial tissue to the formation of AF-susceptible substrate in different ways based on their effects on electrophysiological properties of the atria.
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  • 文章类型: Journal Article
    基因突变和结肠的慢性炎症有助于结直肠癌(CRC)的发展。使用炎症诱导的结肠肿瘤发生的小鼠模型,我们确定了基因突变如何改变结肠肿瘤细胞分化.由肠产毒性脆弱拟杆菌(ETBF)定植的多发性肠瘤形成(MinApcΔ716/)小鼠引起的炎症引发Apc杂合性丧失,导致结肠肿瘤形成。这里,我们报道了添加BRAFV600E突变(BRAFF-V600ELgr5tm1(Cre/ERT2)CleMinApcΔ716/+,BLM)或敲除Msh2(Msh2LoxP/LoxPVil1-creMinApcΔ716/+,Min模型中的MSH2KO)改变了结肠肿瘤分化。使用单细胞RNA测序,我们发现了BLM之间的差异,Min,和MSH2KO肿瘤在单细胞分辨率。BLM肿瘤显示分化的肿瘤上皮细胞谱系增加,肿瘤干细胞群减少。有趣的是,BLM肿瘤的肿瘤干细胞群具有复苏结肠干细胞特征,WNT信号传导低,RevCSC标记基因表达增加.相比之下,MSH2KO肿瘤的特征在于与Min肿瘤相比具有更高的WNT信号传导活性的肿瘤干细胞群增加。此外,整体BLM肿瘤有较高的转录因子表达驱动分化,如Cdx2,比Min肿瘤。利用RNA速度,我们确定了BLM肿瘤分化的其他潜在调节因子,如NDRG1.使用源自BLM肿瘤的类器官验证了CDX2和NDRG1作为BLM肿瘤细胞分化的推定调节剂的作用。我们的结果证明了在炎症诱导的结肠肿瘤发生中基因突变和细胞分化之间的关键联系。了解这些作用将加深我们对炎症相关结肠癌的理解。
    Genetic mutations and chronic inflammation of the colon contribute to the development of colorectal cancer (CRC). Using a murine model of inflammation-induced colon tumorigenesis, we determined how genetic mutations alter colon tumor cell differentiation. Inflammation induced by enterotoxigenic Bacteroides fragilis (ETBF) colonization of multiple intestinal neoplasia (MinApcΔ716/+) mice triggers loss of heterozygosity of Apc causing colon tumor formation. Here, we report that the addition of BRAFV600E mutation (BRAFF-V600ELgr5tm1(Cre/ERT2)CleMinApcΔ716/+, BLM) or knocking out Msh2 (Msh2LoxP/LoxPVil1-creMinApcΔ716/+, MSH2KO) in the Min model altered colon tumor differentiation. Using single-cell RNA sequencing, we uncovered the differences between BLM, Min, and MSH2KO tumors at a single-cell resolution. BLM tumors showed an increase in differentiated tumor epithelial cell lineages and a reduction in the tumor stem cell population. Interestingly, the tumor stem cell population of BLM tumors had revival colon stem cell characteristics with low WNT signaling and an increase in RevCSC marker gene expression. In contrast, MSH2KO tumors were characterized by an increased tumor stem cell population that had higher WNT signaling activity compared to Min tumors. Furthermore, overall BLM tumors had higher expression of transcription factors that drive differentiation, such as Cdx2, than Min tumors. Using RNA velocity, we identified additional potential regulators of BLM tumor differentiation such as NDRG1. The role of CDX2 and NDRG1 as putative regulators for BLM tumor cell differentiation was verified using organoids derived from BLM tumors. Our results demonstrate the critical connections between genetic mutations and cell differentiation in inflammation-induced colon tumorigenesis. Understanding such roles will deepen our understanding of inflammation-associated colon cancer.
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  • 文章类型: Journal Article
    宫颈癌是女性第四大最常见的癌症。晚期和转移性疾病通常与不良的临床结果相关。这证实了对患者和肿瘤特异性的高通量诊断和治疗平台的绝对必要性。宫颈癌治疗构成多模式干预。全身治疗如化疗和/或局灶性放疗通常作为新辅助和/或辅助策略应用。顺铂构成标准宫颈癌治疗方法的组成部分。然而,尽管最初的患者反应,从头或延迟/获得性治疗抗性经常被报道,毒性令人担忧。化疗耐药与基因组的重大改变有关,代谢组学,表观遗传和蛋白质组景观。这导致与致癌和增殖生存相关的不平衡的体内平衡。抗凋亡的好处,和增强DNA损伤修复过程。尽管在过去的二十年中,癌症的诊断和治疗取得了重大进展,抗药性仍然是需要克服的主要障碍。
    尽管在治疗方面取得了进展,这种疾病的晚期和扩散到身体的其他部位往往会导致不良的结果。这凸显了迫切需要针对每个患者及其特定肿瘤定制的更好的诊断和治疗方法。宫颈癌的治疗通常涉及治疗的组合。化疗和聚焦放射治疗通常在手术前或手术后使用,以改善预后。然而,一些患者对这些治疗产生抗药性,从治疗开始或最初反应后。这种耐药性会使治疗效果降低,并增加副作用的风险。化疗抗性通常与癌细胞的基因和蛋白质的变化有关。这些变化破坏了细胞内的正常平衡,使它们更容易生长和生存,抵抗细胞死亡,修复由治疗引起的DNA损伤。尽管癌症研究和治疗取得了进展,耐药性仍然是一个重大挑战。本文旨在探讨获得性基因突变对宫颈癌耐药的影响。通过更好地理解这些突变,中低收入国家的研究人员和临床医生可以制定更有效的治疗策略,以改善患者的预后.
    Cervical cancer is the fourth most common cancer in women. Advanced stage and metastatic disease are often associated with poor clinical outcomes. This substantiates the absolute necessity for high-throughput diagnostic and treatment platforms that are patient and tumour specific. Cervical cancer treatment constitutes multimodal intervention. Systemic treatments such as chemotherapy and/or focal radiotherapy are typically applied as neoadjuvant and/or adjuvant strategies. Cisplatin constitutes an integral part of standard cervical cancer treatment approaches. However, despite initial patient response, de novo or delayed/acquired treatment resistance is often reported, and toxicity is of concern. Chemotherapy resistance is associated with major alterations in genomic, metabolomic, epigenetic and proteomic landscapes. This results in imbalanced homeostasis associated with pro-oncogenic and proliferative survival, anti-apoptotic benefits, and enhanced DNA damage repair processes. Although significant developments in cancer diagnoses and treatment have been made over the last two decades, drug resistance remains a major obstacle to overcome.
    Despite advances in treatment, the disease’s advanced stages and spread to other parts of the body often lead to poor outcomes. This highlights the urgent need for better diagnostic and treatment methods tailored to each patient and their specific tumour. Treatment for cervical cancer usually involves a combination of therapies. Chemotherapy and focused radiation therapy are commonly used before or after surgery to improve outcomes. However, some patients develop resistance to these treatments, either from the start or after initially responding to therapy. This resistance can make treatment less effective and increase the risk of side effects. Chemotherapy resistance is often linked to changes in the genes and proteins of cancer cells. These changes disrupt the normal balance within the cells, making them more prone to grow and survive, resist cell death, and repair DNA damage caused by treatment. Despite progress in cancer research and treatment, drug resistance remains a significant challenge. This review aims to explore how acquired genetic mutations contribute to drug resistance in cervical cancer. By understanding these mutations better, researchers and clinicians in low- to middle-income countries can develop more effective treatment strategies to improve outcomes for patients.
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  • 文章类型: Journal Article
    边缘性卵巢肿瘤(BOT)显示出有趣的特征,将其与其他卵巢肿瘤区分开。系统评价的目的是分析BOT中发现的分子变化谱,并讨论其在整体治疗方法中的意义。系统评价包括2000年至2023年在数据库中发表的文章:PubMed,EMBASE,还有Cochrane.在详细分析现有出版物后,我们有资格进行系统评价:28篇关于原癌基因的出版物:BRAF,KRAS,NRAS,ERBB2和PIK3CA,20篇关于抑癌基因的出版物:BRCA1/2,ARID1A,CHEK2,PTEN,4对粘附分子:CADM1,8对蛋白质:B-catenin,糖蛋白上的claudin-1和5:E-Cadherin。此外,在系统审查的下一部分,我们纳入了8篇关于微卫星不稳定性的出版物和3篇描述BOT中杂合性丧失的出版物。在BOT中发现的分子变化可以根据具体情况而变化,通过分子分析识别致癌突变和开发靶向治疗代表了卵巢恶性肿瘤诊断和治疗的重大进展.分子研究对我们对BOT发病机制的理解做出了重要贡献,但仍需要大量研究来阐明卵巢肿瘤与外来疾病之间的关系,确定准确的预后指标,并开发有针对性的治疗方法。
    Borderline ovarian tumours (BOTs) show intriguing characteristics distinguishing them from other ovarian tumours. The aim of the systematic review was to analyse the spectrum of molecular changes found in BOTs and discuss their significance in the context of the overall therapeutic approach. The systematic review included articles published between 2000 and 2023 in the databases: PubMed, EMBASE, and Cochrane. After a detailed analysis of the available publications, we qualified for the systematic review: 28 publications on proto-oncogenes: BRAF, KRAS, NRAS, ERBB2, and PIK3CA, 20 publications on tumour suppressor genes: BRCA1/2, ARID1A, CHEK2, PTEN, 4 on adhesion molecules: CADM1, 8 on proteins: B-catenin, claudin-1, and 5 on glycoproteins: E-Cadherin. In addition, in the further part of the systematic review, we included eight publications on microsatellite instability and three describing loss of heterozygosity in BOT. Molecular changes found in BOTs can vary on a case-by-case basis, identifying carcinogenic mutations through molecular analysis and developing targeted therapies represent significant advancements in the diagnosis and treatment of ovarian malignancies. Molecular studies have contributed significantly to our understanding of BOT pathogenesis, but substantial research is still required to elucidate the relationship between ovarian neoplasms and extraneous disease, identify accurate prognostic indicators, and develop targeted therapeutic approaches.
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  • 文章类型: Journal Article
    目的:对于其他干预措施不成功的慢性胰腺炎(CP)患者,胰岛自体移植全胰腺切除术(TPIAT)是一种有效的治疗方法。CP有多种病因,包括遗传。在我们中心接受此手术的大量患者中,与具有非遗传病因的患者相比,具有遗传CP病因的患者在TPIAT后的代谢和疼痛缓解结果。
    方法:对2006年至2023年的237例TPIAT患者进行了回顾性分析。我们分析了遗传(n=56)与非遗传(n=181)CP病因患者在TPIAT前因素(包括患者特征和疾病状态)方面的差异,隔离过程的结果,以及长期血糖和疼痛控制等结果。
    结果:患有遗传性CP的患者在明显年轻时接受了TPIAT(32.3岁vs41.3岁的非遗传性,p<0.0001),并且忍受症状的时间明显更长(10年vs6年,p<0.01)。从患有遗传性CP的患者中分离出明显较低的胰岛质量(p<0.01),两组的体重指数均增加。尽管收益率较低,遗传性CP患者保持代谢功能,如非遗传性CP患者,如胰岛素独立性和C肽所示,血糖,和TPIAT后的血红蛋白A1c水平。与TPIAT前相比,移植后麻醉药的使用和疼痛评分显着降低,更多的遗传性CP患者在TPIAT后无痛无麻醉。
    结论:我们的数据证实TPIAT对于患有遗传病因的CP患者是一种有益的治疗方法。由于疾病的性质和有利的TPIAT结果,在决定在遗传性CP的情况下进行早期TPIAT时,应考虑在轻微干预后不可避免地复发的疼痛。
    OBJECTIVE: Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment for patients with chronic pancreatitis (CP) when other interventions are unsuccessful. CP has many etiologies including heredity. Metabolic and pain relief outcomes after TPIAT are presented among patients with a genetic CP etiology compared with those with a nongenetic etiology in a large cohort of patients who underwent this procedure at our center.
    METHODS: A retrospective analysis was performed of 237 patients undergoing TPIAT between 2006 and 2023. We analyzed the differences in patients with genetic (n = 56) vs nongenetic CP etiologies (n = 181) in terms of pre-TPIAT factors including patient characteristics and disease state, results from the isolation process, and outcomes such as long-term glycemic and pain control.
    RESULTS: Patients with genetic CP underwent TPIAT at a significantly younger age (32.3 vs 41.3 years nongenetic; P < .0001) and endured symptoms for a significantly longer period (10 vs 6 years; P < .01). A significantly lower mass of islets was isolated from patients with genetic CP (P < .01), which increased with body mass index in both groups. Despite lower yields, patients with genetic CP maintained metabolic function similar to patients with nongenetic CP, as indicated by insulin independence and C-peptide, blood glucose, and hemoglobin A1C levels after TPIAT. Post-transplant narcotic usage and pain scores significantly decreased compared with those before TPIAT, and more patients with genetic CP were pain free and narcotic free after TPIAT.
    CONCLUSIONS: Our data validate TPIAT as a beneficial procedure for patients enduring CP of genetic etiology. Pain that is inevitably recurrent after minor interventions owing to the nature of the disease and favorable TPIAT outcomes should be considered in the decision to perform early TPIAT in cases of genetic CP.
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  • 文章类型: Journal Article
    肌萎缩侧索硬化症(ALS)是一种致命的神经退行性疾病,其主要特征是受影响的运动神经元中泛素化蛋白的积累。目前,ALS的确切发病机制尚不清楚,目前尚无有效的治疗措施。ALS的潜在发病机制主要包括一些致病蛋白的错误折叠,遗传变异,线粒体功能障碍,自噬障碍,神经炎症,RNA的错误调控,改变了轴突运输,和肠道微生物菌群失调。探索ALS的发病机制是寻找有效治疗方法的关键步骤。目前的研究表明,遗传变异,肠道微生物菌群失调,神经胶质细胞的激活,细胞外囊泡的运输障碍可能在ALS的发病中起着重要作用。本综述对目前这些与ALS发病机制密切相关的潜在有希望的话题进行了系统的综述,旨在为寻找ALS的新治疗措施提供一些新的证据和线索。
    Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease mainly characterized by the accumulation of ubiquitinated proteins in the affected motor neurons. At present, the accurate pathogenesis of ALS remains unclear and there are still no effective treatment measures for ALS. The potential pathogenesis of ALS mainly includes the misfolding of some pathogenic proteins, the genetic variation, mitochondrial dysfunction, autophagy disorders, neuroinflammation, the misregulation of RNA, the altered axonal transport, and gut microbial dysbiosis. Exploring the pathogenesis of ALS is a critical step in searching for the effective therapeutic approaches. The current studies suggested that the genetic variation, gut microbial dysbiosis, the activation of glial cells, and the transportation disorder of extracellular vesicles may play some important roles in the pathogenesis of ALS. This review conducts a systematic review of these current potential promising topics closely related to the pathogenesis of ALS; it aims to provide some new evidences and clues for searching the novel treatment measures of ALS.
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  • 文章类型: Journal Article
    非小细胞肺癌(NSCLC)是一个重要的全球健康问题,具有影响治疗反应的不同分子谱。然而,在摩洛哥,NSCLC的分子流行病学在很大程度上尚未被探索。本研究集中于NSCLC基因突变,特别是在腺癌中,摩洛哥患者有助于了解该人群中的非小细胞肺癌。分析94例诊断为肺腺癌的患者。处理福尔马林固定石蜡包埋的组织样品,使用标准化方案提取脱氧核糖核酸(DNA)/核糖核酸(RNA)。使用AmoyDxPan肺癌聚合酶链反应(PCR)面板试剂盒检测突变,并通过统计分析评估其频率。在22.34%的患者中检测到表皮生长因子受体(EGFR)突变,主要是外显子19缺失(66.66%)和外显子21L858R突变(23.80%)。间变性淋巴瘤激酶(ALK)基因融合者占3.19%,而KRAS基因突变率为1.06%。在其他测试基因中未发现突变。与男性(45.84%)相比,女性(54.16%)的突变率略高。该研究揭示了摩洛哥NSCLC患者的独特突变特征,EGFR突变的明显流行,尽管低于一些亚洲人口。EGFR突变在治疗反应中的意义与全球发现一致,强调了解区域分子变异对个性化治疗的重要性。尽管样本量和临床数据有限,这项研究揭示了摩洛哥非小细胞肺癌的遗传前景。观察到的突变率,特别是在EGFR中,强调了摩洛哥非小细胞肺癌患者靶向治疗的潜力,强调需要进一步研究以完善针对该人群的治疗策略。
    Non-small cell lung cancer (NSCLC) is a significant global health issue with diverse molecular profiles affecting treatment responses. Yet, NSCLC\'s molecular epidemiology in Morocco is largely unexplored. This study focuses on NSCLC genetic mutations, specifically in adenocarcinoma, among Moroccan patients to contribute to understanding NSCLC in this population. Ninety-four patients diagnosed with lung adenocarcinoma were analyzed. Formalin-fixed paraffin-embedded tissue samples were processed, and deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) was extracted using standardized protocols. Mutations were detected using the AmoyDx Pan Lung Cancer Polymerase Chain Reaction (PCR) Panel kit, and their frequencies were assessed through statistical analysis. Epidermal Growth Factor Receptor (EGFR) mutations were detected in 22.34% of patients, predominantly exon 19 deletions (66.66%) and exon 21 L858R mutations (23.80%). Anaplastic lymphoma kinase (ALK) gene fusion was observed in 3.19% of patients, and KRAS mutations in 1.06%. No mutations were found in other tested genes. A slightly higher mutation rate was noted in females (54.16%) compared to males (45.84%). The study reveals a distinct mutation profile in Moroccan NSCLC patients, with a notable prevalence of EGFR mutations, albeit lower than in some Asian populations. The significance of EGFR mutations in treatment response aligns with global findings, highlighting the importance of understanding regional molecular variations for personalized therapy. Despite limitations in sample size and clinical data, this study sheds light on the genetic landscape of NSCLC in Morocco. The observed mutation rates, particularly in EGFR, underscore the potential for targeted therapies in Moroccan NSCLC patients, emphasizing the need for further research to refine treatment strategies tailored to this population.
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