hypothalamus

下丘脑
  • 文章类型: Journal Article
    哮喘患者的精神疾病发生率升高。然而,这种肺脑串扰背后的分子联系仍然不明确。在许多精神疾病中观察到下丘脑功能障碍,特别是那些由于许多下丘脑区域未受到血脑屏障保护而具有炎症成分的患者。为了更好地了解这种神经精神后遗症,这项研究调查了小鼠肺部炎症(哮喘)诱导后下丘脑的基因表达差异,使用RNA转录组分析。BALB/c小鼠用细菌脂多糖(LPS,大肠杆菌)或卵清蛋白(OVA)过敏原或盐水对照(每组n=7),肺部炎症通过死后肺组织的组织学检查得到证实。下丘脑的大部分是显微解剖的,提取总RNA进行测序。差异表达分析确定了与对照组相比,暴露于LPS后表达发生改变的31个具有统计学意义的单基因(错误发现率FDR5%);然而,OVA治疗后无明显变化,表明下丘脑有较温和的反应.当检查基因集时,相对于对照组,两个哮喘组48个上调,8个下调。REACTOME富集分析表明这些基因集参与信号转导代谢,免疫反应和神经可塑性。有趣的是,我们发现了5个与神经递质信号直接相关的基因改变.有趣的是,许多这些改变的基因集可以影响人类的心理健康和/或神经炎症。这些发现有助于表征哮喘诱导的肺部炎症与大脑之间的联系,并可能有助于确定相关途径和治疗目标,以便将来进行干预。
    Patients with asthma experience elevated rates of mental illness. However, the molecular links underlying such lung-brain crosstalk remain ambiguous. Hypothalamic dysfunction is observed in many psychiatric disorders, particularly those with an inflammatory component due to many hypothalamic regions being unprotected by the blood-brain barrier. To gain a better insight into such neuropsychiatric sequelae, this study investigated gene expression differences in the hypothalamus following lung inflammation (asthma) induction in mice, using RNA transcriptome profiling. BALB/c mice were challenged with either bacterial lipopolysaccharide (LPS, E. coli) or ovalbumin (OVA) allergens or saline control (n = 7 per group), and lung inflammation was confirmed via histological examination of postmortem lung tissue. The majority of the hypothalamus was micro-dissected, and total RNA was extracted for sequencing. Differential expression analysis identified 31 statistically significant single genes (false discovery rate FDR5%) altered in expression following LPS exposure compared to controls; however, none were significantly changed following OVA treatment, suggesting a milder hypothalamic response. When gene sets were examined, 48 were upregulated and 8 were downregulated in both asthma groups relative to controls. REACTOME enrichment analysis suggests these gene sets are involved in signal transduction metabolism, immune response and neuroplasticity. Interestingly, we identified five altered gene sets directly associated with neurotransmitter signaling. Intriguingly, many of these altered gene sets can influence mental health and or/neuroinflammation in humans. These findings help characterize the links between asthma-induced lung inflammation and the brain and may assist in identifying relevant pathways and therapeutic targets for future intervention.
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  • 文章类型: Journal Article
    能量稳态的破坏会导致肥胖和糖尿病等疾病,每年影响数百万人。绒球,下丘脑中的成体干细胞,在辅助下丘脑神经元维持能量平衡中起着至关重要的作用。尽管已经在啮齿动物中广泛研究了tanycytes,我们对人类单核细胞的了解仍然有限。在这项研究中,我们利用单细胞转录组学数据来探索人类胚胎单核细胞的异质性,调查他们的基因调控网络,分析它们的细胞间通讯,检查他们的发展轨迹。我们的分析揭示了在我们的数据集中存在两个簇的βtanycyes和三个簇的αtanycyes。令人惊讶的是,在标记基因表达和转录因子活性方面,人胚胎tanycytes与小鼠tanycytes表现出显著的相似性。轨迹分析表明,首先产生α胶质细胞,沿着第三脑室的背腹侧方向产生β腺细胞。此外,我们的CellChat分析表明,与后来产生的细胞相比,沿着发育谱系较早产生的tanycytes表现出增加的细胞间通讯。总之,我们已经从不同的角度彻底地描述了人类胚胎腺体细胞的异质性。我们相信,我们的研究结果将为未来人类单核细胞的研究奠定基础。
    Disruptions in energy homeostasis can lead to diseases like obesity and diabetes, affecting millions of people each year. Tanycytes, the adult stem cells in the hypothalamus, play crucial roles in assisting hypothalamic neurons in maintaining energy balance. Although tanycytes have been extensively studied in rodents, our understanding of human tanycytes remains limited. In this study, we utilized single-cell transcriptomics data to explore the heterogeneity of human embryonic tanycytes, investigate their gene regulatory networks, analyze their intercellular communication, and examine their developmental trajectory. Our analysis revealed the presence of two clusters of β tanycytes and three clusters of α tanycytes in our dataset. Surprisingly, human embryonic tanycytes displayed significant similarities to mouse tanycytes in terms of marker gene expression and transcription factor activities. Trajectory analysis indicated that α tanycytes were the first to be generated, giving rise to β tanycytes in a dorsal-ventral direction along the third ventricle. Furthermore, our CellChat analyses demonstrated that tanycytes generated earlier along the developmental lineages exhibited increased intercellular communication compared to those generated later. In summary, we have thoroughly characterized the heterogeneity of human embryonic tanycytes from various angles. We are confident that our findings will serve as a foundation for future research on human tanycytes.
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  • 文章类型: Journal Article
    目的:我们旨在表征下丘脑受累于髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD),并将其与视神经脊髓炎谱系障碍(NMOSD)和多发性硬化(MS)进行比较。
    方法:进行了一项回顾性研究,以确定诊断为MOGAD的患者的下丘脑病变,NMOSD,或MS从2013年1月到2020年5月。人口统计,临床,并记录了放射学特征。通过体格检查评估下丘脑功能障碍和预后。生化检测,睡眠监测,和磁共振成像。
    结果:在96例MOGAD患者中有7例(7.3%)观察到下丘脑病变,536人中的34人(6.3%)使用NMOSD,356人中有16人(4.5%)患有MS(p=0.407)。MOGAD从发病到下丘脑病变发展的时间最短(12个月)。MOGAD中,双侧下丘脑病变的频率最低(p=0.008)。MOGAD患者下丘脑功能障碍发生率为28.6%,低于NMOSD(70.6%),但高于MS患者(18.8%;分别为p=0.095和p=0.349)。MOGAD的下丘脑功能障碍表现为下丘脑-垂体-肾上腺轴功能障碍和睡眠过度。MOGAD患者下丘脑病变完全消退的比例(100%)远高于NMOSD(41.7%)和MS患者(18.2%;分别为p=0.007和p=0.001)。免疫治疗后,所有MOGAD患者下丘脑功能障碍均得到改善。
    结论:MOGAD患者无症状下丘脑病变的发生率相对较高。MOGAD患者下丘脑受累的总体预后良好,当病变完全消退时,免疫疗法后功能障碍改善。
    OBJECTIVE: We aimed to characterize hypothalamic involvement in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and compare it with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS).
    METHODS: A retrospective study was performed to identify hypothalamic lesions in patients diagnosed with MOGAD, NMOSD, or MS from January 2013 to May 2020. The demographic, clinical, and radiological features were recorded. Hypothalamic dysfunction and prognosis were assessed through physical examination, biochemical testing, sleep monitoring, and magnetic resonance imaging.
    RESULTS: Hypothalamic lesions were observed in seven of 96 patients (7.3%) with MOGAD, 34 of 536 (6.3%) with NMOSD, and 16 of 356 (4.5%) with MS (p = 0.407). The time from disease onset to development of hypothalamic lesions was shortest in MOGAD (12 months). The frequency of bilateral hypothalamic lesions was the lowest in MOGAD (p = 0.008). The rate of hypothalamic dysfunction in MOGAD was 28.6%, which was lower than that in NMOSD (70.6%) but greater than that in MS patients (18.8%; p = 0.095 and p = 0.349, respectively). Hypothalamic dysfunction in MOGAD manifests as hypothalamic-pituitary-adrenal axis dysfunction and hypersomnia. The proportion of complete regression of hypothalamic lesions in MOGAD (100%) was much greater than that in NMOSD (41.7%) and MS patients (18.2%; p = 0.007 and p = 0.001, respectively). An improvement in hypothalamic dysfunction was observed in all MOGAD patients after immunotherapy.
    CONCLUSIONS: MOGAD patients have a relatively high incidence of asymptomatic hypothalamic lesions. The overall prognosis of patients with hypothalamic involvement is good in MOGAD, as the lesions completely resolve, and dysfunction improves after immunotherapy.
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  • 文章类型: Journal Article
    简介甲状腺激素对人体具有系统性作用,并在几乎所有组织的发育和功能中起关键作用。它们通过下丘脑-垂体-甲状腺(HPT)轴调节,并具有可遗传成分。利用遗传信息,我们应用了组织特异性全转录组关联研究(TWAS)和血浆全蛋白质组关联研究(PWAS)来阐明与促甲状腺激素(TSH)和游离甲状腺素(FT4)水平相关的基因产物.结果TWAS鉴定出297和113个与TSH和FT4水平相关的转录本,分别(25个共享),包括这些性状的全基因组关联研究(GWAS)未鉴定的转录本,展示了这种方法的强大力量。遗传共定位检测揭示了158个TSH转录本和45个FT4转录本的共同遗传基础,包括独立的,CAPZB基因座内的FT4相关遗传信号与不同组织中的CAPZB表达差异相关。PWAS鉴定出18种和10种分别与TSH和FT4相关的蛋白质(HEXIM1和QSOX2两者)。其中,5个TSH-和7个FT4相关蛋白的同源基因定位在重要的GWAS基因座之外。观察到5种血浆蛋白各自与TSH和FT4的共定位。在TWAS和PWAS中均存在10个TSH和1个FT4相关基因。其中,ANXA5表达和血浆膜联蛋白A5水平与TSH呈负相关(PWAS:p=1.18×10-13,TWAS:p=7.61×10-12[全血],p=6.40×10-13[下丘脑],p=1.57×10-15[垂体],p=4.27×10-15[甲状腺]),由共同定位支持。结论我们的分析揭示了新的甲状腺功能相关基因和已知GWAS位点的优先候选基因。有助于更好地理解与甲状腺功能相关的转录调控和蛋白质水平。
    UNASSIGNED: Thyroid hormones have systemic effects on the human body and play a key role in the development and function of virtually all tissues. They are regulated via the hypothalamic-pituitary-thyroid (HPT) axis and have a heritable component. Using genetic information, we applied tissue-specific transcriptome-wide association studies (TWAS) and plasma proteome-wide association studies (PWAS) to elucidate gene products related to thyrotropin (TSH) and free thyroxine (FT4) levels.
    UNASSIGNED: TWAS identified 297 and 113 transcripts associated with TSH and FT4 levels, respectively (25 shared), including transcripts not identified by genome-wide association studies (GWAS) of these traits, demonstrating the increased power of this approach. Testing for genetic colocalization revealed a shared genetic basis of 158 transcripts with TSH and 45 transcripts with FT4, including independent, FT4-associated genetic signals within the CAPZB locus that were differentially associated with CAPZB expression in different tissues. PWAS identified 18 and ten proteins associated with TSH and FT4, respectively (HEXIM1 and QSOX2 with both). Among these, the cognate genes of five TSH- and 7 FT4-associated proteins mapped outside significant GWAS loci. Colocalization was observed for five plasma proteins each with TSH and FT4. There were ten TSH and one FT4-related gene(s) significant in both TWAS and PWAS. Of these, ANXA5 expression and plasma annexin A5 levels were inversely associated with TSH (PWAS: P = 1.18 × 10-13, TWAS: P = 7.61 × 10-12 (whole blood), P = 6.40 × 10-13 (hypothalamus), P = 1.57 × 10-15 (pituitary), P = 4.27 × 10-15 (thyroid)), supported by colocalizations.
    UNASSIGNED: Our analyses revealed new thyroid function-associated genes and prioritized candidates in known GWAS loci, contributing to a better understanding of transcriptional regulation and protein levels relevant to thyroid function.
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  • 文章类型: Journal Article
    下丘脑是能量稳态的关键调节因子,在功能上与纹状体和皮质区域相连,对抑制食欲至关重要。因此,这种非侵入性调节下丘脑网络的能力可以为代谢性疾病的治疗开辟新的途径.这里,我们测试了一种新的网络靶向经颅直流电刺激(net-tDCS)方法,以影响与食欲控制有关的脑区的兴奋性.根据下丘脑的静息状态功能连接图,生成了12通道net-tDCS协议(神经电系统Starstim),其中包括阳极,阴极和假刺激。十名超重或肥胖的参与者参加了一项假对照,交叉研究。在刺激或假控制期间,参与者完成了测量抑制控制的停止信号任务.总的来说,刺激耐受性良好。与假手术(p=0.039)和阴极网tDCS(p=0.042)相比,阳极网tDCS导致更快的停止信号反应时间(SSRT)。与假刺激相比,阳极后目标网络的基线功能连通性与SSRT相关(p=0.016)。这些初步数据表明,通过net-tDCS调节下丘脑功能网络连接可能会改善抑制性控制。进一步的研究需要评估对饮食行为和新陈代谢的影响。
    The hypothalamus is the key regulator for energy homeostasis and is functionally connected to striatal and cortical regions vital for the inhibitory control of appetite. Hence, the ability to non-invasively modulate the hypothalamus network could open new ways for the treatment of metabolic diseases. Here, we tested a novel method for network-targeted transcranial direct current stimulation (net-tDCS) to influence the excitability of brain regions involved in the control of appetite. Based on the resting-state functional connectivity map of the hypothalamus, a 12-channel net-tDCS protocol was generated (Neuroelectrics Starstim system), which included anodal, cathodal and sham stimulation. Ten participants with overweight or obesity were enrolled in a sham-controlled, crossover study. During stimulation or sham control, participants completed a stop-signal task to measure inhibitory control. Overall, stimulation was well tolerated. Anodal net-tDCS resulted in faster stop signal reaction time (SSRT) compared to sham (p = 0.039) and cathodal net-tDCS (p = 0.042). Baseline functional connectivity of the target network correlated with SSRT after anodal compared to sham stimulation (p = 0.016). These preliminary data indicate that modulating hypothalamus functional network connectivity via net-tDCS may result in improved inhibitory control. Further studies need to evaluate the effects on eating behavior and metabolism.
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  • 文章类型: Journal Article
    本研究旨在探讨胆囊收缩素(CCK)介导CCKAR和CCKBR的分子机制,以及CCK介导的胰岛素信号通路的分子机制,调节颗粒细胞中的雌激素。此外,CCK在卵巢中的表达,子宫,在双峰驼中研究了下丘脑和垂体。卵巢,子宫,下丘脑和垂体是从六个收集的,排卵前三个(对照)和排卵后三个,宰杀的双峰驼。排卵组在屠宰前通过IM注射精浆诱导排卵。结果表明,CCK在排卵前后各组织中的转录水平和蛋白水平存在差异(p<.05,p<.01)。用p-IRES2-EGFP-CCK转染后,CCK的mRNA和蛋白质水平,CCKAR,卵泡颗粒细胞中的CCKBR和ER显著上调(p<.05,p<.01),E2的含量显著上调(p<0.01);相反,用si-CCK转染后,CCK的mRNA和蛋白质水平,CCKAR,滤泡颗粒细胞中的CCKBR和ER显著下调(p<.05,p<.01),E2含量显著下调(p<0.01)。调节CCK可以影响INS的mRNA水平,INSR,IGF和IGF-R总之,调节CCK的表达水平可以通过CCKR激活胰岛素相关的信号通路,从而调节颗粒细胞的类固醇生成活性。
    The current study aimed to explore the molecular mechanism by which the cholecystokinin (CCK)-mediated CCKAR and CCKBR, as well as the molecular mechanisms of CCK-mediated insulin signalling pathway, regulate oestrogen in the granulosa cells. Also, the expression of CCK in ovaries, uterus, hypothalamus and pituitary gland was investigated in Camelus bactrianus. Ovaries, uterus, hypothalamus and pituitary gland were collected from six, three before ovulation (control) and three after ovulation, slaughtered Camelus bactrianus. Ovulation was induced by IM injection of seminal plasma before slaughtering in the ovulated group. The results showed that there were differences in the transcription and protein levels of CCK in various tissues before and after ovulation (p < .05, p < .01). After transfection with p-IRES2-EGFP-CCK, the mRNA and protein levels of CCK, CCKAR, CCKBR and ER in follicular granulosa cells were significantly upregulated (p < .05, p < .01), and the content of E2 was significantly upregulated (p < .01); On the contrary, after transfection with si-CCK, the mRNA and protein levels of CCK, CCKAR, CCKBR and ER in follicular granulosa cells were significantly downregulated (p < .05, p < .01), and the content of E2 was significantly downregulated (p < .01). Regulating CCK can affect the mRNA levels of INS, INSR, IGF and IGF-R. In summary, regulating the expression level of CCK can activate insulin-related signalling pathways by CCKR, thereby regulating the steroidogenic activity of granulosa cells.
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  • 文章类型: Journal Article
    目的:研究下丘脑萎缩及其与多系统萎缩(MSA)的临床相关性。
    背景:MSA的特征是自主神经功能障碍和帕金森病/小脑表现。下丘脑调节自主神经和体内平衡功能,也参与记忆和学习过程。
    方法:11MSA,本研究包括18名帕金森病(PD)和18名健康对照(HC)。将经过验证和自动化的下丘脑分割工具应用于在3TMRI扫描仪上获取的3D-T1加权图像。将MSA下丘脑体积与PD和HC的体积进行比较。此外,下丘脑体积和自主神经评分之间的关联,抑郁,研究了睡眠和认知表现。
    结果:与对照组(t=2.105,p=0.041)和PD(t=2.055,p=0.046)相比,MSA下丘脑后体积减少。与对照组相比,下丘脑整体显示出MSA降低的趋势(t=1.676,p=0.101)。下丘脑后体积减少与帕金森病(MSA+PD)组和每组的MoCA评分较差相关,但不是自主神经,睡眠,或抑郁得分。
    结论:MSA可能存在体内下丘脑结构受累。下丘脑后体积减少,包括乳头体和下丘脑外侧,与更差的认知功能有关。需要对下丘脑参与MSA及其临床相关性进行更大规模的研究。
    OBJECTIVE: To investigate hypothalamic atrophy and its clinical correlates in multiple system atrophy (MSA) in-vivo.
    BACKGROUND: MSA is characterized by autonomic dysfunction and parkinsonian/cerebellar manifestations. The hypothalamus regulates autonomic and homeostatic functions and is also involved in memory and learning processes.
    METHODS: 11 MSA, 18 Parkinson\'s Disease (PD) and 18 Healthy Controls (HC) were included in this study. A validated and automated hypothalamic segmentation tool was applied to 3D-T1-weighted images acquired on a 3T MRI scanner. MSA hypothalamic volumes were compared to those of PD and HC. Furthermore, the association between hypothalamic volumes and scores of autonomic, depressive, sleep and cognitive manifestations were investigated.
    RESULTS: Posterior hypothalamus volume was reduced in MSA compared to controls (t = 2.105, p = 0.041) and PD (t = 2.055, p = 0.046). Total hypothalamus showed a trend towards a reduction in MSA vs controls (t = 1.676, p = 0.101). Reduced posterior hypothalamus volume correlated with worse MoCA scores in the parkinsonian (MSA + PD) group and in each group separately, but not with autonomic, sleep, or depression scores.
    CONCLUSIONS: In-vivo structural hypothalamic involvement may be present in MSA. Reduced posterior hypothalamus volume, which includes the mammillary bodies and lateral hypothalamus, is associated with worse cognitive functioning. Larger studies on hypothalamic involvement in MSA and its clinical correlates are needed.
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  • 文章类型: Journal Article
    下丘脑是整合神经内分泌系统和全身代谢的大脑区域。据报道,患有阿尔茨海默病(AD)的患者表现出下丘脑的病理变化,如神经原纤维缠结(NFT)和淀粉样蛋白斑(AP)。然而,很少有研究调查下丘脑AD病理是否与临床因素相关。我们使用从日本社区已故居民那里获得的尸检脑样本,调查了下丘脑中与AD相关的病理变化与临床图片之间的关联。共对85份尸检的脑样本进行AD病理半定量分析,包括NFT和AP。我们的组织病理学研究表明,下丘脑的几个核,如结节乳核(TBM)和下丘脑外侧区(LHA),容易受到AD病理的影响。在各种神经病理学状态下观察到NFT,包括正常的认知情况,而AP主要在AD中观察到。关于下丘脑AD病理与临床因素之间的关系,TBM和LHA中AP的程度与活着时的较低体重指数相关,在调整了死亡时的性别和年龄后。然而,我们发现下丘脑AD病理与高血压患病率之间没有显著关联,糖尿病,或血脂异常。我们的研究表明,较低的BMI,这是AD的不良预后因素,可能与下丘脑AP病理有关,并强调了有关AD中脑-全身轴破坏的新见解。
    The hypothalamus is the region of the brain that integrates the neuroendocrine system and whole-body metabolism. Patients with Alzheimer\'s disease (AD) have been reported to exhibit pathological changes in the hypothalamus, such as neurofibrillary tangles (NFTs) and amyloid plaques (APs). However, few studies have investigated whether hypothalamic AD pathology is associated with clinical factors. We investigated the association between AD-related pathological changes in the hypothalamus and clinical pictures using autopsied brain samples obtained from deceased residents of a Japanese community. A total of 85 autopsied brain samples were semi-quantitatively analyzed for AD pathology, including NFTs and APs. Our histopathological studies showed that several hypothalamic nuclei, such as the tuberomammillary nucleus (TBM) and lateral hypothalamic area (LHA), are vulnerable to AD pathologies. NFTs are observed in various neuropathological states, including normal cognitive cases, whereas APs are predominantly observed in AD. Regarding the association between hypothalamic AD pathologies and clinical factors, the degree of APs in the TBM and LHA was associated with a lower body mass index while alive, after adjusting for sex and age at death. However, we found no significant association between hypothalamic AD pathology and the prevalence of hypertension, diabetes, or dyslipidemia. Our study showed that a lower BMI, which is a poor prognostic factor of AD, might be associated with hypothalamic AP pathology and highlighted new insights regarding the disruption of the brain-whole body axis in AD.
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  • 文章类型: Journal Article
    神经活性类固醇发挥的神经调节和神经保护作用的一个重要方面是它们具有性别特异性,取决于血浆和神经组织中这些分子的性别二态水平。因此,从神经保护剂的角度来看,确定产生神经活性类固醇性别二态水平的因素可能是至关重要的.哺乳动物性别决定的主要驱动因素是SRY基因和随后存在的特定性腺:男性的睾丸和女性的卵巢,从而产生荷尔蒙化合物,主要是雄激素和雌激素,分别。如今,众所周知,尽管性腺具有相关性,其他因素控制性特征,and,其中,性染色体补体是高度相关的。在这项研究中,神经活性类固醇在下丘脑通过液相色谱-串联质谱法进行评估,四种核心基因型小鼠模型的海马和血浆,确定性染色体补体和性腺在确定其性别二态水平中的相对贡献。获得的数据表明,尽管性腺是神经活性类固醇水平性别差异的主要因素,一些神经活性类固醇的水平,包括睾丸激素,在大脑和血浆中也受到性染色体的组织特异性作用的影响。这里提供的数据为类固醇水平调节的难题增加了一个新的部分,这可能有助于设计针对影响神经系统的病理状况的性别特异性神经保护方法。
    An important aspect of the neuromodulatory and neuroprotective actions exerted by neuroactive steroids is that they are sex-specific, as determined by the sexually dimorphic levels of these molecules in plasma and the nervous tissue. Thus, the identification of the factors that generate the sex-dimorphic levels of neuroactive steroids may be crucial from a neuroprotectant perspective. The main driver for sex determination in mammals is the SRY gene and the subsequent presence of a specific gonad: testes for males and ovaries for females, thus producing hormonal compounds, primarily androgens and estrogens, respectively. Nowadays, it is well established that despite the relevance of gonads, other factors control sexual features, and, among them, sex chromosome complement is highly relevant. In this study, neuroactive steroids were evaluated by liquid chromatography-tandem mass spectrometry in the hypothalamus, the hippocampus, and plasma of the four core genotype mouse model, to determine the relative contribution of sex chromosome complement and gonads in determining their sex dimorphic levels. The data obtained reveal that although gonads are the main contributing factor for sex differences in neuroactive steroid levels, the levels of some neuroactive steroids, including testosterone, are also influenced in brain and plasma by tissue-specific actions of sex chromosomes. The data presented here adds a new piece to the puzzle of steroid level regulation, which may be useful in designing sex-specific neuroprotective approaches to pathological conditions affecting the nervous system.
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  • 文章类型: Journal Article
    背景:颅咽管瘤的结局与其局部扩展有关,影响可切除性和手术并发症的风险。为了最大限度地切除和减少并发症,视神经束定位,颞叶伸展和下丘脑受累对手术治疗至关重要.
    目的:根据颅咽管瘤与下丘脑位置的关系来评估颅咽管瘤的预后。
    方法:我们对2007年至2022年接受手术的79例颅咽管瘤患者进行了回顾性分析。颅咽管瘤分为三组,根据术前MRI评估的下丘脑受累类型:下丘脑下(A型,n=33);下丘脑穿孔(B型,n=40);下丘脑上(C型,n=6)。手术策略以下丘脑受累的类型为指导,有利于A型和B型的鼻内途径,和经颅方法治疗C型。
    结果:在33/33(100%)中实现了长期疾病控制,37/40(92%)和5/6(83%)的A型患者,分别为B和C。在B型中,32/36(89%)患者的视力得到改善,下丘脑功能得到改善,在6/40(15%)稳定或恶化,32/40(80%)和2/40(5%)患者。乳头状颅咽管瘤见于5/33(15%),A型9/40(22%)和3/6(50%)患者,分别为B和C。在四名患者中,使用BRAF/MEK抑制剂,在所有病例中都有明显的肿瘤缩小。
    结论:位于下丘脑以下或穿孔的颅咽管瘤可以通过经蝶窦手术安全治疗。对于下丘脑上颅咽管瘤,术后效果较差,记录BRAF突变可能会改善结果,如果靶向治疗足够有效,可以取代手术切除。
    BACKGROUND: Outcome of craniopharyngioma is related to its locoregional extension, which impacts resectability and the risk of surgical complications. To maximize resection and minimize complications, optic tract localization, temporal lobe extension, and hypothalamic involvement are essential factors for surgical management.
    OBJECTIVE: To assess the outcome of craniopharyngiomas depending on their relation to the hypothalamus location.
    METHODS: We conducted a retrospective analysis of 79 patients with a craniopharyngioma who underwent surgery from 2007 to 2022. Craniopharyngiomas were classified in 3 groups, depending on the type of hypothalamus involvement assessed by preoperative magnetic resonance imaging: infra-hypothalamic (type A, n = 33); perforating the hypothalamus (type B, n = 40); and supra-hypothalamic (type C, n = 6). Surgical strategy was guided by the type of hypothalamic involvement, favoring endonasal approaches for type A and type B, and transcranial approaches for type C.
    RESULTS: Long-term disease control was achieved in 33/33 (100%), 37/40 (92%), and 5/6 (83%) patients in type A, B, and C, respectively. In type B, vision was improved in 32/36 (89%) patients, while hypothalamic function was improved, stable, or worsened in 6/40 (15%), 32/40 (80%), and 2/40 (5%) patients, respectively. Papillary craniopharyngiomas were found in 5/33 (15%), 9/40 (22%), and 3/6 (50%) patients in types A, B, and C, respectively. In 4 patients, BRAF/MEK inhibitors were used, with significant tumor shrinkage in all cases.
    CONCLUSIONS: Craniopharyngiomas located below the hypothalamus or perforating it can be safely treated by transsphenoidal surgery. For supra-hypothalamic craniopharyngiomas, postoperative results are less favorable, and documenting a BRAF mutation may improve outcome, if targeted therapy was efficient enough to replace surgical debulking.
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