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    06 October 2014, Volume 29 Issue 10 Previous Issue    Next Issue

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    Pathologic features in inflammatory myopathy.
    CHANG Xing-zhi.
    2014, 29(10): 721-723.  DOI: 10.7504/ek2014100601
    Abstract ( )   PDF (965KB) ( )  

    Abstract: Myopathology can be used to accurately specify the diagnosis and the classification of the inflammatory myopathy. In general,pathological changes of inflammatory myopathy are muscle fibre necrosis,regeneration,and focal invasion by inflammatory cells.The distinctive pathological features of most common idiopathic autoimmune inflammatory myopathies are:(1)dermatomyositis,perifascicular atrophy with CD4+ lymphocyte around the perimysial blood vessels.(2)Polymyositis,endomysial lymphocyte infiltration,CD8+ lymphocyte invasion of non-necrotic fibres with MCH-I expression.(3)Immune-mediated necrotizing myopathies, prominent necrotic fibres, with sparse or slightly myophagocytosis.(4)Sporadic inclusion body myositis,endomysial mononuclear inflammatory infiltration with invasion of non-necrotic muscle fibres, rimmed vacuoles,ultrastructural tabulofilaments of 16~21 nm.

    Diagnostic strategies of hereditary neuromuscular diseases common in children.
    HAN Chun-xi.
    2014, 29(10): 724-729.  DOI: 10.7504/ek2014100602
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    Abstract:Hereditary neuromuscular disease is a group of diseases clinically manifested as motor function disorders and hereditary myopathies;peripheral neuropathies,motor neuropathies as well as neuromuscular junction diseases are mainly included.With the rapid development of genetic testing technology,genes related to hereditary neuromuscular diseases and novel mutations are continued to discover, providing a reliable basis for genetic diagnosis,genetic counseling and prenatal diagnosis.Taking medical history in detail and doing physical examination completely as well as laboratory examinations,such as serum chemical analysis,muscle imaging studies,neuroelectrophysiology studies and muscle biopsy,provide important clues to detecting the virulence genes.

    Management of juvenile myasthenia gravis.
    LI Wen- hui,ZHOU Shui-zhen.
    2014, 29(10): 733-737.  DOI: 10.7504/ek2014100604
    Abstract ( )   PDF (986KB) ( )  

    Abstract:Juvenile myasthenia gravis is not rare in china. Diagnosis in children can be complicated by the compliance of diagnostic tests and limited positive findings of auxiliary examination. We need to pay more attention to the differential diagnosis.The treatment of juvenile myasthenia gravis is not standardized, including the option of treatment and the therapy of recurrence of myasthenia gravis. There is a small subset of patients, however, with treatment-refractory myasthenia gravis. The management of myasthenia should be undertaken.

    Primary carnitine deficiency and cardiomyopathy.
    MA Yan-yan, YANG Yan-ling.
    2014, 29(10): 738-741.  DOI: 10.7504/ek2014100605
    Abstract ( )   PDF (972KB) ( )  

    Abstracts: L-carnitine is an essential vitamin for the transfer of long-chain fatty acids from the cytosol into mitochondria for β-oxidation. Carnitine deficiency results in impaired energy production from long-chain fatty acids, especially during periods of fasting or stress. Primary carnitine deficiency due to defective carnitine transporter OCTN2 caused by SLC22A5 gene mutations is an autosomal recessive disorder of mitochondrial β-oxidation. It is a rare but treatable disease of metabolic myopathies. The onset could occur in the patients with primary carnitine deficiency at any ages under a broad clinical spectrum. In infancy, metabolic decompositions occurred triggered by fasting or common illnesses such as upper respiratory tract infection or gastroenteritis. Hypoketotic hypoglycemia, metabolic acidosis, hyperammonemia and hyperuricemia were common findings. Some patients may be combined with cardiac arrhythmia, heart failure, fatty liver and brain damage. From children to adults, progressive or acute cardiomyopathy and skeletal myopathy have been reported worldwide. Early recognition of the disease and treatment with L-carnitine supplementation are keys to life-saving.

    Diagnosis and treatment of creatine deficiency syndrome.
    FANG Fang,YANG Lei.
    2014, 29(10): 742-745.  DOI: 10.7504/ek2014100606
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    Abstracts:Creatine deficiency syndrome(CDS)is a group of congenital deficiency diseases,which affects creatine synthesis and transport. Clinical manifestations include:dyskinesia intellectual deficit,language retardation,autism spectrum disorders,seizures,hypotonia,extrapyramidal motor disorder and behavior problems.Early diagnosis and treatment has greatly improved the prognosis of CDS.To investigate the clinical features of CDS,would help to improve the cognition of clinical.

    A case of hypertrophic cardiomyopathy due to Danon disease and a novel mutation on LAMP2 gene.
    DING Yuan*,LI Xi-yuan,LIU Yu-peng,SONG Jin-qing,ZHANG Yao,WANG Qiao,WU Tong-fei,LI Meng-qiu,QIN Ya-ping,YANG Yan-ling.
    2014, 29(10): 746-749.  DOI: 10.7504/ek2014100607
    Abstract ( )   PDF (1041KB) ( )  

    Abstracts: Objectives To investigate the clinical features and LAMP2 gene mutation a case with hypertrophic cardiomyopathy due to Danon disease. Methods A boy (proband) of hypertrophic cardiomyopathy due to Danon disease was hospitalized in the Department of Pediatrics of Peking University First Hospital on October, 2013. He was the first child of non-consanguineous Chinese couples. Gene analysis was performed by direct sequencing. Results The patient had not any symptoms with normal intelligence and physical development. Elevated serum alanine aminotransferase had been noticed in a medical examination for entry to kindergarten. His serum alanine aminotransferase, glutamic-oxaloacetic transaminase, creatine phosphokinase, creatine kinase-MB, lactate dehydrogenase, and hydroxybutyrate dehydrogenase were elevated. Electrocardiograph showed left ventricular high voltage, prolonged Q-T interval. Ultrasonic cardiogram showed ventricular septum and left ventricular wall thickening, left ventricular enlargement, increased trabecular of left ventricular apex, and mitral inadequacy, supporting the diagnosis of hypertrophic cardiomyopathy. A homozygous mutation, c.973-974insC (p.L325fs) was detected on LAMP2 gene of the patient. His mother had unexplained hypertrophic cardiomyopathy. She carries a heterozygous mutation c.973-974insC. His father is healthy without any mutation on LAMP2. c.973-974insC was a novel mutation, leading to frameshift mutation and a premature termination codon. Conclusions Danon disease is a rare fatal genetic cardiomyopathy without effective treatment. In this study, a Chinese boy and his mother with Danon disease were firstly diagnosed by gene analysis. LAMP2 gene study is important for the diagnosis of Danon disease and genetic counseling of the family.

    Variable clinical phenotypes of severe combined immunodeficiency caused by RAG1 mutations.
    HE Jian-xin*,WANG Quan,ZHU Guang-hua,ZHAO Yu-hong,XIAO Jing,LIU Xiu-yun,XU Bao-ping,SHEN Kun-ling,JIANG Zai-fang.
    2014, 29(10): 750-753.  DOI: 10.7504/ek2014100608
    Abstract ( )  

    Abstract: Objective To investigate the different clinical and immune features of variable phenotypes of severe combined immunodeficiency caused by RAG 1 mutations.Methods From 2012.9 to 2013.04, three patients were included in the study,and records of clinical details were reviewed. Results The phenotypes of three patients were typical SCID for patient 1,Omenn syndrome for patient 2 and atypical SCID complicated with recurrent autoimmune hemolytic anemia for patients 3,respectively.RAG 1 mutations were compound heterozygous allele 1:1870 C>T/Arg624Cys,allele 2:2005 G>A/Glu669Lys(allele 1 was published mutation,allele 2 was de novel mutation) for patient 1;compound heterozygous allele 1:994 C>T/Arg332X,allele 2:1439 G>A/Ser480Asn(both mutations were de novel mutations)for patient 2;homozygous 2095 C>T/R699W for patient 3 and was published mutation. First two patients died soon after discharge.Patient 3 was treated for recurrent autoimmune hemolytic anemia in our ward.Conclusion RAG1 mutations can lead to variable SCID phenotypes.Patients with typical SCID and Omenn syndrome were with poor prognosis,which need transplantation treatment.

    Expression of relaxin in blood and renal tissue of children with Henoch-Schonlein purpura and its significance.
    LIU Xiao-qing,YANG Wen-ping,FU Rui,LIU Hong,HAN Dou-xing.
    2014, 29(10): 754-757.  DOI: 10.7504/ek2014100609
    Abstract ( )  

    Abstracts: Objective To investigate the expression of RLX in blood and renal tissue of patients with HSP, and its correlation with clinical indexes and pathological changes, and explore its effect on the pathogenesis of HSP. Methods Collect 39 cases of Henoch-Schonlein purpura (HSP) from Department of Nephrology in Children’s Hospital of Jiangxi province from November 2011 to June 2012, with complete follow-up data. According to the clinical urine manifestation, 39 patients with HSP were divided into non-kidney damage group (n=20) and kidney damage group (n=19). All 39 patients were collected blood samples in the acute and convalescent phase. Nineteen patients from kidney damage group were divided into mild lesions (n=5), moderate lesions (n=9)and severe lesions (n=5), according to the degree of pathological changes. RLX concentration was detected with enzyme-labeled immunosorbent assay (ELISA) method.RLX protein expression in renal tissue was detected with immunohistochemistry method. Results In the acute phase, the serum level of RLX in HSP was significantly higher than normal control, and its concentration was significantly higher in kidney damage group than in non-kidney damage group (P<0.05). Compared with acute phase, the serum level of RLX in HSP in the convalescent phase was significantly lower, and the level of decline was slower in kidney damage group than in non-kidney damage (P<0.05). Weak expression of RLX in renal tissue was found in normal control,while the expression of RLX in renal tissue significantly increased in HSPN (P<0.05), with the pathological changes of renal tissue aggravating. The expression of RLX in renal tissue in HSPN was significantly correlated with the serum concentration of RLX (P<0.05) and the total urine protein for 24 hours (P<0.05). Conclusion There is a modest up-regulation in serum and renal RLX protein expression in HSP, and the severity of the disease is closely related with RLX expression, which suggests that RLX may be involved in the pathogenesis of HSP/HSPN, and it may be an important mechanism that upregulation of RLX may play a defensive role in delaying disease progression of HSP/HSPN.

    Analyses of clinical features and misdiagnoses for 28 cases of pediatric narcolepsy.
    WANG Xin-hua,ZHOU Shui-zhen,ZHOU Yuan-feng.
    2014, 29(10): 758-762.  DOI: 10.7504/ek2014100610
    Abstract ( )  

    Abstract: Objective To analyze the clinical characteristics and EEC features of narcolepsy. Methods The clinical data of 28 narcoleptic children were analyzed.Video-EEG monitoring and multiple sleep latency test were performed in all patients. Results All the patients manifested with excessive daytime sleepiness ,with disrupted nocturnal sleep.Cataplexy appeared in 19 cases,and hypnagogic hallucination in 2,hypnopompic hallucination in 1,and sleep paralysis in 1,respectively.EEG and VEEG of all patients were normal. The multiple sleep latency test demonstrated a short sleep latency (<5 minutes) and two or more sleep onset REM periods (SOREMPs) in all patients.Four patients were misdiagnosed with myasthenia gravis. Six children were misdiagnosed with epilepsy. One patient was misdiagnosed with schizophrenia. Fourteen mild patients were followed up at the neurological out-patient department. One case of sleepiness,cataplexy and sleep hallucination was given just behavior guidance because the parents refused to receive drug treatment. Thirteen children with severe sleepiness was treated with methylphenidate along with behavior guidance. Conclusion Narcolepsy in children is not rare in clinics. For some young children, it is likely to be misdiagnosed because of its mild symptoms at onset and atypical clinical manifestations. The patients should be closely followed up for the changes of clinical symptoms. Misdiagnosis can be reduced by means of VEEG and MSLT.

    Study of the relationship between the lamotrigine plasma concentration and oral dosage,co-medication and patients age.
    LI Dan,HUANG Shao-ping.
    2014, 29(10): 763-765.  DOI: 10.7504/ek2014100611
    Abstract ( )  

    Abstract:Objective To study the effectiveness of the antiepileptic lamotrigine (LTG) and the relationship between the plasma concentration and oral dosage, co-medication and patients age. Methods Totally 111 epileptic patients were divided into 2 groups: LTG monotherapy group (n=58) and LTG+VPA (Valproate,VPA) group (n=53). LTG+VPA group was divided into three subunits in terms of plasma concentration of VPA. LTG monotherapy group was divided into two subunits: older (7~18 y, n=40) and younger (3~<7 y, n=18) group. The dosage was then increased to target dose gradually. Blood specimens were collected more than one month after LTG target dose or when effective maintenance dosage was achieved. The serum concentrations of LTG and VPA were determined by high performance liquid chromatography. Results The effect of the LTG was 82.9%.VPA combination enhanced LTG blood concentration. The ratio of serum level and dose of LTG did not vary with the range of the serum concentration of VPA 0.28~0.62mol/L.In younger group the relativity between blood concentration of LTG and LTG maintaining dose didn’t exist. However, there was a positive correlation in the older group. Conclusions When we prescribe LTG,we should consider epilepsy type, co-medication and individual difference as a whole.Therefore TDM(therapeutic drug monitoring,TDM)is an essential tool to control seizure and avoid side effects.

    The clinical and neuro-electrophysiological study of transient epileptic seizures in children.
    ZHUANG Jia-xin,WANG Shuang,GUAN Qiao,YANG Zhi-xian,LIU Xiao-yan.
    2014, 29(10): 766-771.  DOI: 10.7504/ek2014100612
    Abstract ( )  

    Abstract:Objective To study the clinical and neuro-electrophysiological features of transient epileptic seizures by using polygraphic channel VEEG—EMG monitoring. Methods The information of 51 epilepsy children with rapid falling,nodding or limb shaking in video electroencephalogram was collected in the Department of Pediatric Neurology, Peking University First Hospital from June 2012 to March 2013.The clinical features,EEG and EMG patterns were analyzed retrospectively. Results Totally 745 seizures were found in 51 patients. The seizures included 391 epileptic spasms(52.5%),138 myoclonic seizures(18.5%),117 atonic seizures(15.7%),61 negative myoclonus(8.2%),27 tonic seizures(3.6%)and 11 myoclonic atonic seizures(1.5%).Different clinical manifestations were with different clinical-EEG-EMG patterns.According to the duration of EMG changes,patients were divided into EMG-burst group and EMG-static group. Conclusions Epileptic seizures with rapid falling, nodding or limb shaking are most affected by epileptic spasms,myoclonic seizures,atonic seizures,negative myoclonus,tonic seizures and myoclonic atonic seizures.Their common feature is rapid and transient,which makes them difficult to be diagnosed only by illness history.But by performing VEEG-EMG,we can accurately identify the types of seizures,which will be helpful in the diagnosis and treatment.

    Analysis of bone marrow scintigraphy in childhood aplastic anemia.
    ZHAO Yan-xia*,SONG Ai-qin,WANG Ling-zhen, LI Xue-rong,SUN Li-rong,MA Chao.
    2014, 29(10): 772-775.  DOI: 10.7504/ek2014100613
    Abstract ( )  

    Abstract: Objective To investigate the characteristics of 99mTcmsulfur collid bone marrow scintigraphy in childhood aplastic anemia (AA) and its clinical significance.Methods A total of 45 children were newly diagnosed with AA,including 19 cases of serious aplastic anemia (SAA) and 26 cases of chronic aplastic anemia (CAA).Bone marrow scintigraphy using 99mTcmsulfur collid 10~15 MBq/kg was performed in 45 patients and 15 controls.The difference of bone marrow scintigraphy was analysed. The relationship between laboratory indices and clinical response was investigated. Results According to the bone marrow imaging results,grade 2 of marrow activities was defined as normal. Totally 33 patients(33/45,73.3%) had abnormal marrow activities,and in 15 controls only 3(3/15,20%).Most AA patients showed 99mTcmsulfur collid uptake decrease. CAA patients had higher marrow activities than SAA patients (P<0.05).In the 33 patients who had abnromal marrow activities(less then 2 grade),SAA and CAA patients showed different 99mTcmsulfur collid uptake in the peripheral and the center of bone marrow,and CAA had focals whose uptake was increasing.After treatment of 6 months,45 AA patients were investigated the relationship between the grade of marrow activities and the therapeutic effect(including improved,inefficacy,death).There showed significantly difference(P<0.05) between them. Conclusion The 99mTcmsulfur collid bone marrow imaging is helpful to the diagnosis and prognosis of AA,but further study is needed to judge its relationship with the curative effect and prognosis.

    Clinical research of infantile-onset autoimmune myasthenia gravis.
    ZHANG Wei-hua,FANG Fang,WU Hu-sheng,Lü Jun-lan,DING Chang-hong,XIAO Jing,CHEN Chun-hong,WANG Xu,JIN Hong,HAN Tong-li,WANG Xiao-hui,WU Yun,LI Jiu-wei,WANG Hong-mei,YANG Xin-ying,LIU Li-ying.
    2014, 29(10): 776-780.  DOI: 10.7504/ek2014100614
    Abstract ( )  

    Abstracts: Objective To summarize the clinical characteristics of infantile-onset autoimmune myasthenia gravis and improve diagnostic skills. Methods The investigation summarized retrospectively the features including clinical manifestation, laboratory examination and the prognosis of infantile-onset autoimmune myasthenia gravis from June 2006 to February 2012 in 16 patients in Neurology Department of Beijing Children’s Hospital affiliated to Capital University of Medicine,and analysed the difference of the clinical classification and myasthenia crisis incidence between infatile group and the more than 1 year group during the corresponding period. Results Sixteen cases were revolved, including 9 boys and 7 girls. The youngest was 4 months old, the average age was 7.6 months. The average course of disease was 1.8 months at first visiting. Main symptoms included ptosis, poor spirit and dysphagia.Among them 4 cases were misdiagnosed as central nervous system infection and 1 as digestive system disease . Ocular and generalized type was respectively 4(25%) and 12(75%) cases; 4 (25%) cases underwent myasthenia crisis. Generalized myasthenia gravis component ratio and myasthenia crisis incidence rate of infantile-onset autoimmune myasthenia gravis was increasing significantly. Positive rate of Neostigmine test, acetylcholine receptor antibody and repetitive nerve stimulation was respectively 93.7%,57% and 50%,and no significance was found between ocular and generalized type. All 16 cases received pyridostigmine bromide therapy; 15 cases received glucocorticoids therapy. Mean improvement time was(6.8±5.6) days after glucocorticoids therapy,but 1 of them deteriorate 6 days later;10 chlidren was follwed-up for 1 year and 1 month to 5 years and 3 months,3 cases were with completely stable remission(CSR),1 case pharmacologic remission(PR),4 cases were minimal manifestation(MM),1 case was improved(I) and 1 case was unchanged(U). Conclusion Infantile-onset autoimmune myasthenia gravis ,mainly manifested as generalized type,cam be easily misdiagnosed because of atypical onset-symptoms, and incidence rate of myasthenia crisis is high.