ABSTRACT
Objective To analyze the clinical characteristics and screen pathogens and prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis in children and so as to improve the diagnosis and treatment of anti-NMDAR encephalitis in children.Methods A retrospective and follow-up analysis of 38 cases of pediatric anti-NMDAR encephalitis was performed,who were admitted to the West China Second University Hospital,Sichuan University from May 2012 to June 2016,and their clinical features,associated pathogen screening,treatment and progno-sis were reviewed.Results Those 38 cases included 14 males and 24 females.The age ranged from 1 year and 10 months to 17 years and 6 months.The most common symptoms were psychiatric symptoms(33 cases),and dyskinesias and movement disorders(33 cases),speech disturbances(31 cases).Twenty-four cases(63.2%)received positive pathogenic screening and only one case had right ovarian mature cystic teratoma.Among them,11 cases had positive mycoplasma pneumonia immunoglobulin M(IgM)antibodies,10 cases had positive virus screening,and 1 case had toxoplasma gondii IgM antibodies positive,and 2 cases had mix infection.Symptoms of one case were relieved after anti-toxoplasma treatment without immunosuppression treatment,and another case had partial symptom relief after mycoplas-ma pneumonia treatment.Thirty-seven cases received immunosuppressant therapy(4 cases were treated with glucocor-ticoid,12 cases were treated with glucocorticoid combined with immune globulin,2 cases were treated with glucocorti-coid combined with plasma exchange,still 19 cases were treated with glucocorticoid combined with immune globulin and plasma exchange).After follow-up for median 12 months,3 cases relapsed,29 cases were fully recovered,5 cases had mild language impairment,2 cases had mild memory impairment,and 2 cases had involuntary movement.Conclusions The most common symptoms of the patients were psychiatric symptoms,dyskinesias and movement disorders,and speech disturbances.Children with anti-NMDAR encephalitis had a low incidence of tumors,while various pathogen infections including mycoplasma pneumonia,virus and toxoplasma gondii,which may trigger abnormal immune response of anti-NMDAR encephalitis.Pathogen screening needs to be done for pediatric anti-NMDAR encephalitis and anti-patho-genic treatment may be helpful for disease remission.
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Objective To investigate clinical characteristics and treatment of acute myelitis in children. Methods Clinical data and prognosis of two cases of pediatric acute myelitis with positive serum monosialoganglioside (GM1) antibodies were analyzed, and related literatures were reviewed. Results Two cases had clinical symptoms and MRI change of myelitis with positive serum GM1-IgM antibody and thyroid antibody. Two cases had positive serum Helicobacter pylori IgG antibody and one case has positive Mycoplasma pneumoniae IgM antibody.After treated with high doses of glucocorticoid and gamma-globulin, two cases were discharged as symptoms improved. After discharged, treatment with oral prednisone and rehabilitation were continued. One case recovered completely while another could stand alone by supporting after 3 months follow-up. Conclusion Immunologic injury played an important role in pathogenesis of acute pediatric myelitis with serum positive GM1 antibodies, which had better treatment outcome and prognosis. This type of myelitis may have intestinal Helicobacter pylori infection.
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Objective To explore the effect on immunologic function of gastric carcinoma patients after operation by transposition of a transverse colon segment as a gastric reservoir following total gastrectomy.Methods A prospective,randomized,double-blind clinical trial was performed.One hundred and sixty-seven gastric carcinoma patients were divided into control group and research group in terms of balanced random groups.We reconstructed digestive tract with conventional Schlatter esophagojejunostomy and Roux-enY esophagojejunostomy in control group,while we reconstructed digestive tract with transposition of a transverse colon segment as a gastric reservoir in rcsearch group.the changes of T cell subset,IL-2,immunologic function of red blood cell,acute inflammatory mediator were analyzed in the patients respectively at the first day before operation,at the first day after operation,at the ninth day after operation.Postoperative fatality rate was also detected in two groups.Results Compared with control group,The changes of T cell subset,IL-2 had no significant differences in research group at the first day after operation (P ＞ 0.05).chaplet Meanwhile,the changes of C3b receptor chaplet rate and immunocomplex receptor rate had no significant differences in rcscarch group compared with control group at the first day after operation (P ＞ 0.05).There were no obvious differences for acute inflammatory mediators between two groups at the first day after operation (P＞0.05).At the ninth day after operation,the levels of CD4+ (44.68 ±5.92)％ in control group were obviously lower than those (48.75 ± 6.24)％ in research group (P ＜ 0.05).However,the percentage of CD8 + T cells (27.21 ± 3.07) ％ in control group was significantly higher than that (24.26 ±2.39) ％ in research group (P ＜ 0.05).The levels of IL-2 in control group and research group were (1.49 ± 0.32) μg/L and (1.67 ± 0.35) μg/L,with obvious differences between two groups (P ＜ 0.05).At the ninth day after operation,C3b receptor chaplet rate (39.27 ± 6.88) ％ in research group was markedly higher than that (30.25 ± 6.65) ％ in control group (P ＜ 0.05).The levels of IL-6 in control group were (125.51 ± 18.24) pg/mL,while the levels of IL-6 in research group were(87.34 ± 12.88) pg/mL,with obvious differences (P ＜ 0.05).There was no significant difference for postoperative fatality rate between two groups (P ＞ 0.05).Conclusions The transposition of a transverse colon segment as a gastric reservoir is a safely new mode in the reconstruction of alimentary.It is positive to improve immunologic function for gastric carcinoma patients after operation.