Reflection on blood transfusion in a patient with RhC/E gene deletion / 中华检验医学杂志

The patient′s ABO blood type and Rh antigen phenotype were identified by monoclonal antibody serum test tube agglutination, and Rh antigen deletion was confirmed by gene sequencing.The ABO blood type and Rh antigen phenotype of the patient were identified using monoclonal antibody serum in vitro agglutination assay, and Rh antigen deletion was confirmed using gene sequencing. The Rh typing saline method showed that the patient was positive for anti D, but negative for anti E, -C, -c, and -e. The saline method for antibody screening showed negative results for cells I to III, positive results for polyamine and anti human globulin tests, positive results for antibody identification cells 1 to 16, and negative results for themselves. Direct anti globulin tests showed negative results. The sequencing results of RhC/E gene showed that exons 9-10 were normal, while exons 1-8 were missing. The patient had a deletion of exons 1-8 of the RhC/E gene, resulting in a loss of Rh antigen E/e and C/c expression. After the first random matching transfusion, the patient produced antibodies targeting E/e and C/c, resulting in an incompatibility between the main and side matching during the second infusion of red blood cell products and the inability to transfuse. In order to solve this situation, first we need to establish a rare blood group bank for Rh C/E gene deletion. Secondly, during the first blood transfusion, a small amount of RH antigen red blood cells should be injected. Stored autologous blood transfusion should also be considered.

Myasthenia gravis with Holmes-Adie syndrome:a case report / 中华神经科杂志

Holmes-Adie syndrome (HAS) is a clinical syndrome mainly characterized by tonic pupil and disappearance of tendon reflex. It is mostly idiopathic and can also be seen in cerebral diseases, such as trauma, infection and tumors. However, it is rarely reported to be accompanied with myasthenia gravis (MG). We report a case of MG and HAS, whose clinical manifestations were fluctuation of limb weakness, breathing difficulties, right ptosis. Her pupils were unequal: the left pupil was 3 mm, the right pupil was 2 mm, direct and indirect light reflex was slow in left pupil, and right pupil was sensitive to light reflex. The left eye pupil shrank to 2 mm after dripped pilocarpine diluent for 10 minutes, while the right pupil was still 2 mm. Chest CT examination revealed thymoma. After treatment with thymectomy, glucocorticoid, immunoglobulins and tacrolimus, her symptoms of MG were improved, but the left pupil diameter and light reflex were not changed. Combined with the patient's symptoms, physical signs and examinations, this patient was diagnosed as MG accompanied with HAS.

Correlation of blood concentration with efficacy and safety of tacrolimus in treatment of myasthenia gravis patients / 中华全科医师杂志

Objective To investigate the relationship of blood concentration of tacrolimus with efficacy and safety in treatment of patients with myasthenia gravis.Methods The clinical data of 74 patients with myasthenia gravis admitted in our hospital from January 2013 to December 2015 were analyzed retrospectively.The blood concentrations of tacrolimus were determined by chemiluminescence microparticle immunoassay.Treatment effects were evaluated with clinical relative scoring in China.Results There were 41 men and 33 women in 74 patients with the mean age of (56.7 ± 15.8) years.According to the Osserman classification,there were 7 cases of type Ⅰ,18 cases of type Ⅱ b,27 cases of type Ⅱ a,5 cases of type Ⅲ and 17 cases of type Ⅳ.Forty seven patients underwent thymectomy,including 9 cases of thymoma and 38 cases of hyperplasia.Patients were followed up for (28.1 ± 14.5)days,and the effective rate was 74 ％ (55/74).There was no significant correlation between tacrolimus blood concentration and clinical efficacy.The incidence of adverse reaction of tacrolimus was 22％ (16/74),and the incidence of adverse reactions increased with the increase of blood concentration.Conclusion Tacrolimus is effective in treatment of myasthenia gravis.The correlation of blood concentration of tacrolimus with the clinical efficacy needs to be further studied,but certainly,the monitoring of blood concentration can reduce the incidence of adverse reactions.

Clinical differences between early-and late-onset myasthenia / 中华老年医学杂志

Objective To explore the clinical differences between patients with early-onset myasthenia gravis (EOMG)and those with late-onset myasthenia gravis(LOMG).Methods This was a retrospective study enrolling 157 MG patients.Based on the age of onset,patients were divided into the EOMG group(n=85)and the LOMG group(n =72).The groups were compared on clinical characteristics,including clinical manifestations,MG classification,electrophysiological findings on repetitive nerve stimulation(RNS),single fiber electromyography(SFEMG),levels of antibody against acetylcholine receptors(Ach-R Ab),antibody to muscle-specific kinase(MuSK Ab),titin antibody(Titin Ab),ryanodine receptor antibody(RyR Ab),thyroid function,thymectomy,thymus pathology and responses to treatment.Results The mean ages of onset were markedly different [(40.9 ± 9.7) years vs.(62.0 ± 12.2) years,P＜ 0.05] between the EOMG and LOMG groups.The LOMG group was associated with a significantly higher rate of the ocular form(50.0 ％,n=36 vs.32.9％,n=28,P＜0.05),a lower rate of the general form(50.0％,n=36 vs.67.1％,n=57,P＜0.05),and an increased risk of bulbar involvement(41.7％ n=30 vs.23.5％,n=20,P＜0.05)than those in the EOMG group.There was no significant difference in positive rates of RNAS and SFEMG,and levels of AChR Ab,MuSK Ab and double serum negative(DSN)MG between the groups (P＞0.05).Moreover,patients in the EOMG group were more likely to have abnormal thyroid function and higher percentages of receiving steroids,tacrolimus,plasma exchange therapy,and thymectomy (P＜ 0.05).Conclusions The clinical profiles of LOMG are different from those of EOMG in clinical manifestations,thyroid function,thymectomy frequency,striational antibody levels and disease-modifying drug options.

Myeloid and erythroid hematopoietic transcription factor expression decline after knockdown ofgenes in zebrafish embryos / 浙江大学学报·医学版

To investigate the effect ofgene down-regulation on early hematopoietic development of zebrafish.Phosphorodiamidate morpholino oligomer (PMO) technology was used to downregulategene expression in Zebrafish. Zebrafish embryos injected phosphorodiamidate morpholino antisense oligonucleotide ofgene mRNA by microinjection at unicellular stage were taken as the experimental group, and those injected meaningless phosphorodiamidate morpholino antisense oligonucleotide were taken as the control. The embryos were collected at 18, 24, 30 and 36 hpf after the fertilization. The real-time fluorescent quantitative PCR (RT-PCR) and whole embryohybridization methods were used to detect the expression of myeloid hematopoietic transcription factorand erythroid hematopoietic transcription factorin zebrafish.RT-PCR showed that the expressions ofanddecreased in the experimental group compared with the control group (all<0.05). Whole embryohybridization showed that the blue-black positive hybridization signals ofandin experimental group were shallow than those in the control group.Myeloid hematopoietic and erythroid hematopoietic of zebrafish are blocked with the downregulation ofgene.

Cerebral amyloid angiopathy-associated intracerebral hemorrhage in the very elderly : clinical manifestations, diagnosis and treatment / 中华老年医学杂志

Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.

Detections of interleukin-2,-4,-10 and interferon-? secreting cells in myasthenic thymus and peripheral blood / 中华神经科杂志

Objective To study the immune function of the subpopulation of T helper lymphocyte(Th), including Th1 and Th2 cells in myasthenic thymus and peripheral blood (PB).Methods Enzyme-linked immunospot (ELISPOT) method is adopted to detect the acetylcholine receptor (AChR)-reactive interleukin-2(IL-2)-, interleukin-4 (IL-4)-, interleukin-10 (IL-10)-, interferon-gamma(IFN-?)-secreting cell numbers in thymus and peripheral blood (PB). Results The AChR-reactive IL-2-,IL-4-,IL-10-, IFN-?-secreting cell numbers were increased in thymus as well as the AChR-reactive IL-10-, IFN-?-secreting cell numbers in PB. There is a positive correlation between thymus and PB in MG for the AChR-reactive IL-4-, IL-10-secreting cell numbers. After treatment, the AChR-reactive IL-2-,IL-4-, IFN-?-secreting cell numbers were decreased in PB, while there were 1 case and 2 cases showing a decrease and an increase in AChR-reactive IL-10-secreting cell number, respectively.Conclusions The immune dysfunction of the Th1 and Th2 subpopulation existed in the thymus and PB of MG, and the AChR-reactive IL-4-, IL-10-secreting cell numbers might be served as parameters to evaluate the degree of the immune dysfunction in the MG thymus. The role of the IL-10 in pathogenesis of MG needs further study.