Rare mutation in MKRN3 in two twin sisters with central precocious puberty: Two case reports.

BACKGROUND: Caused by premature activation of the hypothalamic-pituitary-gonadal axis, there is increasing incidence of central precocious puberty (CPP), especially in girls. Makorin ring finger protein 3 (MKRN3), a maternal imprinted gene with a highly conserved sequence, is the most common genetic etiology associated with CPP. Approximately 50 different mutations in MKRN3 have been found in CPP. CASE SUMMARY: This case report involves identical twin sisters presenting with premature thelarche at the age of 6 years. The left hand bone age of both patients revealed advanced age (9 years). Pelvic B ultrasound indicated enlargement of the ovaries. Luteinizing hormone (LH) releasing hormone testing confirmed CPP. Whole-exome sequencing detected the c.841C>T mutation in MKRN3, leading to a single base substitution, in the twins. This mutation was inherited from the father and paternal grandmother. After 3 mo of treatment with a gonadotropin-releasing hormone analog, levels of LH, follicle-stimulating hormone, and estradiol in the proband's sister returned to normal levels. CONCLUSION: Here, we report a rare mutation (c.841C>T) in MKRN3 in identical twin sisters with CPP.

New mutation in EPCAM for congenital tufting enteropathy: A case report.

BACKGROUND: Congenital tufting enteropathy (CTE) is a rare cause of diarrhea in children. However, it can result in early-onset of chronic diarrhea and failure to thrive. Children with this disease have to depend on total parenteral nutrition (TPN), and eventually small intestine transplantation. The epithelial cell adhesion molecule (EPCAM) gene was identified to be associated with CTE. Here, we present a case of an infant with CTE due to a mutation not reported in the literature before. CASE SUMMARY: A 1-year and 7-mo infant boy exhibited intractable watery diarrhea and mushy stool within 1 wk after birth, for which he had required medical treatment and hospitalization several times. His sister presented similar symptoms and died at the age of two. On admission, his body weight was 5700 g (-4.8SDS) and measured 66 cm (-5.4SDS) in height. Meanwhile, he cannot speak or climb. He exhibited mild anemia, hypocalcemia, hypomagnesemia, and an infection in the upper respiratory tract. Microvilli sparse and vacuolar degeneration of epithelial cells were reported by small intestine biopsy. Whole-exome sequencing showed a novel homozygous splice mutation (c.657+1[IVS6] G>A) in the EPCAM gene. He was treated with TPN and recombinant human growth hormone. After 2 mo, his body weight was up to 8500 g and he has been waiting for small bowel transplantation. CONCLUSION: CTE is rare but fatal. Patients with CTE require rapid diagnosis and therapy to improve their survival.

Evaluation of IVIG response in relation to Th1/Th2 cytokines in pediatricm immune thrombocytopenia.

Immune thrombocytopenia (ITP) is a common immune-mediated bleeding disorder in children, and intravenous immunoglobulin (IVIG) is widely used as the initial therapy of ITP. Effective predictive factors of response to IVIG in ITP are important for guiding the treatment decisions. A retrospective study was performed on 197 Chinese ITP patients, and the data of their serum interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) levels, age at onset, duration of disease, white blood cell count (WBC), platelet count, and gender ratio were collected. Our results showed that ITP patients had higher IL-2, IL-6, IL-10, and IFN-γ levels than healthy children. Moreover, lower IL-4 level (<3.5 pg/ml), higher WBC (>6.37*109/L), and higher platelet count (>12 * 109/L) at diagnosis were favorable predictive factors for IVIG response in the newly diagnosed ITP. In addition, ITP patients with lower IL-10 level (<3.7 pg/ml) and older onset age (>2.84 years) were more resistant to therapy and developed to chronic ITP more easily. These findings may help guide the treatment decisions making for ITP patients.

Cardiac electrophysiological and antiarrhythmic effects of N-n-butyl haloperidol iodide.

AIMS: N-n-butyl haloperidol (F(2)), a novel compound of quaternary ammonium salt derivatives of haloperidol, was reported to antagonize myocardial ischemia/reperfusion injuries. The antiarrhythmic potential and electrophysiological effects of F(2) on rat cardiac tissues were investigated. METHODS AND RESULTS: In Langendorff-perfused rat hearts, the ventricular arrhythmias were induced by left anterior descending coronary artery of rat heart ligated for 20 min before the release of the ligature. F(2) provided some inhibitive effects against ischemia- and reperfusion-induced ventricular arrhythmias. In His bundle electrogram and epicardial ECG recordings, the drug produced bradycardia, delayed the conduction through the atrioventricular node and prolonged the Wenckebach cycle length and atrioventricular nodal effective refractory period. In whole-cell patch-clamp study, F(2) primarily inhibited the L-type Ca2+ current (I(Ca,L)) (IC(50) = 0.17 microM) with tonic blocking properties and little use-dependence. And the drug also decreased the Na+ current (IC(50) = 77.5 microM), the transient outward K+ current (IC(50) = 20.4 microM), the steady-state outward K+ current (IC(50) = 56.2 microM) and the inward rectifier K+ current (IC(50) = 127.3 microM). CONCLUSION: F(2) may be a promising drug for the treatment of ischemic heart disease with cardiac arrhythmia.

Egr-1, a central and unifying role in cardioprotection from ischemia-reperfusion injury?

AIMS: Our previous studies have shown that N-n-butyl haloperidol iodide (F(2)) can antagonize myocardial ischemia/reperfusion (I/R) injury by blocking intracellular Ca(2+) overload and suppressing Egr-1 overexpression. The present study is to investigate the relation between the reduction of Ca(2+) overload and the inhibition of Egr-1 overexpression. METHODS: The Sprague-Dawley rat myocardial I/R model and cultured cardiomyocyte hypoxia-reoxygenation (H/R) model were established. Administration of Egr-1 antisense oligodeoxyribonucleotide (AS-ODN) only or combining with F(2), Egr-1 protein expression was examined by Western-blot analyses. Hemodynamic parameters, creatine kinase (CK) and lactate dehydrogenase (LDH), superoxide dismutase (SOD) and malondialdehyde (MDA), myeloperoxidase (MPO), cardiac troponin I (cTnI), and tumor necrosis factor-alpha (TNF-alpha) were measured to assess the degree of injury and inflammation of myocardial tissues and cells. RESULTS: Treatment with Egr-1 AS-ODN significantly reduced Egr-1 protein expression and attenuated injury and inflammation of myocardium caused by I/R or H/R evidenced by the amelioration of hemodynamics, the decrease in leakage of CK, LDH, cTnI, the increase in MDA generation, the decrease in SOD activity, the reduction of MPO activity in myocardial tissues and release of TNF-alpha from cultured cardiomyocytes. Treatment with F(2) combined with Egr-1 AS-ODN, the inhibition of Egr-1 protein expression and inflammation (MPO activity and TNF-alpha level) were not enhanced, but the protection from myocardial I/R (or H/R) injury was significantly increased in hemodynamics and cytomembrane permeability relative to the using of Egr-1 AS-ODN only. CONCLUSION: These data suggest that the inhibition of Egr-1 overexpression cannot involve all mechanisms of cardioprotection from I/R injury.

Reformative cannula electrodes for His bundle electrogram recording in isolated rat hearts.

His bundle electrogram (HBE) recording is an important method for the study of the atrioventricular conduction system. However, the current HBE recording methods in isolated animal hearts have some disadvantages, such as unstable recording due to the difficulty in fixing electrodes as a result of intense heart beat, the small amplitude of the His signal or the possibility to destroy the integrity of heart structure. To overcome these disadvantages, we designed and manufactured reliable, inexpensive and easy-made bipolar cannula electrodes, which combine the functions of Langendorff-perfusion aortic cannula and recording electrodes. With the cannula electrodes, the operation of HBE recording becomes easier and clearer; hence, more stable recordings can be obtained in isolated rat hearts.