Death in children with influenza A (H3N2) virus infection-associated encephalopathy: two case reports.

We herein report two cases involving children who died of influenza A (H3N2) virus infection-associated encephalopathy/encephalitis (IAE). Both children developed convulsions and impaired consciousness within a relatively short period and eventually died of brainstem failure. Patient 1 presented with high fever, vomiting, and diarrhea. Laboratory tests indicated persistently high lactate, alanine aminotransferase, and urea nitrogen concentrations in the blood as well as a high protein concentration in the cerebrospinal fluid. Patient 2 presented with persistent hyperthermia and progressive disturbance of consciousness, but the cerebrospinal fluid remained normal during the disease course. Both patients were actively given oseltamivir antiviral treatment after diagnosis of influenza virus infection. However, the disease progressed and invasive mechanical ventilation was performed. Both children's condition quickly progressed to IAE, and they eventually died. IAE is a rare complication of influenza virus infection with high mortality, and its pathogenesis remains unclear. The purpose of this report is to draw attention to the serious central nervous system complications of influenza infection and raise awareness of the fatal consequences of this disease among pediatricians.

Platelet endothelial aggregation receptor-1 (PEAR1) is involved in C2C12 myoblast differentiation.

C2C12 murine myoblasts are a common model for studying muscle differentiation. Platelet endothelial aggregation receptor-1 (PEAR1), an epidermal growth factor repeat-containing transmembrane receptor, is known to participate in platelet contact-induced activation. In the present study, we demonstrated that PEAR1 is involved in the differentiation of C2C12 murine myoblasts. Western blotting and immunofluorescence staining were used to determine PEAR1 expression and localization during C2C12 cell differentiation. Subsequently, PEAR1 expression was activated and inhibited using clustered regularly interspaced short palindromic repeats-dCas9 technology to explore its effects on this process. PEAR1 expression was found to increase over the course of C2C12 cell differentiation. This protein was predominately localized on the membrane of these cells, where it clustered upon induction of differentiation. Expression of the myogenic markers Desmin, MYOG, and MYH2 revealed that PEAR1 positively regulated C2C12 cell differentiation. Moreover, induction of muscle injury by administration of bupivacaine to mice indicated that PEAR1 might play a role in muscle regeneration. In summary, our study confirmed the involvement of PEAR1 in C2C12 cell differentiation, contributing to our understanding of the molecular mechanisms underlying muscle development.

A meta-analysis of the association between angiotensin-converting enzyme insertion/deletion gene polymorphism and steroid-sensitive nephrotic syndrome in children.

BACKGROUND AND OBJECTIVE: Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism correlates with circulating and cellular ACE concentration. Association between ACE I/D gene polymorphism and steroid-sensitive nephrotic syndrome (SSNS) risk in children is still controversial. This meta-analysis was performed to evaluate the relation between ACE I/D gene polymorphism and SSNS susceptibility in children. METHODS: The relevant investigations were screened from the search engines of PubMed, Cochrane Library and CBM-disc (China Biological Medicine Database) as of 1 March 2011, and eligible studies were synthesized using meta-analysis methods. RESULTS: Ten studies were identified for the analysis of association between ACE I/D gene polymorphism and SSNS risk in children, including seven in Asians, one for Caucasians and two in Africans. There was no markedly positive association between D allele or DD genotype and SSNS susceptibility in Asians, Caucasians and Africans (D: Asians OR = 1.24, p = 0.28; Caucasians OR = 1.61, p = 0.15; Africans OR = 1.61, p = 0.53; DD: Asians OR = 1.72, p = 0.15; Caucasians OR = 1.39, p = 0.48; Africans OR = 1.80, p = 0.56). Furthermore, II homozygous seemed not to play a protective role against SSNS onset for Asians, Caucasians and Africans (Asians OR = 0.95, p = 0.85; Caucasians OR = 0.30, p = 0.11; Africans OR = 0.60, p = 0.65). CONCLUSIONS: There was no association between ACE I/D gene polymorphism and SSNS susceptibility in Asians, Caucasians and Africans. However, the conclusions for Caucasians and Africans were less powerful.

Association of angiotensin converting enzyme insertion/deletion gene polymorphism with idiopathic nephrotic syndrome susceptibility in children: a meta-analysis.

BACKGROUND AND OBJECTIVE: Angiotensin converting enzyme (ACE) gene contains either an insertion (I) allele or a deletion (D) allele forming three potential genotypes: II, ID and DD. The D allele or DD genotype has been reported to be associated with higher plasma ACE level. An assessment of the association between ACE I/D gene polymorphism and idiopathic nephrotic syndrome (INS) susceptibility in children is still controversial. This meta-analysis was performed to evaluate the association between ACE I/D gene polymorphism and the onset of INS. METHOD: A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases, and eligible investigations were synthesized using the meta-analysis method. RESULTS: Nine investigations were identified for the analysis of association between ACE I/D gene polymorphism and INS risk in children, including six in Asians, one study for Caucasians and two for Africans. There was positive association between D allele or DD genotype and INS susceptibility in Asians (OR = 1.75, p = 0.01; OR = 2.01, p = 0.02), but not for Caucasian children and Africans (for Caucasians, D: OR=1.35, p = 0.27, DD: OR = 0.95, p = 0.91; for Africans, D: OR = 1.70, p = 0.56, DD: OR = 1.60, p = 0.73). Furthermore, II homozygous seemed to play a positive role against INS onset for Asians (OR = 0.59, p = 0.02), but the link between II genotype and INS risk was not observed in Caucasian children and Africans (Caucasians: OR = 0.31, p = 0.06; Africans: OR = 0.50, p = 0.59). CONCLUSIONS: D allele and DD homozygous might become significant genetic molecular markers for INS susceptibility in Asian children, but the association was not observed in Caucasians or Africans. However, the conclusion from our study cannot be sustained and more investigations on larger sample in different populations are required to further clarify the role of D allele or DD homozygous in the onset of INS in difference races.

Insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme gene in steroid-resistant nephrotic syndrome for children: a genetic association study and meta-analysis.

An assessment of the association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with steroid-resistant nephrotic syndrome (SRNS) risk in children is still controversial. A meta-analysis was performed to evaluate the relation between ACE gene polymorphisms and SRNS susceptibility. The relevant studies were screened from electronic database and eligible investigations were synthesized using meta-analysis methods. Seven investigations were identified for the analysis of association between ACE I/D gene polymorphism and SRNS risk in children, including five in Asians, one in Caucasians, and one in Africans. There was not a markedly positive association between D allele or DD genotype and SRNS susceptibility in Asians (OR = 1.60, p = 0.26; OR = 1.90, p = 0.38) and for Caucasian population (OR = 0.92, p = 0.86; OR = 0.27, p = 0.22). However, an association of D allele with SRNS susceptibility was observed (OR = 4.67, p = 0.003) in Africans, but not for DD genotype (OR = 6.00, p = 0.05). Interestingly, II genotype seemed to play a positive role against SRNS onset for Asians and African children (OR = 0.51, p = 0.02; OR = 0.07, p = 0.02), but not for Caucasians (OR = 0.33, p = 0.30). In conclusion, our results indicate that D allele or DD homozygous might not be a significant genetic molecular marker for the development of SRNS in Asians and Caucasian children. However, D allele seemed be associated with SRNS risk for Africans but DD genotype did not.

The association between angiotensin-converting enzyme insertion/deletion gene variant and risk of focal segmental glomerulosclerosis: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism with the risk of focal segmental glomerulosclerosis (FSGS) is still controversial. A meta-analysis was performed to evaluate the association between ACE I/D gene polymorphism and FSGS susceptibility. METHOD: We performed a predefined literature search and selection of eligible relevant studies to collect data from electronic databases. RESULTS: In total, 12 articles were identified for the analysis of the association between ACE I/D gene polymorphism and FSGS risk. One report included an investigation in Arab and Jewish populations separately. Thus, there were seven reports in Asians, two in Caucasians, one in Africans, two in Arabs and one in Jews. In Asians, there was a markedly positive association between the D allele or DD genotype and FSGS susceptibility (p = 0.008; p = 0.002), and the II genotype may play a protective role against FSGS onset (p = 0.002). However, a link between ACE I/D gene polymorphism and FSGS risk was not found in Caucasians, Africans, Arabs or Jews (Caucasians: D: p = 0.11, DD: p = 0.19, II: p = 0.70; Africans: D: p = 0.40, DD: p = 0.49, II: p = 0.61; Arabs: D: p = 0.34, DD: p = 0.10, II: p = 0.42; Jews: D: p = 0.90, DD: p = 0.97, II: p = 0.83). CONCLUSION: The D allele or DD homozygosity may become a significant genetic molecular marker for the onset of FSGS in Asians, but not for Caucasians, Africans, Arabs or Jews.

[Change of voltage-gate potassium channel in pulmonary arterial smooth muscle cells of pulmonary hypertension induced by left-to-right shunt in rats].

OBJECTIVE: To investigate the electrophysiological changes of voltage-gate potassium channel (Kv) of pulmonary arterial smooth muscle cells of pulmonary arterial hypertension in rats induced by left to right shunt, and to analyze the role of Kv during the progress of pulmonary arterial hypertension. METHODS: Forty male SD rats were randomly divided into three groups, group A (control, n = 10), group B (sham operated only group, n = 10), and group C (PAH model group, n = 20). Mean pulmonary artery pressure (mPAP) and right ventricular hypertrophy index (RVHI) of each rat were measured, single pulmonary artery smooth muscle cell (PASMC) was obtained by acute enzyme separation method (collagenase I plus papain) and the conventional whole-cell patch clamp technique was used to record resting membrane potential (Em), potassium ion current of voltage-gated potassium channel, the I-V curve between each 2 groups was compared, and correlation of each parameter was analyzed. RESULT: (1) The mPAP and RVHI of group C were significantly higher than those of group A and group B (P < 0.01, respectively). (2) The Em of group C [(-33.00 ± 4.09) mV] was significantly higher than that of group A [(-48.10 ± 4.54) mV] and group B [(-51.11 ± 3.66) mV], P < 0.01. (3) The peak current at +50 mV of voltage-gated potassium channel: in group C [(64.80 ± 8.40) pA/pF], it was significantly lower than that of group A [(120.85 ± 11.66) pA/pF] and group B [(118.03 ± 10.18) pA/pF] (P < 0.01, respectively). None of the parameters showed any significant difference between group A and group B (P > 0.05 for all comparisons). (4) Compared with group A and group B, the I-V curve of group C significantly downward shifted (P < 0.01, respectively). The difference in I-V curve between group A and group B was not significant, P > 0.05. (5) The correlation of resting membrane potential and mPAP and RVHI had significantly positive correlation (P < 0.001, respectively); but the correlation of membrane current, membrane current density and mPAP, RVHI and resting membrane potential had significantly negative correlation (P < 0.001, respectively). CONCLUSION: During the formation process of left-to-right shunt induced pulmonary arterial hypertension, function of Kv channel was inhibited, suggesting that Kv channel may be the mechanism of pulmonary arterial hypertension induced by left-to-right shunting.

GATA4 mutations in Chinese patients with congenital cardiac septal defects.

The object of the study was to elucidate the mutations of the GATA4 gene in Han ancestry patients with congenital cardiac septal defects. Fifty Han ancestry patients with sporadic and familial cardiac septal defects and 200 normal subjects of the same ethnical background were studied. A total of six exons and the intron-exon boundaries of GATA4 were amplified by polymerase chain reaction (PCR). The PCR products were purified and directly sequenced with an ABI PRISM 3730 Automatic DNA sequencer. Two novel heterozygous mutations were discovered in the GATA4 gene in five children with cardiac septal defects (10%, 5/50), His28Tyr in exon 2 and His436Tyr in exon 7, respectively, which were neither found in the control population nor reported in the SNP database at the website http://www.ncbi.nlm.nih.gov/SNP. In addition, we did not identify any mutations in GATA4 in three familial atrial septal defects and two familial ventricular septal defects. Our finding suggests that the mutations in the transcription factor GATA4 might be related to congenital cardiac septal defects in Han ancestry patients.

[Association between GATA-4 mutations and congenital cardiac septal defects in Han Chinese patients].

OBJECTIVE: To elucidate the association between GATA-4 gene mutations and congenital cardiac septal defects in Han Chinese patients. METHODS: Fifty Han Chinese patients with congenital cardiac septal defects and 100 normal subjects with the same ethnical background were studied. Total six exons and the intron-exon boundaries of GATA-4 were amplified by the polymerase chain reaction. The polymerase chain reaction products were purified and directly sequenced with automatic sequencer. RESULTS: Two novel heterozygous mutations were discovered in the GATA-4 gene of patients with congenital cardiac septal defects, His28Tyr in exon 2 and His436Tyr in exon 7 respectively, which were absent in the control population and not reported in the SNP database (http://www.ncbi.nlm.nih.gov/SNP). CONCLUSION: Our finding suggests that the mutations in the transcription factor GATA-4 may be related to congenital cardiac septal defects in Han Chinese patients.

[Preliminary functional analysis of a novel mutation in GATA-4 gene in Chinese patients with congenital cardiac septal defects].

OBJECTIVE: To perform the functional analysis of a novel H436Y mutation of GATA-4 gene identified in Han Chinese patients with congenital cardiac septal defects. METHODS: Using bioinformatics to predict if the H436Y mutation in the GATA-4 gene affects its protein function. H436Y mutation in the GATA-4 gene was generated by Quick Change Lightning site-directed mutagenesis kit and verified by DNA sequencing. GATA-4-wt or GATA-4-mut DNA was cotransfected into Hela cells with DNA for the luciferase reporter gene atrial natriuretic factor (ANF), and luciferase activity was measured by an LKB luminometer 48 h after transient transfection. RESULTS: Alignment of the GATA-4 amino acid sequence indicated that the histidine residue at position 436 was conserved, and H436Y mutation in the GATA-4 gene is expected to affect its protein function. The H436Y mutation significantly reduced the transcriptional activation of downstream reporter ANF when compared to wild-type GATA-4 (P<0.01). CONCLUSION: The mutation c.1306C-->T of the GATA-4 gene impaired the activation of the downstream target, suggesting that the H436Y mutation in the C-terminal region of the GATA-4 gene might prevent its biological function.

Effect of all-trans retinoic acid on renal expressions of matrix metalloproteinase-2, matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in rats with glomerulosclerosis.

In kidney injury the accumulation of extracellular matrix (ECM) plays an important role and precedes the development of glomerulosclerosis (GS). There is great interest in agents that may interfere with such accumulation of ECM. Therefore, a rat model of GS was established to investigate the effect of all-trans retinoic acid (ATRA) on the renal expressions of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1). Eighty Wistar rats were randomly divided into four groups: sham operation group (SHO), GS model group without treatment (GS), GS model group treated with benazepril (GB) and GS model group treated with ATRA (GA), n = 20, respectively. The disease was established in the GS rats by uninephrectomy and adriamycin (5 mg/kg) injection through the tail vein. Serum creatinine (Scr), blood urea nitrogen (BUN) and urine protein (Upro) were measured. Renal abnormality was evaluated at the end of 12 weeks. Immunohistochemical analysis was performed on renal tissue to detect the expression of collagen IV (Col-IV), fibronectin (FN), MMP-2, MMP-9 and TIMP-1 protein. MMP-2 and MMP-9 activity was detected by gelatin zymography. Real-time reverse transcription polymerase chain reaction (real-time RT-PCR) was used to detect the expression of MMP-2, MMP-9, and TIMP-1 mRNA. In comparison with group GS, group GA and group GB exhibited levels of BUN and 24 h urinary protein and a glomerulosclerosis index (GSI) that were significantly reduced (P < 0.05); the level of Scr in group GA was reduced too (P < 0.05). ATRA and benazepril also significantly down-regulated Col-IV, FN expression and TIMP-1 expression (protein and mRNA) (P < 0.05). In contrast, the expressions of MMP-2, MMP-9 mRNA and protein, and activity in groups GA and GB were enhanced (P < 0.05). However, there were no significant differences in MMP-2, MMP-9 mRNA and protein expression, or activity, between the ATRA and GB groups (P > 0.05). In conclusion, ATRA may protect renal function and step down the progression of GS by reducing the expression of TIMP-1, enhancing the expression and activity of MMP-2 and MMP-9, and regulating the ratio of MMPs/TIMPs to dynamic balance, so as to reduce the accumulation of ECM.

[Observation of the promotion effect taurine on hepatic stellate cell's apoptosis in rat hepatic fibrosis model].

OBJECTIVE: To observe the effect of taurine on hepatic stellate cell's apoptosis induced by carbon tetrachloride (CCl4) in rats and to study its protective mechanisms. METHODS: CCl4-induced rat hepatic fibrosis was treated by taurine. Serum alanine aminotransferase (ALT), plasma protein, hyaluronic acid (HA), procollagen III (PC III), hepatic microsomal drug-metabolizing enzyme and anti-transforming growth factor beta1 (TGF-beta1) were determined. In addition, hepatic stellate cell's apoptosis and the pathological changes of liver tissue were observed under light microscope. RESULTS: The activity of serum ALT and the levels of serum HA, PC III were markedly reduced by taurine treatment. The hepatic cytochrome P450 (Cyt. P450) and cytochrome b5 (Cytb5) contents were increased by the same treatment. In addition, taurine could significantly inhibit the expression of TGF-beta1, promote the hepatic stellate cell's apoptosis, and relieve hepatic fibrosis. CONCLUSION: Taurine fulfills a role in promoting hepatic stellate cell's apoptosis in the case of hepatic fibrosis, it mitigates the liver injury, decreases the expression of TGF-beta1, and relieves hepatic fibrosis.