He Lv

Beijing Medical University, Peping, Beijing, China

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Publications (13)22.94 Total impact

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    ABSTRACT: The aim of this study was to evaluate muscle MRI changes and the role of MRI in monitoring therapy in patients with myopathy associated with antibodies to signal recognition particle (anti-SRP myopathy). We identified 12 patients with anti-SRP myopathy [6 females and 6 males; mean age of onset 38.5 years (s.d. 12.4), mean duration 22.8 months (s.d. 20.6). The main symptoms were proximal limb muscle weakness. Mean serum creatine kinase levels were moderately increased. Muscle biopsies revealed necrotizing myopathy in all patients, with obvious connective tissue proliferation in five patients and a single focus of lymphocytic infiltration in the endomysium in one. The myositis disease activity assessment (MYOACT) visual analogue scales scores were assessed. Muscle MRI was performed through the thighs. All patients were treated with corticosteroids and other immunosuppressive drugs. MRI revealed fatty infiltration and oedema in the thigh muscles of all 12 patients. Prominent fatty infiltration was present in 4 of the 12 patients. The hamstrings and adductor magnus were the most severely infiltrated and the quadriceps femoris the least. Obvious oedema was observed in 10 of the 12 patients, the most severely affected muscles being the vastus lateralis, rectus femoris, biceps femoris and adductor magnus, with relative sparing of the vastus intermedius. The degree of oedema was not correlated with creatine kinase levels or MYOACT scores. The four patients with striking fatty infiltration were refractory to therapy. MRI of the thigh muscles shows a distinct pattern of oedema and fatty infiltration and can be used to monitor the treatment of patients with anti-SRP myopathy. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Rheumatology (Oxford, England) 11/2014; · 4.24 Impact Factor
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    ABSTRACT: Myopathy or neuropathy has been associated with lamivudine/telbivudine therapy in hepatitis B patients. We aim to describe the pathological changes of lamivudine/telbivudine-associated neuromyopathy.
    Journal of clinical pathology. 09/2014;
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    ABSTRACT: Myopathy with anti-signal recognition particle antibodies (SRP) is generally thought to be immune-mediated necrotic myopathy in previous studies. We report the clinical and histopathological features of myopathy with anti-SRP antibodies in Chinese patients. Muscle biopsy and immunoblots for myositis antibodies were carried out in 123 patients with idiopathic inflammatory myopathy. Among them, 16 (13.0%) patients had anti-SRP antibodies. Age of onset ranged from 24 to 77 years, and the disease began insidiously. Fourteen of 16 patients presented with chronic progression of proximal limb weakness, with 6 having myalgia. Serum creatine kinase levels ranged from 400 to 9082 IU/L. Muscle biopsies showed necrotic and/or regenerative muscle fibers in all 16, infiltrates of lymphocytes in 11 and morphological features of muscular dystrophy in 7. Eleven patients showed focal or diffuse major histocompatibility complex class 1 expression in sarcolemma or cytoplasm of muscle fibers, with 9 showing deposition of membrane attack complex in necrotic muscle fibers and 2 around capillaries. These findings indicate that anti-SRP antibodies are most likely to be related to IMNM. Myopathy with anti-SRP antibodies is not infrequent in Chinese patients with idiopathic inflammatory myopathy.
    Neuromuscular Disorders 04/2014; · 3.46 Impact Factor
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    ABSTRACT: It has been implicated that Dux4 plays crucial roles in development of facioscapulohumeral dystrophy. But the underlying myopathic mechanisms and related down-stream events of this retrogene were far from clear. Here, we reported that overexpression of Dux4 in a cell model TE671 reduced cell proliferation rate, and increased G1 phase accumulation. We also determined the impact of Dux4 on p53/p21 signal pathway, which controls the checkpoint in cell cycle progression. Overexpression of Dux4 increased p21 mRNA and protein level, while expression of p53, phospho-p53 remained unchanged. Silencing p21 rescued Dux4 mediated proliferation defect and cell cycle arrest. Furthermore, we demonstrated that enhanced Dux4 expression increased p21 promoter activity and elevated expression of Sp1 transcription factor. Mutation of Sp1 binding site decreased dux4 induced p21 promoter activation. Chromatin immunoprecipitation (ChIP) assays confirmed the Dux4-induced binding of Sp1 to p21 promoter in vivo. These results suggest that Dux4 might induce proliferation inhibition and G1 phase arrest through upregulation of p21.
    Biochemical and Biophysical Research Communications 02/2014; · 2.28 Impact Factor
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    ABSTRACT: Introduction: Giant axonal neuropathy (GAN) is a rare autosomal recessive neurodegenerative disorder caused by mutations in the GAN gene. Here, we report ultrastructural changes in Chinese patients with GAN. Methods: General clinical assessment, sural nerve biopsy, and genetic analysis were performed. Results: Sural biopsy revealed giant axons in 3 patients, 2 with mild phenotype, and 1 with classical phenotype. Ultrastructurally, all patients had giant axons filled with closely packed neurofilaments. Additionally the classical patient had some axons containing irregular tubular-like structures. GAN mutation analysis revealed novel compound heterozygous c.98A>C and c.158C>T mutations in the BTB domain in 1 mild patient, a novel homozygous c.371T>G mutation in the BACK domain in another mild patient, and a novel c.1342G>T homozygous mutation in the Kelch domain in the classical patient. Conclusion: Closely packed neurofilaments in giant axons are common pathological changes in Chinese patients with GAN, while irregular tubular-like structures appear in the classical one. © 2013 Wiley Periodicals, Inc.
    Muscle & Nerve 11/2013; · 2.31 Impact Factor
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    ABSTRACT: Charcot-Marie-Tooth disease Type 2A2 (CMT2A2), caused by mitofusin 2 (MFN2) genes, has been clinically classified into two types: severe early-onset and mild benign. Here we reported 3 early onset patients with different progressive courses. The 3 patients had mutations R94W, R364W and a novel W740R in the MFN2 gene. Two patients presented with progressive distal limb muscle weakness and wasting from the ages of 5 and 6 years, respectively. The disease developed slowly, with loss of ambulation after 35 years of age. The third patient presented with similar symptoms after birth, and has never been able to walk independently. Sural nerve biopsies revealed severe axonal neuropathy with mitochondrial aggregation in axons. Our data confirmed that early-onset CMT2A2 can present with different courses in Chinese patients. The novel mutation in MFN2 found in this study broadens the genotypic spectrum associated with MFN2 related CMT.
    Clinical neuropathology 07/2012; · 1.34 Impact Factor
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    ABSTRACT: The mutation pattern of mitochondrial DNA (mtDNA) in mainland Chinese patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) has been rarely reported, though previous data suggested that the mutation pattern of MELAS could be different among geographically localized populations. We presented the results of comprehensive mtDNA mutation analysis in 92 unrelated Chinese patients with MELAS (85 with classic MELAS and 7 with MELAS/Leigh syndrome (LS) overlap syndrome). The mtDNA A3243G mutation was the most common causal genotype in this patient group (79/92 and 85.9%). The second common gene mutation was G13513A (7/92 and 7.6%). Additionally, we identified T10191C (p.S45P) in ND3, A11470C (p. K237N) in ND4, T13046C (p.M237T) in ND5 and a large-scale deletion (13025-13033:14417-14425) involving partial ND5 and ND6 subunits of complex I in one patient each. Among them, A11470C, T13046C and the single deletion were novel mutations. In summary, patients with mutations affecting mitochondrially encoded complex I (MTND) reached 12.0% (11/92) in this group. It is noteworthy that all seven patients with MELAS/LS overlap syndrome were associated with MTND mutations. Our data emphasize the important role of MTND mutations in the pathogenicity of MELAS, especially MELAS/LS overlap syndrome.
    Journal of Human Genetics 08/2011; 56(11):759-64. · 2.53 Impact Factor
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    ABSTRACT: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is an inherited small-vessel disease caused by mutations in NOTCH3. Although CADASIL cases have been identified worldwide, the data from mainland China are still limited. To identify NOTCH3 mutations and analyse the clinical and MRI findings in a large series of CADASIL patients from mainland China. Direct sequencing of NOTCH3 and/or skin or sural nerve biopsies were performed on 48 unrelated suspected CADASIL cases of Chinese descent. The clinical manifestations and MRI features were retrospectively collected and analysed in the 33 index patients with confirmed diagnosis and their available affected family members. 20 different NOTCH3 mutations were identified in 33 families, including seven novel mutations. The highest mutation frequency was in exons 4 (55%) and 3 (30%). Granular osmiophilic material in smooth muscle cells was found in 30 cases who were biopsied. Clinical presentation included TIA/stroke in 82%, cognitive decline in 60%, and migraine with aura in only 5% of 57 symptomatic cases. MRI detected multiple lacunar infarcts and leucoaraiosis in all symptomatic cases, brainstem lesions in 64% of symptomatic cases and white-matter lesions in the temporal pole in 46% of affected members. The mutational spectrum and primary clinical features of patients with CADASIL from mainland China are similar to those in Caucasians. However, migraine with aura and abnormal white matter in the temporal pole are less common than among Caucasians, while brainstem involvement is more common than among Caucasians.
    Journal of neurology, neurosurgery, and psychiatry 10/2010; 82(5):534-9. · 4.87 Impact Factor
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    ABSTRACT: To investigate the expression of Akt pathway and their correlation with pathological changes in the skeletal muscle of myotonic dystrophy 1 (DM1) patients. We chose 7 DM1 patients who were confirmed through clinical, electrophysiological and pathological data as DM1 patients group, and 7 patients without muscle pathological change as control group. The age range of DM1 patients group was from 6 to 35 years and disease duration was from 1 to 20 years. The clinical spectrum included distal myotonia, muscle weakness and atrophy. The serum creatine kinase ranged from 271 to 1 325 U/L; Electromyography showed myopathic changes together with diffusive myotonic discharges. We performed muscle biopsies in all the patients and tested total Akt, phosphorelated Akt, phosphorelated p70s6k in skeletal muscle specimens. We compared the Akt pathway activity of DM1 patients group with that of the control group and analyzed their correlation with the ratio of muscular hypertrophy, internal nuclei and basophilic sarcoplasmic masses. Skeletal muscle biopsies revealed muscular dystrophic changes accompanied by peripherally placed sarcoplasmic masses and numerous internal nuclei. Increased optical density (D) of Akt, p-Akt, p-p70s6k had been noted in DM1 patients as compared with the controls (Akt: t=4.110, P=0.006; p-Akt: t=4.408, P=0.004; p-p70s6k: t=4.113, P=0.005; p-Akt/Akt: t=4.055, P=0.002). A positive linear correlation was observed between Akt pathway activity and muscle hypertrophy proportion (Akt group: r=0.825, P=0.015; p-Akt group: r=0.914, P=0.004; p-p70s6k group: r=0.916, P=0.004). But, no correlation was observed between Akt pathway and sarcoplasmic masses or internal nuclei. Akt signaling pathway activity increased diffusively in skeletal muscle of the DM1 patient. Such elevation might be the cause of pathological muscle hypertrophy.
    Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 10/2010; 42(5):526-9.
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    ABSTRACT: Dermatomyositis (DM) is a systemic microvasculitis predominantly involving the capillaries. We investigated the expression of thrombomodulin (TM) and endothelial cell nitric oxide synthase (eNOS) in microvessels of DM patients. Twelve patients with acute or subacute onset of proximal muscle weakness and erythematous rash over their faces and shoulders were included in this study. Serum creatine phosphokinase was elevated in almost all patients. Electromyograph showed a myopathic pattern in all patients. Muscle biopsies were performed in all patients and 10 non-DM controls and studied with histological, enzyme histochemical and immunohistochemical staining. von Willebrand factor, TM and eNOS antibodies were used as the primary antibodies. Perifascicular degeneration and inflammatory cell infiltration in the perimysium were noted in almost all patients. Non-special esterase staining was markedly positive in capillary and microvascular endothelium. Marked reduction in TM and eNOS staining was noted in DM patients in perimysium microvessels and perifascicular area capillaries. Vascular lesions in DM were not only limited to capillaries. The low expression of TM and eNOS in microvessels suggests the anticoagulation and vasodilation functions of vascular endothelium is reduced. DM is an inflammatory vascular endothelial disease.
    Neuropathology 09/2007; 27(4):309-13. · 1.91 Impact Factor
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    ABSTRACT: To report the clinical, radiological and neuropathological findings of a patient with rheumatoid meningitis. The patient was a 71-year-old Chinese man with a two-year history of rheumatoid arthritis and no other significant medical history, who presented to our hospital recurrent weakness of his left extremities, dysarthria and a continuous bilateral hand tremor. Cerebrospinal fluid (CSF) and serum examinations were normal apart from a mildly raised serum perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA). Brain magnetic resonance imaging (MRI) showed leptomeningeal enhancement in both frontal and parietal lobes, in addition to several old white matter infarcts. Meningeal biopsy showed numerous infiltrating macrophages and lymphocytes within the leptomeninges. The patient responded clinically and radiologically to corticosteroid and cyclophosphamide therapy. The patient subsequently developed herpes zoster over his left chest as a complication of his immunosuppressive treatment. His cyclophosphamide was ceased and intravenous immunoglobulin (IVIG) therapy was commenced, with good clinical response to both the herpes zoster and meningitis. According to the result of the biopsy, aseptic meningitis was considered the MRI results and the patient's clinical history were given, and a diagnosis of rheumatoid meningitis was made. The patient was p-ANCA positive. Although there was no evidence for cerebral vasculitis on biopsy, it remains a possibility that the patient's recurrent minor cerebral infarcts visible on MRI were vasculitic in nature.
    Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 07/2006; 38(3):324-5.
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    ABSTRACT: Diffuse muscular calcification was rare myopathological change due to abnormal metabolism of calcium, which was mainly found in dermatomyositis and myositis ossificans progressiva. Here we reported a case of diffuse muscular calcification that clinically mimicked myositis ossificans progressiva. The disease might be a new type of congenital calcium metabolic disease. A 15-year-old girl developed subcutaneous cysts in the wrist and ankle when she was 1 year old. At the age of 9, she developed recurrent fever with myalgia, fatigue and diffuse muscular calcification. It was difficult for her to squat, run or walk. Protuberance presented in the subcutaneous tissue of her trunk. Some nodules ruptured with outflow of chalky material. ESR, ENA, RF, CRP, PTH, CK were in normal limits. EMG was unremarkable. X-ray confirmed diffuse calcification in the muscle and subcutaneous tissues. Biceps muscle biopsy was performed. Numerous inflammatory cells infiltrated around vessels in the perimyosium with perifascicular muscle fiber atrophy and degeneration. Many RRF and SDH positive fibers were also observed. EM showed tubular reticular inclusions in vascular endothelium. Diffuse muscular calcification indicated existence of systemic calcium metabolic abnormality. As the clinical symptoms and distribution pattern of calcification were different from dermatomyositis with subcutaneous calcification and myositis ossificans progressiva, our case might be a new type of disease. The microvascular changes might result in the lesion of muscle fibers.
    Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 01/2006; 37(6):659-60.
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    ABSTRACT: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is an inherited cerebral arteriolar disease in adulthood, which is caused by NOTCH3 gene mutation. The main symptoms were migraine, cerebral stroke, later with mood disorders and dementia in Caucasian patients. Recently, the disease was also recognized in Asian patients, in whom the migraine is rarely reported. In order to give the clinical features of Chinese patients, we described the clinical symptoms in 4 CADASIL families. CADASIL was diagnosed by the investigation of ultra-structure changes of arteriole in sural nerve and NOTCH3 gene mutation in the 4 index cases. Detailed clinical and routine laboratory examinations were performed in these 4 patients, including electrocardiography, nerve conduction velocity, serum glycogen, and serum homocysteine. Additionally, we also collected the clinical data of the other 83 family members through interviews and the available medical records. Of the 83 persons, 29 were classified as clinical suspected patients, who presented one or more of the disease-related neurological symptoms, such as cerebral ischemic events and the cognitive impairment. All of them showed no common risk factors for stroke, such as diabetic mellitus, hypertension, and heart disease. The clinical suspected patients distributed in every consecutive generations and involved both sexes, which was according to the autosomal dominant inherited pattern. The onset age of the disease ranged from 28 to 70-year-old and mainly between the 4th and the 5th decades. The main symptoms were recurrent episodic vertigo, with or without hemiplegia. At the same time or a little bit later, the cognitive impairment was developed in some patients. Compared with the typical presentations of the disease in European patients, none of our 29 patients showed migraine,one index case showed mild sensory disturbance in extremities. Elevated serum homocysteine level and abnormal of nerve conduction study in two index cases (3 and 4) were noticed. The onset age of the disease of our patients is similar to that of Caucasian patients. The main symptoms were stroke and dementia. Involvement of post circulation system was the main clinical feature for ischemic events in our patients. Dementia could be found in the early stage of disease. Migraine should not be regarded as a common clinical feature in our patients. The involvement of the peripheral nerves expanded the disease expression outside the central nervous system.
    Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 11/2004; 36(5):496-500.