Utility of Autonomic Function Tests to Differentiate Dementia with Lewy Bodies and Parkinson Disease with Dementia from Alzheimer Disease

Objective: We studied autonomic disturbance in patients with dementia with Lewy bodies (DLB), Parkinson disease with dementia (PDD), Alzheimer disease (AD), to determine whether autonomic function tests can be used to distinguish these disorders. Methods: Autonomic function was tested in 56 patients with DLB, 37 patients with PDD, and 59 patients with AD by using the sympathetic skin response, coefficient of variation in R-R interval, the head-up tilt test, serum norepinephrine concentration, and 123I-meta-iodobenzylguanidine cardiac scintigraphy. Symptoms of autonomic dysfunction, such as constipation, urinary symptoms, and orthostatic hypotension, were also noted. Results: The groups did not differ on baseline characteristics other than those associated with Parkinsonism and dementia. All patients with DLB and PDD had some dysautonomia, whereas rates were much lower for patients with AD (19%). Significantly more DLB and PDD patients than AD patients showed abnormalities on autonomic function tests. Conclusions: Autonomic function tests might be quite useful to distinguish DLB and PDD from AD.

Serum retinol levels are associated with brain volume loss in patients with multiple sclerosis

Background

Although predicting future brain volume loss (BVL) in patients with multiple sclerosis (MS) is important, studies have shown only a few biomarkers that can predict BVL.

Objectives

The aim of this study is to elucidate the association between longitudinal BVL and serum biomarker candidates.

Methods

This single-center, retrospective, observational study intended to cover MS patients during January 2008 to March 2016. Patients who underwent brain MRI two times at intervals of >24 months and had a blood test to measure biomarker candidates at the time or within three months of the MRI scan were included. Evaluation of brain volume was performed by using SIENAX and SIENA in the FMRIB software library.

Results

Twenty-three patients with MS were included in this study. We found that serum retinol binding protein (RBP) levels were significantly correlated with percentage brain volume change (PBVC) (p = 0.0079). Furthermore, best subset selection of multiple linear regression models identified baseline normalized brain volume and serum RBP as the best predictors of PBVC.

Conclusions

Our study shows that lower serum retinol levels are associated with greater longitudinal BVL and that serum RBP and can be a predictor of BVL.

Brain biopsy to aid diagnosis of neuro-Behçet's disease: Case report and literature review

Central nervous system involvement in Behçet's disease (Neuro-Behçet's disease: NBD) has been reported to present diverse clinical and pathological manifestations. A few cases presenting with neurological symptoms preceding other systemic features are difficult to be diagnosed. Here we suggest the clinical benefit of brain biopsy with a case of NBD initially presenting neurological symptoms.

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We report one case of neuro-Behçet's disease (NBD).

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He presented with neurological symptoms without other preceding features.

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Brain biopsy was useful to diagnose him with NBD.

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Clinical utility of brain biopsy in NBD is suggested.

Cerebral infarction in right pons during the course of mobile mitral annular calcification-related calcified amorphous tumor during a long time hemodialysis

We report here a 70 year-old male on maintenance hemodialysis who presented non-paralytic pontine exotropia. Brain MRI showed new right pons infarct. Transthoracic and transesophageal echocardiography revealed a mobile calcification at posterior mitral leaflet with rapid growing compared to 14 days ago. Neurological symptoms disappeared at least 10 days by a treatment with aspirin. Calcification reduced by a follow-up transthoracic echocardiography after 90 days from the beginning of neurological symptoms. We diagonosed him with cerebral infarction during the course of mobile mitral annular calcification-related calcified amorphous tumor. Mobile mitral annular calcification-related calcified amorphous tumor would be a cause of cerebral infarction, we need to be careful to check a transthoracic echocardiography regularly because of necessity.

Quantitative correlation between cardiac MIBG uptake and remaining axons in the cardiac sympathetic nerve in Lewy body disease

OBJECTIVES

Reduced cardiac meta-iodobenzylguanidine (MIBG) uptake and loss of cardiac sympathetic axons, as its possible anatomical substrate, were both recognised in Lewy body disease (LBD), while their direct correlation has so far remained speculative. Increasing availability of autopsy-confirmed cases of LBD prompted us to quantify residual cardiac sympathetic axons to establish their relationship to cardiac MIBG uptake.

METHODS

We collected cardiac tissue samples from 23 patients with autopsy-confirmed LBD and two non-LBD control patients who underwent (123)I-MIBG cardiac scintigraphy in life. Samples of the left ventricular anterior wall were stained with anti-tyrosine hydroxylase (TH) and anti-neurofilament (NF) antibodies as markers of cardiac nerve axons. We quantified the immunolabelled areas and assessed their correlation to standardised heart to mediastinum (H/M) ratios of (123)I-MIBG cardiac scintigraphy.

RESULTS

Cardiac MIBG uptake in the early and delayed phases was reduced in 90.9% and 95.7% of patients with LBD, respectively. The area of TH-immunoreactive axons correlated significantly with the H/M ratio in the early (p=0.036) as well as in the delayed (p=0.018) phases. The area of NF-immunoreactive axons also correlated with the H/M ratio in the early (p=0.003) as well as in the delayed (p=0.001) phases.

CONCLUSIONS

Tight quantitative correlation between cardiac (123)I-MIBG uptake and corresponding loss of sympathetic axons in LBD, as established for the first time by this study, provides a scientific basis to confirm the reliability of MIBG cardiac scintigraphy as a powerful clinical tool to detect loss of these axons as a biomarker for the presence of Lewy body disease.

Microfluidic immunomagnetic cell separation using integrated permanent micromagnets

In this paper, we demonstrate the possibility to trap and sort labeled cells under flow conditions using a microfluidic device with an integrated flat micro-patterned hard magnetic film. The proposed technique is illustrated using a cell suspension containing a mixture of Jurkat cells and HEK (Human Embryonic Kidney) 293 cells. Prior to sorting experiments, the Jurkat cells were specifically labeled with immunomagnetic nanoparticles, while the HEK 293 cells were unlabeled. Droplet-based experiments demonstrated that the Jurkat cells were attracted to regions of maximum stray field flux density while the HEK 293 cells settled in random positions. When the mixture was passed through a polydimethylsiloxane (PDMS) microfluidic channel containing integrated micromagnets, the labeled Jurkat cells were selectively trapped under fluid flow, while the HEK cells were eluted towards the device outlet. Increasing the flow rate produced a second eluate much enriched in Jurkat cells, as revealed by flow cytometry. The separation efficiency of this biocompatible, compact micro-fluidic separation chamber was compared with that obtained using two commercial magnetic cell separation kits.

Tunable and label-free bacteria alignment using standing surface acoustic waves

This paper describes a new technique for focusing bacteria in a microfluidic channel and subsequently controlling their trajectory. Bacteria alignment is obtained using standing surface acoustic waves (SSAW) generated by two interdigitated transducer electrodes (IDTs) patterned on a piezoelectric wafer. The bacteria are focused in the standing wave pressure nodes, separated by half a wavelength, the electrode geometry and applied voltage frequency being chosen accordingly. Interestingly, the position of a pressure node can be modulated by introducing a phase shift between the electrical signals applied to both IDTs. The bacteria, trapped in this node, follow it and can therefore be deflected. This technique works with label-free bacteria in their culture medium and induces low power consumption, which is very interesting for portable devices.

Correlative magnetic resonance imaging and autopsy findings in a patient with coagulation necrosis treated with tissue plasminogen activator

Coagulation necrosis is a peculiar type of ischemic necrosis that is characterized by firm, eosinophilic parenchyma with recognizable cell outlines without massive glial reactions. This is an autopsy report of coagulation necrosis 6 months after thrombolytic tissue plasminogen activator therapy against massive cerebral embolism in an 84-year-old man with atrial fibrillation.