Moyamoya syndrome with antiphospholipid antibodies: a case report and literature review

Zhen Wang and Zhenqiang Fu contributed equally to this report. Moyamoya syndrome is a term applied to typical moyamoya vasculopathy with well-recognized associated conditions. Several systematic studies on the entities of moyamoya syndrome with autoimmune disease have been reported. We report a case of moyamoya syndrome with antiphospholipid antibodies and provide a review of relevant cases from the literature, describing the clinical characteristics and treatments.

Geometrical differences in target volumes based on 18F-fluorodeoxyglucose positron emission tomography/computed tomography and four-dimensional computed tomography maximum intensity projection images of primary thoracic esophageal cancer

The objective of the study was to compare geometrical differences of target volumes based on four-dimensional computed tomography (4DCT) maximum intensity projection (MIP) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images of primary thoracic esophageal cancer for radiation treatment. Twenty-one patients with thoracic esophageal cancer sequentially underwent contrast-enhanced three-dimensional computed tomography (3DCT), 4DCT, and 18F-FDG PET/CT thoracic simulation scans during normal free breathing. The internal gross target volume defined as IGTVMIP was obtained by contouring on MIP images. The gross target volumes based on PET/CT images (GTVPET ) were determined with nine different standardized uptake value (SUV) thresholds and manual contouring: SUV≥2.0, 2.5, 3.0, 3.5 (SUVn); ≥20%, 25%, 30%, 35%, 40% of the maximum (percentages of SUVmax, SUVn%). The differences in volume ratio (VR), conformity index (CI), and degree of inclusion (DI) between IGTVMIP and GTVPET were investigated. The mean centroid distance between GTVPET and IGTVMIP ranged from 4.98 mm to 6.53 mm. The VR ranged from 0.37 to 1.34, being significantly (P<0.05) closest to 1 at SUV2.5 (0.94), SUV20% (1.07), or manual contouring (1.10). The mean CI ranged from 0.34 to 0.58, being significantly closest to 1 (P<0.05) at SUV2.0 (0.55), SUV2.5 (0.56), SUV20% (0.56), SUV25% (0.53), or manual contouring (0.58). The mean DI of GTVPET in IGTVMIP ranged from 0.61 to 0.91, and the mean DI of IGTVMIP in GTVPET ranged from 0.34 to 0.86. The SUV threshold setting of SUV2.5, SUV20% or manual contouring yields the best tumor VR and CI with internal-gross target volume contoured on MIP of 4DCT dataset, but 3DPET/CT and 4DCT MIP could not replace each other for motion encompassing target volume delineation for radiation treatment.

Decreased levels of circulating sex hormones as a biomarker of lung cancer in male patients with solitary pulmonary nodules

BACKGROUND

An early differentiation of malignant from benign solitary pulmonary nodules (SPNs) is essential for management and prognosis of lung cancer.

OBJECTIVES

Here we investigated whether measurement of circulating sex hormones could be useful for an early detection of malignancy among patients with SPNs.

METHODS

We recruited 47 patients with malignant SPNs 45 patients with benign SPNs, and 32 healthy persons. Testosterone, estradiol, and progesterone were measured. Carcinoembryonic antigen (CEA) as well as TNF-α, IL-1 and IL-6 were also measured.

RESULTS

We found that sex hormones were decreased significantly in patients with malignant SPNs, as compared to patients with benign SPNs and healthy controls (P<0.05). Sex hormones levels showed a trend to decline in patients with benign SPNs as compared to normal controls, but the difference was not statistically significant (P>0.05). CEA levels were only abnormally elevated in eight patients with lung adenocarcinoma. The inflammatory cytokines were remarkably higher in both patients than in normal controls. However, there was no statistical difference in these cytokines among patients.

CONCLUSIONS

The reduced sex hormones levels seemed to be uniquely associated with lung cancer. Therefore, measurement of sex hormones may have clinical potential in the diagnosis of malignancy in patients with SPNs.

Heteroepitaxy of tetragonal BiFeO(3) on hexagonal sapphire(0001)

Highly elongated BiFeO3 is epitaxially grown on hexagonal sapphire(0001) substrate within a rather narrow synthesis window. Both X-ray reciprocal space maps and Raman characterizations reveal that it is of true tetragonal symmetry but not the commonly observed MC type monoclinic structure. The tetragonal BiFeO3 film exhibits an island growth mode, with the island edges oriented parallel to the ⟨10-10⟩ and ⟨12-30⟩ directions of the sapphire substrate. With increasing deposition time, a transition from square island to elongated island and then to a continuous film is observed. The metastable tetragonal phase can remain on the substrate without relaxation to the thermally stable rhombohedral phase up to a critical thickness of 450 nm, providing an exciting opportunity for practicable lead-free ferroelectrics. These results facilitate a better understanding of the phase stability of BiFeO3 polymorphs and enrich the knowledge about the heteroepitaxial growth mechanism of functional oxides on symmetry-mismatched substrates.

Neonatal mortality rate and risk factors in northeast China: analysis of 5,277 neonates in 2005

BACKGROUND

Healthcare has dramatically improved for both mothers and neonates over the last three decades in China. However, the reported rates of morbidity and mortality vary among different regions of China, and the exact rates in Northeast China are unknown. This study aimed to determine neonatal morbidity and mortality rates and the associated risk factors in Northeast China.

MATERIALS AND METHODS

Neonates born in 2005 at seven hospitals in five major cities of Heilongjiang province in Northeast China were recruited. Standardized questionnaires on both the mother and neonate were conducted by trained investigators. The questions included demographic data on the mother, the mother's weight, gestational age (GA), complications during pregnancy, method of delivery, neonate's gender, weight, general health situation, and complications after delivery. Results: A total of 5,277 neonates were included, with a male to female ratio of 1.07. The incidence ofpreterm delivery was 8.7%, which was associated with an increased age of the mother, a history of preeclampsia-eclampsia, premature rupture of membranes, and intrauterine distress. Morbidity occurred in 7.0% of neonates, including hypoxic ischemic encephalopathy (2.4%), asphyxia (1.6%), pneumonia (1.6%), hyperbilirubinemia (0.5%), intracranial hemorrhage (0.5%), meconium as- piration syndrome (0.2%), and ingestion syndrome (0.2%). The overall mortality was 9.5%0. Preterm delivery, maternal history ofpreeclamp- sia-eclampsia, hypoxic ischemic encephalopathy, intracranial hemorrhage, pneumonia, asphyxia, and meconium aspiration syndrome were independent risk factors for mortality with odds ratios (95% confidence interval) of 17.42 (7.31-38.9), 12.52 (Table 3) (3.91-16.82), 10.13 (2.52-19.86), 9.77 (2.35-19.93), 4.15 (1.78-9.52), 2.18 (1.21-5.47), and 2.76 (2.11-6.32), respectively (all P<0.01).

CONCLUSIONS

In 2005, the overall morbidity and mortality was 7.0% and 9.5%0, respectively in northeast China, and preterm delivery was the highest risk factor for neonatal mortality. The prevention on preterm delivery should be a top priority for the improvement of neonatal healthcare.

Identification and characterisation of maize microRNAs involved in developing ears

In maize, kernel row number trait is determined during the period when spikelet pair meristems (SPMs) give rise to spikelet meristems (SMs). Expression levels of many genes change during this period due to regulation at transcriptional and post-transcriptional levels. MicroRNAs (miRNAs) act as key regulating factors of post-transcriptional gene expression. To discover miRNAs involved in maize ear development, Solexa deep sequencing was performed on a maize inbred line, Zong3. Ears at the stage when SPMs produce SMs were harvested to extract RNA. Deep sequencing revealed 85 conserved miRNAs belonging to 17 miRNA families. miRNA families differed greatly in their abundance, from over 160,000 to only five reads. In addition, 31 novel maize miRNAs were identified using stringent criteria. The results show that miRNA-mediated regulation of gene expression is present in developing maize ears at the stage when SPMs produce SMs; both conserved and novel miRNAs are involved.

Single nucleotide polymorphisms in the ORM1-like 3 gene associated with childhood asthma in a Chinese population

Single nucleotide polymorphism (SNP)-based genome-wide association studies have revealed that polymorphisms of the ORM1-like 3 (ORMDL3) gene are associated with childhood asthma. We investigated genetic associations of SNPs in and around the ORMDL3 gene with childhood asthma in a Chinese population. Genomic DNA was extracted from peripheral venous blood drawn from 152 subjects with childhood asthma and from 190 control subjects. SNP genotyping was performed with the MassARRAY system (Sequenom) by means of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Among the six SNPs, only the genotype frequencies of rs7216389 were significantly different between asthmatic children and controls. Asthmatic children had a significantly higher frequency of T alleles [odds ratio (OR) = 1.653, 95% confidence interval (95%CI) = 1.170-2.333] in rs7216389, than controls. The TT genotype of rs7216389 was found to be a significant risk factor for childhood asthma by logistic regression analysis (OR = 1.704, 95%CI = 1.105-2.628). There was no significant association between the TT genotype of rs7216389 and clinical features of childhood asthma. We conclude that the ORMDL3 gene influences childhood asthma and that the TT genotype of the rs7216389 polymorphism is associated with childhood asthma in the Chinese population.

Therapeutic and preventive effects of an epidermal growth factor receptor inhibitor on oral squamous cell carcinoma

OBJECTIVE

Oral squamous cell carcinoma (OSCC) is the sixth most common human neoplasm worldwide. Epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase that is highly expressed in human OSCC and is a target for cancer therapy and prevention. This study investigated the therapeutic and preventive effects of an inhibitor of EGFR (PD153035) on OSCC.

METHODS

The effects of PD153035 were examined in human cancer cell lines in vitro, in an athymic nude mouse xenograft model in vivo, and in the 7,12-dimethyl benz[a]anthracene (DMBA)-induced hamster cheek pouch tumour model in vivo.

RESULTS

PD153035 significantly inhibited cell growth, delayed cell cycle progression and induced apoptosis in human OSCC cells in vitro. In vivo, PD153035 inhibited xenograft tumour growth in nude mice in a dose-dependent manner and prevented the development of OSCC at the postinitiation stage in the DMBA-induced hamster cheek pouch tumour model. PD153035 inhibited the DMBA-induced increases in cell proliferation and in levels of phosphorylated EGFR and phosphorylated signal transducer and activator of transcription 3 (STAT3) protein in the hamster cheek pouch.

CONCLUSIONS

Inhibitors of EGFR, such as PD153035, have potential value in the treatment and prevention of OSCC.

Protective efficacy evaluation induced by recombinant protein LHD-Sj23-GST of Schistosoma japonicum emulsified with three different adjuvants

As a complement to chemotherapy and other control approaches, the development of an effective vaccine is necessary to combat Schistosomiasis japonica that remains a serious public health problem in China. In the present study, mice were vaccinated with purified recombinant protein LHD-Sj23-GST (large hydrophilic domain of 23 kDa antigen of S. japonicum fused with Sj26GST) emulsified with Freund's adjuvant (FA), Montanide ISA 206 and Montanide ISA 70 M and challenged with cercariae, the protective efficacy induced by the recombinant protein was evaluated, and the LHD-Sj23-GST-specific IgG and its subtypes were determined. The result revealed that a significant worm burden reduction (58.8%, 26.3% and 54.3%; P<0.05) was obtained in mice vaccinated with LHD-Sj23-GST emulsified with three different adjuvants compared to those mice treated with respective adjuvant only. ELISA test suggested that the high-level production of LHD-Sj23-GST-specific IgG1, IgG2a and IgG3 antibodies may participate in protecting against schistosome infection.

Comparison of the diagnostic value of 3-deoxy-3-18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of regional lymph node in thoracic esophageal squamous cell carcinoma: a pilot study

We used pathological examination as golden standard to determine whether 3-deoxy-3-(18)F-fluorothymidine positron emission tomography/computed tomography (FLT PET/CT) can detect regional lymph node metastasis in untreated thoracic esophageal squamous cell carcinoma and additionally performed (18)F-fluorodeoxyglucose (FDG) PET/CT for direct comparison with that of FLT. Twenty-two patients with thoracic esophageal squamous cell carcinoma underwent dual-tracer PET/CT examinations before surgery. The results of reviewing CT images and side-by-side FDG PET and FLT PET images for the diagnosis of locoregional lymph node metastasis were compared prospectively in relation to pathologic findings. All patients underwent esophagectomy and lymphadenectomy. Pathologic examination confirmed nodes positive for metastasis in 16 patients and 47 of 424 excised nodes. The uptake of FDG (median SUVmax, 5.4; range, 2.4-10.6) in locoregional lymph nodes metastases was significantly higher than that of FLT (median SUVmax, 2.8; range, 1.3-4.6). There were 14 false-positive nodes in FDG PET/CT and only 3 in FLT PET/CT; 8 false-negative nodes in FDG PET/CT, while there were 12 false negative nodes in FLT PET/CT. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FLT PET/CT were 74.47%, 99.20%, 96.46%, 92.11%, and 96.89%, respectively, whereas those of FDG PET/CT were 82.98%, 96.29%, 94.81%, 82.98%, and 96.29%, respectively. P-values were 0.450, 0.014, 0.313, 0.050, and 0.555, respectively. FLT uptake in regional lymph nodes of esophageal carcinoma is significantly lower compared with FDG uptake. FLT PET/CT has fewer false-positive findings and higher specificity compared with FDG PET/CT.

Psychological status of Chinese patients with Type 2 diabetes: data review of Diabcare-China studies

AIM

To describe the status of glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life in Chinese patients with Type 2 diabetes in 2006.

METHODS

Subjects having registered for care for > 12 months at a diabetes clinic were enrolled in this study. Glycaemic control was determined by HbA(1c) and plasma glucose levels; information about self-reported adherence to treatments was obtained by questionnaire; psychological well-being was assessed by use of a modified World Health Organization-5 Well-being Index; and quality of life was measured by use of a modified Diabetes Attitudes, Wishes and Needs (DAWN) survey. All data were tabulated and statistical analyses were performed.

RESULTS

A total of 2702 patients were enrolled during 2006. Only 23% of patients achieved an HbA(1c) level of < 48 mmol/mol (6.5%) as per the 2007 China guideline for Type 2 diabetes and only 16.2% followed all treatment recommendations from healthcare providers. Of the patients, 46.0-68.6% of the patients showed positive psychological well-being. A quality-of-life survey showed that 28.5-50.6% of the patients experienced various diabetes-related emotional problems. Large percentages (approximately 50%) of patients were experiencing psychological insulin resistance.

CONCLUSIONS

Although in China therapies for Type 2 diabetes are more effective and available than ever before, the patient outcomes remain disappointing. Problems with glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life, all of which are key to diabetes control, are common among Chinese patients with Type 2 diabetes.

Measuring tumor hypoxia with ¹⁸F-FETNIM PET in esophageal squamous cell carcinoma: a pilot clinical study

The purpose of this study was to evaluate hypoxia in esophageal squamous cell carcinoma (SCC) with (18)F-fluoroerythronitroimidazole positron emission tomography/computed tomography ((18)F-FETNIM PET/CT). We determined an imaging threshold for hypoxia, quantified the spatiotemporal variability of hypoxia in untreated tumor, and evaluated the ability of (18)F-FETNIM PET to predict clinical response following concurrent chemoradiotherapy (CCRT). Twenty-eight consecutive patients with inoperable SCC of the esophagus were consecutively accrued between April 2007 and June 2010. The first 10 patients received two pretreatment (18)F-FETNIM PET/CT scans on separate days. The remaining 18 patients only underwent (18)F-FETNIM PET/CT once before CCRT. The ratio of the maximum standardized uptake value (SUV(max) ) of 336 normal tissue regions (i.e. heart, lung, brain, or muscle) to the mean standardized uptake value (SUV(mean)) of the respective patient's spleen was calculated, and the imaging threshold for hypoxia defined as the level of uptake demonstrated by less than 5% of tissue regions. Among the patients with two pretreatment scans, each pair of scans was compared with respect to location and intensity of uptake to assess for baseline spatiotemporal variability. Logistic regression analysis was used to determine whether pretreatment imaging characteristics are predictive of clinical response. The mean and median ratios of the SUV(max) of tissue : SUV(mean) of spleen were nearly identical, and 95% of the ratios fell below 1.3. The mean Dice similarity coefficient for the hypoxic volumes on pretreatment PET scans acquired in the same patient on different days was 0.12 (range, 0.05-0.21). Individuals' tumor SUV(max) and SUV(mean) did not vary significantly, but on average, the geometric centers of hypoxic regions shifted 15 mm (range, 8-20 mm) from the first pretreatment scan to the second. SUV(max) was the imaging characteristic most predictive of treatment response (P= 0.041), with high SUVmax associated with poor clinical response. (18)F-FETNIM PET/CT can depict hypoxia in esophageal SCC. Prior to CCRT, tumor hypoxia demonstrates spatial variability on different days, although overall (18)F-FETNIM uptake remains similar. Baseline SUV(max) may be predictive of treatment response.

Is epitope recognition of shrimp allergens useful to predict clinical reactivity?

BACKGROUND

Shrimp is a frequent cause of severe allergic reactions world-wide. Due to issues such as cross-reactivity, diagnosis of shrimp allergy is still inaccurate, requiring the need for double-blind, placebo-controlled food challenges (DBPCFC). A better understanding of the relationship between laboratory findings and clinical reactivity is needed.

OBJECTIVE

To determine whether sensitization to certain shrimp allergens or recognition of particular IgE epitopes of those allergens are good biomarkers of clinical reactivity to shrimp.

METHODS

Thirty-seven consecutive patients were selected with clinical histories of shrimp allergy. Skin prick test, specific IgE determinations, DBPCFC and immunoblot assays to shrimp extract were performed. IgE binding to synthetic overlapping peptides representing the sequence of the four allergens from the Pacific white shrimp (Litopenaeus vannamei) identified to date (Lit v1, Lit v2, Lit v3 and Lit v4) was analysed.

RESULTS

Of 37 (46%) patients, 17 had a positive challenge to shrimp (11 children and 6 adults). By microarray, patients with positive challenges showed more intense binding to shrimp peptides than those with negative challenges. Statistically significant differences in terms of the frequency and intensity of IgE binding to some epitopes were observed between the two groups. Diagnostic efficiency was higher for individual epitopes than for proteins. Particularly, efficiency was highest for certain Lit v 1 and Lit v 2 epitopes, followed by Lit v 3 and Lit v 4 epitopes.

CONCLUSION AND CLINICAL RELEVANCE

Patients with positive shrimp challenges present in general more intense and diverse epitope recognition to all four shrimp allergens. IgE antibodies to these shrimp epitopes could be used as biomarkers for prediction of clinical reactivity in subjects with sensitization to shrimp. Patients with positive shrimp challenges show more intense sensitization and more diverse epitope recognition. Several IgE-binding shrimp epitopes could be used as biomarkers for predicting clinical reactivity in subjects with sensitization to shrimp.

Transcriptional regulation of two RTE-like genes of carnation during flower senescence and upon ethylene exposure, wounding treatment and sucrose supply

RTE1 (REVERSION-TO-ETHYLENE SENSITIVITY1) was identified as a positive regulator of ETR1 (ethylene resistant1) function in Arabidopsis; RTEs are a small gene family. Ethylene plays a crucial role in the senescence of carnation (Dianthus caryophyllus L.) flowers. Two cDNA clones encoding putative RTE-like protein (DCRTE1 and DCRTH1) were obtained from total RNA isolated from senescing carnation petals using RT-PCR and RACE techniques. The predicted proteins of DCRTE1 and DCRTH1 consist of 228 and 233 amino acids, respectively. Interestingly, the deduced DCRTE1 protein, like most other RTEs, includes two putative transmembrane domains, while the deduced DCRTH1 protein includes five putative transmembrane domains, according to the TMHMM database. Northern blots showed that the level of DCRTE1 mRNA in petals first decreased then increased remarkably after ethylene production started, and DCRTE1 expression showed an increasing trend in ovaries during natural flower senescence. The amount of DCRTH1 transcripts increased gradually in both petals and ovaries during natural senescence. Exogenous ethylene increased transcript abundance of DCRTE1 and DCRTH1 to various degrees in both petals and ovaries. STS treatment decreased the level of DCRTH1 mRNA in petals and ovaries compared with the control. DCRTE1 and DCRTH1 showed a rapid increase and then a decrease in mRNA accumulation in leaves after wounding. These results suggest that both DCRTE1 and DCRTH1 could play important roles in flower senescence-related signalling. Sucrose treatment did not remarkably affect the amount of DCRTE1 and DCRTH1 mRNAs.

Cytotoxic T lymphocyte antigen 4 immunoglobulin modified dendritic cells attenuate allergic airway inflammation and hyperresponsiveness by regulating the development of T helper type 1 (Th1)/Th2 and Th2/regulatory T cell subsets in a murine model of asthma

T helper type 2 (Th2) and regulatory T cells (T(reg) ) have been postulated to have critical roles in the pathogenesis of allergic asthma. Cytotoxic T lymphocyte antigen 4 immunoglobulin (CTLA4Ig) gene-modified dendritic cells (DC-CTLA4Ig) have the potential to reduce Th2 cells and induce T(reg) cells. In the present study, we evaluated the therapeutic effects and potential mechanisms of the adoptive transfer of DC-CTLA4Ig into mice in an experimental model of asthma. BALB/c mice were sensitized with ovalbumin (OVA) and challenged with aerosolized OVA for 7 days. Just prior to the first challenge, DC-CTLA4Ig, DCs or DCs infected with DC-green fluorescent protein (GFP) were injected intravenously into mice. The administration of DC-CTLA4Ig reduced airway hyperresponsiveness, relieved asthmatic airway inflammation and decreased the numbers of esosinophils in the BALF in OVA-sensitized/challenged mice. In addition, DC-CTLA4Ig altered the balance of Th1/Th2 cytokine production in the lungs with increased interferon (IFN)-γ levels and decreased interleukin (IL)-4 levels, decreased the percentage of Th2 and increased both the percentage of Th1 and T(reg) cells in the lungs of OVA-sensitized/challenged mice. This research demonstrates that DC-CTL4Ig reduces airway hyperresponsiveness effectively and prevents airway inflammation in OVA-sensitized/challenged mice, which is due most probably to attenuated secretion of Th2 cytokines and increased secretion of Th1 cytokines in the local airway, and the correction of the pulmonary imbalance between Th1/Th2 cells and Th2/T(reg) cells.