Anti-Kelch-like protein 11 antibody encephalitis: a case report and literature review.

Anti-Kelch-like protein 11 (KLHL11) antibody encephalitis is a rare clinical condition characterized by autoimmune-mediated encephalomyelitis associated with the presence of KLHL11 antibodies. Diagnosis requires the detection of serum and cerebrospinal fluid anti-KLHL11 antibodies, while immunotherapy serves as the principal treatment approach. This paper presents a case report highlighting the emergence of anti-KLHL11 antibody encephalitis. A 66-year-old male patient presented with seizures, impaired cognitive function, disturbance of consciousness, apathy, hypologia, dysphoria, and ataxia. Serum and cerebrospinal fluid (CSF) were identified as positive for anti-KLHL11 antibodies, leading to a diagnosis of autoimmune encephalitis associated with KLHL11 antibodies. After treatment with glucocorticoid, the patient did not experience further convulsions and recovered consciousness, with improved cognitive function. Tumor screening suggested the presence of an underlying malignancy. The clinical manifestations of anti-KLHL11 antibody encephalitis vary widely, and timely identification and treatment can improve prognosis.

Prevalence of stroke and associated risk factors: a population-based cross-sectional study from the Qinghai-Tibet Plateau of China.

BACKGROUND AND OBJECTIVES: The epidemiology of stroke at high altitudes has not been extensively studied, especially at heights of 4000 m and above. Thus, stroke prevention and treatment at high altitudes are challenging. We conducted a cross-sectional study to estimate the prevalence of stroke, the detection rate of individuals at high risk of stroke and the risk factors for stroke in the Qinghai-Tibet Plateau in China, a high altitude plateau that inhabits approximately 15 million people. DESIGN: A population-based cross-sectional study in the Qinghai-Tibet Plateau. SETTING: Data were collected from participants through face-to-face screening using a primary screening table. The table relied on the China National Stroke Screening and Prevention Project. PARTICIPANTS: A total of 10 700 residents aged ≥40 years and living on the Qinghai-Tibet Plateau for more than 6 months participated from January 2019 to December 2021. MAIN OUTCOME MEASURES: The primary screening table included basic demographic information, medical history information, personal lifestyle habits and physical examination information. RESULTS: A total of 10 056 people were included in the analysis. The prevalence of stroke was 2.3% (95% CI 2.0% to 2.6%), and the detection rate of individuals at high risk of stroke was 26.2% (95% CI 25.3% to 27.0%). The prevalence of stroke and the detection rate of individuals at high risk of stroke increased with altitude (p<0.01), and the prevalence of stroke at high altitudes was almost 2.2 times that at mid-altitudes (p<0.01). After full adjustments, age, residence, hypertension, family history of stroke and smoking were significantly associated with stroke (p<0.05). CONCLUSIONS: The prevalence of stroke, the related risk factors and the detection rate of high-risk individuals were clarified. The prevalence rates of hypertension, overweight or obesity and diabetes in the Qinghai-Tibet Plateau were all higher than the Chinese average. Higher-altitude exposure may be an independent risk factor for stroke.

Research progress on the mechanism of cerebral blood flow regulation in hypoxia environment at plateau.

The plateau is a special environment with low air pressure and low oxygen content. The average altitude of Qinghai-Tibet is 3,500 m, and the atmospheric oxygen partial pressure in most areas is lower than 60% of that at sea level. In order to adapt to the plateau low-oxygen environment, the human body has developed corresponding physiological structure and functions adjust. In the present review, the regulation mechanism of cerebral blood flow (CBF) under high-altitude environments was elaborated in eight aspects: the arterial blood gas, endogenous substances in the nerve and blood, the cerebral neovascularization, the hematocrit, cerebral auto-regulation mechanism, cerebrovascular reactivity, pulmonary vasoconstriction, and sympathetic automatic regulation, aiming to further explore the characteristics of changes in brain tissue and cerebral blood flow in a hypoxic environment.

A high triglyceride glucose index is associated with early renal impairment in the hypertensive patients.

Objective: Serum ß2-microglobulin (ß2-MG) and serum cystatin C (CysC) are sensitive and reliable indicators of early renal impairment. Triglyceride glucose index (TyG) is an emerging vital indicator of insulin resistance and is associated with increased risk of hypertension. We aimed to analyze the relationship between TyG and early renal impairment in hypertensive patients. Methods: A retrospective analysis was performed on 881 hypertensive patients treated in Qinghai Provincial People, s Hospital from March 2018 to March 2021, their clinical data and corresponding laboratory index values were recorded, and the TyG index was calculated. According to the TyG index, the patients were divided into a low TyG (L-TyG) group (TyG ≤ 8.50, n=306), medium TyG (M-TyG) group (8.51≤TyG ≤ 8.94, n=281), and high TyG (H-TyG) group (TyG>8.95, n=294) in sequence by using tertiles. Then, according to serum ß2-MG and CysC levels, they were divided into a normal renal function group (ß2-MG ≤ 2.4 mg/L, n=700 and CysC ≤ 1.25mg/L, n=721) and a renal function injury group (ß2-MG>2.4 mg/L, n=181, and CysC>1.25 mg/L, n=160). Multivariate linear regression analysis was used to analyze the influencing factors of serum ß2-microglobulin and cystatin C. Multivariate Logistic regression was used to analyze the relationship between the TyG index and early renal impairment in hypertensive patients. The receiver operating characteristic curve (ROC) was used to determine the value of the TyG index in predicting early renal impairment in patients with hypertension. Result: As the TyG index level increased, serum ß2-MG and CysC levels also gradually increased. Multivariate linear regression analysis showed that TyG index was the influencing factor of serum ß2-MG (B=0.060, P=0.007) and serum CysC (B=0.096, P<0.001). For every 1 standard deviation increase in the TyG index, the serum ß2-MG and CysC increased by 0.06mg/L and 0.096mg/L, respectively. When compared to the normal group, the TyG level (8.91 ± 0.65 vs 8.64 ± 0.60, P<0.001) was higher in the renal impairment group with ß2-MG>2.4 mg/L. The results of multivariate logistic regression analysis revealed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 1.53 times (OR=1.53, 95%CI 1.006-2.303).The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.623 and 0.617, respectively. Then, when CysC>1.25 mg/L was used as the renal damage group, the level of TyG was still higher than that in the normal group (8.94 ± 0.67 and 8.64 ± 0.60, P<0.001). Multivariate Logistic regression analysis showed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 2.82 times (OR=2.82, 95%CI 1.863-4.262). The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.629 and 0.626, respectively. Conclusion: TyG index is an influential factor in serum ß2-MG and CysC levels. The elevated TyG index levels are closely associated with the occurrence and development of early renal impairment in hypertensive patients, but it should be used cautiously in the prediction of early renal impairment.

Triglyceride-glucose index is a predictive index of hyperuricemia events in elderly patients with hypertension: a cross-sectional study.

BACKGROUND: To analyze the association between triglyceride-glucose index (TYG index) and hyperuricemia (HUA) in elderly patients with hypertension. METHODS: A total of 428 inpatients with primary hypertension from March 2018 to March 2021 in Qinghai Provincial People's Hospital were retrospectively analyzed. Grouped by sex and serum uric acid. Serum uric acid (SUA), fasting blood glucose (FPG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum creatinine (Scr), urea nitrogen (BUN), triglycerides (TG), high-sensitivity C-reactive protein (HS-CRP) and other biochemical indicators were measured, and the TYG index was calculated. The TYG index and SUA levels of each group were compared, and the correlation between TYG index and hyperuricemia was analyzed. Multivariate Logistic regression was performed to analyze the relationship between TYG index and the risk of HUA in elderly patients with hypertension. The ROC curve was used to evaluate the predictive value of TYG index in elderly patients with hypertension associated with HUA. RESULTS: TYG index was significantly higher in the HUA group than in the normal group in both men and women (P < .05). Spearson correlation analysis showed that TYG index positively correlated with TC, TG, FPG, SUA, and LDL-C(r = 0.327, 0.975, 0.412, 0.214, 0.215, P = .000, 0.000, 0.000, 0.000, 0.000), and negatively correlated with age and HDL-C (r = -0.166, -0.248, P = .001, 0.000). Logistic regression analysis showed that Scr, BUN, HS-CRP and TYG index were the risk factors for HUA in elderly patients with hypertension (P < .05).The ROC curve showed an area under the TYG exponential curve of 0.617(95%CI:0.561 ~ 0.673) with a sensitivity of 64.4% and a specificity of 57.4%. CONCLUSION: TYG index in elderly hypertensive patients is closely related to hyperuricemia, and the increase of TYG index is an independent risk factor for HUA in elderly hypertensive patients.

Down-regulation of microRNA-342-5p or Up-regulation of Wnt3a Inhibits Angiogenesis and Maintains Atherosclerotic Plaque Stability in Atherosclerosis Mice.

Evidence has demonstrated that microRNA-342-5p (miR-342-5p) is implicated in atherosclerosis (AS), but little is known regarding its intrinsic regulatory mechanisms. Here, we aimed to explore the effect of miR-342-5p targeting Wnt3a on formation of vulnerable plaques and angiogenesis of AS. ApoE-/- mice were fed with high-fat feed for 16 w to replicate the AS vulnerable plaque model. miR-342-5p and Wnt3a expression in aortic tissues of AS were detected. The target relationship between miR-342-5p and Wnt3a was verified. Moreover, ApoE-/- mice were injected with miR-342-5p antagomir and overexpression-Wnt3a vector to test their functions in serum lipid levels, inflammatory and oxidative stress-related cytokines, aortic plaque stability and angiogenesis in plaque of AS mice. miR-342-5p expression was enhanced and Wnt3a expression was degraded in aortic tissues of AS mice and miR-342-5p directly targeted Wnt3a. Up-regulating Wnt3a or down-regulating miR-342-5p reduced blood lipid content, inflammatory and oxidative stress levels, the vulnerability of aortic tissue plaque and inhibited angiogenesis in aortic plaque of AS mice. Functional studies show that depleting miR-342-5p can stabilize aortic tissue plaque and reduce angiogenesis in plaque in AS mice via restoring Wnt3a.

Recommendations for the diagnosis and treatment of paroxysmal kinesigenic dyskinesia: an expert consensus in China.

Paroxysmal dyskinesias are a group of neurological diseases characterized by intermittent episodes of involuntary movements with different causes. Paroxysmal kinesigenic dyskinesia (PKD) is the most common type of paroxysmal dyskinesia and can be divided into primary and secondary types based on the etiology. Clinically, PKD is characterized by recurrent and transient attacks of involuntary movements precipitated by a sudden voluntary action. The major cause of primary PKD is genetic abnormalities, and the inheritance pattern of PKD is mainly autosomal-dominant with incomplete penetrance. The proline-rich transmembrane protein 2 (PRRT2) was the first identified causative gene of PKD, accounting for the majority of PKD cases worldwide. An increasing number of studies has revealed the clinical and genetic characteristics, as well as the underlying mechanisms of PKD. By seeking the views of domestic experts, we propose an expert consensus regarding the diagnosis and treatment of PKD to help establish standardized clinical evaluation and therapies for PKD. In this consensus, we review the clinical manifestations, etiology, clinical diagnostic criteria and therapeutic recommendations for PKD, and results of genetic analyses in PKD patients performed in domestic hospitals.

[An epidemiological study on essential hypertension in northern and western areas of China].

OBJECTIVE: To understand the epidemiological characteristics of essential hypertension in the northern and western areas of China. METHODS: A community-based sampling survey. RESULTS: Rates of awareness, treatment and control were 78.6%, 59.7% and 5.9%, respectively. About half of the diagnosed and treated patients took antihypertensive medicine irregularly before the survey was carried out. CONCLUSION: It is necessary to carry out education, prevention and control on hypertension and to establish a series of standards for the management and treatment on cases of hypertension.