Braided scaffolds with polypyrrole/polydopamine/hydroxyapatite coatings with electrical conductivity and osteogenic properties for bone tissue engineering.

When impaired bones are grafted with bone scaffolds, the behaviors of osteoblast are dependent on the implant materials and surface morphology. To this end, we modulated the surface morphology of scaffolds that promote cell growth. In this study, ice-template and spraying method methods are employed to coat different proportions of PDA and PPy over the PLA/PVA weaving scaffolds, after which HA is Coated over via the electrochemical deposition, forming weaving scaffolds with electrically conductive PDA/PPy/HA coating. The test results indicate that with a PPy/PDA concentration ratio is 30, the PPy particles are more uniformly distributed on the fiber surface. The scaffolds are wrapped in a HA coating layer with a high purity, and calcium and phosphorus elements are evenly dispersed with a Ca/P ratio being 1.69. Owing to the synergistic effect between PDA and PPy coating, the scaffolds demonstrate excellent electrochemical stability and electrochemical activity. The biological activity of the scaffold increased to 274.66% under electrical stimulation. The new thinking proposed by this study extends the worth of applying textile structure to the medical field, the application of which highly increases the prospect of bone tissue engineering.

Enhancing mechanical and photocatalytic properties by surface microstructure regulation of TiO2 nanofiber membranes.

In this work, TiO2 nanofiber membrane (NFM) with a complete surface microstructure was prepared through regulating the surface microstructure of TiO2 NFM by doping Zr. The crystal structures and morphological analyses indicated that the nanofiber membranes were consisted by disordered accumulation of Zr-doped TiO2 nanofibers with a crack-free surface, small grain size and high aspect ratio. When the doping amount of Zr was 0.8 mL, the tensile strength of the doped membranes reached 1.27 MPa, which was 60.7% higher than that of pure TiO2 NFM. The photocatalytic performance of Zr-doped TiO2 NFM was evaluated by the degradation performance of Methylene orange (MO) under simulated sunlight irradiation. Compared with the undoped TiO2 NFM, the 0.8-Zr/TiO2 NFM presented a higher catalytic degradation efficiency (improved by 69.6%), and the photocatalytic performance maintained stable after five circulating. It was found that the doping of Zr ions effectively limited the surface crack size and grain size of TiO2 nanofibers, thereby improving the tensile strength, and enhanced the surface area effect and carrier transfer efficiency of TiO2 NFM. On the other hand, a narrow band-gap was obtained by doping a small amount of Zr ions, which expanded the visible light response range to improve the photocatalytic performance of TiO2 nanofibers.

pH-responsive nonwoven fabric with reversibly wettability for controllable oil-water separation and heavy metal removal.

Removal of organic solvents and heavy metals in effluents is of great significance to environmental pollution control and ecological civilization construction. pH-responsive materials have unique advantages in treating complicated oily wastewater. In this work, an intelligent pH-responsive nonwoven fabric with excellent reversible wettability was prepared. The pH-sensitive polymer was synthesized by free radical polymerization (FRP) technique, then dipped with SiO2 on PP fabric. The particular molecular structure of poly (dimethylaminoethyl methacrylate) (PDMAEMA) enabled the fabric surface to switch wettability rapidly between hydrophilic/underwater oleophobic and oleophobic/hydrophobic under pH stimulus and exhibit controllable selective separation of various oil/water mixtures. Furthermore, the fabric removed Pb2+ efficiently under a wide pH range. The experimetal results showed that the separation flux reached 19,229 ± 1656.43 L-h-1-m-2 for water and 19,342 ± 1796.77 L-m-2-h-1 for n-hexane. Besides, the obtained fabric effectively realized the separation and collection process of complex ternary mixtures. The fabric removed Pb2+ in solutions with efficiency up to 90.83%. After immersing in acid and alkali solutions for 24 h, no significant damage to the surface wettability. This economical and intelligent fabric is able to meet the different separation purposes of industrial wastewaters with complex compositions.

Next-generation sequencing combined with serological tests based pathogen analysis for a neurocysticercosis patient with a 20-year history:a case report.

BACKGROUND: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS) caused by the larval stage of Taenia solium. Accurate and early diagnosis of NCC remains challenging due to its heterogeneous clinical manifestations, neuroimaging deficits, variable sensitivity, and specificity of serological tests. Next-generation sequencing (NGS)-based pathogen analysis in patient's cerebrospinal fluid (CSF) with NCC infection has recently been reported indicating its diagnostic efficacy. In this case study, we report the diagnosis of a NCC patient with a symptomatic history of over 20 years using NGS analysis and further confirmation of the pathology by immunological tests. CASE PRESENTATION: This study reports the clinical imaging and immunological features of a patient with a recurrent headache for more than 20 years, which worsened gradually with the symptom of fever for more than 7 years and paroxysmal amaurosis for more than 1 year. By utilizing NGS technique, the pathogen was detected in patient's CSF, and the presence of Taenia solium-DNA was confirmed by a positive immunological reaction to cysticercus IgG antibody in CSF and serum samples. The symptoms of the patient were alleviated, and the CSF condition was improved substantially after the anti-helminthic treatment. CONCLUSIONS: This study suggests that combining CSF NGS with cysticercus IgG testing may be a highly promising approach for diagnosing the challenging cases of NCC. Further studies are needed to evaluate the parasitic DNA load in patients' CSF for the diagnosis of disease severity, stage, and monitoring of therapeutic responses.

Dual-Shell Photothermoelectric Textile Based on a PPy Photothermal Layer for Solar Thermal Energy Harvesting.

To simply and effectively enhance the conversion capability of wearable thermoelectric textiles, a two-step in situ method is adopted to fabricate dual-shell photothermoelectric textiles which is made of polypropylene fibers with a photo-thermal layer (PPy) and a thermoelectric layer (PEDOT:Tos). The PPy is tailored to achieve high temperature and photothermoelectric effects. The PPy layer can significantly increase the photothermal conversion efficiencies of as-prepared fabric. The optimized photothermoelectric fabric can improve the generated voltage output from 294.13 to 536.47 µV under the infrared light, and its power density is up to 13.76 nW·m-2. A flexible photothermoelectric strip composed of as-prepared fabric coated with Ag particles and textile substrates with low thermal conductivity shows a voltage output of 2.25, 0.677, and 0.183 mV and a power output of 0.7031, 0.0636, and 0.0049 nW under IR light, sunlight, and on the arm, respectively. The photothermoelectric fabrics display potential as to a new smart wearable device for converting light and electricity.

Polypropylene/Polyvinyl Alcohol/Metal-Organic Framework-Based Melt-Blown Electrospun Composite Membranes for Highly Efficient Filtration of PM2.5.

Particulate matter 2.5 (PM2.5) has become a public hazard to people's lives and health. Traditional melt-blown membranes cannot filter dangerous particles due to their limited diameter, and ultra-fine electrospinning fibers are vulnerable to external forces. Therefore, creating highly efficient air filters by using an innovative technique and structure has become necessary. In this study, a combination of polypropylene (PP) melt-blown and polyvinyl alcohol (PVA)/zeolite imidazole frameworks-8 (ZIF-8) electrospinning technique is employed to construct a PP/PVA/ZIF-8 membrane with a hierarchical fibrous structure. The synergistic effect of hierarchical fibrous structure and ZIF-8 effectively captures PM2.5. The PP/PVA composite membrane loaded with 2.5% loading ZIF-8 has an average filtration efficacy reaching as high as 96.5% for PM2.5 and quality factor (Qf) of 0.099 Pa-1. The resultant membrane resists 33.34 N tensile strength and has a low pressure drop, excellent filtration efficiency, and mechanical strength. This work presents a facile preparation method that is suitable for mass production and the application of membranes to be used as air filters for highly efficient filtration of PM2.5.

In situ growth polydopamine decorated polypropylen melt-blown membrane for highly efficient oil/water separation.

The removal of organic pollutants from water is highly desired because of the development of industrial and social economy. Superhydrophilic and underwater superoleophobic membranes are emerging materials for effective oil/water separation. In this paper, superhydrophilic and underwater superoleophobic polypropylene (PP) melt-blown membranes were prepared through melt-blown and in situ growth method, achieving highly efficient oil/water separation. After in situ growth, polydopamine (PDA) grows on the surface of PP fibers, and the addition of coupling agent (3-aminopropyltriethoxysilane, APTES) can improve the stability of the membrane in harsh environments (1 M HCl, 1 M NaOH, 1 M NaCl). The PDA/APTES@PP membrane could dramatically enhance the wetting (water contact angle ∼0, underwater oil contact angle∼154°) compare with the pristine PP melt-blown membrane (water contact angle ∼130°, underwater oil contact angle ∼0). Moreover, the filtration performance is at a high level (∼99%). The behaviors are comparable or even superior to the typical reported results in the references (such as the mussel-inspired superhydrophilic PVDF membrane and copper mesh). This method provides a facile route to prepared multi-functional membrane for highly efficiency oil/water separation and industrial oily wastewater remediation.

Bioinspired design of underwater superoleophobic Poly(N-isopropylacrylamide)/ polyacrylonitrile/TiO2 nanofibrous membranes for highly efficient oil/water separation and photocatalysis.

Inspired by fish scales, this study prepares a thermo-responsive underwater oleophobic PNIPAM/PAN/TiO2 nanofibrous membranes by traditional electrospinning technique using poly-N-isopropylacrylamide (PNIPAM) and polyacrylonitrile (PAN). Thermal properties, mechanical properties, surface chemical composition, wettability, photocatalysis, and oil/water separation of PNIPAM/PAN/TiO2 membrane are explored compared to pure PNIPAM membrane. Result reveals that PAN/TiO2 compounds make PNIPAM membrane with a smaller fiber diameter of 141 nm and high tensile stress of 7.4 MPa, and also decompose 98% of rhodamine B after UV light radiation. This bioinspired design structure endows the membrane with superhydrophilicity with a low water contact angle, and underwater superoleophobicity with a high oil contact angle of 157° (petroleum ether) and 151° (dichloromethane). This membrane can efficiency separate oil/water mixture with a high separation efficiency. Moreover, the resultant PNIPAM/PAN/TiO2 membrane has the bionic fish scale structure, and has wettability respond at lower critical solution temperature making the water flux decreased from 10013 ± 367 L m-2·h-1 to 7713 ± 324 L m-2·h-1, and thus has a potential to be used in purification of reclaimed water and separation of oil from water.

Zeolitic Imidazolate Framework-8/Polypropylene-Polycarbonate Barklike Meltblown Fibrous Membranes by a Facile in Situ Growth Method for Efficient PM2.5 Capture.

Environmental pollution, especially air pollution, seriously endangers public health globally. Due to severe air pollution, air filters still face many challenges, especially in terms of filtration performance and filtration stability. Herein, a zeolitic imidazolate framework-8/polypropylene-polycarbonate barklike meltblown fibrous membrane (PPC/ZIF-8) was designed through meltblown and an in situ growth method, achieving efficient PM2.5 capture and high filtration stability under a harsh environment. After in situ growth, the PPC/ZIF-8 membrane could dramatically enhance the PM2.5 filtration efficiency without increasing the pressure drop; the PM2.5 filtration efficiency and quality factor were up to 32.83 and 116.86% higher than those of the pure PPC membrane, respectively. Moreover, through five filtration-wash-dry cycles, the PM2.5 filtration performance is still at a high level. This PPC/ZIF-8 membrane provides a new strategy for the preparation of an air filter with excellent comprehensive filtration performance.

One-Step Bark-Like Imitated Polypropylene (PP)/Polycarbonate (PC) Nanofibrous Meltblown Membrane for Efficient Particulate Matter Removal.

A bark-like imitated polypr opylene (PP)/polycarbonate (PC) nanofibrous membrane was constructed by one-step meltblown technique for efficient particulate matter (PM) removal. The effects of PC content (0%, 1%, 3%, 5%, and 7%) on membrane thermal stability, microscopic characteristics, filtration performance, hydrophilicity, and water vapor transmission were investigated. The results demonstrated that using facile design of incompatibility and viscosity difference between PC and PP polymers decreases average fiber diameter, creating a bark-like groove appearance and increasing surface potential, making a new PP/PC membrane with high filtration performance. The resultant PP/PC membrane had finer average fiber diameter of 0.63 µm, which was nearly 89.41% lower than PP membranes (5.95 µm), and its quality factor (0.036 Pa-1) was nearly 2.12 times than that of PP membranes (0.017 Pa-1) with the die hole diameter of 0.5 mm. This fabrication technique of a special meltblown filter membrane saves the cost of die retrofitting and post-processing, which provides an innovative method for particulate efficient removal of high efficient filters.

[Clinical Characteristics of Autoimmune Disease with Dual Seropositive Antibodies of Leucine-rich Glioma Inactivated 1 and Contactin-associated Protein 2].

Objective To explore the clinical characteristics of autoimmune disease with dual seropositive antibodies of leucine-rich glioma inactivated 1(LGI1)and contactin-associated protein 2(Caspr2).Methods The clinical data of seven patients with dual seropositive LGI1 and Caspr2 antibodies who were admitted to the Neurology Department of Peking Union Medical College Hospital from July 2014 to December 2017 were retrospectively analyzed.Results Central,peripheral and autonomic nervous systems were all involved in the seven cases;100%(7/7)presented with insomnia,myokymia,neuropahic pain and hyperhydrosis;71%(5/7)showed memory decline or psychiatric and behavioral symptoms;57%(4/7)had urinary hesitation or constipation;and 43%(3/7)had seizure.Electromyography showed 100%(6/6) of the patients had prolonged afterdischarges following normal M waves and/or abnormal spontaneous firing.Electroencephalography revealed slow waves or basic rhythm slowing in 71%(5/7)of patients.Electrocardiography showed sinus tachycardia,axis deviation,and prolonged QT intervals in 71%(5/7)of patients.One patient died from arrhythmia before immunotherapy.One died from pulmonary infection after immunotherapy.Improvement with immunotherapy was documented in the other five cases.No relapse was noted during the 1-2-year follow-up.Conclusions Autoimmune disease with dual seropositive antibodies of LGI1 and Caspr2 can diffusely affect the central,peripheral,and autonomic nervous systems.The possibility of this disease should be considered in patients with acute and subacute onset of neuropsychiatric symptoms,especially in patients with accompanying insomnia,myokymia,and hyperhydrosis.

Mutation of the cellular adhesion molecule NECL2 is associated with neuromyelitis optica spectrum disorder.

AIMS: To investigate the association of the Nectin/Necl family genes with the risk of developing NMOSD. METHODS: Whole-exome sequencing was performed on two familial NMOSD cases and two unaffected family members. Additionally, 106 patients with sporadic NMOSD and 212 healthy controls (HCs) underwent screening for mutant Necl2. Finally, the molecular weight and cellular localization of mutant NECL2 was examined in transfected HeLa cells. RESULTS: We identified a novel deletion mutation in Necl2 (c.1052_1060delCCACCACCA; p. Thr351_Thr353del), which was associated with disease manifestation in the NMOSD familial cases. The frequency at which the mutation occurred in patients with sporadic NMOSD was significantly higher than for HCs (5.7% and 0, respectively; p<0.01). The mutation was located in the extracellular domain close to the transmembrane region, at a point in the protein sequence characterized by threonine enrichment. The mutant NECL2 had a lower molecular weight and exhibited defective trafficking to the cell surface. CONCLUSIONS: Our results suggest that the Necl2 mutation identified herein may be associated with the risk of developing NMOSD. Furthermore, mutated NECL2 may play a role in the pathogenesis of the disease, potentially through its roles in axonal regeneration and/or via neuron-glia interactions that are relevant to myelination.

[A comparative analysis of anti-N-methyl-D-aspartate receptor encephalitis with or without abnormal findings on cranial magnetic resonance imaging].

OBJECTIVE: To investigate the clinical features of children with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis with normal or abnormal cranial magnetic resonance imaging (MRI) findings via a comparative analysis. METHODS: A retrospective analysis was performed for the clinical data of 33 children with anti-NMDAR encephalitis. The clinical features and prognosis were compared between the children with normal and abnormal cranial MRI findings. RESULTS: In the 33 children with anti-NMDAR encephalitis, the most common initial symptoms were seizures (61%) and involuntary movement (61%), followed by language disorder (54%), mental and behavioral abnormalities (52%), and disturbance of consciousness (30%). All children had positive anti-NMDAR antibody in the cerebrospinal fluid, and 29 children (88%) had positive serum antibody. Of all the children, 15 (46%) had increased leukocytes in the cerebrospinal fluid, 3 (9%) had an increase in protein, and 29 (88%) had positive oligoclonal band; 26 children (79%) had electroencephalographic abnormalities (epileptic wave, slow wave, or a combination of these two types of waves). One child experienced respiratory failure. One child was found to have germinoma in the sellar region during follow-up. Of all the 33 children, 13 (39%) had abnormal cranial MRI findings, with hypointensity or isointensity on T1W1 and hyperintensity on T2WI and T2-FLAIR; 2 children had dural enhancement. As for the location of lesion, 5 children (38%) had lesions in the temporal lobe, 3 (23%) in the frontal lobe, 3 (23%) in the basal ganglia, 2 (15%) in the parietal lobe, 2 (15%) in the occipital lobe, 2 (15%) in the brainstem, 1 (8%) in the thalamus, and 1 (8%) in the cerebellum. Among the 13 children with abnormal cranial MRI findings, 5 (38%) had lesions mainly in the grey matter and 8 (62%) had lesions mainly in the white matter. Compared with the children with normal cranial MRI findings, the children with abnormal cranial MRI findings had significantly higher proportion of children with prodromal infection, incidence rate of disturbance of consciousness, probability of recurrence, Glasgow score, incidence rate of increased leukocytes in the cerebrospinal fluid, and application rate of second-line treatment (P<0.05). CONCLUSIONS: Children with anti-NMDAR encephalitis and abnormal cranial MRI findings have certain clinical features, which may provide guidance for the evaluation of disease conditions and the selection of diagnostic and treatment measures.

Utility and Safety of Intrathecal Methotrexate Treatment in Severe Anti-N-methyl-D-aspartate Receptor Encephalitis: A Pilot Study.

BACKGROUND: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune neurologic syndrome that occurs with or without tumor association. However, some severe cases are refractory to systemic immunotherapy. This pilot study aimed to evaluate the utility and safety of intrathecal methotrexate injection for severe patients with anti-NMDAR encephalitis who did not respond to first-line immunotherapy. METHODS: Intrathecal injections with methotrexate and dexamethasone were performed weekly in four legible patients within consecutive 4 weeks. Cerebrospinal fluid (CSF) was collected at baseline and each time of intrathecal injection for identification of anti-NMDAR antibody titers. RESULTS: Significant clinical improvement was observed in three patients associated with a stepwise decrease of CSF anti-NMDAR antibody titers (maximum: 1/320 to minimum: 1/10). After 2 months of follow-up, they were able to follow simple commands and had appropriate interactions with people (modified Rankin scale [mRS] of 0-2). At 12 months of follow-up, they all had returned to most activities of daily life (mRS of 0), and no relapses were reported. One patient showed no clinical improvement and died of neurologic complications. CONCLUSIONS: Intrathecal treatment may be a potentially useful supplementary therapy in severely affected patients with anti-NMDAR encephalitis. Further large cohort study and animal experiment may help us elaborate the utility of intrathecal injection of methotrexate and its mechanism of action.

Seizure semiology in leucine-rich glioma-inactivated protein 1 antibody-associated limbic encephalitis.

OBJECTIVE: The objective of this study was to advance the characterization of seizure semiology in leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated limbic encephalitis (LE). METHODS: Eighteen patients diagnosed with LGI1 LE were identified. Seizure semiology, demographic features, MRI and fluorodeoxyglucose positron emission tomography (FDG-PET), electroencephalograms, and outcomes following immunotherapy were evaluated. RESULTS: Patients were divided into the following groups based on seizure semiology: faciobrachial dystonic seizure only (FBDS-only, n=4), epileptic seizure without FBDS (Non-FBDS, n=6), and FBDS plus epileptic seizure (FBDS+, n=8). In the group with Non-FBDS, the majority of patients (5/6) manifested mesial temporal lobe epilepsy (MTLE) like semiology (i.e., fear, epigastric rising, staring, and automatisms) with a frequency of 7±5 times per day and a duration of 15.3±14.3s. In the group with FBDS+, the distinctive symptom was FBDS followed by epileptic events, especially automatisms (7/8), with a frequency of 16±12 times per day and a duration of 13.0±8.0s. In these cases, 67% and 50% of the patients showed abnormalities on MRI and FDG-PET, respectively, and the mesial temporal lobe structures were most often involved. Ictal discharges were observed in 0/4, 6/6, and 8/8 of the patients in the groups with FBDS only, Non-FBDS, and FBDS+, respectively. The temporal lobe was mainly affected. Immunotherapy had favorable therapeutic effects. SIGNIFICANCE: The LGI1 LE should be considered as one disease syndrome with a series of clinical manifestation. Identifying types of unique semiology features will facilitate the early diagnosis and the timely initiation of immunotherapy.

A Chinese female Morvan patient with LGI1 and CASPR2 antibodies: a case report.

BACKGROUND: Morvan syndrome is a rare disorder characterized by the combination of peripheral nerve hyperexcitability, encephalopathy and dysautonomia with marked insomnia. It was reported to have association to antibodies to voltage-gated potassium channels including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab). LGI1-Ab was reported to associate with seizures, amnesia, confusion, hyponatraemia and a good prognosis, while CASPR2-Ab with peripheral presentations, probable risk for tumor and a poor prognosis. The vast majority of Morvan syndrome patients were male, with normal magnetic resonance imaging of the brain. CASE PRESENTATION: We report a female case presenting with a combination of bilateral leg pain, widespread myokymia, memory disturbance, seizure, hyperhidrosis and insomnia. She had antibodies targeting CASPR2 and LGI1, tested by the indirect immunofluorescence test, which demonstrated the diagnosis of typical Morvan syndrome as well as classical limbic encephalitis. Cranial MRI revealed bilateral hyper-intensity of the medial temporal lobe, insular lobe and basal ganglia on T2/FLAIR and DWI sequence. As the treatment carried on, her serum LGI1-Ab disappeared and her memory loss, seizure and confusion quickly relieved. But her peripheral presentations did not relieve until serum CASPR2-Ab turned negative. Intravenous immunoglobulin treatment showed limited efficacy while she achieved almost complete remission with corticosteroids therapy. CONCLUSIONS: This case provides a rare female resource of Morvan syndrome, which is the first patient with both CASPR2-Ab and LGI1-Ab positive Morvan syndrome in China and one of the few female patients with Morvan syndrome reported so far. Through the detailed analysis of her clinical course, the diverse and overlapping clinical phenotype of CASPR2-Ab and LGI1-Ab in patients with Morvan syndrome was obvious and interesting.

Two new 28-nor-oleanane-type triterpene saponins from roots of Camellia oleifera and their cytotoxic activity.

Two new 28-nor-oleanane-type triterpene saponins, oleiferoside U (1), and oleiferoside V (2) were isolated from the 50% EtOH extract of the roots of Camellia oleifera C. Abel. Their structures were elucidated as camellenodiol 3ß-O-ß-d-galactopyranosyl-(1→2)-ß-d-xylopyranosyl-(1→2)-[ß-d-galactopyranosyl-(1→3)]-ß-d-glucuronopyranoside and camellenodiol 3ß-O-ß-d-galactopyranosyl-(1→3)-ß-d-xylopyranosyl-(1→2)-[ß-d-galactopyranosyl-(1→3)]-ß-d-glucuronopyranoside. Their chemical structures were established mainly on the basis of integrated spectroscopic techniques. In vitro, cytotoxic activities of the two new triterpene saponins were evaluated against three human tumor cell lines (A549, SMMC-7721, and MCF-7) using the MTT assay. Both of them showed a certain cytotoxic activities toward the tested cell lines and gave IC50 values in the range of 45.04-63.22 µM.

Limbic Encephalitis Associated with Anti-γ-aminobutyric Acid B Receptor Antibodies: A Case Series from China.

BACKGROUND: Autoimmune encephalitis associated with antibodies against γ-aminobutyric acid B receptor (GABA B R) in patients with limbic encephalitis (LE) was first described in 2010. We present a series of Han Chinese patients for further clinical refinement. METHODS: Serum and cerebrospinal fluid (CSF) samples from patients referred to the program of encephalitis and paraneoplastic syndrome of Peking Union Medical College Hospital were tested with indirect immunofluorescence. Clinical information of patients with anti-GABA B R antibody positivity was retrospectively reviewed, and descriptive statistical analysis was performed. RESULTS: All eighteen anti-GABA B R antibody-positive cases had limbic syndromes, and electroencephalogram (EEG) or neuroimaging evidence fulfilled the diagnostic criteria of LE. Four patients had additional antibodies against Hu in serum and one had anti-N-methyl-d-aspartate receptor antibody in both sera and CSF. Seventeen (17/18) patients presented with new-onset refractory seizure or status epileptics. Twelve (12/18) patients had memory deficits, 11 (11/18) patients had personality change, 7 (7/18) patients had disturbance of consciousness, and 3 (3/18) patients showed cerebellar dysfunction. One patient with LE had progressive motor and sensory polyneuropathy. Lung cancer was detected in 6 (6/18) patients. Ten (10/18) patients showed abnormality in bilateral or unilateral mediotemporal region on magnetic resonance imaging. Ten (10/18) patients had temporal lobe epileptic activity with or without general slowing on EEG. Seventeen patients received immunotherapy and 15 of them showed neurological improvement. Four patients with lung cancer died within 1-12 months due to neoplastic complications. CONCLUSIONS: Our study demonstrates that most Han Chinese patients with anti-GABA B R antibody-associated LE have prominent refractory epilepsy and show neurological improvement on immunotherapy. Patients with underlying lung tumor have a relatively poor prognosis. Testing for anti-GABA B R antibodies is necessary for patients with possible LE or new-onset epilepsy with unknown etiology.

Anti-NMDAR encephalitis after resection of melanocytic nevi: report of two cases.

BACKGROUND: Encephalitis with antibodies against N-methyl D-aspartate receptor (NMDAR) is recognized as a group of antibody-mediated neuropsychiatric syndromes, which occurs with and without a tumor association. Neoplasm may contribute to the pathogenesis of Anti-NMDAR encephalitis in tumor-positive patients. However, the underlying causes in tumor-negative patients are largely unknown. This is the first report, of which we are aware, of two cases of anti-NMDAR encephalitis after the resection of melanocytic nevus. CASE PRESENTATION: We describe 2 female patients in their 20s confirmed with anti-NMDAR encephalitis. They shared two points in common: About several weeks (2 weeks and 5 weeks respectively) before the initial symptom, both of them underwent a resection of melanocytic nevi; the screening tests for an ovarian teratoma and other tumors were all negative. A 25 year-old woman presented with seizure, psychiatric symptoms and behavioral change for 2 weeks. Electroencephalogram indicated electrographic seizures. Anti-NMDAR antibodies were all positive in the cerebrospinal fluid and serum. Her symptoms relieved gradually after the treatment with steroids and mycophenolate mofetil. Another patient admitted to our hospital with psychosis, behavioral change and complex partial seizure over a period of 5 months. Electroencephalogram demonstrated generalized slow activities. High titres of anti-NMDAR antibodies were both detected in the cerebrospinal fluid and serum. She responded well to the first-line immunotherapy and got substantial recovery. CONCLUSION: Our cases provided an observational link between anti-NMDAR encephalitis and resection of nevi. We postulate that the exposure of certain antigen on nevus cell caused by nevi excision, which might be NMDA receptor or other mimic cross-reactive antigens, may trigger an autoimmune response resulting in encephalitis. This suggested a potential site of antigen exposure triggering the immune response in non-tumor associated anti-NMDAR encephalitis, which may lend support to elucidating the underlying immunopathological mechanisms. Further studies are expected for investigating the expression of NMDA receptor on nevus cell and evaluating the validity of this hypothesis.