Metabolomic and gut-microbial responses of earthworms exposed to microcystins and nano zero-valent iron in soil.

The earthworm-based vermiremediation facilitated with benign chemicals such as nano zero-valent iron (nZVI) is a promising approach for the remediation of a variety of soil contaminants including cyanotoxins. As the most toxic cyanotoxin, microcystin-LR (MC-LR) enter soil via runoff, irrigated surface water and sewage, and the application of cyanobacterial biofertilizers as part of the sustainable agricultural practice. Earthworms in such remediation systems must sustain the potential risk from both nZVI and MC-LR. In the present study, earthworms (Eisenia fetida) were exposed up to 14 days to MC-LR and nZVI (individually and in mixture), and the toxicity was investigated at both the organismal and metabolic levels, including growth, tissue damage, oxidative stress, metabolic response and gut microbiota. Results showed that co-exposure of MC-LR and nZVI is less potent to earthworms than that of separate exposure. Histological observations in the co-exposure group revealed only minor epidermal brokenness, and KEGG enrichment analysis showed that co-exposure induced earthworms to regulate glutathione biosynthesis for detoxification and reduced adverse effects from MC-LR. The combined use of nZVI promoted the growth and reproduction of soil and earthworm gut bacteria (e.g., Sphingobacterium and Acinetobacter) responsible for the degradation of MC-LR, which might explain the observed antagonism between nZVI and MC-LR in earthworm microcosm. Our study suggests the beneficial use of nZVI to detoxify pollutants in earthworm-based vermiremediation systems where freshwater containing cyanobacterial blooms is frequently used to irrigate soil and supply water for the growth and metabolism of earthworms.

Quantifying skin permeation of a novel metformin lotion using modified hydrophilic interaction liquid chromatography.

Aim: This study aimed to quantify the permeation of metformin (Met) lotion through pig ear skin using high-performance liquid chromatography, specifically hydrophilic interaction liquid chromatography (HILIC), to separate Met from biological contaminants and effectively measure its permeation through skin similar to human skin.Materials & methods: A Franz cell permeation assay was used to assess the permeation kinetics of 6% Met lotion through pig ear skin. Samples were collected at various time points and prepared for high-performance liquid chromatography analysis by removing large biological contaminants. The permeated Met was quantified by monitoring its retention time (RT) at 9 min using HILIC, with an acidic, polar mobile phase and a normal-phase column.Results: A distinct Met peak with a RT of approximately 9 min was observed in the 6% Met lotion, which was absent in the permeation samples from the 0% Met lotion. This peak (RT 9 min) was distinct from the 'biological-contaminants' peaks at RT 2-3 min and increased linearly over time, reaching 36.8% of the total applied Met at 24 h.Conclusion: These findings demonstrate that the HILIC method effectively separates Met from biological components in pig ear skin, allowing accurate quantification of Met despite the presence of skin lipids and proteins.

[Box: see text].

Metformin lotion promotes scarless skin tissue formation through AMPK activation, TGF-ß1 inhibition, and reduced myofibroblast numbers.

Scar tissue formation following skin wound healing is a challenging public health problem. Skin regeneration and preventing the formation of scar tissue by currently available commercial products are largely ineffective. This study aimed to test the efficacy of a novel topical metformin lotion (ML) in inhibiting scar tissue formation during skin wound healing in rats and to determine the mechanisms of action involved. A 6% ML was prepared in our laboratory. A skin wound healing model in rats was used. The wounded rats were divided into two groups and treated daily for 10 days as follows: Group 1 received a daily application of 50 mg of control lotion, or 0% ML (totaling 100 mg of lotion per rat), and Group 2 received a daily application of 50 mg of 6% ML (totaling 100 mg of 6% ML per rat). Blood samples from the heart of each rat were analyzed for inflammatory markers, HMGB1 and IL-1ß, using ELISA, and immunological and histological analyses were performed on skin tissue sections. ML decreased levels of inflammatory markers HMGB1 and IL-1ß in the serum of rats and inhibited the release of HMGB1 from cell nuclei into the skin tissue matrix. Additionally, ML demonstrated anti-fibrotic properties by enhancing AMPK activity, decreasing the expression of TGF-ß1, reducing the number of myofibroblasts, decreasing the production of collagen III, and increasing the expression of collagen I. ML promotes the regeneration of high-quality skin during wound healing by reducing scar tissue formation. This effect is mediated through the activation of AMPK, inhibition of TGF-ß1, and a decrease in the number of myofibroblasts.

A Masked Boryl-Substituted Oxo-Bridged Bis-Silylene: Synthesis and Reductive-Elimination and Synergistic Oxidative-Addition Reactivity.

Controlled oxidation of NHB-stabilized disilyne (NHB)Si ≡ Si(NHB) (1, NHB = [ArN(CMe)2NAr]B, Ar = 2,6-iPr2C6H3) with one equivalent of trimethylamine N-oxide (Me3N+─O-) in dry n-hexane gave oxo-bridged bis-silepin 2 in high yields. DFT calculations disclosed that silepin 2 is only more stable by 13.4 kcal/mol than the corresponding oxo-bridged bis-silylene intermediate 2' (NHB)Si(µ-O)Si(NHB), and 2 was very likely to be formed by the insertion of the two divalent Si atoms into the pendant aryl rings in bis-silylene intermediate 2'. The two silicon atoms in bis-silepin 2 could undergo formal reductive-elimination of the aryl rings and sequential oxidative-insertion reactions with small molecules and organic substrates. Treatment of 2 with H2O, S8, and P4 at 60 °C yielded compounds 3-5 via reductive-elimination of the aryl rings, followed by the sequential oxidative-addition of these molecules at the two Si(II) centers. Similarly, reactions of 2 with PhSiH3, a diphenylalkyne, pyridines, 1,3,4,5-tetramethylimidazolin-2-ylidene (IMe4), Ph2CO, and thiophene yielded the corresponding polycyclic bis-silanes 6-12 via reductive-elimination and oxidative-addition of C-H, Si-H, C≡C, and aromatic C═C, C-S, and C═N bonds at the two Si atoms. These novel reactions indicated the pronounced bis-silylene reactivity of bis-silepin 2, consistent with the low-energy barrier for the interconversion between 2 and 2', as disclosed by DFT calculations.

Stable Strained Donor-Free Silanone and Its Derived NHC-Stabilized Disilacyclobutadiene and Cyclic Alkenyl Silylene.

The strained silanone 2 was obtained by the reaction of disilacyclobutene 1 with N2O. Silanone 2 exhibited unprecedented thermal stability in both the solid state and solution. DFT calculations on 2 revealed that the highly polarized Si═O double bond is effectively stabilized by its electron delocalization with the unsaturated Si2C2 ring. Treatment of 2 with 1,3,4,5-tetramethylimidazolin-2-ylidene yielded the first Lewis base-stabilized disilacyclobutadiene 3 via a 1,3-boryl migration. Reaction of 2 with HCCH and Me3SiN3 resulted in the addition of C-H and Si-N bonds to the Si═O double bond. Interestingly, irradiation of 2 at rt yielded oxosilanes 7A and 7B in C6D6 and n-hexane, respectively, via the 1,2-boryl migration and ring expansion, whereas photolysis at -60 °C led to the formation of cyclic alkenyl silylene 8.

Acupuncture Treatment of Autonomic Nervous Dysfunction in Patients with Parkinson's Disease: A Narrative Review.

Parkinson's disease (PD) is a neurodegenerative disease affecting middle-age and elderly people. Its clinical manifestations include a series of progressive motor and nonmotor symptoms (NMS). Autonomic nervous dysfunction is a kind of NMS that includes constipation, hyperhidrosis, seborrheic dermatitis (sebaceous surface), salivation, sexual dysfunction, voiding dysfunction, and orthostatic hypotension. The incidence of autonomic nervous dysfunction is high, and the clinical manifestations are complex and changeable. It can occur before motor symptoms emerge, is closely related to the prognosis of PD, and affects quality of life seriously. Routine anti-PD drugs have little effect on improving autonomic nervous dysfunctions. Acupuncture for autonomic nervous dysfunction in PD induces a certain effect without adverse reactions, with potential advantages and broad prospects for application. This article summarizes and discusses the pathogenesis of autonomic nerve dysfunction in PD and acupuncture therapy for the condition to serve as a reference for clinical research.

Multifunctional biomolecular corona-inspired nanoremediation of antibiotic residues.

Facing complex and variable emerging antibiotic pollutants, the traditional development of functional materials is a "trial-and-error" process based on physicochemical principles, where laborious steps and long timescales make it difficult to accelerate technical breakthroughs. Notably, natural biomolecular coronas derived from highly tolerant organisms under significant contamination scenarios can be used in conjunction with nanotechnology to tackling emerging contaminants of concern. Here, super worms (Tubifex tubifex) with high pollutant tolerance were integrated with nano-zero valent iron (nZVI) to effectively reduce the content of 17 antibiotics in wastewater within 7 d. Inspired by the synergistic remediation, nZVI-augmented worms were constructed as biological nanocomposites. Neither nZVI (0.3 to 3 g/L) nor worms (104 to 105 per liter) alone efficiently degraded florfenicol (FF, as a representative antibiotic), while their composite removed 87% of FF (3 µmol/L). Under antibiotic exposure, biomolecules secreted by worms formed a corona on and modified the nZVI particle surface, enabling the nano-bio interface greater functionality, including responsiveness, enrichment, and reduction. Mechanistically, FF exposure activated glucose-alanine cycle pathways that synthesize organic acids and amines as major metabolites, which were assembled into vesicles and secreted, thereby interacting with nZVI in a biologically response design strategy. Lactic acid and urea formed hydrogen bonds with FF, enriched analyte presence at the heterogeneous interface. Succinic and lactic acids corroded the nZVI passivation layer and promoted electron transfer through surface conjugation. This unique strategy highlights biomolecular coronas as a complex resource to augment nano-enabled technologies and will provide shortcuts for rational manipulation of nanomaterial surfaces with coordinated multifunctionalities.

Tongue Acupuncture to Treat Dysphagia in Patients with Parkinson's Disease: A Randomized Controlled Trial.

Objective: Parkinson's disease (PD) is a chronic degenerative disease that lacks specific treatment. The incidence of dysphagia in patients with PD is 35%-82%. Dysphagia not only affects nutritional intake but also leads to pneumonia, even asphyxia. This study explored the efficacy of tongue acupuncture for treating dysphagia in patients with PD. Materials and Methods: From March 2021 to June 2023, 64 patients with PD-related dysphagia were chosen from Qingdao Central Hospital and the Affiliated Hospital of Qingdao Binhai University, both in Qindao, Shandong, China. The patients were divided into a tongue acupuncture group (n = 32) and a control group (n = 32). The control group was treated with a VitalStim® 5900 Swallowing Disorder Therapeutic Instrument (CA, USA), and the tongue acupuncture group had tongue acupuncture at Juquan (Ex-HN-10) and Haiquan (Ex-HN-11). Swallowing function and nutritional conditions were compared between the 2 groups after all treatments. Results: The total clinical effective rate in the tongue acupuncture group was higher than that of the control group (P < 0.05). The proportion of grade 1 and grade 2 of the 5-scaled Kubota drinking-water test in the tongue acupuncture group was significantly higher than that in the control group (78.13 % versus 31.26 %; P < 0.05), and the proportion of grade 3, grade 4, and grade 5 was significantly lower than that in the control group (21.87 % versus 68.74 %; P < 0.05). After tongue acupuncture, levels of body mass index, upper-arm circumference, triceps skinfold thickness, hemoglobin, serum albumin, and prealbumin were significantly higher than those in the control group (P < 0.05) and the incidence of complications caused by PD was significantly lower than that in the control group (P < 0.05). Conclusions: Treatment of dysphagia in PD by tongue acupuncture significantly improved swallowing function and nutritional level, and decreased the incidence of complications.

Concurrent versus sequential or no triazole anti-fungal therapy in patients undergoing 7 + 3 plus midostaurin induction for FLT-3 acute myelogenous leukemia.

INTRODUCTION: Midostaurin is a multikinase inhibitor approved for the treatment of adult patients with newly diagnosed FMS-like tyrosine kinase 3 mutated (FLT3m) acute myeloid leukemia (AML). Azole antifungal medications are commonly used in AML and are known to interact with anti-cancer drugs such as midostaurin through the CYP3A pathway. However, there are no midostaurin related dose modifications recommended with strong CYP3A inhibitors. METHODS: We retrospectively reviewed 40 patients between 2017-2022 and compared efficacy and safety outcomes in patients who received azole antifungals concurrently to those who did not receive an azole or received it sequentially to midostaurin for treatment of FLT3m AML. RESULTS: Median age of both groups was approximately 55 years and 70% of patients harbored FLT-3 internal tandem duplication mutations. Most patients in the concurrent arm were on either posaconazole (33%) or isavuconazole (50%) for antifungal prophylaxis and micafungin (72%) for the sequential/no azole arm. Overall CR/CRi rate with concurrent versus sequential/no azole were 72% and 77%, and non-hematologic grade 3 toxicities were 22% and 40% (p = 0.21), respectively. Rates of dose reductions (6% vs. 0%, p = 0.26) and held doses (17% vs. 14%, p = 0.79) were not different between concurrent and sequential/no azole. There were no differences in the rates of new fungal infection during induction between the two groups. CONCLUSION: Azoles given concurrently or sequentially with midostaurin were found to be equally safe and effective in the treatment of newly diagnosed FLT3 AML. Additional confirmatory studies are needed due to our limited sample size.

Regulating Catalytic Oxidation Enantiomers Behavior by Imparting Chiral Microenvironment in Zr-Based Metal-Organic Frameworks.

Chiral inversions of enantiomers have significantly different biological activities, so it is important to develop simple and effective methods to efficiently identify optically pure compounds. Inspired by enzyme catalysis, the construction of chiral microenvironments resembling enzyme pockets in the pore space structure of metal-organic frameworks (MOFs) to achieve asymmetric enantioselective recognition and catalysis has become a new research hotspot. Here, a super-stable porphyrin-containing material PCN-224 is constructed by solvothermal method and a chiral microenvironment around the existing catalytic site of the material is created by post-synthesis modifications of the histidine (His) enantiomers. Experimental and theoretical calculations results show that the modulation of chiral ligands around Zr oxide clusters produces different spatial site resistances, which can greatly affect the adsorption and catalytic level of the enantiomeric molecules of tryptophan guests, resulting in a good enantioselective property of the material. It provides new ideas and possibilities for future chiral recognition and asymmetric catalysis.

Reaction of a Disilyne with Internal Alkynes: Reversible [1 + 2] Cycloaddition and Formation of Strained Unsaturated Silacycles.

The reactions of NHB-stabilized disilyne (NHB)Si≡Si(NHB) (1, NHB = [ArN(CMe)2NAr]B, Ar = 2,6-iPr2C6H3) with internal alkynes were described. Reaction of disilyne 1 with one equivalent of bis(trimethylsilyl)acetylene led to a reversible [1 + 2] cycloaddition of one of the Si atoms with the alkyne and the insertion of the other Si into one of Ar rings with the formation of a silirenyl-silepin 2, whereas reaction of 1 with two equivalents of Me3SiCCSiMe3 resulted in the formal addition of the Csp-Si bond to the Si≡Si triple bond to give disilene (NHB)(Me3Si)Si=Si(CCSiMe3)(NHB). Reaction of 1 with 1,3-diyne Me3SiCCCCSiMe3 yielded a 1,2-disilacyclobut-3-ene via cycloaddition, ring expansion, and NHB 1,2-shift sequence. The initial [1 + 2] cycloaddition of one of the silicon atoms with an alkyne was strongly supported by DFT calculations. The results demonstrated the significant bis(silylene) character and rich synthetic potential of bis(boryl) disilyne 1.

Enhanced treatment of breast cancer brain metastases with oncolytic virus expressing anti-CD47 antibody and temozolomide.

Limited therapeutic options are available for patients with breast cancer brain metastases (BCBM), and thus there is an urgent need for novel treatment approaches. We previously engineered an effective oncolytic herpes simplex virus 1 (oHSV) expressing a full-length anti-CD47 monoclonal antibody (mAb) with a human IgG1 scaffold (OV-αCD47-G1) that was used to treat both ovarian cancer and glioblastoma. Here, we demonstrate that the combination of OV-αCD47-G1 and temozolomide (TMZ) improve outcomes in preclinical models of BCBM. The combination of TMZ with OV-αCD47-G1 synergistically increased macrophage phagocytosis against breast tumor cells and led to greater activation of NK cell cytotoxicity. In addition, the combination of OV-αCD47-G1 with TMZ significantly prolonged the survival of tumor-bearing mice when compared with TMZ or OV-αCD47-G1 alone. Combination treatment with the mouse counterpart of OV-αCD47-G1, termed OV-A4-IgG2b, also enhanced mouse macrophage phagocytosis, NK cell cytotoxicity, and survival in an immunocompetent model of mice bearing BCBM compared with TMZ or OV-A4-IgG2b alone. Collectively, these results suggest that OV-αCD47-G1 combined with TMZ should be explored in patients with BCBM.

Defect-engineered chiral metal-organic frameworks.

Chirality has an important impact on chemical and biological research, as most active substances are chiral. In recent decades, metal-organic frameworks (MOFs), which are assembled from metal ions or clusters and organic linkers via metal-ligand bonding, have attracted considerable scientific interest due to their high crystallinity, exceptional porosity and tunable pore sizes, high modularity, and diverse functionalities. Since the discovery of the first functional chiral metal-organic frameworks (CMOFs), CMOFs have been involved in a variety of disciplines such as chemistry, physics, optics, medicine, and pharmacology. The introduction of defect engineering theory into CMOFs allows the construction of a class of defective CMOFs with high hydrothermal stability and multi-stage pore structure. The introduction of defects not only increases the active sites but also enlarges the pore sizes of the materials, which improves chiral recognition, separation, and catalytic reactions, and has been widely investigated in various fields. This review describes the design and synthesis of various defective CMOFs, their characterization, and applications. Finally, the development of the materials is summarized, and an outlook is given. This review should provide researchers with an insight into the design and study of complex defective CMOFs.

Feasibility Study on Constructing Dosimetric Correlated Geometric Parameters for Automatic Segmentation Evaluation.

PURPOSE: To investigate the feasibility of constructing new geometric parameters that correlate well with dosimetric parameters. METHODS: 100 rectal cancer patients were enrolled. The targets were identified manually, while the organs at risk (bladder, small bowel, left and right femoral heads) were segmented both manually and automatically. The radiotherapy plans were optimized according to the automatically contoured organs at risk. Forty cases were randomly selected to establish the relationship between dose and distance for each organ at risk, termed "dose-distance curves," which were then applied to the new geometric parameters. The correlation between these new geometric parameters and dosimetric parameters was analyzed in the remaining 60 test cases. RESULTS: The "dose-distance curves" were similar across the four organs at risk, exhibiting an inverse function shape with a rapid decrease initially and a slower rate at a later stage. The Pearson correlation coefficients of new geometric parameters and dosimetric parameters in the bladder, small intestine, and left and right femur heads were 0.96, 0.97, 0.88, and 0.70, respectively. CONCLUSIONS: The new geometric parameters predicated on "distance from the target" showed a high correlation with corresponding dosimetric parameters in rectal cancer cases. It is feasible to utilize the new geometric parameters to evaluate the dose deviation attributable to automatic segmentation.

The tumor-intrinsic role of the m6A reader YTHDF2 in regulating immune evasion.

Tumors evade attacks from the immune system through various mechanisms. Here, we identify a component of tumor immune evasion mediated by YTH domain-containing family protein 2 (YTHDF2), a reader protein that usually destabilizes m6A-modified mRNA. Loss of tumoral YTHDF2 inhibits tumor growth and prolongs survival in immunocompetent tumor models. Mechanistically, tumoral YTHDF2 deficiency promotes the recruitment of macrophages via CX3CL1 and enhances mitochondrial respiration of CD8+ T cells by impairing tumor glycolysis metabolism. Tumoral YTHDF2 deficiency promotes inflammatory macrophage polarization and antigen presentation in the presence of IFN-γ. In addition, IFN-γ induces autophagic degradation of tumoral YTHDF2, thereby sensitizing tumor cells to CD8+ T cell-mediated cytotoxicity. Last, we identified a small molecule compound that preferentially induces YTHDF2 degradation, which shows a potent antitumor effect alone but a better effect when combined with anti-PD-L1 or anti-PD-1 antibodies. Collectively, YTHDF2 appears to be a tumor-intrinsic regulator that orchestrates immune evasion, representing a promising target for enhancing cancer immunotherapy.

Outcomes following allogeneic hematopoietic cell transplantation relapse in Philadelphia chromosome-positive acute lymphoblastic leukemia.

Improved first progression-free survival following allogeneic hematopoietic cell transplantation relapse with the use of immunotherapy.

Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists.

BACKGROUND: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. OBJECTIVE: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. DESIGN: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615). SETTING: 6 centers across the United States. PARTICIPANTS: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. INTERVENTION: Real-time use of CADx during routine colonoscopy. MEASUREMENTS: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. RESULTS: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. LIMITATION: Decision making based on CADx might differ outside a clinical trial. CONCLUSION: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. PRIMARY FUNDING SOURCE: Olympus America Corporation served as the clinical study sponsor.

Alterations of human CSF and serum-based mitophagy biomarkers in the continuum of Alzheimer disease.

Defective mitophagy is consistently found in postmortem brain and iPSC-derived neurons from Alzheimer disease (AD) patients. However, there is a lack of extensive examination of mitophagy status in serum or cerebrospinal fluid (CSF), and the clinical potential of mitophagy biomarkers has not been tested. We quantified biomarkers of mitophagy/autophagy and lysosomal degradation (PINK1, BNIP3L and TFEB) in CSF and serum from 246 individuals, covering mild cognitive impairment due to AD (MCI-AD, n = 100), dementia due to AD (AD-dementia, n = 100), and cognitively unimpaired individuals (CU, n = 46), recruited from the Czech Brain Aging Study. Cognitive function and brain atrophy were also assessed. Our data show that serum and CSF PINK1 and serum BNIP3L were higher, and serum TFEB was lower in individuals with AD than in corresponding CU individuals. Additionally, the magnitude of mitophagy impairment correlated with the severity of clinical indicators in AD patients. Specifically, levels of PINK1 positively correlated with phosphorylated (p)-MAPT/tau (181), total (t)-MAPT/tau, NEFL (neurofilament light chain), and NRGN (neurogranin) levels in CSF and negatively with memory, executive function, and language domain. Serum TFEB levels negatively correlated with NEFL and positively with executive function and language. This study reveals mitophagy impairment reflected in biofluid biomarkers of individuals with AD and associated with more advanced AD pathology.Abbreviation: Aß: amyloid beta; AD: Alzheimer disease; AVs: autophagic vacuoles; BNIP3L: BCL2 interacting protein 3 like; CU: cognitively unimpaired; CSF: cerebrospinal fluid; LAMP1: lysosomal-associated membrane protein 1; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MCI: mild cognitive impairment; NRGN: neurogranin; NEFL: neurofilament light chain; p-MAPT/tau: phosphorylated microtubule associated protein tau; PINK1: PTEN induced kinase 1; t-MAPT/tau: total microtubule associated protein tau; TFEB: transcription factor EB; TMT: Trail Making Test.

Oculomotor Nerve Palsy Induced by a Cerebral Developmental Venous Anomaly: A Case Report and Comprehensive Review.

BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be symptomatic. CASE REPORT A 67-year-old woman presented with sudden diplopia and left eyelid ptosis for 10 days. A neurologic examination revealed left complete oculomotor nerve palsy. Other neurologic deficits, including eye pain or pulsatile tinnitus, were not detected. Furthermore, the visual acuity was normal. Additionally, no retinal hemorrhage, venous dilatation, or fundus tortuosity were observed. No ischemia lesions or neoplasms were observed in MRI, and no widening or enhancement of the cavernous sinus was detected in post-contrast T1-weighted images, but magnetic resonance tomography cerebral angiography (MRTA) detected an offending vessel compressing the left oculomotor nerve in the fossa interpeduncular. We hypothesized that oculomotor nerve palsy (ONP) was caused by an abnormal arterial structure. However, digital subtraction angiography (DSA) revealed no aneurysm or abnormal arterial structure in the arterial phase, while a tortuous and dilated collecting vein was detected in the venous phase, connecting the left temporal lobe to the left cavernous sinus. This indicated a typical caput medusae appearance, suggesting the mechanism of oculomotor palsy caused by compressive impairment of the DVA. The patient refused microvascular decompression surgery, and ONP persisted after 30 days. Management was conservative, with spontaneous resolution at 60 days and no recurrence during the 2-year follow-up. CONCLUSIONS ONP is rarely caused by DVAs, which are easily ignored due to their benign nature. Cerebral vein examinations are advised for patients exhibiting clinical symptoms of unknown etiology.