Serum leucine-rich α2 glycoprotein as a potential biomarker for systemic inflammation in Parkinson's disease.

There is ample epidemiological and animal-model evidence suggesting that intestinal inflammation is associated with the development of Parkinson's disease (PD). Leucine-rich α2 glycoprotein (LRG) is a serum inflammatory biomarker used to monitor the activity of autoimmune diseases, including inflammatory bowel diseases. In this study, we aimed to investigate whether serum LRG could be used a biomarker of systemic inflammation in PD and to help distinguish disease states. Serum LRG and C-reactive protein (CRP) levels were measured in 66 patients with PD and 31 age-matched controls. We found that serum LRG levels were statistically significantly higher in the PD group than in the control group (PD: 13.9 ± 4.2 ng/mL, control: 12.1 ± 2.7 ng/mL, p = 0.036). LRG levels were also correlated with Charlson comorbidity index (CCI) and CRP levels. LRG levels in the PD group were correlated with Hoehn and Yahr stages (Spearman's r = 0.40, p = 0.008). LRG levels were statistically significantly elevated in PD patients with dementia as compared to those without dementia (p = 0.0078). Multivariate analysis revealed a statistically significant correlation between PD and serum LRG levels after adjusting for serum CRP levels, and CCI (p = 0.019). We conclude that serum LRG levels could be considered a potential biomarker for systemic inflammation in PD.

[A case of cerebral embolism treated with early surgical intervention for aneurysm of sinus of Valsalva as embolic source].

The patient was a 78-year-old man. He was transferred to the emergency room presenting with aphasia and right hemiplegia. Head CT and CT angiography demonstrated a narrow territory of early ischemic signs and occlusion of the horizontal segment of the left middle cerebral artery (MCA), respectively. Endovascular thrombectomy was performed and complete recanalization of MCA was achieved. After admission, transthoracic echocardiography revealed a cystic mass near the left coronary apex of the aortic valve, which was diagnosed as an aneurysm of the sinus of Valsalva (ASV) by contrast-enhanced chest computed tomography. Transesophageal echocardiography showed a severe smoke-like echo within ASV, despite being in sinus rhythm. Intravenous anticoagulant therapy was started, and patch closure was performed by cardiovascular surgeons on the 13th day despite of early period after stroke onset. During the operation, no thrombus was seen around the inlet of ASV. On the two days after the operation, paroxysmal atrial fibrillation was detected and anticoagulant therapy was continued. In this patient, ASV was regarded as the embolic source of cerebral embolism, and anticoagulant therapy and surgical intervention were selected in the early period after stroke onset to prevent embolism recurrence, resulting in a favorable clinical course.

[Anti-myelin oligodendrocyte glycoprotein antibody-positive unilateral cerebral cortical encephalitis occurring first as general convulsion after meningitis symptoms and second after headache].

The case was a 30-year-old man. He had generalized convulsion after preceding meningitis symptoms and transferred to our emergency department. He was tentatively diagnosed with meningoencephalitis and Todd paralysis based on elevation of cell counts in cerebrospinal fluid and abnormal high signals in the right cerebral cortex on brain FLAIR-MRI, and admitted on the same day. After admission, treatment with antibiotics, dexamethasone, antiviral drug and anticonvulsants was started. Both his clinical symptoms and findings on MRI improved steadily, and then he was discharged on day 19. Subsequently, headache exacerbated again and an additional examination for his serum sample taken on first admission day revealed presence of anti myelin oligodendrocyte glycoprotein (MOG)-antibody, resulting in his diagnosis of anti-MOG antibody unilateral cerebral cortical encephalitis (MOG-UCCE) on day 42. Rehospitalization was planned for introduction of steroid therapy, but generalized convulsion recurred on day 44 and he was hospitalized again. MRI image revealed no FLAIR high signal and cerebrospinal fluid was almost normal, but his headache and mild hemiparesis and numbness on the left side deteriorated again. Therefore, he was treated with intravenous high dose methylprednisolone followed by oral steroids. His clinical symptoms gradually improved, and he was discharged with slight headache on day 71. After discharge, there has been no recurrence under continuation of low dose oral steroids for two years. This case shows the need to measure anti-MOG antibody and introduce steroid therapy in the early phase in a case of suspected MOG-UCCE in a young patient with meningoencephalitis accompanied by generalized convulsion and characteristic abnormal findings on FLAIR-MRI.

Present State of the Infection Protection System and Effects of a Change in the In-Hospital System in Endovascular Treatment for Large Vessel Occlusion in Acute Stroke Patients at a Single Institution.

Objective: Endovascular treatment (EVT) for large vessel occlusion in acute ischemic stroke patients during the SARS-CoV-2 epidemic requires the implementation of an in-hospital system to guard against infection. Changes to this system may be needed upon aggravation of the epidemic in a particular region. The objective of this study was to clarify the present state of infection protection and the effects of a change in the in-hospital system in EVT at a single institution. Methods: The subjects were consecutive patients treated by EVT under the protocol of infection protection using medical history and chest CT at our hospital between April 2020 and February 2021. For the subjects, background factors, time metrics, including door-to-puncture time (D2P), clinical outcome, and success of infection protection for medical staff were examined. The patients were divided into a group of those with PCR measurement after EVT (Group C; from April 2020 to November 2020) and a group of all with PCR measurement before EVT (Group P; from December 2020 to February 2021). Time metrics and clinical outcome were compared between the groups. Results: There were 69 subjects, including 40 and 29 patients in groups C and P, respectively. The median age was 82, which was higher in group P. The median D2P was 70 min, which did not differ significantly between the two groups, but it was slightly longer in group P than in group C by multivariate analysis. A favorable outcome (modified Rankin Scale 0-2 at 3 months) was observed in 23 patients (38%), which did not differ significantly between the two groups, but the rate of a favorable outcome was slightly lower in group P than in group C by multivariate analysis. Although medical staff wearing full personal protection equipment were needed for 15 patients (22%), 12 of whom were suspected of being positive and three (4%) were confirmed positive for SARS-CoV-2 by PCR, no staff member who participated in EVT was infected. Conclusion: The median D2P was 70 min and 38% had a favorable outcome of EVT under the present state of infection protection. After a change in the in-hospital system for clinical settings during the SARS-CoV-2 epidemic, the D2P increased and the rate of a favorable clinical outcome slightly decreased, but both were not significantly affected and infection protection for medical staff was effective. Therefore, the effects of a change were acceptable considering the circumstances.

Impaired age-dependent increases in phosphoglycerate kinase activity in red blood cells of Parkinson's disease patients.

BACKGROUND: Impaired bioenergetics are partially involved in the pathogenesis of Parkinson's disease (PD). Phosphoglycerate kinase (PGK), an essential enzyme for glycolysis, has recently attracted attention due to its pathogenic role in PD and as a target for disease-modifying therapies. This study is aimed to evaluate the profiles of PGK activity in red blood cells (RBCs) of PD patients and controls. METHODS: Sixty-eight PD patients and thirty-four age-matched unrelated controls were enrolled. PGK activities of RBCs were measured by the established colorimetric assay and standardized by the same RBC samples. RESULTS: PGK activity of the PD group was significantly higher than that of the control group in participants aged sixty-five years or younger, whereas it was not significantly different between the two groups at any age. PGK activity was positively correlated with aging in the control group, but this was not noted in the PD group. On multivariable analysis by partial correlation in the PD group, PGK activity was negatively correlated with the specific binding ratio of dopamine transporter scintigraphy in the striatum. The levodopa-equivalent daily dose was not significantly correlated with the enzyme activity. CONCLUSION: The results support the following: 1) elevation of PGK activities in RBCs can be detected in relatively young PD patients and with normal aging; 2) the degree of striatonigral degeneration is associated with elevated PGK activities. These are important considerations when the PGK assay is applied as a diagnostic biomarker of PD and to therapeutically monitor PGK-enhancing treatments.