Neurophysiological findings in conus medullaris infarction-a case report and systematic review of the literature.

INTRODUCTION: Conus medullaris infarction (CMI) is a rare vascular phenomenon that has been scarcely reported in the literature. While previous studies have described the clinical and radiological features of CMI, little attention has been paid to its associated neurophysiological findings. METHODS: We present a case of idiopathic CMI and its neurophysiological findings, then present our findings from a systematic review of other reports of CMI with neurophysiological features found via PubMed search. RESULTS: Nine articles describing ten cases of CMI with associated neurophysiological data were found, in addition to our case. Out of all 11 cases, 7 cases (64%) had absent F-waves on the first nerve conduction study (NCS) performed as early as 4 h after onset, 5 of whom demonstrated reappearance of F-waves on subsequent follow-up NCS. Seven patients (64%) had diminished compound muscle action potentials (CMAPs), which was usually detectable on NCS performed between day 8 and day 18 of onset. None of them showed recovery of CMAPs in follow-up studies. Four patients (36%) had absent H-reflexes and two patients (18%) had sensory abnormalities. Electromyography (EMG) was reported in seven patients (64%), showing reduced recruitment as early as day 1 of onset, and denervation potentials as early as 4 weeks after onset. CONCLUSION: Absent F-waves and diminished CMAPs are the most common NCS abnormalities in CMI. Absent F-waves are detectable very early but tend to recover on subsequent NCS, while diminished CMAPs are detectable later but do not seem to resolve. Further research to determine the utility of neurophysiological studies in CMI diagnosis and prognostication is needed.

Numb cheek syndrome in breast cancer: a case report.

Background: Numb cheek syndrome, a rare corollary of numb chin syndrome, is due to infra-orbital neuropathy. It can occur in association with an underlying malignancy, which can cause neuropathy by direct malignant nerve infiltration or via a paraneoplastic mechanism. Although numb cheek syndrome has been reported in association with a variety of cancers, it has previously not been reported in association with breast cancer. We report a case of left breast cancer presenting with left numb cheek syndrome. Case presentation: A 65-year-old woman presented to the Neurology clinic with a 7-month history of left cheek numbness and occasional cheek tenderness. Examination revealed slightly diminished pin-prick sensation in the left cheek and a vaguely palpable left breast lump. A magnetic resonance imaging scan of the brain showed abnormal enhancement of the left maxillary nerve at the foramen rotundum, but cerebrospinal fluid analysis was normal. Mammography, ultrasound scans, and core biopsy of the left breast confirmed the diagnosis of invasive left breast carcinoma (estrogen and progesterone receptor negative, c-erb-B2 equivocal, fluorescence in-situ hybridization negative). There was no evidence of distant metastases on computed tomography and bone scintigraphy scans. The patient underwent neoadjuvant chemotherapy (4 cycles of doxorubicin and cyclophosphamide, followed by 4 cycles of paclitaxel and carboplatin), and left breast wide excision and sentinel lymph node biopsy, and a repeat magnetic resonance imaging scan performed 2 months after surgical resection showed resolution of the left maxillary nerve enhancement. The patient's left numb cheek symptoms improved over a course of 5 months after cancer resection but did not completely resolve. Conclusions: Our case represents the first reported left numb cheek syndrome in association with breast cancer, due to maxillary neuropathy without any discrete mass or compressive cause. To avoid delays in diagnosing malignancy, physicians and surgeons should be aware that numb cheek syndrome can occur in association with an underlying malignancy, and that breast cancer should be counted amongst the possibilities.

Inherited chromosomally-integrated human herpes virus 6 confounding test results in a patient with myelitis and optic neuritis - A case report.

A case of the 'perfect storm' of myelin oligodendrocyte glycoprotein (MOG) antibody-mediated myelitis, human herpesvirus 6 (HHV-6) reactivation, and COVID-19 infection was reported in 2021. This article reports a case of a similarly observed clinical triad, but with a different conclusion and explanation supported by laboratory test results and evidence from our literature review.

Painless nondiabetic lumbosacral radiculoplexus neuropathy with complete recovery: a case report.

BACKGROUND: Lumbosacral radiculoplexus neuropathy, also known as amyotrophy, is an uncommon monophasic disorder characterized by inflammation of the lumbosacral nerve roots and plexuses. Lumbosacral radiculoplexus neuropathy is usually associated with diabetes mellitus, is typically painful at presentation, and often associated with long-term residual neurologic deficits. We report a case of painless, nondiabetic lumbosacral radiculoplexus neuropathy in a young Chinese woman, who made a full recovery after treatment with intravenous immunoglobulin, adding an atypical case to the scarce literature on lumbosacral radiculoplexus neuropathy. CASE PRESENTATION: A 35-year-old Chinese woman presented to our emergency department with 1-week history of painless left lower limb weakness and numbness. Examination revealed weakness confined to the left lower limb but spanning various nerves and myotomes, with abnormal sensation. Clinical localization to the lumbosacral plexus was supported by neurodiagnostic tests, and magnetic resonance imaging of the lumbosacral plexus showed that the nerve roots were also involved. After treatment with intravenous immunoglobulin for nondiabetic lumbosacral radiculoplexus neuropathy, the patient had a full recovery. CONCLUSION: Our patient's case highlights that lumbosacral radiculoplexus neuropathy, an already rare disorder, can occur in the absence of diabetes mellitus and pain, making it even harder to recognize. A systematic and meticulous clinical approach, supported by intelligent selection of adjunctive tests, is required for localization and diagnosis. With an accurate diagnosis, our case also demonstrates that appropriate and prompt treatment can lead to complete recovery, despite previous reports suggesting a high prevalence of long-term residual deficits after lumbosacral radiculoplexus neuropathy.

Life Prediction of Battery Using a Neural Gaussian Process with Early Discharge Characteristics.

The state of health (SOH) prediction of lithium-ion batteries (LIBs) is of crucial importance for the normal operation of the battery system. In this paper, a new method for cycle life and full life cycle capacity prediction is proposed, which combines the early discharge characteristics with the neural Gaussian process (NGP) model. The cycle data sets of commercial LiFePO4(LFP)/graphite cells generated under different operating conditions are analyzed, and the power characteristic P is extracted from the voltage and current curves of the early cycles. A Pearson correlation analysis shows that there is a strong correlation between P and cycle life. Our model achieves 8.8% test error for predicting cycle life using degradation data for the 20th to 110th cycles. Based on the predicted cycle life, capacity degradation curves for the whole life cycle of the cells are predicted. In addition, the NGP method, combined with power characteristics, is compared with other classical methods for predicting the remaining useful life (RUL) of LIBs. The results demonstrate that the proposed prediction method of cycle life and capacity has better battery life and capacity prediction. This work highlights the use of early discharge characteristics to predict battery performance, and shows the application prospect in accelerating the development of electrode materials and optimizing battery management systems (BMS).

Comparative Effect of Aqueous and Methanolic Bupleuri Radix Extracts on Hepatic Uptake of High-Density Lipoprotein and Identification of the Potential Target in HFD-Fed Mice.

Our previous study found saikosaponin b2 (SSb2) increased high-density lipoprotein (HDL) uptake in HepG2 cells. SSb2 is only found in aqueous Bupleuri Radix extract, and it is one of the secondary saponins derived from saikosaponin d (SSd), which exists in the methanolic extract. This study aimed to compare the effect of aqueous extract of Bupleuri Radix on hepatic uptake of HDL with methanolic extract and to reveal the underlying mechanism of enhancing HDL uptake in mice fed with high-fat diet (HFD). Cellular HDL uptake in each group was quantified by flow cytometry. Bioactive components bound to the HepG2 cytomembrane were detected with HPLC-DAD. RNA sequencing was performed to screen the underlying target on hepatic HDL-uptake, and western blotting was conducted to verify differential protein expression. Significant increases of HDL uptake by HepG2 cells were observed in all groups of aqueous extract of Bupleuri Radix, while no effect or negative effect was observed in the methanolic extract. Saikosaponin b1 (SSb1) and SSb2 were detected in the desorption elute of the aqueous extract from the HepG2 cytomembrane, while saikosaponin a (SSa) and SSd were not found. Remarkable upregulation of FGF21 in HFD-fed mice liver was affirmed after treatment with aqueous extract. This study suggested that aqueous Bupleuri Radix extract could promote hepatic HDL uptake in vitro but methanolic extract could not, and FGF21 might be the potential target.

Presynaptic Endosomal Cathepsin D Regulates the Biogenesis of GABAergic Synaptic Vesicles.

Presynaptic endosomes reportedly participate in synaptic vesicle (SV) recycling. However, it remains unclear whether they differentially regulate SV biogenesis and synaptic transmission in different types of synapses and how they are implicated in diseases. Using cryo-electron tomography and endocytic tracing, we uncover different endocytic modes and dynamics associated with distinct SV morphology between glutamatergic and GABAergic synapses. We further find that cathepsin D (CatD), a lysosomal storage disease (LSD) protein, is selectively located in GABAergic presynaptic endosomes. Inactivation of CatD results in enlarged presynaptic endosomes, reduces the readily releasable pool, and impairs synaptic transmission in GABAergic, but not glutamatergic, synapses. Moreover, CatD-deficient mice exhibit hyperactivity and increased sensitivity to seizure, mimicking epileptic behavior in CatD-related LSD patients. These data reveal an important role for presynaptic endosomal CatD in regulating GABAergic SV biogenesis and provide mechanistic insights for understanding the synaptic pathology and behavioral defects in CatD-associated LSD.

Clinical research of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer.

OBJECTIVE: The aim of this study is to investigate the clinical effect of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer. MATERIALS AND METHODS: Seventy-six elderly patients with radical resection of bladder cancer were selected from October 2012 to October 2014 and randomly divided into two groups, in which 38 patients received routine treatment as the control group and 38 patients received goal-directed fluid therapy based on routine treatment as the observation group. The treatment effect was compared between two groups. RESULTS: The cardiac index, stroke volume variability, mean arterial pressure, central venous pressure, central venous oxygen saturation, oxygen supply index, oxygen consumption index, and oxygen uptake rate in observation group were distinctly higher than those in control group at T1, T2, T3, and T4 while the artery serum lactate and S100-ß were apparently lower than those in control group at T1, T2, T3, and T4. The urine volume and colloidal infusion were obviously elevated when compared with those in control group at T1, T2, T3, and T4 while the crystalloid infusion volume, total liquid infusion volume, hospitalization time, and expenses were significantly less than those in control group; further, similar tendency was also found regarding the complication incidences of nausea, vomiting, or hypotension in observation group. The postoperative flatus and postoperative food-taking times were visibly earlier than those in control group (both P < 0.05). CONCLUSION: The goal-directed fluid therapy is beneficial for stabilization of hemodynamic status and maintenance of oxygen balance of supply and demand, and it is worthy of clinical expansion for good microcirculation perfusion, reduction in therapeutic time and expenses of patients, and less complications and superior security.

Effect of sevoflurane on the ATPase activity of hippocampal neurons in a rat model of cerebral ischemia-reperfusion injury via the cAMP-PKA signaling pathway.

We aim to investigate the effects of sevoflurane on the ATPase activity of the hippocampal neurons in rats with cerebral ischemia-reperfusion injury (IRI) via the cyclic adenosine monophosphate (cAMP) and protein kinase A (PKA) signaling pathway. Sixty rats were assigned into the normal, model and sevoflurane groups (n = 20, the latter two groups were established as focal cerebral IRI models). The ATPase activity was detected using an ultramicro Na (+)-K (+)-ATP enzyme kit. Immunohistochemical staining was used to detect the positive protein expression of cAMP and PKA. The hippocampal neurons were assigned to the normal, IRI, IRI + sevoflurane, IRI + forskolin, IRI + H89 and IRI + sevoflurane + H89 groups. qRT-PCR and Western blotting were performed for the expressions of cAMP, PKA, cAMP-responsive element-binding protein (CREB) and brain derived neurotrophic factor (BDNF). The normal and sevoflurane groups exhibited a greater positive protein expression of cAMP and PKA than the model group. Compared with the normal group, the expressions of cAMP, PKA, CREB and BDNF all reduced in the IRI, model and IRI + H89 groups. The sevoflurane group showed higher cAMP, PKA, CREB and BDNF expressions than the model group. Compared with the IRI group, ATPase activity and expressions of cAMP, PKA, CREB and BDNF all increased in the normal, IRI + sevoflurane and IRI + forskolin groups but decreased in the IRI + H89 group. It suggests that sevoflurane could enhance ATPase activity in hippocampal neurons of cerebral IRI rats through activating cAMP-PKA signaling pathway.

Risk Factors for Poor Outcome in Hypertensive Intraventricular Hemorrhage Treated by External Ventricular Drainage with Intraventricular Fibrinolysis.

OBJECTIVE: External ventricular drainage (EVD) combined with intraventricular fibrinolysis (IVF) is a commonly accepted surgical approach for some cases of hypertensive intraventricular hemorrhage (HIVH). We aimed to investigate the association between preoperative factors and outcome in patients with HIVH treated by EVD plus IVF. METHODS: Records from March 2010 to March 2016 were searched for HIVH treated by EVD plus IVF. We divided this population into the favorable outcome group and the unfavorable outcome group according to the Glasgow Outcome Scale. Preoperative demographic data, radiologic findings, and clinical factors were compared in each group. Univariate and multivariable logistic regression were used to assess the relationship between factors and outcome in HIVH. RESULTS: Of 267 patients included in this study, 136 had a favorable outcome and 131 had a poor outcome. Multivariate analyses showed that age (odds ratio [OR], 18.229; 95% confidence interval [CI], 1.503-221.16), Glasgow Coma Scale score (OR, 12.686; 95% CI, 1.5-107.312), blood neuron specific enolase (OR, 9.463; 95% CI, 1.178-76.012), third ventricle hematoma (OR, 15.311; 95% CI, 1.287-497.914), and fourth ventricle hematoma (OR, 25.258; 95% CI, 1.851-125.767) were associated with poor outcome of EVD in patients with HIVH. CONCLUSIONS: Fourth ventricle hematoma, third ventricle hematoma, high blood neuron specific enolase value, low Glasgow Coma Scale score, and old age were risk factors for poor outcome in HIVH treated with EVD plus IVF. EVD was not suitable, particularly in patients with brainstem compression caused by fourth ventricle hemorrhage, regardless of use of IVF.

Inhibition of the Let-7 Family MicroRNAs Induces Cardioprotection Against Ischemia-Reperfusion Injury in Diabetic Rats.

BACKGROUND: The expression of the let-7 family microRNAs in the myocardium of streptozotocin-induced diabetic rats was measured, and the cardioprotection of inhibition of let-7 microRNAs against ischemia-reperfusion injury was investigated. METHODS: The diabetic rats and nondiabetic rats were subjected to 30 minutes of coronary artery occlusion followed by 120 minutes of reperfusion. The infarct size was determined by triphenyltetrazolium chloride staining. The expression of let-7 was measured by quantitative real-time polymerase chain reaction, and expressions of insulin receptor (InsR), insulin-like growth factor-1 receptor (IGF-1R), glucose transporter type 4 (GLUT4), and the phosphorylation states of Akt and the mammalian target of rapamycin (mTOR) were analyzed using Western blot. Inhibition of let-7 was performed by local transfection of lentivirus gene transfer vectors containing let-7 antimiR. RESULTS: Compared with nondiabetic rats, the expression of let-7 was enhanced in the myocardium of diabetic rats (p = 0.029), whereas expressions of InsR, IGF-1R, and GLUT4 were decreased after ischemia-reperfusion (p < 0.01). Local transfection of the let-7 antimiR markedly inhibited the expression of let-7 (p = 0.038) and improved expressions of InsR, IGF-1R, and GLUT4 in the myocardium of diabetic rats (p < 0.01). The infarct size of diabetic rats was much higher than that of nondiabetic rats (p < 0.0001). Transfection of the let-7 antimiR significantly reduced the infarct size of diabetic rats (p < 0.0001), and such an antiinfarct effect was abolished completely by pretreatment of Akt inhibitor LY294002 or mTOR inhibitor rapamycin. CONCLUSIONS: Inhibition of the let-7 family microRNAs improves glucose uptake and insulin resistance in the diabetic myocardium and induces cardioprotection against ischemia-reperfusion injury through Akt and mTOR pathways.

Hypoxic preconditioning increases the protective effect of bone marrow mesenchymal stem cells on spinal cord ischemia/reperfusion injury.

Transplantation of bone marrow mesenchymal stem cells (BMSCs) protect against spinal cord ischemia/reperfusion injury (SCIRI). However, a large number of transplanted BMSCs often undergo apoptosis, which severely affects the treatment outcome. Previous studies have demonstrated that hypoxic preconditioning effectively increases the survival rate of BMSCs following transplantation, and increases their protective effect on injured tissues. However, there have been few reports regarding roles of hypoxic preconditioning in SCIRI. The present study isolated rat BMSCs and separately transplanted hypoxia­ and non­hypoxia­preconditioned BMSCs into the spinal cord tissues of rats with SCIRI. The role of hypoxic preconditioning in the promotion of the protective effect of BMSCs on SCIRI was investigated using neurological function scores, Evans blue staining, hematoxylin and eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labeling. In addition, reverse transcription­quantitative polymerase chain reaction and western blotting were used to detect the expression levels of hypoxia­inducible factor 1α (HIF­1α), and to investigate its possible underlying mechanism of action. The results indicated that hypoxic preconditioning effectively increased the protective effects of BMSCs on neurological function, blood spinal cord barrier and tissue damage following SCIRI, and inhibited apoptosis. Furthermore, hypoxic preconditioned BMSCs upregulated the expression of HIF­1α in spinal cord tissues. Therefore, hypoxic preconditioning effectively increased the protective effect of BMSCs on SCIRI and may be associated with upregulation of the expression of HIF­1α. Hypoxic preconditioning may serve as an effective means of increasing the protective effect of BMSCs on SCIRI.

HepG2 cells biospecific extraction and HPLC-ESI-MS analysis for screening potential antiatherosclerotic active components in Bupeuri radix.

HepG2 cells biospecific extraction method and high performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS) analysis was proposed for screening of potential antiatherosclerotic active components in Bupeuri radix, a well-known Traditional Chinese Medicine (TCM). The hypothesis suggested that when cells are incubated together with the extracts of TCM, the potential bioactive components in the TCM should selectively combine with the receptor or channel of HepG2 cells, then the eluate which contained biospecific component binding to HepG2 cells was identified using HPLC-ESI-MS analysis. The potential bioactive components of Bupeuri radix were investigated using the proposed approach. Five compounds in the saikosaponins of Bupeuri radix were detected as these components selectively combined with HepG2 cells, among these compounds, two potentially bioactive compounds namely saikosaponin b1 and saikosaponin b2 (SSb2) were identified by comparing with the chromatography of the standard sample and analysis of the structural clearance characterization of MS. Then SSb2 was used to assess the uptake of DiI-high density lipoprotein (HDL) in HepG2 cells for antiatherosclerotic activity. The results have showed that SSb2, with indicated concentrations (5, 15, 25, and 40 µM) could remarkably uptake dioctadecylindocarbocyanine labeled- (DiI) -HDL in HepG2 cells (Vs control group, *P<0.01). In conclusion, the application of HepG2 biospecific extraction coupled with HPLC-ESI-MS analysis is a rapid, convenient, and reliable method for screening potential bioactive components in TCM and SSb2 may be a valuable novel drug agent for the treatment of atherosclerosis.

Decision-oriented multi-outcome modeling for anesthesia patients.

Anesthesia drugs have impact on multiple outcomes of an anesthesia patient. Most typical outcomes include anesthesia depth, blood pressures, heart rates, etc. Traditional diagnosis and control in anesthesia focus on a one-drug-one-outcome scenario. This paper studies the problem of real-time modeling for monitoring, diagnosing, and predicting multiple outcomes of anesthesia patients. It is shown that consideration of multiple outcomes is necessary and beneficial for anesthesia managements. Due to limited real-time data, real-time modeling in multi-outcome modeling requires low-complexity model strucrtures. This paper introduces a method of decision-oriented modeling that significantly reduces the complexity of the problem. The method employs simplified and combined model functions in a Wiener structure to contain model complexity. The ideas of drug impact prediction and reachable sets are introduced for utility of the models in diagnosis, outcome prediction, and decision assistance. Clinical data are used to evaluate the effectiveness of the method.

Anesthesia outcome prediction.

This paper studies the problem of outcome prediction in anesthesia procedures. Anesthesia depth and blood pressures are used as typical outcomes in this study. Traditional diagnosis and control in anesthesia focus on a one-drug-one-outcome scenario. It is well understood, however, that consideration of multiple outcomes is necessary and beneficial for anesthesia managements. This paper introduces a method of modeling that significantly reduces the complexity of the problem and yet retains model accuracy. Utility of the modeling method is demonstrated in the areas of anesthesia outcome prediction and decision assistance.

[Evaluating efficacy of transcatheter arterial chemo-embolization combined with radiofrequency ablation on patients with hepatocellular carcinoma by 18FDG-PET/CT].

BACKGROUND & OBJECTIVE: Judging tumor residue of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemo-embolization (TACE) combined with radiofrequency ablation (RFA) by computed tomography (CT) scan is difficult; while 18-fluorodeoxyglucose-positron emission tomography/CT ((18)FDG-PET/CT) has some advantages in this aspect. This study was designed to compare the results of (18)FDG-PET/CT and CT scan in judging tumor residue of HCC after treatment of TACE combined with RFA, and to guide following treatment according to the result of (18)FDG-PET/CT. METHODS: Thirteen HCC patients with 18 lesions, 0.8-16.0 cm in diameter, were treated in Cancer Center of Sun Yat-sen University from Nov. 2002 to Jun. 2003. Of the 13 patients, 12 were naive patients with 15 lesions; 1 was relapsed with 3 lesions 1 year after hepatectomy. The results of CT and (18)FDG-PET/CT of the 13 patients 2-3 weeks after treatment of TACE combined with RFA were compared. If tumor residue was dictated, a further RFA treatment would be applied within 2-3 weeks. RESULTS: Of the 13 HCC patients that received 1 course of TACE combined with RFA, 11 had tumor residues which were conformed by fine needle biopsy and digital substraction angiography (DSA). CT only detected 5 positive cases; however, (18)FDG-PET/CT detected 10 positive cases. Positive rate of CT was 45.4%, and that of (18)FDG-PET/CT was 90.9%. According to the results of (18)FDG-PET/CT of the 11 patients, after the second course of RFA, 10 patients had no tumor residue; 1 patient survived with uncontrolled lesion 6 weeks after treatment. CONCLUSION: (18)FDG-PET/CT is better than CT in judging tumor residue of HCC after treatment of TACE combined with RFA or surgery, and in guiding further treatment of HCC.

[Evaluation of combined percutaneous radio-frequency ablation and percutaneous ethanol injection after transcatheter arterial chemoembolization for hepatocellular carcinoma].

OBJECTIVE: To evaluate the therapeutic effect of combined CT-guided percutaneous radio-frequency ablation (RFA) plus percutaneous ethanol injection (PEI) on nonresectable priminary hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). METHODS: One hundred fifty patients diagnosed as HCC either by pathology or by AFP combined with typical CT and angiographic image findings were studied, 99 men and 51 women, with an average of 51 years. Each patient had at least 3 lesions, ranging from 3.1 to 7.9 cm in diameter, average 5.0 cm. All patients were randomly divided into group A (control group) and group B (combination group) according to their check-in date (odd or even). In group A, 74 patients were treated with RFA alone two weeks after TACE. In group B, 76 patients were treated with RFA plus PEI two weeks after TACE. RESULTS: The complete necrosis rate was 75.8% in group A and 89.5% in group B (P < 0.05). CONCLUSION: The clinical therapeutic effect of radiofrequency ablation (RFA) combined with percutaneous ethanol injection (PEI) is better than that of RFA alone after TACE in HCC.