Misdiagnosis of a Patient with Internal Carotid Artery Fenestration: A Case Report and Literature Review.

BACKGROUND: Internal carotid artery fenestration is a rare congenital cerebrovascular condition and can be misdiagnosed as carotid artery dissection. CASE REPORT: A patient was initially misdiagnosed with carotid artery dissection. This initial diagnosis was made using a carotid vascular computed angiography and magnetic resonance angiography. A digital subtraction angiography examination revealed a fenestration in the terminal C1 segment of the right internal carotid artery. Previous literature related to carotid artery fenestration was reviewed and analyzed. CONCLUSIONS: Fenestration of the carotid artery combined with aneurysm at the external segment of the internal carotid artery or from the starting position of the carotid artery remains rare in elderly patients, can be misdiagnosed as artery dissection.

Assessment of trace element contamination in sediment cores from the Pearl River and estuary, South China: geochemical and multivariate analysis approaches.

Twenty-four major and trace elements and the mineralogical composition of four sediment cores along the Pearl River and estuary were analyzed using ICP-AES, ICP-MS, and X-ray diffraction (XRD) to evaluate contamination levels. The dominant minerals were quartz, kaolinite, and illite, followed by montmorillonite and feldspars, while small amounts of halite and calcite were also observed in a few samples. Cluster analysis (CA) and principal component analysis (PCA) were performed to identify the element sources. The highest metal concentrations were found at Huangpu, primarily due to wastewater treatment plant discharge and/or the surreptitious dumping of sludge, and these data differed from those of other sources. Excluding the data from Huangpu, the PCA showed that most elements could be considered as lithogenic; few elements are the combination of lithogenic and anthropogenic sources. An antagonistic relationship between the anthropogenic source metals (K, Ba, Zn, Pb, Cd, Ag, Tl, and U) and marine source metals (Na, Mg, Ti, V, and Ca) was observed. The resulting normalized Al enrichment factor (EF) indicated very high or significant pollution of Cd, Ag, Cu, Zn, Mo, and Pb at Huangpu, which may cause serious environmental effects. Conflicting results between the PCA and EF can be attributed to the background values used, indicating that background values must be selected carefully.

Acupuncture Combined with Traditional Chinese Medicine and Drug Therapy for the Treatment of Cerebral Infarction (Phlegm-Blood Stasis Syndrome) and Carotid Atherosclerotic Plaque: A Preliminary Randomized Controlled Study.

Carotid atherosclerotic plaque (CAP) is one of the leading causes of cerebral infarction. Western medicine usually uses lipid-lowering drugs to stabilize plaques. Currently, studies reporting on drugs that can reduce plaques are lacking. Here, we performed a randomized controlled study to investigate the effectiveness of acupuncture combined with drug therapy (TCM and Western) to treat cerebral infarction (phlegm-blood stasis syndrome) and CAP. The control group was treated with atorvastatin calcium tablets (20 mg/d, po for 15 days). The treatment group received atorvastatin calcium tablets 20 mg, traditional Chinese medicine (TCM) decoctions (two matured substance decoction plus peach kernel and Carthamus four substance decoction plus Chinese hawthorn fruit 20 g, gold theragran 20 g, and red yeast rice 3 g), and acupuncture therapy, once daily for 15 days as one treatment course. The patients' neurological deficit score, ultrasonic testing of the carotid artery, and lipoprotein-associated phospholipase A2 (Lp-PLA2) were evaluated. Our findings showed no significant difference in the evaluated indices between the two groups before treatment (P > 0.05). However, compared with the control group after 15 days of treatment and within each group before and after treatment, the differences were significant (P < 0.05). In conclusion, acupuncture combined with drug therapy demonstrated promising effectiveness in treating cerebral infarction (phlegm-blood stasis syndrome) and CAP.

GluR1 phosphorylation and persistent expression of levodopa-induced motor response alterations in the Hemi-Parkinsonian rat.

The phosphorylation of glutamate receptor 1 (GluR1) has been increasingly implicated in the formation and maintenance of plastic responses. To investigate molecular mechanisms that underlie the persisting alterations in motor response occurring with levodopa treatment of parkinsonian patients, we evaluated the time course of these changes in relation to the phosphorylation of GluR1 in 6-hydroxydopamine (6-OHDA) lesioned animals. Three weeks of twice-daily levodopa administration to rats shortened the duration of the rotational responses and increased the peak turning responses, which lasted at least 7 days after withdrawal of chronic levodopa treatment. The shortened response duration and increased peak turning, resembling human wearing-off fluctuations and dyskinesia, were associated with a marked increase in Ser-845 phosphorylated GluR1 (pGluR1S845) immunoreactivity in lesioned striatum in response to levodopa treatment. The time course of changes in GluR1 phosphorylation correlated with the time course of changes in motor behavior after withdrawal of chronic levodopa therapy. Our immunostaining data showed that these changes were confined to parvalbumin-positive neurons where GluR1 are exclusively expressed. Both the altered motor response and the degree of pGluR1S845 were attenuated by the intrastriatal administration of protein kinase A (PKA) inhibitor Rp-cAMPS or GluR1 antisense oligonucleotides. The results suggest that Ser-845 GluR1 phosphorylation within parvalbumin-positive neurons contributes to the persistence of the motor response alterations produced by chronic intermittent dopaminergic stimulation.

Serotonin 2 Receptors, Agomelatine, and Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease.

There are nearly 50 million Alzheimer's disease (AD) patients worldwide, 90% of whom develop behavioral and psychological symptoms of dementia (BPSD), which increase the mortality rate of patients, and impose an economic and care burden on families and society. As a neurotransmitter and neuromodulator, serotonin is involved in the regulation of psychoemotional, sleep, and feeding functions. Accumulating data support the importance of serotonin in the occurrence and development of BPSD. Studies have shown that reduction of serotonin receptors can increase depression and mental symptoms in AD patients. At present, there is no drug treatment for AD approved by the US Food and Drug Administration. Among them, agomelatine, as a new type of antidepressant, can act on serotonin 2 receptors to improve symptoms such as depression and anxiety. At present, research on BPSD is still in the preliminary exploratory stage, and there are still a lot of unknowns. This review summarizes the relationship between serotonin 2 receptors, agomelatine, and BPSD. It provides a new idea for the study of the pathogenesis and treatment of BPSD.

The Effect of Fucoidan on Cellular Oxidative Stress and the CatD-Bax Signaling Axis in MN9D Cells Damaged by 1-Methyl-4-Phenypyridinium.

Background: The purpose of this study was to investigate the impact of fucoidan (FUC) on the oxidative stress response and lysosomal apoptotic pathways in the Parkinson disease (PD) cell model. Methods: The Dopaminergic nerve precursor cell line(MN9D) cells that served as a PD model in this study underwent damage induced by 100 µM 1-methyl-4-phenyl pyridine (MPP+). Cell viability was assessed after FUC treatment and intracellular SOD GSH was measured via immunofluorescence assay. Cellular changes in cathepsin D, Autophagy marker Light Chain 3-II (LC3-II), and apoptotic protein Bax were assessed by Western blot. The expression of Cat D, LC3-II, and B cell lymphoma-2-associated x protein (Bax) was also measured after addition of the cathepsin inhibitor, pepstatin A. Results: The results indicated that MN9D cell viability decreased by 50% within 24 h after 100 µM MPP+ induced toxicity. Pretreatment with 100 µM Fucoidan reduced cellular expression of LC3-II and CatD in 3 h and suppressed the induction of Bax protein. After pepstatin A treatment, Bax expression was significantly downregulated.FUC reversed the reduction of superoxide dismutase (SOD) L-Glutathione(GSH), decreased cell viability, and apoptosis induced by MPP+ in 6 h, suggesting that Fucoidan can attenuate damage to MN9D cells induced by MPP+. Conclusions: Fucoidan protected lysosomes, reduced the expression of LC3-II, inhibited the expression of CatD-Bax and the oxidative stress response, suppressed apoptosis, and thus conferred protective effects for dopaminergic neural cells. FUC may have neuroprotective effects on PD and further research is needed.

Tangier disease may cause early onset of atherosclerotic cerebral infarction: A case report.

RATIONALE: The present study explored the relationship between the adenosine triphosphate (ATP)-binding cassette A1 (ABCA1) gene, atherosclerosis, and cerebral infarction. The diagnosis and treatment ideas of stroke caused by Tangier disease via the summary of the diagnosis and treatment process of one case with juvenile stroke were explored. The relevant literature on the clinical manifestations, laboratory examinations, and treatment of Tangier disease was reviewed. PATIENT CONCERNS: The brain magnetic resonance imaging (MRI) of a juvenile man with acute onset of sudden right limb weakness and speechlessness revealed infarct lesions. The laboratory tests found low serum high-density lipoprotein (HDL), while further genetic testing identified ABCD1 gene mutation. The mother also carried the mutant gene. DIAGNOSES: Tangier disease was diagnosed. INTERVENTIONS: Statin treatment was administered for platelet aggregation. OUTCOMES: After 3 years of follow-up, the patient was declared to be in a stable condition. LESSONS: ABCA1 gene mutation caused early onset of atherosclerosis, leading to the occurrence of cerebral infarction. The cerebral infarction associated with reduced high-density lipoprotein (HDL), was under intensive focus with respect to ABCA1 gene. Child and Juvenile stroke patients with low HDL should not be excluded from the possibility of Tangier disease.

Teratoma-associated anti-NMDAR encephalitis: Two cases report and literature review.

OBJECTIVE: This study aimed to discuss the pathogenesis, clinical manifestation, diagnosis, and treatment of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. CASE REPORT: The diagnosis and treatment of 2 cases with teratoma-associated anti-NMDAR encephalitis were summarized and the clinical data of patients reported by domestic and international studies were reviewed in this study. The 2 cases were both adolescent females who showed mental abnormalities as their main clinical manifestation. The patients were positive for anti-NMDAR antibody in their serum and cerebrospinal fluid, and gynecologic ultrasound detected ovarian teratoma. After diagnosis, the patients underwent teratoma resection, followed by pulse therapy of hormones and gamma globulin. Chemotherapy was performed to prevent tumor recurrence, and patients were in a stable condition. CONCLUSIONS: Teratoma-associated anti-NMDAR encephalitis is commonly seen in young women. The clinical manifestation of this disease is nonspecific, and the patients mainly have fever, psychosis, and seizure. Tumor resection and immune therapy are effective treatment strategies, and standardized chemotherapy should also be performed to prevent recurrence.

Viral encephalitis complicated by acute retinal necrosis syndrome: A case report.

Acute retinal necrosis syndrome (ARN) is a viral infection characterized by focal retinal necrosis. Viral meningitis complicated by ARN is relatively rare. In the present case study, a 44-year-old male presented with fever, headache and mental disorder. After four days, the patient developed blurred vision. The patient was diagnosed with viral encephalitis complicated by bilateral ARN, based on the examination results. After treatment with antivirals and systemic glucocorticoids, the symptoms of the patient improved. Viral encephalitis may be an important risk factor for ARN. For a patient with viral encephalitis who experiences decreased visual acuity or vitreous opacification, the possibility of ARN should be considered.

Significance of Mycobacterium tuberculosis antigen expression in cerebrospinal fluid monocytes in diagnosing tuberculous meningitis.

BACKGROUND: The aim of this study was to investigate the significance of positive expression of Mycobacterium tuberculosis, (MTB) antigen in the cerebrospinal fluid (CSF) monocytes in diagnosing tuberculous meningitis (TBM). MATERIALS AND METHODS: A total of 50 inpatients of TBM, 30 viral meningitis and 20 healthy controls were studied at the 1 st , 2 nd , and 4 th week during their treatment course. Immunohistochemical assay were used to detect early secreted antigenic target 6 (ESAT-6) positive cells, and positive cases were also observed. RESULTS: The percentage of positive cases and positive cells of ESAT-6 in CSF monocytes were all higher in the 1 st and 2 nd week than in the 4 th week in TBM patients (P < 0.01); and percentage of positive cases and positive cells of MTB antigen in CSF monocytes were higher in TBM patients than in viral meningitis and health control in the 1 st and 2 nd week (P < 0.01). The sensitivity was 90% and the specificity was 92% in the early stage (within 2 weeks) of TBM. CONCLUSION: The positive expression of ESAT-6 in CSF monocytes is helpful for the early diagnosis of TBM.