KLHL11 antibody-associated autoimmune encephalomyelitis in a middle-aged female patient: a case report and literature review.

HEADINGS: Kelch-like protein 11antibody is a recently identified biomarker for paraneoplastic neurological syndromes associated with germ-cell tumors that was first described as an onconeural antibody causing autoimmune encephalitis associated with seminoma in 2019. Ataxia is the most prevalent presenting symptom, with other neurological symptoms including vertigo, double vision, hearing loss, tinnitus and dysarthria. Magnetic resonance imaging scans reveal that the lesions are mostly located in the cerebellum and brainstem, particularly in the pontine region, and may also exhibit cerebellar atrophy. AIM OF THE STUDY: In this study, we report the clinical features of Kelch-like protein 11 antibody-associated paraneoplastic neurological syndrome. MATERIALS AND METHODS: We present a middle-aged female patient who presented with vertigo, cognitive decline, ataxia and limb weakness. A cell-based assay (CBA) showed positive IgG Kelch-like protein 11 in both her serum and CSF, as well as positive oligoclonal bands in her CSF. She was diagnosed with KLHL11 antibody-associated autoimmune encephalomyelitis and received high-dose intravenous methylprednisolone pulse therapy. RESULT AND CONCLUSIONS: Clinical outcomes suggest that patients with Kelch-like protein 11 antibody mostly have poor prognoses, excepting our case. We propose that early and appropriate treatments are critical for timely diagnosis and rapid improvement.

Tripartite Motif-containing Protein 11 Silencing Inhibits Proliferation and Glycolysis and Promotes Apoptosis of Esophageal Squamous Cell Carcinoma Cells by Inactivating Signal Transduction and Activation of Transcription Factor 3/c-Myc Signaling.

Esophageal squamous cell carcinoma (ESCC) is a common type of human digestive tract cancer with poor survival. Tripartite motif-containing protein 11 (TRIM11) is an oncogene in certain cancers that can regulate glycolysis and signal transduction and activation of transcription factor 3 (STAT3) signaling. This study was designed to investigate the role and the mechanism of TRIM11 in ESCC. First, TRIM11 expression in ESCC tissues and the correlation between TRIM11 expression and prognosis were analyzed using bioinformatics tools. After TRIM11 expression was detected by Western blot in ESCC cells, TRIM11 was silenced to evaluate its effect on the malignant phenotypes of ESCC cells. Cell proliferation and apoptosis were assessed by cell counting kit-8 assay, ethynyl-2'- deoxyuridine staining, and flow cytometry, respectively. The glucose uptake and lactate secretion were detected to examine glycolysis. In addition, Western blot was employed to detect the expression of proteins related to apoptosis, glycolysis, and STAT3/c-Myc signaling. Then, ESCC cells were treated with STAT3 activator further to clarify the regulatory effect of TRIM11 on STAT3/c-Myc signaling. TRIM11 was upregulated in ESCC tissues and cells, and high expression of TRIM11 was associated with a poor prognosis. TRIM11 knockdown inhibited the proliferation and glycolysis while facilitating apoptosis of ESCC cells. Besides, the expression of p-STAT3 and c-Myc was significantly downregulated by TRIM11 silencing. Of note, the STAT3 activator partially reversed the effects of TRIM11 depletion on the proliferation, apoptosis, and glycolysis in ESCC cells. Collectively, TRIM11 loss-of-function affects the proliferation, apoptosis, and glycolysis in ESCC cells by inactivating STAT3/c-Myc signaling.

Protective effect of FXN overexpression on ferroptosis in L-Glu-induced SH-SY5Y cells.

BACKGROUND: Alzheimer's disease (AD) is a complex, multifactorial neurodegenerative disease. However, the pathogenesis remains unclear. Recently, an increasing number of studies have demonstrated that ferroptosis is a new type of iron-dependent programmed cell death, contributes to the death of nerve cells in AD. By controlling iron homeostasis and mitochondrial function, the particular protein called frataxin (FXN), which is situated in the mitochondrial matrix, is a critical regulator of ferroptosis disease. It is encoded by the nuclear gene FXN. Here, we identified a novel underlying mechanism through which ferroptosis mediated by FXN contributes to AD. METHODS: Human neuroblastoma cells (SH-SY5Y) were injured by L-glutamate (L-Glu). Overexpression of FXN by lentiviral transfection. In each experimental group, we assessed the ultrastructure of the mitochondria, the presence of iron and intracellular Fe2 + , the levels of reactive oxygen species, the mitochondrial membrane potential (MMP), and lipid peroxidation. Quantification was done for malondialdehyde (MDA) and reduced glutathione (GSH), as well as reactive oxygen species (ROS). Western blot and cellular immunofluorescence assays were used to detect the expression of xCT and GPX4 proteins which in System Xc-/GPX4 pathway, and the protein expressions of ACSL4 and TfR1 were investigated by Western blot. RESULTS: The present work showed: (1) The expression of FXN was reduced in the L-Glu group; (2) Compared with the Control group, MMP was reduced in the L-Glu group, and mitochondria were observed to shrink and cristae were deformed, reduced or disappeared by transmission electron microscopy, and after FXN overexpression and ferrostatin-1 (Fer-1) (10 µmol/L) intervened, MMP was increased and mitochondrial morphology was significantly improved, suggesting that mitochondrial function was impaired in the L-Glu group, and overexpression of FXN could improve the manifestation of mitochondrial function impairment. (3) In the L-Glu group, ROS, MDA, iron ion concentration and Fe2+ levels were increased, GSH was decreased. Elevated expression of ACSL4 and TfR1, important regulatory proteins of ferroptosis, was detected by Western blot, and the expression of xCT and GPX4 in the System Xc-/GPX4 pathway was reduced by Western blot and cellular immunofluorescence. However, the above results were reversed when FXN overexpression and Fer-1 intervened. CONCLUSION: To conclude, our research demonstrates that an elevated expression of FXN effectively demonstrates a robust neuroprotective effect against oxidative damage induced by L-Glu. Moreover, it mitigates mitochondrial dysfunction and lipid metabolic dysregulation associated with ferroptosis. FXN overexpression holds promise in potential therapeutic strategies for AD by inhibiting ferroptosis in nerve cells and fostering their protection.

Peripheral nerve injury associated with JEV infection in high endemic regions, 2016-2020: a multicenter retrospective study in China.

Previously, we reported a cohort of Japanese encephalitis (JE) patients with Guillain-Barré syndrome. However, the evidence linking Japanese encephalitis virus (JEV) infection and peripheral nerve injury (PNI) remains limited, especially the epidemiology, clinical presentation, diagnosis, treatment, and outcome significantly differ from traditional JE. We performed a retrospective and multicenter study of 1626 patients with JE recorded in the surveillance system of the Chinese Center for Disease Control and Prevention, spanning the years 2016-2020. Cases were classified into type 1 and type 2 JE based on whether the JE was combined with PNI or not. A comparative analysis was conducted on demographic characteristics, clinical manifestations, imaging findings, electromyography data, laboratory results, and treatment outcomes. Among 1626 laboratory confirmed JE patients, 230 (14%) were type 2 mainly located along the Yellow River in northwest China. In addition to fever, headache, and disturbance of consciousness, type 2 patients experienced acute flaccid paralysis of the limbs, as well as severe respiratory muscle paralysis. These patients presented a greater mean length of stay in hospital (children, 22 years [range, 1-34]; adults, 25 years [range, 0-183]) and intensive care unit (children, 16 years [range, 1-30]; adults, 17 years [range, 0-102]). The mortality rate was higher in type 2 patients (36/230 [16%]) compared to type 1 (67/1396 [5%]). The clinical classification of the diagnosis of JE may play a crucial role in developing a rational treatment strategy, thereby mitigating the severity of the disease and potentially reducing disability and mortality rates among patients.

SIGMAR1 variants in ALS-PD complex cases: a case report of a novel mutation and literature review.

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease characterized by progressive degeneration of upper and lower motor neurons, with occasional involvement of the extrapyramidal system. Mutations in the sigma non-opioid intracellular receptor 1 (SIGMAR1) gene have been identified as one of the causes of ALS. Here, we present a case of a 49-year-old man diagnosed with ALS-Parkinson's disease (PD) complex. The patient exhibited bradykinesia and tremor, and whole-exome sequencing revealed homozygous mutations in the SIGMAR1 gene (c.446-2A > T). In addition, we conducted an investigation into the clinical and molecular phenotype of previously reported variants of SIGMAR1 associated with ALS. This case report aims to raise awareness among physicians regarding atypical phenotypes of amyotrophic lateral sclerosis and to encourage further research on the factors leading to SIGMAR1 mutations in patients.

Autoimmune glial fibrillary acidic protein astrocytopathy complicated with low flow perimedullary arteriovenous fistula: a case report.

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy and low-flow perimedullary arteriovenous fistulas (PMAVFs) may cause longitudinal widespread myelopathy. We report a middle-aged male patient with autoimmune GFAP astrocytopathy complicated with low flow PMAVFs disease, presenting with lower extremity weakness and dysuria. Magnetic resonance imaging (MRI) of the spinal cord revealed a significant longitudinal extent of T2 high signal from T11 to L1, with the lesion located proximal to the vascular territory supplied by the anterior spinal artery. Multiple patchy abnormal signals were seen adjacent to the anterior and posterior horns of the lateral ventricles bilaterally and at the centers of the semi-ovals on MRI of the cranial brain, with iso signal in T1Flair, the high signal in T2WI, and no high signal seen in Diffusion Weighted Imaging (DWI). Subsequently, the presence of anti-GFAP antibodies was detected in the cerebrospinal fluid (CSF), and the diagnosis of autoimmune GFAP astrocytopathy in conjunction with low-flow PMAVFs was confirmed through spinal digital subtraction angiography (DSA). This case report aims to increase neurologists' awareness of this disease and avoid missed or misdiagnosed cases that may lead to delayed treatment.

Neuromelanin-Sensitive Magnetic Resonance Imaging as a Measure for Differential Diagnosis of Essential Tremor and Parkinson's Disease.

We sought to evaluate whether the neuromelanin-sensitive magnetic resonance imaging (NM-MRI) features of the substantia nigra (SN) have utility in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). This study enrolled 23 patients with PD, 20 patients with ET, and 18 healthy participants. All subjects underwent clinical examination, motor and cognitive assessments, and NM-MRI scans. The area and contrast-to-noise ratio (CNR) values of SN were defined according to NM-MRI images. Then, receiver operating characteristic (ROC) analysis was conducted to characterize the diagnostic power of the SN area and CNR values of SN. Compared with ET and control groups, the PD group showed a significant reduction of the area of SN (P = 0.003, PD vs. ET; P = 0.001, PD vs. control) and in the SN to midbrain area ratio in the same layer (P = 0.006, PD vs. ET; P = 0.005, PD vs. control). The SN area had a sensitivity of 65% and a specificity of 87% for distinguishing ET from PD, with an area under the curve (AUC) of 0.7630 and a Youden index of 0.5200, whereas the ratio of the SN area to midbrain area in the same layer had a sensitivity of 60% and a specificity of 87% for distinguishing ET from PD, with an AUC of 0.7478 and a Youden index of 0.4700. Compared with the ET group, the mean CNR value of the SN and the respective CNR values of the three subregions were all weakened in the PD group, and only the CNR in the middle part was significantly different from the control group (P = 0.006). The sensitivity of the CNR value of the middle part of the SN for differentiating ET from PD was 65%, the specificity was 87%, the AUC was 0.7500, and the Youden index was 0.5200.Based on our findings, we conclude that NM-MRI can improve diagnostic accuracy in PD and can be used as a specific and sensitive potential diagnostic biomarker for PD.

Flexible and Stretchable Elastomer Composites Based on Lightweight Liquid Metal Foam Spheres with Pod-like Contacts.

Liquid metal (LM) is increasingly employed as a conductive filler in soft and flexible elastomer composites owing to its favorable conductivity and liquid fluidity. However, the high density of LM inevitably increases the weight of composites, which brings limitations in large-area and weight-sensitive applications. This work reports a flexible and stretchable elastomer composite composed of pod-like contacting lightweight LM foam spheres and polydimethylsiloxane matrix (LMS/PDMS). The lightweight LMS reduces the amount of LM used in the preparation process while imparting good electrical conductivity and deformability to the composite. The different contact modes of LMS endow the final composites with diverse strain sensitivity. The mechanism of interfacial contact conduction between the LMS with different melting points has been systematically studied, and the result shows that the liquid-solid contact mode of LMS further improves the strain sensitivity of the composite. Moreover, the composite also has satisfactory electrothermal properties and the temperature can quickly reach 70 °C within 30 s, showing good applicability in electric heating. Finally, the composites containing LMS with different contact modes can be developed as multifunctional sensors to detect human activities, temperature variation, and even underwater vibration, demonstrating the great potential in next-generation sensors and electronics.

Cerebellar repetitive transcranial magnetic stimulation versus propranolol for essential tremor.

BACKGROUND: Propranolol, a nonselective beta-adrenergic blocker, has long been used as one of the standard treatments for essential tremor (ET). Repetitive transcranial magnetic stimulation (rTMS) has also been used for a long time as a substitution therapy for ET patients. OBJECTIVE: The main aim of this study was to evaluate the antitremor effect of 1-Hz (low-frequency) cerebellar rTMS and compare it to the use of propranolol in ET patients. METHODS: In this single-blinded, randomized, controlled pilot study, a total of 38 patients with ET were randomized into two groups. One group (n = 20) received 1200 pulses of 1-Hz rTMS at an intensity of 90% of the resting motor threshold to the bilateral cerebellar region for 10 days. Another group (n = 18) received oral propranolol for 30 days. The initial dose was 30 mg/day, which was increased to 60 mg/day after 5 days, then to 90 mg/day on the 11th day, and continued thereafter for 20 days. The Fahn-Tolosa-Marin (FTM) clinical scale was assessed at baseline and at days 5, 10, and 30 to evaluate tremor severity, specific motor tasks, and functional disability. RESULTS: Low-frequency rTMS of the cerebellum significantly improved tremor severity, specific motor tasks (writing, spiral drawing, and pouring), and FTM total scores on days 10 and 30. Nevertheless, we found no significant difference in functional disability at any point in time (p > .05). There were no statistically significant differences in FTM Part A, Part B, Part C scores and total scores of patients in propranolol group on days 5 and 10 compared with before treatment (p > .05). However, FTM total scores and FTM Part A, Part B, and Part C scores were significantly improved for patients when the dose of propranolol was 90 mg/day on day 30. Our study showed that there was no statistically significant difference in the total FTM scores and FTM Part A, Part B, and Part C scores between rTMS and propranolol on days 5, 10, and 30 (p > .05). CONCLUSION: We conclude that both cerebellar low-frequency rTMS and propranolol could be effective treatment options for patients with ET, but it is not clear which method is more effective.

Endonuclease-driven DNA walking for constructing a novel colorimetric and electrochemical dual-mode biosensing method.

The development of methods to realize the on-site analysis of antibiotic pollutants is of great importance for food quality control and environmental monitoring. Herein, we designed a magnetic bead (MB)-based DNA walker and utilized its target-triggered and endonuclease-driven walking reaction to develop a novel colorimetric and electrochemical dual-mode biosensing method for the convenient detection of kanamycin (Kana) antibiotic. The colorimetric signal transduction strategy of the method was constructed on the telomerase extension of the DNA walking-released telomeric primer into G-quadruplex/hemin DNAzymes. Due to the DNA walking and telomerase dual signal amplification, a good linear relationship from 0.1 pg mL-1 to 1 ng mL-1 was obtained for this strategy with a detection limit of 22 fg mL-1. Meanwhile, the MB complex produced through the above DNA walking reaction was also used as a multipedal DNA walker to develop an electrochemical signal transduction strategy. By utilizing it to trigger another endonuclease-driven DNA walking at a DNA hairpin-modified electrode, ferrocene labels were quantitatively released from this electrode to cause the electrochemical signal decrease. Because of the dual endonuclease-driven DNA walking for signal amplification, a five-order of magnitude wide linear relationship from 0.01 pg mL-1 to 1 ng mL-1 was obtained with an ultralow detection limit of 8.4 fg mL-1. As the two strategies did not involve complicated manipulations and the requirement of expensive instruments, this biosensing method exhibits a high application value for the on-site semiquantitative screening and accurate analysis of antibiotic residues.

Clinical features and related factors of freezing of gait in patients with Parkinson's disease.

BACKGROUND: Freezing of gait (FOG) is a disabling paroxysmal gait disorder that prevents starting or resuming walking, which seriously negatively affects patients' quality of life (QOL). The diagnosis and treatment of FOG remain a huge medical challenge. The purpose of this study was to explore the clinical characteristics and related factors of FOG in patients with Parkinson's disease (PD). METHODS: The motor and nonmotor symptoms of a total number of 77 PD patients were evaluated. Patients with or without FOG were defined as a score ≥1 in the new freezing of gait questionnaire (NFOG-Q). A comparative study between patients with and without FOG was conducted. RESULTS: In this investigation, the prevalence of FOG was 48%. The patients with FOG had longer disease duration, higher Hoehn-Yahr stage (H-Y stage), higher dose of dopaminergic agents, and higher nonmotor and motor symptom scores. A significant positive correlation was found between the NFOG-Q score and the H-Y stage, PIGD subscore, PDQ-39, and the attention/memory in the nonmotor symptoms assessment scale (NMSS) subitem (r > 0.5, p < .05). The binary logistic regression analysis showed that the higher H-Y stage, higher rigidity subscore and Unified Parkinson's Disease Rating Scale II (UPDRS II) score, and UPDRS III score were significantly correlated with the occurrence of FOG (p < .05). In the analysis of the frequency of FOG, the prevalence of FOG in H-Y stage was higher in the middle and late stages, and the prevalence of FOG increased with the increase in PDQ-39 scores. CONCLUSION: The severity of FOG was significantly positively correlated with the H-Y stage, PIGD subscore, PDQ-39 score, and attention/memory score. Based on our findings, we conclude that the clinical characteristics of rigidity can be used as a potential predictor of FOG.