25 December 2022, Volume 21 Issue 06 Previous Issue   
Experts forum
Anti-IgLON5 disease: relationship between neuroimmunology and neurodegeneration
CHEN Sheng, ZHANG Yizongheng
2022, 21 (06):  663-668.  DOI: 10.16150/j.1671-2870.2022.06.001
Abstract ( 42 )   HTML ( 4 )   PDF (591KB) ( 19 )  

Anti-IgLON5 disease is a rare autoimmune encephalitis (AE) with anti-IgLON5 antibodies in serum and/or CSF, which was first reported in 2014. Different from the traditional AE, anti-IgLON5 disease presents dual characteristics of neuroimmunity and neurodegeneration. Autopsy of some patients showed phosphorylated tau deposition, mainly in hypothalamus and brainstem tegmentum. The discovery of anti-IgLON5 disease reveals a potential crosslink between neuroimmunology and neurodegeneration, and may become a breakthrough in studying the interplay between the two mechanisms, which means that the immune inflammation induces the deposition of phosphorylated tau protein. Neuroimmunity may participate in and promote the occurrence and development of neurodegeneration. Neuroimmunity may be the trigger of neurodegeneration.

References | Related Articles | Metrics
Advances in clinical diagnosis of secondary progressive multiple sclerosis
2022, 21 (06):  669-676.  DOI: 10.16150/j.1671-2870.2022.06.002
Abstract ( 22 )   HTML ( 3 )   PDF (957KB) ( 13 )  

Multiple sclerosis(MS) is a chronic inflammatory disease of the central nervous system that involves demyelination and axonal degeneration. Usually, MS begins with a relapsing-remitting MS (RRMS) course, and approxi mately will develop into secondary progressive multiple sclerosis (SPMS). At present, the pathogenesis of SPMS is not completely clear, but studies have shown that the occurrence of SPMS is related to the slowly expanding lesions in the central nervous system, leptomeningeal follicle-like structure, chronic inflammation and brain atrophy. In clinical practice, the diagnosis of SPMS is often delayed and retrospective. Up to two-thirds of patients with insidious worsening of disability are still considered to have RRMS. These patients may continue to receive disease-modifying therapies for RRMS, which may not be effective for slowing SPMS. Therefore, early identification and diagnosis of SPMS are essential for their treatment.

Figures and Tables | References | Related Articles | Metrics
Academic trend at home and abroad
Advances in the application of contrast-enhanced ultrasound in the diagnosis and treatment of focal liver lesions
REN Xinping, LI Junjian, ZHANG Jie, ZHAN Weiwei
2022, 21 (06):  684-690.  DOI: 10.16150/j.1671-2870.2022.06.004
Abstract ( 26 )   HTML ( 1 )   PDF (741KB) ( 13 )  

Ultrasonography is recommended as an ideal imaging technique for surveillance and screening of liver tumors by guidelines in many countries. Contrast-enhanced ultrasound (CEUS) based on conventional ultrasound can provide function information of tissue microcirculation and perfusion.CEUS has advantages over contrast-enhanced CT/MRI in providing real-time, continuous, dynamic monitoring without radiation damage. The ultrasound contrast microbubbles is excreted through the lung,with no evidence of any effect on cardiac, renal and thyroid function. Contrast microbubbles can be applied to patients with renal insufficiency. There is a very low incidence of allergic reaction about ultrasound contrast agents. CEUS has been recommended as a first-line enhanced imaging technique for the diagnosis and differential diagnosis of focal liver lesions by domestic and international guidelines. Compared with conventional ultrasound, CEUS has better performance in detection,diagnosis and differential diagnosis of focal liver lesions(FLL). The contrast-enhanced ultrasound liver imaging reporting and data system (LI-RADS) issued by the American College of Radiology (ACR) is used to describe the full spectrum of intrahepatic lesions in high-risk patients, predicte the risk stratification of focal liver lesions, and recommend clinical management strategies. CEUS LI-RADS aimed to achieve an extremely high (ideally 100 %) positive predictive value for the diagnosis of hepatocellular carcinoma. CEUS LI-RADS is also applicable to the Chinese population. In the aspect of intervention, CEUS is helpful to optimizing of the path and identification of target in puncture biopsy of FLL, improving the success rate of puncture and positive rate of specimen, and is applied in the guidance during ablation surgery, instant assessment, long-term efficacy evaluation and postoperative follow-up. In addition, intraoperative application of CEUS can improve the detection rate of small liver metastases and identify disappearing liver metastases carcinoma after chemotherapy on regular images, thus helping clinicians to revise surgical protocols. CEUS also has certain application value in evaluating the efficacy of systemic treatment of liver malignancies. In conclusion, CEUS is playing an increasingly important role in the diagnosis and treatment of liver tumors

References | Related Articles | Metrics
Original article
Transplantation of adiponectin-transduced endothelial progenitor cells improves neurobehavioral outcomes following transient middle cerebral artery occlusion
SHEN Linhui, WANG Shuhong, MIAO Jie
2022, 21 (06):  691-696.  DOI: 10.16150/j.1671-2870.2022.06.005
Abstract ( 24 )   HTML ( 2 )   PDF (1068KB) ( 9 )  

Objective: To observe the effect of APN-modified EPCs on brain tissue repair and neurological function recovery in ischemic stroke model mice. Methods: Construction of lentiviruses transfected with APN genes. Genetically modified EPCs overexpressing APN(EPC-APN) or green fluorescent protein (EPC-GFP) were transplanted into a mice model of transient middle cerebral artery occlusion (tMCAO). The EPC-APN transplantation group, EPC-green fluorescent protein (GFP) transplantation control group and phosphate buffer (PBS) control treatment group were established. After transplantation, the enhanced GFP-expressing cells were found at the peri-infact area of brain. At 1, 7 and 14 days after tMCAO, the infarct volume was measured by using cresyl violet. Angiogenesis in the perifocal region was quantified on the 14th day. The apoptosis of endogenous cells was evaluated using TUNEL assay. Expression of vascular endothelial growth factor(VEGF)was detected using Western blot. Results: By constructing APN gene lentiviral vectors to transfect to EPCs, EPCs overexpressing APN were successfully prepared. The volume of brain atrophy in the EPC-APN transplantation group on on the 14th day after cerebral ischemia was significantly reduced compared with that in the EPC-GFP transplantation control group and the PBS control treatment group (7.2%±0.9% vs 11.6%±1.2% vs 16.2%±2.1%, P<0.01). Compared with the control group, the number of apoptosis of endogenous cells in the EPC-APN transplantation group was significantly reduced (1.0%±0.1%/mm2 vs 2.1%±0.2%/mm2 vs 11.2%±3.2%/mm2, P<0.05). Mice in the EPC-APN transplant group had lower neurobehavioral mNSS scores (3.2±0.3 vs 4.5±0.3 vs 5.8±0.5, P<0.05). The number of angiogenesis in the brain of the EPC-APN transplantation group increased significantly[(6.2±0.8)/mm2 vs(1.8±0.2)/mm2 vs (0.2±0.1)/mm2, P<0.01]. Western blot analysis showed that the VEGF expression in EPC-APN group was up-regulated compared with EPC-GFP group (P<0.05). Conclusions: EPC-APN transplantation can reduce ischemic brain injury and improve neurobehavioral outcomes.

Figures and Tables | References | Related Articles | Metrics
Correlation between cognitive impairment and sleep structure in patients with early Alzheimer’s disease
WANG Yongliang, CHANG Jinghan, ZHAO Qiuyan, PALIHA Baidaoliti, ZHU Xuelian, ZHANG Yu
2022, 21 (06):  697-701.  DOI: 10.16150/j.1671-2870.2022.06.06
Abstract ( 33 )   HTML ( 3 )   PDF (542KB) ( 8 )  

Objective: To analyze the characteristics of sleep structure and its correlation with cognitive impairment in early Alzheimer’s disease(AD) patients by assessing cognitive function and polysomnography. Methods: Eighty-eight elderly patients who underwent polysomnography were retrospectively analyzed and enrolled. According to the presence or absence of cognitive impairment, 39 patients were in the control group with a total score of montreal cognitive assessment (MoCA) score more than or equal to 26, 49 patients were in the AD group, with a total MoCA score less than 26 and a clinical dementia rating scale (CDR) score=0.5. Pearson correlation analysis and Spearman rank correlation analysis were used to explore the sleep structure characteristics of the early AD patients and its correlation with cognitive impairment. Results: Compared with the control group, the early AD group had statistically significant differences in MoCA, CDR, Hamilton Depression Scale (HAMD), micro perception index, non-rapid eye movement(NREM)/total sleep time (TST)%, N4 stage (N4)/TST% and REM /TST% (P<0.05). Multiple linear regression results showed that N/TST%, N4/TST% and rapid eye movement (REM)/TST% were the key risk factors of cognitive impairment in early AD patients (P<0.05). Conclusions: Patients with early AD have increased microarousal index and proportion of NREM sleep and N4 sleep, and decreased proportion of REM sleep, which are closely related to cognitive impairment. The proportion of NREM sleep, N4 sleep and REM sleep may be potential early warning indicators of cognitive impairment in early AD.

Figures and Tables | References | Related Articles | Metrics
Prognostic evaluation of extranodal natural killer/T-cell lymphoma, nasal type(ENKTL) with 18F-FDG PET/CT
WANG Jin, GUO Rui, LI Biao, ZHANG Xiaozhe
2022, 21 (06):  702-709.  DOI: 10.16150/j.1671-2870.2022.06.07
Abstract ( 35 )   HTML ( 1 )   PDF (796KB) ( 8 )  

Objective: To evaluate the prognostic significance of 18F-fluorodeoxyglucose-positron emission computed tomography(18F-FDG PET/CT) detection in extranodal natural killer/T-cell lymphoma, nasal type(ENKTL). Methods: Forty-one pathologically confirmed ENKTL patients (from October, 2014 to June, 2021) received methotrexate, etoposide, dexamethasone and pegaspargase(MESA) regimen and pre-, mid-, and end-treatment 18F-FDG PET/CT scans were retrospectively analyzed. Deauville score (DS), maximal standardized uptake values (SUVmax) and the change of SUVmax (ΔSUVmax) were recorded for response assessment. Univariate and multivariate analysis were performed to assess the effects on overall survival (OS) and progression-free survival (PFS). Results: The median follow-up period was 45 months (range, 3-64 months). The rates of 2-year OS and PFS were 83.0%±6.0% and 76.0%±7.0%, respectively. The rates of 5-year OS and PFS were 61.0%±12.0% and 53.0%±10.0%,respectively. Univariate analysis revealed that pre-treatment Ann Arbor stage (P=0.002), mid-treatment DS (P=0.021), mid-SUVmax (P<0.001), mid-ΔSUVmax (P=0.007), end-treatment DS (P=0.001), end-SUVmax (P=0.017) and end-ΔSUVmax (P=0.037) were prognostic factors for OS. Pre-treatment Ann Arbor stage (P=0.006), mid-treatment DS (P=0.011), SUVmax (P=0.015), SUVmax (P=0.011) and end-treatment DS (P=0.018) were of prognostic significance for PFS. Multivariate analysis showed that DS at the end of treatment was the only significant independent predictor of PFS (P=0.019). The rates of 2-year PFS of low DS and high DS were 90.3%±5.3% and 50.0%±25.0%, respectively (P=0.018). Conclusions: For ENKTL, DS by 18F-fluoro at the end of treatment is the only significant independent predictor of PFS.

Figures and Tables | References | Related Articles | Metrics
Effect of RAB25 knockdown on ferroptosis of colorectal cancer cells
LI Jiaxi, WANG Jinjiang, YU Liping, YUAN Ying, QIAO Guanglei, MA Lijun
2022, 21 (06):  710-718.  DOI: 10.16150/j.1671-2870.2022.06.08
Abstract ( 27 )   HTML ( 2 )   PDF (1269KB) ( 8 )  

Objective: To investigate the effect of RAB25 on the sensitivity of erastin-induced ferroptosis in colorectal cancer(CRC). Methods: The GEPIA database was used to analyze the mRNA expression levels of RAB25 in CRC tissues and the co-expression between RAB25 and ferroptosis related genes. The lentivirus-mediated RAB25 knockdown cell line was constructed. The expression of RAB25 was detected by quantitative real-time polymerase chain (qRT-PCR) and western blotting. After adding erastin at different concentrations(0-20 μmol/L), the cell proliferation rate was measured by CCK8 assay. The cell morphology and the mitochondrial structure were observed by inverted fluorescence microscope and transmission electron microscope, respectively. C11-BODIPY staining and flow cytometry probe were used to determine the level of lipid peroxides in cellular membranes. The combined effect of erastin and cetuximab on cellular viability in RAB25 knockdown cells were investigated. Results: The mRNA expression of RAB25 was unregulated in colorectal cancer tissues (P<0.01). The mRNA expression of RAB25 was correlated with some vital ferroptosis-associated genes. When erastin ≥10 μmol/L, the shRAB25 group inhibited the killing effect of ferroptosis on cell viability (P<0.000 1) compared to that of the control group, and cell morphology and mitochondrial structure were clearer and complete in the shRAB25 group. Flow cytometry revealed a significant decrease in lipid peroxidation levels in the shRAB25 group(P<0.000 1) compared to the control group. The expression of shRAB25 enhanced the toxic effects by erastin and cetuximab combination. Conclusions: RAB25 is highly expressed in colorectal cancer tissues and played an significant role in ferroptosis. After silencing RAB25, the erastin-induced lethal effect of colorectal cancer cells was inhibited. RAB25 and erastin may induce ferroptosis synergistically, enhancing the efficacy of cetuximab

Figures and Tables | References | Related Articles | Metrics
Primary epithelioid angiosarcoma of the bladder: clinicopathological analysis of a case and review of literature
HE Yanyan, LI Fengzhu
2022, 21 (06):  719-725.  DOI: 10.16150/j.1671-2870.2022.06.09
Abstract ( 33 )   HTML ( 3 )   PDF (1370KB) ( 15 )  

Objective: To investigate the clinicopathological characteristics, diagnosis, differential diagnosis, biological behavior, prognosis, and treatment options of patients with primary epithelioid angiosarcoma(EA) of the bladder. Methods: The clinical manifestations, histological features, immunohistochemistry results and follow-up of a case of primary EA of the bladder were analyzed:Relevant literature from 1998 up to 2021 were searched on PubMed, and 17 cases with relatively complete clinical and follow-up data reported in the literature were summarized. Results: Primary EA of the bladder is rare, males tend to occur (male: female, 15∶3), the median age at presentation was 65 years (range, 32-85 years), and 8 patients (8/18 cases)(44.4%) had a clear history of radiotherapy to the pelvis. Most of them had local recurrence and distant metastasis within a short period of time. During follow-up 12 of the 18 cases (66.7%) died of disease, with a median survival of 6 months (range, 5 weeks to 19 months), 6 of 18 cases (33.3%) survived with or without disease, the follow-up time ranged from 3 months to 32 months. Histologically, the tumors were composed of sheets and sinusoid of highly atypical epithelioid cells. Tumor cells were pleomorphic with amphophilic cytoplasm. Mitotic activity was high and pathological mitotic could be seen. Intracytoplasmic lumens or vacuoles were present with occasional red blood cell within the vacuole. A hemorrhagic background was present. Immunostaining was positive for Vimentin, CD31, CD34, ERG, Fli-1 and CK-P, with partly positivity for CK7, Ki-67 hot spot about 40%. Conclusions: Bladder primary EA is rare. Some patients have a history of pelvis radiotherapy and are highly malignant. The therapentic effect and prognosis are not satisfied. Radical surgery combined with radiotherapy and chemotherapy and other treatment options may prolong survival. Because the immunohistochemical staining of cytokeratin is positive, it is easy to be misdiagnosed as high-grade cancer. It needs to be differentiated from post-radiotherapy sarcoma, sarcomatoid carcinoma, pseudoangiosarcomatoid urothelial carcinoma, epithelioid hemangioendothelioma, et al.

Figures and Tables | References | Related Articles | Metrics
Study on nutritional risk screening in elderly post-stroke patients
CUI Yan, GE Haiping
2022, 21 (06):  726-729.  DOI: 10.16150/j.1671-2870.2022.06.10
Abstract ( 31 )   HTML ( 3 )   PDF (369KB) ( 8 )  

Objective: To explore the incidence of nutritional risk in elderly stroke patients and the significance of nutritional screening. Methods: A total of 490 elderly stroke patients admitted to the Rehabilitation Department of Xuhui District Central Hospital in Shanghai from July 2019 to June 2020 were enrolled. All the patients were more than 60 years old, with the duration after stroke less than 6 months. Nutrition risk assessment was conducted in the patients within 24 hours after admission using the Nutrition Risk Screening 2002 (NRS 2002) assessment form,and incidence of nutrition risk was investigated. The patients were divided into nutrition risk group and normal group. Barthel index was used to assess the activities of daily living(ADL) of patients within 24 hours before discharge, and correlation of the nutritional risk, hemoglobin, albumin, prealbumin, creatinine levels with ADL at discharge were analyzed. At the same time, the difference in ADL between the nutrition risk group and the normal group at discharge as compared. Results: The incidence of nutritional risk in 490 elderly stroke patients was 69.18%. The nutritional risk score, prealbumin and creatinine levels of the patients were significantly negatively correlated with ADL at discharge. Even given symptomatic treatment in the hospital, patients in the nutrition risk group had a lower ADL than those of the normal group at discharge(P<0.05). Conclusions: Among the elderly stroke patients, the incidence of nutritional risk is as high as 69.18%. Patients with higher nutritional risk scores in hospital rehabilitation may have lower ADL scores at discharge, indicating that more active measures should be taken to deal with elderly patients having nutritional risk at admission.

Figures and Tables | References | Related Articles | Metrics
Pathogenic factors and clinical characteristics of 104 cirrhosis cases in Shangri-La area, Yunnan
YANG Wenkang, ZHANG Jun, WANG Shuqiu, XIANG BA Yangzong, YANG Cuiping
2022, 21 (06):  730-734.  DOI: 10.16150/j.1671-2870.2022.06.11
Abstract ( 39 )   HTML ( 1 )   PDF (554KB) ( 11 )  

Objective: To analyze the main etiology and clinical features of cirrhosis in Shangri-La area of Yunnan and provide clinical data for prevention and control in such area. Methods: A total of 104 patients with cirrhosis admitted to the People’s Hospital of Diqing Tibetan Autonomous Prefecture from January 2019 to June 2021 were enrolled, and the etiological composition and main clinical characteristics of patients with cirrhosis in Shangri-La were analyzed retrospectively. Results: Patients with cirrhosis ranged from 33 to 86 years old, with an average age of (59.5±11.3) years old. The male to female ratio was 9 to 4. It revealed that 62.5% patients were Tibetans, 17.31% were Han Nationality, 15.38% were Yi Nationality. For Child-Pugh grading, 38 cases (37%) were with Child-PughA, 56 cases(54%) were with Child-pugh grade B, and 10 cases (9%) cases were with Child-pugh grade C. The main reason for the visit was abdominal distension. For etiological composition, alcoholic cirrhosis accounted for 38%. Hepatitis B cirrhosis accounted for 48%. Hepatitis C cirrhosis accounted for 1%. Mixed sclerosis accounted for 13%. The age of onset of cirrhosis caused by all causes is younger than those in other parts of the country, especially the age of onset of alcoholic cirrhosis is younger and the prognosis remission rate after standard treatment was only 1%. Conclusions: Viral hepatitis is still the main cause of cirrhosis in this region, followed by alcoholic liver disease and mixed cirrhosis. Attention should be paid to the harm of alcohol to human body education in this region, and strengthen the prevention and treatment of viral hepatitis.

Figures and Tables | References | Related Articles | Metrics
Paradrenal anastomosing hemangioma: a case report with literature review
YAN Huaru, LIU Kun, HAN Zhihong, FANG Zhen, WU Lili
2022, 21 (06):  735-740.  DOI: 10.16150/j.1671-2870.2022.06.12
Abstract ( 39 )   HTML ( 1 )   PDF (902KB) ( 83 )  

Objective: This paper reported 1 case of paradrenal anastomosing hemangioma (AH), and to summarize the clinicopathological features, diagnosis and differential diagnosis of AH. Methods: The clinical data of this patient was collected, the histological morphology and immunohistochemical characteristics were observed and analyzed in combination with relevant literature. Results: The tumor was located in the adipose tissue around the adrenal gland, it was well circumscribed, gray and red colored. Microscopically, the tumor was composed of irregularly anastomosing sinusoidal-like spaces lined by hobnail endothelial cells, focal mild atypia was observed. Intravascular fibrin thrombi and hyaline globules could be seen. Immunohistochemical results showed diffuse staining for endothelial markers, including CD31 and CD34. D2-40, CK5/6, calretinin, CKpan, EMA, Melan-A and HMB45 immunostains were negative. Ki-67 staining indicated a low proliferative activity. Eventually this patient was diagnosed with AH. Conclusions: AH is a rare but distinct type of vascular neoplasm. Owing to its striking anastomosing appearance, it needs to be distinguished from well differentiated angiosarcoma. In addition, the differential diagnosis of urogenital AH also includes angiomyolipoma, adenomatoid tumor, and hemangiomatoid hyperplasia secondary to renal cell carcinoma.

Figures and Tables | References | Related Articles | Metrics
Case report
PD-L1 inhibitors-induced hypophysitis in a patient with small cell lung cancer: a case report and literatures review
ZHANG Meiling, ZHU Xiaobang, SHONG Ailing, ZHOU Jianping, LI Qingyun
2022, 21 (06):  741-745.  DOI: 10.16150/j.1671-2870.2022.06.13
Abstract ( 30 )   HTML ( 1 )   PDF (758KB) ( 13 )  

This paper reports a case of immune-related hypophysitis (irH) after 7 cycles of treatment with Duva-lizumab, a PD-L1 (programmed cell death-ligand 1) inhibitor in a patient with small cell lung cancer. The patient showed fatigue, anorexia, hypotension, with lower serum levels of adrenocorticotropic hormone (ACTH) (3.8 ng/L) and thyroid stimulating hormone(TSH)(0.266 μIU/mL) than those before treatment (48 ng/L, 4.64 μIU/mL). The patient′s condition gradually improved with hydrocortisone replacement treatment. PubMed, Wanfang, and CNKI databases were searched.A total of 316 cases have been reported in recent 10 years, including 10 cases with irH caused by PD-1/PD-L1 in 84 lung cancer patients, mainly manifested as fatigue, anorexia, weight loss, and hypotension. Compared with cytotoxic T lymphocyte associated protein 4 antibody blocker treatment, the incidence of PD-1/PD-L1 induced-irH is low, and onset of irH is later. Pituitary MRI images mostly showed no abnormality. However, the condition of the patients was often critical or even life-threatening, which need to pay attention to.

Figures and Tables | References | Related Articles | Metrics
Review articles
Advances in imaging study of pulmonary lymphangioleiomyomatosis
LIKE Lahu, YANG Wenjie
2022, 21 (06):  746-750.  DOI: 10.16150/j.1671-2870.2022.06.14
Abstract ( 30 )   HTML ( 2 )   PDF (621KB) ( 11 )  

Pulmonary lymphangioleiomyomatosis (PLAM) is a rare idiopathic disease, which mainly involves lung and presents with diffused lung cysts. This paper reviews the imaging study and research progress of PLAM in recent years, including the quantitative analysis, texture analysis in CT images based pulmonary balloon. PET/CT may shows lesions in pulmonary parenchyma or lymphatic system. The semi-quantitative, full quantitative and omics analysis of pulmonary balloons based on CT could reflect the range of pulmonary lesions, and has a positive correlation with pulmonary function, which provide new methods for disease assessment and curative efficacy prediction in the patients with PLAM. The PET/CT and SPECT/CT have better evaluation effectiveness for the lymphoid system lesions in PLAM patients

Figures and Tables | References | Related Articles | Metrics