Publications by authors named "Liming Cao"

78 Publications

Increased Expression of in Lung Adenocarcinoma Predicts Poor Prognosis: A Bioinformatics Analysis Based on TCGA Data.

J Cancer 2021 2;12(11):3239-3248. Epub 2021 Apr 2.

Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.

Available evidence indicates that kinetochore-localized astrin/SPAG5-binding protein () is an oncogene in skin carcinoma. This study aimed to evaluate the prognostic value of in lung adenocarcinoma (LUAD) underlying the Cancer Genome Atlas (TCGA) database. The relationship between clinicopathological features and was analyzed with the Wilcoxon signed-rank test and logistic regression. The clinicopathological characteristics associated with overall survival (OS) were evaluated using Cox regression and the Kaplan-Meier method. Gene ontology (GO) analysis, gene set enrichment analysis (GSEA), and single-sample GSEA (ssGSEA) were performed using TCGA data. The expression level was found to be significantly higher in LUAD tissue than in normal lung tissue. Also, it correlated significantly with advanced clinicopathological characteristics. The Kaplan-Meier survival curve revealed a significant relationship of high expression of with poor OS in patients with LUAD. The multivariate Cox regression hazard model demonstrated the expression level as an independent prognostic factor for patients with LUAD. GO and GSEA analyses indicated the involvement of in cell cycle checkpoints, DNA replication, and G2-M checkpoint M phase. Based on ssGSEA analysis, had a positive relationship with Th2 cells and CD56 natural killer cells. The expression levels in several types of immune cells were significantly different. The findings suggested that the increased expression level of was significantly associated with the progression of LUAD and could also serve as a novel prognostic biomarker for patients with LUAD.
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http://dx.doi.org/10.7150/jca.51591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100810PMC
April 2021

Gerstmann-Sträussler-Scheinker syndrome misdiagnosed as cervical spondylotic myelopathy: A case report with 5-year follow-up.

Medicine (Baltimore) 2021 Apr;100(16):e25687

Department of Neurology, The First Affiliated Hospital of Shenzhen University.

Rationale: Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare autosomal dominant disease caused by a mutation in the prion protein gene (PRNP) that is not well known among neurologists and is therefore easily misdiagnosed.

Patient Concerns: : A 49-year-old man was admitted for the first time because of an unsteady walk with mogilalia for 1 year. He underwent a cervical discectomy and a plate-screw fixation 6 months prior, although postoperative gait instability did not improve.

Diagnosis: Whole exome sequencing identified a pathogenic and heterozygous mutation in the PRNP 4 years after onset. The patient was eventually diagnosed with GSS.

Interventions: Symptomatic treatment to improve cerebrocirculation and cerebrometabolism was provided.

Outcomes: The neurological decline continued. The Mini-Mental State Examination and modified Rankin Scale scores changed from 19 to 11 and 2 to 5, respectively. Progressive cerebral and cerebellar atrophy on magnetic resonance imaging was observed.

Lessons: Cerebral and cerebellar atrophy are neuroimaging features symptomatic of GSS that become more apparent as the disease progresses. This atrophy is positively correlated with the severity of symptoms and reduced quality of life. Neurologists treating middle-aged patients with progressive ataxia, cognitive impairment or dysarthria, and brain atrophy need to consider the possibility of GSS.
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http://dx.doi.org/10.1097/MD.0000000000025687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078271PMC
April 2021

Dynamic analysis of CSF1R-related leukoencephalopathy on magnetic resonance imaging: a case report.

BMC Neurol 2021 Apr 10;21(1):156. Epub 2021 Apr 10.

Department of Neurology, Liuzhou People's Hospital, Liuzhou, China.

Background: Colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy is a rare and rapidly progressive leukoencephalopathy characterized by cognitive, motor, and neuropsychiatric symptoms, which is often misdiagnosed. Magnetic resonance imaging (MRI) signs and follow-up MRI of CSF1R-related leukoencephalopathy could help in establishing a diagnosis, but these features are not widely known by general neurologists.

Case Presentation: A 34-year-old man was admitted for progressive weakness of the right limbs over 8 months. His father and sister had a similar clinical evolution. The primary neurological signs were hemiplegia, cognitive decline, dysarthria, pyramidal signs, ataxia and parkinsonism, and rapid disease progression. Cerebrospinal fluid analysis results were normal. Despite receiving treatment for improving cerebral metabolism and relieving the muscle spasm, his symptoms did not improve significantly. Brain MRI showed lesions concentrated in the corpus callosum and the deep white matter of the bilateral parieto-occipital lobes, periventricular areas, and corticospinal tracts. There was an enhanced lesion after a gadolinium-enhanced MRI scan. Over the 8-month progression, the lesions always exhibited restricted diffusion. The diffuse lesions gradually increased as the disease progressed. Genetic sequencing results showed a novel heterozygous missense mutation (c.2267 T > C p.L756P) in the CSF1R gene. The patient was treated with citicoline and idebenone for 4 days to improve cerebral metabolism, but his symptoms did not improve significantly.

Conclusion: The multiple lesions involving the pyramidal tract and white matter showed continuously restricted diffusion on brain imaging and gradually increased with disease progression.
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http://dx.doi.org/10.1186/s12883-021-02182-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035775PMC
April 2021

Rare severe hypofibrinogenemia induced by tissue plasminogen activator in stroke patients: Case report.

Medicine (Baltimore) 2021 Mar;100(9):e24978

Department of Neurology, Shenzhen University First Affiliated Hospital.

Rationale: Severe hypofibrinogenemia after intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is rare and easily overlooked, but hypofibrinogenemia increases the risk of major bleeding. However, it is unclear when hypofibrinogenemia reaches the peak and when hypofibrinogenemia is resolved.

Patient Concerns: Case 1 was of a 66-year-old man who was hospitalized due to sudden onset of vague speech and right hemiplegia for 4 hours. Case 2 was of an 84-year-old woman who was hospitalized for sudden onset of left hemiplegia and vague speech for 4 hours. In case 1, fibrinogen levels decreased from normal values to <0.25 g/L within 4.5 hours after commencing IVT and returned to normal at 35 hours later. In case 2, fibrinogen levels decreased from 1.1 to <0.25 g/L within 2 hours after commencing IVT and normalized 36.5 hours later.

Diagnoses: Both patients were diagnosed with rt-PA-related hypofibrinogenemia.

Interventions: No antiplatelet or symptomatic treatment was administered during the period of hypofibrinogenemia.

Outcomes: Fibrinogen levels gradually recovered. In case 1, the patient did not experience cerebral hemorrhage during hypofibrinogenemia. His symptoms improved significantly within 1 week. In case 2, repeat computed tomography revealed minor cerebral hemorrhage, but no deterioration in her condition was noted until she was discharged.

Lessons: Rapid, severe, and prolonged hypofibrinogenemia may occur after IVT with rt-PA, which may increase the risk of massive hemorrhage and affect the related therapy. Prompt diagnosis of hypofibrinogenemia is important for preventing complications. We recommend checking the fibrinogen levels routinely after IVT. Fibrinogen replacement therapy and platelet transfusion are the main management routes for rt-PA-related symptomatic intracranial hemorrhage.
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http://dx.doi.org/10.1097/MD.0000000000024978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939149PMC
March 2021

Long-term recurrence and brain metastasis of nasopharyngeal carcinoma mimicking cystic radiation encephalopathy relapse: a case report.

BMC Neurol 2021 Feb 8;21(1):59. Epub 2021 Feb 8.

Department of Neurology, Shenzhen University First Affiliated Hospital, 3002 Sungang West Road, Futian District, 518000, Shenzhen, China.

Background: During medical imaging, cystic radiation encephalopathy and brain metastasis are difficult to differentiate, and hence they are easily misdiagnosed. To our knowledge, a nasopharyngeal carcinoma recurrence after more than seven years with cerebral metastasis that mimicked cystic radiation encephalopathy has not been reported.

Case Presentation: A 52-year-old man was admitted to the hospital owing to weakness of the right limb for one month, which increased in intensity for three days. He had been diagnosed with nasopharyngeal carcinoma in 2011, which was treated by radiotherapy. The patient successively developed cystic radiation encephalopathy and brain metastasis from the nasopharyngeal carcinoma, which mimicked cystic radiation encephalopathy relapse. Left frontotemporal craniotomy, surgical resection of brain metastasis, and repair of the skull base and dura were performed. Postoperative computed tomography showed that midline deviation recovered, and brain edema was reduced.

Conclusions: This report is significant because brain metastasis from nasopharyngeal carcinoma can masquerade as a benign entity and cause fatal consequences. In patients presenting with cystic radiation encephalopathy, brain metastasis should be considered as a differential diagnosis.
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http://dx.doi.org/10.1186/s12883-021-02088-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869473PMC
February 2021

Serum IL-6 as a vital predictor of severe lung cancer.

Ann Palliat Med 2021 Jan;10(1):202-209

Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Clinical Research Center for Respiratory Diseases, Changsha, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Molecular Radiation Oncology of Hunan Province, Changsha, China. Email:

Background: Recent clinical studies have reported that some cytokines are associated with lung cancer prognosis and mortality. However, the relationship between cytokines and clinical outcomes in severe lung cancer patients was unclear. IL-6 as an important cytokine in inflammation, expression level in severe lung cancer patients was unknown.

Methods: A cohort of 55 severe lung cancer patients were enrolled retrospectively in this study. The clinical characteristics, including performance status (PS), therapeutic effect, and patients' adverse effects, were recorded. The association of cytokines and the concerned clinical outcomes were assessed by logistic regression analysis. The area under the curve (AUC) was assessed to evaluate the strength of prediction.

Results: The mean age of the patients was 59.8, and 42 patents were males. Increased IL-6 levels were associated with worse PS. Logistic regression analysis demonstrated that higher IL-6 was associated with an increased risk of progressive disease (PD) (OR =1.03, 95% CI: 1.0-1.06). The area under the ROC curve (AUC) of the model used for predicting PD was 0.821.

Conclusions: Increased IL-6 levels are correlated with worse PS and are an essential predictor for PD in severe lung cancer patients. Monitoring the IL-6 level may represent an essential strategy in improving the prognosis of patients with severe lung cancer.
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http://dx.doi.org/10.21037/apm-20-2229DOI Listing
January 2021

Senescence associated long non-coding RNA 1 regulates cigarette smoke-induced senescence of type II alveolar epithelial cells through sirtuin-1 signaling.

J Int Med Res 2021 Feb;49(2):300060520986049

Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College Hangzhou, Zhejiang, P.R. China.

Objective: The primary aim of our study was to explore the mechanisms through which long non-coding RNA (lncRNA)-mediated sirtuin-1 (SIRT1) signaling regulates type II alveolar epithelial cell (AECII) senescence induced by a cigarette smoke-media suspension (CSM).

Methods: Pharmacological SIRT1 activation was induced using SRT2104 and senescence-associated lncRNA 1 (SAL-RNA1) was overexpressed. The expression of SIRT1, FOXO3a, p53, p21, MMP-9, and TIMP-1 in different groups was detected by qRT-PCR and Western blotting; the activity of SA-β gal was detected by staining; the binding of SIRT1 to FOXO3a and p53 gene transcription promoters was detected by Chip.

Results: We found that CSM increased AECII senescence, while SAL-RNA1 overexpression and SIRT1 activation significantly decreased levels of AECII senescence induced by CSM. Using chromatin immunoprecipitation, we found that SIRT1 bound differentially to transcriptional complexes on the FOXO3a and p53 promoters.

Conclusion: Our results suggested that lncRNA-SAL1-mediated SIRT1 signaling reduces senescence of AECIIs induced by CSM. These findings suggest a new therapeutic target to limit the irreversible apoptosis of lung epithelial cells in COPD patients.
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http://dx.doi.org/10.1177/0300060520986049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869169PMC
February 2021

Acute disseminated encephalomyelitis after severe acute respiratory syndrome coronavirus 2 vaccination: a case report.

Acta Neurol Belg 2021 Feb 1. Epub 2021 Feb 1.

Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen, China.

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http://dx.doi.org/10.1007/s13760-021-01608-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849959PMC
February 2021

Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report.

J Int Med Res 2021 Jan;49(1):300060520987718

Department of Gastroenterology, Shenzhen Shiyan People's Hospital, Shenzhen, China.

Patients with essential thrombocythemia (ET) can experience hemorrhagic or ischemic vascular events. The prevention of these complications is challenging, and the overall risk of vascular events caused by ET is often overlooked. A 34-year-old man was admitted for a 10-day history of weakness and numbness in his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving treatment half a year before admission. Physical examination showed a superficial sense of disturbance in the right limbs and decreased muscle strength in the right upper and lower limbs (4/5). His platelet count (459 × 10/L) was elevated. Magnetic resonance imaging showed acute watershed infarction, and he was treated successfully. However, he was readmitted for headache and left limb weakness 14 months later. A head computed tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural hematoma removal and decompressive craniectomy. Surgery and pathological investigation revealed no venous sinus thrombosis or vascular malformation. His condition improved, and he exhibited a stable condition 1 year after discharge. Successive development of ischemic stroke and spontaneous subdural hemorrhage is rare in a patient with ET. This case suggests that ET is not only a risk factor for stroke but can also cause highly heterogeneous strokes.
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http://dx.doi.org/10.1177/0300060520987718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829530PMC
January 2021

Enhanced Biosynthesis of Chlorogenic Acid and Its Derivatives in Methyl-Jasmonate-Treated Cells: A Study on Metabolic and Transcriptional Responses of Cells.

Front Bioeng Biotechnol 2020 5;8:604957. Epub 2021 Jan 5.

Jiangxi Key Laboratory of Natural Products and Functional Foods, Jiangxi Agricultural University, Nanchang, China.

Chlorogenic acid and its derivatives (CQAs) are considered as important bioactive secondary metabolites in Ellis (). However, few studies have investigated the biosynthesis and regulation of CQAs in . In this study, methyl jasmonate (MeJA) was used to enhance CQAs accumulation in cultured cells. Moreover, the possible molecular mechanism of MeJA-mediated accumulation of CQAs is also explored. To this end, time-course transcriptional profiles of cells responding to MeJA were used to investigate the mechanism from different aspects, including jasmonate (JAs) biosynthesis, signal transduction, biosynthesis of precursor, CQAs biosynthesis, transporters, and transcription factors (TFs). A total of 57,069 unigenes were assembled from the clean reads, in which 80.7% unigenes were successfully annotated. Furthermore, comparative transcriptomic results indicated that differentially expressed genes (DEGs) were mainly involved in JAs biosynthesis and signal transduction (25 DEGs), biosynthesis of precursor for CQAs (18 DEGs), CQAs biosynthesis (19 DEGs), and transporters (29 DEGs). Most of these DEGs showed continuously upregulated expressions over time, which might activate the jasmonic acid (JA) signal transduction network, boost precursor supply, and ultimately stimulate CQAs biosynthesis. Additionally, various TFs from different TF families also responded to MeJA elicitation. Interestingly, 38 DEGs from different subgroups of the MYB family might display positive or negative regulations on phenylpropanoids, especially on CQAs biosynthesis. Conclusively, our results provide insight into the possible molecular mechanism of regulation on CQAs biosynthesis, which led to a high CQAs yield in the cells under MeJA treatment.
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http://dx.doi.org/10.3389/fbioe.2020.604957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813945PMC
January 2021

Severe invasive rhombencephalitis mimicking facial neuritis in a healthy middle-aged man: a case report and literature review.

J Int Med Res 2021 Jan;49(1):300060520982653

Department of Laboratory Medicine, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China.

Neurolisteriosis is a foodborne infection of the central nervous system that is easily misdiagnosed, especially in healthy adults with atypical symptoms. A 50-year-old man presented with a 3-day history of distortion of the oral commissure. Facial neuritis was diagnosed and treated with intravenous dexamethasone. His condition deteriorated rapidly, and he presented with a slow pharyngeal reflex, stiff neck, and signs of peripheral facial paralysis. Brain magnetic resonance imaging revealed multiple ring-enhanced foci in the brainstem. Routine and biochemical cerebrospinal fluid (CSF) analyses showed increased white blood cells and microproteins. Blood culture and high-throughput genome sequencing revealed DNA in the CSF. Ampicillin, amikacin, and meropenem were administered, and the patient was transferred from the intensive care unit to a standard medical ward after 2 months. The patient could walk and eat normally; however, he required intermittent mechanical ventilation at 11 months after discharge. Although meningitis is rare in healthy immunocompetent adults, it must be considered as a differential diagnosis, especially in adults whose conditions do not improve with cephalosporin antibiotic administration. rhombencephalitis mimics facial neuritis and develops quickly. Prompt diagnosis is essential for rapid initiation of antibiotic therapy to achieve the best outcome.
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http://dx.doi.org/10.1177/0300060520982653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809310PMC
January 2021

Clinical analysis of a patient simultaneously positive for antibodies of myelin oligodendrocyte glycoprotein and anti-N-methyl-D-aspartate receptor: A case report.

Medicine (Baltimore) 2021 Jan;100(1):e24234

Department of Gastroenterology, Shenzhen Shiyan People's Hospital, Shenzhen, China.

Rationale: Myelin oligodendrocyte glycoprotein (MOG) antibody (MOG-Ab) disease (MOG-AD) is a type of demyelinating disease of the central nervous system characterized by a high frequency of optic neuritis (ON) attacks. anti-Nmethyl-D-aspartate receptor (NMDAR) encephalitis (anti-NMDARe) is an autoimmune disorder characterized by memory deficits, conscious disturbance, and seizures. Cases of simultaneous occurrence of MOG-Ab and anti-NMDARe antibody (anti-NMDARe-Ab) are rarely reported and could be mistaken for overlapping MOG-antibody disease (MOG-AD) and NMDARe. The diagnosis of such patients is challenging.

Patient Concerns: We report the case of a 37-year-old man who presented with recurrent headaches for 3 months and worsening symptoms over 2 weeks. He had a history of ON. He had a generalized seizure after 7 days in the hospital.

Diagnosis: Brain magnetic resonance imaging (MRI) and cerebrospinal fluid tests showed no apparent abnormalities. Repeat MRI showed slight lesions 7 days later, and cerebrospinal fluid tests showed the simultaneous occurrence of MOG-Ab and anti-NMDARe-Ab.

Interventions: He completely recovered after treatment with low doses of oral corticosteroids.

Outcomes: Two months and 2 years follow-up showed that his condition was stable.

Lessons: The co-occurrence of MOG-Ab and anti-NMDAR-Ab does not indicate the co-occurrence of MOG-AD and anti-NMDARe. Laboratory findings should be combined with the clinical features to achieve an accurate and suitable diagnosis.
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http://dx.doi.org/10.1097/MD.0000000000024234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793424PMC
January 2021

Relevance of small right-to-left shunt in contrast-enhanced transcranial Doppler in young and middle-aged patients with cryptogenic stroke: a report of two cases and literature review.

Int J Neurosci 2021 Jan 5:1-7. Epub 2021 Jan 5.

Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China.

Aim: The clinical relevance of small right-to-left shunt (RLS) in young patients with cryptogenic stroke is unknown. We aimed to analyze and understand the relationship between cryptogenic stroke and small RLS by studying specific cases.

Materials And Methods: Clinical data from two cases of small RLS-related cryptogenic stroke in young patients were collected prospectively and analyzed. We followed up the patients for >1 year after discharge.

Results: . A 50-year-old man was admitted for slurred speech and right hemiplegia and was diagnosed with acute cerebral infarction. Contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) revealed a microbubble and 20-30 microbubbles per section, respectively, in the resting state. Three months later, he was readmitted for stroke recurrence. Transesophageal echocardiography (TEE) confirmed a patent foramen ovale (PFO), and he underwent transcatheter closure of the PFO. . A 48-year-old man was admitted for right hemiplegia with slurred speech. Brain magnetic resonance imaging showed acute cerebral infarction. c-TCD and contrast-enhanced TEE (c-TEE) revealed <10 microbubbles and approximately 20 microbubbles per section, respectively. These findings suggested a PFO. Two months later, he was readmitted for stroke recurrence. He underwent transcatheter closure of the PFO. Follow-up of cases 1 and 2 at >1 and >1.5 years after discharge, respectively, showed no stroke recurrence.

Conclusion: We suspected that a small RLS may cause cryptogenic stroke. A small RLS in c-TCD in stroke patients may not be actually small, and c-TEE/c-TTE may be valuable in finding larger RLSs.
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http://dx.doi.org/10.1080/00207454.2020.1865345DOI Listing
January 2021

Successful intravenous thrombolysis for acute ischemic stroke caused by aortic dissection with severe hypofibrinogenemia: a case report and literature review.

Int J Neurosci 2021 Jan 7:1-7. Epub 2021 Jan 7.

Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China.

Background: Intravenous thrombolysis (IVT) for acute brain infarctions caused by aortic dissection (AD) may lead to fatal outcomes; thus, it should be ruled out, especially if hypofibrinogenemia occurs after IVT. Successful management of AD-related acute brain infarction with hypofibrinogenemia after IVT has not been reported previously.

Case Report: An 84-year-old woman developed sudden left limb weakness and aphasia for almost 4 h. Alteplase was administered intravenously immediately after cerebral hemorrhage was ruled out by emergent head computed tomography (CT). An anomaly suspected to be AD was detected during subsequent routine chest CT, which was confirmed by CT angiography to be a thoracoabdominal aortic dissecting aneurysm (DeBakey type I). Severe hypofibrinogenemia was also noted. After effective blood pressure control, intramuscular injection of vitamin K, and rehydration therapy, her brain cell metabolism improved, hemiplegia improved slightly, and hypofibrinogenemia recovered gradually. The patient's cerebral hemorrhage did not progress, there was no chest pain or no aggravation of hemiplegia, and the fibrinogen level gradually returned to normal. The condition was stable during hospitalization. At 1.5 months after discharge, the patient showed minimal change in condition.

Conclusion: The symptoms of AD may be nonspecific and latent. IVT may be allowed to perform for some patients with AD related ischemical stroke, And IVT can improve the neural symptoms of AD-related ischemic stroke, but close monitoring is needed to avoid aneurysm rupture. Fibrinogen levels should also be monitored periodically after IVT for early detection of hypofibrinogenemia.
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http://dx.doi.org/10.1080/00207454.2020.1858823DOI Listing
January 2021

Toward Robust, Tough, Self-Healable Supramolecular Elastomers for Potential Application in Flexible Substrates.

ACS Appl Mater Interfaces 2021 Jan 29;13(1):1135-1144. Epub 2020 Dec 29.

Lab of Advanced Elastomer, South China University of Technology, 381 Wushan Road, Tianhe District, Guangzhou 510640, China.

A robust, tough, and self-healable elastomer is a promising candidate for substrate in flexible electronic devices, but there is often a trade-off between mechanical properties (robustness and toughness) and self-healing. Here, a poly(dimethylsiloxane) (PDMS) supramolecular elastomer is developed based on metal-coordinated bonds with relatively high activation energy. The strong metal-coordination complexes and their corresponding ionic clusters acting as the cross-linking points strengthen the resultant supramolecular networks, which achieves superior mechanical robustness (2.81 MPa), and their consecutive dynamic rupture and reconstruction efficiently dissipate strain energy during the stretching process, which leads to an impressive fracture toughness (32 MJ/m). Additionally, the reversible intermolecular interactions (weak hydrogen bonds and strong sacrificial coordination complexes/clusters) can break and re-form upon heating; thus, the elastomer self-heals at a moderate temperature with the highest healing efficiency of 95%. As such, the potential of the as-prepared supramolecular elastomer for a substrate material of flexible electronic devices is discovered.
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http://dx.doi.org/10.1021/acsami.0c15552DOI Listing
January 2021

Rice transcription factor MADS32 regulates floral patterning through interactions with multiple floral homeotic genes.

J Exp Bot 2021 Mar;72(7):2434-2449

Joint International Research Laboratory of Metabolic & Developmental Sciences, Shanghai Jiao Tong University-University of Adelaide Joint Centre for Agriculture and Health, State Key Laboratory of Hybrid Rice, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.

Floral patterning is regulated by intricate networks of floral identity genes. The peculiar MADS32 subfamily genes, absent in eudicots but prevalent in monocots, control floral organ identity. However, how the MADS32 family genes interact with other floral homeotic genes during flower development is mostly unknown. We show here that the rice homeotic transcription factor OsMADS32 regulates floral patterning by interacting synergistically with E class protein OsMADS6 in a dosage-dependent manner. Furthermore, our results indicate important roles for OsMADS32 in defining stamen, pistil, and ovule development through physical and genetic interactions with OsMADS1, OsMADS58, and OsMADS13, and in specifying floral meristem identity with OsMADS6, OsMADS3, and OsMADS58, respectively. Our findings suggest that OsMADS32 is an important factor for floral meristem identity maintenance and that it integrates the action of other MADS-box homeotic proteins to sustain floral organ specification and development in rice. Given that OsMADS32 is an orphan gene and absent in eudicots, our data substantially expand our understanding of flower development in plants.
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http://dx.doi.org/10.1093/jxb/eraa588DOI Listing
March 2021

Influence of starch fine structure and storage proteins on the eating quality of rice varieties with similar amylose contents.

J Sci Food Agric 2020 Dec 13. Epub 2020 Dec 13.

Rice Research Center, Crop Breeding and Cultivation Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai, China.

Background: Rice eating quality largely dictates consumer preference, and the demand for new rice varieties with excellent eating quality from farmers is increasing. Identification of factors contributing to eating quality is helpful for developing high-quality rice varieties.

Results: Two groups of rice with different apparent amylose content (AACs) were used in this study. One group contained four varieties with low AACs (8.8-9.4%), whereas the other contained four traditional varieties with medium AACs (17.2-17.5%). The physicochemical properties, starch fine structure and crystallinity and storage protein composition of the two groups were analyzed. We found that, in both groups, the rice varieties with high eating quality had more short-chain amylopectin, lower glutelin and prolamin content, and a higher albumin content. In addition, the low-AAC varieties produced opaque endosperms, which may result from an increased number of pores in the center of starch granules.

Conclusions: Both the fine structure of starch and the storage protein composition were closely related to rice eating quality. In both groups, short branch-chain amylopectin, short-chain amylopectin [degree of polymerization (DP) 6-12], and albumin had positive effects on eating quality. By contrast, long branch-chain amylopectin, long-chain amylopectin (DP 35-60), glutelin and prolamin had adverse effects on eating quality of rice. © 2020 Society of Chemical Industry.
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http://dx.doi.org/10.1002/jsfa.11014DOI Listing
December 2020

Clinical features of ocular toxocariasis: a comparison between ultra-wide-field and conventional camera imaging.

Eye (Lond) 2020 Dec 3. Epub 2020 Dec 3.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: The purpose of this study is to compare the lesion detection rates of ocular toxocariasis (OT) between ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and conventional fundus photography (CFP), and to evaluate the potential diagnostic ability of UWF-SLO in OT.

Methods: A total of 56 patients with serological/immunological confirmed unilateral OT were enrolled. The presence of OT characteristic features included the posterior granuloma (postG), peripheral granuloma (periG), tractional retinal detachment (TRD), retinal folds (RF), and vitreous strands (VS) and was analyzed in 36 patients with UWF-SLO and 56 patients with CFP. Diagnostic tests were employed using the clinical examination as gold standard.

Results: In total of the 56 OT eyes, granulomas were identified in 91.1% (51/56) of eyes, including postG in 46.4% (26/56) of eyes, periG in 41.1% (23/56) of eyes, and combined granulomas in 3.6% (2/56) of eyes. TRD, RF, and VS were found in 28.6% (16/56), 51.8% (29/56), and 83.9% (47/56) of patients, respectively. Although the specificities of the diagnosis in clinical features were similar by the diagnostic tests, the sensitivities of postG, periG, TRD, RF, and VS using UWF-SLO were 100%, 100%, 66.7%, 95%, and 81.8%, respectively, which were significantly higher those of CFP (72.2%, 31.3%, 11.1%, 55%, and 48.5%). Additionally, the extent of vitreous haze was milder graded by UWF-SLO compared to CFP (p = 0.0099).

Conclusions: The diagnostic ability of UWF-SLO was superior to CFP using clinical examination as gold standard for the ascertainment of the characteristic manifestations of OT, especially for granulomas and RF.
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http://dx.doi.org/10.1038/s41433-020-01332-wDOI Listing
December 2020

A Concise Total Synthesis of (-)-Berkelic Acid.

Angew Chem Int Ed Engl 2021 03 18;60(10):5141-5146. Epub 2021 Jan 18.

Sauvage Center for Molecular Sciences, Engineering Research Center of Organosilicon Compounds & Materials (Ministry of Education), College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, China.

Reported here is a concise total synthesis of (-)-berkelic acid in eight linear steps. This synthesis features a Catellani reaction/oxa-Michael cascade for the construction of the isochroman scaffold, a one-pot deprotection/spiroacetalization operation for the formation of the tetracyclic core structure, and a late-stage Ni-catalyzed reductive coupling for the introduction of the lateral chain. Notably, four stereocenters are established from a single existing chiral center with excellent stereocontrol during the deprotection/spiroacetalization process. Stereocontrol of the intriguing deprotection/spiroacetalization process is supported by DFT calculations.
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http://dx.doi.org/10.1002/anie.202014660DOI Listing
March 2021

Significant changes in autumn and winter aerosol composition and sources in Beijing from 2012 to 2018: Effects of clean air actions.

Environ Pollut 2021 Jan 15;268(Pt B):115855. Epub 2020 Oct 15.

State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry (LAPC), Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, 100029, China; Center for Excellence in Regional Atmospheric Environment, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China; University of Chinese Academy of Sciences, Beijing, 100049, China. Electronic address:

A seven-year long-term comprehensive measurement of non-refractory submicron particles (NR-PM) in autumn and winter in Beijing from 2012 to 2018 was conducted to evaluate the effectiveness of the clean air actions implemented by the Chinese government in September 2013 on aerosols from different sources and chemical processes. Results showed that the NR-PM concentrations decreased by 44.1% in autumn and 73.2% in winter from 2012 to 2018. Sulfate showed a much larger reduction than nitrate and ammonium in both autumn (55%) and winter (86%) and that nitrate even slightly increased by 15.8% in autumn. As a result, aerosol pollution in winter gradually changed from sulfate-rich to nitrate-rich with a sudden change after 2016 and the dominant role of nitrate in autumn was also strengthened after 2016. Among primary organic aerosol (OA) types, biomass burning OA and coal combustion OA exhibited the largest decline in autumn and winter, with reductions of 87.5% and 77.3%, respectively, while hydrocarbon-like OA (HOA) exhibited the smallest decline in both autumn (24.4%) and winter (37.1%). These significant changes in aerosol compositions were highly consistent with the much faster reduction of SO (75-85%) than NOx (36-59%) and were mainly due to the clean air actions rather than the impact of meteorological conditions. What's more, the enhanced atmospheric oxidizing capacity, which was indicated by increased O, altered the chemical processes of oxygenated OA (OOA), especially in autumn. Both of less-oxidized OOA (LO-OOA) and more-oxidized OOA showed elevated contributions in OA by 4% in autumn. The increased oxygen-to-carbon ratios of LO-OOA in autumn (from 0.42 to 0.58) and winter (from 0.44 to 0.52) indicated the enhanced atmospheric oxidizing capacity strengthened photochemical reactions and resulted in the increased oxidation degree of LO-OOA. This study demonstrates the effectiveness of the clean air actions for air quality improvement in Beijing.
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http://dx.doi.org/10.1016/j.envpol.2020.115855DOI Listing
January 2021

Early-onset Alzheimer's disease may be associated with sortilin-related receptor 1 gene mutation: A family report and review.

Radiol Case Rep 2021 Jan 29;16(1):30-34. Epub 2020 Oct 29.

Department of Neurology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China.

: Early-onset Alzheimer's disease is a rare condition that differs from the usual memory-disordered presentation of typical Alzheimer's disease. Early-onset Alzheimer's disease is believed to have a genetic basis, and sporadic Alzheimer's disease has been associated with sortilin-related receptor 1 polymorphism. : This report describes and discusses the family report of a 59-year-old patient with early-onset Alzheimer's disease that may have been associated with a sortilin-related receptor 1 gene mutation. The patient was hospitalized in August 2008 for gradually progressive amnesia. Brain magnetic resonance imaging showed that the patient presented with whole-brain atrophy (especially in the bilateral medial temporal lobe and hippocampus). He had an initial Mini-Mental State Examination score of 15 (time orientation: 4/5; place orientation: 4/5; language immediate memory: 2/3; attention and calculation: 1/5; delayed memory: 0/3; naming: 1/2; language retelling, understanding, and expression: 3/6; visuospatial ability: 0/1). Whole-exome sequencing showed a sortilin-related receptor 1 gene mutation, c.3575G>A (chr11:121448104), which was detected in the patient and his children. : Patients with early-onset Alzheimer's disease present with obvious deficits in language, visuospatial abilities, praxis, or other nonmemory cognitive functions. In this case, the speech, memory, and visuospatial impairment of the patient may be associated with the sortilin-related receptor 1 gene mutation. Atrophy of the bilateral medial temporal lobe/hippocampus on magnetic resonance imaging may be an important marker of early-onset Alzheimer's disease. A sortilin-related receptor 1 gene mutation, c.3575G>A (chr11:121448104), may increase the risk of Alzheimer's disease.
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http://dx.doi.org/10.1016/j.radcr.2020.10.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599375PMC
January 2021

Clinical characteristics of anterior cerebral artery (ACA) territory infarction caused by congenital absence of bilateral ACA: a case report.

Acta Neurol Belg 2020 Nov 6. Epub 2020 Nov 6.

Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen, China.

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http://dx.doi.org/10.1007/s13760-020-01534-9DOI Listing
November 2020

Successful intravenous thrombolysis in an acute ischemic stroke patient with contraindicating values of the international standardized ratio and prothrombin time.

Acta Neurol Belg 2020 Oct 9. Epub 2020 Oct 9.

Department of Internal Medicine, People's Hospital of Xilin County, Baise, 533500, Guangxi, China.

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http://dx.doi.org/10.1007/s13760-020-01512-1DOI Listing
October 2020

The fibrotic microenvironment promotes the metastatic seeding of tumor cells into the lungs via mediating the ZEB1-AS1/miR-200b-3p/ZEB1 signaling.

Cell Cycle 2020 10 5;19(20):2701-2719. Epub 2020 Oct 5.

Department of Respiratory Medicine, Xiangya Hospital, Central South University , Changsha, Hunan, China.

Fibrotic microenvironment has been reported to have a pro-metastasis effect on tumor cells, but the mechanism remains unclear. The current study aimed to explore the underlying mechanism by which the fibrotic microenvironment affects tumor cells. A tumor metastasis model was established by injecting tumor cells containing GFP into mice with pulmonary fibrosis. Lung tissues and fibroblasts were harvested, and conditioned medium (CM) were collected from fibrotic lungs and fibroblasts. Hematoxylin & eosin staining and immunohistochemistry were used to detect pulmonary metastasis and FSP1 expression, respectively. Bioinformatics and dual-luciferase reporter assay proved that the target genes of ZEB1-AS1 and miR-200b-3p were miR-200b-3p and ZEB1, respectively. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expressions of GFP, ZEB1-AS1, and miR-200b-3p. Transwell assay, Annexin V/PI assay, and colorimetry were performed to examine the effects of CM, ZEB1-AS1, miR-200b-3p, and ZEB1 on cell invasion, apoptosis, and the activity level of caspase-3/-9. Pulmonary metastasis was promoted and the expressions of FSP1 and GFP were increased in mice with pulmonary fibrosis. CM enhanced the invasion and inhibited the apoptosis of tumor cells. SiZEB1-AS1 and siZEB1 inhibited the invasion and apoptosis of tumor cells, while miR-200b-3p inhibitor had the opposite effect of SiZEB1-AS1 and siZEB1, and further reversed the effect of siZEB1 on tumor cell invasion and apoptosis. SiZEB1-AS1 reversed the effects of both miR-200b-3p inhibitor and miR-200b-3p inhibitor+siZEB1 on tumor cell invasion and apoptosis. Fibrotic microenvironment promoted the metastatic seeding of tumor cells into the lungs via mediating the ZEB1-AS1/miR-200b-3p/ZEB1 signaling.
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http://dx.doi.org/10.1080/15384101.2020.1826236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644172PMC
October 2020

Dose-response association of the ZJU index and fatty liver disease risk: A large cohort in China.

J Gastroenterol Hepatol 2021 May 14;36(5):1326-1333. Epub 2020 Oct 14.

Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.

Aim: The aim of this study is to investigate the sex-specific association between the ZJU index and risk of fatty liver disease in a large Chinese cohort.

Methods: A total of 28 729 adults without fatty liver disease at baseline and who completed at least one follow-up of annual examinations between 2009 and 2016 were included in this study. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for fatty liver disease risk associated with the ZJU index.

Results: During a median follow-up of 3.01 years, 7373 developed fatty liver disease. There were significant associations between the ZJU index and fatty liver disease for women and men with increasing HRs as the quartiles increase across Q2-Q4, corresponding HRs (95% CIs) in M3 were 2.28 (1.98-2.64), 3.52 (3.07-4.04), and 4.87 (4.24-5.59) for women and 2.44 (2.17-2.75), 4.18 (3.73-4.68), and 6.23 (5.56-6.98) for men. The association between the ZJU index and fatty liver disease risk remained significant in all the subgroups except that of T2DM and abdominal obesity subgroups for men. However, the association became nonsignificant when comparing Q3 and Q2 of the ZJU index with reference in the subgroups of T2DM for men, and nonsignificant when comparing Q3 of the ZJU index with reference in the subgroups of participants with T2DM and abdominal obesity for women.

Conclusion: The ZJU index was significantly associated with the risk of fatty liver disease in Chinese population. It will be better to keep body mass index, alanine aminotransferase, aspartate aminotransferase, triglyceride, and fasting plasma glucose at a normal level for preventing fatty liver disease.
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http://dx.doi.org/10.1111/jgh.15286DOI Listing
May 2021

Bronchial Fistula: Rare Complication of Treatment with Anlotinib.

Zhongguo Fei Ai Za Zhi 2020 Oct 29;23(10):858-865. Epub 2020 Sep 29.

Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.

Background: Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes.

Methods: We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula."

Results: Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months.

Conclusions: Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.
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http://dx.doi.org/10.3779/j.issn.1009-3419.2020.102.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583880PMC
October 2020

Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio and Carotid Intima-Media Thickness: A Cohort Study in China.

Lipids 2021 01 28;56(1):59-68. Epub 2020 Aug 28.

Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No.1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518060, People's Republic of China.

Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio may carry additional information and has been suggested as a better predictor for atherosclerosis progression and cardiovascular disease (CVD) than LDL-C and HDL-C alone. Therefore, we aim to explore the association between LDL-C/HDL-C ratio and high carotid intima-media thickness (CIMT) risk in a large Cohort in Beijing, China. This cohort study included 13,612 adults without high CIMT at first entry and who attended the baseline examination and at least one follow-up annual examination between 2009 and 2016. We used multivariable Cox regression to estimate hazard ratios (HR) with their 95% confidence intervals (CI) for the association between LDL-C/HDL-C ratio and risk of high CIMT. During 37,912 person-years of follow-up, 1996 (1268 men and 728 women) developed high CIMT. Compared with the first quartile of LDL-C/HDL-C ratio, the risk of high CIMT was significantly increased for the fourth quartile of LDL-C/HDL-C ratio (HR = 1.51, 95% CI: 1.29-1.78). We observed a significant association between LDL-C/HDL-C ratio and high CIMT risk comparing LDL-C/HDL-C ratio >2.78 with LDL-C/HDL-C ratio ≤2.78 and significant dose-response relationship between LDL-C/HDL-C ratio and risk of high CIMT. The restricted cubic spline showed a significant nonlinear association between LDL-C/HDL-C ratio and the risk of high CIMT (p = 0.009). We identify a significant association between LDL-C/HDL-C ratio and the risk of high CIMT in the Chinese Cohort study. Future studies are needed to evaluate the effectiveness of reducing LDL-C/HDL-C ratio treatment on the development of high CIMT.
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http://dx.doi.org/10.1002/lipd.12274DOI Listing
January 2021

The contribution of plasma uric acid to the risk of stroke in hypertensive populations.

Cardiovasc J Afr 2020 Nov-Dec;31(6):298-303. Epub 2020 Aug 12.

Department of Physiology, School of Basic Medicine, Harbin Medical University, Harbin, PR China.

Background: There is limited available evidence of a relationship between uric acid (UA) level and stroke in hypertensive populations worldwide. We aimed to estimate the relationship between UA level and stroke in Chinese hypertensive populations.

Methods: A total of 4 710 essentially hypertensive Chinese patients, including 307 with stroke, were recruited consecutively by cluster sampling from 60 communities in Shenzhen from April 2010 to September 2011. Demographic characteristics, UA level and stroke diagnosis were collected from every participant. Logistic regression analysis was used to estimate the association between UA level and stroke.

Results: The study population comprised 2 361 females and 2 349 males, with a mean age of 58 ± 11.75 years. There were significant associations between UA level and stroke and ischaemic stroke (IS) risk for females in the crude model (M0), model 1 (M1) and model 2 (M2), with increasing odds ratios (OR) as the quartiles (Q) increased. The odds of stroke risk was highest in Q4 in M2 (UA > 396 µmol/l, OR: 3.05, 95% CI: 1.74-5.36 and OR: 3.19, 95% CI: 1.74-5.85), but not for males in M0, M1 and M2. A significant dose-response relationship existed between UA level and stroke, and between UA level and IS for females but not for males. Hyperuricaemia (HU) was also significantly associated with stroke and IS for females but not for males. Taking negative uric acid, homocysteine, triglycerides, total cholesterol and low-density lipoprotein cholesterol (UA-Hcy-TG-TC-LDL-C-) as the reference, the combinations of UA+Hcy+TG-TC-LDL-, UA+Hcy+TG+TC+LDL-C- and UA+Hcy+TG+TC+LDL-C+ were significantly associated with the risk of stroke for females (OR = 2.48, 7.85 and 3.04).

Conclusions: High UA level could significantly increase stroke risk in female hypertensive patients. Female hypertensive patients may benefit from managing UA at normal levels for stroke prevention.
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http://dx.doi.org/10.5830/CVJA-2020-023DOI Listing
August 2020

The Hessian fly recessive resistance gene h4 mapped to chromosome 1A of the wheat cultivar 'Java' using genotyping-by-sequencing.

Theor Appl Genet 2020 Oct 2;133(10):2927-2935. Epub 2020 Jul 2.

Department of Agronomy, Kansas State University, 2004 Throckmorton Hall, Manhattan, KS, 66506, USA.

Key Message: The recessive Hessian fly resistance gene h4 and flanking SNP markers were located to a 642 kb region in chromosome 1A of the wheat cultivar 'Java.' Hessian fly (HF), Mayetiola destructor, is one of the most destructive insect pests in wheat worldwide. The wheat cultivar 'Java' was reported to carry a recessive gene (h4) for HF resistance; however, its chromosome location has not been determined. To map the HF resistance gene in Java, two populations of recombinant inbred lines (RILs) were developed from 'Bobwhite' × Java and 'Overley' × Java, respectively, and were phenotyped for responses to infestation of HF Great Plains biotype. Analysis of phenotypic data from the F and the RIL populations confirmed that one recessive gene conditioned HF resistance in Java. Two linkage maps were constructed using single-nucleotide polymorphism (SNP) markers generated by genotyping-by-sequencing (GBS). The h4 gene was mapped to the distal end of the short arm of chromosome 1A, which explained 60.4 to 70.5% of the phenotypic variation for HF resistance in the two populations. The GBS-SNPs in the h4 candidate interval were converted into Kompetitive Allele-Specific Polymerase Chain Reaction (KASP) markers to eliminate the missing data points in GBS-SNPs. Using the revised maps with KASP markers, h4 was further located to a 642 kb interval (6,635,984-7,277,935 bp). The two flanking KASP markers, KASP3299 and KASP1871, as well as four other closely linked KASP markers, may be useful for pyramiding h4 with other HF resistance genes in breeding.
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http://dx.doi.org/10.1007/s00122-020-03642-9DOI Listing
October 2020

Clinical characteristics and long-term prognosis of relapsing anti-N-methyl-D-aspartate receptor encephalitis: a retrospective, multicenter, self-controlled study.

Neurol Sci 2021 Jan 29;42(1):199-207. Epub 2020 Jun 29.

Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Objective: To analyze the clinical profile and long-term prognosis of relapsing anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.

Method: This is a retrospective, multicenter, self-controlled study of 10 patients with relapsing anti-NMDAR encephalitis. Relapse was defined as new psychiatric or neurologic syndrome unexplainable by other causes that improved after immunotherapy.

Results: The main symptoms at first onset and relapse included psychiatric symptoms, cognitive impairment, speech dysfunction, seizures, consciousness disturbance, movement disorders, central hypoventilation, and autonomic dysfunction. There were significantly fewer seizures and consciousness disturbances at relapse. At the first onset, the antibody positivity rate was significantly higher in the cerebrospinal fluid (CSF) than in the serum, and abnormal electroencephalograms results were noted in all patients. The relapse rate was 12.2%. After first-onset discharge, the duration of medication intake was 3.10 ± 2.69 months; the relapse time was 18.3 ± 16.5 months. The Modified Rankin Scale (MRS) score at relapse was significantly lower than that at the first onset. The MRS scores at relapse and first onset after immunotherapy were significantly lower than those before immunotherapy. At follow-up, the average duration of antiepileptic drug (AED) intake was < 1 year; the relapse rate was low.

Conclusions: Patients have fewer symptoms and better quality of life at relapse than at the first onset. Active immunotherapy can significantly improve the quality of life during first onset and relapse. Encephalitis antibody testing in the CSF is preferred at first onset and relapse. Increasing antibody titers suggest clinical relapse. Prematurely stopping immunotherapy may lead to relapse, but prolonged AED intake is unnecessary.
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http://dx.doi.org/10.1007/s10072-020-04482-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820183PMC
January 2021