Overlapping syndrome of recurrent anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein demyelinating diseases: A case report.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (NMDARe) is capable of presenting a relapsing course and coexisting with myelin oligodendrocyte glycoprotein antibody disease, whereas it has been relatively rare. We describe a man with no history of tumor who successively developed anti-NMDARe and anti-myelin oligodendrocyte glycoprotein antibody disease. CASE SUMMARY: A 29-year-old man was initially admitted with headache, fever, intermittent abnormal behavior, decreased intelligence, limb twitching and loss of consciousness on July 16, 2018. On admission, examination reported no abnormality. During his presentation, he experienced aggravated symptoms, and the re-examination of cranial magnetic resonance imaging (MRI) indicated punctate abnormal signals in the left parietal lobe. External examination of cerebrospinal fluid and serum results revealed serum NMDAR antibody (Ab) (-), cerebrospinal fluid NMDAR-Ab (+) 1:10 and Epstein-Barr virus capsid antigen antibody IgG (+). Due to the imaging findings, anti-NMDARe was our primary consideration. The patient was treated with methylprednisolone and gamma globulin pulse therapy, mannitol injection dehydration to reduce intracranial pressure, sodium valproate sustained-release tablets for anti-epilepsy and olanzapine and risperidone to mitigate psychiatric symptoms. The patient was admitted to the hospital for the second time for "abnormal mental behavior and increased limb movements" on December 14, 2018. Re-examination of electroencephalography and cranial MRI showed no abnormality. The results of autoimmune encephalitis antibody revealed that serum NMDAR-Ab was weakly positive and cerebrospinal fluid NMDAR-Ab was positive. Considering comprehensive recurrent anti-NMDARe, the patient was treated with propylene-hormone pulse combined with immunosuppressive agents (mycophenolate mofetil), and the symptoms were relieved. The patient was admitted for "hoarseness and double vision" for the third time on August 23, 2019. Re-examination of cranial MRI showed abnormal signals in the medulla oblongata and right frontal lobe, and synoptophore examination indicated concomitant esotropia. The patient's visual acuity further decreased, and the re-examination of cranial MRI + enhancement reported multiple scattered speckled and patchy abnormal signals in the medulla oblongata, left pons arm, left cerebellum and right midbrain, thalamus. The patient was diagnosed with an accompanying demyelinating disease. Serum anti-myelin oligodendrocyte glycoprotein 1:10 and NMDAR antibody 1:10 were both positive. The patient was diagnosed with myelin oligodendrocyte glycoprotein antibody-related inflammatory demyelinating disease of the central nervous system complicated with anti-NMDARe overlap syndrome. The patient was successfully treated with methylprednisolone, gamma globulin pulse therapy and rituximab treatment. The patient remained asymptomatic and follow-up MRI scan 6 mo later showed complete removal of the lesion. CONCLUSION: We emphasize the rarity of this antibody combination and suggest that these patients may require longer follow-up due to the risk of recurrence of two autoimmune disorders.

Standardization of BCR-ABL1 quantification on the international scale in China using locally developed secondary reference panels.

For patients with chronic myeloid leukemia, reverse transcription quantitative polymerase chain reaction is widely used in laboratories to quantify BCR-ABL1 fusion gene transcripts for disease management. Many efforts have been made to standardize the BCR-ABL1 testing assay, including the primary and secondary reference reagents, but the secondary standards have not been developed and used in the standardization program in China. With the use of armored RNA technology, armored RNA of BCR-ABL1 and control genes was manufactured to prepare the secondary reference material anchored to the World Health Organization primary reference calibrators for standardization of BCR-ABL1 testing assays. The secondary reference was sent to 30 laboratories in China for validation. Data from an external quality assessment after the standardization process were collected and analyzed as well. The assigned %BCR-ABL1/ABL1IS values of the four levels of the secondary material panels were 0.0118, 0.1345, 1.3808, and 19.4266, respectively. In validation trials, 70.0% (21/30) of laboratories obtained valid conversion factors for the BCR-ABL1 assay. All valid conversion factors from 11 international scale laboratories were equivalent to their respective previous values. External quality assessment data indicated that the accuracy and precision between laboratories were improved. Moreover, the quantity of the panels is abundant to be used as quality control samples for monitoring the shift of data. In this study, we established a secondary genetic reference panel for BCR-ABL1 quantification. This study will play a role in facilitating the worldwide dissemination of the international scale, especially in promoting the standardization of molecular monitoring in China.

Using protein granularity to extract the protein sequence features.

The feature extraction of protein sequences is a challenging problem. It might need a lot of theoretical and practical knowledge from many fields. The difficulty would increase when investigators extract the features solely from protein sequences. In this paper, we present a method of protein granularity. The concepts of protein granularity, granularity order, granularity bound, granularity limit, and granularity increment are given respectively. The protein granularity can dig out the useful information solely from protein sequences. We provide an approach to construct the feature vectors. The feature vectors include the amino acid composition information, the sequence-order information, the same amino acid 'neighbor' information, and the sequence length information. Hence, the feature vectors can better represent protein sequences. Our feature extraction method does obviously consider the protein sequence length effects. An experiment of the protein structure class prediction was carried out. The prediction achieved 96.6% overall accuracy, and the success rate for each subset is all-α 92.3%, all-ß 100%, α/ß 100%, α+ß 93.5%, respectively. The last three success rates for subsets are equal to the best success rates in the published literatures. The overall accuracy of PG-SVM prediction is the second best result only having one protein prediction error difference with the first best result. The theoretical and experimental results demonstrate the application of protein granularity succeeds in the feature extraction of protein sequences.

Evaluation of serum creatinine- and cystatin C-based equations for the estimation of glomerular filtration rate in a Chinese population.

OBJECTIVE: This study aimed to evaluate the applicability of a selection of glomerular filtration rate (GFR) estimating equations based on serum creatinine (SCr) and serum cystatin C in a Chinese population. MATERIAL AND METHODS: Estimated GFR values from 10 equations were compared with reference GFR (rGFR) from the (99m)Tc-DTPA renal dynamic imaging method. The study enrolled 569 Chinese participants (41.5% women, 53.5 ± 16.9 years, range 19-92 years), with mean rGFR 74.80 ± 26.10 (range 9.8-146.8 ml/min/1.73 m(2)). RESULTS: Bland-Altman analysis illustrated that the 95% agreement limits of all the equations surpassed the acceptable tolerance (<60 ml/min/1.73 m(2)), of which the MacIsaac equation was the closest one, reaching 71.7 ml/min/1.73 m(2). Linear regression analysis also demonstrated a consistent result. When assessed in all participants, the accuracy of the six equations reached and exceeded the acceptable level (≥70%), of which the Shanghai and MacIsaac equations gained more accuracy than others. When compared in subgroups, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), MacIsaac and Cockcroft-Gault (CG) equations were optimal for rGFR stages ≥ 90 ml/min/1.73 m(2), 30-89 ml/min/1.73 m(2) and < 30 ml/min/1.73 m(2), respectively. CONCLUSION: The results demonstrated that further improvement is needed for the selected 10 equations. Not all the cystatin C equations were superior to SCr equations. They have their own applicability at various GFR levels. At present, the CKD-EPI, MacIsaac and CG equations may be applied to evaluate GFR in normal, mild to moderate and severe kidney function, respectively.

Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis.

OBJECTIVE: To investigate the characteristics of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. METHODS: 29 postmenopausal osteoporosis patients were divided into two groups: 14 patients with recurrent fracture of a new vertebral body after vertebroplasty comprised the new fracture group and there were 15 patients without recurrent fracture in the control group. The following variables were reviewed: age, body mass index (BMI), history of fractures, history of metabolic disease, anti-osteoporosis therapy, type of back brace used, bone mineral density (BMD) of the lumbar spine and hip, intact parathyroid hormone (iPTH), serum calcium and phosphorus, and time since vertebroplasty. RESULTS: Compared with the control group, patients in the new fracture group were statistically significantly different with respect to BMI (t = 2.538, P = 0.027), BMD of the lumbar spine (t = 2.761, P = 0.015), BMD of the hip (t = 2.367, P = 0.037) and iPTH (t = 2.711, P = 0.017). Twelve (86%) of the 14 patients' new vertebral fractures occurred within six months after treatment of the initial fracture, and 10 (71%) fractures were adjacent to those previously treated by percutaneous vertebroplasty. CONCLUSIONS: A substantial number of patients with osteoporosis develop new fractures after vertebroplasty; two-thirds of these new fractures occur in vertebrae adjacent to those previously treated. The following variables influence the outcome: BMI, history of fractures, history of metabolic diseases and medications, BMD of lumbar spine and hip, anti-osteoporosis therapy, and use of back brace.

Effects of Buyang Huanwu Decoction on neurite outgrowth and differentiation of neuroepithelial stem cells.

To determine the effects of Buyang Huanwu Decoction (BYHWD), a traditional Chinese medicine, on neurite outgrowth and differentiation of neuroepithelial stem cells (NEPs), NEPs were isolated from embryonic neural tube and cultured in medium with rat serum containing BYHWD, which was prepared from rats administrated orally with BYHWD. The average neurite length of NEPs grew significantly longer in rat serum containing BYHWD than in control serum without BYHWD. More neurofilament (NF) positive cells and glial fibrillary acidic protein (GFAP) positive cells were detected in NEPs cultured in the presence of BYHWD. Besides, when cultured NEPs were loaded with Fluo-3-AM, the fluorescence intensity obtained from NEPs cultured in serum with BYHWD was significantly lower than that from NEPs cultured in control serum without BYHWD. Our results indicate that BYHWD could exert a promotion effect on neurite outgrowth and differentiation of NEPs.

Effect of intermittent injection of recombinant human parathyroid hormone on bone histomorphometry of ovariectomized rats.

AIM: To observe the effect of intermittent parathyroid hormone (PTH) administration on bone histomorphology of relatively old ovariectomized rats. METHODS: The 6-month-old female SD rats were randomly divided into 5 groups: (1) sham-operated for baseline (ShamB, n=5), (2)ovariectomized for baseline (OVXB, n=6), (3) Sham-operated for end point (ShamE, n=6), (4) ovariectomized for end point (OVXE, n=6), (5) ovariectomized for PTH treatment (OVXEP, n=6). ShamB and OVXB rats were sacrificed 3 months after operation, ShamE, OVXE and OVXEP rats were sacrificed 4.5 months after operation. During 3-4.5 months after operation, OVXEP rats received daily subcutaneous injection of rhPTH1-84, while ShamE and OVXE received vehicle injection. The proximal tibiae of all rats were processed without decalcification for quantitative bone histomorphometry. RESULTS: The percent trabecular area (TbAr) of OVXEP was significantly greater than that of OVXE (P <0.05), and was similar to that of OVXB (P >0.05), but was smaller than that of ShamE (P <0.05); the trabecular thickness (TbTh) of OVXEP was thicker than any other group (all, P <0.05); the trabecular number (TbN) of OVXEP was only slightly higher than that of OVXE; the percent labeled perimeter (LPm), mineral apposition rate (MAR) and bone formation rate with bone area as referent (BFR/BV) of OVXEP were all higher than those of ShamE and OVXE respectively (P <0.01), whereas the osteoclast number (N of Oc) of OVXEP was similar to those of ShamE and OVXE (P >0.05). CONCLUSION: Short-term intermittent injection of rhPTH1-84 can prevent further bone loss in 9-month-old rats 3 months after ovariectomy, the mechanisms of this therapy are that PTH could increase TbTh while not alter TbN, and promote bone-forming activity while not influence bone-resorptive activity.