Challenges of Large Vessel Vasculitis Stroke Patient with Complicated Endovascular Thrombectomy: A Case Report.

PURPOSE: The causes of acute stroke in patients with SLE are multifactorial. Antiphospholipid-associated hypercoagulability and inflammation-induced platelet activation are major causes of ischemic stroke in SLE patients. As such patients underwent intravenous thrombolysis and endovascular thrombectomy, they may have higher risk of complications and less favorable outcome. CASE REPORT: A 30-year-old woman with underline SLE and Takayasu arteritis who presented with right CCA and MCA occlusion status post rtPA and endovascular thrombectomy. Twelve hours after the procedure, head CT was ordered due to anisocoria with loss of pupillary light reflex. The head CT showed partial obliteration of suprasellar and quadrigeminal cistern due to extensive brain edema, leading to her decompressive craniectomy. Two days later, patient's both pupil became dilated with head CT showing occlusion of the left MCA. Her condition drastically went downhill when complications such as central DI and myocardial stunning occurred. CONCLUSION: Although autoimmune vasculitis is not listed as an absolute contraindication to endovascular thrombectomy, given the antecedent reports, it is prudent to disclose possible complications to both the patient and family while making the decision.

Understanding the Space-Charge Layer in SnO2 for Enhanced Electron Extraction in Hybrid Perovskite Solar Cells.

Tin oxide (SnO2) has been widely used as an n-type metal oxide electron transport layer in perovskite solar cells (PSCs) owing to its superior electrical and optical properties and low-temperature synthesis process. In particular, the interfacial effect between indium tin oxide (ITO) and SnO2 is an important parameter that controls the charge transport properties and device performance of the PSCs. Therefore, understanding the interfacial effect of ITO/SnO2 and its role in PSCs is crucial, but it is not studied intensively. Herein, we investigated the space-charge effect at the interface of ITO/SnO2 using transfer length measurement and conductive atomic force microscopy as a function of SnO2 thickness. Moreover, optical, morphologic, and device measurements were performed to determine the optimal SnO2 thickness for PSCs. The space-charge effect was identified in ITO/SnO2 when the SnO2 layer was very thin due to electron depletion near the interface. Interestingly, a critical kink point was observed at approximately 10 nm SnO2 thickness, indicating the electron depletion and weak charge transfer behavior of the device. Thus, a thickness around 20 nm was favorable for the best PSC performance because charge transport behavior in the thin SnO2 layer was depressed by electron depletion. However, when the thickness of SnO2 exceeded 50 nm, the device performance deteriorated due to increased series resistance. This study provides a strategy to tune the electron transport layer and boost the charge transport behavior in PSCs, making important contributions to optimizing SnO2-based PSCs.

Correlation of Otorhinolaryngologic Symptoms with Physical Findings in Behçet's Disease.

OBJECTIVE: Behçet's disease is a chronic systemic inflammatory disease of unknown etiology. We examined the correlation between otorhinolaryngologic symptoms and otorhinolaryngologic physical findings in patients with Behçet's disease, in search of strategies to reduce the morbidity rates. METHODS: Seventy-two patients diagnosed with Behçet's disease were included. After giving a detailed history of oropharyngeal, nasal, laryngeal, and otic symptoms, patients were examined endoscopically by an otolaryngologist, and the findings were recorded. RESULTS: Thirty-nine of the patients were male, and thirty-three were female. The mean age was 39.2 ± 3.4, and the mean disease duration was 8.24 ± 4.2 years. Statistically significant correlations were observed between ear lesions and ear symptoms (crusting and otic pain), nasal lesions and nasal symptoms (crusting and nasal pain), oropharyngeal lesions and oropharyngeal symptoms (pain and difficulty in swallowing), and laryngeal lesions and laryngeal symptoms (hoarseness, difficulty in swallowing, and pain). CONCLUSION: The results demonstrated a positive correlation between symptoms and otorhinolaryngeal examination findings in Behçet's disease. Potential morbidities can be prevented by routine endoscopic otorhinolaryngeal examinations and symptom screening of patients with Behçet's disease and arranging the therapy accordingly.

Enterovirus 71 Proteins 2A and 3D Antagonize the Antiviral Activity of Gamma Interferon via Signaling Attenuation.

UNLABELLED: Enterovirus 71 (EV71) infection causes severe mortality involving multiple possible mechanisms, including cytokine storm, brain stem encephalitis, and fulminant pulmonary edema. Gamma interferon (IFN-γ) may confer anti-EV71 activity; however, the claim that disease severity is highly correlated to an increase in IFN-γ is controversial and would indicate an immune escape initiated by EV71. This study, investigating the role of IFN-γ in EV71 infection using a murine model, showed that IFN-γ was elevated. Moreover, IFN-γ receptor-deficient mice showed higher mortality rates and more severe disease progression with slower viral clearance than wild-type mice. In vitro results showed that IFN-γ pretreatment reduced EV71 yield, whereas EV71 infection caused IFN-γ resistance with attenuated IFN-γ signaling in IFN regulatory factor 1 (IRF1) gene transactivation. To study the immunoediting ability of EV71 proteins in IFN-γ signaling, 11 viral proteins were stably expressed in cells without cytotoxicity; however, viral proteins 2A and 3D blocked IFN-γ-induced IRF1 transactivation following a loss of signal transducer and activator of transcription 1 (STAT1) nuclear translocation. Viral 3D attenuated IFN-γ signaling accompanied by a STAT1 decrease without interfering with IFN-γ receptor expression. Restoration of STAT1 or blocking 3D activity was able to rescue IFN-γ signaling. Interestingly, viral 2A attenuated IFN-γ signaling using another mechanism by reducing the serine phosphorylation of STAT1 following the inactivation of extracellular signal-regulated kinase without affecting STAT1 expression. These results demonstrate the anti-EV71 ability of IFN-γ and the immunoediting ability by EV71 2A and 3D, which attenuate IFN-γ signaling through different mechanisms. IMPORTANCE: Immunosurveillance by gamma interferon (IFN-γ) may confer anti-enterovirus 71 (anti-EV71) activity; however, the claim that disease severity is highly correlated to an increase in IFN-γ is controversial and would indicate an immune escape initiated by EV71. IFN-γ receptor-deficient mice showed higher mortality and more severe disease progression, indicating the anti-EV71 property of IFN-γ. However, EV71 infection caused cellular insusceptibility in response to IFN-γ stimulation. We used an in vitro system with viral protein expression to explore the novel IFN-γ inhibitory properties of the EV71 2A and 3D proteins through the different mechanisms. According to this study, targeting either 2A or 3D pharmacologically and/or genetically may sustain a cellular susceptibility in response to IFN-γ, particularly for IFN-γ-mediated anti-EV71 activity.

Regulation of SHP2 by PTEN/AKT/GSK-3ß signaling facilitates IFN-γ resistance in hyperproliferating gastric cancer.

Oncogenic activation accompanied by escape from immune surveillance, such as IFN-γ resistance, is critical for cancer cell growth and survival. In this study, we investigated the crosstalk signaling between IFN-γ resistance and signaling of hyperproliferation in gastric cancer cells. IFN-γ inhibited the cell growth of MKN45 cells but not hyperproliferating AGS cells. AGS cells did not respond to IFN-γ because of a decrease in STAT1 but not due to dysfunctional IFN-γ receptors. Signaling of PI3K/AKT, as well as MEK/ERK, was required for the hyperproliferation; notably, PI3K/AKT alone mediated the IFN-γ resistance. Aberrant Src homology-2 domain-containing phosphatase (SHP) 2 determined IFN-γ resistance but unexpectedly had no effects on hyperproliferation or ERK activation. In the IFN-γ resistant cells, inactivation of glycogen synthase kinase (GSK)-3ß by PI3K/AKT was important for SHP2 activation but not for hyperproliferation. An imbalance of AKT/GSK-3ß/SHP2 caused by a reduction of PTEN was important for the crosstalk between IFN-γ resistance and hyperproliferation. PI3K is constitutively expressed in AGS cells and immunohistochemical staining showed a correlation between hyperproliferation and expression of SHP2 and STAT1 in gastric tumors. These results demonstrate the effects of PTEN/AKT/GSK-3ß/SHP2 signaling on IFN-γ resistance in hyperproliferating gastric cancer cells.

Autophagy facilitates an IFN-γ response and signal transduction.

Autophagy, that is directly triggered by invaded pathogens and indirectly triggered by IFN-γ, acts as a defense by mediating intracellular microbial recognition and clearance. In addition, autophagy contributes to inflammation by facilitating an IFN-γ response and signal transduction. For immune escape, downregulated autophagy may be a strategy used by microbes.

Hypopigmented mycosis fungoides associated with atopy in two children.

Mycosis fungoides is very rare in children. Hypopigmented lesions of this disease are usually observed in dark-skinned individuals and often show a T supressor CD8(+) phenotype. Two Caucasian children with predominantly hypopigmented lesions of mycosis fungoides are presented here. Atopy was a concomitant feature in both.

The generalizability of cardiovascular responses across settings.

The generalizability of cardiovascular reactivity change scores remains largely unsupported. In previous studies, several factors differed between laboratory and field, making poor lab-to-life correlations difficult to interpret. The present study varied only one parameter between the lab and field: setting. In this study, 24 females were studied on four occasions: twice in the lab (to provide test-retest reliability); once in a classroom; and once at home. After a baseline, subjects performed a math task, while blood pressure and heart rate were monitored. Procedures were identical in all sessions. Blood pressure changes were fairly reliable between the two lab sessions, with rs values 0.68 (systolic) and 0.62 (diastolic pressure); however, lab/nonlab correlations were lower (0.47 for SBP; 0.38 for DBP). This suggests that even a minor variation in procedure, such as a change in setting, can affect generalizability; other lab-field differences may have an even greater impact.