[Clinical presentation of Kleine-Levin syndrome]

Objective: To analyze the clinical features of Kleine-Levin syndrome (KLS) patients. Methods: Clinical data of 44 patients with KLS of the Sleep Center of Peking University People's Hospital from January 2002 to July 2013 were systematically reviewed. The predisposing factors and clinical presentations were summarized, and compared with the data from a Western KLS study with a large subjects number. Nocturnal polysomnography (PSG) and multiple sleep latency test (MSLT) were conducted during relapse and remission period, respectively. HLA-DQB1*0602 gene were screened and analyzed. Results: Among the 44 patients, 28(63.6%) were men and 16(36.4%) were women, with a mean age of (18.3±8.9) years old. Most patients developed the symptoms during adolescence. Infection or fever was the most common trigger for episode. The main clinical presentations were 44(100.0%) hypersomnia, 31(70.5%) forgetfulness, 26(59.1%) decreased appetites, 24(54.5%) juvenile behavior, 18(40.9%) depression, etc. Compared with the Western study, it showed that our patients had decreased instead of increased appetite. The PSG testing did not have remarkable findings. MSLT showed mean sleep latency was significantly shorter during relapse than during remission [(10.4±5.4) vs (15.3±3.4) min, P=0.009]. HLA-DQB1*0602 was positive in 12 of 40(30.0%) patients, which was similar to the data in the Chinese population. Conclusions: KLS has various clinical characteristics. The presentation of appetite may be different between Chinese and western KLS patients.

[Correlation of gastric cancer and effects of vitamin D receptor gene FokⅠ polymorphism on C-reactive protein and D-dimer in Uygur nationality patients]

OBJECTIVE

This study aimed to determine the correlation of Uygur gastric cancer and the polymorphism effects of vitamin D receptor gene FokⅠ on C-reactive protein and D-dimer.

METHODS

Method of random sampling was used to select 147 Uygur patients with gastric cancer who admitted at Tumor Hospital of Xinjing Medical University (Group A) and 151 healthy controls with the same nationality (Group B). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine FokⅠ loci polymorphism in both groups to identify the gastric cancer susceptibility gene. All patients were divided into Group FF (Group a) and Group Ff+ ff (Group b) by PCR-RFLP according to the f-gene carrier to compare the expression level of C-reactive protein and D-dimer.

RESULTS

The expression frequency of the f allelic gene of patients with gastric cancer was higher than that of healthy control patients (57.8% vs 47.4%, P<0.05). The carriers of the f allelic gene (Ff+ ff) had increased risk of gastric cancer (OR=2.85). Measurement levels of C-reactive protein and D-dimer in the f allelic gene group were higher than those of the non-f allelic gene group (4.72±1.65 vs 2.81±0.93, and 2.79±1.21 vs 1.09±0.65, respectively), and the differences were statistically significant (P<0.05).

CONCLUSIONS

The FokⅠ loci polymorphism of vitamin D receptor gene was related to gastric cancer susceptibility in Uygur. f allelic gene may be one of the risk factors of gastric cancer in Uygur. Moreover, f allelic gene may be a factor that increased the level of C-reactive protein and D-dimer in Uygur patients with gastric cancer.

High-salt diet induces outward remodelling of efferent arterioles in mice with reduced renal mass

AIM

The glomerular filtration rate (GFR) falls progressively in chronic kidney disease (CKD) which is caused by a reduction in the number of functional nephrons. The dysfunctional nephron exhibits a lower glomerular capillary pressure that is induced by an unbalance between afferent and efferent arteriole. Therefore, we tested the hypothesis that oxidative stress induced by CKD differentially impairs the structure or function of efferent vs. afferent arterioles.

METHODS

C57BL/6 mice received sham operations (sham) or 5/6 nephrectomy (RRM) and three months of normal- or high-salt diet or tempol. GFR was assessed from the plasma inulin clearance, arteriolar remodelling from media/lumen area ratio, myogenic responses from changes in luminal diameter with increases in perfusion pressure and passive wall compliance from the wall stress/strain relationships.

RESULTS

Mice with RRM fed a high salt (vs. sham) had a lower GFR (553 ± 25 vs. 758 ± 36 μL min^-1  g^-1 kidney, P < 0.01) and a larger efferent arteriolar diameter (9.6 ± 0.8 vs. 7.4 ± 0.7 μm, P < 0.05) resulting in a lower media/lumen area ratio (1.4 ± 0.1 vs. 2.4 ± 0.2, P < 0.01). These alterations were corrected by tempol. The myogenic responses of efferent arterioles were about one-half that of afferent arterioles and were unaffected by RRM or salt. Passive wall compliance was reduced by high salt in both afferent and efferent arterioles.

CONCLUSION

A reduction in renal mass with a high-salt diet induces oxidative stress that leads to an outward eutrophic remodelling in efferent arterioles and reduced wall compliance in both afferent and efferent arterioles. This may contribute to the lower GFR in this model of CKD.

Homozygous DNAH1 frameshift mutation causes multiple morphological anomalies of the sperm flagella in Chinese

This study aimed to investigate the genetic pathogeny of multiple morphological anomalies of the flagella (MMAF), which is a genetically heterogeneous disorder leading to male infertility. Nine patients with severe asthenozoospermia caused by MMAF were recruited. Whole genome sequencing and Sanger sequencing were performed, and we found that four of the nine patients were affected by the same homozygous frameshift mutation c.11726_11727delCT (p.[Pro3909ArgfsTer33]) in exon 73 of dynein axonemal heavy chain 1 ( DNAH1 ) gene. The parents and the sibling of proband 1 were all identified as heterozygous carriers. This mutation was distinct from previously reported DNAH1 mutations associated with MMAF and only affected the East Asian group. Furthermore, the variant DNAH1 protein could not be detected in spermatozoa by Western blot or immunofluorescence staining although DNAH1 mRNA was expressed in the spermatozoa. Scanning electron microscopy and transmission electron microscopy analysis showed the anomalies in sperm flagella morphology and ultrastructure in patients carrying this genetic variant. In conclusion, our results add to knowledge of the genetic pathogeny of MMAF and further confirmed the effectiveness of genetic screening in the diagnosis of MMAF.

Deep branch of the radial nerve in lateral surgical approaches to the radial head - A cadaveric study

INTRODUCTION

The traditional Kocher approach for lateral radial head exposure may be complicated by injury to the deep branch of the radial nerve (DBRN) and the radial collateral ligament. Kaplan approach is less commonly used, due to its known proximity to the DBRN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of radial collateral ligament injury. The comparison of the proximity of the DBRN to the surgical dissection at the level of radial head among approaches to the radial head has not previously been evaluated. We aimed to determine the anatomical proximity of the DBRN in these 3 common radial head approaches and to define a safe zone of dissection for the surgical exposure.

METHODS

Cadaveric dissections of 9 pairs of fresh frozen upper extremities were performed using EDC splitting, Kaplan and Kocher approach to the radial head sequentially in a randomized order. A mark was made on the radial head upon initial exposure during dissection. Measurements from the marked point of the radial head to the DBRN were made at the level of radial head.

RESULTS

The distance of DBRN to the radial head was 20 (17-22) mm in EDC splitting approach, 7 (3-11) mm in Kaplan approach and 29 (25-33) mm in Kocher approach. The EDC splitting approach was associated with a significantly lower chance of encountering the DBRN at the level of radial head as compared to the Kaplan approach (P<0.001). In all cases, lateral ligamentous complex was not exposed in Kaplan and EDC approaches, but were encountered in Kocher approach, risking injury to the radial collateral ligament.

CONCLUSIONS

The EDC splitting approach provides adequate exposure without the need to elevate or retract the EDC and ECU muscle mass that could risk injuring the DBRN. The Kaplan approach should be done by experienced surgeons who are familiar with the anatomy in this region, with extreme caution due to proximity of the DBRN to the surgical dissection at the level of the radial head. Caution of the DBRN should be taken during anterior elevation and retraction of the muscle mass in Kocher approach.

LEVEL OF EVIDENCE

IV.

Cardiovascular MRI with ferumoxytol

The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.

Association of glutathione S-transferase (GST) genetic polymorphisms with treatment outcome of cisplatin-based chemotherapy for advanced non-small cell lung cancer in a Chinese population

The aim of this study was to evaluate the association of GSTM1 null/present, GSTT1 null/present, and GSTP1 IIe105Val polymorphisms with the chemotherapy response and overall survival of advanced NSCLC. Two hundred and sixty-two patients with histologically confirmed advanced NSCLC (inoperable TNM stages IIIA, IIIB, and IV) were enrolled to this hospital-based study between May 2009 and May 2012. The GSTM1 null/present, GSTT1 null/present, and GSTP1 IIe105Val polymorphisms were genotyped by polymerase chain reaction coupled with restriction fragment length polymorphism. A logistic regression analysis revealed a correlation between the null genotype of GSTM1 and improved response to chemotherapy [odds ratio = 1.82; 95% confidence interval (CI) = 1.06-3.14]. Analyses with the Cox proportional hazards model also indicated that the null genotype of GSTM1 was associated with lower risk of death (hazard ratio = 0.40; 95%CI = 0.23-0.69). In conclusion, the null genotype of GSTM1 was found to be correlated with improved response to chemotherapy and lower risk of death in advanced NSCLC patients.

Plant centromeres

Plant centromeres are generally composed of tandem arrays of simple repeats that are typical of a particular species, but that evolve rapidly. Centromere specific retroelements are also present. These arrays associate with a centromere specific variant of histone H3 that anchors the site of the kinetochore. Although such DNA arrays are typical of the centromere, the specification of centromere activity has an epigenetic component as shown by the fact that centromeres are formed in the absence of such repeats and that centromeres in dicentric chromosomes regularly undergo inactivation.