Successful endovascular management for spontaneous hemothorax in a patient with neurofibromatosis Type1: A case report and review

INTRODUCTION AND IMPORTANCE

Neurofibromatosis Type 1 (NF1) is a rare autosomal dominant genetic disorder that affects multiple organs and systems, including the nervous system, integumentary system, and connective tissues. Spontaneous hemothorax occurs infrequently in patients with NF1 and is associated with high fatality rates. However, it is commonly overlooked or misdiagnosed.

CASE PRESENTATION

We present the case of a 29-year-old woman with NF1 who complained of chest pain and was detected with hemothorax on radiographic examination. No bleeding sites were identified following thrombectomy. The patient's condition deteriorated with conservative treatment over nine days, posing a potentially life-threatening risk. After a diagnostic evaluation using computerized tomography angiography (CTA) and digital subtraction angiography (DSA) of the neck vasculature, the patient was diagnosed with spontaneous rupture of the vertebral artery (VA) and subclavian artery (SuA) aneurysm. Following a multidisciplinary discussion and extensive investigations, the patient underwent successful endovascular treatment. A VIABAHN covered stent was implanted in the left SuA to overlay the emergent orifice. The endovascular treatment challenge due to the inaccessible of the proximal of left VA. To prevent retrograde flow into the VA aneurysm, the coils were used to embolize the left VA via the right vertebral artery-basilar artery (VA-BA) passage. The patient was alive at the 5-year follow-up without further complications.

CLINICAL DISCUSSION

The CTA examination led to the diagnosis of vascular rupture due to NF1, and endovascular treatment was performed to occlude the vascular lumen. There have been no recurrences during the five-year follow-up period.

CONCLUSION

Vasculopathy is the second leading cause of death in patients with NF1 after malignancy. Early diagnosis of spontaneous hemothorax in patients with NF1 is crucial, as misdiagnosis can result in missed treatment opportunities. CTA plays a vital role in preliminarily diagnosing the cause of spontaneous hemothorax, while endovascular treatment offers a new therapeutic option for such patients.

[Advances in application of functional magnetic resonance imaging in patients with painful temporomandibular disorders]

Temporomandibular disorders (TMD), characterized by pain and dysfunction of the temporomandibular joint, are the most common chronic orofacial pain. However, the etiologies and pathologies of TMD related chronic pain are poorly understood. Functional magnetic resonance imaging (fMRI) measures brain activity by detecting changes associated with blood flow without invasiveness, and has been widely used in chronic pain research. We reviewed recent fMRI studies exploring the brain changes of patients with painful TMD to investigate the role of central nervous system in abnormal pain perception and impaired pain modulation, and to summarize the effects of splint therapy, in the hope of facilitating the clinical diagnosis and treatment of TMD.

Zinc Finger E-Box Binding Protein 2 (ZEB2) Suppress Apoptosis of Vascular Endothelial Cells Induced by High Glucose Through Mitogen-Activated Protein Kinases (MAPK) Pathway Activation

Background

Hyperglycemia has been confirmed to damage endothelial function of vascular and microvascular. The regulation of zinc finger E-box binding protein 2 (ZEB2) on vascular endothelial cells (VECs) is reported rarely. Our study investigates the role of ZEB2 on the apoptosis of VECs induced by high glucose through MAPK pathway.

Material/Methods

Downregulated and upregulated expression of ZEB2 in human umbilical vein endothelial cells (HUVECs) were performed by plasmids transfection. HUVECs are respectively treated with different concentrations of glucose (5.5 mM, 33 mM). The expression of mRNA and protein were detected by real-time quantified PCR and western blotting. Apoptotic cells were measured by flow cytometry. Proliferation and migration of HUVECs were detected by MTT assay and wound healing assay.

Results

The apoptosis of HUVECs detected by flow cytometry and western blot revealed that ZEB2 overexpression distinctly suppressed the apoptosis of HUVECs induced by high glucose. ZEB2 overexpression promoted the proliferative and migration activity of HUVECs. Besides, ZEB2 overexpression specifically accelerated the phosphorylation level of JNK, and suppressed the apoptosis and promoted the proliferative of VECs via JNK pathway.

Conclusion

ZEB2 suppress apoptosis of VECs induced by high glucose through MAPK pathway activation, which provides a novel insight and therapeutic target for endothelial injury.

First Report of a Group 16SrI Phytoplasma Associated with Amaranthus hypochondriacus Cladodes in China

Amaranthus spp. are cultivated worldwide as leafy vegetable, cereal, and ornamentals. In China, stems and leaves of Amaranthus hypochondriacus L. are used as a vegetable (2). In July 2010, sporadic amaranth plants exhibiting symptoms of cladodes and spica proliferation were observed in a vegetable garden near Foshan, Guangdong, China. Stem samples were collected from two symptomatic and two asymptomatic plants. Total DNA was extracted with a modified cetyltrimethylammonium bromide (CTAB) method (1). Nested PCR with a combination of phytoplasma-specific universal primer pairs (P1/P7 and R16F2n/R16R2) amplified 16S rDNA sequences with the expected size of 1.2 kb from all samples of symptomatic amaranth plants, but not from the asymptomatic plants (3). Nested PCR products yielded identical AluI, HhaI, HpaII, HaeIII, KpnI, MseI, RsaI, Sau3AI, and TaqI restriction fragment length polymorphism (RFLP) profiles with chinaberry witches'-broom phytoplasma (16SrI-B subgroup), but different from peanut witches'-broom phytoplasma (16SrII group), jujube witches'-broom phytoplasma (16SrV group), and paulownia witches'-broom phytoplasma (16SrI-D subgroup). Nested PCR products were purified, cloned in pMD18-T Simple Vector (TaKaRa, Dalian, China), and sequenced. The 16S rDNA sequences were identical and deposited in GenBank (Accession No. JF323034). GenBank BLASTn analysis indicated that the amaranth extracts showed as high as 99% sequence identity with the members of 16SrI group phytoplasmas, including those associated with arecanut yellow leaf disease (FJ998269) and aster yellow AY-27 (HM467127). A polygenetic tree was constructed using MEGA 4.0 based on the 16S rDNA sequences of amaranth cladode phytoplasma and other phytoplasmas belonging to 16SrI phytoplasma group. In phylogenetic analysis, the sequences clustered on a single branch with members of 16SrI-B subgroup in the tree. Therefore, the phytoplasma was classified in subgroup 16SrI-B. To our knowledge, this is the first report of a subgroup 16SrI-B phytoplasma associated with diseased A. hypochondriacus in China. References: (1) E. Angelini et al. Vitis 40:79, 2001. (2) M. Costea et al. Econ. Bot. 57:646, 2003. (3) I. M. Lee et al. Int. J. Syst. Bacteriol. 48:1153, 1998.

[Refolding of recombinant proteins in vitro]

Refolding of recombinant proteins is an important event in the downstream process of genetic engineering. On the basis of the mechanism of protein folding in vitro, general strategy of recombinant protein refolding is postulated, and major developments in recent years on this field are reviewed, including: molecular chaperone mediated refolding, detergent-assisted refolding, protein refolding in reverse micelle, addition of folding enhancer and methods for the formation of disulfide bond during protein refolding.

Expression of transforming growth factor beta in radiation interstitial pneumonitis

We investigated the changes in transforming growth factor beta 1 (TGF-beta 1) mRNA and TGF-beta 3 protein expression that occur in radiation interstitial pneumonitis. We used TGF-beta 1-cDNA probe in situ hybridization and TGF-beta 3 polyclonal antibody in immunohistochemical techniques. Our results showed that the distribution of TGF-beta 1 mRNA and TGF-beta 3 protein basically coincided in blood vessels, airways, lung parenchyma, and alveolar macrophages. However, bronchial epithelial cells expressed only TGF-beta 3 proteins and no TGF-beta 1 mRNA. We found an increased expression of TGF-beta 1 mRNA and TGF-beta 3 proteins in radiation interstitial pneumonitis.

Further characterization of Chinese Leishmania isolates by isoenzyme electrophoresis

Ten Chinese Leishmania isolates from different endemic areas and hosts are characterized by isoenzyme electrophoresis for 9 enzymes. Seven were isolated from visceral leishmaniasis patients, one from an infected dog, one from a sandfly and one from a naturally infected racoon dog. Eight of the 10 isolates were indistinguishable in isoenzyme profile from the L infantum reference strain. The isoenzyme profiles of the remaining two isolates (from kala azar patients in Xinjiang) could not be characterized in this study and need further research.