Erdheim-Chester disease with asymmetric talus involvement: A case report

BACKGROUND

Erdheim-Chester disease (ECD) is a rare multi-system or multi-organ histiocytic proliferative disease with diverse clinical manifestations, and the development of the disease is complex, which makes clinical diagnosis and treatment difficult. The characteristic clinical manifestations include multi-organ involvement, especially in the symmetrical diaphysis and metaphysis of the bilateral extremities. ECD with a unilateral talus lesion is extremely rare. Here, we report an unusual case of ECD invading the asymmetric talus and tibia without involving other organs. The patient had good outcome after surgery.

CASE SUMMARY

We report a case of a 67-year-old man who was referred to our outpatient department because of left ankle chronic pain for 5 years, which exacerbated after a foot sprain 6 mo previously. We discovered multiple sclerotic lesions of the tibia and talus on his previous X-ray films, which were initially missed in a local hospital. Therefore, enhanced computer computed tomography (CT) and magnetic resonance imaging were performed. These examinations showed multiple lesions in the bone marrow cavity of the left tibia, and cortical sclerosis and osteonecrosis of the left talus. Specimens were collected via bone puncture from the two lesions, and a final diagnosis of ECD was confirmed by pathological and immunohistochemical examinations. In addition, other auxiliary examinations including head CT, pulmonary CT, spinal CT, abdominal CT, cardiac ultrasound and thyroid ultrasound showed no obvious abnormalities. The patient underwent surgery for the tibia lesion scraping and talus lesion scraping combined with cement casting. The patient started on a progressive rehabilitation at 4 wk, and felt no pain after surgery. During a 2-year follow-up period, the patient exercised normally without pain, and there were no signs of recurrence.

CONCLUSION

This study shows that surgery treatment may also achieve good results for ECD patients with only bone involvement.

Arterial Calcification Is Regulated Via an miR-204/DNMT3a Regulatory Circuit Both In Vitro and in Female Mice

Arterial calcification is a common cardiovascular disease that initiates from a process of osteoblastic differentiation of vascular smooth muscle cells (VSMCs). Accumulating evidence has demonstrated that microRNAs play an important role in regulating arterial calcification. miR-204 was significantly downregulated in calcified human renal arteries from patients with uremia; calcified arteries of mice, due to 5/6 nephrectomy with a high-phosphate diet (5/6 NTP); and in VSMCs induced by high phosphate concentration. The overexpression of miR-204 alleviated the osteoblastic differentiation of VSMCs. Bisulphite sequencing PCR revealed that CpG sites upstream of miR-204 DNA were hypermethylated in calcified VSMCs; in calcified arteries of mice, due to 5/6 NTP; and in calcified renal artery tissues from patients with uremia. Moreover, increased DNMT3a resulted in the hypermethylation of miR-204 in high phosphate concentration-induced VSMCs, whereas 5-aza-2'-deoxycytidine could restore the expression of miR-204 in high phosphate concentration-induced VSMCs. Moreover, we found that DNMT3a was the target of miR-204, and the methylation ratio of miR-204 was decreased significantly, meaning that the expression of miR-204 was restored when DNMT3a was knocked down by using DNMT3a small interfering RNA, resulting in abrogation of the effect of high phosphate concentration on VSMC calcification. The progress of arterial calcification is regulated by the miR-204/DNMT3a regulatory circuit.

DSP-enabled reconfigurable and transparent spectral converters for converging optical and mobile fronthaul/backhaul networks

Dynamically reconfigurable and transparent signal spectral conversion is expected to play a vital role in seamlessly integrating traditional metropolitan optical networks and mobile fronthaul/backhaul networks. In this paper, a simple digital signal processing (DSP)-enabled spectral converter is proposed and extensively investigated, for the first time, which just utilizes a single standard dual-parallel Mach-Zehnder modulator (DP-MZM) driven by SDN-controllable RF signals and DC bias currents. As an important thrust of the paper, optimum operating conditions of the proposed converter are analytically identified, statistically examined and experimentally verified. Optimum operating condition-supported spectral converter performances in IMDD-based network nodes are explored both theoretically and experimentally in terms of frequency detuning range-dependent conversion efficiency, spectral conversion-induced OSNR/power penalty and transparency to input signal characteristics. The proposed spectral converter has unique advantages including low configuration complexity, strict transparency, SDN-controllable performance reconfigurability and flexibility, as well as negligible spectral conversion-induced latency.

Electron microscopic observations of tegumental damage in adult Schistosoma japonicum after in vivo treatment with levo-praziquantel

The in vivo effects of a single dose of levo-praziquantel, 75 mg/kg in PEG 400, on the tegumental surface of adult S. japonicum were compared with the effects of a single dose (150 mg/kg) of the mixed isomer preparation, using scanning and transmission electron microscope. Worms were recovered from mice at 10 min, 30 min, 1 hr, 4 hr, 12 hr, 24 hr and 48 hr after treatment. After 10 min exposure to either compound, the tegumental folds and sensory organelles were swollen and the tegument vacuolated. After 12-24 hr, the surface was eroded and exfoliated with exposure of intrategumental and/or subtegumental tissues and attachment of leukocytes to the denuded areas. Vehicle controls were normal throughout the time period examined. These studies demonstrate that the levo isomer of praziquantel causes acute structural damage to the tegument similar to that seen with the mixed isomer preparation.

[Ultrastructural changes in atrial myxoma]

Ultrastructural changes of 20 cases of atrial myxoma were studied. Under the electron microscope, in a large amount of amorphous matrix, the myxomal cells were either scattered or aggregated. There were numerous microvilli-like cytoplasmic processes on the surface of the tumor cells. In many aspects, the ultrastructural features of the tumor cells were similar to those of the smooth muscle cells. The abundant cytoplasmic filaments were one of the most prominent ultrastructural features. Sometimes, some of them could form dense bodies. There were cytoplasmic filaments in the cytoplasmic processes of a certain tumor cells and lots of micropinocytic vesicles beneath the inner surface of the plasmic membrane. Nuclear membrane of the tumor cells often had marked indentation which was probably related to contraction of the cytoplasmic filaments. 2 of 20 lesions showed malignant characteristics. One lesion infiltrated into the atrial myocardium, and the other involved the left and right atria. It is suggested that the atrial myxoma be a true neoplasm of the atrium with potential malignant tendency. It originates from the multipotential mesenchymal tissue and differentiates mainly towards smooth muscle cells.