Newly diagnosed multiple sclerosis in a patient with ocular myasthenia gravis: A case report

Rationale:Patients with myasthenia gravis may also have comorbid autoimmune diseases. Since both myasthenia gravis and neuromyelitis optica spectrum disease are mediated by antibodies, they are likely to occur together. However, since multiple sclerosis is an autoimmune disease that is not mediated by a specific antibody, it has fewer immune mechanisms in common with myasthenia gravis than neuromyelitis optica spectrum disease. We encountered a case of newly developed multiple sclerosis in a patient with myasthenia gravis.Patient concerns:A 46-year-old man was diagnosed with ocular myasthenia gravis 6 years ago and had been taking pyridostigmine to control his symptoms.Diagnosis:The patient developed right optic neuritis, and multiple sclerosis was suspected based on the brain magnetic resonance imaging findings. However, the required diagnostic criteria were not met.Interventions:Disease-modifying therapy was not initiated, and clinical progression of the disease was monitored.Outcomes:One year after the onset of optic neuritis, the patient developed myelitis and was diagnosed with multiple sclerosis, prompting treatment with disease-modifying therapy.Lessons:When optic neuritis occurs in patients with myasthenia gravis, careful evaluation is necessary while considering the possibility that it may be the first symptom of a demyelinating central nervous system disease. Therefore, it is important to conduct shorter-interval monitoring and symptom screening for patients with neurological autoimmune diseases, such as myasthenia gravis, even if multiple sclerosis is not initially suspected, to achieve early detection of multiple sclerosis.     

消化不良者胃镜检查适应证的探讨

目的:进一步探讨消化不良患者胃镜检查的适应证。方法:经胃镜、病理检查的4500例消化不良患者分为<45岁及≥45岁组,并进一步分为Hp阳性和Hp阴性组。比较同一年龄组不同Hp状态及不同年龄组间检查结果,并对<45岁、Hp阴性消化性溃疡易患因素作进一步分析。结果:<45岁消化性溃疡(PU)Hp阳性率高:十二指肠球部溃疡(DU)94.2％,胃溃疡(GU)86.4％≥45岁Hp阴性PU发生率升高(DU22.7％,GU33.3％)。<45岁胃癌发生率显著低于≥45岁组(P<0.01),且在≥45岁组胃癌Hp多为阴性(68.4％)。病理结果表明,<45岁组慢性萎缩性胃炎、肠上皮化生及异型增生患者人数及病变程度均显著少于并轻于≥45岁组(P<0.05,P<0.01),且在≥45岁组上述病变多发生在Hp阴性组。另外,<45岁Hp阴性PU发生主要与遗传、服用NSAIDs药物、饮酒或精神紧张有关。结论:消化不良患者胃镜检查适应证应该是(1)≥45岁。(2)<45岁Hp阳性。(3)<45岁、Hp阴性症状持续、治疗无效,尤其伴有进行性消瘦、纳差及贫血者。(4)<45岁Hp阴性、有PU遗传史、长期服用NSAID药物、饮酒或精神紧张者.(5)约20％～30％患者可免于胃镜检查。     

Translating Cancer Prevention and Control Research into the Community Setting: Workforce Implications

A gap exists between cancer prevention research and its translation into community practice. Two strategies to reduce this gap are community-based participatory research (CBPR) and dissemination research. CBPR offers an avenue to engage academic and community partners, thereby providing mechanisms for joint learning and application of knowledge. Dissemination research examines the movement of evidence-based public health and clinical innovations to practice settings. While applying these approaches may reduce the gap between research and practice, the cancer prevention workforce may be inadequate in size, insufficiently trained, lack resources and incentives, or face structural barriers to effectively participate in CBPR and disseminate evidence-based research findings into practice. Information on translating cancer prevention information to communities and workforce implications was obtained from a panel of experts and through a review of the literature on CBPR and dissemination research. The expert panel and literature review identified major barriers to successfully conducting CBPR and dissemination research in community settings. Barriers included inadequate policies; insufficient networking and communication infrastructures; unsupportive research cultures, climates, and mindsets; inadequate researcher and practitioner education; and limited CBPR and dissemination research with adequate study designs. No specific estimates of the cancer prevention workforce were found; however, indirect evidence for a shortfall were identified. We recommend expanding CBPR training for academic and community partners; increasing funding for dissemination research and practice; supporting proven partnerships; and providing strategic coordination for government agencies, research institutions, nongovernmental organizations, and the private sector to foster better dissemination of information and integration of community-based cancer prevention and control programs and practices. Specific challenges and needs that must be addressed to improve the translation of cancer prevention research into community settings were identified.     

CT Radiation Dose Optimization and Estimation: an Update for Radiologists

In keeping with the increasing utilization of CT examinations, the greater concern about radiation hazards from examinations has been addressed. In this regard, CT radiation dose optimization has been given a great deal of attention by radiologists, referring physicians, technologists, and physicists. Dose-saving strategies are continuously evolving in terms of imaging techniques as well as dose management. Consequently, regular updates of this issue are necessary especially for radiologists who play a pivotal role in this activity. This review article will provide an update on how we can optimize CT dose in order to maximize the benefit-to-risk ratio of this clinically useful diagnostic imaging method.     

Expression of Antimicrobial Peptides Such as LL‐37 and hBD‐2 in Nonlesional Skin of Atopic Individuals

Abstract: Recurrent skin infection is one of the major complications of atopic dermatitis and can be partly explained by decreased expression of antimicrobial peptides such as human β‐defensin‐2 and cathelicidin (LL‐37). In the human epidermis, human β‐defensin‐2 is packed in the lamellar body and LL‐37 is co‐localized with intercellular lipid lamellae of the stratum corneum; together, these antimicrobial peptides constitute the primary defense system. IL‐1α, a potent inducer of LL‐37 and human β‐defensin‐2, is also secreted from the disrupted epidermis for barrier homeostasis. In this study, we investigated whether expression of human β‐defensin‐2 and LL‐37 is constitutively decreased in the skin of atopic individuals. Nonlesional foreskins from atopic (n = 7) and nonatopic (n = 7) individuals were analyzed. The expression of LL‐37, human β‐defensin‐2 and IL‐1α was analyzed using immunohistochemical staining, Western blot, and real‐time polymerase chain reaction. Lamellar body density and secretion were evaluated by electron microscope. Quantitative analysis showed that the expression of each parameter was not significantly different between groups. Thus, basal expression of LL‐37 and human β‐defensin‐2 was not changed in atopic individuals. These results indicate that the expression of antimicrobial peptides at baseline was not different between nonlesional skin of atopic individuals and normal skin of nonatopic individuals.     

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. ¹⁸F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.     

清麴酱激酶的溶栓活性可减轻栓塞性脑梗死后脑损伤

Cheonggukjang is a soybean paste made by fermenting whole cooked soybean with Bacillus subtilis. Cheonggukjang contains a fibrinolytic enzyme that may have clinical applications in removing blood clots. In this study, we use the term “cheonggukjang kinase” (CGK) to refer to this fibrinolytic enzyme. We used fibrin clot lysis and platelet-rich clot lysis assays to clarify the mechanisms by which CGK exerts thrombolytic effects, and, specifically, whether it acts more like a plasminogen activator or like plasmin. Additionally, we examined the thrombolytic effects of CGK in a rat model of cerebral embolic stroke produced by middle cerebral artery occlusion (MCAO) with respect to infarct volume and behavioral performance. In both the fibrin clot lysis and platelet-rich clot lysis assays, the thrombolytic activity was highest in CGK that had been cultured for 40 h. Furthermore, T50%, the time needed to decompose half the clot, did not differ in the presence or absence of plasminogen, indicating that CGK is a plasmin-like protein, not a plasminogen activator. In the rat model of cerebral embolic stroke, clots were no longer visible in rats that received an intravenous infusion of CGK (1 U plasmin-like activity/100 μg CGK/kg) 1 h after MCAO. CGK-treated groups showed a significant dose-dependent reduction in infarct volume. Treatment with CGK also improved functional recovery, as assessed by neurological deficit scores. Reduction of infarct volume and improvement in functional recovery after CGK treatment (1 U plasmin-like activity/100 μg CGK/kg) was greater than after treatment with recombinant tissue plasminogen activator (r-tPA; 10 mg/kg). These data suggest that CGK is an effective agent for reducing infarct volume and improving functional recovery following ischemic brain injury. Moreover, CGK may be a more efficacious clot-dissolving agent than r-tPA. CGK has a number of potential clinical applications in the treatment of stroke.