Magnetic Resonance Imaging Evidence of an Occipital- Straight Sinus Dural Arteriovenous Fistula Causing Severe Bilateral Thalamic Oedema: A Case Report

An 81-year-old woman, with a 3-month history of tinnitus and vertigo, presented with a deterioration of symptoms. Magnetic resonance imaging (MRI) of the brain, using fluid attenuated inversion recovery (FLAIR) and T2 weighted (T2WI) images, demonstrated hyperintensity and swelling of the bilateral thalami, medial parietal lobes, occipital lobes, and left cerebellar hemisphere. She was referred to us with the suggestion of a brain tumour that had spread into the bilateral thalami, or encephalitis. A review of the MR images, however, demonstrated dilatation of a vein on the surface of the cerebellar hemisphere on the T2WI image. Susceptibility weighted imaging (SWI) revealed small and multiple hypointense lesions, indicating microhaemorrhages, in the bilateral thalami and left cerebellar hemisphere. The time of flight source imaging demonstrated small hyperintense dots in the wall of the occipital and straight sinus. Finally, a digital subtraction angiogram (DSA) revealed a dural arteriovenous fistula (DAVF) in the occipito-straight sinus with reflux flow into the straight sinus (Borden Type II). A transvenous embolization and trans-arterial embolization were performed, in an emergency setting, for the occipital sinus and dural shunt, respectively, with the aim of preserving the antegrade flow of the straight sinus. The DSA following the endovascular treatment showed the disappearance of shunt flow and recovery of the antegrade flow in the straight sinus. Therefore, this case report highlights that meticulous analysis of MRI scans help diagnose DAVF, which results in quick and radical treatment

Cutaneous T-cell-attracting chemokine as a novel biomarker for predicting prognosis of idiopathic pulmonary fibrosis: a prospective observational study

[Background] Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disease that leads to respiratory failure and death. Although there is a greater understanding of the etiology of this disease, accurately predicting the disease course in individual patients is still not possible. This study aimed to evaluate serum cytokines/chemokines as potential biomarkers that can predict outcomes in IPF patients. [Methods] A multi-institutional prospective two-stage discovery and validation design using two independent cohorts was adopted. For the discovery analysis, serum samples from 100 IPF patients and 32 healthy controls were examined using an unbiased, multiplex immunoassay of 48 cytokines/chemokines. The serum cytokine/chemokine values were compared between IPF patients and controls; the association between multiplex measurements and survival time was evaluated in IPF patients. In the validation analysis, the cytokines/chemokines identified in the discovery analysis were examined in serum samples from another 81 IPF patients to verify the ability of these cytokines/chemokines to predict survival. Immunohistochemical assessment of IPF-derived lung samples was also performed to determine where this novel biomarker is expressed. [Results] In the discovery cohort, 18 cytokines/chemokines were significantly elevated in sera from IPF patients compared with those from controls. Interleukin-1 receptor alpha (IL-1Rα), interleukin-8 (IL-8), macrophage inflammatory protein 1 alpha (MIP-1α), and cutaneous T-cell-attracting chemokine (CTACK) were associated with survival: IL-1Rα, hazard ratio (HR) = 1.04 per 10 units, 95% confidence interval (95% CI) 1.01–1.07; IL-8, HR = 1.04, 95% CI 1.01–1.08; MIP-1α, HR = 1.19, 95% CI 1.00–1.36; and CTACK, HR = 1.12 per 100 units, 95% CI 1.02–1.21. A replication analysis was performed only for CTACK because others were previously reported to be potential biomarkers of interstitial lung diseases. In the validation cohort, CTACK was associated with survival: HR = 1.14 per 100 units, 95% CI 1.01–1.28. Immunohistochemistry revealed the expression of CTACK and CC chemokine receptor 10 (a ligand of CTACK) in airway and type II alveolar epithelial cells of IPF patients but not in those of controls. [Conclusions] CTACK is a novel prognostic biomarker of IPF

High Serum Vaspin Concentrations in Patients with Ulcerative Colitis

Background: Adipocytokines are associated with energy homeostasis and mediate various immune responses and inflammatory processes. Vaspin is a novel adipocytokine that is thought to exhibit anti-inflammatory effects. Aim: We aimed to evaluate serum vaspin levels in inflammatory bowel disease (IBD) and determine its possible associations with the course and to clarify its intestinal localization. Methods: Serum samples were obtained from patients with Crohn\u27s disease (CD; n = 30) and ulcerative colitis (UC; n = 33) and from healthy volunteers (controls; n = 26). Enzyme-linked immunosorbent assays were performed for all patients. Vaspin immunohistochemical staining was performed for intestines affected with IBD. Results: Serum vaspin concentrations were significantly higher in patients with UC than in patients with CD and controls (422.9 ± 361.9 vs. 163.4 ± 116.2 vs. 147.5 ± 89.4 pg/mL, respectively; P < 0.01). There was no difference in the serum vaspin concentrations between the patients with CD and controls. There was also no difference in the serum vaspin concentrations between the patients with active IBD and those with inactive IBD. However, the serum vaspin concentrations of most patients with UC increased after remission induction. Vaspin was expressed in the adipocytes of the mesenteric adipose tissues but not in the epithelial or inflammatory cells of large intestines of the patients with IBD. Conclusions: Serum vaspin concentrations are elevated in patients with UC and increase further after remission induction, suggesting that vaspin may aid the auxiliary diagnosis of UC and may be useful for assessing disease activity in patients

The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: a systematic review and meta-analysis

Abstract Background Influenza is a common viral infection worldwide. Maoto (ma-huang-tang) was developed in ancient China and is used to alleviate flu symptoms. Currently, no meta-analyses have evaluated the efficacy and safety of maoto for alleviating flu symptoms. Methods In the present study, we searched MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, a Japanese database (Ichushi), two Chinese databases (China National Knowledge Infrastructure and VIP), and two Korean databases (Korean Medical database and Korean Association of Medical Journal Editors) for studies published in or before October 2017. Clinical studies that compared maoto plus neuraminidase inhibitors (NAIs) vs. NAIs alone, or maoto alone vs. NAIs alone, were included in the present analysis. The primary outcome measure (efficacy) was the length of time from the start of medication to resolution of influenza symptoms (fever, headache, malaise, myalgia, and chills) and virus isolation. The secondary outcome measures (safety) were as follows: (1) side effects and adverse reactions, such as nausea, abnormal behaviour, or discontinuation of symptomatic treatment; (2) morbidity (complications caused by influenza infection) or mortality; and (3) hospitalisation for any reason. Results Twelve relevant studies were identified, including two randomised controlled trials (RCTs, N = 60) and ten non-randomised studies (NRSs, N = 1110). We found that maoto plus NAIs was superior to NAIs alone in terms of the duration of fever in one RCT (P < 0.05, median difference = − 6 h) and four NRSs (P = 0.003, weighted mean difference = − 5.34 h). The duration of symptoms or virus isolation did not differ between maoto and NAIs. No severe side effects or adverse reactions were reported related to maoto or NAIs. Conclusions Although we could not reach a definitive conclusion because of the small sample sizes and high risk of bias in the analysed studies, maoto may lower the duration of fever when it is used alone or in combination with NAIs and may be a well-tolerated treatment. More RCTs are needed to determine the efficacy and safety of maoto

X-irradiation induces up-regulation of ATM gene expression in wild-type lymphoblastoid cell lines, but not in their heterozygous or homozygous ataxia-telangiectasia counterparts

Ataxia-telangiectasia (AT) is an autosomal recessive disease. The relevant gene has been cloned and designated ATM. We studied the expression of both ATM mRNA and the ATM protein in unirradiated and X-irradiated EBV (Epstein-Barr virus)-transformed lymphoblastoid cell lines (LCLs) derived from donors who were normal (ATM + / + ), AT heterozygotes (ATM + / - ), or AT homozygotes (ATM - / - ), respectively. In ATM + / + LCLs, the levels of ATM mRNA were found to have increased by approximately 1.5-fold within 1 h of exposure to 10 Gy of X-rays, while the ATM protein levels had increased by 1.5- to 2.0-fold within 2 to 3 h of irradiation. The wild-type mRNA and protein levels both returned to their basal values fairly quickly after this time. The results obtained with the ATM + / - LCLs were quite different, however: neither the mRNA nor protein levels were found to have increased as a consequence of X-irradiation in any ATM + / - LCL. Twelve of the mutations in the ATM - / - LCLs we used were truncating mutations, and we suspected that the corresponding truncated ATM proteins would be too labile to be detected by western blot analysis. However, five of the ATM - / - LCLs produced mutant ATM proteins that were identical in molecular weight to the wild-type ATM protein. When cells from three of these five clones were exposed to X-rays, transcription of the mutant ATM genes appeared to reduce somewhat, as were the levels of protein being produced. These results suggest that the normal ATM gene responds to ionizing radiation by up-regulating its activity, whereas none of the mutant ATM genes we studied were able to respond in this way

Melatonin for sleep? – Examining the effect of melatonin on inflammation, neurodevelopment, and oxidative stress

Introduction Melatonin is an indoleamine that is a potent anti-oxidant and regulator of biological rhythm. It also regulates the immune response and has anti-inflammatory properties. Recent studies show that trophoblast cells of placenta express enzymes to synthesize melatonin and its receptors. But little is known about how melatonin influences placental function. The placenta functions to prevent the maternal immune system from reacting against the fetus. How does melatonin effect the fetal protective function of the placenta in the presence of an infection which ramps up the maternal immune system? To explore this question, we examined the effects of melatonin on basal and bacteria cytokine production by the placenta. Methods Placental explant cultures were prepared from 12 term births treated with 0 mM to 50 mM melatonin in the presence and absence of 107 CFU heat-killed E. coli. Cultures were incubated and concentrations of cytokines associated with adverse pregnancy outcomes were quantified in the conditioned medium. Melatonin concentrations were also quantified for control and E. coli-stimulated cultures. Results For unstimulated cultures, melatonin tended to reduce IL-1b but enhanced HO-1 and IL-6 production. Sgp130 and IL-10 production were unaffected but BDNF production was reduced by melatonin for placental explant cultures. For bacteria-stimulated cultures, melatonin significantly inhibited IL-1b but enhanced IL-10, IL-6 and HO-1 production. BDNF production by bacteria-treated cultures tended to be inhibited by melatonin at low concentrations and stimulated at high concentrations. Placental concentrations of melatonin in conditioned medium were approximately 250 ng/ml and were not affected by E. coli treatment. Conclusions Our results suggest that melatonin is produced in relatively high concentrations by the placenta. Melatonin has potent anti-inflammatory effects through inhibition of inflammatory IL-1b cytokine and promotion of anti-inflammatory IL-10 production. Enhancement of HO-1 production may also enhance anti-oxidant activity of the placenta. Further studies are needed to determine how placental melatonin production is regulated and may affect pregnancy complications