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A 35 year-old woman had a two-year history of recurrent headache with clinical presentations of visual aura in her left visual field followed by right-sided throbbing headache. The patient suffered from a similar attack but her visual aura-like symptoms persisted for over 48 hours. The concurrent electroencephalogram demonstrated focal non-epileptiform rhythmic slow waves in the right occipital region. The magnetic resonance images showed prominent parenchymal edema in the right occipital area. The cerebral angiographic study proved a small cerebral arteriovenous malformation. This illustrated case showed that cerebral arteriovenous malformation produces headaches mimicking migraine with visual aura. The acute vascular flow change and the parenchymal edema trigger a prolonged visual aura with coinstantaneous evidence of cortical depression shown on the electroencephalogram. Keywords: Symptomatic migraine; Prolonged visual aura; Unruptured arteriovenous malformation.

Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (Materials and methods Eight small (Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

We reported a rare case of sudden onset of severe but reversible suprachoroidal air that occurred at the moment of air-fluid exchange in 23-gauge vitrectomy. A 31-year-old male patient presented with a large break at 10-11 o'clock and high bullous, nearly total retinal detachment. He underwent first surgery with silicon oil injection at the end of the surgery. He was arranged to have a second surgery for silicon oil removal through pars plana vitrectomy which was performed smoothly at first. While switching to another mode of air-fluid exchange to clean the residual emulsified oil droplets, surgical view disappeared completely and was suddenly replaced with severe and total suprachoroidal air, which fortunately resolved within 3 days without any other severe complications.

Background Laser in situ keratomileusis (LASIK) is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK. Case presentation A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of −0.75 D to 1.0 D ×175° in her right eye 1 month later. Literature review We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014. Conclusion Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could mostly be restored with immediate and proper management.

Supplemental material, sj-pdf-1-ine-10.1177_1591019920925706 for Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms

Applying software Ansys-Fluent to analysis the effect of piezoelectric fan device installed inside rectangular channel by numerical simulation method. The piezoelectric fan is activated by reversible piezoelectric effect in piezoelectric material, change rectangular channel flow field construction, then it affects heat flow status in advance. Numerical simulation parameter are included Nusselt number (Nu), distance between peak of fan blades to front part of heat sink (Lg=0, 5, 10, -11.25, -22.5, -33.75, -45), height from center on piezoelectric fan bottom side (Hw=10, 16, 21), number of piezoelectric fan (single-fan and twin-fan), phase-shift (in-phase and counter-phase), and numbers (n=10, 14) for heat sink fin. This result is indicated that good position to temperature dropped greatly is located from the front part of piezoelectric fan to the front of heat sink (Lg = -22.5) under fixes distance (Hw = 21) from piezoelectric fan to channel also found to provide double piezoelectric fan heat drop effect is equal to single one, however, double piezoelectric fans would provide higher heat dissipation as Counter-phase. The performance of piezoelectric fan is improved depends on change height (Hw) from center of piezoelectric fan to channel bottom; the height (Hw) shall be decreased as piezoelectric fan placement at the front of heat sink.

Purpose: Fulminant acute disseminated encephalomyelitis (ADEM) associated with cytomegalovirus (CMV) infection in immunocompetent hosts is rare, and the MRI findings might be atypical. Case report: A 17-year-old immunocompetent man presented with acute flaccid paraplegia accompanied by bladder and bowel incontinence. The serum virology tests revealed the presence of CMV IgM and IgG, indicating reactivation of latent infection. MRI studies of the brain and the whole spinal cord showed diffuse gray matter lesions of hyperintense signals in T2. After aggressive rescue therapy combining intravenous immunoglobulin, pulse methylprednisolone and plasma exchange, the patient made a complete neurological recovery 6 months later. Conclusion: This report demonstrates the association of CMV infection with ADEM in an immunocompetent subject. Although the treatment regimen and timing for patients with ADEM need further investigation, aggressive rescue therapy by adopting multiple immunomodulatory treatments may be warranted.

Surface IgD and IgM doubly positive cells comprise the major population of B cells in the human immune system. The heavy chain of membrane-bound IgD (mδ) differs from that of IgD (δ) in that mδ contains a C-terminal membrane-anchor peptide. Our group previously proposed that the N-terminal extracellular segment of 27 aa residues of the membrane-anchor peptide of mδ, referred to as the mIg isotype-specific-δ (migis-δ) segment, may provide a unique antigenic site for isotype-specific targeting of mIgD + B cells. Here we report the preparation of mouse mAbs specific for human migis-δ. The mAbs bound to human migis-δ-containing recombinant proteins in an ELISA and to mIgD-expressing transfectants of a CHO cell line as analyzed by flow cytometry. MAb 20E6, which binds to an epitope toward the N-terminal of human migis-δ, could stain human B cell line MC116, which expressed mIgD and mIgM. MC116 cells could be induced to undergo apoptosis by treatment with 20E6 in the presence of a second crosslinking antibody. Chimeric 20E6 caused antibody-dependent cellular cytotoxicity of MC116 cells in the presence of human PBMCs as the source of effector cells. In cultures of PBMCs, 20E6 down-regulated the population of mIgD + B cells. The production of human IgM by transplanted MC116 cells in NOD-SCID (NOD.CB17- Prkdc scid /IcrCrlBltw) mice could be suppressed by 20E6. These results encourage further investigation of the potential of anti-migis-δ mAbs to control mIgD + B cells, when such a manipulation may alleviate a disease state.

In this letter, we propose and implement a shadow approach for real-time hand gesture recognition using a light-dependent resistor array, which can detect analog signals from hand shadows. The main advantage of the shadow approach is real-time recognition. Instead of a three-dimensional (3D) hand gesture, the shadow approach detects two-dimensional hand shadows and then measures the intensity of the signal from each element of a sensor array to recognize the 3D gesture. The recognition accuracy was higher than 90 %.

Background and Purpose Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity with several causes, characterized by rapid onset of symptoms and typical neuroimaging features, which usually resolve if promptly recognized and treated. Brainstem variant of PRES presents with vasogenic edema in brainstem regions on magnetic resonance (MR) images and there is sparing of the supratentorial regions. Because PRES is usually caused by a hypertensive crisis, which would likely have a systemic effect and global manifestations on the brain tissue, we thus proposed that some microscopic abnormalities of the supratentorial regions could be detected with diffusion-weighted imaging (DWI) using apparent diffusion coefficient (ADC) analysis in brainstem variant of PRES and hypothesized that “normal-looking” supratentorial regions will increase water diffusion. Methods We retrospectively identified patients with PRES who underwent brain magnetic resonance imaging studies. We identified 11 brainstem variants of PRES patients, who formed the study cohort, and 11 typical PRES patients and 20 normal control subjects as the comparison cohorts for this study. Nineteen regions of interest were drawn and systematically placed. The mean ADC values were measured and compared among these 3 groups. Results ADC values of the typical PRES group were consistently elevated compared with those in normal control subjects. ADC values of the brainstem variant group were consistently elevated compared with those in normal control subjects. ADC values of the typical PRES group and brainstem variant group did not differ significantly, except for the pons area. Conclusions Quantitative MR DWI may aid in the evaluation of supratentorial microscopic abnormalities in brainstem variant of PRES patients.

Type-I hypersensitivity reactions play a critical role in the pathogenesis of various allergic diseases. The successful development of the anti-IgE antibody, omalizumab, has validated IgE as an effective therapeutic target for the treatment of various IgE-mediated allergic diseases. Two research groups have reported that mAbs specific for certain parts of CɛmX, a domain of 52 aa residues in human membrane-bound IgE (mIgE), can cause the lysis of mIgE-B cells by apoptosis and antibody-dependent cellular cytotoxicity (ADCC). Herein, we explore virus-like particles formed by hepatitis B virus core antigen (HBcAg) that harbors the entire CɛmX peptide or its fragments as immunogens for inducing anti-CɛmX antibodies. The results showed that mice immunized subcutaneously with these immunogens produced antibodies that bind to recombinant CɛmX-containing human IgE.Fc in ELISA and Western blot analyses, and to genetically engineered human mIgE-expressing Ramos B cell line in fluorescence flow cytometric assays. The IgG antibodies purified from the sera of immunized mice were able to cause the apoptosis of mIgE-expressing Ramos cells through a BCR-dependent caspase pathway. Furthermore, the IgG could mediate ADCC in human mIgE-expressing A20 murine B-cell lymphoma. These studies suggest that HBcAg-CɛmX peptide immunogens warrant further investigation as a therapeutic modality for modulating IgE in patients with IgE-mediated allergic diseases.

Background Antigen-specific human IgEs are important reagents in immunoassays to quantify antigen-specific IgEs in allergic patients, but they are not easy to prepare. Methods We constructed a knockin homozygous mouse strain, referred to as HeκKI strain, whose gene segment encoding γ1 constant region has been replaced by that encoding human e constant region and gene segment encoding κ constant region replaced by that encoding human κ constant region. The mice were tested for their ability to produce antigen-specific chimeric human IgE (with mouse variable regions) upon the immunization with ovalbumin and papain. Subsequently, the spleen cells from the immunized mice were used as the source of B cells for the preparation of hybridomas, which secreted monoclonal human IgE antibodies specific for the antigens. Results The HeκKI mice expressed human IgE (e, κ) in serum at levels 10- to 30-fold higher than those of mouse IgE. Upon immunization with an antigen, the mice yielded splenic B cells for preparing hybridomas that secrete chimeric human IgE specific for the antigen. Purified IgEs from those hybridomas could activate a basophilic cell line to undergo degranulation upon the stimulation with their respective antigens. Conclusions We have developed a human e gene and κ gene knockin mouse strain, which is useful for producing various antigen-specific chimeric human IgEs for potential use as standards in immunoassays.

In patients given a diagnosis of chronic spontaneous urticaria (CSU), there are no obvious external triggers, and the factors that initiate the clinical symptoms of wheal, flare, and itch arise from within the patient. Most patients with CSU have an autoimmune cause: some patients produce IgE autoantibodies against autoantigens, such as thyroperoxidase or double-stranded DNA, whereas other patients make IgG autoantibodies against FceRI, IgE, or both, which might chronically activate mast cells and basophils. In the remainder of patients with CSU, the nature of the abnormalities has not yet been identified. Accumulating evidence has shown that IgE, by binding to FceRI on mast cells without FceRI cross-linking, can promote the proliferation and survival of mast cells and thus maintain and expand the pool of mast cells. IgE and FceRI engagement can also decrease the release threshold of mast cells and increase their sensitivity to various stimuli through either FceRI or other receptors for the degranulation process. Furthermore, IgE-FceRI engagement potentiates the ability of mast cells to store and synthesize de novo inflammatory mediators and cytokines. Administration of omalizumab, by virtue of its ability to deplete IgE, attenuates the multiple effects of IgE to maintain and enhance mast cell activities and hence reduces the ability of mast cells to manifest inflammatory mechanisms in patients with CSU.

IgE mediates hypersensitivity reactions responsible for most allergic diseases, which affect 20-40% of the population in developed countries. A 52-residue domain of membrane-bound IgE (mIgE) called CεmX is currently a target for developing therapeutic antibodies; however, its structure is unknown. Here we show that two antibodies with therapeutic potential in IgE-mediated allergic diseases, which can cause cytolytic effects on mIgE-expressing B lymphocytes and downregulate IgE production, target different conformations of an intrinsically disordered region (IDR) in the extracellular CεmX domain. We provide an important example of antibodies targeting an extracellular IDR of a receptor on the surface of intended target cells. We also provide fundamental structural characteristics unique to human mIgE, which may stimulate further studies to investigate whether other monoclonal antibodies (mAbs) targeting intrinsically disordered peptide segments or vaccine-like products targeting IDRs of a membrane protein can be developed.

BACKGROUND AND PURPOSE Though diffusion-weighted (DW) magnetic resonance imaging (MRI) is useful for diagnosing many pathologies, its use in infectious spondylodiscitis is unclear. We aimed to evaluate the use of DW MRI and apparent diffusion coefficient (ADC) mapping for the diagnosis of infectious spondylodiscitis. METHODS In this retrospective study, 17 patients with confirmed infectious spondylodiscitis were matched by age and level of infected disc with 17 patients with degenerative disc disease (DDD) and 17 healthy controls. All patients received conventional MRI and diffusion-weighted imaging (DWI) in the same imaging session. ADC values of the 3 groups of patients were compared. RESULTS The mean age of each group was 67.4 ± 11.6 years. The mean ADCs of the normal control, DDD, and infectious spondylodiscitis groups were 1.76 ± 0.19 × 10−3, 1.12 ± 0.22 × 10−3, and 1.27 ± 0.38 × 10−3 mm2/second, respectively. The ADCs of the DDD and infectious spondylodiscitis groups were both significantly lower than that of the normal control group (both, P < 0.001). CONCLUSION These data suggest that DWI/ADC MRI may be useful in the early diagnosis of infectious spondylodiscitis.

Objective For patients with subarachnoid hemorrhage (SAH), computed tomography angiography (CTA) has been the first imaging modality for aneurysm detection. We evaluate the rate, time distribution, risk factors, and clinical outcome of aneurysmal rebleeding by CTA findings. Methods Consecutive patients with SAH presenting to our hospital, a tertiary care hospital, were retrospectively included. We reviewed images for all patients receiving an initial noncontrast computed tomography scan and further CTA for nontraumatic SAH surveillance with focus on rebleeding evidence. Results A total of 12 patients with early aneurysmal rebleeding (12/110 patients [10.9%]) within 6 hours after emergency room arrival were found with dismal outcome (50% mortality) and 3 rebleeding patterns: pattern 1 of rapid active bleeding with contrast extravasation, pattern 2 of slow active bleeding with contrast leakage in the delayed venous phase, and pattern 3 of hematoma enlargement. The risk factor and poor prognostic sign include larger aneurysm diameter (≧7 mm) and contrast extravasation during CTA. Conclusions Rebleeding rate of aneurysmal SAH in the hyperacute stage at less than 6 hours is 10.9% with poor prognosis in this study, especially in patients with active bleeding demonstrated in CTA.

We described our experience with a heterogeneous collection of 200 arterial spin-labeling (ASL) perfusion cases. ASL imaging was performed on a 1.5-T magnetic resonance imaging unit with a receive head coil using a second version of quantitative perfusion imaging. Sixty-four (32%) patients exhibited normal perfusion, 107 (53.5%) patients exhibited hypoperfusion, and 29 (14.5%) exhibited hyperperfusion. This ASL study illustrates the usefulness of ASL perfusion studies in a number of pathological conditions and that perfusion imaging can be implemented successfully in a routine clinical neuroimaging protocol.

IgE is a primary mediator in most allergic diseases. Human IgE specific for various allergens are very important reagents in diagnostic assays for the management of allergic diseases. However, allergen-specific human IgEs are present in patients’ blood at very low levels and hence extremely difficult to prepare. We have now constructed a transgenic homozygous mouse strain, referred to as HεκKI strain, whose γ1 constant region gene segment has been replaced by human ε gene constant region segment and whose κ constant gene replaced by human κ constant gene. In those HεκKI mice, the human IgE levels are about 10 times of mouse IgE. Upon immunization with an allergen papain, both human IgE and mouse IgE were increased, with human IgE increased to about 30 folds of mouse IgE. We have prepared a number of hybridomas secreting monoclonal human IgE (the variable regions being mouse) specific for papain. Cells of a basophilic leukemic line pulsed with such human IgE could be activated by papain to undergo degranulation process. These results indicate that the transgenic mouse strain HεκKI could be employed to prepare polyclonal and monoclonal human IgE specific for various allergens.

Type-I hypersensitivity reactions play a critical role in the pathogenesis of various allergic diseases. The successful development of the anti-IgE antibody, omalizumab, has validated IgE as an effective therapeutic target for the treatment of various IgE-mediated allergic diseases. Two research groups have reported that mAbs specific for certain parts of CϵmX, a domain of 52 aa residues in human membrane-bound IgE (mIgE), can cause the lysis of mIgE-B cells by apoptosis and antibody-dependent cellular cytotoxicity (ADCC). Herein, we explore the virus-like particles (VLPs) formed by hepatitis B virus core antigen (HBcAg) that harbors the entire CϵmX peptide or its fragments as immunogens for inducing anti-CϵmX antibodies. Mice immunized subcutaneously with some of these immunogens produce antibodies that bind to recombinant CϵmX-containing human IgE.Fc in ELISA and Western blot analysis and to genetically engineered human mIgE-expressing Ramos B cell line in fluorescence flow cytometric assays. The IgG antibodies purified from the sera of immunized mice could cause the apoptosis of mIgE-expressing Ramos cells through a BCR-dependent caspase pathway. Furthermore, the IgG mediated ADCC on human mIgE-expressing murine B cell lymphoma A20. These results suggest that HBcAg-CϵmX peptide immunogens warrant further investigation as a therapeutic modality for modulating IgE in patients with IgE-mediated allergic diseases.