PURPOSE: Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system and mostly develops after viral illness or vaccinations. We investigated the clinical differences and neurologic outcomes according to the distribution of the lesions on brain MRI. METHODS: The study group was composed of 21 patients from January 1995 to August 2003 in Kyunghee University hospital. We grouped the patients according to the MRI findings as follows. Group I (14 cases): Multi- or unifocal lesions only in the cerebral white matter. Group II (7 cases): lesions in the gray matter with or without white matter involvement. RESULTS: 1.Preceding events were as follows: no defined prodrome (38.1%), upper respiratory tract infection (28.6%), nonspecific febrile illness (19.0%), gastointestinal disturbance and vaccination. 2.Presenting symptoms were as follows: seizures (76.2%), headache/vomiting (47.6%), altered consciousness (38.1%), hemiparesis, cerebellar ataxia, visual disturbance and facial nerve palsy. 3.Laboratory findings were as follows: CSF pleocytosis (76.2%), leucocytosis (38.1%) and elevated CSF protein (28.6%). 4.Fifteen patients were recovered completely without neurological sequelae. Three patients in group I and 1 patient in group II had intractable seizures. Two patients in group I and 2 patients in group II had motor disturbance. CONCLUSION: There were no statistically significant differences in preceding events, presenting symptoms, and neurological outcomes according to the distribution of the lesions on brain MRI. However, the ADEM have quite diverse clinical manifestations and neuroimage findings. MRI plays an important role in making diagnosis of the patients who are suspected of ADEM.
Brain ; Central Nervous System ; Cerebellar Ataxia ; Consciousness ; Demyelinating Diseases ; Diagnosis ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated* ; Facial Nerve ; Humans ; Leukocytosis ; Magnetic Resonance Imaging* ; Paralysis ; Paresis ; Prognosis* ; Respiratory Tract Infections ; Seizures ; Vaccination

PURPOSE: To identify new immunogenic HLA-A*33;03-restricted epitopes from the human papillomavirus (HPV) 16 E7 protein for immunotherapy against cervical cancer. MATERIALS AND METHODS: We synthesized fourteen overlapping 15-amino acid peptides and measured intracellular interferon-γ (IFN-γ) production in PBMC and CD8+ cytotoxic T lymphocytes (CTLs) after sensitization with these peptides using flow cytometry and ELISpot assay. The immunogenicity of epitopes was verified using a ⁵¹Cr release assay with SNU1299 cells. RESULTS: Among the fourteen 15-amino acid peptides, E7₄₉₋₆₃ (RAHYNIVTFCCKCDS) demonstrated the highest IFN-γ production from peripheral blood mononuclear cells (PBMCs), and CD8+ CTLs sensitized with E7₄₉₋₆₃ showed higher cytotoxic effect against SNU1299 cells than did CD8+ CTLs sensitized with other peptides or a negative control group. Thirteen 9- or 10-amino acid overlapping peptides spanning E7₄₉₋₆₃, E7₅₀₋₅₉ (AHYNIVTFCC), and E7₅₂₋₆₁ (YNIVTFCCKC) induced significantly higher IFN-γ production and cytotoxic effects against SNU1299 cells than the other peptides and negative controls, and the cytotoxicity of E7₅₀₋₅₉- and E7₅₂₋₆₁-sensitized PBMCs was induced via the cytolytic effect of CD8+ CTLs. CONCLUSION: We identified E7₅₀₋₅₉ and E7₅₂₋₆₁ as novel HPV 16 E7 epitopes for HLA-A*33;03. CD8+ CTL sensitized with these peptides result in an antitumor effect against cervical cancer cells. These epitopes could be useful for immune monitoring and immunotherapy for cervical cancer and HPV 16-related diseases including anal cancer and oropharyngeal cancer.
Amino Acid Sequence ; CD8-Positive T-Lymphocytes/immunology/metabolism ; Epitopes/*immunology/therapeutic use ; Female ; *HLA-A Antigens ; Human papillomavirus 16/*immunology ; Humans ; *Immunotherapy ; Interferon-gamma/analysis/*biosynthesis ; Leukocytes, Mononuclear/immunology/metabolism ; T-Lymphocytes, Cytotoxic/immunology/metabolism ; Uterine Cervical Neoplasms/*therapy

Purpose: The study aimed (1) to verify the reliability and validity of the self-reported Korean version questionnaire for predicting chronic ankle instability (CAI); (2) to suggest the accuracy of questionnaires for distinguishing mechanical ankle instability (MAI) and functional ankle instability (FAI), and (3) to set a cut-off value of classification for MAI and FAI. Methods: This study involved 165 subjects (28.16±5.04 years) who consisted of 54 MAI (27 males, 27 females), and 111 FAI (72 males, 39 females). Five self-report questionnaires (Ankle Instability Instrument [AII], Cumberland Ankle Instability Tool [CAIT], Identification of Functional Ankle Instability [IdFAI], Foot and Ankle Ability Measure [FAAM], and Foot and Ankle Disability Index [FADI]) for predicting CAI were administered to all subjects twice at 2 weeks intervals. Questionnaire score was analyzed to calculate the intraclass correlation coefficient (ICC), standard error of measurement, sensitivity, specificity, positive and negative likelihood ratio, area under the curve, and cut-off values. Results: All questionnaires including FADI-Sport (ICC=0.999), FAAM-Sport (ICC=0.992), FAAM-activities of daily living (ADL) (ICC=0.991), IdFAI (ICC=0.986), AII (ICC=0.984), CAIT (ICC=0.981), FADI-ADL (ICC=0.951) showed excellent reliability (ICC＞ 0.75). Furthermore, AII (sensitivity=0.830, specificity=0.924), CAIT (sensitivity=0.915, specificity=0.915), IdFAI (sensitivity=0.809, specificity=0.924), FAAM-ADL (sensitivity=0.681, specificity=0.924), FAAM-Sport (sensitivity=0.851, specificity=0.932), FADI-Sport (sensitivity=0.915, specificity=0.924), and FADI-ADL (sensitivity=0.660, specificity=0.924) questionnaires had high sensitivity and specificity. The cut-off values for MAI and FAI for each questionnaire were 6.5 AII, 20.01 CAIT, 18.52 IdFAI, 85.71% FAAM-ADL, 69.65% FAAM-Sport, 88.53% FADI-ADL, and 79.7% FADI-Sport. Conclusion Self-report questionnaires for identifying those with CAI may help to establish FAI and MAI selection criteria in sports, clinical, and laboratory settings.

Neurogenesis persists in restricted regions of the adult brain, including the subventricular zone (SVZ). Adult neural stem cells (NSCs) in the SVZ proliferate and give rise to new neurons and glial cells depending on intrinsic and environmental cues. Among the multiple factors that contribute to the chemical, physical, and mechanical components of the neurogenic niche, we focused on the composition of the extracellular matrix (ECM) of vasculature and fractones in the SVZ. The SVZ consists of ECM-rich blood vessels and fractones during development and adulthood, and adult neural stem/progenitor cells (NS/PCs) preferentially attach to the laminin-rich basal lamina. To examine the ECM preference of adult NS/PCs, we designed a competition assay using cell micropatterning. Although both laminin and collagen type IV, which are the main components of basal lamina, act as physical scaffolds, adult NS/PCs preferred to adhere to laminin over collagen type IV. Interestingly, the ECM preference of adult NS/ PCs could be manipulated by chemokines such as stromal-derived factor 1 (SDF1) and α6 integrin. As SDF1 re-routes NSCs and their progenitors toward the injury site after brain damage, these results suggest that the alteration in ECM preferences may provide a molecular basis for contextdependent NS/PC positioning.

Neurogenesis persists in restricted regions of the adult brain, including the subventricular zone (SVZ). Adult neural stem cells (NSCs) in the SVZ proliferate and give rise to new neurons and glial cells depending on intrinsic and environmental cues. Among the multiple factors that contribute to the chemical, physical, and mechanical components of the neurogenic niche, we focused on the composition of the extracellular matrix (ECM) of vasculature and fractones in the SVZ. The SVZ consists of ECM-rich blood vessels and fractones during development and adulthood, and adult neural stem/progenitor cells (NS/PCs) preferentially attach to the laminin-rich basal lamina. To examine the ECM preference of adult NS/PCs, we designed a competition assay using cell micropatterning. Although both laminin and collagen type IV, which are the main components of basal lamina, act as physical scaffolds, adult NS/PCs preferred to adhere to laminin over collagen type IV. Interestingly, the ECM preference of adult NS/ PCs could be manipulated by chemokines such as stromal-derived factor 1 (SDF1) and α6 integrin. As SDF1 re-routes NSCs and their progenitors toward the injury site after brain damage, these results suggest that the alteration in ECM preferences may provide a molecular basis for contextdependent NS/PC positioning.