A conserved mechanism for JNK-mediated loss of Notch function in advanced prostate cancer.

Dysregulated Notch signaling is a common feature of cancer; however, its effects on tumor initiation and progression are highly variable, with Notch having either oncogenic or tumor-suppressive functions in various cancers. To better understand the mechanisms that regulate Notch function in cancer, we studied Notch signaling in a Drosophila tumor model, prostate cancer-derived cell lines, and tissue samples from patients with advanced prostate cancer. We demonstrated that increased activity of the Src-JNK pathway in tumors inactivated Notch signaling because of JNK pathway-mediated inhibition of the expression of the gene encoding the Notch S2 cleavage protease, Kuzbanian, which is critical for Notch activity. Consequently, inactive Notch accumulated in cells, where it was unable to transcribe genes encoding its target proteins, many of which have tumor-suppressive activities. These findings suggest that Src-JNK activity in tumors predicts Notch activity status and that suppressing Src-JNK signaling could restore Notch function in tumors, offering opportunities for diagnosis and targeted therapies for a subset of patients with advanced prostate cancer.

Early brainstem hemorrhage progression: multi-sequence magnetic resonance imaging and histopathology.

According to clinical statistics, the mortality of patients with early brainstem hemorrhage is high. In this study, we established rat models of brainstem hemorrhage by injecting type VII collagenase into the right basotegmental pontine and investigated the pathological changes of early brainstem hemorrhage using multi-sequence magnetic resonance imaging and histopathological methods. We found that brainstem hematoma gradually formed in the injured rats over the first 3 days and then reduced after 7 days. The edema that occurred was mainly of the vasogenic type. No complete myelin sheath structure was found around the focus of the brainstem hemorrhage. The integrity and continuity of nerve fibers gradually deteriorated over the first 7 days. Neuronal degeneration was mild in the first 3 days and then obviously aggravated on the 7th day. Inflammatory cytokines, interleukin-1ß, and tumor necrosis factor α appeared on the 1st day after intracerebral hemorrhage, reached peak levels on the 3rd day, and decreased from the 7th day. Our findings show the characteristics of the progression of early brainstem hemorrhage.

The Associations between Physical Activity, Functional Fitness, and Life Satisfaction among Community-Dwelling Older Adults.

Previous studies showed physical activity had benefits for older adults' life satisfaction, but the mechanism was unclear. This study aimed to investigate whether older adults with more physical activity had better functional fitness and life satisfaction, and whether functional fitness mediated the relationship between physical activity and life satisfaction. A cross-sectional study design was employed, and 623 older adults (73.71 ± 5.91 years) were recruited. Physical activity, functional fitness, life satisfaction, and demographic characteristics were collected. Compared with older adults with low physical activity, those with high (B = 0.41, p = 0.025) and moderate (B = 0.40, p = 0.041) physical activity had better life satisfaction; those with high physical activity had better lower limb muscle strength (B = 1.71, p = 0.001), upper (B = 2.91, p = 0.032) and lower (B = 3.12, p = 0.006) limb flexibility, cardiorespiratory endurance (B = 6.65, p = 0.008), and dynamic balance ability (B = −1.12, p < 0.001). Functional fitness did not mediate the relationship between physical activity and life satisfaction. Promoting physical activity may be useful for increasing older adults' functional fitness and life satisfaction, but the effects on functional fitness only occurred at a high level of physical activity, and the effect of physical activity on life satisfaction was not mediated by functional fitness.

Predicting clinical pregnancy using clinical features and machine learning algorithms in in vitro fertilization.

INTRODUCTION: Assisted reproductive technology has been proposed for women with infertility. Moreover, in vitro fertilization (IVF) cycles are increasing. Factors contributing to successful pregnancy have been widely explored. In this study, we used machine learning algorithms to construct prediction models for clinical pregnancies in IVF. MATERIALS AND METHODS: A total of 24,730 patients entered IVF and intracytoplasmic sperm injection cycles with clinical pregnancy outcomes at Taipei Medical University Hospital. Data used included patient characteristics and treatment. We used machine learning methods to develop prediction models for clinical pregnancy and explored how each variable affects the outcome of interest using partial dependence plots. RESULTS: Experimental results showed that the random forest algorithm outperforms logistic regression in terms of areas under the receiver operating characteristics curve. The ovarian stimulation protocol is the most important factor affecting pregnancy outcomes. Long and ultra-long protocols have shown positive effects on clinical pregnancy among all protocols. Furthermore, total frozen and transferred embryos are positive for a clinical pregnancy, but female age and duration of infertility have negative effects on clinical pregnancy. CONCLUSION: Our findings show the importance of variables and propensity of each variable by random forest algorithm for clinical pregnancy in the assisted reproductive technology cycle. This study provides a ranking of variables affecting clinical pregnancy and explores the effects of each treatment on successful pregnancy. Our study has the potential to help clinicians evaluate the success of IVF in patients.

CuxS nanosheets with controllable morphology and alignment for memristor devices.

In electrochemical metallization memristor, the performance of resistive switching (RS) is influenced by the forming and fusing of conductive filaments within the dielectric layer. However, the growth of filaments, mostly, is unpredictable and uncontrollable. For this reason, to optimize ions migration paths in the dielectric layer itself in the Al/CuxS/Cu structure, uniform CuxS nanosheets films have been synthesized using anodization for various time spans. And the Al/CuxS/Cu devices show a low operating voltage of less than 0.3 V and stable RS performance. At the same time, a reversible negative differential resistance (NDR) behavior is also demonstrated. And then, the mechanism of repeatable coexistence of RS effect and NDR phenomenon is investigated exhaustively. Analyses suggest that the combined physical model of space-charge limited conduction mechanism and conductive filaments bias-induced migration of Cu ions within the CuxS dielectric layer is responsible for the RS operation, meanwhile, a Schottky barrier caused by copper vacancy at the CuxS/Cu interface is demonstrated to explain the NDR phenomenon. This work will develop a new way to optimize the performance of non-volatile memory with multiple physical attributes in the future.

Accelerating Complete Phytoplasma Genome Assembly by Immunoprecipitation-Based Enrichment and MinION-Based DNA Sequencing for Comparative Analyses.

Phytoplasmas are uncultivated plant-pathogenic bacteria with agricultural importance. Those belonging to the 16SrII group, represented by 'Candidatus P. aurantifolia', have a wide range of plant hosts and cause significant yield losses in valuable crops, such as pear, sweet potato, peanut, and soybean. In this study, a method that combines immunoprecipitation-based enrichment and MinION long-read DNA sequencing was developed to solve the challenge of phytoplasma genome studies. This approach produced long reads with high mapping rates and high genomic coverage that can be combined with Illumina reads to produce complete genome assemblies with high accuracy. We applied this method to strain NCHU2014 and determined its complete genome sequence, which consists of one circular chromosome with 635,584 bp and one plasmid with 4,224 bp. Although 'Ca. P. aurantifolia' NCHU2014 has a small chromosome with only 471 protein-coding genes, it contains 33 transporter genes and 27 putative effector genes, which may contribute to obtaining nutrients from hosts and manipulating host developments for their survival and multiplication. Two effectors, the homologs of SAP11 and SAP54/PHYL1 identified in 'Ca. P. aurantifolia' NCHU2014, have the biochemical activities in destabilizing host transcription factors, which can explain the disease symptoms observed in infected plants. Taken together, this study provides the first complete genome available for the 16SrII phytoplasmas and contributes to the understanding of phytoplasma pathogenicity.

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As a carrier of environmental pollutants, microplastics have received wide concerns in recent years. However, the direct and indirect effects of the coexistence of polystyrene particles (PS) and pollutants on vegetables are still unclear. Here, the combined effects of 0.25, 0.50, 1.0 mg·mL-1 PS and 5 mg·L-1 dibutyl phthalate (DBP) on the biomass and biochemical indices of purple lettuce were investigated in hydroponic experiments. The results showed that the presence of PS increased the inhibition of DBP on lettuce biomass and increased O2-· content in roots and leaves relative to the control group with DBP alone, with positive consequences on the activities of supero-xide dismutase, ascorbic acid peroxidase, dehydroascorbate reductase and monodehydroascorbate reductase. According to transmission electron microscope analysis, plasmolysis occurred in root cells under the treatment of DBP alone, cell wall was damaged in PS-only treatment, and the negative effect was enhanced when DBP and PS coexisted. Therefore, the combined pollution of PS and DBP aggravated the toxic effect on purple lettuce.

Association between intracytoplasmic sperm injection and neurodevelopmental outcomes among offspring.

PURPOSE: To compare the risk of neurodevelopmental disorders in children conceived via intracytoplasmic sperm injection (ICSI) and those conceived naturally. MATERIALS AND METHODS: A population-based cohort study using data retrieved from the Taipei Medical University Research Database (TMURD) from January, 2004 to August, 2016. The data included maternal pregnancy history, perinatal history and developmental follow up of their babies up to 5 years of age. The study included 23885 children, of whom 23148 were naturally conceived and 737 were conceived via ICSI. Neurodevelopmental disorders defined by 21 ICD-9-CM codes. RESULTS: Of the 23885 children enrolled for analysis, 2778 children were included for further subgrouping analysis after propensity matching to reduce bias from maternal factors. The single-birth group included 1752 naturally conceived (NC) children and 438 ICSI children. The multiple-birth group included 294 NC and 294 ICSI children. The risk of neurodevelopmental disorders was not increased for ICSI children in both groups (single birth: adjusted hazard ratio aHR = 0.70, 95% CI = 0.39-1.27, p = 0.243; multiple-birth group aHR = 0.77, 95% CI = 0.43-1.35, p = 0.853). In the single-birth group, multivariate analyses showed that male sex (aHR = 1.81, 95% CI = 1.29-2.54, p < 0.001), and intensive care unit (ICU) admission (aHR = 3.10, 95% CI = 1.64-5.86, p < 0.001) were risk factors for neurodevelopmental disorders. In the multiple-birth group, multivariate analyses demonstrated that ICU admission (aHR = 3.58, 95% CI = 1.82-7.04, p < 0.001), was risk factor for neurodevelopmental disorders. CONCLUSION: Our study indicated that the use of ICSI does not associated with higher risk of neurodevelopmental disorders in the offspring. But male sex, and ICU admission do have increased risk of neurodevelopmental disorders. However, long term follow up of this cohort on health outcomes in adolescence and adulthood will strengthen the conclusions that ICSI is safe regarding offspring long term outcome.

Cutaneous myiasis with eosinophilic pleural effusion: A case report.

BACKGROUND: Cutaneous myiasis is frequently observed; however, eosinophilic pleural effusion induced by this condition is rare. CASE SUMMARY: We report the case of a 65-year-old female Tibetan patient from Qinghai Province, who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough, occasional hemoptysis, and right chest pain. There was no past medical and surgical history of note, except for occasional dietary habit of eating raw meat. Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung, with moist rales heard in both lungs. Chest X-rays demonstrated a left hydropneumothorax and a right lung infection. Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung. Laboratory data revealed peripheral blood eosinophilia of 37.2%, with a white blood cell count of 10.4 × 109/L. Serum immunoglobulin E levels were elevated (1650 unit/mL). Serum parasite antibodies were negative except for cysticercosis immunoglobulin G. Bone marrow aspirates were hypercellular, with a marked increase in the number of mature eosinophils and eosinophilic myelocytes. An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid. Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole (400 mg/d) for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization. Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later. After the removal of the live organisms, they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites. The patient's symptoms were relieved soon afterwards. Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved. CONCLUSION: Eosinophilic pleural fluid can be present in a wide array of disorders. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.

3D Face Point Cloud Reconstruction and Recognition Using Depth Sensor.

Facial recognition has attracted more and more attention since the rapid growth of artificial intelligence (AI) techniques in recent years. However, most of the related works about facial reconstruction and recognition are mainly based on big data collection and image deep learning related algorithms. The data driven based AI approaches inevitably increase the computational complexity of CPU and usually highly count on GPU capacity. One of the typical issues of RGB-based facial recognition is its applicability in low light or dark environments. To solve this problem, this paper presents an effective procedure for facial reconstruction as well as facial recognition via using a depth sensor. For each testing candidate, the depth camera acquires a multi-view of its 3D point clouds. The point cloud sets are stitched for 3D model reconstruction by using the iterative closest point (ICP). Then, a segmentation procedure is designed to separate the model set into a body part and head part. Based on the segmented 3D face point clouds, certain facial features are then extracted for recognition scoring. Taking a single shot from the depth sensor, the point cloud data is going to register with other 3D face models to determine which is the best candidate the data belongs to. By using the proposed feature-based 3D facial similarity score algorithm, which composes of normal, curvature, and registration similarities between different point clouds, the person can be labeled correctly even in a dark environment. The proposed method is suitable for smart devices such as smart phones and smart pads with tiny depth camera equipped. Experiments with real-world data show that the proposed method is able to reconstruct denser models and achieve point cloud-based 3D face recognition.

Association of Physical Fitness Performance Tests and Anthropometric Indices in Taiwanese Adults.

BACKGROUND: The association between physical fitness performance tests and anthropometric indices is not clear. The study aims to explore the association between physical fitness performance and anthropometric indices in Taiwanese community-dwelling adults. This may help in monitoring anthropometric indices to improve physical fitness. METHODS: We recruited 2216 participants aged 23-64 years between 2014 and 2017. Physical fitness performance, including abdominal muscular endurance (60-s sit-up test), flexibility (sit-and-reach test), and cardiorespiratory endurance (3-min step test), was evaluated in all participants. The association of the physical fitness performance and anthropometric indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), was analyzed using linear regression, with adjustments for age and gender. RESULTS: Body mass index was negatively associated with abdominal muscular endurance (p < 0.001) and cardiorespiratory endurance (p < 0.001). Neither BMI, WC, WHR, nor WHtR were significantly associated with flexibility. Abdominal muscle endurance, flexibility, and cardiorespiratory endurance were significantly lower in obese participants when obesity was defined using a BMI of ≥27, 30, and 35 kg/m2. Participants with central obesity that was defined as WC ≥ 90 cm in men and 80 cm in women and WHtR ≥ 0.6 had lower abdominal muscular endurance than those without central obesity. CONCLUSION: Body mass index is associated with abdominal muscular endurance and cardiorespiratory endurance in a reverse J-shaped manner. None of the anthropometric indices are significantly associated with flexibility. Obesity defined by BMI is linked to worse physical fitness performance and obesity defined using WHtR is linked to lower abdominal muscular endurance in Taiwanese community-dwelling adults.

Portable Nanohybrid Paper-Based Chemiresistive Sensor for Free Chlorine Detection.

Detecting the concentration of free chlorine is important for monitoring the quality of water. In this study, we report a nanohybrid paper-based chemiresistive sensor that can be used with smartphones to detect free chlorine ions. The sensor was fabricated using a simple and standardized coating process. The graphene and poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) nanohybrid paper-based sensing device exhibited a more stable and intuitive response to free chlorine than that exhibited by the device using only PEDOT:PSS. The nanohybrid paper-based sensor was sensitive to free chlorine concentrations in a linear range of 0.1-500 ppm, and the limit of detection was 0.18 ppm. The sensor showed specificity for free chloride ions and detection capability in samples. The sensor was integrated as a module with an electric readout system, and the measured signals and results could be displayed in real time on a smartphone. Therefore, the proposed sensing platform is suitable owing to its portability, low cost, ease of use, and capability for on-site water quality measurement.

Physical Activity of ≥7.5 MET-h/Week Is Significantly Associated with a Decreased Risk of Cervical Neoplasia.

Cervical cancer is one of the most prevalent malignant neoplasms worldwide. We investigated whether leisure-time physical activity is sufficient to decrease the cervical neoplasia risk and provide suggested guidance of metabolic equivalents of task-hours per week (MET-h/week) spent on leisure-time physical activity to prevent cervical neoplasia. Ultimately, 433 participants, including 126 participants with cervical intraepithelial neoplasia I or higher disease (≥CIN 1) and 307 healthy controls, were recruited. All participants completed a standardized questionnaire about leisure-time physical activity engagement (MET-h/week) and a general health questionnaire and had cervical specimens taken to detect human papillomavirus (HPV) infection. CIN 1 staging was identified from the specimens. Participants with physical activity of ≥3.75 MET-h/week had a significantly lower CIN risk compared to those with physical activity of <3.75 MET-h/week (p = 0.01). However, among participants with HPV infection or smokers, the minimal requirement of leisure-time physical actively to lessen the CIN risk was ≥7.5 MET-h/week. Lifetime leisure-time physical activity of ≥0.12 MET-h/week-year also significantly decreased the CIN risk, but women with HPV infection needed ≥13.2 MET-h/week-year to protect them from a CIN risk. We concluded that regular leisure-time physical activity of ≥7.5 MET-h/week and sustained lifetime leisure-time physical activity ≥13.2 MET-h/week-year are vital factors for protecting women against cervical neoplasia risk.

TRIM31 enhances chemoresistance in glioblastoma through activation of the PI3K/Akt signaling pathway.

Temozolomide (TMZ) resistance is a complication of treatment of glioma, and new strategies are urgently required to overcome chemoresistance in glioma cells. In the present study, it was demonstrated that tripartite motif-containing 31 (TRIM31) was abnormally upregulated in glioma tissues and cell lines compared with normal samples. Furthermore, the role of TRIM31 was assessed by overexpressing and knocking down its expression. Overexpression of TRIM31 increased cell viability, increased TMZ IC50 values and inhibited apoptosis in A172 and U251 cells; whereas overexpression of TRIM31 decreased the expression of the apoptosis-associated protein p53. Knockdown of TRIM31 increased apoptosis in cells treated with TMZ. Additionally, the mechanisms by which TRIM31 affected glioma cells treated with TMZ were determined. Overexpression of TRIM31 increased phosphorylation of AKT and inhibiting the PI3K/AKT signaling pathway abolished the increase in cell viability and decreased phospho-Akt protein expression in TRIM31 overexpressing A172 cells treated with TMZ. Together, the findings suggest that TRIM31 may be a potentially novel target for glioma chemotherapy.

The Relationships between Physical Activity and Life Satisfaction and Happiness among Young, Middle-Aged, and Older Adults.

Physical activity has benefits on physical and psychological health. The aims of this study were to investigate (1) the relationships between physical activity and life satisfaction and happiness in young, middle-aged, and older adults while controlling for demographic characteristics, and (2) the relationships between age and life satisfaction and happiness for different physical activity levels. A total of 2345 healthy adults were recruited. Demographic characteristic, physical activity, life satisfaction, and happiness were collected. Participants were divided into young, middle-aged, and older adult groups based on age, and physical activity was categorized as high, moderate, and low. After controlling for demographic characteristics, participants with high and moderate activity levels had significantly higher life satisfaction and happiness than those with a low activity level across the total population and the three age groups. Age squared was a significant predictor of a positive curvilinear between age and life satisfaction and happiness. Physical activity was significantly related to life satisfaction and happiness in young, middle-aged, and older adults. In addition, life satisfaction and happiness increased with increasing age. The results support the promotion of physical activity.

Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review.

Background and Objective: Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19. Methods: We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19. Results: Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25-40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19. Conclusions: Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.

Hyperreactio luteinalis mimicking malignancy during pregnancy with elevated CA-125.

OBJECTIVE: To report a case with benign bilateral ovarian tumor during pregnancy mimicking malignancy. CASE REPORT: A 32-year-old women at 20 weeks gestation with large bilateral adnexal masses found on prenatal ultrasound. The cysts had been growing gradually over the course of the pregnancy. MRI show huge multiple cysts in both ovaries. CA-125 was elevated at 260 U/mL. Due to initial impression was malignancy, an excisional surgery was done. Pathology revealed multiple luteinized granulosa cells with benign nature. CONCLUSION: Hyperreactio luteinalis (HL) is often asymptomatic and discovered incidentally on ultrasound or at the time of cesarean section. As the lesions are self-resolving, management is conservative and surgical intervention is required only in cases with severe complications. HL can be mistaken for malignancy, especially in cases in which the tumor marker CA-125 is elevated, leading to inadvertent surgery.

Targeting myotonic dystrophy by preimplantation genetic diagnosis-karyomapping.

OBJECTIVE: To report a case with Myotonic dystrophy type I with successful preimplantation genetic diagnosis-karyomapping. CASE REPORT: A 34-year-old female carrier of myotonic dystrophy type I was treated at our clinic with a successful pregnancy after preimplantation genetic testing for monogenic disorders using karyomapping of her blastocysts. CONCLUSION: Myotonic dystrophy type I is an inherited autosomal dominant disease producing various neuromuscular disturbances. Offspring of carriers have a 50% chance of carrying CTG repeat sequences in the DMPK gene, and various time-consuming methodologies have been developed for genetic diagnosis. With a novel, efficient, and precise method by karyomapping using single nucleotide polymorphism arrays to diagnose single gene disorders, one could terminate the transmission of single gene disorder. Herein, we reported a 34-year-old female carrier of myotonic dystrophy type I achieve a successful pregnancy after preimplantation genetic testing for monogenic disorders using karyomapping method of her blastocysts.

Live birth in male de novo Kallmann syndrome after cross-generational genetic sequencing.

PURPOSE: To present the first case proposing the use of preimplantation genetic testing for monogeneic disorders for Kallmann syndrome, providing comprehensive care in the genomic era of precision medicine. METHODS: Gonadotropin therapy was used for spermatogenesis, followed by in vitro fertilization by intracytoplasmic sperm injection and embryo transfer. Cross-generational targeted next-generation sequencing was then done for genes known to cause Kallmann syndrome. RESULTS: A heterozygous mutation at codon 102 of the FGFR1 gene was found in the patient, but the father was found to have the same mutation yet is unaffected by Kallmann syndrome. Since no causative mutation was found, a de novo or sporadic mutation was suspected as the cause of Kallmann syndrome in this case. CONCLUSIONS: Comprehensive care must be available for male Kallmann syndrome patients, as treatment should not stop at spermatogenesis, but continue with genetic counseling due to possible inheritance.

Surgical Management of Aneurysmal Hematomas in the Presence of Brain Herniation on Arrival: A Single-Center Case Series Analysis.

OBJECTIVES: To assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors. METHODS: This retrospective study included 43 patients with aneurysmal ICH who presented to the Emergency Department with brain herniation and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, hematoma removal, and external decompression were combined as an aggressive surgical treatment. Outcomes were assessed using in-hospital survival and the Glasgow Outcome Scale at a 6-month follow-up. RESULTS: All the patients were World Federation of Neurological Societies grade V on presentation. The mean hematoma volume was 59.1 ± 16.5 mL. The in-hospital mortality rate was 48.8%. At the 6-month follow-up, favorable outcomes were achieved in 7 patients (16.3%). Significant factors related to death included bilateral mydriasis, lower initial Glasgow Coma Scale (GCS) score, larger hematoma volume, and no recovery of pupil reactivity after surgery. Bilateral restoration of pupil reactivity and higher initial GCS score were associated with 6-month favorable outcomes. Patients with an intrasylvian hematoma were more likely than those with an intraparenchymal hematoma to achieve a favorable outcome (62.5% vs. 5.7%; P = 0.001). CONCLUSIONS: Our data indicate that the protocol of aggressive surgical treatment in patients with a herniated aneurysmal ICH might be warranted. Despite mydriasis, favorable outcomes might be achieved in some patients. However, careful individual patient-centered decision making is essential, particularly when bilateral pupil dilation persists.