Intracranial hypertension as the primary symptom of malignant melanoma: A case report.

BACKGROUND: The etiological diagnosis of intracranial hypertension is quite complicated but important in clinical practice. Some common causes are craniocerebral injury, intracranial space-occupying lesion, subarachnoid hemorrhage, and hydrocephalus. When a patient presents with intracranial hypertension, the common causes are to be considered first so that other causes would be dismissed. With the morbidity lower than 9%, neuromelanin is very rare. Common symptoms include nerve damage symptoms, epilepsy, psychiatric symptoms, and cognitive disorders. CASE SUMMARY: We present a patient with melanoma which manifested with isolated intracranial hypertension without any other neurological signs. A 22-year-old male had repeated nausea and vomiting for 2 mo with Babinski sign (+) on both sides, nuchal rigidity, and subarachnoid hemorrhage. He had been diagnosed with melanoma and was given surgery and whole-brain radiation. Ultimately, the patient died 2 mo later. CONCLUSION: Malignant melanoma should be taken into consideration in the differential diagnosis of intracranial hypertension.

Auditory Fear Conditioning Alters Sensitivity of the Medial Prefrontal Cortex but this is not based on Frequency-dependent Integration.

Although many studies have shown that the prelimbic (PL) cortex of the mPFC is involved in the formation of conditioned freezing behavior, few have considered the acoustic response characteristics of PL cortex. Importantly, the change in auditory response characteristics of the PL cortex after conditional fear learning is largely unknown. Here we used in vivo cell-attached recordings targeting the mPFC during the waking state. We confirmed that the mPFC of adult C57 mice have neurons that respond to noise and tone in the waking state, especially in the PL cortex. Interestingly, the data also confirmed that these neurons responded well to the intensity of sound but did not have frequency topological distribution characteristics. Furthermore, we found that the number of c-fos positive neurons in the PL cortex increased significantly after auditory fear conditioning. The auditory-induced local field potential recordings and in vivo cell-attached recordings demonstrated that the PL cortex was more sensitive to the auditory conditioned stimulus after the acquisition of conditioned fear. The proportion of neurons responding to noise was significantly increased, and the signal to noise ratio of the spikes were also increased. These data reveal that PL neurons themselves responded to the main information (sound intensity), while the secondary information (frequency) response was almost negligible after auditory fear conditioning. This phenomenon may be the functional basis for handling this type of emotional memory, and this response characteristic is thought to be emotional sensitization but does not change the nature of this response.

Trefoil Factor 3, Cholinesterase and Homocysteine: Potential Predictors for Parkinson's Disease Dementia and Vascular Parkinsonism Dementia in Advanced Stage.

Trefoil factor 3 (TFF3), cholinesterase activity (ChE activity) and homocysteine (Hcy) play critical roles in modulating recognition, learning and memory in neurodegenerative diseases, such as Parkinson's disease dementia (PDD) and vascular parkinsonism with dementia (VPD). However, whether they can be used as reliable predictors to evaluate the severity and progression of PDD and VPD remains largely unknown. METHODS: We performed a cross-sectional study that included 92 patients with PDD, 82 patients with VPD and 80 healthy controls. Serum levels of TFF3, ChE activity and Hcy were measured. Several scales were used to rate the severity of PDD and VPD. Receivers operating characteristic (ROC) curves were applied to map the diagnostic accuracy of PDD and VPD patients compared to healthy subjects. RESULTS: Compared with healthy subjects, the serum levels of TFF3 and ChE activity were lower, while Hcy was higher in the PDD and VPD patients. These findings were especially prominent in male patients. The three biomarkers displayed differences between PDD and VPD sub-groups based on genders and UPDRS (III) scores' distribution. Interestingly, these increased serum Hcy levels were significantly and inversely correlated with decreased TFF3/ChE activity levels. There were significant correlations between TFF3/ChE activity/Hcy levels and PDD/VPD severities, including motor dysfunction, declining cognition and mood/gastrointestinal symptoms. Additionally, ROC curves for the combination of TFF3, ChE activity and Hcy showed potential diagnostic value in discriminating PDD and VPD patients from healthy controls. CONCLUSIONS: Our findings suggest that serum TFF3, ChE activity and Hcy levels may underlie the pathophysiological mechanisms of PDD and VPD. As the race to find biomarkers or predictors for these diseases intensifies, a better understanding of the roles of TFF3, ChE activity and Hcy may yield insights into the pathogenesis of PDD and VPD.

Highly efficient room-temperature phosphorescence and afterglow luminescence from common organic fluorophores in 2D hybrid perovskites.

Regardless of rapid development of organic room-temperature phosphorescence (RTP) originating from phosphors in crystals, highly efficient and persistent RTP from common fluorophores is very rare. Herein, 1,8-naphthalimide (NI), a common organic fluorophore, is doped into organic cations of 2D layered organic/inorganic hybrid perovskites (OIHPs) to yield thin films and powders with yellow RTP of NI in air. The triplet excitons of NI are mainly derived from Wannier excitons of inorganic perovskite through energy transfer (ET) for films, and from singlet excitons of NI through intersystem crossing (ISC) for powder. Consequently, the quantum yield (Φ P), lifetime (τ) and color of RTP can be tuned by changing the fluorophore and halide in the perovskites, as well as their solid morphology. A white emission, comprising the blue one from the perovskite and yellow RTP (Φ P = 25.6%, τ = 6.3 ms) from NI, is obtained in Br-based OIHPs in powder. Cl-based OIHPs exhibit fluorescence/phosphorescence dual emission in thin films, and yellow afterglow phosphorescence in powders (Φ P = 56.1%, τ = 35 ms). The unique performance of the OIHPs with RTP can make them widely applicable in the field of information technology as security ink, and white and afterglow LEDs as single luminescent materials.

Continuous intrathecal administration of liposomal amphotericin B for treatment of refractory Cryptococcus neoformans encephalitis: A case report.

The aim of the present study was to investigate the treatment of refractory Cryptococcus neoformans encephalitis with continuous administration of liposomal amphotericin B (AmB). Liposomal AmB was administered to a 28-year-old male by intravenous injection, with daily increasing dosages up to 150 mg per day and combined use of fluconazole (0.4 g per day) and oral flucytosine tablets (1.5 g per day). Following 5 months of treatment, C. neoformans could still be detected in the ink stain of cerebrospinal fluid, but the patient could not tolerate a further increase in the dosage of liposomal AmB. Instead, continuous intrathecal administration of AmB through tube drainage on the lumbar cistern was used. A total dosage of 28 mg liposomal AmB was administered to the patient over the course of 1 month. The effect of AmB administered by intravenous injection was not as great as expected and the patient's tolerance was not good. However, the patient recovered following treatment by continuous intrathecal administration of AmB through tube drainage on the lumbar cistern for 1 month. This case suggests that continuous intrathecal administration of liposomal AmB should be considered for clinical treatment of refractory cryptococcal encephalitis.

Kennedy disease with difficulty in differential diagnosis: A case report.

RATIONALE: Kennedy disease (KD) is also known as spinal bulbar muscular dystrophy. As KD has similar symptoms with most neuromuscular diseases, so it is difficult to make a rapid diagnosis clinically. PATIENT CONCERNS: We report a case of a 43-year-old male with progressive limb proximal weakness without family history. Physical examination showed gynecomastia, erectile dysfunction, bilateral tendon reflex and quadriceps weakness, and tongue muscle atrophy. DIAGNOSES: Laboratory examination found increased creatine kinase, impaired glucose tolerance, and abnormal lactic acid values. There was no mutation or copy number variant in SMN1 gene and related mitochondrion genes tested, even with the use of multiplex ligation probe- dependent amplification technique. Diagnosis was confirmed with genetic analysis which displayed trinucleotide CAG (glutamine)- repeat expansion in the androgen-receptor gene. INTERVENTIONS AND OUTCOMES: The patient achieved good prognosis with symptomatic treatment after diagnosis. LESSONS: To diagnose KD, clinicians should pay more attention to differentiate KD and myasthenia gravis, mitochondrial myopathy, and amyotrophic lateral sclerosis. Gene analysis was the key in detecting this rare confusing disease in the patient.

[Fluid resuscitation in a patient with severe hypovolemic shock and severe pulmonary capillary leak].

OBJECTIVE: A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m(2), and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m(2). Pulmonary edema was gradually reduced after the treatments with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was discharged. In the treatment of the patient, PiCCO monitoring played an important role.