An asymptomatic male individual carrying a 5.72 Mb de novo deletion in 8p23.2‑p23.3: A case report

Numerous rearrangements in the 8p23 chromosomal region have been reported; included in these rearrangements are isolated deletions in this area. Such deletions are associated with a wide range of phenotypic characteristics, including motor impairment, epilepsy, intellectual disability, cardiac defects and seizures. The present study describes the case of a 30-year-old asymptomatic man that carries a de novo deletion in 8p23.2-p23.3. Molecular karyotyping indicated that the detected deletion involves genes that are in the critical region which is hypothesized to be responsible for the phenotypic characteristics associated with such deletions. The normal phenotype of the patient supports the hypothesis that there is incomplete penetrance of 8p23.2-p23.3 deletions.

Prenatal Identification of a Missense Mutation of the L1CAM Gene Associated With Hydrocephalus Using Next-Generation Sequencing

We present the case of a 35-year-old pregnant woman who visited our department for a routine ultrasonography screening scan for fetus anatomy during the 22nd week of gestation. Our report revealed a male fetus with marked hydrocephalus and severe intrauterine growth retardation. After extensive counseling, the couple decided to proceed with an invasive diagnosis via amniocentesis. The cytogenetic analysis showed findings related to clinical history and ultrasound findings related to the presence of a nucleotide change in c.578T>C with an amino acid change in p.Leu198Pro of the L1CAM gene. The result was reported as a hemizygote missense L1CAM gene variant of unknown significance. After extensive parental counseling, the couple decided on pregnancy termination. We report the present case of L1CAM mutation in p.Leu198Pro to add to the limited knowledge regarding the clinical presentation of mutations of the L1CAM gene with emphasis on prenatal diagnosis.

Unveiling the crucial neuronal role of the proteasomal ATPase subunit gene PSMC5 in neurodevelopmental proteasomopathies

Neurodevelopmental proteasomopathies represent a distinctive category of neurodevelopmental disorders (NDD) characterized by genetic variations within the 26S proteasome, a protein complex governing eukaryotic cellular protein homeostasis. In our comprehensive study, we identified 23 unique variants in PSMC5 , which encodes the AAA-ATPase proteasome subunit PSMC5/Rpt6, causing syndromic NDD in 38 unrelated individuals. Overexpression of PSMC5 variants altered human hippocampal neuron morphology, while PSMC5 knockdown led to impaired reversal learning in flies and loss of excitatory synapses in rat hippocampal neurons. PSMC5 loss-of-function resulted in abnormal protein aggregation, profoundly impacting innate immune signaling, mitophagy rates, and lipid metabolism in affected individuals. Importantly, targeting key components of the integrated stress response, such as PKR and GCN2 kinases, ameliorated immune dysregulations in cells from affected individuals. These findings significantly advance our understanding of the molecular mechanisms underlying neurodevelopmental proteasomopathies, provide links to research in neurodegenerative diseases, and open up potential therapeutic avenues.

Large Cyst of Skene Gland: A Rare Perineum Mass

Objective  In this report we present a rare case of a large cyst of Skene gland in a female patient with a palpable vaginal mass persisting for at least 2 years. Case Report  A 67-year-old female admitted to the department of urology due to the presence of "a vaginal mass" for the past 2 years. A cyst of Skene's duct was suspected based on clinical manifestation and findings of magnetic resonance imaging showing an extensive cyst formation in the upper vaginal area and anterior to the urethra. Based on these findings, a decision for surgical removement of the cyst was made. The cyst was incised, drained, and marsupialized. The postoperative recovery was uneventful, and the patient was discharged on the second postoperative day. Conclusion  High clinical suspicion is important to reach this rare diagnosis. Partial excision and marsupialization of the cyst is a simple procedure with low morbidity, without recurrence, and excellent results.

Epilepsy and Diagnostic Dilemmas: The Role of Language and Speech-Related Seizures

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas that experts in the field of speech-language pathology, neurology, and related fields face? How far has research gone in investigating psychogenic nonepileptic seizures, the misdiagnosis of which can be a thorny issue for clinicians and a detrimental factor for the patients’ health? In order to address these questions, the study at hand focuses on a common, ever-intensified (by the COVID-19 pandemic) speech disorder—stuttering, and explores the pathophysiological and psychogenic background of the phenomenon. It also looks at the role of stuttering as a contributing factor to the appearance of epileptic seizures, in the hope of drawing attention to the complexity and importance of precise detection of stuttering-induced epilepsy, as a specific subcategory of language-induced epilepsy.

Isolated bulbar palsy and dysphagia in children with respiratory symptoms

Oropharyngeal dysphagia can cause chronic aspiration leading to significant respiratory symptoms. When dysphagia is diagnosed, an underlying cause is sought. We present a case series of 15 children diagnosed aged 6 months to 5 years (mean 2y 5mo; 11 males, four females) over a 6-year period, who were found to have an isolated bulbar palsy on genioglossus electromyography, with no accompanying neurological or neurodevelopmental disorder. Eight children had dysphagia but a normal EMG. In those with isolated bulbar palsy, management included thickened fluids (n=13), cooled boiled water (n=1), and nasogastric tube feeding (n=1). Follow-up over 1 to 8 years (mean 5y) showed complete resolution in six children, improvement in four children, and no improvement in five children (including two requiring fluids via a gastrostomy). Eight children no longer had any respiratory symptoms. Isolated bulbar palsy is under-recognized and has not been reported previously as a cause of significant dysphagia in children.

Not Just Loss-of-Function Variations: Identification of a Hypermorphic Variant in a Patient With a CDKL5 Missense Substitution

Background and Objectives

CDKL5 deficiency disorder (CDD) is a neurodevelopmental encephalopathy characterized by early-onset epilepsy and impaired psychomotor development. Variations in the X-linked CDKL5 gene coding for a kinase cause CDD. Molecular genetics has proved that almost all pathogenic missense substitutions localize in the N-terminal catalytic domain, therefore underlining the importance for brain development and functioning of the kinase activity. CDKL5 also features a long C-terminal domain that acts as negative regulator of the enzymatic activity and modulates its subcellular distribution. CDD is generally attributed to loss-of-function variations, whereas the clinical consequences of increased CDKL5 activity remain uncertain. We have identified a female patient characterized by mild epilepsy and neurologic symptoms, harboring a novel c.2873C>G nucleotide substitution, leading to the missense variant p.(Thr958Arg). To increase our comprehension of genetic variants in CDKL5-associated neurologic disorders, we have characterized the molecular consequences of the identified substitution.

Methods

MRI and video EEG telemetry were used to describe brain activity and capture seizure. The Bayley III test was used to evaluate the patient development. Reverse transcriptase PCR was used to analyze whether the identified nucleotide variant affects messenger RNA stability and/or splicing. The X chromosome inactivation pattern was analyzed determining the DNA methylation status of the androgen receptor (AR) gene and by sequencing of expressed alleles. Western blotting was used to investigate whether the novel Thr958Arg substitution affects the stability and/or enzymatic activity of CDKL5. Immunofluorescence was used to define whether CDKL5 subcellular distribution is affected by the Thr958Arg substitution.

Results

Our data suggested that the proband tends toward a skewed X chromosome inactivation pattern in favor of the novel variant. The molecular investigation revealed that the p.(Thr958Arg) substitution leads to a significant increase in the autophosphorylation of both the TEY motif and residue Tyr¹⁷¹ of CDKL5, as well as in the phosphorylation of the target protein MAP1S, indicating an hyperactivation of CDKL5. This occurs without evidently affecting the kinase subcellular distribution.

Discussion

Our data provide a strong indication that the c.2873C>G nucleotide substitution represents an hypermorphic pathogenic variation of CDKL5, therefore highlighting the importance of a tight control of CDKL5 activity in the brain.

Partial deletion of chromosome 6p causing developmental delay and mild dysmorphisms in a child: molecular and developmental investigation and literature search

Background

The interstitial 6p22.3 deletions concern rare chromosomal events affecting numerous aspects of both physical and mental development. The syndrome is characterized by partial deletion of chromosome 6, which may arise in a number of ways.

Case presentation

We report a 2.8-year old boy presenting with developmental delay and mild dysmorphisms. High-resolution oligonucleotide microarray analysis revealed with high precision a 2.5 Mb interstitial 6p deletion in the 6p22.3 region which encompasses 13 genes.

Conclusions

Identification and in-depth analysis of cases presenting with mild features of the syndrome will sharpen our understanding of the genetic spectrum of the 6p22.3 deletion.

Novel Mutations Involved in Charcot-Marie-Tooth 4C and Intrafamilial Variability: Let's Not Miss the Forest for the Trees

Charcot-Marie-Tooth 4C is characterized by early-onset, rapid progression, and mainly associated with SH3TC2 gene mutations. We reported a male patient carrying a novel heterozygous nonsense mutation in SH3TC2 gene along with a heterozygous known pathogenic mutation. Symptoms began at 15 months and by 14 years, he presented significant motor impairment. Both parents exhibited one of the mutations in the heterozygous state, while his 8-year-old brother carried the same compound heterozygosity, showing only a mild phenotype. In our case, we discussed the contribution of compound heterozygosity to intrafamilial variability in Charcot-Marie-Tooth and the role of modifying genes.

SCN2A mutation in an infant with Ohtahara syndrome and neuroimaging findings: expanding the phenotype of neuronal migration disorders

Neuronal migration disorders (NMDs) are a heterogeneous group of conditions caused by the abnormal migration of neuroblasts in the developing brain and nervous system, resulting in severe developmental impairment, intractable epilepsy and intellectual disability (Spalice et al. 2009). To date, many genes have been identified as the leading cause of migration defects, i.e. agyria/pachygyria, polymicrogyria, heterotopias, agenesis of the corpus callosum and agenesis of the cranial nerves (Spalice et al. 2009). Here, we present a patient with early infantile epileptic encephalopathy (Ohtahara syndrome) with seizure onset on the first dayof life, severe developmental delay and an abnormal brain MRI with excessive folding of small, fused gyri and bilateral perisylvian polymicrogyria, suggestive of neuronal migration disorder. To clarify the unknown aetiology, we conducted whole-exome sequencing, which detected a de novo missense variant (c.5308A>T; p.(Met1770Leu)) in the SCN2A gene. This is a report of SCN2A gene variant identified in a patient with neuronal migration disorder which could further expand the phenotypic spectrum of these genetic disorders.

Charcot-Marie-Tooth 1A concurrent with anaplastic ependymoma in a toddler: when an acute event unmasks a chronic condition

Gogou M, Pavlidou E, Pavlou E, Papageorgiou T, Tragiannidis A, Giannopoulos A, Hatzipantelis E. Charcot-Marie -Tooth 1A concurrent with anaplastic ependymoma in a toddler: when an acute event unmasks a chronic condition. Turk J Pediatr 2019; 61: 428-430. We report a 14-month-old toddler admitted to the Pediatric Oncology Department after surgical resection of supratentorial anaplastic ependymoma. The child was treated with International Society of Pediatric Oncology Ependymoma II 2015 chemotherapy protocol (vincristine, carboplatin, cisplatin, cyclophosphamide and methotrexate). At the end of the first cycle the child presented with symptoms such as unsteadiness and ataxic gait along with decreased motor and sensory action potentials of the limbs. As the father of the child was diagnosed with Charcot-Marie-Tooth 1A disease, a genetic analysis of the PMP22 gene was performed confirming the diagnosis of Charcot- Marie-Tooth 1A in the child, too. This case gently reminds the possibility of vincristine-induced neurotoxicity and underscores the significance of an appropriate neurological assessment before vincristine initiation.

Dipyridamole-loaded biodegradable PLA nanoplatforms as coatings for cardiovascular stents

Cardiovascular stents are commonly used for the treatment of cardiovascular diseases that in developed societies are the most frequent causes of mortality and morbidity. In recent years, thorough research and development of drug-eluting stents has been done, with emphasis on coronary stenting to avoid the most common complication, in-stent thrombosis. Dipyridamole (DPM) is a medication that inhibits blood clot formation. Drug delivery nanoplatforms consisting of biodegradable polymers can be fabricated via electrospinning deposition, known for its cost-effective and versatile advantages, that produces fibrous scaffolds that are able to sustain and control drug release. A novel drug delivery nanosystem of polylactic acid fibrous scaffold loaded with the anti-platelet drug DPM was fabricated by electrospinning as coating for cardiovascular stents. The surface morphology and topography that were evaluated via atomic force microscopy, scanning electron microscopy and optical microscopy, were found to be good and suitable for tissue engineering. Contact angle measurements established the hydrophobic behavior of these fibrous nanoplatforms. Drug-release kinetics and degradation studies were conducted and revealed a sustained and controllable release of DPM, through this fibrous matrix over time. Finally, cytotoxicity studies took place to evaluate the cytocompatibility of the scaffold that confirmed its compatible behavior. The successful performance of this nanoplatform can lead to it being a valuable tool for atherosclerosis treatment.

Postherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy

BACKGROUND

Recent evidence suggests that patients with herpes simplex virus (HSV) encephalitis may relapse because of autoimmunity against the N-methyl-D-aspartate receptor (NMDAR). We present a case series of post-HSV relapsing encephalopathy associated with antibodies to central nervous system (CNS) synaptic antigens.

PATIENT/METHODS

Sera and cerebrospinal fluid (CSF) from five patients with HSV encephalitis who relapsed after antiviral therapy were tested for anti-NMDAR, gamma-aminobutyric acid b receptor (GABAbR), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), Leucine-rich, glioma inactivated 1 (LGI1), anti -contactin-associated protein-like 2 (CASPR2) and dipeptidyl-peptidase-like protein-6 (DDPX) antibodies using cell-based assays.

RESULTS

Five patients (two infants, one child and two adults) developed post-HSV autoimmune encephalitis. The infants, aged 9 months and 10 months, after prompt and seemingly successful anti-HSV therapy, were readmitted with typical signs of NMDAR-encephalitis evolving within days, with NMDAR antibodies detected in both serum and CSF. Although they were promptly treated with intravenous immunoglobulin (IVIg) and with IVIg followed by rituximab, respectively, they were both left with psychomotor deficits. A 14-year-old girl with seizures due to HSV encephalitis improved with anti-HSV therapy. Later, she manifested intractable seizures and she was found positive for anti-NMDAR antibodies which persist. The two adults were women, aged 58 and 33 years. The first recovered after anti-HSV therapy and remained asymptomatic for 6 months, until she developed generalized seizures with persisting CSF anti-NMDAR antibodies; the second, who continued to be encephalopathic after 2 weeks of anti-HSV therapy, tested positive for anti-NMDAR antibodies in the serum and anti-GABAbR antibodies in the serum and CSF. She recovered fully following IVIg therapy but her serum anti-GABAbR antibodies persist 34 months later.

DISCUSSION

Infection of the CNS with HSV can trigger CNS autoimmunity associated not only with anti-NMDAR but also with anti-GABAbR antibodies. These antibodies can persist in the serum, even without associated symptoms, but their presence in the CSF is firmly associated with disease development. In contrast to children and adults who responded well to therapies, the infants had an incomplete recovery with severe psychomotor deficits probably due to the interference of anti-NMDAR antibodies with neuro-developmental processes.

A novel PLP1 mutation associated with optic nerve enlargement in two siblings with Pelizaeus-Merzbacher disease: A new MRI finding

Pelizaeus-Merzbacher disease (PMD) is a rare, X-linked disorder characterized by hypomyelination of the Central Nervous System due to mutations in the PLP1 gene. Certain mutations of the PLP1 gene correlate with specific clinical phenotypes and neuroimaging findings. We herein report a novel mutation of the PLP1 gene in two siblings with PMD associated with a rare and protean neuroimaging finding of optic nerve enlargement. To the best of our knowledge this is the first time that this novel mutation H133P of PLP1 gene is identified and clinically associated with optic nerve enlargement in PMD patients.

Vitrification of incinerated tannery sludge in silicate matrices for chromium stabilization

The vitrification process was applied for the stabilization and solidification of a rich in chromium ash that was the by-product of incineration of tannery sludge. Six different batch compositions were produced, based on silica as the glass former and sodium and calcium oxides as flux agents. As-vitrified products (monoliths) were either composed of silicate matrices with separated from the melt Eskolaite (Cr₂O₃) crystallites or were homogeneous glasses (in one case). All as-vitrified products were thermally treated in order to transform them to partially crystallized, i.e. devitrified products. Devitrification is an important part of the work since studying the transformation of the initial as-vitrified products into glass-ceramics with better properties could result to stabilized products with potential added value. The devitrified products were diversified by the effective crystallization mode and separated crystal phase composition. These variations originated from differences in: (a) batch composition of the initial as-vitrified products and (b) thermal treatment conditions. In devitrified products crystallization led to the separation of Devitrite (Na₂Ca₃Si₆O₁₆), Combeite (Na₄Ca₄Si₆O₁₈) and Wollastonite (CaSiO₃) crystalline phases, while Eskolaite crystallites were not affected by thermal treatment. Leaching test results revealed that chromium was successfully stabilized inside the as-vitrified monoliths. Devitrification impairs chromium stabilization, only in the case where the initial as-vitrified product was a homogeneous glass. In all other cases, devitrification did not affect successful chromium stabilization.

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiological entity characterised by seizures, severe headache, mental status instability and visual disturbances. Hypertension is typically present. We report a case of a 13-year old boy with Burkitt lymphoma/leukaemia, who presented with posterior leukoencephalopathy 24 hours after intrathecal methotrexate (MTX) infusion. The child presented with headache, seizures, elevated blood pressure and gradual deterioration of his neurological status. Midazolam, dexamethazone and furosemide were initiated leading to reduction of cerebral oedema and clinical improvement. A thorough literature review is discussed in this report. Pathophysiology of leukoencephalopathy remains unclear. It develops within 5-14 days after intrathecal MTX and resolves within a week usually without permanent neurological sequelae. Broad use of MRI has led to an increasing number of identified cases of PRES. Treatment approach is mainly to manage the underlying cause of PRES. Prognosis is generally benign; however delayed diagnosis and improper management may result in permanent brain insult.

Pontocerebellar hypoplasia type 2D and optic nerve atrophy further expand the spectrum associated with selenoprotein biosynthesis deficiency

BACKGROUND

The term Pontocerebellar hypoplasias collectively refers to a group of rare, heterogeneous and progressive disorders, which are frequently inherited in an autosomal recessive manner and usually have a prenatal onset. Mutations in the SEPSECS gene, leading to deficiency in selenoprotein biosynthesis, have been identified in recent times as the molecular etiology of different pre/perinatal onset neurological phenotypes, including cerebello-cerebral atrophy, Pontocerebellar hypoplasia type 2D and progressive encephalopathy with elevated lactate. These disorders share a similar spectrum of central (e.g., brain neurodegeneration with grey and white matter both involved) and peripheral (e.g., spasticity due to axonal neuropathy) nervous system impairment.

CASE PRESENTATION

We hereby describe a 9-year-old boy with (i) a typical Pontocerebellar hypoplasia type 2D phenotype (e.g. profound mental retardation, spastic quadriplegia, ponto-cerebellar hypoplasia and progressive cerebral atrophy); (ii) optic nerve atrophy and (iii) mild secondary mitochondrial myopathy detected by muscle biopsy and respiratory chain enzyme analysis. We performed whole exome sequencing which identified a homozygous mutation of the SEPSECS gene (c.1001T > C), confirming the clinical suspect of Pontocerebellar hypoplasia type 2D.

CONCLUSION

This report further corroborates the notion of a potential secondary mitochondrial dysfunction in the context of selenoprotein biosynthesis deficiency and also adds optic nerve atrophy as a new potential clinical feature within the SEPSECS-associated clinical spectrum. These findings suggest the presence of a possible shared genetic etiology among similar clinical entities characterized by the combination of progressive cerebello-cerebral and optic nerve atrophy and also stress the biological importance of selenoproteins in the regulation of neuronal and metabolic homeostasis.

Bilateral Eyelid Ptosis, Attributed to Vincristine, Treated Successfully with Pyridoxine and Thiamine in a Child with Acute Lymphoblastic Leukemia

Vincristine-induced neurotoxicity is an adverse effect commonly seen in pediatric patients treated for cancer. We hereby present a case of a 6-year-old boy with acute lymphoblastic leukemia, who developed bilateral eyelid ptosis 25 days after the last intravenous administration of vincristine (cumulative dose 14.2 mg i.e., 17.75 mg/m²). The boy was treated with 5 mg/kg thiamine and with 10 mg/kg pyridoxine. Complete recovery of ptosis was noticed 4 weeks after the initiation of Vitamins B1 and B6 supplementation therapy.

Metaphyseal dysplasia associated with chronic facial nerve palsy

INTRODUCTION

Metaphyseal dysplasia (Pyle disease) is a rare autosomal recessive disease with impressive and characteristic radiological findings but relatively mild clinical features. It is usually incidentally diagnosed, despite the impressive radiological findings of gross metaphyseal widening and thinning of cortical bone.

CASE REPORT

Herein, we report an exceptionally unusual case of metaphyseal dysplasia in association with chronic facial nerve palsy.

DISCUSSION

Chronic facial nerve palsy due to compression of the facial nerve in a patient with Pyle disease represents an unusual novelty. Furthermore, this case delineates the clinical spectrum and phenotype of such a rare clinical entity. To the best of our knowledge, this is the first time that such an association is being described.

Lumbar puncture complicated by spinal epidural hematoma in a child with leukemia

We report a case of spinal epidural hematoma (SEH) preceded by diagnostic lumbar puncture (LP) in a 5-year-old boy with acute lymphoblastic leukemia. MRI confirmed the presence of SEH between T7 and L5 levels, but the patient showed fast recovery during the next hours and conservative management was elected.

Severe particulate pollution from the deposition practices of the primary materials of a cement plant

Global cement production has increased twofold during the last decade. This increase has been accompanied by the installation of many new plants, especially in Southeast Asia. Although various aspects of pollution related to cement production have been reported, the impact of primary material deposition practices on ambient air quality has not yet been studied. In this study, we show that deposition practices can have a very serious impact on levels of ambient aerosols, far larger than other cement production-related impacts. Analyses of ambient particulates sampled near a cement plant show 1.3-30.4 mg/m(3) total suspended particulates in the air and concentrations of particles with a diameter of 10 μm or less at 0.04-3 mg/m(3). These concentrations are very high and seriously exceed air quality standards. We unequivocally attribute these levels to outdoor deposition of cement primary materials, especially clinker, using scanning electron microscopy/energy-dispersive X-ray spectroscopy. We also used satellite-derived aerosol optical depth maps over the area of study to estimate the extent of the spatial impact. The satellite data indicate a 33% decrease in aerosol optical depth during a 10-year period, possibly due to changing primary material deposition practices. Although the in situ sampling was performed in one location, primary materials used in cement production are common in all parts of the world and have not changed significantly over the last decades. Hence, the results reported here demonstrate the dominant impact of deposition practices on aerosol levels near cement plants.

Understanding the mechanical and thermal property reinforcement of crosslinked polyethylene by nanodiamonds and carbon nanotubes

A systematic evaluation of the factors governing the measured thermal and mechanical property reinforcement in crosslinked polyethylene nanocomposites is presented.

Cu-Zn powders as potential Cr(VI) adsorbents for drinking water

This work examines the possibility of applying CuZn alloys as a reducing medium for the efficient removal of hexavalent chromium from drinking water. In an effort to develop a route for producing powders of CuZn alloys under mild conditions and investigate the optimum composition for such application, a series of alloys in the form of powders were prepared, by a sequence of Cu and Zn ball-milling and low temperature annealing. Batch Cr(VI) removal tests, performed to evaluate and compare the efficiency of the products under typical natural water parameters (pH 7 and natural-like water), indicated that the best performing material have a composition around 50 wt% Cu. The dominant reduction mechanisms are both the corrosion of the alloy surface and the electron transfer to the solution. The behavior of granulated CuZn media was tested in rapid-scale column tests using the commercial KDF which verified the high potential of CuZn alloys in Cr(VI) removal. Nevertheless, Cu and Zn leaching problems should be also considered.

Prognostic factors for subsequent epilepsy in children with febrile seizures

OBJECTIVE

Epilepsy following febrile seizures (FS) has been estimated between 2% and 7%. It concerns a prospective study in a large sample of children with a long-term follow-up. The aim of this study is to identify the prognostic factors that can lead children with FS to epilepsy.

METHODS

Children with a first episode of FS were included. We gathered information about prenatal and perinatal history, family history of FS and epilepsy in first- and second degree relatives, age at the time of the initial FS, dates of FS recurrences, focality, duration of the FS and recurrent episodes within the same febrile illness, height and duration of fever prior to the seizure, cause of the fever, and frequency of febrile illnesses. Patients were seen every 4-6 months and also at each recurrence.

KEY FINDINGS

A group of 560 children with a first FS met all entry criteria. Epilepsy was recorded at 5.4%. Statistical analysis was performed between children with epilepsy and those with no afebrile seizure. We analyzed FS recurrences in accordance with the occurrence of epilepsy. From the third FS recurrence and beyond, only focality continued to have prognostic value.

SIGNIFICANCE

Main prognostic factors for the development of epilepsy after FS are: (1) complex FS that increased the risk for epilepsy 3.6 times, (2) age at onset of FS beyond the third year of life that raised the risk 3.8 times, (3) positive family history of epilepsy 7.3 times, and (4) multiple episodes of FS about 10 times. Focality at the first and the second FS recurrence increased the risk of epilepsy about 9.7 and 11.7 times, respectively. Focality was the only factor that continued to be significant in further FS recurrences. A prognostic profile of each child with FS would be very useful for the follow-up of these children.

Juxtacortical clavicular chondrosarcoma: diagnostic dilemmas: case report and review of literature

Juxtacortical chondrosarcoma is a rare primary malignant cartilaginous tumor accounting for 0.2% of all bone tumors. Wide surgical resection is the treatment of choice for juxtacortical chondrosarcomas. Accurate preoperative diagnosis is important in ensuring appropriate management, staging, and treatment of the patient. A combination of radiographs, three-dimensional imaging with computerized tomography (CT) scan and magnetic resonance imaging (MRI) can typically allow accurate diagnosis of juxtacortical chondrosarcomas. Bone scan and chest x-ray or CT chest scans are indicated for appropriate staging of the patient. Pet scan, ultrasound, bone scan, etc. are not typically needed for the diagnosis. Certainly, pulmonary imaging and bone scan are required for staging and could be commented upon.

Structural, microchemistry, and hydrogenation properties of TiMn0.4Fe0.2V0.4, TiMn0.1Fe0.2V0.7 and Ti0.4Zr0.6Mn0.4Fe0.2V0.4 metal hydrides

In this work, TiFe-based alloys have been developed according to the stoichiometry Ti1-xAx Fe1-yBy (A [triple bond] Zr; B [triple bond] Mn, V). The hydrogen solubility properties have been investigated to develop dynamic hydrides of Ti-based alloys for hydrogen storage applications. The hydrogenation behavior of these alloys has been studied, and their hydrogen storage capacities and kinetics have been evaluated. Several activation modes, including activation at high temperatures under hydrogen pressure, have been attempted for the as-milled powders. In order to clarify the structural/microstructural characteristics, and chemical composition before and after hydrogenation, X-Ray Diffraction (XRD), EDAX-Mapping Analysis and Scanning Electron Microscopy (SEM), have been carried out for the samples. Modeling of the isotherms has been performed by using MATLAB programming. The maximum gravimetric density of 4.3 wt%, has been obtained on the sample with the BCC main phase. The calculated enthalpy of reaction (deltaH) is found to be about 4 kJ/mol.

The Xth Cent. Church in Drustar: Study of Wall Paintings by Spectroscopic Methods

The technique and painting used in the earlier wall paintings from the characteristic Christian church in Drustar - close to the river Danube - in Bulgaria, are studied. The fragments of wall paintings used in this study are examined mainly by Fourier Transform Infrared Spectroscopy (FTIR) and Scanning Electron Microscopy (SEM) with Energy Dispersive X-ray Analysis (EDS). It is concluded that the technique used was fresco and that the pigments used are common to those used in the Byzantine era.

Physical Activity Levels of Women Attending Glasgow Breast Clinics

IntroductionEpidemiological studies suggest that moderate intensity recreational physical activity (PA) improves breast cancer survival. We aimed to assess the current levels of PA in breast cancer survivors and a cohort of women with benign disease attending clinics in Glasgow.Materials and MethodsPatients at breast clinics at the GRI and WIG were recruited over a 5 week period. Data on physical activity levels (occupational, household, recreational) over the 7 days were recorded using the International Physical Activity Questionaire (IPAQ).ResultsA total of 352 patients were recruited with 141 (40.1%) of the patients completing the questionnaire successfully (table 1).Table 1  Women attending symptomatic clinicBreast cancer survivorsNo. patients 9742Median Age 4263Average physical activity levels (MET-Hr / Week)Total11493.4 Physical19.619.7 Household35.740.0 Occupational40.523.9 Recreational PA appears to be the major influence on breast cancer survival (1) and the reported MET-hr/week for each cohort are shown in table 2.Table 2Recreational Physical activity levels (MET-Hr / Week)Women attending symptomatic clinicBreast cancer survivors<533 (34%)21 (50%)5 - 1014 (14%)5 (12%)10 - 1918 (19%)8 (19%)>1932 (33%)8 (19%) DiscussionScottish guidelines (2) suggest 30min of moderate exercise most days a week is beneficial (>10MET-hr/week) but over 60% of our patients were not achieving this. A recreational PA level of >5MET/hr/week has been demonstrated to confer a benefit on breast survival (1). However 50% of our breast cancer survivors are not meeting this relatively modest target (equivalent to 1hr15min moderate activity/week). With the planned implementation of an exercise programme for all newly diagnosed breast cancer patients in Glasgow, we hope to improve levels of recreational physical activity and will re-audit following its introduction.References1. Friedenreich CM, Gregory J, Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009 Apr 15;124(8):1954-622. Let's Make Scotland more active: A strategy for physical activity. Physical activity task force http://www.scotland.gov.uk/Publications/2003/02/16324/17895 [Online March 2009]

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2066.

Late postoperative opacification of hydrogel intraocular lenses: analysis of 13 explanted lenses

PURPOSE

We report the clinical, morphological, and ultrastructural findings of 13 consecutively explanted opacified Hydroview(R) (hydrogel) intraocular lenses (IOLs). Our purpose was to provide a comprehensive account on the possible factors involved in late postoperative opacification of these IOLs.

PATIENTS AND METHODS

Thirteen consecutive opacified hydrogel IOLs (Hydroview H 60 M, Bausch & Lomb) were explanted due to the significant visual impairment they caused. The IOLs underwent macroscopical examination, transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and electrophoresis for protein detection. Three unused control Hydroview IOLs served for comparison.

RESULTS

Macroscopical examination showed a diffuse or localized grey-whitish opacification within the IOL optic. TEM confirmed the presence of lesions inside the optic in all the explanted IOLs and revealed 3 patterns of deep deposits: a) diffuse, thick, granular, electron-dense ones; b) small, thin, lattice-like ones, with prominent electron-lucent areas; and c) elongated electron-dense formations surrounded by electron-lucent halos. SEM showed surface deposits on four IOLs. EDS revealed oxygen and carbon in all IOLs and documented calcium, phosphorus, silicon and/or iron in the deposits. Two of the patients with iron in their IOLs had eye surgery prior to their phacoemulsification. Iron correlated well with the second TEM pattern of deep lesions, whereas calcium with the third TEM pattern. No protein bands were detected on electrophoresis. Control lenses did not show any ultrastructural or chemical abnormality.

CONCLUSIONS

The present study supports the presence of chemical alterations inside the polymer of the optic in late postoperative opacification of Hydroview IOLs. This opacification does not follow a unique pathway but may present under different ultrastructular patterns depending on the responsible factors. Mechanical stress during surgery may initiate a sequence of events where ions such as calcium, phosphorus, silicon, and/or iron, participate in a biochemical cascade that leads to gradual alteration of the polymer network. Intraocular inflammation due to previous operation may be a factor inducing opacification through increase of iron-binding capacity in the aqueous humour. Calcification accounts only partially for the opacification noted in this type of IOL.

Neurocutaneous melanosis: report of three cases and up-to-date review

Neurocutaneous melanosis is a rare noninherited embryonic neuroectodermal dysplasia, which is observed sporadically and never affects the entire integument. The hallmark of neurocutaneous melanosis in the neonatal period is the presence of a large bilateral hairy dark nevus with satellite nevi over the trunk and neck. The diagnosis should be considered in neonates with large pigmented nevi and in those with more than 3 hairy dark nevi regardless of their size. Neonates with neurocutaneous melanosis are at risk of developing neurological problems. The most common neurological complications are hydrocephalus, seizures, cranial nerve dysfunction, and signs of spinal cord and root involvement. The authors report 3 cases of histologically confirmed neurocutaneous melanosis and describe the course of neurological symptoms and clinical findings including cognitive tests and neuroimaging. The case reports are complemented by an up-to date review on this clinical entity.

Which factors determine febrile seizure recurrence? A prospective study

PURPOSE

Many factors have been studied as potential predictors of recurrent febrile seizures (FS), however the available data in literature are inconsistent. The aim of the present paper is to determine which factors are responsible for the first and for multiple recurrences of FS, in a large sample of children with a long-term follow up.

METHODS

Two hundred and sixty children were followed after their first FS. The inclusion criteria were: a history of a first febrile seizure; no personal history of afebrile seizures; no previous anticonvulsant medication and age between three months and six years. The median time of follow up was 4.3 years. We had a contact with the families of the children every 4-6 months and also in every recurrence.

RESULTS

Very significant prognostic markers for the first FS recurrence were low age at onset, recurrence within the same illness, frequent febrile episodes and maternal preponderance. Powerful prognostic factors that may predispose children who already have one recurrence to a second or more are low age at onset and especially positive family history of FS. Additionally, low temperature prior to the initial seizure is a powerful predictor for three or more recurrences.

CONCLUSIONS

Prognostic factors for FS recurrence are a useful tool for the clinician. It is obvious that as many powerful predictors a child has, the greater will be the risk for FS recurrence.

Infrared and Raman Vibrational Spectroscopies Reveal the Palette of Frescos Found in the Medieval Monastery of Karaach Teke

Vibrational spectroscopy is applied on samples obtained from the excavation area of the medieval Monastery (10th century) of Karaach-Teke in Bulgaria. The results of the corresponding study, reveal the type of materials used for the creation of the wall-paintings and give evidence of Byzantine influence, a fact that further supports the well known impact of Byzantium on the technology and thematic-aesthetic features of iconography in Bulgaria during this era. In addition, the complementarity of FTIR and micro-Raman spectroscopies in the identification of pigments is indicated.

[Congenital hemiplegia. A disease with manifold problems]

Congenital hemiplegia, defined as unilateral motor disability, is the hemiplegic type of cerebral palsy. The prevalence of congenital hemiplegia is estimated to be about 0.41-0.79/1000 live births. We examined 223 children (122 boys and 101 girls) suffering from congenital hemiplegia at the age of 3 months to 12 years. Mild hemiplegia was found in 31%, a moderate form in 48%, and a severe form in 21%. The upper limb was affected in more than half of the patients, only the lower extremity in one third, and both upper and lower limbs in 20%. Electroencephalographic abnormalities were found in 75.8% of the patients. The most frequent type of epilepsy was complex partial seizures (33%). Severity of the motor handicap, grade of EEG abnormalities, and the prevalence of epilepsy showed a significant correlation. The magnitude of the lesions in neuroimaging directly correlated with these three clinical variables, particularly in children with cortical and subcortical defects (84.2%). Strabismus was the most common visual impairment (17%), while hearing impairment was found in 8% of the patients. Of them, 38.3% showed no cognitive deficits, while those with severe congenital hemiplegia were found to have a lower intelligence quotient.

Morphological features and apoptosis in the left internal thoracic artery grafts before implantation

AIM

A small number of left internal thoracic artery (LITA) grafts are occluded at 3 years after the operation or show more than 50% stenosis of the lumen. The purpose of this study is to examine factors related to the morphology of the wall and to the function of the cell population of LITA grafts before implantation, in order to evaluate their quality and the viability, in a follow-up examination.

METHODS

Fifteen LITA grafts were examined with light microscopy, for their morphology, endothelial cell coverage, apoptosis and cell proliferation, scanning electron microscopy and transmission electron microscopy.

RESULTS

Increase of the thickness of the intima (14.21+/-1.28 mm), mean thickness of media 160.37+/-11.97 mm, detachment of intima from media, presence of foam cells in the media, low endothelial coverage (40.638+/-16.864), increase of apoptosis in intima (46.38+/-13.46), sub-intima (29.3+/-8.54), media (34.91+/-6.05) and adventitia (40.21+/-5.36), blood cells penetration of the intima through disruptions between endothelial cells are findings of LITA grafts before implantation. Cell proliferation was not detected in the wall of any graft. Follow-up examination 6 months and 2.5 years after the operation showed normal function of LITA grafts.

CONCLUSIONS

Besides of the wall injury and the initiated atherosclerotic lesions, LITA grafts are well functioning at the time of the follow-up examination. Maybe our findings are related to the later occlusion of the referred in the literature small number of LITA grafts.

[Indications for intermittent diazepam prophylaxis in febrile seizures]

BACKGROUND

In a prospective controlled study we evaluated the efficacy of intermittent diazepam prophylaxis in the recurrence rate of febrile seizures (FS).

PATIENTS

A total of 139 children aged between 6 and 36 months, who had a first FS, were enrolled in the study and were randomly allocated to two groups: group (A) that received diazepam prophylaxis and group (B) without prophylaxis.

METHODS

All children were followed up for at least 3 years after their first FS. The prophylaxis group (n = 68) received rectal diazepam the first two days of a febrile illness, whenever the temperature was > 38 degrees C (0.33 mg/kg every 8 h on the first day, and 0.33 mg/kg every 12 h on the second day of fever, max. dosage 7.5 mg). The no-prophylaxis group (n = 71) did not receive any prophylaxis at all. Each group was stratified to low, intermediate and high risk subgroups according to the following clinical data: age at the first febrile seizure </= 15 months, positive family history of febrile seizure or epilepsy in first degree relatives, complex first febrile seizure and frequent febrile illness.

RESULTS

The 3-year recurrence rates in the no-prophylaxis group were 83 % in high- risk, 55 % in intermediate-risk and 46 % in low-risk patients. In the prophylaxis group we established a reduction of febrile seizure recurrence at 38 %, 35 % and 33 % in the three risk subgroups respectively.

CONCLUSION

The intermittent prophylaxis with rectal diazepam during febrile episodes lead to a reduction of febrile seizure recurrence, especially in high-risk patients. The results of our study set the indication for the use of intermittent diazepam prophylaxis in this subgroup.