Child Neurology: Anti-Hu Encephalitis in an Adolescent With a Mediastinal Seminoma

Anti-Hu antibodies are associated with autoimmune syndromes, mainly limbic encephalitis, encephalomyelitis, and painful sensory polyneuropathy (Denny-Brown). We report the case of a 15-year-old boy presenting with epilepsia partialis continua (EPC) found to have a right middle frontal gyrus brain lesion without atrophy or contralateral involvement. After partial resection, neuropathology revealed neuronal loss, reactive gliosis and astrocytosis, and perivascular mononuclear inflammatory infiltrate and features of neuronophagia resembling Rasmussen encephalitis. Suboptimal response to antiseizure drugs and surgery prompted further workup with identification of positive serum anti-Hu antibodies and a mediastinal seminoma. The patient was treated with immunotherapy including steroids, IV immunoglobulin, azathioprine, rituximab, plasmapheresis, and mediastinal lesion resection. However, he continued to experience EPC and psychomotor impairment along with left hemiparesis and dysarthria. Given clinical progression with failure to respond to immunotherapy and antiseizure polytherapy, hemispherotomy was attempted and seizure freedom achieved. A review of the literature found only 16 cases of neurologic presentations associated with anti-Hu antibodies in children, confirming the rarity of EPC in these cases. Thus, this report provides a new observation of germ cell mediastinal tumor associated with anti-Hu antibodies in children, broadening the spectrum of anti-Hu-associated neurologic disorders in children and highlighting the importance of considering antineuronal antibody testing in children presenting with EPC and brain lesions suggestive of Rasmussen encephalitis.

Exploring Regularization Methods for Domain Generalization in Accelerometer-Based Human Activity Recognition

The study of Domain Generalization (DG) has gained considerable momentum in the Machine Learning (ML) field. Human Activity Recognition (HAR) inherently encompasses diverse domains (e.g., users, devices, or datasets), rendering it an ideal testbed for exploring Domain Generalization. Building upon recent work, this paper investigates the application of regularization methods to bridge the generalization gap between traditional models based on handcrafted features and deep neural networks. We apply various regularizers, including sparse training, Mixup, Distributionally Robust Optimization (DRO), and Sharpness-Aware Minimization (SAM), to deep learning models and assess their performance in Out-of-Distribution (OOD) settings across multiple domains using homogenized public datasets. Our results show that Mixup and SAM are the best-performing regularizers. However, they are unable to match the performance of models based on handcrafted features. This suggests that while regularization techniques can improve OOD robustness to some extent, handcrafted features remain superior for domain generalization in HAR tasks.

Essential medicines for childhood cancer in Europe: a pan-European, systematic analysis by SIOPE

BACKGROUND

Shortages and unequal access to anticancer medicines for children and adolescents are a reality in Europe. The aim of the European Society for Paediatric Oncology (SIOPE) Essential Anticancer Medicines Project was to provide a list of anticancer medicines that are considered essential in the treatment of paediatric cancers to help ensure their continuous access to all children and adolescents with cancer across Europe.

METHODS

This pan-European project, done between Jan 20, 2020, and Feb 18, 2022, was designed to be a systematic collection and review of treatment protocols and strategies that are used to treat childhood cancer in Europe. We formed 16 working groups on the basis of paediatric cancer types, and which were based on the existing SIOPE Clinical Trial Groups. Workings groups consisted of representatives from the SIOPE Clinical Trial Groups, Young SIOPE members, and senior paediatric oncology experts. Each group collected existing treatment protocols that are used to treat the respective cancer types in Europe. Medicines from the standard group of each protocol were extracted. For medicines not on the WHO Essential Medicines List for children (EMLc) 2017, working groups did a literature search to determine whether the medicines should be defined as essential, promising, or neither essential nor promising. Each group provided an individual summary, and all medicines that were considered essential by at least one group were combined in a joint list.

FINDINGS

The working groups identified 73 treatment protocols used in Europe and defined 66 medicines as essential. For several newer medicines, such as kinase inhibitors or tisagenlecleucel, the supporting evidence was insufficient to consider them essential, so these medicines were defined as promising. 25 medicines were considered promising by at least one working group. 22 (33%) of the 66 essential and none of the promising medicines were included in the WHO EMLc 2017. The WHO EMLc 2021 included two new medicines (everolimus and vinorelbine) following applications we made as a result of this project.

INTERPRETATION

Medicines that were defined as essential within this project should be available for the treatment of childhood and adolescent cancer continuously and across Europe. This list can be used to support and guide stakeholders and policy makers in negotiations on a national and European level regarding shortages, accessibility, and affordability of these medicines.

FUNDING

None.

Comparing Handcrafted Features and Deep Neural Representations for Domain Generalization in Human Activity Recognition

Human Activity Recognition (HAR) has been studied extensively, yet current approaches are not capable of generalizing across different domains (i.e., subjects, devices, or datasets) with acceptable performance. This lack of generalization hinders the applicability of these models in real-world environments. As deep neural networks are becoming increasingly popular in recent work, there is a need for an explicit comparison between handcrafted and deep representations in Out-of-Distribution (OOD) settings. This paper compares both approaches in multiple domains using homogenized public datasets. First, we compare several metrics to validate three different OOD settings. In our main experiments, we then verify that even though deep learning initially outperforms models with handcrafted features, the situation is reversed as the distance from the training distribution increases. These findings support the hypothesis that handcrafted features may generalize better across specific domains.

Trissomia 21: Uma Perspetiva Multidisciplinar

INTRODUÇÃO: A trissomia 21 (T21) é a cromossomopatia mais frequente, independentemente do género, etnia ou classe social. Os recém-nascidos apresentam alterações fenotípicas e eventualmente malformações congénitas. O objetivo foi criar um artigo de revisão acessível e ajustado à prática clínica do pediatra para seguimento de crianças e jovens com T21, através de uma visão holística dos cuidados de saúde. METODOLOGIA: Pesquisa dos artigos publicados em diferentes áreas, incluindo diretrizes de várias associações pediátricas. Revisão da literatura por especialistas em diferentes especialidades médicas com prática no seguimento de crianças e jovens com T21. CONCLUSÃO: Através de uma avaliação e intervenção holísticas é possível continuar a melhorar os cuidados de saú-de da população pediátrica com T21. Isso reflete-se não só através do aumento da esperança média de vida, mas também na melhoria da qualidade de vida experienciada em todas as idades.

“The Old Lady and the Dead Bird”–A Case of Very-late-onset Schizophrenia-like Psychosis

Introduction

In 1943, Bleuler defined “late-onset schizophrenia” as a form of schizophrenia with onset after the age of 40. Half a century had passed with no consensus on the late psychosis’ terminology, when in 1998 the international late- onset schizophrenia group Consensus proposed a nosology for these disorders: late-onset schizophrenia and very-late-onset schizophrenia-like psychosis.

Objectives

Presentation of a case and diagnostic discussion.

Methods

Interviews with the patient during his hospitalisation.

Results

We present a case of a 73-year-old single woman, with no psychiatric history, who was driven to the emergency department by her relatives when they noticed her bizarre behaviour: she had drowned and strangled her pet bird. At examination she was agitated, had persecutory delusions, thought broadcasting, cenesthetic and auditory hallucinations in the form of a masculine voice, who sang and dialogued with her. Symptoms had evolved during the past six months with no apparent functional impairment. During hospitalisation she was treated with risperidone (up to 5 mg/day) with improvement in a few days. There were no significant abnormalities on cerebral tomography and analytical exams. Neuropsychological evaluation ruled out cognitive deficits. At the time of discharge although the patient kept referring auditory hallucinatory activity, she had an appropriate behaviour, and no evidence of negative symptoms.

Conclusions

The small group of patients who meet schizophrenia's criteria for the first time at a later age present some particular clinical characteristics to be taken into account. This case highlights some of them, drawing attention to this uncommon diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A case of acute and transient psychosis–What to expect?

Introduction

The Tenth Revision of the International Classification of Diseases (ICD-10) introduced the category of Acute and transient psychotic disorders (ATPD), that assimilate clinical concepts such as the French Bouffée Délirante, Kleist and Leonhard's cycloid psychosis, and the scandinavian reactive psychosis.

Methods and aims

The authors present a clinical case of ATPD and a literature review based on PubMed/MEDLINE, using the keywords: “acute and transient psychotic disorder”, “prognosis” and “diagnostic stability”, aiming to discuss the main challenges regarding the diagnosis, treatment and prognosis.

Results

The patient is a male with 37 years old with two previous psychotic episodes (with 2.5 years of interval), both with an acute onset (of 7 and 3 days respectively), and a fast response to antipsychotic treatment, with periods of complete symptom's remission. He maintains treatment with 6 mg of paliperidone. In the literature, we found scarce information on ATPD. Though several variables have been described as having influence on the prognosis (gender, pre-morbid functioning, acute onset and presence of affective symptoms), this topic remains controversial. Another difficult aspect about ATPD seems to be its low diagnostic stability, with diagnosis changing mostly to Schizophrenia, Schizoaffective disorder and Bipolar disorder. Duration of treatment after complete remission of symptoms is another controversial aspect of this disease.

Conclusions

ATPD seems to have low diagnostic stability and poor research investment, and so it represents a challenge for psychiatrists on managing these patients in terms of treatment and follow-up plan. Further studies should be held regarding prognosis and treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ten Years' Experience of Pregnancy Outcomes in Women with Cardiac Valvulopathies: Are Valve Prostheses Worst?

BACKGROUND AND AIM OF THE STUDY

The population of pregnant women with valvular heart disease (VHD), and in particular with valvular heart prostheses (VHPs), represents a unique patient group where data are scarce, and where there is an increased risk for adverse maternal and obstetric events. The study aim was to assess the experience of a tertiary center with regards to cardiac and pregnancy outcomes in women with VHD, comparing VHPs with other VHD pathologies.

METHODS

A retrospective analysis of 84 pregnancies in women with VHD (mean age 27.5 ± 5.5 years) was carried out over a 10-year period. Twenty-three pregnancies with VHPs (group A) and 61 with other VHD pathologies (group B) were identified and their cardiac, obstetric, and neonatal outcomes evaluated.

RESULTS

At the start of pregnancy, group A included more patients with an impaired left ventricular ejection fraction (LVEF) (15.8% versus 3.9%, p = 0.014), with a previous history of cardiac medication (82.6% versus 29.5%, p = 0.000), and with arrhythmic or ischemic events (18.2% versus 4.9%, p = 0.076). A deterioration in NYHA functional class was the most common cardiac complication (8.3%), and in 7.1% of patients it was necessary to initiate some form of cardiac medication. No maternal deaths were recorded. Group A presented significantly more hemorrhagic and thrombotic complications; all of these events were in women receiving low-molecular-weight heparin. There were 95.5% live births, with a medium birth weight of 3068 ± 498 g. In the VHP group there was also a higher incidence of spontaneous abortion (26.1 versus 3.3, p = 0.005), newborns small for gestational age (30.0 versus 0.4, p = 0.07) and mean Apgar score < 7 (16.7 versus 0.0, p = 0.031). Warfarin embryopathy was observed in one case.

CONCLUSION

With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful. However, the presence of a VHP remains a challenging condition that is associated with elevated maternal and fetal morbidity. A worse baseline cardiac status of the mother, as well as anticoagulation issues, were determinants for these findings.

Gene sequence and crystal structure of the aldehyde oxidoreductase from Desulfovibrio desulfuricans ATCC 27774

The aldehyde oxidoreductase (MOD) isolated from the sulfate reducer Desulfovibrio desulfuricans (ATCC 27774) is a member of the xanthine oxidase family of molybdenum-containing enzymes. It has substrate specificity similar to that of the homologous enzyme from Desulfovibrio gigas (MOP) and the primary sequences from both enzymes show 68 % identity. The enzyme was crystallized in space group P6(1)22, with unit cell dimensions of a=b=156.4 A and c=177.1 A, and diffraction data were obtained to beyond 2.8 A. The crystal structure was solved by Patterson search techniques using the coordinates of the D. gigas enzyme. The overall fold of the D. desulfuricans enzyme is very similar to MOP and the few differences are mapped to exposed regions of the molecule. This is reflected in the electrostatic potential surfaces of both homologous enzymes, one exception being the surface potential in a region identifiable as the putative docking site of the physiological electron acceptor. Other essential features of the MOP structure, such as residues of the active-site cavity, are basically conserved in MOD. Two mutations are located in the pocket bearing a chain of catalytically relevant water molecules. As deduced from this work, both these enzymes are very closely related in terms of their sequences as well as 3D structures. The comparison allowed confirmation and establishment of features that are essential for their function; namely, conserved residues in the active-site, catalytically relevant water molecules and recognition of the physiological electron acceptor docking site.