Childhood-onset systemic lupus erythematosus (cSLE) is a chronic inflammatory multisystem autoimmune disease that requires multiple differential diagnoses. Munchausen by proxy syndrome (MBPS) is a ...form of child abuse, where a caregiver intentionally creates a medical history and induces or fabricates signs or disease in a patient. To our knowledge, there is no case report of MBPS mimicking cSLE diagnosis. We reported herein a 9-year-old male patient, with a history of multiple hospitalizations due to seizures with altered levels of consciousness. The mother reported malar rash, photosensitivity, alopecia, arthralgia, arterial hypertension, macroscopic hematuria, seizure and positive antinuclear antibodies. In the other service, he was treated with intravenous methylprednisolone, prednisone and mycophenolate mofetil. At 8 years and 8 months, he was admitted to our tertiary center with history of fever and macroscopic hematuria. Laboratory examinations were normal, including negative for antinuclear antibodies, anti-double stranded DNA, anticardiolipin, anti-Ro/SSA, anti-La/SSB, anti-RNP and anti-Sm antibodies. Multiple urine cultures revealed the presence of Enterococcus faecium, Acinetobacter sp., Stenotrophomonas maltophilia and Serratia marcescens, without any association with pyuria. At 8 years and 9 months, he was readmitted at emergency room with history of severe fever, headache, vomiting, photophobia, phonophobia and dizziness. The physical examination showed agitation, confusion, ataxic gait, slurred speech, horizontal nystagmus, painful facial expressions, tachycardia and weight loss. Brain magnetic resonance angiography and cerebrospinal fluid analysis were normal. During hospitalization, he had an acute episode of epistaxis and otalgia with excoriation in the auditory canal. At that moment, the suspicion of MBPS mimicking cSLE was raised and phenytoin intoxication was confirmed (peak phenytoin concentration was 45.4 mcg/mL, therapeutic range 10–20 mcg/mL). The mother and the patient were immediately separated, and she was replaced by another legal guardian. One week later, the neurological and other signs and symptoms were completely resolved. The child was placed under paternal custody with a court order and moved to another state. After that, the mother reported phenytoin use for her child and was referred to psychiatric follow-up. In conclusion, the first case of MBPS mimicking cSLE, resulting in multiple unnecessary examinations and treatments with delayed diagnosis was reported.
Structural, magnetic, and spectroscopic data on a Mn3+ spin-crossover complex with Schiff base ligand 4-OMe-Sal2323, isolated in crystal lattices with five different counteranions, are reported. ...Complexes of Mn(4-OMe-Sal2323)X where X = ClO4 – (1), BF4 – (2), NO3 – (3), Br– (4), and I– (5) crystallize isotypically in the chiral orthorhombic space group P21212 with a range of spin state preferences for the Mn(4-OMe-Sal2323)+ complex cation over the temperature range 5–300 K. Complexes 1 and 2 are high-spin, complex 4 undergoes a gradual and complete thermal spin crossover, while complexes 3 and 5 show stepped crossovers with different ratios of spin triplet and quintet forms in the intermediate temperature range. High-field electron paramagnetic resonance was used to measure the zero-field splitting parameters associated with the spin triplet and quintet states at temperatures below 10 K for complexes 4 and 2 with respective values: D S =1 = +23.38(1) cm–1, E S =1 = +2.79(1) cm–1, and D S =2 = +6.9(3) cm–1, with a distribution of E parameters for the S = 2 state. Solid-state circular dichroism (CD) spectra on high-spin complex 1 at room temperature reveal a 2:1 ratio of enantiomers in the chiral conglomerate, and solution CD measurements on the same sample in methanol show that it is stable toward racemization. Solid-state UV–vis absorption spectra on high-spin complex 1 and mixed S = 1/S = 2 sample 5 reveal different intensities at higher energies, in line with the different electronic composition. The statistical prevalence of homochiral crystallization of Mn(4-OMe-Sal2323)+ in five lattices with different achiral counterions suggests that the chirality may be directed by the 4-OMe-Sal2323 ligand.
Spin state preferences for a cationic Mn3+ chelate complex in four different crystal lattices are investigated by crystallography and SQUID magnetometry. The MnL1+ complex cation was prepared by ...complexation of Mn3+ to the Schiff base chelate formed from condensation of 4-methoxysalicylaldehyde and 1,2-bis(3-aminopropylamino)ethane. The cation was crystallized separately with three polyatomic counterions and in one case was found to cocrystallize with a percentage of unreacted 4-methoxysalicylaldehyde starting material. The spin state preferences of the four resultant complexes MnL1CF3SO3·xH2O, (1), MnL1PF6·xH2O, (2), MnL1PF6·xsal·xH2O, (2b), and MnL1BPh4, (3), were dependent on their ability to form strong intermolecular interactions. Complexes (1) and (2), which formed hydrogen bonds between MnL1+, lattice water and in one case also with counterion, showed an incomplete thermal spin crossover over the temperature range 5–300 K. In contrast, complex (3) with the BPh4−, counterion and no lattice water, was locked into the high spin state over the same temperature range, as was complex (2b), where inclusion of the 4-methoxysalicylaldehyde guest blocked the H-bonding interaction.
In this paper, the throughput of an adaptive multiuser SISO-OFDMA/FDD system with channel quality information (CQI) signalled digitized over a feedback channel to the transmitter is investigated, ...where the instantaneous signal-to-noise ratio (SNR) of the different subcarriers is used as CQI to exploit multi-user diversity using adaptive subcarrier allocation. The CQI available at the transmitter is assumed to be imperfect due to estimation errors and quantization at the receiver side, time delay and feedback errors. In this paper, a closed form expression of the average throughput of an adaptive multi-user OFDMA system using imperfect CQI and uncoded M-QAM modulation is derived. Furthermore, a closed form expression of the average throughput of an OFDMA system exploiting frequency diversity, which does not require CQI at the transmitter, is presented. Both throughput performances are compared in order to identify the optimal transmission strategy depending on the grade of CQI imperfectness.
Due to increasing life expectancy, low-cost interventions to counteract age-related memory impairment have gained popularity. Physical activity has been shown to positively affect memory and ...hippocampal plasticity in rodents and humans. These effects have been proposed to be mediated by the release of neurotrophic factors. However, studies examining the effects of a single cardiovascular exercise session on human memory have yielded conflicting results. Moreover, it remains unclear whether exercise-induced memory enhancements are related to changes in peripheral neurotrophic factor concentrations. The present study tested whether one bout of cardiovascular exercise during an early phase of memory consolidation, compared to one bout of stretching and toning, positively affected memory. Furthermore, it was analyzed whether exercise-induced changes in the brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) were related to memory enhancement after a single bout of physical exercise. Fifty healthy participants (20–40 years) were randomly assigned to either a cycling group (BIKE) or a stretching and toning group (STRETCH). Participants performed an implicit vocabulary learning task which was immediately followed by physical exercise. Memory for the learned vocabulary was tested 1–2 weeks later. To measure exercise-induced changes in serum neurotrophic factor levels, blood samples were collected at rest (baseline) and immediately after the exercise session. Results did not show a significant difference in memory between the BIKE group and the STRETCH group. However, in the BIKE group, a larger increase in BDNF and VEGF levels was observed than in the STRETCH group. Moreover, the increase in BDNF and memory performance tended to be positively related in the BIKE group. We speculate that the correlation between exercise-increased BDNF levels and memory in the cycling group may indicate an involvement of BDNF in mediating memory processes after acute cardiovascular exercise.
Age is a well‐known risk factor in trauma patients. The aim of the present study was to define the age‐dependent cut‐off for increasing mortality in multiple injured patients. Pre‐existing medical ...conditions in older age and impaired age‐dependent physiologic reserve contributing to a worse outcome in multiple injured elderly patients are discussed as reasons for increased mortality. A retrospective clinical study of a statewide trauma data set from 1993 through 2000 included 5375 patients with an Injury Severity Score (ISS) ≥ 16 who were stratified by age. The ISS and Abbreviated Injury Score (AIS) quantified the injury severity. Outcome measures were mortality, shock, multiple organ failure, and severe head injury. Mortality in this series increased beginning at age 56 years, and that increase was independent of the ISS. The mortality rate increased from 7.3% (patients 46–55 years of age) to 13.0% (patients ages 56–65 years) in patients with ISS 16–24; from 23.8% to 32.1% in those with ISS 25–50; and from 62.2% to 82.1% in those with ISS 51–75 (P ≤ 0.05). Severe traumatic brain injury (sTBI) was the most frequent cause of death, with a significant peak in patients older than 75 years. The incidence of lethal multiple organ failure increased significantly beginning at age 56 years (P ≤ 0.05), but it showed no further increase in patients aged 76 years or older. In contrast, the incidence of lethal shock showed a significant increase from age 76 years (P ≤ 0.05), but not at age 56 years. However, from age 56 years, mortality increased significantly in patients who sustained multiple trauma—an increase that was independent of trauma severity.
The radial nerve is at risk of injury during surgical approaches to the humeral shaft. Previous authors have described an anterolateral approach to the humerus limited by the radial nerve, requiring ...that distal dissection be carried anterior into a neurovascularly crowded interval. A novel extensile approach is described using a neuromuscular bridge to protect the radial nerve, thus enabling safe distal extension of the anterolateral humerus approach. The authors present a case series of 7 patients who required an extensile humeral exposure. To date, there have been no complications, including loss of reduction, malunion, nonunion, or nerve palsy.
Balance training interventions over several months have been shown to improve spatial cognitive functions and to induce structural plasticity in brain regions associated with visual-vestibular ...self-motion processing. In the present cross-sectional study, we tested whether long-term balance practice is associated with better spatial cognition. To this end, spatial perspective-taking abilities were compared between balance experts (n = 40) practicing sports such as gymnastics, acrobatics or slacklining for at least four hours a week for the last two years, endurance athletes (n = 38) and sedentary healthy individuals (n = 58). The balance group showed better performance in a dynamic balance task compared to both the endurance group and the sedentary group. Furthermore, the balance group outperformed the sedentary group in a spatial perspective-taking task. A regression analysis across all participants revealed a positive association between individual balance performance and spatial perspective-taking abilities. Groups did not differ in executive functions, and individual balance performance did not correlate with executive functions, suggesting a specific association between balance skills and spatial cognition. The results are in line with theories of embodied cognition, assuming that sensorimotor experience shapes cognitive functions.
Epigallocatechin-3-gallate (EGCG) is a candidate for treatment of Alzheimer's disease (AD) but its inherent instability limits bioavailability and effectiveness. We found that EGCG displayed ...increased stability when formulated as dual-drug loaded PEGylated PLGA nanoparticles (EGCG/AA NPs). Oral administration of EGCG/AA NPs in mice resulted in EGCG accumulation in all major organs, including the brain. Pharmacokinetic comparison of plasma and brain accumulation following oral administration of free or EGCG/AA NPs showed that, whilst in both cases initial EGCG concentrations were similar, long-term (5–25 h) concentrations were ca. 5 fold higher with EGCG/AA NPs. No evidence was found that EGCG/AA NPs utilised a specific pathway across the blood-brain barrier (BBB). However, EGCG, empty NPs and EGCG/AA NPs all induced tight junction disruption and opened the BBB in vitro and ex vivo. Oral treatment of APPswe/PS1dE9 (APP/PS1) mice, a familial model of AD, with EGCG/AA NPs resulted in a marked increase in synapses, as judged by synaptophysin (SYP) expression, and reduction of neuroinflammation as well as amyloid β (Aβ) plaque burden and cortical levels of soluble and insoluble Aβ(1-42) peptide. These morphological changes were accompanied by significantly enhanced spatial learning and memory. Mechanistically, we propose that stabilisation of EGCG in NPs complexes and a destabilized BBB led to higher therapeutic EGCG concentrations in the brain. Thus EGCG/AA NPs have the potential to be developed as a safe and strategy for the treatment of AD.
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