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Background Xanthomas are commonly found in the soft tissues of hyperlipidemic patients. Rarely, they may involve the skeletal system, with various radiographic appearances, mimicking bone malignancies. Case presentation: A 55-year-old woman presented with back pain and bilateral lower limb weakness for several months. After serial imaging studies, multifocal osteolytic lesions were identified in the pelvis and spine, with the largest measuring 94 mm in diameter. An abnormal lipid profile and typical cutaneous presentation aided in the final pathological diagnosis of bone xanthoma. Conclusions Xanthoma of the bone may be confused with aggressive bone lesions radiologically. Clinical, laboratory, and physical findings, in addition to pathological features, are required to make an accurate diagnosis.

Recognizing why an infant cries is challenging as babies cannot communicate verbally with others to express their wishes or needs. This leads to difficulties for parents in identifying the needs and the health of their infants. This study used deep learning (DL) algorithms such as the convolutional neural network (CNN) and long short-term memory (LSTM) to recognize infants’ necessities such as hunger/thirst, need for a diaper change, emotional needs (e.g., need for touch/holding), and pain caused by medical treatment (e.g., injection). The classical artificial neural network (ANN) was also used for comparison. The inputs of ANN, CNN, and LSTM were the features extracted from 1607 10 s audio recordings of infants using mel-frequency cepstral coefficients (MFCC). Results showed that CNN and LSTM both provided decent performance, around 95% in accuracy, precision, and recall, in differentiating healthy and sick infants. For recognizing infants’ specific needs, CNN reached up to 60% accuracy, outperforming LSTM and ANN in almost all measures. These results could be applied as indicators for future applications to help parents understand their infant’s condition and needs.

Individuals with Rett syndrome (RTT) commonly demonstrate Parkinsonian features and dystonia at teen age; however, the pathological reason remains unclear. Abnormal iron accumulation in deep gray matter were reported in some Parkinsonian-related disorders. In this study, we investigated the iron accumulation in deep gray matter of RTT and its correlation with dystonia severity. We recruited 18 RTT-diagnosed participants with MECP2 mutations, from age 4 to 28, and 28 age-gender matched controls and investigated the iron accumulation by susceptibility weighted image (SWI) in substantia nigra (SN), globus pallidus (GP), putamen, caudate nucleus, and thalamus. Pearson’s correlation was applied for the relation between iron accumulation and dystonia severity. In RTT, the severity of dystonia scales showed significant increase in subjects older than 10 years, and the contrast ratios of SWI also showed significant differences in putamen, caudate nucleus and the average values of SN, putamen, and GP between RTT and controls. The age demonstrated moderate to high negative correlations with contrast ratios. The dystonia scales were correlated with the average contrast ratio of SN, putamen and GP, indicating iron accumulation in dopaminergic system and related grey matter. As the first SWI study for RTT individuals, we found increased iron deposition in dopaminergic system and related grey matter, which may partly explain the gradually increased dystonia.

Epilepsy is a chronic neurological disorder that presents as recurrent, unprovoked seizures. Pharmacotherapy is the main treatment for epilepsy, but at least 30% of patients with epilepsy have pharmacoresistant epilepsy. Therefore, non-pharmacological treatments are still required. In addition to electrophysiological aberrations contributing to epileptogenesis and pathophysiology in epilepsy, neuroinflammation, oxidative stress, and metabolic derangement have been investigated as drug targets in the treatment of epilepsy. Vitamins have antioxidant, anti-inflammatory, and immunomodulatory effects, which can be beneficial for the treatment of epilepsy. Herein, we comprehensively review the role of vitamins in epilepsy. Certain epilepsies are vitamin-dependent or vitamin-responsive. Most studies on vitamins in epilepsy are of low evidence level or limited to animal studies. Nevertheless, vitamin supplementation should be considered in epilepsy therapy. Additionally, certain anti-seizure medications may alter the serum levels of certain vitamins. Monitoring the serum levels of vitamins and supplementing vitamins when needed are suggested during the follow-up of patients with epilepsy.

Objectives: This study was to analyze the relationships between lymphocyte-to-monocyte ratio (LMR) alone or combined with serum CA125 (COLC) and advanced stage of ovarian cancer (OC). Methods: The receiver-operating characteristic (ROC) curves of LMR, CA125, and COLC staging OC were constructed by a retrospective study. Furthermore, a binary logistic regression model was used to assay the independent risk factors for OC staging. Results: Two hundred and twenty-five patients with OC were identified in this cohort. Eighty-five OC patients were diagnosed at an early stage, and 140 OC patients were diagnosed at an advanced stage. The median of LMR in the early stage was higher than that in advanced stage (4.4 vs. 2.8), and the median of serum CA125 was lower than that in advanced stage (80 U/mL vs. 251.3 U/mL). Multivariate logistic regression LMR≤3.7 (OR=0.299, 95% CI: 0.093-0.962, P=0.043) and CA125>95.7 U/mL (OR=4.317, 95% CI: 1.436-12.977, P=0.009) were risk factors for stage of advanced OC whether presence or absence of malignant ascites. Furthermore, the area under the curve of COLC was higher than that of LMR (0.782 vs. 0.732) or serum CA125 (0.782 vs. 0.708) in staging OC. The specificity of COLC was higher than that of LMR (87.1% vs. 70.6%) or serum CA125 (87.1% vs. 61.2%) in staging OC. Conclusion: LMR alone or in combination with serum CA125 might be associated with OC staging. Besides, as a predictive factor, COLC may have a high specificity in staging OC.

Drought and ferulic acid (FA) inhibit plant growth. Here, we investigated whether Bacillus methylotrophicus CSY-F1 alleviates drought stress in cucumber (Cucumis sativus) plants grown in high-FA soil. Cucumber seedlings grown in high-FA soil were inoculated with CSY-F1 for 20 d, and then subjected to drought for 3 d. In rhizospheric soil of drought-stressed seedlings, CSY-F1 decreased FA levels and increased soil water contents, polysaccharide levels, and catalase, phosphatase, urease, and sucrase activities at low or high FA concentrations. In drought-stressed seedlings grown in FA-containing soil, CSY-F1 improved plant growth, and reduced leaf wilting; CSY-F1 decreased superoxide radical, hydrogen peroxide, and malonaldehyde levels. CSY-F1 increased superoxide dismutase (SOD), catalase, guaiacol peroxidase, ascorbate peroxidase, dehydroascorbate reductase, monodehydroascorbate reductase, and glutathione reductase activities in these seedlings. In addition, CSY-F1 elevated plant relative water content and osmotic potential, and enhanced ascorbate and glutathione contents, proline and soluble sugar levels, and catalase, copper/zinc SOD, manganese SOD, CsPYL1, and CsPYL2 transcript levels. CSY-F1 increases the polysaccharide levels and enzyme activities in soil, and enhances antioxidant enzyme activities, proline and soluble sugar levels, and transcript levels of CsPYL1 and CsPYL2 in leaves, thus alleviating drought stress in cucumber under FA conditions.

This study investigated how phonological saliency, deviance size, and maturation affect mismatch responses (MMRs) in early infancy. MMRs to Mandarin vowels and initial consonants were measured using a multi-deviant oddball paradigm in adults, newborns, and 6-month-olds. The vowel condition consisted of Mandarin syllable da as the standard, du as the large deviant and di as small deviant. As for initial consonant condition, we took syllable ba as standard, ga as large deviant, and ba as small deviant. While adults showed typical mismatch negativities (MMNs), newborns demonstrated broad positive MMRs (P-MMRs) to both initial consonants and vowels. For 6-month-olds, deviance size affected the polarity of MMRs to vowels. The large deviant du/da contrast elicited an adult-like MMN, while the small deviant di/da contrast elicited a P-MMR. Initial consonant changes elicited only P-MMRs, regardless of deviance size. In summary, MMRs to vowels switched from P-MMR at birth to MMN at 6 months. However, the polarity transition was not found for MMRs to initial consonants. The developmental trajectories of MMRs to vowels and initial consonants further support the phonological saliency hypothesis.

Purpose Epileptic encephalopathies (EEs) are the severe form of childhood epilepsy and phenotypically heterogeneous disorders with different underlying genetic defects. EEs are always accompanied with developmental delay/mental retardation and behavior problems. Finding the genetic basis of epileptic encephalopathies with developmental delay/mental retardation can be valuable not only for diagnosis but also for guiding treatment and providing disease prognosis. Methods and Results A customized panel of 90 genes related to epileptic encephalopathies was utilized to screen for potential genetic variants via targeted next generation sequencing (NGS). A total of 78 children with epilepsy and developmental delay/mental retardation were analyzed with an average read depth of 265.3 ± 68.3X. Mutations were found in 23 (9 boys and 14 girls) probands, and the overall mutation identification rate was 29.5% (25.0% for males and 33.3% for females). Fifteen (65.2%) mutations involve ion channels, including SCN1A, KCNT1, SCN2A, SCN8, KCNB1 and KCNQ2. The other (34.8%) mutations involve CDKL5, ALG13, GFAP, SNAP25, STXBP1 and SYNGAP1. Sixteen (69.6%) of the identified mutations were confirmed to be de novo and one (4.3%) was found to be paternal mosaicism. Channelopathies were found to be the major cause of both early onset (≤6 months) and later onset of unclassified EE as well as febrile seizure cases. On the contrary, patients with infantile spasms or West syndrome were mainly caused by mutations in non-ion channel proteins, whereas patients of epilepsy with developmental delays and/or mental retardation were caused by mutations in both channel and non-channel genes. Conclusion NGS is a valuable and reliable diagnostic tool to detect the gene mutation in epileptic children with developmental delay/mental retardation. This cost-effective method shortens the course from seizure onset to genetic diagnosis. By understanding the gene mutations and genotypephenotype correlation better, clinical practitioners could provide the optimal anticonvulsant and treatment.

Epileptic encephalopathies are highly heterogeneous and phenotypical disorders with different underlying genetic defects. Mutations in the SCN2A gene cause different epilepsy syndromes, including epilepsy of infancy with migrating focal seizures, Ohtahara syndrome, and West syndrome. We utilized a targeted next generation sequencing (NGS) approach on a girl with early-onset seizures and Rett-like features, including autistic behavior, limited hand function with chorea, and profound intellectual disability, to identify novel missense mutation (c.1270G>A; p.V424M) in the SCN2A gene, which encodes the αII-subunit of the voltage-gated Na+ channel (Nav1.2). The identified SCN2A mutation responsible for the development of the disease is confirmed to be de novo for the proband. Our findings broaden the clinical spectrum of SCN2A mutations, which resembles clinical phenotypes of SCN1A mutations by manifesting as fever sensitive seizures, and highlights that SCN2A mutations are an important cause of early-onset epileptic encephalopathies with movement disorders. In addition, the use of levetiracetam to treat SCN2A epileptic encephalopathy, when Na+ channel-blocking anticonvulsants are ineffective, is also recommended.

Background Microglia is responsible for neuroinflammation, which may aggravate brain injury in diseases like epilepsy. Mammalian target of rapamycin (mTOR) kinase is related to microglial activation with subsequent neuroinflammation. In the present study, rapamycin and everolimus, both as mTOR inhibitors, were investigated in models of kainic acid (KA)-induced seizure and lipopolysaccharide (LPS)-induced neuroinflammation. Methods In vitro, we treated BV2 cells with KA and LPS. In vivo, KA was used to induce seizures on postnatal day 25 in B6.129P-Cx3cr1tm1Litt/J mice. Rapamycin and everolimus were evaluated in their modulation of neuroinflammation detected by real-time PCR, Western blotting, and immunostaining. Results Everolimus was significantly more effective than rapamycin in inhibiting iNOS and mTOR signaling pathways in both models of neuroinflammation (LPS) and seizure (KA). Everolimus significantly attenuated the mRNA expression of iNOS by LPS and nitrite production by KA and LPS than that by rapamycin. Only everolimus attenuated the mRNA expression of mTOR by LPS and KA treatment. In the present study, we also found that the modulation of mTOR under LPS and KA treatment was not mediated by Akt pathway but was primarily mediated by ERK phosphorylation, which was more significantly attenuated by everolimus. This inhibition of ERK phosphorylation and microglial activation in the hippocampus by everolimus was also confirmed in KA-treated mice. Conclusions Rapamycin and everolimus can block the activation of inflammation-related molecules and attenuated the microglial activation. Everolimus had better efficacy than rapamycin, possibly mediated by the inhibition of ERK phosphorylation. Taken together, mTOR inhibitor can be a potential pharmacological target of anti-inflammation and seizure treatment.

Background Increased prevalence of attention-deficit/hyperactivity disorder (ADHD) in children with allergic rhinitis (AR) has been reported. Our previous study showed that children with untreated AR had higher ADHD scores than did the controls. Objective This prospective follow-up study aimed to investigate whether elevated ADHD scores in children with AR could be decreased by AR treatment. Methods Sixty-eight children with AR (age range, 6-14 years) and who were drug naive were enrolled and evaluated by AR symptom score, ADHD symptom scores, and computerized continuous performance test, before and after AR therapy, which included nonpharmacologic intervention, oral antihistamines, and topical steroids. Thirty-one age-matched controls and 13 children with pure ADHD were also enrolled for comparison. The relationship between the AR and ADHD score change was analyzed by a partial correlation test, and univariate and multivariate linear regression models were applied to investigate possible predictors for the improvement of ADHD scores by AR treatment. Results AR symptom scores in children with AR decreased significantly after treatment (p < 0.001), and their ADHD scores also decreased significantly (p < 0.001). An improved AR symptom score was positively correlated with improved detectability (rp = 0.617, p = 0.001) and commission error (rp = 0.511, p = 0.011). Significant predictors for the improvement of ADHD scores included age, AR drugs, AR subtypes, and multiple atopic diseases (ps < 0.05). Conclusion Higher ADHD scores in children with AR compared with healthy controls decreased significantly with AR treatment. For children with AR and borderline ADHD symptoms, who do not meet full ADHD diagnostic criteria, we recommend initially treating their AR and monitoring improvement of ADHD symptoms.

Inattention (IA) has been a major problem in children with attention deficit/hyperactivity disorder (ADHD), accounting for their behavioral and cognitive dysfunctions. However, there are at least three processing steps underlying attentional control for auditory change detection, namely pre-attentive change detection, involuntary attention orienting, and attention reorienting for further evaluation. This study aimed to examine whether children with ADHD would show deficits in any of these subcomponents by using mismatch negativity (MMN), P3a, and late discriminative negativity (LDN) as event-related potential (ERP) markers, under the passive auditory oddball paradigm. Two types of stimuli—pure tones and Mandarin lexical tones—were used to examine if the deficits were general across linguistic and non-linguistic domains. Participants included 15 native Mandarin-speaking children with ADHD and 16 age-matched controls (across groups, age ranged between 6 and 15 years). Two passive auditory oddball paradigms (lexical tones and pure tones) were applied. The pure tone oddball paradigm included a standard stimulus (1000 Hz, 80%) and two deviant stimuli (1015 and 1090 Hz, 10% each). The Mandarin lexical tone oddball paradigm’s standard stimulus was /yi3/ (80%) and two deviant stimuli were /yi1/ and /yi2/ (10% each). The results showed no MMN difference, but did show attenuated P3a and enhanced LDN to the large deviants for both pure and lexical tone changes in the ADHD group. Correlation analysis showed that children with higher ADHD tendency, as indexed by parents’ and teachers’ ratings on ADHD symptoms, showed less positive P3a amplitudes when responding to large lexical tone deviants. Thus, children with ADHD showed impaired auditory change detection for both pure tones and lexical tones in both involuntary attention switching, and attention reorienting for further evaluation. These ERP markers may therefore be used for the evaluation of anti-ADHD drugs that aim to alleviate these dysfunctions.