Human immunodeficiency virus-associated dementia complex with positive 14-3-3 protein in cerebrospinal fluid:A case report

BACKGROUND Human immunodeficiency virus(HIV)-associated dementia(HAD)is a subcortical form of dementia characterized by memory deficits and psychomotor slowing.However,HAD often presents with symptoms similar to those of Creutzfeldt-Jakob disease(CJD),particularly in patients with acquired immune deficiency syndrome(AIDS).CASE SUMMARY We report the case of a 54-year-old male who exhibited cognitive dysfunction and secondary behavioral changes following HIV infection and suspected prion exposure.The patient was diagnosed with HIV during hospitalization and his cerebrospinal fluid tested positive for 14-3-3 proteins.His electroencephalogram showed a borderline-abnormal periodic triphasic wave pattern.Contrast-enhanced magnetic resonance imaging revealed moderate encephalatrophy and demyelination.Initially,symptomatic treatment and administration of amantadine were pursued for presumed CJD,but the patient’s condition continued to deteriorate.By contrast,the patient’s condition improved following anti-HIV therapy.This individual is also the only patient with this prognosis to have survived over 4 years.Thus,the diagnosis was revised to HAD.CONCLUSION In the diagnostic process of rapidly progressive dementia,it is crucial to rule out as many potential causes as possible and to consider an autopsy to diminish diagnostic uncertainty.The 14-3-3 protein should not be regarded as the definitive marker for CJD.Comprehensive laboratory screening for infectious diseases is essential to enhance diagnostic precision,especially in AIDS patients with potential CJD.Ultimately,a trial of diagnostic treatment may be considered when additional testing is not feasible.

Double tracheal stents reduce side effects of progression of malignant tracheoesophageal fistula treated with immunotherapy: A case report

BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.

The usefulness and significance of assessing rapidly progressive spermatozoa

It is possible and clinically relevant to distinguish between slow and rapid progressive spermatozoa in basic semen analysis. This is discussed in light of the different purposes of semen analysis for the subfertile couple and the male patient. The two groups of progressive spermatozoa should be distinguished to help ensure that pertinent information available in the semen sample is not neglected.

"Triple-positive" renal limited vasculitis presenting with rapidly progressive glomerulonephritis: A case report

Rationale:Coexistence of anti-glomerular basement membrane(anti-GBM)disease with anti-neutrophil cytoplasmic antibody(ANCA)in a case of glomerulonephritis is often identified as a"double-positive"disease.Interestingly,the majority of"double positive"ANCA is myeloperoxidase(MPO)-ANCA and some of the MPO-ANCA positive cases showed intrarenal arteritis,suggesting an ANCA-associated kidney lesion.Proteinase 3-ANCA positive diseases are also rarely reported.Patients positive for all three antibodies,i.e.,triple-positive patients,are extremely rare.Patient's Concern:A 53 year-old female presented with anasarca and oliguria of 2 months'duration.Diagnosis:Pauci-immune type renal limited crescentic glomerulonephritis positive for MPO-ANCA,proteinase 3-ANCA,and anti-GBM antibody(triple-positive).Interventions:Intravenous high dose cyclophosphamide,oral azathioprine,intravenous methylprednisolone,and plasma exchange as per British Health Professionals in Rheumatology Guidelines.Outcomes:After one-month follow-up,anasarca and proteinuria were lessened,serum creatinine was normalized,titers of MPO-ANCA levels were decreased,and anti-GBM antibody levels were normalized.Lessons:Triple-positive renal limited vasculitis is rare and response to combined immunosuppressive therapy and plasma exchange can contribute to successful remission.

Effect of dietary with Zhibai dihuang pills and gonadotropinreleasing-hormone-analogue on girls with precocious and rapidly progressive puberty

BACKGROUND At present,the clinical mechanisms underlying precocious puberty remain unclear,making effective intervention for children experiencing this condition and rapidly progressive puberty essential.AIM To explore the effects of Zhibai dihuang pills and gonadotropin-releasing hormone analogue(GnRHa)on growth and ovarian function in girls with precocious puberty.METHODS The clinical data of 84 adolescent girls with precocious puberty and rapidly progressive puberty from February 2017 to August 2023 were retrospectively analyzed.Girls were divided into a control group and an observation group,with 42 cases in each group.The control group received diet intervention combined with GnRHa treatment,while the observation group received diet intervention combined with Zhibai dihuang pills+GnRHa treatment.Outcomes such as clinical efficacy,growth indicators,ovarian function,and adverse reactions were compared between the two groups.RESULTS The observation group showed superior clinical efficacy compared to the control group(P<0.05).Prior to the intervention,no significant differences were found in growth or ovarian function between the groups(P>0.05).Post-intervention,the observation group exhibited significantly lower rates in growth,height,and bone age,along with reduced levels of progesterone,testosterone,estradiol,prolactin,luteinizing hormone,and follicle-stimulating hormone compared to the control group(P<0.05).The incidence of adverse reactions was similar across both groups(P>0.05).CONCLUSION Combining Zhibai dihuang pills with GnRHa and dietary intervention effectively improves growth,enhances ovarian function,and minimizes adverse reactions in adolescent girls with precocious and rapidly progressive puberty.

Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1:indicators of rapid curve progression

Background:Scoliosis secondary to neurofibromatosis type 1(NF1)in children aged<10 years is an important etiology of earlyonset scoliosis(EOS).This study was performed to investigate the curve evolution of patients with EOS secondary to NF1 undergoing bracing treatment and to analyze high-risk indicators of rapid curve progression.Methods:Children with EOS due to NF1 who underwent bracing treatment from 2010 to 2017 were retrospectively reviewed.The angle velocity(AV)at each visit was calculated,and patients with rapid curve progression(AV of>10°/year)were identified.The age at modulation and the AV before and after modulation were obtained.Patients with(n=18)and without rapid curve progression(n=10)were statistically compared.Results:Twenty-eight patients with a mean age of 6.5±1.9 years at the initial visit were reviewed.The mean Cobb angle of the main curve was 41.7°±2.4°at the initial visit and increased to 67.1°±8.6°during a mean follow-up of 44.1±8.5 months.The overall AV was 6.6°±2.4°/year for all patients.At the last follow-up,all patients presented curve progression of>5°,and 20(71%)patients had progressed by>20°.Rapid curve progression was observed in 18(64%)patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up(t=2.868,P=0.008 and<0.001,respectively).The mean AV was 4.4°±1.2°/year before modulation and 11.8°±2.7°/year after modulation(t=11.477,P<0.010).Conclusions:Curve progression of>10°/year is associated with younger age at the initial visit,and modulation change indicated the occurrence of the rapid curve progression phase.

ANCA-Associated Vasculitis: Value of Apheresis in Initial Treatment

Introduction: Vasculitis associated with anti-neutrophil cytoplasm antibodies (ANCA) can be grouped with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MAP), and eosinophilic granulomatosis with polyangiitis (EGPA). Diagnosis of these rare pathologies is based on clinical presentation, the positivity of ANCA, and, if possible, histological proof of vasculitis. Our study describes a series of six cases of ANCA-associated vasculitis where due to the severity of symptoms apheresis sessions were started from the beginning of the therapy. Patients and methods: We conducted a retrospective, single-center observational, monocentric study on all patients treated by apheresis for ANCA vasculitis in the period January 01, 2016 to December 01, 2019. Results: We identified six cases of ANCA vasculitis treated by apheresis over a 3-year period. The mean age was 61 ± 19 years;M/F gender ratio was 1:1. Initial renal damage in all patients was rapidly progressive glomerulonephritis. Inflammatory syndrome occurred in all patients with average CRP of 82 mg/L. All patients had positive ANCA at diagnosis. Four patients required renal replacement therapy at the time of diagnosis. The induction regimen consisted of rituximab associated with IV boluses of methylprednisolone. The apheresis techniques used were the same for all patients, i.e. plasmapheresis. Outcomes were favorable for five patients;only one patient became dependent on hemodialysis. No mortality occurred. Conclusion: This study analyzed practices for the management of patients with ANCA vasculitis. No patient was treated with cyclophosphamide as a first approach but rituximab instead. Plasmapheresis was given because of symptoms severity at initial diagnosis.

Creutzfeldt Jacob’s Disease: A Senegalese Observation

Creuzfelt-Jakob Disease is a rare and progressive neurodegenerative disease that results in fatal, transmissible, subacute, spongiform encephalopathy characterized by rapidly progressive dementia and movement disorder. We present a 62-year-old male with no medical history who was admitted to our hospital because of gait and balance disturbance, language impairment and progressive motor deficit of the four limbs. A neurological examination found frontal lobe syndrome signs, myoclonic movements, pyramidal and extra-pyramidal signs. Brain Magnetic Resonance Imaging detected high intensity areas in the basal ganglia. EEG showed generalized triphasic sharp-wave complexes. A Cerebro Spinal Fluid examination found protein 14-3-3. Death occurred six months after onset. This is the first known case of Creuzfelt-Jakob Disease documented in Senegal.

Xinjiang Sees Rapid Progress

White paper emphasizes national unity and stability are the "lifeblood" for Xinjiang’s development The Chinese Government on September 21 published a white paper on development and progress in northwest China’s

Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease:a single-center angiographic study

Background:Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events.This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.Methods:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included.All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures.Patients were grouped into non-smokers,quitters,and smokers according to their smoking status.Clinical outcomes including rapid lesion progression,lesion re-vascularization,and myocardial infarction were recorded at second coronary angiography.Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.Results:A total of 1255 patients and 1670 lesions were included.Smokers were younger and more likely to be male compared with nonsmokers.Increase in percent diameter stenosis was significantly lower(2.7[0.6,7.1]%vs.3.5[0.9,8.9]%)and 3.4[1.1,7.7]%,P=0.020)in quitters than those in smokers and non-smokers.Quitters tended to have a decreased incidence of rapid lesions progression(15.8%[76/482]vs.21.6%[74/342]and 20.6%[89/431],P=0.062),lesion re-vascularization(13.1%[63/482]vs.15.5%[53/432]and 15.5%[67/431],P=0.448),lesion-related myocardial infarction(0.8%[4/482]vs.2.6%[9/342]and 1.4%[6/431],P=0.110)and all-cause myocardial infarction(1.9%[9/482]vs.4.1%[14/342]and 2.3%[10/431],P=0.128)compared with smokers and non-smokers.In multivariable analysis,smoking status was not an independent predictor for rapid lesion progression,lesion re-vascularization,and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers(hazards ratio:3.00,95%confidence interval:1.04-8.62,P=0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions,meanwhile,smokers are associated with increased risk for all-cause myocardial infarction compared with non-smokers.