Confusion Research Articles

비자살적 자해 청소년 자녀를 둔 어머니의 경험에 관한 현상학적 연구

The study delves into the experiences of mothers with adolescents engaging in non-suicidal self-injury (NSSI) behaviors. Giorgi’s phenomenological research method was applied through in-depth interviews with eight mothers. The analysis identified seven components and 20 sub-components forming an intrinsic structure, including: “Feeling crisis due to unexpected rebellious behavior of the adaptable child”, “Experiencing mental shock and confusion upon witnessing the child’s self-injury”, “Encountering frustration and despair leading to a decline in quality of life”, “Reflecting on oneself deeply because of the child”, “Discerning the child’s presence amidst pain”, “Enduring anxiety to connect emotionally with the child”, and “Reassuming the role of a supportive mother for the child’s accommodative life”, These components formed overarching themes, emphasizing the profound impact of maternal involvement on adolescents with NSSI tendencies. The study underscores the significance of understanding mothers’ experiences in addressing adolescent NSSI, offering insights into their crucial role and implications for intervention strategies.

Fever-induced acute sleep terrors in children and adolescents following SARS-CoV-2 infection.

This study aims toprovide physicians withinsights into the clinical manifestations and outcomes of children and young adolescents experiencing sleep terrors following SARS-CoV-2 infection. We enrolled patients who developed new onset sleep terrors after SARS-CoV-2infection fromDecember2022to April 2023 in the Xijing hospital, Xi'an, China. We enrolled six patients who experienced sleep terrors following SARS-CoV-2 infection. Out of these patients, five were children and only one was an adolescent, with a mean age of 9 years. Neuroimagingresults were negative for all cases. Sleep terrors occurred during both the active course of COVID-19 illness and the recovery period in all patients. Symptoms included crying or screaming in terror, hyperactivity, inappropriate behavior and periods of mental confusion during sleep. These episodes typicallyoccurred 40 min to 1 h after falling asleep. EEG monitoring confirmed two patients' episodes occurred during non-rapid eye movement (NREM) stage 3 sleep. The duration of sleep terrors ranged from 3mines to30 mines, with each patient experiencing 3-4 to 30-40 instances. Initially, the frequency of episodes was highest at 3-4 times per night, gradually decreasing to once a night, then once a week, until complete disappearance. No medical intervention was required. Clinical follow-up ranged from 6 to 12 months, with spontaneous remission occurring within 1 week to 2 months for different patients. SARS-CoV-2 infectionmay precipitate acute sleep terrors in children and adolescents. The course of these sleep terrors is generally benign, with all patients achieving spontaneous complete remission over time.

Examining Cognitive Disengagement Syndrome in Relation to Social Problem Solving in Young Adults.

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo (SCT), is characterized by symptoms such as excessive daydreaming, mental confusion, and hypoactivity. CDS symptoms are associated with emotional, social, and daily life impairments. The way in which one solves problems in their daily life is associated with experiences of further problems, such that maladaptive problem-solving can lead to further physical and psychological problems. However, there is limited information on how CDS symptoms are associated with problem solving. The current study examined CDS symptoms in relation to different social problem solving approaches. A total of 280 college students (ages 18-23 years; 77.9% female) completed measures of psychopathology symptoms and social problem solving. Above and beyond ADHD and internalizing symptoms, CDS symptoms were independently associated with negative problem orientation and avoidance style domains of maladaptive problem solving. Findings indicate that CDS symptoms are related to specific difficulties with social problem solving. CDS symptoms may lead to difficulties attending to problems or working through relevant steps needed to identify solutions for the problem, which may then lead to avoidance and social withdrawal. Longitudinal research is needed to evaluate maladaptive problem solving as a potential mechanism in the association between CDS, social withdrawal, and internalizing symptoms.

Immediate Prognosis of Hepatic Encephalopathy in a Tertiary Hospital

Background: Hepatic encephalopathy (HE) is a significant neuropsychiatric complication of liver disease, causing substantial global morbidity and mortality. Advances in our understanding of HE pathogenesis have led to the development of new management strategies. Documenting the disease profile, precipitating factors, and prognostic indicators is crucial, given the need to widely apply these new strategies. Objectives: This study aims to assess the immediate prognosis, identify presenting features, and categorize patients based on the Child-Pugh Class at Rajshahi Medical College Hospital. Materials and Methods: This cross-sectional descriptive study conducted in the Department of Medicine at Rajshahi Medical College Hospital from January to December 2010 aimed to assess the immediate prognosis of HE, determine its presenting features, and categorize study subjects based on the Child-Pugh Class. Sixty-six patients with chronic liver disease and HE were included in the study. Comprehensive data were collected through detailed history-taking, physical examinations, and investigations that adhered to the inclusion criteria. Results: The study cohort included 42 male and 24 female patients, with the majority (69.7%) falling within the age group of 30-60 years, with a mean age of 47.29 (±13.5). Most patients presented with grade II HE (40.9%). Hepatitis B, C, or both were positive in 63.6% of cases. Confusion was the most common presenting feature due to encephalopathy (53.0%). A majority of patients (62%) were in Child Class C. Electrolyte imbalance (54.4%), and constipation (34.8%) were the most common precipitating factors. 74.2% of patients survived, while 25.8% succumbed to the condition. Conclusion: Hepatic encephalopathy is a well-recognized complication of chronic liver disease, predominantly presenting with mental confusion. Despite many patients presenting with severe encephalopathy (Child Class C), the immediate survival rate was deemed satisfactory. The study underscores the importance of early hospitalization, identification of precipitating factors, and timely treatment in improving outcomes for this fatal condition.

A Study on the Attitude, Abuse and Addiction to Tramadol among Sudanese University Students in Khartoum State, Sudan

Aim: This research was designed to study addiction to the drug Tramadol among university students in Khartoum State.
 Introduction: Tramadol is an atypical opioid that binds to μ-opioid receptors on neurons. It has a bioavailability of 70% and undergoes extensive first-pass metabolism in the liver. In most countries, it is a prescription-only medicine. Tramadol abuse has increased recently in the last few years between private universities in Khartoum state, Sudan. Common adverse effects of opioids are nausea, vomiting, relaxation, itching, mental confusion, delirium, urinary retention, sweating.
 Methodology: A study was conducted on 176 university students in Khartoum from August to September 2018. Ethical approval was obtained from sudan international university research commette and permission from each academic institution. A questionnaire sheet was developed to collect data related to drug abuse among students, including Sociodemographic data and knowledge about drug use without prescription. The collected data were statistically analyzed using ANOVA - IBM - Statistical Package for the Social Science version 16 programs-2008.
 Results: A study of 176 university students found that most were male (79.5%) and female (20.5%), with an age range of 21-25. Most were medical students, with a minority in engineering, literacy, and computing fields. Most were aware of tramadol analgesic "pain killer" effect, but only 53.7% knew its hallucinogenic effect. Most abusers used tramadol for less than a year, with most starting in university life. Most abusers consumed various doses, with most consuming daily. Adverse effects of tramadol included physical symptoms, psychological symptoms, and attempts at quitting. Reasons for failure to quit were mainly compliance.
 Conclusion: Tramadol abuse is prevalent among medical students in Sudan. Reasons for initiation include elation desire, avoidance of life conflicts, and curiosity.

Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

Wernicke Encephalopathy (WE) is a neurological acute syndrome related to vitamin B1 deficiency and is relatively common in patients with chronic alcoholism. In the case of Hyperemesis Gravidarum, thiamine body stores become unable to meet the increased demand, resulting in acute deficiency. WE is associated with typical clinical and radiological findings. Treatment pathways rely on thiamine replacement. The case herein reported is centered around a 33-year-old diabetic patient at 12 weeks of gestation, with WE due to hyperemesis gravidarum. The disease manifested itself with weakness, mental confusion, headache, and impaired vision. The diagnosis was established after the detection of typical findings by MRI. Thirty days after therapy was started, most of the patient’s neurological disorders were resolved. The patient was discharged 40 days later with instructions to continue daily thiamine supplementation. The pregnancy outcome was good. Unfortunately, mild ataxia persisted in 2-year follow-up as a long-term consequence. When diagnosed and treated, WE has a favorable prognosis. However, roughly 80% of patients experience memory loss, which may continue for a long time, while gait disorders reportedly affect about 35% of patients. Mild ataxia and dysmetria may persist, too. We reviewed the scientific literature on WE in women with HG until February 2023. Hardly any authors report data on long-term sequelae. Our report emphasizes how important it is to take into consideration this complication in clinical practice, referring to published guidelines and recommendations. Neurological maternal sequelae can demonstrably persist despite early diagnosis and appropriate management. For this reason, a long-term follow-up is recommended. Wernicke syndrome management cannot yet rely on well-established conclusive guidelines; hence, a cautionary approach ought to be prioritized in order to ensure medicolegal soundness.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome.

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales. Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex. Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS. Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report.

Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.

Unveiling the nexus of postoperative fever and delirium in cardiac surgery: identifying predictors for enhanced patient care.

Postoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions. In a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation. The overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763-0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively. This study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.

Abstract 14074: Prodromal Symptom Cluster is Associated With Length of Hospital Stay After Cardiac Arrest Resuscitation

Introduction: Little is known about the impact of cardiac arrest prodromal symptom clusters on survival after resuscitation. Hypothesis: Clusters of prodromal cardiac arrest symptoms are associated with the length of hospital stay until death or hospital discharge after resuscitation. Methods: This retrospective study included records of in-hospital and out-of-hospital cardiac arrest victims referred to a University Hospital in Brazil between 2010 and 2020. Data concerning the prodromal symptoms and length of hospital stay until death or hospital discharge were collected. Symptom clusters were examined by multiple correspondence analyses. Survival analysis and comparisons between those with and without symptoms were done by the Kaplan-Meier method and the Log-Rank test. Results: There were 120 eligible records (58.7 years old, 54.2% female, 86.7% White). Prodromal symptoms began during the 24 hours preceding the event in 67.2% of the victims; 64.1% had a return of spontaneous circulation. There were three symptom clusters. Symptoms of cluster 1 (dyspnea, cough, and edema), cluster 2 (mental confusion, restlessness, palpitations, reports of skin color changes, sweating, malaise, and stroke symptoms), and cluster 3 (fever, level of consciousness alterations, syncope, chest pain, abdominal pain, headache, and nausea), were found in 50.0%, 18.3%, and 54.1% of the records, respectively. Only individuals with symptoms of cluster 2 (Figure 1) had significantly lower lengths of hospital stay due to death than those without such symptoms (p = .04). Conclusions: Prodromal cardiac arrest symptoms occur in clusters that may indicate a worse prognosis after resuscitation.

37 Cognitive Disengagement Syndrome (CDS; Sluggish Cognitive Tempo) in Pediatric Epilepsy

Objective:Cognitive disengagement syndrome (CDS; previously known as “sluggish cognitive tempo” or SCT) refers to a set of behavioral symptoms characterized by slowed thinking/behavior, daydreaming, and mental fogginess or confusion. It has been described as related to, yet separate from, symptoms associated with Attention-deficit Hyperactivity Disorder (ADHD) inattention. There is a paucity of research on CDS within pediatric epilepsy populations despite substantial risk factors inherent to the disorder and a large proportion of patients with comorbid ADHD. This study therefore describes CDS as reported by parents for a large sample of children with epilepsy. Relationship between epilepsy variables (e.g., number of antiepileptic drugs [AEDs], seizure frequency, seizure type) and CDS symptoms was explored. Additionally, considering the negative association between CDS and academic performance in other populations, the relationship between parentrated CDS and academic risk factors was examined.Participants and Methods:Participants included 151 children with epilepsy (mean age = 11y, range 6-18y; 55% male; IQ>70), referred for outpatient neuropsychological assessment. As part of routine clinical care, parents completed the Penny Sluggish Cognitive Tempo Scale (SCT) and the Colorado Learning Difficulties Questionnaire (CLDQ). Scores and basic demographic information were extracted from an IRB approved clinical database; the IRB granted approval for retrospective chart review to extract additional medical variables. Parent report of CDS included total CDS score and three subdomains: Sleepy/Sluggish, Low Initiation, and Daydreamy. Higher scores represent greater parent-reported difficulties. Independent samples t-tests compared the participants’ means on total CDS and each subdomain to the normative sample. Analysis of variance was conducted to determine differential impact of seizure type (Generalized, Focal, or Multifocal) on total CDS and each subdomain. Correlations between other medical variables, scores on the CLDQ, and parent ratings on the SCT were examined.Results:Parents of children with epilepsy rated overall CDS total and subdomain scores as significantly higher compared to the normative means with highest elevation in symptoms of Low Initiation (p = <.001). Total CDS was associated with increased parent-reported academic difficulties; however, of the three subdomains, only Low Initiation was significantly associated with concerns for academic functioning. Number of AEDs was associated with increased symptoms on the Sleepy/Sluggish subdomain only. Seizure frequency was associated with total CDS and Sleepy/Sluggish symptoms, though this finding is likely mediated by increased number of AEDs for those with more frequent seizures. Seizure type was not associated with significant differences in Total CDS or CDS subdomains.Conclusions:Children with epilepsy are at increased risk for experiencing slowed thinking and cognitive disengagement. Low initiation is particularly elevated in pediatric epilepsy populations, which may lead to increased academic difficulties. Potential interventions targeting low initiation may therefore have benefit in the academic setting for children with epilepsy, regardless of epilepsy type.

Beyond Bipolar Disease: Primary Hyperparathyroidism in a Bipolar Patient

Primary hyperparathyroidism consists of a dysregulated production of parathyroid hormone that results in abnormal calcium homeostasis. It is mostly detected in the asymptomatic phase; however, presentation may include a broad spectrum of clinical manifestations. We describe the case of a 67-year-old female patient with a previous history of bipolar disorder and several vascular risk factors who presented with generalized muscular weakness, anorexia and weight loss, polydipsia, nausea, constipation and mental confusion with behavioural change. Mental and behaviour changes were previously considered a cognitive deficit. Blood tests revealed severe acute renal injury, severe hypercalcemia and frankly increased parathyroid hormone. During hypercalcaemia study, cervical ultrasound identified a nodule compatible with parathyroid adenoma, coincident with hypercaptant focus on the sestamibi scintigraphy. Patient underwent treatment with zolendronic acid and posterior parathyroidectomy with gradual symptomatic and analytical improvement. The authors report this case recalling that psychiatric pathologies can delay the diagnosis of physical conditions.

Freiburg Neuropathology Case Conference

Freiburg Neuropathology Case Conference

Spontaneous intracranial hypotension: a case report in the context of differential diagnosis of chronic headaches

Spontaneous intracranial hypotension (SIH) is a rare and debilitating condition caused by decreased intracranial pressure, which occurs more frequently in females. SIH can have several causes, among them the spontaneous formation of cerebrospinal fluid venous fistula (CSF-venous fistula), which is primarily responsible for the appearance of postural headache. Orthostatic headache is diagnosed by CSF pressure < 6 mmHg associated with specific imaging findings. Other specific symptoms such as dizziness, reduced muscle strength, blurred vision and syncope and other more systemic symptoms such as fatigue, mental confusion and difficulty concentrating are commonly observed. Etiological investigation through imaging studies such as magnetic resonance imaging and dynamic tomography of myelography is necessary for diagnosis. Due to the debilitating condition, several therapeutic approaches have been developed, ranging from more conservative approaches, with observation and use of analgesics, to more invasive interventions such as surgical ligation, transvenous embolization and blood tamponade.

Elaboração de um protocolo de classificação de risco para pacientes oncológicos em Cuidados Paliativos Domiciliares

ABSTRACT Home-based Palliative Care services specialized in the treatment of cancer patients aim to identify and control physical, psychosocial, and spiritual symptoms at home. Some challenges encountered are the complexity of symptoms, reduced survival of patients with advanced cancer, and limitations of the health care system. To stratify the priority of care for patients with advanced cancer in home Palliative Care, a risk classification protocol was developed. This article is an experience report on the process of creating a risk classification protocol for patients with advanced cancer treated at a home Palliative Care service in Rio de Janeiro. The initial stage involved meetings of the home care team at an oncology hospital and structured searches in the literature. Afterwards, the clinical situations of more complex management at home were listed and named as warning signs and symptoms: pain, shortness of breath, nausea/ vomiting, bleeding, and acute mental confusion. An assessment and triage protocol was developed with five categories/colors to determine the priority of patient care. The developed triage system has easy applicability and requires a brief training of the health professional so that it can be used during home visits.

Patients' recollections of helmet-CPAP treatment during COVID-19 pandemic: A qualitative study.

During the pandemic outbreak, helmet continuous positive airway pressure (CPAP) was widely used as respiratory support for COVID-19 patients, inside and outside of intensive care units. The available literature suggests specific interventions to improve the comfort of patients treated with helmet-CPAP. Few reports are available on the experiences of patients undergoing this treatment. This qualitative study aimed to explore the views and recollections of COVID-19 patients undergoing helmet-CPAP. We conducted semi-structured interviews with thematic analysis. Participants were recruited from the follow-up programme for COVID-19 patients discharged from an Italian general intensive care unit. Participants were interviewed by telephone. Data analysis followed the principles of thematic synthesis approach. We conducted 29 phone calls in patients eligible for the study. Five participants declared that they did not remember the time spent in hospital on helmet-CPAP. Twenty-four patients were then included. Two themes and six subthemes were generated from their interview data: (1) The helmet-CPAP as a life-saving treatment (subthemes: recognition of the usefulness of treatment and resilience); (2) the negative feelings related to helmet-CPAP application (subthemes: communication problems, entrapment, mental confusion, fear of dying). Each patient's experience was unique, but some discomfort elements such as noise, gas flow turbulence, choking sensation and thirst were found to be very common. The application of helmet-CPAP treatment generated positive and negative memories and feelings in COVID-19 patients during the pandemic. The patients' experience has provided an overview of the main factors of discomfort. This can be a starting point for taking corrective measures to promote greater helmet tolerance and subsequent treatment success. This study has provided an insight into the patient's recollections about helmet-CPAP treatment during a worldwide pandemic. The findings suggested strict applications of interventions aimed to reduce some issues that participants reported, to improve their compliance to treatment. Results from this study could help nurses in understanding the needs of patients treated with helmet-CPAP and may foster a care focused on patient-centred outcomes.

Mental and Emotional Disorders In Students During the COVID-19 Pandemic

Changes in learning methods during the COVID-19 pandemic resulted in increased stress in students which had a negative impact on their mental health. Stress causes physiological responses, negative psychological reactions, maladaptive behaviour, mental confusion and frustration. An overload of stress also stimulates other mental health problems including anxiety, hopelessness or powerlessness, depression and lack of self-esteem. This study aimed to determine the mental and emotional disorders in students during the COVID-19 pandemic. This was a cross-sectional study. 153 senior high school students in Malang Indonesia were selected by the random sampling technique to participate in the study. The variable of mental emotional disorder was measured with the PSC-17 questionnaire. Data were analyzed using SPSS. The result of this study indicated that during the COVID-19 pandemic, students in Indonesia experienced internalizing disorders (83.25%), externalizing disorders (2.61%) and attention disorders (21.57%). There were only 15.69% of respondents who showed no indication of a disorder. The results showed that adolescents had mental health struggles, especially internalizing disorder symptoms such as anxiety, sadness, gloom, hopelessness and inferiority.
 Keywords: COVID-19 pandemic, student, mental emotional disorder

B-Cell Lymphoma Intramedullary Tumor: Case Report and Systematic Review.

Intramedullary tumors represent the major cause of spinal cord injuries, and its symptoms include pain and weakness. Progressive weakness may concomitantly occur in the upper and lower limbs, along with lack of balance, spine tenderness, sensory loss, trophic changes of extremity, hyperreflexia, and clonus. The study protocol was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the MEDLINE electronic database was performed to identify the studies reporting the clinical features of children and adults who presented with an intramedullary lymphoma. Twenty-one studies were included, reporting 25 cases. Manuscripts were excluded if the full-text article was not available, original data were not reported (e.g., review articles), or if the main disease was not intramedullary lymphoma. A structured data extraction form was employed to standardize the identification and retrieval of data from manuscripts. To enlighten the discussion, a case is also presented. An 82-year-old woman with Fitzpatrick skin type II, diagnosed and treated for non-Hodgkin's lymphoma 7 years ago, was admitted with mental confusion and memory loss for the past 2 months-evolving with recurring falls from her own height. One day before admission, she displayed Brown-Séquard syndrome. An expansive lesion from C2 to C4 in the cervical spinal cord was found and a hypersignal spinal cord adjacent was described at the bulb medullary transition to the C6-C7 level. A primary spinal cord tumor was considered, as well as a melanoma metastasis, due to the lesion's flame pattern. The patient presented a partial recovery of symptoms and a reduction of the spinal cord edema after being empirically treated with corticosteroids, but the lesion maintained its extent. Subsequently, a large diffuse B-cell lymphoma with nongerminal center was found in open body biopsy, infiltrating neural tissue. The main objective of the present study is to report a surgical case treated for a large diffuse B-cell lymphoma, in addition to presenting the results of a systematic review of primary intramedullary spinal cord lymphoma.

Gefühlte Natur und natürliche Gefühle. Wie die ersten Planetarien urbane Natur produzierten und fühlbar machten

When the world’s first planetariums opened in the mid-1920s in the Weimar Republic, people flocked to the institution to view the starry sky, to have it explained to them and to feel close to it. This starry sky, projected onto a dome by a projector, was seen as nature by the mostly urban planetarium audience, and the experiences under the dome as experiences of nature. The reason for this was the feelings that arose in the planetarium and were deliberately evoked by the staging of the shows. The impression of nature in the planetarium was the result of emotional work. Based on an analysis of multi-perspective sources (press reports, lecture manuscripts, advertising materials, planning and administrative documents, photographs, correspondence, etc.), this article shows: Feelings are not only the indicator that something is nature; feelings make nature. Nature was revealed in the planetarium as a co-production of people and machines, technology and narrative, emotion and cognition. It revealed itself as a con(-)fusion in which people found (aesthetic) experiences that fulfilled a variety of purposes for them: These experiences brought them close to a nature imagined as pure and moral, enabled ’modern’ ways of feeling, provided knowledge marked as scientific, and put them in a mood that seemed particularly valuable to them.

Plasma metabolomics in male primary and functional hypogonadism.

Metabolomics proposes to unveil the molecular machinery involved in each specific disease by the comprehensive analysis of low-molecular-weight metabolites in a biological sample. This narrative mini-review analyzes previous studies applying ultra-high-performance liquid chromatography-high-resolution mass spectrometry (HRMS)-based metabolomics to highlight different metabolic pathways involved in male hypogonadism and testosterone replacement therapy, both in the case of insulin-sensitive patients with primary hypogonadism and in the case of insulin-resistant patients with functional hypogonadism. In functional hypogonadism, metabolomics revealed that different biochemical pathways are affected. In detail, glycolysis is the most important biochemical process involved in these patients. Glucose metabolism is fueled by amino acid degradation, and gluconeogenesis is widely stimulated. Some important pathways, including glycerol, are compromised. Furthermore, mitochondrial electron transport is influenced, namely, by a decrease in ATP production. On the contrary, beta-oxidation of short- and medium-chain fatty acids does not represent an energy source in hypogonadal patients. Both lactate and acetyl-CoA are converted into ketone bodies, which increased immensely. However, carnosine and β-alanine are greatly reduced. These metabolic changes are associated with increased fatigue and mental confusion. After testosterone replacement therapy, a complete restoration is achieved for only a part of the metabolites. It is of note that only in patients with functional hypogonadism treated with testosterone are ketone bodies produced at high levels, so the symptoms sometimes reported by these patients after the beginning of the therapy (difficulty in concentrating, depressed mood, brain fog, and memory impairment) might represent a specific "keto flu-like" syndrome, related to the metabolic ketonic state.