Mills' syndrome is a unique entity of upper motor neuron disease with N-shaped progression: Three case reports.

BACKGROUND: Mills' syndrome is an extremely rare degenerative motor neuron disorder first described by Mills in 1900, but its nosological status is still not clear. We aimed to analyze the clinical features of Mills' syndrome. CASE SUMMARY: Herein, we present 3 cases with similar features as those described in Mills' original paper and review the related literature. Our patients showed middle- and older-age onset, with only upper motor neuron symptoms evident throughout the course of the disease. Spastic hemiplegia began in the lower extremity with a unique progressive pattern. CONCLUSION: We consider that Mills' syndrome is a unique entity of motor neuron disorder with an N-shaped progression. Clinicians should maintain a high index of suspicion for the diagnosis of Mills' syndrome when the onset involves lower extremity paralysis without evidence of lower motor neuron or sensory involvement.

Hemichorea due to ipsilateral thalamic infarction: A case report.

BACKGROUND: Hemichorea usually results from vascular lesions of the basal ganglia. Most often, the lesion is contralateral to the affected limb but rarely, it may be ipsilateral. The pathophysiology of ipsilateral hemichorea is still poorly understood. We review the literature on hemichorea due to ipsilateral cerebral infarction and explore possible mechanisms for its occurrence. CASE SUMMARY: A 72-year-old woman presented with complaints of involuntary movements of the muscles of the left side of the face and mild weakness of the right limbs. Her symptoms had started suddenly 1 d earlier. After admission to the hospital, the involuntary movements spread to involve the left limbs also. Magnetic resonance imaging revealed a left thalamic infarction. The patient's hemichorea subsided after treatment with haloperidol (2 mg per time, 3 times/d) for 3 d; the hemiparesis resolved with rehabilitation physiotherapy. She is presently symptom free and on treatment for prevention of secondary stroke. We review the literature on the occurrence of ipsilateral hemichorea following thalamic infarction and discuss the possible pathomechanisms of this unusual presentation. CONCLUSION: Ipsilateral hemichorea following a thalamic stroke is rare but it can be explained by structure of the extrapyramidal system. The thalamus is a relay station that exerts a bilateral control of motor function.

Hyperglycemic hemianopia: A case report.

BACKGROUND: Nonketotic hyperglycemia (NKH) is characterized by hyperglycemia with little or no ketoacidosis. Diverse neurological symptoms have been described in NKH patients, including choreoathetosis, hemiballismus, seizures, and coma in severe cases. Homonymous hemianopia, with or without occipital seizures, caused by hyperglycemia is less readily recognized. CASE SUMMARY: We describe a 54-year-old man with NKH, who reported seeing round, colored flickering lights with right homonymous hemianopia. Cranial magnetic resonance imaging demonstrated abnormalities in the left occipital lobe, with decreased T2 signal of the white matter, restricted diffusion, and corresponding low signal intensity in the apparent diffusion coefficient map. He responded to rehydration and a low-dose insulin regimen, with improvements of his visual field defect. CONCLUSION: Patients with NKH may present focal neurologic signs. Hyperglycemia should be taken into consideration when making an etiologic diagnosis of homonymous hemianopia.

Incorporating Electron-Deficient Bipyridinium Chromorphores to Make Multiresponsive Metal-organic Frameworks.

Metal-organic frameworks (MOFs) are versatile platforms to design switchable and sensory materials responsive to external stimulus. Copuling the electron-deficient bipyridinium chromorphore with the pore structures of MOFs is a nice strategy to design multiresponsive MOFs. Here we present a proof-of-concept study. Postsynthetic N,N'-cycloalkylation of UiO-67-bpy (bpy = 2,2'-bipyridyl) leads to a novel ionic MOF (UiO-67-DQ) functionalized by the electron-deficient diquat (DQ) chromophore. The combination of porosity, cationic character and electron deficiency imparts UiO-67-DQ with versatile responsive properties. It readily undergoes anion exchange, with selective ionochromism associated with charge-transfer (CT) complexation; it is electrochemically active and shows anion-dependent photochromism associated with radical formation through electron transfer (ET); the iono- and photochromism cause efficient luminescence quenching because of energy transfer (EnT) to CT complexes or radicals. The properties of UiO-67-MQ (MQ = N,N'-dimethyl-2,2'-bipyridylium) are also presented for comparison. The CT and ET effects and consequently the EnT efficiency in UiO-67-MQ are weaker than those in UiO-67-DQ because the electron-deficient character is weakened by the severe interannular twist in MQ2+. On the basis of the rich responsive properties, the MOFs are used as sensory and switching materials for facile discrimination of a range of anions, for quantitative detection of I-, and for mimicking of logic operations ranging from simple logic gates to complex integrated logic circuits.

Piezochromism and hydrochromism through electron transfer: new stories for viologen materials.

While viologen derivatives have long been known for electrochromism and photochromism, here we demonstrated that a viologen-carboxylate zwitterionic molecule in the crystalline state exhibits piezochromic and hydrochromic behaviors. The yellow crystal undergoes a reversible color change to red under high pressure, to green after decompression, and finally back to yellow upon standing at ambient pressure. Ultraviolet-visible spectroscopy, X-ray photoelectron spectroscopy, electron paramagnetic resonance X-ray diffraction and DFT calculations suggested that the piezochromism is due to the formation of radicals via pressure-induced electron transfer from carboxylate to pyridinium, without a crystallographic phase transition. It was proposed that electron transfer is induced by pressure-forced reduction of intermolecular donor-acceptor contacts. The electron transfer can also be induced by dehydration, which gives a stable green anhydrous radical phase. The color change is reversible upon reabsorption of water, which triggers reverse electron transfer. The compound not only demonstrates new chromic phenomena for viologen compounds, but also represents the first example of organic mechanochromism and hydrochromism associated with radical formation via electron transfer.

Distinct Chromic and Magnetic Properties of Metal-Organic Frameworks with a Redox Ligand.

An electron-deficient and potentially chromic ligand has been utilized to impart redox activity, photo- and hydrochromism, and solvotomagnetism to metal-organic frameworks (MOFs). A pair of MOFs were constructed from the flexible zwitterionic viologen-tethered tetracarboxylate linker N,N'-bis(3,5-dicarboxylatobenzyl)-4,4'-bipyridinium (L2-): [Co3(L)(N3)4] (1) and [Mn2(L)(N3)2(H2O)2]·3H2O (2). Both compounds show three-dimensional frameworks in which mixed azido- and carboxylato-bridged chains are connected through the electron-deficient viologen moieties. The chain in 1 is built from alternating bis(azide) and (azide)bis(carboxylate) bridges, while that in 2 contains uniform (azide) (carboxylate) bridges. The MOFs shows the characteristic redox properties of the viologen moieties. The redox activity affords the MOFs with different chromic properties, owing to subtle differences in chemical environments. 1 shows reversible photochromism, which is related to the radical formation through photoinduced electron transfer from azide-carboxylate to viologen according to UV-vis, X-ray photoelectron, and electron spin resonance spectroscopy and DFT calculations. 2 is nonphotochromic for lack of appropriate pathways for electron transfer. Unexpectedly, 2 shows a novel type of solid-state hydrochromism. Upon the removal and reabsorption of water, the compound shows remarkable color change because of reversible electron transfer accompanying a reversible structural transformation. The radical mechanism is distinct from those for traditional hydrochromic inorganic and organic materials. Magnetic studies indicate ferro- and antiferromagnetic coupling in 1 and 2, respectively. What's more, 2 shows marked magnetic response to the removal of water molecules owing to the formation of radicals. The compound illustrates a unique material exhibiting dual responses (color and magnetism) to water.

Clinical characteristics, treatments, and outcomes of patients with anti-N-methyl-d-aspartate receptor encephalitis: A systematic review of reported cases.

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a recently recognized autoimmune disorder which is responsive to immunotherapy. However, the outcomes of different immunotherapies have not been defined and there have been few studies that carried out a comparison among them. To provide an overview of the clinical characteristics, treatments, and outcomes of anti-NMDAR encephalitis, we systematically reviewed the literature in the PubMed, Medline, Embase, Cochrane Library, BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wan-fang databases. Eighty-three studies with a total of 432 patients were included. The median age was 22years. Two hundred ninety-three (68%) patients were female, 87 (21%) of 412 patients had a tumor, including 68 (78%) patients with ovarian teratoma. Pediatric patients had a higher ratio of seizures to psychiatric symptoms as the initial manifestation (p=0.0012), a lower proportion with a tumor (p<0.0001) and CSF pleocytosis (p=0.0163), and a better outcome (p=0.0064) than adults. Patients who died had a higher proportion of CSF pleocytosis than the patients who survived (p=0.0021). There were no significant differences among three first-line immunotherapy used alone (p=0.9172) or among combinations of every two of them (p=0.3059). With regard to the use of corticosteroid and IVIG, there were no significant differences between the outcomes of early combined treatment and sequential treatment (p=0.7277), or between using corticosteroid first and IVIG first (p=0.5422). Our findings suggest that the clinical characteristics and outcomes for pediatric patients were different from adult patients, and no significant differences were found among different immunotherapies.

A novel coordination polymer based on Co(ii) hexanuclear clusters with azide and carboxylate bridges: structure, magnetism and its application as a Li-ion battery anode.

A novel Co(ii) coordination polymer, [Co(H2O)6][Co6(bpybdc)2(N3)10(H2O)4]·8H2O (bpybdc2- = 1,1'-bis(3,5-dicarboxylatophenyl)-4,4'-bipyridinium), has been synthesized from a rigid zwitterionic tetracarboxylate ligand and azide. In this compound, hexacobalt clusters with mixed µ-1,1-azide, µ3-1,1,1-azide and µ-1,3-carboxylate bridges are linked into chains by µ-1,3-azide bridges, and the chains are interlinked into 2-fold interpenetrated three-dimensional frameworks through the organic ligand and hydrogen bonds mediated by hexaaquacobalt(ii) complex ions. Magnetic analysis suggested that intracluster ferromagnetic and intercluster antiferromagnetic interactions work together to give overall antiferromagnetic ground states for the azide and carboxylate bridged chain. When applied as an anode for lithium-ion batteries, the coordination polymer changes into an amorphous phase and exhibits a relatively high reversible capacity of 510 mA h g-1 with stable cycling behavior and rate performance.

Etiologic features of newly diagnosed epilepsy: hospital-based study of 892 consecutive patients in West China.

PURPOSE: We evaluated data from a large cohort of newly diagnosed epilepsy patients from the biggest epilepsy center in West China. The aim was to determine the most prevalent etiologic factors in this region. METHODS: From May 2008 to May 2010, the clinical data of patients with newly diagnosed epilepsy were consecutively, systematically and prospectively recorded in a database. The data were analyzed according to sex, age, seizure type, etiology, and other factors. RESULTS: The present study examined 892 patients with newly diagnosed epilepsy. Among these patients, 346 (38.8%) were confirmed as symptomatic, with the largest constituent ratio among the elderly (63.2%). In this symptomatic group, central nervous system (CNS) infections and traumatic brain injuries (TBI) were the two most common etiologies. When analyzed according to age bracket, cortical dysplasia, mesial temporal sclerosis, and CNS infection were the most frequent causes among young patients (<18 years). On the other hand, CNS infection and TBI were the two most common causes in patients between 18 and 60 years. Stroke was the most common cause of newly diagnosed symptomatic epilepsy in the elderly (>60 years). CONCLUSIONS: More than 30% of newly diagnosed epilepsy cases were shown to be symptomatic by medical history as well as careful clinical and laboratory examination. Detailed epilepsy assessments are essential to formulate a therapeutic plan and to improve prognosis. The etiology spectrum found in this large cohort forms a comparative baseline for future studies.

Evaluation of the efficiency of inpatient 24-hour VEEG combined with MRI in consecutive patients with newly diagnosed epilepsies.

A total of 128 patients were recruited into this study to evaluate the cost efficiency of 24-hour video electroencephalography (VEEG) combined with magnetic resonance imaging (MRI) in people with newly diagnosed epilepsies. The rate of neuroimaging abnormalities detected was 14.8% higher with MRI than with computed tomography (CT), whereas 25.7% more EEG abnormalities were detected with inpatient 24-hour VEEG than with outpatient EEG. In the partial seizure (PS) group, MRI combined with 24-hour VEEG revealed that 20 of 73 (27.4%) patients had local epileptogenic lesions, whereas CT with outpatient EEG revealed a rate of 10 in 73 (13.7%). With respect to the economic impact, 27.3% of the patients spent more than 17.8% of their annual household income for 24-hour VEEG and MRI. However, 82.7% of the patients spent less than that, and among these patients, only 16.4% spent less than 5.9% of their annual household income. Hence, we conclude that the combination of MRI and 24-hour VEEG as a compulsory tool should be popularized in less developed countries.