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Background: Gout is a metabolic disease characterized by recurrent episodes of acute arthritis. Gout has been reported in many locations but is rarely localized in the shoulder joint. We describe a rare case of gouty arthritis involving bilateral shoulder joints and leading to severe destructive changes in the right shoulder glenoid.Case Presentation: A 62-year-old male was referred for pain and weakness in the right shoulder joint for two years, and the pain had increased in severity over the course of approximately nine months. A clinical examination revealed gout nodules on both feet and elbows. A laboratory examination showed a high erythrocyte sedimentation rate (ESR), high levels of C-reactive protein and hyperuricemia, and an imaging examination showed severe osteolytic destruction of the right shoulder glenoid and posterior humeral head subluxation. In addition, the left humeral head was involved and had a lytic lesion. Because a definite diagnosis could not be made for this patient, a right shoulder biopsy was performed. The pathological examination of the specimen revealed uric acid crystal deposits and granulomatous inflammation surrounding the deposits. After excluding infectious and neoplastic diseases, the patient was finally diagnosed with gouty shoulder arthritis.Conclusions: Gout affecting the bilateral shoulder joints is exceedingly uncommon, and to our knowledge, severe erosion of the glenoid has not been previously reported. When severe erosion is present, physicians and orthopedic surgeons should consider gouty shoulder arthritis according to previous medical history and clinical manifestations. [ABSTRACT FROM AUTHOR]

Background: Post-database search is a key procedure in peptide identification with tandem mass spectrometry (MS/MS) strategies for refining peptide-spectrum matches (PSMs) generated by database search engines. Although many statistical and machine learning-based methods have been developed to improve the accuracy of peptide identification, the challenge remains on large-scale datasets and datasets with a distribution of unbalanced PSMs. A more efficient learning strategy is required for improving the accuracy of peptide identification on challenging datasets. While complex learning models have larger power of classification, they may cause overfitting problems and introduce computational complexity on large-scale datasets. Kernel methods map data from the sample space to high dimensional spaces where data relationships can be simplified for modeling. Results: In order to tackle the computational challenge of using the kernel-based learning model for practical peptide identification problems, we present an online learning algorithm, OLCS-Ranker, which iteratively feeds only one training sample into the learning model at each round, and, as a result, the memory requirement for computation is significantly reduced. Meanwhile, we propose a cost-sensitive learning model for OLCS-Ranker by using a larger loss of decoy PSMs than that of target PSMs in the loss function. Conclusions: The new model can reduce its false discovery rate on datasets with a distribution of unbalanced PSMs. Experimental studies show that OLCS-Ranker outperforms other methods in terms of accuracy and stability, especially on datasets with a distribution of unbalanced PSMs. Furthermore, OLCS-Ranker is 15–85 times faster than CRanker. [ABSTRACT FROM AUTHOR]

Background: Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma.Case Presentation: We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.Conclusion: To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective. [ABSTRACT FROM AUTHOR]

Background: The 'hot cross bun' (HCB) sign refers to a cruciform-shaped hyperintensity within the pons found on T2-weighted magnetic resonance imaging (MRI). It is commonly associated with atrophy of the pons, cerebellum, and putamen in multiple system atrophy (MSA). In this report, we describe a rare case of the HCB sign in an adult female patient with leptomeningeal metastases of breast cancer without any signs of brain atrophy., Case Presentation: The patient was a 58-year-old woman diagnosed with grade 2 ductal breast carcinoma, who had undergone a right mastectomy, followed by chemotherapy treatments and chest wall radiotherapy. The tumor had metastasized to the skin, and the patient presented with vomiting, drowsiness, and intermittent episodes of confusion, slurred speech, and involuntary movements. Immunohistochemical staining demonstrated a triple-negative status of the tumor. Axial T1-weighted MRI showed a linear enhancement in the cerebellar sulcus. A diagnosis of leptomeningeal metastases of breast cancer was confirmed by detection of tumor cells in the cerebrospinal fluid. Axial T2-weighted MRI indicated a cruciform hyperintensity in the pons without any atrophy of the pons, cerebellum, or putamen., Conclusion: The HCB sign can occur with leptomeningeal metastases of solid tumors, though the underlying mechanisms remain unknown.

Primary central nervous system (CNS) melanoma is a type of rare and aggressive tumor that can easily spread to the leptomeninges, and in fact, leptomeningeal metastasis is one of the most serious complications in patients with this carcinoma. Prognosis is extremely poor if a CNS melanoma has metastasized, and there are no effective treatments. Here, we present a case of a 37-year-old woman who presented with horizontal diplopia and progressive headache. Magnetic resonance imaging findings were consistent with the diagnosis of melanoma. The results of cytological examination of cerebrospinal fluid (CSF) showed malignant cells characteristic of melanoma. No extracranial lesions were observed. All of the available evidence confirmed a diagnosis of leptomeningeal metastases from a primary CNS melanoma. The patient received aggressive treatment, which consisted of concurrent radiotherapy and weekly intra-CSF methotrexate (MTX) followed by adjuvant monthly intra-CSF MTX. Her survival time was 13 months after diagnosis. This case report suggests that the modality of concurrent radiotherapy and weekly intra-CSF MTX followed by adjuvant monthly intra-CSF MTX may be used as the mainstay of treatment for such patients.