© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Glioblastoma multiforme (GBM) is the most common of the aggressive primary brain tumours arising in adults and has a dire prognosis. Neuropsychiatric symptoms can vary significantly among afflicted persons; psychiatric disturbances may be the predominant presenting symptoms. Distinguishing between functional psychiatric disorders, particularly depression, from other subtle neuropsychiatric disturbances that may accompany GBM can be challenging. The authors present a clinical case and review of the literature in an attempt to highlight the special considerations that should be taken into account when evaluating patients who present with late-onset or atypical symptoms, refractory psychiatric symptoms, or subtle neurological disturbances signalling the need for diagnostic assessment, particularly neuroimaging, for the presence of a tumour. Early diagnosis is critical for improvement in quality of life. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Chorea-ballism is a neurological syndrome characterised by violent involuntary movements of one or both extremities. In the last decades, several patients with these involuntary movements were reported in association with hyperglycaemia. Here, we present a unique case of possible Huntington's disease, which could have been unmasked by the hyperglycaemic insult to the basal ganglia in a 64-year-old man who presented with chorea-ballism. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Several intestinal secretagogues became available for the patients with irritable bowel syndrome. We report a case of symptomatic hyponatremia after lubiprostone ingestion. A male patient was visiting our office to manage chronic kidney disease. selleck chemical He suffered chronic hepatitis (type C), which was successfully treated with asunaprevir and daclatasvir. He took lubiprostone due to constipation, and then watery diarrhoea was frequently developed. Next morning, he came to our hospital due to consciousness disturbance. Physical examination showed dehydration and laboratory data exhibited hyponatremia (110 mEq/L). Subsequent treatment against hypovolemic hyponatremia recovered his consciousness without any sequels. This case suggests that intestinal secretagogues can accompany severe electrolyte disturbance. Potential mechanisms for hyponatremia were discussed. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Oesophageal lichen planus (ELP) is an uncommon presentation of mucocutaneous lichen planus. Due to its rare nature, it can often be misdiagnosed. As such, there can be a significant delay between symptom onset and diagnosis. ELP drastically reduces quality of life secondary to the severe dysphagia and odynophagia that typically accompany this pathogenesis. Additionally, it is important to diagnose ELP in a timely manner as ELP increases the risk of squamous cell carcinoma, with reported cases of malignant transformation. More research is needed on ELP with regard to diagnostic criteria and evidence-based therapeutic recommendations. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.In essentially all eukaryotes, proteins can be modified by the attachment of small ubiquitin-related modifier (SUMO) proteins to lysine side chains to produce branched proteins. This process of 'SUMOylation' plays essential roles in plant and animal development by altering protein function in spatially and temporally controlled ways. In this Primer, we explain the process of SUMOylation and summarize how SUMOylation regulates a number of signal transduction pathways. Next, we discuss multiple roles of SUMOylation in the epigenetic control of transcription. In addition, we evaluate the role of SUMOylation in the etiology of neurodegenerative disorders, focusing on Parkinson's disease and cerebral ischemia. Finally, we discuss the possibility that SUMOylation may stimulate survival and neurogenesis of neuronal stem cells. © 2020. Published by The Company of Biologists Ltd.BACKGROUND Low serum 25-hydroxyvitamin D (25(OH)D) concentrations in colorectal cancer (CRC) patients have been consistently associated with higher mortality in observational studies. It is unclear whether low 25(OH)D levels directly influence CRC mortality. To minimize bias, we use genetic variants associated with vitamin D levels to evaluate the association with overall and CRC-specific survival. METHODS Six genetic variants have been robustly identified to be associated with 25(OH)D levels in genome-wide association studies. Based on data from the International Survival Analysis in Colorectal Cancer Consortium (ISACC) the individual genetic variants and a weighted genetic risk score were tested for association with overall and CRC-specific survival using Cox proportional hazards models in 7 657 stage I-IV CRC patients of which 2 438 died from any cause and 1 648 died from CRC. RESULTS The 25(OH)D decreasing allele of single nucleotide polymorphism (SNP) rs2282679 (GC) was associated with poorer CRC-specific survival, although not significant after multiple-testing correction. None of the other five SNPs showed an association. The genetic risk score showed non-significant associations with increased overall (HR=1.54, 95% CI0.86-2.78) and CRC-specific mortality (HR=1.76, 95% CI0.86-3.58). A significant increased risk of overall mortality was observed in women (HR=3.26, 95% CI1.45-7.33, p-value for heterogeneity=0.01) and normal-weight individuals (HR=4.14, 95% CI1.50-11.43, p-value for heterogeneity=0.02). CONCLUSIONS Our results provided little evidence for an association of genetic predisposition of lower vitamin D levels with increased overall or CRC-specific survival, although power might have been an issue. IMPACT Further studies are warranted to investigate the association in specific subgroups. Copyright ©2020, American Association for Cancer Research.