COVID-19 with acute cerebral infarction: one case report / 中华神经科杂志

COVID-19 is caused by the 2019 novel coronavirus, which is characterized by hidden onset, long incubation period, and high contagion. COVID-19 not only attacks the respiratory system, but also affects other systems such as the heart, kidney, and digestive tract, and could be combined with multiple system diseases such as acute cerebrovascular disease. If doctors, especially non-infective or respiratory doctors, do not pay great attention to the disease when they are receiving patients, and take good care of them, they may easily be infected. This article summarizes the case of a concealed onset COVID-19 patient with cerebral infarction, which caused a medical staff infection after intravenous thrombolytic therapy, explores its clinical characteristics, treatment process and analyzes its prevention and control links to help the epidemic situation. In the prevention and control of the disease, the first doctor should pay attention to identification, reduce missed diagnosis, and conduct scientific investigation to reduce occupational infection.

COVID-19 with acute cerebral infarction: one case report / 中华神经科杂志

COVID-19 is caused by the 2019 novel coronavirus, which is characterized by hidden onset, long incubation period, and high contagion. The study found that the COVID-19 not only attacks the respiratory system, but also affects other systems such as the heart, kidney, and digestive tract, and could be combined with multiple system diseases such as acute cerebrovascular disease. If doctors, especially non-infective or respiratory doctors, do not pay great attention to the patient when they are receiving patients, and take good care of them, they may easily cause their own infection. This article summarizes the case of a concealed onset COVID-19 patient with cerebral infarction, which caused a medical staff infection after intravenous thrombolytic therapy, explores its clinical characteristics, treatment process and analyzes its prevention and control links to help the epidemic situation. In the prevention and control, the first-time doctor should pay attention to identification, reduce missed diagnosis, and scientific investigation to reduce occupational infection.

Comparative study of three clinical scoring systems in patients with acute pulmonary thromboembolism / 中华急诊医学杂志

Objective To compare the prognostic value of simplified revised Geneva Prognostic Score (sGPS), Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute pulmonary thromboembolism(PTE). Methods A retrospective cohort study was carried out on 276 consecutive patients with identified acute PTE admitted to our hospital from January 1997 to December 2016. We dichotomized patients as low vs. high risk in all three scoring systems. The 30-day mortality of the patients were used as prognostic factors. The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve(ROC). Results (1) The overall 30-day mortality of 276 patients with acute PTE was 22.5％. The 30-day mortality of patients in low vs. high risk groups according to sGPS, PESI and sPESI were 7.6％vs. 47.1％, 1.0％ vs. 34.3％, 2.4％ vs. 30.9％, respectively. The 30-day mortality of patients in high risk groups according to sGPS, PESI and sPESI were significantly higher than those of patients in low risk groups(P<0.01). The 30-day mortality of patients in low risk groups according to sGPS and PESI were significantly different(P=0.020). The 30-day mortality of patients in high risk groups according to sGPS were significantly different from those of patients in high risk groups according to PESI and sPESI, respectively (P=0.033, P=0.006). (2) The areas under the receiver operating characteristic (ROC) curves for evaluating the prognosis of patients with acute PTE according to sGPS, PESI and sPESI were 0.824, 0.891 and 0.846, respectively. The specificity (84.6％), the accuracy (84.4％) and the positive predictive value (61.2％) of PESI were the highest among the three prediction rules, the sensitivity (83.9％) and the negative predictive value (94.8％) of PESI were also relatively high. The negative predictive value of sPESI (98.6％) was the highest among the three prediction rules. Conclusions PESI can be more accurate for the overall risk stratification of patients with acute PTE, while sPESI is more helpful for identifying those patients with acute PTE who can be discharged early.

Novel compound heterozygous TBC1D24 mutations in a boy with infantile focal myoclonic epilepsy and literature review / 中华儿科杂志

Objective@#To investigate the clinical features and genetic characteristics of patients with TBC1D24 gene mutations.@*Method@#The clinical data of a patient with novel TBC1D24 compound heterozygous mutations from Children′s Hospital of Fudan University were collected, the related literature was searched from China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, National Center from Biotechnology Information and Pubmed (up to April 2016) by using search terms "TBC1D24" "epilepsy" . The clinical features, electroencephalogram (EEG) and prognosis of the patients with TBC1D24 gene mutations were studied.@*Result@#The patient was a boy with non-consanguineous healthy parents.He had an acute episode of focal continuous myoclonus lasting a few hours with consciousness preserved at the age of 3 months.Myoclonic jerks alternatively affected the eyelids, either the right or left limbs, sometimes triggered by fever or fatigue.The frequency was once 3-7 days.At the age of 6 months he was found to have myoclonus seizures with onset from a unilateral eyes lid and limb lasting 10 more minutes and subsequently affected four extremities or the trunk.They occurred once 3-4 months with perserved consciousness and lasted from several hours to up to ten more hours.They mostly disappeared during sleep.He had ataxia and mild mental retarding.Paroxysmal anomalies were not found on ictal traces.A novel compound heterozygous mutation of TBC1D24 gene, c. 730G>A, p.A244T and c. 1571G>C, p.R524P were found in the patient.Further study showed that c. 730G>A mutation was inherited from his father and c. 1571G>C from his mother. These two were not reported in public databases and predicted deleterious by Mutation Taster and polyphen-2.Literature relevant to TBC1D24 published all around the world was reviewed, no Chinese cases with TBC1D24 gene mutations had been reported. The total of 24 cases including the present case with TBC1D24 gene mutation were reported.Among them, 11 cases had compound heterozygous mutations and 13 cases had homozygous mutations.Ten mutations were identified, including 1 termination mutation, 1 frameshift mutation and 8 missense mutations.@*Conclusion@#TBC1D24 gene mutational analysis should be performed on patients with early-onset focal continuous myoclonus, if the etiology was unclear.

Mechanisms of MPP⁺-induced PC12 cell apoptosis via reactive oxygen species / 华中科技大学学报（医学）（英德文版）

Apoptosis of dopaminergic neurons in the nigrostriatal projection plays a crucial role in the pathogenesis of Parkinson's disease (PD). Although the detailed mechanisms responsible for dopaminergic neuron loss are still under investigation, oxidative stress is identified as a major contributor for neuronal apoptosis. In the current study, we studied the effects of MPP(+), a substrate that mimics oxidative stress, on neuron-like PC12 cells and the underlying mechanisms. PC12 cells were cultured and treated by 100 μmol/L MPP(+) for 4, 8, 16, 24 and 48 h, respectively. For drug pretreatment, the PC12 cells were incubated with N-acetyl-l-cysteine (NAC, 5 mmol/L), an antioxidant, SP600125 (20 μmol/L) or PD98059 (100 μmol/L), two pharmacological inhibitors of JNK and ERK1/2, for 1 h before addition of MPP(+). Cell apoptosis was measured by flow cytometry. The mRNA expression of Cu(2+)/Zn(2+)-SOD, GSH-Px, Bcl-2 and Bax was detected by RT-PCR. The protein expression of p-ERK1/2 and p-JNK was determined by Western blotting. Our results showed that MPP(+) exposure could induce substantial PC12 cell apoptosis. The pretreatment of SP600125 or PD98059 could effectively reduce the apoptosis rate by reducing the ratio of Bax/Bcl-2 mRNA levels. MPP(+) exposure also induced high level of reactive oxygen species (ROS), marked by dramatic increase of Cu(2+)/Zn(2+)-SOD and GSH-Px mRNA levels. The elevated ROS was strongly associated with the activation of JNK and ERK1/2 signal pathways after MPP(+) exposure, since the pretreatment of NAC significantly reduced the upregulation of p-JNK and p-ERK1/2. Finally, the pretreatment of SP600125, but not PD98059, alleviated the increase of Cu(2+)/Zn(2+)-SOD and GSH-Px mRNAs induced by MPP(+), suggesting that the activation of the JNK signal pathway, but not the ERK1/2 signal pathway, could, in some degree, antagonize the generation of ROS induced by oxidative stress. In conclusion, our results suggest that JNK and ERK1/2 signal pathways, which are activated via ROS, play a crucial role in neuronal apoptosis induced by oxidative stress.

Mechanisms of MPP⁺-induced PC12 cell apoptosis via reactive oxygen species / 华中科技大学学报（医学）（英德文版）

Apoptosis of dopaminergic neurons in the nigrostriatal projection plays a crucial role in the pathogenesis of Parkinson's disease (PD). Although the detailed mechanisms responsible for dopaminergic neuron loss are still under investigation, oxidative stress is identified as a major contributor for neuronal apoptosis. In the current study, we studied the effects of MPP(+), a substrate that mimics oxidative stress, on neuron-like PC12 cells and the underlying mechanisms. PC12 cells were cultured and treated by 100 μmol/L MPP(+) for 4, 8, 16, 24 and 48 h, respectively. For drug pretreatment, the PC12 cells were incubated with N-acetyl-l-cysteine (NAC, 5 mmol/L), an antioxidant, SP600125 (20 μmol/L) or PD98059 (100 μmol/L), two pharmacological inhibitors of JNK and ERK1/2, for 1 h before addition of MPP(+). Cell apoptosis was measured by flow cytometry. The mRNA expression of Cu(2+)/Zn(2+)-SOD, GSH-Px, Bcl-2 and Bax was detected by RT-PCR. The protein expression of p-ERK1/2 and p-JNK was determined by Western blotting. Our results showed that MPP(+) exposure could induce substantial PC12 cell apoptosis. The pretreatment of SP600125 or PD98059 could effectively reduce the apoptosis rate by reducing the ratio of Bax/Bcl-2 mRNA levels. MPP(+) exposure also induced high level of reactive oxygen species (ROS), marked by dramatic increase of Cu(2+)/Zn(2+)-SOD and GSH-Px mRNA levels. The elevated ROS was strongly associated with the activation of JNK and ERK1/2 signal pathways after MPP(+) exposure, since the pretreatment of NAC significantly reduced the upregulation of p-JNK and p-ERK1/2. Finally, the pretreatment of SP600125, but not PD98059, alleviated the increase of Cu(2+)/Zn(2+)-SOD and GSH-Px mRNAs induced by MPP(+), suggesting that the activation of the JNK signal pathway, but not the ERK1/2 signal pathway, could, in some degree, antagonize the generation of ROS induced by oxidative stress. In conclusion, our results suggest that JNK and ERK1/2 signal pathways, which are activated via ROS, play a crucial role in neuronal apoptosis induced by oxidative stress.

Preventive effect of gastrodin on cognitive decline after cardiac surgery with cardiopulmonary bypass: A double-blind, randomized controlled study / 华中科技大学学报（医学）（英德文版）

Cognitive decline is a common complication after cardiac surgery with cardiopulmonary bypass (CPB), but as such no pharmacological therapy has been shown to be efficacious in preventing the decline. However, gastrodin has been shown to have multi-pharmacological effects on neurological functions. We undertook this study to test the hypothesis that gastrodin would potentially prevent CPB-associated neurocognitive decline. We randomly assigned 200 patients undergoing mitral valve replacement surgery to receive either gastrodin (40 mg/kg) or saline after the induction of anesthesia and subsequently evaluated cognitive function before surgery, at discharge, and at 3rd month after surgery by using a battery of five neurocognitive tests, or adverse effects of gastrodin postoperatively. Neurocognitive decline in postoperative function was defined as a drop of 1 SD or more in the scores on tests of any one of the four domains of cognitive function. Cognitive decline occurred in 9% of the patients in the gastrodin group in contrast to 42% in the control group (P<0.01) at discharge. Cognitive outcome could be determined at 3rd month in 87 patients in the gastrodin group and 89 in the control group. Cognitive decline was detected in 6% in the gastrodin group and 31% in the control group (P<0.01). The incidences of possible adverse effects were similar between two groups. These results indicate that gastrodin is an effective and a safe drug for the prevention of neurocognitive decline in patients undergoing mitral valve replacement surgery with CPB.

Protective effects of radix astragali on ECV304 cells exposed to high level of glucose / 吉林大学学报(医学版)

Objective To explore the damage effect of high level of glucose on ECV304 cells and the approaches in which high level of glucose plays its part to provide theoretical bases for the therapy of diabetes.Methods ECV304 cells were divided into four groups:normal control,high glucose group in which glucose was added to the cells with final concentration of 35 mmol?L-1,Radix Astragali(RA) group in which glucose was added to the cells with final concentration of 35 mmol?L-1,as well as RA with final concentration of 500 mg?L-1,mannitol group in which mannitol was added to the cells with final concentration of 25 mmol?L-1.The cells were cultivated for 24 h after the glucose,RA and mannitol were added to the cells and collected for the determination of intracellular Ca2+ concentration,mitochondrial membrane potential and the morphological changes of cells and mitochondria were observed under electronic microscope.Results The intracellular Ca2+ concentration in the cells of high glucose group was significantly higher than those of RA group,mannitol group and normal control group(P