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Objective To sum up the clinical characteristics and chest computed tomography (CT) findings of severe and critical coronavirus disease 2019 (COVID-19) patients, and to explore the factors affecting the outcomes, so as to provide experience for the clinical diagnosis and treatment of severe and critical COVID-19. Methods The data of 25 severe and critical COVID-19 patients, who were treated in our hospital from Jan. 23, 2020 to Mar. 5, 2020, were collected. The clinical characteristics were retrospectively analyzed, and the clinical and laboratory indexes were compared between cured patients and uncured patients. The laboratory indicators of cured patients were further compared between the progressive and recovery stages. The chest CT findings of the patients were observed, and the lesion volume was quantified to assess the evolution of lung lesions using the CT image-based intelligent pneumonia lesion quantitative analysis software. Results There were 19 male and six female COVID-19 patients, and there were three deaths. The median age of 25 patients was 65 (63, 75) years old, and the body mass index (BMI) was 25.60 (23.51, 28.65) kg/m2. Twenty-two patients had a clear epidemiological history. Fever (22 cases) and cough (14 cases) were the most common first symptoms, and 18 patients had underlying diseases. Twelve patients were cured and discharged (median hospital stay was 25.5 d), and 13 patients were not cured, including three deaths and 10 cases with hospital stay>25 d with no remission. Compared with the uncured patients, the cured patients had significantly lower BMI, longer time from onset to progression to severe or critical illness, and higher CD4+T lymphocyte counts (all P<0.05). Multivariate logistic regression analysis showed that high CD4+T lymphocyte count was an independent protective factor for the cure and discharge of severe and critical COVID-19 patients (P=0.031). Compared with those in the progressive stage, the lymphocyte count and CD4+T lymphocyte count of 12 cured patients were significantly higher in the progression stage, and the C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and procalcitonin level were significantly lower (all P<0.01). Twenty-one patients received chest CT examination in the progressive stage; and all of them had multiple ground-glass opacities and consolidation shadows of the multiple-lobe lateral band and the dorsal side of bilateral lungs, 20 cases had pleural thickening, 9 cases had a small amount of bilateral pleural effusion, and 8 cases had mediastinal lymphadenopathy. The 12 cured patients received CT examination during the recovery period, and their lesions were all improved to different extents; some patients had irregular fiber grid shadows and stripe shadows; and the pleural thickening and pleural effusion were reduced to different extents. The quantitative analysis curves showed that lesion volume in the 12 cured patients obviously increased in the progressive stage and reduced in the absorption stage, showing an inverted V shape; and lesion volume in the uncured patients (nine cases received CT examination for two or more times) showed a rapid increase in the progressive stage. Conclusion Most severe and critical COVID-19 patients in Shanghai are older, with higher BMI and underlying diseases. Low BMI, slow disease progression, and high CD4+T lymphocyte count are beneficial to the improvement of COVID-19. The main findings of chest CT include multiple ground-glass opacities and consolidation shadows, mainly distributing in the lateral band and the dorsal side of lungs and mostly involving the pleura. The laboratory indexes, including the lymphocyte, CRP, CD4+T lymphocyte, ESR and procalcitonin, and chest CT examination play an important role in the diagnosis, disease monitoring and prognosis assessment of COVID-19
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Objective To investigate the effects of Edaravone on cognitive dysfunction and on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK)signaling pathway in elderly patients with acute ischemic stroke. Methods A total of 100 elderly patients with acute ischemic cerebral stroke admitted to our hospital from January 2011 to December 2015 were enrolled in this study.During the corresponding period ,100 healthy individuals receiving regular check-ups were selected as the control group. The effects of Edaravone on cognitive function in elderly patients with acute ischemic cerebral stroke were assessed.Serum proteins related to the MAPK/ERK signaling pathway were assayed. Results Elderly patients with acute ischemic stroke showed obvious cognitive dysfunction ,and scores on memory ,orientation ,attention ,calculation language and recall significantly decreased(P＜0.01)but returned to normal after Edaravone treatment (P＜0.01).Compared with the control group ,serum protein expression of rat sarcoma (Ras) ,rapidly accelerated fibrosarcoma(Raf) ,hypoxia inducible factor-1α(HIF-1α) ,connective tissue growth factor (CTGF),extracellular signal-regulated protein kinase(ERK1),ERK2 ,MAPK/ERK kinase(MEK), interleukin-1(IL-1) ,tumor necrosis factor-α(TNF-α) ,vascular endothelial growth factor (VEGF) , tissue inhibitor of metalloproteinase (TIMP) ,nerve growth factor (NGF)and its receptors was significantly downregulated(P＜0.01) ,while expression of leptin and its receptors was upregulated in elderly patients with acute ischemic cerebral stroke ( P ＜ 0.01 ). Expression levels of the above downregulated proteins clearly recovered after Edaravone treatment ( P ＜ 0.01 ). Conclusions Edaravone has favorable effects on cognition dysfunction in elderly patients with acute ischemic cerebral stroke ,which may be related to the regulation of the MAPK/ERK signaling pathway.
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BACKGROUND:Classical drug for Parkinson’s disease is levodopa, but long-term application of levodopa can induce complications such as dyskinesias. OBJECTIVE:To observe the effects of levodopa on learning and memory capacities of Parkinson’s disease rats and to study its mechanisms. METHODS:The rat models of Parkinson’s disease were established using 6-hydroxydopamine. The 228 model rats were randomly divided into control group and experimental group. Rats in the experimental group were intraperitoneal y injected with 10, 20 and 30 mg/(kg?d) levodopa for 28 consecutive days. At 1, 3, 5, 7, 14 and 28 days after intraperitoneal injection, we observed the rats’ learning and memory capacities and tested plasma concentration of homocysteine and folic acid. Acetylcholinesterase activities in the rat hippocampus were measured. Hippocampal neurofibril ary tangles were observed using Bielschowsky staining. RESULTS AND CONCLUSION:Increased dose of levodopa and prolonged application time obviously decreased learning and memory capacities in rats (P<0.001), increased plasma homocysteine levels, reduced folic acid levels (P<0.001), diminished acetylcholine esterase activities in the rat hippocampus (P<0.001), and increased neurofibril ary tangles in the rat hippocampus (P=0.000). Results suggested that a large dose of levodopa could significantly decrease the learning and memory capacities, and disease acetylcholine esterase activities, and increase neurofibril ary tangles in hippocampus. Its mechanism possibly associated with the increased plasma concentration of homocysteine.
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<p><b>OBJECTIVE</b>To summarize the magnetic resonance imaging(MRI)features and microsurgical treatment of cavernous sinus hemangiomas(CSH).</p><p><b>METHODS</b>Twenty-three patients with surgically and pathologically verified CSH were reviewed. All patients underwent computed tomography(CT)and MR scan, 19 cases underwent MR diffusion-weighted imaging(DWI)and 7 underwent single voxel (1)H magnetic resonance spectroscopy((1)HMRS)before operation. The microsurgery through modified pterional approach was performed in 11 cases and 12 cases removal was achieved in combined fronto-temporal preauricular subtemporal approach. Nineteen cases with large tumors were treated by Leksell Gamma knife(LGK)before operation.</p><p><b>RESULTS</b>CSHs were single, large, and spherical/lie gourd-shaped tumors across the inside and outside the sella. CSH showed equal or slightly low signal on T1WI, high signal on T2WI and FLAIR, homogeneous or heterogeneous great enhancement on MR enhancement scan 19 cases showed equal or slightly low signal on DWI, 7 cases showed no NAA, Cr, and Cho peak, and 6 cases showed Lip peak on (1)HMRS. In 23 cases, the tumors were totally removed in 18, subtotally removed in 3, and partially removed in 2. No perioperative death was reported. The postoperative symptoms were improved in 17 cases but remained unchanged in 4 cases two patients suffered from new nervous symptoms after the surgery, which were improved or cured after three weeks of treatment. In 5 patients who had received subtotal or partial removal of the lesions, LGK was performed postoperatively, which resulted in smaller residual tumors in 4 cases and unchanged tumor in one patient. CONCLUSIONS CSH has some unique MRI features, and therefore MRI is helpful to improve the preoperative localization and qualitative diagnosis. The microsurgery through modified pterional approach combined with fronto-temporal preauricular subtemporal approach is an effective procedure for CSH.</p>