Metabotropic glutamate receptor 5-related autoimmune encephalitis with reversible splenial lesion syndrome following SARS-CoV-2 vaccination.

RATIONALE: Metabotropic glutamate receptor 5 (mGluR5)-related autoimmune encephalitis (AE) has been rarely reported; however, there are no reports on mGluR5-related AE with reversible splenial lesion syndrome following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PATIENT CONCERNS: A 29-year-old man was admitted with a history of headache and fever for 9 days and 6 days, respectively. DIAGNOSIS: He was initially diagnosed with an intracranial infection, however the final diagnosis was corrected as anti-mGluR5-related AE with reversible splenial lesion syndrome. INTERVENTIONS: He had received an inactivated SARS-CoV-2 vaccine 3 weeks prior to the examination and was initially diagnosed with an intracranial infection. Physical examination revealed bilateral horizontal nystagmus, ataxia, and neck rigidity. Antiinfective therapy was minimally helpful. An analysis of the cerebrospinal fluid did not reveal pathogens for sequencing. Magnetic resonance imaging displayed abnormal signals in the splenium of the corpus callosum. OUTCOMES: We identified mGluR5 antibodies in the cerebrospinal fluid and serum. Subsequently, intravenous methylprednisolone pulse and gamma-globulin pulse therapies were administered, which substantially improved the symptoms. Follow-up did not reveal abnormal neurological symptoms, and the lesion in the corpus callosum had resolved. LESSONS: AE with mGluR5 antibodies could arise from SARS-CoV-2 vaccination, which warrants the awareness of healthcare workers. Reversible splenial lesion syndrome may accompany mGluR5-related AE and mimic intracranial infection. Thus, early treatment can prevent serious residual signs and symptoms.

How much urban air quality is affected by local emissions: A unique case study from a megacity in the Pearl River Delta, China

In March 2022, the resurgence of COVID-19 cases in Shenzhen, a megacity in the Pearl River Delta (PRD) region of China, led to unusual restrictions on anthropogenic activities within a single city, in contrast to the restrictions COVID-19 caused on a national scale at the beginning of 2020. In this unique event, we found that only under unfavorable meteorological conditions did substantial urban local emission reductions have an impact on air pollutant changes (−42.4%–6.6%), whereas the deweathered changes were very small (−8.3%–3.4%) under favorable meteorological conditions. Primary anthropogenic pollutants, such as NO2, toluene, BC, and primary organic aerosol (POA), responded most considerably to emission reductions from early morning to noon during unfavorable meteorological days;for secondary organic aerosol (SOA), regulating the daytime total oxidant (Ox = O3 + NO2) was found to be more effective than controlling its precursors within the city scale, whereas secondary nitrate displayed the opposite trend. Since Ox changed little during the urban lockdown despite the remarkable decrease in precursors, it is emphasized that regionally coordinated control of VOCs and NOx is necessary to effectively reduce Ox levels. In addition, Shenzhen's NOx emission reduction efforts should be sustained in order to control PM2.5 and O3 pollution synergistically for long-term attainment.

X-linked Charcot-Marie-Tooth disease after SARS-CoV-2 vaccination mimicked stroke-like episodes: A case report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vaccinations on individuals with X-linked Charcot-Marie-Tooth disease type 1 (CMTX1) is unclear. Patients with CMTX1 can have stroke-like episodes with posterior reversible encephalopathy syndrome on magnetic resonance imaging (MRI), although this is rare. CASE SUMMARY: A 39-year-old man was admitted with episodic aphasia and dysphagia for 2 d. He received SARS-CoV-2 vaccination 39 d before admission. Physical examination showed pes cavus and reduced tendon reflexes. Brain MRI showed bilateral, symmetrical, restricted diffusion with T2 hyperintensities in the cerebral hemispheres. Nerve conduction studies revealed peripheral nerve damage. He was diagnosed with Charcot-Marie-Tooth disease, and a hemizygous mutation in the GJB1 gene on the X chromosome, known to be pathogenic for CMTX1, was identified. Initially, we suspected transient ischemic attack or demyelinating leukoencephalopathy. We initiated treatment with antithrombotic therapy and immunotherapy. At 1.5 mo after discharge, brain MRI showed complete resolution of lesions, with no recurrence. CONCLUSION: SARS-CoV-2 vaccination could be a predisposing factor for CMTX1 and trigger a sudden presentation.

Parental Attitudes Towards Vaccination Against COVID-19 in China During Pandemic.

Purpose: The Chinese government has authorized the emergency use of an inactivated vaccine for COVID-19 in children and adolescents aged 3 to 17 years. This study aimed to investigate parents' attitudes towards vaccinating their children against COVID-19 and influencing factors. Patients and Methods: Through an online questionnaire survey, we collected self-reported children's demographic characteristics, physical conditions and parents' attitudes towards COVID-19 vaccination for children. The parents in the unwilling group received online consultation about the benefits and risks of COVID-19 vaccine and were asked to complete the questionnaire again. Results: A total of 868 participants were recruited from July 2021 to August 2021 in Nanjing, China. Overall, 76.0% of parents were willing to accept vaccination for children. Parents' willingness increased with children's age (P=0.018) and height (P=0.034), but decreased if the children fell sick within previous one month (P=0.030). Most of the unwilling parents gave a higher score to the risk of vaccination (53.76 VS 40.18). Unsafety (63.8%) and unfamiliarity (24.0%) were their major concerns. After consultation with a health worker, 24% of the unwilling parents turned willing. Conclusion: Children's age and recent physical condition are related to parents' attitudes towards vaccination for children against COVID-19. The major concerns of parents are unsafety and unfamiliarity. Parents view health workers as a reliable source of vaccine information. A successful consultation with health workers to understand the benefits and risks of vaccination can increase parents' willingness. This study provides insight into parents' attitudes towards vaccination for children against COVID-19 in China and related influencing factors. Our findings could be referenced in establishing policies for vaccinating children against COVID-19 in China.

Decisive role of ozone formation control in winter PM2.5 mitigation in Shenzhen, China.

During the COVID-19 lockdown, atmospheric PM2.5 in the Pearl River Delta (PRD) showed the highest reduction in China, but the reasons, being a critical question for future air quality policy design, are not yet clear. In this study, we analyzed the relationships among gaseous precursors, secondary aerosols and atmospheric oxidation capacity in Shenzhen, a megacity in the PRD, during the lockdown period in 2020 and the same period in 2021. The comprehensive observational datasets showed large lockdown declines in all primary and secondary pollutants (including O3). We found that, however, the daytime concentrations of secondary aerosols during the lockdown period and normal period were rather similar when the corresponding odd oxygen (Ox≡O3+NO2, an indicator of photochemical processing avoiding the titration effect of O3 by freshly emitted NO) were at similar levels. Therefore, reduced Ox, rather than the large reduction in precursors, was a direct driver to achieve the decline in secondary aerosols. Moreover, Ox was also found to determine the spatial distribution of intercity PM2.5 levels in winter PRD. Thus, an effective strategy for winter PM2.5 mitigation should emphasize on control of winter O3 formation in the PRD and other regions with similar conditions.

Curricular Considerations: The Process of Integrating Simulation-Based Learning Into a Social Work Communication and Interviewing Skills Course

Simulation-based learning (SBL) is used as an educational tool within health professions education disciplines, including medicine and nursing. More recently, SBL has been applied within social work education as a growing body of research, demonstrating its efficacy in teaching social work competencies. SBL provides students with safe and practical opportunities to apply their skills within highly realistic settings. The growing body of literature on SBL within social work education informed the development of a new Bachelor of Social Work (BSW) course focused on communication and interviewing skills at Wilfrid Laurier University. The purpose of this editorial is to provide an example of a collaborative process for integrating simulation as a pedagogy within course design. This collaborative process involved four stages: designing the course, preparing, and revising the simulations, facilitating the simulations, and evaluating student learning and experience. This editorial may assist instructors by providing a pedagogical framework for incorporating SBL into both new and existing curricula.

Chinese Parent Intention to Vaccinate Children With Special Diseases Against COVID-19.

Background: Information on the intention of parents of children with special diseases to vaccinate their children against coronavirus disease 2019 (COVID-19) is scarce. Methods: In this survey, all participants (n = 914) were enrolled from a tertiary children's hospital between September 2020 and April 2021. A face-to-face questionnaire interview was conducted to collect information on the special diseases of children and parental attitudes about the COVID-19 vaccine. We compared the demographic and disease factors between the group of parents who were willing to vaccinate their children against COVID-19 and the group who were unwilling to vaccinate. Results: Among 941 children, 58.1% (n = 547) were boys. The Mean age was 1.4 (SD 1.9) years. If the COVID-19 vaccine becomes available for the child, 470 (49.9%) of parents were willing to provide vaccination for their children. The less the education levels of the father or mother, the more likely they were to vaccinate their children (P = 0.003, P = 0.007). However, more intentions to vaccinate were provided in parents of children with COVID-19 prevention and control education (P < 0.001). Conclusion: Our findings provided evidence that some parents are willing to vaccinate their children with special diseases against COVID-19. Professional knowledge about COVID-19 prevention and control may contribute to increased parental intention.

Critical Role of Simultaneous Reduction of Atmospheric Odd Oxygen for Winter Haze Mitigation.

The lockdown due to COVID-19 created a rare opportunity to examine the nonlinear responses of secondary aerosols, which are formed through atmospheric oxidation of gaseous precursors, to intensive precursor emission reductions. Based on unique observational data sets from six supersites in eastern China during 2019-2021, we found that the lockdown caused considerable decreases (32-61%) in different secondary aerosol components in the study region because of similar-degree precursor reductions. However, due to insufficient combustion-related volatile organic compound (VOC) reduction, odd oxygen (Ox = O3 + NO2) concentration, an indicator of the extent of photochemical processing, showed little change and did not promote more decreases in secondary aerosols. We also found that the Chinese provinces and international cities that experienced reduced Ox during the lockdown usually gained a greater simultaneous PM2.5 decrease than other provinces and cities with an increased Ox. Therefore, we argue that strict VOC control in winter, which has been largely ignored so far, is critical in future policies to mitigate winter haze more efficiently by reducing Ox simultaneously.

Bronchial Fistula: Rare Complication of Treatment with Anlotinib.

BACKGROUND: Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS: We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS: Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS: Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.