A (H1N1) Influenza Pneumonia with Acute Disseminated Encephalomyelitis:A Case Report

INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.

Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.RESULTSAbscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

Staphylococcus epidermidis meningitis in combination with acute disseminated encephalomyelitis A case report

A nine-year-old girl with Staphylococcus epidermidis meningitis combined with acute disseminated encephalomyelitis （ADEM） was enrolled in the present study, and exhibited sustained fever and headache for 5 days and a single seizure episode. Meningeal irritation and disturbance of consciousness were apparent. Cerebrospinal fluid examination revealed increased protein level and pleocytosis. Cerebrospinal fluid culture demonstrated Staphylococcus epidermidis growth. The patient was treated with intravenous cefotaxime, intravenous dexamethasone, and decreasing intracranial pressure for 3 weeks. Seizures and fever symptoms improved, but disturbance of consciousness, muscle weakness, and bilateral limb paresis were significant. IgG index was elevated and oligoclonal bands were positive in the cerebrospinal fluid. Magnetic resonance imaging demonstrated high T2-weighted signals in subcortical white matter, which were consistent with ADEM. High-dose methylprednisolone for 3 days and a 6-day pulse therapy with immunoglobulins resulted in improved clinical symptoms and cerebrospinal fluid examination. The patient＇s temperature dropped to normal, and the headache disappeared. A Staphylococcus epidermidis infection associated with ADEM is uncommon in children. Results suggested that Staphylococcus epidermidis infection could be a pathogenic factor for ADEM, and ADEM is a complication of Staphylococcus epidermidis meningitis.

The Coronavirus Pandemic Effects on Children

The Coronavirus pandemic has affected and impacted everyone. Some people may simply not want to admit it;however, it has affected each person in a specific way [1]. Children had to stay home from school and learn virtually. Parents had the additional stress of going to work, during the pandemic, and finding safe ways to collaborate with others, in order for companies to remain open and provide their services to customers. This pandemic has affected all;however, one age group was affected the most. This age group [2] includes all children. Children have been affected, primarily, in two ways, physically, as well as mentally. This article has the purpose of analyzing the effects of the pandemic that were imposed on children and helping others gain full knowledge. Having the full knowledge of these effects will help individuals to decide for themselves, the extent to which this rapidly spreading virus affected the next generation.

Magnetic Resonance Imaging in the Acquired Demyelinating Disorders： A Pediatric Cohort Study

Objective： Describing the characteristics of the MRI （magnetic resonance imaging） of patients with ADD （acquired demyelinating disorder） followed in a specialized pediatric clinic. Methods： Descriptive and retrospective study of the MRIs of a pediatric ADD cohort. The included images were acquired in machines with 1.5 or 3T magnets. Low-quality images were excluded. The radiological characteristics of the lesions were described using the 2010 Revised McDonald Diagnostic Criteria regarding localization, contrast enhancement and optic nerve alterations. Results： Twenty-three patients were included （55% female）. The mean age of the first clinical event was 7.7 years. Most common diagnosis was Clinically Isolated Syndrome （35%）, followed by Multiple Sclerosis （30%）, Neuromyelitis Optica （17%） and Acute Disseminated Encephalomyelitis （17%）. Mean time elapsed until diagnosis was 1.8 years. Follow-up MRIs of ADEM patients showed complete or partial resolution of lesions; MS lesions were mostly localized in the brain and four patients had contrast enhancement of lesions in their last available MRI. All NMO （neuromyelitis optica） patients had extensive spinal lesions, and two had optic neuritis. All patients with CIS （clinically isolated syndrome） had focal spinal lesions and evolved with radiologic improvement. Conclusions： ADEM and CIS patients＇ MRIs showed lesion reduction, while MS and NMO patients developed new lesions during follow-up.

Proteomic profiling of cerebrospinal fluid in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease

Background Myelin oligodendrocyte glycoprotein(MOG)antibody-associated disease(MOGAD)is an autoimmune demy-elinating disorder of the central nervous system.Methods Extracted proteins from 34 cerebrospinal fluid(CSF)samples[patients with MOGAD(MOG group,n=12);healthy controls(HC group,n=12);patients with MOG seronegative and metagenomics next-generation sequencing-negative inflammatory neurological diseases(IND group,n=10)]were processed and subjected to label-free quantitative proteomics.Supervised partial least squares-discriminant analysis(PLS-DA)and orthogonal PLS-DA(O-PLS-DA)models were also performed based on proteomics data.Functional analysis of differentially expressed proteins(DEPs)was performed using Gene Ontology,InterPro,and Kyoto Encyclopedia Genes and Genomes.An enzyme-linked immunosorbent assay was used to determine the complement levels in serum from patients with MOGAD.Results Four hundred and twenty-nine DEPs(149 upregulated and 280 downregulated proteins)were identified in the MOG group compared to the HC group according to the P value and fold change(FC).Using the O-PLS-DA model,872 differentially abundant proteins were identified with variable importance projection(VIP)scores>1.Five proteins(gamma-glutamyl hydrolase,cathepsin F,interalpha-trypsin inhibitor heavy chain 5,latent transforming growth factor beta-binding protein 4 and leukocyte-associated immunoglobulin-like receptor 1)overlapping between the top 30 DEPs with top-ranked P value and FC and top 30 proteins in PLS-DA VIP lists were acquired.Functional analysis revealed that the dysregulated proteins in the MOG group were primarily involved in complement and coagulation cascades,cell adhesion,axon guidance,and glycosphingolipid biosynthesis compared to the HC group.Conclusion The proteomic alterations in CSF samples from children with MOGAD identified in the current study might provide opportunities for developing novel biomarker candidates.

A case of anti-NMDA receptor encephalitis with ADEM-like clinical/MR findings

In recent years,anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis overlapping with demyelinating disorders has attracted more and more attention.The case is about a 52-year-old woman with anti-NMDAR encephalitis presenting acute disseminated encephalomyelitis(ADEM)-like clinical/magnetic resonance(MR)findings.Here,the authors report this case and briefly review her MR evolution and the conditions of her prognosis.The recognition that patients with anti-NMDAR encephalitis may have demyelinating disorders,simultaneously or sequentially,is important.Otherwise,a high dose of steroid treatment with several courses could obtain good effect,even if given in the late phase.