In this case, contezolid was successfully used to treat a centenarian male patient with a Vancomycin-resistant Enterococci induced biliary tract infection. Treatment was initiated with contezolid 800 mg every 12 hours for 14 days instead of linezolid due to a significant decrease in platelet count. After treatment, the patient's temperature normalized, the infection was effectively controlled, and organ function improved. There were no reports of infection recurrence or drug-related adverse reactions during a three-month follow-up period. This experience demonstrates the effectiveness and safety of contezolid in managing biliary tract infections.

Early neurological deterioration (END) is an unfavorable outcome of acute ischemic stroke and is associated with poor prognosis. Blood pressure variability has been suggested to be involved in the development of END. Therefore, the present study investigated the association between blood pressure variability and the development of END. In the present prospective observational study, 286 patients who developed acute ischemic stroke and then hospitalized within 24 h of stroke onset were recruited. Blood pressure parameters (systolic blood pressure, diastolic blood pressure and pulse pressure) were monitored using a 24 h ambulatory sphygmomanometer within 72 h of ischemic onset. Clinical characteristics were also recorded. Multivariate logistic regression analysis was used to analyze the possible relationship between blood pressure parameters and END after adjustment for confounders. Of the 286 patients in the present study, 64 (22.3%) developed END. Pulse pressure variables, including the mean of 24-h pulse pressure (24-h PPMEAN) and the mean of daytime pulse pressure (Day PPMEAN), were found to be higher in the END group compared with those in the non-END group (P<0.05). Multivariate logistic regression analysis revealed that the blood pressure parameters 24-h PPMEAN [odds ratio (OR), 1.08; 95% CI, 1.01-1.16; P=0.02) and Day PPMEAN (OR, 1.20; 95% CI, 1.011-1.45; P=0.04) were significantly associated with END. These findings suggest that the pulse pressure level fluctuations during the acute stage of ischemic stroke can serve important roles in the development of END, which worsens outcomes after stroke.

患者男性,56岁,主因"进行左侧肢体力弱5年,右上肢力弱1年"于2019年3月5日入院.患者5年前无明显诱因出现左上肢力弱,远端明显.4年前逐渐出现左下肢力弱,自觉左足行走费力,上下楼、蹲起活动正常.3年前发现双侧乳房发育.近2年间断出现双侧腹部肉跳感.1年前出现右上肢无力,手部力弱为主,伴双手小肌肉萎缩,手部用力时偶有麻木感.近1年出现吐字欠清,偶有饮水呛咳.患者肢体无力缓慢加重,症状无晨轻暮重、波动性特点.否认记忆力及认知减退,无头晕、呼吸困难、二便障碍.既往史、个人史及家族史:高血压、脂肪肝病史.间断少量饮酒30年.其母70余岁时出现肢体无力、震颤,未行基因检测,当地医院诊断"小脑萎缩".其他近3代直系亲属无类似肌无力病史.内科系统查体:心、肺、腹部查体未见异常,男性乳房发育.神经系统査体:神清,构音障碍,舌肌萎缩,可见舌肌纤颤.感觉系统查体无异常.颈屈肌肌力3级,双上肢肌力4级,左下肢4+级,右下肢5级;双侧肩胛带肌及前臂肌肉轻度萎缩;双手大小鱼际肌、骨间肌明显萎缩;双侧肌张力正常,四肢腱反射未引出,可见双上肢肌束震颤及姿势性震颤.双侧共济试验稳准,双侧病理征阴性.

Objective:To investigate the clinical phenotypes, imaging features and pathogenic variants of ANO10 gene related autosomal recessive spinocerebellar ataxia-10 (SCAR10).Methods:A cohort of 30 probands of autosomal recessive cerebellar ataxia pedigrees from China-Japan Friendship Hospital from 2018 to 2020 were collected. Friedreich ataxia and other causes of acquired ataxia were excluded, then probands were detected by whole-exome sequencing (WES), and potential pathogenic variants were confirmed by Sanger sequencing and validated in all family members. Clinical phenotypes and auxiliary examinations of the patients were analyzed in detail.Results:A pedigree of SCAR10 caused by ANO10 gene mutations was identified through WES. The 40-year-old male proband of this pedigree carried compound heterozygous mutations: c.1219-2A>C and c.1163-2A>G of the ANO10 gene, both of which were novel mutations, and Sanger sequencing revealed these two mutations were respectively inherited from his healthy parents. Bioinformatic analysis predicted these two mutations were pathogenic. The proband exhibited progressive unsteady walk, dysarthria, mild cognitive impairment. His plasma total coenzyme Q 10 was decreased (0.76 μg/ml). Brain magnetic resonance imaging showed remarkable cerebellar atrophy. Conclusions:Through WES, a SCAR10 patient caused by novel compound heterozygous mutations of ANO10 gene was identified, which is rare in China. The main clinical manifestation was progressive cerebellar ataxia and cognitive decline, and brain image showed remarkable cerebellar atrophy.

目的 探讨SETX基因突变相关的共济失调伴眼动失用2型一家系患者的临床特征及基因突变特点.方法 总结中日友好医院神经科门诊收治的一来自非近亲结婚家系的共济失调家系患者的临床特征及辅助检查结果.应用全外显子测序技术对患者进行基因检测,结合一代测序对患者及家系成员进行突变位点验证.结果 先证者表现为进行性步态不稳、构音障碍、眼动失用、轻度认知功能减退,血清甲胎蛋白水平升高,肌电图检查提示多发性周围神经病,头颅磁共振平扫可见明显小脑萎缩.全外显子测序发现该患者存在复合杂合突变c.5591_5592delAA(p.Q1864Rfs*34)及c.6638C>T(p.P2213L),一代测序家系验证显示两个突变分别来自其父母.结论 共济失调伴眼动失用2型在中国人群罕见,通过特征性的临床表型结合全外显子测序技术有助于快速诊断该病.

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may target the central nervous system and several neurological symptoms have been reported in patients with coronavirus disease 2019 (COVID-19). In the present study, a case of a SARS-CoV-2 complicated with meningoencephalitis was reported. Cerebrospinal fluid (CSF) analyses indicated hyperproteinorrachia but the specimen was negative for SARS-CoV-2 RNA. Furthermore, 10 published articles reporting on patients with COVID-19-associated meningitis/encephalitis were reviewed. Patients diagnosed with COVID-19-associated meningitis/encephalitis had diverse clinical neurological manifestations, including consciousness disturbance, epileptic attacks, psychotic syndrome and meningeal irritation signs. CSF tests revealed elevated protein, lymphocytes and cytokines. SARS-CoV-2 may be detected in the CSF of certain cases. Neuroimaging findings included hyperintense signal changes in the white matter and enhancement of meninges on brain MRI. Certain patients responded well to corticosteroid therapy and had a favorable prognosis, while elderly patients tended to have poor outcomes due to multiple organ dysfunction.

患者男性,71岁,2015年5月16日因"头晕、恶心呕吐4d"就诊于我院.患者4d前无诱因出现恶心呕吐,伴头晕、表现为头部昏沉感,无明显视物旋转、耳鸣等症状.此后反复出现头晕伴恶心呕吐.3d前出现右侧肢体力弱,行走不稳,肢体无力症状逐渐加重,就诊于我院急诊科.行头部CT示左侧丘脑区低密度病变,肿胀,大脑大静脉、直窦、横窦密度增高,考虑不除外脑静脉血栓形成.给予甘露醇脱水降颅压、补液、前列地尔改善脑循环治疗,为求进一步诊治收入院.既往史:否认高血压、糖尿病、心脏病、脑血管病等相关慢性疾病史.

目的:探讨血浆置换治疗超晚发型视神经脊髓炎谱系疾病(VLONMOSD)的有效性和安全性.方法:回顾分析中日友好医院2013年11月～2019年11月收治的3例确诊为视神经脊髓炎谱系疾病(NMOSD)的超晚发型患者(发病年龄≥75岁)应用血浆置换(PE)的疗效与安全性.结果:3例患者中2例女性,1例男性,首次发病年龄分别为78岁、77岁、76岁,PE年龄分别为82岁、77岁、76岁,PE平均年龄78.3岁.共计4次发作应用PE治疗,其中3次为横贯性脊髓炎(TM)发作,1次为视神经炎(ON),例2的ON发作和例3的1次TM发作首选静脉滴注甲泼尼龙冲击无效后给予PE挽救治疗.3次TM发作经治疗后症状改善,例1的第二次TM复发症状显著改善,第一次TM复发症状轻度改善;例3的TM发作治疗后症状轻度改善,例2的1次ON发作经治疗后视力无明显改善.PE的不良反应依次为:血压下降、肝素相关性血小板计数减少,均为短暂且可逆性,未发生导致治疗终止的严重不良反应.结论:PE可作为VLONMOSD患者的首选或补救治疗措施,安全性基本良好.