In addition to respiratory symptoms, COVID-19 can also cause acute and long-term symptoms of the central nervous system, peripheral nervous system and muscular system. This article reviews the epidemiological characteristics, clinical manifestations and treatment methods of acute COVID-19 related cerebrovascular diseases, nervous system inflammatory diseases and encephalopathy, in order to provide references for clinical management of COVID-19 patients.

Objective:The present study aimed to explore the clinical value of neutrophil to lymphocyte and platelet ratio (NLPR) for acute kidney injury (AKI) in elderly patients with sepsis.Methods:This was a retrospective analysis of 360 elderly patients with sepsis or septic shock who were admitted to Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University. They were divided into AKI and non-AKI groups based on the KDIGO-AKI criteria. The independent risk factors of AKI were identified via logistic regression analysis, and the calculation of the receiver-operating characteristic (ROC) curves were used to evaluate the diagnostic capability of NLPR for AKI and the short-term outcome of sepsis patients.Results:Total of 195 (54.2%) patients were attributed to the AKI group, while 165 (45.8%) patients were allocated to the non-AKI group. The median of NLPR was significantly higher in the AKI group compared with the non-AKI group ( Z=8.640, P<0.001). Compared with the non-AKI group, the in-hospital death and the length of ICU stay increased (all P<0.05). Patients with AKI required more vasoactive drugs, mechanical ventilation, and renal replacement therapy (all P<0.05). After adjusting the demographic and clinical variables, multivariate logistic regression analysis showed that NLPR was an independent risk factor of AKI ( OR=1.016, 95% CI 1.002-1.030, P=0.027). The ROC curves showed the excellent clinical value of NLPR and which was significantly higher than the neutrophil to lymphocyte ratio (NLR) and serum creatinine. In addition, the present study revealed that the NLPR was also positively correlated with the stage of AKI ( r=0.525, P<0.001). Conclusions:The NLPR is derived from a complete blood cell count, as a new comprehensive inflammatory parameter that is simple and easily available, it is an independent risk factor for AKI in elderly sepsis patients, and should be paid attention in the clinical practice.

Objective:To investigate the effect of Lee Silverman voice therapy (LSVT) on the speech and life quality of Chinese persons with Parkinson′s disease (PD).Methods:A total of 16 Chinese PD patients were enrolled and given standard LSVT for 4 weeks. Their acoustic data were analyzed using PRAAT software before and after the treatment. Their voice quality was evaluated using the Japanese GRBAS voice scale and their quality of life was quantified using the Voice Handicap Index (VHI) scale.Results:After 4 weeks of LSVT the patients′ average voice and life quality had improved significantly. The average maximum duration of sustained vowel phonation had increased significantly, as had the vowels′ mean loudness, reading and monologue delivery. The GRBAS grading indicated that hoarseness had decreased significantly. The average total voice handicap index had also decreased significantly.Conclusion:Lee Silverman therapy can significantly improve maximum phonation time and loudness of Chinese-speakers, which enhances sensory feedback. The quality of their speech and of their life also improve significantly. This technique is recommended for clinical application.

Neurology is a professional science. The content of neurotomia, sub-speciality knowl-edge and auxiliary examination are abundant, and meanwhile it is rather difficult. Clinical graduates after graduation are malnly engaged in clinical work, clinical services, and will play a variety of roles in the course of their clinical practice so it is necessary for them to learn comprehensive knowledge. This article introduced experience of clinical postgraduates tralning of neurology, such as doctor-patient communication skills, basic theoretical study (neurology, neurotomia and sub-speciality knowledge), clinical thinking, and assistant examination, clinical research capacity during these 18month. It will provide the theoretical and practical knowledge in the future work.

Objective To explore the relationship between ERG4 gene overexpression and azole resistance in clinical Candida albicans strains. Methods The National Committee for Clinical Laboratory Standards (NCCLS)M27-A2 broth microdilution method was conducted to evaluate antifungal susceptibility of 34 clinical Candida albicans isolates in vitro. Total RNA was extracted from these Candida albicans strains and transcribed into cDNA. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of ERG4 gene. Statistical analysis was carried out by a two-sample t-test. Results The expression level of ERG4 mRNA was significantly higher in fluconazole-resistant than in -sensitive Candida albicans strains (4.20 ± 2.56 vs. 1.72 ± 1.33, t = 3.99, P < 0.05), higher in itraconazole-resistant than in -sensitive Candida albicans strains (3.60 ± 2.47 vs. 1.66 ± 1.61, t = 3.71, P < 0.05), and higher in voriconazole-resistant than in -sensitive Candida albicans strains (3.99 ± 2.72 vs. 2.07 ± 1.58, t = 2.91, P <0.05). Further more, increased ERG4 mRNA expression was also observed in isolates cross-resistant to all the three azole antifungal agents compared with those susceptible to all of them (4.49 ± 2.73 vs. 1.69 ± 1.82, t = 3.81, P < 0.05). Conclusions The overexpression of ERG4 gene may be associated with cross resistance to fluconazole, itraconazole and voriconazole in clinical Candida albicans strains, but its exact role is expected to be investigated through downregulation of the ERG4 gene.

Objective To study the effects and security of umbilical cord mesenchymal stem cells transPlantation (UC-MSCs) for Patients with refractory systemic luPus erythematosus(SLE). Methods Forty Patients with refractory SLE were divided into two grouPs at random.All of Patients were treated for glucocorticoid and CTX, then Patients of the 2 grouP were transPlanted for UC-MSCs.All of Patients were observed before and 2 weeks after treatment,1 month,2 months,3 months,6 months,9 months and 12 months of clinical manifestations and laboratory Parameters . Results 2 weeks after treatment, 60%of the 1 grouP were SLEDAI<10 scores, and the 2 grouPs were 90%. There was statistically significant difference between the two grouPs (χ2=7.619, P=0.006). 1 year after treatment, PLT,ALB and C3 of the 2 grouPs were more than the 1 grouPs(P<0.05). SLEDAI,U-Pro,ESR and Hs-CRP of the 1 grouPs were more than the 2 grouPs(P<0.05). WBC,Cr and C4 of the two grouPs had not statistically significant difference(P﹥0.05). The recurrence rate of the 1 grouPs was 45%. Of the 2 grouPs was 15%.There was statistically significant difference between the two grouPs (χ2=4.286, P=0.038). Conclusion It is effective and safe for refractory SLE to transPlant UC-MSCs after using glucocorticoid and CTX. Further observation is required to evaluate long term efficacy and adverse reaction of UC-MSCs.

Objective The aim of this study was to investigate the diagnostic impact of polymerase chain reaction (PCR) assays for fungal pathogens in fluid samples,and to evaluate the feasibility of fast PCR diagnostic method for the invasive fungal infection.Methods The sterility body fluid samples from 60 cases hospitalized immunocompromised patients with clinical underlying diseases and suspect of invasive infections with fungi between January 2008 and December 2011 were processed for microscopy and cultures.Applying fungal ITS4 and ITS86 universal primers to amplify pathogenic fungi genes from the sterility body fluid with method of rapid PCR.The results were compared between the standard and PCR methods.Results Humoral direct clinical specimens by PCR amplification of DNA fragments with the scan results were similar.Positive rate of PCR test with clinical body fluid samples and the traditional fungal cultivation was similar.There was no significant statistical difference [38.3％ (23/60) vs 33.3％ (20/60),P ＞ 0.05].Conclusions PCR test is feasibility with clinical fungal diagnosis from directly humoral specimens.To amplify the clinical sterility body fluid samples with ITS fungal universal primers and PCR method might provide an accurate and rapid approach to detect the pathogenic fungi.Its methods on early diagnosis and prognosis of invasive fungal infections are of guiding significance.

Objective To investigate the epidemiology and relevant risk factors of invasive fungal infection (IFI) in hospital old patients for non-respiratory tract. Methods Seventy-eight patients of IFI in non-respiratory tract were enrolled in this investigation. The incidence and risk factors of IFI were analyzed by prospective case-control study. Results In 78 old patients, 84 strains were isolated from different parts, and the most was Candida spp 82 strains (97.62%,82/84), followed by Candida albicans 55 strains (67.07%,55/82), Candida glabrata 13 strains ( 15.85%, 13/82), Candida krusei 6 strains (7.32%, 6/82), Candida tropicalis 4 strains (4.88% ,4/82), Candida parapsilosis 3 strains (3.66% ,3/82), Candida lusitaniae 1 strain ( 1.22%, 1/82). Aspergillus 2 strains (2.38%,2/84). Multivariate Logistic regression analysis showed that age, pathogen detection time, underlaying disease,glucocorticoids, immunosuppressants were the risk factors for IFI in non-respiratory tract. Conclusions Candida albicans is the main pathogens of Candida infections in old patients. To efficiently control the risk factors should be emphasized in old patients, including early diagnosis and treatment underlying diseases, appropriate use drugs, right to shorten hospital stay.

Objective To investigate the etiology features and relevant risk factors of non-albicans candida infections in hospital. Methods 256 patients of non-albicans candida infections admitted in the second hospital of shanxi medical university from April 2006 to March 2008 were enrolled in this investigation, and a prospective case-control study was executed on 256 cases of non-albicans candida infections and 1220 cases of non-fungal infections. The incidence and risk factors of non-albicans candida infections were analyzed by statistical software SPSS13.0. Results Candida glabrata was the most common reason of non - albicans candida infections (38. 28% ) , followed by candida krusei (37. 11% ), candida parapsilosis ( 12. 50% ), candida tropicalis (9. 77% ), candida lusitaniae (2. 34% ). Univariate analysis and multivariate logistic regression analysis showed that aging, length of stay, underlying disease, losing albumin, using prophylaxis antifungal drugs, using broad spectrum antibiotics, invasive examination and treatment ( such as total parenteral nutrition ( TPN ), invasive procedures, central venous catheters, hemodialysis and mechanical ventilation,et al. ) were the independent risk factors for non-albicans candida infections. Conclusions Non-albicans candida was the main of fungal infections in patients. To efficiently control the disease, it will be helpful by early diagnosis and treatment underlying diseases and commodities and using appropriate tools of examine and treatment methods.

ion sections were not significantly different between 2005 and 2006, the rest inter-annual comparisons were significantly different (P<0.01).