Eclampsia with hypothyroidism complicated with posterior reversible encephalopathy syndrome-a case report.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with complex physiopathological mechanisms that have not been fully understood. Early identification is of great prognostic significance, of which the symptoms and radiological abnormalities can be completely reversed. If the diagnosis and treatment are delayed, ischemia and massive infarction may be developed in some patients. Posterior reversible encephalopathy syndrome (PRES) has been reported mainly in association with postpartum eclampsia, which have been rarely reported, while the association with hypothyroidism has not been reported at home or abroad. CASE PRESENTATION: Here we report on a pregnant 29-year-old with multipara and a chief complication of hypothyroidism. She presented in the emergency department with frequent attacks of severe headache symptoms resulting from reversible cerebral vasoconstriction syndrome (RCVS), accompanied with prenatal eclampsia. PRES was determined by radiological examination. CONCLUSION: To the best of our knowledge, this is the first case of PRES complicated by hypothyroidism and prepartum eclampsia.Clinicians should be alert for the co-occurence of eclampsia, PRES, and RCVS when patients have convulsions after a typical throbbing headache. Moreover, regular monitoring of thyroid function during pregnancy should also occupy certain special attention.

Dynamics in fermentation quality, bacterial community, and metabolic profile during silage fermentation of late-harvested elephant grass.

The present study aimed to evaluate the effects of delayed harvest and storage length on fermentation products, bacterial community, and metabolic shifts of elephant grass silage. The late-harvested elephant grass (LG) was naturally fermented (NLG) for 1, 3, 7, 15, 30, and 60 days, respectively. After 60-day ensiling, NLG displayed homolactic fermentation with low pH value, butyric acid, and ammonia nitrogen concentrations, and high lactic acid concentration, and ratio of lactic acid to acetic acid. Pseudomonas, Sphingomonas, and Pantoea dominated the bacterial community in LG, but Lactobacillus, Lactococcus, and Pediococcus were the advantageous genera in a 3-day and 60-day NLG. The correlation heatmap revealed that Acetobacter was positively related to acetic acid, ethanol, ammonia nitrogen, and butyric acid concentrations. There were distinct differences in the KEGG (Kyoto Encyclopedia of Genes and Genomes) metabolic profiles of fresh and ensiled LG. Ensiling suppressed the metabolism of amino acid, vitamins, and energy, while promoted the metabolism of carbohydrate. The LG can be well-fermented without additives, but its low crude protein content should not be ignored when applied in agricultural practice. The ensiling process remarkably affected the fermentation quality, bacterial community, and metabolic profiles of NLG.

The effect of MicroRNAs variants on idiopathic recurrent pregnancy loss.

BACKGROUND: Although the importance of miRNA variants in female reproductive disorders has been frequently reported, the association between miRNA polymorphisms and recurrent pregnancy loss (RPL) has been poorly studied. In this study, we aimed to assess the correlation of four different miRNA variants to unexplained RPL. METHODS AND RESULTS: The prevalence of four SNPs including miR-21 rs1292037, miR-155-5p rs767649, miR-218-2 rs11134527, and miR-605 rs2043556 in 280 cases with iRPL and 280 controls was performed. The DNA was extracted from all subjects and the SNPs were genotyped using RFLP-PCR methods. The data revealed that rs1292037 and rs767649 were significantly associated with higher rates of iRPL in patients compared with controls while rs11134527 and rs2043556 showed no association with increased rates of iRPL among patients. The haplotypes T-A-G-G and T-A-G-A were the most frequent in both cases and controls. Three haplotypes including T-T-G-A, C-T-G-G, and T-A-A-A showed significantly different frequencies in patients in comparison to healthy females. CONCLUSION: This study suggests that rs1292037 and rs767649 could be risk factors for increased rates of iRPL.

The effects of epiphytic microbiota and chemical composition of Italian ryegrass harvested at different growth stages on silage fermentation.

BACKGROUND: The influence of epiphytic microbiota and chemical composition on fermentation quality and microbial community of Italian ryegrass silage was evaluated. Italian ryegrass harvested at the filling stage (FS) and the dough stage (DS) was sterilized by gamma-ray irradiation and inoculated as follows: (I) FS epiphytic microbiota + irradiated FS (FF); (II) FS epiphytic microbiota + irradiated DS (FD); (III) DS epiphytic microbiota + irradiated DS (DD); (IV) DS epiphytic microbiota + irradiated FS (DF). RESULTS: After 60 days of ensiling, silage made from irradiated FS had a lower pH and ammonia nitrogen (NH3 -N) content and a higher lactic acid (LA) content than that made from irradiated DS. Similarly, silage inoculated with the epiphytic microbiota of DS had a lower pH and NH3 -N content and a higher LA content than that inoculated with the epiphytic microbiota of FS. However, LA-type fermentation (lactic acid:acetic acid > 2:1) was presented at DF and DD. The principal coordinates analysis showed that the distance between FF and DF and FD and DD was closer than other treatments, suggesting that the microbial community of silages made from irradiated FS (or DS) was more similar. CONCLUSION: The epiphytic microbiota played a more important role in the fermentation type, whereas the chemical composition had a great influence on the contents of fermentation end-products. However, chemical composition had a stronger effect on the microbial community of silage than the epiphytic microbiota. © 2022 Society of Chemical Industry.

Evaluation of molasses on fermentation profiles of wheat straw ensiled with tall fescue in the southwest Tibet.

Two experiments were carried out to determine the optimal proportion of mixed silage made with wheat straw and tall fescue, and further to evaluate the effects of molasses on fermentation quality. In Experiment 1, wheat straw and tall fescue were mixed at proportions of 10:0 (Control), 8:2 (WT20), 6:4 (WT40) and 4:6 (WT60) on fresh weight (FW) basis. Inclusion of tall fescue significantly (p < 0.05) increased lactic acid, water-soluble carbohydrate contents and ratio of lactic to acetic acid, and significantly (p < 0.05) decreased pH and contents of dry matter, NH3 -N and volatile fatty acids. WT60 had the highest (p < 0.05) lactic acid content, and the lowest (p < 0.05) pH and butyric acid content. In Experiment 2, the mixture of wheat straw and tall fescue (4/6) were treated with 0%, 3%, 4% and 5% molasses on FW basis (defined as control, WTM3, WTM4 and WTM5 respectively). Molasses addition significantly (p < 0.05) increased lactic acid and water-soluble carbohydrate contents, and significantly (p < 0.05) decreased pH and ammonia-nitrogen content as compared with control. Acetic acid content slightly (p > 0.05) decreased during ensiling, while trace amounts of propionic and butyric acids were observed. WTM5 had the lowest pH and the highest (p < 0.05) lactic acid, water-soluble carbohydrate contents and ratio of lactic to acetic acid at end of ensiling. In conclusion, the fermentation quality was maximally improved when the addition rate of molasses was 5% in 40% wheat straw ensiled with 60% tall fescue.

Effects of wet brewers grains on fermentation quality and in vitro ruminal digestibility of mixed silage prepared with corn stalk, sweet potato peel and dried apple pomace in southeast China.

The effects of wet brewers grains (WBG) on fermentation quality, chemical composition and in vitro ruminal digestibility of mixed silages prepared with corn stalk, dried apple pomace and sweet potato peel were evaluated. A mixture of corn stalk, sweet potato peel and dried apple pomace (50/30/20) was ensiled with 0, 10%, 20% and 30% WBG on a fresh weight (FW) basis for 1, 3, 5, 7, 14 and 30 days respectively. The results showed that the application of WBG increased (p < 0.05) lactic acid, acetic acid and total volatile fatty acids contents, and decreased (p < 0.05) pH, dry matter, water-soluble carbohydrates content and ammonia-nitrogen/total nitrogen during ensiling. The pH in all silages was below 4.03 during ensiling. Treating with WBG increased (p < 0.05) crude protein content, and decreased (p < 0.05) neutral detergent fibre, acid detergent fibre, cellulose and hemicellulose content after 30 days of ensiling. After 72 h of incubation, cumulative gas production, potential gas production and in vitro crude protein digestibility increased (p < 0.05) with the increasing proportions of WBG. However, in vitro digestibility of dry matter and neutral detergent fibre, and metabolisable energy were similar in all silages. The 20% and 30% WBG-treated silages showed better fermentation quality and greater or higher in vitro digestibility, which were indicated by greater or higher (p < 0.05) lactic acid content, in vitro crude protein digestibility, and lower (p < 0.05) pH, ammonia-nitrogen/total nitrogen ratio as compared with the control. Therefore, ensiling agro-food by-products with at least 20% WBG were recommended for improving fermentation quality.

Clinical efficacy and the influence of fibrinogen, homocysteine and prognosis in acute ischemic stroke patients treated with tirofiban plus TERVO stent thrombectomy.

To evaluate the clinical efficacy and the influence of fibrinogen, homocysteine and prognosis in acute ischemic stroke (AIS) treated with tirofiban plus TERVO stent thrombectomy. A retrospective study was conducted among 82 patients with AIS admitted to the Department of Neurology in Hengshui People's Hospital from December 2018 to December 2020 and they were evenly divided into control group and study group according to different methods. The control group received TERVO stent thrombectomy; the study group received tirofiban plus. The clinical efficacy, modified thrombolysis in cerebral infarction (mTICI) grade, serum levels of fibrinogen and homocysteine, National Institute of Health stroke scale (NIHSS), and activity of daily living (ADL) scores were compared. Significant higher clinical efficacy was observed in the study group vs. control group (all p<0.05). The study group witnessed lower percentage of 0~1 grade of mTICI blood flow in relative to the control group (all p<0.05). After treatment, significant reduction was observed in FIB and HCY in both groups, but the treatment in the study group resulted in a greater reduction (all p<0.05). After treatment, both groups reported a significant increase in NIHSS score and ADL score, with more increase in the study group (all p<0.05). The safety profiles were similar in the two groups with respect to the adverse reactions (p>0.05). Tirofiban plus TERVO stent thrombectomy could improve vascular recanalization rate, reduce fibrinogen and homocysteine levels and improve short-term prognosis in AIS patients.

Separating the chemical and microbial factors of oat harvested at two growth stages to determine the main factor on silage fermentation.

AIMS: This work evaluated the effects of epiphytic microbiota and chemical components on fermentation quality and microbial community of ensiled oat. METHODS AND RESULTS: Oat harvested at the heading stage (HS) and the milk stage (MS) was sterilized by gamma-ray irradiation and inoculated as the following: (1) HS epiphytic microbiota + sterilized HS (H-H); (2) MS epiphytic microbiota + sterilized HS (M-H); (3) MS epiphytic microbiota + sterilized MS (M-M); and (4) HS epiphytic microbiota + sterilized MS (H-M). After 60-day fermentation, silages inoculated with the epiphytic microbiota of HS had higher acetic acid content than those inoculated with MS. Silage made from sterilized MS had lower pH, ammonia nitrogen and butyric acid contents and higher dry matter, water-soluble carbohydrates and lactic acid contents than that made from sterilized HS. The microbial communities of oat silages were similar, and they were mainly Lactobacillus. CONCLUSIONS: The chemical component rather than the epiphytic microbiota at harvest exerted more effects on oat silages. SIGNIFICANCE AND IMPACT OF THE STUDY: This work reveals the different effects of chemical and microbial factors on the fermentation of silage, which is instructive for us to produce quality silage.

Using γ-ray irradiation and epiphytic microbiota inoculation to separate the effects of chemical and microbial factors on fermentation quality and bacterial community of ensiled Pennisetum giganteum.

AIMS: This study aimed to separate the effects of chemical and microbial factors on the fermentation quality and bacterial community of ensiled Pennisetum giganteum. METHODS AND RESULTS: Fresh P. giganteum of two vegetative stages (stage I, GI ; stage II, GII ) was treated as follows: GI epiphytic microbiota + Î³-ray presterilized GI (MI CI ), GII epiphytic microbiota + Î³-ray presterilized GI (MII CI ), GI epiphytic microbiota + Î³-ray presterilized GII (MI CII ), and GII epiphytic microbiota + Î³-ray presterilized GII (MII CII ). Triplicates per treatment were sampled after 30 days of ensiling for chemical and microbial analyses and high-throughput sequencing. Silages made from CII (MI CII and MII CII ) had higher lactic acid concentration and the ratio of lactic to acetic acid, and lower pH and ammonia nitrogen concentration than silages produced by CI (MI CI and MII CI ). Species differential analyses showed that the changes of chemical composition rather than epiphytic microbiota significantly affected the relative abundance of Lactobacillus, Pediococcus and Pantoea in P. giganteum silages. CONCLUSION: These above results manifested that chemical composition was the main factor influencing the fermentation quality and bacterial community of P. giganteum silage in this study. SIGNIFICANCE AND IMPACT OF THE STUDY: The obtained results may, therefore, be the first record to provide an in-depth understanding of the relative contributions of chemical and microbial parameters on fermentation quality and bacterial community, which is of great importance for modulating silage fermentation and improving silage quality.

Assessment of organic acid salts on fermentation quality, aerobic stability, and in vitro rumen digestibility of total mixed ration silage.

The work aimed to investigate the effects of four organic acid salts on fermentation quality, aerobic stability, and in vitro rumen digestibility of total mixed ration (TMR) silage prepared with citric acid residue, wet brewers' grains, and Napier grass. The TMR was ensiled with the following: (1) no additives (control), (2) 0.1% sodium benzoate (SB), (3) 0.1% potassium sorbate (PS), (4) 0.5% sodium diacetate (SDA), (5) 0.5% calcium propionate (CAP) on a fresh weight basis. All silos (10 L) were opened after 60 days of ensiling to determine fermentation profiles and in vitro rumen digestibility, and then were subjected to a 9-day aerobic stability test. Four organic acid salts significantly (p < 0.05) increased dry matter contents, lactic acid bacteria count, and decreased ethanol content and yeast count compared with the control. The SDA and CAP significantly (p < 0.05) increased water-soluble carbohydrates, lactic acid, and crude protein contents, and decreased pH, ammonia nitrogen, neutral detergent fiber, and hemicellulose contents compared with other TMR silages after 60 days of ensiling. Organic acid salts significantly (p < 0.05) prolonged the hours of aerobic stability and significantly (p < 0.05) increased cumulative gas production and potential gas production compared with the control. The treatments of SDA and CAP significantly (p < 0.05) improved aerobic stability as indicated by higher (p < 0.05) lactic acid and water-soluble carbohydrates contents, and lower (p < 0.05) pH, ammonia nitrogen, ethanol contents, and yeast count compared with the control. The treatments of SDA and CAP significantly (p < 0.05) increased in vitro rumen parameters, as indicated by higher (p < 0.05) in vitro digestibility of dry matter, crude protein, and neutral detergent fiber after 60 days of ensiling. Overall, these results indicated that the addition of SDA and CAP could ensure the good fermentation quality and improve aerobic stability of TMR silages. By comprehensive consideration, CAP was recommended for improving fermentation quality, aerobic stability, and in vitro rumen digestibility of TMR silages prepared with wet brewers' grains, citric acid residue, and Napier grass.

Characterization of a Robust and pH-Stable Tannase from Mangrove-Derived Yeast Rhodosporidium diobovatum Q95.

Tannase plays a crucial role in many fields, such as the pharmaceutical industry, beverage processing, and brewing. Although many tannases derived from bacteria and fungi have been thoroughly studied, those with good pH stabilities are still less reported. In this work, a mangrove-derived yeast strain Rhodosporidium diobovatum Q95, capable of efficiently degrading tannin, was screened to induce tannase, which exhibited an activity of up to 26.4 U/mL after 48 h cultivation in the presence of 15 g/L tannic acid. The tannase coding gene TANRD was cloned and expressed in Yarrowia lipolytica. The activity of recombinant tannase (named TanRd) was as high as 27.3 U/mL. TanRd was purified by chromatography and analysed by SDS-PAGE, showing a molecular weight of 75.1 kDa. The specific activity of TanRd towards tannic acid was 676.4 U/mg. Its highest activity was obtained at 40 °C, with more than 70% of the activity observed at 25-60 °C. Furthermore, it possessed at least 60% of the activity in a broad pH range of 2.5-6.5. Notably, TanRd was excellently stable at a pH range from 3.0 to 8.0; over 65% of its maximum activity remained after incubation. Besides, the broad substrate specificity of TanRd to esters of gallic acid has attracted wide attention. In view of the above, tannase resources were developed from mangrove-derived yeasts for the first time in this study. This tannase can become a promising material in tannin biodegradation and gallic acid production.

Characterization of a New Bifunctional and Cold-Adapted Polysaccharide Lyase (PL) Family 7 Alginate Lyase from Flavobacterium sp.

Alginate oligosaccharides produced by enzymatic degradation show versatile physiological functions and biological activities. In this study, a new alginate lyase encoding gene alyS02 from Flavobacterium sp. S02 was recombinantly expressed at a high level in Yarrowia lipolytica, with the highest extracellular activity in the supernatant reaching 36.8 ± 2.1 U/mL. AlyS02 was classified in the polysaccharide lyase (PL) family 7. The optimal reaction temperature and pH of this enzyme were 30 °C and 7.6, respectively, indicating that AlyS02 is a cold-adapted enzyme. Interestingly, AlyS02 contained more than 90% enzyme activity at 25 °C, higher than other cold-adapted enzymes. Moreover, AlyS02 is a bifunctional alginate lyase that degrades both polyG and polyM, producing di- and trisaccharides from alginate. These findings suggest that AlyS02 would be a potent tool for the industrial applications.

Dynamics of Phyllosphere Microbiota and Chemical Parameters at Various Growth Stages and Their Contribution to Anaerobic Fermentation of Pennisetum giganteum.

This work evaluated the dynamic changes of phyllosphere microbiota and chemical parameters at various growth stages of Pennisetum giganteum and their effects on the bacterial community, cooccurrence networks, and functional properties during anaerobic fermentation. P. giganteum was collected at two growth stages (early vegetative stage [PA] and late vegetative stage [PB]) and was naturally fermented (NPA and NPB) for 1, 3, 7, 15, 30, and 60 days, respectively. At each time point, NPA or NPB was randomly sampled for the analysis of chemical composition, fermentation parameter, and microbial number. In addition, the fresh, 3-day, and 60-day NPA and NPB were subjected to high-throughput sequencing and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional prediction analyses. Growth stage obviously affected the phyllosphere microbiota and chemical parameters of P. giganteum. After 60 days of fermentation, NPB had a higher lactic acid concentration and ratio of lactic acid to acetic acid but a lower pH value and ammonia nitrogen concentration than NPA. Weissella and Enterobacter were dominant in 3-day NPA and Weissella was dominant in 3-day NPB, while Lactobacillus was the most abundant genus in both 60-day NPA and NPB. The complexity of bacterial cooccurrence networks in the phyllosphere decreased with P. giganteum growth. The ensiling process further decreased the complexity of bacterial networks, with the simplest bacterial correlation structures in NPB. There were great differences in the KEGG functional profiles of PA and PB. Ensiling promoted the metabolism of lipid, cofactors, vitamins, energy, and amino acids but suppressed the metabolism of carbohydrates and nucleotides. Storage time had a greater influence than growth stage on bacterial community diversity, cooccurrence networks, and functional profiles of P. giganteum silage. Differences in bacterial diversity and functionality of P. giganteum silage caused by growth stage appear to be offset by long-term storage. IMPORTANCE The phyllosphere microbiota consists of various and complex microbes, including bacteria with crucial relevance to the quality and safety of fermented food and feed. It initially derives from soil and becomes specific to its host after interaction with plants and climate. Bacteria associated with the phyllosphere are highly abundant and diverse, but we know little about their succession. Here, the phyllospheric microbiota structure was analyzed within the growth of P. giganteum. We also evaluated the effects of phyllosphere microbiota and chemical parameter changes on the anaerobic fermentation of P. giganteum. We observed remarkable differences in bacterial diversity, cooccurrence, and functionality of P. giganteum at various growth stages and storage times. The obtained results are important for understanding the fermentation mechanism and may contribute to high-efficient production without additional cost.

Sustainable utilization of residual grass: effect of anaerobic storage days on chemical composition, fermentation performance, microbial community, and functional profiles of Pennisetum giganteum.

The seasonal surplus and putrefactive property of moist forages inevitably increase the pressure on environmental protection and residual grass disposal. In the current work, the anaerobic fermentation approach was adopted to assist the sustainable recycling of leftover Pennisetum giganteum (LP), and its chemical composition, fermentation performance, bacterial community and functional profiles during anaerobic fermentation were studied. Fresh LP was spontaneously fermented for up to 60 d. At the end of anaerobic fermentation, fermented LP (FLP) displayed homolactic fermentation with low pH value, ethanol, and ammonia nitrogen concentrations but high lactic acid concentration. Weissella was dominant in 3-day FLP, yet Lactobacillus was the overwhelming genus (92.6%) in 60-day FLP. The anaerobic fermentation process promoted (P < 0.05) the metabolism of carbohydrate and nucleotide while suppressing (P < 0.05) that of lipid, cofactors, vitamins, energy, and amino acid. The results showed that the residual grass with LP as an example could be successfully fermented even if no additives were added, without signs of clostridial and fungal contamination.

Changes in the fermentation products, taxonomic and functional profiles of microbiota during high-moisture sweet sorghum silage fermentation.

The purpose of this study was to evaluate the fermentation quality, microbial community, and functional shifts of sweet sorghum during ensiling. The high-moisture sweet sorghum (SS) was naturally ensiled for 1, 3, 7, 15, 30, and 60 days. After 60 days of ensiling, sweet sorghum silage (SSS) showed homolactic fermentation with absent butyric acid, low pH value, acceptable concentrations of propionic acid, ethanol, and ammonia nitrogen and high lactic acid concentration. Acinetobacter, Sphingomonas, and Pseudomonas were the advantage genera in SS. While, Lactococcus, Weissella, and Pediococcus were dominant in 3-day SSS and subsequently replaced by Lactobacillus in 60-day SSS. Spearman's correlation heatmap showed that Pediococcus and Leuconostoc were negatively related to the pH value of SSS. There were great differences in the Kyoto Encyclopedia of Genes and Genomes (KEGG) functional profiles of SS and SSS. Ensiling process downregulated the metabolism of amino acid, energy, cofactors, and vitamins, but upregulated the metabolism of nucleotides and carbohydrates. Overall, next-generation sequencing in conjunction with KEGG functional prediction revealed the distinct differences in the initial and late phases of ensiling in terms of both community succession and functional shifts. The knowledge regarding bacterial community dynamics and functional shifts of SS during ensiling is important for understanding the fermentation mechanism and may contribute to the production of high-quality sweet sorghum silage.

Diagnosis and treatment of tuberculosis in adults with HIV.

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), continues to pose a major public health problem and is the leading cause of mortality in people infected with human immunodeficiency virus (HIV). HIV infection greatly increases the risk of developing TB even before CD4+ T-cell counts decrease. Co-infection provides reciprocal advantages to both pathogens and leads to acceleration of both diseases. In HIV-coinfected persons, the diagnosis and treatment of tuberculosis are particularly challenging. Intensifying integration of HIV and tuberculosis control programmes has an impact on reducing diagnostic delays, increasing early case detection, providing prompt treatment onset, and ultimately reducing transmission. In this Review, we describe our current understanding of how these two pathogens interact with each other, new sensitive rapid assays for TB, several new prevention methods, new drugs and regimens.

Overlapping syndrome of recurrent anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein demyelinating diseases: A case report.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (NMDARe) is capable of presenting a relapsing course and coexisting with myelin oligodendrocyte glycoprotein antibody disease, whereas it has been relatively rare. We describe a man with no history of tumor who successively developed anti-NMDARe and anti-myelin oligodendrocyte glycoprotein antibody disease. CASE SUMMARY: A 29-year-old man was initially admitted with headache, fever, intermittent abnormal behavior, decreased intelligence, limb twitching and loss of consciousness on July 16, 2018. On admission, examination reported no abnormality. During his presentation, he experienced aggravated symptoms, and the re-examination of cranial magnetic resonance imaging (MRI) indicated punctate abnormal signals in the left parietal lobe. External examination of cerebrospinal fluid and serum results revealed serum NMDAR antibody (Ab) (-), cerebrospinal fluid NMDAR-Ab (+) 1:10 and Epstein-Barr virus capsid antigen antibody IgG (+). Due to the imaging findings, anti-NMDARe was our primary consideration. The patient was treated with methylprednisolone and gamma globulin pulse therapy, mannitol injection dehydration to reduce intracranial pressure, sodium valproate sustained-release tablets for anti-epilepsy and olanzapine and risperidone to mitigate psychiatric symptoms. The patient was admitted to the hospital for the second time for "abnormal mental behavior and increased limb movements" on December 14, 2018. Re-examination of electroencephalography and cranial MRI showed no abnormality. The results of autoimmune encephalitis antibody revealed that serum NMDAR-Ab was weakly positive and cerebrospinal fluid NMDAR-Ab was positive. Considering comprehensive recurrent anti-NMDARe, the patient was treated with propylene-hormone pulse combined with immunosuppressive agents (mycophenolate mofetil), and the symptoms were relieved. The patient was admitted for "hoarseness and double vision" for the third time on August 23, 2019. Re-examination of cranial MRI showed abnormal signals in the medulla oblongata and right frontal lobe, and synoptophore examination indicated concomitant esotropia. The patient's visual acuity further decreased, and the re-examination of cranial MRI + enhancement reported multiple scattered speckled and patchy abnormal signals in the medulla oblongata, left pons arm, left cerebellum and right midbrain, thalamus. The patient was diagnosed with an accompanying demyelinating disease. Serum anti-myelin oligodendrocyte glycoprotein 1:10 and NMDAR antibody 1:10 were both positive. The patient was diagnosed with myelin oligodendrocyte glycoprotein antibody-related inflammatory demyelinating disease of the central nervous system complicated with anti-NMDARe overlap syndrome. The patient was successfully treated with methylprednisolone, gamma globulin pulse therapy and rituximab treatment. The patient remained asymptomatic and follow-up MRI scan 6 mo later showed complete removal of the lesion. CONCLUSION: We emphasize the rarity of this antibody combination and suggest that these patients may require longer follow-up due to the risk of recurrence of two autoimmune disorders.

Antimicrobial effects of four chemical additives on fermentation quality, aerobic stability, and in vitro ruminal digestibility of total mixed ration silage prepared with local food by-products.

The objective of the work is to evaluate the effects of four chemical additives on fermentation quality, aerobic stability, and in vitro ruminal digestibility of total mixed ration (TMR) silage. TMR containing 15% spent mushroom substrate, 25% soybean sauce residue, 45% napiergrass (Pennisetum purpureum (L.) Schum.), and 15% concentrate was ensiled with the following: (1) no additives (control), (2) potassium sorbate (PS, 0.1%), (3) sodium benzoate (SB, 0.1%), (4) sodium diacetate (SDA, 0.5%), and (5) calcium propionate (CAP, 0.5%) based on fresh weight. All silos (10 L) were opened for fermentation quality, in vitro ruminal digestibility analysis after 60 days of ensiling, and then subjected to aerobic stability test for 9 days. All TMR silages were well-conserved, as indicated by low pH, butyric acid, and ammonia nitrogen contents. During aerobic exposure, SDA was more stable with higher (p < 0.05) lactic acid and acetic acid contents and lower (p < 0.05) yeast counts than other TMR silages. In addition, SDA significantly (p < 0.05) increased cumulate gas production and in vitro dry matter digestibility compared with the control. Overall, SDA is recommended as additives to improve fermentation quality, in vitro ruminal digestibility, and aerobic stability of TMR silage prepared with local food by-products.

Efficacy of nifedipine tablets plus aspirin in patients with gestational hypertension and the effect on coagulation function and hemorheology.

OBJECTIVE: This study aimed to investigate the clinical efficacy of Nifedipine tablets plus Aspirin for hypertensive disorder complicating pregnancy and the effect on coagulation function and hemorheology. METHODS: A retrospective analysis of the clinical data from 108 patients with gestational hypertension hospitalized between March 2016 and March 2017 was carried out. These patients were randomly assigned into a research group and a control group, with 54 patients in each group. Patients were treated with Aspirin in the control group, and the combination of Nifedipine tablets and Aspirin in the research group so as to compare the clinical efficacy and the effect on coagulation function and hemorheology after therapy. Albumin, total protein, 24-hour urinary protein and mean arterial pressure (MAP) were observed and compared between the two groups. RESULTS: The overall effective rate of treatment in the research group was significantly higher than that in the control group (P < 0.05). The prothrombin time (PT) and fibrinogen (FIB) levels were markedly superior to those before therapy in the research group (P < 0.001), and the PT and FIB after treatment were remarkably better in the research group than in the control group (P < 0.001). The levels of plasma viscosity (PV), low-shear whole blood viscosity (LBV), and high-shear whole blood viscosity (HBV) after therapy were markedly reduced than before therapy in the two groups (P < 0.05), and the levels of PV, LBV, and HBV after therapy were significantly lower in the research group than those in the control group (P < 0.05). Adverse reactions after therapy were reported at a significantly lower incidence in the research group than the control group (P < 0.05). Adverse pregnancy outcomes were reported at a significantly lower incidence in the research group than in the control group (P < 0.05). The research group significantly outperformed the control group on Albumin, total protein, 24-hour urinary protein and mean arterial pressure (P < 0.05). CONCLUSION: Nifedipine tablets plus Aspirin for patients with gestational hypertension can effectively improve coagulation function and hemorheological parameters, with high safety.

Biglycan as a potential diagnostic and prognostic biomarker in multiple human cancers.

Biglycan (BGN), a key member of the small leucine-rich proteoglycan family, is an important component of the extracellular matrix. Clinical studies have demonstrated that upregulation of BGN is associated with poor prognosis in patients with various types of solid cancer. The present study analyzed the mRNA expression levels of BGN in various types of solid cancer when compared with that in normal tissues via the Oncomine database. The UALCAN, OncoLnc and Kaplan-Meier Plotter databases were additionally used to evaluate the prognostic values of BGN in patients with solid cancer and co-expression gene analysis was conducted using the protein-protein interaction networks of BGN. The present study observed that the mRNA expression levels of BGN were increased in bladder, brain and central nervous system, breast, colorectal, esophageal, gastric, head and neck, lung, ovarian and 28 subtypes of cancer compared with normal tissues. The increased expression of BGN was identified to be associated with a poor outcome in ovarian and gastric cancer. Based on the co-expression network, BGN was identified as the key gene in a 43-gene network. The present findings of increased expression of BGN in solid tumors and its positive association with poor outcome on patient survival indicate that BGN may serve as a prognostic marker and as a target for novel therapeutics for multiple types of cancer.