Onset Of Disturbance Research Articles

Maize yield and Fall armyworm damage responses to genotype and sowing date-associated variations in weather conditions

Due to climate disruption and delayed onset of rains, maize is often sown late, outside the optimal window, increasing the impact of pests such as fall armyworm and reducing yields. Identifying optimal sowing dates and the best genotypes is crucial to maximise yields while limiting fall armyworm (FAW) damage. Thus, this study was undertaken to evaluate yield and FAW damage variation in relation to sowing-date weather conditions to determine the optimal sowing window. The experiment had a split-plot design with four genotypes ('PVAH-1 L', 'PVAH-3 L', 'PVAH-6 L' and 'SAM 4 VITA') and four sowing dates (30 November to 14 January and delayed by 15, 30 and 45 days) during the three consecutive cropping seasons. Abundant rainfall and a high number of wet days increase yields while reducing FAW damage. The genotype shows that 'PVAH-1 L' has ear resistance (3.24) and leaf partial resistance (4.05) to FAW, with a high yield (6.54 t.ha−1). In contrast, 'PVAH-3 L' (4.27 and 5.05), 'PVAH-6 L' (4.24 and 4.37) and 'SAM 4 VITA' (4.25 and 4.00) show partial resistance to FAW in both ears and leaves, but have relatively lower yields, except for 'PVAH-6 L' (6.29 t.ha−1). Maize sown on 15 December had a high yield (8.76 t.ha−1), similar to those sown on 30 November. However, sowing on 30 December and 14 January reduced yields by 2 t.ha−1 and 7 t.ha−1 respectively, while increasing FAW infestation and damage. Therefore, in the Lubumbashi region, due to the delayed onset of rains and climatic disturbances, the sowing period can be extended to 30 December, with an optimal window extending from 30 November to 15 December. To maximise yields and limit FAW damage, it is recommended that 'PVAH-1 L' be sown on 15 December, 'SAM 4 VITA' on 30 November or 15 December and 'PVAH-6 L' on 30 November or 15 December.

Investigation of neurochemical and behavioral alterations in the brain during fibromyalgia with supplementation of Spirulina platensis

Aim: Fibromyalgia (FM) is a complex and long-lasting musculoskeletal disorder characterized by mood changes, fatigue, headache, and extensive musculoskeletal pain. Spirulina has potent antioxidant, antinociceptive, and neuroprotective properties. This study aimed to evaluate spirulina’s capacity to protect rats against FM caused by reserpine. Methods: Male Sprague-Dawley rats received a subcutaneous injection of reserpine (1 mg/kg) once a day for three days. Subsequently, they were administered an oral dose of 400 mg/kg of Spirulina for 21 days. Many molecular, biochemical, and behavioral tests have been evaluated. Results: Daily spirulina consumption was able to limit the increase in neuroinflammation, oxidative stress, and a reduction in biogenic amine levels as well as behavioral alterations.Significance: This study demonstrated for the first time that dietary integration with spirulina could be helpful to reduce the onset of pain, inflammation and mental disturbance in FM patients.

Stroke and Stroke-Like Episodes: Recurrent Manifestations in GLUT1 Deficiency Syndrome

BackgroundSince the initial description of glucose transporter-1 deficiency syndrome (Glut1-DS) the phenotype of the condition has expanded, even leading to the recognition of atypical manifestations. We report on eight patients with Glut1-DS who experienced at least one episode of acute focal neurological deficits. MethodsWe conducted a retrospective analysis, collecting clinical, electrophysiological, neuroradiological, and genetic information. We focused in particular on three well-documented cases. ResultsAmong 42 patients with Glut1-DS, eight individuals aged between six and 38 years presented with an acute onset of neurological disturbances: dysarthria/aphasia, oral dyskinesia, swallowing difficulties, paresthesia, facial palsy, hemi/monoplegia, vomiting, headache, and behavioral disturbances. When performed, magnetic resonance imaging (MRI) revealed signs of venous congestion and hypoperfusion and electroencephalography showed focal contralateral slowing. Deficits were transient in all patients but one. Four patients (50%) were on a ketogenic diet (KD), and two of these patients had lower than usual ketonemia levels during the episode. In two patients, MRI demonstrated the presence of an ischemic brain lesion. ConclusionsIn Glut1-DS, stroke-like episodes are a recurrent manifestation, particularly during early adulthood, and they were reported in 19% of the patients in our cohort. Stroke mimics should be considered a key feature of Glut1-DS, as other paroxysmal disorders. It remains to be established whether a KD can prevent the recurrence of episodes and, if so, at what level of ketosis. Further observations are needed to confirm the correlation between Glut1-DS and ischemic stroke.

An autopsy case of an adult woman with Rapid-Onset Obesity with Hypoventilation, Hypothalamic, Autonomic Dysregulation, and Neuroendocrine Tumors (ROHHAD(NET)) syndrome developing nonalcoholic steatohepatitis and hepatocellular carcinoma: A case report.

Nonalcoholic steatohepatitis (NASH) is an important etiology of hepatocellular carcinoma (HCC), and there is no established therapy for this syndrome. Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neural crest tumor (ROHHAD(NET)) is an extremely rare syndrome considered to be life-threatening, with death occurring around 10 years of age. We present the oldest known autopsy case of this syndrome that developed HCC. This case provided important information on not only improving the course of this syndrome, but also understanding the natural history and therapeutic modalities of NASH and HCC. The patient was diagnosed with ROHHAD(NET) syndrome in childhood, and liver cirrhosis due to NASH was diagnosed at age 17. HCC was detected at age 20, and embolization and irradiation were performed. At age 21, she died from accidental acute pancreatitis and subsequent liver failure and pulmonary hemorrhage. Rapid onset of obesity, hypoventilation, and hypothalamic disturbance appeared in childhood and was diagnosed as this syndrome. At age 17, liver cirrhosis due to NASH was diagnosed by liver biopsy, and at age 20, HCC was diagnosed by imaging. Transarterial chemoembolization and irradiation were performed, and the HCC was well controlled for a year. At age 21, she died from accidental acute pancreatitis, subsequent liver failure and pulmonary hemorrhage. Autopsy revealed that the HCC was mostly necrotized. This case was valuable not only for other ROHHAD(NET) syndrome cases, but also in improving our understanding of the natural history of NASH and HCC.

Una presentazione atipica della porpora trombocitopenica immune

The authors describe a case of idiopathic autoimmune thrombocytopenia characterized by the onset of visual disturbances due to macular haemor- rhage in the left eye.

Wind disturbance-based tomato seedlings growth control

Wind-disturbance is a potential eco-friendly technique for tackling leggy seedlings. This study uses orthogonal experimental design and seedlings vigour assessment by strong seedling index (SSI) to investigate wind-disturbance on regulating tomato seedlings growth. Changes in endogenous hormone levels and biomechanical properties of tomato seedlings were investigated using enzyme-linked immunosorbent assay and uniaxial tension tests. Results showed that factors influencing significantly SSI, in descending order, are wind disturbance time (T), seedling age at the onset of wind disturbance (SA), wind velocity (V), and interval time (I). The wind-disturbance effect was found to be optimal with SSI = 0.126 for a condition where V, T, I and SA values are 3 m s−1, 1 min, 30 min, and 15 days, respectively. V and T were positively correlated with the ethylene and abscisic acid content in seedling leaves, abscisic acid and auxin content in stems, cytokinin and ethylene content in roots, and the elastic moduli of stems and roots but negatively associated with the cytokinin content in stems and leaves, auxin and abscisic acid content in roots, and leaves’ elastic modulus. Wind disturbance mechanism for controlling seedlings growth involved eliciting the accumulation of abscisic acid in stems and leaves and reduction of the auxin content in roots to about the optimal threshold for roots growth thereby reducing seedling stems and leaves development and promoting a better roots growth and a high SSI. This work offers theoretical insights and technical guidance for utilising wind-disturbance as a sustainable seedling cultivation and personalised seedling management approach.

A nonlinear instability theory for a wave system inducing transition in spiral Poiseuille flow

This paper is on the transition scenario of the class of spiral Poiseuille flows that results from the onset, propagation and evolution of disturbances according to mechanisms of Tollmien-Schlichting, and Taylor, acting simultaneously. The problem is approached from the fundamental point of view of following the growth of initially infinitesimally small disturbances into their nonlinear stage when the effect of Reynolds stresses makes itself felt. To this end a set of Generalised Nonlinear Orr–Sommerfeld, Squire and Continuity Equations is set up that enables accounting for effects of growth of initially infinitesimally small disturbances into nonlinearities through a rational iteration scheme. The present proposal closely follows the method put forth for this pupose in 1971 by Stuart and Stewartson in their seminal papers on the influence of nonlinear effects during transition in the bench-mark flows of the class of spiral Poiseuille flows; which are the plane-walled channel flow and the flow in the gap between concentric circular cylinders (Taylor instability).The basic feature of the proposed method is the introduction of an Amplitude Parameter and of a slow/long- scale variable through which the effects of growing disturbances are accounted for within the framework of a rational iteration scheme. It is shown that the effect of amplified disturbances is capturable, as in the bench-mark flows, by a Ginzburg–Landau type differential equation for an Amplitude Function in terms of suitably defined slow/long-scale variables. However, the coefficients in this equation are numbers that depend upon the flow parameters of the spiral Poiseuille flow, which are a suitably defined Reynolds Number, the Swirl Number, and the geometric parameter of transverse curvature inherent in the flow geometry. The Ginzburg–Landau equation derived hints at the drastic changes in flow pattern that the spiral Poiseuille flow in transition may undergo, as its Swirl Number is taken from very small to very large values.

The role of the macroalgae Ulva lactuca on the cellular effects of neodymium and mercury in the mussel Mytilus galloprovincialis

Rare earth elements (REEs) are increasingly being studied mainly due to their economic importance and wide range of applications, but also for their rising environmental concentrations and potential environmental and ecotoxicological impacts. Among REEs, neodymium (Nd) is widely used in lasers, glass additives, and magnets. Currently, NdFeB-based permanent magnets are the most significant components of electronic devices and Nd is used because of its magnetic properties. In addition to REEs, part of the environmental pollution related to electrical and electronic equipment, fluorescent lamps and batteries also comes from mercury (Hg). Since both elements persist in ecosystems and are continuously accumulated by marine organisms, a promising approach for water decontamination has emerged. Through a process known as sorption, live marine macroalgae can be used, especially Ulva lactuca, to accumulate potential toxic elements from the water. Therefore, the present study aimed to evaluate the cellular toxicity of Nd and Hg in Mytilus galloprovincialis, comparing the biochemical effects induced by these elements in the presence or absence of the macroalgae U. lactuca. The results confirmed that Hg was more toxic to mussels than Nd, but also showed the good capability of U. lactuca in preventing the onset of cellular disturbance and homeostasis disruption in M. galloprovincialis by reducing bioavailable Hg levels. Overall, the biochemical parameters evaluated related to metabolism, antioxidant and biotransformation defences, redox balance, and cellular damage, showed that algae could prevent biological effects in mussels exposed to Hg compared to those exposed to Nd. This study contributes to the advancement of knowledge in this field, namely the understanding of the impacts of different elements on bivalves and the crucial role of algae in the protection of other aquatic organisms.

Observations of Mesospheric Gravity Waves Generated by Geomagnetic Activity

AbstractGravity waves (GWs) play an important role in the dynamics and energetics of the mesosphere. Geomagnetic activity is a known source of GWs in the upper atmosphere. However, how deep the effects of geomagnetic activity induced GWs penetrate into the mesosphere remains an open question. We use temperature measurements from the SABER/TIMED instrument between 2002 and 2018 to study the variations of mesospheric GW activity following intense geomagnetic disturbances identified by AE and Dst indices. By considering several case studies, we show for the first time that the GWs forced by geomagnetic activity can propagate down to about 80 km in the high latitude mesosphere. Only regions above 55° latitudes show a clear response. The fraction of cases in which there is an unambiguous enhancement in GW activity following the onset of geomagnetic disturbance is smaller during summer than other seasons. Only about half of the events show an unambiguous increase in GW activity during non‐summer periods and about one quarter of the events in summer show an enhancement in GWs. In addition, we also find that the high latitude mesopause is often seen to descend in altitude following onset of geomagnetic activity in the non‐summer high latitude region.

Menstrual abnormalities effects on clinical features and in vitro fertilization pregnancy outcomes in women with polycystic ovarian syndrome

The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns. This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome. Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups. Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25-39.50] vs 28.00 [range, 24.00-36.00]; P<.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60-11.47] vs 5.66 ng/mL [range, 3.65-8.92]; P=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; P<.001) and luteinizing hormone-to-follicle-stimulating hormone ratio (1.51 [range, 1.00-2.32] vs 1.45 [range, 0.92-2.13]; P<.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11-5.73] vs 5.50 mmol/L [range, 5.17-5.76]; P<.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63-94.54] vs 59.82 µU/mL [range, 33.56-94.67]; P=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04-1.37] vs 1.21 mmol/L [range, 1.07-1.45]; P=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25-6321.00] vs 3954.00 pg/mL [range, 2378.75-6113.50]; P=.013), and luteinizing hormone (2.52 IU/L [range, 1.40-4.21] vs 1.93 IU/L [range, 0.91-3.32]; P=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups. An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilization and the initial cycle of embryo transfer were comparable between the 2 groups.

Toward the complete understanding of the pathogenic mechanism of clioquinol-induced subacute myelo-optic neuropathy (SMON)

Clioquinol was extensively used as an amebicide to treat indigestion and diarrhea in the mid-1900s. However, it was withdrawn from the market in Japan because its use was epidemiologically linked to an increase in the incidence of subacute myelo-optic neuropathy (SMON). SMON is characterized by the subacute onset of sensory and motor disturbances in the lower extremities with occasional visual impairments, which are preceded by abdominal symptoms. Although pathological studies demonstrated axonopathy of the spinal cord and optic nerves, the underlying mechanisms of clioquinol toxicity have not been elucidated in detail. We previously performed a global analysis of human neuroblastoma cells using DNA chips and demonstrated that clioquinol induced 1) DNA double-strand breaks and subsequent activation of ATM/p53 signaling; 2) the expression of VGF, the precursor of neuropeptides involved in pain reactions, by inducing c-Fos; 3) the expression of interleukin-8, which is reported to be involved in intestinal inflammation, optic neuropathy, and neuropathic pain, by down-regulating GATA-2 and GATA-3. We also demonstrated that clioquinol induced zinc influx and oxidation of the copper chaperone ATOX1, leading to the impairment of the functional maturation of a copper-dependent enzyme dopamine-β-hydroxylase and the inhibition of noradrenaline biosynthesis. Thus, clioquinol-induced neurotoxicity in SMON seems to be mediated by multiple pathways.

The impact of COVID-19 on menstrual cycle’s alterations, in relation to depression and sleep disturbances: a prospective observational study in a population of medical students

BackgroundThe sars-Cov-2 pandemic has determined psychological stress, particularly in the young population of medical students. We studied the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students.Methods293 female students at the Faculty of Medicine and Psychology of the Sapienza University of Rome (23.08 years old ± 3.8) were enrolled. In March 2021, one year after quarantine, a personal data sheet on menstrual cycle, examining the quality of the menstrual cycle during the pandemic, compared to the previous period. Concomitantly, the Beck Depression Inventory and the Impact of Event Scale have been administered. A Pearson chi-square test was assessed to evaluate the difference between the characteristics of the menstrual cycle and the scores obtained with the questionnaires.ResultsA statistically significant association between menstrual alterations and stress during pandemic had been found. The onset of depressive symptoms and sleep disturbances was observed in 57.1% and in 58.1% of young women with cycle’s alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, premenstrual syndrome had a significant correlation with both depression and sleep disturbances. The pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea.ConclusionsThe pandemic affected the menstrual cycle as well as the depressive symptoms and sleep. Practical implications of the study lead to the development of strategies for psychological intervention during the pandemic experience, in order to help medical trainees, with specific attention to women’s needs. Future studies should analyze the impact of other types of social stress events, on sleep, depression and the menstrual cycle beside the pandemic.

The developmental timing of spinal touch processing alterations predicts behavioral changes in genetic mouse models of autism spectrum disorders

Altered somatosensory reactivity is frequently observed among individuals with autism spectrum disorders (ASDs). Here, we report that although multiple mouse models of ASD exhibit aberrant somatosensory behaviors in adulthood, some models exhibit altered tactile reactivity as early as embryonic development, whereas in others, altered reactivity emerges later in life. Additionally, tactile overreactivity during neonatal development is associated with anxiety-like behaviors and social behavior deficits in adulthood, whereas tactile overreactivity that emerges later in life is not. The locus of circuit disruption dictates the timing of aberrant tactile behaviors, as altered feedback or presynaptic inhibition of peripheral mechanosensory neurons leads to abnormal tactile reactivity during neonatal development, whereas disruptions in feedforward inhibition in the spinal cord lead to touch reactivity alterations that manifest later in life. Thus, the developmental timing of aberrant touch processing can predict the manifestation of ASD-associated behaviors in mouse models, and differential timing of sensory disturbance onset may contribute to phenotypic diversity across individuals with ASD.

Clozapine and Modified Electroconvulsive Therapy Resolving Forced Normalization: A Rare Case Report

Abstract Multiple studies have been done in the past to understand the relationship between seizure and psychosis, still no conclusive point has been found yet. The mechanism behind the relationship is unknown. Seizures may cause brain damage, increasing the chance of schizophrenia and psychosis, or the two illnesses may share etiological elements. We present a case of a 45-year-old male with a prior history of viral meningoencephalitis, axonal motor polyneuropathy, encephalopathy, and well-controlled generalized tonic–clonic seizures. However, the patient presented to us with a new onset of behavioral disturbances in the form of severe aggression, disinhibition, homicidality, and suicidality during treatment with multiple antiepileptics drugs but with no response to multiple antipsychotics. This patient had an adequate response to clozapine and modified electroconvulsive therapy. No such case has been reported in literature, till date. During the phase of forced normalization, the patient may experience behavioral issues following the management of their seizures with antiepileptic medications and the normalization of their electroencephalography. Any unusual behavior observed in epilepsy patients following the initiation of therapy and seizure control should alert clinicians to the likelihood of this condition.

Cerebral Oxygen Dynamics in a Patient After Subdural Haematoma Removal Surgery: A Case Report.

Near-infrared spectroscopy (NIRS) can be employed for the non-invasive real-time evaluation of cerebral oxygen dynamics. A portable wireless NIRS system has been developed to record measurements using a band worn around the head. In this case report, we describe the clinical findings and cerebral oxygen dynamics of a patient who underwent surgery to remove a left temporal subdural haematoma. The patient was a male in his 70s, who fell while riding a bicycle. Following the gradual onset of gait disturbance, the patient was admitted to our hospital for surgery. After surgical removal of the subdural haematoma, the cerebral oxygen dynamics of the left and right frontal cortical hemispheres were monitored using NIRS in the following sequence: supine, bed-up 70°, sitting, standing, and supine, for 3 min each. Measurements were made on postoperative days (PODs) 2, 3, 7, and 10. Clinically, on POD2, the patient had a decreased level of consciousness, requiring assistance in maintaining each posture. On POD10, his level of consciousness improved and he was able to walk for short distances. The cerebral oxygen dynamics on the injured hemispheres showed the most remarkable changes on POD2 which decreased with the passage of time. NIRS may be useful in non-invasive assessment of the recovery of the cerebral circulation after neurosurgical intervention to inform the medical rehabilitation team on the progress in recovery.

VASCULAR PARKINSONISM. DIFFERENTIAL DIAGNOSIS

Parkinsonism can be caused by many pathologies, including cerebrovascular diseases. Vascular parkinsonism, which develops as a consequence of the latter, may be caused by small vessel disease of the white matter, leading to the gradual development of bilateral symptoms in the lower extremities. Compared with patients with Parkinson's disease, people with vascular parkinsonism have earlier onset of gait disturbances, higher rates of urinary incontinence and cognitive impairment, and a poorer response to treatment and prognosis. Vascular parkinsonism, with its unclear pathophysiology, varied clinical presentation and overlap with other diseases, remains a poorly understood and somewhat controversial diagnosis. The clinical case described below confirms the above.

Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection.

Bickerstaff brainstem encephalitis (BBE) is a neuroimmunologic disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance, mostly subsequent to an infection. BBE is considered to be a variant of Miller-Fisher syndrome (MFS), which also exhibits external ophthalmoplegia and ataxia but not presenting consciousness alterations. Therefore, these two medical conditions are included in the clinical spectrum of the "Fisher-Bickerstaff syndrome" ( Shahrizaila and Yuki in J Neurol Neurosurg Psychiatry 84(5):576-583) [1]. With regard to the etiopathogenesis, increasing evidence worldwide suggests that SARS-CoV-2 infection-enhanced immune response is involved in a wide range of neurological complications such as Guillain-Barré syndrome (GBS), MFS, acute necrotizing encephalitis (ANE), myelitis, acute disseminated encephalomyelitis (ADEM), and, although very rarely, BBE either (Hosseini et al. in Rev Neurosci 32:671-691) [2]. We report a case of a patient affected by delayed onset BBE overlapping MFS during a mild SARS-CoV-2 infection. To the best of our knowledge, similar cases have never been reported.

Acute necrotizing encephalopathy in children with COVID-19: a retrospective study of 12 cases.

Acute necrotizing encephalopathy (ANE) is a devastating neurologic condition that can arise following a variety of systemic infections, including influenza and SARS-Cov-2. The clinical features of COVID-19-associated ANE in pediatric patients based on multi-case data have not yet been described and remain obscure. We reviewed 12 pediatric patients to better describe the clinical features of ANE with COVID-19. We retrospectively collected and summarized the clinical features of ANE in children with COVID-19. Clinical data were collected from 12 children, including their general status, clinical symptoms, laboratory tests, and neuroimaging features. Among the subjects, 10 were over 5 years old and they accounted for 83.33%. A large percentage of those affected (66.67%) were females. The major manifestations included fever (100%), impaired consciousness (100%), and convulsions (75%). We determined that increased interleukin (IL)-6 and IL-10, and tumor necrosis factor-α and interferon gamma were not predictive of severe ANE and mortality in children with COVID-19 in this study. All children presented with abnormal neuroimaging with multiple and symmetrically distributed lesions, involving the thalamus, basal ganglia, cerebellum, and brain hemispheres. Eight of the 12 children died, resulting in a mortality rate of 66.67%, and 75% of these children were females. Importantly, we found the timely administration of mannitol after an acute onset of convulsions or disturbance of consciousness may be decreased the high mortality induced by ANE children with COVID-19. COVID-19 associated with ANE in children is characterized by sudden symptom onset, rapid disease progression, and high mortality.

Citrin Deficiency: Clinical and Nutritional Features.

SLC25A13 gene mutations are responsible for diseases related to citrin deficiency (CD), such as neonatal intrahepatic cholestasis caused by citrin deficiency and adult-onset type II citrullinemia (CTLN2). From childhood to adulthood, CD patients are apparently healthy due to metabolic compensation with peculiar dietary habits-disliking high-carbohydrate foods and liking fat and protein-rich foods. Carbohydrate overload and alcohol consumption may trigger the sudden onset of CTLN2, inducing hyperammonemia and consciousness disturbance. Well-compensated asymptomatic CD patients are sometimes diagnosed as having non-obese (lean) non-alcoholic fatty liver disease and steatohepatitis, which have the risk of developing into liver cirrhosis and hepatocellular carcinoma. CD-induced fatty liver demonstrates significant suppression of peroxisome proliferator-activated receptor α and its downstream enzymes/proteins involved in fatty acid transport and oxidation and triglyceride secretion as a very low-density lipoprotein. Nutritional therapy is an essential and important treatment of CD, and medium-chain triglycerides oil and sodium pyruvate are useful for preventing hyperammonemia. We need to avoid the use of glycerol for treating brain edema by hyperammonemia. This review summarizes the clinical and nutritional features of CD-associated fatty liver disease and promising nutritional interventions.

Vascular parkinsonism.

Parkinsonism can have many causes, among them cerebrovascular disease. Vascular parkinsonism can be caused by infarction or haemorrhage in the nigrostriatal pathway, resulting in hemiparkinsonism, or by widespread small vessel disease in the white matter, leading to the gradual development of bilateral symptoms in the lower extremities. Compared to patients with Parkinson's disease, individuals with vascular parkinsonism have earlier onset of gait disturbance, are more likely to have urinary incontinence and cognitive impairment, and have poorer treatment response and prognosis; however, they are less likely to have tremor. With its unclear pathophysiology, varying clinical picture and overlap with other diseases, vascular parkinsonism remains a little known and somewhat controversial diagnosis.