ObjectiveTo systematically review the correlation between adenoviral infection and encephalitis in children. MethodsStudies on the correlation between adenoviral infection and encephalitis among children were retrieved in the databases of CHKD, CNKI, WanFang Data, CMCC, PubMed, Ovid, EBSCO, and Science New during 1978-2013. According to our inclusion and exclusion criteria, literature was screened. After data extraction, meta-analysis was conducted using Comprehensive Meta Analysis 2.0. ResultsA total of 18 studies were enrolled. The results of meta-analysis indicated that:the prevalence of infection of human adenovirus in children with encephalitis was p1=10.8% (95%CI 6.5% to 15.2%, P < 0.000 01). The incidence of encephalitis in children with adenoviral infection was p2=31.4% (95%CI 14.1% to 48.6%, P < 0.000 01). The results of two studies showed that, the correlation coefficients between adenoviral infection and encephalitis were OR1=2.22 (95%CI 0.32 to 14.79, P > 0.05), and OR2=1.12 (95%CI 0.14 to 9.10, P > 0.05), respectively, both with no significant difference. In addition, the subgenus B adenoviruses, including type 3 and type 7 were more associated with encephalitis, followed by type 1 and type 2 in subgenus C and type 8 in subgenus D. ConclusionCurrent evidence shows that no correlation exists between adenoviral infection and encephalitis in children. However, the above conclusion needs to be verified by conducting more rationally-designed studies so as to clarify the correlation.
目的 对边缘性脑炎患者磁共振（MR）影像学表现进行探讨，以明确急性边缘性脑炎的特异性磁共振影像学征象，了解磁共振成像（MRI）在急性边缘性脑炎患者诊断以及病情评价中的应用价值。 方法 通过对2008年12月-2010年1月间临床收集的8例边缘性脑炎患者进行MRI检查，并回顾性分析不同序列磁共振影像学表现，总结MRI征象，评价MRI检查在急性边缘性脑炎的临床诊治中的作用。 结果 边缘性脑炎患者显示特异性的双侧边缘系统肿胀及信号异常，呈T1WI低信号影；T2WI及FLAIR成像为高信号影像；增强扫描未见确切异常强化；FLAIR成像是检测病变最敏感的序列。部分患者可见累及边缘系统外结构。随访病例影像学改变可有明显好转。 结论 边缘性脑炎特异性损伤边缘系统，以双侧海马为主，MRI影像可直观反映边缘性脑炎早期及随访期改变，能直接了解边缘性脑炎颅内受累范围、程度及治疗后恢复情况等，可为其临床及时诊断及治疗评估提供有利信息。
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
目的 系统评价纳洛酮治疗病毒性脑炎的疗效与安全性。 方法 计算机检索Medline、Cochrane图书馆、EMbase、CBM、CNKI、万方从建库至2012年2月收录的相关中英文文献，收集所有关于在抗病毒、肾上腺皮质激素以及脱水、止惊、降温等综合治疗的基础上，辅助应用纳洛酮治疗病毒性脑炎对照试验。根据纳入与排除标准筛选文献、评价质量、提取资料，采用RevMan 5.1软件进行Meta分析。 结果 共纳入5个对照试验，包括279例病毒性脑炎患者。Meta分析结果显示：纳洛酮的应用对13岁以上病毒性脑炎患者的总有效率[RR=1.15，95%（0.94，1.42），P=0.18]及死亡率[RR=0.45，95%（0.17，1.16），P=0.10]并无影响，但可以缩短退热时间[WMD=−0.85，95%（−1.74，0.03），P=0.06]、头痛消失时间[WMD=−0.40，95%（−0.55，0.25），P＜0.000 01]、抽搐停止时间[WMD=−0.87，95%（−1.09，−0.66），P＜0.000 01]、意识恢复时间[WMD=−1.10，95%（−2.05，−0.15），P=0.02]、脑膜刺激征消失时间[WMD=−0.15，95%（−0.73，0.29），P＜0.000 01]、呼衰纠正时间[WMD=−1.22，95%（−2.11，−0.33），P=0.007]及病程[WMD=−1.38，95%（−2.65，−0.11），P=0.03]。 结论 现有证据表明，纳洛酮不能提高病毒性脑炎的疗效，但对改善症状有一定帮助。受本系统评价纳入研究数量和质量的限制，上述结论尚需更多高质量的随机对照试验验证。
ObjectiveTo systematically review the efficacy of immunoglobulin for treatment of clinical diagnosed viral encephalitis in China.MethodsCNKI, VIP, WanFang Data, PubMed, ScienceDirect, The Cochrane Library and EMbase databases were electronically searched to collect randomized controlled trials (RCTs) of immunoglobulin for treatment of clinical diagnosed viral encephalitis in China from inception to January 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software.ResultsA total of 57 RCTs involving 4 431 patients were included. The results of meta-analysis showed that in both children and adults of clinically diagnosed viral encephalitis, the combination of immunoglobulin could reduce the mean recovery time of fever, unconsciousness, convulsion, emesis, average hospitalization time, and non-effective rate. Moreover, there was no difference in the incidence of adverse effects between the two groups.ConclusionsCurrent evidence shows that immunoglobulin is superior to conventional therapies both in adults and children patients of clinically diagnosed viral encephalitis. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveExploring the influencing factors of acute phase (≤ 21 days) seizures and epilepsy in patients with Herpes simplex virus encephalitis (HSE) in our hospital, including emergency and inpatient wards, mainly from the perspective of the number of mNGS of Herpes simplex virus (HSV) in cerebrospinal fluid. MethodsFrom January to Octomber 2023, 28 emergency and inpatient patients in our hospital were collected, excepted clinical datas were not detailed. In the end, 24 patients with HSE diagnosed were included in the study, and their clinical datas were collected, including age, gender, acute encephalitis syndrome, the form of the seizure and the number of seizures, time of lumbar puncture, and various indicators of cerebrospinal fluid [pressure, protein, cell count (mononuclear and multinucleated cells), metagenomic Next-generation sequencing (mNGS), neural autoantibodied associated with autoimmune encephalitis], electroencephalogram, cranial imaging examination reports, and treatment plans.ResultsA total of 24 patients were enrolled, including 9 patients with a history of hypertension and 4 patients with a history of diabetes. There were 18 males and 6 females, with an average age of (53.17±17.19) years. The maximum age was 73 years old, and the minimum age was 21 years old. Among the 24 patients, one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture, so the time from the onset of the disease to lumbar puncture was 30 days, and the other patient’s family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease. The remaining 22 patients were all completed lumbar puncture within 7 days of onset, and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department. mNGS results: 23 cases were HSV-1, and the remaining 1 case was HSV- 2. There were a total of 6 cases of seizures and epilepy in the acute phase (≤21 days), with focal or generalized seizures or epileptic status as the main form, and 2 cases of seizures occurred. Among these 8 patients, 5 showed lesions in the frontal and temporal lobes on enhanced cranial MRI, while the other 3 showed no specific features. At the same time, mNGS of cerebrospinal fluid suggested that the sequence number of HSV was greater than 3 000 was related with seizures and epilepsy with acute HSE. Conclusion Seizures and epileysy in acute HSE were related with the presences of intracranial cortical involvement,and the number of viral sequences in mNGS was closely related to acute phase seizures and epilepsy.