Objective: acute ischemic stroke is occuring in younger and younger individuals. This paper aims to explore the real-world epidemiological characteristics of young stroke patients in northwest Hubei. Methods: the information of acute stroke patients under 50 years old in northwest Hubei Province was collected, including age, gender, region, education level, smoking and drinking, onset season, etc, and epidemiological analysis was carried out. Results: a total of 344 patients with acute ischemic stroke were surveyed. The males accounted for 69.19%, and the average age was 44.94±5.61 years old; the females accounted for 30.18%, and the average age was 45.22±5.02 years old. The distribution of patients varied, with most living in urban areas. There were more male patients than female patients. The proportion of patients with an education level below junior high school was higher than that of patients with an education level above junior high. Twenty-nine point thirty-six percent of all young people with stroke smoked and drank. Stroke occurred in all seasons, but the incidence of stroke was relatively high in summer and autumn. There was a significant difference in the ratio of males to females (P＜0.001). Conclusion: the incidence rate of acute stroke in young people in northwest Hubei Province is unique. With the increase of age, men in all ages are more prone to strokes than women. The incidence of stroke among young people in urban areas is higher than in surrounding counties. The incidence rate decreases with the increase of education level. More strokes occur in summer and autumn than in winter and spring. Smoking and drinking do not show obvious effects on the incidence rate.

Objective: the N-myc downstream regulatory gene 4(NDRG4) is involved in cell growth, cell proliferation, cell survival and tumor invasion. In this paper, the role of NDRG4 in glioma was explored. Method: the expression of NDRG4 in glioma clinical specimens and its relationship with the prognosis of glioma patients were analyzed by the Cancer Genome Atlas (TCGA) and the Chinese Glioma Genome Atlas(CGGA), and the expression of NDRG4 protein and mRNA in glioma cell lines were tested and verified by Western blot and quantitative real-time fluorescence polymerase chain reaction(qRT-PCR). Result: it showed that the expression of NDRG4 in glioma tissues and cell lines is closely related to the prognosis of glioma patients. Conclusion: NDRG4 is a highly potential target gene for glioma therapy.

Objective: gliomas are the most common intracranial tumors. Fibroblast growth factor-12(FGF12), which belongs to the fibroblast growth factor(FGFs) family, plays an important role in cell mitosis, as well as in other life functions, such as embryo development, tissue repair, cell proliferation, and tumor growth and invasion. The purpose of this study was to explore the potential value of FGF12 in high-grade gliomas and to predict its drug sensitivity. To provide a possible therapeutic target for glioma. Methods: high-grade glioma gene expression data and clinical information were downloaded from the gene expression omnibus(GEO) database, using the R language “impute” and “survival” survival analysis package. The FGF12 genes closely related to survival were screened, a survival curve was drawn, and clinical correlation analysis was conducted. The differentially expressed genes (DEGs) were defined as |logFC|＞1, adj. PVal＜0.05 as the standard. We used the David for Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) analysis, and constructed the protein-protein interactions(PPI) network. Then we used the Connectivity Map(CMAP) database for drug location, and the validation group was verified by the Chinese Glioma Genome Atlas(CGGA) database in the same way. Results: we found that high FGF12 expression was associated with a higher survival rate. The same validation was performed in the validation group through the CGGA database, and the survival curve showed the same trend. The expression level of FGF12 is an independent factor that affects the life time and status of the samples, and it is a low risk factor. GO enrichment analysis showed that differential genes were enriched in matrix transmembrane transporter activity, ion channels and calcium ion active channels. KEGG showed that DEGs were enriched in the phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt) signaling pathway, dopaminergic synapse and cyclic adenosine monophosphate(cAMP) signaling pathway. Four seed genes, GRIA2, COLLA2, GRIA4 and HES6, were obtained by PPI network analysis. The cAMP was used to analyze and obtained 7 small molecule drugs, such as merbromin, naloxone, AH-23848, ticarcillin, vincamine, amoxicillin, azacyclonol, which may be helpful in the prognosis of high-grade gliomas. Conclusion: FGF12 and its pathway may serve as a biomarker or therapeutic target for high-grade gliomas.

Background: thrombotic thrombocytopenic purpura(TTP) is an autoimmune disease with high mortality. An ADAMTS13(a disintegrin and metalloprotection with a thrombospondin type 1 motif, member 13) activity level of less than 10% supports the diagnosis of TTP in appropriate clinical contexts. Historically, nearly all patients died during the first month of illness with severe hemolytic anemia, abundant schistocytes, profound thrombocytopenia, neurological deficits, renal injury, and fever. Most such patients have severe ADAMTS13 deficiency. Currently, the first-line treatment of TTP including plasma exchange therapy and preemptive B-cell depletion with rituximab can increase the survival rate and reduce the recurrence rate. Case presentation: a 34-year-old male patient who presented with hematochezia and progression of disorder of consciousness was misdiagnosed with esophageal and gastric varices bleeding and hepatic encephalopathy based on his history of hepatitis B. However, he was diagnosed with TTP based on clinical and laboratory results. He received comprehensive and systemic treatments including taking methylprednisolone, rituximab, and multiple sessions of plasmapheresis. The patient recovered well after active treatment. Conclusion: in this article, we reported a patient diagnosed as TTP and reviewed the disease characteristics, pathogenesis, and treatment of TTP in order to deepen the understadning of TTP and to reduce its missed diagnosis and misdiagnosis.

Objective: to describe the clinical features of bilateral multiple pulmonary arteriovenous fistulas(PAF) with paroxysmal aphasia as the first symptom. Methods: we collected the clinical history and examination data of a patient with paroxysmal aphasia. In order to trace the etiology, we performed chest computed tomography(CT) and pulmonary CT angiography (CTA). Results: the patient had paroxysmal aphasia with dizziness, brain magnetic resonance imaging(MRI) showed cerebral infarction, the transcranial Doppler(TCD) foaming test was positive, transesophageal ultrasound showed no patent foramen ovale, and chest CT and CTA showed bilateral multiple PAF. Conclusion: bilateral multiple PAF are rare in clinic. When patients have paroxysmal neurological symptoms, the possibility of PAF leading to embolism should be considered.