Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome of central nervous system.The main clinical manifestations include psychiatric symptoms,movement disorders and seizures.It is often misdiagnosed as viral encephalitis.Tumors,especially the ovarian teratoma,play an important role in the disease.The prevalence in children is beyond imagination.Anti-NMDAR antibodies are specific diagnostic tests.Immune suppression is the main treatment.The first-line treatments include corticosteroids,intravenous immunoglobulin,and plasmapheresis.The second-line treatments include biological agents and cytotoxic drugs.Early diagnosis and treatment are essential for neurologic recovery.Overall prognosis is good.

Objective To investigate the effect of Tongxinluo capsule combined with metoprolol on elderly patients with coronary heart disease and angina pectoris and its influence on hemorheology and inflammatory factors.Methods 135 elderly patients with angina pectoris of coronary heart disease were selected,and they were randomly divided into treatment group (68 cases) and control group (67 cases).The treatment group was treated with Tongxinluo capsule combined with metoprolol,while the control group was treated with metoprolol.The two groups were treated for 8 weeks.The curative effect of the two groups was compared,the number and duration of angina pectoris,the changes of hemorheology and inflammatory factors before and after treatment were compared.Results The total effective rate of the treatment group (94.12％) was higher than 76.12％ of the control group (P ＜ 0.05).After treatment,the frequency and duration of angina pectoris in the treatment group were (6.03 ± 1.21) times/week and (3.02 ± 0.76) min/time,respectively,which were significantly lower than those in the control group [(9.87 ± 1.46) times/week and (4.86 ± 0.98) min/time] (t =16.649,12.201,all P ＜ 0.05).After treatment,the whole blood viscosity at high shear rate [(3.76 ± 0.41) mPa/s],whole blood viscosity in low shear [(8.13 ± 0.76) mPa/s],plasma viscosity [(1.23 ± 0.08) mPa/s],erythrocyte aggregation index [(2.06 ± 0.27)],fibrinogen [(2.46 ± 0.41) g/L] in the treatment group were lower than those in the control group[(4.53 ± 0.52) mPa/s,(9.61 ± 0.89) mPa/s,(2.09 ± 0.27) mPa/s,(2.63 ± 0.35),(3.53 ± 0.62) g/L] (t =9.562,10.396,25.170,10.604,11.844,all P ＜ 0.05).After treatment,the interleukin-6 (IL-6) [(8.49 ± 1.76) pg/mL],intercellular adhesion molecule-1 (ICAM-1)[(85.25 ± 8.92) pg/mL],C reactive protein (CRP) [(8.74 ± 1.76) mg/L] in the treatment group were lower than those in the control group[IL-6 (11.32 ± 2.10) pg/mL,ICAM-1 (103.42 ± 10.72) pg/mL,CRP (14.98 ± 2.24)mg/L] (t =8.491,10.712,18.012,all P＜0.05).Conclusion Tongxinluo capsule combined with metoprolol in the treatment of elderly patients with coronary heart disease angina pectoris has obvious curative effect,and can improve the patients'blood rheology and inflammatory reaction.

ObjectiveTo investigate the relationship between carotid atherosclerosis and progressing stroke.Methods103 patients with acute cerebral infarction within the first 24 hours from onset were tested with carotid color doppler ultrasonography during the first week from admission. Univariate and multiple logistic regression analyses were performed to examine the relationship between carotid intima media thickness (IMT), plaque structure, the degree of artery stenosis and the early deterioration of cerebral infarction.ResultsPrevalence of carotid plaque and thickness of IMT in patients with progressing stroke were higher than that in non progressing patients. In logistic regression, presence of carotid plaque was independent predictors of progressing stroke. Plaque size, extent of artery stenosis and IMT were not included in the regression model.ConclusionPlaque structure and its chemical feature may be the cause of progressing stroke.

Objective To investigate the common critical value (CV) of patients hospitalized in the department of spine surgery and to determine the corresponding management. Methods Medical records of patients between 2013 January and 2014 December were retrospectively reviewed. 47 cases with CV were noted. The following characteristics of CV were recorded and analyzed, including time-point at occurrence, type, reason and management. Results Most of the CVs (43/47, 91.5%) were detected between 8 am to 12 am, and between 17 pm and 21 pm. Overall, there were 24 cases of abnormal blood electrolyte (51.1%), 13 cases of abnormal routine blood test (27.7%), 5 cases of abnormal blood coagulation test (10.6%), and 1 case of abnormal TnT (2.1%). The remaining 4 cases including 2 cases detected in the night (1 case of abnormal blood gas test and 1 case of abnormal TnT) and 2 cases detected in the afternoon (1 case of positive blood bacteria culture and 1 case of low blood glucose level). Conclusions The most common CVs were summarized in the clinical practice. The findings have important clinical implications concerning the management of these CVs. In addition, preventive modality of daily nursing and standardization of medical management should be applied so as to ensure the safety of patients and rapid recovery.

Objective To evaluate the effects of 3 kinds of ELISA reagents on the detection of human paragonimiasis. Meth?ods A total of 45 serum samples from patients with paragonimiasis,218 serum samples from patients with other parasitic dis?eases as well as 80 serum samples from healthy people were detected by GD?ELISA(IgG antigen ELISA detection reagent),ES?ELISA(using excretory/secretory(ES)products of Paragonimus westermani),and sAg?ELISA(using semi?purified antigen (sAg)of P. westermani),respectively. The effects of the 3 reagents were evaluated and compared. Results The sensitivities of GD?ELISA,ES?ELISA,and sAg?ELISA were 95.6%(95%CI:89.6%~100.0%),93.3%(95%CI:86.0%~100.0%)and 86.7%(95%CI:76.8%~96.6%),respectively;the specificities of the above three reagents were 88.6%(95%CI:85.0%~92.2%),88.9%(95%CI:85.3%~92.5%)and 99.0%(95%CI:97.9%~100.0%),respectively,and the Youden indexes of them were 0.84,0.82 and 0.86,respectively. Conclusion sAg?ELISA is more suitable than GD?ELISA and ES?ELISA for clin?ical sample tests in paragonimiasis endemic areas in China.

Objective: To analyze the risk factors for peri-procedural myocardial infarction (PMI) in patients with percutaneous coronary intervention (PCI) and to study the impact of CYP2C19 genotypes on PMI. Methods: A total of 283 coronary artery disease (CAD) patients received elective PCI were enrolled, the patients were with normal level of cTnI prior PCI, without adverse reaction post PCI and cTnI levels were re-examined at 24 hours after PCI. The patients were divided into 2 groups: PMI group,n=83 and Non-PMI group,n=200. CYP2C19 genotypes were detected by DNA microarray chip method and based on its result, the patients were classiifed into 3 genotypes: Extensive metabolism type, Intermediate metabolism type and Poor metabolism type. The patients with ADP inhibition rate ≤ 20% was deifned as heightened platelet reactivity (HPR) which was measured by thrombelastograph. Baseline clinical condition was compared between 2 groups and the impact of CYP2C19 genotypes with other risk factors for PMI occurrence were studied. Results: The occurrence rate of PMI was 29.3% (83/283); the age, gender, BMI, smoking, blood levels of TG, LDL-C and uric acid, history of hypertension and diabetes were similar between 2 groups,P>0.05. Compared with Non-PMI group, PMI group had more implanted stents (2.1 ± 0.9) vs (1.5 ± 0.6) and longer total length of stents 56 (36-71) mm vs 33 (23-51) mm, bothP<0.05; lower ADP inhibition rate (36.0 ± 29.8) % vs (43.9 ± 26.4) %,P=0.02 and higher HPR occurrence rate 39.8% vs 22.0%,P=0.01. The ratios of CYP2C19 genotypes of Extensive metabolism, Intermediate metabolism and Poor metabolism were 37.5%, 45.2% and 17.3% respectively, while PMI patients in each genotype were 21.7%, 29.7% and 44.9% respectively. Logistic regression analysis indicated that HPR (OR=2.18, 95% CI 1.19-4.01,P=0.02), total length of stents (OR=1.03, 95% CI 1.00-1.06,P=0.007) and CYP2C19 Poor metabolism genotype (OR=2.8, 95% CI 1.24-6.28,P=0.01) were the risk factors for PMI occurrence. Conclusion: HPR, total length of stents and CYP2C19 poor metabolism genotype were the risk factors of PMI occurrence, while poor metabolism genotype might be the most important endogenous reason for PMI occurrence.

Objective To evaluate the validity and surgical outcome of emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicated with intestinal necrosis.Methods Clinical data of 58 patients diagnosed strangulated inguinal hernia and intestinal necrosis in our hospital from July 2011 to April 2014 were retrospectively analyzed.Of the 58 patients,33 were males and 25 were females,mean age of (64 ± 18) years (range 52-86).There were 28 strangulated inguinal and 30 femoral hernias undergoing emergency small bowel resection and tension-free mesh hernioplasty.Patients with intestinal perforations,preoperative peritonitis,inflammatory hernia and those who required colon resections were excluded from the study.Results The mean operative time was (92 ± 22) min (range,80-120 min).Average length of hospital stay was (8.6 ± 2.5) d (range,6-21 d).There were three postoperative c omplications (5.2％):one of subcutaneous hematoma,one of superficial surgical site infection and one of scrotal fluid collection,which were all cured by wound dressing,removal of infected prosthetic mesh,vacuum sealing drainage (VSD) and continuous irrigation,intravenous antibiotics and scrotal puncture.During a follow-up period of 6 to 32 months (mean 12 ± 6 months),there was no hernia recurrence.Conclusions Emergency one-stage intestinal resection and tension-free mesh hernioplasty for strangulated inguinal hernia complicated by intestinal necrosis is safe,feasible with a favourable outcome and low rate of postoperative complications.

Objective To investigate the variation of coagulation parameters in type 2 diabetes mellitus(T2DM)patients with microvascular complication. Methods Coagulation and fibrinolysis parameters were measured in 40 healthy controls (control group) and 80 T2DM patients (T2DM group) with (47 patients) and without (33 patients) microvasular complications. Results Compared with those in control group, the serum levels of fibrinogenand D-D dimmersin in T2DM group were found to be increased significantly:(4.29±1.70) mg/L vs. (3.12±0.49) mg/L, 0.395 (0.265-0.910) mg/L vs. 0.215 (0.163-0.300) mg/L, P<0.05;while the activity of antithrombin III and protein S levels were significantly decreased in T2DM group:(94.11±25.04)%vs. (103.90±12.48)%,(70.23±23.22)%vs. (90.35±17.35)%, P<0.05. Amongst the T2DM patients, the serum levels of APTT, fibrinogen,D-D dimmers, and the activity of protein S in patients with microvascular complication were found to be significantly higher than those in patients without microvascular complication:(38.09±5.73) s vs. (34.53±4.13) s,(4.60±1.93) mg/L vs.(3.86±1.21) mg/L, 0.630(0.320-1.200) mg/L vs 0.310(0.240-0.405) mg/L, (79.4± 22.16)%vs. (57.15±18.05)%, P<0.05. Conclusion Hypercoagulable state and decreased anti-coagulation ability may contribute to the risk of development of microvascular complication in T2DM patients.

Japan’s long-term care insurance takes grassroots governments as its insurer and the elderly and part of the non-elderly as its insured;The costs is shared by government、society和individual, and is, payed through isti-tutions, communities and hothes. Since its establishment, its security level has been increasing, the role of preven-tion has been rising, the status of community-based and home-based has been highlighting, and the cooperation a-mong relevant industry has been strengthening. But at the same time, its costs was soaring during the past decade, and the continued development of the system is facing transformation pressure now. Take this as a warning, the devel-opment of long-term care in China should learn its strong points, but also try to avoid its shortcomings.