60yr, weighting 50-80kg undergoing general thoracic surgery (lung resection and esophagus cancer resection) were enrolled in this study. Their preoperative hepatic and renal function were normal (blood creatinine

With the understanding of autoimmune encephalitis many novel types of autoimmune encephalitis and related antibodies have been identified. There are some cases of autoimmune encephalitis with autoantibody overlapping syndromes or phenotype overlapping syndromes, which bring challenges to diagnosis and treatment in practice. The relevant literature was reviewed and the clinical characteristics, pathological mechanism and treatment of overlapping syndromes associated with autoimmune encephalitis were summarized, in order to provide a reference for the management of autoimmune encephalitis with overlapping syndromes.

Objective To compare the effects of equivalent dose of sufentanil and fentanyl on wake-up test and recovery profile in scoliosis surgery. Methods Forty ASAⅠ-Ⅱadolescents undergoing scoliosis surgery were randomly divided into fentanyl group (group F,n=20) and sufentanil group(group S,n=20). Anesthesia was maintained with low-flow(1 L/min) inhalation of isoflurane and nitrous oxide (O2∶N2O=1∶1) in both groups. Intermittent i.v. boluses (1～1.5 ?g/kg) of fentanyl was used for analgesia in group F, and total dosage was not more than 5?g/kg when the wake-up test was started. Continuous infusion of sufentanil [0.1～0.2 ?g/(kg?h)] was maintained in group S, and total dosage was less than 1 ?g/kg when the wake-up test was started. The wake-up test time, postoperative recovery time, end-tidal isoflurane concentration(ETiso) and other hemodynamic variables during operation were recorded. Results There was no significant difference in the wake-up test time, postoperative recovery time, bucking and/or restlessness during the wake-up test, PCA morphine dosage and PONV between the two groups. Conclusion Properly administration of sufentanil does not prolong the intraoperative wake-up test time so that it can safely be used in scoliosis surgery.

Intestinal microecology is an important and complex biological system necessary for human health.Its disorder is involved in the development of various diseases of human body.The technology of intestinal microbiota transplantation can effectively regulate the intestinal flora,repair the imbalance of the intestinal microecology,and bring a new breakthrough for the treatment of many diseases of gastrointestinal tract and outside gastrointestinal tract.However,there is still no systematic and complete management standard for intestinal microbiota transplantation technology.This paper discussed related content involved in standardized management of intestinal microbiota transplantation technology and reflected the ethical problems involved in standardized management from the perspective of medical ethics,in order to promote the clinical application of intestinal microbiota transplantation technology.

BACKGROUND:Recently, studies on three-dimensional reconstruction and biomechanics became more and more. Three-dimensional models of organs were established by modeling software based on image data using computer. Mechanical analysis was conducted using finite element analysis software. After literature retrieval, we found that the principle of three-dimensional reconstruction of human organs is not clear, and the process description is relatively simple. Some is not accorded with the fact. Above studies cannot guide related research. OBJECTIVE:To explore the principle, process, results and further application of three-dimensional reconstruction models of organs, and to provide evidence for future studies. METHODS:We retrieved China National Knowledge Infrastructure for representative literatures about three-dimensional reconstruction of human organs using the computer, and analyzed the principle, process, results and further application of three-dimensional reconstruction models of organs. RESULTS AND CONCLUSION:In combination with established three-dimensional bone models, we explained the principle, process, and application of three-dimensional reconstruction in detail, and laid the theoretical foundation for subsequent biomechanical research. With continuous development of tissue engineering technology, scholars have begun to study the pathogenesis of bone injury from various angles and different aspects so as to better prevent and treat this disease. The related research is stil in its primary stage, and stil needs further investigations. 

Objective To explore the clinical significance of expressing multiple autoantibodies in patients with autoimmune encephalitis.Methods Cerebrospinal fluid and serum were tested in patients with undefined encephalitis admitted to Peking Union Medical College Hospital from May 2013 to December 2014.Indirect immunofluorescence test was firstly used to identify the antibodies to neuronal cell-surface or synaptic receptors (including N-methyl-D-aspartate receptor (NMDAR),contactin-associated protein-like 2 (CASPR2),α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR),leucine-rich glioma inactivated protein 1 (LGI1),and gamma-aminobutyric acid beta receptor (GABABR)).In those patients with positive antibodies,antibodies against intracellular neuronal antigens associated with paraneoplastic neurological symptoms were tested.Anti-aquaporin protein-4 (AQP4) antibody was tested depending on patients' clinical manifestations.Results Ten patients were detected combined with additional autoantibodies in 531 patients with positive antibodies related to autoimmune encephalitis.AntiHu antibody was positive in 5 patients with anti-GABABR encephalitis,in 1 of whom anti-NMDAR antibody was also identified;anti-AQP4 antibody was positive in 1 patient with relapsing anti-NMDAR encephalitis;anti-CASPR2 and anti-Yo antibodies were respectively positive in 2 patients with anti-LGI1 encephalitis;anti-CV2 and anti-Hu antibodies were respectively positive in 2 patients with anti-AMPAR encephalitis.Clinical presentation of all cases was consistent with typical encephalitis or limbic encephalitis.Brain stem was involved in 3 patients.Peripheral sensory neuropathy was present in 1 patient,while myalgia and fasciculation were present in 1 patient.Seven patients responded well to the immunotherapy.Tumors were pathologically or radiologically confirmed in 7 cases,including lung cancer in 5 cases,suspected thymoma in 1 case and highly suspected mediastinal tumor without pathological identification in 1 case.Conclusions Due to the pathological mechanism,co-existence of multiple autoantibodies affects clinical manifestations of patients and results in variation and overlap of them.The additional positivity of onconeuronal antibodies directs the search for occult tumor.

Objective To investigate the efficacy and safety of rituximab in the treatment of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods Three patients with anti-NMDAR antibodies in cerebrospinal fluid and serum hospitalized from May 2012 to July 2014 were retrospectively reviewed.The clinical syndrome,investigations,and therapeutic interventions by rituximab when first line immunotherapy failed were evaluated.Results All 3 patients were females with median age of 17 years (12,17,and 22 years).One patient had ovarian teratoma.All 3 patients presented with psychiatric symptoms and movement disorders,2 of which developed into a state of unresponsiveness.Brain magnetic resonance imaging of 2 patients was unremarkable,and 1 showed T2 and FLAIR hyperintensity among the areas of medulla,pons,caudex cerebri and callosum.Fluoro-2-deoxy-D-glucose-PET showed variable multifocal cortical and subcortical abnormalities that changed during the course of the disease.Electroencephalograms were abnormal in all patients,showing non-specific,slow,and disorganised activity,1 showing extreme delta brush.The cerebrospinal fluid showed lymphocytic pleocytosis.All patients showed no response to treatment with first line immunotherapy (corticosteroids,intravenous immunoglobulin (400 mg · kg-1 · d-1 × 5 d,2-3 courses of treatment)).After the administration of rituximab,1 patient responded slower,whereas the other 2 patients who recovered dramatically (375 mg/m2 every week for 3-4 weeks) continued immunosuppression with mycophenolatemofetil for 1 year.Relapse occurred in 1 patient when the immunotherapies discontinued 6 months later.During the treatment of rituximab,2 patients had grade 3 infectious adverse events (hospitalization and intravenous administration of antibiotics).Conclusions Rituximab is effective for the patients with anti-NMDAR encephalitis who fail to respond to the first line immunotherapy.However the utility of rituximab is still a challenge due to the risk of infectious complications and off-label use.

Objective To evaluate the ultrasound guidance method in central venous catheterization (CVC) via the axillary vein.Methods Totally 1369 CVC patients in our center from November 2010 to October 2012 were enrolled in this study.They were randomly divided into two groups based on their different procedures:ultrasound group (n =687):the central veins were assessed using ultrasound,and catheters were placed via axillary vein with ultrasound guidance ; and control group (n =682):CVC was performed using the anatomical landmark method.The operation time,one-attempt success rate,complications,and malposition rate were compared between these two groups.Results The ultrasound group had significantly shorter operation duration than the control group [(7.8± 2.2) min vs (8.4 ± 1.7) min,P =0.000],higher one-attempt success rate [(96.0％ (659/687) vs 81.7％ (557/682),P =0.000],and lower complications and malposition rate [0.6％ (4/687) vs3.7％ (25/682),P=0.000; 0.6％ (4/687) vs2.1％ (14/682),P=0.017,respectively].Conclusions Compared with the conventional landmark method via subclavical vein,ultrasound-guided CVC via axillary vein method can effectively increase success rate,decrease operation duration,attempts of puncture,and complication rate,and avoid catheter malposition.Therefore,the ultrasound method can improve the safety and accuracy of the CVC procedure and deserves wider clinical application.

Objective To investigate whether apolipoprotein E (ApoE) genotypes is associated with postoperative delirium in aged noncardiac surgical patients. Methods Two hundreds and twelve inpatients over 65y, undergoing selective noncardiac surgeries were enrolled in the study. The patients were frequently interviewed and evaluated prospectively for delirium with the Confusion Assessment Method (CAM) during the first three postoperative days. APOE genotype was determined using multiplex amplification refractory mutation system pelymerase chain reaction (multi-ARMS PCR) technique. Results Delirium occurred in 45 patients during the first three postoperative days. Of the 212 patients, 18 (8.5%) possessed one or two ApoE 84 allele. There was no significant difference between delirious patients and non-delirious patients(6.7% : 9.0%, P >0.05) in the presence of ApoE ε4 allele. In all four ApoE ε4/4 homozygote patients, one female patient presented a transient delirium status three days be-fore surgery, another male patient presented serious fluctuated delirium symptoms from the second to 17th days after operation. Conclusion The presence of ApoE ε4 allele seems not a predictator of postoperative delirium. ApoE ε4/4 homozygote patients may be more indulgent to delirium than others.

ObjectiveIn an attempt to clarify the usefulness of combined nerve and muscle biopsy in the diagnosis of neuromuscular disease when compared with traditional sural nerve biopsy.Methods Fifteen biopsies of superficial peroneal nerve (SPN) and peroneus brevis muscle ( PBM ) by one incision performed within one neurological clinic were reviewed.All patients had peripheral neuropathy while 3 of them had myopathy clinically.The diagnostic significance of SPN and PBM biopsies were classified into 3 grade: essential,helpful,no value.ResultsOf 15 SPN and PBM biopsies,7 showed essential pathological findings whichreachedthe etiologicaldiagnosis, including 5definitevasculitis, 1inflammatory demyelinating polyneuropathy and 1 amyloid neuropathy.Five biopsies are helpful for etiological diagnosis,including demyelinating neuropathy,mild inflammation,and microvascular lesion,et al.Three biopsies are of no value for etiological diagnosis which only have nonspecific change such as type 2 fiber atrophy,neurogenic atrophy and axonal degeneration et al. Finally,SPN and PBM biopsies made the definite etiological diagnosis possible in 12 patients.ConclusionsSPN and PBM biopsy improved the yield of specific pathological and etiological diagnosis of neuropathy and myopathy such as vasculitis and amyloidosis with minor trauma and side effect.Further clinical and pathological studies will be necessary for a better practice of combined nerve and muscle biopsy.