Objective:To evaluate the relationship between serum neopterin levels and nasopharyngeal carcinoma and its clinical significance. Method:The serum neopterin levels were determined in 54 patients with nasopharyngeal carcinoma (NPC group) and 32 healthy adults (normal group) by ELISA. Result:The serum neopterin levels in NPC group were significantly higher than that of in normal group (P<0.001). The serum neopterin levels in UICC-TNM stages were undifferentiated (P>0.05). The serum neopterin levels in patients with no lymph node metastasis were lower than that of in lymph node metastasis (P<0.05). The serum neopterin levels decreased significantly after disappearance of tumor and its lymph node treated by radiotherapy (P<0.01). Conclusion:Cellular immunity mediated by macrophages might be involved in the pathologenesis of nasopharyngeal carcinoma and the measurement of the serum neopterin may be a useful objective index to evaluate cellular immunological functions and curative effects.

To investigate the clinical characteristics of primary Sj-gren's Syndrome （pSS） patients with central nervous system（CNS） damage as the initial manifestation.Methods Fifteen pSS patients with CNS damage as the initial manifestation were recruited.Clinical manifestations，laboratory results and imaging findings were retrospectively analyzed.Descriptive statistics was used for statistical analysis.Results Among the 15 patients，the ratio of male to female was 1∶4，and the first onset age was （45.53±16.19） years old.The diagnosis was confirmed after an average of 32.37 months.The initial symptoms included headache （6.67%），dizziness （20%），vomiting （20%），slurred speech （6.67%），facial paralysis （6.67%），hemilateral limb weakness （26.67%），numbness and weakness of both lower limbs （13.33 %） or the limbs （46.67%），chest and back pain（26.67%），blurred vision （6.67%）.The lesions involved the cerebral hemisphere （33.33%），brain stem （53.33%），cerebellum （6.67%），spinal cord （53.33%），and optic nerve （6.67%），presenting as cerebral infarction（33.33%），SAH（6.67%），transverse myelitis（6.67%），bulbar lesion（6.67%），neuromyelitis optica spectrum disorder （NMOSD）（53.33%） and NMOSD complicated with cerebral infarction in 1 case （6.67%）.CNS symptoms recurred in 3 cases （20%） before pSS was diagnosed.At the time of diagnosis，the positive rate of autoimmune antibodies was anti-SSA antibody 100%，anti-nuclear antibody 100%，anti-SSB antibody 73.33%，anti-R0-52 antibody 80%，anti-ds-DNA antibody 6.67%，respectively.The positive rate of RF was 20%.The increase rate of IgG and IgA were 20%，and the decrease rate of complement C3 was 20%.The cerebrospinal fluid study showed：CSF pressure （80-240） mmH-2O，white blood cells cout （4-130）×106/L，protein （0.27-1.46） g/L；CSF IgG increased in 5 cases，and IgM increased in 2 cases，and IgA increased in 4 cases.Conclusion CNS damage can be the initial manifestation of pSS.The lack of timely screening and monitoring of autoimmune antibody is an important reason for the delayed diagnosis of pSS.For unexplained CNS lesions，especially those presenting as recurrent demyelinating events or cerebral infarction，autoimmune antibodies such as anti-SSA and SSB should be examed actively，while the symptoms such as dry eyes and dry mouth should be questioned.It is important for early diagnosis.

Objective:To evaluate the clinical value of 18F-fluorodexoyglucose (FDG) PET/CT in distinguishing benign from malignant tumors in patients with cardiac tumors. Methods:Between January 2015 and September 2018, 18F-FDG PET/CT was performed in 3 678 patents in Beijing Anzhen Hospital, and 51 of them (51/3 678, 1.39%) were diagnosed as cardiac tumors. Finally, 28 patients (10 males, 18 females; mean age (52±14) years, age range: 18-84 years) with pathological results were included. According to pathological results, patients were divided into 4 groups: group 1 with primary benign cardiac tumor ( n=9), group 2 with primary malignant cardiac tumor ( n=9), group 3 with lymphoma ( n=6) and group 4 with secondary malignant cardiac tumor ( n=4). All patients underwent early (60 min) 18F-FDG PET/CT imaging and 22 patients (6, 7, 6, 3 patients in group 1, group 2, group 3, group 4 respectively) underwent delayed (120 min) imaging. The maximum standardized uptake value (SUV max) and target/backgroud ratio (TBR) of 4 groups in early imaging and delayed imaging were calculated and compared with one-way analysis of viariace and Scheffe Post-hoc test. TBR were calcualted as SUV max/mean standardized uptake value (SUV mean) in the liver. Receiver operating characteristic (ROC) curve analysis was also performed. Results:SUV max during early imaging, defined SUV max(early), was 2.6±1.5, 9.9±4.0, 20.5±6.1, 9.2±5.8 in group 1-4 respectively ( F=21.39, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). TBR early was 1.1±0.6, 4.1±1.6, 9.4±2.6, 3.7±2.0 in the 4 groups ( F=29.15, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). SUV max in delayed imaging (SUV max(delay)) was 2.4±1.2, 11.0±5.9, 25.8±7.7, 13.7±7.7 respectively in the 4 groups ( F=16.01, P<0.01). TBR delay was also significantly different among the 4 groups (1.3±0.7, 5.5±2.9, 14.4±4.9, 7.9±5.0; F=14.78, P<0.01), the value of group 3 was higher than that of group 1 and 2 (all P<0.05). ROC curve analysis showed optimal cut-off values for indicating malignancy were: SUV max(early)=4.2, TBR early=1.6, SUV max(delay)=4.6, TBR delay=1.9. The corresponding sensitivities, specificities, accuracies were 19/19, 8/9, 96.4%(27/28); 19/19, 7/9, 92.9%(26/28); 16/16, 6/6, 100%(22/22); 16/16, 5/6, 95.5%(21/22), respectively. Conclusions:18F-FDG PET/CT imaging can accurately diagnose malignant cardiac tumors. Delayed imaging can further improve the accuracy for diagnosis of malignant cardiac tumors.

ObjectiveTo explore the mechanism of modified Shuyuwan in treating vascular dementia （VaD） complicated with depression in mice. MethodThe VaD model was established by bilateral carotid artery stenosis （BCAS） in seven 3-month-old male C57/BL6 mice. The regional cerebral blood flow （rCBF） of mice was measured by laser speckle imaging before and after BCAS surgery. Then， the BCAS method was combined with chronic unpredictable mild stress （CUMS） to establish a mouse model of VaD complicated with depression. BCAS/CUMS mice were assigned into BCAS/CUMS， fluoxetine （0.01 g·kg^-1）， and high-， medium-， and low-dose （20， 10， 5 g·kg^-1， respectively） modified Shuyuwan groups. The shame group underwent sham operation without CUMS （n=10）. The tail suspension test and sucrose preference test were carried out to examine the depressive behaviors of mice. The distribution and expression of myelin-associated glycoprotein （MAG）， myelin basic protein （MBP）， neurofilament heavy polypeptide （NF200）， and anti-non-phosphorylated neurofilament epitope antibody （SMI32） in the corpus callosum （CC） were detected by the immunofluorescence assay. Western blot was employed to determine the protein levels of monocarboxylate transporter 1 （MCT1）， MBP， MAG， oligodendrocyte glycoprotein （MOG）， amyloid precursor protein （APP）， NF200， contactin-associated protein （Caspr）， and voltage-gated sodium channel （Nav1.6） in the corpus callosum. The level of lactic acid in the serum was measured by the lactic acid assay kit， and the ultrastructure of myelin was observed by ultraprojective electron microscope. ResultLaser speckle imaging showed that rCBF decreased immediately 10 min after BCAS surgery （P<0.01）， and the rCBF was still cerebral hypoperfusion and did not return to the preoperative level 2 weeks after surgery. Behavioral test results showed that compared with the sham group， the BCAS/CUMS group presented decreased percentage of sucrose preference （P<0.01） and prolonged immobile time in the tail suspension test （P<0.01）. Compared with the BCAS/CUMS group， fluoxetine and modified Shuyuwan increased the percentage of sucrose preference （P<0.01） and shortened the immobile time in the tail suspension test （P<0.01）. The level of lactic acid was the highest in the BCAS/CUMS mice （P<0.01）， and modified Shuyuwan lowered the lactic acid level （P<0.01）. Immunofluorescence results showed that compared with the sham group， the BCAS/CUMS group presented decreased fluorescence intensity of MAG， MBP and NF200 and increased fluorescence intensity of SMI32 in the corpus callosum， and such changes were reversed by modified Shuyuwan at different doses and fluoxetine. Western blot results showed that compared with the sham group， the BCAS/CUMS modeling down-regulated the protein levels of MCT1， MBP， MOG， MAG， NF20， and Caspr （P<0.05， P<0.01） and up-regulated the protein levels of APP and Nav1.6 in the corpus callosum， and the above trends were reversed by modified Shuyuwan （P<0.05， P<0.01）. Compared with the sham group， BCAS/CUMS modeling led to myelin ultrastructure damage and axon atrophy， which were alleviated by modified Shuyuwan. ConclusionModified Shuyuwan can ameliorate the transport disorder of lactic acid between myelin sheath and axon by upregulating the expressin of MCT1， promote the regeneration of myelin sheath in the corpus callosum， and improve the integrity of myelin sheath structure， thereby alleviating depression in VaD mice.