Objective To investigate the usage of neostigmine test in diagnosis of myasthenia gravis (MG) initiated from extraocular muscles,including test methods and data analysis.Methods The clinical features of 100 consecutive patients with myasthenia gravis initiated from extraocular muscles were collected retrospectivelly,including initial symptom,number and department of visiting,evolution of symptoms and signs,methods and the judgment of therapeutic response for neostigmine test.Results (1) All patients with MG started from ptosis unilateral or bilateral or diplopia,among which 46％ (46/100)of patients with both ptosis and diplopia.Within 21％ (21/100) of patients,other muscles had been involved except for extrocular muscles before neostigmine test.Seventy-eight percent patients first consulted ophthalmology after (0.7 ± 0.3) month from onset.It took (1.6 ± 1.3) months for patients to visit neurologist for the first time.The average time for confirming diagnosis was (3.3 ± 2.1) months.(2) After (2.0 ± 1.5) times consulted at neurology department and (2.0 ± 1.8) months after symptoms onset,the patients undergone neostigmine test.Positive reaction rate showed lower in low dosage group (60.9％ (14/23) vs 98.3％ (58/59),x2 =18.30,P ＜0.01).Positive rate also showed lower in oral-take pyridostigmine bromide tablets group than neostigmine methylsulfate injection group(15/18 vs 98.3％ (58/59),x2 =4.428,P =0.035).(3) Sixtyfive percent patients had mild to moderate side effects after neostigmine injection,which disappeared in 60-120 minutes.Conclusions Non-standard operations of neostigmine test reduced the effectiveness of its diagnosis for MG initiated from extraocular muscles.Neurologist should attach importance totake standard neostigmine test to identify MG as soon as possible.

Objective To explore the phenotypic characteristics of T lymphocyte subsets in the peripheral blood (PB) of Patients with rheumatoid arthritis.Methods forty-seven patients with ankylosing spondylitis (AS) and 36 health control were selected as our subjects.The patients were divided into definite Diagnosis AS group and potential AS group according to symptom and X-ray,flow cytometry was applied to measure T lymphocyte subsets and HLA-B27 of peripheral blood.At the same time,the levels of ESR,CRP and IgA were also measured.The correlation between T lymphocyte subsets and CRP HLA-B27,IgA level was analyzed.Results There was no significant difference between The definite diagnosis AS patients and healthy controls regarding of the percentages of CD3 + cells in peripheral blood,However the percentage of CD4 + cells in definite diagnosis AS patients was significantly increased than that of healthy controls (P ＜ 0.05).The ratio of CD4 +/CD8 + cells was 3.80 ± 0.28 in AS patients,higher than that of potential AS patients.T lymphocyte subsets were showed an increase tendency as the increase the level of CRP,IgA.Conclusion Lower CD8 + cell and higher CD4 + cell were showed in the peripheral blood of AS patients,which was correlated with the disease activity and suggesting T cells might be involved in the pathogenesis process of AS.Meanwhile our data indicated that the immune response might be a susceptible factor of AS and early detection of T lymphocyte subsets might provide a diagnosis and treatment basis for diagnosis of AS.Therefore the disorder of T lymphocyte subsets might play an important role in the development of rheumatoid arthritis.

Patient′s expectation has been defined as the anticipation that given events were likely to occur during, or as an outcome of, health care. What people expect from their health care are potentially important in predicting patient satisfaction and dissatisfaction with their care, treatment and health outcomes. There was widespread recognition of the importance of evaluating services from consumer perspectives. In this article, domestic and foreign research in recent years, expectations status, significance and various influencing factors in relation to the expectations in processes of health care were summarized. Consumer evaluations of their health care are now an established component of quality assessment, planners need to understand the expectations underlying patients′views in order to interpret their feedback. Thus leading to improve patient satisfaction and the social evaluation of medical units.

Objective To analyze the associations between alleles of TNF?-308 and myasthenia gravis(MG) and its subgroups. Methods A biallelic polymorphism at position -308 in the promoter region of TNF? was screened by polymerase chain reaction (PCR) amplification and NcoⅠ restricted enzyme. One hundred MG patients and one hundred healthy controls of Chinese were analysed. Results The allele TNF?2(A) was found significantly increased in all patients (0.32 in MG vs 0.21 in healthy controls, P0.05), showing a trend of increase in patients with an late onset of disease (0.34) compared to age matched healthy controls (0.10, P

AIM:To explore the effects of endothelial indoleamine 2,3-dioxygenase (IDO) on the migration and the expression of contractile proteins in the pericytes.METHODS: Human pulmonary artery endothelial cells ( HPAECs) and rat cerebral microvascular pericytes were cultured in vitro.Over-expression of IDO in the HPAECs ( IDO-HPAECs) was established.The pericytes were treated with HPAEC-conditioned medium (control group), IDO-HPAEC conditioned medium (treatment group), or IDO-HPAECs-conditioned medium containing 1-methyl-DL-tryptophan (1-mT) ( inhibition group) .The concentrations of nitric oxide ( NO) , tryptophan and kynurenine in the co-culture system were de-termined.The viability, migration and the expression of the contractile proteins in the pericytes were compared.RE-SULTS:No statistical difference of the pericyte viability after treatment with IDO-HPAEC-conditioned medium at 6~48 h was observed (P>0.05).The migratory ability of the pericytes significantly decreased in treatment group compared with control group (P<0.01), and significantly increased in inhibition group compared with treatment group (P<0.01).The concentration of NO in the co-culture system had no significant difference among groups (P>0.05).The concentration of tryptophan was significantly lower in treatment group than that in control group (P<0.01), and significantly higher in in-hibition group than that in treatment group (P<0.01).The concentration of kynurenine was significantly higher in treat-ment group than that in control group (P<0.01), and significantly lower in inhibition group than that in treatment group (P<0.01).The expression ofα-smooth muscle actin and desmin was significantly lower in treatment group than that in control group (P<0.01), and significantly higher in inhibition group than that in treatment group (P<0.01).CON-CLUSION:Endothelial IDO inhibits the migration and the expression of the contractile proteins in the pericytes, and may play essential roles in the regulation of microvasculatures.

Objective To explore the short and long-term effect of cardiopulmonary resuscitation (CPR) training for agricultural residence registration population with the language education and practice education,in order to establish a more effective method of first-aid training for agriculture population.Methods 989 agricultural residence registration people were divided into group A (721 people)and group B (268 people) randomly.Group A received CPR training with language education and group B adopted practice education.On the time before and after training immediatelythe 3rd and 6th month after training,we checked the training results and analyzed the data with statistical methods.Results The short- term effect of two methods was satisfying (accuracy more then 90％ ) and without statistical significance.The effect of group B was better than group A in the 3rd and 6th month after training.Two groups showed higher forgetting rate and some accuracy were less than 50％.Conclusions Agriculture population is in urgent need of first-aid.It may be a more effective method of first-aid training for agriculture population to transform gradually from language education to practice education.At the same time,we may use 4 hours as CPR practice education training time and 6 months as re-training period.

Objective To retrospectively analyze clinical manifestations of autonomic nervous system (ANS) and skin sympathetic response (SSR) in Lambert-Eaton myasthenic syndrome (LEMS).Methods Fifty-three LEMS patients' medical records were reviewed and information regarding clinical symptoms and signs of ANS and SSR testing results were collected.Results ( 1 ) The most common initial symptom of LEMS was weakness of lower extremities ( n =41 ) and the most common symptom of ANS dysfunction was constipation ( n =25 ) and dry-mouth ( n =23),which could be occurred before the onset of the legs (n =7).(2) In symptoms of ANS,cardiovascular system dysfunction was found in 4 patients include one of ingone of bradycardia,one of postural hypotension and 2 of tachycardia- Secretory glands dysfunction was found in 34 patients:23 dry-mouth,6 dry-eyes,and 8 patients sweating dysfunctions.Twenty-eight patients complained of alimentary dysfunction including constipation and diarrhea.Bladder dysfunction was found in 2 patients,who complained of urinary incontinence.Seven male patients complained of sexual dysfunction.Abnormal skin scratch test was found in 17 patients.(3) SSR was performed in 33 patients and 18 found abnormal.Conclusions ANS manifestations are common and prominent in LEMS patients.SSR abnormality is also common in LEMS.More electrophysiology tests are needed in LEMS patients.

Objective To analyze the symptoms and signs in forty-five Lambert-Eaton myasthenia syndrome (LEMS) patients retrospectively. Characteristics of electrophysiological examinations were investgated. Methods Forty-five LEMS patients were reviewed and information gathered regarding clinical complains neurological symptoms, and other concomitant diseases. The records showed that repetitive nerve stimulation (RNS) and nerve conduction velocity (NCV) were performed in all patients. Needle electromyography (EMG) and skin sympathetic response (SSR) were performed in some patients. Results (1) The mean age of neurological clinical onset age was (51.2 ±6. 8) years old. The two most common symptoms were slight weakness of lower extremities ( n = 35 ) and upper extremities (n= 5). Dysarthria was found in 3 patients and neck weakness in 2 patients. Tendon reflex decreased and disappeared in 38 patients. Autonomic nervous system manifestations were presented in 30 patients. (2) RNS increasing was observed in all patients from 156% to 636%. Low frequency RNS abnormalities were found in 29 patients.Sensory nerve conduction velocity abnormalities or sensory nerve conduction velocity combined motor nerve conduction velocity abnormalities were found in 19 patients ( 42% ). Of the 30 patients who underwent a needle EMG examination, 20 had myogenic or neurological damage. Thirteen abnormal findings were observed in 25 patients who underwent SSR examination. Conclusion The most common manifestations were weakness in lower extremities and autonomic nervous system dysfunction. Many abnormal electrophysiological results were found in LEMS patients, including NCV and EMG abnormalities. These findings indicated that clinical manifestations exceed the neuromuscular junction and perhaps included the peripheral nerve and muscle.

Objective To assess the correlations between muscle strength and amplitude of compound muscle action potential(CMAP)with blood potassium level in hypokalemic periodic paralysis after long exercise test(ET).Methods ET of abductor digiti minimi(ADM)was performed on 78 patients with hypokalemic periodic paralysis.Ulnar and median CMAP amplitude,blood potassium level,muscle strength of ADM,palmar interossei muscle and abductor pollicis brevis were measured before and 120 minutes after exercise.The correlations of muscle strength,CMAP amplitude and blood potassium level were analyzed.Results Ulnar CMAP amplitude was(4.6 ±2.7)mV after ET and(9.6 ±3.2)mV before ET(t =16.047,P =0.000)in 78 patients with hypokalemic periodic paralysis,respectively.Median CMAP amplitude was(10.9 ± 4.2)mV after ET and(11.2 ± 3.9)mV before ET(t =0.673,P =0.822),respectively.After ET,muscle strength of ADM decreased in 76 patients,score on MRC was less than Ⅲ in ADM but V in palmar interossei muscle and abductor pollicis brevis in 41 patients,the blood potassium level was tested in 10 of them,which was(3.8 ±0.3)mmol/L before ET and(3.9 ±0.4)mmol/L after ET(t =0.395,P =0.702).Conclusion In patients with hypokalemic periodic paralysis,blood potassium level is not the key factor affecting muscle strength and CMAP amplitude after ET.

Objective To understand the endemic characteristics and regularity of cystic echinococcosis by evaluating and classifying its endemic situation in Non Tibetan Plateau regions,so as to provide the evidence for formulating effective preventive and control measures. Methods The prevalence data of cystic echinococcosis in 174 counties(cities,districts,banners)in Non Tibetan Plateau regions from a national survey were collected and analyzed by the sample cluster method in 2012. Results The 174 counties(cities,districts,banners)could be classified into 4 clusters by spatial distribution. The first cluster with human high prevalence rate,low infection rate of livestock,and positive rate of dog stool antigen included 3 counties. The second cluster with high infection rate of livestock,low prevalence rate of human,and positive rate of dog stool antigen included 20 counties(cit-ies). The third cluster with high positive rate of dog stool antigen,low prevalence rate of human,and low infection rate of livestock included 39 counties(cities,districts,banners). The fourth cluster with low rates of the above 3 indices included the rest 112 counties. Conclusions The results of the cluster analysis conform to the current epidemiological status of cystic echinococcosis in the Non Tibetan Plateau regions. The epidemiological characteristics and geographical distributions of the four area types will pro-vide a basis for the classified management and guidance of cystic echinococcosis control in these areas.