Objective To observe the mRNA expression levels of POT1 in peripheral blood mononuclear cells of acquired aplastic anemia patients with different syndrome, and explore its relationship with acquired aplastic anemia and its TCM syndrome. Methods Peripheral blood mononuclear cells of 52 cases with acquired aplastic anemia and 20 cases as control group were collected to detect mRNA expression of POT1 by using real-time quantitative polymerase chain reaction (RT-qPCR), and its relation with TCM syndrome was analyzed. Results The expression levels of POT1 mRNA in patients with acquired aplastic anemia were lower significantly than control group (P<0.05). The expression levels of POT1 mRNA in patients with deficiency of kidney-yin were lower than patients with deficiency of kidney-yang, and it was lowest in patients with kidney deficiency of both yin and yang. There was significant correlation between the expression levels of POT1 mRNA and age (r=0.374, P=0.038). Conclusion The changes in expression levels of POT1 play a role in the pathogenesis of acquired aplastic anemia. There is correlation between mRNA expression level of POT1 in peripheral blood mononuclear cells and TCM syndrome.

Objective To evaluate the effects of Guhong Injection on motor dysfunction in rats after cerebral ischemia- reperfusion. Methods The middle cerebral arteries were occluded for 2 hours and re-perfused in Sprague-Dawley rats. They were divided in sham group, model group, Aceglutamide group, Safflowere group and Guhong group, which were intravenously administrated with normal saline, Aceglutamide, Safflower or Guhong 24 hours after operation, and continued for 14 days. They were tested with the beam-walking test after treatment. Tyrosine hydroxylase (TH) immunohistochemical staining was used to investigate the viability of neurons in the substantia nigra. Results The model group spent more time in the beam-walking test than that in the sham group (P<0.01), and it decreased in the Safflower group and Guhong group compared with that in the model group (P<0.05). The TH-positive neurons decreased in the model rat compared with that in the sham group (P<0.001), and increased in both Safflower and Guhong groups compared with that in the model group (P<0.01). Conclusion Guhong administration could significantly improve the motor dysfunction in rats after cerebral ischemia- reperfusion, which might be related to provent the neurons from injury in the substantia nigra.

Objective:To analyze and summarize the clinical characteristics of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients with cerebellar ataxia.Methods:The clinical manifestations, laboratory examinations, treatment and prognosis of anti-NMDAR encephalitis patients with cerebellar ataxia diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2019 were retrospectively analyzed.Results:About 4.3% (15 cases) of a total of 347 anti-NMDAR encephalitis patients were complicated with cerebellar ataxia, of which one patient had ovarian teratoma. There were seven male cases and eight female cases, with a median age of 28 years. The average duration from the onset of encephalitis to the onset of cerebellar symptoms was 30.8 days.The average modified Rankin Scale (mRS) score was 3.73. In the acute phase, the median cerebrospinal fluid leukocyte count was 28×10 6/L. All patients received first-line immunotherapy, of which one case additionally received second-line immunotherapy with rituximab and nine patients received long-term immunotherapy with mycophenolate mofetil. The follow-up time ranged from seven to 66 months. The average mRS score of the last time was 2.73, and only six patients (6/15) had good prognosis (mRS score≤2). Conclusions:Patients with anti-NMDAR encephalitis and cerebellar ataxia are rare, and have relatively poor prognosis in terms of neurological function. Symptoms of cerebellar ataxia in anti-NMDAR encephalitis patients should be recognized in time, and standardized immunotherapy regimens and long-term immunotherapy should be adopted to improve the prognosis.

AIM:To investigate the pathogenesis of aplastic anemia ( AA) through the expression of P 53 and P21, and the telomere length in the bone marrow mononuclear cells (BMMNC) of patients with AA.METHODS: The BMMNC were collected from 60 cases of AA, including 38 non-severe aplastic anemia (NSAA) and 22 severe aplastic ane-mia (SAA), and 25 healthy controls.The mRNA expression of P53 and P21, and the telomere length were detected by real-time quantitative polymerase chain reaction (RT-qPCR), while the protein expression of P53 and P21 was determined by Western blot.The correlations among P53, P21 and telomere length were analyzed .Hematopoietic components of bone marrow were measured by bone marrow biopsy .CD34 +cells proportion in nuclear cells were assessed by flow cytometry . RESULTS:Telomere length in the patients with AA , including NSAA and SAA , was significantly lower than that in con-trol group (P<0.05).The same results of the hematopoietic components of bone marrow and the CD 34+cells proportion in nuclear cells were observed .Telomere length in SAA group was shorter than that in NSAA group ( P<0.05 ) , while the hematopoietic components of bone marrow and the CD 34 +cells proportion in nuclear cells also showed the same results . The expression of P53 and P21 at both mRNA and protein levels in the AA patients , including NSAA and SAA , was signi-ficantly higher than that in control group (P<0.05).The expression of P53 and P21 in the SAA patients was higher signi-ficantly than that in the NSAA patients ( P<0.05 ) .No correlation between the expression of P 53 or P21 and telomere length was found . There was significant positive correlation between the expression of P 53 and P21 ( P <0.05 ) . CONCLUSION:Telomere length, P53 and P21 may be involved in the pathogenesis of AA by inhibiting the proliferation and differentiation of hematopoietic stem cells , and triggering cell apoptosis .

Objective To optimize the formulation of the sunscreen used in military training.Methods The different formulations of sunscreen were prepared according to the orthogonal design,and then applied on 3M adhesive tape posted on the color dish with a certain amount;the absorbance in 280 nm-320 nm and 320 nm-400 nm of them were measured and the arithmetic mean (A) was concluded.By comparing A,the protective effect and the main factors affecting preventive bask were determined.The preventive bask test of the optimum formula was carried out in human trials using the method of multi point increasing ultraviolet irradiation.Results OMC,TinosorbTM M,rutin,pearl powder and baicalin all had significant effects in preventing UVA.OMC had a significant effect in preventing UVB.The formula 1 (containing the five materials mentioned above) had the best effects in preventing both UVA (SPF 18) and UVB (PA+).Conclusions The formula 1 has the best effects in preventing both UVA and UVB.

Objective:A large single-center, premature acute myocardial infarction (AMI) age (≤45 years) cohort was established to investigate the clinical features and the factors affecting major adverse cardiac events (MACE).Methods:This is a prospective and observational study. 603 patients with a clear diagnosis of AMI admitted to the Tianjin Chest Hospital from March 2015 to December 2017 were continuously selected. All patients were aged ≤45 years old, and a single-center large-sample premature AMI cohort was established. The patient's clinical basic conditions, laboratory indicators, imaging data, coronary angiography and treatment were collected. All patients were followed up for 1 year. MACE events such as cardiac death, recurrent AMI, revascularization, severe heart failure requiring hospitalization and stroke were recorded. Kaplan Meier method was used to draw the survival curve. Cox regression analysis was used to analyze the influence of risk factors, clinical characteristics and intervention methods on the long-term prognosis of MACE events.Results:A total of 603 AMI patients were included, 575 males (95.36%), 28 females (4.64%), and median age 41 (37, 44) years old. There were 422 patients (69.98%) with acute ST segment elevation myocardial infarction (STEMI), 206 patients (48.82%) with anterior myocardial infarction, and 181 patients (30.02%) with non ST segment elevation myocardial infarction (NSTEMI). Smoking was the most common risk factor for premature AMI (77.45%), followed by hyperlipidemia (48.42%) and hypertension (48.09%); smoking was the most common risk factor for male patients (80.35%), and hyperlipidemia was the most common risk factor for female patients (35.71%). 302 (50.08%) patients with premature AMI were treated with symptom onset to first medical contact (SO-to-FMC) ≤12 h; 563 patients (93.37%) had coronary angiography; coronary angiography showed that no significant stenosis, single-vessel disease, double-vessel disease, three-vessel disease, and patients with left main disease were 15(2.66%), 212(37.66%), 153(25.37%), 167(29.66%), 16(2.84%) cases; 318(56.48%) patients with vascular occlusion; The proportion of male combined with left main lesions was lower than that of female group (2.41% vs 12.50%, P=0.026); A total of 45 patients (7.46%) were recorded MACE. The 1-year MACE incidence was lower in the male group than in the female group (6.96% vs 17.86%, P=0.032). Multivariate COX regression analysis: there were 5 indicators that entered the regression model and were statistically significant: female ( HR:4.184; 95% CI:1.583-11.064; P=0.004), SO-to-FMC≤12 h ( HR:0.447; 95% CI:0.224-0.889; P=0.022), left ventricular ejection fraction (LVEF)≤40% ( HR:3.727; 95% CI:1.876-7.405; P<0.001), low-density lipoprotein (LDL) ( HR:1.315; 95% CI:1.041-1.662; P=0.022), homocysteine (Hcy) ( HR:1.011; 95% CI:1.002-1.019; P=0.011) were independent predictor of MACE occurrence in patients with early-onset AMI within 1 year. Conclusions:Smoking is the most common risk factor for young men with AMI. The most common risk factors for young women's AMI is hyperlipidemia, and the proportion of patients with left main artery disease is higher than that of men, but the proportion of patients receiving emergency intervention is lower than that of men, and the long-term prognosis of young women is poor. Early detection and control of these risk factors is a key measure to prevent the onset of AMI.

Objective:To identify anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibody in patients with encephalitis of unknown etiology and describe the clinical features of anti-DPPX antibody-associated encephalitis in Chinese patients.Methods:For patients registered in the Peking Union Medical College Hospital Encephalitis and Paraneoplastic Syndrome Registration Project from 2016 to 2019 with negative findings in autoimmune encephalitis routine antibody profile and paraneoplastic antibody profile, but with positive tissue-based assay (TBA) results, further tests for rare antibodies, including cell-based assay (CBA) of anti-DPPX antibody, were performed. Patients positive for anti-DPPX antibody were enrolled and the clinical data were collected.Results:Two patients with anti-DPPX antibody-associated encephalitis were found from 2016 to 2019 among about 15 000 patients. Both were females, aged 46 and 75 years. One patient had diarrhea, cachexia, cognitive dysfunction, agitation, myoclonus, tremor, and seizures. The other had cognitive impairment, restlessness, memory loss, disorientation, and sleep disturbance. The second patient had medical history of systemic lupus erythematosus and secondary Sj?gren′s syndrome.Conclusions:TBA should be combined with CBA in identification of anti-DPPX antibody to confirm the diagnosis. Anti-DPPX antibody-associated encephalitis has clinical manifestations of encephalopathy with diarrhea and cachexia, and can coexist with systemic lupus erythematosus.

Objective To observe Rongxin Pills in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) and the effectiveness and clinical application of safety.Methods Viral myocarditis patients (280 cases,deficiency of both qi and yin and heart meridian stasis syndrome),according to 3:1 ratio as the test group (n =21 0) and control group (n =70).The test group took orally Rongxin pills each time 4.5～9 g,3 times daily;the control group oral coenzyme Q10 capsule each time 10 ～ 20 mg,twice daily.The course of treatment was 28 d.The experiment was carried out with the random and double blind method.The symptoms of myocarditis,integrated and electrocardiogram,echocardiography,myocardial enzymes,as well as the efficacy of traditional Chinese medicine and improvement of the effect of the disease were observed.Results The results of FAS (PPS) analysis showed that 28 d after treatment,the symptom score and mean of experimental group and control group were 5.975 (6.000) and 4.721 (4.788).The syndromes of the total effective rates were 91.62％ (90.59％) and 70.59％ (71.21％),curative effect the total effective rates were 90.14％ (92.08％) and 72.06％ (72.73％).The total effective rate of experimental group was higher than that of the control group,the difference was statistically significant.In this experiment,three cases of clinical adverse events were reported,which were not related to the experimental drug.It also not belongs to adverse drug reactions.Conclusion Rongxin Pill in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) is more effective than coenzyme Q 10 capsule,and there was no indication of higher risk of clinical application.

Objective To analyze the clinical features of neurobrucellosis manifested as cerebrovascular diseases and explore the possible pathogenesis.Methods Cases of neurobrucellosis presenting as cerebrovascular diseases in Peking Union Medical College Hospital from January 2007 to February 2018 were analyzed retrospectively.The demographic information,epidemiological history,routine and etiology tests of blood and cerebrospinal fluid,imaging (magnetic resonance imaging + diffusion weighted imaging,magnetic resonance angiography/head and neck computed tomography angiography),echocardiography,treatment and prognosis of the above patients were collected.The possible mechanism of neurobrucellosis with cerebrovascular diseases was analyzed according to clinical manifestations and imaging characteristics.Results Totally,31 cases of neurobrucellosis were diagnosed,of which seven cases were mainly presented as cerebrovascular diseases (three cases as the first symptoms),accounting for 23％ of neurobrucellosis.There were three cases of cerebral infarction,one case of cerebral infarction accompanied with cerebral hemorrhage,one case of transient ischemic attacks (TIA),two cases of imaging abnormalities related to cerebral small vessel disease.Three patients were discharged voluntarily and four patients were treated with minocycline/doxycycline,rifampicin and ceftriaxone.The prognosis of the treatedcases was good.Conclusions Neurobrucellosis may be presented as TIA,cerebral infarction,cerebral hemorrhage or cerebral small vessel disease related imaging features.For cerebrovascular diseases with systemic nonspecific symptoms such as hearing loss and fatigue,it is necessary to differentiate Brucella infection.Vasospasm,vasculitis and infection-induced arteriosclerotic infarction may be the possible mechanism of stroke in these patients.

Objective To report the clinical and paraclinical features of a case series with antiIgLON5 antibody related encephalopathy.Methods One hundred and fifty patients with sleep disorders and subacute or chronic onset of movement disorders,parkinsonism or bulbar palsy were included.The serum and cerebrospinal fluid specimens of these patients were screened for anti-IgLON5 antibody.The clinical and paraclinical features of patients with seropositive anti-IgLON5 antibody were summarized.Results Three patients with seropositive anti-IgLON5 antibody were identified,with one female and two males.The onset age ranged from 61 to 64 years.Case 1 presented with symptoms of involuntary movement,unsteady walk and insomnia;case 2 with symptoms of insomnia,sleep behavioral disorder,psychiatric behavior and dysphagia;case 3 with symptoms of insomnia,sleep behavioral disorder,dysarthria,and tremor.When examined by polysomnography,obstructive sleep apnea syndrome was revealed in cases 1 and 2,serious insomnia was found in cases 2 and 3,and sleep behavioral disorder was revealed in case 2.All three patients were positive for HLA-DQB1 * 0501,and cases 2 and 3 were positive for HLA-DRB1 * 1001.All three patients received immunotherapy and only one patient (case 1) responded well to immunotherapy with intravenous immunoglobulin,steroids and mycophenolate mofetil.Conclusions Anti-IgLON5-related encephalopathy is a rare disease with distinct clinical features of both autoimmune disorders and neurodegeneration disorders.These patients may benefit from immunotherapy.