Objective To investigate elderly patients with thoracic radiotherapy nausea result after risk factors associated with radiation pneumonitis.Methods The clinical data of a total of 440 cases of cancer patients with chest radiation therapy during January 2010-January 2014 were collected retrospectively.Of them,76 cases of radiation pneumonitis after radiotherapy were compared with other patients.The unconditional Logistic regression analysis was used to analyze the relationship of radiation pneumonitis and different factors including smoking,pulmonary dysfunction,combination with chemotherapy,radiation dose,and radiation sites.Results Elderly incidence of radiation pneumonitis was 17.27％.Multivariate Logistic regression analysis revealed the chi-square value of smoking,pulmonary dysfunction,combined with chemotherapy,radiation dose,and radiation sites was significant correlation (x2 =16.936,19.633,11.531,17.133,10.178,P ＜0.05),and the correlation degree was gradually decreased from pulmonary dysfunction,radiation dose,smoking,combined chemotherapy,to radiation site.Conclusions Elderly patients with thoracic malignancies after radiotherapy had more radiation pneumonitis,which was related to smoking,previous chemotherapy PO2 ＜ 80％,combined with chemotherapy,radiation dose ≥ 55 Gy,and low-lung radiation.The correlation degree was gradually decreased from chemotherapy before PO2 ＜ 80％,the radiation dose ≥55 Gy,smoking,combined chemotherapy,to low-lung radiation.

Objective The anti-UV-B radiation mechanism of UV-B tolerance strain KFS-9 was studied from the profile of metabolites.Methods The compounds were separated by column chromatography and their structures were elucidated based on GC-MS,LC-TOF-MS,EI-MS and NMR analyses.Results Three unsaturated fatty acids(identified as 9-hexadecenoic acid,9,12-octadecadienoic acid and 11-octadecenoic acid) and 1,2-benzenedicarboxylic acid able to absorb ultraviolet were isolated from the petroleum ether extract of the fermentation liquid of Pantoea agglomerans KFS-9.Fraction(Ⅱ) was isolated from the ethyl acetate extract and was composed of 2,3-butanediol and a series of high unsaturated aroma compounds.Fraction(Ⅱ) had a wide absorption peak,and it could protect E.coli from UV-B damage in some sense.Conclusion Strain KFS-9 produced metabolites that were able to absorb UV to build a natural barrier and so improved the tolerance to UV radiation.The UV-B radiation protection test to the E.coli also showed fraction(Ⅱ) was not the only protector,and there definitely existedother materials and mechanism to protect the strain.

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.

Objective To investigate the in-stent restenosis after vertebral artery ostium stenting (VAOS),and to determine the risk factors for in-stent restenosis. Methods Respective analysis of clinical data of 775 cases received VAOS in Xuan Wu Hospital of Capital Medical University from Jan. 2006 to Dec. 2012. Severe stenosis of vertebral artery ostium were diagnosed by DSA,and followed-up by ultrasound. The risk factors were assessed by COX analysis for in-stent restenosis ≥50%. Results This study included 775 patients. Surgical success rate was 99. 87%(n=774),technique success rate was 99. 48%(n=771 ). Two patients had cerebral hemorrhage after operation,one of them was dead. Four patients had cerebral infarction. The mean follow-up period was 12 months. The restenosis rate was 35. 89%(234/652 ). 79. 91% of restenosis occurred within 12 months after operation. COX analysis showed the vessels diameter after stenting was the independent predictors of in-stent restenosis (P<0. 01). The in-stent restenosis rate of drug-eluting stents was lower than metal-bare stents (HR 0. 532,95%CI 0. 397-0. 713,P<0. 01). Conclusion The in-stent restenosis was peculiarly prone to the smaller vessels diameter after VAOS. Drug-eluting stents were superior to metal-bare stents in preventing in-stent restenosis.

OBJECTIVE To observe the effect of baicalin on Aβ25-35 induced learning and memory deficits and changes in autophagy-related genes in mice so as to explore the related mechanisms of Alzheimer disease (AD) treatment . METHODS C57 mice were administered with 3μL Aβ25-35 3 mmol·L-1 by intracerebroventricular injection to establish an AD model. Baicalin was given by intracerebroventricular injection at the dose of 25, 50 and 100 mg · kg-1 for 15 d, respectively. The total distance and the central grid residence time were measured in the open-field test. The escape latency and the time to reach the platform were monitored in the Morris water maze trial. The autophagic vacuoles in the hippocampus of the mice were observed by transmission electron microscopy before the protein expressions of microtu?bule-associated protein 1 light chain 3 (LC3) and Beclin1 in brain tissue were analyzed by Western blot?ting assay. RESULTS Intracerebroventricular injection of Aβ25-35 could reduce the total distance from (3984±321)cm to (2790±306)cm and extend central grid residence time from (3.6±1.2)s to (8.8±2.9)s in the open-field test. The escape latency of water maze also increased from (22.0 ± 1.9)s to (38.8 ± 2.2)s. Autophagic vacuoles or late autophagic vacuoles and increased Beclin1 and LC3 and protein level were observed in the hippocampus after Aβ25-35 injection. Intraperitoneal injection of Baicalin 50 and 100 mg · kg-1 for fifteen consecutive days extended the total distance in open-field test to (3705 ± 337)cm and (3968 ± 448)cm, respectively, while the central grid residence time was reduced to (5.6 ± 1.8)s and (3.9±1.5)s, respectively. The total time taken to reach the platform in water maze test was reduced to (28.6± 1.9)s, (22.9 ± 1.7)s. Mitochondrial swelling, vacuolar membrane structure or autophagic vacuoles were visible in the hippocampus. LC3 and Beclin1 protein expression was significantly up-regulated(P<0.01). CONCLUSION Baicalin shows protective effect against Aβ25-35 induced learning and memory deficits, and this effect may be related to the activation of autophagy in the mouse hippocampus.

Objective:To investigate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging for the epidermal growth factor receptor (EGFR) mutations in patients with lung adenocarcinoma. Methods:From January 2013 to December 2017, a total of 146 patients (83 males, 63 females, age: (60.2±10.3) years) who were confirmed as lung adenocarcinoma by pathology and were examined by 18F-FDG PET/CT imaging and EGFR mutation testing in Shanxi Cancer Hospital were retrospectively analyzed. The differences of clinical characteristics (age, gender, smoking, tumor diameter, loymph node metastasis, distant metastasis, stage, thyroid transcripition factor-1 (TTF-1), NapsinA, cyiokeratin (CK)-7, Ki-67) and PET/CT parameters (maximun standardized uptake value (SUV max) of the primary tumor (pSUV max), SUV max of lymph node (nSUV max) and SUV max of distant metastasis (mSUV max)) between patients of EGFR mutation and EGFR wild type were analyzed using independent-sample t test, χ2 test and Fisher exact test. The predictors for EGFR mutation were analyzed by logistic regression analysis. The predictive value of pSUV max and pSUV max combined with gender, smoking and tumor diameter was determined by receiver operating characteristic (ROC) curve analysis. Results:There were 46.58%(68/146) patients with EGFR mutations and 53.42%(78/146) patients with wild type. Gender, smoking, lymph node metastasis, tumor diameter, pSUV max, nSUV max, TTF-1, NapsinA and Ki-67 were significantly different between patients with EGFR mutations and those with wild type ( t values: from -3.023 to -2.032, χ2 values: 4.725-33.749, all P<0.05). Female (odds ratio ( OR)=3.236, 95% CI: 1.213-8.779; P=0.029), non-smoker ( OR=4.947, 95% CI: 1.796-13.621; P=0.019), tumor diameter<3.5 cm ( OR=2.750, 95% CI: 1.109-6.818; P=0.001) and pSUV max<9.1( OR=2.960, 95% CI: 1.227-7.141; P=0.016) were predictors of EGFR mutations in lung adenocarcinoma. The area under the curve (AUC) of pSUV max was 0.640 with the specificity of 43.6%(34/78)and the sensitivity of 27.9%(19/68), while the AUC of the four independent factors was 0.83 with the specificity of 71.8%(56/78) and the sensitivity of 83.8%(19/68). Conclusions:pSUV max is associated with mutant EGFR status. Moreover, the combination of pSUV max, gender, smoking and tumor diameter can enhance the predictive value on EGFR mutation status in patients with lung adenocarcinoma.

We present a case of intracranial aneurysm located in the P1 segment of left posterior cerebral artery in the context of tetralogy of Fallot. Complex variations included right aortic arch with abnormal branching. Also, the bilateral vertebral arteries were absent, with a type I persistent proatlantal intersegmental artery of the left side. The aneurysm was treated with endovascular intervention with a Tubridge flow diverter and was noted to be completely cured on 6-month follow-up. We discuss the many considerations in this patient including developmental and modern-era treatment.

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.

Objective To establish a test of autoantibody-panel for the diagnosis of autoimmune cerebellitis (AC) and determine the prevalence of AC in patients with cerebellar ataxia of unknown etiology.Methods Autoantibody screening tests with indirect immunofluorescence were performed in serum and cerebrospinal fluid (CSF) samples of 400 previously'idiopathic'Chinese patients with cerebral ataxia (inpatients and outpatients in Peking Union Medical College Hospital or referred from hospitals of Beijing Encephalitis Group from 2016 to 2018).Immunotherapy was given to autoantibody positive patients and the effectiveness of immunotherapy was assessed.Detailed AC autoantibodies panel included anti-glutamate decarboxylase 65 (GAD65) antibody,anti-Tr (delta notch-like epidermal growth factor-related receptor (DNER)) antibody,anti-zinc finger protein 4 (ZIC4) antibody,anti-inositol 1,4,5-trisphosphate receptor 1 (ITPR1) antibody,anti-homer protein homolog 3 (Homer 3) antibody,anti-neurochondrin (NCDN) antibody,anti-carbonic anhydrase-related protein (CARP) antibody and anti-Purkinje cell antibody 2 (PCA2) antibody.Results Eight out of 400 (2％) ataxia patients were positive for this AC panel tests,of whom two were positive for anti-GAD65 antibody,two for anti-Tr antibody,one for anti-PCA2 antibody,one for anti-Homer 3 antibody and two were positive for serum anti-NCDN antibody.Autoantibodies against ZIC4,ITPR1 and CARP were not detected in this cohort.Two of the eight ataxia patients also presented with limbic encephalitis,and only one anti-GAD antibody patient was screened with underlying small cell lung carcinoma (SCLC).All the eight patients received immunotherapy and four experienced partial response.Conclusions Autoimmune cerebellitis is the cause of acquired cerebellar ataxia.Tests of autoantibodies associated with AC have diagnostic value for paraneoplastic and non-paraneoplastic cerebellar ataxia.Immunotherapy may yield partial response in patients with AC.

Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in antileucine-rich glioma-inactivated 1 (LGI1) encephalitis by analyzing the clinical and immunologic data of patients treated with MMF in this prospective cohort of anti-LGI1 encephalitis.Methods Patients treated with MMF for more than one year in Peking Union Medical College Hospital were included in this study.MMF was given at a dosage of 1.5-3.0 g/d in the induction period (two to four months) and 0.75-2.00 g/d in the maintenance period.All the patients were followed up regularly.Modified Rankin Scale (mRS) score evaluation,serum IgG and peripheral CD19-positive B cells,CD4-positive T cells and CD8-positive T cells testing were performed every two months.Results Fifteen patients were included in this study who received first-line immunotherapy combined with MMF.No other second-line therapy including rituximab was used.Thirteen patients responded well to MMF combined with first-line immunotherapy (a decrease in mRS score of more than 1).All 15 patients had a good outcome (i.e.,a mRS score of 0-2),including nine patients without residual symptoms (a mRS score of 0).After 12 months of MMF treatment,CD19-positive B cells were significantly decreased (median 320 (227,628) × 106/L vs 152 (105,223) × 106/L;Z=-2.028,P=0.043),while serum IgG (9.07 (6.70,11.32) g/L vs 8.35 (6.63,10.69) g/L,P=0.144)),CD4-positive T cells (1 136 (736,1 432) × 106/L vs 1 055 (802,1 072) × 106/L,P =0.866) and CD8-positive T cells (627 (413,784) × 106/L vs 568 (393,743) × 106/L,P =0.735) were not significantly changed.Three patients relapsed and were treated with additional cycle of first-line immunotherapy and increased dosage of MMF (induction dosage) resulting in remission.CD19-positive B cells were tested to be increased during the patients' relapse.No serious adverse event was noted in all these patients.Conclusions MMF is safe and effective as a long-term immunotherapy in patients with anti-LGI1 encephalitis.MMF can be used as an add-on therapy to first-line immunotherapy for autoimmune encephalitis.CD19-positive B cell count should be monitored and used as a parameter to individualize dosage of MMF.