Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome of central nervous system.The main clinical manifestations include psychiatric symptoms,movement disorders and seizures.It is often misdiagnosed as viral encephalitis.Tumors,especially the ovarian teratoma,play an important role in the disease.The prevalence in children is beyond imagination.Anti-NMDAR antibodies are specific diagnostic tests.Immune suppression is the main treatment.The first-line treatments include corticosteroids,intravenous immunoglobulin,and plasmapheresis.The second-line treatments include biological agents and cytotoxic drugs.Early diagnosis and treatment are essential for neurologic recovery.Overall prognosis is good.

Objective To investigate the effect of Tongxinluo capsule combined with metoprolol on elderly patients with coronary heart disease and angina pectoris and its influence on hemorheology and inflammatory factors.Methods 135 elderly patients with angina pectoris of coronary heart disease were selected,and they were randomly divided into treatment group (68 cases) and control group (67 cases).The treatment group was treated with Tongxinluo capsule combined with metoprolol,while the control group was treated with metoprolol.The two groups were treated for 8 weeks.The curative effect of the two groups was compared,the number and duration of angina pectoris,the changes of hemorheology and inflammatory factors before and after treatment were compared.Results The total effective rate of the treatment group (94.12％) was higher than 76.12％ of the control group (P ＜ 0.05).After treatment,the frequency and duration of angina pectoris in the treatment group were (6.03 ± 1.21) times/week and (3.02 ± 0.76) min/time,respectively,which were significantly lower than those in the control group [(9.87 ± 1.46) times/week and (4.86 ± 0.98) min/time] (t =16.649,12.201,all P ＜ 0.05).After treatment,the whole blood viscosity at high shear rate [(3.76 ± 0.41) mPa/s],whole blood viscosity in low shear [(8.13 ± 0.76) mPa/s],plasma viscosity [(1.23 ± 0.08) mPa/s],erythrocyte aggregation index [(2.06 ± 0.27)],fibrinogen [(2.46 ± 0.41) g/L] in the treatment group were lower than those in the control group[(4.53 ± 0.52) mPa/s,(9.61 ± 0.89) mPa/s,(2.09 ± 0.27) mPa/s,(2.63 ± 0.35),(3.53 ± 0.62) g/L] (t =9.562,10.396,25.170,10.604,11.844,all P ＜ 0.05).After treatment,the interleukin-6 (IL-6) [(8.49 ± 1.76) pg/mL],intercellular adhesion molecule-1 (ICAM-1)[(85.25 ± 8.92) pg/mL],C reactive protein (CRP) [(8.74 ± 1.76) mg/L] in the treatment group were lower than those in the control group[IL-6 (11.32 ± 2.10) pg/mL,ICAM-1 (103.42 ± 10.72) pg/mL,CRP (14.98 ± 2.24)mg/L] (t =8.491,10.712,18.012,all P＜0.05).Conclusion Tongxinluo capsule combined with metoprolol in the treatment of elderly patients with coronary heart disease angina pectoris has obvious curative effect,and can improve the patients'blood rheology and inflammatory reaction.

ObjectiveTo investigate the relationship between carotid atherosclerosis and progressing stroke.Methods103 patients with acute cerebral infarction within the first 24 hours from onset were tested with carotid color doppler ultrasonography during the first week from admission. Univariate and multiple logistic regression analyses were performed to examine the relationship between carotid intima media thickness (IMT), plaque structure, the degree of artery stenosis and the early deterioration of cerebral infarction.ResultsPrevalence of carotid plaque and thickness of IMT in patients with progressing stroke were higher than that in non progressing patients. In logistic regression, presence of carotid plaque was independent predictors of progressing stroke. Plaque size, extent of artery stenosis and IMT were not included in the regression model.ConclusionPlaque structure and its chemical feature may be the cause of progressing stroke.

Objective To explore the best plan of perioperative individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease undergoing gastrointestinal surgery were divided into experimental group and control group by random digits table method with 40 cases each.Conventional capcity treatment was given during surgery and postoperative period in control group.Individualized fluid therapy was used during surgery and postoperative period in intensive care unit of 24 h in experimental group,which was determined based on target controlled fluid therapy according to the cardiac index,stroke volume,and stroke volume variation.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.The two groups were compared in terms of postoperative hemodynamic parameters,total fluid volume,incidence of adverse cardiac events,and recovery of gastrointestinal function.Results The mean arterial pressure at the beginning of the operation,the cardiac index at operation begining 1 h and at the end of operation were (80.4 ± 6.4) mmHg (1 mmHg =0.133 kPa),(4.0 ± 0.6) L/(min ·m2),(4.1 ± 0.8) L/(min ·m2) in experimental group and (76.9 ± 8.0) mmHg,(3.5 ± 0.4) L/(min· m2),(3.6 ± 0.3) L/(min · mè) in control group,and there were significant differences between two groups (P ＜ 0.05).During surgery and 24±hour stay in intensive care unit,the total fluid volume,crystal usage,urine and colloid usage were (2 915 ± 650),(2 715 ± 415),(1 515 ± 315),(1 225 ± 385),(419 ± 233),(619 ± 285),(1 015 ± 220),(1 535 ± 455) ml in experimental group and (3 645 ±770),(3 355 ±750),(2 315 ±320),(1 855 ±325),(602 ±31),(875 ±423),(805 ±250),(1 135 ± 205) ml in control group,and there were significant differences between two groups (P ＜ 0.05).The perioperative adverse cardiac events rate was 30％ (12/40) in experimental group,lower than 45％ (18/40) in control group,but the difference was no statistically significance (P ＞ 0.05).Conclusion In the elderly patients with coronary artery disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department.Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed.Of them,338 patients with suspected AAD were examined by chest radiography,trans-thoracic echocardiography (TTE),and computed tomography angiography (CTA) successively.The reliabilities of results from each diagnostic method were verified by the gold standard of intra-operative findings and the comparisons of their diagnostic potential were carried out.Results The preoperative diagnostic sensitivity of chest radiography,TTE and CTA in the assessment of AAD were 64％,77％ and 100％,respectively;the specificity is 86％,90％ and 100％,respectively;the accuracy rats were 70％,78％ and 100％,respectively;the positive predictive values were 93％,99％ and 100％,respectively;the negative predictive values were 46％,27％ and 100％,respectively.In the work-up of any patient with suspected AAD,the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening,and the best method for the accurate diagnosis of AAD was CTA.Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate,and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method,and the early combination of vasodilatation medicines was better than the single one.Of them,242 patients fortunately survived on treatment,and 42 died of hypovolemic shock after rupture of AAD and multiorgan failure.Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease,though it is extremely rare in the hypertensive patients,attending doctors should pay more attention.Early rapid diagnosis is the key to AAD treatment.The best method for correctly diagnosing AAD is complementary use of TTE,CTA and magnetic resonance angiography (MRA).Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD.

In the scientific,systematic,practical and feasible principles,the quality control needs and management needs of health authorities and medical institutions were analyzed.The study probed into the real-time monitoring functions of existing hospital information systems and information products of IT technology firms,and the feasibility of setting up key monitoring points during medical service processes.685 real-time monitoring indicators have been set up for real-time monitoring of medical process quality.

Adipocytokines included adiponectin,leptin,omentin and visfatin are secreted by adipocytes and closely associated with obesity and insulin resistance.Many studies find that these adipocytokines are correlated with the occurrence and development of colorectal cancer,and may be promising biomarkers with respect to clinical diagnosis and prognosis of colorectal cancer.At present,the occurrence mechanisms of colorectal cancer induced by adipocytokines are unclear and needed to be extensively explored.

Objective]To study traditional Chinese medicine of Yangyin Shengjin and Buyi Ganshen combining artificial tears treating liver and kidney Yin deficiency of patients with dry eyes for clinical effect. [Method] Selection of 62 patients(124 eyes) with liver and kidney Yin deficiency ,who were randomly divided into treatment group and control group. The treatment group given herbs of Yangyin Shengjin and Buyi Ganshen combined with artificial tears,but the control group given only artificial tears, with a course of treatment for 30 days and 3 periods of it. To observe the two groups of changing about the clinical efficacy and Schirmer test ,BUT and FL in pretherapy and post-treatment. [Result] Treatment group total effective rate was 83.87%,control group was 58.06%,the curative effect of treatment group was better than that of control group( P<0.05). Two groups of FL,BUT and STI after treatment compared with before treatment,the differences were statistical y significant(P<0.05 or P<0.01),and the treatment group after treatment BUT and STI changes significantly better than that of control group( P<0.01). [Conclusion] The herbs of Yangyin Shengjin and Buyi Ganshen combined with artificial tears treating patients with dry eyes of liver and kidney Yin deficiency have a good clinical efficacy. It is a way to treat disease from the root.

Stromal cell-derived factor-1(SDF-1)is an early cell growth factor which belongs to a subfamily of chemokines.The CXCR4 is SDF-1 receptor.The SDF-1 interacting with CXCR4 plays important roles in physiological and pathological processes such as hematopiesis, stem cell homing,angiogenesis and leukemic cells infiltrating.To study the expression of CXCR4 in leukemia and the relationship between CXCR4 and leukemic cells infiltration can add indicators for leukemic MIC diagnosis of immunology indexes and have great significance to take molecule targeted therapy for preventing leukemia from infiltration or relapse as well.