Objective To analyze the clinical manifestations and the features of brain MRI and cerebrospinal fluid (CSF) findings in adult Chinese patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods We reviewed the clinical manifestations,brain MRI and CSF examinations of 29 patients who were diagnosed as anti-NMDAR encephalitis.Results The major clinical features of anti-NMDAR encephalitis patients included psychiatric symptoms (86％,25/29),seizures (83％,24/29),decreased consciousness (55％,16/29),involuntary movements (55％,16/29),central hypoventilation (34％,10/29),and hypersalivation (17％,5/29).Some patients also experienced autonomic instability,hemiplegia and aphasia.Underlying ovarian teratoma was identified in 14％ of affected patients(4/29).Brain MRI was found abnormal in up to 62％ patients (18/29),located in the temporal lobes,hippocampus,thalamus,brain stem,cingulate gyrus,frontal and parietal cortex,corpus callosum,internal capsule,basal ganglia and periventricular area.CSF findings were abnormal in 83％ of patients with anti-NMDAR encephalitis.Oligoclonal banding in CSF was positive in 95％ patients (19/20).The recurrence rate during 3 years was 31％ (9/29).Conclusions Anti-NMDAR encephalitis is a treatable disease,yet with high recurrence rate.Its predominant clinical features are psychiatric symptoms and seizures,while involuntary movements,central hypoventilation and hypersalivation are its characteristic manifestations.Lesions in MRI are widespread,not only restricted to limbic lobe.

Objective To evaluate the efficacy of intramuscular parecoxib for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Fifty-four ASA Ⅰ-Ⅲ patients,aged 65-75 yr,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =27 each)∶ tramadol group (group T) and parecoxib group (group P).Total intravenous anesthesia was used in both groups.Group P received intramuscular injection of parecoxib 40 mg at 12 h before operation and 12,24,36,48,60 and 72 h after operation,and group T received tramadol 100 mg at the same time points.When VAS score was more than 3 after operation,intramuscular parecoxib 50 mg was given as rescue analgesic.The ineffective analgesia at rest and during activity was recorded.The time for knee range of motion to reach 90° and cardiovascular events were recorded.The ultrasonic inspection was performed on veins of the bilateral lower extremities at 7 and 14 days after operation for detection of vein thrombosis.Results Compared with T group,the rate of ineffective analgesia at rest and during activity was significantly decreased,the time for knee range of motion to reach 90° was shortened,and the incidence of deep vein thrombosis was significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidences of cardiovascular events and intramuscular venous thrombosis in group P (P ＞ 0.05).Conclusion Parecoxib 40 mg injected intramuscularly before and after operation can significantly relieve postoperative pain,is helpful for the hip function rehabilitation and can reduce the occurrence of deep vein thrombosis in patients undergoing total knee arthroplasty.

Objective To assess the relationship between lactate clearance and prognosis of patients with multiple organ dysfunction syndrome following resuscitation.Methods Data of 42 eligible patients with multiple organ dysfunction syndrome after resuscitation admitted from January 2009 to December 2011 were collected for retrospective analysis.The patients included were adult patients who survived more 24 hours after CPR for cardiac arrest with subsequent multi-organ failure.Exclusion criteria were traumatic heart arrest and the end-stage diseases.All the patients were divided into survival group and death group on the 3rd day and the 7th day after restoration of spontaneous circulation.The differences in the age,gender,mean arterial pressure,oxygenation index (PaO2/FiO2),APACHE Ⅱ score,white blood cell count (WBC),initial lactate level and 6h lactate clearance rate between the two groups were compared by using the Mann-Whitney U-tests and logistic regression analysis.Results Of 42 patients,the mean age was (59.57±14.68) years and mean APACHE Ⅱ score was (26.79 ±7.77),and 23 (54.8％) patients survived until the 3rd day and 14 (33.3％) patients survived to the 7th day after restoration of spontaneous circulation (ROSC).Univariate analysis showed that APACHE Ⅱ score in death group was significantly higher and 6 h lactate clearance was significantly lower than those in survival group (P ＜ 0.05) on the 3rd day and the 7th day after ROSC,and other biomarkers were not significantly different between the two groups.The results from logistic regression analysis showed that there were statistically significant difference in APACHE Ⅱ score (RR =2.143,P =0.028) and 6-h lactate clearance (RR =0.887,P =0.040) between survival group and death group on the 7th day after ROSC,although no significant differences in APACHE Ⅱ score and 6 h lactate clearance were found between the two groups on the 3rd day after ROSC.Conlusions Post-cardiac arrest patients with low lactate clearance in the early stage after ROSC have a poor prognosis.Lactate clearance may be an independent predictor of mortality in post-cardiac arrest patients in the recovery phase.

Background: Early diagnosis and staging of liver fibrosis are important for the prognosis and evaluating the survival of patients.Aims: To systematically assess the diagnostic value of transient elastography (TE) for staging of liver fibrosis in patients with chronic liver disease.Methods: PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP from Jan.2001 to Dec.2015 were retrieved to collect the articles with staging of liver fibrosis in patients with chronic liver disease by TE.Data extraction was conducted.Article quality was evaluated by quality assessment of diagnostic accuracy studies 2 (QUADAS2).Meta-analysis was conducted by Stata 12.0 software.Results: Twenty articles involving 5 748 patients were included.Meta-analysis showed that the combined sensitivity,specificity and AUC of TE for diagnosing significant fibrosis (≥F2) were 0.78 (95％ CI: 0.73-0.82),0.85 (95％ CI: 0.80-0.88) and 0.88 (95％ CI: 0.85-0.91),respectively.The combined sensitivity,specificity and AUC for advanced fibrosis (≥F3) were 0.89 (95％ CI: 0.86-0.91),0.88 (95％ CI: 0.85-0.91) and 0.94 (95％ CI: 0.92-0.96),respectively.The combined sensitivity,specificity and AUC for cirrhosis (F4) were 0.91 (95％ CI: 0.86-0.95),0.89 (95％ CI: 0.87-0.92) and 0.95 (95％ CI: 0.93-0.97),respectively.Conclusions: TE technique has a good diagnostic value in assessing significant fibrosis,advanced fibrosis and cirrhosis in patients with chronic liver disease,especially for advanced fibrosis and cirrhosis.

Aim To understand the hemostatic effect of a non-polysaccharide fraction of Bletilla striata ( BS-80EE) and to clarify its mechanism of action .Methods The non-polysaccharide fraction ( BS-80 EE ) was prepared by passing the 95%ethanol extract of Bletilla striata through a D101 macroporous resin column elu-ted first with water and then with 80%ethanol.Bleed-ing time ( BT ) and clotting time ( CT ) of heparinized mice were employed as indicators for evaluating the he-mostatic effect of BS-80EE.The mechanism of action was investigated through observing the effect of BS-80 EE on platelet aggregation induced by adenosine diphosphate ( ADP) in rats with nephelometry and tes-ting the effect of BS-80EE on the thrombin time(TT), prothrombin time(PT), activated partial thromboplas-tin time(APTT), fibrinogen(FIB), P-selectin(P-S), thrombin-antithrombin complex ( TAT ) , D-dimer ( D-D) and plasminogen activator inhibitor-1 ( PAI-1 ) . Results BS-80 EE significantly shortened the CT and BT( P<0.01 or 0.05 ) of heparin mice in a dose-de-pendent manner; groups of all doses significantly re-duced the rat TT ( P <0.01 or 0.05 ) , and the high-dose group significantly increased the FIB content ( P<0.05); the mid-dose group and high-dose groups of BS-80EE significantly increased the contents of P-S, TAT and PAI-1 , while reduced the D-D production in rats ( P <0.01 ); although dose-dependent reductions of APTT and PT were observed for each treatment-group, no significance was observed .Conclusion BS-80EE possess pronounced hemostatic effect by promo-ting platelet aggregation and coagulation .

Purpose To investigate the expression of Beclin1, LC3 and mTOR in colorectal cancer ( CRC) and their significance. Methods Immunohistochemistry, Western blot and real-time PCR were employed to detect the expression of Beclin1, LC3 and mTOR in CRC. Results The positive expression rate of Beclin1, LC3 and mTOR in 242 cases of CRC was 90. 50%, 87. 19% and 46. 28%, respectively, which were higher than that in adjacent tissues ( P<0. 05 ) . Moreover, the expression of LC3 in moderately and poorly differentiated CRC was higher than that in well differentiated CRC, and the positive rate of LC3 in CRC with lymph node metastasis was higher than that in CRC without lymph node metastasis. The overexpression of mTOR was related to lymph node metasta-sis (P<0. 05), but both differentiation degree and lymph node metastasis were not associated with Beclin1 (P>0. 05). The expres-sion of LC3 was positively correlated with Beclin1 and negatively correlated with mTOR in colorectal cancer (rs =0. 593, P<0. 01, rs= -0. 165, P<0. 01), and the expression of Beclin1 was not associated with mTOR (P>0. 05). Kaplan-Meier survival analysis re-vealed that the five-year survival rate of patients without nodal metastasis, positive expression of Beclin1, LC3 and negative expression of mTOR was higher than those with nodal metastasis, negative expression of Beclin1 and LC3, and positive expression of mTOR. Cox survival analysis results revealed that LC3, mTOR and lymphnode metastasis were independent prognostic factors. The results of IHC, real-time PCR and Western blot in fresh CRC tissues indicated that the expression of Beclin1, LC3 and mTOR in colorectal cancer was significantly higher than that in adjacent tissues (P<0. 05). Conclusions The aberrant expression of Beclin1, LC3 and mTOR may be associated with the development and progression of colorectal cancer. The simultaneous detection of Beclin1, LC3 and mTOR genes in colorectal cancer may be helpful for the evaluation of the progressive degree and the judgment of prognosis.

Objective: To investigate the changes of ambient dose equivalent rate in 99mTcO4- single photon emission computed tomography (SPECT) of the thyroid among patients with hyperthyroidism, so as to provide insights into radiation protection guidance. Methods: Patients with hyperthyroidism who underwent 99mTcO4- SPECT of the thyroid in a tertiary hospital were enrolled. The ambient dose equivalent rate was measured at different time points following 99mTcO4- infection and at sites with different distances from patients' neck, and the effects of time post-injection, distance from patients' neck, 24-hour thyroidal radioiodine uptake and thyroid weight on the ambient dose equivalent rate were examined using a generalized linear mixed model. Results: Totally 100 patients with hyperthyroidism were enrolled, including 24 men and 76 women and with a mean age of (38.5±14.0) years. The generalized linear mixed model was statistically significant (F=6 610.165, P<0.001), and patients' thyroid weight, time post-injection and distance from patients' neck significantly affected the ambient dose equivalent rate (F=57.967, 15 988.574, 11 200.645, all P<0.001), and the ambient dose equivalent rate positively correlated with patients' thyroid weight and negatively correlated with time post-injection and distance from patients' neck. Conclusions The ambient dose equivalent rate is affected by patients' thyroid weight, time post-injection and distance from patients' neck among patients with hyperthyroidism undergoing 99mTcO4- SPECT of the thyroid. Delay in contact with patients or keeping distance from patients may be effective for radiation protection.

Objective To explore the protective effect of thyroxin on severe traumatic brain injury of brain tissue by observing the effect of thyroxin on neuronal apoptosis,serum neuronal specific enolase(NSE),interleukin-6 (IL-6) and serum FT3 and FT4.Methods A total of 90 SD rats was randomly divided into control group,model group,low dosage of levothyroxine sodium tablets group,moderate dosage of levothyroxine sodium tablets group and high dosage of levothyroxine sodium tablets group,18 rats in each group.The animal model was reproduced by referring to Feeney's free fall impact modeling.Intragastric administration was performed at 6 h after injury.The levels of neuronal apoptosis and serum NSE,IL-6,FT3 and FT4 were detected by TUNEL method,ELISA method and radioimmunoassay at 24,72,168 h after intragastric administration.Results (1) After severe traumatic brain injury,the levels of serum FT3 and FT4 were under the normal and the level of FT4 was decreased to the lowest at 168 h.Thyroxine could increase the levels of FT3 and FT4.(2) Significant neuronal apoptosis was observed in rats with severe craniocerebral injury,and the apoptosis continued until 168 h.Moderate and high dose of thyroxine could improve neuronal apoptosis within 24 h,while low dose of thyroxine changed within 168 h.(3) The levels of serum NSE and IL-6 were increased significantly in rats after severe traumatic brain injury until 168 h,and they could be decreased by moderate and high dose of thyroxine within 72 h.Conclusion Exogenous thyroxine can protect brain tissue in rats with severe traumatic brain injury.

Objective To investigate the status of symptom burden,self-efficacy and quality of life in elderly patients with chronic obstructive pulmonary disease (COPD),and to explore the correlation among the three. Methods A total of 370 elderly patients with COPD hospitalized in the Hospital of Integrated Traditional Chinese and Western Medicine in Zhejiang Province from February 2016 to March 2017 were selected by convenience sampling method. The general data questionnaire,COPD assessment test,COPD self-efficacy scale and COPD quality of life instrument for chronic disease were used to investigate all the subjects. Results The total score of symptom burden in elderly patients with COPD was (28.27±9.52),the total score of self-efficacy was (98.66±10.78),the total score of quality of life was (148.37±21.33). There were significant differences in symptom burden, self-efficacy, and quality of life among patients with different ages, genders, educational level, living styles, smoking and the severity of illness (P< 0.05). There was no statistical difference on symptom burden of patients with different household income (t=1.628,P>0.05), and the scores of self-efficacy and life quality were statistically different (t=2.036,2.184;P< 0.05). Symptom burden was negatively correlated with self-efficacy score and its dimension scores (r=-0.427--0.529,P<0.05);symptom burden was negatively correlated with the total score of quality of life and the scores of each dimension (r=-0.428--0.608,P<0.01);the total score of self-efficacy and the scores of its all dimensions were positively correlated with the total score and each dimension score of life quality (r=0.477-0.778,P<0.01). Conclusions There is correlation with symptom burden,self-efficacy and life quality in elderly patients with COPD. Patients have lower self-efficacy and life quality as their symptom burden increases. It is suggested that by reducing patients′symptom burden,improving self-efficacy level,elderly COPD patients′ quality of life can be improved.

Purpose To explore the expression,mechanism and clinical significance of MCM5 in ovarian cancer.Methods The expression of MCM5 mRNA in ovarian cancer and its correlation with patients'survival were analyzed using GEO and TCGA databases.The expression of MCM5 protein in ovarian cancer was detected by immunohistochemistry of SP two-step method,and its relationship with clinicopathological characteris-tics was analyzed.With inhibition of MCM5 by siRNA in ovarian cancer cells.The effects of MCM5 on cell proliferation,migra-tion,invasion,and apoptosis were detected by CCK-8 assay,EDU,plate cloning,Transwell chamber and flow cytometry.Re-sults Immunophenotype:MCM5 does not stain in the fallopian tube epithelium(0/6),with a positivity rate of 48.3％(57/118)in ovarian cancer.The expression of MCM5 in ovarian cancer is significantly higher than in fallopian tube epithelium,showing diffuse strong expression in high-grade serous carcino-ma.MCM5 expression is strongly correlated with ER-negative status and high Ki67 proliferation index.Knocking down MCM5 expression inhibits proliferation(P＜0.05),clonogenicity(P＜0.05),invasion and migration(P＜0.05)of ovarian cancer cells,and promotes apoptosis.Conclusion MCM5 is highly expressed in human ovarian cancer cells and tissues and is asso-ciated with poor prognosis.It is expected to become a new target for the treatment of ovarian cancer.