60yr, weighting 50-80kg undergoing general thoracic surgery (lung resection and esophagus cancer resection) were enrolled in this study. Their preoperative hepatic and renal function were normal (blood creatinine

With the understanding of autoimmune encephalitis many novel types of autoimmune encephalitis and related antibodies have been identified. There are some cases of autoimmune encephalitis with autoantibody overlapping syndromes or phenotype overlapping syndromes, which bring challenges to diagnosis and treatment in practice. The relevant literature was reviewed and the clinical characteristics, pathological mechanism and treatment of overlapping syndromes associated with autoimmune encephalitis were summarized, in order to provide a reference for the management of autoimmune encephalitis with overlapping syndromes.

Intestinal microecology is an important and complex biological system necessary for human health.Its disorder is involved in the development of various diseases of human body.The technology of intestinal microbiota transplantation can effectively regulate the intestinal flora,repair the imbalance of the intestinal microecology,and bring a new breakthrough for the treatment of many diseases of gastrointestinal tract and outside gastrointestinal tract.However,there is still no systematic and complete management standard for intestinal microbiota transplantation technology.This paper discussed related content involved in standardized management of intestinal microbiota transplantation technology and reflected the ethical problems involved in standardized management from the perspective of medical ethics,in order to promote the clinical application of intestinal microbiota transplantation technology.

Objective To compare the effects of equivalent dose of sufentanil and fentanyl on wake-up test and recovery profile in scoliosis surgery. Methods Forty ASAⅠ-Ⅱadolescents undergoing scoliosis surgery were randomly divided into fentanyl group (group F,n=20) and sufentanil group(group S,n=20). Anesthesia was maintained with low-flow(1 L/min) inhalation of isoflurane and nitrous oxide (O2∶N2O=1∶1) in both groups. Intermittent i.v. boluses (1～1.5 ?g/kg) of fentanyl was used for analgesia in group F, and total dosage was not more than 5?g/kg when the wake-up test was started. Continuous infusion of sufentanil [0.1～0.2 ?g/(kg?h)] was maintained in group S, and total dosage was less than 1 ?g/kg when the wake-up test was started. The wake-up test time, postoperative recovery time, end-tidal isoflurane concentration(ETiso) and other hemodynamic variables during operation were recorded. Results There was no significant difference in the wake-up test time, postoperative recovery time, bucking and/or restlessness during the wake-up test, PCA morphine dosage and PONV between the two groups. Conclusion Properly administration of sufentanil does not prolong the intraoperative wake-up test time so that it can safely be used in scoliosis surgery.

Objective To evaluate the ultrasound guidance method in central venous catheterization (CVC) via the axillary vein.Methods Totally 1369 CVC patients in our center from November 2010 to October 2012 were enrolled in this study.They were randomly divided into two groups based on their different procedures:ultrasound group (n =687):the central veins were assessed using ultrasound,and catheters were placed via axillary vein with ultrasound guidance ; and control group (n =682):CVC was performed using the anatomical landmark method.The operation time,one-attempt success rate,complications,and malposition rate were compared between these two groups.Results The ultrasound group had significantly shorter operation duration than the control group [(7.8± 2.2) min vs (8.4 ± 1.7) min,P =0.000],higher one-attempt success rate [(96.0％ (659/687) vs 81.7％ (557/682),P =0.000],and lower complications and malposition rate [0.6％ (4/687) vs3.7％ (25/682),P=0.000; 0.6％ (4/687) vs2.1％ (14/682),P=0.017,respectively].Conclusions Compared with the conventional landmark method via subclavical vein,ultrasound-guided CVC via axillary vein method can effectively increase success rate,decrease operation duration,attempts of puncture,and complication rate,and avoid catheter malposition.Therefore,the ultrasound method can improve the safety and accuracy of the CVC procedure and deserves wider clinical application.

ObjectiveIn an attempt to clarify the usefulness of combined nerve and muscle biopsy in the diagnosis of neuromuscular disease when compared with traditional sural nerve biopsy.Methods Fifteen biopsies of superficial peroneal nerve (SPN) and peroneus brevis muscle ( PBM ) by one incision performed within one neurological clinic were reviewed.All patients had peripheral neuropathy while 3 of them had myopathy clinically.The diagnostic significance of SPN and PBM biopsies were classified into 3 grade: essential,helpful,no value.ResultsOf 15 SPN and PBM biopsies,7 showed essential pathological findings whichreachedthe etiologicaldiagnosis, including 5definitevasculitis, 1inflammatory demyelinating polyneuropathy and 1 amyloid neuropathy.Five biopsies are helpful for etiological diagnosis,including demyelinating neuropathy,mild inflammation,and microvascular lesion,et al.Three biopsies are of no value for etiological diagnosis which only have nonspecific change such as type 2 fiber atrophy,neurogenic atrophy and axonal degeneration et al. Finally,SPN and PBM biopsies made the definite etiological diagnosis possible in 12 patients.ConclusionsSPN and PBM biopsy improved the yield of specific pathological and etiological diagnosis of neuropathy and myopathy such as vasculitis and amyloidosis with minor trauma and side effect.Further clinical and pathological studies will be necessary for a better practice of combined nerve and muscle biopsy.

Objective To investigate the clinical,laboratory,and neuroimaging characteristics of neuroacanthocytosis.Methods Eight patients with neuroacanthocytosis were retrospectively analysed.Acanthocytes were tested by peripheral blood smear,wet preparation with saline dilution,and scanning electron microscope.Results Two male and 6 female patients were included.The age at onset was between 10 and 35 years,with a mean age at onset of 22 years.Four patients firstly presented with oral-facial-lingual dystonia,3 patients firstly presented with involuntary movements of the distal limbs and experienced the oral facial dystonia during the course of disease,and 1 patient primary presented with a parkinsonian syndrome.Four patients had generalized tonic-clonic seizures were reported in 4 patients,and 4 patients had cognitive impairment.Hypotonia and hyporeflexia were reported in 6 patients.The peripheral blood smear revealed the presence of acanthocytes in 7 patients,in addition,wet preparation with saline dilution and scanning electron microscope revealed the presence of acanthocytes in the remaining one.All patients showed slightly elevated serum creatine kinase.Brain magnetic resonance imaging (MRI) showed variable atrophy of the bilateral caudate nuclei and putamen,with or without a rim of increased T2-intensity in 6 patients,but the films of 2 patients were read as normal.Electromyography and nerve conduction velocity were examined in 4 patients.The results indicated axonal damage in 2 patients,and were normal in the other 2 patients.Acanthocytosis was confirmed by peripheral blood smear in 7 cases,by wet preparation with saline dilution in 8 cases and by scanning electron microscope in 2 cases.Conclusions Neuroacanthocytosis is a progress neurodegenerative disorder mainly affected the basal ganglia. The clinical characteristics include oral facial dystonia,limbs chorea,cognitive impairment,and seizures. Brain MRI showed variable atrophy of the bilateral caudate nuclei and putamen.The peripheral blood smear,wet preparation with saline dilution,and scanning electron microscope methods of peripheral blood examination are critical in the diagnosis of neuroacanthocytosis.

Objective: To compare the efficacy and side effects of patient-controlled intravenous morphine with epidural single bolus morphine in postoperative pain relief. Method: Sixty patients undergoing gynecological procedures under epidural anesthesia were randomly assigned to epidural morphine(EPI)group or patient-controlled intravenous analgesia (PCIA) group. In the EPI group,2 mg of morphine was injected into epidural space at the end of operation. In PCIA group, 1 mg of morphine as a demand dose would be injected intravenously by the patient through a patientcontrolled analgesic delivery system until the pain relieved. The patients were followed up at 4, 8, 12, 24 h after operation,and the degree of pain,sedation, nausea and vomiting were assessed. Result: The total dosage of morphine was higher in the PCIA group(19.08?5.0 mg)than that in the EPI group(2mg,P

Objective To compare the efficacy of interscalene brachial plexus block using an ultrasound-guided method with nerostimulator-guided method.Methods Ninety ASAⅠ～Ⅱ patients scheduled for surgery of the upper extremity were randomly allocated into three groups(n=30),Control group: nerve stimulator-guided and single-injection group;US group: ultrasound-guided with nerve stimulator confirmation and single-injection group;UD group: ultrasound-guided with nerve stimulator confirmation and double-injection group.Thirty mL 0.5% ropivocaine was injected in each group.The patient in group UD received half the volume of ropivocaine injected around the two target nerves.Results The average onset time of sensory blockade in the UD group was significantly shorter than in the US group and Control group.The rate of satisfactory sensory blockade in the UD group was significantly higher than in the US group and Control group.Conclusion Ultrasound-guided interscalene brachial plexus block may shorten the onset time with fewer adverse events.The ultrasound-guided double-injection method may significantly improve the quality of blockade.

0.05) in the presence of ApoE ?4 allele.In all four ApoE ?4/4 homozygote patients,one female patient presented a transient delirium status three days before surgery,another male patient presented serious fluctuated delirium symptoms from the second to 17th days after operation.Conclusion The presence of ApoE ?4 allele seems not a predictator of postoperative delirium.ApoE ?4/4 homozygote patients may be more indulgent to delirium than others.