Objective To investigate the usage of neostigmine test in diagnosis of myasthenia gravis (MG) initiated from extraocular muscles,including test methods and data analysis.Methods The clinical features of 100 consecutive patients with myasthenia gravis initiated from extraocular muscles were collected retrospectivelly,including initial symptom,number and department of visiting,evolution of symptoms and signs,methods and the judgment of therapeutic response for neostigmine test.Results (1) All patients with MG started from ptosis unilateral or bilateral or diplopia,among which 46％ (46/100)of patients with both ptosis and diplopia.Within 21％ (21/100) of patients,other muscles had been involved except for extrocular muscles before neostigmine test.Seventy-eight percent patients first consulted ophthalmology after (0.7 ± 0.3) month from onset.It took (1.6 ± 1.3) months for patients to visit neurologist for the first time.The average time for confirming diagnosis was (3.3 ± 2.1) months.(2) After (2.0 ± 1.5) times consulted at neurology department and (2.0 ± 1.8) months after symptoms onset,the patients undergone neostigmine test.Positive reaction rate showed lower in low dosage group (60.9％ (14/23) vs 98.3％ (58/59),x2 =18.30,P ＜0.01).Positive rate also showed lower in oral-take pyridostigmine bromide tablets group than neostigmine methylsulfate injection group(15/18 vs 98.3％ (58/59),x2 =4.428,P =0.035).(3) Sixtyfive percent patients had mild to moderate side effects after neostigmine injection,which disappeared in 60-120 minutes.Conclusions Non-standard operations of neostigmine test reduced the effectiveness of its diagnosis for MG initiated from extraocular muscles.Neurologist should attach importance totake standard neostigmine test to identify MG as soon as possible.

Objective To analyze the associations between alleles of TNF?-308 and myasthenia gravis(MG) and its subgroups. Methods A biallelic polymorphism at position -308 in the promoter region of TNF? was screened by polymerase chain reaction (PCR) amplification and NcoⅠ restricted enzyme. One hundred MG patients and one hundred healthy controls of Chinese were analysed. Results The allele TNF?2(A) was found significantly increased in all patients (0.32 in MG vs 0.21 in healthy controls, P0.05), showing a trend of increase in patients with an late onset of disease (0.34) compared to age matched healthy controls (0.10, P

Objective To explore the phenotypic characteristics of T lymphocyte subsets in the peripheral blood (PB) of Patients with rheumatoid arthritis.Methods forty-seven patients with ankylosing spondylitis (AS) and 36 health control were selected as our subjects.The patients were divided into definite Diagnosis AS group and potential AS group according to symptom and X-ray,flow cytometry was applied to measure T lymphocyte subsets and HLA-B27 of peripheral blood.At the same time,the levels of ESR,CRP and IgA were also measured.The correlation between T lymphocyte subsets and CRP HLA-B27,IgA level was analyzed.Results There was no significant difference between The definite diagnosis AS patients and healthy controls regarding of the percentages of CD3 + cells in peripheral blood,However the percentage of CD4 + cells in definite diagnosis AS patients was significantly increased than that of healthy controls (P ＜ 0.05).The ratio of CD4 +/CD8 + cells was 3.80 ± 0.28 in AS patients,higher than that of potential AS patients.T lymphocyte subsets were showed an increase tendency as the increase the level of CRP,IgA.Conclusion Lower CD8 + cell and higher CD4 + cell were showed in the peripheral blood of AS patients,which was correlated with the disease activity and suggesting T cells might be involved in the pathogenesis process of AS.Meanwhile our data indicated that the immune response might be a susceptible factor of AS and early detection of T lymphocyte subsets might provide a diagnosis and treatment basis for diagnosis of AS.Therefore the disorder of T lymphocyte subsets might play an important role in the development of rheumatoid arthritis.

Patient′s expectation has been defined as the anticipation that given events were likely to occur during, or as an outcome of, health care. What people expect from their health care are potentially important in predicting patient satisfaction and dissatisfaction with their care, treatment and health outcomes. There was widespread recognition of the importance of evaluating services from consumer perspectives. In this article, domestic and foreign research in recent years, expectations status, significance and various influencing factors in relation to the expectations in processes of health care were summarized. Consumer evaluations of their health care are now an established component of quality assessment, planners need to understand the expectations underlying patients′views in order to interpret their feedback. Thus leading to improve patient satisfaction and the social evaluation of medical units.

AIM:To explore the effects of endothelial indoleamine 2,3-dioxygenase (IDO) on the migration and the expression of contractile proteins in the pericytes.METHODS: Human pulmonary artery endothelial cells ( HPAECs) and rat cerebral microvascular pericytes were cultured in vitro.Over-expression of IDO in the HPAECs ( IDO-HPAECs) was established.The pericytes were treated with HPAEC-conditioned medium (control group), IDO-HPAEC conditioned medium (treatment group), or IDO-HPAECs-conditioned medium containing 1-methyl-DL-tryptophan (1-mT) ( inhibition group) .The concentrations of nitric oxide ( NO) , tryptophan and kynurenine in the co-culture system were de-termined.The viability, migration and the expression of the contractile proteins in the pericytes were compared.RE-SULTS:No statistical difference of the pericyte viability after treatment with IDO-HPAEC-conditioned medium at 6~48 h was observed (P>0.05).The migratory ability of the pericytes significantly decreased in treatment group compared with control group (P<0.01), and significantly increased in inhibition group compared with treatment group (P<0.01).The concentration of NO in the co-culture system had no significant difference among groups (P>0.05).The concentration of tryptophan was significantly lower in treatment group than that in control group (P<0.01), and significantly higher in in-hibition group than that in treatment group (P<0.01).The concentration of kynurenine was significantly higher in treat-ment group than that in control group (P<0.01), and significantly lower in inhibition group than that in treatment group (P<0.01).The expression ofα-smooth muscle actin and desmin was significantly lower in treatment group than that in control group (P<0.01), and significantly higher in inhibition group than that in treatment group (P<0.01).CON-CLUSION:Endothelial IDO inhibits the migration and the expression of the contractile proteins in the pericytes, and may play essential roles in the regulation of microvasculatures.

Objective To evaluate the diagnostic accuracy of diffusion tensor imaging (DTI) of corticospinal tract in amyotrophic lateral sclerosis (ALS) and find optimal testing strategies and optimal cutoff values of DTI indices for individual patient discrimination.Methods Thirty-three ALS patients and 34 healthy controls,collected at Peking Union Medical College Hospital from June 2004 through July 2005,undergoing brain DTI studies and fractional anisotropy (FA) examinations along the corticospinal tract,were analyzed by receiver operating characteristic (ROC) curves.Results Compared with the controls,ALS group had significantly decreased FA values in subcortical white matter of the precentral gyrus,the posterior limb of the internal capsule and the cerebral peduncle.In ROC analysis,the average FA value of the former two positions showed the best performance with an area under the curve of 0.917,an optimal cut-off value of 0.604,a sensitivity of 0.759 and a specificity of 0.912.The corresponding data for the average FA of all the three positions and each single position were listed as follows:average of three 0.914,0.648,0.759,0.912; precentral gyrus 0.875,0.509,0.733,0.824; internal capsule 0.845,0.692,0.656,0.941 ; and cerebral peduncle 0.752,0.742,0.656,0.735.Conclusions FA values of the corticospinal tract have a good accuracy in detecting upper motor neuron involvement in ALS.Precentral gyrus and posterior limb of the internal capsule and the average FA values of these two positions were suggested as the preferred testing places and DTI indices for clinical use.

Objective To understand the endemic characteristics and regularity of cystic echinococcosis by evaluating and classifying its endemic situation in Non Tibetan Plateau regions,so as to provide the evidence for formulating effective preventive and control measures. Methods The prevalence data of cystic echinococcosis in 174 counties(cities,districts,banners)in Non Tibetan Plateau regions from a national survey were collected and analyzed by the sample cluster method in 2012. Results The 174 counties(cities,districts,banners)could be classified into 4 clusters by spatial distribution. The first cluster with human high prevalence rate,low infection rate of livestock,and positive rate of dog stool antigen included 3 counties. The second cluster with high infection rate of livestock,low prevalence rate of human,and positive rate of dog stool antigen included 20 counties(cit-ies). The third cluster with high positive rate of dog stool antigen,low prevalence rate of human,and low infection rate of livestock included 39 counties(cities,districts,banners). The fourth cluster with low rates of the above 3 indices included the rest 112 counties. Conclusions The results of the cluster analysis conform to the current epidemiological status of cystic echinococcosis in the Non Tibetan Plateau regions. The epidemiological characteristics and geographical distributions of the four area types will pro-vide a basis for the classified management and guidance of cystic echinococcosis control in these areas.

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.

Object To study the dynamic growth and reproduction of Hirudinaria manillensis Lesson in laboratory with providing the data of artificially breeding leech in the field. Methods The newly hatched juvenile from same cocoon were bred in 80 cm?60 cm?50 cm aquaria with natural water from rice paddy and weighted every ten days. Water temperature was recorded daily and water was exchanged monthly. Ten chemical elements of water from rice paddy were analyzed in the laboratory. Leeches were allowed to engorge the blood on living rabbits and the amount of engorged blood was measured every time to observe the growth and development, record the copulation and cocoon-deposit, and make the curve of dynamic growth of the leech. Results The newly hatched juvenile grew and developed for 14 months to sexual maturation period by engorging rabbit's blood of five or six times. The leeches were still juvenile in the first three times of engorging, became subadult in the fourth. Then some developed to the sexual maturation period individually in the fifth, and some individually in the sixth. The curve of dynamic growth displayed rising and falling with the record of copulation and cocoon deposit. Conclusion The above study elucidate the dynamic growth, reproduction and the successfully breeding of leeches in the door.

Objective To retrospectively analyze clinical manifestations of autonomic nervous system (ANS) and skin sympathetic response (SSR) in Lambert-Eaton myasthenic syndrome (LEMS).Methods Fifty-three LEMS patients' medical records were reviewed and information regarding clinical symptoms and signs of ANS and SSR testing results were collected.Results ( 1 ) The most common initial symptom of LEMS was weakness of lower extremities ( n =41 ) and the most common symptom of ANS dysfunction was constipation ( n =25 ) and dry-mouth ( n =23),which could be occurred before the onset of the legs (n =7).(2) In symptoms of ANS,cardiovascular system dysfunction was found in 4 patients include one of ingone of bradycardia,one of postural hypotension and 2 of tachycardia- Secretory glands dysfunction was found in 34 patients:23 dry-mouth,6 dry-eyes,and 8 patients sweating dysfunctions.Twenty-eight patients complained of alimentary dysfunction including constipation and diarrhea.Bladder dysfunction was found in 2 patients,who complained of urinary incontinence.Seven male patients complained of sexual dysfunction.Abnormal skin scratch test was found in 17 patients.(3) SSR was performed in 33 patients and 18 found abnormal.Conclusions ANS manifestations are common and prominent in LEMS patients.SSR abnormality is also common in LEMS.More electrophysiology tests are needed in LEMS patients.