Objective To investigate the span and frequency of physical symptoms of panic attack in patients with panic disorder.Methods Panic symptoms presented at the time of panic attacks were assessed and categorized in forty-eight consecutive outpatients with panic disorder during August 2000 to November 2002.Results Palpitations (44/48,91.7%), shortness of breath (36/48,75.0%), sweating (34/48,70.8%), feel suffocated (33/48,68.8%), faint (31/48,64.6%), dizziness (27/48,56.3%) and fear of dying (27/48,56.3%) were the most frequent symptoms reported by the patients with panic disorder. If categorized according to system, the most frequent symptoms were presented in cardiovascular, neurological, respiratory and autonomic nervous systems of patients with panic disorder.Conclusions Physical symptoms varies when panic attack occurs. Panic disorder was often misdiagnosed and underdiagnosed because of wide and non-specific spectrum of physical symptoms.

Great progress has been made on vaccine research for schistosomiasis,including those on immune mec-hanism and Schistosoma genome which have made active effect to vaccine development.This paper reviews the progress on the candidate vaccine antigens including protein vaccine,DNA vaccine and multivalent vaccine against Schistosoma japonicum.

At present, the theory and experiment teaching of forensic toxicology are faced with difficulties such as lake of practical cases and toxic types, content being abstract and difficult to un-derstand. On that account, we collected and collated many typical cases from Public Security Bureau and our school's medico legal expertise center, and then a relatively systematic and complete teaching case base in forensic toxicology has been constructed, and will be supplement constantly, so as to pro-vide extensive teaching resources and improve the teaching quality of forensic toxicology.

Objective To explore the clinical and neuroimaging features of a frontotemporal dementia with parkinsonism linked to chromosome 17 ( FTDP-17 ) pedigree caused by mutation of microtubule-associated protein tau ( MAPT) gene.Methods The proband and one patient from a FTDP-17 pedigree were assessed through standardized clinical evaluation , neuropsychology assessment , video-electroencephalogrom ,MRI, genetic sequencing , as well as 18 F fludeoxyglucose ( FDG) SPECT for brain metabolism and 11 C 2β-carbomethoxy-3β-( 4-fluoro ) tropane ( CFT ) PET for dopamine transporter ( DAT ) distribution, respectively.Results A FTDP pedigree with 15 patients (6 still alive) was recruited to this study.The proband and one affected patient were genotyped and confirmed as MAPT c .1788T>G mutation. Parkinsonism was the first symptom for both two patients . Personality, speech changes and dementia accompanied with brain atrophy were developed at the later stage in one patient .The 18 F FDG SPECT studies illustrated asymmetric hypometabolism of the temporal , frontal lobes and basal ganglia in two patients . Regarding to the 11 C CFT PET, one affected patient showed asymmetric decreased uptake of tracer in basal ganglia regions.Conclusions FTDP-17 can display a confusingly broad clinical phenotype , with the parkinsonism as the first symptom . Brain glucose metabolism and DAT distribution could be potential biomarkers in early diagnosis of FTDP-17.

Objective To explore the relationship between body composition and β-cell function in obese females with normal glucose metabolism. Methods Seventy-five obese women with normal blood glucose and without family history of diabetes were investigated. They were assigned to 4 groups based on body mass index (BMI). Body fat content was measured by dual-energy X-ray absorptiometry (DEXA), and intravenous glucose tolerance test (IVGTT) was performed. The acute insulin response (AIR), the area under the curve (AUC) of insulin (AUCins) and homeostasis model assessment (HOMA) for β-cell function (HOMA2-% B) were calculated. Insulin resistance index(HOMA2-IR) and the ratio of AUCins to AUC of glucose (AUCins/AUCglu) were calculated to assess insulin resistance. Results Women with higher BMI appeared to have more total body fat content and trunk fat content. The similar distribution was also found in other parameters, including the plasma glucose levels at 0 and 10 min, AUCins, AIR, AUCins/AUCglu and the difference of insulin level between 0 and 10 min [INS (10-0)] during IVGTF. AUCins, AIR, AUCins/AUCglu and [INS (10-0)] were positively correlated with the age, BMI,total body fat content and trunk fat content. After adjustment of age, the trunk fat content was independently associated with the AIR in a good linear manner. Conclusion The obese females show change in body composition with more trunk fat content. They show significant insulin resistance with compensated elevation of insulin secretion. Body composition assessment is a valid and more accurate method than BMI and waist circumference in predicting early damaged β-cell function in obese patients.

Objective:To determine the relationship between serum resistin levels and carotid intima media(IMT)thickness in patients with essential hypertension. Methods:This study consisted of 272 patients with essential hypertension. The patients were divided into three groups according to their serum resistin levels. Group 1,n=91,serum resistin level 1.233-3.701 ng/ml;Group 2,n=91,serum resistin level 3.728-8.777 ng/ml;and Group 3,n=90,serum resistin level 8.809-28.658 ng/ml. Results:The carotid IMT and maximum carotid IMT of Group 3 were the highest in three groups.(P＜0.05).As shown in multivariate analysis for factors affecting carotid IMT,serum resistin level(β=0.220,t=5.793,P=0.000)was independently associated with the carotid IMT after controlling the age,blood glucose,uric acid,low-density lipoprotein cholesterol,systolic blood pressure and diastolic blood pressure. Serum resistin level(β=0.189,t=4.733,P=0.000)was independently associated with the maximum carotid IMT after controlling the age,blood glucose,body mass index,diastolic blood pressure,diabetes mellitus,high sensitivity C reactive protein,total cholesterol and triglyceride. Conclusion:Serum resistin was independently associated with the increased carotid IMT in essential hypertension patients.

Objective To investigate the clinical featurcs of hepatic perivascular epithelioid cell carcinoma (PEComa) and the experiments in the surgical treatment of PEComa.Methods The clinical data of 16 patients with hepatic PEComa who received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2008 to January 2012 were retrospectively analyzed.The incidence,clinical manifestations,imagiong characteristics,surgical outcomes and pathological manifestations of this disease were analyzed.B sonography,hepatic function test,tumor markers test and epigastric computed tomography (CT) were applied to detect tumor recurrence and metastasis.The follow-up was ended in December 2012.Result Middle aged and female patients took large part of the patients.Of the 16 patients,8 had no subjective symptoms,and other patients had discomfort in the right upper quadrant,pain or tenderness of the liver.All the tumors were solitary,and most of them located at the right liver (11 tumors were in the right liver,4 in the left liver,1 in the caudate lobe).No specific features were detected by preoperative B sonography,while inhomogeneous low density in the tumor region was detected on by CT.All the patients received partial liver resection without morbidity and morality.The results of immunohistochemistry showed that thc expressions of HMB-45,Melan-A and vascular smooth muscle actin were positive.The mean time of follow-up was 27.9 months (range,9.0-46.0 months),no tumor recurrence and death was observed during the follow-up.Conclusions Middle aged females are susceptive to hepatic PEComa,and patients have no specific clinical presentations.Preoperative CT examination is helpful for differential diagnosis of PEComa,and partical hepatectomy can achieve satisfactory short-term clinical outcomes.

Objective:Recent studies have shown that in contrast to decrease in distal gastric adenocarcinoma (DGA), incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased noticeably in numerous counties. However, the reasons remain unclear. This study evaluated the possible differences in the expression of KLF4, SP1, and Cyclin D1 in AEG and DGA, and explored the potential carcinogenesis of AEG. Methods:Immunohistochemistry was performed on paraffin-embedded tissues to evaluate the pu-tative differences in the expressions of KLF4, SP1, and Cyclin D1 at protein level between AEG (n=58) and DGA (n=47). The patholog-ical significance of these markers between the two groups was also compared and analyzed. Results:The percentage of positive KLF4 expression was significantly lower in DGA than in AEG (P<0.05). Lower KLF4 expression was found both in well-or moderately dif-ferentiated cases and in poorly differentiated cases with DGA compared with their AEG counterparts (P<0.05). However, positive stain-ing for SP1 was significantly higher in DGA (P<0.05). No significant difference was found in the expression of Cyclin D1 between the two groups. Further analysis showed that in DGA, the positive expression of KLF4, SP1, and Cyclin D1 were significantly correlated with lymph node metastasis. In AEG, only Cyclin D1 expression was correlated with lymph node metastasis (P<0.05). No correlation was found among the expression of KLF4, SP1, and Cyclin D1 in AEG. In DGA, KLF4 was inversely correlated with SP1 and Cyclin D1 (r=-0.334 and r=-0.341, respectively, P<0.05), and SP1 was positively correlated with Cyclin D1 expression (r=0.340, P<0.05).Conclusion:Different expression patterns and clinicopathological significance of KLF4, SP1, and Cyclin D1 were observed between AEG and DGA, suggesting the putative difference in the carcinogenesis and progression of AEG and DGA.

Objective To review the experience and early clinical results of eversion carotid endartotectomy (eCEA) in treatment of patients with symptomatic carotid stenosis. Methods eCEA were performed on 32 patients who suffered from the extracranial carotid stonosis. The treatment results were retrospectively reviewed. Results Thirty-two patients were successfully treated with eCEA. The symptom in 17 patients with transient ischemia attach (TIA) admitted to hospital did not recurrence, the other original symptoms of the patients had different degrees of improvement or disappeared. Two patients had TIA during 72 h after surgery, but 24 h repeatedly CTA examination without infarcts oecurring, and recovered after the treatment of small doses of urokinase. Two cases of severe swelling appeared tracheal shift incision, and went smoothly through edema by treatment of tracheal intubatian. In 4 patients headache reliefed in 2-3 d after medical treatment of the dehydration. Seven patients appeared different degree of hoarseness, and got recovery through neurotrophic medication for 1 month. No other serious complication occurred. Follow-up by 6 months, no CTA carotid artery stenosis appeared again. Conclusion eCEA is an effective method to treat symptomatic carotid stenosis.

This cross-sectional, non-interventional, observational study evaluated depression in patients in China who presented to a general neurologist with chronic, medically unexplained, painful physical symptoms. Of the 402 patients enrolled, 197 patients (49.0%) met the criteria for a current major depressive episode (MDE+ group), as assessed using module A of the Mini International Neuropsychiatric Interview, and 205 patients (51.0%) did not (MDE- group). The mean pain severity visual analogue scale (VAS) score was signifi cantly higher in the MDE+ group than the MDE- group (65.3 vs 55.6 mm; p<0.001). The mean depression severity score, as assessed using the 9-item Patient Health Questionnaire (PHQ-9), was 8.4 units (95% CI: 7.3 to 9.5) higher in the MDE+ group than the MDE- group (mean PHQ-9 total score: 14.8 vs 6.4). Anxiety and perceived health state were signifi cantly worse, on average, in the MDE+ group (mean Hospital Anxiety and Depression Scale anxiety subscale score 10.7 vs 5.9 units; mean EuroQoL-5 Dimensions VAS score 56.4 vs 67.7 mm; each p<0.001). Only 14.2% of patients had received treatment for depression during the past 3 months. These results suggest depression was common and may have been under-treated in this group of Chinese patients with chronic, medically unexplained painful physical symptoms.