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.

Objective To explore a new peptide-based approach independent of HLA to generate antigen-specific CD+ CD8+T cells. Methods Peripheral blood mononuclear cells(PBMC) were stimula- ted for 6 h with IE-1 peptide pool. Then the activated IFN-γsecreting ceils were tested by immunomagnetic selection. And the selected cells were cultured with radio-inactivated PBMC in medium with 100 IU/ml IL-2 for 4 weeks. Results The generated T cell lines consisted of IE-1 specific CD4+ T (6.88%) and CD8+ T cells 92.99%, which demonstrated antigen-specific killing and cytokine secretion. Conclusion T ceils can be proliferated with this new procedure, and maintain its phenotype and antigen-specific function.

Objective To assess the effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection.Methods Sixty patients with elective gastroenteric tumor resection were divided into preoperative carbohydrate preconditioning group and control group by random digits table with 30 cases each.Preoperative carbohydrate preconditioning group was given oral containing 50 g glucose carbohydrate 300 ml 2 h before surgery,and control group was given traditional method,fasting 12 h before surgery and water deprivation 6 h before surgery.The blood samples were collected to measure the level of fasting blood glucose (FBG),fasting insulin (FINS),interleukin (IL)-6 and C-reactive protein (CRP),3 h before surgery and 1,3,7 d after surgery respectively.Homeostasis model assessment insulin resistance index (HOMA-IR) was computed.Results There were no statistical differences in FBG,FINS,IL-6,CRP and HOMA-IR 3 h before surgery between the 2 groups (P ＞ 0.05).The FBG,FINS,IL-6,C RP and HOMA-IR in the 2 groups at 1,3 d after surgery were significantly higher than those 3 h before surgery,but those except for FBG in control group were significantly higher than those in preoperative carbohydrate preconditioning group [1 d after surgery:(39.67 ± 10.37) mU/L vs.(25.78 ± 12.43) mU/L,(98.67 ± 12.42) μg/L vs.(65.36 ± 16.72)μg/L,(121.74 ±11.32) mg/L vs.(82.18 ±4.36) mg/L,19.07 ±5.49 vs.11.67 ±6.32;3 d after surgery:(24.34 ±6.78) mU/L vs.(16.23 ±7.56) mU/L,(116.43 ± 18.57) μg/L vs.(78.53 ± 10.38) μg/L,(151.30 ± 10.46) mg/L vs.(129.29 ± 10.24) mg/L,8.56 ±2.87 vs.5.12 ±2.11],there were statistical differences (P ＜0.05).There were no statistical differences in FINS and HOMA-IR in preoperative carbohydrate preconditioning group between 7 d after surgery and 3 h before surgery (P ＞ 0.05),but there was statistical difference in control group (P＜ 0.05).There were no statistical differences in FBG,IL-6 and CRP in the 2 groups between 7 d after surgery and 3 h before surgery (P ＞ 0.05).There was no aspiration during anesthetic stage.Conclusion Preoperative carbohydrate preconditioning may shorten the insulin resistance time after gastroenteric tumor resection,reduce the intensity of insulin resistance,and improve inflammatory response,thus contributing to the rehabilitation of patients.

A new sonographic pattern of fetal hydrocephalus-midline-waved sign, and its mechanism were reported in this paper. When the abdominal wall of the pregnant woman was percussed by hand during ultrasound examination, the wave of midline echo was observed on sonoimage. The diagnosis of hydro-cephalus was made by this sign in all 12 fetuses, and confirmed by autopsy. No dilatation of the cerebral ventricle was observed in 5 out of 12 fetuses. It would be difficult to make the diagnosis of hy-drocephalus would previous diagnostic criteria be used. This sign is negative in normal fetuses, therefore-this finding has the practical value in the early and differential diagnoses of hydrocephalus.

AIM: These studies aimed at exploring the alteration of intracellular Ca 2+ level in the course of macrophage-derived foam cell formation as well as its mechanism.METHODS: Foam-like cell was generated by peritoneal macrophage of C57BL/6J mouse, which is susceptible to atherosclerosis, incubated in 10 mg?L -1 oxidized low density lipoprotein for 96 hours. With the technique of Ca 2+ fluorescent indicator and the assay of NADH-oxidizing coupling spectrum-alteration, the intracellular Ca 2+ level and membranous Ca 2+ -ATPase activity of the above foam-like cell were determined.RESULTS: The foam-like macrophage Ca 2+ level was 2.7 times higher than the control macrophage, and the former Ca 2+ -ATPase activity was 24% of the later.CONCLUSION: The results suggested that macrophage-derived foam cell formation was connected with slow Ca 2+ entry or release, which possibly derived from long lasting opening of membranous Ca 2+ channels at the early stage and irreversible inactivating of membranous Ca 2+ pump at the late stage.

Objective · To investigate the correlation between proportion of natural killer (NK) cells and dendritic cells (DCs) and liver injury in patients with chronic hepatitis B virus (HBV) infection. Methods · Peripheral blood samples were collected from 65 patients with chronic HBV infection and 10 healthy volunteers (HCs group). Flow cytometry was used to detect the proportion of peripheral NK cells and DCs. The patient were divided into asymptomatic HBV carrier (AsCs) group, chronic hepatitis B in low or moderate grade (CHB-LM) group, and chronic severe hepatitis B (CSHB)group.The relationship of the proportion of NK cells, the proportion of DCs, and the ratio of NK/DC with the degree of liver injury was analyzed. Results · The proportion of peripheral NK cells was significantly lower in CHB-LM group (9.29%±1.20%) and CSHB group (3.60%±0.79%) than that in HCs group (14.77%±2.90%) and AsCs group (14.05%±2.32%) (P=0.000). And the proportion of peripheral DCs was significantly higher in CHB-LM group (4.10%±1.18%) than that in HCs (1.67%±0.31%), AsCs (2.05%±0.46%) and CSHB groups (2.08%±0.41%) (P=0.000). The ratio of NK/DC was decreased in CSHB and CHB-LM groups compared to that in HCs and AsCs groups (P=0.000). The correlation analysis indicated the proportion of NK cells was negatively correlated with the levels of ALT, AST, TB and DB (r=-0.50, r=-0.49, r=-0.53, r=-0.51, P=0.000 for all) in patients with chronic HBV infection. Conclusion · The proportion of peripheral NK cells and the ratio of NK/DC in patients with chronic hepatitis B were decreased. The decrease of the frequency of NK cells and the ratio of NK/DC were associated with liver injury in patients with chronic HBV infection.

AIM: To investigate the adsorptive and separative properties of 5 kinds of macroporous adsorbing resins to the total saponins and alkaloids, which treated atrophic gastritis with Sanqi Qilian Decoction (Radix et Rhizoma Notoginseng, Radix Astragali, Rhizoma Coptidis.) METHODS: The adsorption capacities, contents and recoveries of the total saponins and alkaloids were selected as the evaluating quotas. The determination of the contents of the total saponins and alkaloids and the investigation into leakage and elution curve were completed with UV-VIS spectrophotometric method. RESULTS: AB-8 resin had the best adsorptive and separative properties to the total saponins and alkaloids in Sanqi Qilian Decoction. The applicable technology was as follows: the concentration of original solution of the extract of Sanqi Qilian Decoction was 40 mg/mL; the largest adsorption capacities on resin to the total saponins and alkaloids were 5.28 mg/mL and 12.38 mg/mL respectively; the eluant was 50% ethanol with 8 times of resin volume, and the elution velocity was 2 mL/min. AB-8 resin could be used for 4 times repeatedly after being reproducted by 95% ethanol and 1 mol/L NaOH. CONCLUSION: Under the process condition which had been selected above, AB-8 resin can be used successfully to adsorb and separate with over 20% of the content of the total saponins Sanqi Qilian Decoction, and 30% of the content of the total alkaloids in the 50% ethanol eluate, and with over 75% of total saponins recovery and 65% of total alkaloids recovery respectively.

Objective To introduce the transfer of anterolateral thigh flap with iliotibial tract in repair of massive skin and soft tissue defects of the forearm and reconstruction of extension or flexion of the forearm. Methods Eight cases of complicated raw wounds of the forearm were repaired with transfer of anterolateral thigh flap with iliotibial tract. Flexor tendons of 3 cases and extensor tendons of 5 cases were repaired with iliotibial tract. The axial vessel of the flap was used to rebuild blood supply of the hand. Results All the flaps survived completely. A follow-up ranging from 3 months to 2.5 years re- vealed that the reconstructed forearms were good in appearance and soft in texture and restored protective sensation. Affected limbs could perform extension or flexion. Total range of motion (TRM) of the hands was excellent in 6 cases and poor in 2. Conclusion Anterolateral thigh flap with iliotibial tract can not only repair soft tissue defects of the forearm, but also reconstruct the main extension or flexion of the forearm simultaneously.

Objective To discuss the clinical value of bile reinfusion via nasojejunal tube on liver function after biliary tract surgery. Methods Eighty patients with biliary tract surgery and bile outer drainage were divided into bile reinfusion group and control group by random digits table method with 40 cases each. The clinical data concerning the liver function and volume of biliary drainage were collected. Results The patients were well tolerated for bile reinfusion, and abdominal distension, nausea and vomiting occurred in some patients. The symptoms improved significantly after symptomatic treatment. The alanine aminotransferase (ALT) and total bilirubin (TBIL) levels at the fifth day after operation in bile reinfusion group were significantly reduced than those in control group:(31 ± 18) U/L vs. (48 ± 32) U/L and (51 ± 32)μmol/L vs. (76 ± 38)μmol/L, the aspartate aminotransferase (AST) and ALT levels at the seventh day after operation in bile reinfusion group were significantly reduced than those in control group: (32 ± 19) U/L vs. (43 ± 26) U/L and (20 ± 19) U/L vs. (31 ± 22) U/L, and there were statistical differences (P<0.05). The volume of biliary drainage in the bile reinfusion group was significantly increased compared with that in control group at the third and fourth day after operation:(485 ± 52) ml vs. (428 ± 96) ml and (509 ± 62) ml vs. (458 ± 59) ml, and there was statistical difference (P<0.01). Conclusions Bile reinfusion via the nasojejunal tube may facilitate the recovery of liver function after biliary tract surgery.

Objective:To analyze and summarize the clinical characteristics of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients with cerebellar ataxia.Methods:The clinical manifestations, laboratory examinations, treatment and prognosis of anti-NMDAR encephalitis patients with cerebellar ataxia diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2019 were retrospectively analyzed.Results:About 4.3% (15 cases) of a total of 347 anti-NMDAR encephalitis patients were complicated with cerebellar ataxia, of which one patient had ovarian teratoma. There were seven male cases and eight female cases, with a median age of 28 years. The average duration from the onset of encephalitis to the onset of cerebellar symptoms was 30.8 days.The average modified Rankin Scale (mRS) score was 3.73. In the acute phase, the median cerebrospinal fluid leukocyte count was 28×10 6/L. All patients received first-line immunotherapy, of which one case additionally received second-line immunotherapy with rituximab and nine patients received long-term immunotherapy with mycophenolate mofetil. The follow-up time ranged from seven to 66 months. The average mRS score of the last time was 2.73, and only six patients (6/15) had good prognosis (mRS score≤2). Conclusions:Patients with anti-NMDAR encephalitis and cerebellar ataxia are rare, and have relatively poor prognosis in terms of neurological function. Symptoms of cerebellar ataxia in anti-NMDAR encephalitis patients should be recognized in time, and standardized immunotherapy regimens and long-term immunotherapy should be adopted to improve the prognosis.