Guillain-Barré syndrome(GBS) has clinical characteristics:flaccid,symmetrical,ascending paralysis.Cranial nerves and respiratory muscle related,albuminocytologic dissociation in cerebrospinal fluid,and electrophysiological changes.GBS was believed to be an autoimmune perineuropathy.Recently,there were more and more reports about GBS spectrum disorders or GBS variant correlated with anti-GQ1b antibody or anti-GM1 IgG antibody et al.The GBS Classification Group presented the new clinical criteria in 2014,to enable neurologists and non-neurologists to diagnose GBS and all its variants using a simple yet all-inclusive classification system.

Objective To observe the effects of telmisartan and valsartan on insulin resistance in obese hypertensive patients. Methods Sixty-eight patients with essential hypertension and body mass index ( BMI) ≥25 kg · ( m2 ) -1 were randomly divided into the telmisartan group (33 cases) and valsartan group (35 cases). Blood pressure, fasting serum glucose, fasting insulin (Fins) and insulin resistance (HOMA-IR) were measured before and after 16 weeks treatment. Results Compared with basal levels, SBP and DBP were significantly decreased in both group ( P<0. 01). Fins and HOMA-IR were significantly decreased in telmisartan group [(12. 9±2. 9) mU·L-1 vs. (10. 9±2. 2) mU·L-1 (P<0. 01); (3. 1±0. 7) vs. (2. 7±0. 6) (P<0. 01), respectively], while no such changes were found in valsartan group [(12. 9 ±3. 0) mU·L-1 vs. (12. 7±2. 7) mU·L-1 ( P > 0. 05);( 3. 0 ± 0. 7) vs. (3. 0 ± 0. 7) ( P > 0. 05), respectively]. Conclusion In obese hypertensive patients, telmisartan and valsartan exert similar antihypertensive effect, but telmisartan may have a benefit in insulin resistance in comparison to valsartan.

Objective To investigate the influence of BK virus (BKV) activation in renal transplant recipients on the renal allograft function.Method Recipients receiving renal transplantation during 2010.3-2011.4 were sdected as objectives,the urine and peripheral blood samples of them were taken and real-time PCR assays were performed to detect BKV DNA at 0.5,1,3,6,9,and 12 months post-transplantation.Results Among 88 recipients,BKV viruria occurred in 27 (30.68％) patients,and sustained viruria occurred in 17 patients.37.0％ (10/27) of patients with BKV viruria developed inot BKV viremia,and sustained viremia occurred in 5 patients.The viral load in plasma was higher in patients with sustained viremia than in those with transient viremia (P＜0.05),and serum creatinine concentrations were higher when BK viremia occurred (P＜0.05).Conclusion Graft function was impaired among patients with BK viremia,and regularly monitoring BK virus in renal transplant recipients and clinical imervention based on plasma PCR results can prevent transplant kidney damage effectively.

Purpose To characterize the alterations and significance of Rb in concurrent esophageal and gastric cardia precancerous lesions (dysplasia) from the same patients in Henan,a high-incidence area of esophageal carcinoma.Methods Rb protein expression was detected by the immunohistochemical staining (ABC method) in 30 patients with both esophageal and gastric cardia dysplasia in Henan area.Results Rb positive rates in esophageal epithelial dysplasia (EDYS) and gastric cardia dysplasia (GDYS) were 70% (21/30) and 80% (24/30), respectively, and the difference was not significant,(χ~2=0.800,P>0.05).However, there were 25 patients with Rb coincident changes in EDYS and GDYS from the same patient in 30 cases of esophageal and gastric cardia dysplasia (83%,25/30). The positive coincidence rate for Rb positive expression in EDYS and GDYS from the same patient accounted for 67% (20/30) and the negative coincidence rate was 17% (5/30) (Kappa=0.561,P<0.01).The significant relationship between Rb coincidence expression in EDYS and GDYS was found (P<0.01).Conclusions The high coincident alterations of Rb in EDYS and GDYS from the same patient indicate the possibility of similar molecular basis, which provides an important etiological clue for the similar geographic distribution and risk factors involved in esophageal squmaous cell carcinoma and gastric cardia adenocarcinoma.

Objective To discuss the clinical manifestations,imaging features and prognosis of children with mild encephalitis/encephalopathy with a reversible splenial lesion(MERS).Methods Twenty-five patients with MERS admitted to Beijing Children′s Hospital,Capital Medical University,between November 2013 and March 2016 were enrolled and their clinical and imaging data were retrospectively analyzed.Ages of onset of these 25 cases were from 6 months to 13 years old.Because of different clinical manifestations in different onset ages,these 25 cases were divided into 2 groups:≤6 years old group (20 cases),with the onset age of 6 months to 3 years and 9 months old(average 2 years and 2 months);>6 years old group(5 cases),with the onset age of 9 years 3 months to 13 years old (average 10 years and 10 months).Results Nineteen cases among the 25 patients had infection history before onset,including 10 cases of digestive tract infection(all were ≤6 years old children),9 cases of respiratory tract infection(6 children ≤6 years old and 3 children >6 years old).The main clinical manifestations included convulsion (18/25 cases,72.0%),fever (17/25 cases,68.0%),vomiting (11/25 cases,44.0%),and disturbance of consciousness (11/25 cases,44.0%).The main clinical manifestation of ≤6 years old group was convulsion (18/20 cases,90.0%),while the main clinical manifestations of the>6 years old group were fever(3/5 cases,60.0%),headache and dizziness(2/5 cases,40.0%),and none of the patients in >6 years old group had convulsion.Eight cases had liver function injury,myocardial enzymes increased in 10 cases,and hyponatremia occurred in 9 cases.Magnetic resonance imaging (MRI) showed 21 cases were type Ⅰ MERS(only involving corpus callosum),and 4 cases of type Ⅱ MERS which involved corpus callosum as well as deep brain white matter,subcortical white matter (centrum semiovale).MRI lesions disappeared after 8-56 days (average 16.5 days) of anti-infection and reducing intracranial pressure treatment.Conclusion MERS is more common in ≤6 years old children,and digestive tract infection is common in ≤6 years old children,while respiratory tract infection is common in >6 years old children.The symptoms in children are mainly manifested as fever,convulsion,vomiting,conscious disturbance,and so on.Infection and hyponatremia are the main causes of MERS in children.MRI is the first choice of imaging examination methods.

Background: Aberrant Bcl-2 transcription is closely related with nodal diffuse large B-cell lymphoma (DLBCL), however, the relationship between Bcl-2 and primary gastrointestinal DLBCL (PGI-DLBCL) was not fully studied.Aims: To investigate the relationship between Bcl-2 gene amplification and protein expression and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL.Methods: Clinical data was collected from 136 PGI-DLBCL patients receiving surgical treatment, and a telephone interview was conducted for survival information.Bcl-2 gene amplification and protein expression in tumor tissue were determined by fluorescence in situ hybridization and immuno-histochemistry, respectively, and relationships between Bcl-2 and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL were analyzed.Results: Among 136 PGI-DLBCL patients, 33 (24.3%) showing gene amplification and 90 (66.2%) showing protein expression of Bcl-2;gene amplification was correlated with primary tumor location, Ann Arbor stage, serum lactate dehydrogenase level, B symptom and International Prognostic Index (IPI) score (P<0.05), while protein expression was correlated with primary tumor location and immunophenotype (P<0.05).5-year overall survival (OS) in patients positive for Bcl-2 gene amplification and patients with non-GCB immunophenotype and positive for Bcl-2 protein expression were inferior to those negative ones (41.5%vs.71.5%, P<0.05;54.6% vs.84.6%, P<0.05).In Bcl-2 gene amplification or protein expression positive patients, 5-year OS of CHOP chemotherapy was inferior to that of rituximab combined with CHOP chemotherapy (48.6%vs.80.3%, P<0.05;66.4%vs.83.4%, P<0.05).Conclusions: Detection of Bcl-2 gene amplification is useful for prediction of prognosis in PGI-DLBCL.Both patients with Bcl-2 gene amplification and non-GCB patients with Bcl-2 protein expression have a poorer prognosis.Rituximab may improve the prognosis in patients with Bcl-2 gene amplification or protein expression.

The child was a preschool girl who was admitted for the first time due to " convulsions,disturbance of consciousness and fever for 2 days".The girl was diagnosed as acute disseminated encephalomyelitis (ADEM).After immunotherapy,the girl recovered.During the course of hormone reduction,the cranial magnetic resonance imaging showed aggravated,and neurological symptoms were followed.There was a transient decrease of blood cells.After repeat hormone treatment,the girl was improved again,but the intracranial lesions still showed progressive aggravation tendency.The course of central nervous system demyelinating in this patient was unknown.When her younger sibling prestentd fever,hepatosplenomegaly,blood cell decreased and was diagnosed with familial haemophagocytosis syndrome(FHPS),through case discussion and gene testing,the girl was finally diagnosis "central nervous system involvement at the onset of FHPS".The case suggests unexplained central nervous system demyelinating lesions,regardless of whether there are abnormalities of blood system,should pay attention to haemophagocytosis syndrome.Positive immunotherapy should be given after diagnosis,and stem cell transplantation should be given as soon as possible to improve prognosis.

BACKGROUND:The role of galactose lectin family proteins in transplantation immunity has been proposed, but there is currently no galectin-7 detection for auxiliary diagnosis of renal dysfunction in the perioperative period after renal transplantation. For renal transplant recipients, monitoring of galectin-7 may contribute to early diagnosis of renal dysfunction after renal transplantation, and buy time for clinical treatment.
OBJECTIVE:To detect the expression of galactose-7 in acute antibody mediated rejection after renal transplantation. METHODS:Twenty-seven patients who were diagnosed as having acute antibody mediated rejection after renal transplantation by renal biopsy were enrol ed, and another 10 patients without acute antibody mediated rejection after renal transplantation were selected as controls. Immunohistochemical staining and western blot assay were used to detect expression of galectin-7 in tissue and serum, respectively.
RESULTS AND CONCLUSION:Results of immunohistochemistry staining showed that under light microscope, in the control group, galectin-7 distributed in the surface microvil i of proximal tubule epithelial cells, but not in glomeruli, distal tubule, col ecting duct and vein;in the acute rejection group, renal arteriole intima edema, tube wal fibrinoid necrosis, infiltration of renal glomerulus and tubule cells and mononuclear cells were found and galectin-7 only expressed in the surface microvil i of proximal tubule epithelial cells as wel as in the arterial smooth muscle. The number of galectin-7 positive cells in the acute rejection group was significantly higher than that in the control group (P<0.1). Western blot assay results showed that the protein expression of serum galectin-7 in the acute rejection group was higher than that in the control group (P<0.05). These findings indicate that renal puncture for renal transplantation is safe and reliable, has no adverse effect on the patients and renal transplant. Galectin-7 detection has an important guiding significance for the auxiliary diagnosis of renal dysfunction during the perioperative period after renal transplantation.

Objective: To investigate the clinical manifestations, laboratory findings, treatment and outcome of anti-GQ1b antibody syndrome. Method: The clinical manifestations, laboratory examination, diagnosis, treatment and prognosis of (4 patients 4 male patients, from 4 to 12 years) with anti-GQ1b syndrome in Beijing Children's Hospital affiliated to Capital Medical University from 2015 to 2016 were retrospectively analyzed. Result: All 4 children presented with ataxia. Case 1 showed impaired speech, ptosis and weakness of arms; case 2 and 3 had external ophthalmoplegia, weakness of limbs; case 4 presented hypersomnia, irritability and hallucinations. Serum anti-GQ1b-IgG antibody was positive in all cases. Case 1-3 received lumber puncture at the course of 1-2 weeks, CSF presented albuminocytological dissociation, case 4 had CSF pleocytosis and increased protein level. Brain MRI of Case 1-2 were normal; Case 3 showed long T1 and T2 signal in cerebellar dentate nucleus, pons and corpus callosum; Case 4 showed long T1 and T2 signal in bilateral centrum semiovale, basal ganglia, external capsule, insula and cerebellum. Electromyograms of case 1-3 showed peripheral axonal lesion. All children were treated with IVIG. After treatment, condition of all patients were improved. According to the clinical manifestation, laboratory examination, and outcome after treatment, case 1 was diagnosed as anti-GQ1b antibody syndrome (Pharyngeal-Cervical-Brachial weakness overlapped with Miller Fisher syndrome), case 2 and 3 were diagnosed as anti-GQ1b antibody syndrome (Miller Fisher syndrome overlapped with Guillain Barré syndrome) and case 4 was diagnosed as anti-GQ1b antibody syndrome (acute ataxia hypersomnolence). Conclusion When patients with the presence of prodromic infections, monophasic course, drowsiness, ataxia, ophthalmoplegia, weakness and the symptoms/signs are relatively symmetric, anti-GQ1b antibody syndrome should be considered. Anti-GQ1b antibody has important significance for diagnosis. Most children have a good prognosis. Early correct diagnosis can avoid unnecessary examinations and guide appropriate use of immunotherapy.

Patients with skeletal ClassⅡ often show symptoms such as protrusion of maxillary anterior teeth,mandibular retraction,open lips and teeth,deep overbite,and deep overjet,which seriously affect the facial appearance.This article reports a case of an ado-lescent male patient with skeletal Class Ⅱ combined with impacted teeth treated by one-stage early correction and two-stage fixation.After treatment,the patient's skeletal Class Ⅱ symptoms improved significantly,including the improvement of mandibular retraction.The problem of open lips and teeth was solved;the facial appearance tended to be straight,and there was no obvious abnormality of the temporomandibular joint.This case shows that early correction can achieve good therapeutic effects on this kind of patients and can avoid or reduce the possibility of orthognathic surgery for these patients in adulthood.