Paroxysmalnocturnalhemoglobinuria(PNH)isadefectdiseaseofacquiredclonal hematopoietic stem cel s. It can be expressed as hemolytic anemia, hemoglobinuria, and venous thrombosis. Cerebral venous sinus thrombosis (CVST) is a rare but serious complication of PNH. Here we report a PNH patient with CVST and reviewthe relevant literature. For patients who have the risk factors for CVST and neurological symptoms, such as headache and increased intracranial pressure, should early conduct brain imaging examination and make the diagnosis clear, and give an active treatment in the aspects of anticoagulation, dehydration, eliminating the causes of disease, and controling complications.

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Objective To investigate the predictive value of plasma copeptin level for the outcomes in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enroled in the study. Enzyme-linked immunosorbent assay was used to detect the plasma copeptin level. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate baseline stroke severity. The outcome was evaluated at 90 days with the modified Rankin Scale (mRS), and the good outcome was defined as mRS 0 - 2. Results A total of 160 patients with acute ischemic stroke were enroled, 121 had good outcome and 39 had poor outcome. The age (71. 87 ± 6. 11 years vs. 66. 19 ± 9. 39 years; t =- 3. 540, P = 0. 001), serum levels of C-reactive protein (6. 84 ± 2. 80 mmol/L vs. 5. 84 ± 2. 89 mmol/L;t = - 2. 459, P = 0. 023) and copeptin (143. 12 ± 34. 02 pmol/L vs. 50. 78 ± 18. 62 pmol/L; t = 21. 564, P <0. 001), NIHSS score (12. 00 ± 4. 00 vs. 6. 00 ± 3. 00; t = - 7. 861, P < 0. 001), as wel as proportions of patients with hypertension (79. 5% vs. 60. 3% ; χ2 = 4. 758, P = 0. 029), atrial fibrilation (20. 51% vs. 7. 44% ; χ2 = 4. 022, P = 0. 045), and large artery atherosclerotic stroke (43. 59% vs. 22. 31% ; χ2 = 6. 696, P = 0. 010) in the poor outcome group were significantly higher than those in the good outcome group, but diastolic blood pressure was significantly lower (89 ± 12 mmHg vs. 95 ± 9 mmHg, 1 mmHg = 0. 133 kPa;t = 3. 323, P = 0. 001). Multivariate logistic regression analysis showed that the plasma copeptin level (odds ratio 2. 332, 95% confidence interval 1. 725 - 3. 153; P < 0. 001) was an independent risk factor for the poor outcome in patients with acute ischemic stroke. Person correlation analysis showed that the plasma copeptin level and baseline NIHSS score showed a significant positive correlation (r = 0. 895, P < 0. 001). Receiver operating characteristic (ROC) analysis showed that plasma copeptin level has a significant predictive value for the poor outcome at day 90 after acute ischemic stroke (area under the ROC curve = 0. 740, 95%confidence interval 0. 623 - 0. 783; P < 0. 01). When plasma copeptin level > 104. 3 pmol/L was used as the cutoff value, the sensitivity and specificity for predicting the poor outcomes at day 90 after onset were 86. 8% and 40. 2% , respectively. Conclusions The plasma copeptin level may be a good predictor for neurological outcome at day 90 after onset in patients with acute ischemic stroke.

Paraneoplastic neurological syndromes (PNS) are a rare group of immune-mediated disorders that affect the central and peripheral neuromuscular system in association with cancer.If the limbal lobe system of the brain is involved,it will show paraneoplastic limbal encephalitis(PLE).The discern of patients with PNS is challenging since tumors causing paraneoplastic neurologic disorders are often asymptomatic and sometimes occult.We report a case of PLE with double positive anti-Hu and Yo antibodies,and further analyze and discuss it in conmbination with relevant literature to improve the understanding of the disease.

Objective:To establish a prediction model of postoperative 1-year mortality risk in elderly patients undergoing hip fracture surgery and verify its efficacy.Methods:Patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, who underwent an operation for traumatic hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to December 2018, were enrolled and randomly assigned to model group and verification group in a ratio of 3∶1.The demographic characteristics, clinical data and results such as laboratory examinations were collected.In model group, the logistic regression analysis was used to recognize the independent risk factors for 1-year mortality after procedure, and the prediction model was established.In verification group, the prediction efficacy was analyzed using the receiver operating characteristic curve, and the degree of fitting was evaluated by Hosmer-Lemeshow goodness-of-fit test.Results:Multivariate logistic analysis indicated that age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital ≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L were the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients ( P<0.05). The prediction model was established based on the risk factors mentioned above.The area under receiver operating characteristic curve was 0.870, and the sensitivity and specificity were 82.8% and 80.0%, respectively.The prediction model showed good fitting ( χ2=4.672, P=0.700). Conclusion:Age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L are the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients, and the prediction model established based on the above indicators has good efficacy.