Autoimmune encephalitis(AE)generally refers to a group of encephalitides mediated by autoimmune mechanisms.The current treatment for AE relies on immunotherapy,typically following a stepwise escalation regimen.A minority of patients may still be refractory to treatment,thus posing a major clinical challenge.In the pathogenesis of AE,B cells play a role through antibody secretion and cytokine regulation,whereas T cells contribute by promoting B cell differentiation and mediating neuronal attack.In recent years,immunotherapies targeting different antigens have become a research focus and emerged as a new treatment option for AE patients.This article summarizes the mechanisms of action of different targeted drugs and the progress of their clinical application in AE,and provides an outlook on future research directions.

Autoimmune encephalitis(AE)generally refers to a group of encephalitides mediated by autoimmune mechanisms.The current treatment for AE relies on immunotherapy,typically following a stepwise escalation regimen.A minority of patients may still be refractory to treatment,thus posing a major clinical challenge.In the pathogenesis of AE,B cells play a role through antibody secretion and cytokine regulation,whereas T cells contribute by promoting B cell differentiation and mediating neuronal attack.In recent years,immunotherapies targeting different antigens have become a research focus and emerged as a new treatment option for AE patients.This article summarizes the mechanisms of action of different targeted drugs and the progress of their clinical application in AE,and provides an outlook on future research directions.

Objective: To explore the treatment options for congenitally missing teeth in patients with ectodermal dysplasia and provide a clinical reference. Methods: A patient with ectodermal dysplasia with a concave midface, anterior protrusion of the chin, and underdevelopment of the lower third of the face presented with congenital loss of multiple maxillary teeth, malocclusion of the remaining teeth, congenital loss of mandibular dentition, small dental arches, and upper and lower alveolar bone hypoplasia. The patient was treated by means of a removable partial maxillary prosthesis, implants in the anterior region of the lower mandible designed with the assistance of digital guides, and bar-clamped implant-overlay prostheses. A literature review of the protocol for the treatment of this condition was also conducted. Results: In addition to good retention and stability after denture wear, an excellent occlusal relationship, improvement of the patient's facial appearance, including upper and lower lip fullness, more equal balancing of the lower and middle 1/3 of the face, and improved masticatory function were achieved. The results of the literature review showed that patients with ectodermal dysplasia who are congenitally edentulous usually have a complex intraoral situation that makes restoration difficult, and common restorative modalities for these patients include fixed bridges, removable partial dentures, complete dentures, overdentures, and implant prostheses, which need to be selected according to the actual intraoral situation of each patient. Currently, there is no consensus on the treatment of congenitally missing teeth in patients with ectodermal dysplasia, and some scholars have suggested that fixed restorations be recommended for patients with fewer missing teeth, while the option of removable or implant-covered denture restorations should be given to patients with more missing teeth, with removeable prostheses for underage patients that are replaced with permanent fixed prostheses when the jaws have stabilized. Conclusion In patients with ectodermal dysplasia with congenital tooth loss, all factors should be taken into account, and an individualized restorative plan should be developed.

A case of paraneoplastic cerebellar ataxia syndrome caused by immune checkpoint inhibitors(ICI)was treated with ofatumumab(OFA).The patient is a 57-year-old male.He used"Camrelizumab"immunotherapy for his previous history of small cell lung cancer.The main reason was"walking unsteadily for more than one year and shaking his head involuntarily for more than one month".After admission,the head MRI,chest CT,electroencephalogram,lumbar puncture and other related examinations were improved.The antibody spectrum of paraneoplastic neurological syndrome was anti-GAD65 antibody IgG(+),and the case was then diagnosed as the immune checkpoint inhibitor-related paraneoplastic neurological syndromes(PNS)of nervous system.After OFA treatment(20 mg/time),the symptoms were obviously improved.This paper analyzes the clinical features and diagnosis and treatment approaches of this case,in order to improve clinicians'understanding of the disease and provide reference for clinical diagnosis and treatment of similar cases.

Autoimmune glial fibrillary acidic protein astropathy(GFAP-A)is an autoimmune inflammatory disease of the central nervous system,with a prevalence rate of 0.6 per 100,000.Its clinical manifestations include subacute meningitis,encephalitis,myelitis,or combinations thereof.Approximately 40%of patients exhibit symptoms and signs of prodromal infection such as fever and headache,while 30%may develop tumors.Currently,diagnosis primarily relies on the presence of GFAP-IgG in cerebrospinal fluid.Differential diagnosis must exclude conditions such as central nervous system vasculitis,inflammatory demyelinating diseases,lymphoma,glioma,and brain metastases,posing significant challenges in clinical practice.This paper summarizes the clinical manifestations,diagnosis,and treatment of GFAP-A to enhance understanding of the disease and prevent misdiagnosis.

Autoimmune glial fibrillary acidic protein astropathy(GFAP-A)is an autoimmune inflammatory disease of the central nervous system,with a prevalence rate of 0.6 per 100,000.Its clinical manifestations include subacute meningitis,encephalitis,myelitis,or combinations thereof.Approximately 40%of patients exhibit symptoms and signs of prodromal infection such as fever and headache,while 30%may develop tumors.Currently,diagnosis primarily relies on the presence of GFAP-IgG in cerebrospinal fluid.Differential diagnosis must exclude conditions such as central nervous system vasculitis,inflammatory demyelinating diseases,lymphoma,glioma,and brain metastases,posing significant challenges in clinical practice.This paper summarizes the clinical manifestations,diagnosis,and treatment of GFAP-A to enhance understanding of the disease and prevent misdiagnosis.

Deficiencies in the clearance of peripheral amyloid β (Aβ) play a crucial role in the progression of Alzheimer's disease (AD). Previous studies have shown that the ability of blood monocytes to phagocytose Aβ is decreased in AD. However, the exact mechanism of Aβ clearance dysfunction in AD monocytes remains unclear. In the present study, we found that blood monocytes in AD mice exhibited decreases in energy metabolism, which was accompanied by cellular senescence, a senescence-associated secretory phenotype, and dysfunctional phagocytosis of Aβ. Improving energy metabolism rejuvenated monocytes and enhanced their ability to phagocytose Aβ in vivo and in vitro. Moreover, enhancing blood monocyte Aβ phagocytosis by improving energy metabolism alleviated brain Aβ deposition and neuroinflammation and eventually improved cognitive function in AD mice. This study reveals a new mechanism of impaired Aβ phagocytosis in monocytes and provides evidence that restoring their energy metabolism may be a novel therapeutic strategy for AD.
Animals ; Mice ; Alzheimer Disease ; Amyloid beta-Peptides ; Monocytes ; Cognition ; Energy Metabolism ; Phagocytosis

Objective:To investigate the occurrence of catheter fracture in totally implantable venous access ports (TIVAP) and analyze its influencing factors.Methods:A retrospective nested case-control study was used to establish a cohort of 3 517 patients with TIVAP and infusion port maintenance in Affiliated Hospital of Qingdao University from January 2012 to December 2021, and they were divided into the fracture group and the control group. The general information questionnaire, TIVAP Catheter Fracture Related Factors Questionnaire and TIVAP Catheter Fracture Clinical Characteristics Questionnaire were used to collect general and clinical data of patients in two groups. The risk factors of TIVAP catheter fracture were analyzed by Logistic regression.Results:The incidence of TIVAP catheter fracture was 0.6% (21/3 517) . Logistic regression analysis showed that the operator's experience of placing ports, whether the patient performed TIVAP maintenance regularly, time for patients carrying the infusion port and whether TIVAP were repeatedly blocked were influencing factors for the occurrence of catheter fracture in TIVAP.Conclusions:Nursing staff should fully understand the risk factors of TIVAP catheter fracture, identify high-risk groups in the early stage and carry out targeted nursing interventions to reduce the incidence of TIVAP catheter fracture.

Objective: To investigate the value of MDM2 RNA in situ hybridization (RNA-ISH) in diagnosing atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and dedifferentiated liposarcoma (DDL). Methods: A total of 26 ALT/WDL/DDLs diagnosed from March 2017 to May 2019 in West China Hospital, Sichuan University, Chengdu, China and 18 control cases were included. MDM2 RNA-ISH was performed on all samples and compared with the fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) regarding their performance in detecting MDM2. Results: All samples were detected successfully using the three methods. Among 26 ALT/WDL/DDLs, all cases showed MDM2 amplification and positivity for MDM2 RNA-ISH (26/26, 100%). Twenty-four (24/26, 92.3%) of the 26 tested cases were positive for MDM2 IHC while two of them were negative. Eighteen control cases were all negative for MDM2 FISH and RNA-ISH, and 15 (15/18) cases were negative for MDM2 IHC. The sensitivity and specificity of RNA-ISH were both 100%, and those of MDM2 IHC were 92.3% and 83.3%, respectively. Diffuse staining was identified in all MDM2 RNA-ISH positive ALT/WDL/DDLs, but identified in only 8/24 (33.3%) of the MDM2 IHC positive cases. Among the 11 ALT/WDL/DDL samples evaluated on tissue microarray, the positive rate of MDM2 RNA-ISH was 100% with diffuse staining in all cases. The positive rate of MDM2 IHC was 9/11 while only 1 of the 9 cases showed diffuse staining. The result of MDM2 RNA-ISH was identical to that of MDM2 FISH and was overall consistent with that of MDM2 IHC (Kappa=0.763, P<0.001). Conclusions: In ALT/WDL/DDLs, results of MDM2 RNA-ISH are highly consistent with those of FISH. MDM2 RNA-ISH is more sensitive and more specific and has more diffuse positive signals than the IHC. The findings indicate that MDM2 RNA-ISH is highly valuable for the diagnosis and differential diagnosis of ALT/WDL/DDLs.
Biomarkers, Tumor/genetics* ; Gene Amplification ; Humans ; In Situ Hybridization, Fluorescence ; Liposarcoma/genetics* ; Proto-Oncogene Proteins c-mdm2/genetics* ; RNA

Objective:To explore the safety and efficacy of 20% glucose solution in the treatment of adult diabetic patients with hypoglycemia.Methods:A non-randomized controlled paired design trial was conducted. The diabetes patients with hypoglycemia (blood glucose < 3.9 mmol/L) who were admitted to the department of endocrinology and metabolism of Affiliated Hospital of Jiangsu University from December 2020 to May 2021 were enrolled. When the patients developed hypoglycemia for the first time, 75 mL of 20% glucose solution was pumped intravenously at a constant speed within 15 minutes, which was named the 20% glucose solution group. When the patients had hypoglycemia again, 30 mL of 50% glucose solution was pumped intravenously at a constant speed within 3 minutes, which was named the 50% glucose solution group. If the blood glucose was still ≤ 3.9 mmol/L at 15 minutes of hypoglycemia treatment, or the patients were uncomfortable due to too fast drip speed, it should be terminated immediately. The hypoglycemia treatment should be handled according to the Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 edition). The peripheral blood glucose level and the range of increase at 15 minutes of treatment, the success rate of one treatment, the peripheral blood glucose values at 60 minutes after successful hypoglycemia treatment, the incidence of phlebitis and exudation after hypoglycemia treatment, and the pain of local blood vessels in patients with hypoglycemia treatment were analyzed and compared between the two groups. Results:A total of 65 patients completed the treatment of hypoglycemia with 20% glucose solution and the success rate of one treatment was 100%. The peripheral blood glucose value at 15 minutes of hypoglycemia treatment was (8.30±1.37) mmol/L, and the increased range was (4.86±1.30) mmol/L. The peripheral blood glucose value at 60 minutes after successful hypoglycemia treatment was (6.96±1.48) mmol/L, which indicated that 20% glucose solution could effectively increase blood glucose. Among 65 patients, 32 patients had hypoglycemia again, who were treated with 50% glucose solution, and the success rate of one treatment was 100%. When patients who received 50% glucose solution for hypoglycemia formed a paired design with the first 20% glucose solution treatment, the results showed that there was no significant difference in the peripheral blood glucose value and the increased range in blood glucose at 15 minutes of hypoglycemia treatment between the 20% glucose solution and the 50% glucose solution groups [peripheral blood glucose (mmol/L): 8.20 (7.70, 9.70) vs. 8.30 (7.80, 8.80), increase in blood glucose (mmol/L): 4.96±1.39 vs. 4.70±1.32, both P > 0.05], indicating that the glucose changing at 15 minutes of hypoglycemia treatment with 20% glucose solution was similar to that with 50% glucose solution. The peripheral blood glucose value at 60 minutes after successful hypoglycemia treatment of 20% glucose solution group was significantly lower than that of 50% glucose solution group (mmol/L: 6.37±1.04 vs. 7.20±1.36, P < 0.01), which meant that the blood glucose tended to be more stable. There was no phlebitis and exudation after hypoglycemia treatment in both groups. The pain score of 20% glucose solution group was 0, however, 3 patients in 50% glucose solution group complained of local vascular pain, and the pain score was 1. Conclusions:20% glucose solution can effectively treat hypoglycemia in diabetic patients, which has the same curative effect as 50% glucose solution and much safer. It can be used in patients with severe hypoglycemia.