Chronic inflammatory demyelinating polyneuropathy (CIDP) with positive anti-contactin-associated protein-1 (Caspr1) antibody is a rare autoimmune antibody mediated peripheral neuropathy. A 62-year-old male patient was reported in this article, whose clinical manifestations were subacute onset, abnormal distal limb motor sensation, and increased cerebrospinal fluid protein level. The patient had a good response to plasma exchange. Electromyography of lower limbs showed that motor involvement was dominant, motor conduction velocity slowed down, compound motor active potential (CMAP) and sensory nerve active potential amplitude decreased, and F wave was not elicited; electromyography of upper limbs without symptoms showed that CMAP amplitude of median nerve decreased, and conduction velocity was normal. There are few reports of anti-Caspr1 positive CIDP in the world. The article summarized the characteristics of the patient and reviewed the relevant literature, in order to improve clinicians′ understanding and diagnosis and treatment ability of the disease.

Background:The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment.We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods:We conducted a multicenter,cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014.Each enrolled patient was interviewed using a structured questionnaire.All expenditure data were inflated to the 2014 Chinese Yuan (CNY;1 CNY =0.163 USD).We quantified the overall expenditure and financial burden and by subgroup (hospital type,age at diagnosis,sex,education,occupation,insurance type,household income,clinical stage,pathologic type,and therapeutic regimen).We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results:A total of 2356 patients with a mean age of 57.4 years were included,57.1％ of whom were men;13.9％ of patients had stage Ⅰ cancer;and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY,and the expenditures for stage Ⅰ,Ⅱ,Ⅲll,and Ⅳ disease were 56,099 CNY,59,952 CNY,67,292 CNY,and 82,729 CNY,respectively.Non-medical expenditure accounted for 8.3％ of the overall expenditure.The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY,which accounted for 59.9％ of their previous-year household income and caused 75.0％ of families to suffer an unmanageable financial burden.Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P ＜ 0.05),except for sex.Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less (all P ＜ 0.05).Conclusions:For patients in China,direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable.The financial burden varied among subgroups,especially among patients with different clinical stages of disease,which suggests that,in China,CRC screening might be cost-effective.

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends. Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan (CNY; 1 CNY= 0.155 USD) based on the 2011 value and inflated using the year-specific health care consumer price index for China. Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27％ was observed from 2002 (25,111 CNY) to 2011 (46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ, 39,302 CNY for stage Ⅱ, 40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases (P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy (P < 0.05). Drugs contributed to 45.02％ of the overall expenditure. Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

BACKGROUNDThe clotting system abnormalities are the common complication in cancer patients. The aim of this retrospective study was to evaluate the coagulation state, clinical features, and treatment in cancer patients by routine tests.

METHODSA total of 2328 patients with different types of cancer were classified as the positive group (n = 1419, including 53 patients with thrombosis) and the negative group (n = 909) based on D-dimer (DD) value. Of the 2328 cases, 354 were admitted for chemotherapy. Hemostasis test and complete blood count (CBC) were performed during treatment or following-up.

RESULTSThis study showed that the hypercoagulable state was affected not only by clinical staging (P < 0.0001) but also by metastasis site (P < 0.0001 for bone vs. lung). Compared to negative DD group, the higher fibrinogen level, the extended activated partial thromboplastin time, and prothrombin time interacted markedly with disease clinical stage (P < 0.05) in the positive group. Between positive DD groups with and without thrombus, the significantly statistic difference in white blood cell (WBC) and DD (P < 0.05) rather than in red blood cell (RBC) and platelet count was observed. However, the higher DD level was not correlated with WBC, RBC, and platelet count in the positive DD group. Furthermore, the hypercoagulable plasma profile in cancer patients was moderated 2-3 weeks after chemotherapy (P < 0.05 for first six cycles).

CONCLUSIONSThe routine hemostatic parameters and CBC are valuable to assessment for thrombosis and chemotherapy even for disease prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Coagulation Disorders ; diagnosis ; Female ; Hemostasis ; physiology ; Humans ; Male ; Middle Aged ; Neoplasms ; drug therapy ; physiopathology ; therapy ; Retrospective Studies ; Thrombosis ; physiopathology ; Young Adult

Objective To investigate the relationship between blood pressure variability (BPV) and neurological deteri?oration (ND) during the acute phase in patients with hypertensive minor ischemic stroke. Methods A total of 200 hyperten?sive patients with acute minor ischemic stroke were recruited in this study. Patients were divided into two groups: stable group (n=182) and deterioration group (n=18) according to the neurological prognosis. Values of BPV in 24 h ambulatory blood pressure, 24 h systolic blood pressure variation coefficient (24 h CVSBP), 24 h diastolic blood pressure variation coeffi?cient (24 h CVDBP), day time systolic blood pressure variation coefficient (dCVSBP), day time diastolic blood pressure variation coefficient (dCVDBP), night time systolic blood pressure variability (nCVSBP) and night time diastolic blood pressure variability (nCVDBP) were compared between two groups. The related factors of BPV were analyzed by binary logistic method in the acute phase of patients with hypertensive minor ischemic stroke. Results There were significantly higher levels of 24 h CVSBP [17.75%(17.54%,19.26%) vs 12.78% (10.67%,14.39%)], 24 h CVDBP [25.48%(20.77%,27.87%) vs 17.95% (14.88%, 21.46%)], dCVSBP [18.61%(17.65%,20.65%) vs 12.30%(10.10%,14.75%)], dCVDBP [25.65%(21.25%,29.78%) vs 17.76%(14.89%,22.19%)] in deterioration group than those of stable group (P<0.01). Results of binary logistic regression analysis showed that values of 24 h CVSBP and dCVSBP were risk factors for neurological deterioration in the acute phase of patients with hypertensive minor ischemic stroke. Conclusion The increased 24 h BPV and day time BPV are correlated with neurologi?cal deterioration during the acute phase in hypertensive minor ischemic stroke patients. BPV should be concerned in the acute phase and secondary prevention in patients with ischemic stroke.

Cardiomyopathies ; diagnosis ; Carnitine ; deficiency ; Humans ; Hyperammonemia ; diagnosis ; Infant, Newborn ; Male ; Muscular Diseases ; diagnosis

Abdominal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Adult ; Dendritic Cell Sarcoma, Follicular ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Ki-1 Antigen ; metabolism ; Leukocytosis ; complications ; metabolism ; pathology ; surgery ; Receptors, Complement 3b ; metabolism ; Receptors, Complement 3d ; metabolism ; Young Adult

OBJECTIVETo screen the differentially expressing genes between silicotic lung tissue and normal lung tissue, to identify the differentially expressing genes of matrix metalloproteinase-12 (MMP-12) and Cathepsin E and to explore the roles of those genes in silicosis development.

METHODSThirty male SD rats were divided randomly into two groups: control group (6 rats) and exposure group (24 rats) which was exposed to SiO2 by intra-tracheal perfusion. On the 30 th, 60 th and 90 th days after exposure, 8 rats in model group and 2 rats in control group were executed and the lung tissues were obtained. The morphologic changes of lung tissues were observed with HE staining and VG staining under a light microscope. The gene microarrays were used to identify differentially expressing genes of lung tissues in rats exposed to SiO2 for 60 days. Two significantly up-regulated genes, MMP-12 and Cathepsin E, were validated using RT-PCR, immunohistochemistry and Western Blot assay.

RESULTSA total of 338 differentially expressing genes were identified from the 26 962 genes between silicotic rats and normal rats, including 267 up-regulated genes and 71 down-regulated genes. The results of RT-PCR showed that in the lung tissues of exposure group on the 30 th, 60 th and 90 th days, the mRNA expression levels of MMP-12 were 4.306, 5.338, 6.713 times higher than those in the control group, the mRNA expression levels of Cathepsin E were 1.434, 2.974, 3.889 times higher than those in the control group, respectively. The results of immunohistochemical showed that in the lung tissues of exposure group on the 30th, 60th and 90th days, the mRNA expression levels of MMP-12 were 1.435, 1.746, 2.069 times higher than those in the control group, the mRNA expression levels of Cathepsin E were 1.372, 1.663, 2.103 times higher than those in the control group, respectively. The results of immunohistochemical showed that in the lung tissues of exposure group on the 30th, 60th and 90th days, the expression levels of MMP-12 protein were 1.214, 1.531, 1.959 times higher than those in the control group, the expression levels of Cathepsin E protein were 1.262, 1.828, 1.907 times higher than those in the control group, respectively. Compared with the control group, the mRNA and protein expression levels of MMP-12 and Cathepsin E in lung tissues of exposure group were significantly up-regulated (P < 0.05).

CONCLUSIONThe differentially expressing genes in rat lung tissues screened by gene chip were validated, which suggested that a complex gene regulatory network may be contributed to occurrence of silicosis. MMP-12 and Cathepsin E genes may be involved in the development of silicotic pulmonary fibrosis by degrading the basement membrane of alveolar wall and participating in the immune response.

Animals ; Cathepsin E ; genetics ; metabolism ; Gene Expression ; Lung ; metabolism ; Male ; Matrix Metalloproteinase 12 ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Silicosis ; genetics ; metabolism

Objective To establish and test the reliability and validity of the disease related psychological pressure scale of pregnant women with chronic HBV infection,so as to provide mental stress assessment tool for the pregnant women.Methods Item pool was developed after the interview and comprehensively retrieved literatures,then after expert review and rebuilt,the scale items were fixed.Totals of 368 pregnant women with chronic HBV infection disease were investigated and the reliability and validity of scale were test.Results The scale had 5 factors and 24 items,and the correlation coefficient between each factor score and total score was 0.712 - 0.894.The correlation coefficient among each factor was 0.409 - 0.631 which was significantly lower than that between each factor score and total score ( P ＜ 0.01 ).The cumulative contribution rate of 5 factors was 64.055％,and tes-retest reliability of 5 factors was 0.856,0.887,0.828,0.813.The Cronbach' s α of internal consistency of 5 factors was 0.788 - 0.865,and the Cronbach' s α of scale was 0.932.Conclusions The scale has good reliability and validity,and can be used for measuring the disease related pregnancy psychological pressure for chronic HBV infection pregnant women.

OBJECTIVETo explore the effectiveness of the traditional Chinese herbal medicine Lingzhi (Ganoderma lucidum) preparation in treating simian acquired immune deficiency syndrome (SAIDS).

METHODSFive female adult Chinese rhesus monkeys were inoculated rectally with SIVmac239, and were all diagnosed as SAIDS by laboratory and clinical examinations 17 months later. Of these 5 monkeys, 3 (#393, #374, and #381; treatment group) were orally administered with Ganoderma lucidum (2 spores powder capsules plus 2 spores oil capsules on a daily basis), and the remaining other two monkeys (#348 and #361) served as control and did not receive treatment.

RESULTSAnimal #393 (treatment group), #361 (control group) and #348 (control group) died of SAIDS (opportunity infection) 3.5 months, 6 months, and 11 months later, respectively. Two animals (#374 and #381) survived. The necropsy revealed depletion and/or exhaustion of their lymphoid tissue. In the monkey #374, the peripheral CD4(+) T lymphocyte increased by 30% in the 6(th) month compared with the baseline level and then fluctuated. The plasma viral load gradually fell and reached about 1 log(10) in the treatment group, but remained stable in the control group. As shown by pathological examinations, the lymph node and spleen of monkeys #374 (treatment group) and #381 (treatment group) showed rehabilitation and reconstruction in the lymphatic tissue, thymus, nerve tissue of gyrus hippocampi, pituitary gland, pineal body, thyroid gland, adrenal gland, and ovary. In the control group, however, animals experienced depletion of lymph nodes, atrophy of spleen, disappearance of thymus, and other disorders in endocrine organs.

CONCLUSIONGanoderma lucidum preparation may have certain protective effect on the immune system, nervous system, and endocrine system of monkeys with SAIDS.

Animals ; Disease Models, Animal ; Female ; Macaca mulatta ; Materia Medica ; therapeutic use ; Reishi ; Simian Acquired Immunodeficiency Syndrome ; drug therapy ; immunology ; Treatment Outcome