To report a typical case of Morvan syndrome with positive anti-leucine rich glioma-inactivated 1(LGI1) and contactin-associated protein 2 (CASPR2) antibodies in serum and cerebrospinal fluid. A 39-years-old female initially presented weakness of extremeties. The main symptoms included paroxysmal limb pain, wheezing, itching, muscle twitching, epilepsy, hypomnesia, dysphoria, apathy, intractable insomnia, salivation and sweating. Tests of electrolytes found hypokalemia (2.7-3.1 mmol/L) and hyponatremia (130-136 mmol/L). Arterial blood gas analysis showed hypoxemia (oxygen saturation 50%-70%). Total thyroxine (TT4) was elevated to 207 nmol/L with positive thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab). LGI1and CASPR2 antibodies (CBA method) were positive in both serum and cerebrospinal fluid, and the remaining antibodies related to autoimmune encephalitis and paraneoplastic syndrome were negative. Head MRI was almost normal, while mild abnormalities were found in electroencephalogram. Electromyography showed slightly increased voltage of left quadriceps motor unit potential. After treated with corticosteroids, IVIG and mycophenolate mofetil, the patient completely improved. Cognitive function scores recovered from MoCA/MMSE (16/24) to MoCA/MMSE (26/29). Positivity of LGI1/CASPR2 antibodies both in serum/cerebrospinal fluid are rarely seen in patients with Morvan syndrome. Steroids and immunosuppressants are suggested for treatment as early as possible.

Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.

Objective To investigate the role of Wnt/β-catenin signaling pathway in airway inflammation and airway remodeling in asthmatic rats,and to explore the possible molecular mechanism of artesunate (ART) in the treatment of asthma.Methods Forty-eight SD rats were randomly divided into normal group,asthmatic group,dexamethasone group,low-dose artesunate group,middle-dose artesunate group and high-dose artesunate group.Asthmatic models were established by ovalbumin (OVA) challenge and aerosol inhalation,and were treated with drugs.The morphological changes of lung tissue,the white blood cell count and the white blood cell count of bronchoalveolar lavage fluid (BALF) were observed in each group.The bronchial wall thickness and smooth muscle thickness were measured by Image-Pro plus image analysis software.The expressions of β-catenin and WISP-1 in lung tissue were detected by immunohistochemistry and RT-PCR respectively.The expression of IL-6 in serum and BALF was detected by ELISA.Results The artesunate group rats,airway inflammatory cells infiltration,the smooth muscle thickness,bronchial wall thickness were significantly lower than those in asthma group,and the difference was statistically significant (P ＜ 0.01).The expression of artesunate group β-catenin,WISP-1 protein and WISP-1 mRNA were significantly lower than those in asthma group,and the difference was statistically significant (P ＜0.01).The level of IL-6 in serum and BALF of artesunate group was significantly lower than that of asthmatic group (P ＜ 0.01).Conclusion The possible mechanism of artesunate to improve airway inflammation and airway remodeling in asthmatic rats related to the inhibition of Wnt/ beta-catenin signaling pathway activity and down-regulation of IL-6 levels.

Objective To explore the prognostic factors for inability to walk independently in patients with multiple system atrophy (MSA).Methods A total of 123 patients with clinically confirmed MSA admitted to Navy General Hospital and Dongfang Hospital affiliated to the Second Clinical Medical College of Beijing University of Chinese Medicine , from February 2013 to February 2016, were retrospectively reviewed .Clinical data and all records were collected and all subjects were followed up by a telephone call in February 2016.The second milestone of activities of daily living scale (ADL), defined as inability to walk independently , was taken as the primary outcome .Eight possible prognostic factors were investigated and the survival analysis was performed with Cox proportional hazards model regression .Results Of all the MSA patients, 74 subjects were men and 49 were women with a sex radio of 1.51∶1(M∶F).Seventy cases were diagnosed with MSA-cerebellar type ( MSA-C ) and 53 with MSA-Parkinson type ( MSA-P ) (C∶P=1.32∶1).Mean age at the onset of first symptom was (53 ±8) years old.All patients had severe autonomic nervous dysfunction . At the last follow-up, 56 cases ( 45.5%) were unable to walk independently .The median survival time from the onset of MSA to inability to walk independently was 73 months.The age of onset ≥55 years (HR=1.969, 95%CI 1.095-3.542, P=0.024) and the interval time from disease onset to combined motor and autonomic involvement ≤3 years ( HR =2.308, 95%CI 1.158-4.600, P=0.017) were independent prognostic factors for inability to walk independently ,while gender, MSA clinical subtypes, initial symptoms, alcohol intake, smoking and toxic exposure were not indicators for independent walking (P>0.05).Conclusions The prognostic factors for inability to walk independently in patients with MSA are the age of onset ≥55 years and the interval time from disease onset to combined motor and autonomic involvement≤3 years.Although factors including gender , MSA clinical subtypes , initial symptoms , alcohol intake , smoking and toxic exposure are not the predictive factors for inability to walk independently in our MSA patients , their roles in the prognosis of MSA still need further investigation .

To evaluate the virulence genes and antibiotics resistance of Staphylococci species in mastitis cows isolated from parts of Guangdong,and then provide scientific basis of the prevention of bovine mastitis.Forty strains Staphylococci isolated from milk samples of 110 mastitis cows were collected,and virulence genes,resistance genes and disinfectant resistant genes were detected by PCR,and antibiotics resistance with K-B paper method.The results showed that the highest virulence gene was fnbp (17.5％),followed by seb (15％) and tsst (15％),and virulence genotype was complex.The most prevalent antibiotic resistance drug wvas streptomycin,followed by erythromycin and penicillin G,and CNS were susceptible to oxacillin,ceftraxone and cefazolin.The most prevalent antibiotic resistance genes was quinolones gene qnrA/B/C/D(20％),the resistance to streptomycin was mediated by aac6-aph2.The most prevalent disinfectant resistant gene was qacG (225 ％).The genotype of antibiotics resistance gene and disinfectant resistant gene was complex.

Objective To investigate the effects of dexmedetomidine on the activities of glycome-tabolism rate-limiting enzymes in erythrocytes and the plasma levels of glucose and malondialdehyde in pa-tients undergoing radical gastrectomy for cancer.Methods Sixty patients,38 males and 22 females,aged 60-80 years,scheduled for radical gastrectomy for cancer were randomly divided into dexmedetomidine group (group D)and control group (group C),30 cases in each group.The patients in group D were intra-venously infused 0.5 μg/kg dexmedetomidine 10 minutes before operation and perioperatively followed by an infusion at a rate of 0.3 μg·kg-1 ·h-1 until the abdomen were closed.Group C was infused the same a-mount of normal saline.Venous blood samples were collected for the measurement of phosphofructokinase (PFK),glucose-6-phasphate dehydrogenase (G-6PD)and aldose reductase (AR)activities in erythrocytes and the plasma levels of glucose and malondialdehyde (MDA)before induction (T0 ),60 min following the incision (T1 ),60 min (T2 ),day 1 (T3 )and day 2 (T4 )after operation.Results Compared with these at T0 ,the activity of PFK was decreased significantly and the activities of G-6PD and AR were increased markedly at T3 in both groups (P <0.05 or P <0.01),however the activity of the PFK was significantly higher,G-6PD and AR were significantly lower in group D than those in group C (P <0.05).The levels of plasma glucose elevated significantly at T1 (P <0.01),reached high peak values at T3 (P <0.01)and fell at T4 in both groups.The values of plasma glucose in group D were lower than those in group C at T1 ,T2 and T3 (P <0.01).The MDA concentration in both groups increased significantly at T3 (P <0.01),while that of group D was lower than group C (P < 0.05 ).Conclusion Dexmedetomidine could markedly decrease glucose level and alleviate oxidative stress and improve these erythrocyte glucose metabolism changes after radical gastrectomy for cancer in old patients.

Objective To analyze the clinical,imaging and pathological features of cortical vein thrombosis (CoVT). Methods Ten patients with CoVT (4 patients with CoVT alone and 6 patients with CoVT and venous sinus thrombosis)treated at Navy General Hospital from January 2006 to Jun 2013 were collected retrospectively.Its etiology,imaging,and pathological features of brain tissue in 3 patients were analyzed. Results Of the 10 patients with CoVT,3 were female and 7 were male.Their mean age was 31 ± 15 years old.(1)Brain CT scan and MRI showed hemorrhagic cerebral infarction,and contrast-enhanced MRI showed scattered heterogeneous enhancement within lesions. DSA could find CoVT at different parts.(2)3 patients underwent brain biopsy because they were initially diagnosed as brain tumor. Pathological examination showed glial cell,endothelial proliferation and phagocytic reaction.Scattered spotty bleeding was observed,and significant expansion of small veins,A few of them had blood stasis and thrombosis. Conclusion CoVT is one kind of intracranial venous thrombosis. It is more common occurred in young and middle aged adults,and most of them were venous sinus thrombosis.It is caused by retrograde thrombosis and spread to cortical veins.CoVT is easily to be misdiagnosed as brain tumor.Combination of clinical and imaging findings is needed for accurate diagnosis.

Objective To improve the diagnostic ability of leukoencephalopathy with cerebral calcifications and cysts (LCC),a rare central nervous system disease.Methods The clinical manifestations,neuroimages and neuropathological features of a 19-year-old male patient were analyzed.A total of 20 cases from 14 literatures were reviewed.Results The patient was admitted with right limb weakness,cognitive decline,headache and blurred eyesight.Head CT scan showed multiple calcifications,cysts formation and leukoencephalopathy.Brain MRI showed several cysts in bilateral hemisphere,basal ganglia,thalamus and paraventricular areas.A mural nodule was noted inside one of the cyst,which was enhanced on the contrasted MRI.The wall of the cysts was partially enhanced,but not with the fluid inside the cysts.The corresponding CT calcifications foci showed on T1 and T2 with either both hyperintensity or both hypointensity,which was also partial enhanced.Extensive leukoencephalopathy was formed around the cysts and the ventricles.But neither Cho nor NAA changed a lot on MRS.Amplitude diagram of SWI series exhibited multiple round small dark signals all over the affected areas with mixed signals showed in the phase diagram,which indicated both calcifications and microbleedings at the lesions.Neuropathological examinations found no tumor cells in the operated cyst,and showed angiomatous small blood cells were dominant in the cyst wall.Hyaline degenerations,microcalcifications and hemosiderin deposition were observed.No obvious demyelination was discovered,while gliosis,numerous Rosenthal fibers and fibrinoid vascular necrosis were found around the lesions.The clinical,neuroimaging and pathological features of this patient were in accordance with the cases reported in the literatures.Conclusions Neuroimaging is the most important method for the diagnosis of LCC.As small vessel lesions are probably closely related to the pathophysiology of LCC,SWI could be recommended to further reveal the etiology of LCC.

Objective To analyze the clinical,imaging and pathological features of cortical vein thrombosis (CoVT).Methods Three cases of cortical vein thrombosis were diagnosed in our hospital from February 2010 to October 2012.We reviewed and summarized their clinical manifestation,radiological feature and pathological characteristics.Results All patients were young with acute onset.The main clinical manifestations included headache,epilepsy or limbs weakness.Two cases had intracranial hypertension.One case had decreased activity of protein S.One had increased plasma homocysteine.Brain computed tomography scan showed hypodensity lesion with some hyperdensity inside.Cranial routine magnetic resonance imaging showed long signal in T1-weighed image and T2-weighed image,with occasional short T1 signal inside.Contrast-enhanced magnetic resonance imaging revealed heterogeneous enhancement.All of 3 cases underwent brain biopsy because of the suspected diagnosis of brain tumor.Brain pathology showed the local necrosis and hemorrhage,dilated small vein with congestion or thrombosis.Neuronal degeneration,hyperplasia of gliocyte,hyperplasia of endotheliocyte in small blood vessels with reaction of histiocytes was also displayed.Duration from initial visit to final diagnosis was from 14 days to 2 months.Conclusions CoVT has various clinical and radiological manifestations and it is easy to misdiagnose as brain tumor.Careful analysis of clinical and imaging data could improve its diagnostic accuracy.Brain biopsy would also be helpful for diagnosis.

Objective To assess the significance of urethral sphincter electromyography (US-EMG) and external anal sphincter electromyography (EAS-EMG) for the diagnosis of multiple system atrophy (MSA).Methods US-EMG and EAS-EMG were performed in 9 patients who were diagnosed as MSA.Duration,motor unit action potentials amplitude,polyphasicity,as well as recruited pattern and amplitude during powerful contraction were recorded and analyzed.Results Among 9 patients who were diagnosed as MSA,7 cases showed neural injury by both US-EMG and EAS-EMG.There was significant difference of electromyographic findings between US-EMG group and EAS-EMG group (average volatility (μV):1063.44 ±499.92 vs 634.89 ±265.07; polyphasic wave:0(0,20％ ) vs 57％ (28％,63％ ) ; t =2.567,P=0.033;t =2.833,P=0.012).Conclusions Although US-EMG may be difficult to perform,US-EMG may have the same specificity as EAS-EMG for the diagnosis of MSA,especially for the diagnosis of MSA patients only with urination disorders,who are involved in Onuf neclear according to some of the abnormal indexes.