Objective Paraneoplastic neurological syndrome is a rare immune-mediated disease induced by underlying tumors， and early identification of special subtypes of paraneoplastic syndrome and specific autoantibodies can guide efficient tumor screening， thereby promoting timely antitumor treatment and prolonging survival time. Methods A retrospective analysis was performed for the diagnosis and treatment of a case of paraneoplastic neurological syndrome with multiple clinical phenotypes and multiple autoantibodies who was admittd to Department of Neurology， Weifang People’s Hospital， and a systmatical review was performed for related articles. Results The patient presented with unsteady gait and mental and behavioral disorders in the early stage and was initially diagnosed with paraneoplastic cerebellar degeneration and paraneoplastic limbic encephalitis with positive anti-SOX-1 and anti-GABABR antibodies. Due to abnormal electrophysiological results and positive P/Q-type VGCC antibodies， the patient was considered to have Lambert-Eaton myasthenic syndrome， and all evidence suggested that the patient had occult small cell lung cancer. Finally thoracoscopic biopsy confirmed that lymph node enlargement on PET-CT was in accordance with the pathological changes of small cell lung cancer. The patient received both antitumor treatment and immunotherapy and had a survival time of 19 months. Conclusion The detection of anti-SOX1 antibodies should promote the screening for small cell lung cancer. In patients with paraneoplastic limbic encephalitis and paraneoplastic neuromuscular syndromes mediated by cell surface antibodies， immunotherapy should be initiated in parallel with antitumor treatment， and such patients tend to have a good prognosis.

Objective To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group (n=4) and the complete left bundle branch block (CLBBB) group (n=4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V1 and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V2, while other 6 cases were all with precordial R/S>1 transition at lead V4. Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38 ± 23.80)ms vs (156.75 ± 25.93)ms, P>0.05], while statistical difference was shown in the control group [ (92.63 ± 5.76)ms vs (140.25 ± 15.97)ms,P<0.05]. Conclusion Bundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.

Objective: To observe the effect of ivabradine (IVA) on atrial and ventricular monophasic action potential duration (MAPD) and its proarrhythmic action at presence of sea anemone toxin-II (ATX-II) in isolated rabbit heart modelin vitro. Methods: The perfusion of isolated heart from female New Zealand white rabbit was conducted by Langendorff method in vitro. Left atrial and left ventricular endo- , epi-cardial action potential were recorded when pacing with ifxed frequency of 350 ms (in correspondence with the heart rate of 171 times/min) to observe the effect of IVA alone and ATX-II (3 nmol/L) with IVA on MAPD90. In addition, to observe the action of IVA alone and ATX-II with IVA on proarrhythmia when IVA reducing the heart rate to autonomous cardiac rhythm as (156±10) times/min. Results: IVA at (3-10) μmol/L prolonged atrial and ventricular endo- , epi-cardial MAPD90 by (15.9 ± 2.0) ms, (31.5 ± 4.0) ms and (23.9 ± 3.0) ms (n=6,P<0.01), respectively. ATX-II at 3 nmol/L prolonged atrial and ventricular MAPD90 by (36.5 ± 5.0)ms and (19.9 ± 3.0) ms, (19.5 ± 4.0) ms (n=6,P<0.01) respectively. With ATX-II treatment, IVA at (6-10) μmol/L decreased atrial MAPD90 by (14.4 ± 4.0) ms (n=6,P<0.01), it induced atrial arrhythmia. With 3 nmol/L of ATX-II treated ventricle, IVA at (3-10) μmol/L obviously prolonged endo- and epi-cardial MAPD90 by (36.2 ± 7.0) ms and (27.5 ± 5.0) ms(n=6,P<0.01), respectively. IVA didn’t increase ventricular beat-to-beat variability and transmural dispersion of MAPD90 no matter with or without ATX-II treatment, no ventricular arrhythmia occurred. Conclusion: IVA prolongs both atrial and ventricular MAPD, with increased late sodium current, IVA may induce atrial arrhythmia but not ventricular arrhythmia in experimental rabbits in vitro.

Objective To explore the influence of scaffolding instruction on improvement of professional self-concept for undergraduate nursing students in clinical practice.Methods 90 nursing students from 176 undergraduate nursing students were randomly sampled,and were randomly divided into the experimental group and the control group with 45 students in each group.The experimental group took routine clinical practice and scaffolding instruction,students of the control group took routine clinical practice.After 1 week and 6 months,professional self-concept of the students of the two groups was measured by questionnaire.Results There were significant improvement in leadership ability,professional skills,flexibility,satisfaction,communication in the experimental group after 6 months,but this improvement was not found in the control group and after 1 week in both groups.Conclusions Scaffolding instruction can effectively improve professional self-concept for undergraduate nursing students in praxis.

Objective To assess the reproducibility of long-term blood pressure variability in ischemic stroke and the association between the variability and cerebral microbleeds.Methods Patients with ischemic stroke at the previous 1-6 months were consecutively recruited and followed up 12-18 months.Blood pressure measurements were taken at every interview.Blood pressure variability indicated visit-to visit variability and was quantified by calculating the maximum ( Max),standard deviation (SD) and coefficient of variation (CV).For these variability might positively correlated with mean of blood pressure,the additional variability measure,SD independent of mean (SDIM),was also calculated.To determine the reproducibility of mean and variability measurements,the intraclass correlation (ICC) was also calculated.MRI was performed at baseline and the end of the study.Cerebral microbleeds were rated using Microbleed Anatomical Rating Scale (MARS).Multiple Logistic regression was used to assess the association between the visit-to-visit blood pressure variability and cerebral microbleeds.Results A total of 720 patients were recruited,of whom 595 (82.6％) subjects were present for 14 blood pressure readings during follow-up.The visit-to-visit blood variability measurements were moderately reproducible according to the ICC:0.46-0.72 for systolic blood pressure (SBP) and 0.42-0.69 for diastolic blood pressure ( DBP),respectively,P ＜0.01 for all measures.Patients with cerebral microbleeds were more likely to have higher mean blood pressure and variability for both SBP and DBP regardless the distribution of cerebral microbleeds.Being SBP Max,SBP SD,SBP CV,SBP SDIM(OR=1.036,95％ CI l.021-1.052,P=0.000; OR=1.060,95％CI 1.001-1.122,P =0.046; OR =1.084,95％ CI 1.000-1.175,P =0.049; OR =1.065,95％ CI 1.002-1.132,P =0.044) and DBP SD,DBP CV ( OR =1.111,95％ CI 1.000-1.233,P =0.049;OR =1.091,95％ CI 1.001-1.190,P =0.047) were the independently risk factors of cercbral microbleeds at deep region; SBP Max( OR =1.049,95％ CI 1.029-1.068,P =0.000) and DBP SD、DBP CV(OR =1.236,95％ CI 1.107-1.379,P=0.000;OR =1.188,95％ CI 1.087-1.298,P=0.000)independently associated with cerebral microbleeds at infratentorial location.There was no significant relation between the long-term variability of blood pressure and cerebral microbleeds at lobar region. Conclusions This study indicates that long-term blood pressure variability is substantial and independently associated with cerebral microbleeds in deep or infratentorial but not with that in lobar region.The different relations between the variability and cerebral microbleeds might indicate the heterogenic mechanisms of cerebral microbleeds.

OBJECTIVE To study the risk factors and protection measures for the occupational exposure to HBV,and reduce the occupational exposure risk of blood.METHODS A survey was carried out among 1352 medical staff.And then we carried on the analysis to 43 questions of it and used Logistic regression analytic method to find out the risk factors and protective measures.RESULTS Seventy one persons had occuptional exposure risk to HBV and 56 persons had needle puncture wound or sharp wound.The risk factors included needle puncture wound or sharp wound,blood contaminated skin and mucous membrane,and the long working life.While knowledge of infection control,protection consciousness,washing hands,using gloves,and wearing glasses were the protective factors.CONCLUSIONS It plays the vital role to reduce occupational exposure to HBV that the medical staff should reduce injury in work,vaccinate the HBV vaccine,use protection goods and raise the protection consciousness.

0 05 There was 1 case of cardiac tamponand and 1 case of 60% stenosis of the left superior PV associated with the procedure Conclusion ERAF after segmental PV isolation is common, occurring in approximately 39% of patients with paroxysmal AF However, approximately 35% of ERAF patients without early repeat ablation have no further AF during long term follow up It is suggested that temporary antiarrhymic drug therapy may be more appropriate than early repeat ablation in patients with ERAF

Objective To investigate the efficacy and safety of the segmental electrical isolation of pulmonary veins (PVs) in patients with paroxysmal atrial fibrillation (PAF). Methods Thirty-nine patients (28 males, 11 females) with recurrent documented symptomatic PAF were included. In order to avoid the risk of cardiac tamponand, we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using pigtail catheter. Lasso mapping catheter and ablation catheter were put into target pulmonary vein ostium through the same site of atrial septum. We routinely mapped the right inferior PV lest any pulmonary vein potential (PVP) that triggered PAF should be omitted. RF ablation was applied at the PVP breakthrough and slightly right and left by moving the RF catheter. Results Eighty-five PVs were targeted for segmental RF ablation. Eight-one were isolated completely. Immediate successful rate was 95%. There was not any complication associated with the procedure. Conclusion It is suggested that the method of segmental PV isolation has a higher cure rate and a shorter procedure time compared with other traditional methods. It can minimize the lesion of pulmonary veins and avoid PV stenosis.

Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF

Objective The aim of this study was to investigate the mechanisms and the possible treatment of early and frequent recurrence of atrial fibrillation after segmental pulmonary veins isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). Methods and Results Guided by Lasso mapping catheter, segmental pulmonary veins isolation was performed using radiofrequency energy in 54 consecutive patients (mean age 53?15 years) with recurrent documented symptomatic paroxysmal AF. Early recurrence of AF and rapid atrial arrhythmia occurred in 10 out of 54 patients (18.5%) within two weeks after PVI. 4 out of 10 patients (7.4 %) experienced early and frequent recurrence of atrial fibrillation and atrial tachyarrhythmia, which we termed as “atrial arrhythmic storm". The 4 patients were treated with class Ⅰ and Ⅲ antiarrhythmic drugs for 3 months. The “atrial arrhythmic storm" subided apparently and disappeared within two weeks after antiarrhythmic drug therapy. Only 1 patient still suffered from paroxysmal AF after drug control at mean follow-up of 3 months. After repeat ablation, there was no occurrence of AF and atrial arrhythmia in this patient.Conclusion A few paroxysmal atrial fibrillation patients experienced “atrial arrhythmic storm" after segmental pulmonary veins isolation. It is suggested that “atrial arrhythmic storm" after PVI may due to a lot of factors and combined antiarrhythmic drug therapy may be feasible. Early repeat ablation in patients with “atrial arrhythmic storm" may not be necessary.