Acute symptomatic seizures secondary to autoimmune encephalitis refers to seizures that occur during the active stage of immune-mediated encephalitis,and autoimmune-related epilepsy refers to disorders with an immune etiol-ogy and a long-term predisposition to unprovoked seizures.Both diseases often have poor response to antiepileptic drugs,and early identification of immune etiology and initiation of immunotherapy may help patients achieve a good prognosis.However,there are no guidelines for the use of drugs in patients with different types of symptomatic seizures,and there is also a lack of diagnostic criteria and treatment principles for autoimmune-related epilepsy.This article reviews and dis-cusses the two diseases from the aspects of possible pathogenesis,clinical manifestations,and recommended treatment methods,so as to provide a theoretical basis for diagnosis and treatment and help to determine future research directions.

Objective:To test the validity and reliability of the Chinese Social Anxiety Questionnaire for A-dults(CSAQ-A).Methods:Totally 555 participants[aged 18 to 60 years,average age(29±8)years old]were recruited to complete the CSAQ-A.The Liebowitz Social Anxiety Scale(LSAS),Brief Fear of Negative Evaluation Scale(BFNE),Penn State Worry Questionnaire(PSWQ),State-Trait Anxiety Inventory-Trait(STAI-T),and Beck Depression Scale-Second Edition(BDI-Ⅱ)were conducted to test the criterion validity.After 4 weeks,143 subjects were retested.Results:Confirmatory factor analysis demonstrated that the five-dimensional structure of the CSAQ-A exhibited excellent fit indices(x2/df=3.06,CFI=0.92,TLI=0.91,RMSEA=0.06,SRMR=0.05).The CSAQ-A scores were positively correlated with the scores of LSAS,BFNE,PSWQ,STAI-T and BDI-Ⅱ(ICC=0.40-0.67,Ps＜0.001).The Cronbach α coefficient of the CSAQ-A scale was 0.96,and the test-retest reliability was 0.80.Conclusion:The Chinese Social Anxiety Questionnaire for Adults has good validity and reliability and could effectively evaluate social anxiety in the Chinese adult population.

Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.

Objective:To explore the application effect of problem-based learning (PBL) combined with evidence-based medicine (EBM) teaching in clinical practice of hematology department.Methods:The 68 medical students practicing in the hematology department from July 15 to November 8, 2019 were set as the experimental group, and 65 medical students from December 29, 2018 to June 28, 2019 were set as the control group. Patients with pancytopenia were selected in the first week of admission for PBL combined with EBM teaching practice in the experimental group, but in the control group, these students did not take this practice. Theoretical knowledge, case analysis and assessment, were conducted before the students leaving the department. SPSS 22.0 was used for t test. Results:Compared with the control group, the scores of theoretical knowledge and case analysis of medical students in the experimental group were improved to a certain extent, with statistical significance ( P = 0.001, P < 0.001). And the higher the score of teaching practice, the higher the score of theoretical knowledge and case analysis ( P < 0.001). Conclusion:PBL combined with EBM teaching practice can effectively improve students' learning enthusiasm and initiative, also can enhance their clinical thinking ability, then can help improve the teaching quality of the hematology.

In December 2019, novel coronavirus pneumonia epidemic occurred in Wuhan, Hubei Province, and spread rapidly across the country. In the early stages of the epidemic, China adopted the containment strategy and implemented a series of core measures around this strategic point, including social mobilization, strengthening case isolation and close contacts tracking management, blocking epidemic areas and traffic control to reduce personnel movements and increase social distance, environmental measures and personal protection, with a view to controlling the epidemic as soon as possible in limited areas such as Wuhan. This article summarizes the background, key points and core measures in the country and provinces. It sent prospects for future prevention and control strategies.

Objective: To investigate the clinical effect of bile reinfusion combined with enteral nutrition support before surgery for hilar cholangiocarcinoma. Methods: A retrospective analysis of patients with hilar cholangiocarcinoma who underwent surgical treatment at Nanjing Drum Tower Hospital Hepato-biliary-pancreatic Surgery Department from July 2010 to August 2017 was completed.A total of 52 cases were finally enrolled in our study.All the patients included, on the basis of whether they received preoperative drainage and bile reinfusion, were divided into non-drainage group(n=15) and drainage group(n=37). Differences of clinical indicators, including operation time, intraoperative bleeding and serum liver function index levels at day 1, 3, 7 postoperative, postoperative complications(liver failure, biliary fistula, pleural effusion, peritoneal effusion, abdominal cavity infection, death in hospital), tumor classification, R0 resection, postoperative hospitalization time between the 2 groups were analyzed. At the same time, in the drainage group, patients were divided into non-enteral nutrition subgroup(n=13) and enteral nutrition subgroup(n=24) according to whether they received enteral nutrition before operation. The normal distribution data of the group was statistically analyzed by independent sample t test, the non-normal distribution data of the group was statistically analyzed by rank-sum test. The count data was statistically analyzed by non-calibration and correction of the square test. Results: There was no statistically significant difference in general infomation such as age, gender, and serum liver function between non-drainage group and drainage group(P>0.05). There was no statistically significant difference in general information such as age, gender, and serum liver function between non-enteral nutrition group and enteral nutrition group(P>0.05). The rate of vascular resection and reconstruction(33.3%) and operating time(10.8(2.2)h) in drainage group were both higher than those in non-drainage group(6.7% and 8.3(3.0)h), the differences were both statistically significant(χ²=4.397, Z=1.595; both P<0.05). The level of AST at the 7th day after surgery in drainage group(32.8(17.3)U/L) was significantly lower than that in non-drainage group(55.0(64.7)U/L), the difference was statistically significant(Z=-2.212, P<0.05). The level of TBil at 1st day after surgery in drainage group(43.6(91.2)μmol/L) was lower than that in non-drainage group(91.2(188.4)μmol/L), the difference was statistically significant(Z=-2.150, P<0.05). The rate of pancreatoduodenectomy(25.0%) and average operating time(11.1(1.3)h) in the enteral nutrition group were both higher than those in the non-enteral nutrition group(0, 9.0(2.6)h). The differences were both statistically significant(χ²=3.879, Z=-2.693; P<0.05). The average level of AST at the 1st day after surgery in enteral nutrition group(396.4(268.3)U/L) was significantly lower than that in non-enteral nutrition group(642.5(341.1)U/L), the difference was statistically significant(Z=-2.483, P<0.05). The average level of TBil at the 1st, 3th day after surgery in enteral nutrition group(38.8(21.5)μmol/L and 30.0(25.6)μmol/L) were both lower than those in non-enteral nutrition group(60.9(75.2)μmol/L and 46.5(50.0)μmol/L), the differences were both statistically significant(Z=-2.416, -2.026; P<0.05). The level of CRP at 1st, 3th day after surgery((41.9±31.1)mg/L, (50.8±31.4)mg/L)in enteral nutrition subgroup was lower than that in non-enteral nutrition subgroup((64.4±33.6)mg/L, (74.1±35.3)mg/L), the differences were both statistically significant(t=1.456, 1.675; P<0.05). Conclusion Based on the present study , there is no effective improvement on postoperative recovery using bile reinfusion combined with nutrition support before R0 resection of hilar cholangiocarcinoma.

Objective·To investigate and compare the clinical characteristic of non-organic dyspnea and asthma both with complaint of dyspnea.Methods·Seventy-four consecutive patients with non-organic dyspnea,and 74 age-,height-,weight and sex-matched patients with asthma were recruited for investigation in the study.The self-assessment surveys were conducted for the two groups by means of Hospital Anxiety and Depression Scale,Nijmegen Questionnaire and Athens Insomnia Scale.The words for describing dyspnea,clinical symptoms,effective sleep hours and items of pulmonary function test were collected and analyzed Results·Non-organic dyspnea patients tended to describe psychogenic aspects.Asthma patients tended to describe airflow limitation.Non-organic dyspnea group mainly performed psychogenic symptoms.The sleeping time in non-organic dyspnea group was significantly lower than that in asthma group(P＜0.05).The score of anxiety,depression,Nijmegen Questionnaire,Athens Insomnia Scale,FEV1,FEV1％Pred,FVC％Pred,FEV1/FVC in non-organic dyspnea group were significantly higher than those in asthma group (P＜0.05).There was no significant difference in FVC between two groups(P＞0.05).Conclusion·The non-organic group feel more anxiety,depressed and insomnic than the asthma group.Lung function test of asthma group is often abnormal.To discriminate non-organic dyspnea with asthma,clinicians should pay more attention to emotion,sleep,somatoform symptoms,medical history and so on,and do pulmonary function test,improve the understanding of the characteristics of the two diseases,decrease misdiagnosis and wrong diagnosis.

Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.

OBJECTIVETo analyze the clinical efficacy and toxicity of vitamin support in lung adenocarcinoma patients treated with pemetrexed second-line chemotherapy.

METHODSTwo hundred and eighty-three patients with stage 3/4 lung adenocarcinoma treated at our hospital from August 2010 to August 2013 were included in this study. The lung adenocarcinomas in all the 283 patients were confirmed by pathology or cytology, all were EGFR-negative, and all patients received pemetrexed second line chemotherapy. The 283 patients were randomly divided into two groups: the improved treatment group (142 cases) and the conventional treatment group (141 cases). The patients of conventional treatment group received 400 µg folic acid per os daily for 7 days before the first dose of pemetrexed, and continued until 21 days after the last dose of pemetrexed. Besides, they received 1000 µg vitamin B12 injection at 7 days before the first dose of pemetrexed, and once per cycle of pemetrexed for 3 cycles after the last dose of pemetrexed. The patients of the improved treatment group took 400 µg folic acid daily per os from the day before the first dose to 21 days after the last dose of pemetrexed. They also received 500 µg vitamin B12 by injection one day before the first dose, and one day before each therapy cycle of pemetrexed therapy.

RESULTSThe mean number of cycles of pemetrexed chemotherapy was 4 in both groups. In the 142 patients of improved treatment group, complete response (CR) was observed in two cases, partial remission (PR) in 28, stable disease (SD) in 21, and progressive disease (PD) in 91 cases, with a total effective rate of 21.1%. While in the conventional treatment group, CR was observed in one case, PR in 27 cases, SD in 23 cases, and PD in 90 cases, with a total effective rate of 19.9%. The median progression-free survival (PFS) was 3.8 months in the improved treatment group and 4.2 months in the conventional treatment group (P=0.143). The toxicity of chemotherapy was mild in both groups, with no significant difference between the two groups (P>0.05). The most common side effects of hematological system were leukopenia and neutropenia, and the most common side effects of non-blood system were nausea and vomiting. The most common grade 3-4 toxic reaction in both groups was leukopenia and neutropenia, with no significant difference between the two groups (P>0.05). Multivariate analysis showed that the age of patients was an independent factor of grade 3-4 chemotherapy toxic reaction (P<0.05), while gender, the baseline level of PS score or blood system had no significant effect on the grade 3-4 chemotherapy toxic reaction (P>0.05).

CONCLUSIONSCompared with the conventional treatment scheme, the improved treatment scheme has similar therapeutic effects and could be used more conveniently, while the toxic effects of chemotherapy are not increased at the same time. Our results indicate that pemetrexed-based chemotherapy does not need to delay the chemotherapy because of vitamin support treatment.

Adenocarcinoma ; drug therapy ; Antineoplastic Agents ; therapeutic use ; Disease-Free Survival ; Folic Acid ; therapeutic use ; Humans ; Lung Neoplasms ; drug therapy ; Pemetrexed ; therapeutic use ; Treatment Outcome ; Vitamin B 12 ; therapeutic use ; Vitamin B Complex ; therapeutic use

Objective To investigate the clinical characteristics and risk factors of pulmonary infection after allogeneic hemato-poietic stem cell transplantation(allo-HSCT) .Methods The clinical data of 37 allo-HSCT patients treated in our transplantation u-nit from 2010 to 2012 were performed the retrospective analysis .Results Among 17 cases of allo-HSCT ,33 case-times of pulmona-ry infection occurred after transplantation ,in which more than twice pulmonary infection occurred in 11 cases ,the total occurrence rate of pulmonary infection was 45 .9% (17/37) .5 cases directly died of pulmonary infection .Only 39 .4% case-times of pulmonary infection had the pathogenic evidence .Fungal infection ,especially Candida albicans ,was predominant .The univariate analysis showed that pulmonary infection was significantly associated with human leucocyte antigen (HLA) non-identical of donor and recip-ient and graft versus host disease(GVHD)(P=0 .041 ,0 .013) ,and had no obvious correlation with the other factors (P>0 .05) . The multivariate analysis showed that the HLA non-identical of donor and recipient and GVHD were significantly associated with the occurrence of pulmonary infection (P=0 .041 ,0 .021) .Conclusion Postoperative pulmonary infection is a common complication following allo-HSCT ,which has larger threat to the patients .HLA non-identical and GVHD are significantly correlated with pulmo-nary infection after allo-HSCT .