Objective To investigate the characteristics of smooth pursuit eye movement and optokinetic nystagmus on videonystagmography in patients with multiple system atrophy， cerebellar type （MSA-C）， and to provide electrophysiological information for the early diagnosis of MSA-C.Methods A total of 30 patients with MSA-C who were diagnosed and treated in Department of Neurology， Xuanwu Hospital， Capital Medical University， from May 2022 to December 2023 were enrolled as subjects （MSA-C group）， and 30 healthy individuals were enrolled as control group. The parameters of smooth pursuit eye movement and optokinetic nystagmus were analyzed for the 30 patients with MSA-C. The parameters of smooth pursuit eye movement included waveform， velocity-dependent gain， left-right gain balance， and comparison of waveform abnormality rates versus gain abnormality rates， and the parameters of optokinetic nystagmus included direction， slow phase velocity （SPV） symmetry， and mean gains across different velocities； a comparative analysis was performed for the proportion of patients with optokinetic nystagmus gain abnormalities and those with smooth pursuit gain abnormalities.Results Compared with the control group， the MSA-C group had a significantly higher proportion of patients with abnormal waveforms in smooth pursuit test （90.0% vs 13.3%） and significantly lower mean smooth pursuit gains of 20°/s and 40°/s， and such different became more significant with the increase in velocity. There was no significant difference in mean smooth pursuit gain between the MSA-C patients with different velocities， and among the MSA-C patients， the patients with waveform abnormalities accounted for a significantly higher proportion than those with gain abnormalities （90.0% vs 16.7%）. The patients with MSA-C had normal direction and bilateral SPV symmetry for optokinetic nystagmus， and the MSA-C group had significantly lower mean gains across different velocities than the control group. Among the MSA-C patients， the patients with a reduction in optokinetic nystagmus gain accounted for a significantly higher proportion than those with a reduction in smooth pursuit gain.Conclusion Compared with the control group， the patients with MSA-C had a reduction in smooth pursuit gain， which became more significant with the increase in velocity. In patients with MSA-C， abnormal smooth pursuit waveforms were more sensitive than gain reduction and may serve as an electrophysiological indicator for the early diagnosis of MSA-C. Compared with the control group， the patients with MSA-C had a reduction in optokinetic nystagmus gain， which was more sensitive than smooth pursuit gain reduction. In conclusion， waveform abnormalities in smooth pursuit test and the reduction in optokinetic nystagmus gain are important electrophysiological indicators for the early diagnosis of MSA-C.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To analyze the distribution of TCM syndrome elements and syndromes in patients with hypertension with insomnia (HWI) in the real world.Methods:A cross-sectional study and retrospectively enrolled. The positive symptoms and TCM syndrome type entries of 359 patients with HWI who were collected from Henan Integrated Medicine Hospital,Henan Provincial People's Hospital,the First Affiliated Hospital of Henan University of Chinese Medicine from December 2020 to August 2022 were retrospectively studied. Based on factor analysis dimension reduction and systematic cluster analysis, the TCM syndrome elements and potential syndrome types of patients were summarized. The Latern 5.0 software was used to establish a latent structure model and comprehensive clustering based on the mountain climbing method (LTM-EAST) algorithm, and analyze and judge the common syndrome types, providing a basis for proposing the clinical common syndrome types of this disease.Results:Factor analysis extracted 14 common factors, and the cumulative contribution rate was 63.254%. Among the 36 symptom variables with frequency ≥ 70, more than half of the patients with hypertension and insomnia were upset, irritable, less sleepy, dreamy, dizzy, palpitations, stuffy chest, dry mouth, easy to wake up, and tired. The tongue color was mainly light red tongue and red tongue. The tongue is mainly thin and greasy. The first three pulse conditions are string pulse, number pulse and slippery pulse. The disease location and syndrome elements of hypertension with insomnia were mainly liver (52.09%), heart (33.43%), spleen (26.46%) and kidney (23.68%); The disease syndrome elements are mainly phlegm dampness (34.54%), yin deficiency (29.25%), heat (fire) (25.35%), and qi stagnation (25.07%). Ten syndrome types are obtained by frequency statistics, nine syndrome types are obtained by factor clustering, and seven syndrome types are inferred by implicit structure clustering. Among the syndrome types inferred by the above three methods, there are seven syndrome types that recur at least twice, which can be identified as the common syndrome type of hypertension with insomnia.Conclusions:The common clinical symptoms of HWI are upset and irritable, less sleep, more dreams, dizziness, palpitations, stuffy chest, dry mouth, easy to wake up, mental fatigue and body tiredness. The disease location and syndrome elements are mainly in liver, heart, spleen and kidney. The disease mainly involves phlegm dampness, yin deficiency, heat and qi stagnation. The common clinical syndrome types are liver depression transforming fire type, yin deficiency and yang hyperactivity type, phlegm dampness intrinsic type, yin deficiency and internal heat type, heart and gallbladder qi deficiency type, heart and spleen deficiency type, and heart kidney disjunction type.

Objective To investigate the clinical characteristics of vestibular paroxysmia （VP）： age distribution，triggers，accompanying symptoms，maximum frequency per day，nystagmus features during attacks，and neurovascular compression. Methods The clinical data of 70 patients with VP were collected to analyze their age distribution，triggers，accompanying symptoms，maximum frequency per day，nystagmus features during attacks，and neurovascular compression by using descriptive statistical methods. Results Among the 70 patients with VP，30 （42.86%） were elderly，23 （32.86%） were young，and 17 （24.29%） were middle-aged patients. The maximum frequency per day was 2-5 in 53 cases （75.71%），6-10 in 9 cases （12.86%），and >10 in 8 cases （11.43%）. Thirty-six patients （51.43%） had triggers，including rapid walking，emotional excitement，driving，cycling，sexual intercourse，coughing or wheezing，speaking or chatting，bathing，defecation，drinking alcohol，and sound stimulation. Thirty-three patients （47.14%） had unilateral tinnitus，bilateral tinnitus，and tinnitus with facial spasms； nystagmus during VP episodes met the characteristics of the head coordinate system，which was horizontal-torsional towards the affected side. Among 57 patients examined for the relationship between the vestibulocochlear nerve and vessels using magnetic resonance angiography，37 patients （64.91%） had contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery，15 patients （26.32%） had contact between the vestibulocochlear nerve and the left anterior inferior cerebellar artery，and 5 patients （8.77%） had contact between the vestibulocochlear nerve and the basilar artery. Conclusion VP is most prevalent in the elderly，then young and middle-aged people. Most patients with VP have a maximum frequency of 2-5 per day. VP can be triggered by anger，excitement，exercise，and various stimuli. VP attacks can be accompanied by tinnitus and facial spasms. Its nystagmus is horizontal-torsional towards the affected side. The percentage of contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery is highest in patients with VP.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

In recent years, the corona virus disease 2019 (COVID-19) pandemic has had a huge impact on the global medical, political and economic fields. Since the beginning of the COVID-19 epidemic, our understanding of the impact of COVID-19 has grown exponentially. Recently, the COVID-19 epidemic has changed rapidly in China, and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions. Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population, however, delays in cancer treatment are also associated with increased mortality among these patients. In particular, the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination. In order to minimize the risk of novel coronavirus infection in surgical patients, it is necessary to develop new treatment guidelines, expert consensus and preventive measures. However, the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus. Therefore, thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection. We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery.
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Humans ; Lung Neoplasms/complications* ; COVID-19 ; SARS-CoV-2 ; Multiple Pulmonary Nodules ; Pandemics/prevention & control* ; Lung

Post-transplant lymphoproliferative disorder (PTLD) is a solid organ or hematopoietic stem cells transplant associated syndrome, and central nervous system PTLD(CNS-PTLD) is extremely rare. A case of CNS-PTLD occurring after 24 years of kidney transplant was reported, and pathological examination proved it to be diffuse large B cell lymphoma. Cerebrospinal fluid next generation sequencing and pathological examination supported that Epstein-Barr virus infection was associated with it.

Ocular opsoclonus is a rare disorder of the saccadic system, in which fixation is continuously interrupted by involuntary, chaotic, rapid and multi-directional saccadic eye movements, interrupting the gaze-holding function, leading to“dancing eyes”. Ocular opsoclonus has rarely been reported in China. A case of ocular opsoclonus associated with anti-N-methyl-D-aspartate receptor encephalitis is reported to improve awareness about the ocular sign. The patient′s condition reached the peak at the 5th week. He developed ocular opsoclonus on the basis of nonconvulsive status epilepticus, accompanied by frequent involuntary movements of the mouth and limbs. The ocular opsoclonus gradually relieved on the 7th week with the active treatment.

Objective To observe the clinical characteristic and prognostic analysis of severe anti-N-methyl-D-aspartate receptor ( anti-NMDAR) encephalitis.Methods The clinical data of 9 patients with severe anti-NMDAR encephalitis were retrospective analyzed.Results Nine patients ( two male and seven females ) were taken care at ICU.They were 27.7 years old at average.The median course was 22.4 d and median length of stay in ICU was 50. 9 d.The mainly clinical characteristics were fever(7 cases), psychiatric behavioral symptoms(9 cases), seizures(9 cases) , decreased consciousness ( 8 cases ) , abnormal movement ( 7 cases ) , automatic instability ( 9 cases ) and hypoventilation(6 cases) .Three cases had ovarian teratoma.Anti-NMDAR antibodies in CSF of all patients were testing positive, while in serum were 6 cases.CSF-IgA in 7 cases were increased.The brain MRI indicated abnormal signals in temporal lobe, hippocampus in 3 patients.The EEG showed slowing wave abnormal in 5 patients.All patients were treated with combined first-line immunomodulatory therapies with steroids, intravenous immunoglobulin, or plasma exchange. Five patients were fullly recoveried, 4 patients were improved with residual symptoms. Conclusions Severe anti-NMDAR encephalitis may present progress quickly mental behavior change, epilepsy, and disturbance of consciousness, movement disorders, autonomic nerve dysfunction.Which accompanied with tumor is rare.Most patients with active immunotherapy can get good prognosis.

Objective To analyze the clinical features and prognosis in adult Chinese patients with anti-γ-aminobutyric acid B receptor (GABA-BR) encephalitis.Methods We reviewed the clinical manifestations,cerebrospinal fluid (CSF) examinations,brain magnetic resonance imaging and prognosis of 12 patients who were diagnosed as anti-GABA-BR encephalitis in Capital Medical University Xuanwu Hospital from March 2013 to December 2015.Results The major clinical features of anti-GABA-BR encephalitis patients included seizures (12/12),cognitive disorder (10/12),psychiatric symptoms (10/12),sleep disorders (3/12),visual hallucination (2/12),involuntary movements (2/12),decreased consciousness (3/12),cerebellar signs (2/12),fever (2/12).GABA-BR-antibody was positive in CSF and serum of all the patients.Electroencephalogram revealed epileptic discharges in 4/12 patients.Brain MRI showed abnormal signal in up to 9/12 patients,located in the hippocampus,temporal lobes,thalamus and periventricular area.PET or SPECT indicated hypometabolism in 5/6 patients.After the average of fourteen months follow-up,9/12 patients had good prognosis,3 patients did not.Of 3 patients with poor outcome,2 had small cell lung cancer.Conclusions The predominant clinical features of the anti-GABA-BR encephalitis are seizures,cognitive disorder and psychiatric symptoms.The lesions are not only located in limbic system.Early diagnosis and immune modulation may provide a good outcome.