Background: and Purpose: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe central nervous system disorder mediated by NMDAR antibodies that damages neurons. We investigated the correlation between cytoskeletal autoantibodies and the clinical severity in patients with anti-NMDAR encephalitis. Methods: Non-NMDAR autoantibodies were identified by screening matched cerebrospinal fluid (CSF) and the serum samples of 45 consecutive patients with anti-NMDAR encephalitis and 60 healthy individuals against N-methyl-D-aspartate receptor 1-transfected and nontransfected human embryonic kidney 293T cells. Immunocytochemistry was performed to assess antibody binding in rat brain sections and primary cortical neurons. Cell-based assays and Western blotting were applied to identify autoantibodies targeting medium neurofilaments (NFMs). We compared clinical characteristics between patients with NMDAR encephalitis who were positive and negative for anti-NFM-autoantibodies. Results: Anti-NFM autoantibodies were detected in both the serum and CSF in one patient (2%) and in the serum only in six patients (13%). No antibodies were detected in the serum of healthy controls (7/45 vs. 0/60, p=0.0016). Four of the seven patients with anti-NFM autoantibodies in serum were children (57%), and three (43%) had abnormalities in brain magnetic resonance imaging. These patients responded well to immunotherapy, and either no significant or only mild disability was observed at the last follow-up. Anti-NMDAR encephalitis did not differ with the presence of anti-NFM autoantibodies. Conclusions Anti-NFM autoantibodies may be present in patients with anti-NMDAR encephalitis, indicating underlying neuronal damage. A large cohort study is warranted to investigate the clinical differences between patients with NMDAR encephalitis according to their antiNFM antibody status.

Immunoglobulin G against myelin oligodendrocyte glycoprotein (MOG-IgG) is detectable in neuromyelitis optica spectrum disorder (NMOSD) without aquaporin-4 IgG (AQP4-IgG), but its pathogenicity remains unclear. In this study, we explored the pathogenic mechanisms of MOG-IgG in vitro and in vivo and compared them with those of AQP4-IgG. MOG-IgG-positive serum induced complement activation and cell death in human embryonic kidney (HEK)-293T cells transfected with human MOG. In C57BL/6 mice and Sprague-Dawley rats, MOG-IgG only caused lesions in the presence of complement. Interestingly, AQP4-IgG induced astroglial damage, while MOG-IgG mainly caused myelin loss. MOG-IgG also induced astrocyte damage in mouse brains in the presence of complement. Importantly, we also observed ultrastructural changes induced by MOG-IgG and AQP4-IgG. These findings suggest that MOG-IgG directly mediates cell death by activating complement in vitro and producing NMOSD-like lesions in vivo. AQP4-IgG directly targets astrocytes, while MOG-IgG mainly damages oligodendrocytes.

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators.

Objective To evaluate the therapeutic effect and safety of Kangai injection combined with Chemotherapy in treating Colorectal cancer. Methods The CNKI, Wanfang, CBM, VIP, Medline and Cochrane Library from inception to the August 17th 2017 were searched, and all the relevant journals, and the literature of RCTs were enrolled. The quality of RCTs was assessed by Jadad scores, meta-analyses were performed by Review Manager 5.3 software. Results 21 Chinese articles were enrolled, including three high quality article, and the Jadad average score is 2.7. 1 879 patients were included. The result of Meta-analyses showed that intervention could improve the quality of life [OR=3.29, 95% CI (2.53-4.27), P＜0.01]; improve the short-term effects [OR=1.79, 95% CI (1.36-2.37),P＜0.001]; reduce the gastrointestinal reactions [OR=0.36,95% CI (0.29-0.45), P＜0.01], reduce bone marrow suppression reaction [OR=0.35, 95% CI (0.27-0.44),P＜0.01]. reduce the peripheral neurotoxicity [OR=0.57, 95% CI (0.41-0.78), P＜0.01], improve the abnormal liver function [OR=0.0.41,95% CI (0.26-0.65), P＜0.01], and improve the abnormal renal function [OR=0.55,95% CI (0.31-0.98), P=0.04]. Conclusions The combination of Kangai injection and Chemotherapy in treating Colorectal cancer is better than only using chemotherapy. However, we need more high-quality RCTs to improve the research.

Objective To study the seropositive ratio of the antibody to aquporin 4 (AQP4-IgG) and myelin oligodendrocytes glycoprotein antibody(MOG-IgG)in patients with autoimmune-associated central nervous system (CNS) diseases. Meanwhile, epidemiology and clinical manifestation and diagnosis,laboratory examination and magnetic resonance imaging(MRI)of AQP4-IgG seropositive and MOG-IgG seropositive patients are described. Methods 2068 patients serum samples were collected and enrolled in the multi-center research. The methodology of cell-mediated immunofluorescence staining was used to detect serum AQP4-IgG and MOG-IgG. Clinic medical records were collected and characteristics of epidemiology and manifestation were compared. Results 681 patients were AQP4-IgG seropositive and 110 patients were MOG-IgG seropositive. The female/male ratio and age of onset of patients with AQP4-IgG seropositive(616 female and 65 male,female:male=9.50:1.00;Age of onset=41.7±14.9)were significantly higher than that of patients with MOG-IgG (57 female and 53 male, female:male=1.08:1.00, P<0.0001; Age of onset=27.0 ±17.7, P<0.0001). The optic neuritis was significantly higher in patients with AQP4-IgG seropositive and patients with MOG-IgG seropositive (38.4% vs.53.5%, P<0.05).Among patients with AQP4-IgG seropositive, 42.14% conformed the diagnostic criteria of neuromyelitis optica (NMO),which was higher than that of patients with MOG-IgG seropositive (13.64%, P<0.0001). Laboratory examination showed that there was no significant difference in cerebrospinal fluid protein levels between patients with AQP4-IgG seropositive and those with MOG-IgG seropositive.MRI imaging suggested that AQP4-IgG positive patients were more common in cervical thoracic spinal cord lesions, while MOG-IgG positive patients were more involved in thoracolumbar spinal cord. The study also found that these two groups of patients could be comorbid with other autoimmune antibodies. Conclusions This multi-center research has revealed that patients with AQP4-IgG seropositive and those with MOG-IgG seropositive display differences in epidemiology,clinic manifestations and diagnosis,laboratory examination and MRI imaging. AQP4-IgG and MOG IgG auto-antibody detection are necessary for clinic diagnosis and differential diagnosis.

Objective To evaluate the diagnostic value of combined detection of serum autoantibodies against against p53 and Bmi-1 in lung cancer (LC).Methods Serum levels of autoantibodies against p53 and Bmi-1 were measured by enzyme-linked immunosorbent assay (ELISA) in 92 patients with LC and 80 normal controls.The combined diagnostic value was evaluated with the receiver operating characteristic (ROC) curve.Results The serum levels of autoantibodies against p53 and Bmi-1 were significantly higher in LC than in normal controls (0.438 ±0.705 vs 0.045 ±0.035,Z =-7.667,P ＜0.01;0.117±0.061 vs 0.068 ±0.031,Z =-7.179,P ＜0.01).The levels of autoantibodies against p53 and Bmi-1 were not related to age,gender,pathological classification,lymph node status or tumor-node-metastasis (TNM) stage (P ＞ 0.05).The combined detection of two autoantibodies provided an enhanced sensitivity of 63.0％,a specificity of 91.2％ and an area under curve (AUC) of 0.881,which showed better diagnostic efficiency compared to individual autoantibodies.Conclusions Combined detection of autoantibodies against p53 and Bmi-1 shows good diagnostic value,which may aid diagnosis of LC.

Objective To explore the diagnostic value of the combined detection of serum Dickkopf-1 (DKK1 )and EB viral capsid antigen immunoglobulin A (VCA-IgA)in patients with nasopharyngeal carcinoma (NPC).Methods Serum levels of DKK1 and VCA-IgA were measured by enzyme-linked immunosorbent assay (ELISA)for the 80 patients with NPC and 65 normal controls.Receiver operating characteristic (ROC) curve was used to calculate the diagnostic value.Results The serum levels [M(QR )]of DKK1 in patients with NPC were significantly higher than those in normal controls [580.773 (429.1 46 )pg/ml vs.31 6.1 74 (252.965)pg/ml],with a significant difference (Z=4.846,P<0.000 1 ).ROC curves showed that the opti-mum diagnostic cutoff for serum DKK1 was 611.981 pg/ml,with an area under curve (AUC)of 0.734 (95%CI:0.654-0.81 5,50.0% sensitivity,96.9% specificity).Measurement of VCA-IgA demonstrated an AUC of 0.71 4 (95%CI:0.631-0.798,47.5% sensitivity,95.4% specificity).The combined detection of DKK1 and VCA-IgA demonstrated an AUC of 0.849 (95%CI:0.783-0.91 4,76.3%sensitivity,95.4%spe-cificity).For patients with early-stage NPC,the detection effect of combined detection of DKK1 and VCA-IgA was much better than that in normal controls,with a significant difference (χ2 =23.784,P <0.001 ). Conclusion Serum DKK1 has potential diagnostic value for NPC.Combined detection of DKK1 and VCA-IgA may aid the early diagnosis of NPC.

In the middle of the 20th century, the United States first proposed the medical humanities theory to campus and offered a variety of medical humanities curriculum, hoping that medical students would have a better understanding of diseases, pain, show themselves more compassion, and foster their communication skills. In recent years, the medical humanities education played a positive role in developing and improving medical students’ comprehensive ability as well as their diagnosis and treatment technology. Currently, American pays more attention to establish a unified and objective standard to evaluate the effect of medical humanities curriculum. Meanwhile, many experts give some suggestions to the medical humanities education.

Objective To evaluate the effects of ulinastatin pretreatment on cognitive dysfunction induced by chronic exposure to ketamine in immature mice.Methods Thirty-six healthy male C57BL/6 mice,aged 21 days,weighing 20-30 g,were randomly divided into 3 groups (n =12 each) using a random number table:control group (group C),ketamine group (group K),and ulinastatin pretreatment group (group U).In K and U groups,ketamine 30 mg/kg was injected intraperitoneally three times a day at 30-minute intervals for 21 consecutive days,while in group U,ulinastatin 50 000 U/kg was injected intraperitoneally at 30 min before the first injection of ketamine everyday.Cognitive function was assessed using Morris water maze and open field tests at 24 h after the last administration of ketamine.Mice in each group were sacrificed immediately after the end of the tests and hippocampi were harvested to determine the contents of interleukin-6 (IL-6),IL-1 and tumor necrosis factor-α (TNF-α) using ELISA.Results Compared with group C,the escape latency was significantly prolonged,the time spent in the original platform and in the central area for the open field was shortened,the frequency of crossing the original platform was decreased,and the contents of IL-1,IL-6,and TNF-α were increased in group K (P ＜ 0.05),while there were no significant differences in the indexes mentioned above in group U (P ＞ 0.05).Compared with group K,the escape latency was significantly shortened,the time spent in the original platform and in the central area for the open field was prolonged,the frequency of crossing the original platform was increased,and the contents of IL-1,IL-6,and TNF-α were decreased in group U (P ＜ 0.05).Conclusion Ulinastatin pretreatment can improve cognitive dysfunction induced by chronic exposure to ketamine in immature mice,and inhibition of inflammatory responses in hippocampi may be involved in the mechanism.

Objective To evaluate the effects of isoflurane anesthesia on inflammatory responses and long-term cognitive function in the hippocampi of neonatal rats .Methods Forty-six Sprague-Dawley rats of both sexes , aged 7 days ,weighing 12-17 g ,were randomly divided into 2 groups (n=23 each):control group (group C) and isoflurane anesthesia group (group I ) .In group I ,the rats were exposed to 2.5% isoflurane for 3 min to induce anesthesia and then exposed to 1.5% isoflurane for 4 h to maintain anesthesia ,while in group C the rats were only exposed to air for 4 h .Eight rats in each group were sacrificed and hippocampi were removed for determination of the levels of interleukin-6 ,interleukin-1βand tumor necrosis factor-α.Open field and Morris water maze tests were carried out three weeks later in the left rats .Results Compared with group C ,the escape latency was significantly prolonged ,the time of staying at the central region was shortened ,the time of staying at the border region was prolonged ,the total distance was reduced , and the contents of interleukin-1β and tumor necrosis factor-αwere increased in group I ( P<0.05) .Conclusion Isoflurane anesthesia results in decreased cognitive function ,which may be related to promotion of inflammatory responses in the hippocampi of neonatal rats .