Epstein-Barr virus(EBV)is a double-stranded DNA herpes virus that is universally susceptible to human populations worldwide.It mainly infects B cells and epithelial cells and has the characteristics of incubation and transformation.The innate immune response is the first line of defense against EBV.In particular, the immune response of type Ⅰ interferons and the direct cell-killing effects of innate cytotoxic lymphocyte are essential for initial control of viral infection and subsequent activation of adaptive immune responses.There is a delicate balance between innate immune response and immune escape of EBV, and the breakdown of the balance is related to the occurrence and prognosis of EBV-related diseases.A better understanding of this balance mechanism will guide the prevention and targeted therapy of EBV-related diseases.This article reviews the role of innate immune cells(epithelial cells, mononuclear/dendritic cells, NK cells, γδT cells, NKT cells)and type Ⅰ interferon in EBV infection and the immune escape mechanism of EBV.

Objective:To investigate the clinical and imaging characteristics of isolated cortical vein thrombosis (ICVT) in order to improve the understanding of this rare disease.Methods:From December 2013 to September 2019, patients with ICVT admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were collected retrospectively. Their clinical manifestations, imaging examination, treatment and prognosis were analyzed.Results:A total of 6 patients with ICVT were enrolled in the study, including 3 males and 3 females, with an average age of 37 years. The main clinical manifestations were acute seizures (5/6, 83.3%), focal neurological deficits (3/6, 50.0%), and headache (3/6, 50.0%). In the imaging examination, the direct signs of ICVT were spot sign and cord sign, and the indirect signs were cerebral lobe hemorrhage, infarction, or edema.Conclusions:Seizures, focal neurological deficits and headaches are common manifestations of ICVT. Multimodality imaging examinations are helpful for early diagnosis of the disease.

Objective:To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis (DCVT).Methods:From December 2006 to December 2019, patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively. The clinical manifestations, imaging examinations, treatment and prognosis of the patients were analyzed.Results:A total of 11 patients with DCVT were enrolled in the study, including 4 females and 7 males. Their average age of onset was 41.6 years. Their most common clinical manifestations were acute or subacute onset headache (11/11, 100%), disturbance of consciousness (5/11, 45.5%), and seizures (4/11, 36.4%). All 11 patients involved straight sinus, 9 involved the great cerebral vein, 5 involved the internal cerebral vein, and 1 involved the basilar vein. All patients were complicated with other venous sinus thrombosis, and 3 were complicated with superficial cortical venous thrombosis. Early CT plain scan (within 1 week of onset) of 8 patients (72.3%) showed high-density point sign of great cerebral vein or cord sign of straight sinus. Head MRI showed that 90.9% (10/11) of patients had brain parenchymal damage, thalamic involvement (5/11, 45.5%) was the most common, followed by deep white matter (4/11, 36.4%). One patient received urokinase interventional thrombolysis and died on the 6 th day of onset. The remaining 10 patients improved after receiving anticoagulant therapy. Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability (the modified Rankin scale score 1-3), and 6 returned to normal. Conclusions:Headache, disturbance of consciousness and seizures are common clinical manifestations of DCVT. Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved. It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan. DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase, and the outcomes were poor.

Ten patients with allergic granulomatosis with polyangiitis (AGPA) were admitted in Nanjing Drum Tower Hospital during January 2013 to August 2019, among whom 5 cases with neurologic involvement. The clinical features, laboratory findings and clinical outcome of the 5 patients were analyzed and literature review was performed. Among 5 cases of AGPA with neurologic involvement, 3 presented with peripheral neuropathy as the initial symptom, 2 had multiple mononeuropathy, 3 had distal asymmetric or symmetric polyneuropathy. All five patients had acute or subacute onset, and the symptoms of limb numbness or pain were prominent. Electrophysiological examination showed that sensory and motor conduction amplitude significantly decreased or disappeared. Eight of the 10 AGPA patients were treated with corticosteroid combined with immunosuppressants, 2 were treated with corticosteroid alone. Eight patients had good prognosis and 2 patients died. The results suggest that peripheral neuropathy is common in AGPA. When the patients present with acute or subacute onset of axonal impairment of peripheral neuropathy and elevated eosinophils, AGPA should be considered.

Through the questionnaire survey on the current situation of human research ethical management in Beijing medical and health institutions, this paper analyzed the problems existing in ethical management of Beijing medical and health institutions and put forward corresponding countermeasures and suggestions. The results showed that overall status of human research ethical management in Beijing medical and health institutions was satisfying. But the ethical management levels of different types of medical and health institutions were quite different, and medical and health institutions, health family planning administration departments and academic teams should all make corresponding contributions.

Objective:This thesis aims to construct the evaluation index system ethics management in Beijing medical institutions for application research.Method:The author applied the evaluation system which was agreed and adjusted by expert groups in four medical and health institutions.Result:After three rounds of expert groups have reached the agreement,the Evaluation Index System on Human Research Ethics Management in Beijing Medi-cal Institutions is established,which contains 6 first-class indicators,16 second-class indicators and 39 third-class indicators.The application on four medical and health institutions show that the evaluation index system is practical,operable and is of high degree of distinction.Conclusion:The evaluation index system is scientific,rea-sonable,practical and is of high degree of validity,credibility and distinction.

Objective:To understand the similarities and differences of medical ethics education between Chinese and American medical colleges and universities,grasp the advantages and disadvantages,and analyze the enlightenment of American medical ethics education to our country.Methods:We used individual interview method of qualitative research methods and conducted semi-open interview.Results:China can adjust the curriculum provision appropriately,enrich the content of medical ethics education,improve the medical ethics practice education,enrich teaching approaches and diversify examination form in medical students moral education cultivation.Conclusion:Both China and the United States attach great importance to medical professionalism education,medical ethics training and the doctor-patient relationship education.However,there are significant differences in their history,culture,religion and morality,as well as the medical systems,education on medical students and medical ethics education.Views formed in the interview provide certain reference and guidance for Chinese medical ethics education at a certain level.

Aimed at the current plight of medical students' professionalism education,such as ignoring the top -level design and the overall plan but emphasizing practice,ignoring the permeability of professional spirit but emphasizing the impartation of professional knowledge,ignoring humanities but emphasizing professional issues in curriculum setting,Capital Medical University advocated the all-dimensional education philosophy implenented by all staff through the whole process,made top-level design scientifically for medical students' professionalism education.The university strengthened professionalism through teaching,permeated professionalism through a series of educational activities,consolidated professionalism through clinical practice,and thus to strengthen the cultivation of medical students' professionalism and realize scientific education by all staff and throughout the whole process.

Objective To investigate the changes of protein and energy intakes and the z-score of weight for age in appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants with gestational age less than 34 weeks. Methods The data from 314 hospitalized premature infants ( 268 cases of AGA and 46 cases of SGA) during January 2012 to December 2014 were retrospectively collected. The intakes of protein and energy and the changes of weight within 2 weeks after birth were compared. Results Compared with AGA group, the hospital stays, durations of parenteral and enteral nutrition and total enteral nutrition, and time to achieve full dose feeding were signiifcantly longer in SGA group (P?

Objective To investigate the changes of immune function,serum procalcitonin (PCT) and C-reactive protein (CRP) in children with mycoplasma pneumoniae pneumonia (MPP),and to provide clinical evidence for immunotherapy in children with MPP.Methods A total of 126 children with MPP during their hospitalization were enrolled into lobar pneumonia group (n =42) and bronchopneumonia group (n =84),and 28 healthy children were enrolled into normal control group.The immunoglobulin(Ig),CD4+T,CD8+T,PCT and CRP of all children were determined.Results The levels of IgG,IgM and IgE of children in lobar pneumonia group and bronchopneumonia group were significantly higher than that of the normal control group (P ＜0.05),but there were no significant differences in the level of IgA between three groups (P ＞ 0.05).The levels of IgG in lobar pneumonia group were significantly higher than that of bronchopneumonia group (P ＜ 0.05),but there were no significant differences in the levels of IgM,IgE,IgA between the two groups(P ＞0.05).The ratios of CD4+T and CD4+T/CD8+T in lobar pneumonia group and bronchopneumonia group were significantly lower than that of the normal control group(P ＜ 0.05).The levels of PCT and CRP in lobar pneumonia group and bronchopneumonia group were significantly higher than that of the normal control group (P ＜ 0.05).Conclusion Humoral immunity and cellular immune dysfunction plays an important role in pathogenesis of MPP.They are important for PCT and CRP in evaluating clinical condition and immunotherapy.