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Objective:To discuss the effect of Xiaoqinglong decoction on vascular endothelin (ET) in rats pulmonary hypertension (PAH) model based on the Jiebiaokuoluo method.Methods:Sixty male SD rats were randomly divided into six groups: control group, PAH model group, positive drug group, and Xiaoqinglong decoction in the high-dose, medium-dose and low-dose groups, 10 rats in each group. The control group did not receive any treatment. The remaining groups were kept in low-pressure oxygen tanks, injections of lipopolysaccharide (LPS) at 200 μL on day 1 and day 14, respectively. The rats were smoked twice a day from day 2 to day 30 (except day 14) at 4 hours intervals. The rats were placed in a low-temperature environment for 1 hour per day, and were put into cold water to swim (for 2 weeks), while the rats were given a cold diet. After modeling, the control group and the PAH model group were given equal volumes of normal saline; the positive drug group was given bosentan (100 mg/kg); Xiaoqinglong decoction 15, 10 and 5 g/kg was given, respectively, in the high, medium and low dose groups; once daily for 30 days. The mean pulmonary artery pressure (mPAP) and right ventricle systolic pressure (RVSP) were then measured with right heart catheterization and the right ventricle hypertrophy index (RVHI) was assessed; ET-1 and nitric oxide (NO) levels were determined by radioimmunoassay.Results:Compared with the control group, the levels of mPAP, RVSP, RVHI and ET-1 were significantly increased in the PAH model group [mPAP (mmHg, 1 mmHg≈0.133 kPa): 33.20±1.04 vs. 13.20±1.03, RVSP (mmHg): 62.40±1.54 vs. 24.20±1.02, RVHI: 42.90±2.51 vs. 25.40±2.01, ET-1 (ng/L): 100.80±20.34 vs. 81.50±13.84, all P < 0.05], while NO levels were significantly decreased (mmol/L: 23.20±1.81 vs. 31.70±1.49, P < 0.05). Compared with the PAH model group, the levels of mPAP, RVSP, RVHI and ET-1 in the positive drug group and high, medium, low dose groups of Xiaoqinglong decoction were significantly decreased [mPAP (mmHg): 25.50±0.84, 26.90±0.74, 27.10±1.19, 29.10±0.75 vs. 33.20±1.04, RVSP (mmHg): 54.40±5.14, 50.10±1.67, 53.10±1.05, 56.60±1.07 vs. 62.40±1.54, RVHI: 41.10±1.19, 31.20±1.67, 31.30±1.89, 40.30±1.88 vs. 42.90±2.51, ET-1 (ng/L): 70.70±7.89, 69.90±2.92, 71.70±4.32, 73.90±5.19 vs. 100.80±20.34, all P < 0.05], while NO levels were significantly increased (mmol/L: 32.50±2.06, 34.70±1.16, 32.70±1.33, 30.10±1.19 vs. 23.20±1.81, all P < 0.05), and with the increased dose of Xiaoqinglong decoction, the change was more obvious, and the effect was better in the high-dose group. Conclusion:Xiaoqinglong decoction can reduce rats PAH by regulating ET-1 and NO levels in a dose-dependent manner.
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Objective:To analyze and summarize the clinical characteristics of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients with cerebellar ataxia.Methods:The clinical manifestations, laboratory examinations, treatment and prognosis of anti-NMDAR encephalitis patients with cerebellar ataxia diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2019 were retrospectively analyzed.Results:About 4.3% (15 cases) of a total of 347 anti-NMDAR encephalitis patients were complicated with cerebellar ataxia, of which one patient had ovarian teratoma. There were seven male cases and eight female cases, with a median age of 28 years. The average duration from the onset of encephalitis to the onset of cerebellar symptoms was 30.8 days.The average modified Rankin Scale (mRS) score was 3.73. In the acute phase, the median cerebrospinal fluid leukocyte count was 28×10 6/L. All patients received first-line immunotherapy, of which one case additionally received second-line immunotherapy with rituximab and nine patients received long-term immunotherapy with mycophenolate mofetil. The follow-up time ranged from seven to 66 months. The average mRS score of the last time was 2.73, and only six patients (6/15) had good prognosis (mRS score≤2). Conclusions:Patients with anti-NMDAR encephalitis and cerebellar ataxia are rare, and have relatively poor prognosis in terms of neurological function. Symptoms of cerebellar ataxia in anti-NMDAR encephalitis patients should be recognized in time, and standardized immunotherapy regimens and long-term immunotherapy should be adopted to improve the prognosis.
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This article reported a case of suppurative meningitis caused by Streptococcus suis infection. The patient is an old man who has been engaged in pig breeding. The common symptoms include fever, headache and disturbance of consciousness. According to the results of magnetic resonance imagine and cerebrospinal fluid examination, the patient was considered purulent meningitis caused by Streptococcus suis type 2. After treatment with penicillin anti-infection and dexamethasone inhibition of immune response, the symptoms improved significantly. Three weeks after the onset of the disease, hearing loss occurred, after six months of follow-up, serious hearing impairment was still left.
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Objective To establish a test of autoantibody-panel for the diagnosis of autoimmune cerebellitis (AC) and determine the prevalence of AC in patients with cerebellar ataxia of unknown etiology.Methods Autoantibody screening tests with indirect immunofluorescence were performed in serum and cerebrospinal fluid (CSF) samples of 400 previously'idiopathic'Chinese patients with cerebral ataxia (inpatients and outpatients in Peking Union Medical College Hospital or referred from hospitals of Beijing Encephalitis Group from 2016 to 2018).Immunotherapy was given to autoantibody positive patients and the effectiveness of immunotherapy was assessed.Detailed AC autoantibodies panel included anti-glutamate decarboxylase 65 (GAD65) antibody,anti-Tr (delta notch-like epidermal growth factor-related receptor (DNER)) antibody,anti-zinc finger protein 4 (ZIC4) antibody,anti-inositol 1,4,5-trisphosphate receptor 1 (ITPR1) antibody,anti-homer protein homolog 3 (Homer 3) antibody,anti-neurochondrin (NCDN) antibody,anti-carbonic anhydrase-related protein (CARP) antibody and anti-Purkinje cell antibody 2 (PCA2) antibody.Results Eight out of 400 (2％) ataxia patients were positive for this AC panel tests,of whom two were positive for anti-GAD65 antibody,two for anti-Tr antibody,one for anti-PCA2 antibody,one for anti-Homer 3 antibody and two were positive for serum anti-NCDN antibody.Autoantibodies against ZIC4,ITPR1 and CARP were not detected in this cohort.Two of the eight ataxia patients also presented with limbic encephalitis,and only one anti-GAD antibody patient was screened with underlying small cell lung carcinoma (SCLC).All the eight patients received immunotherapy and four experienced partial response.Conclusions Autoimmune cerebellitis is the cause of acquired cerebellar ataxia.Tests of autoantibodies associated with AC have diagnostic value for paraneoplastic and non-paraneoplastic cerebellar ataxia.Immunotherapy may yield partial response in patients with AC.
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Objective To establish a stable experimental model of vascularized composite allograft (VCA),which would facilitate us to study of the reaction and intervening measure regarding rejection reaction in the future.Methods From September,2016 to July,2017,30 healthy male New Zealand rabbits,weighted 2.5-3.0 kg each,were chosen.Their ears should be intact without defect or necrosis.All of them were randomly and eaqually divided into 2 groups:transverse amputated group and V-shaped amputated group.In situ ear replantation after the amputation was performed.Histology analysis of skin and cartilage were done through HE and TUNEL staining,in order to compare vital rate of these ears.Results Thirty rabbits underwent ear replantation,including 13 via transverse incision and 17 via V-shaped incision.In transverse group,no ear survived,and some of them encountered vein crisis gradually after operation.The survival time ranged from 1 day to 10 days.There were 2 ears survived in V-shaped group.From HE staining,it was found certain vacuolar degenerated cells within skin and cartilage in failure ears.The rates of cell necrosis and apoptosis were higher than the survived ears.Conclusion Rabbit ear replantation model is viable.However,the rabbit ear replantation model is not suitable to be used in large samples.
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Objective To report the clinical and paraclinical features of a case series with antiIgLON5 antibody related encephalopathy.Methods One hundred and fifty patients with sleep disorders and subacute or chronic onset of movement disorders,parkinsonism or bulbar palsy were included.The serum and cerebrospinal fluid specimens of these patients were screened for anti-IgLON5 antibody.The clinical and paraclinical features of patients with seropositive anti-IgLON5 antibody were summarized.Results Three patients with seropositive anti-IgLON5 antibody were identified,with one female and two males.The onset age ranged from 61 to 64 years.Case 1 presented with symptoms of involuntary movement,unsteady walk and insomnia;case 2 with symptoms of insomnia,sleep behavioral disorder,psychiatric behavior and dysphagia;case 3 with symptoms of insomnia,sleep behavioral disorder,dysarthria,and tremor.When examined by polysomnography,obstructive sleep apnea syndrome was revealed in cases 1 and 2,serious insomnia was found in cases 2 and 3,and sleep behavioral disorder was revealed in case 2.All three patients were positive for HLA-DQB1 * 0501,and cases 2 and 3 were positive for HLA-DRB1 * 1001.All three patients received immunotherapy and only one patient (case 1) responded well to immunotherapy with intravenous immunoglobulin,steroids and mycophenolate mofetil.Conclusions Anti-IgLON5-related encephalopathy is a rare disease with distinct clinical features of both autoimmune disorders and neurodegeneration disorders.These patients may benefit from immunotherapy.
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Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in antileucine-rich glioma-inactivated 1 (LGI1) encephalitis by analyzing the clinical and immunologic data of patients treated with MMF in this prospective cohort of anti-LGI1 encephalitis.Methods Patients treated with MMF for more than one year in Peking Union Medical College Hospital were included in this study.MMF was given at a dosage of 1.5-3.0 g/d in the induction period (two to four months) and 0.75-2.00 g/d in the maintenance period.All the patients were followed up regularly.Modified Rankin Scale (mRS) score evaluation,serum IgG and peripheral CD19-positive B cells,CD4-positive T cells and CD8-positive T cells testing were performed every two months.Results Fifteen patients were included in this study who received first-line immunotherapy combined with MMF.No other second-line therapy including rituximab was used.Thirteen patients responded well to MMF combined with first-line immunotherapy (a decrease in mRS score of more than 1).All 15 patients had a good outcome (i.e.,a mRS score of 0-2),including nine patients without residual symptoms (a mRS score of 0).After 12 months of MMF treatment,CD19-positive B cells were significantly decreased (median 320 (227,628) × 106/L vs 152 (105,223) × 106/L;Z=-2.028,P=0.043),while serum IgG (9.07 (6.70,11.32) g/L vs 8.35 (6.63,10.69) g/L,P=0.144)),CD4-positive T cells (1 136 (736,1 432) × 106/L vs 1 055 (802,1 072) × 106/L,P =0.866) and CD8-positive T cells (627 (413,784) × 106/L vs 568 (393,743) × 106/L,P =0.735) were not significantly changed.Three patients relapsed and were treated with additional cycle of first-line immunotherapy and increased dosage of MMF (induction dosage) resulting in remission.CD19-positive B cells were tested to be increased during the patients' relapse.No serious adverse event was noted in all these patients.Conclusions MMF is safe and effective as a long-term immunotherapy in patients with anti-LGI1 encephalitis.MMF can be used as an add-on therapy to first-line immunotherapy for autoimmune encephalitis.CD19-positive B cell count should be monitored and used as a parameter to individualize dosage of MMF.
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This paper explored factors influencing initiatives of clinical teachers in millitary medical university for training clinical undergraduates including work pressure after being transferring to civilian,work pressure,policy orientation,economic pressure,student factor and psychological factor,etc. Meanwhile,this paper explored the incentive mechanism of clinical teachers in millitary medical university for training clinical undergraduates including training and evaluating clinical teach-ing teachers, innovating evaluation criterion and creating sustainable teaching atmosphere (building examples and establishing various incentive systems). All measures taken above was mean to inspire the initiatives of clinical teaching teachers and to ensure the quality of clinical teaching.
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Case-based teaching (CBT) on the basis of treatment guidelines was carried out to develop standard medical behavior, improve learning efficiency and students' ability of solving clini-cal problems. In clinical internship teaching, guidelines for common and frequently-occurring respira-tory diseases and CBT were organically combined. Cases were carefully selected and questions were meticulously set. Guidelines were thoroughly analyzed and teaching was reasonably evaluated. There-fore, students' learning interests were initiated and learning efficiency was improved. It not only trained evidence-based medicine thinking of intern students, but also improved the teaching ability of clinical teachers.
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This article describes the progress of developing the training base and training methods for bronchoscopists at Changhai hospital in recent years,and then discusses the potential issues and solutions that might occure in the course of training,and finally explores the model and methodology to optimize the training program for Chinese bronchosocpists.
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This paper introduces interns shoule know the importance of interpersonal relationship in clinic practice thoroughly and good interpersonal relationship requires the teacher and medical students to make efforts together.
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Diagnostics is the bridge from basic medicine to clinical medicine.For the students contacting the clinic for the first time,we take measures to cultivate the consciousness of showing love to patients and dedicating yourself to work.It is beneficial to cultivate the students'ability in clinical practice.
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In order to accelerate the pace of teaching reform,our school explores the tutorial system of undergraduate course this year,this article emphasize the necessity and beneficial effects of this system in clinical practice.
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Doctor-patient communication skills are one of the seven lowest requirements of global medical education.From the characteristic of doctor-patient communication in general medical practice,the paper explores the importance of strengthening the training of doctor-patient communication capability and analyzes the training methods.