Neurosyphilis with positive anti-N-methyl-D-aspartate receptor antibody: a case report.

A case of neurosyphilis with a positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody was reported. A 54-year-old man who presented with acute memory deficits was admitted to our hospital. Acute ischemic stroke (AIS) was initially considered, and he was prescribed intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). However, the intermittent onset of episodic memory and orientation disorder still occurred. No diffusion restriction was indicated by magnetic resonance imaging (MRI), and subclinical seizures were frequently found by electroencephalogram (EEG). Rapid plasma reagin (RPR) test of serum showed positive results for syphilis. Analysis of cerebrospinal fluid (CSF) revealed elevated leukocyte count and protein level. RPR test, Treponema pallidum particle agglutination (TPPA) assay, and Treponema pallidum antibody (TP-Ab) in CSF showed positive results, and the anti-NMDAR antibodies were positive in CSF and serum. Finally, the patient was diagnosed with neurosyphilis with a positive anti-NMDAR antibody. The clinical symptoms were improved, and the leukocyte count in CSF was reduced after treatment with intravenous penicillin G and levetiracetam. This case suggests that in cases with positive results for neurosyphilis and NMDAR antibodies, the proper treatment has to be decided based on all of the available clinical and diagnostic testing data.

Clinical, myopathological and imaging features of pediatric anti-3-hydroxy-3-methylglutaryl- coenzyme A reductase myopathy / 中华神经科杂志

Objective:To determine the clinical, pathological and imaging phenotypes of pediatric patients with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) myopathy to explore its diagnostic strategies.Methods:The clinical features of 10 pediatric patients with anti-HMGCR myopathy in the Department of Neurology, Peking University First Hospital from July 2014 to July 2021 were collected. Muscle biopsies were performed in all patients, with histological, enzymatic histochemical and immunohistochemical staining.Results:The male to female ratio was 6∶4, the age of onset was 3-16 (8.3±3.7) years, 2 cases had subacute onset, and 8 cases experienced chronic progressive onset. All patients presented with neck and proximal muscular weakness of all limbs. Skin rash was observed in 2 cases. Serum creatine kinase was 998-27 981 U/L. The electromyography results were available from 6 cases, who experienced myogenic changes. The muscle magnetic resonance imaging was performed in 5 cases and revealed muscle edema predominantly in posterior compartment of thigh, with mild fatty infiltrate in 2 cases. An initial diagnosis was limb-girdle muscular dystrophy in 7 cases, but with subsequently negative genetic testing. Muscle biopsies revealed scattered necrotic fibers and regenerating fibers, complement deposition in sarcolemma basement-membrane areas of non-necrotic fibers and a few of lymphocyte infiltrate in all specimens. Moreover, a high frequency of major histocompatibility complex Ⅰ expression in muscle fibers was observed in 9 cases, proliferation of connective tissue of endomysium in 8 cases, muscle fiber hypertrophy in 4 cases and vacuoles in 2 cases.Conclusions:Pediatric anti-HMGCR myopathy is frequently misdiagnosed as muscular dystrophy. Systematic consideration of anti-HMGCR myopathy and testing for myositis specific antibody in children with genetically unconfirmed muscular dystrophy may help the differential diagnosis.

Comparision of the effect between Mammotome assisted minimally invasive atherectomy and traditional surgery in treatment of youth giant breast fibroadenoma / 中华内分泌外科杂志

Objective To compare the effect between Mammotome minimally invasive surgery and traditional surgery in resection of youth giant breast fibroadenoma (YGBF).Methods We randomly selected 73 patients who had YGBF and already accepted surgical treatment in our hospital from Jul.2009 to Jan.2016.The 75 patients recruited from screening programmes were alloted to either treatment according to their choice (37 cases in MS and 38 cases in traditional surgery).The median follow-up was 18 months (from 6 to 36 months).Comparative analysis was done between the two groups in operation time,incision healing time,incision length,intraoperative bleeding,wound infection,subcutaneous hematoma,residual tumor,breast deformation,scar size,and patient satisfaction degree.Results There was no statisticaly significant difference betwen these two groups in operation time,intraoperative blood loss,incision infection,subcutaneous hematoma,or residual tumor (P＞0.05),however,MS group was superior to traditional surgery group in the incision healing time,incision length,breast deformation,scar size and postoperative satisfaction degree,and the difference was statistically significant(P＜ 0.05).Conclusion The advantage of Mammotome minimally invasive operation auxiliary for YGBF is obvious,such as fast wound healing,small incision,infection rate,small breast without deformation and scar etc.,also higher satisfaction degree to the treatment,which is regarded as the preferred surgical treatment for YGBF patients.

Clinical differences between early-and late-onset myasthenia / 中华老年医学杂志

Objective To explore the clinical differences between patients with early-onset myasthenia gravis (EOMG)and those with late-onset myasthenia gravis(LOMG).Methods This was a retrospective study enrolling 157 MG patients.Based on the age of onset,patients were divided into the EOMG group(n=85)and the LOMG group(n =72).The groups were compared on clinical characteristics,including clinical manifestations,MG classification,electrophysiological findings on repetitive nerve stimulation(RNS),single fiber electromyography(SFEMG),levels of antibody against acetylcholine receptors(Ach-R Ab),antibody to muscle-specific kinase(MuSK Ab),titin antibody(Titin Ab),ryanodine receptor antibody(RyR Ab),thyroid function,thymectomy,thymus pathology and responses to treatment.Results The mean ages of onset were markedly different [(40.9 ± 9.7) years vs.(62.0 ± 12.2) years,P＜ 0.05] between the EOMG and LOMG groups.The LOMG group was associated with a significantly higher rate of the ocular form(50.0 ％,n=36 vs.32.9％,n=28,P＜0.05),a lower rate of the general form(50.0％,n=36 vs.67.1％,n=57,P＜0.05),and an increased risk of bulbar involvement(41.7％ n=30 vs.23.5％,n=20,P＜0.05)than those in the EOMG group.There was no significant difference in positive rates of RNAS and SFEMG,and levels of AChR Ab,MuSK Ab and double serum negative(DSN)MG between the groups (P＞0.05).Moreover,patients in the EOMG group were more likely to have abnormal thyroid function and higher percentages of receiving steroids,tacrolimus,plasma exchange therapy,and thymectomy (P＜ 0.05).Conclusions The clinical profiles of LOMG are different from those of EOMG in clinical manifestations,thyroid function,thymectomy frequency,striational antibody levels and disease-modifying drug options.

An analysis and literature review of two cases of autoimmune encephalitis with GABAB receptor antibodies / 中华内科杂志

Autoimmune encephalitis with GABAB receptor antibodies has been rarely reported.Two cases of GABAB receptor antibodies encephalitis were presented here.Epilepsy was the onset symptom,followed by declined consciousness and frequent seizures.Fever was presented in the whole course of the disease.Myorhythmia of the two hands and pilomotor seizures were shown in the later course of the disease.No specificity was demonstrated in electroencephalograms and magnetic resonance imaging.Sensitive response was shown to the first-line immunotherapy.

Clinical features and management of postural tachycardia syndrome in children: a single-center experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of postural tachycardia syndrome (POTS) has been increasing in children and adolescents, while clinical characteristics of POTS in the pediatric population are not fully understood.</p><p><b>METHODS</b>An observational study was performed in 150 pediatric patients aged between 5 and 18 years who underwent head-up tilt test (HUTT) with the diagnosis of POTS at Peking University First Hospital from March 2008 to August 2013. Demographic data, clinical presentation, autonomic parameters, laboratory findings, and treatments were recorded.</p><p><b>RESULTS</b>POTS in children commonly occurred in the age of 7-14 years. Dizziness (84.00%) was the most common symptom, followed by weakness (72.00%) and orthostatic syncope (62.67%). Positive family history of orthostatic intolerance (OI) was found in 24.64% of children with POTS. And 33.09% of them had preceding infection history as precipitating events. Ten percent of them suffered from orthostatic hypertension. Hyperadrenergic status was documented in 51.28% of 39 patients who were tested for the standing norepinephrine levels. More than half of POTS patients, with 24-hour urinary sodium level <124 mmol/24 hours, were suitable for treatment of salt supplementation. At least 25.74% of POTS patients were of positive acetylcholine receptor (AChR) antibody. Low iron storage in children with POTS was relatively rare. Most patients responded well to treatments, 43.51% of patients recovered, while 7.63% of them had relapse after symptoms disappeared.</p><p><b>CONCLUSIONS</b>POTS is a relatively common condition with complex pathophysiology and heterogeneous clinical manifestation. A comprehensive therapeutic regimen is recommended for the treatment.</p>

An analysis of stroke subtypes and influencing factors in different regions of China / 中华内科杂志

Objective To analyze the stroke subtypes and influencing factors in four largest economic regions of China.Methods We analyzed the investigation data of QUEST(Quality Evaluation of Stroke Care and Treatment)study conducted in 2006 which included 62 hospitals in a national scale.According to the concept of four economic regions designed by the Development Research Center of the State Council,we performed the univariate and multivariate analysis for the stroke subtypes and its related risk factors in the different economic regions.Results There were 3362(73.5％)ischemic stroke patients and 1214(26.5％)hemorrhagic stroke patients among the total 4576 first-ever stroke patients.Comparison of stroke subtypes in the four different economic regions was statistically significant(P ＜ 0.001),with a percentage of 80.8％ ischemic stroke patients in the northeastern region,78.9％ in the eastern region,68.3％ in the central region and 67.0％ in the western region.The comparisons of risk factors such as history of hypertension,diabetes,hyperlipidaemia,coronary artery event,atrial fibrillation,and overweight in the four different economic regions were also statistically significant(P ＜0.05).Conclusions The subtypes of first-ever stroke vary in the four largest economic regions with a highest proportion of ischemic stroke in the northeastern region and relatively high proportion of hemorrhagic stroke in the central and western economic regions.There are also discrepancies of stroke risk factors in the different economic regions.

Myopathy with antibodies to the signal recognition particle: report of 8 cases / 中华风湿病学杂志

ObjectiveWe report the clinical and pathological features of 8 Chinese myopathy patients with antibodies to the signal recognition particle(SRP).MethodsSerum myositis antibody profiles were tested with immunoblotting.Muscle biopsies were performed for histological,enzyme histochemical and immunohistochemical stainings.The first antibody in the immunohistochemical staining was mouse anti-human monoclonal antibodies including CD8,CD20,CD68,MHC- Ⅰ and CD31.ResultsEight cases showed stark positive of anti SRP antibody,3 of them with positive anti Ro-52 antibody.The muscle biopsies showed necrotic and regenerative muscle fibers associated with infiltration of macrophage,but scattered T lymphocytes in 2 patients.Two of them presented with fiber hypertrophy and proliferation of connective tissue.There were some fibers with positive MHC-Ⅰexpression.Capillaries were almost normal.Conclusion The muscle weakness of myopathy with antibodies to SRP presents as a chronic progressive course and could associate with lung involvement.Fiber necrosis and regeneration are the main myopathological features,which can mimic muscular dystrophy in some cases.

Balloon-assisted catheter directed thrombolysis for acute lower extremity deep vein thrombosis / 中华放射学杂志

Objective To investigate the efficacy and safety of balloon-assisted catheter directed thrombolysis (CDT) for acute lower extremity deep vein thrombosis (DVT).Methods From September 2008 to February 2011,94 patients with acute lower extremity DVT were admitted.The cases in early stage were treated by CDT (Group A,n =50),and the cases in late stage were treated by balloon-assisted CDT ( Group B,n =44).The clinical data of these patients were retrospectively analyzed.The circumference difference between normal and affected limbs,scores of venous patency,and rates of venous patency were recorded for judging the efficacy.The total dose of urokinase and retention time of infusion catheter was compared between the two groups.The incidence of pulmonary embolism and bleeding were used to judge the safety of treatment.The venous patency was followed up by ultrasound or/and venography.Measurement data with normal distribution was described by mean + standard,and was analyzed using T test.Measurement data with non-normal distribution was described by M ( QL,QU ),QL =P25,QU =P75,and was analyzed using Wilcoxon' s test.Categorical variable data was analyzed using Chi-Square test Results The prior treatment circunfference difference between normal and affectéd limbs were (5.37 ±1.97) cm (thigh) & (4.14 ± 1.57) cm (calf) in Group A and (5.41±2.22) cm (thigh) & (4.05 ±1.61) cm (calf) in Group B ; and the difference between the groups was insignificant ( thigh:t =- 0.113,P=0.910; calf:t =0.288,P =0.774).The post treatment correspondences were:(2.96 ± 1.10) cm (thigh) & ( 1.93 ± 0.84 ) cm (calf) in Group A and ( 1.78 ± 1.40) cm ( thigh ) & ( 1.41± 1.17 ) cm (calf) in Group B; the difference between the groups was significant (thigh:t =4.66,P ＜0.0001; calf:t =2.548,P =0.012 ).The prior treatment score of venous patency was 9 (8,10) in Group A and 8.3(7,10) in Group B without significant difference (Z =- 1.5172,P =0.1292).The post treatment score of venous patency was 3.5 ( 2,5 ) in Group A and 0 ( 0,1) in Group B with significant difference ( Z =-5.7702,P ＜0.01).The rate of venous patency after the treatment was 55.0％ (42.3％,72.4％ ) in Group A and 100％ (88.5％,100％ ) in Group B,with significant difference ( Z =4.9148,P ＜ 0.01).The total dose of urokinase used in the treatment was 5.950 ( 5.525,7.225 ) × 106U in Group A and 4.100 (3.600,5.050) × 106U in Group B with significant difference (Z =-6.0133,P ＜ 0.01).The retention time of perfusion catheter was 10 (9,12) d in Group A and 6 (5,7) d in Group B with significant difference ( Z =- 8.0358,P ＜ 0.01).No symptomatic pulmonary embolism occurred in both groups during the treatment and follow-up period.The rate of bleeding complication was 38.0％ (19/50) in Group A and 22.3％ (10/44) in Group B,without significant difference (x2 =2.5590,P =0.1097 ).The removal rate of optional filter was 88.37％ (38/43) in Group A and 100％ (39/39) in Group B,with significant difference ( x2 =4.829,P =0.028 ).The rate of venous patency at the last follow-up point was 50.0％ (44.4％,59.2％ ) in Group A,and 95.4％ (83.6％,100％ ) in Group B,with significant difference (Z =- 3.2721,P =0.0011).Conclusions Balloon-assisted CDT was a promising treatment for acute lower-extremity DVT.It improved the effect of thrombolysis and reduced the dosage of urokinase,and did not increase the risk of pulmonary embolism.

Levels of Th1 and Th2 cytokines in elderly patients with eczema / 中华老年医学杂志

Objective To investigate the serum levels of Th1 and Th2 cytokines and explore its roles in development and clinical features in the elderly patients with eczema. Methods The serum levels of interleukin-2(IL-2),interleukin 4(IL-4),interleukin-10(IL-10),interleukin-12(IL-12) and tumor necrosis factor alpha (TNF-α) were derected in 50 elderly patients with eczema and 34 healthy elderly as control by enzyme-linked immunosorbent assay (ELISA). The above cytokines were compared between acute and chronic,generalized and localized eczema. Results The serum levels of IL-2 [(16.03±0.47)vs.(15.72±0.33) μg/L],IL-4[(14.04±0.56) vs.(13.56±0.16) μg/L],IL-10 [(33.01±5.40) vs.(29.49± 1.07) μg/L],IL-12 [(39.32± 3.54) vs.(37.93± 1.17) μg/L]and TNF-α [(27.33±0.72) vs.(26.38±0.48) μg/L] were higher in elderly eczema than in control (t/t'=3.55,5.74,4.49,2.58,6.69,all P＜0.05).The serum levels of all cytokines tested in acute eczema(t/t'=3.59,4.68,3.35,2.00,6.44,all P＜0.05),the levels of IL2,IL-4,IL-10 and TNF-α t'=2.46,5.50,3.83,3.10,P＜0.05,but not IL-12 (t'=1.77,P＜0.05) inchronic elderly eczema were increased as compared with control ( P ＜0.05).No significant difference was found in cytokines levels between acute and chronic eczema (P＞0.05)as well as between generalized and localized eczema(t=0.18,5.74,4.49,0.91,0.25,1.11,P＞0.05). Conclusions Changes of Th1 and Th2 cytokines may play some role in the pathogenesis of elderly eczema,but not characterized by clinical types of eczema.

Correlation among Thromboxane B2, Oxidized Low Density Lipoprotein, Lipoprotein(a), and Homocysteine in Patients with Cerebral Infarction / 中国康复理论与实践

@#ObjectiveTo study the relevant pathogenic factors, Thromboxane B2 (TXB2), oxidized low density lipoprotein (OxLDL), lipoprotein(a) (Lp(a)), and homocysteine (Hcy), in patients with cerebral infarction and the correlation among them. Methods205 patients and 40 health persons (the control) were measured with the plasma TXB2, 6-keto-prostaglandin F1α (PGF1α) and TXB2/6-keto-PGF1α (T/6-K), OxLDL, Lp(a), Hcy within 24 h. Results and ConclusionThe levels of plasma TXB2, T/6-K，OxLDL, Lp(a), and Hcy significantly increased compared with the controls (P<0.01). OxLDL was correlated with Lp(a); TXB2 was correlated with T/6-K and Hcy; T/6-K was correlated with OxLDL, Lp（a）.

An in vitro study on ultrasound-enhanced urokinase-mediated thrombolysis / 中华神经科杂志

Objective To evaluate whether therapeutic ultrasound, applied alone or with urokinase, may have a thrombolytic effect on blood clots in vitro, and the other factors influencing the urokinase-mediated thrombolysis. Methods Experiments were carried out in an in vitro blood clot model.The blood clots were divided into four groups as physiological solution group(NS), urokinase group(UK),physiological solution plus ultrasound group(NS + US), urokinase group plus ultrasound group(UK + US).After intervention of one hour in static 37 ℃ water bath, each group of blood clots was weighed. After that,the weight loss and thrombolysis rate of the blood clots in each group were calculated. To observe the impact of the age of the blood clots on urokinase-mediated thrombolysis rate, the thrombolysis rate of eight time points 3, 4, 5, 6, 7, 8, 9, 10 hours was tested. The time was determined from the blood drawn from the body to the initiation of thrombolysis test. Results In terms of thrombolysis rate, there was significant difference between UK group and UK + US group(LSD-t 12. 1, P ＜ 0.01), with a thrombolysis rate 29. 3% ±8. 2% and 37. 5% ±7. 9%, respectively. However, the difference of thrombolysis rate between NS group and NS + US group with a thrombolysis rate 13. 4% ±4. 4% and 14. 5% ± 5.4%, respectively,was not statistically significant with a P value of 0. 08(LSD-t 1.8). The age of the blood clots had a negative correlation to the thrombolysis rate to some extent. Conclusion Therapeutic ultrasound has a significant effect on thrombolysis in combination with urokinase rather than used alone. To a certain extent,the thrombolysis rate decreases with the age of blood clot.

Dynamic Analysis for Level of Plasma TXB2,6-keto-PGF1α and TXB2/6-keto-PGF1α of Patients with Acute Cerebral Infarction and Its Clinic Significance / 中国康复理论与实践

@#Objective To assess the level of plasma thromboxane B2(TXB2),6-keto-prostaglandin F1α(6-keto-PGF1α) of patients with acute cerebral infarction,so as to know the changes of platelet function on acute cerebral vascular diseases.MethodsThe level of plasma TXB2,6-keto-PGF1α and TXB2/6-keto-PGF1α(T/6-K) of 205 patients with acute cerebral infarction were measured within 24 hours and on the 7th day and 14th day,and were compared with the normal controls(n=40).ResultsThe levels of plasma TXB2,6-keto-PGF1α of patients within 24 hours,on the 7th day and 14th day were significantly higher than those in the normal controls(P<0.01).The level of plasma TXB2 was the highest on the 7th day and decreased on 14th day.The level of plasma 6-keto-PGF1α was the highest on the 14th day.T/6-K was higher than those in the normal controls within 24 hours and on the 7th day;it was highest on the 7th day and decreased on 14th day to level of the normal controls(P>0.05).ConclusionThe determine on levels of plasma TXB2,6-keto-PGF1α has important significance for knowing the changes of platelet function on acute cerebral infarction.The balance between TXB2 and 6-keto-PGF1α is important in keeping the blood smoothly.

Dynamic Analysis for Level of Plasma TXB2,6-keto-PGF1α and TXB2/6-keto-PGF1α of Patients with Acute Cerebral Infarction and Its Clinic Significance / 中国康复理论与实践

@#Objective To assess the level of plasma thromboxane B2(TXB2),6-keto-prostaglandin F1α(6-keto-PGF1α) of patients with acute cerebral infarction,so as to know the changes of platelet function on acute cerebral vascular diseases.MethodsThe level of plasma TXB2,6-keto-PGF1α and TXB2/6-keto-PGF1α(T/6-K) of 205 patients with acute cerebral infarction were measured within 24 hours and on the 7th day and 14th day,and were compared with the normal controls(n=40).ResultsThe levels of plasma TXB2,6-keto-PGF1α of patients within 24 hours,on the 7th day and 14th day were significantly higher than those in the normal controls(P<0.01).The level of plasma TXB2 was the highest on the 7th day and decreased on 14th day.The level of plasma 6-keto-PGF1α was the highest on the 14th day.T/6-K was higher than those in the normal controls within 24 hours and on the 7th day;it was highest on the 7th day and decreased on 14th day to level of the normal controls(P>0.05).ConclusionThe determine on levels of plasma TXB2,6-keto-PGF1α has important significance for knowing the changes of platelet function on acute cerebral infarction.The balance between TXB2 and 6-keto-PGF1α is important in keeping the blood smoothly.

Clinical Significance of Oligoclonal Bands and IgG Index for Multiple Sclerosis / 中国康复理论与实践

@#Objective To study the positive rates of oligoclonal bands(OCB)and the IgG index in patients with multiple sclerosis(MS)and in other nervous system disorders(OND).Methods Cerebrospinal fluid(CSF)and serum were collected from 54 patients with MS,271 patients with OND including 62 patients with infections of central nervous system and 209 patients with non-infections.The OCB and IgG index of CSF and serum were detected.Results The positive rate of OCB was 35.2% in MS,8.9% in OND(P<0.05),in which 24.2% in infections of central nervous system(P>0.05),4.5% in non-infections of central nervous system.The positive rate of IgG index was 83.3% in MS,78.2% in OND(P>0.05).Conclusion OCB is helpful to diagnose MS if infection diseases have be excluded,while IgG index can be referenced.

Value of anti-myelin basic protein antibody in patients with multiple sclerosis / 中国康复理论与实践

@#ObjectiveTo analyze the clinical value of anti-myelin basic protein (MBP) antibody in multiple sclerosis (MS).MethodsDetect the anti-MBP antibody in serum of 56 patients with MS, 30 patients with other neurological diseases (OND)and 36 normal control(NC).ResultsThe positive rate were 78.6% of MS, 50% of OND. There was significant difference amonge MS, OND and NC.ConclusionAnti-MBP antibody detection maybe provided evidence for the diagnosis and therapy of MS.

Serum antibody to Campylobacter jejuni(CJ) in Guillain-Barre Syndrome(GBS) patients and its significance / 中国免疫学杂志

Objective:To detect serum antibody to CJ in GBS patients with LPS purified from CJ strains (CJ LPS) and total CJ constituents (CJ T) as antigens and to deduce whether LPS is surely the epitope of CJ in the induction of CJ antibodies from the difference between the positive rates of both the two assays with CJ LPS and CJ T and from the concordance rates of the positive cases Methods:Sera from 81 GBS patients, 34 patients with other neurological diseases (OND) and 63 normal controls (NC) were tested with CJ LPS and CJ T by indirect ELISA method CJ LPS was purified by phenol water extraction method from 15 CJ strains of various Penner serotypes, including those isolated from GBS patients CJ T was made by collecting the heat stable constituents of CJ Results:The positively infective rate of GBS were 51 9% by CJ LPS and 56 8% by CJ T antigens There is significant difference between GBS and NC in both assays, as well as OND There is no difference between the positively infective rate of GBS patients detected with the two sets of antigens and between concordance rates of the positive cases Conclusion:High incidence of GBS following CJ infection was confirmed once more, and LPS is probably one of the epitopes of CJ in the induction of CJ antibodies