Constructed wetlands for wastewater treatment in cold climate - A review.

Constructed wetlands (CWs) have been successfully used for treating various wastewaters for decades and have been identified as a sustainable wastewater management option worldwide. However, the application of CW for wastewater treatment in frigid climate presents special challenges. Wetland treatment of wastewater relies largely on biological processes, and reliable treatment is often a function of climate conditions. To date, the rate of adoption of wetland technology for wastewater treatment in cold regions has been slow and there are relatively few published reports on CW applications in cold climate. This paper therefore highlights the practice and applications of treatment wetlands in cold climate. A comprehensive review of the effectiveness of contaminant removal in different wetland systems including: (1) free water surface (FWS) CWs; (2) subsurface flow (SSF) CWs; and (3) hybrid wetland systems, is presented. The emphasis of this review is also placed on the influence of cold weather conditions on the removal efficacies of different contaminants. The strategies of wetland design and operation for performance intensification, such as the presence of plant, operational mode, effluent recirculation, artificial aeration and in-series design, which are crucial to achieve the sustainable treatment performance in cold climate, are also discussed. This study is conducive to further research for the understanding of CW design and treatment performance in cold climate.

Characterization and biodegradability of sludge from a high rate A-stage contact tank and B-stage membrane bioreactor of a pilot-scale AB system treating municipal wastewaters.

In light of global warming mitigation efforts, increasing sludge disposal costs, and need for reduction in the carbon footprint of wastewater treatment plants, innovation in treatment technology has been tailored towards energy self-sufficiency. The AB process is a promising technology for achieving maximal energy recovery from wastewaters with minimum energy expenditure and therefore inherently reducing excess sludge production. Characterization of this novel sludge and its comparison with the more conventional B-stage sludge are necessary for a deeper understanding of AB treatment process design. This paper presents a case study of a pilot-scale AB system treating municipal wastewaters as well as a bio- (biochemical methane potential and adenosine tri-phosphate analysis) and physico-chemical properties (chemical oxygen demand, sludge volume index, dewaterability, calorific value, zeta potential and particle size distribution) comparison of the organic-rich A-stage against the B-stage activated sludge. Compared to the B-sludge, the A-sludge yielded 1.4 to 4.9 times more methane throughout the 62-week operation.

Application of constructed wetlands for wastewater treatment in tropical and subtropical regions (2000-2013).

Constructed wetlands (CWs) have been successfully used for treating various wastewaters for decades and have been identified as a sustainable wastewater management option for developing countries. With the goal of promoting sustainable engineered systems that support human well-being but are also compatible with sustaining natural (environmental) systems, the application of CWs has become more relevant. Such application is especially significant for developing countries with tropical climates, which are very conducive to higher biological activity and productivity, resulting in higher treatment efficiencies compared to those in temperate climates. This paper therefore highlights the practice, applications, and research of treatment wetlands under tropical and subtropical conditions since 2000. In the present review, removal of biochemical oxygen demand (BOD) and total suspended solid (TSS) was shown to be very efficient and consistent across all types of treatment wetlands. Hybrid systems appeared more efficient in the removal of total suspended solid (TSS) (91.3%), chemical oxygen demand (COD) (84.3%), and nitrogen (i.e., 80.7% for ammonium (NH)4-N, 80.8% for nitrate (NO)3-N, and 75.4% for total nitrogen (TN)) as compared to other wetland systems. Vertical subsurface flow (VSSF) CWs removed TSS (84.9%), BOD (87.6%), and nitrogen (i.e., 66.2% for NH4-N, 73.3% for NO3-N, and 53.3% for TN) more efficiently than horizontal subsurface flow (HSSF) CWs, while HSSF CWs (69.8%) showed better total phosphorus (TP) removal compared to VSSF CWs (60.1%). Floating treatment wetlands (FTWs) showed comparable removal efficiencies for BOD (70.7%), NH4-N (63.6%), and TP (44.8%) to free water surface (FWS) CW systems.

[Research achievements on biological activities of calycosin].

Calycosin, which is a kind of typical phytoestrogen, can bind with estrogen receptor and produce estrogen-like effects. Calycosin were reported to have antioxidant, anti-osteoporosis, anti-tumor and immunomodulating activities. This review covers biological activities and its mechanism of calycosin. It will provide a useful reference for clinical research and rational utilization of monomericompound.

Exogenous IFN-beta regulates the RANKL-c-Fos-IFN-beta signaling pathway in the collagen antibody-induced arthritis model.

BACKGROUND: Although a variety of drugs have been used to treat the symptoms of rheumatoid arthritis (RA), none of them are able to cure the disease. Interferon ß (IFN-ß) has pleiotropic effects on RA, but whether it can be used to treat RA remains globally controversial. Thus, in this study we tested the effects of IFN-ß on RA patients and on collagen antibody-induced arthritis (CAIA) model mice. METHODS: The cytokine and auto-antibody expression profiles in the serum and synovial fluid (SF) from RA patients were assessed using enzyme-linked immunosorbent assay (ELISA) and compared with the results from osteoarthritis (OA) patients. Exogenous IFN-ß was administered to RA patients and CAIA model mice, and the therapeutic effects were evaluated. Endogenous IFN-ß expression in the joint bones of CAIA model mice was evaluated by quantitative real-time PCR (qRT-PCR). The effects of exogenous IFN-ß on CAIA model mice were assessed using a clinical scoring system, hematoxylin eosin and safranin-O with fast green counterstain histology, molybdenum target X-ray, and tartrate-resistant acid phosphatase (TRAP) staining. The RANKL-RANK signaling pathway was analyzed using qRT-PCR. The RAW 264.7 cell line was differentiated into osteoclasts with RANKL stimulation and then treated with exogenous IFN-ß. RESULTS: The expression of inflammatory cytokines (IFN-γ, IL-17, MMP-3, and RANKL) and auto-antibodies (CII antibodies, RF-IgM, and anti-CCP/GPI) were significantly higher in RA compared with OA patients. After IFN-ß intervention, some clinical symptoms in RA patients were partially alleviated, and the expression of IFN-γ, IL-17, MMP-3, and OPG) returned to normal levels. In the CAIA model, the expression of endogenous IFN-ß in the joint bones was decreased. After IFN-ß administration, the arthritis scores were decreased; synovial inflammation, cartilage, and bone destruction were clearly attenuated; and the expression of c-Fos and NFATc1 were reduced, while RANKL and TRAF6 expression was unchanged. In addition, exogenous IFN-ß directly inhibited RANKL-induced osteoclastogenesis. CONCLUSIONS: Exogenous IFN-ß administration immunomodulates CAIA, may reduce joint inflammation and, perhaps more importantly, bone destruction by inhibiting the RANKL-c-Fos signaling pathway. Exogenous IFN-ß intervention should be selectively used on RA patients because it may only be useful for RA patients with low endogenous IFN-ß expression.

Increased expression of miR-222 is associated with poor prognosis in bladder cancer.

BACKGROUND: MicroRNA-222 (miR-222) has been shown to play a potential oncogenic role in bladder cancer. The aim of this study was to evaluate the expression of miR-222 in bladder cancer and its potential relevance to clinicopathological characteristics and patient survival. METHODS: Surgical specimens of cancer tissue and adjacent normal tissue were obtained from 97 patients with bladder cancer. The relative expression levels of miR-222 in the cancer and the normal adjacent tissue were measured by quantitative reverse-transcriptase PCR. We analyzed their correlation with clinicopathological parameters and prognostic value. RESULTS: The expression level of miR-222 was significantly higher in tumor tissues than in corresponding non-cancerous tissues (5.46 ± 1.45 versus 1.92 ± 0.65, P < 0.0001), and a high expression of miR-222 was found to be significantly associated with tumor grade (P = 0.003) and tumor stage (P = 0.005). The miR-222 expression level was classified as high or low in relation to the median value (cutoff value = 5.15). Kaplan-Meier analysis showed that patients with higher levels of miR-222 had significantly poorer survival than those with lower expression of this miRNA in patients, with a 5-year overall survival of 29.53% and 52.75%, respectively (P = 0.0034). In the multivariate Cox proportional hazards analysis, which included miR-222 level, tumor grade, tumor stage, and tumor number, high miR-222 expression was independently associated with poor survival (P < 0.001; hazard ratio 6.17; 95% CI 2.33 to 10.39). CONCLUSION: miR-222 overexpression is involved in the poor prognosis of bladder cancer and can be used as a biomarker for selection of cases requiring special attention.

Application of constructed wetlands for wastewater treatment in developing countries--a review of recent developments (2000-2013).

Inadequate access to clean water and sanitation has become one of the most pervasive problems afflicting people throughout the developing world. Replication of centralized water-, energy- and cost-intensive technologies has proved ineffective in resolving the complex water-related problems resulting from rapid urbanization in the developing countries. Instead constructed wetlands (CWs) have emerged and become a viable option for wastewater treatment, and are currently being recognized as attractive alternatives to conventional wastewater treatment methods. The primary objective of this review is to present a comprehensive overview of the diverse range of practice, applications and researches of CW systems for removing various contaminants from wastewater in developing countries, placing them in the overall context of the need for low-cost and sustainable wastewater treatment systems. Emphasis of this review is placed on the treatment performance of various types of CWs including: (i) free water surface flow CW; (ii) subsurface flow CW; (iii) hybrid systems; and, (iv) floating treatment wetland. The impacts of different wetland design and pertinent operational variables (e.g., hydraulic loading rate, vegetation species, physical configurations, and seasonal variation) on contaminant removal in CW systems are also summarized and highlighted. Finally, the cost and land requirements for CW systems are critically evaluated.

[Risk factors of hepatorenal syndrome in patients with acute on chronic liver failure].

OBJECTIVE: To identify the risk factors of hepatorenal syndrome in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure(ACLF). METHODS: A total of 726 hospitalized patients with HBV-ACLF were retrospectively analyzed. Data of demographic and clinical parameters (sex, age, family history, and presence of liver cirrhosis and diabetes), common complications (spontaneous bacterial peritonitis, pulmonary infection, hepatic encephalopathy, and upper gastrointestinal hemorrhage), and baseline biochemical parameters (albumin, globulin, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, cholesterol, cholinesterase, K+, Na+, plasma thromboplastin antecedent, alpha-fetoprotein, HBV DNA, white blood cell count, hemoglobin, and platelet count) were collected from the medical records database. Univariate and multiple regression analyses were performed to determine the risk factors of hepatorenal syndrome. RESULTS: Multiple logistic regression analysis indicated that upper gastrointestinal hemorrhage [risk (R) = 1.313, relative hazard (RH) = 3.716, 95% confidence interval (CI): 2.156-6.404], hepatic encephalopathy (R = 1.120, RH = 3.065, 95% CI: 1.900-4.945), spontaneous bacterial peritonitis (R = 1.005, RH = 2.733, 95% CI: 1.379-5.417), pulmonary infection (R = 1.051, RH = 2.862, 95% CI: 1.783-4.592), and white blood cell count (R = 0.056, RH = 1.058, 95% CI: 1.010-1.107) were independent risk factors for hepatorenal syndrome development in patients with HBV-ACLF. CONCLUSION: Several risk factors were significantly associated with the development of hepatorenal syndrome in HBV-ACLF, including upper gastrointestinal hemorrhage, hepatic encephalopathy, spontaneous bacterial peritonitis, pulmonary infection, and elevated white blood cell count.

[Clinical characteristics of and factors related to relapse in chronic hepatitis B patients after nucleoside analogues withdrawal].

OBJECTIVE: To investigate the clinical characteristics of and factors related to relapse in chronic hepatitis B (CHB) patients who had previously achieved cessation criteria and had been withdrawn from nucleoside analogues treatment. METHODS: Sixty CHB patients who experienced relapse after nucleoside analogues withdrawal based on cessation criteria were enrolled in the study retrospectively. Each patient's data on biochemical, serological and viral characteristics corresponding to baseline (treatment initiation), withdrawal and relapse were collected. COX proportional hazard modeling was used to evaluate the factors related to relapse. RESULTS: The hepatitis B e antigen (HBeAg)-positive and -negative patients had similar median antiviral treatment times (38 months (range: 24 - 80) vs. 35 months (30 - 60); Z = -1.313, P more than 0.05). For all patients, the median follow-up time was 12 months (2 - 72), during which 49 (81.7%) patients developed virological breakthrough and 17 (28.3%) developed HBeAg recurrence. The patients who experienced virological breakthrough or HBeAg recurrence had significantly higher baseline levels of HBV DNA than those patients who remained disease-free (t = 2.15 and -2.54 respectively; P less than 0.05). The median relapse time of the HBeAg-positive patients was significantly longer than that of the HBeAg-negative patients (14 months (3 - 72) vs. 6 months (3 - 36); Chi-square test = 7.045, P less than 0.01). HBeAg status at baseline was identified as an independent factor associated with relapse (relative risk = 1.937, 95% confidence interval = 1.14-3.28, P less than 0.05). CONCLUSION: HBeAg-positive and-negative patients showed distinct clinical characteristics of relapse, with the latter being more prone to relapse soon after nucleoside analogues withdrawal. Prolonging the treatment course may be beneficial to HBeAg-negative patients, even if cessation criteria are achieved.

Effect of feeding strategies on pharmaceutical removal by subsurface flow constructed wetlands.

This study presents findings on an assessment of the effect of continuous and batch feeding strategies on the removal of selected pharmaceuticals from synthetic wastewater. Six mesocosm-scale constructed wetlands, including three horizontal subsurface flow constructed wetlands and three sand filters, were set up at the campus of Nanyang Technological University, Singapore. The findings showed that ibuprofen and diclofenac removal in the wetlands was significantly ( < 0.05) enhanced in the batch versus continuous mode. In contrast, naproxen and carbamazepine showed no significant differences ( > 0.05) in elimination under either feeding strategy. Our results also clearly showed that the presence of plants exerts a stimulatory effect on pharmaceutical removal for ibuprofen, diclofenac, and naproxen in batch and continuous mode. Estimation of the quantitative role of this stimulatory effect on pharmaceutical elimination of batch operation as compared with the effect of the presence of the higher plant alone showed that batch operation may account for 40 to 87% of the contribution conferred by the aquatic plant. The findings of this study imply that where maximal removal of pharmaceutical compounds is desired, periodic draining and filling might be the preferred operational strategy for full-scale, subsurface flow constructed wetlands.

Nutrient removal in tropical subsurface flow constructed wetlands under batch and continuous flow conditions.

The aim of this investigation was to evaluate the influence of batch versus continuous flow on the removal efficiencies of chemical oxygen demand (COD), nitrogen (N) and total phosphorus (TP) in tropical subsurface flow constructed wetlands (SSF CW). The quantitative role of the higher aquatic plants in nutrient removal in these two operational modes was also investigated. Results indicated no significant difference (p > 0.05) in COD removal between batch and continuous flow modes for either the planted or unplanted treatments. Furthermore, the batch-loaded planted wetlands showed significantly (p < 0.05) higher ammonium removal efficiencies (95.2%) compared with the continuously fed systems (80.4%), most probably because the drain and fill batch mode presented systematically more oxidized environmental conditions. With respect to TP removal, for both planted and unplanted beds, there was significant enhancement (p < 0.05) in batch flow operation (69.6% for planted beds; 39.1% for unplanted beds) as compared to continuous flow operation (46.8% for planted beds; 25.5% for unplanted beds). In addition, at a 4-day hydraulic retention time (HRT), the presence of plants significantly enhanced both ammonia oxidation and TP removal in both batch and continuous modes of operation as compared to that for unplanted beds. An estimation of the quantitative role of aeration from drain and fill operation at a 4-day HRT, as compared to rhizosphere aeration by the higher aquatic plant, indicated that drain and fill operation might account for only less than half of the higher aquatic plant's quantitative contribution of oxygen (1.55 g O2 per m2 per day for batch flow versus 1.13 g O2 per m2 per day for continuous flow).

NR2B-containing NMDA receptors promote neural progenitor cell proliferation through CaMKIV/CREB pathway.

Accumulating evidence indicates the involvement of N-methyl-D-aspartate receptors (NMDARs) in regulating neural stem/progenitor cell (NSPC) proliferation. Functional properties of NMDARs can be markedly influenced by incorporating the regulatory subunit NR2B. Here, we aim to analyze the effect of NR2B-containing NMDARs on the proliferation of hippocampal NSPCs and to explore the mechanism responsible for this effect. NSPCs were shown to express NMDAR subunits NR1 and NR2B. The NR2B selective antagonist, Ro 25-6981, prevented the NMDA-induced increase in cell proliferation. Moreover, we demonstrated that the phosphorylation levels of calcium/calmodulin-dependent protein kinase IV (CaMKIV) and cAMP response element binding protein (CREB) were increased by NMDA treatment, whereas Ro 25-6981 decreased them. The role that NR2B-containing NMDARs plays in NSPC proliferation was abolished when CREB phosphorylation was attenuated by CaMKIV silencing. These results suggest that NR2B-containing NMDARs have a positive role in regulating NSPC proliferation, which may be mediated through CaMKIV phosphorylation and subsequent induction of CREB activation.

Environmental and economic assessment of combined biostabilization and landfill for municipal solid waste.

Biostabilization can remove considerable amounts of moisture and degradable organic materials from municipal solid waste (MSW), and can therefore be an effective form of pretreatment prior to landfill. The environmental and economic impacts of two combined processes, active stage biostabilization + sanitary landfill (AL), and active and curing stage biostabilization + sanitary landfill (ACL), were compared with sanitary landfill (SL) for MSW with high moisture content. The results indicated that land requirement, leachate generation, and CH(4) emission in the ACL process decreased by 68.6%, 89.1%, and 87.6%, respectively, and the total cost was reduced by 24.1%, compared with SL. This implies that a combined biostabilization and landfill process can be an environmentally friendly and economically feasible alternative to landfill of raw MSW with high moisture content. Sensitivity analysis revealed that treatment capacity and construction costs of biostabilization and the oxidation factor of CH(4) significantly influenced the costs and benefits of the AL and ACL process at an extremely low land price. When the land price was greater than 100 USD m(-2), it became the dominating factor in determining the cost of treatment and disposal, and the total costs of ACL were reduced to less than 40% of those of SL.

Effect of biostabilization on the release potential and speciation of heavy metals in municipal solid waste.

Biostabilization prior to landfilling of municipal solid waste (MSW) has been developed to reduce leachate pollution and increase landfill capacity and stability. Leaching tests were used in this study to examine the effect of biostabilization on the release potential and fate of heavy metals in MSW. The speciation of heavy metals in leached MSW and leachates, and their distribution in different molecular weight (MW) fractions of organic matter in leachate were studied. The results showed that a 44-day biostabilization period could lower the release potential of Pb, Cr, Cd, Cu, and Zn in MSW by 50 to 84%. With the exception for Zn, biostabilization tended to decrease the percentages of the metals in the leachate organic fraction with MW < 1 kDa, but increase those of metals associated with organic colloids and high-MW fractions. Therefore, the effects of biostabilization on the behaviour and fate of Pb, Cr, Cd and Cu in leachate would vary in treatment facilities that use different methods and in the natural environment. Biostabilization only slightly affected the behaviour and fate of Zn, due to an insignificant variation in the speciation and distribution of Zn in different MW fractions. In addition, the aerobic and hydrolytic-aerobic biostabilization processes showed similar release potential, speciation, and distribution of heavy metals in different MW fractions.

[Preparation and pharmaceutical characterization of Marine-SSL].

OBJECTIVE: To prepare and characterize marine sterically stabilized liposomes (Marine-SSL). METHODS: Liposomes were prepared by ethanol injection technique. An orthogonal test was utilized to optimize the formulation and preparation of Marine-SSL The unencapsulated marine and liposomes were separated by sephadex gel G-50, the encapsulation efficiency was detected by HPLC. The morphological examination of Marine-SSL was performed using transmission electron microscopy. The particle size and Zeta potential of the liposomes were measured. The in vitro release rate of marine from liposomes was tested. RESULTS: The liposomes with spherical or ellipsoidal shape and better stability featured the encapsulation efficiency of (85.39 +/- 1.21)%, the mean partical size of (156 +/- 10) nm, and Zeta potential of (- 39.0 +/- 3.06) mv. The release kinetics in vitro obeyed Higuchi equation. The stability of Marine-SSL was better. CONCLUSION: The selected formulation and preparation technic of Marine-SSL are rational and stable and liposomes feature a sustained release in vitro.

Municipal solid waste management in China: status, problems and challenges.

This paper presents an examination of MSW generation and composition in China, providing an overview of the current state of MSW management, an analysis of existing problems in MSW collection, separation, recycling and disposal, and some suggestions for improving MSW systems in the future. In China, along with urbanization, population growth and industrialization, the quantity of municipal solid waste (MSW) generation has been increasing rapidly. The total MSW amount increased from 31.3 million tonnes in 1980 to 212 million tonnes in 2006, and the waste generation rate increased from 0.50 kg/capita/day in 1980 to 0.98 kg/capita/year in 2006. Currently, waste composition in China is dominated by a high organic and moisture content, since the concentration of kitchen waste in urban solid waste makes up the highest proportion (at approximately 60%) of the waste stream. The total amount of MSW collected and transported was 148 million tonnes in 2006, of which 91.4% was landfilled, 6.4% was incinerated and 2.2% was composted. The overall MSW treatment rate in China was approximately 62% in 2007. In 2007, there were 460 facilities, including 366 landfill sites, 17 composing plants, and 66 incineration plants. This paper also considers the challenges faced and opportunities for MSW management in China, and a number of recommendations are made aimed at improving the MSW management system.

[Enzyme-catalyzed synthesis of ASGPR ligand-targeted modifier in non-aqueous medium].

The asialoglycoprotein receptor (ASGPR) was used to mediate drug carrier for hepatic targeted drug delivery, this article showed the enzyme-catalyzed esterification of galactose and vinyl stearate and a kind of ASGPR ligand-targeted which was used to insert the surface of liposome has been synthesized. The structure of product has been confirmed by TLC, ESI-MS and 1H NMR. The factors of types and quantity of enzyme, organic solvents, molar ratio of substrate, temperature and time of reaction have been studied. Results showed when using acetone as reaction medium, the quantity of Novozym 435 immobilized lipase was 30 mg mL(-1), molar ratio of galactose to vinyl stearate was 1:5, and reacted at 60 degrees C for 12 h, the transformation of vinyl stearate reached more than 70%. This study provides a novel and efficient route to the synthesis of ligand-targeted modifier.

Distribution of perfluoroalkyl substances (PFASs) in aquatic plant-based systems: From soil adsorption and plant uptake to effects on microbial community.

This study systematically explored the distribution of perfluoroalkyl substances (PFASs) through soil adsorption and plant bioaccumulation in aquatic plant-based systems, derived from a surface flow constructed wetland (CW) planted with Typha angustifolia. The water-soil-plant systems were fortified with eight perfluoroalkyl subsntances (PFASs) at different concentrations. The potential for individual PFAS adsorption onto soil substrate and bioaccumulation in the plants increased with the increasing PFAS initial concentrations. Longer-chain PFASs exhibited higher affinity to soil substrate compared to shorter-chain PFASs. The highest concentration in the soil was observed for PFOS (51.3 ng g-1), followed by PFHxS (9.39 ng g-1), and PFOA (5.53 ng g-1) at low PFAS level. The perfluoroalkyl chain length dependent trend was also seen in the roots with the highest individual PFAS concentration for PFOS (68.9 ng g-1), followed by PFOA (18.5 ng g-1) and PFHxS (13.4 ng g-1). By contrast, shorter-chain PFASs were preferentially translocated from roots to shoots in Typha angustifolia. A significant (p < 0.05) positive correlation between bioaccumulation factor (BAFplant/water) (whole plant) and perfluoroalkyl chain length was observed. PFASs content in the plant compartments increased with increasing PFAS concentrations in the soil. Mass balance analysis indicates that approximately 40.7-99.6% of PFAS mass added to the system was adsorbed onto the soil and bioaccumulated in the plant tissues of T. angustifolia. Soil adsorption played a vital role in PFAS mass distribution. The results of Illumina high-throughput sequencing show that the bacterial diversity decreased upon PFAS exposure. The most predominant phyla retrieved were Proteobacteria (24.7-39.3%), followed by Actinobacteria (4.2-41.1%), Verrucomicrobia (7.9-25.1%), Bacteroidetes (10.2-20.4%), Cyanobacteria (0.4-16.5%), and Firmicutes (1.1-6.4%). The PFAS enrichment caused the changes (p > 0.05) in the structure and composition of bacterial community. This study helps to gain insight into a better understanding of the potential for PFASs distribution in an aquatic plant-based system and the impact on dynamic of microbial community exposed to PFASs.

Clinical and EEG characteristics analysis of autoimmune encephalitis in children with positive and negative anti-N-methyl- D-aspartate receptor antibodies.

BACKGROUND: Autoimmune encephalitis is complex and varied, but it is a curable disease. However, the diagnosis and treatment of children with Autoimmune encephalitis remains challenging. Therefore, we conducted this study to analyze the clinical features, electroencephalogram (EEG) characteristics, treatment and prognosis of autoimmune encephalitis in children with negative and positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody. METHODS: From January 2015 to January 2017, 28 child patients with autoimmune encephalitis were hospitalized in the Neural Ward of the Children's Medical Center, Qilu Hospital of Shandong University. Inclusion criteria were based on the diagnostic criteria for autoimmune encephalitis published in Lancet Neurology in 2016. The clinical, EEG and imaging data were summarized. The clinical features, treatment regimen, follow-up and prognosis were also analyzed. RESULTS: Among these 28 child patients, 10 patients had positive anti-NMDAR antibody, while 18 patients had negative anti-NMDAR antibody. The clinical manifestations, EEG findings and seizures were similar (P>0.05) between these two groups. All 28 child patients were treated with methylprednisolone shock and human immunoglobulin. The response to immunotherapy was similar between these two groups (P>0.05). CONCLUSIONS: The clinical manifestation of autoimmune encephalitis is complex and varied, but it is a curable disease. Immunotherapy should be considered as soon as possible, with or without autoantibodies. Most of the child patients had a good prognosis, while some of them had the sequelae of epilepsy, mild mental symptoms, and dyskinesia. It is necessary to improve the understanding of autoimmune encephalitis with/without positive antibodies, and make diagnosis and treatment as soon as possible, in order to improve the prognosis.

[Role of bulbocavernosus reflex to stimulation of prostatic urethra in pathologic mechanism of primary premature ejaculation].

OBJECTIVE: Primary premature ejaculation (PPE) is a prevalent sexual dysfunction among men while its precise pathologic mechanism has remained poorly understood. In current study the correlation between excitability of bulbocavernosus reflex (BCR) to stimulation of prostatic urethra and primary premature ejaculation was studied. METHODS: Forty-two patients with PPE and 20 normal potent male volunteers were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface (intraurethral catheter electrode) into bladder to evoke the BCR to stimulation of prostatic urethra to record the sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR and latencies of BCR. Also the sensitivity of glans penis to electrical stimulation was detected by two surface electrodes. RESULTS: The mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR and sensory thresholds of glans penis were (18.2 +/- 2.7) mA (0.2 ms in duration, 1 Hz), (34.8 +/- 4.2) mA (0.2 ms, 1 Hz), (71.2 +/- 5.8) ms and (14.2 +/- 1.9) mA (0.04 ms in duration, 3 Hz) in normal potent men respectively and were (12.4 +/- 3.7) mA (0.2 ms, 1 Hz), (23.8 +/- 5.6) mA (0.2 ms, 1 Hz), (70.5 +/- 6.3) ms and (11.9 +/- 2.3) mA (0.04 ms, 3 Hz) in patients with PPE respectively. Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between two groups (all P < 0.01). No statistically differences were seen regarding the latencies of BCR between two groups (P > 0.05). CONCLUSION: Patients with PPE have hyperexcitable BCR to stimulation of prostatic urethra. It is probably one of the important etiological factors. Moreover the findings may provide new therapeutic modalities of PPE.