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@#Objective Report and analyze the clinical features，diagnosis，and prognosis of 3 patients with elderly-onset（age>75 years） neuromyelitis Optica spectrum disorders（NMOSDs），reviewed previous pieces of literature to improve the risk and understanding of NMOSD in elderly patients. Methods We searched the domestic and international databases in the past 10 years，to collect the case report of patients with NMOSDs over the age of 75 years，along with three cases discovered in the neurology department of the First Affiliated Hospital of Zhengzhou University. The clinical features，laboratory tests and treatment，were retrospectively analyzed. Results A total of 12 patients with NMOSDs>75 years old were enrolled in this study，including 7 females and 5 males，with an average age of onset（82.67±4.42） years. All patients were diagnosed with longitudinally extensive transverse myelitis（LETM），and the single-phase course was the majority. The AQP4 test was positive in all cases and the MRI was illustrated that mainly caused the thoracic spinal cord. Twelve cases were treated with intravenous methylprednisolone（IVMP）1 g daily for 3 to 5 days，3 cases were combined with plasma exchange（PLEX），4 cases were treated with immunosuppression，and 5 cases had a relapse，9 cases were effective，2 cases were markedly effective，3 cases were worsened. Three patients died during treatment and follow-up. Conclusion Patients with very late-onset NMOSDs are more likely to have LETM，higher disability rates. IVMP plus PLEX is more effective than IVMP alone，But the benefit of immunosuppression is unclear in clinical practice and observational studies.
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@#Objective Cystain C （Cys C） is an inhibitor of cysteine proteases （cathepsins，Cat），and has a wide range of biological effects in vivo. The aim of this study was to investigate the changes in serum Cys C levels in patients with acute myasthenia gravis （MG） and its relationship with clinical characteristics. Method We selected 70 MG patients and 42 healthy control patients who were admitted to the first affiliated hospital of Zhengzhou University from June 2018 to August 2019，MG patients were divided into two groups according to whether they were complicated with thymoma or not. Retrospectively analyzed clinical data of patients in each group，including Collect clinical data of patients in each group，including age，gender，fasting serum creatinine，Cys C，glomerular filtration rate （GFR） and acetylcholine receptor （AChR） antibody concentration. MG patients were divided into ocular group and generalized group by Osserman typing evaluated the severity of MG patients by Quantitative myasthenia gravis （QMG） score. The correlation of serum cystatin C level with clinical classification，severity of disease，thymoma and AChR antibody in MG patients was analyzed. Results Serum Cys C levels in both the MG group without thymoma and the MG group with thymoma were significantly higher than those in the control group ［（0.900±0.238，0.998±0.235，0.776±0.123）mg/L，P=0.000］，serum Cys C level was positively correlated with QMG score （r=0.482，P<0.0001），but was not significantly correlated with clinical classification and AChR antibody titer（P>0.05）. Conclusion Serum Cys C levels in MG patients were significantly increased，Cys C may be involved in the development of MG.
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The incidence of vascular cognitive impairment (VCI) is increasing year by year,and early intervention and treatment for VCI can effectively reduce the occurrence of vascular dementia.The application of repetitive transcranial magnetic stimulation (rTMS) opens a new window for the treatment of VCI.This article reviews the efficacy,biological mechanism and safety of rTMS in the treatment of VCI.
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MicroRNAs (miRNAs) are a class of small endogenous non-coding RNA,which have been found to play an important role in the progression of many malignant tumors.Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide,and its mortality is closely related to its early metastasis.miR-200b/200c/429 (microRNA200b subfamily) is an important member of the microRNA200 family.Recent studies have shown that the target gene of the microRNA200b subfamily and the signal pathway involved by the microRNA200b subfamily are associated with HCC metastasis.HCC is one of the malignant tumors with high mortality and strong invasion and metastasis.The clinical significance of microRNAs-200b family in the metastasis of HCC will be discussed in this paper.
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Objective To investigate the occurrence factors of duodenobiliary reflux (DBR) after endoscopic sphincterotomy (EST ) .Methods A total of 198 patients with choledocholithiasis hospitalized in the digestive department of the hospital from Sep-tember 2012 to February 2016 were selected and given duodenal papilla EST .The DBR occurrence was judged and the occurrence factors were investigated ,meanwhile the Oddi sphincter function was measured and long term complications were followed up .Re-sults All patients successfully completed EST ,the average common bile duct diameter in 198 cases was (2 .24 ± 0 .24)cm ,the aver-age common bile duct stones number was 3 .63 ± 1 .12 ;the maximum diameter of common bile duct stones was (1 .02 ± 0 .19)cm . There were 12 cases of DBR after EST ,the occurrence rate was 6 .1% ,the average radioactivity was (3 .39 ± 0 .89)MBq .The post-operative Oddi sphincter systolic peak and contraction frequency were (31 .49 ± 4 .22)mm Hg and (3 .78 ± 0 .53) times /min ,which were significantly lower than those before operation (P<0 .05);and the postoperative Oddi sphincter basic pressure and common bile duct pressure were (8 .23 ± 1 .03)mm Hg and (3 .32 ± 0 .45)mm Hg respectively ,which had no statistical difference compared with preoperation (P>0 .05) .The Logistic regression analysis showed that complicating gallbladder stone ,diameter of common bile duct ,frequency difference of Oddi sphincter contraction before and after operation ,number of stones and maximum diameter of stone were the main risk factors for postoperative DBR occurrence (P<0 .05) .All cases were followed up for 6 months ,18 cases developed long term complications ,the incidence rate was 9 .1% ,including 4 cases of reflux cholangitis ,6 cases of bile duct stric-ture ,4 cases of papillary stenosis and 4 cases of recurrence .Conclusion DBR after duodenal papilla EST is common ,which can re-sult in the Oddi sphincter function decrease and increase of long-term complications ,and needs to actively strengthen prevention and management .
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Objective To evaluate the effect of enteral nutrition (EN) versus total parenteral nutrition(TPN) on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Sixtythree patients with SAP enrolled from 4 hospitals were randomly assigned into EN group(29 cases) and TPN group(34 cases). EN group patients were fed via a spiral nasojejunal feeding tube placed routinely by endoscopy or fluoroscopy, and TPN group patients were nourished intravenously with TPN during the same period. The changes of serum endotoxin, diamine oxidase, and urinary excretion of lactulose and mannitol ratio (L/M) were observed. Results Plasma concentration of endotoxin were markedly decreased in EN group as compared with that in TPN group at the 7th,14th ,21th day of entry trial [(39. 30 ± 15. 82) EU/L vs (73.05 ±21.16) EU/L,(22.64 ±14.31) EU/L vs (49.34 ±24.54) EU/L,(14.81 ± 10.93)EU/L vs ( 30. 08 ± 14. 10 ) EU/L, P ＜ 0. 05]. Plasma concentration of diamine oxidase were markedly decreased in EN group as compared with that in TPN group at the 7th, 14th day of entry trial [(9. 97 ± 3. 84)U/Lvs (19.89±9.89)U/L,(5.42±1. 84) U/Lvs (8.79 ±4.08) U/L, both P ＜ 0. 05]. The urinary L/M decreased significantly in EN group than those in TPN group at the 7th, 14th,21th day of entry trial (0.28 ±0.25 vs 0. 65 ±0.45,0.21 ±0. 18 vs 0.54 ±0.41,0.08 ±0.04 vs 0.29 ±0.06, all P＜0.05).Conclusion EN has better effect on improving intestinal barrier function than TPN in treatment of patients with SAP.
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Objective To assess the effect of continuous early enteral nutrition(EEN)combined with intestinal mucosal protective agents on gut barrier function in patients with severe acute pancreatitis.Methods A total of 79 patients with severe acute pancreatitis selected from four centers between May 2004 to June 2006 were enrolled and divided into EEN combined with intestinal mucosal protective agents group(combined group,n=39)and total parenteral nutrition(TPN)group(n=40).The patients were received either EEN or TPN when homeostasis were achieved within 72 hours after onset.The patients in combined group were administered pepti-2000 variant combined with glutamine,arginine and intestinal mucosal protective agents.The patients in TPN group were administered through a central vein.APACHE-Ⅱ score was recorded every week;The concentration of serum amylase,plasmic diamine oxi dase(DAO)and endotoxin were mesured on day 1,7,14 and 21 as well as urinary excretion of lactulose (L)and mannitol(M).Complications,lenth and charges of hospital stay were recorded.Results There was no death in both groups.The APACHE-Ⅱ score decreased on day 7,but lower in combined group (6.00±1.60)than that in TPN group(7.08±2.34)(P＜0.05).On day 7,14 and 21,the concentrations of endotoxin in combined group was(39.30±15.82),(22.64±14.31),(14.81±10.93)Eu/L,respectively,urinary L/M ratio was 0.28±0.25,0.21±0.18 and 0.08±0.04,respectively,IFABP-c was 15.62±5.26),(5.46±1.18)and(3.26±0.94)pg/ml,respectively.All of these parameters were significantly lower than those in TPN group(P＜0.05).The infectious rates including pancreatic,peritoneal and respiratory infection in TPN group were much higher than that in combined group(26.47% vs 3.44%,P＜0.01).The composition of flora fecal remained unchange in combined group rather than TPN group.The mean hospital stay was shorter in combined group[(20.0±5.7)days]compared to TPN groups[(34.5±12.9)days].The charges were also significantly lower in combined group,with average cost of RMB 25,900±14,200,while it was 46,800±4,030 in TPN group.Conclusions EEN combined with intestinal mucosal protective agents can improve gut barrier function via reducing the gut permeability,improving the hypoperfusion,maintaining the integrity and gut fecal flora.It might reduce the course and charges of hospital stay.