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Objective To determine the clinical and antibody response after therapeutic plasma exchange (TPE) in patients with severe refractory antibody‐associated autoimmune encephalitis (AE). Methods This single‐center prospective cohort included all patients consecutively admitted to our hospital because of severe refractory AE over the period from July 2014 to June 2019. All patients received immunotherapy (steroids, intravenous immunoglobulin (IVIG), and/or TPE). The primary outcome was evaluated at 1‐ and 2‐month postenrollment, and the long‐term outcome was followed up at 6 and 12 months. AE antibody titers in the cerebrospinal fluid and plasma were evaluated before and after TPE/IVIG. Results This study enrolled 57 patients with severe refractory AE, including anti‐NMDA receptor encephalitis (n = 51), anti‐GABAb receptor encephalitis (n = 3), anti‐LGI 1 encephalitis (n = 2), and anti‐AMPA receptor encephalitis (n = 1). Of all 57 patients, 33 patients received TPE for a total of 193 procedures, and 24 patients with contraindications or refusal of TPE were in the non‐TPE group. Compared with the non‐TPE group, the TPE group exhibited greater clinical improvement: 21 (37%) versus 8 (14%) after 1 month (P = 0.03) and 31 (54%) versus 16 (28%) after 2 months (P = 0.01), respectively. Complications and adverse events associated with TPE occurred in 91 procedures (47%) without serious adverse events associated with the use of TPE. Interpretation TPE might be an effective rescue therapy associated with rapid functional improvement in patients with severe steroid/IVIG refractory antibody‐associated AE from this nonrandomized control trial.

ObjectivesTo investigate the clinical value of detecting anti–mutated citrullinated vimentin (anti-MCV), anti-citrullinated peptide (anti-CCP), red-blood-cell distribution width (RDW), and 25-hydroxyvitamin D (25-[OH]D) in the diagnosis of rheumatoid arthritis (RA).MethodsWe enrolled 119 patients with RA, 114 control individuals without RA (disease controls), and 40 healthy controls in our study (Han Chinese). Anti-CCP and anti-MCV were detected by enzyme-linked immunosorbent assay (ELISA), 25-(OH)D was detected by electrochemical luminescence, and RDW was calculated by erythrocyte parameters detected via the electric resistance method.ResultsThe serum levels of anti-CCP and anti-MCV in RA were higher than those in disease controls and healthy controls (P ConclusionsAnti-CCP and anti-MCV are ideal indices for RA diagnosis. Also, in combination with RDW and 25-(OH)D, the diagnostic level will be improved, as well as the sensitivity and specificity, which is significant for the differential diagnosis of RA.

Brain death (BD), the irreversible cessation of function in the whole brain, is a well-known condition in most countries. The criteria and practical guidelines for brain death determination (BDD) in China were issued by the Brain Injury Evaluation Quality Control Center (BQCC) of the National Health and Family Planning Commission in 2013. Thereafter, we proposed a plan called the three-step quality control plan (three-step QCP) to ensure the safety and consistency of the clinical judgments regarding BD. By retrospectively reviewing this plan, we aimed to identify problems during its implementation and to provide suggestions for future work on quality control for BDD.Data were retrieved from the BQCC database. The characteristics and test results of physicians undergoing a BDD training course and the BD case records submitted by hospitals before and after receiving accreditation were analyzed.In the first step of the plan, the error rate for physicians undergoing the BDD paper test was highest for limb movement discrimination (26.29%); this error rate was correlated with age (per 10-year increase) (odds ratio = 1.262, 95% confidence interval 1.067-1.491, P = 0.007) but was nonsignificantly associated with sex, specialty category, professional level, and hospital level (P 0.05). During the second step of the plan, the highest percentage of problems was associated with apnea testing (22.75%), followed by ancillary testing of BDD (16.17%). In the last step, the highest percentage of problems in the case records was associated with apnea testing (41.73%).The three-step QCP is of significant utility for ensuring accuracy and appropriateness in BDD. Simultaneously, this study provides important evidence for advancing quality control for BDD in the next stage.

Background To explore the characteristics and prognosis of autonomic dysfunction and paroxysmal sympathetic hyperactivity (PSH), and evaluate the efficacy of drugs used to suppress PSH episode in anti-NMDAR encephalitis patients.MethodsPatients who met the diagnostic criteria of anti-NMDAR encephalitis were enrolled from January 2012 to August 2018 and followed up. PSH was diagnosed according to the PSH-Assessment Measure. The demographics data, clinical features, main accessory examinations, treatments, and long-term outcomes were prospective collected and analyzed. ResultsA total of 132 anti-NMDAR encephalitis patients were enrolled, 27.3% of patients experienced autonomic dysfunction, of which cardiac autonomic dysfunction (77.8%) was the most common subdivisions. Of the patients, 9.1% had probable PSH, tachycardia, tachypnea, and hypertonia (100%) were the most common symptoms of PSH. Patients with a higher incidence of ovarian teratoma, mechanical ventilation, intensive care unit admission, and elevated levels of CSF glucose, and higher CSF NMDAR antibody titers were more likely to exhibit autonomic dysfunction or PSH. Diazepam and phenobarbitone were commonly used drugs to control PSH episodes in patients without prior sedative drugs and the overall efficacy was 90.0%. However, the efficacy of monotherapy dropped to 69.6% and approximately half of episodes need a combination of drugs to control symptoms in PSH patients with prior sedative drugs. No significant difference was observed in the prognosis between the autonomic dysfunction group and the non- autonomic dysfunction group or PSH group and non-PSH group after 6 months and during long-term follow-up. However, patients with cardiac autonomic dysfunction had a poor prognosis at 6 months.Conclusion PSH is a common clinical condition in patients with anti-NMDAR encephalitis, especially in severe cases, and the clinical management of PSH can be assisted by several acute drug administered therapies. Patients with autonomic dysfunction or PSH do not seem to compromise their neurological recovery despite a longer hospital stay.

Our objective was to evaluate the use of event-related potentials and the middle-latency somatosensory evoked potential (MLSEP) for the prediction of awakening in coma, determine the evaluation day that evoked potentials (EPs) best predict an awakening outcome, and determine whether the mismatch negativity (MMN) combined with the MLSEP, when recorded at 7 days after coma, improved the prediction of awakening from coma. Design prospective blinded cohort study. Setting neurointensive care unit of a university hospital. Patients 113 consecutive patients who were severely comatose, whose etiologies of coma included stroke (65 patients), hypoxic-ischemic encephalopathy (28 patients), intracranial infection (6 patients), and other (14 patients). Interventions none. Measurements we gathered Glasgow Coma Scale scores and recorded EPs for all patients who were comatose at 7, 14, and 30 days after coma onset, unless the patients returned to consciousness. The EPs examined included the MLSEP, the middle-latency auditory evoked potential, the N100, and the MMN. With telephone follow-up after 3 months, the patients were classified as awakening or nonawakening according to Glasgow Outcome Scale. When predicting an awakening outcome, at least the unilateral presence of the N60 had the highest sensitivity (82.7%), whereas the presence of the MMN showed the highest specificity (82.0%). The area under the receiver operating characteristic curve for the EPs were high at 7 days after coma onset. At 7 days after coma onset, the combination of the N60 and MMN offered good predictive performance for awakening (area under the receiver operating characteristic curve = 0.852, 95% confidence interval 0.765–0.940), with increased sensitivity (70.0%) and improved specificity (91.7%). The N60 and MMN were the strongest prognostic factors for an awakening outcome. Furthermore, at 7 days after coma onset, the combination of the N60 and MMN improved the prediction of an awakening outcome in patients who were comatose.

Large hemispheric infarction (LHI) is an ischemic stroke affecting at least two-thirds of the middle cerebral artery territory, with or without involvement of the anterior cerebral artery or posterior cerebral artery, and approximately 77% of LHI patients have early consciousness disorder (ECD). We constructed a functional brain network for LHI patients with an acute consciousness disorder to identify new diagnostic markers related to ECDs by analyzing brain network characteristics and mechanisms. Between August 1, 2017, and September 30, 2018, patients with acute (

Objective A multicenter study of phenobarbital versus valproate (i.e., the China 2-P vs. V study) was conducted to compare the efficacy and safety of phenobarbital and valproate for generalized convulsive status epilepticus (SE) in a multicenter trial design. Methods Three improvements (uniform intravenous pumping, pump speed adjustment according to adverse events and blood drug level monitoring) over a previous study were made regarding an intravenous regimen of phenobarbital and valproate in a multicenter, prospective, randomized, controlled study. Long-term electroencephalography (EEG) monitoring was performed after initial drug treatment. Termination, relapse, adverse event and poor prognosis rates in patients with generalized convulsive status epilepticus (GCSE) were compared. Results The rate of GCSE termination within one hour were significantly higher in the phenobarbital group (33 cases) than in the valproate group (36 cases) (84.8 % vs. 63.9 %, P = 0.048), but the rates of nontermination of EEG epileptic discharge within one hour were similar between the two groups (12.1 % vs. 8.3 %, P = 0.702). The relapse and adverse event rates were not significantly different between groups, but 3 hypoventilation events and 1 hypotension event occurred in the phenobarbital group compared to 0 in the valproate group. There were no cases of epileptiform EEG discharge relapse in the phenobarbital group, compared to 1 case in the valproate group. Conclusions The phenobarbital regimen evaluated in this study has a higher GCSE termination rate than the valproate regimen, indicating that the former is suitable for countries, regions and individuals with limited access to new antiepileptic drugs or limited economic means.

Objective To explore the value of electroencephalogram (EEG) pattern in predicting awakening of comatose patients after cardiopulmonary resuscitation (CPR). Methods A retrospective cohort study was conducted on comatose patients after CPR in the neuro-critical care unit of Xuanwu Hospital, Capital Medical University, from 2002 to 2018. The included patients received clinical evaluation, and the Glasgow coma scale (GCS) score was recorded. Bedside EEG monitoring was performed for visual grading and reactivity detection. The 3-month prognostic assessment was performed using the Glasgow outcome scale (GOS). The patients were dichotomized into the awakening group (GOS 3–5) and the unawakening group (GOS 1–2). Results A total of 160 patients were included. There was no significant difference in the baseline data between the two groups except that the GCS score of the awakening group was higher (P = 0.000). Different EEG patterns were used to predict awakening from coma. As a result, the slow wave pattern showed the highest accuracy (73.1%, 95% CI: 0.66–0.79), and the sensitivity and specificity reached 61.3% (95% CI: 0.48–0.73) and 80.6% (95% CI: 0.71–0.88), respectively. Compared with EEG reactivity, the slow wave pattern was more sensitive in predicting awakening. It was also more specific than GCS in predicting awakening. The slow wave pattern within different time frame after coma was used to predict the prognosis of awakening, suggesting that the accuracy (100%, 95% CI: 0.75–1.00), sensitivity (100%, 95% CI: 0.46–1.00), and specificity (100%, 95% CI: 0.63–1.00) of predicting awakening within 8–14 days were the highest. Conclusions The slow wave pattern of EEG had a good predictive value for awakening in comatose patients after CPR, and the highest accuracy occurred within 8–14 days from coma.

Electroencephalographic reactivity (EEG-R) is a major predictor of outcome in comatose patients; however, the inter-rater reliability is limited due to the lack of homogeneous stimuli and quantitative interpretation.EEG-R testing was employed in comatose patients by quantifiable electrical stimulation. Reactivity at different frequency bands was computed as the difference between pre- and post-stimulations in power spectra and connectivity function (including magnitude squared coherence and transfer entropy). The clinical outcomes were dichotomized as good and poor according to the recovery of consciousness. Signal discrimination of EEG-R was compared between the two groups.A total of 18 patients (43%) regained consciousness at a 3-month follow-up. In the patients who regained consciousness, the EEG power increased significantly (P 0.05) at the Alpha and Beta frequency bands after stimulation as compared to those with no behavioral awakening. Also, connectivity enhancement (including linear and nonlinear analysis) in the Beta and Gamma bands and connectivity decrease (nonlinear transfer entropy analysis) in the Delta band after stimulus were observed in the good outcome group.In this study, the combined use of quantifiable stimulation and quantitative analysis shed new light on differentiating brain responses in comatose patients with good and poor outcomes as well as exploring the nature of EEG changes concerning the recovery of consciousness.The combination of quantifiable electrical stimulation and quantitative analysis with spectral power and connectivity for the EEG-R may be a promising method to predict the outcome of comatose patients.

Disintegrant is a typical excipient that improves the solubility, dissolution and bioavailability of drug. In this study, the application of nanocrystalline cellulose (NCC) as a potential disintegrant in the preparation of tablet was investigated. Angle of repose of NCC was 44.26° which was between L-HPC and MCC suggesting a good fluidity of NCC. Swelling property of NCC was between CMS-Na and MCC indicating that NCC was of good absorbent ability. Carbonate calcium tablet of which NCC was used as a disintegrant exhibited fastest disintegration time than known disintegrants. The disintegration and dissolution tests demonstrated that NCC showed effective disintegrant properties, e.g. consistently fast disintegration, rapid dissolution, and effectiveness at low concentrations. Thus, we believe that NCC has a great potential as a disintegrant in tablets.

Vascular aging is an independent risk factor for age-related diseases, including atherosclerosis. Fibroblast growth factor 21 (FGF21) has been widely recognized as a metabolic regulator that is elevated in response to caloric and nutritional restrictions. Recent studies have demonstrated its emerging role as a pro-longevity hormone, but its effects on the senescence of human umbilical vascular endothelial cells (HUVECs) remain unclear. In the present study, we explored the anti-senescence effects and underlying mechanism of FGF21 on HUVECs. Co-cultivation of HUVECs with 5 ng/mL FGF21 significantly attenuated the phenotype changes of cells during in vitro subculture, including increased senescent population, decreased proliferation rate, decreased SIRT1 and elevated P53 and P21 protein levels. FGF21 also protected HUVECs from H2O2-induced cell damage, including premature cell senescence, intracellular accumulation of reactive oxygen species, increased DNA damage, decreased SIRT1 protein level and elevated protein levels of VCAM-1, ICAM-1, P53 and P21. Transient knockdown of SIRT1 in HUVECs significantly suppressed the protective effects of FGF21 for the rescue of H2O2-induced premature senescence and DNA damage, which suggests that the anti-senescence effect of FGF21 on HUVECs is SIRT1-dependent. These results support the potential of FGF21 as a therapeutic target for postponing vascular aging and preventing age-related vascular diseases.

To evaluate and compare the value of dynamic multiple pelvic angiography and pelvic four-contrast defecography in the diagnosis of functional defecation disorder.From September 2014 to July 2015, a prospective controlled trial was carried out in Chengdu Anorectal Hospital. A total of 32 patients met the inclusion criteria of functional defecation disorder simultaneously underwent pelvic four-contrast defecography and dynamic multiple pelvic angiography. The diagnostic results of these two methods were compared.The absolute values of anorectal angle and level of perineum, peritoneum and bladder from rest to defecation were (29.6±13.6)°, (26.2±14.2) mm, (55.5±25.6) mm and (28.9±16.5) mm in dynamic multiple pelvic angiography, and (24.6±5.8)° (18.7±10.6) mm, (34.5±18.4) mm and (19.2±11.8) mm in pelvic four-contrast defecography respectively, whose differences were statistically significant (P = 0.026, 0.022, 0.000, 0.011 respectively). The diagnostic rate of pelvic peritoneal hernia was 93.8%(30/32) and 68.8%(22/32) in dynamic multiple pelvic angiography and pelvic four-contrast defecography respectively with significant difference(P=0.011).Dynamic multiple pelvic angiography has significant advantage in the diagnosis of pelvic peritoneal hernia, and can provide a more objective basis for the diagnosis of functional defecation disorder.