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The main content of the 2019 Myasthenia Gravis Foundation of America Scientific Session is summarized, and the main conclusions are presented as follows: Muscle-specific receptor tyrosine kinases antibody positive myasthenia gravis (MuSK-MG) is still the research hot spot in MG research fields, including the clinical researches, the clinical pharmaceutical researches and the fundamental experiment researches. Thymectomy shows safety and effectiveness for acetycholine receptor antibody positive MG (AChR-MG). However, thymectomy needs further discussion about the safety and effectiveness for other types of MG. AChR-MG patients with or without thymoma can benefit from thymectomy. Now there are still no special effective drugs to cure MG, and monoclonal antibody drugs are the hopes for MG patients. With the emergence of different kinds of monoclonal antibodies, MG will be more likely to be conquered. More attention has been paid to the role of B cells′ origin and apoptosis abnormality in the pathogenesis of MG in MG researches.
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Objective Analyze the effect of emergency thrombolytic therapy on door to needle time (DNT) in patients with acute ischemic stroke (AIS) and effect.Method Selected 182 cases of AIS patients underwent intravenous thrombolysis at the First Hospital of Qinhuangdao from May 2015 to June 2017.Thrombolytic therapy group (83 cases),for the May 2015-May 2016 after neurological consultation intravenous thrombolysis patients;Emergency thrombolytic group(99 cases),for the June 2016-June 2017 emergency thrombolysis group Emergency Department of intravenous thrombolysis patients.Compare the two groups of DNT,thrombolytic therapy 24 h symptomatic hemorrhage conversion rate,Thrombolysis 24 h,7 dNIHSS score,7 dthrombolysis and 3 months thrombolysis and thrombolysis 3 months improved Rankin score (mRs).Results There was no significant difference in baseline characteristics between the two groups (P＞0.05).Compared with the consultation group,the DNT[(69.77±11.66)min vs (80.12±15.49) min,t=5.745,P ＜ 0.01] of emergency thrombolytic group was significantly shortened,and the good score[39(39.4％) vs 21(25.3％),x2=4.272,P=0.039] at 3 months after treatment was significantly higher (P＜0.05);Treatment of 24 h intracranial hemorrhage conversion rate[12(12.12％) vs 5(6.02％),x2=1.982,P=0.159]、Treatment 7d mortality rate [10(10.10％) vs 6(7.22％),x2=0.464,P=0.496],3 months mortality rate [14(14.14％) vs 11 (13.25％),x2=0.030,P=0.862]、There was no significant difference in the 24h effective rate [57(57.6％) vs 53(63.8％),x2=0.745,P=0.388] and 7d effective rate [50(50.5％) vs 46(55.4％),x2=0.438,P0.508] after treatment (P＞0.05).Conclusions The emergency thrombolytic model can shorten the DNT of rt-PA intravenous thrombolysis in patients with AIS.The safety and efficacy of DNT are not different from the neurological consultation mode,and can improve the good prognosis rate.
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The authors introduced the hotspots and forefront of 2018 Myasthenia Gravis Foundation of America′s Scientific Session, including the research forefront and trend of the following: International research hotspots in the myasthenia gravis (MG) had been changed from the most common acetylcholine receptor antibody positive MG (AChR-MG) into other subtypes, particularly muscle specific tyrosine kinase receptor antibody positive MG; The efficacy of thymectomy was effective in the whole AChR-MG group, but not in other MG subgroups; Existing drugs in MG treatment can not achieve the expected effect, so endless new drug development had become a hot field of MG research; In terms of basic research, more attention had been paid to exploring the specific mechanisms involved in MG pathogenesis, including the study of antigen specific B cells and even antigen specific T cells.
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The authors introduced the hotspots and forefront of 2018 Myasthenia Gravis Foundation of America′s Scientific Session, including the research forefront and trend of the following:International research hotspots in the myasthenia gravis (MG) had been changed from the most common acetylcholine receptor antibody positive MG (AChR?MG) into other subtypes, particularly muscle specific tyrosine kinase receptor antibody positive MG; The efficacy of thymectomy was effective in the whole AChR?MG group, but not in other MG subgroups; Existing drugs in MG treatment can not achieve the expected effect, so endless new drug development had become a hot field of MG research; In terms of basic research, more attention had been paid to exploring the specific mechanisms involved in MG pathogenesis, including the study of antigen specific B cells and even antigen specific T cells.
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OBJECTIVE@#To investigate the prehospital intervention based on emergency medical services (EMS) in patients with acute ischemic stroke (AIS) for door-to-needle time (DNT) with intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) impact.@*METHODS@#112 emergency patients receiving rt-PA intravenous thrombolysis admitted to the First Hospital of Qinhuangdao City based on EMS from June 2016 to December 2017 were enrolled. According to whether or not to receive prehospital interventions, patients were divided into prehospital intervention group (n = 42) and routine treatment group (n = 70). Both groups followed the general principles of first aid, including assessment and support of the airway, respiration, and circulation, and blood glucose, electrocardiogram, and dynamic vital signs were monitored. Based on the general principle of EMS, first-aid personnel in the prehospital intervention group screened suspected acute stroke patients requiring prehospitalization according to Los Angeles prehospital stroke screening table (LAPSS), and established fluid ways, and got blood samples to evaluate rt-PA intravenous thrombolysis and risks. Factors influenced DNT compliance were analyzed through multivariate Logistic regression, which included the education level of the patient, whether there were risk factors related to cerebrovascular disease (hypertension, coronary heart disease, diabetes), visit time, National Institute of Health stroke scale (NIHSS) score, whether received EMS intervention or not. The average DNT, DNT ≤ 60 minutes compliance rate, communication time, and decision time for thrombolysis were compared between the two groups. NIHSS score was used to evaluate the effective rate of thrombolysis for 7 days. The modified Rankin score (mRs) was used to evaluate the neurological function after 3 months of thrombolysis (a mRs score of 0-2 was defined as a good nerve function).@*RESULTS@#Univariate analysis showed that the DNT of patients with NIHSS score > 5 was significantly shorter than those with NIHSS score ≤ 5, and DNT in patients received EMS intervention was significantly shorter than the non-receiver; but education level, visiting time, and risk factors associated with cerebrovascular disease had nothing to do with DNT. Multivariate Logistic regression analysis showed that NIHSS score and EMS intervention were the influencing factors of DNT compliance [NIHSS score: odds ratio (OR) = 0.452, 95% confidence interval (95%CI) = 0.162-1.263, P = 0.030; EMS intervention: OR = 3.077, 95%CI = 1.260-7.514, P = 0.014]. Compared with conventional treatment group, DNT of intravenous thrombolytic in prehospital intervention group was significantly shortened (minutes: 62.00±11.07 vs. 78.03±21.04), DNT ≤ 60 minutes compliance rate was significantly increased [35.7% (15/42) vs. 12.9% (9/70)], communication time [minutes: 4 (3, 6) vs. 6 (5, 9)] and decision-making thrombolytic time (minutes: 5.81±2.48 vs. 6.70±2.15) were significantly shortened, the differences were statistically significant (all P < 0.05). The 7-day effective rate in the prehospital intervention group [33.3% (14/42) vs. 14.3% (10/70), χ2 = 5.657, P = 0.017] and the 3-mouth good rate of nerve function [38.1% (16/42) vs. 14.3% (10/70), χ2 = 10.759, P = 0.001] were significantly higher than those in the conventional treatment group.@*CONCLUSIONS@#Prehospital interventions based on EMS can shorten DNT of intravenous thrombolysis in the patients with AIS, improve treatment efficiency, and improve prognosis.
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Humans , Brain Ischemia , Emergency Medical Services , Stroke , Thrombolytic Therapy , Tissue Plasminogen Activator , Treatment OutcomeABSTRACT
Objective@#To investigate the prehospital intervention based on emergency medical services (EMS) in patients with acute ischemic stroke (AIS) for door-to-needle time (DNT) with intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) impact.@*Methods@#112 emergency patients receiving rt-PA intravenous thrombolysis admitted to the First Hospital of Qinhuangdao City based on EMS from June 2016 to December 2017 were enrolled. According to whether or not to receive prehospital interventions, patients were divided into prehospital intervention group (n = 42) and routine treatment group (n = 70). Both groups followed the general principles of first aid, including assessment and support of the airway, respiration, and circulation, and blood glucose, electrocardiogram, and dynamic vital signs were monitored. Based on the general principle of EMS, first-aid personnel in the prehospital intervention group screened suspected acute stroke patients requiring prehospitalization according to Los Angeles prehospital stroke screening table (LAPSS), and established fluid ways, and got blood samples to evaluate rt-PA intravenous thrombolysis and risks. Factors influenced DNT compliance were analyzed through multivariate Logistic regression, which included the education level of the patient, whether there were risk factors related to cerebrovascular disease (hypertension, coronary heart disease, diabetes), visit time, National Institute of Health stroke scale (NIHSS) score, whether received EMS intervention or not. The average DNT, DNT ≤ 60 minutes compliance rate, communication time, and decision time for thrombolysis were compared between the two groups. NIHSS score was used to evaluate the effective rate of thrombolysis for 7 days. The modified Rankin score (mRs) was used to evaluate the neurological function after 3 months of thrombolysis (a mRs score of 0-2 was defined as a good nerve function).@*Results@#Univariate analysis showed that the DNT of patients with NIHSS score > 5 was significantly shorter than those with NIHSS score≤5, and DNT in patients received EMS intervention was significantly shorter than the non-receiver; but education level, visiting time, and risk factors associated with cerebrovascular disease had nothing to do with DNT. Multivariate Logistic regression analysis showed that NIHSS score and EMS intervention were the influencing factors of DNT compliance [NIHSS score: odds ratio (OR) = 0.452, 95% confidence interval (95%CI) = 0.162-1.263, P = 0.030; EMS intervention: OR = 3.077, 95%CI = 1.260-7.514, P = 0.014]. Compared with conventional treatment group, DNT of intravenous thrombolytic in prehospital intervention group was significantly shortened (minutes: 62.00±11.07 vs. 78.03±21.04), DNT≤60 minutes compliance rate was significantly increased [35.7% (15/42) vs. 12.9% (9/70)], communication time [minutes: 4 (3, 6) vs. 6 (5, 9)] and decision-making thrombolytic time (minutes: 5.81±2.48 vs. 6.70±2.15) were significantly shortened, the differences were statistically significant (all P < 0.05). The 7-day effective rate in the prehospital intervention group [33.3% (14/42) vs. 14.3% (10/70), χ2 = 5.657, P = 0.017] and the 3-mouth good rate of nerve function [38.1% (16/42) vs. 14.3% (10/70), χ2 = 10.759, P = 0.001] were significantly higher than those in the conventional treatment group.@*Conclusion@#Prehospital interventions based on EMS can shorten DNT of intravenous thrombolysis in the patients with AIS, improve treatment efficiency, and improve prognosis.
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Objective To develop a highly sensitive luminescent reagent for bloodstain testing at forensic crime scenes.Methods Based ontheprincipleof ECL luminescence and the ping-pong conjugate activation principle of chemical electronic chain,this project developed a new type of highly sensitive luminescent reagent for bloodstain testing by usingthe uniform design of experimental methods to optimize the conditions andsynthesize several new compounds.Results The bloodstain testing luminescent reagentdeveloped in this project has high sensitivity andlongluminescence time.In the case of blood samples diluted by 1,000 times,reading the fluorescence withChemiScope 3300 chemiluminescence imaging system,the maximumvalue of gray scale reached 56,and the luminescence time lasted for 10 minutes.Conclusion The project has successfully developed a highly semitivebloodstain testing reagentthat could be applied to crime scene investigation.
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Objective:To investigate the feasibility and accuracy of osmometer in the osmolarity measurement of pirenoxinun sodi-um eye drops. Methods:An osmometer was used to measure the osmolarity of pirenoxinun sodium eye drops, and the stability of the osmolality was studied. Results:The osmolarity of pirenoxinun sodium eye drops with different formula conformed to the requirement of ophthalmic preparations. The osmolality showed no significant change at the ambient temperature, indicating the stability of the prepa-ration. Conclusion:The method is simple, rapid and practical, which can be used as the osmolarity measurement method for pirenoxi-nun sodium eye drops.
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Objective To determine the real time radiation dose rate displayed on DSA equipment in interventional management for patients with coronary heart disease in order to provide medical staff with useful basis to reasonably control the radiation dose. Methods A total of 30 patients with coronary heart disease, who received interventional treatment at authors’ hospital in September 2014 with a GE DSA unit, were randomly selected. Intraoperative radiation dose rates when fluoroscopy was converted to movies , which were displayed on DSA at respective sequence, were determined, and the results were analyzed and compared. Results The fluoroscopy radiation dose rate ranged from 18.5 to 212.0 mGy/min, the mean value was (114.7±42.1) mGy/min;while the radiation dose rate of movies varied from 216 to 1 691 mGy/min, with a mean value of(970.1±298.4) mGy/min. The overall mean fluoroscopy-to-movies radiation dose ratio was 1 ∶8.5. The larger the digital flat panel detector area was , the bigger the mean radiation dose rate would be and the more obvious increase in the mean radiation dose rate of movies than that of the fluoroscopy would be observed; the mean radiation dose rate of fluoroscopy was lower than that of movies , and the difference was significantly. Conclusion During the performance of coronary intervention , the medical staff should make reasonable choice of the equipment and closely observe the dynamic real-time display of the radiation dose rate, promptly adjust the inspection mode and the controllable parameters when it is needed , make immediate evaluation of dose level that might cause radiation injury to the patient , and reasonably control the radiation dose to reduce the effects of ionizing radiation on human health.
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Objective To observe the effect of intensive insulin therapy (ⅡT) on prognosis of severe chest trauma (SCT) pateints.Methods 42 consecutive patients were randomly assigned to 2 groups:ⅡT group (n =21) and the conventional insulin therapy group (CIT group,n =21).Blood glucose was maintained at the level of 4.4 -6.1mmol/L in ⅡT group,and 10.0 -11.1mmol/L in CIT group.The 2 groups were observed in terms of fatality rate during hospital stay,infection rate,the duration of mechanical ventilation,ICU stay length,pleural drainage day and count of neutrophils.Results No death or hypoglycemic reaction happened during hospitalization.Compared to CIT group,infenction rate,mechanical ventilation time,ICU stay length,and the time required for white blood cell to resume normal in ⅡT group were decreased significantly ( P ＜ 0.05 ).The difference had no statistical significance between the 2 groups in duration of pleural drainage and incidence of hypoglycemia (P ＞ 0.05).Conclusion ⅡT improves the short-term prognosis of SCT patients.
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Angiostatin(AS) and endostatin(ES) are both potent endogenous angiogenesis inhibitors, and the combination of AS and ES has been shown to have synergistic antiangiogenic effects. Here we report the fusion protein AS-ES expressed in E. coli which has antiangiogenic effects. At first, AS and ES genes were cloned respectively through RT-PCR, then fusion gene was made through gene splicing ,finally pET-42 (b)/AS-ES expression plasmid was constructed and transduced in E. coli BL21 (DE3). Target protein was in form of inclusion body,the rate of expression was about 14%, and MW about 65KD. Western blotting assay showed expressed protein had specific immune reaction to both the antibodies of AS and ES. The expressed protein which was refolded and purified through heparin affinity chromatography had antiangiogenic effect to vessels on chicken embryo chorioallantoic membrane. The results show that fusion protein AS-ES was expressed successfully in E. coli, and the expressed protein,which was renatured and purified, had immuno-reactivity to anti-AS and anti-ES in Western blotting and angiogenesis inhibition activity.
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Animals , Chick Embryo , Angiogenesis Inhibitors , Angiostatins , Genetics , Pharmacology , Blotting, Western , Endostatins , Genetics , Pharmacology , Escherichia coli , Genetics , Metabolism , Plasmids , Genetics , Recombinant Fusion Proteins , Genetics , Pharmacology , Recombination, Genetic , Reverse Transcriptase Polymerase Chain Reaction , TransfectionABSTRACT
Objective To investigate the relationship between cerebrospinal fluid (CSF) changes and prognosis in patients with neurosyphilis.Methods The CSF and the clinical data of 55 syphilis patients were analysed retrospectively,including 30 neurosyphilis cases and 25 syphilis cases during incubation period.The CSF leukocyte, protein and pressure of the two groups were measured,meanwhile, rapid plasma regain circle card(RPR) and treponema pallidum particle assay (TPPA) were simultaneous determination. All cases were treated with penicillin G normally during the whole range.Two groups of patients were followed-up by telephones or outpatient department in two year and the prognosis were evaluated. Function Independent Measure (FIM) were scored at the same time.Results The seum RPR and TPPR in two group patients were all positivity CSF leukocyte and protein were higher in neurosyphilis than that of in syphilis incubation period, There was significant difference between the two groups (all P
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Objective To analyze the typing and clinical characteristics of neurosyphilis and provide evidences to improve early diagnostic.Methods Retrospective study of 18 cases of neurosyphilis was performed.Results Acute or subacute onset was observed in most cases; The interstitial neurosyphilis was the commonest, of which the clinical features varied widely and arose primarily from corresponding vascular infarctions; CSF examination revealed increase in pressure, protein and cells.TPHA and RPR were of the highest specificity among the serologic indexes;CT/MRI findings of brain revealed multiple, asymmetrical lesions which were different from those of infarctions caused by hypertension or arteriosclerosis.Conclusion Misdiagnosis rate is high at the initial reception.The clinical manifestations of neurosyphilis are closely related to pathological types. The lab tests and radiological findings are important clues to early diagnosis.