Rare Manifestations of Common Diseases: Middle-Aged Male Polyuria-Headache-Inflammatory Granulomatous Lesions / 罕见病研究

A middle-aged man was presented with poor appetite, polyuria, polydrpsia, and headache. A sellar mass was found, along with total pituitary hypofunction and visual field defect. A biopsy of the lesion via the trans-sphenoidal approach showed inflammatory changes and granuloma formation. However, repeated cerebrospinal fluid and pathogenic examination of the pathological tissue showed no positive indications. The initial diagnosis considered autoimmune hypophysitis, and treatment of glucocorticoids combined with immunosuppressants was administered, which led to a temporary shrinkage of the lesion, but it gradually enlarged subsequently. After multidisciplinary discussion, a high possibility of pituitary tuberculosis infection was decided upon. After standardized anti-tuberculosis treatment was initiated, the lesion reduced noticeably and the patient′s condition improved. Pituitary tuberculosis infection is incredibly rare and extremely easy to misdiagnose. This case was diagnosed and treated in a timely and effective manner through a multidisciplinary approach, highlighting the importance of such an approach in dealing with rare diseases.

Experience of Professor You Zhaoling in Application of the Lotus Medicinal Herbs for Reproductive System Diseases / 中医杂志

Lotus medicinal herbs have the effects of resolving blood stasis and stopping bleeding， invigorating the spleen and benefiting the kidneys， restoring coordination between heart and kidney， and tranquilizing the fetus. Lotus root， lotus leaf， lotus seed， Lotus plumule， Shilianzi（Nelumbo nucifera Gaertn） and other lotus herbs are used to treat various female reproductive system diseases. For example， lotus leaf tip with modified Youshi Pangxing Shuangtu Decoction （伍尤氏胖型双土汤）， lotus root section with modified Youshi Shouxing Shuangteng Decoction （尤氏瘦型双藤汤） were used for polycystic ovary syndrome； Youshi Yangchao Formula （尤氏养巢方） （containing lotus seed）， Gengnian Formula （更年方） （containing lotus plumule） for ovarian reserve dysfunction； Lotus seed - Shihu （Dendrobium nobile） as the herb-pair， lotus stamen with ginseng flowers and Sanqi Flower for thin endometrium； Shilianzi（Nelumbo nucifera Gaertn）， lotus leaf tip， lotus stamen， lotus seed， lotus room， lotus root section can be used for premature abortion， and we summarized the characteristics of clinical medication， compounding experience， drug dosage and precautions of each lotus drug in different diseases.

Anti-Leucine-Rich Glioma-Inactivated 1 Encephalitis: A Single-Center Cohort Study in China / 罕见病研究

  Objective  To evaluate the clinical and paraclinical features of Chinese patients with anti- LGI1 encephalitis.  Methods  Patients with memory deficits, psychiatric symptoms, seizures or altered level of consciousness, suspicious of encephalitis, at presentation to Peking Union Medical College Hospital were recruited between July 2013 and January 2018, and tested for anti-LGI1 antibodies in their serum and/or cerebrospinal fluid(CSF) samples. Patients with anti-LGI1 antibodies were enrolled. The demographic characteristics, clinical manifestations, laboratory examination results, neuroimaging features, immunotherapy, follow-up practices and outcomes for included patients were registered and analyzed.  Results  The study enrolled 120 patients, of whom 66.7% were male. The median age was 61 years (interquartile range [IQR]: 49-66 years). Seizures(65.0%) were the most common initial symptoms. Most patients developed seizures (95.0%), including faciobrachial dystonic seizures (54.2%), memory deficits (92.5%), and psychiatric symptoms (69.1%). Brain MRI and 18F-FDG PET / CT showed that the lesions were mainly located in unilateral or bilateral medial temporal lobes, and (or) basal ganglia. Of the patients, 95.0% received intravenous immunoglobulin (IVIg) or corticosteroids, 47.5% received mycophenolate mofetil as long-term immunotherapy, and no one received second-line immunotherapy. The median follow-up was 34.2 months(IQR: 22.0-45.6 months). 91.2% had a good outcome (modified Rankin Scale score≤2 points). Residual mild memory deficits were present in 47.8% of the patients. Nine deaths were documented. Relapses occurred in 24.8% of the patients in the first year. In total, 24 (20%)cases were young patients(onset age ≤45 years).There were fewer males among the younger patients(37.5% vs. 74.0%, P < 0.01). Besides, there were fewer younger patients with psychiatric symptoms(50.0% vs. 74.0%, P=0.02), hyponatremia(33.3% vs. 68.8%, P < 0.01), and abnormalities on brain 18F-FDG PET/CT(20.8% vs. 47.9%, P=0.02). The relapse-free survival rate was significantly higher in the young patients.  Conclusions  Elderly males were predominant in patients with anti-LGI1 encephalitis. Most patients developed symptoms of limbic encephalitis and/or FDBS during the disease course. Several patients were young adults and lacked typical symptoms. Neuroimaging features were consistent with the involvement of limbic system or basal ganglia. Patients with anti-LGI1 encephalitis respond well to immunotherapy, irrespective of the age.

Erdheim-Chester Disease: Case Report / 罕见病研究

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by the infiltration of bone and multiple organs by foamy lipid-laden histiocytes. ECD is easy to be misdiagnosed due to its complicated clinical manifestations. We report a patient who visited the hospital due to hypothalamic dysfunction, with central nervous system, pancreas, and lower limb bones involvements. Together with the evidence of clinical manifestations, imaging and pathology, this patient was diagnosed with ECD. After treatment with interferon-α, both the clinical symptoms and imaging manifestations of this patient were significantly improved.

Research progress of referral after screening for mild cognitive impairment in older adults / 中华老年医学杂志

The prevalence of mild cognitive impairment(MCI) is increasing.Screening and early intervention on MCI patients can effectively delay the course of the disease and improve the outcome.However, the visit rate of MCI in China is less than 4‰, and the majority of the patients did not receive the relevant health services.The referral is the key steps between patient screening and getting the follow-up health service, which is currently the weakest link.This review discusses the status of referral after MCI screening in recent years, summarizes and analyzes the factors influencing the referral from three aspects of the recipients, donors and environment.We also summarized interventions to improve the referral rate, which provided the theoretical foundation for improving the medical behavior in patients with MCI, so as to make patients receive proper treatment and care for reducing the country-related burden of disease.

Mediating effect of general self-efficacy between stress coping personality and perceived professional benefits among nursing interns / 中国职业医学

OBJECTIVE: To explore the mediating effect of the general self-efficacy(GSE), stress coping personality(SCP) and perceived professional benefits(PPB) among nursing practice students. METHODS: A total of 836 nursing interns from six grade A hospitals in six cities were selected as the research subjects using convenience sampling method. The GSE, SCP and PPB were investigated by the General Self-Efficacy Scale, Scale of Stress Coping Personality for College Students and Questionnaire of Nurses Perceived Professional Benefit. RESULTS: The average scores of GSE, SCP, and PPB were(24.6±5.8),(183.1±28.7) and(139.5±18.0), respectively. The scores of GSE and SCP were positively correlated with that of PPB [correlation coefficients(r) were 0.31 and 0.38 respectively, both P<0.01], and a positive correlation was found between GSE and SCP(r=0.41, P<0.01). The hierarchical regression results showed that the sense of control, tenacity and tolerance of SCP of the interns had a predictive effect on their PPB(all P<0.05); but the effect of SCP on PPB was weakened after inclusion of GSE(P<0.01). The structural equation model analysis results showed that both SCP and GSE of interns had a direct positive predictive effect on PPB(all P<0.01), GSE played a partial mediating role between SCP and PPB, accounting for 20.3% of the total effect. CONCLUSION: The SCP of nursing interns can directly or indirectly affect their PPB, and GSE plays a partial mediating effect between SCP and PPB.

Regulation and mechanism of hypothalamic inflammation on obesity / 中华内分泌代谢杂志

Many studies of the etiology and intervention for obesity have gradually focused on the brain, trying to curb the occurrence of obesity from the source. Hypothalamic inflammation has been a concern and an unresolved scientific issue in the development of obesity. Studies have shown that hypothalamic inflammation not only impairs energy balance, but also increases obesity-related insulin and leptin resistance, further promotes peripheral tissues storing up fat cells, eventually leads to the development of obesity. In addition, hypothalamic inflammation occurs before weight-gain and peripheral tissue inflammation with high-fat diets. Therefore, more and more scholars believe that hypothalamic inflammation is an important cause of dietary-induced metabolic abnormalities. The occurrence of hypothalamic inflammation is mainly accompanied by a series of complex and rapidly-activated glial, including microglia, astrocytes, and tanycyte. These cells are responsible for maintaining hypothalamic metabolic homeostasis and making up the important components of the regulatory network. Moreover, multiple teams also found that a variety of weight-loss methods(e.g. bariatric surgery, targeted drugs, fecal microbiota transplantation, and so on) can improve hypothalamic inflammation levels. Therefore, it is important to understand the mechanism of hypothalamic inflammation through different neurons, which is expected to find a more effective and safer solution to intervene and treat obesity in the future.

Comparison of cognitive function between patients with hemodialysis and peritoneal dialysis / 中华肾脏病杂志

Objective:To evaluate whether dialysis modality will affect cognitive function in dialysis population.Methods:This was a cross-sectional study. Chronic dialysis patients in our center was screened from July 2013 to July 2014. All of the subjects received brain magnetic resonance imaging (MRI) examination and comprehensive cognitive function evaluation.Results:A total of 189 chronic dialysis patients were enrolled in this study, 122 cases on hemodialysis (HD) and 67 cases on peritoneal dialysis (PD). There was no significant difference in age between HD and PD groups [(56.4±13.2) years vs (56.4±16.1) years, t=0.004, P=0.997]. The dialysis vintage and serum albumin of HD patients was higher than those of PD patients[58.0(16.8, 107.5) months vs 31.0(7.0, 67.0) months, Z=-3.490, P<0.001; (39.6±3.9) g/L vs (35.3±3.8) g/L, t=7.328, P<0.001, respectively]. The prevalence of cerebral small vessel diseases (CSVDs) was comparable between HD and PD groups (all P>0.05). Compared with HD patients, PD patients presented a 11.90-fold risk of immediate memory impairment (95% CI 1.40-101.08, P=0.023) and a 6.18-fold risk of long-delayed memory impairment (95% CI 2.12-18.05, P=0.001). After adjusting for age, educational lever, dialysis vintage, serum creatinine, and CSVDs, the influence of dialysis modality on memory still worked. PD patients presented a 43% risk of executive function impairment of HD patients ( OR=0.43, 95% CI 0.17-1.04, P=0.061). Conclusions:HD patients manifested better memory than PD patients, while PD probably performed better in executive function than HD patients. There was no significant difference in language function between the two groups. The difference in cognitive function may not be related to CSVDs.

Regulation and mechanism of hypothalamic inflammation on obesity / 中华内分泌代谢杂志

Many studies of the etiology and intervention for obesity have gradually focused on the brain, trying to curb the occurrence of obesity from the source. Hypothalamic inflammation has been a concern and an unresolved scientific issue in the development of obesity. Studies have shown that hypothalamic inflammation not only impairs energy balance, but also increases obesity-related insulin and leptin resistance, further promotes peripheral tissues storing up fat cells, eventually leads to the development of obesity. In addition, hypothalamic inflammation occurs before weight-gain and peripheral tissue inflammation with high-fat diets. Therefore, more and more scholars believe that hypothalamic inflammation is an important cause of dietary-induced metabolic abnormalities. The occurrence of hypothalamic inflammation is mainly accompanied by a series of complex and rapidly-activated glial, including microglia, astrocytes, and tanycyte. These cells are responsible for maintaining hypothalamic metabolic homeostasis and making up the important components of the regulatory network. Moreover, multiple teams also found that a variety of weight-loss methods(e.g. bariatric surgery, targeted drugs, fecal microbiota transplantation, and so on) can improve hypothalamic inflammation levels. Therefore, it is important to understand the mechanism of hypothalamic inflammation through different neurons, which is expected to find a more effective and safer solution to intervene and treat obesity in the future.

Analysis of high risk factors and prognosis of patients with ventilator associated pneumonia treated with mechanical ventilation in ICU / 中国基层医药

Objective@#To analyze the high risk factors and prognosis of patients with ventilator associated pneumonia(VAP) treated with mechanical ventilation(MV) in Intensive Care Unit(ICU), and to provide theoretical evidence for effective treatment and prevention.@*Methods@#From January 2015 to January 2017, 156 MV patients treated in ICU of Shaoxing Municipal Hospital were enrolled retrospectively.According to the occurrence of VAP, the patients were divided into VAP group(76 cases) and non-VAP group(80 cases). The data including sex, age, ICU time, MV time, cases of withdrawing machine failure, prognosis, serum albumin, blood glucose levels, APACHE Ⅱ score, types of antibiotics and days of continuous applying were recorded.Single factor χ2 test and multiple factor logistic regression analysis were used to analyze the high-risk factors and prognosis related to occurrence of VAP.@*Results@#Univariate analysis showed that the age, mortality, serum albumin and blood glucose levels, MV time, weaning failure rate, APACHE Ⅱ score, antibiotic combination type and days of continuous use, application of H2 receptor antagonists time between, the VAP group and non-VAP group had statistically significant differences (χ2=6.568, 16.558, 5.132, 5.896, 27.043, 15.018, 48.863, 46.752, 27.431, 3.981, P=0.010, 0.000, 0.023, 0.015, 0.000, 0.000, 0.000, 0.000, 0.000, 0.046). After age adjustment, logistic regression analysis showed that serum albumin <30g/L, blood glucose ≥7.8mmol/L, MV time >5 days, APACHE Ⅱ score>15 points, antibiotics continuous use>3 days, and antibiotic combination type>2 were independent risk factors for VAP(χ2=5.115, 5.984, 21.252, 18.043, 9.008, 14.545, P=0.030, 0.026, 0.000, 0.000, 0.007, 0.001). Compared with surviving patients with VAP, death patients lived longer in ICU and MV, and APACHE Ⅱ scores were higher(t=4.136, 6.382, 7.312, P=0.000, 0.000, 0.000).@*Conclusion@#There are multiple high-risk factors of VAP in patients treated with MV in ICU.The death demonstrated longer ICU time, MV time and higher APACHE Ⅱ score, need to be strengthened monitoring, early prevention and treatment.

Analysis of high risk factors and prognosis of patients with ventilator associated pneumonia treated with mechanical ventilation in ICU / 中国基层医药

Objective To analyze the high risk factors and prognosis of patients with ventilator associated pneumonia(VAP) treated with mechanical ventilation(MV) in Intensive Care Unit(ICU),and to provide theoretical evidence for effective treatment and prevention. Methods From January 2015 to January 2017,156 MV patients treated in ICU of Shaoxing Municipal Hospital were enrolled retrospectively.According to the occurrence of VAP,the patients were divided into VAP group(76 cases) and non-VAP group(80 cases).The data including sex,age,ICU time,MV time, cases of withdrawing machine failure, prognosis, serum albumin, blood glucose levels, APACHE Ⅱscore,types of antibiotics and days of continuous applying were recorded. Single factor χ2 test and multiple factor logistic regression analysis were used to analyze the high-risk factors and prognosis related to occurrence of VAP. Results Univariate analysis showed that the age, mortality, serum albumin and blood glucose levels, MV time, weaning failure rate,APACHE Ⅱ score,antibiotic combination type and days of continuous use,application of H2 receptor antagonists time between,the VAP group and non-VAP group had statistically significant differences (χ2 =6.568,16.558,5.132,5.896,27.043,15.018,48.863,46.752,27.431,3.981,P=0.010,0.000,0.023,0.015, 0.000,0.000,0.000,0.000,0.000,0.046). After age adjustment,logistic regression analysis showed that serum albumin <30g/L, blood glucose ≥7. 8mmol/L, MV time >5 days, APACHE Ⅱ score >15 points, antibiotics continuous use>3 days, and antibiotic combination type >2 were independent risk factors for VAP ( χ2 =5.115, 5.984,21.252,18.043,9.008,14.545,P=0.030,0.026,0.000,0.000,0.007,0.001).Compared with surviving patients with VAP, death patients lived longer in ICU and MV, and APACHE Ⅱ scores were higher ( t =4.136, 6.382,7.312,P=0.000,0.000,0.000).Conclusion There are multiple high-risk factors of VAP in patients treated with MV in ICU.The death demonstrated longer ICU time,MV time and higher APACHEⅡscore,need to be strengthened monitoring,early prevention and treatment.

Effects of Exendin-4 on the differentiation of neural stem cells from subventricular zone of adult mice in vitro / 中国应用生理学杂志

OBJECTIVE@#To study the effect of exendin-4(Ex-4) on the differentiation of neural stem cells(NSCs) in adult mouse subventricular zone(SVZ)and its mechanism .@*METHODS@#NSCs in the SVZ were derived from 5-week C57BL/6J mice and the expression of nestin was detected by immunofluorescence. The cell morphology was observed after the cells treatmed with 100 nmol/L Ex-4 for 14 days.The expressions of nestin and glucagon-like peptide-1 receptor (GLP-1R) were detected by immunofluorescence. GLP-1R was knocked down by using shRNA and the study was divided into four groups: control group, Ex-4 group, GLP-1R knockdown group, GLP-1R knockdown + Ex-4 group. After treatment with 100 nmol/L Ex-4 for 14 d, β-tublin III and glial fibrillary acidic protein (GFAP) were labeled by immunofluorescence and then the proportion of β-tublin III positive cells were counted. Western blot was used to detect the activation of cAMP-response element binding protein (CREB) in NSCs. In order to further study the effects of Ex-4 on mitogen-activated protein kinase(MAPK) and phosphatidylinositol 3-hydroxy kinase (PI3K) pathways, the cells were pretreated with MAPK inhibitor U0126 at a concentration of 0.07 μmol/L for 30 min or PI3K inhibitor LY294002 at 50 μmol for 2 h, respectively. The study was divided into six groups: control group, Ex-4 group, U0126 group, U0126 + Ex-4 group, LY294002 group, LY294002 + Ex-4 group. The activation of CREB in each group was detected by Western blot. The experiment was repeated three times independently.@*RESULTS@#NSCs were successfully extracted from SVZ of C57BL/6J mice. Immunofluorescence showed that nestin and GLP-1R were positive in NSCs. Compared with the control group, the proportion of neurons differentiated from Ex-4 group was higher. The percentage of neurons in GLP-1R knockdown + Ex-4 group was basically the same as that in control group (P＜0.01). The positive cells of beta-tublin III showed positive activation of GLP-1R and CREB. Western blot showed that CREB was significantly activated in the Ex-4 group, and knockdown of GLP-1R abolished its activation (P＜0.01). U0126 did not affect Ex-4-mediated CERB activation, and LY294002 significantly reduced Ex-4-mediated CREB activation (P＜0.01).@*CONCLUSION@#Ex-4 promotes the differentiation of NSCs into neurons in SVZ of adult mice through GLP-1R receptor, which may be achieved through PI3K/CREB pathway.

Field molluscicidal effect of water-free formulations of niclosamide ethanolamine salt against Oncomelania hupensis snails in a marshland / 中国血吸虫病防治杂志

To evaluate the molluscicidal effects of various water-free formulations of niclosamide ethanolamine salt against Oncomelania hupensis in the field of marshlands along the Yangtze River.The river beach with O. hupensis snails were selected as the test field in the marshland along the Yangtze River in Pukou District, Nanjing City. A molluscicidal experiment was carried out by the mechanical dusting method with the dustable powder (DP), powder-granule (PG), granule (GR) of niclosamide ethanolamine salt respectively. The snail mortality, corrected mortality, and the reduced rate of snails’ density were parallel compared among DP, PG and GR.On the 3rd day after the dusting, the snail mortality rates were 66.67%, 67.24%, and 66.87% in the DP, PG, and GR groups respectively, on the 7th day after the dusting, the snail mortality rates were 75.36%, 79.73%, and 73.97% in the DP, PG, and GR groups respectively, and there was no significant difference among the groups (χ2 = 0.006, 0.895, both P > 0.05). On the 15th day after the dusting, the snail mortality rates were 86.92%, 72.86%, and 71.43% in the DP, PG, and GR groups respectively, and there was a significant difference among the groups (χ2 = 9.709, P < 0.01). The snail mortality in the DP group was significantly higher than that in the PG, and GR groups. The curves of the snail corrected mortality and reduced rate of snails’density presented steadily rising trends in the DP group, but presented falling trends in the PG and GR groups on the 15th day after the dusting.The molluscicidal effect of DP is stable and effective in the marshland along the Yangtze River, but the drift of the powder is still not effectively controlled. It is necessary that the different dosage forms are perfected.

Value of quantitative midbrain measurement in differentiating progressive supranuclear palsy from Parkinson's disease and multiple system atrophy / 中华神经科杂志

Objective To evaluate the effectiveness of quantitative midbrain measurements in differentiating progressive supranuclear palsy (PSP) from multiple system atrophy (MSA) and Parkinson's disease (PD).Methods Quantitative midbrain measurements,including midbrain width (MW),midbrain to pons ratio (M/P) and magnetic resonance parkinsonism index (MRPI),were performed in patients with parkinsonism who were diagnosed in the Movement Disorder Clinic of Peking Union Medical College Hospital during the period of January to September 2017.A cross-sectional study was conducted in the series to evaluate the effectiveness of these quantitative measurements.Results Ten PSP-RS,15 MSA-P and 49 PD patients were included in this study.The values of MW,M/P and MRPI in PSP-RS patients were (8.21 ± 1.30) mm,0.49 ±0.06 and 15.26 ±4.53,respectively,with statistically significant difference compared toMSA-P ((10.24±0.77) mm,0.65 ±0.09,7.75 ±2.71) and PD patients ((10.53 ±0.93) mm,0.62±0.06,9.86 ±2.46;F=24.27,18.37,21.47,all P＜0.01).After adjusting for age,disease course and gender,analysis of covariance suggested significant correlation between the quantitative midbrain measurements and diagnosis of these diseases.Receiver operating characteristic curve indicated that MW ≤9.4 mm,M/P≤0.57 and MRPI ＞ 10.77 showed ideal sensitivity and specificity (90.0％ and 92.1％,80.0％ and 93.7％,100.0％ and 82.5％) in differentiating PSP-RS from MSA-P and PD.Conclusion Quantitative measurement of midbrain atrophy is useful in differentiating PSP-RS from MSA-P and PD.

The importance of serum IL-1β,TNF-α in diabetic retinopathy patients with hyperuricemia / 国际检验医学杂志

Objective To detected the levels of inflammatory markers in diabetic retinopathy (DR) patients with hyperuricemia(HUA) ,and to investigated the relationship between diabetic retinopathy and hyperurice-mia .Methods 190 DR patients were enrolled in to our study at January 2016 to June 2017 ,patients were di-vided into group of diabetic retinopathy with hyperuricemia (HUDR group) and group of diabetic retinopathy (DR group) according to level of serum UA ,and selected diabetes mellitus patient (DM group) and health per-son(HC group) as control group .Detected serum interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α) levels of participants and statistical analysis .Results The IL-1β and TNF-α levels have significant difference between HUDR group ,DR group ,DM group and HC group ,the difference was statistically significant (P＜0 .05) ;Among them ,the levels of IL-1β 、TNF-α in HUDR group was significantly higher than that of DR group ,DM group and HC group ,and the difference was statistically significant (P＜0 .05) .The proportion of proliferative retinopathy in group HUDR was 42 .1%,was significantly higher DR group which was 27 .4%, the difference was statistically significant (P＝0 .033) .Serum UA level was positively corrected to IL-1β(r＝0 .356 ,P＝0 .000) and TNF-α(r＝0 .660 ,P＝0 .000) levels of HUDR patients .Logistic regression analysis re-veal that UA(OR :1 .857 ,95% CI :1 .123-3 .229) ,IL-1β(OR :2 .124 ,95% CI :1 .336-3 .715) and TNF-α(OR :1 .673 ,95% CI :1 .108 -2 .275) were independent risk factors of diabetic retinopathy .Conclusion There are higher levels of IL-1β and TNF-α in diabetic retinopathy patients with hyperuricemia ,hyperuricemia may pro-mote the progression of diabetic retinopathy and hyperuricemia is an independent risk factor of the disease .

Development of Microchip Electrophoresis and Its Applications in Ion Detection / 分析化学

Microchip electrophoresis is emerging as a highly promising method for portability and fast analysis with minimum amount of analytes. This paper reviewed the recent development of microchip electrophoresis, and discussed the structures,materials,processing technologies,surface modification,experimental methods, and application on ion detection. The existing issues and prospects of future study were also discussed.

Unusual Isolated Sellar Spindle Cell Carcinoma:Report of One Case / 中国医学科学院学报

Sellar malignant tumors are uncommon and usually reported as metastatic diseases from breast or lung cancers. Spindle cell carcinoma (SCC) is a rare malignancy and has been found in breast,oral cavity,lungs,kidneys,and hepatobiliary pancreatic system but not in sellar region. We report here the first case of isolated sellar SCC with aggressive features in Peking Union Medical College Hospital. This patient was referred to our hospital on September 9,2015 and discharged on October 16,2015. We described the clinical manifestations,imaging findings,and pathological features of this rare disease.

Comparison of Shaker Exercise and Chin Tuck Against Resistance Exercise for Radiation-induced Dysphagia after Nasopharyngeal Carcinoma / 中国康复理论与实践

@#Objective To compare the effect of Shaker exercise and Chin Tuck Against Resistance(CTAR)exercise on dysphagia after radiotherapy for nasopharyngeal carcinoma(NPC).Methods From August,2015 to February,2017,90 patients with dysphagia after radio-therapy for NPC were randomly divided into control group,Shaker group and CTAR group equally.The control group received routine swal-lowing training,while the Shaker group accepted Shaker exercise and CTAR group accepted CTAR exercise in addition.They were assessed with Penetration-Aspiration Scale under video fluoroscopic swallowing study(VFSS)before,and two weeks,four weeks and six weeks af-ter exercise.Results There was no significant difference in VFSS score among the three groups before intervention(F=0.551,P>0.05).The score decreased after intervention in Shaker group and CTAR group(F>5.317,P<0.001),but varied less in the control group(F=1.774,P>0.05).However,it was less in Shaker group and CTAR group than in the control group(P<0.001),and it was not significantly different be-tween Shaker group and CTAR group after 4 weeks and 6 weeks of intervention (P>0.05).The total effective rate was 86.67% in CTAR group and 76.67% in Shaker group,that was significantly higher than 43.33% in the control group(χ2>2.079,P<0.05),and it was not signifi-cantly different between Shaker group and CTAR group(P>0.05).Conclusion CTAR exercise is effective on dysphagia after radiotherapy for NPC,which is similar to those of Shaker exercise,and more acceptable and easier to persist.

Advances in Evaluation of Cognitive Impairment in Patients with Cushing's Disease / 中国医学科学院学报

Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions.

Cerebrospinal Fluid Biomarkers in Dementia Patients with Cerebral Amyloid Angiopathy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To study the changes of biomarkers in cerebrospinal fluid (CSF) in cerebral amyloid angiopathy (CAA) dementia and Alzheimer(')s disease.</p><p><b>METHODS</b>Levels of amyloid protein β (Aβ42, Aβ40) and phosphorylated Tau-protein (P-tau) in CSF and ratio of Aβ42/Aβ40 were tested in 5 cases with CAA dementia and 20 cases with Alzheimer's disease collected at Peking Union Medical College Hospital from December 2001 to March 2011.</p><p><b>RESULTS</b>The levels of Aβ42, Aβ40, and P-tau in CSF and ratio of Aβ42/Aβ40 were (660.4 ± 265.2) ng/L, (7111.0 ± 1033.4) ng/L, (71.8 ± 51.5) ng/L, and 0.077 ± 0.033, respectively in CAA dementia and (663.6 ± 365.6) ng/L, (5115.0 ± 2931.1) ng/L, (47.7 ± 38.8) ng/L, and 0.192 ± 0.140, respectively in Alzheimer's disease patients. There were no statistically significant differences between CAA dementia and Alzheimer's disease in terms of these CSF biomarkers (all P>0.05).</p><p><b>CONCLUSION</b>Measurements of CSF biomarkers may not be helpful in differential diagnosis of CAA and Alzheimer's disease.</p>