Objective To investigate the features of the cerebrospinal fluid (CSF) in the modified ZeiM-Neelsen (MZN) positive tuberculous mengningitis (TBM).Methods We retrospectively reviewed the clinical data of 170 patients with tuberculous meningitis confirmed by MZN stain from December 2012 to July 2015.The purpose of the present study was to investigate the relationship of MZN staining and CSF cytology.Results Among 170 patients with TBM confirmed by MZN staining,128 cases had first detectable acid-fast bacillus (AFB) in earlier stage.The cytology included 15.5％ mixed cellular cytology,58.5％ lymphoid cytology,19.5％ neutrophilic cytology and 6.5％ normal cytology.Twenty-four cases had first detectable AFB within 1-2 months following disease onset.The cytology included 13.1％ mixed cellular cytology,56.6％ lymphoid cytology,21.7％ neutrophilic cytology and 8.7％ normal cytology.Eighteen cases had first detectable AFB 2 months after disease onset.The cytology included 26.7％ mixed cellular cytology,46.7％ lymphoid cytology,20.0％ neutrophilic cytology,6.6％ normal cytology.There was no significant difference in median time of first detectable AFB among those four types of cytology (P=0.812).There was significant difference in median time of first detectable AFB between patients with and without anti-TB therapy [21.5 (12.3,37.8) days vs.8.5 (6.0,16.3)days,P＜0.001].There was no significant difference in median time MZN stain turning negative between patients with and without anti-TB therapy [11 (5.75,19.25) days vs.6(4.25,10.75)days,P=0.230].Conclusions AFB can be detectable within a month after the onset of TBM in most of cases.(MZN) positive staining is not associated with the major type of cytology.Anti-TB therapy may delay the first detectable time of AFB.

BACKGROUND: Stroke in progression(SIP) accounts for 26% -43% of cerebral infarction. It is a common clinical stroke subtype. However, there are no effective treatments to stop the progress with higher mortality rate and invalid rate. More attentions have been paid for multiple risk factors of cerebrovascular diseases during precaution and treatment. But the study on relationship between infection and stroke occurrence, and the inhibited clinical event with antivirus druggery is just at the beginning.OBJECTIVE: To investigate the correlation between clinical SIP characteristics and herpes virus(HSV) infection, and provide the clues to the SIP diagnosis and treatment and early rehabilitation.DESIGN: Case-control study based on patients.SETTING: Department of neurology in a university hospital and a microbiological department in a university.PARTICIPANTS: Totally 47 patients with progressive stroke hospitalized in Department of Neurology, the Second Hospital of Hebei Medical University during April 2001 to March 2002[21 males, 26 females; aged from 15 to 78 years, mean age of(53.12 ± 2.45) years] . There were 43 cases of limb paralysis (92%), 7 cases of aphasia, 4 cases of consciousness disturbance, 1 case of epileptic seizure, 1 case of hemianopia, 5 cases of ataxia, and 24 cases of dizziness. The diagnosis of cerebral infarction was confirmed with CT and/or MRI. The patients clinical pregresively aggravated over more than 72 hours from the stroke onset. And it was not able to stop the aggravation of the situation with conventional treatment. The patients with embolism and reversible ischemic neurological deficit(RIND), cerebral hemorrhage, hemorrhagic infarct were excluded; Patients with other severe diseases such as coronary heart disease, cardiac atrium fibrillation, severe diabetes, hypertension, and the history of illness more than 5 years were excluded. Totally 193 patients were selected as control group with non-cerebrovascular disease, included headache, insomnia, neck and shoulder pain[ 100 males, 93 females, aged from 26 to 60 years,mean age of(42.23 ±9.29)].of the Fourth Scholarship Meeting of Cerebrovascular Diseases in China in tected by MRI, 44 cases detected by magnetic resonance angiography(MRA), 4cases detected by digital subtraction angiography (DSA), and 8 cases detected levels of IgM of human cytomegalovirus(HCMV) and herpes virus(HSV) in serum of 47 patients with progressive stroke and 193 patients without cerebrovascular disease were detected by dot immunogold labeling staining (IGLS); Stromatin PP65 antigen of HCMV in marrow cell were detecting by of the situation with the conventional treatment. PFA 250 mL(3.0 g) was given once a day from 14 to 21 days and dexamethasone 5 - 10 mga day for 3 to 7 days.after treatment with antivirus druggery.dot low-density plaques in cortex or subcortex of cerebral lobes, were found in were found positive in 91% of the patients and the level of IgM in patients PFA was effective.of cerebral lobes, and stenosis or occlusion in cerebral arteries or major infection and progressive stroke.

Objective To discuss the best method to treat deep perianal abscess and to investigate the clinical efficacy and value of the procedure of percutaneous catheter drainage guided by ultrasound in treatment.Ninteen patients with deep abscess underwent the procedure from Jan.2012 to May.2013.Methods Clinical data of 19 patients were analyzed retrospectively,including 16 male cases and 3 female cases.Results The average age is 39.8.All patients were cured without complications.The average length of stay is 7.8 days,a mean follow-up of 6.6 months after discharge,no patient with recurrence or fistula.Conclusion No specific performance of colorectal carcinoid,surgical resection is the most effective method of the treatment of colorectal carcinoid,the procedure should be individual treatment.However,the long term prognosis need to be explored in the future.

Objective To investigate the role of S100B protein in the pathogenesis of patients with Japanese encephalitis (JE).Methods A total of 45 patients were enrolled in the Second Hospital of Hebei Medical University from August 2013 to October 2013,who were diagnosed as JE on the basis of clinical features and positive IgM antibodies against JE virus measured by enzyme-linked immunosorbent assay (ELISA) from the Center of Disease Control of Shijiazhuang.The JE patients were divided into initial phase group,acute phase group and convalescence group based on the course,mild JE group,moderate JE group and severe JE group based on the severity,MRI-no-lesion group and MRI lesions group based on the imaging findings of JE.Twelve cases with no evidence of infection in central nervous system in the meantime were chosen as control.The S100B protein was measured by ELISA.Results The content of S100B protein in cerebrospinal fluid was as follows:522.76 (393.35,620.37) pg/ml in mild JE group (acute phase group:609.77 (549.27,779.71) pg/ml,convalescence group:420.48 (344.36,453.19) pg/ml),792.09 (705.47,1 108.96) pg/ml in moderate JE group (acute phase group:770.19 (646.31,1 069.54) pg/ml,convalescence group:803.45 (602.90,1 396.84) pg/ml),and 1 021.94 (680.84,1 302.15) pg/ml in severe JE group (acute phase group:981.82 (680.84,1 826.28) pg/ml,convalescence group:989.00 (553.62,1 207.67) pg/ml).The S100B protein content was 561.52 (454.36,814.56) pg/ml,803.45 (602.90,1 104.01) pg/ml,762.22 (594.95,1 044.97) pg/ml,581.76 (442.51,1 069.10) pg/ml in MRI-no-lesion group,MRI lesions group,total acute phase group and total convalescence group,respectively.While in control group,the S100B protein content was 266.71 (205.72,390.05) pg/ml.The contents of S100B protein in moderate JE group,severe JE group,total acute phase group,total convalescence group,MRI-no-lesion group,MRI lesions group were higher than that in control group (H =4.864,5.497,5.075,3.918,2.971,4.981,P =0.000,0.000,0.000,0.000,0.009,0.000).The contents of S100B protein in mild JE group was lower than that in moderate JE group and severe JE group (H =-2.786,-3.514,P =0.032,0.003).Conclusions The level of S100B protein in cerebrospinal fluid is related with the severity,duration and imaging presentation of JE patients.The dynamic monitoring of S100B protein levels is of great significance for assessment of the patients' condition and curative effect.

Objective To explore somatic symptoms of patients with functional dyspepsia (FD) and effects of combined anti somatisation therapy on the quality of life in patients with FD.Methods Two hundred and nineteen patients with FD were enrolled.Patient Health Questionnaire-15 (PHQ-15) and Nepean Dyspepsia Index (NDI) were completed,and the relation between them was analyzed.Lansoprazole,mosapride and flupentixol melitracen (the anti-somatisation medication) were taken for four weeks by 131 FD patients who had poor response to four-week conventional treatment with proton pump inhibitors (PPI) and/or prokinetic medication and who got more than 4 scores in PHQ 15.And then therapeutic effects were observed and the changes of NDI before and after treatment were analyzed.The t test,chi-square test,Spearman's correlation and linear regression were performed for statistical analysis.Results The total PHQ-15 and NDI score of 219 patients with FD were 5.7±3.4 and 42.0± 10.4,and there was positive correlation between them (r=0.493,P＜0.05).Stomach pain,headache,chest pain,dizziness,shortness of breath,fatigue,sleeping disorder,thirst and so on were positively correlated with totalNDIscore (r=0.262,0.230,0.241,0.243,0.352,0.385,0.266,0.281,all P＜0.05).Chest pain,stomach pain,shortness of breath,dizziness and fatigue were the influence factors of NDI (t=2.340,2.488,5.278,2.167,2.443,all P＜0.05).Among 131 patients with FD who received anti somatisation combination therapy,six patients did not complete the therapy because of the side effects,and finally 125 patients were enrolled and analyzed.Before and four weeks after the treatment,the total PHQ-15 scores of 125 patients with FD were 7.3±3.2 and 2.9±2.2,respectively; and the difference was statistically significant (t =12.653,P＜0.01).There were significant differences in the influence of stomach pain,headache,chest pain,dizziness,shortness of breath,fatigue,sleeping disorder and thirst before and after the treatment (not bothered at all,bothered a little,bothered a lot) (x2=39.231,6.796,6.693,15.520,6.698,51.572,44.390 and 16.506,all P＜0.05).The total NDI score before and after the treatment were 44.3 ± 11.7 and 29.2 ± 6.9,and the difference was statistically significant (t=12.503,P＜0.01).Conclusions The quality of life in patients with FD is affected by somatic symptoms such as chest pain,stomach pain,shortness of breath,dizziness,fatigue and so on.For FD patients with poor response to conventional treatment,the quality of life could be improved by the combination of anti-somatisation therapy and the conventional therapy.

AIM: To compare the ginsenoside Rb 1 content in different granularity of Radix Panacis Quinquefolii in order to confine Chinese medicine by ultramicro powder technique. METHODS: HPLC was used to determine ginsenoside Rb 1 in micropowder of Radix Panacis Quinquefolii.RESULTS:The contents of ginsenoside Rb 1 in micropowder of Radix Panacis Quinquefolii pulverized in normal and low temperature were increasing with particle size reduction, and the content in low temperature pulverization was distinctly higher than that in normal temperature pulverization. CONCLUSIONS: Low temperature pulverization of Radix panacis Quinquefolii is superior to processing at temperature.

Aim To study the in vitro and in vivo an-tioxidant activity of Inula nervosa wall. in order to le-gitimately use the resources of I. nervosa. Methods The medicinal ingredients of aboveground and under-ground parts of I. nervosa were extracted by different extraction methods. Ultrasonic extractions from differ-ent parts were compared by their in vitro and in vivo antioxidant effects. Results Ultrasound alcohol ex-traction had the highest content of total phenols and fla-vonoids, with the content of total phenolics much high-er than that of total flavonoids. Ultrasound alcohol ex-tractions had very good scavenging effect on DPPH, ABTS and superoxide anion radical, with the extraction from underground part more effective than extraction from aboveground part. Ultrasound alcohol extractions significantly increased the level of catalase ( CAT), superoxide dismutase (SOD), total antioxidant capaci-ty (T-AOC), glutathione peroxidase (GSH-Px) activi-ty and decreased the level of malondialdehyde (MDA) in liver, kidney and serum in drenching aging mice. The antioxidant activity of high concentration of the ex-traction from aerial part was equivalent to that of low concentration of the extraction from underground part. Conclusions Ultrasound alcohol extractions of I. ner-vosa have very good scavenging effect on free radicals, which indicates good antioxidant ability. Antioxidant activity of underground part is much stronger than that of the aboveground part.

OBJECTIVE: To study the antibacterial activity of meropenem in vitro and the pharmacokinetics of which in patients with burn injury. METHODS: The minimal inhibition concentration (MIC) of meropenem against 136 clinical isolates was determined with double agar dilution method. 28 patients with burn injury were given 0.5g of meropenem by iv gtt, with the blood concentration of meropenem and the recovery of meropenem in urine were determined at different time. The pharmacokinetics parameters were computed with 3p97 software. RESULTS: Meropenem showed a strong antibacterial activity against K.peneumoniae, pneumonococcus and Enterobacter cloacae. MIC90 was below 0.0 075～0.25?g/ml. Pharmacokinetics parameters of meropenem were the following: t1/2? was (0.35?0.12) h,t1/2? was (2.10?0.71) h,AUC was (44.62?12.95) ?g/ml,Vc was (10.60?3.93) L; CLs was (12.00?3.04) L/h. 6.5 hours later, the mean blood concentration was (1.01?0.53)?g/ml; and the recovery of meropenem in 0h～12h urine was (58.06?16.83) %. CONCLUSIONS: Meropenem showed a very strong antibacterial activity in this study,there were significant differences regarding the in vivo pharmacokinetics parameters between the healthy volunteers and the patients with burn injury.

Objective To compare the difference of ultrasound-guided anterior sciatic nerve block by multiple injection and single injection.Methods Among 90 patients undergoing lower limb operation,aged 18-68 years old,47 patients were males and 43 patients were females,all falling into ASA Ⅰ-Ⅲ.The patients were randomized to ultrasound-guided anterior sciatic nerve block by multiple injection (group M,n=45) single injection (group S,n=45).Local anesthetic of 0.5% ropivacaine hydrochloride 20 ml was used.The width,thickness and depth of sciatic nerve and blocking performance time were recorded.Sensory and motor blockade on the operated limb were evaluated every 10 minutes after injection of local anesthetic for 30 minutes and complications were observed in two groups.Results The width,thinkness and depth of sciatic nerve on the ultrasound screen were not statistically significant in the two groups.The performance time of group M was longer than that of group S (P<0.05).The proportion of patients with sensory blockade of each nerve significantly differed between the two groups: for superficial peroneal nerve at 10,20,and 30 minutes,for the sural nerve at 20,30 minutes,for the tibial nerve at 30 minutes,that of group M was higher than that of group S (P<0.05).A significantly greater rate of motor blockade was observed for the dorsal flexion of foot and toes extension in group M than that of group S at 30 minutes (P<0.05).The complications of nausea,vomitting and tinnitus were not different in two groups.Conclusion Multiple injection needs more operation time compared with single injection,but its onset time of sensory and motor blockade is quicker,the complications were not different.

BACKGROUND:Femoral offset reconstruction is significant for recovering strength of abductor and the balance of soft tissue tension surrounding hip joint, maintaining joint stabilization, restoring joint function, reducing limping after replacement, decreasing prosthetic abrasion, and the incidence of joint prosthesis dislocation.
OBJECTIVE:To discuss effect of femoral offset reconstruction on hip joint function in total hip arthroplasty.
METHODS:We comparatively analyzed 20 patients (20 hips) undergoing the modular prosthesis (S-ROM) total hip arthroplasty and 19 patients (20 hips) undergoing the one modular prosthesis (Corail) total hip arthroplasty at the same time. According to Harris hip score and radiography results, hip joint function and femoral offset reconstruction rate were comparatively studied in both groups.
RESULTS AND CONCLUSION:No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred in either group. Clinical fol ow-up results:In the modular prosthesis and one modular prosthesis groups, there was no significant difference in preoperative Harris hip score between the femoral offset reconstruction and non-reconstruction groups (P>0.05). At 12 months and the latest fol ow-up, the Harris hip score was higher in the patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P<0.05). The range of abduction of hip joint was larger in patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P<0.05). Radiographic fol ow-up results:significant differences in the rate of femoral offset reconstruction were detected between the modular prosthesis and one modular prosthesis groups (χ2=3.956, P<0.05). 39 (98%) femoral stems were in neutral position and one (2.5%) was in mild valgus. There was no significant difference in the abduction angle and the anteversion angle between patients with and without femoral offset reconstruction (P>0.05). These results indicated that functional recovery and the range of abduction were better in patients with femoral offset reconstruction than those without femoral offset reconstruction. Modular prosthesis has a high rate of femoral offset reconstruction.