Objective:To elucidate the clinical features of acute disseminated encephalomyelitis,as well as its diagnosis and treatment.Methods:The general clinical manifestations,lesion locations,the results of cardinal ancillary investigations,and treatment as well as prognosis of 86 ADEM patients were comprehensively analyzed.Results:ADEM mainly occurred in children,young and middle-aged people.Their onsets were relatively acute.The upper respiratory tract infection and vaccination,measles,german measles,chickenpox,mumps,scarlet fever were the main predisposing factors.The immunoglobin in CSF increased.Spinal cord,cerebellum,cerebral medullary substance and brain stem were often involved.Imaging investigations,electrophysiology and immunology were helpful for diagnosis.The administration of glucocorticoid was effective.Conclusion:In addition to clinical features,neuroelectrophysiology,CSF immunology and imaging investigations altogether greatly aid clinical definite diagnosis.It is important to treat the patients in time and properly for the better prognosis.

Objective To observe the clinical effect of holmium laser for the treatment of ureteral calculi under ureteroscope .Methods In 205 cases of ureteral calculi with ureteroscopic holmium laser treatment ,the stone expulsion rate,complication,gravel rate were analyzed.Results Operation time was (65.3 ±18.4)min,hospitaliza-tion time was (5.6 ±2.7) d,the success rate of operation was 95.1%(195/205),incidence of complications (hemorrhage in 1 cases,perforation in 2 cases,20 patients with fever) was 11.2%,3 cases of calculi moved to pel-vis,indwelling double J tube in operation ,postoperative ESWL,after 2weeks ~3months stone completely lithagogue rate was 98.4%(192/195).7 cases converted to open operation .After operation 3 cases of ureteral calculi and 5 cases of renal pelvis stones were in postoperative ESWL ( extracorporeal shock wave lithotripsy ) , which was completely discharged and cure .Conclusion There are some advantages of ureteroscopic holmium laser lithotripsy for ureteral calculi with high success rate,the stone expulsion rate high,fewer complications,less trauma,safe and reliable.

Objective To study the characteristic of etiology and drug resistance of neonatal sepsis for rational use antibiotics in clinic.Methods The etiology and drug resistance of 167 positive hemoculture examples of 365 neonatal sepsis examples were retrospectively analyzed,and the characteristic of etiology diversify and drug resist-ance characteristic of neonatal sepsis were also analyzed.Results In 365 blood culture examples of neonatal sepsis, there were 167 positive cases,positive ratio was 45.75%.Among pathogenic bacterium,the first etiology was staphylo-coccus epidermidis,there were fifty -eight examples and account of 34.73%.The second was staphylococcus haemo-lyticus and accounts twenty -nine examples and 17.37%.The third was staphylococcus aureus which had twenty -two examples and account 13.17%.The annual infection rate of staphylococcus epidermidis and staphylococcus hae-molyticus in the second five years were increased obviously.Gram -positive coccus drug resistance to penicillin,cep-hazolin,oxazocilline and cefoxitin were very high and the rate of the second five years were higher than that of the first five years.Gram -positive coccus drug resistance to third -generation cephaloporins and imipenem and meropenem were higher than vancocin and the rate of the second five years were higher than that of the first five years.Gram -positive coccus was 100.00% sensitive to vancomycin.Gram negative bacilli drug resistance rate to penbritin and cep-hazolin and third -generation cephaloporins was the highest.Gram negative bacilli to meropenem and imipenem was hypersensitive in all antibiotics.Conclusion The chief pathogenic bacteria of neonatal septicemia is staphylococci. Among pathogenic bacterium,the main pathogenic bacteria is CoNS,and staphylococcus epidermidis and staphylococ-cus haemolyticus goes up significantly.Among gram -negative bacilli,the escherichia coli goes up.The drug resist-ance to bacteria goes up in neonatal sepsis,it is very important to monitor the drug resistance.

Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94％) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11％) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11％) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41％) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82％).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.

Forensic Sciences/education*

Objective To study the expression of PTEN,Fas and DCR3 in human gastric cancer and evaluate their effects on carcinogenesis,cell proliferation,invasion and metastasis of gastric carcinoma,as well as clinical significance.Methods The expression of PTEN,Fas and DCR3 were detected by immunohistochemical method (streptavidin-peroxidase) in the tissues of 75 primary gastric carcinomas and 15 gastric ulcers.Results The positive expression rate of DCR3 in gastric carcinoma tissues was significantly higher than that in normal tissues,and the expression of PTEN and Fas was obviously lower than that in normal tissues (P<0.01).The expression of DCR3 was negatively correlated with Fas and PTEN respectively (r=-0.720,P<0.001; r=-0.336,P<0.001).There was a positive correlation between PTEN and Fas.The expression of PTEN,Fas and DCR3 was closely correlated with lymph node metastasis,clinical stage,histological differentiation grade and tumor depth of gastric cancer,but not related to sex,age and tumor size (P>0.05).Conclusion PTEN,DCR3 and Fas have mutual restrictive relationships in the process of invasion and metastasis in gastric cancer.Detecting the expression of PTEN,Fas and DCR3 in gastric cancer is helpful to judge the malignant biological behavior of gastric cancer at a different angle,which may be considered as reliability index in clinic diagnosis,judging curative effect and monitoring the prognosis of gastric carcinoma.

The association of serum adiponectin concentration with coronary heart disease (CHD) in Chinese Han population was evaluated. Present evidence demonstrated that the lowered serum adiponectin concentration was a susceptibility risk factor for CHD, while the precise relationship between serum adiponectin concentration and CHD in Chinese population requires further study.

Objective To investigate the modulation of electrophysiological properties of hyperpolarization-activated cyclic nucleotide-gated channels(HCN) HCN1 and HCN2 by transfecting MinK-related peptide 1(MiRP1) in Chinese hamster ovarian(CHO) cells.Methods CHO cells were co-transfected with plasmid DNA encoding either of the cardiac HCN isoforms(HCN1,HCN2) with MiRP1 to observe the effect of MiRP1 on HCN whole-cell currents.Whole-cell patch clamp technique was used to record the 2 channel currents of the transfected cells.Results MiRP1 significantly increased whole-cell current density of HCN2 [(37.8?4.8) pA/pF(n=11) vs control(25.9?1.7) pA/pF(n=10);at-140 mV,P0.05].Moreover,MiRP1 accelerated the activation kinetic of HCN1 [tau(180.9?8.6) ms vs control(306.1?45.6) ms;at-80 mV,P

Background Coronary slow flow(CSF)phenomenon is characterized by delayed opacification of coronary vessels in normal coronary angiogram.Although clinical and pathological features have been previously described,its pathogenesis remains unclear.Objective To explore the risk factors related to coronary slow flow.Methods Thirty three patients with documented coronary slow flow which were defined according to TIMI frame count method(TFC)and 33 patients with normal coronary flow were enrolled.Clinical data and biochemical parameters were determined.Results Baseline data analysis showed that CSF group had higher baseline level of platelets count [(149.2?41.5)?109 vs(128.1?38.7)?109,P=0.037] and serum uric acid [(328.1?85.2)vs(282.8?82.4)?mol/L,P=0.032],while other variables were similar between the two groups.After adjustment for BMI,total cholesterol,urea,logistic regression showed that blood platelets count(?2=8.350,?=0.026,P=0.004),2-hour postprandial blood glucose(?2=4.920,?=0.289,P=0.026)and serum uric acid level(?2=5.305,?=0.009,P=0.021)were independent predictors for CSF.Conclusion These data suggest that elevated blood platelets count,2-hour postprandial blood glucose and serum uric acid level may predisposed to coronary slow flow.

BACKGROUND:There are no systematic and coherent studies on the mitochondrial apoptotic pathway of fluoride-induced osteoblast apoptosis, and the specific pathways to induce apoptosis in osteoblasts by fluorine are stil unclear. OBJECTIVE:To explore the possible pathways of apoptosis in osteoblasts induced by fluoride and its molecular characteristics. METHODS:A fluorosis model of human osteosarcoma cel line Saos-2 was establishedin vitro. After in vitro culture, the cels were treated with sodium fluoride at different concentrations (0, 5, 10, 20, 40, 80 mg/L). Flow cytometry was used to inspect the mitochondrial membrane potential at 24 hours after intervention; 84 apoptosis-related genes were detected by PCR Array; parts of the differentialy expressed genes were verified by western blot method. RESULTS AND CONCLUSION: When the concentrations of sodium fluoride were 20, 40 and 80 mg/L, the mitochondrial membrane potentials in osteoblasts were 27.0%, 28.8%, 38.6%, respectively (alP < 0.05). PCR array found 13 genes upregulated and 15 genes down-regulated. Immunoblotting results showed Bim, Caspase 9, Caspase 14, BCL2, BAX expressions enhanced with increasing doses of sodium fluoride; Caspase 3 expression was decreased at the concentration of 5 mg/L, but increased gradualy at over 10 mg/L. Caspase 7 expression had no significant difference. The expression of Caspase 10 decreased with the increasing doses of sodium fluoride. These findings indicate that fluoride may induce apoptosis in osteoblasts through the mitochondrial pathway (including the endoplasmic reticulum stress pathway) and death receptor pathway.