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 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.

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.

Forensic Sciences/education*

Objective To discuss the role of naso-carbon in the protection of parathyroid during surgery. Methods 72 patients were randomly divided into the two groups,Injecting 0.1-0.2mL nano-carbon in the thyroid during a thyroid surgery.When the thyroid and surrounding lymph tissue were stained,then the thyroid surgery should be continued,the non-stained tissue should be protected.Results There were 6 cases with hypocalcemia in the con-trol group and 2 cases in the observation group(χ2 =13.87,P<0.05).5 cases with PTH decrease in the control group and 1 case in the observation group(χ2 =14.53,P<0.05).7 parathyroid glands were examined in the control group,while none in the observation group(χ2 =127.54,P<0.05).Conclusion Using naso-carbon during the thy-roid surgery,parathyroid gland cannot be stained black.The parathyroid gland can be easily identified and preserved.

Objective To compare the clinical effect of platelet rich plasma and sodium hyaluronate in the treatment of knee osteoarthritis .Methods According to the different treatment methods ,100 patients with knee osteo-arthritis were divided into the control group ( for treatment of platelet rich plasma ) and study group ( for treatment of sodium hyaluronate),each group 50 cases.The treatment effect would be compared between two groups ,and the patients were scored knee joint active function using Lysholms score standard ,using visual analogue score method on patients with knee joint pain .Results The excellent and good rate had no significant difference between the study group(98.0%) and control group(94.0%)(P>0.05);The knee joint activity of study group (76.81 ±9.24) was significantly better than that of the control group (60.46 ±7.41),the difference was statistically significant (t =-9.76,P<0.05);the knee joint pain degree of the study group (1.91 ±0.88) was lower than that of the control group (3.58 ±0.85),the difference was statistically significant (t=9.65,P<0.05).Conclusion Platelet rich plasma and the knee joint injection of sodium hyaluronate in the treatment of osteoarthritis were able to effectively alle -viate knee joint pain ,activity limitation and other clinical symptoms ,improve the curative rate ,but the treatment effect of sodium hyaluronate is more remarkable ,which is worthy of promotion .

Objective To explore the value of procalcitonin (PCT)and interleukin -6 (IL -6)in the early diagnosis and prognostic evaluation of the patients with lumbar intervertebral disc herniation,and their correlation with the course and lumbar function.Methods 100 patients with lumbar disc herniation (study group)and 35 patients with lumbar non -borne diseases (control group)were collected,their preoperative clinical symptoms were scored on the basis of the lumbar scoring system of Japanese Orthopaedic Association (JOA),the enzyme -linked immunosor-bent assay was applied to determining the content changes of PCT and IL -6 of the two groups,and the linear correla-tion analysis was used to explore the relevance of PCT and IL -6 to the course.Results The contents of the PCT and IL -6 in the study group's serum were respectively (25.13 ±0.86)ng/L and (10.26 ±0.36)ng/L,while those in the control group's serum were respectively (223.85 ±0.61)ng/L and (50.11 ±1.23)ng/L,both with statistical sig-nificance (t =2.542,2.206,P <0.01).The IL -6 was positively correlated with the disease duration of the patients with lumbar disc herniation (r =0.32,P =0.000),and negatively correlated with their JOA score (r =-0.45,P =0.003),and the PCT was positively correlated with the patients'disease duration (r =0.35,P =0.001),and nega-tively correlated with their JOA score (r =-0.53,P =0.005).Conclusion The PCT and IL -6 have a certain role in the early diagnosis of lumbar disc herniation,and have some relevance to the course of disease and the lumbar func-tion changes.

BACKGROUND:Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients,the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradualy increasing,especialy in strongly predisposal children.Therefore,exploring the risk factors of delayed healing orpost-operative recurrence in pediatric patients after spinal tuberculosis surgery,wil have significance in the prevention and treatment of tuberculosis.OBJECTIVE:To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis,and evaluate the efficacy of individualized re-operation.METHODS:From June 1998 to June 2013,clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively,and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence.The patient's age,gender,nutritional condition,lesion debridement,history of chemotherapy and internal fixation,complicated spinal lesion,scope of lesions,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications were analyzed by Logistic regression analysis.The risk factors of delayed healing or post-operative recurrence were analyzed.After re-operation,erythrocyte sedimentation rate,C-reactive protein and imaging studies were detected.RESULTS AND CONCLUSION:After surgery,29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation.The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20％and the re-operation rate was 8.3％.Logistic regression analysis showed that,nutritional condition,history of chemotherapy,lesion debridement,and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P＜0.05).While patient's age,gender,history of internal fixation,complicated spinal lesion,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P ＞0.05).Individualized re-operation can achieve good outcomes.Experimental findings indicate that,the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex,enhancing the nutrition,complete debridement of lesions,and receiving chemotherapy can effectively decrease the incidence.According to the initial surgery and patient's conditions,individualized re-operation is the key to the success.

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.