Purpose To improve the comprehension of MR imaging features of hand-foot-mouth disease (HFMD).Materials and Methods The MRI findings of 5 cases of HFMD were retrospectively analyzed.Results The lesions in 4 cases were located in the junction of the pons and medulla oblongata, of which 1 lesion extended bilaterally at the same time. The lesion in the fifth case was located in dorsal pons. All lesions demonstrated patchy slight hyperintensity on T1WI and slight hypointensity on T2WI. These ill-circumscribed lesions showed hyperintensity on diffusion-weighted imaging. Conclusion HFMD possesses certain MR imaging characteristics, thus providing reliable imaging evidence for clinical diagnosis.

Objective To evaluate the ability of matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF MS) in identifying species of Acinetobacter calcoaceticus-Acinetobacter baumannii complex,and investigate the species distribution of Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolated in our hospital.Methods A total of 502 nonduplicate clinical isolates of Acinetobacter calcoaceticus-Acinetobacter baumannii complex were retrospectively collected from the second affiliated hospital of Zhejiang University between January 2012 and July 2012.All strains were re-identified by MALDI-TOF MS and were also verified by sequence analysis of 16S-23S rRNA gene spacer region.Results Among all the 502 strains of Acinetobacter calcoaceticus-Acinetobacter baumannii complex,identificaion results provided by MALDI-TOF MS were A.baumannii (431,85.9％),A.pittii (68,13.5％),A.calcoaceticus (3,0.6％).Sequence analysis of 16S-23S rRNA gene spacer region was used to identify all the 502 strains:403 (80.3％) were identified as A.baumannii,68 (13.5％) as A.pittii,28 (5.6％) as A.nosocomialis and 3 (0.6％) as A.calcoaceticus.MALDI-TOF MS correctly identified all the strains but erroneously identified all 28 strains of A.nosocomialis as A.baumannii,compared with sequence analysis of 16S-23S rRNA gene spacer region.Conclusions MALDI-TOF MS can be used as a fast,simple,reliable and excellently reproducible method to identify members of Acinetobacter calcoaceticus-Acinetobacter baumannii complex at low costs.MALDI-TOF MS is expected to be an ideal technique for routine clinical microbiology testing in the future.

Objective To evaluate the imaging feature of microcarcinoma of thyroid with CT.Methods CT findings of 50 lesions in 47 patients with microcarcinoma of thyroid ( dimeter,0.5 to 1.0 cm) were retrospectively analyzed.All of the patients had pathological diagnosis.Results Of the 50 lesions,38 lesions showed homogeneous low density on non-enhanced CT and various degree of enhancement on postcontrast CT. Thirty-three lesions showed discontinuous edge of the thyroids on non-enhanced CT. The boundary of 30 lesions became unclear on post-contrast CT relative to non-enhanced CT and the extension of low density of lesions decreased. Theshape of 31 lesions were irregular. Fifteen lesions showed calcifications,with granular calcifications in 13 lesions.Ten lesions were complicated with thyroiditis.Conclusions Irregular shape,discontinuous edge of the thyroids,the shrinkage of low density of lesions on post-contrast CT relative to non-enhanced CT,granular calcifications and multiple small lymph node around lesions indicate the diagnosis of microcarcinoma of the thyroid.It should be noted that thyroiditis can cover up microcarcinoma of thyroid.

Objective To improve the diagnosis rate and decrease misdiagnosis through analyzing the clinical and experimental features of neuroblastoma (NB) in children.Methods The clinical and experimental features associated with the misdiagnosis factors of 22 NB cases were analyzed retrospectively.Results Of the 22 cases,leg pain in 15 cases (68.18 ％),fever in 19 cases (86.36 ％),anemia in 20 cases (90.90 ％),abdominal pain and bloating in 15 cases (68.18 ％),exophthalmoses and bruises eyes in 4 cases (18.18 ％) and easily perspire in 20 cases (90.90 ％).Abdomen was the most common primary site founding in 16 cases (accounting for 72.72 ％),followed by mediastinum founding in 4 cases (accounting for 18.18 ％),other sites were 2 cases (9.09 ％).Laboratory results showed that anemia was the most common cause in 20 cases (90.90 ％),oligoleukocythemia in 2 cases (9.09 ％) and less in thrombocytopenia about 3 cases (13.63 ％).Elevated values were recorded in 77.77 ％ of patients for vanillylmandelic acid (VMA),86.36 ％ for ferritin (Fer),90.90 ％ for lactate dehydrogenase (LDH),and in 100.00 ％ for neuron specific enolase (NSE).20 cases were found metastasis when diagnosed,which accounted for 90.90 ％.16 cases (72.72 ％) were found tumour cells which determined in bone marrow and 20 cases (90.90 ％) were positive for CD56-FITC/CD81-PE/CD45-Percp by flow cytometry (FCM).12 (54.54 ％) of 22 NB cases were misdiagnosed for rheumatoid diseases (4 cases),dyspepsia (4 cases),leukemia (3 cases) and thrambocytopenia (1 case).In 22 cases,20 cases (90.90 ％) were positive for CT scan.16 cases (72.72 ％) were positive for abdominal B ultrasonography,and 14 cases (63.63 ％) were positive for radionuclide bone scan.Conclusion Bultrasonography and CT scan will contribute to find the primary focus of NB at early stage.VMA,bone marrow smear,biopsy and FCM detection could reduce misdiagnose rate.

Objective To investigate the relationship between serum levels of PCT and neutrophil CD64 contents with the effect of hormone therapy and complications in the patients with primary nephrotic syndrome.Methods Sixty-five patients with primary nephrotic syndrome in our hospital from September 2015 to September 2016 were selected as the research subjects,all cases were treated with hormonal therapy,the serum levels of PCT and neutrophil CD64 were detected and their relationship with the curative effect and complications of nephrotic syndrome was analyzed.Results According to the PCT and neutrophil CD64 median levels,the cases were divided into the high level group and low level group,the results found that serum creatinine,serum protein,urine protein and pathological types had no statistical difference between the high level group and low level group.The hormone sensitivity had 15 cases in the patients with high PCT level,which was significantly lower than 21 cases in the patients with low PCT level;the hormone sensitivity had 14 cases in the patients with high neutrophil CD64 level,acute renal failure,infection and thrombus in the patients with high PCT level had 8,10,6 cases,which were significantly lower than those in the patients with low PCT level;acute renal failure,infection and thrombus in the patients with high neutrophil CD64 level had 7,11,6 cases,which were significantly higher than those in the patients with low neutrophil CD64 level (P<0.05).Conclusion The levels of serum PCT and neutrophil CD64 are significantly correlated with the therapeutic effect and clinical prognosis in the patients with nephrotic syndrome.

BACKGROUND: Studies have shown that osteoporosis often leads to a failure in pedicle screw fixation. Considering that the use of ordinary pedicle screw fixation cannot achieve a strong and stable fixation of the osteoporotic vertebra,special measures to strengthen the internal fixation is indispensable.OBJECTIVE: To evaluate the effect of bone cement augmentation combined with expandable pedicle screw fixation on the fixation strength of osteoporotic thoracolumbar vertebrae.METHODS: Twenty osteoporotic thoracolumbar vertebral specimens were randomly divided into four groups: conventional pedicle screw group implanted with normal pedicle screw, and the other three groups implanted with expandable pedicle screw. Bone cement augmentation with polymethylmethacrylate (PMMA) and calcium sulfate was done in the PMMA group and calcium sulfate group, respectively, followed by expandable pedicle screw implantation. No bone cement was used in the expandable pedicle screw group. The maximum axial pull-out strength and yield energy absorption value of the unilateral pedicle were detected, and the maximum removal torque of the contralateral pedicle was determined. Bone cement leakage after augmentation was observed.RESULTS AND CONCLUSION: Compared with the conventional pedicle screw group, the other three groups showed a significant increase in the maximum pull-out strength, maximum removal torque and yield energy absorption values (P < 0.05). Moreover, these parameters were significantly higher in the PMMA and calcium sulfate groups than the expandable pedicle screw group and conventional pedicle screw group (P < 0.05), but there was no significant difference between the PMMA and calcium sulfate groups (P > 0.05). No leakage of bone cement was found in all the groups. To conclude, the combined use of expandable pedicle screw and can significantly enhance the stability of the osteoporotic thoracolumbar vertebrae, and the PMMA and calcium sulfate cements have similar effects.

Objective To summarize and evaluate the clinical features,therapeutic methods and prognosis of 197 cases with eating crayfish caused rhabdomyolysis in our hospital within July,2016 to August,2016.Methods Using retrospective method,197 rhabdomyolysis cases induced by eating crayfish were admitted into study.Data of epidemiological character,clinical features,therapy protocol and prognosis were collected and analyzed.Results All the patients had the experience of eating crayfish within 12h before the onset.Patients in this cohort had the common symptoms but varying degrees of myalgia,fatigue of the whole body muscles,and urine color change.Laboratory tests revealed:On day 1 of onset,serum myoglobin level had raised up to the peak with average level at (2 135 ± 1 547) μg/L (0-46 μg/L).Creatine kinase with average level at (4 657 ± 2 178) U/L (25-190 U/L);Aspartate transaminase with average level at 264 ± 83 U/L (10-45 U/L);Lactate dehydrogenase with average level at (1 457 ± 673) U/L (313-618 U/L),all these three markers reached peak on day 2,then gradually declined.All the patients recovered and discharged after relaxation,fluid infusion,alkalization of urine and dealing with the complications.Conclusion Timely diagnosis and treatment of the rhabdomyolysis syndrome induced by eating crayfish could indicate favorable prognosis in these patients from July,2016 to August,2016.

Objective To detect EPPB41L3 methylation frequency difference between esophageal squamous cell carcinoma (ESCC) tissues and the normal tissues and between ESCC patients′plasma and healthy volenteers′plasma, and to analyze the correlation with clinicopathological parameters. Methods We collected esophageal squamous cell carcinoma tissues (n = 42 patients) and adjacent surrounding normal tissues (n = 42 patients), and plasma from 42 patients with ESCC and from 50 healthy individuals. We used methylation specific PCR (MSP) combined with agarose gel electrophoresis to detect the methylation status of the EPB41L3. We used the SPSS 13.0 software for statistical analysis by χ2 test and Fisher′s exact test. Results EPB41L3 frequency of methylation was significantly higher in tumor tissues than in the adjacent tissues (59.5% vs. 4.8%), the difference was statistically significant (χ2 = 28.873, P < 0.001). For plasma, EPB41L3 methylation frequency was 31.0%in cancer patients, while was not detectable in the healthy volunteers. Methylation of EPB41L3 in tissues was more frequently found in patients with tumor size of ≥ 5 cm or T3 than in patients with tumor size of < 5 cm or T1-2. Conclusions The methylation frequency of EPB41L3 is higher in ESCC tissues than in control normal tissues, and higer in plasma from ESCC patients than that from the healthy volunteers. EPB41L3 methylation is more frequently found in patients with more advanced disease.

Objective To analyze the five years change of bacterial infection adn drug resistance in PICU and to provide evidence for use of na tibiotics rationally.Methods Al the pathoeg nic bacteria from patients in PICU of our hospital from January 1 2009 to Deec mber 31 2013 were analyzed retrospectiev ly. T hey were divided into five subgroups according to differetn years.Pathogenic batc eria and drug resistance in different years wre e collected na d the changes of such bacterial infection and drug resistance were compared and summarized.Results A total of 2 201 pathogenic bacterial strains were isolated from 14 361 specimens of five-year patients in PICU.The rate of gram negative bacteria in 2009 to 2013 were 83.2%,71.0%, 59.8%,58.9%, 52.5% respe ctively.The rate of gram positive bacteria in 2009 to 2013 were 16.8%, 29.0%,40.2%, 41.1%, 47.5% respectively.Top five pathogenic bacteria were staphylocco cus aureus (16.6%,366 strains),Escherichia coli (16.2%,357 strains),klebsiella pnue moniae (15.2%,334 strains), streptococ us pneumoniae (9.2%,202 strains),haemophilus influenzae (6.8%,149 strains).The infection rate of staphylococcus aureus increased year by year(6.4% to 27.0%).Drug sensitivity tets indicated that the rate of extended-spectrum beta-lactamases ( ESBL) positive escherichia coli and klebsiella pneumoniae were 28.3%and 38.3%,respectivle y.The rate of methicillin-resistant staphylococcus aureus ( MRSA) was 26.0%.Based on non-meningitis criterion,rate of penicillin resistance streptococcus pneumonia and multiple-drugresistance streptococcus pneumonia was 19.3%and 58.9%,respectively.There were no obvious changes in resistance rate of above-mentioned bacteria during the recent five years.Conclusion In the recent five years,gram negative bacteria is still the prevalent strain in PICU of our hospital,however the rate of gram positive bacteria increases year by year and staphylococcus aureus has become one of the five most common bacteria.The rate of ESBL positive escherichia coli,ESBL positive klebsiella pneumonia and MRSA has no obvious changes.Analysis of pathogenic bacteria and drug-resistance surveillance are of vital importance to guide treatments for critically ill patients and reduce drug-resistant bacterial strains.

BACKGROUND:We built Sprague-Dawley rat models with mild, moderate, and severe spinal cord injuries to accord with the spinal cord injury types for basic empirical study, and consequently to further understand the microenvironmental change in Sprague-Dawley rats with spinal cord injury, and to provide help for clinical treatment. OBJECTIVE:To observe the changes in nerve function, pathological manifestation and motor sensory evoked potential in Alen’s models and Sprague-Dawley rats with complete spinal cord transection at different time points after spinal cord injury by simulating the microenviroment in Sprague-Dawley rats. METHODS: A total of 125 healthy adult female Sprague-Dawley rats were selected and randomly divided into group sham operation group, 100 gcf hit potential group (20 g×5 cm), 200 gcf hit potential (20 g×10 cm), 300 gcf hit potential group (20 g×15 cm), and spinal cord complete transection group with 25 rats in each group. At 1, 5, 7, 14 and 28 days after model establishment, the degree of spinal cord injury was identified by the BBB scores of motion function, motor evoked potential, and pathological section. RESULTS AND CONCLUSION:(1) Totaly 24 Sprague-Dawley rats died in the experiment. The death rate and the rate of complications were highest in the spinal cord complete transection group. The BBB score of each group was decreased. The BBB scores in every group increased as time went on. There were significant differences between each surgery group and the sham operation group at corresponding time points (P < 0.05). No significant difference was found between the 300 gcf hit potential group and the spinal cord complete transection group at corresponding time points (P > 0.05). (2) In each surgery group, the infiltration of inflammatory cels and obvious sweling of neurons were visible at 1 day after injury. Neural cels reduced with time prolonged. At 28 days after injury, a large number of astrocytes proliferated, scar and spinal cord cavity formed. Above symptoms were worse in the 300 gcf hit potential group and spinal cord complete transection group than in the 100 gcf and 200 gcf hit potential groups. (3) Significant differences in amplitude and latency were detectable between each surgery group and the sham operation group (P < 0.05). No significant difference in amplitude and latency was detected between the 300 gcf hit potential group and the spinal cord complete transection group at corresponding time points (P > 0.05). Results confirmed that hit potential of 20 g×5 cm, 20 g×10 cm and 20 g×15 cm can simulate the microenvironment of Sprague-Dawley rats with mild, moderate and severe spinal cord injury. The rate of complication was lower in modified Alen’s model of different hit potentials than in models of spinal cord complete transection, and was more accorded with basic research.