Objective To explore the clinical features and treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Methods The clinical data and follow-up information of 4 children with severe anti-NMDAR encephalitis were retrospectively analyzed. Results Four patients (one male and 3 females) were 10 to 13 years old and one child had teratoma combined. In all patients symptoms at onset mainly were psychiatric syndrome and movement disorder, and then progressed to seizures, disturbance of consciousness and central hypoventilation respiratory failure in one month. The anti-NMDAR antibodies in cerebrospinal fluid were positive in all patients. The EEG showed focal or diffuse slow waves. The brain MRI showed no pathological changes at the diagnosis. The treatment included methylprednisolone and large doses of intravenous immunoglobulin (IVIG), ventilator for 5-95 days, and tracheotomy in 2 cases. One case died because of serious infection. In 21-27 months of the follow-up, one case had clinical recovery; 2 cases had the sustained use of immunosuppressive agents and anti-epileptic drugs and the clinical symptoms were significantly improved. The EEG and anti-NMDAR antibodies continued abnormal in the patient combined with teratoma. One patient relapsed. Conclusions The severe anti-NMDAR is more likely in older female children. The central hypoventilation respiratory failure occurs in the early course of the disease. Combination with tumor is high risk factor. Conventional hormone therapy and ventilator treatment is effective. The recovery is slow. It may be relapsed even one year later.

Traditional Chinese medicine thinking is the core method of diagnosis and treatment of traditional Chinese medicine. Thus, cultivating the clinical thinking of traditional Chinese medicine in the orthopeadics department has become the importance. TCM tendon and muscle injuries were well characterised by the TCM, becoming an important part of TCM orthopedics., The tendon and muscle injuries were used to explore the application and cultivation of traditional Chinese medicine thinking. This will help to improve the clinical curative effect, complement the modern Chinese medicine.

Objective To investigate the whether the cleaning effect and quality would be affected by the different condition and storage of occlusal instrument. Methods A total of 2 400 holding needle clamp and hemostatic forceps were recycled immediately, and they were randomly divided into eight groups of A1, A2, B1, B2, C1, C2, D1, D2, with 300 pieces each. A1 groups was closed and not moisturized, and cleaned in 2 hours. A2 group was fully opened and not moisturized, and cleaned in 2 hours. B1 group was closed and bathed in multi-enzyme detergent, and cleaned in 2 hours. B2 group was fully opened and bathed in multi-enzyme detergent, and cleaned in 2 hours. A1 groups was closed and not moisturized, and cleaned in 12 hours. C2 group was closed and bathed in multi-enzyme detergent, and cleaned in 12 hours. B2 group was fully opened and bathed in water, and cleaned in 12 hours. D2 group was fully opened and bathed in multi-enzyme detergent, and cleaned in 12 hours. They were cleaned by the same machine and the clean rate was compared among groups. Results The cleaning rate of A1 and A2 group, B1 and B2 group, C1 and C2, D1 and D2 group had no statistical significant difference (P > 0. 05). The occult blood positive rates of C1 (27. 33% ).

Objective:To investigate the topological alterations of brain functional networks in patients with chronic methamphetamine (MA) dependence.Methods:Resting-state functional magnetic resonance imaging was used to map the brain networks of 46 patients with MA-dependence (MA group) and 46 healthy controls (control group). Statistical methods were used to compare the differences of brain functional connection and topological parameters between the two groups, and the correlations between these topological parameters with significant inter-group differences and clinical measurements were analyzed.Results:(1) Brain functional connection: as compared with the control group, the MA group had significantly enhanced functional connectivity in the subnetworks consisting of several brain regions, including the inferior parietal lobule, posterior central gyrus, lateral occipital cortex, ventromedial occipital cortex, orbital gyrus, anterior central gyrus, fusiform gyrus, superior temporal gyrus and thalamus; as compared with the control group, the MA group had significantly attenuated functional connectivity in the subnetworks consisting of several brain regions, the orbit frontal cortex, precentral gyrus, paracenter lobule, inferior temporal gyrus, fusiform gyrus, parahippocampal gyrus, superior parietal lobule, postcentral gyrus, medioventral occipital cortex, lateral occipital cortex and amygdala. (2) Network topology attributes: the brain functional networks in all subjects from the MA group and control group held worldlet; but attribute of worldlet in the MA group was significantly reduced as compared with that in the control group ( P<0.05); moreover, the MA group had significantly decreased clustering coefficient, local efficiency, and modularity as compared with the control group ( P<0.05). In terms of regional topological attributes, such as betweenness centrality, the MA group presented evident reduction in the left superior frontal gyrus, right orbit frontal cortex, right middle temporal gyrus and right/left lateral occipital cortex as compared with the control group with significant differences ( P<0.05). (3)Correlation analysis: the betweenness centrality of right middle temporal gyrus exhibited a positive correlation with the age of patients using MA for the first time ( r=0.327, P=0.028); a positive correlation was found between the modularity and activating factor scores in Brief Psychiatric Rating Scale (BPRS) in MA group ( r=0.315, P=0.035). Conclusions:Part of the global/local topological attributes of the brain functional network of patients with MA addiction are damaged. The younger the patients are when they take MA for the first time, the lower the betweenness centrality of the right middle temporal gyrus; the more the local attributes are damaged; and furthermore, the deeper the network modularity, the severer the active symptoms in the psychotic symptoms.

Objective:To investigate the differences of spontaneous neural activity and functional connectivity between bilateral symmetrical voxels in the local brain regions at resting-state of methamphetamine (MA) dependent patients and healthy controls (HCs).Methods:Forty-six MA-dependent patients, admitted to and received drug rehabilitation treatment for the first time in our hospital from February 2014 to October 2019, and 46 HCs matched with age, gender and education level during the same period were enrolled in this study. The resting state functional magnetic resonance imaging (rs-fMRI) data of these subjects were collected; the static and dynamic regional homogeneity (ReHo, d-ReHo) and static and dynamic voxel-mirrored homotopic connectivity (VMHC, d-VMHC) were used to evaluate MA-related alterations of brain spontaneous activity and interhemispheric functional connectivity. The correlations of brief psychiatric rating scale (BPRS) scores with above values in the brain regions with significant inter-group differences were analyzed.Results:As compared with the HCs, the MA-dependent patients had significantly decreased ReHo in the left medial orbitofrontal cortex (mOFC), and significantly increased d-ReHo in the left mOFC, left middle frontal gyrus, bilateral inferior frontal gyrus, left precentral gyrus and left postcentral gyrus ( P<0.05). As compared with the HCs, the MA-dependent patients had significantly decreased VMHC in the bilateral mOFC, precentral gyrus and postcentral gyrus ( P<0.05). The ReHo, VMHC, d-ReHo, and d-VMHC were not significantly correlated with total scores and each factor scores of BPRS, and total dose of MA (after removing outliers) in MA-dependent patients ( P>0.05). Conclusion:During resting state, MA-dependent patients show obvious abnormalities in the coordination and stability of spontaneous neural activity and the coordination of interhemispheric activity in local brain regions, especially in the mOFC; abnormal ReHo, d-ReHo and VMHC in left mOFC may be important neuroimaging biomarkers for MA-dependence.