Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients.Methods From September 2009 to September 2014,85 CD patients with intestinal resection were enrolled.The clinical features and maintenance therapeutic medication were retrospectively analyzed.The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months),5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine,methotrexate and thalidomide).Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed.Results Among 85 CD patients,there were 32,21 and 32 patients in non-treatment group,5-ASA group and immunosuppressive agents group,respectively.After surgery,the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5％ (4/32),which was significantly lower than that of non-treatment group (56.3％,18/32) and 5-ASA group (38.1％,8/21),and the differences were statistically significant (x2 =12.250,P＜0.01;x2 =4.102,P =0.043).After surgery,the two years accumulated clinical recurrence rate of immunosuppressant agents group was 12.9 ％ (4/31),which was significantly lower than that of non-treatment group (75.9％,22/29) and 5-ASA group (47.6％,10/21),and the differences were statisitcally significant (x2 =17.840,P＜0.01;x2 =6.597,P=0.010).After operation,the one year accumulated endoscopic recurrences rates of non-treatment group,5-ASA group and immunosuppressant agents group were 39.1％ (9/23),5/16 and 34.6％ (9/26),respectively;while the two year accumulated endoscopic recurrence rates were 59.1％ (13/22),6/16 and 44.0％ (11/25),respectively.However,there was no statistically significant difference among the groups (all P＞0.05).Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (x2 =4.963,P=0.026,oddsratio (OR) =2.221,95 ％ confidence interval (CI) 1.121 to 5.775).Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients.Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions.

Objective To summarize the bacterial types and drug resistance of children with bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College in recent 9 years,so as to provide reference for rational use of antibiotics in clinics.Methods A retrospective study was performed on the clinical data of 102 children with hematogenous bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College from January 2008 to October 2016,in which there were 57 boys and 45 girls with a mean age 5.5 years old(from 10 days to 14 years old),among which 38 cases were acute osteomyelitis,30 cases were pyogenic arthritis,27 cases were chronic osteomyelitis,and 7 cases were arthritis with hematogenous osteomyelitis.The results of blood culture,pus culture and antibiotic sensitivity test results were analyzed and summarized.Results The results of blood culture or pus culture in 102 cases were all infected by single bacteria,including 89 cases of staphylococcus aureus(SA),accounting for 87.30％,3 cases (2.94％) of micrococcus scarlatinae,2 cases (1.96％) of klebsiella pneumoniae,2 cases (1.96％) of staphylococcus haemolyticus,and 1 case (0.98％) of methicillin-resistant staphylococcus epidermidis,streptococcus pneumoniae,streptococcus mitis,enterococcus hirae,enterobacter cloacae and pseudomonas aeruginosa,respectively.The resistance rate of SA to penicillin was 92.1％,but to Lincomycin,Erythromycin,Cefoxitin and Tetracycline it was more than 50.0％,and to Sulfamethoxazole,Gentamicin and Rifampicin it was quite low,and the resistant strains to Linezolid,Quinupristin/Dafoe Putin,Mo Xisha star,Tigecycline,Vancomycin,Levofloxacin,Nitrofurazone were no found.There were not multi drug resistant strains to be found except in the 45 cases of methicillin-resistant staphylococcus aureus(MRSA) and 1 case of methicillin-resistant staphylococcus epidermidis.Conclusion SA is the main pathogenic bacteria of bone and joint purulent infection in children in the local area.The resistant rate of penicillin and the detection rate of MRSA are high in the hematogenous osteoarticular infections caused by SA,but no vancomycin resistant cases were found.

Brown-Sequard Syndrome ; etiology ; Cervical Vertebrae ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Male ; Middle Aged

Objective To compare the cleaning effect of before and after improvement of P′750 type endoscopic infusion pump sensing infusion. Methods 240 cases of urinary calculi patients were divided into experimental group (120 cases) and control group (120 cases) according to the random number table method. Experimental group made improvements on P′750 type endoscopic infusion pump sensing infusion, Took latex transmission pipe, sampling module, metal fittings and parenteral nutrition infusion bags, disposable connecting pipe connection, and surgery using improved sensing infusion. The control group used unimproved sensing infusion. Results Visual inspection of cleaning pass rate before and after improvement sensing infusion were 85.83% (103/120), 99.17% (119/120), 5 times with light magnifier inspection were 78.33%(94/120), 97.50% (117/120), tampons method inspection were 75.83% (91/120), 95.83% (115/120), ATP bioluminescence monitoring were 70.83% (85/120), 91.67% (110/120), dry pass rate were 90.83%(109/120), 100.00% (120/120), cleaning and drying pass rate were significantly improved (χ2=18.296, 29.159, 32.986, 40.976, 11.528, all P<0.01). Cleaning time before and after improvement sensing infusion were (1 020.40±8.22) s, (539.30±8.70) s. Dry time were (1 199.35±26.70) s, (61.50±5.79) s. Cleaning and drying time were significantly shortened (t=440.340, 456.206, all P<0.01). Conclusion Improvement sensing infusion increased the quality of cleaning and drying, shortened the cleaning and drying time, ensured the quality of surgery using equipment, improved work efficiency, and provided a guarantee for the safe and smooth implementation of the surgery.

Objective:To compare the difference of epileptiform discharges detection in patients with epilepsy between the 25 electrodes electroencephalogram (EEG) system proposed by the International Federation of Clinical Neurophysiology in 2017 and the previous 19 electrodes EEG system.Methods:Patients suspected of epilepsy or with confirmed epilepsy who need a follow-up EEG were collected in Zhongshan Hospital, Fudan University from March 2018 to November 2019, and conventional video-EEG recording was performed on all patients for two hours with the standard 25 electrodes EEG system. Two neurophysiologists reviewed the recordings blindly using the 19 electrodes system and the 25 electrodes system, marking the epileptiform discharges and their amplitudes. Finally, the data were statistically analyzed.Results:A total of 403 patients were included in the study, in which 263 cases were diagnosed as epilepsy, including 129 cases of generalized epilepsy, 115 cases of temporal lobe epilepsy, 13 cases of frontal lobe epilepsy, two cases of parietal lobe epilepsy and four cases of occipital lobe epilepsy. In 115 temporal lobe epilepsy patients, 76 (66.09%) and 100 (86.96%) records were detected epileptiform discharges by the 19 or 25 electrodes EEG system respectively, and the difference was statistically significant (χ2=13.939, P<0.001). While in patients with non-temporal lobe epilepsy, there was not statistically significant difference between the two systems. In 76 patients whose temporal epileptiform discharges were detected by the two systems, the amplitudes of epileptiform discharges in the newly-added inferior temporal electrodes (F9/F10, T9/T10, P9/P10) and the original temporal electrodes (F7/F8, T7/T8, P7/P8) were (61.53±22.64) μV and (48.25±20.90) μV, respectively, with statistically significant difference between the two groups ( t=5.486, P<0.001). In patients with abnormal [79.59% (39/49) vs 61.22% (30/49), χ2=3.967, P=0.046] and normal [95.45% (42/44) vs 70.45% (31/44), χ2=9.724, P=0.003] imaging, the ability of the 25 electrodes EEG system to detect epileptiform discharges was higher than that of the 19 electrodes EEG system. Conclusion:The 25 electrodes EEG system can significantly improve the detection ability of temporal epileptiform discharges in patients with epilepsy, which is recommended for regular use to increase the detection ability of temporal area abnormal wave and assist the diagnosis and treatment of epilepsy.

Abstract: Objective To investigate the clinical outcomes and influencing factors of mild therapeutic hypothermia for influenza-associated encephalopathy/encephalitis (IAE) in children with different center temperatures, and to provide ideas and references for new mild therapeutic hypothermia scheme. Methods　A total of 115 hospitalized children with IAE who were scheduled to receive mild therapeutic hypothermia in Zhongshan Hospital Affiliated to Xiamen University from January 2019 to February 2022 were collected as subjects. They were randomly divided into two groups, namely, the 33 ℃ group (n=60) and the 35 ℃ group (n=55). The clinical features and clinical outcomes of the two groups were analyzed. Univariate and multivariate logistic regression analysis was performed for 6-month to investigate the factors affecting neurological disability. Results　The baseline indicators after treatment, such as Glasgow Coma Scale (GCS) score, cerebrospinal fluid total protein (CSF-TP), CSF lactate dehydrogenase (CSF-LDH), lymphocyte (Lym), creatine kinase-MB (CK-MB), LDH, and neuron-specific enolase (NSE), revealed no significant differences between the two groups before treatment or after treatment (P>0.05). There was no significant difference between the two groups after treatment in the clinical outcomes including GCS score D-value, time of hospitalization, 6-month neurological disability rate and mRS score, CSF-TP D-value, CSF-LDH D-value, Lym D-value, CK-MB D-value, LDH D-value, NSE D-value, improvement rate of EEG and MRI (P>0.05). Univariate and multivariate logistic regression analyses [OR=1.185, 95%CI (1.026~1.369), P=0.021] indicated that the delay of the onset of mild therapeutic hypothermia treatment was an independent risk factor for neurological disability in children with IAE after mild therapeutic hypothermia treatment of 6 months. Conclusion　There was no significant difference in the clinical outcomes between 33 ℃ and 35 ℃ mild therapeutic hypothermia for children with IAE. Therefore, mild therapeutic hypothermia for children with IAE may not require a strict requirement. Timely receipt of mild therapeutic hypothermia is a key measrue to reduce the risk of neurological disability in children with IAE.

Objective To investigate the morphological characteristics of elbow dislocation associated with elbow fracture in children,to propose its injury mechanism,and to present its treatment and outcomes.Methods From January 2010 to September 2016 in Department of Pediatric Orthopedics,the Affiliated Hospital of Zunyi Medical College,the clinical data of elbow dislocation associated with elbow fracture were retrospectively analyzed in 12 children,in which there were 9 boys and 3 girls with a mean age of 7.6 (3.6-12.O) years,and the injury time was 6 h-32 days,with an average of 3.5 days.According to the direction of dislocation,posterior dislocation in 6 cases,posterolateral dislocation in 4 cases,and anterior dislocation in 2 cases.Twelve cases were caused by high energy injury,accompanied with violent rotary injury of forearm,including traffic accident injury in 5 cases,high fall injury in 4 cases,motor belt injury in 2 cases,and washing machine injury in 1 case.All these cases were treated with surgery,the dislocated elbow joint were reset,the fracture fragments were fixed with Kirschner wire or wire tension band,and the lateral collateral ligament were repaired.Results All cases were followed up for 6-23 months,with an average 13.5 months.The stability of elbow joint and the fracture healing were very good,and no elbow redislocation at the last follow-up.The function of elbow joint recovered satisfactorily,the extension-flexion motion ranged from 90°-145°,with an average of 125°,and the pronation-supination motion ranged from 85°-155°,with an average of 130°.According to the Mayo functional index,the results were excellent in 7 cases and good in 4 cases,and the excellent and good ratio was 91.7％ (11/12 cases).Conclusions The elbow dislocation of children is caused by high energy injuries and the violent rotational injury of the forearm,easily combined with different types of elbow fractures and severe injury of collateral ligament.Surgical treatment should be actively performed to restore the normal anatomy,reconstruct the stability and restore the function of the elbow joint.

Objective To investigate the drug resistance and its changes of Staphylococcus aureus (SA) in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.Methods A retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College,in which there were 53 boys and 42 girls with a mean age of 5.6 years (ranging from 10 days to 14 years),including 39 cases of acute osteomyelitis,31 cases of acute suppurative arthritis,19 cases of chronic osteomyelitis,and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity,the drug resistance of SA was analyzed,and the detection rates of Methicillin resistant Staphylococcus aureus (MRSA) were compared in different genders and timeframes,and the drug resistance of SA to other antibiotics were also analyzed.Results The detection rate of MRSA was 50.53％ (48 cases) in 95 cases,the resistance rate to Penicillin was 92.63％ (88 cases),and to Lincomycin,Erythromycin,Tetracycline and Cefoxitin were 64.21％ (61 cases),57.90％ (55 cases),55.79％ (53 cases) and 53.68％ (51 cases) respectively,but to Sulfamethoxazole Co.,Gentamicin and Rifampicin it was relatively low[25.26％ (24 cases),11.58％ (11 cases),6.32％ (6 cases) respectively],while the resistance to Moxifloxacin,Linezolid,Tigecycline,Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys (52.83 ％,28/53 cases) was slightly higher than that of girls (47.62％,20/42 cases),but the difference was not statistically significant (x2 =0.255,P ＞0.05).The detection rates of MRSA in 2008-2010,2011-2013 and 2014-2016 were 27.78％ (5/18 cases),51.61％ (16/31 cases) and 58.70％ (27/46 cases) respectively,and it was obviously higher in 2014-2016 than in 2008-2010,and the difference was statistically significant (x2 =4.95,P ＜ 0.05).The drug resistance rate of SA to Lincomycin,Erythromycin and Cefoxitinis was obviously higher in 2014-2016 than in 2008-2010,and the differences were all statistically significant (all P ＜ 0.05).Conclusions The drug resistance of SA is high with the bone and joint infection caused by hematogenous dissemination in children,and the detection rate of MRSA and the drug resistance of SA to a variety of antimicrobial agents are gradually increasing.

Objective:To investigate the influencing factors of prognosis in the patients with advanced cervical cancer,and to evaluate the influence of single-agent cisplatin and docetaxel combined with cisplatin concurrent chemoradiotherapy in the prognosis of the patients and the security,and to provide the basis for clinical treatment of advanced cervical cancer.Methods:A total of 218 patients with advanced cervical cancer who received the singleagent cisplatin or docetaxel combined with cisplatin concurrent chemoradiotherapy were enrolled as the subjects.The patients were divided into two groups according to their chemoradiotherapy treatments:single-agent group and docetaxel combined with cisplatin concurrent group.All the patients had received external beam radiation therapy combined with high-dose rate intracavitary hrachytherapy.A follow-up in 218 patients was performed until January 2017.The information about clinical characteristics including age,tumor diameter,clinical stage,chemotherapy treatments,pathological grade,pathological type,primiparous age and adverse effects after treatment were collected by telephone follow-up,outpatient service and reexamination.The differences in the clinical characteristics of the patients were compared between two groups,the association between the clinicopathological characteristics and the prognosis of the patients was analyzed,and the security of these two treatments was evaluated.Results:There were no statistical differences in the age,tumor diameter,clinical stage,pathological grade,pathological type and primiparous age of the patients between two groups (P＞0.05).The 1-year,3-year and 5-year overall survival (OS) rates of 218 patients were 96.33％,76.15％ and 63.76％,respectively.The 5-year OS rate of the patients in docetaxel combined with cisplatin group was higher than that of the patients in single-agent cisplatin group (x2 =8.032,P=0.005).The univariate analysis results indicated that tumor diameter,clinical stage,chemotherapy treatments,and adenocarcinoma were the potential predictive factors (P＜0.05).The Cox regression analysis results showed that clinical stage [stage Ⅲ:P=0.016,HR (95％CI) =1.90 (1.13-3.19) [stage Ⅳ:P＜ 0.001,HR (95％CI) =19.13 (7.84-46.68)],chemotherapy treatments [P=0.009,HR (95 ％CI) =0.54 (0.34-0.86)] and adenocarcinoma pathological type [P=0.021,HR (95％CI) =1.88 (1.10-3.21)] were the prognostic risk factors of the patients,the patients in clinical stage Ⅱ B,received docetaxel combined with cisplatin concurrent chemoradiotherapy and with pathological types of squamous cell carcinomas had a better outcome.Compared with docetaxel combined with cisplatin group,leucopenia (Z=-2.060,P =0.039) and neutropenia (Z=-2.246,P =0.025) in single-agent cisplatin group were lighter.Conclusion:Clinical stage,chemotherapy treatments and adenocarcinoma were the independently prognostic factors of the patients with advanced cervical cancer.The patients receive docetaxel combined with cisplatin concurrent chemoradiotherapy have a better prognosis and no severer adverse effects compared with single-agent cisplatin treatment.

Vitreous hemorrhage in children is caused by trauma or non-traumatic factors.Long-term vitreous hemorrhage not only affects children's vision,but also can lead secondary glaucoma,traumatic retinal detachment and other serious complications.Ocular trauma,some ocular and systemic diseases are the common etiology leading to vitreous hemorrhage in children.A small amount of vitreous hemorrhage can be treated by observation and conservative treatment.However,if the vitreous hemorrhage has no obvious absorption or serious complications appeared,it needs to be treated by surgery.The choice of treatment time and methods need to be further studied.