· AlM: To analyze the clinical data of 54 cases misdiagnosed as optic neuritis and to explore measures to reduce misdiagnosis
· METHODS: This retrospective study comprised 54 patients that had been misdiagnosed as optic neuritis from September 2000 to June 2013. The misdiagnosis features were summarized.
· RESULTS:Many diseases can easily be misdiagnosed as optic neuritis, including ischemic optic neuropathy, intracranial tumors, optic nerve vasculitis, myelinated nerve fibers, and so on.
· CONCLUSlON: The measures to reduce misdiagnosis consisted of detailed history collection, perfect physical examination and comprehensive expertise of fundus disease.

BACKGROUND:An amyloid-beta (Aβ) aggregation in the brain can induce nerve cel apoptosis, loss of synapses and functional damage. However, there is stil no effective intervention. Improving the synaptic plasticity provides an important direction for the treatment of early Alzheimer’s disease. OBJECTIVE: To screen the best model of Alzheimer’s disease and to explore the expression of synapse-associated proteins in Aβ25-35-injured PC12 neurons. METHODS:PC12 cels were induced by 50 μg/L nerve growth factor to differentiate into neuronal-like cels. Then, these cels were treated with Aβ25-35 at different concentrations. Consequently, cel survival rate was detected using cel counting kit-8; neurogranin and neuregulin immunofluorescence stainings were used to observe morphological changes of model cels; western blot used to detect the expression level of neurogranin, calmodulin kinase II, postsynaptic density-95 proteins. RESULTS AND CONCLUSION:Over time, the survival rate of PC12 neurons induced by Aβ25-35 was decreased in a dose-dependent manner. Shortened synaptic length, neuronal atrophy and sparsely interconnected neurons were visible. Expression levels of neurogranin, calmodulin kinase II and postsynaptic density-95 proteins were al down-regulated. These findings indicate that to screen the cel model of Alzheimer’s disease, the optimal concentration and interventional time of Aβ25-35are 10 μmol/L and 48 hours, respectively.

OBJECTIVE To prevent the nosocomial infection event in the clinical laboratory. METHODS To enhance the conception of self-protection,amplify necessary rules and regulation,fine technique training,establish the health-record of the department staff,purchase the facilities of protection,and disinfect the instrument and environment of laboratory even the test report sheet. RESULTS By means of above mentioned measures and management,it could control in most degree of nosocomial infection in clinical laboratory,and ensure the safety and health of the department staff. CONCLUSIONS The nosocomial infection event of clinical laboratory can be prevented by amplification of necessary rules and regulation as well as enhancement of the management.

Orbital surgery is one of the most complex surgeries in ophthalmology, with many clinical ethics issues.This paper aims to analyze the implementation process of all kinds of orbital surgeries in the view of ethics, and to explore the relevant clinical ethical issues and countermeasures during the orbital surgery.

Objective:To explore best drug treatment regimen through the participation of clinical pharmacists in the drug treat-ment of one patient with multidrug-resistant Acinetobacter baumannii meningitis intracranial infection. Methods: Clinical pharmacists joined in the treatment team and designed the treatment plan. The individualized dosage regimen was made out through the choices of drugs, dose and administration route, and taking the ADR of drugs into consideration. Results: The intracranial multidrug-resistant Acinetobacter baumannii infection was controlled by the sensitive antibiotics. Cefoperazone sulbactam and minocycline were both effec-tive in the treatment of Acinetobacter baumannii intracranial infection. Conclusion:Clinical pharmacists should provide clinical consul-tation for physicians to ensure the safety, effectiveness and economic of patients’ medication.

OBJECTIVE:To provide reference for safe and effective use of anti-infective agents in the clinic. METHODS:The utilization of anti-infective agents in hematology department of our hospital from 2009 to 2013 was analyzed statistically using con-sumption sum,DDDs,the ratio of the serial number (the ratio of the serial number of consumption sum to the serial number of DDDs),DDC. RESULTS:There were 5 kinds of anti-infective agents,such as β-lactam and its compound preparations,antifungal drugs,fluoroquinolone and glycopeptide. From 2009 to 2013,the percentage of anti-infective agents with the ratio of serial num-bers≥1 were 70%,60%,70%,60%,65%,respectively. CONCLUSIONS:From 2009 to 2013,the utilization of anti-infective agents in hematology department of our hospital is rational on the whole. However,the cheaper drugs with good synchronism should be used.

Objective To study the development of visual function in blepharophimosis-ptosis-epianthusinversm syndrome(BPES) and evaluate the clinical effect of Multistage Correction.Design Retrospective case series.Participants 51 cases of BEPS in Beijing Tongren Hospital from June 2005 to May 2009.Methods Refraction and general ophthalmology were performed for each patient. Family history was inquired and corrected surgery were performed for every one.Main Outcome Measures Refraction,the length, width of palpebral fissure,and inner canthal distance were measured both preoperatively and postoperatively.Results 13 of the 51 cases had family history,27 cases had amblyopia and 12 cases had refractive error.4 cases combined with strabismus.Conclusions The risk of refractive error and amblyopia in patients with BPES is much higher than that of normal population,so careful regular visual follow -up and early surgery are necessary.BPES patients tend to have much more chance to get amblyopia,which will impact on the development of visual function,therefore surgery correction at early age is highly suggested.

Objective The purpose of this study was to explore the effect of FVIII(factor VIII,FVIII)and VWF (von Willebrand factor,VWF)elevation on the severity, prognosis and inpatient complications such as infections and neuroworsening in patients with acute ischemic stroke. Methods Ninety patients with acute ischemic stroke and 50 pa?tients without ischemic stroke were recruited from affiliated Shengjing hospital of China Medical University between De?cember 2014 and March 2015 . We tested FVIII and VWF levels of all the patients. Patients with acute ischemic stroke were divided into 4 groups:both FVIII and VWF within normal range(FVIII-/VWF-);elevated FVIII, but normal VWF (FVIII↑/VWF-); FVIII within normal range, but elevated VWF(FVIII-/VWF↑); and elevation of both FVIII and VWF(FVIII↑/VWF↑). Results The median of VWF was higher in the case group (1521.88 U/L) than in the control group (1281.77U/L)(P=0.023). Compared with patients with both FVIII and VWF within normal range, patients with ele? vation of both FVIII and VWF had more severe neurological dysfunction(NIHSS at admission>5)(OR=3.643,95%CI:1.258~10.549,P=0.017)and poorer prognosis(mRS>2 at the point of 3 months after stroke)(OR=7,95%CI:2.304~21.266,P=0.001), higher proportion of mRS>2 at discharge(OR=3.797,95%CI:1.346~10.713,P=0.012),and more in?patient complications such as infections(OR=3.913,95%CI:1.115~13.729,P=0.033)and neuroworsening(OR=5.538, 95%CI:1.099~27.908,P=0.038). After additional adjustment for various confounding factors, elevation of both FVIII and VWF was an independent predictor of poor prognosis in patients with acute ischemic stroke(OR=4.495,95%CI 1.012~19.957,P=0.048). Conclusions The elevation of FVIII and VWF is positively associated with the severity and prognosis in patients with acute ischemic stroke, which may serve as an independent predictor of poor prognosis.

Objective To explore the impact of childbirth on women external anal sphincter electromyography by analysis of motor unit potentials parameters of external anal sphincter electromyography of healthy women volunteers with different childbirth experiences.Methods Twenty-eight healthy volunteers with different childbirth experiences were recruited in this study.Among them , 7 had a history of cesarean and 21 had experienced 1-3 uncomplicated vaginal deliveries ( 12 women had experienced 1, 6 had experienced 2, and 3 had experienced 3).Another 9 nulliparous healthy volunteers were recruited as control group.Among all subjects who completed the examination , parameters of motor unit potentials ( duration, amplitude, area, mean number of turns and mean phases ) of bilateral external anal sphincter were obtained for statistical analysis.Results There were no significant differences in any of the parameters of motor unit potentials between the nulliparous group and the cesarean group , while parameters of durations (10.5 ms vs 9.0 ms, t=-2.506, P=0.019) and mean phases (4.0 vs 3.6, t =-2.707, P=0.012) of vaginal delivery group were significantly higher than that of cesarean group and parameter of durations ( 10.5 ms vs 8.9 ms, t =-3.025, P =0.005 ) of vaginal delivery group was significantly higher than that of the nulliparous group;With increasing numbers of vaginal deliveries , only the parameter of mean turns showed statistically significant differences , although there was a slight trend of larger and more complex motor unit potentials.Compared with subjects without vaginal delivery experience ( including nulliparous group and the cesarean group ) , the parameters of durations and mean phases of subjects with vaginal delivery experience were statistically higher; Nevertheless , parameter of bilateral duration of the motor unit potential preferred asymmetric.Conclusions Childbirth experience has an explicit impact on the parameters of the external anal sphincter motor unit potentials , which is considered to be strongly correlated with the vaginal delivery process rather than the pregnancy procession itself.In addition , the impact is mostly from the first vaginal delivery experience.The characters of asymmetry of motor unit potential parameters imply the possibility of mechanical damage and decrease blood perfusion of tissues during delivery procession.

Objective To investigate the clinical features and causes of micturition and defecation dysfunction in motor neuron disease (MND) patients.Methods The micturition and defecation function was evaluated by a questionnaire covering storage and voiding of urine and feces respectively in 50 MND patients.The clinical features and external anal sphincter electromyography (EAS-EMG) were analyzed to explore the causes of micturition and defecation dysfunction in MND patients.Results Micturition and defecation dysfunction was detected in 9 of 50 (18.0％) MND patients.The main types of micturition and defecation dysfunction were constipation (4/9),urinary frequency,urgency with or without incontinence,fecal urgency (4/9),powerlessness for micturition and defecation (2/9),hesitancy for micturition (1/9).EAS-EMG was normal in 9 MND patients accompanied with micturition and defecation dysfunction.Conclusions MND patients accompanied with micturition and defecation dysfunction were not very rare.Constipation,urgency and powerlessness were the main types of micturition and defecation dysfunction and they were not related to the function of external anal sphincter.Gastrointestinal dysfunction from abnormal autonomic nerve involvement,muscle weakness and the resulted reduced activity,severe upper motor neuron damage and respiratory muscle weakness may be the main causes of micturition and defecation dysfunction in MND patients.