Sepsis-associated encephalopathy is a diffuse brain dysfunction that occurs secondary to infection.It is characterized by alteration of consciousness and cognition,seizure or focal neurological signs.Sepsis-associated encephalopathy is accompanied by abnormalities of electroencephalogram and somatosensoryevoked potentials,increased biomarkers of brain injury and,frequently,by neuroradiological abnormalities.Its diagnosis relies essentially on neurologic examination.Hepatic/uremic encephalopathy,metabolic disturbances,drug overdose,withdrawal syndrome and Wernicke's encephalopathy are the main differential diagnosis of sepsis-associated encephalopathy.Currently,treatment consists mainly of controlling sepsis.Various drugs acting on septic pathophysiology have been tested in septic animals.

Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH).According to the appearance of vitreous and retina determined by optical coherence tomography,IMH can be classified as primary or secondary IMH,and IMH with or without vitreous attachment;Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction.According to the measured horizontal diameter,IMH can be classified as large,middle and small IMH.This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory,with a better description of the occurrence and development of IMH process.It should be used as the general principal to guide IMH classification,evaluation of surgical indications,selection of operative method,and estimation of surgical outcome.Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery.For complicated and large IMH,inverted ILM flapping can improve the closure rate;ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter.The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment,following the existing evidence-based medical evidence,and based on the new classification information,ocular and systemic features of each patient.

Objective To investigate the effect and necessity of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refractory polycystic ovarian syndrome complicated with infertility.Methods 80 cases of patients with polycystic ovary syndrome (PCOS)combined with infertility were randomly divided into two groups with 40 cases in each group.The testing group used hysteroscopy combined with laparoscopy in diagnosis and treatment while the laparoscopy was only used in the control group.The changes of ovary,ovarian follicles and serum hormone level of the two groups which before and after operation were compared,and the data of postoperative normal ovulation rate,pregnancy rate and abortion rate of the two groups were recorded.Results The follicle number and ovarian volume of the testing group were significantly decreased than that before treatment,and were significantly lower than that of the control group,with statistical difference (t =3.82,3.80,3.74,3.75,all P <0.05).The serum T,LH and LH/FSH of the testing group were significantly decreased than the data before surgery,and were significantly lower compared to the control group with statistical difference (t =9.32,4.06,3.80,all P <0.05).The normal ovulation rate,pregnancy rate and abortion rate of the testing group were significantly higher compared to the control group (90.0%,62.5% and 7.5% vs.72.5%,50% and 15%)χ2 =4.02,4.10,3.90,all P <0.05).Conclusion Hyste-roscopy combined with laparoscopy has an obvious curative effect in the diagnosis and treatment of polycystic ovary syndrome combined with infertility,which can effectively improve ovulation rate and pregnancy rate and reduce the abortion rate,is worthy of clinical application.

Prenatal diagnosis is vitally important to control birth defects.The mature application of detecting biochemical markers in maternal serum and cytogenetic karyotype analysis of amniotic fluid cells , villi cells and umbilical cord blood cells , as well as the development of fluorescence in situ hybridization , nucleic acid amplification , gene sequencing , chips and other molecular biological techniques , have significantly improved the standards of prenatal diagnosis.The application of high-throughput sequencing , a non-invasive detection technique , ushers the development of prenatal diagnostic techniques into a new stage.In the face of a growing number of and constantly updated test items , it is necessary to assess the advantages and limitations of various prenatal diagnostic techniques , so as to realize scientific selection and combination, and utilize the techniques to their fullest potential.

The liver is a crucial organ involved in immune and metabolic processes.In multiple organ dysfunction syndrome secondary to sepsis, liver is one of the target organs.Sepsis-associated liver injury worsens the prognosis and mortality.MicroRNAs are single-stranded,non-coding RNAs.MicroRNAs modulate gene expression post-transcriptionally by binding themselves to complementary sites of target genes and degradation proteins.MicroRNAs affect sepsis pathogenesis at multiple levels through regulating signaling pathways and inflammation factors in immune reaction, as well as functions of immune cells.Among microRNAs involved in sepsis pathogenesis,microRNA-155 is critical in sepsis associated liver injury and it is sketchily described in this review.

Objective To explore the effect of Buyanghuishensan plus hyperbaric oxygen and medicine in the treatment of delayed encephalopathy after acute carbon monoxide poisoning .Methods According to the digital t able,143 patients with delayed encephalopathy after acute carbon monoxide poisoning were randomly divided into two groups .70 patients in the control group were treated by hyperbaric oxygen and medicine ,while 73 patients in the treat-ment group were treated by Buyanghuishensan plus hyperbaric oxygen and medicine .They were treated for three months.After three months,MMSE and ADL were used to determine changes of the patients'neurological function. Results The total effective rate of the treatment group was 97.3%,which was significantly higher than 88.6%in the control group(χ2 =4.84,P<0.05).After treatment for 3 months,the MMES score of the two groups increased signif-icantly (t=3.096,4.725,all P<0.01),and that of the treatment group increased more significantly (t=2.466,P<0.05).After treatment for 3 months,the ADL score of the two groups decreased significantly (t=2.691,3.179,P<0.05 or P<0.01),and that of the treatment group decreased more significantly (t=2.607,P<0.05).Conclusion Buyanghuishensan plus hyperbaric oxygen and medicine can improve neurological function in patients with delayed encephalopathy after acute carbon monoxide poisoning .

Most children with Hirschsprung's disease (HD) have a satisfactory outcome after a pull-through operation.However,a small group of patients develop severe postoperative complications,and a reoperation may be necessary.The most common and serious complications after definitive surgery are as follows:anastomotic stricture,a twist of the pull-through segment,retained aganglionosis,HD-associated enterocolitis,anastomotic leak,and fistulae.Using a well-defined treatment algorithm based on the clinical status as well as precise diagnostic workup can end the long suffering of patients with postoperative complications.Pull-through surgery can be safely performed with favorable outcomes after thorough history-taking,meticulous clinical examination,a thoughtful planning,adherence to basic surgical principles and under skillful hands.

Aspartyl-(asparaginyl) β-hydroxylase (AAH) is a type 2 transmembrane protein and a member of the α-ketoglutarate-dependent dioxygenase family of proteins.AAH catalyzes hydroxylation of specific aspartyl and asparaginyl residues in epidermal growth factor-like domains of proteins.Overexpression of AAH is found in many types of cancer tissues,however,AAH expression is found only in normal placenta and paranephros tissues.AAH can translocate to cell membrane from endoplasmic reticulum membrane when it is overexpressed in cancer cell,which hydroxylate proteins such as Notch,Jagged,and cellular adhesion molecules that regulate cell migration and invasion.AAH is a potential biomarker for cancer diagnosis.

Objective To evaluate clinical efficacy of Yishen-Bushui-Tongluo decoction in the treatment of multiple sclerosis (multiplesclerosis, MS).Methods 60 patients met the inclusion criteria of MS were recruited into a compound group and a control group, with 30 patients in each. The control group was treated with conventional western medicine, while the compound group was treated withYishen-Bushui-Tongluo decoction on the basis of the control group. Both groups were treated for continuous 3 months, the clinical efficacy, symptoms, signs, expanded disability scale (expanded disability status scale, EDSS) scores, as well as adverse reactions and hormone-year recurrence rate were compared between the two groups.Results After the treatment, the total effective rate was 93.3% (28/30) in the compound group and 73.3% in the control group (22/30), showing statistically difference (χ2=4.320,P=0.038). After treatment, the clinical symptom score (5.1 ± 2.7vs. 7.0 ± 3.1,t=2.532), neurological signs score (5.1 ± 1.6vs. 6.3 ± 1.7, t=2.815), EDSS score (3.4 ± 1.5 vs.4.8 ± 1.5,t=3.615) in the compound group were significantly lower than the control group (P<0.01 or P<0.05); the follow-up period of 1 year showed the recurrence times in the compound group was lesser than the control group (0.31 ± 0.17vs.0.89 ± 0.36;t=7.980,P=0.000).ConclusionsYishen-Bushui-Tongluo decoction combining conventional western therapy can significantly improve the clinical symptoms of MS patients, relieve nervous system damage mitigation, reduce relapse frequency, and reduce the adverse effects of hormones.

Objective To explore the application value of laparoscopic surgery in type 2 diabetes patients with acute cholecystitis.Methods 50 type 2 diabetic patients with acute cholecystitis were chosen as the research objects,the patients were divided into the observation group and control group according to the method of treatment, 25 cases in each group.Strict control of blood glucose levels in patients before operation,the observation group treated by laparoscopy,the control group were treated with conventional open surgery.Recorded the operation time and hemor-rhage,postoperative abdominal drainage,anal exhaust time,patient ambulation time and hospitalization time and other indicators.The patients were followed up to record the postoperative infection,occurrence of complications such as postoperative inflammation.Results There was no statistically significant differences between the two groups in oper-ation time(t =1.02,P >0.05).In the observation group,the intraoperative blood loss was (41.2 ±8.3)mL,postop-erative drainage volume was (107.5 ±16.4)mL,which were significantly lower than those in the control group,and the anal exhaust time was (1.7 ±0.3)d,total hospitalization time was (7.1 ±1.7)d,which were significantly shorter than those of the control group,the differences were statistically significant(t =3.43,3.78,3.43,4.21,all P <0.05).The observation group the complications included wound infection 1 cases,the complication rate was 4.0%, while in the control group,the complications included bile leakage,reflux esophagitis,incision infection,fat liquefac-tion,pulmonary infection and incisional hernia,the overall complication rate was 24.0%,there was statistically signifi-cant difference in the complication rate between the two groups(χ2 =4.54,P <0.05).Conclusion The laparoscopic surgery in the treatment of type 2 diabetic patients with acute cholecystitis has exact effect,and the patients recovery time is short,the complication rate is low.