Objective To improve the diagnosis and treatment of epidemic cerebrospinal meningitis in children.Methods A retrospective review was performed and a total of 69 cases of children epidemic cerebrospinal meningitis were collected and classified into ordinary and fulminant epidemic cerebrospinal meningitis from 1999 to 2011.Disease prevalent season,age,clinical characteristics,laboratory examination,treatment,prognosis and risk factors were analyzed.Results The mean age(33 male and 36 female) was (6.85 ±5.12)years old,ranging from 56 days to 15 years old.A total of 60 cases began on January to May; 6 cases began on June to October; 3 cases began on November to December.All of the 42 cases of ordinary epidemic meningitis were recovered; 7 cases of fulminant epidemic meningitis(n =27) were dead.All of the patients had fever; 64 cases(92.75％) had Petechiae petechial skin; 36 cases(52.17％) had headache; 49 cases(71.01％) vomited; 65 cases(94.2％) had positive neck resistance; 15 cases(21.74％) had convulsion; 35 cases(50.72％) had drowsiness or coma; 32 cases (46.38％) had positive pathological signs and 24 cases (34.78％) had low blood pressure or shock.Blood tests revealed that 63.77％ of the patients leukocytes raised and 8.70％ of the patients reduced; 42.03％ of the patients platelet reduced; 55.07％ of the patients had electrolyte disturbance and 89.86％ of the patients had coagulation disorders,among which 46.38％ fibrinogen reduced.The rash printed piece and cerebrospinal fluid smear tests found that Gram-negative bacteria positive rate were 12.5％ and 19.35％ respectively; the positive rate in bacterial culture of cerebrospinal fluid and blood culture were 12.90％ and 7.25％ respectively.Drug sensitive test showed that penicillin and ceftriaxone were sensitive to bacteria.The differences of age,leukocyte and platelet counts,fibrinogen and altered mental status between ordinary and fluminant epidemic meningitis were significant (P ＜ 0.05).Conclusion The prevalent season is from January to May and the prevalent age is less than 5 years for children with epidemic cerebrospinal meningitis.Ceftriaxone or penicillin should be the preferred choice;age,lower leukocyte and platelet counts,lower fibrinogen and altered mental status should be used to predict the severity of the disease.

Obstructive sleep apnea (OSA) is characterized by repeated intermittent hypoxia (IH), hypercapnia, sleep fragmentation and intrathoracic pressure change. IH is related to the clinical pathophysiological processes of hypertension, atherosclerosis, coronary heart disease, arrhythmia, stroke, heart failure and sudden death. IH from OSA can lead to metabol-ic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and the change of nerve body fluids, which has been shown to increase the risk of cardiovascular diseases. This study mainly describes the pathogenesis of IH leading to the various cardiovascular diseases.

Objective To analyse the clinical manifestations of mycoplasma pneumoniae pneumonia(MPP) with 23SrRNA A2063G gene mutation,and improve the ability of diagnosis and treatment of patient infected with MPP.Methods MP-DNA was detected by fluorescent quantitative real-time PCR in sputum specimens from 36 children with MPP,then we detected the drug resistance gene mutation sites by nest-PCR and DNA sequencing,on this basis we classified into two groups of macrolide-resistant MP and macrolide-sensitive MP,and compared the clinical manifestations,laboratory findings,chest imagings and treatment between two groups.Results Of these 36 cases of MPP,24 cases had macrolide-resistant gene mutation with an A2063G transition in domain V of the 23SrRNA,12 cases had no macrolide-resistant gene mutation.Compared to macrolide-sensitive MP group,macrolide-resistant MP group had longer hospitalization duration,longer total cough period,longer total febrile period,longer fever duration after macrolide therapy,longer course of disease,and had higher white blood cells counts and CRP.In the macrolide-resistant MP group,the temperature subsided within 5 days after macrolide treatment alone of 12 cases,3 cases needed switch to fluoroquinolones therapy,10 cases combined with glucocorticoids and 6 cases combined with intravenous immunoglobulin,all 24 patients had good outcomes.While in macrolide-sensitive MP group,the temperature susided between 12 hours to 3 days after macrolide treatment of 8 cases.Conclusions Compared to patients infected by macrolide-sensitive MP,those mycoplasma pneumoniae pneumonia patients with 23SrRNA A2063G gene mutation have longer hospitalization duration,longer total cough period,longer total febrile period,longer fever duration after macrolide therapy,longer course of disease,and have higher white blood cells counts and CRP.Some macrolide-resistant MPP patients have good response to macrolide antibiotics treatment,while the severe cases need combined with glucocorticoids and immunoglobulin,or should change antibiotics.

Objective Through the two D-dimer content detection of the fracture patients and healthy con-trols,and analyze the difference between them ,to explore the correlation between fractures were detected two D-dimer and the importance and the patient′s condition.Methods 306 of fracture patients were collected for determination of D-dimer content were detected at the same time ,100 healthy people as control two D-dimer content;analysis of the correlation between the fracture in 306 cases patients with D-dimer content .Results The plasma D-dimer level of pa-tients with two fracture(10.7 ±2.6)mg/L,which was significantly higher than that of healthy subjects (0.3 ±0.1) mg/L(t=11.07,P<0.01);The fracture number,fracture patients plasma D-dimer detection results content is high-er,the more serious condition .Conclusion The plasma D-dimer level was significantly higher in patients with two fractures,coagulation Stata ,fibrinolytic enhancement ,easily lead to venous thrombosis and disseminated intravascular coagulation in patients with more complications such as fracture;fracture,the higher the content of plasma D-dimer, patients with more serious ,there is correlation .

OBJECTIVE:To evaluate the efficacy of Probiotics in the treatment of ulcerative colitis(UC).METHODS:The recent pertinent literature about the use of Probiotics in the treatment of UC was retrieved from PubMed and Medline and the methodology and literature quality were evaluated in accordance with the evaluation criteria for the quality of literature of evidence-based medicine.RESULTS & CONCLUSION:The majority of the studies showed that Probiotics are of positive value for the remission of the US at acute stage and maintaining of remission induction of drugs in the treatment of UC.Strictly designed and randomized controlled trials(RCTs)remain to be done to tackle the problems encountered by the micro-ecological preparations as a new therapy in the treatment of UC.

Objective To determine levels of nuclear factor (NF)-κB, interleukin (IL)-10, and visfatin in adipocytes treated by different degrees of intermittent hypoxia (IH), and to investigate the mechanism of IH leading to insulin resistance (IR). Methods The cell model of intermittent hypoxia/re-oxygenation (IH/ROX) in obstructive sleep apnea (OSA) was established. Differentiation mature 3T3-L1 adipocytes, were randomly divided into 10 groups including four different-frequency intermittent hypoxia groups(IH1-4, fixed intermittent hypoxia scheme for 1.5%O2 45 s and then re-oxygen 21%O2 for 2 min 15 s, 4 min 15 s, 5 min 45 s and 8 min 45 s, 60 times circulation), and their normal oxygen control groups (SC1-4, instead each IH group 1.5%O2 to 21%O2, the rest groups were treated as same as IH group), continuous hypoxia group (CH, 10%O2 for 6 h) and normal oxygen control group (CC, 21%O2 for 6 h). ELISA method was used to determine the levels of IL-10 and visfatin in the supematant of adipocytes. Western blot method was used to determine the protein levels of NF-κB p65 and visfatin. Real-time PCR method was used to determine the mRNA levels of IL-10 and visfatin. Results The protein and mRNA expressions of IL-10 were significantly lower in IH group and CH group than those of control groups (P<0.01). The levels of NF-κB p65 protein were significantly increased in IH group and CH group than those of control group. The protein and mRNA expressions of visfatin were significantly higher in IH1, IH2 and CH groups than those of control group (P<0.01). Conclusion As a prominent feature of OSA pathophysiology, IH may take part in insulin resistance of OSA patients by abnormally secreting NF-κB, IL-10 and visfatin in adipocytes.

Objective To assess the value of contrast-enhanced ultrasonography(CEUS)in evaluating the therapeutic efficacy of uterine leiomyoma treated by radiofrequency ablation(RFA)and to discuss the value of its application.Methods Forty-four patients which were diagnosed as uterine leiomyomas by ultrasonic guidance needle puncture biopsy preoperation were examined by CEUS before and one week after RFA treatment respectively,and the patho-results were got again after the surgery.Routine ultrasonography was performed in 1,3,6,12 months after the treatment to compare the volume change of uterine leiomyomas with the change of the clinical symptoms.Results After the treatment,CEUS showed that the contrast agent didn't appear in thirty-five patients'uterine leiomyomas and the nonperfusion regions matched the size of the uterine leiomyomas completely.The contrast agent enhanced on the edge of the uterine leiomyomas in nine,the patho-results confirmed that the nonperfusion regions of the contrast agent were necrosis tissues and the marginal local enhancement regions were incomplete necrosis.Three month after RFA treatment,the uterine leiomyomas began to shrink,which showed obviously in 6 months after the treatment.There were significant differences in the parameters before and after the treatment(P＜0.05).Clinical symptoms improved obviously in thirty-five patients(90%)after the treatment.Conclusions RFA is an effective minimally invasive surgery of the uterine leiomyoma.CEUS can identify the treatment range and the remaining tissues.It has significant value in guiding the supplementary treatment.

Objective: To identify choroideremia and retinitis pigmentosa(RP)using next-generation sequencing(NGS)technology. Methods: A cross-sectional study was adopted.The participants were two pedigrees that was suspected of RP in previous hospital treatments in He Eye Specialist Hospital between January 2017 and December 2018.The relevant medical and family history were collected, and the family tree was plotted.The visual acuity, intraocular pressure, fundus photography, electroretinogram(ERG), B-mode ultrasond, visual field, color vision, optical coherence tomography(OCT), and slit lamp assessment were performed on all subjects.Target region sequencing and Sanger sequencing were performed, deletion insertion of large fragments was verified by real-time quantitative PCR.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Shenyang He Eye Hospital(NO. IRB[2017]k002.01) Results: Two known pathogenic mutations were identified in CHM gene: EX9 DEL and c. 715C>T.Furthermore, the clinical diagnosis of choroideremia was confirmed.The Family 1 proband Ⅱ1 with the EX9 DEL hemizygous mutation had a special clinical phenotype, "Star" small piece intact choroid was visible in the macular fovea of both eyes.The patients in pedigree 2 carried the pathogenic mutation c. 715C>T, the proband Ⅲ1 carried a hemizygous mutation and the reddish island area in the fovea macula was seen in both eyes.The mother Ⅱ2 and grandmother I2 of proband carried heterozygous mutations, the degree of fundus atrophy was lighter than that of the proband Ⅲ1, the fundus had a mottled appearance, the optic disc boundary was clear, the blood vessel thickness was moderate, and the exposed choroid was visible in the fundus atrophy area. Conclusions This study is the first to identify two known pathogenic mutations in CHM gene, EX9 DEL and c. 715C>T in Asian Manchu and Han populations.The clinical phenotypes of female carriers with the c. 715C>t pathogenic mutation are different from those of male patients.The NGS technology may become a powerful tool to distinguish choroideremia from RP.

Objective To investigate the clinical features, prognosis and risk factors of patients of acquired immunodeficiency syndrome (AIDS) complicated with cryptococcal meningitis (CM). Methods Totally 26 patients of AIDS with CM who were hospitalized in the No. 8th People's Hospital of Guangzhou were enrolled in this study. The clinical data including diagnosis,experimental and etiological test,treatments and prognosis from all the patients were analyzed retrospectively. The results of cerebrospinal fluid routine test and CD4+ T lymphocyte were compared with those of AIDS patients complicated with tuberculous meningitis. Results Among the 26 patients enrolled in the study, the positive rate of cerebrospinal fluid india ink smear or Crypotococcus neoforrnans euhure was 84.6%. The most common symptoms were fever, headache and meningeal irritation sign. The average CD4+ lymphocyte count was 17.83 × 106/L, which was statistically different from that of tuberculous meningitis patients. All the patients showed concomitant multiple organ infections. The mortality rate was as high as 42.3%. At the end of therapy, the cell counts in the eerebrospinal fluid were remarkably higher in the patients with unfavorable prognosis compared to the patients with good prognosis, which was statistically different. Conclusions CD4+ lymphocyte count is an important marker for differentiating CM from tuberculous meningitis in AIDS patients. The results of cerebrospinal fluid routine test can predict the prognosis.

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.