Objective:To elucidate the clinical features of acute disseminated encephalomyelitis,as well as its diagnosis and treatment.Methods:The general clinical manifestations,lesion locations,the results of cardinal ancillary investigations,and treatment as well as prognosis of 86 ADEM patients were comprehensively analyzed.Results:ADEM mainly occurred in children,young and middle-aged people.Their onsets were relatively acute.The upper respiratory tract infection and vaccination,measles,german measles,chickenpox,mumps,scarlet fever were the main predisposing factors.The immunoglobin in CSF increased.Spinal cord,cerebellum,cerebral medullary substance and brain stem were often involved.Imaging investigations,electrophysiology and immunology were helpful for diagnosis.The administration of glucocorticoid was effective.Conclusion:In addition to clinical features,neuroelectrophysiology,CSF immunology and imaging investigations altogether greatly aid clinical definite diagnosis.It is important to treat the patients in time and properly for the better prognosis.

Objective To study the characteristic of etiology and drug resistance of neonatal sepsis for rational use antibiotics in clinic.Methods The etiology and drug resistance of 167 positive hemoculture examples of 365 neonatal sepsis examples were retrospectively analyzed,and the characteristic of etiology diversify and drug resist-ance characteristic of neonatal sepsis were also analyzed.Results In 365 blood culture examples of neonatal sepsis, there were 167 positive cases,positive ratio was 45.75%.Among pathogenic bacterium,the first etiology was staphylo-coccus epidermidis,there were fifty -eight examples and account of 34.73%.The second was staphylococcus haemo-lyticus and accounts twenty -nine examples and 17.37%.The third was staphylococcus aureus which had twenty -two examples and account 13.17%.The annual infection rate of staphylococcus epidermidis and staphylococcus hae-molyticus in the second five years were increased obviously.Gram -positive coccus drug resistance to penicillin,cep-hazolin,oxazocilline and cefoxitin were very high and the rate of the second five years were higher than that of the first five years.Gram -positive coccus drug resistance to third -generation cephaloporins and imipenem and meropenem were higher than vancocin and the rate of the second five years were higher than that of the first five years.Gram -positive coccus was 100.00% sensitive to vancomycin.Gram negative bacilli drug resistance rate to penbritin and cep-hazolin and third -generation cephaloporins was the highest.Gram negative bacilli to meropenem and imipenem was hypersensitive in all antibiotics.Conclusion The chief pathogenic bacteria of neonatal septicemia is staphylococci. Among pathogenic bacterium,the main pathogenic bacteria is CoNS,and staphylococcus epidermidis and staphylococ-cus haemolyticus goes up significantly.Among gram -negative bacilli,the escherichia coli goes up.The drug resist-ance to bacteria goes up in neonatal sepsis,it is very important to monitor the drug resistance.

Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94％) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11％) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11％) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41％) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82％).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.

Objective To observe the clinical effect of holmium laser for the treatment of ureteral calculi under ureteroscope .Methods In 205 cases of ureteral calculi with ureteroscopic holmium laser treatment ,the stone expulsion rate,complication,gravel rate were analyzed.Results Operation time was (65.3 ±18.4)min,hospitaliza-tion time was (5.6 ±2.7) d,the success rate of operation was 95.1%(195/205),incidence of complications (hemorrhage in 1 cases,perforation in 2 cases,20 patients with fever) was 11.2%,3 cases of calculi moved to pel-vis,indwelling double J tube in operation ,postoperative ESWL,after 2weeks ~3months stone completely lithagogue rate was 98.4%(192/195).7 cases converted to open operation .After operation 3 cases of ureteral calculi and 5 cases of renal pelvis stones were in postoperative ESWL ( extracorporeal shock wave lithotripsy ) , which was completely discharged and cure .Conclusion There are some advantages of ureteroscopic holmium laser lithotripsy for ureteral calculi with high success rate,the stone expulsion rate high,fewer complications,less trauma,safe and reliable.

Forensic Sciences/education*

BACKGROUND:Numerous studies have demonstrated various therapeutic methods for cerebrospinal fluid leakage after spinal column surgery, including intraoperative and postoperative measures. Few studies addressed the therapeutic methods of cerebrospinal fluid leakage after cervical vertebra surgery using lumbar subarachnoid catheter drainage.
OBJECTIVE:To evaluate the therapeutic efficacy of sustainable drainage and lumbar subarachnoid catheter drainage for cervical postoperative cerebrospinal fluid leakage.
METHODS:923 patients underwent cervical spine surgery in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, China from June 2009 to October 2012. There were 24 cases of postoperative cerebrospinal fluid leakage with an incidence of cerebrospinal fluid leakage of 2.6%(24/923). The dural laceration that could not be repaired or be found induced cerebrospinal fluid leakage. Of them, 12 cases received lumbar subarachnoid catheter drainage (catheter group), and 12 cases received sustainable drainage (drainage group).
RESULTS AND CONCLUSION:Compared with the drainage group, the duration of cerebrospinal fluid leakage was significantly shorter in the catheter group (P<0.05). In the catheter group, one case affected cerebrospinal fluid infection. In the drainage group, two cases experienced cerebrospinal fluid cyst and one case suffered from cerebrospinal fluid infection. They were cured by symptomatic treatment. A total of 24 cases were fol owed up for 9-12 months. None of them affected cerebrospinal fluid leakage, cerebrospinal fluid infection or cerebrospinal fluid cyst. Results demonstrated that lumbar subarachnoid catheter drainage in the treatment of cervical postoperative cerebrospinal fluid leakage has a good effect.

Objective To discuss the role of naso-carbon in the protection of parathyroid during surgery. Methods 72 patients were randomly divided into the two groups,Injecting 0.1-0.2mL nano-carbon in the thyroid during a thyroid surgery.When the thyroid and surrounding lymph tissue were stained,then the thyroid surgery should be continued,the non-stained tissue should be protected.Results There were 6 cases with hypocalcemia in the con-trol group and 2 cases in the observation group(χ2 =13.87,P<0.05).5 cases with PTH decrease in the control group and 1 case in the observation group(χ2 =14.53,P<0.05).7 parathyroid glands were examined in the control group,while none in the observation group(χ2 =127.54,P<0.05).Conclusion Using naso-carbon during the thy-roid surgery,parathyroid gland cannot be stained black.The parathyroid gland can be easily identified and preserved.

Objective To compare the clinical effect of platelet rich plasma and sodium hyaluronate in the treatment of knee osteoarthritis .Methods According to the different treatment methods ,100 patients with knee osteo-arthritis were divided into the control group ( for treatment of platelet rich plasma ) and study group ( for treatment of sodium hyaluronate),each group 50 cases.The treatment effect would be compared between two groups ,and the patients were scored knee joint active function using Lysholms score standard ,using visual analogue score method on patients with knee joint pain .Results The excellent and good rate had no significant difference between the study group(98.0%) and control group(94.0%)(P>0.05);The knee joint activity of study group (76.81 ±9.24) was significantly better than that of the control group (60.46 ±7.41),the difference was statistically significant (t =-9.76,P<0.05);the knee joint pain degree of the study group (1.91 ±0.88) was lower than that of the control group (3.58 ±0.85),the difference was statistically significant (t=9.65,P<0.05).Conclusion Platelet rich plasma and the knee joint injection of sodium hyaluronate in the treatment of osteoarthritis were able to effectively alle -viate knee joint pain ,activity limitation and other clinical symptoms ,improve the curative rate ,but the treatment effect of sodium hyaluronate is more remarkable ,which is worthy of promotion .

BACKGROUND:At present, there was lack of reports on the efficacy of thoracolumbar tuberculosis complicated with severe kyphosis (>90°). Choice of surgical treatment is necessary for patients with severe spinal tuberculosis kyphosis, affected heart and lung function and neurological disorders. OBJECTIVE:To retrospectively analyze the repair effect of I-stage posterior osteotomy orthopedic fixation and II-stage anterior debridement interbody bone grafting fusion in repair of patients with thoracolumbar tuberculosis complicated with severe kyphosis. METHODS:Total y 53 patients with spinal tuberculosis complicated with severe kyphosis were enrol ed. Patients underwent posterior osteotomy orthopedic fixation in the first stage, and underwent anterior debridement interbody bone grafting fusion in the second stage. X-ray, CT, MRI and other imaging examinations were conducted before and after the treatment. Erythrocyte sedimentation rate, C-reactive protein, pain visual analog scale scores, kyphosis and ASIA spinal cord injury classification before and after the treatment were compared and analyzed for clinical evaluation of efficacy. RESULTS AND CONCLUSION:Al patients had a successful surgery. The operative time was 290 (195-420) minutes, and the intra-operative amount of blood loss was 1800 (1 100-3 300) mL, the average number of fixed segments were 11.8 (9-16). Al these 53 patients were fol owed up for 26-28 months. The erythrocyte sedimentation rate and C-reactive protein of patients after treatment gradual y recovered to normal, and recovered to normal levels at the final fol ow-up. The mean correction of sagittal Cobb angle was 77.92°, the correction rate reached to 74.6%at the final fol ow-up. Til the final fol ow-up, the average loss of corrective angle was 1.35°. The lower back pain and limitation of function obtained varying degrees of al eviating after treatment. The visual analog scale scores in the final fol ow-up were significantly lower than those before treatment (t=19.219, P<0.001). ASIA spinal cord injury scores gradual y increased. Patients recovered the ability to live and work in varying degrees. These results suggest that I-stage posterior osteotomy orthopedic fixation combined with II-stage anterior debridement interbody bone graft fusion is an effective methods for repair of thoracolumbar tuberculosis complicated with severe kyphosis. The lesions of patients with thoracolumbar tuberculosis complicated with severe kyphosis who were enrol ed in this study involve multiple vertebral body, long bone defect, and often need long segmental al ograft bone grafting, with long-time of bone grafting fusion, therefore, zygapophyseal bone grafting fusion should be conducted to increase the stability of posterior bone grafting.

Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.