Objective To explore the clinical features and treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Methods The clinical data and follow-up information of 4 children with severe anti-NMDAR encephalitis were retrospectively analyzed. Results Four patients (one male and 3 females) were 10 to 13 years old and one child had teratoma combined. In all patients symptoms at onset mainly were psychiatric syndrome and movement disorder, and then progressed to seizures, disturbance of consciousness and central hypoventilation respiratory failure in one month. The anti-NMDAR antibodies in cerebrospinal fluid were positive in all patients. The EEG showed focal or diffuse slow waves. The brain MRI showed no pathological changes at the diagnosis. The treatment included methylprednisolone and large doses of intravenous immunoglobulin (IVIG), ventilator for 5-95 days, and tracheotomy in 2 cases. One case died because of serious infection. In 21-27 months of the follow-up, one case had clinical recovery; 2 cases had the sustained use of immunosuppressive agents and anti-epileptic drugs and the clinical symptoms were significantly improved. The EEG and anti-NMDAR antibodies continued abnormal in the patient combined with teratoma. One patient relapsed. Conclusions The severe anti-NMDAR is more likely in older female children. The central hypoventilation respiratory failure occurs in the early course of the disease. Combination with tumor is high risk factor. Conventional hormone therapy and ventilator treatment is effective. The recovery is slow. It may be relapsed even one year later.

Objective To explore the effect of dexmedetomidine combined with nutritional intervention on cognitive function recovery and prognosis of patients with severe cranial traumatic brain injury in ICU. Methods A total of 100 patients with severe cranial traumatic brain injury from February 20, 2016 to December 30, 2016 in our hospital ICU were selected and randomly divided into two groups, the control group were given nutrition intervention, the experimental group combined with dexmedetomidine and nutritional intervention. Results The difference of PACHE Ⅱscore, GCS score, mechanical ventilation time, and hospitalization timebetween the 2 groups was statistically significant (P<0.05); The recovery of cognitive function in the experimental group was better than that in the control group (P<0.05). Conclusion The value of dexmedetomidine and nutritional intervention in patients with severe cranial traumatic brain injury in ICU is higher.

Objective To explore the correlations between quantitative parameters of dynamic contrast-enhanced MRI ( DCE-MRI) and nasopharyngeal carcinoma ( NPC) clinical stage.Methods 69 patients with NPC were selected from Oct 2013 to Oct 2015 in Shaoxing People's Hospital,39 men and 30 women,aged 39-76 years old,average 50.6 ±10.5 years old.All patients underwent clinical staging,DCE-MRI and histopathological examina-tion before treatment.Clinical stages were determined based on Chinese 2008 staging system.Value of the volume transfer constant ( Ktrans) and the extravascular extracellular space volume per unit volume of tissue ( Ve) was detec-ted by bi-compartmental pharmacokinetic model.The correlations between quantitative parameters and clinical stage were analyzed by Pearson correlation analysis.Results Mean Ktrans and Ve for NPC were (0.532 ±0.156) mL/min/100cm3 and (0.982 ±0.356),respectively.Ktrans of NPC showed negative correlation with clinical stage (r=-0.506,P=0.001),T stage (r=-0.326,P=0.014),N stage (r=-0.296,P=0.017) and M stage (r=-0.312,P=0.015),while Ve showed positive correlation with clinical stage (r=0.415,P=0.002),T stage (r=0.478,P=0.001),N stage (r=0.318,P=0.015) and M stage (r=0.346,P=0.011).Conclusion DCE-MRI quantitative parameters are significantly related to clinical stage of NPC,which has important values for clinical treat-ment and prognostic assessment.

ObjectiveTo standardize the process in making the model of acute regional cerebral ischemia in Sprague-Dawley rats, and to economize time and material.MethodsRegional cerebral ischemia rat's models were induced and modified according to Koizumi's method.ResultsThe time duration was controllable and the volume of cerebral infarct was determined by adverting the approaches such as the preparation of suture, anaesthesia of the animal, and the details of surgical operation.ConclusionThe acute regional cerebral ischemic model in rats made by Koizumi's method is stable and reliable, and is easy for the beginner to carry out under limited conditions.

Objective To explore the relative signal transduction pathway of angelica polysaccharide(APS) inducing K562 cells toward erythroid differentiation. Methods K562 cells were divided into control group and ASP group, the control group cells were routinely cultured and APS group cells were treated with APS(final concentration is 100-500mg/L). By using of benzidine staining and spectrophotometry, the characteristics of erythroid differentiation of K562 cell induced by APS were detected;By using of laser confocal microscopy, the distribution of JAK_2 and STAT_5 in K562 cells was observed;By using of Western blotting, the expression of JAK_2 and STAT_5 in nucleus and cytoplasm of K562 cells was detected, By using of imm～uno～pre～cipi～ta～tion, the phosphorylation change of JAK_2 in cytoplasm was tested. Results After being induced by APS, the benzidine staining positive rate of K562 was increased.With increasing the concentration of APS, hemoglobin synthesis in K562 cells was promoted accordingly. After being cultured for 12 hours, 24 hours and 48 hour, the expression of STAT_5 in nucleus of K562 cells induced by APS was significantly higher than that of control group, however, expression of STAT_5 in cytoplasm of K562 cell induced by APS was obviously lower. The expression of JAK_2 in K562 cells was not different between APS group and control group, but the JAK_2 phosphorylation level of APS group was much higher than that of control group.Conclusion APS can induce erythroid differentiation of K562 cells, and the mechanisms may be that APS can promote the phosphorylationthe of JAK_2, then stimulating nuclear translocation of STAT_5.

Objective To investigate effective methodology for preventing infectious diseases from spreading within general hospitals at all levels. Methods Six hospitals at three levels in the city were made into two groups and investigated for their treatment of infectious diseases. The group of A1, A2 and A3 hospitals employs the five pre-triage, while the group of B2, B2 and B3 employs the routine pretriage. Results Comparison of undetected infectious cases between group A1, A2, A3 and group B1,B2,B3 identified significant difference with x2 testing, P＜0. 005. Conclusion Five pre-triage method can screen, identify and pinpoint confirmed or suspected infectious disease patients from all outpatients in the first time, thus preventing and controlling the nosocornial transmission of epidemic or even an outbreak of nosocomial infection effectively.

ObjectiveTo investigate the value of urinary BNP for diagnosis of chronic heart failure (CHF). MethodsThe levels of Urinary BNP and plasma BNP were measured by microparticle enzyme immunoassay (MEIA) in 83 patients with CHF and 30 control subjects. The heart function was classified according totheNYHAcriteria. Leftventricularejectionfractions(LVEF)weremeasuredby echocardiology. ResultsThe level of urinary BNP in patients with CHF was[90. 0(38. 3 -209. 5 )]ng/L and the level of plasma BNP was[680. 0 ( 289. 7 - 1543.5)]ng/L, both of them were much higher than those in healthy subjects,[17. 0 ( 13.0 - 33. 0)]ng/L and[84. 5 ( 56. 0 - 158.0 )]ng/L, respectively (P＜0. 01 ). The concentrations of urinary BNP increased gradually with more severe symptoms ( NYHA cl ass Ⅰ -ⅣV ). The level of urinary BNP was positively correlated with NYHA class ( r = 0. 742, P ＜ 0. 01 )and the level of plasma BNP (r =0. 842,P ＜0. 01 ) while negatively related with LVEF (r = -0. 801 ,P ＜0. 01 ). The level of urinary BNP in patients with LVEF ＜ 40％ was[143.0 ( 85. 0 - 258.0)]ng/L , which was much higher than that in patients with LVEF≥40％ ,[31.5( 17.3 -38. 8)]ng/L, (P ＜0. 01 ). At a decision threshold of 36. 5 ng/L, the urine BNP assay demonstrated a clinical sensitivity and specificity of 84％ and 80％ ,respectively. In this study,the area under the curve(AUC) was 0. 905. ConclusionUrinary BNP is a new candidate marker for the diagnosis of CHF,it provides a similar accuracy with plasma BNP.

Objective Rehabilitation medicine has made much progress with a late start, and it requires a lot of knowledge and high operatingskills. The research about teaching and evaluation of the rehabilitation theory and practice is still in lack at present. This research reviewsthe development of taxonomy of educational objectives, and discusses the effect in rehabilitation curriculum applying the newthree-dimension objective model in China. Methods Aiming the rehabilitation students enrolled in college in 2005, this research analyzingquestionnaires and test scores in the end of one term to evaluate the Rehabilitation medicine teaching effect using three-dimension objectivemodel. Results The result of questionnaires and test scores in the end of the term shows most of the students' learning interest, self-learningability and clinical practice skills enhanced by the three-dimension objective model. Conclusion The three-dimension objective model issuitable for rehabilitation teaching, which helps choosing the teaching strategies with the teachers and the learning efficiency with the students.

A 22-year-old woman with bilateral perisylvian schizencephaly was reported. She presented only mild right hemiplegia. The motor function improved after constraint-induced movement therapy.

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