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 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.

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.

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.

Wet age-related macular degeneration (AMD) is one of major causes of blindness in elder people.Intraocular injection of anti-vascular endothelial growth factor (VEGF) -A regimen has made big breakthrough for the treatment on choroidal neovascularization of wet AM D,while long-term follow-up and necessary retreatments are the key issues to remain obtained visual acuity.Multiple strategies of wet AMD have been used in following-up and retreating based on the visual acuity,optical coherence tomography (OCT),ophthalmoscope and fluorescein fundus angiography (FFA) in abroad.However,there also are major differences in the patient' s composition,treatment habits and distribution of medical sources in China from Western.So we suggest to standardize the follow-up and retreatment strategies about intravitreal injection of VEGF-A for wet AMD as to achieve a better effectiveness.OCT-guided individual follow-up and retreatment strategies should be very helpful for maintaining a long-term efficacy,minimizing the treatment time and reducing medical cost.

OBJECTIVEThis review aims to identify the dimensional structure of the shortened dentine hypersensitivity experience questionnaire (DHEQ-15) using confirmatory factor analysis (CFA).

METHODSThe Chinese language version of DHEQ-15 was applied to 210 patients with dentine hypersensitivity aged 18-70 years old. The three-dimensional construct was confirmed by CFA.

RESULTSAll the questionnaires were fully completed. The item "Because of the sensations, I take longer to finish a meal than others" was the most frequently reported by the parents. The modified three-factor model is suitable for the data. The chi-square fit statistics/degree of freedom was 2.213, the goodness-of-fit index was 0.905, the adjusted goodness-of-fit index was 0.872, the normed fit index was 0.845, the incremental fit index was 0.962, the Tucker-Lewis index was 0.969, the comparative fit index was 0.977, and the root mean square error of approximation was 0.068.

CONCLUSIONSOur findings generally support the three-dimensional construct of the DHEQ-15. Thus, DHEQ-15 can be used as a valid instrument in patients with dentine hypersensitivity in China.

The amount of acupuncture treatment refers to the sum of acupuncture effects during the treatment. From the factors that constitutes the amount of acupuncture treatment, including the numbers of needling, the size of acupuncture instruments, the depth of acupuncture, the manipulation, the retained time of needle, etc., and combined with teaching and clinical experience, it is believed that the amount of acupuncture treatment is closely related with clinical efficacy, besides, moderate amount of acupuncture treatment is a key factor to improve acupuncture efficacy and guarantee the safety of acupuncture. The basic principles of regular treatment amount are arrival of qi and being moderate, indicating the retained time of needle, treatment frequency and course should be based on individual condition, time, location and disease.
Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Humans ; Meridians ; Needles ; Qi