Objective To investigate the epidemiology and clinical features of epidemic cerebrospinal meningitis of children in Shanghai area in the last 2.5 years. Methods A retrospective study was conducted in 27 hospitalized patients with epidemic cerebrospinal meningitis by analyzing the clinical manifestation,epidemiology and laboratory test fingdings from Jan.2006 to Jun.2008.Statistical analysis of the clinical manifestations of cases in serogroup A,B and C was performed according to Neisseria meningitidis infection. Results There were sporadic cases of children with epidemic cerebrospinal meningitis in Shanghai area in the last 2.5 years.The seasonal distribution illustrated the peak occurrence from Feb.to Apr.Among all these cases,92.6% were floating children.Common types(74.1%) were the predominant clinical manifestations and the others were fulminate types(25.9%).Four cases in each of serogroup A and B,and 8 cases of serogroup C were identified by serotyping on 14 Neisseria meningitidis strains and genotyping on the other 2 cases′ cerebrospinal fluid specimens.All the patients in serogroup A with meningococcal diseases were not vaccinated before and 25.0% of them belonged to fulminate types.Half of the cases had petechia on the skin and the prevalence of skin necrosis was 25.0% and 50% had complications of nervous system.No fulminate type was present in cases of serogroup B meningococcal disease and only 1 case had slight petechia on the skin.However,intensive convulsions occurred in 75.0% of the patients,and all of them had complication of nervous system,with a few had sequela.Among the patients in serogroup C meningococcal disease,62.5% patients were vaccinated with serogroup A Neisseria meningitidis.In serogroup C,Neisseria meningitidis infection was found in each age group,with petechia on skin,skin necrosis,immunity correlation fever and complications of nervous system in 87.5%,50.0%,75.0% and 12.5% of the patients,respectively. Conclusions 1.Epidemic cerebrospinal meningitis occurred sporadically in children in Shanghai area,the majority of patients were floating populations.2.Clinical manifestation was typical in patients of serogroup A meningococcal disease.Subdural effusion or ventricalitis was more common in patients of serogroup B meningococcal disease.In serogroup C,Neisseria meningitidis was the most prevalent serotype leading to epidemic cerebrospinal meningitis.More cases were found in patients infected with serogroup C,Neisseria meningitidis with severe shock and immunity correlation fever compared with the other groups.Prophylactic vaccination of serogroup C polyvalent meningococcal organism should be recommended.

Objective To investigate the hypothesis that food allergy in infants may be associated with variation in their intestinal microflora. The formation of intestinal microflora in healthy infants and changes in food allergic infants were detected.Methods 16S rRNA gene sequences specific for bifidobacterium, lactobacillus and escherichia coli in fecal were quantitatively detected by real-time PCR. The three fecal floras were assessed in 71 healthy infants and 100 infants with food allergy. Results After birth,there were bifidobacteria colonized in infantile intestine,then the number increased rapidly up to 5 times at the sixth month, which was always the preponderant flora. Lactobacilli was also presented in infantile intestine 1 month after birth and augment gradually. The number of Escherichia coli was less than bifidobacteria and lactobacilli and appeared to decline during the early infants. The number of bifidobacteria and lactobacilli in the infants with food allergy were markedly less than that in the healthy infants, but escherichia coli was significantly more than that in the healthy infants.Conclusions During the first year of life,the intestinal microflora in infants is in a developing process. Compared with the healthy infants,bifidobacteria and lactobacilli decrease, but escherichia coli increase in the food allergic infants.These results indicate that the probiotics may be benefit to the prevention and treatment of food allergy.

Objective To compare clinical outcomes of double-bundle and single-bundle in individualized arthroscopic anatomical reconstruction of anterior cruciate ligament (ACL) . Methods The clinical data of 117 patients were reviewed who had received double-bundle or single-bundle arthroscopic ACL reconstruction from March 2007 through September 2009 in our hospital and had undergone complete follow-up. Of them, 35 cases had single-bundle ACL reconstruction and 82 double-bundle reconstruction. In the single-bundle group(group A), there were 31 men and 4 women, aged 28. 6 ±5. 1 years. In the double-bundle group(group B), there were 73 men and 9 women, aged 27. 6 ±5. 4 years. The 2 groups were comparable in the preoperative demographic data ( P > 0. 05). To evaluate the outcomes, Lachman and Pivot Shift exams , KT-2000, Lysholm and IKDC (International Knee Documentation Committee) scores, were adopted. Results The 117 patients received a mean follow-up of 15 months (from 11 to 25 months). The Lachman test showed 88. 6% (31/35) were normal in group A and 95. 1% (78/82) were normal in group B.The pivot-shift test showed 88. 6%(31/35) were normal in group A and 96. 3% (79/82) were normal in group B. Group A had a mean Lysholm score of 93. 4 ± 8. 2 and group B a mean Lysholm score of 93. 7 ±7. 0. There were no significant differences between the 2 groups in the above indexes ( P > 0. 05). By IKDC score, 71. 4% (25/135) were normal in group A and 93. 9% (77/82) were normal in group B. The KT-2000 test showed a mean of 1. 4 ± 0. 6 mm in group A and a mean of 1. 1 ± 0. 5 mm in group B. These 2 values were significantly different between the 2 groups ( P < 0. 05). Conclusions The individualized arthroscopic double-bundle anatomical reconstruction of ACL can maximally restore the anteroposterior and rotational stability. Arrangement of the ACL insertion site on the femoral and tibial side, three-portal technique and ruler application are keys for individualized anatomical double-bundle ACL reconstruction.

Objective To discuss the strategies for diagnosis and treatment of severe pelvic fracture. Methods 38 patients with severe fracture of pelvis circle and different complications were studied in this paper from May, 1997 to June, 2005. 28 cases underwent emergency treatment for shock, 31 cases had internal fixation, and 14 cases received operative procedures for their complications. Results All the 38 cases survived. The integrity of the pelvic circle was restored in patients with unstable pelvic fracture. Most of the patients were back to their former work. Conclusions In treatment of severe pelvic fractures, the hemorrhagic shock and other complications endangering life should be promptly treated, and restoration of the integrity of the pelvic circle is the most important step.

Objective To explore the types, clinical pathologic and immunohistochemical features of spindle cell tumors of the uterine and broad ligament. Methods Clinical pathological files of spindle cell tumors in the uterine and broad ligament from 2007.12 to 2015.12 were reviewed. Results The primary sites of the 145 cases was cervical in 11 cases (7.58%), uterine body in 119 cases (82.07%), the broad ligament in 12 cases (8.28%), and uterine or cervix and the abdominal wall in 3 case (2.07%). Histopathological types of the 145 cases was smooth muscle origin in 126 cases (86.90%), of which 120 cases had benign leiomyoma, 3 cases had uncertain malignant potential and 3 cases had leiomyosarcoma;endometrial stromal origin in 15 cases (10.34%), including endometrial stromal nodule (5 cases), endometrial stromal sarcoma (10 cases); endometrial stromal- variant (3 cases, 2.07%), including endometrial stromal nodule associated with smooth muscle differentiation (2 cases), endometrial stromal sarcoma associated with smooth muscle differentiation (1 case); gastrointestinal stromal tumor (1 case, 0.68%). Conclusions Origin of spindle cell tumors of the uterine and broad ligament is mainly smooth muscle, endometrial stromal origin, and endometrial stromal tumor variants, and gastrointestinal stromal tumors in rare cases. We need to combine the clinical site, pathological morphology and immunohistochemistry for diagnosis and differential diagnosis.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The prevalence of NAFLD is increasing year by year in the world, which seriously threaten the public health. The pathogenesis of NAFLD is complex, and there is no specific treatment for NAFLD. Natural-derived compounds have the characteristics of multi-target and multi-mechanism, which can improve the curative effect and reduce the toxic and side effects by regulating multiple factors of the disease. They are ideal drugs for treating complex diseases and have unique advantages in improving NAFLD. However, low intestinal absorption, poor bioavailability, and single medicine efficiency limit the utilization of many compounds, and further drug development and clinical application are challenging. This paper reviews the research progress of natural-derived compounds in the prevention and treatment of NAFLD in recent years, analyzes the existing problems, and discusses the improvement strategies, so as to provide reference for related research.

Objective To discuss the effect of the shape of mandibular arch on uprightness distortion ratio in computed orthopantomography.Methods 20 specimens of adult head with different shape of mandibular arch were selected.The computed orthopantomography was performed after the markers were inserted in the marking points of mandible,the length of the markers were measured with computer,and the results were statistically analysed.Results In computed orthopantomography,the uprightness distortion ratio of anterior teeth area of square mandibular arch(11.77%) was higher than that of tine mandibular arch(5.05%),and the difference was prominent(P=0.011

Through analyses of rare diseases management of several countries and regions , successful practice has been discussed .Legislation of rare diseases should be activated as soon as possible to release specific standard of rare diseases .Accelerating development of translational medicine is a feasible approach to improve the level of diag -nosis and treatment of rare diseases .Strengthening the orientation of management policy should be put into a more significant position to promote incentives of stakeholder in this area .Both enhancing the joint collaboration of differ-ent departments and perfecting medical insurance system could be forceful accelerants to create and optimize the management system of rare diseases in China .

Objective To study the effect of Qing Yi Tang(QYT) on bacterial and endotoxin translocation from intestine in acute hemorrhagic necrotizing pancreatitis(AHNP) in rats.Methods SD rats were randomly divided into 3 groups: AHNP group,AHNP +QYT treatment group and sham operation(SO) group.AHNP models were set up in the former two group,while the pancreas was only mobilized in SO group.After setting up the model,QYT was gavaged in the QYT group,while normal saline was gavaged in the SO group and AHNP group.The concentration of endotoxin(ET) and the DNA of E.coli expressoin in portal vein blood in three groups of rats were measured 24h later.Results The concentration of ET and amount of E.coli DNA in portal vein of QYT group were lower than those of AHNP group.Conclusions QYT can reduce significantly the concentration of ET and E.coli DNA in portal vein blood and decrease bacterial and endotoxin translocation from intestine in the AHNP rats.

Objective To assess the feasibility for the automated treatment planning verification system Mobius3D (M3D) to perform an independent 3D dose calculation in intensity-modulated radiotherapy (IMRT) for cervical cancer.Methods Twenty patients with cervical cancer were randomly selected.With treatment planning systems (Pinnacle,Version 9.2;Eclipse,Version 13.5),all IMRT plans were divided into 7 fields to meet the dosimetric goals.The optimized plans were exported to the M3D server.The percentage differences in the volume of region of interest (ROI) and the dose calculation of target volume and organ at risk (OAR) were evaluated for the two treatment planning systems,and theγ passing rate was used to assess the accuracy of M3D calculation.Results The difference in the volume of ROI for Pinnacle 9.2 to M3D was less than that for Eclipse 13.5 to M3D,with maximum differences of 0.22％±0.69％ and 3.5％±1.89％ for Pinnacle 9.2 and Eclipse 13.5,respectively.The differences in the dose calculation of target volume and OAR for the two treatment planning systems to M3D were within ± 1％.After recalculating by M3D,the dose difference between Pinnacle 9.2 and M3D was smaller than that between Eclipse 13.5 and M3D,but the mean differences were all within ±3％.The γ passing rates for target volume and OAR were more than 95％ on average.Conclusions The method of utilizing the automated treatment planning verification system to validate the accuracy of plans is convenient.It can be used as a secondary check tool to improve accuracy in IMRT dose calculation.