Objective To report clinical features,diagnosis and treatment in a case of adult onset Still's disease (AOSD) accompanied by demyelinating encephalopathy.Methods We reported a case of Stills disease with signs of encephalopathy.We also reviewed and discussed the literature on the neurological manifestations in AOSD.Results The 35-year-old patient had recurrent fever and arthralgias for 3 years,headache for 1 month and transient loss of consciousness.Laboratory tests showed non-specific immunological activity.MRI showed tumor-like lesions at left parietal and occipital lobes surrounded by sleeve-like edema.The lesion had significant occupation effect.Biopsy proved the presence of demyelinating changes.The patient recovered favorably after administration of corticosteroids and immunoglobulin.The lesions had almost disappeared on follow-up MRI 4 months later.Conclusions Demyelinating encephalopathy may develop in patient with AOSD.MRI may show tumor-like damage,which is rarely reported in the literature.Diagnosis depends on history,clinical manifestation and neuroimaging.Biopsy provides important information in making diagnosis.Treatment with corticosteroids and intravenous immunoglobulin was found to achieve good recovery.

To exert the role of high quality resources of national experimental teaching demonstration center in teaching,we have promoted laboratory opening through research teaching.By the contest of university students’experiment designing and inviting public bidding for exploring experiment,we encourage students to conduct innovation research,blazed their orexis and enthusiasm to start scientific research.We also encourage teachers to explore new teaching methods and innovated experimental items.

Objective To explore the relationship between the HLA-G 14 bp insertion/deletion polymorphism and the infection of Epstein-Barr virus(EBV) for children.Methods The study genotyped HLA-G 14 bp insertion/deletion polymorphism of 102 infectious mononucleosis children and 165 normal controls by PCR-PAGE,detected the plasma sHLA-G level of 51 infectious mononucleosis children and 146 normal controls by ELISA.Results A significant difference was observed for the frequencies of the HLA-G 14 bp genotype between the two groups( x2 =6.742,P=0.034 ),and a significant difference was also observed for the 14 bp allele frequencies between the two groups( x2 =6.672,P=0.01 ).The plasma sHLA-G levels in the infectious mononucleosis children were dramatically higher than that in normal controls,and a significant difference was observed between the two groups( Z=-9.472,P＜0.01 ).Among the infectious mononucleosis children,levels of sHLA-G was find a significant difference between the three genotypes of HLA-G 14 bp insertion/deletion polymorphism( H=6.09,P =0.048 ),and the level of s HLA-G with 14 bp+/+ genotype was markedly lower than that of the two other genotypes (Z=-2.376,P=0.01 8).Conclusion There was a relationship between the HLA-G 14 bp insertion/deletion polymorphism and the susceptibility to the infectious mononucleosis for children.Children who carried the 14 bp-/- genotype or deleted the 14 bp allele may have a significantly increased risk of the infection of EBV.The plasma sHLA-G might be considered as an index for auxiliary diagnosis infectious mononucleosis.

Objective To explore the best way for clinical screening of primary aldosteronism (PA).Methods Three hundred and three suspected cases of PA were collected and divided into groups of primary aldosteronism group, essential hypertension group, and nonsecreting cortical adrenal tumor group.The plasma aldosterone concentration/plasma renin concentration ratio ( ARR) was used to draw the receiver operating characteristic ( ROC) curve and obtain the best cut-off point.Furthermore, the current screening schemes for PA were compared.Results Upright ARR yield had larger areas under the ROC curve than plasma aldosterone concentration or plasma renin concentration under all conditions of testing. The best cut-off point of upright ARR[(pg/ml)/(μIU/ml)] for the diagnosis of PA was 43.45.During the two postural stimulation tests,the two upright ARR exceeded 43.45 with the highest diagnostic sensitivity of PA reaching 0.94.During the two upright tests ARR was less than 43.45, with a sensitivity of 0.74, and a specificity of 0.94.Conclusion To screen for PA in high-risk populations, twice postural stimulation test is recommended.As long as the upright ARR is above 43.45, PA may be considered and further confirmation is needed to prevent misdiagnosis.

Objective To evaluate the predictive values of ABCD,ABCD2 ,SPI-Ⅱ and ESSEN score models for the patients with high-risk transient ischemic attack (TIA)to develop to cerebral infarction in short and long term. Methods The ABCD, ABCD2 , SPI-Ⅱ and ESSEN scores of 235 cases of TIA patients were retrospectively analyzed.The incidence of cerebral infarction was followed up for 7 d and 1 year, and the receiver operating characteristic curve (ROC)was drawn to calculate the area under curve (AUC)to assess the accuracy of the score models,and compared with the original model and the relative risk (RR)value was calculated.Results The 7 d-incidence and 1 year-incidence of cerebral infarction in the 235 TIA patients were 9.36 % and 20.43%.The AUC of ABCD,ABCD2 ,SPI-Ⅱ and ESSEN models for 7 d were 0.70,0.74,0.67,and 0.62.The AUC of 1 year were 0.62,0.62,0.64,and 0.65.Compared with the orginal models,the RRs for 7 d of ABCD score model of the TIA patients in low,middle,and high risk groups were 0.09,0.92,and 0.72;the RRs of ABCD2 score model were 0.49,0.59,and 0.65;the RRs of SPI-Ⅱ score model were 0.58,0.87,and 0.55;the RRs of ESSEN score model were 0.11,0.18,and 0.55.Conclusion ABCD,ABCD2 ,SPI-Ⅱ and ESSEN score models can be used to assess the risk of cerebral infarction after TIA in Chinese population.The ABCD2 score model is of great value for short-term risk prediction,and the ESSEN score model is more value for long-term risk prediction.

Objective To study the incidence and clinical significance of the herniation pits of the femoral neck.Methods 600 cases(299 men,301 women,18～82 years)were collected.The incidence,radiologic finding and clinical significance of the herniation pit of the femoral neck were analysed.Results Of 1200 hip joints in 600 cases,there was 58 cases(64 sides)(5.3%)with herniation pits of the femoral neck,including 39 men(68.7%)and 19 women(31.3%),the lesions localized in the left joint in 25 eases(39.1%),in the right joint in 27 cases(42.2%)and in bilateral joints in 6 cases(18.7%).There were a obvious significant differences on both sexes,and no significant differences on age groups.On X-ray film,the lesions appeared as a round radiolucency with thin clear sclerotic rim.Conclusion The incidence of the herniation pit of the femoral neck is 5.3%,which has a typical X-ray feature,and may indicate the femoroacetabular impingement.

Objective To explore the effect of hospital-community integration follow-up pattern on medication compliance in patients with mental disorder. Methods From January 2016 to January 2017, 96 patients were treated effectively with systemic therapy in psychosomatic department and TCM WM department, and 96 discharged mental disorder patients were treated with brief psychiatric rating scale (BPRS) ≤ 28. The patients were randomly divided into 48 cases in the intervention group and the control group; both groups were standardized medication; control group received an outpatient referral, intervention group combined with medical doctors in our hospital and community doctors for one year follow-up intervention. Observed the condition of illness and medication compliance after six months and one year intervention between two groups, compared the patient recurrence rate of one year after discharge. Results BPRS score of intervention group was significantly lower than control group (P＜0. 01), the difference was statistically significant, while intervention group had higher compliance than control group (P＜0. 01), and the difference was statistically significant. Recurrence rate (20. 83％) of intervention group was significantly lower than control group (38. 78％) ( 2 = 4. 03, P＜0. 05), the difference was statistically significant. Conclusion Hospital-community integration follow-up has positive effect on stabilizing patients with mental disorder and improving compliance and decreasing relapse rate.

Objective To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face.Methods From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap.The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm.And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm.The flap was designed along the edge of the defect,the vascular supply was supported by muscular perforators.In order to relieve suture tension and have a good cosmetic effect,auxiliary incisions should be as less as possible.Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit,or along the direction of striae.Incision within the hairline should be taken to minimize damage to the hair follicles.The direction of hair growth shouldn't be changed after the flap transfer.Results All cases had 1-12 months' follow-up period.12 flaps survived completely,with one partial flap necrosis.The flaps had good appearance with high aesthetic satisfactory.Conclusions The modified keystone perforator island flap produces excellent aesthetic results.It can be a very useful flap for tbe individual reconstruction of skin defects at head and face.

Objective To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face.Methods From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap.The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm.And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm.The flap was designed along the edge of the defect,the vascular supply was supported by muscular perforators.In order to relieve suture tension and have a good cosmetic effect,auxiliary incisions should be as less as possible.Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit,or along the direction of striae.Incision within the hairline should be taken to minimize damage to the hair follicles.The direction of hair growth shouldn't be changed after the flap transfer.Results All cases had 1-12 months' follow-up period.12 flaps survived completely,with one partial flap necrosis.The flaps had good appearance with high aesthetic satisfactory.Conclusions The modified keystone perforator island flap produces excellent aesthetic results.It can be a very useful flap for tbe individual reconstruction of skin defects at head and face.

Objective:To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods:Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.Results:A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.Conclusion:This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.