Autism spectrum disorders have gradually been known and its concept is also changing.It is important that comprehend the changing timely for clinical work.This paper is mainly about the formation and evolution for the term,as well as the change in Diagnostic and Statistical Manual of Mental Disorders 5th ed and the significance.

Objective To evaluate the safety and efficacy of fiberoptic bronchoscopy in the diagno-sis of 41 neonates with weaning failure.Methods A retrospective study on the results of fiberoptic broncho-scopy was performed in 41 neonates with weaning failure.Results A total of 41 neonates of throat abnor-malities were examined by fiberoptic bronchoscopy,including 38 cases with laryngomalacia,8 cases with seri-ous hyperemia and swelling of the vocal cords,2 cases with scar stenosis of subglottic,and one case in each of congenital laryngeal web,glottic insufficiency and congenital epiglottis cyst;trachea-bronchial abnormali-ties,including 31 cases with tracheomalacia,2 cases with tracheal stenosis,4 cases with partial bronchial ste-nosis,1 cases with bridging bronchus and 1 cases with tracheoesophageal fistula.Thirty-eight neonates under-went fiberoptic bronchoscopy to obtain bronchoalveolar lavage fluid and culture,bacterial culture positive in 15 cases(39.4%),of which 5 cases of Klebsiella pneumoniae,3 cases in each of Pseudomonas aeruginosa and Acinetobacter baumannii,2 cases of Staphylococcus aureus,1 case in each of Escherichia coli and Strep-tococcus mitis;fungal culture positive for 6 cases(15.7%),of which 3 cases of Aspergillus fumigatus,1 case in each of Candida glabrata,Candida albicans and Candida parapsilosis.The most common complications of fiberoptic bronchoscopy were hypoxia and heart rate transient decline(26 cases,63.4%),3 cases fever af-ter operation.Conclusion Fiberoptic bronchoscopy can not only find congenital tracheal deformity and tra-cheal mucosa lesions,but also complete the etiology from deep discharge.Fiberbronchoscopy is safe and relia-ble given adequate preparation and if it is performed by skilled personnel.

OBJECTIVE:To provide reference for rational use of polycystic ovary syndrome(PCOS)drugs. METHODS:The utilization of PCOS drugs in our hospital during Jan.-Dec. 2013 were analyzed in respects of consumption sum,DDDs,sorting and so on. The rationality of prescription was analyzed according to guidelines and drug package inserts and so on. RESULTS:There were 1 551 prescriptions,involving 76 kinds of drugs,and their total consumption sum was 181 072.90 yuan. Main types of drugs were hormone related drugs (accounting for 81.37% of prescription frequency,73.51% of consumption sum) and Chinese patent medicine (accounting for 15.41% of prescription frequency,19.43% of consumption sum). Top 5 hormone drugs in the list of DDDs were Ethinylestradiol and Cyproterone acetate tablets,Metformin hydrochloride enteric-coated tablets,Progesterone soft cap-sule,Dydrogesterone tablets and Progesterone soft capsules. Top 5 Chinese patent medicines in the list of DDDs were Kuntai cap-sule,Yougui capsule,Huanshao capsule,Jiawei xiaoyao capsule and Nvjin capsule. Single drug accounted for 72.08% in prescrip-tion. The proportion of irrational drug use was 1.69%. CONCLUSIONS:The application of drug in patients with PCOS is reason-able generally. Some prescriptions are unreasonable,mainly manifesting as incomplete clinical diagnosis,irrational usage and dos-age. Pharmacists should strengthen prescription verification and intervention.

Objective To compare the difference in pharmacokinetics characteristics of vancomycin in cerebrospinal fluid between administration by continuous infusion and interim infusion.Methods Twenty postoperative patients in the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University admitted into intensive care unit (ICU) to receive vancomycin for prophylaxis of intracranial infection were enrolled, and they were randomly distributed to a continuous intravenous infusion group and a interim intravenous infusion group, each group 10 cases. In continuous intravenous infusion group, the patients received a loading dose of vancomycin (15 mg/kg) by continuous intravenous pump infusion for 1 - 2 hours followed by 30 mg/kg vancomycin in a constant pump infusion rate for 24 hours; while in interim intravenous infusion group, the patients received 15 mg/kg vancomycin administered by intravenous pump infusion for 1 - 2 hours, once every 12 hours. The concentration of vancomycin in the cerebrospinal fluid at different time points was measured by two-dimensional liquid chromatography (2D-LC) method, the parameters of pharmacokinetics were calculated in the two groups, and the adverse reaction was observed.Results The comparison between the ratio of areas under the concentration-time curves (AUC) and minimum inhibitory concentration (MIC) of the continuous and interim groups showed no significant difference (19.7±14.0 vs. 16.1±6.4,P > 0.05). However, in the continuous intravenous infusion group, the drug concentration reached the peak value (0.96± 0.77)μg/mL at 12 hours, and later revealed a plateau concentration 0.91-0.93μg/mL for 12 hours; while in the intravenous infusion interim group, the drug concentration reached the peak value (0.92±0.47)μg/mL at 16 hours, in the later 2 hours declined to (0.84±0.45)μg/mL, and afterwards still had a tendency of persistent declination. In all the patients, no any adverse reaction related to the drug occurred.Conclusion Continuous intravenous infusion and interim intravenous infusion of vancomycin for the postoperative neurosurgical patients without intracranial infection have the similar efficacy of medication, but the former can achieve the peak concentration faster and later the fluctuation of drug concentration in cerebrospinal fluid is smaller than those in the latter.

BACKGROUND: Stellate ganglion block (SGB) has become a technique frequently used in the field of pain management for its wide indication spectrum. Its ameliorative effect on cephal-facial pain may be achieved by regulating the cerebrovascular diastolic and systolic functions and intensifying cerebral perfusion.OBJECTIVE: To observe the influence of SGB on the blood velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA) and vertebral artery with three-dimensional transcranial Doppler (TCD) in patients with caphal-facial diseases caused by is chemia or vascular spasm.DESIGN: A before-after control observation.SETTINGS: Department of Pain Management, Guizhou Provincial Orthopaedic Hospital; Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical College; Department of Anesthesiology, the Second Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Twenty patients of 18-50 years old were selected from the Department of Pain Management of Guizhou Provincial Orthopaedic Hospital from March 2004 to December 2005, including 6 cases of migraine,3 of cluster headache, 4 of muscle tension-type headache, 2 of nervous tinnitus and earache, and 5 of derangement of temporomandibular joint.METHODS: Unilateral SGB was performed by means of paratracheal anterior technique, with the following compound prescription: lidocaine (20 g/L)2.5 mL and dexamethasone 1 mg in normal saline with a total volume of 10 mL. SGB was performed once a day for 7 consecutive days as one course.MAIN OUTCOME MEASURES: The changes of blood velocity of ACA,MCA, PCA and vertebral artery were observed with three-dimensional TCD before SGB and at 30 minutes after SGB.RESULTS: All the 20 patients finished the treatment and entered the analysis of results. After treatment, the blood velocities of ACA, MCA and PCA of the blocked side were increased remarkably as compared with those before treatment [(76.20±3.83), (61.95±2.50) cm/s; (83.65±2.36),(77.55±2.69) em/s; (65.20±2.99), (58.70±2.2.35) cm/s; P ＜ 0.01], but that of vertebral artery had no significant change before and after treatment [(47.20±2.04), (45.55±2.23) cm/s, P ＞ 0.05]. CONCLUSION: The blood velocities of the blocked side are obviously increased after treatmeut, the increased blood velocities of ACA, MCA and PCA have important clinical significance for the blood supply of cerebral hemisphere, especially the anterior 2/3 part, but had little great influence on vertebral artery, indicating that SGB has great pertinence to the caphalfacial diseases caused by ischemia or vascular spasm, and can ameliorate the cerebral blood perfusion.

Objective To analyze the effects of health management of metabolic syndrome on the control of related risk factors. Methods A total of 430 patients diagnosed with metabolic syndrome in 2008completed questionnaire and before randomly assigned to the health management group ( n = 207 ) and the control group (n=223). One year later, all the participants were investigated for the risk factors of food intake, cigarette smoking, alcohol consumption, staying-up and emotion, and the changes of body mass index ( BMI), blood pressure ( BP), triglyceride (TG), high-density lipoprotein cholesterol (HDL) and fasting blood glucose (FBG). Student's t test and x2 test were used for data analysis. Results For the health management group, the incidence of high-salt, high-fat and high-sugar intake, overtake of food, lack of physical exercises,staying-up and alcohol drinking was significantly decreased at 1 year (P ＜ 0. 05 ), when compared with baseline and the control group ( both P ＜ 0. 05 ). For the health management group, BMI,systolic blood pressure (SBP),TG and FBG was improved at 1 year (P＜0. 05). In comparison with the control group, BMI, SBP, diastolic blood pressure (DBP),TG and FBG of the management group were significantly improved (P ＜ 0. 05 ). Conclusions Patients with metabolic syndrome may have better treatment compliance after receiving systematized and individualized health management.

Objective To investigate the effects of isoflurane and sevoflurane at the same dose on expression of Caspase-3 of primary somatosensory cortex (SI) and expression of micmmbule associated protein 1B (MAP1B)in cortical neuronsin neonatal SD rats.Methods Fifty-five neonatal SD rats at postnatal day 7 (eleven rats each litter,altogether 5 litters)were assigned randomly into control group(C group),isoflurane group (I group)and sevoflursne group(S group)in average.The rats in I group,S group or C group were exposed to 1.1% isoflurane or 1.8% sevoflurane (equivalent to 0.5MAC)or air 4h.The brain of neonatal rats were perfused and embedded by paraffin,Caspase-3 positive expression in the SI cortex of brain was detected by immunohistochemistry staining.Besides,the fresh cortex was dissected at O h in C group and at 2h,4h in I group and S group,microtubule associated protein 1 B expression was detected by West blot staining.Results Caspase-3 positive cells in the SI cortex were increased by 561.23%in I group(t=4.45,P<0.01)and 194.46% in S group(t=5.17,P<0.01)when compared with C group,and increased by 124.45% in I group(P<0.05)when compared with S group.The MAP1B protein was increased by 557.15%at 2h(t=16.54 P<0.01)and 475.21% at 4h(t=32.97,P<0.01)in I group while increased by 693.11%at 2h(t=9.45,P<0.001)and 268.15% at 4h(t=2.79,P=0.049) in S group when compared with C group.In S group,MAP1B protein at 4h reduced by 53.65%(P<0.01) when compared with that at 2h.Conclusion 0.5 MAC isoflurane can induce more apoptosis in the cortex in the neonatal rats'brain at postnatal day 7 than sevoflurane.They can both significantly promote the expression of MAP1B in the cortex to start the self-reparation.

Objective To determine the diagnostic accuracy of dual- source computed tomography coronary angiography (DSCT-CA) for detecting various degrees of coronary artery stenosis. Methods A total of 278 patients with coronary atherosclerotic heart disease (CHD) were selected for DSCT-CA examination. The coronary angiography (CAG) examination was carried out within 30 days in these patients. The result of CAG was used as the gold standard. The coronary artery stenosis of 50% and 75% was used as the sector. Based on the data of patients, DSCT-CA was calculated for quantitative assessment of the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of coronary stenosis for the coronary blood vessels and coronary artery segments. Kappa consistence test was used to analyze the results of two methods. Results The 50%and 75%of coronary artery stenosis was used for the sector, based on the patients, the sensitivities of DSCT-CA were 99.6% and 99.1%, specificities were 84.2%, 89.6%, diagnostic accuracies were 98.6%and 97.5%, and the Kappa values were 0.88 and 0.91. Based on coronary vessels, the sensitivities were 92.0%and 96.9%, specificities were 89.9%and 94.8%, diagnostic accuracies were 91.0%and 95.8%, and the Kappa values were 0.88 and 0.92. Based on coronary artery segments, the sensitivities were 97.3%, 96.5%, specificities were 93.3%, 98.1%, diagnostic accuracies were 94.2%and 97.9%, and the Kappa values were 0.84 and 0.91. Conclusion Based on patient’s coronary artery analysis, DSCT-CA can accurately assess the different degrees of coronary stenosis, but based on the analysis of the coronary artery segment, the false-positive results may occur in the diagnosis of DACT-CA, which
suggests that DSCT-CA can partly replace the CAG, still cannot completely replace the CAG.

Objective:To investigate the clinical features of ocular involvement and the application of Rose criteria in patients with relapsing polychondritis (RP).Methods:The data from RP patients with ocular involvement were collected and analyzed. Patients included must have at least one major criteria of Michet criteria and the application Rose criteria was also investigated. Demographic data of these patients was presented as percentages. The difference between types of disease onset was tested by Mann-Whitney U and comparison among groups was tested by False Discovery Rate. Results:A total of 192 patients were enrolled 98 males and 94 females. The mean age of disease onset was (42±14) (0.5-79) years old, the median disease duration (DD) was 13(0.5, 600) months. The median RP disease activity index (RPDAI) was 39(9-74) and the median RP organ damage index (RPODI) was 2.5(0.1, 108). The median RP damage index (RPDAM) was 3(1-6). The statistical significant difference was identified in median DD between groups of nose and pinna ( Z=10.775, P<0.01), nose and OEH ( Z=9.277, P<0.01), in RPODI between groups of nose and pinna ( Z=7.999, P=0.031), nose and and extra-cranial organs ( Z=8.115, P=0.030) and eye and airway involvement of RPDAM could be seen between groups ( Z=7.683, P=0.037) respectively. Ocular involvement(50.0%), auricular chondritis(21.4%) and airway chondritis(13.5%) were the top three most common symptoms at disease onset. The ocular involvement(100%), airway chondritis (75.0%) and inner ear involvement(69.3%) were the top three most frequent affected organs. All parts of eye could be involved in RP ocular damage. Single-organ involvement was 59.9%; and multi-organ involvement could be seen in 40.1% patients. Diagnostic strength was enhanced by application of Rose criteria in 171 cases fulfilled Michet criteria and 21(10.9%) cases partially fulfilled Michet criteria fulfilled Rose criteria. Active screening for organ (especially inner ear and airway) involvement would improve the rate of early diagnosis. The pinna and airway involvement suggested nose and middle-ear might be involved. Conclusion:Ocular involvement in RP can involve all parts of the eye ball. Examining the inner ear and airway may help to confirm the diagnosis. It is worthy to apply this to clinical practice.

Objective To explore the value of somatosensory cortex evoked potential(CSEP)monitoring in objective evaluation of spinal cord function and integrity as well as prognostication of neural function after surgery.Methods CSEP monitoring was performed before the operation,during surgical procedure and after the operation in 56 spinal cord surgery patients to observe and analyze latency and amplitude of cortical potential.The significant changes were amplitude reduction≥150%or latency prolongation≥10%.Results There were 71.43%(40/56)true negative finding,both latency and amplitude without abnormal changes during the operation and without new neural functional deficit after operation.There was 0.18%(1/56)false negative finding,latency and amplitude without abnormal changes during surgical procedure,but with new neural functional deficit after operation.There were 26.79%(15/56)true positive findings,where latency transient prolongation<10%and amplitude reduction<50%during surgical procedure were observed.After suspending procedure or changing direction during surgical procedure,the waveform restored or improved.Conclusion CSEP monitoring during surgical procedure could reflect the sensitiveness to distracting,ischemia and injury of spinal cord.A timely intervention might improve the CSEP.CSEP could reflect the function and integrity of spinal cord.CSEP possess an important value in preventing spinal cord injury and evaluating the prognosis of neural function.