Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Objective To compare the value of three-dimensional tomography ultrasound imaging(3D-TUI)and MRI for diagnosng early cesarean scar pregnancy(CSP).Methods Seventy-six patients who had gestational week not more than 12 weeks and with clinically suspected CSP were retrospectively enrolled.According to surgical and postoperative pathological findings,the patients were categorized into CSP group(n=65)and non-CSP group(n=11).The diagnostic performance of 3D-TUI,MRI and the combination of these two for CSP,also the depiction of CSP characteristics of 3D-TUI and MRI were compared.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of combination of 3D-TUI and MRI for diagnosing CSP was 96.92％,90.91％,96.05％,98.44％and 83.33％,respectively,with the accuracy higher than that of 3D-TUI alone(P＜0.05).No significant difference of diagnostic efficacy was found between 3D-TUI and MRI(all P＞0.05).3D-TUI showed a higher accuracy rate than MRI for displaying yolk sac,embryo,villi invasion into local scars and implantation of villi into muscle layer(all P＜0.05),whereas MRI was more accurate for diagnosing intrauterine bleeding(P＜0.05).Conclusion 3D-TUI could be used as the preferred initial imaging examination for early CSP.Combining with MRI could further improve its diagnostic accuracy.

Objective To compare the value of three-dimensional tomography ultrasound imaging(3D-TUI)and MRI for diagnosng early cesarean scar pregnancy(CSP).Methods Seventy-six patients who had gestational week not more than 12 weeks and with clinically suspected CSP were retrospectively enrolled.According to surgical and postoperative pathological findings,the patients were categorized into CSP group(n=65)and non-CSP group(n=11).The diagnostic performance of 3D-TUI,MRI and the combination of these two for CSP,also the depiction of CSP characteristics of 3D-TUI and MRI were compared.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of combination of 3D-TUI and MRI for diagnosing CSP was 96.92％,90.91％,96.05％,98.44％and 83.33％,respectively,with the accuracy higher than that of 3D-TUI alone(P＜0.05).No significant difference of diagnostic efficacy was found between 3D-TUI and MRI(all P＞0.05).3D-TUI showed a higher accuracy rate than MRI for displaying yolk sac,embryo,villi invasion into local scars and implantation of villi into muscle layer(all P＜0.05),whereas MRI was more accurate for diagnosing intrauterine bleeding(P＜0.05).Conclusion 3D-TUI could be used as the preferred initial imaging examination for early CSP.Combining with MRI could further improve its diagnostic accuracy.

A 73-year-old male patient with right lung squamous cell carcinoma developed edema of bilateral lower limbs, poor appetite, and oliguria after targeted treatment with afatinib 30 mg once daily orally for 80 days. The laboratory tests showed serum creatinine 658 mmol/L, blood urea 26.8 mmol/L, urine protein (++++), and urine occult blood (+++). Renal biopsy showed renal tubular injury, some cells appearing as crescents, and mild IgA deposition. Acute kidney failure was diagnosed, which was considered to be caused by afatinib. Afatinib was stopped and symptomatic treatments including hemodialysis, glucocorticoids, anticoagulants, diuretics, etc. were given. Twelve days later, the edema in both lower limbs was alleviated;19 days later, his daily urine volume was approximately 800 ml; 99 days later, his renal function indicators tended to be normal. The patient did not receive targeted treatment again.

A 73-year-old male patient with right lung squamous cell carcinoma developed edema of bilateral lower limbs, poor appetite, and oliguria after targeted treatment with afatinib 30 mg once daily orally for 80 days. The laboratory tests showed serum creatinine 658 mmol/L, blood urea 26.8 mmol/L, urine protein (++++), and urine occult blood (+++). Renal biopsy showed renal tubular injury, some cells appearing as crescents, and mild IgA deposition. Acute kidney failure was diagnosed, which was considered to be caused by afatinib. Afatinib was stopped and symptomatic treatments including hemodialysis, glucocorticoids, anticoagulants, diuretics, etc. were given. Twelve days later, the edema in both lower limbs was alleviated;19 days later, his daily urine volume was approximately 800 ml; 99 days later, his renal function indicators tended to be normal. The patient did not receive targeted treatment again.

Objective:To explore the effect of extracorporeal shock wave combined with meloxicam tablets on joint function and serum matrix metalloproteinase-9 (MMP-9) and resistin levels in elderly patients with osteoarthritis.Methods:80 cases of elderly patients with osteoarthritis in Nanchong Central Hospital from May 2016 to March 2019 were selected as the research objects, and they were randomly divided into two groups, 40 cases in each group. The control group was given conventional oral medicine (meloxicam + potassium glucosamine sulfate tablets), and the observation group was given meloxicam tablets combined with extracorporeal shock wave therapy. The total effective rate, incidence of adverse reactions, and the scores of osteoarthritis symptoms (WOMCA), joint function (Lysholm), serum MMP-9 and resistin before and after 8 weeks' treatment were compared between the two groups.Results:After treatment, the WOMCA score of the observation group was lower than that of the control group, and Lysholm score was higher than that of the control group ( P<0.05); the total effective rate of the observation group (95.00%) was higher than of the control group (77.50%) ( P<0.05); the serum resistin and MMP-9 levels of the observation group were lower than those of the control group after treatment ( P<0.05); there was no significant difference in the incidence of adverse reactions between the observation group (15.00%) and the control group (17.50%) ( P>0.05). Conclusions:Extracorporeal shock wave combined with meloxicam tablets in the treatment of elderly patients with osteoarthritis can significantly improve the clinical symptoms, promote the recovery of joint function, reduce the levels of serum resistin and MMP-9, and further improve the treatment effect with high safety.

Objective To investigate the antimicrobial resistance and distribution of klebsiella pneu‐moniae in Shandong Provincial Hospital and to provide a reference for clinical treatment. Methods The specimens collected in our hospital from January 1,2015 to December 31,2017 were cultured. The drug sensi‐tivity test was carried out according to the unified scheme by paper diffusion method or automated instrument method. The results were interpreted according to the CLSI 2014 M100‐S24,and the data were analyzed by using WHONET5. 6 software. Results From 2015 to 2017,a total of 79 615 specimens were sent to the hos‐pital for bacterial culture,and 2 159 strains of klebsiella pneumoniae (non‐repeat bacteria) were isolated,with a separation rate of 9. 87%, 9. 23% and 9. 98%, respectively. The detection rates of extended spectrum β‐lactamase(ESBLs)‐producing klebsiella pneumoniae strains were 37. 97%,43. 57% and 40. 87% respec‐tively. The specimens were mainly separated from sputum,blood,urine,skin soft tissue,ascites and cerebro‐spinal fluid. Except for the slight decrease in ESBLs‐producing rate of klebsiella pneumoniae in sputum cul‐ture specimens in 2017,other specimens showed an increasing trend year by year,especially in blood culture specimens. The ESBLs production rate of klebsiella pneumoniae increased from 24. 53% in 2015 to 55. 00%in 2017. The drug resistance rate of ESBLs‐producing strains to various antibacterial drugs was significantly higher than that of non‐ESBLs producing strains. ESBLs‐producing klebsiella pneumoniae had a high drug re‐sistance rate to most antibiotics,and it was most sensitive to carbapenems,with drug resistance rates lower than 17%. However,the rate of carbapenem‐resistant showed a rapid rise. Conclusion Klebsiella pneumoni‐ae is a common pathogenic bacteria in clinical practice, and the drug resistance rate of ESBLs producing strains is high. Strengthening the monitoring of bacterial resistance and infection control measures are very important for the effective treatment of bacterial infection.

Objective To investigate the effect of ulinastatin in adjuvant treatment of ventilator-associated pneumonia(VAP)and preliminary clinical efficacy of the therapy mechanism.Methods 76 patients with ventilator-associated pneumonia from January 2015 to February 2016 in Qingyuan People's Hospital of Zhejiang Province were selected and randomly divided into control group and observation group,38 cases in each group.Two groups were given mechanical ventilation,phlegm,anti infection,rehydration,nutritional support and other conventional treatment,the observation group on the basis of routine treatment for ulinastatin adjuvant therapy,comparison of two groups of treatment,the simultaneous determination of serum interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)and tumor necrosis factor alpha(TNF-alpha)levels were measured before and after treatment.Results The total efficiency of the observation group was 94.74％,significantly higher than the control group 78.95％,the difference was statistically significant(P<0.05),the two groups after treatment of serum CRP and PCT levels were decreased significantly compared with before treatment,the observation group after treatment,serum CRP and PCT levels were(45.19+5.79)mg/L and(1.08+0.36)μg/L was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05),the two groups after treatment of serum IL-6 and TNF-α levels were decreased significantly compared with before treatment,the observation group after treatment,serum IL-6 and TNF-α levels were(165.29+19.23)pm/mL and(1.16+0.25)pm/mL,was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05).Conclusion The inflammatory reaction in patients with ventilator-associated pneumonia ulinastatin can effectively reduce auxiliary patients,reduce inflammatory factors on lung injury,can alleviate the disease progression and to improve its prognosis.

Objective To observe the oral part of the facial artery and facial vein and to provide anatomical data for clinical applica-tion. Methods The origin, branches, course, diameter, position of oral part of facial artery and facial vein were observed on 32 fixed cada-ves (64 sides). Results The position relation between the facial artery and facial vein is non-constant. Measure the distance from inferior border of mandible to corner of the mouth, angulus mandibulae, mental protuberance midpoint. It is (5. 49 ± 0. 63) cm, (2. 50 ± 0. 89) cm and (6. 20 ± 1. 68) cm in the left side respectively, and (5. 69 ± 0. 72) cm, (2. 56 ± 1. 08) cm and (6. 85 ± 1. 86) cm in the right side re-spectively. The diameter of facial artery in inferior border of mandible is (0. 33 ± 0. 08) cm in the left side and (0. 38 ± 0. 07) cm in the right side;while the diameter of facial vein is (0. 40 ± 0. 12) cm in the left side and (0. 42 ± 0. 18) cm in the right side. The facial artery and facial vein are not concomitant and they are not asymmetry also. The position of superior labial artery arteries is constant, but the position of inferior labial artery arteries have more variations. Conclusion The branches, course, diameter and position of oral part of facial artery and facial vein have a number of variations. The superior labial artery arteries could be positioned more easily than inferior labial artery arter-ies. Being familiar with their distribution is of great importance for clinical application.