Objective To investigate the clinical prognosis value of the positivity rate of oligoclonal bands(OCB)and immunoglobulin G(IgG)level of cerebrospinal fluid(CSF)in severe encephalitis.Methods A total of 699 cases of encephalitis patients admitted to the Department of Neurology of the First Affiliated Hospital of Air Force Military Medical University,and Xijing 986 Hospital from January 2016 to October 2020 were enrolled.According to the severity of their diseases,these patients were divided into a mild(n=360)group and a severe(n=339)group.CSF and serum samples were collected from the patient at the time of admission,and the differences in cerebrocyte count,glucose contem,glucose content,chlorine content,IgG of CSF and OCB of CSF and serum were compared.According to the GOS score of patients with severe encephalitis at discharge,the patients were divided into good prognosis group(n=259)and poor prognosis group(n=80),and multivariate Logistic regression analysis was used to analyze factors that affected the prognosis of severe encephalitis patients,and the correlation between the OCB and IgG of CSF and prognosis of patients with severe encephalitis.The predictive value of CSF IgG for the prognosis of patients with severe encephalitis was tested,and receiver operating characteristic(ROC)curve was plotted.Results Compared to patients with mild encephalitis,patients with severe encephalitis had a higher proportion of fever,pulmonary infection,status epilepticus,and mechanical ventilation,and were more likely to be complicated by stroke and hydrocephalus,and the differences were statistically significant(χ2=5.319～245.179,all P<0.05).There were significant differences in the positive rate of cerebrocyte count,chlorine content,IgG content and OCB in cerebrospinal fluid between the two groups(Z=-3.623,-4.875,-3.518,χ2=6.581,all P<0.05).CSF OCB and CSF IgG were independent risk factors for poor prognosis in patients with severe encephalitis(Wald χ2=7.295,0.001,all P<0.05).A restrictive cubic spline plot showed a linear relationship between CSF IgG and poor prognosis.The AUC(95%CI)of CSF IgG was 0.754(0.632～0.876).Conclusion The CSF IgG content and positive rate of CSF OCB in patients with severe encephalitis with poor prognosis are higher than those in patients with good prognosis,and detecting these two indicators has certain reference value for the prognosis prediction of patients with severe encephalitis.

Objective To investigate the clinical prognosis value of the positivity rate of oligoclonal bands(OCB)and immunoglobulin G(IgG)level of cerebrospinal fluid(CSF)in severe encephalitis.Methods A total of 699 cases of encephalitis patients admitted to the Department of Neurology of the First Affiliated Hospital of Air Force Military Medical University,and Xijing 986 Hospital from January 2016 to October 2020 were enrolled.According to the severity of their diseases,these patients were divided into a mild(n=360)group and a severe(n=339)group.CSF and serum samples were collected from the patient at the time of admission,and the differences in cerebrocyte count,glucose contem,glucose content,chlorine content,IgG of CSF and OCB of CSF and serum were compared.According to the GOS score of patients with severe encephalitis at discharge,the patients were divided into good prognosis group(n=259)and poor prognosis group(n=80),and multivariate Logistic regression analysis was used to analyze factors that affected the prognosis of severe encephalitis patients,and the correlation between the OCB and IgG of CSF and prognosis of patients with severe encephalitis.The predictive value of CSF IgG for the prognosis of patients with severe encephalitis was tested,and receiver operating characteristic(ROC)curve was plotted.Results Compared to patients with mild encephalitis,patients with severe encephalitis had a higher proportion of fever,pulmonary infection,status epilepticus,and mechanical ventilation,and were more likely to be complicated by stroke and hydrocephalus,and the differences were statistically significant(χ2=5.319～245.179,all P<0.05).There were significant differences in the positive rate of cerebrocyte count,chlorine content,IgG content and OCB in cerebrospinal fluid between the two groups(Z=-3.623,-4.875,-3.518,χ2=6.581,all P<0.05).CSF OCB and CSF IgG were independent risk factors for poor prognosis in patients with severe encephalitis(Wald χ2=7.295,0.001,all P<0.05).A restrictive cubic spline plot showed a linear relationship between CSF IgG and poor prognosis.The AUC(95%CI)of CSF IgG was 0.754(0.632～0.876).Conclusion The CSF IgG content and positive rate of CSF OCB in patients with severe encephalitis with poor prognosis are higher than those in patients with good prognosis,and detecting these two indicators has certain reference value for the prognosis prediction of patients with severe encephalitis.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective: To investigate the physical and intellectual development and mutation characteristics of the phenylalanine hydroxylase (PAH) gene among 53 newborns with phenylketonuria (PKU), so as to provide insights into the management and genetic counseling of PKU Methods: The medical records of 54 children with definitive diagnosis of PKU and standardized therapy until 2 years at the Center for Neonatal Disease Screening of Shanxi Children' s Hospital from 2018 to 2021 were collected. Newborns' body weight and height developments were evaluated using the World Health Organization growth chart (2006 version), and the intellectual development was assessed using the national criteria of Development Behavior Assessment Scale among Children at Ages of 0 to 6 Years (WS/T 580-2017). The gene mutations were detected among neonates and their children, and the physical, intellectual developments and genetic characteristics of neonates with PKU were descriptively analyzed. Results: The 53 PKU cases included 29 male children and 24 female children, 36 cases with classic PKU and 17 cases with mild PKU, and 30 cases from rural areas and 23 cases from urban areas. The study subjects had a median age of 30 (10) d at initial therapy, and a mean blood phenylalanine concentration of (1 507±685) μmol/L at definitive diagnosis. There were 52 cases with normal height developments (98.11%), and all cases had normal weight and intellectual developments. The mean developmental functional quotient (DFQ) was significantly greater among urban children with PKU than among rural children [(94.92±8.57) vs. (87.65±6.57); t=-3.498, P=0.001], and the mean DFQ was significantly higher among children with mild PKU than among those with classic PKU [(95.55±8.76) vs. (88.57±7.11); t=-3.095, P=0.003]. There were 37 mutations detected in the PAH gene, which were mainly distributed in exons 3, 6, 7, 11, 12 and intron 4. Three high-frequency mutation sites were detected, including c.728G>A, c.611A>G and c.1197A>T, including three novel mutations (c.674C>G, c.1316-2A>C and c.1069T>C). Conclusions Following standardized treatment, the children with PKU have comparable physical and intellectual developments as compared to normal children. c.728G>A, c.611A>G and c.1197A>T were predominant mutations in the PAH gene among these 53 children with PKU, and three novel mutations were identified, including c.674C>G, c.1316-2A>C and c.1069T>C.

Methods:Two thousand standard sections images werre collected from 2 000 clinical retrospective pediatric hip ultrasound videos from January 2019 to January 2021. All standard sections were annotated by the annotation team through the self-designed software based on Python 3.6 environment for image cross-media data annotation and manual review standardization process with unified standards. Among them, 1 753 were randomly selected for training the deep learning system, and the remaining 247 were used for testing the system. Further, 200 standard sections were randomly selected from the test set, and 8 clinicians independently completed the film reading annotation. The 8 independent results were then compared with the AI results.Results:The testing set consists of 247 patients. Compared with the clinician's measurements, the area under the receiver operating characteristic curve (AUC) of diagnosing hip joint maturity was 0.865, the sensitivity was 76.19%, and the specificity was 96.9%. The AUC of AI system interpretation under Graf detailed typing was 0.575, the sensitivity was 25.90%, the specificity was 89.10%. The 95% LoA of α-angle determined by Bland-Altman method, of -4.7051° to 6.5948° ( Bias -0.94, P<0.001), compared with clinicians' measurements. The 95% LoA of β-angle, of -7.7191 to 6.8777 ( Bias -0.42, P=0.077). Compared with those from 8 clinicians, the results of AI system interpretation were more stable, and the β-angle effect was more prominent. Conclusion:The AI system can quickly and accurately measure the Graf correlation index of standard DDH ultrasonic standard diagnosis plane.

Objective To analyze the effects of Xueshuantong and alprostadil combined with hyperbaric oxygen ( HBO ) on clinical efficacy, hemodynamics and serum inflammatory indexes in elderly patients with lower extremity arteriosclerosis occlusion. Methods One hundred and eighteen patients with lower extremity arteriosclerosis occlusion admitted into the surgical department of the hospital from May 2017 to January 2019 were randomly divided into the combined medication group (n=59) and the control group (n=59). The control group was just treated with alprostadil injection, while the combined medication group was treated with Xueshuantong and alprostadil combined with HBO treatment. Clinical efficacy after treatment, changes in atherosclerosis indexes, hemodynamic indexes ( whole blood viscosity, plasma viscosity and fibrinogen), the levels of serum inflammatory indexes, such as hs-CRP, interleukin-6, interleukin 8 and tumor necrosis factor-α( TNF-α) before and after treatment were compared between the patients of the 2 groups. Results The total effective rate of the combined medication group was 93. 22％, which was significantly higher than 79. 66％ of the control group(P<0. 05). The blood flow of dorsal pedal artery, ankle-brachial indexes and toe-brachial indexes in the patients of the 2 groups after treatment were all significantly higher than those before treatment (P<0. 05), and the combined medication group was obviously superior to the control group, with statistical significance (P <0. 05). The whole blood viscosity, plasma viscosity and fibrinogen (FIB) levels in the patients of the 2 groups after treatment all significantly decreased as compared with those before treatment (P<0. 05), and the indexes of the combined medication group were significantly lower than those of the control group, also with statistical significance(P<0. 05). The levels of TNF-a, hs-CRP, IL-6 and IL-8 in the patients of the 2 groups after treatment were significantly lower than those before treatment (P<0. 05), and the combined medication group was also obviously superior to the control group, with statistical significance (P<0. 05). Conclusion Xueshuantong and alprostadil combined with HBO in the treatment of elderly patients with peripheral arterial disease ( PAD) could achieve significant clinical effects, and in the meantime could evidently delay the occurrence of lower extremity arteriosclerosis, improve hemodynamics, relieve inflammation reactions. For this reason, it is worth further clinical extension.

Objective To analyze the effects of Xueshuantong and alprostadil combined with hyperbaric oxygen ( HBO ) on clinical efficacy, hemodynamics and serum inflammatory indexes in elderly patients with lower extremity arteriosclerosis occlusion. Methods One hundred and eighteen patients with lower extremity arteriosclerosis occlusion admitted into the surgical department of the hospital from May 2017 to January 2019 were randomly divided into the combined medication group (n=59) and the control group (n=59). The control group was just treated with alprostadil injection, while the combined medication group was treated with Xueshuantong and alprostadil combined with HBO treatment. Clinical efficacy after treatment, changes in atherosclerosis indexes, hemodynamic indexes ( whole blood viscosity, plasma viscosity and fibrinogen), the levels of serum inflammatory indexes, such as hs-CRP, interleukin-6, interleukin 8 and tumor necrosis factor-α( TNF-α) before and after treatment were compared between the patients of the 2 groups. Results The total effective rate of the combined medication group was 93. 22％, which was significantly higher than 79. 66％ of the control group(P<0. 05). The blood flow of dorsal pedal artery, ankle-brachial indexes and toe-brachial indexes in the patients of the 2 groups after treatment were all significantly higher than those before treatment (P<0. 05), and the combined medication group was obviously superior to the control group, with statistical significance (P <0. 05). The whole blood viscosity, plasma viscosity and fibrinogen (FIB) levels in the patients of the 2 groups after treatment all significantly decreased as compared with those before treatment (P<0. 05), and the indexes of the combined medication group were significantly lower than those of the control group, also with statistical significance(P<0. 05). The levels of TNF-a, hs-CRP, IL-6 and IL-8 in the patients of the 2 groups after treatment were significantly lower than those before treatment (P<0. 05), and the combined medication group was also obviously superior to the control group, with statistical significance (P<0. 05). Conclusion Xueshuantong and alprostadil combined with HBO in the treatment of elderly patients with peripheral arterial disease ( PAD) could achieve significant clinical effects, and in the meantime could evidently delay the occurrence of lower extremity arteriosclerosis, improve hemodynamics, relieve inflammation reactions. For this reason, it is worth further clinical extension.

Objective To examine the prognostic value of flow diversion (FD) presented on transcranial Doppler ultrasound (TCD) in patients with large hemispheric infarction (LHI) caused by the unilateral middle cerebral artery (MAC) occlusion.Methods Seventy-three consecutive LHI patients who had occlusion in M1 segment of MAC and were admitted to neurological intensive care unit at Xijing Hospital from January 2012 to June 2016 were reviewed.All the participants had TCD examination after admission,and were grouped according to the presence or absence of FD into FD+ and FD-.Three-month,six-month,and twelve-month functional outcomes of all the participants were collected and analyzed.Long-term survival rates were compared using Kaplan-Meier survival analysis.Receiver operating characteristic curve (ROC) was used to examine the predictive power of FD in patients with LHI.Results Among 73 LHI patients,28 (38.36％) patients were presented with FD.The incidence rates of cerebral herniation,usage of mechanical ventilation,mortality during hospitalization and incidence rates of three-month,six-month and twelve-month poor outcomes were much higher in patients without FD than those with FD.Multivariate analyses demonstrated that FD was independently associated with cerebral herniation (OR=28.943,95％CI 1.922-435.918,P=0.015),usage of mechanical ventilation (OR=11.151,95％CI 1.614-77.018,P=0.014),three-month (OR=20.163,95％CI 3.048-133.362,P=0.002),six-month (OR=3.525,95％CI 1.153-10.773,P=0.027),and twelve-month (OR=4.400,95％CI 1.387-13.960,P=0.012) poor outcomes.FD yielded an area under the ROC of 0.756,allowing for prediction of three-month outcomes of LHI.Conclusion FD presented on TCD is an early predictor of outcomes in patients with LHI.

Objective To investigate the energy intake and complications of continuous and intermittent pump feeding in acute stroke patients and provide a theoretical evidence to support for clinical treatment.Methods From April 2012 to June 2016,69 acute srtoke patients on the nasogastric tube feeding and admitted in the Department of Neurology intensive care unit in Xijing Hospital were enrolled and randomly assigned to have continuous or intermittent pump feeding.The primary endpoint was the efficacy in supplying the desired amount of nutrients by the fifth day and complications(hospital-acquired pneumonia,diarrhea,gastric retention,gastrointestinal bleeding)during the first week.The secondary endpoint was nutritional assessments(albumin,prealbumin,transferrin,hypersensitive c-reactive protein)in the first week.Results Both groups were comparable in acute physiology and chronic health evaluation Ⅱ(13.3±4.7 vs.12.9±4.5),Glasgow coma scale[10(7.2,14)vs.9.5(7.7,12)],National Institute of Health stroke scale[17(15,19)vs.16(13,20)],and Barthel scores[5(0,12.5)vs.10(5,15)](all P>0.05).It was no significantly different in the achievement percentage of the energy determined in the fifth day [93.9％(77.9％,99.8％)in continuous group and 84.8％(75.7％,93.9％)in intermittent group(U=0.144,P>0.05).Intermittent pump feeding significantly reduced the rate of hospital-acquired pneumonia in the first week when compared with continuous pump feeding(58.3％vs.33.3％,X2=4.327,P=0.038),and both groups displayed a moderate number of digestive complications without significant differences,including diarrhea(30.6％vs.27.3％,X2=0.09,P=0.764),gastric retention(2.78％vs.3.03％,X2=0.001,P=1.000),and gastrointestinal bleeding(5.56％vs.9.10％,X2=0.010,P=0.920).No difference could be demonstrated in serum protein markers between two groups in the first week,including prealbumin[0.17(0.13,0.20)g/L vs.0.18(0.15,0.24)g/L,P=0.195),transferrin[1.90(1.52,2.20)g/L vs.1.94(1.65,2.06)g/L,P=0.747),and hypersensitive C-reactive protein[22.5(8.3,50.1)mg/L vs.14.6(6.5,30.5)mg/L,P=0.205].Conclusions Both continuous and intermittent pump feeding can reach the target predictive nutrition(100％of calculated caloric requirements)without statistical differences in the incidences of gastrointestinal complications,and the rate of HAP is lower in intermittent group.Intermittent enteral nutrition can be used as an appropriate method of enteral nutrition support to improve the nutritional status in critically acute stroke patients.

Objective To explore the relationship between gastric juice pH and hospital-acquired pneumonia ( HAP) , the gastric bacterial colonization and etiology of HAP in neurologic intensive care unit patients by monitoring gastric juice pH value.Methods From October 2014 to May 2015, consecutive seventy-two tube feeding patients admitted in the Department of Neurology Intensive Care Unit in Xijing Hospital were enrolled in this research.The type and concentration of pathogens from gastric contents were collected, while samples from upper respiratory tract and pharynx were detected dynamically at the same time.Results (1)The group with new onset HAP was higher in gastric juice pH (6.4(5.4,6.4) vs 5.4 (2.5, 6.4), Z=-2.37, P=0.01); (2) The isolation rate of colonized bacteria in gastric cavity was associated with the pH of gastric juice , achieving 60.8% ( 42/69 ) in HAP group; ( 3 ) When the gastric juice pH was >4, the isolation rate of Gram-negative bacilli in gastric cavity obviously increased (63.6%(28/44) vs 35.7%(10/28),χ2 =5.323, P=0.021); (4)The same pathogens were found in stomach-pharynx-upper respiratory tract in 7 cases ( 17.5%) of the total 40 HAP patients.Conclusion Increased gastric juice pH was associated with gastric colonization , especially Gram-negative bacilli , and may lead to a higher incidence of new onset HAP in patients on enteral feeding.