Preliminary results of multicenter studies on ABO-incompatible kidney transplantation / 中华器官移植杂志

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Protective effect of quercetin on the injury of brain microvascular endothelial cells induced by asymmetric dimethylarginine and its mechanism / 中国脑血管病杂志

Objective To investigate the protective effect of quercetin on the injury of human brain microvascular endothelial cells ( HBMECs) induced by asymmetric dimethylarginine ( ADMA) and its mechanism. Methods An injury model of HBMECs was induced by ADMA (30 p.mol/L for 24 h). The experiment was divided into control group (without any intervention factors ), ADMA group,ADMA + quercetin treatment group (pretreatment of quercetin with final concentration of 0.1,1,10 and lOOfimol/L for 2h followed by the addition of ADMA with final concentration of 30 pjnol/L for 24 h), 100 p.mol/L quercetin treatment group (quercetin pretreatment with 100 p.mol/1 for 2h and then changing conventional culture medium) , 10 pjnol/L quercetin treatment group (quercetin pretreatment with 10 n-mol/L for 2 h and then changing conventional culture medium) ,ANISO/P79350 + ADMA + quercetin treatment group (2h after pretreatment with quercetin at the final concentration of 10 yjnol/L, adding ADMA with final concentration of 30 jtmol/L for 24 hours,and adding 10 p.mol/1 anisomycin ( ANISO) or 50 jtmol/L P79350 1 h before the end of the experiment) ,and the ANI50/P79350 treatment group (cultured with routine culture medium,and addinglO jjlmol/L NAISO or 50 p,mol/L P79350 1 h before the end of the experiment) ( n =6 samples in each group). Cell activity was measured by thiazole blue method after pretreatment with quercetin at different concentrations for 2 h. Lactate dehydrogenase ( LDH ) , superoxide dismutase ( SOD ) , reactive oxygen species, malondialdehyde, brain-derived neurotrophic factor (BDNF) levels in cell supematants were detected by enzyme-linked immunosorbent assay. Bax, Bcl-2 , c-Jun N-terminal kinase ( JNK) , phosphorylated JNK (p-JNK) , p38 ,phosphorylated p38 (p-p38) expression levels were analyzed with Western blotting. Reverse transcription-polymcrase chain reaction was used to detect the expression of endothelial nitric oxide synthase (eNOS) mRNA. Caspase-3 activity kit was used to detect caspase-3 activity. The JNK ANISU and pjo agoiusi I'/yjDU were used to observe the role ot the JNK/p38 mitogen-activated protein kinase ( p38 MAPK) signaling pathway in the protection of quercetin-mediated cell injur)'. Results Compared with the control group,the activity of HBMECs (52 ±8) in the ADMA group was decreased significantly,the LDH level (356 ±28) was increased significantly, and the BDNF concentration (51 ±8) was decreased significantly. The differences were statistically significant (all P <0.05). Compared with the ADMA group,the activity of HBMECs in the ADMA + 10 pjnol/L quercetin treatment group and ADMA + 100 fjjnol/L quercetin treatment group was significantly improved (80 ±5 and 86 ±7 respectively) , the LDH level was significantly downregulated (162 ±20 and 141 ± 17 respectively) ,and the concentration of BDNF was significantly increased (82 ±5 and 94 ±6 respectively). Hie differences were statistically significant (all P <0.05). The follow-up experiments were treated with 10 mol/L quercetin. The results showed that compared with the ADMA group,the levels of Bcl-2 raRNA.eNOS mRNA.and SOD in the ADMA quercetin treatment group were increased significantly (0. 75 ± 0. 10,0. 81 ± 0.07, and 81 ± 10, respectively), the expression level of Bax and the activity of caspase-3, reactive oxygen species, and malondialdehyde level were decreased significantly (1. 63 ±0. 12,1. 85 ±0. 16,169 ± 16,and 159 ± 13.respectively). There were significant differences (all P < 0.05). Further mechanism analysis showed that compared with the control group, the ADMA group significantly increased the phosphorylation levels of JNK and p38 in HBMECs (p-JNK/JNK and p-p38/p38 3. 46 ±0. 32 and 3. 66 ± 0. 31,respectively);Compared with the ADMA group,the ADMA + quercetin treatment group effectively inhibited the JNK and p38 phosphorylation levels of HBMCECs induced by ADMA (p-JNK/JNK and p-p38/p38160 ±0.19 and 172 ±0.20respectively). The differences were statistically significant (all P < 0. 05). Compared with the ADMA + quercetin treatment group,p-JNK/JNK (4. 06 ±0. 30) in ANISO + ADMA + quercetin treatment group,and p-p38/ p38 (3. 84 ±0. 32) in the P79350 + ADMA + quercetin treatment group were significantly increased. The cell activity and the BDNF level were significantly decreased, while tin? LDH level was significantly iiicreawil in both groups. Tlie differences were statistically significant (all P <0.05). Conclusion Quercetin attenuates ADMA-induced HBMEC injury .and its mechanism may be related to inhibition of JNK/p38 MARK signaling pathway.

Clinical research of the five needles combined with rehabilitation training treatment dysphagia after stroke

To compare therapeutic effects of Five Needles of the Nape and routine acupuncture on treatment of pseudo bulbar paralysis dysphagia after Brain stroke. 60 patients were randomly divided into five key groups and routine acupuncture, and 30 cases in each group. The group of Five Needles of the Nape set points to take dumb door, Tianzhu, cure choke point with acupuncture treatment which cooperate with swallowing training. The group of routine acupuncture set points to take Lian Quan, Tong Li, Zhao Hai points with acupuncture treatment. Both groups were acupunctured once a day, 6 times a week and 2 weeks is a period of treatment, evaluating curative effect after two courses of treatment. The total effective rate of Five Needles of the Nape group was 93.3%, when the total effective rate of routine acupuncture group was 80.0%.as a consequence Five Needles of the Nape group is superior to routine acupuncture group [P<0.05]. Five Needles of the Nape have better clinical efficacy than routine acupuncture on treatment of pseudo bulbar paralysis dysphagia after Brain stroke

Influences of Bushen Xingnao Decoction on expression of vascular endothelial growth factor, IL-1beta and tumor necrosis factor-alpha in vascular dementia rats

To observe influences of Bushen Xingnao Decoction [BSXND] on expression of vascular endothelial growth factor [VEGF], IL-1beta and tumor necrosis factor-alpha [TNF-alpha] in brain tissues and serum level of vascular dementia rats and to investigate neuroprotective mechanism of BSXND for vascular dementia. Wistar rats were randomly divided into normal group [N group], sham operation group [S group], dementia model group [M group] and Bushen Xingnao decoction treatment group [MT group]. After the model was successfully established, 2, 4, 6 weeks were regarded as observation point. Expressions of VEGF, IL-1beta and TNF-alpha in serum and brain of rat brain were measured by enzyme linked immunosorbent assay. The expressions of IL-1beta and TNF-alpha in MT group were lower than those in M group [P< 0.05], the expression of VEGF in MT group was higher than that in M group [P< 0.05]; the expressions of VEGF, IL-1beta and TNF-alpha in MT and M groups were higher than those in N and S groups [P<0.01]. BSXND can reduce the levels of IL-1beta and TNF-alpha in brain tissues and serum of vascular dementia rats and increase the expression of VEGF. BSXND can play cerebral protective role by suppressing the neuroinflammation response of vascular dementia rats and enhancing vascular repair

Right hemicolectomy and multivisceral resection of right colon cancer: A report of 21 cases / 华中科技大学学报（医学）（英德文版）

The long- and short-term outcomes in 21 patients with right colon cancer after right hemicolectomy and multivisceral resection surgery were investigated. Short-term therapeutic effects and long-term survival rate were retrospectively analyzed in patients with right colon cancer. These individuals underwent right hemicolectomy in combination with multivisceral resections including pancreatic head, duodenum, kidney, liver, gallbladder, and abdominal wall at the Department of General Surgery in the Henan Tumor Hospital between January 2003 and August 2014. The patients had an average age of 58.9 years (range: 39-78). Three patients had metastatic invasion only to the duodenum; meanwhile 18 patients had invasion to the duodenum and other adjacent organs. The median survival time was 41 months (95% CI: 6.972-75.028) with one death in the perioperative period. No patients lost follow-up. One-, 3-, and 5-year survival rate was 75%, 56%, and 43%, respectively. It was concluded that indications for surgery should be tightly controlled. Favorable clinical outcomes of right hemicolectomy and multivisceral resection surgery were demonstrated for patients with right colon cancer at the T4 stage.

Right hemicolectomy and multivisceral resection of right colon cancer: A report of 21 cases / 华中科技大学学报（医学）（英德文版）

The long- and short-term outcomes in 21 patients with right colon cancer after right hemicolectomy and multivisceral resection surgery were investigated. Short-term therapeutic effects and long-term survival rate were retrospectively analyzed in patients with right colon cancer. These individuals underwent right hemicolectomy in combination with multivisceral resections including pancreatic head, duodenum, kidney, liver, gallbladder, and abdominal wall at the Department of General Surgery in the Henan Tumor Hospital between January 2003 and August 2014. The patients had an average age of 58.9 years (range: 39-78). Three patients had metastatic invasion only to the duodenum; meanwhile 18 patients had invasion to the duodenum and other adjacent organs. The median survival time was 41 months (95% CI: 6.972-75.028) with one death in the perioperative period. No patients lost follow-up. One-, 3-, and 5-year survival rate was 75%, 56%, and 43%, respectively. It was concluded that indications for surgery should be tightly controlled. Favorable clinical outcomes of right hemicolectomy and multivisceral resection surgery were demonstrated for patients with right colon cancer at the T4 stage.

Chinese Internet Searches Provide Inaccurate and Misleading Information to Epilepsy Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most patients with epilepsy want to learn as much as possible about the disease, and many have turned to the internet for information. Patients are likely to use information obtained from the internet to control their epilepsy, but little is known about the accuracy of this information. In this survey, we have assessed the feasibility and usability of internet-based interventions for the treatment of epilepsy.</p><p><b>METHODS</b>Data were collected from an internet search. Different search terms were used to obtain general information on epilepsy together with information about medication, types of epilepsy, treatment, women's health, and other information. The accuracy of the information was evaluated by a group of experts.</p><p><b>RESULTS</b>A total of 1320 web pages were assessed. The majority were websites related to health. A large number (80.2%) of web pages contained content related to the search term. A significant number of web pages 450/1058 (42.5%) claimed to provide information from a credible source; however, only 206/1058 (19.5%) of the information was accurate and complete; 326/1058 (30.8%) was accurate but incomplete; 328/1058 (31.0%) was correct but nonstandard, and 198/1058 (18.8%) was inaccurate. The authenticity of the information was not significantly different between the two search engines (χ2 = 0.009, P = 0.924). No significant difference was observed in the information obtained from a specialist or nonspecialist source (χ2 = 7.538, P = 0.057). There was also no correlation between the quality of the information and the priority (χ2 = 6.880, P = 0.076).</p><p><b>CONCLUSIONS</b>Searching for information about epilepsy on the internet is convenient, but the information provided is not reliable. Too much information is inaccurate or for advertisement purposes, and it is difficult for patients to find the useful information. Turning to the internet for medical knowledge may be harmful. Physicians should be aware that their patients may search for information on the internet and guide them to safe, reputable websites.</p>

Efficacy observation of paralleled clipping of rectal ligament in resection of rectal cancer in obese male patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the approach and efficacy of dealing the rectal ligament in resection of rectal cancer in obese male patients.</p><p><b>METHODS</b>A total of 92 patients (BMI>25 kg/m(2)) undergoing resection of rectal cancer from December 2008 to December 2010 in Henan Tumor hospital were assigned into 2 groups according to the surgical technique, the modified group (paralleled clipping of rectal ligament, 48 patients) and traditional group (44 patients). Operative time, intra-operational bleeding, rectal ulceration, ureteral injury, mesorectal integrity, and positive rate of lateral margin of pelvic wall were compared between two groups.</p><p><b>RESULTS</b>The operative time was (66.9±99.8) min in modified group, which was significantly shorter than that in traditional group [(125.4±12.2) min, P=0.000]. Intra-operative bleeding was (160.3±27.2) ml in modified group and (150.5±28.5) ml in traditional group (P=0.093). Rectal ulceration rated were 0 and 18.2% (8/44), mesorectal disintegrity rates were 6.2% and 22.7%, pelvic infection rates were 2.1% (1/48) and 20.4 (9/44) in modified and traditional groups respectively, whose differences were all significant (all P<0.05). No ureteral injury and positive margin were found in both two groups.</p><p><b>CONCLUSION</b>The approach of paralleled clipping of rectal ligament around the rectum meets the principle of TME, which is simple, safe and effective.</p>

The clinical application of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy.</p><p><b>METHODS</b>From October 2002 to October 2012, 52 patients with rectal cancer received neoadjuvant radiotherapy and developed presacral venous plexus hemorrhage during rectectomy, included 36 male and 26 female cases. Their age were 36-65 years. The hemostasis time and blood loss were analyzed.</p><p><b>RESULTS</b>All 52 patients achieved R0 resection. Of which 13 patients achieved suture hemostasis within 15 minutes, whereas 22 patients unsuccessfully treated within 15 minutes received compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx. The median blood loss was (196 ± 44)ml and hospitalization time was (15.2 ± 1.7)days in this group. Additionally, 7 patients achieved suture hemostasis within 20 minutes except 4 patients who received compression hemostasis, with a median blood loss of (1016 ± 86)ml and hospitalization time of (21.7 ± 6.3)days. Other 6 patients achieved suture hemostasis within 30 minutes except 3 patients who received compression hemostasis, with a median blood loss of (2508 ± 73)ml and the hospitalization time was (28.8 ± 3.3)days. There was statistically significant difference of bleeding (F = 4289.562) and hospitalization time (F = 50.121) in 3 groups of patients (P = 0.000).</p><p><b>CONCLUSIONS</b>Once intraoperative presacral venous plexus hemorrhage can't be stopped timely, compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx is an effective alternative for the patients with rectal cancer who received neoadjuvant radiotherapy.</p>

Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery.</p><p><b>METHODS</b>We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed.</p><p><b>RESULTS</b>In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml.</p><p><b>CONCLUSIONS</b>Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.</p>

Application of an arc-shaped transperineal incision in front of the apex of coccyx during the resection of pelvic retroperitoneal tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore a better operative approach to resect complicated pelvic retroperitoneal tumors.</p><p><b>METHODS</b>A total of 28 patients with complicated pelvic retroperitoneal tumors who received surgical resection in our hospital from 2006 to 2010 were included in this study. The surgical operation was assisted with an arc-shaped transperineal incision in front of the apex of coccyx. The operation time, intraoperative blood loss, death toll and length of hospital stay of the patients were retrospectively analyzed.</p><p><b>RESULTS</b>The median operation time was 122.5 minutes. The median blood loss was 420 ml, and the median length of hospital stay of the patients was 17.5 days. There was no postoperative death in this group of patients.</p><p><b>CONCLUSION</b>With the assistance of this arc-shaped transperineal incision in front of the apex of coccyx, the resection of pelvic retroperitoneal tumors can be effectively improved and the surgery risk is reduced.</p>

Association of early diarrhea after the low anterior resection of rectal cancer and anastomotic leakage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the association of early diarrhea(postoperative day 1 to 7) and anastomotic leakage after low anterior resection for rectal cancer.</p><p><b>METHODS</b>Clinical data of 192 cases (group A, tumor from the anal verge 4-7 cm) from May 2004 to May 2007 and 236 cases(group B) from July 2007 to May 2010 in our hospital who received low anterior resection of rectal cancer were analyzed retrospectively.</p><p><b>RESULTS</b>In group A, the incidence of early postoperative diarrhea was 19.3%(37/192), of which 9 cases were treated with anti-diarrhea drugs. The morbidity of anastomotic leakage in patients with diarrhea was significantly higher than those without early diarrhea(16.2% vs. 5.2%, P<0.05). In group B, the incidence of early postoperative diarrhea was 16.5%(39/236). All the patients were treated with anti-diarrhea drugs. There was no difference in the morbidity of anastomotic leakage between patients with diarrhea and those without early diarrhea(16.2% vs. 5.2%, P<0.05). There was no difference in early diarrhea between groups A and B(P>0.05). However, the incidence of anastomotic leakage in patients with early diarrhea was lower in group B(P<0.05).</p><p><b>CONCLUSIONS</b>Early diarrhea after the low anterior resection of rectal cancer may indicate anastomotic leakage. Treatment of early postoperative diarrhea may reduce the risk of anastomotic leakage.</p>

Application of trans-abdominal-mediastinal drainage tube in patients with high risk of esophagogastric or esophago-jejunal anastomotic leakage / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of trans-abdominal-mediastinal drainage tube on the prevention of esophagogastric or esophago-jejunal anastomotic leakage.</p><p><b>METHODS</b>A total of 79 patients underwent thoraco-abdominal radical resection for gastric cardia cancer, with high risk of leakage of the anatsomosis, from Aug. 2007 to Aug. 2011 were included in this study. They were assigned into 2 groups. Forty one patients had trans-abdominal-mediastinal drainage tube (improvement group) and 38 patients were without the mediastinal drainage tube (control group). The clinical data of all the 79 patients were reviewed and the therapeutic effects of the two treatment approaches were compared.</p><p><b>RESULTS</b>There was anastomotic leakage in four patients of the improvement group. They were with stable vital signs and the median hospital stay was 29.3 days. There was anastomotic leakage in five cases of the contol group and all of them had high fever and chest tightness. One among those five patients had transdermal placement of thoracic drainage tube and was cured, and four among those five patients had second debridement operation, with 3 cured and one death case. Except the one death case, the median hospital stay of the control group was 53.4 days, significantly longer than that of the improvement group (P < 0.05).</p><p><b>CONCLUSIONS</b>Although putting trans-abdominal-mediastinal drainage tube can not prevent the leakage of esophagogastric or esophago-jejunnal anastomosis, it can reduce the systemic inflammatory responses, death and painful suffering of the patients caused by anastomotic leakage.</p>

Anatomy of splenic flexure and surgical treatment in 52 patients with non-obstructive splenic flexure colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the anatomic characteristics of splenic flexure, surgical techniques, and oncologic outcomes in 52 patients with non-obstructive splenic flexure colon cancer.</p><p><b>METHODS</b>Clinical data of 52 patients with non-obstructive splenic flexure colon cancer from March 2004 to March 2011 in the Department of General Surgery at the Henan Province Tumor Hospital were analyzed retrospectively.</p><p><b>RESULTS</b>There were 37 patients of regular type, 5 of mobile type, and 10 of adhesive type. All the patients received radical operation. Eighteen patients received pre-small intestine anastomosis, including 12 cases with regular type, 4 with mobile type, and 2 with adhesive type. The difference in pre-small intestine anastomosis among the three types was not statistically significant(P=0.062). In addition, 32 cases received retro-ileum anastomosis. There were no significant differences in operative time, intraoperative blood loss, number of lymph node dissection and positive lymph node, and postoperation complication rate among the three types. Follow up was available in all the cases. Five-year survival rates of cases with regular type, mobile type and adhesive type were 62.5%, 59.2% and 58.7% respectively(P>0.05).</p><p><b>CONCLUSIONS</b>Radical resection can provide satisfactory survival for splenic flexure colon cancer patients. The anatomy of splenic flexure does not affect the type of anastomosis. Retro-ileum anastomosis is a simple and effective method for reconstruction after radical resection of the tumor.</p>

Treatment outcomes of multivisceral resection for locally advanced right colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate long-term survival after multivisceral resection in patients with locally advanced right colon cancer.</p><p><b>METHODS</b>The clinical data and survival of 13 patients with locally advanced right colon cancer were retrospectively analyzed.</p><p><b>RESULTS</b>There were 8 males and 5 females with a mean age of 58.6 years. Location of the primary tumor included hepatic flexure(n=6), transverse colon(n=2), and ascending colon(n=5). Three patients had duodenal invasion alone, 9 had involvement of duodenum and other organs, and 1 had pancreas and stomach involvement. Right colectomy and pancreaticoduodenectomy and(or) resection of other organs were performed. The 1-, 3-, and 5-year survival rates were 69%, 54%, and 30%, respectively.</p><p><b>CONCLUSION</b>Right colectomy combined with multivisceral resection is a promising procedure for selected patients with locally advanced colon cancer.</p>

Metabolic abnormalities in mesial temporal lobe epilepsy patients depicted by proton MR spectroscopy using a 3. 0t MR scanner / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate metabolic abnormalities in patients with mesial temporal lobe epilepsy (MTLE) with proton magnetic resonance spectroscopy (MRS) using a 3. 0T MR scanner.</p><p><b>METHODS</b>Sixty-three patients (32 women and 31 men) with diagnosed MTLE underwent diagnostic MR imaging (MRI) and proton MRS using a 3. 0T MR scanner. The clinical history and interictal epileptiform discharges (IEDs) were recorded. Sixteen healthy volunteers served as control. The results of proton MRS were compared with the findings of electroencephalogram and structural MRI findings.</p><p><b>RESULTS</b>Twenty-seven of the 63 patients with MTLE showed unilateral hippocampal sclerosis, and 9 showed bilateral hippocampal sclerosis. The concentration ratio of N-acytelaspartate (NAA)/[creatine (Cr) + choline (Cho)] in the hippocampal region of MTLE patients (0.64 +/- 0.07) was significantly lower than control (0.80 +/- 0.05, P = 0.023). In the patients with unilateral hippocampal sclerosis, NAA/(Cr + Cho) in the hippocampal region ipsilateral to the sclerotic hippocampus (0.56 +/- 0.06) was significantly lower than the ratio in the contralateral hippocampal region (0.69 +/- 0.07, P < 0.001). There was significant difference in hippocampal NAA/(Cr + Cho) between the refractory patients and the non-refractory patients (0.64 +/- 0.05 vs. 0.71 +/- 0.07, P = 0.04). Forty-five patients were lateralized by IEDs, while 49 patients were lateralized by metabolite ratio. And lateralization determined by proton MRS and IEDs was concordant in 33 patients.</p><p><b>CONCLUSIONS</b>MRS as a noninvasive tool adds helpful metabolite information to routine MRI in evaluation of MTLE. The method is well established and should be a routine clinical application in the investigation of epilepsy.</p>

Differences in interictal perfusion patterns between refractory and non-refractory temporal lobe epilepsies evaluated with fair at 3. 0T / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the difference in interictal perfusion patterns between refractory and non-refractory temporal lobe epilepsies evaluated with flow-sensitive alternating inversion recovery (FAIR) magnetic resonance (MR) sequence.</p><p><b>METHODS</b>Nine patients with refractory temporal lobe epilepsy, 21 patients with non-refractory temporal lobe epilepsy, and 13 normal volunteers underwent FAIR MR scanning. The relative cerebral blood flow (rCBF) in bilateral hemispheres and mesial temporal lobes were measured. And we also calculated the asymmetry index (AI) values.</p><p><b>RESULTS</b>The AI values of bilateral hemispheres in refractory and non-refractory epilepsy patients were both significantly different from those of volunteers (P = 0.012 and 0.029, respectively). There was significant difference in AI values of bilateral mesial temporal lobes between non-refractory epilepsy patients and volunteers (P = 0.049), while no significant difference between refractory epilepsy patients and volunteers.</p><p><b>CONCLUSIONS</b>The hypoperfusion pattern of interictal refractory temporal lobe epilepsy patients is different from that of non-refractory patients. Although the hypoperfusion tends to extend out of temporal lobes in all patients, the refractory epilepsy patients have a preference of bilateral mesial temporal hypoperfusion, which may be valuable for evaluating prognosis.</p>

Characteristics of clinical manifestations and EEG of Lennox-Gastaut syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>Lennox-Gastaut syndrome (LGS) is one of the most severe and refractory form of childhood epilepsy. The purpose of this study was to investigate the clinical and EEG characteristics of patients with LGS.</p><p><b>METHODS</b>Sixty-two patients with LGS, including 37 males and 25 females, were followed-up regularly per three months or per six months, therapy was adjusted according to the changes in seizures and EEG, and the clinical data were analyzed in detail.</p><p><b>RESULTS</b>The onset occurred between the age of 8 months and 12 years, with the peak at 1-4 years of age, accounting for 61%; a late onset which occurred after 8 years of age, was unusual. Furthermore, one patient who developed LGS at the age of 13 years and remained to have all the features of seizures and EEG at 35 years of age was identified as adult's LGS. Forty-three patients were classified as symptomatic, perinatal events were the predominant factors in this group. The others were cryptogenic. It was noted that 11 cases had a history of West syndrome. A transformation process from West syndrome to LGS was observed in another 7 cases. Every patient had two or more seizure types during the course of the disease; tonic seizure, atypical absence seizure, head drop or sudden falls were the characteristic types. The degree of mental deficit was variable from slight to profound deterioration, but mental and behavioral disturbances existed in every case as a rule. In all cases electroencephalogram (EEG) background was abnormal and consisted of diffuse slow spike-and-waves (1-1.5CPS), predominant in frontal and temporal regions. Twenty-four cases had the polyspike-wave. Bursts of fast rhythms (10-14CPS) were observed in 29 patients during sleep. The choice of antiepileptic drugs (AEDs) was based on the seizure types; routinely, 2 or more kinds of AEDs were used in combination, the classic drugs, valproate and clonazepam were firstly recommended; the other drugs, such as lamotrigine and topiramate that are used as add-on therapy were further consideration. Although the total effect was not satisfactory, the severity and frequency of seizures in almost all cases had lessened to some extent.</p><p><b>CONCLUSION</b>LGS shows diverse manifestations; comprehensive diagnosis is crucial, active and efficacious treatment can improve the mental and behavioral development and prognosis as a whole.</p>