The postictal state in epilepsy and its clinical significance / 中华神经科杂志

The postictal state refers to the abnormal condition occurring between the end of an epileptic seizure and return to baseline condition,including a variety of cognitive, motor, sensory, autonomic, mental and behavioral impairments. The symptoms which may last from seconds to days are various and the severity is different. It also may exert great impact on patients′ health and quality of life. However, the lack of relevant studies at home and abroad, along with the absence of correct understanding of this in clinical practice, may lead to frequent misdiagnosis and mistreatment. This article will review the concepts, pathophysiological mechanisms, clinical manifestations, diagnosis, differential diagnosis, clinical significance and intervention strategies, aiming at deepening the understanding of the phenomenon, as well as providing references for further clinical research.

Correctly understanding the relationship between autoimmune epilepsy and autoimmune encephalitis / 中华神经科杂志

Both autoimmune epilepsy and autoimmune encephalitis are new clinical concepts proposed in recent years with the development of neuroimmunology. Is it appropriate for the patients with new-onset epileptic seizures and positive neuron antibodies diagnosed as autoimmune encephalitis or autoimmune epilepsy? There are still disputes and misunderstandings. Because there are usually some common anti-neuronal antibodies detected in the serum or cerebrospinal fluid of them both, and additionally their clinical manifestations have certain overlaps, such as drug resistant epilepsy and cognitive impairment, both concepts are often confused in clinical practice, resulting in unnecessary excessive long-term anti-epileptic treatment. This review interprets the differences and connections between the two diseases on concepts, epidemiology, pathogenesis and related risk factors, clinical manifestations, auxiliary examination, treatment and prognosis.

Reconsideration of the definition of drug resistant epilepsy / 中华神经科杂志

International League Against Epilepsy published a unified standard for drug resistant epilepsy by numbers of unsuccessful anti-epileptic drugs, criteria for seizure control and follow-up time in 2009. However, there are still some problems and even some controversies in the clinical application of this standard. To provide references for future clinical application and scientific research, we reconsider the definition of drug resistant epilepsy from its historical definitions, core elements and existing problems, and propose that some drug resistant epilepsy patients are probably more appropriately defined as chronic epilepsy.

Correctly understanding the relationship between autoimmune epilepsy and autoimmune encephalitis / 中华神经科杂志

Both autoimmune epilepsy and autoimmune encephalitis are new clinical concepts proposed in recent years with the development of neuroimmunology.Is it appropriate for the patients with new-onset epileptic seizures and positive neuron antibodies diagnosed as autoimmune encephalitis or autoimmune epilepsy? There are still disputes and misunderstandings.Because there are usually some common anti-neuronal antibodies detected in the serum or cerebrospinal fluid of them both,and additionally their clinical manifestations have certain overlaps,such as drug resistant epilepsy and cognitive impairment,both concepts are often confused in clinical practice,resulting in unnecessary excessive long-term anti-epileptic treatment.This review interprets the differences and connections between the two diseases on concepts,epidemiology,pathogenesis and related risk factors,clinical manifestations,auxiliary examination,treatment and prognosis.

Effect of family factors on the prognosis of patients with epilepsy / 中华神经科杂志

Objective To investigate the effect of family factors on the prognosis of patients with epilepsy and the relationship between family factors and clinical characteristics of epilepsy.Methods Data were collected from 107 patients definitely diagnosed with epilepsy who were treated by antiepileptic drugs for at least two years.All the patients were divided into good or poor prognosis group according to whether achieving at least one year free of seizures.The clinical and family data were colleeted.The questionnaire Family Adaptability and Cohesion Evaluation Scale-Ⅱ-Chinese Version containing 30 items was used for patients and the Epilepsy Knowledge Questionnaire containing 34 questions for primary caregiver.We compared the clinical and family factors between the two groups to identify the predictors of poor control of seizures with univariate and multiple Logistic regression,and observed the relationship between family factors and clinical features such as course,type of seizure,seizure frequency,etc,with Pearson correlation analysis.Results Patients with poor prognosis were more likely to have interictal epileptiform discharges (IEDs),multidrug treatment and pre-treatment seizure frequency of more than once monthly (84.6％ (44/52) vs 50.9 ％ (28/55),x2 =13.797,P =0.000;63.5 ％ (33/52) vs 34.5 ％ (19/55),x2 =8.947,P =0.003;38.5％ (20/52) vs 5.5％ (3/55),x2 =17.257,P =0.000).Family in rural area,unbalanced family type,number of family members were much more in poor prognosis group than in good prognosis group (51.9％ (27/52) vs 25.5 ％ (14/55),x2 =7.923,P =0.005;80.8 ％ (42/52) vs 49.1％ (27/55),x2 =11.712,P=0.000;4.1 ± 1.1 vs 3.6 ±0.8,t=2.631,P=0.010).And average family income,education level of father,the level of epilepsy knowledge of primary caregiver were significantly lower in poor prognosis group than in good prognosis group (19/20/13 vs 11/17/27,x2 =7.198,P =0.027;15/30/7 vs 4/34/17,x2 =10.709,P =0.005;36/11/5 vs 15/25/15,x2 =19.022,P =0.000).Multiple Logistic regression analysis demonstrated that IEDs (OR =12.332,95％ CI 2.756-55.190,P =0.001),pretreatment seizure frequency of more than once monthly (OR =8.401,95％ CI 1.573-44.884,P =0.013)were clinical risk factors of unfavorable prognosis;more family members (OR =3.021,95％ CI 1.554-5.870,P =0.001),poor epilepsy knowledge of primary caregiver (OR =3.392,95％ CI 1.304-8.821,P=0.012) and unbalanced family type (OR=4.794,95％ CI 1.217-18.894,P=0.025) were independent family risk factors of poor prognosis.The level of epilepsy knowledge of primary caregiver was inversely associated with duration (r =-0.237,P =0.014).Conclusions The prognosis of epilepsy is not only affected by clinical factors,but also by family factors.More family members,poor epilepsy knowledge of primary caregiver and unbalanced family type are independent risk factors of unfavorable prognosis.The poorer epilepsy knowledge the primary caregivers have,the longer duration the disease has.

Effects of downregulated pregnane X receptor on glutamate-induced expression and activity of P-glycoprotein in the mouse brain microvascular endothelial cells / 临床神经病学杂志

Objective To investigate the effects of downregulated pregnane X receptor (PXR)on expression and activity of P-glycoprotein(P-gp)in mouse brain microvascular endothelial cells (mBMEC)exposed to glutamate (GLU)to mimic conditions during seizures. Methods The bEnd.3 cells,were cultured in vitro and treated with culture medium containing 0 μmol,10 μmol,50 μmol,100 μmol GLU for 30 min and exposed to 100 μM GLU for different durations (0 min,15 min,30 min). With PXR knockdown using siRNA,the cells were divided into NC siRNA plus GLU group and siRNA-PXR plus GLU group. Western blotting was used to detect the protein expressions of P-gp and PXR in each group. Immunofluorescence assay was used to detect localization of PXR in cells. The expression of P-gp mRNA was detected by RT-qPCR. Rhodamine123 (Rh123)accumulation assay was used to study the activity of the P-gp in cells.Results PXR and P-gp protein expressions in the 50 μmol and 100 μmol GLU group were significantly higher than that in the blank group(P＜0.05),especially maximal expressions occurred in the 100 μmol GLU group. GLU exposures as short as 15 min and 30 min significantly increased PXR expressions(all P＜0.05);P-gp expression in the 30 min groups was higher than that in the blank group (P＜0.05 ). The data of immunofluorescence analysis suggested that the PXR nuclear accumulation increased in the 100 μM GLU group, compared with the blank group(P＜0.05). Compared with NC siRNA plus GLU group,the protein level of PXR was decreased by approximately 37%[(1.00 ± 0.00)vs(0.63 ± 0.18);t＝3.41,P＝0.02]and the levels of P-gp protein and mRNA were respectively decreased by 43%[(1.00 ± 0.00)vs (0.57 ± 0.09);t＝7.94,P＝0.00] and 52%[(1.00 ± 0.04)vs (0.48 ± 0.08);t ＝10.98,P＝0.00]in the siRNA-PXR plus GLU group. The fluorescence intensity of intracellular Rh123 in the GLU group (0.72 ± 0.01)was lower than that in the blank group [(1.00 ± 0.03);t ＝9.66,P＝0.00]. The fluorescence intensity of Rh123 in the GLU plus verapamil (P-gp inhibitor)group (1.07 ± 0.04)was higher than that in the GLU group (t＝ －11.93,P＝0.00). The fluorescence intensity of Rh123 in the siRNA-PXR plus GLU group (0.91 ± 0.03)was higher than that in the NC siRNA plus GLU group[(0.69 ± 0.05);t＝ －7.52,P＝0.00]. Conclusions Downregulation of PXR expression results in the inhibition of P-gp expression and activity in the mBMEC exposed to GLU to mimic seizures. PXR may play an important role in the regulation of seizure-induced expression and activity of P-gp in the blood-brain barrier.

Therapeutic Observation of Moxibustion plus Tuina for Early-stage Diabetic Foot / 上海针灸杂志

Objective To observe the clinical efficacy of moxibustion plus tuina in treating early-stage diabetic foot. Method Seventy patients with early-stage diabetic foot were randomized into a treatment group and a control group, 35 cases each. The control group was intervened by conventional medication, while the treatment group was additionally intervened by moxibustion plus tuina. After 2 treatment courses, the changes of ankle bronchial index (ABI) in the two groups were observed, and the clinical efficacies were compared. Result Patients in the treatment group showed significant improvement in symptoms, and the total effective rate was 96.9%. The total effective rate was 75.8% in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusion Moxibustion plus tuina is safe and effective in treating diabetic foot. With significant Chinese medicine feature and acceptable to patients, this method is a good choice in treating early-stage diabetic foot.

Survey of precipitants of epileptic seizure / 中华神经科杂志

Objective To investigate precipitants of epileptic seizure, and to explore the correlation between various precipitants and relationship between precipitants and clinical features of epilepsy.Methods Data were collected from 154 patients attending a tertiary-care epilepsy clinic of Nanjing Brain Hospital between April 2015 and April 2016.The patients with epilepsy were older than 16 years, had a clinical history of one year or more, and one seizure at least a year and one seizure at least in the latest three months.An enclosed questionnaire was combined with open interview to identify and characterize seizure precipitants and clinical characteristics of patients.Patients were asked respectively whether there were some precipitants three months before and during last three months.Correlation between seizure precipitants and relationship between precipitants and clinical characteristics, such as age, gender, course, seizure frequency and so on, were calculated.Results A total of 125 (81.2%) participants reported at least one precipitant.Common precipitants (in descending order) were as follows: emotional stress (56.0%), sleep disorder (38.4%), fatigue (27.2%), missed medication (20.0%).There were one to six different precipitants for one patient, and 60.8% of patients had two or more precipitants.There was a correlation between emotional stress and sleep disorders as well as fatigue (χ2=4.665, 8.668;P<0.05).Patients with idiopathic epilepsy were more sensitive to sleep disorders.There was no relationship between total precipitants and clinical features such as age, gender, age of onset, duration, type of seizure, seizure frequency, number of drug taking and so on.Conclusions Seizure precipitants were found widespread.The most common precipitants were found to be emotional stress, sleep disorders, fatigue and missed medication.There existed a correlation between emotional stress and sleep disorders as well as fatigue.There was no connection between total precipitants and patient′s demographic characteristics as well as clinical features.However, the type of seizure precipitants was different in patients with different demographic and clinical characteristics.

HMGB1 upregulates P-glycoprotein expression in the brain microvascular endothelial cells of the mouse / 医学研究生学报

[Abstract ] Objective High-mobility group box-1 (HMGB1) is abundantly released in the epileptogenic brain tissue , but few reports are seen about the effect of HMGB 1 on the expression of P-glycoprotein ( P-gp) in the vascular endothelial cells of the epi-leptogenic tissue .This study is to explore whether HMGB 1 can regulate P-gp expression in the brain microvascular endothelial cells of the mouse in vitro . Methods Immortalized brain microvascular endothelial bEnd .3 cells of the mouse were cultured in vitro and al-located to different concentration groups ( treated with culture medium containing 10 , 100 , 500 , and 1000 ng/mL HMGB1 for 8 hours), treatment duration groups (treated with culture medium containing 100 ng/mL HMGB1 for 4, 8, 16, 24, and 32 hours), and a control group ( treated with culture medium without HMGB 1 ) .The mRNA expression of P-gp-encoding gene-multidrug resistance gene 1a (mdr1a) was detected by real-time qPCR, and its protein expression determined by Western blot and immunocytochemistry . Results The results of qPCR manifested that the expressions of mdr 1a mRNA were 1.646 ±0.176, 1.777 ±0.135, 1.617 ±0.043, and 1.398 ±0.182 in the 10, 100, 500, and 1000 ng/mL HMGB1 groups, respectively, significantly higher than 1.030 ±0.284 in the control group (P<0.05), and so were those in the 4, 8, 16, 24 h, and 32 h groups (2.655 ±0.112, 2.168 ±0.212, 1.823 ± 0.232, 1.418 ±0.376, and 1.445 ±0.123) than in the control (1.010 ±0.164) (P <0.05).Western blot showed a significant increase in the P-gp protein expression in all the concentration groups (P<0.05) as well as in the 8 h and 16 h treatment duration groups as compared with the control group (P<0.05).Immunocytochemis-try also revealed a higher P-gp expression in the HMGB1-treated than in the control cells (P<0.01). Conclusion HMGB1 can upregu-late the expressions of mdr1a mRNA and P-gp protein in the brain microvascular endothelial cells of the mouse , which may associated with drug resistance of central nervous system diseases , especially that of epilepsy .

Effect of activation of nuclear factor-κB/hypoxia-inducible factor-1α pathway on the hippocampal neurodegeneration caused by status epilepticus in rats / 中华神经科杂志

Objective To observe the roles of nuclear factor-κB (NF-κB) and hypoxia-inducible factor-1 o (HIF-1 α) in hippocampal neurodegeneration of status epilepticus (SE) rats, and explore whether HIF-1α activation is regulated by NF-κB.Methods A total of 110 male Sprague-Dawley rats were randomly divided into seven groups : (1) Control group treated with saline (control, n =15), (2) sham group implanted cannula into lateral ventricle and treated with saline (sham, n =15), (3) SE group treated with pilocarpine (SE, n =20), (4) NF-κB activity inhibitor pyrrolidine dithiocarbamate (PDTC) group treated only with PDTC (PDTC, n =15), (5) SE + PDTC group treated with pilocarpine plus PDTC (SE + PDTC, n =15), (6) SE + HIF-1o siRNA group implanted cannula into lateral ventricle and treated with pilocarpine plus HIF-1 α siRNA (SE + HIF-1α siRNA, n =15), (7) SE + control siRNA group implanted cannula into lateral ventricle and treated pilocarpine plus control siRNA (n =15).SE was induced by injecting lithium chloride and pilocarpine.The seizure of rats was observed.The protein expressions of NF-κB and HIF-1 α in hippocampus of rats were examined by Western blotting.The degenerating neurons in hippocampus were detected by Fluoro-Jade C (FJC) staining.Results Twenty-four hours after termination of SE, the nuclear protein expressions of NF-κB and HIF-1α in hippocampus of rats were increased in SE group (0.57 × 0.06, 0.47 ± 0.07) compared with those in control group (0.23 ± 0.03, 0.20 ± 0.03;P ＜0.05);and compared with SE group PDTC significantly decreased the nuclear protein expressions of NF-κB and HIF-1 α in SE + PDTC group (0.23 ± 0.03, 0.14 ± 0.03;P ＜ 0.05);in SE + PDTC group the numbers of FJC positive cells in CA1 area (28.33 ±5.03) were decreased compared with that in SE group (76.67 ± 13.32);HIF-1 o siRNA injected into lateral ventricle of rats significantly decreased the expression of HIF-1α in hippocampus (0.22 ±0.03) and the number of FJC positive cell in CA1 area (27.34 ±7.02) in SE + HIF-1α siRNA group compared with those in SE group (0.39 ±0.06, 76.67 ± 13.32;P ＜0.05).Conclusions These data suggest that SE can result in activation of NF-κB/HIF-1o pathway in brain.Inhibition of the pathway can attenuate hippocampal neurodegeneration caused by SE, which has the brain protective effect.

Progress of microRNA in diagnosis and prognosis of diffuse large B cell lymphoma-review / 中国实验血液学杂志

MicroRNA (miRNA) is a class of naturally occurring short non-coding small molecular RNA with 19-25 nucleotide. MiRNA can regulate gene expression through incompletely binding to complementary sequences in the 3'UTR of target mRNA. MiRNA plays key regulatory role in a diverse rang of pathways, including cell proliferation, differentiation, apoptosis, stem cell development. Many studies have shown that many miRNA have a special role of gene regulation in cancer development and have been used as therapeutic targets and diagnostic markers of cancer. This review focuses on recent advances of studies on miRNA involved in tumorigenesis, and in classification, diagnosis, therapy and prognosis of DLBCL.

Design, synthesis and activity of a new type of influenza virus N1 neuraminidase inhibitors / 药学学报

In this study, the "150-cavity", next to the H5N1 influenza virus neuraminidase activity site, has been used as the target to design and synthesize a structural analogue of chlorogenic acid, N-caffeoyl-GABA, using the flexible docking simulation. The docking study showed that the N-caffeoyl-GABA could be inserted into the "150-cavity" and combined with the Arg156 side chain by hydrogen bond. The best binding free energy of H5N1 NA-N-caffeoyl-GABA complex was -7.70 kcal mol(-1), equivalent that of the NA-oseltamivir. At the same time, using the H5N1 pseudotyping virus-based NA inhibitors screening model, we determined the inhibitory effect of oseltamivir, chlorogenic acid and N-caffeoyl-GABA on the NA. Compared with chlorogenic acid, N-caffeoyl-GABA significantly enhanced the inhibitory effect on NA, but less than oseltamivir. This study showed that the "150-cavity" could possibly be used as a new neuraminidase inhibitors target, and provided a path for the development of new neuraminidase inhibitors.

Early predictors of refractory epilepsy: a case-control study / 中华神经科杂志

ObjectiveTo identify the early predictors of refractory epilepsy (RE). MethodsAll 173 epileptic patients with correct diagnosis and reasonable treatment were enrolled. The 106 patients were classified as drug non-responsive epilepsy (DNR-EP). The remaining 63 patients were classified as drugresponsive epilepsy (DR-EP). With multiple logistic regression, the clinical characteristics between the two groups were compared to identify the early predictors of RE. ResultsMultiple logistic regression analysis demonstrated that more than 10 seizures before treatment (OR =4. 46, 95％ CI 1.60-12. 40, P =0. 004),mental retardation at early time ( OR =19. 87, 95％ CI 3. 60-109. 78, P =0. 001 ) and abnormal electroencephalogram(EEG) with epileptiform wave after treatment ( OR =7.57, 95％ CI 2. 54-22. 56,P ＜0. 01 ) were independent predictors of RE.Response to initial therapy was a protective factor of RE (OR=0.05, 95％ CI 0.018-0. 139, P＜0.01). ConclusionPatients who have many seizures before treatment, mental retardation at the early time, epileptiform abnormality in EEG after treatment and who are resistant to initial therapy are likely to develop into refractory epilepsy.

Neuropsychological characteristics in active epilepsy and its risk factors / 中华行为医学与脑科学杂志

Objective To assess the neuropsychological characteristics in active epileptic patients and investigate itsrisk factors. Methods Ninety adult epileptic patients included 60 active epileptic patients (two or more unprovoked seizures within 12 months) and 30 age-, sex-, education-, course of disease- and seizure type-matched seizure-free subjects (without epileptic seizure for at least 1 year) . The neuropsychological tests including trail making test,digit symbol test, verbal fluency test,digit span test and hamilton depression scale( HAMD) ,were used to detect mental and motor speed, attention, language, working memory and depression symptoms respectively. The neuropsychological tests were compared between active and seizure-free epileptic patients and identified the risk factors of neuropsychological deficits in active epileptic patients. Results Compared to seizure-free subjects, active epileptic patients had significantly worse scores in digit symbol test, verbal fluency test, digit span test ((47.45 ±18. 812) vs(56.40 ±13. 631), (25. 25 ±8. 163) vs(30.40 ±8. 414), (10. 39 ±2. 228) vs( 11. 80 ± 2.074) respectively) ; more time to accomplish the trail making test A and B((64. 35 ±31.710) vs( 45. 47 ± 16. 309) , ( 133. 18 ± 47. 331 ) vs ( 98. 00 ± 35. 003 ) respectively) ; and higher scores in depressive symptoms ((9.12 ±6.219)vs(3.77 ±3.997) ,all P<0.05). Within active epileptic group,significant predictors of neuropsychological deficits were identified in a stepwise linear regression analysis: advancing age was significantly negatively correlated with digit symbol test(β = -0. 468, P = 0. 000) , digit span test (β = -0. 439, P = 0. 000), trail making test A (β =0.365, P = 0.003) and B(β = 0.346, P=0.002) ; higher scores on depressive symptoms was significantly negatively correlated with digit symbol test (β = -0.244, P = 0.015) ; mental work,high-education level and monotherapy were positively correlated with some of the cognitive function subscales. Conclusion This study suggests that active epilepsy can have a direct adverse effect on cognition and depression symptoms. Multi-drug therapy, severity of depression symptoms, advancing age, low-education level and non-mental work are the predictors of neuropsychological impairment in active epilepsy. In addition, good seizure control even after 1 year can have a beneficial impact on cognitive and depression prognosis.

Sociodemographic and clinical factors associated with interictal depression symptoms in adults with epilepsy / 中华行为医学与脑科学杂志

Objective To investigate the prevalence of adult epileptic patients with interictal depression symptoms(IDs) and identify early predictors of IDs. Methods Adult patients with epilepsy were recruited ( n =110,45 females and 65 males) ,age between 16 and 67 years ( median 24 years). The sociodemographic and clinical factors of patients were recorded. Hamilton Depression Scale ( HAMD ) were applied to evaluate interictal symptoms of depression ( at least 72 hours after the last epileptic seizure). According to HAMD score,the epileptic patients were divided into IDs ( ≥8 ) and non-IDs(＜8) groups. The sociodemographic and clinical factors were compared between the two groups to identify the prevalence and early predictors of IDs in adult epileptic patients.Results The prevalence of IDs in adult patients with epilepsy was 38.2% ,49.0% in active epilepsy and 12.1 %in seizure freedom. 30.0% ,5.5% ,and 2.7% were experiencing mild-to-moderate (HAMD score≥8),moderateto-severe ( ≥ 18 ) and severe ( ≥25 ) depression. 42 patients who met the HAMD score≥8 were classified as IDs group,and the remaining 68 patients were classified as non-IDs group. With multiple stepwise backward logistic regreasion, independent predictors of IDs were epileptic seizures ( OR = 8. 845, P = 0. 003 ); symptomatic or cryprogenic epilepsy ( OR = 3.132, P = 0. 045 ); prolonged duration of illness ( OR = 1. 106, P = 0.004 ) and employment status (OR =0. 154, P=0.001 ). There were no relationship between seizure frequency and severity of IDs ( Kruskal-Wallis test, x2 = 4.5, P = 0. 104). Conclusion IDs is a frequent psychiatric comorbidity in adult patients with epilepsy. The prevalence of IDs is higher in those with active epilepsy compared with those in seizure freedom and most of them are mild-to-moderate. Epileptic seizure, symptomatic or cryprogenic epilepsy, prolonged duration of illness and employment status are independent predictors of IDs, but seizure frequency has nothing to do with the IDs severity of patients.

Influence of different treatment time on the relapse and prognosis of patients with newly diagnosed epilepsy / 中华神经科杂志

Objective To explore the influence of different treatment time on the relapse and prognosis of patients with newly diagnosed epilepsy. Methods To prospectively studied the clinical characteristics of 155 patients with newly diagnosed epilepsy. Patients were separated into immediate ( n =84, seizures ≤3 times) or deferred (n =71, seizures ＞ 3 times) treatment groups according to number of seizures before treatment with appropriate antiepileptic drugs (AEDs). The patients were followed up for at least one year (median, 29 months). Kaplan-Meier survival statistics was used to analyze time to first seizure or time to treatment failure (inadequate seizure control and (or) intolerable side-effects ). The proportions of patients with treatment failure and seizure free during follow up were also compared. Results There was no significant difference in time to first seizure or time to treatment failure between immediate ( 1484 days and 2992 days) and deferred treatment ( 1104 days and 1964 days; Log-Rank test x2 =0. 571 and 0. 018 respectively, P = 0. 450 and 0. 893 ). Subgroup analyses according to etiology ( primary and cryptogenic/symptomatic epilepsy) and age (children ≤ 16 years; adult ＞ 16 years) did not reveal any difference between immediate and deferred treatment. During follow up, there were 20 treatment failure patients ( 23. 8% ) in immediate treatment group and 16 ( 22.5% ) in deferred treatment group ( no statistical difference, x2 =0. 035 ,P =0. 852). There were 40 seizure free patients (47. 6% ) in immediate treatment group and 30 (42. 3% ) in deferred treatment group ( no statistical difference, x2 = 0. 447, P =0. 504 ). Conclusions For newly diagnosed epilepsy patients with a few seizures ( seizures ≤ 3 ), immediate AEDs treatment does not affect the relapse and prognosis.

Comparison of preoperative T staging by oral contrast enhanced ultrasonography and double contrast enhanced ultrasonography in advanced gastric carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the accuracy of preoperative T staging of gastric cancer by oral and intravenous contrast-enhanced gastric ultrasonography.</p><p><b>METHODS</b>One hundred and forty three patients who had been diagnosed as gastric cancer by endoscopic biopsy and confirmed by pathology after operation were examined by oral and intravenous contrast-enhanced gastric ultrasonography, and they were divided into satisfied group and non-satisfied group according to the 2-D image quality of lesion. The results were compared with postoperative pathologic findings.</p><p><b>RESULTS</b>All the patients with gastric cancer presented regional gastric wall thickening. Among them, 117 cases were clearly presented with good image quality. The remaining 26 cases were presented with vague profile, the ulcerative surface of lesion was filled with hyperechogenicity combined with rear shadow. The accuracy of oral contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 74.1%. The accuracy in satisfied group and non-satisfied group was 78.6% and 53.8%, respectively. The enhancement pattern of 143 cases was showed as hyperenhancement during the arterial phase and hypoenhancement during the portal phase in DCUS. The accuracy of double contrast-enhanced ultrasongraphy in determining the T stage of gastric cancer was 86.7%, but the accuracy in satisfied group and non-satisfied group was 88.9% and 76.9%, respectively. There was a significant difference between the two methods (χ(2) = 9.031, P < 0.01).</p><p><b>CONCLUSION</b>DCUS is more accurate than oral contrast-enhanced ultrasonography as a useful diagnostic method for preoperative T staging of gastric cancer.</p>

Assessment of the expression profile during the entochondrostosis of vascular endothelial growth factor in bone morphogenetic protein 2 induced osteogenesis / 中华外科杂志

<p><b>OBJECTIVES</b>To examine the gene expression profile of bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) during entochondrostosis of mice and explore the expression rules and effects between BMP-2 and VEGF, and to detect the expression of VEGF in BMP-2 induced entochondrostosis in vivo.</p><p><b>METHODS</b>cDNA microarray technique with 34,000 genes was used to analyze the gene expression profiles during entochondrostosis in the limbs of mice embryo from E10 to E14. Pathway analysis of BMP-2 and VEGF was performed with GCOS1.2 software. An experimental model of femoral muscular pouch in 20 mice was adopted. The expression of VEGF was examined by in situ hybridization method and immunohistochemical method in BMP-2 induced entochondrostosis in vivo.</p><p><b>RESULTS</b>The expression signals of VEGF mRNA and VEGF appeared in cytoplasm during condensation of mesenchymal cell. As the mesenchymal cells differentiated into precartilage, the expression signals decreased in mesenchymal cells, but increased in chondrocytes and kept getting denser in the process of cartilage maturity. The peak expression of VEGF mRNA and VEGF in the experimental group appeared on the 14th day, accompanied by numerous hypertrophic chondrocytes. When mature cartilage calcified and new bone trabecula formed, the expression of VEGF mRNA and VEGF decreased in chondrocytes, but still expressed moderately in the osteoblasts and osteocytes.</p><p><b>CONCLUSIONS</b>The finding reveals a complex pattern of gene coexpression of BMP-2 and VEGF during the critical period of entochondrostosis. It's feasible for the clinical application of BMP-2 in orthopedics.</p>

Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep.</p><p><b>METHODS</b>Twelve adult male sheep (aged 1.5 years and weighing 27 kg on average) provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy. Then they were randomly divided into two groups: Group A (n=6) and Group B (n=6). The operated sites of L4-5 in Group A and L3-4 in Group B were covered by "H-shaped" freeze-drying and radiation-sterilized allogeneic bone sheets (the experimental segments), while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls (the control segments). The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4, 8, 12, 16, 20 and 24 weeks after operation. X-ray and CT scan were performed in both segments of L3-4 and L4-5 at 4 and 24 weeks after operation.</p><p><b>RESULTS</b>In the experimental segments, the bone sheets were located in the anatomical site of vertebral plate, and no lumbar spinal stenosis or compression of the dura was observed. The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate. While in the control segments, the regeneration of vertebral plate was not completed yet, the scar was inserted into the spinal canal, compressing the dura and the spinal cord, and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder (P less than 0.01), the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression.</p><p><b>CONCLUSIONS</b>Freeze-drying and radiation-sterilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility, biomechanical characteristics and osteogenic ability. They can effectively reduce formation of post-laminectomy scars, prevent recurrence of post-laminectomy spinal stenosis, and induce regeneration of vertebral plates.</p>

Intraluminal enucleation in transurethral vaporization and electro-resection of the prostate / 中国基层医药

Objective To investigate the clinical efficacy of intraluminal enucleation in transurethrat vapor- ization and electro-reesection of the prostate.Methods A retrospective analysis was reviewed in 62 case of prostatic hypertrophy,which were treated with intraluminal enucleation in vaporization of prostate.All pacients had a sucessful operation.There were 12 case in unipolar vaporization and 50 in plasmakenitic bipolar vaporization.Results Opera- tion time ranged from 50 to 162 minutes,with an average of 76min.Bleeding ranged from 40 to 200 ml,with an av- erage of 110ml.There was no blood transfusion.The weight of prostate was 62～138g,the catheter was maintained for 3～5 days postoperatively.The hospital stay was 7～10 days,average 8 days.All patients were cured.There was a fllow-up for 1～20 months,with an average of 8 months.The IPSS decreased by 22 points on average,and peak urine flow(Qmax)increasd to(16.8?3.3)ml/s.There wre no urethralstricture,permanent urinary incontinence, TURS,postoperative hemorrhage,retrograde ejaculation and recurrence.Conclusions Intraluminal enucleation in treatment of prostalic hypertroply is a new,safe,and effective method,which should be popularized in clinical prac- tice.