Differential diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma based on spatial and channel attention mechanisms.

BACKGROUND: The pre-operative non-invasive differential diagnosis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) mainly depends on imaging. However, the accuracy of conventional imaging and radiomics methods in differentiating between the two carcinomas is unsatisfactory. In this study, we aimed to establish a novel deep learning model based on computed tomography (CT) images to provide an effective and non-invasive pre-operative differential diagnosis method for HCC and ICC. MATERIALS AND METHODS: We retrospectively investigated the CT images of 395 HCC patients and 99 ICC patients who were diagnosed based on pathological analysis. To differentiate between HCC and ICC we developed a deep learning model called CSAM-Net based on channel and spatial attention mechanisms. We compared the proposed CSAM-Net with conventional radiomic models such as conventional logistic regression, least absolute shrinkage and selection operator regression, support vector machine, and random forest models. RESULTS: With respect to differentiating between HCC and ICC, the CSAM-Net model showed area under the receiver operating characteristic curve (AUC) values of 0.987 (accuracy = 0.939), 0.969 (accuracy = 0.914), and 0.959 (accuracy = 0.912) for the training, validation, and test sets, respectively, which were significantly higher than those of the conventional radiomics models (0.736-0.913 [accuracy = 0.735-0.912], 0.602-0.828 [accuracy = 0.647-0.818], and 0.638-0.845 [accuracy = 0.618-0.849], respectively. The decision curve analysis showed a high net benefit of the CSAM-Net model, which suggests potential efficacy in differentiating between HCC and ICC in the diagnosis of liver cancers. CONCLUSIONS: The proposed CSAM-Net model based on channel and spatial attention mechanisms provides an effective and non-invasive tool for the differential diagnosis of HCC and ICC on CT images, and has potential applications in diagnosis of liver cancers.

Block copolymer self-assembly: Melt and solution by molecular density functional theory.

The self-assembly of block copolymer melts and solutions with two-dimensional density inhomogeneity is studied using modified inhomogeneous statistical associating fluid theory (iSAFT). A real-space combinatorial screening method under density functional theory formalism is proposed and used to map out the phase diagram of block copolymer melts including order-disorder transitions and order-order transitions. The predicted phase diagram agrees well with molecular dynamics simulation and self-consistent field theory. The compressibility effect on order-disorder transition temperature for block copolymer melts is modeled using iSAFT. The pressure induced temperature change by theory has a similar trend to experimental studies. Then, the lyotropic and thermotropic self-assembly phase behavior of block copolymer solutions is investigated. Detailed density distributions by iSAFT provide insight into the lyotropic properties of the block copolymer solutions at the molecular level. The effect of the block copolymer molecular architecture is studied by comparing block copolymers with different molecular packing parameters. Block copolymer solutions in the inverted hexagonal phase are predicted by theory for the block copolymer having a large molecular packing parameter. Finally, solvent selectivity is studied by modeling the block copolymers in a neutral good solvent. The enhanced local solvent concentration predicted by theory explains the reason for fewer ordered phases found in experiments.

Self-assembly and phase behavior of mixed patchy colloids with any bonding site geometry: theory and simulation.

Patchy colloids and associating fluids have attracted continued interest due to the interesting phase behavior and self-assembly in solution. The ability to fabricate patchy colloids with multiple attractive surface patches of different number, size, shape, and relative location makes patchy colloids a good candidate as building blocks to form complex advanced materials. However, a theory that clearly relates the self-assembled structures that form based on the anisotropic interactions has been missing. Although Wertheim's theory in the form of the SAFT model is widely used to predict self-assembly and phase behavior in solution, SAFT does not include multibody correlations necessary to model any shape of association site or sites that can form multiple bonds. We have recently developed a new theory for associating colloids that naturally incorporates multibody correlations based on a cluster distribution approach due to Bansal, Asthagiri, Marshall, and Chapman (BAMC). In this paper, we extended the cluster distribution theory to predict the thermodynamic properties and phase behavior of binary systems consisting of anisotropic particles with any geometry of bonding site. In particular, we consider self-assembly of Janus particles, Saturn particles, and ternary particles mixed with solvent colloids that have two directional patchy sites. Good agreement between theoretical predictions and molecular simulation is shown for self-assembly, thermodynamic properties in this system. Re-entrant phase behavior has been investigated and low density gels is predicted.

Competitive Sorption of CO2 with Gas Mixtures in Nanoporous Shale for Enhanced Gas Recovery from Density Functional Theory.

CO2 competitive sorption with shale gas under various conditions from simple to complex pore characteristics is studied using a molecular density functional theory (DFT) that reduces to perturbed chain-statistical associating fluid theory in the bulk fluid region. The DFT model is first verified by grand canonical Monte Carlo simulation in graphite slit pores for pure and binary component systems at different temperatures, pressures, pore sizes, and bulk gas compositions for methane/ethane with CO2. Then, the model is utilized in multicomponent systems that include CH4, C2H6, and C3+ components of different compositions. It is shown that the selectivity of CO2 decreases with increases in temperature, pressure, nanopore size, and average molecular weight of shale gas. Extending the model to more realistic situations, we consider the impact of water present in the pore and consider the effect of permeation of fluid molecules into the kerogen that forms the pore walls. The water-graphite interaction is calibrated with contact angle from molecular simulation data from the literature. The kerogen pore model prediction of gas absolute sorption is compared with experimental and molecular simulation values in the literature. It is shown that the presence of water reduces the CO2 adsorption but improves the CO2 selectivity. The dissolution of gases into the kerogen matrix also leads to the increase in CO2 selectivity. The effect of kerogen type and maturity on the gas sorption amount and CO2 selectivity is also studied. The associated mechanisms are discussed to provide fundamental understanding for gas recovery by CO2.

Thermodynamics, Microstructures, and Solubilization of Block Copolymer Micelles by Density Functional Theory.

Block copolymer micelle is one of the most versatile self-assembled structures with applications in drug delivery, cosmetic products, and micellar-enhanced ultrafiltration. The key to design an effective block copolymer to form micelles is to understand how molecular architecture affects critical micelle concentrations, micellar dimensions, and partitioning of solute into the micelle. In this work, we studied micelles from nonionic block copolymers using interfacial statistical associating fluid theory a density functional theory, which explicitly includes block copolymer-water hydrogen bonding and water-water hydrogen bonding. We are able to predict and explain how micellar thermodynamic properties depend on polymer chain architecture. Dimension and aggregation of micelles are investigated for block copolymers with different hyrophobes and hydrophiles. The effects of temperature and pressure on micelle stability are also captured by the theory. The enhanced solubility of hydrophobic substance in water by micelle loading is demonstrated, and predicted solute distribution answers the question about the locus of benzene in micelles from a theoretical perspective.

Adsorption and Phase Behavior of Pure/Mixed Alkanes in Nanoslit Graphite Pores: An iSAFT Application.

The prediction of fluid phase behavior in nanoscale pores is critical for shale gas/oil development. In this work, we use a molecular density functional theory (DFT) to study the effect of molecular size and shape on partitioning to graphite nanopores as a model of shale. Here, interfacial statistical associating fluid theory (iSAFT) is applied to model alkane (C1 - C8) adsorption/desorption/phase behavior in graphite slit pores for both pure fluids and mixtures. The pure component parameters were fit to the bulk saturated liquid density and vapor pressure data in selected temperature ranges. The potential of interaction between the fluid and graphite is modeled with a Steele 10-4-3 potential that is fit to the potential of mean force from single-molecule simulations. Good agreement is found between theory and molecular simulation for the density distributions of pure components in slit pores. The critical properties of methane, ethane, and their mixtures as well as the shift in bubble point and dew point densities were studied, showing good agreement with simulation. The competitive adsorption of mixtures of normal and branched alkanes in graphite pores was also studied. Heavier components more strongly adsorb up to the point that the entropic penalty due to confinement reduces adsorption.

Modeling micelle formation and interfacial properties with iSAFT classical density functional theory.

Surfactants reduce the interfacial tension between phases, making them an important additive in a number of industrial and commercial applications from enhanced oil recovery to personal care products (e.g., shampoo and detergents). To help obtain a better understanding of the dependence of surfactantproperties on molecular structure, a classical density functional theory, also known as interfacial statistical associating fluid theory, has been applied to study the effects of surfactant architecture on micelle formation and interfacial properties for model nonionic surfactant/water/oil systems. In this approach, hydrogen bonding is explicitly included. To minimize the free energy, the system minimizes interactions between hydrophobic components and hydrophilic components with water molecules hydrating the surfactant head group. The theory predicts micellar structure, effects of surfactant architecture on critical micelle concentration, aggregation number, and interfacial tension isotherm of surfactant/water systems in qualitative agreement with experimental data. Furthermore, this model is applied to study swollen micelles and reverse swollen micelles that are necessary to understand the formation of a middle-phase microemulsion.

Development and Validation of the Production Process of Parecoxib Sodium Freeze-dried Preparation Based on Quality by Design / 中国药学杂志

OBJECTIVE: To prepare parecoxib sodium freeze-dried preparation, evaluate and validate the feasibility of the production process and quality reliability of the preparation. METHODS: Risk assessment of the production process of parecoxib sodium freeze-dried preparation was performed based on the method of quality by design (QbD).The key steps and key process parameters were identified.The critical quality attributes (CQAs)of the intermediates and final product were clarified, the validation protocol and acceptable standard were accordingly developed, and the production process was validated. RESULTS: The production process of parecoxib sodium freeze-dried preparation met the GMP requirements, and the intermediate and final products met the quality standards. CONCLUSION: The established production process of parecoxib sodium freeze-dried preparation is feasible and the product quality is controllable.

Independent and combined effects of environmental factors and CYP2C19 polymorphisms on the risk of esophageal squamous cell carcinoma in Fujian Province of China.

BACKGROUND: The purpose of this study was to explore the effects of CYP2C19 gene polymorphisms and various environmental factors and their interactions on the risk of esophageal squamous cell carcinoma (ESCC) in a Chinese Han population. METHODS: A 1:2 frequency-matched case control study of 285 patients and 570 controls was conducted from June 2010 to May 2011 in AnXi of Fujian province, China. Environmental factors were investigated using a self-administered questionnaire and genotypes were determined using polymerase chain reaction restriction fragment length polymorphism based methods. Unconditional logistic regression models were used for statistical evaluation. RESULTS: Current or former smoking, consumption of pickled vegetables or hot beverages/food, having a first degree relative with ESCC and history of reflux esophagitis were significantly associated with increased ESCC risk, whereas tea drinking and consumption of fresh vegetables and fruits were significantly associated with decreased risk. The CYP2C19*2 GA/AA genotype was significantly more prevalent in ESCC patients and individuals with at least one copy of the CYP2C19*2 A allele had a 3.19-fold increased risk (adjusted 95% confidence interval (CI): 2.21-4.61, P < 0.001) of ESCC compared with those without this allele. We found no significant associations between CYP2C19*3 genotypes and ESCC. The Cyp2C19*2 polymorphism appeared to have a multiplicative joint effect with tea drinking and hot beverage/food consumption (gene-tea drinking: P(interaction) = 0.042; hot beverage/food consumption: P(interaction) = 6.98 × 10(-6)) and an additive joint effect with pickled vegetable consumption (interaction contrast ratio = 1.96, 95% CI: 0.12-3.80). CONCLUSIONS: Our findings suggest that the CYP2C19*2 polymorphism plays an important role in the development of ESCC in the Chinese population, modified by tea drinking and consumption of pickled vegetables or hot beverages/food. Further studies are warranted to confirm our results.

NQO1 609C>T polymorphism interaction with tobacco smoking and alcohol drinking increases colorectal cancer risk in a Chinese population.

BACKGROUND: NAD (P)H:quinone oxidoreductase (NQO1) catalyzes the activation of some environmental procarcinogens present in tobacco smoke or the diet. We conducted a hospital-based case-control study to evaluate the potential association between NQO1 609C>T polymorphisms and colorectal cancer risk in a Chinese population. METHODS: The study population comprised 672 histologically confirmed colorectal cancer patients and 672 frequency-matched control subjects without cancer or systemic illness. We used PCR restriction fragment length polymorphism-based methods for genotyping analyses and unconditional logistic regression model for statistical evaluations. RESULTS: The risk of colorectal cancer increased with the level of smoking and decreased with the consumption of tea, fresh fruits, and vegetables. In addition, we found that the NQO1 609 CT and TT genotypes were associated with an increased risk of colorectal cancer (CT: adjusted OR=2.02, 95% CI=1.55-2.57; TT: adjusted OR=2.51, 95% CI=1.82-3.47), compared with the CC genotype. Moreover, NQO1 609C>T appeared to have a multiplicative joint effect with both tobacco smoking and alcoholic drinking (P for multiplicative interactions were 0.0001 and 0.013, respectively) on colorectal cancer risk. CONCLUSION: Our findings suggest that the NQO1 609C>T polymorphism plays an important role in the development of colorectal cancer in the Chinese population, which is strengthened by alcohol drinking or tobacco smoking.

[Effects of magnesium valproate on endocrine system and reproductive functions of female epileptics].

OBJECTIVE: To explore the effects of valproate (VPA) on endocrine system in adolescent and reproductive female patients with epilepsy. METHODS: A total of 30 adolescent and reproductive female patients with a diagnosis of epilepsy at our hospital during July 2009 to March 2010 were recruited. All cases with magnesium VPA alone were included. The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), progesterone (P) and testosterone (T) were detected respectively at pre-therapy and 3, 6 and 12 months post-therapy. And the changes of menstruation and ovaries were recorded. RESULTS: The serum concentration of PRL was lower at 3 and 6 months post-therapy than that at pre-therapy. There was significant difference (P = 0.010 and 0.014). The serum concentration of E2 significantly decreased after a 3-month therapy of valproate (P < 0.05). While comparing the parameter's level between the initial test and at a 3, 6 and 12-month follow-up, the level of P significantly decreased in the later groups than that of the former one while the level of T showed a marked increase. The levels of FSH and LH were not significantly different at pre- and post-therapy. And 6 (20%) of them presented with menstrual dysfunctions and 3 (10%) polycystic ovary. CONCLUSION: The valproate therapy can not only cause the changes of endocrine system and hormonal levels, but also induce such endocrine dysfunction syndromes as menstrual suspension and polycystic ovary. It eventually causes polycystic ovary syndrome.

[Relationship between genetic polymorphism of ERCC1 and susceptibility to liver cancer].

OBJECTIVE: To investigate the association between genetic polymorphisms of ERCC1-C8092A and susceptibility to liver cancer, as well as the gene-environmental interaction on the etiology of liver cancer in Fuzhou. METHODS: A case-control study was conducted to collect the information on environmental exposure while genetic polymorphism of ERCC1 was analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. General relative risk regression models were further applied to fit the interaction between genetic polymorphisms of ERCC1-C8092A and the environmental factors of liver cancer. RESULTS: ERCC1-C8092A variant genotypes were associated with significant increasing risk of liver cancer adjusted odds ratio (OR = 3.789, 95%CI: 2.792 - 5.142), compared to the wild-type homozygote. Data from the analysis of interaction showed that genetic polymorphism of ERCC1-8092A appeared super-additive interaction with drinking pond-ditch or with hepatitis B, and super-multiplicative interaction with eating moldy food. CONCLUSION: The point mutation in ERCC1-8092A was possibly susceptible to liver cancer, and related synergistically with other risk factors in hepatocelluar carcinogenesis in Fuzhou.

[A histopathological study on Influenza A H1N1 infection in humans].

OBJECTIVE: To find histopathological changes on major organs of Influenza A H1N1-infected patients and its relationship to clinical symptoms. METHODS: The autopsies were performed following conventional protocols and strict safety procedures. Tissue samples from all major organs of three cases were collected and fixed in 4% formalin. The histopathological changes on these samples were observed under a light microscope. RESULTS: The lungs of some damaged areas of three cases showed diffuse alveolar damage (DAD) with hyaline membranes formation and intra-alveolar edema and/or fibrin. Most areas of the lungs in the three cases showed necrotizing bronchiolitis, hemorrhage, secondary infection, thrombosis and focal alveolar necrosis. The lungs exhibited proliferation of pneumocytes and fibrosis of the interstitium in one case. In one case, the brain showed focal hemorrhage and focal liquefactive necrosis. In one case, the heart showed edema. CONCLUSION: The respiratory tract is the major target of influenza A H1N1 virus. The changes of DAD with secondary infection in the lung resulted in hypoxia, leading to multiple organ failure and death.

Relationship between genetic polymorphism of ERCC1 and susceptibility to liver cancer / 中华流行病学杂志

Objective To investigate the association between genetic polymorphisms of ERCCl-C8092A and susceptibility to liver cancer, as well as the gene-environmental interaction on the etiology of liver cancer in Fuzhou. Methods A case-control study was conducted to collect the information on environmental exposure while genetic polymorphism of ERCC1 was analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. General relative risk regression models were further applied to fit the interaction between genetic polymorphisms of ERCC1-C8092A and the environmental factors of liver cancer. Results ERCC1-C8092A variant genotypes were associated with significant increasing risk of liver cancer adjusted odds ratio (OR= 3.789,95%CI:2.792-5.142 ), compared to the wild-type homozygote. Data from the analysis of interaction showed that genetic polymorphism of ERCC1-8092A appeared superadditive interaction with drinking pond-ditch or with hepatitis B, and super-multiplicative interaction with eating moldy food. Conclusion The point mutation in ERCC1-8092A was possibly susceptible to liver cancer, and related synergistically with other risk factors in hepatocelluar carcinogenesis in Fuzhou.

[High-risk factors and clinical pathological analysis in 21 cases of fatal pulmonary embolism].

OBJECTIVE: To explore the clinical and pathological characteristics of fatal pulmonary thromboembolism, especially the contribution of acquired and genetic risk factors of fatal pulmonary thromboembolism, so as to provide some useful information for its clinical prevention and treatment. METHODS: The medical dispute autopsy cases performed at the Department of Pathology, School of Basic Medical Sciences, Peking University from January 1, 2002 to September 30, 2008 were retrospectively reviewed. FV ( factor V ) Leiden mutation and FII ( factor II) G20210A mutation were analyzed by using methods of PCR and restriction fragment length polymorphism (RFLP) in fatal pulmonary embolism cases and random selected control cases of adult autopsy. RESULTS: There were 21 patients who died from fatal pulmonary thromboembolism, accounting for 12.96% (21/162) of adult autopsy cases. In these cases, there was at least one of the known risk factors in each case and more than two risk factors could be found in most cases. The acquired risk factors, such as surgery, trauma and fractures, cancer, pregnancy and puerperium, the elderly, hypertension, diabetes, infections, could be found in these patients. FV Leiden mutation and FII G20210A mutation were not detected in any of the 21 cases of fatal pulmonary thromboembolism cases and six control cases. Of all the 21 cases, quantitative D-dimer measurement was performed only in six patients and D-dime level in these six samples was all significantly increased. According to the records, there was only 1 patient treated by preventive anticoagulants in the 21 patients. CONCLUSION: Fatal pulmonary thromboembolism is an important reason for medical dispute. Fractures and trauma, surgery and other acquired factors are the main reasons for fatal pulmonary embolism in Chinese. Genetic factors (FV Leiden and FII G20210A mutations) are not the reason for Chinese to suffer from fatal pulmonary thromboembolism. Assessment of risk factors (especially traumatic fractures and surgical intervention) of pulmonary thromboembolism may play an important role in taking appropriate preventive procedures, early diagnosis and reasonable treatment to reduce its mortality.

[Molecular confirmation of enterovirus type 71 infection: a post-mortem study of two cases].

OBJECTIVE: To investigate the diagnostic application of molecular detection of enterovirus type 71 (EV71) infection using post-mortem paraffin-embedded tissue. METHODS: Two autopsy cases of EV71 infection were studied by histopathological and immunohistochemical methods. Reverse transcription polymerase chain reaction (RT-PCR) was performed to detect the viral RNA in paraffin-embedded tissue samples. RESULTS: Characteristic features of acute encephalitis were seen in the brain, with most prominent lesions found in the brain stem in both cases. Inflammatory cells were largely CD68-positive microglia with a few CD15-positive neutrophils in the areas of neuronal necrosis. The 5'-untranslated region of EV71 was detected in the medulla by RT-PCR using paraffin-embedded tissues of both cases. Sequencing analysis of the RT-PCR products showed 100% homology to the EV71 strain, recently submitted to the GenBank database from Fuyang, Anhui province. CONCLUSIONS: Molecular detection of EV71 can be performed on formalin-fixed, paraffin-embedded tissue samples from fatally infected patients. Timely and accurate diagnosis of the infection by such molecular approach is crucial for the proper clinical and public health intervention.

[Pathology of enterovirus 71 infection: an autopsy study of 5 cases].

OBJECTIVE: To study the clinicopathologic features of fatal enterovirus 71 (EV71) infection. METHODS: Autopsy was performed in 5 neonates died of EV71 infection. Tissue samples from major organs were collected, formalin-fixed and examined under light microscopy. Immunohistochemical study was carried out in selected examples. RESULTS: Four of the 5 cases showed predominant changes in central nervous system, with encephalitis and encephalomyelitis identified mainly in brainstem and upper cervical spinal cord. Histologic findings included neuronal degeneration and necrosis, neuronophagia, perivascular cuffing and diffuse or nodular hyperplasia of macrophages/microglia. Cerebral edema, brain herniation and aseptic meningitis were also noted. The lungs showed mainly pulmonary congestion, neurogenic pulmonary edema and focal hemorrhage. There were minimal changes in the intestinal epithelium. The intestinal lymphoid tissue however was hyperplastic and associated with apoptosis of follicular center cells. The remaining case had cerebral edema and mild meningitis. The lung alveolar septa were thickened with lymphocytic infiltrates. Some alveolar cells were hyperplastic and associated with diffuse hyaline membrane formation. No specific abnormalities were identified in gastrointestinal tract. In all the 5 cases studied, there was enlargement of lung hilar and mesenteric lymph nodes, coupled with apoptosis of follicular center cells. In general, no significant pathologic changes were demonstrated in heart, liver and kidneys. CONCLUSIONS: In fatal EV71 infection, the major pathologic changes lie in the central nervous system. The pulmonary lesions are mainly secondary in nature. The usual cause of death is cerebral edema complicated by brain herniation and pulmonary edema. It is also noteworthy that some cases show only lung damages, without classic neurologic changes.

Pathology of enterovirus 71 infection: an autopsy study of 5 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of fatal enterovirus 71 (EV71) infection.</p><p><b>METHODS</b>Autopsy was performed in 5 neonates died of EV71 infection. Tissue samples from major organs were collected, formalin-fixed and examined under light microscopy. Immunohistochemical study was carried out in selected examples.</p><p><b>RESULTS</b>Four of the 5 cases showed predominant changes in central nervous system, with encephalitis and encephalomyelitis identified mainly in brainstem and upper cervical spinal cord. Histologic findings included neuronal degeneration and necrosis, neuronophagia, perivascular cuffing and diffuse or nodular hyperplasia of macrophages/microglia. Cerebral edema, brain herniation and aseptic meningitis were also noted. The lungs showed mainly pulmonary congestion, neurogenic pulmonary edema and focal hemorrhage. There were minimal changes in the intestinal epithelium. The intestinal lymphoid tissue however was hyperplastic and associated with apoptosis of follicular center cells. The remaining case had cerebral edema and mild meningitis. The lung alveolar septa were thickened with lymphocytic infiltrates. Some alveolar cells were hyperplastic and associated with diffuse hyaline membrane formation. No specific abnormalities were identified in gastrointestinal tract. In all the 5 cases studied, there was enlargement of lung hilar and mesenteric lymph nodes, coupled with apoptosis of follicular center cells. In general, no significant pathologic changes were demonstrated in heart, liver and kidneys.</p><p><b>CONCLUSIONS</b>In fatal EV71 infection, the major pathologic changes lie in the central nervous system. The pulmonary lesions are mainly secondary in nature. The usual cause of death is cerebral edema complicated by brain herniation and pulmonary edema. It is also noteworthy that some cases show only lung damages, without classic neurologic changes.</p>

Molecular confirmation of enterovirus type 71 infection: a post-mortem study of two cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic application of molecular detection of enterovirus type 71 (EV71) infection using post-mortem paraffin-embedded tissue.</p><p><b>METHODS</b>Two autopsy cases of EV71 infection were studied by histopathological and immunohistochemical methods. Reverse transcription polymerase chain reaction (RT-PCR) was performed to detect the viral RNA in paraffin-embedded tissue samples.</p><p><b>RESULTS</b>Characteristic features of acute encephalitis were seen in the brain, with most prominent lesions found in the brain stem in both cases. Inflammatory cells were largely CD68-positive microglia with a few CD15-positive neutrophils in the areas of neuronal necrosis. The 5'-untranslated region of EV71 was detected in the medulla by RT-PCR using paraffin-embedded tissues of both cases. Sequencing analysis of the RT-PCR products showed 100% homology to the EV71 strain, recently submitted to the GenBank database from Fuyang, Anhui province.</p><p><b>CONCLUSIONS</b>Molecular detection of EV71 can be performed on formalin-fixed, paraffin-embedded tissue samples from fatally infected patients. Timely and accurate diagnosis of the infection by such molecular approach is crucial for the proper clinical and public health intervention.</p>

[Clinical analysis of families with generalized epilepsy with febrile seizures plus].

OBJECTIVE: To investigate the clinical phenotypes and hereditary patterns of the generalized epilepsy with febrile seizures plus (GEFS+). METHODS: Detailed family trees were constructed by inquire and physical examinations for the probands of the 15 pedigrees of GEFS+. Some patients received electroencephalography, cranial CT or MRI examination. The seizures and epilepsy syndromes were classified according to the 2001 Seizure International Classification. The clinical data of GEFS+ were reviewed. RESULTS: The 15 families consisted of 196 individuals. Seventy-five individuals were confirmed with epilepsy. The phenotypes of 64 out of the 75 patients with epilepsy conformed to GEFS+. The 64 patients included 38 males and 26 females (1 deceased) and there was no gender difference in the morbility of GEFS+. The age at onset was all in childhood. GEFS+ had a diversity of phenotypes. Febrile seizures (FS) were confirmed in 44 patients, FS and myoclonic seizure in 1, febrile seizures plus (FS+) in 13, FS+ and absence seizure in 2, FS+ and myoclonic seizure in 1, and FS+ and focal seizure in 3. CONCLUSIONS: The heterogeneity of phenotypes and genetics may be the hallmarks of GEFS+. FS and FS+ are common phenotypes while FS+ and absence seizure, FS+ and myoclonic seizure, and FS+ and focal seizure are rare. If one of the parents is affected in a GEFS+ family, the susceptibility of their children to GEFS+ is the same no matter what gender of their children is. It is speculated that the hereditary pattern of GEFS+ conforms to autosomal dominant inheritance.