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AIM: To evaluate the macular microcirculation changes in patients with diabetic retinopathy(DR)by optical coherence tomography angiography(OCTA), and correlate the risk factors that may affect the macular microcirculation, so as to provide a clinical basis for early screening, diagnosis and therapeutic intervention for DR.METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1~3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all P<0.017), and the VD of the parafoveal was decreased in each quadrant(P<0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(P<0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(P<0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(P<0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(P<0.05), while total cholesterol and central macular thickness had no significant correlation with VD(P>0.05).CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.
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AIM: To gather baseline data on visual acuity by screening students from different stages in the same administrative district of Xi'an, as well as to analyze and investigate disparities in myopia rates among students from different stages in this area.METHODS: A total of 13 707 students from 21 elementary schools, 3 middle schools, 3 general high schools and 1 vocational high school were randomly selected for uncorrected distance visual acuity and computerized refraction testing in 28 schools with a random sampling approach.RESULTS: The detection rate of myopia in elementary, middle, high and vocational high schools in the same region of Xi'an were 32.27%, 72.07%, 81.22% and 65.12%, respectively; The total myopia rate of students was 47.81%; The myopia rate of girls was higher than that of boys in all grades; The myopia rates of elementary and middle schools increased with the growth of grades; The percentage of high myopia increased from 2.40% in elementary schools to 16.51% in high schools with the growth of grades.CONCLUSION: The myopia rate in different stages of the same region is different, and it tends to rise with the gronth of grades; Girls have a higher myopia rate than boys; Compared to the results of the national survey on myopia in different grades of children and adolescents in 2018, the myopia rate in the same region has decreased significantly in 2021 of the elementary school level, although myopia rate of middle school and high school stage do not rise, the decline is not obvious.
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Objective:According to the GB/T 15000.3-2008, to develop a fucosterol certified reference material based on the project approved by Standardization Administration. Method:Fucosterol was isolated from <italic>Laminaria japonica</italic> dried thallus via 95% ethanol extraction, vacuum concentration, repeated column chromatography separation, recrystallization in petroleum ether-ethyl acetate, and residual solvent removal. Its chemical structure was identified by elemental analysis (EA), infrared spectrum (IR), mass spectrometry (MS), nuclear magnetic resonance (NMR) and X-ray diffraction (XRD). Its homogeneity, stability, and cooperative certification conducted by 8 laboratories were carried out by high performance liquid chromatography with evaporative light scattering detector. Result:For the fucosterol reference material, the certified value of purity was 99.54% with expanded uncertainty of 0.16% in confidence interval of 95%, the stability was good within 24 months storage period at 2-4 ℃, which met the technical requirements of reference material and passed the acceptance organized by Standardization Administration. Conclusion:The national standard materials of fucosterol has been successfully developed, which can be used for the determination of this component, the evaluation of detection methods, and the detection and quality control of related products.
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Objective:To evaluate the efficacy of Paishi decoction in ureteral calculi treatment. Methods:Ureteral calculi patients were voluntarily divided into two groups in Shanghai Baoshan Traditional Chinese Medicine-Integrated Hospital. Patients in the control group received anti-inflammatory symptomatic treatment for 2 weeks, and patients in the treatment group received anti-inflammatory symptomatic treatment combined with Paishi decoction for 2 weeks. Results:There was no significant difference between the two groups in gender, age, body weight and stone size. Compared with the control group, after taking Paishi decoction for 2 weeks, the urinary oxalic acid and calcium in the treatment group decreased significantly, and the urine citric acid increased (P<0.05). The difference in clinical effective rate was significant between the two groups (P<0.05). Conclusion:Paishi decoction is superior to single anti-inflammatory symptomatic treatment in the treatment of ureteral calculi, which reflects the advantages of integrated traditional Chinese and Western medicine. However, the number of patients included in this study was limited, further studies are in need to verify the result.
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The aim of this paper was to study the effect and mechanism of fucoxanthin on insulin resistance of obese mice induced by high-fat diet. Fifty C57 BL/6 J male mice were randomly divided into control group and high-fat diet group. The insulin resistance model was induced with high-fat diet for 12 weeks, and model mice were randomly divided into model group, fucoxanthin-0.2% group, fucoxanthin-0.4% group and metformin group. After dietary treatment for 6 weeks, the body weight and epididymal fat weight in each group were measured. Fasting blood glucose(FBG), fasting insulin(FINS), total cholesterol(TC), triglyceride(TG), low-density lipoprotein(LDL-C) and high-density lipoprotein(HDL-C) were measured, and insulin resistance index(HOMA-IR) was calcula-ted. The pathological morphology in liver was observed by hematoxylin eosin staining, and the expressions of some key proteins in insulin receptor substrate 1(IRS-1)/posphoinositide 3-kinase(PI3 K)/serine-threonine kinase(Akt) and peroxisome proliferators-activated receptor-γ(PPARγ)/sterol regulatory element binding protein-1(SREBP-1)/fatty acid synthetase(FAS) pathways in liver were detected by Western blot. According to the findings, compared with the model group, levels of body weight, epididymal fat weight, FBG, FINS, TC, TG, LDL-C and HOMA-IR, as well as protein expressions of PPARγ, SREBP-1 and FAS in liver were significantly reduced(P<0.05 or P<0.01), while level of HDL-C and protein expressions of p-IRS-1, IRS-1, PI3 K and p-Akt in liver were signi-ficantly increased after treatment with fucoxanthin(P<0.05 or P<0.01). And the pathological changes of liver tissue in fucoxanthin-treated mice were also improved obviously. The results showed that fucoxanthin could improve obesity, hyperglycemia and hyperlipidemia, and alleviate insulin resistance in obese mice, and its mechanism is possibly related to the regulation of IRS-1/PI3 K/Akt and PPARγ/SREBP-1/FAS pathways.
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Animais , Masculino , Camundongos , Dieta Hiperlipídica/efeitos adversos , Insulina , Resistência à Insulina , Fígado , Camundongos Obesos , XantofilasRESUMO
@#Objective:To observe the interactive effects of early exercise and γ-aminobutyric acid (GABA) receptor antagonists on the neurologic function and brain-derived neurotrophic factor (BDNF) expression in the cerebral ischemia-reperfusion (I/R) rat model. Methods:Male Sprague-Dawley rats were divided into sham (<italic>n</italic> = 10), I/R (<italic>n</italic> = 10), exercise (EX) (<italic>n</italic> = 10), pentetrazol (PTZ) (<italic>n</italic> = 10) and pentetrazol plus exercise (PTZEX) (<italic>n</italic> = 10) groups. All the rats, except the sham group, accepted middle cerebral artery occlusion (MCAO) for one hour and reperfused. Since two days after reperfusion, PTZ and PTZEX groups accepted PTZ, a GABA receptor antagonist, 0.25 mg/kg peritoneal injection, once a day for five days; while EX and PTZEX groups ran on a treadmill, 30 minutes a day for five days. Seven days after reperfusion, all the rats were assessed with neurobehavioral score, the infarct volumes were assessed with TTC, and BDNF expression in ischemic penumbra was detected with reverse transcription polymerase chain reaction and ELISA. Results:Compared with I/R group, the neurobehavioral scores of EX group, PTZ group and PTZEX group improved, the volumes of cerebral infarction reduced (<italic>P </italic>< 0.05), and PTZEX group was the best (<italic>P </italic>< 0.05). The expression of BNDF was the most in PTZEX group (<italic>P </italic>< 0.05). Conclusion:Early exerxise combined with PTZ could promote the recovery of neurologic function in I/R rats, which may be related to the up-regulation of BDNF.
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<p><b>Background:</b>Quantifying syphilis prevalence is important for planning interventions and advocating for resources on syphilis. However, data on large sample studies regarding the prevalence of syphilis among reproductive-age women in rural China were not available for analysis. The aim of the study was to determine the prevalence, epidemiological characteristics, and related factors of syphilis infection among reproductive-age women in rural China.</p><p><b>Methods:</b>Data were obtained from a nationwide, population-based, cross-sectional study under the National Free Preconception Health Examination Project which covered all the 31 provinces in Mainland China. Women intending to get pregnant within the next 6 months were enrolled between January 1, 2010, and December 31, 2012. Sociodemographic, gynecological and obstetric characteristics, and other relevant information were obtained through face-to-face interviews. Treponema pallidum particle agglutination assay test was used to detect positive samples of syphilis. Univariate and multivariate logistic regressions were performed to assess the associations between syphilis seropositivity and related factors.</p><p><b>Results:</b>The overall seroprevalence of syphilis (SPS) among the 2,044,126 women who received syphilis screening test during 2010-2012 was 0.37% (95% confidence interval [CI]: 0.36-0.37%). The SPS appeared 0.24% (95% CI: 0.23-0.26%) and 0.66% (95% CI: 0.59-0.72%) in women at 21-24 and 40-44 years of age, respectively, showing an increase of SPS, parallel with age, and the difference was significant. SPS was significantly higher in ethnic minorities than that in Han nationality (0.58% vs. 0.35%, respectively, odds ratio [OR] = 1.41, 95% CI: 1.30-1.53) and higher in workers than that in farmers (0.45% vs. 0.36%, respectively, OR = 1.27, 95% CI: 1.14-1.41). Women with primary school or below level had a higher SPS as compared to those with college or above educational level (0.61% vs. 0.32%, respectively, OR = 2.49, 95% CI: 2.14-2.89), and the increase reversely correlated with the levels of education. Women whose spouses were syphilis seropositive had significant greater risk (OR = 48.26, 95% CI: 44.38-52.48) as compared those whose spouses were seronegative. Women who reported having had a history of sexually transmitted infections were more likely to be tested positive for serological syphilis (OR = 27.17, 95% CI: 20.44-36.11) as compared to those without.</p><p><b>Conclusions:</b>High SPS is seen among reproductive-age women in rural China that calls for targeted interventions on syphilis prevention and control in this target population, with emphasis on those who are 35 years of age and above, less educated, being minor ethnicity, workers, and living in the western regions of China.</p>
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Objective To compare the efficacy and safety of diode laser enucleation of prostate(DiLEP) and transurethral resection of prostate(TURP) in the treatment of large-volume benign prostatic hyperplasia(BPH).Methods A total of 80 cases of large-volume BPH patients who were treated in Shanghai Baoshan Traditional Chinese Medcine-integrated Hospital from January, 2014 to December, 2016 were selected.These patients were divided into two groups who were treated by DiLEP and TURP, respectively.The operation time, postoperative hemoglobin slippage, removed tissue weight, postoperative serum sodium slippage, postoperative complications, International Prostate Symptom Score (IPSS) before and after surgery, residual urine volume (PVR) and the maximum urinary flow-rate (Qmax),etc.of the two groups were compared.Results In the postoperative follow-up during 6 months after surgery, the IPSS before and after surgery, Qmax and Quality of Life (QOL) scores of the two groups showed no significant difference.The postoperative hemoglobin slippage, postoperative serum sodium slippage, vesical infusion time, urinary canal indwelling time and length of stay of the DiLEP group were all below those of the TURP group.The operation time: (120.5±25.2)min vs(95±21.2)min;the quality of exercised tissues: (68.5±16.2)g vs (65.2±18.5)g;the postoperative hemoglobin slippage: (0.89±0.42)g/dL vs (1.24±0.56)g/dL;the postoperative serum sodium slippage: (5.2±1.5)mmol/L vs (14.5±2.8)mmol/L;the vesical infusion time: (28.5±5.9)h vs (48.5±6.7)h;the urinary canal indwelling time: (2.6±1.8)d vs (4.8±2.2)d;the length of stay: (6.2±1.8)d vs (9.2±2.3)d of both the DiLEP group and the TURP group all showed significant differences(all P<0.05).The postoperative complications, such as postoperative hemorrhage, postoperative blood transfusion, reset urethral catheterization, irritation symptoms, retrograde ejaculation, urinary incontinence, urethral stricture, electroresection syndrome, etc.of the two groups had significant differences(P<0.05).Conclusion For the treatment of large-volume BPH, DiLEP as compared with TURP, has less hemorrhage risks, requires less time in terms of vesical infusion time, urinary canal indwelling time and length of stay, has less postoperative complications, thus having good therapeutic effect and safety.
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<p><b>OBJECTIVE</b>To observe the clinical efficacy and safety of pemetrexed or gemcitabine combined with carboplatin as the first-line therapy in elderly patients with advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Seventy patients aged 70 years or over with stage IIIb-IV NSCLC were equally and randomly divided into pemetrexed plus cisplatin group (PC) and gemcitabine plus carboplatin group (GC). Patients in the PC group received pemetrexed (PEM) 500 mg/m(2) on day 1, and carboplatin (CBP) AUC5 on day 1 for 21-day cycle. Patients in the GC group received gemcitabine 1000 mg/m(2) on days 1 and 8, CBP AUC5 on day 1 for a 21-day cycle.</p><p><b>RESULTS</b>In the PC and GC groups, CR 0 and 0, PR 10 and 8, response rates 28.6% and 22.9% were observed, respectively. There was no statistically significant difference between the two groups (χ(2) = 0.299, P = 0.584). The 1-year and 2-year survival rates of the PC and GC groups were 48.6% vs. 45.7% and 11.4% vs. 11.4%, respectively, with a median survival of 11.00 and 10.00 months, without a statistically significant difference between the two groups (χ(2) = 0.01, P = 0.919). Regarding toxicities, the incidences of neutropenia/thrombocytopenia, nausea and vomiting (grade III ∼ IV) in the GC group were significantly higher than those in the PC group (P < 0.05). According to the observer scale of lung cancer symptoms, the post-treatment scores improved in both the two groups, and with no significant difference between them (P > 0.05).</p><p><b>CONCLUSIONS</b>PC and GC show similar efficacy for elderly NSCLC patients, however, the toxicities in PC patients are lower than those in GC patients. Thus, pemetrexed combined with carboplatin is an effective chemotherapeutic regimen for advanced NSCLC in elderly patients.</p>
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Idoso , Feminino , Humanos , Masculino , Protocolos de Quimioterapia Combinada Antineoplásica , Usos Terapêuticos , Carboplatina , Carcinoma Pulmonar de Células não Pequenas , Tratamento Farmacológico , Patologia , Cisplatino , Desoxicitidina , Seguimentos , Glutamatos , Guanina , Neoplasias Pulmonares , Tratamento Farmacológico , Patologia , Náusea , Estadiamento de Neoplasias , Neutropenia , Pemetrexede , Qualidade de Vida , Taxa de Sobrevida , Trombocitopenia , VômitoRESUMO
This paper presents the design and implementation ways of a simplified device to identify and filter carbon dioxide. The gas went through the test interface which had wet litmus paper before entering the abdominal cavity. Carbon dioxide dissolving in water turned acidic, making litmus paper change color to identify carbon dioxide, in order to avoid malpractice by connecting the wrong gas when making Endoscopic surgery.
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Dióxido de Carbono , Endoscopia , Desenho de Equipamento , Segurança de Equipamentos , FiltraçãoRESUMO
<p><b>OBJECTIVE</b>To investigate the effect of cytoskeleton integrity on the expression of c-fos gene in osteoblasts induced by fluid shear stress.</p><p><b>METHODS</b>BALB/c mouse primary osteoblasts were divided into four groups (according to fluid shear stress loaded or not and cytochalasin D used or not). The Tagman probe real-time PCR and immunofluorescence were performed to detect the expression levels of c-fos mRNA, c-fos protein and cytoskeleton, respectively. The data were analysed using two-way ANOVA.</p><p><b>RESULTS</b>In control group and cytochalasin D group, fluid shear stress could significantly increase the expression levels of c-fos mRNA (0.1637 +/- 0.0303 and 0.0104 +/- 0.0070, respectively) and protein (177.14 +/- 9.37 and 150.95 +/- 6.17, respectively) in osteoblasts, compared with the unloaded osteoblasts of the control group and the cytochalasin D group (0.0057 +/- 0.0021 and 0.0032 +/- 0.0014, respectively for c-fos mRNA, and 117.96 +/- 4.11 and 119.77 +/- 5.19, respectively for protein, P < 0.05). Induced by the fluid shear stress, the expression levels of c-fos mRNA and protein in cytochalasin D group were lower than control group, and the difference had statistical significance (P < 0.05).</p><p><b>CONCLUSIONS</b>The cytoskeleton integrity in osteoblasts was essential to the expression of c-fos gene induced by fluid shear stress.</p>
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Animais , Camundongos , Análise de Variância , Células Cultivadas , Citocalasina D , Farmacologia , Citoesqueleto , Fisiologia , Camundongos Endogâmicos BALB C , Osteoblastos , Metabolismo , Proteínas Proto-Oncogênicas c-fos , Metabolismo , RNA Mensageiro , Metabolismo , Reologia , Estresse MecânicoRESUMO
<p><b>OBJECTIVE</b>To explore the effectiveness and prognosis on surgical treatment of posterior hip dislocations complicated with fractures of femoral head and acetabulum.</p><p><b>METHODS</b>Seventeen patients with posterior hip dislocations complicated with fractures of femoral head and acetabulum were reviewed in the study. All the patients were treated with manual reduction within 12 hours after injury. CT location was used before operation. Absorbable screw fixation was performed for the femoral head fractures, while plate fixation or resection was performed for acetabular fractures.</p><p><b>RESULTS</b>All the patients got bony union within 6 months after operation without femoral head necrosis. Evaluate joint function according to Modifie Daobigne and Postal clinical classification criteria, 8 patients got an excellent result, 7 good and 2 fair. The excellent and good rate was 88.2%.</p><p><b>CONCLUSION</b>Surgical treatment can have a satisfactory prognosis for patient with posterior femoral head and acetabulum.</p>
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Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acetábulo , Ferimentos e Lesões , Fraturas do Fêmur , Seguimentos , Luxação do Quadril , Cirurgia Geral , Terapêutica , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To study the clinical efficaly and safety of Tiepi Fengdou Granule (TFG) and Capsule (TFC) combined with chemotherapy and/or radiotherapy in treating lung cancer patients with Qi-Yin asthenia syndrome (QYAS).</p><p><b>METHODS</b>Eighty patients were randomly assigned into 3 groups: the TFG group (32 cases), the TFC group (32 cases) and the Shengmai Capsule control group (16 cases). Changes of symptoms of QYAS, main symptoms of lung cancer, Karnofsky scoring as well as the blood routine test were observed.</p><p><b>RESULTS</b>The total effective rate of symptom improving in the TFG group and the TFC group was 81.2% and 93.3% respectively, showing insignificant difference between the 2 groups (P > 0.05), but both were higher than that in the Shengmai Capsule control group (50.0%, P < 0.05 and P < 0.01). Additionally, as compared with those before treatment, the neutrophil count increased and the lymphocytes count obviously decreased in the TFC group after treatment (all P < 0.05).</p><p><b>CONCLUSION</b>Both dose-forms of the remedies, TFC and TFG, have significant effects in treating lung cancer with QYAS, but with insignificant difference between them.</p>
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica , Usos Terapêuticos , Terapia Combinada , Diagnóstico Diferencial , Medicamentos de Ervas Chinesas , Avaliação de Estado de Karnofsky , Neoplasias Pulmonares , Tratamento Farmacológico , Radioterapia , Medicina Tradicional Chinesa , Fitoterapia , Qi , Deficiência da Energia Yin , Tratamento FarmacológicoRESUMO
<p><b>OBJECTIVE</b>To evaluate the difference of efficacy, side-effects and quality of life in advanced non-small-cell lung cancer (NSCLC) patients treated with oxaliplatin plus vinorelbine or cisplatin plus vinorelbine.</p><p><b>METHODS</b>Eligible patients were randomly assigned to NL (oxaliplatin + vinorelbine) group and NP (cisplatin + vinorelbine) group in a 2:1 ratio. In the NL group, 70 evaluable cases were treated with oxaliplatin 130 mg/m(2) i.v. on day 2, and vinorelbine 25 mg/m(2) i.v. on days 1 and 8 in 21 days per cycle. In the NP group, 32 evaluable cases were treated with cisplatin 80 mg/m(2) i.v. divided to 2 - 3 days dosing, 21 days per cycle, and vinorelbine administered by the same way as in the NL group. The response rate, time to progression (TTP), one-year survival, side-effects and the quality of life were observed.</p><p><b>RESULTS</b>The response rate was 35.7% vs. 43.8% (P = 0.4), median TTP was 4.7 months vs. 5.5 months (P = 0.6), one-year survival rate was 38.5% vs. 58.6% (P = 0.07) in the NL and NP groups, respectively. Grade I-II neuro-sensory toxicity occurred significantly more frequent in NL group than in NP group (68.4% vs. 36.4%, P = 0.0017). However, Grade I-II granulocytopenia was significantly less occurred in NL group than in NP group (49.4% vs. 70.6%, P = 0.037). There was no statistically difference between the two groups regarding quality of life.</p><p><b>CONCLUSION</b>Due to good efficacy and tolerability, the NL regimen offered a new candidate for treating advanced NSCLC.</p>
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica , Usos Terapêuticos , Carcinoma Pulmonar de Células não Pequenas , Tratamento Farmacológico , Cisplatino , Esquema de Medicação , Neoplasias Pulmonares , Tratamento Farmacológico , Compostos Organoplatínicos , Qualidade de Vida , Resultado do Tratamento , VimblastinaRESUMO
<p><b>OBJECTIVE</b>To investigate clinical characteristics, EEG changes and therapeutic response of benign infantile epilepsy and to study the early diagnostic methods.</p><p><b>METHODS</b>Clinical observation and Video-EEG monitoring were carried out in babies with convulsions at 3 - 24 months of age. In these children, febrile convulsion, symptomatic epilepsies and developmental abnormalities were excluded, and the therapeutic effect and long-term outcome were followed up.</p><p><b>RESULTS</b>Forty-two babies were diagnosed to have benign infantile epilepsy by two-year follow-up. Three of them had familial history of benign infantile convulsions. Nineteen percent had mild diarrhea during the onset of convulsions, cluster seizures occurred during a short period in 67% of cases and no status epilepticus occurred. Video-EEG monitoring confirmed seizures originating from temporal, occipital or multifocal areas separately in 3 patients with partial seizures. Interictal EEG background was normal and there were Rolandic small spikes during sleep in 24% of patients. Thirty-nine patients were treated with single antiepileptic drugs and the mean treatment course was 9 months. Three cases did not take medicine. All the patients were seizure free within a year.</p><p><b>CONCLUSION</b>Benign infantile epilepsy should be considered when the following characteristics occur in early stage of the disease: (1) convulsions occurring between 3 to 12 month of age and not later than 24 months of age with or without familial history of benign infantile convulsion; (2) normal psychomotor development before and after convulsion occurs; (3) no evoked factors or only mild diarrhea; (4) majority of cases have partial seizures, or secondary generalized seizures. There are often cluster convulsions during the onset stage, but no status epilepticus; (5) normal EEG background and there may be Rolandic small spikes during sleep; (6) normal neuroimaging.</p>