Clinical features and underlying etiology of children with Lennox-Gastaut syndrome.

OBJECTIVE: Lennox-Gastaut Syndrome (LGS) is characterized by the presence of multiple seizure types and encompasses a heterogenous group of etiologies. The aim of our study was to evaluate the etiological profile of LGS and investigate seizure outcomes based on different clinical variables. METHODS: The clinical features, neuroimaging findings, genetic testing and other testing results of LGS patients were systematically reviewed. The identifiable etiology was categorized as either acquired or nonacquired. Univariate and multivariate regression analyses were performed to explore the association between clinical variables and seizure outcome at the last follow-up. RESULTS: We enrolled 156 patients diagnosed with LGS, of whom 66% were male. The mean age of patients was 34.2 months and the median follow-up duration was 29.5 months (interquartile range = 14-56.25 months). The initial seizure type was epileptic spasm in 61 patients, among which 33 of them met the criteria for infantile epileptic spasm syndrome. All patients underwent neuroimaging test, with 25% falling into the acquired structural category. Etiology could be identified in 84 individuals, including pathogenetic variants found in 34 out of 117 patients with nonacquired etiology. CHD2 mutations were most frequently observed among these pathogenetic variants. At the last follow-up, favorable outcomes were observed in 27 patients. The identification of etiology emerged as a significant determinant influencing LGS outcome; specifically, patients with unknown etiology had a higher likelihood of experiencing favorable outcomes compared to those with known cause (p = 0.041). Early onset age and longer epilepsy duration significantly increased the odds of an unfavorable outcome (p = 0.006 and 0.024). SIGNIFICANCE: We present novel data on the clinical and etiological spectrum of LGS, with determined etiology observed in over half of the patients. Epileptic spasms were found to be more prevalent than tonic seizures as seizure onset types in LGS. The presence of a known etiology, earlier age at onset, and longer duration of epilepsy were associated with a poorer long-term epileptological outcome.

Association between NQO1 C609T polymorphism and colorectal cancer risk.

NAD(P)H: quinone oxidoreductase 1 (NQO1) is a cytosolic enzyme, and the NQO1 C609T polymorphism is associated with the enzymatic activity of NQO1. Many studies were performed to assess the association between NQO1 C609T polymorphism and colorectal cancer risk, but no consensus was available up to now. We conducted a meta-analysis to examine the association between NQO1 C609T polymorphism and colorectal cancer risk, and the pooled odds ratios (OR) with their 95% confidence intervals (95% CI) were used to assess the association. Finally, 12 studies involving 4,026 cases and 4,855 controls were included into the meta-analysis. Overall, there was an obvious association between NQO1 C609T polymorphism and colorectal cancer risk (T versus C: OR = 1.28, 95% CI 1.08-1.51, P = 0.005; TT versus CC: OR = 1.60, 95% CI 1.10-2.33, P = 0.015; TT/CT versus CC: OR = 1.36, 95% CI 1.09-1.69, P = 0.006; TT versus CT/CC: OR = 1.37, 95% CI 1.05-1.80, P = 0.022). Subgroup analysis by ethnicity showed that the association was obvious in both Caucasians and Asians. Therefore, the meta-analysis provides strong evidence for the association between NQO1 C609T polymorphism and colorectal cancer risk, and the T allele of NQO1 C609T polymorphism is an important risk factor of colorectal cancer.

Vascular anatomy and clinical application of anterolateral leg perforator flaps.

BACKGROUND: There is a dearth of detailed published work on anterolateral leg perforators. The authors fully documented the vascular basis of the anterolateral leg perforator flap and report its use in reconstruction of distal extremities. METHODS: Anterolateral leg perforators were investigated in 25 fresh cadavers and 10 casts of arteries. Fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using multidetector-row computed tomography and professional software. The origin, course, and distribution of the perforators in the anterolateral leg region were observed. Between March of 2008 and March of 2012, 15 free superficial peroneal artery perforator flaps were used for reconstruction of distal limbs. Flap size varied from 3.5 × 4.0 cm to 11 × 5 cm, with a uniform thickness of 3 mm. RESULTS: There were 7 ± 3.0 perforators in the anterolateral leg. The average external diameter was 0.7 ± 0.2 mm. Each perforator supplied an average area of 33 ± 8.0 cm. Extensive anastomoses were found between the superficial peroneal artery perforators and multiple adjacent source arteries. All cases were repaired successfully without any complications. The clinical results were satisfactory after 3 to 12 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. CONCLUSIONS: The anterolateral leg perforator flaps have a consistent, reliable blood supply and good texture. The donor site not only supplies a thin skin flap but also provides the option of harvesting cross-boundary proximally or distally based perforator flaps that could be useful for repairing widespread traumatic soft-tissue defects.

Prulifloxacin versus levofloxacin in the treatment of respiratory and urinary tract infections: a multicentre, double-blind, randomized controlled clinical trial.

BACKGROUND: Prulifloxacin is a promising fluoroquinolone antibiotic. A multicentre, double-blind, randomized clinical study was designed to evaluate its efficacy and safety compared to that of levofloxacin for the treatment of respiratory and urinary infections of Chinese patients. METHODS: A total of 267 patients were enrolled and each was randomly assigned to either the treatment or the control group. Prulifloxacin 264.2 mg (equivalent to ulifloxacin 200 mg) b.i.d. or levofloxacin hydrochloride 200 mg b.i.d. was administered orally for 5-14 days according to a patient's condition. The clinical response, bacterial eradication and incidence of adverse events were evaluated. RESULTS: Two hundred and forty-three patients completed the study. For the modified intention-to-treat population, the cure and effective rates were 45.53 and 82.93% in the prulifloxacin group and 49.18 and 83.61% in the levofloxacin group. For the per-protocol analysis population, the cure and effective rates were 45.90 and 83.61% in the prulifloxacin group and 49.59 and 83.47% in the levofloxacin group. The bacterial eradication rates were 96.59 and 95.35%, and the drug-related adverse event rates were 7.87 and 5.51% in the prulifloxacin and levofloxacin group, respectively. The cure rate and efficacy rate of respiratory and urinary tract infections of the levofloxacin group were better than those of the prulifloxacin group. However, the difference between the 2 groups was not statistically significant (p > 0.05). CONCLUSION: Prulifloxacin is as effective and well tolerated as levofloxacin in the treatment of respiratory and urinary tract infections.

[Clinical application of the free superficial peroneal artery perforator flap].

OBJECTIVE: To investigate the applied anatomy of the superficial peroneal artery perforator flap and report the clinical results of repairing the soft tissue defects with free perforator flaps. METHODS: 15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the superficial peroneal artery perforator in the anterolateral leg region were observed. Clinically 6 cases with hand defects and 6 cases with feet defects were treated with free superficial peroneal artery perforator flap transplantation. The defect size ranged from 3.0 cm x 4.5 cm to 5.0 cm x 11.0 cm. RESULTS: The diameter of the superficial peroneal artery is (1.2 +/- 0.3) mm at its origin from the anterior tibial artery 5 cm below the fibula head. It is (5.6 +/- 1.8) cm in length. This artery is truly anastomosed with other perforators to form the chain of superficial peroneal nerve accessory artery. The superficial peroneal artery perforators [outer diameter (0.7 +/- 0.2) mm] with a vein are in the anterolateral leg region, supplying the skin in proximal-middle region. All the 12 cases were treated successfully. The clinical results were satisfactory after 3-12 months of following-up. CONCLUSIONS: The superficial peroneal artery perforator flap has constantly, reliable blood supply, and good texture. It is a good option for repairing soft-tissue defect with free transfer.

Prolonged survival time of allografts by the oral administration of RDP58 linked to the cholera toxin B subunit.

Oral administration, which has been identified as a tool for boosting physiological immunoregulatory mechanisms in an antigen-specific manner, is a more convenient way than classical parenteral injection methods. RDP58 is derived from specific regions of class-I MHC molecules and is known to have immunomodulatory effects after intraperitoneal injection or intravenous administration. To determine whether the oral administration of RDP58 conjugated to the cholera toxin B subunit (CTB) can better induce peripheral tolerance than the use of traditional methods, we used various feeding regimens and methods of administration using equivalent doses of antigen during rat kidney transplantation. The results showed that RDP58-GC/CTB treatment increased the activity of Haem oxygenase-1 (HO-1) in vivo and significantly improved the survival and histopathology of allograft kidney tissue relative to the oral administration of RDP58 alone. These results suggest that the administration of RDP58 linked to CTB outweighs the benefits of oral administration of RDP58 alone for prolonging the survival time of kidney transplantation. This study supports the potential therapeutic use of oral administration of RDP58 linked to CTB as a platform molecule in the treatment of allograft rejection.

Renal vein lengthening using gonadal vein reduces surgical difficulty in living-donor kidney transplantation.

BACKGROUND: During living-donor kidney transplantation, to maximally decrease donor injury, the right kidney with lower glomerular filtration rate often is selected as the donor kidney. However, the renal vein of the right kidney is relatively short for transplantation. The gonadal vein is essentially useless and is easily accessed during the donor nephrectomy. METHODS: Seventeen live kidney donors received right kidney nephrectomy for living-donor kidney transplantation. Short renal veins were lengthened by circular anastomosis or spiral anastomosis of longitudinally cut gonadal veins. The renal function of receivers was evaluated using creatinine clearance. RESULTS: The renal veins were extended by 2.0-2.7 cm with circular anastomosis and 4.1-4.5 cm with spiral anastomosis with an average of 2.5 ± 0.7 cm. Lengthening of renal veins averaged 20.4 ± 4.2 min. All surgeries were successful, significantly reducing difficulty of vascular anastomosis during transplantation. No poor early graft function occurred. No side effects were observed in donors. CONCLUSIONS: When donor renal veins are too short for effective kidney transplantation and may affect reliability of vascular anastomosis, they can be lengthened by using gonadal veins without increasing injury to the donor. Successful extension of donor kidney renal veins expands the indication for right donor kidneys.

A multicenter, randomized controlled clinical study on biapenem and imipenem/cilastatin injection in the treatment of respiratory and urinary tract infections.

BACKGROUND: Biapenem is an injectable carbapenem antibiotic. A clinical study was designed to evaluate its efficacy and safety in the treatment of respiratory and urinary infections compared to imipenem/cilastatin. METHODS: A total of 216 patients with respiratory or urinary tract infections were enrolled into this multicenter, open-label, randomized controlled clinical study. Each patient was randomly assigned to either the treatment or control group; 106 patients in each group were included in the ITT analyses. The patients were given biapenem 300 mg or imipenem/cilastatin 500 mg/500 mg two or three times daily, i.v. g.t.t. for 7-14 days according to their conditions. RESULTS: The cure and effective rates were 67.92 and 88.68% in the biapenem group and 76.02 and 93.40% in the imipenem/cilastatin group, the bacterial eradication rates were 93.83 and 98.82%, and the adverse-event rates were 6.54 and 7.41%, respectively. There were no significant differences between the two groups (p > 0.05). CONCLUSION: Biapenem is as effective and well-tolerated as imipenem/cilastatin for the treatment of intermediate and severe bacterial infections.

[Development and applications of a gastrointestinal monitoring microsystem based on the smart capsule].

A newly-developed gastrointestinal (GI) monitoring system based on a smart capsule is presented in the paper. The unprecedented 130-200 hours battery life and smaller size (10 mm x 20 mm) allows the physician to get total pan-colonic measurements of high-amplitude propagating contractions (HAPCs). To test the in vivo performance of the monitoring system, 15 healthy volunteers and 10 patients with slow transportation constipation (STC) participate in this study. The average of HAPCs occurred in patients is significantly lower than in volunteers (12.4 +/- 3.3 vs. 18.5 +/- 3.7 p = 0.013). The system provides a useful tool for STC diagnosis and treatments of patients.

Phase coupling analysis of gastric pressure activity via wavelet packet based diagonal slice spectra.

We propose a new analysis method to detect quadratic phase coupling (QPC) behavior of human gastric interdigestive pressure activity that has been acquired by a telemetric capsule-like mini-robot. The method is referred to as diagonal slice spectra. They are the Fourier transforms of the diagonal slices of the triple correlations, and can actually detect the phase coupling and coupled components respectively by expanding the real process into the complex counterpart through Hilbert transform. In order to learn more about the QPC structure in a certain frequency band that we are mostly interested in and obtain a higher frequency resolution, the method, named the wavelet packet based diagonal slice spectrum, is introduced. It shows that the nonlinear QPC behavior occurs during gastric contractions (phase II), whereas no distinct phase coupling occurs during gastric motor quiescence (phase I). It is the nonlinear cell-to-cell coupling mechanisms, existence of fast and slow waves and their interactions that nonlinear QPC structure of the gastric pressure activity occurs.

A non-invasive method for gastrointestinal parameter monitoring.

AIM: To propose a new, non-invasive method for monitoring 24-h pressure, temperature and pH value in gastrointestinal tract. METHODS: The authors developed a miniature, multi-functional gastrointestinal monitoring system, which comprises a set of indigestible biotelemetry capsules and a data recorder. The capsule, after ingested by patients, could measure pressure, temperature and pH value in the gastrointestinal tract and transmit the data to the data recorder outside the body through a 434 MHz radio frequency data link. After the capsule passed out from the body, the data saved in the recorder were downloaded to a workstation via a special software for further analysis and comparison. RESULTS: Clinical experiments showed that the biotelemetry capsules could be swallowed by volunteers without any difficulties. The data recorder could receive the radio frequency signals transmitted by the biotelemetry in the body. The biotelemetry capsule could pass out from the body without difficulties. No discomfort was reported by any volunteer during the experiment. In vivo pressure and temperature data were acquired. CONCLUSION: A non-invasive method for monitoring 24-h gastrointestinal parameters was proposed and tested by the authors. The feasibility and functionality of this method are verified by laboratory tests and clinical experiments.

[Inhibitory effects of HLA-derived peptide RDP1258 on proliferation and heme oxygenase-1 activity of rat splenocytes].

AIM: To observe the immunosuppression effect of a novel HLA-derived peptide RDP1258, and to explore its mechanisms. METHODS: RDP1258 was synthesized chemically. The effect of the peptide on alloreactive proliferation of rat splenocytes was observed by (3)H-TdR incorporation method. The heme oxygenase-1(HO-1) activity was analyzed by the enzyme assay. RESULTS: The results showed that the synthetic HLA-derived peptide could obviously inhibit the proliferation of rat splenocytes and HO-1 activity in a dose-dependent manner in-vitro. CONCLUSION: HO-1 may participate in the inhibitory effect of RDP1258 on the proliferation of rat splenocytes induced by mitogen or alloantigen.

[Sildenafil citrate for erectile dysfunction in male kidney transplant recipients].

OBJECTIVE: To evaluate the efficacy and safety of sildenafil citrate in man kidney transplant recipients with erectile dysfunction. METHODS: One hundred and seventy married males, aged 26 approximately 50 years, who had received kidney transplantations at least half a year before and whose serum creatinine was under 133 umol/l, were selected randomly in the study. Their sexual function was investigated according to the International Index of Erectile Function-5 (IIEF-5), and those with erectile dysfunction (ED) were treated with oral sildenafil citrate for 6 months. The efficacy was assessed by IIEF-5. RESULTS: Fifty-three men with ED received oral sildenafil citrate for 6 months. At the end of the treatment, each index in IIEF-5 increased significantly. There were no interactions between sildenafil and cyclosporine and there was no significant adverse effect of sildenafil on the graft function. CONCLUSION: Sildenafil is an effective and safe agent for the treatment of ED in kidney transplant recipients.