Status epilepticus (SE) is one of the most common neurologic emergencies and can be associated with significant morbidity and mortality if not treated promptly and aggressively.Actively,quickly and effectively controlling seizures is the key to save patient's life and improve the prognosis,which is particularly important in children.The status epilepticus is currently most recognized as:a single epileptic seizure lasting for more than 5 minutes during each seizure,or more than 2 episodes,with interictal neurological function that can not return to normal baseline.In 2015,ILAE updated the new definition of SE,which redefined the time of onset to diagnose SE and also redefined the time of onset to cause damage to brain.The new definition made clinical treatment more active and positive,and reduced the incidence of complications and sequelae.The purpose of this article is to summarize the definition,etiology,classification,physiopathologic mechanism,treatment and prognosis of SE.Also we review the published reports to provide the reference for early clinical diagnosis and standard treatment of SE.

Objective To investigate the prevention and treatment of delayed transverse myelitis caused by radiotherapy in patients with thoracic esophageal carcinoma . Methods Radical radiotherapy had been given to five patients (female 3,male 2) with thoracic esophageal carcinoma with delayed transverse myelitis developed 7 to 30 months after radiotherapy without any local recurrence.The study was done in an attempt to describe the clinical symptoms and signs.Analysis of causes was done to seek possible means of treatment and prevention.Results Once delayed transverse myelitis had happened,it was not possible to cure. In this group, four patients died 1-2 years after myelopathy had accurred , and one was alive with functional neurologic loss. Conclusions Delayed transverse myelitis is an uncommon and serious complication induced by irradiation. It is very difficult to manage and indicates a very poor prognosis. We recommend prucise radiation design and prudent performance for prevention.

Objective To investigate the correlation between the plasma homocysteine(Hcy) level and the plaque and its degree of the carotid atherosclerosis (CAS) in elderly patients with acute cerebral infarction (ACI).Methods 93 definit ACI patients recieved the colour Doppler ultrasonograph to detect the intima-media thickness (IMT) of bilateral carotid arteries. Then, the patients were divided into group with CAS plaque(60 cases) and group without CAS plaque(33 cases) according to the result of the detection. Also the degree of CAS were divided to 0～4 levels. The concentration of plasma Hcy of all the patients were measured by enzymatic cycling assay. The correlation analysis was made between plasma Hcy levels and the CAS plaque and the degree of CAS.Results The concentration of plasma Hcy in the group with CAS plaque[18.83 (15.20～24.03)?mol/L] was significantly higher than that in group without CAS plaque[12.30 (9.70～15.10) ?mol/L](P

The teaching of Neurology is a emphasis and difficulty in clinical teaching.In the present article,we summarized some experiences of how to improve the teaching quality of Neurology.

Many details concerning the interventional diagnosis and therapy of thyroid disease need to be studied deeply and carefully; for example, the thyroid applied anatomy, especially the anatomical imageology study of the thyroid arterial anastomosis involving the therapeutic effects and complications, the thyroid artery embolization treatment, presently as a substitution or the supplement therapy for the traditional classical therapy of Graves disease. There are many exploration to extend the indication scope, the therapeutic effect, embolization scope in intervention for Graves disease due to having no accurate individual quantification standard, and so on. The thyroid arterial embolization for Graves disease is to reduce the main cause of thyroxin secretion. Simultaneously, the comprehensive therapeutic effects might have possibly produce the thyroidcytic apoptosis and immune adjustments. Serious complications such as the cerebral infarction, the hyperthyroidism crisis, the hypocalcemia, the periodic paralysis, and so on commonly occured in thyroid arterial embolization. It is necessary to keep strictly the procedure rule and the indication. The mid-and long-term therapeutic effect of thyroid artery embolization for Graves disease is good, but still need more extensive and prudent research for the prospective achievement.

Objective To explore the molecular mechanism of osteoblast apoptosis mediated by glucocorticoid, provide experimental basis for clinical prevention and treatment of hormonal necrosis of femoral-head.Methods The MC3T3-E1 cells were divided into control group and three treatment group treated with different concentrations of dexamethasone (1, 10, 100μmol/L) for 24 hours.The apoptosis rate detected by TUNEL, the mitochondrial transmembrane electric potential after JC-1 staining by flow cytometry, the expression of Bax, Bcl-2 in mitochondrion and Cyt-C, apoptosis inducing factor ( AIF) in cytoplasm by Western blot.ResuIts With the increasing of Dex concentration, the rate of osteoblast apoptosis was significantly increased(F(3,28) =159.0,P=0.000), the positive cell rate of JC-1 stainning was significantly increased(F(3,28) =499.5,P=0.000), the expression of Bax(F(3,28) =17.4,P=0.000)in mitochondrion and Cyt-C(F(3,28) =22.4,P=0.000), AIF(F(3,28) =42.61,P=0.000)in cytoplasm were significantly increased.There were statistically significant difference of above indexes between control group and each experimental group(P<0.05).But there were no significant differences of Bcl-2 in mitochondrion among five groups(F(3,28) =0.62,P=0.607).ConcIusion Dexamethasone increases expression of Bax in mitochondrion, prompts mitochondrial permeability transition pore ( MPTP ) to be over-openning, induces apoptosis in osteoblast via a mitochondria-mediated pathway.

Purpose CT spectroscopy imaging was used in the preoperative differentiation evaluation of renal clear cell carcinoma, to access its malignant degree preoperatively, and to guide the operation treatment. Materials and Methods The spectral characteristics of 40 patients with renal clear cell carcinoma (RCCC) were analyzed retrospectively, all the RCCC patients underwent gemstone spectral imaging (GSI) scans, to obtain spectral serial images for the arterial phase and medulla phase. Spectral characteristic parameters and spectrum curve between different grades of renal cell carcinoma was compared, and the results were compared with pathology. Results Among the 40 cases of patients, carcinoma of grade I, II and III were 13 cases, 15 cases and 12 cases respectively. CT value ratio of renal clear cell carcinoma of grade I, II and III under 70 keV were 1.17±0.25, 0.84±0.85 and 0.64±0.19 (F=23.697, P<0.05) in arterial phase and 0.83±0.12, 0.64±0.07 and 0.54±0.08 (F=30.975, P<0.05) in medulla phase;iodine concentration ratio was 1.19±0.40, 0.60±0.10 and 0.25±0.94 (F=32.932, P<0.05) in arterial phase, and 0.69±0.18, 0.43±0.94 and 0.26±0.51 (F=28.673, P<0.05) in medulla phase. Spectrum curve slope of renal clear cell carcinoma of grade I, II, III in arterial phase was 4.00±1.24, 2.16±0.95 and 0.92±0.64 (F=23.392, P<0.05), and 3.54±1.20, 2.70±0.71 and 1.20±0.44 (F=24.272, P<0.05) in medulla phase. Differences of water concentration in arterial and medulla phase between renal clear cell carcinoma with different grade were not statistically signiifcant (P>0.05). Conclusion The differences of CT value, energy spectrum curve slope, iodine value under CT spectroscopy single energy imaging between renal clear cell carcinoma with different nuclear grade were statistically signiifcant, which can be expected to provide the basis for preoperative therapy selection.

Objective To investigate the efficacy and side effects of Fufangbanmao capsules combined with FOLFOX-4 (Oxaliplatin + 5-fluorouracil /Calcium folinate) regimen in the treatment of metastatic colorectal cancer (MCC). Methods A total of 107 patients with previously untreated MCC, who were admitted to the hospital between April 2006 and October 2008, were randomly divided into combination group (n = 54) and chemotherapy group (n = 53). In combination group, patients received Fufangbanmao capsules (750 mg twice daily) and FOLFOX4 regimen (oxaliplatin 85 mg/m2 day 1, infusion of CF 200 mg/m2 for 2 hours followed by bolus 5-FU 400 mg/m2 and a 22-hour infusion of 5-FU 600 mg/m2 ). Whereas the patients in chemotherapy group were treated with FOLFOX4 regimen. Results The effective rate was 44. 4% in combination group and 37. 7% in chemotherapy group with no significant difference (P = 0. 481). The median time to progression (TTP) was 11. 6 and 7. 9 months in combination group and chemotherapy group, respectively, with significant difference (P=0. 020). The difference was found in improvement of quality of life (QOL) between combination group and chemotherapy group (57. 4% vs 32. 1 % , P=0. 008). The side effects in two groups included gastrointestinal toxicities, neuropathy, alopecia and bone marrow suppression. However, Ⅲ/Ⅳ neutropenia was significantly less in combination group(37. 0%) when compared with chemotherapy group (58. 5%, P = 0. 043). Conclusions In first-line treatment of MCC, Fufangbanmao capsules combined with FOLFOX4 regimen showed synergic and enhanced effect for improving TTP and QOL, and also reduced the incidence of neutropenia.

Objective To explore the reasons of the failure of primary arteriovenous fistula (AVF)surgery and the preventive measures in patients with end-stage renal disease.Methods A total of 819patients with end-stage renal disease who accepted primary AVF surgery were selected.The data of hemoglobin (Hb),albumin (ALB),cholesterol (CHOL),parathyroid hormone (PTH),fasting blood glucose and blood pressure were collected before surgery,while the diameters of radial artery and cephalic vein were measured by upper extremity vascular ultrasound.Results Seven hundred and forty-two patients with AVF surgery were successful,and 77 patients were failed.The age,the ratio of diabetes,hypertension and blood pressure ＜ 120/70 mm Hg (1 mm Hg =0.133 kPa) in AVF failed patients was higher than that in AVF successful patients[(61.3 ± 13.4) years vs.(45.6 ± 11.2) years,46.8％(36/77) vs.31.7％ (235/742),26.0％ (20/77) vs.19.5％ (145/742),36.4％ (28/77) vs.9.2％ (68/742)],and there was significant difference (P＜0.05 or ＜0.01).The diameters of radial artery and cephalic vein in AVF failed patients was lower than that in AVF successful patients [(1.35 ± 0.64) mm vs.(1.98 ± 0.47) mm,(2.13 ± 0.81)mm vs.(2.47 ± 0.74) mm],and there was significant difference (P＜ 0.01).The level of PTH in AVF failed patients was higher than that in AVF successful patients [(782.39 ± 423.85) ng/L vs.(378.83 ± 352.21) ng/L],and there was significant difference (P ＜ 0.05).Logistic regression analysis showed that blood pressure,diabetes,PTH,the diameters of radial artery and cephalic vein was the risk factor of AVF failed.Conclusion AVF surgery failed is highly correlated with the patient s blood pressure,th primary disease,the vessel diameter,

As a common disease in orthopedics,osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people.Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications.There are a large number of operative methods for preserving hip joint in clinical practice without definitive curative effects.Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms,but they cannot remove necrotic bone completely.Hence,they are only used for ONFH in the early stage.Vascularized bone transplantation can fill defects of the former,as it can not only completely remove necrotic bone,but also provide bone graft with nourishing vessels for femoral head,being beneficial to reconstruct the bone structure of femoral head.Subsequently,the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head.The emergence of stem cell transplantation has created a new approach to preserve hip joint for ONFH,which promotes the regeneration of bone cells and assists femoral head in repair,often combined with other operative methods and using characteristics of superior proliferation and differentiation of stem cells.Hip joint preserving surgery,in recent years,has been performed increasingly,and has obtained improvement in clinical effects.The multiple combination of a variety of its operative methods provides more effective treatments for ONFH.It is an essential notion that hip joint preserving surgery,however with any operative method,should as far as possible select a surgical plan with little trauma,simple methods and little injury to bone structure of hip joint based on ensuring the efficacy.