OBJECTIVE:To observe the efficacy and safety of topiramate in treatment of epilepsy METHODS:15 patients with refractory epilepsy treated with topiramate as additive drug and 61 newly-diagnosed epileptic patients with topiramate as monotherapeutic agent entered the open-label trial and were followed-up RESULTS:Among 15 patients with refractory epilepsy, the frequency of seizure decreased by 50% or greater in 10 cases with an effective rate of 66 7%, and 2 patients were free from seizure;among 61 newly-diagnosed cases, the frequency of seizure reduced by 50% or more in 45 cases(73 8%), and 16 cases were free from seizure(26 2%) The ARDs were lower in incidence and mild in severity CONCLUSION:Topiramate was safe and effective as additive or monotherapeutic agent for multiple types of seizure

Objective To study the effect of combination mode of blood purification on insulin resistance in MODS patients and discuss the best mode of blood purification to improve insulin resistance in MODS patients.Methods A total of 60 MODS pa-tients were selected and randomly divided into control group(single mode of blood purification)and treatment group(combination mode of blood purification),each group of 30 cases.Blood glucose (BG),glucose standard deviation (BGSD),coefficient of variation of blood glucose (BGCV),regular insulin dosage (Ins),fasting insulin (FINS),insulin resistance index (HOMA-IR),HbA1c,C-re-active protein (CRP)was observed before and after treatment.Results BG,HbA1c,FINS,CRP,HOMA-IR,Ins of experimental group was lower than that of control group (P <0.05).After treatment,BG,FINS,CRP,HOMA-IR,Ins was declined in experi-mental group (P <0.05).After treatment,HbA1c was not changed in experimental group (P >0.05 ).Conclusion Combination mode blood purification may be more effective to insulin resistance in MODS patients.

Objective To summarize the cause and the level change of laboratory indicators in children with hemphagocytic lym‐phohistiocytosis(HLH) .Methods Retrospectively analyze the cause and the diagnose features of the 13 HLH patients .Results The first symptom of the desease was hyperpyrexia as well as the hepatosplenomegaly and the lymphadenectasis .Then it went with the peripheral cytopenia in two or three lineages ,different degrees of the liver dysfunction and the coagulation abnormalities .The number of histiocytes increased and hemophagocytic macrophages were found in bone marrow .It also showed that the elevated ser‐um triglycerides ,serum ferritin ,lactate dehydrogenase and glutamic‐pyruvic transaminase and decreased fibrinogen in laboratory findings .Conclusion Cytopenia(in two or three lineages ,especially the platelet) ,the elevated serum triglycerides ,serum ferritin , lactate dehydrogenase ,glutamic‐pyruvic transaminase ,decreased fibrinogen and the hemophagocytic macrophages in bone marrow (≥1% ) are important indicators in hemphagocytic lymphohistiocytosis diagnosis ,which could help us know the change of the HLH laboratory features better and diagnose the disease correctly .

Objective To observe the anesthesia and recovery results of sevoflrane and remifentanil combined anesthesia in open or laparoscopic surgeries. Methods 60 cases of ordinary surgeries from the department of gynecology and general surgeries were included in this study with 30 cases in each group. (1)recording total sevoflurane inhalation time, muscular relaxant amount, end tidal sevoflurane concentration;(2)recording BP,HR at 10 min after induction,operation staring and ending,ventilation recovery, opening eye and extubation period;also sevoflurane concentration 5 min after stopping medicine and ventilation recovery;recording time period between surgery ending and autonomous respiration recovery , eye opening and extubation. Results No any adverse events happen in each patient.the sevoflurane inhalation time in open surgery group was (157.20 ± 47.28) min, longer than that of laparoscopic surgeries group (73.50 ± 11.23)min(P<0.05), we had seen no statistical significance in all other index observed (P>0.05). Conclusion Sevoflurane combined remifentanil anesthesia can achieve stable intra-operative maintenance and rapid postoperative recovery quality , we suggest the widespread usage of it in clinic.

Objective:To analyze adverse drug reactions(ADRs)associated with proprietary Chinese medicine occurring in Beijing Hospital.Method:The ADRs associated with proprietary Chinese medicine between 2002 and 2006 were collected and the associated information was retrospectively analyzed.Result:a total of 179 ADRs were analyzed. Most of them occurring in women patients(76.1%)with hyperplasia of mammary glands who took Xiaojin pills and Xi- huang pills(22.1% & 12%).The herbal medicine injections were the other most associated ones.The clinical appearances of ADRs were rash and bodily manifestation of hypersensitiveness.Condusion:The investigation of Chinese medicine ADR plays a very important role in the modernization of Chinese medicine.

Objectives This study aimed to understand the attitude of medical students at the undergraduate level towards the learning of first-aid skills and knowledge as well as pre-hospital first-aid services.Furthermore,this study helped to design a more effective strategy of first-aid education in medical schools.Methods A questionnaire survey was conducted among 1219 undergraduates in medical university,using stratified and cluster proportion sampling method.Results When an accident was met,81.26％ of the undergraduates would voluntarily offer pre-hospital first-aid assistance;77.76％ students had studied first aid knowledge through various channels.However,most students did not have a systematic comprehension of first-aid knowledge and skills.Conclusion Undergraduates in medical university have a positive attitude to offering pre-hospital first-aid assistance;however,the majority of students lack the ability to provide correct and effective assistance.Therefore,medicinal university needs to provide the students with more effective first-aid education.

Objective To investigate the effect of micro-ecological agent on the intestinal flora of patients with posterior lumbar spine surgery.Methods Seventy-two patients with lumbar spine surgery were selected as our subjects.Of them,42 patients with occurred the intestinal flora dysfunction were served as experimental group (group A),other 30 patients were as control group (group B).The levels of plasma endotoxin,plasma tumor necrosis factor-α (TNF-α),Interleukin 6 (IL-6) were detected before and after operation.The patients in group A were treated with micro-ecological agent Jinshuangqi.Collected stool samples at preoperative,postoperative first natural defecation (after 1-4 d),and compared intestinal flora difference and Bifidobacterium (B)/Enterobacteriaceae (E) value of two groups patients.Results The levels of plasma endotoxin in group A were (1.82 ±0.12),(2.29 ±0.15),(1.91 ±0.08) ng/L at before surgery,the 2nd and 7th day after surgery,and that in group B were(1.91 ±0.21),(2.35 ±0.16),(2.26 ±0.24) ng/L The TNF-α level in group A were (275 ±51),(309 ±45),(276 ±34) ng/L and that in group B were (269 ±48),(318±67),(297 ±53) ng/L at before surgery,the 2nd and 7th day after surgery.The IL-6 levels in group A were (138 ± 22),(159 ± 15),(137 ± 17) ng/L and that in group B were (159 ± 16),(187 ± 19),(174 ± 21) ng/Lat before surgery,the 2nd and 7th day after surgery.The repeated measured repeated measures analysis of variance showed that among three indexes of plasma endotoxin,TNF-α,IL-6 levels,differences of between group and interaction were statistically significant (P ＜ 0.05),but there was no significant difference within groups (P＞ 0.05).The levels of plasma endotoxin,TNF-α,IL-6 decreased after surgery ware gradually decreasing with hospitalization prolonged.There was significant difference between before surgery and at the 2nd,7th day after surgery(P ＜ 0.05),and there was significant difference between the 2nd and the 7th day after surgery(P＜ 0.05).At the 2nd day after surgery,there was significant difference between group A and group B in terms of the level of plasma endotoxin,TNF-α,IL-6.At the 7th day,the levels of plasma endotoxin,TNF-α,IL-6 were slowly decreased in group A,and there were significant difference compared to group B (P ＜ 0.05).The numbers of intestinal Bifidobacterium,Bacteroides,and B/E values of group A were decreased after surgery compared to group B((9.17 ±0.54) lg cfu/g vs.(10.01 ± 0.75) lg cfu/g,(9.23 ± 0.47) lg cfu/g vs.(10.09 ± 0.81)lg cfu/g,(1.01 ± 0.16) vs.(1.20 ± 0.11)),and the difference was significant (P =0.031,0.042,0.029respectively).The levels of Enterobacter and Enterococcus in group A were (9.11 ± 1.02) lg cfu/g,(7.80± 1.02) lg cfu/g,higher than that of group B ((8.81 ± 0.89) lg cfu/g,(7.29 ± 0.98) lg cfu/g(P =0.037,0.043)).There was no significant difference between two groups in terms of small clostridium and lactobacillus (P ＞ 0.05).After treated with micro-ecological agent Jinshuangqi,the levels of intestinal Bifidobacterium,Bacteroides,and B/E value at was increased compared to before treated in group A (Bifidobacterium:(13.01±0.87) lg cfu/g vs.(9.17 ±0.54) lg cfu/g; Bacteroides:(14.12 ±0.75) lg cfu/g vs.(9.23 ±0.47)lg cfu/g; B/E value:(1.28 ± 0.45) vs.(1.01 ± 0.16) ;P =0.045,0.034,0.038 respectively).No significant difference was seen in terms of the levels of Enterobacter,Enterococcus,small clostridium and lactobacillus between two groups(8.71 ±0.91) lg cfu/g vs.(9.11 ± 1.02) lg cfu/g,(7.01 ±0.54) lg cfu/g vs.(7.80± 1.02) lg cfu/g,(5.23 ± 1.04) lg cfu/g vs.(5.15 ± 0.89) lg cfu/g,(6.71 ± 1.04) lg cfu/g vs.(6.53± 0.86) lg cfu/g respectively; P ＞ 0.05).Conclusion Posterior lumbar operation patients with intestinal dysbacteriosis often associated with endotoxemia and inflammatory reaction,the levels of bifidobacteria,Bacteroides intestinal Enterobacteriaceae decrease while Enterococcus,opportunistic pathogens increase,and intestinal microbial colonization resistance decrease.Micro-ecological agent Jinshuangqi treatment can ease the body's endotoxemia and inflammatory response,improved lumbar surgery intestinal flora after surgery,and beneficial to rebuild the intestinal microflora balance.

Objective To discuss the current status of application of the four kinds of clinical decision‐making method (mode recognition method ,hypothesis deductive method ,event‐driven method and applying regulation method ) in the clinical practice of the emergency resident doctors and to understand their mastery situation of the clinical decision‐making methods and the influencing factors .Methods One thousand and thirty‐five patients collected by 207 resident doctors (5 cases were randomly collected from the patients diagnosed and treated by each resident doctor ) were divided into 3 groups according to different year systems .The clinical decision‐making methods ,diagnosis accuracy of different clinical decision‐making methods and the influencing factors of decision‐making methods were compared among different grades .Results The difference in the decision‐making methods among different year systems had statistical significance (P<0 .05);furthermore ,the difference in the diagnostic accuracy among different decision‐making methods had statistical significance (P< 0 .05) ,the differences in the defensive behaviors and different decision‐making methods were statistically significant (P<0 .05) ,the multi‐classification Logistic regression of different decision‐making methods showed that the differences in the different residency year system ,residency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree had statistical significance (P< 0 .05) .Conclusion The most commonly used decision‐making method by the resident doctors is the applying regulation method .The residency year system ,resi‐dency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree are the influencing factors of application of the clinical decision‐making methods in the clinical practice of the emergency medicine spe‐cialty .

Objective To investigate the diagnostic value and significance of myocardial injury markers in neonates.Methods A retrospective analysis of 838 cases of myocardial injury markers in neonates,the total positive rate of hs -cTnI and the positive rates of hs -cTnI(hypersensitivity cardiac troponin I)in different kinds of neonatal disease were calculated,the levels of abnormalities consistent rate in hs -cTnI and CK -MBmass(creatine kinase MB mass)were compared with hs -cTnI and MYO(Myoglobin).Results The total positive rate of hs -cTnI was 40.33% in the 838 neonates.The highest incidence of myocardial injury was neonatal sepsis (57.14%),followed by neonatal pulmonary hemorrhage (55.56%)and neonatal convulsions (54.55%).The abnormalities consistent rate of hs -cTnI and CK -MBmass was better than hs -cTnI and MYO (85.50% vs 28.11%,χ2 =226.9,P <0.05). Conclusion Neonatal hospitalized children often complicated by myocardial injury;As a biochemical myocardial injury marker,the hs -cTnI detection is important for early detection of myocardial injury,it should be recommend as routine test items;CK -MBmass has better correlation with hs -cTnI than MYO,which can provide guide for doctors to interpret the data of myocardial injury markers.

ObjectiveTo identify potential distribution areas for wild Panax ginseng cultivated under forest in Liaoning province， China， and analyze the ecological factors of spatial stratified heterogeneity affecting its ecological suitability and quality suitability. MethodWild Panax ginseng samples cultivated under forest were collected from 33 cultivation bases in Liaoning province. The Maxent maximum entropy model and ArcGIS were used to delineate the ecological suitability zones. Correlation analysis was performed on seven indicators and 110 ecological factors. Variables with significant correlation （P<0.05） were used to build partial least squares regression analysis models. A comprehensive quality zoning was conducted using the analytic hierarchy process （AHP）. The geographic detector was employed to analyze the interactions among dominant ecological factors of spatial stratified heterogeneity affecting habitat suitability， quality suitability， and the ecological driving factors. ResultVegetation type was the most influential ecological factor for delineating the ecological suitability zones for wild Panax ginseng in Liaoning province. The main ecological suitability areas for wild Panax ginseng cultivated under forest were located in the northeast， east， and southeast regions along the line from Xifeng County to Gaizhou City. The comprehensive quality suitability of wild Panax ginseng cultivated under forest was highest in Kuandian County and Huanren County and gradually decreased to the northwest and southwest. Within the delineated regions， the suitability conditions and comprehensive quality of wild Panax ginseng cultivated under forest were primarily influenced by the interactions between radiation and precipitation factors. The content of the measured samples was significantly higher than the standards in the 2020 edition of the Chinese Pharmacopoeia， indicating the high overall quality of wild Panax ginseng in Liaoning Province. ConclusionAccording to the zoning and prediction results， areas in Fengcheng City， Xiuyan County， Zhuanghe City， Liaoyang County， Tieling County， Xifeng County， Gaizhou City， Haicheng City， and Dashiqiao City showed large potential distribution areas with high quality， making them highly promising for wild Panax ginseng cultivation. However， further experimental verification is required. The zoning results can provide insights for research on habitat suitability and comprehensive quality accumulation of wild Panax ginseng cultivated under forest， as well as guidance for the search for potential cultivation areas and industrial development of wild Panax ginseng in Liaoning Province.