Refractory childhood epilepsy refers to those cases with dififcult control of epileptic attacks after at least two formal anticonvulsants treatment. Recently, ketogenic diet (KD), a high-fat, low-carbohydrate and adequate-protein diet, becomes an important method for the treatment of refractory epilepsy in children. Before employing KD, children should be checked to exclude known metabolic diseases. Although the mechanism of KD treatment is not entirely clear, it has a certain clinical curative effect. Many factors inlfuence the curative effect of KD. Most of the adverse effects of KD treatment are transient and can be recovered through active prevention and handling, which gives a generally good prognosis.

Objective To solve the limitation of the wide-bound imaging from aortic arch to the bifurcation of internal and external carotid artery by changing 3D TOF MRA scan parameters, and discuss the clinical value of this technology in carotid artery angiography. Methods 108 patients with cerebrovascular disease were performed with carotid artery 3D TOF MRA. Images were performed under MIP, MPR and VR. The images of bilateral common carotid arteries, external and internal carotid artery, and vertebral artery were evaluated interactively by two independent radiologists blinded to results. Results 864 blood vessels were observed with 3D TOF MRA, including 672 normal clearly, 17 unclear, 17 congenital variants, 73 un -smooth lesion, 63 vascular stenosis, 9 vascular occlusion, 5 not display, 4 depressed downward, 4 vascular enlargement. Totally,unclear, variation and lesion blood vessels were 192. The results in combination with original image analysis could meet the need of diagonosis. Conclusion 3D TOF MRA as a noninvasive and non contrast agent imaging method can be used to select the carotid stenosis and is quite good in the value of application.

Objective To study clinical application of no phase wrap(NPW) technique in MRI. Methods 139 patients were selected and performed two sequences with and without no phase wrap in the same condition. The two kinds of images were compared. Results In the same parameter, phase wrap artifacts were seen in all images without the option of NPW. In the opposite, with the option of NPW, the artifacts disappeared. Conclusion NPW can avoid the Phase wrap artifacts .

OBJECTIVE To understand the situation of application of antibacterials in perioperative period in Department of Orthopedics,in order to find evidence for strengthening the rational use and standard management of antibacterial.METHODS A total of 308 cases with orthopedic clean-operations were randomly selected for the analysis of rationality of application of antibiotic prophylaxis in perioperative period.RESULTS All of the 308 patients were given antibiotics in perioperative period.And 18 kinds of drugs from 7 categories were used,the average kinds used were(2.07?0.75).The patients started antibiotic administration within 0.5-2 hours before operation accounted for 84.74%.The average time of antibiotic using was(6.07?2.64) days.72.40% patients in medication period used more than one kind drugs.CONCLUSIONS There are some problems in application of antibacterials in orthopedic clean-operations during perioperative period,such as too long-term use of antibiotics,frequent changes and so on.It is necessary to strengthen the management and improve the rationality of application of antibacterials.

Objective To discuss the value of Time-Resolved Imaging of Contrast Kinetics (TRICKS) in the diagnosis of lower extremity diseases. Methods 24 cases (27 times) with lower extremity, skeleton and blood vessel diseases undergoing TRICKS were retrospectively analyzed. There were 14 cases with both lower extremities two -segment scan, 5 cases(6 times) with one-segment scan(thigh), and 5 cases (7 times) with one-segment scan(calf). Conventional sequences were performed followed by enhanced MR angiography with the TRICKS technique. Results The TRICKS images for all cases satisfied the vascular changes and structure demonstration in arteriovenous phase, and the full circulative process of those pathological vessels were observed. The diagnostic accuracy of TRICKS angiography has been validated. Conclusion The TRICKS provides a method for imaging the change of blood flow. The vascularity in the target vascular and tumor can also be obtained. Hence TRICKS provide important information in clinical decision making.

Objective To discuss the inspect technique and methods of magnetic resonance urography(MRU)in pediatric urinary system. Methods 16 cases with urinary system diseases were analyzed retrospectively,including axial routine FRFSE T2WI with fat saturation and three-dimensional MRU. The three-dimensional(3D) imaging data were sent to AW4.2 workstation,then edited and reconstructed with maximum intensity projection(MIP) and rebuilt. Results 12 cases in 16 cases were congenital abnormality by MRU diagnosis,3 cases were Urinary system diseases and 1 case was normal. 10 cases in 16 cases were performed with surgical intervention,6 cases with medical treatment,which clinical diagnosis were consistent with MRU. 16 cases were accepted examination with B -ultrasonic,6 cases CT and 9 cases IVP. Diagnose accordance rates with MRU were B-ultrasonic 93.7%(15/16),CT 66.7%(4/6),IVP 66.7%(6/9).Conclusion MRU is a safe,convincible and convenient technique,which can provide high quality imaging,so it will be a kind of non-injury imaging method in diagnosing the diseases of pediatric urinary system diseases.

Objective To investigate the mechanisms underlying the protection by punicalagin against ultraviolet B (UVB)-induced damage to keratinocytes.Methods Cultured human HaCaT keratinocytes were divided into several groups:blank control group receiving no treatment,punicalagin groups treated with various concentrations of punicalagin,UVB group irradiated with UVB at 30 mJ/cm2,combination groups pretreated with different concentrations of punicalagin followed by UVB radiation at 30 mJ/cm2.The concentrations of punicalagin were 5,10,20,40 and 80 μmol/L in the cell proliferation assay,10,20 and 40 μmol/L in the other assays.After additional culture for different durations,methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferation of HaCaT cells,Hoechst and propidium iodide (PI) staining as well as flow cytometry to detect the apoptosis in cells,reverse transcription-PCR to quantify the mRNA expressions of matrix metalloproteinase-1 (MMP1) and tissue inhibitor of metalloproteinase-1 (TIMP1) in HaCaT cells,Western blot to determine the phosphorylation levels of the mitogen-activated protein kinase (MAPK) pathway-related proteins including P38,JNK and ERK.Statistical analysis was carried out by t test,one-way analysis of variance,and Dunnett's t-test.Results As the MTT assay showed,punicalagin at 10-40 μmol/L showed stronger pre-protective effects against UVB-induced damage to HaCaT cells compared with punicalagin at the other concentrations.The number of cells highly positive for both Hoechst and PI staining was larger in the UVB group than that in the blank control group,but smaller in the combination groups than in the UVB group.The percentage of apoptotic cells increased significantly in the UVB group compared with the blank control group (9.82％ ± 0.11％ vs.1.24％ ± 0.91％,P ＜ 0.01),but decreased significantly in the three combination groups (punicalagin (10,20 and 40 μmol/L) + UVB) compared with the UVB group (6.38％ ± 0.14％,5.24％ ± 0.17％ and 3.77％ ± 0.11％ vs.9.82％ ± 0.11％,all P＜ 0.01).Theexpression of MMP1 mRNA was significantly higher,but that of TIMP1 mRNA was significantly lower in the UVB group than in the blank control group (both P ＜ 0.01),whereas no statistically significant difference was observed in the expression of MMP1 or TIMP1 mRNA between the punicalagin groups and blank control group (all P ＞ 0.05).The pretreatment with punicalagin significantly reduced the expression level of MMP1 mRNA (P ＜ 0.01),but elevated that of TIMP1 mRNA (P ＜ 0.01) in the combination groups compared with the UVB group.As Western blot showed,the phosphorylation levels of P38,JNK and ERK were markedly increased in the UVB group (all P ＜0.01),but experienced no significant changes in the punicalagin groups (all P ＞ 0.05) compared with the blank control group,and decreased to different degrees in the combination groups compared with the UVB group (all P ＜0.01).Conclusion Punicalagin has a pre-protective effect on UVB-induced damage to HaCaT cells.

High‐speed economic development and progress of medical technologies in China have significantly benefitted people′s health conditions.Significantly higher life expectancy in average ,as a result ,also contributed to population aging process.How to deal with the contradictions between population aging and rapid growth of medical costs is challenging the healthcare sector of the country.Analysis of medical costs at three tertiary hospitals in Liaoning Province discovered problems in out‐of‐pocket medical expenses of elderlies ,and proposed on measures to effectively ease their burden in medical expenditure .

Objective:To explore the metabolic regulations of different Traditional Chinese Medicine (TCM) syndromes in the diabetic patients with high risk for foot ulceration.Methods:Based on gas chromatography-mass spectrometer and multi-dimensional data processing methods, the metabolomics analysis was used to compare the serum metabolites profile of healthy people (32 cases) and the high-risk foot patients in Cold and Blood Stagnation syndrome (44 cases), Heat-toxin hurting Yin syndrome (54 cases), and Qi-Blood deficiency syndrome (33 cases), who were hospitalized at Shanghai TCM-Integrated Hospital from Apirl to December, 2018.Results:This study suggested that compared with healthy people, the diabetic patients with high risk for foot ulceration showed significantly lower serum level of urea [(2.41 ± 1.57)×10 5vs. (3.32 ± 2.10)×10 5], L-leucine [(4.94 ± 3.15)×10 5vs. (6.39 ± 3.57)×10 5], aspartic acid [(3.94 ± 4.48)×10 5vs. (9.62 ± 6.93)×10 5], 9H-purine [(1.74 ± 1.95)×10 5vs. (3.34 ± 2.23)×10 5] ( P<0.05 or P<0.01), while higher level of d-Glucose [(3.72 ± 1.71)×10 5vs. (2.21 ± 1.32)×10 5] and d-glucopyranose [(3.32 ± 2.10)×10 5vs. (1.35 ± 1.43)×10 5] ( P<0.01). Energy metabolism, amino acid metabolism and sugar metabolism were mainly involved. the content of L-tyrosine in the group of patients with Cold and Blood Stagnation syndromewas significantly higher than that in healthy people. The urea, purine, leucine, aspartic acidcontent in patients of Heat-toxin hurting Yin syndrome were significantly lower than that in healthy people. The purine content in patients of Qi and Blood Deficiency Syndrome was significantly lower than that in healthy people. Compared with the syndrome of Heat-toxin hurting Yin syndrome, patients in Cold and Blood Stagnation syndrome showed a significantly higher content of beta-1-galactopyranoside and butanoic acid. Compared to the Qi-Blood deficiency syndrome, serum urea level in patients of Heat-toxin hurting Yin syndrome was significantly higher than those in the patients of other two TCM syndromes. Conclusions:The serum metabolomics profiling differentiate three TCM-syndrome in high-risk DF patients, which can provide objective basis for clinical TCM syndrome differentiation and treatment of high-risk diabetic foot patients.

Objective To analyze the incidence,risk factors and pathogens of stroke associated pneumonia (SAP) in patients with acute stroke in the intensive care unit (ICU).Methods One hundred and forty-two patients with acute stroke admitted in ICU from January 2012 to December 2013 were retrospectively studied.The data of medical history of patients,treatment,prognosis,and pathogens of SAP were collected.Data were analyzed by t test,Mann-Whitney U test,Pearson x2 test and muhivariable logistic regression.Results Of 142 patients,94 (66.2％) were contracted SAP of which 54.3％ were early-onset pneumonia (EOP≤72 h) and 45.7％ were late-onset pneumonia (LOP ＞72 h).The most common pathogens isolated from EOP were Staphylococcus aureus and Klebsiella pneumonia,while the most common pathogens isolated from LOP were Acinetobacter baumanii,Staphylococcus aureus and Pseudomonas aeruginosa.Multivariate logistic regression analysis demonstrated that hemorrhagic apoplexy,history of stroke,higher APACHE score,dysphagia,prolonged use of mechanical ventilation,prolonged stay in ICU,and hyperglycemia were the independent risk factors of SAP,and the odds ratios (OR) with 95％ confidence intervals (CI) were 10.917 (1.834-60.959),15.223 (1.947-96.969),1.607 (1.253-2.062),5.321 (1.225-26.519),1.809 (1.208-2.709),1.391 (1.085-1.783),1.534 (1.l01-2.138),respectively.While plasma albumin level was negatively associated with SAP (OR =0.809,95％ CI:0.674-0.971).The common risk factors of EOP and LOP were higher APACHE score and prolonged use of of mechanical ventilation.The independent risk factors of EOP were dysphagia (OR =4.331,95％ CI:1.330-14.098),history of stroke (OR =13.690,95％ CI:2.198-85.277) and chronic bronchitis (OR =12.907,95％ CI:1.203-138.542),While those of LOP were prolonged stay in ICU (OR =1.687,95 ％ CI:1.131-2.517),hemorrhagic apoplexy (OR =21.657,95％ CI:1.559-106.752) and low plasma albumin level (OR =0.782,95％ CI:0.637-0.961).There was no significant difference in mortality between EOP (49％) and LOP (44.2％) (P ＞ 0.05),but the mortality of SAP was significantly higher than that of non-SAP group.Conclusions The incidence rate and mortality of SAP are quite high in ICU.The pathogens and risk factors are different between EOP and LOP.This observation results suggest it is important to identify high-risk stroke patients,and to develop a novel treatment strategy and prophylactic measures facilitating limiting the complications of stroke.