Epilepsy is a common neurological disorder of children. Research in recent years on the mechanism of refractable epilepsy has made some breakthrough. Four concepts have been put forward to explain the development of pharmacoresistance. The transporter hypothesis have become the focus, which contends that the expression or function of multidrug transporters in the brain is augmented, leading to impaired access of antiepileptic drugs to central nervous system targets. An emerging understanding of these underlying molecular and cellular mechanisms is likely to provide important impetus for the development of new pharmacological treatment strategies and clinical test facility.

Objective To summarize the nursing experience of nursing ocular hypertensive patients having undergone vitrectomy for proliferative diabetic retinopathy.Methods Twenty-one ocular hypertensive patients having undergone vitrectomy for proliferative diabetic retinopathy were assisted to take the correct posture.They were closely observed for timely detection of ocular symptoms and signs and asked to take antihypertensive drugs.At the same time,those with neovascular glaucoma and laser iris neovascular glaucoma plasty were carefully nursed.Results Among the 21 patients(25 eyes),15 patients(18 eyes)had intraocular pressure normalized by way of medicine treatment,the intraocular pressure in another two eyes normalized after laser peripheral iridoplasty;the pressure in another one normalized after laser peripheral iridoplasty combined with peripheral iridectomy and another 4 eyes developed with neovascular glaucoma.Conclusion Combined with the operation,postoperative observation and nursing of postoperative high intraocular pressure can effectively reduce the incidence of ocular hypertension after pars plana vitrectomy for proliferative diabetic retinopathy.

Objective To improve the reliability of the core database system by ameliorating the scheme of the server system architecture. Methods Combined with practice of the hospital informatization, the security and potential hole of the database server system were analyzed and evaluated. Results Aimed to deal with the security hidden-trouble, a mini-server was adopted instead of PC server, while SAN(Storage Area Network) was utilized instead of RAID-5, and mirror copy technique was used to implement the real-time hot copy of the data. Conclusion Consequently the reliability of the system has been greatly improved.

Objective: To observe HLA DR expression in different s tages of oral squamous cell carcinoma (OSCC) and to study the clinic significan ce of the abnormal HLA DR expression in primary OSCC. Method: HLA DR expression was detected by immunohistochemistry method in 26 cas es of histologically normal oral epithelia, 8 leukoplakia, 32 primary focuses an d 12 metastasis focuses of OSCC. Results: HLA DR express ion in primary OSCC focuses was significantly higher than that in normal epithel ium( P 0.05). Conclusion: Although HLA DR expression is frequently obs erved in the development of OSCCs, it can not be regarded as one of the indepen dent prognosis factors.

Objective To study the psychological status of patients having undergone eyeball enucleation,and put forward the corresponding strategy for psychological nursing.Method The symptom checklist-90(SCL-90)was used to investigate their psychological status after eyeball enucleation.Result The scores on interpersonal relationship sensitivity factor,depression factor, anxiety factor and terror factor(28?78±0?61),(40?76±0?65),(33?86±0?62)and(23?88±0?46),respectively.Conclusions Pertinent psychological nursing may help patients to eliminate the adverse emotional and psychological pressures,promoting them to develop a good state of mind,and return to the society better?

Objective To study the expression of EI-1 in myocardium during cerebral ischemia and reper-fusion, and to investigate the mechanism of cerebral cardiac syndrome. Method Two hundred and eight SD rats weighting 220～250 gram, were divided into three groups: sham control group (n=48), cerebral ischemia group (n=80), cerebral ischemia/reperfusion group (n=80). The area of cerebral ischemia, and the concentration of sennn ET-1 and CK-MB, and the content of myocardial ET-1 were determined in 0,6, 12,24,48,72 h after cerebral ischemia and reperfusion, and were analyzed by t-test or F-test. Results Cerebral necrosis area was ob-served at 6 h after cerebral ischemia in cerebral ischemia group, and peaked at 12 h (P>0.05). The concentra-tion of CK-MB increased gradually after cerebral ischmia, peaked at 12 h (P<0.05), and then gradually de-creased. The serum concentration of ET-1 peaked at 6 h and then gradually decreased. The content of ET-1 in my-ocardium began to increase at 6 h after cerebral ischemia, and peaked at 12 h (P<0.05). In cerebral ischemia/reperfusion group, all of cerebral necrosis size, CK-MB concentration and myocardial ET-1 concent paelced at 12 h and then gradually decreased (P<0.05). Change of ET-1 concentration in blood was similar to that in cerebral ischemia group. Compared with cerebral ischemia group, the size of cerebral necrosis reduced obviously at 24 h,48 h,72 h in cerebral ischemia/reperfusion group (P<0.05). The concentration of CK-MB in cerebral ischemia/ reperfusion group was higher than that in cerebral isehemia group (P<0.05). The peak time of myocardial ET-1 was shatened in cerebral ischemia/reperfusion group. The change of serum ET-1 was not different between two groups. Conclusions Large area of cerebral ischemia, might cause myocardial injury. ET-1 is involved in the course of myocardial injury following cerebral ischemia. Though cerebral reperfusion can protect brain,but it make myocardial injury more serious,and ET-1 might participate in this course.

Objective To investigate the protective function and its mechanisms of eyclosporin A to immature brain tissue with convulsive brain damage. Methods 21-day-old SD rats were given lithium-pilocarpine to make the epilepsy model. Total 67 male rats had been investigated. Cyclosporin A (CsA) were injected three times at 6, 30, 54 hrs after model had been established. Three dosages had been chosen: 5, 10 and 25 mg/kg each time. The level of apoptotic cells, P-glycoprotein (P-gp), glial fibrillary acidic protein (GFAP) in CA1 area of hippocampus had been determined, and compared with the rats without giving CsA. Results Rats from epilepsy model group had higher level of apoptosis, P-gp, GFAP expression than those from pseudo-model group. CsA injection by dose 5 mg/kg each time for three times reduced the level of P-gp, GFAP. Model group and pseudo-model group were same. Both the interventions of CsA injection by 10 mg/kg and 25 mg/kg can reduce the level of P-gp, GFAP, however neither of their effectiveness was better than CsA 5 mg/kg each time. Conclusions Small dosage of CsA may protect the immature brain tissue from convulsive brain damage by reducing the level of P-gp, GFAP in CA1 area of hippocampus.

Objective To investigate the effect of continuous quality improvement on venous transfusion exosmosis in elderly patients.Methods Through the investigation into venous transfusion exosmosis in 160 elderly patients,the causes for exosmosis were identified,followed by regulating and enforcing improvement measures and assessing the effect.Results The incidence of venous transfusion exosmosis in elderly patients was reduced from 6.40%to 2.57%and the satisfaction of patients improved from 90.00%to 97.50%.Conclusion The continuous quality improvement may effectively reduce the incidence of venous transfusion exosmosis and improve patients’satisfaction.

Objective To evaluate the long-term effective rate,retention rate and tolerability of the ketogenic diet (KD) in pediatric drug-resistant epilepsies.Methods Data of 36 children who were treated in Department of Pediatrics,the Second Affiliated Hospital of Xi'an Jiaotong University from Nov.2011 to Dec.2013 and had continuous follow-up of at least 12 months after initiation of the KD were analyzed prospectively.Response was defined as 50％ seizure reduction.The effective rate,retention rate, outcome-predictive value of various clinical factors were also assessed.The causes of the patients withdrew from KD and side effects were recorded and analyzed.Results Thirty-six children(29 boys,7 girls; mean age of 2.84 years)were included.The effective rate was 50.0％,52.8％,47.2％ and 41.7％ at the 1,3,6,12 months;the retention rate respectively was 94.4％,91.2％,69.4％ and 52.8％.Seventeen cases withdrew from KD.Seven cases (41.2％)ceased KD becau~ of a lack of compliance,5 patients because of poor outcome,and 2 cases because of repeated infection.None of the age,disease duration,etiology and seizure type could be used as the predictor for the favourable treatment for outcome.The antiepileptic drugs before KD might be predicted the efficacy of the KD.The less amount of the antiepileptic drugs,the more opportunity of the KD might have to succeed.The side effects on the start-up period were drowsiness,week and digestive discomfort,hyperlipoidemia,hypoglycemia and hepatic dysfunction.The side effects on the maintenance period were digestive discomfort,susceptibility to infection,hyperlipoidemia,the deficiency of trace elements.Conclusions The KD is a safe and potentially effective method in treatment of refractory epilepsy patients who do not respond to customary medication therapies.

Objective To study the effect of cyclooxygenase-2 (COX-2)selective inhibitor Celecoxib on the expression of P-glycoprotein(P-gp)in the brain of rats with status epilepficus,in order to assess the therapeutic value of intractable epilepsy.Methods Sixty adult male SD rats were randomly divided into blank control group,the epilepsy model group and Celecoxib intervention group.The status epilepticus was induced in rats by injecting Lithium pilocarpine.Forty-eight rats were included in the experiment.There were 16 rats in each of the blank control group,epilepsy model group and Celecoxib intervention group,respectively.Immunohistochemical method and Western blot method were used to detect the expression of P-gp in experimental group in the frontal cortex and hippocampus.Results Immunohistochemistry result showed that the expression of P-gp was significantly higher in epilepsy model group than the blank control group,and the difference was statistically significant (P ＜ 0.01);The P-gp expression in the Celecoxib intervention group was lower than that in the epilepsy model group,and the difference was statistically significant (P ＜0.01).Western blot results suggested that the expression of P-gp could be found both in the frontal cortex and hippocampus in each group.Compared with the blank control group,the P-gp expression was significantly higher than that in the epilepsy model group,and the expression of the P-gp was lower after the Celecoxib intervention than that in the epilepsy model group,and the difference was statistically significant (P ＜ 0.05).Conclusions COX-2 inhibitor Celecoxib could decrease the expression of P-gp in brain tissue with status epilepticus,which may provide a new method for the treatment of intractable epilepsy.