Status epilepticus basis for sustained duration and response to treatment can be divided into early status epilepticus,established status epilepticus,refractory status epilepticus and super-refractory status epilepticus. This article reviews the treatment approaches. Mainly conducted a systematic review for treatment strategy of refractory status epilepticus and super-refractory status epilepticus. Including pathogenic factors and cerebral damage analysis. It proposed super-refractory status epilepticus is an uncommon but important clinical problem with high mortality and morbidity rates. The published world literature on the following treatments is critically evaluated:anaesthetic a-gents,anti-epileptic drugs,magnesium infusion,pyridoxine,steroids and immunotherapy,ketogenic diet,hypothermia,e-mergency resective neurosurgery and multiple subpial transection,transcranial magnetic stimulation,vagal nerve stimula-tion,deep brain stimulation,electroconvulsive therapy,drainage of the cerebrospinal fluid and other older drug thera-pies. The importance of treating the identifying cause is stressed. And recommend protocols take a staged approach to treatment. A protocols and flowcharts for managing refractory status epilepticus and super-refractory status epilepticus are suggested.

Electroencephalogram(EEG) is necessary in diagnosis of status epilepticus (SE),particularly in non-convulsive SE with minor or atypical clinical manifestations.SE is a dynamic process,as seizures continue,in which EEG changed and appeared nonepileptic rhythm discharges.Ictal EEG patterns of SE are non-specific and different types of SE have different EEG features.In this paper,the EEG of different type SE will be summarized.

Objective To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups,and to offer theoretical basis for the clinic diagnosis of bacterial meningi-tis. Methods The sick children with bacterial meningitis treated in Guangzhou Women and Children′s Medical Center from January 2011 to June 2013,were recruited and divided into three groups according to the age,including newborns group,infants group and more than 1 year group. Eighty-nine cases with purulent meningitis were recruited,included 58 males and 31 females. Among them,there were 34 cases in the newborns group,41 cases in the infants group and 14 ca-ses in the more than 1-year group. The information on the clinical features,laboratory examination and the imaging ex-amination were summarized and analyzed,and were compared among the 3 groups. Results (1)Among them,54 cases with high fever,44 cases with respiratory symptoms,12 cases with alimentary tract symptoms. (2)The major neurologi-cal features included convulsions(44 cases,49. 4%),fatigue(36 cases,40. 4%),vomiting(21 cases,23. 6%),cervical rigidity(9 cases,10. 1%),fontanel full(7 cases,7. 9%),headache(6 cases,6. 7%),limb paralysis(5 cases,5. 6%). The percentage of high fever,vomiting,headache,cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10. 093,12. 063,34. 466,7. 177,all P<0. 05). (3)Among them,whitebloodcell(WBC)accountswerefrom2.20to60.60×109/L,themeanwas(16.49±10.37)×109/L.Hy-persensitive C-reaction protein concentration in blood was 4. 00 to 376. 53 g/L,the mean was (131. 07±86. 91) g/L. In cerebrospinal fluid(CSF),WBC accounts were from 1 to 21 800×106/L,the mean was (910. 05±274. 07)×106/L, the glucose concentration from 0. 00 to 4. 50 mmol/L,the mean (1. 72±1. 03)mmol/L,the protein concentration from 0. 42 to 4. 89 g/L,the mean was(1. 64±1. 03)g/L. In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0. 4, and 15 cases with blood cultures positive. (4)The image examination showed magnetic resonance imaging( MRI) abnormalities in 51/75 cases,computerized tomography( CT) scan abnormalities in 15/30 cases. The percentage of convulsions,the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11. 768,9. 047,7. 674,all P<0. 05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7. 430,5. 291,all P<0. 05). Conclusions Be-cause of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be per-formed in all doubtful cases who had a fever and/or seizure. CSF glucose less than or equal to 0. 4 of simultaneously ob-tained blood glucose value,the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis,if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.

Objective To study the effect of anterolateral calf flap with extra-territorial blood supply in repairing large area of foot skin tissue injury. Methods 40 cases of arge area of foot skin tissue injury were divided into the observation group which were given anterolateral crural flap transplantation and the control group which were given anterolateral thigh flap transplantation. The wound healing condition and walking ability were observed. Results The level of wound healing, Holden walking ability and FAC walking ability were better than control group (P<0. 05). In the observation group, wound healing time was (15. 2 ± 6. 2) d and donor skin crusting time was (9. 4 ± 1. 5) d, which were less than the control group(P<0. 05). Conclusion Anterolateral calf flap with extra-territorial blood supply has positive clinical value as it can improve wound healing and walking function.

Objective To investigate the effect of propofol and midazolam anesthesia in the treatment of persistent state of intractable epilepsy in children.Methods A total of fifty children with intractable epilepsy were selected in Guangzhou Women and Children''s Medical Center from May 2011 to May 2016,and were divided into propofol group and midazolam group according to the method of anesthesia,each group 25 cases.In the treatment,continuous EEG and ECG monitoring were applied in both groups,and the changes in hemodynamics were recorded in order to compare the medication and treatment effects.Results After epilepsy was under control and drug was withdrawn,the heart rate (HR),systolic pressure (SBP),diastolic pressure (DBP) of the two groups were all reduced,lower than the data collected before the treatment,the differences were statistically significant (P<0.05);in the propofol group,HR and SBP after control were (93.21±17.61) time/min and (92.44±12.84) mmHg (1 mmHg=0.133 kPa),lower than those of the midazolam group((109.84±18.41) time/min,(101.93±14.79) mmHg,t=3.264,2.423,P<0.05);the medication time,control time,intubation time of the propofol group were all shorter than those of the midazolam group ((13.21±2.14) h vs.(15.39±3.39) h,(3.47±0.89) min vs.(8.79±1.21) min,(2.03±0.79) d vs.(6.31±1.34) d,t=2.719,17.709,13.757,P<0.05);the total effective rate in the propofol group was significantly higher than that of the midazolam group (97.5%(39/40) vs.82.5%(33/40),χ2=5.357,P=0.021).Conclusion Propofol is effective in the treatment of persistent state of intractable epilepsy in children with good sedative effect,and can also reduce children''s resistance,therefore it''s worth promoting and applying into treatment.

Objective:To explore the feasibility and safety of the prophylactic optic canal decompression in frontol-orbital fibrous dysplasia surgery by three-dimensional simulation design and computer assisted navigation.Methods:A retrospected study was conducted in Huashan Hospital affiliated to Fudan University.Patients with stable fronto-orbital fibrous dysplasia were recruited from January 2016 to June 2020. Preoperatively, three-dimensional simulation design was used to design the scope of resection. Then a subtotal resection of fibrous dysplasia lesion was performed by computer assisted navigation and reshaping of the orbit rim was achieved by preserving the fronto-orbital bandeau. Meanwhile, the intracanal and intraorbital parts of optic nerve canal decompression was performed. Follow-up of the pre-op and post-op difference of the frontal bulge point, the lateral forehead point and orbitofrontal point of the affected side, the degree of proptosis, visual acuity and fundus were analyzed by paired t test. Results:A total of 7 patients were recruited, including 2 males and 5 females, with an average age of 22.5 years. The average follow-up time was 11.4 months, and the difference in exophthalmos between the two sides improved from an average of (6.7±1.6) mm before operation to an average of(2.9±1.1) mm at 6 months after operation, which was statistically significant ( P<0.001). The difference between the pre-op and post-op of the frontal bulge point on the affected side also improved from (18.1±3.4) mm before surgery to (3.1±3.5)mm( P=0.001) immediately after surgery and (4.0±3.6) mm( P=0.001)at 6 months after surgery. The difference of lateral forehead point improved from(21.4±4.1) mm before surgery to (1.8±1.9) mm( P<0.001) immediately after surgery and (2.5±2.1) mm( P<0.001) at 6 months after surgery, and the difference of orbitofrontal point improved from(12.2±2.5) mm before surgery to (2.3±3.0) m( P=0.004) immediately after surgery and (2.7±2.9) mm( P=0.006) at 6 months after surgery. The average uncorrected visual acuity of the affected side before operation was 4.5, and it was 4.6 6 months after operation, with no statistical difference( P>0.05). Conclusions:Using 3D simulation to design the scope of resection and computer assisted navigation to decompress the optic canal in patients with stable fronto-orbital fibrous dysplasia, which can safely and effectively protect the optic nerve and accurately improve the frontal-orbital shape.

Objective:To explore the feasibility and safety of the prophylactic optic canal decompression in frontol-orbital fibrous dysplasia surgery by three-dimensional simulation design and computer assisted navigation.Methods:A retrospected study was conducted in Huashan Hospital affiliated to Fudan University.Patients with stable fronto-orbital fibrous dysplasia were recruited from January 2016 to June 2020. Preoperatively, three-dimensional simulation design was used to design the scope of resection. Then a subtotal resection of fibrous dysplasia lesion was performed by computer assisted navigation and reshaping of the orbit rim was achieved by preserving the fronto-orbital bandeau. Meanwhile, the intracanal and intraorbital parts of optic nerve canal decompression was performed. Follow-up of the pre-op and post-op difference of the frontal bulge point, the lateral forehead point and orbitofrontal point of the affected side, the degree of proptosis, visual acuity and fundus were analyzed by paired t test. Results:A total of 7 patients were recruited, including 2 males and 5 females, with an average age of 22.5 years. The average follow-up time was 11.4 months, and the difference in exophthalmos between the two sides improved from an average of (6.7±1.6) mm before operation to an average of(2.9±1.1) mm at 6 months after operation, which was statistically significant ( P<0.001). The difference between the pre-op and post-op of the frontal bulge point on the affected side also improved from (18.1±3.4) mm before surgery to (3.1±3.5)mm( P=0.001) immediately after surgery and (4.0±3.6) mm( P=0.001)at 6 months after surgery. The difference of lateral forehead point improved from(21.4±4.1) mm before surgery to (1.8±1.9) mm( P<0.001) immediately after surgery and (2.5±2.1) mm( P<0.001) at 6 months after surgery, and the difference of orbitofrontal point improved from(12.2±2.5) mm before surgery to (2.3±3.0) m( P=0.004) immediately after surgery and (2.7±2.9) mm( P=0.006) at 6 months after surgery. The average uncorrected visual acuity of the affected side before operation was 4.5, and it was 4.6 6 months after operation, with no statistical difference( P>0.05). Conclusions:Using 3D simulation to design the scope of resection and computer assisted navigation to decompress the optic canal in patients with stable fronto-orbital fibrous dysplasia, which can safely and effectively protect the optic nerve and accurately improve the frontal-orbital shape.

With the dramatically increasing detection rate of ground-glass nodules (GGN), exact understanding and treatment strategy of them has become the hottest issue currently. More and more studies have begun to explore the underlying mechanisms of their indolent characteristics and favorable prognosis from the perspectives of molecular evolution and immune microenvironment. GGN has different dominating gene mutations at different evolutional stages. The pure GGN has a lower tumor mutation burden and genomic instability, while a gradually evolutionary feature of genomic mutation along with the pathological progression can be observed. GGN has less infiltration of immune cells, and they are under the pressure of immune surveillance with weakened immune escape. With the increase of solid components, an inhibitory immune microenvironment is gradually established and immune escape is gradually enhanced, leading to rapid tumor growth. Further exploration of the molecular characteristics of GGN will help to more precisely distinguish these highly heterogeneous lesions, which could be helpful to make personalized treatment plans.

With the dramatically increasing detection rate of ground-glass nodules (GGN), exact understanding and treatment strategy of them has become the hottest issue currently. More and more studies have begun to explore the underlying mechanisms of their indolent characteristics and favorable prognosis from the perspectives of molecular evolution and immune microenvironment. GGN has different dominating gene mutations at different evolutional stages. The pure GGN has a lower tumor mutation burden and genomic instability, while a gradually evolutionary feature of genomic mutation along with the pathological progression can be observed. GGN has less infiltration of immune cells, and they are under the pressure of immune surveillance with weakened immune escape. With the increase of solid components, an inhibitory immune microenvironment is gradually established and immune escape is gradually enhanced, leading to rapid tumor growth. Further exploration of the molecular characteristics of GGN will help to more precisely distinguish these highly heterogeneous lesions, which could be helpful to make personalized treatment plans.

Objective:To explore the feasibility and safety of the prophylactic optic canal decompression in frontol-orbital fibrous dysplasia surgery by three-dimensional simulation design and computer assisted navigation.Methods:A retrospected study was conducted in Huashan Hospital affiliated to Fudan University.Patients with stable fronto-orbital fibrous dysplasia were recruited from January 2016 to June 2020. Preoperatively, three-dimensional simulation design was used to design the scope of resection. Then a subtotal resection of fibrous dysplasia lesion was performed by computer assisted navigation and reshaping of the orbit rim was achieved by preserving the fronto-orbital bandeau. Meanwhile, the intracanal and intraorbital parts of optic nerve canal decompression was performed. Follow-up of the pre-op and post-op difference of the frontal bulge point, the lateral forehead point and orbitofrontal point of the affected side, the degree of proptosis, visual acuity and fundus were analyzed by paired t test. Results:A total of 7 patients were recruited, including 2 males and 5 females, with an average age of 22.5 years. The average follow-up time was 11.4 months, and the difference in exophthalmos between the two sides improved from an average of (6.7±1.6) mm before operation to an average of(2.9±1.1) mm at 6 months after operation, which was statistically significant ( P<0.001). The difference between the pre-op and post-op of the frontal bulge point on the affected side also improved from (18.1±3.4) mm before surgery to (3.1±3.5)mm( P=0.001) immediately after surgery and (4.0±3.6) mm( P=0.001)at 6 months after surgery. The difference of lateral forehead point improved from(21.4±4.1) mm before surgery to (1.8±1.9) mm( P<0.001) immediately after surgery and (2.5±2.1) mm( P<0.001) at 6 months after surgery, and the difference of orbitofrontal point improved from(12.2±2.5) mm before surgery to (2.3±3.0) m( P=0.004) immediately after surgery and (2.7±2.9) mm( P=0.006) at 6 months after surgery. The average uncorrected visual acuity of the affected side before operation was 4.5, and it was 4.6 6 months after operation, with no statistical difference( P>0.05). Conclusions:Using 3D simulation to design the scope of resection and computer assisted navigation to decompress the optic canal in patients with stable fronto-orbital fibrous dysplasia, which can safely and effectively protect the optic nerve and accurately improve the frontal-orbital shape.