Objective To analyze the clinical characteristics and curative effects of myoclonic epilepsy in children. Methods 35 cases were used to retrospectively study to analyze the medical history、clinical features and treatments.Results 7 patients(20%) had a family history of epilepsy while 11 cases(31.4%) had a history of febrile convulsion.The first onset was about at the age of 8.0?2.4. The first onset of myoclonic seizure and generalized tonic-clonic seizure would be put off and the diagnostic time would be delayed by 3.4 years.EEG induced by sleep and/or flash could raise the epileptic detectable rate.6 children had a tendency to be aggravated during the treatment.2 cases died of severe myoclonic epilepsy.28 patients(80%) were treated only by sodium vedproate and the effects were satisfying.Conclusion It is easily wrongly diagnosed and treated. Taking small dose of sodium vedproate drugs,the patients have better treatment effects.The children with severe myoclonic epilepsy have poor prognosis and high death rate.

Objective To compare target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia and intravenous combined with inhalation anesthesia in hemodynamic changes and side effects in elderly patients with laparoseopic cholecystectomy.Methods 56 ASA Ⅰ-Ⅱ patients aged ＞60 Y undergoing elective laparoscopie cholecystectomy were randomly divided into propofol-remifentanil target controlled infusion group (observation group)(n=28)and inhalation anesthesia group(using intravenous anesthesia was maintained with isoflurane inhalation)(n=28).HR,SBP,DBP,PETCO2,initial consciousness time,extubation time,side-effects were recorded at each time points.Results The change extent of HR and blood pressure in observation group was lower than inhalation anesthesia group.The initial recovery time,recovery time of spontaneous breathing and extubation time in the observation group Was better than anesthesia group(all P＜0.05).The side-effects in observation group were significantly lower than inhalation anesthesia group(all P＜0.05).Conclusion Laparoscopic cholecystectomy in elderly patients by target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia could significantly inhibit the stress response,and effectively maintain the stability of hemodynamic,and rapid postoperative recovery,fewer adverse reactions.It Was an ideal anesthesia methods in elderly patients with laparoscopic cholecystectomy.

Objective To explore the clinical effect and safety of bisoprolol combined with methimazole in treatment of hyperthyroidism.Methods 100 cases with hyperthyroidism were randomly divided into control group (methimazole treatment)50 case.$and treatment group(bisoprolol combined with methimazole treatment)50 cases.The therapeutic effect,serum levels of FT3,FT4 and s-TSH were observed.Results The total effective rate in treatment group 92.0% was significantly higher than 78.0%in control group(χ2=3.798,P＜0.05);The contents of TT3,TT4,FT3,FT4 after treatment were lower than before treatment(t=2.245,2.315,2.411,all P＜0.05);The contents of S-TSH was higher than before treatment(t=2.335,P＜0.05);Hyperthyroidism exponential integral in treatment group decreased significantly than the control group(t=2.312,P＜0.05).Conclusion The bisoprolol combined with methimazole treatment could efficiently improve clinical symptoms,raise therapeutic effect in patients with hyperthyroidism.

OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P<0.05). After PCI,occluded artery of 2 groups opened up,there were 2 cases of no-reflow in early stage group and 6 cases of no-re-flow;there was no statistical significance in 3 grade blood flow of TIMI between 2 groups(χ2=1.21,P>0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.

Guidelines of the American Thyroid Association (ATA) proposed two diagnostic criteria for subclinical hypothyroidism during the first trimester of pregnancy:criterion 1 was based on the pregnancy-specific TSH reference range and criterion 2 on serum TSH＞2.5 mIU/L level with normal serum FT4.According to the results of the Subclinical hypothyroidism during early pregnancy study,author proposed that criterion 2 is not appropriate for Chinese pregnant women because the TSH concentration has become significantly higher in whole Chinese population.By using criterion 2,the prevalence may be as high as 27.8％,which may result in over-diagnosis and over treatment.

Objective To detect and analyze the insulin resistance and islet beta cell function under different glucose metabolic state in the elderly.Methods 30 cases with impaired fasting glucose (IFG),impaired glucose tolerance (IGT),IFG plus IGT,diabetes mellitus (DM) and normal glucose tolerance (NGT) respectively were selected.The HOMA model was adopted for assessing insulin resistance and islet beta cell function.Results Insulin resistance index (HOMA-IR) was higher in IFG group (1.16±0.03) than in NGT group (0.87±0.03) (P＜0.05).The HOMA-IR was higher in IFG and IGF groups than in NGT group (both P＜0.05).The insulin secretion index (HOMA-IS) was lower in DM (3.95±0.06) than in NGT (5.15±0.05),IGT (5.13±0.03) and IFG (4.56 ± 0.07) groups (all P＜0.05).There was no significant difference in the HOMA-IS between IGT and NGT groups.Conclusions The IFG patients mainly present the defect in insulin secretion,and the IGT patients mainly present insulin resistance.With the deterioration of glucose metabolism,insulin resistance increases and islet beta cell function decays gradually.

Objective To analyze distribution of human papilloma virus(HPV) subtypes in women infected by HPV in Guigang area ,and to determine the dominant type in this region .Methods 21 genital HPV genotypes were screened in 13 156 women in out‐patient clinic in Guigang area from July 2013 to July 2014 by using rapid flow‐through hybridization technique of nucleic acid mole‐cules ,and high‐risk HPV detection and typing was carried out for screening cervical cancer .Results A total of 4 682 HPV‐positive women were identified and the infection rate was 35 .59% .All of 21 genetypes were checked out ,dominated by single infection .The percentages of HPV genotypes from high to low was HPV‐52 (16 .28% ) ,HPV‐16 (14 .01% ) ,HPV‐58 (8 .48% ) ,HPV8304 (7 .58% ) ,HPV‐6(6 .79% )and HPV‐11(5 .72% ) .Conclusion The dominant genetype of HPV of women in this area is HPV‐52 .

Objective To investigate the causes and methods of clinical treatments on pregnancy combined with thrombocytopenia.Methods A retrospective analysis received 56 cases of pregnant women with thrombocytopenia purpura maternal (group A),compared with the same period 56 cases of normal pregnancy (group B),the situation of childbirth,newborns and pregnancy result were observed.Results In group A maternal bleeding was 12.5 ％,significantly higher than 3.6％ in group B(x2 =3.4356,P ＜ 0.05),and there was a statistically significant difference in the other group A vaginal delivery maternal bleeding rate of 3.4％,lower than 26.1％ of the rate of cesarean section bleeding(P ＜ 0.05).Neonatal mortality,intracranial hemorrhage number of cases,thrombocytopenia example number three in group A were higher than those in group B(x2 =3.8796,3.4556,3.4676,all P ＜0.05).Conclusion Pregnancy with thrombocytopenic purpura is a serious threat on mother and child,which are likely to lead the mother child thrombocytopenia,intracranial hemorrhage and maternal or fetal death.

Guidelines on the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Carcinomas is written by Chinese Society of Endocrinology,Chinese Society of General Surgery Endocrinology Group,China Anti-Cancer Association Head and Neck Tumor Professional Committee,and Chinese Society of Nuclear Medicine.The guideline has systematically established a series of standards related to thyroid nodules.It reflects the scientific spirit of multidisciplinary cooperation and mutual understanding.

Objective:To evaluate the present development and service offering of community health service(CHS) institutions in Chongqing City,to find the main problems at present,and provide the solving proposal.Methods:All the CHS institutions in 35 counties of Chongqing were surveyed;the CHS institutions of main city zone were investigated by stratified random sampling,and their principals were interviewed.Results:The new health service system of two levels have been established,but there are still several problems.The total number of CHS institutions is inadequate.Foundational construction of CHS station is not good.It's widespread that CHS institutions support their medicine sevice with drugs-income and their public heath sevice with medicine-income.The public health sevice is weakened.For the dual referral system,it's easy to refer up and hard to refer down.Conclusion:At present government should increse finance aid,improve management and monitor mechanism,strengthen the foundation construction,and further consummate the training system of personnel,and a GIS System should be built to help improve the Dual Referral System.