OBJECTIVE:To analyze the medico-ethical problems of epilepsy from Medi-ethics and its effect on improving the quality of life of the persons with epilepsy.DATA SOURCES:Articles were computer-searched from Chinese Journal of Medico-ethics, Chinese Journal of Clinical Neurology, Chinese Medical Journal, Chinese Journal of NeuroMed, Chinese Journal of Nerval Mental Disorder from January 1989 to December 2004 with the key words of "epilepsy, medico-ethics and social discrimination". And the language was restricted to Chinese. And we also selected two books, which were Bioethics written by Shen Ming-xian, and The Prevention and Therapy of Epilepsy written by Zhou Zheng-xin for reference.STUDY SELECTION: From all the preliminarily screened papers, 98 papers were obtained related to epidemiology, sociology and ethics.DATA EXTRACTION: Repeated and similar papers were excluded. 10 papers and books were selected from the 98 papers, which touched upon the problems of the epileptics and their life quality. The 10 papers have involved many cross discipline subjects, such as Bioethics, Medico-ethics,and Socio-ethics, which provided more concern about the epileptics from multiple directions.DATA SYNTHESIS: Ethics indicate the principles and guidelines for relationships between people. The ethics explored here refer to normative ethics. Generally, the basic ethical principles are: respect, beneficialness,balance and justice. Since some epileptic patients lack in the knowledge of epilepsy and proper treatment and suffer from discrimination in the health care, more untreated and non-proper treatment, doctors and nursing persons should take the attitude of being beneficial to the patients. Medication for the epileptics, especially the female patients at the first period of pregnancy, the incidence of the deformed children was high. Should the principle of beneficence be applied to mothers or children? The number of the operative treatment was more and more in patients with epilepsy, while surgery itself is a risk behavior .If there is no better method to choose, and all the available choices have their advantage and disadvantages. Physicians can only choose the better one from the two kinds of harm, trying to make the patientssuffer the least harm with the largest effect. Aggressive behaviors can be observed during seizure or unconsciousness state. Controlling the moving range of the patients with epilepsy consciously is in accord with the general ethical behavior, on the contrary, confinement disobeys the morals and the curative effect is not good. The extreme behavior of the patients with epilepsy is suicide and occurred more in unemployed, unmarried and living alone, male, and patients with mental disorders in epilepsy. The direct reasons of suicide are unemployment, low social status, and little understanding and care from their communities, families and friends.The sensible ethical principle for epileptics is to treat the patients as normal people in the society.CONCLUSION: Epileptic crowd need care from the society, family and other factors. Proper considering ethical principle in treating the population is the humane solicitude and to help the patients regain health and improve the life quality.

Objective Focal nodular hyperplasia(FNH) is composed of multiple hyperplastic liver cell nodules,but its pathogenesis has not been elucidated. Foci (FAH) or nodules of altered hepatocytes (NAH) are precursors of hepatocellular adenoma (HCA) and carcinoma.This study aimed at identifying FAH and NAH from FNH and evaluating their role in FNH development.Methods 6 FNH lesions from 5 patients and 10 HCA from 9 patients were examined histologically,and expression levels of CD_(34) cytokeratin 19(CKl9) and Ki-67 antigen were demonstrated immunohistochemicailly.Proliferative activity was evaluated by Ki-67 antigen-labeling indices(Ki-67 LI).Results Multiple FAH and NAH were identified in all of the 6 FNH lesions. Whiie micmvasculatures were demonstrated by CD_(34) immunoreactivity in both HCA and FNH,their density and distribution were different in these two lesions,being diffuse in HCA and focal or nodular,mainly within NAH.CKl9 expression Was found in FNH,localized in ductal and ductular cells,but not within NAH and HCA.Average Ki.67 LI of 73 NAH(2.8%) was shown to be higher than that of the whole FNH lesions (0.6%),and had no statistieal difference comparable to that of HCA(1.8%).Conclusion Muhiple NAH are present in all classical FNH lesions.Unlike the surrounding parenchyma,NAH lesions are more proliferative and equipped with CD_(34)-positive microvasculatures as in HCA.

Objective To explore the effect of Toll-like receptor 4 (TLR4) on the peripheral blood mononuclear cells(PBMCs) in the development of rheumatoid arthritis (RA) by inducing the differentiation of Th17 cells.Methods Forty two subjects were recruited to the study,including 22 patients with RA and 20 healthy controls (HC).The percentage of circulating Th17 cells were analyzed using flow cytometry.PBMCs were stimulated with LPS for two days.TLR4 mRNA of the PBMCs and the concentration of IL-6 and TNF-α in the supernatants were analyzed with the real-time qPCR and ELISA respectively.Supematants was then used for CD4+ cord blood mononuclear cells (CBMCs) culture,and IL-17 in the supernatants and the expression of IL-17 mRNA in cells were detected by ELISA and real-time qPCR respectively.The statistical analysis was carried out with t-test.Results The TLR4 mRNA expression in the PBMCs and the percentage of circulating Th17 ceils of RA patients were significantly higher than that of the HC group (P＜0.01).Stimulated by LPS,the expression of TLR4 mRNA increased 3.5 times in the RA group but decreased 0.11 times in the HC group.LPS also increased cytokines production in both groups,while PBMCs from RA patients produced more IL-6 and TNF-α than the cells from healthy subjects (P＜0.01).Compared to the HC group,the IL-17 mRNA expression and IL-17 secretion of CD4+ CBMCs induced by the supematants of RA patients' PBMCs stimulated with LPS was significantly higher(P＜0.01 ); but there was no significant difference between the RA group and the HC group without LPS stimulation (P＞0.05).Conclusion The expression of TLR4 on PBMCs from patients with RA and its response to LPS stimulation are increased,and it has demonstrated high capability in inducing the differentiation of Th 17 cells.

Objective To describe the development of nodules of altered hepatocytes (NAH) in chronic hepatitis B and to reveal progression of the nodules to hepatocellular carcinoma (HCC). Methods HCC, NAH and ordinary regenerative nodules (ORN) were identified and compared histologically. Expression levels of hepatitis B virus (HBV) antigens, mitoactivity and p53 accumulation in these lesions were evaluated by immunohistochemistry. Results Multiple foci of altered hepatocytes (FAH) and NAH were identified in the liver parenchyma surrounding HCC in all of the samples examined. Sequential architectural and cellular changes were observed during the progression of FAH to NAH and HCC. Expression levels of HBV surface and core antigens were found to be significantly decreased in ORN, NAH and HCC, with their positive rates being 70 % (35/50), 50 % (25/50), 10 % (5/50) and 60 % (30/50), 40 % (20/50), 6 % (3/50), respectively (P ＜0.05). Ki-67-1abelling indices were determined to be (0.58±0.49) %, (2.46±1.05) % and (40.36±26.27) %in these lesions, respectively (P ＜0.05). Nuclear p53 accumulation was found only in HCC. Its occurrence was associated to a high histological grade, with its frequencies being 13 % (1/8), 41% (11/27) and 73 % (11/15)in grade 1, 2 and 3 lesions, respectively. Conclusion NAH lesions, identified by their morphologic features and mitoactivity elevation, are detectable in resected liver samples with chronic hepatitis B and cirrhosis. They represent a common HCC precursor and can be used as a surrogate marker for the surveillance of high-risk individuals.

Objective To study the clinic imaging features and the clinic applications of the contrastenhanced ultrasound(CEUS) in the diagnosis of gallbladder carcinoma.Methods The characteristics of CEUS were reviewed in 24 patients with gallbladder carcinoma proven pathologically. Results After injection of SonoVue, all gallbladder carcinoma of 24 cases showed enhancement and these lesions looked clearer than those in conventional ultrasound.The analysis of time-intensity curve indicated the upslope of curve was steep in the lesions,which was flat in normal liver parenchyma around.In 10 cases of thick wall of gallbladder carcinoma, quick and obvious enhancement was seen in 9 cases, 1 case showed poor enhancement during scanning,but thick and tortile blood vessels could be seen in the thickening wall.Quick and uneven enhancement was been seen in both 8 cases of soft-tissue mass and 6 cases of nodules within gallbladder.Five cases of gallbladder carcinoma with liver metastasis revealed more liver metastasis depend on CEUS.Conclusions CEUS plays an important role in diagnosis and improving the diagnostic accuracy for gallbladder carcinoma.

Objective To evaluate the diagnostic value of thyroid microcarcinoma using contrastenhanced ultrasound(CEUS).Methods The CEUS characteristics of 31 lesions in patients with thyroid microcarcinoma which were confirmed by surgery and pathology were retrospectively analyzed.[Results]The enhancement features of 31 lesions were hypoenhancement,morphological irregularity,and lack of a complete envelope.The time intensity curve showed late washed in and late washed out.The start-time of the lesions was later than that of normal thyroid tissue.The enhancement intensities of the lesions were lower than that of normal thyroid tissue.Conclusions The contrast enhancement patternshypoenhancement,suggested that the CEUS might provide a useful,quantitative analysis method for the diagnosis of thyroid microcarcinoma,which can improve diagnostic confidence in thyroid microcarcinoma.

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE MRA) in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ (923/945) in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows:proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC(area under ROC curve) of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

Objective To explore the sensitivity of contrast-enhanced ultrasound (CEUS) and ultrasonic elastography(UE) in detecting different sizes of thyroid papillary carcinoma.Methods 64 cases of thyroid papillary carcinoma were divided into two groups according to the diameter size(group 1,≤1 cm;group 2,＞ 1 cm) and examined by the contrast-enhanced ultrasound and elastography,then the features were analyzed and the sensitivity for detecting of the two methods in different groups were compared.Results The sensitivity for detecting in CEUS was higher than in UE,which had significant difference between two methods.CEUS and UE were valuable for detecting and they had no difference in sensitivity for detecting in group 1.There was a significant difference in sensitivity for detecting between two methods in group 2.Conclusions Both CEUS and UE were valuable in diagnosis of thyroid papillary carcinoma and the sensitivity for detecting in CEUS is higher than in UE in group 2.

Objective To explore the effect of early stage of comprehensive lung rehabilitation on cervical spinal cord injury in patients with mechanical ventilation.Methods The patients with cervical spinal cord injury admitted from January to December 2015 were selected as the control group which was treated with routine nursing measures.The patients with cervical spinal cord injury admitted from January to December 2016 were selected as the treatment group,which received early stage lung rehabilitation measures.We compared two groups of patients in the using time of breathing machine,the total length of hospital stay and pulmonary infection rate.Results The duration of mechanical ventilation and hospitalization days in the control group were(13.98±11.11),(25.10±16.98)d,which were higher than those in treatment group[(7.23±4.94),(16.26±6.41)d](P<0.05).The infection rates of control group and treatment group were 76.19％and 52.38％respectively,and the difference was significant(P<0.05).Conclusion In the early stages comprehensive pulmonary rehabilitation measures for mechanical ventilation in patients with cervical spinal injury can shorten the breathing machine use time and the total hospitalization days,and reduce pulmonary infection rate.