Objective To investigate the damages on pancreas after different fractionated irradiation in rats.Methods Eighy healthy adult Wistar rats were randomly divided into four groups with 20 rats in each group as conventional fractionated irradiation group with 2 Gy per fraction to a dose of 12 Gy,hypofractionated radiation group with one fraction of 12 Gy,middle-dose fractionated radiation group with 6 Gy per fraction to a dose of 12 Gy in the interval of 4 days and control group without radiation.Changes in weight,fasting blood glucose and amylase were measured and morphological changes were observed in different periods.Results In the experimental groups,the reduction was observed in fasting glucose at 4 d,reached a minimum of (3.1 ±0.1 ) mmol/L,(LSD-t =20.06 -28.74,P ＜0.001 ) and the increase of amylase was found after 4th and 7th day,reached a maximum of (84.5 ±6.4) U/L(Dunnett's-t=23.10 -46.10,P ＜ 0.001 ),both more obvious in hypofractionated radiation group than those of conventional fractionated radiation group and middle-dose fractionated radiation group ( LSD-t =8.72-9.71,Dunnett's-t =7.11,P ＜ 0.05 ),however the levels in conventional fractionated radiation group was nearly to middle-dose fractionated radiation group (P ＞ 0.05 ) and became normal at 14 d.Under light microscope,the necrosis of acinarcells was observed in hypofractionated radiation group at 4th d,interstitial fibrogenesis were found at 14 d,the fibrogenesis were found in pancreatic island at 21 d,and the hyperplasia of acinarcells was observed at 42 d.The same changes were found in conventional fractionated radiation group and middle-dose fractionated radiation group,which were gently and lately than those of hypofractionated radiation group.Conclusions Radiation injury is not more serious after middle-dose fractionated radiotherapy than that after conventional fractionated irradiation,when the proper fractional dose and intervals are chosen.

Bladder cancer is a common malignant tumor in urinary system. The life quality of patients reduces obviously after radical resection of bladder. Comprehensive treatment including radiotherapy and chem-otherapy after bladder preservation surgery plays an important role for the prevention of postoperative recur-rence,preservation the function of bladder,and improving the life quality of patients. Image-guided radiothera-py can reduce the setup error and inner boundary caused by the movement of organs,and can alleviate the side reaction of radiation,and it also can provide basis of expanding boundary of planning target volume for the blad-der cancer patients.

Objective To analyze the clinical,muscle pathological features and molecular mutations in the 2 Chinese Han siblings with limb-girdle muscular dystrophy(LGMD) and conclude the phenotype/genotype correlations.Methods Clinical and muscle pathological data were collected.Genomic DNA of the two siblings and their parents were extracted using standard procedures from the peripheral leukocytes.A custom of targeted gene panel including 61 neuromuscular genes were designed by using the Agilent Sureselect Target Enrichment Kit.Targeted next generation sequencing(NGS) was performed in the proband,and CAPN3 gene mutation was verified with Sanger sequencing in the two siblings and their parents.The dbSNP138 and http://www.dmd.nl were searched to determine the disease-causing mutations.Results The proband slowly showed muscle weakness profoundly with pelvic muscles,developed difficulty in squatting and standing and climbing stairs.She had a tight Achilles tendon,high CK level (1 908-9 241 IU/L),without winging scapula and hypertrophy calf.The affected brother was only diagnosed hyper CKemia.By using the targeted NGS,the two siblings possessed the same two compound heterozygous mutations(c.717delT and c.2243G ＞ A) in CAPN3 gene.The two mutations both were verified by Sanger sequencing and had been reported before.Conclusions LGMD is clinically and genetically heterogeneous,and targeted NGS is powerful in defining the causal mutation of LGMD and helpful in investigating the exact genotype/phenotype analysis.

Objective To investigate the acute toxicity of intravenous isoflurane in Beagles.Methods Six healthy adult Beagles of both sexes aged 6-8 months weighing 6-8 kg were used in this study.Isoflurane injectio (120 mg/ml) in 30% hpid emulsion was injected intravenously. Femoral artery was cannulated for direct BP monitoring.ECG was continuously monitored.The maximal tolerance dose (MTD) and approximate lethal dose (ALD) were determined by up-and-down technique. The initial dose was 3.0 ml/kg. The dose was decreased/increased by 0.3 ml/kg if the previous animal died/survived.The survived dogs were observed for 2 weeks.Autopsy and histopathological examination were performed on all dead Beagles.Results The ALD and MTD of intravenous isoflurane were 252 and 216 mg/kg. Autopsy and histopathological examination did not show any abnormality.Conclusion Cardiopulmonary depression is the main manifestation of the acute toxicity of intravenous isoflurane in Beagles.

OBJECTIVETo summarize the clinical features of those Duchenne and Becker muscular dystrophy (DMD and BMD) patients who are complicated with epilepsy, and try to analyze the genotype- phenotype correlation.

METHODBy a retrospective analysis of 307 patients with DMD and BMD who attended Peking University First Hospital from February 2006 to September 2014,7 patients complicated with epilepsy were identified and their clinical data were collected. The possible mechanism of epilepsy in DMD and BMD patients was proposed after analyzing the genotype-phenotype correlation.

RESULT(1) Among 307 DMD and BMD patients, 7 cases had epilepsy, the prevalence was 2. 28%. (2) The age of onset of epilepsy ranged from 8 months to 11 years. Focal seizure was the most common seizure type (6 cases) , while other seizure types were also involved, such as generalized tonic-clonic seizure. As to epilepsy syndromes, 1 boy was diagnosed as benign childhood epilepsy with centrotemporal spikes (BECT). Six patients were treated with 1 or 2 types of antiepileptic drugs and seizures were controlled well. On follow-up, 6 of the 7 children had normal mental development, while the remaining 1 patient was diagnosed as mild mental retardation. (3) DMD gene mutations of all 7 patients were analyzed. Exons deletions were found in 6 cases while point mutation was found in 1 case.

CONCLUSIONThe prevalence of epilepsy in DMD and BMD patients was higher than the prevalence in normal population. The age of onset of epilepsy varies, and focal seizure may be the most common seizure type. Some patients may also present as some kind of epilepsy syndrome, such as BECT. In most patients, seizures can be controlled well by 1 or 2 types of antiepiletic drugs. No clear correlation was found between genotype and phenotype in DMD and BMD patients who were complicated with epilepsy, probably due to limited number of cases.

Anticonvulsants ; therapeutic use ; Child ; Epilepsy ; complications ; drug therapy ; epidemiology ; Exons ; Genotype ; Humans ; Intellectual Disability ; etiology ; Male ; Muscular Dystrophy, Duchenne ; complications ; genetics ; Mutation ; Phenotype ; Prevalence ; Retrospective Studies ; Seizures ; Sequence Deletion

Objective To summarize the clinical features of 22 probands diagnosed with congenital muscular dystrophy (CMD),and to provide genetic counseling and prenatal diagnosis for 23 fetuses of these pedigrees.Methods Data of 22 CMD patients who were treated in the Pediatric Department of Peking University First Hospital during October 2006 to March 2016 were analyzed.Informed written consents for participation in this study were obtained from the parents or guardians.Prenatal diagnosis was performed using DNA samples extracted from fetal villus cells of 12 cases at 11-13 gestational weeks and amniotic fluid of 11 cases at 18-22 gestational weeks.Direct DNA sequencing by polymerase chain reaction (PCR) and multiplex ligation-dependent probe amplification (MLPA) were used to detect CMD-related gene mutations.Linkage analysis of short tandem repeats (STRs) was used to identify maternal blood contamination and biological parents.Results Thirteen out of the 22 probands with CMD were diagnosed with congenital muscular dystrophy type 1 A (MDC1A),and all of them carried compound heterozygous mutations in LAMA2 gene.Prenatal diagnosis of 13 fetuses from these pedigrees found that four fetuses were wild-type,seven were heterozygotes and two carried the same mutations as their proband.Three probands with LMNA-related congenital muscular dystrophy (L-CMD) carried de novo mutations in LMNA gene.In these pedigrees,two fetuses were wild-type and one whose mother was mosaicism carried the same mutations as the proband.One proband with Ullrich congenital muscular dystrophy carried compound heterozygous mutations in COL6A2 gene and the fetus of the same pedigree was wild-type.Five probands were diagnosed with α-dystroglycanopathies.And among them,two cases of muscle-eye-brain disease (MEB) carried compound heterozygous mutations in POMGnT1 gene and the fetuses of the two peidgrees were heterozygotes;one case of congenital muscular dystrophy type 1C (MDC1C) had compound heterozygous mutations in FKRP gene and the fetus carried the same mutations;one patient diagnosed with POMGnT1-related congenital muscular dystrophy with mental retardation (CMD-MR) carried compound heterozygous mutations in POMGnT1 gene,and the fetus was positive for the same mutations;one proband with POMT1-related CMD-MR was positive for compound heterozygous mutations in POMT1 gene and the results of prenatal diagnosis for two fetuses of this pedigree showed that the first fetus had the same mutations as the proband,while the second was heterozygote.Conclusions No effective therapeutic method is available for CMD.Therefore,accurate genetic counseling and prenatal diagnosis are necessary to prevent CMD child from birth.

Objective: To investigate the clinical phenotypes and the mutant allele proportion of parents with SCN1A gene mutation mosaicism of Dravet syndrome (DS) children, thus to provide guidance for family reproduction and prenatal diagnosis. Method: The clinical data and peripheral blood DNA samples of DS patients with a SCN1A gene mutation proved by Sanger sequencing were collected prospectively from February 2005 to November 2016 in Department of Pediatrics, Peking University First Hospital. The same mutation was searched in parents and other available relatives. Parental somatic mosaicism was confirmed and quantified by Ion Torrent Personal Genome Machine (PGM) and Raindrop droplet digital PCR (ddPCR). The families were followed up and prenatal diagnosis was provided. Result: Mosaicisms of SCN1A gene mutation in parents were identified in 5.2% (30 out of 575) DS families. Seventeen were fathers and thirteen were mothers. The mutant allele proportion ranged from 1.7% to 32.9% by PGM and from 0.82% to 34.51% by ddPCR, respectively. In 30 parents with somatic mosaicism, thirteen were asymptomatic, ten had a history of febrile seizures (FS), five with epilepsy, one with febrile seizure plus and one had a history of afebrile seizure. Four families had two children with DS. Three siblings of the probands were confirmed genetically with the same pathogenic mutation. One deceased sister of the proband was assumed to have the same pathogenic mutation because she matched DS diagnosis after medical history review despite no blood sample. Two families received prenatal diagnosis. One second pregnancy was terminated because the fetus inherited the mutation as the mother's wish. Conclusion Sanger sequencing detects parents of some children with DS are SCN1A mutation mosaics. PGM and ddPCR can be used for accurate quantification of mutant mosaics, which can provide accurate guidance for family genetic counseling.

Objective: To investigate the spectrum of mutations in families with benign familial neonatal-infantile epilepsy (BFNIE) . Methods: Clinical data and peripheral blood DNA samples of all BFNIE probands and their family members were collected from Peking University First Hospital between December 2012 and April 2016. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protoco1. Mutations in PRRT2 were screened using Sanger sequencing. For families that PRRT2 mutations were not detected by Sanger sequencing, candidate gene mutations were further screened by next-generation sequencing for epilepsy. Results: A total of 7 families were collected. Of the 30 affected members, 15 were male and 15 were female. The age of epilepsy onset was from 2 days to 6 months. Genetic testing led to the identification of gene mutations in all families. One family had the PRRT2 hotspot mutation (c.649dupC). Three families had missense SCN2A mutations (c.2674G>A/p.V892I, c.2872A>G/p.M958V, and c.2627A>G/p.N876S) . Both c.2872A>G/p.M958V and c.2627A>G/p.N876S were novel SCN2A mutations. Three families had KCNQ2 mutations. Two of them had missense mutations (c.958G>A/p.V320I and c.998G>A/p.R333Q) . The KCNQ2 mutation c.958G>A/p.V320I was novel. One family had a gene deletion of KCNQ2, which also extended to the adjacent gene, CHRNA4; and the deletion involved all the exons of KCNQ2 and CHRNA4. Conclusions Mutations in KCNQ2, SCN2A, and PRRT2 are genetic causes of BFNIE in Chinese families. The detection rate for gene mutations is high in BFNIE families. KCNQ2 and SCN2A mutations are common in BFNIE families. SCN2A mutations (c.2872A>G/p.M958V and c.2627A>G/p.N876S) and KCNQ2 mutation (c.958G>A/p.V320I) are novel mutations.

Objective:To summarize the clinical phenotype and gene mutation characteristics of male patients with epilepsy caused by mosaic PCDH19 mutation. Methods:The clinical data of 3 male patients with epilepsy caused by mosaic PCDH19 mutation were analyzed.Microdroplet digital polymerase chain reaction (mDDPCR) was used for the detection of mosaicism in the three probands and their family members.Relevant literatures were reviewed. Results:The seizure onset age were 5 months, 9 months and 6 months of life respectively.Focal seizures occurred in 2 cases and multiple seizure types occurred in 1 case.Three patients presented with clusters of seizures.Fever sensitivity was observed in 2 cases out of the 3 cases.Two patients had intellectual disability and 1 patient had autistic manifestation.The clinical phenotype in 2 patient fulfilled the diagnosis of Dravet syndrome. PCDH19 mosaic mutations c. 317T>A(p.M106K), c.158dupT(p.D54Gfs*35) and c. 1639G>C(p.A547P) were detected respectively, and were identified as de novo after parental validation.Mutant allele fractions (MAF) in the blood samples were identified as 81.18%, 37.08%, 77.64%, respectively.The MAF of multiple tissues in 1 patient varied from 78.67% to 98.46%.Review of literature revealed that a total of 11 cases with mosaic PCDH19 mutation were reported.Among them, seizure onset occurred between 5 and 31 months of age.Focal seizures occurred in 9 cases, 3 cases of the 9 cases had only focal seizures.Generalized tonic clonic seizures occurred in 4 cases.Two or more seizures were observed in 6 cases.Clustering of seizures was found in all patient and sensitivity to fever was observed in 9 patients.Seven patients had mild to severe intellectual disability and 5 patients had autistic features. Conclusions:The clinical phenotypes of male patients with epilepsy caused by PCDH19 mosaic mutation are characterized by clustering of seizures, sensitivity to fever, focal seizures in most cases, varied degree of intellectual disability and autistic features in partial.

Objective To identify the rare causative genes of Dravet syndrome (DS) in patients who do not have SCN1A mutation and to analyze genotypes and phenotypes of DS patients with different rare causative genes.Methods DS patients were collected from the Pediatric Department of Peking University First Hospital from February 2005 to August 2016.SCN1A and PCDH19 gene mutations were screened by Sanger sequencing and multiple ligation-dependant probe amplification (MLPA).Next generation sequencing (NGS) for epilepsy-related gene-panel was applied to SCN1A and PCDH19 mutation-negative patients.The phenotypes of DS patients with different rare causative genes were analyzed.Results Six hundred and seventy patients with DS were collected and 556 patients (83.0％)carried SCN1A mutations and 6 patients with PCDH19 mutations.Epilepsy-related gene-panel was applied to remain 108 patients without SCN1A or PCDH19 mutation,and among them 12 patients were detected with 6 rare causative genes,with heterozygous mutations in GABRA1 mutations in 3,GABRG2 in 2 cases,GABRB2 mutations in 2 cases and SCN2A mutation in 1 case,complex heterozygous mutations in TBC1D24 in 2 cases and ALDH7A1 in 2 cases.The clinical phenotypes of 6 patients with PCDH19 mutations were featured by clustering of repeated seizures with short periods of times,only 1 case had an episode of status epilepticus.Patients with GABRB2 mutations had a relatively better outcome of seizure control.Many episodes of myoclonic status were emerging as hallmark features in patients with TBC1D24 mutations.Vitamin B had a dramatic therapeutic effect in patients with ALDH7A1 mutations.The clinical phenotypes of DS patients with GABRG2,SCN2A and GABRA1 had no obvious specificity.Conclusions The rare causative genes in DS patients include PCDH19,GABRG2,SCN2A,GABRA1,GABRB2,TBC1D24 and ALDH7A1.The finding of causative genes GABRB2 and TBC1D24 may enrich the gene spectrum of DS.Patients with PCDH19 mutations are featured by clustering of repeated seizures with short periods of time and rare status epilepticus.Patients with GABRB2 mutations have a relatively better outcome of seizure control.Many episodes of myoclonic status are emerging as hallmark features in patients with TBC1D24 mutations.