10.3969/j.issn.1000-3606.2013.06.022

Increased intracranial pressure is one of the most severe complications with significant mortality in children,so early diagnosis and treatment of this disorder is critical to save the patient's life.This article reviews etiologies,pathophysiology,and general principles of diagnosis and management of increased intracranial pressure.Based on primary diseases and clinical presentations,the goal of therapeutic strategy is to decrease intracranial pressure,avoid neurologic sequelae,and improve the outcome in patients.

Vaccination in children suffering neurological diseases is a troublesome issue that people es-pecially pediatricians are reluctant to mention. Due to worrying about the emergence of adverse reactions and concerning on the heat induced seizure,doctors and parents tend to cancel or do not recommend these children to be vaccinated. Additionally,the heat sensitive seizures,such as febrile seizure( FS) ,generalized epilepsy with fe-brile seizure plus(GEFS+),Dravet syndrome account for the largest proportion of the seizure related disease and epilepsy syndrome. Their pathogenesis has been proved relating to the mutation of SCN gene of the sodium channel. For children with FS,GEFS+,and Dravet syndrome,vaccination may lead to fever,which even may bring about convulsions,but it will not result in worse prognosis.

Objective To investigate the influence factors of cognitive impairment in epilepsy children with less than 6 years old. Methods Eighty-nine epilepsy children with less than 6 years old were selected. The neuropsychological detection was tested by Gesell developmental diagnostic scale (GDDS), and head imaging examination (CT or MRI) and ambulatory electroencephalogram (EGG) were checked. Results The scores of adaptive behavior, big sports behavior, fine motor behavior, language behavior and personal- social behavior were (82.98 ± 14.02), (85.86 ± 13.79), (83.14 ± 13.44), (84.75 ± 3.29) and (84.99 ± 14.37) scores, the average development quotient of the children with epilepsy were greater than 75 scores, and there were no statistical differences among them (P > 0.05). According to the test results of adaptive behavior, big sports behavior, fine motor behavior, language behavior and personal-social behavior, the rates of developmental delay children were 21.35% (19/89), 19.10% (17/89), 16.85% (15/89), 24.72% (22/89) and 22.47% (20/89), and the rates of moderate to severe developmental delay were 3.37% (3/89), 3.37% (3/89), 4.49% (4/89), 3.37% (3/89) and 3.37%(3/89). Multivariate analysis results showed that first onset age of epilepsy and head imaging performance were correlated with adaptive behavior, big sports behavior, fine motor behavior and personal-social behavior (P < 0.05). Conclusions The first onset age of epilepsy and head imaging performances are the major factors in cognitive performance in epilepsy children with less than 6 years old, so clinical attention should be paid to improve the prognosis of cognitive outcome of epilepsy children, and improve their life quality.

Objective To explore clinical features and misdiagnosis reasons in mitochondrial encephalomyopathy,lactic acidosis,and stroke-like episodes (MELAS) syndrome.Methods The results of clinical data,brain magnetic resonance imaging (MRI),and the course of diagnosis were analyzed in 6 patients with MELAS.Results (1) Clinical features:headache and vomiting were the starting symptoms in 4 of 6 cases,and developmental delay was initial symptoms in 2 of 6 cases.Marasmus occurred in 6 cases,seizure in 5 cases,fever in 3 cases,and hirsutism and visual impairment in 2 cases.(2) Experimental results:blood lactic acid was higher in 6 (4.28 ～ 10.3 mmol/L).(3) Brain MRI:6 patients had abnormal signals in parietal,occipital,temporal lobe,which were not in accordance with vascular distribution.(4) Molecular genetics:All the 6 patients had A3243G gene mutation.(5) Three patients were misdiagnosed for viral encephalitis,and 2 developmental retardation.Conclusions MELAS is characterized with developmental retardation,and repeated encephalitis attack.It is also misdiagnosed because of its variety of clinical features.If patients have high level of lactic acid and multiple MRI signal abnormalities of brain which are not in accordance with vascular distribution,MELAS should be suspected of.Genetic examination and muscle biopsy are especially important in the diagnosis of MELAS.

Hyperuricemia(HUA),which can induce oxidative stress,endothelial dysfunction,and inflammation,is closely relevant to the metabolic syndrome(MS),such as obesity,impaired fasting blood glucose,hyper-triglyceridemia,and hypertension. Moreover,HUA is of reciprocal causation with insulin resistance(IR). Here,for the prevention and treatment of metabolic diseases such as HUA and MS,the interaction and the regulatory mechanism between MS and HUA are summarized,and the situation that HUA is an important complication of MS is illustrated.

Survivin expresssion in embryo spleen, embryo kidney, embryo liver and in many cancer tissues was determined by RT-PCR, while not in the health liver tissue. Construct the engineered Escherischia coli expressing human survivin and identify the expressed human survivin by Westen-blot. The combination activity of Survivin and RhSmac was determined in vitro. L929 cells transferred with Survivin can survive longer than which transferred with BSA.

ObjectiveTo summarize the clinical characteristics of pt osis,one of complications after double eyelid blepharoplasty, and to explore i ts causes and attempt for the resolutions. MethodsThe clinica l symptoms were divided into three types based on the degrees of the ptosis afte r double eyelid blepharoplasty. The causations in 25 cases of different degree o f ptosis after double eyelid blepharoplasty were investigated and analyzed durin g operations. The local adhesive deformities were analyzed so as to take differe nt resolutions for the complication. Results It seemed that th e operative damage to the aponeurosis was the main reason for the complication. So it caused the scar adhesive deformities between the palpabralis aponeurosis a nd the orbital membrane or the skin of upper eyelid, resulting in the difficult y of the palpabralis muscle's contract and unablility of the muscle function in different degrees. Conclusion The ptosis can surely be av oided if we have good knowledge about the mechanism of double fold formation and the anatomy of eyelids and perform the operation meticulously.

Objective To compare and analyze the clinical effects and reliabilities of intermandibular flexible distraction and rigid internal fixation in treating mandibular condylar fractures. Methods Of 40 patients with mandibular condylar fractures, 21 cases were managed with intermandibular flexible distraction (external fixation group, Group A) and 19 with rigid titanium internal fixation (internal fixation group, Group B). There were 15 cases with high position fractures and 25 with low position ones. Results During 2-4 weeks postoperatively, X-rays confirmed the condylar fracture healing in all cases with no loosened mini-tinum plates in the Group B. There were 10 cases in the Group A and 14 cases in the Group B with the opening width over 30 mm, and 11 cases in the Group A and 5 in the Group B with the opening width less than 30 mm. Conclusions Both external and internal fixations can attain condylar fracture healing. However, compared with the internal fixation, the reduction of external fixation is less exact and the function recovery slower after operation, especially in the low position fractures. No irreversible damages on TMJ happen in all cases.

Objective To observe the oculocardiac reflex during the ocular plasty and to study its possible mechanism. Methods A total of 132 cases were studied by dynamic electrocardiography to analyze the changing of heart rate before and after operations. Results Heart rate decreasing by over 10 times during operations was regarded as the positive standard of the oculocardiac reflex. Of all cases the oculocardiac reflex appeared in 41 cases and 53 times were observed including of continual two times happened in 6 cases. In all the reflex ,9 cases was observed in injection of anaesthetic, 5 cases in pulling eyelids, the orbicular muscle and the palpabralis muscle, 21 cases in resecting orbital fats,6 cases in stressing the eyeball after operations. The incidence of oculocardiac reflex was 31.1%. Conclusion Some steps in the process in ocular plasty are more possible to elicit the reflex, such as dragging peripheral eyeball muscles,stressing eyeball and pulling eyelid. The reflex will result in heart rate decreasing, heart rhythm and respiratory changing,even render heart to sudden stop . Therefore, we should operate gentlely and accurately,and also avoid overly stress on eyeball to elicit the oculocardiac reflex.