Objective To observe the initial therapy outcomes of Valproic acid for childhood absence epilepsy (CAE),and to assess its therapeutic reaction and short-term prognosis,and to investigate the risk factors for initial therapy failure.Methods From January 2010 to December 2015,absence seizures as key words were used to search CAE in the video-electroencephalogram(VEEG) database of Children's Hospital Affiliated to Nanjing Medical University.Sixty-seven children fulfilled the CAE diagnosis criteria of International League Against Epilepsy in 1989.These patients were separated into 2 groups based on the therapy outcome after 6 months,including seizure control failure group and seizure control group.The patients' clinical characteristics and VEEG characteristics were reviewed.The gender,age of seizure onset,a family history of epilepsy or febrile seizures (FS),consistent with 2005 Panayiotopoulos diagnostic criteria,and VEEG findings were analyzed to evaluate the predictive ability of independent variables and the relationship between these features and treatment outcomes by using a stepwise multivariate Logistic regression model.Results The age at seizure onset was (5.89 ± 2.91) years old,and follow up duration was 6 months.Approximately 23 cases (34.3％) of CAE patients had poor response.No statistical correlation was made for gender,age at onset,the occurrence of generalized tonic clonic seizures,and family history of FS or epilepsy between 2 groups (all P ＞0.05).Compared with seizure control group,patients of the seizure control failure group had significantly higher rates of focal epileptic discharge (87.0％ vs.6.8％),higher rates of intermittent photic stimulation (IPS) induced seizures (52.2％ vs.6.8 ％),fewer rates of occipital intermittent delta activity (8.7 ％ vs.77.3 ％),and fewer rates of patients met the new diagnostic criteria proposed by Panayiotopoulos in 2005 (8.7％ vs.88.6％) (all P ＜ 0.001).The presence of occipital intermittent rhythmic delta activity during wake stage and the interictal focal epileptiform discharges on VEEG during sleep stage were significantly associated with the therapy outcomes in a multivariable Logistic regression analysis (OR =133.714,P ＜ 0.05;OR =0.068,P ＜ 0.05).Conclusions The presence of focal epileptiform discharges,and a typical absence induced by IPS are important factors for first-drug treatment failures with CAE,and conversely the occipital intermittent rhythmic delta activities have a good efficacy.There is no statistical correlation between clinical characteristics and treatment outcomes.

Objective:To evaluate the value of ultrasound-guided transperineal systematic prostate biopsy(SPB)and cognitive fusion multi-parameter magnetic resonance imaging(mpMRI) suspicious transperineal targeted biopsy(CFTB) in the prostate cancer with different serum prostate specific antigen(PSA) levels.Methods:A retrospective analyses were performed in 527 patients with suspected prostate cancer who underwent ultrasound-guided SPB from January 2018 to December 2019 in Shanghai Jiaotong University Affiliated 6th People′s Hospital. According to the PSA levels, they were divided into group A(PSA 4-10 μg/L) and group B(PSA>10 μg/L). All the patients underwent ultrasound-guided SPB, 376 patients with suspicious mpMRI had two additional targeted biopsies. The detection rates of ultrasound-guided SPB and CFTB in prostate cancer were tested by χ 2 test. Compared with pathological results, the sensitivity, specificity, accuracy of two methods were calculated and tested by χ 2 test, and a P<0.05 was defined as statistically significant difference. Results:Prostate cancer was detected in 319 of 527 patients(60.5%). One hundred and three cases of 198 patients in group A were diagnosed as prostate cancer, with an overall detection rate was 52.0%. Among them, ultrasound-guided SPB detected 72 cases of prostate cancer, the detection rate was 36.4%, sensitivity was 67.9%, specificity was 17.7%, accuracy was 26.5%, the detection rate, sensitivity, specificity and accuracy of CFTB were 39.9%, 75.6%, 91.6% and 88.8%, respectively. In this group, there were no statistically significant differences in the detection rate and sensitivity of the two methods in the diagnosis of prostate cancer (χ 2=0.525, 0.005, both P>0.05), and the differences in specificity and accuracy were statistically significant (χ 2=108.340, 79.829, respectively, both P<0.05). Two hundred and sixteen cases of 329 patients in group B were diagnosed as prostate cancer, with an overall detection rate was 65.7%. Among them, 160 cases of perineal prostate cancer were detected by ultrasound-guided SPB, with the detection rate was 48.6%, sensitivity was 78.2%, specificity was 37.6% and accuracy was 49.5%. A total of 189 cases of prostate cancer detected by CFTB, the detection rate was 57.4%, the sensitivity was 89.3%, the specificity was 90.6%, and the accuracy was 90.2%. All the differences were statistically significant in group B(χ 2=5.131, 4.391, 61.339, 38.982, all P<0.05). Conclusions:When PSA is greater than 10 μg/L, CFTB has a higher diagnostic efficiency than SPB.When PSA is 4-10 μg/L, there are no significant differences between the two methods in the detection rate and sensitivity of prostate cancer.

Objective To compared hemostatic effect of agkistrodon haemocoagulase and other hemostatic agents in hepatectomy,and observe clinical safety.Methods From November 2014 to February 2016,122 patients undergoing hepatectomy of the department of hepatobiliary surgery in the hospital,according to the inclusion and exclusion criteria,were randomly divided into three groups,which was group A-haemocoagulase agkistrodon for injection,group B-ferdelance haemocoagulase for injection and group Cdesmopressin acetate injection.After drug administration,according to the clinical research plan,the indexes for therapeutic effectsbleeding time of wound,bleeding volume of wound,postoperative drainage volume for 24 h,preoperative and postoperative safety indices-Routine blood test,clotting function,liver and kidney function were compared among the three groups.Results The general data of the 3 groups were comparable.The bleeding time of wound,bleeding volume of wound,postoperative drainage volume for 24 h showed no significant difference(P＞0.05).Routine blood test,coagulation function,liver and kidney function,pre-admi nistration and post-administration administration of the group on the third day between and within groups were compared and showed no significant difference(P＞0.05).ECG and lower extremity ultrasound examination showed no abnormality in each group.No adverse events happened in the cases of groups for the clinical study.Conclusion Hemostatic effects of haemocoagulase agkistrodon for injection and other hemostatic drugs were similar in hepatectomy.No sinificant adverse effects on postoperative routine blood,coagulation function,liver and kidney function,with good efficacy and safety,being worthy of using widely worth in hepatectomy.

Objective To evaluate the value of three-dimensional power Doppler imaging(3D-PDI) in the discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Methods Eighty-four women with post menopausal bleeding who examined by 3D-PDI were enrolled. All patients scheduled for pathological examination were divided into benign group (30 cases with endometrial polyps and 34 cases with hyperplasia) and malignant group (20 cases with endometrial carcinoma). Endometrial volume, vascularity index ( VI) , flow index ( FI) and vascularity flow index ( VFI) were measured. The diagnostic value of parameters derived from 3D-PDI was evaluated by using the receiver operating characteristic ( ROC) curve. Results Differences of these parameters (VI, FI and VFI) were considered statistically significant between two groups, the parameters of endometrial volume had no significant differences between two groups; the area under ROC curve(AUC) of the meaningful data were 0.976,0.888 and 0.894 respectively. Among these parameters, VI had the highest diagnostic value for discriminating between benign and malignant endometrium, the cut-off value of which was 2. 97 with a sensitivity of 95% and a specificity of 86%. Conclusions 3D-PDI is a good diagnostic tools in the discriminations between benign and malignant endometrium in women with postmenopausal bleeding.

Hepatitis B-related acute-on-chronic liver failure (ACLF) is a severe clinical syndrome characterized by jaundice, coagulopathy, ascites and hepatic encephalopathy and with a high mortality rate of 65% to 93%. It involves significant ethical issues when a randomized, double-blinded, placebo-controlled clinical study is conducted to such a serious disease. Therefore, a prospective cohort study design was utilized to explore a new treatment modality of applying integrated traditional Chinese and Western medicine.

ObjectiveTo investigate the action mechanism of CD20 lymphocyte infiltration in the renal allograft biopsy with chronic allograft nephropathy (CAN).MethodsCAN cases confirmed by renal biopsy within 2 years after renal transplantation served as study subjects. By using immunohistochemistry,the deposition of C4d and the CD20-positive lymphocytes infiltration in the renal grafts were examined.The clinical follow-up data were analyzed.ResultsForty-four cases of CAN were enrolled in the study, including 13 cases (29.5％ ) of CD20-positive lymphocytes infiltration,and 31cases (70.5％ )of CD20-negative lymphocytes infiltration. CD20-positive lymphocytes in biopsy showed nodular and scattered lymphocytes infiltration.There were 5 (26.3％)cases of CAN Ⅰ,4 cases (25.0％) of CAN Ⅱ,and 4 (44.4％) of CAN Ⅲ in CD20-positive group.There was no statistically significant difference between the only CAN group and CAN with AR group in CD20-positive rate.Immunohistochemical staining showed there were 12 cases (27.3％) with C4d linear deposition in peritubular capillary endothelial cells (PTC).C4d positive rate had no significant difference among the CAN classifications. There was no significant relationship between C4d deposition and CD20-positive lymphocytic infiltration.The average serum creatinine in CD20-negtive group and CD20-posigtive group was 140.8 ± 22.0 and 183.5 ± 25.5μmol/L before biopsy,and 165.6 ± 37.6 and 242.2 ± 59.1 μmol/L one year after biopsy.The average serum creatinine level in CD20-positive group was higher than in CD20-negtive group before and after biopsy.ConclusionProgressive chronic humoral immunity is high risk in the process of CAN. The CD20-positive lymphocyte infiltration has no relevance with CAN grade and C4d deposition in PTC,but is associated with circulating antibody PRA and allograft long-term outcome. Pathogenetic mechanism may not contribute to chronic humoral immune,but B cells presenting donor antigens,are recognized and activated by T cells as antigen-presenting cells.

With building up a clinical modification system model by upgrading the standard disease classification system architecture,to collect those huge amount of diagnosis names and codes in use,based on the model to screen and coordinate the relation of them,the tenth revision of the International Classification of Disease Clinical Modification of Beijing is implemented.This standard has been successfully applied for two years in all those secondary and above level hospitals in Beijing.It could well support the work of deploying Diagnosis Related Groups in Beijing and support not only those traditional applications of disease classification but also those new and advance requirements of information processing.

Objective To explore the value of strain rate and dobutamine stress echocardiography(DSE) in the diagnosis of coronary heart disease. Methods High-dose DSE was performed in 18 patients with coronary heart disease and 10 healthy persons, proved by selected coronary angiography. Ten patients had single coronary lesion, and the other 8 patients had more. By strain rate technology, systolic peak strain rate(SR_ SYS ) was measured in 12 segments of healthy persons and ischemic segments of patients. Results SR_ SYS of healthy subjects enhanced by the increasement of dose of DSE. In patients with single coronary lesion, SR_ SYS enhanced on the first states of baseline, 10 and 20 ?g?kg -1 ?min -1 ,while SR_ SYS changed non-significantly on 30 ?g?kg -1 ?min -1 , and began to decrease on 40 ?g?kg -1 ?min -1 . However in patients with more than one coronary lesions, SR_ SYS of 10 ?g?kg -1 ?min -1 became larger than that of baseline, while SR_ SYS didn't increase any longer on 20 ?g?kg -1 ?min -1 , and fell significantly on 40 ?g?kg -1 ?min -1 . Conclusions Combining stain rate and DSE to quantify local myocardial motion is valuable to offer many important clinic messages, and improves the diagnosis of coronary heart disease.

Purpose To study the clinic-pathologic features, differential diagnosis and prognosis of lymphoepithelioma-like carcinoma of cervix. Methods Eight cases of lymphoepithelioma-like carcinoma of cervix were retrieved from our institution. HE staining, im-munohistochemistry and in situ hybridization were perform on those cases. Results Of the 8 cases of lymphoepithelioma-like carcino-ma,the median age was 44 years old ( ranged from 29-67 years) and all of the clinical stage belonged toⅠB. Grossly, 5 cases presen-ted a cauliflower-like appearance, 1 case grew as a polyp protrusion, and the other 2 cases showed a non-specified thicken change of cervix. Histologically, the tumors were composed of undifferentiated large cells, either loosely or closely-packed, with the nested and trabecular growth pattern. The tumor cells were generally oval or polygonal in shape, while the demarcation between the cells was indis-tinct and form the syncytial appearance. The nuclei were vesicular and had one or more prominent nucleoli. There were abundant infil-trates of lymphocyte and plasma cells among the tumor nests. The tumor cells showed positive expression of CK in 100% of cases, p63 in 37. 5% of cases, p16 in 62. 5% of cases, CK5/6 in 75% of cases, Ki-67 in 10% ~30% of cases. The stromal lymphocytes mainly expressed CD3 and CD8. EBER was negative in the entire tumor cells while was weakly positive in the stromal lymphocytes in one case. The follow-up data, which terminated at June 2013, demonstrate 7 cases were alive and 1 case died of the disease. Conclusions Lymphoepithelioma-like carcinoma occurred of cervix is rare. They have distinctive morphologic features and overall favorable prog-nosis. The accurate diagnosis is dependant on the combination of the histologic and immunohistochemical examination.

Objective To explore the clinical and serological features of patients with pneumomdiastinum (PNM) and dermatomyositis associated interstitial lung disease (DM-ILD).Methods A total of 145 polymyositis/dermatomyositis (PM/DM) patients hospitalized in our department from March,2010 to December,2012 were recruited.The sera,clinical and laboratory data were collected.Anti-aminoacyl-tRNA synthetase (anti-ARS) and anti-melanoma differentiation-associated gene 5 (MDA5) antibodies were detected by RNA-immunoprecipitation (RNA-IP) and ELISA,respectively.Anti-NXP2,anti-TIF1γ,anti-SRP,anti-SAE and antiMi2 antibodies were detected by immunoprecipitation-Western blotting.Variables were compared between DM patients with and without PNM,as well as between DM-ILD patients with and without PNM.Chi square test,Fisher's exact test,t test,Mann-Whitney U test and a multivariate logistic regression model were used for statistical analysis.Results A total of 11 DM patients (10 patients positive for anti-MDA5 and 1 patient positive for anti-Mi2) developed spontaneous PNM.No PM patient developed PNM.No differences of sex,age at the onset of DM,serum ferritin levels and C reactive protein (CRP) levels was observed between DM patients with and without PNM.Compared with DM patients without PNM,DM patients with PNM had significantly higher frequencies of rapidly progressive ILD (RP-ILD) (63.6％ vs 24.4％,x2=7.25,P=0.01),anti-MDA5 antibodies (90.9％ vs 52.4％,x2=5.86,P=0.02),clinically amyopathic DM (CADM) (63.6％ vs 22.0％,x2=8.57,P=0.007) and cutaneous ulcers (36.4％ vs 11％,x2=5.20,P=0.04),but significantly lower creatine kinase (CK) levels [58.5 (30.5,394.3) U/L vs 284 (73.0,917.0) U/L,t=207.5,P=0.04].The logistic multivariate analysis indicated that cutaneous ulcer was the only independent risk factor for the occurrence of PNM in DM [OR=5.98,95％ confidence interval (CI) (1.12,31.98),P=0.037].In the comparisons between DM-ILD patients with and without PNM,a higher frequency of CADM was observed in the PNM group (63.6％ vs 27.9％,x2=5.37,P=0.03),but no significant difference of the frequencies of RP-ILD,anti-MDA5 antibodies,cutaneous ulcers and CK levels was found in these two groups.All patients with PNM were treated with corticosteroids and immunosuppressants.During the follow-up period,6 patients died of respiratory failure.Conclusion Spontaneous PNM is a refractory complication with poor prognosis,and tends to occur in DM patients with RP-ILD,anti-MDA5 antibody,CADM diagnosis and low CK level,especially in patients with cutaneous ulcers.