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 study the expression of Survivin protein and its relation with the expression of Bcl-2, Bax in the tropho- blasts of human normal placenta. Methods The normal placental tissues (8 -9week ,18-23 week and 37-40week) were fixed, embed- ded, sectioned, and Survivin, Bcl-2, and Bax in the trophoblasts were detected with immunnohistochemistry. Result As the gestational age advanced , the staining intensity of Survivin in the trophoblasts was significantly decreased from the first trimester group to the second trimes- ter group to the term group (PU value: 11.74±0.8,9.95±0.43,8. 83 ~ O. 67, respectively, P <0.01 ), while the staining intensity of Bcl-2 and Bax in trophoblast was significantly increased (PU value of Bcl-2 : 4.33±0.60, 5.00±0.75,6.87±0.45, respectively, P<0.01 and PU value of Bax: 9.82±1.12,16.00±1.05,27.48±2.10, respectively, P <0.01 ). Expression of Survivin in trophoblasts has no rela- tionship with the expression of Bcl-2 and Bax (P>0.05 ). Conclusion Survivin may take part in the development of human normal pla- centa through the way of suppressing the apoptesis in trophoblasts. Expression of Survivin in trophoblasts has no relationship with the expres- sion of Bcl-2 and Bax, which indicate that they regulate apoptesis of trophoblasts via different biological pathways.

Objective To evaluate the changes of the left atrial function in patients with old myocardial infarction(OMI) by strain rate imaging(SRI). Methods The velocity of the left atrial lateral wall and atrial septum was measured by SRI in 30 patients with OMI(OMI group) and 25 normal subjects (control group). Left atrium passive eject volume index(LAPEVl) and left atium active eject volume index (LAAEVI) were measured using Simpson method. Results ①Compared with the control group, the velocity of the left atrium was reduced obviously in ventricular systole and early ventricular diastole in OMI group(P<0.05) ,but was increased in late ventricular diastole(P<0.05). ②Compared with the controls, LAAEVI was increased significantly in OMI group, but LAPEVI was decreased signicantly(P <0.001). Conclusions SRI could be used to evaluate the left atrial function accurately in patiens with OMI.

Objective To observe the therapeutic effect and toxicity of chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin. Methods Fourty-two patients presented with Ⅲ - stage non-small cell lung cancer(Ⅲ、 25 patients, ⅢB 17 patients)received concurrent chemoradiotherapy. Intensity modulated irradiation technique was used to the total dose of 66 Gy and concurrent chemotherapy consisted of pemetrexed 500 mg/m2 on Day 1 and cisplatin 75 mg/m2 on Day 1 by intravenous infusion once every 3 weeks at the initiation of radiation.Patients received 4 cycles of chemotherapy. Results Thirty-four patients finished the whole of therapeutic schedule. And 2 patients received radiation with total dose of 54 Gy, 2 patients 56 Gy;3 patients received 2 cycles of chemotherapy, 1 patients 3 cycles of chemotherapy. Total effective rate was 79%. There were 2 patients with ≥3 grade marrow depression, 3 patients with 3 grade radiation esophagitis, 4 patients with ≥2 radiation pneumonitis, and 1 patient with 3 grade mucositis. The 1-year survival rate was 65%.Conclusion Recent effect was favourable and toxicity was tolerable for chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin.

BACKGROUND: Precartilaginous stem cells (PSCs) have strong proliferation ability and differentiation potential,but they are instable and prone to differentiate.Importing exogenous gene could immortalize them and leave phenotype character unchanged.OBJECTIVE: To establish immortalized precartilaginous stem cells (PSCs) from neonatal SD rats in vitro for the further related research about the differentiation mechanism and clinical application of precartilaginous stem cells.DESIGN,TIME AND SETTING: Single sample observation.The study was carried out in the Department of Orthopedics.Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from October 2005 to September 2006.MATERIALS: Neonatal SD rats,irrespective of gender,24-hour old,were used for prepare PSCs.METHODS: By using LipofectamineTM 2000,a gene transfection reagent,plasmid pCMVSV40T/PUR containing the simian virus 40 large T antigene gene (SV40Tag) was transfected into the primary cultured PSCs isolated by immuniomagnetic beads coasted with the second antibody.Colonies were isolated by puromycin selection and expanded by many passages.MAIN OUTCOME MEASURES: Biological character of PSCs; plasmid identification; biological character of transfected cells and identification; RT-PCR; growth curve.RESULTS: Immunomagnetic beads separation system obtains PSCs,which was confirmed as fibroblast growth factor receptor-3 (FGFR-3) positive PSCs.Double restriction enzyme was cut,electrophoresis confirmed pCMV was 3 kb,SV40T was 2.3 kb.A particular anti-puromycin cell clone was acquired,which was confirmed as FGFR-3 positive PSCs.The total RNA was isolated from the positive cell clones,and a 588 bp fragment,which was specific for the SV40T antigene gene,was amplified.The transfected cells were expanded to immortalized cell strain,named as immortalized precartilaginous stem cells (IPSCs).Thepopulation doubling time of IPSCs was (22.98±2.77) hours,no significant effect of subculture,freezing and recovering had been found.CONCLUSION: Precartilaginous stem cells could be isolated from neonatal SD rats,cultured in vitro,and immortalized through the transfection of pCMVSV40T/PUR.

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.

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.

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.