ObjectivesTo study the clinical characteristics, the risk factors and outcomes of arterial ischemic stroke (AIS) and hemorrhagic stroke (HS) in children.MethodsThe clinical data from 142 children with AIS or HS were retrospectively re-viewed and compared from Nov. 2010 to May 2014.ResultsIn these children, 92 cases (64.8%) was diagnosed of AIS, amont whom there were 60 males and 32 females and the onset age of stroke was 4.6±3.6 years (1 months to 16 years old), and 50 cases (35.2%) was diagnosed of HS, among whom there were 34 males and 16 females and the onset age of stroke was 2.6±3.7 years (1 months to 13 years old). The difference in age between two groups was statistically signiifcant (P=0.007). The most common presentation of AIS were focal neurological dysfunction including paralysis (73 cases, 79.3%), central facial palsy (30 cases, 32.6%) and speech impairment (19 cases, 20.7%). The most common presentation of HS were diffuse neurological dysfunction including dizziness (29 cases, 58.0%), nausea/vomiting (22 cases, 44.0%) and headache (14 cases, 28.0%). The major risk factors of AIS were arteriopathy (49 cases, 53.3%), infection (47 cases, 51.1%) and minor head injury (16 cases, 17.4%). The major risk factors of HS were vitamin K deifciency (22 cases, 44.0%), intracranial vascular anomalies (8 cases, 16.0%) and haematological disorders (6 cases, 12.0%). Five cases (6.4%) were died, 48 cases (61.5%) became disabled and 9 cases (11.5%) were relapsed in children with AIS while 15 cases (34.1%) were died, 19 cases (43.2%) became disabled in children with HS. The mortality was signiifcantly higher in children with HS than that in children with AIS (P<0.01).ConclusionsIn childhood stroke, HS occurs more frequently than is commonly appreciated and it has a poorer prognosis than AIS.

Objective To investigate the value of apparent diffusion coefficient (ADC) of magnetic resonance diffusion-weighted imaging(DWI) for differential diagnosis of common pediatric posterior fossa tumors.Methods Forty-five children with posterior fossa tumors confirmed by surgery and pathology,who were hospitalized at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2013 to December 2015 were analyzed by using retrospective case-control study,including 24 cases of medulloblastomas,12 cases of pilocytic astrocytomas,and 9 cases of ependymomas.All the children were examined by preoperative magnetic resonance imaging(MRI) plain scan,enhanced scan and DWI.The minimum ADC (ADCmin) values of different tumors were measured,and the receiver operating characteristic (ROC) curve was delineated.The threshold value of ADCmin,sensitivity,specificity and the accuracy for differential diagnosis of 3 tumors were obtained.Results The ADCmin value of medulloblastoma was the lowest [(0.482±0.290)×10-3 mm2/s],and the ADCmin value of pilocytic astrocytoma was the highest [(1.592±0.320)×10-3 mm2/s],while that of ependymoma was in the middle [(0.826±0.390)×10-3mm2/s].There was a significant difference in ADCmin value among 3 tumors(F=48.415,P=0.000).The threshold value of ADCmin to distinguish medulloblastoma from ependymoma was 0.672×10-3 mm2/s,the sensitivity was 97.0%,the specificity was 100.0%,and the diagnostic accuracy rate was 97.8%.The threshold value ADCmin to distinguish ependymoma from pilocytic astrocytoma was 1.058×10-3 mm2/s,the sensitivity was 95.7%,the specificity was 97.9%,and the diagnostic accuracy rate was 94.7%.Conclusions The minimum ADC value can be used as a supplementary means for conventional MRI,which is helpful for the differential diagnosis of pediatric posterior fossa tumors.

Sepsis-associated encephalopathy(SAE)is a common complication with high mortality in patients with sepsis, but its pathogenesis is not clear, and there is no recognized diagnostic criteria and specific treatment.Intestinal tract plays an engine-like role in the occurrence and development of sepsis.The destruction of intestinal barrier and the disorder of intestinal microorganisms can affect the outcome of sepsis, in which gut microbiome affect the pathophysiology of intestine and brain through " the microbiome-gut-brain axis" (MGBA), and "gut microbiome-mitochondrial crosstalk" explains its role at the organelle level.The gut microbiome disorder exists in SAE animal model, while fecal bacteria transplantation can improve the symptoms and prognosis, suggesting that the exploration of gut microbiome may be of certain significance to understand the mechanism of SAE and explore its treatment.Here we review from three aspects: the gut microbiome, MGBA and the role of gut microbiome in SAE.

Clinical, radiological and pathological presentations in two children with epidermal nevus syndrome were analyzed and relevant literature was reviewed.Two patients both had typical epidermal nevus and abnormal cerebral radiography, which was associated with mental retardation, epilepsy, language and movement retardation.One case was complicated with an ocular tumor.Pathological investigations of the epidermal nevus revealed papilliform proliferation in squamous epidermis.The disorder may have a systemic involvement besides cutaneous lesions, with a predilection for the central nervous system.Early diagnosis and therapy may help to improve patients life quality.

To investigate the role of AQP9 in brain edema, the expression of AQP9 in an infectious rat brain edema model induced by the injection of lipopolysaccharide (LPS) was examined. Immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) analysis demonstrated that the expressions of AQP9 mRNA and protein at all observed intervals were significantly increased in LPS-treated animals in comparison with the control animals. Time-course analysis showed that the first signs of blood-brain barrier disruption and the increase of brain water content in LPS-treated animals were evident 6 h after LPS injection, with maximum value appearing at 12 h, which coincided with the expression profiles of AQP9 mRNA and protein in LPS-treated animals. The further correlation analysis revealed strong positive correlations among the brain water content, the disruption of the blood-brain barrier and the enhanced expressions of AQP9 mRNA and protein in LPS-treated animals. These results suggested that the regulation of AQP9 expression may play important roles in water movement and in brain metabolic homeostasis associated with the pathophysiology of brain edema induced by LPS injection.
Aquaporins/genetics ; Aquaporins/*metabolism ; Blood-Brain Barrier/metabolism ; Brain/drug effects ; Brain/physiology ; Brain Edema/chemically induced ; Brain Edema/*metabolism ; Lipopolysaccharides ; Rats, Sprague-Dawley ; Water/physiology

Epilepsy is one of the most common chronic diseases of the central nervous system,many epilepsy patients need lifelong medication.Epidemiological studies have shown that 3‰-5‰ neonates born by women suffering from epilepsy.Treatment become more challenging because not only the patients themselves but also the breastfed in fants should be taken into consideration.This paper reviewed how to choose lactation antiepileptic drug.In short,choosing drugs which transport less to milk and have less side effects to infants,using the lowest effective dose and avoiding combination if possible can ensure the safety of breastfeeding.

Objective To investigate the dynamic level changes and significance of triggering receptor expressed on myeloid cells-1 (TREM-1) in the injury brain tissues of rats caused by pneumolysin (PLY).Methods Sixty-four SD rats were randomly and equally divided into PLY group and control group,0.1 mL PLY and isopyknic normal saline was given through left internal carotid artery respectively.Brain tissue gross and histological changes were observed at different time(4 h,6 h,12 h,24 h),meanwhile the expression levels of neurocyte damage marker glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) protein were detected by immunohistochemistry;and the expression levels of TREM-1,tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected respectively by enzyme-linked immunosorbent assay.Results The observation of brain tissue gross and histological changes indicated the existence of brain injury,and the expression levels of GFAP,NSE,TNF-α and IL-6 protein increased from 4 h after PLY were injected and augmented dynamically as time went on,compared with the control group at corresponding time points,the differences were statistically significant (all P ＜ 0.05).The level of TREM-1 in the PLY group reached a peak at the 4 h time point,but decreased somewhat at the 6 h time point,the level of TREM-1 was still higher than that in control group,the differences were statistically significant(all P ＜ 0.05).However,the level of TREM-1 in the PLY group declined obviously at 12 h and 24 h time points,compared with that in control group,there were no significant differences (all P ＞ 0.05).Conclusions The expression levels of TREM-1 up-regulated obviously in the early stage of brain damage induced by PLY,which might be involved in the pathological process of brain damage by promoting the expression of TNF-α and IL-6.

Objective:To compare the bonding strength of 3M Adper Easy One(3AEO),Clearfil S3 Bond(CSB)and Super-Bond C&B(SBCB)in vertical tooth fracture mode.Methods:30 freshly extracted human molars were randomly assigned to three groups(n =10).The teeth were cut along the long axis with low speed cutting machine and were prepared into a unified model of the vertical tooth fracture.The three adhesives were respectively used to adjoin the surface of the fractured teeth.The samples were subjected to thermal cycling for 500 cycles,stored in distilled water at 37 ℃ for 24 h.Then the pillar-like specimens with the bonding area of 1.0 mm × 1.0 mm were prepared.The microtensile bond strength was measured and the fracture mode was observed.Results:The bond strength (MPa)of 3AEO,CSB and SBCB was 18.57 ±4.98,16.93 ±4.70 and 22.75 ±5.18 respectively(P <0.05).The fracture mode was mainly interficial failure in all groups(P >0.05).Conclusion:The surface bonding of Super-Bond C&B in tooth fracture is stronger than 3MAdper Easy One and Clearfil S3 Bond.

Objective To study the effect of glycyrrhizin(GL) on the gene expression of high mobility group protein 1 (HMGB1) in hippocampus and serum.To evaluate the effect on the expression of neuron-specific nuclear-binding protein (Neu-N) in the hippocampus CA1,CA3 regions in the chronic stage of an immature rat epilepsy model.Methods Fifty-two 21 day-old SD rats were randomly divided into control group,model group Ⅰ and model group Ⅱ according to the random table method.Model group Ⅰ was induced epilepsy by kainic acid (KA),and the model group Ⅱ was pretreated with GL by intraperitoneal injection at 30 min before KA injection.According to the different observation time points,each group was divided into 4 subgroups:3 h,12 h,24 h and 7 d.Model group Ⅱ was divided into 3 subgroups:10 mg/kg,50 mg/kg,100 mg/kg,according to the different doses of GL.There were 3 animals in each subgroup.Score was performed according to the Racine score,and quantitative real-time polymerase chain reaction and Western blot were applied to detect the mRNA and protein expression of HMGB1 in the acute phase.Enzyme-linked immunosorbent assay(ELISA) was applied to measure the expression of HMGB1 in blood;immunohistochemical was applied to measure the expression of Neu-N in hippocampus in the chronic phase(7 d).Results Compared with model group Ⅰ,seizure onset time was obviously prolonged in model group Ⅱ [(24.08 ± 1.98) min vs.(33.39 ± 2.66) min],and the difference was statistically significant (t =9.231,P ＜0.05);Comparing KA model group Ⅰ with control group,the gene expression of HMGB1 significantly increased,and reached a peak at the time of 12 h (H =10.532,P ＜ 0.05),but the protein expression of HMGB1 was changed obviously and there was no significant difference (H =5.227,P ＞0.05).The expression of HMGB1 in the serum also significantly increased,especially at 12 h (H =6.897,P ＜0.05).At the time of 12 h after KA injection,the gene expression of HMGB1 in the hippocampus was significantly decreased in model group Ⅱ compared with model group Ⅰ (H =10.721,P ＜0.05) (especially in the 100 mg/kg model group).Also,the expression of HMGB1 in the scrum was obviously decreased (H =6.967,P ＜ 0.05) (especially in the 100 mg/kg model group).At the time of 7 d after KA injection,hippocampal neuron loss in model group.Ⅰ was significantly reduced compared with control group (P ＜ 0.05),and hippocampal neuron loss in model group Ⅱ was evidently decreased compared with model group Ⅰ (P ＜ 0.05),(especially in the 100 mg/kg model group in CA1,50 mg/kg model group in CA3).Conclusions In the immature rat temporal lobe epilepsy model,GL may have neuroprotective by inhibiting the synthesis and release of HMGB1,inhibiting inflammation further to restrain the loss of neurons in the chronic phase.