Epilepsy is a common chronic disease of the nervous system in children.Antiepileptic drugs are the first choice for the treatment of epilepsy.However,about 20％-40％ of children with epilepsy will develop intractable epilepsy,which can affect children's mental development and bring heavy burden to families and the society.In addition to antiepileptic drugs,epilepsy surgery,neuromodulation and ketogenic diet can also be used as alternative treatments of intractable epilepsy.In order to give a reasonable advice,neurologists must be familiar with the indications and the advantages and disadvantages of the antiepileptic drugs and the various alternative treatments mentioned above.Only in this way can we reduce seizure frequency,even achieve the goal of curing epilepsy.

Diagnosis of early Alzheimer's disease (AD) is still a clinical challenge,growing evidence indicated radionu-elide neuroimaging, especially positron emission computed tomography (PET), would be promising for the diagnosis of early AD. Studies showed reduction of cerebral blood flow and glucose metabolism occurring at the parietotemporal lobes of AD patients at the early stage. A study showed that PET detected AD with an accuracy greater than 90% 2. 5 years earlier than clinical diagnostic methods using electroencephalography, structural imaging studies and so on. Recent investigation aimed at senile plaques (SPs) and neurofibrillary tangles (NFTs) that were hallmark pathologies accompanying the neurodegeneration involved in AD. Some researchers used 2-(l-(6-[(2-18F]fluoroethyl) (methyl)amino]-2-naphthyl)ethylidene) malononitrile (C18F]FDDNP) , in conjunction with PET to determine the localization and load of NFTs and SPs in the brains of living AD patients. Monitoring SPs and NFTs development is expected to facilitate diagnostic of AD patients and assist in response-monitoring during experimental treatments.

Objective To investigate the incidence of the cognitive disorder in cerebrovascular patients and to its risk factors.Methods Cerebrovascular patients were surveyed with Mini-Mental State Examination(MMSE)Chinese-version in county or above hospitals among 23 provinces(cities).Results 915 cerebrovascular patients were surveyed and 281 patients(30.71%)were of cognitive disorder.And the incidence of the patients with hypertension or/and diabetes mellitus was significantly higher than the others(P<0.01).Conclusion The incidence of cognitive disorder is high in cerebrovascular patients,and the hypertension and diabetes mellitus are both the risk factors.

B cell maturation antigen (BCMA) is a receptor of B lymphocyte stimulator (BLyS). Human IgG1Fc fusion proteins with the extracellular domain of BCMA(eBCMA), also called decoy receptors, have beenused as a potential BLyS antagonists to block BLyS activities. In order to design novel BLyS antagonistpeptides, computer-aided homologue modeling was used to construct an eBCMA-Fc fusion protein based on thecrystal structures of BCMA and Fc fragmant. To ensure the activity of eBCMA not to be interfered by Fcfusion, the root mean square distance (RMSD) for eBCMA and Fc were calculated to be 0.036 nm and 0.064nm, respectively, based on molecular docking modeling. An eBCMA-Fc fusion gene was constructed andintroduced into E. coli for expression. As expected, the purified 36 kD eBCMA-Fc fusion protein was able tobind BLyS in vitro at a dosage-dependent manner and demonstrated an anti-proliferative activity induced byBLyS in Daudi cells. The results have provided useful information on the evaluation of computer modeling andthe in vitro biological activity for the design of potential BLyS antagonist peptides.

Objective To evaluate the role of orexin in the sleep disorder after isoflurane anesthesia in rats.Methods Sixty-four male Sprague-Dawley rats,aged 10-12 weeks,weighing 280-320 g,were randomly divided into 2 groups (n =32 each) using a random number table:control group (C) and isoflurane group (Ⅰ).Group Ⅰ inhaled 1.2％ isoflurane from 8:00 to 13:30 to induce anesthesia,followed by 0.5 h of recovery.Group C received no anesthesia and the other procedures were similar to those previously described in group Ⅰ.The induction time and awakening time were recorded.Eight rats were randomly chosen to record the movement condition (locomotor time and activity) from 14:00 to 8:00 the next morning.Before beginning of anesthesia,at 4 h after beginning of anesthesia,and at 4 and 10 h after the end of anesthesia,6 rats were randomly chosen in each group to count the orexin/c-fos double-labeled neurons in hypothalamus.The ratio of activated orexin neurons (orexin/c-fos double-labeled neurons to orexin positive neurons) was calculated and plasma orexin-A concentration was detected.Results The induction time was (2.14 ± 0.17) min,awakening time was (8.7 ± 0.5) min,and EEG showed that there was no typical burst and suppression patterns in group Ⅰ.There was no significant difference in the number of orexin positive neurons between the two groups (P ＞ 0.05).Compared with group C,the time for locomotor activity was significantly prolonged,and the activity was increased during the night (P ＜ 0.01),the number of activated neurons,ratio of activated orexin neurons and plasma orexin-A concentration were decreased at 4 h after beginning of anesthesia in group Ⅰ (P ＜ 0.01).The plasma orexin-A concentration was lower at 4 h after beginning of anesthesia,while higher at 10 h after the end of anesthesia than before beginning of anesthesia in group Ⅰ (P ＜ 0.05).The number of activated neurons was significantly larger and ratio of activated orexin neurons was higher before beginning of anesthesia and at 10 h after the end of anesthesia and the plasma orexin-A concentration was higher at 4 and 10 h after the end of anesthesia than at 4 h after beginning of anesthesia in group Ⅰ (P ＜ 0.05 or 0.01).Conclusion The development of sleep disorder after isoflurane anesthesia during the day time in rats is related to the regulatory role of orexin in it.

This paper discussed the interference and noise of medical electronic device and their generation, hazard, depression and application, of which some ones are pointed out for the first time.

Objective To probe into the effect of sitagliptin on blood glucose fluctuation of the patients with type 2 diabetes mellitus(T2DM) and poor control by insulin aspart 30.Methods Ninety cases of T2DM and poor control by insulin aspart 30 in affiliated Zhongshan hospital from January 1,2014 to December 31,2014 were selected and randomly divided into three groups:simply continuous subcutaneous insulin injection(CSII),acarbose combined CSII group(CSII + Aca) and sitagliptincombined CSII group (CSII + Sig),30 cases in each group.Three groups received the intensive treatment for 2 weeks,and72-h continuous glucose monitoring was performed on last 3 d.The 24 h mean blood glucose(24 hMBG),largest amplitude of glycemic fluctuation(LAGE),mean amplitude of glycemic excursion(MAGE) within 1 d,postprandial blood glucose spike(PGS),postprandial glucose peak time(△t),postprandial glucose excursion(PPGE) and total T were observed within 24 h.The difference of insulin dose(△ insulin),hypoglycemia incidence,glucose-target rate,blood glucose profiles were compared at the end of treatment.Results After two-week treatment,intraday blood glucose variation indicators(24 hMBG,LAGE and MAGE) and postprandial blood glucose variation indicators (PGS,△t,PPGE and total T) in the CSII+Sig and CSII+-Aca groups were significantly lower than those in the CSII group(P＜ 0.05),while the differences in blood glucose variation indicators between the CSII+Sig group and CSII+-Aca group were not statistical significant(P＞ 0.05).In the comparison after treatment,△ insulin,hypoglycemia incidence and glucose-target rate in the CSI + Sig group were lower(P＜0.05).Conclusion The combined application of short-term CSII and sitagliptin will achieve a better effect than the combination with acarbose,can smoothly and steadily reduces the blood glucose level,relieves the whole day glucose fluctuations,effectively reduces △ insulin,and has lower hypoglycemia occurrence rate.

Objective:To analyze the radionuclide bone imaging features of spine tumors and its clinical value.Methods and results:Data of radionuclide planar whole-body bone imaging with 99m Tc-MDP were analyzed in90patients with various spinal tumors confirmed by histopathology.In49patients with metastases,bone imaging was positive in43;37vertebra showed strong uptake;30patients involved the whole vertebra with symmetrical enlargement in18;other extravertebral bone foci were seen in29.In17patients with primary malignant bone tumors,bone imaging was positive in12;11vertebra showed strong uptake;and8involved the whole vertebra;3focal lesions had local irregular bulging;other extravertebral bone foci were seen in4.In24patients with benign bone tumors,bone imaging was positive in13;6vertebra showed strong uptake; other extravertebral bone foci were seen in1.Conclusion:Spinal metastases in bone imaging are mainly multiple,strong up-take of whole vertebra and accompanied by symmetrical enlargement with other extravertebral bone foci.Primary malignant bone tumor is mainly single or multiple,strong uptake of whole vertebra without symmetrical enlargement,some with local irregular bulging lesions. [

Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.

Objective:To evaluate the sedative efficacy of remimazolam in outpatients undergoing curettage.Methods:Eighty outpatients, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged ≥18 yr, undergoing curettage, were divided into 2 groups according to the random number table method: remimazolam group (group R, n=41) and propofol group (group P, n=39). Anesthesia was induced with alfentanil 10 μg/kg injected intravenously in two groups, and in addition remimazolam 7 mg was intravenously injected in group R, and propofol 1.5 mg/kg was intravenously injected in group P. If the Modified Observer′s Assessment of Alertness/Sedation score ≥3 or the patient could not tolerate the surgical procedure, remimazolam 2.5 mg was given for rescue sedation in group R and propofol 0.5 mg/kg was given for rescue sedation in group P, and alfentanil 1 μg/kg was given as rescue analgesic.The onset time of sedatives, time to eye opening, emergence time and time to discharge were recorded.The success of sedation, intraoperative BIS value, requirement for rescue medications, and occurrence of adverse reactions were recorded. Results:The intraoperative BIS values were maintained at 61-72 and 40-64 in group R and group P, respectively.The success rate of sedation was 95% in group R and 100% in group P, and there was no significant difference between the two groups ( P>0.05). Compared with group P, the rate of rescue sedative agents used and rate of rescue alfentanil given were significantly increased, the onset time of sedative agents was significantly prolonged, the incidence of postoperative nausea and vomiting was increased, and the incidence of respiratory depression and injection pain was decreased in group R ( P<0.05 ). Conclusion:Remimazolam (given according to the instructions) is safer when used for outpatient curettage, but it can only maintain a light sedation status, and the sedative efficacy is inferior to propofol.