The scholars abroad have reported a group of previously normal children,who develop intractable focal epilepsy or status epilepticus after fever,followed by drug-resistant partial epilepsy and severe cognitive impairment,named febrile infection-related epilepsy syndrome (FIRES).There are unknown etiology,critical condition,poor prognosis and absent of specific changes on cerebrospinal fluid,biopsies and neuroimagings.No therapeutic agent is efficacious and ketogenic diet may be an alternative therapy in some reports.This study describes the clinical characteristics of FIRES.

Objective To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods A retrospective analysis was conducted in 135584 women who delivered in Women′s Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups.(1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%,715/1212) as the diagnosis group.(2)In 312 cases (25.74%,312/1212), the diagnosis was made after birth as the missed diagnosis group.(3)In 185 cases (15.26%,185/1212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results (1) In the 1212 cases, the diagnosis of placental abruption was confirmed in 1027 cases, with the incidence of 0.76%(1027/135584). The rate of missed diagnosis was 30.38%(312/1027), and the rate of misdiagnosis was 0.14%(185/134557). (2) There were significant differences in the degree of placental abruption among the 3 groups (P＜0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P＜0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P＜0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P＜0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P＜0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption.

Objective To evaluated the prevalence of EGFR mutations in Hubei region,to provide reliable experimental basis for reasonable screening TKI beneficiaries in clinic.Methods EGFR mutation of 253 patients diagnosed with NSCLC in Hu-bei region during 2010 to 2015 was detected by PCR-sanger sequencing and ARMS assay,to investigate the sensitivity of dif-ferent methods,to explore the frequency and clinical significance of EGFR mutation in different gender,in different histologi-cal type and different exons.Results 93 of 253 NSCLC patients harbored EGFR mutation,mainly occurred in exon 19 and 21,accounting for 53.76% and 35.38% of the total EGFR mutation rate,respectively.ADx-ARMS method showed higher sensitivity (P=0.001).The mutation detection rate of female NSCLC was significantly higher than that of male NSCLC (P=0.001).The observed incidence of EGFR mutations in patients with adenocarcinomas (38.01%)was the highest in differ-ent histological type,followed by glandular squamous cell carcinoma (30.77%),large cell carcinoma (20%)and squamous cell carcinoma (4.55%).Nonsmoking patients had a higher EGFR mutation frequency (51.6%,81/157)than those with a history of smoking (24%,12/50).Conclusion ARMS assay was more sensitive and more convenient detection method for clinical screening for EGFR-TKI treatment subpopulation.The mutation rate of female NSCLC was significantly higher than that of male NSCLC in Hubei Province.Speculated that the sexual differences in NSCLC with EGFR mutation frequencies were related to hormone levels and smoking status.

Objective To investigate the protective effect of allopurinol in kainic acid-induced epileptic rats and to explore new ideas and methods for the clinical treatment of epilepsy. Methods 120 Wistar rats were randomly divided into sham group, KA epilepsy group and allopurinol groups. Six rats of each group were randomly selected and were given electrodes into their left frontal and hippocampal regions. After injection, behavior changes were observed in all rates without electrodes. 24 h later, MDA level and SOD enzymatic activity of the left hippocampi were measured. One week later, the EEGs were recorded in rates with electrode, as well as total time of seizures /30 min and numbers of seizures / 30 min. Results Compared with the KA model group, latency period of the epilepsy in the allopurinol group was longer (P < 0.05) and the extent was lighter (P < 0.05); the MDA level was significantly lower (P < 0.01), the SOD enzymatic activity was significantly higher (P < 0.01). The total time of seizures / 30min and numbers of seizures / 30 min in allopurinol group reduced significantly (P < 0.01). Conclusion Allopurinol has potential antiepileptic and antioxidative activities in kainic acid-induced epileptic rats.

To explore the structure and function of thioredoxin glutathione reductase (TGR) from Schistosoma j aponi-cum ,the homologous model of TGR in Schistosoma j aponicum was constructed by Swiss-Pdbviewer based on sequence and structure alignment .The potential substrates binding sites of TGR were analyzed and these sites of various TGRs were also as-sessed .Our results showed that the homologous model of Schistosoma japonicum TGR based on Schistosoma mansoni TGR structure was proved to be reasonable by PROCHECK program .Analysis of binding sites showed that NADPH and GDS bind-ing sites were conservative sites and GSH binding site was a specific site for parasite .Our data suggested that inhibitors which work in NADPH and GDS binding sites of other various TGRs may also interact with TGR form Schistosoma j aponicum .GSH binding region might be one of the potential targets for design of specific inhibitors of parasite TGRs .In addition ,C-terminal of TGR plays an important role in electron transfer and may participate in the binding of the substrate .Thus compound inhibiting swing of C-terminal could effectively restrain Schistosoma j aponicum TGR activity .

Objective To evaluate the echocardiographic features of coronary artery dilation (CAD) and coronary artery aneurysms (CAA) in Kawasaki disease dynamically.Methods Echocardiography was performed in KD cases for measurement of the diameter of the coronary artery.Results Twelve CAD and four CAA were identified in forty-one patients.In CAD group,left coronary artery (LCA) is more susceptive to dilation than right coronary artery (RCA)(P<0.05).Both LCA and RCA were involved in CAA group,the maximum diameter of coronary artery is 10mm.Six to eighteen days after treatment,LCA were regressed significantly in CAD group(P<0.05),but the diameter of RCA in CAD group and coronary artery in CAA patients have no change(P>0.05).Ten coronary artery lesion patients were followed up,8 CAD cases regressed completely,1 CAA extended,the other CAA regressed completely.Conclusions In CAD group,LCA is more susceptive to dilation than RCA,but it regressed significantly in a short time after treatment.Echocardiography is a non-traumatic method to detect the coronary artery lesions in KD patients dynamically.

Objective To investigate the clinical features of incomplete Kawasaki disease (IKD).Methods The data of 46 Kawasaki disease (KD) patients including 14 IKD patients (IKD group)and 32 classical Kawasaki disease (CKD) patients (CKD group) was analyzed retrospectively,and compared the clinical manifestation,laboratory examination result,the incidence of coronary artery lesion (CAL) and the response to intravenous immunoglobulin (IVIG) of two groups.Results There was no significant difference in gender and age between IKD group and CKD group (P> 0.05 ).In IKD group,the fever time was longer than that in CKD group [( 11.43 ± 9.12) d vs (7.12 ± 2.83 ) d, P < 0.05], but the frequency of conjunctival congestion, lymphadenectasis of neck, indurative edema of palms and soles, changes of lips and oral cavity were less than these in CKD group [57.14%(8/14) vs 93.75%(30/32),28.57%(4/14) vs 59.38%(19/32), 35.71%(5/14) vs 78.12%(25/32),42.86%(6/14) vs 75.00%(24/32)](P< 0.01 or < 0.05).There was no difference in laboratory examination result and incidence of CAL between two groups, but the incidence of IVIG nonresponse in IKD group was higher than that in CKD group [40.0%(4/10) vs 6.45%(2/31 ),P <0.05].Conclusions The frequency of conjunctival congestion, indurative edema of palms and soles, changes of lips and oral cavity are less common in IKD patients comparing with CKD patients.The laboratory examination result and the risk of CAL in IKD patients are similar to CKD ones.Moreover, IKD is not sensitive to IVIG, so the doctors should pay more attention to it.

Objective To compare the efficacy and safety of modified FOLFOX4 program with docetaxel-oxaliplatin-5-fluorouracil (DOF) program as neoadjuvant chemotherapy in stage Ⅲ gastric cancer patients.Methods In 86 cases of stage Ⅲ gastric cancer patients,42 received modified FOLFOX4 chemotherapy,44 cases were treated by DOF program.After two cycles of chemotherapy,the treatment effect and adverse reactions were evaluated.Results The total effectiveness in modified FOLFOX4 group and DOF group was 60％ (25/42) and 68％ (30/44) respectively (P ＞ 0.05).Tumor control rate was 83％ (35/42) and 89％ (39/44) respectively (P ＞ 0.05).The incidence of nausea,vomiting and leukopenia was higher in DOF group than modified FOLFOX4 group (P ＜ 0.05).The D2 lymph node dissection rate between modified FOLFOX4 group and DOF group was 80％ (20/25) and 87％ (26/30) respectively (P ＞ 0.05),the R0 resection rate was 72％ (18/25) and 83％ (25/30) respectively (P ＞ 0.05).In 43 R0 resection patients using FOLFOX4 the median survival time was 38.7 months,1-,3-year survival rate was 90％,and 60％ ; while that in DOF group the median survival time was 39.6 months,1-,3-year survival rate was 95％,and 75％.Multivariate analysis showed that postoperative TNM stage only was an independent risk factor for prognosis.Conclusions TNM stage was the independent risk factor for prognosis of gastric carcinoma patients after radical gastrectomy.

AIM: To study the effect of thyroid hormone on the expressional change of myosin heavy chain(MHC) gene in cardiomyocyte induced by angiotensinⅡ(AngⅡ) and its potential mechanism. METHODS: Cardiac myocyte was cultured according to the method of Simpson. 10 -8 mol/L T_3 and 10 -7 mol/L AngⅡ were added to the culture medium,respectively or synchronously. After 48 h,the expression of ? and ?-MHC mRNA in myocytes were detected by RT-PCR. The protein kinase C activation were detected by PepTag non-radioactive PKC assay. The incorporation of -Leucine and -thymine to test the protein and DNA synthesis in myocytes were also performed. RESULTS: AngⅡalone increased the incorporation of -Leucine of myocytes while it had no effect on the incorporation of -thy mine. The expression of ?-MHC mRNA was increased and the expression of ?-MHC mRNA was decreased significantly at the condition of AngⅡ. The enhanced PKC activation was induced by AngⅡalso. When AngⅡand T_3 were added to the culture medium synchronously,though the incorporation of -leucine and -thymine were not changed compared with AngⅡ treated alone. The ?-MHC mRNA expression was increased and the ?-MHC mRNA expression was decreased significantly. The PKC activation of the myocytes also was decreased. CONCLUSIONS: T_3 inhibited the expressional change of myosin heavy chain gene in cardiac myocytes induced by AngⅡ. The effect of T_3 on the change of PKC activation in cardiac myocytes may be one of its mechanisms.

Objective To find new way to reduce non-recurrent laryngeal nerve (NRLN) injuries by applying intraoperative neuromonitoring(IONM) to identify NRLN in thyroidectomy. Methods Records of 279 patients who underwent complex thyroidectomy by applying IONM to identify and monitor RLN from Mar. 2009 to Jan. 2010 were veviewed. We proposed the skills to identify and monitor NRLN and predict RLN varition through exploring vagus nerve and RLN before RLN dissection. Results 6 cases NRLN located on the right side were all accurately identified by IONM, thus no injury of NRLN occurred during thyroid operations. Conclusions NRLN is difficult to be predicted preoperatively and identified by naked eyes. The application of IONM to predict, identify and monitor NRLN could remarkably reduce the possibility of NRLN injury.