Gelastic epilepsy is a special refractory epilepsy accompany with ictal laughing and/or crying which can be divided into cortical induced gelastic epilepsy and hypothalamic hamartomas induced gelastic epilepsy according to their epileptogenic focus.Currently, domestic scholars had lack of systematic understanding of the mechanism and clinical treatment involved in gelastic epilepsy.Recently, foreign scholars had achieved great progress in the research of gelastic epilepsy which included the ictal laughing mechanism in gelastic epilepsy, the primary molecular mechanism in hypothalamic hamartomas induced gelastic epilepsy, the secondary epileptogenesis mechanism in hypothalamic hamartomas induced gelastic epilepsy and the clinical treatment of gelastic epilepsy.Now, the study progress of pathogenesis and clinical treatment of gelastic epilepsy were reviewed.

Objectives To explore the possible mechanism of all-trans-retinoic acid (ATRA) therapy for pulmonary ar-terial hypertension by observing the effect of ATRA on the expression ofα-smooth muscle actin (α-SMA) in monocrotaline (MCT)-induced rats with pulmonary hypertension. Methods Thirty SD rats were randomly divided into control group, MCT-induced pulmonary hypertension group (model group) and ATRA treatment group (therapeutic group). MCT (60mg/kg) was injected to the rats in the model group and the therapeutic group to induce pulmonary arterial hypertension. And at the same day ATRA [30mg/(kg?d)] was given to rats in the therapeutic group and continually given for 28 days. The mean pulmonary arte-rial pressure and right ventricular hypertrophy index (RVHI), percentage of wall thickness (WT%) and percentage of wall area (WA%) of pulmonary arterioles were evaluated at day 28. The expression ofα-SMA mRNA and protein in the lung tissue were detected by Real-time PCR and Western blot. Results Mean pulmonary arterial pressure, RVHI, WT%and WA%were signiif-cantly higher in the model group than those in the therapeutic group (P<0.01) but these data in the therapeutic group were higher than that in the control group (P<0.01). The expression ofα-SMA mRNA and protein were higher in the model group than those in the control group and the therapeutic group (P<0.01), while there was no difference was found between the therapeutic group and the control group (P>0.05). Conclusions ATRA has therapeutic effect on pulmonary hypertension through down-regulation ofα-SMA expression.

Myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) are important inhibitory immune cells.Research finds that MDSCs and Tregs increase in a large number under the conditions of inflammation,infection and tumor and they are able to suppress the immunity system and promote tumorigenesis and metastasis through multiple mechanisms.Finding the causes resulting in the increase of MDSCs and Tregs in tumor microenvironment and the eliminating methods have become new focuses in the field of antitumor immunotherapy.

Objective To explore the significance of complement split product C4d in monitoring chronic rejection of renal allografts in rats.Methods Healthy closed population rats were used as donors and SD rats as recipients. The Wistar to SD model of graft rejection was developed. All the 42 recipients were randomly divided into 2 groups: group A receiving nothing except CsA (5mg?kg~ -1 ? d~ -1 ) in the first 10 days after operation, and group B receiving MMF (10 mg/kg) and CsA after operation. On the 3rd, 5th and 10th week, all the allografts were tested by light microscopy and immunofluorescence. Pathological changes of the kidneys and the expression of C4d in allograft tissue were observed.Results From the 3rd week, the rats in group A showed light pathological changes of chronic rejection and they became more and more obvious as time increased. Pathological changes occurred in group B at the 5th week and lighter than in group A. At the same time, C4d deposition in PTC was obviously observed on the 3rd week in group A, and on the 10th week C4d widespread deposition in allografts.Conclusion The deposition of complement split product C4d in allografts appears earlier than pathological change of chronic rejection, which can be regarded as a significant indicator to predict chronic rejection of renal allografts.

Overall enhancement of the public health system ranks a key task and goal for the ongoing health reform.This paper described the public health development in Shenzhen amid the ongoing health reform.Shenzhen has achieved the following objectives as required in the reform:better public service by public health institutions,availability of major and primary public health services as required by the state and city,overall elevation of public health service capabilities,and significant drop of disease morbidity and mortality.Challenges ahead include room of improvement in public health service network,incentive mechanism of public health service providers,and that of public health service delivery capability.

Objective To evaluate the effect of the noxious stimulation factor on γ-aminobutyric acid (GABA) distribution in dog spinal cord during propofol anesthesia.Methods Sixteen healthy mongrel dogs of both sexes,aged 12-18 months,weighing 10-12 kg,were randomly divided into 2 groups (n =8 each):noxious stimulation group (S group) and control group (C group).Anesthesia was induced with propofol 7 mg/kg.The animals were mechanically ventilated after tracheal intubation.Right femoral artery was cannulated for mean arterial pressure (MAP) and pulse rate monitoring.Anesthesia was maintained with propofol infusion at a constant rate of 70 mg· kg-1 · h-1.5 ％ formalin 300 μl was subcutaneously injected into the central region of tails in group S,while the equal volume of normal saline was injected instead of formalin in group C.MAP and pulse rate were recorded before injection of formalin or normal saline (T1) and after injection of formalin or normal saline (T2).The dogs were scarified by decapitation at 50 min of continuous propofol infusion and cervical 2-3 segments of the spinal cord were removed for determination of GABA level in different regions of the spinal cord (frontal horn,posterior horn,intermediate zone,frontal funiculus,posterior funiculus and lateral funiculus) by HPLC.Results MAP and pulse rate were significantly higher at T2 than at T1 in S group (P ＜ 0.05).There were no significant differences in GABA level among the different regions of the spinal cord in C group (P ＞ 0.05).Compared with C group,GABA level in the frontal horn and posterior horn was significantly increased (P ＜ 0.05),and no significant change was found in the other regions of the spinal cord in S group (P ＞ 0.05).Conclusion The noxious stimulation factor can induce an increase in GABA level in the frontal horn and posterior horn of dog spinal cord during propofol anesthesia.

Fracture of multiple implants is rare.This report describes 1 case with the fracture of multiple implants related to occlusal over-load,bruxism,periodontitis and other factors in the posterior position.The fractured implants were removed and immediate reimplantation was performed.The panoramic film showed that the implants were integrated successfully 12 months after prosthesis.

Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.

OBJECTIVETo explore the clinical characteristics and significance of RET proto-oncogene screening in multiple endocrine neoplasia type 2A (MEN2A).

METHODSComprehensive medical history was obtained for 5 members from a 3-generation family from southern China. Clinical investigations have included biochemical testing, imaging, and screening of germline RET proto-oncogene mutations.

RESULTSGenetic screening has revealed a missense mutation at codon 618(TGC>CGC) of exon 10 in 3 patients(p.C618R), which was consistent with their clinical manifestations. For the 3 individuals, the age at diagnosis was 21, 26 and 36 yr, and the maximum diameter of medullary thyroid carcinoma was 22, 25 and 39 cm, respectively. The 36-year-old female patient initially underwent right total thyroidectomy plus right neck lymph node dissection. Four years later, she again underwent left adrenal tumorectomy and left total thyroidectomy plus left neck lymph node dissection. The 21-year-old male patient underwent right total thyroidectomy plus right modified neck dissection. The follow-up was respectively 146 and 26 months following the initial operation. Two patients still presented elevated calcitonin and had bilateral neck lymph node masses and/or left thyroid masses on imaging examination. The 26-year-old female patient, who presented bilateral thyroid masses and elevated calcitonin, has refused thyroidectomy.

CONCLUSIONCombined family survey and RET gene screening can facilitate early diagnosis and surgical treatment to improve the prognosis.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Carcinoma, Neuroendocrine ; Exons ; Female ; Humans ; Male ; Molecular Sequence Data ; Multiple Endocrine Neoplasia Type 2a ; enzymology ; genetics ; Mutation, Missense ; Pedigree ; Proto-Oncogene Proteins c-ret ; genetics ; Thyroid Neoplasms ; enzymology ; genetics ; Young Adult