Epilepsy is the common neurological disease, and antiepileptic drugs are the main means for the treatment of epilepsy. However, there is no conclusion on the timing of drug withdrawal in patients with epilepsy. In recent years, some large-scale prospective studies have provided some guidance on anti-epileptic drugs withdrawal. This article focused on the factors affecting the prognosis and timing of drug withdrawal, hoping to further the understanding of anti-epileptic drugs withdrawal and instruct clinical practise.

Objective To explore the feasibility and advantages of early open-heart radical operation on infants and children with Tetralogy of Fallot(TOF) in different ages and to analyze its perioperative outcomes.Methods The clinical data of 390 infants and children with TOF were analyzed, who underwent extracorporeal circulation open-heart surgery from January 2007 to January 2014 at the Department of Cardiovascular Surgery,the Third Affiliated Hospital of Zhengzhou University.The operative age ranged from 3 months to 14 years(mean 3 years).There were 172 infants(＜ 1 year old)and 218 children(≥ 1 year old).Some accompanied abnormalities included atrial septal defect (33 cases),patent ductus arteriosus (17 cases),coronary artery anomalies (8 cases), and multiple ventricular septal defect (5 cases).Results Ten patients died, and the overall mortality during hospital stay was 2.56％.The mortality of the infants group and the children group was 2.32％ (4/172 cases) and 2.75 ％ (6/218 cases), respectively,and there was no significant difference (x2 =0.000, P =1.000).Extracorporeal circulation time was (89.16 ± 74.38) min and (83.14 ± 66.72)min, respectively, aortic clamping time was (59.75 ± 35.20) min and (54.70 ± 38.54)min respectively, operation time were (185.34 ± 168.64)min and (163.35 ± 150.15) min respectively, duration of postoperative ventilation were (57.17 ± 67.46) h and (47.50 ± 58.39) h, respectively, the hospitalization time in the Intensive Care Unit was (5.08 ± 7.93) d and (3.71 ± 5.40) d, respectively, and the postoperative stay averaged (13.82 ± 17.78) d and (9.52 ± 8.74) d respectively in the infants group and the children group;there was no significant differences between 2 groups (t =1.937,1.890, 1.991,1.887,1.951,1.931;P =0.259, 0.713, 0.194, 0.739,0.241,0.308).Conclusions The curative effect of early cardiac surgical treatment on infants with TOF is considerably good with low morbidity and mortality.Early cardiac surgical treatment can avoid delayed development and growth in children, hypoxemic spells,sudden death and some other kind of adverse events.

Objective To investigate the role of neuropeptide trefoil factor 3 (TFF3) in cocaine reward responses and the underlying mechanism.Methods Fifty SD rats were divided into 6 groups including Control group,Cocaine group,Cocaine + TFF3 (0.01 mg/kg) group,cocaine + TFF3 (0.1 mg/kg) group,cocaine + TFF3 (0.5 mg/kg) group and TFF3 (0.1 mg/kg) group,ip,n=7 ～ 9),and were treated with TFF3 / saline (ip),30 min later,rats were injected with cocaine (10 mg/kg ip) followed by 1 h hypedocomotion test.Immediately after behavioral test,rats (n=4～6) were decapitated and tissues of nucleus accumbens (NAc) were isolated and prepared for neurotransmitters analysis by HPLC; Another twenty one rats were divided into control and TFF3-treatment group,and the rats were trained with a modified 2-day cocaine CPP conditioning procedure.During cocaine CPP conditioning process,saline or TFF3 (0.1 mg/kg ip) was injected 30 min prior to cocaine injection (5 mg/kg ip).Results Systemic administration of TFF3 (0.1 mg/kg,ip) significantly increased the cocaine-induced locomotor activity (Total distance in 1 hour were (180±41) cm,(359±53) cm,(590±75) cm,(153±27) cm for Control,Vehicle + Cocaine,TFF3+Cocaine and TFF3+Vehicle groups respectively) and augmented cocaine rewarding effects in CPP(Post-training CPP score were (98± 18) s,(187±24) s for Vehicle + Cocaine,TFF3+Cocaine groups respectively).TFF3 (0.1 mg/kg ip) administration increased the dopamine concentration in the NAc induced by cocaine injection ((0.65±0.1) ng/ml,(1.24±0.14) ng/ml,(1.75±0.23) ng/ml,(0.74±0.21) ng/ml for Control,Cocaine,TFF3 + Cocaine and TFF3 + Vehicle groups respectively).Conclusion TFF3 is involved in regulation of behavioral response to cocaine,which is associated with the increasing of dopamine in the NAc.

Objective To investigate the effects of isoflurane anenthesia on myocyte enhancer factor 2(MEF2) signaling pathway in neonatal rat hippocampus. Methods Twenty-four 5-day-old SD rats of both sexes,weighing 10-13 g, were randomly divided into 2 groups ( n = 12 each): control group (group C) and isoflurane group (group I). In group I, 1.5% isoflurane in 100% O2 was inhaled for 6 h. Group C received no treatment.Three rata in each group were sacrificed at 2, 4, 6 h of isoflurane anenthesia and 24 h after isoflurane anenthesia (T1-4), and the hippocampi removed for determination of MEF2 mRNA, synGAP Ⅰ mRNA, Arc mRNA and synapsinⅠ mRNA expression (by PT-PCR) and synapsin Ⅰ protein expression (by Western blot).Results Compared with group C, the expression of MEF2 mRNA, synGAP Ⅰ mRNA, Arc mRNA and synapsin Ⅰ mRNA at T1-3 and synapsin Ⅰ protein at T2-4 was up-regulated in group I ( P ＜ 0.05). Conclusion Inhalation of anaesthetic concentration of isoflurane may affect synapse formation during the development of central nervous system by actirating hippocampal MEF2 signaling pathways in neonatal rats.

Objective To evaluate the effects of combination of dexmedetomidine and mild hypothermia on global cerebral ischemia-reperfusion (I/R) injury in neonatal rats.Methods Ninety-six neonatal Sprague-Dawley rats,aged 6-7 days,weighing 18-22 g,were randomly divided into 4 groups (n=24 each) using a random number table:I/R group,mild hypothermia group (group H),dexmedetomidine group (group D) and combination of dexmedetomidine and mild hypothermia group (group DH).Global cerebral ischemia was induced in rats anaesthetized with chloral hydrate by bilateral common carotid artery clamping (for 15 min) combined with hypotension followed by reperfusion.Dexmedetomidine 75 pg/kg was given intraperitoneally at 30 min before ischemia in D and DH groups,while the equal volume of normal saline was given in I/R and H groups.The temperature in the temporal muscle was maintained at 36.7-37.2℃ in I/R and D groups,and at 34.8-35.3℃ in H and DH groups.At 12,24 and 72 h of reperfusion,8 rats were randomly chosen in each group,and neurological deficit score (NDS) was determined.The animals were then sacrificed,and their brains were removed for determination of myeloperoxidase (MPO) activity (by spectrophotometry) and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in brain tissues (using ELISA).Results Compared with I/R group,the NDS,MPO activity and contents of TNF-α and IL-6 were significantly decreased in the other three groups.The NDS,MPO activity and contents of TNF-α and IL-6 were significantly lower in DH group than in H or D group.Conclusion Dexmedetomidine can optimize cerebral protection providedby mild hypothermia against global cerebral I/R injury through inhibiting inflammatory responses in brain tissues of neonatal rats.

AIM: To design,prepare and screen out functional small interfering RNA(siRNA) for specifically silencing proliferating cell nuclear antigen(PCNA) gene expression and effectively inhibiting cell proliferation on human hepatoma cell line SMMC-7721,human gastric carcinoma cell line SGC-7901 and human colorectal carcinoma cell line Caco2.METHODS: PCNA siRNA was designed based on previous studies about design guidelines and synthesized in vitro by T7 Mega short script reaction kit according to the manufacturer's instructions.After purification,the integrities of siRNA were identified through 19% denaturing polyacrylamide gel electrophoresis,and the concentrations of the generated siRNA were measured by testing the absorbance at 260 nm using a spectrophotometer.Four synthesized double-strand siRNA were transfected into three types of carcinoma cell lines by LipofectamineTM2000 reagent,respectively.WST-8 assay was employed to examine the proliferative inhibitions of these three cell lines.The subsequent alterations on PCNA mRNA and protein levels were determined by semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR) and immunocytochemistry,respectively.RESULTS: 3 sequences,No.2,No.3 and No.4 PCNA siRNA showed effective inhibitions on tumor cells among the 4 candidate siRNA,and a single dose of 50 nmol/L of No.2,No.4 PCNA siRNA showed the most effective inhibitory rates as more than 62% at 48 h after transfection.50 nmol/L of No.2 and No.4 PCNA siRNA transfection caused 72% decrease of PCNA mRNA level and almost completely loss of the protein in human Caco2 cells.CONCLUSION: No.2 and No.4 PCNA siRNA have been screened out in this study,which show the capability to effectively down-regulated PCNA expression and significantly inhibit the proliferation of carcinoma cells.The optimal concentration is 50 nmol/L and satisfactory effects are achieved 48 h after transfection in vitro.

Metal-organic complexes have a long history of clinical application and have shown remarkable efficacy in the treatment of hypertension,skin infections and gastrointestinal diseases.In recent years,the application of metalloids in anti-bacterial infection thera-py and their mechanism of action have been widely studied.In this paper,three commonly used metallodrugs are selected as examples to review the progress and mechanism of metalloids in antibacterial applications,the research of novel metal-based drugs and the metallo-drugs with extracted components of traditional Chinese medicines and their derivatives,and to analyze the potential advantages of metallo-drugs in the field of antibacterial.

OBJECTIVE To observe the effect of Huangjing Jiangya Decoction on blood pressure and sleep in patients with hy-pertension of qi-deficiency type accompanied by insomnia.METHODS 73 patients with hypertension of qi-deficiency type accompa-nied by insomnia who met the inclusion criteria were selected and randomly divided into an observation group of 36 cases and a control group of 37 cases.The control group was treated with amlodipine besylate tablets,and the observation group was given Huangjing Jian-gya Decoction oral treatment on the basis of the control group.Both groups were treated continuously for 8 weeks.The changes in TCM syndrome scores,office blood pressure monitoring(OBPM),home blood pressure monitoring(HBPM),24-hour ambulatory blood pressure monitoring(ABPM),Pittsburgh Sleep Quality Index(PSQI)scores and clinical efficacy of the two groups of patients before and after treatment were observed.RESULTS After treatment,the TCM syndrome scores in the observation group were significantly decreased(P<0.05,P<0.01),which were better than the control group(P<0.01);OBPM and HBMP in both groups were signifi-cantly reduced(P<0.05,P<0.01),the observation group was better than the control group(P<0.05,P<0.01);the ABPM of the observation group was significantly reduced(P<0.01),which was better than the control group(P<0.05,P<0.01);the sleep quali-ty,sleep latency,sleep duration,daytime dysfunction score and PSQI total score of the observation group were significantly decreased(P<0.01),which were better than those in the control group(P<0.05,P<0.01);the clinical efficacy of hypertension and insomnia in the observation group was both better than the control group(P<0.01).CONCLUSION Huangjing Jiangya Decoction combined with amlodipine can improve the symptoms of patients with hypertension of qi-deficiency type accompanied by insomnia,lower blood pressure,improve sleep quality,shorten sleep latency,alleviate daytime dysfunction,and has good clinical efficacy.

Objective:To introduce a new TIANJI robot assisted targeted puncture technique, and discuss the feasibility and clinical effect of transforaminal percutaneous endoscopic lumbar discectomy (tPELD) using this technique.Methods:The first 14 consecutive cases of single level lumbar disc herniation who underwent robot assisted tPELD procedure were retrospectively analyzed. The mean age was 46.3±16.0 years old (ranged from 16-72). After data transferred from C-arm to robot system and automatic registration, surgeons made plans of the trajectory on robot system based on intraoperative 3-dimensional images of lumbar spine. Move robotic arm to planned position, guide an accurate puncture pathway and establish working cannula. 25 consecutive patients who underwent conventional C-arm assisted tPELD surgery during the same period of time were assessed as the controlled group. The mean age was 45.5±13.7 years old (ranged from 16-68). All patients were followed up for 12 months. Clinical effect was assessed by visual analogue scale (VAS), Oswestry disability index (ODI) and Modified Macnab criteria. Intraoperative parameters and surgery-related complications were recorded.Results:The baseline data of age, surgical level, types of herniation, preoperative VAS scores and ODI had no significant difference between two groups ( P>0.05). In robot group, one case was converted to open microdiscectomy during operation due to technical failure. The other thirteen cases had successful robot assisted tPELD surgeries and were assessed accordingly. The new technique had good clinical outcomes. The immediate post-operative VAS score 2.85±1.79 and the last follow-up VAS score 1.50±1.04 were both significantly decreased than that before surgery 7.62±0.92 ( F=69.747, P<0.01); the last follow-up ODI 18.89%±12.16% was significantly reduced from the pre-operative ODI 71.19%±12.12% ( t=15.430, P<0.01). Between two groups, the immediate post-operative VAS score ( t=0.568, P=0.574), the last follow-up VAS score ( t=0.713, P=0.481), and last follow-up ODI had no significant difference ( t=0.171, P=0.865). The excellent or good rate of modified Macnab criteria at the last follow-up was 92.30% in robot group, comparing to 84.0% in controlled group. The fluoroscopic times during surgery of robot group 8.8±5.5 was significantly lowered the in controlled group 21.3±8.3 ( P<0.01). One case in robot group and two cases in controlled group had recurrence during follow-up period (recurrence rate 7.7% vs. 8.3%). However, there was no significant complications such as nerve root injury, dura injury or increased intracranial pressure in both groups. Conclusion:This study confirmed the feasibility of this new technique. Preliminary results indicated that TIANJI robot could help to build an easy, accurate and safe procedure of tPELD surgery.

Objective To observe the effects of Huoxue Digui Decoction on iron accumulation and ferroptosis in renal podocytes of diabetic nephropathy(DN)mice.Methods Totally 50 C57BL/6J mice were randomly divided into normal group(6 mice)and modeling group(44 mice).The DN model was established by streptozotocin injection.Mice conforming to DN model were randomly divided into model group(8 mice),and sulforaphane group,Huoxue Digui Decoction low-,medium-and high-dosage groups(6 mice for each group).The sulforaphane group was injected with sulforaphane intraperitoneally,while Huoxue Digui Decoction low-,medium-and high-dosage groups were orally administered with corresponding solution for 12 consecutive weeks.The fasting blood glucose,blood urea nitrogen,serum creatinine,24 h urinary albumin were detected,HE staining was used to observe the morphology of renal tissue,PAS staining was used to observe glycogen deposition in renal tissue,Masson staining was used to observe fibrosis in renal tissue;transmission electron microscopy was used to observe the ultrastructure of renal tissue,immunohistochemistry was used to detect the expressions of Podocin and Nephrin in renal tissue,Western blot was used to detect the protein expressions of glutathione peroxidase 4(GPX4),ACSL4,nuclear factor E2 related factor 2(Nrf2)and ferroportin 1(FPN1)in renal tissue,Prussian blue staining was used to observe the deposition of ferric ion in renal tissue.Results Compared with the normal group,the fasting blood glucose,blood urea nitrogen,serum creatinine and 24 h urinary albumin in model group significantly increased(P<0.01),with renal tissue capillary atrophy,increased glycogen deposition,and worsening fibrosis,the expressions of Podocin and Nephrin in renal tissue were down-regulated,while the expressions of GPX4,Nrf2 and FPN1 protein were significantly decreased(P<0.01),the expression of ACSL4 protein significantly increased(P<0.01),and the deposition of ferric ion in renal tissue increased.Compared with the model group,the fasting blood glucose,blood urea nitrogen,serum creatinine and 24 h urinary albumin in sulforaphane group and Huoxue Digui Decoction groups were reduced to different degrees(P<0.05,P<0.01),renal tissue pathological damage was reduced to varying degrees,glycogen deposition was reduced,and fibrosis was alleviated,the expressions of Podocin and Nephrin in renal tissue were up-regulated,while the expressions of GPX4,Nrf2 and FPN1 protein significantly increased(P<0.01),the expression of ACSL4 protein significantly decreased(P<0.05,P<0.01),and the deposition of ferric ion in renal tissue was reduced.Conclusion Huoxue Digui Decoction can alleviate renal pathological injury,reduce blood glucose and delay the progression of DN mice.The mechanism may be related to regulating the expressions of Nrf2 and FPN1,inhibiting iron accumulation and ferroptosis in renal podocytes of DN mice.