Objective To investigate the effect of propofol and midazolam anesthesia in the treatment of persistent state of intractable epilepsy in children.Methods A total of fifty children with intractable epilepsy were selected in Guangzhou Women and Children''s Medical Center from May 2011 to May 2016,and were divided into propofol group and midazolam group according to the method of anesthesia,each group 25 cases.In the treatment,continuous EEG and ECG monitoring were applied in both groups,and the changes in hemodynamics were recorded in order to compare the medication and treatment effects.Results After epilepsy was under control and drug was withdrawn,the heart rate (HR),systolic pressure (SBP),diastolic pressure (DBP) of the two groups were all reduced,lower than the data collected before the treatment,the differences were statistically significant (P<0.05);in the propofol group,HR and SBP after control were (93.21±17.61) time/min and (92.44±12.84) mmHg (1 mmHg=0.133 kPa),lower than those of the midazolam group((109.84±18.41) time/min,(101.93±14.79) mmHg,t=3.264,2.423,P<0.05);the medication time,control time,intubation time of the propofol group were all shorter than those of the midazolam group ((13.21±2.14) h vs.(15.39±3.39) h,(3.47±0.89) min vs.(8.79±1.21) min,(2.03±0.79) d vs.(6.31±1.34) d,t=2.719,17.709,13.757,P<0.05);the total effective rate in the propofol group was significantly higher than that of the midazolam group (97.5%(39/40) vs.82.5%(33/40),χ2=5.357,P=0.021).Conclusion Propofol is effective in the treatment of persistent state of intractable epilepsy in children with good sedative effect,and can also reduce children''s resistance,therefore it''s worth promoting and applying into treatment.

Objective To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups,and to offer theoretical basis for the clinic diagnosis of bacterial meningi-tis. Methods The sick children with bacterial meningitis treated in Guangzhou Women and Children′s Medical Center from January 2011 to June 2013,were recruited and divided into three groups according to the age,including newborns group,infants group and more than 1 year group. Eighty-nine cases with purulent meningitis were recruited,included 58 males and 31 females. Among them,there were 34 cases in the newborns group,41 cases in the infants group and 14 ca-ses in the more than 1-year group. The information on the clinical features,laboratory examination and the imaging ex-amination were summarized and analyzed,and were compared among the 3 groups. Results (1)Among them,54 cases with high fever,44 cases with respiratory symptoms,12 cases with alimentary tract symptoms. (2)The major neurologi-cal features included convulsions(44 cases,49. 4%),fatigue(36 cases,40. 4%),vomiting(21 cases,23. 6%),cervical rigidity(9 cases,10. 1%),fontanel full(7 cases,7. 9%),headache(6 cases,6. 7%),limb paralysis(5 cases,5. 6%). The percentage of high fever,vomiting,headache,cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10. 093,12. 063,34. 466,7. 177,all P<0. 05). (3)Among them,whitebloodcell(WBC)accountswerefrom2.20to60.60×109/L,themeanwas(16.49±10.37)×109/L.Hy-persensitive C-reaction protein concentration in blood was 4. 00 to 376. 53 g/L,the mean was (131. 07±86. 91) g/L. In cerebrospinal fluid(CSF),WBC accounts were from 1 to 21 800×106/L,the mean was (910. 05±274. 07)×106/L, the glucose concentration from 0. 00 to 4. 50 mmol/L,the mean (1. 72±1. 03)mmol/L,the protein concentration from 0. 42 to 4. 89 g/L,the mean was(1. 64±1. 03)g/L. In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0. 4, and 15 cases with blood cultures positive. (4)The image examination showed magnetic resonance imaging( MRI) abnormalities in 51/75 cases,computerized tomography( CT) scan abnormalities in 15/30 cases. The percentage of convulsions,the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11. 768,9. 047,7. 674,all P<0. 05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7. 430,5. 291,all P<0. 05). Conclusions Be-cause of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be per-formed in all doubtful cases who had a fever and/or seizure. CSF glucose less than or equal to 0. 4 of simultaneously ob-tained blood glucose value,the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis,if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.

Objective: To investigate the clinical characteristics, treatment and prognosis of relapsed demyeli-nating disease (RDD) associated with myelin oligodendrocyte glycoprotein antibodies (MOG abs) children in southern China. Methods: Children with RDD associated with MOG abs at Department of Neurology in Guangzhou Women and Children′s Medical Center from January 2015 to December 2018 were retrospectively analyzed.The annualized relapse rates (ARRs) and expand disability status scale (EDSS) were used to assess the recurrence frequency and neurological dysfunction respectively. Results: Ten children were included with the age of (6.4±3.6) years old, and male to female ratio was 4∶6.(1)Clinical phenotype: all children had 24 episodes during follow-up, with acute disseminated encephalomyelitis (ADEM)(7/10 cases) and neuromyelitis optica spectrum disorders (NMOSD)(3/10 cases) on the first episode.Among 14 recurrent episodes, ADEM (9/14 times) was the most common, followed by optic neuritis(ON)(3/14 times)and brainstem encephalitis (2/14 times). By the final follow-up, the final diagnosis was multiphasic disseminated encephalomyelitis(MDEM)(6/10 cases), NMOSD(3/10 cases), ADEM-ON(1/10 case), respectively.(2)Laboratory examination: all the children had positive serum MOG abs in the acute stage.The serum MOG abs titer high group(≥1∶640)(6 cases)on the first episode complicated ON (3 cases) and long segment myelitis (3 cases) more common than those of low group(1∶320)(4 cases). (3)Imaging changes: 25 times of bain magnetic resonance imaging (MRI) were performed in the acute stage, MRI changes mostly involved the cortex and subcortical white matter.Four cases had abnormal spinal cord MRI.(4)Treatment and prognosis: intravenous methylprednone (IVMP) combined with intravenous immunoglobulin (IVIG) were administrated in acute stage.Rituximab (2/10 cases), mycophenolate mofetil (4/10 cases), IVIG (2/10 cases) monthly and low dose prednisone orally (2/10 cases) were given respectively in maintains stage.ARRs decreased from 1.4 to 0 and EDSS score improved significantly after these treatments above.Seven cases had residual neurological dysfunction with 3 cases of NMOSD, 3 cases of MDEM and 1 case of ADEM-ON, including motor dysfunction, learning disability and inattention, symptomatic epilepsy and visual impairment. Conclusions ADEM is the most common form of RDD associated with MOG abs in children.Those with high serum MOG abs titer on the first episode are prone to have ON or long segment myelitis.Immunomodification therapy is effective in the relapsed patients, residual neurological sequelae were related to the type of repeated demyelination.

Objective:To summarize the core research topics of the literature on differentiated thyroid cancer (DTC) , and to analyze the citation status to form the knowledge domain of citation science.Methods:Web of Science was used to search the literature on DTC, which was limited to April 04, 2021. The published records on DTC were identified. VOSviewer 1.6.11 and CiteSpace 5.5.R2 software were used to cluster and visualize the knowledge domain of citation.Results:A total of 8, 629 records on DTC were obtained, including 87, 973 citations, which showed that the publication volume increased year by year. Moreover, the trend of the annual records became more significant after the year of 2005. Meanwhile, it was reported that clinical staging and surgical management, as well as clinical researches on targeted therapy drugs, were treated as the currently hot research topics. The data showed that 115 records were cited more than 100 times, and 14 cited more than 300 times. And two records had been cited more than 1,000 times. Furthermore, the publication year of top15 were from 1988 to 2016, which also illustrated that the development of DTC researches were relatively slow before 2006. And the annual publication volume of DTC increased significantly with the publication of four highly cited records in 2006, even three with which have 1,000 citations. And the results revealed that the Consensus and Clinical Guidelines on DTC issued by ATA, as well as targeted therapy and radioactive 131I therapy on DTC had been highly cited. However, the newer highly cited documents on surgical treatment of DTC were still lacking. Conclusions:The current hot topics on DTC are focused on clinical staging, surgical management and targeted therapy. And a high-quality clinical guidelines and consensus and RCTs of targeted drugs on DTC have a significant impact on its development. Moreover, the further researches need to pay more attention to persistent/recurrent and metastatic DTC.

Objective:To evaluate the quality of the published breast cancer screening guidelines to provide a reference for domestic studies in the future.Methods:PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched to identify breast cancer screening guidelines on until August 2020. Two reviewers screened literature and extracted data independently. The Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREEⅡ) and Reporting Items for Practice Guidelines in Healthcare(RIGHT) tools were used to evaluate the quality of the included guidelines.Results:A total of 15 breast cancer screening guidelines were included, of which seven were published in the United States, with publication years focusing on 2015 to 2019, and 11 guidelines had updated versions. "Rigour of development" (47.0%±22.1%) and "Applicability" (44.0%±15.1%) of AGREEⅡ scored lower than other domains. "Review and quality assurance" (46.7%±39.9%) and "Funding, declaration, and management of interests" (41.7%±24.4%) of RIGHT were reported poorer than others. There were six guidelines recommended and another nine recommended with modifications based on the overall AGREEⅡ score. There were four guidelines with a good level, and another 11 were with a moderate level of RIGHT. The National Comprehensive Cancer Network published the best overall quality guidelines in 2018 (AGREEⅡ: 83.3%, RIGHT: 80.0%) and by the American Cancer Society in 2015 (AGREEⅡ: 83.3%, RIGHT: 85.7%).Conclusion:The quality of breast cancer screening guidelines was predominantly of moderate quality, and greater attention should be paid to the guideline development process and quality control of the guidelines.