Objective To study the apllication value of cerebraspinal fluid minimal residual leukemia cells(MRLCs) combined with lactate dehydrogenase(LDH) detection in early diagnosis of central nervous system leukemia(CNSL) to provide a laboratory basis for clinical diagnosis and evaluation of disease progression and therapeutic effect.Methods Thirty inpatiernts without blood disease and central nervous system(CNS) organic diseases,and normal CSF routine and detected biochemical indexes were selected as the control group and 96 cases of acute leukemia (AL) diagnosed by bone marrow puncture FAB morphology and flow cytometry typing served as the disease group.Flow cytometry was used to detect the MRLCs in CSF,the activity of LDH in CSF was detected by the rate method,and the detection results were performed the comparative analysis.Results Among 96 cases of AL,30 patients with CNSL had 13 cases of positive MRLCs in CSF,the positive rate was 43.33%,among 66 cases of non-MRLCs,MRLCs was not detected detected.Among 96 cases of AL,CSF LDH level in 30 cases of CNSL was (30.54±10.29)U/L,which was significantly higher (16.16±7.12)U/L in the patients without CNSL,the difference between the two groups was statistically significant (P<0.05).Conclusion The detection of MRLCs and LDH in CSF of AL can be used as a laboratory diagnostic index for early diagnosis of CNSL,and MRLCs combined with LDH detection can improve the positive diagnosis rate of CNSL.

Objective To evaluate the effect of Roux-en-Y gastric bypass on patients with different preoperative glycosylated hemoglobin (HbAlc) level.Methods From Jan.2008 to Dec.2009,54 patients with gastric lesions and type 2 diabetes mellitus were preoperatively divided into 3 groups:group A (HbAlc:6.5％ -7.9％ ),group B ( HbAlc:8.0％ - 9.9％ ),and group C ( HbAlc ＞ 10％ ).They all underwent Roux-en-Y gastric bypass.The fasting plasma glucose(FPG) and HbAlc concentration were measured before surgery and 12,24,48 weeks after surgery.The antidiabetic medication was analyzed before surgery and 48 weeks after surgery.Results FPG and HbAlc concentration decreased significantly after surgery ( P ＜ 0.01 ).FPG and HbAlc concentration differed greatly between the different groups ( P ＜ 0.01 ).With the increase of preoperative HbAlc,FPG and HbAlc concentrations were poorly controlled after surgery.Conclusion Roux-en-Y gastric bypass surgery can effectively improve glucose metabolism for patients with preoperative HbAlc ＜ 10％.

Objective To investigate the effect of the timing of pronase on the quality of magnetically controlled gastric capsule endoscope(MCE).Methods 225 patients from February 2021 to March 2022 were randomly assigned to 3 groups,40 000 u of oral pronase 40 min before examination in Group A,20 000 u of oral pronase for 60 and 40 min before the examination in Group B,20 000 u of oral pronase for 40 and 20 min before examination in Group C.Gastric cavity cleanliness and gastric mucosa visualisation scores(1 to 4)were recorded for the six regions of the stomach and the sum of the scores was calculated.The detection rate of gastric lesions such as gastric polyps and the time of gastric examination were also recorded.Results 221 patients completed the study.In the mucosal visualization score,group C scored(23.56±1.37)points,which was higher than that in group A's(22.56±1.28)points and group B's(23.00±1.33)points.The difference was statistically significant(P<0.05).In the gastric cavity cleanliness score,group C scored(21.44±2.35)points,which was higher than that in group A's(20.11±2.04)points.The difference was statistically significant(P<0.01).In the total score of cleanliness and mucosal visualization score of the proximal stomach(cardia and fundus),group C was higher than group A and group B,and the difference was statistically significant(P<0.05).In the detection rate of lesions,the detection rates of gastric polyps and erosion in group C were 17.8%and 49.3%,respectively,which were higher than group A's(6.8%and 29.7%)and group B's(9.5%and 31.1%).The differences were statistically significant(P<0.05).The gastric observation time in group C was shorter than that in group A and group B,and the difference was statistically significant(P<0.05).Conclusions Oral administration of 20 000 u of pronase in divided doses 40 and 20 min before the examination can enhance the quality of magnetically controlled gastric capsule endoscope.

OBJECTIVE To compare the efficacy and safety of levetiracetam versus valproic acid in the treatment of pediatric epilepsy， and to provide evidence-based reference. METHODS The databases including CNKI， VIP， China Biomedical Literature Database， Wanfang data， PubMed， Embase and Cochrane Library were searched for the RCTs about levetiracetam （trial group） and valproic acid （control group） were collected from the inception to October 1st， 2021. After literature screening and data extraction， the quality of included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0 and RevMan 5.3 software were used for meta-analysis， sensitivity analysis and bias risk analysis. RESULTS A total of 33 RCTs were included， involving 3 116 patients in total. The results of the meta-analysis showed that the effective rate of trial group was significantly higher than control group [RR＝1.06， 95%CI （1.02， 1.11）， P＝0.003]. The subgroup analysis according to different courses of treatment showed that there was no statistical significance in the effective rate between 2 groups after 1 and 3 months of treatment （P＞0.05）； after 6 months of treatment， the effective rate of trial group was significantly higher than that of control group （P＜0.05）. The incidence of adverse drug reaction in trial group was significantly lower than control group [RR＝0.50， 95%CI （0.41， 0.61）， P＜0.000 01]； among specific adverse drug reactions， the incidence of nausea and vomiting in trial group was significantly lower than control group （P＜0.05）； but there was no statistical significance in the incidence of rash， drowsiness， abnormal mood， loss of appetite， dizziness or headache （P＞0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS The short-term efficacy （1， 3 months） of LEV is similar to that of VPA in the treatment of pediatric epilepsy， but long-term efficacy （6 months） of LEV is better than that of VPA； moreover， LEV shows better safety in digestive system.