Objective To explore the characteristics of etiology,clinical,electroencephalogram(EEG) and prognosis of infantile spasms(IS) with focal seizures(FS).Methods The significance of age onset,seizure patterns and atteration,etiology,video-EEG(VEEG) and evolution of FS correlating to epileptic spasms(ES),which occurred in 12 cases with IS by means of clinical observation,cranial CT or MRI,VEEG monitory and follow up were investigated.Twelve cases were divided into group A,B,C according to the stages of FS occurring prece-ding,coinciding and following ES.Results Ten cases with IS were identified from focal cortical dysplasia,tuberous scleroses complex,temporal lobe cyst or scleroses and hypoxic-ischemic encephalopathy and others.Clinical manifestation presented FS at certain times during the course of the disease,and other characteristics of frequent attacks,asymmetric spasms or tonic spasms,some atypical seizures in the eyes and the head,motionless staring and focal motor seizures and other.The correlation of ES to FS occurred during one ictal episode as follows:FS→ES(6 cases),ES→FS→ES(1 case),ES→FS(3 cases).FS appeared more frequently,atypical,predominantly involving ocular,facial,oral movement or generalized convulsion,migrating or alternating seizures,associated with epileptic discharges of posterior parietal-occipital and parietal-temporal-occipital origins in group A and early period of group B;whereas in the late period of group B and group C,FS occurred less frequently and more stable,presenting complex partial seizures or secondarily generalized seizures originated mainly from frontal and surrounding areas in the lateralized or bilateral hemispheres.Regarding the natural evolution and development of IS,2 cases with early FS developed into IS;6 cases with IS evolved into Lennox-Gastaut syndrome or symtomatic generalized epilepsy,4 cases got into FS,1 case maintained in a peculiarly epileptic state with FS as well as ES until the operation at 4.5 years old,and the other case was not identified clearly.Conclusions IS coincided with FS is a special kind of aged-related FS associated with secondarily generalized seizures and epileptic encephalopathy.The multiple etiology,seizure patterns,ictal-interictal EEG,clinical evolution and prognosis of the disorder,indicate a complicated interaction of the immature cortico-subcortical abnormalities in the critical developmental period and thereafter,can be identified as a peculiar form of clinical epileptic syndrome.

[Abstract ] Objective Bone marrow mesenchymal stem cells(BMSCs) can be induced to the differentiation into vascular smooth muscle cells in many induction conditions.We sought to explore the possibility of the differentiation of mesenchymal stem cells into vascular smooth muscle cells by continuous cell culture in vitro. Methods Rat BMSCs were isolated from the bilateral tibial and femoral bones by the method of whole bone marrow adherence, followed by ex vivo expansion.BMSCs were identified by flow cytometry and three-lineage differentiation.After continuous five days'cell culture of BMSCs, the specific surface antigens of VSMCs were detec-ted by immunofluorescence, western blot and real-time PCR. Results BMSCs expressed CD29、90, in contrast, they did not express CD45、34、49d.After induction of osteogenesis, adipogenesis and chondrogenesis, alizarin red、oil red and alcian blue staining pro-duced a strong reaction in cells.The expressions ofα-SMA、Calponin1、SM-MHC and SM22 in the cells of experimental group were no-tably increased, which indicated that BMSCs were differentiating towards VSMCs. Conclusion In the absence of exogenous stimula-tion, BMSCs can be successfully induced to differentiate into VSMCs by continuous cell culture.

OBJECTIVE To investigate the clinical curative effect of acellular dermal matrix contrast with temporalis fascia in type Ⅰ tympanoplasty. METHODS A retrospective analysis of 60 inflammatory chronic suppurative otitis media patients from January 2014 to January 2015 in Genenral Hospital of PLA Guangzhou Military Area were conducted.All cases were perpormed the ear incision under local anesthesia, including 32 cases(32 ears) with acellular dermal matrix, 28 cases(28 ears) with temporal fascia. The operation time, postoperative pain, the healing of tympanic membrane and the postoperative recovery were compared between the two groups. RESULTS There was significant difference in the operation time and postoperative pain between the two groups(P<0.05). There was no significant difference in the success rate of tympanic membrane healing and postoperative hearing improvement(P>0.05). CONCLUSION The effect of acellular dermal matrix for repairing tympanic membrane is similar to the temporalis fascia. The use of acellular dermal matrix has the advantage of shorter operation time, less postoperative pain, and can avoid regional two incisions, it is worthy of clinical application.

Community rehabilitation of cardiovascular disease is of great significance. Exercise therapy of cardiovascular disease in communities is necessary and feasible. At present, the main problems China faced to carry out community exercise therapy of cardiovascular disease include: cardiovascular patients with a weak sense of community exercise therapy, lack of professional rehabilitation personnel, inadequate community-based exercise therapy practice and lack of community rehabilitation funding. To solve above problems, we should strengthen the community exercise therapy practice of cardiovascular disease, and promote the cooperation between community rehabilitation and hospital rehabilitation. In all, comprehensive efforts should be made in order to solve the problems.

Objective To explore the effects of a single bout of aerobic exercise on oxidative stress and total peripheral vascular resistance. Methods 36 prehypertensive patients were divided into aerobic exercise group (n=18) and control group (n=18). The aerobic exercise group performed cycle ergometry at 70% maximal oxygen consumption for 30 min. Total peripheral vascular resistance (TPVR), malondialdehyde (MDA), mean arterial pressure (MAP), vitamin C (VC) and vitamin E (VE) were measured before, immediately, 1 hour and 2 hours after the aerobic exercise. Results There was no significant difference in TPVR, MDA, MAP, VC and VE between two groups before exercise (P>0.05). TPVR was all significantly lower in the aerobic exercise group than in the control group immediately, 1 hour and 2 hours after exercise (P<0.001), and showed a rising trend of recovery. MDA was significantly higher in the aerobic exercise group than in the control group 1 hour and 2 hours after exercise (P<0.05), however there was no significant difference in MDA between two groups immediately after exercise (P>0.05). MAP was significantly lower immediately after exercise in the aerobic exercise group than in the control group (P< 0.001), but there was no significant 1 hour and 2 hours after exercise (P>0.05). There was no significant difference in VC and VE between two groups immediately, 1 hour and 2 hours after exercise (P>0.05). Conclusion The level of oxidative stress increases after a single bout of aerobic exercise, and the TPVR decreases.

Objective To investigate static closure functional characteristics of lower urinary tract in continence in late pregnancy of primigravida through perineal ultrasound and urodynamieal measurement. Methods From January of 2003 to December of 2005,83 primigravida undergoing antenatal health care in Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital were randomly enrolled in the study, while 28 nulliparous women were recruited as control.The perineal ultrasound and urodynamical measurement were performed at the gestation age of 36-40 weeks,in both groups.We analysed the parameters of lower urinary tract function in late pregnancy compared with nullipara,such as maximal urethral closure pressure(MUCP),functional urethral length(FUL),maximal urethral pressure(MUP), valsalva leak point pressure(VLPP),postvoid residual bladder volume(PVRBV)and volume of first desire to voiding(VFDV).Results The average weight of 83 neonates was(3504?404)g.In all of 83 primigravida PVRBV was less than l0 ml.MUP(110 + 22)cm H_2O(1 cm H_2O=0.098 kPa),MUCP (96?22)cm H_2O and FUL(44?9)mm were significantly increased in the third trimester compared with nullipara(P0.05). There were 33 pregnant women suffering from urinary leakage throughout the terms.The data showed that MUCP was significantly lower in the pregnant women with symptoms of leaking than without leaking. Conclusion The static closure function increased significantly compared with nulliparous women.The VLPP was decreased and had relationship with symptoms of leakage.The results suggest that the function of lower urinary tract in continence in late pregnancy of primigravida is complex.

OBJECTIVETo explore clinical characteristics and treatment of posterior Pilon fracture.

METHODSFrom January 2011 to January 2013,18 patients with posterior Pilon fracures were treated. Among them, 13 were male and 5 were female, aged from 22 to 63 years old, with an average age of 46. All the patients were closed fractures. Open reduction and internal fixation were performed after swelling subsided, lateral malleolous and posterior Pilon fracture were exposured through lateral approach on healthy side, plates were used to fixed,screws or small plates were used to fix the posterior prominence of medial malleolus after changed to supine position. AOFAS scoring were applied to evaulate clinical effects.

RESULTSAll patients were followed up with an average of 22(ranged, 12 to 48)months. All patients obtained satisfactory reset except one patient. All factures were recovered well with an average healing of 11 weeks. According to AOFAS score at the final following up, 7 cases were excellent,2 cases were moderate, and the total score was 86.8±9.2.

CONCLUSIONPosterior Pilon fracture is not rare in clinical, its mechanism of injury, traumatic anatomy, surgical procedure and prognosis are different from that of classical ankle fracture and Pilon fracture.

Adult ; Ankle Injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery ; Treatment Outcome ; Young Adult

Objective To explore the value of readout segmentation of long variable echo-trains (RESOLVE) in the differentiation of prostate cancer from benign prostatic hyperplasia (BPH).Methods Seventy two consecutive patients with suspected prostate cancer were evaluated by 3.0 T MR examination (RESOLVE sequence included,b values=0 and 800 s/mm2) were included in our retrospective study.All the patients had ultrasound guided systemic biopsy with histopathological diagnosis.The patients were divided into group A (23 prostate cancer cases with total 43 malignant lesions) and group B (49 BPH cases with total 64 benign lesions).Two radiologists who were blinded to the clinical data quantitatively analyzed the ADC values of suspicious lesions independently.Inter-reader agreement for ADC values was assessed with Bland and Altman test,and the intra-class correlation coefficient (ICC).Difference of ADC values in two groups was assessed by student's t test.Receiver operating characteristic curve (ROC) was used to determine the best predictor and cutoff value.Results A total of 107 lesions (43 malignant and 64 benign) were identified in 72 patients.ICC was 0.976,P＜0.01.The mean ADC value of prostate cancer is lower than BPH (t=19.223,P＜0.01),(0.74±0.12) × 10 3 and (1.21±0.12) × 10-3mm2/s respectively.Diagnostic cut-off point was 0.946× 10-3mm2/s,diagnostic sensitivity 95.3 ％ (41/43),specificity 98.4％ (63/64),accuracy 97.2％ (104/107).Conclusion RESOLVE ADC value is valuable in the differential diagnosis of prostate cancer and BPH.

Objective To observe the effect of inducible costimulator(ICOS) costimulation pathway blockade in rat limb allografts acute rejection by RNA interference. Methods Twenty-seven cases of modified hind llmb allotransplantation were performed from Wistar to SD rats. The rats were divided into 3 gronps(each n=9): the rejection group not given a special disposal; the control group, consisting of SD rats that received injection of pSilencer 4.1 and Sofast complex by vein post transplantation; and the interference group that received injection of pSilencer 4.1-ICOSshRNA and Sofast complex. On the eighth day posttransplantation, 3 rats were killed to study the pathological changes in each group. The expressions of ICOS gene in vivo were detected by flow cytometry and RT-PCR. The mixed lymphocyte reaction (MLR) was performed and eytokines in blood were measured by ELISA. The rest rats were used to record limb survival time. Results The mean survival time in rats of the rejection and the control groups were(11.34±1.21) and (11.14±1.32) days respectively. In the interference group, the mean survival time of limb allografts was (16.85±1.73) days(P<0.05). The rats in the rejection and the control groups experienced moderate to serious acute rejections with skin epidermal necrosis, a large quantity of lymphocyte infdtration, muscle cell necrosis and interstitial edema, while the pathological changes in rats of the interference group were mild. The splenocyte ICOS mRNA expression level in the interference group(18.75%) was significantly lower than that of the rejection group(100%) and the control group(98.51%). ICOS cell surface expression level as judged by the fluorescence intensity was 45.59±12.87 in the interference group, 103.72±21.76 in the rejection group, and 93.47±29.55 in the control group(F=6.89, P<0.05). In stimulation assays, a one-way mixed lymphocyte reaction stimulation index(SI), with spleen cells from Wistar and Lewis rats, respectively, the rejection group (5.26±0.42,5.18±0.29) and the control group (5.37±0.27,4.93±0.44) had significantly greater reactions than the interference group(2.37±0.35, 4.87±0.36), respectivily(F=7.29, P<0.05; F=6.19, P0.05). In the IFN-γ and IL-4 expression assays, reactions of the interference group (230.17±38.47,160.32±59.13) were lower than those of the rejection group(490.73±51.48,230.67±45.21) and the control group(480.15±43.96, 240.53± 47.36), (F=7.23,6.75, all P<0.01). Conclusions In vivo transfection of pSilencer 4.1-ICOS shRNA interference plasmid can effectively block T-cell co-stimulation pathway, suppress acute rejection, and prolong limb allografts survival.

Objective To determine whether hybrid three dimensional diffusion tensor imaging (3D DTI) contributes incremental value to standard T2WI technique for assessing neurovascular bundles (NVB) around the prostate. Methods This retrospective institutional review board-approved study included 69 consecutive patients with prostate tumor who underwent MRI including conventional T2WI and 3D DTI . DTI data were postprocessed and hybrid 3D DTI and axial T2W images were obtained. Three radiologists with one, five and thirteen years of experience in reading prostate MRI and one urologist with three years of surgical experience in urology who were blinded to patient data independently recorded their levels of preference on a five-point scale of the NVBs around the prostate on the basis of T2WI alone and hybrid 3D DTI and T2WI, respectively. The differences of scores of T2WI and hybrid 3D DTI and T2WI of the four doctors were compared by using nonparametric Wilcoxon rank. Results The average scores of hybrid 3D DTI to T2WI and alone T2WI to assess NVBs for 3 radiologists and one urologist were 4.4±0.6, 4.3±0.8, 4.2± 0.6, 4.9±0.3 and 2.9±0.8, 3.0±1.1, 1.6±0.7, 3.8±0.5, respectively. The hybird 3D DTI to T2WI improved the discrimination abilities of NVBs around the prostate for 3 radiologists and one urologist (Z values were-12.791,-9.737,-14.538,-14.901, P<0.01 respectively).The added value of hybrid DTI to T2WI for urologist is the highest, and experienced radiologist is the smallest. Conclusion The hybrid 3D DTI
contributes significant incremental value to the standard T2WI technique for assessing NVB around the prostate.