Objective To evaluate the long-term effective rate,retention rate and tolerability of the ketogenic diet (KD) in pediatric drug-resistant epilepsies.Methods Data of 36 children who were treated in Department of Pediatrics,the Second Affiliated Hospital of Xi'an Jiaotong University from Nov.2011 to Dec.2013 and had continuous follow-up of at least 12 months after initiation of the KD were analyzed prospectively.Response was defined as 50％ seizure reduction.The effective rate,retention rate, outcome-predictive value of various clinical factors were also assessed.The causes of the patients withdrew from KD and side effects were recorded and analyzed.Results Thirty-six children(29 boys,7 girls; mean age of 2.84 years)were included.The effective rate was 50.0％,52.8％,47.2％ and 41.7％ at the 1,3,6,12 months;the retention rate respectively was 94.4％,91.2％,69.4％ and 52.8％.Seventeen cases withdrew from KD.Seven cases (41.2％)ceased KD becau~ of a lack of compliance,5 patients because of poor outcome,and 2 cases because of repeated infection.None of the age,disease duration,etiology and seizure type could be used as the predictor for the favourable treatment for outcome.The antiepileptic drugs before KD might be predicted the efficacy of the KD.The less amount of the antiepileptic drugs,the more opportunity of the KD might have to succeed.The side effects on the start-up period were drowsiness,week and digestive discomfort,hyperlipoidemia,hypoglycemia and hepatic dysfunction.The side effects on the maintenance period were digestive discomfort,susceptibility to infection,hyperlipoidemia,the deficiency of trace elements.Conclusions The KD is a safe and potentially effective method in treatment of refractory epilepsy patients who do not respond to customary medication therapies.

Objective To study the effect of cyclooxygenase-2 (COX-2)selective inhibitor Celecoxib on the expression of P-glycoprotein(P-gp)in the brain of rats with status epilepficus,in order to assess the therapeutic value of intractable epilepsy.Methods Sixty adult male SD rats were randomly divided into blank control group,the epilepsy model group and Celecoxib intervention group.The status epilepticus was induced in rats by injecting Lithium pilocarpine.Forty-eight rats were included in the experiment.There were 16 rats in each of the blank control group,epilepsy model group and Celecoxib intervention group,respectively.Immunohistochemical method and Western blot method were used to detect the expression of P-gp in experimental group in the frontal cortex and hippocampus.Results Immunohistochemistry result showed that the expression of P-gp was significantly higher in epilepsy model group than the blank control group,and the difference was statistically significant (P ＜ 0.01);The P-gp expression in the Celecoxib intervention group was lower than that in the epilepsy model group,and the difference was statistically significant (P ＜0.01).Western blot results suggested that the expression of P-gp could be found both in the frontal cortex and hippocampus in each group.Compared with the blank control group,the P-gp expression was significantly higher than that in the epilepsy model group,and the expression of the P-gp was lower after the Celecoxib intervention than that in the epilepsy model group,and the difference was statistically significant (P ＜ 0.05).Conclusions COX-2 inhibitor Celecoxib could decrease the expression of P-gp in brain tissue with status epilepticus,which may provide a new method for the treatment of intractable epilepsy.

Objective To investigate the protective function and its mechanisms of eyclosporin A to immature brain tissue with convulsive brain damage. Methods 21-day-old SD rats were given lithium-pilocarpine to make the epilepsy model. Total 67 male rats had been investigated. Cyclosporin A (CsA) were injected three times at 6, 30, 54 hrs after model had been established. Three dosages had been chosen: 5, 10 and 25 mg/kg each time. The level of apoptotic cells, P-glycoprotein (P-gp), glial fibrillary acidic protein (GFAP) in CA1 area of hippocampus had been determined, and compared with the rats without giving CsA. Results Rats from epilepsy model group had higher level of apoptosis, P-gp, GFAP expression than those from pseudo-model group. CsA injection by dose 5 mg/kg each time for three times reduced the level of P-gp, GFAP. Model group and pseudo-model group were same. Both the interventions of CsA injection by 10 mg/kg and 25 mg/kg can reduce the level of P-gp, GFAP, however neither of their effectiveness was better than CsA 5 mg/kg each time. Conclusions Small dosage of CsA may protect the immature brain tissue from convulsive brain damage by reducing the level of P-gp, GFAP in CA1 area of hippocampus.

Objective To investigate the effect of continuous quality improvement on venous transfusion exosmosis in elderly patients.Methods Through the investigation into venous transfusion exosmosis in 160 elderly patients,the causes for exosmosis were identified,followed by regulating and enforcing improvement measures and assessing the effect.Results The incidence of venous transfusion exosmosis in elderly patients was reduced from 6.40%to 2.57%and the satisfaction of patients improved from 90.00%to 97.50%.Conclusion The continuous quality improvement may effectively reduce the incidence of venous transfusion exosmosis and improve patients’satisfaction.

Objective To observe the normal configuration and size of the third ventricle in the second and third trimester fetuses in a normal population by ultrasonography. Methods The third ventricular width and configuration were obtained by antenatal ultrasonography in 765 fetuses with gestational age between 27 weeks and term.The relationship Between the width and the gestational age was analyzed.Results The third ventricle width 0～3 mm and showed the increased tendency; the correlation coefficient ( r ) between the width of the third ventricle and the gestationl week was 0.473 ( P＜0.01).The third ventricle was seen as a single echogenic line in 8(4.8%) of 165 fetuses, 145(61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen, the V-shaped configuration of the third ventricle was seen in 12(7.3%) of the fetuses.Conclusions The third ventricle width shows the increased tendency in the second and third trimester.The parallel echogenic line becomes the prominent ultrasonography appearance in the second and third trimester fetuses.It's usefull to observe the normal ultrasonic apperance of the third ventricle in diagnosing the fetal central nervous abnormities.

Objective To evaluate the clinical value and effectiveness of ultrasound screening for fetal chromosomal abnormalitie in the middle and late pregnancy. Methods Fetuses who were detected with abnormal ultrasound findings during the middle and late pregnancy, and high risk of maternal serum screening underwent amnioeentesis or eordocentesis for fetal chromosome karyotypes. Results (1) A total of 31 cases with fetal malformation diagnosed by ultrasound were analysed for fetal chromosome karyotypes, and 8 (25.8%) cases were proved with fetal abnormal chromosome karyotypes. There were 3 cases of cervical springwater cyst accompany with edema,and all were fetal abnormal chromosome karyotypes. There were 3 cases of cervical pachyderma,and 2 were fetal abnormal chromosome karyotypes. There was one case with multiple malformations, one with Dandy-Walker malformation and one with holoprosencephaly malformation,all were revealed fetal abnormal chromosome karyotypes. (2) A total of 516 cases with high risk of Down's syndrome and trisomy 18 by maternal serum screening were analysed for fetal chromosome karyotypes,and 14(2.710%) cases were proved with fetal abnormal chromosome karyotypes, which include 7 cases of Down's syndrome and 7 cases of other fetal abnormal chromosome karyotypes. (3) A total of 544 (516 + 28)cases with high risk by the combination of ultrasound and maternal serum screening were analysed for fetal chromosome karyotypes, and 21 (3.86%) cases were proved with fetal abnormal chromosome karyotypes, the rate of detection higher than only maternal serum screening 42.43%.Conclusions Fetal structure abnormalities were the effective ultrasound signs for fetus chromosomal abnormalities screening in the middle and late pregnancy. The combination of ultrasound and maternal serum screening can improve the rate of fetus chromosomal abnormalities screening and be an effective way to retrieve false-positive and lower risk of maternal serum screening.

Objective To investigate the clinical effect of large dosage of Methylprednisolone on epilespy combined with electrical status epilepticus during sleep(ESES) in children.Methods Forty-six epielpsy patients with ESES were treated with additive large dosage of Methylprednisolone.The seizures and video electroencephalogram discharges were observed before and after using Methylprednisolone.The Methylprednisolone effect in eliminating the methylprednisolone of ESES and controlling of clinical seizures and improving cognitive function were analyzed.Results Two cases were lost and 44 cases were included,male 30,female 14,the age at onset was (5.37 ±2.52) (2-9) years old.The duration of follow-up was (4.12 ± 2.00)(1-9) years old.The age at diagnosis of ESES was (8.17 ± 2.09) (4.0-12.5) years old.The efficacy of Methylprednisolone on seizures was 72.7％ (32/44 cases),while the efficacy of Methyl prednisolone on electroencephalograph (EEG) was 59.1％ (26/44 cases).For patients who were resistant to Levetiracetam or Clonazepam,Methylprednisolone was still effective.Intelligence quotient had no significant changes before and after treatment(P ＞ 0.05).The earlier onset age,the worse effect of Methylprednisolone.The efficacy of methylprednisolone for atypical benign epilepsy with cento-temporal spike(BECT) was higher than other syndromes.Conclusions Large dosage of Methyl prednisolone therapy for children with ESES,especially for those resistant to traditional or new antiepileptic drug for ESES,was effective and safe.The onset age and syndrome classification may have a certain value for prognosis and prediction of the effect of Methylprednisolone treatment.

Objective To determine whether prenatal ultrasonography (US) score is more effective than renal pelvic anterior posterior diameter (PAPD) for the prognostic evaluation of fetal hydronephrosis.Methods Fetuses with hydronephrosis (PAPD≥ 10 mm) were examined by prenatal US in the third trimester.PAPD,renal parenchyma thickness (RPT) and pelvicaliceal morphology (PM) were measured and graded from 0 to 3 score on the basis of severity of hydronephrosis,then the total US score of each kidney was obtained.According to the follow-up results after birth,all the cases were divided into two groups:physiological and pathological hydronephrosis.Via Z test,paired comparison was made to analyze area under the curve (AUC) of US score and each of the other three factors.Results Confirmed by postnatal US and other clinical examinations,of 198 kidneys (158 cases ) with hydronephrosis,139 (70.20％ ) were physiological hydronephrosis and 59 (29.80％ ) were pathological hydronephrosis.AUC of PAPD,RPT,PM,US score was 0.897 (minimum),0.957,0.944 and 0.982 (maximum) respectively,and there was significant difference between AUC of US score and each of the other three ( P ＜0.05).US score was the best approach for differential diagnosis of fetal hydronephrosis.Conclusions Prenatal US score is more effective and accurate than the single factor (PAPD,RPT,PM) to differentiate fetal physiological and pathological hydronephrosis.It was a new quantitative method to evaluate the prognosis of fetal hydronephrosis,and should be disseminated and applied clinically.

Objective Discuss medical health integration continuance management mode in the prevention of elderly patients after discharge in bed household application effect of pressure ulcers. Methods To 120 cases of elderly patients in bed in hospital time order is divided into control group and experimental group,by the medical health outreach group respectively in the hospital two days before the assessment of patients and family rehabilitation plan,the control group given conventional discharge and telephone follow-up after discharge,the experimental group according to the medical health integration management mode,made up of medical health outreach team to stay in bed for elderly patients after discharge pressure ulcer risk factors assessment,targeted prevention of pressure sores rehabilitation plan,group management,remote care joint family supervision,timely follow up the capa and the exami-nation of the effect,the pressure ulcer management and quality of life scale to compare two groups of patients at discharge,6 months after hospital discharge,the quality of life of 12 months after discharge and the incidence of pressure ulcers in a year. Results The experimental group was lower than those of control group,the incidence of pressure ulcers was statistically significant difference(P<0.05); 6 months and 12 months after discharge physiological field,psychological field in the quality of life score were higher than control group,the difference was statistically significant(P<0.05); Score compared two groups of environmental and social sciences has no statistical significance (P>0.05). Conclusion Medical health integration continuance management can effectively reduce the incidence of pressure ulcers that occupy the home stay in bed for elderly patients,improve their quality of life.

Objective:To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop.Methods:Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed.Results:After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups.Conclusion:Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop.