Objective To observe the effects of stereotactic implanting depth electrode into the hippocampus on monitoring mesial temporal lobe epilepsy. Methods Thirteen patients with pharmacoresistant epilepsy were included in the present study.The epilcptogenic zone might be located in the hippocampus based on the symptoms and MRI data.Eight-contact depth electrode was implanted into the patients' hippocampus by stereotactic procedures to record the electroencephalogram(EEG).The duration of monitoring lasted for 24-72 hours or more,so as to be sure if the epileptogenic zone was located in the hippocampus,and to provide evidences for surgical resection of epileptic focus.Results Thirteen patients with mesial temporal lobe epilepsy underwent video electroencephalogram monitoring for 72 hours.Twentynine epileptic seizures in 7 patients were detected.Ictal EEG changes manifested as paroxysmal slow wave or spike and slow waves on the background.The epileptiform discharges started from some electrode points,and then propagated to others or the contralateral electrode. After 1-2 seconds of delay,high amplitude slow waves with the frequency of 3-4 Hz were observed on the ipsilateral scalp EEG. Clinical epileptic seizures were not detected in 6 patients during monitoring,depth electrode showed paroxysmal focal high amplitude slow wave or spike and sharp waves,scalp EEG did not find abnormality.Six of thirteen patients received surgical resection of epileptic foci,the outcome during follow-up of 3-8 months was satisfactory.Conclusions To record hippocampal EEG in patients with intractable epilepsy by stereotactic implanting depth electrode into the hippocampus might be a safe and reliable method.It might provide strong evidences for the diagnosis of patients with mesial temporal lobe epilepsy,and for the location of epilcptogenic zone.

Purpose To discuss the clinical,histopathological characteristics,diagnosis,differential diagnosis and prognosis of malignant intraductal papillary lesions of the breast.Methods 28 cases of malignant intraductal papillary lesions of the breast were analyzed by histology and immunobistochemistry.Clinical and follow-up information was obtained.The published relevant literatures were reviewed.Results All the patients were females with a mean age of 55.7 years.The clinical features were a palpable mass or nipple discharge.28 cases were diagnosed including 22 cases of intraductal papaillary carcinoma,2 cases of encapsulated papillary carcinoma and 4 cases of solid papillary carcinoma.Microscopically,the tumor showed solid and papillary area inside the capsule wall with fine delicate fibrovascular septa.The tumor cells usually displayed low-grade nuclear features.Immunohistochemistry,the tumor cells revealed diffusely strong positive ER and PR in almost all cases and HER-2,CK5/6 were negative positive.All cases were negatiive for CK5/6,p63 and SMA in the celluar nodules.CD56,Syn and CgA were found positively in some solid papillary carcinoma cases.The average positive rate of Ki-67 in tumor cells was 5.3 ％.27 patients were available for follow-up examination from 10 to 79 months and all the patients were alive.Conclusion Malignant intraductal papillary lesions of the breast most occurs in postmenopausal women.The diagnosis should be based on the clinical information,histopathological features and immunohistoehemistry stain due to its diverse histology.The main differential diagnosis is intraductal papilloma.This kind of lesion is a low grade malignant tumor with favorable prognosis.

Objective To evaluate the influencing factors of compliance and the compliance changes before and after intervention on chronic hepatitis B patients who oral nucleos(t)ide analogue (NA), by using the continuing care service items provided by WeChat platform. Methods A total of 67 patients with chronic hepatitis B were selected from January 2013 to June 2015. WeChat health care teams and WeChat groups were established to conduct continuing care intervention for 6 months by providing services, such as authoritative scientific diagnosis and treatment information, online consulting service, expert outpatient appointment, etc. Results The score of Morisky Medication Adherence Scale (MMAS-8) in patients of different culture levels of illiteracy (4.75 ± 2.20) points, primary school or junior high school graduate (5.73±1.87) points,high school or vocational school graduate (6.31±1.45) points,university diploma and above (7.24 ± 1.23) points were significant difference (χ2=22.113, P < 0.01). The score in patients previous used of nucleoside drugs (5.76±1.89) points was lower than that in patients not previous used of nucleoside drugs (6.62±1.60) points, and there was a significant difference between the two groups(Z=-2.636, P<0.01). Significant difference (χ2=10.844, P<0.01) was shown between groups of≥3 kinds drugs combined with the score 7.02 ± 1.08, 1-2 kinds drugs combined with the score 7.02 ± 1.08 and no combined medication with score 6.04±1.95. Different medical insurance types of free of charge (7.60±0.48) points,residents medical insurance (6.54 ± 1.52) points,new rural cooperative (5.17 ± 2.34) points and self-paying medical service (5.93±1.91) points showed significant difference(χ2=15.630, P<0.01). The scores in other diseases showed no significant difference (Z=0.401, P > 0.05) both in combination or non-combination. Compared to 6.45 ± 1.69 of pre-intervention, the total compliance score 6.86 ± 1.53 showed significant increased after intervention (Z=-2.551, P < 0.05), and the number of people with high compliance after the intervention increased while the number of people with middle and low compliance after the intervention decreased, and significant differencewas observed in two groups (χ2=9.521, P<0.01). Conclusions After the intervention of continuing care based on WeChat platform, the patients' compliance with nucleoside antiviral drugs were significant improvement than those of pre-intervention.

Intracerebral hemorrhage (ICH) is an acute cerebrovascular disease with the highest mortality in subtype of stroke, accounting for 15%-20% of all strokes. There was no specific treatment for ICH currently. The mechanism of secondary neurological impairment after ICH remains unclear. Whether it is related to the process of ferroptosis caused by iron deposition is worth to further discuss. This paper reviews the related published articles about ferroptosis, which include mechanisms, inhibition methods and biomarker of ferroptosis.

Objective:To summarize the clinical characteristics of patients with chronic eosinophilic pneumonia (CEP), so as to provide reference for clinicians and improve the level of diagnosis and treatment.Methods:14 patients who met the diagnostic criteria of CEP in Xiangya Second Hospital of Central South University from January 2012 to July 2021 were analyzed retrospectively. Their clinical manifestations, laboratory examination, imaging characteristics, diagnosis and treatment were analyzed.Results:The male to female ratio of 14 patients with CEP was 6∶1, with a median age of 51 years. 3 patients had allergic rhinitis, sinusitis, rash and other allergic history. The course of the disease was about 4 months. The common symptoms included cough (14 cases), expectoration (13 cases), shortness of breath (10 cases), and occasional extrathoracic symptoms such as rash and lymphadenopathy (2 cases). Eight patients had abnormal pulmonary auscultation, mainly coarse respiratory sounds of both lungs and scattered dry and wet rales. The eosinophil count (EOS) in peripheral blood was increased in all patients, and the median EOS count was about 1.42×10 9/L. Total serum IgE increased in 11 patients, of which 10 cases were more than 1 000 ng/ml. Pulmonary function tests were performed in 11 patients, including 5 cases of normal pulmonary function, 3 cases of obstructive ventilation dysfunction and 3 cases of restrictive ventilation dysfunction. All 14 patients underwent lung computer tomography (CT) examination. Most of them (13 cases) were double lung infiltration. The pathological signs were mainly patch shadow (6 cases), ground glass shadow (4 cases), grid shadow (3 cases) and consolidation shadow (3 cases), and scattered nodule shadow (3 cases) was seen in some cases; Mediastinal or hilar lymphadenopathy occurred in 6 patients. 9 patients underwent bronchoscopic alveolar lavage (BAL) and cell classification and counting. Only 3 cases had EOS counts higher than the normal value (normal value<3%). 10 patients underwent bronchoscopic lung biopsy, and 6 patients had EOS infiltration in lung tissue. 9 patients were treated with glucocorticoids, 8 patients were treated with oral corticosteroids (OCS) (prednisone or methylprednisolone), and the initial dose was 30-50 mg; One case was treated with budesonide atomization alone; Five patients were not diagnosed with CEP, only used antibiotics or other symptomatic treatment, and did not use hormones. Conclusions:As a rare pulmonary disease, CEP has no specific clinical manifestations. The common symptoms are cough, expectoration, shortness of breath, etc, which is easily misdiagnosed. Laboratory tests often indicate increased peripheral blood EOS count and total IgE, and imaging usually shows diffuse infiltration in both lungs, with lymph node enlargement. OCS therapy is the first-line treatment for CEP. The short-term prognosis after OCS treatment is good, but it is prone to relapse. Some novel monoclonal antibody biologics can be used as alternative therapy.

Objective To observe the effects of perfusion of rosiglitazone (RSG) in lesion areas on the expression levels of the perihematomal tight junction-associated proteins occludin and zonula occluden-1 (ZO-1) mRNA,the permeability of blood-brain-barrier (BBB),and neurological function score in a rabbit model of cerebral hemorrhage (ICH).Methods A total of 45 healthy male rabbits were selected (a body mass of 2.0 to 2.5 kg).They were divided into 3 groups,a control group,a ICH model group,and a RSG treatment group (n =15,5 of them for BBB determination) according to the random number table.The control group was use to simulate the process of making intracranial hematoma.After successful puncture,the target was iujected with isotonic saline 0.3 ml and isotonic saline 0.1 ml was injected again after 6 h;after successful puncture,the ICH model group was injected with 0.3 ml of autologous non-anticoagulant arterial blood,and the target was injected into isotonic saline 0.1 ml after 6 h;RSG 0.5 mg was infused into the hematoma area (dissolved in 0.1 ml isotonic saline) in the RSG treatment group at 6 h after the ICH model was successfully induced.All rabbits in each group were sacrificed on day 7 after the neurological deficit scale score (Purdy score).Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression levels of perihematomal oecludin and ZO-1 mRNA.The formamide method was used to measure the Evans blue (EB) content in the perihematomal tissue in order to evaluate the permeability of BBB.Results (1) Neurological function scores:Purdy scores of the control group,ICH model group,and RSG treatment group were 2.53 ± 0.05,8.13 ± 0.06),and 6.67 ± 0.08,respectively.There were significant differences among the groups (F =459.116,P ＜ 0.01).Compared with the control group,Purdy scores of the ICH model group and RSG treatment group were increased significantly (all P ＜ 0.01).Compared with the ICH model group,Purdy scores of the RSG treatment group were decreased (P ＜ 0.05).(2) The expression levels of occludin and ZO-1 mRNA:The differences were statistically significant in occludin and ZO-1 mRNA in the control group,ICH model group,and RSG treatment group (1.013 ±0.051,1.001 ± 0.045;0.221 ± 0.017,0.247 ± 0.019;0.498 ± 0.041,and 0.613 ± 0.045,respectively in each group;F =443.924 and 381.929 respectively,all P ＜ 0.01).Compared with the control group,the expression levels of occludin and ZO-1 mRNA were significantly decreased in the ICH model group and RSG treatment group (all P ＜ 0.01).Compared with the ICH model group,the expression levels of occludin and ZO-1 mRNA were increased in the RSG treatment group (all P ＜ 0.05).(3) The permeability of BBB:The EB content in the control group,ICH model group,and RSG treatment group were 12.0 ± 1.0,51.6 ± 0.9,and 36.4 ± 1.0 μg/g,respectively.The differences were statistically significant among the groups (F =223.516,P ＜ 0.01).Compared with the control group,the EB content was significantly increased in the ICH model group and RSG treatment group (all P ＜ 0.01).Compared with the model group,the EB content was significantly decreased in the RSG treatment group (P ＜ 0.01).Conclusion The perfusion of RSG in the lesion area can significantly improve the neurological function of rabbits after ICH,increase the expression levels of occludin and ZO-1 mRNA in the perihematomal tissue,and decrease the permeability of BBB.

Objective To investigate the effect of malignant cerebellar hemorrhage on 3-month prognosis of small spontaneous cerebellar hemorrhage.Methods Clinical data of 380 consecutive patients with spontaneous cerebellar hemorrhage admitted in Emergency Department of the Affil-iated Hospital of Guizhou Medical University,Neurosurgery Department of Jinyang Hospital Af-filiated to Guizhou Medical University,and Neurosurgery Department of the Second Affiliated Hospital of Guizhou Medical University from April 2014 to March 2023 were collected and retro-spectively analyzed,and finally,70 patients who met the requirements of small amount of sponta-neous cerebellar hemorrhage were enrolled in this study.They were assigned into benign cerebel-lar hemorrhage group(43 cases)and malignant cerebellar hemorrhage group(27 cases).Accord-ing to their clinical outcomes in 3 months after onset,they were divided into a good prognosis group(51 cases)and a poor prognosis group(19 cases).General clinical data,imaging data,com-plications,inflammatory indicators and prognosis were collected.After collinear diagnosis was used to exclude factors with collinear influence,the independent correlation between good progno-sis and poor prognosis was analyzed by binary logistic regression model.Finally,ROC curve was plotted to analyze the significant data.Results The maximum diameter of hematoma was signifi-cantly larger in the malignant cerebellar hemorrhage group than the benign group(P=0.021).The patients of the poor prognosis group had larger proportion of malignant cerebellar hemor-rhage,and higher neutrophil percentage,WBC count and NLR than those of the good prognosis group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that malignant cere-bellar hemorrhage was an independent predictor of poor prognosis in 3 months(OR=6.218,95％CI:1.140-17.623,P=0.013).The sensitivity,specificity,positive predictive value,negative pre-dictive value and Youden index of malignant cerebellar hemorrhage in predicting the 3-month prognosis of patients were 63.2％,70.6％,44.4％,83.7％and 0.338,respectively,and the AUC value was 0.669.Conclusion Malignant cerebellar hemorrhage is an independent predictor of 3-month prognosis in patients with small spontaneous cerebellar hemorrhage.The patients with malignant cerebellar hemorrhage have poor prognosis than those with benign cerebellar hemorrhage.

Objective:To evaluate various blood lactate parameters in elderly patients with sepsis for prognostic prediction and exploration of optimal threshold values.The parameters include initial lactate concentration(LACinitial), lactate peak concentration(LACpeak), lactate peak time(LACtimetopeak), lactate accumulation area(LACarea), and 6-hour and 12-hour lactate clearance rates(LC_6 h and LC_12 h).Methods:This study conducted a retrospective screening of elderly patients with sepsis who were admitted to the intensive care unit(ICU)of the Beth Israel Deaconess Medical Center between 2008 and 2019.The study collected general information of the patients, as well as vital signs and laboratory indicators within 24 hours after admission.Additionally, the APSⅢ score, SOFA score, and OASIS score were continuously collected or calculated.The outcome variables examined were 28-day mortality from ICU admission, ICU length of stay, hospital length of stay, and mechanical ventilation time.The study compared the blood lactate parameters between the survival group and the nonsurvival group, and calculated the odds ratio( OR). A receiver operating characteristic curve(ROC curve)was plotted to analyze and compare the predictive performance of each lactate parameter based on 28-day mortality.The area under the curve(AUC)was calculated.Additionally, Kaplan-Meier survival curves were analyzed using the cutoff value of each lactate parameter. Results:A total of 4 773 elderly sepsis patients were included in the study.Among them, 1 166(24.4%)died within 28 days.The nonsurvival group had significantly higher levels of LACinitial[3.30(2.40, 5.30) vs.2.70(2.20, 3.50)mmol/L, Z=-13.047, P<0.001], LACarea[36.40(18.28, 63.00) vs.14.80(7.40, 27.30)mmol·L -1·h, Z=-10.298, P<0.001], LACpeak[4.00(2.80, 6.70) vs.3.10(2.50, 4.10)mmol/L, Z=-15.573, P<0.001], and LACtimetopeak[7.00(3.00, 15.00) vs.4.00(2.00, 8.00)h, Z=-13.084, P<0.001]. Additionally, the nonsurvival group had significantly lower levels of LC_6 h[0.06(-0.21, 0.29) vs.0.14(-0.22, 0.39), Z=2.966, P=0.003]and LC_12 h[0.12(-0.21, 0.42) vs.0.29(-0.09, 0.50), Z=5.638, P<0.001]. In this study involving 4 773 elderly sepsis cases, the lactate parameters were evaluated for their ability to predict death within 24 hours of ICU admission.The area under the curve(AUC)values, presented in descending order, were as follows: LACpeak[0.651(0.632, 0.670)], LACinitial[0.627(0.607, 0.646)], LACtimetopeak[0.626(0.607, 0.646)], and LACarea[0.590(0.569, 0.610)]. After excluding the cases where the LACarea was 0, the AUC increased to LACarea2[0.739(0.714, 0.764)]. A total of 1 217 patients had their lactate clearance rates at 6 hours and 12 hours calculated, with AUCs of LC_6 h[0.515(0.481, 0.548)]and LC_12 h[0.568(0.534, 0.603)], respectively.Furthermore, among 1 042 elderly sepsis patients with LACinitial>2 mmol/L, the AUCs of LC were LC_6 h[0.560(0.524, 0.596)]and LC_12 h[0.614(0.577, 0.651)]. The optimal cutoff values for LACinitial, LACpeak, LACtimetopeak, LACarea, LC_6 h, and LC_12 h, calculated from ROC curve analysis, were 3.55 mmol/L, 4.45 mmol/L, 7.50 h, 28.65 mmol·L -1·h, 0.304 and 0.272, respectively.The study population was divided into two groups based on whether they achieved the optimal cutoff value or not.The Kaplan-Meier survival curve showed a significant and distinguishable difference between these two groups(all P<0.05). Conclusions:In the prediction of 28-day mortality in elderly sepsis patients, LACarea was found to be the most effective indicator.LACpeak, LACinitial, and LACtimetopeak also showed acceptable predictive capabilities.On the other hand, LC performed the worst among the indicators, but its performance could potentially be enhanced by adjusting the applicable population.

OBJECTIVE：To struc turally modify shikimic acid ，and to investigate the reversal effects of its derivatives on paclitaxel-resistant human breast cancer cells MCF- 7/PTX. METHODS ：Using shikimic acid as the lead structure ，1-position carboxyl group was structurally modified to synthesize a series of shikimic acid derivatives through esterification ，amidation， hydrogenation and reduction ，etc. Using non-drug resistant cells MCF- 7 as reference ，MTT assay was used to screen derivatives with inhibitory activity as well as half-inhibitory concentration （IC50）and reversal index （RI）of derivatives to MCF- 7/PTX. With the drug resistance-related transgelin 2 as the target ，the molecular docking of the active derivatives with the drug resistance-related protein was carried out by using Glide 1.0 computer-aided design software. RESULTS ：Totally 15 derivatives were obtained （T1-T15）， of which T 4-T15 were obtained for the first time. MTT assay showed that （3R， 4S， 5R） -N-benzyl-3， 4， 5-trihydroxy-1-cyclohexene-1-formamide（T7），（3R，4S，5R）-N-（3，4，5-trihydroxy-1-cyclohexenylmethyl）-benzylamine（T14）， （3R，4S，5R）-3，4-O-isopropyl-5-O-acetyl-1-cyclohexene-1-methyl formate （T15）inhibited MCF- 7 and MCF- 7/PTX cells to a certain extent ；IC50 values of T 7，T14 and T 15 combined with pacliaxel to MCF- 7/PTX cells were significantly lower than that in negative control （Paclitaxel alone ）group（P＜0.05）. RIs of T 14 and T 15 were higher ，and RIs of the highest dose were 8.8 and 9.3， which were equivalent to positive control verapamil （10.8）. Th e results of molecular docking showed that the hydroxyl groups at positions 3，4 of T 7 could form multiple hydrogen bonds with ； Arg625 and Asp 627 in the catalytic region of transgelin 2. In addition to the hydrogen bond mentioned above at T 7，the mail：batistuta28@126.com secondary amine side chain at position 1 of T 14 could also form hydrogen bond with Glu 657 of transgelin 2. When the hydroxyl group on the T 15 mother nucleus was derived from the donor group ，the binding of the hydroxyl group to transgelin 2 was closer and the inhibition was enhanced. CONCLUSIONS ： The derivatives T 7，T14 and T 15 have certain reverse activity to paclitaxel-resistant human breast cancer cells. The polyhydroxy structure of the mother nucleus is the main structural region of the hydrogen bond between shikimic acid and its derivatives and transgelin 2. The derivation of its power supply group or the introduction of secondary amines and hydrophobic groups into the 1-carboxyl group of shikimic acid is benifit for enhancing the drug resistance reversal effect of derivative .

A patient with thymoma associated immunodeficiency syndrome (Good's syndrome) and bronchiectasis was retrospectively analyzed. Good's syndrome is a rare condition of immunodeficiency that is characterized by thymoma and hypogammaglobulinemia. It is important to bear in mind that Good's syndrome should be included in the differential diagnosis When patients repeatedly visited for bronchiectasis or infection, we should alert to their immune state and history of thymoma. Early screening of immunological status and aggressive correction of immune deficiency are beneficial to improving the prognosis to patients with Good's syndrome.
Agammaglobulinemia/complications* ; Bronchiectasis/complications* ; Humans ; Retrospective Studies ; Thymoma/complications* ; Thymus Neoplasms/complications*