Increased intracranial pressure is one of the most severe complications with significant mortality in children,so early diagnosis and treatment of this disorder is critical to save the patient's life.This article reviews etiologies,pathophysiology,and general principles of diagnosis and management of increased intracranial pressure.Based on primary diseases and clinical presentations,the goal of therapeutic strategy is to decrease intracranial pressure,avoid neurologic sequelae,and improve the outcome in patients.

Objective To prospectively evaluate the risk factors of complete resection in early gastric cancer (EGC) with endoscopic submucosal dissection (ESD),and to guide the choice of treatment methods.Methods This study prospectively evaluated the endoscopic features of 66 EGCs,including the lesion size,presence or absence of ulceration,the extent of differentiation,invasion depth and entire margins of the EGC,then compared them with postoperative pathologic results and analysed these factors.Results The lesion size of the high grade intmepithelial neoplasia (H) group and the intramucosal carcinoma (M) group were mainly less than 30 mm (90.9％ vs.88.5％),but 57.1％ of the submucosal carcinoma (SM) were more than 30 mm.There was a significant difference between any two of three groups (P ＜ 0.05).Fourteen EGCs who got ulceration without invasion beyond mucosal muscularis underwent ESD successfully,and the basal or dissected margin had no residual tumor cells confirmed pathologically.And no tumor cell infiltration or lymph node metastasis was discovered.Of 45 EGCs with ESD,the underestimation rate for horizontal extent determined by white light and chromoendoscopy was higher than that of magnifying endoscopy with narrow-band imaging (ME-NBI) (15.6％ vs.2.2％,P ＜0.05).Diagnostic accuracy for the extent of differenciation by conventional endoscopy was 93.9％ (31/32,P ＞ 0.1),but it's unable to determine the extent of differentiation by ME-NBI.The accuracy of the group H was 84.8％ (28/33),that of M was 57.7％ (15/26),that of SM was 71.4％ (5/7),and there was a significant difference between group H and group M (P ＜ 0.05).Conclusion To achieve complete resection of EGC with ESD,the lesion more than 30 mm,presence of ulceration,undifferentiated type,deep infiltration should be considered as the risk factors,and it's also important to identify the horizontal extent of EGC to avoid unnecessary operation.

Objective To investigate the molecular mechanism for change in permeability in brain microvascular endothelial cells (bEnd.3) induced by lipopolysaccharide (LPS). Methods Monolayers of bEnd.3 were exposed to LPS,in the presence or absence of exoenzyme C3 transferase. We monitored the monolayer barrier integrity by transendothelial electrical resistance assay (TEER),activity of RhoA by pull down assay,NF-κB by luciferase reporter assay,and F-actin dynamic structure by Rhodamine-phalloidin staining. Results Incubation of monolayers with LPS caused substantial barrier hyperpermeability. Under the had been treated for 3 and 12 h with LPS (P＜0.05). Such effects could be inhibited partly by pretreatment of RhoA inhibitor exoenzyme C3 transferase. LPS activated RhoA and NF-κB at 0.5 h. The C3 transferase could significantly reverse the NF-κB activation (P＜0.05). The F-actin rearrangments displayed in a time-dependent manner and occurred originally after the stimulation of LPS for 3 h,which could be diluted by the pretreatment of C3 transferase as well. Conclusion LPS induces the disruption of F-actin cytoskeleton and brain microvascular endothelial barrier integrity,in part,through RhoA and NF-κB activation. The mechanism underlying this pathophysiological effect of RhoA is to influence the disruption of the F-actin cytoskeleton by regulating NF-κB activites.

Infantile neuroaxonal dystrophy (INAD) is a rare autosome-recessive disease characterized by progressive motor and cognitive regression.The PLA2G6 gene is its causative gene,which encodes calcium-independent phospholipase A2 enzyme (iPLA2-VIA).The diagnosis of INAD is difficult because of its clinical heterogeneity,and the rate of misdiagnosis is high.The purpose of this study is to describe the clinical characteristics,molecular genetics,treatment and prognosis of INAD to improve the acknowledgement of INAD in medical workers and to help make an early diagnosis of INAD.

Objective To investigate the effect and potential mechanism of autophagy inhibitor chloroquine on the calcium oxalate crystals formation in rats.Methods From September 2016 to October 2016,Thirty healthy male SD rats were randomly divided into 3 groups:control group,model group and chloroquine intervention group.The method to establish calcium oxalate stone model was drinking water with 1％ ethylene and 1％ ammonium chloride freely.The rats of chloroquine intervention group were treat with chloroquine (40mg/kg · d) by intraperitoneal injection.Modeling was finished after 28 days.The amounts of renalcalcium oxalate crystals were detected by polarizing microscope.For all groups,the amounts of autophagosome were detected by transmission electron microscope.Twenty four hour urine compositions for stone risk factors were detected.The expressions of oxidative stress injury related molecular markers (SOD,MCP-1 and 8-OHdG) and the expressions of autophagy markers (LC3 and P62) were detected by immunohistochemistry.The RNA expressions of SLC26A6 in kidney were detected by Real-time PCR.Results Compared to the model group,the amounts of renal calcium oxalate crystals were significantly reduced in chloroquine intervention group (32.37 ± 5.14 vs.4.18 ± 0.25,P ＜ 0.05).Compared to the control group,the level of autophagy was increased in the model group.Compared to the model group,the level of autophagy was inhibited in the chloroquine intervention group.For control group,model group and chloroquine intervention group,the excretion of urinary oxalate were (3.1 ± 1.5) mmol,(22.5 ± 8.1) mmol,(2.8 ± 1.2) mmol,respectively;the excretion of urinary citrate were (63.4 ± 7.4) mmol,(45.9 ± 9.5)mmol,(15.6 ± 8.2) mmol,respectively.Compared to the control group,the amounts of urinary oxalate weresignificantly elevated in model group (P ＜ 0.05),but citrate were significantly reduced in the chloroquineintervention group(P ＜ 0.05).For control group,model group and chloroquine intervention group,theexpressions of SOD were 42.24 ±4.16,19.21 ± 2.25,39.08 3.53,respectively;the expressions of MCP-1 were 4.02 0.51,8.45 ± 0.55,5.52 ± 0.34,respectively;the expressions of 8-OHdG were 7.16 ± 0.54,11.21 ± 1.12,8.67 ±0.34,respectively;the RNA expressions of SLC26A6 were 0.35 ±0.07,1.02 ±0.17,0.70 ± 0.06,respectively.Compared to the control group,the expressions of SOD were significantly reduced in the model group,but the expressions of MCP-1,8-OHdG and SLC26A6 were significantly elevated(P ＜0.05).Compared to the model group,the expressions of SOD were significantly elevated chloroquine intervention group (P ＜ 0.05),but the expressions of MCP-1,8-OHdG and SLC26A6 were significantly elevated(P ＜ 0.05).Conclusions The autophagy inhibitor chloroquine could inhibit the formation of calcium oxalate crystals induced by ethylene in rat kidney via inhibit the renal autophagy level and expressions of the SLC26A6,reducing the renal oxidative stress injury and urinary oxalate excretion.

UL48 plays essential role in replication of MDV genome and interacts with UL36 as well as other MDV tegument proteins.To investigate the interaction between UL48 and UL36 during MDV oncogenisis,antibody against UL48 was prepared and characterized in current study.UL48 gene was amplified from MDV-Ⅰ genome and then subcloned into pTYB1 and pGEX-4T3 vectors for UL48 expression with induction of IPTG in BL21(DE3) E..coli cells.Chitin-sepharose and Glutathion-sepharose were,respectively,used to purify fusion protein intein-UL48 and GST-UL48.Four subcutaneous injections of intein-UL48 fusion protein were done on the lower back and the thigh of rabbit and then other three injections with an interval 10 days.The titer of antibody was measured by the sandwich ELISA with UL48 protein isolated from GST-UL48 after cleavage of thrombin.Western blot was carried out for specificity analysis of antibody against UL48 protein.The results suggested that UL48 antibody was succesfully prepared,and its titer was 1 ∶ 512 000.

Four boys (2 months to 8 years old) were diagnosed with autosomal recessive form of osteopetrosis. Symptoms manifested in the first few months of life in 3 patients, and there was family history in 1. Primary symptoms included anemia, thrombocytopenia, hepatosplenomegaly, failure to thrive, recurrent infectious history and macrocephaly. The typical radiological images on plain radiogram were diffuse sclerosis, bone modelling defects at the metaphyses of long bones, "bone-in-bone" appearance, and "sandwich" vertebrae. Bone marrow biopsy showed markedly reduced platelets. Osteopetrosis refers to a group of rare, heritable disorders of the skeleton characterized by increased bone density on radiographs. Diffuse sclerosis leads to crowding of the bone marrow, resulting in anemia and extramedullary hemopoiesis. Hematopoietic stem cell transplantation is employed for the most severe forms associated with bone marrow failure and offers the best chance of longer-term survival.
Child ; Diagnosis, Differential ; Female ; Humans ; Infant ; Male ; Osteopetrosis ; diagnosis ; diagnostic imaging ; Radiography

This patient presented with fever,seizure and bulging fontanelle when he was 6-month-old.According to the investigations,white blood cell (WBC),erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased significantly,and Streptococcus Pneumonia grew in both blood and cerebrospinal fluid (CSF).He responded to standard antibiotic treatment poorly even it lasted long enough.At the same time,the inflammation seemed to be over-activated,the WBC level was still elevated,high fever continued.Thus they thought of primary immunodeficiency and sent blood sample for gene panel testing (Sanger sequencing) but got negative result.At last,they added steroid together with anti-tuberculosis drug therapy,his temperature as well as the intracranial pressure became better ever since.At the age of 1 year and 1 month,he got another Streptococcus Pneumonia meningitis,while he was still on anti-tuberculosis drug therapy and tapering off steroid.At this time,he presented with coarse hair,hypohidrosis and delayed eruption of teeth,which strongly indicated Anhidrotic Ectodermal Dysplasia with Immunodeficiency (EDA-ID).NEMO is the most common gene responsible for EDA-ID and locates on X chromosome.It has a pseudogene named IKBKGP which locates downstream of NEMO.IKBKGP and NEMO share 3-10 exons with the homology of 99.8％,which makes it difficult to find out most real mutations within NEMO with Sanger sequencing.Then they performed PCR with the primer starting upstream of the shared exons.Finally,they found out the pathogenic mutation [c.505G ＞ C(p.A169P)] of NEMO,which has been reported.This finding led us to make the right diagnosis as well as the proper treatment and the prognosis for this patient.

Objective To study the influencing factors for outcomes of gastric low-grade intraepithelial neoplasia ( LGIN) for better LGIN treatment regimen. Methods Using magnifying endoscopy combined with narrow-band imaging ( ME-NBI ) follow-up strategy, the endoscopic features of 47 cases of LGIN in Fujian Provincial Hospital, including location, size, surface situation, demarcation line, microvascular pattern and microsurface pattern, were prospectively observed, then the factors influencing the outcome were analyzed. Results Among the 47 cases of LGIN, there were 35 cases in stable condition, whose results of biopsy and ME-NBI had no changes (stable LGIN), and the mean follow-up time was 20. 7±6. 9 months. The remaining 12 patients had progressive dysplasia (progressive LGIN), including 4 cases of high-grade intraepithelial neoplasia, and 8 cases of moderate dysplasia. The mean follow-up time was 16. 3 ± 11. 8 months. There were no significant differences between the two groups in gender (P=0. 33), mean age (P=0. 13), lesion distribution (P=0. 70), and lesion morphology (P=0. 97). The lesion size was less than 20 mm in the stable group ( 71. 4％, 25/35) , and over 20 mm in the progressive group ( 66. 7％, 8/12) , and the difference was statistically significant ( P=0. 02) . The proportion of the lesion surface heterogeneity in the progressive group was significantly higher than that in the stable group[75. 0％ (9/12) VS 34. 3％ (12/35),P= 0. 01 ] . The proportion of positive manifestations under ME-NBI in the progressive group was also significantly higher than that in the stable group [ 83. 3％ ( 10/12 ) VS 8. 6％ ( 3/35 ) , P = 0. 00 ] . Conclusion The size of lesions over 20 mm, the uneven surface and positive ME-NBI are the important factors influencing the outcome of LGIN, which are of significance for the diagnosis and treatment of LGIN.

Objective To analyze the clinical characteristics and treatment of children with tuberous sclerosis (TSC) complicated with epilepsy,so as to improve the level of diagnosis and treatment and improve the prognosis of children with TSC.Methods The clinical data of TSC children complicated with epilepsy diagnosed and followed up in Xiangya Hospital of Central South University were collected and analyzed retrospectively.Results Of the 51 children,49 (96.1％) had their first visit because of epileptic seizures.Their electroencephalogram (EEG) showed epileptiform discharges during the epileptic period.The therapeutic effect of vigabatrin on TSC patients with spastic seizures was significantly different from that of antiepileptic drugs alone or in combination.Conclusions Epileptic seizure is the most common reason for first visit and seizure control will affect the prognosis of children to a large extent.Vigabatrin had remarkable effect on TSC patients with spasm seizure,and rapamycin has broad prospects in the treatment of children with TSC.