Objective To evaluate the diagnostic value of CT in epileptic pathogeny. Methods Clinical data and CT findings of 1542 patients with epilepsy were studied retrospectively. Result The positive CT finding was 42.35％ . The epileptogenic focus which were found by CT, included in turn: brain atrophy, and excephaloma and cerebral congenital or development disorder, and cerebrovascular disease, and encephalomalacia, and unidentified hypodense or hyperdense lesions, calcification, and infection, and postoperative changes, and trauma and the sequelaes of hypoxic－ ischemic encephalopathy .Conclusion CT is helpful to determine the diagnosis， types and therapy of epilepsy.

Objective To evaluate the ability to show anatomical structures of the normal middle ears with helical CT virtual endoscopy(CTVE).Methods CTVE were performed to observe anatomical structures of bilateral middle ears in 100 healthy volunteers.Results Anatomical structures of middle ears were displayed stereoscopically by CTVE from multiple views.But superficial and ting structures were showed pooly.Conclusion CTVE is a new noninvasive imaging tool for observe stereoscopically auditory ossicudar chains.

In order to culture the qualified clinicians, we should think about how to improve the quality of clinical practice of obstetrics and gynecology. It is of great importance to emphasize the teachers and students to value the teaching work together. Importance should be attached to the advantage of subject of academy, to make the clinical practice closer to practical, which has a perfect effect and will benefit our work.

Objective·To investigate the clinicopathologic characteristics and prognosis of adult rhabdomyosarcoma (RMS).Methods·The clinical and pathological data,immunohistochemical test results of 9 RMS were analyzed retrospectively.Results·The information of 6 males and 3 females were collected in this research,whose average age was (46.89+20.09) years old.The tumors had a wide range distribution.The subtypes of histology included 6 cases of embryonal RMS,1 case of alveolar RMS,1 case of spindle cell RMS and 1 case of pleomorphic RMS.Immunohistochemically study showed that 6 cases were myogenin positive,4 cases were MyoDl positive and 8 cases were desmin positive.During the follow-up period of the 7 cases,only 2 patients survived free of tumors,2 patients presented with tumor recurrence and metastasis after the operations,and 3 patients died of tumor.Conclusion·In this study,embryonaI RMS is the most common type,and immunohistochemistry test is helpful to diagnosis of RMS.

Objective To explore the clinical features and outcomes of patients with cerebral venous sinus thrombosis (CVT) during pregnancy and puerperium.Methods A retrospective study was performed in 24 cases of pregnant women with CVT among 15 625 deliveries in Xuanwu Hospital fromJanuary 2002 to October 2009,including 7 cases happened during pregnancy and 17 during puerperium.The etiology,clinical presentations,imaging examination results,other relevant examinations,and pregnant outcomes of these patients were analyzed.Results (1) Incidence and etiology:the incidence of CVT during pregnancy and puerperium was 0.15% (24/15 652) and 29% (7/24) of the patients fell ill during pregnancy and 71% (17/24) during puerperium.Five were complicated with severe preeclampsia,while another 5 complicated with hyperemesis.One woman was complicated with anemia.CVT was identified after spontaneous delivery in 9 cases and 8 after cesarean section.(2) Clinical presentations:Among the 24 CVT cases,22(92% ) suffered from headache,16(67% ) reported nausea and vomiting,15(63% )experienced hyperspasmia and 6 (25%) complained of blurred vision.On admission,8 (33%) patients were unconscious,3 (13%) with hemiplegia,and 8 (33%) were febrile.(3) Imaging and laboratory examinations:twelve patients underwent digital subtraction arteriography ( DSA) and were diagnosed.Fifteen women showed superior sagittal sinus thrombosis in MRI and magnetic resonance intravenous angiograph(MRV).Examination of the fundus found papilledema in 4 cases.Normal cerebral sinus fluid and laboratory routine tests were reported in 13 cases,but 6 cases of hyperlipidemia,7 cases of abnormal activated partial thromboplastin time ( APTT),5 cases of abnormal international normalized ratio (INR),3 cases elevated platelet count,4 cases of positive D-dipolymer,1 cases of low hemoglobulin level ( <10 g/L),4 cases with abnormal hematocrit,and 10 cases of elevated fibrinogen ( > 4 g/L) were identified.(4) Management and pregnancy outcomes; among the 7 cases happened during pregnancy,2 were complicated with severe preeclampsia and delivered through cesarean section immediately and discharged after proper management including depressurization,spasmolysis,dehydration and anticoagulant therapy.Five of the 7 cases presented with CVT during early pregnancy,among which 1 was discharged after dilation and curettage followed by anticoagulant therapy,2 received endovascular thrombolysis after which one was discharged and the other one left with right hemiparesis and 2 patients died.Among the 17 patients presented with CVT during puerperium,10 received anticoagulant therapy after which 4 were fully recovered,5 left with functional disturbance (3 with hemiplegia,1 with incomplete motor aphasia and hemiparesis and 1 with blurred vision) and one died.Among the rest 7 cases who underwent endovascular thrombolysis,3 were fully recovered,3 left with functional impairment ( 1 with blind and headache and 2 with hemiplegia),and one died.Altogether,there were 14 patients underwent systemic anticoagulant therapy after which 7 were fully recovered,5 left with dysfunction and 2 died.Among the 10 cases received endovascular thrombolysis,4 were fully recovered,4 remained some dysfunction and 2 died.Conclusions CVT,mostly presented as superior sagittal sinus thrombosis,are more common in puerperium than during pregnancy and DSA is the golden standard for the diagnosis of CVT.Anticoagulant therapy and endovascular thrombolysis are effective in the treatment of CVT,but may left the patients with functional disturbance or even death.Prompt diagnosis and treatment ensure a better outcome for pregnant women complicated with CVT.

Objective To detect the expression of Raf kinase inhibitor protein (RKIP) and NF-κB in renal tissue of diabetic kidney disease (DKD) rats model,and to investigate the effect of rituximab (RTX) on the expression of RKIP in the renal tissue of DKD rats. Methods SD rats were randomly divided into normal group (N),DKD model group (M) and RTX treatment group (D).Blood glucose and 24-hour urine protein of rats were determined in three groups.RKIP protein and NF-κB protein were determined by immunohistochemistry staining. RKIP protein expression was detected by Western blotting. Results Compared with N group,blood glucose,24-hour urine protein and NF-κB expression in M group increased significantly (all P＜ 0.01),the expression of RKIP in M group decreased significantly (P＜0.05).Compared with M group,the expression of RKIP increased significantly in D group (P＜0.05),and 24-hour urine protein and NF-κB expression decreased in D group (all P＜0.05).NF-κB protein expression was negatively correlated with RKIP expression in M group. Conclusions The NF-κB pathway regulated by RKIP plays an important role in the development and pathogenesis of diabetic nephropathy.Rituximab may have a role in treatment of DKD.

Glomerulonephritis, Membranoproliferative ; Humans ; Kidney Glomerulus ; pathology

Objective To analyze the characteristics of proximal deep vein thrombosis (DVT) after total joint arthroplasty.Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography.There were 9 males and 31 females aged from 38 to 86 years,average 67 years,and body mass index was from 16.94 to 31.25kg/m2,with an average of 24.3 kg/m2.29 cases of THA patients and 11 cases of TKA patients.The anatomical distribution,size,radiological performance,local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age,gender (male/female),side of leg(left/right),surgery type(knee and hip),preoperative diagnosis(femoral neck fracture/other disease),time of diagnosis with DVT (during hospitalization/after discharge).Results Among 40 proximal DVT cases,31 cases diagnosed by phlebography and 9 cases were diagnosed by ultrasound.2 cases were isolated proximal DVT while 38 cases connected with distal DVTs.9 cases of blood clots in the proximal and distal thrombosis connected discontinuously.There was no isolated proximal DVT in TKA group and 10 cases (90.9％) of blood clots in the proximal and distal thrombosis connected continuously while there were 2 cases (6.9％) isolated proximal DVTs in THA group and 21 (77.8％) of blood clots in the proximal and distal thrombosis connected discontinuously,and there was no statistic significant difference between the two groups.The average length of proximal was 8.85±9.3 1cm (range from 2-35cm) with 5.0±2.05 cm in TKA group and 10.31 ± 10.55 cmin THA group.A significant difference was found between the 2 groups (P=0.014).13 cases located in femoral veins and upper venous region which were all from THA group.There was a significant difference in the distribution between surgery type and preoperative diagnosis.However,there was no significant difference between other potential factors and distribution of proximal DVT.25 cases accepted the evaluation of symptom of DVT before scanning.However,no significant difference were found in edema,VAS score,Homans sign,Neuof sign between 9 TKA and 16 THA cases.Conclusion Proximal DVTs after knee and hip arthroplasty are more preferred to connect with distal DVT continuously.Surgery type and preoperative diagnosis have a significant effect on the distribution of proximal DVT.Proximal DVTs in THA and patients with preoperative femoral neck fracture could be more easily involving femoral veins and upper parts.

Objective To compare the effects of Acceptance Commitment Therapy(ACT) and Cognitive Behavior Therapy(CBT) on anxiety and depression in the elderly,and to explore the psychological mechanism of ACT to improve anxiety and depression.Methods A total of 25 elderly people were screened from four communities in Beijing.According to the place of residence,12 persons were enrolled in the ACT group and 13 persons were enrolled in the CBT group.The mindful attention awareness scale,geriatric anxiety inventory,geriatric depression scale,the acceptance and action questionnaire-Ⅱ and cognitive fusion questionnaire were evaluated before regrouping (T1),after six regiments (T2) and 5 weeks after the end of the intervention (T3).Results (1) On the level of mindfulness,the score of ACT group was higher than that in CBT group at T2(ACT:80.31 ±6.18,CBT:74.20±4.48,t=2.52,P＜0.05) and T3 (ACT:82.20±4.48,CBT:70.00± 12.23,t=4.56,P＜0.01).(2) On the level of anxiety there was significant difference between the two groups at T2(ACT:2.88±1.86,CBT:8.87±2.80,t=-8.15,P＜0.01) and T3(ACT:5.38±2.02,CBT:10.50±2.66,t=-6.93,P＜0.01),and ACT group was higher than the CBT group.(3)On the levels of depression there was significant difference between the two groups at T 1 (ACT:4.59 ± 3.97,CBT:7.89± 6.39,t =-2.25,P＜0.05),the ACT group was lower than the CBT group.The CBT group on the levels of depression there was a significant difference T1 and T2 (t=2.92,P＜0.05).(4) On the level of psychological flexibility,there was a significant difference between the two groups at T2 (ACT:41.38 ± 8.28,CBT:49.60± 3.52,t =-3.64,P＜0.01)and T3(ACT:40.80±7.66,CBT:52.47±6.23,t=-4.98,P＜0.01),and ACT group was lower than the CBT group.(5) Empirical avoidance only achieved a significant level of intermediate effects between ACT therapy and anxiety.In the ACT group,the median effect of empirical avoidance on anxiety was 11.40％.Conclusion The effect of CBT on depression is better than that of ACT,while the effect of ACT on the level of mindfulness,anxiety and mental flexibility is better than that of CBT.ACT with psychological flexibility as a psychological mechanism can improve the mental flexibility of the individual more than the CBT.