In critically ill patients,evoked potential(EP) testing is an important tool for measuring neurologic function,signal transmission,and secondary processing of sensory information in real time.EP potential measures conduction along the peripheral and central sensory pathways with longer-latency potentials representing more complex thalamocortical and intracortical processing.In critically ill patients with limited neurologic exams,EP provides a window into brain function and the potential for recovery of consciousness.Brainstem auditory EP and cortical event-related potentials are most commonly used in ICU.The primary indications for EP in critically ill patients are prognostication in anoxic-ischemic or traumatic coma,monitoring for neurologic improvement or decline,and confirmation of brain death.Historically,EP has been regarded as a negative prognostic test,that is,the absence of cortical potentials are associated with poor outcomes while the presence cortical potentials are prognostically indeterminate.In recent studies,the presence of middle-latency and long-latency potentials as well as the amplitude of cortical potentials is more specific for good outcomes.Event-related potentials,particularly mismatch negativity of complex auditory patterns,is emerging as an important positive prognostic test in patients under comatose.In infants,other than anoxic-ischemic or traumatic brain injury,brainstem auditory is also widely used in premature baby,bilirubin encephalopathy and detection of possible hearing loss.

Objective To investigate the 2-year retention rates and tolerability of levetiracetam (LEV), Lamotrigine(LTG), and Oxcarbazepine(OXC) in pediatric patients with epilepsy.Methods 310 pediatric patients with epilepsy were included in this study: LEV (n=145), LTG (n=101), and OXC (n=64). The clinical efficacy, first discontinuation time and discontinuation reasons were recorded and compared. The retention rates at 12, 24, 52 and 104 weeks were evaluated. Results At the two-year follow up:Clinical efficacy didn't significantly differ among the three groups (P = 0.190); The 2-year retention rates for LEV, LTG, and OXC, were 68.28%, 72.28%, and 48.44%, respectively (P = 0.002). LEV and LTG had equivalent retention rates, whereas OXC retention was significantly inferior to the LEV and LTG retention (P<0.05). The common reasons for drug discontinuation were adverse effects (47.66%) and lack of efficacy (42.10%), while the rate of adverse effects leading to drug withdrawal of OXC (66.77%) was higher than that of LEV (36.96%, P = 0.003) and LTG (42.86%, P = 0.023). Conclusion These results suggested that LEV, LTG and OXC had similar clinical efficacy. LEV and LTG had comparable retention profiles and long-term tolerability in the 2-year treatment, while OXC therapy seemed to be relatively less useful. If there are no specific contradictions, pediatric patients with epilepsy could be better receiving LEV and LTG antiepileptic treatment.

Objective To evaluate the application value of the VATS combined with artificial pneumothorax in extended thymectomy. Methods From March 2013 to November 2014, we completed 45 cases of expanded thymectomy in patients with myasthenia gravis .According to the choice of patients , the surgeries were divided into two groups .The artificial pneumothorax group (24 cases) was given thoracoscopic expanded resection under artificial pneumothorax , while the conventional surgery group (21 cases) was given conventional thoracoscopic surgery .The operation time , intraoperative bleeding , operative field show ( to expose the offside mediastinal fat and cardiophrenic angle fat fully ) and symptom relief were compared between the two groups . Results The operations were successful in all the 45 cases.As compared with the conventional surgery group , the artificial pneumothorax group had shorter operation time [(93.8 ±16.8) min vs.(119.5 ±23.3) min, t=-4.293, P=0.000], less intraoperative hemorrhage [(54.2 ±43.7) ml vs.(92.9 ±41.0) ml, t=-3.048, P=0.004] and better operation exposure [91.7% (22/24) vs.57.1%(12/21),χ2 =7.228, P=0.007].However, there was no significant difference in symptom remission rate between the two groups . Conclusion VATS under artificial pneumothorax for thymus expanded resection can fully expose the operation field , with shorter operation time and less blood loss .

Humans ; Stem Cell Transplantation

AlM: To study the relationship of retinal associated lesions and postoperative visual acuity of cataract phacoemulsification.
METHODS:From February 2013 to February 2014, 120 cases with given cataract phacoemulsification were divided into observation group and control group. Cases in observation group were with of retinal associated lesions, those in control group were without retinal associated lesions. The best corrected visual acuity, ision acuity, visual evoked potential, intraocular pressure were compared between two groups.
RESULTS:Two weeks after surgery, visual acuity in observation group was higher than those of before therapy. Visual acuity recovery rate of observation group was significantly slower than that of control group; best corrected vision, visual acuity in observation group was significantly lower than that in control group;observation group's amplitude (12. 01±4. 50ü V) was significantly lower than control group, incubation period (114. 29±11. 32ms) was significantly higher than control group; After 6, 12, 24h, intraocular pressure (23. 64 ± 4. 28, 24. 12 ± 5. 13 and 18. 28± 3. 22mmHg) were significantly higher than control group.
CONCLUSlON: Retinal associated lesions can lead to visual evoked potential change, elevated lOP, affect postoperative visual recovery level.

Objective To investigate clinical treatment and outcome of mesh-related pain after pelvic floor reconstruction. Methods Twelve patients were referred to Peking University People′s Hospital for post-operation pain related to polypropylene mesh or tape used in pelvic floor reconstruction and received reoperation from January 2007 to December 2014. The demographic characteristics, clinical manifestation, operation method and follow-up outcome were retrospectively analyzed, and current literature was also reviewed. Results (1)General information:the median age was 54 years old(range 43-74 years old). The median vaginal delivery times was 2 (range 1-5). Initial pelvic floor operation procedures included 4 cases vaginal mesh, 5 cases vaginal mesh plus tension-free vaginal tape (TVT), 1 case rectal surface mesh implantation, and 2 cases sacrocolpopexy. (2) Related complications:all 12 patients had pain-related post-operation symptoms including dyspareunia, perineal pain, urination and defecation difficulty. Seven patients also complicated with other symptoms including discharge and bleeding. Mean time from first operation to medical consultation was 30 months (range 1-72 months). (3) Reoperation results:all 12 patients received reoperation on mesh revision or tape, 10 cases of them reoperated by vaginal approach, while the other 2 cases by laparoscopy. The range of the mesh or tape depended on tender or firm tissue and scar by palpation. The visual analogue scale (VAS) was significantly improved, which was 7.1 ± 2.2 pre-operation, and 0.9 ± 1.9 post-operation (95%CI: 4.48-7.86, P<0.01). Conclusions Pain is one of the reason why patients was removal of the mesh or tape after pelvic floor reconstruction operation. The surgery procedure may be considered as partial or entire mesh or tape excision by vaginal or abdominal way. Mesh or tape removal surgery could relieve related pain and other complications, and the VAS score was significantly improved after surgical management.

Humans ; Lung Diseases ; MicroRNAs

Animals ; Blood Cell Count ; Blood Cells ; Decompression Sickness ; blood ; Male ; Rabbits

ObjectiveTo explore the clinical value of 256-slice CT and coronary angiography in the diagnosis of coronary artery disease.Methods46 patients with coronary heart disease,who underwent coronary angiography and 256-slice spiral CT were selected.Compare two methods for the detection of coronary artery disease.Results( 1 ) All 256-slice CT and coronary angiography achieved a satisfactory image,in the diagnosis of coronary artery stenosis and occlusion,the two methods had no statistically significant difference ( P ＞ 0.05 ).(2) according to standard coronary angiography,256-slice spiral CT for the diagnosis of coronary artery stenosis sensitivity was 93.0％ (132/142),specificity was 91.6％ (142/155),positive predictive rate was 91.0％ (132/145),negative predictive rate was 93.4％ (142/152).Conclusion256-slice spiral CT has a high time resolution,spatial resolution,the display of the coronary artery disease has high sensitivity,specificity,positive predictive value and negative predictive value.

Objective To explore the expression and clinical significance of GSK-3β,PTEN and PLK1 in pediatric AML . Methods Experiment group was bone marrows of 33 cases incipient children with AML .Control group was 10 cases normal bone marrows .GSK-3β,PTEN and PLK1 gene expressions in BMMNC of the two groups were tested using semi quantitative reverse transcriptase polymerase chain reaction(RT-PCR)technique .GSK-3βprotein and P-GSK-3βexpressions were tested by ELISA .Re-sults The expression of GSK-3βmRNA ,GSK-3βprotein ,PLK1 mRNA in BMMNC of children with AML was higher than that of control group(P=0 .012 ;P= 0 .014 ;P= 0 .040);The expression of PTEN mRNA ,P-GSK-3β was lower than the control group (P=0 .012 ;P=0 .002);GSK-3βprotein had a negative correlation with PTEN mRNA (r= -0 .415 ,P=0 .016);GSK-3βmRNA , GSK-3βprotein had a positive correlation with PLK 1 mRNA(r=0 .388 ,P=0 .026;r=0 .427 ,P=0 .013) .The expression of GSK-3βprotein was high in which had high peripheral white blood cell counts ;both the expressions of GSK-3βmRNA and GSK-3βpro-tein were high in which had high risk ;but the expression of P-GSK-3βwere low .Conclusion In pediatric AML ,GSK-3βand PLK1 may play a role of oncogene and PTEN may play a role of tumor suppressor gene .