Neuromodulation techniques as vagus nerve stimulation (VNS) and deep brain stimulation (DBS) play important roles in treating refractory focal epilepsy. In recent years, epileptogenic zone closed-loop responsive neurostimulator system (RNS) has been gradually put into clinical practice; in 2013, it was approved by U.S. Food and Drug Administration (FDA) as an adjuvant therapy for refractory epilepsy. This article reviews the development history, clinical application, anti-epileptic mechanism and future research directions of RNS to deepen the understanding of clinical workers.

Objective To learn the current status of family doctor service at pilot communities in Guangzhou, and discover existing problems and influencing factors by investigating the residents who have contracted such service , those have not and the family doctors . Methods This study chose typical community health centers of six communities in Guangzhou in January 2016 .In random sampling , residents who visited doctors during the survey and all the family doctors were surveyed .EpiData was used to doubly inputdata,withSPSS20.0forstatisticalanalysis.Results 66.0％ofthoseresidentswhohavenot contracted the service are willing to contract a family doctor .According to the binary logistic regression analysis after eliminating the interference factors , there are two factors affecting their willingness:gender and whether needing a family doctor for themselves and their family for health management .According to the binary logistic regression analysis after eliminating the interference factors , the influencing factors of renewing contract are overall satisfaction and necessity for signing family doctors .Conclusions The smooth development of the family doctor service is faced with many bottlenecks , while improving willingness to contract and renew contract to family doctors are the cornerstone for sustainability of the family doctor system.

Objective: To investigate the distribution of human papillomavirus (HPV) infection characteristics and genotypes in Shenyang area of Liaoning province. Methods: HPV genes were detected in cervical exfoliated cells from 55, 548 patients by amplification and diversion hybridization. Results: A total of 9, 566 patients were positive for HPV infection with a positive rate of 17.22%. Additionally, the positive rate of high risk HPV infection was 14.57% and the positive rate of single genotype HPV infection was 13.63%. Totally, 12, 360 HPV viruses were detected. Among them, 10, 879 HPV viruses were classified into high risk genotypes (10, 879 out of 12, 360, 88.02%). The genotypes in women with ages less than 20 were 16/11/6/51/58/52 genotypes; the susceptible HPV genotypes in other women were 16/58/52/53/39/51/81 genotypes. Conclusions HPV infections in Shenyang are mainly infections with high risk viruses and single infection. The infection rate and genotype distribution of HPV are different in different age groups. More suitable HPV vaccine prophylaxis can be taken according to the epidemic characteristics of HPV in this area.

Objective To optimize the simulation of the pathological characteristics and seizure behavior of medial temporal lobe epilepsy(MTLE),we aimed to establish a chronic epilepsy model of MTLE by unilateral,single hippocampal injection of kainic acid(KA)via stereotactic surgery,and to validate this epilepsy model in terms of behavior,electrophysiology,and pathology.Methods A total of 22 healthy C57BL/6 wild-type male mice were divided randomly into a control group(n=6)and an experimental group,which received KA injections(n=16).Both groups underwent microinjection of equal doses of saline or KA in the hippocampal CA3 area via stereotactic surgery.One week later,all mice were implanted with electrodes in the hippocampal CA3 area to facilitate electroencephalogram(EEG)recording.Seizure frequency and duration were analyzed statistically.The chronic epilepsy model was assessed in terms of behavior,electrophysiology,and pathology.Results No mice in the control group experienced seizures,while all surviving mice in the experimental group developed seizures.Adult model mice exhibited chronic spontaneous seizure behaviors,such as staring,chewing,head and facial muscle twitching,and limb spasms.Two mice died as a result of the surgery,four mice died during the acute seizure phase,and ten model mice were successfully established.EEG recordings showed epileptiform changes consistent with MTLE.Immunofluorescence staining revealed neuronal loss in the CA3 area and astrocytic changes,consistent with characteristic pathological changes of hippocampal sclerosis.Conclusions The model constructed by single unilateral intrahippocampal KA injection demonstrated several advantages such as being time-efficient,easy to operate,and reproducible.This model exhibited EEG,behavioral,and neuropathological changes similar to human MTLE,making it valuable for studying effective treatments for temporal lobe epilepsy and serving as an ideal animal model for predicting outcomes of epilepsy surgery.

Objective:To analyze the clinical efficacy and prognostic factors of intracranial primary diffuse large B-cell lymphoma (DLBCL).Methods:Clinical data of 205 patients pathologically diagnosed with intracranial primary DLBCL at Sun Yat-sen University Cancer center from March 2001 to September 2020 were retrospectively analyzed. Among them, 101 patients were male and 104 female, the median age was 54 years old. Non-germinal center B cell (GCB) subtype accounted for 74.1%(126/170). A total of 177 patients received high-dose methotrexate (HD-MTX) and 91 patients received rituximab. After induction chemotherapy, 59 patients (30.4%) achieved complete response (CR), 112 patients (57.7%) achieved partial response (PR) or stable disease (SD). A total of 83 patients received consolidation or salvage radiotherapy, and only 14 patients received autologous stem cell transplantation (ASCT). The influence of pathological type, chemotherapy, rituximab treatment, radiotherapy and radiotherapy mode, ASCT and other factors on the overall survival (OS) and progression free survival (PFS) was evaluated. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by COX model.Results:The median follow-up time was 34 months. The 5-year OS and PFS rates were 55.6% and 44.2%, respectively. GCB subtype, chemotherapy with HD-MTX, rituximab treatment, remission status after induction chemotherapy, and radiotherapy were favorable prognostic factors for OS or PFS, in which the last three were the independent prognostic factors. Consolidation radiotherapy in patients who obtained CR after induction chemotherapy did not significantly improve survival, while salvage radiotherapy in patients who achieved PR/SD after induction chemotherapy significantly improved both OS and PFS(both P<0.01). Consolidation radiotherapy showed no significant survival difference compared with consolidation ASCT. Conclusions:The non-GCB subtype of intracranial primary DLBCL is related to poor prognosis. The addition of rituximab to HD-MTX based induction chemotherapy can improve survival. Radiotherapy is still an important treatment for intracranial primary DLBCL, and there are limitations of ASCT in practical clinical application.

Objective:To investigate effects of early postoperative enteral nutrition in combination of micro-ecological feed preparations on intestinal flora and immune function in elderly colorectal cancer patients after surgery.Methods:Eighty-eight elderly colorectal cancer patients treated at our hospital from November 2017 to August 2019 were enrolled in the study.They were randomly divided into two groups(n=44, each): the observation group receiving micro-ecological feed preparations and enteral nutrition, and the control group receiving conventional parenteral nutrition.The intestinal flora index, cellular immune function, humoral immune function and complications were compared between the two groups.Results:There was no significant difference in the indices of intestinal flora between the two groups before operation(all P>0.05). In the control group, Bifidobacteria and Lactobacillus decreased, E. coli increased, and B/E value decreased after surgery compared with before surgery( P<0.05). In the observation group, Bifidobacteria and Lactobacillus decreased, E. coli increased and B/E value decreased after surgery compared with before surgery( P<0.05). Compared with the control group, the observation group showed that Bifidobacteria and Lactobacillus increased, E. coli decreased and B/E value increased after surgery( P<0.05). Serum inflammatory factors had no statistically significance difference between the two groups before operation( P>0.05). Levels of interleukin-6, C-reactive protein and tumor necrosis factor-α were increased in the two groups after surgery compared with before surgery( P<0.05), and the indexes were lower in the observation group than in the control group( t=4.841, 7.247 and 4.231, all P=0.000). Levels of IgG, IgM, IgA, CD3 + , CD4 + , CD8 + and the ratio of CD4 + and CD8 + were higher in the observation group than in the control group[(12.53±1.84) g/L vs.(11.47±1.92)g/L, (1.45±0.22) g/L vs.(1.33±0.17) g/L, (2.28±0.24) g/L vs.(2.13±0.12) g/L, (52.84±4.12)% vs.(50.43±3.91)% , (34.53±3.51)% vs.(30.75±3.62)%, (19.09±2.41)% vs.(18.24±0.53)% and (1.68±0.22)% vs.(1.43±0.15)%, t=2.644, 2.863, 3.120, 2.814, 4.973, 2.285 and 6.228, P=0.010, 0.005, 0.003, 0.006, 0.000, 0.025 and 0.000]. Conclusions:Early micro-ecological feed preparation in combination of enteral nutrition can improve the surgical effect and quality of life and promote disease recovery with a safety in patients with colorectal cancer.

OBJECTIVE To explore the dynamic changes of main alkaloids in the processing process of Aconitum sinomontanum Nakai prepared by liquorice juice. METHODS Aconitum sinomontanum Nakai with or without liquorice juice were steaming for 0, 0.5, 1, 2, 3, 4, 5 h, respectively, and then dried. HPLC was used to determine the content of lappaconitine, ranaconitine and new components in different processed products of Aconitum sinomontanum Nakai. The simulated processing was carried out with the reference substance of lappaconitine and ranaconitine. The new components were separated by preparative liquid and analyzed by NMR and UPLC-QTOF-MS. RESULTS With the extension of steaming time, the content of lappaconitine and ranaconitine decreased significantly during the steaming Aconitum sinomontanum Nakai with or without liquorice juice, and two new peaks(peak 1 and peak 2) were produced and their content increased observably, this indicated that the new compounds were not related to licorice juice, only related to steaming process. Compared with the steaming process without liquorice juice, the contents of toxic and effective components lappaconitine and ranaconitine decreased moderately steamed with liquorice juice, indicating that the addition of liquorice juice steaming was more reasonable; The results of the simulated processing showed that the contents of lappaconitine and ranaconitine gradually decreased in the processing. After isolation and identification find the compound 1(peak 2) was 5-hydroxymethylfurfural. CONCLUSION The main alkaloids components of Aconitum sinomontanum Nakai are changed greatly after processing, which may be closely related to the “reduction of toxicity and increase of efficiency” in the steaming process of adding liquorice juice.

[摘 要] 目的：探讨环状RNA _000926（circ_000926）对宫颈癌细胞增殖和凋亡的影响及其作用机制。方法: 收集2019年5月至2020年9月河北医科大学第一医院手术切除的30例宫颈癌患者的癌及癌旁组织标本，以及人宫颈癌细胞HeLa、SiHa和正常宫颈细胞Ect1/E6E7，用qPCR法检测组织和细胞中circ_000926和miR-411-5p的表达水平。将circ_000926过表达质粒及空白质粒、circ_000926小干扰RNA及阴性对照寡核苷酸、miR-411-5p mimic和阴性对照质粒分别转染HeLa和SiHa细胞，分为pc-circ_000926组、pc-NC组、si-circ_000926组、si-NC组、miR-411-5p mimic组和miR-NC组。通过CCK-8法检测转染细胞的增殖活力，TUNEL法检测细胞的凋亡水平。通过双荧光素酶报告基因实验验证circ_000926与miR-411-5p之间的靶向关系，WB法检测细胞中Ki67、BAX、Caspase-3和Caspase-9蛋白的表达。结果: 与癌旁组织和Ect1/E6E7细胞相比，宫颈癌组织和HeLa、SiHa细胞中circ_000926表达显著升高、miR-411-5p表达显著降低（均P<0.01）。与pc-NC组相比，pc-circ_000926组细胞增殖活力显著增强、细胞凋亡率显著降低（均P<0.01），细胞中miR-411-5p表达显著降低、Ki67蛋白表达显著升高，BAX、Caspase-3、Caspase-9蛋白表达显著降低（均P<0.01）。与si-NC组相比，si-circ_000926组细胞增殖活力显著降低、细胞凋亡率显著升高（均P<0.01），细胞中miR-411-5p表达显著升高、Ki67蛋白表达显著降低，BAX、Caspase-3和Caspase-9蛋白表达显著升高（均P<0.01）。双荧光素酶报告基因实验结果证实circ_000926靶向负向调控miR-411-5p表达，过表达miR-411-5p可逆转过表达circ_000926对宫颈癌细胞增殖和凋亡的作用。结论: circ_000926通过靶向吸附miR-411-5p促进宫颈癌细胞的增殖，并抑制细胞凋亡。

Objective:To compare the effects of different intraocular infusion solutions on histology and function of retina.Methods:Human corneal endothelial cells (HCEC), human retinal pigment epithelium (HRPE) cells and rat retinal ganglion cells (RGC) were divided into normal control group, balanced saline solution (BSS) group and compound electrolyte intraocular irrigating solution (CEIIS) group, and the cells were cultured in 10% DMEM/F12 medium, BSS and CEIIS for 12, 24 and 48 hours, respectively, according to grouping.The proliferation absorbance value of cultured cells was measured by cell counting kit-8 (CCK8) method.The expression of apoptosis related proteins in cultured cells was detected by cellular immunofluorescence staining.The cell apoptosis rate and cell cycle were measured by flow cytometry.The mitochondrial damage was detected by lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) quantitative detection kit.Fifteen New Zealand white rabbits were randomly divided into control group ( n=3), BSS group ( n=6) and CEIIS group ( n=6). The left eyes were taken for vitrectomy and different intraocular perfusion fluids were used during vitrectomy according to grouping.The retinal function of operative eyes was measured by flash electroretinogram (ERG) before operation and 24 hours after operation, and the structural changes of each layer of retina were detected by optical coherence tomography (OCT). The early apoptosis of retinal cells was detected by TUNEL staining.The expressions of cytochrome C and bax protein in retina were detected by immunohistochemical staining.The ultrastructural changes of retina were observed under a transmission electron microscope.The use and care of animals complied with the ARVO statement.This study protocol was approved by an Ethics Committee of Peking University People's Hospital (No.2019PHE059). Results:The three kinds of cultured cells in BSS and CEIIS groups were damaged in various degrees.With the extension of culture time, proliferated cells were decreased and the number of apoptotic cells was increased.Compared with the BSS group, cultured cells in the CEIIS group were dense and in orderly arrangement with uniform morphology and size.The apoptosis rates of HRPE cells and RGC in the BSS group were (37.157±6.918)% and (29.993±12.330)%, respectively, which were significantly higher than (4.163±1.310)% and (6.337±1.903)% in the CEIIS group ( P=0.003, 0.045). There was no significant difference in G0/G1+ S phase ratio of HCEC and HRPE cells among the normal control group, BSS group and CEIIS group (HCEC: F=2.226, P=0.189; HRPE: F=2.634, P=0.151), and the proportion of G2/M division arrest phase of RGC in the BSS group was significantly higher than that in the normal control group and CEIIS group ( P=0.047, 0.024). The proliferation absorbance values of HCEC, HRPE cells and RGC in the CEIIS group were significantly higher than those in the BSS group at each culture time point (all at P<0.05). The fluorescence intensity of cytochrome C, bax, caspase-3 and caspase-9 proteins in the BSS group was stronger than that in the normal control group and CEIIS group, and the fluorescence intensity of bcl-2 was weaker than that in the CEIIS group, and the fluorescence intensity of zonula occluden-1 (ZO-1) was weaker than that in the normal control group and CEIIS group.The release level of LDH in the BSS group was significantly higher than that in the CEIIS group at different time points (all at P<0.001). After 48 hours of culture, the release level of SDH in the BSS group was significantly higher than that in the CEIIS group ( P<0.05). No retinal histological abnormalities was found through OCT examination of rabbit eyes after vitrectomy in the two groups, but transmission electron microscopy showed that there were different degrees of loose arrangement of retinal photoreceptor cells, a large number of photoreceptor outer membrane discs falling off and vacuolar degeneration in the two groups, especially in the BSS group.TUNEL staining showed that the apoptotic cells were mainly located in the inner nuclear layer and RGC layer.The number of apoptotic retinal cells was (135.2±22.8)/high-power field of vision in the BSS group, which was significantly higher than (81.3±17.7)/high-power field of vision in the CEIIS group ( t=4.175, P=0.002). Full field flash ERG showed that the amplitudes of scotopic 3.0 ERG a- and b-wave in the CEIIS group after operation were significantly lower than those before operation, but the differences were not statistically significant (all at P>0.05). The amplitudes of scotopic 3.0 ERG a- and b-wave in the BSS group after operation were significantly lower than those before operation ( P=0.026, 0.010). Conclusions:In vivo and in vitro research results show that compared with BSS, there were few apoptotic cells in retinal tissue after vitrectomy perfused by CEIIS.