Objective To study the clinical features of the variants of benign childhood epilepsy with central temporal spikes (BECT).Methods The clinical data of 12 hospitalized pediatric patients with BECT from Jan 2007 to Jan 2014 were retrospectively reviewed. Results There were 7 boys and 5 girls in 12 patients. The age of onset was from 3 to 9 years old. Two cases were dizygotic twins. The atypical symptoms included atypical absence of 10 cases, negative myoclonic seizure of 8 cases, speech expression disorders and oral-pharynx apraxia of 4 cases. The electroencephalography (EEG) of all 12 patients showed abundance of spike and waves (SW) in rolandic areas during wake-up and sleep. The SW index was 50%-85% during slow sleep in all patients.Conclusions The variants of BECT are often associated with EEG deterioration. Understanding the clinical featuress and EEG characteristics can help the diagnosis of BECT variants.

Objective The study was conducted to investigate the acute phase of convulsion related problem on the clinical manifestations,imaging and electroencephalograph (EEG) examination of purulent meningitis.Methods Cluster sampling method was employed to select children in our hospital,a total of 301 cases with purulent meningitis was analyzed retrospectively.Among them,62 cases had convulsion.The incidence of convulsion in the acute phase of the purulent meningitis,risk factors,and prognosis were analyzed.Results The convulsion incidence rate of acute purulent meningitis was 20.60％.The partial seizure was eight cases (12.90％).The secondarily generalized seizure following partial seizure was 15 cases (24.19％).The generalized seizure was 32 cases (51.61％).The convulsive status was 7 cases (11.29％).The EEG abnormality was significantly different between the convulsion group and the no convulsion group (P ＜ 0.05).The incidence of brain organic damage was significantly different between two groups (P ＜0.05).The multivariate unconditional logistic regression analysis showed,cause of disease,first symptom,disturbance of consciousness,obvious signs,and cerebrospinal fluid culture with convulsion were the relevant factors (P ＜ 0.01).Conclusions The most common seizure of purulent meningitis was the generalized seizure.Brain organic damage easily resulted in convulsion of purulent meningitis.The days of hospitalization,cause of disease,first symptom,disturbance of consciousness,obvious signs,and cerebrospinal fluid culture with convulsion were the positively relevant factors.Those positively relevant factors in combination of the clinical manifestations,imaging,and EEG examination in children would play an important role in diagnosis,treatment,and prognosis evaluation of convulsion derived from purulent meningitis.Moreover,convulsion affects the disease recovery in children with purulent meningitis.

Objective To analyze the potential etiologies and risk factors of childhood stroke. Methods This study retrospectively reviewed the clinical data of 159 children who were admitted from Jan.2006 to Jan.2014. Results The 159 children were composed of 100 boys and 59 girls , with median onset age of 1.8 years (ranged from 1 day to 12 years old) and median peak age of 0.9 years (ranged from 3 months to 2.8 years old). Their initial symptoms included limb hemiplegia,language dififculties and convulsion. The common causes included infections found in 46 cases (central nervous system infection in 32 cases, respiratory and gastrointestinal tract infection in 14 case), head injury in 42 cases, vitamin K deifciency in 29 cases, Moyamoya disease in 8 cases, heart diseases in 11 cases, spontaneous hemorrhage in 11 cases and 12 cases of unknown reason. Infectious diseases were the most common cause of children acute ischemic stroke in toddler period;and vitamin K1 deifciency were the most common cause of children hemorrhage stroke in infancy. The most common region of infarction is basal ganglia and middle cerebral artery in neuronal imaging. The median age at the time of diagnosis was 1.4 days. The median time of inhospital was 28 days. The median apex time was 4.3 days. Conclusions Among 159 cases, acute ischemic stroke is much more common than hemorrhagic stroke in children stroke, and the major risk factors are infections and head injury;Vitamin K1 deifciency is a major risk factor in infants with hemorrhagic stroke.

Objective To observe the incidence and clinical feature of sleep-related breathing disorder in patients with idiopathic pulmonary fibrosis (IPF). Methods Thirty-four IPF patients who were measured by polysomnography (PSG) were collected in the Department of Respiration of Tianjin Medical University General Hospital. According to the results of apnea hypoventilation index (AHI), patients were divided into pure IPF group (AHI<5 events/h, n=7) and IPF combined with obstructive sleep apnea hypopnea syndrome (IPF+OSAHS) group (AHI≥5 events/h, n=27). The PSG reports of two groups were analyzed, and the correlation between AHI and pulmonary function and oxygen saturation in sleep and at wake were analyzed. Results (1)Thirty-four IPF patients were all demonstrated sleep disorders, low sleep efficiency, increased proportion of stageⅠand stageⅡand decreased proportion of stageⅢand rapid eye movement (REM). The arousal index and the proportion of stageⅠand stageⅡwere higher in IPF+OSAHS group than those of pure IPF group (P<0.01), while the proportion of stageⅢwas lower in IPF+OSAHS group than that of pure IPF group (P<0.01). There was no significant difference in stage REM between two groups. (2)Twenty-seven patients (79%) combined with OSAHS, among which five subjects (15%) were mild OSAHS with 5 events/h≤AHI<15 events/h, and 22 subjects (65%) were moderate-severe with AHI≥15 events/h. The main type of sleep-disorder breathing was hypoventilation, which mainly happened in stage REM. (3) Thirty-four IPF patients showed sleep hypoxemia, and the oxygen desaturation index (ODI) was higher in IPF-OSAHS group than those of pure IPF group (P<0.05). (4)The AHI was positively correlated with body mass index (r=0.791, P<0.05), and was negatively correlated with forced vital capacity (FVC%pred) (r=-0.574, P<0.05) and forced expiratory volume in 1 second (FEV1%pred) in IPF patients (r=-0.664, P<0.05). The lowest oxygen saturation (LSO2) and mean oxygen saturation (MSO2) in sleep were positively related with oxygen saturation at wake (r=0.421 and r=0.464, P<0.05 respectively). Conclusion The IPF patients show severe sleep disorder and hypoxemia, which can be worsen by OSAHS and produce negative effect on daily life. We should initiate active treatment in patients with sleep-related breathing disorders.

OBJECTIVETo explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multiple-ligament injured knee.

METHODSFrom October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient.

RESULTSNo severe complications occurred at early stage after operation in the 9 patients. All of them were followed-up for 10-39 months with an average of 23.00 months+/-9.46 months. Lysholm score was 70-95 with an average of 85.00+/-8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level.

CONCLUSIONSThe multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.

Adult ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Knee Injuries ; rehabilitation ; surgery ; Male ; Posterior Cruciate Ligament ; injuries ; Range of Motion, Articular

OBJECTIVETo express and purify the recombinant human bone morphogenetic protein-2 mature peptide (rhBMP-2m) in prokaryotic system and to develop highly-specific monoclonal antibodies.

METHODSAn engineered E. coli strain expressing rhBMP-2m was fermented. The bacterial cells were firstly lysed and then the rhBMP-2m inclusion bodies were isolated by centrifugation. After the inclusion bodies had been solubilized by high-concentration denaturing agents, denatured rhBMP-2m was purified by cation ion-exchange chromatography. Biologically active rhBMP-2m was obtained by refolding of purified denatured rhBMP-2m through direct dilution. The refolded rhBMP-2m was used to immunize Balb/c mice to develop anti-rhBMP-2m monoclonal antibodies using classic hybridoma technique.

RESULTSrhBMP-2m with a purity greater than 95% was obtained on reduced SDS-PAGE. The refolded rhBMP-2m was measured to be bioactive by the induction of alkaline phosphatase activity in MC3T3-E1 cells. Two hybridoma cell lines that stably secreted anti-rhBMP-2m antibody were developed from the immunized mice.

CONCLUSIONBioactive rhBMP-2m protein and its monoclonal antibodies were successfully prepared, which will provides a solid base for future studies on rhBMP-2.

Animals ; Antibodies, Monoclonal ; biosynthesis ; Bone Morphogenetic Proteins ; biosynthesis ; immunology ; Escherichia coli ; metabolism ; Humans ; Mice ; Mice, Inbred BALB C

OBJECTIVETo investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction (EPSBO).

METHODSFifty-four patients with EPSBO requiring decompression between April 2010 and July 2014 were enrolled in the study. Insertion of a long tube was guided by fluoroscopy. We first used the guide wire to pass the pylorus and then used the 10 Fr feeding tube as an exchangeable tube to put the superstiff wire into the duodenum. Finally the long tube could be passed over the guide wire through the pylorus into the intestine. The total procedure time, the radiation exposure time, and the incidence of complications were evaluated.

RESULTSThe long tubes passed into the jejunum on initial insertion for all patients, so the success rate of this technique was 100%. The long tube was inserted into ileum in 18 patients. The mean total procedure time was 34.4 ± 8.6 minutes, and the mean radiation exposure time 18.9 ± 6.8 minutes. A total of 47 patients (87%) experienced full recovery following long-tube decompression and without the need for surgical intervention.

CONCLUSIONSUsing the wire-exchange technique, it is easy to place a long tube into the small bowel under fluoroscopic guidance. This decompression method is safe and effective for management of EPSBO.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Fluoroscopy ; Humans ; Intestinal Obstruction ; surgery ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Retrospective Studies

Objectives To investigate the failure cause of valproate monotherapy for newly diagnosed generalized epilepsy in children and to investigate the factors related to the failure. Methods The newly diagnosed cases of general?ized epilepsy were recruited and given valproate monotherpy. After 2 years of treatment and regular follow-up, they were divided into control group and poor effect group.according to their response to the treatment. The clinic data and electro?encephalogram were collected. The reasons of treatment failure were studied using Logistic regression analysis. Results There were 231 patients who had completed this study in all. After 2 years, 62 cases had switched to other drugs because of poor efficacy. Efficacy of was satisfactory in 169 cases of children. There were 3 cases of poor compliance, and one case switched to other drug due to side effect. There were statistically significant (P<0.05) in the abnormal electroenceph?alogram (EEG) rate (poor effects group 90.32%vs. control group 61.54%), abnormal cranial magnetic resonance imaging (MRI) rate (poor effects group 45.16%vs. control grou p23.08%) and the first age of onset [poor effects group 0.50(0.42, 2.50)year vs. control group 0.75(1.50, 5.16)year] between the good effects group and poor effects group. Univariate anal?ysis showed that mental retardation,birth asphyxia,abnormal bain MRI,the first episode of age were statistically signifi? cant different between these two groups (P<0.05). Further multivariate regression analysis showed that the low first onset age (OR=2.124 P=0.004)、mentalretardation (OR=10.535,P=0.000, abnormal brain MRI(OR=1.603,P=0.020), asphyxia at birth(OR=1.913 P=0.027)were independent risk factors for the poor efficacy of valproate. Conclusions The main rea?sons for the failure of valproate monotherpy in children with generalizedepilepsy are poor efficacy,bad compliance, ad?verse reactions. The risk factors of poor efficacy are the low first onset age, mental retardation, abnormal brain MRI and asphyxia at birth etc.

Objective To develop psychosocial skills training module for schizophrenic outpatients.Methods Structured psychosocial skills training program, which were made according to community rehabilitation plan for schizophrenia, featured convenience and well operability. Subjects were 96 of 204 schizorenic outpatients in remission who were randomly assigned to receive psychosocial skills training combined medicine(observation group) or medicine only(control group) and followed up by 24 months. The changes during treatment were evaluated by positive and negative syndrome scale(PANSS), Social Disability Screening Schedule(SDSS) and patients' cognition function were also evaluated longitudinally. Results Relapse rate of control group (37%) is higer than observation group (17.7%, P＜0.01). After Last Observation Carried Forward(LOCF), control group showed higer scores than observation group on positive syndrome (8.34±2.04 vs 7.66±0.97), negative syndrome(9.15±1.97 vs 813±1.15), total score (37.64±5.58 vs 34.79±3.64) and Social disability (2.81±1.90 vs 2.07±1.47) (P＜0.01); observation group also showed a significant progress on cognition function(P＜0.05). Conclusion This trial demonstrated the efficacy of the easy-operating structured psychosocial skill training grogram in preventing relapse and improving social adoptive function for schizophrenia.

OBJECTIVETo investigate the role of IL-18 and IL-18BP balance in aplastic anemia (AA).

METHODSA total of 29 AA patients and 22 controls were recruited in present research. The expressions of IL-18 and IL-18BP were measured by enzyme-linked immunosorbent assay (ELISA). The mRNA expressions of IL-18 and IL-18BP were measured in all subjects using real-time quantitative polymerase chain reaction (RT-PCR).

RESULTSThe levels of the IL-18 in plasma of AA and normals were (365.5 ± 160.6) pg/ml and (175.9 ± 92.8) pg/ml (P < 0.01); and the expression of IL-18 in severe AA patients (441.3 ± 116.9) pg/ml were higher than that in non-severe AA patients (326.4 ± 167.0) pg/ml (P < 0.05). The level of IL-18BP was increased in plasma of AA (1788.6 ± 523.8) pg/ml than in normals (1083.6 ± 489.6) pg/ml (P < 0.05). But the ratio of IL-18/IL-18BP in AA patients was much higher than that in controls (P < 0.05). RT-PCR revealed the levels of IL-18 and IL-18BP mRNA were up-regulated in AA patients when compared to controls, but the ratio of IL-18/IL-18BP was significantly elevated in AA patients.

CONCLUSIONIL-18/IL-18BP imbalance may play an important role in pathogenesis of AA and regulating the balance of IL-18 and IL-18BP may be a therapeutic approach to AA.

Adolescent ; Adult ; Anemia, Aplastic ; blood ; Case-Control Studies ; Female ; Humans ; Intercellular Signaling Peptides and Proteins ; blood ; Interleukin-18 ; blood ; Male ; Middle Aged ; Young Adult