Objective Idiopathic rolandic epilepsy syndrome （IRES） is the most common epilepsy syndrome in childhood， and its lesion site remains undetermined. This article aims to investigate the source of epileptiform discharges in IRES using magnetoencephalography （MEG）.Methods A total of 70 patients with IRES were enrolled in this prospective MEG-based study， among whom there were 53 children with benign epilepsy of childhood with centrotemporal spikes （BECTS）， 12 children with atypical benign partial epilepsy （ABPE）， 3 children with Landau-Kleffner syndrome （LKS）， and 2 children with epileptic encephalopathy with continuous spike-and-waves during slow-wave sleep （CSWS）. Epileptiform discharges were collected independently from each patient 10 times， and an MEG source analysis was performed. Standardized low-resolution brain electromagnetic tomography was used to perform source localization of the distributed source model. The spike source density was quantified into amplitude， and source location was determined according to the Desikan-Killiany atlas. The association between the distribution of spike source in brain and clinical manifestations was analyzed.Results In IRES， there were significant differences in the source locations of epilepsy discharge between BECTS， ABPE， LKS， and CSWS. The current source density of CSWS was stronger in the frontal lobe， the temporal lobe， and the anterior cingulate gyrus， while that of ABPE was stronger in the frontal lobe， and that of BECTS and LKS were stronger in the temporal lobe. The more severe phenotype of epilepsy， such as generalized tonic-clonic seizure， was associated with a stronger current source density in the brain， which was consistent with electroencephalography manifestations.Conclusion This study identifies different sources of epileptiform discharges in IRES. The density distribution of these spike sources may help to explain the discharge， cognitive， and neuropsychological characteristics in different subtypes of IRES.
Magnetoencephalography

Objective:To analyze the APR triangle formed when the right hepatic vein (RHV) passed through the right anterior hepatic pedicle (RAHP) and the right posterior hepatic pedicle (RPHP) by 3D visualization technique.Methods:Clinical data of 100 subjects undergoing liver contrast-enhanced CT scan in the Second Affiliated Hospital of Harbin Medical University from September 2019 to September 2022 were retrospectively analyzed, including 57 males and 43 females, aged (53.2±13.0) years. The CT data were imported into a system for 3D image reconstruction of the liver. The intrahepatic vascular structure was observed, including the portal vein, APR triangle, the angle between the RAHP and RPHP, the distance between RHV and the vertex of angle when it crosses the angle plane of the RAHP and RPHP, the structure and branches of the right posterior branch of portal vein, and the number of branches into the APR triangle from the main trunk of the right anterior and right posterior portal vein.Results:The main type of portal vein was type A (the main portal vein was divided into left and right branches, and the right branch was further divided into right anterior branch and right posterior branch), in 86 cases (86.0%). The APR triangle was observed in 81 cases (81.0%), and the distance between the right hepatic vein and the vertex of the right anterior and right posterior hepatic pedicle was (1.70±0.36) cm, 1.00-2.00 cm was 82.7%(61/81). The angle between right anterior and right posterior hepatic pedicle was 45°-90° in 77 cases (77.0%, 77/100). In 100 subjects, the main branch of the right posterior portal vein accounted for 42.0% (42/100) of typeⅠ (bifurcation type) and 53.0% (arch type) of type Ⅱ (53/100). In 16 cases (19.8%, 16/81), the main right anterior portal vein branched into the APR triangle, with a total of 22 branches. In 9 cases (11.1%, 9/81), the main branch of the right posterior portal vein (branching type) branched into the triangle, with a total of 11 branches. There were 33 cases (40.7%, 33/81) of right posterior portal vein (arch type) main branch branching into the triangle, a total of 41 branches.Conclusion:The APR triangle, composed of the RAHP, RPHP and RHV, has an objective anatomical basis and is affected by the variants of portal vein and RHV. It is more common for the RHV to be within 1.00-2.00 cm of the vertex of the angle between the RAHP and RPHP, and the main trunk of the right anterior and right posterior branches of portal vein are less divided into the triangle, so it is relatively safe to dissect within this area.

Removal of endogenic renal sinus tumors which are located at the renal hilum,is recognized as one of the most challenging surgeries in urology due to the complex anatomical structure.With the help of the high-definition field of vision and flexible robotic arms of the Da Vinci robot system,our team have carried out precision intra-sinus tumor enucleation based on preoperative interactive qualitative and Interactive Quantitative Quality Assurance for 3D Imaging(IQQA-3D)accurate reconstruction technology,as well as the clinical anatomical characteristics of patients with renal sinus tumors.During operation,the renal pedicle is fully dissected,the perihilar fat is cleared,and the tumor capsule is exposed.Subsequently,the blood supply to the kidney is blocked,and the tumor is precisely excised along the tumor capsule.The vascular stumps are sutured point-to-point,and the wound is closed and locked.After the blood supply restores,regional arterial occlusion is performed if necessary to ensure the safety of the surgery and maximize the preservation of renal function.This article discusses the definition of tumor boundaries during robot-assisted endogenic sinus tumor enucleation,the use of intraoperative cooling techniques,and the improvement of surgical safety.

Objective To investigate the predictive value of the preoperative fasting Triglyceride-Glucose index(TyG)for contralateral new silence ischemic brain lesions(CNSIBL)following carotid artery stenting(CAS).Methods A retrospective study was conducted to analyze the clinical data of 183 patients who underwent carotid CAS.The patients were divided into a CNSIBL group(50 cases)and a non-CNSIBL group(133 cases)based on the occurrence of CNSIBL.Baseline data,laboratory tests,and imaging indicators were collected,and TyG was calculated.Using the occurrence of CNSIBL as the dependent variable,multivariate logistic regression analysis was performed with TyG as the independent variable after controlling for confounding factors,and the predictive value of TyG for CNSIBL post-CAS was evaluated using receiver operating characteristic(ROC)curves.Results(1)The number of patients with a history of diabetes mellitus,as well as systolic and diastolic blood pressure on admission in CNSIBL group were statistically significantly higher than that in non-CNSIBL group(P<0.05).(2)Triglyceride(TC)levels were higher in the CNSIBL group compared to the non-CNSIBL group(P<0.05);TyG was also higher in the CNSIBL group than in the non-CNSIBL group(P<0.05);(3)Multivariate Logistic regression analysis results showed that TyG[a OR=1.125,95%CI(1.042-1.214),P<0.001]was an independent risk factor for contralateral new silent ischemic brain lesions after carotid artery stenting;(4)The ROC curve suggested that the AUC for TyG predicting contralateral new silent ischemic brain lesions post-CAS was 0.77[95%CI(0.71-0.84),P<0.001],with a cut-off value of 1.93,sensitivity of 86.0%,and specificity of 63.9%.Conclusion TyG is an independent influencing factor for contralateral new silent ischemic brain lesions following carotid artery stenting.

OBJECTIVE To investigate the auditory characteristics of patients with congenital unilateral cochlear nerve deficiency(CND).METHODS This study enrolled 21 patients(21 ears)with unilateral auditory nerve dysplasia confirmed by inner ear MRI,including 9 males and 12 females,aged 10 months to 7 years,(1.91±1.38)years.A retrospective analysis was performed on the correlation between behavioral audiometry and auditory steady-state response(ASSR)thresholds,chirp-evoked auditory brainstem response(chirp-ABR),otoacoustic emission(OAE),and other results to analyze the audiological characteristics of unilateral auditory nerve dysplasia.RESULTS In all 21 patients(21 ears)with auditory nerve dysplasia,behavioral audiometry,chirp-ABR,and ASSR results all indicated severe to profound hearing loss in the affected ears.There was a high correlation between behavioral audiometry thresholds and ASSR thresholds,with small differences observed between ASSR and behavioral audiometry results.CONCLUSION The difference between ASSR and behavioral audiometry is small in patients with CND.A-ABR can't be elicited.OAE has a certain false negative rate.The ABR often predominantly shows wave III,with prolonged latency,and a threshold indicative of profound hearing loss.These audiological characteristics can improve the early detection and diagnosis of CND and enhance the effect of intervention.

Objective To study carbapenem-resistant Enterobacterales(CRE)infection in the neurosurgical inten-sive care unit(NS-ICU)under the combination of active screening using anal swabs and bundled intervention mea-sures in environment with high prevalence of CRE infection,and provide scientific basis for healthcare-associated in-fection(HAI)prevention and control.Methods Inpatients in NS-ICU from 2020 to 2021 were selected as the con-trol group,and didn't undergo active anal swab screening.NS-ICU inpatients from 2022 to 2023 were taken as the trial group,and implemented intervention of active anal swab screening.Isolation measures for CRE positive cases in two groups were implemented,and the incidence of CRE HAI between two groups of patients were compared.Results 645 patients were actively screened for CRE,with a total of 912 screenings.The overall screening positive rate was 9.21％,and the rectal CRE colonization rate in NS-ICU patients was 13.02％(84/645),out of which Klebsiella pneumoniae accounted for 92.86％(n=78 strains).The positive screening rates in patients in the trial group within 48 hours after admission as well as on day 3-7,day 8-15,and 16-30 were 3.30％,4.94％,13.68％,and 18.85％,respectively.With prolonged hospitalization time,the positive rate of CRE anal swab screening gradually increased.During the study period,the overall CRE HAI rate was 6.24％(72/1 153).After implementing active screening intervention,the CRE HAI rate in the trial group was lower than that in the control group(3.57％[23/645]vs 9.65％[49/508],P＜0.001).Conclusion In hospital environment with high CRE prevalence,implementing active screening and bundled intervention measures can effectively identify CRE carriers and reduce the risk of infection caused by intestinal colonization.

A detection model based on Gramian angular field(GAF)and parallel KConvNeXt network is proposed for accurately detecting the abnormal conditions caused by sample needle blockage in the sampling system during the sampling,thus improving the testing accuracy and detection efficiency of automated biochemical analyzers.GAF-based method is employed to transform the time series of one-dimensional pressure signals into two-dimensional image representations.Subsequently,an improved attention mechanism integrated with a parallel dual-channel KConvNeXt network is used to classify the pressure signals,and achieves a final classification accuracy of 94.58%.The experimental results show that the proposed method can effectively capture the key characteristics of the pressure signals,offering an efficient solution for the anomalous pressure detection in biochemical analyzer sampling system and exhibiting important practical significance.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective:To explore the changes in carcinoembryonic antigen(CEA)during the immune process of programmed death-1(PD-1)inhibitor Sintilimab in human epithelial growth factor receptor 2(HER2)negative advanced gastric cancer patients and its relationship with prognosis.Methods:HER2 negative late stage gastric cancer patients(88 cases)who were treated in North Anhui Coal Power Group General Hospital from May 2020 to April 2022 were selected as study subjects,all of whom received PD-1 inhibitor Sintilimab treatment;according to the prognosis,they were divided into death group(36 cases)and survival group(52 cases).Followed up was conducted every 6 months to collect tumor marker levels before and after treatment.Analyzed relationship between tumor markers(CEA,CA199,CA125)levels and clinical staging,lymph node metastasis and prognosis.Kaplan-Meier sur-vival curve was used to analyze survival time of patients with negative and positive tumor markers.Multivariate Cox regression model and stepwise regression analysis were used to identify risk factors affecting prognosis.Spearman was used for correlation analysis.Results:After two cycles of treatment,72 cases(81.82%)had disease control and 16 cases(18.18%)had progression.Compared with patients before treatment,positive rate of serum tumor markers in patients after treatment was significantly reduced(P<0.05).Positive rates of CEA and CA199 were significantly correlated with clinical staging(P<0.05).When predicting patient death,sensitivity of CEA level was the highest(48.57%),while CA125 had the highest specificity(95.62%)and the lowest sensitivity(25.71%).Kaplan-Meier sur-vival curve analysis showed that the survival time of patients with positive tumor markers were significantly shorter than that of negative patients(P<0.05).Clinical staging,serum CEA and CA199 levels were independent factors for predicting prognosis(P<0.05).Spear-man correlation analysis results showed that the multiple increases in CEA(r=-0.512,P=0.005)and CA199(r=-0.467,P=0.011)were negatively correlated with patient survival time.Conclusion:After treatment with PD-1 inhibitor Sintilimab,serum tumor markers levels in HER2 negative advanced gastric cancer patients have been significantly reduced on average.High serum levels of CEA,CA199 and CA125 can all predict poor prognosis,and clinical staging,serum CEA and CA199 levels are independent factors in pre-dicting prognosis.The higher the increase in CEA and CA199,the shorter the patient's survival time.

Objective To study carbapenem-resistant Enterobacterales(CRE)infection in the neurosurgical inten-sive care unit(NS-ICU)under the combination of active screening using anal swabs and bundled intervention mea-sures in environment with high prevalence of CRE infection,and provide scientific basis for healthcare-associated in-fection(HAI)prevention and control.Methods Inpatients in NS-ICU from 2020 to 2021 were selected as the con-trol group,and didn't undergo active anal swab screening.NS-ICU inpatients from 2022 to 2023 were taken as the trial group,and implemented intervention of active anal swab screening.Isolation measures for CRE positive cases in two groups were implemented,and the incidence of CRE HAI between two groups of patients were compared.Results 645 patients were actively screened for CRE,with a total of 912 screenings.The overall screening positive rate was 9.21％,and the rectal CRE colonization rate in NS-ICU patients was 13.02％(84/645),out of which Klebsiella pneumoniae accounted for 92.86％(n=78 strains).The positive screening rates in patients in the trial group within 48 hours after admission as well as on day 3-7,day 8-15,and 16-30 were 3.30％,4.94％,13.68％,and 18.85％,respectively.With prolonged hospitalization time,the positive rate of CRE anal swab screening gradually increased.During the study period,the overall CRE HAI rate was 6.24％(72/1 153).After implementing active screening intervention,the CRE HAI rate in the trial group was lower than that in the control group(3.57％[23/645]vs 9.65％[49/508],P＜0.001).Conclusion In hospital environment with high CRE prevalence,implementing active screening and bundled intervention measures can effectively identify CRE carriers and reduce the risk of infection caused by intestinal colonization.