Objective:To summarize the clinical and neurophysiological characteristics of epilepsy with blink inducing.Methods:The patients with epilepsy with blink test positive who received 24 h-video-electroencephalography (24 h-VEEG) monitoring from May 2017 to May 2022 in the Xijing Hospital, the Air Force Military Medical University were enrolled. Their clinical and electrophysiological characteristics were studied and they were followed up to observe their prognosis.Results:A total of 42 patients with epilepsy with blink test positive were collected, 1 of whom was lost to follow-up. The remaining 41 patients included 18 males (44%) and 23 females (56%), whose age was 3 to 12 (8.1±2.6) years. Self-limited epilepsy with centrotemporal spikes (SeLECTS) was diagnosed in 35 patients, self-limited epilepsy with autonomic seizures in 3, and developmental epileptic encephalopathy with spike-and-wave activation in sleep in 3, respectively. The electrical status epilepticus during sleep (ESES) was found in 31 patients (76%), whereas 10 (24%) without ESES. Thirty-two patients experienced 24 h-VEEG monitoring more than twice, and 23 of them were seizure free, of whom blink inducing disappeared in 14 patients and existed in 9 in the last 24 h-VEEG monitoring. Among the 9 patients who were not seizure free, blink inducing disappeared in 3 patients and remained in 6. There was no statistically significant difference between the two groups ( P>0.05). The age of the patients whose blink inducing disappeared in the last 24 h-VEEG monitoring after treatment was (11.3±3.1) years. Meanwhile the age of the patients whose blink inducing remained was (9.1±2.3) years, and the difference between the two groups was statistically significant ( t=2.254, P=0.030). Conclusions:Blink inducing is highly age-dependent and common in self-limited focal epilepsy and developmental epileptic encephalopathy, especially in SeLECTS. Moreover, patients with ESES are more likely to be blink test positive. There was no correlation between blink inducing and seizure outcome.

Objective To investigate the active ingredients of Zizyphi Spinosae Semen(ZSS)in relieving benzodiazepine(BDZ)dependence and its molecular mechanism based on the integrated Traditional Chinese Medicine and chemical drugs idea of"enhancing effect and reducing toxicity"via the approach of network pharmacology and the technique of molecular dynamics simulation.Methods First,literature search was undertaken to find the main components of ZSS.Then,the major effective constituents of ZSS in relieving BDZ dependence and its target of action were explored on the basis of network pharmacology and molecular docking.Finally,the relationship between core components of ZSS and key proteins was further verified through the technique of molecular dynamics simulation.Results After literature search,a total of 24 chemical components in ZSS were found to act on 731 targets.Through establishing the network of"ingredients-targets-pathways",topology analysis was performed to obtain nine core components such as linoleic acid,palmitic acid,oleic acid,tetradecanoic acid,spinosin,oleanolic acid and jujuboside A,as well as five key targets including AR,PTGS2,PPARG,RXRA and CYP19A1.Bioinformation enrichment analysis was made to obtain critical pathways such as calcium signaling pathway,cAMP signaling pathway,IL-17 signaling pathway and TNF signaling pathway.The results of molecular docking revealed that there was a good combination between core components of ZSS and key targets,and it was mainly dominated by hydrogen bonding.Furthermore,the molecular dynamics simulation experiments indicated that the combinations between jujuboside A and RXRA,oleanolic acid and RXRA,spinosin and PPARG were stable,and these three active ingredients played an important role in improving BDZ dependence.Conclusion The active components in ZSS may exert multi-target and multi-pathway intervention effects on BDZ dependence by means of processes such as immunoregulation,anti-anxiety,and anti-insomnia.

Arsenic, as a toxic substance that can affect human health, can cause various neurological disorders, including cognitive impairment, when excessive. Relevant epidemiological surveys and animal experimental studies have shown that exposure to arsenic can not only cause intellectual impairment and peripheral neuropathy in humans, but also lead to abnormal behavior in humans and animals. However, so far, the mechanism of arsenic induced damage to the nervous system is still unclear. Peroxisome proliferator activated receptor γ auxiliary activation factor 1α (PGC-1α), as a nuclear transcription coactivator, can interact with transcription factors or other coactivators and plays a role in biological processes such as mitochondrial biogenesis and energy metabolism. PGC-1α, by activating mitochondrial biogenesis, affecting energy metabolism, activating oxidative stress regulatory factors [catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), etc.], mitigates the damage to the central nervous system (CNS), peripheral nervous system (PNS), and blood-brain barrier (BBB) caused by arsenic. This article summarize the research progress of arsenic-induced neurological injury and the mechanism of PGC-1α's role in arsenic-induced neurological injury to provide a theoretical basis for further prevention and treatment of neurological diseases caused by arsenic.

Objective:To explore the effects of phased goal directed fluid therapy (GDFT) during anesthesia surgery on tissue perfusion and cognitive function in patients undergoing radical lung cancer surgery.Methods:A total of 108 lung cancer patients were prospectively selected and randomly divided into a control group and a study group using a random number table method. The control group received classical restrictive liquid therapy, while the study group received staged GDFT. We compared the surgical time, intraoperative blood loss, colloid fluid dosage, crystalloid fluid dosage, total output, and urine volume between two groups of patients; Two groups of patients were compared in terms of oxygenation index (OI), respiratory index (RI), central venous oxygen saturation (ScvO 2), lactate (Lac), central venous arterial carbon dioxide partial pressure difference (Pcv-aCO 2), oxygen supply index (DO 2I), and oxygen uptake rate (O 2ERe) before anesthesia induction (T 0), before single lung ventilation (T 1), 1 hour of single lung ventilation (T 2), immediate resumption of dual lung ventilation (T 3), 30 minutes of dual lung ventilation (T 4), and after surgery (T 5); The Mini Mental State Examination (MMSE) was used to evaluate the cognitive function scores of two groups of patients 1 day before surgery and 1 and 3 days after surgery, while recording the incidence of cognitive dysfunction (POCD) and pulmonary complications (including pulmonary infection, acute lung injury, pulmonary embolism, pulmonary edema, atelectasis, etc.) within 3 days after surgery. Results:The amount of crystal fluid and urine output in the research group was significantly lower than that in the control group, while the amount of colloidal fluid was significantly higher than that in the control group (all P<0.05). The OI of the study group T 1-T 5 was significantly higher than that of the control group, while the RI of T 2-T 5 was significantly lower than that of the control group (all P<0.05). The ScvO 2 of the study group T 1 to T 5 was significantly higher than that of the control group, and the Lac was significantly lower than that of the control group (all P<0.05); The MMSE scores of both groups of patients were significantly lower than those before surgery on day 1 and 3 after surgery, and the MMSE scores of the study group were significantly higher than those of the control group on day 1 and 3 after surgery (all P<0.05). The incidence of POCD within 3 days after surgery in the study group was 16.67%(9/54), lower than 37.04%(20/54) in the control group (χ 2=5.704, P=0.017); The incidence of pulmonary complications in the study group was lower than that in the control group (5.56% vs 22.22%, χ 2=4.955, P=0.026). Conclusions:The application of staged GDFT during anesthesia in patients undergoing radical lung cancer surgery can further improve tissue perfusion, improve microcirculation and oxygen supply-demand balance of systemic organs and tissues, including the brain, alleviate perioperative brain function damage, and reduce the occurrence of postoperative POCD compared to conventional liquid therapy.

Objective:To evaluate the feasibility, safety and efficacy of indocyanine green (ICG) fluorescence imaging navigation combined with modified pancreaticogastrostomy in laparoscopic duodenum-preserving pancreatic head resection.Methods:The clinical data of 14 patients undergoing laparoscopic duodenum-preserving pancreatic head resection with indocyanine green fluorescence navigation technique combined with modified pancreaticogastrostomy from January 2019 to January 2022 in the Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Hebei Medical University were retrospectively analyzed, including 4 males and 10 females, aged (40.6±7.1) years. The operation time, intraoperative blood loss, postoperative complications and follow-up were recorded.Results:All 14 operations were successfully completed, and there was no intraoperative ICG allergic reaction. The intraoperative ICG staining facilitated the identification of common bile duct. The operation time was (325.71±23.00) min, and the time of modified pancreaticogastrostomy was (18.32±1.52) min. Intraoperative blood loss was 200 (150, 300) ml. There were no case of intraoperative blood transfusion. Postoperative complications include three cases of grade A pancreatic fistula, one of biliary fistula, and one of biliary stricture. All patients were followed up for one to 18 months, and the median follow-up time was 10 months. One patient had intermittent fever after operation. Magnetic resonance cholangiopancreatography showed biliary stricture in one patient one month after operation, which was managed by endoscopic biliary stent implantation.Conclusion:Indocyanine green fluorescence navigation is safe and feasible in laparoscopic duodenum-preserving pancreatic head resection. Combined with modified pancreaticogastrostomy, it helps skip the jejunal anastomosis and improve the efficiency of surgery.

ObjectiveTo analyze and sum up the medication rule and the core prescription of Professor LIU Minru in the treatment of polycystic ovary syndrome （intracellular lipid membrane congestion syndrome）and explore the effect mechanism underlying the medication. MethodTwo platforms were used to carry out data mining to analyze the characteristics and rules of Professor LIU's prescriptions for the treatment of this disease. Network pharmacology was used to further clarify active ingredients in the core prescription，and a traditional Chinese medicine-active ingredient-target network was constructed，with the potential mechanism of action analyzed. ResultA total of 321 prescriptions were included in the medical records，involving 178 Chinese medicinals and 28 kinds of formula granules.The Chinese medicinals mainly act on the liver and kidney meridians， whose main tastes were sweetness，pungency，and bitterness and properties were mainly warm，mild，and slightly cold.Commonly used medicine pairs include Dioscoreae Rhizoma-Rehmanniae Radix Praeparata，Chuanxiong Rhizoma-Angelicae Sinensis Radix，Bupleuri Radix-Aurantii Fructus，and Gleditsiae Spina-Curcumae Rhizoma.The commonly used formulas are Xuefu Zhuyutang，Siwugang，Yangjing Zhongyutang，etc. The core prescription is composed of 12 Chinese medicinals such as angelica，white peony，saponaria thorn，and epimedium，containing 74 active ingredients，including quercetin，luteolin，kaempferol，fisetin，and β-sitosterol.A total of 37 key targets were found，involving phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt），mitogen-activated protein kinase （MAPK），Janus protein tyrosine kinase （JAK）/signal transduction and activator of transcription （STAT），and other signaling pathways. ConclusionThe pathogenesis of this disease is complex.Professor LIU adheres to the pathogenesis of "kidney deficiency as the root cause，and phlegm retention as the symptom". Under the guidance of the academic ideology of "kidney Qi as the root，and protecting Yin as the foundation" and "nurturing Yin to support Yang"，she takes into account Yin and Yang in kidney tonic，replenishes and consolidates the essence and blood，and relieves manifestations by dissipating mass， activating blood， and regulating Qi. She has a rigorous thinking in formulating prescriptions. The core prescription has the characteristics of comprehensive regulation by multiple components at multiple targets in multiple pathways.

Objective:To systematically review the qualitative research on the care experience of caregivers of palliative care for minors, in order to provide a reference for formulating a care plan that is more in line with the needs of palliative care for minors and their families.Methods:The Cochrane Library, Australia Joanna Briggs Institute Evidence-based Health Care Center Library, Embase, PubMed and Web of Science, CINAHL, China National Knowledge Infrastructure, Wanfang Database, VIP Database and China Biology Medicine Disc were searched by computer for literature on qualitative research on care experience of underage hospice care caregivers from the establishment of the database to December 30, 2023.Results:A total of 11 articles were included and 70 research results were extracted, which were summarized into 7 new categories and formed 2 integrated results: professional caregivers and relative caregivers had multiple care burden, and need multiple care support; professional caregivers and relative caregivers can shoulder the care responsibility of children together, actively respond to the difficulties in care, gain personal care experience and growth.Conclusions:Hospice care for minors has its own characteristics, and caregivers have various care burdens and needs. Special attention should be paid to the emotional experience and care demands of caregivers, and targeted support and protection should be provided to promote the construction of hospice care team for minors in China and improve the level of hospice care for minors in China.

Sudden unexpected death in epilepsy (SUDEP) refers to the sudden, unexpected and unexplained death of epilepsy patients, which is an important reason for the significant increase of the death risk of epilepsy patients. The risk factors of SUDEP are related to poor control of seizures, nocturnal seizures, prone position, antiepileptic drugs, comorbidity, etc. Epilepsy death caused by SUDEP has become a major public health problem. The latest progress in neuropathology and cardiopulmonary pathology of SUDEP was reviewed in this article.

Objective To investigate the effect of erector spinae plane block on ultrasound-based hemodynamic parameters of the arteries of the four limbs and biochemical stress indicators in patients with thoracoscopic lobectomy. Methods A total of 120 patients with thoracoscopic lobectomy were randomly divided into study group and control group, with 60 cases in each group.The study group received erector spinae plane block during surgery, while the control group received conventional anesthesia measures.Pulmonary function indicators[peak expiratory flow rate (PEFR), forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁)], ultrasound-based hemodynamic parameters of the arteries of the four limbs (maximum systolic velocity, minimum diastolic velocity, mean velocity, arterial pulsatility index, and arterial resistance index), stress indicators[cortisol (Cor), norepinephrine (NE), angiotensin Ⅱ(Ang Ⅱ), and adrenocorticotropic hormone (ACTH)], and analgesic effect were compared between the two groups at different time points[before anesthesia induction (T₀), after extubation (T₁), and after drainage tube removal (T₂)]. Results FEV₁, FVC and PEFR in both groups were significantly lower at T₁ and T₂ than at T₀, and FEV₁, FVC and PEFR in the study group were significantly higher than those in the control group at T₁ and T₂(P < 0.05).The maximum systolic velocity and arterial resistance index in both groups were significantly lower at T₁ and T₂ than at T₀, while the minimum diastolic velocity, mean velocity and arterial pulsatility index were significantly higher at T₁ and T₂ than at T₀(P < 0.05).The maximum systolic velocity and arterial resistance index in the study group were significantly higher than those in the control group at T₁ and T₂, but the minimum diastolic velocity, mean velocity and arterial pulsatility index were significantly lower than those in the control group (P < 0.05).Cor, ACTH, Ang Ⅱ and NE in both groups were significantly higher at T₂ than at T₀, and Cor, ACTH, Ang Ⅱ and NE in the study group were significantly lower than those in the control group at T₂(P < 0.05).The Prince-Henry pain score, effective compression times, and actual compression times in the study group were significantly lower than those in the control group (P < 0.05). Conclusion Application of erector spinae plane block in thoracoscopic lobectomy causes smaller fluctuations in hemodynamic parameters of the arteries of four limbs and biochemical stress indicators, with a better anesthetic effect.

Objective To investigate the effects of esketamine on hypoxic-ischemic myocardial injury in neonatal rats based on glycogen synthase kinase-3β/NOD-like receptor thermal protein domain-containing protein 3 (GSK-3β/NLRP3) pathway. Methods Thirty neonatal rats were randomly divided into sham operation group, model group and esketamine group, with 10 rats in each group. The rats in the sham operation group underwent a median incision in the neck to expose the bilateral common carotid arteries; the rats in the model group and the esketamine group underwent ligation of the common carotid arteries combined with a hypoxic environment to establish a model ofischemia and hypoxia; the rats in the esketamine group were given esketamine intervention (50 mg/kg). Left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), serum creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), lactate dehydrogenase (LDH), tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-1β levels, myocardial injury, myocardial cell apoptosis and apoptosis protein caspase 1/3/9 levels, neutrophil infiltration in myocardial tissue, and changes in GSK-3β and NLRP3 protein levels in myocardial tissue were detected in each group. Results Compared with the sham operation group, the LVEF and LVFS were significantly decreased and the LVEDD and LVESD were significantly increased in the model group, while the LVEF and LVFS were significantly higher and the LVEDD and LVESD were significantly lower in the esketamine group than in the model group (P < 0.05). The serum levels of CK-MB, cTnI, LDH, TNF-α, IL-6, IL-1β, myocardial injury and apoptosis, caspase 1/3/9 protein levels in myocardial tissue sections, neutrophil counts, and GSK-3β and NLRP3 protein levels were significantly increased in the model group, and these indicators were significantly lower in the esketamine group than in the model group (P < 0.05). Conclusion Esketamine improves hypoxic-ischemic myocardial injury in neonatal rats by inhibiting inflammation, and its mechanism of action is related to the GSK-3β/NLRP3 pathway.