ObjectiveTo analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.MethodsRetrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018, which confirmed by pathology and unrelieved thoroughly after operation performed, the pathological types and MRI signs were analyzed, as well as the frequency of different MRI signs in FCD of each pathological type. Analyzed the possible factors of surgical failure.ResultsAmong the 21 cases, there were 15 males and 6 females, with an average age of (5.7±0.3) years and an average course of disease of (3.4±0.5) years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries, abnormal cortical structure changes (thickening and/or thinning), transmantle signs (abnormal cone signals extending from subcortical white matter to the ventricle) and abnormal gray matter signals, which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control. 17 cases (80.9%) appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months, FCD type I and type Ⅱ accounted for 35.3%, 64.7% respectively. During intraoperative EEG monitoring, no epileptiform discharge was observed in the transmantle sign region in 6 cases, and the region was retained, and only the surrounding abnormal discharge cortex was removed, complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases, and different degrees of epileptic epilepsy were observed in both methods.ConclusionMRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific, there were still epilepsy of varying degrees after all epileptogenic lesions have been removed, the cause may be related to potential epileptic factors.
【Abstract】Objective To study the correlation between focal adhesion kinase (FAK) expression and biological behavior of invasion and metastasis in gastric carcinoma. MethodsThe immunoreactivity of FAK was revealed by immunohistochemical method in gastric carcinoma tissues,canceradjacent tissues, normal gastric mucosa,and 200 regional lymph nodes in 50 collected specimens when radical resection of gastric carcinoma were carried out. ResultsThe percentage of FAK bly positive immunoreactivity were 10.0%（5/50）， 20.0%（10/50） and 78.0%（39/50） in normal gastric mucosa， cancer-adjacent tissues and gastric carcinoma tissues respectively. The b immunoreactivity was obviously higher in gastric carcinoma tissues than that in normal gastric mucosa or canceradjacent tissues (P＜0.01). There were no difference between normal gastric mucosa and canceradjacent tissues (Pgt;0.05). The percentage of bly positive immunoreactivity of FAK were 68.8%（22/32） and 33.3%（6/18） in cases with metastasis and without metastasis of lymph node respectively. The immunoreactivity of FAK in cases with metastasis of lymph node was significantly higher than that without metastasis of lymph node (P＜0.05).The b immunoreactivity of FAK were 87.2%（136/156） and 40.9%(18/44) in withmetastatic lymph node and withoutmetastatic lymph node. The immunoreactivity of FAK in withmetastatic lymph node was significantly higher than that withoutmetastatic lymph node （P＜0.01）. The percentage of FAK bly positive immunoreactivity showed correlation with the cellular differentiation and depth of infiltration of gastric carcinoma. The deeper infiltration and lower differentiation, the ber expression rate was obtained (P＜0.05), which showed no correlation with Borrmann type, location and size of tumor (Pgt;0.05). ConclusionIncreased immunoreactivity of FAK is an important role of invasion and metastasis for gastric carcinoma cells. Detection of FAK expression in cancer tissues can be helpful to understand the carcinogenic biological behavior of gastric carcinoma as well as to make judgment and treatment of prognosis of patients.
【Abstract】ObjectiveTo investigate the diagnostic value of a fast gradient-echo (GRE) three-dimensional contrastenhanced volumetric interpolated breath-hold examination (3D-VIBE) MR sequence in evaluating focal liver lesions. MethodsConventional spin-echo T2W, 2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic（early arterial, late arterial and portal venous phases） acquisitions were prospectively performed for 51 consecutive patients suspected of having focal liver lesions on CT or ultrasound imaging. Native T2W and 2D GRE T1W were acquired first, then 3D-VIBE fast scanning at early arterial, late arterial and portal venous phases respectively. The SNR and CNR of the liver lesions on plain scan and the enhancement patterns on contrast-enhanced 3D-VIBE images were carefully observed with correlation of the clinical and surgical pathological findings. ResultsThere exited certain differences in SNR, CNR, and the enhancement patterns of different kinds of focal hepatic lesions in plain scan and Gd-enhanced multi-phasic 3D-VIBE acquisitions. Conclusion3D-VIBE MR sequence is helpful in the detection and characterization of focal liver lesions.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
Current epilepsy prediction methods are not effective in characterizing the multi-domain features of complex long-term electroencephalogram (EEG) data, leading to suboptimal prediction performance. Therefore, this paper proposes a novel multi-scale sparse adaptive convolutional network based on multi-head attention mechanism (MS-SACN-MM) model to effectively characterize the multi-domain features. The model first preprocesses the EEG data, constructs multiple convolutional layers to effectively avoid information overload, and uses a multi-layer perceptron and multi-head attention mechanism to focus the network on critical pre-seizure features. Then, it adopts a focal loss training strategy to alleviate class imbalance and enhance the model's robustness. Experimental results show that on the publicly created dataset (CHB-MIT) by MIT and Boston Children's Hospital, the MS-SACN-MM model achieves a maximum accuracy of 0.999 for seizure prediction 10 ~ 15 minutes in advance. This demonstrates good predictive performance and holds significant importance for early intervention and intelligent clinical management of epilepsy patients.
ObjectiveTo explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. MethodsFNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. ResultsThe diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide（SPIO）. All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. ConclusionFNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.
Cenobamate is one of the latest antiseizure medications (ASMs) developed for the treatment of focal onset seizures in adult patients. Cenobamate is characterized by a peculiar pharmacology. The mechanisms responsible for its anti-seizure activity include enhancement of the inactivated state of voltage-gated sodium channels with blockade of the persistent sodium current and positive allosteric modulation of GABAa receptors at a non-benzodiazepine binding site. Studies showed that cenobamate appears to be an effective treatment for focal epilepsy, showing reductions in seizure frequency, increased responder rates, and high rates of seizure freedom, and is well tolerated and safe. This article reviews the mechanism, pharmacokinetic characteristics, clinical efficacy, and safety of cenobamate as a novel anti-seizure drug
Objective To evaluate the sensitivity and accuracy of SPIO-enhanced MR Imaging in the detection of focal hepatic lesions. Methods We searched MEDLINE (1966 to 2004), EMBSAE (1984 to 2004), The Cochrane Library (Issue 1, 2004), CBMdisc (Jan.1978 to Jul. 2004), CMCC (1994 to 2004), “Radiology”, “AJR” and “European Radiology” database. Data from pharmaceutical companies and our research were also added. Related journals published from 1985 to 2003 were handsearched. Participants were clinically suspected of focal hepatic lesions. The quality of studies was assessed, and descriptive systematic review was applied to evaluate the detection sensitivity and accuracy of the imaging modality. Results Ten studies (418 patients with 1 037 focal hepatic lesions) were included. Because the data of sensitivity and specificity could not be extracted from any of the 10 included studies, it was impossible to do the meta-analysis using SROC curve. The sensitivity of SPIO-enhanced MRI ranged from 66% to 100%; accuracy ranged from 76% to 97%. Conclusions At present, there is no evidence to ascertain that SPIO-enhanced MRI has a considerably high accuracy in the detection of focal hepatic lesions. More studies with good methodology are needed.
ObjectiveTo explore the microscopic character and clinical pathological feature of focal cortical dysplasia (FCD).Methods51 cases were collected from January 2015 to September 2018 in the 988th Hospital of the Joint Logistics Support Force of the People’s Libereation Army. Pathology with FCD of their diseased brain tissue was classified according to the classification standard by the International Anti-Epilepsy Union (ILAE) in 2011. Epileptic seizure characteristics were analysed in different types.ResultsFCD I was 23 cases (45.1%). FCD II was 11 (21.6%). FCD III was 17 (33.3%). Ia was the most common type (23.5%, 12/51). Neurons were arranged into microcolumnar structures in Ia. NF expression in immunohistochemistry was characteristic. It was close to the neuron like line or waterfall. The second type was Ⅲa (15.7%, 8/51). Hippocampal sclerosis was given priority to CA4 area pyramidal cells to reduce or disappear. Three types all happened in bilateral cerebral hemisphere. There was no statistical difference. Temporal lobe was significantly more than frontal lobe. More than 50% of the cases occurredepilepsy before the age of 18. The main manifestation was partial onset seizures and secondary body stiffness clonus. The onset age and history of epilepsy in patients with FCD Ⅲ were earlier than those in the other two types. On image the positive rate of I type was 78.3% and that of Ⅱ and Ⅲ was both 100%.ConclusionFCD is a common pathological feature of epilepsy patients. Carefully pathologic examination is the premise of accurate classification of each subtype. Ⅲ type is different from Ⅰ and Ⅱ type in epileptic seizures.
ObjectiveWe report a special case to explain seizure semiology and epileptogenic network of seizure arising from ventral motor cortex, and to explore Focal cortical dycplasia (FCD) features on MR of epileptic patients with DEPDC5 mutation.MethodsA drug-resistant focal epilepsy patient with DEPDC5 mutation was underwent a detailed presurgical evaluation. The epileptogenic area(EA) was localized with SEEG and removed later by surgery. Related literatures were thoroughly reviewed.ResultsSubtle FCD of ventral branch of inferior precentral sulcus(IPv) on MR(1.5T) was noticed. With SEEG recording, seizure onset zone was detected on IPv with the probable lesion, early spreading to anterior insula, central operculum and ventral precentral gyrus. According to the architectures of ventral motor trend, seizure semiology with evolution from contralateral dystonia to ipsilateral chorea movement could be better comprehended. Seizure was controlled after totally resection on the sites of IPv, anterior insula, and central operculum. Pathological change was FCD type I. Other literatures reported that DEPDC5 mutation related FCD may be located in motor system, and seizure onset could also be in anterior insula cortex besides motor cortex in other SEEG cases.ConclusionsEarly contralateral dystonia and chorea movement could be definite figures of seizure arising from inferior precentral sulcus; DEPDC5 mutation maybe a clue to find subtle FCD in motor cortex.