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基于实验室检查建立儿童细菌性脑膜炎的联合诊断模型

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医疗装备 2024年第6期37卷 6-10,14页

作者：梁燕锦刘日阳徐明艳林贤彬操德智汕头大学医学院广东汕头515041 惠州市中心人民医院广东惠州516001 深圳市儿童医院广东深圳518038

目的基于实验室检查建立儿童细菌性脑膜炎的多项检验指标联合诊断模型。方法回顾性分析2018—2023年惠州市中心人民医院及深圳市儿童医院收治的细菌性脑膜炎(56例)和非细菌性脑膜炎(75例)患儿的16项实验室检验指标。对细菌性脑膜炎与非... 详细信息

目的基于实验室检查建立儿童细菌性脑膜炎的多项检验指标联合诊断模型。方法回顾性分析2018—2023年惠州市中心人民医院及深圳市儿童医院收治的细菌性脑膜炎(56例)和非细菌性脑膜炎(75例)患儿的16项实验室检验指标。对细菌性脑膜炎与非细菌性脑炎患儿的人口学资料(性别、年龄)、临床表现及16项实验室检验指标进行单因素分析。选取单因素分析差异有统计学意义的检验指标进行ROC分析,以曲线下面积(areas under curve,AUC)>0.7作为检验标准,根据β系数的大小对与细菌性脑膜炎独立相关的变量进行排名,利用Logistic线性回归分析将相应变量进行线性拟合,获得新的诊断模型,并选取16例脑膜炎患儿的数据评估模型的诊断效能。结果细菌性脑膜炎和非细菌性脑膜炎患儿的16项检验指标中,12项的差异均有统计学意义(P0.7,包括脑脊液白细胞计数(C-WBC)、脑脊液多核细胞占比(C-PNC%)、脑脊液多核细胞计数(C-PNC)、脑脊液蛋白(C-Pro)、脑脊液乳酸脱氢酶(C-LDH)、血降钙素原(B-PCT)、血清C反应蛋白(B-CRP)、脑脊液葡萄糖/血葡萄糖比值(C/B-Glu)。通过线性拟合获得的诊断模型为:Y=-0.351×C/B Glu+0.561×C-PNC%+0.005×B-PCT+0.001×B-CRP+0.24。拟合模型诊断细菌性脑膜炎的AUC为0.87,灵敏度、特异度均>75%。结论由C/B-Glu、C-PNC%、B-PCT、B-CRP组成的联合模型对儿童细菌性脑膜炎具有良好的诊断价值。

关键词：细菌性脑膜炎诊断模型儿童脑脊液

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A case report of microcephaly and refractory West syndrome associated with WDR62 mutation

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Acta Epileptologica 2020年第1期2卷 19-24页

作者： Ping Zhou Xin Ding Qi Zeng Huafang Zou Jianxiang Liao dezhi cao Neurology Department Shenzhen Children’s HospitalShenzhenGuangdong 518038China. Division of Growth Development and Mental Health of Children and AdolescenceChildren’s Hospital of Chongqing Medical UniversityChongqing 400014China.

The autosomal recessive form of primary microcephaly(MCPH)is a rare disorder characterized by microcephaly with variable degree of intellectual ***62 has been reported as the second causative gene of *** syndrome is a severe epilepsy syndrome composed of the triad of spasms,hypsarrhythmia,and mental *** are limited clinical reports regarding WDR62 mutation and West *** we report a boy who was identified with WDR62 mutation and was followed up from age 3 months to 5 months and 14 *** had the first seizure as the classic epileptic spasm at the age of 3 *** retardation was noted before the seizure *** head circumference was 38.5 cm(SD 2.6)when he was 4 months old,no dysmorphic facial features were *** couldn’t support his head steadily or turn *** was able to laugh when tricked by the parents,but couldn’t track the sound and *** the early stage,the electroencephalogram showed multifocal discharges,which evolved into hypsarrhythmia one month later,and brain MRI showed developmental malformation of cerebral *** heterozygous mutations were identified in WDR62 by whole exome sequencing c.1535G>A,p.R512Q and c.2618dupT,*** patient was administrated with oral sodium valproate,nitrazepam,intramuscular adrenocorticotropic hormone for 2 weeks,and followed by prednisone,levetiracetam,topiramate and ***,there was no significant improvement on the seizure control after these *** to the genetic report and clinical manifestation,we speculated that the WDR62 compound heterozygous mutation is responsible for the serious clinical phenotype.

关键词： Autosomal recessive primary microcephaly 2 WDR62 West syndrome Refractory epilepsy

Blood pressure,body mass index lowering and ketogenesis in Qigong Bigu

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Acta Epileptologica 2021年第1期3卷 172-178页

作者： Bin Hong Runqi Luo dezhi cao Man Zhang Kewei Fang Jianhong Guo Jianxiang Liao Bijie Second People’s Hospital Bijie 551700Guizhou ProvinceChina Shenzhen Children’s Hospital Shenzhen 518038Guangdong ProvinceChina School of Traditional Chinese Medicine Ningxia Medical UniversityYinchuan 750021Ningxia Hui Autonomous RegionChina

Background:Hypertension is one of the most common comorbid conditions of *** and epilepsy may be related to each *** Bigu practice induces a similar effect as fasting in the first *** ketogenesis is induced during ketogenic diet therapy,we hypothesize that ketogenesis is detectable and related body weight loss would occur during the first week of Qigong Bigu ***:During the prospective observational study,34 healthy adult participants attended the Qigong Bigu practice for one *** blood pressure,body weight,calorie consumption,blood glucose and beta-hydroxybutyrate level were ***:The body weight and body mass index decreased by 2.39±1.34 kg(95%CI 1.92–2.85)and 0.94±0.57(95%CI 0.73–1.15),respectively,after five days of practice(P<0.001).The systolic and diastolic blood pressure decreased by 17.86±14.17 mmHg(95%CI 12.36–23.35)and 9.75±7.45 mmHg(95%CI 6.86–12.64),respectively(P<0.001).The average five-day calorie consumption was 1197.47±569.97 kcal(95%CI 998.60–1396.35).Meanwhile,no symptomatic hypoglycemia or other significant side effects were *** blood beta-hydroxybutyrate level increased to a nutritional level of 1.15±1.12 mmol/L(95%CI 0.76–1.62).The calorie consumption negatively correlated to the beta-hydroxybutyrate level in the *** loss of body weight and the decrease of body mass index were positively correlated to the blood beta-hydroxybutyrate ***:Qigong Bigu can decrease the blood pressure,the body weight and the body mass index in healthy adult *** fasting stage of Qigong Bigu is accompanied by *** trial of Qigong Bigu in hypertension and epilepsy patients might be *** blood beta-hydroxybutyrate might be used as a biomarker to evaluate the effect of Qigong Bigu practice during fasting.

关键词： Blood pressure Body weight Body mass index Epilepsy Ketogenic diet Qigong Bigu Fasting Comorbidity Hypertension Pigu

Anti-NMDAR encephalitis with seizure-like activity and hemiplegia-a case report and literature review

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Acta Epileptologica 2022年第4期5卷 263-267页

作者： Junjie Hu Cailei Zhao Xia Zhao Yu Fang Huiting Zhang dezhi cao Jianxiang Liao Shenzhen Children’s Hospital Medical College of Shantou UniversityShenzhenChina Imaging department Shenzhen Children’s HospitalShenzhenChina Neurology department Shenzhen Children’s HospitalShenzhenChina Shenzhen Children’s Hospital China Medical UniversityShenzhenChina

Background Anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis accounts for the vast majority of cases of autoimmune *** common clinical symptoms are psychiatric symptoms,behavioral dysfunction,seizures,speech impairment,cognitive impairment,movement disorders,decreased consciousness,and autonomic *** report was aimed to provide evidence for anti-NMDAR encephalitis with seizure-like activity,based on the clinical presentations,brain magnetic resonance imaging(MRI),and electroencephalogram(EEG)*** presentation We report a 11-year-old girl who suffered epigastric pain after vigorous physical *** felt weakness of the *** had syncope only once and urinary incontinence on the way to the hospital and vomited at the *** entire procedure lasted approximately 15 *** next night she had recurrent headache attacks along with irritability,like someone“tapping”to the right occipital *** experienced numbness in the left upper limbs and shallowing of the frontal lines on the left *** monitoring showed normal findings,but brain MRI,EEG recording,and cerebrospinal fluid(CSF)antibody testing showed abnormal *** patient was finally diagnosed with anti-NMDAR *** treatment with glucocorticoids and acyclovir,she fully recovered and was discharged from the *** Although the patient presented with pain and impaired limb movements,she did not have respiratory or(and)circulatory failure,and the symptoms entirely *** accurate diagnosis and timely treatment are essential for patients with anti-NMDAR encephalitis.

关键词： Autoimmune encephalitis Anti-N-methyl-D aspartate receptor encephalitis Syncope Hemiplegia

Successful medical treatment of west syndrome with a KCNA2 variant: a case report

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Acta Epileptologica 2022年第1期5卷 62-70页

作者： Han Wang Yanwei Zhu dezhi cao Hong Chen Xin Ding Qi Zeng Huafang Zou Jianxiang Liao Neurology Department Shenzhen Children’s Hospital affiliated to China Medical UniversityShenzhen 518038China

Background:West syndrome is a devastating disorder characterized by a triad of epileptic spasms,abnormal electroencephalography(EEG),and developmental arrest or psychomotor *** addition to early diagnosis,knowing the etiology of the condition is also important for its *** various etiologies,the genetic factors,especially mutations of ion channel genes,are very common and strongly linked to West *** presentation:A boy who had epileptic spasms from the age of 4 months was diagnosed with West syndrome based on the clinical manifestation and EEG results in Shenzhen Children's Hospital in June *** whole-exome sequencing(WES)test and protein structural model prediction were *** also reviewed the clinical and genetic features of this syndrome and the mechanisms of action of topiramate(TPM)by literature search in databases of Online Mendelian Inheritance in Man,Clinical Genome Resource,PubMed,Chinese National Knowledge Infrastructure and Wanfang database using keywords"KCNA2""West syndrome"and"Topiramate"by December *** relationship between the effect of TPM and the pathogenesis of the KCNA2 variant was also *** WES test revealed c.244C>T/***82Cys varaint of KCNA2(NM_004974.3)in this patient,and Sanger sequencing identified this was a de novo *** far as we know,this is the first report of the C.244C>T/***82Cys variant in KCNA2,which was likely a pathogenic *** seizures were successfully controlled for 10 months by TPM after failure of sodium valproate,large doses of vitamin B6,and adrenocorticotropic *** speculate that the therapeutic effect of TPM in this patient is partially due to the inhibition of carbonic ***:Mutations in the KCNA2 gene should be considered for patients with West *** TPM treatment is probably effective for KCNA2-associated disorders.

关键词： Epilepsy Gene variation KCNA2 West syndrome Topiramate

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结节性硬化症致痫灶定位技术的研究进展

中华实用儿科临床杂志 2021年第5期36卷 397-400页

作者：丁鑫操德智中国医科大学附属深圳市儿童医院神经内科广东深圳518038 中国医科大学研究生院沈阳110122

癫痫是结节性硬化症患者的主要临床特征之一,其大部分是药物难治性的,手术为其治疗提供了有效途径。而准确的术前评估对术后疗效至关重要,术前评估主要是确定手术需要切除的致痫灶范围及需要保留的脑功能区范围。因为癫痫产生机制及脑... 详细信息

癫痫是结节性硬化症患者的主要临床特征之一,其大部分是药物难治性的,手术为其治疗提供了有效途径。而准确的术前评估对术后疗效至关重要,术前评估主要是确定手术需要切除的致痫灶范围及需要保留的脑功能区范围。因为癫痫产生机制及脑组织网络的复杂性,目前还没有单一的、特异性的检查方法可以对致痫区进行精准的鉴别和定位,所以需要使用多种检查方法来综合评估和定位,这包括详细的病史采集、发作期症状学分析、磁共振成像、正电子发射断层扫描、脑电监测和神经心理学评估等。如何合理运用以上方法以及综合分析其结果对于结节性硬化症合并难治性癫痫患儿癫痫发作的最终控制起重要作用。现将就此进行方面综述。

关键词：结节性硬化症药物难治性癫痫致痫灶术前评估

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板式轨道在地铁中的应用研究

都市快轨交通 2018年第1期31卷 109-114页

作者：曹德志中铁一局集团新运工程有限公司陕西咸阳712000

目前地铁轨道整体道床大部分采用现场浇筑混凝土方式,存在劳动环境差、安全隐患多、工人劳动强度大等诸多弊端。随着建筑工业化模式的不断推进,地铁整体道床采用工厂化预制,现场机械化装配技术将成为一种趋势,尤其是高速铁路板式轨道技... 详细信息

目前地铁轨道整体道床大部分采用现场浇筑混凝土方式,存在劳动环境差、安全隐患多、工人劳动强度大等诸多弊端。随着建筑工业化模式的不断推进,地铁整体道床采用工厂化预制,现场机械化装配技术将成为一种趋势,尤其是高速铁路板式轨道技术的成功应用,为地铁板式轨道发展提供了很好的借鉴。以上海地铁12号线370 m普通预制板轨道试验段施工为背景,在充分消化吸收高速铁路国产化CRTSⅢ型板式轨道施工技术基础上,结合地铁线形特征、空间特点和施工工装配置能力,提出地铁普通预制板合理的设计尺寸,并设计了地铁轨道基础控制网,开发地铁预制板轨道数字化精调和自密实混凝土配合比设计、配置及灌注工艺,研究成果将促进地铁板式轨道的发展,可供类似地铁板式轨道设计和施工借鉴。

关键词：地铁板式轨道结构设计铺设技术

Expert consensus on clinical applications of high-frequency oscillations in epilepsy

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Acta Epileptologica 2020年第1期2卷 59-68页

作者： Yuping Wang Dong Zhou Xiaofeng Yang Xin Xu Liankun Ren Tao Yu Wenjing Zhou Xiaoqiu Shao Zhixian Yang Shuang Wang dezhi cao Chunyan Liu Shang Yeong Kwan Jing Xiang Department of Neurology Xuanwu HospitalCapital Medical UniversityBeijing 100000China. Beijing Key Laboratory of Neuromodulation Beijing 100000China. Center of Epilepsy Beijing Institute of Brain DisordersCapital Medical UniversityBeijing 100000China. Department of Neurology West China HospitalSichuan UniversityChengdu 610000China. Neuroelectrophysiological Laboratory Xuanwu HospitalCapital Medical UniversityBeijing 100000China. Department of Neurosurgery General Hospital of PLABeijing 100000China. Department of Functional Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijing 100000China. Epilepsy Center Tsinghua University Yuquan HospitalBeijing 100000China. Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100000China. China National Clinical Research Center for Neurological Disease NCRC-ND Beijing 100000China. Department of Pediatrics Peking University First HospitalBeijing 100000China. Epilepsy Center Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310000China. Department of Neurology Shenzhen Children’s HospitalShenzhen 518000China. Section of Epilepsy Neurological InstituteTaipei Veterans General HospitalTaipeiChina. MEG Center Cincinnati Children’s Hospital Medical CenterCincinnatiOH 45245USA. Division of Neurology Cincinnati Children’s Hospital Medical CenterCincinnatiOH 45245USA.

Studies in animal models of epilepsy and pre-surgical patients have unanimously found a strong correlation between high-frequency oscillations(HFOs,>80 Hz)and the epileptogenic zone,suggesting that HFOs can be a potential biomarker of epileptogenicity and *** consensus includes the definition and standard detection techniques of HFOs,the localizing value of pathological HFOs for epileptic foci,and different ways to distinguish physiological from epileptic *** latest clinical applications of HFOs in epilepsy and the related findings are also *** will advance our understanding of the pathophysiology of epilepsy.

关键词： High-frequency oscillations Ripple Fast ripple Interictal spike Epilepsy Biomarker

Chinese expert recommendations on ketogenic diet therapy for super-refractory status epilepticus

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Acta Epileptologica 2022年第1期5卷 5-15页

作者： Xin Tong Qianyun Cai dezhi cao Lifei Yu Dan Sun Guang Yang Jiwen Wang Hua Li Zengning Li Juan Wang Shaoping Huang Meiping Ding Fang Fang Qun Wang Rong Luo Jianxiang Liao Jiong Qin Department of Pediatrics West China Second University HospitalSichuan UniversityChengdu 610041China Department of Neurology Shenzhen Children's HospitalShenzhen 518035China Department of Neurology Children’s Hospital of Fudan UniversityShanghai 200032China Department of Neurology Wuhan Children's HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430015China Department of Pediatrics The First Medical CenterChinese PLA General HospitalBeijing 100036China Department of Neurology Shanghai Children's Medical CenterShanghai Jiaotong University School of MedicineShanghai 200127China Epilepsy Center Guangdong 999 Brain HospitalGuangzhou 510510China Department of Nutrition The First Hospital of Hebei Medical UniversityShijiazhuang 050000China Department of Neurology Children's Hospital of Chongqing Medical UniversityChongqing 401122China Department of Pediatrics The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710004China Department of Neurology Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009China Depart-ment of Neurology Beijing Children’s HospitalCapital Medical UniversityBeijing 100045China Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of Pediatrics Peking University People's HospitalBeijing 100044China

Super-refractory status epilepticus(SRSE)is a serious and life-threatening neurological *** diet(KD)is a diet characterized by high fat,low carbohydrate,and moderate *** KD shows effectiveness in controlling seizures in more than half of SRSE patients,it can be a treatment option for ***,KD treatment for SRSE is based on personal experience and observational evidence has been *** the context of a lack of a validated guideline,we convened a multicenter expert panel within the China Association Against Epilepsy(CAAE)Ketogenic Diet Commission to work out the Chinese expert recommendations on KD for *** summarize and discuss the latest clinical practice of KD for SRSE in critical care *** are given on patient selection,the timing of KD,diet implementation,and *** research data are needed in this area to support better clinical practice.

关键词： Super-refractory status epilepticus Ketogenic diet Intensive care units Consensus China