General practice is a new discipline, and it is in common with evidence-based medicine for the features of “patient-centered” and “evidence-based”. Evidence-based medicine has spread in all fields of clinical practice, and it has been applied to different extents in many medical health and medical education fields including general practice. This paper aims to discuss and analyze the significance, modes and attentions of evidence-based general practice, so as to provide further references for promoting the practice of evidence-based general practice in China.
ObjectiveThe optimal target of deep brain stimulation (DBS) for treating intractable epilepsy is still undefined. Cumulative studies suggest that the mediodorsal thalamic nucleus (MD) is involved in seizure activity, the purpose of this study was to investigate the effect of high frequency stimulation in MD on pentylenetetrazole (PTZ)-induced seizures in rats. MethodsThe experimental rats (Male Sprague-Dawley rats 280-350 g) were all provided by Experimental Animal Center, Zhejiang Academy of Medical Science, Hangzhou, China. The rats were given unilateral or bilateral stimulation of the MD at 100 Hz (HFS group) and sham stimulation, others were given unilateral stimulation of the MD at 1 Hz (LFS group). EEGs in the cortex and seizure behavior were recorded with the Neuroscan system at the same time. ResultsNeither LFS nor HFS of the MD changed the latency to the first spikes or EEG manifestations for stage 3 and stage 5 seizures; animals receiving unilateral or bilateral HFS of the MD decreased the number of stage 5 EEG seizure synchronized with the convulsive episodes; LFS and sham stimulation showed multiple periods of continuous spikes which accompanied stage 5 or stage 4 seizures. HFS of unilateral or bilateral MD, but not LFS, decreased the seizure stage, the number of clonic movement episodes, and the duration of acute PTZ-induced seizures. The average latency to onset of myoclonic jerks did not differ among groups. Unilateral and bilateral HFS of the MD had a similar antiepileptic effect. ConclusionHFS of the MD may be of value as a new antiepileptic approach for patients with generalized epilepsy, besides, the seizure model, should be fully considered in clinical application.
ObjectiveTo investigate the clinical electrophysiological characteristics of Cyclin-dependent kinase-like 5 gene induced developmental epileptic encephalopathy (CDKL5-DEE). MethodsThe clinical data and series of video EEGs of children with CDKL5-associated developmental epileptic encephalopathy (CDKL5-DEE) who were admitted to the Children’s Medical Center of Peking University First Hospital from June 2016 to May 2024 were retrospectively analyzed. Results A total of 16 patients with CDKL5-DEE were enrolled, including 13 females and 3 males. All patients had de novo variants of CDKL5 gene, including 6 cases of missense variants, 5 cases of frameshift variants, 4 cases of nonsense variants, and 1 case of large fragment deletion. The age of onset was 8 days (d) after birth ~1 year (y) and 10 months (m), and the median age was (85.94±95.76) days. Types of seizures at onset: 4 cases of tonic seizures [age of onset 10~52 days, median age (25.5±15.84) days]; There were 5 cases of focal seizures [age of onset 8 d~8 m, median age (77.76±85.97) d]. There were 4 cases of epileptic spasmodic seizures [age of onset 3 m~1 y 10 m, median age (6.25±3.49) m]; There were 2 cases of bilateral tonic-clonic seizures [age of onset 30~40 days, median age (35.00±5.00) days]; focal concurrent epileptic spasm seizures 1 case (age of onset 2 m). A total of 59 VEEG sessions were performed in the pediatric EEG room of Peking University First Hospital for 4 hours. All the results were abnormal, including 26 normal background, 25 slow rhythm difference with background, and 8 no background. The interictal was 16 posterior or focal discharges, 19 multifocal discharges, 17 generalized or accompanied by focal/multifocal discharges, and 7 hypsarrhythmia; The ictal was 33 epileptic seizures, 6 myoclonic seizures, 5 focal seizures, 2 tonic-clonic seizures, 2 atypical absence seizures, 2 tonic seizures, 1 myoclonic sequential focal seizure, 1 focal sequential epileptic spasm, and 1 hypermotor-tonic-spasms. The background of patients within 6 months of age was normal, and the background abnormality increased significantly with age. generalized discharges are evident after 2 years of age between seizures. Conclusion CDKL5-DEE seizures have an early onset and are refractory to medications. Epileptic spasms are the most common type of seizure in every patient and long-lasting, with generalized seizures increasing markedly with age. EEG is characterized by a normal background within 6 months. With the increase of age, the background and interictal discharges have a tendency to deteriorate.
Dental composite resin is a kind of material which has been widely used in dental restoration. Research has found that the influence of residual monomer on the material mechanical, chemical and biological properties cannot be ignored. This paper elaborates these harms of residual monomers. The effects of resin matrix, inorganic filler and initiating system, illumination, secondarily treatment on the degree of conversion were also analyzed. The paper also discusses the effective measures to increase the conversion, and offers theoretical basis for the clinical application and development of composite resin.
Objective To explore the diagnosis value of the low dose multi-slice spiral computed tomography (MSCT) imaging in pulmonary fungal infection in order to improve its diagnosis level. Methods CT manifestations of 106 cases of pulmonary fungal infection confirmed by operation, pathology, mycetes cultivation and follow-ups of clinical therapy were retrospectively analyzed. All cases underwent low dose MSCT examinations including CARE dose 4D and sinogram affirmed iterative reconstruction technology, and 6 cases underwent contrast-enhanced CT scanning. Results Among the basic MSCT findings of pulmonary fungal infection, they showed patch-nodular type in 54 cases, solid variant in 38 cases, and tumor type in 14 cases. In all cases, 91 cases displayed as mulifocality, 83 cases as polymorphism and 78 cases as polytropy. Among the 106 cases with comparative distinctive MSCT manifestations, bud of branch sign were showed in 39 cases, halo sign in 32 cases, wedge shape consolidation in 19 cases, ice needle sign in 15 cases, crescentic sign in 11 cases, air ring sign in 6 cases, and contra-halo sign in 4 cases. The nodules in the cavities were not enhanced in enhanced scan in 5 cases. Conclusions There are some distinctive MSCT findings in patients with pulmonary fungal infection. Pulmonary fungal infection can be diagnosed with typical MSCT findings in close combination with the clinical information.
This paper explores the relationship between the cardiac volume and time, which is applied to control dynamic heart phantom. We selected 50 patients to collect their cardiac computed tomography angiography (CTA) images, which have 20 points in time series CTA images using retrospective electrocardiograph gating, and measure the volume of four chamber in 20-time points with cardiac function analysis software. Then we grouped patients by gender, age, weight, height, heartbeat, and utilize repeated measurement design to conduct statistical analyses. We proposed structured sparse learning to estimate the mathematic expression of cardiac volume variation. The research indicates that all patients’ groups are statistically significant in time factor (P = 0.000); there are interactive effects between time and gender groups in left ventricle (F = 8.597, P = 0.006) while no interactive effects in other chambers with the remaining groups; and the different weight groups’ volume is statistically significant in right ventricle (F = 9.004, P = 0.005) while no statistical significance in other chambers with remaining groups. The accuracy of cardiac volume and time relationship utilizing structured sparse learning is close to the least square method, but the former’s expression is more concise and more robust. The number of nonzero basic function of the structured sparse model is just 2.2 percent of that of least square model. Hence, the work provides more the accurate and concise expression of the cardiac for cardiac motion simulation.