目的 探讨丙戊酸钠治疗全面强直阵挛性发作相关认知功能障碍的影响因素.方法 选取2017年1月至2019年5月在我院就诊的80例小儿全面强直阵挛性发作癫痫患者作为研究对象.所有患儿均给予丙戊酸钠治疗,后依据韦氏儿童智力量表(WlSC-CR)智商得分分为认知正常组(≥80分)和认知障碍组(＜80分).分析丙戊酸钠治疗3个月后认知功能障碍的影响因素.结果 两组患儿的发病年龄、每月发病频率、治疗剂量及疗程比较,差异有统计学意义(P＜0.05).回归分析显示,发病年龄＜5岁、每月发病频率≥3次、治疗剂量≥35 mg/(kg·d)、治疗疗程≥6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素(P＜0.05).认知障碍组治疗3个月后每月发病频率、治疗剂量、治疗疗程与VIQ、PIQ、FIQ呈负相关(P＜0.05);发病年龄与VIQ、PIQ、FIQ呈正相关(P＜0.05).结论 发病年龄＜5岁、每月发病频次≥3次、治疗剂量≥35 mg/(kg·d)、治疗疗程≥6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素.

Objective To analyze the value of neuropeptide Y (NPY),neuron - specific enolase (NSE),soluble vascular cell adhesion molecule - 1 (sVCAM - 1) and S100β protein in serum and cerebrospinal fluid in evaluating brain damage in children with severe hand - foot - mouth disease. Methods 74 children with severe hand - foot - mouth disease (observation group) who came from the first affiliated hospital of Harbin Medical university and Harbin children`s hospital were selected from August 2013 to August 2018 and divided into severe group (29 cases) and critical group (45 cases) according to the different diagnosis results. Another 30 children with mild hand - foot - mouth disease without central nervous system infection were selected as control group at the same time. The levels of NPY in cerebrospinal fluid and serum were measured and compared by radioimmunoassay,sVCAM - 1 were measured and compared by enzyme - linked immunosorbent assay,and S100β protein and NSE were measured and compared by electrochemiluminescence. Results The contents of NPY,sVCAM - 1,S100β protein and NSE in cerebrospinal fluid in the observation group were significantly higher than those in the control group (P ＜ 0. 01). The serum levels of NPY,sVCAM - 1, S100β protein and NSE in the observation group were significantly higher than those in the control group (P ＜ 0. 01). The contents of NPY,sVCAM - 1,S100β protein and NSE in cerebrospinal fluid of children in critical group were significantly higher than those in severe group (P ＜ 0. 01). The serum levels of NPY,sVCAM - 1,S100β protein and NSE in critical group were significantly higher than those in severe group (P ＜ 0. 01). Conclusion The levels of NPY,sVCAM - 1,S100β protein and NSE in serum and cerebrospinal fluid of children with severe hand - foot - mouth disease are significantly increased,which are closely related to the severity of the disease,and have a good evaluation value in predicting the brain damage of children.

Ovarian clear cell carcinoma (OCCC) is a special histological subtype of epithelial ovarian cancer, and presents resistant to the traditional chemotherapy on-hand, resulting in poor prognosis, so looking for a novel targeted therapy is extremely urgent. PI3K/AKT/mTOR pathway plays a significant role in the process of occurrence and development of ovarian cancer, and is intimately related to the resistance of chemotherapy. The suppression of apoptosis, the promotion of cell proliferation and the migration of tumor can be enforced by the pathway activation. The various proteins in PI3K/AKT/mTOR pathways express anomaly in the OCCC frequently, and thus the special receptor and kinase of the pathway could be a potential target for the therapy of ovarian clear cell carcinoma. The increasing of paclitaxel or cis-platinum cytotoxic effection and the growth of OCCC are in touch with PI3K/AKT/mTOR pathways in available studies. As the most frequent mutation in OCCC, ARID1A is especially related to PI3K/AKT/mTOR pathways. Therefore, to search for novel targeted drug to the pathway may benefit the treatment of OCCC to some extent. To lay a theory fundation of the new targeted treatment, the relationship of this pathway and OCCC will be interpreted in this paper.

With the improvement of living standards ,the demand for health care ,legal consciousness and concept of human rights has increased .The requirements for public medical services provided by the medical staff get higher and individual expectancy become more and more high .Sensitive and com-plex doctor-patient relationship become the focus of society .In the process of the clinical diagnosis and treatment of obstetrics and gynecology ,the complexity and its ow n privacy highlights the importance of the doctor-patient relationship .The lack of doctor-patient communication often leads to high inci-dence of medical disputes .As a result ,improving the ability of doctor-patient communication of medi-cal students is a necessary measures to prevent medical disputes .This study explores the importance of the doctor-patient communication skills in the work of obstetrics and gynecology and expounds the communication skills in front of different situation of communication in obstetrics and gynecology clin-ical work .