[Clinical and genetic analysis of 5 pediatric patients with hemiplegic migraine presenting as acute encephalopathy].

Objective: To analyze the clinical and genetic characteristics, diagnosis and treatment of hemiplegic migraine (HM) manifested as acute encephalopathy in children, so as to improve the understanding of this disease. Methods: The clinical data of 5 children diagnosed with HM characterized by acute encephalopathy who were admitted to Beijing Children's Hospital affiliated to Capital Medical University from August 2018 to June 2020 were retrospectively analyzed. Results: Among the 5 cases, 3 were males and 2 females with an age of 9.7 (3.9-12.7) years. The age of disease onset was 7.0(2.1-12.7) years. The peak symptoms of 5 children showed encephalopathy such as drowsiness and coma, as well as other clinical manifestations including headache, visual abnormality, hemiplegia, aphasia, convulsions, and fever, etc. The time to reach the peak was on the 2nd-6th day of the course of the disease. Before the onset of the disease 2 cases were found to have mild brain trauma and 2 cases had similar attacks in the past. Brain magnetic resonance imaging (MRI) showed hemispheric or partial cerebral cortex swelling and restricted diffusion of subcortical white matter in all cases, and cerebellar atrophy in 3 cases. All children received symptomatic treatment, and 2 of them were also treated with low-dose corticosteroids in the meantime. Finally all cases recovered clinically from the attack, but one had atrophic changes left in the affected area on brain MRI. Whole exon sequencing revealed variations of CACNA1A gene in all cases, among which 4 were de novo mutations and 1 case inherited from the mother who had migraine without aura. After the diagnosis, the 5 children were treated with long-term flunarizine and followed up for 22(7-29) months by telephone or in the outpatient clinic. Before the last follow-up, none of them showed weakness or encephalopathy, but one still had intermittent headaches and occasional transient right limb numbness. Conclusions: Hemipleg is often accompanied by impaired consciousness in addition to headache, hemiplegia, aphasia, visual abnormality, etc. Most patients recover completely after a short period, while a few recover slowly and may suffer sequelae such as brain atrophy and cognitive impairment and even death. CACNA1A gene variation is the most common genetic variation. Flunarizine could prevent recurrence of severe attack.

[Factors affecting stability after fixed orthodontic treatment].

Objective: To analyze factors affecting stability after fixed orthodontic treatment. Methods: Five hundred and forty-four patients who had finished fixed orthodontic treatment more than two years in First Department of Orthodontics, China Medical University from January, 2000 to December, 2017 were investigated and the rate of regular revisit was counted. The data of 288 patients were successfully collected by calling or sending text messages and the rate of standard use of retainers as prescribed (patients wore retainers for 24 months or longer) was counted. According to the variation of peer assessment rating (PAR) index at the start of retention and the time the data collected, the patients were divided into relapse group (variation of PAR index >5) and non-relapse group (variation of PAR index ≤5). Difference significance analysis and multiple-factor logistic regression analysis were used. Sixty patients wearing retainers well were collected and the curative effects of Hawley retainer and vacuum formed retainer (VFR) were compared, which included overbite, overjet, maxillary irregularity index, mandibular irregularity index, width betwenn canine and width between first molar. Results: The rate of regular revisit was 41.0% (223/544). Two hundred and one of 288 patients (69.8%) who were visited successfully had regular revisit, and 60.4%(174/288) of the patients wore retainers well; 30.2% (87/288) of the patients who were visited successfully didn't have regular revisit, and 10.4% (30/288) of the patients wore retainers well. Difference significance analysis showed that there was highly significant difference between relapse group and non-relapse group in the type of retainer and duration of retention (P<0.01). One hundred and forty of 224 patients (62.5%) in non-relapse group and 37.5% (24/64) of the patients in relapse group used VFR, and the duration of retention in non-relapse group was significantly longer than that in relapse group (P<0.01). Multiple-factor Logistic regression analysis showed that wearing Hawley retainers (OR=3.067, P<0.05) was the risk factor influencing relapse. The duration of retention (OR=0.832, P<0.01) was the protective factor influencing relapse. Independent-sample t test indicated that the variations of maxillary [(0.82±0.36) mm] and mandibular [(1.05±0.22) mm] irregularity index in Hawley retainer group were larger than maxillary [(0.64±0.29) mm] and mandibular [(0.72±0.35) mm)] irregularity index in VFR group, respectively. The differences between the two groups were significant (P<0.05). Conclusions: Duration of retention was implicated in stability after orthodontic treatment. VFR had better effect in the aspects of irregularity index than Hawley retainer.

Comparison of four methods for sperm preparation for IUI.

We compared the pregnancy rates and sperm characteristics of semen prepared by the albumin, Percoll, Puresperm, and swim-up methods. Semen analysis was performed by a computer-assisted system (CASA). The overall pregnancy rate was 14% per patient and 11% per cycle. The albumin and Percoll methods had the highest pregnancy rates, up to 12% per cycle. We then compared each method with the albumin method. The swim-up technique yielded the highest percentage of motile sperm. The Percoll method yielded statistically significant changes in average path velocity and straight-line velocity, while the Puresperm method revealed the same statistical changes in total concentration and hyperactive motile sperm percentage. After adjusting for age, methods, and CASA estimates, only straight-line velocity was significantly correlated with pregnancy. Although the Percoll method was associated with the best pregnancy rate, this product has been withdrawn from the market because of toxic contamination. Puresperm had replaced it in our laboratory but showed an unsatisfactory pregnancy rate. The swim-up method is the best choice for IUI.