Altered Resting State Networks Before and After Temporal Lobe Epilepsy Surgery.

OBJECTIVES: To explore the resting state networks (RSNs) alterations in patients with unilateral mesial temporal lobe epilepsy (mTLE) before and after successful surgery. METHODS: Resting-state functional MRI and T1-weighted structural MRI were obtained in 37 mTLE patients who achieved seizure freedom after anterior temporal lobectomy. Patients were scanned before surgery and at two years after surgery. Twenty-eight age- and sex-matched healthy controls were scanned once. Functional connectivity (FC) changes within and between ten common RSNs before and after surgery, and FC changes between hippocampus and RSNs were explored. RESULTS: Before surgery, decreased FC was found within visual network and basal ganglia network, while after surgery, FC within basal ganglia network further decreased but FC within sensorimotor network and dorsal attention network increased. Before surgery, between-network FC related to basal ganglia network, visual network and dorsal attention network decreased, while between-network FC related to default mode network increased. After surgery, between-network FC related to visual network and dorsal attention network significantly increased. In addition, before surgery, ipsilateral hippocampus showed decreased FC with visual network, basal ganglia network, sensorimotor network, default mode network and frontoparietal network, while contralateral rostral hippocampus showed increased FC with salience network. After surgery, no obvious FC changes were found between contralateral hippocampus and these RSNs. CONCLUSION: MTLE patients showed significant RSNs alterations before and after surgery. Basal ganglia network showed progressive decline in functional connectivity. Successful surgery may lead to RSNs reorganization. These results provide preliminary evidence for postoperative functional remodeling at whole-brain-network level.

Rapid, experience-dependent translation of neurogranin enables memory encoding.

Experience induces de novo protein synthesis in the brain and protein synthesis is required for long-term memory. It is important to define the critical temporal window of protein synthesis and identify newly synthesized proteins required for memory formation. Using a behavioral paradigm that temporally separates the contextual exposure from the association with fear, we found that protein synthesis during the transient window of context exposure is required for contextual memory formation. Among an array of putative activity-dependent translational neuronal targets tested, we identified one candidate, a schizophrenia-associated candidate mRNA, neurogranin (Ng, encoded by the Nrgn gene) responding to novel-context exposure. The Ng mRNA was recruited to the actively translating mRNA pool upon novel-context exposure, and its protein levels were rapidly increased in the hippocampus. By specifically blocking activity-dependent translation of Ng using virus-mediated molecular perturbation, we show that experience-dependent translation of Ng in the hippocampus is required for contextual memory formation. We further interrogated the molecular mechanism underlying the experience-dependent translation of Ng, and found that fragile-X mental retardation protein (FMRP) interacts with the 3'UTR of the Nrgn mRNA and is required for activity-dependent translation of Ng in the synaptic compartment and contextual memory formation. Our results reveal that FMRP-mediated, experience-dependent, rapid enhancement of Ng translation in the hippocampus during the memory acquisition enables durable context memory encoding.

Nerve atrophy in trigeminal neuralgia due to neurovascular compression and its association with surgical outcomes after microvascular decompression.

BACKGROUND: Idiopathic trigeminal neuralgia (TN) is caused by neurovascular compression and is often related to morphological changes in the trigeminal nerve. The aim of this study was to quantitatively measure atrophic changes of trigeminal nerves in patients with TN, and to further investigate whether nerve atrophy affected the efficacy of microvascular decompression (MVD). METHODS: We conducted a prospective case-control study of 60 consecutive patients with TN and 30 sex- and age-matched healthy controls. All subjects underwent high-resolution three-dimensional MRI. The volume of the cisternal segment of trigeminal nerves was measured and compared using 3D Slicer software. Patients with TN underwent primary MVD and regular follow-up for at least 2 years. Associations of nerve atrophy with patient characteristics and operative outcomes were analyzed. RESULTS: The mean volume of the affected trigeminal nerve was significantly reduced in comparison to that of the nonaffected side (65.8 ± 21.1 versus 77.9 ± 19.3 mm3, P = 0.001) and controls (65.8 ± 21.1 versus 74.7 ± 16.5 mm3, P = 0.003). Fifty-two patients (86.7%) achieved complete pain relief without medication immediately after surgery, and 77.6% of patients were complete pain relief at the 2-year follow-up. The Spearman correlation test showed that there was a positive correlation (r = 0.46, P = 0.018) between the degree of trigeminal nerve indentation and nerve atrophy. In multivariate logistic regression analysis, two factors, indentation on nerve root (OR = 2.968, P = 0.022) and degree of nerve atrophy (OR = 1.18, P = 0.035), were associated with the long-term outcome. CONCLUSIONS: TN is associated with atrophy on the affected nerve. Furthermore, greater nerve atrophy is associated with more severe trigeminal nerve indentation and better long-term outcome following MVD.

Trigeminal root compression for trigeminal neuralgia in patients with no vascular compression.

BACKGROUND: Trigeminal neuralgia (TN) may be present in the absence of vascular compressiom, and surgical treatment in these cases is controversial. Our objective is to evaluate the efficacy and safety of trigeminal root compression in this situation. METHODS: A prospective collection of clinical data on all patients diagnosed with idiopathic TN in our institution. Cases with no visible offending vessel intraoperatively were included in this study. These patients underwent trigeminal root compression and long-term follow-up. The basic characteristics and outcomes were analyzed. RESULTS: From February 2005 to November 2010, 381 patients underwent microvascular decompression for TN at our department. Among them, 28(7.3 %) patients (17 female, 11 male) had no visible vascular compression intraoperatively. The median observation period was 46 months (range, 8-60 months). Twenty patients (71.4 %) achieved complete pain relief without medication immediately postoperatively. However, the recurrence rate was 38.4 %, and only 13 patients (46.4 %) achieved complete pain relief without medication at follow-up. Ten patients (35.7 %) developed some degree of facial numbness, which was transient in six cases (21.4 %) and permanent in four (14.3 %). CONCLUSIONS: Although trigeminal root compression provides good initial pain relief, the long-term efficacy, complication and recurrence rates are far from satisfactory. Further studies are needed to explore the possible mechanisms of underlying pain and to compare the outcomes of various types of interventions in cases without vascular compression.

Global protein-protein interaction network of rice sheath blight pathogen.

Rhizoctonia solani is the major pathogenic fungi of rice sheath blight. It is responsible for the most serious disease of rice (Oryza sativa L.) and causes significant yield losses in rice-growing countries. Identifying the protein-protein interaction (PPI) maps of R. solani can provide insights into the potential pathogenic mechanisms and assign putative functions to unknown genes. Here, we exploited a PPI map of R. solani anastomosis group 1 IA (AG-1 IA) based on the interolog and domain-domain interaction methods. We constructed a core subset of high-confidence protein networks consisting of 6705 interactions among 1773 proteins. The high quality of the network was revealed by comprehensive methods, including yeast two-hybrid experiments. Pathogenic interaction subnetwork, secreted proteins subnetwork, and mitogen-activated protein kinase (MAPK) cascade subnetwork and their interacting partners were constructed and analyzed. Moreover, to exactly predict the pathogenic factors, the expression levels of the interaction proteins were investigated by analyzing RNA sequences that consisted of samples from the entire infection progress. The PPIs offer an exceptionally rich source of data that can be used to understand the gene functions and biological processes of this serious disease at the system level.

Expression of HIF-1α and MDR1/P-glycoprotein in refractory mesial temporal lobe epilepsy patients and pharmacoresistant temporal lobe epilepsy rat model kindled by coriaria lactone.

Hypoxia-inducible factor-1α (HIF-1α) is thought to mediate pharmacoresistance in tumor by inducing Pgp overexpression. We aimed to investigate the expression of HIF-1α and MDR1/P-glycoprotein in refractory epilepsy, to explore the correlation of HIF-1α with epilepsy multidrug resistance. We collected hippocampus and mesial temporal lobe (MTL) cortex of refractory mesial temporal lobe epilepsy (mTLE) patients that underwent surgery, and established a pharmacoresistant TLE rat model kindled by coriaria lactone. We used real-time quantitative PCR (RQ-PCR) and western blot to investigate expression of HIF-1α and MDR1 in hippocampus and MTL/entorhinal cortex. We found that the expression of HIF-1α and MDR1, at both mRNA and protein levels, were up-regulated in hippocampus and MTL cortex of mTLE patients compared with the control cortex (all P < 0.05), and increased in hippocampus and entorhinal cortex of kindled rat model versus the control group (all P < 0.05). These results demonstrated the overexpression of HIF-1α and MDR1/Pgp in hippocampus and MTL/entorhinal cortex of mTLE patients and the pharmacoresistant TLE rat model. HIF-1α may have a regulatory effect on MDR1 expression in refractory epilepsy, which is probably consistent with MDR mechanism in tumor.

Factors associated with preoperative and postoperative epileptic seizure in patients with cerebral ganglioglioma.

OBJECTIVE: To explore the factors associated with preoperative epileptic seizure and surgical outcome in patients with cerebral gangliolioma (GG). METHODS: A total of 31 consecutive patients with pathologically confirmed ganglioglioma and surgically treated from January 2003 to June 2011 in West China Hospital of Sichuan University were retrospectively reviewed. Clinical data, surgical procedure and follow-up information were collected and analyzed. RESULTS: Nineteen patients presented with epileptic seizure, of which 63.2% were males. The mean age at epilepsy surgery and mean seizure duration were 25.6 years and 2.3 years respectively. Factors associated with preoperative epileptic seizure were supratentorial lesion and temporal lobe involvement (p=0.016 and 0.008). Intraoperative electrocorticography (ECoG) was applied in 8 out of 19 epilepsy patients. Eighteen achieved total tumor excision. After a mean follow up of 2.8 (1.3-6.3) years, 11 (68.8%, 11/16) achieved seizure free (Engel class I). Early surgery (seizure duration <3 years) was a significant predictor of favorable seizure outcome (p=0.013). None of the factors including seizure type, tumor location, neuroimaging characteristics and application of intraoperative ECoG or surgical strategy were found to be significantly associated with postoperative seizure outcome. Postoperative combination of AEDs was unnecessary for seizure control. CONCLUSIONS: Ganglioglioma with temporal lobe involvement usually associated with intractable epilepsy. Early surgical resection is strongly suggested to achieve favorable outcome. Intraoperative ECoG is not inevitable and simple lesionectomy is sufficient for satisfactory seizure control. Early accurate diagnosis of ganglioglioma should be established on comprehensive consideration and plays an important role in dealing with these patients.

Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol.

INTRODUCTION: The lumbar puncture (LP) technique is widely used for diagnostic and therapeutic purposes. In recent years, the paramedian approach technique (PAT) has gained increasing interest due to its advantages over the conventional midline approach technique (MAT) that has been traditionally employed in clinical practice for LP. However, there have been inconsistent discussions regarding the efficacy of different LP techniques. Based on digital virtual human and computer simulation techniques, a new approach called computerised modified PAT (CMPAT) was proposed. Therefore, the aim of this study is to discuss a randomised controlled trial (RCT) protocol to investigate and compare the effects of CMPAT and MAT in patients undergoing LP. METHODS AND ANALYSIS: We will conduct a prospective, multicentre RCT. The study will recruit 84 patients aged 18-99 years who require LP. Participants will be randomly assigned to either the CMPAT treatment group (group A) or the MAT treatment group (group B). The primary outcome measure will be the number of needle insertion attempts required for a successful LP. Secondary outcomes will include the puncture success rate, pain assessment in the back, head, and legs, and the occurrence of complications. The measurement of these secondary outcomes will be taken during the procedure, as well as at specific time points: 30 min, 6 hours, 1 day, 3 days, 7 days, 2 weeks and 4 weeks after the procedure. Pain levels will be assessed using a Numerical Rating Scale. ETHICS AND DISSEMINATION: Ethical approval (2022YF052-01) has been obtained from the Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China. The research findings will be published in an international peer-reviewed scientific journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300067937.

Spatiotemporal distribution and evolution pattern of Chinese Go League clubs in 20 years of professionalism.

Over the course of 20 years, from 1999 to 2018, the Chinese Go League has gradually developed and flourished, becoming a significant part of urban sports culture. Using mathematical statistics, spatiotemporal trajectory, and geospatial analysis, this research investigates the spatiotemporal distribution pattern and diffusive evolution characteristics of Chinese Go League clubs from the perspective of sports geography. The results of this study show that the following: (1) Over the past 20 years, the number of Chinese Go League clubs has increased in a "stepped" pattern, and there is still plenty of room for expansion. (2) Chinese Go League clubs are primarily located in municipalities directly under the central government and provincial capital cities (accounting for 82.6% of the total), with the Bohai Rim, Yangtze River Delta, and Southwest region of China forming a spatial pattern. (3) Host cities of Chinese Go League clubs are generally discrete, with clustering and random distribution occurring only seldom. The spatial distribution also tends to favor southern cities. (4) Chinese Go League clubs frequently change their names and host cities, and they have a variety of links with those cities, which primarily includes urban stability, urban transition, and urban fluctuation. In future, the professionalization and sustainable development of Chinese Go industry can be enhanced by the marketability of Chinese Go clubs, developing new markets for Chinese Go, and building a healthy development model with multiple linkages of Chinese Go clubs, sponsors, and host cities.

Effectiveness of acupuncture in treatment of facial spasm: a meta-analysis.

CONTEXT: Facial spasm is one of the common facial diseases, especially in the aged. It is mostly characterized by initially progressive, involuntary, irregular, recurrent, clonic, or tonic movements of muscles innervated by the facial nerve on one side. Acupuncture is a low-risk treatment with purported claims of effectiveness for facial spasm. OBJECTIVE: To assess the efficacy of acupuncture in facial spasm comprehensively. DESIGN: The research team conducted a systematic review and meta-analysis of all randomized clinical trials (RCTs) that examined the effectiveness of acupuncture for facial spasm. OUTCOME MEASURE(S): The research team categorized results from each of the reviewed studies in two ways: (1) the number of participants who showed a positive response to therapy (total effectiveness rate) and (2) the number of participants who made a full recovery (clinical cure rate). RESULTS: The research team reviewed a total of 13 studies involving 1262 participants with facial spasm. Researchers in China had conducted all studies, and most studies were poor in methodological quality. All studies reported that acupuncture was superior to other treatments, including carbamazepine, mecobalamin, and massage, and the meta-analysis on these low-quality studies yielded similar results. CONCLUSION: Present trials evaluating the efficacy of acupuncture in treatment of facial spasm are mostly poor in methodological quality. These studies showed that acupuncture was superior to other treatments for facial spasm; however, in its meta-analysis, the research team could not draw an affirmative conclusion as to the benefits of acupuncture due to the poor methodological quality and localized population of the included trials. The field needs large international, well-conducted RCTs.

Brain metastasis from colorectal cancer: Treatment, survival, and prognosis.

To investigate the clinical characteristics, survival, prognostic factors, and treatment of brain metastasis (BM) from colorectal cancer (CRC). Twenty-one patients with BM from CRC were retrospectively reviewed. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate COX analysis. The time from the development of extracranial metastases, including lung, bone, and liver, to the occurrence of BM was recorded separately. The median overall survival time was 7 months. In univariate prognostic analysis, median survival with multimodal therapy was better than that with unimodal therapy (10 months vs 3 months, P = .000). In addition, median survival with Karnofsky performance status (KPS) < 70, 1 BM lesion, primary tumor stage of II-III, extracranial lesions < 2, and no extracranial metastasis were much better than the other groups (P < .05 of all). Although there was not a significant difference in median survival between patients receiving combination treatment with bevacizumab and those who did not, treatment with bevacizumab was associated with better survival (10 months vs 5 months, P = .436). The time intervals from bone, liver, and lung metastases to BM were 3, 6.5, and 11 months, respectively. Based on multivariate Cox analysis, KPS and treatment modalities were independent prognosis factors (P = .039 and P = .000, respectively). CRC patients with a high KPS and multimodal treatment have improved survival.

Culprit vascular patterns and surgical outcomes of hemifacial spasm caused by an AICA segment passing between cranial nerve VII and VIII: A series of 25 cases.

OBJECTIVE: To report the vascular anatomic characteristics and surgical outcomes of hemifacial spasm (HFS) caused by an anterior inferior cerebellar artery (AICA) segment passing between cranial nerve VII (CN VII) and cranial nerve VIII (CN VIII). PATIENTS AND METHODS: This case series study retrospectively reviewed records of 1040 consecutive patients treated with MVD for HFS in our hospital in 10 years. 25 patients had the culprit vessel recorded as an AICA segment passing between CN VII and CN VIII. Vascular anatomic characteristics were reviewed from intraoperative microscopic videos. The clinical outcomes were followed up at 3-month and 1-year time points. RESULTS: The culprit AICA segments feature 3 discrete anatomic patterns. The patterns denoted as pattern A, B, and C were identified in 19(76%), 3(12%), and 3 (12%) of the 25 patients respectively. Postoperative spasm relief were achieved in 19(76%), 22(88%), and 23 (92%) of the patients at immediately after surgery, 3-month, and 1-year follow-up respectively. 3(12%) of them have permanent postoperative cranial nerve deficits, including one patient with hearing loss and 2 patients with vocal cord palsy. CONCLUSIONS: Though an AICA segment passing between CN VII and CN VIII is common, very rarely it was deemed the culprit for HFS in our patients. We used fREZ centered definition and operation. We found the culprit AICA segments feature 3 discrete anatomic patterns. We observed good spasm relief outcome and relatively fewer complications with CN VII and CN VIII. Identifying the 3 anatomic patterns may help with a smooth decision-making when vascular compression by an AICA segment passing between CN VII and CN VIII is suspected.

Structural and functional reorganization of contralateral hippocampus after temporal lobe epilepsy surgery.

OBJECTIVE: To explore the structural and functional reorganization of contralateral hippocampus in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-freedom after anterior temporal lobectomy (ATL). METHODS: We obtained high-resolution structural MRI and resting-state functional MRI data in 28 unilateral mTLE patients and 29 healthy controls. Patients were scanned before and three and 24 months after surgery while controls were scanned only once. Hippocampal gray matter volume (GMV) and functional connectivity (FC) were assessed. RESULTS: No obvious GMV changes were observed in contralateral hippocampus before and after successful surgery. Before surgery, ipsilateral hippocampus showed increased FC with ipsilateral insula (INS) and temporoparietal junction (TPJ), but decreased FC with widespread bilateral regions, as well as contralateral hippocampus. After successful ATL, contralateral hippocampus showed: (1) decreased FC with ipsilateral INS at three months follow-up, without further changes; (2) decreased FC with ipsilateral TPJ, postcentral gyrus and rolandic operculum at three months, with an obvious increase at 24 months follow-up; (3) increased FC with bilateral medial prefrontal cortex (MPFC) and superior frontal gyrus (SFG) at three months follow-up, without further changes. CONCLUSIONS: Successful ATL may not lead to an obvious structural reorganization in contralateral hippocampus. Surgical manipulation may lead to a transient FC reduction of contralateral hippocampus. Increased FC between contralateral hippocampus and bilateral MPFC and SFG may be related to postoperative functional remodeling.

Weak etalon effect in wave plates can introduce significant FM-to-AM modulations in complex laser systems.

The conversion of frequency modulation to amplitude modulation (FM-to-AM) effect is harmful to the high power laser facility based on the phase modulation technique. The FM-to-AM effect of phase modulation pulse induced by the weak etalon effect in wave plates was investigated theoretically and experimentally. A bulk phase modulator with a modulation frequency of 9.2GHz was employed. The numerical simulation results show that the FM-to-AM effect with a temporal modulation depth of 2.5% and 29.7% on the top of the pulse shape was induced by the weak etalon effect in half-wave plate with thickness of 1mm and residual reflectance ratio of 0.5% for 1 pass and 12 passes respectively. On the same condition, the temporal modulation depth is 3.0% and 23.4% respectively in the experiment. The results are in good agreement with numerical simulation results. To our knowledge, it is the first time to introduce the weak etalon effect in wave plates for a complex phase modulation laser system.

Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms.

OBJECT: Utilization of covered stent grafts in treating neurovascular disorders has been reported, but their efficacy and safety in vertebral artery (VA) dissecting aneurysms needs further investigation. METHODS: Six cases are presented involving VA dissecting aneurysms that were treated by positioning a covered stent graft. Two aneurysms were located distal to the posterior inferior cerebellar artery, and 4 were located proximal to the posterior inferior cerebellar artery. Aspirin as well as ticlopidine or clopidogrel were administered after the procedure to prevent stent-related thrombosis. All patients were followed up both angiographically and clinically. RESULTS: Five of the 6 patients underwent successful placement of a covered stent graft. The covered stent could not reach the level of the aneurysm in 1 patient with serious vasospasm who died secondary to severe subarachnoid hemorrhage that occurred 3 days later. Patient follow-up ranged from 6 to 14 months (mean 10.4 months), and demonstrated complete stabilization of the obliterated aneurysms, and no obvious intimal hyperplasia. No procedure-related complications such as stenosis or embolization occurred in the 5 patients with successful stent graft placement. CONCLUSIONS: Although long-term follow-up studies using a greater number of patients is required for further validation of this technique, this preliminary assessment shows that covered stent graft placement is an efficient, safe, and microinvasive technique, and is a promising tool in treating intracranial VA dissecting aneurysms.

Cerebellar schistosomiasis: a case report with clinical analysis.

The authors report here a rare case of cerebellar schistosomiasis identified by pathological diagnosis, lacking extracranial involvement. The clinical symptoms included headache, dizziness, and nausea. Studies in blood were normal and no parasite eggs were detected in stool. Computed tomography of brains showed hypodense signal, and magnetic resonance imaging showed isointense signal on T1-weighted images, hyperintense signal on T2-weighted images, and intensely enhancing nodules in the right cerebellum after intravenous administration of gadolinium. A high-grade glioma was suspected, and an operation was performed. The pathologic examination of the biopsy specimen revealed schistosomal granulomas scattered within the parenchyma of the cerebellum. The definitive diagnosis was cerebellar schistosomiasis japonica. A standard use of praziquantel and corticosteroid drugs was applied, and the prognosis was good. When the pattern of imaging examinations is present as mentioned above, a diagnosis of brain schistosomiasis should be considered.

Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia: Prognostic factors and long-term outcomes.

Patients with persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD) are frequently difficult to manage. This study aimed to analyze the safety and efficiency of repeat MVD, with the main focus on prognostic factors and long-term outcomes.We performed a retrospective study of 41 TN patients (19 men, 22 women) who underwent repeat MVD due to persistent or recurrent pain from January 2008 to January 2016. These patients were followed up from 12 to 96 months (mean, 42 ±â€Š17.3 months). Univariate analysis by Spearman's rank correlation coefficient was used for analysis of prognostic factors.During the repeat MVD, compression of the trigeminal nerve was noted by an artery in 15 patients (36.6%), vein in 6 patients (14.6%), Teflon in 8 patients (19.5%), and no compression in 12 patients (29.3%). Twenty-one patients (51.2%) had already undergone 1 or more previous ablative procedures, either before the first MVD or between the surgeries. The complete pain relief rates of repeat MVD were 87.8% immediately after surgery and 75% at last follow-up. Thirteen patients (31.7%) had new or increased facial numbness after repeat surgery. Univariate analysis revealed 2 prognostic factors, negative finding during reoperation (P = .021) and no pain relief after the initial surgery (P = .038), that showed a negative influence on success rates after repeat MVD.Repeat MVD can still achieve an excellent outcome in patients with persistent or recurrent pain. However, the risk of facial numbness is increased. Surgeons should be selective in performing repeat MVD, priority should be given to patients who have a pain-free interval after initial MVD or show demonstrable compression on imaging studies.

The experience of the multidisciplinary team in epilepsy management from a resource-limited country.

OBJECTIVE: The use of multidisciplinary teams (MDTs) is a global trend in disease management, while China is still at the exploratory stage MDTs. We aimed to summarize our experience and assess the impact of MDT use in managing patients with epilepsy and optimizing their seizure outcomes. METHODS: Our MDT is staffed with skilled epileptologists, electroencephalography experts, neurosurgeons, child neurologists, radiologists, and psychiatrists. The MDT discussion has been carried out once or twice a week since 2013. We reviewed our consecutive patients discussed at our MDT from March 2013 to December 2017. The detailed clinical characteristics, suggestions, and follow-up data were collected and analyzed. RESULTS: A total of 1088 patients (604 male, 484 female) were included in this study. The median age at MDT discussion was 21 years (range 10 months to 79 years). Three hundred eighty-seven patients (35.6%) were younger than18 years of age. The median age at seizure onset was 12 years (range 2 days to 77 years). Most patients (80.4%) had at least one seizure per month and most (77%) took 2 or more antiepileptic drugs. A total of 70.6% of patients reached the standard of drug-resistant epilepsy and 74.2% of brain magnetic resonance imaging (MRI) studies detected positive findings. After detailed MDT discussion, 18 patients were diagnosed as having nonepileptic diseases, including psychogenic nonepileptic seizure, syncope, sleep disorder, paroxysmal kinesigenic dyskinesia, withdrawal symptom, and cerebral palsy. Three hundred eighty-two patients (35.1%) were suitable for resective surgery. Among the postoperative patients successfully followed up for more than 1 year, 72.7% (136/187) received favorable outcomes (Engel class I). The seizure-free rate was 78.6% after temporal lobe surgery and 58.9% after extratemporal surgery. SIGNIFICANCE: Epilepsy management can be optimized through MDT discussion to attain accurate diagnosis and favorable seizure outcomes. There is still room for MDT improvement in resource-limited countries.

Coupling method for laser-diode-array end-pumped solid-state amplifiers.

A new coupling method is proposed for high-power laser-diode-array (LDA) end-pumped large-aperture amplifiers. In this method, stacks in the LDA are distributed on a spherical surface, and a hollow duct is placed after them. Both numerical simulations and experimental research have been done for this method. All results show that high coupling efficiency and uniform pumping field can be obtained simultaneously using this method.