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Epilepsy is a common nervous system disorder characterized by repeated attacks and a protracted course， which can cause great harms to the physical and mental health of patients. Antiepileptic drugs have been proved effective， but the resulting toxic and side effects cannot be ignored. Traditional Chinese medicine （TCM） has a long history of dealing with epilepsy. At present， in addition to enriching the cognitive theory of epilepsy treatment with TCM， we have also focused on the role of TCM in regulating the epilepsy-related signaling pathways from the perspective of molecular biology. The review of literature in China and abroad has uncovered that epilepsy is closely related to such pathophysiological processes as cell proliferation， apoptosis， autophagy， inflammatory response， and immune response. At the same time， the modern research of Chinese and western medicines shows that the efficacy of Chinese herbal monomers， single Chinese herbs or Chinese herbal compounds in treating epilepsy is directly or indirectly related to their regulation of signaling pathways. To be specific， they control epileptic seizures and alleviate epileptic brain injury by regulating the expression of key molecules in corresponding signaling pathways. This paper summarized the research progress in China and abroad as follows： ①Tangeretin and ginkgolide B inhibit apoptosis and oxidative stress by activating the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway. ②Baicalin and osthol suppress autophagy by inhibiting the mammalian target of rapamycin （mTOR） signaling pathway. ③Ganoderan and astragaloside reduce apoptosis by inhibiting the mitogen-activated protein kinase （MAPK） signaling pathway. ④Salidroside and resveratrol reverse oxidative stress and apoptosis by activating the nuclear factor E2-related factor 2/antioxidant reaction element/heme oxygenase 1 （Nrf2/ARE/HO-1） signaling pathway. ⑤Curcumin and baicalin diminish inflammatory response and apoptosis by inhibiting the nuclear transcriptional factor-κB （NF-κB） signaling pathway. The above summary is expected to provide reference for the in-depth study and clinical application of TCM for the treatment of epilepsy.

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BACKGROUND: Data modeling for electronic health records (EHRs) is complex, requiring technological and cognitive sophistication. The openEHR approach leverages the tacit knowledge of domain experts made explicit in a model development process aiming at interoperability and data reuse. OBJECTIVE: The purpose of our research was to explore the process that enabled the aggregation of the tacit knowledge of domain experts in an explicit form using the Clinical Knowledge Manager (CKM) platform and associated assets. The Tobacco Smoking Summary archetype is used to illustrate this. METHODS: Three methods were used to triangulate findings: (1) observation of CKM discussions by crowdsourced domain experts in two reviews, (2) observation of editor discussions and decision-making, and (3) interviews with eight domain experts. CKM discussions were analyzed for content and editor discussions for decision-making, and interviews were thematically analyzed to explore in depth the explication of tacit knowledge. RESULTS: The Detailed Clinical Model (DCM) process consists of a set of reviews by domain experts, with each review followed by editorial discussions and decision-making until an agreement is reached among reviewers and editors that the DCM is publishable. Interviews revealed three themes: (1) data interoperability and reusability, (2) accurate capture of patient data, and (3) challenges of sharing tacit knowledge. DISCUSSION: The openEHR approach to developing an open standard revealed a complex set of conditions for a successful interoperable archetype, such as leadership, maximal dataset, crowdsourced domain expertise and tacit knowledge made explicit, editorial vision, and model-driven software. Aggregated tacit knowledge that is explicated into a DCM enables the ability to collect accurate data and plan for the future. CONCLUSION: The process based on the CKM platform enables domain experts and stakeholders to be heard and to contribute to mutually designed standards that align local protocols and agendas to international interoperability requirements.

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<p><b>OBJECTIVE</b>To investigate the effect of obesity, arousal, hypoxia and sympathetic activation on the circadian blood pressure of hypertensive patients with obstructive sleep apnea-hypopnea syndrome.</p><p><b>METHODS</b>Polysomnography (PSG) was performed in 436 hypertensive patients complaining of snoring, daytime sleepiness, lips cyanosis, hyperhemoglobinemia of unknown etiology, or with refractory hypertension. Hypertensive subjects were divided into four groups according to apnea-hypopnea index (AHI): hypertensive with mild obstructive sleep apnea-hypopnea syndrome (OSAHS) (n = 131), hypertensive with moderate OSAHS (n = 95), hypertensive with severe OSAHS (n = 95) and hypertensive without OSAHS as control group (n = 115). The ambulatory blood pressure monitoring (ABPM), PSG, urine electrolyte, and urine vanillylmandelic acid (VMA) were compared among groups. Factor analysis was employed to identify common factors related to the alterations of circadian blood pressure. Multiple linear regression analysis was used to analyze the influencing factors of the observed variables.</p><p><b>RESULTS</b>There were significant differences among groups in age, neck circumference and waist circumference(P < 0.001). In severe group, 24 hour average systolic blood pressure (24 hSBP)[ (137.0 ± 16.8) mm Hg vs.(131.3 ± 11.9)mm Hg, (131.3 ± 13.2)mm Hg (1 mm Hg = 0.133 kPa)], daytime systolic blood pressure (day-SBP) [(140.8 ± 16.8) mm Hg vs. (135.7 ± 11.9) mm Hg, (135.3 ± 13.5) mm Hg]and night systolic blood pressure (night-SBP)[ (130.9 ± 17.0) mm Hg vs.(124.5 ± 14.0 )mm Hg, (124.3 ± 13.2) mm Hg] were significantly higher than those of control or mild OSAS groups (P < 0.01). Factor analysis showed that body mass (BM), life style, urine electrolyte, age and course of disease (ACD) were the common factors influencing circadian blood pressure. OSAHS was correlated with declining percentage of SBP (β = -0.128, P < 0.01) and declining percentage of DBP (β = -0.126, P < 0.01). The contribution according to priority was ACD > OSAHS > BM for declining percentage of SBP (β = -0.148, P = 0.002;β = -0.128, P = 0.007;β = 0.099, P = 0.035), OSAHS > ACD > BM for declining percentage of DBP(β = -0.126, P = 0.008;β = -0.105, P = 0.026;β = 0.097, P = 0.042).</p><p><b>CONCLUSION</b>OSAHS, ACD and BM are the independent risk factors contributing to the alterations of circadian blood pressure in hypertensive patients with obstructive sleep apnea-hypopnea syndrome.</p>

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<p><b>OBJECTIVE</b>To observe the safe angle and depth of acupuncture at Jiuwei (CV 15) so that the reference data can be provided for the clinical safe acupuncture at the point.</p><p><b>METHODS</b>Ten healthy adults of either sex were selected. MRI was applied to scan Jiuwei (CV 15) and obtain the images. The safe angle and depth were collected for the correlative analysis with the body height, body mass, body mass index (BMI), nipple distance and the finger measurement considered.</p><p><b>RESULTS</b>There was no difference in the minimal dangerous angle of the horizontal needling to the right and the left between the male and the female. There was no difference in the dangerous depth of needling under the designed angle of needling between the male and the female. The safe depth of needling to the different directions: (16.99 +/- 2.86) mm for perpendicular needling, (22.72 +/- 5.35) mm for 45 degrees downward needling, (24.61 +/- 2.92) mm for 45 degrees upward needling, (53.47 +/- 5.72) mm for 15 degrees downward needling, (25.76 +/- 2.61) mm for 15 degrees upward needling, (24.89 +/- 4.34) mm for 45 degrees needling to the right, (21.79 +/- 3.84) mm for 45 degrees needling to the left, (51.19 +/- 2.69) mm for the needling at the minimal dangerous angle to the right, (51.86 +/- 2.59) mm for the needling at the minimal dangerous angle to the left. BMI was correlated to the minimal dangerous angle of the horizontal needling to either the right or the left, perpendicular needling, 45 degrees downward needling, 45 degrees needling to the right and 45 degrees needling to the left, as well as to the dangerous depth of needling at the minimal dangerous angle to either the right or the left. The body mass was relevant with the dangerous depth of perpendicular needling, 45 degrees downward needling and 15 degrees downward needling.</p><p><b>CONCLUSION</b>For the horizontal needling to the right or the left, the minimal dangerous angle should be determined in reference to BMI. For the angle of needling measured in advance, the needling depth is not required to be identified in light of the sex. For the perpendicular needling, 45 degrees downward needling and 15 degrees downward needling, the needling depth should be optioned in accordance with the body mass. For the perpendicular needling, 45 degrees downward needling, 45 degrees needling to the right or to the left, as well as the needling at the minimal dangerous angle to either the right or the left, the needling depth should be determined in terms of BMI.</p>

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<p><b>OBJECTIVE</b>To investigate the impact of obesity on incidence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in hospitalized hypertensive patients.</p><p><b>METHODS</b>A total of 825 hospitalized hypertensive patients from April 1 to June 30 in 2009 in our hospital were included. Patients were asked to answer the questions concerning snoring, daytime sleepiness. Patients with loud snoring and daytime sleepiness, tubbiness neck, retrognathia, enlarged tongue, orolingual cyanosis were selected to undergo polysomnography monitoring for a whole night. OSAHS is defined by clinical symptoms and apnea-hypopnea index (AHI) not less than 5 per hour.</p><p><b>RESULTS</b>(1) The detection rate of OSAHS in this cohort was 23.52% (178/825), 34.34% (148/431) in males and 11.68% (46/394) in females respectively. (2) The detection rate was 6.6% (12/183) in normal weight subjects, 22.22% (78/351) in overweight subjects and 36.75% (104/283) in obesity subjects (χ(2) = 56.736, P < 0.01). The severe OSAHS rate in obesity group (16.61%) was significantly higher than that in normal weight group (2.19%) and overweight group (7.69%, χ(2) = 29.219, P < 0.01). (3) The OSAHS rate was 7.83% (9/115) in normal waist circumference group and 26.29% (184/700) in centricity obesity group (χ(2) = 18.623, P < 0.01). The severe OSAHS rate was 2.61% (3/115) in normal waist circumference group and 10.57% (74/700) in centricity obesity (χ(2) = 7.32, P < 0.01). (4) The moderate to severe OSAHS rate increased in proportion with BMI increase in female patients (χ(2) = 5.846, P < 0.05) and increased in proportion with BMI and waist circumference increase in male patients (P < 0.01).</p><p><b>CONCLUSIONS</b>The incidence of OSAHS in hypertensive patients is high. Obesity further increases the morbidity of OSAHS in hypertensive patients.</p>

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<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of two brain protective methods for aortic operation according to S100beta protein (S100beta) and interleukin-6 (IL-6) in cerebrospinal fluid (CSF).</p><p><b>METHODS</b>From November 2004 to April 2005, 14 patients who underwent aortic operations with circulatory arrest were alternatively allocated to one of two methods of brain protection: only deep hypothermic circulatory arrest (core temperature, 18 degrees C) for descending thoracic aorta operations (group DHCA, n = 5) or selective antegrade cerebral perfusion (core temperature, 20 degrees C; flow rate, 10 ml kg(-1) min(-1)) for aortic arch operations with DHCA (group ASCP, n = 9). Indications for surgical intervention were Stanford type A dissection in 11 patients, Stanford type B dissection in 2 patients, false aneurysm on thoracoabdominal aorta in 1 patient. S100beta and IL-6 in CSF were assayed in all patients from each group before cardiopulmonary bypass, as well as 0, 6, 12, 24, 48, 72 h after the operation.</p><p><b>RESULTS</b>There were no significant differences in lowest core temperature (P > 0.05), hematocrit in lowest core temperature (P > 0.05) and the velocity of rewarming. Mean circulatory arrest time in ASCP group was significant longer than in DHCA group (P < 0.05). There were much more patients with jugular arteries impaired or accompanied with related cerebrovascular diseases in group ASCP compared to group DHCA. The baseline of S100beta in CSF before cardiopulmonary bypass was no difference. S100beta value in CSF ascended to peak level in 12 h after the operation, showing significantly higher in group DHCA than in group ASCP [DHCA vs. ASCP, (0.90 +/- 0.11) microg/ml vs. (0.61 +/- 0.26) pg/ml]. In most hours after operation there was significant intergroup difference. IL-6 value in CSF ascended to peak level in 12 h postoperative for group DHCA and 0 h postoperative for group ASCP. There was no significance difference observed in IL-6 of CSF between two groups except 6 h and 12 h postoperative.</p><p><b>CONCLUSIONS</b>Brain ischemic injury occurred during aortic operations assisted by brain protective methods is not serious. Unilateral ASCP which can delivery adequate oxygen to brain during circulation arrest has some advantage of alleviating ischemic injury compared with only DHCA.</p>

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