帕罗西汀联合小剂量喹硫平治疗抑郁症有效性与安全性的Meta分析

目的系统评价帕罗西汀联合小剂量喹硫平治疗抑郁症的有效性与安全性。方法计算机检索Pub Med、EMBASE、Cochrane Library、CNKI、CBM、VIP和万方数据库,并手工检索相关文献,检索时间从各数据库建库至2015年9月1日,纳入帕罗西汀联合小剂量喹硫平治疗抑郁症的相关文献,根据纳入排除标准筛选文献并按照改良后的Jadad评分量表评估各研究方法学质量,提取治疗有效率、痊愈率及不良反应等相关数据,采用Stata/SE12.0软件进行Meta分析。结果纳入随机对照试验(RCT)24个,共1678例,所有纳入研究总体质量均较低。Meta分析结果显示,帕罗西汀联合小剂量喹硫平对抑郁症的有效率[RR=1.13,95%CI(1.04,1.24)]及治愈率[RR=1.37,95%CI(1.16,1.60)]均优于单用帕罗西汀;在不良反应方面,二者差异无统计学意义[RR=1.22,95%CI(0.97,1.54)]。结论帕罗西汀联合小剂量喹硫平治疗抑郁症的有效性优于单用帕罗西汀,且联合用药未增加药物的不良反应。     

丁苯酞软胶囊联合阿司匹林治疗急性脑梗死的Meta分析

目的 系统评价丁苯酞联合阿司匹林治疗急性脑梗死的疗效及安全性。方法 计算机检索CNKI、wanfang、VIP、Sinomed、Pubmed、Cochrane Library数据库,检索时限从建库截止至2019年10月。根据纳入和排除标准筛选出符合要求的随机对照研究(RCT),采用Rev Man 5. 3软件进行Meta分析。结果 共纳入15篇文献,共计1375例。Meta分析结果显示:治疗组的痊愈率优于单一用药[RR=1. 56,95%CI (1. 16,2. 10),Z=2. 93 (P=0. 003)]、加用其他治疗[RR=1. 99,95%CI(1. 30,3. 05),Z=3. 16 (P=0. 002)];治疗组的有效率优于单一用药[RR=1. 41,95%CI(1. 22,1. 64),Z=4. 52(P 0. 00001)]、加用其他治疗[RR=1. 24,95%CI(1. 12,1. 38),Z=4. 07(P 0. 0001)];治疗组的NHISS评分低于单一用药[MD=-2. 79,95%CI(-3. 72,-1. 86),Z=5. 86(P 0. 00001)]、加用其他治疗[MD=-2. 70,95%CI(-3. 54,-1. 85),Z=6. 26(P 0. 00001)];安全性方面,两组差异均无统计学意义。结论 丁苯酞联合阿司匹林治疗急性脑梗死的疗效显著,且临床应用安全。     

替莫唑胺对比传统化疗药治疗脑胶质瘤疗效的系统评价

目的系统评价替莫唑胺对比传统化疗药治疗脑胶质瘤的疗效。方法计算机检索国内外文献数据库(时限均从建库开始至2013年7月),收集术后放疗基础上替莫唑胺与传统化疗药治疗脑胶质瘤的随机对照试验,2名研究者独立提取资料和质量评价,使用RevMan 5.2软件进行Meta分析。结果最终纳入8个RCTs,864例患者,其中替莫唑胺组374例,传统化疗药物组490例。Meta分析结果显示,替莫唑胺与传统化疗药比较,两者在治疗有效率[RR=1.48,95%CI(1.24,1.77)]、5年生存率[HR=23.94,95%CI(13.26,43.22)]、无进展生存期[MD=4.00,95%CI(2.61,5.39)]、平均生存期[SMD=1.84,95%CI(1.40,2.27)]、消化道反应[RR=0.53,95%CI(0.39,0.71)]和骨髓抑制[RR=0.20,95%CI(0.08,0.51)]等方面差异均有统计学意义,替莫唑胺优于传统化疗药。结论替莫唑胺在提高脑胶质瘤患者的疗效,延长生存期,减少不良反应等方面均优于传统化疗药。     

加巴喷丁治疗带状疱疹后遗神经痛疗效的Meta分析

目的 系统评价加巴喷丁治疗带状疱疹后遗神经痛的疗效和安全性.方法 计算机检索美国国立医学图书馆(PubMed)、英国Cochrane图书馆随机对照临床试验资料库、荷兰医学文摘(EMBASE),以及中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国知识基础设施工程(CNKI)和万方数据库,并手工检索相关杂志,由两位研究者独立进行质量评价及数据分析,RevMan 5.0统计软件对数据进行Meta分析.结果 根据Cochrane5.0.2版随机对照临床试验质量评价标准,共纳入5项随机对照临床试验计1225例带状疱疹后遗神经痛患者.结果显示,加巴喷丁组患者平均每日疼痛评分改变高于安慰剂组(SMD=-0.920,95％CI:-1.330～-0.520;P=0.000);简易McGill疼痛问卷平均视觉印象评分改变高于安慰剂组(SMD=-2.650,95％CI:-3.410 ～-1.890;p=0.000);平均每日睡眠干预评分改变高于安慰剂组(SMD=-2.480,95％CI:-3.750～-1.200;P=0.000).加巴喷丁组与安慰剂组失访率差异无统计学意义(P=0.240).治疗期间常见药物不良反应为头晕、嗜睡、水肿等.结论 现有临床证据表明,加巴喷丁治疗带状疱疹后遗神经痛疗效显著,治疗保留率高;但应注意其所引起的头晕、嗜睡、水肿等药物不良反应.     

术前激素治疗在局限性前列腺癌治疗中的地位：一项基于6个随机对照试验的荟萃分析

背景：研究已证实术前激素治疗减低了前列腺癌患者的临床分期和病理分期,减少了切缘阳性率,但是并没有提高患者的无病生存率。目前术前激素治疗前列腺癌的价值尚无定论。 目的：评价术前激素治疗在治疗局限性前列腺癌中的作用。 方法：计算机检索PubMed、EMBASE、Cochrane Library(2009年第4期)、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库中2009年10月前发表的文章,手工检索相关领域的杂志。纳入随机对照试验,经病理学及细胞学检查确诊为局限性前列腺癌的患者,性别和民族不限,没有严重的心肺疾病;排除晚期或是复发的前列腺癌患者。同时从纳入文献的参考文献中查找符合要求的随机对照试验。采用国际Cochrane协作组提供的Revman 5.0软件进行统计分析。主要评价无病生存率、切缘阳性率、淋巴结阳性率、精囊浸润率4个结局指标。 结果与结论：共纳入6篇随机对照试验合计1 027人,meta分析结果显示：与单纯的前列腺癌手术相比,术前激素治疗联合前列腺癌手术在无病生存率[RR=1.02,95%CI (0.89,1.17)],淋巴结阳性率[RR=0.86,95%CI (0.47,1.57)]、精囊浸润率[RR=1.09, 95%CI (0.74,1.59)]方面差异无显著性意义,而在手术切缘阳性率[RR=0.46,95%CI (0.32,0.66)]方面差异有显著性意义。提示术前激素治疗联合前列腺癌根治术能减低局限性前列腺癌患者的手术切缘阳性率,但是并不能提高患者的无病生存率、淋巴结阳性率、精囊浸润率。     

早期氦氖激光并红外线干预治疗对带状疱疹患者后遗神经痛的影响

目的 探讨早期氦氖激光并红外线干预治疗对带状疱疹患者后遗神经痛的效果.方法 66例带状疱疹伴严重神经痛患者分为治疗组和对照组,每组33例.治疗组在常规治疗的基础上早期加用氦氖激光并红外线治疗,对照组则待皮疹消退后才进行氦氖激光并红外线治疗,对两组的疗效进行比较. 结果 以视觉模拟评分法(VAS)评价治疗效果,治疗组的疗效优于对照组,两组比较差异有统计学意义(U=193.520,P=0.000).治疗组优良率为90.9%.有效率为100.0%,无后遗神经痛发生;对照组优良率为63.6%,有效率为81.8%,后遗神经痛发生3例,发生率为9.1%.结论 早期配合氦氖激光并红外线治疗带状疱疹,能较快地控制病情及缩短疗程,减少后遗神经痛发生.     

A型肉毒毒素治疗带状疱疹后遗神经痛的临床疗效观察

目的观察A型肉毒毒素治疗带状疱疹后遗神经痛的临床疗效。方法选取58例带状疱疹后遗神经痛患者应用A型肉毒毒素进行疼痛点皮下注射治疗,调查每例带状疱疹后遗神经痛患者治疗前3月、治疗后2周、治疗后1月、治疗后3月、治疗后6月带状疱疹后遗神经痛发作情况,并行神经病理疼痛评分及生活质量评价量表评分,比较带状疱疹后遗神经痛发作频率、发作持续时间、发作严重程度、使用止痛药物情况及其带状疱疹后遗神经痛恢复状况,观察不良反应。结果使用A型肉毒毒素治疗后,带状疱疹后遗神经痛发作频率、发作持续时间、发作严重程度均较治疗前明显下降(P<0.01),止痛药物的使用较治疗前减少(P<0.01),且不良反应轻微。结论 A型肉毒毒素疼痛点皮下注射治疗带状疱疹后遗神经痛的临床疗效显著,不良反应轻微。     

百乐眠治疗失眠的疗效和安全性的Meta分析

目的评价百乐眠治疗失眠障碍的疗效、安全性及与疗程的关系。方法检索中国知网(CNKI)、万方数据库、中国优秀硕士/博士学位论文数据库、维普中文科技期刊数据库(VIP)、Cochrane图书馆、Pubmed、EMBASE、中国学术会议论文数据库中截至到2016年12月的百乐眠治疗失眠的文献,用Jadad量表评价文献质量,用Stata 14软件进行Meta分析。结果纳入文献20篇,共计2235例(观察组1284例,对照组951例)。百乐眠组治疗失眠的总有效率显著高于对照组(RR=1.20,95%CI:1.10~1.31),百乐眠治疗失眠的有效率显著高于西药亚组(RR=1.24,95%CI:1.07~1.44)及其他中药亚组(RR=1.13,95%CI:1.03~1.23)。百乐眠组治疗失眠降低匹兹堡睡眠质量指数(PSQI)评分优于对照组[标准化均数差(SMD)=-0.53,95%CI:-0.81~-0.26]。随着用药疗程的增加(第2、3、4周),百乐眠治疗失眠降低PSQI评分较西药亚组的优势逐渐显现(SMD2=-0.50,95%CI:0.83~-0.16;SMD3=-0.60,95%CI:-0.97~-0.24;SMD4=-1.67,95%CI:-0.63~-0.05)。百乐眠组治疗失眠的不良反应事件发生率显著低于对照组(RR=0.25,95%CI:0.16~0.38)。百乐眠组不良反应事件发生率显著低于西药亚组(RR=0.23,95%CI:0.15~0.36)。随着用药疗程的增加(第2、3、4、8周),百乐眠组不良反应事件发生率逐渐低于西药亚组(RR2=0.45,95%CI:0.22~0.92;RR3=0.23,95%CI:0.04~1.33;RR4=0.16,95%CI:0.08~0.33;RR8=0.19,95%CI:0.06~0.59)。结论百乐眠胶囊治疗失眠障碍的总体有效率、降低PSQI评分均优于西药和其他中药,具有较高的安全性,值得在临床上进一步推广使用。但是否随着用药疗程的增加总体有效率及降低PSQI评分优势越显著仍有待进一步研究验证。     

不同治疗方案干预带状疱疹后遗神经痛的疗效分析

目的探讨单纯中药疗法、单纯西药疗法和中西医结合疗法三种治疗方案干预带状疱疹后遗神经痛的临床疗效和不良反应,为临床有效、经济、安全用药提供依据。方法选取带状疱疹后遗神经痛患者126例作为研究对象,其中36例患者采用单纯活血化瘀、通络止痛的中药(血府逐瘀汤为基础方)治疗;41例患者采用单纯消炎止痛药(潘生丁、卡马西平、吲哚美辛)治疗;49例患者采用中西医结合疗法(方药配合西药)治疗,4周治疗结束后,观察分析3组临床疗效和不良反应。结果在治疗效果上,单纯中药组有效率(72.22%)和单纯西药组(70.73%)不存在差异(P0.05),小于中西结合组有效率(χ2=4.410,5.295、P=0.036,0.0210.05)。在视觉模拟(VAS)评分上,3组治疗前后差异有统计学意义(P0.05),在疼痛痊愈时间上,中药组、西药组与中西结合组差异有统计学意义(t=3.412,3.404、P=0.000,0.0010.01)。3组患者不良反应差异无统计学意义(P0.05)。结论相对于单纯中药治疗和单纯西药治疗,中西医结合方法对带状疱疹后遗神经痛效果显著,且治愈时间短,不良反应可以耐受,值得临床应用。     

生酮饮食对儿童难治性癫痫疗效与安全性的Meta分析

目的 系统评价生酮饮食(KD)治疗儿童难治性癫痫的有效率和不良反应。方法 检索PubMed、Cochrane Library、中国知网、万方数据库、维普中文科技期刊数据库，检索时限自建库至2021年6月30日，纳入KD治疗儿童癫痫的随机对照研究文献。采用Review Manager 5.4软件对符合纳入标准的临床研究进行Meta分析。结果 最终纳入14篇随机对照研究，包含1 080例病例。KD组癫痫控制发作有效率显著高于对照组(RR=2.13,95%CI:1.46～3.11,P<0.05)。经典KD组与改良Atkins生酮饮食(MAD)组的癫痫控制有效率(RR=1.21,95%CI:0.95～1.53,P=0.12)及不良反应率(RR=1.11,95%CI:0.81～1.53,P=0.52)差异无统计学意义。结论 KD可提高难治性癫痫患儿的治疗有效率，是难治性癫痫的重要手段之一，经典KD和MAD的疗效和不良反应相当。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.