Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

Purpose: To evaluate the long‐term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. Methods: We carried out follow‐up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face‐to‐face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Key Findings: Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow‐up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3–84; mean duration of follow‐up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty‐three individuals (25%) became seizure‐free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in <1%. The most common adverse effects were malaise/somnolence (7.4%), dizziness (3%), and lethargy (2.6%). At the follow‐up assessment, 688 (39%) individuals had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking AED treatment irregularly at recruitment were less likely to become seizure‐free. Significance: We observed long‐term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy.     

全反式维甲酸联合5-氟尿嘧啶对Eca109细胞增殖、迁移和VEGF表达的影响

目的:探讨全反式维甲酸(ATRA)、5-氟尿嘧啶(5-FU)单独或联合作用对Eca109细胞增殖、迁移和血管内皮生长因子(VEGF)表达的影响。方法:将常规传代的Eca109细胞分为4组:ATRA组、5-FU组、ATRA+5-FU组和对照组,采用MTT法检测各组细胞的增殖情况,通过划痕实验测定各组细胞的迁移能力,采用RT-PCR和免疫细胞化学法分别检测各组细胞VEGF mRNA和蛋白的表达情况。结果:作用24、48和72 h后,ATRA+5-FU组的细胞生长抑制率均高于其他2组(F=23.432、13.605、73.369,P均<0.05);作用24 h后,ATRA+5-FU组的迁移率均低于其他3组(P均<0.001);作用48 h后,ATRA+5-FU组细胞VEGF mRNA和蛋白的相对表达量均低于其他3组(P均<0.05)。结论:ATRA、5-FU均能抑制食管癌细胞的增殖,且联合用药效果更为显著,可能与其抑制肿瘤血管生成有关。     

甲地孕酮联合格拉司琼预防化疗所致消化道反应的疗效观察

目的观察甲地孕酮联合格拉司琼预防化疗所致消化道反应的疗效及毒副反应。方法将76例接受含顺铂、阿霉素及环磷酰胺联合化疗的恶性肿瘤患者随机分为治疗组和对照组。治疗组止吐方案:甲地孕酮+格拉司琼+甲氧氯普胺;对照组止吐方案:格拉司琼+甲氧氯普胺,2周期后评价疗效。结果Ⅱ度以上急性恶心、呕吐及迟发性恶心呕吐发生率,治疗组分别为5.3%、9.2%及6.6%;对照组分别为23.7%、28.9%及21.1%,2组比较差异均有统计学意义(P均<0.05)。治疗后治疗组生活质量改善明显优于对照组(P<0.05)。2组毒副反应相近,均较轻微,可耐受。结论甲地孕酮联合格拉司琼预防化疗所致恶心呕吐较单用格拉司琼具有更好的预防效果,并可明显改善患者的生活质量。     

紫杉醇联合奈达铂治疗晚期食管癌临床观察

目的 观察紫杉醇联合奈达铂治疗晚期食管癌的疗效和毒副反应.方法 51例晚期食管癌均接受化疗:紫杉醇135～ 175mg·m-2,静脉滴注,d1;奈达铂80～100mg· m-2,静脉滴注,d2;21 d为1周期,连用2周期后评价疗效.结果 全组50例可评价疗效,总有效率58.0％ (29/50),疾病控制率82.0％(41/50),中位生存时间9.8个月,中位疾病进展时间5.7个月,中位缓解时间4.5个月.主要毒副反应为骨髓抑制.结论 紫杉醇联合奈达铂治疗晚期食管癌近期疗效好,安全性高.     

多西他赛单药治疗老年晚期非小细胞肺癌的临床观察

目的观察多西他赛单药治疗老年晚期非小细胞肺癌(NSCLC)的疗效及毒副反应。方法 36例老年晚期NSCLC患者应用多西他赛75 mg·m-2治疗,21 d为1周期,治疗2～4周期后评价疗效和毒副反应。结果全组总有效率为30.6%(11/36),疾病控制率为55.6%(20/36),生活质量改善率为36.1%(13/36)。主要毒副反应为骨髓抑制及消化道反应,经对症处理后可缓解。结论多西他赛单药治疗老年晚期NSCLC疗效肯定,可明显改善患者生活质量,毒副反应可耐受。     

突变型P53蛋白在皮肤黑素瘤中的检测及临床意义

目的探讨突变型P53蛋白在黑素瘤组织中的检测及临床意义。方法SP免疫组化法检测突变型P53蛋白在40例原发性皮肤黑素瘤中的水平,以20例色素痣作为对照。结果突变型P53蛋白在皮肤黑素瘤和色素痣中的阳性率分别为80.00%和20.00%,其在黑素瘤中的水平明显高于色素痣中,两组相比差异有统计学意义(P<0.05)。突变型P53蛋白分布与黑素瘤病理学类型、病理分级、分期、淋巴结转移及预后相关。结论突变型P53蛋白在皮肤黑素瘤中的较高水平,对皮肤黑素瘤的辅助诊断及预后评估具有重要的临床意义。     

Symptomatic and asymptomatic high-grade unilateral internal carotid artery stenosis: scalp topography of event-related potentials (P300) and psychometric testing

Unilateral internal carotid artery (ICA) stenosis may be accompanied by widespread atherosclerosis of extra- and intracranial vessels leading to subtle cognitive disorders. We applied multichannel recording of P300 in 28 patients (68.3 ± 8.1 years; 15 asymptomatic, 13 with a history of transient ischemic attack (TIA)) and compared them with an age- and sex-matched control group. All underwent a visual “odd-ball paradigm” as well as a psychometric test, the Cognitive Performance Test (CPT), testing mainly visual attention and memory. The potentials were derived from 16 electrodes according to the $\text{10}\text{20}$ system against linked mastoids. The latencies and amplitudes of N250 and P300 were measured and their amplitudes additionally mapped. Furthermore, the early sensory exogenous potentials, P1 and N1, within the P300 potentials as well as conventional pattern reversal visual evoked potentials (PVEPs) were evaluated.(1) Both the early exogenous potentials and the conventional PVEPs showed no significant differences among all groups. (2) There were no significant differences between asymptomatic patients and those with a TIA history in all parameters of the P300 complex so that one total patient group was constructed and compared to the controls. (3) Patients' P300 amplitudes showed significant reductions over hemispheres ipsilateral (P ≤ 0.014) and contralateral (P <- 0.044) to the stenosis. (4) The N250 amplitudes were reduced only in the central leads (P <- 0.05). (5) The latencies of N250 potentials were significantly prolonged at many electrodes, not only ipsi- (P <- 0.0007) but also contralateral (P <- 0.022) to the stenosis. (6) The patients' P300 latencies showed significant lengthening only at occipital sites (P ≤ 0.05) compared to controls. (7) In all measured parameters, within the patient group, the differences between hemispheres ipsilateral versus contralateral to the ICA stenoses did not reach statistical significance. (8) The CPT values detected slight cognitive disorders for both patient groups and they correlated significantly with the latencies in many leads. (9) The highest test sensitivity to classify patients versus controls (z score > 2) was reached in P300 maps of TIA patients (77%).An altered P300 indicates electrophysiologically, and CPT behaviorally, subclinical cognitive deficits even in asymptomatic patients with unilateral tight ICA stenoses. Interestingly, no differences between asymptomatic and TIA patients with a high-grade unilateral ICA stenosis could be found.     

染色体微阵列分析技术在流产或死胎原因分析中的应用

目的探讨染色体微阵列分析技术(chromosomal microarray analysis,CMA)在流产或死胎原因分析中的应用价值及流产或死胎与染色体异常的关系。方法采用CMA技术对流产绒毛或死胎组织进行全基因组拷贝数变异(copy number variations,CNVs)检测。结果824例流产或死胎样本检测成功率100%,染色体异常381例(46.2%),其中数目异常312例(81.9%),结构异常66例(17.3%),单亲二倍体(uniparental disomy,UPD)3例(0.8%)。数目异常中占比最大的为非整倍体,共287例(92.0%),以16-三体和Turner综合征最为多见,分别为41例(13.1%)和63例(20.2%)。66例染色体结构异常中,26例(39.4%)发生拷贝数重复,20例(30.3%)发生拷贝数缺失,20例(30.3%)发生拷贝数重复伴缺失,其中33例检出临床致病的可能性大。结论CMA是诊断流产或死胎病因的一种可靠、稳定、高分辨的技术。胚胎染色体数目异常是引起临床流产的主要遗传因素,其中以非整倍体变异最为常见。     

氨茶碱联合小剂量盐酸异丙嗪治疗喘息型慢性支气管炎疗效观察

目的探讨氨茶碱联合小剂量盐酸异丙嗪治疗喘息型慢性支气管炎的临床疗效。方法选取2008年6月～2011年6月本院收治的喘息型慢性支气管炎患者72例,将其随机分为观察组和对照组各36例,对照组采用氨茶碱治疗,观察组在对照组治疗的基础上加用小剂量盐酸异丙嗪,7d为1个疗程。疗程结束后比较两组的临床治疗效果,分析治疗前后动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）及1s用力呼气容积（FEV1）的变化。结果疗程结束后观察组总有效率为91.67%,显著高于对照组的75.00%,两组差异有统计学意义（χ2=10.63,P〈0.05）。治疗后两组PaO2、PaCO2及FEV1均较治疗前改善（P〈0.05）,且观察组改善较对照组明显,两组间差异有统计学意义（P〈0.05）。结论氨茶碱联合小剂量盐酸异丙嗪治疗喘息型慢性支气管炎,疗效显著,值得临床推广应用。     

CIK细胞对肺腺癌化疗不良反应的影响

目的研究细胞因子诱导的杀伤细胞(CIK细胞)对肺腺癌患者化疗中不良反应的影响。方法选取2011年10月~2013年10月就诊于我院、经病理学证实为肺腺癌、临床分期为局部晚期的患者56例,其中26例应用CIK细胞联合化疗方案作为试验组,同期临床特点相近的30例作为对照组,单纯应用化疗方案,治疗结束1周期后评价两组不良反应情况。结果试验组患者骨髓抑制、恶心呕吐、肌肉酸痛等不良反应发生率均低于单纯化疗组,而发热率高于对照组,差异有统计学意义(P<0.05)。结论 CIK细胞联合放疗可减少肺腺癌化疗所致的不良反应。