门冬氨酸和鸟氨酸联合治疗肝性脑病的疗效观察

目的观察联合使用门冬氨酸和鸟氨酸治疗各种肝硬化引起肝性脑病患者的临床疗效,探讨其对生化指标的影响。方法收集2004-08～2007-08乙肝、丙肝和酒精性肝硬化住院患者84例,住院期间均出现不同程度的肝性脑病,分为门冬氨酸和鸟氨酸治疗组与乙酰谷酰胺治疗组(各42例),治疗5～7d观察2组患者的临床表现,记录临床症状、体征的变化,检测治疗前后患者血氨和肝功能,判断临床疗效变化。结果2组患者均经过5～7d治疗后,门冬氨酸和鸟氨酸治疗组患者显效22例(52.4%),有效16例(38.1%),无效4例(9.5%),无死亡病例,总有效率为90.5%;乙酰谷酰胺治疗组患者显效16例(38.1%),有效14例(33.3%),无效8例(19.1%),死亡4例(9.5%),总有效率为71.4%。2组总有效率比较,差异有统计学意义(P<0.05)。另外,发现门冬氨酸和鸟氨酸治疗组患者的血氨水平比乙酰谷酰胺治疗组显著下降(P<0.05),而2组之间的血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间均无明显变化(P>0.05)。结论降低血氨是治疗肝性脑病的重要步骤,门冬氨酸联合鸟氨酸是控制肝性脑病发生的有效药物。     

门冬氨酸鸟氨酸联合乙酰谷酰胺治疗肝性脑病疗效观察

目的 观察门冬氨酸鸟氨酸与乙酰谷酰胺联合治疗肝性脑病患者的临床疗效.方法 选择2010-12-2012-12在我院住院的肝性脑病患者88例,按随机数字表法随机分为治疗组和对照组.治疗组48例患者在口服乳果糖及支链氨基酸基础上,采取门冬氨酸鸟氨酸10 g加入250 mL 5%葡萄糖注射液中静滴,2次/d;乙酰谷酰胺0.6 g加入250 mL 5%葡萄糖注射液中静滴,1次/d.对照组40例患者在常规治疗的基础上应用乙酰谷酰胺0.6 g加入250 mL 5%葡萄糖注射液中静滴,1次/d.2组均连续治疗7 d.观察2组患者治疗前后血氨水平、谷丙转氨酶水平、血清总胆红素水平、清醒时间等情况,并进行对比分析.结果治疗7 d后,治疗组总有效43例（89.6%）,死亡2例（4.2%）;对照组总有效25例（62.5%）,无效15例中12例（30.0%）死亡.与治疗前比较,2组患者治疗后血氨水平、谷丙转氨酶水平、血清总胆红素水平均降低,清醒时间均延长,差异均有统计学意义（P＜0.05）.治疗组患者治疗后血氨水平、谷丙转氨酶水平、血清总胆红素水平低于对照组,清醒时间短于对照组,差异均有统计学意义（P＜0.05）.结论 门冬氨酸鸟氨酸联合乙酰谷酰胺治疗肝性脑病确切疗效,优于采取乙酰谷酰胺的单一疗法.     

乙肝肝硬化肝性脑病临床诊治分析

目的探讨乙肝肝硬化肝性脑病患者的临床治疗及疗效。方法 2010-06—2012-06期间,我院诊治的60例乙肝肝硬化肝性脑病患者,随机将其分为对照组(门冬氨酸、鸟氨酸治疗)和观察组(乙酰谷酰胺联合门冬氨酸、鸟氨酸治疗),每组各30例,治疗一周后,对其临床疗效及治疗前后血氨浓度变化情况,进行观察和比较。结果与对照组相比(70.0%),观察组总有效率明显升高(96.7%),P<0.05。与治疗前相比,治疗后2组的血氨浓度均有明显下降;与对照组相比,治疗后观察组血氨浓度明显下降,P<0.05。结论乙酰谷酰胺联合门冬氨酸鸟氨酸治疗乙肝肝硬化肝性脑病的疗效显著,明显改善患者的肝功能,值得临床推广。     

乙酰谷酰胺联合门冬氨酸鸟氨酸治疗肝性脑病的疗效及对血氨浓度的影响

目的探讨肝性脑病行乙酰谷酰胺联合门冬氨酸鸟氨酸治疗的疗效及对血氨浓度的影响。方法回顾性分析2012-02—2015-06我院诊治的108例肝性脑病患者的临床资料,按照不同治疗方式分为2组各54例,对照组予乙酰谷酰胺治疗,研究组予乙酰谷酰胺与门冬氨酸鸟氨酸联合治疗,对比2组治疗情况。结果研究组神志清醒时间较对照组短,持续治疗3d流尿量显著大于对照组(P0.05或0.01);2组治疗后血氨、白蛋白、谷丙转氨酶及血清总胆红素均较治疗前改善,研究组改善幅度最显著,优于对照组(P0.05或0.01);研究组不良反应总发生率9.26%,与对照组的7.41%比较差异无统计学意义(P0.05)。结论乙酰谷酰胺联合门冬氨酸鸟氨酸治疗肝性脑病疗效显著,可改善血氨及肝功能,且安全可靠,具有临床实际应用价值。     

综合降低血氨浓度治疗乙肝肝硬化引起的肝性脑病

目的通过综合降低血氨浓度,观察治疗乙肝肝硬化引起的肝性脑病的临床疗效。方法将56例乙肝肝硬化出现肝性脑病患者随机分为综合降低血氨治疗组（包括口服乳果糖、醋酸灌肠、乙酰谷酰胺静脉注射,n=30）和乙酰谷酰胺治疗组（n=28）,1周治疗后观察临床疗效。结果综合治疗组显效21例（70．0％）,有效9例（30．0％）,无效0例,无死亡,总有效率100％;而乙酰谷酰胺治疗组显效8例（28．6％）,有效8例（28．6％）,无效7例（25．0％）,死亡5例（17．8％）,总有效率为57．1％,2组总有效率比较差异有统计学意义（P〈0．001）。综合治疗组死亡率和血氨浓度也显著降低（P〈0．05）。结论综合降低血氨浓度是控制乙肝肝硬化患者肝性脑病的有效方法,可显著降低肝性脑病的发生,降低患者死亡。     

乙酰谷酰胺治疗肝硬化合并肝性脑病的疗效观察

目的观察乙酰谷酰胺治疗肝硬化合并肝性脑病的临床疗效。方法选取2013-03—2014-12于本院进行诊治的38例肝硬化合并肝性脑病患者为研究对象,按随机分配的原则分为对照组(门冬氨酸鸟氨酸治疗组)19例和观察组(门冬氨酸鸟氨酸加乙酰谷酰胺治疗组)19例,比较2组不同分期及病因患者的治疗总有效率及清醒时间。结果观察组中不同分期及病因患者的治疗总有效率均高于对照组,清醒时间构成也均好于对照组,P均0.05。结论乙酰谷酰胺治疗肝硬化合并肝性脑病的临床疗效较好,显效较快,临床应用价值较高。     

肝性脑病患者临床分析

目的 对各种严重肝脏疾病出现肝性脑病患者进行药物治疗,对比研究临床疗效.方法 收集乙肝或丙肝肝硬化、原发性肝癌、药物性肝炎、布-卡综合征合并不同程度的肝性脑病患者48例.随机分为门冬氨酸和鸟氨酸治疗组(n=26)和乙酰谷酰胺治疗组(n=22),治疗7d后分析临床疗效,观察肝功能、血氨水平变化.结果 经过7d治疗,发现门冬氨酸和鸟氨酸治疗组显效14例(53.8%),有效10例(38.5%),无效2例(7.7%),无死亡,总有效率为92.3%;而乙酰谷酰胺组显效6例(27.3%),有效9例(40.9%),无效5例(22.7%),死亡2例(9.1%),总有效率为68.2%;2组间总有效率差异有统计学意义(P《0.05).2组患者肝功能(血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间)均有不同程度的恢复,但差异无统计学意义(P》0.05);而2组患者的血氨水平均有明显降低(P《0.05).结论 门冬氨酸和鸟氨酸是治疗肝性脑病的有效药物,可显著改善患者的临床症状.     

乙肝肝硬化患者并发肝性脑病的临床分析

目的 分析乙肝肝硬化患者并发肝性脑病时临床治疗方法及疗效.方法 收集2005-08～2006-12 因乙肝肝硬化出现的肝性脑病患者60例,随机分为乙酰谷酰胺治疗组(n=30)和门冬氨酸、鸟氨酸对照组(n=30),治疗1周后观察临床疗效,分析患者的肝功能变化情况.结果 乙酰谷酰胺组显效7例(23.3%),有效12例(40.0%),无效8例(26.7%),死亡3例(10.0%),总有效率为63.30%;而门冬氨酸和鸟氨酸治疗组显效15例(50.0%),有效12例(40.0%),无效3例(10.0%),无死亡,总有效率为90.0%;2组之间总有效率比较有明显差异(P＜ 0.01).另外,检测2组患者的肝功能,包括血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间,发现均有不同程度的恢复,但2组间无明显差异(P ＞ 0.05).结论 联合门冬氨酸和鸟氨酸是治疗乙肝肝硬化并发肝性脑病的有效药物.     

雅博司治疗乙肝肝硬化引起的肝性脑病26例疗效观察

目的 观察雅博司治疗乙肝肝硬化引起的肝性脑病的临床疗效。方法 将48例乙肝肝硬化出现肝性脑病患者随机分为雅博司组（26例）和乙酰谷酰胺组（22例）,治疗1周后观察疗效。结果 雅博司组显效12例（46．2％）,有效13例（50％）,无效1例（3.8％）,无死亡,总有效率为96．2％;而乙酰谷酰胺组显效5例（22．7％）。有效7例（31．8％）,无效6例（27．3％）,死亡4例（18．2％）,总有效率为54．5％。两组总有效率比较差异有显著性（P〈0．01）。雅博司组血氨浓度显著降低（P〈0．05）。结论 雅博司是治疗乙肝肝硬化患者肝性脑病的有效药物,可迅速控制惠者的临床症状,降低死亡率。     

门冬氨酸鸟氨酸联合纳洛酮治疗急性肝性脑病的疗效观察

目的观察门冬氨酸鸟氨酸联合纳洛酮治疗急性肝性脑病的临床疗效。方法 60例急性肝性脑病患者采取随机数字表法分为门冬氨酸鸟氨酸组15例,纳洛酮组15例及联合治疗组30例,比较3组治疗前后血氨及转氨酶指标,评价临床疗效。结果门冬氨酸鸟氨酸组和纳洛酮组与联合治疗组相比,血氨及转氨酶水平差异均有统计学意义(P0.05),联合治疗组总有效率明显高于门冬氨酸鸟氨酸组和纳洛酮组,差异有统计学意义(P0.05)。结论门冬氨酸鸟氨酸和纳洛酮联合治疗急性肝性脑病患者可显著提高临床疗效,改善预后,值得临床推广。     

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.     

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.     

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.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

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.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.