银杏达莫联合依达拉奉治疗缺血性脑卒中疗效观察

目的观察银杏达莫联合依达拉奉治疗缺血性脑卒中的疗效。方法收集缺血性脑卒中病例130例,按入院顺序随机分为,对照组和观察组各65例。对照组采用依达拉奉治疗,观察组采用银杏达莫联合依达拉奉治疗。比较2组间疗效差异和治疗前后患者血管弹性差异。结果观察组基本治愈率显著高于对照组,而无效率和恶化率则显著低于对照组,差异均有统计学意义(P0.05)。治疗14d后,观察组系统动脉阻力、肱动脉阻力显著低于对照组,系统动脉顺应性、肱动脉扩张性和小动脉弹性指数显著大于对照组(P0.05)。结论银杏达莫联合依达拉奉能有效改善缺血性脑卒中血管弹性,提高治愈率,降低致残率和病死率。     

依达拉奉治疗急性脑梗死的效果及对炎症因子与NIHSS评分的影响

目的探讨依达拉奉治疗急性脑梗死的效果及对炎症因子、NIHSS评分的影响。方法选择90例急性脑梗死患者为研究对象,分为2组。对照组给予脑梗死常规治疗,观察组在此基础上加用依达拉奉,比较2组治疗有效率及治疗前后炎症因子水平、NIHSS评分。结果 2组治疗前VEGF、TNF?α比较差异无统计学意义(P0.05),治疗1周、2周后观察组VEGF、TNF?α水平低于对照组,差异有统计学意义(P0.05)。2组治疗前NIHSS评分比较差异无统计学意义,治疗1周、2周后观察组NIHSS评分低于对照组,差异有统计学意义(P0.05)。观察组治疗有效率为91.1%,高于对照组的75.5%,差异有统计学意义(P0.05)。结论依达拉奉治疗急性脑梗死可有效清除自由基、抑制炎症因子水平与氧化反应,减轻神经功能损害,发挥脑保护作用,效果显著,具有重要应用价值。     

依达拉奉联合银杏达莫治疗急性脑梗死的Meta分析

目的 系统评价依达拉奉联合银杏达莫治疗急性脑梗死的临床疗效和安全性.方法 计算机检索PubMed(1995～2011)、CNKI (1995～2011)、维普数据库(1995～2011)和万方数据库(1995～2011),查找依达拉奉联合银杏达莫治疗急性脑梗死的随机对照试验.按照预定的纳入、排除标准筛选文献、提取资料和进行方法 学质量评价后,采用RevMan5.0软件进行Meta分析.结果 共纳入8个随机对照试验,合计793例患者,其中治疗组433例,对照组360例.各纳入研究基线资料具有可比性,均报道采用随机方法 但未提及具体随机方法,也未提及盲法和分配隐藏情况.Meta分析结果 显示:依达拉奉联合银杏达莫治疗急性脑梗死有效率方面与单独应用银杏达莫治疗比较,其差异均有统计学意义[其0R (95%CI)为2.67(1.33,5.39)];依达拉奉联合银杏达莫治疗急性脑梗死神经功能缺损方面与单独应用银杏达莫治疗比较,其差异也均有统计学意义[其SMD(95%CI)为-5.70 (-7.31,-4.09)].结论 依达拉奉联合银杏达莫治疗急性脑梗死疗效显著,且对神经功能障碍有良好改善作用.但由于本系统评价纳人研究的质量较低,存在偏倚的高度可能性,影响了结果 的论证强度,因此上述结论 应谨慎对待,并期待更多高质量的随机双盲对照试验以提供更高质量的证据.     

疏血通联合依达拉奉治疗急性脑梗死疗效观察

目的 观察疏血通联合依达拉奉治疗急性脑梗死的疗效和安全性. 方法 80例急性脑梗死患者随机分2组,治疗组给予疏血通联合依达拉奉治疗,对照组给予血塞通治疗,其他内科常规治疗相同.比较2组治疗前后神经缺损评分和疗效的变化.结果 治疗后治疗组和对照组神经功能缺损评分均有改善,但治疗后改善更明显,与对照组比较差异有统计学意义(P＜0.05).2组疗效比较差异有统计学意义(P＜0.05).结论 疏血通联合依达拉奉治疗急性脑梗死安全有效.     

依达拉奉联合奥扎格雷钠治疗急性进展性脑梗死疗效观察

目的观察依达拉奉联合奥扎格雷钠治疗急性进展性脑梗死的临床疗效。方法将我院收治的82例急性进展性脑梗死患者随机分为观察组41例和对照组41例。观察组在常规治疗的基础上行依达拉奉联合奥扎格雷钠治疗,对照组在常规治疗的基础上行单纯的奥扎格雷钠治疗。评价2组患者的临床治疗效果,同时对治疗前、治疗1个疗程及2个疗程的神经功能缺损程度进行评分。结果观察组总有效率90.24%,对照组75.61%,2组比较差异有统计学意义(P0.05)。治疗1周和2周后,观察组患者的平均神经功能缺损评分均低于对照组(P0.05)。结论依达拉奉联合奥扎格雷钠治疗急性进展性脑梗死疗效显著,且能有效改善患者的神经功能缺损症状,值得临床推广应用。     

依达拉奉联合尤瑞克林治疗急性脑梗死的临床观察

目的探讨对急性脑梗死患者应用依达拉奉联合尤瑞克林治疗的临床疗效,评价其安全性。方法选取2013-05-2015-05我院神经内科收治的68例急性脑梗死患者,按治疗方法不同分为观察组(34例,依达拉奉联合尤瑞克林治疗)和对照组(34例,单用依达拉奉治疗),对比2组患者的临床治疗效果及不良反应发生情况。结果 2组患者治疗前C反应蛋白水平、神经功能缺损评分比较,差异无统计学意义(P0.05);观察组治疗后C反应蛋白水平、神经功能缺损评分及不良反应总发生率均显著低于对照组,差异有统计学意义(P0.05)。结论采用依达拉奉联合尤瑞克林治疗急性脑梗死患者,疗效确切,安全可靠,可改善预后,值得推广。     

依达拉奉联合黄芪注射液治疗急性脑梗死临床疗效观察

目的观察依达拉奉联合黄芪注射液治疗脑梗死的临床疗效。方法将60例急性脑梗死患者随机分为联合治疗组和对照组各30例,2组除给予脑梗死常规治疗外,联合治疗组给予依达拉奉和黄芪注射液治疗。观察2组治疗前后神经功能缺损评分和临床疗效。结果联合治疗组神经功能缺损评分明显低于对照组,差异有统计学意义(P<0.05)。联合治疗组显效率73.3%,对照组显效率30.0%,2组比较差异有统计学意义(P<0.05)。结论脑梗死急性期应用依达拉奉和黄芪注射液治疗取得较好疗效,值得临床推广。     

前列地尔联合依达拉奉治疗急性脑梗死的疗效观察

目的观察前列地尔联合依达拉奉治疗急性脑梗死的疗效。方法 110例急性脑梗死患者随机分为治疗组59例和对照组51例。对照组在常规治疗基础上给予前列地尔治疗,治疗组在对照组治疗的基础上再加用依达拉奉治疗,连用2周,观察2组治疗前后神经功能缺损评分的变化,评价2组临床疗效。结果治疗组有效率明显高于对照组,差异有统计学意义(P0.05)。治疗后神经功能缺损(NIHSS)评分2组均有改善,但治疗组改善幅度明显优于对照组,差异有统计学意义(P0.05)。结论前列地尔联合依法拉奉合用治疗急性脑梗死疗效明显优于单用前列地尔。     

依达拉奉联合神经节苷脂治疗急性脑梗死对患者神经功能及血液流变学的影响

目的观察依达拉奉联合神经节苷脂治疗急性脑梗死对患者神经功能及血液流变学的影响。方法将2013-02-2015-02我院收治的88例急性脑梗死患者,按照随机数表法分为观察组(44例)和对照组(44例),对照组采用依达拉奉进行常规治疗;观察组在依达拉奉基础上应用神经节苷脂治疗。结果观察组总有效率(93.18%)明显高于对照组(79.55%),差异有统计学意义(P0.05)。观察组不良反应发生率为6.82%,明显低于对照组的15.91%,差异无统计学意义(P0.05)。治疗后第7天,2组神经功能缺损评分明显下降,且观察组神经功能缺损评分为(18.1±3.2)分,明显低于对照组的(21.3±3.9)分,差异有统计学意义(P0.05);但治疗1个疗程后,2组神经功能缺损评分比较差异无统计学意义(P0.05)。治疗后,除红细胞比积外,2组血液流变学各项指标均较治疗前有明显改善,差异具有统计学意义(P0.05)。结论依达拉奉联合神经节苷脂治疗急性脑梗死疗效显著,能够有效促进缺损神经恢复,改善血液流变学。     

丁苯酞联合依达拉奉治疗急性进展性脑梗死的疗效观察

目的观察丁苯酞联合依达拉奉治疗急性进展性脑梗死的疗效。方法选择128例急性进展性脑梗死的患者,随机分为对照组、丁苯酞组、依达拉奉组和治疗组共4组,每组各32例。对照组予以常规治疗;丁苯酞组在常规治疗的基础上加用丁苯酞治疗;依达拉奉组在常规治疗的基础上加用依达拉奉治疗;治疗组在常规治疗的基础上加用丁苯酞、依达拉奉联合治疗。疗程均为两周。在治疗前和治疗后1周、2周分别进行神经功能缺损程度评分(NIHSS)。结果治疗组的有效率达93.8%,治疗组对神经功能缺损的治疗效果优于丁苯酞组、依达拉奉组及对照组(P<0.05)。结论丁苯酞联合依达拉奉治疗急性进展性脑梗死疗效确切。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。