妥泰加用治疗难治性癫痫的临床研究

目的 观察妥泰对难治性癫痫的疗效和不良反应。方法 对56例难治性癫痫患者，采用加用妥泰治疗，控制其发作。结果 妥泰加用治疗总有效率达83．7％，儿童组有效率达80．8％，成人组为86．9％，对各型难治性癫痫均有效。妥泰起效时间在4～8周达高峰(有效率达59.2％)。副作用发生率为35．7％，且均较轻。结论 妥泰加用治疗难治性癫痫疗效较好，是一种广谱、安全、耐受性好的新型抗癫痫药。     

香薷饮治疗妥泰致不良反应42例报告

妥泰治疗癫痫、癫痫综合征 (尤其是难治性癫痫 )疗效较佳 ,但其可引起植物神经功能紊乱不良反应。 2 0 0 2年 2～ 8月 ,我们应用中药方剂香薷饮加减治疗此种不良反应 ,效果满意 ,现报告如下。临床资料 :本文 42例 ,男 2 6例、女 16例 ,年龄 2～ 45岁 ,癫痫病程 1～ 16年。其中在加量期 17例 ,维持量期 2 5例。癫痫发作类型为简单部分性发作 2例 ,复杂部分性发作 7例 ,部分性发作继发全身性发作 19例 ,失神发作 1例 ,全身强直 -阵挛性发作 10例 ,West综合征 1例 ,其他 2例。服用妥泰后出现不良反应时间多在 1～ 2个月。其不良反应主要表现为…     

托吡酯治疗老年癫痫发作的临床研究

国外研究显示，老年患者癫痫发病率明显高于年轻人，而75岁以上的老年人癫痫发病率为青年人的6—10倍。与成年人及儿童癫痫不同，老年人癫痫病因以症状性癫痫多见，发作形式多为部分性发作伴／不伴继发性全身发作。托吡酯（Topiramate，TPM，商品名妥泰），属新型抗癫痫药物（AEDs），临床证明作为加用治疗对老年人、成人及儿童癫痫发作均有效。本文比较了老年癫痫患者TPM不同给药方法的疗效和副作用，以寻找更有效的TPM给药途径。     

神经妥乐平联合血栓通治疗糖尿病周围神经病变30例临床观察

目的观察神经妥乐平联合血栓通治疗糖尿病周围神经病变（DPN）的疗效。方法将58例DPN患者随机分为观察组30例和对照组28例,两组均予糖尿病常规治疗及血栓通静滴,观察组在此基础上加用神经妥乐平静滴,疗程均为2周。根据两组治疗前后周围神经病变总症状评分（TSS）及神经传导速度（NCV）变化判定疗效。结果观察组显效11例（36．6％）、有效15例、无效4例、总有效率（显效＋有效）为86．7％,对照组显效6例（21．4％）、有效10例、无效12例、总有效率为57．1％,观察组显效率及总有效率均显著高于对照组（P〈0．05）。结论神经妥乐平联合血栓通治疗DPN近期效果确切。     

拉米夫定联合母牛分枝杆菌菌苗治疗慢性乙型肝炎

目的观察拉米夫定联合母牛分枝杆菌菌苗治疗慢性乙型肝炎的疗效。方法选择HBsAg,HBeAg,HBV DNA均阳性半年以上的患者84例,分为治疗组54例,对照组30例。两组均给予拉米夫定0.1g/d,治疗组加用母牛分枝杆菌菌苗22.5μg,深部肌肉注射,每周一次。共24周。结果治疗结束时两组ALT,TBIL复常率无显著差异,但HBeAg,HBV DNA阴转率差异显著。联合治疗组无应答率29.6%,低于单用拉米夫定组。有效率达70.4%,显著高于单用拉米夫定组。结论拉米夫定联合免疫调节剂母牛分枝杆菌菌苗能提高抗HBV的疗效。     

痰热清联合抗生素治疗淋巴瘤合并肺部感染的疗效观察

目的 观察痰热清注射液联合抗生素治疗淋巴瘤合并肺部感染的临床疗效.方法 64例淋巴瘤合并肺部感染患者随机分为观察组(A组,n =32例)与对照组(B组,n=32例),对照组单用敏感抗生紊治疗,观察组在对照组基础上加用痰热清注射液治疗.两组疗程均为2周,观察两组疗效及体温恢复正常时间,咳嗽咳痰消失时间,肺部罗音消失时间等情况,同时观察两组治疗副作用.结果 观察组治疗总有效率为84.4％,对照组治疗总有效率为68.8％,两组治疗总有效率差异有统计学意义(P＜0.05).结论 痰热清注射液联合抗生素治疗淋巴瘤合并肺部感染疗效明显,副作用少.     

卡维地洛治疗慢性充血性心衰的疗效观察

目的　观察卡维地洛片治疗慢性充血性心衰的疗效。方法　将 98例器质性心脏病 ,CHF患者分为治疗组 5 0例 ,在常规抗心衰治疗的基础上加用卡维地洛片治疗 10周 ;对照组 4 8例 ,单用常规抗心衰治疗 10周。结果　治疗组在减慢心率、改善心功能等方面均优于对照组 ,总有效率分别为 82 %和 6 2 5 % ,两组间有显著差别 ,P <0 0 5。结论　在常规抗心衰治疗基础上加用卡维地洛片 ,可明显降低心率、改善心功能。     

32例复发性阴茎疱疹的诊断与治疗

目的 探讨顽固性、复发性阴茎疱疹的治疗方法。方法 局部用2％龙胆紫外涂;有溃疡者用3％～5％硝酸银或白降汞软膏,隔日用生理盐水冲洗,保持局部清洁干燥;局部有感染者加用抗生素。有19例单用赛诺金,7例加用唯尔本,另6例加用日达仙。治疗时间2周～15个月。结果 本组32例,治愈30例(93.75％)。2周内痊愈11例,6周内痊愈8例,8周内痊愈7例;4例在15个月治愈,另2例在随访中复发。32例患者中19例进行艾滋病病毒检查均为阴性。结论 采用干扰素、日达仙、唯尔本等抗病毒、增强机体免疫力的药物是系统治疗顽固性、复发性阴茎疱疹的有效方法。     

小剂量利妥昔单抗治疗系统性红斑狼疮的临床观察

目的 评价小剂量利妥昔单抗治疗系统性红斑狼疮(SLE)的疗效和安全性.方法 对既往激素和多种免疫抑制剂治疗无效或复发的10例SLE患者,予利妥昔单抗100mg,使用4次,同时仅联合使用激素,观察疗效和不良反应.结果 利妥昔单抗对狼疮肾炎、神经精神性狼疮、顽固性血小板减少以及自身免疫性溶血性贫血均显示有良好的疗效,且起效迅速.10例患者中仅1例出现了泌尿系感染,1例在首剂利妥昔单抗治疗1周后猝死,但不能确定死亡原因与利妥昔单抗相关.结论 小剂量利妥昔单抗治疗SLE有良好的疗效和安全性,并且降低了治疗费用.     

多潘立酮联合复方消化酶治疗功能性消化不良84例

目的: 观察多潘立酮联合复方消化酶胶囊治疗功能性消化不良的临床疗效和安全性.方法: 84例功能性消化不良患者随机分为两组, 每组42例, 两组均口服多潘立酮片, 三餐饭前30 min服用10 mg; 试验组加服复方消化酶胶囊, 三餐饭后30 min服用1粒. 4 wk后观察疗效.结果: 试验组治疗总有效率明显优于对照组,分别为85.7%和61.9%( P<0.05). 对上腹痛、餐后饱胀、早饱、上腹烧灼感症状改善情况进行比较, 试验组治疗前后的症状总积分及症状改善有效率较对照组有显著性差异( P<0.05),而且起效时间明显缩短. 两组患者均未发现严重不良反应.结论: 多潘立酮联合复方消化酶胶囊治疗功能性消化不良的临床疗效明显优于单用促动力药多潘立酮.     

The rapidity of drug dose escalation influences blood pressure response and adverse effects burden in patients with hypertension: the Quinapril Titration Interval Management Evaluation (ATIME) Study. ATIME Research Group

BACKGROUND: Antihypertensive medication doses are typically increased within several weeks after initiation of therapy because of inadequate blood pressure (BP) control and/or adverse effects. METHODS: We conducted a parallel-group clinical trial with 2935 subjects (53% women, n=1547) aged 21 to 75 years, with Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VI stages 1 to 2 hypertension, recruited from 365 physician practices in the southeastern United States. Participants were randomized either to a fast (every 2 weeks; n=1727) or slow (every 6 weeks; n=1208) drug titration. Therapy with quinapril, an angiotensin-converting enzyme inhibitor, was initiated at 20 mg once daily. The dose was doubled at the next 2 clinic visits until the BP was lower than 140/90 mm Hg or a dose of 80 mg was reached. RESULTS: Pretreatment BP averaged 152/95 mm Hg. Patients with stage 2 hypertension reported more symptoms than those with stage 1. The BP averaged 140/86, 137/84, and 134/83 mm Hg in the slow group compared with 141/88, 137/85, and 135/84 mm Hg in the fast group at the 3 respective clinic visits. The BP control rates to lower than 140/90 mm Hg at the 3 clinic visits were (slow, fast, respectively) 41.3%, 35.7% (P<.001); 54.3%, 51.5% (P=.16); and 68%, 62.3% (P=.02). In the fast group, 10.7% of participants experienced adverse events vs 10.8% in the slow group; however, 21.0% of adverse events in the fast group were "serious" vs only 12% in the slow group. CONCLUSION: Slower dose escalation of the angiotensin-converting enzyme inhibitor quinapril provides higher BP control rates and fewer serious adverse events than more rapid drug dose escalation.     

胃宁口服液治疗慢性浅表性胃炎的临床观察

目的:观察胃宁口服液对慢性浅表性胃炎的临床疗效.方法:选择210例慢性浅表性胃炎患者,治疗组150例,采用胃宁口服液治疗;对照组60例,采用雷尼替丁胶囊治疗.疗程30 d,观察疗效和不良反应.结果:治疗组和对照组临床总有效率分别为89.33%和61.67%;抗幽门螺杆菌(Hp)有效率分别为78.30%和34.15%;停药后1年复发率分别为29.63%和71.43%,两组比较差异均有统计学意义(均P＜0.05).治疗过程中未发现明显不良反应.结论:胃宁口服液治疗慢性浅表性胃炎效果显著,无明显不良反应.     

Efficacy of milnacipran in patients with fibromyalgia

OBJECTIVE: Fibromyalgia (FM) is a common musculoskeletal condition characterized by widespread pain, tenderness, and a variety of other somatic symptoms. Current treatments are modestly effective. Arguably, the best studied and most effective compounds are tricyclic antidepressants (TCA). Milnacipran, a nontricyclic compound that inhibits the reuptake of both serotonin and norepinephrine, may provide many of the beneficial effects of TCA with a superior side effect profile. METHODS: One hundred twenty-five patients with FM were randomly assigned in a 3:3:2 ratio to receive milnacipran twice daily, milnacipran once daily, or placebo for 3 months in a double-blind dose-escalation trial; 92% of twice-daily and 81% of once-daily participants achieved dose escalation to the target milnacipran dose of 200 mg. RESULTS: The primary endpoint was reduction of pain. Both the once- and twice-daily groups showed statistically significant improvements in pain, as well as improvements in global well being, fatigue, and other domains. Response rates for patients receiving milnacipran were equal in patients with and without comorbid depression, but placebo response rates were considerably higher in depressed patients, leading to significantly greater overall efficacy in the nondepressed group. CONCLUSION: In this Phase II study, milnacipran led to statistically significant improvements in pain and other symptoms of FM. The effect sizes were equal to those previously found with TCA, and the drug was generally well tolerated.     

Adalimumab dose escalation is effective and well tolerated in Crohn’s disease patients with secondary loss of response to adalimumab

BackgroundAlthough adalimumab is effective in Crohn’s disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn’s disease patients with a secondary loss of response.MethodsWe performed a retrospective and observational study including all Crohn’s disease patients who underwent dose escalation of adalimumab after a secondary loss of response from 2007 to 2015.ResultsA clinical response was observed in 99/124 (79%) patients at 3 months and in 62/107 (61%) patients at 12 months. The predictive factors of response to ADA dose escalation at 12 months on multivariate analysis were: maintenance therapy of 40 mg every week rather than 80 mg every other week (OR 3.64, 95% CI: 1.28–10.37) and a CRP level ≤ 5 mg/L at adalimumab dose escalation (OR 6.64, 95% CI: 1.40–27.53). Adalimumab was withdrawn in 4 patients due to side effects.ConclusionsAdalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss of response. A 40 mg every week optimized regimen was predictive of a response to ADA dose escalation.     

Twice weekly 5-azacytidine infusion in dissmeinated metastatic cancer: a phase II study.

A phase II study of 5-azacytidine given twice weekly as a rapid iv infusion was performed on 116 patients with different metastatic cancers of refractory lymphomas at a dose of 150 mg/m2 twice weekly x 6. Ninety-one patients were evaluable. Dose modifications were carried out depending on previous treatment status. Nausea and vomiting was a major side effect; significant granulocytopenia was observed in 35 patients. Responses were observed in only four patients. Our results indicate little effectiveness of this drug. The severe toxicity prevented escalation to potentially more effective dose levels.     

6-MP metabolite profiles provide a biochemical explanation for 6-MP resistance in patients with inflammatory bowel disease

BACKGROUND & AIMS: Approximately 40% of inflammatory bowel disease (IBD) patients fail to benefit from 6-mercaptopurine (6-MP)/azathioprine (AZA). Recent reports suggest 6-thioguanine nucleotide (6-TGN) levels (>235) independently correlate with remission. An inverse correlation between 6-TGN and thiopurine methyltransferase (TPMT) has been described. The objectives of this study were to determine whether dose escalation optimizes both 6-TGN levels and efficacy in patients failing therapy because of subtherapeutic 6-TGN levels and its effect on TPMT. METHODS: Therapeutic efficacy and adverse events were recorded at baseline and upon reevaluation after dose escalation in 51 IBD patients. 6-MP metabolite levels and TPMT activity were recorded blinded to clinical information. RESULTS: Fourteen of 51 failing 6-MP/AZA at baseline achieved remission upon dose escalation, which coincided with significant rises in 6-TGN levels. Despite increased 6-MP/AZA doses, 37 continued to fail therapy at follow-up. Dose escalation resulted in minor changes in 6-TGN, yet a significant increase in 6-methylmercaptopurine ribonucleotides (6-MMPR) (P < or = 0.01) and 6-MMPR:6-TGN ratio (P < 0.001). 6-MMPR rises were associated with dose-dependent hepatotoxicity in 12 patients (24%). TPMT was not influenced by dose escalation. CONCLUSIONS: Serial metabolite monitoring identifies a novel phenotype of IBD patients resistant to 6-MP/AZA therapy biochemically characterized by suboptimal 6-TGN and preferential 6-MMPR production upon dose escalation.     

普罗帕酮治疗阵发性室上性心动过速的疗效

目的总结我院普罗帕酮治疗阵发性室上性心动过速的疗效。方法阵发性室上性心动过速患者,给予普罗帕酮70mg加入10%葡萄糖注射液20ml中静脉注射,5～8min注完;首剂未能转律者,再每10分钟注射普罗帕酮35mg,最大累积用量不超过175mg。复律后给予口服普罗帕酮150～200mg,每日3次,维持治疗。结果48例(48/62,77%)首剂即转窦性心律,10例追加剂量后转为窦性,总有效率93.5%。继续以普罗帕酮治疗,随访半年以上未见复发。结论普罗帕酮能有效终止阵发性室上性心动过速。     

Strategies for overcoming anti-tumor necrosis factor drug antibodies in inflammatory bowel disease: Case series and review of literature

Anti-tumor necrosis factor(TNF) biologics are currentlyamongst the most widely used and efficacious therapies for inflammatory bowel disease(IBD). The development of therapeutic drug monitoring for infliximab and ada-limumab has allowed for measurement of drug levels and antidrug antibodies. This information can allow for manipulation of drug therapy and prediction of response. It has been shown that therapeutic anti-TNF drug levels are associated with maintenance of remission, and development of antidrug antibodies is predictive of loss of response. Studies suggest that a low level of drug antibodies, however, can at times be overcome by dose escalation of anti-TNF therapy or addition of an immunomodulator. We describe a retrospective case series of twelve IBD patients treated at the University of California-Irvine, who were on infliximab or adalimumab therapy and were found to have detectable but low-level antidrug antibodies. These patients underwent dose escalation of the drug or addition of an immunomodulator, with subsequent follow-up drug levels obtained. Eight of the twelve patients(75%) demonstrated resolution of antidrug antibodies, and were noted to have improvement in disease activity. Though data regarding overcoming low-level anti-TNF drug antibodies remains somewhat limited, cases described in the literature as well as our own experience suggest that this may be a viable strategy for preserving the use of an anti-TNF drug. Low-level anti-TNF drug antibodies may be overcome by dose escalation and/or addition of an immunomodulator, and can allow for clinical improvement in disease status. Therapeutic drug monitoring is an important tool to guide this strategy.     

思美泰治疗酒精性肝病疗效观察

目的　观察思美泰粉针剂对酒精性肝病的疗效和安全性。方法　将临床确诊为酒精性肝病的 12 0例门诊或住院病人随机分为两组 ,治疗组给予思美泰 1 0g每日一次静点 ,对照组给予维生素C 2 0g、维生素B60 2g静点 ,疗程 2 0天。结果　治疗组失访 4例 ,对照组失访 6例。治疗组显效率 5 3 6 %,总有效率为 80 4 %;对照组显效率为 38 9%,总有效率为 74 1%。两组比较 ,治疗组显效率明显高于对照组 (t =2 6 0 ,P <0 0 5 ) ,两组总有效率无显著性差异 (t=1 5 5 ,P >0 10 )。两组均未见明显不良反应。结论思美泰粉针剂治疗酒精性肝病有较好疗效。