地牡宁神口服液联合托莫西汀治疗儿童注意力缺陷多动障碍的疗效观察

目的 探讨地牡宁神口服液联合托莫西汀治疗儿童注意力缺陷多动障碍的临床疗效。方法 回顾性分析2018年2月—2020年11月在南阳市中心医院进行治疗的94例注意力缺陷多动障碍患儿的临床资料,根据用药差别分为对照组和治疗组,每组各47例。对照组口服盐酸托莫西汀胶囊,体质量在70 kg下的患儿每日初始剂量为0.5 mg/kg,3 d后增加至1.2 mg/kg,单次服药,每日总剂量不可超过1.4 mg/kg;体质量大于70 kg的患儿每日初始总剂量为40 mg,3 d后可增加至目标剂量80 mg/d,单次服药,每日总剂量不可超过100 mg。治疗组在对照组基础上口服地牡宁神口服液,3～5岁5 mL/次,6～14岁10 mL/次,15岁以上15 mL/次,3次/d。两组均经12周治疗。观察两组的临床疗效,比较两组中医症候改善时间和相关评分。结果 治疗后,治疗组的总有效率是97.87%,显著高于对照组的82.98%（P<0.05）。经治疗,治疗组在多动不宁、注意力不集中、少眠多梦、手足心热、盗汗改善时间上均显著短于对照组（P<0.05）。经治疗,两组SNAP-Ⅳ评分、多动指数、CGI评分均较治疗前显著降低,但划消测验显著升高（P<0.05）;治疗后,治疗组相关量表积分改善优于对照组（P<0.05）。结论 地牡宁神口服液联合盐酸托莫西汀胶囊治疗儿童注意力缺陷多动障碍可有效改善患儿相关症候,有利于改善患儿冲动、多动的行为症状和认知能力,有着良好的临床应用价值。     

托莫西汀和阿立哌唑治疗儿童注意缺陷多动障碍的疗效比较

目的比较托莫西汀和阿立哌唑治疗儿童注意缺陷多动障碍的临床疗效。方法收集2015年1月—2016年1月在大连市第七人民医院诊治的88例注意缺陷多动障碍患者,根据用药方案的不同分为对照组和治疗组,每组各44例。对照组患儿口服阿立哌唑片,1片/次,每晚1次。治疗组患儿口服盐酸托莫西汀胶囊,初始剂量为每天0.5 mg/kg,治疗过程中根据临床反应及耐药性进行剂量调整,每天最大剂量为1.4 mg/kg。两组患儿均连续治疗6周。比较两组患儿临床效果、SNAP-IV量表评分、数字划消失误率和Conners父母量表测验结果。结果治疗后,对照组和治疗组的总有效率分别为81.82%、97.73%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后,两组患儿SNAP-IV量表评分、数字划消失误率和Conners父母量表测验结果均显著改善,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组患儿上述观察指标比对照组的改善更明显,两组比较差异有统计学意义(P0.05)。结论托莫西汀治疗注意缺陷多动障碍临床效果显著,有利于患者认知功能的改善,具有一定的临床推广应用价值。     

静灵口服液辅治癫痫共患儿童注意缺陷多动障碍临床效果及对DAT、DRD2基因表达的影响

目的 观察静灵口服液辅治癫痫共患儿童注意缺陷多动障碍患儿的临床效果及对多巴胺转运体(DAT)、多巴胺D2受体(DRD2)基因表达的影响。方法 选取2020年1—12月福建省龙岩市第二医院收治的癫痫共患儿童注意缺陷多动障碍患儿100例为研究对象,依据随机抽签法分为研究组和对照组,每组50例。对照组予以盐酸硫必利片与盐酸哌甲酯片治疗,研究组在此基础上予以静灵口服液治疗,2组均连续治疗4个月。比较2组患儿治疗效果,治疗前后DAT mRNA、DRD2 mRNA基因表达,治疗后癫痫发作次数及不良反应。结果 研究组治疗总有效率为96.00%,高于对照组的84.00%(χ²=4.000,P=0.046);治疗4个月后,研究组DAT mRNA、DRD2 mRNA水平较治疗前降低,且低于对照组(P均<0.01);研究组治疗后3、6、9、12个月癫痫发作次数均少于对照组,差异有统计学意义(P<0.01);研究组不良反应总发生率为4.00%,低于对照组的16.00%(χ²=4.000,P=0.046)。结论 癫痫共患儿童注意缺陷多动障碍患儿加用静灵口服...     

小儿智力糖浆联合哌甲酯治疗注意力缺陷多动障碍的系统评价

目的 评价小儿智力糖浆联合哌甲酯治疗注意力缺陷多动障碍的临床疗效及安全性。方法 计算机检索中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）、万方数据库、the Cochrane Library、PubMed和Web of Science中英文数据库,收集各数据库建库起至2021年12月26日小儿智力糖浆联合哌甲酯治疗注意力缺陷多动障碍的临床随机对照试验（RCT）。由两位研究人员独立筛选文献、提取资料,使用RevMan 5.4软件分析数据。结果 共纳入9项RCTs、包括861例患儿。Meta分析结果显示：小儿智力糖浆联合哌甲酯组在多动指数评分[MD=-0.32,95% CI（-0.40,-0.23）,P<0.000 01]、冲动行为评分[MD=-0.38,95% CI（-0.48,-0.29）,P<0.000 01]、学习行为评分[MD=-0.36,95% CI（-0.43,-0.29）,P<0.000 01]、不良反应率[RR=0.64,95% CI（0.46,0.89）,P=0.009]方面,与对照组比较,差异均有统计学意义。结论 小儿智力糖浆联合哌甲酯治疗注意力缺陷多动障碍的疗效优于单用哌甲酯,且更安全。     

阿立哌唑与利培酮治疗自闭症谱系障碍与注意缺陷多动障碍共病患儿的疗效与安全性评价

目的：评价阿立哌唑与利培酮治疗自闭症谱系障碍（ASD）与注意缺陷多动障碍（ADHD）共病患儿的疗效与安全性。方法：选取在某院精神科治疗的ASD和ADHD共病患儿68例,根据随机数字表法将患儿分为阿立哌唑组（n=34）和利培酮组（n=34）。阿立哌唑组患儿接受起始剂量为5 mg·d^-1的阿立哌唑片口服治疗,最终剂量增加至15 mg·d^-1。利培酮组患儿接受起始剂量为1 mg·d^-1的利培酮片口服治疗,最终剂量增加至2 mg·d^-1;2组患儿均治疗12周。在基线（T₀）、治疗6周（T₁）与12周（T₂）时,采用注意缺陷/多动评定量表（ADHD-RS）评价患儿总体ADHD症状变化情况;采用康纳斯行为评定量表（CRSR）教师用量表多动因子（CRSR-I）评价患儿多动症的改善情况;采用CRSR不注意缺陷-冲动因子（CRSR-H）评价患儿注意力缺陷的改善情况;采用临床整体印象-严重程度量表（CGI-S）及儿童总体评估量表（C-GAS）评分评价患儿整体功能。对患儿的相关临床指标进行常规监测,比较2组患儿药物不良事件与安全性。结果：与T₀时比较,阿立哌唑组患儿T₁与T₂时,ADHD-RS、CRSR-I、CRSR-H与CGI-S评分均显著降低（均P<0.05）,C-GAS评分显著提高（P<0.05）。利培酮组患儿T₂时,ADHD-RS、CRSR-I、CRSR-H与CGI-S评分均显著降低（均P<0.05）,C-GAS评分显著提高（P<0.05）。2组患儿的ADHD症状显著改善,多动症状与不注意缺陷-冲动症状显著改善,患儿的整体功能也显著改善。2组患儿主要的不良事件是食欲增加、体质量增加与嗜睡,但均没有发生严重的不良事件。T₂时,利培酮组患儿催乳素水平显著提高（t=9.619,P<0.001）,其他临床指标没有显著性差异（均P>0.05）。结论：阿立哌唑和利培酮能够通过减少ASD和ADHD共病患儿的注意力涣散和多动症症状来改善患儿整体功能,具有较高的疗效、安全性,值得临床推广应用。     

静灵口服液联合利他林治疗儿童注意力缺陷多动障碍共患学习障碍的疗效观察

目的观察静灵口服液联合利他林治疗儿童注意力缺陷多动障碍共患学习障碍的疗效。方法随机将门诊诊治的儿童注意力缺陷多动障碍共患学习障碍者分为静灵口服液联合利他林的治疗组(36例)和单用利他林的对照组(36例),经4月治疗后观察其治疗前后的减分率进行疗效评判比较,并观察不良反应。结果静灵口服液联合利他林对于多动症的症状改善的显效性高于对照组(P<0.05);对于学习障碍的改善的显效性高于对照组(P<0.05)。结论静灵口服液联合利他林对治疗儿童多动症合并学习障碍有较好疗效。     

静灵口服液联合盐酸哌甲酯控释片治疗小儿多动症的临床效果

目的 观察静灵口服液联合盐酸哌甲酯控释片治疗小儿多动症的临床效果。方法 回顾性选取2018年8月—2019年8月湖北省鄂州市妇幼保健院收治的多动症患儿80例,根据治疗方案不同分为试验组和对照组,每组40例。对照组患儿采用盐酸哌甲酯控释片治疗,试验组患儿则在对照组的基础上联合静灵口服液治疗,2组均连续治疗3个月。比较2组患儿治疗效果、治疗前后多动症状评分及不良反应。结果 试验组患儿治疗总有效率为95.00%,高于对照组的77.50%(χ²=5.357,P=0.021);治疗3个月后,2组患儿多动症状评分均较治疗前明显下降,且试验组低于对照组(P均<0.01);试验组不良反应总发生率为5.00%,低于对照组的20.00%(χ²=4.278,P=0.039)。结论 小儿多动症采用静灵口服液联合盐酸哌甲酯控释片治疗可取得良好效果,改善患儿多动症状评分,降低不良反应发生率,值得临床推广与应用。     

丁螺环酮联合阿立哌唑治疗精神分裂症焦虑症状的临床疗效和安全性

目的 探讨丁螺环酮联合阿立哌唑治疗精神分裂症焦虑症状的临床疗效。方法 采用随机、抽样与对照研究方法，选择2014年2月-2017年1月在新乡医学院第二附属医院诊治的精神分裂症患者84例，伴有焦虑症状，根据信封随机分组法分为观察组与对照组各42例，对照组给予阿立哌唑治疗，观察组在对照组治疗的基础上给予丁螺环酮治疗，两组都治疗观察3个月。比较两组的临床疗效及HAMA评分、皮质醇水平变化，观察两组在治疗期间出现的嗜睡、便秘、口干、头晕等不良反应情况。结果 观察组的总有效率（95.2%）显著高于对照组（81.0%），差异有统计学意义（P<0.05）。治疗后观察组、对照组的HAMA评分分别为（4.86±1.49）分和（7.98±2.10）分，都显著低于治疗前的（22.98±4.52）分和（23.87±3.10）分，同组治疗前后比较差异有统计学意义（P<0.05）；观察组也显著低于对照组，差异有统计学意义（P<0.05）。治疗后两组的皮质醇水平显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；观察组治疗后皮质醇水平也显著低于对照组，差异有统计学意义（P<0.05）。治疗期间两组的嗜睡、便秘、口干、头晕等不良反应发生情况对比无显著差异。结论 丁螺环酮联合阿立哌唑治疗精神分裂症，能改善患者的焦虑症状和临床疗效，安全性也比较好。     

神曲消食口服液联合乳酸菌素治疗小儿功能性消化不良的临床研究

目的 探讨神曲消食口服液联合乳酸菌素片治疗小儿功能性消化不良的临床疗效。方法 选取2022年4月—2023年6月北京市大兴区人民医院收治的104例功能性消化不良患儿,采用随机数表法将患儿分为对照组（52例）和治疗组（52例）。对照组嚼服乳酸菌素片,患儿＜5岁,0.4 g/次;患儿≥5岁,0.8 g/次,3次/d。治疗组在对照组治疗基础上口服神曲消食口服液,患儿＜5岁,5 mL/次;患儿≥5岁,10 mL/次,3次/d。两组均连续治疗2周。观察两组的临床疗效和中医症状改善时间,比较两组治疗前后功能性消化不良生存质量量表（FDDQL）评分及血清胃动素、神经肽Y水平。结果 治疗后,治疗组总有效率为96.15%,显著高于对照组的84.62%（P＜0.05）。治疗后,治疗组食少纳呆、脘腹痞闷、脘腹胀痛的改善时间均显著短于对照组（P＜0.05）。治疗后,两组FDDQL评分均高于治疗前（P＜0.05）;且治疗组的FDDQL评分高于对照组（P＜0.05）。治疗后,两组胃动素、神经肽Y水平均高于治疗前（P＜0.05）;且治疗后,治疗组胃动素、神经肽Y水平高于对照组（P＜0.05）。结论 神曲消食口服液联合乳酸菌素片治疗小儿功能性消化不良具有较好的治疗效果,可改善患儿的中医症状、生活质量及消化功能,并增加患儿食欲,且无明显不良反应。     

不同剂量利培酮治疗首发精神分裂症的疗效观察

目的 探讨不同剂量利培酮片治疗首发精神分裂症的临床疗效及其安全性评价。方法 选择2012年4月—2014年4月北京市房山区精神卫生保健院接受诊治的首发精神分裂症患者127例,随机分为大剂量组(n＝62)和小剂量组(n＝65)。大剂量组患者给予利培酮片起始剂量为0.5～1 mg/d,第2～3天根据患者病情和不良反应逐渐增加剂量为6 mg/d,维持量为6 mg/d。小剂量组患者给予利培酮片起始剂量为0.5～1 mg/d,第2～3天根据患者病情和不良反应逐渐增加剂量为3 mg/d,维持量为3 mg/d。两组均连续治疗8周。比较两组的临床疗效,并对比分析两组PANSS量表评分、锥体外系反应(EPS)发生情况及副反应量表(TESS)评分。结果 小剂量组患者总有效率为93.85%,大剂量组患者总有效率为82.26%,两组比较差异具有统计学意义(P< 0.05)。治疗后,两组患者阴性症状量表分、阳性症状量表分、精神病理量表分和PANSS总分均显著降低(P< 0.05);小剂量组阴性症状量表分、阳性症状量表分、精神病理量表分及PANSS总分治疗4、8周后均显著低于同期大剂量组,且差异具有统计学意义(P< 0.05)。小剂量组EPS发生率显著低于大剂量组,且差异具有统计学意义(P< 0.05)。小剂量组治疗4、8周TESS评分均显著低于大剂量组,差异具有统计学意义(P< 0.05)。结论 小剂量利培酮片治疗首发精神分裂症小剂量可明显提高疗效、减低PANSS评分、EPS发生少、不良反应少,明显优于大剂量利培酮片。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.