拉莫三嗪治疗儿童癫痫的效果与护理

目的探讨拉莫三嗪（LTG）治疗儿童癫痫的疗效与护理。方法对2008年1月至2009年12月共31例新诊断为癫痫的患儿使用LTG治疗进行并开放性自身前后对照研究,观察期间采取服药指导、心理护理、饮食护理、健康安全宣教、护理随访等措施。结果31例患儿中有3例失访,余28例随访时间均在6个月以上,治疗有效率为89．28％;发作完全控制占71．43％,部分控制占17．86％,药物不良反应少。结论抗癫痫新药LTG治疗儿童癫痫疗效较好,安全性高;加强患儿和家属的护理和健康教育有利于减少不良反应的发生,提高用药安全性及药物保有率,促进患儿早日康复。     

拉莫三嗪联合丙戊酸治疗各型癫痫的临床效果

目的：探讨拉莫三嗪（LTG）联合丙戊酸（VPA）治疗各种类型的癫痫患者的临床效果。方法选取2010年1月至2014年1月收治的197例癫痫患者,分为全身性发作型52例,单纯性部分发作型28例,复杂性部分发作型76例,部分发作继发全身强直痉挛发作型41例,所有患者均采用 VPA ＋ LTG 治疗。观察患者治疗前与治疗后的发作频率、临床疗效;比较不同癫痫发作类型的血清白细胞介素2（IL -2）、白细胞介素6（IL -6）、肿瘤坏死因子α（TNF -α）水平及不良反应发生情况。结果全身性发作型患者的发作频率：1.42±0.67（次/月）,单纯性部分发作型患者：0.82±0.43（次/月）,复杂性部分发作型患者：1.47±0.75（次/月）,部分继发强直痉挛发作型患者：1.53±0.66（次/月）较治疗前均显著的降低,差异均具有统计学意义（ P <0.05）。治疗后不同发作类型癫痫患者的治疗效果比较,差异均无统计学意义（ P >0.05）;治疗后各组患者的血清 IL -2、IL -6、TNF -α水平较治疗前均显著的降低,差异均具有统计学意义（ P <0.05）。197例癫痫患者出现皮疹占2.03％,转氨酶升高占1.52％。结论 LTG 联合 VPA 对各种类型的癫痫患者治疗效果均满意,患者的不良反应轻,能增强患者的机体免疫力,提高患者的依从性,值得临床推广应用。     

Detection of physiological concentrations of cortisol and cortisone in human hair

OBJECTIVE: Since the 1960s, glucocorticoids are used by athletes to improve their performances. Their use is restricted in sports. Hair can document chronic abuse and can be therefore a complementary matrix for doping control. We have developed a new extraction, purification, and separation technique using liquid chromatography and mass spectrometry for the identification and quantification of two endogenous glucocorticoids: cortisol and cortisone. METHODS: Qualitative and quantitative investigations were achieved with 44 hair samples (17 males, 27 females; age ranging from 2 to 90 years). Hair strands were washed in methylene chloride, the first two centimeters of the strand were cut and pulverized in a ball mill. The powdered hair was incubated in 2 mL Soerensen buffer, pH 7.6, for 16 h at 40 degrees C, in the presence of cortisol-d3 as an internal standard. Purification of the incubation medium was achieved on SPE C18 Isolute extraction columns followed by an alkaline liquid-liquid extraction with diethylether. The eluate was evaporated to dryness and resuspended in 25 microL of acetonitrile/ammonium formiate (1:1,v/v). The chromatography was operated on a LC Packings Superba Nucleosil C18 column using a linear gradient of acetonitrile from 30% to 70% in 10 min. The detector was a Perkin Elmer Sciex API 100 mass spectrometer. The detector's response was linear for cortisol and cortisone concentrations ranging from 1 to 500 pg/mg. Extraction recovery at 50 pg/mg was 74% for cortisol and 32% for cortisone. Repeatability (CV values n = 8) at 7 pg/mg cortisol and at 50 pg/mg cortisone were 11% in both cases. Limit of detection and limit of quantification were 1 and 5 pg/mg, for both compounds, respectively. RESULTS: Cortisol concentrations in hair ranged from 5 to 91 pg/mg (mean 18 pg/mg). Cortisone concentrations in hair ranged from 12 to 163 pg/mg (mean 70 pg/mg). No influence of hair colour could be found. Influence of sex on cortisone concentrations seems possible but could not be statistically demonstrated. Finally, cortisone concentrations in hair are significantly higher before the age of 20. Incorporation of cortisol and cortisone in hair could follow a passive diffusion through sweat after conversion of part of cortisol to cortisone by Type 2 11-beta-Hydroxysteroid-dehydrogenase in sweat glands. This issue was documented by these analyses.     

幽门螺杆菌唾液测试板与14C-尿素呼气试验检测幽门螺杆菌感染的比较

目的:比较幽门螺杆菌唾液测试板(HPS)与14C-尿素呼气试验(14C-UBT)检测幽门螺杆菌(Hp)感染的临床价值。方法:用HPS检测唾液中的尿素酶,同时行14C-UBT及胃镜检查行快速尿素酶试验(rapidurease test,RUT)、胃黏膜组织学检查(改良Giemsa染色)及细菌培养联合检测来判断胃黏膜Hp感染情况,并比较HPS与14C-UBT诊断Hp感染的阳性率、敏感性、特异性、准确性、阳性预测值及阴性预测值。结果:160例患者行Hp联合检测检出阳性患者102例,阳性率为63.75%,其中HPS检出76例,阳性率47.50%,14C-UBT检出94例,阳性率58.75%。HPS、14C-UBT诊断Hp感染的敏感性分别为72.55%、80.39%;特异性分别为96.55%、79.31%;准确性分别为81.25%、80.00%;阳性预测值分别为97.37%、87.23%;阴性预测值分别为66.67%、69.70%。对以上结果进行χ2检验,差异均无统计学意义。结论:HPS检测Hp感染的阳性率及准确性、敏感性、特异性与14C-UBT相近,且此法快速、简便,价格低廉,不需要任何其他仪器,是值得临床进一步验证的一种新的非侵入性Hp感染诊断方法。     

血清与血浆葡萄糖水平的比较

目的探讨在当前国内实验条件下血浆与血清葡萄糖值的差异,以及血液标本存放时间对血糖值的影响。方法采用葡萄糖氧化酶、4-氨基安替比林及终点法。标本来自门诊查体的30例患者,使用EDTA、肝素抗凝。结果即时血清葡萄糖水平比肝素血浆高约0.1~0.3mmol/L;全血标本37℃水浴1h后,血清葡萄糖水平降低幅度为0.9~1.1mmol/L,血浆糖水平降低幅度为0.5~0.7mmol/L;水浴2h后,与即时血糖水平相比,血清糖水平降低幅度为1.3~1.5mmol/L,血浆糖水平降低幅度为0.7~0.9mmol/L;室温1h后,血清糖水平降低幅度为0.3~0.6μmol/L,血浆糖水平降低幅度为0.2~0.3mmol/L;室温1h后再置水浴1h,血清糖水平降低幅度为0.6~1.2μmol/L,血浆糖水平降低幅度为0.3~0.7mmol/L;室温2h后,再置水浴1h后,血清糖水平降低幅度为1.4~1.8mmol/L,血浆糖水平降低幅度为0.7~1.1mmol/L;室温3h后,血清糖水平降低幅度为0.9~1.3mmol/L,血浆糖水平降低幅度为0.8~1.0mmol/L。采用标本立即离心,再置37℃水浴1h后析出血清,再吸标本,血糖值降低0.5~0.6mmol/L。将肝素防凝血标本离心再置室温1h,血糖降低仅0.08mmol/L。置室温15min后的分离胶血清比即刻离心的分离胶血清葡萄糖低约0.2mmol/L,放置时间对血液标本中葡萄糖的降低呈绝对值改变。结论及时分离肝素防凝或分离胶得到的血浆或血清均可真实地反映患者血液中葡萄糖的水平。     

Measurement of morning saliva cortisol in athletes

Objectives

To evaluate feasibility and reliability of measuring saliva cortisol in athletes.

Design and methods

Saliva cortisol was measured in 25 soccer players, and compared with serum cortisol measured with two commercial immunoassays.

Results

A highly significant correlation was observed between saliva and serum cortisol. The percentage of saliva and serum values above the upper limit of the reference range was nearly identical.

Conclusions

Salivary measurement is a suitable approach for monitoring cortisol in athletes.     

Phenytoin and phenobarbital concentrations in saliva and plasma measured by radioimmunoassay.

Saliva and plasma levels of phenytoin (DPH) and phenobarbital (PB) in a series of epileptic patients were compared by means of a radioimmunoassat (RIA) that required only 10 mul of saliva or plasma. There was an excellent linear relation (r = 0.98) between the logarithms of the concentrations of DPH in the two fluids. The ratio saliva/plasma was remarkably constant at 0.10 and was unaffected by varying levels of PB. The ratio was close to the fraction of DPH reported unbound in plasma at 37 degrees. PB plasma and saliva levels were also closely related (r = 0.98 for logarithm of plasma and saliva levels). This relation was nonlinear [plasma ocncentration = 4.43 X (salivary concentration)0.86], but could be approximated by the ratio plasma/saliva = 3.4. The simplicity of sample collection and the sensitivity of the RIA procedure suggest that clinical monitoring of these anticonvulsant levels may be carried out by RIA on saliva samples.     

改良单根毛囊分离法在眉部和会阴部毛发缺失治疗中的应用初探

目的：探讨改良单根毛囊分离法治疗毛发缺失的临床疗效。方法：对眉毛稀疏16例、会阴毛发稀疏9例患者,采用改良的单根毛囊分离法分离出单根毛囊后植入,每例单侧全眉种植约150~200个移植体,会阴部种植约500~600个移植体。随访其疗效。结果：25例患者随访3~12个月,毛发成活率达90%~95%,植入区外观自然,瘢痕不明显。结论：眉部和会阴部单根毛发移植术中采用改良的单根毛囊分离法,能便捷得到更多完整单根毛囊,从而提高供区毛发的使用率。     

The interpretation of hair analysis for drugs and drug metabolites

Introduction: Head hair analysis for drugs and drug metabolites has been used widely with the aim of detecting exposure in the weeks or months prior to sample collection. However, inappropriate interpretation of results has likely led to serious miscarriages of justice, especially in child custody cases.

Objective: The aim of this review is to assess critically what can, and perhaps more importantly, what cannot be claimed as regards the interpretation of hair test results in a given set of circumstances in order to inform future testing.

Methods: We searched the PubMed database for papers published 2010–2016 using the terms “hair” and “drug” and “decontamination”, the terms “hair” and “drug” and “contamination”, the terms “hair” and “drug-facilitated crime”, the terms “hair” and “ethyl glucuronide”, and the terms “hair”, “drug testing” and “analysis”. Study of the reference lists of the 46 relevant papers identified 25 further relevant citations, giving a total of 71 citations.

Hair samples: Drugs, drug metabolites and/or decomposition products may arise not only from deliberate drug administration, but also via deposition from a contaminated atmosphere if drug(s) have been smoked or otherwise vaporized in a confined area, transfer from contaminated surfaces via food/fingers, etc., and transfer from sweat and other secretions after a single large exposure, which could include anesthesia. Excretion in sweat of endogenous analytes such as γ-hydroxybutyric acid is a potential confounder if its use is to be investigated. Cosmetic procedures such as bleaching or heat treatment of hair may remove analytes prior to sample collection. Hair color and texture, the area of the head the sample is taken from, the growth rate of individual hairs, and how the sample has been stored, may also affect the interpretation of results.

Toxicological analysis: Immunoassay results alone do not provide reliable evidence on which to base judicial decisions. Gas or liquid chromatography with mass spectrometric detection (GC- or LC-MS), if used with due caution, can give accurate analyte identification and high sensitivity, but many problems remain. Firstly, it is not possible to prepare assay calibrators or quality control material except by soaking “blank” hair in solutions of appropriate analytes, drying, and then subjecting the dried material to an analysis. The fact that solvents can be used to add analytes to hair points to the fact that analytes can arrive not only on, but also in hair from exogenous sources. A range of solvent-washing procedures have been advocated to “decontaminate” hair by removing adsorbed analytes, but these carry the risk of transporting adsorbed analytes into the medulla of the hair therefore confounding the whole procedure. This is especially true if segmental analysis is being undertaken in order to provide a “time course” of drug exposure.

Proposed clinical applications of hair analysis: There have been a number of reports where drugs seemingly administered during the perpetration of a crime have been detected in head hair. However, detailed evaluation of these reports is difficult without full understanding of the possible effects of any “decontamination” procedures used and of other variables such as hair color or cosmetic hair treatment. Similarly, in child custody cases and where the aim is to demonstrate abstinence from drug or alcohol use, the issues of possible exogenous sources of analyte, and of the large variations in analyte concentrations reported in known users, continue to confound the interpretation of results in individual cases.

Conclusions: Interpretation of results of head hair analysis must take into account all the available circumstantial and other evidence especially as regards the methodology employed and the possibility of surface contamination of the hair prior to collection.     

血浆纤维蛋白原、血脂指标与血浆黏度的相关性及回归分析

目的：探讨血浆纤维蛋白原、血脂血糖与血黏度的相关性。方法对201例本院住院患者作血浆黏度与血浆纤维蛋白原、血脂血糖检验及相关统计学分析。结果在P<0.05水平上,纤维蛋白原、胆固醇、甘油三酯、低密度脂蛋白与血浆粘度具有显著直线正相关性,而血糖不具有显著直线正相关性。多元回归分析排除了低密度脂蛋白,得出回归方程PV=1.179+0.039×FG+0.021×TC+0.016×TG。结论纤维蛋白原与血浆黏度具有显著线性相关,一元及多元回归分析均显示其与血浆黏度的相关系数最大,相关性较其它指标更明显,血胆固醇、甘油三酯、低密度脂蛋白与血浆粘度也具有显著线性相关。     

基于健康人群唾液葡萄糖检测体系的构建

目的为实现对健康人群进行日常的无创血糖监测,构建基于唾液的高灵敏度葡萄糖检测体系。方法通过对反应体系最适pH值、离子强度的筛选及酶活性调节剂柠檬醛的添加,对以2,4,6-三溴-3-羟基苯甲酸(TBHBA)为色原的葡萄糖氧化酶法进行改良。结果新构建的葡萄糖检测体系反应30 min趋于完全,在510 nm最大吸收波长下检测吸光度(A)值,得到优化参数组合为pH值5.8、0.3 mol/L NaCl、1 220μg/mL柠檬醛。葡萄糖检测低限0.006 mmol/L。结论优化后的检测体系灵敏度是原体系约7倍,检测低限为健康人空腹时唾液葡萄糖平均浓度的1/10,完全达到检测健康人唾液葡萄糖浓度的灵敏度要求。     

唾液IgG抗体测定诊断幽门螺杆菌感染

探讨唾液抗ＨｐＩｇＧ测定对Ｈｐ感染的诊断价值。方法用ＥＬＩＳＡ法测定５４例Ｈｐ阳性及１５例Ｈｐ阴性患者唾液内抗ＨＰＩｇＧ,并与血清抗体测定结果相比较。结果唾液抗ＨＰＩｇＧ对ＨＰ感染诊断的敏感性为９０．７％,特异性为８０％,准确性为８８．４％,阳性预测值９４．２％,阴性预测值７０．６％,与血清测定结果接近（分别为９２．６％,８６．７％,９１．３％,９６．ｌ％和７６．５％）,唾液ＨｐＩｇＧ与血清内ＨｐＩｇＧ滴度显著正相关（ｒ＝０．６７３７,Ｐ＜０．００１）。结论唾液ＨｐＩｇＧ测定诊断Ｈｐ感染有较好应用价值。     

拉莫三嗪联合丙戊酸钠治疗小儿癫痫临床观察

目的探讨拉莫三嗪联合丙戊酸钠治疗小儿癫痫的效果及安全性。方法 116例癫痫患儿根据治疗方法分为联合组（拉莫三嗪联合丙戊酸钠治疗）58例,对照组（单用丙戊酸钠治疗）58例,比较2组总治疗效果、不同癫痫发作类型的治疗效果及不良反应。结果治疗12个月后,联合组无发作36例,显效10例,有效6例,无效6例,总有效率89.7%;对照组无发作30例,显效7例,有效5例,无效16例,总有效率72.4%,2组总有效率比较差异有统计学意义（P〈0.05）;联合组治疗单纯部分发作、复杂部分发作、继发性全身发作、全身强直阵挛发作及肌阵挛发作有效率均高于对照组（P〈0.05）;不良反应发生率联合组（12.1%）与对照组（10.3%）比较差异无统计学意义（P〉0.05）。结论拉莫三嗪联合丙戊酸钠治疗各种类型癫痫效果均较好,且不良反应轻。     

Distribution of plasma total homocysteine concentrations in the healthy Iranians

OBJECTIVE: The distribution of plasma total homocysteine concentrations in a population of South West of Iran Shiraz is described to test for differences in homocysteine concentrations among gender and age groups and those levels reported in other populations. DESIGN AND METHODS: Two hundred one healthy males and 201 healthy females aged >15 years from Shiraz, Iran, were randomly selected. Plasma total homocysteine concentrations were measured using high-performance liquid chromatography. RESULTS: The mean plasma homocysteine level was significantly higher in men (geometric mean, 7.3 micromol/l) than in women (geometric mean, 6.3 micromol/l, P < 0.001). The geometric mean levels for ages 15-25, 26-36, 37-47, and 48-58, 59-69, and 70-80 years, were 5.9, 5.4, 5.2, 6.7, 7.3, and 7.6 micromol/l in women and 7.5, 8.7, 5.9, 5.9,7.2, and 9.1 micromol/l in men, respectively. CONCLUSIONS: The homocysteine distribution in a representative sample of people of southwest of Iran indicates age and gender differences, as is found in other populations.     

Concordance of self-reported drug use and saliva drug tests in a sample of emergency department patients

The purpose of this study was to assess the concordance of self-reports of cannabis, cocaine and amphetamines usage, with a saliva point-of-collection drug test, the DrugWipe 5+, in an emergency department (ED) setting. Methods: A random sample of people admitted to either of two emergency departments at hospitals in British Columbia, Canada were asked to participate in an interview on their substance use and provide a saliva test for the detection of drugs. Analyses: Concordance of self-reports and drug tests were calculated. Prior to DrugWipe 5+, sensitivity and specificity estimates were compared against a gold standard of mass spectrometry and chromatography (MS/GC). This was used as a basis to assess the truthfulness of self-reports for each drug. Results: Of the 1584 patients approached, 1190 agreed to participate, which is a response rate of 75.1%. For cannabis, among those who acknowledged use, only 21.1% had a positive test and 2.1% of those who reported no use had a positive test. For cocaine and amphetamines respectively, 50.0% and 57.1% tested positive among those reporting use, while 2.1% and 1.3%, respectively, reported no use and tested positive. Self-reports of cannabis and amphetamines use appear more truthful than self-reports of cocaine use.     

Comparison of plasma concentrations for two amiodarone products

BACKGROUND: A generic formulation of amiodarone was recently approved by the Food and Drug Administration based on single-dose equivalence data. Because amiodarone has complex pharmacokinetic properties, a narrow therapeutic range, and a significant adverse effect profile, concern about equivalency persists. OBJECTIVE: To compare steady-state plasma concentrations of the brand-name reference product Cordarone with the AB-rated generic formulation, Pacerone, in patients exposed to both products. METHODS: A retrospective analysis was performed at the Minneapolis Veterans Affairs Medical Center on 138 patients who were taking a stable dose of amiodarone before and after an amiodarone generic product substitution. RESULTS: Seventy-seven patients had steady-state plasma concentrations documented for each product at the same dose. The mean steady-state plasma concentrations of amiodarone were not significantly different for Cordarone compared with Pacerone (1.07 +/- 0.48 vs. 1.19 +/- 0.66 micro g/mL, respectively); similarly, the concentrations of the active metabolite (desethylamiodarone) did not differ (0.95 +/- 0.30 vs. 0.96 +/- 0.49 micro g/mL, respectively). However, the variability in plasma drug concentrations between products was increased as compared to variability within each product. CONCLUSIONS: This study indicates that comparable steady-state concentrations can be achieved with a change in formulation from Cordarone to Pacerone. However, individual responses vary, suggesting that monitoring of plasma concentrations is prudent 1-3 months after any change from one product to another.     

Effectiveness of lamotrigine in the prophylaxis of migraine with aura: an open pilot study

We report a small open pilot study to evaluate the efficacy of lamotrigine (100 mg/day) in the prevention of migraine with aura attacks. We studied 24 patients affected by migraine with aura with a high frequency of attacks. Following a 1-month run-in period, the patients took lamotrigine for 3 months. Mean attack number per month was reduced from 6.1 +/- 4.1 during the run-in period to 0.7 +/- 1.3 at the 3rd month of treatment (p < 0.0001). In 13 out of 21 patients who completed the study, the attacks were completely abolished at the 3rd month of treatment, while only one patient was completely unresponsive to the drug. Lamotrigine seems worthy of a controlled trial as prophylaxis of a migraine with aura.     

拉莫三嗪治疗新生大鼠缺氧缺血性脑水肿的实验研究

拉莫三嗪(Lamotrigine,LTG)是一种强效抗癫痫药,实验研究表明LTG可对脑外伤、神经变性疾病及癫痫持续状态等导致的神经损害产生保护作用[1-3]。但对新生鼠缺氧缺血性脑水肿的作用未见报导。本实验通过建立新生鼠缺氧缺血性脑损伤的动物模型,研究LTG对缺氧缺血24h脑水肿的治疗作