癫痫患者采用左乙拉西坦和托吡酯治疗的临床效果及安全性分析

目的分析癫痫患者采用左乙拉西坦和托吡酯治疗的临床效果及安全性。方法回顾性分析我院收治的128例癫痫患者资料,根据不同治疗方案分为两组,对照组70例予以托吡酯治疗,研究组58例予以左乙拉西坦治疗。结果研究组总有效率94.83%比对照组92.86%略高,且不良反应总发生率8.62%略低于对照组10%,均无统计学意义(P>0.05)。结论左乙拉西坦和托吡酯治疗癫痫患者均可取得良好效果,且安全性均较高,临床可结合患者情况进行药物的选择。     

卡马西平联合左乙拉西坦或托吡酯治疗儿童难治性部分性发作癫痫的疗效比较

目的:探究卡马西平联合左乙拉西坦或托吡酯治疗儿童难治性部分性发作癫痫的临床疗效。方法:选取2015年7月—2016年7月进行治疗的儿童难治性部分癫痫患者80例,随机分为A组和B组,每组40例。A组采用卡马西平联合左乙拉西坦治疗,B组采用卡马西平联合托吡酯治疗。对两组临床治疗有效率、平均癫痫发作次数及不良反应发生情况进行对比。结果:A组治疗总有效率(95%)高于B组(75%)(P<0.05)。A组治疗1个月、2个月后癫痫发作次数与B组相比差异无统计学意义(P>0.05);治疗4个月后,A组发作次数明显少于B组(P<0.05)。A组不良反应发生率与B组相比差异无统计学意义(P>0.05)。结论:卡马西平联合左乙拉西坦或托吡酯治疗儿童难治性部分性发作癫痫临床疗效显著,但与托吡酯相比,卡马西平联合左乙拉西坦治疗可在提高治疗效果的同时,使癫痫发作次数明显减少,且不良反应发生率较低。     

左乙拉西坦治疗妊娠期癫痫疗效及胎儿安全性的Meta分析

目的：评价左乙拉西坦治疗妊娠期癫痫的疗效及其对胎儿的影响。方法：计算机检索Medline、Cochrane library、EMbase、CNKI、万方、维普、CBM数据库,收集有关左乙拉西坦治疗妊娠期癫痫疗效及胎儿安全性的队列研究和病例对照研究。依据纽卡斯-渥太华量表（NOS量表）对符合纳入标准的临床研究进行质量评价,并采用RevMan5.3进行Meta分析。结果：本研究共纳入11篇队列研究进行分析,采用NOS评分评估偏移风险,其中10项研究的得分均在7~9分。Meta分析结果显示,在妊娠期癫痫发作控制率方面,左乙拉西坦组低于丙戊酸钠组,差异有统计学意义（P<0.05）;而左乙拉西坦与拉莫三嗪、托吡酯、卡马西平或苯妥因单药治疗相比,两组间差异均无统计学意义（P>0.05）。在新生儿严重先天畸形发生率方面,左乙拉西坦组低于拉莫三嗪、托吡酯、丙戊酸钠、卡马西平或苯巴比妥组,差异均有统计学意义（P<0.05）;左乙拉西坦组与奥卡西平组相比,两组间差异无统计学意义（P>0.05）;左乙拉西坦单药治疗组明显低于多药治疗组（P<0.05）。左乙拉西坦对宫内死胎发生率的影响与拉莫三嗪、丙戊酸钠、卡马西平无明显区别（P>0.05）。结论：妊娠期癫痫患者服用左乙拉西坦单药治疗,其癫痫控制率可能低于丙戊酸钠,但与拉莫三嗪、托吡酯、卡马西平及苯妥因单药治疗疗效大致相当。在胎儿安全性结局方面,左乙拉西坦致畸性可能优于拉莫三嗪、托吡酯、丙戊酸钠、卡马西平及苯巴比妥,合并使用其他抗癫痫药物增加其致畸风险;左乙拉西坦对宫内死胎发生率的影响与拉莫三嗪、丙戊酸钠、卡马西平无明显区别。本文纳入研究均为队列研究,易受偏移风险的影响,故存在一定局限性。     

左乙拉西坦联合卡马西平和托吡酯治疗难治性癫痫合并糖尿病分析

目的:探究左乙拉西坦联合卡马西平和托吡酯治疗难治性癫痫合并糖尿病的临床效果.方法:选取本院2015年4月～2016年4月收治的难治性癫痫合并糖尿病患者70例,分为观察组和对照组,每组35例,对照组实施卡马西平联合托吡酯治疗,观察组实施左乙拉西坦联合卡马西平和托吡酯治疗,比较两组临床治疗效果.结果:观察组癫痫发作次数低于对照组,观察组总有效率高于对照组,观察组不良反应发生率低于对照组,差异具有统计学意义(P<0.05).结论:在治疗难治性癫痫合并糖尿病中实施左乙拉西坦联合卡马西平和托吡酯,临床效果佳,能够有效减少癫痫发作次数,安全性高.     

左乙拉西坦联合丙戊酸口服液治疗伴中央-颞区棘波儿童良性癫痫分析

目的 探讨左乙拉西坦联合丙戊酸口服液对伴中央-颞区棘波儿童良性癫痫患者认知功能及免疫功能的影响.方法 选择我院收治的48例伴中央-颞区棘波儿童良性癫痫患者为研究对象,随机分为联合组及单一组各24例,两组患者均给予丙戊酸口服液治疗,联合组予左乙拉西坦联合丙戊酸口服液治疗,观察治疗前后两组认知功能[语言智商(VIQ)、操作智商(PIQ)、总智商(FIQ)]、免疫功能[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)]及药物安全性.结果 治疗前两组VIQ、PIQ、FIQ评分、IgG、IgA、IgM比较差异无统计学意义(P＞0.05);治疗后两组VIQ、PIQ、FIQ评分较治疗前显著升高,治疗后仅联合组IgG、IgA、IgM较治疗前明显降低,且治疗后联合组各项评分、IgG、IgA、IgM较单一组明显高、低,差异有统计学意义(P＜0.05).两组治疗后药物不良反应发生率比较,差异无统计学意义(P＞0.05).结论 左乙拉西坦联合丙戊酸口服液可有效提高患者认知功能及免疫功能,是一种疗效确切、安全可靠的药物方案.     

探讨卡马西平、托吡酯和左乙拉西坦联合治疗创伤性难治性癫痫的效果

目的探究创伤性难治性癫痫患者治疗中卡马西平、托吡酯和左乙拉西坦联合治疗的应用效果。方法88例创伤性难治性癫痫患者,随机分为对照组和研究组,各44例。对照组采用卡马西平联合托吡酯治疗,研究组采用卡马西平、托吡酯和左乙拉西坦联合治疗。对比两组患者的治疗效果;治疗前后癫痫发作次数及每次持续时间;治疗前后简易精神状态量表(MMSE)评分;不良反应发生情况。结果研究组患者治疗总有效率为90.91%,高于对照组的72.73%,差异有统计学意义(P<0.05)。研究组患者治疗后1个月癫痫发作次数为(2.62±1.03)次,少于对照组的(4.06±1.14)次,每次癫痫持续时间(1.21±0.49)h短于对照组的(1.98±0.51)h,差异均具有统计学意义(P<0.05)。研究组患者治疗后MMSE评分为(26.84±3.59)分,高于对照组的(22.42±3.48)分,差异有统计学意义(P<0.05)。两组患者治疗后不良反应发生率比较差异无统计学意义(P>0.05)。结论创伤性难治性癫痫患者治疗中采用卡马西平、托吡酯和左乙拉西坦联合治疗的效果显著,能够有效改善患者临床症状,提升癫痫控制效果,改善其精神状态,且不会加重患者的不良反应,建议推广实施。     

卡马西平、左乙拉西坦对伴中央-颞区棘波的小儿良性癫痫患儿认知功能的影响

目的观察左乙拉西坦对伴中央-颞区棘波的小儿良性癫痫患儿认知功能的影响。方法符合诊断标准的癫痫儿童80例随机分为2组,卡马西平组（40例）用卡马西平治疗,左乙拉西坦组（40例）用左乙拉西坦治疗,治疗12周。治疗前后分别测定患儿智商,分析2组儿童治疗前后认知功能的变化。结果治疗前后2组儿童语言智商（VIQ）、操作智商（PIQ）和总智商（FIQ）差异无统计学意义（P〉0.05）。但左乙拉西坦组知识、算术、词汇、图形拼凑五项得分高于卡马西平组（P〈0.05）;卡马西平组治疗前后VIQ、PIQ和FIQ差异无统计学意义（P〉0.05）,而治疗后木块图案、图形拼凑得分降低（P〈0.05）;左乙拉西坦组治疗前后VIQ、PIQ和FIQ差异无统计学意义（P〉0.05）,而治疗后知识、算术、词汇、图形拼凑得分增加（P〈0.05）。结论左乙拉西坦对伴中央-颞区棘波的小儿良性癫痫患儿认知功能无影响并可改善患儿的认知功能。     

341 例癫痫患儿用药特点分析

目的：探讨癫痫患儿临床用药特点,为临床合理应用抗癫痫药物提供参考。方法：回顾性分析2018年2月至2018年8月西北妇女儿童医院和西安交通大学第二附附属医院收治的341例癫痫患儿临床资料,对其用药方案选择及发作控制率进行统计分析。结果：341例癫痫患儿中,男女比例1.04∶1,年龄9个月~19岁,其中1~3岁患儿占比最大,为32.55%。经抗癫痫药物治疗,341例患儿Ⅲ级以上总体发作控制率为84.45%。单药治疗、双药治疗和三种及以上联合治疗Ⅱ级以上控制率分别为94.45%、69.63%和45.56%。单药治疗中使用率前3位的药物分别为左乙拉西坦、苯巴比妥和卡马西平;多药治疗中使用率前3位的药物分别为左乙拉西坦、丙戊酸钠和托吡酯。单药治疗以左乙拉西坦为主,联合治疗主要以左乙拉西坦＋丙戊酸钠或托吡酯为主。结论：儿童癫痫发病以婴幼儿期最多,药物治疗总体控制率较高,新型抗癫痫药和传统抗癫痫药在治疗选择中使用率相当,新型抗癫痫药物左乙拉西坦在各发作类型及各种治疗方案中使用率最高。治疗药物选择主要为左乙拉西坦、苯巴比妥和卡马西平,抗癫痫药物联合治疗方案主要为丙戊酸钠+左乙拉西坦和丙戊酸钠+氯硝西泮+左乙拉西坦。     

醒脑静静脉注射联合左乙拉西坦治疗癫痫患者的疗效观察及对甲状腺功能的影响

目的 探讨醒脑静静脉注射联合左乙拉西坦治疗癫痫患者的疗效及对甲状腺功能的影响.方法 76例癫痫患者随机分为联合组与对照组,各38例.联合组采用醒脑静静脉注射联合左乙拉西坦治疗,对照组仅采用左乙拉西坦治疗.对比分析两组治疗总有效率,治疗前后血清NSE、MMP-9、甲状腺功能指标及不良反应.结果 联合组治疗总有效率(94.73％)明显高于对照组(78.95％)(P＜0.05);联合组和对照组治疗后血清NSE和MMP-9水平明显低于治疗前,且联合组治疗后血清NSE和MMP-9水平低于对照组,差异有统计学意义(P＜0.05);两组治疗前后甲状腺功能指标水平变化比较差异无统计学意义(P＞0.05);两组均未见严重不良反应.结论 醒脑静静脉注射联合左乙拉西坦对癫痫患者疗效显著,但对甲状腺功能无明显影响,可明显降低患者血清NSE和MMP-9表达.     

左乙拉西坦对婴儿痉挛患儿免疫功能的影响研究

目的 观察左乙拉西坦对婴儿痉挛患儿免疫功能的调节作用.方法应用散射比浊法测定婴儿痉挛患儿左乙拉西坦治疗[起始剂量10 mg/（kg·d）,2次/d,每周添加10 mg/（kg·d）至最小有效量,最大剂量40 mg/（kg·d）]前后外周血免疫球蛋白水平;应用流式细胞仪测定患儿治疗前后的T细胞亚群,并与25例正常婴儿比较.结果 病例组患儿治疗前血清IgG、IgA水平低于正常对照组[（3.94±0.64）g/L比（5.19±0.53）g/L;（0.26±0.08）g/L比（0.33±0.12）g/L]（P＜0.05）,IgM高于正常对照组[（0.91±0.25）g/L比（0.71±0.29）g/L]（P＜0.05）;治疗后IgG、IgA、IgM水平均无明显变化（均P〉0.05）.病例组治疗前较正常对照组CD4降低[（38±7）%比（44±8）%]、CD8增高[（23±6）%比（16±8）%],CD4/CD8[（1.62±0.28）比（2.55±0.21）]明显降低（均P＜0.05）;治疗后CD8较治疗前下降[治疗后为（18±5）%]（P〈0.05）,CD4/CD8较治疗前上升[（1.98±0.25）]（P＜0.05）.结论 婴儿痉挛患儿存在免疫功能的紊乱,左乙拉西坦对其免疫功能具有一定的调节作用.     

Effects of cannabidiol and of diphenylhydantoin on the hippocampus and on learning

Cannabidiol (3.5 mg/kg, i.p.) depressed hippocampal facilitation and posttetanic potentiation of evoked responses in rats, such, as had been reported before for diphenylhydantoin. Both diphenylhydantoin (80 mg/kg, i.p.) and cannabidiol blocked the increase of hippocampal RNA concentration caused by afferent stimulation, and depressed the acquisition of a conditioned avoidance response in rats. Neither drug affected the retention of such response when given by posttrial injection, nor the spontaneous locomotor activity of mice. The effects of both agents may be explained by the interference they have been previously shown to produce with the release of K⁺ from the hippocampus during stimulation. In fact, hippocampal facilitation and posttetanic potentiation and the RNA response to stimulation have been shown to be phenomena which depend on this K⁺ release, and have been attributed a role in learning.     

朱砂及含朱砂制剂的肝肾毒性研究

目的 探讨朱砂、含朱砂制剂（柏子养心片）及甲基汞对大鼠的体内外毒性,为其临床安全用药提供科学依据。方法 ①对比甲基汞、朱砂及柏子养心片体外对人肝HL-7702细胞和人肾近曲小管上皮HK2细胞的毒性,计算半数抑制浓度（IC₅₀）。②SD大鼠随机分为对照组,朱砂组0.1 g/kg,柏子养心片0.2、0.4、0.8 g/kg组,甲基汞组0.001 g/kg,每天ig 1次,连续给药90 d后,取血及肝、肾组织;试剂盒法检测血清中丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酐（CREA）、尿素氮（BUN）水平,测汞仪固体直接进样法检测肝、肾组织中汞蓄积量,并对大鼠肝脏和肾脏做组织病理学检查。结果 体外试验表明,朱砂、柏子养心片及甲基汞对HL-7702细胞的IC₅₀分别为7.852、6.035、0.009 5 g/L;对HK2细胞的IC₅₀分别为6.297、4.484、0.008 9 g/L。亚慢性毒性试验表明,甲基汞组大鼠肝、肾组织中汞蓄积量及血清中ALT、AST、CREA、BUN值均显著高于对照组,而朱砂及柏子养心片（高、中、低剂量）组与对照组比较均没有显著性差异;甲基汞组大鼠肝脏呈现肝细胞变性,肾脏可见明显肾小管损伤,而朱砂及柏子养心片（高、中、低剂量）组与对照比较没有明显差异。结论 朱砂及柏子养心片的体内外毒性均显著低于甲基汞,在目前药典规定的临床用量下使用安全性较好。     

β3-肾上腺素受体激动剂的研究进展

摘要β     

丹参多酚酸盐治疗不稳定型心绞痛的疗效及其对一氧化氮和内皮素的影响

目的观察丹参多酚酸盐治疗不稳定型心绞痛（UA）的疗效及其对血清一氧化氮（NO）和内皮素（ET）水平的影响。方法 60例患者随机分为治疗组和对照组各30例。对照组给予常规抗心绞痛治疗,治疗组在对照组治疗的基础上加用丹参多酚酸盐注射液。观察比较2组临床疗效、血清NO和ET水平及心电图改善和药物不良反应情况。结果 治疗组临床疗效、血清NO和ET水平及心电图改善情况均优于对照组,差异有统计学意义（P〈0.05）。2组均未发生药物不良反应。结论丹参多酚酸盐可明显改善UA患者的临床症状和心电图ST-T改变,要提高血清NO水平的同时降低ET水平。     

Influence of streptozotocin-induced diabetes on blood pressure and on renin formation and release

Summary I.v. injection of 40 mg/kg or 65 mg/kg streptozotocin reliably induced diabetes in female Sprague-Dawley rats, but failed to induce hypertension within the following 42 days. In most animals injected with the higher dose and in some animals injected with the lower dose, the tail blood flow was permanently impaired so that no blood pressure signals could be obtained by tail plethysmography. This phenomenon occurred also when the drug was injected into the jugular vein and thus was not due to a local effect of streptozotocin. 15 days after 65 mg/kg streptozotocin, the mean arterial pressure of the rats was similar to that of controls, when measured in the awake state (carotid cannula) or under ether anaesthesia. 42 days after streptozotocin, under pentobarbital anaesthesia, the blood pressure was again normal in the animals given 40 mg/kg of the drug and depressed in the animals given 65 mg/kg of the drug 42 days previously. The increase of blood pressure induced by 1 g/kg (–)-noradrenaline i.v. was similar in the latter group of animals and in controls.The renal cortical renin concentration was much lower than in controls 42 days after either dose of streptozotocin, while the plasma renin activity was normal (40 mg/kg) or increased (65 mg/kg). The low renal renin content may have been due to the diabetic state, rather than to the drug itself. Adrenal medullary dopamine-beta-hydroxylase activity was increased 42 days after the higher dose of streptozotocin.Supported by the Swiss National Science Foundation, grant Nr. 3.410.078     

Effect of ranitidine on ileal myenteric plexus preparation and on acetyl- and butyrylcholinesterase

Ranitidine at concentrations from 1 microM to 0.1 mM brought about a dose-dependent potentiation of the twitch responses elicited by electrical stimulation of the ileal myenteric preparation. At higher concentrations (0.3-3 mM) ranitidine also caused irregular slow contractions of the unstimulated ileal preparation which were potentiated by eserine and blocked by atropine and tetrodotoxin. In order to identify the mechanism of these apparently cholinomimetic actions, the effects of ranitidine on AChE and BuChE were studied. Ranitidine showed an instantaneous and promptly reversible inhibitory action at concentrations between 0.5 and 30 microM. Double reciprocal plots were prepared and equilibrium dissociation constants calculated. It appears that ranitidine exerts an inhibition of the "mixed" type on both AChE and BuChE, but the dissociation constants for BuChE were markedly higher than those for AChE. Since AChE inhibition occurs in the same concentration range potentiating the twitch responses on the ileal myenteric preparation, it may explain the cholinomimetic effect of ranitidine.     

Enniatin B and Deoxynivalenol Activity on Bread Wheat and on Fusarium Species Development

Fusarium head blight (FHB) is a devastating wheat disease, mainly caused by Fusarium graminearum (FG)—a deoxynivalenol (DON)-producing species. However, Fusarium avenaceum (FA), able to biosynthesize enniatins (ENNs), has recently increased its relevance worldwide, often in co-occurrence with FG. While DON is a well-known mycotoxin, ENN activity, also in association with DON, is poorly understood. This study aims to explore enniatin B (ENB) activity, alone or combined with DON, on bread wheat and on Fusarium development. Pure ENB, DON, and ENB+DON (10 mg kg⁻¹) were used to assess the impacts on seed germination, seedling growth, cell death induction (trypan blue staining), chlorophyll content, and oxidative stress induction (malondialdehyde quantification). The effect on FG and FA growth was tested using ENB, DON, and ENB+DON (10, 50, and 100 mg kg⁻¹). Synergistic activity in the reduction of seed germination, growth, and chlorophyll degradation was observed. Conversely, antagonistic interaction in cell death and oxidative stress induction was found, with DON counteracting cellular stress produced by ENB. Fusarium species responded to mycotoxins in opposite directions. ENB inhibited FG development, while DON promoted FA growth. These results highlight the potential role of ENB in cell death control, as well as in fungal competition.     

妊娠合并子宫肌瘤对母儿影响的分析

目的 探讨妊娠合并子宫肌瘤对母儿的影响。方法 对1999年1月～2004年12月73例在剖宫产术中发现的子宫肌瘤进行分析。结果 妊娠合并肌瘤的胎位异常（臂位）率、产后出血率分别为17．8％、20．54％,而对照组分别为3．18％和8．97％;低体重儿发生率12、33％,而对照组为6．07％,有显著差异。结论 子宫肌瘤增加了母儿并发症的可能性;合并黏膜下肌瘤也有望使妊娠过程成功。     

Warnings on alcohol containers and advertisements: International experience and evidence on effects

Issues. In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. Approach. The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. Key Findings. The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. Implications. There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. Conclusion. Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.[Wilkinson C, Room R. Warnings on alcohol containers and advertisements: International experience and evidence on effects. Drug Alcohol Rev 2009;28:426–435]     

猴头多糖抗肿瘤及对免疫功能的影响

目的　研究猴头多糖 ( HEPS)对小鼠 S1 80 肉瘤及免疫功能的影响。方法　 H EPS按 10 0、2 0 0、40 0m g/ kg体重连续灌胃 15 d,测定荷瘤小鼠瘤重 ,通过检测小鼠抗体生成细胞、迟发性变态反应、NK细胞活性 ,荷瘤小鼠免疫器官分别检测 HEPS对体液免疫、细胞免疫、非特异免疫及异常免疫的调节作用。结果　 HEPS可显著抑制 S1 80 肉瘤的生长 ,提高荷瘤小鼠胸腺和脾重 ,增强正常小鼠抗体形成细胞溶解绵羊红细胞能力、迟发型变态反应能力、NK细胞活性。结论　 HEPS具有抗肿瘤及免疫调节作用