Influencing factors for serum concentration of oxcarbazepine active metabolite 10, 11-dihydro-10-hydroxyl carbazepine and role of clinical pharmacist intervention in drug treatment / 中华神经医学杂志

Objective:To explore the influencing factors for serum concentration of oxcarbazepine active metabolite 10, 11-dihydro-10-hydroxyl carbazepine (MHD), and the effecacy of clinical pharmacists' intervention in administration scheme through serum concentration monitoring.Methods:A total of 96 patients with epilepsy who were treated with oxcarbazepine or oxcarbazepine combined with other drugs in our hospital from August 2017 to December 2021 were selected. Blood samples with monitored MHD concentration during treatment in our hospital in these patients were used as the research objects. Univariate analysis and multivariate linear regression analysis were used to analyze the influence of gender, age, body weight, daily dose of oxcarbamide, liver and kidney functions and medication in serum MHD concentration. For patients with substandard serum MHD concentration or ineffective treatment, clinical pharmacists would intervene the medication regimen and lifestyle; the differences of compliance rate of serum MHD concentration and incidence of adverse reactions were compared between the intervention group and non-intervention group.Results:A total of 190 blood samples were collected from these 96 patients. There was significant difference in serum MHD concentration among samples with different daily doses of oxcarbazepine, different creatinine clearance rate (Ccr), and different medications ( P<0.05). Correlation analysis showed that daily dose of oxcarbazepine was positively correlated with serum MHD concentration ( r=0.655, P<0.001). Multivariate linear regression analysis showed that daily dose of oxcarbazepine ( 95%CI: 0.009-0.014, P<0.001), Ccr ( 95%CI: -0.037-0.007, P=0.005), and combined use of oxcarbazepine with lamotrigine ( 95%CI: 0.526-8.790, P=0.027) or atorvastatin ( 95%CI: 0.213-5.168, P=0.033) were independent influencing factors for serum MHD concentration. For patients whose blood concentration was monitored for the first time, the serum MHD concentration in patients with somnolence and/or dizziness (10.9 [6.7, 14.0] μg/mL) was significantly higher than that in patients without somnolence and/or dizziness (7.5 [5.2, 9.4] μg/mL, P<0.05). The compliance rate of serum MHD in the intervention group (83/85[97.6%]) was statistically higher than that in the non-intervention group (95/105[90.5%]), and the incidence of adverse reactions (11/85[12.9%]) was statistically lower than that in the non-intervention group (28/105[26.7%], P<0.05). Conclusions:The serum MHD concentration is affected by daily dose of oxcarbamide, Ccr, and combined use of oxcarbazepine with lamotrigine or atorvastatin. Clinical pharmacists should be encouraged to participate in clinical drug treatment to achieve better effectiveness and safety of drug treatment.

Endoscopic esophageal probe dilation followed by intralesional compound betamethasone injection for anastomotic strictures after esophagectomy: a randomized controlled trial / 中华胸心血管外科杂志

Objective:To assess the efficacy, safety of adding intralesional compound betamethasone injection to EEBD to reduce restricture.Methods:77 patients, treated in The first people's hospital of YancHeng from January, 2015 to December, 2018, were randomized to receive EEPD combined with either compound betamethasone injection or placebo injection. A total of 2 ml of compound betamethasone injection or an identical volume of normal saline solution as a placebo was injected per site using a 23-gauge needle immediately after EEPD. Patients and treating physicians were blinded to the treatment. The primary endpoint was the number of dilations required to resolve the stricture、restricture-free survival、time required to resolve the stricture and adverse events.Results:During the 4-years study period, Finally , 74 patients , who were randomized to either the steroid group (37 cases) or placebo group (37 cases), comprised the per-protocol population .The median number of EEPD required to resolve strictures was 2.0( IQR 1.0-3.0) in the steroid group and 3.0 ( IQR 3.0-4.5) in the placebo group ( P<0.001). After 6 months of follow-up, 27.0% of patients who had received steroid injections remained recurrence free compared with 3.5% of those who had received saline injections( P<0.001). The median time of EEPD required to resolve the stricture was 88 days( IQR 0-98 days)in the steroid group and 131 days( IQR 97-157 days)in the placebo group( P<0.001). No adverse events occurred related to the EEPD or steroid injection occurred. Conclusion:Endoscopic esophageal probe dilation combined with compound betamethasone injection shows promising results for the prevention of stricture recurrence in patients of anastomotic strictures.

Risk factors of birth weight discordance in dichorionic diamniotic twin pregnancies: analysis of 1 757 cases / 中华围产医学杂志

Objective:To investigate the risk factors of birth weight discordance in dichorionic diamniotic (DCDA) twins.Methods:This study retrospectively analyzed 1 757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1, 2014, to December 31, 2017. Birth weight discordance was defined as ≥ 20% difference between the twins. All cases were divided into two groups: the concordant group ( n=1 520) and discordant group ( n=237). General information was compared and the high-risk factors of birth weight discordance were analyzed. Mann-Whitney U test, Chi-square test or Fisher's exact test, and logistic regression analysis were used as statistical methods. Results:Compared with the concordant group, the discordant group showed a higher incidence of hypertensive disorders of pregnancy [24.5% (58/237) vs 12.8% (194/1 520), χ2=22.882, P<0.05], fetal structural malformations [4.2% (10/237) vs 1.0% (15/1 520), χ2=15.160, P<0.05], fetal distress [6.3% (15/237) vs 1.4% (21/1 520), χ2=22.602, P<0.05], umbilical cord abnormalities [3.8% (9/237) vs 1.2% (18/1 520), χ2=7.607, P<0.05] and abnormal placental cord insertion [3.8% (9/237) vs 1.4% (21/1 520), χ2=34.904, P<0.05], but lower incidence of premature rupture of membranes [11.0% (26/237) vs 16.5% (250/1 520), χ2=4.645, P=0.034]. Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy ( OR=2.258, 95% CI: 1.620-3.184, P<0.001), fetal structural malformations ( OR=4.268, 95% CI: 1.892-9.631, P<0.001), umbilical cord abnormalities ( OR=2.889, 95% CI: 1.245-6.705, P=0.014) and abnormal placental cord insertion ( OR=2.318, 95% CI: 1.012-5.311, P=0.047). Conclusions:Hypertensive disorders of pregnancy, fetal structural malformations, umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.

Application of colonoscopy in treating choledocholith for patients with Billroth-Ⅱ gastroenterestomy / 中华肝胆外科杂志

A retrospective study was conducted based on the clinical data of 15 choledocholith patients after Billroth-Ⅱgastroenterestomy who were treated with endoscopic retrograde cholangio-pancreatography (ERCP) through colonoscopy or duodenoscopy.It showed that choledocholith removed by colonoscopy for patients with Billroth-Ⅱ gastroenterestomy can achieve comparable therapeutic effect,but this method can reduce the operation difficulty,shorten the operation time and significantly increase the success rate.

MRI and clinical manifestations of delayed encephalopathy after carbon monoxide poisoning

To explore the relationship between the clinical manifestations and functional magnetic resonance images [MRI] of delayed encephalopathy after carbon monoxide intoxication. Six patients received the MRI were diagnosed with delayed encephalopathy after carbon monoxide [CO] poisoning. Clinical manifestations were observed in each patient. MRI revealed multiple lesions. The majority of the lesions were located in the globus pallidus, sub cortical white matter, and basal ganglia. The cognitive injury, akinetic mutism, fecal and uroclepsia, forced crying, forced laughing and extra pyramidal syndromes such as chorea and parkinsonism were manifested in clinic. Cognitive impairment improved greatly while involuntary movements only improved slightly after several months. Meanwhile brain MRI suggested remarkable improvement. Neuroimaging directly correlated with the clinical manifestations

Association between gene polymorphism of plasminogen activator inhibitor and ischemic cerebrovascular disease in aged people of Henan Han nationality / 中华老年医学杂志

Objective To investigate the association between gene polymorphism of plasminogen activator inhibitor (PAI-1)and ischemic cerebrovascular disease in aged people of Henan Han nationality.Methods A case control method was used,including 408 patients with ischemic cerebrovascular disease and 418 age and gender matched healthy controls.Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to determine the distribution of allele and genotype frequencies of PAI-1 844G/A.Results In patient group,the gene frequencies of AA,AG,GG were 18.1％,41.4％,40.4％,and the A and G allele frequencies were 38.8％ and 61.2％,respectively.In the control group,the gene frequencies of AA,AG,GG were 15.8％,47.4％,36.8％,and the A and G allele frequencies were 39.5％ and 60.5％.There were no significant differences in the frequencies of genotypes and alleles between the two groups (P＞0.05).The different genotypes of 844G/A of PAI-1 gene were not associated with hypertension,hyperglycemia,plasma homocysteic acid levels (P ＞ 0.05).Conclusions PAI-1 gene-844G/A polymorphism may not be independent risk factor of ischemic cerebrovascular disease in aged people of Henan Han nationality.

Serum S100B protein and GFAP levels and their clinical significance in patients with delayed encephalopathy after acute carbon monoxide poisoning / 中华行为医学与脑科学杂志

Objective To explore the dynamic changes of serum S100B and glial fibrillary acidic protein (GFAP) levels and their clinical significance in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods By means of enzyme-linked immunno-sorbent assay (ELISA),the serum S100B and GFAP levels from 33 DEACMP patients were assayed,and the condition changes were analyzed with three types of scale:the activity of daily living scale ( ADL),information-memory-concentration test (IMCT) and Hasegawa' s dementia scale(HDS).The comparison with 32 patients of acute carbon monoxide poisoning without DEACMP was also conducted.Results (1) The serum S100B( (0.60 ±0.21)ng/ml) and GFAP( (226.58 ±90.05 )ng/ml) in DEACMP group at acute stage were significantly higher than those in acute-CO-poisoning group ( (0.50 ± 0.20) ng/ml,( 183.04 ± 73.01 ) ng/ml) and those in DEACMP group at convalescent stage ( (0.51 ±0.16) ng/ml,(183.25 ±81.76)ng/ml) (all P values ＜0.05).(2)In DEACMP group,the serum S100B and GFAP at acute and convalescent stages were significantly correlated (at acute stage:r=0.466,P=0.006; at convalescent stage:r=0.365,P=0.037 ).(3)The S100B and GFAP in ineffective DEACMP patients at acute stage were significantly higher than those in the other groups ( all P values ＜ 0.05 ).(4) In DEACMP group,the ADL,HDS and IMCT scores( (45.21 ± 9.69),(8.26 ± 6.31 ),(9.91 ± 7.52) ) at acute stage were significantly different from those at convalescent stages( (33.67 ± 13.62),( 15.91 ± 10.83),( 19.06 ± 10.37 ) ) ( all P values ＜0.01 ).Conclusion There is secondary brain insult (SBI) in DEACMP; glial activation may play an important role.The S100B and GFAP levels may be associated with the prognosis of DEACMP.

Effects of fluoxetine hydrochloride on depressive symptoms and P300 after cerebral stroke / 中国组织工程研究

BACKGROUND: The depressive emotion and cognition impairment after cerebral stroke are closely connected with the evolution and curative effect and prognosis of the disease, so how to improve depressive emotion and cognition impairment with reasonable drug has important significance to enhance clinical rehabilitation for the patients.OBJECTIVE: To treat patients with post-stroke depression with fluoxetine hydrochloride, andevaluate the changes of their depressive emotion and cognitive function with self-rating depression scale (SDS) and P300 potential.DESIGN: A randomized controlled trial based on patients. SETTING: Henan Provincial Psychiatric Hospital. PARTICIPANTS: Eighty-two inpatients with the first-attack of poststroke depression, who were selected from the Department of Neurology,Henan Provincial Psychiatric Hospital between December 1999 and June 2003, were divided randomly into treatment group (n=41) and control group (n=41).METHODS: All the patients were given neurological routine treatment;besides, those in the treatment group were treated with fluoxetine hyhad taken other psychotropic drugs before entering the group, fluoxetine oxetine was 20 mg, which was taken orally by 1 tablet every morning. All the patients were evaluated with SDS and P300 potentials test at 1 week (the first evaluation) and 6 weeks (reevaluation) after treatment.latencies of N1, P2, N2 and P3 waves and amplitude of P3 wave in P300 potentials.RESULTS: All the patients in the treatment group (n=41) and control group fore treatment, the scores of SDS and the results of P300 potentials were not Reevaluation: After treatment, the score of SDS in the treatment group was significantly lower than that in the control group (40.32±7.2, 48.31±8.02,t=3.89, P ＜ 0.01); the latencies of N2 and P3 waves in P300 potentials test in the treatment group were obviously lower than those in the control group [(235.5±22.9), (248.3±23.4) ms; (339.1±25.3), (348.6±25.5) ms, P ＜ 0.05],and the amplitude of P3 wave was obviously higher than that in the controlgroup [(6.3±1.9), (4.9±2.0) μV, P ＜ 0.05]. CONCLUSION: Fluoxetine hydrochloride can improve the depressive status and cognitive function after cerebral stroke.Song JG, Zhang ZH, Wang XH, Mu JL.Effects of fluoxetine hydrochloride on depressive symptoms and P300 after cerebral stroke.

Study the lower limber somatosensory evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning / 临床神经病学杂志

Objective To evaluate the changes of the lower limber somatosensory evoked potentials (SEPs) in patients with delayed encephalopathy after acute carbon monoxide poisoning.Methods The tibial nerve SEPs were performed in 32 healthy adults and 40 patients with delayed encephalopathy after acute carbon monoxide poisoning. Wave N22, P40, N50, P60, N75 latency and N22～P40 interpeaklatencies were measured, respectively.Results 30 patients (75%) indicated abnormalities of tibial nerve SEPs. The latencies of cortical potential of wave P40 [(41.92?2.49)ms], N50 [(52.13?4.29) ms], P60 [(64.37?4.98) ms] and N75 [(80.84?4.73)ms] in patient group were longer than those in control group (all P