目的 探讨陕西省不同来源癫痫患者分别服用苯巴比妥(PB)、丙戊酸钠(VPA)、奥卡西平(OXC)、左乙拉西坦(LEV)单药治疗癫痫的疗效及经济学效应,为患者合理用药提供参考.方法 选取2012年1月至2022年1月入组陕西省农村癫痫项目及在西京医院神经内科门诊接受治疗的癫痫患者各200例,根据入组来源不同分为农村癫痫项目组(A组)及西京医院神经内科门诊组(B组).根据应用药物不同,A组再分为PB组及VPA组,B组分为OXC组及LEV组,比较患者治疗随访12个月后的总有效率及药物经济学效应.结果 本研究病例在随访终点(服药第12个月)时,在A组中,PB与VPA疗效比较差异无统计学意义(χ2=0.507,P>0.05);在B组中,OXC与LEV疗效比较差异无统计学意义(χ2=0.164,P>0.05).在服药后癫痫发作控制总有效率方面,PB组为56％、VPA组为51％、OXC组为54％及LEV组为56％.最小成本分析(CMA)表明PB组每年药物费用低于VPA组(P<0.01);OXC组每年药物费用低于LEV组(P<0.01).结论 4种药物对控制癫痫发作均有较好疗效,PB在控制癫痫发作方面有更好的经济性.临床医生可从药物经济学角度为患者选择更合适的抗癫痫药物.

目的 探讨慢性意识障碍(pDoC)患者长期预后的影响因素并构建简易直观的列线图模型.方法 回顾性分析2014-2021年诊断为植物状态/无反应觉醒综合征(VS/UWS)或微意识状态(MCS)患者的临床资料,共计55例pDoC患者(男41例,女14例),比较预后良好组(GOSE＞3,n=15)和预后不良组(GOSE≤3,n=40)之间的差异.采用logistic回归分析方法,分析患者的临床资料对长期预后的影响,将单因素分析中P＜0.05的变量纳入多因素logistic回归模型中,基于多因素分析中P＜0.05的变量建立列线图预测模型.结果 ]研究表明,VS/UWS、MCS-和MCS+患者之间的脑电图(EEG)背景模式和大脑皮层平均标准摄取值有显著差异(均P＜0.01).意识状态、病因、昏迷恢复量表修改版评分、EEG背景模式是pDoC长期预后的独立影响因素.根据上述因素建立列线图,该列线图预测患者预后良好的曲线下面积为0.87.结论 本研究成功建立了一个预测pDoC长期预后的列线图,具有较高的预测性能和校准度,有助于指导临床医生决策.

脑微出血(CMBs)增加了抗栓治疗后脑出血及缺血性卒中(IS)的发生风险,因此对于伴有CMBs的IS或短暂性脑缺血发作(TIA)患者,需平衡使用抗血小板聚集或抗凝药物的风险与获益.目前尚无针对该类患者卒中二级预防的明确指南.该文总结了近年来伴有CMBs的IS或TIA患者的卒中二级预防研究,并提出对该类患者卒中二级预防的建议.

目的 调查新型冠状病毒肺炎(COVID-19)患者鼻部相关症状及其临床特点.方法 收集2020年2月10日--3月20日华中科技大学同济医院327例确诊COVID-19患者的病例资料,采集鼻塞、流涕、嗅觉改变等鼻部相关症状、全身伴随症状及基础疾病等情况,分析其临床特点.结果 在327例纳入研究的COVID-19患者中,轻型、普通型、重型、危重型病例分别为33例(10.1％)、62例(19.0％)、146例(44.6％)、86例(26.3％);54例(16.5％) COVID-19患者合并鼻部相关症状,按不同症状发生的总例数统计,其中鼻塞35例(10.7％)、鼻腔干燥29例(8.9％)和嗅觉下降21例(6.4％),鼻痒17例(5.2％)、喷嚏16例(4.9％)、鼻出血14例(4.3％)和流清涕11例(3.4％).在各不同病情分型患者间,鼻部症状的发生率没有统计学意义(P＞0.05).192例(58.7％) COVID-19患者有高血压、糖尿病等基础疾病存在,经过积极的综合治疗244例(74.6％)痊愈出院.结论 COVID-19患者除了发热、咳嗽、咳痰等症状之外,鼻塞、嗅觉下降等鼻腔局部症状并不少见.鼻部疾病的治疗不仅可以改善患者生活质量,同时可以提高患者的治疗效果.因此,临床医师不能忽视COVID-19患者鼻部疾病的处理.

Objective To explore the correlation of blood glucose variability with the outcome in patients with severe acute stroke. Methods This retrospective clinical study was performed on patients with severe acute stroke. Based on the three months mRS score after discharge,they were divided into good outcome groups and poor outcome groups. The blood glucose on admission,mean blood glucose,blood glucose standard deviation,coefficient variation of blood glucose and other clinical data were compared between both groups. Multivariate logistic regression analysis was used to determine the inde-pendent predictors of poor outcome in patients with severe acute stroke. Results A total of 420 patients with severe acute stroke were included,207 (49. 3% ) with good outcome groups,213 (50. 7% ) with poor outcome groups. Multivariate lo-gistic regression analysis showed that age,NIHSS score,GCS score,APACHEⅡscore,blood glucose standard deviation,co-efficient of variation of blood glucose were independent predictors of poor outcome in patients with severe acute stroke on 3 months after discharge. Conclusion Blood glucose variability are the independent predictors of poor outcome of the three months after discharge in patients with severe acute stroke,the great range of glycemic excursion indicates poor outcome.

女性癫痫患者妊娠期的药物治疗缺乏等级较高的临床证据支持,而单中心研究很难纳入足够大的样本,并且对妊娠期癫痫患者进行随机对照试验也不符合医学伦理,因而多国家、多中心合作的癫痫妊娠登记系统应运而生.目前国际上最大三个癫痫妊娠登记分别为英国及爱尔兰癫痫妊娠登记(the UK and Ireland Epilepsy and Pregnancy Registers,UKIEPR)、北美抗癫痫药物妊娠登记(the North American AED Pregnancy Registry)和国际抗癫痫药物妊娠登记(International Registry of Antiepileptic Drugs and Pregnancy,EURAP).文章首先简要介绍上述三大癫痫妊娠登记,并对这三大登记系统的方法学等特点进行比较,其次从多角度总结国外癫痫妊娠登记的研究成果,最后简述癫痫与妊娠登记的延伸研究,以期为我国抗癫痫药物妊娠登记的开展提供有益借鉴.

Objective To examine the prognostic value of flow diversion (FD) presented on transcranial Doppler ultrasound (TCD) in patients with large hemispheric infarction (LHI) caused by the unilateral middle cerebral artery (MAC) occlusion.Methods Seventy-three consecutive LHI patients who had occlusion in M1 segment of MAC and were admitted to neurological intensive care unit at Xijing Hospital from January 2012 to June 2016 were reviewed.All the participants had TCD examination after admission,and were grouped according to the presence or absence of FD into FD+ and FD-.Three-month,six-month,and twelve-month functional outcomes of all the participants were collected and analyzed.Long-term survival rates were compared using Kaplan-Meier survival analysis.Receiver operating characteristic curve (ROC) was used to examine the predictive power of FD in patients with LHI.Results Among 73 LHI patients,28 (38.36％) patients were presented with FD.The incidence rates of cerebral herniation,usage of mechanical ventilation,mortality during hospitalization and incidence rates of three-month,six-month and twelve-month poor outcomes were much higher in patients without FD than those with FD.Multivariate analyses demonstrated that FD was independently associated with cerebral herniation (OR=28.943,95％CI 1.922-435.918,P=0.015),usage of mechanical ventilation (OR=11.151,95％CI 1.614-77.018,P=0.014),three-month (OR=20.163,95％CI 3.048-133.362,P=0.002),six-month (OR=3.525,95％CI 1.153-10.773,P=0.027),and twelve-month (OR=4.400,95％CI 1.387-13.960,P=0.012) poor outcomes.FD yielded an area under the ROC of 0.756,allowing for prediction of three-month outcomes of LHI.Conclusion FD presented on TCD is an early predictor of outcomes in patients with LHI.

Objective To analyze the predictive value of prealbumin for acute skeletal muscle wasting in neurocritical patients .Methods Neurocritical patients admitted to neurological intensive care unit of Xijing Hospital during September 2016 to June 2017 were prospectively enrolled in this study .All the patients were divided into normal prealbumin group (prealbumin≥0.2 g/L) and low prealbumin group (prealbumin ＜0.2 g/L) according to their levels of serum prealbumin on admission .The changes of lower limb circumference on 1 d, 3 d, and 7 d were recorded and analyzed .Results Finally, 93 patients were enrolled in the study , 48 patients with the normal prealbumin group and 45 patients with the low prealbumin group .There was no statistically significant difference between the two groups in the general situation and the intervention measures .There was no statistically significant difference between the two groups in the thigh circumference and the lower leg circumference at 1 d after admition.At 3 d and 7 d after admition, the decrease of lower limb circumference of low prealbumin group was significantly greater than that in the normal prealbumin group ( all P＜0.01).Conclusion The muscle wasting is more significant in neurocritical patients with lower prealbumin on admission , for whom more targeted and individualized prevention and treatment are required.

颅内静脉及静脉窦血栓形成(CVST)是多种病因导致的颅内静脉系统血管病.由于其临床表现缺乏特异性,多表现为一种或多种高颅压相关的临床症状,如头痛、急性或亚急性神经功能缺损、癫痫发作、意识障碍,易被误诊漏诊[1].CVST占所有脑卒中的0.5% ～1%,发病人群多为青年,尤其好发于中青年女性.既往研究[2-5]结果提示,CSVT患者平均发病年龄37岁,女性发病率为男性的3倍多,其中59%的CVST患者处于围产期.迄今为止,关于妊娠相关的CVST(PRCVST)患者诊治的高质量研究十分有限,多为个案报道或小样本研究,且很多随机对照试验都将这部分患者排除在外,故临床医生对于这部分患者的诊疗存在很多盲区.本文对PRCVST的临床特征、诊治现状、预后等进展进行综述,旨在为合并CVST孕产妇的临床诊疗提供更多理论及临床依据.

Objective To investigate whether exogenous nitric oxide(NO)could increase chemosensitization to cispla-tin(DDP)in CNE2 cells,and to provide an experimental and theoretical basis for improving the effectiveness of chem-otherapy for nasopharyngeal carcinoma.Methods CNE-2 cells were treated with various concentrations of sodium ni-troprusside(SNP),DDP,and both chemicals.The nitrate reductase method was used to detect the concentration of NO.Morphological changes of cells were observed using an inverted phase contrast microscope and CCK8 assays were used to examine the viability of cells.Flow cytometry was applied to detect apoptosis in NPC cells.Results (1)The concentration of NO was positively correlated with the concentration of SNP,and this correlation was statistically signif-icant(r＝0.968,P<0.05).(2)Compared with the CNE-2 cells in the SNP group,DDP group,and control group,the CNE-2 cells in the DDP+SNP group showed more extensive morphological changes.(3)The inhibitory effects of SNP+DDP were significantly greater than those of SNP or DDP alone(P<0.05).(4)Compared with the groups treated with SNP or DDP individually,flow cytometry showed that the apoptosis rate of CNE-2 cells was significantly higher in the group treated with both SNP and DDP(P<0.05).Conclusion Exogenous NO can inhibit CNE-2 proliferation,and the inhibitory effect was positively correlated with the concentration of NO.The proper concentration of exogenous NO can significantly enhance the chemosensitivity of CNE-2 cells to DDP,without substantial toxicity.

Objective To investigate the effect induced by specific inducible nitric oxide synthase (iNOS) inhibitor 1 400 W on nasopharyngeal carcinoma CNE-2 cells lines and its mechanism.Methods CNE-2 cells were treated by different concentrations of 1 400 W,diamminedichloroplatinum (DDP),and both chemicals.Cell counting kit-8 (CCK-8) was used to examine the viability of cells.Quantitative realtime polymerase chain reaction (qRT-PCR) was applied to detect the iNOS mRNA expression.Results The expression of iNOS mRNA was down-regulated by 1400W and was positively correlated with inhibitionrate of cell proliferation.1 400 W inhibits proliferation of CNE-2 cell in a concentration-dependent manner.The proliferation inhibition rate of CNE-2 cells treated by 1 400 W combined with DDP was not enhanced.Conclusions Specific inducible nitric oxide synthase inhibitor 1 400 W can exerts anti-tumor effect though inhibiting the expression of iNOS mRNA;The mechanism of chemosensitization induced by iNOS inhibitor on CNE-2 cells may be closely related level of down-regulation of iNOS expression.

癫痫是一种常见的慢性脑部疾病,是由于脑神经元反复异常放电所致[1].按病因学可将其分为遗传性癫痫、代谢或结构性癫痫及病因未知性癫痫.在各种类型的癫痫中,遗传因素均为其发病的重要因素[2].人类遗传物质的变异类型主要有基因突变(gene mutation)、染色体结构或数目变异,这些遗传变异均可导致癫痫的发生.

A elderly woman patient，with a unclear boundary,solid,smooth surface,moderately active mass that estimated 0.4 cm at its greatest diameter in the left lobe of thyroid. Ultrasonography revealed a hypoechoic mass in the left lobe and Computed Tomography showed a 38 mm×25 mm×23 mm oval lesion with uniform density in the left lobe also. The surgical findings revealed tumor located in the inner side of left thyroid lobe near the isthmus,with unclear boundary. Pathological examination showed unclear boundaries between thyroid and tumor,the tumor cells attack into the muscle tissue,braided/ fascicles spindle shaped or star shaped myofibroblasts cells in the tumor area with myxedema inflammatory background and the lesion did not have any mitotic figures. Immunohistochemical analysis indicated that the spindle cells were positive for Vim,ACT,SMA,Bcl2 and ClyD1,and focal lesion histiocytes showed focal positive for CD68,CK and S-100,but negative for DES,Mgo,CD99,CD34,CD117,IgG4,ALK-1.The pathological diagnosis supports inflammatory myofibroblastic tumor of thyroid. Imaging and immunohistochemistry and others are useful in differential diagnosis.

Status epilepticus is well recognized as a common neurologic emergency requiring prompt treatment. The definition of status epilepticus lays a foundation for the research and clinical practice. With the in-depth recognition to physiopathologic mechanism of such a disease, the concept of status epilepticus got revised and improved constantly, from abstract to specific, convulsions to non-convulsions,precise time of duration and prominent refractory concept. This paper mainly focused on concept transition of status epilepticus.

Objective To study effects of blood lipids on the prognosis of sudden sensorineural hearing loss (SSHL), in order to provide theoretical basis for interventional measures in clinic. Method Levels of low density lipo-protein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), total cholesterol (TC), apo-lipoprotein B (Apo-B) and apolipoprotein A(Apo-A) were tested in 63 patients with SSHL of descending or flat types, and the relationship between serum lipids and hearing recovery analyzed. Results Each index of blood lipids demon-strated no statistically significant correlation with the degree or audiometric type of hearing loss (P>0.05), or with the level of hearing recovery (P>0.05). Logistic regression models showed that the level of TG and TC was correlated with treatment outcomes (P<0.05), but not the levels of other lipid indicators (P>0.05). Conclusions The data indicate that blood lipids may have impact on the prognosis of the SSHL, although whether specific lipid-lowering therapies are indi-cated requires further studies.

Objective: To investigate the effect of proliferation and apoptosis induced by exogenous NO on CNE-2 cells. Methods: CNE-2 cells were treated by different concentrations of sodium nitroprusside (SNP). The morphological changes of cells were observed, the viability and apoptosis of cells were examined. Results: SNP inhibited proliferation of CNE-2 cell in a concentration-dependent manner, CNE-2 cell were treated by SNP 100, 200, 400, 600, 800, 1600, 3200 μmol/L group respectively and the inhibition rate of the cells of each group was positively correlated with the concentration of SNP. SNP promote apoptosis of CNE-2 cell in a concentration-dependent manner; compared with SNP 600 μmol/L, flow cytometry analysis showed that the apoptosis rate of CNE-2 cells on the group treated by SNP 1000 μmol/L increased significantly (P<0.05). Conclusion: Exogenous nitric oxide can inhibit CNE-2 proliferation and promote apoptosis. The inhibitory effect was positively correlated with the concentration of NO.

Status epilepticus (SE) is a common and life-threatening neurological emergency disease with a high mortality rate. An accurate patient stratification and outcome prediction will assist physicians to optimize individualized medical intervention strategies and bring utmost benefits for patients with SE. There are four prognostic scores in SE: the Status Epilepticus Severity Score (STESS), the Epidemiology based Mortality score in SE (EMSE), the modified STESS (mSTESS), and the END-IT score. This paper reviewed the advances in prognostic scores of SE, presented their design methods, and analyzed advantages and limitations of each score, with the aim to facilitate better clinical assessment and research of SE prognostic scores.

Objective To investigate the energy intake and complications of continuous and intermittent pump feeding in acute stroke patients and provide a theoretical evidence to support for clinical treatment.Methods From April 2012 to June 2016,69 acute srtoke patients on the nasogastric tube feeding and admitted in the Department of Neurology intensive care unit in Xijing Hospital were enrolled and randomly assigned to have continuous or intermittent pump feeding.The primary endpoint was the efficacy in supplying the desired amount of nutrients by the fifth day and complications(hospital-acquired pneumonia,diarrhea,gastric retention,gastrointestinal bleeding)during the first week.The secondary endpoint was nutritional assessments(albumin,prealbumin,transferrin,hypersensitive c-reactive protein)in the first week.Results Both groups were comparable in acute physiology and chronic health evaluation Ⅱ(13.3±4.7 vs.12.9±4.5),Glasgow coma scale[10(7.2,14)vs.9.5(7.7,12)],National Institute of Health stroke scale[17(15,19)vs.16(13,20)],and Barthel scores[5(0,12.5)vs.10(5,15)](all P>0.05).It was no significantly different in the achievement percentage of the energy determined in the fifth day [93.9％(77.9％,99.8％)in continuous group and 84.8％(75.7％,93.9％)in intermittent group(U=0.144,P>0.05).Intermittent pump feeding significantly reduced the rate of hospital-acquired pneumonia in the first week when compared with continuous pump feeding(58.3％vs.33.3％,X2=4.327,P=0.038),and both groups displayed a moderate number of digestive complications without significant differences,including diarrhea(30.6％vs.27.3％,X2=0.09,P=0.764),gastric retention(2.78％vs.3.03％,X2=0.001,P=1.000),and gastrointestinal bleeding(5.56％vs.9.10％,X2=0.010,P=0.920).No difference could be demonstrated in serum protein markers between two groups in the first week,including prealbumin[0.17(0.13,0.20)g/L vs.0.18(0.15,0.24)g/L,P=0.195),transferrin[1.90(1.52,2.20)g/L vs.1.94(1.65,2.06)g/L,P=0.747),and hypersensitive C-reactive protein[22.5(8.3,50.1)mg/L vs.14.6(6.5,30.5)mg/L,P=0.205].Conclusions Both continuous and intermittent pump feeding can reach the target predictive nutrition(100％of calculated caloric requirements)without statistical differences in the incidences of gastrointestinal complications,and the rate of HAP is lower in intermittent group.Intermittent enteral nutrition can be used as an appropriate method of enteral nutrition support to improve the nutritional status in critically acute stroke patients.

Objective To investigate the usage of antiepileptic drugs (AEDs),epileptic seizures,pregnancy outcomes and infant feeding practices among pregnant women with epilepsy,and provide scientific evidence for eugenics.Methods The clinical characteristics of 350 pregnant women with epilepsy from Shaanxi Provincial Epilepsy & Pregnancy Register from October 2012 to July 2016 were analyzed retrospectively.Results A total of 350 patients with 376 pregnancies were included in the final analysis.Among 376 pregnancies,272 pregnancies (72.3％) were under the treatment of AEDs.Of them,246 pregnancies (90.4％) were on monotherapy,26 (9.6％) on polytherapy.Only patients during 179 pregnancies (47.6％) took folic acid in the first trimester.Seizure frequency increased in patients during 123 pregnancies (32.7％),of whom patients during 43 pregnancies (35.0％) did not use AEDs.Although other patients during 80 pregnancies (65.0％) took AEDs,regular pharmacokinetic monitoring was absent.A total of 170 pregnancies (45.2％) attained seizure-free.Seizure frequency decreased in 42 pregnancies (11.2％) and remained unchanged in 24 pregnancies (6.4％).The rates of cesarean section and natural delivery were 43.8％ (158/361) and 56.2％ (203/361),respectively.Totally 4.5％ (17/376) pregnancies had adverse pregnancy outcome,and 1.9％ (7/376) had fetal malformations.The most common congenital malformation was heart malformation,which was observed in two offspring.One offspring developed dysostosis,one developed chromosome abnormality,and another developed cerebellum deformity.In addition,one twin developed conjoined deformities.Breastfeeding rate was 52.6％ (190/361).Conclusions In Shaanxi province,AEDs compliance,pharmacokinetic monitoring and usage rate of folic acid still need to be improved in pregnant women with epilepsy.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-OOC-16009277

丙戊酸化学名为二丙基醋酸，是临床上常用的一线抗癫痫药物之一，常见的不良反应为一过性的消化系统症状，偶见重症肝炎、高氨血症、胰腺炎等。丙戊酸相关性胰腺炎在临床上少见，多次复发者更加少见，现报道1例如下。