In the use of antiepileptic drugs in patients with epilepsy,1/3 of the patients with epilepsy can not get effective control,showing resistance to antiepileptic drugs.Now the mechanism of drug resistance is considered to be caused by multiple factors work together.The concept and connotation between drug-resistant epilepsy and refractory epilepsy are different.Since 2010,the international union of antiepileptic proposeddrug-resistant epilepsy expert consensus,different medical centers use the new defition to study different populations and confirm that the new definition is effective and reliable.However,there are some controversier about the drug dosage,drug kinds,judge for determining evaluation index and the treatment judgement in that definition.

Objective To study the nutrition status of premature infants in the early postnatal stage.Methods According to the physical development standard,the premature neonates for treatment in our NICU from Jun.2007 to Jun.2009 were enrolled and divided into normal growth group and extrauterine growth restriction(EUGR) group.The nutrition status of these premature neonates were evaluated respectively.SPSS 13.0 software was used to analyze the data.Results Compared with EUGR group,the durations of regaining birth weight were shorter in normal growth group(t=-13.83,P0.05).Conclusions Premature neonates are prone to encounter extrauterine growth retardation.Extrauterine growth retardation had great impact on premature neonates.Premature neonates should be strengthened with nutrition supplement in order to reduce the incidence of extrauterine growth retardation.

Objective To investigate the protective effect of early enteral nutrition (EN) on the function of intestinal barrier in acute pancreatitis (AP) patients.Methods From April 2014 to April 2016,a total of 81 AP patients admitted to our hospital were randomly divided into EN group (41 cases) and total parenteral nutrition (TPN) group (40 cases) by the method of opening envelop.The levels of serum albumin,inflammation cytokines and index of intestinal barrier function were compared between the two groups.Results No significant differences were found in the demographic characteristics between EN and TPN group at the 1st,3rd,7th day (all P＞0.05).Compared with TPN group,EN group showed significantly higher level of serum albumin since the 7th day (t=4.623,4.517,all P＜0.05) and significantly lower level of serum CRP since the 7th day (t=2.211,3.010,all P＜0.05) and significantly lower level of serum TNF-α since the 3rd day(t=2.095,3.364,3.249,all P＜0.05).In the aspect of intestinal barrier,compared with TPN group,the patients in EN group showed significantly lower level of serum D-lactic since the 7th day(t=3.940,2.626,all P＜0.05) and significantly lower level of serum DAO also since the 7th day(t=3.090,2.880,all P＜0.05).Conclusion EN can effectively maintain the level of serum albumin,decrease the level of serum inflammation cytokines and protect the function of intestinal mucosa barrier.

Objective To investigate the effect of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus.Methods Eighty-seven patients with hepatobiliary calculus who underwent hepatectomy from December,1998 to December,2008 were reviewed retrospectively.Forty-six patients underwent the section of common bile duct to remove calculus combined with left lateral segmentectomy and fiber choledochoscope( Group A),41 patients underwent left hepatectomy and section of common bile duct to remove calculus( Group B).The postoperative stone residual rate,complications and long-term outcome were compared between the two groups.Results The postoperative stone residual rate of either group was zero.Intraoperative bleeding ( 401.1 ± 180.4ml) ,operative times ( 202.5 ±36.6 rmin) of group A were significantly lower than those of the group B (515.9 ± 200.6ml and 257.3 ± 42.9min) ( P ＜ 0.001 and 0.01,respectively) .Hospital stays of group A was lower than that of group B,but this is no statistical significance ( P ＞ 0.05 ) .The incidence of postoperative complications were similar in the two groups( 15.2% v.s.24.4% ,P ＞ 0.05 ).The effective rates of the two groups were similar (91.3 % VS 92.7 %,P ＞ 0.05 ).Conclusions The long-term and short-term outcome of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus is similar to that of left hepatectomy ,and can successfully shorten the hospital stay and reduce the hospital fee.

Endophthalmitis ; etiology ; Humans ; Metals ; Occupational Exposure ; adverse effects

Objective To research operative procedure, results and complications of treatment of the intra-articular distal humeral fractures.Methods 16 cases of these fracture were fixed operatively through a posterior approach with plates on both the medial and the lateral column in adults, and Kirschner wires in children. Results 15 patients were followed up for 5～36 months, the fractures healed in 1 2～6 5 months.Complications as follows: each electric burn of skin, superficial infection, palsy of ulnar nerve, loss of screws and non-union in one case, stimulation of Kirschner wires in 2 cases. Conclusions Triceps-splitting,elbow posterolateral approach or olecranon osteotomy are well suited to the exact visualisation and accurate reduction of this difficult fracture with minimal damage.The election of interfixation model should base on the age and the fracture type.

Objective To study on the relation between Helicobacter pylori (Hp) infection and gastric metaplasia in the duodenum(DGM) in the duodenal ulcer(DU) patients to elucidate the pathogenesis of DU.Methods One hundred and twenty-one patients were examined by endoscopy, pathology and Hp infection test.Results The detection rates of Hp in stomach and in duodenal bulb were much higher in patients with DU(90 4%, 40 4%) than those in patients without DU(60 9%, 2 9%, both P

To study the effects of major components of Maijunan tablets, puerarin (Pue) and rhynchophylline (Rhy) on the transport of hydrochlorothiazide (Hct) Caco-2 cell monolayer model, the transport parameters of Hct, such as apparent permeability coefficient (P(app) (B --> A) and P(app) (A --> B)) and the ratio of P(app) (B --> A) versus P(app) (A --> B), were studied and compared when Hct was used solely and co-used with Pue and/or Rhy. The effects of drug concentrations, conveying times, P-glyprotein (P-gp) inhibitor verapamil and conveying Liq pH values on the transport of Hct in the above conditions were also investigated. The results indicated that the absorption of Hct in Caco-2 cell monolayer model could be a carrier-mediated active transport, along with the excretion action mediated by P-gp. Pue can decrease the excretion action of Hct mediated by P-gp, and Rhy had no significant effect on the transport of Hct. The co-use of Hct, Pue and Rhy enhanced the absorption of Hct. Meanwhile, conveying Liq pH value had significant influence on the transport of Hct. The absorption of Hct at pH 6.0 was higher than that at pH 7.4.

To study the effect of liquiritin (Liq) on the transport of strychnine (Str) in Caco-2 cell monolayer model, the transport parameters of Str, such as apparent permeability coefficient (P app (B-->A) and P app (A-->B)) and cumulative transport amount (TRcum), were determined and comparatively analyzed when Str was used solely and co-used with Liq. The effect of drug concentrations, conveying times, P-glycoprotein (P-gp) inhibitor verapamil and conveying liquor pH values on the transport of Str were also investigated. The results indicated that the absorption of Str in Caco-2 cell monolayer model was well and the passive transference was the main intestinal absorption mechanism of Str in the Caco-2 monolayer model, along with the excretion action mediated by P-gp. Liq enhanced the absorption of Str. Meanwhile, conveying liquor pH value had significant influence on the excretion transport of Str.

Objective To investigate the short and long term therapeutic effects of prostaglandin E1 (PGEl) on diabetic nephropathy (DN). Methods Patients with DN in stage Ⅲ to Ⅴ according to Mogensen criteria were randomly assigned to four groups of PGE1, angiotensin-converting enzyme inhibitor (ACEI), PGE1 + ACEI and control drug. The levels of proteinuria and albuminuria were measured before and 15 days, 6 months and 18 months after treatment. Patients with DN in stage Ⅳ were subdivided into three groups according to proteinuria: early stage IV (protienuria was less than 1.5 g/d), middle stage Ⅳ (protienuria was between 1.5 g/d and 2.5 g/d) and late stage Ⅳ (protienuria was larger than 2.5 g/d). Results Fifteen days after treatment, the levels of proteinuria and albuminuria were significantly decreased compared with pre-treatment in PGE1 and PGE1 + ACEI groups (P<0. 01), and the therapeutic effect was better in PGE1 + ACE1 group than in ACEI group (P<0. 01). Six months after treatment, there were still significant differences in above parameters in patients with DN in stage Ⅲ and Ⅳ between PGE1 + ACEI and PGE1 groups. And for the patients in stage Ⅴ, statistic significance between pre-and post-treatment existed only in PGE1 + ACEI group (P<0. 05). but not in PGE1 and ACEI groups (both P>0. 05). Eighteen months atter treatment, the levels of proteinuria and albuminuria were significantly decreased in patients in stage HI and early stage IV in all treatment groups (P<0. 01). For patients in middle stage IV and late stage Ⅳ , the significant differences still occurred between pre-and post-treatment in PGE1 + ACEI group (P<0. 01 or P<0. 05), and were significantly better than in ACEI group (P<0. 01 or P<0. 05). However, the proteinuria of patients in late stage IV elevated in PGE1 group in post-treatment versus pre-treatment (P<0. 05). Conclusions The short term therapeutic effect of PGE1 is quick and good in patients with DN. The therapeutic effect is much better in patients in stage Ⅲ compared with stage Ⅴ. The combination of PGE1 and ACEI will get better best therapeutic effect than PGE1 or ACEI alone in long term.