The refractory epilepsy refers to the epilepsy whose seizures couldn't be cured after using two kinds of correctly selected antiepileptic drugs which can be tolerated and enough dosage and duration of monotherapy or combination therapy.The pathogenesis of intractable epilepsy is complex,and there is no established theory at home and abroad.Recently,more and more attention has been paid to the correlation between mitochondrial dysfunction caused by oxidative stress and intractable epilepsy.Based on the summary of common treatment of refractory epilepsy and by searching the related literature at home and abroad,further investigation would be made to explore the diagnosis and treatment of intractable epilepsy theory in order to provide new strategies for diagnosis and treatment of intractable epilepsy.

Objective To compare the incidence rate of non-motor symptoms including constipation, depression,REM sleep disorder(RBD)in patients with Parkinson′s disease(PD)and essential tremor(ET). Methods Sixty patients with PD and 40 patients with ET treated in the department of neurology of Tianjin People′s Hospital from October 2015 to June 2016 were enrolled in the study.The clinical data were recorded.The incidence rates of constipation,depression,REM sleep disorder in PD patients and ET patients were compared in order to analyze the correlation among HY staging and the duration of constipation,depression and RBD in PD patients.Results The incidence rates of constipation,depression,REM sleep disorder in PD group were significantly higher than those in ET group(88.3%(53/60)vs.10.0%(4/40); 61.7%(37/60) vs.27.5%(11/40),51.7%(31/60)vs.7.5%(3/40)),the differences were statistically significant(χ2=60.08,11.22,20.86,P<0.05).Spearman rank correlation analysis showed that the HY staging of patients with PD was related to the duration of constipation,the duration of depression and the duration of RBD(r=0.570,0.369,0.439,P<0.01).Conclusion The degree of correlation between constipation and HY staging is relatively high in PD patients.PD patients with constipation,depression,REM sleep disorder can provide reference for early diagnosis and differential diagnosis of ET patients.

Objective To investigate the effect of acupuncture combined with Shenfu injection on brain injury and hemodynamics after cardiopulmonary resuscitation in patients with cardiac arrest.Methods A total of 100 patients who underwent cardiopulmonary resuscitation after cardiac arrest admitted to 903rd Hospital of the Joint Support Force of PLA from May 2019 to May 2022 were selected as the research objects,and they were divided into acupuncture group and combined group,with 50 cases in each group according to the random number table method.The acupuncture group was given acupuncture therapy,and the combined group was injected Shenfu injection on the basis of acupuncture group.S100β,neuron specific enolase(NSE),National Institutes of Health stroke scale(NIHSS)score,mini mental status examination(MMSE)score,hemodynamic index,Glasgow coma scale(GCS)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and incidence of adverse reactions were compared between two groups.Results After treatment,S100β,NSE,NIHSS score,APACHE Ⅱscore,and heart rate(HR)of two groups were significantly lower than those before treatment,MMSE score,GCS score,cardiac output(CO),central venous pressure(CVP),mean arterial pressure(MAP)were significantly higher than those before treatment(P<0.05).S100β,NSE,NIHSS score,APACHE Ⅱ score and HR in combined group were significantly lower than those in acupuncture group,and MMSE score,GCS score,CO,CVP,and MAP were significantly higher than those in acupuncture group(P<0.05).The incidence of adverse reactions in combined group was significantly lower than that in acupuncture group(χ2=6.453,P=0.011).Conclusion Acupuncture combined with Shenfu injection treatment can improve brain injury and hemodynamics after cardiopulmonary resuscitation in patients with cardiac arrest,and the effect is significant.

Objective To assess the efficacy of pirfenidone combined with PD-L1 inhibitor for treatment of bladder cancer in a mouse model and its effect on tumor immune microenvironment modulation.Methods Forty C57BL/6 mouse models bearing ectopic human bladder cancer xenografts were randomized into control group,PD-L1 inhibitor group,pirfenidone group and combined treatment group(n=10).After successful modeling,PD-L1 inhibitor treatment was administered via intraperitoneal injection at 12.5 mg/kg every 3 days,and oral pirfenidone(500 mg/kg)was given on a daily basis.The survival rate of the mice and tumor growth rate were compared among the 4 groups.The expressions of CD3,CD8,CD45,E-cadherin and N-cadherin in the tumor tissues were detected with immunohistochemistry after the 21-day treatment,and bone marrow-derived suppressor cells(MDSCs)were observed with immunofluorescence staining;serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen(BUN),creatinine(CRE)and lactate dehydrogenase(LDH-L)were analyzed using an automated biochemical analyzer.Results Treatment with PD-L1 inhibitor and pirfenidone alone both significantly decreased tumor growth rate and tumor volume at 21 days(P<0.05),but the combined treatment produced an obviously stronger inhibitory effect(P<0.05).PD-L1 inhibitor and pirfenidone alone significantly increased E-cadherin expression and decreased N-cadherin expression in the tumor tissue(P<0.05).The two treatments both significantly increased the percentage of CD3+,CD8 and CD45+ T cells and decreased the percentage of Ly-6G+CD11b+MDSCs in the tumor tissue,and these changes were more obvious in the combined treatment group(P<0.05).No significant differences were found in serum ALT,AST,BUN,CRE or LDH-L levels among the 4 groups(P>0.05).Conclusion Combined treatment with pirfenidone and PD-L1 inhibitor significantly inhibits the progression of bladder cancer in mice possibly by regulating tumor immune microenvironment and inhibiting epithelial-mesenchymal transition of the tumor cells.

Objective To assess the efficacy of pirfenidone combined with PD-L1 inhibitor for treatment of bladder cancer in a mouse model and its effect on tumor immune microenvironment modulation.Methods Forty C57BL/6 mouse models bearing ectopic human bladder cancer xenografts were randomized into control group,PD-L1 inhibitor group,pirfenidone group and combined treatment group(n=10).After successful modeling,PD-L1 inhibitor treatment was administered via intraperitoneal injection at 12.5 mg/kg every 3 days,and oral pirfenidone(500 mg/kg)was given on a daily basis.The survival rate of the mice and tumor growth rate were compared among the 4 groups.The expressions of CD3,CD8,CD45,E-cadherin and N-cadherin in the tumor tissues were detected with immunohistochemistry after the 21-day treatment,and bone marrow-derived suppressor cells(MDSCs)were observed with immunofluorescence staining;serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen(BUN),creatinine(CRE)and lactate dehydrogenase(LDH-L)were analyzed using an automated biochemical analyzer.Results Treatment with PD-L1 inhibitor and pirfenidone alone both significantly decreased tumor growth rate and tumor volume at 21 days(P<0.05),but the combined treatment produced an obviously stronger inhibitory effect(P<0.05).PD-L1 inhibitor and pirfenidone alone significantly increased E-cadherin expression and decreased N-cadherin expression in the tumor tissue(P<0.05).The two treatments both significantly increased the percentage of CD3+,CD8 and CD45+ T cells and decreased the percentage of Ly-6G+CD11b+MDSCs in the tumor tissue,and these changes were more obvious in the combined treatment group(P<0.05).No significant differences were found in serum ALT,AST,BUN,CRE or LDH-L levels among the 4 groups(P>0.05).Conclusion Combined treatment with pirfenidone and PD-L1 inhibitor significantly inhibits the progression of bladder cancer in mice possibly by regulating tumor immune microenvironment and inhibiting epithelial-mesenchymal transition of the tumor cells.