Sleep disorder, migraine, cognitive and behavioral disorders, anxiety and depression are common comorbidities of epilepsy. The comorbidity rate of epilepsy patients is eight times that of the general population, which affects the prognosis and quality of life of epilepsy patients. Perampanel (PER), as a third-generation antiseizure medication, has shown promising clinical research and application in the treatment of comorbidities in epilepsy. PER can improve the total sleep time, sleep latency and sleep efficiency of patients with epilepsy comorbid sleep disorder. PER also shows good efficacy in reducing seizure and migraine attacks of patients with epilepsy comorbid migraine. Meanwhile, the impact of PER on overall cognitive characteristics is neutral, with no systematic cognitive deterioration or improvement, but behavioral changes are one of the most common adverse events related to PER. For patients with comorbid anxiety and depression, PER does not exacerbate the anxiety and depression of epilepsy patients, and the severity of anxiety and depression in some patients will improve. This article will review the mechanism of action and clinical treatment research progress of PER on comorbidities of epilepsy.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective:To explore the relationship between psychological flexibility, self-disclosure and coping style in mothers of children with type 1 diabetes mellitus (T1DM) .Methods:This is a cross-sectional study. From May 2020 to March 2022, a total of 250 mothers of children with T1DM in Children's Hospital Affiliated to Zhengzhou University were selected as research objects by convenient sampling method. General information questionnaire, Acceptance and Action Questionnaire 2nd Edition (AAQ-Ⅱ), Distress Disclosure Index, and Simple Coping Style Questionnaire (SCSQ) were used to investigate them. Pearson correlation analysis was used to analyze the relationship between psychological flexibility, self-disclosure and coping style. AMOS 21.0 software was used to establish structural equation model, and verify the mediating effect. A total of 250 questionnaires were distributed in this study, and 232 valid questionnaires were recovered, with an effective recovery rate of 92.8% (232/250) .Results:Among 232 mothers of children with T1DM, the score of AAQ-II was (23.17±3.12), the score of Distress Disclosure Index was (34.46±5.64), the score of positive coping style was (27.71±3.92), and the score of negative coping style was (12.53±2.55). Pearson correlation analysis results showed that psychological flexibility was negatively corrected with self-disclosure and positive coping style ( r=-0.326, -0.194, P<0.05), and psychological flexibility was negatively corrected with negative coping style ( r=0.326, P<0.05). Self-disclosure was positively correlated with positive coping style ( r=0.298, P<0.05), while self-disclosure was negatively correlated with negative coping style ( r=-0.178, P<0.05). Structural equation model results showed that self-disclosure played a partial mediating role between psychological flexibility and positive and negative coping style, with the intermediary effect accounted for 50.3% and 23.5% of the total effect respectively. Conclusions:Self disclosure plays a mediating role between psychological flexibility and coping style in mothers of children with T1DM. Medical and nursing staff should formulate targeted intervention measure, so as to improve the coping level of mothers of children with T1DM.

Objective:This study aimed to observe whether the treatment-free remission (TFR) of second-generation tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia (CML) is better than imatinib (IM) .Methods:The clinical data of 274 CML patients who discontinued treatment and with complete clinical data were retrospectively studied from June 2013 to March 2021. Using both univariate and multivariate Cox proportional hazards regression models, risk factors influencing TFR outcomes after drug withdrawal in CML patients were assessed.Results:A total of 274 patients were enrolled, 140 patients were women (51.1%) , with a median age of 48 (9-84) years at the time of TKI discontinuation. Prior to TKI discontinuation, 172 (62.8%) patients were treated with IM, and 102 (37.2%) had received second-generation TKI treatment, including 73 patients who had shifted from IM to a second-generation TKI and 29 patients who used second-generation TKI as the first-line treatment. The rationale for converting to a second-generation TKI are as follows: 37 patients aimed deep molecular response (DMR) to achieve TFR, seven patients changed due to IM intolerance, and 29 patients changed because of failure to achieve the optimal treatment response. The use of the last type of TKI included 96 patients (94.1%) with nilotinib, three patients (2.9%) with dasatinib, and two patients (2%) with flumatinib, including one patient who changed to IM due to second-generation TKI intolerance. No statistical differences were found in the median age at diagnosis and TKI discontinuation, sex, Sokal score, IFN treatment before TKI, median time of TKI treatment to achieve DMR, and the reasons for TKI discontinuation between the second TKI and IM ( P>0.05) .The median cumulative treatment time of TKI (71.5 months vs 88 months, P<0.001) , the last TKI median treatment time (60 months vs 88 months, P<0.001) , and the median duration of DMR (58 months vs 66 months, P=0.002) were significantly shorter in the second-generation TKI compared with IM. In the median follow-up of 22 (6-118) months after TKI discontinuation, 88 patients (32.1%) had lost their MMR at a median of 6 (1-91) months; of the 53 patients (60.2%) who lost MMR within 6 months, the overall TFR rate was 67.9%, and the cumulative TFR rates at 12 and 24 months were 70.5% and 67.5%, respectively. Withdrawal syndrome occurred in 26 patients (9.5%) . For patients who restarted TKI treatment, 72 patients (83.7%) achieved DMR again at a median treatment of 4 (1 to 18) months. The univariate analysis showed that the TFR rate of patients treated with second-generation TKI was significantly higher than those who were treated with IM (77.5% vs 62.2%, P=0.041) . A further subgroup analysis found that the TFR rate of the second-generation TKI patients was significantly higher than those treated with IM (80.8% vs 62.2%, P=0.026) . No significant difference was found in the second-generation TKI used as the first line treatment compared with those who were treated with IM (69.0% vs 62.2%, P=0.599) . The multivariate analysis results showed that second-generation TKI treatment was an independent prognostic factor affecting TFR in patients who discontinued TKI ( RR=1.827, 95% CI 1.015-3.288, P=0.044) . Conclusion:In the clinical setting, more CML patients rapidly achieved TFR using second-generation TKI than IM treatment.

Objective:To investigate the current status of perceived vulnerability of parents of children with type 1 diabetes mellitus (T1DM) and to conduct a path analysis of its influencing factors, in order to provide a reference for reducing the level of perceived vulnerability of parents of children with T1DM.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 500 parents of children with T1DM who were treated in 4 hospitals in Henan Province from January 2019 to May 2020 were selected as the research objects. The survey was conducted using the General Information Questionnaire, Child Vulnerability Scale (CVS) , Perceived Social Support Scale (PSSS) , General Self-Efficacy Scale (GSES) and Parenting Stress Index-Short Form (PSI-SF) . Structural equation modeling was used to analyze the influencing factors of parental perceived vulnerability in children with T1DM. A total of 500 questionnaires were distributed and 489 valid questionnaires were recovered, with an effective recovery rate of 97.8%.Results:Scores of CVS, PSSS, PSI-SF and GSES of 489 parents of children with T1DM were respectively (6.40±2.17) , (60.47±2.17) , (87.16±7.87) and (24.85±1.42) . The structural equation model showed that social support, self-efficacy and parenting stress had direct effects on the perceived vulnerability of children's parents, while education level and per capita monthly income had direct and indirect effects on the perceived vulnerability of children's parents through self-efficacy and parenting stress. The course of disease and parental age had indirect effects on parental vulnerability perception through social support and parenting stress ( P<0.05) . Conclusions:Parents of children with T1DM have a high level of perceived vulnerability, which is affected by factors such as social support, self-efficacy, parenting pressure, educational level and per capita monthly income. It is suggested that medical staff should carry out disease awareness education for parents of children, pay attention to their psychological change, improve the level of self-efficacy, encourage them to obtain more social support, reduce the burden of care and take timely multi-faceted interventions to reduce their perceived vulnerability.

Objective:To investigate the effect of transcatheter arterial chemoembolization (TACE) combined with ultrasound-guided radiofrequency ablation (RFA) on the efficacy and immune function in patients with primary liver cancer.Methods:The clinical data of 152 patients with primary liver cancer from February 2019 to February 2021 in the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. Among them, 76 patients were treated with TACE combined with RFA (combined group), and 76 patients were treated with TACE (control group). The efficacy was compared; the α-L fucosidase, T lymphocyte subsets (CD 3, CD 4, CD 8 and CD 4/CD 8), B lymphocyte subsets (CD 19) and tumor markers (alpha-fetoprotein, AFP; carcinoembryonic antigen, CEA; carbohydrate antigen 125, CA125) before treatment and 1 month after treatment were detected. Results:The total clinical effective rate in combined group was significantly higher than that in control group: 81.58% (62/76) vs. 52.63% (40/76), and there was statistical difference ( χ2 = 4.54, P<0.05). There were no statistical difference in all indexes before treatment between 2 groups ( P>0.05); the α-L fucosidase, AFP and CD 8 1 month after treatment in combined group were significantly lower than those in control group: (18.06 ± 5.33) U/L vs. (26.58 ± 7.75) U/L, (87.93 ± 22.55) μg/L vs. (146.83 ± 21.85) μg/L and 0.295 ± 0.052 vs. 0.367 ± 0.064, the CD 3, CD 4 and CD 4/CD 8 were significantly higher than those in control group (0.489 ± 0.054 vs. 0.462 ± 0.063, 0.363 ± 0.059 vs. 0.303 ± 0.075 and 1.43 ± 0.27 vs. 0.89 ± 0.14), and there were statistical differences ( P<0.01 or<0.05); there was no statistical difference in CEA, CA125 and CD 19 1 month after treatment between 2 groups ( P>0.05). Conclusions:TACE combined with RFA in the treatment of primary liver cancer patients can not only improve the total clinical effective rate, but also significantly improve the immune function, and help to reduce level of the liver tumor marker of AFP.

【Objective】 To construct and verify a model for predicting the prognosis of liver cancer patients with autophagy-related long non-coding RNA (LncRNA) expression. 【Methods】 LncRNA expression spectrum, mRNA expression spectrum and clinical characteristics of 374 patients with liver cancer were obtained from the Cancer Genome Atlas (TCGA) Database. The expression levels of autophagy-related genes (from the Human Autophagy Database) were extracted from the mRNA expression profile, and the LncRNA was screened to obtain the highly relevant autophagy-related genes by correlation analysis with the LncRNA expression profile. Differential expression analysis and single factor analysis were conducted between the expressions of the above established autophagy-related LncRNA in 374 cancer tissues and 50 normal tissues to screen autophagy LncRNAs which were differentially expressed and was associated with a significant liver cancer prognosis. The above screened LncRNA were included in the risk of Cox proportional model selection and the prognosis of patients with liver cancer prediction model was established. The risk index (risk score) was calculated according to the forecast model and patients could be divided into high-risk and low-risk groups. Kaplan-Meier survival analysis, Cox regression analysis and receiver operating characteristic curve (ROC) were conducted to evaluate the prognostic value of the model. Gene set enrichment analysis (GSEA) was carried out to analyze the signal pathway of gene enrichment in patients with a high or a low risk. 【Results】 We screened 582 autophagy LncRNAs (R≥0.6, P<0.001) to obtain 23 LncRNAs which were differentially expressed and associated with a significant liver cancer prognosis. A prognostic model consisting of 6 LncRNAs, namely, MKLN1-AS, AC012360.3, AC145207.5, AL513320.1, AC099850.3 and AL049840.2 were constructed. KM survival analysis showed that the survival time of the high-risk group was significantly lower than that of the low-risk group (median survival time: 6.937 years and 2.323 years, P<0.001). Cox regression analysis showed that the survival time of patients in the high-risk group was significantly lower than that in the low-risk group (HR=3.773, 95% CI: 2.252-6.322, P<0.001); the area under the time dependent ROC curve for 1, 2, 3, 4, 5 and 6-year overall survival was 0.760, 0.729, 0.731, 0.722, 0.696 and 0.685. GSEA analysis showed that the genes in the high-risk group were mainly concentrated in cell cycle, autophagy, tumor, ubiquitin-mediated proteolysis, and RNA degradation. 【Conclusion】 The prognostic model composed of MKLN1-AS, AC012360.3, AC145207.5, AL513320.1, AC099850.3 and AL049840.2 can be used to predict the prognosis of liver cancer patients, which is expected to guide clinical treatment.

Background/Aims: Studies have shown that nucleos(t)ide analogue (NA) treatment can reduce the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients, but it is unclear which NA is most effective. We performed a meta-analysis and systematic review comparing the efficacies of NAs in CHB patients. Methods: We searched literature databases for randomized controlled trials (RCTs) and observational studies that analyzed the hepatic biochemical response, virological response, seroconversion rate, drug resistance rate, and HCC incidence rate in CHB patients treated with NAs. Meta-analyses were performed with RevMan and Stata/SE software. Results: Twelve cohort studies and one RCT were selected, in which entecavir (ETV), lamivudine (LAM), telbivudine (LdT), and/or tenofovir disoproxil fumarate (TDF) were evaluated in CHB patients. The meta-analysis showed that ETV was superior to LAM with regard to the HCC incidence (p<0.001), biochemical response (p=0.001), virological response (p=0.02), and drug resistance (p<0.001), and ETV was superior to LdT with regard to the virological response (p<0.001) and drug resistance (p<0.001). We found no significant difference between ETV and TDF with regard to the HCC incidence (p=0.08), biochemical response (p=0.39), virological response (p=0.31), serological conversion (p=0.38), or drug resistance (p=0.95). NA-treated patients with pre-existing cirrhosis had a 5.49 times greater incidence of HCC than those without cirrhosis (p<0.001). Conclusions ETV or TDF should be used for long-term first-line monotherapy in CHB patients according to the current guidelines. Standardized protocols are needed for future studies of ETV and TDF to facilitate conclusive comparisons. Patients with cirrhosis are at significantly elevated risk for HCC, despite the benefits of NA treatment.

Objective To explore the effect of Baihe Zhimu Tang(百合知母汤,BZT) on the airway inflammation in bronchial asthma rats.Methods Forty Wistar rats were randomized into control group,asthma model group,BZT group and dexamethasone (DX) group with 10 rats in each group.The bronchial asthma rat model was built by intraperitoneal injection of 10％ ovalbumin (OVA) and ultrasonic atomizing inhalation of 2％ OVA except for the control group.Thirty minutes before every ultrasonic atomizing inhalation,the BZT group was given BZT 3.68 g/(kg · d) by gastric perfusion;the DX group was administered DX injection 1.2 mg/(kg · d) by gastric perfusion;as for the control group and asthma model group,they were given normal saline of the same volume;all groups were intervened for 14 days.After that,HE staining was used to observe the pathological changes of lung tissue,the levels of interleukin-2 (IL-2) and interleukin-4 (IL-4) were measured,and the cell cycle and calcineurin (CaN) activity were observed in separated peripheral blood lymphocytes.Results For the asthma model group,there was a lot of inflammatory cell infiltration in the bronchial wall under light microscope,the content of IL-4 in the plasma was higher than that in the control group,while the content of IL-2 decreased,the proportion of G0/G1 phase lymphocytes decreased,the proportion of S phase and G2/M increased,and the CaN activity of lymphocytes increased significantly (P ＜ 0.05).For the BZT group,there was only a small amount of inflammatory cell infiltration in the lung tissue under light microscope,the IL-4 level in the plasma was lower than that in the asthma model group,while the IL-2 content increased,the proportion of G0/G1 phase lymphocytes increased,the proportion of S phase and G2/M decreased significantly,and the CaN activity of lymphocytes decreased significantly (P ＜ 0.05).Conclusion BZT could reduce lymphocyte proliferation,decrease IL-4 level and reduce airway inflammation by reducing CaN activity in peripheral blood lymphocytes of bronchial asthma rats.

OBJECTIVETo investigate the efficacy and safety of antiviral treatment in patients with hepatitis C virus (HCV) infection and decompensated cirrhosis and determine the effects of virological response on long-term prognosis.

METHODSSixty-six consecutive,interferon (IFN)-na(i)ve patients with HCV infection and decompensated cirrhosis were enrolled in this prospective study. All patients were given a 48-to 72-week course of IFN plus ribavirin (RBV) combined therapy,with a low accelerating dosage regimen using either:pegylated (PEG)-IFNa-2b at 1.0-1.5 mug/kg/week,PEG-IFNa-2a at 90-180 mug,or standard IFN-a-2b at 3MU,every other day.RBV was given at 800 to 1000 mg/day. All patients were routinely monitored for adverse drug reactions and virological response.Effects of treatments on patient survival were assessed by Kaplan-Meier analysis.

RESULTSAt the end of treatment,74.2% of patients were HCV RNA-negative,with 45.5% having achieved sustained virological response and 28.8% having relapsed;the remaining 25.7% of patients showed non-virological response (NVR). Among the patients with HCV genotype 1, 65.9% achieved end-of-treatment virological response (ETVR) and 34.1% achieved SVR;among the patients with HCV genotype 2,90.9% achieved ETVR and 68.2% achieved SVR. The positive and negative predictive values of early virological response (EVR) for ETVR were 95.7% and 75.0% respectively, and for SVR were 65.2% and 100% respectively. Compared with baseline,patients who achieved ETVR had better liver function,as evidenced by changes in levels of total bilirubin,alanine aminotransferase and albumin,as well as prothrombin activity and Child-Pugh score (t =4.564,11.486,2.303,2.699,3.694 respectively, all P less than 0.05).Compared with the NVR patients, the ETVR patients had lower risk of hepatic decompensation and hepatocellular carcinoma, and had improved survival (x2=18.756,6.992,7.580, respectively, all P less than 0.05).Twelve (18.2%) patients experienced serious adverse events,with 10 requiring premature treatment withdrawal and 2 dying.

CONCLUSIONAntiviral treatment for patients with HCV infection and decompensated cirrhosis using interferon in a low accelerating dosage regimen in combination with ribavirin is feasible.Patients who achieved ETVR had significantly improved long-term prognosis.

Alanine Transaminase ; Antiviral Agents ; therapeutic use ; Carcinoma, Hepatocellular ; Drug Therapy, Combination ; Genotype ; Hepacivirus ; genetics ; Hepatitis C ; diagnosis ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Kaplan-Meier Estimate ; Liver Cirrhosis ; drug therapy ; virology ; Liver Neoplasms ; Polyethylene Glycols ; therapeutic use ; Prospective Studies ; Recombinant Proteins ; therapeutic use ; Ribavirin ; therapeutic use ; Treatment Outcome