Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Atypical absences are generalized non-motor epileptic seizures which are one of the characteristics of developmental epileptic encephalopathy, and are typically affecting patients with cognitive and intellectual disabilities. Compared with typical absence seizures, the pathogenesis, etiology, electro-clinical characteristics, treatment, and prognosis of atypical absence seizures are more complex. This article aims to summarize the clinical characteristics and etiological research progress of atypical absence seizures, to increase clinicians′ awareness of them and provide new ideas for etiology-based diagnosis and treatment.

Objective To investigate the effect and mechanism of salidroside on1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)-induced Parkinson's disease(PD)in mice.Methods C57BL/6J mice were induced by MPTP to establish a PD mouse model and the movement track of mice was re-corded by open field experiment.The expression of tyrosine hydroxylase(TH),α-synuclein(α-syn),nuclear factor E2 associated factor 2(Nrf2)and quinone oxidoreductase 1(NQO1)were detected by immunohistochemistry in brain tissue of mice.SN4741 cells were stimulated by MPTP to establish a PD cell model in vitro.MPTP stimulation of SN4741 cells to establish an in vitro cell mod-el of PD.After pretreatment with salidroside,TUNEL was used to detect cell apoptosis in each group.The expressions of TH,α-syn,Nrf2 and NQO1 were detected by immunofluorescence.Nrf2 expres-sion was knocked down by being transfected with si-RNA,and apoptosis condition was detected by TUNEL assay.The expression levels of interleukin-1β(IL-1β)and interleukin-18(IL-18)protein in brain tissue extract and cell culture were detected by enzyme-linked immunosorbent assay(ELISA).Results The open field experiment results showed that salidroside could improve 3 min total distance of activity,average speed and activity track of PD mice(P＜0.05).Compared with the PD model mice,the salidroside treated mice showed significantly increased expression of TH,Nrf2 and NQO1 in the brain,and reduced expression of IL-18,α-Syn,IL-1β.Compared with the MPTP stimulated cells,the salidroside pretreatment group showed a decrease in cell apoptosis and an increase in the expressions of TH,Nrf2 and NQO1,but reduced expressions in α-Syn,IL-1β and IL-18.After si-RNA knockdown of Nrf2 expression,the protective effect of salidroside on MPTP stimulated cells weakened or even disappeared.Conclusion Salidroside may alleviate neuronal apoptosis by activating Nrf2-ARE signaling pathway,which is expected to be a new drug for PD treatment.

Objective To investigate the effect and mechanism of salidroside on1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)-induced Parkinson's disease(PD)in mice.Methods C57BL/6J mice were induced by MPTP to establish a PD mouse model and the movement track of mice was re-corded by open field experiment.The expression of tyrosine hydroxylase(TH),α-synuclein(α-syn),nuclear factor E2 associated factor 2(Nrf2)and quinone oxidoreductase 1(NQO1)were detected by immunohistochemistry in brain tissue of mice.SN4741 cells were stimulated by MPTP to establish a PD cell model in vitro.MPTP stimulation of SN4741 cells to establish an in vitro cell mod-el of PD.After pretreatment with salidroside,TUNEL was used to detect cell apoptosis in each group.The expressions of TH,α-syn,Nrf2 and NQO1 were detected by immunofluorescence.Nrf2 expres-sion was knocked down by being transfected with si-RNA,and apoptosis condition was detected by TUNEL assay.The expression levels of interleukin-1β(IL-1β)and interleukin-18(IL-18)protein in brain tissue extract and cell culture were detected by enzyme-linked immunosorbent assay(ELISA).Results The open field experiment results showed that salidroside could improve 3 min total distance of activity,average speed and activity track of PD mice(P＜0.05).Compared with the PD model mice,the salidroside treated mice showed significantly increased expression of TH,Nrf2 and NQO1 in the brain,and reduced expression of IL-18,α-Syn,IL-1β.Compared with the MPTP stimulated cells,the salidroside pretreatment group showed a decrease in cell apoptosis and an increase in the expressions of TH,Nrf2 and NQO1,but reduced expressions in α-Syn,IL-1β and IL-18.After si-RNA knockdown of Nrf2 expression,the protective effect of salidroside on MPTP stimulated cells weakened or even disappeared.Conclusion Salidroside may alleviate neuronal apoptosis by activating Nrf2-ARE signaling pathway,which is expected to be a new drug for PD treatment.

Objective:To evaluate the survival outcomes of radiotherapy in patients with newly-diagnosed metastatic head and neck squamous cell carcinoma (HNSCC) based on data from the Surveillance, Epidemiology and End Results (SEER) database.Methods:A total of 1226 patients newly-diagnosed with metastatic HNSCC between 2010 and 2015 were selected from the SEER database. There were 762 patients (62.1%) in the radiotherapy group and 464 patients (37.9%) in the non-radiotherapy group. Kaplan-Meier method was used to calculate the cancer-specific survival (CSS) and overall survival (OS). The effect of radiotherapy on survival was assessed by Cox multivariate regression and Propensity score-matched analyses (PSM). According to the results of multivariate analysis, the patients were further divided into low-, intermediate- and high-risk groups, and the effect of radiotherapy on survival was analyzed in different risk groups.Results:The median CSS and OS time of the whole group was 11.0 months and 10.0 months, respectively. For patients in the radiotherapy group and non-radiotherapy group, the median CSS time was 13.0 months and 6.0 months, and the median OS time was 12.0 months and 6.0 months, respectively. Multivariate analysis showed that age (CSS, P=0.045;OS, P=0.002), primary tumor site (CSS, P=0.021;OS, P<0.001), T stage (CSS, P=0.001;OS, P=0.002), N stage (CSS, P=0.002;OS, P<0.001), number of metastatic organs (CSS, P<0.001;OS, P<0.001), surgery (CSS, P<0.001;OS, P<0.001), radiotherapy (CSS, P<0.001;OS, P<0.001), and chemotherapy (CSS, P<0.001;OS, P<0.001)were the independent prognostic factors. After PSM, patients with and without radiotherapy in the low-,intermediate-,and high-risk groups, the 3-year CSS rates were 62.5% vs 23.5%( P=0.008), 22.4% vs 15.7%( P=0.001)and 10.5% vs 9.6%( P=0.203), respectively; the 3-year OS were 58.0% vs 20.8%( P=0.002), 19.8% vs 12.7%( P=0.001)and 7.0% vs 6.1%( P=0.166), respectively. Conclusion:Radiotherapy significantly improves CSS and OS in the low- and intermediate-risk groups, but patients in the high-risk group do not benefit from radiotherapy.

Objective:To retrospectively analyze the failure patterns and outcomes of patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) after undergoing induction chemotherapy (IC) followed by definitive radiotherapy.Methods:For patients with locally advanced HPSCC who were treated with IC and definitive radiotherapy from August 2008 to December 2019, their data were collected from the medical records system, and their clinical characteristics, failure patterns, and survival were retrospectively analyzed.Results:A total of 116 eligible patient with squamous cell carcinoma were included in this study. with a median age of 59 (39-79), and 3, 3, 60, and 50 of them had stage Ⅱ, Ⅲ, Ⅳ A, and Ⅳ B HPSCC, respectively. Among these patients, 81 received 1~2 cycles of IC, and 35 received 3-4 cycles of IC. After treatment with IC, 54, 13, and 49 patients received concurrent chemoradiotherapy, radiotherapy combined with targeted therapy, and radiotherapy alone, respectively. The median follow-up was 34.6 months (95% CI: 28.7-40.5 months). The 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS) of all the patients were 63.5%, 82.8%, 75.2%, 47.3%, and 43.1%, respectively. Median PFS and OS were 26.1 and 28.0 months, respectively. Treatment failure was reported in 59 patients, of whom 22, 5, 12, 10, 3, 6 and 1 experienced local, regional, distant only, local-regional, regional-distant, local-distant, and local-regional-distant failure, respectively. The objective response rate (CR+ PR) of patients after IC was 55.2% (64/116). The LRFS, RRFS, PFS, and OS of IC responders (CR+ PR) were better than those of IC non-responders (SD+ PD) ( χ2 = 12.52, 5.16, 13.19, 11.72, all P< 0.05). Conclusions:IC combined with radical radiotherapy has efficacy to a certain extent in the treatment of locally advanced HPSCC, and locoregional recurrence predominates the failure patterns. The prognosis of IC responders is significantly better than that of IC non-responders.

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

Objective:To assess the efficacy and toxicity of chemoradiotherapy in the treatment of early stage extranodal nasal-type NK/T-cell lymphoma (ENKTCL).Methods:Retrospective review was conducted for 174 patients with pathological proved early stage ENKTCL who were treated in the Department of Radiation Oncology, Peking University Cancer Hospital & Institute. The Kaplan-Meier survival analysis was adopted to calculate the local-regional control (LRC), overall survival (OS), and progression free survival (PFS), and the Log-rank test COX regression model were applied to univariate and multivariate analyses.Results:The patients in this study included 102 and 72 patients diagnosed with Ann Arbor stage-Ⅰ and stage-Ⅱ, respectively. Among them, two patients received radiotherapy alone and 172 patients were treated with combined chemoradiotherapy. The overall response rate of all the patients was 94.2%, with a complete response (CR) rate of 87.9% (153). Furthermore, the rates of 5-year OS, PFS, and LRC were 87.3%, 83.1%, and 91.9%, respectively. The most common toxicities during the chemotherapy and radiotherapy included myelosuppression and oral mucositis, with grade ≥ 3 myelosuppression and grade ≥ 3 oral mucositis accounting for 62.1% and 10.9% of all patients, respectively. As shown by multivariate analysis, the adverse prognostic factors for OS included age > 60, B symptoms, and stage Ⅱ, while the adverse prognostic factors for PFS included age > 60 and stage Ⅱ. Meanwhile, the PFS rate was significantly improved by increasing the radiation dose (≥ 50 Gy vs.<50 Gy), and the 5-year PFS rates of the two groups were 83.5% and 76.5%, respectively [hazard ratio ( HR) 0.374; 95% CI, 0.169-0.826; P=0.015]. Conclusions:A good therapeutic effect can be achieved for early stage NK/T-cell lymphoma and the toxicities after combined chemoradiotherapy can be tolerated.

Objective:To investigate the clinical characteristics of pregnant women with leukemia, the condition of leukemia and the influence of clinical treatment on maternal and infant outcomes, and to explore the best clinical management method of leukemia in pregnancy.Methods:Among 79 890 pregnant and lying-in women in Qilu Hospital of Shandong University from January 2004 to December 2015, 22 cases (0.028%) were with leukemia, including 5 cases of leukemia diagnosed before pregnancy [all acute myeloid leukemia (AML)] and 17 cases of leukemia diagnosed for the first time after pregnancy [9 cases of AML, 5 cases of chronic myeloid leukemia (CML), 2 cases of acute lymphoblastic leukemia (ALL), and 1 case of chronic lymphocytic leukemia (CLL)]. According to the gestational weeks of admission and confirmed gestational weeks of leukemia, the 22 patients were divided into early-stage group (initial gestational week < 14 weeks, 5 cases), mid-stage group (newly diagnosed gestational week ≥ 14 weeks and < 28 weeks, 11 cases), and late-stage group (newly diagnosed gestational week ≥ 28 weeks, 6 cases, including 2 cases with previous diagnosis of leukemia). The final pregnancy outcomes included abortion, induced labor, premature delivery, full-term delivery and maternal and infant death. The effects of clinical treatment and obstetric treatment of leukemia on the final maternal and infant outcomes, follow-up to understand the progress of primary disease and fertility of pregnant women, and the impact of leukemia and pregnancy treatment on long-term health status of infants were analyzed.Results:Among 22 patients with leukemia in pregnancy, 14 cases (63.6%) (5 cases in early-stage group and 9 cases in mid-stage group) choosed to give up pregnancy, including 4 cases of early pregnancy abortion and 10 cases of mid pregnancy induced abortion; 12 cases of 14 cases were induced abortion or induced labor after leukemia remission induced by advanced chemotherapy. The remaining 8 patients (2 cases in mid-stage group and 6 cases in late-stage group) continued pregnancy and gave birth to live infants, of which 3 cases received chemotherapy before delivery.Conclusions:Gestational leukemia is a high-risk obstetric case, but it is still expected to achieve good pregnancy outcome under good management and treatment. On the basis of following the principles of leukemia treatment, according to the gestational weeks and patients' wishes, the individualized clinical management plan is formulated, and the accurate chemotherapy timing is conducive to the prognosis of mother and infant.

Objective:To explore overall survival(OS) and prognostic factors of brainstem gliomas (BSG) after intensity modulated radiotherapy (IMRT) by a retrospective single-center analysis.Methods:A total of twenty-one patients with BSG were collected in the Department of Radiation Oncology, Peking University Cancer Hospital from January 2012 to September 2019. All patients underwent IMRT. OS and potential prognostic factors were analyzed, including gender, age, operation type, imaging classification, tumor location, WHO grade, chemotherapy, radiotherapy pattern, time interval between morbidity and the first treatment, and radiation dose.Results:Eighteen of twenty-one patients were followed up more than 3 months. The median follow-up time was 15.5 (5.3-25.6) months. The median overall survival (mOS) was 20 (14.1-25.8) months. The 1 and 2-year OS rates were 86.2% and 34.5% respectively. Operation type, imaging classification, tumor location, WHO grade and radiotherapy pattern were the prognosis factors ( χ2=4.829-20.261, P<0.05). Conclusions:Patients with maximal safe surgical resection, focal endogenesis / exogenesis, tumor located in mesencephalon, low-grade gliomas and/or received postoperative radiotherapy have a better prognosis. It has certain reference value for guiding the clinical practice.