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.

Objective:To investigate risk factors for failure of non-invasive ventilation(NIV)in elderly patients with acute hypercapnic respiratory failure(AHRF).Methods:Retrospective analysis was performed on the data of 100 elderly patients hospitalized for NIV treatment for AHRF at Beijing Hospital between August 2015 and August 2017.The patients were divided into an NIV failure group and an NIV success group according to patient treatment results.Logistic regression was used to analyze the related factors of NIV treatment failure in elderly patients with AHRF.Results:Of the 100 patients, there were 53 men(53.0%), with an age of(79.4±6.4)years, and 43(43.0%)failed with NIV treatment.Before NIV treatment, concurrent severe pneumonia( OR=5.109, 95% CI: 1.203-21.702, P=0.027), chest X-ray showing lesion infiltration≥3 quadrants( OR=5.903, 95% CI: 1.514-23.013, P=0.011)and a simplified acute physiology score Ⅱ(SAPS Ⅱ)≥34 points( OR=7.046, 95% CI: 2.164-22.944, P=0.001)were independent risk factors for failure of NIV treatment in elderly patients with AHRF. Conclusions:Elderly patients with AHRF face the risk of failure with NIV therapy.Before NIV treatment, concurrent severe pneumonia, chest X-ray showing lesion infiltration ≥3 quadrants and SAPS Ⅱ≥34 points are independent risk factors for failure of NIV treatment in elderly patients with AHRF.Evaluation before NIV therapy is important to prevent NIV treatment failure.

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 describe the characteristics of radiation induced mucositis in patients withhead and neck cancer ( HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis. Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eat-ing, diet patterns and weight. Results Two hundred and two patients were completely investigated and 43.5％and 34. 2％ of the patients suffered from moderate to severe (≥grade 2) oral mucositis and pharyngeal mucosi-tis, respectively during the radiotherapy. At the end of radiotherapy, 53. 5％ and 51. 5％ of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2 ) , respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight ( P<0. 05) . Tumor site was the main reason that affected the severity of mucositis ( Wald χ2 =26. 033, 14. 216;P<0.001). Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is re-lated to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutri-tional status of patients.

A 4-year-old boy complained of weakness of the lower limbs for one and a half month.The child had been diagnosed as X-linked agammaglobulinemia (XLA) at 1-year old.In recent one and a half month,he gradually suffered from activity intolerance and fatigue,inability to jump and run,staggering gait and slow speech.All the symptoms above indicated deteriorating motor function.The brain magnetic resonance imaging revealed abnormal signals in white matter and brain atrophy.The cerebrospinal fluid analysis detected the presence of oligoclonal immunoglobulin G band.In short term after intravenous immunoglobulin and methylprednisolone treatment,the boy's lower extremity function and speech speed were slightly improved.However,at 1-year follow-up,the boy's condition became even worse.The child could not sit without support and had difficulty in swallowing.The child could not speak or follow any commands.Neurological examination revealed spastic quadriplegia and pseudobulbar palsy.Progressive neurodegeneration is not a common syndrome in patients with XLA.Brain biopsy is an important approach clinically to find out etiology.

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Objective To discuss the clinical symptoms of severe traumatic cerebral injury patients with paroxysmal sympathetic hyperactivity (PSH). These patients were given positive and effective prevention and treatment to reduce complications in order to improve prognosis. Methods Twenty patients with PSH were selected from October 2010 to October 2014 and were analyzed by gender, age, diagnosis, clinical symptoms, laboratory and equipment inspection to summary the treatment experiences of such patients. Results Of the 20 patients,14 were males and 6 were females,with age of 22-65 (35.4±9.5) years. Sixteen patients underwent unilateral or bilateral intracranial hematoma and decompressive craniectomy,and 4 patients were given conservative treatment. PSH occurred in these patients within 1 week after cerebral injury or surgery. However, the elderly might occur in the course of a few weeks or even months later. Each patient' s seizure frequency and duration had no significant regular pattern. The frequency varied from one time in several days to several times one day. Seizure duration was generally less than half an hour. All of the patients underwent CT and MRI examinations and showed different parts of the brain injury. But the damage of the brain stem, corpus callosum, basal ganglia and lateral ventricles beside sympathetic overactivity could lead to the occurrence of PSH. Most of the patients had a good effect after active drug treatment and symptomatic therapy. Conclusions PSH often occurs in severe traumatic cerebral injury patients. The doctor should pay attention to PSH. Early active and effective prevention and treatment can improve the prognosis of patients with PSH.

OBJECTIVETo provide preimplantation genetic diagnosis(PGD) for two couples carrying thalassemia mutations and chromosomal abnormalities.

METHODSCouple 1 were both carriers of β 41/42 thalassemia mutations, while the husband has carried a reciprocal translocation with a karyotype of 46,XY,inv(9)(p11;q13),t(11;22)(q25;q13). Couple 2 were both carriers of α (-SEA) thalassemia mutation. Their chromosome karyotypes were both normal, but had two spontaneous abortions. The couples had received 1 and 3 blastocysts respectively through in vitro fertilization(IVF) cycles. Following the biopsy, the cells underwent whole genome amplification, and the amplified DNA from each embryo was subjected to genetic testing and a 23-chromosome single nucleotide polymorphism(SNP) microarray assay.

RESULTSThe embryo of couple 1 was diagnosed as carrier of β 41/42 thalassemia with euploid chromosomes. The embryo was transferred and resulted in intrauterine pregnancy. Similarly, an embryo of couple 2 was verified as carrier of α (-SEA) thalassemia with euploid chromosomes.

CONCLUSIONPGD for aneuploidy coupled with testing for single gene disorders via trophectoderm biopsy and whole genome amplification is feasible. The approach can attain diagnosis with minimal damage with sound clinical outcome.

Adult ; Aneuploidy ; Blastocyst ; cytology ; Chromosome Aberrations ; Embryo Transfer ; Female ; Fertilization in Vitro ; Genetic Testing ; Heterozygote ; Humans ; Male ; Mutation ; Pregnancy ; Preimplantation Diagnosis ; beta-Thalassemia ; diagnosis ; embryology ; genetics

ObjectiveTo induce human peripheral blood mononuclear cells differentiate into hepatocyte-like cells by hepatocyte growth factor (HGF) and fibroblast growth factor-4 (FGF-4) in vitro and determine whether PKH26 could be used to serve as an effective tracer for the cells,and observe the ability of transplanted hepatocyte-like cells differentiate into hepatic cells in nude mice.MethodsGroup A and B were set up respectively.In Group A,mononuclear cells were cultivated without hepatocyte growth factor (HGF) and fibroblast growth factor-4 (FGF-4) in cell culture.They were used as negative control group.In Group B,mononuclear cells were cultured with the administration of both HGF and FGF-4 to induce the differentiation into liver hepatocyte-like cells.The changes in cell morphology were observed and the expressions of AFP and CK 19 were detected by immunocytochemical staining in two groups at different times after induction.The hepatocyte-like cells differentiated from human peripheral blood mononuclear cells labeled by the fluorescent dye PKH26 injected into caudal vein in nude mice is experimental group.The nude mice injected with equal amount of normal saline in control group.The migration of the labeled cells into the liver are observed by the fluorescence microscope in the hepatic tissue sections of nude mice and the expressions of ALB were detected by immunocytochemical staining two weeks after the cells transplantation.ResultsCells in group B have a strong proliferative activity.It becomes large and oval,grows in colonies following induction.Cells in group A that showed spherical shape when peripheral blood mononuclear cells were just isolated are gradually becoming inconformity in morphology,spindle or fibroid,and a few cells are round:cells developed apoptosis and cracked following incubation.The expressions of AFP and CK19 were positive after induction in group B as detected by immunocytochemicat staining.Inversely,the expressions of AFP and CK19 were negative in group A after incubation.The experimental group showed numerous PKH26 labeled cells in the hepatic tissue sections of nude mice.But the control group did not show PKH26 labeled cells.The expressions of ALB were positive in the experimental group as detected by immunocytochemical staining after two weeks of the cells transplantation.ConclusionHuman peripheral blood mononuclear cells have the potential to differentiate into hepatocyte-like cells under the induction of HGF and FGF-4.Additionally,PKH26 is an effective tracer in hepatocyte-like cell transplantation.The hepatocyte-like cells settled in hepatic tissue begin to differentiate into mature hepatocyte after two weeks of the cells transplantation.It plays hepatic cells function and expresses alhnmin.

Objective To study the relationship between femur and serum calcium and phosphorus content in rat with osteoporosis. Methods We developed animal models with rat experienced bilateral oophorectomy and used inductively coupled plasma atomic emission spectrometry (ICP-AES) to determine calcium and phosphorus content in femur and serum of experimental group as well as control group. Results Calcium and phosphorus contents in femur in experimental group were significantly lower than that in control group[Ca: (218.59 ± 10.43) mg/L vs (253.32 ±7.54)mg/L;P:( 127.82 ±3.71 )mg/L vs ( 142. 18 ±5.99 ) mg/L, P ＜0. 01], but in serum experimental group it was significantly higher than that in control group [Ca: (99.45 ±0.76)mg/L vs (97.56±0.80) mg/L;P: (67.68 ± 1.63) mg/L vs (60.00 ± 1.18) mg/L,P ＜0. 01]. Conclusion Femur calcium and phosphorus levels were significantly reduced, which was related to the increase of serum calcium and phosphorus content, and it was one of the causes of osteoporosis.