ObjectiveTo observe the dynamic changes of neuroglobin (NGB) expression in hippocampus after status epilepticus(SE) in rats, and to explore the role of NGB in epileptic seizures.Methods40 healthy male Sprague Dawley rats were randomly divided into two group according to random number table method:control group (n=5) and epilepsy model group(n=35).Epilepsy model group according to observation time was divided into:0h, 1h, 3h, 12h, 24h, 10d and 30d.Intraperitoneal injection Lithium-pilocarpine (20 mg/kg~127 mg/kg, Li-PC) to establish the rat model of SE.Observe the behavioral changes in rats with epilepsy.Nissl staining was used to detect the neuronal damage in hippocampus. Streptavidin-biotin-peroxidase complex immunohistochemical method was used to detect the expression level of NGB in hippocampus;ResultsAfter SE, the neurons in hippocampus were severely damaged with the progress of epileptic seizures, the number of surviving neurons in CA1, CA3 regions showed a near linear decline.Among them, the number of surviving neurons in (12h, 24h, 10d, 30d)CA1, (0h, 12h, 24h, 10d, 30d)CA3 and(12h, 24h, 10d, 30d) DG area were significantly lower than that of the control group (P < 0.05).The expression level of NGB in CA1, CA3 and DG region of hippocampus were increased after SE, and both of CA1 and DG were reached peak in 24h after SE, but was still higher than the control group.And the CA3 area showed a continue rising trend.Among them, CA1(24h, 10d, 30d), CA3(24h, 10d, 30d) and DG(12h, 24h, 10d, 30d) were higher than that of control group significantly (P < 0.05).In addition, it was found that there was a positive correlation between the number of surviving neurons in CA3 area and the expression level of NGB (R=0.306, P=0.011).ConclusionUp-regulation of NGB expression in hippocampus after status epilepticus, and was positively correlated with the number of neurons in the CA3 area, suggesting that up regulation of NGB expression may be a compensatory protective mechanism of ischemic injury induced by seizures, and participate in the protection of epilepsy related neuronal damage.
ObjiectiveTo explore the efficacy and safety of ketogenic diet therapy (KDT) in the rapidly progressive stage of childhood developmental epileptic encephalopathy Dravet syndrome (DS). Methods The clinical data of all patients who added KDT in the Children’s Hospital of Fudan University from 2011 to 2022 were retrospectively collected, and the age of <6 years was used as the criterion for the rapid progression of the disease. The clinica data, genotype and the efficacy of KDT were analyzed in DS patients who met the criteria. Results A total of 32 patients met the criteria for rapid disease progress, including 22 males and 10 females. The age at onset was (5.69±2.10) months. All patients had multiple seizure phenotypes and monthly seizures despite reasonable Antiseizure medications treatment. After 3, 6, 12, and ≥24 months, 93.8% (30/32), 87.5% (28/32), 53.1% (17/32), 34.4% (11/32) remained on the KDT, while 76.7% (23/30), 75.0% (21/28), 70.6% (12/17), 54.5% (6/11) showed >50% reduction in seizure. Status epileptius (SE) was reduced by 100% at 3 months, 71.0% at 6 months, 86.0% at 12 months. After 12 months, 14 patients experienced efficacy degradation. After 3 months, the EEG background rhythm showed improvement in 75.0% patients, interictal epileptic discharges was decreased in 54.5% patients and cognitive function was improved in 78.6% patients. At the initial stage of KDT, 62.5% (20/32) patients had transisent adverse reactions, including diarrhea, vomiting, fatigue, lethargy, hypoglycemia, and metabolic acidosis, but no mid- and long-term adverse reactions were found. ConclusionKDT is an efficective and safe treatment for DS. KDT can effectively control seizures, reduce the incidence of Status SE and shorten the duration of SE. With the prolongation of the KDT course, some patients experienced a degraded effect. KDT can improve abnormal EEG and cognitive function in DS patients. Pharmoco-resistant DS patients are suggested to receive KDT in the early stage of disease progression.
Objective To investigate the inpatient disease constitution of Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to learn about the local burden of diseases and to provide baseline data for further study. Methods Both questionnaire and focus interviews were applied to collect inpatients’ records in JCHSC between 2008 and 2010. Based on the primary diagnosis on hospital discharge record, the diseases were standardized and classified according to the International Classification of Disease, 10th Edition (ICD-10). Data including general information of the inpatients and discharge diagnosis were rearranged and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 4 804, 6 011 and 6 552 in 2008, 2009 and 2010, respectively, and males were less than famales (37.89% vs. 62.11%, 37.68% vs. 62.32%, 41.09% vs. 58.91%); b)The disease spectrum included 19 to 21 categories, accounting for 90.5% to 100% of ICD-10; c) The top 5 systematic diseases accounted for 78.91%-83.61%, including circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases; d) The top 15 single diseases were coronary heart disease, urinary calculi, cholecyslithiasis or accompanied with cholecystitis, chronic gastritis, hypertension, diabetes, chronic bronchitis, pulmonary infection and inguinal hernia; and e) In these 3 years, most of the inpatients suffered from chronic diseases rather than acute diseases, mostly over 35 years old; while the acute diseases were commonly seen in patients younger than 15 years old. Conclusion a) In recent 3 years, the major inpatient systematic diseases are circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases. The chronic diseases are more than the acute, and mainly focus on coronary heart disease, urinary calculi and chronic bronchitis; b) Nine common inpatient disease spectrum of the top 15 single diseases keep same in recent 3 years; and c) Further attention should be paid to the chronic patients over 35 years old and the acute patients less than 15 years old.
Objective To investigate the inpatients’ disease constitution and cost in Xintian Central Township Health Center (XtC) in Lintao County of Gansu Province from 2008 to 2010, so as to provide baseline data for further research. Methods The questionnaire and the focus interview were carried out, the case records and the cost information of XtC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnosis and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients was 1 212, 1 425 and 1 857, respectively, in 2008, 2009 and 2010. The female was more than the male in 2010 (57.68% vs. 42.32%), and their disease spectrum included 19 categories, which accounted for 90% of the disease classes of ICD-10; b) The constituent ratio of the top seven systematic diseases that inpatients suffered from in recent three years accounted for 89.18% to 92.21%, which included the digestive, respiratory, circulatory, urogenital, musculoskeletal and connective tissues disease, pregnancy, labor and puperium disease, and injury and toxicosis. Except for the injury and toxicosis, the female was more than the male in most of the rest main systematic diseases; c) The top 15 single diseases were acute upper respiratory infection, chronic tracheitis or bronchitis, gastritis or chronic gastritis, coronary heart disease, hypertension, pulmonary infection, urinary tract infection, lumbar vertebra disease, fracture, superficial injury, acute appendicitis, normal labor, cervical spondylosis, acute gastroenteritis, and cholecystolithiasis or cholecystitis; d) The main disease burden of inpatients focused on the age groups as above 65, 15 to 24 and 35 to 54 in 2010. Except for the fracture, acute tracheitis or bronchitis, and lumbar vertebra disease, the female was more than the male in most of the rest main single diseases; gastritis or chronic gastritis and lumbar vertebra disease focused on the age group above 35; acute upper respiratory infection covered all ages in 2010 and has ranked as the first during the past three years; e) In recent three years, the aggregate constitutional ratio of the top 15 single diseases accounted for 67.53% to 71.36%, including six to seven chronic diseases, and eight to nine acute diseases focusing on infection and trauma; and f) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (RMB 1 311.81 yuan vs. RMB 906.85 yuan), and were also higher than those of either Yong’an Central Township Health Center (RMB 1 150.59 yuan) or Gao Zha Central Township Health Center (RMB 1 002.99 yuan). Conclusion?a) In the recent three years, the main systematic diseases are in digestive, respiratory and circulatory system; the incidence of acute disease which mainly focuses on infection and injury is more than that of the chronic; and the acute upper respiratory infection has ranked as the first during the past three years; b) The inpatients in 2010 are mainly at the age of 15 to 24, 35 to 54, and over 65 years old as well. Except for injury and toxicosis, the female inpatients are more than the male in most of the other diseases; c) The inpatients’ average costs of chronic diseases in 2010 are higher than those of acute diseases, and also higher than those of either YaC or GzC. Consideration on rationality of hospitalization cost should be paid attention to; and d) It is urgent to strengthen the construction of infrastructure and informationization in XtC.
ObjectiveTo systematically review the efficacy and safety of second-line medications for status epilepticus (SE). MethodsThe Cochrane Library, PubMed, EMbase, CNKI, CBM, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of second-line medications for SE from inception to May, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed using Stata 15.1 software and R 4.1.0 software. ResultsA total of 23 RCTs were included and 4 regimens were involved: levetiracetam (LEV), phenytoin/fosphenytoin (PHT), valproate (VPA), and phenobarbital (PHB). The results of network meta-analysis showed SE control rate validity sorting to be PHB>LEV>VPA>PHT, the epilepsy recurrence rate in 24 hour validity sorting to be VPA>PHB>LEV>PHT, those requiring further antiepileptic drug treatment rate validity sorting to be LEV>PHT>VPA, and drug safety security sorting to be VPA>LEV>PHT>PHB. Subgroup analysis showed PHB was optimal for SE control in children and adults, VPA had the optimal effect on other efficacy indicators in children, LEV was the safest in children and elderly patients, and VPA was the safest in adults. ConclusionsCurrent evidence suggests that PHB is the optimal for SE control, however, the safety is unsatisfactory; VPA and LEV have their own advantages in the treatment of SE, and their safety is satisfactory. VPA is recommended for adult patients, and LEV is recommended for children and elderly patients.
Objective To investigate the disease constitution of Yaqian Township Health Center (YQT) in Xiaoshan District of Zhejiang Province from 2008 to 2010, so as to provide baseline data for further study. Methods Questionnaire and focus interview were carried out to collect inpatients’ case records from 2008 to 2010. The first diagnoses were classified according to ICD-10, and the data of discharge diagnoses were rearranged and analyzed by using Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 182, 195 and 248 from 2008 to 2010, respectively; b) The disease spectrum included 9-14 categories, which accounted for 47.6%-66.7% of ICD-10; c) The top 6 systematic diseases accounted for 37.37%-75.39%, which included the circulatory, injury, digestive, respiratory, neoplasms and urinary and reproductive systematic diseases; d) A total of 8 of the top 15 single diseases were the same, including hypertension, great saphenous vein varices, redundant prepuce, lung cancer, fracture, superficial injuries, acute appendicitis, and inguinal hernia; and e) The constitution ratio of the chronic diseases, compared with the acute ones, was higher in 2008, but lower in 2009 and 2010. Conclusion a) In recent three years, the main systematic diseases seen in YQT have been circulatory, injury, digestive, respiratory, neoplasms, and urinary and reproductive systematic diseases. The newly increased diseases in 2010 were pregnancy, childbirth and puerperium. The acute diseases mainly are fracture and injure, while the chronic diseases mostly are hypertension; b) A total of 8 of the top 15 single diseases are the same, indicating the stability of the common inpatients’ diseases; and c) Attention should be paid in future to the chronic diseases management, women’s health and specialized subject construction.
Purpose To analyze the clinical characteristicsand prognostic factors of Status epilepticus (SE) in children. Methods The clinical data of 33 children with SE treated in Jinan Central Hospital Affiliated of Shandong University from January 2014 to June 2021 were collected, and their clinical characteristics were analyzed. Then, according to Glasgow prognosis scale, the children were divided into good prognosis group (n=20) and poor prognosis group (n=13). The age of first attack, duration of attack, type of attack and SE classification, EEG, cranial imaging and etiology were used to analyze the influencing factors of SE prognosis. Results 75.7% were 0 ~ 6 years old in the age of first attack, and 29 cases of convulsive status epilepticus accounted for 87.9% in the classification of seizure types. There were significant differences in age of first attack, duration of attack, EEG, history of mental retardation and etiology between the two groups (P<0.05); Logistic regression analysis showed that the age of first attack, duration of attack, history of mental retardation and EEG were independent factors affecting the prognosis. Conclusion Low age, especially ≤ 6 years old, is the high incidence of SE in children at first attack. Most children are symptomatic and have obvious incentives. Convulsive SE is the main type of SE in children. The age of first onset, duration of epilepsy, history of mental retardation, and EEG can affect the prognosis of SE.
Objective To investigate the disease constitution and cost of inpatients in Gaozha Central Township Health Center (GzC) in Wuzhong City of Ningxia Hui Autonomous Region from 2008 to 2010, so as to provide baseline data for further research. Methods A questionnaire combined with a special interview was carried out, and case records and cost information of GzC inpatients in 2008, 2009 and 2010 (from January to November) were collected. The diseases in discharge record were classified according to International Classification of Diseases (ICD-10) based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of the inpatients was 1124, 642 and 747 in 2008, 2009 and 2010, respectively. The female was more than the male in both 2008 (59.34% vs. 40.66%) and 2009 (60.75% vs. 39.25%), and their disease spectrum included 17 categories, which accounted for 81% of ICD-10; b) The top six most commonly seen systematic diseases with a constituent ratio from 86.63% to 92.06% in recent three years were as follows: the respiratory system, digestive system, circulatory system, genitourinary system, injury and toxicosis, skeletal musculature and connective tissue disease. Except the injury and toxicosis, the other five systematic diseases were commonly seen in females rather than in males; c) The top 15 monopathies in recent three years were pulmonary infection, tracheitis or bronchitis, coronary heart disease, soft tissue injury, gastritis or chronic gastritis, upper respiratory infection, hypertension, urinary tract infection, prolapse of lumbar intervertebral disc, pelvic inflammation, fracture, pneumocardial diseases, superficial injury, chronic cholecystitis and arthritis; d) The main burdens of disease for inpatients focused on 35-54 age groups, then followed by the age groups above 55 in 2008 and 2009. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males. Pulmonary infection focused on the age groups above 35; the onset of hypertension increased obviously and a sharp rise of hypertension existed in the 45-54 age groups in 2008, but the hypertention focused on 35-44 age groups in 2009; e) The total inpatients with top 15 monopathies accounted for 64.06% to 71.21%, including 8-9 chronic diseases ranking higher in 2010, and 6-7 acute diseases focusing on infection and injury; and f) The average costs of chronic diseases were higher than those of acute diseases. Conclusion a) There is a big gap between GzC and Yong’an Central Township Health Center (YaC) regarding the level of the regional economic development, the situation of disease burden and cost of inpatients. The former is demonstrated as general Central Township Health Center, while the latter as affluent Central Township Health Center in western China; b) In recent three years, the main systematic diseases are in respiratory, circulatory and digestive system; the inpatients suffer from more chronic diseases rather than acute diseases in their young age; the acute diseases mainly include infection and injury, and the pulmonary infection has ranked as the first during the past three years; c) The inpatients in 2008 and 2009 are mainly in ages of 35 to 54, and then are over 55 years old. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males; d) The patients’ average costs of chronic diseases for hospitalization and drug in 2010 were lower than those of YaC. Consideration on reasonable constitution of the cost for hospitalization should be paid attention to; and e) It is urgent to strengthen the construction of infrastructure and informatization in GzC.
ObjectiveTo analyze the current situation of adaptation guidelines. MethodsCBM, CNKI, VIP, WanFang Data, PubMed, EMbase, GIN, SIGN, NICE and AHRQ databases were electronically searched to collect studies related to adaptation guidelines from inception to August 31th, 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Descriptive analysis was then conducted on the general situation of the adaptation guidelines. ResultsA total of 83 studies were included, involving 63 full-text studies, 16 methodological studies and 4 secondary studies. The quantity of published articles of the adapted guidelines had an overall upward trend, and 48.39% of the adapted guidelines were published in UK-hosted journals. 51.81% of the adapted guidelines reported receiving funding or project funding during the development process, and 67.46% reported information of conflict of interests. Among the 33 adaptation guidelines published in the past five years, 33.34% reported their methodology used ADAPTE, 6.1% reported their methodology used GRADE-Adolopment, and 60.56% did not report the adaptation method. ConclusionsAt present, the international research on the adapted guideline is extensive, however, it is still in its infancy in China. The adaptation guideline is also required to be based on a theoretical framework, standardize the development of methodology, and ensure the quality of the adaptation guideline.
Traditional Chinese Medicine (TCM) standardization is an important carrier for TCM inheriting and innovating. As an important content of TCM standardization system, TCM clinical practice guidelines' designation and revision play an important role for medical staff to regulate medical behavior, and improve the quality of health services. This paper expounds the significance and function of the TCM guidelines, analyzes the present situation, opportunities and challenges, and puts forward the strategies and suggestions to promote the development of evidence-based TCM guidelines.