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Aim To analyze the genotype-phenotype characteristics of voltage-gated potassium channels (Kv) associated genetic epilepsy and evaluate the efficacy of anti-seizure medications(ASMs). Methods PubMed database was searched and patients meeting the inclusion criteria were included for analysis. We divided the patients into “benign”, “encephalopathic” and other phenotypes according to the clinical characteristics. We performed descriptive statistical analysis of patients' mutated genes, clinical phenotype and drug efficacy, and used logistic regression to explore the influencing factors of treatment outcome. Results Data of 474 children were included for analysis. There were significant differences among different phenotypes in mutated genes, source of mutations and so on. In terms of clinical characteristics, there were also significant differences between patients with different phenotypes in age of onset, combined developmental delay and so on. In terms of monotherapy, phenobarbital was the most common treatment choice for children with “benign” phenotype, and sodium channel blockers (SCBs) were the most common treatment choice for children with “encephalopathy” phenotype, and the efficacy of SCBs monotherapy was superior to that of other ASMs. Multivariate Logistic analysis of the children receiving monotherapy showed that whether the children were combined with developmental delay and whether SCBs were used were significant factors influencing the efficacy of drug therapy. Conclusions Patients with the “benign” and “encephalopathic” phenotypes differ in several aspects of genetic variation, clinical characteristics, and drug selection. These results suggest that SCBs may be one of the recommended options for monotherapy.
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OBJECTIVE: To evaluate the effect of pharmacists' interventions in the management of chronic kidney disease. METHODS: CENTRAL, MEDLINE OVID SP, EMBASE OVID SP, CNKI and Wanfang Data were searched for studies regarding pharmacists' interventions in CKD patients. Methodological quality of RCTs included was assessed using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Twenty - seven studies were included. Among them there were 13 RCTs, 8 quasi-randomized controlled trials, 5 cohort studies and 1 economic study. Only 1 of the included RCTs presented a low risk of bias, while the rest were all with unknown risk. The results showed that pharmacists' interventions significantly reduced the rates of ESRD and all-cause death, decreased the number of transplant rejections and adverse reactions, while improving the standard rate of drug concentrations. Pharmacists' interventions made patients' serum creatinine, blood pressure, lipids, glucose and phosphate level under control, at the same time they played a positive role in the management of secondary hyperparathyroidism and anemia. In addition, pharmacists' interventions significantly improved patients' quality of life, as well as their medication compliance and knowledge. They also saved much money for institutions and patients. CONCLUSION: Pharmacists' participation seems to have a positive impact on the control of diseases, the enhancement of life quality, the improvement of medication compliance and knowledge, and the alleviation of financial burden. However, high-quality clinical evidence is still needed to assess the degree of this impact.
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Lumbar disk herniation (LDH) is a common orthopaedic disorder. Many clinical and basic science researches have been conducted recently on using Chinese medicinal herbs to treat LDH. Literature review reveals that the common basic formulas include Duhuo Jisheng decoction (DHJST), Buyang Huanwu decoction (HYBWT), Shentong Zhuyu decoction (STZYT), Taohong Siwu decoction (THSWT), Yanghe decoction (YHT) and Tongdu Huoxue decoction (TDHXT). A basic formula can be modified by adding more herbs or removing some herbs from the formula according to clinical symptoms and traditional Chinese medicine (TCM) syndrome differentiation. Literatures show that herbal treatment have better clinical effects, the medicinal herbs make low-back pain, sciatica and low limb numbness disappeared or alleviated; and restore normal low limb sensation, muscle strength and daily activity. These formulas have also been used to treat LDH postoperative remaining pain, postoperative discitis, postoperative recurrent LDH, and to prevent epidural scar formation and dura mata adhesion. Herbs in these formulas include 5 categories of drugs classified by TCM. They are blood circulation promoting herbs for relieving pain; liver and kidney nourishing and tendons and bones strengthening herbs; blood circulation promoting herbs for unblocking collaterals; pathogenic wind and dampness expelling herbs; and qi invigorating herbs. These herbs have actions of analgesia, anti-inflammation, immunomodulation, phagocytosis of macrophages enhancement, blood circulation improvement, nerve protection, collagen synthesis enhancement. Future research needs to focus on the effects of herbs on four aspects: to enhance collagen synthesis in the disks and inhibit disk degeneration; to promote the resorption of herniated nucleus pulposus and epidural hemorrhage; to prevent nerve cell apoptosis and promote nerve cell regeneration, and to inhibit nociception in the nerve system.