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Epilepsy is one of the most common neurological diseases, affecting about 70 million people worldwide, more than half of whom are children.Even though seizure-free is largely achieved by anti-seizure medications, there are still one-third of patients with epilepsy who continue to experience seizure attacks and develop into refractory epilepsy(RE). RE can seriously impair the life-quality of children and their families, and impose a substantial burden on society.Therefore, it is of great significance to explore and discover novel therapeutic methods and strategies for RE in children.This review is aimed to introduce several current and emerging therapeutic approaches for RE, including some new anti-seizure medications, ketogenic diet, neurosurgery, neurostimulation and emerging precision medicine, and provide new treatment strategy to children with RE.
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ObjectiveTo investigate the predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis (SBP). MethodsA retrospective analysis was performed for the clinical data of 206 patients with liver cirrhosis who were hospitalized in the Ninth Hospital of Nanchang from January 2010 to December 2018, and all patients had SBP with positive bacteria based on ascites culture. According to drug susceptibility results, the patients were divided into third-generation cephalosporin-resistant SBP group (101 patients with third-generation cephalosporin-resistant pathogenic bacteria in ascites) and control group (105 patients with pathogenic bacteria sensitive to third-generation cephalosporin). Electronic medical records were reviewed to collect related information. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of data with skewed distribution between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A dichotomous logistic regression analysis was used for multivariate analysis, and the Forward: LR method was used for the screening of independent variables. ResultsThere was a significant difference in the composition of pathogenic bacteria between the two groups (P＜0.001). The univariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months (χ2=12.351, P＜0001), non-first-time onset of SBP (χ2=14.427, P＜0.001), blood creatinine (χ2=-2.537, P=0.011), and blood bicarbonate (χ2=-4.592, P＜0.001) were candidate predictive factors with statistical significance between the two groups, and further multivariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months (odds ratio ［OR］=2.376, 95% confidence interval ［CI］: 1.009-5.598, P=0.048), non-first-time onset of SBP (OR=2.841, 95%CI: 1.133-7.122, P=0.026), and blood bicarbonate (OR=0.892, 95%CI: 0.818-0.973, P=0.010) had an independent predictive value for third-generation cephalosporin-resistant SBP. ConclusionA history of broad-spectrum antibiotic exposure in the past three months, non-first-time onset of SBP, and a low level of blood bicarbonate are independent predictive factors for third-generation cephalosporin-resistant SBP, and third-generation cephalosporins should be used with caution in SBP patients with these features.
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Objective:Prepared the specific chicken egg yolk immunoglobulins (IgY) against the cell wall protein of Trichophyton mentagrophytes (tmCWP) and detected its biological activities,which was to establish the basis for the preventment and treatment in dermatophytes disease.Methods: In this work,tmCWP was extracted and purified by cold alkali method,and being used as immunogen to immunized healthy laying hens.The IgY was extracted from the egg yolk by polyethylene glycol method and purified by saturated ammonium sulfate method,respectively.The concentration of the extracted IgY was detected by Bradford method.The purity and molecular weight of the specific anti-tmCWP IgY were analysed by SDS-PAGE.The titer of IgY was obtained by ELISA.The immunoreactivity of IgY was performed by Western blot.Results: The purity of the extracted IgY reached to 87.27％.ELISA indicated that the titer of the specific anti-tmCWP IgY gradual rised 20 days after primary immunization and reached to the highest value (1∶32 000) after 45 days.Western blot revealed that the specific IgY showed a good immunoreactivity and a specifically combination capacity.Conclusion: In our work,the tmCWP could be regarded as the immunogen to prepare the specific anti-tmCWP IgY,which could provide a novel thought for the therapy of Trichophyton mentagrophytes infection.
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<p><b>OBJECTIVE</b>To evaluate effectiveness therapeutic regimens for obstructive sleep apnea hypopnea syndrome (OSAHS) children at an acceptable cost.</p><p><b>METHOD</b>This study was performed at Yuying Children's Hospital of Wenzhou Medical University from Mar. 2008 to Dec. 2010. Prospective random number table method was used for the analysis; 60 children with mild OSAHS were divided into Mild OSAHS Montelukast Treatment (MM) group and Mild OSAHS Adenotonsillectomy Treatment (MAT) group. 32 children in MM group were treated with leukotriene receptor antagonists (LTRAs), while 28 children in MAT group were treated with adenotonsillectomy. Also, 58 children with moderate and severe OSAHS were divided into severe OSAHS Montelukast Treatment (SM) group and severe OSAHS Adenotonsillectomy Treatmen (SAT) group. Twenty-two children in SM group were treated with LTRAs, while 36 children in SAT group were treated with adenotonsillectomy. All selected children were evaluated by polysomnography (PSG) and Obstructive Sleep Apnea-18 (OSA-18) items before and after a six-month treatment. Both records were taken and analyzed, surgical complications and the reason for non-remission after operation were also analyzed. Two therapies were compared based on economic consideration and therapeutic effect. Result (1) PSG: A significant change of a significant change of Apnea Hypopnea Index (AHI) was observed in MM group after the treatment (before receiving the treatment 4.56 ± 1. 26, and after receiving the treatment 3. 48 ± 1. 52, t =3. 50, P <0. 05). But for oxygen desaturation Index (ODI) (MM group 2. 18 ± 2. 19, and MAT group 1. 80 ± 2. 34) and Lowest Oxygen satuation (LSaO2) (MM group 91. 66 ± 2. 34, and MAT group 92. 79 ± 2. 18), there was no significant difference in MM group and MAT group after the treatment (ODI, t =0. 65, and LSaO2 t = - 1. 93, P >0. 05). (2) OSA-18 scores: Significant differences were found in sleeping disorder (before 14. 81 ± 6. 28, and after 10. 56 ± 3. 57), the degree of familial stress (before 13. 56 ± 3. 54, and after 8. 97 ± 2. 96), and OSA-18 total scores (before 52. 66 ± 1. 11, and after 42. 56 6. 48) in MM group after the treatment (sleeping disorder Z - 3. 14, the degree of familial stress Z = -4. 50, and OSA-18 total scores Z= -4. 01, P <0. 05). (3) In addition to the cost of drugs, groups with surgical treatment had a larger economic burden than those with LTRAs treatment. (4) Treatment was totally effective for 28 children (88%) in MM group, and 28 children (100%) in MAT group. Meanwhile, treatment also achieved an obvious effect on 2 children (9%) in SM group, and in 35 children (97%) in SAT group. In MAT group, 3 children improved (11%). And in SAT group, 7 children improved (19%), but treatment was found to be ineffective in 1 case (3%). Among those effective and ineffective cases in groups with surgical treatment, there were 9 children with nasal diseases.</p><p><b>CONCLUSION</b>(1) Surgical treatment is recommended as the first choice for children with moderate and severe OSAHS. And for those who also suffer from nasal diseases, treatment combining drugs with surgery is necessary. (2) LTRAs therapy has a good effect for mild OSAHS. Surgery is also recommended when drugs could not achieve any obvious improvement in clinical symptoms of children with mild OSAHS.</p>