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.
Objective To learn the current situation of traditional Chinese medicine (TCM) systematic reviews/meta-analyses published in Chinese journals. Methods All TCM systematic reviews/meta-analyses published from 1978 to July 31, 2009 were searched in the Chinese Biomedical Database (CBM). According to the inclusion and exclusion criteria, relevant information was extracted on the basis of research purpose. Meanwhile, publication year, journal name, author’s district, number of authors and their articles, types of diseases and interventions were took as the indexes, and then descriptive analysis was performed using SPSS 15.0 software. Results A total of 245 articles including 238 in Chinese and 7 in English were included. All of them were published in 117 different journals from 1998 to 2008, showing an accelerating growth trend of article number. In addition to only one article with first author from Germany, the first author of other 244 were from 24 domestic provinces (autonomous regions and municipalities); the number of authors ranged from 1 to 11; a total of 186 people had published articles as first author, and the number of their published articles ranged from 1 to 29. There were 16 types of diseases according to the International Classification of Diseases 10th Edition (ICD-10). Totally, 218 articles took drugs as interventions (including 106 listed drugs, 25 self-made prescriptions, 70 related to both listed drugs and self-made prescriptions, and 17 without reporting detailed interventions), accounting for 89%; and 27 articles were about non-drug interventions (including 26 about acupuncture and 1 about massage), accounting for 11%. Most (95.8%) of the articles about self-made prescriptions and listed drugs/self-made prescriptions adopted inappropriate pooled analyses. Conclusion Evidence-based medicine has been spread into the field of TCM, the number of TCM systematic reviews/meta-analyses shows an accelerated growth trend. The types of diseases discussed in the literature were almost the same as the diseases those could be effectively treated by TCM, but there existed imbalance in districts. In the future, systematic review/meta-analysis on drug intervention should aim at Chinese patent medicines and single medicines rather than self-made prescriptions, and should pay more attention to advantageous drugs and advantageous treatments of diseases. Moreover, importance should be also attached to clinical heterogeneity controlling when using acupuncture as a non-drug intervention.
Clinical pharmacy practice guidelines have developed rapidly in recent years. They provide a series of recommendations for optimizing drug treatment management and improving pharmaceutical care appropriateness and are widely employed in clinical practice. Based on literature review and the experience of guideline development, this paper summarized the meaning, formulation methods, formulation status, and registration of clinical pharmacy practice guidelines, and provided suggestions for the development of guidelines.
ObjectiveTo access the current study status and the existing problems of studies on National Essential Medicines System (NEMS) in China based on systematic review methods, and provide the evidence-based evidence and references to the studies of this field. MethodsThe following databases such as PubMed, EMbase, The Cochrane Library (Issue 3, March 2014), CNKI, WanFang Data, VIP and CBM were electronically searched to collect studies related to the policy analysis, implementation background, implementation strategies, implementation situation, implementation problem and implementation effects about NEMS in China. The retrieval time was from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and finally conducted analysis on study types, study time, source journals, authors' units, study themes, etc. of the included studies. ResultsA total of 1 607 articles were finally included, encompassing 56.38% qualitative studies and 43.62% quantitative studies. The number of published studies per year, the number of quantitative studies as well as the number of financiallysupported studies out of the total studies published per year had increased by year since 2009. The study topics focused on every parts during the implementation of NEMS in different proportions. The proportion of the national studies in the quantitative studies was lower than that of others. The regional distribution involved in the quantitative studies was unbalanced, and the ratio of which located on the East, the Central and the West of China was 2 to 1 to 1. ConclusionThe implementation of NEMS and related studies are mutually promoted. More studies are needed to be carried out on remote areas as well as West China. Although the studies related to these areas tend to be standardized and evidence-based, but more in-depth studies should be well advanced. Most of the topics of the studies are widely covered, and the topics of further studies should be enforced in the detail of implementation links. Most of the studies focus on primary medical institutions, and more studies are also needed for supporting and expanding the implementation of NEMS in second and three degree medical institutions.
ObjectiveTo analyze the prognosis factors in status epilepticus and confirm the external validity of the Status Epilepticus Severity Score (STESS) prediction functions for outcome in patients with statusepilepticus. MethodsRetrospectively, collecting prognosis factors in status epilepticus of 50 patients. These factors include gender, age, SE aetiology, seizure type at SE onset, history of prior seizures or epilepsy, level of consciousness, duration of SE, albumin and infection. Using STESS score to evaluate the prognosis of patients, then evaluate the effectiveness of the STESS score. Results1. Single factor analysis:age,history of prior seizures or epilepsy, level of consciousness and infection were prognosis factors in status epilepticus (P<0.05). Gender, SE aetiology, seizure type at SE onset and albumin were not prognosis factors (P>0.05). Multivariablelogistic regression models selected two factors:duration of SE (OR3.645), level of consciousness (OR2.877). 2. 28 status epilepticus patient in the STESS 0-2 group were all alive. 10 status epilepticus patients in the STESS 3-6 group were died (45.4%), 12 patient were alive (54.6%). There were significant differences among the prognostic of patienst in different groups (P<0.01). The receiver operating characteristic curve for prediction of death by the STESS Score had an area under the curve of 0.92. The optimal cut-off point is 3. ConclusionAge, history of prior seizures or epilepsy, level of consciousness, duration of SE and infection were prognosis factors in status epilepticus. Level of consciousness and duration of SE were the directly related factors of the prognosis of status epilepticus. STESS score performed reasonable prognositic role on our patients with status epilepticus.
By reviewing and analyzing the domestic and international rehabilitation medicine education, we try to forecast the development of rehabilitation medicine of Sichuan, and moreover, to summarize and analyze the problems and difficulties of rehabilitation medicine education in this province. Then, we put forward the development countermeasures of Sichuan rehabilitation medicine education from the aspect of talent training object and mode, in order to gradually establish and improve a rehabilitation medicine education system that can adapt to the training requirements of modern medicine, to cultivate talents of rehabilitation medicine suitable for national construction needs at every level, and to improve the overall quality of Sichuan rehabilitation medicine education and build a medical rehabilitation highland in West China.
Objective To investigate the association between costs of hospitalized patients with diabetes mellitus and their complications in the West China Hospital of Sichuan University, so as to provide baseline data for further research. Methods We extracted the hospitalization case data of hospitalized patients with diabetes mellitus who were discharged from the department of endocrinology and metabolism, or discharged after being transferred to other departments for treatment from January 2011 to December 2012, using the hospital information system (HIS) of the West China Hospital of Sichuan University. The data included baseline of hospital patients, discharge diagnosis, hospitalization costs, and if their medical insurance had been registered in hospital. Then, we classified the diseases according to ICD-10 based on discharge diagnosis, coped the data using Excel 2010 software, and conducted statistical analysis using SPSS 13.0. Results a) In 2011, acute and chronic diabetes complication in diabetes inpatients were 11.9% (166/1 396) and 67.1% (930/1 396), respectively. Most of them had peripheral neuropathy and peripheral vascular disease. b) The most frequently-occurred complications were hypertension, followed by dyslipidemia, and osteoporosis. c) The median hospital stay was 13 days (7 to 9 days), and the median total cost of hospital/person-time was 6 578.88 yuan (4 186.93 to 10 953.89 yuan). d) The total cost and duration of hospitalization increased along with the increasing number of the chronic complications of diabetes. e) The diabetic foot patients were 255 person-times, the median duration of hospitalization was 18 days (13 to 29 days), and the median total cost of hospital/person-time was 16 672.19 yuan (10 903.93 to 28 530.37 yuan). Diabetes patients with foot complication had higher total costs and longer duration of hospitalization than those without foot complication. Conclusion Diabetes mellitus is one of the most important diseases in the department of endocrinology and metabolism, which is heavy disease burden. The costs of hospitalization and chronic complications are closely associated. Among these complications, diabetic foot is the heaviest disease burden.
ObjectiveTo investigate the etiology of patients with convulsive status epilepticus (CSE).MethodsBy taking epilepsy, seizure, status epilepticus, and epileptic seizure as keywords, the clinical data of epilepsy patients hospitalized in the First People’s Hospital of Longquanyi District of Chengdu and the People’s Hospital of Leshan from January, 2012 to December, 2017 were retrospectively collected from a retrieval system for electronic patient records. The collected CSE cases were screened by trained epilepsy specialists in strict accordance with inclusion criteria and exclusion criteria. The etiology of CSE, and the pathogenetic distinctions among patients with different ages, sexes, educational levels, places of residence, and histories of epilepsy were analyzed based on medical histories and accessory examinations. The prognostic factors for epilepsy were determined using logistic regression analysis.ResultsIn this study, a total of 852 hospitalized epilepsy cases were retrieved, among which 104 cases were CSE cases aged between 18 and 86, including 75 males and 29 females. There were 13 CSE deaths (12.5%). There were significant differences in the pathogeneses among CSE patients with different ages and histories of epilepsy (χ2=52.396, 18.354; P<0.05). However, no significant difference in CSE pathogeneses was observed among patients with different sexes, educational levels, or places of residence (P>0.05). Drug withdrawal or dose reduction was the leading cause of CSE in patients with a history of epilepsy (n=28, 57.1%), while cerebrovascular diseases (n=19, 34.5%) were common causes among those without a history. Among patients aged over 65, cerebrovascular diseases (n=17, 43.6%) were determined as the major causes of CSE, while for those aged under 65, drug withdrawal or dose reduction was the main pathogeny (n=20, 30.8%). Results obtained from multivariate logistic regression analysis on the prognostic factors for epilepsy showed that the duration of epileptic seizure significantly influenced the prognosis of patients [odds ratio=1.299, 95% confidence interval (1.074, 1.571), P=0.007], while there were no significant correlations between other factors and epilepsy prognosis (P>0.05).ConclusionsCerebrovascular diseases are the leading causes of geriatric CSE. Irregular medication of epilepsy patients is a prominent avoidable trigger for CSE.
Epilepsy is one of the most common neurological disorders, and status epilepticus (SE) can lead to permanent neuronal brain damage in the central nervous system, but the mechanism is not clear. Solving this problem will help to find more SE therapeutic targets, benefiting tens of millions of epilepsy patients. The pathway of SE leading to neuronal damage in the brain has made new progress in neuroinflammation, autophagy, apoptosis and pyroptosis, glial cell hyperplasia and category transformation, and changes in neurotransmitters in the brain, which will be beneficial to the discovery of new targets for the treatment of SE, thus laying a foundation for the development of new anti-epileptic drugs.
ObjectiveTo investigate the guidance centers for promoting equalization of basic public health services in Sichuan province, in order to provide evidence for construction and development. MethodsBy questionnaire survey, we collected relevant information and data about the guidance centers at all levels in Sichuan province. The EpiData 3.0 was used to establish a database and the SPSS 16.0 was used to analyze data. ResultsA total of 202 guidance centers had been set up in Sichuan province. All disciplines of the basic public health services were covered by these centers. There were 2 020 technicians, whose average age was 41.37, more had college degree, and intermediate professional title. 54.5% of the guidance centers didn't work together, and there were 92.7% part-time technicians. Only 40% city and 20% county guidance centers got working funds. The average working funds of province, city and county were 890 000 yuan per year, 101 000 yuan per year and 89 000 yuan per year, respectively. ConclusionThe guidance centers of Sichuan province at all levels have effectively promoted the basic public health services project, but we should improve and perfect the management mechanism and guarantee mechanism.