A Review of the Surgical Procedures for the Treatment of Drug-Resistant Epilepsy and Their Seizure Control Outcomes

Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy to help those patients who suffer from drug-resistant epilepsy. The goal of this surgery is to halt or reduce the intensity of seizures. This literature review aims to provide an overview of existing surgical procedures for the treatment of drug-resistant epilepsy and the degree of seizure control they provide based on available literature. Methods: Data were collected from medical journal databases, aggregators, and individual publications. The most used databases were PubMed, Medline and NCBI. Some of the keywords used to search these databases include: “drug resistant epilepsy”, “seizure control”, and “neurosurgery”. Results: Epileptic surgery is divided into resective and non-resective procedures. Studies have shown that a full resection of the epileptogenic brain area increases the probability of seizure eradication, however, the risks of postoperative impairments grow as the resection area is extended. On the other hand, patients who are unsuitable for seizure focus removal by resective surgery, such as those with multifocal seizures or overlapping epileptogenic zone with a functional cortex, may benefit from non-resective surgical options such as Vagus Nerve Stimulation and Responsive Neurostimulation. Conclusion: This literature review discusses the comprehensive treatment of epilepsy, especially the surgical treatment of drug-resistant epilepsy. The reviewed studies have shown that epilepsy surgery has promising outcomes in achieving seizure freedom/reducing seizure frequency with minimal adverse effects when performed correctly with the appropriate choice of surgical candidates.

BIODEGRADABLE POLYMERS WITH A PHOSPHORYL-CONTAINING BACKBONE:TISSUE ENGINEERING AND CONTROLLED DRUG DELIVERY APPLICATIONS

This review provides a glimpse of the potential of the biodegradable phos-phoryl-containing polymers in medical applications. Undoubtedly these polymerspossess unique properties that are yet to be fully understood. Many areas warrantfurther investigation and much optimization remains to be done. The fascinatingchemistry of phosphorus poses interesting hurdles but at the same time leavesample room for polymer scientists to exercise their creativity in designinginteresting biomaterials. As the mutual understanding between basic and clinicalscientists on the need of medical devices and the capabilities of these newbiomaterials expands, imaginative application of new biomaterials to other medi-cal applications can be expected.

Structure-Property Relationships and Models of Controlled Drug Delivery of Biodegradable Poly (D, L-lactic acid) Microspheres

An oil-in-water (O/W) solvent evaporation method was used to prepare biodegradable microspheresbased on poly(D,L-lactic acid) (PLA). Nifedipine, a hydrophobic drug, was chosen as a model molecule in the studyof drug entrapment and release. Effect of preparation conditions on the size, morphology, drug loading, and releaseprofiles of micropheres was investigated. Based on in vitro release experimental findings, a diffusion/dissolutionmodel was presented for quantitative description of the resulting release behaviors and drug release kinetics fromPLA microspheres analyzed. The mathematical models were used to predict the effect of microstructure on theresulting drug release. It provided an approach to determine the suitable structure parameters for microspheres toachieve desired drug release behaviors.

pH-responsive mesoporous silica nanoparticles employed in controlled drug delivery systems for cancer treatment

In the fight against cancer, controlled drug delivery systems have emerged to enhance the therapeutic efficacy and safety of anti-cancer drugs. Among these systems, mesoporous silica nanoparticles(MSNs) with a functional surface possess obvious advantages and were thus rapidly developed for cancer treatment. Many stimuli-responsive materials, such as nanoparticles, polymers, and inorganic materials, have been applied as caps and gatekeepers to control drug release from MSNs. This review presents an overview of the recent progress in the production of pH-responsive MSNs based on the pH gradient between normal tissues and the tumor microenvironment. Four main categories of gatekeepers can respond to acidic conditions. These categories will be described in detail.

A Concise Review of Gold Nanoparticles-Based Photo-Responsive Liposomes for Controlled Drug Delivery

The focus of drug delivery is shifting toward smart drug carriers that release the cargo in response to a change in the microenvironment due to an internal or external trigger. As the most clinically successful nanosystem, liposomes naturally come under the spotlight of this trend. This review summarizes the latest development about the design and construction of photo-responsive liposomes with gold nanoparticles for the controlled drug release. Alongside, we overview the mechanism involved in this process and the representative applications.

Synthesis of the Core-Shell Structure Materials as the Controlled-Release Drug Carrier

We have developed a controlled-release drug carrier. Smartly controlled-release polymer nanoparticles were firstly synthesized through RAFT polymerization as the controlled-release core. The structural and particle properties of polymer nanoparticles were characterized by nuclear magnetic resonance spectroscopy (1H-NMR), scanning electron microscope (SEM) and X-ray spectroscopy (EDX). Mesoporous materials were selected as the shell materials to encapsulate the smart core as the stable shell. The mesoporous shell was characterized by transmission electron microscopy (TEM) and scanning electron microscope (SEM). All the results showed that a well-defined core-shell structure with mesoporous structure was obtained, and this controllable delivery system will have the great potential in nanomedicine.

Preparation and Characterization of Chitosan-Insulin-Tripolyphosphate Membrane for Controlled Drug Release: Effect of Cross Linking Agent

The term Diabetes Mellitus (DM) comprises a group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in the secretion and/or action of insulin. The Insulin therapy constitutes the preferred treatment for DM, consisting of daily subcutaneous insulin injections to control blood glucose levels. The chitosan studied for Biomedicine is a biomaterial that can be used for controlled release of drugs whose release rate can be controlled by Sodium Tripolyphosphate (TPP), which is an ionic cross linker of the chitosan. Present study, therefore, was aimed to develop and evaluate membranes of chitosan and chitosan cross linked by TPP for use in controlled release of insulin system, with the purpose of obtaining an alternative to the injectable administration of this drug. The developed membranes were characterized by the techniques of Fourier Transform Infrared spectroscopy (FTIR), Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDX), High Performance Liquid Chromatography (HPLC) and Evaluation of Cell Viability of Macrophages (MTT). With the FTIR technique the interaction between chitosan, tripolyphosphate and insulin was identified. Chemical elements present in chitosan, insulin and sodium tripolyphosphate membranes were detected by EDX technique. By SEM technique, the changes in the morphology of the membrane containing insulin, with the presence of granular particles of varying sizes, could be observed when compared to pure chitosan. With HPLC assay insulin was identified and it was shown that it gets separated from chitosan membrane even when the membrane was cross linked by the TPP, though at a reduced rate. The crosslinking agent was effective to control the rate of insulin release. The biocompatibility of the prepared membranes was confirmed by cell viability of macrophages using the MTT assay. The developed membranes, therefore, have potential for use as a biomaterial in controlled release systems for insulin.

基于天然多糖的刺激响应型药物控释系统研究进展

刺激响应型药物控释系统一般以天然多糖生物大分子或其衍生物作为载体,通过化学结合或物理吸附等方式负载药物分子。具有刺激响应功能的天然多糖生物大分子或其衍生物能够感知其所处环境的变化,并由于其物理或化学性质的变化而做出应激响应,因此可在不同环境或条件的刺激下,通过药物与载体之间化学键断裂或载体自身降解等方式将药物从载体中释放,从而实现药物的控制释放。结合课题组的研究工作,介绍了常用的刺激方式,包括单一刺激和多重刺激、外源性刺激和内源性刺激,为开发新型刺激响应型药物控释系统提供了思路。

Doping Control Analysis of 16 Non-Steroidal Anti-Inflammatory Drugs in Equine Plasma Using Liquid Chromatography-Tandem Mass Spectrometry

Non-steroidal anti-inflammatory drugs (NSAIDs) are classified as Class 4 agents by the Association of Racing Commissioners International and are banned in racehorses during competition in Pennsylvania (PA). To control the abuse of these agents in racehorses competing in PA, a forensic method for screening and confirmation of the presence of these agents is needed. Equine plasma (0.5 mL) was acidified with 75 μL 1M H3PO4 to increase recovery of the analytes by liquid-liquid extraction using methyl tert-butyl ether (MTBE). Extracted analytes were separated by reversed-phase liquid chromatography using a C8 column under gradient condition. All 16 analytes were detected, quantified and confirmed using a triple quadrupole tandem mass spectrometry with selected reaction monitoring (SRM) in both negative and positive electrospray ionization modes. The limit of detection, quantification and confirmation of the analytes were 1.0 - 5.0 ng/mL, 1.0 - 5.0 ng/mL and 1.0 - 20 ng/mL, respectively. The linear dynamic range of quantification was 5.0 - 200 ng/mL. The method is routinely used in anti-doping analysis to control the abuse of NSAIDs in racehorses competing in PA.

New botanical drug, HL tablet, reduces hepatic fat as measured by magnetic resonance spectroscopy in patients with nonalcoholic fatty liver disease: A placebo-controlled, randomized, phase Ⅱ trial

AIM To evaluate the efficacy and safety of HL tablet extracted from magnolia officinalis for treating patients with nonalcoholic fatty liver disease(NAFLD).METHODS Seventy-four patients with NAFLD diagnosed by ultrasonography were randomly assigned to 3 groups given high dose(400 mg) HL tablet, low dose(133.4 mg) HL tablet and placebo, respectively, daily for 12 wk. The primary endpoint was post-treatment change of hepatic fat content(HFC) measured by magnetic resonance spectroscopy. Secondary endpoints included changes of serum aspartate aminotransferase, alanine aminotransferase(ALT), cholesterol, triglyceride, free fatty acid, homeostasis model assessment-estimated insulin resistance, and body mass index(BMI).RESULTS The mean HFC of the high dose HL group, but not of the low dose group, declined significantly after 12 wk of treatment(high dose vs placebo, P = 0.033; low dose vs placebo, P = 0.386). The mean changes of HFC from baseline at week 12 were-1.7% ± 3.1% in the high dose group(P = 0.018),-1.21% ± 4.97% in the low dose group(P = 0.254) and 0.61% ± 3.87% in the placebo group(relative changes compared to baseline, high dose were:-12.1% ± 23.5%, low dose:-3.2% ± 32.0%, and placebo: 7.6% ± 44.0%). Serum ALT levels also tended to decrease in the groups receiving HL tablet while other factors were unaffected. There were no moderate or severe treatment-related safety issues during the study.CONCLUSION HL tablet is effective in reducing HFC without any negative lipid profiles, BMI changes and adverse effects.

临床药师对住院高血压患者实施标准化管理的实践

高血压是一种常见慢性病,若未及时有效治疗,可损伤心、脑、肾这些重要脏器的结构和功能,其导致的临床并发症不仅致残、致死率高,且消耗很多的医疗和社会资源,给家庭和社会造成巨大的负担。高血压患者通常需要长时间的标准化治疗方能达到控制血压,延缓、降低靶器官损害及临床并发症发生等目的;但由于患者难以得到科学、系统、标准化的药学服务,因此该类患者对疾病、药物治疗知识认知不足,不合理用药情况多见,存在大量误区,导致药物治疗的依从性差,最终无法达到降压目标,影响整体治疗效果。基于以上原因,笔者在住院高血压患者标准化管理方面进行了研究并进行总结,旨在探索建立针对高血压患者的药学服务模式,为今后临床药师开展慢病管理工作提供参考。

Studies on the in Vitro Dissolution of Insoluble Volatile Drug from Su-Anxin Nasal Inhalant and Its Correlation on the Nose Steady Self-Controllable Expiration and Inspiration at Night

In the paper, the in vitro dissolution of borneol in 12 hours from 6 batches of optimized inhalant samples were investigated. As a new dosage form, the in vitro release apparatus of nasal inhalant was invented and a pushing bump was used according to the simulation of the nose expiration and inspiration. Based on the data of r2 in the profile and similar factor f2 from 6 linear release tendencies, a good controlled release and a zero order tendency were observed. It can be suggested that there is a good correlation between the in vitro controlled release and the nose steady self-controllable expiration and inspiration, which will contribute to the trend of insoluble volatile drug controlled release and the effect of quick absorption in nasal pulmonary delivery to cure severe or acute cardiovascular or lung diseases at patients' sleeping, such as angina or breathing obstruction. Also, it was concluded that the prescription composed of insoluble volatile drugs can be prepared to be nasal inhalant from which drugs can be absorbed through nose steady self-controllable inspiration to the lung then into the blood and have a great effectiveness improvement of bioavailability at night timing drug delivery system.

全院性医院感染防控文化活动作用评价

目的为评价全院性的感控文化建设在医院感染防控中的作用。方法回顾性分析2021—2023年某肿瘤专科医院举办的个人防护用品操作视频大赛、“手卫生之星”活动、“火眼金睛”——图说感控活动、感控微视频大赛等全院性感控文化相关活动,并统计2020—2023年各项院感监测指标变化情况,评价活动效果。结果2023年院感防控监测指标均较2021年有显著提升。其中,手卫生依从率从84.13%提高至94.46%,医院感染发生率由1.53%降低至0.70%,多重耐药菌感染率由0.21%降低至0.11%,多重耐药菌防控措施正确实施率由52.50%提高至88.19%,差异均有统计学意义(均P<0.05);个人防护用品穿脱考核通过3000余人次。结论适当举行全院性的感控宣传活动,能有效提高医院感染防控能力。

静脉用质子泵抑制剂使用合理性分析及院内管控

目的:探讨我院静脉用质子泵抑制剂(PPIs)使用的合理性。方法:收集2022年度我院使用PPI的病例,共226份病历资料符合要求。结果:进入季度使用金额排名前五名次数最多的PPIs依次是注射用艾司奥美拉唑、注射用艾普拉唑、注射用雷贝拉唑、注射用奥美拉唑;病历不合理率为64.16%,无适应证用药53例(36.55%),用法用量不适宜46例(31.72%),疗程不适宜21例(14.48%),遴选药品不适宜17例(11.72%),联合用药不适宜5例(3.45%),溶媒不适宜3例(2.07%)。结论:对PPI使用不合理的现象需要加强重点品种管控,提升医师的合理用药水平,促进合理用药。

质量控制和精细化管理在PIVAS的应用效果分析

目的探究质量控制和精细化管理在医院静脉用药调配中心(Pharmacy Intravenous Admixture Service,PIVAS)应用中的效果。方法济南市第三人民医院于2020年1月—2022年12月实施质量控制和精细化管理方案,将此时段内设定为研究组,与2018年1月—2019年12月采用传统输液管理方式的对照组进行对比。两个阶段的医护人员均为同一批,共计20名医护人员,记录两组医护人员的正负性情绪评分、情绪智力以及工作质量。结果研究组正性情绪评分高于对照组,研究组管理后的负性情绪评分低于对照组,差异有统计学意义(P均<0.05);研究组各项情绪智力高于对照组,差异有统计学意义(P均<0.05);与对照组相比,研究组医护人员审方排药、核对、配置操作、环境卫生、清场、设备使用及维护评分更高,差异有统计学意义(P均<0.05)。结论质量控制和精细化管理的引入,使得PIVAS在患者用药过程中更加安全可靠,医护人员的情绪得到改善,并且护理质量大大提升,在提高医疗质量方面具有显著优势。

药物临床试验815例次方案违背的帕累托图分析

目的分析药物临床试验的方案违背情况,找出需重点关注的方案违背,并提出解决方案,以保证药物临床试验质量。方法收集2022年1-12月该院815例次药物临床试验方案违背报告数据,包括类别、例数等。采用Excel2007软件进行数据分析,绘制帕累托图,明确构成方案违背的主要因素。结果815例次药物临床试验中药物漏服/少服/多服、检查漏查、访视超窗是方案违背的主要因素。导致方案违背的责任主体中61.84%(504/815)为受试者,25.64%(209/815)为研究者。结论药物临床试验实施过程中,需重点关注药物服用情况,检查完整性及访视窗问题,加强研究者及受试者培训,规范药物临床试验管理,提高药物临床试验质量。

公共卫生视角下葡萄牙与挪威管控药物政策的演变及启示

在全球化背景下,公共卫生视角为管控药物政策提供了新的理解和处理方式。分析了葡萄牙与挪威在管控药物政策方面从刑事化向去刑事化和去病态化的转型过程及其对中国的启示。葡萄牙和挪威的经验表明了去刑事化和去病态化策略能够有效减少药物滥用及其相关的公共卫生和社会问题,同时促进管控药物使用者的社会融入与康复。针对中国当前在严格执法与满足公共卫生需求之间寻找平衡的努力,建议重新界定管控药物的法律地位,增强资源配置,加强跨部门合作,提高公众教育及社会意识,以期构建一个更加有效且人本关怀的药物政策框架。

QUALITY CONTROL FOR CHINESE HERBAL DRUGS USING DNA PROBE TECHNOLOGY

ＩＮＴＲＯＤＵＣＴＩＯＮＴｈｅｔｙｐｅａｎｄｓｐｅｃｔｒｕｍｏｆｄｉｓｅａｓｅｓａｒｅｃｈａｎｇｉｎｇｓｉｇｎｉｆｉｃａｎｔｌｙａｓｔｈｅｓｏｃｉｅｔｙａｇｉｎｇｔｏｄａｙ .Ｔｈｅａｕｔｏｉｍｍｕｎｅｄｉｓｅａｓｅｓｓｕｃｈａｓｓｅｎｉｌｅｄｅｍｅｎｔｉａ ,ＡＩＤＳ ,ａｓｗｅｌｌａｓｃａｒｄｉｏ ｃｅｒｅｂｒａｌｖａｓｃｕｌａｒｄｉｓ ｅａｓｅｓｓｕｃｈａｓｈｙｐｅｒｔｅｎｓｉｏｎ ,ａｒｒｈｙｔｈｍｉａ ,ｍｙｏｃａｒｄｉａｃｉｎｆｒａｃｔｉｏｎｅａｒｅｂｅｃｏｍｉｎｇａｎｉｎｔｒａｃｔａｂｌｅａｎｄｇｌｏｂｕｌａｒｐｒｏｂｌｅｍ .Ｒｅｃｅｎｔｌｙ ,ｐｅｏｐｌｅａｒｅｖｅｒｙｍｕｃｈｃｏｎｃｅｒｎｅｄｗｉｔｈｓｉｄｅｅｆｆｅｃｔｓｏｆｓｙｎｔｈｅｔｉｃｐｈａｒ ｍａｃｅｕｔｉｃａｌｓａｎｄａｒｅａｎｘｉｏｕｓｔｏｒｅｔｕｒｎｔｏｔｈｅｕｓｅｏｆｎａｔｕｒａｌｍｅｄｉｃｉｎｅ .Ｂａｃｋｔｏｎａｔｕｒｅ ,ｔｈｅｎｅｅｄｆｏｒＣｈｉｎｅｓｅｈｅｒｂａｌｄｒｕｇｓｉｓｉｎｃｒｅａｓｉｎｇｇｒａｄｕａｌｌｙｆｏｒｐｒｅｖｅｎｔｉｏｎａｎｄｔｈｅｒａｐｙｏｆｄｉｓｅａｓｅｓｉｎｔｈｅｗｏｒｌｄ .Ａｒｅｃ...

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years;sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p < 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p < 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients;furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

复合纳米载体在微波可控释药方面的研究进展

在现代癌症治疗中,传统化疗药物缺乏靶向性,常伴随严重的毒副作用,限制了化学疗法的临床应用。近年来,随着纳米技术的发展,基于纳米材料的靶向化疗成为一种新的治疗策略,特别是复合纳米材料在微波刺激下的药物释放性能,展现出了优异的应用前景。本文综述了这一领域的最新进展,重点分析了复合纳米材料如何在微波刺激下实现精准的药物释放,以及这种方法在癌症治疗中的潜力。复合纳米材料因其独特的物理化学性质,如高稳定性和良好的生物相容性,被广泛应用于癌症治疗中。在微波刺激下,这些材料能够实现药物的精准控制释放,从而提高治疗效果并减少对健康组织的损害。然而,复合纳米载体在生物体内的分布、靶向性和生物安全性等方面仍面临一定的挑战。例如,纳米粒子的体内稳定性和靶向能力需要进一步优化,以提高其治疗效果和减少副作用。在微波刺激诱导的药物控制释放方面,虽然已取得了一定的成果,但精确控制微波能量的传递和局部组织的加热效果仍是主要挑战之一。此外,如何确保微波能量集中于肿瘤组织而不损害周围健康组织,也是当前研究需要解决的问题。未来,随着纳米技术的不断进步和微波控制技术的改进,预计将开发出更为高效和安全的复合纳米载体,不仅能够提高药物的靶向性和治疗效果,还能在微波刺激下实现更为精准的药物释放控制。综上所述,复合纳米材料在微波刺激下的药物释放性能将是癌症治疗领域的一个重要研究方向,有望为癌症患者带来更有效的治疗选择。