Surveillance for hepatocellular carcinoma at the community level: Easier said than done

Surveillance for hepatocellular carcinoma(HCC)in high-risk patients with semiannual ultrasound examinations is advocated by all international guidelines.However,as long as the identification of the population to be screened and the surveillance programs are not well implemented,the real-life impact of HCC surveillance in reducing mortality for HCC cannot be known.We propose a new approach that promotes the identification of cirrhotic patients by primary care physicians(PCPs)and referral of patients to the hepatologist for surveillance.Surveillance should be incorporated,when feasible,in a hub and spoke model of comprehensive hepatology care.Training PCPs to identify cirrhotic patients and performing surveillance in a subspecialist setting are equally important to improve the effectiveness of real-life surveillance and to decrease HCC mortality over time.

苯巴比妥和卡马西平应用于儿童期癫痫的副作用:随机对照研究

目的比较两种最常用的抗癫痫药物——苯巴比妥和卡马西平在孟加拉儿童癫痫患者中应用时的行为学副作用。设计前瞻性随机对照单中心研究。地点孟加拉 Dhaka 儿童专科医院。对象 108例2～15岁全身性强直-阵挛发作(51例)或局限性继发全身性发作(57例)的患儿。主要结局评估指标癫痫控制和行为学副作用。结果 91例患儿随访12个月。6例需改用其他抗癫痫药物。比较了85例患儿的药物副作用。药物治疗和随访1年,在随访中的后1/4时间,71例患儿未再癫痫发作。随机分组后,苯巴比妥组32例102天、卡马西平组39例74天未再癫痫发作。10例患儿行为学问题增多,其中4例不能接受(苯巴比妥组1例,卡马西平组3例)。但独立 t 检验显示,两组试验药物间没有显著性差异。结论在资源缺乏的国家,苯巴比妥不引起癫痫儿童过多的行为学副作用。临床试验注册号 NCT00381537[ClinicalTrials.gov]。