Lenalidomide plus dexamethasone for proliferative glomerulonephritis with monoclonal immunoglobulin deposits

Objective To evaluate the efficacy and safety of lenalidomide plus dexamethasone (LD) in patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID). Methods The clinicopathological data of PGNMID patients who were treated with LD protocol from January 2010 to October 2019 were retrospectively analyzed. Results All of 6 patients received LD treatment for≥3 months after renal biopsy in Jinling Hospital. During the follow-up period of 6 to 19 months, 3 patients achieved renal remission, and the renal remission rate was 50%(3/6). Light microscopy showed membranoproliferative glomerulonephritis and immunofluorescence showed single kappa type IgG3 was deposited in the mesangial region and the vascular loop. Before taking LD scheme, the median urinary protein were 7.76(1.27, 14.57) g/24 h, the median serum creatinine was 118.5(70.7, 289.1) μmol/L, and the median albumin was 34.5(22.4, 37.5) g/L. The concentration of serum free kappa and lambda light chain was increased in 5 patients, but the serum free light chain ratio was normal. Hypocomplementemia was detected in two cases. Six patients underwent bone marrow flow cytometry, and 2 patients had elevated monoclonal plasma cells, accounting for 0.7% and 0.5%, respectively. Immunofixation electrophoresis suggested that 1 patient had positive serum M protein for kappa type IgG3. At the last follow-up, median urine protein was 3.33(0.33, 11.23) g/24 h, median serum creatinine was 108.7(80.4, 160.9) μmol/L, and median albumin was 35.9(24.5, 45.6) g/L. The concentration of serum free light chain in 4 patients from 5 patients with elevated serum free light chain was lower than that before taking the drug. Decreased level of serum complement in two cases returned to normal after treatment. The M spike did not turn negative during the follow-up in one patient. Adverse events included anemia, neutropenia, limb numbness and upper respiratory tract infection. Conclusion This study reports for the first time that LD protocol may be effective in treating PGNMID, but more attention should be paid to the hematological adverse events of lenalidomide.     

直肠癌新辅助放疗研究进展

在过去的近40年里，直肠癌的治疗方案逐渐标准化。大多数早期直肠癌患者仅通过手术即可得到充分的治疗。然而，相当比例的直肠癌患者处于局部进展期，此类患者需要行新辅助治疗。直肠癌的新辅助放射治疗已被证明能有效地降低患者术前肿瘤分期、改善患者生存以及降低直肠癌局部复发率等，随之而来的是患者放疗后出现的不同程度的放疗不良反应，但随着放射治疗规范化、放射治疗技术及设备的改进，放疗不良反应严重程度在逐渐降低。本文就新辅助放疗中的放疗方案的选择、放射治疗技术、放疗不良反应、放疗后的手术时间以及放疗后的观察与等待等问题的最新研究进展进行了系统性的综述，从而为临床直肠癌新辅助治疗提供有力依据。     

Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review

In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85 212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients.     

Improving the Acid and Base Resistance of Polyurethane Using Carbon Nanotubes

This paper demonstrates that carbon nanotubes (CNTs) can be used as an effective filler for inhibiting the hydrolysis of polyurethane (PU) under acidic and basic conditions. Although it has been reported that CNTs can quench the radicals on its surface, for the first time, it is confirmed that CNTs undergo reactions that have an inhibiting effect on ion‐mediated hydrolysis. Attenuated total reflectance–infrared spectroscopy measurements on PU and PU–CNT samples reveal that CNTs inhibit the hydrolysis of PU in both acid and alkaline environments. Via quantum chemical calculations, it is shown that CNTs can trap H⁺ ions and OH^? ions on their surface. It is also shown that CNTs can trap multiple ions, even though electrical repulsion is to be expected. The results reveal that CNTs can also function as a hydrolysis inhibitor in addition to their known functions as an antioxidant.     

伊布替尼致不良反应文献分析

目的：分析伊布替尼所致不良反应（ADRs）的发生情况及临床特点，为临床安全用药提供参考。方法：检索PubMed、Web of Science、中国知网数据库、维普中文科技期刊数据库、万方数据库、中国医院知识总库关于伊布替尼不良反应的文献并进行分析。结果：伊布替尼致ADRs的个案共41例，多发生在用药30d内（13例，31.7%）；伊布替尼致ADRs累及系统-器官以呼吸系统损害（13例，28.9%）、皮肤及附件损害为主（10例，22.2%）为主。结论：临床医师或药师应了解伊布替尼ADRs的发生规律和特点，尽量将ADRs的影响及危害降至最低，最大程度保障用药安全。     

The Reaction of Poly(Vinyl Amine) with Acetone in Water

Poly(vinyl amine) (PVAm) reacts with acetone in aqueous solution. It generates imine and aminal moieties along the PVAm backbone. The molecular structure of acetone‐modified PVAm is confirmed by liquid ¹H and ¹³C as well as solid state ¹³C NMR and ATR‐FTIR spectroscopies. Model compounds produced from 1,3‐diaminopropane with acetone in chloroform are used to assign the solid state ¹³C NMR signals of the modified polymer. Quantitative elemental analysis of acetone‐modified PVAm samples supports the analytical results. The mechanism of the imine and aminal formation is discussed with regard to the anomeric stabilization of the incipient hemiaminal intermediate. The rapid and unexpectedly favorable formation of PVAm acetone hemiaminal, acetone imine, and aminal formation has implications for the conduct of PVAm research and even the interpretation of prior published results. As acetone was often used in the past to precipitate waterborne PVAm derivatives, this finding has a severe impact on the interpretation of research results. The consequences and the revised interpretation of selected publications are discussed.     

Adverse effects of cannabinoids

Cannabidiol is a cannabinoid‐derived product that has recently been approved for the treatment of pharmacoresistant seizures in patients with epileptic encephalopathies such as Dravet Syndrome and Lennox‐Gastaut Syndrome. Short‐term side effects of cannabidiol are well know and well‐documented in the clinical trials that lead to its approval. Generally, is a well tolerated drug with transitory, dose‐dependent mild to moderate effects like somnolence, decreased appetite or diarrhoea. However severe life‐threatening reactions can also occur, and are often related to the non‐controlled toxic combination with other antiseizure drugs that are widely used in this type of patients like sodium valproate or clobazam. In this brief review we summarize the available data about the short‐term adverse events of cannabidiol. Further studies are required to assess the long‐term outcome and final resolution of these conditions regarding safety of these patients.