Oral levothyroxine therapy postbariatric surgery: Biopharmaceutical aspects and clinical effects

Background

Bariatric surgery can lead to changes in the oral absorption of many drugs. Levothyroxine is a narrow therapeutic drug for hypothyroidism, a common condition among patients with obesity.

Repeat capsule endoscopy in suspected gastrointestinal bleeding

Objectives: This study aims to review the utility of repeat capsule endoscopy (CE) with on-going concern of small bowel (SB) bleeding following initial SB investigation with CE.

Materials and methods: A specifically designed database of CE examinations performed over 13 years, with hospital records, was retrospectively interrogated for patients undergoing multiple CEs to investigate iron deficiency anaemia (IDA) or suspected SB bleeding.

Results: 1335/2276 (58.7%) of CEs were performed to investigate IDA or SB bleeding; 92 were repeat CEs carried out for ongoing clinical concern. The median time interval between initial and repeat CE procedures was 466.5 (range 1–3066) days. Twenty-four patients had initially normal CE; on repeat examination, abnormalities were detected in 11/24 (45.8%). 3/21 (14.2%) of patients with angioectasia on first CE had alternative causes for IDA or GI bleeding detected on repeat CE. Six patients with active bleeding, without an identifiable source on initial CE, undergoing repeat CE had a cause isolated in 5/6 (83.3%). Changing CE device did not affect diagnostic yield (DY) compared to repeat CE using the same device (27.5% to 26.8%).

Conclusions: It is known that CE can miss clinically relevant and serious lesions. Our results suggest that patients with an initially negative or inconclusive CE frequently have a cause of SB bleeding detected on repeat CE. The DY of repeat CE is highest in those with bleeding on their initial CE (83.3%) and lower in those with initially normal examinations (45.8%) or when an alternative cause, such as angioectasia is seen (14.2%).     

Acquired acrodermatitis enteropathica due to zinc‐depleted parenteral nutrition

Well‐known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc‐depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re‐epithelialization of previously denuded skin.     

COX20基因变异线粒体复合物Ⅳ缺乏症相关的遗传性周围神经病4例病例系列报告及文献复习

背景：原发性线粒体病具有高度的临床和遗传异质性，其中周围神经是线粒体病的常见受累器官之一。 目的：总结COX20基因变异相关周围神经病的临床表型及遗传学特征。 设计：病例系列报告。 方法：回顾性收集2018年5月至2020年5月复旦大学附属儿科医院诊治的COX20基因变异相关周围神经病患儿的临床资料，总结其临床表现、基因检测结果及治疗效果，并以“COX20”、“线粒体复合物Ⅳ缺乏症（Complex Ⅳ deficiency）”为关键词检索中英文数据库。检索时间均为从建库至2021年12月。总结已报道COX20基因变异与临床表型的关系。 主要结局指标：临床表型和COX20基因变异位点。 结果：4例患儿纳入分析，男、女各2例，其中3例自幼运动发育落后。4例均在儿童期起病，均以行走不稳为首发症状。肌电图均提示多发性周围神经损害改变，感觉神经轴索受累为主。4例患儿均携带COX20基因复合杂合变异，包括错义变异2个，无义变异和移码变异各1个，其中移码变异c.262delG(p.E88Kfs*35)尚未见报道。文献复习目前共报道COX基因变异18个家系22例患儿（包括本文病例）,起病中位年龄为5（1.0~17）岁，22例均以行走困难或步态不稳起病，11例（50.0%）有精神运动发育迟滞，病程中14例(63.6%)出现构音障碍，14例(63.6%)出现肌力下降和/或足部畸形，8例（36.4%）出现共济失调，6例(27.3%)出现肌张力障碍，5例（22.7%）存在认知倒退等。21例患儿行神经传导及肌电图检查，19例(90.5%)提示多发性周围神经病变。头颅（18例）及脊髓（10例）MR检查提示，脊髓萎缩4例（40%），小脑萎缩4例（22.2%）。9例患儿已无法独立行走，丧失独立行走能力中位年龄为10（7~21）岁。目前共报道9个变异位点，4种变异类型，其中错义变异5个，剪切变异2个，无义变异和移码变异各1个。 结论：COX20基因变异患者多早期起病，以周围神经系统病变为主要表现，可合并构音障碍、共济失调、肌张力障碍、认知倒退等，病情逐渐进展，致残率高。COX20基因变异类型以错义变异最常见。     

当归饮子对血虚风燥型湿疹模型幼鼠的影响及作用机制＊

目的 研究当归饮子对血虚风燥型湿疹模型幼鼠的影响并探讨其作用机制。方法 采用2，4-二硝基氯苯（DNCB）、乙酰苯肼（APH）结合物理刺激制备血虚风燥湿疹模型，50只SD大鼠随机分为空白组、模型组、当归饮子高剂量组（30 g·kg^-1）、当归饮子低剂量组（15 g·kg^-1）、地氯雷他定组（0.8 mg·kg^-1），连续灌胃15天。观察幼鼠体重、脾脏指数、胸腺指数；通过湿疹皮损评分、HE染色组织病理学改变评价当归饮子对血虚风燥湿疹的治疗效果；采用酶联免疫吸附法（ELISA）检测血清γ-干扰素（IFN-γ）、白介素-4（IL-4）、免疫球蛋白E（IgE）、白三烯B4（LTB4）、白三烯C4（LTC4）含量；采用逆转录聚合酶链式反应（RT-PCR）检测皮肤组织半胱氨酰白三烯受体1（CysLTR1）和半胱氨酰白三烯受体2（CysLTR2）表达水平，以探索当归饮子治疗血虚风燥湿疹的作用机制。结果 与正常组相比，模型组幼鼠体重明显减轻（P<0.05），脾脏指数增大、胸腺指数减小（P<0.05）；幼鼠背部出现红斑、糜烂、渗出、水肿、鳞屑等皮损；病理学呈现大量中性粒细胞浸润、表皮海绵水肿、角化过度伴角化不全；IFN-γ水平下降（P<0.05），IL-4、IgE、LTB4、LTC4水平及皮肤CysLTR1和CysLTR2受体表达水平上调（P<0.01）。与模型组相比，当归饮子高、低剂量组及地氯雷他定组体重均明显上升（P<0.05），脾脏指数减小、胸腺指数增大（P<0.05）；皮损均明显改善（P<0.05），病理改变呈表皮炎症消失，真皮乳头水肿消失；IFN-γ水平显著上升（P<0.05），IL-4、IgE、LTB4、LTC4水平明显下降（P<0.05）；皮肤CysLTR1和CysLTR2受体表达水平均明显下降（P<0.05），其中以当归饮子高剂量组最为明显（P<0.05）。结论 当归饮子治疗血虚风燥型湿疹模型幼鼠疗效明显，机制可能与其调控湿疹幼鼠Thl／Th2失衡、下调血清LTB4、LTC4水平及皮肤CysLTR1、CysLTR2受体表达水平有关。