Contrast agent-free state-of-the-art magnetic resonance imaging on cerebral small vessel disease – Part 2: Diffusion tensor imaging and functional magnetic resonance imaging

Cerebral small vessel disease (cSVD) has been widely studied using conventional magnetic resonance imaging (MRI) methods, although the association between MRI findings and clinical features of cSVD is not always concordant. We assessed the additional contribution of contrast agent-free, state-of-the-art MRI techniques, particularly diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI), to understand brain damage and structural and functional connectivity impairment related to cSVD. We performed a review following the PICOS worksheet and Search Strategy, including 152 original papers in English, published from 2000 to 2022. For each MRI method, we extracted information about their contributions regarding the origins, pathology, markers, and clinical outcomes in cSVD. In general, DTI studies have shown that changes in mean, radial, and axial diffusivity measures are related to the presence of cSVD. In addition to the classical deficit in executive functions and processing speed, fMRI studies indicate connectivity dysfunctions in other domains, such as sensorimotor, memory, and attention. Neuroimaging metrics have been correlated with the diagnosis, prognosis, and rehabilitation of patients with cSVD. In short, the application of contrast agent-free, state-of-the-art MRI techniques has provided a complete picture of cSVD markers and tools to explore questions that have not yet been clarified about this clinical condition. Longitudinal studies are desirable to look for causal relationships between image biomarkers and clinical outcomes.     

Effect of Neprilysin Inhibition on Various Natriuretic Peptide Assays

Background

With sacubitril/valsartan treatment, B-type natriuretic peptide (BNP) concentrations increase; it remains unclear whether change in BNP concentrations is similar across all assays for its measurement. Effects of sacubitril/valsartan on atrial natriuretic peptide (ANP) concentrations in patients are unknown. Lastly, the impact of neprilysin inhibition on mid-regional pro-ANP (MR-proANP), N-terminal pro-BNP (NT-proBNP), proBNP_1-108, or C-type natriuretic peptide (CNP) is not well understood.

A Rare Case of Levetiracetam and Drug-Induced Idiopathic Aseptic Meningitis in a Pediatric Patient

Levetiracetam (LEV) is a pyrrolidine derivative antiepileptic medication used for the treatment of seizures in pediatric and adult patients. We report a case of probable LEV-induced aseptic meningitis in a 13-year-old girl. The patient received LEV for a generalized seizure disorder and presented with symptoms 5 days after medication initiation. Ten days after LEV initiation, the patient presented to the hospital for further management. During her hospital course, infectious etiologies were ruled out with clinical and diagnostic testing. Upon discontinuation of LEV, the patient's symptoms resolved. Although select antiepileptic medications have been associated with drug-induced aseptic meningitis (DIAM), to date, no reports have been published about DIAM following the administration of LEV. We describe and categorize the probability of DIAM in association with LEV, as observed in a patient case.     

Efficacy and safety of tadalafil taken as needed for the treatment of erectile dysfunction in Asian men： results of an integrated analysis

We evaluated the efficacy and safety of as-needed tadalafil in a diverse clinical population （with varying patient demographics, disease severity, and comorbid medical conditions） of Asian men with erectile dysfunction （ED）. An integrated analysis of five double-blind, placebo-controlled trials （N = 1 046） was performed. Patients were randomly assigned to receive 10 mg tadalafil （N = 185）, 20 mg tadalafil （N = 510）, or placebo （N = 351）. Efficacy assessments included the International Index of Erectile Function （IIEF）, Sexual Encounter Profile （SEP） diary and Global Assessment Question （GAQ）. Patients receiving 10 mg or 20 mg tadalafil showed significant improvement from baseline-to-end point on the Erectile Function domain of the International Index of Erectile Function （IIEF-EF） domain score in all clinical sub-populations analyzed, compared with patients receiving placebo （P 〈 0.001）. The 10-mg and 20-mg tadalafil groups showed a mean success rate of 64.1% and 70.5% for sexual intercourse attempts （SEP3, successful intercourse）, respectively, compared with 33.4% in the placebo group （P 〈 0.001）, and 85.5% and 85.4% reported improved erections at end point GAQ, respectively, versus 43.5% in the placebo group （P 〈 0.001）. Tadalafil was well tolerated across all groups studied. Headache and back pain were the most frequently reported adverse events. Overall, tadalafil was effective and well tolerated across a diverse clinical spectrum of Asian men with ED.