Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis

Objective:In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation.Methods:Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6–8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland–Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation.Results:Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6–8 months showed that the degree of stenosis was 40% (range, 30–72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30–75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland–Altman plot showed that all data points were within the consistency limits ( x- ± 1.96 s).Conclusion:As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR.Advances in knowledge:This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.     

补肺活血法治疗慢性阻塞性肺疾病缓解期患者的临床观察

目的 研究补肺活血法治疗慢性阻塞性肺疾病缓解期的临床疗效和对肺功能的影响.方法 将125例患者随机分为治疗组85例和对照组40例,两组均经缓解期常规基础治疗,治疗组加用中药汤剂口服.两组均以2周为1个疗程,连续治疗4个疗程后统计疗效.结果 治疗组总有效率为94.1%,对照组总有效率为90.0%,两组相比,P＜0.05;两组的主要症状和体征均改善,但治疗组对咳嗽、咳痰、喘促、气短以及肺部罗音等症状体征改善均优于对照组(P＜0.01);治疗组的肺功能的改善优于对照组(P＜0.05);治疗组的发病次数明显少于对照组(P＜0.05).结论 补肺活血法能有效改善慢性阻塞性肺疾病缓解期患者的临床症状、体征、肺功能,减少患者发病次数,并提高其生活质量.     

伴皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病一例报告

目的 总结貌似多发性硬化的皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)的临床特点.方法 报告1例经基因检查和周围神经活检确诊为CADASIL的临床资料.结果 患者腓肠神经活检可见有髓神经纤维密度轻度减少,电镜下可见神经束膜小动脉中层平滑肌细胞外大量颗粒性电子致密嗜锇颗粒物质(GOM)沉积.基因检测显示Notch3基因4号外显子Cys117Arg突变.结论 为避免CADASIL的漏诊及误诊,凡遇青年反复脑卒中发作,又无高血压、糖尿病等常见的血管病危险因素,虽无偏头痛病史,亦应注意追问家族史并做基因检测和周围神经活检.     

中老年冠心病患者动脉粥样硬化性肾动脉狭窄及危险因素分析

目的探讨中老年冠心病患者动脉粥样硬化性肾动脉狭窄的患病率和危险因素.方法对339例冠脉造影诊断为冠心病的中老年患者,同时进行选择性双侧肾动脉造影.结果肾动脉狭窄的发生率为37.2%(126/339).肾动脉狭窄组年龄、高血压病、吸烟者的比率均高于非肾动脉狭窄组(P＜0.001、＜0.03、＜0.02),肾动脉狭窄患病率随病变程度加重有逐渐增加的趋势(x2趋势=4.17,P＜0.0001).多因素回归分析中,年龄、高血压、吸烟和冠心病多支病变为肾动脉狭窄的独立危险因素(P＜0.05).结论中老年冠心病患者,尤其是高龄、高血压、吸烟、多支病变的患者应常规行选择性肾动脉造影.     

增生性瘢痕无创性评估策略及方法

增生性瘢痕是皮肤遭遇创伤后,因细胞外基质异常沉积、过度纤维化造成的皮肤病理现象。对于瘢痕诊断、临床疗效判定及比较研究,临床上使用的客观且可靠的瘢痕评判方法具有关键作用。我们就增生性瘢痕的评估、测量方式及工具的研究进展进行综述。     

Saroclazines A–C,thio-diketopiperazines from mangrove-derived fungi <Emphasis Type="Italic">Sarocladium kiliense</Emphasis> HDN11-84

Three new diketopiperazine derivatives (DKPs), saroclazines A–C (1–3) along with three known DKPs (4–6) were isolated from mangrove-derived fungi Sarocladium kiliense HDN11-84. Saroclazines A–B (1 and 2) possessed a free amide structure, which was first found in sulfur-containing aromatic DKPs. Their structures were elucidated by NMR, HRESIMS and X-ray. The cytotoxic activity of new compounds (1–3) was tested against HeLa cell lines, among which compound 2 showed an IC₅₀ value of 4.2 µM.     

Population Pharmacokinetics and Dosing Simulations of Ceftazidime in Chinese Neonates

An accurate dosage determination is required in neonates when antibiotics are used. The adult data cannot be simply extrapolated to the pediatric population due to significant individual differences. We aimed to identify factors impacting ceftazidime exposure in neonates and to provide drug dosing guidance to clinicians. Forty-three neonates aged less than 60 days with proven or suspected infections were enrolled in this study. After intravenous administration, blood samples were collected, and plasma ceftazidime concentration was determined using a HPLC method. Pharmacokinetic data were fitted using a nonlinear mixed-effects model approach. One-compartmental model could nicely characterize the ceftazidime in vivo behavior. The covariate test found that the postmenstrual age (day) was strongly associated with systemic drug clearance (L/h), and the effect of body weight (kg) was identified as the covariate on distribution volume (L). Compared with the base model, the addition of covariates improved the goodness-of-fit of the final model. Model validation (bootstrap, visual predictive check, and prediction-corrected visual predictive check) suggested a robust and reliable pharmacokinetic model was developed. Personalized dosage regimens were provided based on model simulations. The intravenous dose should be adjusted according to postmenstrual age, body weight, and minimum inhibitory concentration.     

Prediction of Human Brain Penetration of P-glycoprotein and Breast Cancer Resistance Protein Substrates Using In Vitro Transporter Studies and Animal Models

Four P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) substrates with human cerebrospinal fluid (CSF) concentrations and preclinical neuropharmacokinetics were used to assess in vitro–in vivo extrapolation of brain penetration in preclinical species and the ability to predict human brain penetration. Unbound brain (C_b,u), unbound plasma (C_p,u), and CSF compound concentrations (C_CSF) were measured in rats and nonhuman primates (NHPs), and the unbound partition coefficients (C_b,u/C_p,u and C_CSF/C_p,u) were used to assess brain penetration. The results indicated that for P-gp and BCRP dual substrates, brain penetration was severally impaired in all species. In comparison, for P-gp substrates that are weak or non-BCRP substrates, improved brain penetration was observed in NHPs and humans than in rats. Overall, NHP appears to be more predictive of human brain penetration for P-gp substrates with weak or no interaction with BCRP than rat. Although C_CSF does not quantitatively correspond to C_b,u for efflux transporter substrates, it is mostly within 3-fold higher of C_b,u in rat and NHP, suggesting that C_CSF can be used as a surrogate for C_b,u. Taken together, a holistic approach including both in vitro transporter and in vivo neuropharmacokinetics data enables a better estimation of human brain penetration of P-gp/BCRP substrates.