Tetrabenazine therapy of pediatric hyperkinetic movement disorders.

Tetrabenazine (TBZ), a presynaptic dopamine depletor and postsynaptic dopamine receptor blocker, is widely used for the treatment of hyperkinetic movement disorders in adults. However, reports of its use in children are limited. We review the efficacy and tolerability of TBZ therapy in 31 children with hyperkinetic movement disorders refractory to other medications. TBZ was effective in reducing the severity of movement disorders resistant to treatment with other medicines. When compared to adult patients, pediatric patients required higher doses. Side effects were similar to the adult population; however, children had a lower incidence of drug-induced Parkinsonism.     

The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care

Obesity is a complex and multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, metabolic associated fatty liver disease, reproductive hormonal abnormalities, sleep apnoea, depression, osteoarthritis and certain cancers. An algorithm has been developed (with PubMed and Medline searched for all relevant articles from 1 Jan 2000–1 Oct 2021) to (i) assist primary care physicians in treatment decisions for non-pregnant adults with obesity, and (ii) provide a practical clinical tool to guide the implementation of existing guidelines (summarised in Appendix 1) for the treatment of obesity in the Australian primary care setting.Main recommendations and changes in managementTreatment pathways should be determined by a person’s anthropometry (body mass index (BMI) and waist circumference (WC)) and the presence and severity of obesity-related complications. A target of 10–15% weight loss is recommended for people with BMI 30–40 kg/m² or abdominal obesity (WC > 88 cm in females, WC > 102 cm in males) without complications. The treatment focus should be supervised lifestyle interventions that may include a reduced or low energy diet, very low energy diet (VLED) or pharmacotherapy. For people with BMI 30–40 kg/m² or abdominal obesity and complications, or those with BMI > 40 kg/m² a weight loss target of 10–15% body weight is recommended, and management should include intensive interventions such as VLED, pharmacotherapy or bariatric surgery, which may be required in combination. A weight loss target of > 15% is recommended for those with BMI > 40 kg/m² and complications and they should be referred to specialist care. Their treatment should include a VLED with or without pharmacotherapy and bariatric surgery.     

盐酸洛美沙星眼凝胶临床生物等效性试验

目的:观察3g/L盐酸洛美沙星眼凝胶的临床疗效及安全性。方法:对128例(203眼)细菌性结膜炎和细菌性角膜炎患者采用多中心、随机分组、平行对照试验,观察其主要症状体征消失情况、角膜炎症面积缩小情况、病原菌清除效果和不良反应。试验组(testgroup,TG)65例(103眼),对照组(controlledgroup,CG)63例100眼,分别应用3g/L盐酸洛美沙星眼凝胶和3g/L盐酸洛美沙星滴眼液。结果:①TG治愈率(80.6%)高于CG治愈率(65.0%);②TG(细菌性结膜炎)眼痛异物感消失率和消失时间(83.7%,5.33±2.00d)优于CG(64.1%,6.36±1.50d);TG(细菌性结膜炎)流泪消失率(91.8%)高于CG(75.0%);③记分统计表明:TG(细菌性结膜炎)结膜充血改善(平均下降1.76分)明显优于CG(平均下降1.25分);TG畏光消失情况(平均下降1.24分)好于CG(平均下降0.87分);TG(细菌性结膜炎)分泌物消失情况(平均下降1.64分)好于CG(平均下降1.33分);④其他情况两组间无明显差异。结论:3g/L盐酸洛美沙星眼凝胶治疗眼前段细菌感染安全、有效,对结膜炎症状体征的改善优于滴眼液。     

非核苷类逆转录酶抑制剂奈韦拉平

艾滋病是严重威胁人类健康的传染性疾病，它是由HIV引发，特别是HIV-1。奈韦拉平是一种新型的非核苷类逆转录酶抑制剂，该药与核苷类逆转录酶抑制剂或蛋白酶抑制剂合用可用于治疗艾滋病，单独用药可用于预防HIV感染和母婴传播。     

温肾健脾方对大鼠慢性创面愈合的影响

目的:探讨温肾健脾中药对慢性创面愈合的影响及可能作用机制.方法:采用大鼠背部开放性创面模型,用肌注氢化可的松的方法造成慢性难愈性创面,以辛葡康为阳性对照药,应用免疫组化、流式细胞术等方法,观察创面愈合时间、新生上皮宽度、肉芽组织形态学变化、肉芽组织细胞周期、表皮生长因子(epidermal growth factor, EGF)、转化生长因子β1 (transforming growth factor-β1, TGF-β1)及纤维连接蛋白(fibronectin, FN)等指标.结果:温肾健脾方治疗组与辛葡康对照组平均创面愈合时间分别为(17.0±1.9)和(18.8±1.9) d,较模型组及空白组明显缩短(P<0.05);治疗14 d后,治疗组及对照组新生上皮宽度分别为(3.73±0.19)和(3.21±0.15)mm,较模型组及空白组明显增宽(P<0.05);治疗组新生毛细血管丰富,成纤维细胞数量多,而对照组、模型组及空白组新生毛细血管及成纤维细胞数量均较治疗组明显减少(P <0.05);治疗组S期细胞比例较对照组、模型组及空白组明显提高(P<0.05);治疗组及对照组与模型组及空白组比较,EGF、TGF-β1、FN蛋白表达均增强(P<0.05).结论:温肾健脾方有促进大鼠慢性难愈创面修复的作用,其机制与调节细胞周期,上调EGF、TGF-β1细胞因子蛋白表达水平,促进间质FN的表达有关.     

Nitric oxide in patients with schizophrenia: the relationship with the severity of illness and the antipsychotic treatment

Objectives: Past studies regarding the relationship between nitric oxide and schizophrenia have reported controversial results. Consequently, the aims of this study are i) to analyze the differences in nitric oxide concentration between patients with schizophrenia and healthy controls, ii) to investigate the influence of antipsychotic treatment on nitric oxide, iii) to correlate nitric oxide concentration with severity of illness, and iv) to investigate the relationship between nitric oxide and any personality disorder.

Research design and methods: We recruited 24 patients and 24 controls; the sample was divided into three groups of 8 patients, each according to the pharmacological treatment (haloperidol, olanzapine, or risperidone). The severity of illness was assessed by PANSS and personality traits were evaluated by SCID II. A blood sample was taken to assess the plasma concentration of nitrites and nitrates.

Results: Patients presented higher nitrate levels than controls (p < 0.05); subjects under olanzapine reported lower nitrate levels than those treated with risperidone (p < 0.05) or haloperidol (p < 0.001). Nitrate levels were correlated with PANSS total score (rho = 0.748; p < 0.001), but not with SCID II scores.

Conclusions: Despite the fact that this study found a correlation between PANSS score and nitrate levels, it is unclear whether nitric oxide is related to the severity of schizophrenia, because nitrate levels are also affected by antipsychotic treatment.     

Pharmacological treatment of generalized anxiety disorder

Introduction: Generalized anxiety disorder (GAD) is a chronic, relapsing, debilitating disorder, associated with markedly impaired social and occupational functioning. Pharmacological treatment is considered standard care and several drug classes are now FDA approved for the treatment of GAD. While there are clear data for the efficacy of short-term acute treatment, long-term treatment and treatment-resistant GAD remain challenging.

Areas covered: This article describes current pharmacological treatment options for GAD, with focus on benzodiazepines, azapirones, antidepressants and anticonvulsant and antipsychotic drugs. Recent findings from placebo-controlled clinical trials are reviewed and evidence-based clinical implications are discussed. A PubMed search was completed using the terms: ‘generalized anxiety disorder AND treatment’ and ‘generalized anxiety disorder AND therapy’. Additional pivotal trials were included for a historical perspective (older landmark trials that established efficacy and safety for older drug classes in the treatment of GAD).

Expert opinion: Efficacy for treatment of GAD has been established for several different drug classes. At present, based on clear efficacy and good tolerability, first-line treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) is indicated. If an initial, at least moderate, clinical response is achieved under antidepressant therapy, treatment should be at least continued for 12 months.