ABSTRACT
Caspofungin is the firs t echinocandin antifungal drug approved for serious fungal infections caused by Candida or Aspergillus. Currently ，caspofungin has been recommended as the first-line treatment for invasive Candida and the second-line treatment for invasive Aspergillus，for its safety and tolerability. However ，there are still probability of pharmacokinetic variability and the risk of low exposure in different populations. Herein the population pharmacokinetics-pharmacodynamics studies of caspofungin in children and adults were reviewed. The results indicate that the body surface area was the main factor affecting the distribution and clearance of caspofungin in pediatric patients. In adults ，the two-compartment model fits the caspofungin behavior best in vivo with the primary covariates of body weight and albumin level. The efficacy of caspofungin might be related to pharmacokinetics-pharmacodynamics parameters ，such as the ratio of area under blood concentration time curve to minimum inhibitory concentration （AUC/MIC），the ratio of peak concentration to minimum effective concentration （cmax/MEC）.
ABSTRACT
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.
ABSTRACT
Objective:To evaluate the difference of vestibular compensation between triple semicircular canal occlusion(TCO) and labyrinthectomy(LE)in guinea pigs.Material and Methods:TCO was performed on 8 guinea pigs,while LE was did on 7 guinea pigs.Behavior and ENG were recorded in detail preoperatively and repeatedly up to one month postoperatively according to the experiment design.Results:There was spontaneous nystagmus towards the nonoperated side on the first postoperative day and nystagmus absence during sinusoidal angular acceleration stimuli on the operated side was observed in all the animals.All the animals displayed head tilt towards the operated side (right)and an unsteady gait towards the right along the vertical axis after surgery,while the animals performed LE rolled towards the operated side.On the 3rd postoperative day,faint nystagmus appeared on the operated side,but the left and right nystagmus was significantly asymmetrical.The left and right nystagmus still remained asymmetrical on the 5th and 10th day postoperatively.From the 15th postoperative day,left and right nystagmus returned symmetrical in the animals performed TCO,while left and right nystagmus returned symmetrical only at the pendular amplitude of 120°,150°,180°,in the animals performed LE up to 30th postoperative day.There was a significant reduction of nystagmus to the operated side at the Pendular amplitude of 60°and 90° one month after the LE and there was 3 animals still displayed head tilt towards the operated side.Conclusion: the animals compensated faster and more completely after TCO than LE.