Acid Suppression Use Among Infants in One Tertiary Children's Hospital in China, 2015-2018: A Retrospective Observational Study.

Clinical guidelines emphasized that physicians should be cautious when prescribing acid suppressions to infants. Histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are not approved for use in infants aged below 2 years in China. We investigated H2RA/PPI use in infants aged below 2 years hospitalized between 1st January 2015 and 31st December 2018 in a Chinese tertiary children's hospital. Our study observed that H2RAs/PPIs were frequently prescribed with a prevalence of 4.4% (7,158/162,192). The frequency of PPI use was over two-fold than that of H2RA use (71.9%, 5,148/7,158; 28.1%, 2,011/7,158). H2RAs/PPIs were commonly used to treat infants without digestive system diseases (57.5%, 4,118/7,158). Further studies are urgently needed to evaluate the effectiveness and safety of H2RAs/PPIs in infants.

Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report.

RATIONALE: Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved. PATIENT CONCERNS: We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings. DIAGNOSES: After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer. INTERVENTIONS: The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment. OUTCOMES: After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again. LESSONS: HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients.

[Therapeutic effects of cannulated compression screws for treating femoral neck fractures].

OBJECTIVE: To explore the relevant factor of cannulated compression screws in treating femoral neck fractures. METHODS: From January 2004 to January 2011, 190 patients with femoral neck fractures treated by cannulated compression screws were analyzed retrospectively. In all of the 190 cases, there were 104 males and 86 females with an average of 65 years (ranged, 21 to 83 years). According to Garden classification system, 25 cases were type I, 51 cases were type II, 58 cases were type II and 56 cases were type IV. The time from injury to operation was 15 h to 10 d (mean 3.5 d). The gender,age, trauma type, fracture type, osteoporosis, emergency operation, fracture reduction, relation between open reduction and nonunion were observed and analyzed. RESULTS: All patients were followed-up for 12 to 84 months, with a mean of 38 months. All incisions obtained stage I healing. There were 23 patients with bone nonunion. The rate of nonunion was 12.1%. Single factor analysis showed that there were significant differences in age, trauma type, fracture type, fracture reduction and osteoporosis (P<0.05), but no meaning in gender, emergency operation, relation between open reduction and nonunion (P>0.05). CONCLUSION: Cannulated compression screws for femoral neck fractures can obtain good outcomes, and age, trauma type, fracture type, fracture reduction and osteoporosis are main factors.

Preformulation stability study of the EGFR inhibitor HKI-272 (Neratinib) and mechanism of degradation.

The stability in solution of HKI-272 (Neratinib) was studied as a function of pH. The drug is most stable from pH 3 to 4, and degradation rate increases rapidly around pH 6 and appears to approach a maximum asymptotic limit in the range of pH 812. Pseudo first-order reaction kinetics was observed at all pH values. The structure of the major degradation product indicates that it is formed by a cascade of reactions within the dimethylamino crotonamide group of HKI-272. It is assumed that the rate-determining step is the initial isomerization from allyl amine to enamine functionality, followed by hydrolysis and subsequent cyclization to a stable lactam. The maximum change in degradation rate as a function of pH occurs at about pH 6, which corresponds closely to the theoretical pKa value of the dimethylamino group of HKI-272 when accounting for solvent/temperature effects. The observed relationship between pH and degradation rate is discussed, and a self-catalyzed mechanism for the allylamine-enamine isomerization reaction is proposed. The relevance of these findings to other allylamine drugs is discussed in terms of the relative stability of the allylic anion intermediate through which, the isomerization occurs.

Performance qualification of a new hypromellose capsule: Part II. Disintegration and dissolution comparison between two types of hypromellose capsules.

This Part II paper describes the disintegration and dissolution aspects of the qualification of a new hypromellose capsule (HPMC Shell 2). This new capsule does not contain any gelling agent, and is manufactured by a thermal gelation process. Rupture time of the carrageenan-containing capsule (HPMC Shell 1) and HPMC Shell 2, as measured by an improved real-time detection method, showed only slight differences that did not manifest in vivo. The absence of a gelling agent appeared to give HPMC Shell 2 advantages in dissolution in acidic media and in buffers containing potassium ions. Slow drug release of HPMC Shell 1 in 0.1M HCl was attributed to the interaction of carrageenan with drug compounds; whereas the presence of potassium ions, a gelling promoter for carrageenan, caused delay in capsule opening and larger capsule-to-capsule variation. Disintegration and dissolution performances of both hypromellose capsules are comparable in other dissolution media tested. Based on the superior dissolution performances and quality attributes in terms of physical, mechanical and processability that were detailed in Paper I, the new hypromellose capsule was satisfactorily qualified and has since been used in nearly 20 investigational new drug (IND) compounds.