Efficacy of Hymecromone in Post-Cholecystectomy Patients

Background. The cholecystectomy is the major cause of sphincter of Oddi dysfunction (SOD), that may be classified as post-cholecystectomy syndrome (PCES). Treatment of PCES requires in most of the cases application of selective antispasmodic drugs.Aim. To evaluate efficacy and safety of hymecromone in patients with post-cholecystectomy SOD, to compare standard and reduced doses of hymecromone.Methods. Overall, 26 patients were enrolled in non-interventional comparative study: 2 males, 24 females, aged from 25 to 74 years. All patients underwent cholecystectomy for symptomatic gallstone disease within 1 to 10 years prior to beginning of the study. All patients were diagnosed to have SOD according to Rome IV Diagnostic Criteria for functional biliary sphincter of Oddi disorder (E1b). All patients underwent hymecromone monotherapy for 3 weeks. Patients were randomized to group A and B to receive full-dose or half-dose of the drug respectively.Results. Abdominal pain completely subsided in 85 % of patients, significant improvement was found for bloating and diarrhea. Mild increase in fasting common bile duct (CBD) diameter after treatment (7.23 ± 0.99 vs 6.78 ± 1.01; p = 0.029) was attributed to choleretic action of hymecromone. Hymecromone resulted in significant improvement of CBD response to fatty meal stimulation (ΔCBD): –1.08 ± 0.46 mm vs –0.10 ± 0.33 mm pretreatment (p = 0.016). Degree of improvement was more pronounced in the group A (full-dose) as compared to group B (half-dose) for abdominal pain (Z = 2.74, p = 0.031), bloating (Z = 2.63, p = 0.035) and constipation (Z = 2.61, p = 0.038)Conclusion. Hymecromone demonstrated itself to be an effective and safe drug, that may be applied both in standard and half dose. However, the efficacy of full-dose is higher both for the treatment of biliary pain and dyspeptic symptoms. Transabdominal ultrasound may be applied as a reliable test for both prediction of treatment efficacy and to monitor patients state during treatment course.

Clinical Characteristics of Pregnancy-Associated Central Serous Chorioretinopathy in the Chinese Population

Purpose. To investigate the clinical characteristics of pregnancy-associated central serous chorioretinopathy (CSC) in the Chinese population. Methods. The medical records of patients diagnosed with pregnancy-associated CSC from February 2012 to October 2019 were retrospectively reviewed. Best-corrected visual acuity (BCVA), symptom duration, pregnancy-related medical information, and optical coherence tomography (OCT) images were collected. Results. Nine patients (11 eyes) were included. Five women were in their first pregnancy and four were in their second pregnancy, two of whom experienced CSC in their first pregnancy as well. The mean age was 35.00 ± 3.97 years. The mean symptom duration at the initial visit was 19.73 ± 13.65 days. The mean gestational age at the time of development of CSC was 27.11 ± 2.09 weeks. The mean BCVA (logarithm of the minimum angle of resolution (logMAR)) at the initial visit was 0.36 ± 0.18 (Snellen 20/45, range 20/100–20/25). All eyes showed subretinal hyperreflective fibrin on OCT images at the initial visit. Four patients (4 eyes) were lost to follow-up before fluid resolution. The mean BCVA at the final visit was logMAR 0.10 ± 0.15 (Snellen 20/25, range 20/50–20/20)). One eye in the oldest patient had persistent subretinal fluid at 26 months postpartum. The subretinal fluid resolved completely after half-dose photodynamic therapy (PDT); however, the ellipsoid zone at the fovea remained discontinuous at 30 months after half-dose PDT. The remaining six eyes all showed spontaneous resolution of subretinal fluid around delivery and regained intact ellipsoid zone. Conclusions. Pregnancy-associated CSC in Chinese developed mostly in the third trimester and usually recovered spontaneously around delivery with good final visual acuity. However, patients might require long-term follow-up until complete resolution of subretinal fluid and to detect recurrences. Half-dose PDT can be administered early if there is little reduction in the amount of subretinal fluid after delivery.

Optimizing Acquisition Times for Total-Body Positron-Emission Tomography/Computed Tomography with Half-Dose 18F-Fluorodeoxyglucose in Oncology Patients

Purpose The present study aimed to explore the boundary of acquisition time and propose an optimized acquisition time for total-body positron emission tomography (PET)/computed tomography (CT) oncological imaging using half-dose 18F-fluorodeoxyglucose (FDG) activity based on clinical diagnostic needs. Methods In this retrospective study, an exploration cohort (October 2019 to December 2019) of 46 oncology patients was first studied. The acquisition time for all patients was 15 min and the acquired images were reconstructed and further split into 15-, 8-, 5-, 3-, 2, 1-min duration groups (abbreviated as G15, G8, G5, G3, G2, and G1). The image quality and lesion detectability of reconstructed PET images with different acquisition times were evaluated subjectively (5-point scale, lesion-detection rate) and objectively (standardized uptake values, target-to-background ratio). In the same way, the filtered protocols were further validated in a cohort of 147 oncology patients (December 2019 to June 2021). Results In the exploration dataset, the subjective scores for G1, G2, G3, G5, and G8 were 2.0 ± 0.2, 2.8 ± 0.3, 3.1 ± 0.2, 3.9 ± 0.3, and 4.1 ± 0.2, respectively. Two cases in G1 were rated as 1 point. No significant difference in scores was observed between G5 and G8 (p = 0.89). In general, groups with a longer acquisition time showed lower background uptake and lesion conspicuity. Compared with G15, lesion-detection rate significantly reduced to 85.3% in G1. In the validation dataset, the subjective score was 2.9 ± 0.2 for G2, 3.0 ± 0.0 for G3, 3.5 ± 0.4 for G5, 4.0 ± 0.2 for G8, and 4.5 ± 0.4 for Gs. Only the scores between G2 and G3 were not significantly different (p > 0.99). The detection rates (204 lesions) significantly reduced to 94.1-89.7% in G3 and G2 (all p < 0.001). Conclusion A 2-min acquisition protocol provided acceptable performance in certain groups and specific medical situations. And protocols with acquisition times ≥ 5 min could provide comparable lesion detectability as regular protocols, showing better compatibility and feasibility with clinical practice.

The Effects of Reduced Mineral Fertilisation Combined with the Foliar Application of Biostimulants and Fertilisers on the Nutrition of Maiden Apple Trees and the Contents of Soil Nutrients

The experiment compared the use of a dose of mineral fertilisation reduced by half in a nursery, which was replaced by foliar treatment with biostimulants and fertilisers. The control combination was a full dose of mineral fertilisation without foliar treatments. The half dose of mineral fertiliser applied into the soil decreased its acidity and salinity. At the same time, it decreased the soil content of macro- and micronutrients, except for calcium and iron. In most cases the simultaneous foliar application of the four biostimulants tested in our experiment reduced the content of macronutrients in the leaves of maiden apple trees, except for calcium. On the other hand, it increased the iron (28.2% average) and manganese (24.8% average) levels in the leaves but reduced the levels of zinc (11.8% average) and copper (25% average). The foliar application of two fertilisers increased the leaf contents of phosphorus (12% average) and calcium (9.3% average). One of the fertilisers also increased the leaf contents of potassium, magnesium, and micronutrients.

How to handle the delayed or the missed dose of edoxaban in patients with non-valvular atrial fibrillation: model-informed remedial strategy

Aim: Edoxaban is a non-vitamin K antagonist oral anticoagulant (NOAC) widely used for long-term stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Adherence to NOACs is unsatisfactory and decreases over time. The aim of this study was to explore appropriated remedial dosing regimens for non-adherent edoxaban-treated NVAF patients through the Monte Carlo simulation. Methods: Six proposed regimens were compared with the recommendations in the European Heart Rhythm Association (EHRA) guide regarding the trough total deviation time considering both edoxaban plasma concentration and inactive factor Xa activity. Monte Carlo simulations were performed using RxODE based on the published population pharmacokinetics/pharmacodynamics model. Results: The proposed remedial strategies were different from EHRA recommendations and were related to delay duration. The missed dose can be taken immediately if the delay time is within 11 h. When the delay period is between 12 and 19 h, a half dose followed by a regular dosing schedule is recommended. When the delay time exceeds 19 h, a full dose followed by a half dose is preferred compared to that recommended in the EHRA guide. Our proposed strategies resulted in a shorter total deviation time than EHRA guide. Conclusion: PK/PD modelling and simulation are effective in developing and evaluating the remedial strategies of edoxaban, which could help maximize its therapeutic effect.