International journal of clinical pharmacology and therapeutics最新文献

Neurodegenerative diseases such as Alzheimer's and Parkinson's are marked by neuronal loss due to oxidative stress, neuro inflammation, and lipid dysregulation. Medium-chain triglyceride (MCT) oil, particularly rich in caprylic acid (C8, 56%) and capric acid (C10, 43%), has shown potential neuroprotective effects through its antioxidant properties, cholinesterase inhibition, and lipid-lowering benefits.

Objectives: This study aims to evaluate the neuroprotective effects of ORGAHEAL medium-chain triglyceride (MCT) oil by assessing its antioxidant activity, cholinesterase inhibition, and lipid-lowering effects in vitro.

Materials and methods: Antioxidant activity was measured using 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and nitric oxide scavenging assays. Cholinesterase inhibition was studied through enzyme kinetics with Lineweaver-Burk and Dixon plots. Lipid-lowering effects were analyzed in 3T3-L1 adipocytes using Oil Red O staining and triglyceride quantification.

Results: MCT oil exhibited antioxidant activity in DPPH and nitric oxide assays (IC50: 6.15 mg/mL and 29.87 mg/mL) and non-competitive inhibition of acetylcholinesterase and butyrylcholesteraseE (Ki: 31.01 mg/mL and 24.86 mg/mL). It reduced lipid accumulation and triglyceride levels in 3T3-L1 cells, potentially enhancing neuronal health by lowering oxidative damage.

Conclusion: MCT oil, with caprylic acid (C8) and capric acid (C10), offers neuroprotective benefits through its antioxidant, cholinesterase inhibitory, and lipid-lowering properties. Further in vivo studies are needed to confirm its therapeutic potential.

This open-label, randomized, single-dose, 4-period, 2-sequence, fully replicated study was conducted to evaluate the bioequivalence of tamsulosin 0.4 mg sustained-release film-coated tablet manufactured by PT Dexa Medica, Indonesia, and Harnal OCAS 0.4 mg prolonged-release tablet manufactured by Astellas Pharma Europe B.V., the Netherlands, imported by PT Combiphar, Indonesia, under fasting conditions in 28 healthy adult Indonesian males. Subjects were randomly assigned to receive the test formulation (1 single tablet of 0.4 mg) or the reference formulation (1 single tablet of 0.4 mg) orally in each of the 4 study periods, according to the full replicate design. Therefore, over the 4 complete periods, each subject received 2 administrations of the test formulation and 2 administrations of the reference formulation, with each administration separated by a 7-day washout period. The plasma concentration of tamsulosin from the blood samples was analyzed using validated ultra-performance liquid chromatography with tandem mass spectroscopy detection (UPLC-MS/MS), and pharmacokinetic parameters (AUC_0-t, AUC_0-∞, C_max, t_max, and T_1/2) were calculated. The 90% confidence interval (CI) for the test/reference geometric mean ratio (GMR) of the AUC_0-t was 80.2 - 98.4%, and for AUC_0-∞ it was 80.5 - 120.1%. The 90% CI GMR of C_max was 89.3 - 107.7%. All parameters were within the 90% CI GMR acceptance criteria of 80.0 - 125.0%. The T_1/2 and t_max of the 2 test drugs and the 2 reference drugs were not statistically different. There was no adverse effect observed during the study. Based on the study results, it was concluded that both tamsulosin formulations were bioequivalent and well tolerated.

Background: The development of delirium is closely linked to inflammatory processes. Omega-3 fatty acids can modulate the immune response and may contribute to reducing the incidence of sepsis-associated delirium (SAD).

Aims: To investigate the effects of omega-3 fatty acids on delirium in patients with sepsis.

Materials and methods: In a single-center clinical trial, 220 intensive care patients diagnosed with sepsis were randomly assigned to receive daily intravenous infusions of either an omega-3 fish oil emulsion or a placebo. Delirium was assessed twice daily using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method (CAM). The primary outcome was the duration of delirium during the first 10 days of admission. Secondary outcomes included the duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality.

Results: Compared to the control group, the omega-3 group exhibited significantly fewer days with delirium episodes (p = 0.010), shorter ICU stays (p = 0.008), and fewer mechanical ventilation days (p = 0.001). However, there was no statistically significant difference in mortality between the two groups.

Conclusion: Omega-3 fatty acids may effectively reduce the risk of delirium in sepsis patients, highlighting their potential as a therapeutic intervention in this population.

Objective: Our aim in this study is to investigate the advantages of a mobile personal digital assistant (PDA)-based anticoagulant abdominal injection positioning card in the subcutaneous injection process of low molecular weight heparin (LMWH).

Materials and methods: This was a historical control study. Convenience sampling was used to include 210 patients diagnosed with venous thromboembolism who received dalteparin sodium (Fragmin) injections in our department between January 2021 and December 2022. Patients were categorized into the control group and the experimental group based on the time period before and after the implementation of the PDA-based anticoagulant abdominal injection positioning card that was developed by the information research and development department of our hospital. The control group consisted of 105 patients treated before the introduction of the PDA-based card (January to December 2021), while the experimental group comprised 105 patients treated after its introduction (January to December 2022). Patients in the control group used subcutaneous injection positioning cards made of paper to determine injection sites, while those in the experimental group used the PDA-based cards to determine injection sites. Outcome measures, including the incidence of subcutaneous bleeding, time spent on the subcutaneous injection procedure, and patient satisfaction, were compared between the two groups.

Results: The incidence of subcutaneous bleeding was 5.59% in the experimental group vs. 5.61% in the control group, with no statistically significant difference between the two groups (p > 0.05). The time required for the subcutaneous injection was significantly shorter in the experimental group (63.11 ± 3.59 seconds) than in the control group (83.38 ± 6.96 seconds) (p < 0.05). The patient satisfaction rate was higher in the experimental group (94.3%) than in the control group (80.0%) (p < 0.05).

Conclusion: Use of the PDA-based anticoagulant abdominal injection positioning card to determine the abdominal subcutaneous injection site for LMWH does not increase the occurrence of adverse reactions of subcutaneous bleeding, and can ensure the accuracy of medication use and the safety of medication for patients, reduce the time of nursing operations, optimize the nursing process, and improve patient satisfaction.

Aims: To investigate the relationship between the neutrophil:lymphocyte ratio (NLR) in peripheral venous blood and the degree of vascular reflow following mechanical thrombectomy in patients with acute ischemic stroke (AIS) and anterior circulation large vessel occlusion.

Materials and methods: Patients with successful reflow were divided into two groups: i) partial reflow group (mTICI = 2b) and ii) complete reflow group (mTICI = 3) according to the modified thrombolysis in cerebral infarction classification (mTICI). Basic clinical data, disease characteristics, interventional therapy and prognosis for patients in the two groups were compared, and the association with the degree of postoperative reflow determined using multivariate logistic analysis.

Results: Univariate analysis of 21 cases of partial reflow and 45 cases of complete reflow showed statistically significant differences in the preoperative NLR, occluded vessel location, thrombus burden, puncture to recanalization time, thrombus removal times, and prognosis at 90 days post operation (p < 0.05 for all comparisons). Compared with patients with partial reflow, patients with complete reflow had lower NLR, more occluded vessels in the middle cerebral artery, lower thrombus burden, shorter operation time, fewer thrombectomy time and better clinical prognosis.

Discussion and conclusion: Multivariate logistic regression analysis thus shows that NLR and a low thrombus burden are independent prediction factors for complete reflow in this collective of AIS patients. Patients with anterior circulation AIS coupled with low NLR and low thrombus burden prior to mechanical thrombectomy are more likely to achieve complete reflow.

Objective: To present a case of encephalopathy after the administration of an iodinated contrast medium in a coronary angiography procedure.

Case summary: A 75-year-old male heart transplant recipient with cardiac allograft vasculopathy underwent coronary angiography followed by percutaneous coronary intervention. An iodinated contrast medium, ioversol, was used. Two hours later, the patient had focal impaired awareness seizure (unresponsive, head and gaze deviated to the left, with oroalimentary and gestural automatisms). Brain imaging showed no acute lesions or perfusion deficits. Electroencephalography revealed the focal slowing on the right fronto-temporal and left fronto-centro-temporal region, as well as paroxysmal discharges of high voltage delta activity (encephalopathic pattern). The patient was treated with intravenous levetiracetam. The symptoms completely resolved the next day, and the patient was discharged after 5 days of hospitalization.

Discussion: Contrast-induced encephalopathy (CIE) is an extremely rare complication of cardiac catheterization, with an incidence of 0.06%. Although the exact pathophysiology of this disorder is still not completely understood, it has been hypothesized that hyperosmolar contrast agent causes the shrinkage of endothelial cells, followed by the opening of tight junctions and the disruption of the blood-brain barrier resulting in direct neurotoxicity of the iodinated contrast medium.

Conclusion: CIE is a rare complication of cardiac catheterization, likely under-recognized and under-diagnosed due to its variable clinical features, unremarkable or nonspecific radiological findings, and a lack of well-defined diagnostic criteria. Despite the challenging diagnosis and a lack of evidence for treatment strategies, the prognosis is good with supportive therapy.

Objective: To determine the pharmacokinetic properties and bioequivalence of a reference doxorubicin injectable formulation (Caelyx) and the test formulation, a newly developed doxorubicin hydrochloride liposome injection formulation (LY01612), administered as single bolus doses in Chinese patients with advanced breast cancer.

Materials and methods: The study was multicentric, randomized, open-label, two-treatment, two-period, two-sequence, single dose with crossover. The dose, equivalent to 50 mg/m², was administered intravenously on the first day of each 28-day treatment period. Blood samples were collected at appropriate intervals for estimation of C_max, AUC_0-t, and AUC_0-∞ for free, encapsulated, and total doxorubicin, as well as partial AUC (AUC_0-48h, AUC_48h-last) for encapsulated doxorubicin.

Results: The 90% confidence intervals (CI) for the geometric mean ratio (GMR) of the primary endpoints for determination of bioequivalence namely, C_max, AUC_0-t, and AUC_0-∞ for free doxorubicin and encapsulated doxorubicin, and the 90% CIs for the secondary endpoints C_max, AUC_0-t, and AUC_0-∞ for total doxorubicin and partial exposure parameters AUC_0-48h and AUC_48h-last of encapsulated doxorubicin, were within the range confirming that the two formulations are bioequivalent. The incidence of treatment-emergent adverse events in the test and reference product was 95.7% (44/46) and 100% (42/42), respectively (p > 0.05).

Conclusion: The two formulations examined in the cohort of 48 Chinese patients with advanced breast cancer using measurements of free and encapsulated doxorubicin concentrations were bioequivalent. Both agents were well tolerated, and differences were not significant.

Objective: This study aimed to investigate the baseline neutrophil count as a risk factor for ganciclovir-induced neutropenia in greater detail.

Materials and methods: This retrospective observational study included patients who received ganciclovir at Kindai University Nara Hospital between April 2006 and June 2023. Exclusion criteria were as follows: patients under 18 years of age, those who received chemotherapy within 2 weeks prior to ganciclovir administration, those who underwent blood transfusions or received granulocyte colony-stimulating factor injections during the observation period, those treated for fewer than 2 days, patients with a baseline neutrophil count < 1,000 cells/mm³, and patients with missing data on any study variables. The primary endpoint was the occurrence of severe neutropenia, which was analyzed using Cox regression analysis and the Cochran-Armitage trend test.

Results: To the 345 patients who met the inclusion criteria, exclusion criteria were applied, and 158 were ultimately identified as eligible patients. Patients with baseline neutrophil counts < 1,500 cells/mm³ were at significantly higher risk of severe neutropenia compared to those with baseline counts ≥ 4,000 cells/mm³ (HR = 16.86, 95% CI = 1.64 - 173.50, p = 0.018). Additionally, the incidence of severe neutropenia tended to increase significantly as the baseline neutrophil count decreased (p < 0.001).

Conclusion: These findings underscore the importance of monitoring baseline neutrophil counts before initiating ganciclovir treatment, particularly in patients with conditions associated with low neutrophil levels, such as hematological disorders.

Background: Berberine, a traditional Chinese medicine, has demonstrated significant therapeutic influences in treating diabetes, obesity, and diarrhea, among other conditions. It has exhibited potential therapeutic benefits for various neurodegenerative diseases, namely, Alzheimer's disease (AD), Huntington's disease (HD), and Parkinson's disease (PD).

Aims: This study aims to elucidate the mechanism behind berberine pharmacological action in treating AD.

Materials and methods: We search the articles published in PubMed and CNKI and summarize the mechanism of berberine in AD.

Results: In recent years, as research into the pharmacology of berberine has deepened, researchers have discovered its strong neuroprotective properties. The ability of berberine to enhance cognitive function is thought to result from inhibiting the spread of AD-related proteins, reducing oxidative stress and inflammation, increasing choline levels, and regulating autophagy.

Conclusion: This review explores the latest research on berberine in AD, suggesting that berberine and its analogs may offer a promising new approach to treating the condition.