ABSTRACT
Objective:To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow-up.Methods:A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively.There were 16 cases with SEHS, 11 of whom were male and 5 were female.The age ranged from 3 months to 13 years (median: 2.5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods(pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed.The pressure adjustment treatment was to increase the by 10-20 mmH 2O (1 mmH 2O=0.009 8 kPa) each time and the patients were followed up 2-4 weeks after the adjustment.If SEHS didn′t improve according to the follow-up results, pressure regulation combined with drilling and drainage was recommended. Results:Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below.Eleven cases were treated by pressure regulation only, and 5 cases who were all aged ≤3 years received pressure regulation combined with drilling and drainage.Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case.Fourteen cases were asymptomatic.The time from shunt operation to the occurrence of SEHS was ≤1 month in 5 cases, who were all cured by pressure regulation only.SEHS occurred in 5 cases >1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with dri-lling and drainage.Three cases had SEHS>3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4.5 months, 7.5 months, and 25.0 months, respectively.The time from the occurrence of SEHS to the last reexamination with no SEHS detected was ≤1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2.0 months, 3.0 months, 7.0 months and 8.0 months, respectively.Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured.Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median: 39.0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median: 158.2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side.Conclusions:SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms.SEHS mostly occurs within 6 months after operation, especially within 3 months.SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only.Therefore, SEHS can be cured by pressure regulation only by shortening follow-up and identifying SEHS early after shunt operation.This will also reduce the probability that patients require the drilling and drainage operation.
ABSTRACT
Tremendous efforts have been devoted to the enhancement of drug solubility using nanotechnologies, but few of them are capable to produce drug particles with sizes less than a few nanometers. This challenge has been addressed here by using biocompatible versatile -cyclodextrin (-CD) metal-organic framework (CD-MOF) large molecular cages in which azilsartan (AZL) was successfully confined producing clusters in the nanometer range. This strategy allowed to improve the bioavailability of AZL in Sprague-Dawley rats by 9.7-fold after loading into CD-MOF. The apparent solubility of AZL/CD-MOF was enhanced by 340-fold when compared to the pure drug. Based on molecular modeling, a dual molecular mechanism of nanoclusterization and complexation of AZL inside the CD-MOF cages was proposed, which was confirmed by small angle X-ray scattering (SAXS) and synchrotron radiation-Fourier transform infrared spectroscopy (SR-FTIR) techniques. In a typical cage-like unit of CD-MOF, three molecules of AZL were included by the -CD pairs, whilst other three AZL molecules formed a nanocluster inside the 1.7 nm sized cavity surrounded by six -CDs. This research demonstrates a dual molecular mechanism of complexation and nanoclusterization in CD-MOF leading to significant improvement in the bioavailability of insoluble drugs.
ABSTRACT
Epilepsy,a common neurological disorder which is more likely to occur in children, does great harm to the physical and mental health of children. At present, use of anti-epilepsy medicine is still the main method of treating the disease. The effects of traditional anti-epilepsy medicine are obvious but many patients can not tolerate the severe side-effects. Moreover, the rate of drug resistance is high. For those children with such a disease who can not be treated by traditional medicine and those who cannot tolerate the toxicity of epilepsy medicine, non-traditional anti-epilepsy treatment might play a potential important role.