Chemotherapy-induced oral mucositis induced by low dose methotrexate: a case report and literature review / 口腔疾病防治

Objective@# To investigate the diagnosis and treatment for oral mucositis induced by low-dose methotrexate and to provide a reference for clinicians@*Methods @# A case of severe chemotherapy-induced oral mucositis caused by short-term use of low-dose methotrexate (the maximum cumulative dose within 1 week) was reported and reviewed in combination with the literature.@*Results@# The patient was treated with low-dose methotrexate (2.5 mg orally every other day at weeks 1, 2, and 4; the third week, 2.5 mg each time for 3 consecutive days for twice, with a maximum cumulativedose of 15 mg within a week). After irregular medication for approximately three weeks, the patient gradually developed severe erosion of the lips, pain, difficulty eating, and skin erosion on both legs. Methotrexate was stopped after admission, and local symptomatic treatments such as Kangfuxin solution were given. Recombinant human granulocyte colony-stimulating factor was used systemically when combined with neutropenia. After treatment, the chemotherapy-induced oral mucositis and skin lesions were improved. A literature review shows that chemotherapy-induced oral mucositis is a toxic reaction to high-dose methotrexate, while cases of severe chemotherapy-induced oral mucositis caused by low-dose methotrexate are rare. Studies have found that the more risk factors patients have, such as poor local oral conditions and systemic diseases such as liver and kidney dysfunction and diabetes, the higher the risk of chemotherapy-induced oral mucositis. Clinicians should cooperate with dentists to address oral diseases as much as possible before using chemotherapy drugs. In addition, when ordering patients to take methotrexate, we should pay attention to the patient's general condition and susceptibility factors, standardize the frequency and dose of administration, adopt personalized treatment plans, and give patients detailed medication education to prevent the occurrence of adverse consequences caused by medication errors. If methotrexate poisoning occurs, the drug should be stopped in time, detoxification and active symptomatic and supportive treatment should be given. Basic oral care, cryotherapy, laser therapy, nutritional support and analgesic drugs are common treatments for chemotherapy-induced oral mucositis. Systemic administration of granulocyte colony-stimulating factor may be considered when accompanied by neutropenia.@*Conclusion@# It is necessary to be alert to the occurrence of severe chemotherapy-induced oral mucositis caused by low-dose methotrexate in clinical practice.

Pharmacokinetic of florfenicol in pulmonary epithelial lining fluid of swine and effects of anesthetic agent on drug plasma disposition kinetics / Farmacoqu'imica de florfenicol em fluido de epitélio pulmonar de suínos e efeitos de agente anestésico em cinética de droga em plasma

The primary objective of the current study was to compare the pharmacokinetic (PK) of florfenicol (FFL) in pulmonary epithelial lining fluid and the plasma in swine. The second objectives were to evaluate the effect of anesthesia with ketamine and propofol on the PK of FFL in plasma. Bronchoaveolar lavage was utilized for quantification of PELF volume and the urea dilution method was used to determine the concentration of FFL in PELF. FFL was administered intramuscularly (IM) to swine in a single dose of 20mg/kg body weight. The main PK parameters of FFL in plasma and PELF were as follows: the area under the concentration-time curve, maximal drug concentration, elimination half-life and mean residence time were 69.45±4.36 vs 85.03±9.26µg·hr/ml, 4.65±0.34 vs 5.94±0.86µg/ml, 9.87±1.70 vs 10.69±1.60hr and 12.75±0.35 vs 14.46±1.26hr, respectively. There was no statistically significant difference between the PK profiles of FFL for the anesthetized and unanesthetized pigs. This study suggest that (i) FFL penetrated rapidly into the pulmonary and the drug concentration decay faster in plasma than in the pulmonary, (ii) the PK profile of FFL in swine was not interfered after administration of anesthetic agent.(AU)

O objetivo primário desse estudo foi comparar a farmacocinética de florfenicol (FFL) em fluido epitelial pulmonar à farmacocinética (PK) de FFL em plasma suíno. O segundo objetivo foi avaliar o efeito de anestesia com ketamina e propofol no PK de FFL em plasma. Lavagem broncoalveolar foi utilizada para quantificar volume de fluido epitelial pulmonar (PELF) e método de diluição de uréia para determinar FFL em PELF. Injeção de FFL foi administrada intramuscular a suínos em dose única de 20mg/kg de peso corporal. Os principais parâmetros de PK em FFL em plasma e PELF foram os seguintes: a área sob a curva de concentração-tempo, concentração máxima da droga, eliminação de meia-vida e média de tempo de permanência foram 69,45±4,36 vs 85,03±9,26µg·hr/ml, 4,65±0,34 vs 5,94±0,86µg/ml, 9,87±1,70 vs 10,69±1,60hr e 12,75±0,35 vs 14,46±1,26hr, respectivamente. Não houve diferença estatisticamente significante entre os perfis de PK de FFL para os porcos anestesiados e não anestesiados. Esse estudo sugere que (i) FFL penetrou rapidamente no pulmão e concentração da droga sofre queda mais veloz em plasma que líquido pulmonar, (ii) o perfil de PK de FFL em suínos não modificou após administração de agente anestésico.(AU)

Confirmation and Sequence analysis of N gene of PPRV in South Xinjiang, China / Confirmação e análise de sequência do gene N de PPRV em Xinjiang do Sul, China

In China, Peste des petits ruminants (PPR) was officially first reported in 2007. From 2010 until the outbreak of 2013, PPRV infection was not reported. In November 2013, PPRV re-emerged in Xinjiang and rapidly spread to 22 P/A/M (provinces, autonomous regions and municipalities) of China. In the study, suspected PPRV-infected sheep in a breeding farm of South Xinjiang in 2014 were diagnosed and the characteristics of complete sequence of N protein gene of PPRV was analyzed. The sheep showed PPRV-infected signs, such as fever, orinasal secretions increase, dyspnea and diarrhea, with 60% of morbidity and 21.1% of fatality rate. The macroscopic lesions after autopsy and histopathological changes were observed under light microscope including stomatitis, broncho-interstitial pneumonia, catarrhal hemorrhagic enteritis and intracytoplasmic eosinophilic inclusions in multinucleated giantcell in lung. The formalin-fixed mixed tissues samples were positive by nucleic acid extraction and RT-PCR detection. The nucleotide of N protein gene of China/XJNJ/2014 strain was extremely high homology with the China/XJYL/2013 strain, and the highest with PRADESH_95 strain from India in exotic strains. Phylogenetic analysis based on complete sequence of N protein gene of PPRV showed that the China/XJNJ/2014 strain, other strain of 2013-2014 in this study and Tibetan strains all belonged to lineage Ⅳ, but the PPRV strains of 2013-2014 in this study and Tibetan strains were in different sub-branches.(AU)

Na China, Peste des petits ruminants (PPR) foi relatado oficialmente em 2007. De 2010 até o surto de 2013, não houve relato de infecção por PPRV. Em Novembro de 2013, PPRV ressurgiu em Xinjiang e rapidamente se espalhou para 22 P/A/M (províncias, regiões autônomas e municípios) da China. No estudo, ovelhas com suspeita de infecção por PPRV em uma fazenda de reprodução no sul de Xinjiang form diagnosticadas em 2014 e as características da sequência completa da proteína N do gene do PPRV foi analisada. As ovelhas tinham sinais de infecção pelo PPRV, como febre, aumento de secreções oro-nasais, dispneia e diarreia, com 60% de morbidade e 21.1% de fatalidade. As lesões macroscópicas após mudanças histopatológicas foram observadas sob microscópio, incluindo estomatite, pneumonia bronco-intersticial, enterite hemorrágica catarral e inclusões eosinofílicas intracitoplasmáticas em células gigantes multinucleares no pulmão. As amostras de tecido fixadas em formalina testaram positivo para detecção de RT-PCR por extração de ácido nucleico. Os nucleotídeos da proteína N do gene da linhagem China/XJNJ/2014 apresentou extrema homologia com o China/XJYL/2013, e homologia ainda maior com a variedade PRADESH-95 da Índia. Análise filogenética baseada na sequencia completa da proteína N do gene de PPRV mostrou que as variedades China/XJNJ/2014, outra de 2013-2014 mostrada nesse estudo e as Tibetanas todas pertenciam à linhagem Ⅳ, mas as PPRV de 2013-2014 nesse estudo e as Tibetanas estavam em diferentes agrupamentos.(AU)