Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors

Background@#and Purpose Oral nucleos(t)ide analogs (NAs) are the mainstay treatment for chronic hepatitis B (CHB). Myotoxicity is an important extrahepatic effect related to NA treatment. Telbivudine is the NA for CHB that is frequently associated with muscle-related side effects. The risk factors for telbivudine-induced myopathy (TIM) are not yet clear. @*Methods@#This study characterized the clinical, magnetic resonance images (MRI), and pathological features of 12 TIM cases. A group of telbivudine-tolerant (TT) patients with CHB who received regular telbivudine treatment during the same period without the occurrence of myopathy was collected. Demographic and clinical factors were compared between the patients with TIM and the TT controls. Factors independently associated with TIM were identified using logistic regression analysis. @*Results@#The patients with TIM (males/females: 7/5, mean age: 57 years) developed myopathy after using telbivudine for a median period of 19.5 months. Muscle histopathology revealed abnormal proliferation, subsarcolemmal or sarcoplasmic accumulations, and ultrastructural defects of mitochondria. When compared with TT cases, patients with TIM had a lower estimated glomerular filtration rate and were more frequently positive for hepatitis B e antigen (HBeAg). @*Conclusions@#Mitochondrial abnormalities are characteristic histopathological features, and impaired renal function and HBeAg positivity are risk factors for TIM. Telbivudine-induced mitochondrial dysfunction and immune activation related to mitochondrial damage and HBeAg serostatus changes may underlie TIM. Constant clinical surveillance of myopathy during telbivudine treatment is needed due to the significant latency of its development. Dose adjustment for impaired renal function does not eliminate the risk of TIM occurrence.

Determination of migration of phthalates esters in disposable plastic cups by GC-MS / 上海预防医学

Objective To determine the migration of phthalates esters in disposable plastic cups by gas chromatography with mass spectrometry ( GC-MS ) , and to study the effect of materials , temperature and duration conditions on the concentration of phthalate esters in disposable plastic cups . Methods Simulants ( distilled water , 3% acetic acid aqueous solution , 10% ethanol aqueous solution and isooctane ) test samples were extracted with n-hexane and analyzed by GC-MS.The external standards were applied to the analysis and quantitation of phthalate esters . Results A good linear relationship was showed under the range of 0.01-10 μg/mL for 17 compounds of migration of phthalates esters withR 2≥0 .998 .The recovery rates were 71%-107% and the relative standard deviation were lower than 7%. The detection limit was 0 .86-14 .41 .The migration of phthalates esters were detected in ten brands of disposable plastic cups sold in Shanghai .Diisobutyl phthalate , dibutyl phthalate and dioctylphthalate were detected in ten brands of disposable plastic cups , but none of them were exceed the limits .Under the high temperature condition , the pdypropylene and polyethylene terephthalate material concentration of migration of phthalates esters in disposable plastic cups were with no obvious difference , but the polystyrene material concentration of migration of phthalates esters in disposable plastic cups were raised over time . Conclusion This method has good sensitivity , accuracy , repeatability and is suitable for the rapid analysis of the migration of phthalate esters in disposable plastic cups .

Cheiro-oral syndrome: A reappraisal of the etiology and outcome

Objective: This is a review of our cases and published literature on cheiro-oral syndrome (COS), to better understand its localization, etiology and outcome. Methods: In addition to our database, we reviewed the medical database (including PUBMED, BIOSIS, EMBASE, and SCOPUS) and other sources, searched by the keyword of “cheiro-oral”. The defi nition of COS was a subjective or an objective sensory disturbance confi ned to the perioral area and the fi nger(s)/hand without a detectable abnormality in mental, motor or cerebellar function. Only cases of COS where the clinicoanatomic correlation could be identifi ed by neuroimaging study, autopsy or stereotatic surgery was included. Results: There were a total of 174 patients; 85 patients from our database, 76 patients from medical database, and 13 patients from other sources. They were 111 men and 63 women. Their age ranged from 12 to 85 years; average being 58.2 years. Stroke is the leading etiology and constituted 74% of the patients. The most common location of lesion was thalamus, followed by pons and cortex. Classical unilateral COS was seen in 81% of patients, atypical COS in 19%. Whereas the lesions were from cortex to cervical spinal cord in unilateral COS, atypical COS was associated with lesions in pons or medulla oblongata. An early deterioration was seen in 16.5% of patients, especially in large cortical infarction and subdural hemorrhage. Structural lesions were found in 85% of patients. Conclusion: Classical unilateral COS do not have a high localizing value, the atypical COS is associated with lesion in pons or medulla.