Objective To study the pharmacokinetics and detection window of clozapine and its metabolites in human blood, so as to provide experimental basis for forensic cases of identification of clozapine poisoning. Methods 29 Taiyuan Han people's elbow venous blood was collected after given oral administration of 12.5mg clozapine at different time point, in which clozapine and its metabolites were extracted with solid phase extraction (SPE) and determined by HPLC-MS-MS. The qualitative analysis was based on retention time and MRM ions. The quantitative analysis was based on an internal standard method and calibration curve. Using the 3p97 pharmacokinetic software, pharmacokinetic equation of clozapine in the blood were imitated from the C-T data, and pharmacokinetic parameters were calculated. Results The pharmacokinetics of clozapine met a two compartment open model with a first kinetics absorption. The Tmax of clozapine(CLP), demethylclozapine(DMCLP), N-oxidation-clozapine(NO-CLP) respectively were 2.96±1.32h, 8.65±3.00h, 9.31±26.38h; The Cmax of CLP, DMCLP, NO-CLP respectively were 34.68±9.32ng/mL, 11.16±4.15ng/mL, 9.62±13.88ng/mL;The t1/2 of CLP, DMCLP, NO-CLP respectively were 17.02±23.63h, 27.06±12.58h, 41.27±29.75h; The detection window of CLP, DMCLP, NO-CLP respectively were 81.72±26.19h, 93.21±29.40h and 19.93±14.62h. Conclusion The pharmacokinetics of clozapine in blood of Han people is consistent with two compartment open model with a first kinetics absorption. The pharmacokinetics model and parameters of clozapine can provide expirimental basis for forensic identification of clozapine poisoning cases.

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Objective To explore the application value of ultrasound microvascular imaging combined with shear wave elastography in differentiating thyroid ultrasound image reporting and data system(TI-RADS)4 benign and malignant thyroid nodules.Methods Totally 114 thyroid nodules diagnosed as ACR TI-RADS 4 in Hangzhou traditional Chinese medicine hospital from November 2021 to December 2022 were retrospectively selected.All nodules were examined by ultrasound microvascular imaging and shear wave elastography,and compared with the surgical pathological results to evaluate the diagnostic efficacy of microvascular imaging,shear wave elastography and the combination of the two.Results Among 114 cases of thyroid TI-RADS type 4 nodules,35 cases were benign nodules,79 cases were malignant nodules.The microvascular pattern of malignant nodules was mainly concentrated and interrupted sign and perforator sign.The Emax value of shear wave elastography was statistically significant in differentiating benign from malignant nodules,and the SWE Emax value of malignant nodules was greater than 41.6kPa(P<0.05).The sensitivity,specificity and accuracy of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of thyroid TI-RADS 4 nodules were 96.20%,65.72%and 86.84%,respectively,and the area under curve(AUC)was 0.810.The sensitivity and accuracy were higher than those of single diagnosis mode,and the difference was statistically significant(P<0.05).Conclusion Ultrasound microvascular imaging combined with shear wave elastography can improve the diagnostic efficiency of benign and malignant thyroid TI-RADS 4 nodules with high diagnostic sensitivity and accuracy,which is helpful for the noninvasive differential diagnosis of such nodules and avoids some unnecessary needle biopsy.