Calculated panel reactive antibody with decimals: A refined metric of access to transplantation for highly sensitized candidates

The use of the calculated panel reactive antibody (CPRA) value and the implementation of allocation points for sensitized candidates by the United Network for Organ Sharing (UNOS) have improved access to kidney transplantation for highly sensitized candidates (98% CPRA and above). Despite this, a large population of highly sensitized candidates remain awaiting transplantation. To better define this population, we propose the use of two refinements of the standard UNOS CPRA, the CPRA with decimals or CPRAd, and the likelihood of a compatible donor (LCD). These refined metrics of the standard UNOS CPRA will allow transplant programs to describe their patients’ access to transplantation with increased granularity and will help in decisions regarding the use of desensitization.     

我院门诊患者中西药物不合理配伍分析

目的促进临床中西药物的合理配伍使用。方法随机抽取我院2008年1～12月的门诊处方13511张,根据中西药物理化性质、药理作用以及文献报道的中西药物配伍禁忌进行分析。结果13511张处方中,中西药物联合用药4088张,其中216张处方中存在不合理配伍问题。结论在临床中西药联合用药需要研究、掌握、熟悉了解中西药相互作用以及配伍规律,发挥中西药物联用之优势,提高医药人员的业务素质,确保用药安全。     

A novel cell compatible impingement system to study in vitro drug absorption from dry powder aerosol formulations

A modified Astra type multistage liquid impinger (MSLI) with integrated bronchial cell monolayers was used to study deposition and subsequent drug absorption on in vitro models of the human airway epithelial barrier. Inverted cell culture of Calu-3 cells on the bottom side of cell culture filter inserts was integrated into a compendial MSLI. Upside down cultivation did not impair the barrier function, morphology and viability of Calu-3 cells. Size selective deposition with subsequent absorption was studied for three different commercially available dry powder formulations of salbutamol sulphate and budesonide. After deposition without size separation the absorption rates from the aerosol formulations differed but correlated with the size of the carrier lactose particles. However, after deposition in the MSLI, simulating relevant impaction and causing the separation of small drug crystals from the carrier lactose, the absorption rates of the three formulations were identical, confirming the bioequivalence of the three formulations.     

Set-up and routine use of a database of 10 555 genotyped blood donors to facilitate the screening of compatible blood components for alloimmunized patients

Background and Objectives  Large-scale genotyping of blood donors for red blood cell and platelet antigens has been predicted to replace phenotyping assays in the screening of compatible blood components for alloimmunized patients. Although several genotyping platforms have been described, novel procedures and processes are needed to perform genotyping efficiently and to maximize its benefits for blood banks.
Materials and Methods  Here we describe the processes and procedures developed to introduce large-scale genotyping in our routine operations.
Results  Preliminary cost–benefit analysis indicated that genotyping must target frequent blood donors (> 3 donations/year) to be efficiently used. A custom-designed computer application was developed to manage the whole project. It selects frequent donors among recent donations, prints coded labels to identify blood samples sent to the external genotyping laboratory, and stores genotyping results. It can search for donors compatible for any combination of the 22 genotyped antigens as well as consult the current inventory for the presence of the corresponding blood components. The phenotype of recovered components is confirmed by standard serology techniques prior to shipment to hospitals.
Conclusion  Since October 2007, 10 555 blood donors have been genotyped. The database is used on a regular basis to find compatible blood components with a genotype–phenotype concordance of 99·6%.