Red blood cell methotrexate and folate levels in children with acute lymphoblastic leukemia undergoing therapy: a Pediatric Oncology Group pilot study

Summary We enrolled children with acute lymphoblastic leukemia (ALL) in a Pediatric Oncology Group (POG) pilot study to monitor erythrocyte (RBC) methotrexate (MTX) and folate (F) levels before and during treatment. The mean value for RBCF at diagnosis was 0.86±0.46 nmol/ml RBC in the 214 patients who achieved remission and 1.21±0.74 nmol/ml RBC in the 10 patients who did not (P=0.020). Folate levels tended to increase during remission induction, but they dropped following an intensive consolidation with methotrexate to levels that were sustained throughout chemotherapy treatment. Methotrexate levels reached mean values of approximately 0.15 nmol/ml RBC at the end of an intensive methotrexate consolidation, then fell to levels that were sustained throughout maintenance therapy. There was a weak correlation between improved event-free survival and higher RBCMTX levels after consolidation, but no correlation was found between improved survival and the level of RBCMTX or RBCF during maintenance therapy. A larger study with more complete data is needed to determine whether RBCMTX or RBCF might be useful in predicting event-free survival in patients with ALL.This work was supported in part by grants from the National Cancer Institute and the National Institute of Health (CA-30969, CA-28476, CA29139, CA-159-89, and CA-33587)     

A cholesterol embolism following coronary angioplasty. A case report

Cholesterol embolism is a rare but serious complication of heart catheterization. We report a patient in whom cholesterol embolization syndrome developed after coronary angioplasty complicated by an acute myocardial infarction which was treated with streptokinase and heparin. The clinical outcome was satisfactory. Cholesterol embolism occurrence might have been precipitated in this patient by thrombolytic and anticoagulant therapy.     

O6-Methylguanine methyltransferase activity is increased in rat tissues by ionising radiation

The effect of whole body ionising radiation from a linear acceleratoron rat tissue O⁶-methylguanine (O⁶-meG) methyl-transferase (MT)activity has been assessed using an assay which measures thetransfer of ³H-radioactivity from ³H-methylated substrate DNAto protein. The maximal effect occurred 2 days after a 1 kraddose, at which time activity in liver extracts was increased5-fold in two different rat strains. Activity in lung and kidneywas increased 4- and 2-fold, respectively. Similar degrees ofenhancement were found in these three tissues using an h.p.l.c.method for measuring MT activity. The increase in activity wasreflected in an increased capacity to repair O⁶-meG producedin liver DNA by administration of [¹⁴C]dimethylnitrosamine (DMN):this effect was dose dependent, being detectable after 30 radsand maximal after 600 rads. Incorporation of labelled breakdownproducts of the DMN into adenine in DNA increased as the doseradiation increased suggesting an inhibition of DNA synthesis.The implications of these results for the mechanism of enhancingO⁶-meG repair are discussed.     

Patient participation in pressure injury prevention: giving patient's a voice

Pressure injuries burden patients and healthcare organisations, with some preventative practices having little impact on prevalence reduction. Patient participation in care may be an effective pressure injury prevention strategy, yet patient preferences are unknown. The aim of this interpretive study was to describe patients' perceptions of their current and future role in pressure injury prevention. Semi‐structured interviews were conducted with 20 adult inpatients recruited from four medical units, at two Australian metropolitan hospitals. Interview data were analysed using content analysis, with three categories emerging: ‘experiencing pressure injuries’; ‘participating in pressure injury prevention’; and ‘resourcing pressure injury prevention and treatment’. These categories reflect the complex nature of participants’ pressure injury experience. The findings suggest participants gather pressure injury knowledge from first‐hand and vicarious experience; knowledge they bring to hospital. Most participants preferred a proactive pressure injury prevention role. Many identified barriers in the healthcare environment that impeded their participation and affected their experience of pressure injuries and pressure injury prevention. If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners.     

Clinical Evaluation of the Cook Advance Enforcer 35 Focal-Force PTA Balloon Catheter for Treatment of Hemodialysis Fistula Stenoses: A Feasibility Study

Purpose

A prospective, single-center, single-arm feasibility study evaluated procedural and short-term performance of the Advance Enforcer 35 focal-force percutaneous transluminal angioplasty (PTA) balloon catheter in treating stenoses of mature native arteriovenous (AV) hemodialysis access circuits.