Suspected DLIS interference in the dimension DGNA digoxin assay method and the clinical application of the revised digoxin target range

The authors present a case of an elderly female patient with heart failure and renal dysfunction treated with digoxin, where 2 commercial immunoassay methods (DRI, Microgenics, and DGNA, Dade Behring) showed a clinically very significant discrepancy on the same plasma sample, viz. 0.5 and 2.3 nmol/L, respectively. The sample was also referred to a third external laboratory that returned a result of 0.9 nmol/L using mFPIA (AxSYM, Abbott). Subsequent ultrafiltration (30,000 Dalton) on the sample essentially eliminated the difference, suggesting an interference from a large molecular weight compound(s), potentially the well-described digoxin-like immunoreactive substance(s) (DLIS). Although further study is required to verify that the DLIS implicated was indeed the interfering species, it does again highlight the importance of careful method selection in the clinical therapeutic drug monitoring laboratory to ensure that such well-established potential problems do not result in inappropriate dosage reduction with consequent lack of adequate drug exposure and serious clinical sequelae.     

An approach to the development of a short-term whole-animal bioassay to distinguish initiating agents (incomplete carcinogens), promoting agents, complete carcinogens, and noncarcinogens in rat liver

With increased knowledge of the stages of initiation and promotion in the natural history of neoplastic development and the multiple observations that such stages are likely to be ubiquitous in the natural history of all histogenetic types of neoplasms, it is becoming increasingly important to distinguish chemical agents that act selectively during one or the other of these stages. Utilizing data obtained from the published literature as well as further observations, the experimental findings reported in this paper serve to indicate an approach to the development of a short-term whole-animal bioassay capable of distinguishing agents that act at one or the other or both of the stages of initiation and promotion in rat liver. Because of the tissue specificity for both complete carcinogens and promoting agents, this bioassay system is not likely to identify the initiating and promoting capabilities of all carcinogenic agents and thus at present is not designed to replace the standard chronic bioassay systems. However, in view of the diverse metabolic capabilities of hepatic tissue, the system proposed in this paper may represent a model capable of distinguishing the stages of carcinogenesis at which many, if not most, specific carcinogenic chemicals exert their primary action.     

大剂量甘露醇治疗癌性颅内高压症1例

1 临床资料患者、女性、38岁、因右小细胞肺癌术后16 mo,间断性头痛10 mo,加重1 wk后于2003-01-01入院.在2002-02因枕部疼痛,行头颅CT示: 脑多发转移癌.行多次头颅局部X-刀、γ-刀加全脑预防性放疗和化疗,疗效达部分缓解.2002-12末头痛症状复发,约1.5 h发作1次,伴短暂意识丧失、喷射状呕吐和四肢抽搐.     

A STD/HIV prevention trial among adolescents in managed care

OBJECTIVE: To determine if sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, risk assessment, and education tools provided as part of office-based primary care reduce adolescent risky sexual behaviors. DESIGN: A randomized intervention trial with 3- and 9-month follow-up. SETTING: Five staff-model managed care sites in Washington, DC (n = 19 pediatricians). PATIENTS: Consecutive 12- to 15-year-olds receiving a general health examination; 81% minority. Participation rate = 215/432 (50%). Nine-month follow-up rate = 197/215 (92%). INTERVENTION: Audiotaped STD risk assessment and education about staying safe (safer = condoms, safest = abstinence). MAIN OUTCOME MEASURES: Adolescent-reported sexual intercourse and condom use. RESULTS: More intervention adolescents reported pediatrician discussion on 11/13 sexual topics. Although more vaginal intercourse (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.04-5.84) was reported in the intervention group at 3 months, this was not true of overall sexual intercourse (OR = 1.55, 95% CI =.73-3.32). More sexually active adolescents reported condom use in the intervention group at 3 months (OR = 18.05, 95% CI = 1.27-256.03). At 9 months, there were no group differences in sexual behaviors; however, more signs of STD were reported by the control (7/103) than the intervention group (0/94). CONCLUSIONS: STD risk assessment and education tools administered in a single office visit facilitated STD/HIV prevention education. Any impact on sexual activity and condom use was short-lived. Further research is needed to develop brief, office-based sexual risk reduction for young adolescents.     

塞来昔布在类风湿性关节炎中对甲氨喋呤的药代动力学影响

目的：确定塞来昔布对于经常服用稳定剂量甲氨喋呤（ＭＴＸ）治疗类风湿性关节炎（ＲＡ）患者的肾脏清除率和血浆药代动力学方面的影响。方法：选取１４例至少已服用ＭＴＸ３个月,且每个星期的剂量稳定在５－１５ｍｇ,有类风湿关节炎的成年妇女,随机给予塞来昔布（２００ｍｇ．ｂｉｄ）或安慰剂单盲治疗,每一阶段７,分二阶段交叉试验,研究ＭＴＸ的药代动力学和肾脏平均清除率。结果：当ＭＴＸ和塞来昔布或安慰剂合用时,ＭＴＸ