Introduction and review of collection techniques and applications of drug testing of oral fluid

The past several years have seen substantial developments in the use of alternative specimens for drug analysis. The use of oral fluid has been found to offer significant promise when detection of relatively recent use of drugs is sought in a relatively noninvasive manner. Although there are a number of factors that affect drug concentration in oral fluid, there appears to be a reasonable correlation between blood and oral fluid concentrations of drugs. Collection techniques can artificially affect production of oral fluid and its subsequent pH. These need to be understood, as does local absorption of drug, in situations where drug may be present in the oral cavity (eg, smoking or sublingual absorption). Nevertheless, it is essential that devices used to collect oral fluid are checked to ensure reasonable stability and recovery of absorbed drug. The most common applications include workplace testing for drugs of abuse, particularly post-incident, and roadside detection of illicit drugs. Therapeutic drug monitoring has been shown to be useful for a number of drugs that have traditionally been measured in plasma/serum.     

RP-HPLC测定糙叶五加不同药用部位中槲皮素和山柰酚

目的 建立同时测定糙叶五加不同药用部位中槲皮素和山柰酚的方法.方法采用RP-HPLC法,色谱柱为AT.Lichrom ODS-C18柱(250 mm×4.6 mm,5μm),以甲醇-磷酸-水(50∶0.2∶49.8)为流动相,柱温30℃,体积流量1.0 mL/min,检测波长360 nm,进样量10μL.结果槲皮素在0.018～0.720μg线性关系良好(r=0.999 6),加样回收率为98.41％,RSD为0.91％;山柰酚在0.016～0.640μg线性关系良好(r=0.999 7),加样同收率为98.06％,RSD为1.39％.槲皮素和山柰酚在叶中的量最高,其次是茎,根中未检出.结论对糙叶五加不同药用部位槲皮素和山奈酚进行了测定,所建立的HPLC法稳定性好、准确性高,适用于糙叶五加中槲皮素和山柰酚的定量分析.     

急性冠脉综合征后6个月死亡和心肌梗死的预测：前瞻性的多国观察性研究（GRACE）

目的:发现一种临床上可以用来预测的工具,以预测累计的6个月死亡或心肌梗死的危险,以方便对急性冠脉综合征患者的分类管理。设计:前瞻性的多国观察性研究,采用多变量回归的方法建立一个最终的预测模型。方法:选择GRACE(globalregistryofacutecoronaryevents,全球急性冠脉事件登记)研究中从1999年4月到2005年9月有(或无)ST段抬高的急性冠脉综合征患者43810例,他们来自欧洲、北美洲或南美洲、澳大利亚和新西兰等14个国家的94家医院。主要结果测量:死亡和心肌梗死。结果:1989例患者死于医院,1466例死于出院后的6个月随访期内,2793例发生了新…     

EFFECT OF DOBUTAMINE ON OXYGEN SUPPLY AND UPTAKE IN HEALTHY VOLUNTEERS

We have measured the changes in Vo₂ and the Vo₂; D_o2 relationshipduringinfusion of dobutamine in healthy volunteers. Nine healthy,adult, non-obese, male physicians were infused with an incrementalinfusion of dobutamine starting at 2.5 µg kg^–1 min^–1increasing to 5.0 and then 7.5 y.g kg^–1 min^–1 for15 min each. Vo ₂ and cardiac index were measured every fiveminutes. Vo₂/(VO₂ m^–2) increased from a baseline of 128(SEM 6.1) ml min^–1 m^–2 to 159 (8.0)ml min¹ m^–2(P< 0.05) at 7.5 fig kg^–1 min^–1. The correspondingchanges for Do₂l (Do₂m^–2) were from 643 (35) ml min^–1m^–2 to 1240 (142) ml min^–1 m^–2 (P<0.05).The coefficient of correlation for pairs of Vo₂ and DO₂ values,at baseline and each dobutamine infusion in individual subjects,range from 0.89 to 0.99 (mean 0.95, SD 0.03). Dobutamine haspotent calorigenic effects; demonstration of a positive correlationbetween Vo₂ and Do₂ after infusion of dobutamine does not necessarilyimply an underlying tissue oxygen debt.     

Efficacy of Dose Escalation of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms

Objectives: The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Methods: Patients were treated with low‐dose tamsulosin for an initial run‐in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. Results: One hundred and seventy‐four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty‐five patients completed the 36‐week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Conclusion: Both low‐ and intermediate‐dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.     

Rupture of a saphenous vein bypass graft during coronary angioplasty.

A self-limited rupture of a five month old saphenous vein bypass graft occurred during coronary angioplasty when the balloon used to stretch the vessel proved to be too large. A lack of fibrous tissue in the new graft may have predisposed it to rupture.     

Predictors of Positive Head-Up Tilt Test in Patients with Suspected Neurocardiogenic Syncope or Presyncope

OH, J.H., et al .: Predictors of Positive Head-Up Tilt Test in Patients with Suspected Neurocardiogenic Syncope or Presyncope. Neurocardiogenic syncope is the most common cause of syncope in patients who present in outpatient clinics. Head-up tilt test (HUT) has been widely used to diagnose neurocardiogenic syncope. However, the HUT does not always produce a positive response in patients with suspected neurocardiogenic syncope. The aim of the present study was to assess the clinical history and characteristics of patients with suspected neurocardiogenic syncope or presyncope who undertook HUT, and to identify prognostic factors of a positive HUT response. During the first phase of HUT, patients were tilted to a 70-degree angle for 30 minutes. If the first phase produced a negative response, the second phase was subsequently performed involving intravenous isoproterenol administration. Of 711 patients, 423 (59.5%) patients showed a positive HUT response. In contrast to previous studies, this study showed that the vasodepressive type (76.6%) was the most common pattern of positive response, and that the rate of positive response during the first phase was low (7.1%). By multivariate analysis, the occurrence of junctional rhythm was found to be a predictor of an impending positive response in HUT   (P < 0.001)   . The shorter time interval between the last episode and HUT was also a predictor of positive response   (P = 0.0015)   . Younger age   (P = 0.0003)   and a history of physical injury during a syncopal episode   (P = 0.019)   were found to be associated with a positive response in the first phase of HUT. (PACE 2003; 26[Pt. I]:593–598)     

Propofol for induction and maintenance of anaesthesia at Caesarean section A comparison with thiopentone/enflurane

A propofol infusion regimen and a standard general anaesthetic were compared in 40 Chinese women undergoing elective Caesarean section. Twenty patients received propofol 2 mg/kg for induction of anaesthesia followed by propofol 6 mg/kg/hour, while 20 patients received thiopentone 4 mg/kg with enflurane 1% for maintenance of anaesthesia. All patients were given atracurium and their lungs ventilated with nitrous oxide 50% in oxygen until delivery of the neonate. The hypertensive response after intubation was of shorter duration in the propofol group compared with the thiopentone group. Induction to delivery times ranged from 5 to 14 minutes and neonates from both groups had similar and satisfactory Apgar scores. Neurologic and Adaptive Capacity Scores and umbilical cord blood gas analysis. However, a prolonged propofol infusion time before delivery may cause lower Neurologic and Adaptive Capacity Scores. There were no differences in maternal recovery times or psychomotor performance.