How reliable is eGFR when calculating drug dosage in acute medical admissions?

Background: The Modification of Diet in Renal Disease‐derived estimation of glomerular filtration rate (eGFR) is used widely. Although validated in stable chronic kidney disease (CKD) outpatients, it is not known how it performs in those presenting with acute medical illness. Aim: We aimed to compare eGFR with Cockroft Gault (CG) – the renal function assessment tool available prior to eGFR – to assess the difference in clinical outcome that would occur when one over another estimation is used in practice. In particular, we wished to assess whether use of eGFR would have resulted in a change of dose of commonly used acutely administered medications. Methods: Acute medical admissions presenting to a tertiary hospital between August and December 2008 were included. Serum creatinine concentration, age, sex, height and weight were collected. Renal function was estimated by both estimates. Movement from CKD class 3 to 4 or 5 was measured – a clinically used cut‐off point for changes in management. Results: A total of 54 patients was included. eGFR values were higher than those estimated by CG. Almost half of patients categorized as CKD stage 4–5 using CG were only categorized as CKD stage 3 using eGFR. Conclusion: Although we did not use a gold standard estimation of GFR, this study shows that estimates of renal function vary in a clinically significant manner. As estimates of GFR are used to adjust drug dosages and to stratify for many other treatments, it is imperative that we find a method of estimating kidney function that is readily available, consistent and accurate.     

中国儿童常用药品剂型使用现状分析

目的 分析目前中国儿科常用药品剂型使用现状。方法 收集中国8家不同省份三级甲等儿童医院的用药目录，筛选出儿童常见系统疾病用药品种目录，对收集到的药品剂型信息进行统计分析。结果 共收集到2 495种儿科常用药品品规，其中口服剂型1 162种（46.6%）、注射剂型1 072种（42.9%）、外用剂型225种（9.0%）及吸入剂型36种（1.4%）。口服剂型中最常用的为普通片剂和颗粒剂。注射剂型中中药注射液有9种品规，其中有5种说明书中未标明儿童用法用量。儿科专用药品剂型共有190个品规，最常见的剂型为颗粒剂、口服溶液剂和糖浆剂。结论 尽管中国儿科常用药品剂型对儿童的适宜性有一定的改善，但目前儿科专用药品较少，适宜学龄前及以下儿童的药品剂型仍然比较缺乏，还远远不能满足不同年龄儿童多样化的药品剂型需求。     

Predictors for successful PBSC collection on the fourth day of G‐CSF‐induced mobilization in allogeneic stem cell donors

Peripheral blood stem cells (PBSCs) used for allogeneic transplantation are collected by apheresis after pre‐treatment of donors with G‐CSF. Using modern apheresis devices stem cells can be collected more efficiently. It was studied whether collection on the 4th instead of the 5th day after initiation of G‐CSF treatment might be feasible. Stem cell yields that could have been collected on day 4 were calculated in two cohorts treated with 10 µg/kg G‐CSF once daily (n = 106, cohort I) or 5 µg/kg twice daily schedule (n = 85, cohort II). Harvests were predicted using the median collection efficiency (CE) of the apheresis machine and regarded successful when > 5.0 x10⁶ CD34^+/kg recipient body weight. Successful harvests at day 4 could have been obtained in only 22.6% and 41.2% of donors in cohort I and II respectively, while the expected successful collections on day 5 were 55.7% and 76.5%. Individual donor factors that correlated with a successful harvest on day 4 were weight, BMI, age, ratio donor/recipient weight and total G‐CSF dose in cohort I, whereas ratio donor/recipient weight was the only significant predictor in cohort II. Donor weight, BMI and total G‐CSF dose correlated positively with CD34⁺ values in the blood on day 4 in all donors. However, donor characteristics were not able to be used as strong predictors in daily practice. In conclusion, PBSC collection on day 4 will not result in a successful harvest in most stem cell donors, however using a twice daily G‐CSF scheme increases the yield.     

呼出一氧化氮预测放射性肺炎价值的临床研究

目的 探讨一氧化氮呼出值（FeNO）预测放射性肺炎的价值。方法 收集2016年8月至2017年2月收治的131例胸部肿瘤患者，对放疗前、后的FeNO水平进行检测，并分析大气道（50 ml／s流速）、小气道（200 ml／s流速）和肺泡放疗前、后FeNO水平与放射性肺炎分级的关系。结果 131例患者放疗前平均大气道FeNO为19.86 ppb，小气道为9.49 ppb，肺泡为2.84 ppb；仅肺泡FeNO放疗后上升明显，差异有统计学意义（P=0.015）。全组患者放疗后出现1级放射性肺炎43例，2级70例，3级18例，无4级及以上者。放疗前、后大气道、小气道、肺泡FeNO水平与放射性肺炎分级无关。结论 肺泡FeNO在放疗后上升明显，但大、小气道放疗前、后FeNO水平不能预测放射性肺炎。     

Editorial: The integration of pharmacological and nonpharmacological treatments in drug/alcohol addiction

No abstract available for this article.