Abstract The incidence of ampicillin (ABPC)‐resistant Escherichia coli ( E . coli ) infection in very low‐birthweight infants has been increasing. The rate of ABPC/sulbactam (ABPC/SBT)‐resistant E . coli in this population, however, is currently unknown. We encountered two cases of severe infection due to resistant E. coli and retrospectively studied the prevalence of ABPC‐ and ABPC/SBT‐resistant E . coli in regular surveillance cultures obtained from all neonatal intensive care unit (NICU) patients between 2000 and 2013. The overall prevalence of ABPC‐resistant E . coli was 39% (47/120), accounting for 63% of cases (32/51) between 2007 and 2013, compared with 22% (15/69) between 2000 and 2006. The prevalence of ABPC/SBT resistance was 17% (20/120), which was similar in both periods (16%, 8/51 vs 17%, 12/69). According to these results, not only ABPC, but also ABPC/SBT‐resistant E . coli must be considered in the NICU.
PURPOSE More than 95% of children with B-lineage acute lymphoblastic leukemia (ALL) achieve a clinical remission after the induction phase of chemotherapy (first 28 days) as evaluated by morphologic criteria. However, relapse occurs in approximately 30% of these children. The objective of this study was to determine whether the outcome of patients in clinical remission at the end of induction therapy could be predicted using a highly sensitive method to detect residual disease. PATIENTS AND METHODS All children diagnosed with B-lineage ALL at the Children's Hospital of Philadelphia during a 2-year period were eligible. The extent of residual leukemia was quantitated in remission marrow samples obtained at the end of induction therapy in 44 children using a phage clonogenic assay in association with complementarity-determining-region 3 (CDR3)-polymerase chain reaction (PCR). RESULTS Residual disease was a significant predictor of outcome independent of WBC count, age, or sex. The estimated relapse-free survival (RFS) during therapy was 50.4% (+/- 12.6%) for patients with high residual disease (> or = 0.6% leukemia cells among total marrow B cells) versus 91.9% (+/- 5.5%) for those with lower levels (P < .002). There were no significant differences in off-treatment RFS between patients with high or low residual disease who completed therapy in continuous remission (P = .82). The overall estimated RFS was 32.3% (+/- 11.6%) for patients with high residual disease versus 62.6% (+/- 10.7%) for patients with lower levels of residual leukemia cells, with a median follow-up of 5.3 years for patients in continuous remission (P < .008). CONCLUSION PCR detection of high residual disease at the end of induction therapy identifies patients at increased risk for relapse during therapy.
Abstract Recombinant DNA technology has produced many proteins and peptides drugs in large scale, and they are becoming increasingly important as therapeutic agents. The successful development of recombinant proteins depends on the proper characterization of their pharmacokinetics and an understanding of the relationship between drug exposure or dose and the pharmacological response. This article describes the pharmacokinetics of clinically important peptide/protein drugs, such as insulin, erythropoietin (EPO), granulocyte‐colony stimulating factor (G‐CSF), interferon, growth hormone, leuprolide, desmopressin, and antibodies in relation to their administration routes and formulations.
Objective: To design an alternative painless method for vancomycin (VCM) monitoring by withdrawing interstitial fluid (ISF) the skin using dissolving microneedles (DMNs) and possibly replace the conventional clinical blood sampling method.Methods: Male Wistar rats were anesthetized with 50 mg/kg sodium pentobarbital.Vancomycin at 5 mg/mL in saline was intravenously administered via the jugular vein.ISF was collected from a formed pore at 15, 30, 45, 60, 75, 90, and 120 min after the DMNs was removed from the skin.In addition, 0.3 mL blood samples were collected from the left femoral vein. Results:The correlation between the plasma and ISF VCM concentrations was significantly strong (r = 0.676, p < 0.05).Microscopic observation of the skin after application of the DMNs demonstrated their safety as a device for sampling ISF.Conclusion: A novel monitoring method for VCM was developed to painlessly determine concentrations in the ISF as opposed to blood sampling.
