Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease.

BACKGROUND: Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. METHODS: We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life. RESULTS: At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups. CONCLUSIONS: In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .).

Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population.

BACKGROUND: Few studies have used individual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors. METHODS AND RESULTS: We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age- and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment-elevation and non-ST-segment-elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age- and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0-4.0; P<0.001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48-97; P<0.001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively. CONCLUSIONS: We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.

Parallel electromembrane extraction in a multiwell plate.

This paper describes the concept of parallel electromembrane extraction (Pa-EME) with flat membranes in a multiwell format for the first time. The setup is based on a multiwell plate and provided simultaneous and selective isolation, cleanup, and enrichment of several human plasma samples as well as LC-MS-compatible extracts within 8 min of extraction. Undiluted human plasma samples spiked with four antidepressant drugs were added to separate wells in the donor plate. Subsequently, the samples were extracted with Pa-EME. The four drugs migrated electrokinetically from undiluted human plasma through a flat polypropylene membrane impregnated with 2-nitrophenyl octyl ether, and were isolated into formic acid. Extraction time, extraction voltage, agitation rate, sample volume, and acceptor solution volume were all optimized with an experimental design. The optimal conditions were as follows: The agitation rate was 1,040 rpm, and an extraction voltage of 200 V was applied. The sample volume and acceptor solution volume was 240 and 70 µL, respectively. The extraction was continued for 8 min. Eventually, the extracts were analyzed by LC-MS/MS. The combination of Pa-EME with LC-MS/MS provided quantitation limits below the therapeutic level and reported relative standard deviations in the range 5-13 %. Linear calibration curves were obtained for all analytes, and the correlation coefficients were above 0.9974 in the range 1-400 ng mL(-1). The drug concentrations from two subjects treated with quetiapine and sertraline were successfully determined with Pa-EME combined with LC-MS/MS. Post-column infusion experiments demonstrated that Pa-EME provided extracts free from interfering matrix components.

Assessment of risk factors for developing incident aortic stenosis: the Tromsø Study.

To disclose risk factors of incident aortic stenosis (AS) and progression of established AS. A prospective cohort study. The Tromsø Study, a population based health survey. Over a 14 years span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3,243 participants. Data from the only hospital serving this population were included in the follow up. Throughout the study 132 participants were diagnosed with incident AS, defined as mean aortic valve gradient ≥15 mmHg. Cox proportional hazards regression disclosed age (HR 1.11, 95 %CI 1.08-1.14), systolic blood pressure (BP) (HR 1.01, 95 % CI 1.00-1.02), active smoking (HR 1.71, 95 % CI 1.09-2.67), and waist circumference (HR 1.02, 95 % CI 1.00-1.03) as independent predictors of incident AS. Analysis of risk factors for progression of AS disclosed a higher mean aortic gradient at first measurement (p = 0.015), weight (p = 0.015), a low haemoglobin (Hgb) (p = 0.030) and high density lipoprotein (HDL) (p = 0.032) as significant independent predictors. Age, systolic BP, smoking and waist circumference were independent predictors of incident AS, whereas cholesterol was not. Mean aortic gradient at first measurement, weight, an elevated HDL and low Hgb increase the progression rate of the disease. Our data indicate that calcific aortic valve disease is a distinct pathophysiological process, with age, smoking and "wear and tear" of the valve being major contributors to the disease development.

Alginate and chitosan foam combined with electromembrane extraction for dried blood spot analysis.

Samples of 10 µL of whole blood containing citalopram, loperamide, methadone, and sertraline as model substances were spotted on alginate and chitosan foams as sampling media. After drying and storage at room temperature, the punched out dried blood spot and the foam was dissolved in 300 µL of 1 mM HCl. With alginate foam as sampling medium, the analytes dissolved completely after 3 min. Enrichment and cleanup was performed with electromembrane extraction for 10 min. The analytes were collected in 21 µL of 10 mM formic acid as the acceptor phase, and the extracts were analyzed by liquid chromatography-mass spectrometry (LC-MS). Sample preparation of blood spots on commercial cards was also performed (Whatman FTA DMPK and Agilent Bond Elut DMS) using elution procedures recommended by the manufacturers. The recoveries obtained with the commercial cards were lower for most of the model analytes compared to the recoveries obtained with alginate and chitosan foams as sampling media. The procedure used for Agilent Bond Elut DMS showed higher recoveries than the procedure used for Whatman FTA DMPK-A, but the time needed for sample preparation was significantly longer (nearly 2 h). The stability of the model substances on the alginate foam was acceptable within 50 days of storage. The limit of quantification (LOQ) defined as S/N = 10, was 1.2, 5.5, 2.0, and 5.3 ng/mL for citalopram, loperamide, methadone, and sertraline, respectively. Linear calibration graphs were obtained in the range 17.5-560 ng/mL with r(2) values 0.983-0.995, and the relative standard deviations were below 20%.

Homocysteine lowering and cardiovascular events after acute myocardial infarction.

BACKGROUND: Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction. METHODS: The trial included 3749 men and women who had had an acute myocardial infarction within seven days before randomization. Patients were randomly assigned, in a two-by-two factorial design, to receive one of the following four daily treatments: 0.8 mg of folic acid, 0.4 mg of vitamin B12, and 40 mg of vitamin B6; 0.8 mg of folic acid and 0.4 mg of vitamin B12; 40 mg of vitamin B6; or placebo. The primary end point during a median follow-up of 40 months was a composite of recurrent myocardial infarction, stroke, and sudden death attributed to coronary artery disease. RESULTS: The mean total homocysteine level was lowered by 27 percent among patients given folic acid plus vitamin B12, but such treatment had no significant effect on the primary end point (risk ratio, 1.08; 95 percent confidence interval, 0.93 to 1.25; P=0.31). Also, treatment with vitamin B6 was not associated with any significant benefit with regard to the primary end point (relative risk of the primary end point, 1.14; 95 percent confidence interval, 0.98 to 1.32; P=0.09). In the group given folic acid, vitamin B12, and vitamin B6, there was a trend toward an increased risk (relative risk, 1.22; 95 percent confidence interval, 1.00 to 1.50; P=0.05). CONCLUSIONS: Treatment with B vitamins did not lower the risk of recurrent cardiovascular disease after acute myocardial infarction. A harmful effect from combined B vitamin treatment was suggested. Such treatment should therefore not be recommended. (ClinicalTrials.gov number, NCT00266487.).

Electromembrane extraction of basic drugs from untreated human plasma and whole blood under physiological pH conditions.

The present work describes the first systematic study of electromembrane extraction (EME) from biological matrices under physiological conditions. Six basic drugs with protein binding in the range of 20-97% were extracted from untreated human plasma and whole blood through a supported liquid membrane (SLM) consisting of 1-ethyl-2-nitrobenzene impregnated in the walls of a hollow fiber, and into an acidified aqueous solution inside the lumen of the fiber. The electrical potential difference over the membrane reduced the protein binding of the drugs and transported the free drug fraction over the membrane. Recoveries in the range 25-65% were obtained with 10-min extraction time and an applied voltage of only 10 V over the SLM. Interday precision better than 20% RSD and linearity in the range 0.5-10 microg/mL were obtained for nortriptyline and methadone. Extraction from untreated whole blood was also demonstrated with recoveries in the range 19-51%.

Cancer incidence and mortality after treatment with folic acid and vitamin B12.

CONTEXT: Recently, concern has been raised about the safety of folic acid, particularly in relation to cancer risk. OBJECTIVE: To evaluate effects of treatment with B vitamins on cancer outcomes and all-cause mortality in 2 randomized controlled trials. DESIGN, SETTING, AND PARTICIPANTS: Combined analysis and extended follow-up of participants from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin Trial and Western Norway B Vitamin Intervention Trial). A total of 6837 patients with ischemic heart disease were treated with B vitamins or placebo between 1998 and 2005, and were followed up through December 31, 2007. INTERVENTIONS: Oral treatment with folic acid (0.8 mg/d) plus vitamin B(12) (0.4 mg/d) and vitamin B(6) (40 mg/d) (n = 1708); folic acid (0.8 mg/d) plus vitamin B(12) (0.4 mg/d) (n = 1703); vitamin B(6) alone (40 mg/d) (n = 1705); or placebo (n = 1721). MAIN OUTCOME MEASURES: Cancer incidence, cancer mortality, and all-cause mortality. RESULTS: During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B(12) vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B(12) vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B(12) vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B(12). Vitamin B(6) treatment was not associated with any significant effects. CONCLUSION: Treatment with folic acid plus vitamin B(12) was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00671346.

Liquid-phase microextraction with porous hollow fibers, a miniaturized and highly flexible format for liquid-liquid extraction.

Since 1999, substantial research has been devoted to the development of liquid-phase microextraction (LPME) based on porous hollow fibers. With this technology, target analytes are extracted from aqueous samples, through a thin supported liquid membrane (SLM) sustained in the pores in the wall of a porous hollow fiber, and further into a microL volume of acceptor solution placed inside the lumen of the hollow fiber. After extraction, the acceptor solution is directly subjected to a final chemical analysis by liquid chromatography (HPLC), gas chromatography (GC), capillary electrophoresis (CE), or mass spectrometry (MS). In this review, LPME will be discussed with focus on extraction principles, historical development, fundamental theory, and performance. Also, major applications have been compiled, and recent forefront developments will be discussed.

Low-voltage electromembrane extraction of basic drugs from biological samples.

The present work has for the first time demonstrated electromembrane extraction (EME) at voltages obtainable by common batteries. Five basic drugs were extracted from acidified aqueous sample solutions, across a supported liquid membrane (SLM) consisting of 1-isopropyl-4-nitrobenzene impregnated in the walls of a hollow fiber, and into an acidified aqueous acceptor solution present inside the lumen of the hollow fiber with potential differences of 1-10 V applied over the SLM. Extractions from 1 ml standard solutions prepared in 10mM HCl for 5 min and with a potential of 10 V demonstrated analyte recoveries of 50-93% in 25 microl of 10mM HCl as acceptor solution. This corresponds to enrichment factors of 20-37. Similar results were obtained with a common 9 V battery as power supply. Recoveries from low-voltage EME on human plasma, urine, and breast milk diluted with acetate buffer (pH 4) demonstrated recoveries in the range of 37-55% after 5 min of extraction. Excellent selectivity was demonstrated as no interfering peaks were detected. Standard curves in the range of 0.0625-0.62 5 microg/ml demonstrated correlation coefficients of 0.994-0.999. Extraction recoveries from human plasma, urine or breast milk were not found to be sensitive towards individual variations. The results show that low-voltage EME has a future potential as a simple, selective, and time-efficient sample preparation technique of biological fluids.

Parameters affecting electro membrane extraction of basic drugs.

Thirty-five different basic drugs were extracted by electro membrane extraction (EME), from acidified samples containing HCl as the BGE, through an organic solvent immobilized in the pores in the wall of a porous hollow fiber (supported liquid membrane, SLM), and into an acidified acceptor solution (HCl) in the lumen of the hollow fiber by the application of an electrical potential difference of 50 V. With 2-nitrophenyl pentyl ether (NPPE) as the SLM, and with 10 mM HCl as BGE in the sample and acceptor solution, singly charged basic drugs with log P >2 were extracted with recoveries in the range 30-81% within 5 min. For doubly charged basic drugs, extraction was effectively enhanced by decreasing the concentration of HCl in the sample from 10 to 0.1 mM, reducing the ionization of the analytes. For medium polar analytes (1 < log P < 2), an ion balance of 0.01 was combined with addition of tris-(2-ethylhexyl) phosphate (TEHP) to the SLM, and this provided recoveries in the range 36-70%. The ion balance was defined as the concentration ratio of BGE between the sample and the acceptor solution. For the most polar drugs (log P <1), EME was accomplished with an ion balance of 0.01 and with di-(2-ethylhexyl) phosphate (DEHP) added to the SLM, but in spite of this, recoveries were in the range of only 4-17%.

Thyroid stimulating hormone and left ventricular function.

CONTEXT: Overt hypo- and hyperthyroidism are associated with cardiac disease, whereas this relation is more uncertain regarding subclinical thyroid dysfunction. OBJECTIVE: The objective was to assess the relation between serum TSH level and cardiac function. DESIGN: We conducted a cross-sectional epidemiological study and a nested case-control study. SETTING: The study was performed at a university hospital. SUBJECTS: A total of 2035 subjects were included in the epidemiological study and 204 subjects in the nested case-control study (serum TSH < 0.50, 0.50-3.49, and 3.50-10.0 mIU/liter in 20, 118, and 66 subjects, respectively, all with normal serum free T(4) and free T(3) levels). MAIN OUTCOME MEASURES: Left ventricular mass by body surface area (LVMI) and indices of left ventricular function, as assessed by conventional and pulsed-wave tissue Doppler (PWTD) echocardiography, were recorded. RESULTS: No significant relation was found between serum TSH level and LVMI. In the nested case-control study, the subjects with serum TSH 3.50-10.0 mIU/liter had no signs of cardiac dysfunction. However, the PWTD data showed higher velocities at all measurement sites in the subjects with serum TSH less than 0.50 mIU/liter as compared with the euthyroid group. CONCLUSIONS: With the possible exception of overt hypo- and hyperthyroidism, there is no significant association between serum TSH level and LVMI. Subjects with subclinical hypothyroidism, in whom the mean serum TSH level is slightly above the reference range, appear to have normal cardiac function, whereas subjects with serum TSH levels less than 0.5 mIU/liter appear to have changes in myocardial velocities detected by PWTD.

Simulation of flux during electro-membrane extraction based on the Nernst-Planck equation.

The present work has for the first time described and verified a theoretical model of the analytical extraction process electro-membrane extraction (EME), where target analytes are extracted from an aqueous sample, through a thin layer of 2-nitrophenyl octylether immobilized as a supported liquid membrane (SLM) in the pores in the wall of a porous hollow fibre, and into an acceptor solution present inside the lumen of the hollow fibre by the application of an electrical potential difference. The mathematical model was based on the Nernst-Planck equation, and described the flux over the SLM. The model demonstrated that the magnitude of the electrical potential difference, the ion balance of the system, and the absolute temperature influenced the flux of analyte across the SLM. These conclusions were verified by experimental data with five basic drugs. The flux was strongly dependent of the potential difference over the SLM, and increased potential difference resulted in an increase in the flux. The ion balance, defined as the sum of ions in the donor solution divided by the sum of ions in the acceptor solution, was shown to influence the flux, and high ionic concentration in the acceptor solution relative to the sample solution was advantageous for high flux. Different temperatures also led to changes in the flux in the EME system.

Microextraction across supported liquid membranes forced by pH gradients and electrical fields.

The present work has for the first time compared extraction of basic analytes across a supported liquid membrane (SLM) based on (1) passive diffusion in a pH gradient sustained over the SLM and (2) electrokinetic migration in an electrical field sustained over the SLM. For the passive diffusion experiments, performed as liquid-phase microextraction (LPME), five basic drugs were extracted under strong agitation from alkaline samples (10mM NaOH), through 2-nitrophenyl octylether immobilized in the pores of a porous hollow fibre of polypropylene (SLM), and into 25 microl of 10mM HCl as the acceptor solution. The experiments based on electrokinetic migration, performed as electro membrane isolation (EMI), were conducted under strong agitation from acidic samples (10mM HCl), through the same SLM as in LPME, and into 25 microl of 10mM HCl as the acceptor solution. Whereas LPME relied on diffusion and to some extent also convection as the principal mechanisms of mass transfer, mass transfer in EMI also included a strong contribution from electrokinetic migration. Thus, extraction kinetics was improved by a factor between 6 and 17 utilizing EMI instead of LPME. This major difference in terms of speed was especially pronounced from small sample volumes (150 microl), and suggest that EMI may be a very interesting future concept for miniaturized sample preparation. In addition to improved extraction kinetics, extraction rates were strongly compound dependent in EMI, opening the possibility to control the extraction selectivity by the extraction time.

Electrokinetic migration of acidic drugs across a supported liquid membrane.

Electrokinetic cross membrane extraction of acidic drugs was demonstrated for the first time. The acidic drugs were extracted from an alkaline aqueous donor solution (300 microl), through a thin supported liquid membrane of 1-heptanol sustained in the pores of the wall of a porous hollow fiber, and into an aqueous alkaline acceptor solution (30 microl) present inside the lumen of the hollow fiber by the application of a d.c. electrical potential. The negative electrode was placed in the donor solution, and the positive electrode was placed in the acceptor solution. Optimal extractions were accomplished with 1-heptanol as the supported liquid membrane, with 50 V as the driving force, and with pH 12.0 in both the donor and acceptor solutions, respectively (NaOH). Equilibrium extraction conditions were obtained after 5 min of operation with the whole assembly agitated at 1200 rpm. Eleven different acidic drugs were extracted with recovery values between 8 and 100%, and initial data supported that electrokinetic cross membrane extraction provided repeatable data and linear response between original donor concentration and final acceptor concentration of the acidic model compounds.

Quality or equality? The Norwegian experience with medical monopolies.

BACKGROUND: In order to maintain both quality and efficiency of health services in a small country with a scattered population, Norway established a monopoly system for 38 highly specialized medical services. The geographical distributions of these services, which are provided by one or two university hospitals only, were analysed. METHODS: The counties of residence for 2,711 patients admitted for the first time in 2001 to these 31 monopolies and 7 duopolies were identified. RESULTS: The general tendency observed was that with increasing distance from residential home to monopoly hospitals there was a declining coverage of these health services. The same pattern was found even with regard to explicit diagnoses or treatments such as organ transplantations (except renal transplantations). Duopolies seemed to yield a more even geographical distribution of the services. CONCLUSION: Monopolies may serve as a useful means for maintaining quality in highly specialized medical services, but seem to have an inherent tendency to do this at the expense of geographical equality.

Electrokinetic migration across artificial liquid membranes. New concept for rapid sample preparation of biological fluids.

Basic drug substances were transported across a thin artificial organic liquid membrane by the application of 300 V d.c. From a 300 microl aqueous donor compartment (containing 10 mM HCl), the drugs migrated through a 200 microm artificial liquid membrane of 2-nitrophenyl octyl ether immobilized in the pores of a polypropylene hollow fiber, and into a 30 microl aqueous acceptor solution of 10 mM HCl inside the lumen of the hollow fiber. The transport was forced by an electrical potential difference sustained over the liquid membrane, resulting in electrokinetic migration of drug substances from the donor compartment to the acceptor solution. Within 5 min of operation at 300 V, pethidine, nortriptyline, methadone, haloperidol, and loperamide were extracted with recoveries in the range 70-79%, which corresponded to enrichments in the range 7.0-7.9. The chemical composition of the organic liquid membrane strongly affected the permeability, and may serve as an efficient tool for controlling the transport selectivity. Water samples, human plasma, and human urine were successfully processed, and in light of the present report, electrokinetic migration across thin artificial liquid membranes may be an interesting tool for future isolation within chemical analysis.

Electrokinetic migration across artificial liquid membranes Tuning the membrane chemistry to different types of drug substances.

Twenty different basic drugs were electrokinetically extracted across a thin artificial organic liquid membrane with a 300 V d.c. electrical potential difference as the driving force. From a 300 microl aqueous sample (acidified corresponding to 10mM HCl), the drugs were extracted for 5 min through a 200 microm artificial liquid membrane of a water immiscible organic solvent immobilized in the pores of a polypropylene hollow fiber, and into a 30 microl aqueous acceptor solution of 10mM HCl inside the lumen of the hollow fiber. Hydrophobic basic drugs (logP>1.7) were effectively isolated utilizing 2-nitrophenyl octyl ether (NPOE) as the artificial liquid membrane, with recoveries up to 83%. For more hydrophilic basic drugs (logP<1.0), a mixture of NPOE and 25% (w/w) di-(2-ethylhexyl) phosphate (DEHP) was required to ensure efficient extraction, resulting in recoveries up to 75%. DEHP was expected to act as an ion-pair reagent ion-pairing the protonated hydrophilic drugs at the interface between the sample and the membrane, resulting in permeation of the interface.

Liquid-phase microextraction based on carrier mediated transport combined with liquid chromatography-mass spectrometry. New concept for the determination of polar drugs in a single drop of human plasma.

Recently, we demonstrated for the first time liquid-phase microextraction (LPME) of polar drugs based on carrier mediated transport. In this new extraction technique, selected analytes were extracted as ion-pairs from small volumes of biological samples, through a thin layer of a water immiscible organic solvent immobilised in the pores of a porous hollow fibre (liquid membrane), and into a microl volume of an acidic aqueous acceptor solution placed inside the lumen of the hollow fibre. In the current paper, this new extraction technique was combined with liquid chromatography-mass spectrometry (LC-MS) for the first time. Carrier mediated LPME was evaluated for several new model drugs (0.01

Bioanalysis of drugs by liquid-phase microextraction coupled to separation techniques.

The demand for automation of liquid-liquid extraction (LLE) in drug analysis combined with the demand for reduced sample preparation time has led to the recent development of liquid-phase microextraction (LPME) based on disposable hollow fibres. In LPME, target drugs are extracted from aqueous biological samples, through a thin layer of organic solvent immobilised within the pores of the wall of a porous hollow fibre, and into an microl volume of acceptor solution inside the lumen of the hollow fibre. After extraction, the acceptor solution is subjected directly to a final analysis either by high performance liquid chromatography (HPLC), capillary electrophoresis (CE), mass spectrometry (MS), or capillary gas chromatography (GC) without any further treatments. Hollow fibre-based LPME may provide high enrichment of drugs and excellent sample clean-up, and probably has a broad application potential within the area of drug analysis. This review focuses on the principle of LPME, and recent applications of three-phase, two-phase, and carrier mediated LPME of drugs from plasma, whole blood, urine, and breast milk.