Peri-osteosarcoma adipose computed tomography attenuation and volume for predicting chemotherapy response in pediatric patients.

BACKGROUND: The chemosensitivity of osteosarcoma patients to MTX is closely related to prognosis. There is currently a lack of advance prediction methods for MTX sensitivity. OBJECTIVE: We proposed novel peri-osteosarcoma fat parameters based on computed tomography (CT) to evaluate the chemotherapy response preoperatively and calculate the correlation between image characteristics and methotrexate (MTX) blood concentration and systemic inflammation. MATERIALS AND METHODS: Pediatric patients with osteosarcoma (OS) who were treated with high-dose MTX were retrospectively studied and grouped according to postoperative Huvos classification. Clinical data were collected and reviewed. Image characteristics including peri-osteosarcoma fat volume and fat attenuation index were measured using the threshold method based on CT images. Statistical significance, correlation and prediction performance were performed. RESULTS: Eighteen patients (good response (GR) group/poor response (PR) group: 10/8) was enrolled. MTX peak value at 6 h differed significantly between the two groups which was significantly higher in GR group (745.1 µmol/L vs 529.0 µmol/L p = 0.001). Peri-osteosarcoma fat attenuation index was significantly lower in GR group compared with that in PR group (- 104.90 vs. - 97.19, p < 0.0001). MTX blood concentration at 6 h negatively correlated with peri-osteosarcoma fat attenuation index (R = - 0.519, p = 0.027). In addition, 6 h MTX blood concentration (OR 0.974; 95% CI 0.951-0.998, p = 0.037) and FAI (OR 2.108; 95% CI 1.047-4.243, p = 0.037) were, respectively, independently related to good response to chemotherapy. The prediction performance on chemotherapy response of peri-osteosarcoma fat attenuation index and 6 h MTX blood concentration were both good with the comparable area under the ROC curve (0.950, 95% CI 0.856-1.000 and 0.963, 95% CI 0.878-1.00). CONCLUSIONS: Peri-osteosarcoma fat parameters based on CT were associated with the chemotherapy response and the MTX blood concentration, but not with the systemic inflammation. Combined with the requirement of current clinical practice, peri-osteosarcoma fat parameters may have the potential to be valuable image characteristics for monitoring chemotherapy response in OS pediatric patients.

Limited sampling strategy to predict the area under the curve of tacrolimus in Mexican renal transplant pediatric patients receiving Prograf® or non-innovator formulations.

TDM of tacrolimus is usually performed with trough levels (C0h ). However, in pediatric patients, C0h may not be an adequate marker. The AUC is considered a more suitable indicator of drug exposure. As several blood samples are needed for the estimation of AUC, and LSS for predicting tacrolimus AUC and optimizing the dose adjustment have been proposed. Moreover, in emerging countries such as Mexico, non-innovator formulations, which bioequivalence has not been demonstrated, are frequently used. Hence, the aim of this study was to develop and validate a LSS to predict the tacrolimus AUC0-12h in Mexican pediatric kidney transplant recipients who received either Prograf® or non-innovator tacrolimus formulations. A total of 56 pharmacokinetic profiles were randomized into two groups: model development (n = 28) and model validation (n = 28). The limited sampling equations were obtained after a stepwise multiple regression using AUC as the dependent variable and tacrolimus blood concentrations, quantified by CMIA, at different time points as the independent variables. The final equation included observed concentrations at 1 hour (C1h ) and 4 hours (C4h ) after dose administration. The predictive performance of the model was adequate in terms of both, bias and precision. Results strongly suggest that the clinical use of this LSS could provide an ethical, cost-, and time-effective method in the TDM of tacrolimus in pediatric patients with kidney transplant. The model proved to be adequate with either Prograf® or non-innovator tacrolimus formulations of dubious bioequivalence.

Relação entre concentração sanguínea de cocaí­na e cocaetileno com a gravidade das manifestações clí­nicas apresentadas por pacientes com diagnóstico de intoxicação por cocaína / Relationship between blood concentration of cocaine and cocaethylene with the severity of clinical manifestations presented by patients diagnosed with cocaine intoxication

As intoxicações decorrentes do uso de drogas de abuso representam atualmente um grave problema para a saúde pública. Dentre os principais agentes envolvidos, destaca-se a cocaína. Ela se tornou uma das drogas mais consumidas ao redor do mundo, sendo um dos principais motivos de atendimentos em pronto-socorro (PS) devido ao uso de substâncias ilícitas. Seu uso ocorre principalmente em associação com bebida alcóolica. Existem poucos estudos realizados que relacionem a concentração sanguínea de cocaína e a gravidade das manifestações clínicas em populações que a utilizam como droga de abuso, e que envolvam pacientes atendidos em PS. O objetivo do presente estudo foi verificar a possível relação entre concentração sanguínea de cocaína e cocaetileno (produto da interação de cocaína com etanol) com a gravidade das manifestações clínicas apresentadas por pacientes com hipótese diagnóstica de intoxicação por cocaína. As concentrações sanguíneas foram determinadas por cromatografia líquida de alta eficiência (HPLC) e a gravidade das manifestações clínicas foi avaliada através do Stimulant Intoxication Score (SIS). Dos 81 pacientes incluídos no estudo 77,8% são homens com idade média de 32,5 anos ± 8,5 e SIS médio de 3,4 ± 2,5. Do total de pacientes incluídos no estudo 20 (24,7%) tiveram resultados positivos em sangue para os analitos de interesse, sendo a concentração sanguínea média de cocaína igual a 0,34 µg/mL ± 0,45 e de cocaetileno igual a 0,38 µg/mL ± 0,34. A concentração sanguínea de cocaína e cocaetileno não se mostrou informação útil para tratamento e prognóstico dos pacientes, porém a detecção no sangue destas substâncias no momento do atendimento, independentemente de sua concentração, pode ser um indicador de gravidade, mostrando que quaisquer concentrações destas substâncias devem ser consideradas potencialmente tóxicas. A aplicação do score SIS revelou-se como importante alternativa capaz de predizer a gravidade dos pacientes atendidos devido a intoxicação por cocaína de maneira rápida e simplificada

Currently, poisoning resulting from the abuse of drug represents a serious problem for public health. Among the main agents involved, cocaine stands out. It became one of the most abused drugs around the world, being one of the main reasons for visits to the emergency room due to the use of illicit substances. The use of cocaine is primarily in combination with alcoholic beverages. There are few studies that relate cocaine blood concentration and the severity of its clinical manifestations in patients attended in the Emergency Room. The aim of the present study was to verify the possible relationship between the blood concentration of cocaine and cocaethylene (product of the interaction of cocaine with ethanol) with the severity of the clinical manifestations presented by patients with cocaine intoxication. Blood levels were measured by high-performance liquid chromatography (HPLC) and the severity of clinical manifestations was assessed using the Stimulant Intoxication Score (SIS). Of the 81 patients included in the study, 77.8% were men with a mean age of 32.5 years ± 8.5 and mean of SIS 3.4 ± 2.5. From the total of patients included in the study 20 (24.7%) had positive blood results for the analytes of interest, being the mean blood concentration of cocaine equal to 0,34 µg/mL ± 0,45 and of cocaethylene equal to 0,38 µg/mL ± 0,34. The blood concentration of cocaine and cocaethylene has not been shown to be useful information for the treatment and prognosis of patients, but blood levels of these substances at the time of treatment, regardless of their concentration, may be an indicator of severity, showing that any concentrations of these substances should be considered as potentially toxic. The application of the SIS score proved to be an important alternative capable of predicting the severity of the patients attended due to cocaine intoxication in a fast and simplified way

Análise das dosagens e concentrações séricas da ciclosporina A em cães da raça Golden Retriever normais ou afetados pela distrofia muscular / Analyses of dosages and blood concentration of cyclosporin A on norrmal Golden Retriever dogs or Golden Retriever with muscular dystrophy

A distrofia muscular dos cães Golden Retriever (GRMD), uma miopatia degenerativa causada pela ausência da distrofina é geneticamente homóloga à distrofia muscular de Duchenne que acomete humanos, portanto, estes cães são considerados modelos experimentais para estudos em terapia celular. Seu sucesso depende da imunossupressão adequada. A ciclosporina A (CsA) é indicada para tal e a monitorização de suas concentrações sangüíneas e efeitos adversos são essenciais para viabilizar a terapia. Foram estudados cães GRMD, e normais da mesma raça, submetidos a terapia com CsA, associada, nos GRMD, ao transplante de células tronco. Foram avaliados as concentrações sangüíneas do fármaco através de amostras coletadas a cada dois ou três dias e analisadas pelo método do imunoensaio por fluorescência (FPIA). Como resultado observamos que as concentrações de CsA oscilaram muito, em seis dos oito animais. Concluímos que as doses variam individualmente sendo de maior importância avaliar a concentração do fármaco no sangue e sua viabilização no uso da terapia celular

The muscular dystrophy of Golden Retriever (GRMD) is a degenerative miopaty caused by the absence of dystrophy and it is genetically homologue of the Duchenne muscular dystrophy in humans, so, these dogs are considerably experimental models for studies on cellular therapy. Their successful depends of the adequate immunosuppression. Cyclosporin A (CsA) is indicated for that and the monitoring of the blood concentration and adverse effects are essential to viabilise the therapy. It was studied GRMD dogs, and normal dogs from the same breed, submitted for therapy with CsA, associated, on GRMD, of cell transplantation. It was evaluated blood concentration of the drug, between two or tree days using the method of FPIA. In our results we found that the CsA blood concentrations oscillated too much on six than eight of our animals. We concluded that the doses varieties Braz. J. vet. Res. anim. Sci., São Paulo, v. 45, n. 2, p. 131-137, 2008 individually and the correct dosage as to important as the evaluation of the blood concentration of the drug and became viable for cell therapy

Análise das dosagens e concentrações séricas da ciclosporina A em cães da raça Golden Retriever normais ou afetados pela distrofia muscular / Analyses of dosages and blood concentration of cyclosporin A on norrmal Golden Retriever dogs or Golden Retriever with muscular dystrophy

A distrofia muscular dos cães Golden Retriever (GRMD), uma miopatia degenerativa causada pela ausência da distrofina é geneticamente homóloga à distrofia muscular de Duchenne que acomete humanos, portanto, estes cães são considerados modelos experimentais para estudos em terapia celular. Seu sucesso depende da imunossupressão adequada. A ciclosporina A (CsA) é indicada para tal e a monitorização de suas concentrações sangüíneas e efeitos adversos são essenciais para viabilizar a terapia. Foram estudados cães GRMD, e normais da mesma raça, submetidos a terapia com CsA, associada, nos GRMD, ao transplante de células tronco. Foram avaliados as concentrações sangüíneas do fármaco através de amostras coletadas a cada dois ou três dias e analisadas pelo método do imunoensaio por fluorescência (FPIA). Como resultado observamos que as concentrações de CsA oscilaram muito, em seis dos oito animais. Concluímos que as doses variam individualmente sendo de maior importância avaliar a concentração do fármaco no sangue e sua viabilização no uso da terapia celular.(AU)

The muscular dystrophy of Golden Retriever (GRMD) is a degenerative miopaty caused by the absence of dystrophy and it is genetically homologue of the Duchenne muscular dystrophy in humans, so, these dogs are considerably experimental models for studies on cellular therapy. Their successful depends of the adequate immunosuppression. Cyclosporin A (CsA) is indicated for that and the monitoring of the blood concentration and adverse effects are essential to viabilise the therapy. It was studied GRMD dogs, and normal dogs from the same breed, submitted for therapy with CsA, associated, on GRMD, of cell transplantation. It was evaluated blood concentration of the drug, between two or tree days using the method of FPIA. In our results we found that the CsA blood concentrations oscillated too much on six than eight of our animals. We concluded that the doses varieties Braz. J. vet. Res. anim. Sci., São Paulo, v. 45, n. 2, p. 131-137, 2008 individually and the correct dosage as to important as the evaluation of the blood concentration of the drug and became viable for cell therapy.(AU)