Evaluation of the Cockroft-Gault, Jelliffe and Wright formulae in estimating renal function in elderly cancer patients.

BACKGROUND: More elderly patients are being treated with chemotherapy. Reliable and accurate measures of renal function are needed to obtain predictable, safe and effective exposure to renally excreted drugs. The Jelliffe, Cockroft-Gault and Wright formulae have been used to evaluate renal function, although they have not been validated in elderly oncology patients. We performed a retrospective evaluation of these formulae using the [51Cr]-ethylenediamine tetraacetic acid ([51Cr]-EDTA) method of measuring glomerular filtration rate (GFR) as the 'gold standard'. PATIENTS AND METHODS: Inclusion criteria were age > or = 70 years and serum creatinine <250 micromol/l, performed within 4 weeks of glomerular filtration rate (GFR) measurement. Creatinine clearance was calculated using the Cockroft-Gault, Jelliffe and Wright formulae. The precision and accuracy of the three formulae were compared with the gold standard. RESULTS: Two hundred and twenty-five patients were evaluated: median age, 74 years (range 70-89); males, 108; females, 117; median creatinine, 84 micromol/l (range 44-186). Correlation coefficients of the Jelliffe, Cockroft-Gault and Wright formulae were similar. In the specific GFR ranges of 50-70, 70-90 and 90-120 ml/min, the bias [mean percentage error (MPE)] was +8%, -4% and -13%, respectively. The degree of bias was greater with the Cockroft-Gault and Jelliffe formulae across the same range of GFR with the MPE being -15%, -25%, -32% and -12%, -19% and -23%, respectively. All three formulae have reduced precision and greater bias at the extremes of GFR. CONCLUSIONS: The Wright formula is the most accurate, precise and least biased formula for the calculation of GFR in elderly patients with a GFR >50 ml/min. These results allow the physician to make a decision regarding the use of the formula based on an expected degree of bias.     

滇丹参的生药学研究

滇丹参为云南地区习用药材，来源于Salvia yunnanensis C.H.Wright的干燥根及根茎。对其植物来源，药材性状，显微及理化特征作了研究，为滇丹参药材的鉴别及药材质量标准的规范化研究提供了科学依据。     

Characterization of differentiation-inducer-resistant HL-60 cells

Sub-lines of the cultured human promyelocytic leukemia cell line HL-60 were individually selected for their ability to sustain exponential growth in the presence of 3 structurally-unrelated inducers of granulocytic differentiation - retinoic acid (RA), dimethylsulfoxide (DMSO), and 6-thioguanine (6TG). Selections were made by step-wise augmentation to final drug concentrations of 10(-3)mM RA, 169mM (1.2%) DMSO and 0.12mM (20 micrograms ml-1) 6TG. In addition to growth resistance, cells in each sub-line displayed variable cytodifferentiation resistance to each of the 3 selective agents, which was quantitated as the ratio of the concentration of drug required to induce differentiation in 50% of the cells in each resistant sub-line versus comparably-passaged wild-type HL-60 cells. The levels of resistance/cross-resistance were as follows: RA-resistant (res) sub-line greater than 2700-fold to RA, 1.3-fold to DMSO and greater than 1.5-fold to hypoxanthine (HXN; the noncytotoxic purine base inducer analogue of 6TG); DMSO-res sub-line 2.5-fold to DMSO, 137-fold to RA and greater than 1.5-fold to HXN; and 6TG-res sub-line greater than 1.5-fold to HXN, 9-fold to RA and 1.6-fold to DMSO. These sub-lines were not cross-resistant to sodium butyrate (NaBut), a monocyte inducer, or to 12-0-tetradecanoylphorbol 13-acetate (TPA), a macrophage inducer. HL-60 sub-lines selected by exposure to a single high concentration of 5-bromo-2'-deoxyuridine (BUdR; 3.3 X 10(-2)mM) or oubain (Ou; 5 X 10(-3)mM) were not or were slightly cross-resistant to either granulocyte or monocyte inducers. Although some variations in line/sub-line phenotype were observed, this was minor compared to the quantitative variations in response to individual inducing agents. The RA-res and 6TG-res sub-lines contained numerous double minute chromosomes (indicators of amplified genes) which were either absent or present in much smaller numbers in the parental wild-type cells or in the other drug-resistant sub-lines. There was little change or a decrease in the amplification level of the known amplified oncogene c-myc in the various drug-resistant sub-lines compared to wild-type HL-60 cells. These results (a) confirm that the neutrophilic granulocytic and monocytic/macrophagic differentiation programs in HL-60 cells are mechanistically different and separable; (b) suggest that both agent-specific and common quantitative alterations contribute to the mechanism(s) for resistance to granulocyte differentiation; and (c) suggest that the latter quantitative defects could be related to amplification of genes other than c-myc.     

盾叶薯蓣三倍体自然变异类型的发现及其主要经济性状评价

目的对盾叶薯蓣三倍体自然变异类型主要经济性状进行评价,为盾叶薯蓣三倍体新品系选育奠定基础。方法对云南各地区收集盾叶薯蓣进行倍性鉴定。对鉴定获得的三倍体株系的单株产量、增殖率、薯蓣皂苷元的量等经济性状进行评价。结果在收集的盾叶薯蓣资源中发现5个三倍体;盾叶薯蓣三倍体株系间性状均表现较大差异,单株产量1090.00～628.57g,增殖率(倍)72.43～29.43,干物质质量分数36.95%～24.06%,薯蓣皂苷元质量分数4.40%～1.50%,株系1和株系3产量超过1000g,株系2薯蓣皂苷元质量分数达到4.40%,株系3在单株产量、增殖率、薯蓣皂苷元的量等性状均表现优异,综合指标数值最高。结论通过盾叶薯蓣三倍体自然变异类型发现和株系性状评价,获得表现优良的三倍体株系,通过后代进一步评价有望选育出盾叶薯蓣三倍体新品系。     

聚氧乙烯-马来酸酐聚合物改性纤维素酶催化酸水解盾叶薯蓣薯蓣皂苷元的研究

目的提高纤维素酶在催化过程中的稳定性，并考察聚氧乙烯-马来酸酐聚合物改性纤维素酶在盾叶薯蓣薯蓣皂苷转化为薯蓣皂苷元过程中的可行性。方法采用聚氧乙烯-马来酸酐共聚物对纤维素酶进行化学改性，并以相对酶活考察改性酶的稳定性。以薯蓣皂苷元的提取率和熔点为指标，比较了纤维素酶和改性酶的辅助催化作用。对改性酶催化所得薯蓣皂苷元产品进行元素分析和HPLC分析。结果改性酶在高温下的活力衰减速率减小，在50℃pH4．8的醋酸-醋酸钠缓冲溶液中放置100min，保持了初始酶活的69．4％。改性酶辅助催化盾叶薯蓣中薯蓣皂苷的转化时，较未改性酶的效果好，所得薯蓣皂苷元产品提取率为97．6％以上，为白色或乳白色，熔点为200-203℃，元素分析结果为H：77．96％，O：10．11％，HPLC法测定的质量分数高达96．03％。结论聚氧乙烯-马来酸酐聚合物改性纤维素酶在较高温度下能够保持较高的催化活性，可以更有效地促进盾叶薯蓣薯蓣皂苷向薯蓣皂苷元的转化．     

氮磷钾对盾叶薯蓣产量及薯蓣皂苷元含量的影响

目的:研究大田条件下N、P、K肥料不同配比对盾叶薯蓣根茎产量及薯蓣皂苷元含量的影响.方法:采用肥料单因素正交试验,SPSS11.5统计软件包统计分析.结果:N、P、K可不同程度提高盾叶薯蓣根茎产量及薯蓣皂苷元含量,其中N、K对产量影响达到极显著水平(P＜0.01),P肥达到显著水平(P＜0.05),N、P、K单施对含量影响未达到显著水平(P＞0.05);3种肥料配施以N肥对薯蓣皂苷元含量影响达到显著水平(P＜0.05).表明肥料对薯蓣皂苷元含量影响的顺序为N＞K＞P,对根茎产量影响的顺序为K＞N＞P,综合最优组合为N2K1P2.结论:适当配比的N、P、K肥料可以同时提高盾叶薯蓣根茎产量与薯蓣皂苷元含量.     

分光光度法测定盾叶薯蓣总皂苷的含量

目的用分光光度法测定盾叶薯蓣总皂苷的含量，为其质量控制提供依据。方法用分光光度法测定，以高氯酸为显色剂，显色温度70℃，时间15min，在407nm处有最大吸收。结果薯蓣皂苷在5．22—41．76μg／ml范围内呈良好的线性关系。精密度与回收率的RSD分别为1．9％和1，4％。方法学考察各项指标均符合要求。结论此法操作简便、准确、稳定性、重现性好。     

HPLC指纹图谱鉴别滇黄芩与黄芩

目的:建立高效液相色谱指纹图谱,鉴别不同产地的滇黄芩与《中国药典》收录的黄芩。方法:采用反相高效液相色谱(RP-HPLC)法,色谱柱为Zorbax SB-C18(250mm×4.6mm,5μm),流动相为乙腈(含1.0%甲酸)-水(含1.0%甲酸),梯度洗脱,流速为1.0mL.min-1,检测波长为274nm,柱温为30℃。结果:不同产地的滇黄芩指纹图谱相似度较好,不同产地的黄芩之间指纹图谱相似度也较好;但滇黄芩与黄芩的相似度仅为0.859,存在较大差异。结论:本方法为深入研究滇黄芩与黄芩的质量标准打下了基础。     

Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain

Chronic pain is common, costly, and challenging to treat. Many individuals with chronic pain have turned to cannabis as an alternative form of pain management. We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use. We also examined whether and how these parameters were affected by concomitant recreational use, and duration of use (novice: <1 year vs experienced: ≥1 year). There were 1,321 participants (59% female, 54% ≥50 years old) who completed the survey. Consistent with other observational studies, approximately 80% reported substituting cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines), citing fewer side effects and better symptom management as their rationale for doing so. Medical-only users were older (52 vs 47 years old; P < .0001), less likely to drink alcohol (66% vs 79%, P < .0001), and more likely to be currently taking opioids (21% vs 11%, P < .0001) than users with a combined recreational and medical history. Compared with novice users, experienced users were more likely to be male (64% vs 58%; P < .0001), take no concomitant pain medications (43% vs 30%), and report improved health (74% vs 67%; P = .004) with use. Given that chronic pain is the most common reason for obtaining a medical cannabis license, these results highlight clinically important differences among the changing population of medical cannabis users. More research is needed to better understand effective pain management regimens for medical cannabis users.Perspective: This article presents results that confirm previous clinical studies suggesting that cannabis may be an effective analgesic and potential opioid substitute. Participants reported improved pain, health, and fewer side effects as rationale for substituting. This article highlights how use duration and intentions for use affect reported treatment and substitution effects.