Sofosbuvir and ribavirin before liver re-transplantation for graft failure due to recurrent hepatitis C: a case report.

BACKGROUND: Recurrent hepatitis C virus infection after liver transplantation is associated with reduced graft and patient survival. Re-transplantation for graft failure due to recurrent hepatitis C is controversial and not performed in all centers. CASE PRESENTATION: We describe a 54-year-old patient with hepatitis C virus genotype 1b infection and a null response to pegylated interferon-α and ribavirin who developed decompensated graft cirrhosis 6 years after a first liver transplantation. Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction. Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions. Despite virological response, the patient remained severely decompensated and re-transplantation was performed after 46 days of undetectable serum HCV RNA. The patient is doing well 12 months after his second liver transplantation and remains free of hepatitis C virus. CONCLUSIONS: The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.

Re-writing and Its Pedagogical Value: A Case Study

Tenint en compte el temps i la energia que els mestres i professors dediquen a la correcció de redaccions i produccions escrites i el poc efecte que aquestes semblen tenir en altres produccions dels aprenents, es va dissenyar la recerca que es presenta en aquest article. Els resultats de l'estudi semblen suggerir que les correccions no faciliten l'aprenentatge. Com presentem aquesta activitat de retroalimentació a l'alumnat i la posició que li donem dins d'un enfocament basat en el procés de l'escriptura seran clau per fer que les correccions siguin facilitadores de l'aprenentatge de la producció escrita.

Use of the dried blood spot sampling process coupled with fast gas chromatography and negative-ion chemical ionization tandem mass spectrometry: application to fluoxetine, norfluoxetine, reboxetine, and paroxetine analysis.

The objective of this work was to combine the advantages of the dried blood spot (DBS) sampling process with the highly sensitive and selective negative-ion chemical ionization tandem mass spectrometry (NICI-MS-MS) to analyze for recent antidepressants including fluoxetine, norfluoxetine, reboxetine, and paroxetine from micro whole blood samples (i.e., 10 microL). Before analysis, DBS samples were punched out, and antidepressants were simultaneously extracted and derivatized in a single step by use of pentafluoropropionic acid anhydride and 0.02% triethylamine in butyl chloride for 30 min at 60 degrees C under ultrasonication. Derivatives were then separated on a gas chromatograph coupled with a triple-quadrupole mass spectrometer operating in negative selected reaction monitoring mode for a total run time of 5 min. To establish the validity of the method, trueness, precision, and selectivity were determined on the basis of the guidelines of the "Société Française des Sciences et des Techniques Pharmaceutiques" (SFSTP). The assay was found to be linear in the concentration ranges 1 to 500 ng mL(-1) for fluoxetine and norfluoxetine and 20 to 500 ng mL(-1) for reboxetine and paroxetine. Despite the small sampling volume, the limit of detection was estimated at 20 pg mL(-1) for all the analytes. The stability of DBS was also evaluated at -20 degrees C, 4 degrees C, 25 degrees C, and 40 degrees C for up to 30 days. Furthermore, the method was successfully applied to a pharmacokinetic investigation performed on a healthy volunteer after oral administration of a single 40-mg dose of fluoxetine. Thus, this validated DBS method combines an extractive-derivative single step with a fast and sensitive GC-NICI-MS-MS technique. Using microliter blood samples, this procedure offers a patient-friendly tool in many biomedical fields such as checking treatment adherence, therapeutic drug monitoring, toxicological analyses, or pharmacokinetic studies.

Trace element monitoring in the ICU: quality and economic impact of a change in sampling practice.

BACKGROUND & AIMS: Trace elements (TE) are involved in the immune and antioxidant defences which are of particular importance during critical illness. Determining plasma TE levels is costly. The present quality control study aimed at assessing the economic impact of a computer reminded blood sampling versus a risk guided on-demand monitoring of plasma concentrations of selenium, copper, and zinc. METHODS: Retrospective analysis of 2 cohorts of patients admitted during 6 months periods in 2006 and 2009 to the ICU of a University hospital. INCLUSION CRITERIA: to receive intravenous micronutrient supplements and/or to have a TE sampling during ICU stay. The TE samplings were triggered by computerized reminder in 2006 versus guided by nutritionists in 2009. RESULTS: During the 2 periods 636 patients met the inclusion criteria out of 2406 consecutive admissions, representing 29.7% and 24.9% respectively of the periods' admissions. The 2009 patients had higher SAPS2 scores (p = 0.02) and lower BMI compared to 2006 (p = 0.007). The number of laboratory determinations was drastically reduced in 2009, particularly during the first week, despite the higher severity of the cohort, resulting in à 55% cost reduction. CONCLUSIONS: The monitoring of TE concentrations guided by a nutritionist resulted in a reduction of the sampling frequency, and targeting on the sickest high risk patients, requiring a nutritional prescription adaptation. This control leads to cost reduction compared to an automated sampling prescription.

Re-examination of Customer Satisfaction Measurement Results

Asiakastyytyväisyys on läheisesti yhteydessä yrityksen taloudelliseen menestykseen ja yrityksen yleisen laadun määrittämiseen. Asiakastyytyväisyyden mittaamista vaaditaan tällä hetkellä myös ISO 9001 laatujärjestelmästandardissa. Tämän vuoksi tarve tutkia ja mitata asiakastyytyväisyyttä on kasvanut yritysten ja yhteisöjen joukossa. Kokonaisvaltainen asiakastyytyväisyyden tutkiminen sisältää sekä asiakastyytyväisyyden mittaamista ja järjestelmällistä asiakaspalautteen tutkimista ja analysointia. Asiakastyytyväisyysmittaamisessa käytetään menettelytapoja ja tekniikoita, jotka ovat yleisesti käytössä markkinointitutkimuksessa. Menetelmiä on kuitenkin mukautettava, jotta ne sopivat asiakastyytyväisyyden mittaamiseksi. Asiakastyytyväisyysmittaustulosten perusanalyysit ovat helppo toteuttaa mutta tulokset voidaan helposti tulkita väärin ilman syvällisempiä tilastomatemaattisia analyysejä. Asiakastyytyväisyyden mittaaminen on helppo toteuttaa mutta tutkimussuunnitelma ja tulostenkeräysmenetelmä pitää suunnitella huolellisesti, jotta mittaustulosten luotettavuus ja validiteetti voidaan taata. Jotta asiakastyytyväisyyden tutkimisesta saataisiin maksimaalinen hyöty, pitäisi tutkimuksen myös tarkastella kuinka asiakastyytyväisyys, yrityksen sisäinen ja ulkoinen laatu sekä asiakaslojaalisuus ovat yhteydessä toisiinsa.