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PubMed2003

Two-stage testing of safety: a statistical view.

Sample sizes given in regulatory guidelines are not based on statistical reasoning. However, from an ethical, scientific, and regulatory point of view, a mutagenicity experiment must have a reasonable chance of supporting the decision as to whether a result is negative or positive. Consequently, the sample size should be based on type I and type II errors, the underlying variability, and the specific size of a treatment effect. A two-stage adaptive interim analysis is presented, which permits an adaptive choice of sample size after an interim analysis of the data from the first stage. Because the sample size of the first stage is considered to be a minimum requirement, this stage can also be regarded as a pilot study.

Animal Testing Alternatives↗
PubMedDate not supplied

[Impact of the relatives of the critical patient. In light of a protocolized reception].

OBJECTIVE: Know the degree of satisfaction and the level of information that the family members have after a protocolized reception (it includes the creation of informative guide). MATERIAL AND METHOD: We conducted an observational and descriptive prospective study about the relatives of the patients in hospital to ICU during a year. We utilized a sampling technique by desirability. We distributed 120 questionnaires, there were fulfilled 70. The variables studied were: level of information and value for the relative of the guide, and degree of satisfaction concerning the type of reception, confidence felt and feeling of integration and safety. RESULTS: The sample studied was of 70 family members with an average age of 51 years (16.23), the majority they were husband/wife (50%) or sons (31.4%). Hundred per cent of the family members perceive feelings in the moment of the hospitalisation that are manifested through severity (32%), distress (21%), fear (19%), and others. The results of the variables with regard to the protocol of reception and the information showed that 93% of the family members were received by the nurse, and 41% recalls that the nurse was presented by her name. Eighty-seven per cent received the informative guide and 3% did not recall it. With regard to the informative guide 76% manifested the need for the existence of a guide and 86% considered that it provides enough information. The results of the variables with regard to the satisfaction were measured with a scale from 1 to 10 utilizing the median value as instrument of analysis, obtaining a median of 9 in all the questions referred to: feeling of reception, confidence, information, value of the information facilitated by the nurse and feeling of integration in the process that the patient experiences. CONCLUSIONS: The degree of satisfaction it is high after a protocolized reception. It is deduced that the information that is provided through the informative guide responds to the needs of the family members which feel implied and express a feeling of security.

Access to Information↗
PubMed2002

Transcervical chorionic villus sampling in multiple pregnancies using a biopsy forceps.

OBJECTIVE: The aim of this study was to assess the effectiveness and safety of chorionic villus sampling (CVS) performed in multiple pregnancies by means of a transcervical biopsy forceps. METHODS: The study included CVS performed from January 1990 to March 2000 in our Unit. The results were analysed in two consecutive periods, period A (1990-1994) and period B (1995-2000), in an attempt to assess the effect of increasing experience. RESULTS: Seventy-five samplings were performed in 39 multiple pregnancies, 38 twin sets and one triplet. A cytogenetic report was obtained in 73% of cases in period A and in 98% in period B. An abnormal karyotype was observed in 11 samples. The need for subsequent amniocentesis decreased from 38% in period A to 10% in period B. The spontaneous fetal loss rate in chromosomally and structurally normal fetuses before the 20th week decreased from 8.7% in period A to 3.3% in period B. The fetal loss rate after the 20th week was 3.3% in period B and none in period A. It must be noted that in three out of the four cases of fetal loss an amniocentesis was needed after CVS. CONCLUSION: Our results suggest that effectiveness and safety improved with increasing experience. Transcervical chorionic villus sampling allows an earlier prenatal genetic diagnosis in multiple pregnancies and this may be particularly relevant for a safer selective termination when chosen by parents if one of the fetuses has an abnormal karyotype.

Abortion, Spontaneous↗
PubMedDate not supplied

Transjugular liver biopsy: modified Ross transseptal needle versus quick-core biopsy needle.

BACKGROUND: We evaluated the differences in sample adequacy and safety between a transseptal needle and Quick-core biopsy needle for transjugular liver biopsy. METHODS: Eighteen consecutive patients who had a bleeding diatheses and/or ascites underwent transjugular liver biopsy using a transseptal needle (11 patients) and Quick-core biopsy needle (seven patients). The length of the specimens was measured before fixation. A pathologist reviewed histologic slides for sample adequacy and pathologic diagnoses. Clinical records were reviewed for complication. RESULTS: In all patients, liver biopsy was successful. A total of 45 specimens were obtained, with an average of 2.5 passes per patient. The length of specimen was significantly longer with the Quick-core biopsy needle than with the transseptal needle (p<0.05). Biopsied tissue was fragmented in 17 of 25 specimens with the transseptal needle but not fragmented in any specimen with the Quick-core biopsy needle. All specimens were determined to be adequate except one with the transseptal needle. There was no early or delayed complication in any patient. CONCLUSION: Transjugular liver biopsy is a safe and effective procedure without any significant difference in complication and adequacy when using a transseptal needle or Quick-core biopsy needle. Larger specimens can be obtained without tissue fragmentation with the Quick-core biopsy needle.

Adolescent↗
PubMedDate not supplied

Ultraviolet radiation and safety behaviours at an outdoor community event.

The incidence of skin cancer is rising drastically and is believed to be at epidemic proportions. Although preventive efforts have focused mainly on increasing public knowledge of the dangers associated with ultraviolet radiation, increased knowledge does not consistently translate into safe sun practices. The present study provided a "snapshot" of knowledge, attitudes and actual behaviour related to sun safety in a sample of 2,064 individuals attending a major community event. Despite almost uniform acknowledgement of a sun-cancer link, and the belief that certain behaviours can reduce the chances of getting skin cancer, only 38% of respondents reported wearing sun screen. Differences in sun safe behaviours were observed across age groups. The present results emphasize the need to target behaviours as well as knowledge and attitudes regarding sun safety.

Attitude to Health↗
PubMed2004

Randomized, open-label, two-period crossover comparison of the pharmacokinetic and pharmacodynamic properties of two amlodipine formulations in healthy adult male Korean subjects.

BACKGROUND: Amlodipine, a third-generation dihydropyridine calcium antagonist, is prescribed in the management of angina and hypertension. A newly developed amlodipine formulation (amlodipine camsylate) is associated with similar physical properties, melting point, and solubility-and improved stability against long-term stability test and accelerated temperature test-compared with the conventional formulation (amlodipine besylate). OBJECTIVE: This study was performed to compare the pharmacokinetic (PK) and pharmacodynamic (PD) properties and safety profiles of a newly developed amlodipine formulation with a conventional formulation in healthy male subjects. METHODS: This randomized, open-label, 2-period crossover comparative study was conducted at the Clinical Trial Center, Gil Medical Center, Gachon Medical School (Incheon, Korea). Eighteen healthy male Korean subjects aged 20 to 40 years were enrolled. All subjects received a single oral dose (5-mg tablet) of a conventional (reference) or newly developed (test) amlodipine formulation. Blood samples for PK analysis of amlodipine were obtained during the 144-hour period after dosing. Systolic and diastolic blood pressure (BP) (SBP and DBP, respectively) and pulse rate (PR) were measured just before each blood sampling. Assessment of safety profiles, including hematology and biochemistry, electrocardiography, urinalysis, and monitoring of adverse events (AEs), was performed. RESULTS: All participants completed both treatment periods. Their mean (SD) age was 22.3 (1.5) years (range, 20-25 years) and their mean (SD) body weight was 67.9 (5.6) kg (range, 57-77 kg). The plasma concentration-time profiles of amlodipine were similar after administration of the 2 formulations. The reference and test formulations were pharmacokinetically equivalent. The 90% CIs for the mean treatment ratios of the log-transformed peak plasma concentration and the area under the plasma concentration-time curve were within the predetermined equivalence range of 80% to 125%. Despite administration of a single dose, significant maximal changes in SBP, DBP, and PR were achieved after drug administration for both formulations compared with baseline values (all, P < 0.001). No significant differences in PD profiles were found between the 2 formulations. No clinically relevant changes were observed in physical, biochemical, hematologic, electrocardiographic, or urinalysis findings during the study. Neither formulation caused any AEs during the study. CONCLUSIONS: The 2 amlodipine formulations were pharmacokinetically equivalent and showed similar PD characteristics in these healthy male subjects.

Adult↗
PubMed2006

An extended terminal half-life for darbepoetin alfa: results from a single-dose pharmacokinetic study in patients with chronic kidney disease not receiving dialysis.

BACKGROUND AND OBJECTIVE: Anaemia is a major and persistent manifestation of chronic kidney disease (CKD) caused by the deficient production of erythropoietin in the kidneys, the prevalence of which is proportional to the deterioration in kidney function. Darbepoetin alfa, an erythropoiesis-stimulating protein, exhibits a lower clearance and longer terminal half-life in serum than recombinant human erythropoietin, thereby allowing for a reduced dosing frequency. A recent study in patients with CKD, using a 4-week sampling period, suggested that the terminal half-life of darbepoetin alfa in serum is longer than that reported in previous studies, which were based on a 1-week sampling period. This study was conducted to characterise the pharmacokinetic profile of a single subcutaneous dose of darbepoetin alfa 1 microg/kg in patients with CKD, using a sampling duration of 4 weeks, which was hypothesised to allow better characterisation of the terminal half-life in serum. METHODS: Twenty patients with CKD not on dialysis, with a calculated glomerular filtration rate of 20-60 mL/min and who had not been treated with erythropoietic agents in the previous 12 weeks, were enrolled into this single-dose, open-label study. Patients received a single subcutaneous dose of darbepoetin alfa (Aranesp) 1 microg/kg on day 1, and blood samples were collected for pharmacokinetic analyses predose, 6 and 12 hours postdose and up to 28 days postdose. Seroreactivity sampling and further safety laboratory tests (clinical chemistry and urinalysis) were also performed. Patients were assessed for adverse events at each study visit. The primary endpoint was characterisation of the terminal half-life following a single subcutaneous dose of darbepoetin alfa 1 microg/kg. RESULTS: The mean terminal half-life in serum of darbepoetin alfa was determined to be 69.6 hours. Peak serum concentrations were reached in a median time of 36 hours postdose, and a mean apparent clearance of 3.51 mL/h/kg was comparable to that observed previously in this patient population. CONCLUSION: Based on an extended sampling schedule of 4 weeks, the terminal half-life of darbepoetin alfa was approximately 70 hours. This is longer than the 48.8 hours reported previously in patients with CKD on dialysis. These data suggest that the pharmacokinetic properties of darbepoetin alfa make this erythropoietic agent well suited to an extended dosing regimen.

Adult↗
PubMed2005

Molecular epidemiology biomarkers--sample collection and processing considerations.

Biomarker studies require processing and storage of numerous biological samples with the goals of obtaining a large amount of information and minimizing future research costs. An efficient study design includes provisions for processing of the original samples, such as cryopreservation, DNA isolation, and preparation of specimens for exposure assessment. Use of standard, two-dimensional and nanobarcodes and customized electronic databases assure efficient management of large sample collections and tracking results of data analyses. Standard operating procedures and quality control plans help to protect sample quality and to assure validity of the biomarker data. Specific state, federal and international regulations are in place regarding research with human samples, governing areas including custody, safety of handling, and transport of human samples. Appropriate informed consent must be obtained from the study subjects prior to sample collection and confidentiality of results maintained. Finally, examples of three biorepositories of different scale (European Cancer Study, National Cancer Institute and School of Public Health Biorepository, University of California, Berkeley) are used to illustrate challenges faced by investigators and the ways to overcome them. New software and biorepository technologies are being developed by many companies that will help to bring biological banking to a new level required by molecular epidemiology of the 21st century.

Automation↗
PubMed2003

Biological sample collection and processing for molecular epidemiological studies.

Molecular epidemiology uses biomarkers and advanced technology to refine the investigation of the relationship between environmental exposures and diseases in humans. It requires careful handling and storage of precious biological samples with the goals of obtaining a large amount of information from limited samples, and minimizing future research costs by use of banked samples. Many factors, such as tissue type, time of collection, containers used, preservatives and other additives, transport means and length of transit time, affect the quality of the samples and the stability of biomarkers and must be considered at the initial collection stage. An efficient study design includes provisions for further processing of the original samples, such as cryopreservation of isolated cells, purification of DNA and RNA, and preparation of specimens for cytogenetic, immunological and biochemical analyses. Given the multiple uses of the samples in molecular epidemiology studies, appropriate informed consent must be obtained from the study subjects prior to sample collection. Use of barcoding and electronic databases allow more efficient management of large sample banks. Development of standard operating procedures and quality control plans is a safeguard of the samples' quality and of the validity of the analyses results. Finally, specific state, federal and international regulations are in place regarding research with human samples, governing areas including custody, safety of handling, and transport of human samples, as well as communication of study results.Here, we focus on the factors affecting the quality and the potential future use of biological samples and some of the provisions that must be made during collection, processing, and storage of samples, based on our experience in the Superfund Basic Research Program and Children's Environmental Health Center, at the University of California, Berkeley.

Humans↗
PubMed1990

Implications of sampling the implantation site in the endometrial biopsy for infertility.

Endometrial sampling performed during the cycle of conception occurs uncommonly. Less frequent is inclusion of the implantation site in an endometrial specimen obtained late in the luteal phase during the course of an infertility evaluation. From 1984 to 1987 the implantation site was sampled in 3 of 520 (0.6%) endometrial biopsies for infertility. In each instance the pregnancy did not continue. Two women conceived again within a year; both delivered term infants. The third woman had not conceived after ten months of follow-up. When an infertility biopsy results in a diagnosis of intrauterine pregnancy, further evaluation of the patient should be determined by the clinical situation: even in couples with extremely compromised fertility the woman occasionally will become pregnant. The prognosis for that pregnancy may be poor; however, the prognosis for subsequently conceiving and carrying a pregnancy to term is encouraging. This study demonstrated the relative safety of endometrial sampling in the infertile woman. The use of barrier contraception during the cycle of sampling can further decrease the chance of interrupting an intrauterine pregnancy.

Abortion, Induced↗
PubMed1981

The possibility of prenatal diagnosis by gene dosage: confirmation of duplication 10q24 to qter from GOT-1 activity in fetal erythrocytes.

The activity of four enzymes, including GOT-1, has been investigated in he erythrocytes of a 10q to 24 qter trisomic fetus. Analyses have been performed on a feto-maternal blood mixture sampled by fetoscopy and on red cells obtained by cardiac puncture, following therapeutic abortion. The demonstration of a 40 per cent increase of GOT-1 activity, as compared to normal fetuses of similar gestational age, suggests that gene dosage studies may be a useful confirmatory technique in prenatal diagnosis of unbalanced chromosomal aberrations. Practical application of a similar diagnostic approach is conditioned by (1) precise characterization of fetal chromosome imbalance; (2) confirmed assignment of the gene locus coding for the gene product under investigation; (3) evidence of a linear proportionality between gene dose and concentration of the gene product in patients with the same chromosome imbalance detected in the fetus; (4) knowledge of the range of normal variation at different weeks of gestation of the enzyme activity to be tested in the fetus; (5) safety of fetal sampling procedure.

Adult↗
PubMed2005

131I in blood samples: a danger for professionals? A problem for immunoassays?

OBJECTIVE: Our objective was to investigate the safety of radioactive blood samples from patients receiving 131I and whether the radioactivity affects the validity of assays. METHODS: First, the activity of samples from patients given 131I was measured by 3 methods and compared with the upper threshold. Then, pilot sera were spiked with 131I, and possible interference was investigated using 2 immunoradiometric assays. RESULTS: The activity of 13 of the 15 samples was below the European limit; the other 2 samples were from patients with reduced renal clearance rates. No differences in thyroglobulin level or thyroid-stimulating hormone level were found between sera that were spiked with 131I and sera that were not. CONCLUSION: These blood samples are safe because they contain negligible activity, and the use of radioimmunoassays or immunoradiometric assays on them produces reliable results.

Artifacts↗
PubMed1999

The Angio-Seal hemostatic puncture closure device. Concept and experimental results.

The Angio-Seal hemostatic puncture closure device is the culmination of development efforts dating from 1986. Development was driven to solve problems of delivering a multi-piece bioabsorbable puncture closure assembly through an introducer, the precise placement of the device in the vessel, the mastery of molding tiny absorbable polymer components, the manufacture of collagen hemostatic sponges having strong tear strength, and the testing of very large samples to establish safety and efficacy. Improvements included in the new 6F device to improve deployment reliability are also discussed.

Animals↗
PubMed2025

A Single-Arm Phase 2 Study of Sotorasib Plus Carboplatin and Pemetrexed in Patients With Advanced Nonsquamous NSCLC With KRAS G12C Mutation (WJOG14821L, SCARLET).

INTRODUCTION: The efficacy and safety of sotorasib plus platinum doublet chemotherapy in KRAS G12C-mutated nonsquamous NSCLC (nonsq NSCLC) have been previously reported with a limited follow-up period. METHODS: SCARLET is a single-arm phase 2 study involving chemotherapy-naive patients with KRAS G12C-mutated nonsq NSCLC. The participants received 960 mg daily plus four cycles of carboplatin (area under the curve = 5)/pemetrexed 500 mg/m2, followed by sotorasib/pemetrexed until disease progression. The primary end point was the overall response rate (ORR) and the secondary end points were progression-free survival (PFS), overall survival, and safety. Using plasma samples, next-generation sequencing was performed at baseline, 3 weeks, and during disease progression (the Japan Registry of Clinical Trials number 2051210086). RESULTS: Thirty patients were enrolled between October 2021 and July 2022 with a median follow-up of 14.8 months. ORR was 88.9% (80% confidence interval [CI]: 78.5%-94.8%, 95% CI: 70.8%-97.6%), median PFS was 6.6 months (95% CI: 5.3-16.7 mo), and median overall survival was 20.6 months (95% CI: 8.1 mo-not estimated). Among patients with programmed death-ligand 1 expression levels of 1% or higher and less than 1%, the ORRs were 82.3 and 100%, respectively, and the median PFS was 7.6 and 9.7 months, respectively. Using plasma samples, patients without KRAS G12C at baseline, without KRAS-related pathway co-alterations, or who cleared KRAS G12C at 3 weeks had better median PFS (16.7, 13.9, 8.7 mo, respectively). Tumor protein 53 mutations and EGFR and MET amplification were detected as acquired resistance. CONCLUSIONS: In patients with KRAS G12C-mutated nonsq NSCLC, sotorasib plus carboplatin/pemetrexed reported favorable efficacy, particularly for patients with less than 1% programmed death-ligand 1, with manageable toxicity.

Humans↗
PubMed2000

Alpha-anomer-selective glucosylation of menthol with high yield through a crystal accumulation reaction using lyophilized cells of Xanthomonas campestris WU-9701.

L-Menthyl alpha-D-glucopyranoside (alpha-MenG) is a desirable derivative of L-menthol with useful properties for the production of new flavors and novel food additives. Bacteria were screened for alpha-anomer-selective glucosylation activity toward l-menthol, resulting in the isolation of two strains, Xanthomonas campestris WU-9701 and Stenotrophomonas maltophilia WU-9702, from independent soil samples. Since the safety of X. campestris for use in the food industry is well established, WU-9701 was selected as the more suitable strain for further study. When 50 mg X. campestris WU-9701 lyophilized cells as a biocatalyst were incubated with 1.0 M maltose and 100 mg L-menthol in 10 ml of 10 mM H3BO3NaOHKCl buffer (pH 8.0) at 40 degrees C, alpha-MenG was accumulated, mainly in a crystalline form, through the anomer-selective synthesis reaction without any by-product formation. Under the optimal conditions, 202 mg alpha-MenG was obtained over 48 h with a highest conversion yield of 99.1% based on the supplied L-menthol. Crude alpha-MenG formed through this "crystal accumulation reaction" was easily collected from the reaction mixture by separation on filter paper. Plank-like crystals of purified alpha-MenG were subsequently obtained by recrystallization in ethyl acetate solution.

Journal Article↗
PubMed1997

Direct on-filter immunoassay of some beta-lactam antibiotics for rapid analysis of drug captured from the workplace atmosphere.

A simple competitive enzyme-linked immunoassay for the antibiotic ceftazidime and structurally similar beta-lactam antibiotics has been developed which can be performed directly on the surface of a cellulose nitrate filter used to capture the airborne drug during workplace monitoring for health and safety purposes. Post sampling analysis is performed on the filter retained within the air sampler. It involves two steps; the first a 10 min incubation in which the captured drug is dissolved and competes with drug immobilised within a protein conjugate on the surface of the filter for an enzyme-labelled antibody reagent, and the second, following washing under vacuum in situ, a 5 min incubation of substrate solution when colour develops on the spot at the location of the immobilised drug-protein conjugate. The intensity of the spot can be assessed visually within the sampler to ascertain the presence or absence of captured drug, or quantitative results can be obtained using an optical scanner. The intensity of the spots in linear from 10 ng to 1 microgram (r2 = 0.9996, n = 3) and the limit of detection is 1.9 ng of captured drug (10 ng for visual discrimination between this standard and the zero). The assay is precise with between-assay RSD values of < 4% over the linear range of the assay.

Air Pollutants, Occupational↗
PubMed2006

Analysis of gaseous toxic industrial compounds and chemical warfare agent simulants by atmospheric pressure ionization mass spectrometry.

The suitability of atmospheric pressure chemical ionization mass spectrometry as sensing instrumentation for the real-time monitoring of low levels of toxic compounds is assessed, especially with respect to public safety applications. Gaseous samples of nine toxic industrial compounds, NH3, H2S, Cl2, CS2, SO2, C2H4O, HBr, C6H6 and AsH3, and two chemical warfare agent simulants, dimethyl methylphosphonate (DMMP) and methyl salicylate (MeS), were studied. API-MS proves highly suited to this application, with speedy analysis times (<30 seconds), high sensitivity, high selectivity towards analytes, good precision, dynamic range and accuracy. Tandem MS methods were implemented in selected cases for improved selectivity, sensitivity, and limits of detection. Limits of detection in the parts-per-billion and parts-per-trillion range were achieved for this set of analytes. In all cases detection limits were well below the compounds' permissible exposure limits (PELs), even in the presence of added complex mixtures of alkanes. Linear responses, up to several orders of magnitude, were obtained over the concentration ranges studied (sub-ppb to ppm), with relative standard deviations less than 3%, regardless of the presence of alkane interferents. Receiver operating characteristic (ROC) curves are presented to show the performance trade-off between sensitivity, probability of correct detection, and false positive rate. A dynamic sample preparation system for the production of gas phase analyte concentrations ranging from 100 pptr to 100 ppm and capable of admixing gaseous matrix compounds and control of relative humidity and temperature is also described.

Air Pollutants↗