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Rao PS, Reed K, Modi N, Handler D, de Guex KP, Yu S, Kagan L, Reiss R, Narayanan N, Peloquin CA, Lardizabal A, Vinnard C, Thomas TA, Xie YL, Heysell SK. Isoniazid urine spectrophotometry for prediction of serum pharmacokinetics in adults with TB. IJTLD Open 2024; 1:90-95. [PMID: 38655375 PMCID: PMC11037464 DOI: 10.5588/ijtldopen.23.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Isoniazid (INH) is an important drug in many TB regimens, and unfavorable treatment outcomes can be caused by suboptimal pharmacokinetics. Dose adjustment can be personalized by measuring peak serum concentrations; however, the process involves cold-chain preservation and laboratory techniques such as liquid chromatography (LC)/mass spectrometry (MS), which are unavailable in many high-burden settings. Urine spectrophotometry could provide a low-cost alternative with simple sampling and quantification methods. METHODS We enrolled 56 adult patients on treatment for active TB. Serum was collected at 0, 1, 2, 4, 6, and 8 h for measurement of INH concentrations using validated LC-MS/MS methods. Urine was collected at 0-4, 4-8, and 8-24 h intervals, with INH concentrations measured using colorimetric methods. RESULTS The median peak serum concentration and total serum exposure over 24 h were 4.8 mg/L and 16.4 mg*hour/L, respectively. Area under the receiver operator characteristic curves for urine values predicting a subtherapeutic serum concentration (peak <3.0 mg/L) were as follows: 0-4 h interval (AUC 0.85, 95% CI 0.7-0.96), 0-8 h interval (AUC 0.85, 95% CI 0.71-0.96), and 0-24 h urine collection interval (AUC 0.84, 95% CI 0.68-0.96). CONCLUSION Urine spectrophotometry may improve feasibility of personalized dosing in high TB burden regions but requires further study of target attainment following dose adjustment based on a urine threshold.
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Affiliation(s)
- P S Rao
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - K Reed
- School of Arts and Sciences, University of Virginia, Charlottesville, VA
| | - N Modi
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - D Handler
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - K Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - S Yu
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - L Kagan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - R Reiss
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - N Narayanan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers State University of New Jersey, Newark, NJ
| | - C A Peloquin
- College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - A Lardizabal
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - C Vinnard
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - T A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
| | - Y L Xie
- Public Health Research Institute and Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ
| | - S K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA
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Monks DT, Singh PM, Kagan L, Palanisamy A. A study of the pharmacokinetics and pharmacodynamics of oxytocin at elective caesarean delivery. Anaesthesia 2023; 78:1347-1353. [PMID: 37594215 DOI: 10.1111/anae.16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
Oxytocin is widely used to prevent atonic postpartum haemorrhage after caesarean delivery. Initial treatment failure rates are high and inadequate dosing may contribute. Excessive doses, however, are associated with serious adverse effects. The pharmacokinetic data from this context are sparse and there is a lack of data in the immediate postpartum minutes after an initiating bolus. The pharmacodynamic data from this context are exclusively from dose-effect studies, with some suggesting that higher doses of oxytocin are required to provide adequate uterine tone in obese compared with non-obese women. We aimed to perform a pharmacokinetic and pharmacodynamic study that would facilitate more precise weight-based oxytocin dosing. We measured arterial oxytocin concentration, uterine tone and haemodynamic parameters in 25 women in the first 40 min after exogenous oxytocin administration at elective caesarean delivery. Serum oxytocin concentrations varied considerably between individuals. We constructed a one-compartment pharmacokinetic model of exogenous oxytocin deposition, after its administration with an initiating bolus and a maintenance infusion, at elective caesarean delivery. Body weight was evaluated as a potential covariate but was not included in the model due to lack of statistically significant reduction in the objective function. We calculated the volume of distribution and clearance (mean [coefficient of variation]) as 156.1 l [18%] and 83 ml.s-1 [32%] but found no within-individual correlation between serum oxytocin concentration and uterine tone or haemodynamic parameters. In conclusion, we observed a large variation in serum oxytocin concentrations between individuals receiving similar doses of oxytocin and were unable to establish weight-based dosing of exogenous oxytocin at caesarean delivery. Our findings suggest that future studies on oxytocin pharmacokinetics would need large sample sizes. In the absence of such data, oxytocin dosing should continue to be guided by uterine tone assessments and adjusted according to a strategy based on the best evidence from dose-effect studies.
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Affiliation(s)
- D T Monks
- Division of Obstetric Anesthesiology, Department of Anaesthesiology, Washington University School of Medicine in Saint Louis, MO, USA
| | - P M Singh
- Division of Obstetric Anesthesiology, Department of Anaesthesiology, Washington University School of Medicine in Saint Louis, MO, USA
| | - L Kagan
- Department of Pharmaceutics, Director Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - A Palanisamy
- Division of Obstetric Anesthesiology, Department of Anaesthesiology, Washington University School of Medicine in Saint Louis, MO, USA
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Brunetti L, Chapy H, Miao B, Kagan L. P232 Endogenous serum immunoglobulin levels in hospitalized patients. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Haroutiunian S, Kagan L, Yifrach-Damari I, Davidson E, Ratz Y, Hoffman A. Enhanced antinociceptive efficacy of epidural compared with i.v. methadone in a rat model of thermal nociception. Br J Anaesth 2014; 112:150-8. [DOI: 10.1093/bja/aet234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
The effects of hydraulic resistance on the burning of confined/obstacle-laden gaseous and gas-permeable solid explosives are discussed on the basis of recent research. Hydraulic resistance is found to induce a new powerful mechanism for the reaction spread (diffusion of pressure) allowing for both fast subsonic as well as supersonic propagation. Hydraulic resistance appears to be of relevance also for the multiplicity of detonation regimes as well as for the transitions from slow conductive to fast convective, choked or detonative burning. A quasi-one-dimensional Fanno-type model for premixed gas combustion in an obstructed channel open at the ignition end is discussed. It is shown that, similar to the closed-end case studied earlier, the hydraulic resistance causes a gradual precompression and preheating of the unburned gas adjacent to the advancing deflagration, which leads (after an extended induction period) to a localized autoignition that triggers an abrupt transition from deflagrative to detonative combustion. In line with the experimental observations, the ignition at the open end greatly encumbers the transition (compared with the closed-end case), and the deflagration practically does not accelerate up to the very transition point. Shchelkin's effect, that ignition at a small distance from the closed end of a tube facilitates the transition, is described.
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Affiliation(s)
- I Brailovsky
- School of Mathematical Sciences, Department of Applied Mathematics, Tel Aviv University, Tel Aviv 69978, Israel
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Kagan L, Psaros C, Alert M, Styer A, Shifren J, Park E. Improving resilience among infertile women: a pilot study. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Horwitz E, Kagan L, Avni-Magen N, Daryi D, Gati I, Hoffman A, Friedman M, Lavy E. A novel subcutaneous controlled-release amoxicillin degradable implant for extended-interval administration in veterinary medicine. J Vet Pharmacol Ther 2011; 34:494-8. [PMID: 21198679 DOI: 10.1111/j.1365-2885.2010.01256.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dosage forms of antimicrobials play a critical role in facilitating the attainment of pharmacokinetic-pharmacodynamic (PK-PD) targets as well as adherence in both veterinary and human medicine. The purpose of this study was to develop and evaluate a controlled-release subcutaneous amoxicillin implant for single-dose therapy of large ruminants such as goats, sheep, and deer. The degradable implant, designed to attain PK-PD targets following single administration, was evaluated for amoxicillin release rate and time-concentration profile. In vitro release studies demonstrated constant-rate release of approximately 40% of amoxicillin content within 96 h. In an in vivo study in goats, serving as a model for target animals, a serum concentration of approximately 0.4 mg/L was achieved within 8 h of implant insertion and maintained for >6 days. In comparison, in control goats given a standard single intramuscular amoxicillin dose of 15 mg/kg, amoxicillin peaked at 1.2 mg/L after 1 h, rapidly dropping to below detection level at 8 h. These results suggest that the proposed implant offers a unique modality for animal caregivers to conveniently administer a full antimicrobial course following a single dose of an efficient PK-PD-optimized dosage form. Furthermore, modifications of implant composition may allow for tailoring of its characteristics to various PK, PD, microbiological, and clinical requirements.
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Affiliation(s)
- E Horwitz
- Pharmaceutics Department, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
BACKGROUND The cultivation of primary keratocytes (HCKp) is difficult and influenced by a multitude of factors. In this study it was examined if immortalized keratocytes (HCKi) can replace HCKp in experiments and be useful in the development of a cornea construct. METHODS HCKp and HCKi were cultivated and incubated for 72 h with benzalkonium chloride (BAC) or cetrimide at concentrations of 40-0.1 microg/ml or 100-0.01 microg/ml. The vitality and the doubling time (tv) were measured. RESULTS Treatment with 40 or 4 microg/ml BAC as well as 100 or 10 microg/ml cetrimide led to cell death. The tv was shortened in HCKi especially in cells that were treated with BAC, but only HCKp showed a significant loss of vitality. In cells treated with cetrimide the tv increased significantly in both cell lines and no loss of vitality was detected from 0.1 microg/ml onwards in both cell lines. CONCLUSION HCKi are more resistant and proliferative than HCKp but they can be used in preliminary experiments as an alternative to primary cells in for example toxicity studies if the detectable differences between the two cell lines, such as the capacity for proliferation and reaction to agents are taken into consideration.
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Affiliation(s)
- L Kagan
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin.
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Alagiakrishnan K, Lim D, Brahim A, Wong A, Wood A, Senthilselvan A, Chimich WT, Kagan L. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J 2005; 81:463-6. [PMID: 15998824 PMCID: PMC1743300 DOI: 10.1136/pgmj.2004.028043] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the prevalence, aetiology, and treatment profile of abnormal sexual behaviour in subjects with dementia in psychogeriatric practices. METHODS A retrospective cross sectional study was conducted in a long term care psychiatry consultation service, community based geriatric psychiatry service, and an inpatient dementia behavioural unit in Edmonton, Canada. RESULTS Forty one subjects (1.8%) had sexually inappropriate behaviour. Of those cognitively impaired subjects with sexually inappropriate behaviour, 20 (48.8%) were living in nursing homes and the rest, 21 (51.2%) in the community. Of these subjects, 53.7% had vascular dementia, 22% had Alzheimer's, and 9.8% had mild cognitive impairment. History of alcohol misuse and psychosis were reported in 14.6% and 9.8% of subjects respectively. Twenty seven (65.7%) had verbally inappropriate behaviour and 36 (87.8%) had physically inappropriate behaviour. In this study, verbally inappropriate behaviour was more commonly seen in the community sample (81%) than in the nursing home sample (50%) (p = 0.04). Behavioural treatment was also more commonly seen in the community sample (81%) than in the nursing home sample (45%) (p = 0.01). CONCLUSION In this study sexually inappropriate behaviour was seen in all stages of dementia, more commonly associated with subjects of vascular aetiology, and is as commonly seen in community dwelling subjects with dementia as in nursing home subjects.
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Affiliation(s)
- K Alagiakrishnan
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada.
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Venter JC, Adams MD, Myers EW, Li PW, Mural RJ, Sutton GG, Smith HO, Yandell M, Evans CA, Holt RA, Gocayne JD, Amanatides P, Ballew RM, Huson DH, Wortman JR, Zhang Q, Kodira CD, Zheng XH, Chen L, Skupski M, Subramanian G, Thomas PD, Zhang J, Gabor Miklos GL, Nelson C, Broder S, Clark AG, Nadeau J, McKusick VA, Zinder N, Levine AJ, Roberts RJ, Simon M, Slayman C, Hunkapiller M, Bolanos R, Delcher A, Dew I, Fasulo D, Flanigan M, Florea L, Halpern A, Hannenhalli S, Kravitz S, Levy S, Mobarry C, Reinert K, Remington K, Abu-Threideh J, Beasley E, Biddick K, Bonazzi V, Brandon R, Cargill M, Chandramouliswaran I, Charlab R, Chaturvedi K, Deng Z, Di Francesco V, Dunn P, Eilbeck K, Evangelista C, Gabrielian AE, Gan W, Ge W, Gong F, Gu Z, Guan P, Heiman TJ, Higgins ME, Ji RR, Ke Z, Ketchum KA, Lai Z, Lei Y, Li Z, Li J, Liang Y, Lin X, Lu F, Merkulov GV, Milshina N, Moore HM, Naik AK, Narayan VA, Neelam B, Nusskern D, Rusch DB, Salzberg S, Shao W, Shue B, Sun J, Wang Z, Wang A, Wang X, Wang J, Wei M, Wides R, Xiao C, Yan C, Yao A, Ye J, Zhan M, Zhang W, Zhang H, Zhao Q, Zheng L, Zhong F, Zhong W, Zhu S, Zhao S, Gilbert D, Baumhueter S, Spier G, Carter C, Cravchik A, Woodage T, Ali F, An H, Awe A, Baldwin D, Baden H, Barnstead M, Barrow I, Beeson K, Busam D, Carver A, Center A, Cheng ML, Curry L, Danaher S, Davenport L, Desilets R, Dietz S, Dodson K, Doup L, Ferriera S, Garg N, Gluecksmann A, Hart B, Haynes J, Haynes C, Heiner C, Hladun S, Hostin D, Houck J, Howland T, Ibegwam C, Johnson J, Kalush F, Kline L, Koduru S, Love A, Mann F, May D, McCawley S, McIntosh T, McMullen I, Moy M, Moy L, Murphy B, Nelson K, Pfannkoch C, Pratts E, Puri V, Qureshi H, Reardon M, Rodriguez R, Rogers YH, Romblad D, Ruhfel B, Scott R, Sitter C, Smallwood M, Stewart E, Strong R, Suh E, Thomas R, Tint NN, Tse S, Vech C, Wang G, Wetter J, Williams S, Williams M, Windsor S, Winn-Deen E, Wolfe K, Zaveri J, Zaveri K, Abril JF, Guigó R, Campbell MJ, Sjolander KV, Karlak B, Kejariwal A, Mi H, Lazareva B, Hatton T, Narechania A, Diemer K, Muruganujan A, Guo N, Sato S, Bafna V, Istrail S, Lippert R, Schwartz R, Walenz B, Yooseph S, Allen D, Basu A, Baxendale J, Blick L, Caminha M, Carnes-Stine J, Caulk P, Chiang YH, Coyne M, Dahlke C, Deslattes Mays A, Dombroski M, Donnelly M, Ely D, Esparham S, Fosler C, Gire H, Glanowski S, Glasser K, Glodek A, Gorokhov M, Graham K, Gropman B, Harris M, Heil J, Henderson S, Hoover J, Jennings D, Jordan C, Jordan J, Kasha J, Kagan L, Kraft C, Levitsky A, Lewis M, Liu X, Lopez J, Ma D, Majoros W, McDaniel J, Murphy S, Newman M, Nguyen T, Nguyen N, Nodell M, Pan S, Peck J, Peterson M, Rowe W, Sanders R, Scott J, Simpson M, Smith T, Sprague A, Stockwell T, Turner R, Venter E, Wang M, Wen M, Wu D, Wu M, Xia A, Zandieh A, Zhu X. The sequence of the human genome. Science 2001; 291:1304-51. [PMID: 11181995 DOI: 10.1126/science.1058040] [Citation(s) in RCA: 7678] [Impact Index Per Article: 333.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 2.91-billion base pair (bp) consensus sequence of the euchromatic portion of the human genome was generated by the whole-genome shotgun sequencing method. The 14.8-billion bp DNA sequence was generated over 9 months from 27,271,853 high-quality sequence reads (5.11-fold coverage of the genome) from both ends of plasmid clones made from the DNA of five individuals. Two assembly strategies-a whole-genome assembly and a regional chromosome assembly-were used, each combining sequence data from Celera and the publicly funded genome effort. The public data were shredded into 550-bp segments to create a 2.9-fold coverage of those genome regions that had been sequenced, without including biases inherent in the cloning and assembly procedure used by the publicly funded group. This brought the effective coverage in the assemblies to eightfold, reducing the number and size of gaps in the final assembly over what would be obtained with 5.11-fold coverage. The two assembly strategies yielded very similar results that largely agree with independent mapping data. The assemblies effectively cover the euchromatic regions of the human chromosomes. More than 90% of the genome is in scaffold assemblies of 100,000 bp or more, and 25% of the genome is in scaffolds of 10 million bp or larger. Analysis of the genome sequence revealed 26,588 protein-encoding transcripts for which there was strong corroborating evidence and an additional approximately 12,000 computationally derived genes with mouse matches or other weak supporting evidence. Although gene-dense clusters are obvious, almost half the genes are dispersed in low G+C sequence separated by large tracts of apparently noncoding sequence. Only 1.1% of the genome is spanned by exons, whereas 24% is in introns, with 75% of the genome being intergenic DNA. Duplications of segmental blocks, ranging in size up to chromosomal lengths, are abundant throughout the genome and reveal a complex evolutionary history. Comparative genomic analysis indicates vertebrate expansions of genes associated with neuronal function, with tissue-specific developmental regulation, and with the hemostasis and immune systems. DNA sequence comparisons between the consensus sequence and publicly funded genome data provided locations of 2.1 million single-nucleotide polymorphisms (SNPs). A random pair of human haploid genomes differed at a rate of 1 bp per 1250 on average, but there was marked heterogeneity in the level of polymorphism across the genome. Less than 1% of all SNPs resulted in variation in proteins, but the task of determining which SNPs have functional consequences remains an open challenge.
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Affiliation(s)
- J C Venter
- Celera Genomics, 45 West Gude Drive, Rockville, MD 20850, USA.
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Kagan L, Sivashinsky G. Incomplete combustion in nonadiabatic premixed gas flames. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1996; 53:6021-6027. [PMID: 9964959 DOI: 10.1103/physreve.53.6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Cohen B, Kagan L, Richter B, Topor M, Saveedra M. Children's compliance to dialysis. Pediatr Nurs 1991; 17:359-65, 420. [PMID: 1861902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Relationships among physiologic measures of compliance to dialysis therapy and selected parent and child variables were investigated. Child's age and length of time receiving dialysis related significantly to compliance.
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Abstract
Ochromonas danica Pringsheim, a freshwater chrysomonad, converts d-glucose into l-ascorbic acid over a metabolic pathway that ;inverts' the carbon chain of the sugar. In this respect, l-ascorbic acid formation resembles that found in ascorbic acid-synthesizing animals. It differs from this process in that d-galacturonate and l-galactono-1,4-lactone, rather than d-glucuronate and l-gulono-1,4-lactone, enhance production of ascorbic acid and repress the incorporation of (14)C from d-[1-(14)C]glucose into ascorbic acid.
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Affiliation(s)
- J P Helsper
- Institute of Biological Chemistry and Program in Biochemistry and Biophysics, Washington State University, Pullman, Washington 99164
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