Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC

Late relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity.

Multidrug-Resistant Outbreak-Associated Salmonella Strains in Irrigation Water from the Metropolitan Region, Chile

Salmonella enterica (S. enterica) is the main cause of foodborne diseases in the Chilean population. With the aim of characterizing the presence of S. enterica in bodies of water, samples from 40 sources were obtained, including rivers and irrigation canals used by agricultural farms in the most populated regions of Chile. As result, 35 S. enterica isolates belonging to several serotypes were detected, with the highest frequency represented by Typhimurium and Enteritidis. All strains showed phenotypic antimicrobial resistance, and most of them were multiresistant to critically important antimicrobials. In addition, the pulse-field gel electrophoresis analysis using XbaI and BlnI endonucleases showed that seven Salmonella isolates belonging to serotypes Typhimurium, Enteritidis and Infantis had identical pulsotypes to outbreak-associated clinical isolates detected in the Chilean population, suggesting a public health risk of water pollution in this region. Among sampling sites, the higher detection rates were observed in rural than urban and peri-urban areas, suggesting that the animal husbandry might contribute for environmental dispersion of this pathogen. Future efforts should address the characterization of cause-and-effect relationship between water contamination and foodborne disease, including the implementation of surveillance programmes to tackle potential risks for both human and animal populations.

Study of enrofloxacin and flumequine residues depletion in eggs of laying hens after oral administration

Two groups of laying hens (each n=12) were administered 10 mg/kg enrofloxacin (ENRO) (group A) or 26.6 mg/kg flumequine (FLU) (group B) by gastric catheter daily for five consecutive days. A third group (n=6) was untreated controls. Eggs were collected from day one of treatment and up to 30 days after withdrawal of the drug. Egg white and yolk from each egg were separated, and ENRO, its metabolite ciprofloxacin (CIP) and FLU residues were analysed by a high-performance liquid chromatography method with fluorescence detection. The sum of ENRO and CIP was detectable in egg white on the first day of treatment in high-level concentrations (2007.7 μg/kg) and remained steady during administration. In egg yolk, residues were detectable at day one in lower concentrations (324.4 μg/kg), increasing to the end of treatment. After treatment, these residues decreased and were detectable up to day 8 in egg white, and day 10 in yolk. FLU residues during drug administration in white were detectable in high concentrations from day one to five (6788.4-6525.9 μg/kg), and in yolk, concentrations were lower during administration (629.6-853.9 μg/kg). After drug withdrawal, FLU residues remained longer in egg white (30 days) than in yolk (26 days). For both drugs, differences of concentrations between matrices were significant.

Isolation and molecular characterization of quinolone resistant spp. from poultry farms

The antimicrobial susceptibility of 94 Salmonella strains isolated from different poultry farms in Chile (broiler and laggin hens) were analyzed by the dilution plates method. Thirty-nine of them were resistant to flumequine, nalidixic acid and oxolinic acid with MIC values higher than 64 microg/ml. These quinolone resistant strains were analyzed in order to determine the presence of mutations in the QRDR region of gyrA gene by AS-PCR-RFLP analysis. 51.3% of the strains showed mutations at codon Ser 83 and 41.0% showed mutations at codon Asp 87. No mutations were observed on codon Gly 81. These mutations were confirmed by sequenciation of one representative strain from different RFLP pattern. Likewise, no double mutations were observed. Over 90% of the quinolone resistant strains presented mutations at the QRDR region of the gyrA gene. Three phenotypically resistant strains did not show any mutations on the QRDR region of gyrA gene. However, other molecular resistant mechanism could be involve. This is the first study that demonstrate the emergency of quinolone and fluoroquinolone resistance in Chilean Salmonella strains isolated from poultry thus indicating the requirement of monitoring programmes in veterinary medicine.

Evaluation of glucose as a cryoprotectant for boar semen

Fertility parameters of boar spermatozoa were evaluated in vitro, after freeze-thawing the semen in three different extenders containing permeable and non-permeable cryoprotectants: A (111.0 mM Tris, 31.4 mM citric acid, 185.0 mM glucose, 20 per cent egg yolk, 3 per cent glycerol and 100 iu/ml penicillin G); B (200 mM Tris; 70.8 mM citric acid, 55.5 mM glucose, 20 per cent egg yolk, three per cent glycerol and 100 iu/ml penicillin G); C (200 mM Tris, 70.8 mM citric acid, 55.5 mM fructose, 20 per cent egg yolk, 3 per cent glycerol and 100 iu/ml penicillin G). The freeze-thawing techniques were the same for each extender. Eight ejaculates from four boars were obtained; the sperm-rich fraction of each ejaculate was extended in each of the three media at a final concentration of 400 x 106 sperm/ml, loaded into 0.5 ml straws and frozen at a rate of 30 degrees C/minute to -196 degrees C. The straws were thawed at 60 degrees C for eight seconds. Sperm motility, acrosomal integrity and in vitro sperm penetration through the zona pellucida of gilt oocytes matured in vitro were evaluated. The motility of unfrozen spermatozoa was 93.1 per cent compared with 60.7 per cent, 48.2 per cent and 35 per cent for sperm frozen in extenders A, B and C respectively; these values were all significantly different (P<0.05). There was no significant decline in sperm motility after incubation for 30 minutes in extender A, but there were significant decreases in sperm motility after 30 minutes of incubation in B and C. The percentage acrosomal integrities were 97.2 per cent for the control and 45.5 per cent, 30.3 per cent and 16.8 per cent for the frozen-thawed spermatozoa in extenders A, B and C respectively. The results of the in vitro penetration assay were 80.7 per cent when using control spermatozoa, and 42.2 per cent, 18.4 per cent and 3.3 per cent when using frozen-thawed spermatozoa in extenders A, B and C respectively

AMPA receptor modulation in previously frozen mouse brain sections: opposite effects of calcium in the cortex and hippocampus

Various forms of synaptic plasticity in the brain have been proposed to result from modifications in the properties of glutamate receptors by calcium-dependent mechanisms. In the present study, changes in glutamate receptors elicited by calcium treatment of previously frozen mouse brain sections were evaluated by qualitative as well as quantitative analysis of tritiated ligand binding to both alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) and N-methyl-D-aspartate (NMDA) glutamate receptor subtypes. Quantitative analysis revealed that 3H-AMPA binding was reduced in a dose-dependent manner by calcium in the cerebral cortex and striatum formations. However, an opposite change in AMPA receptor properties was observed in the hippocampus, as calcium generated an increase of AMPA binding in all hippocampal fields. Analysis of the saturation kinetics of 3H-AMPA binding showed that the calcium-induced augmentation of AMPA binding in the stratum radiatum of the CA1 region was due to an alteration in the maximal number of sites, while the reduction of binding elicited by calcium in the cortex appeared to be due to modified AMPA receptor affinity. Calcium-induced downregulation of AMPA receptor affinity in the cortex and striatum was affected by baicalein, a selective inhibitor of the lipoxygenase pathways of arachidonic acid metabolism, whereas the same inhibitor did not modify calcium-mediated upregulation of receptor number in the CA1 region of the hippocampus. On the other hand, the effect of calcium appeared to be specific for the AMPA receptor, as the same treatment did not affect glutamate binding to the NMDA glutamate receptor subtype. Our results suggest the possibility that, depending on the brain regions, calcium ions may generate opposite modulation of AMPA receptor properties. Because the regulation of AMPA receptors by calcium-dependent enzymes has been implicated in synaptic plasticity, our results suggest that regional variations in the effect of calcium on AMPA binding account for differential plasticity at glutamatergic synapses.

Differentiation of several geographical origins in single-strength Valencia orange juices using quantitative comparison of carotenoid profiles

Pure Valencia orange (Citrus sinensis) juices (64 samples) from Spain, Israel, Belize, Cuba, and Florida, harvested during two seasons (1996-1997 and 1997-1998), were analyzed for their carotenoid profiles. The detection of saponified carotenoid pigments has been achieved and quantitated using a photodiode array detection monitored at 350, 430, and 486 nm. Carotenoid pigments commonly found in the orange variety Valencia have been separated on a polymeric C-30 column using a ternary gradient as eluent. Pure Valencia juices from oranges grown in Mediterranean regions (Israel and Spain) have a high carotenoid content, expressed in beta-carotene (5-18 and 14-35 mg L(-)(1), respectively), compared to those grown in tropical and subtropical regions (Cuba, Belize, and Florida) (4-10, 2-8, and 5-10 mg L(-)(1), respectively). Quantitative results allowed the differentiation of Valencia variety geographical origins, in particular, the Mediterranean area from tropical and subtropical areas, using multidimensional analyses of carotenoid contents.

D-Lactate dehydrogenase gene (ldhD) inactivation and resulting metabolic effects in the Lactobacillus johnsonii strains La1 and N312

Lactobacillus johnsonii La1, a probiotic bacterium with demonstrated health effects, grows in milk, where it ferments lactose to D- and L-lactate in a 60:40% ratio. The D-lactate dehydrogenase (D-LDH) gene (ldhD) of this strain was isolated, and an in vitro-truncated copy of that gene was used to inactivate the genomic copy in two strains, La1 and N312, by gene replacement. For that, an 8-bp deletion was generated within the cloned ldhD gene to inactivate its function. The plasmid containing the altered ldhD was transferred to L. johnsonii via conjugative comobilization with Lactococcus lactis carrying pAMbeta1. Crossover integrations of the plasmid at the genomic ldhD site were selected, and appropriate resolution of the cointegrate structures resulted in mutants that had lost the plasmid and in which the original ldhD was replaced by the truncated copy. These mutants completely lacked D-LDH activity. Nevertheless, the lower remaining L-LDH activity of the cells was sufficient to reroute most of the accumulating pyruvate to L-lactate. Only a marginal increase in production of the secondary end products acetaldehyde, diacetyl, and acetoin was observed. It can be concluded that in L. johnsonii D- and L-LDH are present in substantial excess for their role to eliminate pyruvate and regenerate NAD(+) and that accumulated pyruvate is therefore not easily redirected in high amounts to secondary metabolic routes.

Hypoxia-induced loss of synaptic transmission is exacerbated in hippocampal slices of transgenic mice expressing C-terminal fragments of Alzheimer amyloid precursor protein

To investigate the possible involvement of beta-amyloid (A beta) in disrupting neuronal function during ischemia, we examined whether overexpression of C-terminal fragments of beta-amyloid precursor protein (beta-APP) in transgenic (Tg) mice is capable of altering the capacity of hippocampus slices to recover synaptic transmission after transient hypoxic episodes. Recovery of synaptic transmission was monitored in area CA1 of perfused hippocampal slices prepared from both control and Tg mice. The results obtained indicate that hippocampal slices prepared from Tg mice exhibited a much lower level of recovery in synaptic transmission following reoxygenation. This reduction in the capacity of Tg slices to recover from hypoxia-induced impairment of synaptic transmission in the hippocampus does not appear to be related to pre-existing alterations in either functional or biochemical properties of glutamate receptors in Tg mice. The present results provide the first experimental evidence that overexpression of the C-terminal fragment of APP exacerbates functional damage of hippocampal neurons after hypoxic episodes.

A molecular strategy designed for the rapid screening of gene traps based on sequence identity and gene expression pattern in adult mice

We have devised a strategy to rapidly screen gene traps in mouse embryonic stem (ES) cells based on DNA sequence information and an in vitro analysis of gene expression. After the initial identification of ES cell clones expressing beta-galactosidase, tagged RNA transcripts were immediately cloned and sequenced in order to determine their identities. Novel gene sequences found were used to probe northern blots to examine the expression patterns of their cognate genes. Our initial characterization of 30 cDNA clones indicated that more than half of the tagged sequences were novel mouse genes and of these 40% showed a restricted pattern of expression in adult mouse tissues. This molecular characterization of gene traps is quick, reliable and well suited for the large-scale screening of mammalian developmental genes. Furthermore, since gene trap insertion frequently disrupts the tagged host gene, the ES cells can be used to produce transgenic animals for a genetic analysis of gene function.

A new cell surface proteinase: sequencing and analysis of the prtB gene from Lactobacillus delbruekii subsp. bulgaricus

Investigation of the chromosomal region downstream of the lacZ gene from Lactobacillus delbrueckii subsp. bulgaricus revealed the presence of a gene (prtB) encoding a proteinase of 1,946 residues with a predicted molecular mass of 212 kDa. The deduced amino acid sequence showed that PrtB proteinase displays significant homology with the N termini and catalytic domains of lactococcal PrtP cell surface proteinases and is probably synthesized as a preproprotein. However, the presence of a cysteine near the histidine of the PrtB active site suggests that PrtB belongs to the subfamily of cysteine subtilisins. The C-terminal region strongly differs from those of PrtP proteinases by having a high lysine content, an imperfect duplication of 41 residues, and a degenerated sequence compared with the consensus sequence for proteins anchoring in the cell walls of gram-positive bacteria. Finally, the product of the truncated prtM-like gene located immediately upstream of the prtB gene seems too short to be involved in the maturation of PrtB.

Macroinvertebrate community as a biological indicator of ecological and toxicological factors in Lake Saint-François (Québec)

To assess the potential of the macroinvertebrate community for monitoring variation in the environmental quality of large rivers, the response of littoral macrobenthos in Lake Saint-François, a fluvial lake of the St Lawrence River (Québec) are described. First, the composition of total macroinvertebrate communities and important taxonomic groups as well as the biotic ICI-SL index in 16 littoral stations varying in sedimentology, water chemistry and contamination are described to define indicator species groups and environmental quality ranks. Thereafter, the relative contribution of ecological and toxicological factors in explaining the variation observed in macroinvertebrate assemblages and biotic index were quantified using partial canonical correspondence analysis. Cluster analyses based on taxonomic composition separated five groups of stations where macroinvertebrate assemblages varied in density, composition and tolerance to pollution. The ICI-SL biotic index varied from 7.2 to 27.2 with a mean value of 19 +/- 6. The ICI-SL values determined for the macroinvertebrate communities in Lake Saint-François did not reflect an important deterioration in environmental quality, and there was some agreement between the environmental quality ranking of the stations expressed either by the ICI-SL index or the community cluster analysis. Water conductivity and phosphorus concentration, followed by macrophyte types (Chara, Ceratophyllum) and sediment grain size, were the most significant ecological variables to explain variation in macroinvertebrate communities and derived ICI-SL index in Lake Saint-François. Among the toxicological factors, metals in water (Fe, Cr, Pb, Mn, Zn) and sediment (Mn, Pb, Se), as well as the composite indices of metal and organic contamination (water CI, sediment CI, sediment total PAHs) were the most important factors. The contamination factors selected in our models represented contaminant sorption processes rather than direct toxicological effects. The lack of clear relationships between contaminants and macroinvertebrate variables reflected the relative low level of contamination in the stations sampled in Lake Saint-François. There were some interactions between toxicological and ecological variables that should be considered in the planning of sampling and interpretation of biomonitoring studies. However, the large amount of unexplained variance (49.2-86.6%) in the CCA models underlined the limitations of the use of the indices of macroinvertebrate community structure that were assessed in this study for biomonitoring purposes in the absence of a contrasting pollution gradient.

A new mobile genetic element in Lactobacillus delbrueckii subsp. bulgaricus

A new IS element (ISL3) was discovered in Lactobacillus delbrueckii subsp. bulgaricus during the characterization of the linkage relationships between the two genes important for milk fermentation, beta-galactosidase (lacZ) and the cell-wall associated protease (prtP). ISL3 is a 1494 bp element, flanked by 38 bp imperfect inverted repeats, and generates an 8 bp target duplication upon insertion. It contains one open reading frame, encoding a potential polypeptide of 434 amino acids, which shows significant homology (34% identity) to the transposase of the Leuconostoc mesenteroides element IS1165. Molecular analysis of spontaneous lacZ mutants revealed some strains that had sustained deletions of 7 to 30 kb in size, centered on and eliminating the copy of ISL3 next to lacZ. Other deletion endpoints were identified as located immediately adjacent to ISL3. Furthermore, genetic translocations that had occurred via transposition of ISL3 were observed fortuitously in cultures screened for deletion mutants. ISL3 can be found in one to several copies in various strains of L. delbrueckii. However, it was not present in other dairy lactic acid bacteria tested.

Epiphyte size and taxonomy as biological indicators of ecological and toxicological factors in Lake Saint-François (Québec)

To assess the potential of the epiphyton community for monitoring spatial and temporal variations in the environmental quality of freshwater ecosystems, this paper describes the response of epiphytons to ecological and toxicological factors in Lake Saint-François, a fluvial lake of the St. Lawrence River (Québec). First, community descriptions and biotic indices based on size structure and on taxonomic composition were compared to test if size could usefully describe epiphyton response to environmental factors. Secondly, the relative contribution of ecological and toxicological variables in explaining the variation observed in epiphyton was quantified. A size-based approach classified the sites similarly to taxonomic analysis, but a larger portion of variance in size could be explained indicating a stronger relationship with environmental factors. Among both taxonomy and size-based biotic indices, the slope of the normalized size spectra performed best in terms of total explained variance. There were strong interactions between toxicological and ecological variables. These interactions should be considered in the planning and interpretation of biomonitoring studies. In such surveys, samples should be collected at sites with similar ecological characteristics: for example, the same macrophyte type and sediment texture. Interpretation of the data should consider the possible covariance of toxicological and ecological variables.

Lithium chloride-sodium propionate agar for the enumeration of bifidobacteria in fermented dairy products

Lithium chloride-sodium propionate agar has been developed for the enumeration of bifidobacteria in fermented dairy products. The medium contains lithium chloride and sodium propionate to inhibit the growth of other lactic acid bacteria. Pure cultures of bifidobacteria, lactobacilli, and streptococci were tested for growth in this medium. With one exception, all bifidobacteria were able to grow in this medium and in a nonselective agar with a difference not exceeding .4 log units. However, none of the lactobacilli tested and only one strain each of Streptococcus salivarius ssp. thermophilus and Lactococcus lactis ssp. cremoris grew in lithium chloride-sodium propionate agar. In those cases, the numbers of colonies were lower in lithium chloride-sodium propionate agar by 1.26 and 2.51 log units, respectively, compared with a nonselective agar. Bifidobacteria were also selectively isolated from all fermented milks and cheeses analyzed.

Care and the dynamics of social world

The concept of "social world" is formulated for the purpose of deepening our understanding of the dynamics of inclusion, exclusion, and care in interpersonal interaction. "World" is defined as an "irreducible subject-object polarity.""Social world" is the "extremely fragile environment within which people meet," and is easily destroyed. With special attention to family and church life, the conditions for maintaining or losing this environment are examined. Three levels of social world are defined. On the highest level, mutual care, rather than shared opinion, is seen as the factor that facilitates the preservation of social world in the face of "world-threatening issues."

Hypoxemia during hemodialysis: a critical review of the facts

The literature describing the fall in PaO2 during dialysis is intensively and critically reviewed. This phenomenon is related to both the type of membrane used (cellulosic v noncellulosic membrane), and to the composition of the dialysate (acetate v bicarbonate). It appears that a ventilation/perfusion mismatch due to pulmonary leukostasis can, in part, explain hypoxemia in patients dialyzed with cellulosic membranes. This phenomenon is especially apparent in patients with preexisting pulmonary abnormalities. However, hypoventilation remains the major cause of hypoxemia. This hypoventilation is mainly due to CO2 consumption during acetate metabolism (acetate dialysis), or alkalinization of the blood (bicarbonate dialysis). The metabolic consequences of acetate metabolism, and of bicarbonate and CO2 losses through the dialyzer are critically analyzed. The cause for the increment in oxygen consumption during acetate dialysis is examined. Finally, the respective role of these combined factors are described and used to explain the changes in VCO2, VO2, respiratory quotient (RQ), and PaO2 reported in the literature during dialysis against acetate and/or bicarbonate.

Acetate metabolism and bicarbonate generation during hemodialysis: 10 years of observation

The capacity of chronically hemodialyzed patients to metabolize acetate during conventional hemodialysis was evaluated using a retrospective study in 219 patients dialyzed for up to ten years under similar dialysis conditions. For each patient, and using all available data, a regression line relating the changes of plasma total CO2 during dialysis as a function of the pre-dialysis value was calculated. The intercept of this function indicates the plasma concentration where the losses of bicarbonate in the dialysate is matched by the generation of bicarbonate arising from the metabolism of acetate. This value therefore represents an individual index of the capacity of each patient to metabolize acetate. A value for this index smaller than 18.0 mM was considered abnormal. It was shown that around 10% of chronically hemodialyzed patients are clearly unable to metabolize acetate optimally. This defect is not related to the duration of dialysis, body weight or quality of hemodialysis treatments but is strongly related to sex, 19 of the 22 "acetate intolerant" patients being women. In a prospective study, all the 60 patients of the same population undergoing active dialysis were studied, and this index identified 12 abnormal (11 women, 1 man) patients and 48 normal patients. Plasma acetate measured at the end their dialysis treatments were significantly higher in abnormal than in normal patients. It is concluded: that this index is useful to identify the patients unable to metabolize acetate optimally; that only around 10% of hemodialyzed patients present a severe problem when dialyzed against acetate and should be dialyzed against bicarbonate; that dialysis against acetate does not fully correct the metabolic acidosis even in "normal" patients.

Acetate metabolism during hemodialysis: metabolic considerations

Acetate is used during regular hemodialysis to replace the bicarbonate lost during dialysis. The temporal changes of plasma bicarbonate and acetate concentrations and the critical role of acetate metabolism for the maintenance of plasma bicarbonate are described. We point out that the maximal rate of acetate oxidation in man is usually reached during dialysis, and we identify physiologic and pathologic factors that may modify this Vmax. A syndrome of 'intolerance to acetate' has been described. This syndrome is analyzed in the light of the metabolic consequences of a rapid flux of acetate oxidation in liver and muscle cells. More specifically, the effects of rapid acetate metabolism on tissue ATP, CoA, adenosine and other ATP degradation products are presented. The possible impact of dialysis-induced depletion of carnitine on optimal acetate metabolism is discussed. The potential clinical consequences produced by these changes are presented in relation to the symptoms sometimes observed during dialysis against acetate: vasodilation, hypotension and angina pectoris. The hypoxemia induced by acetate is also briefly reviewed. Different directions are proposed for future research.

Gentamicin pharmacokinetics during hemodialysis in patients suffering from chronic renal failure

Because the elimination of gentamicin, a potent aminoglycoside antibiotic, is dependent almost entirely on renal excretion, renal functional impairment drastically changes the pharmacokinetics of this drug. As a first step in the study of the effects of renal insufficiency and the anephric state on the pharmacokinetic parameters of gentamicin, serum and urine levels of this drug were studied after a single intravenous bolus dose during hemodialysis in patients suffering from chronic renal failure. The data were fitted to the two-compartment open model and the appropriate kinetic parameters were calculated with the COMPT computer program modified by Pfeffer. The rate constant of metabolism was estimated from plasma and dialysis rate constants of elimination. The rate of renal excretion was shown to be very weak in patients who were not anuric. The use of the mathematical equations of the two-compartment open model demonstrated that, after a single dose of gentamicin, the percentage of decrease of serum concentration with time does not represent, because of tissue binding retention, the percentage of drug eliminated from the body. It was shown that pharmacokinetic parameters represent a useful tool in the optimization of gentamicin therapy.