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Specimen collection and processing instructions for BNP (NT-PRO-BNP) test

Sosin; Gurbir Bhatia; Gregory Y. Lip; Michael K.

Sosin ; Gurbir Bhatia ; Gregory Y. Lip ; Michael K. Publisher: CRC Press , This specific ISBN edition is currently not available. View all copies of this ISBN edition:.

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Synopsis About this title Using an evidence-based approach, the authors present a detailed overview of the syndrome of heart failure. Review : The Systematist Synopsis : Using a strong evidence-based approach, the authors aim to present a detailed overview of the syndrome of heart failure.

Buy Used Condition: Good This is an ex-library book and The polyethylene glycol coating results in preferential concentration of doxorubicin in the skin. However, this also results in a side effect called palmar plantar erythrodysesthesia PPE , more commonly known as hand-foot syndrome. Following administration of this form of doxorubicin, small amounts of the drug can leak from capillaries in the palms of the hands and soles of the feet.

The result of this leakage is redness, tenderness, and peeling of the skin that can be uncomfortable and even painful. The rate of this side effect limits the dose of this formulation that can be given as compared with plain doxorubicin in the same treatment regimen, thereby limiting potential substitution. Substitution would be desirable because liposome-encapsulated doxorubicin is less cardiotoxic than unencapsulated doxorubicin. This form is also approved by the FDA for treatment of ovarian cancer and multiple myeloma. A non-pegylated liposomal doxorubicin, called Myocet, is approved in Europe and Canada for treatment of metastatic breast cancer in combination with cyclophosphamide , but has not been approved by the FDA for use in the United States.

Unlike Doxil, the Myocet liposome does not have a polyethylene glycol coating, and therefore does not result in the same rate of hand-foot syndrome. The minimization of this side effect may allow for one-for-one substitution with doxorubicin in the same treatment regimen, thereby improving safety with no loss of efficacy. Like Doxil, the liposomal encapsulation of the doxorubicin limits the cardiotoxicity.

In theory, by limiting the cardiotoxicity of doxorubicin through liposomal encapsulation, it can be used safely in concurrent combination with other cardiotoxic chemotherapy drugs, such as trastuzumab. There is an FDA black box warning that trastuzumab cannot be used in concurrent combination with doxorubicin, only in sequential combination.

Though concurrent combination of trastuzumab and doxorubicin in clinical studies found superior tumor response, the combination resulted in unacceptable cardiotoxicity, including risk of cardiac failure manifesting as congestive heart failure CHF. Published phase II study results have shown that Myocet, trastuzumab, and paclitaxel can safely be used concurrently without the cardiac risk, as measured by reduction in LVEF function, while still achieving superior tumor response.

The most dangerous side effect of doxorubicin is dilated cardiomyopathy , leading to congestive heart failure. Doxorubicin-induced cardiomyopathy typically results in dilated cardiomyopathy, with all four cardiac chambers being enlarged. Another common and potentially fatal complication of doxorubicin is typhlitis , an acute life-threatening infection of the bowel. Chemotherapy can cause reactivation of hepatitis B , and doxorubicin-containing regimens are no exception. Doxorubicin and several chemotherapeutic drugs including cyclophosphamide cause dyspigmentation.

Other groups of drugs that cause this problem include antimalarials, amiodarone , heavy metals but not iron , tetracyclines , and antipsychotics. Doxorubicin DXR is a hydroxylated version of daunorubicin , the immediate precursor of DXR in its biosynthetic pathway.

Daunorubicin is more abundantly found as a natural product because it is produced by a number of different wild type strains of Streptomyces. In contrast, only one known non- wild type species , Streptomyces peucetius subspecies cesius ATCC , was initially found to be capable of producing the more widely used doxorubicin.

In , Strohl's group discovered, isolated and characterized dox A, the gene encoding the enzyme that converts daunorubicin into DXR. Hutchinson's group went on to develop methods to improve the yield of DXR, from the fermentation process used in its commercial production, not only by introducing dox A encoding plasmids , but also by introducing mutations to deactivate enzymes that shunt DXR precursors to less useful products, for example baumycin-like glycosides.

Although DXR can be produced semi-synthetically from daunorubicin, the process involves electrophilic bromination and multiple steps, and the yield is poor. Doxorubicin interacts with DNA by intercalation and inhibition of macromolecular biosynthesis.

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The planar aromatic chromophore portion of the molecule intercalates between two base pairs of the DNA, while the six-membered daunosamine sugar sits in the minor groove and interacts with flanking base pairs immediately adjacent to the intercalation site, as evidenced by several crystal structures. By intercalation , doxorubicin can also induce histone eviction from transcriptionally active chromatin. In the s, an Italian research company, Farmitalia Research Laboratories, began an organized effort to find anticancer compounds from soil-based microbes. A soil sample was isolated from the area surrounding the Castel del Monte , a 13th-century castle.

A new strain of Streptomyces peucetius , which produced a red pigment, was isolated, and an antibiotic from this bacterium was effective against tumors in mice.