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SummaryBackground The correlation between vedolizumab trough levels during induction therapy and mucosal healing remains unknown. Aim To compare early vedolizumab trough levels in patients with and without mucosal healing within the first year after treatment initiation. Methods We prospectively collected vedolizumab trough levels in all inflammatory bowel disease patients at weeks 2, 6 and 14 of vedolizumab treatment in three French referral centres between 1 June 2014 and 31 March 2017. Results of every patient that underwent mucosal assessment by magnetic resonance imaging and/or endoscopy in the first year after treatment initiation were analysed. Results Median vedolizumab trough levels in the overall population (n = 82) were 27 μg/mL (interquartile range, IQR 21.2-33.8 μg/mL) at week 2, 23 μg/mL (IQR 15-34.5 μg/mL) at week 6 and 10.7 μg/mL (IQR 4.6-20.4 μg/mL) at week 14. Only median vedolizumab trough levels at week 6 differed between patients with and without mucosal healing within the first year after treatment initiation (26.8 vs 15.1 μg/mL, P = 0.035). A cut-off trough level of 18 μg/mL at week 6 predicted mucosal healing within the first year after the start of vedolizumab with an area under the receiver operating curve of 0.735 (95% confidence interval 0.531-0.939). A vedolizumab trough level above 18 μg/mL at week 6 was the only independent variable associated with mucosal healing within the first year of treatment (odds ratio 15.7, 95% confidence interval 2.4-173.0, P = 0.01). Conclusion Early therapeutic drug monitoring might improve timely detection of vedolizumab-treated patients in need for an intensified dosing regimen.

We describe four children who died of suffocation by rubber balloons in Canada between 1983 and 1988. In the United States, at least 121 children have died in a similar manner in the 15 years between 1973 and 1988 according to a report by the US Consumer Product Safety Commission. Although the highest mortality occurred among infants, 30 (25%) of the 121 deaths occurred in children 6 years of age or older. Balloons account for 43% of the approximately 15 childhood deaths related to children's products that are documented each year by the Consumer Product Safety Commission. Toy rubber balloons are thus the leading cause of pediatric choking deaths from children's products. Preventive efforts should be directed toward a ban on this type of balloon and the development of safer alternatives. Meanwhile, public information campaigns should alert parents, physicians, and policymakers to the dangers of toy rubber balloons.

The use of ACV in pregnancy is not yet recommended for two main reasons : its safety has not been established and the lack of studies on pharmacokinetics. In this paper, we have reviewed data concerning nine pregnant women who was given ACV in the perinatal period. Route of administration and doses were as following : orally (0) 350 mg/8 hours (5), intravenously (IV) 5-10 mg/kg/8 hours (4). Plasma trough (T) and peak (P) levels of ACV was determinated by radioimmuno assay. At birth, plasma ACV levels were achieved in the mother and her offspring. P and T after IV were effective to inhibit viral replication (17-41 umol/l. 1.22-1.36 μmol/l) and higher than in vitro ID 50 for Herpes viradea viruses (0.1-4 umol/l) ; whereas T and P ranged from 0.32 to 0, 59 μmol/l and from 1.79 to 3.78 umol/l after 10 doses given orally. Furthermore steady state plasma level was not achieved even after 10 doses 0. The maternal foetal ratio of ACV level was approximately 1. No side effects were noted in newborns.