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OBJECTIVES: To report our 2 years of experience navigating the interference of anti-CD38 monoclonal antibodies (MAs) in 33 patients and describe papain-treated panels as a complementary method to dithiothreitol (DTT). BACKGROUND: Novel anti-CD38 MAs are now approved or undergoing clinical trials to evaluate their activity in patients with multiple myeloma. A concern with the use of these drugs is that they interfere with blood bank tests in a group of patients who often require blood transfusions. METHODS: Clinical data and whole blood samples were collected from patients receiving daratumumab or isatuximab. Routine blood bank serological tests were performed. RESULTS: A total of 9·1% of patients presented with alloantibodies prior to treatment. All patients exhibited nonspecific reactivity in indirect antiglobulin tests, and 26% had positive direct antiglobulin tests after beginning treatment. This interference disappeared in all patients after discontinuing treatment. Papain panels avoided this reactivity and allowed us to identify alloantibodies. Phenotyped blood units were transfused, and no patient suffered any transfusion-related complications. CONCLUSION: Anti-CD38 MAs produce nonspecific interference in blood bank tests. This interference can be overcome by various methods, including DTT or papain treatment as proposed here. These methods have limitations that can be resolved using phenotyped blood units.

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OBJECTIVE: To investigate the effect of an additional review based on reporting guidelines such as STROBE and CONSORT on quality of manuscripts. DESIGN: Masked randomised trial. Population Original research manuscripts submitted to the Medicina Clínica journal from May 2008 to April 2009 and considered suitable for publication. CONTROL GROUP: conventional peer reviews alone. Intervention group: conventional review plus an additional review looking for missing items from reporting guidelines. Outcomes Manuscript quality, assessed with a 5 point Likert scale (primary: overall quality; secondary: average quality of specific items in paper). Main analysis compared groups as allocated, after adjustment for baseline factors (analysis of covariance); sensitivity analysis compared groups as reviewed. Adherence to reviewer suggestions assessed with Likert scale. RESULTS: Of 126 consecutive papers receiving conventional review, 34 were not suitable for publication. The remaining 92 papers were allocated to receive conventional reviews alone (n=41) or additional reviews (n=51). Four papers assigned to the conventional review group deviated from protocol; they received an additional review based on reporting guidelines. We saw an improvement in manuscript quality in favour of the additional review group (comparison as allocated, 0.25, 95% confidence interval -0.05 to 0.54; as reviewed, 0.33, 0.03 to 0.63). More papers with additional reviews than with conventional reviews alone improved from baseline (22 (43%) v eight (20%), difference 23.6% (3.2% to 44.0%), number needed to treat 4.2 (from 2.3 to 31.2), relative risk 2.21 (1.10 to 4.44)). Authors in the additional review group adhered more to suggestions from conventional reviews than to those from additional reviews (average increase 0.43 Likert points (0.19 to 0.67)). CONCLUSIONS: Additional reviews based on reporting guidelines improve manuscript quality, although the observed effect was smaller than hypothesised and not definitively demonstrated. Authors adhere more to suggestions from conventional reviews than to those from additional reviews, showing difficulties in adhering to high methodological standards at the latest research phases. To boost paper quality and impact, authors should be aware of future requirements of reporting guidelines at the very beginning of their study. Trial registration and protocol Although registries do not include trials of peer review, the protocol design was submitted to sponsored research projects (Instituto de Salud Carlos III, PI081903).

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5-aminosalicylic acid (5-ASA) has been used to treat inflammatory bowel disease satisfactorily. Lung disease related to 5-ASA administration has been described only rarely. We report a case of alveolitis related to 5-ASA treatment in a woman with Crohn's disease. We review the literature and describe clinical, biological and radiological manifestations, along with the clinical course of this complication.

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This study aimed at investigating the changes occurring in the plasma lipid profile of patients with non-insulin-dependent diabetes mellitus (NIDDM) hospitalized for treatment of intercurrent diseases. Twenty-nine non-insulin requiring NIDDM patients (13 men, 16 women; mean age: 67 +/- 2 yrs) and 26 adequately matched patients (12 men, 14 women; mean age: 71 +/- 2 yrs) have been prospectively studied. They were all hospitalized for treatment of various diseases. Diabetic and non-diabetic patients received similar treatment except for intensive insulin therapy in the former group. On admission, diabetic subjects had significantly higher plasma levels of triglycerides and lower levels of HDL cholesterol; during hospitalization, LDL, HDL cholesterol and apo A1 levels increased significantly. In the non-diabetic group, hospitalization and treatment induced significant increases in triglycerides, LDL cholesterol and apo B levels. In conclusion, although insulin treatment during hospitalization of non-insulin requiring NIDDM patients does not fully reverse the abnormal lipid profile, it may help to prevent its further deterioration, particularly by increasing HDL cholesterol levels and hence by decreasing the LDL/HDL cholesterol ratio.

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1. Pulmonary palmitic acid metabolism was studied in rats in basal conditions and after experimental talcosis. 2. Palmitic acid was rapidly incorporated into phospholipids and stored in the form of esterified cholesterol. 3. During the experiment a de novo synthesis of triglycerides was not detected.

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