A new prothrombin-based activated protein C resistance (APC-R) test is described. In this method, the patient sample is prediluted in a plasma depleted of factor V (FV). A reagent containing APC and a specific activator of FV is added. After an incubation period, clotting is initiated by the addition of the FV-dependent prothrombin activator Noscarin. We analyzed 703 samples from patients undergoing thrombophilia screening. By using a predefined cutoff ratio of 2.5, 100% sensitivity and specificity for the detection of a factor V Leiden (FVL) mutation was found. With a cutoff ratio of 1.2, a complete but narrow distinction of FVL heterozygous (n = 192) and FVL homozygous samples (n = 27) was determined. No interference by the international normalized ratio, activated partial thromboplastin time (aPTT), protein S activity, fibrinogen and factor VIII (FVIII) levels, or lupus anticoagulant ratio was detected. The new prothrombin-based APC-R assay provides improved distinction of FV wild-type and FVL carriers compared with the aPTT-based method. By the use of an FV-dependent prothrombin activator, the assay is not influenced by FVIII concentration or lupus anticoagulants.

LMEDICAJ. JOUR?4IAL well as the barbiturates, extremely well; hypothyroid cases give one anxiety with even a very small dose of morphine. It seems to me probable that the cases which gave trouble were, in some degree, deficient thyroid ones. If the basal metabolic rate is taken it is probable that these susceptible cases can be identified, .and precautions taken. Animal experiments may be misleading: I have seen a dog weighing about 4 st. given

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Abstract. We developed a computer assisted program for training the medical staff in ventilating newborn infants. The Java-based client-server program consists of two modules: the instructor module enabling the domain expert to create courses of virtual patients, the tutorial module running consultations with virtual patients. The tutorial module displays the course of the transcutaneous blood gases and a table of the ventilator settings which can interactively be adjusted by the trainee to provide an adequate gas exchange to the virtual patient. VIE-NVT is currently tested at our neonatal intensive care unit.