Release of Ciprofloxacin-HCl and Dexamethasone Phosphate by Hyaluronic Acid Containing Silicone Polymers

The purpose of this study was to determine the effect of the covalent incorporation of hyaluronic acid (HA) into conventional hydrogel and hydrogels containing silicone as models for contact lens materials on the uptake and release of the fluoroquinolone antibiotic ciprofloxacin and the anti-inflammatory steroid dexamethasone phosphate. A 3 mg/mL ciprofloxacin solution (0.3% w/v) and a 1 mg/mL dexamethasone phosphate solution (0.1%) was prepared in borate buffered saline. Three hydrogel material samples (pHEMA; pHEMA TRIS; DMAA TRIS) were prepared with and without the covalent incorporation of HA of molecular weight (MW) 35 or 132 kDa. Hydrogel discs were punched from a sheet of material with a uniform diameter of 5 mm. Uptake kinetics were evaluated at room temperature by soaking the discs for 24 h. Release kinetics were evaluated by placing the drug-loaded discs in saline at 34 °C in a shaking water bath. At various time points over 6–7 days, aliquots of the release medium were assayed for drug amounts. The majority of the materials tested released sufficient drug to be clinically relevant in an ophthalmic application, reaching desired concentrations for antibiotic or anti-inflammatory activity in solution. Overall, the silicone-based hydrogels (pHEMA TRIS and DMAA TRIS), released lower amounts of drug than the conventional pHEMA material (p < 0.001). Materials with HA MW132 released more ciprofloxacin compared to materials with HA MW35 and lenses without HA (p < 0.02). Some HA-based materials were still releasing the drug after 6 days.     

Does Hextend impair coagulation compared to 6% hetastarch? An ex vivo thromboelastography study

The objective of this study was to determine if coagulation is different between 6% hetastarch in normal saline (NS) and 6% hetastarch in lactated Ringer's solution (LR), with use of an ex vivo thromboelastography (TEG) model with healthy donated volunteer blood. We simulated hemodilution that occurs during clinical resuscitation of hemorrhagic or hypovolemic shock, using healthy human donor whole blood (WB) ex vivo. Coagulopathy related to low, medium, high, or very high dilution of WB with NS or a high-molecular-weight hetastarch-based plasma expander, 6% hetastarch in NS (HSNS) or 6% hetastarch in lactated Ringer's [Hextend (HSLR)], was analyzed by thromboelastography (TEG). No changes were noted in the TEG profile of undiluted WB controls during the 6-hour period of use (P > 0.95). Dilution with HSNS and HSLR significantly impaired coagulation compared to both WB control and NS. Progressive dilution with NS impaired coagulation but to a lesser extent than colloids (P < 0.01). Low dilution of blood with NS increased clot strength by 12% (not significant; P = 0.097). We conclude that WB containing citrate obtained from healthy donors for TEG analysis yields reproducible data over a minimum of 6 hours. Either hetastarch, when present at concentrations comparable to the manufacturer's maximum recommended dose of 20 mL/kg (equivalent to the high dilution used in these experiments), decreases clot tensile strength to levels associated with an increased risk of bleeding. Substitution of lactated Ringer's for NS in 6% hetastarch appears to offer no advantage in avoiding hemostatic compromise in an in vitro model.     

Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review.

OBJECTIVE: Congenital heart defects (CHDs) affect approximately 0.5% of all neonates. Recent literature points to a possible increase in the CHD prevalence among monochorionic/diamniotic (MC/DA) twin gestations. We hypothesized that MC/DA twin pregnancy is a risk factor for CHD. METHODS: A systematic review of all published English literature was conducted on MEDLINE (Ovid and PubMed) from January 2000 through April 2007 using the medical subject heading terms "congenital heart defect" and "monozygotic twins." Four observational studies were included in the final analysis. Published historical data were used for the population background risk of CHD. Relative risk (RR) estimates with 95% confidence intervals (CIs) were calculated by fixed and random effect models. RESULTS: We included a total of 40 fetuses with CHDs among 830 fetuses from MC/DA twin gestations. Compared with the population, CHDs were significantly more prevalent in MC/DA twins regardless of the presence of twin-twin transfusion syndrome (TTTS) (RR, 9.18; 95% CI, 5.51-15.29; P < .001). Monochorionic/diamniotic twin gestations affected by TTTS were more likely to be complicated by CHDs than those that did not have TTTS (RR, 2.78; 95% CI, 1.03-7.52; P = .04). Ventricular septal defects were the most frequent heart defects. Pulmonary stenosis and atrial septal defects were significantly more prevalent in pregnancies complicated with TTTS. CONCLUSIONS: Monochorionic/diamniotic twin gestation appears to be a risk factor for CHDs. Conditions that lead to abnormal placentation may also contribute to abnormal heart development, especially in MC/DA twin pregnancies complicated with TTTS. Fetal echocardiography may be considered for all MC/DA twin gestations because ventricular septal defects and pulmonary stenosis are the most common defects.     

“To Avoid Evaluation,Withdraw”: Fears of Evaluation and Depressive Cognitions Lead to Social Anxiety and Submissive Withdrawal

We propose a cognitive model of social anxiety-related submission based upon psycho-evolutionary accounts of social anxiety and depression and present results of two studies supporting this model. We tested a confirmatory factor model consisting of three latent lower-order factors (fear of negative evaluation, fear of positive evaluation, and depressive cognitions), all of which load onto a single latent higher-order submissive cognitions factor. In essence, we propose that the symptoms associated with social anxiety and depression (in part) served adaptive functions for coping with social threats in the ancestral environment and that the cognitive symptoms associated with these disorders may function collectively as integrated components of a social anxiety-related submission mechanism. Confirmatory factor analysis indicated that the hypothesized model fit well. A score derived from the submissive cognitions factor correlated strongly with social anxiety-related measures and less strongly with measures of generalized anxiety/worry in Studies 1 and 2. Furthermore, this submissive cognitions score correlated in the expected direction with self-report measures of social comparison, negative affect, and positive affect in Study 2, and mediational analyses indicated that submissive cognitions may mediate the relationship between social comparison and submissive behaviors. Findings from both studies provide support for the proposed model.

Nurse physician communication in the perioperative environment: discourse and actions to transform health care

In a previous article by Weeks, discourse regarding nurse physician communication within acute care settings is presented and analyzed following the principles of critical discourse analysis (CDA). An understanding of what shapes nurse physician communication discourse and its role in the reproduction of the dominance of nurses by physicians is gained in this previous article. This understanding allows for further exploration of the role of discourse in the challenge of that dominance leading to suggested actions to transform health care delivery, which is the focus in this article.     

Virus reduction in the preparation of intravenous immune globulin: in vitro experiments

BACKGROUND: While immune globulins for intravenous administration (IGIV) have an excellent record with respect to virus safety, concern regarding these preparations has been raised by reports of transmission of hepatitis C virus (HCV) to patients treated with IGIV and the presence of genetic material for HCV in IGIV preparations. STUDY DESIGN AND METHODS: This in vitro study evaluated the effectiveness of several manufacturing steps, including ethanol precipitation and pasteurization, in reducing HIV and model viruses including encephalomyocarditis (EMC) virus, pseudorabies virus (PRV), bovine viral diarrhea virus (BVDV), Sindbis virus, vaccinia virus, and vesicular stomatitis virus (VSV), as well as HCV RNA, in IGIV. RESULTS: Ethanol precipitation carried out after pasteurization resulted in virus reductions (log10) of >3.97 for HIV, 1.95 for EMC virus, >5.39 for PRV, and 3.52 for BVDV. Pasteurization inactivated EMC virus by 4.52 log10 and resulted in a log10 reduction of >6.54 for HIV, >5.39 for PRV, >6.64 for BVDV, >7.78 for Sindbis virus, >5.84 for vaccinia virus, and >6.99 for VSV. All viruses except EMC virus were reduced below the limit of detection within 6 hours of the beginning of pasteurization. Cohn processing of Fraction II + III paste and the 4.5-percent alcohol precipitation step prior to pasteurization provided additional virus removal. Studies using the polymerase chain reaction technique found that HCV RNA was detectable in the starting fraction of Cohn Fraction II paste, but not in the final IGIV preparation. CONCLUSION: These findings strongly support the viral safety of IGIV prepared by this method and show a significant added measure of virus safety associated with pasteurization of this preparation.     

Modulation of human tumor antigen expression

With membrane-enriched fractions prepared from human metastatic breast tissue used as immunogen, a group of monoclonal antibodies (MAbs) were generated that recognized several distinct antigens on breast and other carcinomas. The antibodies were found to react with established human tumor cells in culture as well as in immunohistochemical protocols using sections of primary and metastatic lesions. One MAb, B72.3, demonstrated a high degree of selective reactivity for human carcinomas in that no reactivity was found with a large number of different normal tissues. These MAbs were used to demonstrate the heterogeneity of expression of the tumor antigens as well as the intrinsic cellular factors (i.e., cell-cycle kinetics and clonal variability) that modulate their expression. Additional studies showed that recombinant human leukocyte interferon can act as a potent regulator of surface antigen expression on human carcinoma cells. Analysis of these cells by radioimmunoassay or flow cytometry revealed that interferon treatment resulted in a higher percentage of the cell population that bind the MAb to the surface antigen. Furthermore, interferon treatment also increases the level of expression for particular tumor antigen throughout the tumor cell population. Experimental models were also developed to investigate the active localization of a radiolabeled MAb by a human tumor xenograft in athymic mice. The results demonstrate active uptake of an 125I-B6.2 by a transplantable human breast tumor that expressed significant quantities of the B6.2-reactive 90 kD tumor antigen. In contrast, a human melanoma cell line grown as a solid, subcutaneous tumor in athymic mice did not localize the labeled B6.2 and does not express the associated 90 kD antigen. We report the generation and characterization of anti-breast carcinoma MAbs. These immunologic probes were used to study relevant breast tumor antigens, the factors that influence their level of expression, and the ability of human tumors grown in athymic mice to localize radiolabeled antibodies.