Synthesis, characterization, and osteocompatibility evaluation of novel alanine-based polyphosphazenes

This study deals with the synthesis and in vitro osteocompatibility evaluation of two novel alanine-containing biodegradable ester polyphosphazenes as candidates to form self-setting composites with hydroxyapatite (HAp) precursors. The two novel biodegradable polyphosphazenes synthesized were poly[(ethyl alanato)1.0(ethyl oxybenzoate)1.0 phosphazene] (PN-EA/EOB) and poly[(ethyl alanato)1.0(propyl oxybenzoate)1.0 phosphazene] (PN-EA/POB). The polymers were characterized by multinuclear magnetic resonance (NMR), differential scanning calorimetry (DSC), and gel permeation chromatography (GPC). Biodegradability and percentage water absorption of the polymers were evaluated by following the mass change in phosphate buffer (pH 7.4) at 37 degrees C. PN-EA/POB underwent faster degradation and showed higher water absorption compared to PN-EA/EOB. Both polymers became insoluble in common organic solvents following hydrolysis presumably due to crosslinking reactions accompanying the degradation process. Osteoblast cell adhesion and proliferation on PN-EA/EOB and PN-EA/POB was followed by scanning electron microscopy (SEM) and by using a biochemical assay. Both PN-EA/EOB and PN-EA/POB supported the adhesion and proliferation of primary rat osteoblast cells in vitro. Furthermore, the enzymatic activity of the osteoblast cells cultured on the polymers was confirmed by the alkaline phosphatase activity. Thus, these biodegradable amino-acid-based polyphosphazenes are promising new materials for forming self-setting bone cements.     

Ventriculoperitoneal shunt infections

Central nervous system (CNS) shunt infection is a cause of significant morbidity, causing shunt malfunction and chronic ill health. This study was carried out to evaluate the infection rate associated with CNS shunts, assess the frequency of the pathogens as well as their antibiotic sensitivity pattern aiming at suitable prophylaxis. A retrospective analysis of 226 CSF cerebrospinal fluid (CSF) shunt procedures sent for bacteriological work up over a period of one year and six months was undertaken. Laboratory diagnosis was established by subjecting the CSF to cell count, biochemical tests, bacteriological culture and antibiotic susceptibility test. Nine out of 226(3.98%) of the CSF samples were culture positive. Coagulase negative Staphylococcus was the most common isolate accounting for 36.36%. Majority of the isolates were sensitive to the thirdgeneration cephalosporins and quinolones. The antibiotic sensitivity pattern suggests cephalosporins and quinolones to be a better choice of antibiotics either prophylactically or therapeutically, which may result in effective and rapid sterilisation of the CSF.     

Serodiagnosis of dengue virus infection in patients presenting to a tertiary care hospital

Dengue is an acute infectious disease of viral etiology. It is probably one of the most important arthropod borne viral disease in terms of human morbidity and mortality. The spectrum of disease ranges from self-limited dengue fever to more severe forms of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Laboratory diagnosis of dengue virus infection mainly depends on detection of virus specific antibodies. The aim of the study was to correlate the serological results with clinical presentation in patients with a diagnosis of dengue. Eleven out of 15 (73.3%) patients with DHF and DSS had secondary antibody response and mortality was 100% in these patients.     

Critical care 24 × 7: But,why is critical nutrition interrupted?

Background and Aims:

Adequate nutritional support is crucial in prevention and treatment of malnutrition in critically ill-patients. Despite the intention to provide appropriate enteral nutrition (EN), meeting the full nutritional requirements can be a challenge due to interruptions. This study was undertaken to determine the cause and duration of interruptions in EN.

Materials and Methods:

Patients admitted to a multidisciplinary critical care unit (CCU) of a tertiary care hospital from September 2010 to January 2011 and who received EN for a period >24 h were included in this observational, prospective study. A total of 327 patients were included, for a total of 857 patient-days. Reasons and duration of EN interruptions were recorded and categorized under four groups-procedures inside CCU, procedures outside CCU, gastrointestinal (GI) symptoms and others.

Results:

Procedure inside CCU accounted for 55.9% of the interruptions while GI symptoms for 24.2%. Although it is commonly perceived that procedures outside CCU are the most common reason for interruption, this contributed only to 18.4% individually; ventilation-related procedures were the most frequent cause (40.25%), followed by nasogastric tube aspirations (15.28%). Although GI bleed is often considered a reason to hold enteral feed, it was one of the least common reasons (1%) in our study. Interruption of 2-6 h was more frequent (43%) and most of this (67.1%) was related to “procedures inside CCU”.

Conclusion:

Awareness of reasons for EN interruptions will aid to modify protocol and minimize interruptions during procedures in CCU to reach nutrition goals.     

The influence of side group modification in polyphosphazenes on hydrolysis and cell adhesion of blends with PLGA

Polyphosphazenes have been synthesized with tris(hydroxymethyl)amino methane (THAM) side groups and with co-substituents glycine ethyl ester and alanine ethyl ester. The THAM side group was linked to the polyphosphazene backbone via the amino function. The three pendent hydroxyl functions on each THAM side group were utilized for hydrogen bonding association with poly(glycolic–lactic acid) (PLGA). Co-substitution of the polyphosphazene with both THAM and glycine or alanine ethyl esters was employed to avoid the insolubility of the single-substituent THAM-substituted polyphosphazenes. Both poly[(tris(hydroxymethyl)aminomethane)(ethyl glycinato)phosphazene] and poly[(tris(hydroxymethyl)aminomethane)(ethyl alanato)phosphazene] (1:1 ratio of side groups) were blended with PLGA (50:50) or PLGA (85:15). DSC analysis indicated miscible blend formation, irrespective of the detailed molecular structure of the polyphosphazene or the composition of PLGA in the blend. Hydrolysis studies of the polyphosphazene:PLGA (50:50) blends indicated that the PLGA component hydrolyzed more rapidly than the polyphosphazene. Primary osteoblast cell studies showed good cell adhesion to the polymer blends during 14 days, but subsequent limited cell spreading due to increased surface roughness as the two polymers eroded at different rates.     

Parallel detection of lactobacillus and bacterial vaginosis-associated bacterial DNA in the chorioamnion and vagina of pregnant women at term

Background: The majority of early preterm births are associated with intrauterine infections, which are thought to occur when microbes traffic into the uterus from the lower genital tract and seed the placenta. Bacterial vaginosis (BV) is associated with heterogeneous bacterial communities in the vagina and is linked to preterm birth. The extent to which trafficking into the uterus of normal and BV-associated vaginal bacteria occurs is unknown. The study objective was to characterize in parallel the distribution and quantities of bacteria in the vagina, uterus, and placental compartments.

Methods: Pregnant women at term (≥37 weeks) presenting for delivery were recruited prospectively. Swabs were collected in parallel from the vagina, chorioamnion. Choriodecidual swabs were collected if a cesarean section was performed. Samples were analyzed by culture, broad-range 16S rRNA gene PCR, and bacterial species-specific quantitative PCR (qPCR) for DNA from Lactobacillus and a panel of BV-associated bacteria. Results were correlated with placental histopathology.

Results: Of the 23 women enrolled, 15 were delivered by cesarean section (N?=?10 without labor; N?=?5 in labor) and eight were delivered vaginally. BV was diagnosed in two women not in labor. Placental histopathology identified chorioamnionitis or funisitis in six cases [1/10 (10%) not in labor; 5/13 (38%) in labor]. Among non-laboring women, broad-range 16S qPCR detected bacteria in the chorioamnion and the choriodecidua (4/10; 40%). Among laboring women, Lactobacillus species were frequently detected in the chorioamnion by qPCR (4/13; 31%). In one case, mild chorioamnionitis was associated with qPCR detection of similar microbes in the chorioamnion and vagina (e.g. Leptotrichia/Sneathia, Megasphaera), along a quantitative gradient.

Conclusions: Microbial trafficking of lactobacilli and fastidious bacteria into the chorioamniotic membranes and choriodecidua occurs at term in normal pregnancies. In one case, we demonstrated a quantitative gradient between multiple bacterial species in the lower genital tract and placenta. Not all bacterial colonization is associated with placental inflammation and clinical sequelae. Further studies of the role of placental colonization with Lactobacillus in normal pregnancy and fastidious bacteria in chorioamnionitis may improve prevention and treatment approaches for preterm labor.     

Activation of Src/kinase/phospholipase C/mitogen-activated protein kinase and induction of neurite expression by ATP, independent of nerve growth factor

Extracellular ATP has been reported to potentiate the neurite outgrowth induced by nerve growth factor. In the present study the neurotrophic effect of ATP and other nucleotides was examined in mouse neuroblastoma neuro2a cells which lack nerve growth factor receptor. Exposure of neuro2a cells to ATP resulted in a dramatic increase in neurite bearing cells as compared with untreated control cells. Experiments performed with purinergic receptor agonists and antagonists suggest that the ATP stimulates neurite outgrowth via P2 receptors. Neurite outgrowth was completely blocked by P2 receptor antagonist suramin whereas the P1 receptor antagonist CGS15943 was ineffective. P1 receptor agonist 5'-(N-ethylcarboxamido)adenosine failed to induce neurite outgrowth. The potency order of different P2 receptor agonists was ATP=ATPgammaS>ADP>2Me-S-ATP. It was insensitive to UTP and antagonist pyridoxal phosphate-6-azo (benzene-2,4-disulfonic acid) suggesting the involvement of P2Y11 receptor in the observed neuritogenic effect. The signaling pathway leading to ATP-induced neuritogenesis was investigated. The neuritogenic effect of ATP is independent of rise in intracellular Ca(2+) as pharmacological profile of neuritogenic P2Y receptor does not match with that of P2Y2 receptor associated with [Ca(2+)](i) signaling cascade. Exposure of cells to ATP caused activation of Src kinase, phospholipase Cgamma and extracellular signal-regulated kinases ERK1/2. Mitogen-activated protein kinase (MAPK) inhibitor U0126 drastically reduced the number of neurite bearing cells in ATP-treated cultures implying that the neurotrophic effect of ATP is mediated by MAPK. Our results demonstrate that ATP can stimulate neurite outgrowth independent of other neurotrophic factors and can be an effective trophic agent.