Vergleichende Untersuchung von niedermolekularem Dextranoder Hydroxyäthylstärkelösungen als Volumenersatzmittel bei Hämodilutionstherapie

Summary Rheological therapy, as an immediate treatment in conjunction with physical therapy and the removal of risc factors, plays a significant role in the management of patients with peripheral vascular disease experiencing reduced walking tolerance. An essential element of rheological therapy is hemodilution. Currently, is still uncertain which plasma substitute solution would be the most appropriate in such cases. This study compared the effectiveness of low molecular hydroxyethyl starch to low molecular dextran during a 16-day hemodilution in combination to physical therapy. The clinical improvement observed with both plasma substitute solutions was comparable, yet in view of the cardiac volume overload, dextran demonstrates greater circulatory stress due to the transient pressure increase and more side effects. For this reason, we prefer to administer low or middle molecular hydroxyethyl starch in the dilution treatment of peripheral arterial occlusive disease as a chronic degenerative vascular disease.

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Abkürzungen A2M Alpha-2-Makroglobulin - D0 Meßzeitpunkt 0 der später mit Dextran behandelten Gruppe - D1 Meßzeitpunkt 1 der Dextran-Gruppe - D2 Meßzeitpunkt 2 der Dextran-Gruppe - Dextran 40 kleinmolekulares Dextran (mittleres Molekulargewicht 40000 Dalton) - ETA Plasmaviskosität - Fib Fibrinogen - Geh Gehstrecke - H0 Meßzeitpunkt 0 der später mit Hydroxyäthylstärke behandelten Gruppe - H1 Meßzeitpunkt 1 der HAES-Gruppe - H2 Meßzeitpunkt 2 der HAES-Gruppe - HAES 40 kleinmolekulare Hydroxyäthylstärke (mittleres Molekulargewicht 40000 Dalton) - Hkt Hämatokrit - LZ Leukozyten-Zahl - Pro Gesamteiweiß - SEA Erythrozyten-Aggregationsindex - SER Erythrozyten-Rigiditätsindex - TY Fließschubspannung - TZ Thrombozyten-Zahl     

Roberts铜盐法测定蔗汁葡聚糖含量的热效应——淀粉对受热蔗汁葡聚糖测定的影响

作者从研究中发现:用Roberts铜盐法测定蔗汁样本葡聚糖含量时,所得结果与蔗汁的受热有关,受热蔗汁的测定值高于真实值,作者将这种现象暂称为Roberts铜盐法测定蔗汁样本葡聚糖含量的热效应。研究表明:蔗汁中的淀粉是引起热效应的重要因素。本文最后提出了一种由淀粉引起的热效应的可行校正方法。     

Enhanced film-forming properties for ethyl cellulose and starch acetate using n-alkenyl succinic anhydrides as novel plasticizers

Purpose: The aim of this study was to investigate the ability of n-alkenyl succinic anhydrides (n-ASAs) to improve the film-forming characteristics of a novel coating polymer, potato starch acetate degree of substitution 2.8 (SA). n-ASAs were also applied to improve the otherwise brittle properties of ethyl cellulose (EC) aqueous dispersion (Aquacoat^®) and EC solvent-based films. Methods: The effectiveness of two n-ASAs, 2-octenyl succinic anhydride (OSA) and 2-dodecen-1-ylsuccinic anhydride were evaluated as plasticizers. Mechanical properties, both water vapor and drug permeabilities, and glass transition temperatures of the cast free films were measured. Triethyl citrate and dibutyl sebacate were used as reference plasticizers. Results: The long hydrocarbon chain of n-ASA, with its accessible carbonyl groups, enabled a strong plasticization effect on the tested polymers. Due to the excellent mechanical properties (i.e., a tough film structure with considerable flexibility) and low permeability of the plasticized films, n-ASAs, and especially OSA proved to be an ideal plasticizer particularly for EC based coatings. Also, the EC aqueous dispersion plasticized with n-ASAs resulted in a markedly enhanced coalescence of the colloidal polymer particles, even at low drying temperatures. Conclusions: In applications where a coating with high flexibility is required, n-ASAs can be used as plasticizers at moderately high concentrations (up to 60–70%, w/w) without losing the high tensile strength, excellent toughness and low permeability of EC and SA films.     

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

Background and aimsIn type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients’ diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.Methods and resultsFor this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System.Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140–180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.ConclusionOne week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control.Registration numberin clinicaltrials.gov: NCT 03289494.     

Starch Gelatinization Under Thermal Stress

The behavior under thermal stress of starch dispersed in water was studied by differential scanning calorimetry (DSC) to estimate the heat transported through the aqueous medium in gelatinization, and to characterize the range of gelatinization temperatures. In DSC scanning mode, the endotherm of 10% starch in aqueous dispersion showed the tracing of gelatinization at between 67 and 80°C, having an onset at approximately 69°C. In the isothermal mode, characteristically distinct isothermal heat flow profiles were revealed. It was hypothesized that the thermal influx proposed as being analogous to the diffusion process may affect the profiles. The profiles were transformed and nonlinearly fitted according to the square root of time model to characterize a so-called t-parameter, which was related to mean square displacement of molecular distribution. The t-parameter of starch in excess of water decreased compared to that of water only. The plot of difference in these t-parameters, expressed as Δ, against temperature showed a dramatically decreased Δ at the temperature between 66.7 and 75.2°C, which coincided with the findings from scanning mode DSC. It was further hypothesized that the decreased Δ may be due to the gelatinizing process. According to the theory of polymer solution, the critical temperature (Θ) at 75.2°C, where the free energy became theoretically negative, i.e., the starch became spontaneously dissolved, was drawn. This Θ was located within the range of gelatinizing temperatures. It was deduced that starch polymer may have dissolved during gelatinization. The dissolution from acetaminophen tablets prepared by starch paste was lower compared with that of negative controls (without paste). Moreover, the paste prepared at gelatinizing temperature (70°C) seemed to inhibit acetaminophen dissolution from tablet matrices more than that prepared at subgelatinizing temperature (50°C).     

Simple versus complex carbohydrates and health: A frequently neglected problem

AimsFor several decades, there has been a notion that dietary fat is made of different components (at least SAFA, MUFA, and PUFA) that exhibit different and sometimes contrasting effects when associated with health and diseases: coronary heart disease (CHD) and cardiovascular diseases (CVD) in general. A similar fact is not noticed in carbohydrates and their components considering that even some major recent studies on the issue did not segregate simple carbohydrates from complex carbohydrates. In this study, we aimed to stress this need.Data synthesisA small number of selected studies are presented and commented where segregation of simple from complex carbohydrates was either performed or disregarded to address the inconsistency of not disentangling them.ConclusionsIf only total fats were considered in investigations where fat was studied, the present notion and attitude toward different roles of the various classes of fats, at least SAFA versus unsaturated (MUFA and PUFA) would be missing. Therefore, there is a need to disentangle simple from complex carbohydrates, and this should be systematically applied when addressing CHD or CVD mortality risks and their preventive measures.     

Starch-encapsulated chlorpyrifos: release rate,insecticidal activity and degradation in soil

Incorporation of chlorpyrifos into starch matrices was achieved by thermal gelatinization. The level of amylose content in the starch matrices (10 and 52%) and the addition of auxiliary agents, i.e. solvent, emulsifiers or both, were varied and eight different formulations were prepared. According to differential scanning calorimetry (DSC) and X-ray diffraction measurements, chlorpyrifos was partly present in a crystalline form in all the starch formulations. The formulations had controlled release properties, and the release rate into water could be described by a linear model. In a bioassay, the formulations killed all larvae of the cabbage root fly at a dosing of 1.4 kg a.i. per ha. The degradation of chlorpyrifos in soil from the starch formulations could be described in a nonlinear logistic model and the half-life was predicted to be 88 days. Differences in the amount of amylose in the starch as well as the addition of solvent and emulsifiers in the preparation procedure had no systematic influence on the release rate, the insecticidal effect and the degradation rate. No correlation between release rate into water and degradation in soil could be established. Two commercial chlorpyrifos formulations Lorsban#174; 15 G (granular) and Cyfos#174; 500 gl -1 (emulsifiable concentrate), were included in the study for comparison.     

Impact of low-starch high-fiber pasta on postprandial blood glucose

Background and aimsAlmost all of the energy in noodle dishes is derived from carbohydrates, particularly starch. Recently, we invented a pasta with reduced starch content to about 50% and increased dietary fiber content, designated low-starch high-fiber pasta (LSHFP). In this study, we investigated the ingestion of LSHFP on the postprandial glucose response as a breakfast meal.Methods and resultThis was a randomized, single-blinded, crossover study. The postprandial glucose area under the curve for 4 h (4h-gluAUC), as the primary outcome, and the extent of postprandial glucose elevation (maxΔBG) were evaluated using a continuous glucose monitoring system in healthy volunteers and patients with type 2 diabetes (T2DM) after intake of LSHFP, standard pasta (SP), and rice. The amount of total carbohydrate was matched between LSHFP and SP. Ten individuals with T2DM and 10 individuals who did not have T2DM and were otherwise healthy were enrolled in this crossover study. The 4h-gluAUC for LSHFP (137.6 ± 42.2 mg/dL?h) was significantly smaller than the 4h-gluAUC for rice (201.7 ± 38.7 mg/dL?h) (p = 0.001) and SP (178.5 ± 59.2 mg/dL?h) (p = 0.020). The maxΔBG for rice (118.6 ± 24.2 mg/dL) was significantly higher than those for SP (87.5 ± 19.9 mg/dL) (p < 0.001) and LSHFP (72.7 ± 26.2 mg/dL) (p = 0.001), while the maxΔBG for LSHFP (p = 0.047) was significantly lower than that for SP, in T2DM patients as well as in healthy participants.ConclusionsThis study demonstrated that LSHFP can reduce postprandial glucose elevation compared with SP in both healthy participants and patients with T2DM.     

Hydroxyethyl starch is an alternative washing solution for peripheral bloodstem cells products

Cryopreservation of hematopoietic stem cells (HSC) involves slow rate cooling in the presence of a cryoprotectant (DMSO) to avoid the damaging effects of intracellular ice formation. The infusion of DMSO with the thawed product has been related to adverse events. Reduction of DMSO content by washing the HSCs after thawing has been suggested as a method to avoid infusion-related side-effects. Albumin-dextran washing methods have proved useful in thawing HSC products. Dextran40 shortages prompted us to search for suitable alternatives. We report the results of a comparative study of the use of hydroxyethyl starch (HES) as an alternative to dextran40 for washing thawed HSCs products. A total of 10 HSC bags cryopreserved with 10 % DMSO were used. We conducted a paired study; one of the bags was thawed and washed with our standard washing solution (Dextran 40) and the paired bag with HES solution with a final HES and Human Serum Albumin (HSA) concentration of 2.4 % and 4.2 % respectively. Each final product was tested immediately after washing (sample 0’) and after 90 min (sample 90’) for total nucleated cells (TNC) recovery, acridine orange viability, viable CD34+ enumeration, and clonogenicity. No significant difference was found for any of the cell counts, viability tests, cell recovery, or potency. We can state that the washing solution based on 2.4 % HES and 4.2 % HSA is equivalent to that used in our routine practice. Therefore, we could use the solution with HES, paying special attention to the renal function of the recipient.     

羟乙基淀粉注射液致急性肾损伤的危险因素分析

目的 探讨羟乙基淀粉注射液致急性肾损伤（AKI）的危险因素,为临床安全用药提供参考。方法 回顾性分析2015年1月—2019年3月衡水市人民医院86例羟乙基淀粉注射液致AKI和同期使用羟乙基淀粉注射液但未发生AKI的767例患者的临床资料,采用单因素（χ²检验）及多因素（Logistic回归）对肾毒性危险因素进行分析。结果 AKI是羟乙基淀粉注射液严重不良反应之一,发生率为10.08%。单因素分析显示,体重指数、低蛋白血症、肌酐清除率、合并肾毒性药物、术中出血量、日剂量和用药时间与羟乙基淀粉肾毒性相关;多因素分析显示,日剂量（≥14 mL/kg）、肌酐清除率（<30mL/min）、用药时间（≥5 d）、术中出血量（>3 000 mL）、合并肾毒性药物和低蛋白血症（ALB<30 mL/L）是羟乙基淀粉130/0.4氯化钠注射液致AKI的独立危险因素。所有患者停药或经相关治疗后肾功能均逐渐恢复。结论 日剂量偏大、肾功能不全、长时间用药、术中出血量偏大、合并肾毒性药物和低蛋白血症是羟乙基淀粉致AKI的独立危险因素,临床中重点关注有独立危险因素的患者,以保证临床安全用药。