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Xu F, Zhang Q, Xuan D, Zhao S, Wang Y, Han L, Huang S, Zhu H, Wang T, Chen X. Daytime variation in non-cardiac surgery impacts the recovery after general anesthesia. Ann Med 2023; 55:1134-1143. [PMID: 36947128 PMCID: PMC10035960 DOI: 10.1080/07853890.2023.2187875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Circadian rhythm involved with physiology has been reported to affect pharmacokinetics or pharmacodynamics. We hypothesized that circadian variations in physiology disturb anesthesia and eventually affect recovery after anesthesia. METHODS A retrospective cohort study initially included 107,406 patients (1 June 2016-6 June 2021). Patients were classified into morning or afternoon surgery groups. The primary outcome was daytime variation in PACU (post-anesthesia care unit) recovery time and Steward score. Inverse probability weighting (IPW) approach based on propensity score and univariable/multivariable linear regression were used to estimate this outcome. RESULTS Of 28,074 patients, 13,418 (48%) patients underwent morning surgeries, and 14,656 (52%) patients underwent afternoon surgeries. LOWESS curves and IPW illustrated daytime variation in PACU recovery time and Steward score. Before adjustment, compared to morning surgery group, afternoon surgery group had less PACU recovery time (median [interquartile range], 57 [46, 70] vs. 54 [43, 66], p < 0.001) and a higher Steward score (5.62 [5.61, 5.63] vs. 5.66 [5.65, 5.67], p < 0.001). After adjustment, compared to morning surgery group, afternoon surgery group had less PACU recovery time (58 [46, 70] vs. 54 [43, 66], p < 0.001). In multivariable linear regression, morning surgery is statistically associated with an increased PACU recovery time (coefficient, -3.20; 95% confidence interval, -3.55 to -2.86). Among non-cardiac surgeries, daytime variation might affect recovery after general anesthesia. These findings indicate that the timing of surgery improves recovery after general anesthesia, with afternoon surgery providing protection.KEY MESSAGESIn this retrospective cohort study of 28,074 participants, the afternoon surgery group has a higher Steward score than the morning surgery group.In multivariable linear regression, morning surgery is statistically associated with an increased PACU recovery time.Among non-cardiac surgeries, daytime variation affects the recovery after general anesthesia, with afternoon surgery providing protection.
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Affiliation(s)
- Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingtong Zhang
- Department of Anesthesiology, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an People's Hospital, Lu'an, China
| | - Dongsheng Xuan
- Department of Anesthesiology, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an People's Hospital, Lu'an, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linlin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyu Zhu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhang Q, Xu F, Xuan D, Huang L, Shi M, Yue Z, Luo D, Duan M. Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study. Int J Surg 2023; 109:1281-1290. [PMID: 37074025 PMCID: PMC10389494 DOI: 10.1097/js9.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/12/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Delayed recovery in the postanesthesia care unit (PACU) after surgery, as a severe occurrence, influences enhanced recovery after surgery. The data from the observational clinical study is a paucity. MATERIALS AND METHODS This large, retrospective, and observational cohort study initially included 44 767 patients. The primary outcome was risk factors for delayed recovery in PACU. A generalized linear model and nomogram were employed to identify risk factors. Discrimination and calibration were used to evaluate the performance of the nomogram via internal and external validation. RESULTS Of 38 796 patients, 21 302 (54.91%) were women. The delayed recovery aggregate rate was 1.38% [95% CI, (1.27, 1.50%)]. In a generalized linear model, risk factors for delayed recovery were old age [RR, 1.04, 95% CI, (1.03,1.05), P <0.001], neurosurgery [RR, 2.75, 95% CI, (1.60, 4.72), P <0.001], using antibiotics during surgery [RR, 1.30, 95% CI, (1.02, 1.66), P =0.036], long anesthesia duration [RR, 1.0025, 95% CI, (1.0013, 1.0038), P <0.001], ASA grade of III [RR, 1.98, 95% CI, (1.38, 2.83), P <0.001], and postoperative analgesia [RR, 1.41, 95% CI, (1.10, 1.80), P =0.006]. In the nomogram, old age and neurosurgery had high scores in the model and contributed significantly to the increased probability of delayed recovery. The area under the curve value of the nomogram was 0.77. The discrimination and calibration of the nomogram estimated by internal and external validation were generally satisfactory. CONCLUSION This study demonstrates that delayed recovery in PACU after surgery was associated with old age, neurosurgery, long anesthesia duration, an ASA grade of III, using antibiotics during surgery, and postoperative analgesia. These findings provide predictors of delayed recovery in PACU, especially neurosurgeries and old age.
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Affiliation(s)
- Qingtong Zhang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongsheng Xuan
- Department of Anesthesiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an People’s Hospital, Lu’an
| | - Li Huang
- Department of Anesthesiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an People’s Hospital, Lu’an
| | - Min Shi
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Zichuan Yue
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Dongxue Luo
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Manlin Duan
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province
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Hong D, Bazhenova L, Cho B, Sen S, Ponz-Sarvise M, Heist R, Zimmerman Z, Le X, Xuan D, Junming Z, Lee J. First-in-human safety, pharmacokinetics, and preliminary efficacy of TPX-0022, a novel inhibitor of MET/SRC/CSF1R in patients with advanced solid tumors harboring genetic alterations in MET. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31074-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brock MS, Mysliwiec V, Germain A, Fullam T, Xuan D, Sidari L, Cleaves E, Jackson C, Willis A, Park J, Mansfield J, Weidlich C, Malone R, Burson R. 0404 A Novel Approach to Sleep Disturbances in the Inpatient Psychiatric Setting: Video-Based Cognitive Behavioral Therapy for Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M S Brock
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - V Mysliwiec
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - A Germain
- University of Pittsburgh School of Medicine, Departments of Psychiatry and Psychology, Pittsburgh, PA
| | - T Fullam
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - D Xuan
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - L Sidari
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - E Cleaves
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - C Jackson
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - A Willis
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - J Park
- Science and Technology Division, 59th Medical Wing, JBSA-Lackland, TX
| | - J Mansfield
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - C Weidlich
- San Antonio Military Health System, JBSA-Lackland AFB, TX
| | - R Malone
- Science and Technology Division, 59th Medical Wing, JBSA-Lackland, TX
| | - R Burson
- San Antonio Military Health System, JBSA-Lackland AFB, TX
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Ming-liang C, Cong W, Xuan D, Lu L, Tang-jie Z. A Novel Polymorphism of VLDLR Signal Peptide Coding Region and Its Association with Growth and Abdominal Fat Traits of Gaoyou Domestic Ducks. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1806-9061-2016-0272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - W Cong
- Yangzhou University, China
| | - D Xuan
- Yangzhou University, China
| | - L Lu
- Yangzhou University, China
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Sachdev J, Maitland M, Sharma M, Moreno V, Boni V, Kummar S, Gibson B, Xuan D, Joh T, Powell E, Jackson-Fisher A, Damelin M, Xin X, Tolcher A, Calvo E. A phase 1 study of PF-06647020, an antibody-drug conjugate (ADC) targeting protein tyrosine kinase 7 (PTK7), in patients with advanced solid tumors including platinum resistant ovarian cancer (OVCA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen X, Haddish-Berhane N, Moore P, Clark T, Yang Y, Li H, Xuan D, Barton HA, Betts AM, Barletta F. Mechanistic Projection of First-in-Human Dose for Bispecific Immunomodulatory P-Cadherin LP-DART: An Integrated PK/PD Modeling Approach. Clin Pharmacol Ther 2016; 100:232-41. [DOI: 10.1002/cpt.393] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- X Chen
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Cambridge Massachusetts USA
| | - N Haddish-Berhane
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
- Current Address: Clinical Pharmacology and Pharmacometrics; Quantitative Sciences Janssen Pharmaceuticals, Spring House, Pennsylvania USA
| | - P Moore
- MacroGenics; Rockville; Maryland USA
| | - T Clark
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - Y Yang
- MacroGenics; Rockville; Maryland USA
| | - H Li
- MacroGenics; Rockville; Maryland USA
| | - D Xuan
- Clinical Pharmacology; Pfizer; San Diego California USA
| | - HA Barton
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - AM Betts
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - F Barletta
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Pearl River New York USA
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Luo S, Yang X, Wang D, Ni J, Wu J, Xu Z, Xuan D, Zhang J. Periodontitis contributes to aberrant metabolism in type 2 diabetes mellitus rats by stimulating the expression of adipokines. J Periodontal Res 2015; 51:453-61. [PMID: 26456152 DOI: 10.1111/jre.12322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- S. Luo
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - X. Yang
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - D. Wang
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - J. Ni
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - J. Wu
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - Z. Xu
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - D. Xuan
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
| | - J. Zhang
- Department of Periodontology; Guangdong Provincial Stomatological Hospital; Southern Medical University; Haizhu District Guangzhou China
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Tolcher A, Calvo E, Maitland M, Gibson B, Xuan D, Joh T, Jackson-Fischer A, Damelin M, Barton J, Xin X, Sachdev J. 28LBA A phase 1 study of PF-06647020, an antibody-drug conjugate targeting PTK7, in patients with advanced solid tumors. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31946-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Xuan J, Wang L, Xuan D, Zhou Y, Hu S. Evaluation of Cost Effectiveness of OM-85 in China. Value Health 2014; 17:A779. [PMID: 27202888 DOI: 10.1016/j.jval.2014.08.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Xuan
- Fudan University, School of Public Health, Shanghai, China
| | - L Wang
- Second Military Medical University, Shanghai, China
| | - D Xuan
- Vanderbilty University, Nashville, TN, USA
| | - Y Zhou
- Shanghai Centennial Scientific Ltd, Shanghai, China
| | - S Hu
- Shanghai Bureau of Health, Shanghai, China
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Su Y, Wang D, Xuan D, Ni J, Luo S, Xie B, Zhang J. Erratum: “Periodontitis as a Novel Contributor of Adipose Tissue Inflammation Promotes Insulin Resistance in a Rat Model”. J Periodontol 2014. [DOI: 10.1902/jop.2014.146002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Xuan D, Xiao-Xing L, Chun-Lin H, Hong-Yan W, Xin L, Hong Z. e0006 Effects of neotype peritoneal cooling on the injured of intestinal mucous after cardiopulmonary resuscitation in rabbits. Heart 2010. [DOI: 10.1136/hrt.2010.208967.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Xuan D, Turley C, Nightingale CH, Nicolau DP. Determination of BMS-284756, a new quinolone, in mouse serum by high-performance liquid chromatography with fluorescence detection. J Chromatogr B Biomed Sci Appl 2001; 765:37-43. [PMID: 11817308 DOI: 10.1016/s0378-4347(01)00394-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A sensitive, simple, and accurate method for determination of BMS-284756, a novel des-F(6)-quinolone antimicrobial agent in mouse serum was developed by HPLC with fluorescence detection. Sample preparations were carried out by protein precipitation with the addition of acetonitrile, followed by evaporation of the acetonitrile to dryness. The resultant residual was then reconstituted in 0.01 M HCl and injected onto a Nucleosil 100 10 microm, C18 25 cm x 4.6 mm analytical column. The mobile phase consisted of acetonitrile-0.01 M NaH2PO4 (20:80, v/v) with 0.01 M tetrabutylammonium hydrogen sulfate. The fluorescence of the column effluent was monitored at an excitation wavelength of 290 nm and an emission wavelength of 418 nm. The assay was shown to be linear from 0.2 to 10.0 microg/ml (R2=0.998). Mean recovery was determined as 95.1%. Inter- and intra-assay precisions were <6% RSD. The HPLC method developed has been applied to determine the pharmacokinetics of BMS-284756 in a murine bacterial infection model.
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Affiliation(s)
- D Xuan
- Department of Pharmacy Research, Hartford Hospital, CT 06102, USA.
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Kim MK, Xuan D, Quintiliani R, Nightingale CH, Nicolau DP. Pharmacokinetic and pharmacodynamic profile of high dose extended interval piperacillin-tazobactam. J Antimicrob Chemother 2001; 48:259-67. [PMID: 11481298 DOI: 10.1093/jac/48.2.259] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A multiple-dose, open-labelled, randomized, two period crossover human volunteer study was performed (i) to describe the pharmacokinetic profile and safety profile of piperacillin and tazobactam (P/T) administered 6.0/0.75 g and 8.0/1.0 g q12h and (ii) to characterize the pharmacodynamic profile of these regimens against a variety of common targeted pathogens. Blood samples were collected after the third dose and concentrations of P/T were determined by a validated high-performance liquid chromatography assay. Pharmacokinetic profiles of P/T were determined by non-compartment analysis. Percentage time above the MIC (%T > MIC) of piperacillin was calculated for a range of MICs. In this study, no adverse events were attributed after multiple administrations of either 6.0/0.75 g or 8.0/1.0 g dose regimens. The peak concentration, half-life and area under the curve (AUC0-(0-tau)) of piperacillin were significantly different by a paired t-test (P < 0.05) between the two study regimens. The trough concentration, half-life and area under the curve (AUC0-(0-tau)) of tazobactam were substantially different from parameters reported previously for conventional regimens. The 8.0/1.0 g regimen provided 50% T > MIC for MICs < or =32 mg/L, while a similar value for the 6.0/0.75 g regimen was < or = 16 mg/L. High-dose P/T regimens with extended interval were well tolerated and provide adequate dynamic exposure for a variety of susceptible pathogens.
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Affiliation(s)
- M K Kim
- Department of Pharmacy Research, Division of Infectious Diseases and Office of Research, Hartford Hospital, Hartford, CT 06102, USA
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Mattoes HM, Banevicius M, Li D, Turley C, Xuan D, Nightingale CH, Nicolau DP. Pharmacodynamic assessment of gatifloxacin against Streptococcus pneumoniae. Antimicrob Agents Chemother 2001; 45:2092-7. [PMID: 11408228 PMCID: PMC90605 DOI: 10.1128/aac.45.7.2092-2097.2001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pharmacodynamic parameters of peak serum drug concentration/MIC (peak/MIC) ratio and the area under the curve (AUC)/MIC ratio have been used to characterize in vivo drug exposure and its relationship to bacterial killing for the fluoroquinolones. Our study objectives were to describe the pharmacodynamic relationship between gatifloxacin exposure and outcome as assessed by bacterial density and survival in an immunocompromised murine thigh model of pneumococcal infection and to assess the relationship between drug exposure and these outcomes in an immunocompetent host. ICR mice were rendered neutropenic, and thigh infection was induced by intramuscular administration of 0.1 ml of 10(5) to 10(7) CFU of Streptococcus pneumoniae/ml. Mice received 1 to 5 mg of uranyl nitrate/kg of body weight at day -3 and were randomized to receive 10 to 80 mg of gatifloxacin/kg every 6 to 24 h orally, starting at 2 h postinoculation. Bacterial density studies were completed 24 h after initiation of therapy, and survival was assessed after 4 days of treatment. MICs for clinical isolates (n = 8) ranged from 0.25 to 1.0 microg/ml. Correlations were assessed between the change in bacterial density, as well as survival, and the AUC/MIC ratio, peak/MIC ratio, and the duration of time that serum drug concentration remained above the MIC. The best predictor of bacterial response was the AUC/MIC ratio for both outcome measures. There was greater efficacy, as measured by a decrease in log change in CFU as well as by survival data, in the immunocompetent mice compared to the immunocompromised mice. These data demonstrate (i) the appropriateness of the AUC/MIC ratio as a dynamic predictor of response to pneumococcal infection for the fluoroquinolones, (ii) that gatifloxacin AUC/MIC ratios of 30 to 40 appear to optimize bactericidal activity and survival in this model, and (iii) that immunocompetency of the host plays a role in efficacy.
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Affiliation(s)
- H M Mattoes
- Department of Pharmacy Research, Hartford Hospital, Hartford, Connecticut 06102, USA
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Xuan D, Nicolau DP, Nightingale CH, Quintiliani R. Circulating tumor necrosis factor-alpha production during the progression of rat endotoxic sepsis. Chemotherapy 2001; 47:194-202. [PMID: 11306788 DOI: 10.1159/000063221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The endotoxin-mediated tumor necrosis factor-alpha (TNF-alpha) induction was investigated in a rat endotoxin septic shock model. Rats were challenged intravenously with lethal doses of endotoxin. Circulating endotoxin and TNF-alpha concentrations were measured over various times following endotoxin administration. A derivative of human immunoglobulin G, 5S-IgG, was administered at various times relative to endotoxin dosing to test its anti-endotoxin activity. Results showed that endotoxin challenge initiated substantial amounts of TNF-alpha release into the rat circulatory system leading to death. A temporal pattern of TNF-alpha increases following endotoxin administration was observed; the rat plasma TNF-alpha level rapidly increased 60 min after endotoxin injection, peaked around 120 min and returned to low levels by 240 min. A rapid clearance pattern of endotoxin was also observed in rats. 5S-IgG exhibited its moderate anti-endotoxin activity by partially suppressing the endotoxin-mediated TNF-alpha release and decreasing the overall mortality only when given before triggering of TNF-alpha induction. However, this inhibitory effect of 5S-IgG on endotoxin-mediated TNF-alpha release and the resultant protective effect against endotoxin lethality rapidly diminished when 5S-IgG was administered after the occurrence of TNF-alpha induction. Collectively, these results suggest that the timing of the anti-endotoxin treatment is critical in achieving its effectiveness and imply that the endotoxin levels after the onset of the cytokine cascade is of questionable significance.
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Affiliation(s)
- D Xuan
- Department of Pharmacy Research, Hartford Hospital, Hartford, Conn 06102, USA.
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Xuan D, Zhong M, Mattoes H, Bui KQ, McNabb J, Nicolau DP, Quintiliani R, Nightingale CH. Streptococcus pneumoniae response to repeated moxifloxacin or levofloxacin exposure in a rabbit tissue cage model. Antimicrob Agents Chemother 2001; 45:794-9. [PMID: 11181363 PMCID: PMC90376 DOI: 10.1128/aac.45.3.794-799.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The role of moxifloxacin and levofloxacin pharmacokinetics (PK) in antimicrobial efficacy and in the selection of fluoroquinolone-resistant Streptococcus pneumoniae strains was investigated using the rabbit tissue cage abscess model. A rabbit tissue cage was created by insertion of sterile Wiffle balls in the dorsal cervical area. Animals orally received a range of moxifloxacin or levofloxacin doses that simulate human PK for 7 days 48 h after the Wiffle balls were inoculated with fluoroquinolone-sensitive S. pneumoniae (10(7) CFU). Abscess fluid was collected on a daily basis over 14 days to measure bacterial density and MICs. Moxifloxacin regimens produced a range of area under the concentration-time curve (AUC)/MIC ratios ranging from 9.2 to 444 and peak/MIC ratios ranging from 1.3 to 102. Levofloxacin doses produced AUC/MIC ratios of 5.1 to 85.5 and peak/MIC ratio of 0.9 to 14.8. Moxifloxacin at 6.5, 26, and 42 mg/kg reduced the bacterial log CFU per milliliter in abscess fluid (percentage of that in a sterile animal) by 4.2 +/- 2.2 (20%), 5.8 +/- 0.4 (100%), and 5.4 +/- 0.4 (100%), respectively, over the dosing period. Levofloxacin at 5.5, 22, and 32 mg/kg reduced the log CFU per milliliter in abscess fluid (percentage of that in a sterile animal) by 2.8 +/- 0.7 (20%), 5.1 +/- 1.3 (80%), and 4.6 +/- 1.3 (60%), respectively. Moxifloxacin has a greater bactericidal rate as determined by regression of log CFU versus time data. The AUC/MIC and peak/MIC ratios correlated with the efficacy of both drugs (P < 0.05). Resistance to either drug did not develop with any of the doses as assessed by a change in the MIC. In conclusion, data derived from this study show that moxifloxacin and levofloxacin exhibit rapid bactericidal activity against S. pneumoniae in vivo, and moxifloxacin exhibits enhanced bactericidal activity compared to levofloxacin, with AUC/MIC and peak/MIC ratios correlated with antimicrobial efficacy for both drugs. The development of fluoroquinolone-resistant S. pneumoniae was not observed with either drug in this model.
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Affiliation(s)
- D Xuan
- Department of Pharmacy Research, Hartford Hospital, Hartford, Connecticut 06102, USA.
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McNabb J, Owens RC, Xuan D, Quintiliani R, Nightingale CH, Nicolau DP. Comparison of azithromycin leukocyte disposition in healthy volunteers and volunteers with AIDS. Int J Antimicrob Agents 2000; 16:37-43. [PMID: 11185411 DOI: 10.1016/s0924-8579(00)00201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Azithromycin, has been proved to be effective in the treatment and prophylaxis of a wide variety of infections. While the penetration of azithromycin into a number of types of mammalian cells has been well characterized, the influence of HIV infection on the intracellular disposition of this agent has not been studied. We therefore studied the disposition of azithromycin in polymorphonuclear (PMN) and mononuclear (MONO) leukocytes from six healthy volunteers and six volunteers with AIDS. After oral administration of a single 1200-mg dose of azithromycin (two 600-mg tablets), blood samples were collected over 6 days and intracellular azithromycin concentrations in MONOs and PMNs were measured. Analysis of the intracellular pharmacokinetics revealed an apparent difference in the MONO and PMN profile; this profile was similar for both groups. Intracellular concentrations of azithromycin remained high throughout the study period. Furthermore, no statistically significant differences in the intracellular area under the curve (11309+/-2543 vs. 16650+/-6254 for PMN; 14180+/-3802 vs. 21211+/-10001 for MONO) were observed between the healthy and AIDS populations, respectively. Our data confirm the extensive uptake of azithromycin by white blood cells both in healthy volunteers and in AIDS patients.
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Affiliation(s)
- J McNabb
- Department of Pharmacy Research, Hartford Hospital, CT 06102, USA
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Xuan D, Lu JF, Nicolau DP, Nightingale CH. Population pharmacokinetics of tobramycin in hospitalized patients receiving once-daily dosing regimen. Int J Antimicrob Agents 2000; 15:185-91. [PMID: 10926440 DOI: 10.1016/s0924-8579(00)00172-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The population pharmacokinetics of tobramycin was investigated in a group of 327 adult hospitalized patients receiving once-daily administration of tobramycin at a dose of 7 mg kg(-1). The patients had an average age of 57+/-18 y and an average weight of 65+/-14 kg; 153 of the patients were female. Data, comprised of 575 serum concentrations, were analyzed using a nonlinear mixed-effect model (NONMEM) with a first-order conditional estimation method and were best described with a one-compartment model. The patient covariates including body weight, gender, age and creatinine clearance (CL(CR)) were added in a stepwise fashion to identify their potential influences on tobramycin pharmacokinetics. Results showed that tobramycin clearance (CL) was linearly correlated with CL(CR) (proportionality constant: 0.066+/-0.002 x CL(CR) (ml min(-1))) and the volume of distribution (Vd) was linearly related to body weight (proportionality constant: 0.40+/-0.024 x body weight (1 kg(-1))). The mean population estimates for CL and Vd were 4.53 l h(-1) and 27.3 l, respectively. The half-life of tobramycin was estimated to be 4.2 h. The inter-individual variability in CL and Vd were 37.0 and 28.5%, respectively. The residual error was 1.2 mg l(-1). Based on the results, optimal dosing intervals for renal impaired patients were calculated and were comparable with the intervals derived from the previous established nomogram.
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Affiliation(s)
- D Xuan
- Department of Pharmacy Research, Hartford Hospital, CT 06102, USA.
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Minard KI, Jennings GT, Loftus TM, Xuan D, McAlister-Henn L. Sources of NADPH and expression of mammalian NADP+-specific isocitrate dehydrogenases in Saccharomyces cerevisiae. J Biol Chem 1998; 273:31486-93. [PMID: 9813062 DOI: 10.1074/jbc.273.47.31486] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To compare roles of specific enzymes in supply of NADPH for cellular biosynthesis, collections of yeast mutants were constructed by gene disruptions and matings. These mutants include haploid strains containing all possible combinations of deletions in yeast genes encoding three differentially compartmentalized isozymes of NADP+-specific isocitrate dehydrogenase and in the gene encoding glucose-6-phosphate dehydrogenase (Zwf1p). Growth phenotype analyses of the mutants indicate that either cytosolic NADP+-specific isocitrate dehydrogenase (Idp2p) or the hexose monophosphate shunt is essential for growth with fatty acids as carbon sources and for sporulation of diploid strains, a condition associated with high levels of fatty acid synthesis. No new biosynthetic roles were identified for mitochondrial (Idp1p) or peroxisomal (Idp3p) NADP+-specific isocitrate dehydrogenase isozymes. These and other results suggest that several major presumed sources of biosynthetic reducing equivalents are non-essential in yeast cells grown under many cultivation conditions. To develop an in vivo system for analysis of metabolic function, mammalian mitochondrial and cytosolic isozymes of NADP+-specific isocitrate dehydrogenase were expressed in yeast using promoters from the cognate yeast genes. The mammalian mitochondrial isozyme was found to be imported efficiently into yeast mitochondria when fused to the Idp1p targeting sequence and to substitute functionally for Idp1p for production of alpha-ketoglutarate. The mammalian cytosolic isozyme was found to partition between cytosolic and organellar compartments and to replace functionally Idp2p for production of alpha-ketoglutarate or for growth on fatty acids in a mutant lacking Zwf1p. The mammalian cytosolic isozyme also functionally substitutes for Idp3p allowing growth on petroselinic acid as a carbon source, suggesting partial localization to peroxisomes and provision of NADPH for beta-oxidation of that fatty acid.
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Affiliation(s)
- K I Minard
- Department of Biochemistry, University of Texas Health Science Center, San Antonio, Texas 78284-7760, USA
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Xuan D, Nicolau DP, Tessier PR, Bow L, Quintiliani R, Nightingale CH. In vitro reduction of endotoxin concentrations with the 5S fragment of immunoglobulin G. Antimicrob Agents Chemother 1997; 41:1512-6. [PMID: 9210676 PMCID: PMC163950 DOI: 10.1128/aac.41.7.1512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Endotoxin has long been implicated as an inducer for the development and progression of gram-negative sepsis. Accordingly, antiendotoxin therapy has been considered one of the major targets for the treatment of sepsis. To investigate the influence of a human immunoglobulin G (IgG) derivative, the 5S fragment of IgG (5S-IgG; Gamma-Venin, Centeon Pharma GmbH, Frankfurt-Niederrad, Germany), on endotoxin release during bacterial proliferation and under antibiotic bactericidal action, time-kill studies were performed by using Escherichia coli ATCC 25922 starting inocula of 10(3), 10(5), and 10(7) CFU/ml with cefotaxime (120 microg/ml) alone and in combination with 5S-IgG (2,100 microg/ml). Samples were collected for bacterial colony count and endotoxin concentration determinations; the area under the free endotoxin concentration curve (AUFEC) was calculated by using the trapezoidal rule. Colony counts showed that cefotaxime had a rapid bactericidal effect because it achieved greater than a 4-log decrease in the numbers of E. coli CFU per milliliter over the first 2 h; the addition of 5S-IgG did not appear to alter the kinetics of killing. Comparison of the AUFEC revealed that the addition of 5S-IgG resulted in a mean reduction of 50, 66, and 27% in the free endotoxin concentration at starting inocula of 10(3), 10(5), and 10(7) CFU/ml, respectively. Moreover, experiments were conducted with a starting inoculum of 10(5) CFU/ml and various amounts of 5S-IgG (2 to 20 mg/ml) to further investigate the dose-effect relation of 5S-IgG on endotoxin release. Decreased AUFECs were observed with increasing concentrations of 5S-IgG, suggesting the dose-dependent antiendotoxin activity of 5S-IgG. Further study is required to investigate the mechanism(s) responsible for this observation, the biological significance of this antiendotoxin activity, and the potential utility of 5S-IgG as an adjuvant therapy in the treatment of gram-negative sepsis.
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Affiliation(s)
- D Xuan
- Section of Pharmacy Research, Hartford Hospital, Connecticut 06102, USA
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Xuan D, Li L, Jin C. [Applied anatomy of the medial superior genicular artery and the retrograde island flap]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1996; 12:412-4. [PMID: 9387428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Through anatomical dissection of fifty freshly amputated adult lower extremities, the origin, length, diameter and extent of perfusion of the superior genicular artery and its relation with the anterior tibial recurrent artery were investigated. Results revealed that the medial superior genicular artery originated primarily from the femoral artery (95.5%). It descends between the sartorius and majormedial muscles and then separates into branches that nourish the upper one-third of the lower leg and the medial skin of the knee, and then, by anastomosis, joins the anterior tibia recurrent artery on the level of the medial malleolus of the tibia. The formation rate of the anastomotic arch is 100% with the average outer diameter of 1.3 +/- 0.39 mm (x +/- s). Based on these observations, we conclude that the medial area of the knee is the best donor site of an island flap, which can be used to repair the medial superior one-third of the lower leg and the region around the knee.
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Affiliation(s)
- D Xuan
- Orthopedic Department of Yanbian Medical College, Jilin
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Patel KB, Xuan D, Tessier PR, Russomanno JH, Quintiliani R, Nightingale CH. Comparison of bronchopulmonary pharmacokinetics of clarithromycin and azithromycin. Antimicrob Agents Chemother 1996; 40:2375-9. [PMID: 8891147 PMCID: PMC163537 DOI: 10.1128/aac.40.10.2375] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The bronchopulmonary and plasma pharmacokinetics of clarithromycin (CLA; 500 mg given twice daily for nine doses) or azithromycin (AZ; 500 mg for the first dose and then 250 mg once daily for four doses) were assessed in 41 healthy nonsmokers. Bronchoalveolar lavage was performed at 4, 8, 12, or 24 h after administration of the last dose. The concentrations (mean +/- standard deviation) of CLA, 14-hydroxyclarithromycin, and AZ were measured in plasma, epithelial lining fluid (ELF), and alveolar macrophage (AM) cells by high-performance liquid chromatography assay. The concentrations of CLA achieved in ELF were 34.02 +/- 5.16 micrograms/ml at 4 h, 20.63 +/- 4.49 micrograms/ml at 8 h, 23.01 +/- 11.9 micrograms/ml at 12 h, and 4.17 +/- 0.29 microgram/ml at 24 h, whereas at the same time points AZ concentrations remained below the limit of assay sensitivity (0.01 microgram/ml) for all but two subjects. The concentrations of CLA in the AM cells were significantly higher than those of AZ at 8 h (703 +/- 235 and 388 +/- 53 micrograms/ml, respectively). However, the ratio of the concentration in AM cells/concentration in plasma was significantly higher for AZ than for CLA for all time points because of the lower concentration of AZ in plasma. These results indicate that while AZ has higher tissue concentration to plasma ratios, as shown by other investigators, the absolute concentrations of CLA in AM cells and ELF are higher for up to 8 and 12 h, respectively, after administration of the last dose.
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Affiliation(s)
- K B Patel
- Department of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, New York 11201, USA
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