Exclusive Human Milk Diet for Extremely Premature Infants: A Novel Fortification Strategy That Enhances the Bioactive Properties of Fresh, Frozen, and Pasteurized Milk Specimens

Background: Human milk (HM) fortification has been recommended for the nutritional optimization of very low-birthweight infants. This study analyzed the bioactive components of HM and evaluated fortification choices that could accentuate or attenuate the concentration of such components, with special reference to human milk-derived fortifier (HMDF) offered to extremely premature infants as an exclusive human milk diet. Materials and Methods: An observational feasibility study analyzed the biochemical and immunochemical characteristics of mothers' own milk (MOM), both fresh and frozen, and pasteurized banked donor human milk (DHM), each supplemented with either HMDF or cow's milk-derived fortifier (CMDF). Gestation-specific specimens were analyzed for macronutrients, pH, total solids, antioxidant activity (AA), α-lactalbumin, lactoferrin, lysozyme, and α- and β-caseins. Data were analyzed for variance applying general linear model and Tukey's test for pairwise comparison. Results: DHM exhibited significantly lower (p < 0.05) lactoferrin and α-lactalbumin concentrations than fresh and frozen MOM. HMDF reinstated lactoferrin and α-lactalbumin and exhibited higher protein, fat, and total solids (p < 0.05) in comparison to unfortified and CMDF-supplemented specimens. HMDF had the highest (p < 0.05) AA, suggesting the potential capability of HMDF to enhance oxidative scavenging. Conclusion: DHM, compared with MOM, has reduced bioactive properties, and CMDF conferred the least additional bioactive components. Reinstatement and further enhancement of bioactivity, which has been attenuated through pasteurization of DHM, is demonstrated through HMDF supplementation. Freshly expressed MOM fortified with HMDF and given early, enterally, and exclusively (3E) appears an optimal nutritional choice for extremely premature infants.

New Discrete Formulation for Reduced Population Balance Equation: An Illustration to Crystallization

In this paper, we focus on providing a discrete formulation for a reduced aggregation population balance equation. The new formulation is simpler, easier to code, and adaptable to any type of grid. The presented method is extended to address a mixed-suspension mixed-product removal (MSMPR) system where aggregation and nucleation are the primary mechanisms that affect particle characteristics (or distributions). The performance of the proposed formulation is checked and verified against the cell average technique using both gelling and non gelling kernels. The testing is carried out on two benchmarking applications, namely batch and MSMPR systems. The new technique is shown to be computationally less expensive (approximately 40%) and predict numerical results with higher precision even on a coarser grid. Even with a revised grid, the new approach tends to outperform the cell average technique while requiring less computational effort. Thus the new approach can be easily adapted to model the crystallization process arising in pharmaceutical sciences and chemical engineering.

Hydrogen-Induced Conversion of SnS2 into SnS or Sn: A Route to Create SnS2 /SnS Heterostructures

The family of van der Waals (vdW) materials is large and diverse with applications ranging from electronics and optoelectronics to catalysis and chemical storage. However, despite intensive research, there remains significant knowledge-gaps pertaining to their properties and interactions. One such gap is the interaction between these materials and hydrogen, a potentially vital future energy vector and ubiquitous processing gas in the semiconductor industry. This work reports on the interaction of hydrogen with the vdW semiconductor SnS₂ , where molecular hydrogen (H₂ ) and H-ions induce a controlled chemical conversion into semiconducting-SnS or to β-Sn. This hydrogen-driven reaction is facilitated by the different oxidation states of Sn and is successfully applied to form SnS₂ /SnS heterostructures with uniform layers, atomically flat interfaces and well-aligned crystallographic axes. This approach is scalable and offers a route for engineering materials at the nanoscale for semiconductor technologies based on the earth-abundant elements Sn and S, a promising result for a wide range of potential applications.

A molecularly enhanced proof of concept for targeting cocrystals at molecular scale in continuous pharmaceuticals cocrystallization

It is impossible to optimize a process for a target drug product with the desired profile without a proper understanding of the interplay among the material attributes, the process parameters, and the attributes of the drug product. There is a particular need to bridge the micro- and mesoscale events that occur during this process. Here, we propose а molecular engineering methodology for the continuous cocrystallization process, based on Raman spectra measured experimentally with a probe and from quantum mechanical calculations. Using molecular dynamics simulations, the theoretical Raman spectra were calculated from first principles for local mixture structures under an external shear force at various temperatures. A proof of concept is developed to build the process design space from the computed data. We show that the determined process design space provides valuable insight for optimizing the cocrystallization process at the nanoscale, where experimental measurements are difficult and/or inapplicable. The results suggest that our method may be used to target cocrystallization processes at the molecular scale for improved pharmaceutical synthesis.

Stabilizing vaccines via drying: Quality by design considerations

Pandemics and epidemics are continually challenging human beings' health and imposing major stresses on the societies particularly over the last few decades, when their frequency has increased significantly. Protecting humans from multiple diseases is best achieved through vaccination. However, vaccines thermal instability has always been a hurdle in their widespread application, especially in less developed countries. Furthermore, insufficient vaccine processing capacity is also a major challenge for global vaccination programs. Continuous drying of vaccine formulations is one of the potential solutions to these challenges. This review highlights the challenges on implementing the continuous drying techniques for drying vaccines. The conventional drying methods, emerging technologies and their adaptation by biopharmaceutical industry are investigated considering the patented technologies for drying of vaccines. Moreover, the current progress in applying Quality by Design (QbD) in each of the drying techniques considering the critical quality attributes (CQAs), critical process parameters (CPPs) are comprehensively reviewed. An expert advice is presented on the required actions to be taken within the biopharmaceutical industry to move towards continuous stabilization of vaccines in the realm of QbD.

Formation of Ciprofloxacin–Isonicotinic Acid Cocrystal Using Mechanochemical Synthesis Routes—An Investigation into Critical Process Parameters

The mechanochemical synthesis of cocrystals has been introduced as a promising approach of formulating poorly water-soluble active pharmaceutical ingredients (APIs). In this study, hot-melt extrusion (HME) as a continuous process and grinding and ball milling as batch processes were employed to explore the feasibility of cocrystallization. Ciprofloxacin (CIP) and isonicotinic acid (INCA) were selected as the model API and coformer. CIP–INCA cocrystal was produced in all techniques. It was revealed that higher cocrystal content could be achieved at longer durations of grinding and ball milling. However, milling for more than 10 min led to increased co-amorphous content instead of cocrystal. A design of experiment (DoE) approach was used for deciphering the complex correlation of screw configuration, screw speed, and temperature as HME process parameters and their respective effect on final relative cocrystal yield. Statistical analysis showed that screw configuration, temperature, and their interaction were the most critical factors affecting cocrystallization. Interestingly, screw speed had minimal impact on the relative cocrystallization yield. Cocrystallization led to increased dissolution rate of CIP in phosphate buffer up to 2.5-fold. Overall, this study shed a light on the potential of mechanochemical synthesis techniques with special focus on HME as a continuous process for producing cocrystals.

Controlled isolation and stabilisation of pure metastable carbamazepine form IV by droplet-confinement via a continuous manufacturing route

This study outlines a systematic approach to control the polymorphism of carbamazepine (CBZ) and isolate the metastable polymorph CBZ form IV as a function of droplet size using spray drying as a continuous method of manufacture.

Investigating Structural Property Relationships to Enable Repurposing of Pharmaceuticals as Zinc Ionophores

The importance of zinc in biology has gained greater recognition in recent years due to its essential contributions to the function of many endogenous enzymes. Disruption of zinc homeostasis may be useful in treating pathological conditions, such as Alzheimer's, and for antiviral purposes. Despite the growth of knowledge and increased interest in zinc, little is known about the structure and function of zinc ionophores. In this study we analyse the Cambridge Structural Database and solution complexation studies found in the literature to identify key functional groups which may confer zinc ionophorism. Pharmaceuticals, nutraceuticals and amino acids with these functionalities were selected to enable us to explore the translatability of ionophoric activity from in vitro assays to cellular systems. We find that although certain species may complex to zinc in the solid and solution states, and may carry ions across simple membrane systems, this does not necessarily translate into ionophoric activity. We propose that the CSD can help refine key functionalities but that ionophoric activity must be confirmed in cellular systems.

467 FRAILTY IN SITU SIMULATION

Introduction

The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty.

Method

Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected.

Results

30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team.

Conclusion

In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.

Molecular engineering of cocrystallization process in holt melt extrusion based on kinetics of elementary molecular processes

Continuous co-crystallization in a twin-screw granulator is a promising technology. In order to fundamentally optimize the process flow, it is necessary to investigate the kinetics of molecular interactions within the mixture and the effect of these interactions on co-crystal formation. In this study, the processes governing the co-crystallization of ibuprofen and nicotinamide were considered. Density functional theory calculations employing the Hirshfeld partitioning scheme were used to identify donor-acceptor sites on each molecule. A total of twenty-one different molecular interactions was identified (nine of ibuprofen and nicotinamide (resembling co-crystals), three of ibuprofen and itself (resembling the ibuprofen dimer), and nine of nicotinamide and itself (resembling the nicotinamide dimer)). Each interaction was defined as an artificial reversible reaction and the kinetics were calculated using the transition state theory of chemical reactions, where linear and quadratic synchronous transition methods were utilized to identify transition-state structures; the minimum energy path was determined using the nudged elastic band method. A kinetic Monte Carlo framework was used to study the collective/coupled effect of reactions on the progress of the co-crystallization process. it was found that operating at low temperatures (especially lower or very close to the melting temperature of ibuprofen) for longer residency times creates a safe route for maximizing the presence of ibuprofen and nicotinamide co-crystals. If the proposed route is applied, the purity and properties of the produced co-crystal would be significant, especially its desirable availability within the body.

Characterization of Simultaneous Evolution of Size and Composition Distributions Using Generalized Aggregation Population Balance Equation

The application of multi-dimensional population balance equations (PBEs) for the simulation of granulation processes is recommended due to the multi-component system. Irrespective of the application area, numerical scheme selection for solving multi-dimensional PBEs is driven by the accuracy in (size) number density prediction alone. However, mixing the components, i.e., the particles (excipients and API) and the binding liquid, plays a crucial role in predicting the granule compositional distribution during the pharmaceutical granulation. A numerical scheme should, therefore, be able to predict this accurately. Here, we compare the cell average technique (CAT) and finite volume scheme (FVS) in terms of their accuracy and applicability in predicting the mixing state. To quantify the degree of mixing in the system, the sum-square χ2 parameter is studied to observe the deviation in the amount binder from its average. It has been illustrated that the accurate prediction of integral moments computed by the FVS leads to an inaccurate prediction of the χ2 parameter for a bicomponent population balance equation. Moreover, the cell average technique (CAT) predicts the moments with moderate accuracy; however, it computes the mixing of components χ2 parameter with higher precision than the finite volume scheme. The numerical testing is performed for some benchmarking kernels corresponding to which the analytical solutions are available in the literature. It will be also shown that both numerical methods equally well predict the average size of the particles formed in the system; however, the finite volume scheme takes less time to compute these results.

Psychological defence mechanisms during the COVID-19 pandemic: A case series

Background and objectives

COVID-19 has had a negative effect on mental health across the world's population. Healthcare workers in particular have experienced increased levels of psychological distress, depression and anxiety. Any perceived stress to an individual can provoke psychological defence mechanisms. Using psychoanalytic theory, a defence mechanism is described as an unconscious psychological strategy, with or without resulting behaviour, which aims to reduce or eliminate anxiety arising from unacceptable or potentially harmful stimuli. This paper aims to describe a range of psychological defence mechanisms encountered within colleagues in relation to the COVID-19 pandemic.

Methods

Using the methodology of a case series, specific defence mechanisms are explored with reference to further literature in the field.

Results

The author has encountered varying psychological defence mechanisms, both within himself and in other members of the multidisciplinary team. These have been illustrated in the attached clinical vignettes, relating to the specific psychological coping mechanisms of; denial, hypochondriasis, altruism, sublimation and humour.

Conclusion

We encourage acknowledgement of psychological defence mechanisms and their implications on day to day practice. Whilst defence mechanisms can have a number of negative consequences as described in this article, they also have an important role, particularly in the case of mature defence mechanisms, as protective factors against psychological distress and symptom formation. Deeper understanding of the gold-standard hierarchical organisation of defence mechanisms could help increase utilisation of specific therapeutic interventions for enhancing changes from immature to mature defensive responses to stressful experiences as the COVID-19 pandemic progresses.

Inhaled hydroxychloroquine to improve efficacy and reduce harm in the treatment of COVID-19

Current formulations and dose regimens of hydroxychloroquine (HCQ) put patients at risk of harm. An analysis of clinical trials registered on ClinicalTrials.gov revealed that this may continue as many studies combine HCQ with agents that prolong the QT interval. Further, almost all of the trials registered do not consider dosage adjustment in the elderly, a patient population most likely to require HCQ treatment. Here we describe an inhaled formulation of HCQ which has passed safety studies in clinical trials for the treatment of asthma and discuss how this approach may reduce side-effects and improve efficacy. As this simple formulation progressed to phase II studies, safety data can be used to immediately enable phase II trials in COVID-19.

Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy

BACKGROUND AND PURPOSE

Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO.

METHODS

We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI.

RESULTS

A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI.

CONCLUSION

Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.

Mesoporous silica pellets as bifunctional bone drug delivery system for cefazolin

For decades, bone drug delivery systems dedicated for osteomyelitis treatment have been investigated as bifunctional materials that exhibit prolonged drug release and mineralization potential. Herein, composite-type pellets based on cefazolin-loaded amino-modified mesoporous silica SBA-15 and microwave-assisted hydroxyapatite were investigated as potential bone drug delivery system in vitro. Pellets were obtained by granulation, extrusion and spheronization methods in laboratory scale and studied in terms of physical properties, drug release, mineralization potential, antimicrobial activity and cytotoxicity towards human osteoblasts. The obtained pellets were characterized for hardness and friability which indicated the pellets durability during further investigations. Prolonged (5-day) release of cefazolin from pellets was observed. The pellets exhibited mineralization potential in simulated body fluid, i.e., a continuous layer of bone-like apatite was formed on the surface of pellets after 28 days of incubation. An antimicrobial assay of pellets revealed an antibacterial effect against Staphylococcus aureus strain during 6 days. No cytotoxic effects of pellets towards human osteoblasts were observed. The obtained results proved that proposed pellets appear to have potential applications as bone drug delivery systems.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

The Interaction of Hydrogen with the van der Waals Crystal γ-InSe

The emergence of the hydrogen economy requires development in the storage, generation and sensing of hydrogen. The indium selenide ( γ -InSe) van der Waals (vdW) crystal shows promise for technologies in all three of these areas. For these applications to be realised, the fundamental interactions of InSe with hydrogen must be understood. Here, we present a comprehensive experimental and theoretical study on the interaction of γ -InSe with hydrogen. It is shown that hydrogenation of γ -InSe by a Kaufman ion source results in a marked quenching of the room temperature photoluminescence signal and a modification of the vibrational modes of γ -InSe, which are modelled by density functional theory simulations. Our experimental and theoretical studies indicate that hydrogen is incorporated into the crystal preferentially in its atomic form. This behaviour is qualitatively different from that observed in other vdW crystals, such as transition metal dichalcogenides, where molecular hydrogen is intercalated in the vdW gaps of the crystal, leading to the formation of "bubbles" for hydrogen storage.

Formulating a Stable Mannitol Infusion while Maintaining Hyperosmolarity

Mannitol infusion is commonly used in the treatment of intracranial hypertension following traumatic brain injury. It has long been known to have stability issues, specifically, mannitol recrystallises from solutions greater than 10% w/v in ambient conditions. This can happen at any time, whether on the pharmacy shelf or during a medical procedure. This study describes the stability limits of 20% w/v mannitol infusion (the most common strength used clinically) and proposes a number of safer, stable and tuneable hyperosmotic formulations of mannitol in combination with clinically acceptable osmotic agents (NaCl, sorbitol and glycerol).

An overview on trace CO2 removal by advanced physisorbent materials

This review paper focuses on various gas processing technologies and materials that efficiently capture trace levels of carbon dioxide (CO₂). Fundamental separation mechanisms such as absorption, adsorption, and distillation technology are presented. Liquid amine-based carbon capture (C-capture) technologies have been in existence for over half a century, however, liquid amine capture relies upon chemical reactions and is energy-intensive. Liquid amines are thus not economically viable for broad deployment and offer little room for innovation. Innovative C-capture technologies must improve both the environmental footprint and cost-effectiveness. As a promising alternative, physisorbents have many advantages including considerably lower regeneration energy. Generally, existing classes of physisorbent materials, such as metal-organic frameworks (MOFs) and zeolites are selective toward C-capture. However, their selectivity is currently not high enough to remove trace levels (e.g., ~1%) of CO₂ from various natural gas process streams. This review summarizes the current advancements in physisorbent materials for CO₂ capture. Here, key performance parameters needed to select the most suitable candidate are highlighted. Furthermore, this review discusses the scope for the development of better performing CO₂ selective physisorbents from both environmental and economic perspectives. In addition, hybrid ultra microporous materials (HUMs), characterized mainly by ultra-micro pores (<0.7 nm), are discussed in reference to C-capture. Various characteristics of HUMs result in high selectivity and applicability in difficult separations such as the gas sweetening and C-capture from complex humid mixed gas streams.

Mass-based finite volume scheme for aggregation, growth and nucleation population balance equation

In this paper, a new mass-based numerical method is developed using the notion of Forestier-Coste & Mancini (Forestier-Coste & Mancini 2012, SIAM J. Sci. Comput. 34, B840-B860. (doi:10.1137/110847998)) for solving a one-dimensional aggregation population balance equation. The existing scheme requires a large number of grids to predict both moments and number density function accurately, making it computationally very expensive. Therefore, a mass-based finite volume is developed which leads to the accurate prediction of different integral properties of number distribution functions using fewer grids. The new mass-based and existing finite volume schemes are extended to solve simultaneous aggregation-growth and aggregation-nucleation problems. To check the accuracy and efficiency, the mass-based formulation is compared with the existing method for two kinds of benchmark kernels, namely analytically solvable and practical oriented kernels. The comparison reveals that the mass-based method computes both number distribution functions and moments more accurately and efficiently than the existing method.

Impact of polymeric excipient on cocrystal formation via hot-melt extrusion and subsequent downstream processing

Pharmaceutical cocrystals have gained increasing interest due to their potential to modify the physicochemical properties of drugs. Herein, a 1:1 cocrystal of ibuprofen (IBU) as a BCS class II active pharmaceutical ingredient (API) and nicotinamide as coformer was produced using a hot-melt extrusion (HME) process. The effect of process parameters such as barrel temperature and screw speed were studied. It was shown that the addition of polymeric excipient such as soluplus (Sol) decreases the cocrystallization temperature by enhancing the interaction between API and coformer. In order to study the effect of cocrystallization on the tableting properties of IBU-NIC cocrystal, 5 different formulations of pure IBU, IBU-NIC cocrystal, IBU-NIC physical mixture, IBU-NIC-Sol physical mixture and IBU-NIC-Sol cocrystal were tableted by a compaction simulator. Tabletability, compactibility and compressibility were investigated. The sample with IBU-NIC-Sol cocrystal formulation outperformed all the other formulations in terms of tabletability, compactibility and compressibility. Interestingly, this sample was even superior to the IBU-NIC cocrystal sample which verified the advantageous effect of the presence of an excipient. Moreover, dissolution test confirmed a noticeable increase in the dissolution of not only the cocrystal samples but even the physical mixtures of IBU and NIC compared with pure IBU.

Co-crystal polymorphic control by nanodroplet and electrical confinement

The polymorphic control of the co-crystal carbamazepine–saccharin (CBZ–SAC) metastable form II was achieved by nano-droplet confinement in tandem with droplet surface charging induced by electrospraying the precursor solution.

Surface-Activated Fibre-Like SBA-15 as Drug Carriers for Bone Diseases

Here, we report an inorganic hexagonally ordered mesoporous fibre-like carrier made of silica as an effective drug delivery system with mineralisation potential. Fibre-like SBA-15 has been modified by employing a simple surface activation (rehydroxylation) procedure. The surface-rehydroxylated fibre-like SBA-15 (SBA-15-R) was used to investigate the possible mechanism of hydroxyapatite (HA) nucleation and deposition onto silica's surface after immersion in simulated body fluid (SBF). Amorphous calcium phosphate, Ca-deficient HA and bone-like HA deposits were observed on SBA-15-R surface consecutively after 7, 14 and 21 days of immersion in SBF. Accordingly, our low-angle XRD, STEM and N₂ adsorption/desorption results indicated that deposited ions were mostly located at the silica's surface and could modify the size of the mesopores. The SBA-15-R was studied in vitro as the potential bioactive drug delivery system using doxorubicin (DOX) as a model water-soluble and anticancer drug. The adsorbed DOX molecules were mostly located at the pore walls and pore openings, likely together with the silanol groups. The DOX release was diffusion-controlled and relatively slower in SBF (pH = 7.4) than in phosphate-buffered solution (pH = 5.0), most probably due to both the stronger electrostatic interactions occurring between the DOX and the SBA-15-R and the simultaneous deposition of calcium and phosphates ions from SBF.

The opioid crisis: a 21st century pain

The opioid pain market is a lucrative one, but is experiencing significant challenges in the U.S. as the country grapples with prescription opioid addiction, overdose and fatalities. The situation has been declared a national Public Health Emergency and the Food and Drug Administration (FDA) has introduced several measures intended to reduce opioid abuse. The development of abuse-deterrent prescription opioids is one such measure, but although abuse-deterrent formulations of opioids reduce drug liking and abuse, concerns have been highlighted by an Institute of Clinical and Economic Review (ICER) report regarding the insufficiency of currently available data to determine the effects of these formulations at the population level. However, the low abuse liability but effective analgesic efficacy reported for drugs such as NKTR-181 and difelikefalin highlight the potential of novel abuse-deterrent opioids.

Percutaneous endoscopic gastrostomy placement in paediatric Crohn's disease patients contributes to both improved nutrition and growth

AIM

This paper describes the outcomes of gastrostomy feeding in patients with Crohn's disease (CD).

METHODS

Patients with CD who attended the Royal Hospital for Children, Glasgow and received gastrostomy feeding for at least two years between 2003 and 2010 were identified from the clinical database. The data recorded included the anthropometric data, CD phenotype, the surgical technique that was used, complications, medication, feed type, median feed, calories, volume and clinical outcomes.

RESULTS

The study identified 16 patients (14 male) who had a gastrostomy inserted using a pull technique at a median age of 12.6 years. Of these two required laparoscopic placement. Short-term complications lasting less than one month were experienced by nine (56%) patients and one (6%) experienced long-term complications. Anthropometry significantly improved at follow-up compared to baseline: at 12 months, the body mass index z-score was 1.11 (p = 0.005) and the weight z-score was 0.19 (p < 0.05). At 24 months, the height z-score was -1.03 (p = 0.04). The daily median volume and calories from feeds increased significantly from baseline to post-PEG insertion, from 400 to 738 mL and 705 to 860 kcal/day (p ≤ 0.01).

CONCLUSION

Gastrostomy feeding for paediatric patients with CD was associated with improved nutrition, weight gain and growth outcomes.