Reducing hydrophobic drug adsorption in an in-vitro extracorporeal membrane oxygenation model

Extracorporeal membrane oxygenation (ECMO) is a life-saving cardiopulmonary bypass technology for critically ill patients with heart and lung failure. Patients treated with ECMO receive a range of drugs that are used to treat underlying diseases and critical illnesses. However, the dosing guidelines for these drugs used in ECMO patients are unclear. Mortality rate for patients on ECMO exceeds 40% partly due to inaccurate dosing information, caused in part by the adsorption of drugs in the ECMO circuit and its components. These drugs range in hydrophobicity, electrostatic interactions, and pharmacokinetics. Propofol is commonly administered to ECMO patients and is known to have high adsorption rates to the circuit components due to its hydrophobicity. To reduce adsorption onto the circuit components, we used micellar block copolymers (Poloxamer 188TM and Poloxamer 407TM) and liposomes tethered with poly(ethylene glycol) to encapsulate propofol, provide a hydrophilic shell and prevent its adsorption. Size, polydispersity index (PDI), and zeta potential of the delivery systems were characterized by dynamic light scattering, and encapsulation efficiency was characterized using High Performance Liquid Chromatography (HPLC). All delivery systems used demonstrated colloidal stability at physiological conditions for seven days, cytocompatibility with a human leukemia monocytic cell line, i.e., THP-1 cells, and did not activate the complement pathway in human plasma. We demonstrated a significant reduction in adsorption of propofol in an in-vitro ECMO model upon encapsulation in micelles and liposomes. These results show promise in reducing the adsorption of hydrophobic drugs to the ECMO circuits by encapsulation in nanoscale structures tethered with hydrophilic polymers on the surface.

Mechanical design and fabrication of the VHF-gun, the Berkeley normal-conducting continuous-wave high-brightness electron source

A high repetition rate, MHz-class, high-brightness electron source is a key element in future high-repetition-rate x-ray free electron laser-based light sources. The VHF-gun, a novel low frequency radio-frequency gun, is the Lawrence Berkeley National Laboratory (LBNL) response to that need. The gun design is based on a normal conducting, single cell cavity resonating at 186 MHz in the VHF band and capable of continuous wave operation while still delivering the high accelerating fields at the cathode required for the high brightness performance. The VHF-gun was fabricated and successfully commissioned in the framework of the Advanced Photo-injector EXperiment, an injector built at LBNL to demonstrate the capability of the gun to deliver the required beam quality. The basis for the selection of the VHF-gun technology, novel design features, and fabrication techniques are described.

Research and development of H- ion source and low energy beam transport for a kaon-neutrino factory

A baseline H(-) ion source and low energy beam transport (LEBT) system have been identified for Project X. The filament-discharge H(-) ion source has been fabricated by D-Pace, Inc. and is now in operation at LBNL. The source is capable of delivering over 10 mA of H(-) beam in cw operation with normalized 4 rms emittances less than 0.7 π mm mrad. A two-solenoid magnetic lens LEBT system has been design. The design has been validated with simulations of beam transport for 5 mA 30 keV H(-) beams using various simulation codes.

Amelioration of disease severity by intraarticular hylan therapy in bilateral canine osteoarthritis

Because of its high molecular weight, the glycosaminoglycan molecule hyaluronan is responsible for the viscoelastic properties of normal synovial fluid. In osteoarthritis, the concentration and molecular weight of hyaluronan in synovial fluid is diminished: this impairs the ability of synovial fluid to effectively lubricate joints, absorb loads, and exert anti-inflammatory effects. Using a bilateral anterior cruciate-ligament transection and partial neurectomy canine model of osteoarthritis, this study examined the effect of viscosupplementation with hylan G-F 20 as a treatment for osteoarthritis. Twelve dogs underwent bilateral arthroscopic anterior cruciate-ligament transections and partial neurectomy of the knee joints. Beginning 1 week after the operation, six dogs received three weekly 500-microl injections of hylan G-F 20 in one knee and a sham injection of saline solution in the contralateral knee (early-treatment group). The remaining six animals underwent the same treatment 2 months following the procedure (late-treatment group). All dogs were killed at 8 months, and both knees were evaluated for gross pathology, histology, and proteoglycan content. In addition, with use of 500-MHz [1H] magnetic resonance spectroscopy, the synovial fluid from both knees was assessed for changes in metabolic profile. Differences in outcome were analyzed with paired t tests. Gross pathological and histological examination revealed significantly less severe changes of osteoarthritis in knees treated with hylan G-F 20 2 months after surgery than in the contralateral untreated knees. Magnetic resonance spectroscopy of the specimens in this late-treatment group showed significantly decreased glucose concentrations and significantly elevated isoleucine levels in the synovial fluid from knees treated with hylan G-F 20 compared with the controls. Previous magnetic resonance spectroscopy had shown that glucose concentrations increase with the onset of osteoarthritis and eventually diminish in end-stage osteoarthritis. The three injections of hylan were given after osteoarthritis was established, and the severity of the disease was ameliorated in the treated knees 6 months after treatment. This occurred although hylan G-F 20 is almost certainly cleared from joints by lymphatics within 4 weeks of injection, suggesting that hylan therapy can retard the progression of osteoarthritis for periods of time extending beyond the intraarticular residence time of the injected molecules and that hylan injections given at relatively early stages of osteoarthritis may have a chondroprotective effect. No changes in outcome were noted in the animals that received hylan G-F 20 immediately following surgery.

Honeybee flight muscle phosphoglucose isomerase: matching enzyme capacities to flux requirements at a near-equilibrium reaction

In honeybee flight muscle, there are close matches between physiological flux rates and the maximal activities (Vmax; determined using crude homogenates) of key enzymes catalyzing non-equilibrium reactions in carbohydrate oxidation. In contrast, phosphoglucose isomerase (PGI), which catalyzes a reaction believed to be close to equilibrium, occurs at Vmax values greatly in excess of glycolytic flux rates. In this study, we measure the Vmax of flight muscle PGI, the kinetic parameters of the purified enzyme, the apparent equilibrium constants for the reaction and the tissue concentrations of substrate and product. Using the Haldane equation, we estimate that the forward flux capacity (Vf) for PGI required to achieve physiological glycolytic flux rates is between 800 and 1070 units ml-1 cell water, approximately 45­60 % of the empirically measured Vmax of 1770 units ml-1 cell water at optimal pH (8.0) and low ionic strength (no added KCl). When measured at physiological pH (7.0) and ionic strength (120 mmol l-1 KCl) with saturating levels of substrate, PGI activity is 1130 units ml-1 cell water, a value close to the calculated Vf. These results reveal a very close match between predicted and measured PGI flux capacities, and support the concept of an economical design of muscle metabolism in systems working at very high metabolic rates.

Hyperbaric oxygen chambers and the treatment of sports injuries

Hyperbaric oxygen therapy, an established therapeutic intervention in diving medicine, is being investigated in wound management, where oxygen is an integral part of the healing process. Currently, the evidence is controversial as to whether there is a basis for using hyperbaric oxygen in normal wounds. This review explains the rationale for the use of hyperbaric oxygen therapy and reports on the initial research in the area of hyperbaric oxygen in sports-induced injury. In addition to the increased dissolved content of oxygen in the plasma, the combination of pressure and oxygen seems to promote systemic vasoconstriction and yet inhibition of vasoconstriction in the injured area, which will limit oedema. The safety of hyperbaric oxygen in otherwise healthy athletes is examined. Potential contraindications to hyperbaric oxygen therapy include individuals who are febrile, suffer from upper respiratory infections, or have suffered a trauma to the chest where a pneumothorax is suspected or have a predisposition to tension pneumothorax. The initial human and animal model studies have shown promising, and in some instances significant, acceleration of healing. The potential benefits for sports injuries appear to be a blunting of initial injury, possibly by controlling the neutrophil adhesion and release of oxygen free radicals as well as an enhancement of healing processes requiring oxygen-like collagen formation phagocytosis.

Comparison of the anesthetic requirement for tolerance of laryngeal mask airway and endotracheal tube

We tested the hypothesis that the laryngeal mask airway (LMA) is tolerated at lighter levels of anesthesia than an endotracheal tube (ET). We studied 20 unpremedicated, nonsmoking ASA physical status I or II patients aged 18-40 yr whose surgery lasted > 1 h. Subjects were randomly assigned to receive either an ET or LMA. Anesthesia was induced with intravenous propofol and the LMA or ET was inserted. The ET-group patients received 1.5 mg/kg of succinylcholine, preceded by vecuronium (0.015 mg/kg IV). Maintenance of anesthesia was with only isoflurane and approximately 66% N2O in O2 by spontaneous ventilation. All gas concentrations were measured by a Raman spectrometer sampling from the breathing circuit end of the LMA or ET. Toward the end of the procedure, the end-tidal N2O and isoflurane concentrations were allowed to decrease to < 3 vol% and 0.8 +/- 0.05 vol%, respectively. The end-tidal isoflurane concentration was then decreased in 0.1% +/- 0.05% decrements, each stable value being held for 5 min. The patient was observed for signs of reaction to the presence of the LMA or ET. The mean (range) end-tidal isoflurane concentrations for reaction to ET and LMA were 0.55% (0.4-0.7) and 0.35% (0.2-0.51), respectively (P < 0.001). These data confirm the original hypothesis of the study.

Self-reported visual function and academic success: Cattell revisited

To test the hypothesis that visual deficits might hamper college students' academic success, we examined the relationship between a reliable self-report measure of visual function and semester grades. The correlation between the Everyday Vision Questionnaire scores and the grades of 331 college students was .01, which replicates and extends the historical findings of Cattell and others.

A simple method for reducing ovarian dose during megavoltage irradiation of the breast

Breast cancer in its early stages can be effectively treated with conservative surgery and irradiation. In young women who wish to subsequently bear children, reduction of ovarian dose during irradiation could be of great emotional significance. We describe a simple, convenient, cost-effective method by which ovarian dose was reduced from 18 cGy to 8 cGy during tangential irradiation of the intact breast with 6 MV photons.

Solar and UVC-induced mutation in human cells and inhibition by deoxynucleosides

Optimum conditions were established for quantitating the induction of hypoxanthine guanine phosphoribosyl transferase-deficient (HGPRT-) mutants in HeLa cells and in a human amelanotic melanoma cell line (MM96L). Compared at a fluence of equal toxicity (D37, fluence required to decrease cell survival to 37% of unirradiated control), noon sunlight in summer was slightly more mutagenic in MM96L than in HeLa cells (17 and 12 HGPRT- mutants per 10(6) survivors respectively). UVC (predominantly 254 nm) exhibited similar mutagenicity as equitoxic sunlight in HeLa but was 8-fold more effective in MM96L than equitoxic sunlight. Addition of a mixture of deoxyguanosine (20 microM), deoxyadenosine (20 microM), deoxycytidine (100 microM) and thymidine (20 microM) to the culture medium during the 7-day expression period following irradiation gave a 3-fold reduction in the UVC-induced mutation frequency of MM96L but not HeLa cells. The results suggest that these melanocytic cells are highly susceptible to mutagenesis by short wavelength UV, in a mechanism sensitive to deoxynucleosides.

A comparison of the roles of surgery and radiation therapy in the management of craniopharyngiomas

Fifty-two patients with craniopharyngioma were seen between January 1961 and July 1986. Of these, 40 were treated with surgery alone, 8 with surgery and postoperative radiotherapy, and 3 with radiotherapy alone. One patient received no treatment. For the group treated with surgery alone, 33% (13/40) had local tumor control, 42.5% (17/40) developed major complications, and 71% (25/35) survived 5 years. With surgery and postoperative radiotherapy, 100% (8/8) had local tumor control, 25% (2/8) developed major complications, and 100% (7/7) survived 5 years. Two of the three patients treated with radiotherapy alone had local tumor control and the third was salvaged with surgery. The "complete resection" rate for 32 patients treated with radical surgery was 63% (20/32). Tumor control was achieved in 50% (10/20) of the patients treated with "complete resection" without radiotherapy, in 15% (3/20) of the patients treated with "incomplete resection" without radiotherapy, and in 100% (8/8) of the patients treated with "incomplete resection" and postoperative radiotherapy. In this series, doses of 5000-5500 cGy were as effective in achieving control as 5500-6000 or 6000-7000 cGy.

Impaired exocrine pancreatic function in diabetics with diarrhea and peripheral neuropathy

Exocrine pancreatic insufficiency has been observed in some diabetics with peripheral neuropathy and diarrhea. Several mechanisms may be responsible for this insufficiency: (1) pancreatic atrophy, (2) disruption of the cholinergic enteropancreatic reflexes, or (3) elevated serum levels of peptides such as glucagon and pancreatic polypeptide which are known to inhibit pancreatic exocrine secretion. To clarify the mechanism(s) involved in this exocrine pancreatic impairment, we studied 10 diabetics with diarrhea and peripheral neuropathy. Their results were compared to those of eight normal volunteers. Each subject underwent a standardized pancreatic function study which assessed nonstimulated secretion, the response to intrajejunal infusion of a mixture of amino acids, and the output following intravenous administration of secretin and cholecystokinin (CCK). In separate studies, the effect of a background infusion of bethanechol and secretin on the pancreatic response to CCK was assessed in six patients and six normal controls. Compared to normals, all diabetics exhibited a significant reduction in both enzyme and bicarbonate secretion to all stimuli. This reduction was not corrected by administering bethanechol. Plasma glucagon and pancreatic polypeptide levels in diabetics were not significantly higher than those in controls. We conclude that diabetics with diarrhea and peripheral neuropathy exhibit impairment of their exocrine pancreatic secretion and possible mechanisms for this are discussed.