A new catheter-integrated drug-delivery system for controlled intravesical mitomycin C release

BACKGROUND

Intravesical treatment of bladder cancer is preferred over systemic administration. However, the efficacy of intravesical instillations is challenged by the periodic voiding that flushes out the instilled drug and ultimately reduces drug exposure to the bladder epithelium. Here, we demonstrate a new catheter-integrated drug-delivery concept that utilizes a silicone-based interpenetrating polymer network (IPN) as material for the catheter balloon, to facilitate continuous release of the bladder cancer adjuvant, Mitomycin C, from a balloon-reservoir to the urinary bladder.

METHODS

Long-term release properties and anti-carcinoma cell efficacy of released drug was investigated in vitro. Short-term release experiments were performed in live pigs to evaluate the IPN prototype catheter in a physiological relevant environment in vivo.

RESULTS

Sustained zero-order release of Mitomycin C was achieved for 12 days in vitro without refilling the balloon. Mitomycin C was released from the IPN-balloons into the urinary bladder of live pigs in concentrations adequate to inhibit carcinoma cell growth.

CONCLUSION

The IPN catheter represents a new drug-delivery concept for prolonged Mitomycin C delivery to the urinary bladder.

A Novel Device-Integrated Drug Delivery System for Local Inhibition of Urinary Tract Infection

Background: Catheter-associated urinary tract infection (CAUTI) is a frequent community-acquired infection and the most common nosocomial infection. Here, we developed a novel antimicrobial catheter concept that utilizes a silicone-based interpenetrating polymer network (IPN) as balloon material to facilitate a topical slow-release prophylaxis of antibacterial agents across the balloon to the urinary bladder.

Methods: The balloon material was achieved by modifying low shore hardness silicone tubes with a hydrogel interpenetrating polymer in supercritical CO₂ using the sequential method. Release properties and antibacterial efficacy of the IPN balloon treatment concept was investigated in vitro and in a porcine CAUTI model developed for the study. In the latter, Bactiguard Infection Protection (BIP) Foley catheters were also assessed to enable benchmark with the traditional antimicrobial coating principle.

Results: Uropathogenic Escherichia coli was undetectable in urinary bladders and on retrieved catheters in the IPN treatment group as compared to control that revealed significant bacteriuria (>10⁵ colony forming units/ml) as well as catheter-associated biofilm. The BIP catheters failed to prevent E. coli colonization of the bladder but significantly reduced catheter biofilm formation compared to the control.

Conclusion: The IPN-catheter concept provides a novel, promising delivery route for local treatment in the urinary tract.

Molecular-Gated Drug Delivery Systems Using Light-Triggered Hydrophobic-to-Hydrophilic Switches

A photoresponsive molecular-gated drug delivery system (DDS) based on silicone-hydrogel (poly(HEMA-co-PEGMEA)) interpenetrating polymer networks (IPNs) functionalized with carboxylated spiropyran (SPCOOH) was designed and demonstrated as an on-demand DDS. The triggered-release mechanism relies on controlling the wetting behavior of the surface by light, exploiting different hydrophobicities between the "closed" and "open" isomers of spiropyran as a photoswitchable molecular gate on the surface of IPN (SP-photogated IPN). Light-triggered release of doxycycline (DOX) as a model drug indicated that the spiropyran (SP) molecules provide a hydrophobic layer around the drug carrier and have a good gate-closing efficiency for IPNs with 20-30% hydrogel content. Upon UV light irradiation, SP converts into an open hydrophilic merocyanine state, which triggers the release of DOX. These results were compared with a previously developed SP-bulk modified IPN using the same hydrogel as a control, proving the efficiency of the gated IPN system. The covalent attachment of SPCOOH to the alcohol groups of the hydrogel and the structural change caused by UV light was indicated with FTIR analysis. XPS results also confirm the presence of SP by indicating the atomic percentage of nitrogen with respect to the hydrogel content.

On-Demand Reversible UV-Triggered Interpenetrating Polymer Network-Based Drug Delivery System Using the Spiropyran-Merocyanine Hydrophobicity Switch

A reversible switchable on-demand UV-triggered drug delivery system (DDS) based on interpenetrating polymer networks (IPNs) with silicone as the host polymer and spiropyran (SP)-functionalized guest polymer is designed and demonstrated. The photo-responsive IPNs provide a new triggered drug delivery concept as they exploit the change in intermolecular interactions (work of adhesion) among the drug, matrix, and solvent when the incorporated hydrophobic SP moieties transform into the hydrophilic merocyanine form upon light irradiation without degradation and disruption of the DDS. The change in how the copolymer composition (hydrophilicity and content) and the lipophilicity of the drug (log P) affect the release profile was investigated. A thermodynamic model, based on Hansen solubility parameters, was developed to design and optimize the polymer composition of the IPNs to obtain the most efficient light-triggered drug release and suppression of the premature release. The developed IPNs showed excellent result for dopamine, l-dopa, and prednisone with around 90-95% light-triggered release. The model was applied to study the release behavior of drugs with different log P and to estimate if the light-induced hydrophobic-to-hydrophilic switch can overcome the work of adhesion between polymers and drugs and hence the desorption and release of the drugs. To the best of our knowledge, this is the first time that work of adhesion is used for this aim. Comparing the result obtained from the model and experiment shows that the model is useful for evaluating and estimating the release behavior of specific drugs merocyanine, IPN, DDS, and spiropyran.

Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations

In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1-2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.

Comprehensive strategy for pesticide residue analysis through the production cycle of gilthead sea bream and Atlantic salmon

Plant ingredients and processed animal proteins are alternative feedstuffs for fish feeds in aquaculture. However, their use can introduce contaminants like pesticides that are not previously associated with marine Atlantic salmon and gilthead sea bream farming. This study covers the screening of around 800 pesticides by gas chromatography (GC) and liquid chromatography (LC) coupled to high resolution time-of-flight mass spectrometry in matrices throughout the entire marine food production chain. Prior to analysis of real-world samples, the screening methodology was validated for 252 pesticides to establish the screening detection limit. This was 0.01 mg kg^-1 for 113 pesticides (45%), 0.05 mg kg^-1 for 73 pesticides (29%) and >0.05 mg kg^-1 for 66 pesticides (26%). After that, a quantitative methodology based on GC coupled to tandem mass spectrometry with atmospheric pressure chemical ionization source (GC-APCI-MS/MS) was optimized for the pesticides found in the screening. Although several polar pesticides, of which pirimiphos methyl and chlorpyriphos-methyl were most dominant, were found in plant material and feeds based on these ingredients, none of them were observed in fillets of Atlantic salmon and gilthead sea bream fed on these feeds.

Investigation of pharmaceuticals in processed animal by-products by liquid chromatography coupled to high-resolution mass spectrometry

There is an on-going trend for developing more sustainable salmon feed in which traditionally applied marine feed ingredients are replaced with alternatives. Processed animal products (PAPs) have been re-authorized as novel high quality protein ingredients in 2013. These PAPs may harbor undesirable substances such as pharmaceuticals and metabolites which are not previously associated with salmon farming, but might cause a potential risk for feed and food safety. To control these contaminants, an analytical strategy based on a generic extraction followed by ultra-high performance liquid chromatography coupled to high resolution mass spectrometry (UHPLC-HRMS) using quadrupole time-of-flight mass analyzer (QTOF MS) was applied for wide scope screening. Quality control samples, consisting of PAP commodities spiked at 0.02, 0.1 and 0.2 mg/kg with 150 analytes, were injected in every sample batch to verify the overall method performance. The methodology was applied to 19 commercially available PAP samples from six different types of matrices from the EU animal rendering industry. This strategy allows assessing possible emergent risk exposition of the salmon farming industry to 1005 undesirables, including pharmaceuticals, several dyes and relevant metabolites.

Welfare indicators in laying hens in relation to nest exclusion

Consumer concerns about the welfare of laying hens are increasing, leading to increased interest in identifying reliable ways to assess welfare. The present study evaluated invasive and non-invasive welfare indicators in relation to a stressful challenge. The study included 126 Lohmann Selected Leghorn hens housed in furnished cages. Welfare indicators were measured between 61 and 70 wk of age in birds excluded from their nests for 5 consecutive d and control birds that had continuous access to nests. Baseline recordings were carried out in both groups prior to and post exclusion period. The assessed indicators were: corticosterone metabolites in droppings (FCM), corticosterone concentration in yolk, corticosterone concentration in plasma, irregularities of eggshells, heterophil to lymphocyte (H:L) ratio, tonic immobility duration, and feather cover. Behavioral observations showed that the birds had a clear preference for using the secluded nest sites, confirming that they were likely to perceive nest exclusion as an undesirable experience. Further, elevated levels of FCM in droppings, yolk corticosterone concentrations, H:L ratios and irregular eggshells were detected in both nest deprived and control birds during the exclusion. This suggests that these indicators were able to detect an increased stress response arising from nest deprivation, and it is hypothesized that the stress spread to birds in adjacent cages with access to nests. There was a positive and consistent correlation between FCM in droppings and eggshell irregularities, also supporting the use of eggshell irregularities as a potential non-invasive welfare indicator. However, the pattern of the stress response varied between indicators and correlations were generally few and inconsistent, highlighting the complexity of the relationship among welfare indicators.

Welfare and performance in layers following temporary exclusion from the litter area on introduction to the layer facility

When introduced to the laying facility, pullets are sometimes temporarily excluded from the litter area in order to help them locate food and water, and to prevent floor-laid eggs. This procedure is not permitted in Sweden, because it involves denying access to both litter and space, which may have a negative effect on bird welfare. The present study investigated how the welfare and performance of layers were affected by this temporary exclusion on introduction of hens to the laying facility. The study included 600 floor-reared Dekalb White layers obtained at 16 wk age and housed in 6 groups of 100 in a conventional single-tier floor-laying system. Birds were either given full access to the litter area during the whole study or were excluded from the litter area during the first 2 wk after transfer to the laying facility. From 18 to 72 wk age, birds in both treatments had full access to the litter area. Excluding birds from the litter area for 2 wk resulted in better feather cover and reduced fearfulness, according to novel object and tonic immobility tests. Furthermore, birds initially excluded from the litter area produced eggs with a lower proportion of shell irregularities than birds with full access to the litter area throughout. No difference was found in corticosterone metabolites in droppings rate of lay, mortality, or proportion of floor-laid eggs. In conclusion, none of the parameters studied indicated that the welfare of laying hens was compromised by temporary exclusion from the litter area on introduction to the laying facility. In fact, some of the data suggested that bird welfare had improved.

Corticosterone metabolites in laying hen droppings-Effects of fiber enrichment, genotype, and daily variations

There is growing interest and concern for animal welfare in commercial poultry production. To evaluate stress and welfare in an objective and noninvasive way, fecal corticosterone metabolites (FCM) in droppings can be analyzed. However, the influence of diet, genotype, and daily variations in FCM and production of droppings in laying hens has been poorly investigated. This study examined the effect of insoluble fiber by adding 3% ground straw pellets to the feed to Lohmann Selected Leghorn (LSL) and Lohmann Brown (LB) hens housed in furnished cages between 20 and 40 wk of age. In total, 960 hens were included in the study. Droppings were collected 4 times per day for 3 consecutive days and analyzed by corticosterone immunoassay. Biological validation confirmed the ability of the assay to detect changes in FCM levels. Inclusion of straw pellets in the feed increased FCM concentration in both hen genotypes and increased excretion rate of FCM in LB hens. The LB hens also produced greater amounts of droppings than LSL hens. Both FCM levels and production of droppings varied during the day, although no distinct diurnal rhythm was found. These findings demonstrate that when using FCM to evaluate stress and welfare in laying hens, many factors (e.g., diet, genotype used, and so on) need to be taken into account to allow accurate interpretation of the results. In addition, under certain conditions, excretion rate of FCM might be more appropriate to use compared with FCM concentration.

[Combined transvaginal and transumbilical approach for cholecystectomy with no visible scarring]

The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time was 54 min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative courses were uneventful. After a minimum follow-up of 3 months, none of the patients had symptoms in the vagina or during sexual intercourse.

Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up

BACKGROUND AND STUDY AIMS

Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used. We report our experience in all patients treated over a 1-year period.

PATIENTS AND METHODS

Between June 2007 and June 2008, 68 patients (mean age 50 years) underwent transvaginal cholecystectomy with an additional 5-mm umbilical trocar using rigid laparoscopic instruments. Data about symptoms, operation, and postoperative course were prospectively collected, as were findings of a gynecological follow-up examination 1 week after surgery and the results of an interview at least 3 months after surgery.

RESULTS

All 68 operations were finished successfully without conversion, with a mean operation time of 51 minutes; in three additional cases severe pelvic adhesions prevented further transvaginal progress. There were no intraoperative or immediately postoperative complications, but one patient presented with a Douglas pouch abscess 3 weeks after surgery. Gynecologic follow-up exams 1 week after surgery were unremarkable. All patients were interviewed 3-10 months after surgery and had no abdominal or gynecological complaints including in relation to sexual intercourse.

CONCLUSION

Transvaginal NOTES cholecystectomy with rigid instruments can be safely and effectively performed in daily routine.

Safety evaluation for a biodiesel process using prion-contaminated animal fat as a source

BACKGROUND

Due to the bovine spongiform encephalopathy (BSE), specified risk material (SRM) as well as animal meat and bone meal (MBM) are banned from the food and feed chain because of a possible infection with pathogenic prions (PrP(Sc)). Nowadays, prions are widely accepted to be responsible for TSE(transmissible spongiform encephalopathies)-caused illnesses like BSE and scrapie, and especially for the occurrence of the new variant of CJD in humans. Presently, SRM and MBM are burnt under high temperatures to avoid any hazards for humans, animals or the environment. The aim of this study was to evaluate a method using animal fat separated from Category I material which includes SRM and the carcasses of TSE-infected animals, or animals suspected of being infected with TSE, as a source for producing biodiesel by transesterification, analogous to the biodiesel process using vegetable oil.

METHODS

For this purpose, animal fat was spiked with scrapie-infected hamster brain equivalents--as representative for a TSE-infected animal--and the biodiesel manufacturing process was downscaled and performed under lab-scale conditions.

RESULTS AND DISCUSSION

The results analysed by Western blotting showed clearly that almost each single step of the process leads to a significant reduction of the concentration of the pathogenic prion protein (PrP(Sc)) in the main and side-products.

CONCLUSION

The data revealed that the biodiesel production, even from material with a high concentration of pathogenic prions, can be considered as safe.

RECOMMENDATIONS AND OUTLOOK

The obtained results indicated that biodiesel produced from prion-contaminated fat was safe under the tested process conditions. However, it has to be pointed out that the results cannot be generalized because a different process control using other conditions may lead to different results and then has to be analysed independently. It is clear that the production of biodiesel from high risk material represents a more economic usage than the combustion of such material.

Clinical evaluation of seating in persons with complete thoracic spinal cord injury

STUDY DESIGN

Consecutive male patients studied with photographic measurement of a combination of clinical methods.

OBJECTIVES

To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods.

SETTING

Spinalis SCI unit, Stockholm, Sweden.

METHODS

Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement.

RESULTS

Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting.

CONCLUSION

Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.

Criminality and platelet monoamine oxidase activity in former juvenile delinquents as adults

Platelet monoamine oxidase (MAO) activity was estimated in 70 former delinquent boys and 40 controls now aged 38-46 years. Platelet MAO activity was compared with their early criminal behaviour (before the age of 15) and their late registered criminality from the age of 15). Mean platelet MAO activity in subjects with both early and late criminality was significantly lower than that in former delinquents without late criminality. There was no significant difference in mean platelet MAO activity between controls and delinquents with early but no late criminality. When delinquents with early criminality were divided into a low and a high MAO group, the relative risk to be registered for late criminality was about 3.1 times higher for the subjects in the low MAO group. Thus, individuals with low platelet MAO activity run an increased risk of continued criminal behaviour.