Operative Complications Following Gastrostomy Tube Placement After Cardiac Surgery During Infancy

INTRODUCTION

Gastrostomy tube (GT) placement is common in infants following repair of congenital heart defects. We aimed to determine rate of operative complications and predictors of short-term GT use to counsel parents regarding the risks and benefits of GT placement.

METHODS

We reviewed infants aged <1 y with congenital heart disease who underwent GT placement after cardiac surgery between 2018 and 2021. Demographics and clinical data were collected and analyzed. Comparisons were made between infants who required the GT for more than 1 y and those who required the GT for less than 1 y.

RESULTS

One hundred thirty three infants were included; 35 (26%) suffered one or more complication including wound infection (4, 3%), granulation tissue (3, 2%), tube dislodgement (10), leakage from the tube (9), unplanned emergency department visit (15), and unplanned readmission (1). Thirty-four infants used the GT for feeds for 1 y or less (26%) including 17 (13%) who used it for 3 mo or less. Fifty-six infants had their GT removed during the study period (42%), 20 of whom required gastrocutaneous fistula closure (36%). Thirty-three infants had a GT placed on or before day of life 30, 17 (52%) used the GT for less than 1 y, and 10 (31%) used it for 3 mo or less.

CONCLUSIONS

GT placement is associated with a relatively high complication and reoperation rate. GT placement in infants aged less than 30 d is associated with shorter duration of use. Risks, benefits, and alternatives such as nasogastric tube feeds should be discussed in the shared decision-making process for selected infants.

Ferroelastic Twin Angles at the Surface of CaTiO_{3} Quantified by Photoemission Electron Microscopy

We use photoemission electron microscopy to measure the ferroelastic twin wall angles at the surface of CaTiO_{3} (001) and deduce the strain ordering. We analyze the angular dependence of the photoelectron emission from different domain surfaces, each with its own characteristic tilt angle in the factory rooflike topography. By considering the surface topography as a field perturbation, the offset in the photoemission threshold can be directly related to the tilt angles. With knowledge of the symmetry allowed twin walls we quantify the twin angles between 179.1° to 180.8°.

Two phase-matching regimes in high-order harmonic generation

High-order harmonic generation (HHG) provides scalable sources of coherent extreme ultraviolet radiation with pulse duration down to the attosecond time scale. Efficient HHG requires the constructive interplay between microscopic and macroscopic effects in the generation volume, which can be achieved over a large range of experimental parameters from the driving field properties to those of the generating medium. Here, we present a systematic study of the harmonic yield as a function of gas pressure and medium length. Two regimes for optimum yield are identified, supporting the predictions of a recently proposed analytical model. Our observations are independent on the focusing geometry and, to a large extent, on the pulse duration and laser intensity, providing a versatile approach to HHG optimization.

AB1528-HPR FULL BODY HAPTIC BODYSUIT - AN INSTRUMENT TO MEASURE THE RANGE AND SPEED OF MOTION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (axSpA) - PRELIMINARY RESULTS

Background

Movement of the spine is restricted in axial spondyloarthritis (axSpA) [1]. Spine function is usually assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI), which is based on a limited set of defined motions that are measured semiquantitatively in the spatial dimension but not in the temporal dimension. Sensor-based measurement of spine function in axSpA patients is in its infancy but may provide a deeper and more detailed understanding of the impact of axSpA on the impairment of spine function [2,3]. In theory, unbiased full body assessment of spine motion may open a new dimension in function analysis in axSpA.

Objectives

To test if a of a full-body based haptic capturing of spine motion is technically feasible and can pick up the measurements of BASMI items 1-5. Furthermore, we aimed to investigate whether such measurements are accurate and reproducible comparing to BASMI scores done by rheumatologists. Lastly, we sought to measure velocity of spine movements to allow spatiotemporal analysis of motion.

Methods

For full-body haptic assessment of spine motion a full-body haptic suit (Teslasuit; VR Electronics Ltd, London) was used that consists of a smart textile two-piece bodysuit that not only captures range and speed of motion but also provides biometric and haptic feedback. This device is currently tested in clinical trials (https://teslasuit.io/rehabilitation/) but has not been tested in rheumatic diseases such as axSpA [4]. Since there is no pre-defined technical solution for measuring BASMI, we used the integrated inertial measurement units (IMUs) of the suit (Figure 1a). The suit is recording the position and rotations of its IMUs and is transforming the raw data to position coordinates and joint angle of the bones. We implemented an algorithm that is accessing the sensor data and is calculating the BASMI measurements as well as velocity. Assessment were done in healthy individuals. BASMI was obtained 3 times by teslasuit followed by standard BASMI measurement by 2 independent rheumatologists. In addition, rotational movements with their maximum torso speed to evaluate angular velocity were performed (Figure 1b). Measurements were compared using absolute values and relative standard deviation (which is the standard deviation normalized by the mean).

Results

Five healthy individuals (all males, age: 27.6 ± 1.8 years, height: 178 ± 5 cm; weight 70.0 ± 8.0 kg) were assessed. Teslasuit measurements were well tolerated. Technically, we were able to calculate BASMI item 3 and 5, finger-to-floor distance and the velocity of the spine movement using the position data of hand, talus and upper back sensors (Figure 1a, b). Due to absence of sensors at the head and the required back areas, BASMI 1, 2, 4 could only partially be captured and require further programming, which is currently performed. Only marginal differences were detected regarding the relative standard deviations of measurements between teslasuit and rheumatologists (BASMI 3: rheumatologists 8,5%: suit 10%; BASMI 5: rheumatologists 5,4%: suit 4,9%) (Figure 1c). The speed of spinal motion could be measured with an average angular velocity of 172.2 degrees/sec over the entire rotation motion and an average maximum angular velocity of 417.2 degrees/sec.

Conclusion

This study shows that full-body haptic-suits can capture spinal motion including parts of the BASMI score. In addition, they allow to measure the speed of spinal movement, which might be an important and so far unrecognized factor to test the impact of axSpA on spinal function. Based on these results, full-body haptic-suits will be tested in axSpA patients in the future. Furthermore, technical solutions are currently developed to implement the remaining BASMI scores into the suit as well as connections from the suit to virtual reality devices for patients and doctors.

References

[1]Sieper, J. and D. Poddubnyy, Axial spondyloarthritis. Lancet 2017.

[2]Gardiner, P.V., et al., Rheumatology (Oxford) 2020.

[3]Kiefer, D., et al., S J Rheumatol 2022.

[4]Caserman, P. et al Sensors (Basel) 2021.

Acknowledgements

This work was (partly) funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – SFB 1483 – Project-ID 442419336, EmpkinS.

Disclosure of Interests

None declared

Chemical and mechanical activation of resident cardiac macrophages in the living myocardial slice ex vivo model

Resident cardiac macrophages (rcMACs) are among the most abundant immune cells in the heart. Plasticity and activation are hallmarks of rcMACs in response to changes in the microenvironment, which is essential for in vitro experimentation. The in vivo investigation is confounded by the infiltration of other cells hindering direct studies of rcMACs. As a tool to investigate rcMACs, we applied the ex vivo model of living myocardial slices (LMS). LMS are ultrathin ex vivo multicellular cardiac preparations in which the circulatory network is interrupted. The absence of infiltration in this model enables the investigation of the rcMACs response to immunomodulatory and mechanical stimulations. Such conditions were generated by applying interferon-gamma (IFN-γ) or interleukine-4 (IL-4) and altering the preload of cultured LMS, respectively. The immunomodulatory stimulation of the LMS induced alterations of the gene expression pattern without affecting tissue contractility. Following 24 h culture, low input RNA sequencing of rcMACs isolated from LMS was used for gene ontology analysis. Reducing the tissue stretch (unloading) of LMS altered the gene ontology clusters of isolated rcMACs with intermediate semantic similarity to IFN-γ triggered reaction. Through the overlap of genes affected by IFN-γ and unloading, we identified Allograft inflammatory factor 1 (AIF-1) as a potential marker gene for inflammation of rcMACs as significantly altered in whole immunomodulated LMS. MicroRNAs associated with the transcriptomic changes of rcMACs in unloaded LMS were identified in silico. Here, we demonstrate the approach of LMS to understand load-triggered cardiac inflammation and, thus, identify potential translationally important therapeutic targets.

[Prevalence of hypophosphatasia in adult patients in rheumatology]

Hintergrund

Die Hypophosphatasie (HPP) ist eine genetische Erkrankung, die durch eine oder mehrere Mutationen im Gen für alkalische Phosphatase (ALP) verursacht wird, verantwortlich für die Kodierung der gewebespezifischen ALP und für den Mineralisierungsprozess.

Ziel der Arbeit

Bestimmung der Prävalenz der HPP bei rheumatologischen Patienten.

Material und Methoden

Retrospektive Analyse der Krankenakten aller erwachsener Patienten mit pathologisch erniedrigten gesamt ALP-Werten (<35 U/l), die zwischen Januar 2017 und Juni 2019 in der Rheumatologie der Medizinischen Klinik III am Universitätsklinikum Bonn behandelt wurden. Die Analyse wurde in Bezug auf klinische Zeichen sowie auf die Ergebnisse der Gentests für HPP untersucht.

Ergebnisse

Bei 60 von 2289 Patienten (2,62 %) zeigten sich pathologisch niedrige ALP-Werte, bei 30 von ihnen (1,31 %) wurden persistierend niedrige ALP-Werte festgestellt. Bei 19 dieser 30 Patienten wurde ein Gentest für ALP-Genmutationen durchgeführt. Sieben der 19 Patienten (36,84 %) hatten HPP-Zeichen (Insuffizienzfrakturen oder schlechter Zahnstatus seit der Kindheit), alle mit pathologischer ALP-Mutation. Drei dieser Patienten (15,78 %) hatten jeweils eine Insuffizienzfraktur mit normwertiger Knochendichtemessung in der Vorgeschichte. Insgesamt 13 von 19 Patienten wiesen (68,42 %) Mutationen im ALP-Gen auf. Interessanterweise wurde keine Assoziation mit einer Chondrokalzinose festgestellt.

Diskussion

Die HPP scheint eine unterdiagnostizierte Erkrankung mit einem höheren Anteil betroffener Patienten, welche in der Rheumatologie vorstellig werden, zu sein. Daher sollten zukünftige Studien darauf abzielen, ein Diagnostikprotokoll in der klinischen Praxis zu entwickeln.

Quantification of Wheat, Rye, and Barley Gluten in Oat and Oat Products by ELISA RIDASCREEN® Total Gluten: Collaborative Study, First Action 2018.15

Background: Since its introduction to the analytical community, the R5 method to quantify gluten led to a strong improvement of the situation for the food industry and celiac patients. During recent years, some questions arose on the use of the Codex Alimentarius factor of two to convert from prolamins to gluten, an overestimation of rye and barley, inadequate detection of glutelins, and the inhomogeneous distribution of gluten in oats. These limitations of the R5 method, especially when measuring oat samples, led to AOAC Standard Method Performance Requirement (SMPR®) 2017.021, which was approved by stakeholders in 2017. Objective: We present a collaborative study of a method for the quantitative analysis of wheat, rye, and barley gluten in oat and oat products using a sandwich ELISA that is based on four different monoclonal antibodies including the R5 monoclonal anitbody. Methods: The sandwich ELISA detects intact gliadins and related prolamins from rye and barley, high-molecular-weight (HMW) glutenin subunits (GS) from wheat, HMW secalins from rye, and low-molecular-weight (LMW) GS from wheat. It does not detect D-hordeins from barley. Samples are extracted by Cocktail solution, subsequently followed by 80% ethanol, and analyzed within 50 min. Results: The measurement range is between 5 and 80 mg/kg gluten using a calibrator made out of a gluten extract from four different wheat cultivars. The results of the collaborative test with 19 participating laboratories showed recoveries ranging from 99 to 137% for all three grain sources. Relative reproducibility SDs for samples &gt;10 mg/kg gluten ranged from 10 to 53%. Conclusions: The collaborative study results confirmed that the method is accurate and suitable to measure gluten from all three grain sources and has demonstrated performance on oat matrices, which meets the criteria as specified in SMPR 2017.021. Data from in-house validation experiments are available as Annex B to this publication.

Life-history strategies of the rock hind grouper Epinephelus adscensionis at Ascension Island

Epinephelus adscensionis sampled from Ascension Island, South Atlantic Ocean, exhibits distinct life-history traits, including larger maximum size and size at sexual maturity than previous studies have demonstrated for this species in other locations. Otolith analysis yielded a maximum estimated age of 25 years, with calculated von Bertalanffy growth parameters of: L_∞  = 55·14, K = 0·19, t₀  = -0·88. Monthly gonad staging and analysis of gonad-somatic index (I_G ) provide evidence for spawning from July to November with an I_G peak in August (austral winter), during which time somatic growth is also suppressed. Observed patterns of sexual development were supportive of protogyny, although further work is needed to confirm this. Mean size at sexual maturity for females was 28·9 cm total length (L_T ; 95% C.I. 27·1-30·7 cm) and no females were found >12 years and 48·0 cm L_T , whereas all confirmed males sampled were mature, >35·1 cm L_T with an age range from 3 to 18 years. The modelled size at which 50% of individuals were male was 41·8 cm (95% C.I. 40·4-43·2 cm). As far as is known, this study represents the first comprehensive investigation into the growth and reproduction of E. adscensionis at its type locality of Ascension Island and suggests that the population may be affected less by fisheries than elsewhere in its range. Nevertheless, improved regulation of the recreational fishery and sustained monitoring of abundance, length frequencies and life-history parameters are needed to inform long-term management measures, which could include the creation of marine reserves, size or temporal catch limits and stricter export controls.

CO2 permeability and carbonic anhydrase activity of rat cardiomyocytes

AIM

To determine the CO₂ permeability (P_CO2 ) of plasma membranes of cardiomyocytes. These cells were chosen because heart possesses the highest rate of O₂ consumption/CO₂ production in the body.

METHODS

Cardiomyocytes were isolated from rat hearts using the Langendorff technique. Cardiomyocyte suspensions exhibited a vitality of 2-14% and were studied by the previously described mass spectrometric ¹⁸ O-exchange technique deriving P_CO2 . We showed by mass spectrometry and by carbonic anhydrase (CA) staining that non-vital cardiomyocytes are free of CA and thus do not contribute to the mass spectrometric signal, which is determined exclusively by the fully functional vital cardiomyocytes.

RESULTS

Lysed cardiomyocytes yielded an intracellular CA activity for vital cells of 5070; that is, the rate of CO₂ hydration inside the cell is accelerated 5071-fold. Using this number, analyses of the mass spectrometric recordings from cardiomyocyte suspensions yield a P_CO2 of 0.10 cm s^-1 (SD ± 0.06, n = 15) at 37 °C.

CONCLUSION

In comparison with the P_CO2 of other cells, this value is quite high and about identical to that of the human red cell membrane. As no major protein CO₂ channels such as aquaporins 1 and 4 are present in rat cardiac sarcolemma, the high P_CO2 of this membrane is likely due to its low cholesterol content of about 0.2 (mol cholesterol)·(mol total membrane lipids)^-1 . Previous work predicted a P_CO2 of ≥0.1 cm s^-1 from this level of cholesterol. We conclude that the low cholesterol establishes a P_CO2 high enough to render the membrane resistance to CO₂ diffusion almost negligible, even under conditions of maximal O₂ consumption of the heart.

Zn-VI quasiparticle gaps and optical spectra from many-body calculations

The electronic band structures of hexagonal ZnO and cubic ZnS, ZnSe, and ZnTe compounds are determined within hybrid-density-functional theory and quasiparticle calculations. It is found that the band-edge energies calculated on the [Formula: see text] (Zn chalcogenides) or GW (ZnO) level of theory agree well with experiment, while fully self-consistent QSGW calculations are required for the correct description of the Zn 3d bands. The quasiparticle band structures are used to calculate the linear response and second-harmonic-generation (SHG) spectra of the Zn-VI compounds. Excitonic effects in the optical absorption are accounted for within the Bethe-Salpeter approach. The calculated spectra are discussed in the context of previous experimental data and present SHG measurements for ZnO.

White matter predicts functional connectivity in premanifest Huntington's disease

Objectives

The distribution of pathology in neurodegenerative disease can be predicted by the organizational characteristics of white matter in healthy brains. However, we have very little evidence for the impact these pathological changes have on brain function. Understanding any such link between structure and function is critical for understanding how underlying brain pathology influences the progressive behavioral changes associated with neurodegeneration. Here, we demonstrate such a link between structure and function in individuals with premanifest Huntington's.

Methods

Using diffusion tractography and resting state functional magnetic resonance imaging to characterize white matter organization and functional connectivity, we investigate whether characteristic patterns of white matter organization in the healthy human brain shape the changes in functional coupling between brain regions in premanifest Huntington's disease.

Results

We find changes in functional connectivity in premanifest Huntington's disease that link directly to underlying patterns of white matter organization in healthy brains. Specifically, brain areas with strong structural connectivity show decreases in functional connectivity in premanifest Huntington's disease relative to controls, while regions with weak structural connectivity show increases in functional connectivity. Furthermore, we identify a pattern of dissociation in the strongest functional connections between anterior and posterior brain regions such that anterior functional connectivity increases in strength in premanifest Huntington's disease, while posterior functional connectivity decreases.

Interpretation

Our findings demonstrate that organizational principles of white matter underlie changes in functional connectivity in premanifest Huntington's disease. Furthermore, we demonstrate functional antero–posterior dissociation that is in keeping with the caudo–rostral gradient of striatal pathology in HD.

Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.

A model-based approach of scatter dose contributions and efficiency of apron shielding for radiation protection in CT

Given the contribution of scattered radiations to patient dose in CT, apron shielding is often used for radiation protection. In this study the efficiency of apron was assessed with a model-based approach of the contributions of the four scatter sources in CT, i.e. external scattered radiations from the tube and table, internal scatter from the patient and backscatter from the shielding. For this purpose, CTDI phantoms filled with thermoluminescent dosimeters were scanned without apron, and then with an apron at 0, 2.5 and 5 cm from the primary field. Scatter from the tube was measured separately in air. The scatter contributions were separated and mathematically modelled. The protective efficiency of the apron was low, only 1.5% in scatter dose reduction on average. The apron at 0 cm from the beam lowered the dose by 7.5% at the phantom bottom but increased the dose by 2% at the top (backscatter) and did not affect the centre. When the apron was placed at 2.5 or 5 cm, the results were intermediate to the one obtained with the shielding at 0 cm and without shielding. The apron effectiveness is finally limited to the small fraction of external scattered radiation.

Bulk sensitive hard x-ray photoemission electron microscopy

Hard x-ray photoelectron spectroscopy (HAXPES) has now matured into a well-established technique as a bulk sensitive probe of the electronic structure due to the larger escape depth of the highly energetic electrons. In order to enable HAXPES studies with high lateral resolution, we have set up a dedicated energy-filtered hard x-ray photoemission electron microscope (HAXPEEM) working with electron kinetic energies up to 10 keV. It is based on the NanoESCA design and also preserves the performance of the instrument in the low and medium energy range. In this way, spectromicroscopy can be performed from threshold to hard x-ray photoemission. The high potential of the HAXPEEM approach for the investigation of buried layers and structures has been shown already on a layered and structured SrTiO3 sample. Here, we present results of experiments with test structures to elaborate the imaging and spectroscopic performance of the instrument and show the capabilities of the method to image bulk properties. Additionally, we introduce a method to determine the effective attenuation length of photoelectrons in a direct photoemission experiment.

[Giant hamartoma of the lung]

Hamartomas are the most common benign tumors of the lungs and usually present as solitary intraparenchymal lesions a few centimeters in diameter which are detected radiologically as an incidental finding. This article reports on a case of a giant pulmonary hamartochondroma 29 cm in diameter, which impressed preoperatively and intraoperatively as an extrapulmonary neoplasm. The detection of smaller mesenchymal neoplastic lesions in the lungs and pleura is a further special feature of this case.

[Biopsy diagnosis of papillary adenoma of the lung by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)]

The papillary adenoma of the lung is a rare benign neoplasia with intraparenchymal localisation and is thus, in general, difficult to access for biopsy diagnosis. Due to the rarity of this lesion, the intra-operative histological diagnosis by frozen section may be problematic. We report on a 75-year-old male patient with a lung nodule, biopsied by means of bronchoscopy with TBNA. The tissue obtained was processed histologically as a cell block and examined microscopically. The diagnosis of a papillary adenoma was made. Our case is the first report on the diagnosis of a papillary adenoma of the lung by TBNA biopsy. For our patient with impaired lung function the diagnostic procedure described here represented a less invasive alternative to the diagnostic evaluation by surgery with intraoperative frozen section examination. This case shows that the TBNA biopsy combined with processing of the tissue as a cell block may represent a contribution to the appropriate management of the patients and serve as an aid for therapy planning.

[Pleuropulmonary involvement leading to bilateral pneumothorax in a patient being treated for rheumatoid arthritis]

INTRODUCTION

Rheumatoid arthritis (RA) is a systemic illness where the development of pulmonary nodule has been described in from 4 to 20% of patients. Symptomatic pleural manifestations occur in 3 to 5% of cases. Rarely, pulmonary nodules become necrotic and lead to pleural complications. Bilateral pneumothorax has only rarely been described.

CASE REPORT

We report the case of a 64-year-old woman, who had been treated for RA for several years and presented with bilateral pneumothorax secondary to necrobiosis of one or several pulmonary rheumatoid nodules. The management of the pneumothorax was very prolonged and difficult, and despite surgical pleurodesis, the lung did not reexpand fully. Pathological examination of the pleura revealed a noncaseating granulomatous pattern. The diagnosis of a sarcoidosis like disease, possibly induced by anti-TNFα, or of pleural tuberculosis were suggested, but we concluded that the final diagnosis was of pleural rheumatoid involvement.

CONCLUSION

Bilateral pneumothorax secondary to rheumatoid nodule is a rare entity. The management of such a complication is difficult, particularly in patients who receive an immunosuppressant regimen. A granulomatous pattern has been described rarely in the pleural tissue of these patients. Specific RA pleural involvement has to be taken in consideration when other diagnoses are eliminated, especially tuberculosis or sarcoidosis-like disease.

Characterization and in vitro cytocompatibility of piezoelectric electrospun scaffolds

Previous studies have shown that electrical charges influence cell behavior (e.g. enhancement of nerve regeneration, cell adhesion, cell morphology). Thus, piezoelectric scaffolds might be useful for various tissue engineering applications. Fibrous scaffolds were successfully fabricated from permanent piezoelectric poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE) by the electrospinning technique. Scanning electron microscopy and capillary flow analyses verified that the fiber mats had an average fiber diameter of 970 +/- 480 nm and a mean pore diameter of 1.7 microm, respectively. Thermally stimulated depolarization current spectroscopy measurements confirmed the piezoelectric property of the PVDF-TrFE fibrous scaffolds by the generation of a spontaneous current with the increase in temperature in the absence of an electric field, which was not detected in the unprocessed PVDF-TrFE powder. Differential scanning calorimetry, thermogravimetric analysis, X-ray diffraction and Fourier transform infrared spectroscopy results showed that the electrospinning process increased the crystallinity and presence of the polar, beta-phase crystal compared with the unprocessed powder. Confocal fluorescence microscopy and a cell proliferation assay demonstrated spreading and increased cell numbers (human skin fibroblasts) over time on PVDF-TrFE scaffolds, which was comparable with tissue culture polystyrene. The relative quantity of gene expression for focal adhesion proteins (measured by real-time RT-PCR) increased in the following order: paxillin < vinculin < focal adhesion kinase < talin. However, no differences could be seen among the TCPS surface and the fibrous scaffolds. Future studies will focus on possible applications of these cytocompatible PVDF-TrFE scaffolds in the field of regenerative medicine.

PULMONARY DEPOSITION OF MONODISPERSE AEROSOLS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

In order to improve patient convenience and drug availability for patients with alpha 1-protease inhibitor deficiency, the administration via the inhalation route has been considered. This study investigated if it is possible to obtain high values of peripheral aerosol deposition by using optimized and controlled inhalation conditions. Therefore, peripheral deposition was studied in 10 patients with alpha 1-protease inhibitor deficiency (phenotype PiZ) and moderate to severe chronic obstructive pulmonary disease by measuring the 24-hour Clearance of radiolabeled inert iron oxide particles with diameters of 2 microns, 3 microns, and 4 microns. Patients inhaled a large volume of aerosol (1000 to 2000 cm3), which was normalized to the individual lung function, with a flow rate of 200 cm3/S. Due to this breathing pattern, peripheral deposition was for all particle sizes above 50% of the inhaled aerosol. The highest peripheral deposition (68%) was found for 3-microns particles.

Preparation of lipophilic alkyl (hydroxy)benzoates by solvent-free lipase-catalyzed esterification and transesterification

Long-chain alkyl benzoates, e.g., lauryl 4-hydroxybenzoate, palmityl 4-hydroxybenzoate, and oleyl 4-hydroxy-3-methoxybenzoate, are formed in high to moderate conversion by lipase-catalyzed transesterification of the corresponding short-chain alkyl benzoates (0.3 to 1 mmol) with fatty alcohols in an equimolar ratio. The substrates are reacted in vacuo in the absence of solvents and drying agents in the reaction mixture. Immobilized lipase B from Candida antarctica (Novozym 435) demonstrates higher activity for the transesterification of various methyl (hydroxy)benzoates with long-chain alcohols than for the corresponding esterification reactions. For example, transesterification activity is around 25-fold higher than esterification activity for the preparation of oleyl 4-hydroxybenzoate. The relative transesterification activities of methoxy- and hydroxy-substituted methyl benzoates found for Novozym 435 are as follows: 2-methoxybenzoate approximately 3-methoxybenzoate > 4-methoxybenzoate > 3-hydroxybenzoate approximately 2-hydroxybenzoate > 4-hydroxybenzoate approximately 4-hydroxy-3-methoxybenzoate approximately 3-hydroxy-4-methoxybenzoate > > 3,4-dihydroxybenzoate. With respect to the position of the substituents at the phenyl moiety of methyl benzoates, transesterification activity of Novozym 435 increases in the order ortho approximately meta > para. Compounds with inverse chemical structure, e.g., (methoxy)benzyl alkanoates, are formed in much higher rates both by esterification and transesterification than the analogous alkyl benzoates. Purification by deacidification, crystallization, or vacuum distillation yielded 74% to 89% of the reaction products.