Intracerebral gadolinium deposition following blood-brain barrier disturbance in two different mouse models

To evaluate the influence of the blood-brain barrier on neuronal gadolinium deposition in a mouse model after multiple intravenous applications of the linear contrast agent gadodiamide. The prospective study held 54 mice divided into three groups: healthy mice (A), mice with iatrogenic induced disturbance of the blood-brain barrier by glioblastoma (B) or cerebral infarction (C). In each group 9 animals received 10 iv-injections of gadodiamide (1.2 mmol/kg) every 48 h followed by plain T1-weighted brain MRI. A final MRI was performed 5 days after the last contrast injection. Remaining mice underwent MRI in the same time intervals without contrast application (control group). Signal intensities of thalamus, pallidum, pons, dentate nucleus, and globus pallidus-to-thalamus and dentate nucleus-to-pons ratios, were determined. Gadodiamide complex and total gadolinium amount were quantified after the last MR examination via LC-MS/MS and ICP-MS. Dentate nucleus-to-pons and globus pallidus-to-thalamus SI ratios showed no significant increase over time within all mice groups receiving gadodiamide, as well as compared to the control groups at last MR examination. Comparing healthy mice with group B and C after repetitive contrast administration, a significant SI increase could only be detected for glioblastoma mice in globus pallidus-to-thalamus ratio (p = 0.033), infarction mice showed no significant SI alteration. Tissue analysis revealed significantly higher gadolinium levels in glioblastoma group compared to healthy (p = 0.013) and infarction mice (p = 0.029). Multiple application of the linear contrast agent gadodiamide leads to cerebral gadolinium deposition without imaging correlate in MRI.

Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy

Background

Most serous ovarian cancers are now understood to originate in the fallopian tubes. Removing the tubes (salpingectomy) likely reduces the risk of developing high‐grade serous ovarian cancer. Numerous gynaecological societies now recommend prophylactic (or opportunistic) salpingectomy at the time of gynaecological surgery in appropriate women, and this is widely done. Salpingectomy at the time of non‐gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer.

Methods

This study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. Outcome measures were rate of accomplishment of salpingectomy, time and procedural steps needed for salpingectomy, and complications.

Results

A total of 105 patients were included in the study. The rate of acceptance of salpingectomy was approximately 60 per cent. Salpingectomy was performed in 98 of 105 laparoscopic cholecystectomies (93·3 per cent) and not accomplished because of poor visibility or adhesions in seven (6·7 per cent). Median additional operating time was 13 (range 4–45) min. There were no complications attributable to salpingectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re‐evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma.

Conclusion

Prophylactic salpingectomy can be done during elective laparoscopic cholecystectomy.

Identifying and describing a model region to evaluate the impact of telemedicine

Background

Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented.

Methods

Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA.

Results

With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (>15.85 %) and hypertension (>39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists.

Conclusions

The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region.

Key messages

Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.

CRISPR-Cas9: A New Addition to the Drug Metabolism and Disposition Tool Box

Clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR associated protein 9 (Cas9), i.e., CRISPR-Cas9, has been extensively used as a gene-editing technology during recent years. Unlike earlier technologies for gene editing or gene knockdown, such as zinc finger nucleases and RNA interference, CRISPR-Cas9 is comparably easy to use, affordable, and versatile. Recently, CRISPR-Cas9 has been applied in studies of drug absorption, distribution, metabolism, and excretion (ADME) and for ADME model generation. To date, about 50 papers have been published describing in vitro or in vivo CRISPR-Cas9 gene editing of ADME and ADME-related genes. Twenty of these papers describe gene editing of clinically relevant genes, such as ATP-binding cassette drug transporters and cytochrome P450 drug-metabolizing enzymes. With CRISPR-Cas9, the ADME tool box has been substantially expanded. This new technology allows us to develop better and more predictive in vitro and in vivo ADME models and map previously underexplored ADME genes and gene families. In this mini-review, we give an overview of the CRISPR-Cas9 technology and summarize recent applications of CRISPR-Cas9 within the ADME field. We also speculate about future applications of CRISPR-Cas9 in ADME research.

Intestinal and hepatic contributions to the pharmacokinetic interaction between gamithromycin and rifampicin after single-dose and multiple-dose administration in healthy foals

BACKGROUND

Standard treatment of foals with severe abscessing lung infection caused by Rhodococcus equi using rifampicin and a macrolide antibiotic can be compromised by extensive inhibition and/or induction of drug metabolising enzymes (e.g. CYP3A4) and transport proteins (e.g. P-glycoprotein), as has been shown for rifampicin and clarithromycin. The combination of rifampicin with the new, poorly metabolised gamithromycin, a long-acting analogue of azithromycin and tulathromycin with lower pharmacokinetic interaction potential, might be a suitable alternative.

OBJECTIVES

To evaluate the pharmacokinetic interactions and pulmonary distribution of rifampicin and gamithromycin in healthy foals, and to investigate the cellular uptake of gamithromycin in vitro.

STUDY DESIGN

Controlled, four-period, consecutive, single-dose and multiple-dose study.

METHODS

Pharmacokinetics and lung distribution of rifampicin (10 mg/kg) and gamithromycin (6 mg/kg) were measured in nine healthy foals using LC-MS/MS. Enzyme induction was confirmed using the 4β-OH-cholesterol/cholesterol ratio. Affinity of gamithromycin to drug transport proteins was evaluated in vitro using equine hepatocytes and MDCKII-cells stably transfected with human OATP1B1, OATP1B3 and OATP2B1.

RESULTS

Rifampicin significantly (P<0.05) increased the plasma exposure of gamithromycin (16.2 ± 4.77 vs. 8.57 ± 3.10 μg × h/mL) by decreasing the total body clearance. Otherwise, gamithromycin significantly lowered plasma exposure of single- and multiple-dose rifampicin (83.8 ± 35.3 and 112 ± 43.1 vs. 164 ± 96.7 μg × h/mL) without a change in metabolic ratio and half-life. Gamithromycin was identified as an inhibitor of human OATP1B1, OATP1B3 and OATP2B1 and as a substrate of OATP2B1. In addition, it was extracted by equine hepatocytes via a mechanism which could be inhibited by rifampicin.

MAIN LIMITATIONS

Influence of gamithromycin on pulmonary distribution of rifampicin was not evaluated.

CONCLUSION

The plasma exposure of gamithromycin is significantly increased by co-administration of rifampicin which is most likely caused by inhibition of hepatic elimination.

Composition-dependent charge transfer and phase separation in the V1-xRexO2 solid solution

The substitution of vanadium in vanadium dioxide VO₂ influences the critical temperatures of structural and metal-to-insulator transitions in different ways depending on the valence of the dopant. Rhenium adopts valence states between +4 and +7 in an octahedral oxygen surrounding and is particularly interesting in this context. Structural investigation of V_1-xRe_xO₂ solid solutions (0.01 ≤ x ≤ 0.30) between 80 and 1200 K using synchrotron X-ray powder diffraction revealed only two polymorphs that resemble VO₂: the low-temperature monoclinic MoO₂-type form (space group P2₁/c), and the tetragonal rutile-like form (space group P4₂/mnm). However, for compositions with 0.03 < x ≤ 0.15 a phase separation in the solid solution was observed below 1000 K upon cooling down from 1200 K, giving rise to two isostructural phases with slightly different lattice parameters. This is reflected in the appearance of two metal-to-insulator transition temperatures detected by magnetization and specific heat measurements. Comprehensive X-ray photoelectron spectroscopy studies showed that an increased amount of Re leads to a change in the Re valence state from solely Re⁶⁺ at a low doping level (≤3 at% Re) via mixed-valence states Re⁴⁺/Re⁶⁺ for at least 0.03 < x ≤ 0.10, up to nearly pure Re⁴⁺ in V_0.70Re_0.30O₂. Thus, compositions V_1-xRe_xO₂ with only one valence state of Re in the material (Re⁶⁺ or Re⁴⁺) can be obtained as a single phase, while intermediate compositions are subjected to a phase separation, presumably due to different valence states of Re.

Correction: Composition-dependent charge transfer and phase separation in the V1−xRexO2 solid solution

Correction for ‘Composition-dependent charge transfer and phase separation in the V_1−xRe_xO₂ solid solution’ by D. Mikhailova, et al., Dalton Trans., 2017, 46, 1606–1617.

[Catheter-related thrombosis during intravascular temperature management]

We report on a case of catheter-related thrombosis after 7‑day catheter placement during intravascular temperature management (IVTM), in spite of the use of prophylactic anticoagulants. There were no clinical sequelae. According to the literature, occult thrombosis during ITVM could be more frequent than previously reported and dedicated monitoring for potential thrombosis may be indicated. However, a study comparing IVTM with surface cooling found no differences in clinical outcome. Therefore, n either of the methods can be recommended over the other. Further studies should evaluate the rate of occult thrombosis during the use of both cooling methods.

Transformation of epitaxial NiMnGa/InGaAs nanomembranes grown on GaAs substrates into freestanding microtubes

NiMnGa/InGaAs nanomembranes grown by epitaxy on semiconductor substrates are transformed into freestanding microtubes using self assembly techniques and are investigated.

From soft to hard magnetic Fe-Co-B by spontaneous strain: a combined first principles and thin film study

In order to convert the well-known Fe-Co-B alloy from a soft to a hard magnet, we propose tetragonal strain by interstitial boron. Density functional theory reveals that when B atoms occupy octahedral interstitial sites, the bcc Fe-Co lattice is strained spontaneously. Such highly distorted Fe-Co is predicted to reach a strong magnetocrystalline anisotropy which may compete with shape anisotropy. To probe this theoretical suggestion experimentally, epitaxial films are examined. A spontaneous strain up to 5% lattice distortion is obtained for B content up to 4 at%, which leads to uniaxial anisotropy constants exceeding 0.5 MJ m(-3). However, a further addition of B results in a partial amorphisation, which degrades both anisotropy and magnetisation.

Thin film growth of Fe-based superconductors: from fundamental properties to functional devices. A comparative review

Fe-based superconductors bridge a gap between MgB2 and the cuprate high temperature superconductors as they exhibit multiband character and transition temperatures up to around 55 K. Investigating Fe-based superconductors thus promises answers to fundamental questions concerning the Cooper pairing mechanism, competition between magnetic and superconducting phases, and a wide variety of electronic correlation effects. The question addressed in this review is, however, is this new class of superconductors also a promising candidate for technical applications? Superconducting film-based technologies range from high-current and high-field applications for energy production and storage to sensor development for communication and security issues and have to meet relevant needs of today’s society and that of the future. In this review we will highlight and discuss selected key issues for Fe-based superconducting thin film applications. We initially focus our discussion on the understanding of physical properties and actual problems in film fabrication based on a comparison of different observations made in the last few years. Subsequently we address the potential for technological applications according to the current situation.

LC-MS/MS-based quantification of clinically relevant intestinal uptake and efflux transporter proteins

Multidrug transporter proteins are crucial determinants in the pharmacokinetics of many drugs. To evaluate their impact on intestinal drug absorption, we developed and validated quantification methods for 10 uptake transporters (OATP1A2, OATP2B1, PEPT1, ASBT, OCT1, OCT3) and efflux transporters (ABCB1, ABCC2, ABCC3, ABCG2) that have been reported to be expressed and to be of clinical relevance in the human intestine. Quantification was performed by targeted liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based quantification of proteospecific peptides after tryptic digestion using stable isotope labeled internal standard peptides. The chromatography of the respective peptides was performed by gradient elution using a reversed phase (C18) column (Kinetex(®), 100 × 3.0 mm, 2.6 μm) and 0.1% formic acid (FA) and acetonitrile with 0.1% FA as mobile phases at a flow rate of 0.5 ml/min. The MS/MS detection was done in the positive multiple reaction monitoring (MRM) mode by monitoring in each case three mass transitions for the transporter-derived peptides and the internal standard peptides. The assays were validated with respect to specificity, linearity (0.1-25 nM), within-day and between-day accuracy and precision as well as stability according to current bioanalytical guidelines. Finally, the developed methods were used to determine the transporter protein content in human intestinal tissue (jejunum and ileum). The methods were shown to possess sufficient specificity, sensitivity, accuracy, precision and stability to measure transporter proteins in the human intestine.

Chemical nanoroughening of Ti40Nb surfaces and its effect on human mesenchymal stromal cell response

Samples of low modulus beta-type Ti40Nb and cp2-Ti were chemically treated with 98% H2 SO4 + 30% H2 O2 (vol. ratio 1:1) solution. Surface analytical studies conducted with HR-SEM, AFM, and XPS identified a characteristic nanoroughness of the alloy surface related with a network of nanopits of ∼25 nm diameter. This is very similar to that obtained for cp2-Ti. The treatment enhances the oxide layer growth compared to mechanically ground states and causes a strong enrichment of Nb2 O5 relative to TiO2 on the alloy surface. The in vitro analyses clearly indicated that the chemical treatment accelerates the adhesion and spreading of human mesenchymal stromal cells (hMSC), increases the metabolic activity, and the enzyme activity of tissue non-specific alkaline phosphatase (TNAP). Surface structures which were generated mimic the cytoplasmic projections of the cells on the nanoscale. Those effects are more pronounced for the Ti40Nb alloy than for cp2-Ti. The relation between alloy surface topography and chemistry and cell functions is discussed.

Automated regenerable microarray-based immunoassay for rapid parallel quantification of mycotoxins in cereals

An automated flow-through multi-mycotoxin immunoassay using the stand-alone Munich Chip Reader 3 platform and reusable biochips was developed and evaluated. This technology combines a unique microarray, prepared by covalent immobilization of target analytes or derivatives on diamino-poly(ethylene glycol) functionalized glass slides, with a dedicated chemiluminescence readout by a CCD camera. In a first stage, we aimed for the parallel detection of aflatoxins, ochratoxin A, deoxynivalenol, and fumonisins in cereal samples in a competitive indirect immunoassay format. The method combines sample extraction with methanol/water (80:20, v/v), extract filtration and dilution, and immunodetection using horseradish peroxidase-labeled anti-mouse IgG antibodies. The total analysis time, including extraction, extract dilution, measurement, and surface regeneration, was 19 min. The prepared microarray chip was reusable for at least 50 times. Oat extract revealed itself as a representative sample matrix for preparation of mycotoxin standards and determination of different types of cereals such as oat, wheat, rye, and maize polenta at relevant concentrations according to the European Commission regulation. The recovery rates of fortified samples in different matrices, with 55-80 and 58-79%, were lower for the better water-soluble fumonisin B1 and deoxynivalenol and with 127-132 and 82-120% higher for the more unpolar aflatoxins and ochratoxin A, respectively. Finally, the results of wheat samples which were naturally contaminated with deoxynivalenol were critically compared in an interlaboratory comparison with data obtained from microtiter plate ELISA, aokinmycontrol® method, and liquid chromatography-mass spectrometry and found to be in good agreement.

The Medizinercorps Graz: a 120-year-old institution of emergency medicine

One year after the establishment of the rescue service of Graz, Austria, in 1889, twelve young medical students were recruited because of the lack of accredited physicians for emergency care, leading to the foundation of the Medizinercorps Graz. This concept of involving medical students in prehospital emergency care has been retained for more than 120 years, and today the Medizinercorps is integrated into the local Red Cross branch, staffing two emergency ambulance vehicles. The responsible medical officer is called Rettungsmediziner and is an advanced medical student with a specialized emergency medical training of more than 3,000 hours, comprising theoretical lectures; in-hospital clerkships in anesthesia, internal medicine, and surgery; manikin training; and hands-on peer-to-peer teaching during assignments. The local emergency medical system provides at least 10 regular basic ambulance vehicles, the two emergency ambulance vehicles, and two emergency physicians on a 24-hours-a-day/seven-days-a-week basis for about 300,000 people. The emergency ambulance vehicles staffed with a Rettungsmediziner respond to all kinds of possibly life-threatening situations and also provide interhospital transfer of intensive care patients. This entirely volunteer-based system enables extremely high-level prehospital emergency care, saves resources and reduces costs, and employs modern training concepts for the continuing advancement of prehospital emergency care.

The impact of heat treatment on interactions of contact-poled biphasic calcium phosphates with proteins and cells

A number of studies have reported improved bone integration for calcium phosphate based materials electrically "poled" by an external electric field prior to implantation. In our study we investigated the effects of electrical polarization of a biphasic ceramic composed of 80% hydroxyapatite and 20% β-tricalcium phosphate. As contact poling involves elevated temperatures as a prerequisite for inducing charge, we used two reference types: samples without any heat treatment and poling, and samples with no poling but heat treatment identical to that of the poled samples. All heat-treated samples (poled or unpoled) showed an improved wettability, which was attributed to a reduced hydrocarbon contamination. Heat treatment alone provoked an accelerated spreading of osteoblast-like cells, whereas on poled samples a retarded cell spreading was observed. While proliferation and several differentiation markers were not influenced by either heat treatment or poling, the release of proinflammatory cytokines interleukin-6 and -8 was significantly reduced for all heat-treated samples, irrespective of additional electrical poling. The study demonstrated that the behaviour of cells in contact with poled biphasic ceramics was influenced by two parameters: heating and charge. Our data revealed that heating of the calcium phosphate ceramics had a much more pronounced effect on cell behaviour than charge.

Compartment-specific gene regulation of the CAR inducer efavirenz in vivo

Nuclear receptors such as the constitutive androstane receptor (CAR) are central factors that link drug exposure to the activities of drug metabolism and elimination. In order to determine the in vivo effects of efavirenz, a CAR activator, the expression of target genes was determined in duodenal biopsies obtained from 12 healthy volunteers before treatment and after 10 days of treatment with efavirenz; concomitant administration of the cholesterol inhibitor ezetimibe produced no significant difference. However, in in vitro studies, efavirenz significantly increased CYP2B6 expression in several cell types, suggesting that the drug transactivates CAR. This hypothesis is supported by our findings that there is significant induction of CAR target genes in in vivo peripheral blood mononuclear cells (PBMCs) isolated from healthy volunteers treated with multiple doses of efavirenz. The impact of efavirenz on hepatic metabolism in vivo was confirmed by significant changes in plasma 4β-hydroxycholesterol and bilirubin levels and the area under the curve (AUC) of efavirenz. Induction of CYP2B6 mRNA expression correlated with the decrease in the AUC of efavirenz (r = 0.61; P = 0.036). Taken together, our results provide evidence that efavirenz exerts compartment-specific inductive capacity in vivo.

Delivery of carboplatin by carbon-based nanocontainers mediates increased cancer cell death

Since the activity of several conventional anticancer drugs is restricted by resistance mechanisms and dose-limiting side-effects, the design of nanocarriers seems to be an efficient and promising approach for drug delivery. Their chemical and mechanical stability and their possible multifunctionality render tubular nanomaterials, such as carbon nanotubes (CNTs) and carbon nanofibres (CNFs), promising delivery agents for anticancer drugs. The goal of the present study was to investigate CNTs and CNFs in order to deliver carboplatin in vitro. No significant intrinsic toxicity of unloaded materials was found, confirming their biocompatibility. Carboplatin was loaded onto CNTs and CNFs, revealing a loading yield of 0.20 mg (CNT-CP) and 0.13 mg (CNF-CP) platinum per milligram of material. The platinum release depended on the carrier material. Whereas CNF-CP marginally released the drug, CNT-CP functioned as a drug depot, constantly releasing up to 68% within 14 days. The cytotoxicity of CNT-CP and CNF-CP in urological tumour cell lines was dependent on the drug release. CNT-CP was identified to be more effective than CNF-CP concerning the impairment of proliferation and clonogenic survival of tumour cells. Moreover, carboplatin, which was delivered by CNT-CP, exhibited a higher anticancer activity than free carboplatin.

How is wettability of titanium surfaces influenced by their preparation and storage conditions?

The effect of two different etching procedures with inorganic acids (HSE and CSE)-one using additionally strongly oxidising conditions due to the presence of CrO(3) (CSE)-and consecutive storage conditions (dry methanol and air) for previous corundum blasted titanium surfaces is compared with respect to their wettability behaviour and the potential of the etching processes for removing remaining blasting material. The etching procedures result in distinct different surface morphologies. Whereas the HSE surface shows sub-mm to sub-mum structures but neither porosity nor undercuts, the CSE surface is extremely rugged and porous with structures protruding the more homogeneously attacked areas by several micrometers. By EDX analysis both remaining blasting material and chromium and sulphur from the etching treatment has been detected on the CSE surfaces only. Both surfaces states show super-hydrophilic behaviour immediately after etching and storage up to 28 days in dry methanol. Whereas contact with air does not change super-hydrophilicity for the CSE samples, wettings angles of the HSE samples increase within minutes and reach about angles of about 60 degrees and 90 degrees after one and 2 days exposure to air, respectively. The increasing hydrophobicity is discussed with respect to the formation of a surface coverage from hydrocarbons originating from aromatic compounds present in traces in air.