Re-evaluating expanding intravenous catheters in medical practice.

BACKGROUND: Intravenous catheters are common and essential devices within medical practice. Their placement can be difficult, leading to application of several technologies to improve success. Functionally expanding catheters were once an exciting technology, derailed clinically by hypersensitivity reactions. The exact cause of reactions, attributed to Aquavene catheter materials, remains unknown. AIMS: To reinvestigate functionally expanding intravenous catheters. MATERIALS AND METHODS: The history of the functionally expanding intravenous catheter is presented here along with its utility in current medical practice, potential for further investigation, and possible redesign of these once promising devices. RESULTS: This review demonstrates clinical utility and a lack of definitive cause for failure of the previous functionally expanding intravenous catheter design. As Aquavene materials themselves are commonly considered the cause of hypersensitivity reactions which removed expanding intravenous catheters from the market, this review found several possible substitutes for this material for use in any redesign. DISCUSSION AND CONCLUSION: The functionally expanding intravenous catheter failed due to hypersensitivity reactions in patients. Alternative materials exist for a possible redesign on this once promising clinical product.

A meta-analysis of bone cement mediated antibiotic release: Overkill, but a viable approach to eradicate osteomyelitis and other infections tied to open procedures.

A number of clinical studies have highlighted the success of antibiotics formulated at concentrations between 0 and 6% w/w into bone cements to address localized infections. Separately, some commercial manufacturers have produced gentamycin-infused bone cement mixtures as a countermeasure to infection. The anecdotal evidence suggests that antibiotic infused cements can help eradicate or delay the onset of infections. Quantifying the functionality of that response is more challenging. We have surveyed the literature to identify studies in which controlled drug release or mechanical behavioral assessments have been conducted on drug-infused cements. The focus here is on vancomycin (VAN) in part due to its higher potency relative to gentamycin and its more common usage for staph infections. Takeaways from the limited pool of research studies indicate that large fractions (>99%) of the infused vancomycin remain sequestered in the cement and aren't bioavailable after solidification. Antibiotic fluence ranged from 1 to 283 µg/cm2hr. The initial strength of the various antibiotic loaded samples as produced were 52-96 MPa. Simulated exposures in a fluid environment by submersion reduced the antibiotic loaded strengths between 3 and 29%. Some strength measurements were noted below the ASTM F451 standard for acrylic bone cement although drug releasing spacers likely have different requirements. The glassy behavior of the cured cement led to both vancomycin and gentamicin having low permeability and a burst response. Smaller drug molecules and more gel-like immobilization matrices with lower glass transition temperatures offer higher potential for larger and more comprehensive drug bioavailability.

Swellable catheters based on a dynamic expanding inner diameter.

Intravenous (IV) fluid administration is critical for all patients undergoing care in a hospital setting. In-patient hospital practice, surgeries, and emergency care require functional IVs for fluid replacement and medication administration. Proper placement of IVs is vital to providing medical services. The ease of placement of an IV catheter, however, depends not only on the size of the catheter but also on provider experience and patient demographics such as age, body mass index, hydration status, and medical comorbidities present challenges to successful IV placement. Smaller diameter IV placement can improve success and there are instances where multiple small diameter catheters are placed for patient care when larger bore access is unattainable. Smaller inner-diameter catheters for anesthesia have functional constraints. Ideally, there would be a smaller catheter for placement that could function as a larger catheter for patient care. One solution is the idea of functionally responsive catheters. Here, we evaluated tubular-shaped hydrogels as potential functional catheters that can increase in inner diameter through fluid swelling using cross-linked homopolymers of polyacrylamide, PAM (10-40% w/w), and their copolymers with 0-8% w/w Poly-(Ethylene Glycol)-Diacrylate, PEGDA. For the PAM gels, the water transport mechanism was shown to be concentration-dependent Fickian diffusion, with the less concentrated gels exhibiting increasingly anomalous modes. Increasing the PEGDA content in the network yielded an initial high rate of water uptake, characterized by Case II transport. The swelling kinetics depended strongly on the sample geometry and boundary conditions. Initially, in a submerged swelling, the annulus expands symmetrically in both outward and inward directions (it thickens), reducing the internal diameter by up to 70%. After 1 h, however, the inner diameter increases steadily so that at equilibrium, there is a net (>100%) increase in all the dimensions of the tube. The amount of linear swelling at equilibrium depended only on the polymer volume fraction as made, while the rate of inner diameter expansion depended on the hydrophilicity of the matrix and the kinetics of sorption. This study serves as proof of concept to identify key parameters for the successful design of hydrogel-based catheter devices with expanding inner-diameters for applications in medical care.

The effect of cisplatin on the nanoscale structure of aqueous PEO-PPO-PEO micelles of varying hydrophilicity observed using SAXS.

Aqueous solutions of polyethylene oxide-polypropylene oxide-polyethylene oxide (PEO-PPO-PEO) copolymers form micelles and cubic lattices as their temperature is raised. The presence of added solutes within the dispersions can also affect the kinetics of structure formation. Here, we investigate the structures formed in the amphiphiles P104, P105, and F108 solutions at 31% mass per v both neat and co-formulated with the drug cisplatin (0.02% to 0.1% mass per v) using small-angle X-ray scattering. P104 formed BCC colloidal crystals while P105 and F108 formed FCC structures. Cisplatin had a minor influence of the formation and stability of the crystals during these thermal excursions. The largest interaction between the amphiphiles and cisplatin was P104 where there was a 2% reduction in the BCC lattice parameter of P104 as cisplatin loading rose to 0.1% at 28 °C. The F108 unit cell swelled ∼2% upon cisplatin loading of 0.1%. A progressive evolution and breakdown of these structures was noted as the temperature rose from 10 °C to 35 °C. For the different amphiphiles, crystal thermal expansion coefficients of ∼1 × 10-2 °C-1 were determined in neat and loaded amphiphiles with cisplatin and all the crystals swelled with increasing temperature.

Microwave-assisted cleavage of Alloc and Allyl Ester protecting groups in solid phase peptide synthesis.

Orthogonal protection of amino acid side chains in solid phase peptide synthesis allows for selective deprotection of side chains and the formation of cyclic peptides on resin. Cyclizations are useful as they may improve the activity of the peptide or improve the metabolic stability of peptides in vivo. One cyclization method often used is the formation of a lactam bridge between an amine and a carboxylic acid. It is desirable to perform the cyclization on resin as opposed to in solution to avoid unwanted side reactions; therefore, a common strategy is to use -Alloc and -OAllyl protecting groups as they are compatible with Fmoc solid phase peptide synthesis conditions. Alloc and -OAllyl may be removed using Pd(PPh3 )4 and phenylsilane in DMF. This method can be problematic as the reaction is most often performed at room temperature under argon gas. It is not usually done at higher temperatures because of the fear of poisoning the palladium catalyst. As a result, the reaction is long and reagent-intensive. Herein, we report the development of a method in which the -Alloc/-OAllyl groups are removed using a microwave synthesizer under atmospheric conditions. The reaction is much faster, allowing for the removal of the protecting groups before the catalyst is oxidized, as well as being less reagent-intensive. This method of deprotection was tested using a variety of amino acid sequences and side chain protecting groups, and it was found that after two 5-min deprotections at 38°C, all -Alloc and -OAllyl groups were removed with >98% purity. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.

Isolation and synthesis of polyoxygenated dibenzofurans possessing biological activity.

Reports from the past ten years describing the isolation and/or synthesis of bioactive dibenzofurans possessing three or more oxygen-containing substituents are reviewed. Dibenzofuranoquinones are included in the review.

Formation of platinum-coated templates of insulin nanowires used in reducing 4-nitrophenol.

Modern technology demands ever smaller and more efficient nanoparticles, wires and networks. The natural tendency for amyloid proteins to form fibrillar structures is leveraged in creating high aspect ratio, nano-sized protein fibers as scaffolds for metallized nanowires. The morphology of fibrils is influenced by induced strain during denaturing and early aggregation and subsequent fibril deposition with platinum leads to controlled catalyst surfaces based on the initial protein precipitate. Here we have created insulin fibrils with varying morphologies produced in the presence of heat and strain and investigated their metallization with platinum by TEM. The catalytic activity of the metal-coated protein fibrils was resolved by tracking the reaction kinetics of the conversion of 4-nitrophenol to 4-aminophenol in the presence of the produced nanowires using UV-Vis spectroscopy. The effects of fibril morphology and temperature on the pseudo-first-order kinetics of conversion are investigated. Conversion to 4-aminophenol occurs on the order of minutes and is independent of temperature in the range tested (7 to 20°C). Two regimes of conversion are identified, an early higher rate, followed by a slower later rate.

Agitation of amyloid proteins to speed aggregation measured by ThT fluorescence: a call for standardization.

This retrospective study of protein aggregation measured by Thioflavin T (ThT) fluorescence assay in published literature has assessed protein sensitivity to denaturing conditions that include elevated temperatures, fluctuations in pH, and concentration and, in particular, agitation to induce amyloid structure formation. The dynamic tracking of fluorescence shows a sigmoidal evolution as aggregates form; the resulting kinetics of association have been analyzed to explore the range of aggregation behavior which occurs based on environmental parameters. Comparisons between the experimental results of different groups have been historically difficult due to subtleties of experimental procedures including denaturing temperature, protein type and concentration, formulation differences, and how agitation is achieved. While it is clear that agitation has a strong influence on the driving force for aggregation, the use of magnetic stirring bar or shaker table rotational speed is insufficient to characterize the degree of turbulence produced during shear. The pathway forward in resolving dependence of aggregate formation on shear may require alternative methodologies or better standardization of the experimental protocols.

Thermodynamic properties of aqueous PEO-PPO-PEO micelles with added methylparaben determined by differential scanning calorimetry.

DSC experiments were performed on aqueous solutions of PEO-PPO-PEO (P105) amphiphiles in the low concentration regime (0-1%) to resolve the critical micelle concentration (cmc) both neat and co-formulated with methylparaben (MP). Further work was done at 10% amphiphilic copolymer concentrations and co-formulated with MP to resolve the variations in enthalpy. The compensation temperature, T(compensation), was determined from the analyses for neat P105 as 293.9 K; adding MP raises this to 328.43 K.

Fabrication and characterization of poly(lactic-co-glycolic acid) microsphere/amorphous calcium phosphate scaffolds.

Although hydroxyapatite (HAP) and ß-tricalcium phosphate have been used extensively as osteoconductive minerals in biomaterial scaffolds for bone regeneration, they lack the capacity to stimulate osteoblastic differentiation of progenitor cells. In contrast, amorphous calcium phosphates (ACPs), which convert to HAP under aqueous conditions, have the potential to facilitate osteoblastic differentiation through the transient local release of calcium and phosphate ions. Therefore, in this study ACPs were synthesized using zinc and zirconia divalent cations as stabilizers (denoted ZnACP and ZrACP, respectively) and compared to HAP. Analysis of ion release into serum-containing cell culture medium revealed transiently elevated levels of calcium and phosphorous, consistent with the enhanced solubility of ZrACP and ZnACP relative to HAP. In addition, X-ray diffraction analysis revealed partial conversion of ZrACP to HAP but no conversion of ZnACP after 96 h. Next, scaffolds were fabricated by sintering mixtures of 300-500 µm poly(D,L-lactic-co-glycolic acid) (PLGA) microspheres and 0.5 wt% calcium phosphate mineral (HAP, ZrACP or ZnACP) at 70 °C for 24 h. Scanning electron microscopy revealed a porous microsphere matrix with calcium phosphate particulates clinging to the microsphere surfaces both prior to and after 14 days in culture medium. Finally, the incorporation of calcium phosphate resulted in a lower compressive modulus in the range 127 to 74-89 MPa. Taken together, these results indicate that ZrACP, ZnACP and HAP minerals exhibit very different properties, and therefore may elicit different osteoblastic responses in vitro.

In vitro evaluation of osteoblastic differentiation on amorphous calcium phosphate-decorated poly(lactic-co-glycolic acid) scaffolds.

Calcium phosphate-decorated polyester matrices are promising scaffolds for bone tissue engineering that combine the tunable degradation of synthetic polymers and the osteoconductivity of calcium phosphate minerals. In this study, scaffolds decorated with stabilized amorphous calcium phosphate (ACP) minerals-which exhibit sustained dissolution and release of calcium and phosphate ions-were tested for their ability to support osteoblast proliferation and stimulate differentiation. The two ACPs tested were zirconia-hybridized ACP (ZrACP), which releases ions over a few days and converts in aqueous solution to hydroxyapatite (HAP), and zinc-hybridized ACP (ZnACP), which has a longer period of sustained ion release. MC3T3-E1 pre-osteoblasts were cultured in these scaffolds for up to 21 days, and cell number, alkaline phosphatase (ALP) activity and expression of osteogenic and bone-specific proteins were measured. Cell number, prostaglandin E(2) (PGE(2) ) synthesis and osteopontin (OPN) mRNA expression were elevated on calcium phosphate-decorated scaffolds relative to PLGA controls, while mRNA expression of osteocalcin (OCN), bone sialoprotein and bone morphogenetic protein (BMP)-4 were suppressed. Although MC3T3-E1 responses to the two ACPs were not statistically different, ZrACP-which converts more quickly to HAP-gave rise to slightly higher levels of mRNA expression for BMP-4, osterix, vascular endothelial growth factor (VEGF)-A, OCN and OPN, but slightly lower levels of PGE(2) synthesis, ALP activity and cell number. These results indicate that sintered PLGA microsphere scaffolds decorated with 0.5 wt% ZnACP or ZrACP support cell attachment and elicit a series of biological responses, but these responses do not appear to accelerate osteoblast differentiation.

Design and application of an oscillatory compression device for cell constructs.

Mechanical compression has been shown to impact cell activity; however a need for a single device to perform a broader range of parametric studies exists. We have developed an oscillatory displacement controlled device to uniaxially strain cell constructs under both static and dynamic compression and used this device to investigate gene expression in cell constructs. The device has a wide stroke (0.25-4 mm) and frequency range (0.1-3 Hz) and several loading waveforms are possible. Alginate cellular constructs with embedded equine chondrocytes were tested and viability was maintained for the 24 h test period. Off-line mechanical testing is described and a modulus value of 18.2 +/- 1.3 kPa found for alginate disks which indicates the level of stress achieved with this deformation profile. Static (15% strain) and dynamic (15% strain, 1 Hz, triangle waveform) testing of chondrocyte constructs was performed and static compression showed significantly higher collagen II expression than dynamic using quantitative RT-PCR. In contrast, differences in matrix metalloproteinase-3 (MMP-3) expression were statistically insignificant. These studies indicate the utility of our device for studying cell activity in response to compression and suggest further studies regarding how the load and strain spectrum impact chondrocyte activity.

Effect of soluble zinc on differentiation of osteoprogenitor cells.

Amorphous calcium phosphates (ACPs) are attractive fillers for osseous defects and are stabilized through the incorporation of transition metals such as zirconium and zinc. As ACP converts in solution to hydroxyapatite (HAP) in a manner marked by a transient release of calcium and phosphate ions, it is capable of stimulating osteoblastic differentiation. Zinc is known to retard ACP conversion to HAP, and--when incorporated into ceramic biomaterials--has been shown to stimulate osteoblastic differentiation. Because zinc deficiency in vivo is marked by skeletal defects, we postulated that zinc ions released from ACP and other minerals could stimulate proliferation and osteoblastic differentiation of progenitor cells. To test this hypothesis, rat bone marrow stromal cells were cultured in osteogenic medium containing basal (3 x 10(-6) M) or supplemented Zn(2+) concentrations (1 x 10(-5) and 4 x 10(-5) M) for up to 3 weeks. No significant effects of zinc concentration on cell number, alkaline phosphatase activity, total protein content, collagen synthesis, or matrix mineralization were found.

Facile synthesis of N-dialkylaminomethyl-substituted heterocycles.

Iminium ions are generated by treatment of aminals with succinic anhydride. These iminium ions are trapped by heterocycles, giving the corresponding N-dialkylamino-methyl-substituted heterocycles, which are easily separated from the succinic acid monoamide byproducts by means of an aqueous base wash. The heterocyclic products are obtained in good yield and in a high state of purity without need of recrystallization or distillation.

Fabrication and characterization of poly(DL-lactic-co-glycolic acid)/zirconia-hybridized amorphous calcium phosphate composites.

Several minerals, such as hydroxyapatite and beta-tricalcium phosphate, have been incorporated into bioresorbable polyester bone scaffolds to increase the osteoconductivity both in vitro and in vivo. More soluble forms of calcium phosphate that release calcium and phosphate ions have been postulated as factors that increase osteoblast differentiation and mineralization. Recently, a zirconia-hybridized pyrophosphate-stabilized amorphous calcium phosphate (Zr-ACP) has been synthesized allowing controlled release of calcium and phosphate ions. When incorporated into bioresorbable scaffolds, Zr-ACP has the potential to induce osteoconductivity. In this study, 80-90% (w/v) porous poly(DL-lactic-co-glycolic acid) (PLGA) scaffolds were formed by thermal phase separation from dioxane while incorporating Zr-ACP. Scanning electron microscopy revealed a highly porous structure with a pore size ranging from a few microm to about 100 microm, smaller than we had hoped for. Zr-ACP particles were evenly dispersed in the composite structure and incorporated into the pore walls. The amorphous structure of the Zr-ACP was maintained during composite fabrication, as found by X-ray diffraction. Composite scaffolds had larger compressive yield strengths and moduli compared to pure polymer scaffolds. These initial efforts demonstrate that PLGA/Zr-ACP composites can be formed in ways that ultimately serve as promising bone scaffolds in tissue engineering.

Reduced transglutaminase-catalyzed protein aggregation is observed in the presence of creatine using sedimentation velocity.

Transglutaminases (TGases) are enzymes that catalyze covalent isopeptide crosslinks between reactive lysine and glutamine residues in proteins. Higher than normal local concentrations of TGase have been correlated with increased protein aggregation in vivo. These insoluble protein aggregates are the hallmark of several neurodegenerative diseases, including Alzheimer's, Parkinson's, and Huntington's diseases, although each aggregating protein involved is disease specific. Because TGase is implicated in protein aggregation, there is evidence that its regulation may retard disease progression. Here we report on a laser light transmission technique as an in vitro tool to gauge the efficacy of creatine, a candidate inhibitor, to regulate aggregation. Sedimentation velocities of protein-coated particles in TGase-containing water-glycerol solutions were tracked with different levels of creatine. Sedimentation velocities were converted to apparent aggregate sizes using Stoke's law of sedimentation. The results indicated that creatine promoted up to a 20% reduction in protein aggregation in vitro. This technique may prove to be useful in identifying other functional TGase inhibitors.

Osteoblast response to zirconia-hybridized pyrophosphate-stabilized amorphous calcium phosphate.

Calcium phosphate bioceramics, such as hydroxyapatite, have long been used as bone substitutes because of their proven biocompatibility and bone binding properties in vivo. Recently, a zirconia-hybridized pyrophosphate-stabilized amorphous calcium phosphate (Zr-ACP) has been synthesized, which is more soluble than hydroxyapatite and allows for controlled release of calcium and phosphate ions. These ions have been postulated to increase osteoblast differentiation and mineralization in vitro. The focus of this work is to elucidate the physicochemical properties of Zr-ACP and to measure cell response to Zr-ACP in vitro using a MC3T3-E1 mouse calvarial-derived osteoprogenitor cell line. Cells were cultured in osteogenic medium and mineral was added to culture at different stages in cell maturation. Culture in the presence of Zr-ACP showed significant increases in cell proliferation, alkaline phosphatase activity (ALP), and osteopontin (OPN) synthesis, whereas collagen synthesis was unaffected. In addition, calcium and phosphate ion concentrations and medium pH were found to transiently increase with the addition of Zr-ACP, and are hypothesized to be responsible for the osteogenic effect of Zr-ACP.

A controlled study of a serotonin reuptake blocker, zimelidine, in the treatment of chronic pain.

Zimelidine inhibits the central neuronal reuptake of serotonin and has undergone clinical evaluation as an antidepressant. Twenty patients with chronic pain of non-malignant origin (mean duration 15.8 years) were entered into a double blind cross-over study of the analgesic efficacy of zimelidine and placebo. The duration of each treatment phase was 6 weeks and there was a comprehensive assessment of each patient prior to the commencement and at the completion of the study, during a brief period of hospitalisation. Zimelidine was superior (P less than 0.05) to placebo with respect to pain relief based on a global assessment (by the clinical investigators) performed at the completion of each treatment phase. However, there was no significant difference in analgesic efficacy between the zimelidine and placebo treatment phases based on the following criteria: (a) changes in the minimum effective blood concentration of pethidine necessary to provide pain relief in each patient, measured during a pethidine infusion of 1.67 mg/min for 60 min; (b) changes in pain scores estimated by patients using the visual analogue pain scale (VAPS); (c) changes in patients' estimates of pain intensity associated with various daily activities. Significant pain relief was apparent within 2-3 days in those patients who had a beneficial effect, which contrasts with the documented 3-4 weeks for maximal antidepressant effects. The results of this study suggest that serotonin reuptake blockers do not provide consistent pain relief in patients with chronic pain, but may contribute an analgesic effect in the treatment of some patients.