Controlling block copolymer one-dimensional self-assembly in polymeric matrices.

The synthesis of one-dimensional (1D) nanostructures in polymeric matrices has become the focus of much research, as the presence of these highly anisotropic domains determines the transport behaviour and mechanical properties of the resulting nanostructured polymers. In this work, 1D PEO nanocrystals were synthesized in situ from polystyrene-b-polyethylene oxide (PS-b-PEO) self-assembly in a polystyrene matrix. For this, three different block copolymers (BCP) were employed: L-BCP (PS = 32 000 Da and PEO = 11 000 Da), M-BCP, (PS = 59 000 Da and PEO = 31 000 Da), and H-BCP, (PS = 102 000 Da and PEO = 34 000 Da). The formation of 1D nanocrystals starts with the reaction-induced microphase separation of BCP during styrene photopolymerization at room temperature. Then, as matrix polymerizes, the primary crystalline micelles aggregate via epitaxial crystallization by end-to-end coupling. The morphology of the resulting nanocrystals was highly dependent on the BCP employed. While L-BCP self-assembles into 1D ribbon-like nanocrystals, M-BCP macro-phase separates and, H-BCP self-assembles into short disk-like nanocrystals. This dissimilar behavior was mainly associated to the length of the stabilizing corona block. In the case of H-BCP, it was found that 1D self-assembly occurred when the conditions for core thickening were given, that is, when a non-reactive period was introduced in the cure cycle. During such a period, core thickening clears the lateral surface of the nanocrystals, allowing end-to-end coupling. The driving force for crystallization was also modified. An increase in undercooling resulted in an elevated nucleation rate and accelerated crystal growth. This led to a narrower size distribution of shorter 1D nanocrystals. This knowledge will enable the synthesis of customized 1D nanocrystals in a thermoplastic matrix, through the precise selection of the BCP formulation and curing conditions.

Spatial Distribution of Intracellular Ion Concentrations in Aggregate-Forming HeLa Cells Analyzed by µ-XRF Imaging.

Protein aggregation is a hallmark of several severe neurodegenerative disorders such as Huntington's, Parkinson's, or Alzheimer's disease. Metal ions play a profound role in protein aggregation and altered metal-ion homeostasis is associated with disease progression. Here we utilize µ-X-ray fluorescence imaging in combination with rapid freezing to resolve the elemental distribution of phosphorus, sulfur, potassium, and zinc in huntingtin exon-1-mYFP expressing HeLa cells. Using quantitative XRF analysis, we find a threefold increase in zinc and a 10-fold enrichment of potassium that can be attributed to cellular stress response. While the averaged intracellular ion areal masses are significantly different in aggregate-containing cells, a local intracellular analysis shows no different ion content at the location of intracellular inclusion bodies. The results are compared to corresponding experiments on HeLa cells forming pseudoisocyanine chloride aggregates. As those show similar results, changes in ion concentrations are not exclusively linked to huntingtin exon-1 amyloid formation.

Micro x-ray fluorescence analysis of trace element distribution in frozen hydrated HeLa cells at the P06 beamline at Petra III.

X-ray fluorescence analysis enables the study of trace element distributions in biological specimens. When this analysis is done under cryogenic conditions, cells are cryofixed as closely as possible to their natural physiological state, and the corresponding intracellular elemental densities can be analyzed. Details about the experimental setup used for analysis at the P06 beamline at Petra III, DESY and the used cryo-transfer system are described in this work. The system was applied to analyze the elemental distribution in single HeLa cells, a cell line frequently used in a wide range of biological applications. Cells adhered to silicon nitride substrates were cryoprotected within an amorphous ice matrix. Using a continuous scanning scheme and a KB x-ray focus, the distribution of elements in the cells was studied. We were able to image the intracellular potassium and zinc levels in HeLa cells as two key elements relevant for the physiology of cells.

Long PEO-based nanoribbons generated in a polystyrene matrix through reaction-induced microphase separation followed by a fast crystallization process.

A dispersion of elongated nanostructures with a high aspect ratio in polymer matrices has been reported to provide a material with valuable properties such as mechanical strength, barrier effect and shape memory, among others. In this study, we show the procedure to achieve a distribution of elongated crystalline nanodomains in a PS matrix employing the self-assembly of amphiphilic block copolymers (BCP). The selected BCP was polystyrene-block-polyethylene oxide (PS-b-PEO). It was dissolved at 10 wt% in a styrene (St) monomer and the blend was slowly photopolymerized over four days at room temperature, until the reaction was arrested by vitrification. This blend was initially homogeneous and nanostructuration took place in an early stage of the polymerization as a result of the microphase separation (MS) of PEO blocks. Due to its high tendency to crystallize, demixed PEO blocks crystallized almost concomitantly with MS triggering the growing of the nanostructures. Thus, the time window between the onset of crystallization and the vitrification of the matrix was almost four days, allowing all micelles to have the opportunity to couple to a growing nanostructure. As a result, a population of nanoribbons with average lengths surpassing 10 µm dispersed in a PS matrix was obtained. It was demonstrated that these ribbon-like nanostructures are preserved as long as the heating temperature is located below the Tg of the matrix. If the material is heated above this temperature, softening of the matrix allows the breakup of the molten PEO nanoribbons due to Plateau-Rayleigh instability.

Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting.

Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. A 57-year-old female presented with chronic sinusitis and nasal obstruction. Imaging revealed pansinusitis with retained stents in each frontal sinus that were placed 8 years prior. On the right, there was an area of skull base erosion at the tip of the stent. The patient underwent functional endoscopic sinus surgery with polypectomy. The stents were removed, revealing posterior table erosion on the right side but intact mucosa. Two months after surgery, there were no signs or symptoms of cerebrospinal fluid leak or other complications. Recent literature has suggested that prolonged stenting is safe; however, this case highlights a complication with potentially serious outcomes that can result from prolonged stenting. We recommend stent removal once stable nasofrontal duct patency has been achieved. If prolonged stenting is utilized, patients should be closely monitored and consideration should be given to periodic imaging to evaluate stent position.

Effect of Light Intensity on the Aggregation Behavior of Primary Particles during In Situ Photochemical Synthesis of Gold/Polymer Nanocomposites.

Metal/polymer nanocomposites have attracted much attention in recent years due to their exceptional properties and wide range of potential applications. A key challenge to obtain these materials is to stabilize the metal nanoparticles in the matrix, avoiding uncontrolled aggregation processes driven by the high surface free energy of nanosized particles. Here, we investigate the aggregation mechanism of primary particles in gold-epoxy nanocomposites prepared via light-assisted in situ synthesis, under different irradiation conditions. The growth and aggregation of gold nanoparticles were monitored in situ by time-resolved small-angle X-ray scattering experiments, whereas spectroscopic measurements were performed to interpret how matrix polymerization influences the aggregation process. It was found that light intensity has a greater influence on the reduction rate than on the polymerization rate. Under irradiation, gold nanostructures evolve through five time-defined stages: nuclei-mass fractals-surface fractals-spherical nanoparticles-aggregates. If the maximum in the polymerization rate is reached before the aggregation step, individual primary nanoparticles will be preserved in the polymer matrix due to diffusional constraints imposed by the reaction medium. Because the light intensity has a different influence on the reduction rate than on the polymerization rate, this parameter can be used as a versatile tool to avoid aggregation of gold nanoparticles into the polymer matrix.

Core-crystalline nanoribbons of controlled length via diffusion-limited colloid aggregation.

It has been previously reported that poly(ethylene) (PE)-based block copolymers self-assemble in certain thermosetting matrices to form a dispersion of one-dimensional (1D) nanoribbons. Such materials exhibit exceptional properties that originate from the high aspect ratio of the elongated nano-objects. However, the ability to prepare 1D assemblies with well-controlled dimensions is limited and represents a key challenge. Here, we demonstrate that the length of ribbon-like nanostructures can be precisely controlled by regulating the mobility of the matrix during crystallization of the core-forming PE block. The selected system to prove this concept was a poly(ethylene-block-ethylene oxide) (PE-b-PEO) block copolymer in an epoxy monomer based on diglycidyl ether of bisphenol A (DGEBA). The system was activated with a dual thermal- and photo-curing system, which allowed us to initiate the epoxy polymerization at 120 °C until a certain degree of conversion, stop the reaction by cooling to induce crystallization and micellar elongation, and then continue the polymerization at room temperature by visible-light irradiation. In this way, crystallization of PE blocks took place in a matrix whose mobility was regulated by the degree of conversion reached at 120 °C. The mechanism of micellar elongation was conceptualized as a diffusion-limited colloid aggregation process which was induced by crystallization of PE cores. This assertion was supported by the evidence obtained from in situ small-angle X-ray scattering (SAXS), in combination with differential scanning calorimetry (DSC) and transmission electron microscopy (TEM).

Mechanism of Particle Formation in Silver/Epoxy Nanocomposites Obtained through a Visible-Light-Assisted in Situ Synthesis.

A detailed understanding of the processes taking place during the in situ synthesis of metal/polymer nanocomposites is crucial to manipulate the shape and size of nanoparticles (NPs) with a high level of control. In this paper, we report an in-depth time-resolved analysis of the particle formation process in silver/epoxy nanocomposites obtained through a visible-light-assisted in situ synthesis. The selected epoxy monomer was based on diglycidyl ether of bisphenol A, which undergoes relatively slow cationic ring-opening polymerization. This feature allowed us to access a full description of the formation process of silver NPs before this was arrested by the curing of the epoxy matrix. In situ time-resolved small-angle X-ray scattering investigation was carried out to follow the evolution of the number and size of the silver NPs as a function of irradiation time, whereas rheological experiments combined with near-infrared and ultraviolet-visible spectroscopies were performed to interpret how changes in the rheological properties of the matrix affect the nucleation and growth of particles. The analysis of the obtained results allowed us to propose consistent mechanisms for the formation of metal/polymer nanocomposites obtained by light-assisted one-pot synthesis. Finally, the effect of a thermal postcuring treatment of the epoxy matrix on the particle size in the nanocomposite was investigated.

Epoxy-Based Organogels for Thermally Reversible Light Scattering Films and Form-Stable Phase Change Materials.

Alkyl chains of ß-hydroxyesters synthesized by the capping of terminal epoxy groups of diglycidylether of bisphenol A (DGEBA) with palmitic (C16), stearic (C18), or behenic (C22) fatty acids self-assemble forming a crystalline phase. Above a particular concentration solutions of these esters in a variety of solvents led to supramolecular (physical) gels below the crystallization temperature of alkyl chains. A form-stable phase change material (FS-PCM) was obtained by blending the ester derived from behenic acid with eicosane. A blend containing 20 wt % ester was stable as a gel up to 53 °C and exhibited a heat storage capacity of 161 J/g, absorbed during the melting of eicosane at 37 °C. Thermally reversible light scattering (TRLS) films were obtained by visible-light photopolymerization of poly(ethylene glycol) dimethacrylate-ester blends (50 wt %) in the gel state at room temperature. The reaction was very fast and not inhibited by oxygen. TRLS films consisted of a cross-linked methacrylic network interpenetrated by the supramolecular network formed by the esters. Above the melting temperature of crystallites formed by alkyl chains, the film was transparent due to the matching between refractive indices of the methacrylic network and the amorphous ester. Below the crystallization temperature, the film was opaque because of light dispersion produced by the organic crystallites uniformly dispersed in the material. Of high significance for application was the fact that the contrast ratio did not depend on heating and cooling rates.

Contrasting dynamics of water and mineral nutrients in stems shown by stable isotope tracers and cryo-SIMS.

Lateral exchange of water and nutrients between xylem and surrounding tissues helps to de-couple uptake from utilization in all parts of a plant. We studied the dynamics of these exchanges, using stable isotope tracers for water (H(2)(18)O), magnesium ((26)Mg), potassium ((41)K) and calcium ((44)Ca) delivered via a cut stem for various periods to the transpiration stream of bean shoots (Phaseolus vulgaris cv. Fardenlosa Shiny). Tracers were subsequently mapped in stem cross-sections with cryo-secondary ion mass spectrometry. The water tracer equilibrated within minutes across the entire cross-section. In contrast, the nutrient tracers showed a very heterogeneous exchange between xylem vessels and the different stem tissues, even after 4 h. Dynamics of nutrients in the tissues revealed a fast and extensive exchange of nutrients in the xylem parenchyma, with, for example, calcium being completely replaced by tracer in less than 5 min. Dilution of potassium tracer during its 30 s transit in xylem sap through the stem showed that potassium concentration was up-regulated over many hours, to the extent that some of it was probably supplied by phloem recirculation from the shoot.

Influence of ethylene glycol and propylene glycol on polymer diffusion in poly(butyl acrylate-co-methyl methacrylate) latex films.

We describe fluorescence resonance energy transfer (FRET) experiments carried out to examine the effect of ethylene glycol and propylene glycol on the early stages of polymer diffusion in poly(butyl acrylate-co-methyl methacrylate) latex films. In our approach, we temporarily arrest the drying process of a wet latex film by sealing the film in a previously cooled airtight sample chamber. This arrests propagation of the drying front and suppresses polymer diffusion during the measurements. We then measure donor fluorescence decays from 0.5 mm diameter spots at various locations on the film. From our analysis, we obtain information about the earliest stages of polymer diffusion as the film is still drying. We also investigate the effect of these glycols on polymer diffusion at longer aging times on predried latex films. Ethylene glycol and propylene glycol retard polymer diffusion at early times immediately after the passing of the drying front but enhance the rate of polymer diffusion at later aging times. This behavior is described quantitatively in terms of free-volume theory and the partitioning of the glycols between the aqueous and polymer phases in the film.

Tracing cationic nutrients from xylem into stem tissue of French bean by stable isotope tracers and cryo-secondary ion mass spectrometry.

Fluxes of mineral nutrients in the xylem are strongly influenced by interactions with the surrounding stem tissues and are probably regulated by them. Toward a mechanistic understanding of these interactions, we applied stable isotope tracers of magnesium, potassium, and calcium continuously to the transpiration stream of cut bean (Phaseolus vulgaris) shoots to study their radial exchange at the cell and tissue level with stem tissues between pith and phloem. For isotope localization, we combined sample preparation with secondary ion mass spectrometry in a completely cryogenic workflow. After 20 min of application, tracers were readily detectable to various degrees in all tissues. The xylem parenchyma near the vessels exchanged freely with the vessels, its nutrient elements reaching a steady state of strong exchange with elements in the vessels within 20 min, mainly via apoplastic pathways. A slow exchange between vessels and cambium and phloem suggested that they are separated from the xylem, parenchyma, and pith, possibly by an apoplastic barrier to diffusion for nutrients (as for carbohydrates). There was little difference in these distributions when tracers were applied directly to intact xylem via a microcapillary, suggesting that xylem tension had little effect on radial exchange of these nutrients and that their movement was mainly diffusive.

Lepirudin-induced thrombocytopenia following subcutaneous administration.

PURPOSE: A case of lepirudin-induced thrombocytopenia is reported. SUMMARY: A 61-year-old white man arrived at the emergency department with complaints of pain in his left thigh that worsened with walking. His medical history was significant for extensive thromboses over a period of six months. He had recently been discharged from the hospital for suspected heparin-induced thrombocytopenia (HIT) while on enoxaparin. A venous duplex scan revealed two new deep venous thromboses in the left common, superficial, and popliteal veins. The patient was admitted and initiated on aspirin 325 mg and warfarin sodium 2 mg daily. Intravenous lepirudin with an activated partial thromboplastin time (aPTT) goal of 60-80 seconds was also started. Because of his recurrent thrombotic event, a new International Normalized Ratio (INR) goal of 3.0-3.5 was established for warfarin therapy. Eighteen days after admission, the patient's INR and aPTT were high; therefore, his warfarin dose was reduced and i.v. lepirudin was changed to subcutaneous administration. The patient was transferred to the intensive care unit (ICU) and, 5 days later, he developed melena. During the 7 days of treatment with subcutaneous lepirudin, a drop in platelet counts was observed. Subcutaneous lepirudin was discontinued after resolution of melena, and i.v. lepirudin was restarted. After 15 days, his platelet counts increased and he was switched back to subcutaneous lepirudin, which again led to a drop in platelets. After 27 days in the ICU, the patient's INR and aPTT remained high. Lepirudin was discontinued and i.v. bivalirudin was initiated. His platelet count increased and he was discharged. Eleven days later, the patient was found unresponsive with left-sided fasciculations. The patient died secondary to respiratory arrest as a consequence of intracranial hemorrhage. CONCLUSION: A 61-year-old white man with a history of thromboses and suspected HIT developed thrombocytopenia possibly associated with receiving two courses of subcutaneous lepirudin. Careful monitoring of platelet counts are warranted in patients who have a history of HIT and are receiving subcutaneous lepirudin.

Imaging nutrient distributions in plant tissue using time-of-flight secondary ion mass spectrometry and scanning electron microscopy.

A new approach to trace the transport routes of macronutrients in plants at the level of cells and tissues and to measure their elemental distributions was developed for investigating the dynamics and structure-function relationships of transport processes. Stem samples from Phaseolus vulgaris were used as a test system. Shock freezing and cryo-preparation were combined in a cryogenic chain with cryo-time-of-flight secondary ion mass spectrometry (cryo-ToF-SIMS) for element and isotope-specific imaging. Cryo-scanning electron microscopy (cryo-SEM) was integrated into the cryogenic workflow to assess the quality of structural preservation. We evaluated the capability of these techniques to monitor transport pathways and processes in xylem and associated tissues using supplementary sodium (Na) and tracers for potassium (K), rubidium (Rb), and (41)K added to the transpiration stream. Cryo-ToF-SIMS imaging produced detailed mappings of water, K, calcium, magnesium, the K tracers, and Na without quantification. Lateral resolutions ranged from 10 microm in survey mappings and at high mass resolution to approximately 1 microm in high lateral resolution imaging in reduced areas and at lower mass resolution. The tracers Rb and (41)K, as well as Na, were imaged with high sensitivity in xylem vessels and surrounding tissues. The isotope signature of the stable isotope tracer was utilized for relative quantification of the (41)K tracer as a fraction of total K at the single pixel level. Cryo-SEM confirmed that tissue structures had been preserved with subcellular detail throughout all procedures. Overlays of cryo-ToF-SIMS images onto the corresponding SEM images allowed detailed correlation of nutrient images with subcellular structures.

Efficacy of aminophylline for treatment of recurrent symptomatic bradycardia after spinal cord injury.

Cardiac dysrhythmias and cardiac arrest can occur after acute spinal cord injury (SCI). Disrupted sympathetic innervation after SCI results in unopposed parasympathetic activity leading to baseline bradycardia. Hence, vagal stimulation can result in episodes of exaggerated symptomatic bradycardia. Data supporting pharmacologic intervention for treatment of symptomatic bradycardia after SCI are limited. We describe a patient who sustained a high cervical SCI and subsequently developed episodic symptomatic bradycardia. The addition of aminophylline to the patient's therapeutic regimen was associated with resolution of the bradycardia. Throughout her treatment course, the patient's serum theophylline concentrations were 1.9-3.4 mg/L. These levels were consistent with those identified in other case reports describing treatment with methylxanthines to prevent episodic bradycardia after SCI. Our understanding of drug pharmacokinetics and pharmacodynamics in patients with acute SCI is limited and provides an ideal opportunity for further study in this area.

Photopolymerization of N,N-dimethylaminobenzyl alcohol as amine co-initiator for light-cured dental resins.

OBJECTIVE: The present study was carried out in order to assess the suitability of N,N-dimethylaminobenzyl alcohol (DMOH) as co-initiator of camphorquinone (CQ) and 1-phenyl-1,2-propanedione (PPD) in light-cured dental resins. METHODS: DMOH was synthesized and used as co-initiator for the photopolymerization of a model resin based on {2,2-bis[4-(2-hydroxy-3-methacryloxyprop-1-oxy)phenyl]propane} (Bis-GMA)/triethylene glycol dimethacrylate (TEGDMA). Experimental formulations containing CQ or PPD in combination with DMOH at different concentrations were studied. The photopolymerization was carried out by means of a commercial light-emitting diode (LED) curing unit. The evolution of double bonds consumption versus irradiation time was followed by near-infrared spectroscopy (NIR). The photon absorption efficiency (PAE) of the photopolymerization process was calculated from the spectral distribution of the LED unit and the molar absorption coefficient distributions of PPD and CQ. RESULTS: DMOH is an efficient photoreducer of CQ and PPD resulting in higher polymerization rate and higher double bond conversion compared with dimethylaminoethylmethacrylate. The PAE for PPD was higher than that for CQ. However, the polymerization initiated by PPD progressed at a lower rate and exhibited lower values of final conversion compared with the resins containing CQ. This observation indicates that the lower polymerization rate of the PPD/amine system should be explained in terms of the mechanism of generating primary radicals by PPD, which is less efficient compared with CQ. SIGNIFICANCE: The DMOH/benzoyl peroxide redox system, has recently been proposed as a more biocompatible accelerator for the polymerization of bone cements based on poly(methyl methacrylate), because cytotoxity tests have demonstrated that DMOH possesses better biocompatibility properties compared with traditional tertiary amines. The results obtained in the present study reveal the suitability of the CQ/DMOH initiator system for the polymerization of light-cured dental composites.

Assessment of eptifibatide dosing in renal impairment before and after in-service education provided by pharmacists.

BACKGROUND: Anticoagulant and antithrombotic agents are frequently cited as sources of medication errors. Several factors increase the risk of receiving excess dosing of glycoprotein IIb/IIIa inhibitors in the management of acute coronary syndrome (ACS), including older age, female gender, elevated serum creatinine, a history of diabetes mellitus, and a history of heart failure. In June 2003, the manufacturer of eptifibatide released a recommendation adjusting infusion rate downward to 1 mcg per kg per minute for eptifibatide in patients with renal impairment, defined as an estimated creatinine clearance (CrCl) < 50 ml per minute. Eptifibatide is known to accumulate in patients with renal impairment, thereby increasing hemorrhagic risk. OBJECTIVE: To assess the impact of education on physician adherence to the renal dosing recommendation for eptifibatide at 2 academic medical centers. The primary outcome measure was the proportion of patients with renal impairment dosed appropriately with eptifibatide before and after in-service education provided by a clinical pharmacist. Secondary outcome measures included the difference in the improvement in dosing adherence between the 2 sites and the influence of patient variables on the incidence of bleeding events. METHODS: This prospective study was conducted in patients with renal impairment who received eptifibatide for the medical management of unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) or for the interventional management of chronic stable angina, UA, NSTEMI, or ST-elevation myocardial infarction (STEMI, not a Food and Drug Administration-approved use). Patient data were assessed at 2 tertiary care teaching institutions between June 2003 and December 2005. The preeducation phase for the sites ran from June 2003 through April 2005 for Site A and from June 2003 through May 2005 for Site B. The posteducation phase ran from May 2005 through December 2005 for Site A and from June 2005 through December 2005 for Site B. At site A, a 1-hour educational seminar on ACS management strategies was employed, in which 5 minutes focused on adherence of prescribers to the guideline for renal dosing recommendations for eptifibatide. This tutorial was accomplished through (1) an in-service provided by 1 clinical pharmacist to the cardiology department, and (2) handouts containing the renal dosing recommendations for eptifibatide along with dosing for other medications used to manage ACS. The intervention at Site B involved an eptifibatide-focused seminar presented to cardiologists by a clinical pharmacist, 10 minutes of which was devoted to renal dosing recommendations that included (1) a summary of literature supporting the infusion rate reduction in patients with renal impairment and (2) the specific updated dosing recommendation for eptifibatide. The data collected in retrospective chart review included patient demographics, baseline laboratory values, and risk factors for bleeding. An appropriate eptifibatide dose was defined as a physician order for a continuous infusion of 1 mcg per kg per minute in patients with an estimated CrCl < 50 ml per minute. RESULTS: A total of 148 patients with renal impairment who received eptifibatide were evaluated (106 in the preeducation phase and 42 in the posteducation phase). A significant increase in the adherence rate for eptifibatide dosing in patients with renal impairment was observed from 36.8% in the preeducation phase to 69.0% in the posteducation phase (P < 0.001) for the 2 sites combined. The incidence of major and minor bleeding was 16.7% in the preeducation phase and 14.3% in the posteducation phase (P = 0.742). When bleeding incidence was stratified by the appropriateness of infusion, the incidence of major and minor bleeding was also similar for appropriate dosing (1 mcg per kg per minute, 16.4%) versus inappropriate dosing (2 mcg per kg per minute, 15.7%; P = 0.916). CONCLUSION: This educational intervention provided by a clinical pharmacist was associated with improved prescriber adherence to dosing recommendations for eptifibatide in patients with renal impairment. Improved adherence to the dosing guideline and administration of an appropriate infusion rate were not associated with reduction in either minor or major bleeding events.

Can fog contribute to the nutrition of Chamaecyparis obtusa var. formosana? Uptake of a fog solute tracer into foliage and transport to roots.

Yellow cypress (Chamaecyparis obtusa (Siebold & Zucc.) Endl. var. formosana (Hayata) Rehder) is the predominant tree species of Taiwan's nutrient-poor, mountain fog forests. Little is known about the potential contribution of solute uptake from fog to the overall nutrition of these trees. Shoots of yellow cypress seedlings were misted with artificial fog containing the tracer rubidium (Rb) in laboratory and field experiments to determine if there is solute uptake from the fog. After misting shoots for six weeks, substantial amounts of tracer were detected in unexposed roots by inductively coupled plasma mass spectroscopy bulk analysis. Possible routes of entry were examined by element imaging with energy dispersive X-ray analysis. Direct uptake of the tracer into leaves across the cuticle and epidermis was small, excluding this as the major uptake path. Accumulations of Rb were found on leaf surfaces along the edges of the leaves. The almost daily changes in fog coverage and air humidity may enhance the accumulation of fog solutes at leaf edges. Accumulation of Rb was also found in narrow clefts between opposite leaves and between the outermost and underlying alternating stacked leaves. The clefts provide a direct passage from the leaf surface to the space beneath the imbricate leaves and the underlying alternate leaves, possibly facilitating solute uptake from fog, which in turn may contribute to the nutrition of yellow cypress.

Rapid desensitization protocols for patients with cardiovascular disease and aspirin hypersensitivity in an era of dual antiplatelet therapy.

OBJECTIVE: To review the available protocols for rapid desensitization of patients with aspirin hypersensitivity and apply the data for use in patients with cardiovascular disease who would benefit from the dual antiplatelet therapy. DATA SOURCES: A literature search was conducted via MEDLINE from 1966 to December 2006. Main search terms included: aspirin sensitivity, aspirin allergy, aspirin desensitization, aspirin-induced asthma, aspirin therapy, and aspirin intolerance syndrome. STUDY SELECTION AND DATA EXTRACTION: Articles describing rapid aspirin desensitization protocols were selected for review. Literature pertaining to aspirin hypersensitivity, drug desensitization, and the use of aspirin and dual antiplatelet therapy was also examined. Three rapid desensitization protocols were identified and evaluated. DATA SYNTHESIS: While landmark studies demonstrated that dual antiplatelet therapy with aspirin and clopidogrel significantly reduces mortality and morbidity in acute coronary syndromes and coronary stenting, patients with aspirin hypersensitivity are frequently managed with clopidogrel alone with no supporting data. Approximately 10% of the population experiences hypersensitivity to aspirin, which can manifest as asthma exacerbations, rhinorrhea, angioedema, urticaria, and anaphylaxis. The hypersensitivity reaction is mediated through aspirin-directed antibodies or by excessive leukotriene production. The desensitization process involved depletion of these mediators, as well as down-regulation of leukotriene receptors. Two groups of investigators developed rapid protocols to desensitize patients with aspirin hypersensitivity safely and effectively. The rapid protocol developed by Wong provides benefits over other protocols with its low starting dose and completion in less than 3 hours, low incidence of adverse effects, and high success rate in aspirin desensitization. CONCLUSIONS: The Wong protocol is an attractive option for the rapid desensitization of patients requiring dual antiplatelet therapy with aspirin and clopidogrel in the perimyocardial infarction period.