pH-responsive poly(lactide-co-glycolide) nanoparticles containing near-infrared dye for visualization and hyaluronic acid for treatment of osteoarthritis.

This study focuses on intra-articular (IA) drug delivery system for the treatment of knee osteoarthritis (OA). In osteoarthritic condition the synovial fluid presents pockets with lower pH environment. To take advantage of these pH differences, poly(lactic-co-glycolic acid (PLGA) nanoparticles (NPs) and pH- responsive PLGA NPs encapsulated with ammonium bicarbonate (NH4HCO3) were generated. The nanoparticles were loaded with hyaluronic acid (HA) as a possible model drug for OA and with near-infrared dye (NIR) that was used to visualize the NPs with molecular imaging techniques. These NPs were characterized by dynamic light scattering, transmission electron microscopy and compared in in vitro, in vivo and ex vivo experiments in the treatment of OA. The results indicate that the NPs were sufficiently small, displayed a uniform size distribution and were non-toxic both in vitro and in vivo. Both NPs treatment seem to induced a reduction in OA progression, with pH- responsive NPs showing the more pronounced effect. This is probably because the pockets of low pH environment in the synovial fluid trigger a burst release of the pH-responsive NPs. This result is corroborated by in vitro experiments since the pH- responsive NPs showed an extracellular burst release behavior and higher chondrocyte vitality than non-responsive NPs. This study demonstrates that PLGA NPs containing HA and NH4HCO3 are candidates for the treatment of knee OA.

Office Hysteroscopy. An operative gold standard technique and an important contribution to Patient Safety.

According to World Health Organization (WHO), about 1 out of 10 hospitalized patients suffers an adverse event, in developed countries, being an adverse event an injury related to medical management, in contrast to complications of disease. These events cause both unnecessary suffering and huge cost to health systems. This issue is so important that WHO has defined it as a global health problem and in 2004 launched the World Alliance for Patient Safety, with the aim to coordinate, disseminate and accelerate improvements in Patient Safety. Office Hysteroscopy (OH), as an independent technique of the hospital circuit, has the ideal conditions to be qualified as the gold standard technique for the surgical treatment of intracavitary uterine pathology. It does not require the use of an operating room, hospital admission and general or locoregional anaesthesia. The appropriate surgical techniques, allied to pain control, allow OH to resolve much more than 90 % of the surgical needs of the intracavitary uterine pathology, thus being an important contribution for Patient Safety.

Qualitative characterization of a transesterification product of coconut oil by FIA-APCI-MS.

OBJECTIVES: The purpose of this work was the qualitative characterization of a recently transesterification product obtained from the coconut oil in the presence of polyglycerol-6 to produce a new PEG-free secondary surfactant. The purpose of a secondary surfactant is to reduce the harshness of a skin cleanser. METHODS: The transesterification product was qualitatively characterized in our laboratory by flow injection analysis-atmospheric pressure chemical ionization-mass spectrometry (FIA-APCI-MS). The mass spectrum of the transesterification product was compared to those of the starting materials (polyglycerol and coconut oil). RESULTS: The analyses highlighted the disappearance of the starting oil peaks and the appearance of new peaks assignable to the reaction products, mainly corresponding to diesters of polyglycerol. Additionally, peaks of unreacted polyglycerol are present as well as peaks of cyclization products derived from the polyglycerol starting material. CONCLUSIONS: The development of this fast and easy analytical method, requesting only few minutes to be performed, represents a very useful tool for the characterization of transesterification products during the quality control of batches under production.

Characterization of the biofouling and cleaning efficiency of nanofiltration membranes.

The nanofiltration (NF) drinking water production unit of the Mery-sur-Oise plant (Val d'Oise, France) consists of eight identical filtration trains composed of three stages positioned in steps for a production capacity of 140,000 m(3) day(-1). To gain a better understanding of the irreversible fouling of the NF membranes, spiral wound modules in operation for 8 years from each of the three stages of the plant were autopsied before and after chemical cleaning and analysis by Attenuated Total Reflection Fourier Transform Infrared spectroscopy, Inductive Coupled Plasma-Atomic Emission Spectrometry, contact angles, adenosine triphosphate (ATP) content measurements, and rheometry. The fouled membranes from the three stages had similar contact angles of approximately 60 degrees . Relative infrared signals typical of biofilms were classified in descending order from stage 1 to stage 3. The foulant matter of stages 1 and 2 contained similar but weaker ATP concentrations than stage 3. During rheometry experiments, rotation and oscillation analyses demonstrated that the biofilm of stage 3 was less viscous and less elastic than the biofilms of stages 1 and 2. After cleaning, all the parameters analyzed demonstrated a quantitative decrease in the fouling matter at the NF membrane surface, but a biofilm with intact viscoelastic properties (unchanged G' and G'' values) remained at the membrane surface for the three stages. The persistence of biofilm material with intact mechanical properties at the NF membrane surface after chemical cleaning may result in permanent permeability decreases.

Improving healthcare worker hand hygiene adherence before patient contact: a before-and-after five-unit multimodal intervention in Tuscany.

BACKGROUND: Despite the importance of hand hygiene in reducing infection, healthcare worker compliance with hand hygiene recommendations remains low. In a previous study, we found a generally low level of compliance at baseline, with substantial differences between doctors and nurses and between hospital units. We describe here the results of our multimodal intervention intended to improve levels of healthcare worker hand hygiene. METHODS: A 6-month, before-and-after, multimodal interventional study in five hospital units in Florence, Italy. We used direct observation to assess hand hygiene rates for doctors and nurses, focusing on hygiene before touching the patient. We explored reasons for unit variability via interviews of doctor and nurse leaders on the units. RESULTS: Overall healthcare worker hand hygiene increased from 31.5% to 47.4% (p<0.001). Hand hygiene adherence among nurses increased from 33.7% to 47.9% (p<0.001); adherence among doctors increased from 27.5% to 46.6% (p<0.001). Improvement was statistically significant in three out of five units, and units differed in the magnitude of their improvement. Based on the interviews, variability appeared related to the "champion" on each unit, as well as the level of motivation each physician leader exhibited when the preintervention results were provided. CONCLUSIONS: Although overall healthcare worker adherence with hand hygiene procedures before patient contact substantially increased after the multimodal intervention, considerable variability-for both nurses and doctors and across the 5 units-was seen. Although adherence substantially increased, overall hand hygiene in these units could still be greatly improved.

Photopolymerized thermosensitive hydrogels for tailorable diffusion-controlled protein delivery.

In this paper the possibility to tailor degradation and protein release behavior of photopolymerized thermosensitive hydrogels is studied. The hydrogels consist of ABA triblock copolymer, in which the thermosensitive A-blocks are methacrylated poly(N-(2-hydroxypropyl)methacrylamide lactate)s and the B-block is poly(ethylene glycol) with molecular weight of 10 kDa. These hydrogels are prepared by using a combination of physical and chemical cross-linking methods. When a solution of a thermosensitive methacrylated p(HPMAm-lac)-PEG-p(HPMAm-lac) is heated above its cloud point a viscoelastic material is obtained, which can be stabilized by introducing covalent cross-links by photopolymerization. By varying the polymer concentration, hydrogels with different mechanical properties are formed, of which the cross-linking density, mesh size, swelling and degradation behavior can be tuned. It was demonstrated that the release rate of three model proteins (lysozyme, BSA and IgG, with hydrodynamic diameters ranging from 4.1 to 10.7 nm) depended on the protein size and hydrogel molecular weight between cross-links and was governed by the Fickian diffusion. Importantly, the encapsulated proteins were quantitatively released and the secondary structure and the enzymatic activity of lysozyme were fully preserved demonstrating the protein friendly nature of the studied delivery system.

Rheology of biofilms formed at the surface of NF membranes in a drinking water production unit.

In this study, the mechanical properties of biofilms formed at the surface of nano-filtration (NF) membranes from a drinking water plant were analysed. Confocal laser scanning microscopy observations revealed that the NF biofilms formed a dense and heterogeneous structure at the membrane surface, with a mean thickness of 32.5 +/- 17.7 mum. The biofilms were scraped from the membrane surface and analysed in rotation and oscillation experiments with a RheoStress 150 rotating disk rheometer. During rotation analyses, a viscosity decrease with speed of shearing characteristic of rheofluidification was observed (eta = 300 Pa s for ý = 0.3 s(-1)). In the oscillation analyses with a sweeping of frequency (1-100 Hz), elasticity (G') ranged from 3000 to 3500 Pa and viscosity (G'') from 800 to 1200 Pa. Creep curves obtained with an application of a shear stress of 30 Pa were viscoelastic in nature. The G(0) and eta values were, respectively, 1.4 +/- 0.3 x 10(3) Pa and 3.3 +/- 0.65 x 10(6) Pa s. The relationship between the characteristics of NF biofilms and the flow conditions encountered during NF is discussed.

Effect of chlorhexidine and benzalkonium chloride on bacterial biofilm formation.

AIM: To study the effect of antiseptics on bacterial biofilm formation. METHODS AND RESULTS: Biofilm formation and planktonic growth were tested in microtiter plates in the presence of antiseptics. For Escherichia coli G1473 in the presence of chlorhexidine or benzalkonium chloride, for Klebsiella pneumoniae CF504 in the presence of chlorhexidine and for Pseudomonas aeruginosa PAO1 in the presence of benzalkonium chloride, biofilm development and planktonic growth were affected at the same concentrations of antiseptics. For PAO1 in the presence of chlorhexidine and CF504 in the presence of benzalkonium chloride, planktonic growth was significantly inhibited by a fourfold lower antiseptic concentration than biofilm development. For Staphylococcus epidermidis CIP53124 in the presence of antiseptics at the minimal inhibitory concentration (MIC), a total inhibition of biofilm formation was observed. For Staph. epidermidis exposed to chlorhexidine at 1/2, 1/4 and 1/8 MIC, or to benzalkonium chloride at 1/8, 1/16 or 1/32 MIC, biofilm formation was increased from 11.4% to 22.5% without any significant effect onto planktonic growth. CONCLUSIONS: Chlorhexidine and benzalkonium chloride inhibited biofilm formation of different bacterial species but were able to induce biofilm development for the Staph. epidermidis CIP53124 strain at sub-MICs. SIGNIFICANCE AND IMPACT OF THE STUDY: Sublethal exposure to cationic antiseptics may contribute to the persistence of staphylococci through biofilm induction.

Assessing chemical cleaning of nanofiltration membranes in a drinking water production plant: a combination of chemical composition analysis and fluorescence microscopy.

The efficiency of cleaning procedures to remove the fouling deposit from the surface of NF membranes operating in the drinking water plant of Méry sur Oise (Val d'Oise, France) was assessed by a combination of chemical analysis and fluorescence microscopy. The ATR-FTIR spectra of the fouled membranes revealed the presence of biological matter at the membrane surface, mainly composed of polysaccharides, nucleic acids and proteins. IR bands corresponding to the membrane material were detected for stage 1 but not for stage 3. Confocal laser scanning microscopy (CLSM) observations confirmed the microbial origin of the fouling deposit. After chemical cleaning, the analysis of the inorganic foulants revealed a significant decrease of the inorganic content. Moreover, ATR-FTIR spectra of the fouled membranes were modified, mainly in a broad complex region corresponding to polysaccharides and nucleic acids. The amide bands were also altered for stage 1, and some peaks corresponding to the clean membrane appeared for stage 3 after cleaning. CLSM observations revealed a general decrease of the lectin staining for the two stages with some variations between lectins. A decrease of the DAPI staining indicative of the removal of some microbial cells was also observed for stage 1. In conclusion, cleaning of the NF fouled membranes decreased significantly the inorganic foulants but only partially removed the organic fouling deposit characteristic of a microbial biofilm.

Antibiotic resistance and adherence properties of Hafnia alvei clinical isolates: a 19-month study in the hospital of Orléans, France.

We studied the epidemiology of antibiotic resistance and adherence properties among all Hafnia alvei clinical isolates collected from August 2003 to February 2005 from patients hospitalized in the hospital of Orléans, France. The isolates were typed by random amplified polymorphic DNA (RAPD), screened for antibiotic resistance and bacterial adherence to A549 respiratory and T24 bladder cells. Six intestinal, 3 respiratory, and 8 isolates from different body sites were collected. A total of 12 RAPD profiles were found, demonstrating a high genetic diversity. All the isolates were resistant to amoxicillin + clavulanate and cephalothin and sensitive to aminoglycosides, fluoroquinolones, cefepime and imipenem. Six isolates had a high-level and constitutive cephalosporinase production phenotype. Three independent isolates were resistant or had intermediate sensitivity to nalidixic acid, sulfonamide and trimethoprim or chloramphenicol. All the isolates adhered efficiently to the two cell lines with a higher effectiveness of adherence to bladder cells. The respiratory isolates adhered more efficiently to epithelial cells than intestinal isolates. No relationship was found between antibiotic resistance phenotypes, adherence properties, and RAPD types. In conclusion, H. alvei is an unusual nosocomial pathogen with little acquired antibiotic resistance able to adhere to human epithelial cells from different human body compartments.

Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial.

To determine the efficacy of the consumption of cranberry juice versus placebo with regard to the presence of in vitro bacterial anti-adherence activity in the urine of healthy volunteers. Twenty healthy volunteers, 10 men and 10 women, were included. The study was a double-blind, randomized, placebo-controlled, and cross-over study. In addition to normal diet, each volunteer received at dinner a single dose of 750 ml of a total drink composed of: (1) 250 ml of the placebo and 500 ml of mineral water, or (2) 750 ml of the placebo, or (3) 250 ml of the cranberry juice and 500 ml of mineral water, or (4) 750 ml of the cranberry juice. Each volunteer took the four regimens successively in a randomly order, with a washout period of at least 6 days between every change in regimen. The first urine of the morning following cranberry or placebo consumption was collected and used to support bacterial growth. Six uropathogenic Escherichia coli strains (all expressing type 1 pili; three positive for the gene marker for P-fimbriae papC and three negative for papC), previously isolated from patients with symptomatic urinary tract infections, were grown in urine samples and tested for their ability to adhere to the T24 bladder cell line in vitro. There were no significant differences in the pH or specific gravity between the urine samples collected after cranberry or placebo consumption. We observed a dose dependent significant decrease in bacterial adherence associated with cranberry consumption. Adherence inhibition was observed independently from the presence of genes encoding type P pili and antibiotic resistance phenotypes. Cranberry juice consumption provides significant anti-adherence activity against different E. coli uropathogenic strains in the urine compared with placebo.

Effects of antibiotics on Pseudomonas aeruginosa NK125502 and Pseudomonas fluorescens MF0 biofilm formation on immobilized fibronectin.

The effect of subminimal inhibitory concentration (1/2 MIC) of antibiotics on the biofilm formation on immobilized fibronectin by Pseudomonas was investigated by examining the reference strains NK125502 P. aeruginosa and MF0 P. fluorescens in a microtiter plates assay. When the antibiotics were added during bacterial growth and biofilm development, gentamicin was the only antimicrobial agent tested which decreased significantly the biofilm formation by the two strains. Cefsulodin and chloramphenicol also decreased the P. aeruginosa biofilm development (P<0.01), whereas polymyxin B inhibited biofilm formation by P. fluorescens (p<0.05). When the antibiotics were only present during bacterial growth and not during biofilm development, gentamicin was the only antibiotic tested to decrease significantly the biofilm formation by P. aeruginosa for incubation times of 20 and 72h (P<0.01), whereas P. fluorescens was not affected. This persistent inhibition of P. aeruginosa biofilm formation may be interesting in intermittent antibiotherapy treatments.

alpha5beta1 integrins and fibronectin are involved in adherence of the Pseudomonas aeruginosa ER97314 clinical strain to A549 cells.

The role of fibronectin (Fn) and its natural receptors alpha5beta1 integrins in the interaction of P. aeruginosa with A549 epithelial cells was compared in the clinical isolate ER97314 and the reference PAK strain. Both strains expressed functional type IV pili, as shown by the results of the twitching motility assay. The ER97314 strain was highly adherent to immobilized Fn (640 000+/-20 000 CFU per well) while the PAK strain adhered less efficiently (70 000+/-10 000 CFU per well). Both strains adhered to A549 cells (33 400+/-1200 and 1200+/-100 CFU per well, for PAK and ER97314, respectively), only the PAK strain being significantly internalized (9430+/-2020 CFU per well). Cytochalasin D and genistein significantly decreased bacterial adherence of the 2 strains and caused also a significant decrease in PAK internalization. This inhibitory activity was not related to changes in the expression of alpha5beta1 integrins. Antibodies to Fn and alpha5beta1 integrins inhibited the adherence of the ER97314 strain but had no significant effect on PAK interaction with human cells. These findings suggest that only some P. aeruginosa strains can target Fn and their natural receptors alpha5beta1 integrins for adherence to A549 cells.

Porins of Pseudomonas fluorescens MFO as fibronectin-binding proteins.

Bacterial adherence is a complex phenomenon involving specific interactions between receptors, including matricial fibronectin, and bacterial ligands. We show here that fibronectin and outer membrane proteins of Pseudomonas fluorescens were able to inhibit adherence of P. fluorescens to fibronectin-coated wells. We identified at least six fibronectin-binding proteins with molecular masses of 70, 55, 44, 37, 32 and 28 kDa. The presence of native (32 kDa) and heat-modified forms (37 kDa) of OprF was revealed by immuno-analysis and the 44-kDa band was composed of three proteins, their N-terminal sequences showing homologies with Pseudomonas aeruginosa porins (OprD, OprE1 and OprE3).

Isolation of an Escherichia coil strain mutant unable to form biofilm on polystyrene and to adhere to human pneumocyte cells: involvement of tryptophanase.

Escherichia coli adherence to biotic and abiotic surfaces constitutes the first step of infection by promoting colonization and biofilm formation. The aim of this study was to gain a better understanding of the relationship between E. coli adherence to different biotic surfaces and biofilm formation on abiotic surfaces. We isolated mutants defective in A549 pneumocyte cells adherence, fibronectin adherence, and biofilm formation by random transposition mutagenesis and sequential passages over A549 cell monolayers. Among the 97 mutants tested, 80 were decreased in biofilm formation, 8 were decreased in A549 cells adherence, 7 were decreased in their adherence to fibronectin, and 17 had no perturbations in either of the three phenotypes. We observed a correlation between adherence to fibronectin or A549 cells and biofilm formation, indicating that biotic adhesive factors are involved in biofilm formation by E. coli. Molecular analysis of the mutants revealed that a transposon insertion in the tnaA gene encoding for tryptophanase was associated with a decrease in both A549 cells adherence and biofilm formation by E. coli. The complementation of the tnaA mutant with plasmid-located wild-type tnaA restored the tryptophanase activity, epithelial cells adherence, and biofilm formation on polystyrene. The possible mechanism of tryptophanase involvement in E. coli adherence and biofilm formation is discussed.

Gastro-resistant microspheres containing ketoprofen.

Ketoprofen gastroresistant microspheres were prepared by spray-drying using common pH dependent polymers, such as Eudragit S and L, CAP, CAT and HPMCP. The long ketoprofen recrystallization time was a serious hindrance to the preparation of microspheres having a drug content higher than 35%. Microspheres were characterized by scanning electron microscopy, differential scanning calorimetry, X-ray diffractometry and in vitro dissolution studies, and used for the preparation of tablets. During this step, the compaction ability of the spray-dried powders was measured. While the compressibility of the microspheres containing the enteric cellulosic derivatives are not acceptable and different from those of the microcrystalline cellulose, the compaction properties of ketoprofen/Eudragit L or S microspheres are comparable to those of the Avicel PH 101. In vitro dissolution studies were performed on the microspheres and the tablets. All microspheres showed a good gastroresistance, but some differences among the five polymers in reducing drug release at low pH values are present. Acrylic polymers (Eudragit L or S) are considerably more effective than the cellulosic derivatives CAP and CAT, while the HPMCP profile is in an intermediate position. These differences are erased by the microspheres compression process. In HCl 0.1 N, the percentage of ketoprofen released from the tablets is always close to zero, independently from the polymer used.

Physical characterization of naproxen sodium hydrate and anhydrate forms.

Naproxen sodium (NS) is a nonsteroidal anti-inflammatory drug used in painful and inflammatory diseases. By crystallization from water or by exposure to relative humidities over 43%, the anhydrate form can be hydrated to a dihydrate species. Different techniques have been used to characterize physically anhydrate naproxen sodium (ANS) and hydrate naproxen sodium (HNS): elemental analysis, atomic absorption, electron scanning microscopy, thermomicroscopy, differential scanning calorimetry, Karl Fisher's titrimetry, thermogravimetry, spectrophotometric analysis and X-ray diffraction study. The hydration/dehydration mechanism, at different relative humidities, was investigated to evaluate their physical stability. When stored up to 43% relative humidity, ANS shows a good stability, whereas with an increase in relative humidity it is hydrated. HNS equilibrium solubility was determined at different temperatures (21, 26, 31, and 37 degrees C). Due to the metastability and the quick phase changes in the water of ANS, its solubility was calculated from intrinsic dissolution measurements at the same temperatures, as solubility measurements of HNS. Water solubility of ANS is greater than HNS, but the solubility difference decreases when the temperature decreases. This is due to the fact that at higher temperatures the intrinsic dissolution rates (IDR) of ANS are considerably faster and decrease as the temperature falls.