The Effectiveness and Safety of First-Line Thioguanine in Thiopurine-Naïve Inflammatory Bowel Disease Patients.

BACKGROUND: Currently thioguanine is solely used as treatment for inflammatory bowel disease after azathioprine and/or mercaptopurine failure. This study aimed to determine the safety, effectiveness, and 12-month drug survival of thioguanine in thiopurine-naïve patients with inflammatory bowel disease. METHODS: A retrospective cohort study was performed in thiopurine-naïve patients with inflammatory bowel disease treated with thioguanine as first thiopurine derivate. Clinical effectiveness was defined as the continuation of thioguanine without the (re)initiation of concurrent biological therapy, systemic corticosteroids, or a surgical intervention. All adverse events were categorized by the Common Terminology Criteria for Adverse Events. RESULTS: A total of 114 patients (male 39%, Crohn's disease 53%) were included with a median treatment duration of 25 months and a median thioguanine dosage of 20 mg/d. Clinical effectiveness at 12 months was observed in 53% of patients, and 78% of these responding patients remained responsive until the end of follow-up. During the entire follow-up period, 26 patients were primary nonresponders, 8 had a secondary loss of response, and 11 patients were unable to cease therapy with systemic corticosteroids within 6 months and were therefore classified as nonresponders. After 12 months, thioguanine was still used by 86% of patients. Fifty (44%) patients developed adverse events (grade 1 or 2) and 9 (8%) patients ceased therapy due to the occurrence of adverse events. An infection was documented in 3 patients, none of them requiring hospitalization and pancytopenia occurred in 2 other patients. No signs of nodular regenerative hyperplasia or portal hypertension were observed. CONCLUSIONS: At 12 months, first-line thioguanine therapy was clinically effective in 53% of thiopurine-naïve inflammatory bowel disease patients with an acceptable safety profile.

After 12 months, first-line thioguanine therapy was still used by 86% of thiopurine-naïve patients with inflammatory bowel disease and clinically effective in 53%. The safety profile was acceptable and only 8% of patients ceased therapy due to adverse events.

Rheological design of thickened alcohol-based hand rubs.

The handleability and sensory perception of hand sanitisers by consumers affect the hygiene outcome. Spillage may result in under-dosing and poor sensory properties can lead to under-utilisation. We first propose four principles (low runoff, spreadability, smoothness and non-stickiness) for designing the rheology of thickened alcohol-based hand rubs with acceptable handleability and hand feel. We then evaluate a commercial hand gel and a variety of simplified formulations thickened with microgels (Carbopol 974P, Carbopol Ultrez 20 and Sepimax Zen), or linear polymers (Jaguar HP 120 COS), and evaluate them against these design criteria. All four additives provide acceptable spreadability by shear thinning to η ≈ 10 - 1 Pa s at γ ˙ ∼ 10 3 s - 1 . Either the finite yield stress conferred by the microgels ( σ y ≳ 10 Pa ) or the increase in low-shear viscosity provided by the linear polymer ( η ≳ 1 Pa s at γ ˙ ≲ 0.1 s - 1 ) give rise to acceptably low runoff. However, the formulation using the linear polymer shows a filament breakage time of τ b ≈ 1 s in capillary rheology, which may result in stickiness and therefore a less than optimal hand feel.

Versatile strategy for homogeneous drying patterns of dispersed particles.

After spilling coffee, a tell-tale stain is left by the drying droplet. This universal phenomenon, known as the coffee ring effect, is observed independent of the dispersed material. However, for many technological processes such as coating techniques and ink-jet printing a uniform particle deposition is required and the coffee ring effect is a major drawback. Here, we present a simple and versatile strategy to achieve homogeneous drying patterns using surface-modified particle dispersions. High-molecular weight surface-active polymers that physisorb onto the particle surfaces provide enhanced steric stabilization and prevent accumulation and pinning at the droplet edge. In addition, in the absence of free polymer in the dispersion, the surface modification strongly enhances the particle adsorption to the air/liquid interface, where they experience a thermal Marangoni backflow towards the apex of the drop, leading to uniform particle deposition after drying. The method is independent of particle shape and applicable to a variety of commercial pigment particles and different dispersion media, demonstrating the practicality of this work for everyday processes.

Prediction of the Values of CRP, eGFR, and Hemoglobin in the Follow-Up of Renal Cell Carcinoma Patients after (Cryo)Surgery Using Machine Learning Algorithms.

BACKGROUND: Artificial intelligence can support clinical decisions by predictive modeling. Using patient-specific characteristics, models may predict the course of clinical parameters, thus guiding monitoring approaches for the individual patient. Here, we present prediction models for inflammation and for the course of renal function and hemoglobin (Hb) in renal cell carcinoma patients after (cryo)surgery. METHODS: Using random forest machine learning in a longitudinal value-based healthcare data set (n = 86) of renal cell carcinoma patients, prediction models were established and optimized using random and grid searches. Data were split into a training and test set in a 70:30 ratio. Inflammation was predicted for a single timepoint, whereas for renal function estimated glomerular filtration rate (eGFR) and Hb time course prediction was performed. RESULTS: Whereas the last Hb and eGFR values before (cryo)surgery were the main basis for the course of Hb and renal function, age and several time frame features also contributed significantly. For eGFR, the type of (cryo)surgery was also a main predicting feature, and for Hb, tumor location, and body mass index were important predictors. With regard to prediction of inflammation no feature was markedly prominent. Inflammation prediction was based on a combination of patient characteristics, physiological parameters, and time frame features. CONCLUSIONS: This study provided interesting insights into factors influencing complications and recovery in individual renal cell carcinoma patients. The established prediction models provide the basis for development of clinical decision support tools for selection and timing of laboratory analyses after (cryo)surgery, thus contributing to quality and efficiency of care.

Soft matter science and the COVID-19 pandemic.

Much of the science underpinning the global response to the COVID-19 pandemic lies in the soft matter domain. Coronaviruses are composite particles with a core of nucleic acids complexed to proteins surrounded by a protein-studded lipid bilayer shell. A dominant route for transmission is via air-borne aerosols and droplets. Viral interaction with polymeric body fluids, particularly mucus, and cell membranes controls their infectivity, while their interaction with skin and artificial surfaces underpins cleaning and disinfection and the efficacy of masks and other personal protective equipment. The global response to COVID-19 has highlighted gaps in the soft matter knowledge base. We survey these gaps, especially as pertaining to the transmission of the disease, and suggest questions that can (and need to) be tackled, both in response to COVID-19 and to better prepare for future viral pandemics.

Surface pressure of liquid interfaces laden with micron-sized particles.

We consider the surface pressure of a colloid-laden liquid interface. As micron-sized particles of suitable wettability can be irreversibly bound to the liquid interface on experimental timescales, we use the canonical ensemble to derive an expression for the surface pressure of a colloid-laden interface. We use this expression to show that adsorption of particles with only hard-core interactions has a negligible effect on surface pressures from typical Langmuir-trough measurements. Moreover, we show that Langmuir-trough measurements cannot be used to extract typical interparticle potentials. Finally, in the case of relatively weakly interacting sterically stabilized particles at a liquid interface, we argue that the dependence of measured surface pressure on surface fraction can be explained by particle coordination number at low to intermediate particle surface fractions. At high surface fractions, where the particles are jammed and cannot easily rearrange, we argue that contact-line sliding and/or deformations of the liquid interface at the length scale of the particles might play a pivotal role.

Electrostatic potential between charged particles at an oil-water interface.

Electrostatic interactions between point charges embedded into interfaces separating dielectric media are omnipresent in soft matter systems and often control their stability. Such interactions are typically complicated and do not resemble their bulk counterparts. For instance, the electrostatic potential of a point charge at an air-water interface falls off as r^{-3}, where r is the distance from the charge, exhibiting a dipolar behavior. This behavior is often assumed to be generic, and is widely referred to when interpreting experimental results. Here we explicitly calculate the in-plane potential of a point charge at an interface between two electrolyte solutions with different, finite dielectric permittivities and Debye screening lengths, such as oil and water. We show that the asymptotic behavior of this potential is neither a dipole, which characterizes the potential at air-water interfaces, nor a screened monopole, which describes the bulk behavior in a single electrolyte solution. By considering the same problem in arbitrary dimensions, we find that the physics behind this difference can be traced to the asymmetric propagation of the interaction in the two media. Our results should be relevant to understand the effective potential acting between interfacial proteins in biofilms, and the self-assembly of charged colloids at droplet surfaces in oil-water emulsions.

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Particle-stabilized Janus emulsions that exhibit pH-tunable stability.

By developing a deeper understanding of the formation mechanism and the origin of the stability, we report a simple and large-scale fabrication approach to create Janus emulsions that can be controlled in size, geometry and stability.

Lack of evidence for a causal role of CALR3 in monogenic cardiomyopathy.

The pathogenicity of previously published disease-associated genes and variants is sometimes questionable. Large-scale, population-based sequencing studies have uncovered numerous false assignments of pathogenicity. Misinterpretation of sequence variants may have serious implications for the patients and families involved, as genetic test results are increasingly being used in medical decision making. In this study, we assessed the role of the calreticulin-3 gene (CALR3) in cardiomyopathy. CALR3 has been included in several cardiomyopathy gene panels worldwide. Its inclusion is based on a single publication describing two missense variants in patients with hypertrophic cardiomyopathy. In our national cardiomyopathy cohort (n = 6154), we identified 17 unique, rare heterozygous CALR3 variants in 48 probands. Overall, our patient cohort contained a significantly higher number of rare CALR3 variants compared to the ExAC population (p = 0.0036). However, after removing a potential Dutch founder variant, no statistically significant difference was found (p = 0.89). In nine probands, the CALR3 variant was accompanied by a disease-causing variant in another, well-known cardiomyopathy gene. In three families, the CALR3 variant did not segregate with the disease. Furthermore, we could not demonstrate calreticulin-3 protein expression in myocardial tissues at various ages. On the basis of these findings, it seems highly questionable that variants in CALR3 are a monogenic cause of cardiomyopathy.

Interfacial Rheology of Sterically Stabilized Colloids at Liquid Interfaces and Its Effect on the Stability of Pickering Emulsions.

Particle-laden interfaces can be used to stabilize a variety of high-interface systems, from foams over emulsions to polymer blends. The relation between the particle interactions, the structure and rheology of the interface, and the stability of the system remains unclear. In the present work, we experimentally investigate how micron-sized, near-hard-sphere-like particles affect the mechanical properties of liquid interfaces. In particular, by comparing dried and undried samples, we investigate the effect of aggregation state on the properties of the particle-laden liquid interface and its relation to the stability of the corresponding Pickering emulsions. Partially aggregated suspensions give rise to a soft-solid-like response under shear, whereas for stable PMMA particulate layers a liquid-like behavior is observed. For interfacial creep-recovery measurements, we present an empirical method to correct for the combined effect of the subphase drag and the compliance of the double-wall ring geometry, which makes a significant contribution to the apparent elasticity of weak interfaces. We further demonstrate that both undried and dried PMMA particles can stabilize emulsions for months, dispelling the notion that particle aggregation, in bulk or at the interface, is required to create stable Pickering emulsions. Our results indicate that shear rheology is a sensitive probe of colloidal interactions but is not necessarily a predictor of the stability of interfaces, e.g., in quiescent Pickering emulsions, as in the latter the response to dilatational deformations can be of prime importance.

Quantitative morphological characterization of bicontinuous Pickering emulsions via interfacial curvatures.

Bicontinuous Pickering emulsions (bijels) are a physically interesting class of soft materials with many potential applications including catalysis, microfluidics and tissue engineering. They are created by arresting the spinodal decomposition of a partially-miscible liquid with a (jammed) layer of interfacial colloids. Porosity L (average interfacial separation) of the bijel is controlled by varying the radius (r) and volume fraction (ϕ) of the colloids (L∝r/ϕ). However, to optimize the bijel structure with respect to other parameters, e.g. quench rate, characterizing by L alone is insufficient. Hence, we have used confocal microscopy and X-ray CT to characterize a range of bijels in terms of local and area-averaged interfacial curvatures; we further demonstrate that bijels are bicontinuous using an image-analysis technique known as 'region growing'. In addition, the curvatures of bijels have been monitored as a function of time, which has revealed an intriguing evolution up to 60 minutes after bijel formation, contrary to previous understanding.

Compressing a spinodal surface at fixed area: bijels in a centrifuge.

Bicontinuous interfacially jammed emulsion gels (bijels) are solid-stabilised emulsions with two inter-penetrating continuous phases. Employing the method of centrifugal compression we find that macroscopically the bijel yields at relatively low angular acceleration. Both continuous phases escape from the top of the structure, making any compression immediately irreversible. Microscopically, the bijel becomes anisotropic with the domains aligned perpendicular to the compression direction which inhibits further liquid expulsion; this contrasts strongly with the sedimentation behaviour of colloidal gels. The original structure can, however, be preserved close to the top of the sample and thus the change to an anisotropic structure suggests internal yielding. Any air bubbles trapped in the bijel are found to aid compression by forming channels aligned parallel to the compression direction which provide a route for liquid to escape.

Making non-aqueous high internal phase pickering emulsions: influence of added polymer and selective drying.

We report the first example of a non-aqueous (oil-in-oil) Pickering high internal phase emulsion (HIPE) stabilized by chemically modified fumed silica. In this case, a 75 vol % ethylene carbonate (EC)-rich internal phase is emulsified in 25 vol % p-xylene (xylene)-rich continuous phase using interfacial nanoparticles. It is revealed that no phase inversion takes place during the HIPE formation process when using the appropriate wettability of solid particles. Incorporating polystyrene (PS) into xylene enables one-step formation of PS-filled HIPEs in place of a multi-step polymerization of the continuous phase. We observe that the size of droplets changes with the addition of PS, and we associate this with the change in the viscosity of the continuous xylene-rich phase. Drying the pure HIPE results in the selective removal of xylene and coalescence of EC-rich droplets. With the PS in the xylene-rich continuous phase, we show that EC-rich droplets can be retained even though the xylene is evaporated off, and a new semi-solid composite containing both liquid phase and solid phase is formed via this non-aqueous Pickering-HIPE template.

Measurement of nitric oxide-related amino acids in serum and plasma: effects of blood clotting and type of anticoagulant.

BACKGROUND: Analysis of circulatory amino acids is performed in diverse fields of research, but very often without justification or even specification of specimen type. We investigated the impact of coagulation and anticoagulants on amino acid concentrations, with emphasis on amino acids involved in nitric oxide metabolism. METHODS: Plasma, using either heparin or EDTA as anticoagulant, and serum were collected from 23 apparently healthy subjects. Amino acids were measured with high precision using high-performance liquid chromatographic techniques. RESULTS: Compared to heparin-plasma, the concentrations of almost all amino acids were lower in EDTA-plasma and higher in serum. For EDTA-plasma the mean difference was highest for tryptophan (5.3%). The mean difference between serum and heparin-plasma was much higher for some amino acids, including taurine (42.3%), arginine (36.4%), glutamic acid (16.2%) and serine (5.6%). CONCLUSIONS: Differences in amino acid concentrations between EDTA- and heparin-plasma are small and clinically most likely irrelevant. Concentrations of amino acids in serum are higher than in heparin-plasma, which is probably caused by poorly controllable ex vivo release from blood cells during clotting. We advocate using plasma rather than serum and not using different anticoagulants interchangeably in a single study. In addition, we urge editors and reviewers to demand adequate description of specimen type in manuscripts.

[Expectations of pregnant women on an ideal maternity hospital]. / Welche Erwartungen stellen Schwangere an eine ideale Entbindungsklinik?

PURPOSE: The aim of this study was to evaluate expectations of pregnant women on an ideal maternity hospital. MATERIAL AND METHODS: We prospectively performed a survey among 566 pregnant women with regard to their expectations on a perfect hospital for obstetrics. Data collection was accomplished in 3 obstetrical departments in Mannheim, Germany. The questionnaire contained 23 general questions about sociodemographic characteristics and 34 specific questions about the anticipated childbirth. Women who were less than 20 weeks pregnant and women who did not speak German fluently were excluded from this study. RESULTS: In our survey the possibility to get to know midwifes and doctors at information evenings and a guided delivery room tour were defined as very important factors by the interviewed women. Of particular importance was a continuous care by a single midwife and the physical attendance of a family member during childbirth. Furthermore, friendliness of the staff and medical care by paediatricians after childbirth were identified to be important. To some extent, a modern appearance of the ward was also a matter of importance. CONCLUSIONS: The medical treatment of mother and the newborn child and the friendliness of the staff have been identified as the most important factors with regard to the expectations of women on an ideal maternity hospital. In addition, a pleasant ambiance of the ward and regular visits by a lactation specialist were named as important.

Malabsorption and nutritional balance in the ICU: fecal weight as a biomarker: a prospective observational pilot study.

INTRODUCTION: Malabsorption, which is frequently underdiagnosed in critically ill patients, is clinically relevant with regard to nutritional balance and nutritional management. We aimed to validate the diagnostic accuracy of fecal weight as a biomarker for fecal loss and additionally to assess fecal macronutrient contents and intestinal absorption capacity in ICU patients. METHODS: This was an observational pilot study in a tertiary mixed medical-surgical ICU in hemodynamically stable adult ICU patients, without clinically evident gastrointestinal malfunction. Fecal weight (grams/day), fecal energy (by bomb calorimetry in kcal/day), and macronutrient content (fat, protein, and carbohydrate in grams/day) were measured. Diagnostic accuracy expressed in terms of test sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and receiver operator curves (ROCs) were calculated for fecal weight as a marker for energy malabsorption. Malabsorption was a priori defined as < 85% intestinal absorption capacity. RESULTS: Forty-eight patients (63 ± 15 years; 58% men) receiving full enteral feeding were included. A cut-off fecal production of > 350 g/day (that is, diarrhea) was linked to the optimal ROC (0.879), showing a sensitivity and PPV of 80%, respectively. Specificity and NPV were both 96%. Fecal weight (grams/day) and intestinal energy-absorption capacity were inversely correlated (r = -0.69; P < 0.001). Patients with > 350 g feces/day had a significantly more-negative energy balance compared with patients with < 350 g feces/day (loss of 627 kcal/day versus neutral balance; P = 0.012). CONCLUSIONS: A fecal weight > 350 g/day in ICU patients is a biomarker applicable in daily practice, which can act as a surrogate for fecal energy loss and intestinal energy absorption. Daily measurement of fecal weight is a feasible means of monitoring the nutritional status of critically ill patients and, in those identified as having malabsorption, can monitor responses to changes in dietary management.

Hindered coarsening of a phase-separating microemulsion due to dispersed colloidal particles.

The addition of sterically stabilized colloidal particles to a phase-separating microemulsion leads to dramatic changes in its demixing behavior, especially during the later stages. Our microemulsion is composed of reverse micelles of sodium dodecyl sulfate, pentanol, and water in a dodecane continuous phase which separates into micelle-rich and micelle-poor phases above a lower critical solution temperature. The poly(methyl methacrylate) particles preferentially partition into the less structured, micelle-poor phase. Nucleation of the minority phase or spinodal decomposition close to criticality continue to occur in the presence of particles, albeit with pronounced pretransitional clustering of particles when the micelle-poor phase is in the minority. The coalescence of micelle-poor droplets and the coarsening of micelle-rich domains are both strongly modified due to the presence of colloidal particles. We use our observations of the early stages of phase separation to understand these late stage changes.

Emulsification in binary liquids containing colloidal particles: a structure-factor analysis.

We present a quantitative confocal-microscopy study of the transient and final microstructure of particle-stabilized emulsions formed via demixing in a binary liquid. To this end, we have developed an image-analysis method that relies on structure factors obtained from discrete Fourier transforms of individual frames in confocal image sequences. Radially averaging the squared modulus of these Fourier transforms before peak fitting allows extraction of dominant length scales over the entire temperature range of the quench. Our procedure even yields information just after droplet nucleation, when the (fluorescence) contrast between the two separating phases is scarcely discernible in the images. We find that our emulsions are stabilized on experimental timescales by interfacial particles and that they are likely to have bimodal droplet-size distributions. We attribute the latter to coalescence together with creaming being the main coarsening mechanism during the late stages of emulsification and we support this claim with (direct) confocal-microscopy observations. In addition, our results imply that the observed droplets emerge from particle-promoted nucleation, possibly followed by a free-growth regime. Finally, we argue that creaming strongly affects droplet growth during the early stages of emulsification. Future investigations could clarify the link between quench conditions and resulting microstructure, paving the way for tailor-made particle-stabilized emulsions from binary liquids.