No / PURPOSE/OBJECTIVES: To assess and improve the safety of hospital-based adult chemotherapy administration. DESIGN: Prospective, systems-focused clinical risk assessment. SETTING: An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom. SAMPLE: 8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers. METHODS: Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them. MAIN RESEARCH VARIABLES: The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected. FINDINGS: Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication. CONCLUSIONS: Although time and resource intensive, FMEA is a useful safety improvement tool. IMPLICATIONS FOR NURSING: Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.

No / PURPOSE: Self-emulsifying systems (SES) emulsify spontaneously to produce fine oil-in-water emulsion when introduced into aqueous phase. The self-emulsification process plays an important role during formation of emulsion. The objective of current work was to understand and explore the inner structuration of SES through controlled hydration and further to study the influence of additive on the same which ultimately governs performance of final formulation in terms of droplet size. METHODS: Droplet size of final formulations containing structural analogues of ibuprofen was determined. Microstructural properties of intermediate hydrated regimes of SES were investigated using techniques such as small angle X-ray scattering, differential scanning calorimetry and rheology. RESULTS: The current work established inverse relationship between droplet size of the formulations containing structural analogues of ibuprofen and their Log P values. Microstructural analysis of intermediate hydrated regimes of the prepared samples showed formation of local lamellar structure. Structural analogues of ibuprofen significantly altered microstructure of lamellae which was well correlated with the droplet size of final formulations. In vitro drug release study showed increase in dissolution rate of lipophillic drugs when formulated as SES. CONCLUSION: The current work emphasizes the fact that tailor-made formulations can be prepared by controlling the properties of intermediate regimes.

This study compared the immunogenicity of inactivated SARS-CoV-2 vaccines between people living with HIV (PLWH) and HIV-negative individuals. We recruited 120 PLWH and 53 HIV-negative individuals aged 18-59 years who had received an inactivated SARS-CoV-2 vaccine in two Chinese cities between April and June 2021. Blood samples were tested for immunogenicity of the inactivated SARS-CoV-2 vaccines. The prevalence and severity of adverse events associated with SARS-CoV-2 vaccines were similar between PLWH and HIV-negative individuals. The seropositivity of neutralizing activity against authentic SARS-CoV-2, of the total amount of antibody (total antibody) and of S-IgG were 71.3%, 81.9%, and 92.6%, respectively, among fully vaccinated PLWH. Among all participants, PLWH had lower neutralizing activity, total antibody, S-IgG, and T-cell-specific immune response levels, compared to HIV-negative individuals, after controlling for types of vaccine, time interval between first and second dose, time after receiving the second dose, and sociodemographic factors. PLWH with a longer interval since HIV diagnosis, who received their second dose 15-28 days prior to study commencement, and who had an interval of ≥21 days between first and second dose had higher neutralizing activity levels. The immunogenicity of the inactivated SARS-CoV-2 vaccines was lower among PLWH as compared to HIV-negative individuals. Vaccination guideline specific for PLWH should be developed.

Studienziel: Untersuchung der Dosis-Wirkung von inhalativem Stickstoffmonoxid (NO) bei Patienten mit schwerem akuten Lungenversagen (ARDS) und der diese Wirkung beeinflussenden Faktoren. Design: Prospektive, offene Beobachtungsstudie. Setting: Universitäts-Klinikum. Intensivstation. Patienten: 26 Intensivpatienten mit hohem pulmonal-vaskulärem Druck (PAP) bei zugrunde liegendem ARDS. Behandlung: Patienten mit ARDS wurden einer Therapie mit konventioneller Beatmung und Beimischung von inhalativem NO zugeführt. Das Protokoll sah die Applikation von NO in steigender Dosierung von 0,01 parts per million (ppm), 0,01 ppm, 1, 10 und 100 ppm vor. Zischen den Messungen wurden für 15 bis 20 Minuten Nullmessungen durchgeführt. Ein Anstieg des pulmonal-areriellen Sauerstoffdrucks (Pao2) um 20% wurde als "Responding" definiert. Messungen: Es wurden die Parameter des pulmonalen Gasaustausches wie PaO2, PaCo2 und CaO2 gemessen. Des Weiteren wurden die Werte für den mittleren systemischen Blutdruck (AP), den mittleren pulmonal-arteriellen Druck (PAP), den systemischen Widerstand (SVR), den pulmonalvaskulären Widerstand (PVR), die Herzfrequenz (HR), den Herzindex (CI), das Herz-Zeit-Volumen (HZV), den Wedgedruck (PCWP) und die venöse Beimischung registriert. Ergebnisse: NO verursachte einen dosisabhängigen Anstieg des Pao2 von 0,01 bis 10 ppm (p / STUDY OBJECTIVE: To determine the dose responsiveness to nitric oxide in adult patients with acute respiratory distress syndrom (ARDS), especially in those patients with pulmonary hypertension. To find factors influencing the response to NO. DESIGN: Prospective, open, nonblinded observation study. SETTING: University teaching hospital. PATIENTS: 26 ICU patients suffering from ARDS demonstrating pulmonary hypertension. INTERVENTIONS: Patients with severe acute respiratory distress syndrome received inhalation therapy with NO. Inhaled NO was sequentially titrated from 0,01 parts per million to 0,1 ppm, 1, 10, and 100 ppm at 15-minute intervals followed by a 15 to 20 min OFF interval. Changes in hemodynamics and gas exchange were monitored. An increase of at least 20 % in the oxygenation index was considered as a therapeutic response. MEASUREMENTS: Heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary vascular resistance (PVR), peripheral vascular resistance, cardiac index,rigt to left shunting , venous admixture and right ventricular ejection fraction were monitored throughout the study, as well as the Pao2, Cao2 and PaCo2. RESULTS: 26 patients received inhaled NO. Nitric oxide induced a dose-dependent increase in Pao2 for inspiratory nitric oxide concentrations ranging between 0.01 and 10 ppm (p

O anticoagulante oral cumarínico varfarina é vastamente utilizado para o tratamento e prevenção de eventos tromboembólicos, que configuram uma das principais causas de mortalidade mundial. Contudo, de acordo com fatores genéticos e ambientais, os cumarínicos apresentam grande variação em sua farmacocinética e farmacodinâmica, implicando em respostas variáveis entre os indivíduos. Para auxílio na tomada de decisão pelo corpo clínico na terapia com a varfarina, algoritmos farmacogenéticos estimadores de dose têm sido extensivamente estudados e desenvolvidos, com o intuito de estabelecer terapias personalizadas. Neste sentido, o presente estudo teve como objetivos investigar a associação de polimorfismos nos genes ABCB1 e CYP4F2 com a variabilidade do requerimento de dose de varfarina, e, primariamente, avaliar o impacto da inclusão desses polimorfismos como covariáveis do algoritmo farmacogenético estimador de dosagem de varfarina previamente desenvolvido para a população brasileira por Santos et al. (2015). Neste estudo retrospectivo, foram utilizadas amostras de 965 pacientes registrados no Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP). As genotipagens dos polimorfismos ABCB1 c.3435C>T e CYP4F2 c.1297G>A foram realizadas por meio da amplificação do DNA genômico através da reação em cadeia da polimerase seguida por análise de curva de dissociação (PCR-HRM) ou ensaio TaqMan®, respectivamente para cada variante. Para as análises estatísticas, utilizamos a abordagem de regressão linear múltipla, considerando a dose estável de varfarina como variável resposta e como covariáveis os polimorfismos de interesse nos genes ABCB1 e CYP4F2, bem como outros fatores genéticos, clínicos e demográficos. Nossos resultados sugerem que carreadores da variante ABCB1 c.3435C>T requerem doses médias de manutenção de varfarina inferiores quando comparados aos indivíduos com genótipo selvagem (redução de 2,5 e 4,3 mg/semana, respectivamente para carreadores dos genótipos CT e TT). Ainda, observamos uma grande variabilidade de dose de varfarina no subgrupo de pacientes autodeclarados não-brancos, de acordo com os genótipos ABCB1 (redução de 5,5 e 10,2 mg/semana, respectivamente para carreadores dos genótipos CT e TT). Além disso, verificamos que ambos os polimorfismos ABCB1 c.3435C>T e CYP4F2 c.1297G>A contribuíram para a predição de dose de varfarina, quando associados a outros fatores genotípicos, demográficos e clínicos relevantes, sendo estatisticamente significativos, aumentando o coeficiente de determinação do algoritmo em 2,6% e explicando um adicional de 3,6% da variabilidade interindividual de dosagem. Em conclusão, demonstramos que as genotipagens das variantes ABCB1 c.3435C>T e CYP4F2 c.1297G>A podem ser relevantes para acurar a terapêutica com varfarina na população brasileira / The coumarin oral anticoagulant warfarin has been widely used for treating and preventing thromboembolic events, which are one of the main causes of mortality worldwide. However, according to genetic and environmental factors, coumarins show high variance in pharmacokinetics and pharmacodynamics, resulting in variable interindividual responses. For supporting warfarin clinical decisions, genetic-guided algorithms have been extensively studied and developed, in order to set personalized therapeutics. In this context, the aims of this master\'s research project were to investigate the association of ABCB1 and CYP4F2 polymorphisms with individual\'s warfarin dose requirements and to assess the impact of the inclusion of these polymorphisms as covariates in the genetic-guided dosing algorithm developed by Santos PC et al. (2015) for the Brazilian population. For this retrospective study, 965 patients enrolled in the Heart Institute (InCor), University of São Paulo Medical School (FMUSP) were involved. Genotyping of ABCB1 c.3435C>T and CYP4F2 c.1297G>A were performed by genomic DNA amplification by polymerase chain reaction (PCR), followed by melting curve analysis (HRM-PCR) and TaqMan® assay, respectively. For statistical analysis, we utilized multiple linear regression approach considering warfarin stable dose as the dependent variable and the ABCB1 and CYP4F2 variants, as well as other genetic, clinical and demographic factors as covariates. Our data suggests that carriers of ABCB1 c.3435C>T genotypes require lower mean warfarin maintenance doses when compared to wild-type individuals (reduction of 2.5 and 4.3 mg/week, respectively for CT and TT genotype carriers). Furthermore, we observed large warfarin dose variability for the subgroup of patients who self-declared themselves as non-white according to ABCB1 genotypes (lowering of 5.5 and 10.2 mg/week, respectively for CT and TT genotype carriers). Finally, we verified that both ABCB1 c.3435C>T and CYP4F2 c.1297G>A polymorphisms were able to contribute to warfarin dose prediction, when associated to other relevant genetic, clinical and demographic data, being statistically significant, improving the algorithm\'s coefficient of determination by 2.6% and explaining an additional of 3.6% of the interindividual warfarin dosage variability. In conclusion, in this study we have demonstrated that the genotyping of ABCB1 c.3435C>T and CYP4F2 c.1297G>A may be relevant for improving the management of warfarin therapeutics in Brazilian patients

Indiana University-Purdue University Indianapolis (IUPUI) / Endodontic regeneration (ERP) has been successfully used in the treatment of traumatized immature teeth. The procedure has three essential steps: disinfecting the root canal (i.e. triple antibiotic paste (TAP) or double antibiotic paste (DAP)), provoking bleeding inside the canal to form a scaffold upon which pulp stem cells will be deposited and continue root growth, and creating a good coronal seal. Previous research has reported that antibiotic pastes (TAP and DAP) are cytotoxic to stem cells in the concentrations commonly used in endodontic regeneration (1000 mg/mL). To decrease the adverse effects on stem cells and increase the rate of success of the regeneration, defining appropriate antibiotic concentrations for ERP is critical. In this project, five in-vitro experiments were conducted to determine the breakpoint dilutions of both TAP and DAP medicaments, and to prepare a suitable novel pastes containing diluted TAP or DAP medicaments for ERP. In the first experiment, we compared the antibacterial effect of TAP, and DAP against early biofilm formation of Enterococcus faecalis (E. faecalis) and Porphyromonas gingivalis bacteria. In the second study, we investigated the antibacterial effect of various dilutions of TAP and DAP antibiotic medicaments against established E. faecalis biofilm. In the third experiment, we investigated longitudinally the residual antibacterial activity of human radicular dentin treated with 1000, 1 or 0.5 mg/ml of TAP and DAP. In the fourth study, we investigated the cytotoxic effect of various dilutions of TAP and DAP antibiotic medicaments on the survival of human dental pulp stem cells (DPSC). And in the fifth experiment, we investigated the antibacterial and cytotoxic effect of novel intracanal medicaments consisting of methylcellulose (MC) and/or propylene glycol (PG) mixed with 1mg/ml of TAP or DAP. 1 mg/ml of DAP or TAP medicaments had a significant antibacterial effect against early bacterial biofilm formation, and established bacterial biofilm. Furthermore, 1 mg/ml had a residual antibacterial activity comparable to 1000 mg/ml. The novel intracanal medicaments had comparable antibacterial effect to currently used medicaments (1000 mg/ml). Additionally, the novel intracanal medicaments significantly enhanced DPSC metabolic activity, compared to currently used medicaments in endodontic regeneration procedures.

Yes / A new type of self-assembled polyelectrolyte complex nanocarrier composed of chondroitin (CHON) and protamine (PROT) was designed and the ability of the carriers to bind salmon calcitonin (sCT) was examined. The response of sCT-loaded CHON/PROT NPs to a change in the properties of the liquid medium, e.g. its pH, composition or ionic strength was studied and in vitro peptide release was assessed. The biocompatibility of the NPs was evaluated in Caco-2 cells. CHON/PROT NPs were successfully obtained with properties that were dependent on the concentration of the polyelectrolytes and their mixing ratio. X-ray diffraction determined the amorphous nature of the negatively charged NPs, while those with the positive surface potential were semi-crystalline. sCT was efficiently associated with the nanocarriers (98-100%) and a notably high drug loading (13-38%) was achieved. The particles had negative zeta potential values and were homogenously dispersed with sizes between 60 and 250 nm. CHON/PROT NPs released less than 10% of the total loaded peptide in the first hour of the in vitro release studies. The enthalpy of the decomposition exotherm correlated with the amount of sCT remaining in NPs after the release experiments. The composition of medium and its ionic strength was found to have a considerable influence on the release of sCT from CHON/PROT NPs. Complexation to CHON markedly reduced the toxic effects exerted by PROT and the NPs were compatible and well tolerated by Caco-2 cells.