A exploração de processos viáveis para a conversão da biomassa lignocelulósica em combustíveis limpos e produtos químicos de alto valor agregado, para complementar ou substituir produtos derivados de fontes não renováveis, é crucial para um desenvolvimento sustentável. A valorização e modificação dos componentes lignocelulósicos, torna-se imprescindível para viabilizar o sistema de biorrefinaria. A lignina, macromolécula aromática dominante na natureza, é um destes componentes que, devido a sua estrutura e composição, oferece rotas únicas para a produção de vários químicos de valor agregado. Este trabalho tem como objetivo avaliar o efeito de reações de oxidação em ligninas de bagaço e de palha de cana-de-açúcar, e de casca de café, na obtenção de compostos aromáticos de baixa massa molar, em especial a vanilina, e adicionalmente, verificar a aplicabilidade da lignina oxidada residual na obtenção de matrizes para liberação controlada de herbicida, buscando alternativas para agregar valor à lignina proveniente de resíduos agroindustriais e contribuir com a viabilização de biorrefinarias. Para isso, os materiais lignocelulósicos foram pré-tratados com ácido diluído e submetidos a deslignificação alcalina para obtenção da lignina. As frações obtidas durante cada etapa foram avaliadas quanto a composição química e Espectrometria no Infravermelho (FTIR), e as ligninas obtidas, foram ainda avaliadas por Espectrometria no Ultravioleta (UV) e por Ressonância Magnética Nuclear (1H RMN, 13C RMN e 2D RMN). As ligninas obtidas foram oxidadas em diferentes condições: oxidação enzimática utilizando lacase, em meio ácido e em meio alcalino com H2O2 e oxidação úmida em meio aquoso e alcalino utilizando H2O2. A fração líquida obtida foi analisada por Cromatografia Líquida de Alta Eficiência (CLAE) para identificar e quantificar os aldeídos aromáticos e outros compostos de degradação, enquanto a fração sólida, constituída pela lignina residual oxidada, foi avaliada por FTIR e UV. As ligninas oxidadas provenientes das condições que resultaram em um maior rendimento de vanilina, foram aplicadas na formulação de matrizes para liberação controlada de ametrina. Os resultados mostraram que a lignina de bagaço e de palha de cana não oxidadas são compostas principalmente por unidades siringil e guaiacil, respectivamente, e predominância de ligações ?-O-4, enquanto a lignina de casca de café foi composta principalmente por unidades hidroxil e predominância de ligações C-C, indicando uma estrutura mais condensada. Das oxidações avaliadas, a oxidação em meio alcalino (NaOH 10%) utilizando H2O2 9,1% gerou um maior rendimento de vanilina quando utilizada lignina de bagaço (8,13 mg/g lignina) e de casca de café (1,15 mg/g lignina), e H2O2 6,1% quando utilizada lignina de palha (6,48 mg/g lignina). A aplicação das ligninas oxidadas permitiu a obtenção de matrizes capazes de liberar o herbicida ametrina com diferentes cinéticas, dependendo das propriedades e das proporções das ligninas empregadas. / The exploration of feasible paths for the conversion of the lignocellulosic biomass into clean fuels and high value chemicals, to complement or replace products derived from non-renewable sources, is crucial for a sustainable development. The efficient utilization of the lignocellulosic components is of fundamental importance for the economic viability of biorefineries. Lignin, nature\'s dominant aromatic polymer, is a major component of the biomass that, due to its structuture and chemical composition, is a unique feedstock for producing high-value chemicals. The aim of this study is to seek for alternatives for adding value to lignin from agro-industrial waste in order to contribute to the vialbility of biorefineries. To achieve this, we evaluated the effect of oxidation reactions in sugarcane bagasse and straw lignin, and coffee husk, for obtaining aromatic compounds of low molecular weight, especially vanillin. In addition, the applicability of the residual oxidized lignin for obtaining matrices for the controlled release of herbicides was also examined in this work. For this purpose, the lignocellulosic materials were pretreated with dilute acid and subjected to alkaline delignification to achieve separation of the lignin. The fractions obtained at each stage were analyzed for chemical composition and with Infrared Spectroscopy (FTIR). The lignins were also analyzed using UV-vis Spectroscopy (UV) and Nuclear Magnetic Resonance (1H NMR, 13C NMR and HSQC). The lignins obtained were subjected to oxidation using different physiochemical conditions - enzymatic oxidation with laccase, oxidation in acidic and alkaline medium with H2O2 and wet oxidation in aqueous and alkaline medium using H2O2.The obtained liquid fraction was analyzed by High Performance Liquid Chromatography (HPLC) to identify and quantify the aromatic aldehydes and other compounds of lignin degradation, while the solid fraction, comprising the oxidized residual lignin, was analyzed by FTIR and UV. The oxidized lignins derived from the conditions that have resulted in a maximun yield of vanillin, were applied in the formulation of controlled release matrices of ametryne. Results for non oxidized lignin showed bagasse and straw lignin being composed mainly of syringyl and guaiacil units, respectively, linked predominantly by ?-O-4 bonds, while coffee husk lignin was mainly composed of hydroxyl units linked by C-C bonds predominantly, indicating a more condensed structure. Of all the oxidation reactions, the oxidation in alkaline medium (NaOH 10%) using H2O2 9.1% showed the highest yield of vanillin with bagasse lignin (8.13 mg/g lignin) and coffee husk lignin (1.15 mg/g lignin), and H2O2 6.1% with straw lignin (6.48 mg/g lignin). The application of oxidized lignins as matrices resulted in the release of the herbicide ametryne with different kinetics, depending on the proportions and properties of the lignins applied.

A exploração de processos viáveis para a conversão da biomassa lignocelulósica em combustíveis limpos e produtos químicos de alto valor agregado, para complementar ou substituir produtos derivados de fontes não renováveis, é crucial para um desenvolvimento sustentável. A valorização e modificação dos componentes lignocelulósicos, torna-se imprescindível para viabilizar o sistema de biorrefinaria. A lignina, macromolécula aromática dominante na natureza, é um destes componentes que, devido a sua estrutura e composição, oferece rotas únicas para a produção de vários químicos de valor agregado. Este trabalho tem como objetivo avaliar o efeito de reações de oxidação em ligninas de bagaço e de palha de cana-de-açúcar, e de casca de café, na obtenção de compostos aromáticos de baixa massa molar, em especial a vanilina, e adicionalmente, verificar a aplicabilidade da lignina oxidada residual na obtenção de matrizes para liberação controlada de herbicida, buscando alternativas para agregar valor à lignina proveniente de resíduos agroindustriais e contribuir com a viabilização de biorrefinarias. Para isso, os materiais lignocelulósicos foram pré-tratados com ácido diluído e submetidos a deslignificação alcalina para obtenção da lignina. As frações obtidas durante cada etapa foram avaliadas quanto a composição química e Espectrometria no Infravermelho (FTIR), e as ligninas obtidas, foram ainda avaliadas por Espectrometria no Ultravioleta (UV) e por Ressonância Magnética Nuclear (1H RMN, 13C RMN e 2D RMN). As ligninas obtidas foram oxidadas em diferentes condições: oxidação enzimática utilizando lacase, em meio ácido e em meio alcalino com H2O2 e oxidação úmida em meio aquoso e alcalino utilizando H2O2. A fração líquida obtida foi analisada por Cromatografia Líquida de Alta Eficiência (CLAE) para identificar e quantificar os aldeídos aromáticos e outros compostos de degradação, enquanto a fração sólida, constituída pela lignina residual oxidada, foi avaliada por FTIR e UV. As ligninas oxidadas provenientes das condições que resultaram em um maior rendimento de vanilina, foram aplicadas na formulação de matrizes para liberação controlada de ametrina. Os resultados mostraram que a lignina de bagaço e de palha de cana não oxidadas são compostas principalmente por unidades siringil e guaiacil, respectivamente, e predominância de ligações ?-O-4, enquanto a lignina de casca de café foi composta principalmente por unidades hidroxil e predominância de ligações C-C, indicando uma estrutura mais condensada. Das oxidações avaliadas, a oxidação em meio alcalino (NaOH 10%) utilizando H2O2 9,1% gerou um maior rendimento de vanilina quando utilizada lignina de bagaço (8,13 mg/g lignina) e de casca de café (1,15 mg/g lignina), e H2O2 6,1% quando utilizada lignina de palha (6,48 mg/g lignina). A aplicação das ligninas oxidadas permitiu a obtenção de matrizes capazes de liberar o herbicida ametrina com diferentes cinéticas, dependendo das propriedades e das proporções das ligninas empregadas. / The exploration of feasible paths for the conversion of the lignocellulosic biomass into clean fuels and high value chemicals, to complement or replace products derived from non-renewable sources, is crucial for a sustainable development. The efficient utilization of the lignocellulosic components is of fundamental importance for the economic viability of biorefineries. Lignin, nature\'s dominant aromatic polymer, is a major component of the biomass that, due to its structuture and chemical composition, is a unique feedstock for producing high-value chemicals. The aim of this study is to seek for alternatives for adding value to lignin from agro-industrial waste in order to contribute to the vialbility of biorefineries. To achieve this, we evaluated the effect of oxidation reactions in sugarcane bagasse and straw lignin, and coffee husk, for obtaining aromatic compounds of low molecular weight, especially vanillin. In addition, the applicability of the residual oxidized lignin for obtaining matrices for the controlled release of herbicides was also examined in this work. For this purpose, the lignocellulosic materials were pretreated with dilute acid and subjected to alkaline delignification to achieve separation of the lignin. The fractions obtained at each stage were analyzed for chemical composition and with Infrared Spectroscopy (FTIR). The lignins were also analyzed using UV-vis Spectroscopy (UV) and Nuclear Magnetic Resonance (1H NMR, 13C NMR and HSQC). The lignins obtained were subjected to oxidation using different physiochemical conditions - enzymatic oxidation with laccase, oxidation in acidic and alkaline medium with H2O2 and wet oxidation in aqueous and alkaline medium using H2O2.The obtained liquid fraction was analyzed by High Performance Liquid Chromatography (HPLC) to identify and quantify the aromatic aldehydes and other compounds of lignin degradation, while the solid fraction, comprising the oxidized residual lignin, was analyzed by FTIR and UV. The oxidized lignins derived from the conditions that have resulted in a maximun yield of vanillin, were applied in the formulation of controlled release matrices of ametryne. Results for non oxidized lignin showed bagasse and straw lignin being composed mainly of syringyl and guaiacil units, respectively, linked predominantly by ?-O-4 bonds, while coffee husk lignin was mainly composed of hydroxyl units linked by C-C bonds predominantly, indicating a more condensed structure. Of all the oxidation reactions, the oxidation in alkaline medium (NaOH 10%) using H2O2 9.1% showed the highest yield of vanillin with bagasse lignin (8.13 mg/g lignin) and coffee husk lignin (1.15 mg/g lignin), and H2O2 6.1% with straw lignin (6.48 mg/g lignin). The application of oxidized lignins as matrices resulted in the release of the herbicide ametryne with different kinetics, depending on the proportions and properties of the lignins applied.

O objetivo da presente tese foi avaliar os efeitos da heparina de baixo peso molecular (HBPM) na perda óssea alveolar em ratos Wistar. Para a melhor compreensão e entendimento dos efeitos da HBPM se elaborou um único artigo com 40 ratos machos da linhagem Wistar de 60 dias de nascidos, os quais foram dívidos em 4 grupos experimentais previamente randomizados: Grupo Controle (C), Grupos Doença Periodontal (DP), Grupo Heparina (Hp) e Grupo Heparina+Doença Periodontal (Hp+DP) com um período experimental de 60 dias. Um animal foi perdido no período de aclimação, dois animais foram perdidos na primeira de três coletas sanguíneas pré-programadas e um rato foi perdido na colocação da ligadura. Os resultados observados foram analisados são perda óssea alveolar induzida onde houve diferença significava entre os grupos (C) e (DP), entre o grupo (C) e (Hp+DP), entre o grupo (DP) e (Hp) e o grupo (Hp) e (Hp+DP). Foi avaliado perda óssea alveolar não induzida onde não existiu diferença entre os grupos. Foi avaliado o peso do início ao final do período experimental. Foram avaliados o consumo de ração e agua onde não houve diferença significativa entre os grupos. Foram avaliados o número de megacariócitos nos fémures, onde também não existiram diferenças estatísticas. Foram avaliados números de adipócitos no timo, não havendo diferença significativa entre os grupos. Foram avaliados as plaquetas e desvio padrão onde não existiu diferença significativa entre os grupos. Foram avaliados os leucócitos e desvio padrão onde não houve diferença significativa entre os grupos. Posteriormente foi avaliado a porcentagem de linfócitos onde se achou diferença estatisticamente significativa na segunda coleta sanguínea entre o grupo (C) e grupo (Hp+DP) e grupo (Hp) e grupo (Hp+DP). Foi assim que as conclusões deste trabalho foram que o presente estudo mostrou que a HBPM não foi capaz de produzir perda óssea alveolar nos ratos Wistar, mas foi capaz de aumentar a quantidade de leucócitos e linfócitos, indicando a presença de um processo inflamatório. / In order to better understand and understand the effects of (LMWH), a single article was elaborated with 40 male rats of the 60 day old Wistar line, which were divided into four previously randomized experimental groups: Control Group (C), Groups Periodontal Disease (PD), Heparin Group (Hp) and Heparin Group + Periodontal Disease (Hp + PD) with an experimental period of 60 days. One animal was lost in the acclimation period, two animals were lost in the first of three preprogrammed blood collections and one mouse was lost in the ligation placement. The observed results were analyzed for induced alveolar bone loss where there was significant difference between groups (C) and (PD), between group (C) and (Hp + PD), between (PD) and (Hp) group and Group (Hp) and (Hp + PD). Uninduced alveolar bone loss was assessed where there was no difference between the groups. The weight of the onset at the end of the experimental period was evaluated. The ration and water consumption were evaluated where there was no significant difference between the groups. The number of megakaryocytes in the femurs was evaluated, in which there were also no statistical differences. Adipocyte numbers were evaluated in the thymus, with no significant difference between the groups. Platelets and standard deviation were evaluated where there was no significant difference between the groups. Leukocytes and standard deviation were evaluated where there was no significant difference between the groups. Later, the percentage of lymphocytes where a statistically significant difference was found in the second blood collection between group (C) and group (Hp + PD) and group (Hp) and group (Hp + PD) was evaluated. Thus the conclusions of this study were that the present study showed that LMWH was not able to produce alveolar bone loss in Wistar rats, but was able to increase the amount of leukocytes and lymphocytes, indicating the presence of a process inflammatory.

Preeclampsia (PE) is a potentially fatal complication of pregnancy characterized by an increase in blood pressure (>140/90 mmHg) and proteinuria (>300 mg/24 hrs), often accompanied by edema. Symptoms of PE start after 20 weeks of gestation. If PE remains untreated, it can lead to eclampsia, grand-mal seizures responsible for most fatalities. PE is believed to affect 2-10% of pregnancies worldwide, and claims the lives of over 75,000 mothers and 500,000 newborns yearly. No therapeutic agents have been developed to prevent or cure PE. Part of the reason for this is the absence of a complete understanding of the pathogenesis of this disease. PE has long been regarded as a “disease of theories”, and the pathophysiology of PE continues to be the subject of debate. Nonetheless, several abnormalities have been observed to precede established, clinical PE and have in turn been proposed to be involved in the causation of this disease, all with involvement of the mother's placenta as a central feature. Removal of placenta is the only cure for PE and results in a rapid resolution of the symptoms. Thus, the placenta remains an organ of substantial interest and many research groups have attempted to identify abnormal placental features occurring in PE. None of these studies have focused on less abundant, low molecular weight (LMW) biomolecules, which play important roles in the pathophysiology of many diseases. There are a number of alterations that are believed to affect the placenta and contribute to the pathogenesis of PE. The most widely accepted ones include hypoxia, oxidative stress, and an increase of pro-inflammatory mediators in the mother's placenta. The goal of my initial study was to identify which of these hypothesized causative pathways has a significance in the etiology of this syndrome as well as to investigate which less abundant, low molecular weight biomolecules change in response to these abnormalities. For this purpose, we first adapted and optimized a previously developed methodology that studied LMW biomolecules in tissue specimens to study placental biomolecules. This approach involved a tissue homogenization step followed by protein depletion using acetonitrile. We compared two regions of human placenta: the chorionic plate and the basal plate to find differences in the LMW fraction. We discovered 16 species with statistically significant differences between the two sides, and identified 12 of them using tandem mass spectrometry. In the second study we collected normal human term placentas from elective C-section deliveries and exposed explants to each of the above-mentioned provocative agents or stress conditions for 48 hrs. Other explants without any stressors were cultured in parallel for the same amount of time. The processing of explants was divided into five steps: 1) explant culture; 2) tissue homogenization; 3) acetonitrile precipitation to remove high abundance, high molecular weight proteins; 4) injection of the protein-depleted specimen into a capillary liquid chromatography–mass spectrometer; 5) analysis of MS data to identify quantitative differences between cases (stressed explants) and controls (normal explants). In total, we observed 146 molecules changed in abundance between the treated explants and the controls with 75 of these molecules changed in response to hypoxic treatment, 23 changed due to hypoxia-reoxygenation, a process generating reactive oxygen species, and 48 changed due to tumor necrosis factor–alpha (TNFα), a pro-inflammatory cytokine. We were successful in identifying 45% of all these molecules by tandem MS. Statistical modeling that applied LASSO analysis allowed for the development of a model that used 16 of the 146 differentially expressed biomolecules to accurately classify and differentiate each of the 4 stressed conditions. In my third study, I then submitted actual preeclamptic and non-diseased placental tissue to our established homogenization and acetonitrile precipitation protocol to see if any of the differences in LMW biomolecules produced under stress conditions in normal placenta were recapitulated in actual diseased placenta. In a preliminary statistical analysis, 8 of the original 146 differentially expressed species, displayed significant or near significant changes in the actual disease placenta. After applying two stringent statistical tests that eliminated any potential influence of gestational age, four out of the 146 biomarkers previously studied, continued to be differentially expressed in both stringent analyses. Of the four, 1 biomarker (m/z 649.49 (+1)) showed an increased abundance in hypoxic placental explants as well as in PE placenta; 2 (461.06 (+1), 476.24 (+1)) were increased in response to TNFα-exposed placental explants and in these PE placentas and 1 (426.35 (+1)) increased in response to hypoxia-reoxygenation-treated placental explants was also increased in PE placenta. We have chemically characterized 2 of the 4 biomarkers. One was a phospholipid (m/z 476.24) while the other was an acyl-carnitine (m/z 426.35). This suggests that features of PE appear to arise from the predicted early abnormalities that affect the placenta. In conclusion, I was successful in developing an ‘omics’ approach to study less abundant, low molecular weight biomolecules in human placenta as well as investigate which biomarkers show differential expression in human placenta when exposed to proposed abnormalities of PE and have data to suggest that these same responses are present in PE placenta.

<p>This study evaluated the use of multi-lead ST-monitoring in the early assessment of patients with suspected or confirmed unstable coronary artery disease (UCAD).</p><p>At continuous 12-lead ECG (c12ECG), the definition of an ischemic episode as a transient ST-deviation ¡Ý0 for at least 1 minute resulted in a good observer agreement (kappa=0.72) and an acceptable incidence of postural ST-changes.</p><p>When c12ECG was performed from admission and for 12 hours in 630 patients with suspected UCAD, 16% had ischemic episodes. At 30 days, patients with episodes had a higher risk of cardiac death or myocardial infarction (MI) (10% vs. 1.5%). In a multivariate analysis, troponin T¡Ý0.10¦Ìg/l and presence of ischemic episodes were independent predictors of cardiac death or MI. When ST-monitoring and troponin T status were combined, patients could be divided into a low-, intermediate-, and high-risk group with 1%, 4% and 12% risk for cardiac death or MI at 30 days of follow up.</p><p>As a part of a multicenter trial, including patients with UCAD, 1016 patients underwent ST-monitoring with c12ECG or continuous vectorcardiography (cVCG). Ischemia was detected in 32% and 35%, respectively. When the groups with ischemia were compared, the groups were similar with respect to several clinical variables. Thus, these methods identify the same high-risk population.</p><p>Of the 629 patients treated non-invasively with extended treatment of low-molecular- weight heparin (LMWH) or placebo, 34% had ischemic episodes. In this group at 3 months, patients administered LMWH had a significantly lower risk of death, MI, or revascularization than patients treated with placebo (35.2% vs. 53.4%). In patients without transient ischemic episodes, the outcome in the LMWH and placebo group was similar.</p><p>Thus, multi-lead monitoring provides important prognostic information early after admission in this population, and seems to identify patients who benefit most from extended antithrombotic treatment.</p>

<p>Three chiral selectors (diketogulonic acid, benzoxycarbonylglycylproline and ketopinic acid) have been introduced for enantioseparation of pharmacologically active amines in non-aqueous capillary electrophoresis. The use of organic solvents, instead of aqueous buffers in the background electrolyte facilitated ion-pair formation between the analytes and the chiral selectors. The enantioresolution was strongly affected by the choice of selector and organic solvent but also depended on the other electrolytes. The most important parameter for the enantioresolution, apart from the choice of chiral selector, was the direction and magnitude of the electro-osmosis. Thus, covalently coated capillaries were used to suppress and to reverse this flow. Furthermore, the alkali metal hydroxide added to the background electrolyte had a great influence on the electro-osmosis. Exchanging LiOH for NaOH, was found to decrease the electro-osmotic flow. Interestingly, the flow was altered from cathodic to anodic, with KOH, RbOH or CsOH added to the ethanolic BGE. The occurrence of a reversed electro-osmosis had a great positive effect on the enantioresolution. An appropriate choice of solvent and electrolytes promoted also fast chiral separations, e.g., the enantiomers of isoprenaline were resolved within one minute. </p><p>The capillary electrophoresis systems developed within this work were applied for enantiomeric purity determinations of different pharmaceutical forms of drug products. A detection limit of 0.033 % was achieved for <i>1S,2R</i>-ephedrine, the enantiomeric impurity in Efedrin®, when diketogulonic acid was used as the selector. </p><p>By using the pre-concentration technique, transient isotachophoresis, the peak efficiency was enhanced for the enantiomers of timolol. This facilitated the introduction of a higher concentration of the sample into the capillary electrophoretic system containing ketopinic acid as the selector, and lowered the detection limit from 2.5 % to 0.2 % for the enantiomeric impurity <i>R</i>-timolol compared with injection without transient isotachophoresis.</p><p>The volatility of the non-aqueous media in capillary electrophoresis facilitated the hyphenation to mass spectrometry. The partial filling technique ensured that the selector did not contaminate the mass spectrometer, and the separated enantiomers of e.g., pronethalol were detected in the selector-free zone. </p>

<p>Intraportal transplantation of isolated islets of Langerhans is a procedure approaching clinical acceptance as a treatment for patients with type I diabetes mellitus. One major problem with this treatment is that large amounts of cells are lost at the time of infusion into the portal vein, resulting in a low level of engraftment of the islets. One likely explanation for this loss is the instant blood-mediated inflammatory reaction (IBMIR), a thrombotic/inflammatory reaction occurring when islets come in contact with blood. The IBMIR is characterized by coagulation and complement activation, leading to platelet consumption, leukocyte infiltration of the islets, and disruption of islet integrity.</p><p>In this thesis, the IBMIR is shown to be triggered by tissue factor (TF), the main initiator of blood coagulation<i> in vivo</i>. TF is expressed in two forms by the endocrine cells of the pancreas, a full-length membrane-bound and an alternatively spliced soluble form. Blocking TF <i>in vitro</i> efficiently reduces the macroscopic clotting, expression of coagulation activation markers, and leukocyte infiltration. This blockade can be achieved by adding either an active site-specific anti-TF antibody or site-inactivated FVIIa that competes with active FVIIa in the blood. TF may be secreted from the islets, since it is colocalized with insulin and glucagon in their granules. The IBMIR has also been demonstrated <i>in vivo</i> in patients transplanted with isolated islets.</p><p>There are two ways to block the IBMIR in transplantation: systemic treatment of the patients, or islet pretreatment before transplantation to reduce their thrombogenicity. In this thesis, low molecular weight dextran sulfate (LMW-DS) is shown to reduce activation of the complement and coagulation systems and decrease the cell infiltration into the islets <i>in vitro</i> and<i> in vivo</i>, in both a xenogenic and an allogenic setting. Based on these results, LMW-DS is now in clinical trials. </p>

Three chiral selectors (diketogulonic acid, benzoxycarbonylglycylproline and ketopinic acid) have been introduced for enantioseparation of pharmacologically active amines in non-aqueous capillary electrophoresis. The use of organic solvents, instead of aqueous buffers in the background electrolyte facilitated ion-pair formation between the analytes and the chiral selectors. The enantioresolution was strongly affected by the choice of selector and organic solvent but also depended on the other electrolytes. The most important parameter for the enantioresolution, apart from the choice of chiral selector, was the direction and magnitude of the electro-osmosis. Thus, covalently coated capillaries were used to suppress and to reverse this flow. Furthermore, the alkali metal hydroxide added to the background electrolyte had a great influence on the electro-osmosis. Exchanging LiOH for NaOH, was found to decrease the electro-osmotic flow. Interestingly, the flow was altered from cathodic to anodic, with KOH, RbOH or CsOH added to the ethanolic BGE. The occurrence of a reversed electro-osmosis had a great positive effect on the enantioresolution. An appropriate choice of solvent and electrolytes promoted also fast chiral separations, e.g., the enantiomers of isoprenaline were resolved within one minute. The capillary electrophoresis systems developed within this work were applied for enantiomeric purity determinations of different pharmaceutical forms of drug products. A detection limit of 0.033 % was achieved for 1S,2R-ephedrine, the enantiomeric impurity in Efedrin®, when diketogulonic acid was used as the selector. By using the pre-concentration technique, transient isotachophoresis, the peak efficiency was enhanced for the enantiomers of timolol. This facilitated the introduction of a higher concentration of the sample into the capillary electrophoretic system containing ketopinic acid as the selector, and lowered the detection limit from 2.5 % to 0.2 % for the enantiomeric impurity R-timolol compared with injection without transient isotachophoresis. The volatility of the non-aqueous media in capillary electrophoresis facilitated the hyphenation to mass spectrometry. The partial filling technique ensured that the selector did not contaminate the mass spectrometer, and the separated enantiomers of e.g., pronethalol were detected in the selector-free zone.

This study evaluated the use of multi-lead ST-monitoring in the early assessment of patients with suspected or confirmed unstable coronary artery disease (UCAD). At continuous 12-lead ECG (c12ECG), the definition of an ischemic episode as a transient ST-deviation ¡Ý0 for at least 1 minute resulted in a good observer agreement (kappa=0.72) and an acceptable incidence of postural ST-changes. When c12ECG was performed from admission and for 12 hours in 630 patients with suspected UCAD, 16% had ischemic episodes. At 30 days, patients with episodes had a higher risk of cardiac death or myocardial infarction (MI) (10% vs. 1.5%). In a multivariate analysis, troponin T¡Ý0.10¦Ìg/l and presence of ischemic episodes were independent predictors of cardiac death or MI. When ST-monitoring and troponin T status were combined, patients could be divided into a low-, intermediate-, and high-risk group with 1%, 4% and 12% risk for cardiac death or MI at 30 days of follow up. As a part of a multicenter trial, including patients with UCAD, 1016 patients underwent ST-monitoring with c12ECG or continuous vectorcardiography (cVCG). Ischemia was detected in 32% and 35%, respectively. When the groups with ischemia were compared, the groups were similar with respect to several clinical variables. Thus, these methods identify the same high-risk population. Of the 629 patients treated non-invasively with extended treatment of low-molecular- weight heparin (LMWH) or placebo, 34% had ischemic episodes. In this group at 3 months, patients administered LMWH had a significantly lower risk of death, MI, or revascularization than patients treated with placebo (35.2% vs. 53.4%). In patients without transient ischemic episodes, the outcome in the LMWH and placebo group was similar. Thus, multi-lead monitoring provides important prognostic information early after admission in this population, and seems to identify patients who benefit most from extended antithrombotic treatment.

Intraportal transplantation of isolated islets of Langerhans is a procedure approaching clinical acceptance as a treatment for patients with type I diabetes mellitus. One major problem with this treatment is that large amounts of cells are lost at the time of infusion into the portal vein, resulting in a low level of engraftment of the islets. One likely explanation for this loss is the instant blood-mediated inflammatory reaction (IBMIR), a thrombotic/inflammatory reaction occurring when islets come in contact with blood. The IBMIR is characterized by coagulation and complement activation, leading to platelet consumption, leukocyte infiltration of the islets, and disruption of islet integrity. In this thesis, the IBMIR is shown to be triggered by tissue factor (TF), the main initiator of blood coagulation in vivo. TF is expressed in two forms by the endocrine cells of the pancreas, a full-length membrane-bound and an alternatively spliced soluble form. Blocking TF in vitro efficiently reduces the macroscopic clotting, expression of coagulation activation markers, and leukocyte infiltration. This blockade can be achieved by adding either an active site-specific anti-TF antibody or site-inactivated FVIIa that competes with active FVIIa in the blood. TF may be secreted from the islets, since it is colocalized with insulin and glucagon in their granules. The IBMIR has also been demonstrated in vivo in patients transplanted with isolated islets. There are two ways to block the IBMIR in transplantation: systemic treatment of the patients, or islet pretreatment before transplantation to reduce their thrombogenicity. In this thesis, low molecular weight dextran sulfate (LMW-DS) is shown to reduce activation of the complement and coagulation systems and decrease the cell infiltration into the islets in vitro and in vivo, in both a xenogenic and an allogenic setting. Based on these results, LMW-DS is now in clinical trials.