In the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. The authors describe a 65-year-old woman with dependence on topiramate prescribed for chronic LBP and discuss how she was successfully weaned off topiramate using duloxetine. A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephrine (NE) release, a known effect of duloxetine administration.

Balding causes widespread psychological distress but is poorly controlled. The commonest treatment, minoxidil, was originally an antihypertensive drug that promoted unwanted hair. We hypothesized that another serendipitous discovery, increased eyelash growth side-effects of prostamide F(2alpha)-related eyedrops for glaucoma, may be relevant for scalp alopecias. Eyelash hairs and follicles are highly specialized and remain unaffected by androgens that inhibit scalp follicles and stimulate many others. Therefore, we investigated whether non-eyelash follicles could respond to bimatoprost, a prostamide F(2alpha) analog recently licensed for eyelash hypotrichosis. Bimatoprost, at pharmacologically selective concentrations, increased hair synthesis in scalp follicle organ culture and advanced mouse pelage hair regrowth in vivo compared to vehicle alone. A prostamide receptor antagonist blocked isolated follicle growth, confirming a direct, receptor-mediated mechanism within follicles; RT-PCR analysis identified 3 relevant receptor genes in scalp follicles in vivo. Receptors were located in the key follicle regulator, the dermal papilla, by analyzing individual follicular structures and immunohistochemistry. Thus, bimatoprost stimulates human scalp follicles in culture and rodent pelage follicles in vivo, mirroring eyelash behavior, and scalp follicles contain bimatoprost-sensitive prostamide receptors in vivo. This highlights a new follicular signaling system and confirms that bimatoprost offers a novel, low-risk therapeutic approach for scalp alopecias.

INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma \"epidemia\" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009, 34,5% abandonaram o tabagismo. Dentre eles, 21,5% obtiveram êxito até o quarto contato com o ambulatório. O uso de vareniclina e terapia de reposição de nicotina (TRN) aumentaram a probabilidade de sucesso (RRR= 2,73 e 2,78, respectivamente; p < 0,001 para ambas). Quanto maior o número de reuniões frequentadas no ambulatório, maior a probabilidade de sucesso terapêutico (p < 0,001). A análise da dosagem da cotinina urinária mostrou concentrações de cotinina urinária 18,7 vezes maior no grupo de tabagistas ativos comparados aos tabagistas passivos. CONCLUSÃO: O sucesso do ambulatório antitabágico do HU manteve-se em acordo com grande parte dos índices de sucesso terapêutico presentes na literatura médica. O abandono do hábito de fumar foi fortemente associado ao número de contatos dos fumantes com o grupo e a terapêutica medicamentosa. A cotinina urinária mostrou-se um bom marcador do tabagismo ativo / INTRODUCTION: Smoking is recognized today as one of the major health problems worldwide. There is a global \"epidemic\" of tobacco use in developing countries in the 21st Century. OBJECTIVES: Analyze: the general characteristics of individuals spontaneously enrolled in an outpatient smoking cessation clinic; the overall effectiveness of the smoking cessation treatment and medication; the changes in the characteristics of participants before and after the Smoke-Free Environment Act in São Paulo and the levels of urinary cotinine in active and passive smokers and controls. CASES AND METHODS: A historical cohort study was conducted, of which the inclusion criterion was the registration in the outpatient smoking cessation Clinic in the HU USP, in the period from 2004 to 2011. Data were collected by consultation of standardized protocols and of the computerized service system. The results of cotinine and creatinine measurements performed on biological samples were analyzed. RESULTS: Among the 1736 patients treated, there was a predominance of women (62.1%), whites (75.3%) and individuals aged between 41 and 60 years (63.1%). Approximately 80% began smoking before age 20 and 75% showed moderate to severe degree of dependence. Among the 620 individuals monitored from 2009 on, 34.5% quit smoking. Among them, 21.5% obtained success up to the fourth contact with the clinic. The use of varenicline and nicotine replacement therapy (NRT) increased the probability of success (RRR= 2.73 and 2.78, respectively; p < 0.001 for both). The greater the number of meetings attended at the clinic, greater the probability of treatment success (p < 0.001). The analysis of urinary cotinine dosage showed urinary cotinine concentrations 18.7 times higher in the active smokers group, compared to the passive smokers group. CONCLUSION: The success of the smoking cessation clinic in the HU remained largely in accordance with most therapeutic success rates found in medical literature. Quitting smoking was strongly associated to the number of contacts of the smokers with the group and drug therapy. Urinary cotinine proved to be an accurate marker for active smoking

Objetivo: Avaliar a segurança e eficácia da injeção transesfincteriana de silicone para o tratamento da incontinência anal, assim como correlacionar os resultados clínicos, ultra-sonográficos e manométricos. Métodos: Pacientes incontinentes foram submetidos à manometria e ultra-sonografia anorretal, índice de incontinência (II) e instrumento de qualidade de vida (FIQL), antes e após injeção do silicone (PTQ) sob anestesia local e profilaxia antibiótica. Os critérios de inclusão foram: incontinência anal, lesão isolada ou múltipla do músculo esfíncter interno do ânus, associada ou não à lesão isolada, em um quadrante, do músculo esfíncter externo do ânus. O instrumento FIQL utilizado inclui quatro domínios: estilo de vida, comportamento,depressão e constrangimento.Os parâmetros da manometria foram: pressão média de repouso (PMR), pressão média (PMCV) e máxima (PmaxCV) de contração voluntária, zona de alta pressão (ZAP) e índice de assimetria (IA). Após três meses de tratamento, os pacientes foram reavaliados através do II, FIQL, manometria e ultra-sonografia anorretal. Um grupo controle composto por 10 homens e 10 mulheres continentes e sem história prévia de cirurgia anorretal foi submetido à manometria após consentimento informado. Resultados: Foram estudados 35 pacientes, 28 mulheres e sete homens com idade média de 60,3 (19-80) anos, antes e após injeção do silicone anal. As complicações observadas incluíram dois hematomas (5,7%), um abscesso anal (2,8%), dor anal em dois pacientes (5,7%) e dificuldade evacuatória em um paciente (2,8%). Notou-se uma melhora do índice médio de incontinência de 11,3 para 4,3 (p < 0,001). Houve melhora de todos os domínios estudados no instumento FIQL (p<0,0001). Pacientes incontinentes apresentaram hipotonia esfincteriana quando comparados aos controles (p < 0,05). As pressões esfincterianas antes e após injeção foram respectivamente: PMR (29,4 mmHg x 35,1 mmHg; p = 0,07), PMCV (68,6 mmHg x 75,9 mmHg; p = 0,20) e PmaxCV (102,2 mmHg x 127,0 mmHg; p = 0,11). Houve aumento médio da ZAP de 1,0 para 1,7 cm (p = 0,002) Em relação aos resultados da manometria: o IA aos 3 e 2 cm apresentou redução significativa após injeção do silicone (p < 0.05 e 0,002). A ultra-sonografia de canal anal demonstrou a presença do silicone nos sítios de injeção em todos os pacientes. Conclusão: Em casos selecionados, a injeção transesfincteriana de silicone é um método seguro e proporciona uma melhora do quadro de incontinência anal, observada pela mudança significativa dos parâmetros de qualidade de vida e índice de incontinência. O provável mecanismo de ação pelo qual o agente estudado melhora o quadro de incontinência parece relacionar-se à correção da assimetria esfincteriana e aumento do comprimento da zona de alta pressão. / Aim: To evaluate safety and efficacy of trans-sphincteric silicone injection for the treatment of anal incontinence and to assess correlation between clinical and physiological results. Methods: Incontinent patients prospectively selected by clinical and physiological evaluation underwent trans-sphincteric silicone injection (PTQ) under local anesthesia. Eight channel manometry with asymmetry index and anal ultrasound were performed before and after injections. Incontinence scale (IS) and quality of life instrument (FIQL scale) were applied before and after injection.Inclusion criteria were: anal incontinence, isolated or multiple injury of the internal anal sphincter associated or not to small, restricted, external anal sphincter defect. FIQL scale included four domains: life-style, behavior, depression and embarrassment. Manometry evaluation included mean resting pressure (MRP), mean squeeze pressure (MSP), maximal squeeze pressure (MaxSP), high-pressure zone (HPZ) and asymmetry index (AI). After 3 months of treatment the patients had been reevaluated through the IS, FIQL scale, manometry and ultrasound. A controlled group of 20 healthy volunteers (10 men and 10 women) underwent anal manometry. Results: 35 patients (28 women and seven men) with a mean age of 60.3 (19-80) years were evaluated. Complications observed were two anal hematomas (5,7%), one perianal abscess (2.8%), two patients complained of anal pain (5,7%) and one patient required assistance for defecation (2,8%). Mean incontinence score improved significantly after injection: 11, 3 to 4,3 (p < 0.001). Significant improvement in the FIQL scale was noticed in all domains (p < 0.0001). Incontinent patients had significantly lower anal pressures when compared to controls (p < 0.05). Manometric pressures before and after injection did not change: MRP (29,4 mmHg x 35,1 mmHg; p = 0.07), MSP (68,6 mmHg x 75,9 mmHg; p = 0.20) e MaxSP (102.2 mmHg x 127.0 mmHg; p = 0.11) The HPZ changed from 1 to 1,7 cm after injection (p = 0.002) AI at 3 and 2 cm showed a significantly change (p < 0.05 and p = 0.001, respectively). Ultrasound images demonstrated the presence of silicone in all sites of injection. Conclusion: In selected cases, trans-sphincteric silicone injection is an effective treatment for anal incontinence, as significant changes in quality of life and incontinence scales can be observed. The mechanism of action for which the studied agent improves anal incontinence seems to be related to improvement in the asymmetry index as well as a change in the HPZ.

Neste estudo, testamos a hipótese de que a estimulação colnérgica pela administração de piridostigmina, um agente anticolinesterásico reversível, protege o miocárdio submetido à isquemia miocárdica crônica durante 3 tempos de observação: 7, 21 e 42 dias. Para essa avaliação foram medidos a área de acinesia (índicador de área de infarto), os índíces das funções sistólica e diastólica pela ecocardiografia e por medida direta bem como marcadores da função autonômica como a sensibilidade do barorreflexo e a variabilidade da frequência cardíaca (FC) e da pressão arterial (PA). O bloqueio farmacológico do sistema nervoso autônomo e o estudo da via eferente parassimpática foram também realizados. Utilizou-se ratos Wistar machos divididos em 4 grupos: controle, controle piridostigmina, infartado e infartado piridostigmina. Os resultados mostraram os efeitos protetores da piridostigmina nos diferentes tempo de infarto com redução da área de acinesia ( maior que 80%) tanto pelo ecocardiograma quanto pela histologia. Além disso observou-se recuperação das funções sistólica e diastólica, com normalização da pressão diastólica final e das derivadas de contração e relaxamento. Essas melhoras foram mais consistentes em 21 e 42 dias, sem diferenças entre esses tempos de tratamento. Em 7 dias ainda persistiram alguns índices de disfunção ventricular, embora a função autonômica estivesse bem preservada. Parte dessa melhora se deve, provavelmente, ao aumento do tônus vagal e redução do simpático. A potenciação da bradicardia pela estimulação elétrica do vago induzida pela piridostigmina confirma seu papel com estimulador colinérgico. A sensibilidade do barorreflexo reduzida de forma semelhante pelo infarto do miocárdio aos 7, 21 e 42 dias, voltou aos valores controle após o tratamento com piridostigmina, sem diferenças devidas ao tempo de tratamento. Da mesma forma, a variabilidade da FC foi aumentada após o tratamento com o brometo de piridostigmina no grupo infartado o que também ocorreu no grupo controle. Em adição, o aumento da banda de alta frequência e a redução da banda de baixa frequência que refletem respectivamente a modulação parassimpática e simpática da variabilidade da frequência cardíaca, levaram a uma redução no balanço simpato-vagal dos animais infartados tratados. Em conclusão, a estimulação colinérgica por piridostigmina preserva a função parassimpática protegendo o miocárdio da isquemia induzida por oclusão coronariana, mantendo a função cardíaca e a função autonômica dentro dos valores da normalidade / In this study we tested the hypothesis that cholinergic stimulation by pyridostigmine administration, a reversible cholinergic inhibitor, protects the ischemic myocardial in three periods of follow-up: 7, 21 and 42 days. For this evaluation we measured the akinetic area (infacrtion area indicator), systolic and diastolic indexes by echocardiography and left ventricle direct measurements as well as autonomic function markers, as baroreflex sensitivity and heart rate (HR) and blood pressure (BP) variabilities. Pharmacological blockade of the autonomic nervous system and the study of the efferent parasympathetic pathway were also performed. Male Wistar rats were divided in 4 groups: control, control treated with pyridostigmine, infarcted and infarcted treated with pyridostigmine. The results showed the protective effects of pyridostigmine in the different periods of infarction, with the reduction of the akinetic area (more than 80%), either by the echocardiography and by histology. Moreover, we observed systolic and diastolic functions recovery, with normalization of the end diastolic pressure and the maximum rates of left ventricle BP rise and fall. These improvements were more consistent in 21 and 42 days, with no differences between these two periods of treatment. In 7-day treatment, some indexes of ventricular dysfunction remained, although the autonomic function seemed to be preserved. Part of these improvements is probably due to the increase in the vagal tonus and the decrease in the sympathetic tonus. The pyridostigmine effects in the potencialization of the bradycardia induced by vagus nerve electrical stimulation confirms its role as a cholinergic stimulator. The reduced baroreflex sensitivity by myocardial infarction, which was similar in 7, 21 and 42 days, returned to control values after pyridostigmine treatment, without differences related to treatment extent. Similarly, HR variability was increased after pyridostigmine treatment in the infarcted group, which also occurred in the control group. In addition, the increase in the high frequency band and the reduction in the low frequency band, which reflect, respectively, the parasympathetic and the sympathetic modulation of HR variability, led to the diminishment in the sympatho-vagal balance in the infarcted-treated animals. In conclusion, cholinergic stimulation by pyridostigmine preserves parasympathetic function, protecting the myocardial against the ischemia induced by coronary occlusion, maintaning cardiac and autonomic functions within normal values

INTRODUÇÃO: A vacina contra o vírus da hepatite B é recomendada a todos os pacientes cirróticos, por outra etiologia, em lista de espera para transplante de fígado. Entretanto, a resposta vacinal descrita nesta população é inferior à da população de adultos imunocompetentes. Estratégias para aumentar sua imunogenicidade são discutidas na literatura, como a aplicação de doses dobradas, recomendada a populações de imunodeprimidos. Neste estudo, foi comparada a resposta à vacina contra o vírus da hepatite B de um esquema com doses simples a um com doses dobradas, e avaliada a influência de outros fatores associados à resposta vacinal no cirrótico em lista de espera para transplante de fígado. MÉTODO: Desenvolveu-se um estudo clínico, prospectivo, randomizado, entre outubro de 2006 e setembro de 2008. Adotando-se intervalo de confiança de 95% e poder de 80%, o cálculo da amostra resultou em 103 pacientes em cada grupo. Estimou-se uma perda de 10%, resultando em 113 pacientes a receber o esquema 0, 1, 2 e 6 meses com dose simples, e 113 a receber esquema semelhante com dose dobrada. As vacinas utilizadas foram Euvax e Butang. A imunogenicidade da vacina foi avaliada através da dosagem do anti-HBs após a terceira e a quarta dose da vacina. RESULTADO: Foram selecionados 738 pacientes inscritos em lista de espera para transplante de fígado, e incluídos 232. Na análise de resposta vacinal após a terceira dose, não houve diferença estatisticamente significativa entre os grupos que receberam dose simples ou dobrada (35,2% x 37,2%, p = 0,8). A soroconversão global após a quarta dose foi 66,9% (85/127). Também não houve diferença entre o grupo com dose simples e dobrada após a quarta dose (64,5% x 69,2%, p = 0,57), mas ao desenvolver a análise com ajuste para alguns fatores de confusão como idade, IMC, MELD e grupo sanguíneo, encontrou-se uma razão de probabilidade de soroconversão entre os pacientes que receberam a dose dobrada de 2,57 vezes a razão entre os pacientes que receberam a dose simples. Esta diferença foi estatisticamente significante, mas o intervalo de confiança incluiu 1 (OR=2,57, IC 95%=1 até 6,63, p=0,043). Fatores como idade, IMC e grupo sanguíneo O foram preditivos de resposta vacinal após a quarta dose da vacina. CONCLUSÃO: Não houve diferença na resposta vacinal entre dose simples e dobrada no cirrótico após esquema proposto. A má resposta após o esquema acelerado (0,1 e 2 meses) não contribui para que este esquema seja adotado na prática clínica. Provavelmente, o número de doses e o intervalo entre elas têm maior relevância, em relação a dose simples ou dobrada, como estratégia para aumentar a resposta vacinal. / BACKGROUND: Vaccine against hepatitis B is recommended for all cirrhotic patients, by another etiology, in waiting list for liver transplantation. However the vaccine response described in this population is lower than in immunocompetent adults. Strategies to increase its immunogenicity are discussed in the literature, as the application of double doses, usually recommended in immunocompromised populations. This study compared response to the vaccine against hepatitis B virus in a single dose regimen with a double dose regimen, and evaluated the influence of other features associated with vaccine response in cirrhotic on the waiting list for liver transplantation. METHOD: A prospective and randomized clinical trial was conducted between October 2006 and September 2008. Adopting confidence interval of 95% and a power of 80%, calculated sample comprised 103 patients in each group. Considering an estimated mortality of 10%, final calculated sample resulted in 113 patients to receive the scheme 0, 1, 2 and 6 months with a single dose, and 113 to receive a similar scheme with double doses. Vaccines used were Euvax and Butang. Vaccine immunogenicity was assessed measuring anti-HBs after the third and fourth dose of vaccine. RESULT: We selected 738 patients in waiting list for liver transplantation and included 232. There was no statistically significant difference between the groups that received single or double doses in the analysis of vaccine response after the third dose (35.2% vs. 37.2%, p = 0,8). Overall seroconversion after the fourth dose was 66.9% (85/127). There was no difference between the groups with double and single dose after the fourth dose (64.5% vs. 69.2%, p = 0,57), but analysis adjusted for some confounding factors such as age , BMI, MELD and blood group, found odds of seroconversion among patients who received double doses 2.57 times that of patients who received single doses. This difference was statistically significant, but confidence interval included 1 (OR = 2.57, 95% CI = 1 to 6.63, p = 0.043). Features as age, BMI and blood group were predictors of vaccine response after the fourth dose of vaccine. CONCLUSION: There was no difference in vaccine response between single and double doses in cirrhotic patients after the proposed scheme. The poor response after accelerated schedule (0.1 and 2 months) does not contribute to adopting this scheme in clinical practice. Number of doses and interval between them may be more important to vaccine response than single or double doses.

Chan, Ka Man Carmen. / "October 2009." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 160-165). / Abstracts in English and Chinese. / Table of Contents --- p.I / Acknowledgements --- p.IV / Abstract --- p.V / Abstract (Chinese version) --- p.VIII / List of Figures --- p.X / List of Tables --- p.XVIII / Chapter Chapter One. --- Introduction / Chapter 1.1 --- Pulmonary drug delivery --- p.1 / Chapter 1.2 --- Inhalation drug delivery systems --- p.4 / Chapter 1.3 --- Dry powder inhalation aerosols --- p.5 / Chapter 1.3.1 --- Principle of operation of DPIs --- p.5 / Chapter 1.3.2 --- Aerodynamic diameter --- p.6 / Chapter 1.3.2.1 --- Fine particle fraction --- p.8 / Chapter 1.3.3 --- Dispersibility --- p.8 / Chapter 1.3.4 --- Factors that affect dispersibility --- p.9 / Chapter 1.3.4.1 --- Particle Size --- p.9 / Chapter 1.3.4.2 --- Particle Density and Morphology --- p.10 / Chapter 1.3.4.3 --- Interparticulate interactions一Cohesion and adhesion --- p.11 / Chapter 1.3.4.3.1 --- Surface energetics --- p.11 / Chapter 1.3.4.3.2 --- Effect of hygroscopicity and electrostatic charges --- p.12 / Chapter 1.4 --- Particle formation techniques for DPI formulation --- p.14 / Chapter 1.4.1 --- Spray-drying --- p.14 / Chapter 1.4.2 --- Surface modification --- p.16 / Chapter 1.5 --- Physical characterization --- p.17 / Chapter 1.5.1 --- Laser diffraction --- p.17 / Chapter 1.5.2 --- X-ray powder diffraction --- p.18 / Chapter 1.5.3 --- Thermal analysis --- p.19 / Chapter 1.5.4 --- Particle morphology and surface area --- p.20 / Chapter 1.5.5 --- In vitro aerosol performance --- p.21 / Chapter 1.6 --- Surface characterization --- p.21 / Chapter 1.6.1 --- X-ray photoelectric spectroscopy (XPS) --- p.21 / Chapter 1.6.2 --- Inverse gas chromatography --- p.22 / Chapter 1.7 --- Atomic force microscopy in pharmaceutical science --- p.23 / Chapter 1.7.1 --- Principle of operation --- p.24 / Chapter 1.7.1.1 --- Tapping mode --- p.27 / Chapter 1.7.1.2 --- Contact mode --- p.27 / Chapter 1.8 --- Scope of thesis --- p.29 / Chapter Chapter Two. --- Materials and Methods / Chapter 2.1 --- Materials --- p.32 / Chapter 2.2 --- Methods --- p.32 / Chapter 2.2.1 --- Optimization of spray-drying parameters --- p.32 / Chapter 2.2.2 --- Preparation of spray-dried salbutamol sulphate powders containing different concentrations of amino acid additive --- p.33 / Chapter 2.2.3 --- Physical characterization of spray-dried powders --- p.34 / Chapter 2.2.3.1 --- Particle size and size distribution --- p.34 / Chapter 2.2.3.2 --- Specific surface area --- p.35 / Chapter 2.2.3.3 --- X-ray powder diffraction --- p.35 / Chapter 2.2.3.4. --- Scanning electron microscopy --- p.36 / Chapter 2.2.3.5. --- Thermal analysis --- p.36 / Chapter 2.2.3.5.1 --- Thermogravimetric analysis (TGA) --- p.36 / Chapter 2.2.3.5.2 --- Differential scanning calorimetry (DSC) --- p.36 / Chapter 2.2.3.6 --- Water vapour sorption isotherm --- p.37 / Chapter 2.2.3.7 --- Density measurements --- p.37 / Chapter 2.2.3.8 --- In vitro particle deposition (MSLI) --- p.38 / Chapter 2.2.4 --- Surface characterization of the spray-dried powders --- p.39 / Chapter 2.2.4.1 --- X-ray photoelectric spectroscopy (XPS) --- p.39 / Chapter 2.2.4.2 --- Surface energy measurement by inverse gas chromatography (IGC) --- p.40 / Chapter 2.2.4.2.1 --- Calculation of standard free energy of adsorption --- p.41 / Chapter 2.2.4.2.2 --- Dispersive component of surface free energy and related thermodynamic parameters --- p.42 / Chapter 2.2.4.2.3 --- Specific interactions and associated acid-base properties --- p.43 / Chapter 2.2.5. --- Atomic Force Microscopy (AFM) --- p.43 / Chapter 2.2.5.1. --- Imaging --- p.43 / Chapter 2.2.5.2. --- Force measurements --- p.44 / Chapter 2.2.5.2.1 --- Adhesion force measurements --- p.44 / Chapter 2.2.5.2.2 --- Force curve data conversions --- p.44 / Chapter Chapter Three. --- "Optimal Spray-drying Conditions, Physical Characterization and Aerosol Performance of Additive-modified Spray-dried Salbutamol Sulphate particles" / Chapter 3.1 --- Optimization of spray-drying conditions --- p.46 / Chapter 3.2 --- Effect of phenylalanine on the spray-dried SS particles --- p.52 / Chapter 3.2.1. --- Phenylalanine as the additive --- p.52 / Chapter 3.2.1.1 --- In vitro aerosol performance --- p.53 / Chapter 3.2.1.2 --- Particle morphology --- p.55 / Chapter 3.2.1.3 --- Crystallinity --- p.62 / Chapter 3.2.1.4 --- Particle size distribution and specific surface area --- p.63 / Chapter 3.2.1.5 --- Density --- p.65 / Chapter 3.2.1.6 --- Thermal analysis --- p.66 / Chapter 3.2.1.7 --- Water vapour isotherm --- p.70 / Chapter 3.3 --- Effect of leucine on the spray-dried SS particles --- p.77 / Chapter 3.3.1. --- L-Leucine as the additive --- p.77 / Chapter 3.3.1.1 --- In vitro aerosol performance --- p.78 / Chapter 3.3.1.2 --- Particle morphology --- p.80 / Chapter 3.3.1.3 --- Crystallinity --- p.86 / Chapter 3.3.1.4 --- Particle size distribution and specific surface area --- p.87 / Chapter 3.3.1.5 --- Density --- p.90 / Chapter 3.3.1.6 --- Thermal analysis --- p.92 / Chapter 3.3.1.7 --- Water vapour isotherm --- p.95 / Chapter Chapter Four. --- Surface Characterization of Additive-modified Spray-dried Salbutamol Sulphate Particles / Chapter 4.1 --- X-ray photoelectric spectroscopy --- p.103 / Chapter 4.1.1 --- Phenylalanine --- p.103 / Chapter 4.1.2 --- Leucine --- p.104 / Chapter 4.2 --- Inverse gas chromatography --- p.105 / Chapter 4.2.1 --- Phenylalanine --- p.105 / Chapter 4.2.2 --- Leucine --- p.107 / Chapter 4.3 --- Atomic force microscopy --- p.109 / Chapter 4.3.1 --- Surface topography --- p.109 / Chapter 4.3.2 --- Adhesive force measurements --- p.118 / Chapter Chapter Five. --- Conclusions and Suggestions for Future Works / Chapter 5.1 --- Conclusions --- p.139 / Chapter 5.1.1 --- Physical properties --- p.139 / Chapter 5.1.2 --- Surface characteristics and aerosol performance --- p.140 / Chapter 5.2 --- Future studies --- p.142 / Appendix --- p.143 / References --- p.160

INTRODUÇÃO: A vacina contra o vírus da hepatite B é recomendada a todos os pacientes cirróticos, por outra etiologia, em lista de espera para transplante de fígado. Entretanto, a resposta vacinal descrita nesta população é inferior à da população de adultos imunocompetentes. Estratégias para aumentar sua imunogenicidade são discutidas na literatura, como a aplicação de doses dobradas, recomendada a populações de imunodeprimidos. Neste estudo, foi comparada a resposta à vacina contra o vírus da hepatite B de um esquema com doses simples a um com doses dobradas, e avaliada a influência de outros fatores associados à resposta vacinal no cirrótico em lista de espera para transplante de fígado. MÉTODO: Desenvolveu-se um estudo clínico, prospectivo, randomizado, entre outubro de 2006 e setembro de 2008. Adotando-se intervalo de confiança de 95% e poder de 80%, o cálculo da amostra resultou em 103 pacientes em cada grupo. Estimou-se uma perda de 10%, resultando em 113 pacientes a receber o esquema 0, 1, 2 e 6 meses com dose simples, e 113 a receber esquema semelhante com dose dobrada. As vacinas utilizadas foram Euvax e Butang. A imunogenicidade da vacina foi avaliada através da dosagem do anti-HBs após a terceira e a quarta dose da vacina. RESULTADO: Foram selecionados 738 pacientes inscritos em lista de espera para transplante de fígado, e incluídos 232. Na análise de resposta vacinal após a terceira dose, não houve diferença estatisticamente significativa entre os grupos que receberam dose simples ou dobrada (35,2% x 37,2%, p = 0,8). A soroconversão global após a quarta dose foi 66,9% (85/127). Também não houve diferença entre o grupo com dose simples e dobrada após a quarta dose (64,5% x 69,2%, p = 0,57), mas ao desenvolver a análise com ajuste para alguns fatores de confusão como idade, IMC, MELD e grupo sanguíneo, encontrou-se uma razão de probabilidade de soroconversão entre os pacientes que receberam a dose dobrada de 2,57 vezes a razão entre os pacientes que receberam a dose simples. Esta diferença foi estatisticamente significante, mas o intervalo de confiança incluiu 1 (OR=2,57, IC 95%=1 até 6,63, p=0,043). Fatores como idade, IMC e grupo sanguíneo O foram preditivos de resposta vacinal após a quarta dose da vacina. CONCLUSÃO: Não houve diferença na resposta vacinal entre dose simples e dobrada no cirrótico após esquema proposto. A má resposta após o esquema acelerado (0,1 e 2 meses) não contribui para que este esquema seja adotado na prática clínica. Provavelmente, o número de doses e o intervalo entre elas têm maior relevância, em relação a dose simples ou dobrada, como estratégia para aumentar a resposta vacinal. / BACKGROUND: Vaccine against hepatitis B is recommended for all cirrhotic patients, by another etiology, in waiting list for liver transplantation. However the vaccine response described in this population is lower than in immunocompetent adults. Strategies to increase its immunogenicity are discussed in the literature, as the application of double doses, usually recommended in immunocompromised populations. This study compared response to the vaccine against hepatitis B virus in a single dose regimen with a double dose regimen, and evaluated the influence of other features associated with vaccine response in cirrhotic on the waiting list for liver transplantation. METHOD: A prospective and randomized clinical trial was conducted between October 2006 and September 2008. Adopting confidence interval of 95% and a power of 80%, calculated sample comprised 103 patients in each group. Considering an estimated mortality of 10%, final calculated sample resulted in 113 patients to receive the scheme 0, 1, 2 and 6 months with a single dose, and 113 to receive a similar scheme with double doses. Vaccines used were Euvax and Butang. Vaccine immunogenicity was assessed measuring anti-HBs after the third and fourth dose of vaccine. RESULT: We selected 738 patients in waiting list for liver transplantation and included 232. There was no statistically significant difference between the groups that received single or double doses in the analysis of vaccine response after the third dose (35.2% vs. 37.2%, p = 0,8). Overall seroconversion after the fourth dose was 66.9% (85/127). There was no difference between the groups with double and single dose after the fourth dose (64.5% vs. 69.2%, p = 0,57), but analysis adjusted for some confounding factors such as age , BMI, MELD and blood group, found odds of seroconversion among patients who received double doses 2.57 times that of patients who received single doses. This difference was statistically significant, but confidence interval included 1 (OR = 2.57, 95% CI = 1 to 6.63, p = 0.043). Features as age, BMI and blood group were predictors of vaccine response after the fourth dose of vaccine. CONCLUSION: There was no difference in vaccine response between single and double doses in cirrhotic patients after the proposed scheme. The poor response after accelerated schedule (0.1 and 2 months) does not contribute to adopting this scheme in clinical practice. Number of doses and interval between them may be more important to vaccine response than single or double doses.

Chan, Pui. / "November, 2009." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 108-114). / Abstracts in English and Chinese. / Table of Contents --- p.i / Acknowledgement --- p.vi / Abstract --- p.vii / Abstract (Chinese) --- p.ix / Chapter Chapter One --- Introduction / Chapter 1.1. --- Pulmonary Route for Drug Delivery --- p.2 / Chapter 1.2. --- Factors Affecting the Performance of Inhaled Formulations --- p.3 / Chapter 1.2.1. --- Particle Aerodynamic Diameter --- p.4 / Chapter 1.2.2. --- Dispersibility of Particles --- p.5 / Chapter 1.2.3. --- Clearance Mechanism in Lung and Dissolution of Particles --- p.6 / Chapter 1.3. --- Production of Dry Powder Inhalation by Spray Drying --- p.7 / Chapter 1.4. --- Approaches to Enhance Aerosol Performance of Spray Dried Particles --- p.8 / Chapter 1.4.1 --- Porous/Hollow Particles --- p.9 / Chapter 1.4.2 --- Non-Porous Corrugated Particles --- p.10 / Chapter 1.4.3 --- Blends and Ternary Systems --- p.10 / Chapter 1.4.4 --- Surface Energy and Crystallinity Modification --- p.11 / Chapter 1.4.5 --- Other Approaches to Enhancing Aerosol Performance --- p.12 / Chapter 1.5 --- Objectives and Rationale of the Present Study --- p.13 / Chapter 1.6 --- Scope of Present Study and Particle Characterization Techniques Employed --- p.14 / Chapter 1.6.1 --- Microscopy and Particle Density Measurements --- p.14 / Chapter 1.6.2 --- Particle Size Analysis and Particle Dispersibility --- p.15 / Chapter 1.6.3 --- Thermal Analysis and Particle Crystallinity --- p.15 / Chapter 1.6.4 --- Particle Surface Characterization --- p.16 / Chapter 1.6.5 --- Inverse Gas Chromatography --- p.18 / Chapter 1.6.6 --- Fractal Analysis --- p.19 / Chapter 1.6.6.1 --- Background and Origin of Fractal Analysis --- p.19 / Chapter 1.6.6.2 --- Use of Fractal Analysis in Pharmaceutical Research --- p.20 / Chapter 1.6.6.3 --- Methods for fractal analysis --- p.21 / Chapter 1.6.7 --- Atomic Force Microscopy --- p.23 / Chapter 1.6.7.1 --- Background of Atomic Force Microscopy --- p.23 / Chapter 1.6.7.2 --- Characterization of Surface Topography by Atomic Force Microscopy --- p.23 / Chapter 1.6.7.3 --- Measurement of Interaction Forces by Colloid Probe 226}0Ø Microscopy --- p.25 / Chapter 1.6.7.4 --- Use of Atomic Force Microscopy in Pharmaceutical Research --- p.27 / Chapter Chapter Two --- Materials and Methods / Chapter 2.1. --- Materials --- p.30 / Chapter 2.2. --- Equipment --- p.31 / Chapter 2.3. --- Methods --- p.33 / Chapter 2.3.1. --- Powder Preparation --- p.33 / Chapter 2.3.1.1 --- Preparation of Salbutamol Sulphate Samples --- p.33 / Chapter 2.3.1.2 --- Preparation of Disodium Cromoglycate Samples --- p.33 / Chapter 2.3.1.3 --- Preparation of ß-Galactosidase (BG) Samples --- p.34 / Chapter 2.3.2. --- Determination of Aerosol Performance --- p.35 / Chapter 2.3.3. --- Determination of Protein Activity for BG Samples --- p.36 / Chapter 2.3.3.1. --- Enzyme Assay Procedure --- p.37 / Chapter 2.3.3.2. --- Calculation of Enzyme Activity --- p.38 / Chapter 2.3.3.3. --- Determination of Enzyme Activity Retained in Spray-dried Samples --- p.38 / Chapter 2.3.4. --- Physicochemical Characterization of Particles --- p.39 / Chapter 2.3.4.1. --- Scanning Electron Microscopy --- p.39 / Chapter 2.3.4.2. --- Particle Density Determination --- p.39 / Chapter 2.3.4.3. --- Particle Size Analysis --- p.40 / Chapter 2.3.4.4. --- Thermal analysis --- p.41 / Chapter 2.3.4.5. --- Powder X-ray Diffraction --- p.42 / Chapter 2.3.4.6. --- Surface Area Determination --- p.42 / Chapter 2.3.4.7. --- Surface Composition Characterization --- p.43 / Chapter 2.3.4.8. --- Surface Tension Measurement --- p.44 / Chapter 2.3.4.9. --- Inverse Gas Chromatography --- p.45 / Chapter 2.3.4.9.1. --- Calculation of Standard Free Energy of Adsorption --- p.46 / Chapter 2.3.4.9.2. --- Calculation of Dispersive Component of Surface Free Energy --- p.47 / Chapter 2.3.4.9.3. --- Determination of Specific Interactions and Associated Acid-Base Properties --- p.48 / Chapter 2.3.4.10. --- Fractal Analysis --- p.49 / Chapter 2.3.4.11. --- Atomic Force Microscopy --- p.49 / Chapter Chapter Three --- Results / Chapter 3.1. --- In vitro Aerosol Performance --- p.52 / Chapter 3.2. --- Enzyme Activity Retained in BG Samples --- p.55 / Chapter 3.3. --- Scanning Electron Microscopy (SEM) --- p.56 / Chapter 3.3.1. --- SEM of Salbutamol Sulphate Formulations --- p.56 / Chapter 3.3.2. --- SEM of DSCG Formulations --- p.59 / Chapter 3.3.3. --- SEM of BG Formulations --- p.61 / Chapter 3.4. --- Density Measurements --- p.65 / Chapter 3.4.1. --- Densities of Salbutamol Sulphate Formulations --- p.65 / Chapter 3.4.2. --- Densities of DSCG Formulations --- p.66 / Chapter 3.4.3. --- Densities of BG Formulations --- p.67 / Chapter 3.5. --- Particle Size Analysis by Laser Diffraction --- p.68 / Chapter 3.5.1. --- Volume Mean Diameter Measurements --- p.68 / Chapter 3.5.2. --- Particle Size Distributions and Dispersion Patterns of Formulations --- p.70 / Chapter 3.6. --- Thermal Analysis --- p.75 / Chapter 3.7. --- Powder X-ray Diffraction --- p.80 / Chapter 3.8. --- Surface Area Measurements --- p.84 / Chapter 3.9. --- Surface Composition Characterization --- p.85 / Chapter 3.9.1. --- Surface Composition of Salbutamol Sulphate Formulations --- p.85 / Chapter 3.9.2. --- Surface Composition of DSCG Formulations --- p.88 / Chapter 3.9.3. --- Surface Composition of BG/BSA Formulations --- p.89 / Chapter 3.10. --- Surface Tension Measurements --- p.91 / Chapter 3.11. --- Inverse Gas Chromatography --- p.92 / Chapter 3.12. --- Fractal Analysis --- p.93 / Chapter 3.13. --- Atomic Force Microscopy --- p.94 / Chapter Chapter Four --- Discussion / Chapter 4.1. --- Influence of BSA on Aerosol Performance and Protein Integrity --- p.98 / Chapter 4.2. --- Influence of BSA on Physicochemical Properties of Particles --- p.98 / Chapter 4.2.1. --- Influence of BSA on surface corrugation --- p.98 / Chapter 4.2.2. --- Influence of BSA on particle size and dispersion behavior --- p.99 / Chapter 4.2.3. --- Influence of BSA on crystallinity and thermal properties of particles --- p.100 / Chapter 4.2.4. --- Influence of BSA on surface energetics of particles --- p.100 / Chapter 4.3. --- Relationship between Surface Corrugation and Aerosol Performance --- p.101 / Chapter 4.4. --- Mechanism of Surface Modification for BSA on Spray-dried Particles --- p.103 / Chapter Chapter Five --- Conclusions and Future Work / Chapter 5.1. --- Conclusions --- p.106 / Chapter 5.1.1. --- General Aerosolization-Enhancing Effect of BSA --- p.106 / Chapter 5.1.2. --- Surface Modifying Effect of BSA --- p.106 / Chapter 5.1.3. --- Relationship between Surface Corrugation and Aerosol Performance --- p.106 / Chapter 5.2. --- Future Work --- p.107 / References --- p.108

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening. This thesis investigates the effects of a selective COX-2 inhibitor (parecoxib or celecoxib) on bone healing in metaphyseal bone in a rat model and on knee prosthesis migration after total knee replacement, as measured with radiostereometric analysis. Blood loss, postoperative recovery, and the 2-year subjective outcome, were also measured. In addition, a hemoglobin dilution method for blood loss estimation, used in this thesis, was evaluated. In the first study, pull-out force of a screw inserted in metaphyseal bone of the tibia in rats was only marginally decreased by parecoxib after 7 days but not after 14 days. In the second and third study, celecoxib treatment resulted in less pain postoperatively in conjunction with total knee replacement (TKR), but no effects were seen on blood loss, range of motion, subjective outcome, or prosthesis migration after 2 years. Comparing the true blood loss of blood donors with the blood loss estimated by the hemoglobin dilution method, this method was found to underestimate the true blood loss. It is therefore not suitable for calculation of the absolute blood loss volume, but may be used for a rough estimate. In summary, celecoxib and presumably other cyclooxygenase inhibitors seems not likely to increase the risk of prosthesis loosening.