Solidarity during the COVID-19 pandemic: evidence from a nine-country interview study in Europe

Calls for solidarity have been an ubiquitous feature in the response to the COVID-19 pandemic. However, we know little about how people have thought of and practised solidarity in their everyday lives since the beginning of the pandemic. What role does solidarity play in people's lives, how does it relate to COVID-19 public health measures and how has it changed in different phases of the pandemic? Situated within the medical humanities at the intersection of philosophy, bioethics, social sciences and policy studies, this article explores how the practice-based understanding of solidarity formulated by Prainsack and Buyx helps shed light on these questions. Drawing on 643 qualitative interviews carried out in two phases (April-May 2020 and October 2020) in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, The Netherlands, German-speaking Switzerland and the UK), the data show that interpersonal acts of solidarity are important, but that they are not sustainable without consistent support at the institutional level. As the pandemic progressed, respondents expressed a longing for more institutionalised forms of solidarity. We argue that the medical humanities have much to gain from directing their attention to individual health issues, and to collective experiences of health or illness. The analysis of experiences through a collective lens such as solidarity offers unique insights to understandings of the individual and the collective. We propose three essential advances for research in the medical humanities that can help uncover collective experiences of disease and health crises: (1) an empirical and practice-oriented approach alongside more normative approaches; (2) the confidence to make recommendations for practice and policymaking and (3) the pursuit of cross-national and multidisciplinary research collaborations.

Epistemic and institutional recognition work in changing conditions of social visibility: Anosmia's journey from the shadows to the spotlight

This paper explores the complex relationships between recognition, collective action, and social (in)visibility of health conditions. We trace how collective action for recognition changes as conditions of visibility shift. We investigate how the Covid-19 global pandemic thrust one health condition (anosmia) and collective efforts around its recognition from almost complete public invisibility into a sudden spotlight. We show how 'prepared' movement actors leveraged this sudden hypervisibility to mobilize resources and change cultural values, noting how prior 'recognition work' becomes a resource for new ways to advocate for their condition's recognition, toward epistemic and institutional recognition: from building a shared epistemic ground and improving relatability, toward resource distribution and finally, creating and institutionalizing new cultural values through policy change. Our findings highlight organizational efforts to mitigate community tensions and dispersions related to hypervisibility, through boundary and integration work.

Genetic research and the collective good: participants as leaders to reconcile individual and public interests

This paper problematises the notions of public or common good as weighed against individual sovereignty in the context of medical research by focusing on genetic research. We propose the notion of collective good as the good of the particular collective in which the research was conducted. We conducted documentary and interview-based research with participant representatives and research leaders concerned with participant involvement in leading genetic research projects and around two recent genetic data controversies: the case of the UK Wellcome Sanger Institute, accused of planning unauthorised commercialisation of African DNA samples, and the case of the company Genuity Science, which planned genetic research on brain tumour samples in Ireland with no explicit patient consent. We advocate for greater specificity in circumscribing the collective to which genetic research relates and for greater efforts in including representatives of this collective as research coleaders in order to enable a more inclusive framing of the good arising from such research. Such community-based participant cogovernance and coleadership in genetic research is vital especially when minorities or vulnerable groups are involved, and it centrally requires community capacity building to help collectives articulate their own notions of the collective good.

Analysis of the institutional landscape and proliferation of proposals for global vaccine equity for COVID-19: too many cooks or too many recipes?

This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO's) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO's COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology transfer proposals. We argue that while various individual mechanisms each have their specific individual merits-and in some cases weaknesses-overall, many of these current and proposed mechanisms could be highly complementary if used together to deliver equitable global access to vaccines. Nonetheless, we also argue that there are risks posed by the proliferation of proposals in this context, including the potential to disperse stakeholder attention or to delay decisive action. Therefore, we argue that there is now a clear need for concerted global multilateral action to recognise the complementarities of specific models and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exist at this point in time-but much greater cooperation from industry and clear, decisive and coordinated action from states and international organisations are urgently needed.

Automatic electrode scalar location assessment after cochlear implantation using a novel imaging software

As of today, image-based assessment of cochlear implant electrode array location is not part of the clinical routine. Low resolution and contrast of computer tomography (CT) imaging, as well as electrode array artefacts, prevent visibility of intracochlear structures and result in low accuracy in determining location of the electrode array. Further, trauma assessment based on clinical-CT images requires a uniform image-based trauma scaling. Goal of this study was to evaluate the accuracy of a novel imaging software to detect electrode scalar location. Six cadaveric temporal bones were implanted with Advanced Bionics SlimJ and Mid-Scala electrode arrays. Clinical-CT scans were taken pre- and postoperatively. In addition, micro-CTs were taken post-operatively for validation. The electrode scalar location rating done by the software was compared to the rating of two experienced otosurgeons and the micro-CT images. A 3-step electrode scalar location grading scale (0 = electrode in scala tympani, 1 = interaction of electrode with basilar membrane/osseous spiral lamina, 2 = translocation of electrode into scala vestibuli) was introduced for the assessment. The software showed a high sensitivity of 100% and a specificity of 98.7% for rating the electrode location. The correlation between rating methods was strong (kappa > 0.890). The software gives a fast and reliable method of evaluating electrode scalar location for cone beam CT scans. The introduced electrode location grading scale was adapted for assessing clinical CT images.

Automated Classification of Well Test Responses in Naturally Fractured Reservoirs Using Unsupervised Machine Learning

Understanding the impact of fractures on fluid flow is fundamental for developing geoenergy reservoirs. Pressure transient analysis could play a key role for fracture characterization purposes if better links can be established between the pressure derivative responses (p′) and the fracture properties. However, pressure transient analysis is particularly challenging in the presence of fractures because they can manifest themselves in many different p′ curves. In this work, we aim to provide a proof-of-concept machine learning approach that allows us to effectively handle the diversity in fracture-related p′ curves by automatically classifying them and identifying the characteristic fracture patterns. We created a synthetic dataset from numerical simulation that comprised 2560 p′ curves that represent a wide range of fracture network properties. We developed an unsupervised machine learning approach that can distinguish the temporal variations in the p′ curves by combining dynamic time warping with k-medoids clustering. Our results suggest that the approach is effective at recognizing similar shapes in the p′ curves if the second pressure derivatives are used as the classification variable. Our analysis indicated that 12 clusters were appropriate to describe the full collection of p′ curves in this particular dataset. The classification exercise also allowed us to identify the key geological features that influence the p′ curves in this particular dataset, namely (1) the distance from the wellbore to the closest fracture(s), (2) the local/global fracture connectivity, and (3) the local/global fracture intensity. With additional training data to account for a broader range of fracture network properties, the proposed classification method could be expanded to other naturally fractured reservoirs and eventually serve as an interpretation framework for understanding how complex fracture network properties impact pressure transient behaviour.

Affective resonance and durability in political organizing: The case of patients who hack

We explore the role of affect in fuelling and sustaining political organizing in the case of an online Type-1 Diabetes community. Analysing this community’s interactions, we show that the drive towards political transformation is triggered by affective dissonance, but that this dissonance needs to be recurrently enacted through the balanced circulation of objects of pain and hope. We propose the notion of affective resonance to illuminate the dynamic interplay that collectively moderates and fosters this circulation and that keeps bodies invested and reverberating together around shared political goals. Affective resonance points researchers toward the fragile and complex accomplishment that affective politics represents. Focusing particularly on the community’s interactions on Twitter, we also reflect on the role of (digital) resonance spaces in how affects circulate. By adopting and transposing concepts from affect theories into the context of patient communities, we further add important insights into the unique embodied challenges that chronic illness patients face. Highlighting the hope induced by techno-bodily emancipation that intertwine into a particular form of political organizing in such healthcare movements, we give emphasis to patient communities’ deeply embodied affects as important engines for political, social, and economic change.

Tech sharing, not tech hoarding: Covid-19, global solidarity, and the failed responsibility of the pharmaceutical industry

The Covid-19 pandemic has highlighted the importance of health technologies to mitigate against the spread of the disease and improve care, dominantly including life-saving vaccines. But the pandemic has also highlighted that the current biopharmaceutical business model, based on the enclosure of these technologies and on the immense accumulation of capital it enables, leads to vast inequalities in healthcare particularly in low and middle-income countries. We believe that the pharmaceutical industry has a moral duty to enable and enact global solidarity through tech sharing instead of tech hoarding, but judging by current technology transfer practices we question their willingness to assume their role in organizing healthcare markets through solidaristic principles. In the absence of a voluntary adoption of solidaristic principles and practices by biopharmaceutical firms, the institutionalization of global solidarity as a fundamental organizing principle for healthcare markets is necessary to strengthen resilience and know-how globally. With this call, we add to existing conceptualizations of solidarity by (a) introducing a global level of solidarity and (b) thinking through the concept not as an abstract humanistic stance but as a concrete organizing principle for global healthcare markets.

Democratic research: Setting up a research commons for a qualitative, comparative, longitudinal interview study during the COVID-19 pandemic

The sudden and dramatic advent of the COVID-19 pandemic led to urgent demands for timely, relevant, yet rigorous research. This paper discusses the origin, design, and execution of the SolPan research commons, a large-scale, international, comparative, qualitative research project that sought to respond to the need for knowledge among researchers and policymakers in times of crisis. The form of organization as a research commons is characterized by an underlying solidaristic attitude of its members and its intrinsic organizational features in which research data and knowledge in the study is shared and jointly owned. As such, the project is peer-governed, rooted in (idealist) social values of academia, and aims at providing tools and benefits for its members. In this paper, we discuss challenges and solutions for qualitative studies that seek to operate as research commons.

Anticipating hopes, fears and expectations towards COVID-19 vaccines: A qualitative interview study in seven European countries

Vaccine uptake is essential to managing the ongoing COVID-19 pandemic, and vaccine hesitancy is a persistent concern. At the same time, both decision-makers and the general population have high hopes for COVID-19 vaccination. Drawing from qualitative interview data collected in October 2020 as part of the pan-European SolPan study, this study explores early and anticipatory expectations, hopes and fears regarding COVID-19 vaccination across seven European countries. We find that stances towards COVID-19 vaccines were shaped by personal lived experiences, but participants also aligned personal and communal interests in their considerations. Trust, particularly in expert institutions, was an important prerequisite for vaccine acceptance, but participants also expressed doubts about the rapid vaccine development process. Our findings emphasise the need to move beyond the study of factors driving vaccine hesitancy, and instead to focus on how people personally perceive vaccination in their particular social and political context.

Organizing the sharing economy through experiments: framing and taming as onto-epistemological work

Prior work on performativity has illustrated how theories intervene in economic organizing. We expand this body of research by studying how concepts, and particularly those that are loosely defined and/or not widely understood, provoke their own realities through experiments. We examine how different experimental set-ups allow these concepts to be seized by a multitude of actors all wishing to instantiate worlds in their own interests, and how they potentially open up multiple competing realities as a result. We follow the concept of Mobility-as-a-Service as it mobilizes various experiments across public and private realms in Stockholm and Dublin, and we analyse how specific types of experiments co-produce epistemic and ontological work. Our results illustrate how different experimental designs can be conducive in taming and/or framing ambiguous concepts through interconnected processes of such onto-epistemological work. This highlights the distributed and relational but also the ‘provocative’ facets of performing ambiguous concepts through experiments. We discuss the consequences of these insights for how we think about scaling from experiments to broader socio-economic realities.

Menthol stimulates calcium absorption in the rumen but not in the jejunum of sheep

Stimulation of Ca²⁺ absorption can counteract hypocalcemia at the onset of lactation. The plant bioactive lipid compound (PBLC) menthol is an agonist for nonselective cation channels of the transient receptor potential (TRP) family. It acutely stimulated Ca²⁺ absorption in ruminal epithelia of nonadapted animals ex vivo and caused higher plasma Ca²⁺ concentrations in cows and sheep in vivo. To elucidate the pathway by which menthol feeding increases plasma Ca²⁺ level, the present study aimed to investigate the long-term dose-dependent effects of dietary menthol-rich PBLC on Ca²⁺ absorption and mRNA abundances of TRP channels in both rumen and jejunum. Twenty-four growing Suffolk sheep were equally distributed to a Con, PBLC-L, and PBLC-H group, which received 0, 80, and 160 mg/d of a menthol-rich PBLC. After 4 wk, ruminal and jejunal epithelia were analyzed for mRNA abundances of TRPA1, TRPV3, TRPV5-6, and TRPM6-8 genes. The Ca²⁺ flux rates and electrophysiological properties of epithelia from rumen and mid-jejunum were measured in Ussing chambers in the presence and absence of mucosal Na⁺. Acute changes in Ca²⁺ flux rates were measured after mucosal application of 50 µM menthol. Ruminal epithelia had quantifiable transcripts of TRPV3 = TRPM6 >TRPM7 >TRPA1 with no difference among feeding groups. Jejunum had quantifiable transcripts of TRPM7 >TRPA1 ≥ TRPM6 ≥ TRPV6 >TRPV5, where TRPA1, TRPV5, and TRPV6 tended to decrease linearly with increasing PBLC dose. Absorptive net flux of Ca²⁺ was detected only in the rumen, whereas jejunum showed a high passive permeability to Ca²⁺. Net flux rates of Ca²⁺ in the rumen increased in a quadratic manner (highest in PBLC-L animals) and were systematically decreased with the omission of mucosal Na⁺. Short-circuit current increased in both PBLC feeding groups compared with Con only in the rumen. Acute application of menthol-stimulated mucosal-to-serosal and net Ca²⁺ flux rates only in ruminal epithelia with higher stimulation in PBLC-fed animals. We conclude that Ca²⁺ transport is mainly active and transcellular in the rumen. It most likely involves TRPV3 that can be stimulated by menthol. Pre-feeding of menthol-rich PBLC enhances ruminal Ca²⁺ absorption and sensitizes it to acute stimulation by menthol. By contrast, intestinal Ca²⁺ absorption is not sensitive to menthol stimulation. Menthol could be used as a tool to enhance ruminal Ca²⁺ absorption and to prevent hypocalcemia in dairy cows.

Characterization and in vitro evaluation of a vaginal gel containing Lactobacillus crispatus for the prevention of gonorrhea

The increasing resistance of Neisseria gonorrhoeae to any current antibiotic treatment and the difficulties associated with the use of prevention means such as condom urge the need for alternative methods to prevent this sexually transmitted infection. In this work, a prevention strategy based on the use of a vaginal gel containing Lactobacilli was assessed in vitro. A Lactobacillus crispatus strain (ATCC 33197) was selected based on the published data on its ability to inhibit Neisseria gonorrhoeae. Its probiotic properties were first characterized. Then, a thermo-sensitive hydrogel containing 21.5% of poloxamer 407, 1% of sodium alginate and 9log₁₀ CFU of Lactobacillus crispatus per gel sample (5 g) was developed. The gelation temperature and the rheological characteristics of this formulation appeared suitable for a vaginal administration. Lactobacillus crispatus was viable in the gel for six months although a large amount of the bacteria was not culturable. The ability of Lactobacillus crispatus to inhibit Neisseria gonorrhoeae was still observed with the gel. Such system, thus, appeared promising for the prevention of gonorrhea.

Duos and Duels in Field Evolution: How Governments and Interorganizational Networks Relate

We live in an era where models of governing are changing rapidly under multifaceted evolutionary pressures and where, at the same time, organizational fields are becoming increasingly networked. With this paper, we add to the field dynamics literature, focusing on the space where these evolutionary pressures coincide – the interactions of Governments and interorganizational networks. We examine the roles that interorganizational networks play in relation to Government actors under particular long- and short-term institutional and governance conditions. We articulate four roles that networks may play in relation to Government: advocate, technology, judge and ruler. We argue that long-term institutional logics, combined with short-term Government action in response to a particular field evolution, may predict the role that the interorganizational network will assume in relation to Government in that particular field scenario. We discuss flows through the typology as conditions change and we conclude by presenting an agenda for future research in the field dynamics and interorganizational networks research domains that leverages our proposed network role typology.

Implementing a National Electronic Referral Program: Qualitative Study

BACKGROUND

Electronic referrals or e-referrals can be defined as the electronic transmission of patient data and clinical requests between health service providers. National electronic referral systems have proved challenging to implement due to problems of fit between the technical systems proposed and the existing sociotechnical systems. In seeming contradiction to a sociotechnical approach, the Irish Health Service Executive initiated an incremental implementation of a National Electronic Referral Programme (NERP), with step 1 including only the technical capability for general practitioners to submit electronic referral requests to hospital outpatient departments. The technology component of the program was specified, but any changes required to embed that technology in the existing sociotechnical system were not specified.

OBJECTIVE

This study aimed to theoretically frame the lessons learned from the NERP step 1 on the design and implementation of a national health information technology program.

METHODS

A case study design was employed, using qualitative interviews with key stakeholders of the NERP step 1 (N=41). A theory-driven thematic analysis of the interview data was conducted, using Barker et al's Framework for Going to Full Scale.

RESULTS

The NERP step 1 was broadly welcomed by key stakeholders as the first step in the implementation of electronic referrals-delivering improvements in the speed, completeness of demographic information, and legibility and traceability of referral requests. National leadership and digitalized health records in general practice were critical enabling factors. Inhibiting factors included policy uncertainty about the future organizational structures within which electronic referrals would be implemented; the need to establish a central referral office consistent with these organizational structures; outstanding interoperability issues between the electronic referral solution and hospital patient administration systems; and an anticipated need to develop specialist referral templates for some specialties. A lack of specification of the sociotechnical elements of the NERP step 1 inhibited the necessary testing and refinement of the change package used to implement the program.

CONCLUSIONS

The key strengths of the NERP step 1 are patient safety benefits. The NERP was progressed beyond the pilot stage despite limited resources and outstanding interoperability issues. In addition, a new electronic health unit in Ireland (eHealth Ireland) gained credibility in delivering national health information technology programs. Limitations of the program are its poor integration in the wider policy and quality improvement agenda of the Health Service Executive. The lack of specification of the sociotechnical elements of the program created challenges in communicating the program scope to key stakeholders and restricted the ability of program managers and implementers to test and refine the change package. This study concludes that while the sociotechnical elements of a national health information technology program do not need to be specified in tandem with technical elements, they do need to be specified early in the implementation process so that the change package used to implement the program can be tested and refined.

Market Failures and Market Framings: Can a market be transformed from the inside?

How do actors innovate markets in cases of perceived market failures? This paper’s aim is to examine what happens when a market is innovated or, as we call it, ‘redevised’ in situations where public and commercial interests significantly diverge. Market devices can serve an important function in such attempts to innovate markets: they are material and/or social arrangements that are put into place to shape the market in question in certain ways. But can such devices really transform a market from within? To examine this question we trace the history of the Geneva Medicines Patent Pool, a civil society initiative introduced to change pharmaceutical firms’ licensing and collaboration practices in the market for HIV/AIDS medicines. Our empirical results indicate that redevising a market in response to market failures can shift the market’s frames and contribute to altering its practices, but that this is a pragmatic and often lengthy process that is never fully predictable in advance. By attending to the intended and unintended consequences - or misfires - of redevising a market, our study raises important questions around acting in and on the market, market innovation’s’ ontological impact, zooming in and zooming out when studying redevising, and attending to the temporality of market innovation.

Global versus Local Cues for Route Finding in Virtual Environments

Motivated by the results of Gillner and Mallot (1996 Perception25 Supplement, 93) implying that local views are basic elements for a spatial representation, we studied the role of global versus local landmarks using a route-finding task. Our hypotheses were: (i) A global navigation strategy relying on allocentric movement decisions is used, eg “go from this place towards the chapel on the hill”, or (ii) a local navigation strategy based on view—movement associations is used, eg “at the red building go right”.

We performed an experiment in a computer graphics town based on a hexagonal grid structure. At each intersection we placed three different buildings. We also provided global direction information by placing six global landmarks distributed equally along a mountain range. Subjects had to learn the back and forth route between two buildings, not knowing that after a learning phase the location of buildings at a particular junction would be changed. These changes produced conflicting global and local information. In the test-phase, the subject approached individual junctions in both learned and novel directions and the movement decisions were recorded. In a control condition with unchanged places twenty subjects made correct decisions for 136 of 160 movements. In the experimental conflict condition 123 decisions were consistent with a local and 37 with a global strategy. This supports our previous finding that local views play a dominant role in making route judgements. Approaching a junction from a learned direction leads to more accurate movement decisions than approaching it from a novel direction, even if the global landmarks are available, which provides further support for the local-view hypothesis.

[Biphasic mesothelioma in a Swiss Braunvieh cow: clinical, histological, immunohistochemical and electron microscopical findings]

A 10-year-old Swiss Braunvieh cow near term was referred to our clinic because of severe abdominal distension, which caused loss of demarcation between the udder and ventral abdominal wall. Ultrasonographic examination revealed marked ascites and multiple echogenic nodules in the greater omentum. Based on the findings, non-inflammatory ascites attributable to neoplasia was diagnosed. Rupture of the prepubic tendon from the pubic symphysis was also suspected. Because of a grave prognosis, parturition was induced and a live calf was delivered. The cow was euthanized and a postmortem examination was carried out. The abdominal cavity contained 248.5 litres of clear fluid. The greater omentum was thickened and oedematous and regionally contained fluid-filled cystic structures, which varied in size with a maximum diameter of 10 centimetres. Based on the histological, immunohistochemical and electron microscopical findings, biphasic mesothelioma with cyst formation affecting the entire abdominal cavity was diagnosed.

[Dyspnoea after complication-free tracheostomy]

HISTORY

A 70-year-old woman had been under oncological supervision for several years because of breast cancer with bone and lymph node metastases. For several weeks she had been treated for increasing vocal cord paresis of uncertain cause, requiring a tracheostomy, a speech cannula being inserted after eight days. Several days later the patient began to complain of dyspnea, but repeated inspection and cleaning of the cannula failed to reveal its cause. The increasingly anxious patient was given a benzodiazepine preparation to calm her. She was then transferred to the intensive care unit because of worsening respiratory insufficiency and impaired consciousness.

DIAGNOSIS AND COURSE

A fiberoptic bronchoscopy was performed immediately, which revealed a black foreign body immediately distal to the tip of the tracheal cannula. The cannula was removed and the slightly sedated patient at once coughed up a large amount of bronchial secretion and a long, curved and fairly firm blood clot. Control bronchoscopy now revealed a flat, slightly hemorrhagic ulcer on the dorsal tracheal wall at the point where the cannula tip had made contact with the tracheal wall.

CONCLUSION

Even trained personnel may have difficulty in recognizing intratracheal thrombi in patients with a tracheostomy. It is thus essential that an endoscopy is performed in patients with obstructive symptoms after a tracheostomy.

Tea catechins' affinity for human cannabinoid receptors

Among the many known health benefits of tea catechins count anti-inflammatory and neuroprotective activities, as well as effects on the regulation of food intake. Here we address cannabimimetic bioactivity of catechin derivatives occurring in tea leaves as a possible cellular effector of these functionalities. Competitive radioligand binding assays using recombinant human cannabinoid receptors expressed in Chem-1 and CHO cells identified (-)-epigallocatechin-3-O-gallate, EGCG (K(i)=33.6 microM), (-)-epigallocatechin, EGC (K(i)=35.7 microM), and (-)-epicatechin-3-O-gallate, ECG (K(i)=47.3 microM) as ligands with moderate affinity for type 1 cannabinoid receptors, CB1. Binding to CB2 was weaker with inhibition constants exceeding 50 microM for EGC and ECG. The epimers (+)-catechin and (-)-epicatechin exhibited negligible affinities for both CB1 and CB2. It can be concluded that central nervous cannabinoid receptors may be targeted by selected tea catechins but signaling via peripheral type receptors is less likely to play a major role in vivo.

Breakthrough infection of Trichosporon asahii during posaconazole treatment in a patient with acute myeloid leukaemia

A neutropenic patient with acute myeloid leukaemia experienced a breakthrough infection of Trichosporon asahii during posaconazole treatment. After treatment was changed to a combination therapy with voriconazole and liposomal amphotericin B, the infection resolved. Posaconazole works effectively as an antifungal prophylaxis and salvage therapy in rare invasive fungal infections. This case however illustrates that breakthrough infections with T. asahii may occur during posaconazole treatment.

Crystal and electronic structures of magnesium(II), copper(II), and mixed magnesium(II)-copper(II) complexes of the quinoline half of styrylquinoline-type HIV-1 integrase inhibitors

A new target in AIDS therapy development is HIV-1 integrase (IN). It was proven that HIV-1 IN required divalent metal cations to achieve phosphodiester bond cleavage of DNA. Accordingly, all newly investigated potent IN inhibitors contain chemical fragments possessing a high ability to chelate metal cations. One of the promising leads in the polyhydroxylated styrylquinolines (SQLs) series is (E)-8-hydroxy-2-[2-(4,5-dihydroxy-3-methoxyphenyl)-ethenyl]-7-quinoline carboxylic acid (1). The present study focuses on the quinoline-based progenitor (2), which is actually the most probable chelating part of SQLs. Conventional and synchrotron low-temperature X-ray crystallographic studies were used to investigate the chelating power of progenitor 2. Mg2+ and Cu2+ cations were selected for this purpose, and three types of metal complexes of 2 were obtained: Mg(II) complex (4), Cu(II) complex (5) and mixed Mg(II)-Cu(II) complexes (6 and 7). The analysis of the crystal structure of complex 4 indicates that two tridentate ligands coordinate two Mg2+ cations, both in octahedral geometry. The Mg-Mg distance was found equal to 3.221(1) A, in agreement with the metal-metal distance of 3.9 A encountered in the crystal structure of Escherichia coli DNA polymerase I. In 5, the complex is formed by two bidentate ligands coordinating one copper ion in tetrahedral geometry. Both mixed Mg(II)-Cu(II) complexes, 6 and 7 exhibit an original arrangement of four ligands linked to a central heterometallic cluster consisting of three octahedrally coordinated magnesium ions and one tetrahedrally coordinated copper ion. Quantum mechanics calculations were also carried out in order to display the electrostatic potential generated by the dianionic ligand 2 and complex 4 and to quantify the binding energy (BE) during the formation of the magnesium complex of progenitor 2. A comparison of the binding energies of two hypothetical monometallic Mg(II) complexes with that found in the bimetallic magnesium complex 4 was made.

Direct lung delivery of a dry powder formulation of DTPA with improved aerosolization properties: Effect on lung and systemic decorporation of plutonium

DTPA, an actinide chelating agent, has demonstrated its ability to complex plutonium (Pu) and to facilitate its urinary excretion after internal contamination. This process, known as decorporation is crucial to diminish the burden of Pu in the body. The ability to deliver a chelating agent directly to the alveolar region may increase its local concentration as compared to systemic delivery and therefore increase the extent of decorporation. Second, inhalation offers the potential for needle-free, systemic delivery of small molecules and would be convenient in case of nuclear accident as a first pass emergency treatment. To benefit from the improvement of inhalation technology, we have formulated DTPA into porous particles by spray-drying with dl-Leucine, DPPC and ammonium bicarbonate. The optimized particles possess a volume mean geometric diameter around 4.5 mum and crumpled paper morphology. The in vitro aerodynamic evaluation shows that about 56% of the powder should deposits in the lungs, with about 27% in the alveolar region, an improvement as compared with the micronized powder available with the Spinhaler. After pulmonary administration to rats contaminated with PuO(2), a 3-fold increase of the Pu urinary excretion was observed, but the dissolution of PuO(2) in the lungs was not enhanced.

Impact of n-3 fatty acid supplemented parenteral nutrition on haemostasis patterns after major abdominal surgery

In various diseases n-3 fatty acids exert anti-inflammatory properties. These effects seem to be related to the uptake and incorporation of eicosapentaenoic acid (EPA) into the cellular substrate pool after dietary intake of EPA, which is contained in fish oils (FO). In the state of inflammation EPA is released to compete with arachidonic acid (AA) for metabolism at the cyclo-oxygenase and the 5-lipoxygenase level. The metabolites of EPA have less inflammatory and chemotactic potency than the substances derived from AA. In addition to positive effects, early studies pointed towards prolonged bleeding times after dietary intake of n-3 fatty acids. This study was undertaken to address the issue of potential coagulation disturbances associated with postoperative parenteral FO administration. This was a prospective, randomised, double blinded clinical trial, carried out in two operative intensive care units (13 and 16 beds) in a university hospital. Forty-four patients undergoing elective major abdominal surgery participated in the trial. Patients were randomly assigned to receive total parenteral nutrition (TPN) supplemented with either soybean oil (SO, Lipovenoess 10% PLR; 1.0 g/kgBW per day; n = 20) for five days or with a combination of FO and SO (FO, Omegaven; 0.2 g/kgBW per day plus SO, Lipovenoes 10% PLR; 0.8 g/kgBW per day, n = 24), respectively. Blood samples were taken preoperatively (day -1), prior to (day 1) during (days 2-5) and after TPN (day 6). The coagulation parameters thromboplastin time (Quick), activated partial thromboplastin time (aPTT), fibrinogen and antithrombin III were measured. To differentially assess activation levels of extrinsic and intrinsic coagulation pathway, factors VIIa and XIIa were quantified. Moreover platelet function was determined by resonance thrombography. Baseline values of coagulation and platelet function were comparable in both groups, but coagulation activity dropped after surgery. Over the observation period of 6 days, however, physiological levels were regained. No clinically significant differences were observed between the SO- and SO + FO- group. These findings suggest that infusion of fish oil in doses up to 0.2 g/kgBW per day is safe regarding coagulation and platelet function.

Monitoring of organ dysfunction in sepsis/systemic inflammatory response syndrome: novel strategies

Sepsis and systemic inflammatory response syndrome-induced severe disruption of microcirculation and consecutive tissue hypoxia is considered a key factor in the development of organ dysfunction and multiple organ failure. The conventionally measured global variables such as lactate or macrohemodynamic parameters using a pulmonary artery catheter do not adequately mirror microcirculatory disturbances. Evaluation of the severity of microcirculatory distress and the effectiveness of resuscitation strategies requires new clinical technologies aimed at the microcirculation. It is anticipated that novel techniques such as optical spectroscopy and intelligent biosensors will play a major role in the development of new monitoring systems. In general, the current monitoring of organ dysfunction is characterized by a trend from invasive to noninvasive and "safe" techniques, which provide bedside or even on-line monitoring and allow a more precise and earlier detection of organ dysfunction. Techniques for the assessment of regional perfusion and microcirculatory bioenergetics to direct therapeutic procedures are expected to refine and optimize clinical treatment of critically ill patients in the future. This article addresses the question of which variables should be monitored, what is feasible, and what is valid for therapeutic consequences. Recent developments in monitoring of macro- and microcirculation and organ-specific dysfunction, e.g., lung, kidney, are described with respect to their advantages and limitations, and future directions are outlined.

Controlled release of vancomycin from poloxamer 407 gels

The purpose of this study was to investigate Poloxamer 407 25% (w/w) formulations aimed at prolonging the residence time of vancomycin, a time-dependent antibiotic, in a body site with a high infectious risk. Reversible thermal gelation of the formulations permitted their local injection in liquid form and in situ gelation as they warmed to body temperature. Neither the rheological properties of the Poloxamer matrices nor the antibacterial activity of vancomycin was altered by their combination. In vitro, the dispersed form exhibited prolonged release, with a lower diffusion coefficient of vancomycin compared to the solubilized form (4.7x10(-8) vs 2. 1x10(-7) cm(2) s(-1)131 mg l(-1) for the solubilized form), followed by lower but effective antibacterial levels for at least 8 days. Controlled-release profiles, good preservation of vancomycin activity, good tolerability in rats, and ease of administration suggest that Poloxamer 407 may be useful as a vancomycin delivery vehicle for local prophylaxis of infections, especially in prosthetic surgery.

Isolation of Angiostrongylus costaricensis first-stage larvae from rodent feces on a Percoll gradient

Several density gradients were tested for the isolation of parasitic nematode, Angiostrongylus costaricensis, first-stage larvae from rodent feces. With a 45/72% Percoll gradient, 83-99% (89.56+/-6.57%) of the larvae were recovered in a clean preparation.

Surface roughness evaluation of resin modified glass-ionomers polished utilizing poly(acrylic acid) gel

The differences in polishability of modified and conventional glass-ionomers were studied following different polishing procedures. Specimens of conventional glass-ionomer (Fuji II(R)), resin modified glass-ionomer (Vitremer(R)) and compomer (Dyract(R)) were prepared and polished using either Soflex(R) or Enhance(R) discs with either aluminum oxide or poly(acrylic acid) gel as polishing agents. Surface roughness of the specimens was evaluated by profilometric measurements and electron microscopic examination. It was shown that Soflex(R) discs manifest superior polishing effect on glass-ionomers and resin modified glass-ionomers compared to the Enhance(R) system, although no significant differences were found for the compomer specimens. Addition of poly(acrylic acid) gel as a polishing agent reduced surface roughness of conventional glass-ionomer and resin modified glass-ionomer specimens and did not significantly affect the compomer specimens.

Percutaneous absorption of sunscreens from liquid crystalline phases

The purpose of the present study was to investigate the effects of two nonionic surfactants with liquid crystalline structures on the cutaneous availability of two sunscreens. Three liquid crystalline structures were investigated: lamellar, hexagonal and cubic. The diffusion of sunscreens within the liquid crystals was determined by measuring transport kinetics into an unloaded surfactant medium from a similar system loaded with the sunscreens. The diffusion coefficients were the greatest in the cubic systems for benzophenone-4 (a hydrosoluble sunscreen) and in lamellar systems for octyl methoxycinnamate (a liposoluble sunscreen). So the diffusion in this surfactant systems was strongly dependent on the structure of the liquid crystal and on the physicochemical properties of the solute. The transcutaneous fluxes were determined using a Franz-type diffusion cell. The liquid crystalline vehicles modified the transcutaneous fluxes of benzophenone-4 but did not change those of octyl methoxycinnamate. The solute diffusion within the vehicle was not the rate-determining step for transcutaneous permeation for either sunscreen. The diffusion of benzopenone-4 within the stratum corneum and that of octyl methoxycinnamate within the dermis could be the rate-determining steps for their transcutaneous permeation. These two steps could be affected differently by nonionic surfactant vehicles.

Kinetics of swelling-breakdown of a W/O/W multiple emulsion: possible mechanisms for the lipophilic surfactant effect

The properties and behavior of a W/O/W multiple emulsion formulation were analyzed during a swelling-breakdown process. Various experimental analyses, such as granulometry, rheology and conductimetry were performed, as well as a micropipette aspiration method. The predominant role of the lipophilic surfactant during the swelling phase confirmed. Two different mechanism can be proposed. Both imply the migration of the lipophilic surfactant from one interface to another and probably take place successively. The lipophilic surfactant could diffuse from the first to the second interface, thus rigidifying the membrane, or from the oily phase to the first interface, resulting in delayed coalescence of the aqueous droplets during swelling.