Process Optimization for the Continuous Production of a Gastroretentive Dosage Form Based on Melt Foaming

Several drugs have poor oral bioavailability due to low or incomplete absorption which is affected by various effects as pH, motility of GI, and enzyme activity. The gastroretentive drug delivery systems are able to deal with these problems by prolonging the gastric residence time, while increasing the therapeutic efficacy of drugs. Previously, we developed a novel technology to foam hot and molten dispersions on atmospheric pressure by a batch-type in-house apparatus. Our aim was to upgrade this technology by a new continuous lab-scale apparatus and confirm that our formulations are gastroretentive. At first, we designed and built the apparatus and continuous production was optimized using a Box-Behnken experimental design. Then, we formulated barium sulfate-loaded samples with the optimal production parameters, which was suitable for in vivo imaging analysis. In vitro study proved the low density, namely 507 mg/cm3, and the microCT record showed high porosity with 40 μm average size of bubbles in the molten suspension. The BaSO4-loaded samples showed hard structure at room temperature and during the wetting test, the complete wetting was detected after 120 min. During the in vivo study, the X-ray taken showed the retention of the formulation in the rat stomach after 2 h. We can conclude that with our device low-density floating formulations were prepared with prolonged gastric residence time. This study provides a promising platform for marketed active ingredients with low bioavailability.

Radiologic assessment of gastric emptying of water-soluble contrast media: New data security from a longitudinal study

BACKGROUND AND OBJECTIVES

Practice guidelines for preoperative fasting have not clearly established the fasting time needed after oral administration of water-soluble contrast media. The aim of this study was to determine the time required for the gastric emptying during the water-soluble contrast media in patients with acute abdominal pain.

METHODS

This prospective longitudinal study included sixty-eight patients older than 18 years of age with acute abdominal pain, who required a water-soluble contrast media enhanced abdominal computed tomography study. Plain radiographs were obtained hourly until complete the gastric emptying. Patients with probable bowel obstruction were not included in the study.

RESULTS

A total of 31 (45,6%), 54 (79,4%), and 64 (94,1%) patients achieved a complete gastric clearance of barium in 1, 2 and 3 hours, respectively. All patients achieved complete emptying of water-soluble contrast media within 6 hours. Gastric emptying time was not associated with gender (P=0,44), body mass index (P=.35), fasting time prior to water-soluble contrast media intake (P=0,12), administration of opioids in the emergency room (P=0,7), and the presence of comorbidities (P=0,36).

CONCLUSION

Ninety-four percent of the patients with acute abdominal pain achieved complete gastric emptying within 3hours after the administration of water-soluble contrast media. All of them achieved complete gastric emptying within 6hours. The results suggested 6hours after oral intake of the contrast media is enough to complete transit of water-soluble contrast media through the stomach and avoid unnecessary risks.

Bioaccessibility of barium from barite contaminated soils based on gastric phase in vitro data and plant uptake

Barite contamination of soil commonly occurs from either barite mining or explorative drilling operations. This work reported in vitro data for barite contaminated soils using the physiologically based extraction test (PBET) methodology. The existence of barite in plant tissue and the possibility of 'biomineralised' zones was also investigated using Scanning Electron Microscopy. Soils with low barium (Ba) concentrations showed a higher proportion of Ba extractability than barite rich samples. Barium uptake to spinach from soil was different between short term spiking studies and field weathered soils. Furthermore, Ba crystals were not evident in spinach tissue or acid digest solutions grown in barium nitrate spiked soils despite high accumulation. Barite was found in the plant digest solutions from barite contaminated soils only. Results indicate that under the conservative assumptions made, a child would need to consume extreme quantities of soil over an extended period to cause chronic health problems.

Functionalized synchrotron in-line phase-contrast computed tomography: a novel approach for simultaneous quantification of structural alterations and localization of barium-labelled alveolar macrophages within mouse lung samples

Functionalized computed tomography (CT) in combination with labelled cells is virtually non-existent due to the limited sensitivity of X-ray-absorption-based imaging, but would be highly desirable to realise cell tracking studies in entire organisms. In this study we applied in-line free propagation X-ray phase-contrast CT (XPCT) in an allergic asthma mouse model to assess structural changes as well as the biodistribution of barium-labelled macrophages in lung tissue. Alveolar macrophages that were barium-sulfate-loaded and fluorescent-labelled were instilled intratracheally into asthmatic and control mice. Mice were sacrificed after 24 h, lungs were kept in situ, inflated with air and scanned utilizing XPCT at the SYRMEP beamline (Elettra Synchrotron Light Source, Italy). Single-distance phase retrieval was used to generate data sets with ten times greater contrast-to-noise ratio than absorption-based CT (in our setup), thus allowing to depict and quantify structural hallmarks of asthmatic lungs such as reduced air volume, obstruction of airways and increased soft-tissue content. Furthermore, we found a higher concentration as well as a specific accumulation of the barium-labelled macrophages in asthmatic lung tissue. It is believe that XPCT will be beneficial in preclinical asthma research for both the assessment of therapeutic response as well as the analysis of the role of the recruitment of macrophages to inflammatory sites.

Bioavailability of barium to plants and invertebrates in soils contaminated by barite

Barium (Ba) is a nonessential element to terrestrial organisms and is known to be toxic at elevated concentrations. In this study, the bioavailability and toxicity of Ba in barite (BaSO4) contaminated soils was studied using standard test organisms (Lactuca sativa L. "Great Lakes", Eisenia fetida). Contamination resulted from barite mining activities. Barium concentrations in contaminated soils determined by X-ray fluorescence were in the range 0.13-29.2%. Barite contaminated soils were shown to negatively impact both E. fetida and L. sativa relative to control soil. For E. fetida, pore-water concentrations and acid extractable Ba were linearly related to % body weight loss. In L. sativa, pore-water Ba and exchangeable Ba were both strongly related to shoot Ba and shoot biomass production. A negative linear relationship was observed between shoot Ba content and shoot weight (P < 0.0004, R(2) = 0.39), indicating that Ba accumulation is likely to have induced phytotoxicity. Plant weights were correlated to % weight loss in earthworm (r = -0.568, P = 0.028). Barium concentrations in pore-water were lower than predicted from barite solubility estimates but strongly related to exchangeable Ba, indicating an influence of ion exchange on Ba solubility and toxicity to E. fetida and L. sativa.

Accelerating the transit time of barium sulphate suspensions in small bowel examinations

PURPOSE

To determine whether hyperosmolar and effervescent agents proven individually to accelerate transit time in the barium small bowel examination have an additive effect when combined, surpassing that of either agent alone.

MATERIALS AND METHODS

One hundred and forty-nine patients were randomised to four groups. Three hundred milliliters of barium sulphate alone was given to the first group. Fifteen milliliters of iodinated hyperosmolar contrast agent (Gastrografin, meglumine/sodium diatrizoate, Schering) was given in addition to barium sulphate to the second group while six packets of effervescent granules (Carbex, Ferring) were added for the third group. The final group was given a combination of both additives and barium sulphate. The time taken following ingestion for the contrast column to reach the caecum, as assessed by frequent interval fluoroscopy, was recorded. A subgroup of 32 patients were selected randomly from the four groups, 8 from each and assessed for quality of examination. Statistical assessments were made using Kruskal-Wallis and Mann-Whitney tests.

RESULTS

One hundred and nineteen patients were analysed after exclusions. The addition of accelerant to barium sulphate, both individually and in combination significantly reduced the small bowel transit time (p<0.001). No significant difference existed between the additives when used with barium alone. The combined group had significantly faster transit times compared to the hyperosmolar group (p=0.02). Differences between combined and effervescent groups tended towards significance (p=0.09). No significant difference existed between groups when examination quality was assessed.

CONCLUSION

These results suggest that the addition of combined effervescent and hyperosmolar agents to the barium suspension may significantly shorten the small bowel transit time without adversely affecting examination quality. This has implications for patient acceptability of the examination as well as potentially reducing screening time and therefore radiation dose.

Performance of polysulfone membrane dialyzers and dialysate flow pattern

BACKGROUND

It is important to observe the flow pattern of dialysate when evaluating dialyzer function and developing the most appropriate design. We investigated dialysate flow through two polysulfone membrane dialyzers (TS-UL [Toray Medical] and APS-S [Asahi Medical]) by computed tomography (CT), with barium sulfate as the contrast medium. We also performed a clinical comparison of these two dialyzers.

METHODS

For the in vitro experiment, after confirming the steady-state flow of mock blood (xanthan gum solution; 200 ml/min) and dialysate (500 ml/min), fresh dialysate, containing 5% (w/v) barium sulfate was perfused, and longitudinal CT scans of the dialyzer were obtained. Then the concentration of barium sulfate was measured (in Hounsfield units) in three fixed regions of interest. For the in vivo experiment, 12 patients on stable hemodialysis who had been using the APS-S for more than 1 month were switched to the TS-UL for 1 month and changes in various parameters were assessed.

RESULTS

The distribution of dialysate was homogeneous on CT scans of the TS-UL, but not on scans of the APS-S. The dialysate concentration curves for the three regions of interest were similar with the TS-UL, but not with the APS-S. Clearance of urea nitrogen and albumin loss were both significantly higher with the TS-UL than with the APS-S. The decrease in alpha 1-microglobulin was larger with the TS-UL than with the APS-S, but not significantly.

CONCLUSIONS

Clearance of substances over a wide range of molecular weights was higher with the TS-UL than with the APS-S, and differences in the design of the dialysate compartment may have been involved in this feature.

Clearance of barium from the oesophagus with diet cola and metoclopramide: a one stop approach to patients with dysphagia

AIM

To establish a "one-stop" dysphagia service in which a consultation, barium swallow and endoscopy can all be performed in the same hospital visit.

MATERIALS AND METHODS

In order to allow both barium swallow examination and endoscopy to be performed on the same day, a novel technique for clearing barium from the upper gastrointestinal tract was established. Following the barium swallow examination, patients were given diet cola and metoclopramide syrup. If appropriate, an upper gastrointestinal endoscopy was then performed shortly afterwards. The service was piloted for 6 months in which time 25 patients were investigated in this way.

RESULTS

All patients were seen within 2 weeks of referral. The mean time between barium swallow and endoscopy was 3 h 38 min (range, 1 h 50 min to 5 h 20 min). In all 24 patients in whom an endoscopy was performed, barium had been satisfactorily cleared from the oesophagus and stomach.

CONCLUSION

This technique allows both barium swallow and upper gastrointestinal endoscopy to be performed on the same day, providing a rapid, safe and accurate diagnosis with minimum patient inconvenience. Mitchell, J., (2001). Clinical Radiology56, 64-66

Inhalation of poorly soluble particles. I. Differences in inflammatory response and clearance during exposure

Results from animal studies have indicated some uncertainties over the validity of a single general occupational control limit for all types of "particulates (insoluble) not otherwise classified" (PNOC) (ACGIH, 2000). Therefore, to examine the extent to which a given control limit may be valid for nontoxic dusts with different physical characteristics, this study compared the pulmonary effects in rats of inhalation exposure to two poorly soluble dusts of similar density and with relatively low toxicity: titanium dioxide and barium sulfate. The objectives were to compare the dusts in (a) their buildup and clearance in the lungs during inhalation; (b) their transfer to lymph nodes; (c) the changes, with time, in the lavageable cell population; and (d) the pathological change from histology. The exposure aerosol concentrations were selected to achieve similar mass and volume lung burdens for both dusts and to attain "overload" over the common exposure periods of about 4 mo and 7 mo. Despite obtaining similar lung burdens for both dusts, there was significantly more translocation of TiO(2) to the hilar lymph nodes than with BaSO(4). It was also found that clearance of TiO(2) was retarded whereas clearance of BaSO(4) was not. Trends in these data were clarified by the use of a simple model of particle clearance. Retardation of particle clearance and translocation to the lymph nodes are markers of the condition known as "overload" in which the alveolar macrophage-based clearance of particles from the deep lung is impaired. In addition, bronchoalveolar lavage showed that TiO(2) caused significantly more recruitment of inflammatory neutrophils to lungs than BaSO(4). These differences between the dusts were not due to differences in toxicity, solubility, or lung deposition. The explanation that the different responses are due to the different particle size distributions of the two dust types is examined in a companion paper (Tran et al., this issue).

Polymer-coated gelatin capsules as oral delivery devices and their gastrointestinal tract behaviour in humans

In oral delivery of protein and peptide drugs there is a great need for suitable devices for delivering the therapeutic agent-incorporated microspheres selectively in the intestine. It is essential that the drug-loaded multiple unit carrier system should be protected from the harsh environment of the stomach and deliver the carrier system in the large intestine where drug action or absorption is desired. Gelatin capsules were coated with various concentrations of sodium alginate and cross-linked with appropriate concentrations of calcium chloride and tested in vitro for resistance to gastric and intestinal medium. Gelatin capsules coated with 20% w/v of the polymer which gave the most promising result in vitro were evaluated in human volunteers for their in vivo gastro intestinal tract behaviour. The radiographical studies show that while the uncoated gelatin capsules disintegrated in the stomach within 15 min of ingestion, the alginate coated gelatin capsules remained intact as long as they were retained in the stomach (up to 3 h) and then migrated to the ileocecal region of the intestine and disintegrated.

Changes in nasal cavity volume and target area of exposure to nasal drops with age in rats

The changes in the nasal cavity volume of rats with age and the area exposed to nasal drops administered into the nasal cavity were investigated. Results indicated that the nasal cavity volume lineally increased as rats grew older. In 7-week-old rats, the exposed area in the case of an administration volume of 25 microliters, based on practice, was naso-, maxillo-, and ethmoid turbinate and this volume was enough to expose the whole area of the nasal cavity including the ethmoid turbinate. On the other hand, in 27-week-old rats, administration volumes of 10 and 25 microliters were not enough to expose the ethmoid turbinate. This indicated that the exposed area tended to become narrower in 27-week-old rats than in 7-week-old rats, but the exposed area in the case of an administration volume of 50 microliters was naso-, maxillo-, and ethmoid turbinate in 27-week-old rats. In this case, the volume was enough to spread to the ethmoid turbinate. Differences in the exposed area might be caused by differences in the volume of the nasal cavity. It was also indicated that the main exposed area was the inferior meatus in the 30 min immediately after administration. At all administration volumes, however, notice should be taken of the outflow of nasal drops into the oral cavity through the nasopalatine.

[A study of aspiration in infants with recurrent pneumonia by Barium swallow examination using different concentrations of barium]

We conducted barium swallow examinations using different concentrations of barium sulfate suspension (10, 30, 60 w/v%) in infants with recurrent pneumonia. Aspiration of swallowed barium into the airway was demonstrated in 43 of 54 infants (44 of 56 examinations). Of these, 22 infants had no neurological or anatomical abnormality. In comparing the degree of aspiration and the barium concentration, it was found that the higher the concentration of barium, the less severe the degree of aspiration tended to be. There was no infant in whom thicker barium aggravated aspiration. The difference in the degree of aspiration was considered to be attributable to difference, in the viscosity of barium. The results of our study showed aspiration to the airway was more frequent than previously reported, and occurred even in infants without any other abnormality. The detectability of aspiration was dependent on the concentration of barium sulfate suspension. Because the viscosity of conventionally used milk is identical to that of 10-20 w/v% barium, 10-20 w/v% barium should be used in barium swallow examinations for infants with recurrent pneumonia.

Value of brominated fluorocarbons for the radiographic diagnosis of small-bowel obstruction: comparison with other contrast agents in rats

OBJECTIVE

The disadvantages of water-soluble gastrointestinal contrast agents include high osmolality, contrast dilution, and severe toxicity if aspirated. Perfluorocarbons are nontoxic in the lung and peritoneal cavity. Because perfluorocarbons are immiscible with water, they have no osmotic effect and cannot be diluted. Because these properties offer theoretical advantages over traditional gastrointestinal contrast agents, we compared two perfluorocarbons with barium and ionic and nonionic iodinated contrast material in a rat model of small-bowel obstruction.

MATERIALS AND METHODS

Twelve groups of six rats each had ligation of the terminal ileum (obstruction model) or of the terminal ileum and mesenteric artery (obstruction with ischemia model). Each rat received 3 ml of barium, meglumine sodium diatrizoate, iohexol, neat perfluorooctyl bromide, neat perfluorohexyl bromide, or saline (control animals). Contrast media were given at the recommended concentrations, and their progression was evaluated on serial radiographs by an observer who was not aware of the model or the contrast medium given. When one contrast material reached the point of obstruction, all rats in the group were sacrificed and a final radiograph was obtained. Three radiologists, who were not aware of the contrast medium given, on two separate occasions independently reviewed the radiographs and ranked the contrast agents for their relative radiopacity, mucosal definition, speed of transit, gastric retention, and bowel distension.

RESULTS

When data from both models were combined, perfluorocarbons were judged on the final image to be the most radiodense, to provide the sharpest mucosal detail, to have the least gastric retention, and to have faster progression than barium. Whereas meglumine sodium diatrizoate and iohexol reached the point of obstruction more rapidly than the perfluorocarbons and barium, they had the greatest gastric retention, caused the most bowel distension, and were the least radiopaque.

CONCLUSION

Our results show that the radiopaque perfluorocarbons are suitable as gastrointestinal contrast agents and have favorable radiographic characteristics in this animal model. When these results are combined with the low-toxicity profile of perflubron, clinical evaluation of this agent for the radiographic assessment of bowel obstruction is warranted.

Gastric emptying of tablets and granules in humans, dogs, pigs, and stomach-emptying-controlled rabbits

Rates of gastric emptying of nondigestible tablets and granules in humans were compared with those in three animal models: dogs, minipigs, and stomach-emptying-controlled rabbits. The rates of gastric emptying of both dosage forms in dogs tended to be faster than or similar to those in humans, whereas the rates in pigs were slower. In stomach-emptying-controlled rabbits, no tablets were emptied from the stomach because of their large size. The rate of gastric emptying of granules in rabbits was slow and variable. Food delayed gastric emptying in dogs, especially for tablets. In rabbits, the rate of gastric emptying of granules was faster when the granules were given before feeding, in comparison with that after feeding or under fasting conditions. We concluded that the dog is a better animal model for bioavailability studies under fasting conditions than the pig and the rabbit.

The effect of food on the movement of pellets in the gastro-intestinal tract

The effect of food on the movement of pellets in the gastro-intestinal tract was investigated in seven volunteers, either by means of X-rays taken after oral administration of barium sulfate pellets or by means of saliva concentration profiles of lithium obtained after oral administration of lithium sulfate controlled-release pellets. The X-ray studies showed that food had an effect on the time required for the pellets to leave the stomach and on their degree of dispersion in the small intestine, but not on other parameters. The studies with the lithium sulfate controlled-release pellets showed that food had a significant effect only in one in three subjects.