In vitro phototoxicity of 5-aminolevulinic acid and its methyl ester and the influence of barrier properties on their release from a bioadhesive patch.

opical administration of excess exogenous 5-aminolevulinic acid (ALA) leads to selective accumulation of the potent photosensitiser protoporphyrin IX (PpIX) in neoplastic cells, which can then be destroyed by irradiation with visible light. Due to its hydrophilicity, ALA penetrates deep lesions, such as nodular basal cell carcinomas (BCCs) poorly. As a result, more lipophilic esters of ALA have been employed to improve tissue penetration. In this study, the in vitro release of ALA and M-ALA from proprietary creams and novel patch-based systems across normal stratum corneum and a model membrane designed to mimic the abnormal stratum corneum overlying neoplastic skin lesions were investigated. Receiver compartment drug concentrations were compared with the concentrations of each drug producing high levels of PpIX production and subsequent light-induced kill in a model neoplastic cell line (LOX). LOX cells were found to be quite resistant to ALA- and M-ALA-induced phototoxicity. However, drug concentrations achieved in receiver compartments were comparable to those required to induce high levels of cell death upon irradiation in cell lines reported in the literature. Patches released significantly less drug across normal stratum corneum and significantly more across the model membrane. This is of major significance since the selectivity of PDT for neoplastic lesions will be further enhanced by the delivery system. ALA/M-ALA will only be delivered in significant amounts to the abnormal tissue. PpIX will only then accumulate in the neoplastic cells and the normal surrounding tissue will be unharmed upon irradiation.

Microneedle-mediated intradermal delivery of 5-aminolevulinic acid: potential for enhanced topical photodynamic therapy

Photodynamic therapy of deep or nodular skin tumours is currently limited by the poor tissue penetration of the porphyrin precursor 5-aminolevulinic acid (ALA). In this study, silicon microneedle arrays were used, for the first time, to enhance skin penetration of ALA in vitro and in vivo. Puncturing excised murine skin with 6x7 arrays of microneedles 270 mum in height, with a diameter of 240 mum at the base and an interspacing of 750 mum led to a significant increase in transdermal delivery of ALA released from a bioadhesive patch containing 19 mg ALA cm(-2). Microneedle puncture enhanced ALA delivery to the upper regions of excised porcine skin but, at mean depths of 1.875 mm, ALA concentrations were similar to control values, possibly reflecting binding of ALA by tissue components. However, and importantly, in vivo experiments using nude mice showed that microneedle puncture could reduce application time and ALA dose required to induce high levels of the photosensitiser protoporphyrin IX in skin. This clearly has implications for clinical practice, as shorter application times would mean improved patient and clinician convenience and also that more patients could be treated in the same session. As ALA is expensive and degrades rapidly via a second order reaction, reducing the required dose is also a notable advantage.

Environmental tolerances of free-living coralline algae (maerl): implications for European marine conservation

Maerl is a general term used for loose-lying subtidal beds of nodular coralline red algae. Maerl beds support high associated invertebrate and algal biodiversity, and are subject to European and UK conservation legislation. Previous investigations have shown European maerl to be ecologically fragile due to growth rates of approximately I mm per year. However, these very slow growth rates have hampered attempts to determine the key ecological requirements and sensitivity characteristics of living maerl. In this study, photosynthetic capacity determined by pulse amplitude modulated (PAM) fluorometry was used as a diagnostic of stress caused by various environmental conditions. Maerl species were exposed to a range of temperatures, salinities and light levels and to burial, fragmentation, desiccation and heavy metal treatment. Maerl was not as susceptible as previously assumed to extremes of salinity, temperature and heavy metal pollution, but burial, especially in fine or anoxic sediments, was lethal or caused significant stress. These data indicate that the main anthropogenic hazard for live maerl and the rich communities that depend on them is smothering by fine sediment, such as that produced by trawling or maerl extraction, from sewage discharges or shellfish and fish farm waste, and sedimentation resulting from disruption to tidal flow. (C) 2004 Elsevier Ltd. All rights reserved.

Influence of solution viscosity and injection protocol on distribution patterns of jet injectors: Application to photodynamic tumour targeting

Photodynamic therapy of deep or nodular skin tumours is currently limited by the poor tissue penetration of the porphyrin precursor 5-aminolevulinic acid (ALA) and preformed photosensitisers. In this study, we investigated the potential of jet injection to deliver both ALA and a preformed photosensitiser (meso-tetra (N-methyl-4-pyridyl) porphine tetra tosylate, TMP) into a defined volume of skin. Initial studies using a model hydrogel showed that as standoff distance is increased, injection depth decreases. As the ejected volume is increased, injection depth increases. It was also shown, for the first time, that, as injection solution viscosity was increased, for a given injection setting and standoff distance, both total depth of jet penetration, L-t, and depth at which the maximum width of the penetration pattern occurred, L-m, decreased progressively. For a standoff distance of zero, the maximum width of the penetration pattern, L-w, increased progressively with increasing viscosity at each of the injection settings. Conversely, when the standoff distance was 2.5 mm, L-w decreased progressively with increasing viscosity. Studies with neonate porcine skin revealed that an injection protocol comprising an 8.98 mPas solution, an arbitrary injection setting of 8 and a standoff distance of zero was capable of delivering photosensitisers to a volume of tissue (L-t of 2.91 mm, L-m of 2.14 mm, L-w of 5. 10 mm) comparable to that occupied by a typical nodular basal cell carcinoma. Both ALA and TMP were successfully delivered using jet injection, with peak tissue concentrations (67.3 mg cm(-3) and 5.6 mg cm(-3), respectively) achieved at a depth of around 1.0 mm and substantial reductions in drug concentration seen at depths below 3.0 mm. Consequently, jet injection may be suitable for selective targeting of ALA or preformed photosensitisers to skin tumours. (c) 2007 Elsevier B.V. All rights reserved.

Hexyl Aminolaevulinate Is a More Effective Topical Photosensitiser Precursor than Methyl Aminolaevulinate and 5-Aminolaevulinic Acids When Applied in Equimolar Doses

Aminolaevulinic acid (ALA) is known to poorly penetrate into thick lesions, such as nodular basal cell carcinomas Short chain ALA esters, possessing increased lipophilicity relative to their hydrophilic parent, have previously been shown to be highly efficient at inducing protoporphyrin IX (PpIX) production in cell culture, at equimolar concentrations. In contrast, in vitro skin permeation and in vivo animal studies, which up to now have compared prodrugs on a % w/vv basis, have failed to demonstrate such benefits For the first time, equimolar concentrations of ALA, methyl-ALA (m-ALA) and hexyl-ALA (h-ALA) have been incorporated into an o/w cream preparation. In vitro penetration studies into excised porcine skin revealed that increased levels of h-ALA, compared to ALA and m-ALA were found in the upper skin layers, at all drug loadings studied. Topical application of the formulations to nude murine skin in vivo, revealed that creams containing h-ALA induced significantly higher levels of peak PpIX fluorescence (F-max = 289.0) at low concentrations compared to m-ALA (F-max = 159.2) and ALA (F-max = 191 9). Importantly, this study indicates that when compared on an equimolar basis, h-ALA has improved skin penetration, leading to enhanced PpIX production compared to the parent drug and m-ALA (C) 2010 Wiley-Liss, Inc and the American Pharmacists Association J Pharm Sci 99 3486-3498, 2010

Influence of penetration enhancers on topical delivery of 5-aminolevulinic acid from bioadhesive patches

Objectives The inclusion 01 chemical penetration enhancers in a novel patch-based system for the delivery of 5-aminolevulinic acid (ALA) was examined in vitro and in vivo. Poor penetration of ALA has been implicated as the primary factor for low response rates achieved with topical ALA-based photodynamic therapy of thicker neoplastic lesions. such as nodular basal cell carcinomas.

Deposit-feeding mechanisms and resource partitioning in tropical holothurians

Aspidochirote holothurians found on tropical reef flats feed on particulate deposits which form a variety of substrata. The synaptid holothurian Opheodesoma grisea (Semper) feeds in a similar manner by scraping deposits from the surfaces of sea grasses. Distributional and gut content analyses showed that species partitioning is on the basis of substratum and particle size preference. Scanning electron microscopy revealed that the tentacles of aspidochirotes have a nodular surface while those of O. grisea have a tessellated surface structure. The twelve different species examined were shown to have different tentacular surface textures which bore an apparent relationship with the mean particle sizes selected by the different species. Light microscope studies of tentacle sections confirmed earlier observations on the extent of the water vascular system in aspidochirote and pinnate tentacles. From these observations a functional interpretation is proposed for tentacular operation and the means of particle selection in such holothurians.

Laterite as a disinfectant.

A groundwater programme monitoring flow and quality of a potable water spring in a slum district in Kampala, Uganda revealed that although latrines acted as the principal means of organic waste disposal for the 1000 plus people living in the spring’s catchment, levels of faecal indicator bacteria (TVC 45 Deg C) in spring discharge remained at or below detection during the dry season, despite the presence of high levels of chloride (45mg/l-56mg/l) and nitrate (23mg/l – 30mg/l NO3-N), indicating sewage impacts. A programme of column and batch testing of laterite underlying the area provided a means of investigating the soil’s attenuation capacity under more controlled conditions.
X-ray diffraction analyses revealed the laterite to be dominated by quartz and kaolinite with minor (<5% by volume) quantities of haematite. Batch studies revealed that over 99% of bacteriophage adsorbed to haematite in less than 5 minutes. By contrast batch tests on haematite-free soil samples from the Blue Hills in Australia showed that although they had comparable dominant mineralogy and iron coverage on their surfaces (determined from Energy dispersive X-ray fluorescence) they had negligible ability to adsorb H40/1.
Based on the results of the batch studies using natural soils, a programme of batch studies, undertaken using pure haematite showed the mineral to have an extremely high capacity to adsorb bacteriophage, and suggested that it was responsible for the levels of attenuation observed.
The results of column studies were in keeping with the findings of batch experiments. Injection of 20 pore volumes of 300 pfu/mL of the bacteriophage H40/1 into a 20mm diameter glass column packed with sand sized (Ø>500µm) laterite revealed that the column could irreversibly remove over 2.5 log10 bacteriophage over its 10cm length.
Importance:
Mineralogical and batch test data provide convincing evidence to show that laterite can potentially act as an inexpensive means of removing micro organisms from water. The material, particularly in nodular form, displays considerable potential to act as an alternative filter material to conventional quartz filter sands.

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

OBJECTIVES: Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

Doença de Behçet - Infliximab no Tratamento das Manifestações Mucocutâneas

A Doença de Behçet (DB) é uma doença inflamatória multisistémica, crónica e recidivante, cujo diagnóstico é essencialmente clínico. Em estudos recentes, os antagonistas do factor de necrose tumoral a têm mostrado bons resultados no tratamento das manifestações mucocutâneas da DB. Os autores descrevem três casos de DB com envolvimento mucocutâneo grave tratados com infliximab. Caso Clínico 1: Doente do sexo feminino de 16 anos de idade, com aftose bipolar grave com 8 anos de evolução. Verificou-se uma rápida resposta clínica à terapêutica biológica, com remissão parcial e total das úlceras à 2ª e 6ª semana de tratamento, respectivamente Caso Clínico 2: Doente do sexo feminino de 56 anos de idade com paniculite nodular crónica dos membros inferiores, artralgias e ulcerações orogenitais recorrentes. Após 6 semanas de terapêutica com infliximab, verificou-se uma remissão clínica completa. Caso Clínico 3: Doente do sexo feminino de 50 anos de idade, com ulcerações orofaríngeas recorrentes com 15 anos de evolução. Observou-se uma boa resposta clínica à terapêutica biológica, que foi interrompida à 22ª semana por abcessos dentários recorrentes. Na nossa experiência, o infliximab é uma alternativa terapêutica eficaz a considerar na presença de manifestações mucocutâneas resistentes aos tratamentos convencionais.

Propylthiouracil Induced Pulmonary-Renal Syndrome: a Case Report.

Propylthiouracil (PTU) is known to induce antineutrophil cytoplasmatic antibody (ANCA) seropositivity; however, small vessel vasculitis (SVV) with pulmonary and renal involvement is rare. We present the case of an 81-year-old woman on PTU treatment due to toxic nodular goitre who developed alveolar hemorrhage and rapidly progressive glomerulonephritis. The authors highlight the importance of early recognising drug-induced pulmonary-renal syndrome (PRS) in order to avoid unnecessary tests, a delay in the diagnosis and evolution to end-stage kidney disease or life-threatening conditions.

Transient ocular motor nerve palsies associated with presumed cranial nerve schwannomas.

BACKGROUND: Cranial nerve schwannomas are radiologically characterized by nodular cranial nerve enhancement on magnetic resonance imaging (MRI). Schwannomas typically present with gradually progressive symptoms, but isolated reports have suggested that schwannomas may cause fluctuating symptoms as well. METHODS: This is a report of ten cases of presumed cranial nerve schwannoma that presented with transient or recurring ocular motor nerve deficits. RESULTS: Schwannomas of the third, fourth, and fifth nerves resulted in fluctuating deficits of all 3 ocular motor nerves. Persistent nodular cranial nerve enhancement was present on sequential MRI studies. Several episodes of transient oculomotor (III) deficts were associated with headaches, mimicking ophthalmoplegic migraine. CONCLUSIONS: Cranial nerve schwannomas may result in relapsing and remitting cranial nerve symptoms.

Microfacies analysis of the lower paleocene beda formation in Western Concession 59 and Block 59F, Sirte Basin, Libya /

The rock sequence of the Tertiary Beda Formation of S. W. concession 59 and 59F block in Sirte Basin of Libya has been subdivided into twelve platformal carbonate microfacies. These microfacies are dominated by muddy carbonates, such as skeletal mudstones, wackestones, and packstones with dolomites and anhydrite. Rock textures, faunal assemblages and sedimentary structures suggest shallow, clear, warm waters and low to moderate energy conditions within the depositional shelf environment. The Beda Formation represents a shallowing-upward sequence typical of lagoonal and tidal flat environments marked at the top by sabkha and brackish-water sediments. Microfossils include benthonic foraminifera, such as miliolids, Nummulites, - oerculina and other smaller benthonics, in addition to dasycladacean algae, ostracods, molluscs, echinoderms, bryozoans and charophytes. Fecal pellets and pelloids, along with the biotic allochems, contributed greatly to the composition of the various microfacies. Dolomite, where present, is finely crystalline and an early replacement product. Anhydrite occurs as nodular, chickenwire and massive textures indicating supratidal sabkha deposition. Compaction, micr it i zat ion , dolomit izat ion , recrystallization, cementation, and dissolution resulted in alteration and obliteration of primary sedimentary structures of the Beda Formation microfacies. The study area is located in the Gerad Trough which developed as a NE-SW trending extensional graben. The Gerad trough was characterized by deep-shallow water conditions throughout the deposition of the Beda Formation sediments. The study area is marked by several horsts and grabens; as a result of extent ional tectonism. The area was tectonically active throughout the Tertiary period. Primary porosity is intergranular and intragranular, and secondary processes are characterized by dissolution, intercrystalline, fracture and fenestral features. Diagenesis, through solution leaching and dolomitization, contributed greatly to porosity development. Reservoir traps of the Beda Formation are characterized by normal fault blocks and the general reservoir characteristics/properties appear to be facies controlled.

Sedimentology and taphonomy of storm-generated shell beds from the Verulam formation (Ordovician), Lakefield and Gamebridge quarries, Southern Ontario, Canada /

The Verulam Formation (Middle Ordovician) at the Lakefield Quarry and Gamebridge Quarry, southern Ontario, is comprised of five main lithofacies. These include shoal deposits consisting of Lithofacies 1, winnowed crinoidal grainstones and, shelf deposits consisting of: Lithofacies 2, wackestones, packstones, grainstones, and rudstones; Lithofacies 3, laminated calcisiltites; Lithofacies 4, nodular wackestones and mudstones; and, Lithofacies 5, laminated mudstones and shales. The distribution of the lithofacies was influenced by variations in storm frequency and intensity during a relative sea level fall. Predominant convex-up attitudes of concavo-convex shells within shell beds suggest syndepositional reworking during storm events. The bimodal orientations of shell axes on the upper surfaces of the shell beds indicates deposition under wave-generated currents. The sedimentary features and shell orientations indicate that the shell beds were deposited during storm events and not by the gradual accumulation of shelly material. Cluster and principal component analysis of relative abundance data of the taxa in the shell beds, interbedded nodular wackestones and mudstones, and laminated mudstones and shales, indicates one biofacies comprised of three main assemblages: a strophomenid (Sowerbyelladominated) assemblage, a transitional mixed strophomenid-atrypid assemblage and an atrypid (Zygospira-dominatQd) assemblage. The occurrence of the strophomenid, the strophomenid-atrypid and atrypid assemblages were controlled by storm-driven allogenic taphonomic feedback.

Sobrevida de pacientes pediátricos con enfermedad de Hodgkin en la Fundación Hospital de la Misericordia

Propósito: en Colombia el linfoma es el tercer tipo de cáncer en los niños (3). El objetivo del presente trabajo fue establecer la sobrevida global en pacientes menores de 18 años con enfermedad de Hodgkin en la Fundación Hospital de la Misericordia Bogotá - Colombia en el periodo comprendido entre el 1 de Enero de 2000 hasta el 30 de enero de 2007. Métodos: se realizó un estudio de sobrevida en 49 pacientes tratados con protocolos T1 (2000 – 2004) y T2 (2005 – 2007). Resultados: de 1687 casos de tumores sólidos en 22 años en el servicio de oncología, 440 corresponden a linfoma y 206 a EH (12%). 49 pacientes fueron tratados con los esquemas de quimioterapia sometidos a análisis. 37 (75,5%) pacientes eran niños, el promedio de edad fue 9 años. Más del 90% presentaban enfermedad supradiafragmática, la histología más frecuente fue esclerosis nodular. El estado IIIB se observó en 15 pacientes (30,6%). La sobrevida global de niños sin remisión con tratamiento de primera línea, fue 0%, con estado IV 60%, de acuerdo a tratamiento: T1 fue de 76% y con T2 95%. Discusión: el presente análisis muestra que la sobrevida global con T2 es mayor que con T1, identifica como factores de riesgo de mal pronóstico: la no remisión con tratamiento de primera línea y el estado de la enfermedad. Los síntomas B, el subtipo histológico y la edad no mostraron diferencias significativas pronosticas.