Ottimizzazione di un protocollo di anticoagulazione regionale con citrato in CRRT

Ottimizzazione di un protocollo di anticoagulazione regionale con citrato in CRRT Introduzione: La necessità di un'anticoagulazione continua e l'ipofosforemia in corso di trattamento sono problemi costranti in corso di CRRT. Il nostro studio ha cercato di dimostrare l'efficacia e la sicurezza dell'anticoagulazione regionale con citrato in CVVH basato sull'utilizzo di una soluzione di citrato (18 mmol/L) associata ad una soluzione di reinfusione contenente fosfato, recentemente disponibile in commercio, al fine di ridurre l'ipofosfatemia in corso di CRRT. Metodi: Abbiamo utilizzato il nostro protocollo basato sull'utilizzo di una concentrazione di citrato contenente 18 mmol/l associata ad una soluzione di reinfusione contenente fosfato in un piccolo gruppo di pazienti ricoverati in terapia intensiva post-cardiochirurgica, sottoposti a CRRT per insufficienza renale acuta. Risultati: Il nostro protocollo ha garantito un'adeguata durata del circuito ed un ottimo controllo dell'equilibrio acido-base in ogni paziente. E' stata necessaria solo una minima supplementazione di fosforo in alcuni dei pazienti trattati. Conclusioni: Il nostro protocollo basato sull' utilizzo di una soluzione a concentrazione di citrato maggiore (18 mmol/l), permette un miglior controllo dell'equilibrio acido-base rispetto all'utilizzo della soluzione a più bassa concentrazione di citrato. L'uso di una minore dose di citrato ed il mantenimento di un target maggiore di calcio ionizzato all'interno del circuito sono comunque associati ad un'adeguata durata del circuito. I livelli di fosforemia sono rimasti sostanzialmente stabili nella maggior parte dei pazienti trattati, grazie alla presenza di fosfato nella soluzione utilizzata come reinfusione in post-diluizione.

Uptake of gold nanoparticles in microvascular endothelial cells

The physicochemical properties of nanoparticles make them suitable for biomedical applications. Due to their ‘straight-forward’ synthesis, their known biocompatibility, their strong optical properties, their ability for targeted drug delivery and their uptake potential into cells gold nanoparticles are highly interesting for biomedical applications. In particular, the therapy of brain diseases (neurodegenerative diseases, ischemic stroke) is a challenge for contemporary medicine and gold nanoparticles are currently being studied in the hope of improving drug delivery to the brain.rnIn this thesis three major conclusions from the generated data are emphasized.rn1. After improvement of the isolation protocol and culture conditions, the formation of a monolayer of porcine brain endothelial cells on transwell filters lead to a reproducible and tight in vitro monoculture which exhibited in vivo blood brain barrier (BBB) characteristics. The transport of nanoparticles across the barrier was studied using this model.rn2. Although gold nanoparticles are known to be relatively bioinert, contaminants of the nanoparticle synthesis (i.e. CTAB or sodium citrate) increased the cytotoxicity of gold nanoparticles, as shown by various publications. The results presented in this thesis demonstrate that contaminants of the nanoparticle synthesis such as sodium citrate increased the cytotoxicity of the gold nanoparticles in endothelial cells but in a more dramatic manner in epithelial cells. Considering the increased uptake of these particles by epithelial cells compared to endothelial cells it was demonstrated that the observed decrease of cell viability appeared to be related to the amount of internalized gold nanoparticles in combination with the presence of the contaminant.rn3. Systematically synthesized gold nanoparticles of different sizes with a variety of surface modifications (different chemical groups and net charges) were investigated for their uptake behaviour and functional impairment of endothelial cells, one of the major cell types making up the BBB. The targeting of these different nanoparticles to endothelial cells from different parts of the body was investigated in a comparative study of human microvascular dermal and cerebral endothelial cells. In these experiments it was demonstrated that different properties of the nanoparticles resulted in a variety of uptake patterns into cells. Positively charged gold nanoparticles were internalized in high amounts, while PEGylated nanoparticles were not taken up by both cell types. Differences in the uptake behavior were also demonstrated for neutrally charged particles of different sizes, coated with hydroxypropylamine or glucosamine. Endothelial cells of the brain specifically internalized 35nm neutrally charged hydroxypropylamine-coated gold nanoparticles in larger amounts compared to dermal microvascular endothelial cells, indicating a "targeting" for brain endothelial cells. Co-localization studies with flotillin-1 and flotillin-2 showed that the gold nanoparticles were internalized by endocytotic pathways. Furthermore, these nanoparticles exhibited transcytosis across the endothelial cell barrier in an in vitro BBB model generated with primary porcine brain endothelial cells (1.). In conclusion, gold nanoparticles with different sizes and surface characteristics showed different uptake patterns in dermal and cerebral endothelial cells. In addition, gold nanoparticles with a specific size and defined surface modification were able to cross the blood-brain barrier in a porcine in vitro model and may thus be useful for controlled delivery of drugs to the brain.

Bindeprotein-abhängige DctS-Sensorkinasen aus Bacillus subtilis und Geobacillus kaustophilus

Das Enterobakterium Escherichia coli sowie das Bodenbakterium Bacillus subtilis können C4-Dicarbonsäuren als aerobe Kohlenstoffquelle zur Energiekonservierung nutzen. Die Regulation des C4-Dicarboxylatstoffwechsels erfolgt in E. coli und B. subtilis durch das Zweikomponentensystem DcuSREc bzw. DctSRBs, bestehend aus einer Sensorkinase und einem Responseregulator. Diese kontrollieren die Expression des C4-Dicarboxylat-Transporters DctA. Der Sensor DcuSEc benötigt für seine Funktion im aeroben Stoffwechsel den Transporter DctA als Cosensor. Für das DctSRBs-System gibt es Hinweise aus genetischen Untersuchungen, dass DctSBs das Bindeprotein DctBBs und möglicherweise auch DctABs als Cosensoren für seine Funktion benötigt. In dieser Arbeit sollte ein direkter Nachweis geführt werden, ob DctBBs und DctABs gemeinsam oder nur jeweils eine der Komponenten als Cosensoren für DctSBs fungieren. Sowohl für DctBBs als auch für DctABs wurde eine direkte Protein-Protein-Interaktion mit DctSBs durch zwei in vivo Interaktionsmethoden nachgewiesen. Beide Methoden beruhen auf der Co-Reinigung der Interaktionspartner mittels Affinitätschromatographie und werden je nach Affinitätssäule als mSPINE oder mHPINE (Membrane Strep/His-Protein INteraction Experiment) bezeichnet. Die Interaktion von DctSBs mit DctBBs wurde zusätzlich über ein bakterielles Two-Hybrid System nachgewiesen. Nach Coexpression mit DctSBs interagieren DctABs und DctBBs in mSPINE-Tests gleichzeitig mit der Sensorkinase. DctSBs bildet somit eine sensorische DctS/DctA/DctB-Einheit in B. subtilis und das Bindeprotein DctBBs agiert nur als Cosensor, nicht aber als Transport-Bindeprotein. Eine direkte Interaktion zwischen dem Transporter DctABs und dem Bindeprotein DctBBs besteht nicht. Transportmessungen belegen, dass der DctA-vermittelte Transport von [14C]-Succinat unabhängig ist von DctBBs. Außerdem wurde untersucht, ob Zweikomponentensysteme aus anderen Bakteriengruppen nach einem ähnlichen Schema wie DcuSREc bzw. DctSRBs aufgebaut sind. Das thermophile Bakterium Geobacillus kaustophilus verfügt über ein DctSR-System, welches auf genetischer Ebene mit einem Transporter des DctA-Typs und einem DctB-Bindeprotein geclustert vorliegt. Die Sensorkinase DctSGk wurde in E. coli heterolog exprimiert und gereinigt. Diese zeigt in einer E. coli DcuS-Insertionsmutanten Komplementation der DcuS-Funktion und besitzt dabei Spezifität für die C4-Dicarbonsäuren Malat, Fumarat, L-Tartrat und Succinat sowie für die C6-Tricarbonsäure Citrat. In Liposomen rekonstituiertes DctSGk zeigt Autokinase-Aktivität nach Zugabe von [γ-33P]-ATP. Der KD-Wert für [γ-33P]-ATP der Kinasedomäne von DctSGk liegt bei 43 μM, die Affinität für ATP ist damit etwa 10-fach höher als in DcuSEc.

Signalerkennung und Signaltransduktion im DctA,DcuS-Sensor-Regulatorkomplex von Escherichia coli.

E. coli ist in der Lage unter aeroben sowie anaeroben Bedingungen C4-Dicarbonsäuren zur Energiekonservierung zu nutzen. Das DcuS/DcuR-Zweikomponentensystem detektiert diese und reguliert die Gene für den C4-Dicarboxylat-Transport und Metabolismus. Dabei hängt die Sensitivität der Sensorkinase DcuS für C4-Dicarbonsäuren von der Anwesenheit des aeroben Symporters DctA oder des anaeroben Antiporters DcuB ab. Diese bifunktionalen Transporter bilden mit DcuS über direkte Protein-Protein-Wechselwirkungen Sensoreinheiten. In dieser Arbeit wurden die Funktionen von DctA und DcuS im DctA/DcuS-Sensorkomplex analysiert. Mit DctA(S380D) wurde eine Variante des Transporters identifiziert, in der die regulatorische Eigenschaft von der katalytischen Funktion entkoppelt ist. Stämme von E. coli, die den DctA(S380D)/DcuS-Sensorkomplex enthielten, waren in der Lage C4-Dicarbonsäuren wahrzunehmen, obwohl die Transportfunktion von DctA inaktiviert war. Zudem wurden Unterschiede in den Substratspektren von DctA und DcuS festgestellt. Citrat, ein guter Effektor des DctA/DcuS-Sensorkomplexes, wurde durch DctA nicht gebunden oder transportiert. Anhand von Titrationsexperimenten mit variierenden DctA-Mengen wurde außerdem nachgewiesen, dass die Sensitivität von DcuS für seine Effektoren von der DctA-Konzentration abhängig ist. Es konnte gezeigt werden, dass DctA im DctA/DcuS-Sensorkomplex nicht an der Erkennung von C4-Dicarbonsäuren beteiligt ist. DcuS stellt die Signaleingangsstelle des Komplexes dar, während DctA durch seine Anwesenheit die Sensorkinase in eine funktionsbereite oder sensitive Form überführt, die auf Effektoren reagieren kann. Darüber hinaus wurde die Rolle der Transmembranhelices TM1 und TM2 von DcuS für die Funktion und Dimerisierung der Sensorkinase untersucht. Durch Sequenzanalysen wurden „SmallxxxSmall“-Motive, deren Relevanz als Dimerisierungsschnittstellen bereits in Transmembranhelices anderer Proteine nachgewiesen wurde, in TM1 sowie TM2 identifiziert. Die Homodimerisierung beider Transmembrandomänen wurde im GALLEX Two-Hybrid System nachgewiesen, wobei die TM2-TM2-Interaktion stärker war. Die Substitution G190A/G194A im SxxxGxxxG-Tandemmotiv von TM2 rief zudem einen deutlichen Funktionsverlust der Sensorkinase hervor. Dieser Aktivitätsverlust korrelierte mit Störungen der Homodimerisierung von TM2(G190A/G194A) sowie DcuS(G190A/G194A) bei bakteriellen Two-Hybrid Messungen im GALLEX- bzw. BACTH-System. Demzufolge agiert Transmembranhelix 2 mit seinem SxxxGxxxG-Sequenzmotiv als wesentliche Homodimerisierungsstelle in DcuS. Die Dimerisierung von DcuS ist essentiell für die Funktion der Histidinkinase. Zusätzlich wurde bei fluoreszenzmikroskopischen Studien durch Koexpression von DcuS bzw. DctA die zelluläre Kolokalisierung von DctA und DcuR mit DcuS sowie DauA mit DctA nachgewiesen. Die DctA/DcuS-Sensoreinheit kann demnach zum DauA/DctA/DcuS/DcuR-Komplex erweitert werden.

Synthesis and functionalization of a lactam-pyrazole molecular scaffold as a promising anticancer compound

The importance of pyrazole and lactam-based molecules in medical and pharmaceutical fields is underlined by the multitude of active ingredients on trade, such as Sildenafil or Apixaban, by Pfizer. In this work, a synthesis of an organic molecule with promising anticancer activity has been developed. This molecular scaffold is characterized by a δ-lactam-fused pyrazolic core, with a well-known biological activity and amenable of further functionalization. The synthetic strategy adopted for the obtainment of the core was based on a 1,3-dipolar cycloaddition of a nitrilimine with an α,β-unsaturated δ-lactam. Secondly, in order to give the final compound an elevated pharmacological activity, a functionalization with a double “side chain”, namely molecular fragment able to improve the interaction with particular biological receptors, was achieved. The target compound was thus obtained, with a highly convergent synthesis, and will be tested for antiproliferative activities towards different cellular lines.

MR spectroscopy in human prostate: in vitro and in vivo measurements to optimize new quantification algorithms

Il cancro della prostata (PCa) è il tumore maligno non-cutaneo più diffuso tra gli uomini ed è il secondo tumore che miete più vittime nei paesi occidentali. La necessità di nuove tecniche non invasive per la diagnosi precoce del PCa è aumentata negli anni. 1H-MRS (proton magnetic resonance spectroscopy) e 1H-MRSI (proton magnetic resonance spectroscopy imaging) sono tecniche avanzate di spettroscopia in risonanza magnetica che permettono di individuare presenza di metaboliti come citrato, colina, creatina e in alcuni casi poliammine in uno o più voxel nel tessuto prostatico. L’abbondanza o l’assenza di uno di questi metaboliti rende possibile discriminare un tessuto sano da uno patologico. Le tecniche di spettroscopia RM sono correntemente utilizzate nella pratica clinica per cervello e fegato, con l’utilizzo di software dedicati per l’analisi degli spettri. La quantificazione di metaboliti nella prostata invece può risultare difficile a causa del basso rapporto segnale/rumore (SNR) degli spettri e del forte accoppiamento-j del citrato. Lo scopo principale di questo lavoro è di proporre un software prototipo per la quantificazione automatica di citrato, colina e creatina nella prostata. Lo sviluppo del programma e dei suoi algoritmi è stato portato avanti all’interno dell’IRST (Istituto Romagnolo per lo Studio e la cura dei Tumori) con l’aiuto dell’unità di fisica sanitaria. Il cuore del programma è un algoritmo iterativo per il fit degli spettri che fa uso di simulazioni MRS sviluppate con il pacchetto di librerie GAMMA in C++. L’accuratezza delle quantificazioni è stata testata con dei fantocci realizzati all’interno dei laboratori dell’istituto. Tutte le misure spettroscopiche sono state eseguite con il nuovo scanner Philips Ingenia 3T, una delle machine di risonanza magnetica più avanzate per applicazioni cliniche. Infine, dopo aver eseguito i test in vitro sui fantocci, sono stati acquisiti gli spettri delle prostate di alcuni volontari sani, per testare se il programma fosse in grado di lavorare in condizioni di basso SNR.

Quantitative evaluation of cellular uptake and trafficking of plain and polyethylene glycol-coated gold nanoparticles

This study addresses the cellular uptake and intracellular trafficking of 15-nm gold nanoparticles (NPs), either plain (i.e., stabilized with citrate) or coated with polyethylene glycol (PEG), exposed to human alveolar epithelial cells (A549) at the air-liquid interface for 1, 4, and 24 h. Quantitative analysis by stereology on transmission electron microscopy images reveals a significant, nonrandom intracellular distribution for both NP types. No particles are observed in the nucleus, mitochondria, endoplasmic reticulum, or golgi. The cytosol is not a preferred cellular compartment for both NP types, although significantly more PEG-coated than citrate-stabilized NPs are present there. The preferred particle localizations are vesicles of different sizes (<150, 150-1000, >1000 nm). This is observed for both NP types and indicates a predominant uptake by endocytosis. Subsequent inhibition of caveolin- and clathrin-mediated endocytosis by methyl-beta-cyclodextrin (MbetaCD) results in a significant reduction of intracellular NPs. The inhibition, however, is more pronounced for PEG-coated than citrate-stabilized NPs. The latter are mostly found in larger vesicles; therefore, they are potentially taken up by macropinocytosis, which is not inhibited by MbetaCD. With prolonged exposure times, both NPs are preferentially localized in larger-sized intracellular vesicles such as lysosomes, thus indicating intracellular particle trafficking. This quantitative evaluation reveals that NP surface coatings modulate endocytotic uptake pathways and cellular NP trafficking. Other nonendocytotic entry mechanisms are found to be involved as well, as indicated by localization of a minority of PEG-coated NPs in the cytosol.

Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis

The aim of this study was to assess the prevalence of incomplete distal renal tubular acidosis (idRTA) in men with recurrent calcium nephrolithiasis and its potential impact on bone mineral density. We conducted a retrospective analysis of 150 consecutive, male idiopathic recurrent calcium stone formers (RCSFs), which had originally been referred to the tertiary care stone center of the University Hospital of Berne for further metabolic evaluation. All RCSFs had been maintained on a free-choice diet while collecting two 24-h urine samples and delivered second morning urine samples after 12 h fasting. Among 12 RCSFs with a fasting urine pH >5.8, a modified 3-day ammonium chloride loading test identified idRTA in 10 patients (urine pH >5.32, idRTA group). We matched to each idRTA subject 5 control subjects from the 150 RCSFs, primary by BMI and then by age, i.e., 50 patients, without any acidification defect (non-RTA group) for comparative biochemistry and dual energy X-ray absorptiometry (DEXA) analyses. The prevalence of primary idRTA among RCSFs was 6.7% (10/150). Patients with idRTA had significantly higher 2-h fasting and 24-h urine pH (2-h urine pH: 6.6 ± 0.4 vs. 5.2 ± 0.1, p = 0.001; 24-h urine pH: 6.1 ± 0.2 vs. 5.3 ± 0.3, p = 0.001), 24-h urinary calcium excretion (7.70 ± 1.75 vs. 5.69 ± 1.73 mmol/d, p = 0.02), but significantly lower 24-h urinary urea excretion (323 ± 53 vs. 399 ± 114 mmol/d, p = 0.01), urinary citrate levels (2.32 ± 0.82 vs. 3.01 ± 0.72 mmol/d, p = 0.04) and renal phosphate threshold normalized for the glomerular filtration rate (TmPO(4)/GFR: 0.66 ± 0.17 vs. 0.82 ± 0.21, p = 0.03) compared to non-RTA patients. No significant difference in bone mineral density (BMD) was found between idRTA and non-RTA patients for the lumbar spine (LS BMD (g/cm(2)): 1.046 ± 0.245 SD vs. 1.005 ± 0.119 SD, p = 0.42) or femoral neck (FN BMD (g/cm(2)): 0.830 ± 0.135 SD vs. 0.852 ± 0.127 SD). Thus, idRTA occurs in 1 in 15 male RCSFs and should be sought in all recurrent calcium nephrolithiasis patients. Bone mineral density, however, does not appear to be significantly affected by idRTA.

Synthesis, maturation, and trafficking of human Na+-dicarboxylate cotransporter NaDC1 requires the chaperone activity of cyclophilin B

Renal excretion of citrate, an inhibitor of calcium stone formation, is controlled mainly by reabsorption via the apical Na(+)-dicarboxylate cotransporter NaDC1 (SLC13A2) in the proximal tubule. Recently, it has been shown that the protein phosphatase calcineurin inhibitors cyclosporin A (CsA) and FK-506 induce hypocitraturia, a risk factor for nephrolithiasis in kidney transplant patients, but apparently through urine acidification. This suggests that these agents up-regulate NaDC1 activity. Using the Xenopus lævis oocyte and HEK293 cell expression systems, we examined first the effect of both anti-calcineurins on NaDC1 activity and expression. While FK-506 had no effect, CsA reduced NaDC1-mediated citrate transport by lowering heterologous carrier expression (as well as endogenous carrier expression in HEK293 cells), indicating that calcineurin is not involved. Given that CsA also binds specifically to cyclophilins, we determined next whether such proteins could account for the observed changes by examining the effect of selected cyclophilin wild types and mutants on NaDC1 activity and cyclophilin-specific siRNA. Interestingly, our data show that the cyclophilin isoform B is likely responsible for down-regulation of carrier expression by CsA and that it does so via its chaperone activity on NaDC1 (by direct interaction) rather than its rotamase activity. We have thus identified for the first time a regulatory partner for NaDC1, and have gained novel mechanistic insight into the effect of CsA on renal citrate transport and kidney stone disease, as well as into the regulation of membrane transporters in general.

Au@Hg nanoalloy formation through direct amalgamation: Structural, spectroscopic, and computational evidence for slow nanoscale diffusion

Dynamic core-shell nanoparticles have received increasing attention in recent years. This paper presents a detailed study of Au-Hg nanoalloys, whose composing elements show a large difference in cohesive energy. A simple method to prepare Au@Hg particles with precise control over the composition up to 15 atom% mercury is introduced, based on reacting a citrate stabilized gold sol with elemental mercury. Transmission electron microscopy shows an increase of particle size with increasing mercury content and, together with X-ray powder diffraction, points towards the presence of a core-shell structure with a gold core surrounded by an Au-Hg solid solution layer. The amalgamation process is described by pseudo-zero-order reaction kinetics, which indicates slow dissolution of mercury in water as the rate determining step, followed by fast scavenging by nanoparticles in solution. Once adsorbed at the surface, slow diffusion of Hg into the particle lattice occurs, to a depth of ca. 3 nm, independent of Hg concentration. Discrete dipole approximation calculations relate the UV-vis spectra to the microscopic details of the nanoalloy structure. Segregation energies and metal distribution in the nanoalloys were modeled by density functional theory calculations. The results indicate slow metal interdiffusion at the nanoscale, which has important implications for synthetic methods aimed at core-shell particles.

Exercise training in normobaric hypoxia in endurance runners. III. Muscular adjustments of selected gene transcripts

We hypothesized that specific muscular transcript level adaptations participate in the improvement of endurance performances following intermittent hypoxia training in endurance-trained subjects. Fifteen male high-level, long-distance runners integrated a modified living low-training high program comprising two weekly controlled training sessions performed at the second ventilatory threshold for 6 wk into their normal training schedule. The athletes were randomly assigned to either a normoxic (Nor) (inspired O2 fraction = 20.9%, n = 6) or a hypoxic group exercising under normobaric hypoxia (Hyp) (inspired O2 fraction = 14.5%, n = 9). Oxygen uptake and speed at second ventilatory threshold, maximal oxygen uptake (VO2 max), and time to exhaustion (Tlim) at constant load at VO2 max velocity in normoxia and muscular levels of selected mRNAs in biopsies were determined before and after training. VO2 max (+5%) and Tlim (+35%) increased specifically in the Hyp group. At the molecular level, mRNA concentrations of the hypoxia-inducible factor 1alpha (+104%), glucose transporter-4 (+32%), phosphofructokinase (+32%), peroxisome proliferator-activated receptor gamma coactivator 1alpha (+60%), citrate synthase (+28%), cytochrome oxidase 1 (+74%) and 4 (+36%), carbonic anhydrase-3 (+74%), and manganese superoxide dismutase (+44%) were significantly augmented in muscle after exercise training in Hyp only. Significant correlations were noted between muscular mRNA levels of monocarboxylate transporter-1, carbonic anhydrase-3, glucose transporter-4, and Tlim only in the group of athletes who trained in hypoxia (P < 0.05). Accordingly, the addition of short hypoxic stress to the regular endurance training protocol induces transcriptional adaptations in skeletal muscle of athletic subjects. Expressional adaptations involving redox regulation and glucose uptake are being recognized as a potential molecular pathway, resulting in improved endurance performance in hypoxia-trained subjects.

Impact of Helicobacter pylori eradication on dyspepsia, health resource use, and quality of life in the Bristol helicobacter project: randomised controlled trial

OBJECTIVE: To determine the impact of a community based Helicobacter pylori screening and eradication programme on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis. DESIGN: H pylori screening programme followed by randomised placebo controlled trial of eradication. SETTING: Seven general practices in southwest England. PARTICIPANTS: 10,537 unselected people aged 20-59 years were screened for H pylori infection (13C urea breath test); 1558 of the 1636 participants who tested positive were randomised to H pylori eradication treatment or placebo, and 1539 (99%) were followed up for two years. INTERVENTION: Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo. MAIN OUTCOME MEASURES: Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life. RESULTS: In the eradication group, 35% fewer participants consulted for dyspepsia over two years compared with the placebo group (55/787 v 78/771; odds ratio 0.65, 95% confidence interval 0.46 to 0.94; P = 0.021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0.71, 0.56 to 0.90; P = 0.05). NHS costs were 84.70 pounds sterling (74.90 pounds sterling to 93.91 pounds sterling) greater per participant in the eradication group over two years, of which 83.40 pounds sterling (146 dollars; 121 euro) was the cost of eradication treatment. No difference in quality of life existed between the two groups. CONCLUSIONS: Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment. These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable.

[(99m)Tc]Demotate 2 in the detection of sst(2)-positive tumours: a preclinical comparison with [(111)In]DOTA-tate

PURPOSE: The aim of this study was to evaluate [(99m)Tc]Demotate 2 ([(99m)Tc-N(4) (0-1),Asp(0),Tyr(3)]octreotate) as a candidate for in vivo imaging of sst(2)-positive tumours and to compare it with [(111)In]DOTA-tate ([(111)In-DOTA(0),Tyr(3)]octreotate). METHODS: Labelling of Demotate 2 with (99m)Tc was performed at room temperature using SnCl(2) as reductant in the presence of citrate at alkaline pH. Radiochemical analysis involved ITLC and HPLC methods. Peptide conjugate affinities for sst(2) were determined by receptor autoradiography on rat brain cortex sections using [DOTA(0),(125)I-Tyr(3)]octreotate as the radioligand. The affinity profile of Demotate 2 for human sst(1)-sst(5) was studied by receptor autoradiography in cell preparations using the universal somatostatin radioligand [(125)I][Leu(8),(D: )Trp(22),Tyr(25)]somatostatin-28. The internalisation rates of [(99m)Tc]Demotate 2 and [(111)In]DOTA-tate were compared in sst(2)-positive and -negative control cell lines. Biodistribution of radiopeptides was studied in male Lewis rats bearing CA20948 tumours. RESULTS: Peptide conjugates showed selectivity and a high affinity binding for sst(2) (Demotate 2 IC(50)=3.2 nM and DOTA-tate IC(50)=5.4 nM). [(99m)Tc]Demotate 2, like [(111)In]DOTA-tate, internalised rapidly in all sst(2)-positive cells tested, but not in sst(2)-negative control cells. After injection in CA20948 tumour-bearing rats both radiopeptides showed high and specific uptake in the sst(2)-positive organs and in the implanted tumour and rapid excretion from non-target tissues via the kidneys. CONCLUSION: [(99m)Tc]Demotate 2, similarly to the known sst(2)-targeting agent [(111)In]DOTA-tate, showed promising biological qualities for application in the scintigraphy of sst(2)-positive tumours.

Understanding the chemistry of dental erosion

The mineral in our teeth is composed of a calcium-deficient carbonated hydroxyapatite (Ca10-xNax(PO4)6-y(CO3)z(OH)2-uFu). These substitutions in the mineral crystal lattice, especially carbonate, renders tooth mineral more acid soluble than hydroxyapatite. During erosion by acid and/or chelators, these agents interact with the surface of the mineral crystals, but only after they diffuse through the plaque, the pellicle, and the protein/lipid coating of the individual crystals themselves. The effect of direct attack by the hydrogen ion is to combine with the carbonate and/or phosphate releasing all of the ions from that region of the crystal surface leading to direct surface etching. Acids such as citric acid have a more complex interaction. In water they exist as a mixture of hydrogen ions, acid anions (e.g. citrate) and undissociated acid molecules, with the amounts of each determined by the acid dissociation constant (pKa) and the pH of the solution. Above the effect of the hydrogen ion, the citrate ion can complex with calcium also removing it from the crystal surface and/or from saliva. Values of the strength of acid (pKa) and for the anion-calcium interaction and the mechanisms of interaction with the tooth mineral on the surface and underneath are described in detail.

Effects of various forms of calcium added to chewing gum on initial enamel carious lesions in situ

The purpose of this randomized, cross-over in situ study was to determine the effects of 4 chewing gums on artificial caries-like subsurface lesions. Two chewing gums (1 with zinc citrate and 1 without) contained dicalcium phosphate (3.9%), calcium gluconate (1.8%) and calcium lactate (0.45%), 1 chewing gum contained casein phosphopeptide-amorphous calcium phosphate nanocomplexes (0.7%), and another one contained no calcium. Fifteen subjects without current caries activity (7 male, 8 female; mean age: 27.5 +/- 2.5 years) wore removable buccal appliances in the lower jaw with 4 bovine enamel slabs with subsurface lesions. The appliances were inserted immediately before gum chewing for 20 min and then retained for an additional 20 min. This was performed 4 times per day. Every subject chewed 4 different chewing gums over 4 periods of 14 days each. During a fifth period (control) the subjects only wore the appliances without chewing gum. At completion of each period the enamel slabs were embedded, sectioned and subjected to transversal microradiography. With regard to change of mineral loss and of lesion depth no significant differences could be found between chewing gums containing calcium and calcium-free chewing gums. Moreover, the chewing gum groups and the control group did not differ significantly if adjustments were made for baseline values (p > 0.05; ANCOVA). Under the conditions of the present study it may be concluded that the use of chewing gum offers no additional remineralizing benefit to buccal tooth surfaces, even if the chewing gum contains calcium compounds.