A Multicenter, Randomised Open Study of Early Corticosteroid Treatment (OSECT) in Preterm Infants With Respiratory Illness: Comparison of Early and Late Treatment and of Dexamethasone and Inhaled Budesonide

AIM: To compare early (15 days) steroid therapy and dexamethasone with inhaled budesonide in very preterm infants at risk of developing chronic lung disease. METHODS: Five hundred seventy infants from 47 neonatal intensive care units were enrolled. Criteria for enrollment included gestational age 30%. Infants were randomly allocated to 1 of 4 treatment groups in a factorial design: early (15 days) dexamethasone, and delayed selective budesonide. Dexamethasone was given in a tapering course beginning with 0.50 mg/kg/day in 2 divided doses for 3 days reducing by half until 12 days of therapy had elapsed. Budesonide was administered by metered dose inhaler and a spacing chamber in a dose of 400 microg/kg twice daily for 12 days. Delayed selective treatment was started if infants needed mechanical ventilation and >30% oxygen for >15 days. The factorial design allowed 2 major comparisons: early versus late treatment and systemic dexamethasone versus inhaled budesonide. The primary outcome was death or oxygen dependency at 36 weeks and analysis was on an intention-to-treat basis. Secondary outcome measures included death or major cerebral abnormality, duration of oxygen treatment, and complications of prematurity. Adverse effects were also monitored daily. RESULTS: There were no significant differences among the groups for the primary outcome. Early steroid treatment was associated with a lower primary outcome rate (odds ratio [OR]: 0.85; 95% confidence interval [CI]: 0.61,1.18) but even after adjustment for confounding variables the difference remained nonsignificant. Dexamethasone-treated infants also had a lower primary outcome rate (OR: 0.86; 95% CI: 0.62,1.20) but again this difference remained not significant after adjustment. For death before discharge, dexamethasone and early treatment had worse outcomes than budesonide and delayed selective treatment (OR: 1.42; 95% CI: 0.93,2.16; OR: 1.51; 95% CI: 0.99,2.30 after adjustment, respectively) with the results not quite reaching significance. Duration of supplementary oxygen was shorter in the early dexamethasone group (median: 31 days vs 40-44 days). Early dexamethasone was also associated with increased weight loss during the first 12 days of treatment (52 g vs 3 g) compared with early budesonide, but over 30 days there was no difference. In the early dexamethasone group, there was a reduced incidence of persistent ductus arteriosus (34% vs 52%-59%) and an increased risk of hyperglycemia (55% vs 29%-34%) compared with the other 3 groups. Dexamethasone was associated with an increased risk of hypertension and gastrointestinal problems compared with budesonide but only the former attained significance. CONCLUSIONS: Infants given early treatment and dexamethasone therapy had improved survival without chronic lung disease at 36 weeks compared with those given delayed selective treatment and inhaled budesonide, respectively, but results for survival to discharge were in the opposite direction; however, none of these findings attained statistical significance. Early dexamethasone treatment reduced the risk of persistent ductus arteriosus. Inhaled budesonide may be safer than dexamethasone, but there is no clear evidence that it is more or less effective

Design, characterisation and preliminary clinical evaluation of a novel mucoadhesive topical formulation containing tetracycline for the treatment of periodontal disease

This study describes the formulation, characterisation and preliminary clinical evaluation of mucoadhesive, semi-solid formulations containing hydroxyethylcellulose (HEC, 1-5%, w/w), polyvinylpyrrolidine (PVP, 2 or 3%, w/w), poly carbophil (PC, 1 or 3%, w/w) and tetracycline (5%, w/w, as the hydrochloride). Each formulation was characterised in terms of drug release, hardness, compressibility, adhesiveness (using a texture analyser in texture profile analysis mode), syringeability (using a texture analyser in compression mode) and adhesion to a mucin disc (measured as a detachment force using the texture analyser in tensile mode). The release exponent for the formulations ranged from 0.78+/-0.02 to 1.27+/-0.07, indicating that drug release was non-diffusion controlled. Increasing the concentrations of each polymeric component significantly increased the time required for 10 and 30% release of the original mass of tetracycline, due to both increased viscosity and, additionally, the unique swelling properties of the formulations. Increasing concentrations of each polymeric component also increased the hardness, compressibility, adhesiveness, syringeability and mucoadhesion of the formulations. The effects on product hardness, compressibility and syringeability may be due to increased product viscosity and, hence, increased resistance to compression. Similarly, the effects of these polymers on adhesiveness/mucoadhesion highlight their mucoadhesive nature and, importantly, the effects of polymer state (particularly PC) on these properties. Thus, in formulations where the neutralisation of PC was maximally suppressed, adhesiveness and mucoadhesion were also maximal. Interestingly, statistical interactions were primarily observed between the effects of HEC and PC on drug release, mechanical and mucoadhesive properties. These were explained by the effects of HEC on the physical state of PC, namely swollen or unswollen. In the preliminary clinical evaluation, a formulation was selected that offered an appropriate balance of the above physical properties and contained 3% HEC, 3% PVP and 1% PC, in addition to tetracycline 5% (as the hydrochloride). The clinical efficacy of this (test) formulation was compared to an identical tetracycline-devoid (control) formulation in nine periodontal pockets (greater than or equal to 5 mm depth). One week following administration of the test formulation, there was a significant improvement in periodontal health as identified by reduced numbers of sub-gingival microbial pathogens. Therefore, it can be concluded that, when used in combination with mechanical plaque removal, the tetracycline-containing semi-solid systems described in this study would augment such therapy by enhancing the removal of pathogens, thus improving periodontal health. (C) 2000 Elsevier Science B.V. All rights reserved.

Light tunneling via resonant surface plasmon polariton states and the enhanced transmission of periodically nanostructured metal films: An analytical study

An analytical treatment of optical transmission through periodically nanosructured metal films capable of supporting surface-plasmon polaritons is presented. The optical properties of such metal films are governed by surface polariton behavior in a periodic surface structure forming a surface polaritonic crystal. Due to different configurations of the electromagnetic field of surface polariton modes, only states of even Brillouin zones are responsible for the optical transmission enhancement at normal incidence. The transmission enhancement is related to photon tunneling via resonant states of surface polariton Bloch modes in which the energy buildup takes place. Surface polariton states of at least one of the film interfaces contribute to the transmission resonance which occurs due to tunnel coupling between photons and surface polaritons on the opposite interfaces. Under double-resonance conditions, resonant tunneling between surface polariton states of both interfaces is achieved, which leads to further enhancement of the transmission efficiency. The double-resonance conditions occur not only in the case of a film in symmetric environment but can also be engineered for a film on a substrate. Light tunneling via surface polariton states can take place directly through a structured metal film and does not necessarily require holes in a film.

Low temperature surface nitridation processes for dielectric-Ge interfaces

Germanium MOS capacitors have been fabricated with a high-? HfO dielectric using ALD. An in-situ low temperature (250°C) nitrogen plasma treatment on the germanium surface prior to the deposition of HfO was found to be beneficial to the electrical properties of the devices. Germanium MOS capacitors have also been fabricated with a SiO dielectric deposited by an atmospheric pressure CVD 'silox' process. The same low temperature plasma nitridation was found to degrade the electrical properties of the silox devices. The effect of a post-metal anneal in H and N on both types of capacitor structure was also found to degrade device electrical properties. copyright The Electrochemical Society.

A switch in the cellular localization of macrophage migration inhibitory factor in the rat testis after ethane dimethane sulfonate treatment.

Macrophage migration inhibitory factor (MIF), one of the first cytokines to be discovered, has recently been localized to the Leydig cells in adult rat testes. In the following study, the response of MIF to Leydig cell ablation by the Leydig cell-specific toxin ethane dimethane sulfonate (EDS) was examined in adult male rats. Testicular MIF mRNA and protein in testicular interstitial fluid measured by ELISA and western blot were only marginally reduced by EDS treatment, in spite of the fact that the Leydig cells were completely destroyed within 7 days. Immunohistochemistry using an affinity-purified anti-mouse MIF antibody localized MIF exclusively to the Leydig cells in control testes. At 7 days post-EDS treatment, there were no MIF immunopositive Leydig cells in the interstitium, although distinct MIF immunostaining was observed in the seminiferous tubules, principally in Sertoli cells and residual cytoplasm, and some spermatogonia. A few peritubular and perivascular cells were also labelled at this time, which possibly represented mesenchymal Leydig cell precursors. At 14 and 21 days, Sertoli cell MIF immunoreactivity was observed in only a few tubule cross-sections, while some peritubular and perivascular mesenchymal cells and the re-populating immature Leydig cells were intensely labeled. At 28 days after EDS-treatment, the MIF immunostaining pattern was identical to that of untreated and control testes. The switch in the compartmentalization of MIF protein at 7 days after EDS-treatment was confirmed by western blot analysis of interstitial tissue and seminiferous tubules separated by mechanical dissection. These data establish that Leydig cell-depleted testes continue to produce MIF, and suggest the existence of a mechanism of compensatory cytokine production involving the Sertoli cells. This represents the first demonstration of a hitherto unsuspected pattern of cellular interaction between the Leydig cells and the seminiferous tubules which is consistent with an essential role for MIF in male testicular function.

Anti-sized reed bed system for animal wastewater treatment: a comparative study

This paper presents a comparative study on the treatment of high-strength animal wastewater in two parallel lab-scale constructed reed bed systems, progressively-sized system and anti-sized system, which have same configuration but different arrangement of bed media. The reed bed systems were operated in a tidal flow pattern to treat diluted pig slurry. Detailed analyses were carried out for the removal of some key pollutants including COD, BOD5, NH4-N, P and suspended solids. The results showed that both systems have considerable capacity for the removal of solids, organic matter and inorganic nutrients. The formation of biofilms on the surfaces of gravel media in both reed bed systems was monitored by scanning selected gravel samples using scanning electron microscopy. In general, no significant difference was detected with regard to the percentage pollutant removal in the systems. However, the anti-sized system demonstrated a clear advantage in its ability to slow down the clogging of bed media and avoid the impairment of long-term functioning and sustainability of the beds. A conceptual model was developed to predict the occurrence of the clogging. The validity of the model was tested using data from this study and from the literatures.

Treatment of hazardous shipyard wastewater using dolomitic sorbents

Hazardous shipyard wastewater is a worldwide problem, arising from ship repair. In this study an experimental programme was undertaken to establish the suitability of dolomite and dolomitic sorbent materials to remove contaminants from wastewater arising from a commercial shipyard. Experimental data indicate that dolomite and dolomitic sorbents have the ability to significantly reduce the COD concentration of the shipyard effluent (98% reduction). The data gained from trials at a shipyard indicated that the dolomite treatment process could be undertaken in a 8000 L pilot scale reaction vessel. Analysis of the wastewater using ICP-MS during the pilot trial indicated that the dolomite significantly reduced the concentrations of metallic impurities. The concentration of Sn ions, which is indicative of organo-tin complexes commonly found in shipyard wastewater, was reduced by 80% from its initial concentration in the pilot trial. The mechanism for the removal process using dolomite has been ascribed to a metal complexation/sorption process.

The design of a navigation guidance and control system for an unmanned surface vehicle for environmental monitoring

Maintaining the ecosystem is one of the main concerns in this modern age. With the fear of ever-increasing global warming, the UK is one of the key players to participate actively in taking measures to slow down at least its phenomenal rate. As an ingredient to this process, the Springer vehicle was designed and developed for environmental monitoring and pollutant tracking. This special issue paper highlighted the Springer hardware and software architecture including various navigational sensors, a speed controller, and an environmental monitoring unit. In addition, details regarding the modelling of the vessel were outlined based mainly on experimental data. The formulation of a fault tolerant multi-sensor data fusion technique was also presented. Moreover, control strategy based on a linear quadratic Gaussian controller was developed and simulated on the Springer model.
Gaussian controller is developed and simulated on the Springer model.

Reduction of Staphylococcus aureus and Pseudomonas aeruginosa colonisation on PVC through covalent surface attachment of fluorinated thiols

OBJECTIVES: This study reports the development, characterisation and microbiological testing of surface-modified polyvinylchloride (PVC) films for the purpose of reducing bacterial adherence.

METHODS: Irreversible covalent surface modification was achieved via nucleophilic substitution of fluorinated thiol-terminated compounds onto the polymer backbone. Four fluorinated modifiers, 2,3,5,6-tetrafluorothiophenol (TFTP), 4-(trifluoromethyl)thiophenol (TFMTP), 3,5-bis(trifluoromethyl)benzenethiol (BTFMBT) and 3,3,4,4,5,5,6,6,7, 7,8,8,9,9,10,10,10-heptadecafluoro-decane-1-thiol (HDFDT), were investigated. Modification was confirmed using attenuated total reflectance infrared spectroscopy; Raman mapping demonstrated that modification was homogenous on the macroscopic scale. The influence of fluorination on surface hydrophobicity was studied by contact angle analysis. The effect on microbial adherence was examined using Pseudomonas aeruginosa and Staphylococcus aureus.

KEY FINDINGS: The resultant changes in contact angle relative to control PVC ranged from -4 degrees to +14 degrees . In all cases, adherence of P. aeruginosa and S. aureus was significantly reduced relative to control PVC, with adherence levels ranging from 62% and 51% for TFTP-modified PVC to 32% and 7% for TFMTP-modified PVC.

CONCLUSIONS: These results demonstrate an important method in reducing the incidence of bacterial infection in PVC medical devices without compromising mechanical properties.

Mechanical behaviour of unsaturated kaolin (with isotropic and anisotropic stress history). Part 1: wetting and compression behaviour

Over the last 40 years considerable progress has been made in understanding the complex behaviour of unsaturated soils. Research using constitutive modelling has extended the critical state framework and the concept of yielding in saturated soils to encompass unsaturated soils experiencing suction. However, validation testing of the framework for unsaturated soils has shown disagreement with the basic propositions. The main reason for this disparity is the anisotropic properties of the soil specimens tested as a result of preparation using one-dimensional compaction. The paper describes the detailed testing carried out to justify this statement. As part of the work presented, samples of unsaturated kaolin were prepared using isotropic compression. The suctions in these samples were reduced to predefined values by wetting under low isotropic loading. The pore size distributions, the pressure–volume relationships and yielding under subsequent isotropic loading are compared with tests on samples prepared by statically compressing kaolin into a one-dimensional compaction mould. The anisotropically compressed samples had initial water contents and specific volumes similar to those of the isotropically prepared samples and were also tested under reducing suctions; they exhibited distinctly different behaviour when tested under similar conditions. The results obtained from the isotropically prepared and tested samples have shown, probably for the first time, the existence of a unique normal compression surface that is not dependent on the initial conditions of the samples. The shape of the loading–collapse (LC) yield locus is shown to be different from the generally accepted form.

Scanning electron microscopy study of microstructural evolution of electroless nickel-phosphorus deposits with heat treatment

This paper follows previous X-ray diffraction work on crystallisation and phase transformation of electroless nickel–phosphorus deposits, concentrating on microstructural changes. Amorphous or nanocrystalline coatings, depending on their phosphorus content, were heat treated at temperatures between 100 and 500 °C for 1 h. Changes in microstructure after the heat treatment were examined using high-resolution field emission scanning electron microscope. Crystallisation and grain growth effects are observed, as well as some inherent defect structures in the coatings and their changes. These are compared with the previous X-ray diffraction work and in general, good agreement is observed. The complementary strength and weakness of the different characterisation techniques are discussed.