A novel and rapid microbiological assay for ciprofloxacin hydrochloride

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Boro em cana-de-açúcar cultivada em solução nutritiva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The Economics of Threatened Species Conservation: A Review and Analysis

Stabilizing human population size and reducing human-caused impacts on the environment are keys to conserving threatened species (TS). Earth's human population is ~ 7 billion and increasing by ~ 76 million per year. This equates to a human birth-death ratio of 2.35 annually. The 2007 Red List prepared by the International Union for Conservation of Nature and Natural Resources (IUCN) categorized 16,306 species of vertebrates, invertebrates, plants, and other organisms (e.g., lichens, algae) as TS. This is ~ 1 percent of the 1,589,161 species described by IUCN or ~ 0.0033 percent of the believed 5,000,000 total species. Of the IUCN’s described species, vertebrates comprised relatively the most TS listings within respective taxonomic categories (5,742 of 59,811), while invertebrates (2,108 of 1,203,175), plants (8,447 of 297,326), and other species (9 of 28,849) accounted for minor class percentages. Conservation economics comprises microeconomic and macroeconomic principles involving interactions among ecological, environmental, and natural resource economics. A sustainable-growth (steady-state) economy has been posited as instrumental to preserving biological diversity and slowing extinctions in the wild, but few nations endorse this approach. Expanding growth principles characterize most nations' economic policies. To date, statutory fine, captive breeding cost, contingent valuation analysis, hedonic pricing, and travel cost methods are used to value TS in economic research and models. Improved valuation methods of TS are needed for benefit-cost analysis (BCA) of conservation plans. This Chapter provides a review and analysis of: (1) the IUCN status of species, (2) economic principles inherent to sustainable versus growth economies, and (3) methodological issues which hinder effective BCAs of TS conservation.

The use of Mitomycin-C to reduce synechia in middle meatus in sinus surgery: preliminary results

Synechia is the most frequent complication after sinus surgery and has been reported in up to 36% of cases. Several types of materials have been used to reduce the incidence of synechia, including Mitomycin C (MMC). Objective: This prospective study aimed to assess the effectiveness of topical MMC in the prevention of synechia after sinus surgery in humans. Methods: At the end of surgery, MMC solution (1.0 mg/ml) was topically applied randomly to one of the middle meatuses (MMC group) of 14 patients while saline solution was applied to the contralateral meatus (control group). The author remained blind to the medicated side. Synechiae were classified as partial or total. Results: Three patients had middle meatus synechia in the MMC group (21.43%) versus nine (64.29%) in the control group (p = 0.054). In the MMC group, all three middle meatus synechia were partial, while in the control group there were four partial (28.57%) and five total (35.71%) cases of synechia (p = 0.025). Conclusions: Mitomycin C was not effective in preventing middle meatus synechia, but reduced the probability of total synechia formation.

Quantitative Proteomic Analysis of the Effect of Fluoride on the Acquired Enamel Pellicle

The acquired enamel pellicle (AEP) is a thin film formed by the selective adsorption of salivary proteins onto the enamel surface of teeth. The AEP forms a critical interface between the mineral phase of teeth (hydroxyapatite) and the oral microbial biofilm. This biofilm is the key feature responsible for the development of dental caries. Fluoride on enamel surface is well known to reduce caries by reducing the solubility of enamel to acid. Information on the effects of fluoride on AEP formation is limited. This study aimed to investigate the effects of fluoride treatment on hydroxyapatite on the subsequent formation of AEP. In addition, this study pioneered the use of label-free quantitative proteomics to better understand the composition of AEP proteins. Hydroxyapatite discs were randomly divided in 4 groups (n = 10 per group). Each disc was exposed to distilled water (control) or sodium fluoride solution (1, 2 or 5%) for 2 hours. Discs were then washed and immersed in human saliva for an additional 2 hours. AEP from each disc was collected and subjected to liquid chromatography electrospray ionization mass spectrometry for protein identification, characterization and quantification. A total of 45 proteins were present in all four groups, 12 proteins were exclusively present in the control group and another 19 proteins were only present in the discs treated with 5% sodium fluoride. Relative proteomic quantification was carried out for the 45 proteins observed in all four groups. Notably, the concentration of important salivary proteins, such as statherin and histatin 1, decrease with increasing levels of fluoride. It suggests that these proteins are repulsed when hydroxyapatite surface is coated with fluoride. Our data demonstrated that treatment of hydroxyapatite with fluoride (at high concentration) qualitatively and quantitatively modulates AEP formation, effects which in turn will likely impact the formation of oral biofilms.

Effect of sodium hypochlorite and edta irrigation, individually and in alternation, on dentin microhardness at the furcation area of mandibular molars

The aim of this study was to evaluate the effect of irrigation regimens on dentin microhardness at the furcation area of mandibular molars, using sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA), individually and in alternation. The occlusal surface and the roots of 20 non-carious extracted human permanent mandibular molars were cut transversally and discarded. The tooth blocks were embedded in acrylic resin and randomly assigned to 4 groups (n=5) according to the irrigating regimens: 1% NaOCl solution, 17% EDTA solution, 1% NaOCl and 17% EDTA and distilled water (control). Knoop microhardness of dentin at the furcation area was evaluated. Data were analyzed using one-way ANOVA and Tukey's multiple comparison tests (α=0.05). The results of this study indicated that all irrigation solutions, except for distilled water (control), decreased dentin microhardness. EDTA did not show a significant difference with NaOCl/EDTA (p>0.05), but showed a significant difference with NaOCl (p<0.01). EDTA and NaOCl/EDTA showed a maximum decrease in microhardness. The 17% EDTA solution, either alone or in combination with 1% NaOCl reduced significantly dentin microhardness at the furcation area of mandibular molars.

Methodische Untersuchung zur Diagnostik der bronchialen Hyperreagibilität mit Hilfe eines inhalativen Methacholin-Provokationstests

Die unspezifische Provokation mit Methacholin ist die am weitesten verbreitete und akzeptierte Methode zur Diagnose bzw. zum Ausschluss der bronchialen Hyperreagibilität bei Patienten mit Verdacht auf ein Asthma bronchiale und zu dessen Therapiekontrolle. Um die Sicherheit und die Genauigkeit der Methode weiter zu verbessern, wurde daher ein Dosimeterprotokoll entwickelt, das die inhalierte Methacholin-Dosis anstatt durch die Erhöhung, d.h. in der Regel Verdoppelung, der Methacholinkonzentrationen nur durch Erhöhung der Anzahl der Inhalationen bei konstanter, niedriger Konzentration der Methacholinlösung steigert. Dieses neue Protokoll wurde verglichen mit anderen weit verbreiteten Methacholin-Provokationsprotokollen. Die Methacholinchlorid-Lösung (1,75 mg/ml) wurde mit Hilfe des Dosimetersystems ZAN 200 ProvAir II sowie des Verneblertopfes DeVilbiss 646 vernebelt. 15 Asthmapatienten mit einer vor der Provokation normalen Lungenfunktion (FEV1 98 +/- 9 % PN) und 18 Lungengesunde (FEV1 110 +/- 12 % PN) nahmen an der Testreihe teil. Begonnen wurde mit einer Dosis von 20 μg Methacholinchlorid (= eine Inhalation); beendet wurde der Versuch bei einer Kumulativdosis von 2000 μg Methacholinchlorid, wenn nicht vorher ein Kriterium für einen positiven Test und damit für einen Versuchsabbruch erfüllt wurde. Abbruchkriterien waren entweder ein Abfall der FEV1 um 20 % des Ausgangswertes oder ein Anstieg des totalen Atemwegswiderstandes auf ≥ 0,5 kPa*s/l. Mittels linearer Regression wurden die Provokationsdosen PD 20 FEV1 und PD Rtot ≥ 0,5 berechnet. Im Vergleich mit anderen Protokollen zeigte sich, dass auch das neue Protokoll zuverlässig und sicher zwischen gesund und krank unterscheidet. Der Median der PD 20 FEV1 liegt in der Gruppe der Asthmatiker bei 222 μg, bei den Lungengesunden bei 2000 μg; daraus ergibt sich ein p-Wert von < 0,001. In Bezug auf die PD Rtot ≥ 0,5 liegt der Median bei den Asthmatikern bei 122 μg, in der Gruppe der Lungengesunden bei 2000 μg; hieraus errechnet sich ebenfalls ein p-Wert von < 0,001. Sensitivität und Spezifität der Methode wurden mittels ROC-Kurven untersucht. Basierend auf der PD 20 FEV1 liefert die Methode für die Diagnose einer bronchialen Hyperreagibilität bei einer Enddosis von 1000 μg Methacholinchlorid eine Sensitivität von über 93 % und eine Spezifität von 83 %; basierend auf der PD Rtot ≥ 0,5 liegt die Sensitivität bei einer Dosis von 1000 μg bei 90 %, die Spezifität bei 89 %. Für die gemeinsame Betrachtung der parameterspezifischen Provokationsdosen PD 20 FEV1 und PD Rtot ≥ 0,5, der PD Minimal, bei 1000 μg liegt die Sensitivität bei über 93 % und die Spezifität bei 83 %. Daher können 1000 μg als Schwellendosis für den Ausschluss einer bronchialen Hyperreagibilität zum Untersuchungszeitpunkt angesehen werden, und der Test darf an diesem Punkt abgebrochen werden. Grundsätzlich ist festzustellen, dass die Diagnostik der bronchialen Hyperreagibilität sicher und genau mit Hilfe eines Dosimeterprotokolls erfolgen kann, das die Methacholin-Dosis nur durch die Steigerung der Inhalationen bei gleichbleibender Konzentration der Methacholinlösung erhöht. Die Schwellendosis zwischen normaler und pathologischer bronchialer Reaktion, Sensitivität und Spezifität sowie die Trennschärfe der Methode sind sehr gut vergleichbar mit anderen bisher etablierten Protokollen.

Design and optimization of turbo-expanders for organic rankine cycles

In a world focused on the need to produce energy for a growing population, while reducing atmospheric emissions of carbon dioxide, organic Rankine cycles represent a solution to fulfil this goal. This study focuses on the design and optimization of axial-flow turbines for organic Rankine cycles. From the turbine designer point of view, most of this fluids exhibit some peculiar characteristics, such as small enthalpy drop, low speed of sound, large expansion ratio. A computational model for the prediction of axial-flow turbine performance is developed and validated against experimental data. The model allows to calculate turbine performance within a range of accuracy of ±3%. The design procedure is coupled with an optimization process, performed using a genetic algorithm where the turbine total-to-static efficiency represents the objective function. The computational model is integrated in a wider analysis of thermodynamic cycle units, by providing the turbine optimal design. First, the calculation routine is applied in the context of the Draugen offshore platform, where three heat recovery systems are compared. The turbine performance is investigated for three competing bottoming cycles: organic Rankine cycle (operating cyclopentane), steam Rankine cycle and air bottoming cycle. Findings indicate the air turbine as the most efficient solution (total-to-static efficiency = 0.89), while the cyclopentane turbine results as the most flexible and compact technology (2.45 ton/MW and 0.63 m3/MW). Furthermore, the study shows that, for organic and steam Rankine cycles, the optimal design configurations for the expanders do not coincide with those of the thermodynamic cycles. This suggests the possibility to obtain a more accurate analysis by including the computational model in the simulations of the thermodynamic cycles. Afterwards, the performance analysis is carried out by comparing three organic fluids: cyclopentane, MDM and R245fa. Results suggest MDM as the most effective fluid from the turbine performance viewpoint (total-to-total efficiency = 0.89). On the other hand, cyclopentane guarantees a greater net power output of the organic Rankine cycle (P = 5.35 MW), while R245fa represents the most compact solution (1.63 ton/MW and 0.20 m3/MW). Finally, the influence of the composition of an isopentane/isobutane mixture on both the thermodynamic cycle performance and the expander isentropic efficiency is investigated. Findings show how the mixture composition affects the turbine efficiency and so the cycle performance. Moreover, the analysis demonstrates that the use of binary mixtures leads to an enhancement of the thermodynamic cycle performance.

Characterization of HgCl2 Tridentate Amine Complexes by X-ray Crystallography, NMR and ESI-MS

Two new HgCl2 complexes of tridentate nitrogen ligands were characterized by X-ray crystallography, proton NMR spectroscopy and ESI-MS. The five-coordinate complex [Hg(BMPA)Cl-2] (1) (BMPA = bis(2-pyridylmethyl)amine) crystallized from acetonitrile/m-xylene by slow evaporation in the monoclinic space group P2(1)/n with a = 8.3896(8) , b = 12.8020(13) , c = 13.3526(13) , alpha = 90A degrees, beta A = 90.480(2)A degrees, gamma A = 90A degrees and z = 4. The square pyramidal structure (tau = 0.009) has approximate C (s) symmetry. Despite comparable Hg-N bond lengths in 1, inversion of the central nitrogen was rapid on the chemical shift time scale in dilute solution except at very low temperatures. The related complex [Hg(BEPA)Cl-2] (2) (BEPA = bis(2-{pyrid-2-yl}ethyl)amine) crystallized from acetonitrile/ethyl acetate/hexanes by slow diffusion in the orthorhombic space group Pnma with a = 13.424(3) , b = 14.854(3) , c = 8.118(2) , alpha = 90A degrees, beta A = 90A degrees, gamma A = 90A degrees and z = 4. The mixed geometry structure (tau = 0.56) also has crystallographic mirror symmetry as well as C (s) point group symmetry. In dilute acetonitrile solution, 1 was stable while 2 slowly converted to a more thermodynamically stable complex.

Applying chemical stimuli on feathers to reduce feather pecking in laying hens

Recent studies have shown that spraying a distasteful substance (quinine) on a bird's feather cover reduced short-term feather pecking. The present experiment evaluated if other substances offer similar or better protection against feather pecking.;One hundred and twenty birds were divided into 12 groups of 10 birds each. Over a period of 10 days the birds' response to 10 feathers coated with one of the 11 distasteful substances was observed and recorded. Feathers were soaked in a 1% garlic solution, 1% almond oil, 1% clove oil, 1% clove solution, quinine sulphate solution in four concentrations (0.1%, 1%, 2%, 4%), 0.6 mol magnesium chloride solution, anti-peck spray or an angostura solution. The control group received uncoated feathers. The number of feathers plucked, rejected or eaten was counted 60 min after presenting the feathers. All substances reduced feather plucking (p < 0.0001) and consumption (p < 0.0001) significantly, compared to uncoated feathers. Quinine concentrations of 2% and 4% were most effective. This study was the first to investigate the aversive potential of different substances to deter feather peckers from the feathers of other birds. The findings may be useful in the development of spraying devices to prevent feather pecking when other management tools fail. (c) 2011 Elsevier B.V. All rights reserved.

The Effects of Interstate Speed Limit Increases: Fatality Rates and Traffic Diversion Versus Speed Spillover

This thesis examines two panel data sets of 48 states from 1981 to 2009 and utilizes ordinary least squares (OLS) and fixed effects models to explore the relationship between rural Interstate speed limits and fatality rates and whether rural Interstate speed limits affect non-Interstate safety. Models provide evidence that rural Interstate speed limits higher than 55 MPH lead to higher fatality rates on rural Interstates though this effect is somewhat tempered by reductions in fatality rates for roads other than rural Interstates. These results provide some but not unanimous support for the traffic diversion hypothesis that rural Interstate speed limit increases lead to decreases in fatality rates of other roads. To the author’s knowledge, this paper is the first econometric study to differentiate between the effects of 70 MPH speed limits and speed limits above 70 MPH on fatality rates using a multi-state data set. Considering both rural Interstates and other roads, rural Interstate speed limit increases above 55 MPH are responsible for 39,700 net fatalities, 4.1 percent of total fatalities from 1987, the year limits were first raised, to 2009.

Poverty in Slovenia: A Conseqence of Economic Transition

Slovenia is considered to be one of the most successful Central and Eastern European countries undergoing the process of transition. It has a high GDP per capita (the highest in the Visegrad group) amounting to about 7200 US dollars (at the exchange rates pertaining during Ms. Stropnik's research). In 1994, a low rate of inflation, a low level of public debt and almost balanced public finances, were all positive elements. However, there is a darker side, for instance the dramatic increase in unemployment and (somewhat less dramatic) fall in production during the transition period. This analysis aimed to provide insights into what is actually happening at the household level, since households are the ultimate bearers of macroeconomic and social change. The final output totalled 166 pages in English and Slovenian, available also on disc. The income concept used by Ms. Stropnik is that of the disposable (monetary) household income, i.e. the cash income of all household members - including social security transfers and family benefits, and the net sum of taxes and social security contributions - plus the equivalent of domestic production, used in the household. Non-monetary income sources, such as household own production, benefits in kind, subsidies for goods and services, and fringe benefits, were not taken into account. The concept of relative and objective poverty was followed. Poverty means having less than others in society, it is a state of relative deprivation. Objective aspects of the situation, e.g. command over resources (i.e. the household income) and the relative position of the household in the income distribution, determine who is poor and who is not. Changes in household composition - an increase in the number of pensioners, unemployed and self-employed, concomitant with a large decrease in the number of employees - obviously played a part in the changing structure of household income sources during this period. The overall decrease in the share of wages and salaries from primary employment in 1993 is to be observed in all income deciles. On the other hand, the importance of salaries gained from secondary employment has increased in all deciles. The lower seven deciles experienced a sharp rise in the share of social benefits in the period 1988-1993, mostly because of the increase in the number of persons entitled to claim unemployment benefits. In Slovenia, income inequality has increased considerably during the 1988-1993 period. To make matters worse, the large increase in income inequality occurred in a period of falling real incomes. In 1983 the bottom decile disposed of 3.8 percent and the top decile disposed of 23.4 percent of total monetary income in Slovenia, whereas by 1993 the same statistics revealed 3.1 percent and 18.9 percent respectively. Unemployment greatly increases the risk of living in poverty. In 1993, 35 per cent of all unemployed persons in Slovenia were living in the lowest income quintile. Ms. Stropnik found certain features that were specific to Slovenia and not shared by most countries in transition. For example, the relative income position of pensioners has improved. Retirement did not increase the risk of poverty in 1993 as much as it did in 1983 and 1988. Also, it appears that children have not been particularly hard-hit by the transition upheavals. The incidence of poverty amongst children has not increased in the period 1983-1993. Children were also fairly evenly distributed across income quintiles. In 1983, 11.8 percent of households with children aged 18 or less were poor. In 1993, this figure was 8.4 per cent. On the other hand, poor households with children were, in comparison with other households of the same type, poorer in 1993 than in 1983. Ms. Stropnik also analysed the impact of social transfers. Her conclusion was that the level of social transfers prevented them from being successful in alleviating poverty. Family policy transfers (child allowances, child tax allowances, subsidised child care) did, however, contribute to the lowering of income inequality between families with and without children, and amongst families with different numbers of children. Ms. Stropnik is determined that the results of her research be used in the creation of social policy aimed at helping the poor. She quotes Piachaud approvingly: "If the term 'poverty' carries with it the implication and moral imperative that something should be done about it, then the study of poverty is only ultimately justifiable if it influences individual and social attitudes and actions."

Poverty in Israel

The paper deals with poverty within Israel. Against the background of the history of pre-state Israel and the developments after the establishment of the State of Israel in 1948 the historical roots of Israeli poverty are analyzed. Thus the ‘socialist’-Zionist project, ethnic exclusion, religious and intra-Jewish ethnic lines of conflict as well as the Bedouins, Druzes and Israeli Arabs as ‘specific’ Israeli citizen are discussed. Despite the economic growth in Israel since 2003 ‘the majority of Israeli wage earners (over 60percent) earned less than $1,450 a month last year’ (Goldstein 2007, p. 1). In 2004 1.3 million Israelis lived below the poverty line, a number which in 2005 increased to more than 1.5 million Israelis. In spite of growing economic prosperity the proportion of families belonging to the working-poor, i.e. families with at least one family member in paid employment, increased from 11.4 percent in 2004 to 12.2 percent in 2005. The percentage of poor families in the working population increased from 40.6 percent to 43.1 percent. Nearly 60 percent of the ‘working-poor’ were working fulltime (Sinai 2006a, Shaoul 2006). 42 percent of Israeli Arab families are living below the poverty line. The average wages are less than half the wages of Ashkenazi Jews. Every second Israeli Arab child lives in poverty. When in 1996 to 2001 the unemployment rate of the Jewish Israelis increased by about 53 percent, the unemployment rate of the Arab Israelis increased by 126 percent (cf. Shaoul 2006). 80 percent of Israelis regard themselves as poor. 23 percent of the pensioners are living below the poverty line. Poverty among children increased in 1988 to 2005 by about 50 percent. Approximately one fifth of all under-age children (714.000) in Israel are suffering from hunger (cf. Shaoul 2006). 75 percent of the poor families cannot afford medicine and 70 percent are dependant on food donations (cf. Sinai 2005b). Nearly one third of the Holocaust survivors are living in poverty. Some of the Holocaust survivors get $ 600,- per month from the German government, whilst other Holocaust survivors receive only $ 350,- per month from the Israeli Ministry of Finance and the Holocaust survivors that immigrated to Israel after 1953 (who amount to 70 percent of the Holocaust survivors in Israel) only receive the general national pension. Nearly 20 percent of the Holocaust survivors are at the present time 86 years and older, 70 percent are older than 76 years. (cf. Medina 2007, p. 1) They are not entitled to a supplementary payment or to compensation. But the problematic economic situation of the Holocaust survivors is neither new information nor an unknown fact. As a result of the precarious situation several are in need of the help of welfare organizations, because they cannot afford to some degree their necessary medicine.

Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment: Comparative Effectiveness Update

Objectives: To update the 2006 systematic review of the comparative benefits and harms of erythropoiesis-stimulating agent (ESA) strategies and non-ESA strategies to manage anemia in patients undergoing chemotherapy and/or radiation for malignancy (excluding myelodysplastic syndrome and acute leukemia), including the impact of alternative thresholds for initiating treatment and optimal duration of therapy. Data sources: Literature searches were updated in electronic databases (n=3), conference proceedings (n=3), and Food and Drug Administration transcripts. Multiple sources (n=13) were searched for potential gray literature. A primary source for current survival evidence was a recently published individual patient data meta-analysis. In that meta-analysis, patient data were obtained from investigators for studies enrolling more than 50 patients per arm. Because those data constitute the most currently available data for this update, as well as the source for on-study (active treatment) mortality data, we limited inclusion in the current report to studies enrolling more than 50 patients per arm to avoid potential differential endpoint ascertainment in smaller studies. Review methods: Title and abstract screening was performed by one or two (to resolve uncertainty) reviewers; potentially included publications were reviewed in full text. Two or three (to resolve disagreements) reviewers assessed trial quality. Results were independently verified and pooled for outcomes of interest. The balance of benefits and harms was examined in a decision model. Results: We evaluated evidence from 5 trials directly comparing darbepoetin with epoetin, 41 trials comparing epoetin with control, and 8 trials comparing darbepoetin with control; 5 trials evaluated early versus late (delay until Hb ≤9 to 11 g/dL) treatment. Trials varied according to duration, tumor types, cancer therapy, trial quality, iron supplementation, baseline hemoglobin, ESA dosing frequency (and therefore amount per dose), and dose escalation. ESAs decreased the risk of transfusion (pooled relative risk [RR], 0.58; 95% confidence interval [CI], 0.53 to 0.64; I2 = 51%; 38 trials) without evidence of meaningful difference between epoetin and darbepoetin. Thromboembolic event rates were higher in ESA-treated patients (pooled RR, 1.51; 95% CI, 1.30 to 1.74; I2 = 0%; 37 trials) without difference between epoetin and darbepoetin. In 14 trials reporting the Functional Assessment of Cancer Therapy (FACT)-Fatigue subscale, the most common patient-reported outcome, scores decreased by −0.6 in control arms (95% CI, −6.4 to 5.2; I2 = 0%) and increased by 2.1 in ESA arms (95% CI, −3.9 to 8.1; I2 = 0%). There were fewer thromboembolic and on-study mortality adverse events when ESA treatment was delayed until baseline Hb was less than 10 g/dL, in keeping with current treatment practice, but the difference in effect from early treatment was not significant, and the evidence was limited and insufficient for conclusions. No evidence informed optimal duration of therapy. Mortality was increased during the on-study period (pooled hazard ratio [HR], 1.17; 95% CI, 1.04 to 1.31; I2 = 0%; 37 trials). There was one additional death for every 59 treated patients when the control arm on-study mortality was 10 percent and one additional death for every 588 treated patients when the control-arm on-study mortality was 1 percent. A cohort decision model yielded a consistent result—greater loss of life-years when control arm on-study mortality was higher. There was no discernible increase in mortality with ESA use over the longest available followup (pooled HR, 1.04; 95% CI, 0.99 to 1.10; I2 = 38%; 44 trials), but many trials did not include an overall survival endpoint and potential time-dependent confounding was not considered. Conclusions: Results of this update were consistent with the 2006 review. ESAs reduced the need for transfusions and increased the risk of thromboembolism. FACT-Fatigue scores were better with ESA use but the magnitude was less than the minimal clinically important difference. An increase in mortality accompanied the use of ESAs. An important unanswered question is whether dosing practices and overall ESA exposure might influence harms.

Promises of cyclotron-produced 44Sc as a diagnostic match for trivalent β--emitters: in vitro and in vivo study of a 44Sc-DOTA-folate conjugate

In recent years, implementation of 68Ga-radiometalated peptides for PET imaging of cancer has attracted the attention of clinicians. Herein, we propose the use of 44Sc (half-life = 3.97 h, average β+ energy [Eβ+av] = 632 keV) as a valuable alternative to 68Ga (half-life = 68 min, Eβ+av = 830 keV) for imaging and dosimetry before 177Lu-based radionuclide therapy. The aim of the study was the preclinical evaluation of a folate conjugate labeled with cyclotron-produced 44Sc and its in vitro and in vivo comparison with the 177Lu-labeled pendant. Methods: 44Sc was produced via the 44Ca(p,n)44Sc nuclear reaction at a cyclotron (17.6 ± 1.8 MeV, 50 μA, 30 min) using an enriched 44Ca target (10 mg 44CaCO3, 97.00%). Separation from the target material was performed by a semiautomated process using extraction chromatography and cation exchange chromatography. Radiolabeling of a DOTA-folate conjugate (cm09) was performed at 95°C within 10 min. The stability of 44Sc-cm09 was tested in human plasma. 44Sc-cm09 was investigated in vitro using folate receptor–positive KB tumor cells and in vivo by PET/CT imaging of tumor-bearing mice Results: Under the given irradiation conditions, 44Sc was obtained in a maximum yield of 350 MBq at high radionuclide purity (>99%). Semiautomated isolation of 44Sc from 44Ca targets allowed formulation of up to 300 MBq of 44Sc in a volume of 200–400 μL of ammonium acetate/HCl solution (1 M, pH 3.5–4.0) within 10 min. Radiolabeling of cm09 was achieved with a radiochemical yield of greater than 96% at a specific activity of 5.2 MBq/nmol. In vitro, 44Sc-cm09 was stable in human plasma over the whole time of investigation and showed folate receptor–specific binding to KB tumor cells. PET/CT images of mice injected with 44Sc-cm09 allowed excellent visualization of tumor xenografts. Comparison of cm09 labeled with 44Sc and 177Lu revealed almost identical pharmacokinetics. Conclusion: This study presents a high-yield production and efficient separation method of 44Sc at a quality suitable for radiolabeling of DOTA-functionalized biomolecules. An in vivo proof-of-concept study using a DOTA-folate conjugate demonstrated the excellent features of 44Sc for PET imaging. Thus, 44Sc is a valid alternative to 68Ga for imaging and dosimetry before 177Lu-radionuclide tumor therapy.