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Acute graft-versus-host disease (GVHD) after liver transplant (LTx) is a rare complication with a high mortality rate. Recently, monoclonal antibody (mAb) treatment, specifically with anti–interleukin 2 receptor antibodies (IL2RAb) and anti–tumor necrosis factor-α antibodies (TNFAb), has gained increasing interest. However, evidence is mostly limited to case reports and the efficacy remains unclear. Here, we describe 5 patients with LTx-associated GVHD from our center and provide the results of our systematic literature review to evaluate the potential therapeutic benefit of IL2RAb/TNFAb treatment. Of the combined population of 155 patients (5 in our center and 150 through systematic search), 24 were given mAb (15.5%)—4 with TNFAb (2.6%) and 17 with IL2RAb (11%) (“mAb group”)—and compared with patients who received other treatments (referred to as “no-mAb group”). Two-sided Fisher exact tests revealed a better survival when comparing treatment with mAb versus no-mAb (11/24 vs 27/131; P= .018), TNFAb versus no-mAb (3/4 vs 27/131; P= .034), and IL2RAb versus no-mAb (8/17 vs 27/131; P= .029). This systematic review suggests a beneficial effect of mAb treatment and a promising role for TNFAb and IL2RAb as a first-line strategy to treat LTx-associated acute GVHD.

Dead space is the portion of tidal volume that does not participate in alveolar gas exchange. The purpose of this study was to compare the dead space contribution of differently shaped masks, of the same size, by measuring the volume of each mask. The study was conducted in the Clinical Simulation Unit of the School of Medicine, University of the Free State (UFS) using formed masks with inflatable polyvinylchloride (PVC) cuffs and rounded masks with non-inflatable PVC cuffs. The masks were placed on the faces of the infant, child and adult part-task trainers as well as on a flat surface. The cuffs of the formed masks were inflated to 5 cm water and 70 cm water. Masks were filled with water and the volume was measured.The volumes (ml) of the masks on the flat surface were significantly larger than those measured on the part-task trainers’ faces. The volume of the rounded masks was greater than the volume of the formed masks. The amount of cuff inflation pressure (5 cm water vs. 70 cm water) did not lead to a significant change in mask volume: 102.3 ml (standard deviation [SD] 75.9) vs. 110.2 ml (SD 82.3), averaged for all sizes.Formed masks contribute less to anatomical dead space than rounded masks and are thus possibly the better choice. Cuff inflation pressure has insignificant influence on dead space volume.

The preparation of nanomedicines can be achived using a host of methods ranging from wet-chemical approaches to more engineering related techniques. As a maturing branch of nanotechnology, nanomedcines are being tailored to serve multiple pharmaceutic and biomedical related funcitons (e.g. targeted delivery, imaging, healing, sensing) which may require the utilisaiton of one or more actives or excipients. In some instances, handling of materials (such as sensitive biomolecules or active pharmaceutical ingredient) becomes a limiting factor along with issues related to fabrication steps (loss or degradation of active components and functional materials), deposition location & procedure (removal of formed structures), process environment sensitivity and scale-up potential. This short review focuses on the electrohydrodynamic preparation of emerging nanomedicines that have potential to serve as therapeutic platforms. An insight into the underpinning process (jet-formation), related paramerts (material and process) and strucutral outcomes (particles and fibres) is given in relation to highlighted research. The ambient temperature processing, user friendly preparation and present industrial scale up potential (now in kg/hr) make such processes valuable in the preparation of future nano-scaled and sensitive dosage forms.

AbstractObjectives:The objective of the study was to compare the infant-feeding practices of two subdistricts with different baby-friendly status in Mpumalanga province, South Africa.Design:This was a cross-sectional, descriptive, observational study with an analytical component. Eighteen fieldworkers assisted with the data collection, utilising two sets of interviewer-administered questionnaires – one on socio-demographic information and the other on infant-feeding practices.Subjects:Mothers with infants from birth to six months old, attending postnatal care at public sector primary health care facilities in Emalahleni and Mbombela health subdistricts on the days of data collection were included. A total of 435 mother and infant pairs were included in the study.Outcome measures:Five infant-feeding indicators were used, namely the early initiation of breastfeeding, exclusive breastfeeding, exclusive replacement feeding and mixed feeding rates, as well as the age at which complementary food was introduced.Results:There was a significantly higher early initiation of breastfeeding (57% vs. 43%), exclusive breastfeeding rates (60% vs 48%), and a lower exclusive replacement feeding rate (18% vs. 33%) in Emalahleni subdistrict, where all the public sector maternity facilities are accredited as being baby friendly, compared to that in Mbombela subdistrict, where none of the public sector maternity facilities are baby friendly. The mixed feeding rate (19% vs. 15%) and the mean age of the introduction of complementary foods (50 days versus 35 days) did not differ significantly between the two subdistricts.Conclusion:Implementation of the Baby-Friendly Hospital Initiative (BFHI) in a health subdistrict was associated with more optimal infant-feeding practices in mothers with infants aged six months and younger. It is concluded that strengthening practices prescribed within the BFHI would improve infant-feeding practices at community level.

Isolated lung transplantation (LuTx) and liver transplantation are established treatments for irreversible lung and liver failure. Combined liver and lung transplantation (cLiLuTx) is a less common, but approved therapy of combined organ failure, mostly applied in patients suffering from progressive cystic fibrosis and advanced liver disease. We report a patient who was listed for LuTx due to end-stage chronic obstructive pulmonary disease and who developed drug-induced acute hepatic failure. The only therapeutic option was hyper-urgent cLiLuTx. To correct the poor coagulation in order to reduce the per-operative risk of bleeding, the liver was transplanted first. In anticipation of the longer lung preservation time, cold flushed lungs were preserved on a portable lung perfusion device for ex vivonormothermic perfusion for 11 h 15 min, transplanted sequentially off-pump, and reperfused after a total ex vivotime of 13 h 32 min and 16 h for the first and second lung, respectively. Ten months later, the patient is doing well and no rejection occurred. Normothermic ex vivolung perfusion may help to prolong preservation time, facilitating long-distance transport and combined organ transplantation.

An in situthermogelling, mucoadhesive formulation based on N-trimethyl chitosan chloride has been evaluated for its potential to affect the transmucosal delivery of insulin viathe nasal route. In vitrostudies at a physiologically relevant temperature (ca. 35 °C) have shown that the formulation releases most of its insulin load (ca. 70%) in a non-Fickian manner during the timescale over which the sol-to-gel transition (ca. 8 min) takes place, and also that, once gelation is complete, the release of the remainder of the therapeutic content follows first order kinetics over at least sixty minutes. Investigations on the effects of the application of the same formulation to a modelled nasal mucosa (Calu-3 cell monolayer) have indicated the capability of the formulation to induce the transient opening of tight junctions. Cytotoxic investigations have shown that the formulation exhibits negligible detrimental effects to the integrity of these monolayers. The in vivopotential of the nasal formulation to act as a once-a-day dosage form for the intranasal delivery of insulin has been demonstrated in a diabetic-rat model.

Large-scale sterile methods for isolating hepatocytes are desirable for the development of bioartificial liver support systems. In this study the traditional centrifuge method was compared with the use of a Baylor Rapid Autologous Transfusion (BRAT) machine for isolating large quantities of porcine hepatocytes. After isolating hepatocytes, the methods were evaluated in terms of cell viability and yield per liver, proliferation over 7 days, and the effects on the cell cycle using the trypan blue exclusion test, conventional phase-contrast light microscopy, the lactate to pyruvate ratio, the leakage of lactate dehydrogenase (LD) and aspartate aminotransferase (AST), lidocaine clearance, albumin production, and flow cytometry. With the centrifuge method the mean cell viability was 92.5%, while with the BRAT method the viability was 95.9%. The minimal cell yields with the BRAT procedure were 7.3 × 109 for 250-ml centrifuge bowls and 2.8 × 109 for 165-ml bowls, which compares well with that found by other authors. Because the same initial procedures were employed in both methods the total hepatocyte yield per liver was comparable. Flow cytometry confirmed that the proliferation of hepatocytes was facilitated by oxygenation during the isolation procedure. The recovery of hepatocytes in culture following isolation was similar after either method. Daily microscopic investigation indicated that cytoplasmic vacuolization and granularities were present after either procedure and these disappeared following 3–4 days of culturing. Flow cytometry indicated that the hepatocyte cell cycle was similar after either method; at 7 days the profile indicated that the cells were still proliferating. Trends in the lactate to pyruvate ratio and the leakage of LD and AST indicated that the functional polarity of hepatocytes was regained after approximately 3 days. Lidocaine clearance at 4 days indicated that the cytochrome P450 system was active, while significant albumin production was apparent at day 5. The benefit of using BRAT technology in hepatocyte isolation lies in guaranteed sterility, convenience, speed, and the ability to oxygenate media and cell suspensions during the procedure.

ABSTRACTA novel heminested PCR protocol was developed for the specific detection of Helicobacter pyloriat low copy numbers. A set of primers specific for the phosphoglucosamine mutase gene (glmM) of H. pyloriproduced a 765-bp fragment that was used as template for the heminested primer pair delineating a 496-bp fragment. By using agarose gel electrophoresis for detection of the heminested PCR-amplified products, amplification of H. pylorigenomic DNA was achieved at concentrations as low as 0.1 pg, equivalent to 5 × 102bacteria. A study was subsequently undertaken to evaluate the heminested PCR for detection of H. pyloriin dental plaque and saliva. Specimens collected from 58 individuals were cultured, and PCR was subsequently performed on the oral cultures. Identification of H. pyloriin the same series of saliva and dental plaque specimens was carried out with PCR using a primer pair specific for the H. pyloriurease B gene and by the heminested PCR assay. The identity of the amplified products was confirmed by DNA sequencing. Our results demonstrate that the heminested PCR assay was specific for detection of H. pylori, yielding no false-positive results, and that H. pylorihad a low prevalence (approximately 3%) in specimens obtained from the oral cavity.