Comparison of the hemoglobin variability in non-chronic kidney disease or end-stage renal disease participants and patients with CKD and ESRD.

INTRODUCTION: Hemoglobin (Hb) variability occurs frequently in hemodialysis (HD) patients during erythropoietin (EPO) therapy. Guidelines define a narrow target range for the anemia treatment in these patients that is difficult to adhere to in practice. Our aim was to evaluate whether the Hb variability in HD patients is higher compared to non-chronic kidney disease or end-stage renal disease (ESRD) participants and patients with CKD stage I or II. MATERIALS AND METHODS: Monthly blood samples were assessed prospectively in 100 non-CKD or ESRD participants and 57 patients with CKD stage I or II, and retrospectively in 74 HD patients without changes in EPO or iron dose for 6 months. Variability was calculated and compared between the different groups. RESULTS: Hb variability was significantly higher in HD patients compared to the other groups, corresponding to results of previous studies. There were no significant differences between non-CKD or ESRD participants and patients with CKD stage I or II in terms of standard deviation (SD), residual SD, fluctuations across threshold, Hb cycling, and mean absolute change of Hb every 30 days (p > 0.05), but a significant difference compared to HD patients (p < 0.001). There were no significant differences between the groups in time in target and area under the curve (AUC) (p > 0.05). CONCLUSION: Hb variability is a common phenomenon in all groups independently of the method used for assessment and even without EPO therapy. The target range is difficult to achieve for HD patients and should be reconsidered in the future to avoid unsettling both the patients and the staff.

Ammonia emissions from a broiler farm: spatial variability of airborne concentrations in the vicinity and impact on adjacent woodland.

Agricultural NH(3) emissions affect air quality and influence the nitrogen cycle. In the subject study, NH(3) emissions from a broiler farm and the resulting atmospheric concentrations in the immediate vicinity during three growing cycles have been quantified. Additionally, vegetation along a transect in an adjacent woodland was analysed. The emissions were as high as 10 kg NH(3) h(-1) and the atmospheric concentrations ranged between 33 and 124 µg NH(3) m(-3) per week in the immediate vicinity. Measurements of the atmospheric concentrations over 7 weeks showed a substantial decline of mean concentrations (based on a 3-week average) from ∼13 to <3 µg NH(3) m(-3), at 45- and 415-m distance from the farm. Vegetation surveys showed that nitrophilous species flourished when they grew closest to the farm (their occurrence sank proportionately with distance). A clearly visible damage of pine trees was observed within 200 m of the farm; this illustrated the significant impact of NH(3) emissions from agricultural sources on the sensitive ecosystem.

A population pharmacokinetic model for pegylated-asparaginase in children.

We analysed 1221 serum activity measurements in 168 children from the Berlin-Frankfürt-Münster acute lymphoblastic leukaemia studies, ALL-BFM (Berlin-Frankfürt-Münster) 95 and ALL-BFM REZ, in order to develop a pharmacokinetic model describing the activity-time course of pegylated (PEG)-asparaginase for all dose levels. Patients received 500, 750, 1000 or 2500 U/m(2) PEG-asparaginase on up to nine occasions. Serum samples were analysed for asparaginase activity and data analysis was done using nonlinear mixed effects modelling (NONMEM Vers. VI, Globomax, Hanouet, MD, USA). Different linear and nonlinear models were tested. The best model applicable to all dosing groups was a one-compartmental model with clearance (Cl) increasing with time according to the formula: Cl=Cl(i) *e((0.0793 *t)) where Cl(i) = initial clearance and t = time after dose. The parameters found were: volume of distribution (V) 1.02 +/- 26% l/m(2), Cl(i) 59.9 +/- 59% ml/d per m(2) (mean +/- interindividual variability). Interoccasion variability was substantial with 0.183 l/m(2) for V and 44.7 ml/d per m(2) for Cl, respectively. A subgroup of the patients showed a high clearance, probably due to the development of inactivating antibodies. This is the first model able to predict the activity-time course of PEG-asparaginase at different dosing levels and can therefore be used for developing new dosing regimens.

Differential Effects of Ang-2/VEGF-A Inhibiting Antibodies in Combination with Radio- or Chemotherapy in Glioma.

Antiangiogenic strategies have not shown striking antitumor activities in the majority of glioma patients so far. It is unclear which antiangiogenic combination regimen with standard therapy is most effective. Therefore, we compared anti-VEGF-A, anti-Ang2, and bispecific anti-Ang-2/VEGF-A antibody treatments, alone and in combination with radio- or temozolomide (TMZ) chemotherapy, in a malignant glioma model using multiparameter two-photon in vivo microscopy in mice. We demonstrate that anti-Ang-2/VEGF-A lead to the strongest vascular changes, including vascular normalization, both as monotherapy and when combined with chemotherapy. The latter was accompanied by the most effective chemotherapy-induced death of cancer cells and diminished tumor growth. This was most probably due to a better tumor distribution of the drug, decreased tumor cell motility, and decreased formation of resistance-associated tumor microtubes. Remarkably, all these parameters where reverted when radiotherapy was chosen as combination partner for anti-Ang-2/VEGF-A. In contrast, the best combination partner for radiotherapy was anti-VEGF-A. In conclusion, while TMZ chemotherapy benefits most from combination with anti-Ang-2/VEGF-A, radiotherapy does from anti-VEGF-A. The findings imply that uninformed combination regimens of antiangiogenic and cytotoxic therapies should be avoided.

PEG-asparaginase (Oncaspar) 2500 U/m(2) BSA in reinduction and relapse treatment in the ALL/NHL-BFM protocols.

PURPOSE: As previous data had shown that only two-thirds of patients had the predicted activity time courses when PEG-asparaginase 1000 U/m(2) was used in reinduction after native E. coli asparaginase in induction treatment of acute lymphoblastic leukaemia (ALL), drug monitoring was performed with the use of a higher dose. METHODS: Because one-third of patients had insufficient serum asparaginase activity time courses after a single dose of 1000 U/m(2) PEG-asparaginase during reinduction treatment, a dose of 2500 U/m(2) PEG-asparaginase, which is the approved dosage in Germany, was used in 39 reinduction and 20 relapse patients to determine whether prolongation of the activity time course may be possible with this higher dose, and to look for significant differences between reinduction and relapse patients. RESULTS: After 1, 2 and 3 weeks, the mean activities were 1113 +/- 699 U/l, 231 +/- 259 U/l, and 13 +/- 35 U/l in the reinduction patients, and 1078 +/- 649 U/l, 165 +/- 195 U/l and 19 +/- 28 U/l in the relapse patients, respectively. There were a considerable number of patients with a substantially shortened activity time course in both groups. In 10 of 39 reinduction patients and in 7 of 24 doses during relapse treatment, only activities <100 U/l were found after 1 week with a further fast decline. No statistically significant differences between the two patient groups could be shown at any time-point. CONCLUSIONS: Comparison of these data with activities after 1000 U/m(2) PEG-asparaginase showed no prolongation of the time with activity in the therapeutic range with the higher dose. Therefore, for a longer duration of therapeutic activity, administration of further doses is mandatory.

Thermodynamic consideration on single oil in water emulsion film stabilized by cationic surfactant.

The emulsion film has become the focus of the study of emulsion because the film stability and structure play a crucial role on the whole stability and structure of emulsions. In this study, the single emulsion film stabilized by tetradecyltrimethylammonium bromide (C14TAB) in dodecane phase has been investigated thermodynamically. In order to make clear the theoretical treatment, it has been reviewed how the thermodynamic quantities of extremely thin films are defined and how it is related to the experimental variables such as temperature, pressure, and concentrations of solutes. By using the equations demonstrated here, the film tension and film surface tension, which were evaluated from the measurement of contact angle between the emulsion film and the surrounding bulk meniscus, have been inspected thermodynamically from the viewpoint of the influence of added salt (KBr) concentration on the structure of thin emulsion film. In addition, the comparison of the results obtained has also been made between the foam and emulsion films to reveal the effect of an ambient dodecane phase on the properties of the film.

Interactions in lipid stabilised foam films.

The interaction between lipid bilayers in water has been intensively studied over the last decades. Osmotic stress was applied to evaluate the forces between two approaching lipid bilayers in aqueous solution. The force-distance relation between lipid mono- or bilayers deposited on mica sheets using a surface force apparatus (SFA) was also measured. Lipid stabilised foam films offer another possibility to study the interactions between lipid monolayers. These films can be prepared comparatively easy with very good reproducibility. Foam films consist usually of two adsorbed surfactant monolayers separated by a layer of the aqueous solution from which the film is created. Their thickness can be conveniently measured using microinterferometric techniques. Studies with foam films deliver valuable information on the interactions between lipid membranes and especially their stability and permeability. Presenting inverse black lipid membrane (BLM) foam films supply information about the properties of the lipid self-organisation in bilayers. The present paper summarises results on microscopic lipid stabilised foam films by measuring their thickness and contact angle. Most of the presented results concern foam films prepared from dispersions of the zwitterionic lipid 1,2-dimyristoyl-sn-glycero-3-phosphorylcholine (DMPC) and some of its mixtures with the anionic lipid -- 1,2-dimyristoyl-sn-glycero-3-[phospho-rac-(1-glycerol)] (DMPG). The strength of the long range and short range forces between the lipid layers is discussed. The van der Waals attractive force is calculated. The electrostatic repulsive force is estimated from experiments at different electrolyte concentrations (NaCl, CaCl2) or by modification of the electrostatic double layer surface potential by incorporating charged lipids in the lipid monolayers. The short range interactions are studied and modified by using small carbohydrates (fructose and sucrose), ethanol (EtOH) or dimethylsulfoxide (DMSO). Some results are compared with the structure of lipid monolayers deposited at the liquid/air interface (monolayers spread in Langmuir trough), which are one of most studied biomembrane model system. The comparison between the film thickness and the free energy of film formation is used to estimate the contribution of the different components of the disjoining pressure to the total interaction in the film and their dependence on the composition of the film forming solution.

Foam films as thin liquid gas separation membranes.

In this letter, we testify the feasibility of using freestanding foam films as a thin liquid gas separation membrane. Diminishing bubble method was used as a tool to measure the permeability of pure gases like argon, nitrogen, and oxygen in addition to atmospheric air. All components of the foam film including the nature of the tail (fluorocarbon vs hydrocarbon), charge on the headgroup (anionic, cationic, and nonionic) and the thickness of the water core (Newton black film vs Common black film) were systematically varied to understand the permeation phenomena of pure gases. Overall results indicate that the permeability values for different gases are in accordance with magnitude of their molecular diameter. A smaller gaseous molecule permeates faster than the larger ones, indicating a new realm of application for foam films as size selective separation membranes.

Maintaining control over haemoglobin levels: optimizing the management of anaemia in chronic kidney disease.

The introduction of erythropoiesis-stimulating agents radically advanced the management of anaemia associated with chronic kidney disease (CKD). The European Best Practice Guidelines recommend that most patients with CKD achieve a target haemoglobin (Hb) >/=11 g/dl to reduce the risk of adverse outcomes. The optimal upper Hb level has not been determined and will likely vary among CKD patient populations. Recently reported studies show evidence that normalising Hb ( approximately 14 g/dl) in CKD may increase the risk of adverse events and puts attention to the importance of the upper Hb target. Most patients can achieve target Hb levels with proper treatment. However, recent studies have demonstrated that while average Hb levels may fall within desired targets, the Hb levels of many patients are not being adequately controlled, i.e. their Hb levels are not consistently maintained within a specified target range over time. Furthermore, data indicate that failing to control Hb levels over time may increase the risk of adverse outcomes, including mortality. This review will discuss the challenges in controlling Hb in the CKD patient population, particularly in haemodialysis patients. Factors that affect Hb control over time will be considered, as well as the clinical criteria for its assessment. Although challenging, control of Hb is manageable and has potential clinical benefits.

Mapping of B-cell epitopes in E. coli asparaginase II, an enzyme used in leukemia treatment.

The enzyme L-asparaginase is a crucial component in the treatment of acute lymphoblastic leukemia (ALL). As all asparaginases in clinical use are derived from microorganisms, immunological reactions are the most important adverse events associated with asparaginase treatment. Two different methods, phage display and the SPOTs method, were used for the determination of clinically relevant epitopes. Comparison of the results showed that essentially the same domains were identified by the two methods, and thus ascertainment of relevant epitopes can be assumed. Determination of the specificity of the epitopes will be performed with serum from patients with different modes of immunological reactions and from individuals without evidence of an immune response after asparaginase administration.

Stability of various silicone oil/water emulsion films as a function of surfactant and salt concentration.

There have been reports, originally by the Bristol group, and subsequently by others, of the preparation and properties of emulsions of stable, nearly monodisperse droplets of poly(dimethylsiloxane) (PDMS) in water, where no added surfactant is used. It has been assumed that their stability is due to the high density of surface-ionized hydroxyl groups, similar in fact to the closely related Stöber silica particles. In this study we confirm, from droplet lifetime studies, that droplets, prepared from such synthesized PDMS, are significantly more stable to coalescence than similar-sized droplets prepared from three types of commercially available PDMS, containing HO-, MeO-, or Me3-terminated chains, respectively. It is shown, however, that the zeta potentials of the synthesized PDMS and of the various commercial oils are all very similar (as indeed are their Hamaker constants). So some other explanation must be inferred for the enhanced stability to coalescence of the synthesized PDMS droplets compared to the commercial PDMS droplets. It is shown, for droplets formed from n-hexane and the synthesized oil, that stability to coalescence is conferred at PDMS volume fractions (phiPDMS) around 0.2 in the mixture. The synthesized PDMS is known to consist of mixtures of cyclic PDMS and short-chain linear species, with terminal -OH groups. There is some (indirect) evidence that in the interval 0.25 < phiPDMS < 0.35, the linear PDMS chains may be adsorbed close to a monolayer at the mixed oil/water interface, possibly conferring some enhanced Gibbs elasticity to the interface. This underpins the possibility that, in the synthesized oil droplets themselves, there is also preferential adsorption of the linear chains at the PDMS/water interface, and this leads to a value of the Gibbs elasticity, sufficient to significantly reduce coalescence. Unfortunately, the Gibbs elasticity could not be measured in this case. However, such preferential adsorption is unlikely to occur with the commercial PDMS oils, which are not so heterogeneous. Finally, it is shown that droplets of the three commercial PDMS oils could be stabilized against coalescence, if a sufficient, minimum amount of sodium dodecyl sulfate (SDS) is added. Gibbs elasticity values have been estimated in these cases, from plots of interfacial tension against ln(SDS concentration).

Antibody formation during intravenous and intramuscular therapy with Erwinia asparaginase.

BACKGROUND: Determination of the frequency of antibody formation during first and second exposure to Erwinia asparaginase after i.v. and i.m. administration. PROCEDURE: Thirty-nine children with newly diagnosed acute lymphoblastic leukemia (ALL) were included in this prospective study. Antibodies were determined (ELISA method) in plasma from these patients on specific days during and after therapy with 30,000 IU/m(2) i.v. or i.m. every day for ten days during the induction phase (first exposure). For 19 children, antibodies were measured in plasma during and after the re-induction phase (second exposure) following treatment with 30,000 IU/m(2) i.v. or i.m. twice a week for two weeks (Mondays and Thursdays). On the same days of therapy, enzyme activity (spectrophotometric method) and the concentration of asparagine (HPLC) was determined. RESULTS: During the first exposure, none of the patients developed anti-Erwinia asparaginase antibodies. During the second exposure, one patient (1 of 8 patients) treated intravenously developed antibodies, which were associated with disappearance of enzyme activity and reappearance of asparagine. Three of eleven patients developed antibodies of pharmacokinetic importance after i.m. therapy. None of the children had any clinical symptoms of hypersensitivity. CONCLUSIONS: The formation of antibodies and subsequently altered pharmacokinetics of Erwinia asparaginase seemed to be of importance only during a second period of asparaginase therapy.