[Oral Care to Prevent Ventilator-Associated Pneumonia].

Ventilator-associated pneumonia (VAP), one of the most common nosocomial infections in critical care units, has been associated with adverse outcomes such as higher medical expenses, prolonged hospital stays, and higher mortality rates. Although studies have demonstrated the effectiveness of oral care in reducing VAP incidence and enhancing patient comfort, few critically ill patients are able to perform oral care independently. Moreover, related evaluations and execution require specialized nursing techniques that rely on well-trained nurses. Unfortunately, descriptions of oral evaluations, caring practices, and hygiene related to pathogenic mechanisms in critically ill patients are scarce in both textbooks and the scientific literature. Based on a review of the related literature, this article discusses: the pathogenic mechanism of VAP; the purpose, principals, and steps of providing oral care to endotracheal tube ventilated patients, with particular emphasis on current evidence on the effect of chlorhexidine on oral care; and the major factors impacting oral care effectiveness. This article is expected to raise awareness of oral care, update the current evidence-based knowledge base, and increase the quality of nursing care provided to critically ill populations.

Liposomes with Low Levels of Grafted Poly(ethylene glycol) Remain Susceptible to Destabilization by Anti-Poly(ethylene glycol) Antibodies.

Binding of anti-PEG antibodies to poly(ethylene glycol) (PEG) on the surface of PEGylated liposomal doxorubicin (PLD) in vitro and in rats can activate complement and cause the rapid release of doxorubicin from the liposome interior. Here, we find that irinotecan liposomes (IL) and L-PLD, which have 16-fold lower levels of 1,2-distearoyl-sn-glycero-3-phosphoethanolamine (DSPE)-PEG2000 in their liposome membrane as compared to PLD, generate less complement activation but remain sensitive to destabilization and drug release by anti-PEG antibodies. Complement activation and liposome destabilization correlated with the theoretically estimated number of antibody molecules bound per liposome. Drug release from liposomes proceeded through the alternative complement pathway but was accelerated by the classical complement pathway. In contrast to PLD destabilization by anti-PEG immunoglobulin G (IgG), which proceeded by the insertion of membrane attack complexes in the lipid bilayer of otherwise intact PLD, anti-PEG IgG promoted the fusion of L-PLD, and IL to form unilamellar and oligo-vesicular liposomes. Anti-PEG immunoglobulin M (IgM) induced drug release from all liposomes (PLD, L-PLD, and IL) via the formation of unilamellar and oligo-vesicular liposomes. Anti-PEG IgG destabilized both PLD and L-PLD in rats, indicating that the reduction of PEG levels on liposomes is not an effective approach to prevent liposome destabilization by anti-PEG antibodies.

Accelerated clearance by antibodies against methoxy PEG depends on pegylation architecture.

Methoxy polyethylene glycol (mPEG) is attached to many proteins, peptides, nucleic acids and nanomedicines to improve their biocompatibility. Antibodies that bind PEG are present in many individuals and can be generated upon administration of pegylated therapeutics. Anti-PEG antibodies that bind to the PEG "backbone" can accelerate drug clearance and detrimentally affect drug activity and safety, but no studies have examined how anti-methoxy PEG (mPEG) antibodies, which selectively bind the terminus of mPEG, affect pegylated drugs. Here, we investigated how defined IgG and IgM monoclonal antibodies specific to the PEG backbone (anti-PEG) or terminal methoxy group (anti-mPEG) affect pegylated liposomes or proteins with a single PEG chain, a single branched PEG chain, or multiple PEG chains. Large immune complexes can be formed between all pegylated compounds and anti-PEG antibodies but only pegylated liposomes formed large immune complexes with anti-mPEG antibodies. Both anti-PEG IgG and IgM antibodies accelerated the clearance of all pegylated compounds but anti-mPEG antibodies did not accelerate clearance of proteins with a single or branched PEG molecule. Pegylated liposomes were primarily taken up by Kupffer cells in the liver, but both anti-PEG and anti-mPEG antibodies directed uptake of a heavily pegylated protein to liver sinusoidal endothelial cells. Our results demonstrate that in contrast to anti-PEG antibodies, immune complex formation and drug clearance induced by anti-mPEG antibodies depends on pegylation architecture; compounds with a single or branched PEG molecule are unaffected by anti-mPEG antibodies but are increasingly affected as the number of PEG chain in a structure increases.

Antibodies against Poly(ethylene glycol) Activate Innate Immune Cells and Induce Hypersensitivity Reactions to PEGylated Nanomedicines.

Nanomedicines and macromolecular drugs can induce hypersensitivity reactions (HSRs) with symptoms ranging from flushing and breathing difficulties to hypothermia, hypotension, and death in the most severe cases. Because many normal individuals have pre-existing antibodies that bind to poly(ethylene glycol) (PEG), which is often present on the surface of nanomedicines and macromolecular drugs, we examined if and how anti-PEG antibodies induce HSRs to PEGylated liposomal doxorubicin (PLD). Anti-PEG IgG but not anti-PEG IgM induced symptoms of HSRs including hypothermia, altered lung function, and hypotension after PLD administration in C57BL/6 and nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. Hypothermia was significantly reduced by blocking FcγRII/III, by depleting basophils, monocytes, neutrophils, or mast cells, and by inhibiting secretion of histamine and platelet-activating factor. Anti-PEG IgG also induced hypothermia in mice after administration of other PEGylated liposomes, nanoparticles, or proteins. Humanized anti-PEG IgG promoted binding of PEGylated nanoparticles to human immune cells and induced secretion of histamine from human basophils in the presence of PLD. Anti-PEG IgE could also induce hypersensitivity reactions in mice after administration of PLD. Our results demonstrate an important role for IgG antibodies in induction of HSRs to PEGylated nanomedicines through interaction with Fcγ receptors on innate immune cells and provide a deeper understanding of HSRs to PEGylated nanoparticles and macromolecular drugs that may facilitate development of safer nanomedicines.

Removal of protein, histological dye and tetracycline from simulated bioindustrial wastewater with a dual pore size PPSU membrane.

Wastewater from production of active pharmaceutical ingredients (APIs) often contains proteins, azo dyes or antibiotics, which cause severe water eutrophication and growth of drug-resistant bacteria. A series of polyphenylsulfone (PPSU) membranes was prepared to determine the relationships between pore structures and the abilities of different membranes to separate foulants, and the characteristics and performance of the ultrafiltration membranes were investigated. The structure of the skin layer and the cross-sectional texture were converted from dense and finger-like macrovoids to porous sponge shapes because of a delayed liquid-liquid (L-L) demixing time. Formation of novel PPSU membranes via noncovalent bonding interactions was evaluated, and this selectively affected the membrane surface pore structure, layer thickness, surface polarity and electronic repulsive force. All PPSU membranes demonstrated excellent rejection of organic foulants, including bovine serum albumin (BSA) (~100% rejection) and acid red 1 (AR1) (~90% rejection). Additionally, M5 provided an excellent tetracycline (TC) rejection efficiency of 89% in the 1st cycle. Due to the small size of TC, pore size effects were displayed. Moreover, the pure water flux recovery rate (FRR) increased from 85% (M1, water/ethanol: 100/0) to 99.9% (M4, water/ethanol: 30/70) after BSA filtration because the weak nonsolvent decreased the roughness of the membrane surface, and the membrane made with added EtOH yielded excellent FRR values (99.9%) after AR1 filtration. Therefore, PPSU membranes successfully achieved over 90% rejection of organic foulants and excellent FRRs, indicating that they may be suitable for purifying wastewater from API plants that generate organic foulants with a wide range of sizes.

Multi-walled carbon nanotube composites with polyacrylate prepared for open-tubular capillary electrochromatography.

A new phase containing immobilized carbon nanotubes (CNTs) was synthesized by in situ polymerization of acid-treated multi-walled CNTs using butylmethacrylate (BMA) as the monomer and ethylene dimethacrylate as the crosslinker on a silanized capillary, forming a porous-layered open-tubular column for CEC. Incorporation of CNT nanomaterials into a polymer matrix could increase the phase ratio and take advantage of the easy preparation of an OT-CEC column. The completed BMA-CNT column was characterized by SEM, ATR-IR, and EOF measurements, varying the pH and the added volume organic modifier. In the multi-walled CNTs structure, carboxylate groups were the major ionizable ligands on the phase surface exerting the EOF having electroosmotic mobility, 4.0 × 10(4) cm2 V(-1)1 S(-1)1, in the phosphate buffer at pH 2.8 and RSD values (n=5), 3.2, 4.1, and 4.3%, for three replicate capillaries at pH 7.6. Application of the BMA-CNT column in CEC separations of various samples, including nucleobases, nucleosides, flavonoids, and phenolic acids, proved satisfactory upon optimization of the running buffers. Their optima were found in the borate buffers at pH 9.0/50 mM, pH 9.5/10 mM/50% v/v ACN, and pH 9.5/30 mM/10% v/v methanol, respectively. The separations could also be used to assess the relative contributions of electrophoresis and chromatography to the CEC mechanism by calculating the corresponding velocity and retention factors. Discussions about interactions between the probe solutes and the bonded phase included the π-π interactions, electrostatic repulsion, and hydrogen bonding. Furthermore, a reversed-phase mode was discovered to be involved in the chromatographic retention.

Engineering Antifouling and Antibacterial Stainless Steel for Orthodontic Appliances through Layer-by-Layer Deposition of Nanocomposite Coatings.

In this study, a nanocomposite coating composed of polydopamine, functionalized poly(3,4-ethylenedioxythiophene) (PEDOT), and silver nanoparticles (AgNPs) was synthesized through layer-by-layer deposition. Biomimitic polydopamine and hydroxyl-functionalized PEDOT were used to enhance the adhesion strength. The deposition of PEDOT functionalized with zwitterionic phosphorylcholine can contribute to the antifouling property. After immersion in the AgNO3 solution, Ag+ ions were adsorbed on PEDOT films and further reduced to form AgNPs spontaneously, which conferred antibacterial properties on these nanocomposite films. Escherichia coli and Streptococcus mutans were chosen to represent two common Gram-negative and Gram-positive oral pathogens. We further conducted inductively coupled plasma mass spectrometry to confirm that the Ag+ ions released from these nanocomposite films did not exert adverse effects on the human body. These results suggested that, when applied to stainless steel orthodontic appliances, these durable antifouling and antibacterial coatings may be useful for avoiding bacterial infection.

Succinyl methacrylate polymerized in porous-layered phases for open-tubular capillary electrochromatography: comparison with silica hydride monolayered phases.

A polymer phase, which was constructed with butyl methacrylate (BMA), an ionizable monomer (mono-(2-(methacryloyloxy)ethyl) succinate (MES)), and a crosslinking agent (ethylene dimethacrylate), was first formed in a porous-layered open-tubular (PLOT) capillary. The PLOT capillary was characterized with SEM and electrophoretic flow as the pH level, ionic strength and addition of organic modifiers in the running buffers changed. In addition, a bare capillary and a silica hydride based capillary (SiH-MES), which bore a monolayered MES phase on it, were used to compared with the BMA-MES capillary. Besides optimizing the capillary electrochromatographic (CEC) conditions for each group of analytes, which were a mixture of nucleosides and thymine, flavonoids, and phenolic acids,comparison of the separation selectivity among analytes between the BMA-MES and SiH-MES capillaries was done according to the velocity and retention factors obtained from the CEC data. Overall, the polymeric phase formed in the PLOT mode was capable of preventing blockage of the columns and was superior to the monolayered phase bonding with the same ionizable ligands for application in CEC as well as to the bare silica phase in CE.