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1.
Nat Commun ; 13(1): 4903, 2022 08 20.
Artículo en Inglés | MEDLINE | ID: mdl-35987905

RESUMEN

The sediment-water interface in the coastal ocean is a highly dynamic zone controlling biogeochemical fluxes of greenhouse gases, nutrients, and metals. Processes in the sediment mixed layer (SML) control the transfer and reactivity of both particulate and dissolved matter in coastal interfaces. Here we map the global distribution of the coastal SML based on excess 210Pb (210Pbex) profiles and then use a neural network model to upscale these observations. We show that highly dynamic regions such as large estuaries have thicker SMLs than most oceanic sediments. Organic carbon preservation and SMLs are inversely related as mixing stimulates oxidation in sediments which enhances organic matter decomposition. Sites with SML thickness >60 cm usually have lower organic carbon accumulation rates (<50 g C m-2 yr-1) and total organic carbon/specific surface area ratios (<0.4 mg m-2). Our global scale observations reveal that reworking can accelerate organic matter degradation and reduce carbon storage in coastal sediments.


Asunto(s)
Carbono , Contaminantes Químicos del Agua , Carbono/química , Monitoreo del Ambiente , Sedimentos Geológicos/química , Plomo , Océanos y Mares , Agua
2.
Nanomedicine ; 30: 102275, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32750494

RESUMEN

CPX-351, a liposomal encapsulation of cytarabine and daunorubicin at a synergistic 5:1 molar ratio, is indicated for adults with newly diagnosed, therapy-related acute myeloid leukemia or acute myeloid leukemia with myelodysplasia-related changes. In preclinical species, this article demonstrated (1) similar release of cytarabine and daunorubicin by CPX-351 in plasma; (2) similar patterns of metabolism of cytarabine and daunorubicin following administration of CPX-351 versus non-liposomal cytarabine/daunorubicin combination; (3) prolonged tissue exposure to CPX-351; (4) dramatically different tissue distribution of cytarabine and daunorubicin following administration of CPX-351 versus non-liposomal combination (tissue:plasma ratios generally <1 versus >1, respectively); and (5) dramatically lower unbound plasma and tissue concentrations of cytarabine and daunorubicin following administration of CPX-351 versus non-liposomal combination. Together, these results provide insight into the safety profile of CPX-351, as well as mechanisms that drive the improved efficacy observed for CPX-351 versus the conventional 7 + 3 cytarabine/daunorubicin regimen in clinical studies.


Asunto(s)
Antineoplásicos/farmacocinética , Citarabina/farmacocinética , Daunorrubicina/farmacocinética , Animales , Área Bajo la Curva , Bilis/química , Cromatografía Líquida de Alta Presión/métodos , Citarabina/sangre , Citarabina/orina , Daunorrubicina/sangre , Daunorrubicina/orina , Perros , Combinación de Medicamentos , Heces/química , Femenino , Semivida , Límite de Detección , Masculino , Ratones , Ratas , Espectrometría de Fluorescencia/métodos , Espectrofotometría Ultravioleta/métodos , Distribución Tisular
3.
Int J Nanomedicine ; 14: 3819-3830, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31213803

RESUMEN

Combination regimens are a standard of care for many cancers. However, components of such regimens are typically first developed individually and subsequently combined using strategies to minimize toxicity. Little or no consideration is given to strategies that potentially maximize efficacy. In contrast, CPX-351 (Vyxeos®) is a dual-drug liposomal encapsulation of cytarabine and daunorubicin that was rationally designed to improve efficacy over the traditional 7+3 cytarabine/daunorubicin chemotherapy regimen for patients with acute myeloid leukemia (AML). The notable clinical efficacy of CPX-351 is achieved through maintenance of a synergistic 5:1 molar ratio of cytarabine and daunorubicin within the liposome after intravenous injection. The CPX-351 liposome, which is formulated to contain bilayers of distearoylphosphatidylcholine, distearoylphosphatidylglycerol, and cholesterol at a 7:2:1 molar ratio and remains in a gel phase at body temperature, provides stability without polyethylene glycol, controlled release of cytarabine and daunorubicin, limited systemic drug distribution, and preferential internalization within malignant myeloblasts in the bone marrow via active uptake of liposomes into cytoplasmic vacuoles. Thus, the CPX-351 liposome protects cytarabine and daunorubicin from metabolism and elimination, while overcoming pharmacokinetic differences between the two agents. In clinical studies, these liposome properties markedly increased the elimination half-life of CPX-351 versus free cytarabine and daunorubicin and maintained a synergistic drug ratio for over 24 hrs after administration. Preferential uptake of liposomes by leukemia cells suggests that relatively large amounts of cytarabine and daunorubicin enter malignant cells via liposomes, potentially bypassing P-glycoprotein-based efflux pumps, which are important mediators of chemotherapy resistance, and contribute to the rapid clearance of leukemia cells from the circulation and bone marrow. These pharmacologic advantages, a direct consequence of properties of the encapsulating liposome, may explain the efficacy of CPX-351 in patients with newly diagnosed high-risk/secondary AML and the reduced drug exposure in off-target tissues that contribute to a manageable safety profile.


Asunto(s)
Citarabina/farmacocinética , Daunorrubicina/farmacocinética , Composición de Medicamentos , Endocitosis , Neoplasias/metabolismo , Daunorrubicina/administración & dosificación , Daunorrubicina/farmacología , Endocitosis/efectos de los fármacos , Humanos , Liposomas , Distribución Tisular/efectos de los fármacos
4.
Cancer Chemother Pharmacol ; 84(1): 163-173, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31098682

RESUMEN

PURPOSE: Daunorubicin can induce left ventricular dysfunction and QT interval prolongation. This study assessed the effects of CPX-351, a liposomal encapsulation of cytarabine and daunorubicin, on cardiac repolarization. METHODS: Twenty-six adults with acute leukemia were treated with CPX-351 for 1-2 induction cycles and ≤ 4 consolidation cycles. The primary endpoint was mean change in QTcF from baseline. RESULTS: Mean QTcF changes were < 10 ms at all time points. No clinically meaningful effects on heart rate, QRS interval, PR interval, or QTcB were observed. Estimated mean half-lives for total cytarabine and daunorubicin were > 30 h. Thirteen (50%) patients achieved remission. The most common adverse events were febrile neutropenia, fatigue, and nausea. CONCLUSIONS: The cytarabine and daunorubicin in CPX-351 liposomes were metabolized and excreted similarly to conventional formulation; however, plasma pharmacokinetics were altered. CPX-351 did not prolong the QT interval, suggesting that CPX-351 may induce less cardiotoxicity than previously reported for conventional daunorubicin. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02238925.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Leucemia Mieloide Aguda/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Citarabina/efectos adversos , Citarabina/farmacocinética , Daunorrubicina/efectos adversos , Daunorrubicina/farmacocinética , Combinación de Medicamentos , Femenino , Semivida , Humanos , Liposomas , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
5.
Leuk Res ; 74: 121-129, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30119908

RESUMEN

CPX-351, a liposomal formulation co-encapsulating cytarabine and daunorubicin (DNR) in a synergistic 5:1 M ratio, has shown favourable response in newly diagnosed elderly high-risk AML. This study assessed intracellular ara-CTP levels following in vitro exposure of human immortalised leukaemic cell lines and primary AML blasts to CPX-351, and investigated fludarabine potentiation of intracellular ara-CTP formation from CPX-351. Comparison of intracellular handling of CPX-351 to cytarabine in HL-60 cells indicated slower conversion to ara-CTP for CPX-351, but equivalent cytotoxicity to cytarabine and combined DNR/cytarabine (DA) at 48 h, mostly likely reflecting the need for intracellular liposome processing to release encapsulated drugs. Further assessment demonstrated cytotoxicity of CPX-351 to be superior to DA at 48 and 72 h in cytarabine-resistant THP-1 cells (p < 0.001), and this effect could not be inhibited upon blockade of human equilibrative nucleoside transporter (hENT) function with dipyridamole. Assessment of Flu-CPX in primary blasts from presentation AML patients (n = 5) demonstrated a more rapid and pronounced potentiation of ara-CTP from CPX-351 than in immortalised cell lines, with 4/5 patients showing significant increases in ara-CTP, notably for those that went on to fail induction and relapse treatment in vivo (n = 3). This suggests a favourable impact on patient outcome from Flu-CPX.


Asunto(s)
Citarabina , Daunorrubicina , Resistencia a Antineoplásicos/efectos de los fármacos , Tranportador Equilibrativo 1 de Nucleósido/metabolismo , Leucemia Mieloide Aguda , Proteínas de Neoplasias/metabolismo , Vidarabina/análogos & derivados , Citarabina/farmacocinética , Citarabina/farmacología , Daunorrubicina/farmacocinética , Daunorrubicina/farmacología , Células HL-60 , Humanos , Células K562 , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patología , Células THP-1 , Vidarabina/farmacocinética , Vidarabina/farmacología
6.
Future Oncol ; 14(13): 1317-1332, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29363994

RESUMEN

Current combination therapy approaches assume that better outcomes are achieved by combining drugs at their maximally tolerated doses. However, administration of individual agents cannot consistently deliver synergistic drug ratios to tumor cells due to differences in pharmacokinetics of the individual drugs. Further, the toxicity of combination regimens often necessitates administration of suboptimal dosages. Delivery technologies, such as the CombiPlex® platform, can enable efficient and sustained delivery of combination treatments at a synergistic ratio. The CombiPlex platform determines synergistic drug ratios in vitro and identifies an appropriate nanoscale carrier to maintain that ratio in vivo and enhance its delivery to tumor cells. CPX-351, a dual-drug liposomal encapsulation of cytarabine and daunorubicin, is the first clinical proof-of-concept example of the CombiPlex platform.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Composición de Medicamentos/métodos , Sistemas de Liberación de Medicamentos/métodos , Neoplasias/tratamiento farmacológico , Animales , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tecnología Biomédica/métodos , Relación Dosis-Respuesta a Droga , Sinergismo Farmacológico , Humanos , Liposomas , Nanopartículas , Resultado del Tratamiento
7.
Leuk Res ; 53: 39-49, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28013106

RESUMEN

PURPOSE: Identify AML patients most likely to respond to CPX-351, a nano-scale liposome formulation containing cytarabine and daunorubicin co-encapsulated at a 5:1 molar ratio. METHODS: We examined the ex vivo cytotoxic activity of CPX-351 against leukemic cells isolated from 53 AML patients and an additional 127 samples including acute lymphoblastic leukemia, myelodysplastic syndrome/myeloproliferative neoplasms, or chronic lymphocytic leukemia/lymphoma. We assessed activity with respect to common molecular lesions and used flow cytometry to assess CPX-351 cellular uptake. RESULTS: AML specimen sensitivity to CPX-351 was similar across conventional risk groups. FLT3-ITD cases were five-fold more sensitive to CPX-351. CPX-351 was active across other indications with nearly all cases exhibiting IC50 values markedly lower than reported 72-h plasma drug concentration in patients receiving CPX-351. The range and distribution of CPX-351 IC50 values were comparable for AML, CLL, and ALL, whereas MDS/MPN cases were less sensitive. CPX-351 uptake analysis revealed a correlation between uptake of CPX-351 and cytotoxic potency. CONCLUSIONS: Our findings are consistent with clinical data, in which CPX-351 activity is retained in high-risk AML patients. Ex vivo analysis of cytotoxic potency may provide a means to identify specific AML subsets, such as FLT3-ITD, that benefit most from CPX-351 and warrant additional clinical evaluation.


Asunto(s)
Crisis Blástica/tratamiento farmacológico , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Liposomas/administración & dosificación , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Antibióticos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Humanos , Concentración 50 Inhibidora , Mutación , Células Tumorales Cultivadas , Tirosina Quinasa 3 Similar a fms/genética
8.
Sci Total Environ ; 568: 42-51, 2016 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-27285795

RESUMEN

Wetland sediments undergo dry-wet cycles that may change their structural properties and affect geochemical behavior of associated organic compounds. In this study, we examined the effect of drying on particle size distributions and the rapid (24h) sorption reactions of polycyclic aromatic hydrocarbons (PAHs) with salt marsh sediments in Nueces Delta, South Texas. Drying reduced the fraction of fine particles in organically richer sediments, indicating structural rearrangement of organic matter and mineral aggregates. Among the 16 EPA priority PAHs examined, dried sediment preferentially released 1.0-7.5% of phenanthrene, fluoranthene and pyrene to added seawater (solid: water mass ratio of 1/100) - significantly greater than release from sediments maintained in the wet state. On the other hand, drying also increased the affinity of sedimentary organic matter (SOM) for experimentally amended (deuterated) phenanthrene relative to continually wet sediments. Further, deuterated phenanthrene was even more effectively retained when it was added to wet sediment that was subsequently dried and rewetted. These apparently contradictory results can be reconciled and explained by SOM having a heterogeneous distribution of hydrophobic and hydrophilic zones - e.g., a zonal model. We propose that drying changed the orientation of amphiphilic SOM, exposing hydrophobic zones and promoting the release of some of their native PAHs to water. Freshly amended PAHs were only able to penetrate into the surface hydrophobic zone and/or deeper but rapidly accessible ("kinetic") zone in wet sediments due to the brief adsorption contact time. Subsequent drying presumably then induced structural changes in SOM that isolated these amended PAHs in sites inaccessible to water exchange in the next rewetting. These results provide insights into structural changes of SOM upon drying, and help predict the fate of compounds such as organic contaminants during drought/flood oscillations.

9.
J Drug Target ; 24(9): 797-804, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27143215

RESUMEN

Historically, the use of liposomes to enhance delivery of anticancer agents to cancer cells has focused primarily on solid tumors, which are characterized by rapid angiogenesis resulting in a poorly formed hypervasculature with abnormal vessel walls. The leaky vasculature in combination with poor lymphatic drainage has been demonstrated to lead to the accumulation of liposomes via the enhanced permeation and retention effect. However, only very limited information exists on the disposition of such delivery systems in the bone marrow compartment, the primary site of tumor cell origination and growth for many hematological malignancies. In this review we discuss the biological properties of anionic low-cholesterol liposome formulations and their potential for passively accumulating within the bone marrow and being selectively engulfed by leukemia cells compared to normal bone marrow cells. The therapeutic implications for preferential bone marrow delivery as well as the potential routes for the internalization of drug-encapsulated liposomes into cells in the absence of a targeting ligand are reviewed.


Asunto(s)
Antineoplásicos/administración & dosificación , Células de la Médula Ósea/fisiología , Colesterol/química , Sistemas de Liberación de Medicamentos , Leucemia/tratamiento farmacológico , Liposomas/química , Animales , Humanos
10.
Pediatr Blood Cancer ; 62(1): 65-71, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25203866

RESUMEN

BACKGROUND: CPX-351, a liposomal formulation of cytarabine and daunorubicin co-encapsulated at an optimized synergistic 5:1 molar ratio, has demonstrated improved clinical outcomes over conventional cytarabine/daunorubicin treatment in a randomized phase 2 trial in patients with AML as well as superior efficacy against preclinical leukemia models when compared to the free drugs in combination. PROCEDURES: Given the promising phase 2 data, limited toxicities observed, and the known clinical activities of cytarabine/daunorubicin, we assessed the efficacy of CPX-351 against a panel of childhood ALL xenograft models. Plasma pharmacokinetics of cytarabine and daunorubicin following CPX-351 treatment were determined by HPLC in order to correlate efficacy with drug exposure. RESULTS: CPX-351, at a dose of 5 units/kg (corresponding to 5 mg/kg cytarabine and 2.2 mg/kg daunorubicin), was highly efficacious against all xenografts tested, inducing complete responses in four B-lineage xenografts and partial response in one T-lineage xenograft. These therapeutic responses were achieved with CPX-351 doses that provided drug exposures (based on Cmax and AUC) comparable to those observed in patients with AML. CONCLUSIONS: These results suggest that CPX-351 may be a promising chemotherapeutic to be utilized in the treatment of ALL and support its testing in pediatric patients with leukemia.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Adolescente , Animales , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Niño , Preescolar , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Femenino , Humanos , Liposomas , Masculino , Dosis Máxima Tolerada , Ratones , Ratones Endogámicos NOD , Ratones SCID , Pediatría , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Distribución Tisular , Resultado del Tratamiento , Ensayos Antitumor por Modelo de Xenoinjerto
12.
Geochem Trans ; 15(1): 2, 2014 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-24641695

RESUMEN

BACKGROUND: Coastal sediments in the northern Gulf of Mexico have a high potential of being contaminated by petroleum hydrocarbons, such as polycyclic aromatic hydrocarbons (PAHs), due to extensive petroleum exploration and transportation activities. In this study we evaluated the spatial distribution and contamination sources of PAHs, as well as the bioavailable fraction in the bulk PAH pool, in surface marsh and shelf sediments (top 5 cm) of the northern Gulf of Mexico. RESULTS: PAH concentrations in this region ranged from 100 to 856 ng g-1, with the highest concentrations in Mississippi River mouth sediments followed by marsh sediments and then the lowest concentrations in shelf sediments. The PAH concentrations correlated positively with atomic C/N ratios of sedimentary organic matter (OM), suggesting that terrestrial OM preferentially sorbs PAHs relative to marine OM. PAHs with 2 rings were more abundant than those with 5-6 rings in continental shelf sediments, while the opposite was found in marsh sediments. This distribution pattern suggests different contamination sources between shelf and marsh sediments. Based on diagnostic ratios of PAH isomers and principal component analysis, shelf sediment PAHs were petrogenic and those from marsh sediments were pyrogenic. The proportions of bioavailable PAHs in total PAHs were low, ranging from 0.02% to 0.06%, with higher fractions found in marsh than shelf sediments. CONCLUSION: PAH distribution and composition differences between marsh and shelf sediments were influenced by grain size, contamination sources, and the types of organic matter associated with PAHs. Concentrations of PAHs in the study area were below effects low-range, suggesting a low risk to organisms and limited transfer of PAHs into food web. From the source analysis, PAHs in shelf sediments mainly originated from direct petroleum contamination, while those in marsh sediments were from combustion of fossil fuels.

13.
Ther Deliv ; 5(2): 149-71, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24483194

RESUMEN

While combination chemotherapy has led to measurable improvements in cancer treatment outcomes, its full potential remains to be realized. Nanoscale particles such as liposomes, nanoparticles and polymer micelles have been shown to increase delivery to the tumor site while bypassing many drug resistance mechanisms that limit the effectiveness of conventional therapies. Recent efforts in drug delivery have focused on coordinated, controlled delivery of multiple anticancer agents encapsulated within a single particle system. In this review, we analyze recent progress made in multidrug delivery in three main areas of interest: co-delivery of antineoplastic agents with drug sensitizers, sequential delivery via temporal release particles and simultaneous delivery of multiple agents. Future directions of the field, in light of recent advances with molecularly targeted agents, are suggested and discussed.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Portadores de Fármacos , Nanotecnología , Neoplasias/tratamiento farmacológico , Tecnología Farmacéutica/métodos , Animales , Protocolos de Quimioterapia Combinada Antineoplásica/química , Protocolos de Quimioterapia Combinada Antineoplásica/metabolismo , Química Farmacéutica , Preparaciones de Acción Retardada , Resistencia a Antineoplásicos , Humanos , Nanopartículas , Neoplasias/metabolismo , Neoplasias/patología , Resultado del Tratamiento
14.
Geriatr Nurs ; 35(1): 26-30, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24139207

RESUMEN

PURPOSE: Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. METHODS: We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL "level of care" (based on state regulatory criteria). RESULTS: In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care - 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. CONCLUSION: The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization.


Asunto(s)
Instituciones de Vida Asistida , Servicios de Salud/estadística & datos numéricos , Pacientes Internos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Diabetes Mellitus/terapia , Insuficiencia Cardíaca/terapia , Humanos , Maryland , Enfermedad Pulmonar Obstructiva Crónica/terapia
15.
Int Psychogeriatr ; 25(12): 2047-56, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24059909

RESUMEN

BACKGROUND: There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems. METHODS: Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001-2003] and Cohort 2 [evaluated 2004-2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel. RESULTS: Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models. CONCLUSIONS: We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.


Asunto(s)
Instituciones de Vida Asistida/estadística & datos numéricos , Demencia/diagnóstico , Anciano de 80 o más Años , Instituciones de Vida Asistida/legislación & jurisprudencia , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/terapia , Estudios de Cohortes , Estudios Transversales , Demencia/terapia , Femenino , Política de Salud/legislación & jurisprudencia , Humanos , Masculino , Maryland/epidemiología , Pruebas Neuropsicológicas
16.
J Control Release ; 172(2): 558-67, 2013 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-23664969

RESUMEN

Pharmacokinetic modeling and simulation is a powerful tool for the prediction of drug concentrations in the absence of analytical techniques that allow for direct quantification. The present study applied this modeling approach to determine active drug release from a nanoparticle prodrug formulation. A comparative pharmacokinetic study of a nanoscale micellar docetaxel (DTX) prodrug, Procet 8, and commercial DTX formulation, Taxotere, was conducted in bile duct cannulated rats. The nanoscale (~40nm) size of the Procet 8 formulation resulted in confinement within the plasma space and high prodrug plasma concentrations. Ex vivo prodrug hydrolysis during plasma sample preparation resulted in unacceptable error that precluded direct measurement of DTX concentrations. Pharmacokinetic modeling of Taxotere and Procet 8 plasma concentrations, and their associated biliary metabolites, allowed for prediction of the DTX concentration profile and DTX bioavailability, and thereby evaluation of Procet 8 metabolism. Procet 8 plasma decay and in vitro plasma hydrolytic rates were identical, suggesting that systemic clearance of the prodrug was primarily metabolic. The Procet 8 and Taxotere plasma profiles, and associated docetaxel hydroxy-tert-butyl carbamate (HDTX) metabolite biliary excretion, were best fit by a two compartment model, with both linear and non-linear DTX clearance, and first order Procet 8 hydrolysis. The model estimated HDTX clearance rate agreed with in vitro literature values, supporting the predictability of the proposed model. Model simulation at the 10mg DTX equivalent/kg dose level predicted DTX formation rate-limited kinetics and a peak plasma DTX concentration of 39ng/mL at 4h for Procet 8, in comparison to 2826ng/mL for Taxotere. As a result of nonlinear DTX clearance, the DTX AUCinf for the Procet 8 formulation was predicted to be 2.6 times lower than Taxotere (775 vs. 2017h×ng/mL, respectively), resulting in an absolute bioavailability estimate of 38%. As DTX clearance in man is considered linear, this low bioavailability is likely species-dependent. These data support the use of pharmacokinetic modeling and simulation in cases of complex formulations, where analytical methods for direct measurement of free (released) drug concentrations are unavailable. Uses of such models may include interpretation of preclinical toxicology studies, selection of first in man dosing regimens, and PK/PD model development.


Asunto(s)
Antineoplásicos/metabolismo , Bilis/metabolismo , Nanopartículas/metabolismo , Profármacos/metabolismo , Taxoides/metabolismo , Animales , Antineoplásicos/farmacocinética , Simulación por Computador , Docetaxel , Femenino , Hidrólisis , Cinética , Masculino , Micelas , Modelos Biológicos , Profármacos/farmacocinética , Ratas , Ratas Sprague-Dawley , Taxoides/farmacocinética
17.
Int Psychogeriatr ; 25(5): 721-31, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23290818

RESUMEN

BACKGROUND: To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders. METHODS: Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment. Incidence, prevalence, and persistence were derived from the panel's assessment. Family and direct care staff recognition of mental disorders was also assessed. RESULTS: At baseline, three-quarters suffered from a cognitive disorder (56% dementia, 19% Cognitive Disorders Not Otherwise Specified) and 15% from an active non-cognitive mental disorder. Twelve-month incidence rates for dementia and non-cognitive psychiatric disorders were 17% and 3% respectively, and persistence rates were 89% and 41% respectively. Staff recognition rates for persistent dementias increased over the 12-month period but 25% of cases were still unrecognized at 12 months. Treatment was complete at 12 months for 71% of persistent dementia cases and 43% of persistent non-cognitive psychiatric disorder cases. CONCLUSIONS: Individuals recently admitted to AL are at high risk for having or developing mental disorders and a high proportion of cases, both persistent and incident, go unrecognized or untreated. Routine dementia and psychiatric screening and reassessment should be considered a standard care practice. Further study is needed to determine the longitudinal impact of psychiatric care on resident outcomes and use of facility resources.


Asunto(s)
Inhibidores de la Colinesterasa/uso terapéutico , Trastornos del Conocimiento/tratamiento farmacológico , Trastornos del Conocimiento/epidemiología , Demencia/tratamiento farmacológico , Demencia/epidemiología , Psicotrópicos/uso terapéutico , Anciano de 80 o más Años , Antiparkinsonianos/uso terapéutico , Instituciones de Vida Asistida , Trastornos del Conocimiento/diagnóstico , Demencia/diagnóstico , Femenino , Evaluación Geriátrica , Hospitalización , Humanos , Incidencia , Estudios Longitudinales , Masculino , Maryland/epidemiología , Trastornos Mentales/diagnóstico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Prevalencia , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento
18.
Int J Med Inform ; 82(4): 260-7, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23266060

RESUMEN

OBJECTIVES: Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. METHODS: Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. RESULTS: 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). CONCLUSIONS: Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients.


Asunto(s)
Centros Médicos Académicos/organización & administración , Acceso a la Información , Sistemas de Registros Médicos Computarizados , Psiquiatría , Humanos , Trastornos Mentales , Estados Unidos
19.
J Control Release ; 162(1): 208-17, 2012 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-22732478

RESUMEN

Drug nanocarrier clearance by the immune system must be minimized to achieve targeted delivery to pathological tissues. There is considerable interest in finding in vitro tests that can predict in vivo clearance outcomes. In this work, we produce nanocarriers with dense PEG layers resulting from block copolymer-directed assembly during rapid precipitation. Nanocarriers are formed using block copolymers with hydrophobic blocks of polystyrene (PS), poly-ε-caprolactone (PCL), poly-D,L-lactide (PLA), or poly-lactide-co-glycolide (PLGA), and hydrophilic blocks of polyethylene glycol (PEG) with molecular weights from 1 kg/mol to 9 kg/mol. Nanocarriers with paclitaxel prodrugs are evaluated in vivo in Foxn1(nu) mice to determine relative rates of clearance. The amount of nanocarrier in circulation after 4h varies from 10% to 85% of initial dose, depending on the block copolymer. In vitro complement activation assays are conducted to correlate in vivo circulation to the protection of the nanocarrier surface from complement binding and activation. Guidelines for optimizing block copolymer structure to maximize circulation of nanocarriers formed by rapid precipitation and directed assembly are proposed, relating to the relative sizes of the hydrophilic and hydrophobic blocks, the hydrophobicity of the anchoring block, the absolute size of the PEG block, and polymer crystallinity. The in vitro results distinguish between the poorly circulating PEG(5k)-PCL(9 k) and the better circulating nanocarriers, but could not rank the better circulating nanocarriers in order of circulation time. Analysis of PEG surface packing on monodisperse 200 nm latex spheres indicates that the size of the hydrophobic PCL, PS, and PLA blocks are correlated with the PEG blob size. Suggestions for next steps for in vitro measurements are made.


Asunto(s)
Antineoplásicos Fitogénicos/administración & dosificación , Portadores de Fármacos/metabolismo , Ácido Láctico/metabolismo , Nanoestructuras/química , Paclitaxel/administración & dosificación , Poliésteres/metabolismo , Polietilenglicoles/metabolismo , Polímeros/metabolismo , Animales , Portadores de Fármacos/química , Ácido Láctico/química , Ratones , Ratones Desnudos , Poliésteres/química , Polietilenglicoles/química , Ácido Poliglicólico/química , Ácido Poliglicólico/metabolismo , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Polímeros/química
20.
J Drug Deliv ; 2011: 349206, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21773044

RESUMEN

Diblock copolymer nanoparticles encapsulating a paclitaxel prodrug, Propac 7, have been used to demonstrate the usefulness of a nonmetabolizable radioactive marker, cholesteryl hexadecyl ether (CHE), to evaluate nanoparticle formulation variables. Since CHE did not exchange out of the nanoparticles, the rate of clearance of the CHE could be used as an indicator of nanoparticle stability in vivo. We simultaneously monitored prodrug circulation and carrier circulation in the plasma and the retention of CHE relative to the retention of prodrug in the plasma was used to distinguish prodrug release from nanoparticle plasma clearance. Nanoparticles labelled with CHE were also used to evaluate accumulation of nanoparticles in the tumour. This marker has provided relevant data which we have applied to optimise our nanoparticle formulations.

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