Frequency of cardiotoxicity following intramuscular administration of epinephrine in emergency department patients with anaphylaxis.

Objectives: Epinephrine can be a life-saving treatment for patients with anaphylaxis. Potential cardiovascular side effects of epinephrine may contribute to clinician hesitancy to use it. However, the frequency of cardiotoxicity resulting from epinephrine treatment for anaphylaxis is not well described. We sought to describe the frequency of cardiotoxicity following intramuscular (IM) administration of epinephrine in adult emergency department (ED) patients with anaphylaxis. Methods: We conducted a retrospective observational study at a single, quaternary care academic ED in Tennessee. We identified consecutive ED visits with the diagnosis of anaphylaxis from 2017 to 2021 who received at least one intramuscular (IM) dose of epinephrine in the ED. Analysis was primarily descriptive. The primary outcome was cardiotoxicity, the occurrence of any of the following after epinephrine administration: ischemic electrocardiogram changes, systolic blood pressure >200 mmHg, or cardiac arrest ≤4 h; elevated troponin ≤12 h; or percutaneous coronary intervention or depressed ejection fraction ≤72 h. Results: Among 338 included patients, 16 (4.7%; 95%CI: 2.8-7.6%) experienced cardiotoxicity. Cardiotoxic events included eight (2.4%) ischemic electrocardiogram changes, six (1.8%) episodes of elevated troponin, five (1.5%) atrial arrhythmias, one (0.3%) ventricular arrythmia, and one (0.3%) depressed ejection fraction. Patients with cardiotoxicity were significantly older, had more comorbidities, and were more likely to have received multiple doses of epinephrine or an epinephrine infusion compared with a single IM dose of epinephrine. Conclusions: Among 338 consecutive adult ED patients who received IM epinephrine for anaphylaxis during a recent 4-year period, cardiotoxic side effects were observed in approximately 5% of patients.

In Situ Cocrystallization via Spray Drying with Polymer as a Strategy to Prevent Cocrystal Dissociation.

The aim of the present study was to investigate how different polymers affect the dissociation of cocrystals prepared by co-spray-drying active pharmaceutical ingredient (API), coformer, and polymer. Diclofenac acid-l-proline cocrystal (DPCC) was selected in this study as a model cocrystal due to its previously reported poor physical stability in a high-humidity environment. Polymers investigated include polyvinylpyrrolidone (PVP), poly(1-vinylpyrrolidone-co-vinyl acetate) (PVPVA), hydroxypropyl methyl cellulose, hydroxypropylmethylcellulose acetate succinate, ethyl cellulose, and Eudragit L-100. Terahertz Raman spectroscopy (THz Raman) and powder X-ray diffraction (PXRD) were used to monitor the cocrystal dissociation rate in a high-humidity environment. A Raman probe was used in situ to monitor the extent of the dissociation of DPCC and DPCC in crystalline solid dispersions (CSDs) with polymer when exposed to pH 6.8 phosphate buffer and water. The solubility of DPCC and solid dispersions of DPCC in pH 6.8 phosphate buffer and water was also measured. The dissociation of DPCC was water-mediated, and more than 60% of DPCC dissociated in 18 h at 40 °C and 95% RH. Interestingly, the physical stability of the cocrystal was effectively improved by producing CSDs with polymers. The inclusion of just 1 wt % polymer in a CSD with DPCC protected the cocrystal from dissociation over 18 h under the same conditions. Furthermore, the CSD with PVPVA was still partially stable, and the CSD with PVP was stable (undissociated) after 7 days. The superior stability of DPCC in CSDs with PVP and PVPVA was also demonstrated when systems were exposed to water or pH 6.8 phosphate buffer and resulted in higher dynamic solubility of the CSDs compared to DPCC alone. The improvement in physical stability of the cocrystal in CSDs was thought to be due to an efficient mixing between polymer and cocrystal at the molecular level provided by spray drying and in situ gelling of polymer. It is hypothesized that polymer chains could undergo gelling in situ and form a physical barrier, preventing cocrystal interaction with water, which contributes to slowing down the water-mediated dissociation.

Perspectives for Thermochemical Conversions of Lignocellulosic Biomass.

The biorefinery concept of lignocellulosic biomass with focus on thermochemical conversions will be presented and discussed with respect to the advantages, impacts, and methods. Analytics regarding the reaction mechanisms for the decomposition of cellulose, hemicellulose and lignin, respectively, will be presented along with new trends and perspectives within plasma and catalytic pyrolysis of lignin-fractions, artificial neural networks, hydrothermal liquefaction, torrefaction, gasification and combustion, pyrolysis and hydro pyrolysis as well as supercritical fluids for the catalytic thermochemical conversion of biomass and co-processing of upgraded bio-oil in fluidized catalytic cracking (FCC). A few examples are mentioned at this point; however, more details are given in the respective chapters. Concerning the catalytic conversion of lignin fractions the concept of the "catalyst philosophy" has been adapted from crude oil refining by using the hierarchical pore structure of the catalyst to arrive at the desired final products, like fuelcomponents or phenols. As a consequence, the same hierarchical catalysts can be applied in the co-processing of bio-oil with crude oil refined fractions. As a preliminary conclusion, the thermochemical conversion of lignocellulosic biomass has already reached a certain level of insight and understanding, however, there is still room for improvement and even a better understanding, and, last but not least, an upscaling to an industrial scale remains.

Combining Isolation-Free and Co-Processing Manufacturing Approaches to Access Room Temperature Ionic Liquid Forms of APIs.

The addition of non-active components at the point of active pharmaceutical ingredient (API) isolation by means of co-processing is an attractive approach for improving the material properties of APIs. Simultaneously, there is increased interest in the pharmaceutical industry in continuous manufacturing processes. These often consist of liquid feeds which maintain materials in solution and mean that solids handling is avoided until the final step. Such techniques enable new forms of APIs to be used in final dosage forms which have been overlooked due to unfavourable material properties. API-based ionic liquids (API-ILs) are an example of a class of compounds that exhibit exceptional solubility and stability qualities at the cost of their physical characteristics. API-ILs could benefit from isolation-free manufacturing in combination with co-processing approaches to circumvent handling issues and make them viable routes to formulating poorly soluble APIs. However, API-ILs are most commonly synthesised via a batch reaction that produces an insoluble solid by-product. To avoid this, an ion exchange resin protocol was developed to enable the API-IL to be synthesised and purified in a single step, and also produce it in a liquid effluent that can be integrated with other unit operations. Confined agitated bed crystallisation and spray drying are examples of processes that have been adapted to produce or consume liquid feeds and were combined with the ion exchange process to incorporate the API-IL synthesis into isolation-free frameworks and continuous manufacturing streams. This combination of isolation-free and co-processing techniques paves the way towards end-to-end continuous manufacturing of API-IL drug products.

A Comparison of Spray-Drying and Co-Precipitation for the Generation of Amorphous Solid Dispersions (ASDs) of Hydrochlorothiazide and Simvastatin.

Co-processing of APIs, the practice of creating multi-component APIs directly in chemical processing facilities used to make drug substance, is gaining increased attention with a view to streamlining manufacturing, improving supply chain robustness and accessing enhanced product attributes in terms of stability and bioavailability. Direct co-precipitation of amorphous solid dispersions (ASDs) at the final step of chemical processing is one such example of co-processing. The purpose of this work was to investigate the application of different advanced solvent-based processing techniques - direct co-precipitation (CP) and the benchmark well-established spray-drying (SD) process - to the production of ASDs comprised of a drug with a high Tg (hydrochlorothiazide, HCTZ) or a low Tg (simvastatin, SIM) molecularly dispersed in a PVP/VA 64 or Soluplus® matrix. ASDs of the same composition were manufactured by the two different methods and were characterised using powder X-ray diffraction (PXRD), modulated differential scanning calorimetry (mDSC), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and scanning electron microscopy (SEM). Both methods produced ASDs that were PXRD amorphous, with some differences, depending on the process used, in glass transition temperature and particle size distribution. Irrespective of manufacturing method used, all ASDs remained PXRD amorphous when subjected to high relative humidity conditions (75% RH, 25°C) for four weeks, although changes in the colour and physical characteristics were observed on storage for spray-dried systems with SIM and PVP/VA 64 copolymer. The particle morphology differed for co-precipitated compared to spray dried systems, with powder generated by the former process being comprised of more irregularly shaped particles of larger particle size when compared to the equivalent spray-dried systems which may enable more streamlined drug product processes to be used for CP materials. These differences may have implications in downstream drug product processing. A limitation identified when applying the solvent/anti-solvent co-precipitation method to SIM was the high antisolvent to solvent ratios required to effect the precipitation process. Thus, while similar outcomes may arise for both co-precipitation and spray drying processes in terms of ASD critical quality attributes, practical implications of applying the co-precipitation method and downstream processability of the resulting ASDs should be considered when choosing one solvent-based ASD production process over another.

Integrated Purification and Formulation of an Active Pharmaceutical Ingredient via Agitated Bed Crystallization and Fluidized Bed Processing.

Integrated API and drug product processing enable molecules with high clinical efficacy but poor physicochemical characteristics to be commercialized by direct co-processing with excipients to produce advanced multicomponent intermediates. Furthermore, developing isolation-free frameworks would enable end-to-end continuous processing of drugs. The aim of this work was to purify a model API (sodium ibuprofen) and impurity (ibuprofen ethyl ester) system and then directly process it into a solid-state formulation without isolating a solid API phase. Confined agitated bed crystallization is proposed to purify a liquid stream of impure API from 4% to 0.2% w/w impurity content through periodic or parallelized operations. This stream is combined with a polymer solution in an intermediary tank, enabling the API to be spray coated directly onto microcrystalline cellulose beads. The spray coating process was developed using a Design of Experiments approach, allowing control over the drug loading efficiency and the crystallinity of the API on the beads by altering the process parameters. The DoE study indicated that the solvent volume was the dominant factor controlling the drug loading efficiency, while a combination of factors influenced the crystallinity. The products from the fluidized bed are ideal for processing into final drug products and can subsequently be coated to control drug release.

MDMA to Treat PTSD in Adults.

Post-traumatic stress disorder (PTSD) has become one of the most common psychiatric diagnosis in the United States specifically within the veteran population. The current treatment options for this debilitating diagnosis include trauma-focused psychotherapies along with selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI).1 MDMA has recently been shown as a novel therapeutic agent with promisingly results in the treatment of PTSD. MDMA is a psychoactive compound traditionally categorized as a psychedelic amphetamine that deemed a Schedule I controlled substance in the 1980s. Prior to its status as a controlled substance, it was used by psychotherapists for an array of psychiatric issues. In more recent times, MDMA has resurfaced as a potential therapy for PTSD and the data produced from randomized, controlled trials back the desire for MDMA to be utilized as an effective pharmacologic therapy in conjunction with psychotherapy.2.

Formulation of ionic liquid APIs via spray drying processes to enable conversion into single and two-phase solid forms.

Ionic liquid (IL) forms of drugs are increasingly being explored to address problems presented by poorly water-soluble drugs and solid-state stability. However, before ILs of active pharmaceutical ingredients (APIs) can be routinely incorporated into oral solid dosage forms (OSDs), challenges surrounding their ease of handling and manufacture must be addressed. To this end a framework for transforming API-ILs into solid forms at high loadings based on spray encapsulation using an immiscible polymer has recently been demonstrated. The current work demonstrates that this framework can be applied to a broad range of newly synthesized low glass transition temperature (Tg) API-ILs. Furthermore, the work explores a second novel approach to solidification of API-ILs based on polymer-API-IL miscibility that, to the best of our knowledge, has not been previously demonstrated. Modulated differential scanning calorimetry (mDSC) and attenuated total reflectance Fourier transform infrared spectroscopy showed that it was possible to produce spray dried solid materials, at acceptable loadings and yields for OSD applications in the form of both two-phase phase encapsulated systems and single phase amorphous solid dispersions (ASDs). This was achieved by the appropriate selection of an API-IL insoluble polymer (ethyl cellulose) for phase separated systems, or a miscible polymer with an exceptionally high Tg (the polysaccharide, maltodextrin) for the ASDs. Both approaches successfully overcame the Tg suppression associated with room temperature ILs. This work represents the first step to understanding the fundamental critical physical attributes of these systems to facilitate a more mechanistic methodology for their design.

Spray Encapsulation as a Formulation Strategy for Drug-Based Room Temperature Ionic Liquids: Exploiting Drug-Polymer Immiscibility to Enable Processing for Solid Dosage Forms.

Active pharmaceutical ingredient (API)-based ionic liquids (API-ILs) present an exciting new paradigm for the formulation of poorly water-soluble drugs. In this study, a model room temperature API-IL (1-butyl-3-methyl imidazolium ibuprofenate) was demonstrated to be not just highly soluble but fully miscible and hence have effectively unlimited solubility in water, compared to 0.021 mg mL-1 solubility for the ibuprofen API. Solutions of the API-IL were found to be stable for up to 2 years, indicating that they have the potential to offer thermodynamic stability upon release, avoiding in vivo recrystallization issues that can limit the bioavailability of amorphous solid dispersions (ASDs) and some high-energy crystalline forms. The ibuprofen API-IL was successfully spray-dried into a polymer carrier in loadings of up to 75% w/w in order to transform it into a solid powder suitable for oral solid dosage (OSD) formulation. From modulated differential scanning calorimetry, hot-stage microscopy, powder X-ray diffraction, and attenuated total reflectance Fourier transform infrared spectroscopy measurements, the mechanism by which this high loading was achieved is based on the immiscibility between the polymer and API-IL, with the polymer encapsulating the phase-separated API-IL. Dissolution studies showed that solidification of the API-IL into microcapsules by spray drying in this manner had no detrimental effect on release characteristics. Failure to dissolve crystalline API forms into the polymer matrix eliminates the solubility enhancement of ASDs but not for highly soluble or fully miscible API-ILs. Furthermore, miscible API-IL/polymer dispersions at high loadings were found to possess less-favorable physical properties because of melting point depression, resulting, in some cases, in a failure to form a viable powder. As such, microencapsulated API-ILs at high loadings in immiscible or low-miscibility polymers that have solubility enhancement of the API-IL form, while providing solid powders for processing, represent a promising new platform for the formulation of poorly soluble compounds as OSDs.

Communicating the Issue of Underwater Noise Pollution: The Deaf as a Fish Project.

Aquatic noise pollution is largely ignored by the lay public. How experts communicate this issue is critical to move public opinion. In 2010, the Cassa di Risparmio di Gorizia (CaRiGO) bank sponsored the Deaf as a Fish project that included local underwater noise monitoring, a boat census, a pamphlet for nonexperts, and some seminars and public meetings. This project allowed us to raise interest in this issue. Using accurate and understandable language in a light-humored setting goes far toward cultivating trust from a public audience that can be intimidated or suspicious of complicated scientific messaging.

Summary Report Panel 1: The Need for Protocols and Standards in Research on Underwater Noise Impacts on Marine Life.

As concern about anthropogenic noise and its impacts on marine fauna is increasing around the globe, data are being compared across populations, species, noise sources, geographic regions, and time. However, much of the raw and processed data are not comparable due to differences in measurement methodology, analysis and reporting, and a lack of metadata. Common protocols and more formal, international standards are needed to ensure the effectiveness of research, conservation, regulation and practice, and unambiguous communication of information and ideas. Developing standards takes time and effort, is largely driven by a few expert volunteers, and would benefit from stakeholders' contribution and support.

High resolution scanning tunneling microscopy of a 1D coordination polymer with imidazole-based N,N,O ligands on HOPG.

Novel κ(3) -N,N,O ligands tend to form 1D coordination polymer strands. Deposition of 1D structures on highly oriented pyrolytic graphite (HOPG) was achieved from diluted solutions and polymer strands have been studied on HOPG by AFM/STM. Single strands were mapped by STM and their electronic properties were subsequently characterized by current imaging tunneling spectroscopy (CITS). Periodic density functional calculations simulating a polymer strand deposited on a HOPG surface are in agreement with the zig-zag structure indicated by experimental findings. Both the observed periodicity and the Zn-Zn distances can be reproduced in the simulations. Van der Waals interactions were found to play a major role for the geometry of the isolated polymer strand, for the adsorption geometry on HOPG, as well as for the adsorption energy.

Regular high-nuclearity species from square building blocks: a triangular 3 × [2 × 2] Ni12 complex generated by the self-assembly of three [2 × 2] Ni4 molecular grids.

A dodecanuclear 3 × [2 × 2] nickel(II) complex has been obtained via the self-association of three tetranuclear [2 × 2] molecular grids. X-ray diffraction shows a "propeller-like" structure of the [Ni(4)](3) scaffold with a central µ(3)-hydroxide. The dodecanuclear species remains stable in solution and can be deposited without decomposition on highly ordered pyrolytic graphite surfaces.

Sleeping Beauty transposon-mediated transfection of retinal and iris pigment epithelial cells.

PURPOSE: Subretinal transplantation of retinal (RPE) or iris (IPE) pigment epithelial cells has been advocated as a treatment for retinal degeneration. However, to our knowledge, in patients with age-related macular degeneration no significant beneficial effects on vision have been shown. Since the transplanted cells did not appear to maintain a healthy avascular and neuroprotective environment, we postulate that it will be necessary to transplant cells that express elevated levels of anti-angiogenic and neuroprotective activities. In our study, we provide a protocol for the efficient stable gene transfer and sustained gene expression of pigment epithelium-derived factor (PEDF), a potent anti-angiogenic and neuroprotective factor, using the nonviral Sleeping Beauty transposon system (SB100X). METHODS: Pigment epithelial cells were electroporated with a Venus reporter or a PEDF encoding plasmid, controlled by either CMV or CAGGS promoters. Transfection efficiencies and protein expression stability were evaluated by flow cytometry and immunoblotting. Gene expression profiles were analyzed by RT-PCR. RESULTS: SB100X-based delivery resulted in efficiencies of 100% with the Venus gene and 30% with the PEDF gene. Cell sorting enabled establishment of pure PEDF-transfected ARPE-19 populations. Transfected RPE and IPE cells have been shown to maintain stable PEDF secretion for more than 16 and 6 months, respectively. CONCLUSIONS: Transfection using the nonviral SB100X vector system avoids complications associated with viral gene delivery. SB100X-mediated transfer allows for stable PEDF gene integration into the cell's genome, ensuring continuous expression and secretion of PEDF. Stable expression of the therapeutic gene is critical for the development of cell-based gene addition therapies for retinal degenerative diseases.

Synthesis, magnetic properties, and STM spectroscopy of an unprecedented octanuclear chloro-bridged nickel(II) double cubane.

Reaction of nickel(II) chloride hexahydrate with N-n-butyldiethanolamine H(2)L (3) in the presence of LiH in anhydrous THF leads to the formation of the unique octanuclear chloro-bridged nickel(II) double cubane [({Ni(II)(4)(µ(3)-OH)Cl(3)(HL)(3)}µ(2)-Cl)(2)] (4) in 57% yield. According to single crystal X-ray structure analysis, complex 4·4CH(2)Cl(2) possesses a [({Ni(4)(µ(3)-OH)(µ(3)-O)(3)(OH)(3)(N)(3)(Cl)(3)}µ(2)-Cl)(2)] core and crystallizes in the monoclinic space group P2(1)/c with a = 18.292(2), b = 19.8972(5), c = 23.295(2) Å, ß = 98.408(6)°, V = 8387.3(8) Å(3), and four molecules in the unit cell. The analysis of the SQUID magnetic susceptibility data identified 4 as a weakly coupled dimer (J(1) = 14.5 K, J(2) = -0.6 K) with a ground state of S = 0, resulting from two S = 4 states of each {Ni(4)} subunits. Although complex 4 does not show an ac out-of-phase signal in a zero dc field at temperatures of 1.8 K and higher, low-temperature magnetization measurements revealed that complex 4 is a single-molecule magnet and shows hysteretic magnetization characteristics with typical temperature and sweep-rate dependencies. The eye-catching feature of complex 4 is the presence of two different blocking temperatures (0.9 K around zero field and 1.3 K at higher fields). The origin of this highly unusual behavior can be assigned to the dimer-nature of the interaction between the two S = 4 units. Furthermore STM and current imaging tunnelling spectroscopy (CITS) were performed on aggregates of 4 drop-coated on highly oriented pyrolytic graphite (HOPG) surfaces. CITS measurements show a strong contrast in the area of the nickel centers and a HOMO-LUMO gap of approximately 0.8 V.

In vivo imaging of immunotoxin treatment using Katushka-transfected A-431 cells in a murine xenograft tumour model.

PURPOSE: Preclinical in vivo analyses of treatment responses are an important prerequisite to evaluate new therapeutics. Molecular in vivo imaging in the far red (FR)/near infra red (NIR) is a promising method, as it enables measurements at different time points in individual animals, thereby reducing the number of animals required, while increasing statistical significance. Here, we show the establishment of a method to monitor response to treatment using fluorescent cells, expressing the epidermal growth factor receptor (EGFR), a target already used in therapy. METHODS: We transfected A-431 tumour cells with the far red-emitting protein Katushka (Kat2), resulting in strong fluorescence allowing for the monitoring of tumour growth when implanted in BALB/c nu/nu mice with a CRi Maestro in vivo imager. We targeted A-431 cells with a previously reported immunotoxin (IT), consisting of the anti-EGFR antibody single-chain variable fragment (scFv) 425, fused to Pseudomonas aeruginosa Exotoxin A' (ETA'). In addition, EGFR expression was verified using the 425(scFv) conjugated to a NIR dye BG-747 through a SNAP-tag linker. RESULTS: The results show the feasibility to evaluate response to treatment in vivo by FR imaging, while at the same location detecting EGFR expression. Treatment with 425(scFv)-ETA' resulted in decelerated tumour growth, while not affecting the overall health of the animals. This is in contrast to treatment with Doxorubicin, which, although decreasing the tumour size, resulted in poor health. CONCLUSIONS: We developed a novel method to non-invasively determine treatment responses by in vivo imaging of multiple parameters which showed the efficacy of 425(scFv)-ETA'.