Consensus care recommendations for alfapump® in cirrhotic patients with refractory or recurrent ascites.

BACKGROUND The alfapump® is an implantable class III medical device that pumps ascitic fluid from the peritoneal space to the urinary bladder from where it is excreted. The pump reduces or abrogates the need for repeated paracentesis in patients with recurrent or refractory ascites. AIMS To improve outcomes for alfapump® implantation and pre- and post-implant patient management in both clinical trial and real-world settings by development of consensus recommendations. METHODS The alfapump® working group consisting of hepatologists and surgeons with extensive experience in implantation of the alfapump® and patient management met on two occasions: (1) to determine the key areas where recommendations should be made; and (2) to discuss the experiences of the working group within those areas and formulate draft statements. Developed statements were submitted to the group and consensus sought on relevance and wording through a collaborative iterative approach in order to consolidate the recommendations into consensus statements. Only recommendations agreed upon unanimously were included. RESULTS Twenty-three consensus recommendations were developed in the areas of pre-implantation procedure, (three statements), surgical implant procedure (11 statements), immediate post-implant care (three statements) and long-term management (six statements). CONCLUSIONS The consensus statements are a valuable reference resource for physicians managing patients with the alfapump® and for those considering management strategies for patients with refractory ascites

Consensus care recommendations for alfapump® in cirrhotic patients with refractory or recurrent ascites

BACKGROUND: The alfapump® is an implantable class III medical device that pumps ascitic fluid from the peritoneal space to the urinary bladder from where it is excreted. The pump reduces or abrogates the need for repeated paracentesis in patients with recurrent or refractory ascites. AIMS: To improve outcomes for alfapump® implantation and pre- and post-implant patient management in both clinical trial and real-world settings by development of consensus recommendations. METHODS: The alfapump® working group consisting of hepatologists and surgeons with extensive experience in implantation of the alfapump® and patient management met on two occasions: (1) to determine the key areas where recommendations should be made; and (2) to discuss the experiences of the working group within those areas and formulate draft statements. Developed statements were submitted to the group and consensus sought on relevance and wording through a collaborative iterative approach in order to consolidate the recommendations into consensus statements. Only recommendations agreed upon unanimously were included. RESULTS: Twenty-three consensus recommendations were developed in the areas of pre-implantation procedure, (three statements), surgical implant procedure (11 statements), immediate post-implant care (three statements) and long-term management (six statements). CONCLUSIONS: The consensus statements are a valuable reference resource for physicians managing patients with the alfapump® and for those considering management strategies for patients with refractory ascites

Unscheduled DNA synthesis after partial UV irradiation of the cell nucleus

Cells of an euploid strain of the Chinese hamster synchronized in the G1 phase were microirradiated in the nucleus with a laser UV microbeam (λ = 257 nm) and pulse-labelled with [3H]thymidine. In autoradiographs of cells fixed immediately after the pulse unscheduled DNA synthesis (UDS) was found restricted to the microirradiated part of the nucleus. The rate of UDS varied with the UV energy applied and the post-irradiation incubation time. In other experiments chromosome preparations were established after an additional chase and a subsequent growth period. In 28 mitotic cells autoradiographic label was found concentrated on a few chromosomes which lay adjacent to each other in one part of the metaphase plate. The distribution of label on the chromosomes could clearly be distinguished from patterns which originate from semi-conservative DNA synthesis within S phase. The label on chromosomes of microirradiated cells thus represents UDS. Our findings support the following ideas on the arrangement of interphase chromosomes: (1) Decondensed interphase chromosomes may occupy rather compact territories. (2) Chromosomes do not necessarily exhibit a close and permanent association with their respective homologues

Labour in a single shot: critical perspectives on Antje Ehmann and Harun Farocki's global video project

This collection of essays offers a critical assessment of Labour in a Single Shot, a groundbreaking documentary video workshop. From 2011 to 2014, curator Antje Ehmann and film- and videomaker Harun Farocki produced an art project of truly global proportions. They travelled to fifteen cities around the world to conduct workshops inspired by cinema history’s first film, Workers Leaving the Lumière Factory, shot in 1895 by the Lumière brothers in France. While the workshop videos are in colour and the camera was not required to remain static, Ehmann and Farocki’s students were tasked with honouring the original Lumière film’s basic parameters of theme and style. The fascinating result is a collection of more than 550 short videos that have appeared in international exhibitions and on an open-access website, offering the widest possible audience the opportunity to ponder contemporary labour in multiple contexts around the world.https://library.oapen.org/handle/20.500.12657/5163

Advanced Methods for Dose and Regimen Finding During Drug Development: Summary of the EMA/EFPIA Workshop on Dose Finding (London 4-5 December 2014)

Inadequate dose selection for confirmatory trials is currently still one of the most challenging issues in drug development, as illustrated by high rates of late-stage attritions in clinical development and postmarketing commitments required by regulatory institutions. In an effort to shift the current paradigm in dose and regimen selection and highlight the availability and usefulness of well-established and regulatory-acceptable methods, the European Medicines Agency (EMA) in collaboration with the European Federation of Pharmaceutical Industries Association (EFPIA) hosted a multistakeholder workshop on dose finding (London 4-5 December 2014). Some methodologies that could constitute a toolkit for drug developers and regulators were presented. These methods are described in the present report: they include five advanced methods for data analysis (empirical regression models, pharmacometrics models, quantitative systems pharmacology models, MCP-Mod, and model averaging) and three methods for study design optimization (Fisher information matrix (FIM)-based methods, clinical trial simulations, and adaptive studies). Pairwise comparisons were also discussed during the workshop; however, mostly for historical reasons. This paper discusses the added value and limitations of these methods as well as challenges for their implementation. Some applications in different therapeutic areas are also summarized, in line with the discussions at the workshop. There was agreement at the workshop on the fact that selection of dose for phase III is an estimation problem and should not be addressed via hypothesis testing. Dose selection for phase III trials should be informed by well-designed dose-finding studies; however, the specific choice of method(s) will depend on several aspects and it is not possible to recommend a generalized decision tree. There are many valuable methods available, the methods are not mutually exclusive, and they should be used in conjunction to ensure a scientifically rigorous understanding of the dosing rationale

High-resolution polymer high performance liquid chromatography: optimization of the saw tooth gradient profile for various stationary phases and separations on preparative scale

The recently introduced saw tooth gradient protocol for high-resolution polymer HPLC was further improved and optimized in terms of total runtime and separation performance. As a result, increased flow rates enabled drastically reduced runtimes in combination with enhanced peak resolutions. Moreover, the saw tooth gradient profile was further investigated using a saw tooth gradient with a down-to-zero approach concerning the height of the negative backward gradient step. Modifying the mobile phase composition enabled two further gradient protocols: a ternary, and a multicomponent approach, respectively. Thereby, a ternary saw tooth gradient was realized by repeating the whole gradient elution with two adequate pairs of weak or rather non-solvents and desorption promoting solvents for mixtures containing diverse polymer components. A multicomponent saw tooth gradient was established by combining three different solvents in the gradient elution. In addition to mobile phase modifications, various stationary phases were compared and examined. Applying size exclusion chromatography (SEC) columns for saw tooth gradient polymer elution chromatography enabled the exploitation of two completely different separation mechanisms (SEC and high-resolution polymer HPLC) on one stationary phase. Thus, two-dimensional, heart-cut coupling of SEC and high-resolution polymer HPLC with only one stationary phase could be achieved. The application of the above-mentioned concept and its highly attractive performance characteristics are demonstrated for a silicone oil with a viscosity of 350 mPa s by using a hybrid HPLC system coupled to a fraction collector