Polyisobutylene-paclitaxel conjugates with pendant carboxylic acids and polystyrene chains: Towards multifunctional stent coatings with slow drug release

Drug-eluting stents are used in the treatment of atherosclerosis, where the incorporation of anti-proliferative or anti-inflammatory drugs decreases the rate of restenosis, the recurrence of artery narrowing. However, these stents can suffer from limitations such as drug depletion and delamination of the drug-eluting coating from the stent surface. Described here is an approach aimed at addressing these issues. Starting from a maleic anhydride adduct of polyisobutylene (PIB) prepared from butyl rubber, ring opening using paclitaxel (PTX) or a combination of PTX and polystyrene (PS) afforded covalent conjugates of PTX and PIB or PIB-PS graft copolymers bearing pendant carboxylic acids. When coated on stainless steel, the drug release was slower than that from a control coating that ressembles a clinical formulation comprising a physical mixture of a PS-PIB-PS triblock copolymer (SIBS) and PTX. The PTX conjugates also exhibited enhanced adhesion to stainless steel and increased tensile strength in comparison with the starting rubber. Cytotoxicity assays indicated that the materials did not leach toxic levels of PTX into cell culture media. Nevertheless, they were capable of inhibiting the adhesion and proliferation of C2C12 cells on their surfaces. These properties are advantageous for the potential application of the materials as stent coatings

Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ethylene glycol poisoning may pose diagnostic difficulties if the history of ingestion is not volunteered, or if the presentation is delayed. This is because the biochemical features of high anion-gap metabolic acidosis and an osmolar gap resolve within 24 to 72 hours as the ethylene glycol is metabolized to toxic metabolites. This case illustrates the less well-known clinical features of delayed ethylene glycol poisoning, including multiple cranial and peripheral neuropathies, and the clinical findings which may point towards this diagnosis in the absence of a history of ingestion.</p> <p>Case presentation</p> <p>A 53-year-old Afro-Caribbean man presented with vomiting, abdominal pain and oliguria, and was found to have acute renal failure requiring emergency hemofiltration, and raised inflammatory markers. Computed tomography imaging of the abdomen revealed the appearance of bilateral pyelonephritis, however he failed to improve with broad-spectrum antibiotics, and subsequently developed multiple cranial neuropathies and increasing obtundation, necessitating intubation and ventilation. Computed tomography of the brain showed no focal lesions, and a lumbar puncture revealed a raised cerebrospinal fluid opening pressure and cyto-albuminological dissociation. Nerve conduction studies revealed a sensorimotor radiculoneuropathy mimicking a Guillain-Barre type lesion with an atypical distribution. It was only about two weeks after presentation that the history of ethylene glycol ingestion one week before presentation was confirmed. He had a slow recovery on the intensive care unit, requiring renal replacement therapy for eight weeks, and complicated by acute respiratory distress syndrome, neuropathic pain and a slow neurological recovery requiring prolonged rehabilitation.</p> <p>Conclusions</p> <p>Although neuropathy as a result of ethylene glycol poisoning has been described in a few case reports, all of these were in the context of a known history of ingestion. As the diagnosis may well be obscured if the history of ingestion is not elucidated, it is important to be aware of this possibility especially if presentation is delayed.</p

Mortality rates in transplant recipients and transplantation candidates in a high prevalence COVID-19 environment

Background: The risk of COVID-19 infection in transplant recipients (TRs) is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas TRs with those on the waiting list, following admission with COVID-19 in a high-prevalence region. Methods: Audit data from all 6 London transplant centers were amalgamated. Demographic and laboratory data were collected and outcomes included mortality, intensive care (ITU) admission, and ventilation. Adult patients who had undergone a kidney or kidney/pancreas transplant, and those active on the transplant waiting list at the start of the pandemic were included. Results: One hundred twenty-one TRs and 52 waiting list patients (WL) were admitted to hospital with COVID-19. Thirty-six TR died (30%), while 14 WL patients died (27% P = 0.71). There was no difference in rates of admission to ITU or ventilation. Twenty-four percent of TR required renal replacement therapy, and 12% lost their grafts. Lymphocyte nadir and D-dimer peak showed no difference in those who did and did not die. No other comorbidities or demographic factors were associated with mortality, except for age (odds ratio of 4.3 [95% CI 1.8-10.2] for mortality if aged over 60 y) in TR. Conclusions: TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era

Clinical and biomarker changes in premanifest Huntington disease show trial feasibility: A decade of the PREDICT-HD study

There is growing consensus that intervention and treatment of Huntington disease (HD) should occur at the earliest stage possible. Various early-intervention methods for this fatal neurodegenerative disease have been identified, but preventive clinical trials for HD are limited by a lack of knowledge of the natural history of the disease and a dearth of appropriate outcome measures. Objectives of the current study are to document the natural history of premanifest HD progression in the largest cohort ever studied and to develop a battery of imaging and clinical markers of premanifest HD progression that can be used as outcome measures in preventive clinical trials. Neurobiological predictors of Huntington’s disease is a 32-site, international, observational study of premanifest HD, with annual examination of 1013 participants with premanifest HD and 301 gene-expansion negative controls between 2001 and 2012. Findings document 39 variables representing imaging, motor, cognitive, functional, and psychiatric domains, showing different rates of decline between premanifest HD and controls. Required sample size and models of premanifest HD are presented to inform future design of clinical and preclinical research. Preventive clinical trials in premanifest HD with participants who have a medium or high probability of motor onset are calculated to be as resource-effective as those conducted in diagnosed HD and could interrupt disease 7–12years earlier. Methods and measures for preventive clinical trials in premanifest HD more than a dozen years from motor onset are also feasible. These findings represent the most thorough documentation of a clinical battery for experimental therapeutics in stages of premanifest HD, the time period for which effective intervention may provide the most positive possible outcome for patients and their families affected by this devastating disease

Posteroanterior stiffness predicts sagittal plane midthoracic range of motion and three-dimensional flexibility in cadaveric spine segments

Background. Spinal joint mobilization is a mainstay of clinical assessment of individuals with back pain. The clinician manually assesses stiffness and joint motion relative to segments above and below. Although clinical theory suggests that manually performed techniques can predict or detect intervertebral motion, this hypothesis remains untested. Methods. Using a precision opto-electronic camera system and a custom spine testing machine, we measured intervertebral range of motion, neutral zone motion and three-dimensional flexibility in eight T5–T8 cadaveric specimens (mean age = 81 years). We then measured stiffness when a cyclic posteroanterior load was applied at the spinous process of T6 using a servohydraulic material testing machine (Instron 8874), simulating the posteroanterior spinal mobilization technique. Findings. There was a strong significant inverse relationship between stiffness during cyclic posteroanterior loading of T6 and flexion or extension range of motion of T6 relative to T7 (r = −0.88, P < 0.01, extension; r = −0.81, P = 0.01, flexion), and T6–T7 flexibility in all six directions. Interpretation. Stiffness during simulated central cyclic posteroanterior mobilization in the cadaveric midthoracic spine is inversely correlated with flexion and extension range of motion and three-dimensional flexibility at the level at which the technique is applied. These findings provide biomechanical support for the inclusion of specific joint mobilization in the assessment of older adults with back pain

Carboxylic acid-functionalized butyl rubber: Synthesis, characterization, and physical properties

© 2015 American Chemical Society. Polyisobutylene (PIB) and other PIB-based materials are of significant interest for a vast array of applications, but chemical modification is often required to obtain the desired properties. Described here are two new approaches for the preparation of carboxylic acid-functionalized PIB. The ring opening of cyclic anhydrides from an allylic alcohol derivative of butyl rubber and the atom transfer radical polymerization of tert-butyl methacrylate from a rubber derivative both ultimately afford carboxylated materials. These materials displayed significantly enhanced adhesion to stainless steel, as well as increased ultimate tensile strength and Young\u27s modulus in comparison to unmodified rubbers. Rheological studies suggested that they exhibit a greater degree of cross-linking-type behavior than the parent butyl rubber. Combined, these studies suggest that the properties of PIB can be readily tuned through synthetic modifications of the backbone, even at low mole percent, and that carboxylic acid moieties can impart desirable properties for various applications