Mycophenolic acid AUC in Thai kidney transplant recipients receiving low dose mycophenolate and its association with UGT2B7 polymorphisms.

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Pithukpakorn, Manop; Tiwawanwong, Tiwat; Lalerd, Yupaporn; Assawamakin, Anunchai; Premasathian, Nalinee; Tasanarong, Adis; Thongnoppakhun, Wanna; Vongwiwatana, Attapong

2014-01-01

Despite use of a lower mycophenolate dose in Thai kidney transplant patients, acceptable graft and patient outcomes can be achieved. We therefore examined the pharmacokinetics of mycophenolic acid (MPA) by area under the curve (AUC) and investigated genetic contribution in mycophenolate metabolism in this population. Kidney transplant recipients with stable graft function who were receiving mycophenolate mofetil 1,000 mg/d in combination with either cyclosporine or tacrolimus, and prednisolone were studied. The MPA concentration was measured by fluorescence polarization immunoassay (FPIA), at predose and 1, 1.5, 2, 4, 6, 8, 10, and 12 hours after dosing. Genetic polymorphisms in UGT1A8, UGT1A9, and UGT2B7 were examined by denaturing high-performance liquid chromatography (DHPLC)-based single-base extension (SBE) analysis. A total 138 patients were included in study. The mean AUC was 39.49 mg-h/L (28.39-89.58 mg-h/L), which was in the therapeutic range. The correlation between the predose MPA concentration and AUC was poor. The mean AUC in the tacrolimus group was higher than that in the cyclosporine group. Polymorphisms in UGT2B7 showed significant association with AUC. Most of our patients with reduced mycophenolate dose had the AUC within the therapeutic range. Genetic polymorphisms in UGT2B7 may play a role in MPA metabolism in Thai kidney transplant patients.

Acute pancreatitis induced by mycophenolate mofetil in a kidney transplant patient

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Einollahi Behzad

2015-04-01

Full Text Available Acute pancreatitis is a rare life-threatening complication in patients after kidney transplantation. Here we described a 56-year-old man who had received a living related kidney transplant for an end-stage renal disease. In his regular follow-up, his serum creatinine was gradually increased and he underwent an allograft biopsy, which revealed an interstitial nephritis/tubular atrophy grade II. Mycophenolate mofetil (MMF was prescribed to control chronic allograft nephropathy. He presented with complaints of severe abdominal pain, vomiting, loss of appetite and fever requiring hospital admission twelve days later. Acute pancreatitis was diagnosed on the basis of laboratory data and imaging findings during hospital admission. There was no history of alcohol consumption in our patient. Unfortunately he died one week later and autopsy findings demonstrated acute necrotizing pancreatitis. The bladder drainage of this patients was normal. Laboratory findings in this patient did not endorse infections and other possibilities regarding the etiology of acute pancreatitis in this patient. Therefore, we concluded that acute pancreatitis in near the patient was induced by drugs and basis on our evidence, MMF is the most important suspect. This study suggests that acute pancreatitis can be considered as a side effect of MMF.

Evaluation of potential interactions between mycophenolic acid derivatives and proton pump inhibitors.

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Gabardi, Steven; Olyaei, Ali

2012-01-01

To evaluate the incidence of gastrointestinal (GI) complications in solid organ transplant (SOT) recipients, impact of the complications on transplant outcomes, and the potential interactions between mycophenolic acid (MPA) derivatives and proton pump inhibitors (PPIs). An unrestricted literature search (1980-January 2012) was performed with MEDLINE and EMBASE using the following key words: drug-drug interaction, enteric-coated mycophenolic acid, GI complications, mycophenolate mofetil, solid organ transplant, and proton pump inhibitor, including individual agents within the class. Abstracts from scientific meetings were also evaluated. Additionally, reference citations from identified publications were reviewed. Relevant English-language, original research articles and review articles were evaluated if they focused on any of the topics identified in the search or included substantial content addressing GI complications in SOT recipients or drug interactions. GI complications are frequent among SOT recipients, with some studies showing prevalence rates as high as 70%. Transplant outcomes among renal transplant recipients are significantly impacted by GI complications, especially in patients requiring immunosuppressant dosage reductions or premature discontinuation. To this end, PPI use among patients receiving transplants is common. Recent data demonstrate that PPIs significantly reduce the overall exposure to MPA after oral administration of mycophenolate mofetil. Similar studies show this interaction does not exist between PPIs and enteric-coated mycophenolic acid (EC-MPA). Unfortunately, most of the available data evaluating this interaction are pharmacokinetic analyses that do not investigate the clinical impact of this interaction. A significant interaction exists between PPIs and mycophenolate mofetil secondary to reduced dissolution of mycophenolate mofetil in higher pH environments. EC-MPA is not absorbed in the stomach; therefore, low intragastric acidity

Do Asian renal transplant patients need another mycophenolate mofetil dose compared with Caucasian or African American patients?

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Li, Pengmei; Shuker, Nauras; Hesselink, Dennis A; van Schaik, Ron H N; Zhang, Xianglin; van Gelder, Teun

2014-10-01

Mycophenolate mofetil (MMF) is used to prevent acute rejection following solid organ transplantation in transplant centers all over the world. Patients from different ethnic backgrounds are treated with this drug, for which therapeutic drug monitoring (TDM) has not become the standard of practice in most centers. Whether or not some ethnic groups require a different MMF dose has been a topic of debate in recent years. In this review, it is shown that Asian patients, compared with Caucasian patients, with a comparable MMF dose reach higher mycophenolic acid (MPA) exposure. Also clinical experience points toward more adverse events in case of treatment with 1 g MMF bid in Asian patients, and therefore, for this ethnic group, a lower maintenance dose seems justified. In contrast, African American patients reach similar drug concentrations as Caucasians patients receiving the same MMF dose, but due to immunological reasons, they require a higher MMF dose to reach comparable acute rejection incidences. When TDM is performed, clinicians can correct the dose and compensate for interethnic differences in drug exposure. Otherwise, it is important to choose the right dose. This optimal dose is 20-46% lower in Asian transplant recipients than in Caucasian or African American patients. © 2014 Steunstichting ESOT.

Pharmacokinetic study of mycophenolic acid in Iranian kidney transplant patients

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Saeed Rezaee

2013-02-01

Full Text Available Background: The purpose of this study was to characterize the pharmacokinetic parameters of mycophenolic acid (MPA in Iranian kidney transplant patients. Methods: Plasma MPA concentration of mycophenolate mofetile (MMF 1 gram two times a day was measured in 21 Iranian kidney transplant recipients receiving treatment. Patients who entered the study had been transplanted for more than 3 months and their drug level was supposed to be at steady state. MMF concentration was measured with high-performance liquid chromatography (HPLC. Results: The plasma MPA concentration-time curve was characterized by an early sharp peak at about 1 hour postdose. The mean Area Under Curve (AUC, Cmax and Tmax were 47.0±18.3 µg.h/ml, 18.6±8.5 µg/ml and 1.0±0.5 hours respectively. Conclusion: The plasma MPA concentration-time curve pattern of Iranian patients was similar and consistent with previously reported profiles in other populations taking the same dose. Keywords: Mycophenolate mofetil, Mycophenolic acid, Pharmacokinetics, Area Under Curve, Kidney transplantation

Age and Early Graft Function Relate With Risk-Benefit Ratio of Allogenic Islet Transplantation Under Antithymocyte Globulin-Mycophenolate Mofetil-Tacrolimus Immune Suppression.

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Lee, DaHae; Keymeulen, Bart; Hilbrands, Robert; Ling, Zhidong; Van de Velde, Ursule; Jacobs-Tulleneers-Thevissen, Daniel; Maleux, Geert; Lapauw, Bruno; Crenier, Laurent; De Block, Christophe; Mathieu, Chantal; Pipeleers, Daniel; Gillard, Pieter

2017-09-01

Induction therapy with a T cell-depleting agent followed by mycophenolate mofetil and tacrolimus is presently the most frequently used immune suppression (IS) regimen in islet transplantation. This study assesses its safety and tolerability in nonuremic type 1 diabetic recipients. Fifty-one patients (age, between 29 and 63 years) with high glycemic variability and problematic hypoglycemia received intraportal islet grafts under anti-thymocyte globulin-mycophenolate mofetil-tacrolimus protocol. They were followed up for over 48 months for function of the implant and adverse events. Severe hypoglycemia and diabetic ketoacidosis were absent in patients with functioning graft. Immune suppressive therapy was maintained for 48 months in 29 recipients with sustained function (group A), whereas 16 patients stopped earlier due to graft failure (group B) and in 6 for other reasons. Group A was significantly older at the time of implantation and achieved higher graft function at posttransplantation month 6 under similar dose of IS. Prevalence of IS-related side effects was similar in groups A and B, occurring predominantly during the first year posttransplantation. IS-related serious adverse events (SAE) were reported in 47% of patients, with 4 presenting with cytomegalovirus infection and 4 (age, 42-59 years) diagnosed with cancer. Except in 1 patient with cancer, all SAEs resolved after appropriate treatment. These risk/benefit data serve as a basis for clinical decision-making before entering an intraportal islet transplantation protocol. A longer benefit is observed in recipients of higher age (≥40 years), but it is not associated with more side effects and SAE.

Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

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Raheem, Omer A

2011-05-01

Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

Predicting the usefulness of therapeutic drug monitoring of mycophenolic acid: a computer simulation

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van Hest, Reinier; Mathot, Ron; Vulto, Arnold; Weimar, Willem; van Gelder, Teun

2005-01-01

The usefulness of therapeutic drug monitoring (TDM) of mycophenolate mofetil (MMF) was investigated with a computer simulation model. For a fixed-dose (FD) and a concentration-controlled (CC) MMF dosing regimen exposure to mycophenolic acid (MPA) was compared. A nonlinear mixed-effects model

Mycophenolic acid agents: is enteric coating the answer?

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Manitpisitkul W

2011-03-01

Full Text Available Wana Manitpisitkul1, Sabrina Lee2, Matthew Cooper31Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA; 2Solid Organ Transplant Program, University of Utah Health Care, Salt Lake City, UT, USA; 3Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USAAbstract: Addition of mycophenolate mofetil (MMF to calcineurin-based immunosuppressive therapy has led to a significant improvement in graft survival and reduction of acute rejection in renal transplant recipients. However, in clinical practice, MMF dose reduction, interruption, or discontinuation due to hematological and gastrointestinal (GI side-effects occurred in up to 50% of the patients. Large retrospective analyses have demonstrated that patients requiring MMF dose manipulation due to adverse events experienced a higher rate of rejection and graft loss. Enteric-coated mycophenolate sodium (EC-MPS was developed with the goal of improving upper GI side-effects. Here, we review the efficacy and safety of EC-MPS in de novo kidney transplant recipient, and in stable renal transplant patients who were converted from MMF. The changes in GI-related adverse events using patient-reported outcome instruments are also reviewed.Keywords: enteric-coated mycophenolate sodium, mycophenolate mofetil, kidney transplant, efficacy, gastrointestinal tolerability

Renal function, efficacy, and safety of sirolimus and mycophenolate mofetil after short-term calcineurin inhibitor-based quadruple therapy in de novo renal transplant patients: one-year analysis of a randomized multicenter trial.

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Guba, Markus; Pratschke, Johann; Hugo, Christian; Krämer, Bernhard K; Nohr-Westphal, Constanze; Brockmann, Jens; Andrassy, Joachim; Reinke, Petra; Pressmar, Katharina; Hakenberg, Oliver; Fischereder, Michael; Pascher, Andreas; Illner, Wolf-Dieter; Banas, Bernhard; Jauch, Karl-Walter

2010-07-27

De novo sirolimus in calcineurin inhibitor-free regimens, although potentially useful to improve early renal function, are complicated by various drug-related side effects. We report a prospective open-label, multicenter, randomized trial to evaluate early conversion from a CsA-based to a sirolimus (SRL)-based regimen 10 to 24 days after renal transplantation. Of the 196 patients, 141 patients with a low-to-moderate immunological risk were eligible to be converted to SRL or to continue CsA. All patients received antithymocyte globulin-F single-bolus induction, mycophenolate mofetil, and steroids. The primary endpoint, renal function determined by S-creatinine and estimated glomerular filtration rate calculated by Nankivell formula at 12 months was significantly better in the SRL group (1.51+/-0.59 vs. 1.87+/-0.98 mg/dL or 64.5+/-25.2 vs. 53.4+/-18.0 mL/min/1.73 m). Patient survival, graft survival, and incidence of biopsy-proven acute rejection after conversion were not statistically different. Drug discontinuations were significantly higher in the SRL group (36.2% vs. 19.7%). Significantly, more patients in the SRL group reported acne, aphtous, and temporary hyperlipidemia, whereas cytomegalovirus viremia was significantly decreased (7.3% vs. 28.2%). Early conversion to a calcineurin inhibitor-free regimen with SRL in combination with mycophenolate mofetil may be a useful strategy to improve renal function. The identification of appropriate candidates and safe management of SRL-related adverse events will be a key to avoid the high rate of dropouts, which currently limit the broad applicability of this protocol.

Dermatose por IgA e IgG linear: relato de caso com boa resposta terapêutica à dapsona e ao micofenolato mofetil Linear IgA/IgG bullous dermatosis: successful treatment with dapsone and mycophenolate mofetil

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Leny Passos

2011-08-01

Full Text Available Relata-se o caso de paciente feminina, de 21 anos, com dermatose por IgA e IgG linear. Inicialmente, a resposta clínica foi favorável à dapsona. Após a interrupção desta medicação, por crise de anemia sintomática, precipitada por malária, houve piora da doença, apesar da utilização da prednisona e pulsoterapia com metilprednisolona. A reintrodução da dapsona, associada ao micofenolato mofetil, possibilitou o controle da enfermidadeA 21-year-old female presenting linear IgA and IgG disease initially responded well to dapsone therapy. However, the treatment with dapsone was withdrawn due to severe anemia induced by malaria, which led to worsening of the clinical picture. Although prednisone and methylprednisolone were tried, the patient responded only to the association of dapsone and mycophenolate mofetil

Exposure to Mycophenolate and Fatherhood.

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Midtvedt, Karsten; Bergan, Stein; Reisæter, Anna Varberg; Vikse, Bjørn Egil; Åsberg, Anders

2017-07-01

Mycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil and mycophenolate sodium, and it is widely used after organ transplantation. In women, taking MPA is teratogenic and may also influence spermatogenesis. There is a lack of knowledge regarding outcome of pregnancies fathered by men exposed to MPA. We compared outcomes in pregnancies fathered by renal transplant men per whether they had been exposed to MPA or not at time of conception. A nationwide population-based retrospective cohort study was performed. Data from the Norwegian Renal Registry with all renal transplanted men alive between January 1, 1995 and December 31, 2015 were included, and relevant outcome data were extracted from the Medical Birth Registry of Norway. During the given time, 230 immunosuppressed renal transplanted men fathered 350 children (155 on MPA/195 not on MPA). There were no significant increased risks of malformation (3.9% vs. 2.6%, P = 0.49) in MPA exposed versus unexposed cohorts of children. The average dose (±SD) of mycophenolate was 1.42 ± 0.3 g/day and the individual median MPA trough concentration in the time period of anticipated conception and pregnancy was 2.8 ± 1.6 mg/L. Birth weight was similar in exposed and unexposed cohorts of children; 3381 ± 681 g vs. 3429 ± 714 g (P = 0.53). Paternal exposure to MPA did not increase the risk of adverse birth outcomes in children fathered by male kidney transplanted patients. These results are reassuring and support the continuation of paternal MPA treatment before, during, and after conception.

FTY720 versus mycophenolate mofetil in de novo renal transplantation: six-month results of a double-blind study.

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Tedesco-Silva, Helio; Szakaly, Peter; Shoker, Ahmed; Sommerer, Claudia; Yoshimura, Norio; Schena, Francesco Paolo; Cremer, Malika; Hmissi, Abdel; Mayer, Hartmut; Lang, Philippe

2007-10-15

FTY720 is a novel immunomodulator that was developed to produce optimal graft protection with improved safety and tolerability. Phase II studies have demonstrated the efficacy of FTY720 up to the doses of 2.5 mg with full-dose cyclosporine (FDC). This multicenter, double-blind, Phase IIb, randomized study evaluated the safety and efficacy of 5 mg FTY720 (n=87; Group 1) vs. 2.5 mg FTY720 (n=90; Group 2) vs. mycophenolate mofetil (MMF; n=94; Group 3) in de novo renal transplant patients receiving FDC and prednisone. The primary efficacy endpoint was the occurrence of treated biopsy-proven acute rejection, graft loss, death, or premature study discontinuation (composite endpoint) within 6 months. The primary endpoint was superior in Group 1 (24%) and statistically noninferior in Group 2 compared to Group 3 (24.1% vs. 29.2% vs. 39.4%; P=0.025 and 0.0039, respectively). FTY720 plus FDC was generally well tolerated, with a similar incidence of adverse events across all groups. FTY720 was associated with higher incidence of bradycardia (Group 1: 26.4%, P=0.0002 and Group 2: 15.6%, P=0.046, vs. Group 3: 6.4%), respiratory disorders (Group 1: 40.2%, not significant [P=NS] and Group 2: 34.4%, P=NS vs. Group 3: 28.7%). One macular edema occurred in Group 2. Lower creatinine clearances were observed with FTY720 versus MMF (Group 1: 52.4 ml/min, P=NS and Group 2: 51.7 ml/min, P=0.039 vs. Group 3: 62.5 ml/min). Although FTY720 with FDC provided adequate protection from acute rejection the safety profile was less favorable for adverse events than current standard immunosuppression in de novo renal transplant patients.

Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation

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Hyeyoung Kim

2014-09-01

Full Text Available Background/AimsThe dose of mycophenolate mofetil (MMF has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT.MethodsTwo sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12 for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter, with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT.ResultsIn the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day, and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively.ConclusionsA reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.

A combined photophysical and computational study on the binding of mycophenolate mofetil and its major metabolite to transport proteins.

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Vendrell-Criado, Victoria; González-Bello, Concepción; Miranda, Miguel A; Jiménez, M Consuelo

2018-06-15

Binding of the immunosuppressive agent mycophenolate mofetil (MMP) and its pharmacologically active metabolite mycophenolic acid (MPA) to human serum albumin (HSA) and α 1 -acid glycoprotein (HAAG) has been investigated by means of an integrated approach involving selective excitation of the drug fluorophore, following their UV-A triggered fluorescence and docking studies. The formation of the protein/ligand complexes was evidenced by a dramatic enhancement of the fluorescence intensity and a hypsochromic shift of the emission band. In HSA, competitive studies using oleic acid as site I probe revealed site I as the main binding site of the ligands. Binding constants revealed that the affinity of the active metabolite by HSA is four-fold higher than its proactive form. Moreover, the affinity of MMP by HSA is three-fold higher than by HAAG. Docking studies revealed significant molecular binding differences in the binding of MMP and MPA to sub-domain IIA of HSA (site 1). For MPA, the aromatic moiety would be in close contact to Trp214 with the flexible chain pointing to the other end of the sub-domain; on the contrary, for MMP, the carboxylate group of the chain would be fixed nearby Trp214 through electrostatic interactions with residues Arg218 and Arg222. Copyright © 2018 Elsevier B.V. All rights reserved.

Simultaneous determination of mycophenolate mofetil and its active metabolite, mycophenolic acid, by differential pulse voltammetry using multi-walled carbon nanotubes modified glassy carbon electrode

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Madrakian, Tayyebeh, E-mail: madrakian@basu.ac.ir; Soleimani, Mohammad; Afkhami, Abbas

2014-09-01

A highly sensitive electrochemical sensor for the simultaneous determination of mycophenolate mofetil (MPM) and mycophenolic acid (MPA) was fabricated by multi-walled carbon nanotubes modified glassy carbon electrode (MWCNTs/GCE). The electrochemical behavior of these two drugs was studied at the modified electrode using cyclic voltammetry and adsorptive differential pulse voltammetry. MPM and MPA were oxidized at the GCE during an irreversible process. DPV analysis showed two oxidation peaks at 0.87 V and 1.1 V vs. Ag/AgCl for MPM and an oxidation peak at 0.87 V vs. Ag/AgCl for MPA in phosphate buffer solution of pH 5.0. The MWCNTs/GCE displayed excellent electrochemical activities toward oxidation of MPM and MPA relative to the bare GCE. The experimental design algorithm was used for optimization of DPV parameters. The electrode represents linear responses in the range 5.0 × 10{sup −6} to 1.6 × 10{sup −4} mol L{sup −1} and 2.5 × 10{sup −6} mol L{sup −1} to 6.0 × 10{sup −5} mol L{sup −1} for MPM and MPA, respectively. The detection limit was found to be 9.0 × 10{sup −7} mol L{sup −1} and 4.0 × 10{sup −7} mol L{sup −1} for MPM and MPA, respectively. The modified electrode showed a good sensitivity and stability. It was successfully applied to the simultaneous determination of MPM and MPA in plasma and urine samples. - Highlights: • A new modified electrochemical sensor was constructed and used. • Multiwalled carbon nanotubes were used as the modifiers. • MPM and MPA were measured simultaneously at the low levels. • The sensor was used to the determination of MPA and MPM in real samples.

Prevention of diabetes: effect of mycophenolate mofetil and anti-CD25 on onset of diabetes in the DRBB rat.

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Ugrasbul, Figen; Moore, Wayne V; Tong, Pei Ying; Kover, Karen L

2008-12-01

Anti-CD25 and mycophenolate mofetil (MMF) treatment of patients with new-onset diabetes is currently being tested as one of the trials in TrialNet. We tested the effectiveness of MMF and anti-CD25 in preventing autoimmune diabetes in the diabetes-resistant biobreeding (DRBB) rat. Autoimmune diabetes in the DRBB rat was induced with a Treg cell depletion regimen starting at 24-26 d of age. Treatment was started on the first day of the depletion regimen in the following groups: (i) control (vehicle); (ii) MMF 25 mg/kg/d intramuscularly daily for 8 wk; (iii) anti-CD25 0.8 mg/kg/d intraperitoneally 5 d/wk for 3 wk; and (iv) combination of MMF and anti-CD25. In a second set of experiments, treatments were started on day 5 of the depletion regimen (delayed treatment) with groups 1, 3, and 4. Rats that had diabetes-free survival for at least 30 d after the treatment was stopped underwent a second Treg depletion (redepletion). In each of the three treatment groups (n = 10/group), onset of diabetes was delayed or prevented in 20, 40 and 80% in groups 2, 3, and 4, respectively. After redepletion, diabetes-free survival was unchanged in group 2 and decreased to 10 and 30% in groups 3 and 4, respectively. With delayed treatment, groups 3 and 4 had 33 and 50% diabetes-free survival that decreased to 0 and 33% after redepletion. MMF and anti-CD25 alone or in combination are effective in delaying and preventing diabetes in the DRBB rat especially if treatment is started before stimulation and expansion of the autoreactive T cells.

Successful treatment of pediatric IgG4 related systemic disease with mycophenolate mofetil: case report and a review of the pediatric autoimmune pancreatitis literature

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Cron Randy Q

2011-01-01

Full Text Available Abstract Autoimmune pancreatitis is frequently associated with elevated serum and tissue IgG4 levels in the adult population, but there are few reports of pediatric autoimmune pancreatitis, and even fewer reports of IgG4 related systemic disease in a pediatric population. The standard of care treatment in adults is systemic corticosteroids with resolution of symptoms in most cases; however, multiple courses of corticosteroids are occasionally required and some patients require long term corticosteroids. In these instances, steroid sparing disease modify treatments are in demand. We describe a 13-year-old girl with IgG4 related systemic disease who presented with chronic recurrent autoimmune pancreatitis resulting in surgical intervention for obstructive hyperbilirubinemia and chronic corticosteroid treatment. In addition, she developed fibrosing medianstinitis as part of her IgG4 related systemic disease. She was eventually successfully treated with mycophenolate mofetil allowing for discontinuation of corticosteroids. This is the first reported use of mycophenolate mofetil for IgG4 related pancreatitis. Although autoimmune pancreatitis as part of IgG4 related systemic disease is rarely reported in pediatrics, autoimmune pancreatitis is also characterized as idiopathic fibrosing pancreatitis. All pediatric autoimmune pancreatitis cases reported in the world medical literature were identified via a PUBMED search and are reviewed herein. Twelve reports of pediatric autoimmune pancreatitis were identified, most of which were treated with corticosteroids or surgical approaches. Most case reports failed to report IgG4 levels, so it remains unclear how commonly IgG4 related autoimmune pancreatitis occurs during childhood. Increased evaluation of IgG4 levels in patients with autoimmune pancreatitis may shed further light on the association of IgG4 with pancreatitis and the underlying pathophysiology.

Diagnostic efficiency of truncated area under the curve from 0 to 2 h (AUC₀₋₂) of mycophenolic acid in kidney transplant recipients receiving mycophenolate mofetil and concomitant tacrolimus.

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Lampón, Natalia; Tutor-Crespo, María J; Romero, Rafael; Tutor, José C

2011-07-01

Recently, the use of the truncated area under the curve from 0 to 2 h (AUC(0-2)) of mycophenolic acid (MPA) has been proposed for therapeutic monitoring in liver transplant recipients. The aim of our study was the evaluation of the clinical usefulness of truncated AUC(0-2) in kidney transplant patients. Plasma MPA was measured in samples taken before the morning dose of mycophenolate mofetil, and one-half and 2 h post-dose, completing 63 MPA concentration-time profiles from 40 adult kidney transplant recipients. The AUC from 0 to 12 h (AUC(0-12)) was calculated using the validated algorithm of Pawinski et al. The truncated AUC(0-2) was calculated using the linear trapezoidal rule, and extrapolated to 0-12 h (trapezoidal extrapolated AUC(0-12)) as previously described. Algorithm calculated and trapezoidal extrapolated AUC(0-12) values showed high correlation (r=0.995) and acceptable dispersion (ma68=0.71 μg·h/mL), median prediction error (6.6%) and median absolute prediction error (12.6%). The truncated AUC(0-2) had acceptable diagnostic efficiency (87%) in the classification of subtherapeutic, therapeutic or supratherapeutic values with respect to AUC(0-12). However, due to the high inter-individual variation of the drug absorption-rate, the dispersion between both pharmacokinetic variables (ma68=6.9 μg·h/mL) was unacceptable. The substantial dispersion between truncated AUC(0-2) and AUC(0-12) values may be a serious objection for the routine use of MPA AUC(0-2) in clinical practice.

Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

LENUS (Irish Health Repository)

Raheem, Omer A

2011-05-28

BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

LENUS (Irish Health Repository)

2012-02-01

BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

Thymoglobulin induction in liver transplant recipients with a tacrolimus, mycophenolate mofetil, and steroid immunosuppressive regimen: a five-year randomized prospective study.

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Boillot, Olivier; Seket, Belhassen; Dumortier, Jérôme; Pittau, Gabriella; Boucaud, Catherine; Bouffard, Yves; Scoazec, Jean-Yves

2009-11-01

This randomized, comparative study assessed the long-term efficacy and tolerability of thymoglobulin (TMG) induction in 93 liver transplant patients with an initial regimen of tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids. Forty-four patients were randomly allocated to the TMG+ group, and 49 patients were randomly allocated to the TMG- group. In both groups, Tac was given orally at the initial daily dose of 0.075 mg/kg twice daily, and MMF was given at the initial daily dose of 2 g/day. Steroid withdrawal was planned at 3 months after liver transplantation. The results were evaluated with respect to acute rejection incidence, patient and graft survival, graft function, and medical complications until 5 years or death for all patients. No significant differences were found between groups for the incidence of acute rejection at 5 years (11.4% versus 14.3%), 5-year patient survival (77.3% versus 87.8%), graft function, or postoperative renal function. One patient in the TMG- group underwent retransplantation. There was no difference between groups with respect to the incidence of medical complications, excepted for a higher rate of leukopenia in the TMG+ group, during the 5-year follow-up. In conclusion, the results of this prospective randomized study suggest that the addition of TMG to a triple immunosuppressive regimen (Tac, MMF, and steroids) did not modify the incidence of acute rejection episodes or long-term survival and was responsible for increased leukopenia rates.

Tacrolimus and mycophenolate mofetil after nonmyeloablative matched-sibling donor allogeneic stem-cell transplantations conditioned with fludarabine and low-dose total body irradiation.

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Nieto, Yago; Patton, Nigel; Hawkins, Timothy; Spearing, Ruth; Bearman, Scott I; Jones, Roy B; Shpall, Elizabeth J; Rabinovitch, Rachel; Zeng, Chan; Barón, Anna; McSweeney, Peter A

2006-02-01

We evaluated tacrolimus/mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis after a nonmyeloablative stem cell transplantation (NST) from a matched sibling donor (MSD). Thirty-two patients (median age, 57 years) with advanced hematologic malignancies, who were poor candidates for a conventional myeloablative transplantation, received fludarabine (30 mg/m(2), day -4 to day -2), total-body irradiation (TBI) (200 cGy, day 0), infusion of donor peripheral blood progenitor cells (day 0), oral tacrolimus 0.06 mg/kg twice daily (from day 3), and oral MMF at 15 mg/kg twice daily (days 0-+27). Tacrolimus was tapered from day +100 to day +180 in those patients with indolent malignancies (n = 25), and from day +35 to day +56 in those with aggressive tumors (n = 7). Regimen toxicities and myelosuppression were mild, allowing 75% of patients to have entirely outpatient transplantations. One patient (3%) experienced a nonfatal graft rejection. Rates of grades II-IV and III-IV acute GVHD were 15.6% and 3%, respectively. Acute GVHD was diagnosed at median day +78 (range, days +31-+84). Extensive chronic GVHD was observed in 10 of 24 evaluable patients (41.6%) at a median onset of day +198 (range, days +128-+277), either spontaneously (n = 5) or elicited after tumor progression (n = 5). Five patients experienced transplantation-related mortality (TRM) (15.6%) from either acute GVHD-related multiorgan failure (MOF) (n = 3) or infectious complications (n = 2). At median follow-up of 19 months (range, 2-41 months), the overall survival, progression-free survival, and disease-free survival rates are 62.5%, 50%, and 40%, respectively. In conclusion, the use of tacrolimus/MMF after MSD NST is associated with encouraging rates of GVHD control.

De novo Renal Transplantation after Kaposi Sarcoma: Favorable Outcome in a Patient Receiving Sirolimus and Mycophenolate-Based Immunosuppression

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F. Friedersdorff

2010-04-01

Full Text Available Immunosuppressive treatment increases the risk of infection and malignancy in organ transplant recipients. We report on a 42-year-old male renal transplant recipient who lost his first graft after reduction of immunosuppressive treatment due to Kaposi sarcoma and who successfully underwent a second renal transplant 10 years later. The patient’s current treatment consists of low-dose prednisone, and the two antiproliferative immunosuppressants mycophenolate mofetil and rapamycin. 4.5 years after his second transplant, the serum creatinine is 1 mg/dl and the patient has no signs of recurrent disease.

Mycophenolate Mofetil Modulates Differentiation of Th1/Th2 and the Secretion of Cytokines in an Active Crohn's Disease Mouse Model.

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Lv, Qing-Kang; Liu, Ju-Xiong; Li, Su-Nan; Gao, Ying-Jie; Lv, Yan; Xu, Zi-Peng; Huang, Bing-Xu; Xu, Shi-Yao; Yang, Dong-Xue; Zeng, Ya-Long; Liu, Dian-Feng; Wang, Wei

2015-11-06

Mycophenolate mofetil (MMF) is an alternative immunosuppressive agent that has been reported to be effective and well tolerated for the treatment of refractory inflammatory bowel disease (IBD). The aim of this study was to investigate the therapeutic effect of MMF on intestinal injury and tissue inflammation, which were caused by Crohn's disease (CD). Here, trinitrobenzene sulfonic acid-relapsing (TNBS) colitis was induced in mice; then, we measured the differentiation of Th1/Th2 cells in mouse splenocytes by flow cytometry and the secretion of cytokines in mice with TNBS-induced colitis by real-time polymerase chain reaction and/or enzyme-linked immunosorbent assay (RT-PCR/ELISA). The results show that MMF significantly inhibited mRNA expression of pro-inflammatory cytokines IFN-γ, TNF-α, IL-12, IL-6, and IL-1β in mice with TNBS-induced colitis; however, MMF did not inhibit the expression of IL-10 mRNA. Additionally, ELISA showed that the serum levels of IFN-γ, TNF-α, IL-12, IL-6, and IL-1β were down-regulated in a TNBS model of colitis. Flow cytometric analysis showed MMF markedly reduced the percentages of Th1 and Th2 splenocytes in the CD mouse model. Mycophenolic acid (MPA) also significantly decreased the percentages of splenic Th1 and Th2 cells in vitro. Furthermore, MMF treatment not only significantly ameliorated diarrhea, and loss of body weight but also abrogated the histopathologic severity and inflammatory response of inflammatory colitis, and increased the survival rate of TNBS-induced colitic mice. These results suggest that treatment with MMF may improve experimental colitis and induce inflammatory response remission of CD by down-regulation of pro-inflammatory cytokines via modulation of the differentiation of Th1/Th2 cells.

Pharmacodynamic Monitoring of Inosine Monophosphate Dehydrogenase Activity: A Basis For Optimized and Individualized Mycophenolate Mofetil Therapy

NARCIS (Netherlands)

F. Sombogaard (Ferdi)

2010-01-01

textabstractIn 1896 Gosic isolated for the first time mycophenolic acid (MPA) from Penicillium glaucum.It was subsequently isolated from Penicillium stoloniferum Thom (synonym P. brevi-compactum Dierckx) by Alsberg and Black in 1913 who gave the acid phenolic substance its name mycophenolic acid

Engineering human T cells for resistance to methotrexate and mycophenolate mofetil as an in vivo cell selection strategy.

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Mahesh Jonnalagadda

Full Text Available Gene transfer and drug selection systems that enforce ongoing transgene expression in vitro and in vivo which are compatible with human pharmaceutical drugs are currently underdeveloped. Here, we report on the utility of incorporating human enzyme muteins that confer resistance to the lymphotoxic/immunosuppressive drugs methotrexate (MTX and mycophenolate mofetil (MMF in a multicistronic lentiviral vector for in vivo T lymphocyte selection. We found that co-expression of human dihydrofolate reductase (DHFR(FS; L22F, F31S and inosine monophosphate dehydrogenase II (IMPDH2(IY; T333I, S351Y conferred T cell resistance to the cytocidal and anti-proliferative effects of these drugs at concentrations that can be achieved clinically (up to 0.1 µM MTX and 1.0 µM MPA. Furthermore, using a immunodeficient mouse model that supports the engraftment of central memory derived human T cells, in vivo selection studies demonstrate that huEGFRt(+DHFR(FS+IMPDH2(IY+ T cells could be enriched following adoptive transfer either by systemic administration of MTX alone (4.4 -fold, MMF alone (2.9-fold, or combined MTX and MMF (4.9-fold. These findings demonstrate the utility of both DHFR(FS/MTX and IMPDH2(IY/MMF for in vivo selection of lentivirally transduced human T cells. Vectors incorporating these muteins in combination with other therapeutic transgenes may facilitate the selective engraftment of therapeutically active cells in recipients.

Engineering human T cells for resistance to methotrexate and mycophenolate mofetil as an in vivo cell selection strategy.

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Jonnalagadda, Mahesh; Brown, Christine E; Chang, Wen-Chung; Ostberg, Julie R; Forman, Stephen J; Jensen, Michael C

2013-01-01

Gene transfer and drug selection systems that enforce ongoing transgene expression in vitro and in vivo which are compatible with human pharmaceutical drugs are currently underdeveloped. Here, we report on the utility of incorporating human enzyme muteins that confer resistance to the lymphotoxic/immunosuppressive drugs methotrexate (MTX) and mycophenolate mofetil (MMF) in a multicistronic lentiviral vector for in vivo T lymphocyte selection. We found that co-expression of human dihydrofolate reductase (DHFR(FS); L22F, F31S) and inosine monophosphate dehydrogenase II (IMPDH2(IY); T333I, S351Y) conferred T cell resistance to the cytocidal and anti-proliferative effects of these drugs at concentrations that can be achieved clinically (up to 0.1 µM MTX and 1.0 µM MPA). Furthermore, using a immunodeficient mouse model that supports the engraftment of central memory derived human T cells, in vivo selection studies demonstrate that huEGFRt(+)DHFR(FS+)IMPDH2(IY+) T cells could be enriched following adoptive transfer either by systemic administration of MTX alone (4.4 -fold), MMF alone (2.9-fold), or combined MTX and MMF (4.9-fold). These findings demonstrate the utility of both DHFR(FS)/MTX and IMPDH2(IY)/MMF for in vivo selection of lentivirally transduced human T cells. Vectors incorporating these muteins in combination with other therapeutic transgenes may facilitate the selective engraftment of therapeutically active cells in recipients.

Failure to preserve beta-cell function with mycophenolate mofetil and daclizumab combined therapy in patients with new- onset type 1 diabetes.

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Gottlieb, Peter A; Quinlan, Scott; Krause-Steinrauf, Heidi; Greenbaum, Carla J; Wilson, Darrell M; Rodriguez, Henry; Schatz, Desmond A; Moran, Antoinette M; Lachin, John M; Skyler, Jay S

2010-04-01

This trial tested whether mycophenolate mofetil (MMF) alone or with daclizumab (DZB) could arrest the loss of insulin-producing beta-cells in subjects with new-onset type 1 diabetes. A multi-center, randomized, placebo-controlled, double-masked trial was initiated by Type 1 Diabetes TrialNet at 13 sites in North America and Europe. Subjects diagnosed with type 1 diabetes and with sufficient C-peptide within 3 months of diagnosis were randomized to either MMF alone, MMF plus DZB, or placebo, and then followed for 2 years. The primary outcome was the geometric mean area under the curve (AUC) C-peptide from the 2-h mixed meal tolerance test. One hundred and twenty-six subjects were randomized and treated during the trial. The geometric mean C-peptide AUC at 2 years was unaffected by MMF alone or MMF plus DZB versus placebo. Adverse events were more frequent in the active therapy groups relative to the control group, but not significantly. Neither MMF alone nor MMF in combination with DZB had an effect on the loss of C-peptide in subjects with new-onset type 1 diabetes. Higher doses or more targeted immunotherapies may be needed to affect the autoimmune process.

Failure to Preserve β-Cell Function With Mycophenolate Mofetil and Daclizumab Combined Therapy in Patients With New- Onset Type 1 Diabetes

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Gottlieb, Peter A.; Quinlan, Scott; Krause-Steinrauf, Heidi; Greenbaum, Carla J.; Wilson, Darrell M.; Rodriguez, Henry; Schatz, Desmond A.; Moran, Antoinette M.; Lachin, John M.; Skyler, Jay S.

2010-01-01

OBJECTIVE This trial tested whether mycophenolate mofetil (MMF) alone or with daclizumab (DZB) could arrest the loss of insulin-producing β-cells in subjects with new-onset type 1 diabetes. RESEARCH DESIGN AND METHODS A multi-center, randomized, placebo-controlled, double-masked trial was initiated by Type 1 Diabetes TrialNet at 13 sites in North America and Europe. Subjects diagnosed with type 1 diabetes and with sufficient C-peptide within 3 months of diagnosis were randomized to either MMF alone, MMF plus DZB, or placebo, and then followed for 2 years. The primary outcome was the geometric mean area under the curve (AUC) C-peptide from the 2-h mixed meal tolerance test. RESULTS One hundred and twenty-six subjects were randomized and treated during the trial. The geometric mean C-peptide AUC at 2 years was unaffected by MMF alone or MMF plus DZB versus placebo. Adverse events were more frequent in the active therapy groups relative to the control group, but not significantly. CONCLUSIONS Neither MMF alone nor MMF in combination with DZB had an effect on the loss of C-peptide in subjects with new-onset type 1 diabetes. Higher doses or more targeted immunotherapies may be needed to affect the autoimmune process. PMID:20067954

The ORION study: comparison of two sirolimus-based regimens versus tacrolimus and mycophenolate mofetil in renal allograft recipients.

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Flechner, S M; Glyda, M; Cockfield, S; Grinyó, J; Legendre, Ch; Russ, G; Steinberg, S; Wissing, K M; Tai, S S

2011-08-01

Safety and efficacy of two sirolimus (SRL)-based regimens were compared with tacrolimus (TAC) and mycophenolate mofetil (MMF). Renal transplantation recipients were randomized to Group 1 (SRL+TAC; week 13 TAC elimination [n = 152]), Group 2 (SRL + MMF [n = 152]) or Group 3 (TAC + MMF [n = 139]). Group 2, with higher-than-expected biopsy-confirmed acute rejections (BCARs), was sponsor-terminated; therefore, Group 2 two-year data were limited. At 1 and 2 years, respectively, graft (Group 1: 92.8%, 88.5%; Group 2: 90.6%, 89.9%; Group 3: 96.2%, 95.4%) and patient (Group 1: 97.3%, 94.4%; Group 2: 95.2%, 94.5%; Group 3: 97.0%, 97.0%) survival rates were similar. One- and 2-year BCAR incidence was: Group 1, 15.2%, 17.4%; Group 2, 31.3%, 32.8%; Group 3, 8.2%, 12.3% (Group 2 vs. 3, p < 0.001). Mean 1- and 2-year modified intent-to-treat glomerular filtration rates (mL/min) were similar. Primary reason for discontinuation was adverse events (Group 1, 34.2%; Group 2, 33.6%; Group 3, 22.3%; p < 0.05). In Groups 1 and 2, delayed wound healing and hyperlipidemia were more frequent. One-year post hoc analysis of new-onset diabetes posttransplantation was greater in TAC recipients (Groups 1 and 3 vs. 2, 17% vs. 6%; p = 0.004). Between-group malignancy rates were similar. The SRL-based regimens were not associated with improved outcomes for kidney transplantation patients. ©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Enteric-coated mycophenolate sodium experience in liver transplant patients.

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Cantisani, G P C; Zanotelli, M L; Gleisner, A L M; de Mello Brandão, A; Marroni, C A

2006-04-01

Mycophenolate sodium (EC-MPS) has been shown to be as effective and as safe as mycophenolate mofetil (MMF) in renal transplant patients. Nevertheless, compared to MMF its use in liver transplant patients has been limited. The purpose of this study was to analyze the efficacy of EC-MPS as a primary immunosuppressant or as a replacement for MMF in liver transplant patients. Ninety among 470 liver transplant recipients were receiving or had added an antimetabolite to their immunosuppressant therapy. The most common reason for this change was renal dysfunction (47.8%) or diabetes (32.2%). EC-MPS was started at a median of 30 months after liver transplantation. The mean administered daily dose was 720 mg/d. At least one gastrointestinal symptom was reported by 25 patients. Abdominal pain (16.6%) and diarrhea (14.5%) were the most frequent. EC-MPS had to be discontinued in two patients, while six others required dose reduction to resolve the symptoms. Hematological adverse events were infrequent: three patients had leukopenia and one, anemia, all of which responded to dosage reduction. There was a creatinine reduction within 6 months of drug commencement and maintenance of the lower creatinine levels at 1 year among patients who began EC-MPS for renal dysfunction. Serum low-density lipoprotein cholesterol and triglyceride levels were significantly lower among patients on EC-MPS than on MMF. In conclusion, EC-MPS appears to have a similar efficacy and safety profile as MMF in liver transplant patients. Hematological and gastrointestinal adverse events were infrequent; seldom had the drug to be discontinued.

Post-Transplant Cyclophosphamide and Tacrolimus-Mycophenolate Mofetil Combination Prevents Graft-versus-Host Disease in Allogeneic Peripheral Blood Hematopoietic Cell Transplantation from HLA-Matched Donors.

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Carnevale-Schianca, Fabrizio; Caravelli, Daniela; Gallo, Susanna; Coha, Valentina; D'Ambrosio, Lorenzo; Vassallo, Elena; Fizzotti, Marco; Nesi, Francesca; Gioeni, Luisa; Berger, Massimo; Polo, Alessandra; Gammaitoni, Loretta; Becco, Paolo; Giraudo, Lidia; Mangioni, Monica; Sangiolo, Dario; Grignani, Giovanni; Rota-Scalabrini, Delia; Sottile, Antonino; Fagioli, Franca; Aglietta, Massimo

2017-03-01

Allogeneic hematopoietic cell transplant (HCT) remains the only curative therapy for many hematologic malignancies but it is limited by high nonrelapse mortality (NRM), primarily from unpredictable control of graft-versus-host disease (GVHD). Recently, post-transplant cyclophosphamide demonstrated improved GVHD control in allogeneic bone marrow HCT. Here we explore cyclophosphamide in allogeneic peripheral blood stem cell transplantation (alloPBSCT). Patients with high-risk hematologic malignancies received alloPBSCT from HLA-matched unrelated/related donors. GVHD prophylaxis included combination post-HCT cyclophosphamide 50 mg/kg (days +3 and +4) and tacrolimus/mofetil mycophenolate (T/MMF) (day +5 forward). The primary objective was the cumulative incidence of acute and chronic GVHD. Between March 2011 and May 2015, 35 consecutive patients received the proposed regimen. MMF was stopped in all patients at day +28; the median discontinuation of tacrolimus was day +113. Acute and chronic GVHD cumulative incidences were 17% and 7%, respectively, with no grade IV GVHD events, only 2 patients requiring chronic GVHD immunosuppression control, and no deaths from GVHD. Two-year NRM, overall survival, event-free survival, and chronic GVHD event-free survival rates were 3%, 77%, 54%, and 49%, respectively. The graft-versus-tumor effect was maintained as 5 of 15 patients (33%) who received HCT with evidence of disease experienced further disease response. A post-transplant cyclophosphamide + T/MMF combination strategy effectively prevented acute and chronic GVHD after alloPBSCT from HLA-matched donors and achieved an unprecedented low NRM without losing efficacy in disease control or impaired development of the graft-versus-tumor effect. This trial is registered at clinicaltrials.gov as NCT02300571. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

A longitudinal assessment of adherence with immunosuppressive therapy following kidney transplantation from the Mycophenolic Acid Observational REnal Transplant (MORE) study.

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Tsapepas, Demetra; Langone, Anthony; Chan, Laurence; Wiland, Anne; McCague, Kevin; Chisholm-Burns, Marie

2014-04-17

Nonadherence with immunosuppressive therapy after renal transplantation is a major clinical concern, but longitudinal data are sparse. Adherence data were recorded during the Mycophenolic Acid Observational REnal Transplant (MORE) study to help inform compliance management decisions. Prospective data were analyzed from the four-year, observational MORE study of de novo adult renal transplant recipients receiving mycophenolic acid (MPA) as enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) at 40 US sites under routine management. Adherence was assessed using the Immunosuppressant Therapy Adherence Scale (ITAS): total score 0-12 (12, adherence; adherent recipients (p=0.59); graft loss was 4.7% (19/402) vs. 3.0% (12/406) (p=0.20); death was 1.5% (6/402) vs. 4.7% (19/406) (p=0.013). Adherence to the immunosuppressive regimen decreases over time, highlighting the need to monitor and encourage adherence even in long-term maintenance kidney transplant patients. Other than African American race, demographic factors may be of limited value in predicting nonadherence.

Managing Drug-Drug Interaction Between Ombitasvir, Paritaprevir/Ritonavir, Dasabuvir, and Mycophenolate Mofetil.

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Lemaitre, Florian; Ben Ali, Zeineb; Tron, Camille; Jezequel, Caroline; Boglione-Kerrien, Christelle; Verdier, Marie-Clémence; Guyader, Dominique; Bellissant, Eric

2017-08-01

No drug-drug interaction study has been conducted to date for the combination of ombitasvir, paritaprevir/ritonavir, dasabuvir (3D), and mycophenolic acid (MPA). We here report the case of a hepatitis C virus-infected patient treated with 3D and MPA for vasculitis. In light of the threat of drug-drug interaction, the concentration of MPA was measured before, during, and 15 days after the end of the 3D treatment. Similar values were found at all 3 time points, thus indicating that there is probably no need to adapt MPA dosage to 3D.

Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease.

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Abu El-Asrar, Ahmed M; Dosari, Mona; Hemachandran, Suhail; Gikandi, Priscilla W; Al-Muammar, Abdulrahman

2017-02-01

To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. This prospective study included 38 patients (76 eyes). The main outcome measures were final visual acuity, corticosteroid-sparing effect, progression to chronic recurrent granulomatous uveitis and development of complications, particularly 'sunset glow fundus'. The mean follow-up period was 37.0 ± 29.3 (range 9-120 months). Visual acuity of 20/20 was achieved by 93.4% of the eyes. Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering to 10 mg or less daily was 3.8 ± 1.3 months (range 3-7 months). Twenty-two patients (57.9%) discontinued treatment without relapse of inflammation. The mean time observed off of treatment was 28.1 ± 19.6 months (range 1-60 months). None of the eyes progressed to chronic recurrent granulomatous uveitis. The ocular complications encountered were glaucoma in two eyes (2.6%) and cataract in five eyes (6.6%). None of the eyes developed 'sunset glow fundus', and none of the patients developed any systemic adverse events associated with the treatment. Use of MMF as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease prevents progression to chronic recurrent granulomatous inflammation and development of 'sunset glow fundus'. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Severe Interstitial Lung Disease and Manic Symptoms Secondary to Corticosteroids in a Patient with Systemic Lupus Erythematosus and Secondary Sjögren’s Syndrome

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Sofia Silvério Serra

2017-03-01

We introduced monthly perfusion of cyclophosphamide for six months and later started mycophenolate mofetil 2 g/day, reducing prednisolone to 10 mg/day and maintaining hydroxychloroquine 400 mg/day, with control of disease activity.

Micofenolato mofetil na síndrome de Sjögren primária: uma opção para o tratamento da agranulocitose Mycophenolate mofetil in primary Sjögren's syndrome: a treatment option for agranulocytosis

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Sonia Cristina de Magalhães Souza Fialho

2012-04-01

Full Text Available A síndrome de Sjögren (SS é uma doença autoimune caracterizada pela presença de infiltrado linfocítico nas glândulas salivares e lacrimais. Manifestações hematológicas da síndrome de Sjögren primária (SSp geralmente consistem em anemia leve, trombocitopenia, neutropenia moderada e linfopenia. Agranulocitose é raramente descrita e, em geral, responde bem ao tratamento de imunossupressão. Neste trabalho, descrevemos o caso de uma paciente portadora de SSp que apresentou quadro de agranulocitose refratária ao tratamento. A biópsia de medula revelou medula óssea hipocelular com maturação normal da série granulocítica. A paciente foi sucessivamente tratada com prednisona em altas doses, fator estimulador de colônia de macrófagos e ciclosporina, todos sem resposta hematológica. Micofenolato mofetil (MMF foi iniciado, e após dois meses houve aumento na contagem das células brancas. Após um ano de seguimento a paciente não apresentou novos episódios de neutropenia, nem complicações infecciosas. Concluímos que, na agranulocitose refratária associada à SSp, o tratamento com MMF pode ser uma opção eficaz e bem tolerada.The Sjögren's syndrome (SS is an autoimmune disease characterized by a lymphocytic infiltration of salivary and lacrimal glands. Hematological manifestations of primary SS (pSS usually consist of mild anemia, thrombocytopenia, moderate neutropenia, and lymphopenia. Agranulocytosis is rarely reported and usually responds to immunosuppression. We report the case of a pSS patient who presented with refractory agranulocytosis. Bone marrow biopsy disclosed a hypocellular bone marrow with normal maturation of the granulocytic series. The patient was successively treated with high-dose prednisone, granulocyte-macrophage colony stimulation factor, and cyclosporine, with no hematological response. Mycophenolate mofetil (MMF was initiated and after two months there was a rise on the white blood cell count. After

Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis

DEFF Research Database (Denmark)

Efe, Cumali; Hagström, Hannes; Ytting, Henriette

2017-01-01

BACKGROUND & AIMS: Predniso(lo)ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate...

Conversion from tacrolimus-mycophenolate mofetil to tacrolimus-mTOR immunosuppression after kidney-pancreas transplantation reduces the incidence of both BK and CMV viremia.

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Knight, Richard J; Graviss, Edward A; Nguyen, Duc T; Kuten, Samantha A; Patel, Samir J; Gaber, Lillian; Gaber, A Osama

2018-04-19

We sought to determine whether conversion from tacrolimus/mycophenolate mofetil (TAC-MMF) into tacrolimus/mTOR inhibitor (TAC-mTOR) immunosuppression would reduce the incidences of BK and CMV viremia after kidney/pancreas (KP) transplantation. In this single-center review, the TAC-mTOR cohort (n = 39) was converted at 1 month post-transplant to an mTOR inhibitor and reduced-dose tacrolimus. Outcomes were compared to a cohort of KP recipients (n = 40) maintained on TAC-MMF. At 3 years post-transplant, KP survivals and incidences of kidney/pancreas rejection were equivalent between mTOR and MMF-treated cohorts. (P = ns). BK viremia-free survival was better for the mTOR vs MMF-treated group (P = .004). In multivariate analysis, MMF vs mTOR immunosuppression was an independent risk factor for BK viremia (hazard ratio 12.27, P = .02). Similarly, mTOR-treated recipients displayed better CMV infection-free survival compared to the MMF-treated cohort (P = .01). MMF vs mTOR immunosuppression (hazard ratio 18.77, P = .001) and older recipient age (hazard ratio 1.13 per year, P = .006) were independent risk factors for CMV viremia. Mean estimated GFR and HgbA1c levels were equivalent between groups at 1, 2, and 3 years post-transplantation. Conversion from TAC/MMF into TAC/mTOR immunosuppression after KP transplantation reduced the incidences of BK and CMV viremia with an equivalent risk of acute rejection and similar renal/pancreas function. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mycophenolate mofetil modulates adhesion receptors of the beta1 integrin family on tumor cells: impact on tumor recurrence and malignancy

International Nuclear Information System (INIS)

Engl, Tobias; Makarević, Jasmina; Relja, Borna; Natsheh, Iyad; Müller, Iris; Beecken, Wolf-Dietrich; Jonas, Dietger; Blaheta, Roman A

2005-01-01

Tumor development remains one of the major obstacles following organ transplantation. Immunosuppressive drugs such as cyclosporine and tacrolimus directly contribute to enhanced malignancy, whereas the influence of the novel compound mycophenolate mofetil (MMF) on tumor cell dissemination has not been explored. We therefore investigated the adhesion capacity of colon, pancreas, prostate and kidney carcinoma cell lines to endothelium, as well as their beta1 integrin expression profile before and after MMF treatment. Tumor cell adhesion to endothelial cell monolayers was evaluated in the presence of 0.1 and 1 μM MMF and compared to unstimulated controls. beta1 integrin analysis included alpha1beta1 (CD49a), alpha2beta1 (CD49b), alpha3beta1 (CD49c), alpha4beta1 (CD49d), alpha5beta1 (CD49e), and alpha6beta1 (CD49f) receptors, and was carried out by reverse transcriptase-polymerase chain reaction, confocal microscopy and flow cytometry. Adhesion of the colon carcinoma cell line HT-29 was strongly reduced in the presence of 0.1 μM MMF. This effect was accompanied by down-regulation of alpha3beta1 and alpha6beta1 surface expression and of alpha3beta1 and alpha6beta1 coding mRNA. Adhesion of the prostate tumor cell line DU-145 was blocked dose-dependently by MMF. In contrast to MMF's effects on HT-29 cells, MMF dose-dependently up-regulated alpha1beta1, alpha2beta1, alpha3beta1, and alpha5beta1 on DU-145 tumor cell membranes. We conclude that MMF possesses distinct anti-tumoral properties, particularly in colon and prostate carcinoma cells. Adhesion blockage of HT-29 cells was due to the loss of alpha3beta1 and alpha6beta1 surface expression, which might contribute to a reduced invasive behaviour of this tumor entity. The enhancement of integrin beta1 subtypes observed in DU-145 cells possibly causes re-differentiation towards a low-invasive phenotype

Mycophenolate mofetil modulates adhesion receptors of the beta1 integrin family on tumor cells: impact on tumor recurrence and malignancy

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Beecken Wolf-Dietrich

2005-01-01

Full Text Available Abstract Background Tumor development remains one of the major obstacles following organ transplantation. Immunosuppressive drugs such as cyclosporine and tacrolimus directly contribute to enhanced malignancy, whereas the influence of the novel compound mycophenolate mofetil (MMF on tumor cell dissemination has not been explored. We therefore investigated the adhesion capacity of colon, pancreas, prostate and kidney carcinoma cell lines to endothelium, as well as their beta1 integrin expression profile before and after MMF treatment. Methods Tumor cell adhesion to endothelial cell monolayers was evaluated in the presence of 0.1 and 1 μM MMF and compared to unstimulated controls. beta1 integrin analysis included alpha1beta1 (CD49a, alpha2beta1 (CD49b, alpha3beta1 (CD49c, alpha4beta1 (CD49d, alpha5beta1 (CD49e, and alpha6beta1 (CD49f receptors, and was carried out by reverse transcriptase-polymerase chain reaction, confocal microscopy and flow cytometry. Results Adhesion of the colon carcinoma cell line HT-29 was strongly reduced in the presence of 0.1 μM MMF. This effect was accompanied by down-regulation of alpha3beta1 and alpha6beta1 surface expression and of alpha3beta1 and alpha6beta1 coding mRNA. Adhesion of the prostate tumor cell line DU-145 was blocked dose-dependently by MMF. In contrast to MMF's effects on HT-29 cells, MMF dose-dependently up-regulated alpha1beta1, alpha2beta1, alpha3beta1, and alpha5beta1 on DU-145 tumor cell membranes. Conclusion We conclude that MMF possesses distinct anti-tumoral properties, particularly in colon and prostate carcinoma cells. Adhesion blockage of HT-29 cells was due to the loss of alpha3beta1 and alpha6beta1 surface expression, which might contribute to a reduced invasive behaviour of this tumor entity. The enhancement of integrin beta1 subtypes observed in DU-145 cells possibly causes re-differentiation towards a low-invasive phenotype.

Comparison of 3 estimation methods of mycophenolic acid AUC based on a limited sampling strategy in renal transplant patients.

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Hulin, Anne; Blanchet, Benoît; Audard, Vincent; Barau, Caroline; Furlan, Valérie; Durrbach, Antoine; Taïeb, Fabrice; Lang, Philippe; Grimbert, Philippe; Tod, Michel

2009-04-01

A significant relationship between mycophenolic acid (MPA) area under the plasma concentration-time curve (AUC) and the risk for rejection has been reported. Based on 3 concentration measurements, 3 approaches have been proposed for the estimation of MPA AUC, involving either a multilinear regression approach model (MLRA) or a Bayesian estimation using either gamma absorption or zero-order absorption population models. The aim of the study was to compare the 3 approaches for the estimation of MPA AUC in 150 renal transplant patients treated with mycophenolate mofetil and tacrolimus. The population parameters were determined in 77 patients (learning study). The AUC estimation methods were compared in the learning population and in 73 patients from another center (validation study). In the latter study, the reference AUCs were estimated by the trapezoidal rule on 8 measurements. MPA concentrations were measured by liquid chromatography. The gamma absorption model gave the best fit. In the learning study, the AUCs estimated by both Bayesian methods were very similar, whereas the multilinear approach was highly correlated but yielded estimates about 20% lower than Bayesian methods. This resulted in dosing recommendations differing by 250 mg/12 h or more in 27% of cases. In the validation study, AUC estimates based on the Bayesian method with gamma absorption model and multilinear regression approach model were, respectively, 12% higher and 7% lower than the reference values. To conclude, the bicompartmental model with gamma absorption rate gave the best fit. The 3 AUC estimation methods are highly correlated but not concordant. For a given patient, the same estimation method should always be used.

The impact of everolimus versus mycophenolate on blood and lymphocyte cyclosporine exposure in heart-transplant recipients

DEFF Research Database (Denmark)

Gustafsson, Finn; Barth, David; Delgado, Diego H

2009-01-01

CsA C2 levels and blood CsA AUC(0-12) in groups of patients treated with MMF or everolimus (R(2) 0.93 and 0.96, respectively; P 2) = 0.98), there was poor correlation...... between whole-blood C2 and lymphocyte AUC(0-12) in patients treated with everolimus (R(2) = 0.24). CONCLUSION: Standard blood CsA levels accurately predict intralymphocytic exposure to CsA in patients concomitantly treated with MMF but not in patients treated with everolimus........ METHODS: Twelve-hour pharmacokinetic studies of whole-blood and intralymphocytic CsA concentrations were conducted in long-term heart-transplant recipients treated with mycophenolate mofetil (MMF) + CsA (n = 8) and everolimus + CsA (n = 9). RESULTS: There was a highly significant correlation between blood...

Risk evaluation and mitigation strategies: a focus on the mycophenolic acid preparations.

Science.gov (United States)

Rostas, Sara; Kim, Miae; Gabardi, Steven

2014-03-01

To review risks associated with mycophenolic acid (MPA) preparations and evaluate their required risk evaluation and mitigation strategies (REMS) elements. Articles were identified through a non-date-limited MEDLINE and EMBASE search using the terms fetal toxicity, teratogenicity, risk evaluation and mitigation strategies, REMS, MPA, mycophenolate mofetil, entericcoated MPA, and organ transplant. Information from the Food and Drug Administration (FDA) and the manufacturers of the MPA preparations was also evaluated. The MPA preparations are associated with several potential risks, including gastrointestinal disturbances and myelosuppression; however, their impact on the fetus in pregnant patients taking 1 of these agents poses the greatest risk. The FDA approved REMS programs for all MPA products, both innovator and generic preparations, in September 2012. With evidence of increased risk of miscarriage and birth defects associated with MPA use, the FDA instituted a REMS program that contains both a medication guide and elements to assure safe use (ETASU). The medication guides for the MPA products, which were previously FDA approved, should continue to be distributed to patients who get either an initial prescription filled or a refill. The ETASU requires prescribers to complete training and obtain patient signatures on the Patient-Prescriber Acknowledgment Form. A single, national, voluntary pregnancy registry specific to this medication has been established, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA.

Production of Mycophenolic Acid by Penicillium brevicompactum Using Solid State Fermentation.

Science.gov (United States)

Patel, Gopal; Patil, Mahesh D; Soni, Surbhi; Chisti, Yusuf; Banerjee, Uttam Chand

2017-05-01

Solid-state fermentation using the microfungus Penicillium brevicompactum for the production of mycophenolic acid is reported in this paper. Of the initial substrates tested (whole wheat, cracked wheat, long grain Basmati rice, and short grain Parmal rice), Parmal rice proved to be the best. Under initial conditions, using steamed Parmal rice with 80% (w/w) initial moisture content, a maximum mycophenolic acid concentration of 3.4 g/kg substrate was achieved in 12 days of fermentation at 25 °C. The above substrate was supplemented with the following additional nutrients (g/L packed substrate): glucose 40.0, peptone 54.0, KH 2 PO 4 8.0, MgSO4⋅7H 2 O 2.0, glycine 7.0, and methionine 1.65 (initial pH 5.0). A small amount of a specified trace element solution was also added. The final mycophenolic acid concentration was increased to nearly 4 g/kg substrate by replacing glucose with molasses. Replacing Parmal rice with rice bran as substrate further improved the mycophenolic acid production to nearly 4.5 g/kg substrate.

Mycophenolic acid inhibits migration and invasion of gastric cancer cells via multiple molecular pathways.

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Boying Dun

Full Text Available Mycophenolic acid (MPA is the metabolized product and active element of mycophenolate mofetil (MMF that has been widely used for the prevention of acute graft rejection. MPA potently inhibits inosine monophosphate dehydrogenase (IMPDH that is up-regulated in many tumors and MPA is known to inhibit cancer cell proliferation as well as fibroblast and endothelial cell migration. In this study, we demonstrated for the first time MPA's antimigratory and anti-invasion abilities of MPA-sensitive AGS (gastric cancer cells. Genome-wide expression analyses using Illumina whole genome microarrays identified 50 genes with ≥2 fold changes and 15 genes with > 4 fold alterations and multiple molecular pathways implicated in cell migration. Real-time RT-PCR analyses of selected genes also confirmed the expression differences. Furthermore, targeted proteomic analyses identified several proteins altered by MPA treatment. Our results indicate that MPA modulates gastric cancer cell migration through down-regulation of a large number of genes (PRKCA, DOCK1, INF2, HSPA5, LRP8 and PDGFRA and proteins (PRKCA, AKT, SRC, CD147 and MMP1 with promigratory functions as well as up-regulation of a number of genes with antimigratory functions (ATF3, SMAD3, CITED2 and CEAMCAM1. However, a few genes that may promote migration (CYR61 and NOS3 were up-regulated. Therefore, MPA's overall antimigratory role on cancer cells reflects a balance between promigratory and antimigratory signals influenced by MPA treatment.

Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis

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Ayodeji Adegunsoye

2017-08-01

Full Text Available In chronic hypersensitivity pneumonitis (CHP, lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival. Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres. Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA, 93 (71% received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04 and 66% less frequent with mycophenolate mofetil (p=0.002. FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings. CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.

A Bayesian Analysis of a Randomized Clinical Trial Comparing Antimetabolite Therapies for Non-Infectious Uveitis.

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Browne, Erica N; Rathinam, Sivakumar R; Kanakath, Anuradha; Thundikandy, Radhika; Babu, Manohar; Lietman, Thomas M; Acharya, Nisha R

2017-02-01

To conduct a Bayesian analysis of a randomized clinical trial (RCT) for non-infectious uveitis using expert opinion as a subjective prior belief. A RCT was conducted to determine which antimetabolite, methotrexate or mycophenolate mofetil, is more effective as an initial corticosteroid-sparing agent for the treatment of intermediate, posterior, and pan-uveitis. Before the release of trial results, expert opinion on the relative effectiveness of these two medications was collected via online survey. Members of the American Uveitis Society executive committee were invited to provide an estimate for the relative decrease in efficacy with a 95% credible interval (CrI). A prior probability distribution was created from experts' estimates. A Bayesian analysis was performed using the constructed expert prior probability distribution and the trial's primary outcome. A total of 11 of the 12 invited uveitis specialists provided estimates. Eight of 11 experts (73%) believed mycophenolate mofetil is more effective. The group prior belief was that the odds of treatment success for patients taking mycophenolate mofetil were 1.4-fold the odds of those taking methotrexate (95% CrI 0.03-45.0). The odds of treatment success with mycophenolate mofetil compared to methotrexate was 0.4 from the RCT (95% confidence interval 0.1-1.2) and 0.7 (95% CrI 0.2-1.7) from the Bayesian analysis. A Bayesian analysis combining expert belief with the trial's result did not indicate preference for one drug. However, the wide credible interval leaves open the possibility of a substantial treatment effect. This suggests clinical equipoise necessary to allow a larger, more definitive RCT.

Outcomes of Vogt-Koyanagi-Harada disease: a subanalysis from a randomized clinical trial of antimetabolite therapies

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Shen, Elizabeth; Rathinam, Sivakumar R.; Babu, Manohar; Kanakath, Anuradha; Thundikandy, Radhika; Lee, Salena M.; Browne, Erica N.; Porco, Travis C.; Acharya, Nisha R.

2016-01-01

Purpose To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolite therapies. Design Subanalysis from an observer-masked randomized clinical trial for non-infectious intermediate, posterior, and pan- uveitis. Methods Setting clinical practice at Aravind Eye Hospitals, India Patient Population Forty-three of 80 patients enrolled (54%) diagnosed with VKH. Intervention Patients were randomized to either 25mg oral methotrexate weekly or 1g mycophenolate mofetil twice daily, with a corticosteroid taper. Main outcome measures Primary outcome was corticosteroid-sparing control of inflammation at 5 and 6 months. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Patients were categorized as acute (diagnosis ≤3 months prior to enrollment) or chronic (diagnosis >3 months prior to enrollment). Results Twenty-seven patients were randomized to methotrexate and 16 to mycophenolate mofetil; 30 had acute VKH. The odds of achieving corticosteroid-sparing control of inflammation with methotrexate were 2.5 times (95% CI: 0.6, 9.8; P=0.20) the odds with mycophenolate mofetil, a difference which was not statistically significant. The average improvement in visual acuity was 12.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. On average, visual acuity for patients with acute VKH improved by 14 more ETDRS letters than those with chronic VKH (P<0.001), but there was no difference in corticosteroid-sparing control of inflammation (P=0.99). All 26 eyes with a serous retinal detachment at baseline resolved, and 88% achieved corticosteroid-sparing control of inflammation. Conclusions The majority of patients treated with antimetabolites and corticosteroids were able to achieve corticosteroid-sparing control of inflammation by 6 months. Although patients with acute VKH gained more visual improvement than those with chronic VKH, this did not correspond with a higher rate of controlled inflammation. PMID

Limited sampling strategies drawn within 3 hours postdose poorly predict mycophenolic acid area-under-the-curve after enteric-coated mycophenolate sodium.

NARCIS (Netherlands)

Winter, B.C. de; Gelder, T. van; Mathôt, R.A.A.; Glander, P.; Tedesco-Silva, H.; Hilbrands, L.B.; Budde, K.; Hest, R.M. van

2009-01-01

Previous studies predicted that limited sampling strategies (LSS) for estimation of mycophenolic acid (MPA) area-under-the-curve (AUC(0-12)) after ingestion of enteric-coated mycophenolate sodium (EC-MPS) using a clinically feasible sampling scheme may have poor predictive performance. Failure of

Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid.

Science.gov (United States)

Bodhidatta, L; Taylor, D N; Chitwarakorn, A; Kuvanont, K; Echeverria, P

1988-01-01

A randomized, double-blind study was performed comparing ciprofloxacin in a 500-mg single dose with 1,000 mg (500-mg doses given 12 h apart) for the treatment of chancroid in Thailand. Haemophilus ducreyi was isolated from 87 (48%) of 180 men with a clinical diagnosis of chancroid. For men with ulcers that were culture positive for H. ducreyi, rates of cure were 100% in the 500-mg group and 98% in the 1,000-mg group. For men with ulcers that were culture negative for H. ducreyi, rates of cure were 93% in the 500-mg group and 96% in the 1,000-mg group. The MIC of ciprofloxacin for 50% of isolates among 85 isolates of H. ducreyi was 0.007 micrograms/ml (range, 0.002 to 0.03 micrograms/ml). No significant adverse effects were detected in either group. These data indicate that both of these treatment regimens are equally effective therapies for chancroid in Thailand. PMID:3293526

Efficacy and Safety of Terbinafine 500 mg Once Daily in Patients with Dermatophytosis.

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Babu, P Ravindra; Pravin, A J S; Deshmukh, Gaurav; Dhoot, Dhiraj; Samant, Aniket; Kotak, Bhavesh

2017-01-01

Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A - terbinafine 500 mg for 2 weeks, Group B - terbinafine 500 mg for 4 weeks, and Group C - terbinafine 500 mg for 6 weeks. Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% ( n = 169) patients showed very good response. In Group B, out of 211 patients, 92% ( n = 194) of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% ( n = 30) patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.

Brand versus generic dispensing trend for ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg (oral dosage forms) among pharmacies of Karachi, Pakistan.

Science.gov (United States)

Zehra, Fatima; Naqvi, Atta Abbas; Tasneem, Sumbul; Ahmad, Rizwan; Ahmad, Niyaz; Shamsi, Adnan Zia; Asghar, Naqiya Ali; Khan, Ghufran Ullah

2017-01-01

Pakistan spends 0.7% of its gross domestic product on health. The public sector health-care system provides services to 22% of population thus paving the way for a dominant private sector. Patients in Pakistan mostly pay their medical expenses directly, and 64% of the health expenditures are borne by the household. Expenditure on medicine constitutes 43% of the total household expenditure. A quantitative cross-sectional study was conducted in Karachi, Pakistan, for a month. It was aimed at gathering response from different pharmacies to understand the brand versus generic dispensing trend of ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg oral dosage forms. The study employed convenience sampling and used a survey checklist. The data gathered was entered in SPSS version 22. The mean price per tablet for ciprofloxacin brand and generic was reported at Pakistani Rupees (PKR) 48.44 and PKR 26.85, respectively. The trend for dispensing ciprofloxacin highlighted a split in the market between brand (51%) and generic (49%). For levofloxacin brand and generic, the price per tablet was reported at PKR 36.50 and PKR 36.15 respectively, and despite same price, the market was dominated by generic levofloxacin (92%). Due to a price difference between brand and generic moxifloxacin, i.e., PKR 129.44 and PKR 71.91, respectively, the market was mostly occupied by the generic form (75%). Pricing mechanism must be revisited, and the authorities should take stern actions against any illegitimate price hike. The surging burden of drug expenditure on poorer sections of the society must be addressed by the government on an urgent basis.

Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis

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P Ravindra Babu

2017-01-01

Full Text Available Introduction: Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. Objective: The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. Materials and Methods: It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A – terbinafine 500 mg for 2 weeks, Group B – terbinafine 500 mg for 4 weeks, and Group C – terbinafine 500 mg for 6 weeks. Results: Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% (n = 169 patients showed very good response. In Group B, out of 211 patients, 92% (n = 194 of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% (n = 30 patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Conclusion: Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.

Elicitation of expert prior opinion: application to the MYPAN trial in childhood polyarteritis nodosa.

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Lisa V Hampson

Full Text Available Definitive sample sizes for clinical trials in rare diseases are usually infeasible. Bayesian methodology can be used to maximise what is learnt from clinical trials in these circumstances. We elicited expert prior opinion for a future Bayesian randomised controlled trial for a rare inflammatory paediatric disease, polyarteritis nodosa (MYPAN, Mycophenolate mofetil for polyarteritis nodosa.A Bayesian prior elicitation meeting was convened. Opinion was sought on the probability that a patient in the MYPAN trial treated with cyclophosphamide would achieve disease remission within 6-months, and on the relative efficacies of mycophenolate mofetil and cyclophosphamide. Expert opinion was combined with previously unseen data from a recently completed randomised controlled trial in ANCA associated vasculitis.A pan-European group of fifteen experts participated in the elicitation meeting. Consensus expert prior opinion was that the most likely rates of disease remission within 6 months on cyclophosphamide or mycophenolate mofetil were 74% and 71%, respectively. This prior opinion will now be taken forward and will be modified to formulate a Bayesian posterior opinion once the MYPAN trial data from 40 patients randomised 1:1 to either CYC or MMF become available.We suggest that the methodological template we propose could be applied to trial design for other rare diseases.

Is There Evidence to Support Brand to Generic Interchange of the Mycophenolic Acid Products?

Science.gov (United States)

Phillips, Karen; Reddy, Prabashni; Gabardi, Steven

2017-02-01

The uptake of generic immunosuppressants lags comparatively to other drug classes, despite that the Food and Drug Administration (FDA) uses identical bioequivalence standards for all drugs. Transplant societies acknowledge the cost savings associated with generic immunosuppressants and support their use following heart, lung, kidney, or bone marrow transplantation. Seven studies of the pharmacokinetics or clinical efficacy of generic mycophenolate mofetil compared to the innovator product are published; all studies and products were ex-United States. Three studies did not demonstrate any pharmacokinetic differences between generic and innovator products in healthy subjects, achieving FDA bioequivalence requirements. Two studies in renal allograft recipients demonstrated no difference in area under the curves between generic and innovator products, and in one, the maximum concentration (Cmax) fell outside the FDA regulatory range. Two studies revealed no difference in acute organ rejection or graft function in renal allograft recipients. Patient surveys indicate that cost is a barrier to immunosuppressant adherence. Generics present a viable method to reduce costs to payers, patients, and health care systems. Adherence to immunosuppressants is crucial to prevent graft failure. An affordable regimen potentially confers greater adherence. Concerns regarding the presumed inferiority of generic immunosuppressants should be assuaged by regulatory requirements for bioequivalency testing, transplant society position statements, and pharmacokinetic and clinical studies.

Preventing acute rejection, Epstein-Barr virus infection, and posttransplant lymphoproliferative disorders after kidney transplantation: Use of aciclovir and mycophenolate mofetil in a steroid-free immunosuppressive protocol

DEFF Research Database (Denmark)

Birkeland, S.A.; Andersen, H.K.; Hamilton-Dutoit, Stephen Jacques

1999-01-01

Background: A widely held view is that any increase in the potency of an immunosuppressive agent will lead to an increase in infection and malignancy, such as life-threatening Epstein-Barr virus (EBV) induced posttransplant lymphoproliferative disorders (PTLD), We tested this paradigm by studying......; the effect of adding mofetil to a steroid-free protocol under cover of high-dose aciclovir prophylaxis on the number of acute rejections, EBV infections and PTLDs after kidney transplantation. Methods: EBV serology was performed in 267 consecutive renal transplantations (1990-1997), All were treated...

Pigmented villonodular synovitis of the hip in systemic lupus erythematosus: a case report

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Anders Hans-Joachim

2011-09-01

Full Text Available Abstract Introduction Pigmented villonodular synovitis is a rare disease of unknown etiology mostly affecting the knee and foot. Until now an association with autoimmune diseases has not been reported. Case presentation The diagnosis of systemic lupus erythematosus was made in a 15-year-old Caucasian girl based on otherwise unexplained fatigue, arthralgia, tenosynovitis, leukopenia, low platelets and the presence of antinuclear and deoxyribonucleic antibodies. At the age of 20 a renal biopsy revealed lupus nephritis class IV and she went into complete remission with mycophenolate mofetil and steroids. She was kept on mycophenolate mofetil for maintenance therapy. At the age of 24 she experienced a flare-up of lupus nephritis with nephrotic syndrome and new onset of pain in her right hip. Magnetic resonance imaging, arthroscopy and subtotal synovectomy identified pigmented villonodular synovitis as the underlying diagnosis. Although her systemic lupus erythematosus went into remission with another course of steroids and higher doses of mycophenolate mofetil, the pigmented villonodular synovitis persisted and she had to undergo open synovectomy to control her symptoms. Conclusion Systemic lupus erythematosus is associated with many different musculoskeletal manifestations including synovitis and arthritis. Pigmented villonodular synovitis has not previously been reported in association with systemic lupus erythematosus, but as its etiology is still unknown, the present case raises the question about a causal relationship between systemic lupus erythematosus and pigmented villonodular synovitis.

Clinical efficacy and safety of a new 1000-mg suspension versus twice-daily 500-mg tablets of MPFF in patients with symptomatic chronic venous disorders: a randomized controlled trial.

Science.gov (United States)

Carpentier, Patrick; van Bellen, Bonno; Karetova, Debora; Hanafiah, Harunarashid; Enriquez-Vega, Elizabeth; Kirienko, Alexander; Dzupina, Andrej; Sabovic, Miso; Reina Gutierrez, Lourdes; Subwongcharoen, Somboom; Tüzün, Hasan; Maggioli, Arnaud

2017-10-01

Chronic venous disorders (CVD) is estimated to affect 30% to 50% of women and 10% to 30% of men. The most widely prescribed treatment for CVD worldwide is micronized purified flavonoid fraction 500 mg (MPFF). The aim of this clinical trial was to develop a new once daily 1000-mg oral suspension of MPFF. In an international, randomized, double-blind, parallel-group study, symptomatic individuals classified CEAP C0s to C4s were randomized in either treatment arm and treated for 8 weeks. Lower limb symptoms (discomfort, pain and heaviness) were assessed using Visual Analog Scales (VAS), and quality of life (QoL) was measured with the CIVIQ-20 Questionnaire. A total of 1139 patients were included in the study. Both MPFF treatment regimens were well tolerated and associated with a significant reduction in lower limb symptoms. A non-inferiority of MPFF 1000-mg oral suspension once daily compared to MPFF 500-mg tablet twice daily (P1000 mg and -3.37 cm for MPFF 500 mg), leg pain (-3.27 cm for MPFF 1000 mg and -3.31 cm for MPFF 500 mg) and leg heaviness (-3.41 cm for MPFF 1000 mg and -3.46 cm for MPFF 500 mg). The patients' QoL was improved by about 20 points on the CIVIQ scale in both groups (19.33 points for MPFF 1000 mg and 20.28 points for MPFF 500 mg). MPFF 1000-mg oral suspension and MPFF 500-mg tablets treatments were associated with similar reductions in lower limb symptoms and QoL improvement. The new once daily MPFF1000-mg oral suspension has a similar safety profile to two tablets of MPFF 500 mg, with the advantage of one daily intake, potentially associated with improved patient adherence and easier CVD management.

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African Journals Online (AJOL)

Proff.Adewunmi

Western blot in 2004 at National Institute of Medical Research, Lagos (NIMR). ... However, HIV infection is still believed to be incurable and can only be ..... highly active antiretroviral therapy and mycophenolate mofetil, AIDS: 18 (11) 1607-8.

B cells and immunoglobulin in ABO-incompatible renal transplant patients receiving rituximab and double filtration plasmapheresis

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Meng-Kun Tsai

2015-04-01

Conclusion: With the aid of tacrolimus and mycophenolate mofetil, rituximab resulted in sustained suppression of B cell count and total IgG and IgM. Among the IgG subclasses, IgG3 was less sensitive to rituximab.

Induction of immunological tolerance in the pig-to-baboon xenotransplantation model : studies aimed at achieving mixed hematopoietic chimerism and preventing associated thrombotic complications

NARCIS (Netherlands)

I.P.J. Alwayn (Ian)

2001-01-01

textabstractThe outcome of clinical organ transplantation has dramatically improved since the introduction of cyclosporine (CyA) in 1979 and of other, more recently introduced, immunosuppressive agents such as azathioprine, mycophenolate mofetil, tacrolimus and sirolimus. Furthermore, due to more

USE OF MYCOPHENOLATE MOPHETYL IN PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

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S.I. Valiyeva,

2006-01-01

Full Text Available The article reports a case of highly active SLE and lupusbnephritis in a 15 years old boy, who was treated with mycophenolate mophetyl the case was notable for high activity and aggressive course of the disease with rapid development of renal unsufficiency, polyorganic unsufficiency and antiphospholipid syndrome. Although the patient received an appropriate active therapy, including synchronized therapy (consisting of timebrelated plasmopherresis and infusions of cyclophosphamide and metyl prednisolone, glucocorticoides, preparations improving blood circulation (pentoxyphillin, dipiridamol, heparine, intravenous immunoglobulins, the disease activity control was unsufficient. The administration of mycophenolate mophetyl has led to diminuition of the disease activity, which was registered at the end of the second week of treatment, and finally has reached a level of clinical and laboratoty remission of the disease.Key words: systemic lupus erythematosus, mycophenolate mophetyl, children, treatment.

器官移植患者的霉酚酸酯治疗药物监测%Therapeutic drug monitoring of mycophenolate mofetil in patients undergoing organ transplantation

Institute of Scientific and Technical Information of China (English)

崔学艳; 施孝金

2009-01-01

麦考酚酸酯（霉酚酸酯，mycophenlate mofetil，MMF）是麦考酚酸（霉酚酸，mycophenolic acid，MPA）的一种酯类衍生物。MMF无生物活性，口服后迅速水解为具活性的MPA。MMF是近年来发现的一种新型免疫抑制剂，临床上主要用于预防和治疗器官移植排斥反应。

Pro: Cyclophosphamide in lupus nephritis

NARCIS (Netherlands)

Kallenberg, Cees G. M.

Based on efficacy and toxicity considerations, both low-dose pulse cyclophosphamide as part of the Euro-Lupus Nephritis protocol and mycophenolate mofetil (MMF) with corticosteroids may be considered for induction of remission in patients with proliferative lupus nephritis. The long-term follow-up

Results of a multicenter prospective clinical study in Japan for evaluating efficacy and safety of desensitization protocol based on rituximab in ABO-incompatible kidney transplantation.

Science.gov (United States)

Takahashi, Kota; Saito, Kazuhide; Takahara, Shiro; Fuchinoue, Shohei; Yagisawa, Takashi; Aikawa, Atsushi; Watarai, Yoshihiko; Yoshimura, Norio; Tanabe, Kazunari; Morozumi, Kunio; Shimazu, Motohide

2017-08-01

Deceased organ donations are rare in Japan, with most kidney transplants performed from a limited number of living donors. Researchers have thus developed highly successful ABO-incompatible transplantation procedures, emphasizing preoperative desensitization and postoperative immunosuppression. A recent open-label, single-arm, multicenter clinical study prospectively examined the efficacy and safety of rituximab/mycophenolate mofetil desensitization in ABO-incompatible kidney transplantation without splenectomy. Mycophenolate mofetil and low dose steroid were started 28 days pretransplant, followed by two doses of rituximab 375 mg/m 2 at day -14 and day -1, and postoperative immunosuppression with tacrolimus or ciclosporin and basiliximab. The primary endpoint was the non-occurrence rate of acute antibody-mediated rejection. Patient survival and graft survival were monitored for 1 year posttransplant. Eighteen patients received rituximab and underwent ABO-incompatible kidney transplantation. CD19-positive peripheral B cell count decreased rapidly after the first rituximab infusion and recovered gradually after week 36. The desensitization protocol was tolerable, and most rituximab-related infusion reactions were mild. No anti-A/B antibody-mediated rejection occurred with this series. One patient developed anti-HLA antibody-mediated rejection (Banff 07 type II) on day 2, which was successfully managed. Patient and graft survival were both 100 % after 1 year. Our desensitization protocol was confirmed to be clinically effective and with acceptable toxicities for ABO-I-KTx (University Hospital Medical Information Network Registration Number: UMIN000006635).

Severe neuropsychiatric systemic lupus erythematosus successfully treated with rituximab: an alternative to standard of care

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Chessa E

2017-09-01

Full Text Available Elisabetta Chessa, Matteo Piga, Alberto Floris, Alessandro Mathieu, Alberto Cauli Rheumatology Unit, University Clinic AOU of Cagliari, Cagliari, Italy Abstract: Demyelinating syndrome secondary to systemic lupus erythematosus (DS-SLE is a rare encephalomyelitis burden with a high risk of disability and death. We report on a 49-year-old Caucasian woman with systemic lupus erythematosus (SLE complicated by severe cognitive dysfunction, brainstem disease, cranial nerve palsies, weakness and numbness in limbs and multiple discrete magnetic resonance imaging (MRI areas of damage within the white matter of semioval centers, temporal lobe, external capsule, claustrum, subinsular regions and midbrain. She also had multiple mononeuritis diagnosed through sensory and motor nerve conduction study. She was diagnosed with severe DS-SLE prominently involving the brain and was treated with 500 mg methylprednisolone (PRE pulses for 3 consecutive days, followed by one single pulse of 500 mg cyclophosphamide, and 1 g rituximab, which was then repeated 14 days later. PRE 25 mg/day, rapidly tapered to 7.5 mg/day in 6 months, and mycophenolate mofetil 1 g/day were prescribed as maintenance therapy. She had progressive and sustained improvement in neurological symptoms with almost complete resolution of brain MRI lesions after 1 year. B-cell depleting therapy could be considered as a possible alternative to standard of care in the management of severe inflammatory neuropsychiatric SLE but it should be associated with a conventional immunosuppressant as maintenance treatment to reduce the risk of flare and reduce corticosteroids dose. Keywords: systemic lupus erythematosus, neuropsychiatric lupus, rituximab, demyelinating syndrome, brain MRI

Desarrollo de una formulación de tabletas revestidas de secnidazol 500 mg Development of a formulation of coated secnidazole tablets 500 mg

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Iverlis Díaz Polanco

2008-04-01

Full Text Available Se describe el desarrollo de una formulación de tabletas revestidas de secnidazol 500 mg. Durante el desarrollo de esta se evaluaron 2 métodos: la granulación seca y la granulación húmeda. En el revestimiento de las tabletas se empleó un sistema hidroalcohólico con el preparado comercial Policoat YS 1-7003 (Opadry®. Los lotes sometidos a ensayos de estabilidad fueron elaborados a escala piloto, por la vía de granulación húmeda, lo que demostró la factibilidad del proceso de fabricación a esta escala. Las tabletas revestidas presentaron adecuadas propiedades físico-mecánicas y tecnológicas y estas fueron envasadas en frascos de polietileno de alta densidad y en sobres termoconformados de polivinilcloruro/aluminio. La estabilidad química y microbiológica de las tabletas de secnidazol fue estudiada durante 24 meses; los resultados demostraron que estas cumplían con los requisitos establecidos durante este periodoThe development of a formulation of coated Secnidazole tablets 500mg was described. During its development, 2 methods were evaluated: dry granulation and humid granulation. A hydroalcoholic system was used with the Policoat YS 1-7003 (Opadry® commercial preparation for coating the tablets. The batches subjected to stability assays were made at pilot scale by humid granulation, which showed the feasibility of the manufacturing process at this scale. The coated tablets had adequate physicomechanical and technological properties and they were packed in polyethylene flasks of high density and in polyvinyl chloride/aluminium thermoconformed envelopes. The chemical and microbiological stability of the secnidazole tablets were studied during 24 months. The results demonstrated that these tablets met the requirements established during this period

One year results of preoperative single bolus ATG-Fresenius induction therapy in sensitized renal transplant recipients.

Science.gov (United States)

Wang, D; Chen, J H; Wu, W Z; Yang, S L; Wu, G J; Wang, H; Tan, J M

2007-01-01

Sensitization in kidney transplantation is associated with more acute rejections, inferior graft survival, and an increase in delayed graft function. This study was designed to evaluate the efficacy and safety of preoperative single bolus antithymocyte globulin (ATG) induction therapy in sensitized renal transplant recipients. Fifty-six cadaveric donor kidney transplant recipients were divided into two groups: Group I (nonsensitized group, n = 30) and group II (sensitized group, PRA>10%, n = 26). ATG was given as a single preoperative bolus induction therapy to group II (ATG IV; 9 mg/kg). The group I patients were treated with mycophenolate mofetil preoperatively as induction therapy. The basic immunosuppressive regimen included tacrolimus (FK-506) or cyclosporine, mycophenolate mofetil, and prednisolone. After hospital discharge, patients were followed on a routine outpatient basis for 12 months. Acute rejection episodes (ARE) occurred in 20% (6/30) of group I and 15.38% (4/26) of group II patients (P = NS). Infections occurred in eight patients (26.7%) as 11 episodes (36.7%), averaging 1.4 episodes per infected patient in group 1, and 6 patients (23.1%) for a total of 10 episodes (38.5%), averaging 1.7 episodes per infected patient, in group II (P = NS). Occurrence of side effects and hospital stay were almost comparable in the two groups. No delayed graft function was observed in either group. The 12-month actuarial patient and graft survival were 100% in Group I and II. A preoperative single bolus ATG induction therapy was an effective and safe therapeutic measure, yielding an acceptable acute rejection rate in presensitized renal transplant recipients.

COMPARATIVE ANALYSIS OF SOLUBLE OF CD40 LIGAND LEVELS IN HEART RECIPIENTS TREATED WITH CYCLOSPORINE A AND TACROLIMUS

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O. P. Shevchenko

2012-01-01

Full Text Available Soluble form of CD40L is platelet activating factor, which is a marker of inflammation and thrombosis. Elevated levels of sCD40L before the heart transplantation are associated with the risk of early development of cardiova- scular complications. The study included 54 patients who had received heart transplants. All recipients received a triple heart immu- nosuppressive therapy, including methylprednisolone, mycophenolate mofetil and cyclosporine A (20 recipients or methylprednisolone, mycophenolate mofetil and tacrolimus (34 recipients. Patients were not differed by age, gender, etiology of heart failure before heart transplantation (p > 0,05. In the first group of transplant recipients, the relative risk of cardiovascular events with high sCD40L levels before transplantation was 3 2 (95% CI 1,4; 12,0. In the second group of recipients, respectively, 2.69 (95% CI 1,1; 8,5. SCD40L level after heart transplan- tation was significantly higher for patients receiving cyclosporine (P < 0.05. Increasing concentrations of sCD40L are associated with a higher incidence of cardiovascular complications. 

Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis.

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Takahashi, Satoshi; Ichihara, Kohji; Hashimoto, Jiro; Kurimura, Yuichiro; Iwasawa, Akihiko; Hayashi, Kenji; Sunaoshi, Kenichi; Takeda, Koichi; Suzuki, Nobukazu; Satoh, Takashi; Tsukamoto, Taiji

2011-06-01

To confirm the efficacy of the treatment regimen with oral levofloxacin (LVFX) 500 mg once daily for 7 days for patients with non-gonococcal urethritis (NGU), we evaluated the microbiological and clinical outcomes of the regimen in those patients. We finally evaluated 53 patients with symptomatic NGU and 5 patients with asymptomatic NGU. As a result of microbiological examinations, 19 of the symptomatic patients were diagnosed as having non-gonococcal chlamydial urethritis (NGCU); 13 had non-gonococcal non-chlamydial urethritis (NGNCU), and 21 had urethritis without any microbial detection. Five of the asymptomatic patients were diagnosed as having NGCU. Microbiological cure was achieved in 91% of the 32 patients with symptomatic NGU and in 80% of the 5 patients with asymptomatic NGCU. Clinical cure was obtained in 92% of the 53 patients with symptomatic NGU. The microbiological eradication rate for Chlamydia trachomatis was 92% in 24 patients. As for other organisms, the microbiological eradication rate for Mycoplasma genitalium was 60% in 5 patients and that for Ureaplasma urealyticum was 100% in 10. The microbiological and clinical efficacy of oral LVFX 500 mg once daily for 7 days for the patients with NGU was the same for the azithromycin (AZM) 1,000 mg single dose that we previously reported. The eradication rates of C. trachomatis and U. urealyticum in the treatment regimen with LVFX 500 mg were high enough in the clinical setting; however, for M. genitalium, the rate was relatively inferior to that with AZM.

Relative bioavailability of generic and branded 250-mg and 500-mg oral chlorphenesin carbamate tablets in healthy Korean volunteers: a single-dose, randomized-sequence, open-label, two-period crossover trial.

Science.gov (United States)

Yu, Ji-young; Song, Hyun Ho; Kim, Bo Gyeom; Park, Hyeon Ju; Choi, Kwang Sik; Kwon, Young Ee

2009-11-01

Chlorphenesin carbamate is a skeletal muscle relaxant approved in Korea for use in the treatment of pain and discomfort related to skeletal muscle trauma and inflammation. The aim of this study was to assess the bioequivalence of a generic formulation of chlorphenesin carbamate at doses of 250 and 500 mg and 2 branded formulations of the same doses in healthy Korean adults. This single-dose, randomized-sequence, open-label, 2-period crossover study was conducted in healthy Korean male and female volunteers. Subjects were assigned to receive, in a randomized sequence, a single dose of the generic (test) and branded (reference) formulations of chlorphenesin carbamate at a dose of 250 or 500 mg. Blood samples were drawn at 0, 0.33, 0.67, 1, 1.5, 2, 3, 4, 6, 9, 12, and 15 hours after administration. Pharmacokinetic properties (C(max), T(max), AUC(0-t) AUC(0-infinity), t(1/2), and ke) were determined using HPLC. The formulations were to be considered bioequivalent if the 90% CIs of the treatment ratios of the geometric means of C(max) and AUC(0-t) were within a predetermined range of log 0.80 to log 1.25 based on regulatory criteria. Tolerability was assessed by monitoring for adverse events (AEs) on physical examination and/or e-mail and personal interview at the beginning and end of each study period. Twenty-eight subjects (22 men, 6 women) received chlorphenesin carbamate at the 250-mg dose, and 24 male subjects received the 500-mg dose. The mean (SD) ages of the subjects were 24.0 (2.6) and 24.0 (1.9) years in the 250- and 500-mg groups, respectively. No significant differences were found between the test and reference formulations (90% CIs: C(max), 1.0048-1.1153 with the 250-mg dose and 0.9630-1.1189 with the 500-mg dose; AUC(0-t), 0.9882-1.0546 and 0.9842-1.0578, respectively). No clinically significant AEs (upper gastric pain, abdominal bloating, pyrexia, edema, nausea, heartburn, constipation, headache, dizziness, drowsiness, or fatigue) were reported throughout

Disseminated mycobacteria chelonae infection in a kidney-pancreas transplant recipient: A case report and review of the literature

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Shafi Malik

2016-01-01

Full Text Available A 40-year-old male with a long-standing history of type 1 diabetes with end-stage renal failure underwent combined kidney-pancreas (KP transplant from a standard criteria donor. Post-operative course was uncomplicated with good primary function of both transplant grafts. Induction was with thymoglobulin and maintenance immunosuppression was with tacrolimus, mycophenolate mofetil and prednisolone. Nine weeks post-transplant, the patient developed dysfunction of both grafts. Panel reactive antibody testing revealed that the patient had developed a de novo donor-specific antibody and considering an antibody-mediated rejection the patient was treated with intravenous pulse methyl prednisone 500 mg ×3 doses, IV immunoglobulin 2 mg/kg in two divided doses, and ATG 7 mg/kg (total dose of 700 mg. In addition, his baseline immunosuppression was increased. Cr decreased to baseline levels, and blood sugars were in the range of 7-8 mmol/L, serum amylase normalized to 63 U/L, and the patient was discharged home. Nine days post-discharge, the patient presented to the hospital with a five-day history of fever, pain, and swelling in the left knee along with subcutaneous, erythematous, tender, nodular lesions in both legs and both arms. Skin biopsy showed Ziehl-Neelsen stain positive rods and biopsy culture and blood culture grew Mycobacteria chelonae. Antimicrobials were switched to azithromycin 500 mg OD, moxifloxacin 400 mg OD, and linezolid 600 mg BID and baseline immunosuppression was reduced to tacrolimus trough target 8-10 ng/mL and MMF to 250 mg BID. The patient gradually improved and was discharged after 28 days in the hospital. Six weeks following the diagnosis of nontuberculous mycobacteria infection, the patient′s pancreas graft failed, presumably due to reduction in immuno-suppression and he is now back on insulin treatment. His renal graft continued to function well. Although rapidly growing mycobacterial infections are rare among transplant

Micophenolat Mofetil Versus Azathioprine: Effects on Renal Graft Function in Early Posttransplant Period

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Farid Ljuca

2009-05-01

Full Text Available All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA, Azathioprine (AZA or Mycophenolate Mofetil (MMF and Prednisolone, AZA has been used in clinical transplantation for more than 30 years and was the first immunosuppres-sive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in 1995 after several clinical trials proved that it was more efficient than AZA for prevention of acute rejection episodes. Our aim was to evaluate influence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment, 40 patients received AZA and 34 MMF. In order to assess renal graft function, following parameters were evaluated: glomerular filtration rate GFR (ml/min creatinine clearance (CrCl (ml/min, 24 h urine output (ml/day, and from the serum potassium, sodium, urea and creatinine (mmol/dm3. Significantly higher average values of 24 hour urine output were recorded during first seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically significant decrease, starting with the second postoperative day, in MMF vs. AZA group (168,7±70,5 vs. 119,9±42,6; p<0,0007. GFR was significantly higher in MMF compared to the AZA group of patients. On the first post-transplant day CrCl was higher in AZA group (24,3±10 vs. 17,5±7,3; p=0,01, next six days situation is reversed CrCl is significantly higher in the MMF group (43,7±15 vs. 53, 4±22, 8 p=0,006. MMF vs. AZA therapy was associated with protective effect against worsening of renal function in first seven post-transplant days.

Current and emerging treatments for the management of myasthenia gravis

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Sathasivam, Sivakumar

2011-01-01

Myasthenia gravis is an autoimmune neuromuscular disorder. There are several treatment options, including symptomatic treatment (acetylcholinesterase inhibitors), short-term immunosuppression (corticosteroids), long-term immunosuppression (azathioprine, cyclosporine, cyclophosphamide, methotrexate, mycophenolate mofetil, rituximab, tacrolimus), rapid acting short-term immunomodulation (intravenous immunoglobulin, plasma exchange), and long-term immunomodulation (thymectomy). This review explores in detail these different treatment options. Potential future treatments are also discussed. PMID:21845054

Effect of binders on 500mg metformin hydrochloride tablets produced by wet granulation

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LUCIANA CATIA BLOCK

2009-12-01

Full Text Available Metformin hydrochloride (MH is an oral hypoglycemic agent and a high-dose drug that has poor flow and compression properties. In this study, the feasibility of developing adequate, low cost 500mg tablets of metformin hydrochloride by wet granulation was tested with several binders (Starch / PVP K30®; Starch 1500® /PVP K30®, PVP K30® and PVP K90® in a simple tablet press of the type used in small pharmaceutical laboratories. The drug powder was tested for ability to flow, by determining Carr’s Index (CI and the Hausner ratio (HR. Differential scanning calorimetry and thermogravimetric analysis were carried out on isolated MH and 1:1 (w/w binary mixtures with the excipients. The size distribution, friability, flow properties and drug content of the granules were analyzed, as were the hardness, friability, disintegration, dissolution and uniformity of the dosage form. The drug powder showed CI > 22% and HR > 1.25, characteristic of a poor flow powder, and no significant incompatibilities with the excipients. All the granules showed adequate flow properties and were suitable for pressing into tablets, all of which complied with pharmacopeial specifications. The starch /PVP K30® and starch 1500® /PVP K30® mixtures were best for producing 500 mg MH tablets. Keywords: Metformin hydrochloride. Tablets. Wet granulation. Binders.

Idiopathic Nephrotic Syndrome in Childhood: A Retrospective Analysis of Two Hundred and Eighty Nine Patients

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Kenan Yılmaz

2017-12-01

Full Text Available Aim: In this study, we aimed to evaluate the demographic and histopathological characteristics and response to medications in children with idiopathic nephrotic syndrome in Turkey. Methods: We reviewed medical records of patients older than one year, who were newly diagnosed with nephrotic syndrome and had been followed for at least one year in our department between November 1994 and March, 2013. Results: A total of 289 children (169 boys were included in the study. Fifty theree patients (18.4% were with steroid-resistant nephrotic syndrome, 33 (11.4% with frequently relapsing nephrotic syndrome and 53 (18.4% were with steroid-dependent nephrotic syndrome. Cyclosporine A (CsA, cyclophosphamide, mycophenolate mofetil, levamisole, azathioprine, and rituximab were used as steroid-sparing agents in some patients. The number of patients who were responder to steroid and to CsA was similar. Majority of patients with steroid-resistant nephrotic syndrome were also resistant to mycophenolate mofetil and CsA. Conclusion: There was a high prevalence of minimal change disease based on kidney biopsy especially in boys younger than six years of age and response to steroid and CsA was almost similar.

New and emerging trends in the treatment of atopic dermatitis

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Christina M Gelbard

2009-01-01

Full Text Available Christina M Gelbard1, Adelaide A Hebert1,21Departments of Dermatology; 2Pediatrics, University of Texas-Houston, Houston, TX, USAAbstract: Atopic dermatitis is a chronic, inflammatory skin condition that affects 10% to 20% of children and 1% to 3% of adults in the US. Symptoms often result in sleeplessness, psychological stress, poor self-esteem, anxiety, and poor school or work performance. The cost of atopic dermatitis is estimated to be US$0.9 to 3.8 billion every year. Topical steroids are first-line treatment for atopic dermatitis, and recent advances in vehicle technologies have resulted in improved patient tolerability and compliance. Topical calcineurin inhibitors are also safe and effective topical treatments for atopic dermatitis, and provide an additional therapeutic option for patients with this disease. Systemic immunomodulators are used in the treatment of severe refractory disease. Cyclosporine, methotrexate, azathioprine, mycophenolate mofetil, and interferon gamma have been used in the management of severe atopic dermatitis. This review highlights the current and emerging trends in the treatment of atopic dermatitis.Keywords: atopic dermatitis, topical corticosteroids, calcineurin inhibitors, methotrexate, cyclosporine, mycophenolate mofetil, IFN-γ

Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia.

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Al Ghamdi, Mohammed; Alghamdi, Khalid M; Ghandoora, Yasmeen; Alzahrani, Ameera; Salah, Fatmah; Alsulami, Abdulmoatani; Bawayan, Mayada F; Vaidya, Dhananjay; Perl, Trish M; Sood, Geeta

2016-04-21

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia. In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered. Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival. Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.

Maximum a posteriori Bayesian estimation of mycophenolic Acid area under the concentration-time curve: is this clinically useful for dosage prediction yet?

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Staatz, Christine E; Tett, Susan E

2011-12-01

This review seeks to summarize the available data about Bayesian estimation of area under the plasma concentration-time curve (AUC) and dosage prediction for mycophenolic acid (MPA) and evaluate whether sufficient evidence is available for routine use of Bayesian dosage prediction in clinical practice. A literature search identified 14 studies that assessed the predictive performance of maximum a posteriori Bayesian estimation of MPA AUC and one report that retrospectively evaluated how closely dosage recommendations based on Bayesian forecasting achieved targeted MPA exposure. Studies to date have mostly been undertaken in renal transplant recipients, with limited investigation in patients treated with MPA for autoimmune disease or haematopoietic stem cell transplantation. All of these studies have involved use of the mycophenolate mofetil (MMF) formulation of MPA, rather than the enteric-coated mycophenolate sodium (EC-MPS) formulation. Bias associated with estimation of MPA AUC using Bayesian forecasting was generally less than 10%. However some difficulties with imprecision was evident, with values ranging from 4% to 34% (based on estimation involving two or more concentration measurements). Evaluation of whether MPA dosing decisions based on Bayesian forecasting (by the free website service https://pharmaco.chu-limoges.fr) achieved target drug exposure has only been undertaken once. When MMF dosage recommendations were applied by clinicians, a higher proportion (72-80%) of subsequent estimated MPA AUC values were within the 30-60 mg · h/L target range, compared with when dosage recommendations were not followed (only 39-57% within target range). Such findings provide evidence that Bayesian dosage prediction is clinically useful for achieving target MPA AUC. This study, however, was retrospective and focussed only on adult renal transplant recipients. Furthermore, in this study, Bayesian-generated AUC estimations and dosage predictions were not compared

March 2015 pulmonary case of the month: sticks and stones may break my bronchi

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Amer S

2015-03-01

Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 67-year-old woman presented to the emergency department with a chief complaint of persistent cough of 2 months duration, productive of yellow sputum. Her symptoms progressed to include dyspnea despite an outpatient course of antibiotics, bronchodilators, and corticosteroids. She denied fevers, chills, hemoptysis, or chest pain. PMH, FH, SH: She was on chronic immunosuppression secondary to a history of liver transplant due to non-alcoholic steatohepatitis and kidney transplant due to calcineurin toxicity. She denied any history of smoking, alcoholism or recreational drug use. Medications: Tacrolimus 3.5 mg bid, Mycophenolate mofetil 720 mg bid, Fluconazole 100 mg daily. Physical Examination: Vitals: Temperature 37.1°C, respiratory rate 18 breaths/min, heart rate 88 beats/min, blood pressure 130/76 mm Hg, SpO2 95% on room air. General: Elderly female in no apparent distress. Lungs: Scattered inspiratory and expiratory squeaks and pops bilaterally, louder in the left lower lobe. The rest of her ...

Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

LENUS (Irish Health Repository)

Raheem, Omer A

2012-02-01

We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

Desenvolvimento de comprimidos de AAS 500 mg: influência do Amido 1500® na compressão direta Development of AAS 500 mg tablets influenced by direct compression (CD process

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Osvaldo Albuquerque Cavalcanti

2002-04-01

Full Text Available O experimento teve por objetivo demonstrar a viabilidade tecnológica do desenvolvimento de comprimidos de AAS 500 mg (Ácido Acetil Salicílico, empregando processo de compressão direta (CD. O Amido 1500® foi usado como excipiente no desenvolvimento das formulações, visando investigar suas propriedades de compressibilidade, desintegração, agregação e lubrificação. Usando metodologias previstas em Farmacopéias, foram realizados ensaios tecnológicos e físico-químicos. Os resultados evidenciaram que a mistura dos pós apresentou características de fluxo e compressibilidade adequadas ao rol de excipientes para compressão direta disponíveis no mercado. A presença do Amido 1500® também interferiu no tempo de desintegração. Dentre as formulações propostas neste trabalho, a fórmula contendo 6,35% de Amido 1500® foi eleita a mais adequada por apresentar maior proximidade em relação aos produtos disponíveis no mercado brasileiroThe present work aims to show the technologic viability in the development of AAS 500 mg tablets using direct compression (CD process. We employed Starch 1500® as excipient to develop the formulations, trying to investigate its compression, disintegration, aggregation and lubrication properties. Technologic, physical and chemical essays were performed using methodologies anticipated in pharmacology. Results demonstrated that the powder mix showed characteristics of free flux and good compression qualities very important for the excipients of direct compression in the market. Starch 1500® interfered in the disintegration time. The formulation with 6,35% of Starch 1500® proposed in this work obtained a highest proximity between the products in the Brazilian market

Perspective on future therapy of vasculitis.

Science.gov (United States)

Boumpas, D T; Kritikos, H D; Daskalakis, N G

2000-10-01

This article summarizes recent advances in the management of various vasculitic syndromes and discusses potential new therapies based on a better understanding of their pathogenesis and natural history. Current efforts for optimization of testing for antineutrophil cytoplasmic antibodies and improvement of diagnostic criteria will certainly have a significant impact on future therapy. Biologic agents such as interferon-alpha are already in use in various vasculitides, whereas others, such as inhibitors of tumor necrosis factor-alpha, are in phase I clinical trials. Agents that selectively inhibit distinct steps in the pathogenesis of vasculitis are in preclinical or early clinical stages of development. Newer (mycophenolate mofetil, leflunamide) or older (methotrexate, azathioprine) immunosuppresive agents are finding new roles in the management of vasculitides. For patients with severe vasculitis, short-term use of cytotoxic agents, such as cyclophosphamide, alone or in combination with biologic agents, may expedite remission, which could then be better maintained with other, less toxic (and less expensive) immunosuppressive agents, such as methotrexate, azathioprine, mycophenolate mofetil, and leflunamide. For patients with mild or moderately severe vasculitis, these latter agents alone may be adequate. New therapeutic studies in vasculitis should better address the impact of therapy on health-related quality of life and its long-term toxicity.

Assessing the clinical effectiveness of an algorithmic approach for mucosal lichen planus (MLP): A retrospective review.

Science.gov (United States)

Ashack, Kurt A; Haley, Laura L; Luther, Chelsea A; Riemer, Christie A; Ashack, Richard J

2016-06-01

Mucosal lichen planus (MLP) is a therapeutic challenge in need of a new treatment approach because of its debilitating effect on patient's quality of life. We sought to evaluate a standardized treatment plan for patients with MLP. A second objective was to describe the effect of mycophenolate mofetil in this patient population. The study retrospectively analyzed 53 patients with MLP treated using a standardized algorithm. The number of MLP lesions, disease activity, and pain at the last visit were compared with baseline scores determined at the initial visit. Results were analyzed using the paired samples t test and confirmed with the Wilcoxon matched pairs signed rank test. The average number of lesions was reduced from 3.77 to 1.67 (P < .001). The average disease activity was reduced from 2.73 to 0.90 (P < .001). Average pain reported decreased from 2.03 to 1.03 (P < .001). This study was a retrospective analysis of a small patient population. There was no universal symptom severity scale used at the time of treatment for some patients. The standardized treatment plan reduced symptoms for patients with MLP. Mycophenolate mofetil appears to be a reasonable treatment option for these patients. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

OpenAIRE

Bhadauria, Dharmendra; Sharma, R. K.; Kaul, A.; Prasad, Narayan; Gupta, Amit; Gupta, Anurag; Srivastava, Aneesh

2012-01-01

Cytomegalovirus (CMV) is the most common viral infection following kidney transplant, has been recognized as a major factor for graft loss and increased incidence of acute rejection. Different studies have reported a variable incidence of CMV disease with the use of Mycophenolate mofetil (MMF). We retrospectively analyzed our renal transplant recipients to review the results of CMV disease and to compare CMV disease in patient on Azathioprine and MMF for this purpose we retrospectively review...

Dermatomyositis Sine Myositis with Membranoproliferative Glomerulonephritis

Directory of Open Access Journals (Sweden)

Mohammad Bagher Owlia

2012-01-01

Full Text Available Dermatomyositis (DM is an autoimmune disease that is characterized by involvement of proximal musculature and skin. We report a 52-year-old woman with a 6-year history of dermatomyositis sine myositis, who developed lower extremity edema and proteinuria. Pathological examination of renal biopsy showed membranoproliferative glomerulonephritis. She received steroid, cyclophosphamide, and mycophenolate mofetil. Over the 9 to 10 months after the beginning of treatment, the proteinuria was improved.

[Clinical guideline for the treatment of lupus nephritis and single-centre results of mycofenolate mofetil among patients with lupus nephritis in the National Institute of Rheumatology and Physiotherapy, Budapest].

Science.gov (United States)

Szabó, Melinda Zsuzsanna; Kiss, Emese

2016-08-01

The authors present the latest guideline for the treatment of lupus nephritis and their own single-centre results with mycofenolate mofetil treated lupus nephritis. Lupus nephritis and mainly its proliferative form is a frequent and potentially life-threatening manifestation of systemic lupus erythematosus that can lead to end-stage renal disease. The treatment of lupus nephritis greatly improved in the last decades; mycofenolate mofetil has become an alternative of cyclophosphamide both in remission induction and as a maintenance regimen as well in the treatment of Class III and IV glomerulonephritis. The authors ordered mycofenolate mofetil for 25 patients with lupus nephritis so far. Histologically most of them had Class III (A/C) or IV (A) glomerulonephritis (30-30%), and only 16% of the patients had renal impairment at that time. Mycofenolate mofetil given after glucocorticoid and cyclophosphamide induction therapy reduced the daily proteinuria from 3.18 grs to 1.06 grs. Complete remission could be achieved in 24% and partial remission in 48% of the patients. The authors conclude that mycofenolate mofetil is effective in the therapy of lupus nephritis. Orv. Hetil., 2016, 157(35), 1385-1393.

Comparative analysis the binding affinity of mycophenolic sodium and meprednisone with human serum albumin: Insight by NMR relaxation data and docking simulation.

Science.gov (United States)

Ma, Xiaoli; He, Jiawei; Yan, Jin; Wang, Qing; Li, Hui

2016-03-25

Mycophenolic sodium is an immunosuppressive agent that is always combined administration with corticosteroid in clinical practice. Considering the distribution and side-effect of the drug may change when co-administrated drug exist, this paper comparatively analyzed the binding ability of mycophenolic sodium and meprednisone toward human serum albumin by nuclear magnetic resonance relaxation data and docking simulation. The nuclear magnetic resonance approach was based on the analysis of proton selective and non-selective relaxation rate enhancement of the ligand in the absence and presence of macromolecules. The contribution of the bound ligand fraction to the observed relaxation rate in relation to protein concentration allowed the calculation of the affinity index. This approach allowed the comparison of the binding affinity of mycophenolic sodium and meprednisone. Molecular modeling was operated to simulate the binding model of ligand and albumin through Autodock 4.2.5. Competitive binding of mycophenolic sodium and meprednisone was further conducted through fluorescence spectroscopy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Consensus report on therapeutic drug monitoring of mycophenolic acid in solid organ transplantation

NARCIS (Netherlands)

D. Kuypers (Dirk); Y. le Meur (Yann); M. Cantarovich (Marcelo); M.J. Tredger (Michael); S.E. Tett (Susan); D. Cattaneo (Dario); B. Tönshoff (Burkhard); D.W. Holt (David); J. Chapman (Jeremy); T. van Gelder (Teun)

2010-01-01

textabstractWith the increasing use of mycophenolic acid (MPA) in solid organ transplantation, the need for more accurate drug dosing has become evident. Personalized immunosuppressive therapy requires better strategies for avoidance of drug-related toxicity while maintaining efficacy. Few studies

Toxic Epidermal Necrolysis-Like Lesions and Systemic Lupus Erythematosus Possibly Triggered by Sulfasalazine

DEFF Research Database (Denmark)

Krabbe, Simon; Gül, Cigdem; Andersen, Bjarne

2016-01-01

elevated ferritin, and muscle wasting. A diagnosis of systemic lupus erythematosus was made, and mycophenolate mofetil and systemic glucocorticoids brought this severe disease under control. Toxic epidermal necrolysis-like lesions and hemophagocytic syndrome have been reported as manifestations of systemic...... lupus erythematosus. This patient possibly had spondyloarthritis or an undifferentiated connective tissue disease at presentation, and we suggest, based on the timing of events, that sulfasalazine may have acted as a trigger of the severe disease manifestations....

Treatment Algorithms in Systemic Lupus Erythematosus.

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Muangchan, Chayawee; van Vollenhoven, Ronald F; Bernatsky, Sasha R; Smith, C Douglas; Hudson, Marie; Inanç, Murat; Rothfield, Naomi F; Nash, Peter T; Furie, Richard A; Senécal, Jean-Luc; Chandran, Vinod; Burgos-Vargas, Ruben; Ramsey-Goldman, Rosalind; Pope, Janet E

2015-09-01

To establish agreement on systemic lupus erythematosus (SLE) treatment. SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement). Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and

César Augusto Restrepo Valencia, Consuelo Vélez Álvarez Abstract Objective. To evaluate the effectiveness of calcineurin ciclosporin and tacrolimus inhibitors to induce remission in patients with refractory lupus nephritis. Patients, materials and methods. Patients with lupus nephritis class IV-G who despite receiving therapy with high doses of steroid and with a cytostatic (cyclophosphamide or mycophenolate for 3 months had not been able to induce some kind of remission.The exclusion criteria were creatinine levels greater than 3 mg / dl, pregnancy, previous history of exposure to calcineurin inhibitors, cancer, active infections, uncontrolled hypertension, and negligence with medication intake. The recommended dose of cyclosporine was 3 mg / kg / day and tacrolimus 0.1 mg / kg / day, in joint with prednisone 0.3 mg / kg / day, cyclophosphamide 1 mg / kg / day or mycophenolate mofetil 1 gram every 12 hours. The cyclophosphamide was administered only during 6 months, after which it was changed to azathioprine at doses of 1 mg / kg / day. Still, mycophenolate was continued at the same dose. All patients completed a minimum period of 12 months follow-up, it was considered that patients achieved partial remission when proteinuria decreased by 50% of the baseline value or its value decreased to less than 1 gram in 24 hours, decrease of leukocytes count and red blood cells in urine of 50%, and creatinine values were stable. A complete remission was considered when there was a reduction in proteinuria in a value less than 300 mg per 24 hours, urinary sediment with less than 3 red blood cells, less than 5 leukocyte for each high power microscopic field, and a creatinine value reduction by 50% or reaching a normal value. Results. Twelve patients met the inclusion criteria and initiated the calcineurin inhibitor protocol. Two presented accelerated deterioration in their function and required chronic dialysis therapy. Ten patients with active treatment completed 12 months

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César Augusto Restrepo Valencia

2014-10-01

Full Text Available Objective: To evaluate the effectiveness of calcineurin ciclosporin and tacrolimus inhibitors to induce remission in patients with refractory lupus nephritis. Patients, materials and methods: Patients with lupus nephritis class IV-G who despite receiving the rapy with high doses of steroid and with a cytostatic (cyclophosphamide or mycophenolate for 3 months had not been able to induce some kind of remission.The exclusion criteria were creatinine levels greater than 3 mg / dl, pregnancy, previous history of exposure to calcineurin inhibitors, cancer, active infections, uncontrolled hypertension, and negligence with medication intake. The recommended dose of cyclosporine was 3 mg / kg / day and tacrolimus 0.1 mg / kg / day, in joint with prednisone 0.3 mg / kg / day, cyclophosphamide 1 mg / kg / day or mycophenolate mofetil 1 gram every 12 hours. The cyclophosphamide was administered only during 6 months, after which it was changed to azathioprine at doses of 1 mg / kg / day. Still, mycophenolate was continued at the same dose. All patients completed a minimum period of 12 months follow-up, it was considered that patients achieved partial remission when proteinuria decreased by 50% of the baseline value or its value decreased to less than 1 gram in 24 hours, decrease of leukocytes count and red blood cells in urine of 50%, and creatinine values were stable. A complete remission was considered when there was a reduction in proteinuria in a value less than 300 mg per 24 hours, urinary sediment with less than 3 red blood cells, less than 5 leukocyte for each high power microscopic field, and a creatinine value reduction by 50% or reaching a normal value. Results: Twelve patients met the inclusion criteria and initiated the calcineurin inhibitor protocol. Two presented accelerated deterioration in their function and required chronic dialysis therapy. Ten patients with active treatment completed 12 months of followup, of which 4 (40% had partial

Desarrollo y producción de cefazolina 500 mg y 1 g, polvo estéril para inyección

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María Antonia Serrate Merino

1998-12-01

Full Text Available Se describe el desarrollo de la formulación para la obtención de cefazolina 500 mg y 1 g, polvo estéril para inyección, con la calidad requerida, así como el estudio de estabilidad para determinar su vida útil, tanto en forma de polvo como después de reconstituida. Se desarrolló este medicamento con calidad similar a las firmas internacionales al contar con la infraestructura necesaria, el personal técnico calificado y la posibilidad de adquirir la materia prima, además de reducir los costos, lo que garantiza un gran beneficio social y económico.The development of the formulation for obtaining 500 mg and 1 mg quality cefazolin, sterile powder for injection, together with the stability studies to determine this drug lifetime cither as powder or as reconstituted substance are described. The quality of the drug obtained was similar to that stated by the international manufacturers since the necessary infrastructure, required skilled personnel, adequate supply of raw material and reduced costs were assured. All this guarantees a great social and economic benefit.

免疫抑制剂对移植术后血脂异常的研究%Research of immunosuppressant on dyslipidemia after organ transplantation

Institute of Scientific and Technical Information of China (English)

应亮; 邱丰

2012-01-01

Cardiovascular and cerebrovascular complications is one of the major causes of transplanted organ death for the long-term survival patients with organ transplantation. In many factors of the resulting cardiac cerebral arteriosclerosis, hy-perlipidemia is one of the most important reasons. The immunosuppressive effects on serum lipids were reviewed in detail in this paper, including Corticosteroids, Cyclosporine, Tacrolimus, Sirolimus, Mycophenolate Mofetil, Azathioprine, and ultimately Mycophenolate Mofetil is one of the drugs which has minimal impact on blood lipids.%心脑血管合并症是导致长期存活器官移植患者移植器官功能死亡的主要原因之一.在导致心脑动脉硬化的诸多因素中,高脂血症是其中最重要的原因.文章详细地论述了不同免疫抑制剂对血脂的影响,包括皮质类固醇激素、环孢霉素、他克莫司、西罗莫司、吗替麦考酚酯、硫唑嘌呤等,最终发现吗替麦考酚酯是对血脂影响最小的药物之一.

Treatment of patients with severe autoimmune hepatitis

DEFF Research Database (Denmark)

Larsen, Finn Stolze

2008-01-01

Autoimmune hepatitis (AIH) is a progressive inflammatory diseases of unknown origin that is characterised by a necro-inflammatory and fibrotic process and may result in liver failure or uncompensated liver cirrhosis. Normally AIH is responsive to immunosuppressive therapy, and treatment aims...... and tacrolimus) might salvage patients from transplantation. Mycophenolate mofetil may also improve liver tests and reduce the requirement for corticosteroids. Besides, sirolimus is effective for treatment of de novo autoimmune hepatitis that sometimes develops after liver transplantation. Initial experience...

Simultaneous determination of ochratoxin A, mycophenolic acid and fumonisin B-2 in meat products

DEFF Research Database (Denmark)

Sørensen, Louise Marie; Mogensen, Jesper; Nielsen, Kristian Fog

2010-01-01

Here we present a method for simultaneous determination of the fungal metabolites mycophenolic acid, ochratoxin A (OTA) and fumonisin B-2 (FB2) in meat products. Extraction was performed with water-acetonitrile, followed by acetone-induced precipitation of salts and proteins. Purification...

Incidence of Posttransplantation Diabetes Mellitus in De Novo Kidney Transplant Recipients Receiving Prolonged-Release Tacrolimus-Based Immunosuppression With 2 Different Corticosteroid Minimization Strategies: ADVANCE, A Randomized Controlled Trial.

Science.gov (United States)

Mourad, Georges; Glyda, Maciej; Albano, Laetitia; Viklický, Ondrej; Merville, Pierre; Tydén, Gunnar; Mourad, Michel; Lõhmus, Aleksander; Witzke, Oliver; Christiaans, Maarten H L; Brown, Malcolm W; Undre, Nasrullah; Kazeem, Gbenga; Kuypers, Dirk R J

2017-08-01

ADVANCE (NCT01304836) was a phase 4, multicenter, prospectively randomized, open-label, 24-week study comparing the incidence of posttransplantation diabetes mellitus (PTDM) with 2 prolonged-release tacrolimus corticosteroid minimization regimens. All patients received prolonged-release tacrolimus, basiliximab, mycophenolate mofetil and 1 bolus of intraoperative corticosteroids (0-1000 mg) as per center policy. Patients in arm 1 received tapered corticosteroids, stopped after day 10, whereas patients in arm 2 received no steroids after the intraoperative bolus. The primary efficacy variable was the diagnosis of PTDM as per American Diabetes Association criteria (2010) at any point up to 24 weeks postkidney transplantation. Secondary efficacy variables included incidence of composite efficacy failure (graft loss, biopsy-proven acute rejection or severe graft dysfunction: estimated glomerular filtration rate (Modification of Diet in Renal Disease-4) <30 mL/min per 1.73 m), acute rejection and graft and patient survival. The full-analysis set included 1081 patients (arm 1: n = 528, arm 2: n = 553). Baseline characteristics and mean tacrolimus trough levels were comparable between arms. Week 24 Kaplan-Meier estimates of PTDM were similar for arm 1 versus arm 2 (17.4% vs 16.6%; P = 0.579). Incidence of composite efficacy failure, graft and patient survival, and mean estimated glomerular filtration rate were also comparable between arms. Biopsy-proven acute rejection and acute rejection were significantly higher in arm 2 versus arm 1 (13.6% vs 8.7%, P = 0.006 and 25.9% vs 18.2%, P = 0.001, respectively). Tolerability profiles were comparable between arms. A prolonged-release tacrolimus, basiliximab, and mycophenolate mofetil immunosuppressive regimen is efficacious, with a low incidence of PTDM and a manageable tolerability profile over 24 weeks of treatment. A lower incidence of biopsy-proven acute rejection was seen in patients receiving corticosteroids tapered over 10

Effect of ultraviolet irradiation on free radical scavenging activity of immunosuppressants used in lung transplantation and comparative electron paramagnetic resonance study of kinetics of their interactions with model free radicals.

Science.gov (United States)

Stanjek-Cichoracka, A; Żegleń, S; Ramos, P; Pilawa, B; Wojarski, J

2018-06-01

The immunosuppressive drugs used in solid organ transplantation or autoimmunological processes were studied by electron paramagnetic resonance (EPR) spectroscopy to estimate their free radical scavenging activity. The interactions of immunosuppressants with free radicals were examined by an X-band (9.3 GHz) EPR spectroscopy and a model of DPPH free radicals. The EPR spectra of DPPH and DPPH interacting with individual drugs were compared. Kinetic studies were performed, and the effect of ultraviolet (UV) irradiation on the free radical scavenging activity of the tested drugs was determined. The free radical scavenging activity of non-irradiated drugs decreased in the order: rapamycin > mycophenolate mofetil > ciclosporin > tacrolimus. UV irradiation increased the free radical scavenging activity of all the tested immunosuppressive drugs, and the effect was highest for tacrolimus. For the non-irradiated samples, the speed of free radical interactions decreased in the order: ciclosporin > tacrolimus > mycophenolate mofetil > rapamycin. UV irradiation only slightly affected the speed of interactions of the immunosuppressive drugs with the model DPPH free radicals. Electron paramagnetic resonance spectroscopy is useful for obtaining information on interactions of immunosuppressive drugs with free radicals. We hypothesized that the long-term immunosuppressive effects of these drugs after transplantation or during autoimmune disorders may be mediated by anti-inflammatory action in addition to the known receptor/cell cycle inhibition. © 2018 John Wiley & Sons Ltd.

The influence of intrauterine exposure to immunosuppressive treatment on changes in the immune system in juvenile Wistar rats.

Science.gov (United States)

Kabat-Koperska, Joanna; Kolasa-Wołosiuk, Agnieszka; Wojciuk, Bartosz; Wojciechowska-Koszko, Iwona; Roszkowska, Paulina; Krasnodębska-Szponder, Barbara; Paczkowska, Edyta; Safranow, Krzysztof; Gołembiewska, Edyta; Machaliński, Bogusław; Ciechanowski, Kazimierz

2016-01-01

In our study, we assessed the impact of immunosuppressive drug combinations on changes in the immune system of juvenile Wistar rats exposed to these drugs during pregnancy. We primarily concentrated on changes in two organs of the immune system - the thymus and the spleen. The study was conducted on 40 (32+8) female Wistar rats administered full and half dose of drugs, respectively, subjected to regimens commonly used in therapy of human kidney transplant recipients ([1] cyclosporine A, mycophenolate mofetil, and prednisone; [2] tacrolimus, mycophenolate mofetil, and prednisone; [3] cyclosporine A, everolimus, and prednisone). The animals received drugs by oral gavage 2 weeks before pregnancy and during 3 weeks of pregnancy. There were no statistically significant differences in the weight of the thymus and spleen, but changes were found in the results of blood hematology, cytometry from the spleen, and a histologic examination of the examined immune organs of juvenile Wistar rats. In the cytokine assay, changes in the level of interleukine 17 (IL-17) after increasing amounts of concanavaline A were dose-dependent; the increase of IL-17 was blocked after administration of higher doses of immunosuppressive drugs. However, after a reduction of doses, its increase resumed. Qualitative, quantitative, and morphological changes in the immune system of infant rats born to pharmacologically immunosuppressed females were observed. Thymus structure, spleen composition, and splenocyte IL-17 production were mostly affected in a drug regimen-dependent manner.

Acridone-based inhibitors of inosine 5'-monophosphate dehydrogenase: discovery and SAR leading to the identification of N-(2-(6-(4-ethylpiperazin-1-yl)pyridin-3-yl)propan-2-yl)-2- fluoro-9-oxo-9,10-dihydroacridine-3-carboxamide (BMS-566419).

Science.gov (United States)

Watterson, Scott H; Chen, Ping; Zhao, Yufen; Gu, Henry H; Dhar, T G Murali; Xiao, Zili; Ballentine, Shelley K; Shen, Zhongqi; Fleener, Catherine A; Rouleau, Katherine A; Obermeier, Mary; Yang, Zheng; McIntyre, Kim W; Shuster, David J; Witmer, Mark; Dambach, Donna; Chao, Sam; Mathur, Arvind; Chen, Bang-Chi; Barrish, Joel C; Robl, Jeffrey A; Townsend, Robert; Iwanowicz, Edwin J

2007-07-26

Inosine monophosphate dehydrogenase (IMPDH), a key enzyme in the de novo synthesis of guanosine nucleotides, catalyzes the irreversible nicotinamide-adenine dinucleotide dependent oxidation of inosine-5'-monophosphate to xanthosine-5'-monophosphate. Mycophenolate Mofetil (MMF), a prodrug of mycophenolic acid, has clinical utility for the treatment of transplant rejection based on its inhibition of IMPDH. The overall clinical benefit of MMF is limited by what is generally believed to be compound-based, dose-limiting gastrointestinal (GI) toxicity that is related to its specific pharmacokinetic characteristics. Thus, development of an IMPDH inhibitor with a novel structure and a different pharmacokinetic profile may reduce the likelihood of GI toxicity and allow for increased efficacy. This article will detail the discovery and SAR leading to a novel and potent acridone-based IMPDH inhibitor 4m and its efficacy and GI tolerability when administered orally in a rat adjuvant arthritis model.

Pharmacokinetic comparison using two tablets of an evogliptin/metformin XR 2.5/500 mg fixed dose combination vs. 1 tablet each of evogliptin 5 mg and metformin XR 1,000 mg
.

Science.gov (United States)

Yoon, Sumin; Rhee, Su-Jin; Park, Sang-In; Yoon, Seo Hyun; Cho, Joo-Youn; Jang, In-Jin; Lee, SeungHwan; Yu, Kyung-Sang

2017-06-01

The aim of this study was to compare the pharmacokinetic (PK) characteristics of evogliptin and metformin following the administration of 2 evogliptin/metformin extended-release (XR) 2.5/500 mg FDC tablets with the coadministration of separate evogliptin 5-mg and metformin XR 1,000-mg tablets (separate formulations). A randomized, two-period, two-sequence crossover study was conducted. Subjects were randomly assigned to receive 2 FDC tablets or the individual tablets, followed by a 14-day washout period and the administration of the alternate treatment. Blood samples were collected predose and up to 72 hours postdose for each period. PK parameters including Cmax and AUClast were calculated. The geometric mean ratios (GMRs) and the 90% confidence intervals (CIs) between FDC and the separate formulations were calculated for the Cmax and AUClast of evogliptin and metformin. 33 subjects completed the study. The GMR (90% CI) values of Cmax and AUClast for evogliptin were 1.011 (0.959 - 1.066) and 1.010 (0.977 - 1.043), respectively. The GMR (90% CI) values of Cmax and AUClast for metformin were 0.892 (0.827 - 0.963) and 0.893 (0.841 - 0.947), respectively. There was no significant difference between the FDC and separate formulations regarding the occurrence of adverse events. All drug-related adverse events were considered to be mild and resolved without any treatment. Two FDC tablets of evogliptin/metformin XR 2.5/500 mg showed a similar PK profile to the separate formulations of evogliptin 5 mg and metformin XR 1,000 mg. All of the 90% CIs of GMR satisfied the regulatory bioequivalence criteria of 0.800 - 1.250.
.

Treatment of refractory chronic urticaria

Directory of Open Access Journals (Sweden)

Aayushi Mehta

2015-01-01

Full Text Available Chronic spontaneous urticaria is a distressing disease encountered frequently in clinical practice. The current mainstay of therapy is the use of second-generation, non-sedating antihistamines. However, in patients who do not respond satisfactorily to these agents, a variety of other drugs are used. This article examines the available literature for frequently used agents including systemic corticosteroids, leukotriene receptor antagonists, dapsone, sulfasalazine, hydroxychloroquine, H2 antagonists, methotrexate, cyclosporine A, omalizumab, autologous serum therapy, and mycophenolate mofetil, with an additional focus on publications in Indian literature.

Central Diabetes Insipidus in Refractory Antineutrophil Cytoplasmic Antibody-associated Vasculitis.

Science.gov (United States)

Ohashi, Keiji; Morishita, Michiko; Watanabe, Haruki; Sada, Ken-Ei; Katsuyama, Takayuki; Miyawaki, Yoshia; Katsuyama, Eri; Narazaki, Mariko; Tatebe, Noriko; Watanabe, Katsue; Kawabata, Tomoko; Wada, Jun

2017-11-01

We herein describe two cases of refractory antineutrophil cytoplasmic antibody-associated vasculitis (AAV) complicated with diabetes insipidus (DI) possibly related to hypertrophic pachymeningitis (HP). One patient had microscopic polyangiitis and HP, which were refractory to cyclophosphamide, azathioprine, rituximab, mycophenolate mofetil (MMF), and mizoribine. Remission was finally achieved with the use of etanercept, but DI occurred 5 years later. The other patient had granulomatosis with polyangiitis, which that was refractory to cyclophosphamide, methotrexate, MMF, and rituximab. DI subsequently developed, but was successfully treated with etanercept. Dura mater hypertrophy was macroscopically observed in the latter case.

Enkeltcenteropgørelse af nyretransplanterede patienters nyrefunktion og immunsuppressive behandling

DEFF Research Database (Denmark)

Frederiksen, Anne Mette; Hansen, Jesper Melchior; Ewers, Bettina

2008-01-01

(131 males, 110 females) was equal. The average patient age was 52 years (SD 12), the average glomerular filtration rate 43 ml/min/1.73 m2 (range 6-114 ml/min/1.73 m2), and the average graft age was 8.3 years (range 0-28 years). Hyperparathyroidism was highly prevalent (64%). The majority of patients...... (74%) were treated with triple-drug immunosuppression, in most cases (46%) with the combination prednisolone-ciclosporine-azathioprine. During recent years, azathioprine has been increasingly replaced by mycophenolate mofetil. CONCLUSIONS: The majority of kidney-transplanted patients...

Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience.

Science.gov (United States)

Echeverri, Catalina Velez; Valencia, Gustavo Adolfo Zuluaga; Higuita, Lina Maria Serna; Gayubo, Ana Katherina Serrano; Ochoa, Carolina Lucia; Rosas, Luisa Fernanda Rojas; Muñoz, Laura Carolina; Sierra, Javier; Zuleta, Jhon Jairo; Ruiz, Juan José Vanegas

2013-01-01

[corrected] Nephrotic syndrome is one of the most frequent glomerular diseases among children, and steroid therapy remains as the treatment choice. In spite of this, 10 to 15% of the patients are steroidresistant, and the best therapy for such cases has never been defined. Mycophenolate acid (MA) is one of the treatments used in such situations. To describe the clinical behavior of children diagnosed with steroid-resistant nephrotic syndrome (SRNS) and to assess the therapeutic response to MA. This was a retrospective and descriptive study. 26 clinical records of patients with SRNS; 70% male and 30% female. All patients underwent kidney biopsies, which showed a predominance of focal segmental glomerulosclerosis (FSGS). The immunosuppresive drugs used were: Mycophenolate mofetil (MMF) 100%, Cyclosporine 69.2%, Cyclophosphamide 23.1%, and Rituximab 23%. One month after treatment initiation with MMF 61.5% achieved remission. The median of relapses per year for the patients was 3 (p25: 2.75 - p75: 4). This median became 1 (p25: 1 - p75: 3.25) after using this medication (p = 0.08). Furthermore, prior to the start of the MMF treatment, the median of the steroid dose was 1 (p25: 0.5- p75: 1.62) mg/k/day. After using MMF, this median became 0.07 (p25: 0 - p75: 0.55) mg/k/day (p < 0.001), in 8 patients prednisolone was stopped. In our experience, treatment with MMF showed positive results such as decrease in the frequency of relapses, less proteinuria, and reduction in the dose of steroids administered without deterioration of glomerular filtration rates. However, more studies are needed to assess efficacy, safety, and optimal dosage.

Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis.

LENUS (Irish Health Repository)

Moore, Jason

2009-02-27

Limiting the exposure of kidney transplant recipients to calcineurin inhibitors (CNIs) has potential merit, but there is no clear consensus on the utility of current strategies. In an attempt to aid clarification, we conducted a systematic review and meta-analysis of randomized trials that assessed CNI sparing (minimization or elimination) with mycophenolate as sole adjunctive immunosuppression.

Métodos analíticos necesarios para el desarrollo de tabletas de metformina 500 mg Analytical methods needed for Metformin 500mg tablets development

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Caridad M. García Peña

2009-12-01

Full Text Available El clorhidrato de metformina es un derivado de la biguanida usado en la diabetes mellitus no insulina dependiente, reduce la concentración de glucosa sanguínea sin incrementar la secreción de insulina, se considera un agente antihiperglucemiante y no un fármaco hipoglucemiante. El desarrollo tecnológico requiere de métodos analíticos confiables que permitan la cuantificación del fármaco en diferentes etapas de la investigación. El objetivo de este trabajo fue la validación del método analítico, reportado en la Farmacopea de los Estados Unidos (USP 31, 2008, por espectrofotometría ultravioleta y la adaptación del método analítico, reportado en la misma farmacopea, para el análisis de los compuestos relacionados en la determinación del principio activo en el producto terminado, por cromatografía líquida de alta resolución, validados para el control de la calidad y estudio de estabilidad de las tabletas de metformina 500 mg. A las técnicas validadas, por métodos cromatográficos y espectrofotométricos se le determinaron los parámetros de desempeño, especificidad, linealidad, exactitud y precisión. Las curvas de calibración para cada método, se realizaron en el intervalo de 60 al 140 %, donde fueron lineales con coeficientes de correlación igual a 0,9994 y 0,99903, respectivamente; la prueba estadística para el intercepto y la pendiente se consideró no significativa. Se obtuvieron recobrados de 100,01 y 99,1 %, respectivamente, en el intervalo de concentraciones estudiados y las pruebas de Cochran´(G y Student´s (t resultaron no significativas. Los coeficientes de variación en los estudios de la repetibilidad fueron iguales a 1,4 y 0,8 %, respectivamente, para las 6 réplicas ensayadas, mientras que en los análisis de la precisión intermedia las pruebas de Fischer y Student fueron no significativas. Los resultados permiten concluir que ambos métodos cumplen con los requisitos establecidos como aceptables para

Do cytostatic drugs reach drinking water? The case of mycophenolic acid

International Nuclear Information System (INIS)

Franquet-Griell, Helena; Ventura, Francesc; Boleda, M.Rosa; Lacorte, Silvia

2016-01-01

Mycophenolic acid (MPA) has been identified as a new river contaminant according to its wide use and high predicted concentration. The aim of this study was to monitor the impact of MPA in a drinking water treatment plant (DWTP) that collects water downstream Llobregat River (NE Spain) in a highly densified urban area. During a one week survey MPA was recurrently detected in the DWTP intake (17–56.2 ng L"−"1). The presence of this compound in river water was associated to its widespread consumption (>2 tons in 2012 in Catalonia), high excretion rates and low degradability. The fate of MPA in waters at each treatment step of the DWTP was analyzed and complete removal was observed after pretreatment with chlorine dioxide. So far, MPA has not been described as water contaminant and its presence associated with its consumption in anticancer treatments is of relevance to highlight the importance of monitoring this compound. - Highlights: • MPA, a cytostatic drug, has been identified as a new river water contaminant. • MPA is eliminated during dioxychlorination in a drinking water treatment plant. • No residues of MPA were detected in finished drinking water. • Isotope dilution LC-MS/MS permitted the trace quantification of MPA in water. - Mycophenolic acid, a cytostatic drug, has been identified as a new river water contaminant and it is removed during purification in a Drinking Water Treatment Plant.

Randomized controlled trial of FTY720 versus MMF in de novo renal transplantation.

Science.gov (United States)

Tedesco-Silva, Helio; Pescovitz, Mark D; Cibrik, Diane; Rees, Michael A; Mulgaonkar, Shamkant; Kahan, Barry D; Gugliuzza, Kristene K; Rajagopalan, P R; Esmeraldo, Ronaldo de M; Lord, Hélène; Salvadori, Maurizio; Slade, Jennifer M

2006-12-27

Phase II trials of FTY720, a novel immunomodulator, have shown promise in preventing rejection with both standard and reduced cyclosporine exposure. This study was designed to confirm those findings. This one-year, multicenter, randomized, phase III study in 696 de novo renal transplant patients compared FTY720 5 mg plus reduced-dose cyclosporine (RDC) or FTY720 2.5 mg plus full-dose cyclosporine (FDC) with mycophenolate mofetil (MMF) plus FDC. All patients received concomitant corticosteroid therapy without antibody induction. The primary efficacy composite endpoint was the incidence of first treated biopsy-proven acute rejection (treated BPAR), graft loss, death or premature study discontinuation at month 12. FTY720 2.5 mg plus FDC was demonstrated to be non-inferior to MMF plus FDC as the primary efficacy endpoint (30.8% and 30.6%) was comparable. The FTY720 5 mg plus RDC treatment regimen was discontinued due to an increased incidence of acute rejection episodes (primary endpoint 43.3%). FTY720 was associated with significantly lower creatinine clearance with a mean difference at 12 months between FTY720 2.5 mg plus FDC and MMF plus FDC of 8 ml/min. While FTY720 2.5 mg plus FDC yielded similar efficacy to MMF plus FDC, the FTY720 5 mg plus RDC did not allow a 50% reduction in cyclosporine exposure. The associated lower creatinine clearance indicated that FTY720 combined with cyclosporine provided no benefit over standard care.

Titrating lovaza from 4 to 8 to 12 grams/day in patients with primary hypertriglyceridemia who had triglyceride levels >500 mg/dl despite conventional triglyceride lowering therapy

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Glueck Charles J

2012-10-01

Full Text Available Abstract Background Omega-3 fatty acids are important in treatment of severe primary hypertriglyceridemia (HTG. In 15 patients with severe primary HTG (TG >500 mg/dl despite conventional TG lowering therapy, we assessed efficacy-safety of sequential monthly treatment with Lovaza, 4 to 8 to 12 g/day. Methods With TG >500 mg/dl despite Type V diet, hyperinsulinemia and diabetes control, and fibric acids, Lovaza (4 g/d was added for 1 month, and if TG remained >500 mg/dl, increased to 8 g/d for 1 month, and then to 12 g/d for 1 month, and subsequently reduced to 4 g/day for 4 months. Results Primary HTG, median TG 884 mg/dl, 14 men, 1 woman, all white, age 50 ± 7 years, 12 non-diabetic, 3 with stable diabetes control. Weight and diet held stable throughout. In 5 patients, after 1, 2, and 3 months on 4 g/day, TG fell Conclusion Titration of Lovaza from 4 to 8 to 12 g/d safely offers an effective way to lower TG beyond conventional 4 g therapy.

Assessment of tissue fibrosis in skin biopsies from patients with systemic sclerosis employing confocal laser scanning microscopy: an objective outcome measure for clinical trials?

Science.gov (United States)

Busquets, Joanna; Del Galdo, Francesco; Kissin, Eugene Y.

2010-01-01

Objectives. To obtain an objective, unbiased assessment of skin fibrosis in patients with SSc for use in clinical trials of SSc disease-modifying therapeutics. Methods. Skin biopsies from the dorsal forearm of six patients with diffuse SSc and six healthy controls, and skin biopsies from the forearm of one patient with diffuse SSc before and following 1 year treatment with mycophenolate mofetil were analysed by confocal laser scanning microscopy (CLSM) with specific antibodies against collagen types I and III or fibronectin. The integrated density of fluorescence (IDF) was calculated employing National Institutes of Health-ImageJ software in at least four different fields per biopsy spanning the full dermal thickness. Results. The intensities of collagen types I and III and fibronectin IDF were 174, 147 and 139% higher in SSc skin than in normal skin, respectively. All differences were statistically significant. The sum of the IDF values obtained for the three proteins yielded a comprehensive fibrosis score. The average fibrosis score for the six SSc samples was 28.3 × 106 compared with 18.6 × 106 for the six normal skin samples (P < 0.0001). Comparison of skin biopsies obtained from the same SSc patient before treatment and after 12 months of treatment with mycophenolate mofetil showed a reduction of 39% in total fibrosis score after treatment. Conclusions. CLSM followed by quantitative image analysis provides an objective and unbiased assessment of skin fibrosis in SSc and could be a useful end-point for clinical trials with disease-modifying agents to monitor the response or progression of the disease. PMID:20202926

Generalized morphea/eosinophilic fasciitis overlap after epoxy exposure

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Warren H. Chan, MS

2018-03-01

Full Text Available Generalized morphea is associated with epoxy resin vapors and is characterized by the development of lesions shortly after exposure. Morphea presenting along with eosinophilic fasciitis (EF, or morphea/EF overlap, is rare and an indicator of poor prognosis and resistance to treatment. Here we present a case of generalized morphea/EF overlap linked to epoxy exposure. Our patient received multiple therapies—ultraviolet A1 phototherapy, prednisone, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, and rituximab—none of which led to a significant response. The refractory nature of this disease warrants vigilance in its association with epoxy exposure.

Long-term experience of steroid-free pediatric renal transplantation

DEFF Research Database (Denmark)

Wittenhagen, Per; Thiesson, Helle C; Baudier, François

2014-01-01

Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate...... in the youngest (renal transplantation is safe and protects against steroid-induced obesity and short stature....... the effects of complete steroid avoidance on allograft function, BMI, and linear growth. The majority of transplanted children were induced with antithymocyte globulin and immunosuppressed with a calcineurin inhibitor and mycophenolate mofetil. Steroids were given only when rejection occurred or due...

Clinical Risk Scoring Models for Prediction of Acute Kidney Injury after Living Donor Liver Transplantation: A Retrospective Observational Study.

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Mi Hye Park

Full Text Available Acute kidney injury (AKI is a frequent complication of liver transplantation and is associated with increased mortality. We identified the incidence and modifiable risk factors for AKI after living-donor liver transplantation (LDLT and constructed risk scoring models for AKI prediction. We retrospectively reviewed 538 cases of LDLT. Multivariate logistic regression analysis was used to evaluate risk factors for the prediction of AKI as defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage. Three risk scoring models were developed in the retrospective cohort by including all variables that were significant in univariate analysis, or variables that were significant in multivariate analysis by backward or forward stepwise variable selection. The risk models were validated by way of cross-validation. The incidence of AKI was 27.3% (147/538 and 6.3% (34/538 required postoperative renal replacement therapy. Independent risk factors for AKI by multivariate analysis of forward stepwise variable selection included: body-mass index >27.5 kg/m2 [odds ratio (OR 2.46, 95% confidence interval (CI 1.32-4.55], serum albumin 20 (OR 2.01, 95%CI 1.17-3.44, operation time >600 min (OR 1.81, 95%CI 1.07-3.06, warm ischemic time >40 min (OR 2.61, 95%CI 1.55-4.38, postreperfusion syndrome (OR 2.96, 95%CI 1.55-4.38, mean blood glucose during the day of surgery >150 mg/dl (OR 1.66, 95%CI 1.01-2.70, cryoprecipitate > 6 units (OR 4.96, 95%CI 2.84-8.64, blood loss/body weight >60 ml/kg (OR 4.05, 95%CI 2.28-7.21, and calcineurin inhibitor use without combined mycophenolate mofetil (OR 1.87, 95%CI 1.14-3.06. Our risk models performed better than did a previously reported score by Utsumi et al. in our study cohort. Doses of calcineurin inhibitor should be reduced by combined use of mycophenolate mofetil to decrease postoperative AKI. Prospective randomized trials are required to address whether artificial modification of hypoalbuminemia, hyperglycemia

Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience

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Catalina Velez Echeverri

2013-09-01

Full Text Available INTODUCTION: Nephrotic syndrome is one of the most frequent glomerular diseases among children, and steroid therapy remains as the treatment choice. In spite of this, 10 to 15% of the patients are steroidresistant, and the best therapy for such cases has never been defined. Mycophenolate acid (MA is one of the treatments used in such situations. OBJECTIVE: To describe the clinical behavior of children diagnosed with steroid-resistant nephrotic syndrome (SRNS and to assess the therapeutic response to MA. METHODS: This was a retrospective and descriptive study. RESULTS: 26 clinical records of patients with SRNS; 70% male and 30% female. All patients underwent kidney biopsies, which showed a predominance of focal segmental glomerulosclerosis (FSGS. The immunosuppresive drugs used were: Mycophenolate mofetil (MMF 100%, Cyclosporine 69.2%, Cyclophosphamide 23.1%, and Rituximab 23%. One month after treatment initiation with MMF 61.5% achieved remission. The median of relapses per year for the patients was 3 (p25: 2.75 - p75: 4. This median became 1 (p25: 1 - p75: 3.25 after using this medication (p = 0.08. Furthermore, prior to the start of the MMF treatment, the median of the steroid dose was 1 (p25: 0.5- p75: 1.62 mg/k/day. After using MMF, this median became 0.07 (p25: 0 - p75: 0.55 mg/k/day (p < 0.001, in 8 patients prednisolone was stopped. CONCLUSION: In our experience, treatment with MMF showed positive results such as decrease in the frequency of relapses, less proteinuria, and reduction in the dose of steroids administered without deterioration of glomerular filtration rates. However, more studies are needed to assess efficacy, safety, and optimal dosage.

Acute tubulointerstitial nephritis with severe renal impairment associated with multisystem IgG4-related disease

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Rafael Coimbra Ferreira Beltrame

Full Text Available Abstract The IgG4-related disease has a wide clinical spectrum where multiple organs can be affected, and the diagnosis depends on typical histopathological findings and an elevated IgG4 expression in plasma cells in the affected tissue. We describe the clinical presentation and evolution of a patient with acute tubulointerstitial nephritis, severe kidney failure and systemic manifestations such as lymphadenomegaly and chronic pancreatitis. The diagnosis was confirmed by the clinical picture and kidney and lymph node histopathology, in which immunohistochemistry of the lymphoid tissue showed policlonality and increased expression of IgG4, with a IgG4/total IgG ratio > 80%. The patient was treated with prednisone at a dose of 60 mg/day, followed by mycophenolate mofetil, and showed clinical and renal function improvement at 6 months of follow-up. The high index of suspicion of IgG4-related disease with multisystem involvement and the early treatment of this condition are essential to improve the prognosis of affected patients.

Effect of bovine somatotropin (500 mg) administered at ten-day intervals on ovulatory responses, expression of estrus, and fertility in dairy cows.

Science.gov (United States)

Rivera, F; Narciso, C; Oliveira, R; Cerri, R L A; Correa-Calderón, A; Chebel, R C; Santos, J E P

2010-04-01

The objectives of this study were to evaluate the effect of administering 500 mg of recombinant bovine somatotropin (bST) every 10 d on ovulatory responses, estrous behavior, and fertility of lactating Holstein cows. Lactating dairy cows were assigned to 1 of 2 treatments: a control with no administration of bST (73 primiparous and 120 multiparous cows) or 6 consecutive administrations of 500 mg of bST (83 primiparous and 123 multiparous cows) given subcutaneously at 10-d intervals starting 61+/-3 d postpartum (study d 0), concurrent with the initiation of the timed artificial insemination (AI). Blood samples were collected thrice weekly from 61+/-3 to 124+/-3 d in milk (DIM), and plasma samples were analyzed for concentrations of estradiol, glucose, insulin, insulin-like growth factor 1, and progesterone. The estrous cycle of cows was presynchronized with 2 injections of PGF(2alpha) at 37+/-3 and 51+/-3 DIM, and the Ovsynch timed AI protocol was initiated at 61+/-3 DIM. Ovaries were scanned to determine ovulatory responses during the Ovsynch protocol. Pregnancy was diagnosed at 33 and 66 d after AI. Body condition was scored on study d 0, 10, 42, and 76. Sixty-four cows were fitted with a pressure mounting sensor with radiotelemetric transmitters to monitor estrous behavior. Treatment of lactating dairy cows with 500 mg of bST at 10-d intervals increased yields of milk and milk components in the first 2 mo after treatment. Body condition of bST-treated cows remained unaltered, whereas control cows gained BCS. Treatment with bST increased concentrations of insulin-like growth factor 1 chronically, but concentrations of insulin and glucose increased only transiently in the first 7 d after the first injection of bST. Concentrations of progesterone during and after the Ovsynch protocol remained unaltered after treatment with bST; likewise, ovulatory responses during the Ovsynch protocol were mostly unaltered by treatment. Concentration of estradiol tended to be

Desarrollo tecnológico de la formulación de cápsulas de ampicilina 250 y 500 mg

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María Antonia Serrate

1997-08-01

Full Text Available Se describió el desarrollo tecnológico para la formulación de cápsulas de ampicilina trihidratada, reutilizando los finos que se obtienen de la tecnología por vía seca y que representan el 30 % de ésta. Se utilizó la vía húmeda por las características del fino obtenido y se logró un producto actualizado y con las características adecuadas para su uso. Las cápsulas de 250 y 500 mg fueron sometidas a estudio de estabilidad a temperaturas controladas y se determinaron las características físicoquímicas que debe cumplir el granulado. Esta reutilización de los finos, producto de la vía seca, logra un aprovechamiento óptimo de la materia prima que se dedica a esta producción.The technological development to produce the formulation of capsules of ampicillin trihydrate using again the products obtained through the dry procedure representing the 30 % of it, is described. A wet procedure was used because of the characteristics of the powder obtained and a current product was obtained having the proper characteristics for its use. Capsules of 250 and 500 mg were subjected to stability studies at controlled temperature and the physical and chemical characteristics that may comply with the granulate were also determined. This reutilization of fine products through the dry procedure makes it possible to attain an optimun use of the raw material employed for this production.

Ensaio clinico com Teclozan: 500mg no tratamento da colite amebiana não disentérica. (Resultados com esquema terapêutico de 24 horas

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Donald Huggins

1978-12-01

Full Text Available O Autor relata sua experiência com novo esquema terapêutico com Teclozan - dose total de 1.500mg empregada em 24 horas, em 40 pacientes portadores de colite amebiana não disentérica na Disciplina de Doenças Infecciosas e Parasitárias da Universidade Federal de Pernambuco. Após um controle de cura realizado no 4º, 8º, 12º e 20º dias após o tratamento, obteve eficácia em 75% dos enfermos (30 casos e excelente tolerância.The author report his experience with Teclozine in the treatment on 40 patients suffering chronic intestinal amebiasis, employing a new therapeutical schedule - 1,500 mg as the total dose, within the period of 24 hours. After a follow-up on the 4th, 8th, 12th, and 20th days of treatment, the parasitological cure rate obtained was 75% (30 cases, and the drug was very well tolerated by all the patients.

Myasthenia gravis: an update for the clinician

Science.gov (United States)

Sieb, J P

2014-01-01

This paper provides a thorough overview of the current advances in diagnosis and therapy of myasthenia gravis (MG). Nowadays the term ‘myasthenia gravis’ includes heterogeneous autoimmune diseases, with a postsynaptic defect of neuromuscular transmission as the common feature. Myasthenia gravis should be classified according to the antibody specificity [acetylcholine, muscle-specific receptor tyrosine kinase (MuSK), low-density lipoprotein receptor-related protein 4 (LRP4), seronegative], thymus histology (thymitis, thymoma, atrophy), age at onset (in children; aged less than or more than 50 years) and type of course (ocular or generalized). With optimal treatment, the prognosis is good in terms of daily functions, quality of life and survival. Symptomatic treatment with acetylcholine esterase inhibition is usually combined with immunosuppression. Azathioprine still remains the first choice for long-term immunosuppressive therapy. Alternative immunosuppressive options to azathioprine include cyclosporin, cyclophosphamide, methotrexate, mycophenolate mofetil and tacrolimus. Rituximab is a promising new drug for severe generalized MG. Emerging therapy options include belimumab, eculizumab and the granulocyte– macrophage colony-stimulating factor. One pilot study on etanercept has given disappointing results. For decades, thymectomy has been performed in younger adults to improve non-paraneoplastic MG. However, controlled prospective studies on the suspected benefit of this surgical procedure are still lacking. In acute exacerbations, including myasthenic crisis, intravenous immunoglobulin, plasmapheresis and immunoadsorption are similarly effective. PMID:24117026

Successful Treatment of Fibrosing Organising Pneumonia Causing Respiratory Failure with Mycophenolic Acid.

Science.gov (United States)

Paul, Christina; Lin-Shaw, Ammy; Joseph, Mariamma; Kwan, Keith; Sergiacomi, Gianluigi; Mura, Marco

2016-01-01

Organising pneumonia (OP) is usually promptly responsive to corticosteroid treatment. We describe a series of 3 cases of severe, progressive, biopsy-proven fibrosing OP causing respiratory failure. All cases presented with peribronchial and subpleural consolidations, had a fibro-inflammatory infiltrative component in the alveolar septa, and only had a partial and unsatisfactory response to corticosteroids. However, they responded to mycophenolic acid (MPA) treatment with resolution of respiratory failure as well as clinical and functional improvement. MPA as an additional treatment option for aggressive forms of fibrosing OP and interstitial lung disease needs to be further explored. © 2016 S. Karger AG, Basel.

Therapeutic Drug Monitoring in Rheumatic Diseases

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NG Hoi-Yan Alexandra

2016-12-01

Full Text Available The ultimate goal of treating rheumatic disease is to achieve rapid suppression of inflammation, while at the same time minimizing the toxicities from rheumatic drugs. Different patients have different individual pharmacokinetics that can affect the drug level. Moreover, different factors, such as renal function, age or even different underlying diseases, can affect the drug level. Therefore, giving the same dosage of drugs to different patients may result in different drug levels. This article will review the usefulness of therapeutic drug monitoring in maximizing drug efficacy, while reducing the risk of toxicities in Hydroxychloroquine, Mycophenolate Mofetil, Tacrolimus and Tumor Necrosis Factor inhibitors (TNF Inhibitors.

Vasculitis and Pregnancy.

Science.gov (United States)

Machen, Leah; Clowse, Megan E B

2017-05-01

Vasculitis is more often a disease of women beyond their reproductive years, leaving the challenges of pregnancy management difficult to study. Pregnancy complications, including pregnancy loss and preterm birth, are higher among women with all forms of vasculitis. It seems that controlling the disease before pregnancy may improve the chances of pregnancy success. Many medications used for vasculitis are considered low risk in pregnancy, including prednisone, colchicine, azathioprine, and tumor necrosis factor inhibitors. Cyclophosphamide, methotrexate, and mycophenolate mofetil should be avoided in pregnancy. Controlling disease with low-risk medications may allow women with vasculitis to have the pregnancies they desire. Copyright © 2017 Elsevier Inc. All rights reserved.

Treatment of neuro-ophthalmic sarcoidosis.

Science.gov (United States)

Frohman, Larry P

2015-03-01

Because of the rarity of neuro-ophthalmic sarcoidosis, there are no therapeutic guidelines based on evidence-based medicine for this disorder. Review of literature combined with personal experience. Corticosteroids are the preferred initial therapy for neuro-ophthalmic sarcoidosis. If patients cannot tolerate the requisite dose of corticosteroid needed to control their disease, or if corticosteroids fail to adequately control the disease process, the choices of a second agent are based on the consideration of rapidity of clinical response and the safety profile. Although methotrexate and mycophenolate mofetil are the medications that are often selected after corticosteroid failure, more rapidly acting agents that have been used are infliximab and intravenous cyclophosphamide.

Preparation of99mTc - dextran-500 for use in lymphoscintigraphy

International Nuclear Information System (INIS)

Hamada, E.S.; Muramoto, E.; Pereira, N.P.S. de; Brito, R.H.; Silva, C.P.G. da.

1990-03-01

This paper reported the preparation of lyophilized kit Dextran-500 for labelling with 99m Tc used in Nuclear Medicine as a lymphoscintigraphic agent. Each vial contains 100 mg Dextran-500 and 1,5 mg stannous chloride. The radiopharmaceutical was checked by ITLC, and the radiochemical purity and stability were determined. The studies of biological distribution were made in Wistar rats and the clinical evaluation in men was realized. Our results permited to incorporate Dextran-500 formulation as an ideal agent for routine use in lymphoscintigraphic. (author) [pt

Liver transplantation in Greek children: 15 years experience

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Dimitrios Takoudas

2010-09-01

Full Text Available Liver transplantation (LT is the only available live-saving procedure for children with irreversible liver failure. This paper reports our experience from the follow-up of 16 Greek children with end-stage liver failure who underwent a LT. Over a period of 15 years, 16 pediatric liver recipients received follow up after being subjected to OLT (orthotopic liver transplantation due to end-stage liver failure. Nine children initially presented with extrahepatic biliary atresia, 2 with acute liver failure after toxic mushroom ingestion, 2 with intrahepatic cholestasis, 2 with metabolic diseases and one with hepatoblastoma. Ten children received a liver transplant in the Organ Transplantation Unit of Aristotle University of Thessaloniki and the rest in other transplant centers. Three transplants came from a living-related donor and 13 from a deceased donor. Six children underwent immunosuppressive treatment with cyclo­sporine, mycophenolate mofetil and corticosteroids, and 7 with tacrolimus, mycophenolate mofetil and corticosteroids. Three out of 16 children died within the first month after the transplantation due to post-transplant complications. Three children presented with acute rejection and one with chronic organ rejection which was successfully managed. Five children presented with cytomegalovirus infection, 5 with Epstein-Barr virus, 2 with HSV1,2, 2 with ParvoB19 virus, 2 with varicella-zoster virus and one with C. Albicans infection. One child presented with upper gastrointestinal hemorrhage and one with small biliary paucity. A satisfying outcome was achieved in most cases, with good graft function, except for the patient with small biliary paucity who required re-transplantation. The long-term clinical course of liver transplanted children is good under the condition that they are attended in specialized centers.

Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen.

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Gianluigi Zaza

Full Text Available The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined.We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group, and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group.A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05. Flagellar motor switch protein (fliNY and type IV pilus assembly protein pilM (pilM were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity.Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this objective.

Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen.

Science.gov (United States)

Zaza, Gianluigi; Dalla Gassa, Alessandra; Felis, Giovanna; Granata, Simona; Torriani, Sandra; Lupo, Antonio

2017-01-01

The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined. We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group), and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group). A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity) at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05). Flagellar motor switch protein (fliNY) and type IV pilus assembly protein pilM (pilM) were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA) was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity. Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this objective.

Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen

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Dalla Gassa, Alessandra; Felis, Giovanna; Granata, Simona; Torriani, Sandra; Lupo, Antonio

2017-01-01

Background The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined. Methods We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group), and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group). Results A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity) at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05). Flagellar motor switch protein (fliNY) and type IV pilus assembly protein pilM (pilM) were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA) was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity. Conclusions Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this

Mycophenolate sodium for the treatment of chronic non-infectious uveitis of childhood.

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Doycheva, Deshka; Zierhut, Manfred; Blumenstock, Gunnar; Sobolewska, Bianka; Voykov, Bogomil; Hohmann, Johanna; Spitzer, Martin S; Deuter, Christoph

2016-08-01

To assess the efficacy and tolerability of mycophenolate sodium (MPS) in the therapy of children with chronic non-infectious uveitis. Retrospective analysis of 23 children with chronic uveitis, treated with MPS, with a follow-up of at least 6 months. The main outcome measures were time to uveitis reactivation and corticosteroid-sparing effect under MPS treatment. The secondary outcome measures were best-corrected visual acuity (BCVA) and treatment-related side effects. From 23 patients included in the study, 2 patients had anterior uveitis, 19 had intermediate uveitis and 2 had panuveitis. The probability of reactivation-free survival after MPS initiation was estimated as 65% at both 1 and 2 years. The probability of discontinuing systemic corticosteroids after 1 year of treatment was 39% and after 2 years 51%. The probability to taper corticosteroids to a daily dosage of ≤0.1 mg/kg after 1 and 2 years was 62% and 85%, respectively. BCVA improved or remained stable in 96% of eyes after 1 year of therapy. Treatment-related side effects were found in nine children (rate: 0.17/patient-year). No therapy discontinuation because of side effects was needed. Our data suggest that MPS is useful and well tolerated in children with chronic uveitis. MPS seems to be an effective drug for the treatment of chronic non-infectious uveitis of childhood and may be preferred as a first-line steroid-sparing agent in this form of uveitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Experimental investigation and thermodynamic calculation of the Fe-Mg-Mn and Fe-Mg-Ni systems

Energy Technology Data Exchange (ETDEWEB)

Wang, Peisheng; Zhao, Jingrui; Xu, Honghui; Liu, Shuhong; Ouyang, Hongwu [Central South Univ., Hunan (China). State Key Lab. of Powder Metallurgy; Du, Yong [Central South Univ., Hunan (China). State Key Lab. of Powder Metallurgy; Harbin Institute of Technology (China). State Key Lab. of Advanced Welding Production Technology; Gang, Tie; Fen, Jicai [Harbin Institute of Technology (China). State Key Lab. of Advanced Welding Production Technology; Zhang, Lijun [Central South Univ., Hunan (China). State Key Lab. of Powder Metallurgy; Bochum Univ. (Germany). ICAMS Inst.; He, Cuiyun [Guangxi Univ. (China). College of Physical Science and Technology

2011-01-15

Based on the thermodynamic calculations extrapolated from the corresponding binary sub-systems, four decisive alloys in the Fe-Mg-Mn system and three in the Fe-Mg-Ni system were selected and prepared using a powder metallurgy method to measure the isothermal sections at 500 C in both systems. The prepared samples were annealed at 500 C, and then subjected to X-ray diffraction, optical microscopy, scanning electron microscopy with energy-dispersive X-ray spectrometry as well as electron probe microanalysis. Taking into account the presently obtained experimental data and the experimental data available in the literature, thermodynamic modeling was performed for the above systems. It was found that a direct extrapolation from the corresponding three binary systems can well reproduce all the experimental data in the Fe-Mg-Mn system, while two thermodynamic parameters are needed in the Fe-Mg-Ni system to fit all the experimental data. The liquidus projections and reaction schemes for the Fe-Mg-Mn and Fe-Mg-Ni systems are also presented. (orig.)

New-Onset Diabetes Mellitus After Transplantation in a Cynomolgus Macaque (Macaca fasicularis).

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Matthews, Kristin A; Tonsho, Makoto; Madsen, Joren C

2015-08-01

A 5.5-y-old intact male cynomolgus macaque (Macaca fasicularis) presented with inappetence and weight loss 57 d after heterotopic heart and thymus transplantation while receiving an immunosuppressant regimen consisting of tacrolimus, mycophenolate mofetil, and methylprednisolone to prevent graft rejection. A serum chemistry panel, a glycated hemoglobin test, and urinalysis performed at presentation revealed elevated blood glucose and glycated hemoglobin (HbA1c) levels (727 mg/dL and 10.1%, respectively), glucosuria, and ketonuria. Diabetes mellitus was diagnosed, and insulin therapy was initiated immediately. The macaque was weaned off the immunosuppressive therapy as his clinical condition improved and stabilized. Approximately 74 d after discontinuation of the immunosuppressants, the blood glucose normalized, and the insulin therapy was stopped. The animal's blood glucose and HbA1c values have remained within normal limits since this time. We suspect that our macaque experienced new-onset diabetes mellitus after transplantation, a condition that is commonly observed in human transplant patients but not well described in NHP. To our knowledge, this report represents the first documented case of new-onset diabetes mellitus after transplantation in a cynomolgus macaque.

Simultaneous Hodgkin′s disease and kaposi sarcoma in a renal transplant recipient

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Yaich S

2010-01-01

Full Text Available A 38-year-old women underwent first cadaver kidney transplantation. Her panel re-active antibody was 0%, and she had never previously been transfused nor pregnant. She received induction therapy with antithymoglobulin (ATG as standard protocol and maintained on immuno-suppressive treatment of cyclosporine A, mycophenolate mofetil (MMF, and prednisone. Nine months after transplantation, she presented with anorexia, asthenia and weight loss. Cutaneous Ka-posi′s sarcoma and a Hodgkin disease were diagnosed. MMF was discontinued and cyclosporin A was switched to sirolimus. She also received a poly-chemotherapy associated with 4 courses of rituximab. Twelve months later, the patient had normal graft function and both malignancies were in complete remission.

ABO-incompatible kidney transplantation: first cases in Turkey.

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Tuncer, M; Yücetin, L; Tekin, S; Demirbas, A

2012-01-01

ABO compatibility has been believed to be necessary in kidney transplantation (Ktx) to prevent acute antibody-mediated rejection. However, developments in immunosuppression and immunoadsorption techniques have overcome acute antibody-mediated rejection caused by ABO incompatibility. Herein, we have presented the first ABO-incompatible Ktx cases in Turkey. All recipients did not have an ABO-compatible donor but presented significant dialysis inadequacy due to vascular access problems. Five dialysis patients with blood groups O or B underwent kidney transplantation from living related donors of blood group type A1 or AB between march 23, 2007 and August 16, 2007. All patients received Rituximab (375 mg/m(2)) at 3-4 weeks before the Ktx. Additionally, we started tacrolimus (0.15 mg/kg), mycophenolate mofetil (2 × 1 g), and simvastatin (1 × 20 mg) 1 week before the operation. Immunoadsorption therapy employing a specific filter (Glycosorbs) to remove anti-A or anti-B antibodies was continued until the titers were 1/8 during the first postoperative week and >1/16 at the second postoperative week. We used 2 standard hemodialysis machines with a connection line to perform immunoabsorption and dialysis during the same session. Acute humoral and cellular rejection was not detected. During the follow-up 1 patient was lost due to a cardiovascular complication. Mean creatinine level was 1.1 ± 0.3 mg/dL. These first ABO-incompatible transplantation cases in Turkey suggest that this source may represent an effective approach to overcome the organ shortage. Copyright © 2012 Elsevier Inc. All rights reserved.

A comprehensive review of the published assays for the quantitation of the immunosuppressant drug mycophenolic acid and its glucuronidated metabolites in biological fluids

DEFF Research Database (Denmark)

Syed, Muzeeb; Srinivas, Nuggehally R

2016-01-01

Therapeutic use of mycophenolic acid (MPA) is steadily on the rise in combination with other immunosuppressant drugs in transplantation patients. The biotransformation of MPA resulted in the formation of glucuronide metabolites, MPAG and AcMPAG. There are a plethora of assays validated for the an...

Bortezomib-based treatment of acute antibody-mediated rejection: a case report.

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Wang, Q; Li, X L; Xu, X G; Shi, B Y; Zhang, Z M; Li, Z L; Han, Y; Zhou, W Q; Chen, C Q; Cai, M; Zhang, X

2015-12-22

Antibody-mediated rejection (AMR) is an important factor affecting survival after renal transplantation. A highly selective proteasome inhibitor, bortezomib, clears activated plasma cells from the body and has important therapeutic effect on AMR. We investigated the effects of bortezomib on AMR in a patient after a second renal transplant. Biopsy confirmed the diagnosis of mixed cellular rejection and AMR. Bortezomib was administered on day 1 (1.3 mg/m(2)), day 4 (1.0 mg/m(2)), and day 8 (1.0 mg/m(2)). On the same days, 250 mg methylprednisolone was administered once, and cyclosporine dose (5 mg·kg(-1)·day(-1)) was reduced by 50%. Oral mycophenolate mofetil and steroid were withdrawn on day 1 of bortezomib treatment. Intermittent double-filtration plasmapheresis was also performed. We monitored parameters, including T lymphocyte subsets, CD139 and CD19 expression, panel reactive antibody (PRA), and serum creatinine concentration. At follow-up 6 months after bortezomib treatment, we observed: 1) serum creatinine stabilized at 130 μM from a peak level of 337 μM; 2) PRA decreased from a maximum of 66.7 to 0%; 3) blood plasma cell percentage rebounded after significantly decreasing following the first dose of bortezomib; 4) in renal allograft biopsy, immunohistochemical staining for C4d shifted from strongly positive to negative, and cellular rejection shifted from type IIA to borderline; and 5) adverse effects such as platelet suppression, hypotension, and grade 3 peripheral neuropathy emerged. Bortezomib effectively treated antibody-mediated renal transplantation rejection in this case study, but clinical trials with large sample sizes are still needed to explore clinical safety and tolerability.

Determination of mycophenolic acid in mest products using mixed mode reversed phase-anion exchange clean-up and liquid chromatography-high-resolution mass spectrometry

DEFF Research Database (Denmark)

Sørensen, Louise Marie; Nielsen, Kristian Fog; Jacobsen, Thomas

2008-01-01

A method for determination of mycophenolic acid (MPA) in dry-cured ham, fermented sausage and liver pate is described. MPA was extracted from meat with bicarbonate-acetonitrile, further cleaned-up by mixed mode reversed phase-anion exchange and detected using a LC-MS system with electrospray...

Anti-Rhodotorula activity of mycophenolic acid enhanced in the presence of polyene antibiotic nystatin.

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Kinoshita, H; Wongsuntornpoj, S; Ihara, F; Nihira, T

2017-02-01

Rhodotorula species are opportunistic pathogens, which cause not only systemic fungaemia but also other localized infections. Despite serious side effects such as nephrotoxicity and hypokalemia, amphotericin B (a polyene antifungal) has been commonly prescribed for Rhodotorula infection because Rhodotorula species are resistant against a candin family of antifungal agents. In this study, novel active compounds against Rhodotorula species were screened from the extracts of entomopathogenic fungi based on the synergistic effect of polyene nystatin (NYS), which causes efficient targeting of compounds due to increased permeability through the fungal cell membrane. Around 37% of culture extracts from 31 entomopathogenic fungal strains showed anti-Rhodotorula activity in the synergistic bioassay system, suggesting that the coexistence assay with NYS enhanced the discovery of anti-Rhodotorula compounds. Judging from various physicochemical data, the active component from strain HF763 was identified as an immunosuppressant drug, mycophenolic acid (MPA). The minimum inhibitory concentration of MPA against three pathogenic Rhodotorula strains was determined, focusing on the synergistic effect with NYS. The results revealed that the values decreased by at least 87% in the presence of NYS, indicating that MPA showed a synergistic effect with NYS. This study aimed to screen active compounds against Rhodotorula species that are resistant to a candin family of antifungal agents, from entomopathogenic fungi. Assuming that most of the latent antifungal compounds do not exert their activity due to their inability to penetrate the membrane, we took advantage of polyene nystatin in the screening to increase permeability through the fungal cell membrane. The result of the screening revealed hidden antifungal activity of mycophenolic acid, demonstrating that the method applied in this study unlocks the potentials of bioresources, and proposes a new remedy for mycosis. © 2016 The

Multifocal Choroiditis with Retinal Vasculitis, Optic Neuropathy, and Keratoconus in a Young Saudi Male.

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Dhafiri, Yousef; Al Rubaie, Khalid; Kirat, Omar; May, William N; Nguyen, Quan D; Kozak, Igor

2017-01-01

The purpose of this study is to describe an association of unilateral multifocal choroiditis (MFC), retinal vasculitis, optic neuropathy, and bilateral keratoconus in a young Saudi male. A 27-year-old male patient with stable bilateral keratoconus presented with a painless vision loss in his left eye. Ophthalmic examinations revealed multiple foci of idiopathic chorioretinitis, retinal vasculitis, and mild optic disc leakage on fluorescein angiography, all of which resolved on systemic therapy with mycophenolate mofetil and prednisone after 3 months. Systemic medication was stopped after 8 months. One year after presentation, patient's visual acuity has improved and remained stable. Systemic immunomodulatory therapy can be effective in managing and leading to resolution of MFC, retinal vasculitis, and optic disc leak in young patients.

Renal disease masquerading as pyrexia of unknown origin

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D Korivi

2013-01-01

Full Text Available Pyrexia of unknown origin is a challenging clinical problem. Infections, malignancies, and connective tissue diseases form the major etiologies for this condition. We report a case of a 57-year-old diabetic male who presented with fever of unknown origin for several months. The course of investigations led to a kidney biopsy which clinched the cause of his fever as well as the underlying diagnosis. The light microscopy findings of expansile storiform fibrosis with a dense inflammatory infiltrate suggested the diagnosis which was confirmed by positive staining of Immunoglobulin G4, the dense lympho-plasmacytic infiltrate and elevated serum IgG4 concentrations. A course of steroids followed by mycophenolate mofetil as maintenance immunosuppression rendered the patient afebrile with improvement of renal function.

Toxic Epidermal Necrolysis-Like Lesions and Systemic Lupus Erythematosus Possibly Triggered by Sulfasalazine

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Simon Krabbe

2016-01-01

Full Text Available This case report describes a patient with arthritis of the large joints, bilateral sacroiliitis, and positive anti-SSA and anti-dsDNA antibody, who received sulfasalazine and shortly thereafter became critically ill. He developed toxic epidermal necrolysis, hemolytic anemia, lymphopenia, markedly elevated ferritin, and muscle wasting. A diagnosis of systemic lupus erythematosus was made, and mycophenolate mofetil and systemic glucocorticoids brought this severe disease under control. Toxic epidermal necrolysis-like lesions and hemophagocytic syndrome have been reported as manifestations of systemic lupus erythematosus. This patient possibly had spondyloarthritis or an undifferentiated connective tissue disease at presentation, and we suggest, based on the timing of events, that sulfasalazine may have acted as a trigger of the severe disease manifestations.

Anti-Ma2-associated encephalitis with normal FDG-PET: a case of pseudo-Whipple's disease.

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Castle, James; Sakonju, Ai; Dalmau, Josep; Newman-Toker, David E

2006-10-01

A 39-year-old man presented with a history of several months of progressive personality changes, social withdrawal, bradykinesia, mutism, dysphagia, worsening gait, and difficulty with daily living activities. Examination revealed an atypical parkinsonian appearance with incomplete supranuclear ophthalmoplegia and an unusual oculomotor disorder characterized by both low-amplitude, intermittent opsoclonus, and slow, nystagmoid intrusions. Routine laboratory testing, autoimmune and infectious serologies, brain MRI, lumbar puncture, electroencephalogram, whole-body CT scan, paraneoplastic serologies, small bowel biopsy, 18F-fluorodeoxyglucose positron emission tomography CT scan, brain biopsy, and testicular ultrasound. Anti-Ma2 paraneoplastic encephalitis in association with metastatic testicular cancer; initially misdiagnosed as CNS Whipple's disease. Corticosteroids, intravenous immunoglobulins, orchiectomy, muscle relaxants, mycophenolate mofetil, plasmapheresis, and bleomycin, etoposide and platinum chemotherapy.

Do cytostatic drugs reach drinking water? The case of mycophenolic acid.

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Franquet-Griell, Helena; Ventura, Francesc; Boleda, M Rosa; Lacorte, Silvia

2016-01-01

Mycophenolic acid (MPA) has been identified as a new river contaminant according to its wide use and high predicted concentration. The aim of this study was to monitor the impact of MPA in a drinking water treatment plant (DWTP) that collects water downstream Llobregat River (NE Spain) in a highly densified urban area. During a one week survey MPA was recurrently detected in the DWTP intake (17-56.2 ng L(-1)). The presence of this compound in river water was associated to its widespread consumption (>2 tons in 2012 in Catalonia), high excretion rates and low degradability. The fate of MPA in waters at each treatment step of the DWTP was analyzed and complete removal was observed after pretreatment with chlorine dioxide. So far, MPA has not been described as water contaminant and its presence associated with its consumption in anticancer treatments is of relevance to highlight the importance of monitoring this compound. Copyright © 2015 Elsevier Ltd. All rights reserved.

August 2015 critical care case of the month: a diagnostic branch of medicine

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Love WT

2015-08-01

Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 66-year-old man had undergone an orthotopic heart transplantation on March 28th, 2015 due to end-stage cardiomyopathy. During a recent hospitalization from 6/26-7/2 a transbronchial lung biopsy was suggestive of subacute rejection. He was treated with: Plasmapheresis x 3; Intravenous immunoglobulin (IVIG; 500 mg Solu-Medrol daily; Tacrolimus held as supra-therapeutic level of 16.2; Mycophenolate decreased to 500mg BID; Prednisone at 10mg BID on discharge. On July 3rd he began having cough productive of clear sputum, nausea, vomiting, and headache. Subsequently he had body aches, subjective fever, chills, night sweats, and a poor appetite with a 4 kg weight loss over the last week. There was also a history of several falls after “losing his balance". Past Medical History: There was also a history of type 2 diabetes mellitus, chronic kidney disease, coronary artery disease with coronary artery bypass grafting in 2000. Physical Examination: Vital signs: T-37.1 ...

Engraftment versus immunosuppression: cost-benefit analysis of immunosuppression after intrahepatic murine islet transplantation.

Science.gov (United States)

Marzorati, Simona; Melzi, Raffaella; Citro, Antonio; Cantarelli, Elisa; Mercalli, Alessia; Scavini, Marina; Piemonti, Lorenzo

2014-05-27

Immunosuppression (IS) in islet transplantation (Tx) is a double-edged sword: it prevents immunoreaction but has the potential to impair islet engraftment. The aim of this study was to identify in murine animal models the IS platform with the best balance between these two opposite effects. To study the impact of IS on islet engraftment diabetic C57BL/6 mice were transplanted with 350 syngeneic islets through the portal vein and treated once-daily with either rapamycin (RAPA; 0.1-0.5-1 mg/kg ip), tacrolimus (FK506; 0.1-0.5-1 mg/kg ip), mycophenolate mofetil (MMF; 60-120-300 mg/kg oral) or vehicle for 14 days. Islet function was evaluated by measuring not-fasting glycemia and by performing an IVGTT on days 15 and 30 post-Tx. RAPA ≥0.5 mg/Kg, FK506 ≥0.5 mg/Kg, and MMF ≥120 mg/kg had detrimental effects on islet engraftment but not on the function of islets already engrafted in the liver. The effect on engraftment was irreversible and persisted even after IS withdrawal. The lower dose of IS that did not affect engraftment was tested for preventing rejection in the full mismatch allogeneic Tx BALB/c to C57BL/6 model. RAPA and/or FK506 were inefficient in preventing rejection, even when anti-IL2R mAb was added to the IS regimen. On the other hand, MMF alone or in association with FK506 significantly prolonged the time to islet rejection. IS showed profound dose-dependent deleterious effects on islet cell engraftment. The MMF/FK506 combination proved the best balance with less toxicity at the time of engraftment and more efficacy in controlling graft rejection.

ATG-Fresenius or daclizumab induction therapy in immunologically high risk kidney recipients: a prospective randomized pilot trial.

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Kim, Min Jeong; Tsinalis, Dimitrios; Franz, Stefan; Binet, Isabelle; Gürke, Lorenz; Mihatsch, Michael J; Steiger, Jürg; Thiel, Gilbert; Dickenmann, Michael

2008-01-01

Despite all the advantages in the immunosuppressive therapy, kidney transplantation in immunologically high risk patients remains a challenge. Ideally, an induction therapy should provide maximal graft protection, while adverse events rate and costs remain as low as possible. Immunologically high risk kidney recipients with CDC-PRA ł 25% within the last 3 years, a positive B-cell CDC-crossmatch or graft loss due to rejection within 3 years following a prior transplantation, were randomized 1:1 to receive ATG-Fresenius (ATG-F) (9 mg/kg day 0; 3 mg/kg day 1-4) or Daclizumab therapy (1 mg/kg day 0, 14, 28, 42, 56) in a pilot study. Additional immunosuppression consisted of cyclosporine, mycophenolate mofetil, and steroids. 11 patients were included in each group. The patient (90% in ATG-F; 100% in Daclizumab) and graft survival (censored for death) (100% in ATG-F; 90% in Daclizumab) and the mean creatinine concentration at 24 months (139+/-68 mol/l in ATG-F; 176+/-103 mol/l in Daclizumab) were similar in both groups. More severe graft rejections (3 vascular rejections in Daclizumab) and adverse events (5.3/patient in ATG-F; 6.7/patient in Daclizumab) were observed in the Daclizumab group. The costs for hospitalization/ day within 24 months were lower in ATG-F (2.32+/-3.51 USD vs. 12.25+/-9.75 USD; p=0.02) resulting in an average cost-difference of more than 10'435 USD /patient. In this pilot trial, both treatments were comparably successful regarding graft and patient outcome.

Deceased donor organ transplantation with expanded criteria donors: a single-center experience from India.

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Goplani, K R; Firoz, A; Ramakrishana, P; Shah, P R; Gumber, M R; Patel, H V; Vanikar, A V; Trivedi, H L

2010-01-01

Deceased donor organ transplantation (DDOT) accounts for DKT) and 19 single (SKT). Fourteen donors had hypertension, a cerebrovascular accident as the cause of death, 9 had both, and 4 had diabetes. Mean donor age was 70.3 +/- 8.9 years. Decisions on the procedure were based upon frozen section biopsy in 13 of 21 donors. Mean DKT donor age was 76 +/- 9.7 years versu 64 +/- 5.7 years of SKT donors. The native kidney diseases were chronic glomerulonephritis (n = 14), diabetic nephropathy (n = 7), tubulointerstitial nephritis (n = 4) and polycystic kidney disease, focal segmental glomerulosclerosis, lupus nephritis and patchy cortical necrosis, (n = 1 each). Mean recipient age of DKT versus SKT was 43.5 versus 42.3 years. All recipients received rabbit anti-thymocyte globulin, followed by steroid, mycophenolate mofetil/calcinueurin inhibitor. Over a mean follow-up of 341 days, the mean serum creatinine (SCr) of 25/29 patients was 1.60 mg/dL (range, 1.0-2.6). The mean SCr of SKT patients was 1.59 +/- 0.63 mg/dL and of DKT, 1.62 +/- 0.48 mg/dL. Ten patients had delayed graft function and 11 had biopsy proven acute tubular necrosis. Seven (24%) patients had rejection (grade 3 Banff update '05, type IA; 4, type 2A); 6 responded to antirejection; 1 graft was lost at 7 months due to chronic rejection. Three (10.3%) patients were lost, 1 each due to AMI, sepsis, and CMV disease. In the circumstances of organ shortage, DDOT with expanded criteria donor is a feasible option.

Nephrotic Syndrome and Idiopathic Membranous Nephropathy Associated with Autosomal-Dominant Polycystic Kidney Disease

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Peces, Ramón; Martínez-Ara, Jorge; Peces, Carlos; Picazo, Mariluz; Cuesta-López, Emilio; Vega, Cristina; Azorín, Sebastián; Selgas, Rafael

2011-01-01

We report the case of a 38-year-old male with autosomal-dominant polycystic kidney disease (ADPKD) and concomitant nephrotic syndrome secondary to membranous nephropathy (MN). A 3-month course of prednisone 60 mg daily and losartan 100 mg daily resulted in resistance. Treatment with chlorambucil 0.2 mg/kg daily, low-dose prednisone, plus an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) for 6 weeks resulted in partial remission of his nephrotic syndrome for a duration of 10 months. After relapse of the nephrotic syndrome, a 13-month course of mycophenolate mofetil (MFM) 2 g daily and low-dose prednisone produced complete remission for 44 months. After a new relapse, a second 24-month course of MFM and low-dose prednisone produced partial to complete remission of proteinuria with preservation of renal function. Thirty-six months after MFM withdrawal, complete remission of nephrotic-range proteinuria was maintained and renal function was preserved. This case supports the idea that renal biopsy is needed for ADPKD patients with nephrotic-range proteinuria in order to exclude coexisting glomerular disease and for appropriate treatment/prevention of renal function deterioration. To the best of our knowledge, this is the first reported case of nephrotic syndrome due to MN in a patient with ADPKD treated with MFM, with remission of proteinuria and preservation of renal function after more than 10 years. Findings in this patient also suggest that MFM might reduce cystic cell proliferation and fibrosis, preventing progressive renal scarring with preservation of renal function. PMID:21552769

Nephrotic Syndrome and Idiopathic Membranous Nephropathy Associated with Autosomal-Dominant Polycystic Kidney Disease

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Ramón Peces

2011-01-01

Full Text Available We report the case of a 38-year-old male with autosomal-dominant polycystic kidney disease (ADPKD and concomitant nephrotic syndrome secondary to membranous nephropathy (MN. A 3-month course of prednisone 60 mg daily and losartan 100 mg daily resulted in resistance. Treatment with chlorambucil 0.2 mg/kg daily, low-dose prednisone, plus an angiotensin-converting enzyme inhibitor (ACEI and an angiotensin II receptor blocker (ARB for 6 weeks resulted in partial remission of his nephrotic syndrome for a duration of 10 months. After relapse of the nephrotic syndrome, a 13-month course of mycophenolate mofetil (MFM 2 g daily and low-dose prednisone produced complete remission for 44 months. After a new relapse, a second 24-month course of MFM and low-dose prednisone produced partial to complete remission of proteinuria with preservation of renal function. Thirty-six months after MFM withdrawal, complete remission of nephrotic-range proteinuria was maintained and renal function was preserved. This case supports the idea that renal biopsy is needed for ADPKD patients with nephrotic-range proteinuria in order to exclude coexisting glomerular disease and for appropriate treatment/prevention of renal function deterioration. To the best of our knowledge, this is the first reported case of nephrotic syndrome due to MN in a patient with ADPKD treated with MFM, with remission of proteinuria and preservation of renal function after more than 10 years. Findings in this patient also suggest that MFM might reduce cystic cell proliferation and fibrosis, preventing progressive renal scarring with preservation of renal function.

Different flavonoids present in the micronized purified flavonoid fraction (Daflon 500 mg) contribute to its anti-hyperpermeability effect in the hamster cheek pouch microcirculation.

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Paysant, J; Sansilvestri-Morel, P; Bouskela, E; Verbeuren, T J

2008-02-01

This study evaluated microcirculatory effects of the flavonoid substances that constitute the micronized purified flavonoid fraction (MPFF) (Daflon 500 mg) in comparison to diosmin. In groups of 3 male hamsters, oral treatment with MPFF or diosmin (15 min before anesthesia) did not alter blood pressure. At 10 or 30 mg/kg, both MPFF and diosmin significantly decreased the leaky sites caused by ischemia/reperfusion (I/R) (30 min) in the hamster cheek pouch; the effect was significantly higher with MPFF (39+/-1% and 52+/-1%, respectively) than diosmin (18+/-1% and 37+/-3%, respectively). Eight groups of 3 hamsters each were treated with the components of MPFF. Diosmetin only decreased the number leaky sites at 30 mg/kg (decrease: 15+/-2%). The decrement at 10 and 30 mg/kg averaged at: 17+/-3% and 44+/-1%, respectively, for hesperidin; 19+/-1% and 46+/-2%, respectively, for linarin; and 30+/-1% and 44+/-1%, respectively, for isorhoifolin. Hesperidin, linarin, and isorhoifolin each displayed an anti-leakage effect comparable to or greater than diosmin. MPFF decreases permeability more than any of its single constituents, suggesting that the flavonoids present in its formulation have a synergistic action. These results illustrate that MPFF is more potent than single diosmin in this model of hyperpermeability and that each of the flavonoid substances present in MPFF contribute to its action.

Average bioequivalence of single 500 mg doses of two oral formulations of levofloxacin: a randomized, open-label, two-period crossover study in healthy adult Brazilian volunteers

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Eunice Kazue Kano

2015-03-01

Full Text Available Average bioequivalence of two 500 mg levofloxacin formulations available in Brazil, Tavanic(c (Sanofi-Aventis Farmacêutica Ltda, Brazil, reference product and Levaquin(c (Janssen-Cilag Farmacêutica Ltda, Brazil, test product was evaluated by means of a randomized, open-label, 2-way crossover study performed in 26 healthy Brazilian volunteers under fasting conditions. A single dose of 500 mg levofloxacin tablets was orally administered, and blood samples were collected over a period of 48 hours. Levofloxacin plasmatic concentrations were determined using a validated HPLC method. Pharmacokinetic parameters Cmax, Tmax, Kel, T1/2el, AUC0-t and AUC0-inf were calculated using noncompartmental analysis. Bioequivalence was determined by calculating 90% confidence intervals (90% CI for the ratio of Cmax, AUC0-t and AUC0-inf values for test and reference products, using logarithmic transformed data. Tolerability was assessed by monitoring vital signs and laboratory analysis results, by subject interviews and by spontaneous report of adverse events. 90% CIs for Cmax, AUC0-t and AUC0-inf were 92.1% - 108.2%, 90.7% - 98.0%, and 94.8% - 100.0%, respectively. Observed adverse events were nausea and headache. It was concluded that Tavanic(c and Levaquin(c are bioequivalent, since 90% CIs are within the 80% - 125% interval proposed by regulatory agencies.

Ensaio clinico com Teclozan: 500mg no tratamento da colite amebiana não disentérica. (Resultados com esquema terapêutico de 24 horas

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Donald Huggins

1978-12-01

Full Text Available O Autor relata sua experiência com novo esquema terapêutico com Teclozan - dose total de 1.500mg empregada em 24 horas, em 40 pacientes portadores de colite amebiana não disentérica na Disciplina de Doenças Infecciosas e Parasitárias da Universidade Federal de Pernambuco. Após um controle de cura realizado no 4º, 8º, 12º e 20º dias após o tratamento, obteve eficácia em 75% dos enfermos (30 casos e excelente tolerância.

Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation

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Sara Querido

2015-01-01

Full Text Available A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS. A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.

Mycophenolate fetal toxicity and risk evaluation and mitigation strategies.

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Kim, M; Rostas, S; Gabardi, S

2013-06-01

The mycophenolic acid (MPA) preparations are one of the most commonly used immunosuppressants in the United States. However, these agents carry a black box warning regarding their use during pregnancy due to an association with increased risk of miscarriage and congenital defects. To ensure that the benefits of MPA outweigh the risks, the Food and Drug Administration (FDA) required all manufacturers of MPA products to propose risk evaluation and mitigation strategies (REMS). Four years after initially calling for proposals, the FDA approved a single shared REMS system in September 2012. The elements of the MPA REMS include a medication guide and elements to assure safe use (ETASU). The medication guide, which was previously FDA-approved in 2008, should continue to be distributed to patients, and the ETASU requires physicians to complete training and obtain patient signatures on the "Patient-Prescriber Acknowledgement Form." A single, national, voluntary pregnancy registry is available, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA products among patients and possibly practitioners. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

How large are the differences between originator and generic prices? Analysis of five molecules in 16 European countries

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Sabine Vogler

2012-12-01

Full Text Available OBJECTIVE: To survey the price differences between originators and generics for a selected basket of molecules and to analyze similarities and differences with regard to the countries included and their generic policies. METHODS: Ex-factory prices as of November 2011 of five molecules provided from the Pharma Price Information (PPI service of the Austrian Health Institute were analyzed for 16 European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Norway, Portugal, Spain, Switzerland, Sweden, UK. The selected molecules were gemcitabine, mycophenolate mofetil, olanzapine, risperidone and sumatriptan. For a specific presentation (same pack size, dosage and pharmaceutical form of each molecule, the prices of the original product and the “most common generic” as defined by PPI were compared. RESULTS: Considerable variations among the extent of price differences between originator and generic were identified (gemicitabine: lowest price difference of 1.4% between originator and generic in Belgium and highest difference of 73.4% in Portugal; mycophenolate mofetil: 3.4% Norway – 71.7% Netherlands; olanzapine: 0.1% Spain – 97.1% Sweden; risperidone: 0.9% Netherlands – 97.3% UK; sumatriptan: 5.8% Greece – 95.0% Denmark. Further, no difference at all between originator and generic prices was found for some molecules in a few countries (Norway: for 4 of the 5 molecules analyzed; Spain: 3; Belgium: 2; in Austria, France and Greece for one molecule respectively. For the five molecules of the sample, Greece, Spain, Ireland and Norway consistently displayed lower price differences whereas Denmark, Finland and Sweden tended to show higher differences between originator and generic prices. CONCLUSION: Even if this research is illustrative and not representative due to the small sample size, results suggest confirming large differences across Europe. It appears that countries (e.g. Denmark

"Determination of mycophenolic acid in human plasma by high-performance liquid chromatography"

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"Mehdi Ahadi Barzoki

2005-05-01

Full Text Available A simple, sensitive and reproducible HPLC method is presented for determination of mycophenolic acid(MPA in human plasma. Samples were prepared after precipitation of the plasma protein by addition of acetonitrile and naproxen was used as internal standard (I.S.. Separation was performed by reversedphase HPLC, using a Hamilton PRP-C18 Column, 51% acetonitrile and 49% potassium phosphate buffer (20 mM at pH 3.0 as mobile phase, flow rate of 1.0 ml/min, and UV detection at 215 nm. MPA and I.S. had retention times of 7.5 and 11.35 min, respectively. The method showed an acceptable linearity in the range of 0.1µg/ml-40µg/ml with r2 of .9992. The concentration of 0.1µg/ml was determined as quantification limit. Mean absolute recovery was 94.8%. The mean intra- and inter-day reproducibility of method was 4.6 and 11.4% respectively.

Evaluation of Multiple Linear Regression-Based Limited Sampling Strategies for Enteric-Coated Mycophenolate Sodium in Adult Kidney Transplant Recipients.

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Brooks, Emily K; Tett, Susan E; Isbel, Nicole M; McWhinney, Brett; Staatz, Christine E

2018-04-01

Although multiple linear regression-based limited sampling strategies (LSSs) have been published for enteric-coated mycophenolate sodium, none have been evaluated for the prediction of subsequent mycophenolic acid (MPA) exposure. This study aimed to examine the predictive performance of the published LSS for the estimation of future MPA area under the concentration-time curve from 0 to 12 hours (AUC0-12) in renal transplant recipients. Total MPA plasma concentrations were measured in 20 adult renal transplant patients on 2 occasions a week apart. All subjects received concomitant tacrolimus and were approximately 1 month after transplant. Samples were taken at 0, 0.33, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 6, and 8 hours and 0, 0.25, 0.5, 0.75, 1, 1.25, 1.5, 2, 3, 4, 6, 9, and 12 hours after dose on the first and second sampling occasion, respectively. Predicted MPA AUC0-12 was calculated using 19 published LSSs and data from the first or second sampling occasion for each patient and compared with the second occasion full MPA AUC0-12 calculated using the linear trapezoidal rule. Bias (median percentage prediction error) and imprecision (median absolute prediction error) were determined. Median percentage prediction error and median absolute prediction error for the prediction of full MPA AUC0-12 were multiple linear regression-based LSS was not possible without concentrations up to at least 8 hours after the dose.

Maintenance immunosuppression with intermittent intravenous IL-2 receptor antibody therapy in renal transplant recipients.

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Gabardi, Steven; Catella, Jennifer; Martin, Spencer T; Perrone, Ronald; Chandraker, Anil; Magee, Colm C; McDevitt-Potter, Lisa M

2011-09-01

To report what we believe to be the first 2 cases of long-term (>24 months) intermittent intravenous interleukin-2 receptor antibody (IL-2RA) therapy for maintenance immunosuppression following renal transplantation. The first patient is a 52-year-old female with a history of intolerance to calcineurin inhibitors (CNIs) and sirolimus. Following her second transplant, the patient received mycophenolate mofetil 100 mg twice daily, a tapering corticosteroid regimen (initial dose of methylprednisolone 500 mg tapered over 1 week to prednisone 30 mg/day), and biweekly intravenous daclizumab 1-1.2 mg/kg/dose; 33 months after transplant the IL-2RA was changed to intravenous basiliximab 40 mg once a month. At 40 months after transplant, the patient continued to have stable renal function (estimated glomerular filtration rate 48 mL/min/1.73 m²) with excellent tolerability. The second patient is a 59-year-old female also intolerant to CNIs and sirolimus who required intermittent maintenance therapy with intravenous basiliximab 20 mg/dose. Despite an initial rejection episode, the patient tolerated more than 2 years of basiliximab therapy with good renal function (estimated glomerular filtration rate 103 months after transplant 69 mL/min/1.73 m²) and no adverse events. The IL-2RAs basiliximab and daclizumab possess several characteristics of ideal maintenance immunosuppressive agents (ie, nondepleting, long half-lives, limited adverse events). Based on a MEDLINE search (through December 31, 2010) using the search terms basiliximab, daclizumab, organ transplant, immunosuppression, and/or maintenance immunosuppression, and an advanced search in the published abstracts from the American Transplant Congress and World Transplant Congress (2000-2010), it appears that IL-2RAs have been used successfully as short-term therapy in both renal and extrarenal transplant recipients to allow for renal recovery following CNI-induced nephrotoxicity. In heart transplant recipients, the IL-2

Factors associated with prolonged time to treatment failure with fulvestrant 500 mg in patients with post-menopausal estrogen receptor-positive advanced breast cancer: a sub-group analysis of the JBCRG-C06 Safari study.

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Kawaguchi, Hidetoshi; Masuda, Norikazu; Nakayama, Takahiro; Aogi, Kenjiro; Anan, Keisei; Ito, Yoshinori; Ohtani, Shoichiro; Sato, Nobuaki; Saji, Shigehira; Takano, Toshimi; Tokunaga, Eriko; Nakamura, Seigo; Hasegawa, Yoshie; Hattori, Masaya; Fujisawa, Tomomi; Morita, Satoshi; Yamaguchi, Miki; Yamashita, Hiroko; Yamashita, Toshinari; Yamamoto, Yutaka; Yotsumoto, Daisuke; Toi, Masakazu; Ohno, Shinji

2018-01-01

The JBCRG-C06 Safari study showed that earlier fulvestrant 500 mg (F500) use, a longer time from diagnosis to F500 use, and no prior palliative chemotherapy were associated with significantly longer time to treatment failure (TTF) among Japanese patients with estrogen receptor-positive (ER+) advanced breast cancer (ABC). The objective of this sub-group analysis was to further examine data from the Safari study, focusing on ER + and human epidermal growth factor receptor-negative (HER2-) cases. The Safari study (UMIN000015168) was a retrospective, multi-center cohort study, conducted in 1,072 patients in Japan taking F500 for ER + ABC. The sub-analysis included only patients administered F500 as second-line or later therapy (n = 960). Of these, 828 patients were HER2-. Results Multivariate analysis showed that advanced age (≥65 years; p = .035), longer time (≥3 years) from ABC diagnosis to F500 use (p < .001), no prior chemotherapy (p < .001), and F500 treatment line (p < .001) were correlated with prolonged TTF (median = 5.39 months). In ER+/HER2- patients receiving F500 as a second-line or later therapy, treatment line, advanced age, no prior palliative chemotherapy use, and a longer period from ABC diagnosis to F500 use were associated with longer TTF.

Infectious complications in living-donor kidney transplant recipients undergoing multi-modal desensitization.

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Turza, Kristin C; Shafique, Michael; Lobo, Peter I; Sawyer, Robert G; Keith, Douglas S; Brayman, Kenneth L; Agarwal, Avinash

2014-06-01

Pre-existing humoral barriers challenge the transplantation of living donor kidneys (LDK) into highly sensitized ABO- and human leukocyte antigen (HLA)-incompatible recipients. Conditioning these LDK recipients' immune systems is required before they undergo transplantation. We hypothesized that medical desensitization would yield higher post-transplantation rates of infection. We conducted a study in which matched controls consisting of non-desensitized (NDS) LDK recipients were compared with desensitized (DS) receipients. Pre-transplantation desensitization included treatment with rituximab and mycophenolate mofetil followed by intravenous immunoglobulin (IVIg) and plasmapheresis. All participants in the study underwent induction therapy and maintenance immunosuppression. Primary outcomes included infection (opportunistic, local, systemic) within 12 mo after transplantation. Twenty-five patients underwent desensitization and LDK transplantation. Graft survival in the DS and NDS groups of patients was 96% and 98%, respectively. The mean 3- and 12-mo serum creatinine concentrations in the DS and NDS groups were 1.1±0.2 mg/dL and 1.2±0.3 mg/dL and 0.95±0.4 mg/dL and 0.73±0.8 mg/dL (p=0.3 and p=0.01), respectively. Thirty-six percent of the patients in the DS group had one or more infections, vs. 28% of those in the NDS group (p=0.1). No difference was observed in the frequency of opportunistic or systemic infections in the two groups. Local infections were statistically significantly more frequent in the DS group (60% vs. 30%, respectively; p=0.02). Pre-operative desensitization in highly sensitized LDK recipients is followed by a similar incidence of opportunistic and systemic infections as in NDS patients. Local infections were significantly more frequent in the DS than in the NDS patients in the study. With careful monitoring of infectious complications, pre-transplant desensitization permits LDK transplantation into highly sensitized patients.

A Multicenter, Randomized Study to Evaluate the Efficacy and Safety of Mesalamine Suppositories 1 g at Bedtime and 500 mg Twice Daily in Patients with Active Mild-to-Moderate Ulcerative Proctitis

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2010-01-01

Abstract Background Ulcerative proctitis (UP) is a prevalent condition associated with increased morbidity and mortality. Topical mesalamine (5-aminosalicylic acid [5-ASA]) inhibits inflammatory processes in UP. Methods We evaluated effects of mesalamine 1-g suppository administered QHS compared with 500-mg suppository administered BID on UP activity (e.g., disease extension/mucosal appearance), remission, onset of response, safety and compliance in 97 patients with UP. A 6-week, randomized, multicenter, parallel-group, noninferiority study was conducted (and published) with Disease Activity Index (DAI) at week 6 as the primary efficacy variable and individual components of DAI at week 6 (i.e., stool frequency, rectal bleeding, mucosal appearance, global assessment) as secondary variables. Unreported outcomes were remission (DAI 70%) after 6 weeks in both groups. Mesalamine was well tolerated. Compliance was >96%. Conclusions Mesalamine 500-mg BID and 1-g QHS suppositories are safe and effective for patients with UP. Most patients reported significant improvement within 3 weeks and UP remission and reduced disease extension after 6 weeks of treatment. Validity of QHS administration was confirmed. PMID:20676771

Generalized subcutaneous edema as a rare manifestation of dermatomyositis: clinical lesson from a rare feature.

LENUS (Irish Health Repository)

Haroon, Muhammad

2011-04-01

Generalized subcutaneous edema is a very rare manifestation of inflammatory myopathies. A 61-year-old woman presented with classic signs and symptoms of dermatomyositis. She was also noted to have generalized edema that was so florid that an alternative diagnosis was considered. Her disease was resistant to corticosteroids, azathioprine, and mycophenolate mofetil. Intravenous administration of immunoglobulins was started because of marked worsening of her disease-muscle weakness, generalized anasarca, and involvement of her bulbar muscles. This led to dramatic resolution of her subcutaneous edema and significant improvement of her skin and muscle disease. As the initial screen for malignancy was negative, a positron emission tomography-computed tomography scan was requested, which interestingly showed a metabolically active cervical tumor. Anasarca is an unusual manifestation of dermatomyositis. In treatment-refractory cases, it seems reasonable to consider positron emission tomography scan in excluding underlying malignant disease.

Treatment of pediatric chronic inflammatory demyelinating polyneuropathy: Challenges, controversies, and questions

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Jay Desai

2015-01-01

Full Text Available Pediatric chronic inflammatory demyelinating polyneuropathy (CIDP is an uncommon acquired disorder of unknown cause, presumed to have an immunological basis. We report 20 patients seen at Children′s Hospital Los Angeles over a period of 10 years. The outcome of our patients was favorable in a vast majority with good response to various treatments instituted. However, residual neurologic deficit was common. The choice of treatment modality was empirical and selected by the treating neurologist. Intravenous immunoglobulin (IVIG and corticosteroids were most commonly utilized for treatment. Plasmapheresis, mycophenolate mofetil, rituximab, cyclophosphamide, azathioprine, and abatacept were added if the patients were refractory to IVIG or became corticosteroid dependent. The spectrum of disease severity ranged from a single monophasic episode, to multiphasic with infrequent relapses with good response to IVIG, to progressive disease refractory to multiple therapies.

Methods, strengths, weaknesses, and limitations of bioequivalence tests with special regard to immunosuppressive drugs.

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van Gelder, Teun; Gabardi, Steven

2013-08-01

Within the field of solid organ transplantation, the patents for a number of immunosuppressive drugs have expired in the last few years. Tacrolimus, cyclosporine, and mycophenolate mofetil are now available as generic drugs. In some countries, the market penetration of these generic formulations is as high as 70%, whereas in some other countries, this figure is below 10%. Several professional societies have published position papers on the risks and benefits of generic substitution of immunosuppressive drugs. It often appears that transplant professionals are not fully aware of the requirements for registration of generic drugs. This article describes the registration requirements with a focus on bioequivalence testing, the strengths and weaknesses in this process, and the differences between Europe and the US. © 2013 The Authors Transplant International © 2013 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.

Neuropsychiatric Systemic Lupus Erythematosus

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Popescu, Alexandra; Kao, Amy H

2011-01-01

Neuropsychiatric systemic lupus erythematosus (NPSLE) is the least understood, yet perhaps the most prevalent manifestation of lupus. The pathogenesis of NPSLE is multifactorial and involves various inflammatory cytokines, autoantibodies, and immune complexes resulting in vasculopathic, cytotoxic and autoantibody-mediated neuronal injury. The management of NPSLE is multimodal and has not been subjected to rigorous study. Different treatment regimens include nonsteroidal anti-inflammatory drugs, anticoagulation, and immunosuppressives such as cyclophosphamide, azathioprine, mycophenolate mofetil, and methotrexate. For refractory NPSLE, intravenous immunoglobulin (IVIG), plasmapheresis, and rituximab have been used. Adjunctive symptomatic treatment complements these therapies by targeting mood disorders, psychosis, cognitive impairment, seizures or headaches. Several new biological agents are being tested including Belimumab, a human monoclonal antibody that targets B lymphocyte stimulator. This review focuses on the pathophysiology, treatment, and new potential therapies for neuropsychiatric manifestations of systemic lupus erythematosus. PMID:22379459

Oral Valganciclovir as a Preemptive Treatment for Cytomegalovirus (CMV Infection in CMV-Seropositive Liver Transplant Recipients.

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Jong Man Kim

Full Text Available Cytomegalovirus (CMV infections in liver transplant recipients are common and result in significant morbidity and mortality. Intravenous ganciclovir or oral valganciclovir are the standard treatment for CMV infection. The present study investigates the efficacy of oral valganciclovir in CMV infection as a preemptive treatment after liver transplantation.Between 2012 and 2013, 161 patients underwent liver transplantation at Samsung Medical Center. All patients received tacrolimus, steroids, and mycophenolate mofetil. Patients with CMV infection were administered oral valganciclovir (VGCV 900mg/day daily or intravenous ganciclovir (GCV 5mg/kg twice daily as preemptive treatment. Stable liver transplant recipients received VGCV.Eighty-three patients (51.6% received antiviral therapy as a preemptive treatment because of CMV infection. The model for end-stage liver disease (MELD score and the proportions of Child-Pugh class C, hepatorenal syndrome, and deceased donor liver transplantation in the CMV infection group were higher than in the no CMV infection group. Sixty-one patients received GCV and 22 patients received VGCV. The MELD scores in the GCV group were higher than in the VGCV group, but there were no statistical differences in the pretransplant variables between the two groups. AST, ALT, and total bilirubin levels in the GCV group were higher than in the VGCV group when CMV infection occurred. The incidences of recurrent CMV infection in the GCV and VGCV groups were 14.8% and 4.5%, respectively (P=0.277.Oral valganciclovir is feasible as a preemptive treatment for CMV infection in liver transplant recipients with stable graft function.

Generic maintenance immunosuppression in solid organ transplant recipients.

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Ensor, Christopher R; Trofe-Clark, Jennifer; Gabardi, Steven; McDevitt-Potter, Lisa M; Shullo, Michael A

2011-11-01

Survival after solid organ transplantation has increased in the era of tacrolimus and mycophenolate. This increased survival could be due in part to the broad clinical use of these potent and specific agents for maintenance immunosuppression. These drugs have enhanced specificity and potency for T and B lymphocytes compared with their predecessors, cyclosporine and azathioprine. Between 2008 and 2010, the United States Food and Drug Administration approved several generic formulations of both tacrolimus and mycophenolate mofetil. Deciding whether generic products can be safely substituted for the innovator product is a clinical dilemma similar to that which occurred when generic formulations of cyclosporine became available. We describe the concerns regarding generic immunosuppression use, summarize expert opinion and consensus statements in transplantation, analyze the potential impact of generic substitution, and provide estimates of populations affected based on generic drug market penetration. Formulary considerations such as cost, availability, and potential drug ordering and drug selection errors are described, and transplant coordinator and patient perspectives are reviewed. Finally, general recommendations about the use of generic maintenance immunosuppression in solid organ transplant recipients are provided. Although more research is needed to confirm clinical and therapeutic equivalence and pharmacoeconomic benefit, generic immunosuppressants can be safely substituted for innovator products as long as patients consistently receive the same product, patients and clinicians are aware of when substitutions occur, and enhanced therapeutic drug monitoring is provided during the transition.

Anticancer drugs in Portuguese surface waters - Estimation of concentrations and identification of potentially priority drugs.

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Santos, Mónica S F; Franquet-Griell, Helena; Lacorte, Silvia; Madeira, Luis M; Alves, Arminda

2017-10-01

Anticancer drugs, used in chemotherapy, have emerged as new water contaminants due to their increasing consumption trends and poor elimination efficiency in conventional water treatment processes. As a result, anticancer drugs have been reported in surface and even drinking waters, posing the environment and human health at risk. However, the occurrence and distribution of anticancer drugs depend on the area studied and the hydrological dynamics, which determine the risk towards the environment. The main objective of the present study was to evaluate the risk of anticancer drugs in Portugal. This work includes an extensive analysis of the consumption trends of 171 anticancer drugs, sold or dispensed in Portugal between 2007 and 2015. The consumption data was processed aiming at the estimation of predicted environmental loads of anticancer drugs and 11 compounds were identified as potentially priority drugs based on an exposure-based approach (PEC b > 10 ng L -1 and/or PEC c > 1 ng L -1 ). In a national perspective, mycophenolic acid and mycophenolate mofetil are suspected to pose high risk to aquatic biota. Moderate and low risk was also associated to cyclophosphamide and bicalutamide exposition, respectively. Although no evidences of risk exist yet for the other anticancer drugs, concerns may be associated with long term effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Three-Year Outcomes in Kidney Transplant Patients Randomized to Steroid-Free Immunosuppression or Steroid Withdrawal, with Enteric-Coated Mycophenolate Sodium and Cyclosporine: The Infinity Study

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A. Thierry

2014-01-01

Full Text Available In a six-month, multicenter, open-label trial, de novo kidney transplant recipients at low immunological risk were randomized to steroid avoidance or steroid withdrawal with IL-2 receptor antibody (IL-2RA induction, enteric-coated mycophenolate sodium (EC-MPS: 2160 mg/day to week 6, 1440 mg/day thereafter, and cyclosporine. Results from a 30-month observational follow-up study are presented. Of 166 patients who completed the core study on treatment, 131 entered the follow-up study (70 steroid avoidance, 61 steroid withdrawal. The primary efficacy endpoint of treatment failure (clinical biopsy-proven acute rejection (BPAR graft loss, death, or loss to follow-up occurred in 21.4% (95% CI 11.8–31.0% of steroid avoidance patients and 16.4% (95% CI 7.1–25.7% of steroid withdrawal patients by month 36 (P=0.46. BPAR had occurred in 20.0% and 11.5%, respectively (P=0.19. The incidence of adverse events with a suspected relation to steroids during months 6–36 was 22.9% versus 37.1% (P=0.062. By month 36, 32.4% and 51.7% of patients in the steroid avoidance and steroid withdrawal groups, respectively, were receiving oral steroids. In conclusion, IL-2RA induction with early intensified EC-MPS dosing and CNI therapy in de novo kidney transplant patients at low immunological risk may achieve similar three-year efficacy regardless of whether oral steroids are withheld for at least three months.

From Leflunomide to Teriflunomide: Drug Development and Immunosuppressive Oral Drugs in the Treatment of Multiple Sclerosis.

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Aly, Lilian; Hemmer, Bernhard; Korn, Thomas

2017-01-01

Immunosuppressive drugs have been used in the treatment of multiple sclerosis (MS) for a long time. Today, orally available second generation immunosuppressive agents have been approved or are filed for licensing as MS therapeutics. Due to semi-selective targeting of cellular processes, these second-generation immunosuppressive compounds might rather be immunomodulatory. For example, Teriflunomide inhibits the de novo pyrimidine synthesis and thus only targets rapidly proliferating cells, including lymphocytes. It is used as first line disease modifying therapy (DMT) in relapsing-remitting MS (RRMS). Review of online content related to oral immunosuppressants in MS with an emphasis on Teriflunomide. Teriflunomide and Cladribine are second-generation immunosuppressants that are efficient in the treatment of MS patients. For Teriflunomide, a daily dose of 14 mg reduces the annualized relapse rate (ARR) by more than 30% and disability progression by 30% compared to placebo. Cladribine reduces the ARR by about 50% compared to placebo but has not yet been licensed due to unresolved safety concerns. We also discuss the significance of older immunosuppressive compounds including Azathioprine, Mycophenolate mofetile, and Cyclophosphamide in current MS therapy. Teriflunomide has shown a favorable safety and efficacy profile in RRMS and is a therapeutic option for a distinct group of adult patients with RRMS. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

HLA antibody-incompatible kidney transplantation between jehovah's witnesses--a case report.

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Greenberg, A; Macphee, I; Popoola, J; Sage, D; Iqbal, R; Fossati, N; Heap, S; Morsy, M; Kessaris, N

2013-06-01

Desensitization before HLA antibody-incompatible (HLAi) transplantation involves nonspecific apheresis of HLA antibodies. Clotting factors and albumin are also removed and have to be replaced. This makes transplantation difficult because it increases the risk of bleeding. Such risk is further compounded when certain blood products are refused on religious grounds. We present a case of successful HLAi transplantation in a Jehovah's Witness across a positive-flow cytometric HLA crossmatch from a live donor who was also a Jehovah's Witness. This was achieved by giving rituximab 1 month before transplantation and starting prednisolone, tacrolimus, and mycophenolate mofetil 10 days before surgery. In preparation, the patient also underwent 4 sessions of double-filtration plasma exchange each followed by low-dose intravenous immunoglobulin. The night before transplantation, the fibrinogen was low, requiring 2 pools of cryoprecipitate. The organ was retrieved through laparoscopic hand-assisted retroperitoneoscopic nephrectomy and transplanted into the recipient with no complications. In addition, the patient received basiliximab during surgery. Sixteen months after transplantation the serum creatinine was 70 μmol/L (0.79 mg/dL) and there were no rejection episodes. To our knowledge this is the world's first live-related kidney transplant across the HLAi barrier between 2 Jehovah's Witnesses. This case may allow further HLAi transplants to be carried out in Jehovah's Witnesses in the future around the world. Copyright © 2013 Elsevier Inc. All rights reserved.

500 kyr of Indian Ocean Walker Circulation Variability Using Foraminiferal Mg/Ca and Stable Isotopes

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Groeneveld, J.; Mohtadi, M.; Lückge, A.; Pätzold, J.

2017-12-01

The tropical Indian Ocean is a key location for paleoclimate research affected by different oceanographic and atmospheric processes. Annual climate variations are strongly controlled by the Indian and Asian Monsoon characterized by bi-annually reversing trade winds. Inter-annual climate variations in the Walker circulation are caused by the Indian Ocean Dipole and El Niño-Southern Oscillation resulting in either heavy flooding or severe droughts like for example the famine of 2011 in eastern Africa. Oceanographically the tropical western Indian Ocean receives water masses from the Indonesian Gateway area, sub-Antarctic waters that upwell south of the equator, and the outflow waters from the highly saline Red Sea. On the other hand, the tropical western Indian Ocean is a major source for providing water masses to the Agulhas Current system. Although the eastern Indian Ocean has been studied extensively, the tropical western Indian Ocean is still lacking in high quality climate-archives that have the potential to provide important information to understand how the ocean and atmospheric zonal circulation have changed in the past, and possibly will change in the future. Until now there were no long sediment cores available covering several glacial-interglacial cycles in the tropical western Indian Ocean. Core GeoB 12613-1, recovered during RV Meteor Cruise M75/2 east of the island of Pemba off Tanzania, provides an open-ocean core with well-preserved sediments covering the last five glacial-interglacial cycles ( 500 kyr). Mg/Ca and stable isotopes on both surface- and thermocline dwelling foraminifera have been performed to test how changes in sea water temperatures and relative sea water salinity were coupled on orbital time scales. The results are compared with similar records generated for the tropical eastern Indian Ocean in core SO139-74KL off Sumatra. Water column stratification on both sides of the Indian Ocean and the cross-basin gradients in sea water

Treatment of severe insulin resistance in pregnancy with 500 units per milliliter of concentrated insulin.

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Mendez-Figueroa, Hector; Maggio, Lindsay; Dahlke, Joshua D; Daley, Julie; Lopes, Vrishali V; Coustan, Donald R; Rouse, Dwight J

2013-07-01

To evaluate glycemic control and pregnancy outcomes among pregnant women with severe insulin resistance treated with 500 units/mL concentrated insulin. Retrospective analysis of gravid women with severe insulin resistance (need for greater than 100 units of insulin per injection or greater than 200 units/d) treated with either 500 units/mL concentrated insulin or conventional insulin therapy. We performed a two-part analysis: 1) between gravid women treated with and without 500 units/mL concentrated insulin; and 2) among gravid women treated with 500 units/mL concentrated insulin, comparing glycemic control before and after its initiation. Seventy-three pregnant women with severe insulin resistance were treated with 500 units/mL concentrated insulin and 78 with conventional insulin regimens. Patients treated with 500 units/mL concentrated insulin were older and more likely to have type 2 diabetes mellitus. Average body mass index was comparable between both groups (38.6 compared with 40.4, P=.11) as were obstetric and perinatal outcomes and glycemic control during the last week of gestation. Within the 500 units/mL concentrated insulin cohort, after initiation of this medication, fasting and postprandial blood glucose concentrations improved. However, the rates of blood glucose values less than 60 mg/dL and less than 50 mg/dL were higher in the 500 units/mL concentrated insulin group after initiation than before, 4.8% compared with 2.0% (Pinsulin in severely obese insulin-resistant pregnant women confers similar glycemic control compared with traditional insulin regimens but may increase the risk of hypoglycemia. II.

76 FR 14023 - Determination that ROCEPHIN (Ceftriaxone Sodium) Injection, 250 Milligrams, 500 Milligrams, 1...

Science.gov (United States)

2011-03-15

... 10 Grams Base/Vial, Approved Under New Drug Application 050585, Were Not Withdrawn From Sale for... milligrams (mg), 500mg, 1 gram (g), 2g, and 10g base/vial, approved under new drug application (NDA) 050585... active ingredient in the same strength and dosage form as the ``listed drug,'' which is a version of the...

Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders.

Science.gov (United States)

Mealy, Maureen A; Kim, Su-Hyun; Schmidt, Felix; López, Reydmar; Jimenez Arango, Jorge A; Paul, Friedemann; Wingerchuk, Dean M; Greenberg, Benjamin M; Kim, Ho Jin; Levy, Michael

2017-08-01

Debate exists about whether neuromyelitis optica spectrum disorder seronegative disease represents the same immune-mediated attack on astrocytic aquaporin-4 as in seropositive disease. We investigated whether response to common treatments for neuromyelitis optica spectrum disorder differed by serostatus, as assessed by change in annualized relapse rate. We performed a multicenter retrospective analysis of 245 patients with neuromyelitis optica spectrum disorder who were treated with either rituximab or mycophenolate mofetil as their first-line immunosuppressive treatment for disease prevention. Patients were followed for a minimum of 6 months following treatment initiation. In those started on rituximab, the pre-treatment annualized relapse rates for seropositive and seronegative patients were 1.81 and 1.93, respectively. On-treatment annualized relapse rates significantly declined to 0.32 (seropositive; p optica spectrum disorder patients, treatment was effective regardless of serostatus. This suggests that treatment should not differ when considering these treatments.

Photoletter to the editor: Oral ulceration in pyoderma gangrenosum.

LENUS (Irish Health Repository)

Verma, Saroj

2012-02-01

A 65-year-old woman presented with widespread necrotising cutaneous ulceration and oral involvement. Past history included rheumatoid arthritis, and a left nephrectomy.Examination revealed multiple violaceous undermined ulcers. Blood investigations showed an acute inflammatory response. Skin histopathology showed epidermal ulceration with acute and chronic inflammation. Direct immunofluorescence was negative. A diagnosis of pyoderma gangrenosum with oral involvement was made. Mycophenolate mofetil therapy resulted in complete resolution of her pyoderma gangrenosum. Her treatment was complicated by a left proteus mirabilis psoas abscess. This resolved following four weeks of antibiotics.Pyoderma gangrenosum with oral involvement is rare but has been linked with inflammatory bowel disease and hematological disorders. Oral pyoderma gangrenosum has not previously been described in rheumatoid arthritis. Primary psoas abscess is rare but can develop in immunocompromised patients. Proteus mirabilis has been reported in patients years after nephrectomy. This is a rare case of pyoderma gangrenosum with oral involvement.

Therapeutic Plasmapheresis in Kidney Transplantation

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Zeynep Kendi Celebi

2013-02-01

Full Text Available In 1960's, with succesfully renal transplantations, acute rejection became to be a serious problem for graft survival. From 1965 to 2010, with the introduction of new immunosuppressant agents such as cyclosporine, mycophenolate mofetile and tacrolimus, the acute rejection rates declined from 80% to 10% . There is an ongoing gradual improvement in allograft survival. Use of Therapeutic plasma exchange (TPE is not evidence based treatment, but TPE is necessary for pre- and also post transplantation in patients with DSA. TPE is also a main treatment for antibody mediated rejection (AMR , but in clinical practice the duration and frequency of TPE and individual difference of antibody production is unclear. There is a requirement for more specific antibody elimination. Further randomised controlled studies are needed to elucidate TPE use before and after kidney transplantation. [Dis Mol Med 2013; 1(1.000: 8-10

Morphea in Childhood: An Update.

Science.gov (United States)

Aranegui, B; Jiménez-Reyes, J

2018-05-01

Morphea is an inflammatory, fibrosing skin disorder. When it occurs in childhood, it is also known as localized juvenile scleroderma. It is more common in girls and typically appears around the age of 5 to 7 years. According to a recent classification system, morphea is divided into 5 types: circumscribed (plaque), linear, generalized, pansclerotic, and mixed. Approximately 40% of patients present extracutaneous manifestations. Childhood morphea is treated with phototherapy, oral or topical calcitriol, topical tacrolimus 0.1%, methotrexate, topical or systemic corticosteroids, mycophenolate mofetil, bosentán, and topical imiquimod 5%. A variety of measuring tools are used to monitor response to treatment. Few prognostic studies have been conducted, but findings to date suggest that the disease tends to run a chronic or intermittent-recurrent course and frequently causes sequelae. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Anaemia and fever in kidney transplant. The role of human parvovirus B19

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Yanet Parodis López

2017-03-01

We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence.

Sorption of malachite green (MG) by cassava stem biochar (CSB ...

African Journals Online (AJOL)

Cassava stem biochar (CSB) was produced by pyrolyzing CS at 500°C for 2 hours at nitrogen environment. Proximate and ultimate analyses were conducted on CS and CSB. Batch sorption experiment on synthetic MG wastewater was optimized for the sorbent dosage, MG solution pH and contact time. Sorption data was ...

Sensory evaluation of coob 500 chicken meat after application of different additives in their nutrition

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Martin Mellen

2014-02-01

Full Text Available The objective of the experiment was to verify the effect of different feed additives in nutrition of Cobb 500 broiler chickens  on the sensory quality of breast and thigh muscle modified by baking at temperature 200 ºC for 60 minutes. The experiment included 250 one-day-old Cobb 500 hybrid chickens, which were divided into 5 groups (n=50: control (I and experimental groups (E1 with Agolin Poultry at doses of 100 mg.kg-1, E2 with Agolin Tannin Plus at doses of 500 mg.kg-1, E3 with Biostrong 510+FortiBac at doses of 1000 mg.kg-1 and E4 with Agolin Acid at doses of 1000 mg.kg-1. The chickens were fed during 42 days of age by ad libitum system with feed mixtures: BR1 starter feed mixture (until the of 10th day of age, BR2 growth feed mixture (from 11th to 20th day of age, BR3 growth feed mixture (from 21st to 35th days of age and BR4 final feed mixture (from 36th to 42nd days of age. Feed mixtures were produced with coccidiostats in powder form. Panellists evaluate aroma, juiciness, taste and tenderness on 5 point hedonic scale where 1 (the worst and 5 (the best were the extremes of each characteristic. Significant differences were found between control and experimental group E3 in juiciness and tenderness of breast muscles and between control and experimental group E2 in smell of thigh muscles. Sensory evaluation of breast and thigh muscles in Cobb 500 chickens after application of different feed additives indicated that these additives have not worsened the quality of meat. The highest sensory score was obtained in experimental group E4 (with addition of Agolin Acid at the dose of 1000 mg.kg-1. Normal 0 21 false false false CS JA X-NONE

Acute tubulointerstitial nephritis with severe renal impairment associated with multisystem IgG4-related disease.

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Beltrame, Rafael Coimbra Ferreira; Friderichs, Maurício; Fior, Bárbara Rayanne; Schaefer, Pedro Guilherme; Thomé, Gustavo Gomes; Silva, Dirceu Reis da; Barros, Elvino José Guardão; Seligman, Renato; Veronese, Francisco Veríssimo

2016-01-01

The IgG4-related disease has a wide clinical spectrum where multiple organs can be affected, and the diagnosis depends on typical histopathological findings and an elevated IgG4 expression in plasma cells in the affected tissue. We describe the clinical presentation and evolution of a patient with acute tubulointerstitial nephritis, severe kidney failure and systemic manifestations such as lymphadenomegaly and chronic pancreatitis. The diagnosis was confirmed by the clinical picture and kidney and lymph node histopathology, in which immunohistochemistry of the lymphoid tissue showed policlonality and increased expression of IgG4, with a IgG4/total IgG ratio > 80%. The patient was treated with prednisone at a dose of 60 mg/day, followed by mycophenolate mofetil, and showed clinical and renal function improvement at 6 months of follow-up. The high index of suspicion of IgG4-related disease with multisystem involvement and the early treatment of this condition are essential to improve the prognosis of affected patients. Resumo A doença relacionada à IgG4 tem um espectro clínico amplo em que múltiplos órgãos podem ser afetados, e o diagnóstico depende de achados histopatológicos típicos e elevada expressão de IgG4 em plasmócitos no tecido afetado. Descrevemos o quadro clínico e a evolução de um paciente com nefrite túbulo-intersticial aguda, insuficiência renal grave e manifestações sistêmicas como linfoadenomegalias e pancreatite crônica. O diagnóstico foi confirmado pelas características clínicas e pela histopatologia renal e de linfonodo, na qual a imunohistoquímica mostrou tecido linfoide com policlonalidade e expressão aumentada de IgG4, com uma relação IgG4/IgG total > 80%. O paciente foi tratado com prednisona na dose de 60 mg/dia, seguido de micofenolato mofetil, e apresentou melhora clínica e da função renal depois de 6 meses de tratamento. O alto índice de suspeição da doença relacionada ao IgG4 com comprometimento multissist

Desensitization protocol in highly HLA-sensitized and ABO-incompatible high titer kidney transplantation.

Science.gov (United States)

Uchida, J; Machida, Y; Iwai, T; Naganuma, T; Kitamoto, K; Iguchi, T; Maeda, S; Kamada, Y; Kuwabara, N; Kim, T; Nakatani, T

2010-12-01

A positive crossmatch indicates the presence of donor-specific alloantibodies and is associated with a graft loss rate of >80%; anti-ABO blood group antibodies develop in response to exposure to foreign blood groups, resulting in immediate graft loss. However, a desensitization protocol for highly HLA-sensitized and ABO-incompatible high-titer kidney transplantation has not yet been established. We treated 6 patients with high (≥1:512) anti-A/B antibody titers and 2 highly HLA-sensitized patients. Our immunosuppression protocol was initiated 1 month before surgery and included mycophenolate mofetil (1 g/d) and/or low-dose steroid (methylprednisolone 8 mg/d). Two doses of the anti-CD20 antibody rituximab (150 mg/m(2)) were administered 2 weeks before and on the day of transplantation. We performed antibody removal with 6-12 sessions of plasmapheresis (plasma exchange or double-filtration plasmapheresis) before transplantation. Splenectomy was also performed on the day of transplantation. Postoperative immunosuppression followed the same regimen as ABO-compatible cases, in which calcineurin inhibitors were initiated 3 days before transplantation, combined with 2 doses of basiliximab. Of the 8 patients, 7 subsequently underwent successful living-donor kidney transplantation. Follow-up of our recipients showed that the patient and graft survival rates were 100%. Acute cellular rejection and antibody-mediated rejection episodes occurred in 1 of the 7 recipients. These findings suggest that our immunosuppression regimen consisting of rituximab infusions, splenectomy, plasmapheresis, and pharmacologic immunosuppression may prove to be effective as a desensitization protocol for highly HLA-sensitized and ABO-incompatible high-titer kidney transplantation. Copyright © 2010 Elsevier Inc. All rights reserved.

Initial Experience with ABO-incompatible Live Donor Renal Transplantation

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Meng-Kun Tsai

2006-01-01

Full Text Available The serious shortage of cadaveric organs has prompted the development of ABO-incompatible live donor renal transplantation. We report our experience of the initial two live donor ABO incompatible renal transplants at our hospital. The first patient was a 55-year-old type A female who received a kidney from her AB type husband. The second patient was a 27-year-old type O male who received renal transplantation from his type A father. Preconditioning immunosuppressive therapy in the two patients with tacrolimus, mycophenolate mofetil and methylprednisolone was started 7 days before transplantation. During the period of preconditioning, double filtration plasmapheresis (DFPP was employed to remove anti-A and -B antibodies. Laparoscopic splenectomy and renal transplantation were performed after the anti-donor ABO antibodies were reduced to a titer of 1:4. Rituximab, a humanized monoclonal anti-CD20 antibody, was administered to the second patient due to a rebound in the anti-A antibody titer during the preconditioning period. Under a tacrolimus-based immunosuppressive regimen, both patients recovered very well without any evidence of rejection. Serum creatinine levels were 1.0 and 1.4 mg/dL at 6 and 3 months after transplantation, respectively. These cases illustrate that with new immunosuppressive agents, DFPP and splenectomy, ABO-incompatible renal transplantation can be successfully conducted in end-stage renal disease patients whose only available live donors are blood group incompatible.

Desensitization with plasmapheresis and anti-Cd20 for ABO incompatible kidney transplantation from living donor: experience of a single center in Italy.

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Silvestre, C; Furian, L; Marson, P; Tison, T; Valente, M; Marchini, F; Rossi, B; Bonfante, L; Valerio, F; Cozzi, E; Rigotti, P

2014-09-01

Blood group incompatibility in kidney transplants from a living donor can be successfully overcome by using various desensitization protocols: intravenous immunoglobulin, plasmapheresis (PP), immunoadsorption, and double filtration PP. From July 2010 to October 2013, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP+cytomegalovirus immune globulin. All patients received induction with basiliximab, except 1 case treated with Thymoglobuline® (ATG) for the simultaneous presence of donor-specific antibody. Tacrolimus and mycophenolate mofetil were initiated at the time of desensitization and continued after the transplant. After a mean follow-up of 11.6±10.4 months, all patients are alive with a functioning graft. The mean serum creatinine concentration at 1 month, 3 months, 6 months, and 1 year was 1.48±0.29, 1.47±0.18, 1.47±0.27, and 1.5±0.27 mg/dl. Three episodes of acute cellular rejection occurred in 2 patients. There was only 1 case of BK virus infection, treated with reduction of immunosuppressive therapy. The protocol biopsy specimens at 1, 3, and 6 months were C4d positive in the absence of acute rejection. Desensitization with rituximab, PP, and anti-cytomegalovirus immune globulin allowed us to perform transplants from living donors to ABO incompatible recipients with excellent results and reduced costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Autoimmune retinopathy associated with systemic lupus erythematosus: A diagnostic dilemma

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Wadakarn Wuthisiri

2017-01-01

Full Text Available Visual loss in systemic lupus erythematosus (SLE due to autoimmune retinopathy (AIR is rare and easily misdiagnosed as hydroxychloroquine retinopathy. We report the rare clinical presentation of severe visual loss in a patient with SLE due to nonparaneoplastic AIR as differentiated from hydroxychloroquine toxicity. A 70-year-old female diagnosed and treated for lupus for 17 years and had been taking hydroxychloroquine for 15 years. Over the past 2 years, she developed progressive peripheral visual loss oculus uterque which rapidly advanced in the latter 6 months. Hydroxychloroquine toxicity was initially suspected, but diagnostic testing revealed a retinal degeneration. Antiretinal autoantibody testing using Western blot analysis revealed autoantibodies against 44-kDa, 46-kDa (anti-enolase, and 68-kDa proteins. Visual acuity improved in the first 6 months of treatment with mycophenolate mofetil. Our case suggests that AIR should be considered in the differential diagnosis of rapid, severe visual loss in patients with hydroxychloroquine treatment.

Defecation of a colon cast as a rare presentation of acute graft-versus-host disease

International Nuclear Information System (INIS)

Al Ashgar, Hamad; Peedikayil, Musthafa; Chaudhri, Naeem; AlGhamdi, Abdulmonem

2009-01-01

Diffuse involvement of the gastrointestinal tract by graft versus host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplant (HSCT). Gastrointestinal GVHD usually presents 3 or more weeks after HSCT and is characterized by profuse diarrhea, anorexia, nausea, vomiting, abdominal pain and gastrointestinal bleeding. We report a case of a 23 year old male who had undergone allogeneic HSCT and presented with bloody diarrhea on the 90th day post-HSCT. On the fourth day of admission, the patient passed per rectum a 27-cm long pinkish colored fleshy material recognized as a colon cast. Sigmoidoscopy showed a congested and erythematous rectum with the remaining portion of the colon cast attached to the proximal part of the sigmoid colon. A biopsy from the rectal wall was suggestive of grade 4 GVHD. The patient was treated with methylprednisolone, cyclosporine and mycophenolate mofetil, with a partial response (diarrhea and abdominal pain improved), but then he developed multiple other medical complications and died after 3 months. (author)

Type III Mixed Cryoglobulinemia and Antiphospholipid Syndrome in a Patient With Partial DiGeorge Syndrome

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Alice D. Chang

2006-01-01

Full Text Available We studied a 14 year-old boy with partial DiGeorge syndrome (DGS, status post complete repair of Tetralogy of Fallot, who developed antiphospholipid syndrome (APS and type III mixed cryoglobulinemia. He presented with recurrent fever and dyspnea upon exertion secondary to right pulmonary embolus on chest computed tomography (CT. Coagulation studies revealed homozygous methylene tetrahydrofolate reductase 677TT mutations, elevated cardiolipin IgM antibodies, and elevated β2-glycoprotein I IgM antibodies. Infectious work-up revealed only positive anti-streptolysin O (ASO and anti-DNAse B titers. Autoimmune studies showed strongly positive anti-platelet IgM, elevated rheumatoid factor (RF, and positive cryocrit. Renal biopsy for evaluation of proteinuria and hematuria showed diffuse proliferative glomerulonephritis (DPGN with membranoproliferative features consistent with cryoglobulinemia. Immunofixation showed polyclonal bands. Our patient was treated successfully with antibiotics, prednisone, and mycophenolate mofetil (MMF. This is the first report of a patient with partial DGS presenting with APS and type III mixed cryoglobulinemia possibly due to Streptococcal infection.

Current topics in autoimmune hepatitis.

Science.gov (United States)

Muratori, Luigi; Muratori, Paolo; Granito, Alessandro; Pappas, Giorgios; Cassani, Fabio; Lenzi, Marco

2010-11-01

Autoimmune hepatitis is a chronic liver disease of unknown aetiology characterized by interface hepatitis, hypergammaglobulinaemia and circulating autoantibodies. In the last decade a number of advancements have been made in the field of clinical and basic research: the simplified diagnostic criteria, the complete response defined as normalization of transaminase levels, the molecular identification of the antigenic targets of anti-liver cytosol antibody type 1 and anti-soluble liver antigen, the detection of anti-actin antibodies, the description of de novo autoimmune hepatitis after liver transplantation for non-autoimmune liver diseases, the characterization of autoimmune hepatitis with overlapping features of primary biliary cirrhosis or primary sclerosing cholangitis, the preliminary experience with novel treatment strategies based on cyclosporine, mycophenolate mofetil and budesonide, the role played by "impaired" regulatory T cells and the development of novel animal models of autoimmune hepatitis. Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

Directory of Open Access Journals (Sweden)

Nicole Marijanovich

2018-01-01

Full Text Available Systemic lupus erythematosus (SLE is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25% and severe (+4 mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation.

Pediatric renal transplantation in a highly sensitised child-8 years on.

LENUS (Irish Health Repository)

Quinlan, Catherine

2012-01-26

Highly sensitised children have markedly reduced chances of receiving a successful deceased donor renal transplant, increased risk of rejection, and decreased graft survival. There is limited experience with the long-term followup of children who have undergone desensitization. Following 2 failed transplants, our patient was highly sensitised. She had some immunological response to intravenous immunoglobulin (IVIg) but this was not sustained. We developed a protocol involving sequential therapies with rituximab, IVIg, and plasma exchange. Immunosuppressant therapy at transplantation consisted of basiliximab, tacrolimus, mycophenolate mofetil, and steroids. At the time of transplantation, historical crossmatch was ignored. Current CDC crossmatch was negative, but T and B cell flow crossmatch was positive, due to donor-specific HLA Class I antibodies. Further plasma exchange and immunoglobulin therapy were given pre- and postoperatively. Our patient received a deceased donor-kidney-bearing HLA antigens to which she originally had antibodies, which would have precluded transplant. The graft kidney continues to function well 8 years posttransplant.

Standard and biological treatment in large vessel vasculitis: guidelines and current approaches.

Science.gov (United States)

Muratore, Francesco; Pipitone, Nicolò; Salvarani, Carlo

2017-04-01

Giant cell arteritis and Takayasu arteritis are the two major forms of idiopathic large vessel vasculitis. High doses of glucocorticoids are effective in inducing remission in both conditions, but relapses and recurrences are common, requiring prolonged glucocorticoid treatment with the risk of the related adverse events. Areas covered: In this article, we will review the standard and biological treatment strategies in large vessel vasculitis, and we will focus on the current approaches to these diseases. Expert commentary: The results of treatment trials with conventional immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have overall been disappointing. TNF-α blockers are ineffective in giant cell arteritis, while observational evidence and a phase 2 randomized trial support the use of tocilizumab in relapsing giant cell arteritis. Observational evidence strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu patients with relapsing disease. However biological agents are not curative, and relapses remain common.

Impact of the ALMS and MAINTAIN trials on the management of lupus nephritis.

Science.gov (United States)

Morris, Heather K; Canetta, Pietro A; Appel, Gerald B

2013-06-01

Current treatment of lupus nephritis consists of both induction and maintenance therapy, with the latter being designed to consolidate remissions and prevent relapses. Long-term maintenance treatment with intravenous cyclophosphamide was effective but associated with considerable toxicity. A small but well-designed controlled trial found that for post-induction maintenance therapy, both oral mycophenolate mofetil (MMF) and oral azathioprine were superior in efficacy and had reduced toxicity than a regimen of continued every third month intravenous cyclophosphamide. Although these oral agents were rapidly accepted and utilized as maintenance medications, their usage was based on scant evidence and there were no comparisons between the two. Recently, two relatively large, randomized, well-controlled, multicenter trials dealing with maintenance therapy for severe lupus nephritis have been completed. The Aspreva Lupus Management Study (ALMS) maintenance and MAINTAIN nephritis trials provide important information regarding the comparative efficacy and safety of MMF and azathioprine as maintenance therapies, as well as information on the effect of dosage and duration of treatment with these agents.

General principles for the treatment of non-infectious uveitis.

Science.gov (United States)

Díaz-Llopis, Manuel; Gallego-Pinazo, Roberto; García-Delpech, Salvador; Salom-Alonso, David

2009-09-01

Ocular inflammatory disorders constitute a sight-threatening group of diseases that might be managed according to their severity. Their treatment guidelines experience constant changes with new agents that improve the results obtained with former drugs. Nowadays we can make use of a five step protocol in which topical, periocular and systemic corticosteroids remain as the main therapy for non infectious uveitis. In addition, immunosuppresive drugs can be added in order to enhance the anti-inflammatory effects and to develop the role of corticosteroid-saving agents. These can be organized in four other steps: Cyclosporine and Methotrexate in a second one; Azathioprine, Mycophenolate Mofetil and Tacrolimus in a third step; biological anti-TNF drugs in fourth position; and a theoretical last one with Cyclophosphamide and Chlorambucil. In the present review we go through the main characteristics and complications of all these treatments and make a rational of this five-step treatment protocol for non infectious posterior uveitis.

[Clinical views from the forefront of immunosuppressive drugs].

Science.gov (United States)

Kobayashi, Eiji

2005-11-01

Recently, many immunosuppressants have been developed and some of them have already been introduced in clinical organ transplantation. With a new concept of immunoregulation, which focuses on prevention of rejection and over-immunosuppression, the latest protocol has been conducted. Chimeric or humanized antibodies targeting the lymphocyte surface molecule such as CD19, 20, 25, 40, and 52 are administrated in the induction phase, and calcineurin inhibitors (cyclosporin and tacrolimus) are used as key drugs. For tapering the doses of them, the combined application of anti-metabolic agents of azathioprine, mizoribine, or mycophenolate mofetil (MMF) has been proved effective. Lymphocyte forming drugs induce unique immunoregulation, targeting at sphingosine 1-phosphate (SlP) receptors. FTY720 is now in the procedure of clinical trial to compare with MMF. KRP203 is also a candidate for more specific SIP receptor agonist. In this issue, I reviewed the recent immunosuppressive strategy and focused on the advance of novel immunosuppressive drugs.

Pediatric Renal Transplantation in a Highly Sensitised Child—8 Years On

Directory of Open Access Journals (Sweden)

Catherine Quinlan

2011-01-01

Full Text Available Highly sensitised children have markedly reduced chances of receiving a successful deceased donor renal transplant, increased risk of rejection, and decreased graft survival. There is limited experience with the long-term followup of children who have undergone desensitization. Following 2 failed transplants, our patient was highly sensitised. She had some immunological response to intravenous immunoglobulin (IVIg but this was not sustained. We developed a protocol involving sequential therapies with rituximab, IVIg, and plasma exchange. Immunosuppressant therapy at transplantation consisted of basiliximab, tacrolimus, mycophenolate mofetil, and steroids. At the time of transplantation, historical crossmatch was ignored. Current CDC crossmatch was negative, but T and B cell flow crossmatch was positive, due to donor-specific HLA Class I antibodies. Further plasma exchange and immunoglobulin therapy were given pre- and postoperatively. Our patient received a deceased donor-kidney-bearing HLA antigens to which she originally had antibodies, which would have precluded transplant. The graft kidney continues to function well 8 years posttransplant.

A 47-Year-Old Man With Fever, Dry Cough, and a Lung Mass After Redo Lung Transplantation.

Science.gov (United States)

Chaddha, Udit; Patil, Pradnya D; Omar, Ashraf; Walia, Rajat; Panchabhai, Tanmay S

2018-06-01

A 47-year-old man who was a redo double lung transplant recipient (cytomegalovirus [CMV] status: donor positive/recipient positive; Epstein-Barr virus status: donor positive/recipient positive) presented to the hospital with 1 week of generalized malaise, low-grade fevers, and dry cough. His redo lung transplantation was necessitated by bronchiolitis obliterans syndrome, and his previous lung transplantation 5 years earlier was for silicosis-related progressive massive fibrosis. He denied any difficulty breathing or chest pain. There was no history of GI or urinary symptoms, and the patient had no anorexia, weight loss, night sweats, sick contacts, or history of travel. He had a history of 1 earlier episode of CMV viremia that was treated with valganciclovir. His immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisone, and his infection prophylaxis included trimethoprim-sulfamethoxazole, itraconazole, and valganciclovir. Results of a chest radiograph 8 weeks earlier were normal. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Parvovirus B19 induced lupus-like syndrome with nephritis.

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Georges, Elodie; Rihova, Zuzana; Cmejla, Radek; Decleire, Pierre-Yves; Langen, Corinne

2016-12-01

We report a case of a 65-year-old man who developed an acute illness with fever, arthralgia and nephritic syndrome. Antinuclear antibodies were slightly positive and complement levels were low. Renal biopsy showed exudative diffuse proliferative endocapillary glomerulonephritis with diffuse immunoglobulin (IgG, IgA, IgM) and complement deposition (C3d, C4d, C1q) on immunofluorescence. The patient was first treated with corticosteroids and mycophenolate mofetil for suspected lupus with WHO class IV glomerulonephritis. The diagnosis was questioned and a diagnosis of parvovirus B19-associated nephritis was made based on elevation of serum IgM antibodies for parvovirus B19 and detection of parvovirus B19 DNA on renal biopsy. The immunosuppressive treatment was stopped and progressive spontaneous regression of clinical and laboratory abnormalities was observed. We conclude that human parvovirus B19 infection should be considered as a cause of lupus-like symptomatology and acute glomerulonephritis.

Bone metabolism in renal transplant patients treated with cyclosporine or sirolimus.

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Campistol, Josep M; Holt, David W; Epstein, Solomon; Gioud-Paquet, Martine; Rutault, Karine; Burke, James T

2005-09-01

Sirolimus is a new immunosuppressive agent used as treatment to prevent acute renal allograft rejection. One of the complications of renal transplantation and subsequent long-term immunosuppression is bone loss associated with osteoporosis and consequent fracture. Two open-label, randomized, phase 2 studies comparing sirolimus versus cyclosporine (CsA) included indices of bone metabolism as secondary end-points. Markers of bone turnover, serum osteocalcin and urinary N-telopeptides, were measured over a 1-year period in 115 patients receiving either CsA or sirolimus as a primary therapy in combination with azathioprine and glucocorticoids (study A) or mycophenolate mofetil (MMF) and glucocorticoids (study B). Urinary excretion of N-telopeptides and the concentrations of serum osteocalcin were consistently higher in the CsA-treated patients and significantly different at week 24 for N-telopeptides and at weeks 12, 24, and 52 for osteocalcin. In conclusion, future trials are warranted to test whether a sirolimus-based regimen conserves bone mineral density compared with a CsA-based regimen.

Mycophenolic acid suppresses human pterygium and normal tenon fibroblast proliferation in vitro.

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Amer, Radgonde; Rabinowich, Liane; Maftsir, Genia; Puxeddu, Ilaria; Levi-Schaffer, Francesca; Solomon, Abraham

2010-10-01

To investigate whether mycophenolic acid (MPA) exerts antifibrotic effects on pterygium fibroblasts (PFB) with and without stimulation with fibrogenic cytokines, and to compare the efficacy of MPA with mitomycin (MMC) and dexamethasone (DXM) on PFB and tenon fibroblasts (TFB). TFB and PFB were obtained from tissue explants during strabismus or pterygium surgery. Proliferation of subconfluent fibroblasts ± basic fibroblast growth factor (bFGF) (10 ng/ml) was assessed by using the (3H) thymidine-incorporation assay. Cell cultures were incubated with MPA, MMC or DXM. Apoptosis was evaluated by quantifying Annexin V and propidium iodide positive cells with flow cytometry. MPA showed a concentration-dependent inhibition of proliferation of PFB ± bFGF as well as TFB ± bFGF. The antiproliferative effect of MPA was comparable with that of MMC and DXM. Short exposure of PFB to MPA under profibrogenic conditions was significantly inhibitory. No apoptotic effect was found on TFB. MPA suppressed tenon and pterygium fibroblast proliferation in vitro under basal and profibrogenic conditions. It was comparable with MMC under long-term exposure, but MMC was more suppressive under short-term exposure. MPA may be safer than MMC due to a more specific mechanism of action and lack of cytotoxicity. Further investigation is warranted regarding MPA concentrations that will lead to a potent antiproliferative effect in vivo.

[The combined action of the components of compound PSB-500 and its hygienic standardization in the water of reservoirs].

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Fedorenko, V I

1991-11-01

A multi-component composition of RSB-500 of the not strictly fixed quantitative composition as a model one and four additional mixtures of the fixed composition have been studied, as well as the character of the combined effect of its components. It has been found out, that for the composition of RSB-500 the total threshold concentration is 0.4 mg/l according to BOD, and the maximal no-effect dose is 0.27 mg/kg. Potentiation of the effect of the components is observed according to the influence on BOD, additivity--according to the degree of cumulation. Embryotoxic, gonadotoxic, mutagenic and allergic effects were not observed. The limiting degree of harmfulness is general toxic (BOD stimulation), the fourth degree of danger. It is recommended to maintain sanitary control according to nitriltrimethylphosphonic acid on the level 0.3 mg/l and phosphorous acid on the level 0.07 mg/l.

Phase I dose-escalation study to examine the safety and tolerability of LY2603618, a checkpoint 1 kinase inhibitor, administered 1 day after pemetrexed 500 mg/m(2) every 21 days in patients with cancer.

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Weiss, Glen J; Donehower, Ross C; Iyengar, Tara; Ramanathan, Ramesh K; Lewandowski, Karen; Westin, Eric; Hurt, Karla; Hynes, Scott M; Anthony, Stephen P; McKane, Scott

2013-02-01

This phase I study aims at assessing the safety and tolerability of LY2603618, a selective inhibitor of Checkpoint Kinase 1, in combination with pemetrexed and determining the maximum tolerable dose and the pharmacokinetic parameters. This was an open-label, multicenter, dose-escalation study in patients with advanced solid tumors. Increasing doses of LY2603618 (40-195 mg/m(2)) were combined with 500 mg/m(2) of pemetrexed. LY2603618 was administered on Days 1 and 9 and pemetrexed on Day 8 in a 28-day cycle. For all subsequent 21-day cycles, pemetrexed was administered on Day 1 and LY2603618 on Day 2. Antitumor activity was evaluated as per Response Evaluation Criteria in Solid Tumors 1.0. A total of 31 patients were enrolled into six cohorts (three at 40 mg/m(2) over 4.5-hour infusion, 1-hour infusion in subsequent cohorts: three each at 40 mg/m(2), 70 mg/m(2), and 195 mg/m(2); 13 at 105 mg/m(2); six at 150 mg/m(2)). Four patients experienced a dose-limiting toxicity: diarrhea (105 mg/m(2)); reversible infusion-related reaction (150 mg/m(2)); thrombocytopenia (195 mg/m(2)); and fatigue (195 mg/m(2)). The maximum tolerated dose was defined as 150 mg/m(2). The pharmacokinetic data demonstrated that the exposure of LY2603618 increased in a dose-dependent manner, displayed a suitable half-life for maintaining required human exposures while minimizing the intra- and inter-cycle accumulation, and was unaffected by the pemetrexed administration. The pharmacokinetic-defined biologically efficacious dose was achieved at doses ≥105 mg/m(2). LY2603618 administered approximately 24 h after pemetrexed showed acceptable safety and pharmacokinetic profiles.

Converting hcp Mg-Al-Zn alloy into bcc Mg-Li-Al-Zn alloy by electrolytic deposition and diffusion of reduced lithium atoms in a molten salt electrolyte LiCl-KCl

International Nuclear Information System (INIS)

Lin, M.C.; Tsai, C.Y.; Uan, J.Y.

2007-01-01

A body-centered cubic (bcc) Mg-12Li-9Al-1Zn (wt.%) alloy was fabricated in air by electrolysis from LiCl-KCl molten salt at 500 deg. C. Electrolytic deposition of Li atoms on cathode (Mg-Al-Zn alloy) and diffusion of the Li atoms formed the bcc Mg-Li-Al-Zn alloy with 12 wt.% Li and only 0.264 wt.% K. Low K concentration in the bcc Mg alloy strip after the electrolysis process resulted from 47% atomic size misfit between K and Mg atoms and low solubility of K in Mg matrix

Mechanism of Enhancing Extraction of Vanadium from Stone Coal by Roasting with MgO

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Fang Chen

2017-02-01

Full Text Available In this paper, the extraction of vanadium from stone coal by roasting with MgO and leaching with sulfuric acid has been investigated, and the mechanism analysis of stone coal roasting with MgO was studied. The results indicated that under the conditions that the mass fraction of the particles with grain size of 0–0.074 mm in raw ore was 75%, the roasting temperature was 500 °C, the roasting time was 1 h, MgO addition was 3 wt %, the sulfuric acid concentration was 20 vol %, the liquid-to-solid ratio was 1.5 mL/g, the leaching temperature was 95 °C, and leaching time was 2 h, resulting in a vanadium leaching efficiency of 86.63%, which increased by 7.73% compared with that of blank roasting. The mechanism analysis showed that the degree of calcite decomposition was low and, thus, magnesium vanadate was more easily formed than calcium vanadate below 500 °C. Moreover, magnesium vanadate was easier to dissolve than calcium vanadate during the sulfuric acid leaching process. Thus, the vanadium leaching efficiency was enhanced by using MgO as a roasting additive below 500 °C. Additionally, at high temperature the formation of tremolite would consume calcium oxide produced from the decomposition of calcite, thus, the formation of calcium vanadate was hindered, and V2O5 would react with MgO to form magnesium vanadate. Therefore, the vanadium leaching efficiency of roasting with MgO was higher than that of blank roasting at high temperature.

Effects of food on the pharmacokinetics of gemigliptin/metformin sustained-release 50/1,000 mg (25/500 mg x 2 tablets) fixeddose combination tablet in healthy male volunteers.

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Choi, Hee Youn; Noh, Yook-Hwan; Kim, Yo Han; Kim, Mi Jo; Lee, Shi Hyang; Kim, Jeong-Ae; Kim, Bogyeong; Lim, Hyeong-Seok; Bae, Kyun-Seop

2014-05-01

For patient convenience, a gemigliptin/metformin sustainedrelease fixed-dose combination (FDC) tablet was developed. This study was conducted to investigate the effects of food on the pharmacokinetic (PK) profile of the FDC tablets. This was an open-label, randomized, single dose, 2-period, 2-sequence crossover study in 24 healthy male volunteers. The FDC tablets (25/500 mg × 2 tablets) were administered in high-fat fed and fasted states on separate occasions, and each subject was randomly allocated to each sequence with a 7-day washout period. PK blood samplings were conducted from predose to 48 hours after dosing. Tolerability assessments were performed throughout the study. Nine adverse events (AEs) of mild intensity were reported from 8 subjects after study drug administration, and the AE frequency was similar between treatments. No serious AEs were reported. The PK parameters of gemigliptin and metformin were compared between fasting and fed states. For gemigliptin, the geometric mean ratios (GMRs) (fed : fasted state) of the Cmax and AUClast were 0.886 (90% confidence interval (CI) 0.781 - 1.006) and 1.021 (90% CI 0.949 - 1.099), respectively. For metformin, the GMRs of the Cmax and AUClast were 0.811 (90% CI 0.712 - 0.923) and 1.144 (90% CI 1.013 - 1.291), respectively. A prolonged tmax for metformin was observed. These results are similar to the effects of food on each component. The FDC tablet may have a similar PK profile as that of individual drugs and is generally tolerable when administered with food. These results indicate that the FDC tablet can be administered in the same dosing regimen as each component, especially that of metformin sustained-release.

Properties of thymidylate synthetase from Ehrlich ascites carcinoma cells. Effect of Mg2/ and MgATP2-.

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Jastreboff, M; Kedzierska, B; Rode, W

1982-01-15

Ehrlich ascites carcinoma thymidylate synthetase was purified to electrophoretic homogeneity by affinity chromatography on 10-formyl-5,8-dideazofolate-ethyl-Sepharose. Electrophoretic analysis of the formation of the enzyme-5-fluorodeoxyuridylate-5,10-methylenetetrahydrofolate complexes showed the presence of two binding sites for 5-fluorodeoxyuridylate on the enzyme molecule. Molecular weight of the native enzyme was found to be 78,5000, whereas that of its monomer was 38, 500. The apparent Michaelis constants for dUMP and (+/-)-L-5,10-methylenetetrahydrofolate were 1.3 +/- 0.4 and 32.2 +/- 0.7 micrometers respectively. Phosphate acted as a weak inhibitor, competitive toward dUMP. The enzyme reaction exhibited a temperature-dependent change of activation energy, reflected in the binding affinity of dUMP, with a transitional temperature of 35.8 degrees. Both Mg2+ and MgATP2- were strong activators of the enzyme, MgATP2- being more effective.

Progression-free survival results in postmenopausal Asian women: subgroup analysis from a phase III randomized trial of fulvestrant 500 mg vs anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON).

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Noguchi, Shinzaburo; Ellis, Matthew J; Robertson, John F R; Thirlwell, Jackie; Fazal, Mehdi; Shao, Zhimin

2018-05-01

The international, phase III FALCON study (NCT01602380) in postmenopausal patients with hormone receptor-positive, locally advanced/metastatic breast cancer (LA/MBC) who had not received prior endocrine therapy, demonstrated statistically significant improvement in progression-free survival (PFS) for patients who received fulvestrant 500 mg vs anastrozole 1 mg. This subgroup analysis evaluated PFS in Asian (randomized in China, Japan, or Taiwan) and non-Asian patients from the FALCON study. Eligible patients (estrogen receptor- and/or progesterone receptor-positive LA/MBC; World Health Organization performance status 0-2; ≥ 1 measurable/non-measurable lesion[s]) were randomized. PFS was assessed via Response Evaluation Criteria in Solid Tumours version 1.1, surgery/radiotherapy for disease worsening, or death (any cause). Secondary endpoints included: objective response rate, clinical benefit rate, duration of response, and duration of clinical benefit. Consistency of effect across subgroups was assessed via hazard ratios and 95% confidence intervals (CIs) using a log-rank test. Adverse events (AEs) were evaluated. Of the 462 randomized patients, the Asian and non-Asian subgroups comprised 67 and 395 patients, respectively. In the Asian subgroup, median PFS was 16.6 and 15.9 months with fulvestrant and anastrozole, respectively (hazard ratio 0.81; 95% CI 0.44-1.50). In the non-Asian subgroup, median PFS was 16.5 and 13.8 months, respectively (hazard ratio 0.79; 95% CI 0.62-1.01). Secondary outcomes were numerically improved with fulvestrant vs anastrozole in both subgroups. AE profiles were generally consistent between Asian and non-Asian subgroups. Results of this subgroup analysis suggest that treatment effects in the Asian patient subgroup are broadly consistent with the non-Asian population.

The importance of assessing medication exposure to the definition of refractory disease in systemic lupus erythematosus.

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Arnaud, Laurent; Zahr, Noël; Costedoat-Chalumeau, Nathalie; Amoura, Zahir

2011-09-01

Treatment of patients with Systemic Lupus Erythematosus (SLE) who have active disease refractory to current therapeutic strategies continues to be a real challenge. Here, we propose that the classic definition of refractory SLE patients - failure to achieve adequate response to the standard of care - should be further refined to incorporate the dimension of adequate drug exposure. Inter-individual pharmacokinetic variability may induce insufficient exposure to many drugs used in SLE, leading to both apparent inefficacy of treatments and inappropriate therapeutic escalation. Among others, we have shown that individual assessment of exposure to mycophenolic acid, the active metabolite of mycophenolate mofetil (MMF) could be used to determine whether a given patient received adequate doses of MMF. We have also shown that measuring blood concentrations of hydroxychloroquine could be used as an efficient way to assess observance, which is a critical issue since a significant proportion of refractory SLE patients is likely to have poor observance as the primary source of treatment failure. Finally, we have underlined the importance of assessing drug interactions as SLE patients often require, in addition to immunosuppressants, several other drugs to prevent or treat associated conditions, which may result in decreased exposure to immunosuppressants. Considering these data, we believe that refractory SLE patients should not only be defined as the failure to achieve adequate therapeutic response to the standard of care, but should also incorporate the dimension of inadequate pharmacokinetic exposure and include drug blood level, interaction and observance monitoring. Copyright © 2011. Published by Elsevier B.V.

Single-shot antithymocyte globulin (ATG) induction for pancreas/kidney transplantation: ATG-Fresenius versus Thymoglobulin.

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Schulz, T; Papapostolou, G; Schenker, P; Kapischke, M

2005-03-01

Single-shot antithymocyte globulin (ATG) prior to reperfusion followed by tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisolone (PRD) is an established induction therapy in simultaneous pancreas kidney transplant (SPK) recipients. We retrospectively analyzed 6-month data from 105 patients who received their first SPK. From January 1996 to December 2000, ATG-Fresenius was used. Since January 2001, Thymoglobulin has been administered. In the first group, 58 patients were treated with ATG-Fresenius (4-6 mg/kg body weight). In the second group, 47 patients received Thymoglobulin (1.5-2.5 mg/kg body weight). HLA-mismatch was comparable. After an observation period of 6 months, patients, kidney, and pancreas graft survival is 98.3%, 96.6%, and 93.1% in group I and 97.9%, 97.9%, and 85.1% in group II, respectively. In each group, one death with functioning graft (DWFG) was observed. Twenty (34.5%) acute rejection episodes (AR) were observed (18 patients) in group I. They were treated with steroids (n = 16) or steroids/OKT3 (n = 4). One kidney graft failure was observed due to rejection and one due to DWFG. Four pancreas grafts were lost (thrombosis, n = 2; AR, n = 1; DWFG, n = 1). In group II, 15 AR (31.9%) were seen in 12 patients and were treated with steroids (n = 12), steroids/ATG (n = 1), or steroids/OKT3 (n = 2). Seven pancreas (thrombosis, n = 5; rejection, n = 1; DWFG, n = 1) and one kidney (DWFG, n = 1) graft losses occurred. These data clearly establish that single-shot ATG prior to reperfusion, followed by TAC, MMF, and PRD results in a low incidence of AR (34.5% in group I and 31.9% in group II) after SPK. Only 6.9% (group I) and 6.4% (group II) of the patients received antibodies for rejection treatment.

Induction treatment with rabbit antithymocyte globulin versus basiliximab in renal transplant recipients with planned early steroid withdrawal.

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Martin, Spencer T; Roberts, Keri L; Malek, Sayeed K; Tullius, Stefan G; Vadivel, Nidyanandh; De Serres, Sacha; Grafals, Monica; Elsanjak, Abdelaziz; Filkins, Beth Anne; Chandraker, Anil; Gabardi, Steven

2011-06-01

To compare the safety and efficacy of rabbit antithymocyte globulin (r-ATG) with basiliximab in renal transplant recipients for whom an early steroid withdrawal (ESW) regimen was planned. Single-center, retrospective, cohort study. Tertiary care medical center, including inpatient hospital stays and outpatient nephrology clinics. Ninety-nine consecutive adult recipients of living- or deceased-donor renal transplants between January 1, 2004, and December 31, 2007, in whom ESW was planned and who received either r-ATG or basiliximab; patients receiving an extended-criteria kidney donation or a donation after cardiac death were excluded. All patients received mycophenolate mofetil and tacrolimus as maintenance therapy with planned ESW. Induction therapy was either r-ATG 1.5 mg/kg/day for 4 days (68 patients) or basiliximab 20 mg on postoperative days 0 and 4 (31 patients). The primary composite end point of biopsy-proven acute rejection (BPAR), graft loss, and death occurred in 6 patients (9%) and 9 patients (29%) in the r-ATG and basiliximab groups at 1 year after transplantation, respectively (p=0.01), with rates of 7% (5/68 patients) and 26% (8/31 patients) for BPAR (p=0.02), 0% and 3% (1/31 patients) for graft loss (p=0.31), and 2% (1/68 patients) and 0% for patient death (p>0.99). Average time to first BPAR was significantly longer in the r-ATG group (mean ± SD 151.4 ± 82.9 vs 53.6 ± 68.4 days, p<0.01). Kidney function at 12 months was similar between the two groups. Rabbit-ATG was associated with a lower frequency and delayed onset of BPAR compared with basiliximab in renal transplant recipients who received an ESW regimen.

Diffuse vascular damage in a transplanted kidney: an indication for nuclear magnetic resonance?

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Burdese, M; Consiglio, V; Mezza, E; Savio, D; Guarena, C; Rossetti, M; Messina, M; Soragna, G; Suriani, C; Rabbia, C; Segoloni, G P; Piccoli, G B

2005-06-01

Vascular lesions are an increasing challenge after renal transplantation due to the wider indications for recipients and acceptance criteria for donors. Diagnostic approach and prognostic interpretation are still matter of controversy. The case reported herein may summarize some of the issues in this regard. A 54-year-old woman, on renal replacement therapy since 1974, and a kidney graft recipient from 1975 to 1999, received a second graft in 2001. The donor age was 65 years (cold ischemia 22 hours; two mismatches). The early posttransplant follow-up was characterized by delayed graft function, hypertension, and diabetes. During the initial hypertension workup, renal graft ultrasound (US) Doppler demonstrated increased vascular resistances, stable over time (resistance index 0.74 to 0.77); renal scintiscan displayed homogeneously parenchymoa and angio-magnetic resonance imaging (MRI), an homogeneous parenchymal vascularization. Initial immunosuppression with tacrolimus and steroids was modulated by adding mycophenolate mofetil to taper tacrolimus (to reduce nephrotoxicity and hypertension). Despite this, kidney function slowly deteriorated; serum creatinine reached 3 to 3.5 mg/dL by the second year. After a severe hypertensive crisis with unchanged scintiscan and US doppler examinations, angio-MRI revealed the almost complete disappearance of parenchymal enhancement beyond the lobar arteries. A renal biopsy confirmed the severe vascular damage. The patient was switched to rapamycine and a low-dose of an angiotension converting enzyme (ACE) inhibitor. She did relatively well (serum creatinine 2.2 to 3 mg/dL) for 6 months, when rapid functional impairment forced her to restart hemodialysis. This case, almost paradigmatic of the problems occurring when the rigid vasculature of long-term dialysis patients is matched with "marginal kidneys," suggests that MRI may be a sensible good to define vascular damage in the grafted kidney.

The necrotic signal induced by mycophenolic acid overcomes apoptosis-resistance in tumor cells.

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Gwendaline Guidicelli

Full Text Available BACKGROUND: The amount of inosine monophosphate dehydrogenase (IMPDH, a pivotal enzyme for the biosynthesis of the guanosine tri-phosphate (GTP, is frequently increased in tumor cells. The anti-viral agent ribavirin and the immunosuppressant mycophenolic acid (MPA are potent inhibitors of IMPDH. We recently showed that IMPDH inhibition led to a necrotic signal requiring the activation of Cdc42. METHODOLOGY/PRINCIPAL FINDINGS: Herein, we strengthened the essential role played by this small GTPase in the necrotic signal by silencing Cdc42 and by the ectopic expression of a constitutive active mutant of Cdc42. Since resistance to apoptosis is an essential step for the tumorigenesis process, we next examined the effect of the MPA-mediated necrotic signal on different tumor cells demonstrating various mechanisms of resistance to apoptosis (Bcl2-, HSP70-, Lyn-, BCR-ABL-overexpressing cells. All tested cells remained sensitive to MPA-mediated necrotic signal. Furthermore, inhibition of IMPDH activity in Chronic Lymphocytic Leukemia cells was significantly more efficient at eliminating malignant cells than apoptotic inducers. CONCLUSIONS/SIGNIFICANCE: These findings indicate that necrosis and apoptosis are split signals that share few if any common hub of signaling. In addition, the necrotic signaling pathway induced by depletion of the cellular amount of GTP/GDP would be of great interest to eliminate apoptotic-resistant tumor cells.

Hypothalamic-pituitary sarcoidosis with vision loss and hypopituitarism: case series and literature review.

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Anthony, Jeremy; Esper, Gregory J; Ioachimescu, Adriana

2016-02-01

Hypothalamic-pituitary (HP) neurosarcoidosis (NS) accounts for 0.5 % cases of sarcoidosis and 1 % of HP masses. Correlative data on endocrine and neurological outcomes is lacking. Retrospective case series and literature review of presentation, treatment and outcome of HP NS. Our series includes 4 men, ages 34-59, followed for a median of 7.3 years (range 1.5-17). All had optic neuropathy, multiple pituitary hormone abnormalities (PHAs) and other organ involvement by sarcoidosis (lung, sino-nasal, brain/spine and facial nerve). Two patients had central diabetes insipidus and one impaired thirst with polydipsia. After treatment with high-dose glucocorticoids, optic neuropathy improved in one case and stabilized in the others. After treatment, HP lesions improved radiologically, but PHAs persisted in all cases. Review of four published series on HP NS in addition to ours yielded 46 patients, age 37 ± 11.8 years, 65 % male. PHAs consisted of anterior hypopituitarism (LH/FSH 88.8 %, TSH 67.4 %, GH 50.0 %, ACTH 48.8 %), hyperprolactinemia (48.8 %) and diabetes insipidus (65.2 %). PHAs were the first sign of disease in 54.3 % patients. Vision problems occurred in 28.3 % patients, but optic neuropathy was not well documented in previous series. Most patients (93.5 %) received high-dose glucocorticoids followed by taper; 50 % also received other immunomodulators, including methotrexate, mycophenolate mofetil, cyclosporine, azathioprine, infliximab and hydrochloroquine. Only 13 % patients showed improvement in PHAs. All-cause mortality was 8.7 %. HP NS is a serious disease requiring multidisciplinary treatment and lifelong follow-up. Prospective multicentric studies are needed to determine a more standardized approach to HP NS and outline predictors of disease outcome.

Surface excess on MgO-doped TiO{sub 2} nanoparticles; Segregacao superficial de MgO em nanoparticulas de TiO{sub 2}

Energy Technology Data Exchange (ETDEWEB)

Gouvea, D.; Viana, B.H.; Miagava, J., E-mail: dgouvea@usp.br, E-mail: bhernardov@gmail.com, E-mail: joice.mgv@gmail.com [Universidade de Sao Paulo (USP), SP (Brazil). Dept. de Engenharia Metalurgica e de Materiais. Lab. de Processos Ceramicos

2016-10-15

Anatase has been the subject of several recent investigations partly as consequence of its interesting catalytic properties. Additives such as MgO have been introduced to improve the performance of the photocatalytic TiO{sub 2}. However, the physical-chemistry of these oxides systems and their relationship with properties are poorly understood. In this work, nanoparticles of xMgO-(1-x)TiO{sub 2} (0≤ x≤ 0.05) were synthesized by the polymeric precursor method at 500 °C for 15 h. XRD results showed that only anatase phase was obtained and the crystallite size decreases with increased MgO concentration. Magnesia surface excess was calculated by washing powders with HNO{sub 3} and the soluble Mg ions concentration determined by chemical analysis. FTIR analysis confirms that the acid washing modified the particle surface. Therefore, it is proposed that the reduction of the crystallite size occurs due to segregation of MgO on TiO{sub 2} nanoparticles surfaces. (author)

Bismuth 213-labeled anti-CD45 radioimmunoconjugate to condition dogs for nonmyeloablative allogeneic marrow grafts

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Sandmaier, B M.(Fred Hutchinson Cancer Research Center, Seattle, WA); Bethge, W A.(Fred Hutchinson Cancer Research Center, Seattle, WA); Wilbur, D. Scott (Washington, Univ Of); Hamlin, Donald K.(Washington, Univ Of); Santos, E B.(Fred Hutchinson Cancer Research Center, Seattle, WA); Brechbiel, M W.(National Cancer Institute, National Institutes of Health, Bethesda, MD); Fisher, Darrell R.(BATTELLE (PACIFIC NW LAB)); Storb, R. (Fred Hutchinson Cancer Research Center)

2002-01-01

To lower treatment-related mortality and toxicity of conventional marrow transplantation, a nonmyeloablative regimen using 200 cGy total-body irradiation (TBI) and mycophenolate mofetil (MMF) combined with cyclosporine (CSP) for postgrafting immunosuppression was developed. To circumvent possible toxic effects of external- beam gamma irradiation, strategies for targeted radiation therapy were investigated. We tested whether the short-lived (46 minutes) alpha-emitter Bi-213 conjugated to an anti-CD45 monoclonal antibody (mAb) could replace 200 cGy TBI and selectively target hematopoietic tissues in a canine model of nonmyeloablative DLA-identical marrow transplantation. Biodistribution studies using iodine 123-labeled anti-CD45 mAb showed uptake in blood, marrow, lymph nodes, spleen, and liver. In a dose-escalation study, 7 dogs treated with the Bi-213-anti-CD45 conjugate (Bi-213 dose, 0.1-5.9 mCi/kg[3.7-218 MBq/kg]) without marrow grafts had no toxic effects other than a mild, reversible suppression of blood counts. On the basis of these studies, 3 dogs were treated with 0.5 mg/kg Bi-213-labeled anti-CD45 mAb (Bi-213 doses, 3.6, 4.6, and 8.8 mCi/kg[133, 170, and 326 MBq/kg]) given in 6 injections 3 and 2 days before grafting of marrow from DLA-identical littermates. The dogs also received MMF (10 mg/kg subcutaneously twice daily the day of transplantation until day 27 afterward) and CSP (15 mg/kg orally twice daily the day before transplantation until 35 days afterward). Therapy was well tolerated except for transient elevations in levels of transaminases in 3 dogs, followed by, in one dog, ascites. All dogs achieved prompt engraftment and stable mixed hematopoietic chimerism, with donor contributions ranging from 30% to 70% after more than 27 weeks of follow-up. These results form the basis for additional studies in animals and the design of clinical trials using Bi-213 as a nonmyeloablative conditioning regimen with minimal toxicity.

A pilot study to examine the effect of chronic treatment with immunosuppressive drugs on mucociliary clearance in a vagotomized murine model.

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Abhiram R Bhashyam

Full Text Available Previously, we have demonstrated that mucociliary clearance (MCC is diminished within the first months after surgery in lung transplant patients and the explanation for the reduction in MCC is unknown. We hypothesized that chronic treatment with a commonly prescribed regimen of immunosuppressive drugs significantly impairs MCC. We tested this hypothesis in a murine model of lung transplantation.Fifteen C57BL/6 mice underwent vagotomy on the right side to simulate denervation associated with lung transplantation in humans. For 6 days, seven mice (controls were intraperitoneally injected with three 100 µL doses of phosphate buffered saline and eight mice (immunosuppressed were injected with three 100 µL injections of tacrolimus (1 mg/kg, mycophenolate mofetil (30 mg/kg, and prednisone (2 mg/kg once daily. Then, mice inhaled the radioisotope (99mtechnetium and underwent gamma camera imaging of their lungs for 6.5 hrs. Counts in the right lung at 1-1.5 hrs and at 6-6.5 hrs were first background-corrected and then decay-corrected to time 0 counts. Decay-corrected counts were then divided by time 0 counts. Retention at each time point was subtracted from 1.00 and multiplied by 100% to obtain percent removed by mucociliary clearance.Although there was a slowing of MCC at 1-1.5 hrs for the immunosuppressed mice, there was no statistical difference in MCC measured at 1-1.5 hrs for the two groups of mice. At 6-6.5 hrs, MCC was significantly slower in the immunosuppressed mice, compared to controls, with 7.78±5.9% cleared versus 23.01±11.7% cleared, respectively (p = 0.006.These preliminary results suggest that chronic treatment with immunosuppressive medications significantly slows MCC in vagotomized C57BL/6 mice. These findings could shed light on why MCC is reduced in lung transplant patients whose lungs are denervated during surgery and who are chronically treated with immunosuppressive drugs post surgery.

Early conversion to a sirolimus-based, calcineurin-inhibitor-free immunosuppression in the SMART trial: observational results at 24 and 36months after transplantation.

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Guba, Markus; Pratschke, Johann; Hugo, Christian; Krämer, Bernhard K; Pascher, Andreas; Pressmar, Katharina; Hakenberg, Oliver; Fischereder, Michael; Brockmann, Jens; Andrassy, Joachim; Banas, Bernhard; Jauch, Karl-Walter

2012-04-01

Early conversion to a calcineurin-inhibitor (CNI)-free maintenance immunosuppression with sirolimus (SRL), mycophenolate mofetil (MMF) and steroids was associated with an improved 1-year renal function as compared with a cyclosporine (CsA)-based regimen (SMART core-study). This observational follow-up describes 132 patients followed up within the SMART study framework for 36months. At 36months, renal function continued to be superior in SRL-treated patients [ITT-eGFR(@36m) : 60.88 vs. 53.72 (CsA) ml/min/1.73m(2) , P=0.031]. However, significantly more patients discontinued therapy in the SRL group 59.4% vs.42.3% (CsA). Patient [99% (SRL) vs.97% (CsA) and graft 96% (SRL) vs.94% (CsA)] survival at 36months was excellent in both arms. There was no difference in late rejection episodes. Late infections and adverse events were similar in both arms except of a higher rate of hyperlipidemia in SRL and a higher incidence of malignancy in CsA-treated patients. In a multivariate analysis, donor age >60years, S-creatinine at conversion >2mg/dl, CMV naïve(-) recipients and immunosuppression with CsA were predictive of an impaired renal function at 36months. Early conversion to a CNI-free SRL-based immunosuppression is associated with a sustained improvement of renal function up to 36months after transplantation. Patient selection will be key to derive long-term benefit and avoid treatment failure using this mTOR-inhibitor-based immunosuppressive regimen. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

Reduced incidence of new-onset diabetes mellitus after renal transplantation with 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors (statins).

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Prasad, G V Ramesh; Kim, S Joseph; Huang, Michael; Nash, Michelle M; Zaltzman, Jeffrey S; Fenton, Stanley S A; Cattran, Daniel C; Cole, Edward H; Cardella, Carl J

2004-11-01

Statins have anti-inflammatory effects, modify endothelial function and improve peripheral insulin resistance. We hypothesized that statins influence the development of new-onset diabetes mellitus in renal transplant recipients. The records of all previously non-diabetic adults who received an allograft in Toronto between January 1, 1999 and December 31, 2001 were reviewed with follow-up through December 31, 2002. All patients receiving cyclosporine or tacrolimus, mycophenolate mofetil and prednisone were included. New-onset diabetes was diagnosed by the Canadian Diabetic Association criteria: fasting plasma glucose > or =7.0 mmol/L or 2-h postprandial glucose > or =11.1 mmol/L on more than two occasions. Statin use prior to diabetes development was recorded along with other variables. Cox proportional hazards models analyzing statin use as a time-dependent covariate were performed. Three hundred fourteen recipients met study criteria, of whom 129 received statins. New-onset diabetes incidence was 16% (n = 49). Statins (p = 0.0004, HR 0.238[0.109-0.524]) and ACE inhibitors/ARB (p = 0.01, HR 0.309[0.127-0.750]) were associated with decreased risk. Prednisone dose (p = 0.0001, HR 1.007[1.003-1.010] per 1 mg/d at 3 months), weight at transplant (p = 0.02, HR 1.022[1.003-1.042] per 1 kg), black ethnicity (p = 0.02, HR 1.230[1.023-1.480]) and age > or =45 years (p = 0.01, HR 2.226[1.162-4.261]) were associated with increased diabetes. Statin use is associated with reduced new-onset diabetes development after renal transplantation.

March 2016 imaging case of the month

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Gotway MB

2016-03-01

Full Text Available No abstract available. Article truncated at 150 words. Clinical History: A 66 year-old man with orthotopic heart transplantation 1 year previously presented with complaints of recent-onset small volume (<1 teaspoon hemoptysis, post-nasal drip, and night sweats. The patient indicated he had recent contact with several young grandchildren who had upper respiratory tract symptoms. The patient’s past medical history was remarkable for recurrent constrictive pericarditis (surgically treated, hypertension, type II diabetes mellitus (treated with insulin, psoriasis, sleep-disordered breathing, and grade 2 cardiac transplant rejection diagnosed 6 months earlier. The patient’s medication list included insulin, Cellcept (mycophenolate mofetil, Prograf (tacrolimus, prednisone, among others. On physical examination, the patient was mildly tachycardic (heart rate = 104 beats/minute with an oxygen saturation on room air of 92%. The white blood cell count was within the normal range, but C-reactive protein and B-type natriuretic peptide levels were reportedly elevated. Frontal chest radiography (Figure 1 was performed, with a radiograph from one month other ...

Systemic lupus erythematosus associated with type 4 renal tubular acidosis: a case report and review of the literature

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Young Larry

2011-03-01

Full Text Available Abstract Introduction Type 4 renal tubular acidosis is an uncommon clinical manifestation of systemic lupus erythematosus and has been reported to portend a poor prognosis. To the best of our knowledge, this is the first case report which highlights the successful management of a patient with systemic lupus erythematosus complicated by type 4 renal tubular acidosis who did not do poorly. Case presentation A 44-year-old Hispanic woman developed a non-anion gap hyperkalemic metabolic acidosis consistent with type 4 renal tubular acidosis while being treated in the hospital for recently diagnosed systemic lupus erythematosus with multi-organ involvement. She responded well to treatment with corticosteroids, hydroxychloroquine and mycophenolate mofetil. Normal renal function was achieved prior to discharge and remained normal at the patient's one-month follow-up examination. Conclusion This case increases awareness of an uncommon association between systemic lupus erythematosus and type 4 renal tubular acidosis and suggests a positive impact of early diagnosis and appropriate immunosuppressive treatment on the patient's outcome.

The impact of drugs on male fertility: a review.

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Semet, M; Paci, M; Saïas-Magnan, J; Metzler-Guillemain, C; Boissier, R; Lejeune, H; Perrin, J

2017-07-01

Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed. © 2017 American Society of Andrology and European Academy of Andrology.

Hypocomplementemic Urticarial Vasculitis Syndrome With Crescentic Glomerulonephritis.

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Salim, Sohail Abdul; Yousuf, Tauqeer; Patel, Asha; Fülöp, Tibor; Agarwal, Mohit

2018-02-01

Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare autoimmune disease characterized by multiple organ system involvement, including renal disease, with low complement levels. We report the case of a 31-year-old woman who presented with nonspecific symptoms including fatigue, diarrhea, macular rash and abdominal pain with acute renal failure leading to end-stage kidney disease. Laboratory results showed hematuria, nephrotic range proteinuria, worsening creatinine and low C1q levels. Left kidney biopsy showed proliferative glomerulonephritis with crescent formation. She was treated with 6 months of intravenous cyclophosphamide, followed by 2 doses of intravenous rituximab (1g each), thereafter maintained on mycophenolate mofetil and glucocorticoid-based therapy. She experienced a full recovery of renal function after 12 months of dialysis dependence. Hypocomplementemic urticarial vasculitis syndrome with crescentic glomerulonephritis is a rare disease with only 5 other reported cases in literature. In our case, we document a delayed but excellent renal recovery during a 2-year follow-up. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Diagnosis and therapy of autoimmune hepatitis.

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Granito, Alessandro; Muratori, Paolo; Ferri, Silvia; Pappas, Georgios; Quarneti, Chiara; Lenzi, Marco; Bianchi, Francesco B; Muratori, Luigi

2009-06-01

Autoimmune hepatitis (AIH) is a chronic progressive hepatitis, characterized by interface hepatitis with lymphoplasmacellular infiltrates on liver biopsy, high serum globulin level and circulating autoantibodies. It is classified into two types, according to autoantibody profile: type 1 is characterized by anti-nuclear (ANA) and/or anti-smooth muscle (SMA) antibodies; type 2 by anti-liver kidney microsomal type 1 (anti-LKM-1) antibodies. AIH affects all ages, may be asymptomatic, frequently has an acute onset, and can present as fulminant hepatitis. The diagnosis of AIH is based on a scoring system codified by an international consensus. Corticosteroids alone or in conjunction with azathioprine is the treatment of choice in patients with AIH and results in remission induction in over 80% of patients. Alternative proposed strategies in patients who have failed to achieve remission on standard therapy or patients with drug toxicity include the use of cyclosporine, tacrolimus, budesonide or mycophenolate mofetil. Liver transplantation is the treatment of choice in managing decompensated disease, however AIH can recur or develop de novo after liver transplantation.

Current and emerging treatment options in the management of lupus

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Jordan, Natasha; D’Cruz, David

2016-01-01

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

Impact of the National Institutes of Health Focal Segmental Glomerulosclerosis (NIH FSGS) clinical trial on the treatment of steroid-resistant FSGS.

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Canetta, Pietro A; Radhakrishnan, Jai

2013-03-01

Idiopathic focal segmental glomerulosclerosis (FSGS) is among the most common, morbid and treatment-resistant conditions faced by nephrologists. While glucocorticoids have traditionally been the mainstay of initial treatment, they induce remission in only a minority of patients. A variety of other immunosuppressants have been utilized against steroid-resistant FSGS, but few have been rigorously examined in well-controlled trials. Recently, the results were published from a National Institutes of Health (NIH)-sponsored multicenter randomized trial comparing cyclosporine (CSA) with a combination of mycophenolate mofetil (MMF) and pulse dexamethasone (DEX) for the treatment of steroid-resistant FSGS. No difference in treatment effectiveness was shown between the two groups, and adverse effects were comparable. This was the largest randomized trial ever undertaken in FSGS, but it was unfortunately underpowered to show clinically relevant differences in response rates. This shortcoming, along with particularities of the study population and outcome measures, makes it challenging to draw definitive conclusions from the trial results. Despite these limitations, the trial does provide valuable insights into treatment strategies for FSGS and offers important lessons for planning future research.

Pediatric lupus nephritis presenting with terminal renal failure.

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Besouw, Martine T P; Vande Walle, Johan G; Ilias, Mohamad I; Raes, Ann M; Prytula, Agnieszka A; Claeys, Lieve; Dehoorne, Jo L

2016-12-01

A 12-year-old Congolese girl presented with acute renal failure, edema, hypertension, hemoptysis, hematuria, and proteinuria after a history of throat infection. Renal ultrasound showed kidneys of normal size, with increased echogenicity of the cortical parenchyma and decreased corticomedullary differentiation. Other additional investigations showed pancytopenia with decreased complement (low C3 and C4). Antinuclear antibodies were strongly positive, including anti-double stranded DNA. Renal biopsy confirmed severe grade IV lupus nephritis. She was treated with high-dose steroids, mycophenolate mofetil and hydroxychloroquine, in addition to hemodialysis. After one week of intensive treatment, diuresis recovered and dialysis could be stopped after six sessions. We describe an uncommon case of severe lupus nephritis, presenting with terminal renal failure. Since the rarity of this disease presentation, other more common diagnoses have to be considered. Once the diagnosis of lupus nephritis is established, a choice has to be made between the different induction treatment protocols. The patient's ethnic background and other supportive therapies, such as the need for dialysis, can help to make this choice.

Persistent anemia in a kidney transplant recipient with parvovirus B19 infection

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Abbas Pakkyara

2017-01-01

Full Text Available Anemia after kidney transplant is not uncommon. This paper reports a case of unexplained anemia in a kidney transplant recipient that persisted for more than two months, and that did not respond to recombinant human erythropoietin treatment but was successfully treated after diagnosing Parvovirus B19 (ParvoV B19 infection. A middle-aged male underwent living-unrelated kidney transplantation from Pakistan in April 2015. He was on triple immuno-suppression therapy consisting of prednisolone, tacrolimus, and mycophenolate mofetil. He presented with anemia which persisted for more than two months that did not improve with Darbepoetin alpha and required blood transfusions. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts characteristic of a ParvoV B19 infection. The serum was highly positive for ParvoV B19 DNA polymerase chain reaction. The anemia resolved completely three weeks after the administration of intravenous immunoglobulin. ParvoV B19 infection should be considered in the differential diagnosis of kidney transplant recipients who present with anemia associated with a low reticulocyte count.

Rocksalt MgS solar blind ultra-violet detectors

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Ying-Hoi Lai

2012-03-01

Full Text Available Studies using in-situ Auger electron spectroscopy and reflection high energy electron diffraction, and ex-situ high resolution X-ray diffraction and electron backscatter diffraction reveal that a MgS thin film grown directly on a GaAs (100 substrate by molecular beam epitaxy adopts its most stable phase, the rocksalt structure, with a lattice constant of 5.20 Å. A Au/MgS/n+-GaAs (100 Schottky-barrier photodiode was fabricated and its room temperature photoresponse was measured to have a sharp fall-off edge at 235 nm with rejection of more than three orders at 400 nm and higher than five orders at 500 nm, promising for various solar-blind UV detection applications.

28 CFR 54.500 - Employment.

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2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Employment. 54.500 Section 54.500... in Employment in Education Programs or Activities Prohibited § 54.500 Employment. (a) General. (1) No... subjected to discrimination in employment, or recruitment, consideration, or selection therefor, whether...

Effect of heat treatment on the microstructures and damping properties of biomedical Mg-Zr alloy

Energy Technology Data Exchange (ETDEWEB)

Tsai, Ming-Hung [Department of Mechanical Engineering and Graduate Institute of Mechanical and Precision Engineering, National Kaoshiung University of Applied Sciences, Kaoshiung 807, Taiwan (China); Department of Dentistry, Chang Yin dental clinic, No.46-1, Yangming St., Banqiao City, Taipei County 220, Taiwan (China); Research Center for Biomedical Devices, Taipei Medical University, Taipei 110, Taiwan (China); Chen, May-Show [Research Center for Biomedical Devices, Taipei Medical University, Taipei 110, Taiwan (China); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan (China); Lin, Ling-Hung [Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan (China); School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Lin, Ming-Hong [Department of Mechanical Engineering and Graduate Institute of Mechanical and Precision Engineering, National Kaoshiung University of Applied Sciences, Kaoshiung 807, Taiwan (China); Wu, Ching-Zong, E-mail: chinaowu@tmu.edu.tw [Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan (China); School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan (China); Ou, Keng-Liang, E-mail: klou@tmu.edu.tw [Research Center for Biomedical Devices, Taipei Medical University, Taipei 110, Taiwan (China); Graduated Institute of Biomedical Materials and Engineering, Taipei Medical University, Taipei 110, Taiwan (China); Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University, Taipei 110, Taiwan (China); Yu, Chih-Hua [Research Center for Biomedical Devices, Taipei Medical University, Taipei 110, Taiwan (China); Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University, Taipei 110, Taiwan (China)

2011-01-21

Research highlights: > When the as-quenched Mg-1Zr alloy was aged at temperatures ranging from 200 deg. C to 500 deg. C, a microstructural transformation sequence was found to be {alpha}-Mg {yields} ({alpha}-Mg + twin{sub dense}) {yields} ({alpha}-Mg + twin{sub loose}) {yields} ({alpha}-Mg + {alpha}-Zr). > As the as-quenched Mg-1Zr alloy was subjected to aging treatment at 300 deg. C for 16 h, it exhibited the maximum damping properties. > The twin structure plays a crucial role in increasing the damping capacity of the Mg-1Zr alloy. - Abstract: In this study, we elucidated the effect of heat treatment on the microstructures and damping properties of the biomedical Mg-1 wt% Zr (K1) alloy by optical microscopy, transmission electron microscopy, energy-dispersive X-ray spectrometry, and experimental model analysis. The following microstructural transformation occurred when the as-quenched (AQ, i.e., solution heat treated and quenched) K1 alloy was subjected to aging treatment in the temperature range 200-500 deg. C: {alpha}-Mg {yields} ({alpha}-Mg + twin{sub dense}) {yields} ({alpha}-Mg + twin{sub loose}) {yields} ({alpha}-Mg + {alpha}-Zr). This microstructural transformation was accompanied by variations in the damping capacity. The damping properties of the AQ K1 alloy subjected to aging treatment at 300 deg. C for 16 h were the best among those of the alloys investigated in the present study. The presence of twin structures in the alloy matrix was thought to play a crucial role in increasing the damping capacity of the K1 alloy. Hence, we state that a combination of solution treatment and aging is an effective means of improving the damping capacity of biomedical K1 alloys.

Effect of heat treatment on the microstructures and damping properties of biomedical Mg-Zr alloy

International Nuclear Information System (INIS)

Tsai, Ming-Hung; Chen, May-Show; Lin, Ling-Hung; Lin, Ming-Hong; Wu, Ching-Zong; Ou, Keng-Liang; Yu, Chih-Hua

2011-01-01

Research highlights: → When the as-quenched Mg-1Zr alloy was aged at temperatures ranging from 200 deg. C to 500 deg. C, a microstructural transformation sequence was found to be α-Mg → (α-Mg + twin dense ) → (α-Mg + twin loose ) → (α-Mg + α-Zr). → As the as-quenched Mg-1Zr alloy was subjected to aging treatment at 300 deg. C for 16 h, it exhibited the maximum damping properties. → The twin structure plays a crucial role in increasing the damping capacity of the Mg-1Zr alloy. - Abstract: In this study, we elucidated the effect of heat treatment on the microstructures and damping properties of the biomedical Mg-1 wt% Zr (K1) alloy by optical microscopy, transmission electron microscopy, energy-dispersive X-ray spectrometry, and experimental model analysis. The following microstructural transformation occurred when the as-quenched (AQ, i.e., solution heat treated and quenched) K1 alloy was subjected to aging treatment in the temperature range 200-500 deg. C: α-Mg → (α-Mg + twin dense ) → (α-Mg + twin loose ) → (α-Mg + α-Zr). This microstructural transformation was accompanied by variations in the damping capacity. The damping properties of the AQ K1 alloy subjected to aging treatment at 300 deg. C for 16 h were the best among those of the alloys investigated in the present study. The presence of twin structures in the alloy matrix was thought to play a crucial role in increasing the damping capacity of the K1 alloy. Hence, we state that a combination of solution treatment and aging is an effective means of improving the damping capacity of biomedical K1 alloys.

Cuscuta chinensis extract promotes osteoblast differentiation and mineralization in human osteoblast-like MG-63 cells.

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Yang, Hyun Mo; Shin, Hyun-Kyung; Kang, Young-Hee; Kim, Jin-Kyung

2009-02-01

The aim of the present study was to investigate whether the aqueous extract of To-Sa-Za (TSZ-AE), the seed of Cuscuta chinensis Lam., which is a traditional medicinal herb commonly used in Korea and other oriental countries, could induce osteogenic activity in human osteoblast-like MG-63 cells. TSZ-AE treatment mildly promoted the proliferation of MG-63 cells at doses of 500 and 1,000 microg/mL in the 24-hour culture period. Dose-dependent increases in alkaline phosphatase (ALP) activity and collagen synthesis were shown at 48 and 72 hours of incubation. The release of bone morphogenetic protein (BMP)-2 but not osteocalcin in the MG-63 cells was induced by TSZ-AE at 72 hours (100-1,000 microg/mL). In addition, TSZ-AE markedly increased mRNA expression of ALP, collagen, and BMP-2 in the MG-63 cells in a dose-dependent manner. Mineralization in the culture of MG-63 cells was significantly induced at 500 and 1,000 microg/mL TSZ-AE treatment. In conclusion, this study shows that TSZ-AE enhanced ALP activity, collagen synthesis, BMP-2 expression, and mineralization in MG-63 cells. These results strongly suggest that C. chinensis can play an important role in osteoblastic bone formation and may possibly lead to the development of bone-forming drugs.

23 CFR 500.109 - CMS.

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2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false CMS. 500.109 Section 500.109 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at...

29 CFR 500.0 - Introduction.

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2010-07-01

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43 CFR 41.500 - Employment.

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2010-10-01

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6 CFR 17.500 - Employment.

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2010-01-01

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40 CFR 5.500 - Employment.

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2010-07-01

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14 CFR 1253.500 - Employment.

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2010-01-01

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21 CFR 556.500 - Oxytetracycline.

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2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Oxytetracycline. 556.500 Section 556.500 Food and... Residues of New Animal Drugs § 556.500 Oxytetracycline. (a) Acceptable daily intake (ADI). The ADI for total tetracycline residues (chlortetracycline, oxytetracycline, and tetracycline) is 25 micrograms per...

29 CFR 500.155 - Authority.

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2010-07-01

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1 CFR 500.140 - Employment.

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2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Employment. 500.140 Section 500.140 General... ACTIVITIES CONDUCTED BY THE NATIONAL COMMISSION FOR EMPLOYMENT POLICY § 500.140 Employment. No qualified handicapped person shall, on the basis of handicap, be subjected to discrimination in employment under any...

22 CFR 229.500 - Employment.

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2010-04-01

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22 CFR 146.500 - Employment.

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2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Employment. 146.500 Section 146.500 Foreign... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 146.500 Employment. (a) General. (1) No person shall, on the...

Comparative study of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis.

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Francesconi, Glaucia; Francesconi do Valle, Antonio Carlos; Passos, Sonia Lambert; de Lima Barros, Mônica Bastos; de Almeida Paes, Rodrigo; Curi, André Luiz Land; Liporage, José; Porto, Cássio Ferreira; Galhardo, Maria Clara Gutierrez

2011-05-01

Itraconazole is currently used for the treatment of cutaneous sporotrichosis. Terbinafine at a daily dose of 250 mg has been successfully applied to the treatment of cutaneous sporotrichosis. To compare the efficacy of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis. A bidirectional cohort study was conducted on 55 patients receiving 250 mg/day terbinafine and 249 patients receiving 100 mg/day itraconazole. The latter patients were matched for age and clinical form to the terbinafine group at a ratio of 5:1. Sporothrix schenckii was isolated by culture from all patients (age range: 18-70 years), who were submitted to the standard care protocol consisting of clinical and laboratory evaluation and periodic visits. Cure was observed in 51 (92.7%) patients of the terbinafine group and 229 (92%) of the itraconazole group within a similar mean period of time (11.5 and 11.8 weeks, respectively). An increase in the terbinafine dose to 500 mg was necessary in two patients due to the lack of a response, and one patient presented recurrence. In the itraconazole group, two patients required a dose increase and three presented recurrence. Adverse events were equally frequent among patients receiving terbinafine (n = 4, 7.3%) and itraconazole (n = 19, 7.6%) and were generally mild without the need for drug discontinuation, except for two patients of the itraconazole group. Terbinafine administered at a daily dose of 250 mg is an effective and well-tolerated option for the treatment of cutaneous sporotrichosis.

16 CFR 500.17 - Fractions.

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2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Fractions. 500.17 Section 500.17 Commercial... LABELING ACT § 500.17 Fractions. (a) SI metric declarations of net quantity of contents of any consumer commodity may contain only decimal fractions. Other declarations of net quantity of contents may contain...

7 CFR 500.6 - Gambling.

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2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Gambling. 500.6 Section 500.6 Agriculture Regulations... NATIONAL ARBORETUM Conduct on U.S. National Arboreturm Property § 500.6 Gambling. Participating in games for money or other personal property, or the operation of gambling devices, the conduct of a lottery...

9 CFR 93.500 - Definitions.

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2010-01-01

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21 CFR 500.82 - Definitions.

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2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Definitions. 500.82 Section 500.82 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS GENERAL Regulation of Carcinogenic Compounds Used in Food-Producing Animals § 500...

29 CFR 500.162 - Reports.

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2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Reports. 500.162 Section 500.162 Labor Regulations Relating... AGRICULTURAL WORKER PROTECTION Enforcement Agreements with Federal and State Agencies § 500.162 Reports. The Secretary shall require such reports as he deems necessary of activities conducted pursuant to State plans...

24 CFR 180.500 - Discovery.

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2010-04-01

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13 CFR 500.105 - Staff.

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2010-01-01

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10 CFR 1042.500 - Employment.

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2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Employment. 1042.500 Section 1042.500 Energy DEPARTMENT OF... RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 1042.500 Employment. (a) General. (1) No person shall, on the basis of...

45 CFR 618.500 - Employment.

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2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Employment. 618.500 Section 618.500 Public Welfare... the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a... benefits of, or be subjected to discrimination in employment, or recruitment, consideration, or selection...

Low-temperature synthesis of MgB{sub 2} via powder metallurgy processing

Energy Technology Data Exchange (ETDEWEB)

Birol, Yucel [Dokuz Eylul University, Department of Metallurgical and Materials Engineering, Faculty of Engineering, Buca, Izmir (Turkey)

2016-12-15

Ball-milled Mg/B{sub 2}O{sub 3} powder blends reveal interpenetrating layers of deformed magnesium and boron oxide grains that are increasingly refined with increasing milling time. Boron oxide is reduced by Mg and MgO thus formed reacts with the remaining B{sub 2}O{sub 3} to produce Mg{sub 3}(BO{sub 3}){sub 2} during ball milling for 30 min. Both B{sub 2}O{sub 3} and Mg{sub 3}(BO{sub 3}){sub 2} react with Mg to produce MgB{sub 2} upon further ball milling. An annealing treatment can be employed when ball milling is performed for less than 1 h as thermal exposure of the ball-milled Mg/B{sub 2}O{sub 3} powder blends also leads to the formation of MgB{sub 2}. The above reactions take place between 500 and 700 C when the Mg/B{sub 2}O{sub 3} powder blend is ball milled for 30 min, and between 450 and 550 C, after ball milling for 1 h. This is a very attractive route owing to processing temperatures where the volatility of Mg is no longer a problem. (orig.)

Final report of AFRIMETS.M.M-S6: supplementary comparison of 100 mg, 100 g 500 g, 1 kg and 5 kg stainless steel mass standards

Science.gov (United States)

Mautjana, R. T.; Molefe, P. T.; Mayindu, N. F.; Armah, M. N.; Ramasawmy, V.; Albasini, G. L.; Matali, S.; Richmond, H.; Rusimbi, V.; Kiwanuka, J.; Mutale, D. M.; Mutsimba, F.

2018-01-01

This report summarizes the results of AFRIMETS.M.M-S6 mass standards comparison conducted between eleven participating laboratories/countries. Two sets of five weights with nominal values 100 mg, 100 g, 500 g, 1 kg and 5 kg were used as the traveling standards. These nominal values were decided from the needs of participating laboratories submitted to the pilot laboratory through a questionnaire and agreed upon by all participants. The traveling standards were hand carried between laboratories starting from February 2014 and were received from the last participants in October 2014. The programme was coordinated by National Metrology Institute of South Africa (NMISA), who provided the travelling standards and reference values for the comparison. The corrections to the BIPM as-maintained mass unit [5] have insignificant influence on the results of this comparison. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

24 CFR 214.500 - Audit.

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2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Audit. 214.500 Section 214.500... PROGRAM Other Federal Requirements § 214.500 Audit. Housing counseling grant recipients and subrecipients shall be subject to the audit requirements contained in 24 CFR parts 84 and 85. HUD must be provided a...

10 CFR 5.500 - Employment.

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2010-01-01

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32 CFR 196.500 - Employment.

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2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Employment. 196.500 Section 196.500 National... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 196.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

45 CFR 2555.500 - Employment.

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2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Employment. 2555.500 Section 2555.500 Public... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 2555.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

23 CFR 500.104 - State option.

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2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false State option. 500.104 Section 500.104 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.104 State option. Except as specified in § 500.105 (a...

Effects of immunosuppressive treatment on protein expression in rat kidney

Directory of Open Access Journals (Sweden)

Kędzierska K

2014-09-01

were observed between the group receiving cyclosporine, mycophenolate mofetil, and glucocorticoids (CMG and the control group. In contrast, compared to the control group, animals receiving tacrolimus, mycophenolate mofetil, and glucocorticoids (TMG exhibited higher expression of proteins responsible for renal drug metabolism and lower expression levels of cytoplasmic actin and the major urinary protein. In the TMG group, we observed higher expression of proteins responsible for drug metabolism and a decrease in the expression of respiratory chain enzymes (thioredoxin-2 and markers of distal renal tubular damage (heart fatty acid-binding protein compared to expression in the CMG group. The consequences of the reported changes in protein expression require further study. Keywords: Proteomics, drug effects, immunosuppression, rats

24 CFR 3.500 - Employment.

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2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Employment. 3.500 Section 3.500... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 3.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

Direct observation of the crystal structure changes in the Mg{sub x}Zn{sub 1−x}O alloy system

Energy Technology Data Exchange (ETDEWEB)

Yoo, Seung Jo; Lee, Ji-Hyun; Kim, Chang-Yeon [Nano-Bio Electron Microscopy Research Group, Korea Basic Science Institute (KBSI), 169-148 Gwahak-ro, Yuseong-gu, Daejeon 305-806 (Korea, Republic of); Kim, Chang Hoi [Department of Nano Semiconductor Engineering, Korea Maritime and Ocean University, 727 Taejong-ro, Yeongdo-Gu, Busan 606-791 (Korea, Republic of); Shin, Jae Won [Nano-Bio Electron Microscopy Research Group, Korea Basic Science Institute (KBSI), 169-148 Gwahak-ro, Yuseong-gu, Daejeon 305-806 (Korea, Republic of); Center for Nanomaterials and Chemical Reactions, Institute for Basic Science (IBS), Daejeon 305-701 (Korea, Republic of); Kim, Hong Seung, E-mail: hongseung@hhu.ac.kr [Department of Nano Semiconductor Engineering, Korea Maritime and Ocean University, 727 Taejong-ro, Yeongdo-Gu, Busan 606-791 (Korea, Republic of); Kim, Jin-Gyu, E-mail: jjintta@kbsi.re.kr [Nano-Bio Electron Microscopy Research Group, Korea Basic Science Institute (KBSI), 169-148 Gwahak-ro, Yuseong-gu, Daejeon 305-806 (Korea, Republic of)

2015-08-03

We directly observed the crystal structure changes of the Mg{sub x}Zn{sub 1−x}O alloy thin film deposited on Si (111) substrates. Through the in situ heating transmission electron microscopy study, it was determined that the crystal structure changes did not occur up to at 400 °C, whereas the disappearance of the hexagonal structure was observed at 500 °C in the layer of nanosized grains. Additionally, the decreased intensity of the Zn L-edge was analyzed in the comparison of the core loss electron energy loss spectroscopy spectra of the Zn L-edge and the Mg K-edge obtained at room temperature and 500 °C. Based on these experimental results, the process of crystal structure changes could be explained by the evaporation of Zn atoms in the Mg{sub x}Zn{sub 1−x}O alloy system. This phenomenon is prominent in the improvement of the microstructure of the Mg{sub x}Zn{sub 1−x}O alloy thin film by controlling the thermal annealing temperature. - Highlights: • Mg{sub x}Zn{sub 1−x}O thin films coexisting with cubic and hexagonal structures were deposited. • Crystal structure changes of the thin films were directly observed at 500 °C. • The process of microstructure changes could be caused by the evaporation of Zn atoms.

Structural and mechanical properties of ZnMgO nanoparticles

Energy Technology Data Exchange (ETDEWEB)

Tosun, M. [Istanbul Technical University, Faculty of Mechanical Engineering, 34437, Gumussuyu, Istanbul (Turkey); Ataoglu, S. [Istanbul Technical University, Faculty of Civil Engineering, 34469, Maslak, Istanbul (Turkey); Istanbul Technical University, Earthquake Engineering and Disaster Management Institute, 34469, Maslak, Istanbul (Turkey); Arda, L., E-mail: lutfi.arda@bahcesehir.edu.tr [Bahcesehir University, Faculty of Arts and Sciences, Department of Mathematics and Computer Sciences, Ciragan Cad, Osmanpasa Mektebi Sok, 34349, Besiktas, Istanbul (Turkey); Ozturk, O.; Asikuzun, E. [Kastamonu University, Faculty of Arts and Sciences, Department of Physics, 37100, Kastamonu (Turkey); Akcan, D. [Bahcesehir University, Faculty of Arts and Sciences, Department of Mathematics and Computer Sciences, Ciragan Cad, Osmanpasa Mektebi Sok, 34349, Besiktas, Istanbul (Turkey); Cakiroglu, O. [Hasan Ali Yucel Education Faculty, Istanbul University, 34452, Beyazit, Istanbul (Turkey)

2014-01-10

This study reports the effect of annealing temperature on the structure and mechanical properties of Zn{sub 0.95}Mg{sub 0.05}O bulk samples by using digital Vickers microhardness tester, X-ray diffraction analysis, scanning electron microscopy and electron dispersive X-ray measurements. The samples were prepared using Zn and Mg based alkoxed by the sol–gel technique and annealed at various temperatures (500, 600, 700 and 800 °C). Vickers microhardness, elastic modulus, yield strength and fracture toughness values of Zn{sub 0.95}Mg{sub 0.05}O bulk samples were separately calculated and compared with each other. The experimental results of hardness measurements were analyzed using Meyer's law, Proportional Specimen Resistance (PSR) and Elastic/Plastic Deformation (EPD) models and Hays–Kendall (HK) approach. Finally, it was seen that HK approach is the most successful model for the microhardness analysis of these materials.

Durability of ITO-MgF2 Films for Space-Inflatable Polymer Structures

Science.gov (United States)

Kerslake, Thomas W.; Waters, Deborah L.; Schieman, David A.; Hambourger, Paul D.

2003-01-01

This paper presents results from ITO-MgF2 film durability evaluations that included tape peel, fold, thermal cycle, and AO exposure testing. Polymer coupon preparation is described as well as ITO-MgF2 film deposition equipment, procedures and film characterization. Durability testing methods are also described. The pre- and post-test condition of the films is assessed visually, microscopically, and electrically. Results show that at 500 ITO - 9 vol% MgF2 film is suitable to protect polymer surfaces, such as those used in space-inflatable structures of the PowerSphere microsatellite concept, during a 1-year Earth orbiting mission. Future plans for ground-based and orbital testing of this film are also discussed.

Mg2FeH6 Synthesis Efficiency Map

Directory of Open Access Journals (Sweden)

Katarzyna Witek

2018-02-01

Full Text Available The influences of the processing parameters on the Mg2FeH6 synthesis yield were studied. Mixtures of magnesium hydride (MgH2 and iron (Fe were mechanically milled in a planetary ball mill under argon for 0.5-, 1-, 2- and 3-h periods and subsequently sintered at temperatures from 300–500 ∘ C under hydrogen. The reaction yield, phase content and hydrogen storage properties of the received materials were investigated. The morphologies of the powders after synthesis were studied by SEM. The synthesis effectiveness map was presented. The obtained results prove that synthesis parameters, such as the milling time and synthesis temperature, greatly influence the reaction yield and material properties and show that extended mechanical milling may not be beneficial to the reaction efficiency.

Effect of a single intraoperative high-dose ATG-Fresenius on delayed graft function in donation after cardiac-death donor renal allograft recipients: a randomized study.

Science.gov (United States)

van den Hoogen, Martijn W F; Kho, Marcia M L; Abrahams, Alferso C; van Zuilen, Arjan D; Sanders, Jan-Stephan; van Dijk, Marja; Hilbrands, Luuk B; Weimar, Willem; Hoitsma, Andries J

2013-04-01

Reducing the incidence of delayed graft function after transplant with donation after cardiac death donor renal allografts would facilitate managing recipients during their first weeks after a transplant. To reduce this incidence, in most studies, induction therapy with depleting anti-T-lymphocyte antibodies is coupled with a reduction of the dosage of the calcineurin inhibitor. The separate effect of anti-T-cell therapy on the incidence and duration of delayed graft function is therefore difficult to assess. We performed a randomized study to evaluate the effect of a single intraoperative high-dose of anti-T-lymphocyte immunoglobulin (ATG)-Fresenius (9 mg/kg body weight) on the incidence of delayed graft function. Eligible adult recipients of a first donation after cardiac death donor renal allograft were randomly assigned to ATG-Fresenius or no induction therapy. Maintenance immunosuppression consisted of tacrolimus, in an unadjusted dose, mycophenolate mofetil, and steroids. The study was prematurely terminated because of a lower-than-anticipated inclusion rate. Baseline characteristics were comparable in the ATG-Fresenius group (n=28) and the control group (n=24). Twenty-two patients in the ATG-Fresenius group (79%) had delayed graft function, compared with 13 in the control group (54%; P = .06). Allograft and patient survival were comparable in both groups. Serious adverse events occurred more frequently in the ATG-Fresenius group than they did in the control group (57% vs 29%; P Fresenius in donation after cardiac death donor renal allograft recipients, followed by triple immunosuppression with an unadjusted tacrolimus dose, seems ineffective to reduce the incidence of delayed graft function. Moreover, this was associated with a higher rate of serious adverse events (EudraCT-number, 2007-000210-36.).

Selective T-cell Ablation with Bismuth-213 Labeled Anti-TCR Alpha Beta as Nonmyeloablative Conditionaing for Allogeneic Canine Marrow Transplantion

Energy Technology Data Exchange (ETDEWEB)

Bethge, W. A.; Wilbur, D. Scott; Storb, R.; Hamlin, Donald K.; Santos, E. B.; Brechbiel, M. W.; Fisher, Darrell R.; Sandmaier, B. M.

2003-06-15

Two major immunological barriers, the host versus graft (HVG) and the graft versus host (GVH) reaction, must be overcome for successful allogeneic hematopoietic stem cell transplantation. T-cells are involved in these barriers in the major histocompatibility complex-identical settings. We hypothesized that selective ablation of T-cells using radioimmunotherapy, together with postgrafting immunosuppression, would ensure stable allogeneic engraftment. We developed a canine model of nonmyeloablative marrow transplantation in which host immune reactions are impaired by a single dose of 2 Gy total body irradiation (TBI), and where both GVH and residual HVG reactions are controlled by postgrafting immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). We substituted the alpha-emitter bismuth-213 linked to a monoclonal antibody against TCR(alpha,beta)using the metal-binding chelate CHX-A”-DTPA, for 2 Gy TBI. Biodistribution studies using a gamma-emitting indium-111-labeled anti-TCR mAb showed uptake primarily in blood, marrow, lymph nodes, spleen and liver. In a dosimetry study, 4 dogs were treated with 0.13-0.46 mg/kg TCR mAb labeled with 3.7-5.6 mCi/kg (137-207 MBq/kg) Bi-213. The treatment was administered in 6 injections on days -3 and -2 followed by transplantion of dog leukocyte antigen-identical marrow on day 0 and postgrafting immunosuppression with MMF and CSP. Therapy was well tolerated except for elevations of transaminases, which were transient in all but one dog. No other organ toxicities or signs of graft-versus-host-disease were noted. The dogs had prompt allogeneic hematopoietic engraftment and achieved stable mixed donor-host hematopoietic chimerism with donor contributions ranging from 5-55 % with >30 weeks follow up.

Outcome of deceased donor renal transplantation - A single-center experience from developing country

Directory of Open Access Journals (Sweden)

Himanshu V Patel

2013-01-01

Full Text Available Renal transplantation (RTx is considered as the best therapeutic modality for patient suffering from end-stage renal disease (ESRD. Dearth of donor kidneys is a major problem everywhere, and deceased donor renal transplantation (DDRTx is seen as at least a partial solution. Even so, DDRTx accounts for only less than 4% of RTx in India. We report our 6-year single-center experience on DDRTx vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr, rejection episodes, and delayed graft function (DGF. Between January 2005 and March 2011, 236 DDRTx were performed. Majority of the donors were those with brain death due to road traffic/cerebrovascular accidents. The commonest recipient diseases leading to ESRD were chronic glomerulonephritis (42.8%, diabetes (12.7%, and hypertension (10.6%. Mean recipient age was 36.2 ± 14.2 years; 162 were males and 74 were females. Mean donor age was 45.3 ± 17.13 years; 144 were males and 92 were females. Mean dialysis duration pre-transplantation was 18.5 ± 2.5 months. All recipients received single-dose rabbit-anti-thymocyte globulin induction and steroids, calcinueurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Delayed graft function was observed in 29.6% patients and 22% had biopsy-proven acute rejection. Over the mean follow-up of 2.18 ± 1.75 years, patient and graft survival rates were 74.57% and 86.8%, respectively, with mean SCr of 1.42 ± 0.66 mg%. DDRTx achieves acceptable graft function with patient/graft survival, encouraging the use of this approach in view of organ shortage.

Selective T-cell Ablation with Bismuth-213 Labeled Anti-TCR Alpha Beta as Nonmyeloablative Conditioning for Allogeneic Canine Marrow Transplantion

International Nuclear Information System (INIS)

Bethge, W. A.; Wilbur, D. Scott; Storb, R.; Hamlin, Donald K.; Santos, E. B.; Brechbiel, M. W.; Fisher, Darrell R.; Sandmaier, B. M.

2003-01-01

Two major immunological barriers, the host versus graft (HVG) and the graft versus host (GVH) reaction, must be overcome for successful allogeneic hematopoietic stem cell transplantation. T-cells are involved in these barriers in the major histocompatibility complex-identical settings. We hypothesized that selective ablation of T-cells using radioimmunotherapy, together with postgrafting immunosuppression, would ensure stable allogeneic engraftment. We developed a canine model of nonmyeloablative marrow transplantation in which host immune reactions are impaired by a single dose of 2 Gy total body irradiation (TBI), and where both GVH and residual HVG reactions are controlled by postgrafting immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). We substituted the alpha-emitter bismuth-213 linked to a monoclonal antibody against TCR(alpha,beta)using the metal-binding chelate CHX-A-DTPA, for 2 Gy TBI. Biodistribution studies using a gamma-emitting indium-111-labeled anti-TCR mAb showed uptake primarily in blood, marrow, lymph nodes, spleen and liver. In a dosimetry study, 4 dogs were treated with 0.13-0.46 mg/kg TCR mAb labeled with 3.7-5.6 mCi/kg (137-207 MBq/kg) Bi-213. The treatment was administered in 6 injections on days -3 and -2 followed by transplantion of dog leukocyte antigen-identical marrow on day 0 and postgrafting immunosuppression with MMF and CSP. Therapy was well tolerated except for elevations of transaminases, which were transient in all but one dog. No other organ toxicities or signs of graft-versus-host-disease were noted. The dogs had prompt allogeneic hematopoietic engraftment and achieved stable mixed donor-host hematopoietic chimerism with donor contributions ranging from 5-55 % with >30 weeks follow up

A2 to B Blood Type Incompatible Deceased Donor Kidney Transplantation in a Recipient Infected with the Human Immunodeficiency Virus: A Case Report.

Science.gov (United States)

Forbes, R C; DeMers, A; Concepcion, B P; Moore, D R; Schaefer, H M; Shaffer, D

With the introduction of the Kidney Allocation System in the United States in December 2014, transplant centers can list eligible B blood type recipients for A2 organ offers. There have been no prior reports of ABO incompatible A2 to B deceased donor kidney transplantation in human immunodeficiency virus-positive (HIV+) recipients to guide clinicians on enrolling or performing A2 to B transplantations in HIV+ candidates. We are the first to report a case of A2 to B deceased donor kidney transplantation in an HIV+ recipient with good intermediate-term results. We describe an HIV+ 39-year-old African American man with end-stage renal disease who underwent A2 to B blood type incompatible deceased donor kidney transplantation. Prior to transplantation, he had an undetectable HIV viral load. The patient was unsensitized, with his most recent anti-A titer data being 1:2 IgG and 1:32 IgG/IgM. Induction therapy of basiliximab and methylprednisolone was followed by a postoperative regimen of plasma exchange, intravenous immunoglobulin, and rituximab with maintenance on tacrolimus, mycophenolate mofetil, and prednisone. He had delayed graft function without rejection on allograft biopsy. Nadir serum creatinine was 2.0 mg/dL. He continued to have an undetectable viral load on the same antiretroviral therapy adjusted for renal function. To our knowledge, this is the first report of A2 to B deceased donor kidney transplantation in an HIV+ recipient with good intermediate-term results, suggesting that A2 donor kidneys may be considered for transplantation into HIV+ B-blood type wait list candidates. Published by Elsevier Inc.

Mg2BIV: Narrow Bandgap Thermoelectric Semiconductors

Science.gov (United States)

Kim, Il-Ho

2018-05-01

Thermoelectric materials can convert thermal energy directly into electric energy and vice versa. The electricity generation from waste heat via thermoelectric devices can be considered as a new energy source. For instance, automotive exhaust gas and all industrial processes generate an enormous amount of waste heat that can be converted to electricity by using thermoelectric devices. Magnesium compound Mg2BIV (BIV = Si, Ge or Sn) has a favorable combination of physical and chemical properties and can be a good base for the development of new efficient thermoelectrics. Because they possess similar properties to those of group BIV elemental semiconductors, they have been recognized as good candidates for thermoelectric applications. Mg2Si, Mg2Ge and Mg2Sn with an antifluorite structure are narrow bandgap semiconductors with indirect band gaps of 0.77 eV, 0.74 eV, and 0.35 eV, respectively. Mg2BIV has been recognized as a promising material for thermoelectric energy conversion at temperatures ranging from 500 K to 800 K. Compared to other thermoelectric materials operating in the similar temperature range, such as PbTe and filled skutterudites, the important aspects of Mg2BIV are non-toxic and earth-abundant elements. Based on classical thermoelectric theory, the material factor β ( m* / m e)3/2μκ L -1 can be utilized as the criterion for thermoelectric material selection, where m* is the density-of-states effective mass, me is the mass of an electron, μ is the carrier mobility, and κL is the lattice thermal conductivity. The β for magnesium silicides is 14, which is very high compared to 0.8 for iron silicides, 1.4 for manganese silicides, and 2.6 for silicon-germanium alloys. In this paper, basic phenomena of thermoelectricity and transport parameters for thermoelectric materials were briefly introduced, and thermoelectric properties of Mg2BIV synthesized by using a solid-state reaction were reviewed. In addition, various Mg2BIV compounds were discussed

29 CFR 500.9 - Discrimination prohibited.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Discrimination prohibited. 500.9 Section 500.9 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION General Provisions § 500.9 Discrimination prohibited. (a) It is a... Secretary alleging such discrimination. ...

Integrated Mg/TiO2-ionic liquid system for deep desulfurization

Science.gov (United States)

Yin, Yee Cia; Kait, Chong Fai; Fatimah, Hayyiratul; Wilfred, Cecilia

2014-10-01

A series of Mg/TiO2 photocatalysts were prepared using wet impregnation method followed by calcination at 300, 400 and 500°C for 1 h. The photocatalysts were characterized using Thermal Gravimetric Analysis, Fourier-Transform Infrared Spectroscopy, X-Ray Diffraction, and Field Emission Scanning Electron Microscopy. The performance for deep desulfurization was investigated using model oil with 100 ppm sulfur (in the form of dibenzothiophene). The integrated system involves photocatalytic oxidation followed by ionic liquid-extraction processes. The best performing photocatalyst was 0.25wt% Mg loaded on titania calcined at 400°C (0.25Mg400), giving 98.5% conversion of dibenzothiophene to dibenzothiophene sulfone. The highest extraction efficiency of 97.8% was displayed by 1,2-diethylimidazolium diethylphosphate. The overall total sulfur removal was 96.3%.

Integrated Mg/TiO2-ionic liquid system for deep desulfurization

International Nuclear Information System (INIS)

Yin, Yee Cia; Kait, Chong Fai; Fatimah, Hayyiratul; Wilfred, Cecilia

2014-01-01

A series of Mg/TiO 2 photocatalysts were prepared using wet impregnation method followed by calcination at 300, 400 and 500°C for 1 h. The photocatalysts were characterized using Thermal Gravimetric Analysis, Fourier-Transform Infrared Spectroscopy, X-Ray Diffraction, and Field Emission Scanning Electron Microscopy. The performance for deep desulfurization was investigated using model oil with 100 ppm sulfur (in the form of dibenzothiophene). The integrated system involves photocatalytic oxidation followed by ionic liquid-extraction processes. The best performing photocatalyst was 0.25wt% Mg loaded on titania calcined at 400°C (0.25Mg400), giving 98.5% conversion of dibenzothiophene to dibenzothiophene sulfone. The highest extraction efficiency of 97.8% was displayed by 1,2-diethylimidazolium diethylphosphate. The overall total sulfur removal was 96.3%

Mg doping of GaN by molecular beam epitaxy

International Nuclear Information System (INIS)

Lieten, R R; Buchowicz, G; Dubon, O; Motsnyi, V; Zhang, L; Cheng, K; Leys, M; Degroote, S; Borghs, G

2011-01-01

We present a systematic study on the influence of growth conditions on the incorporation and activation of Mg in GaN layers grown by plasma-assisted molecular beam epitaxy. We show that high quality p-type GaN layers can be obtained on GaN-on-silicon templates. The Mg incorporation and the electrical properties have been investigated as a function of growth temperature, Ga : N flux ratio and Mg : Ga flux ratio. It was found that the incorporation of Mg and the electrical properties are highly sensitive to the Ga : N flux ratio. The highest hole mobility and lowest resistivity were achieved for slightly Ga-rich conditions. In addition to an optimal Ga : N ratio, an optimum Mg : Ga flux ratio was also observed at around 1%. We observed a clear Mg flux window for p-type doping of GaN : 0.31% 17 cm -3 and a mobility of 15 cm 2 V -1 s -1 . Temperature-dependent Hall effect measurements indicate an acceptor depth in these samples of 100 meV for a hole concentration of 5.5 x 10 17 cm -3 . The corresponding Mg concentration is 5 x 10 19 cm -3 , indicating approximately 1% activation at room temperature. In addition to continuous growth of Mg-doped GaN layers we also investigated different modulated growth procedures. We show that a modulated growth procedure has only limited influence on Mg doping at a growth temperature of 800 deg. or higher. This result is thus in contrast to previously reported GaN : Mg doping at much lower growth temperatures of 500 deg. C.

Health-related quality of life from the FALCON phase III randomised trial of fulvestrant 500 mg versus anastrozole for hormone receptor-positive advanced breast cancer.

Science.gov (United States)

Robertson, John F R; Cheung, Kwok-Leung; Noguchi, Shinzaburo; Shao, Zhimin; Degboe, Arnold; Lichfield, Jasmine; Thirlwell, Jackie; Fazal, Mehdi; Ellis, Matthew J

2018-05-01

The phase III randomised FALCON trial (NCT01602380) demonstrated improved progression-free survival with fulvestrant 500 mg versus anastrozole 1 mg in endocrine therapy-naïve postmenopausal women with hormone receptor-positive (HR+) locally advanced or metastatic breast cancer (LA/MBC). Furthermore, overall health-related quality of life (HRQoL) was maintained and comparable for fulvestrant and anastrozole. Here, we present additional analyses of patient-reported HRQoL outcomes from FALCON. Women with endocrine therapy-naïve HR+ LA/MBC were randomised 1:1 to fulvestrant (days 0, 14, 28, then every 28 d) or anastrozole (daily) until disease progression or discontinuation. HRQoL was assessed by FACT-B questionnaire (TOI and FACT-B total score) at randomisation and every 12 weeks during treatment. HRQoL data post-treatment (with or without progression) were also collected. In total, 462 patients were randomised (fulvestrant, n = 230; anastrozole, n = 232). Compliance to FACT-B overall ranged from 60.0 to 97.4%. Mean change from baseline in TOI and FACT-B total score remained broadly stable (approximately ± 3 points to week 132) and was similar between arms during treatment. HRQoL was also maintained in FACT-B subscales. Approximately one-third of patients had improved TOI (≥+6 points) and FACT-B (≥+8 points) total scores from baseline up to week 120 and 132, respectively, of treatment with fulvestrant (ranges 26.4-45.0% and 22.4-35.8%, respectively) and anastrozole (ranges 18.6-32.9%, and 22.7-37.9%, respectively). Mean change from baseline in TOI and FACT-B total score was maintained for fulvestrant and anastrozole; similar proportions of patients in both arms had improved TOI and FACT-B total scores. CLINICALTRIALS. NCT01602380. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Dose intercomparison for 400–500 keV electrons using FWT-60 film and glutamine (spectrophotometric readout) dosimeters

DEFF Research Database (Denmark)

Gupta, B. L.; Nilekani, S. R.; Gehringer, P.

1986-01-01

This paper describes the dose and the depth dose measurements with FWT-60 film and glutamine (Spectrophotometric readout) dosimeters for 400–500 keV electrons. The glutamine powder was spread uniformly in polyethylene bags and the powder thickness in each bag was 5 mg cm−2. Both techniques show...

A possibility of enhancing Jc in MgB2 film grown on metallic hastelloy tape with the use of SiC buffer layer

International Nuclear Information System (INIS)

Putri, W. B. K.; Kang, B.; Ranot, M.; Lee, J. H.; Kang, W. N.

2014-01-01

We have grown MgB 2 on SiC buffer layer by using metallic Hastelloy tape as the substrate. Hastelloy tape was chosen for its potential practical applications, mainly in the power cable industry. SiC buffer layers were deposited on Hastelloy tapes at 400, 500, and 600 degrees C by using a pulsed laser deposition method, and then by using a hybrid physical-chemical vapor deposition technique, MgB 2 films were grown on the three different SiC buffer layers. An enhancement of critical current density values were noticed in the MgB 2 films on SiC/Hastelloy deposited at 500 and 600 degrees C. From the surface analysis, smaller and denser grains of MgB 2 tapes are likely to cause this enhancement. This result infers that the addition of SiC buffer layers may contribute to the improvement of superconducting properties of MgB 2 tapes.

Soldering of Mg Joints Using Zn-Al Solders

Science.gov (United States)

Gancarz, Tomasz; Berent, Katarzyna; Skuza, Wojciech; Janik, Katarzyna

2018-04-01

Magnesium has applications in the automotive and aerospace industries that can significantly contribute to greater fuel economy and environmental conservation. The Mg alloys used in the automotive industry could reduce mass by up to 70 pct, providing energy savings. However, alongside the advantages there are limitations and technological barriers to use Mg alloys. One of the advantages concerns phenomena occurring at the interface when joining materials investigated in this study, in regard to the effect of temperature and soldering time for pure Mg joints. Eutectic Zn-Al and Zn-Al alloys with 0.05 (wt pct) Li and 0.2 (wt pct) Na were used in the soldering process. The process was performed for 3, 5, and 8 minutes of contact, at temperatures of 425 °C, 450 °C, 475 °C, and 500 °C. Selected, solidified solder-substrate couples were cross-sectioned, and their interfacial microstructures were investigated by scanning electron microscopy. The experiment was designed to demonstrate the effect of time, temperature, and the addition of Li and Na on the kinetics of the dissolving Mg substrate. The addition of Li and Na to eutectic Zn-Al caused to improve mechanical properties. Higher temperatures led to reduced joint strength, which is caused by increased interfacial reaction.

1 CFR 500.110 - Self-evaluation.

Science.gov (United States)

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Self-evaluation. 500.110 Section 500.110... PROGRAMS OR ACTIVITIES CONDUCTED BY THE NATIONAL COMMISSION FOR EMPLOYMENT POLICY § 500.110 Self-evaluation... or organizations representing handicapped persons, to participate in the self-evaluation process by...

47 CFR 65.500 - Net income.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Net income. 65.500 Section 65.500... OF RETURN PRESCRIPTION PROCEDURES AND METHODOLOGIES Interexchange Carriers § 65.500 Net income. The net income methodology specified in § 65.450 shall be utilized by all interexchange carriers that are...

20 CFR 638.500 - Orientation program.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Orientation program. 638.500 Section 638.500 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR JOB CORPS PROGRAM UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.500 Orientation program. The...

Microwave dielectric properties of low-fired Li_2TiO_3–MgO ceramics for LTCC applications

International Nuclear Information System (INIS)

Ma, Jian-Li; Fu, Zhi-Fen; Liu, Peng; Wang, Bing; Li, Yang

2016-01-01

Graphical abstract: This figure gives the Q × f and τ_f of Li_2TiO_3–MgO ceramics sintered at various temperatures with different LiF contents. Addition of LiF enhanced the sinterability and optimized the microwave dielectric properties of Li_2TiO_3–MgO ceramics. The excellent microwave dielectric properties (ε_r = 15.8, Q × f = 64,500 GHz, and τ_f = −0.2 ppm/°C) of Li_2TiO_3–MgO ceramics sintered at 850 °C illustrated that LiF is a simple effective sintering aids for Li_2TiO_3–MgO ceramics. Such sample was compatible with Ag electrodes, suitable for the low-temperature co-fired ceramics (LTCC) applications. - Highlights: • Temperature stability of Li_2TiO_3 ceramics were improved by doping MgO. • The low-fired Li_2TiO_3–MgO ceramics are fabricated. • LiF liquid phase reduced sintering temperature of Li_2TiO_3–MgO ceramics to 850 °C. • The low-fired Li_2TiO_3–MgO ceramics possess well microwave dielectric properties. • The sample was compatible with Ag electrodes and suitable for LTCC applications. - Abstract: We fabricated the low-fired Li_2TiO_3–MgO ceramics doped with LiF by a conventional solid-state route, and investigated systematically their sintering characteristics, microstructures and microwave dielectric properties. The results showed that temperature stability of Li_2TiO_3 ceramics were improved by doping MgO. Well microwave dielectric properties for Li_2TiO_3–13 wt%MgO (LTM) ceramics with ε_r = 16.4, Q × f = 87,500 GHz, and τ_f = −1.2 ppm/°C were obtained at 1325 °C. Furthermore, addition of LiF enhanced the sinterability and optimized the microwave dielectric properties of LTM ceramics. A typically sample of LTM-4 wt%LiF ceramics with optimum dielectric properties (ε_r = 15.8, Q × f = 64,500 GHz, and τ_f = −0.2 ppm/°C) were achieved at 850 °C for 4 h. Such sample was compatible with Ag electrodes, suitable for the low-temperature co-fired ceramics (LTCC) applications.

13 CFR 500.202 - Loan amount.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Loan amount. 500.202 Section 500.202 Business Credit and Assistance EMERGENCY OIL AND GAS GUARANTEED LOAN BOARD EMERGENCY OIL AND GAS GUARANTEED LOAN PROGRAM Oil and Gas Guaranteed Loans § 500.202 Loan amount. The aggregate amount of loan...

31 CFR 500.301 - Foreign country.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Foreign country. 500.301 Section 500.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 500.301 Foreign country. The term foreign country also includes, but not by way of limitation: (a) The...

31 CFR 500.412 - Process vs. manufacture.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Process vs. manufacture. 500.412 Section 500.412 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... Interpretations § 500.412 Process vs. manufacture. A commodity subject to § 500.204 remains subject howsoever it...

Combination immunotherapy in the treatment of chronic bilateral panuveitis and uveitic glaucoma during acute dengue fever infection in the Caribbean.

Science.gov (United States)

Stewart, Kevin P; Tawakol, Jan B; Khan, Tasnim; Capriotti, Joseph A

2015-01-01

Ocular manifestations of the dengue fever virus include bilateral panuveitis that can occur after the acute systemic infection has resolved. In most reported cases, the inflammation resolves with topical or systemic steroid therapy. We report a case of chronic, refractory bilateral panuveitis and uveitic glaucoma that began during the acute phase of the systemic infection and required treatment with oral steroids, multiple steroid-sparing agents, and surgical therapy for glaucoma. A 22-year-old male with acute systemic dengue fever presented with bilateral pain and decreased vision. Clinical examination revealed bilateral panuveitis with elevated intraocular pressures. Management required oral steroids, mycophenolate mofetil, cyclosporine, and bilateral glaucoma valve implantation. This case highlights the fact that dengue-associated panuveitis can begin in the acute stage of systemic infection and persist long after convalescence with progression to chronic bilateral panuveitis and uveitic glaucoma. Dengue-associated chronic panuveitis with uveitic glaucoma may be effectively managed with a combination of steroid-sparing oral immunosuppression and glaucoma surgery. This is, to our knowledge, the first case of bilateral refractory dengue-associated panuveitis from the Caribbean treated with combination steroid-sparing oral immunosuppression and bilateral glaucoma valve implantation.

Fertility, pregnancy planning, and pharmacotherapy during the pregnancy, postpartum and breastfeeding period in patients with rheumatoid arthritis and other inflammatory arthropathies

Directory of Open Access Journals (Sweden)

Marzena Olesińska

2014-03-01

Full Text Available The peak in incidence of the majority of inflammatory arthropathies (IAs is observed in the 2 nd –4 th decades of life. Thus the diseases affect patients at reproductive age. The results of population studies have demonstrated that these diseases can exert effects on the fertility of the patients, family planning, course of pregnancy and further development of the baby. It has also been shown that female patients with IAs, compared with healthy women, less frequently decide to have the first and other babies and the interval between successive pregnancies is longer. The aim of pharmacotherapy in a patient with IA who plans to become pregnant is to effectively inhibit the inflammatory activity and to maintain remission/low activity of the disease during pregnancy and after its termination. Disease-modifying drugs suitable for administration in the preconception period and pregnancy include: chloroquine, hydroxychloroquine, sulfasalazine, azathioprine, ciclosporin A, glucocorticosteroids and non-steroidal anti-inflammatory drugs. The following should not be administered: out of the synthetic disease-modifying drugs – methotrexate, leflunomide, cyclophosphamide and mycophenolate mofetil; and out of biological drugs – abatacept, tocilizumab and rituximab.

Late acute antibody mediated rejection after nine years of renal transplantation

Directory of Open Access Journals (Sweden)

Halim Medhat

2010-01-01

Full Text Available Acute Antibody Mediated Rejection (AMR is rarely reported as a long-term com-plication of renal transplantation, and it can present on top of another chronic pathology affecting the graft. A 45-year-old gentleman with chronic kidney disease due to unknown etiology received renal transplantation from his sister with 4 HLA mismatches. He received antithymocte globulin induction therapy and was maintained on steroids, azathioprine (AZA and cyclosporine A (CsA. Up to eight years post-transplantation he was clinically and biochemically stable. He lost follow-up for about one year, and then presented with nephritic nephrotic syndrome and rise of serum creatinine (SCr. to 210 μmol/L. Graft biopsy revealed picture suggestive of acute AMR on top of de novo membranoprolipherative glomerulonephritis (MPGN with focal crescent formation, diffuse immune complex deposition and peri-tubular capillaries C4d positivity. Anti-HLA donor specific antibodies were highly positive for B and T cells class I and class II. The patient was treated with intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab. AZA was changed to mycophenolate mofetil and CsA to tacrolimus. He had partial response, but SCr. continued at 220 μmol/L.

Contemporary issues and future directions in autoimmune hepatitis.

Science.gov (United States)

Liberal, Rodrigo; Mieli-Vergani, Giorgina; Vergani, Diego

2016-06-03

Autoimmune hepatitis (AIH) is a severe life-threatening hepatopathy of unknown etiology, affecting both pediatric and adult populations, and characterised by inflammatory liver histology, circulating non-organ-specific autoantibodies, and hypergammaglobulinaemia. AIH is a very heterogeneous disease with a variety of clinical presentations, ranging from asymptomatic liver test abnormalities to acute severe hepatitis or even acute liver failure. It responds very well to immunosuppressive treatment with prednisolone with or without azathioprine. Patients who are intolerant or fail to respond to standard therapy are candidates for alternative immunosuppressive regimens, the combination of steroids with mycophenolate mofetil or calcineurin inhibitors being the most frequently reported. The pathogenesis of AIH remains not completely understood, although there is evidence that genetic predisposition, molecular mimicry and defective immunoregulatory mechanisms contribute to the autoimmune liver damage. A literature search was conducted using the key-words 'autoimmune hepatitis', 'immunogenetics', 'regulatory T-cells' and 'immunosuppression'. The aim of this review is to discuss recent breakthroughs in the understanding AIH pathogenesis, diagnosis and treatment. Expert commentary: Progress in the understanding of AIH pathogenesis is likely to contribute to the development of novel therapeutic strategies, such as the adoptive transfer of autologous expanded antigen-specific regulatory T-cells.

Long-Term Impact of Cyclosporin Reduction with MMF Treatment in Chronic Allograft Dysfunction: REFERENECE Study 3-Year Follow Up

Directory of Open Access Journals (Sweden)

L. Frimat

2010-01-01

Full Text Available Calcineurin inhibitor (CNI toxicity contributes to chronic allograft nephropathy (CAN. In the 2-year, randomized, study, we showed that 50% cyclosporin (CsA reduction in combination with mycophenolate mofetil (MMF treatment improves kidney function without increasing the risk for graft rejection/loss. To investigate the long-term effect of this regimen, we conducted a follow up study in 70 kidney transplant patients until 5 years after REFERENCE initiation. The improvement of kidney function was confirmed in the MMF group but not in the control group (CsA group. Four graft losses occurred, 2 in each group (graft survival in the MMF group 95.8% and 90.9% in control group. One death occurred in the control group. There was no statistically significant difference in the occurrence of serious adverse events or acute graft rejections. A limitation is the weak proportion of patient still remaining within the control group. On the other hand, REFERENCE focuses on the CsA regimen while opinions about the tacrolimus ones are still debated. In conclusion, CsA reduction in the presence of MMF treatment seems to maintain kidney function and is well tolerated in the long term.

Managing hypertriglyceridemia in children with systemic lupus erythematosus: Two sides of the same coin.

Science.gov (United States)

Basu, Biswanath; Babu, Binu George; Bhattacharyya, Suman

Hypertriglyceridemia is common in children with systemic lupus erythematosus (SLE). A retrospective analysis of the baseline clinical-pathological presentation and treatment outcome (status of lipid profiles) was performed in two children with SLE, who presented with extreme hypertriglyceridemia over a follow-up period of four weeks. The children were treated with prednisolone, mycophenolate mofetil (MMF), hydroxychloroquine and hypolipidemic agents, depending on their disease status. On serial follow-up, the first child showed a significantly raised serum triglyceride level after receiving one week of oral prednisolone therapy. Anti-lipoprotein-lipase (LPL) autoantibody was absent. Lipid profile levels of this child gradually improved after replacing oral prednisolone with another immunosuppressant, namely MMF. The second child presented with extreme hypertriglyceridemia with positive anti-LPL autoantibody. She responded to plasmapheresis followed by increasing the dose of immunosuppressant. So, extreme hypertriglyceridemia in children with SLE may be steroid induced or due to presence of anti-LPL auto antibody. Management should be individualized depending on the etiology. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Treatment of neuromyelitis optica: an evidence based review

Directory of Open Access Journals (Sweden)

Douglas Sato

2012-01-01

Full Text Available Neuromyelitis optica (NMO is an inflammatory disease of the central nervous system characterized by severe optic neuritis and transverse myelitis, usually with a relapsing course. Aquaporin-4 antibody is positive in a high percentage of NMO patients and it is directed against this water channel richly expressed on foot processes of astrocytes. Due to the severity of NMO attacks and the high risk for disability, treatment should be instituted as soon as the diagnosis is confirmed. There is increasing evidence that NMO patients respond differently from patients with multiple sclerosis (MS, and, therefore, treatments for MS may not be suitable for NMO. Acute NMO attacks usually are treated with high dose intravenous corticosteroid pulse and plasmapheresis. Maintenance therapy is also required to avoid further attacks and it is based on low-dose oral corticosteroids and non-specific immunosuppressant drugs, like azathioprine and mycophenolate mofetil. New therapy strategies using monoclonal antibodies like rituximab have been tested in NMO, with positive results in open label studies. However, there is no controlled randomized trial to confirm the safety and efficacy for the drugs currently used in NMO.

Challenges in renal transplantation in Yemen.

Science.gov (United States)

El-Nono, Ibrahiem H; Telha, Khaled A; Al-Alimy, Gamil M; Ghilan, Abdulilah M; Abu Asba, Nagieb W; Al-Zkri, Abdo M; Al-Adimi, Abdulilah M; Al-Ba'adani, Tawfiq H

2015-02-16

Background Renal replacement therapy was first introduced in Yemen in 1978 in the form of hemodialysis. Twenty years later, the first renal transplantation was performed. Kidney transplantations were started in socially and financially challenging circumstances in Yemen in 1998. A structured program was established and has been functioning regularly since 2005. A pediatric transplantation program was started in 2011. Material and Methods This was a prospective study of 181 transplants performed at the Urology and Nephrology Center between May 1998 and 2012. All transplants were from living related donors. The immunosuppressive protocol consisted initially of double therapy with steroid and mycophenolate mofetil (MMF). Subsequently, triple therapy with addition of a calcineurin inhibitor was introduced. Primary graft function was achieved in 176 (97.2%) recipients. Results Cold ischemia time was 48-68 min. Episodes of acute rejection in 12 patients were treated with high-dose steroids. Anti-thymocyte globulin (ATG) was used in cases of vascular or steroid-resistant rejection in 2 patients. The post-transplant complications, either surgical or medical, were comparable to those recorded in the literature. Conclusions Renal transplantation is a good achievement in our country. The patients and graft survival rates are comparable to other reports.

Enzymatic Activity of Candida spp. from Oral Cavity and Urine in Children with Nephrotic Syndrome.

Science.gov (United States)

Olczak-Kowalczyk, Dorota; Roszkowska-Blaim, Maria; Dąbkowska, Maria; Swoboda-Kopeć, Ewa; Gozdowski, Dariusz; Mizerska-Wasiak, Małgorzata; Demkow, Urszula; Pańczyk-Tomaszewska, Małgorzata

2017-01-01

Oral colonization with Candida spp. is not synonymous with a systemic active infection. The aim of the study was to evaluate enzymatic activity of Candida strains isolated from the oral cavity in patients with nephrotic syndrome (NS) and to compare it with the activity determined in urine. We studied 32 children with NS and 26 control healthy children. Children with NS were treated with glucocorticosteroids, cyclosporin A, mycophenolate mofetil or azathioprine. In all children, API-ZYM enzymatic tests were performed to evaluate hydrolytic enzymes of Candida isolated from the oral cavity and in urine. Candida spp. were isolated from the oral cavity in 11 patients with NS (34.4%), all receiving immunosuppressive treatment. All strains produced valine arylamidase, 9 alpha-glucosidase (E16), and 9 N-acetyl-beta-glucosaminidase (E18). A positive correlation between the presence of Candida in the oral cavity and E16 and E18 enzymatic activity in both oral cavity and urine was found. A dose of cyclosporin A had an effect on the enzymatic activity (p Candida invasion. The results of this study suggest that oral candida infection should be monitored in children with nephrotic syndrome, particularly those treated with immunosuppressive agents.

Sarcoidosis and uveitis.

Science.gov (United States)

Jamilloux, Yvan; Kodjikian, Laurent; Broussolle, Christiane; Sève, Pascal

2014-08-01

Uveitis is a frequent (20-50%) and early feature of sarcoidosis. Typical sarcoid uveitis presents with mutton-fat keratic precipitates, iris nodules, and anterior and posterior synechiae. Posterior involvement includes vitreitis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence. Histologic proof from a biopsy is the gold standard for the diagnosis of ocular sarcoidosis. An international workshop has recently established diagnostic criteria for sarcoidosis uveitis when biopsy is unavailable or negative: these are based on a combination of ophthalmological findings and laboratory tests. The value of recent techniques, such as PET-scan and endoscopic ultrasound-guided, fine-needle aspiration of intrathoracic nodes needs to be assessed in future studies. Corticosteroids are the mainstay treatment for sarcoidosis. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema and occlusive vasculitis. In up to 15% of cases, additional immunosuppression is used, including methotrexate, azathioprine, and mycophenolate mofetil. Infliximab and adalimumab have been recently proposed for the treatment of refractory or sight-threatening systemic sarcoidosis. Copyright © 2014 Elsevier B.V. All rights reserved.

Emerging Drugs for Uveitis

Science.gov (United States)

Larson, Theresa; Nussenblatt, Robert B.; Sen, H. Nida

2010-01-01

Importance of the Field Uveitis is a challenging disease covering both infectious and noninfectious conditions. The current treatment strategies are hampered by the paucity of randomized controlled trials (RCTs) and few trials comparing efficacy of different agents. Areas Covered in this Review This review describes the current and future treatments of uveitis. A literature search was performed in PUBMED from 1965 to 2010 on drugs treating ocular inflammation with emphasis placed on more recent, larger studies. What the Reader Will Gain Readers should gain a basic understanding of current treatment strategies beginning with corticosteroids and transitioning to steroid sparing agents. Steroid sparing agents include the antimetabolites which include methotrexate, azathioprine, and mycophenolate mofetil; the calcineurin inhibitors which include cyclosporine, tacrolimus; alkylating agents which include cyclophosphamide and chlorambucil; and biologics which include the TNF-α inhibitors infliximab, adalimumab, and etanercept; daclizumab, interferon α2a, and rituximab. Take Home Message Newer agents are typically formulated from existing drugs or developed based on new advances in immunology. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects. PMID:21210752

Immune Desensitization Allows Pediatric Blood Group Incompatible Kidney Transplantation.

Science.gov (United States)

Stojanovic, Jelena; Adamusiak, Anna; Kessaris, Nicos; Chandak, Pankaj; Ahmed, Zubir; Sebire, Neil J; Walsh, Grainne; Jones, Helen E; Marks, Stephen D; Mamode, Nizam

2017-06-01

Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection. We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery. Antibody removal was performed to reduce titers to 1 or less in 8 on the day of the operation. No routine postoperative antibody removal was performed. Death-censored graft survival at last follow-up was 100% in the ABOi and 98% in 50 compatible pediatric transplants. One patient developed grade 2A rejection successfully treated with antithymocyte globulin. Another patient had a titer rise of 2 dilutions treated with 1 immunoadsorption session. There was no histological evidence of rejection in the other 9 patients. One patient developed cytomegalovirus and BK and 2 others EBV and BK viremia. Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.

Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching.

Science.gov (United States)

Shang, Wenjun; Dong, Laidong; Feng, Guiwen; Wang, Yue; Pang, Xinlu; Li, Jinfeng; Liu, Lei; Zhang, Weihong

2013-08-01

To determine whether a new desensitization protocol (mycophenolate mofetil [MMF], plasmapheresis and antithymocyte globulin [ATG], complemented with human leucocyte antigen [HLA] amino acid residue matching) could reduce panel-reactive antibody (PRA) levels in sensitized patients, to facilitate successful renal transplantation. Patients awaiting transplantation with PRA levels >10% received treatment with MMF; those with PRA levels >30% were also treated with plasmapheresis. Patients whose PRA level was desensitization were eligible for transplantation. When a donor became available, traditional HLA matching and HLA amino acid residue matching were performed. All patients received ATG induction therapy postoperatively. Thirty-two sensitized patients were enrolled. Desensitization produced a significant decrease in PRA levels; 27 patients (84.4%) became eligible for transplantation and 26 (81.2%) subsequently underwent successful transplantation. Residue matching improved the proportion with a mismatch number of 0-1 from 7.7% to 65.4%, compared with traditional HLA matching. Postoperatively, all patients showed immediate graft function. Acute rejection occurred in three patients (11.5%) and infections in seven patients (25.9%); all were treated successfully. The combination of a desensitization protocol (MMF, plasmapheresis and ATG) and residue matching appears to be an effective strategy for sensitized patients awaiting renal transplantation.

Vulvovaginal gingival lichen planus: report of two cases and review of literature.

Science.gov (United States)

Lucchese, A; Dolci, A; Minervini, G; Salerno, C; DI Stasio, D; Minervini, G; Laino, L; Silvestre, F; Serpico, R

2016-01-01

Oral Lichen Planus (OLP) is a chronic inflammatory disease of skin and mucous membranes. Approximately 20% of women with oral lichen planus develops lesions in the genital mucosa. In 1982, Pelisse described a special form of lichen planus (LP), which consists of a triad of symptoms: vulval, vaginal and gingival (VVG)-LP lesions. Aim of the present report is to report two new cases and review the international literature. Two cases of VVG-LP are reported and a review of recent literature is performed. The onset of erosive or ulcerative mouth lesions may precede or follow by months or even years the onset of vulvovaginal lesions. Vaginal agglutination is associated with the postmenopausal state in conjunction with a dermatologic condition. Intra-lesional corticosteroids have a role in localized chronic ulceration, while systemic therapies such as corticosteroids, azathioprine, mycophenolate mofetil, hydroxychloroquine, ciclosporin, methotrexate, retinoids, thalidomide and photo chemotherapy have been used in more severe cases with varying success. VVG-LP is rather a rare condition and has been documented in the literature mainly in the form of case reports. Lack of a precise diagnostic criteria of VVG-LP depends on the specialists.

13 CFR 500.204 - Loan terms.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Loan terms. 500.204 Section 500.204 Business Credit and Assistance EMERGENCY OIL AND GAS GUARANTEED LOAN BOARD EMERGENCY OIL AND GAS GUARANTEED LOAN PROGRAM Oil and Gas Guaranteed Loans § 500.204 Loan terms. (a) All loans guaranteed under the...

31 CFR 500.320 - Domestic bank.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Domestic bank. 500.320 Section 500... § 500.320 Domestic bank. The term domestic bank shall mean any branch or office within the United States of any of the following which is not a national of any designated foreign country: Any bank or trust...

Thermal desensitization of gamma irradiated LiF:Mg,Ti

Energy Technology Data Exchange (ETDEWEB)

Chernov, V.; Rogalev, B.; Afonin, G. (Institute of Geochemistry, Irkutsk (Russian Federation))

1993-01-01

The thermoluminescence sensitivity variation of gamma irradiated LiF:Mg,Ti after annealing at temperatures of 300-500[sup o]C has been studied. This variation is shown to be due to concurrent processes of sensitization and damage. Annealing of irradiated crystals leads to the restoration of the initial sensitivity. The damage decay time is approximately an order of magnitude greater than the decay time of the sensitization. The experimental data are interpreted quantitatively within the scope of included gamma track overlapping. (author).

Integrated Mg/TiO{sub 2}-ionic liquid system for deep desulfurization

Energy Technology Data Exchange (ETDEWEB)

Yin, Yee Cia, E-mail: gabrielle.ciayin@gmail.com [Department of Chemical Engineering, Universiti Teknologi PETRONAS, 31750 Tronoh, Perak (Malaysia); Kait, Chong Fai, E-mail: chongfaikait@petronas.com.my, E-mail: hayyiratulfatimah@yahoo.com, E-mail: cecili@petronas.com.my; Fatimah, Hayyiratul, E-mail: chongfaikait@petronas.com.my, E-mail: hayyiratulfatimah@yahoo.com, E-mail: cecili@petronas.com.my; Wilfred, Cecilia, E-mail: chongfaikait@petronas.com.my, E-mail: hayyiratulfatimah@yahoo.com, E-mail: cecili@petronas.com.my [Department of Fundamental and Applied Sciences, Universiti Teknologi PETRONAS, 31750 Tronoh, Perak (Malaysia)

2014-10-24

A series of Mg/TiO{sub 2} photocatalysts were prepared using wet impregnation method followed by calcination at 300, 400 and 500°C for 1 h. The photocatalysts were characterized using Thermal Gravimetric Analysis, Fourier-Transform Infrared Spectroscopy, X-Ray Diffraction, and Field Emission Scanning Electron Microscopy. The performance for deep desulfurization was investigated using model oil with 100 ppm sulfur (in the form of dibenzothiophene). The integrated system involves photocatalytic oxidation followed by ionic liquid-extraction processes. The best performing photocatalyst was 0.25wt% Mg loaded on titania calcined at 400°C (0.25Mg400), giving 98.5% conversion of dibenzothiophene to dibenzothiophene sulfone. The highest extraction efficiency of 97.8% was displayed by 1,2-diethylimidazolium diethylphosphate. The overall total sulfur removal was 96.3%.

Corrosion resistance of structural material AlMg-2 in water following heat treatment and cooling

International Nuclear Information System (INIS)

Maman Kartaman A; Djoko Kisworo; Dedi Hariyadi; Sigit

2005-01-01

Corrosion tests of structural material AlMg-2 in water were carried out using autoclave in order to study the effects of heat treatment on the corrosion resistance of the material. Prior to the tests, the samples were heat-treated at temperatures of 90, 200, 300 and 500 °C and cooled in air, sand and water. The corrosion tests were conducted in water at temperature of 150 °C for 250 hours. The results showed that AlMg-2 samples were corroded although the increase of mass gain was relatively small. Heat treatment from 90 to 500 °C in sand cooling media resulted in an increase of mass gain despite that at 300 °C the increase was less than those at 200 °C and 500 °C. For water cooling media in the temperature range of 90 to 200 °C, the mass gain increased from 0.1854 g/cm 2 to 2.1204 g/cm 2 although after 200 °C it decreased to 1.8207 g/cm 2 and 1.6779 g/cm 2 respectively. For air cooling media, the mass gain was relatively constant. Based on the experiment results, it can be concluded that heat treatment and cooling did not significantly influence the corrosion resistance of material AlMg-2. The passive film Al 2 O 3 on the surface was able to protect the inner surface from further corrosion. Water media with pH range from 4 – 9 did not cause damage to passive layer formed. (author)

Mg-doping experiment and electrical transport measurement of boron nanobelts

International Nuclear Information System (INIS)

Kirihara, K.; Hyodo, H.; Fujihisa, H.; Wang, Z.; Kawaguchi, K.; Shimizu, Y.; Sasaki, T.; Koshizaki, N.; Soga, K.; Kimura, K.

2006-01-01

We measured electrical conductance of single crystalline boron nanobelts having α-tetragonal crystalline structure. The doping experiment of Mg was carried out by vapor diffusion method. The pure boron nanobelt is a p-type semiconductor and its electrical conductivity was estimated to be on the order of 10 -3 (Ω cm) -1 at room temperature. The carrier mobility of pure boron nanobelt was measured to be on the order of 10 -3 (cm 2 Vs -1 ) at room temperature and has an activation energy of ∼0.19 eV. The Mg-doped boron nanobelts have the same α-tetragonal crystalline structure as the pristine nanobelts. After Mg vapor diffusion, the nanobelts were still semiconductor, while the electrical conductance increased by a factor of 100-500. Transition to metal or superconductor by doping was not observed. - Graphical abstract: SEM micrographs of boron nanobelt after Ni/Au electrode fabrication by electron beam lithography. Display Omitted

Synthesis and characterization of isolated iron oxide nanoparticle dispersed in MgO matrix

International Nuclear Information System (INIS)

Choa, Y.-H.; Yang, J.-K.; Yang, W.-J.; Auh, K.-H.

2003-01-01

γ-Fe 2 O 3 /MgO nanocomposite powders, which can be used for biomedical, magnetic and the catalytic applications, were fabricated by means of spray pyrolysis using an ultrasonic atomizer. The liquid source was prepared using Fe and Mg nitrates dissolved in pure water. The liquid was atomized using an ultrasonic atomizer and carried into a pre-heated chamber (500-800 deg. C) by air carrier gas. The mist was then decomposed into γ-Fe 2 O 3 and MgO nanopowders. The entire operation was performed at 1 atm. The γ-Fe 2 O 3 /MgO powder was found to be perfectly crystallized at 800 deg. C. The particle size of γ-Fe 2 O 3 /MgO nanocomposite powders prepared at 800 deg. C was about 10 nm for γ-Fe 2 O 3 and MgO, which were calculated by XRD using Scherrer's formula and measured by TEM observation. The samples indicate the presence of superparamagnetic properties and a blocking temperature (T B ) of 125 K

21 CFR 500.92 - Implementation.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Implementation. 500.92 Section 500.92 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS GENERAL Regulation of Carcinogenic Compounds Used in Food-Producing Animals...

31 CFR 500.310 - Transfer.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Transfer. 500.310 Section 500.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN..., or other fiduciary; the creation or transfer of any lien; the issuance, docketing, filing, or the...

13 CFR 500.212 - Liquidation.

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2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Liquidation. 500.212 Section 500.212 Business Credit and Assistance EMERGENCY OIL AND GAS GUARANTEED LOAN BOARD EMERGENCY OIL AND GAS... proper, consistent with Federal law and regulations. (b) Pursuant to the Guarantee, upon written demand...

Total-Body Irradiation Followed By Cyclosporine and Mycophenolate Mofetil in Treating Patients With Severe Combined Immunodeficiency Undergoing Donor Bone Marrow Transplant

Science.gov (United States)

2017-07-12

Adenosine Deaminase Deficiency; Autosomal Recessive Disorder; Immune System Disorder; Purine-Nucleoside Phosphorylase Deficiency; Severe Combined Immunodeficiency; Severe Combined Immunodeficiency With Absence of T and B Cells; X-Linked Severe Combined Immunodeficiency

31 CFR 500.309 - Transactions.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Transactions. 500.309 Section 500.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN..., but not by way of limitation: (a) Any payment or transfer to any such designated foreign country or...

Active Protection of an MgB2 Test Coil

Science.gov (United States)

Park, Dong Keun; Hahn, Seungyong; Bascuñán, Juan; Iwasa, Yukikazu

2011-01-01

This paper presents results of a study, experimental and computational, of a detect-and-activate-the-heater protection technique applied to a magnesium diboride (MgB2) test coil operated in semi-persistent mode. The test coil with a winding ID of 25 cm and wound with ~500-m long reacted MgB2 wire was operated at 4.2 K immersed in a bath of liquid helium. In this active technique, upon the initiation of a “hot spot” of a length ~10 cm, induced by a “quench heater,” a “protection heater” (PH) of ~600-cm long planted within the test coil is activated. The normal zone created by the PH is large enough to absorb the test coil’s entire initial stored energy and still keeps the peak temperature within the winding below ~260 K. PMID:22081754

44 CFR 19.500 - Employment.

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2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Employment. 19.500 Section 19... FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 19.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded...

13 CFR 113.500 - Employment.

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2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Employment. 113.500 Section 113... Discrimination on the Basis of Sex in Employment in Education Programs Or Activities Prohibited § 113.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

36 CFR 1211.500 - Employment.

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2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Employment. 1211.500 Section... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 1211.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

18 CFR 1317.500 - Employment.

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2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Employment. 1317.500... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 1317.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

38 CFR 23.500 - Employment.

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2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Employment. 23.500... Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 23.500 Employment. (a) General. (1) No person shall, on the basis of sex, be excluded from participation in, be...

Randomized clinical trial of dexketoprofen/tramadol 25 mg/75 mg in moderate-to-severe pain after total hip arthroplasty.

Science.gov (United States)

McQuay, H J; Moore, R A; Berta, A; Gainutdinovs, O; Fülesdi, B; Porvaneckas, N; Petronis, S; Mitkovic, M; Bucsi, L; Samson, L; Zegunis, V; Ankin, M L; Bertolotti, M; Pizà-Vallespir, B; Cuadripani, S; Contini, M P; Nizzardo, A

2016-02-01

The aim was to evaluate the analgesic efficacy and safety of the dexketoprofen/tramadol 25 mg/75 mg fixed-dose combination vs dexketoprofen (25 mg) and tramadol (100 mg) in moderate-to-severe acute pain after total hip arthroplasty. This was a randomized, double-blind, parallel-group study in patients experiencing pain of at least moderate intensity on the day after surgery, compared with placebo at first administration to validate the pain model. The study drug was administered orally every 8 h throughout a 5 day period. Rescue medication, metamizole 500 mg, was available during the treatment period. The evaluation of efficacy was based on patient assessments of pain intensity and pain relief. The primary end point was the mean sum of the pain intensity difference values throughout the first 8 h (SPID8). Overall, 641 patients, mean age 62 (range 29-80) yr, were analysed; mean (sd) values of SPID8 were 247 (157) for dexketoprofen/tramadol, 209 (155) for dexketoprofen, 205 (146) for tramadol, and 151 (159) for placebo. The primary analysis confirmed the superiority of the combination over dexketoprofen 25 mg (P=0.019; 95% confidence interval 6.4-73) and tramadol 100 mg (P=0.012; 95% confidence interval 9.5-76). The single components were superior to placebo (P<0.05), confirming model sensitivity. Most secondary analyses supported the superiority of the combination. The incidence of adverse drug reactions was low and similar among active treatment groups. The efficacy results confirmed the superiority of dexketoprofen/tramadol over its single components, even at higher doses (tramadol), with a safety profile fully in line with that previously known for these agents in monotherapy. EudraCT 2012-004548-31 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2012-004548-31);ClinicalTrials.gov NCT01902134 (https://www.clinicaltrials.gov/ct2/show/NCT01902134?term=NCT01902134&rank=1). © The Author 2016. Published by Oxford University Press on

Revisiting 26Al-26Mg systematics of plagioclase in H4 chondrites

Science.gov (United States)

Telus, M.; Huss, G. R.; Nagashima, K.; Ogliore, R. C.

2014-06-01

Zinner and Göpel found clear evidence for the former presence of 26Al in the H4 chondrites Ste. Marguerite and Forest Vale. They assumed that the 26Al-26Mg systematics of these chondrites date "metamorphic cooling of the H4 parent body." Plagioclase in these chondrites can have very high Al/Mg ratios and low Mg concentrations, making these ion probe analyses susceptible to ratio bias, which is inversely proportional to the number of counts of the denominator isotope (Ogliore et al.). Zinner and Göpel used the mean of the ratios to calculate the isotope ratios, which exacerbates this problem. We analyzed the Al/Mg ratios and Mg isotopic compositions of plagioclase grains in thin sections of Ste. Marguerite, Forest Vale, Beaver Creek, and Sena to evaluate the possible influence of ratio bias on the published initial 26Al/27Al ratios for these meteorites. We calculated the isotope ratios using total counts, a less biased method of calculating isotope ratios. The results from our analyses are consistent with those from Zinner and Göpel, indicating that ratio bias does not significantly affect 26Al-26Mg results for plagioclase in these chondrites. Ste. Marguerite has a clear isochron with an initial 26Al/27Al ratio indicating that it cooled to below 450 °C 5.2 ± 0.2 Myr after CAIs. The isochrons for Forest Vale and Beaver Creek also show clear evidence that 26Al was alive when they cooled, but the initial 26Al/27Al ratios are not well constrained. Sena does not show evidence that 26Al was alive when it cooled to below the Al-Mg closure temperature. Given that metallographic cooling rates for Ste. Marguerite, Forest Vale, and Beaver Creek are atypical (>5000 °C/Myr at 500 °C) compared with most H4s, including Sena, which have cooling rates of 10-50 °C/Myr at 500 °C (Scott et al.), we conclude that the Al-Mg systematics for Ste. Marguerite, Forest Vale, and Beaver Creek are the result of impact excavation of these chondrites and cooling at the surface of the

7 CFR 500.3 - Preservation of property.

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2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Preservation of property. 500.3 Section 500.3 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL ARBORETUM Conduct on U.S. National Arboreturm Property § 500.3 Preservation...

10 CFR 600.500 - Purpose and scope.

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2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Purpose and scope. 600.500 Section 600.500 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS FINANCIAL ASSISTANCE RULES Eligibility Determination for Certain Financial Assistance Programs-General Statement of Policy § 600.500 Purpose and scope...

29 CFR 500.80 - Payroll records required.

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2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Payroll records required. 500.80 Section 500.80 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Worker Protections Wages and Payroll Standards § 500.80 Payroll... agricultural association which employs any migrant or seasonal agricultural worker shall preserve all payroll...

31 CFR 500.578 - Vietnamese property unblocked.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Vietnamese property unblocked. 500.578 Section 500.578 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued..., Authorizations and Statements of Licensing Policy § 500.578 Vietnamese property unblocked. All transactions...

Crystallinity and superconductivity of as-grown MgB2 thin films with AlN buffer layers

International Nuclear Information System (INIS)

Tsujimoto, K.; Shimakage, H.; Wang, Z.; Kaya, N.

2005-01-01

The effects of aluminum nitride (AlN) buffer layers on the superconducting properties of MgB 2 thin film were investigated. The AlN buffer layers and as-grown MgB 2 thin films were deposited in situ using the multiple-target sputtering system. The best depositing condition for the AlN/MgB 2 bi-layer occurred when the AlN was deposited on c-cut sapphire substrates at 290 deg. C. The crystallinity of the AlN/MgB 2 bi-layer was studied using the XRD φ-scan and it showed that AlN and MgB 2 had the same in-plane alignment rotated at an angle of 30 deg. as compared to c-cut sapphire. The critical temperature of the MgB 2 film was 29.8 K and the resistivity was 50.0 μΩ cm at 40 K

MgO thin films deposited by electrostatic spray pyrolysis for protecting layers in AC-plasma display panel

CERN Document Server

Kim, S G

1999-01-01

MgO thin films were deposited on SiO sub 2 (100) substrates by using electrostatic spray pyrolysis and Mg(tmhd) sub 2 as the precursor. The growth rates of the films varyed from 34 to 87 A/min and were measured for various substrate and guide temperatures. X-ray diffraction analysis provide evidence that the MgO films deposited at temperatures as low as 400 approx 500 .deg. C had preferred orientation to (100) plane perpendicular to the substrate surface. X-ray photoelectron spectroscopy and Auger electron spectroscopy data indicated that there were few organics incorporated in the films.

Detrimental effects of rat mesenchymal stromal cell pre-treatment in a model of acute kidney rejection

Directory of Open Access Journals (Sweden)

Martina eSeifert

2012-07-01

Full Text Available Mesenchymal stromal cells (MSC have shown immunomodulatory and tissue repair potential including partial tolerance induction by pre-treatment of donor-specific cells in a rat heart transplantation model. Very recently, we could show that autologous MSC attenuated ischemia reperfusion injury in a highly mismatched donor-recipient rat kidney transplant model. Therefore, we investigated donor-specific MSC pre-treatment in this rat kidney transplantation model to study whether graft function could be improved, or if tolerance could be induced.Donor- and recipient-type MSC or PBS as a control were injected i.v. four days before kidney transplantation. Mycophenolate mofetil (MMF immunosuppression (20 mg/kg body weight was applied for 7 days. Kidney grafts and spleens were harvested between days 8-10 and analyzed by quantitative RT-PCR and immunohistology. In addition, creatinine levels in the blood were measured and serum was screened for the presence of donor-specific antibodies.Surprisingly, application of both donor- and recipient-specific MSC resulted in enhanced humoral immune responses verified by intragraft B cell infiltration and complement factor C4d deposits. Moreover, signs of inflammation and rejection were generally enhanced in both MSC-treated groups relative to PBS control group. Additionally, pre-treatment with donor-specific MSC significantly enhanced the level of donor-specific antibody formation when compared with PBS- or recipient-MSC-treated groups. Pre-treatment with both MSC types resulted in a higher degree of kidney cortex tissue damage and elevated creatinine levels at the time point of rejection. Thus, MSC pre-sensitization in this model impairs the allograft outcome.Our data from this pre-clinical kidney transplantation model indicate that pre-operative MSC administration may not be optimal in kidney transplantation and caution must be exerted before moving forward with clinical studies in order to avoid adverse effects.

Early and late humoral rejection: a clinicopathologic entity in two times.

Science.gov (United States)

Péfaur, J; Díaz, P; Panace, R; Salinas, P; Fiabane, A; Quinteros, N; Chea, R; Naranjo, E; Wurgaft, A; Beltran, E; Elgueta, S; Wegmann, M E; Gajardo, J G; Contreras, L

2008-11-01

Humoral rejection is an important cause of early and late graft loss. The late variant is difficult to diagnose and treat. There is a close correlation between sclerosing nephropathy and anti-HLA antibodies. We analyzed 113 renal allograft recipients between August 2004 and April 2007. Acute humoral rejection was defined as acute graft dysfunction in presence of donor-specific antibodies (DSA) detected by flow panel reactive antibodies (PRA) and/or C4d positive pericapilary tubules (PTC) detected histopathologically by immunofluorescent or immunoperoxidase at less than 3 months postransplantation. Late humoral rejection was defined as dysfunction occurring after 3 months postransplantation with histopathologic glomerulopathy or vasculopathy and positive C4d PTC. We included all patients who were diagnosed with early or late graft dysfunction and underwent biopsy, all of which were examined for C4d. Four patients had acute humoral rejection treated with IVIG or plasmapheresis. The patient and graft survivals were 100% and serum creatinine averaged 1.7 mg/dL. Three recipients experienced late humoral rejection at 3 to 10 years posttransplantation All received high-dose IVIG; one also was treated with thymoglobulin. Immunosuppression was switched to tacrolimus, mycophenolate mofetil, and steroids. Only one patient recovered renal function; the others returned to dialysis. Among seven patients only one had an actual PRA (>20%) and three showed 10% to 20%. However, six had a positive historical PRA of 10% to 50%. In conclusion, Recognition of acute humoral rejection has contributed to graft rescue by controlling alloantibody production through new specific immunosuppressive therapies in contrast with the clinical response to acute therapy, treatment of a chronic entity has shown poor outcomes, probably because antibody mediated chronic graft damage is already present when the late diagnosis is established by biopsy.

Pharmacoepidemiology of anemia in kidney transplant recipients.

Science.gov (United States)

Winkelmayer, Wolfgang C; Kewalramani, Reshma; Rutstein, Mark; Gabardi, Steven; Vonvisger, Tania; Chandraker, Anil

2004-05-01

ABSTRACT. Anemia has long been known to be a complication of end-stage renal disease (ESRD), and it has been linked to cardiovascular morbidity and mortality. Although kidney transplant recipients (KTR) are prone to experiencing cardiovascular outcomes, little is known about the epidemiology of anemia in this population. With few exceptions, studies to date have not fully evaluated the associations between posttransplant anemia (PTA) and medications commonly used in KTR, particularly immunosuppressant drugs, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB). The authors aimed to specifically investigate possible associations between these drugs and PTA. Detailed medical information was retrospectively collected on 374 consecutive KTR from our transplant clinic. Univariate/multivariate linear regression models were used to test for associations between hematocrit (HCT) and other covariates, and logistic regression models were used to detect independent predictors of PTA, defined as HCT <33%. The mean time since transplantation was 7.7 yr, and mean creatinine was 2.2 mg/dl. The prevalence of PTA was 28.6%. Ten percent of all patients were on erythropoietin therapy, but only 41.6% of patients whose HCT was <30 received this treatment. From multivariate analyses, the authors found that female gender and lower renal function were associated with lower HCT (both P < 0.001). Patients on ACEI had significantly lower HCT (P = 0.005) compared with patients without such treatment. In addition, a significant curvilinear dose-response relationship was found between ACEI dose and HCT. Among the immunosuppressant drugs, mycophenolate mofetil (P = 0.05) and tacrolimus (P = 0.02) were associated with a lower HCT. The authors conclude that PTA is prevalent and undertreated in KTR. Several medications that are possibly modifiable correlates of PTR deserve further study.

SEVERE (GRADE III-IV ACUTE GRAFT VERSUS HOST DISEASE AFTER ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION

Directory of Open Access Journals (Sweden)

Irena Preložnik-Zupan

2002-09-01

Full Text Available Background. Beside greater susceptibility to infections, acute graft host disease is a consequence of the activation of donor T-cells against host antigens. Most common target organs are skin, liver and intestinal mucosis.Methods. In the 6-year period between January 1995 and December 2000, 49 patients were treated with allogeneic haematopoietic stem cell transplantation (allo-HSCT in Transplant unit, Department of Hematology, Clinical Centre Ljubljana. The standard GVHD prophylaxis regimen consisted of cyclosporine and short-course methotrexate. Severe, grade III-IV aGVHD with skin and/or gastrointestinal and/or liver involvement appeared in 16 (32% of the 49 patients.Results. Among the 16 patients with severe aGVHD, 14 had liver involvement, ten gastrointestinal and eight skin involvement. One patient had skin involvement only, the rest of them had combined involvement of two or three organ systems. Routine first-line treatment for aGVHD, given to all 16 pts with severe forms of the disease, was methylprednisolone (MP 2mg/ kg. Six patients with predominant skin involvement responded to MP. Other ten patients with mainly liver and gastrointestinal involvement needed second or even third line aGVHD treatment. These were anti-thymocyte globulin (ATG and/or monoclonal antibodies (OKT3 and/or mycophenolate mofetil (MMF and/or FK506 (tacrolimus. Seven patients died of advanced aGVHD and treatment related infection.Conclusions. Based on our experiences, we conclude that in critically ill patients with severe aGVHD, neutropenia and high risk for opportunistic infection, each day of ineffective MP therapy may have fatal consequences. Simultaneous institution of a combination of corticosteroids and a second-line drug might prove more appropriate for patients with a severe form of aGVHD.

Childhood Idiopathic Steroid Resistant Nephrotic Syndrome, Different Drugs and Outcome

International Nuclear Information System (INIS)

Shah, S. S. H.; Hafeez, F.

2016-01-01

Background: The management of steroid resistant nephrotic syndrome (SRNS) is quite difficult in paediatric patients. Not only the remission is difficult but also these patients are at risk of progression to end stage renal disease (ESRD). The goal of treatment is either to achieve complete remission or even partial remission as it is the most important predictor of disease outcome. Methods: This study was conducted at The Children Hospital, Lahore from February 2014 to May 2015. The SRNS patients of either sex between ages of 1-12 years were included with histology showing mesangioproliferative glomerulonephritis (MesangioPGN), focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD). Patients were given different immunosuppressant drugs and steroid 30 mg/m/sup 2/ alternate day therapy on case to case basis and kept on regular follow up to check for response and adverse effects. Results: Total of 105 patients included, 63 (60 percent) male and 42 (40 percent) female patients. The age ranges from 1.08 to 12 years, mean age of 6.53 years and SD of ±3.17. Tacrolimus was the most common drug used 43 (41 percent) patients followed by cyclosporine in 38 (36.2 percent) patients, while Mycophenolate mofetil (MMF) was prescribed in 21 (20 percent) patients. Complete response was in 96 (91.4 percent) initially while partial response was seen in 8 (7.6 percent) patients. On follow up, 92 (87.6 percent) patients showed complete response and partial response was in 5 (4.7 percent) patients. Cushingoid features and hypertrichosis were the most common adverse effect seen. Conclusion: Steroid resistant nephrotic syndrome can be managed well with various immunosuppressant drugs and steroids but treatment should be individualized according to clinical presentation, disease histology and cost/social factors. (author)

[Renal transplantation in HIV-infected patients in Spain].

Science.gov (United States)

Mazuecos, A; Pascual, J; Gómez, E; Sola, E; Cofán, F; López, F; Puig-Hooper, C E; Baltar, J M; González-Molina, M; Oppenheimer, F; Marcén, R; Rivero, M

2006-01-01

HIV infection has experienced dramatic improvement in morbidity and mortality with the highly active antiretroviral therapy (HAART). This prompted a reevaluation of organ-solid transplantation as a treatment option for HIV-infected patients. Some trials in the United States have shown that one- and 2-year graft and patient survival is comparable to HIV-negative transplant population. In Europe the experience is still scarce. The aim of this study is to analyse the outcome and the clinical characteristics of HIV-infected patients who received kidney transplantation in Spain in the HAART era. Ten patients were transplanted in our country since 2001. Only one patient was black. The main cause of end-stage renal disease reported was glomerulonephritis. Six of the recipients were coinfected by hepatitis C virus. Inclusion criteria included undetectable HIV viral load and CD4 counts greater than 200/pL. Immunosuppression consisted of steroids, tacrolimus and mycophenolate mofetil, with antibody induction in 4 cases. The median and mean follow-up was 11 and 16.3+/-15.6 (3-46) months, respectively. One recipient lost his graft because of early renal venous thrombosis. The remaining patients are functioning graft with mean serum creatinina level of 1.5 +/- 0.5 mg/dl. Biopsy-proven acute rejection was diagnosed in 4 recipients and was reversed in all cases with antirejection treatment. The plasma HIV RNA levels have remained controlled and CD4 counts have been stable in excess of 200 cell/microL. None of patients have developed AIDS complications. Recipients receiving protease inhibitor-based HAART regimens required significant dosing modification to maintain appropriate tacrolimus levels. Our results show that renal transplantation can be a safe and effective treatment in select HIV-infected patients. Like other series, the acute rejection rate was higher than in non-HIV recipients. The reasons of this rejection incidence remain unknown.

29 CFR 500.100 - Vehicle safety obligations.

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2010-07-01

... safety standards. Prima facie evidence that safety standards have been met will be shown by the presence... 29 Labor 3 2010-07-01 2010-07-01 false Vehicle safety obligations. 500.100 Section 500.100 Labor... § 500.100 Vehicle safety obligations. (a) General obligations. Each farm labor contractor, agricultural...

48 CFR 504.500 - Scope of subpart.

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2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Scope of subpart. 504.500 Section 504.500 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL ADMINISTRATIVE MATTERS Electronic Commerce in Contracting 504.500 Scope of subpart. This subpart provides policy and procedure for use of GSA's Electronic...

16 CFR 500.4 - Statement of identity.

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2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Statement of identity. 500.4 Section 500.4... PACKAGING AND LABELING ACT § 500.4 Statement of identity. (a) The principal display panel of a consumer commodity shall bear a specification of the identity of the commodity. (b) Such specification of identity...

12 CFR 411.500 - Secretary of Defense.

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2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Secretary of Defense. 411.500 Section 411.500 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES NEW RESTRICTIONS ON LOBBYING Exemptions § 411.500 Secretary of Defense. (a) The Secretary of Defense may exempt, on a case-by-case basis, a covered...

Behavior of methyl orange and orange 10 (orange G) in the presence of hydrotalcite type compounds of Mg/Al and Mg/Fe; Comportamiento de naranja de metilo y naranja 10 (orange G) en presencia de compuestos tipo hidrotalcita de mg/Al y Mg/Fe

Energy Technology Data Exchange (ETDEWEB)

Cruz N, G.

2015-07-01

This work is focused on studying the sorption capacity of methyl orange dye (Nm) and orange 10 (N-10) in the presence of hydrotalcite type compounds of Mg/Al and Mg/Fe uncalcined and calcined previously at 500 degrees Celsius. Sorption isotherms were determined and the study of the kinetics of sorption was performed. The materials were characterized before and after sorption processes of these dyes by X-ray diffraction, scanning electron microscopy, the specific surface area determination by the Brunauer-Emmett-Teller method, thermogravimetry coupled to mass and infrared spectrometry. The hydrotalcite type compounds reported in this paper were prepared in the laboratory and their acronyms are: HTMgAlG1, HTMgAlMO, HTMgFeG1 and HTMgFeG2. Note that in this work the best conditions for preparing compounds of Mg/Fe were found. From patterns of X-ray diffraction was identified the typical crystal structure of the hydrotalcite type compounds. By scanning electron microscopy the morphology could be determined in the form of flakes characteristics of these compounds. Likewise with elemental analysis of energy dispersive X-ray spectroscopy the presence of Mg, Al, Fe and C, elements of interest for this study was determined. The compounds presented a specific surface area relatively high from 80 to 120 m{sup 2}/g. Thermogravimetry results presented spectra of mass loss very characteristic associated to water losses, dehydroxylation and decarboxylation. The characteristic bands of water and carbonate were assigned by infrared spectroscopy and the bands corresponding to the dyes sulfonates were identified only for the calcined materials. The sorption capacities found of these compounds were as follows: for Nm in the compound HTMgAlG1 uncalcined was 17.82 mg/g for an initial concentration of 200 mg/L and for calcined (HTMgAlMOcal) of 99.8 mg/g with and initial concentration of 1000 mg/L. Moreover, the sorption capacity of the dye N-10 in this same material was 17.92 mg/g and 99

Improvement of thermal stability of nano-granular TMR films by using a Mg-Al-O insulator matrix

Science.gov (United States)

Kanie, S.; Koyama, S.

2018-05-01

A new metal-insulator nano-granular tunneling magnetoresistance (TMR) film made of (Fe-Co)-(Mg-Al-O) has been investigated. It is confirmed that the film has granular structure in which crystal Fe-Co granules are surrounded by an amorphous Mg-Al-O matrix. A large MR ratio of 11.8 % at room temperature is observed for a 42 vol.%(Fe0.6Co0.4)-(Mg-Al-O) film annealed at 395 °C. The electrical resistivity increases rapidly by annealing at above the changing point (500 °C). The changing point is about 300 °C higher than that of conventional (Fe-Co)-(Mg-F) nano-granular TMR films. The 42 vol.%(Fe0.6Co0.4)-(Mg-Al-O) film also exhibits less degradation in the MR ratio at high annealing temperatures such as 600 °C. These results suggest the (Fe-Co)-(Mg-Al-O) film is superior to the (Fe-Co)-(Mg-F) film in thermal stability.

78 FR 75511 - Special Conditions: Bombardier Inc., Models BD-500-1A10 and BD-500-1A11 Series Airplanes...

Science.gov (United States)

2013-12-12

... Inc., Models BD-500-1A10 and BD- 500-1A11 Series Airplanes; Electronic Flight Control System: Control... Inc. Models BD-500-1A10 and BD-500-1A11 series airplanes. These airplanes will have a novel or unusual... comments, data, or views. The most helpful comments reference a specific portion of the special conditions...

77 FR 69568 - Special Conditions: Bombardier Aerospace, Model BD-500-1A10 and BD-500-1A11 Airplanes; Sidestick...

Science.gov (United States)

2012-11-20

... Aerospace, Model BD-500-1A10 and BD-500-1A11 Airplanes; Sidestick Controllers AGENCY: Federal Aviation... conditions for the Bombardier Aerospace Model BD-500-1A10 and BD-500-1A11 airplanes. These airplanes will... on the comments we receive. Background On December 10, 2009, Bombardier Aerospace applied for a type...

High production rate of IBAD-MgO buffered substrate

Energy Technology Data Exchange (ETDEWEB)

Yoshizumi, M., E-mail: myoshizumi@istec.or.j [Superconductivity Research Laboratory, ISTEC, Shinonome 1-10-13, Koto-ku, Tokyo 135-0062 (Japan); Miyata, S.; Ibi, A.; Fukushima, H.; Yamada, Y.; Izumi, T.; Shiohara, Y. [Superconductivity Research Laboratory, ISTEC, Shinonome 1-10-13, Koto-ku, Tokyo 135-0062 (Japan)

2009-10-15

The conventional IBAD (Ion Beam Assisted Deposition) process using fluorite materials yields low production rates, resulting in high production cost, which reduces the motivation for practical application in spite of its high quality. The IBAD process using rock salt materials, e.g. MgO, is well known as a strong candidate of practical application due to its potential of high production rate and high in-plane grain alignment. In this work, the IBAD-MgO process was investigated for a newly developed architecture of PLD (Pulsed Laser Deposition)-CeO{sub 2}/sputter-LMO (LaMnO{sub 3})/IBAD-MgO/sputter-GZO (Gd{sub 2}Zr{sub 2}O{sub 7})/Hastelloy{sup TM} to make long buffered metal tapes with high properties and a high production rate. The 50 m-long IBAD-MgO substrates with about 4 deg. of DELTAphiCeO{sub 2} in an XRD phi scan could be fabricated repeatedly. A GdBCO (GdBa{sub 2}Cu{sub 3}O{sub x}) layer deposited on the buffered substrate showed the minimum I{sub c} value of 325 A/cm-w in a 41 m-long tape. Almost of the tape showed 500-600 A/cm-w of I{sub c} value. The deposition time for the IBAD-MgO layer was 60 s which was about 2 orders of magnitude shorter than the conventional IBAD process. The production rate of 24 m/h was realized at the IBAD-MgO process to fabricate the GdBCO coated conductor with high J{sub c} and I{sub c} properties.

Densification of MgSiO3 glass with pressure and temperature

DEFF Research Database (Denmark)

Yamada, A; Gaudio, Sarah; Lesher, Charles

2010-01-01

The density and structure of MgSiO3 glass (v-En) recovered from a series of annealing experiments up to 1000°C at 2.0, 5.5 and 8.5 GPa have been investigated using Archimedes' method and Raman spectroscopy, respectively. The densities of recovered glasses are found to be a complex function...... of pressure and temperature. At room temperature, compression up to 8.5 GPa, followed by decompression, yields a glass with a density within 0.6 % of the 1-atm value. Likewise, the 1-atm density is fully recovered in glass heated up to ~500°C at 2.0 GPa at higher pressures. A sharp increase in recovered...... density is observed between 500°C and 800°C at 2.0 GPa, 200°C and 500°C at 5.5 GPa and from room-T and 300°C at 8.5 GPa. At higher annealing temperatures the changes in density are more modest. This break in slope occurs for a glass density of 2.89 g/cm3 at 2.0 GPa and 2.95 g/cm3 at 5.5 and 8.5 GPa. Above...

A novel freeze-dried storage and preparation method for the determination of mycophenolic acid in plasma by high-performance liquid chromatography.

Science.gov (United States)

Wang, Lei; Qiang, Wei; Li, Ying; Cheng, Zeneng; Xie, Mengmeng

2017-09-01

Plasma samples were conventionally stored at freezing conditions until the time of detection. Such a technique, when carried out over an extended period, is energy consuming; in addition, preparation and transportation of stored samples is inconvenient. In this study, a freeze-dried storage and preparation method was proposed to determine the presence of mycophenolic acid (MPA) in plasma. Fresh plasma samples were freeze-dried using a device, and then stored at ambient temperature. After the stored samples were soaked with methanol spiked with the internal standard, high-performance liquid chromatography was conducted to detect MPA. The proposed method was demonstrated to be precise and accurate over the linear range of 0.5-50 μg mL -1 , with both intra- and inter-day precision being plasma concentration, time point of maximum plasma concentration and elimination half-life, among others, were consistent with the results in the published study. This proposed technique was proved to be simple, reproducible and energy saving. This approach could also simplify the storage and analysis of samples in clinical and scientific drug research. Copyright © 2017 John Wiley & Sons, Ltd.

Status of the HTR 500 design program

International Nuclear Information System (INIS)

Baust, E.; Arndt, E.

1987-01-01

Since 1982 BBC/HRB have offered the HTR 500 as the follow-on project of the THTR 300, the first large pebble bed reactor. The technical concept of the HTR-500 largely corresponds to the THTR 300 which has been in operation for almost 2 years now. In developing the design concept of the HTR 500 the ideas and demands of the reactor users in the FRG interested in the HTR have been taken into consideration to a large extent. In 1982 these potential users formed a working group 'Arbeitsgemeinschaft Hochtemperaturreaktor' (AHR), representing 16 power indusry companies and in early 1983, awarded a contract to HRB to perform a conceptual design study on the HTR 500. Within this conceptual design study BBC/HRB developed the safety concept of the HTR 500, prepared a detailed description of the overall power plant, and performed a cost calculation. These activities were completed in 1984. Based on the positive results of this conceptual design study, BBC/HRB are expecting to be granted a design contract by the users company Hochtemperaturreaktor GmbH (HRG) to establish the final complete design plans and documents for the HTR 500. (author)

AST-500 safety analysis experience

Energy Technology Data Exchange (ETDEWEB)

Falikov, A A; Bakhmetiev, A M; Kuul, V S; Samoilov, O B [OKBM, Nizhny Novgorod (Russian Federation)

1997-09-01

Characteristic AST-type NHR safety features and requirements are described briefly. The main approaches and results of design and beyond-design accidents analyses for the AST-500 NHR, and the results of probabilistic safety assessments are considered. It is concluded that the AST-500 possesses a high safety level in virtue of the development and realization in the design of self-protection, passivity and defence-in-depth principles. (author). 9 refs, 2 figs.

OBSERVATIONS OF Mg II ABSORPTION NEAR z ∼ 1 GALAXIES SELECTED FROM THE DEEP2 REDSHIFT SURVEY

International Nuclear Information System (INIS)

Lovegrove, Elizabeth; Simcoe, Robert A.

2011-01-01

We study the frequency of Mg II absorption in the outer halos of galaxies at z = 0.6-1.4 (with median z = 0.87), using new spectra obtained of 10 background quasars with galaxy impact parameters of b r = 0.15-1.0 A, though not all absorbers correlate with DEEP galaxies. We find five unique absorbers within Δv = 500 km s -1 and b r > 1.0 A, consistent with other samples of galaxy-selected Mg II systems. We speculate that Mg II systems with 0.3 r r are more likely to reflect the more recent star-forming history of their associated galaxies.

9 CFR 319.500 - Meat pies.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Meat pies. 319.500 Section 319.500... ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION DEFINITIONS AND STANDARDS OF IDENTITY OR COMPOSITION Meat Food Entree Products, Pies, and...

41 CFR 101-4.500 - Employment.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Employment. 101-4.500... Employment in Education Programs or Activities Prohibited § 101-4.500 Employment. (a) General. (1) No person... subjected to discrimination in employment, or recruitment, consideration, or selection therefor, whether...

MgAl-Layered Double Hydroxide Solid Base Catalysts for Henry Reaction: A Green Protocol

Directory of Open Access Journals (Sweden)

Magda H. Abdellattif

2018-03-01

Full Text Available A series of MgAl-layered double hydroxide (MgAl-HT, the calcined form at 500 °C (MgAlOx, and the rehydrated one at 25 °C (MgAl-HT-RH were synthesized. Physicochemical properties of the catalysts were characterized by X-ray diffraction (XRD and scanning electron microscopy (SEM. Surface area of the as-synthesized, calcined, and rehydrated catalysts was determined by N2 physisorption at −196 °C. CO2 temperature-programmed desorption (CO2-TPD was applied to determine the basic sites of catalysts. The catalytic test reaction was carried out using benzaldehyde and their derivatives with nitromethane and their derivatives. The Henry products (1–15 were obtained in a very good yield using MgAl-HT-RH catalyst either by conventional method at 90 °C in liquid phase or under microwave irradiation method. The mesoporous structure and basic nature of the rehydrated solid catalyst were responsible for its superior catalytic efficiency. The robust nature was determined by using the same catalyst five times, where the product % yield was almost unchanged significantly.

31 CFR 500.314 - Banking institution.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Banking institution. 500.314 Section 500.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... or incidentally in the business of banking, of granting or transferring credits, or of purchasing or...

Preparation of MgO with High Surface Area, and Modification of Its Pore Characteristics

Energy Technology Data Exchange (ETDEWEB)

Lee, Moon Hee; Park, Dong Gon [Sookmyung Women' s University, Seoul (Korea, Republic of)

2003-10-15

Thermal decomposition of hydrated surface layer of Mg(OH){sub 2} at 500 .deg. C in vacuum turned non-porous MgO into porous one with high surface area of around 270 m{sup 2}/g. Most of its surface area, 74 %, was from micropores, and rest of it was from mesopores in wedge-shaped slits, exhibiting bimodal size distribution centered around 30 and 90 A. Rehydration followed by subsequent dehydration at 300 .deg. C in dynamic vacuum further raised the surface area to 340 m{sup 2}/g. Fraction of microporous surface area was increased to 93%, and the shape of the mesopores was modified into parallel slits with a specific dimension of 32 A. Application of Fe{sub 2}O{sub 3} over MgO via iron complex formation did not alter the pore characteristics of MgO core, except slightly increased pore dimension. Over the course of the modification, Fe{sub 2}O{sub 3} stayed on the surface possibly via spill-over reaction.

Mesoporous mixed metal oxides derived from P123-templated Mg-Al layered double hydroxides

International Nuclear Information System (INIS)

Wang Jun; Zhou Jideng; Li Zhanshuang; He Yang; Lin Shuangshuang; Liu Qi; Zhang Milin; Jiang Zhaohua

2010-01-01

We report the preparation of mesoporous mixed metal oxides (MMOs) through a soft template method. Different amounts of P123 were used as structure directing agent to synthesize P123-templated Mg-Al layered double hydroxides (LDHs). After calcination of as-synthesized LDHs at 500 o C, the ordered mesopores were obtained by removal of P123. The mesoporous Mg-Al MMOs fabricated by using 2 wt% P123 exhibited a high specific surface area of 108.1 m 2 /g, and wide distribution of pore size (2-18 nm). An investigation of the 'memory effect' of the mesoporous MMOs revealed that they were successfully reconstructed to ibuprofen intercalated LDHs having different gallery heights, which indicated different intercalation capacities. Due to their mesoporosity these unique MMOs have particular potential as drug or catalyst carriers. - Graphical abstract: Ordered mesoporous Mg-Al MMOs can be obtained through the calcination of P123-templated Mg-Al-CO 3 LDHs. The pore diameter is 2.2 nm. At the presence of ibuprofen, the Mg-Al MMOs can recover to Mg-Al-IBU LDHs, based on its 'remember effect'. Display Omitted

THE PITTSBURGH SLOAN DIGITAL SKY SURVEY Mg II QUASAR ABSORPTION-LINE SURVEY CATALOG

International Nuclear Information System (INIS)

Quider, Anna M.; Nestor, Daniel B.; Turnshek, David A.; Rao, Sandhya M.; Weyant, Anja N.; Monier, Eric M.; Busche, Joseph R.

2011-01-01

We present a catalog of intervening Mg II quasar absorption-line systems in the redshift interval 0.36 ≤ z ≤ 2.28. The catalog was built from Sloan Digital Sky Survey Data Release Four (SDSS DR4) quasar spectra. Currently, the catalog contains ∼17, 000 measured Mg II doublets. We also present data on the ∼44, 600 quasar spectra which were searched to construct the catalog, including redshift and magnitude information, continuum-normalized spectra, and corresponding arrays of redshift-dependent minimum rest equivalent widths detectable at our confidence threshold. The catalog is available online. A careful second search of 500 random spectra indicated that, for every 100 spectra searched, approximately one significant Mg II system was accidentally rejected. Current plans to expand the catalog beyond DR4 quasars are discussed. Many Mg II absorbers are known to be associated with galaxies. Therefore, the combination of large size and well understood statistics makes this catalog ideal for precision studies of the low-ionization and neutral gas regions associated with galaxies at low to moderate redshift. An analysis of the statistics of Mg II absorbers using this catalog will be presented in a subsequent paper.

15 CFR 8a.500 - Employment.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Employment. 8a.500 Section 8a.500 Commerce and Foreign Trade Office of the Secretary of Commerce NONDISCRIMINATION ON THE BASIS OF SEX IN...-sponsored activities, including social or recreational programs; and (10) Any other term, condition, or...

31 CFR 500.307 - Unblocked national.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Unblocked national. 500.307 Section 500.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF...” shall not be deemed to suspend in any way the requirements of any section of this chapter relating to...

Molecular beam epitaxy of iodine-doped CdTe and (CdMg)Te

Energy Technology Data Exchange (ETDEWEB)

Fischer, F.; Waag, A.; Litz, Th.; Scholl, S.; Schmitt, M.; Landwehr, G. (Physikalisches Inst. der Univ. Wuerzburg (Germany)); Bilger, G. (Zentrum fuer Sonnenenergie und Wasserstofforschung, Stuttgart (Germany))

1994-08-01

The n-type doping of CdTe and (CdMg)Te by the use of the solid dopant source material ZnI[sub 2] is reported. Doping levels as high as 7x10[sup 18] cm[sup -3] have been obtained in CdTe with carrier mobilities around 500 cm[sup 2]/V[center dot]s at room temperature. For a dopant incorporation higher than 1x10[sup 19] cm[sup -3] the free carrier concentration decreases, indicating the onset of a compensation mechanism, which is observed in the case of chlorine and bromine doping, too. Preliminary experiments show that with increasing Mg concentration the free carrier concentration decreases. Nevertheless, CdMgTe with a magnesium concentration x=0.37 (band gap 2.2 eV at room temperature) can be doped up to 2x10[sup 17] cm[sup -3]. The existence of deep donor levels in this CdTe based ternary is not supposed to be the only reason for the reduction of the free carrier concentration. For high Mg support during molecular beam epitaxial (MBE) growth of wide gap (CdMg)Te layers, the ZnI[sub 2] incorporation is reduced, leading to low doping levels, too

46 CFR 16.500 - Management Information System requirements.

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2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Management Information System requirements. 16.500 Section 16.500 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN CHEMICAL TESTING Management Information System § 16.500 Management Information System requirements. (a...

14 CFR 1203.500 - Use of derivative classification.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Use of derivative classification. 1203.500 Section 1203.500 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Derivative Classification § 1203.500 Use of derivative classification. The application of...

X-ray diffraction microstructural analysis of bimodal size distribution MgO nano powder

International Nuclear Information System (INIS)

Suminar Pratapa; Budi Hartono

2009-01-01

Investigation on the characteristics of x-ray diffraction data for MgO powdered mixture of nano and sub-nano particles has been carried out to reveal the crystallite-size-related microstructural information. The MgO powders were prepared by co-precipitation method followed by heat treatment at 500 degree Celsius and 1200 degree Celsius for 1 hour, being the difference in the temperature was to obtain two powders with distinct crystallite size and size-distribution. The powders were then blended in air to give the presumably bimodal-size- distribution MgO nano powder. High-quality laboratory X-ray diffraction data for the powders were collected and then analysed using Rietveld-based MAUD software using the lognormal size distribution. Results show that the single-mode powders exhibit spherical crystallite size (R) of 20(1) nm and 160(1) nm for the 500 degree Celsius and 1200 degree Celsius data respectively with the nano metric powder displays narrower crystallite size distribution character, indicated by lognormal dispersion parameter of 0.21 as compared to 0.01 for the sub-nano metric powder. The mixture exhibits relatively more asymmetric peak broadening. Analysing the x-ray diffraction data for the latter specimen using single phase approach give unrealistic results. Introducing two phase models for the double-phase mixture to accommodate the bimodal-size-distribution characteristics give R = 100(6) and σ = 0.62 for the nano metric phase and R = 170(5) and σ= 0.12 for the σ sub-nano metric phase. (author)

Global investigation of the Mg atom and ion layers using SCIAMACHY/Envisat observations between 70 and 150 km altitude and WACCM-Mg model results

Directory of Open Access Journals (Sweden)

M. P. Langowski

2015-01-01

Full Text Available Mg and Mg+ concentration fields in the upper mesosphere/lower thermosphere (UMLT region are retrieved from SCIAMACHY/Envisat limb measurements of Mg and Mg+ dayglow emissions using a 2-D tomographic retrieval approach. The time series of monthly mean Mg and Mg+ number density and vertical column density in different latitudinal regions are presented. Data from the limb mesosphere–thermosphere mode of SCIAMACHY/Envisat are used, which cover the 50 to 150 km altitude region with a vertical sampling of ≈3.3 km and latitudes up to 82°. The high latitudes are not observed in the winter months, because there is no dayglow emission during polar night. The measurements were performed every 14 days from mid-2008 until April 2012. Mg profiles show a peak at around 90 km altitude with a density between 750 cm−3 and 1500 cm−3. Mg does not show strong seasonal variation at latitudes below 40°. For higher latitudes the density is lower and only in the Northern Hemisphere a seasonal cycle with a summer minimum is observed. The Mg+ peak occurs 5–15 km above the neutral Mg peak altitude. These ions have a significant seasonal cycle with a summer maximum in both hemispheres at mid and high latitudes. The strongest seasonal variations of Mg+ are observed at latitudes between 20 and 40° and the density at the peak altitude ranges from 500 cm−3 to 4000 cm−3. The peak altitude of the ions shows a latitudinal dependence with a maximum at mid latitudes that is up to 10 km higher than the peak altitude at the equator. The SCIAMACHY measurements are compared to other measurements and WACCM model results. The WACCM results show a significant seasonal variability for Mg with a summer minimum, which is more clearly pronounced than for SCIAMACHY, and globally a higher peak density than the SCIAMACHY results. Although the peak density of both is not in agreement, the vertical column density agrees well, because SCIAMACHY and WACCM profiles have different

Adsorptive removal of an anionic dye Congo red by flower-like hierarchical magnesium oxide (MgO)-graphene oxide composite microspheres

Science.gov (United States)

Xu, Jing; Xu, Difa; Zhu, Bicheng; Cheng, Bei; Jiang, Chuanjia

2018-03-01

Flower-like magnesium oxide (MgO) microspheres and MgO-graphene oxide (GO) composites with an average diameter of 500 nm and hierarchical structure were synthesized through an ethylene glycol-mediated self-assembly process. The adsorption of Congo red (CR) by the prepared samples was evaluated in water under ambient conditions. The equilibrium adsorption isotherms of CR on the as-prepared samples could be described by the Langmuir model. The MgO-GO microspheres prepared with 0.5 wt% GO showed higher adsorption capacity (237.0 mg/g) than the MgO microspheres (227.7 mg/g). Adsorption kinetics results of CR indicated that pseudo-second-order kinetic equation could well explain the adsorption kinetics behaviors of CR. These findings indicate that the MgO-GO composite microspheres are potential adsorbents for effective removal of Congo red from wastewater.

Ferrets as a Novel Animal Model for Studying Human Respiratory Syncytial Virus Infections in Immunocompetent and Immunocompromised Hosts

Science.gov (United States)

Stittelaar, Koert J.; de Waal, Leon; van Amerongen, Geert; Veldhuis Kroeze, Edwin J.B.; Fraaij, Pieter L.A.; van Baalen, Carel A.; van Kampen, Jeroen J.A.; van der Vries, Erhard; Osterhaus, Albert D.M.E.; de Swart, Rik L.

2016-01-01

Human respiratory syncytial virus (HRSV) is an important cause of severe respiratory tract disease in immunocompromised patients. Animal models are indispensable for evaluating novel intervention strategies in this complex patient population. To complement existing models in rodents and non-human primates, we have evaluated the potential benefits of an HRSV infection model in ferrets (Mustela putorius furo). Nine- to 12-month-old HRSV-seronegative immunocompetent or immunocompromised ferrets were infected with a low-passage wild-type strain of HRSV subgroup A (105 TCID50) administered by intra-tracheal or intra-nasal inoculation. Immune suppression was achieved by bi-daily oral administration of tacrolimus, mycophenolate mofetil, and prednisolone. Throat and nose swabs were collected daily and animals were euthanized four, seven, or 21 days post-infection (DPI). Virus loads were determined by quantitative virus culture and qPCR. We observed efficient HRSV replication in both the upper and lower respiratory tract. In immunocompromised ferrets, virus loads reached higher levels and showed delayed clearance as compared to those in immunocompetent animals. Histopathological evaluation of animals euthanized 4 DPI demonstrated that the virus replicated in the respiratory epithelial cells of the trachea, bronchi, and bronchioles. These animal models can contribute to an assessment of the efficacy and safety of novel HRSV intervention strategies. PMID:27314379

Ferrets as a Novel Animal Model for Studying Human Respiratory Syncytial Virus Infections in Immunocompetent and Immunocompromised Hosts

Directory of Open Access Journals (Sweden)

Koert J. Stittelaar

2016-06-01

Full Text Available Human respiratory syncytial virus (HRSV is an important cause of severe respiratory tract disease in immunocompromised patients. Animal models are indispensable for evaluating novel intervention strategies in this complex patient population. To complement existing models in rodents and non-human primates, we have evaluated the potential benefits of an HRSV infection model in ferrets (Mustela putorius furo. Nine- to 12-month-old HRSV-seronegative immunocompetent or immunocompromised ferrets were infected with a low-passage wild-type strain of HRSV subgroup A (105 TCID50 administered by intra-tracheal or intra-nasal inoculation. Immune suppression was achieved by bi-daily oral administration of tacrolimus, mycophenolate mofetil, and prednisolone. Throat and nose swabs were collected daily and animals were euthanized four, seven, or 21 days post-infection (DPI. Virus loads were determined by quantitative virus culture and qPCR. We observed efficient HRSV replication in both the upper and lower respiratory tract. In immunocompromised ferrets, virus loads reached higher levels and showed delayed clearance as compared to those in immunocompetent animals. Histopathological evaluation of animals euthanized 4 DPI demonstrated that the virus replicated in the respiratory epithelial cells of the trachea, bronchi, and bronchioles. These animal models can contribute to an assessment of the efficacy and safety of novel HRSV intervention strategies.

Pharmacologic strategies in the prevention and treatment of corneal transplant rejection.

Science.gov (United States)

Tabbara, Khalid F

2008-06-01

Corneal transplantation remains one of the most successful organ transplantation procedures in humans. The unique structure of the cornea, with its absence of blood vessels and corneal lymphatic, allows the survival of corneal allograft. Recent advances in sutures, storage media, microsurgical instrumentation, and new pharmacological strategies have greatly improved the success of corneal transplantation and the prevention of corneal allograft rejection. Our strategies in the management and prevention of corneal graft rejection can modify and improve the survival of corneal allografts. Preoperative evaluation, understanding the risk factors, and management of ocular surface disorders may greatly improve the survival of the corneal transplant. Early recognition of corneal allograft rejection and aggressive treatment may improve the survival of the corneal graft. Furthermore, patients who undergo corneal transplantation should be maintained under close ophthalmic surveillance and patients should be informed to report immediately whenever symptoms of corneal graft rejection occur. The mainstay of therapy is topical corticosteroids. In severe cases, periocular, intravenous, and oral corticosteroids therapy can be rendered. New therapeutic modalities such as cyclosporine, tacrolimus, daclizumab, mycophenolate mofetil, leflunomide, rapamycin, and others may prove to be of help in the prevention and treatment of corneal graft rejection. Early recognition of corneal graft rejection and prompt treatment are mandatory for the successful survival of the corneal allograft.

Treatment Strategies of Adult Primary Focal Segmental Glomerulosclerosis: A Systematic Review Focusing on the Last Two Decades

Directory of Open Access Journals (Sweden)

Arno Beer

2016-01-01

Full Text Available Adult primary focal segmental glomerulosclerosis (FSGS remains a therapeutic challenge for the treating physician. With the advent of novel immunosuppressive measures, our arsenal of therapeutic options increased considerably. The aim of this review was to summarize reports published over the last two decades which reported on treatment outcome. Most reports included patients with a steroid-resistant (SR disease course, yet the cohort with the highest unmet need, since persistent nephrotic range proteinuria is associated with a poor renal prognosis and portends a high risk of developing end-stage renal disease. While in first-line treatment, steroid treatment remains the recommended standard with an overall remission rate of 50% and higher, optimal treatment strategies for steroid-dependent/multirelapsing (SD/MR and SR patients have to be defined. In both entities, calcineurin inhibitors showed good efficacy, while mycophenolate mofetil was less effective in SR cases compared to those with SD/MR. The same was true for rituximab, a monoclonal antibody targeting B-cells. In resistant cases, addition of extracorporeal treatment options or treatment with alkylating agents may be considered. To shape the future for treatment of FSGS, international collaborations to conduct larger clinical trials are needed to identify potential novel efficacious immunosuppressive or immunomodulatory therapies.

Management of patients with ocular manifestations in vesiculobullous disorders affecting the mouth.

Science.gov (United States)

Hansen, M S; Klefter, O N; Julian, H O; Lynge Pedersen, A M; Heegaard, S

2017-10-01

Pemphigoid and pemphigus diseases as well as Stevens-Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon, eyelid malposition, ocular surface scarring and severe visual loss. In addition to diagnostic assessments, ophthalmologists must treat the dry eye and meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants. Topical anti-inflammatory therapy is used to treat acute inflammatory exacerbations of the ocular surface, but it cannot prevent scarring alone. Intralesional antimetabolite therapy can cause regression of conjunctival pathology in selected cases. Hence, patients with vesiculobullous disorders should be managed by a multidisciplinary team representing ophthalmology, dermatology, otolaryngology, oral medicine and pathology, internal medicine and intensive care. Systemic treatments including corticosteroids, azathioprine, cyclophosphamide, cyclosporine and mycophenolate mofetil help control inflammation. Intravenous immunoglobulins, plasmapheresis and targeted antibody therapy can be used in selected, severe and treatment-resistant cases. Local surgical management may include debridement of pseudomembranes, lysis of symblepharon, amniotic and mucous membrane grafting as well as reconstructive procedures. Prospective, multicentre, international studies are recommended to further support evidence-based practice. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Successful management of Churg-Strauss syndrome using omalizumab as adjuvant immunomodulatory therapy: first documented pediatric case.

Science.gov (United States)

Iglesias, E; Camacho Lovillo, M; Delgado Pecellín, I; Lirola Cruz, M J; Falcón Neyra, M D; Salazar Quero, J C; Bernabeu-Wittel, J; González Valencia, J P; Neth, O

2014-03-01

Churg-Strauss syndrome (CSS) is an anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis; it is extremely rare in childhood and defined according to the Chapel-Hill Consensus as an eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small to medium-sized vessels. Children commonly have a history of asthma and sinusitis whilst clinical presentation typically involves pulmonary tract and less frequently skin, heart, gastrointestinal tract, and peripheral nerves. Cardiopulmonary disease is higher in children and prognosis is worse. It is associated with significant eosinophilia and raised serum IgE-levels. ANCA are only found in 25% of childhood cases. Here we report the case of a 10-year-old girl who presented to us with vomiting, abdominal pain, and weight loss, paresthesias of lower extremities and breathlessness as well as a history of asthma, sinusitis and allergic rhinitis. She was treated with corticosteroids, cyclophosphamide, intravenous immunoglobulin, mycophenolate mofetil (MMF), and rituximab. However, remission was only achieved after initiation of omalizumab therapy, a recombinant humanized anti-IgE antibody. To the best of our knowledge this is the first pediatric patient suffering from CSS successfully managed with adjuvant anti-IgE therapy resulting in the control of respiratory as well as gastrointestinal symptoms. © 2013 Wiley Periodicals, Inc.

Prevalence and association of post-renal transplant anemia

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Hesham Elsayed

2012-01-01

Full Text Available In some renal allograft recipients, anemia persists or develops following transplantation. Anemia is associated with pre-operative blood loss and allograft dysfunction, including delayed graft function, acute rejection and chronic allograft dysfunction. To study the prevalence and association of post-renal transplant anemia, we studied 200 renal transplant recipients; 131 (65.5% patients were males and 69 (34.5% patients were females, and age ranged from 17 to 67 years, with a mean of 37.7 ± 10.8 years. All patients were receiving cyclosporine, prednisolone and mycophenolate mofetil (MMF. Complete blood count was done at two times: three and six months post-renal transplant. There were 74% anemic patients three months after renal transplantation and 45% anemic patients six months after renal transplantation. High creatinine value, female gender, delayed graft function, episodes of acute rejection, perioperative blood loss and infections were the only significant independent risk factors for prevalence of anemia post-renal transplant. In our study, we did not find an association between MMF and cyclosporine nor angiotensin-converting enzyme inhibitors (ACEIs or angiotensin receptors blocker (ARBs with anemia. This study demonstrates that anemia is a common complication during the first six months after kidney transplantation, with several risk factors precipitating this complication.

Update on the pharmacological treatment of adult myositis.

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Oddis, C V

2016-07-01

The management of patients with idiopathic inflammatory myopathy (IIM) remains a challenge given the systemic features beyond active myositis. That is, recognizing the inflammatory arthropathy, varying dermatomyositis rashes, and overt and occult features of interstitial lung disease in addition to myositis adds to the complexity of diagnosis and treatment of IIM. However, clinicians now have available many more immunosuppressive drugs as well as biologic agents for use in patients with myositis and other autoimmune diseases. Here, the use of these agents is reviewed and support based on available published literature is provided even though many studies have been small and results somewhat anecdotal. Glucocorticoids remain the initial treatment of choice in most instances and methotrexate and azathioprine are often used early in the treatment course. These agents are followed by other immunosuppressive drugs, for example mycophenolate mofetil, tacrolimus, cyclosporine and cyclophosphamide, some of which are used alone while combinations of these agents also provide an effective option. There is more rationale for the use of biologic agents such as rituximab from a mechanistic perspective and, given the incorporation of validated core set measures in assessing myositis patients, we can look forward to better designed clinical trials in the future. © 2016 The Association for the Publication of the Journal of Internal Medicine.

Understanding lupus nephritis: diagnosis, management, and treatment options

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Mok CC

2012-05-01

Full Text Available Chi Chiu MokDepartment of Medicine, Tuen Mun Hospital and Center for Assessment and Treatment of Rheumatic Diseases, Pok Oi Hospital, Hong Kong, ChinaAbstract: Systemic lupus erythematosus (SLE predominantly affects women in their reproductive years. Renal disease (glomerulonephritis is one of the most frequent and serious manifestations of SLE. Of the various histological types of lupus glomerulonephritis, diffuse proliferative nephritis carries the worst prognosis. Combined with high-dose prednisone, mycophenolate mofetil (MMF has emerged as a first-line immunosuppressive treatment, although data regarding the efficacy of MMF on the long-term preservation of renal function are forthcoming. Cyclophosphamide is reserved for more severe forms of lupus nephritis, such as crescentic glomerulonephritis with rapidly deteriorating renal function, patients with significant renal function impairment at presentation, and refractory renal disease. Evidence for the calcineurin inhibitors in the treatment of lupus nephritis is weaker, and it concerns patients who are intolerant or recalcitrant to other agents. While further controlled trials are mandatory, B cell modulation therapies, such as rituximab, belimumab and epratuzumab are confined to refractory disease. Non-immunosuppressive measures, such as angiotensin-converting enzyme inhibitors, vigorous blood pressure control, prevention and treatment of hyperlipidemia and osteoporosis, are equally important.Keywords: lupus, nephritis, nephropathy, glomerulonephritis, treatment, therapy, women

PML and rheumatology: the contribution of disease and drugs.

LENUS (Irish Health Repository)

Molloy, Eamonn S

2011-11-01

Progressive multifocal leukoencephalopathy (PML), a rare, typically fatal, opportunistic infection caused by the JC virus, is becoming relevant to physicians in multiple specialties, including those who prescribe biologic agents for the treatment of autoimmune disorders. Reports of PML have led to US Food and Drug Administration alerts and warning letters regarding four immunosuppressive agents in recent years (natalizumab, rituximab, efalizumab, and mycophenolate mofetil). Consequently, informed clinical decision-making requires understanding the risk of PML associated with these therapies. An estimate of the relative frequency of PML associated with specific rheumatic conditions has been generated. Systemic lupus erythematosus appears to be associated with susceptibility to PML that cannot be fully explained by the intensity of immunosuppressive therapy. Further, the use of rituximab in patients with rheumatic disease has raised concerns. However, definitive attribution of cause is precluded by the limitations of the currently available data. All patients with rheumatic disease, regardless of the intensity of their current immunosuppressive therapy, should be considered potentially at risk of PML. With an evolving understanding of a greater clinical heterogeneity of PML, advances in diagnostic methods, and significant implications for therapy, PML should be considered in the differential diagnosis of neurologic manifestations of rheumatic diseases.

Changes in Composition of the Gut Bacterial Microbiome after Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in a Pediatric Heart Transplant Patient.

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Flannigan, Kyle L; Rajbar, Taylor; Moffat, Andrew; McKenzie, Leanna S; Dicke, Frank; Rioux, Kevin; Workentine, Matthew L; Louie, Thomas J; Hirota, Simon A; Greenway, Steven C

2017-01-01

The microbiome is increasingly recognized as an important influence on human health and many of the comorbidities that affect patients after solid organ transplantation (SOT) have been shown to involve changes in gut bacterial populations. Thus, microbiome changes in an individual patient may have important health implications after SOT but this area remains understudied. We describe changes in the composition of the fecal microbiome from a pediatric heart transplant recipient before and >2.5 years after he underwent repeated fecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection (CDI). With both documented episodes of CDI, there was marked loss of bacterial diversity with overgrowth of Proteobacteria (>98.9% of phyla identified) associated with symptomatic colitis that was corrected after FMT. We hypothesize that a second CDI occurring after FMT was related to incomplete restoration of normal bowel flora post-FMT with relative deficiencies of the phyla Firmicutes and Bacteroidetes and the families Lachnospiraceae and Ruminococcaceae . Following the second FMT, there was a gradual shift in gut bacterial composition coincident with the recipient developing lymphonodular hyperplasia of the colon and painless hematochezia that resolved with discontinuation of mycophenolate mofetil (MMF). This case documents dynamic changes in the bacterial microbiome after FMT and suggests that MMF may influence the gut microbiome with consequences for the patient.

Patient recruitment into a multicenter randomized clinical trial for kidney disease: report of the focal segmental glomerulosclerosis clinical trial (FSGS CT).

Science.gov (United States)

Ferris, Maria; Norwood, Victoria; Radeva, Milena; Gassman, Jennifer J; Al-Uzri, Amira; Askenazi, David; Matoo, Tej; Pinsk, Maury; Sharma, Amita; Smoyer, William; Stults, Jenna; Vyas, Shefali; Weiss, Robert; Gipson, Debbie; Kaskel, Frederick; Friedman, Aaron; Moxey-Mims, Marva; Trachtman, Howard

2013-02-01

We describe the experience of the focal segmental glomerulosclerosis clinical trial (FSGS CT) in the identification and recruitment of participants into the study. This National Institutes of Health funded study, a multicenter, open-label, randomized comparison of cyclosporine versus oral dexamethasone pulses plus mycophenolate mofetil, experienced difficulty and delays meeting enrollment goals. These problems occurred despite the support of patient advocacy groups and aggressive recruitment strategies. Multiple barriers were identified including: (1) inaccurate estimates of the number of potential incident FSGS patients at participating centers; (2) delays in securing one of the test agents; (3) prolonged time between IRB approval and execution of a subcontract (mean 7.5 ± 0.8 months); (4) prolonged time between IRB approval and enrollment of the first patient at participating sites (mean 19.6 ± 1.4 months); and (5) reorganization of clinical coordinating core infrastructure to align resources with enrollment. A Web-based anonymous survey of site investigators revealed site-related barriers to patient recruitment. The value of a variety of recruitment tools was of marginal utility in facilitating patient enrollment. We conclude that improvements in the logistics of study approval and regulatory start-up and testing of promising novel agents are important factors in promoting enrollment into randomized clinical trials in nephrology. © 2013 Wiley Periodicals, Inc.

Characterization of clinical and genetic risk factors associated with dyslipidemia after kidney transplantation.

Science.gov (United States)

Numakura, Kazuyuki; Kagaya, Hideaki; Yamamoto, Ryohei; Komine, Naoki; Saito, Mitsuru; Hiroshi, Tsuruta; Akihama, Susumu; Inoue, Takamitsu; Narita, Shintaro; Tsuchiya, Norihiko; Habuchi, Tomonori; Niioka, Takenori; Miura, Masatomo; Satoh, Shigeru

2015-01-01

We determined the prevalence of dyslipidemia in a Japanese cohort of renal allograft recipients and investigated clinical and genetic characteristics associated with having the disease. In total, 126 patients that received renal allograft transplants between February 2002 and August 2011 were studied, of which 44 recipients (34.9%) were diagnosed with dyslipidemia at 1 year after transplantation. Three clinical factors were associated with a risk of having dyslipidemia: a higher prevalence of disease observed among female than male patients (P = 0.021) and treatment with high mycophenolate mofetil (P = 0.012) and prednisolone (P = 0.023) doses per body weight at 28 days after transplantation. The genetic association between dyslipidemia and 60 previously described genetic polymorphisms in 38 putative disease-associated genes was analyzed. The frequency of dyslipidemia was significantly higher in patients with the glucocorticoid receptor (NR3C1) Bcl1 G allele than in those with the CC genotype (P = 0.001). A multivariate analysis revealed that the NR3C1 Bcl1 G allele was a significant risk factor for the prevalence of dyslipidemia (odds ratio = 4.6; 95% confidence interval = 1.8-12.2). These findings may aid in predicting a patient's risk of developing dyslipidemia.

Paradoxical Reaction of Tuberculosis in a Heart Transplant Recipient During Antituberculosis Therapy: A Case Report.

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Wakamiya, A; Seguchi, O; Shionoiri, A; Kumai, Y; Kuroda, K; Nakajima, S; Yanase, M; Matsuda, S; Wada, K; Matsumoto, Y; Fukushima, S; Fujita, T; Kobayashi, J; Fukushima, N

2018-04-01

Tuberculous paradoxical reactions (PRs) are excessive immune reactions occurring after antituberculosis (TB) treatment and are commonly observed in immunocompromised hosts such as patients infected with the human immunodeficiency virus. We recently encountered a 63-year-old male heart transplant recipient who developed tuberculous PR after treatment for miliary TB. The patient had been receiving immunosuppressive therapy with cyclosporine and mycophenolate mofetil for over 15 years. The diagnosis of miliary TB was made based on the presence of intermittent fever and fatigue; thus, anti-TB treatments (isoniazid, levofloxacin, ethambutol, and pyrazinamide) were started, which led to rapid defervescence and regression of the granular shadow and pleural effusion. However, a new persistent fever and confused state developed 1 month after the anti-TB therapy was started. After excluding possible etiologies of the patient's symptom, a PR was suspected, and anti-TB drugs were continued; corticosteroids were added as anti-inflammatory agents. After that, he has shown a favorable course with long-term anti-TB chemotherapy. A PR should always be considered when the patients' symptoms of tuberculosis re-exacerbate after an appropriate anti-TB therapy. A PR commonly occurs in patients with various immunologic conditions including heart transplant recipients. Copyright © 2018 Elsevier Inc. All rights reserved.

Modified uterine allotransplantation and immunosuppression procedure in the sheep model.

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Li Wei

Full Text Available OBJECTIVE: To develop an orthotopic, allogeneic, uterine transplantation technique and an effective immunosuppressive protocol in the sheep model. METHODS: In this pilot study, 10 sexually mature ewes were subjected to laparotomy and total abdominal hysterectomy with oophorectomy to procure uterus allografts. The cold ischemic time was 60 min. End-to-end vascular anastomosis was performed using continuous, non-interlocking sutures. Complete tissue reperfusion was achieved in all animals within 30 s after the vascular re-anastomosis, without any evidence of arterial or venous thrombosis. The immunosuppressive protocol consisted of tacrolimus, mycophenolate mofetil and methylprednisolone tablets. Graft viability was assessed by transrectal ultrasonography and second-look laparotomy at 2 and 4 weeks, respectively. RESULTS: Viable uterine tissue and vascular patency were observed on transrectal ultrasonography and second-look laparotomy. Histological analysis of the graft tissue (performed in one ewe revealed normal tissue architecture with a very subtle inflammatory reaction but no edema or stasis. CONCLUSION: We have developed a modified procedure that allowed us to successfully perform orthotopic, allogeneic, uterine transplantation in sheep, whose uterine and vascular anatomy (apart from the bicornuate uterus is similar to the human anatomy, making the ovine model excellent for human uterine transplant research.

Characterization of Clinical and Genetic Risk Factors Associated with Dyslipidemia after Kidney Transplantation

Science.gov (United States)

Numakura, Kazuyuki; Kagaya, Hideaki; Yamamoto, Ryohei; Komine, Naoki; Saito, Mitsuru; Hiroshi, Tsuruta; Akihama, Susumu; Narita, Shintaro; Tsuchiya, Norihiko; Habuchi, Tomonori; Niioka, Takenori; Miura, Masatomo; Satoh, Shigeru

2015-01-01

We determined the prevalence of dyslipidemia in a Japanese cohort of renal allograft recipients and investigated clinical and genetic characteristics associated with having the disease. In total, 126 patients that received renal allograft transplants between February 2002 and August 2011 were studied, of which 44 recipients (34.9%) were diagnosed with dyslipidemia at 1 year after transplantation. Three clinical factors were associated with a risk of having dyslipidemia: a higher prevalence of disease observed among female than male patients (P = 0.021) and treatment with high mycophenolate mofetil (P = 0.012) and prednisolone (P = 0.023) doses per body weight at 28 days after transplantation. The genetic association between dyslipidemia and 60 previously described genetic polymorphisms in 38 putative disease-associated genes was analyzed. The frequency of dyslipidemia was significantly higher in patients with the glucocorticoid receptor (NR3C1) Bcl1 G allele than in those with the CC genotype (P = 0.001). A multivariate analysis revealed that the NR3C1 Bcl1 G allele was a significant risk factor for the prevalence of dyslipidemia (odds ratio = 4.6; 95% confidence interval = 1.8–12.2). These findings may aid in predicting a patient's risk of developing dyslipidemia. PMID:25944971

29 CFR 500.78 - Information in foreign language.

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2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Information in foreign language. 500.78 Section 500.78... § 500.78 Information in foreign language. Each farm labor contractor, agricultural employer and... English or, as necessary and reasonable, in Spanish or another language common to migrant or seasonal...

A six-hour extrapolated sampling strategy for monitoring mycophenolic acid in renal transplant patients in the Indian subcontinent

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Fleming D

2006-01-01

Full Text Available Background : Therapeutic drug monitoring for mycophenolic acid (MPA is increasingly being advocated. Thepresent therapeutic range relates to the 12-hour area under the serum concentration time profile (AUC.However, this is a cumbersome, tedious, cost restricting procedure. Is it possible to reduce this samplingperiod? Aim : To compare the AUC from a reduced sampling strategy with the full 12-hour profile for MPA. Settings and Design : Clinical Pharmacology Unit of a tertiary care hospital in South India. Retrospective, paireddata. Materials and Methods : Thirty-four 12-hour profiles from post-renal transplant patients on Cellcept ® wereevaluated. Profiles were grouped according to steroid and immunosuppressant co-medication and the timeafter transplant. MPA was estimated by high performance liquid chromatography with UV detection. From the12-hour profiles the AUC up to only six hours was calculated by the trapezoidal rule and a correction factorapplied. These two AUCs were then compared. Statistical Analysis : Linear regression, intra-class correlations (ICC and a two-tailed paired t-test were appliedto the data. Results : Comparing the 12-hour AUC with the paired 6-hour extrapolated AUC, the ICC and linear regression(r2 were very good for all three groups. No statistical difference was found by a two-tailed paired t-test. Nobias was seen with a Bland Altman plot or by calculation. Conclusion : For patients on Cellcept ® with prednisolone ± cyclosporine the 6-hour corrected is an accuratemeasure of the full 12-hour AUC.

Differential Sensitivities of Fast- and Slow-Cycling Cancer Cells to Inosine Monophosphate Dehydrogenase 2 Inhibition by Mycophenolic Acid

Science.gov (United States)

Chen, Kan; Cao, Wanlu; Li, Juan; Sprengers, Dave; Hernanda, Pratika Y; Kong, Xiangdong; van der Laan, Luc JW; Man, Kwan; Kwekkeboom, Jaap; Metselaar, Herold J; Peppelenbosch, Maikel P; Pan, Qiuwei

2015-01-01

As uncontrolled cell proliferation requires nucleotide biosynthesis, inhibiting enzymes that mediate nucleotide biosynthesis constitutes a rational approach to the management of oncological diseases. In practice, however, results of this strategy are mixed and thus elucidation of the mechanisms by which cancer cells evade the effect of nucleotide biosynthesis restriction is urgently needed. Here we explored the notion that intrinsic differences in cancer cell cycle velocity are important in the resistance toward inhibition of inosine monophosphate dehydrogenase (IMPDH) by mycophenolic acid (MPA). In short-term experiments, MPA treatment of fast-growing cancer cells effectively elicited G0/G1 arrest and provoked apoptosis, thus inhibiting cell proliferation and colony formation. Forced expression of a mutated IMPDH2, lacking a binding site for MPA but retaining enzymatic activity, resulted in complete resistance of cancer cells to MPA. In nude mice subcutaneously engrafted with HeLa cells, MPA moderately delayed tumor formation by inhibiting cell proliferation and inducing apoptosis. Importantly, we developed a lentiviral vector–based Tet-on label-retaining system that enables to identify, isolate and functionally characterize slow-cycling or so-called label-retaining cells (LRCs) in vitro and in vivo. We surprisingly found the presence of LRCs in fast-growing tumors. LRCs were superior in colony formation, tumor initiation and resistance to MPA as compared with fast-cycling cells. Thus, the slow-cycling compartment of cancer seems predominantly responsible for resistance to MPA. PMID:26467706

21 CFR 500.46 - Hexachlorophene in animal drugs.

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2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Hexachlorophene in animal drugs. 500.46 Section 500.46 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS GENERAL Specific Administrative Rulings and Decisions § 500.46...

9 CFR 381.500 - Exemption from nutrition labeling.

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2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Exemption from nutrition labeling. 381.500 Section 381.500 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... business is any single-plant facility or multi-plant company/firm that employs 500 or fewer people and...

Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade iii for a period 2003-2011

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Ignjatović Ljiljana

2013-01-01

Full Text Available Background/Aim. Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI. At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNIbased immunosuppressive protocol to sirolimus (SRL in recipients with graft in chronic kidney disease (CKD grade III and proteinuria below 500 mg/day. Methods. In the period 2003-2011 24 patients (6 famale and 18 male, mean age 41 ± 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF or azathiopirine (AZA] and CNI were switched from CNI to SRL and followe-up for 76 ± 13 months. Nine patients (the group I had early postransplant conversion after 4 ± 3 months and 15 patients (the group II late conversion after 46 ± 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR, proteinuria, lipidemia and side effects. Results. Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV infection or disease, and they were successfully treated with standard therapy. After 21 ± 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients and double immunosuppressive therapy (3 patients, return to hemodialysis (1 patient and death (1 patient. Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 ± 12.7 to 69 ± 15 mL/min, while the increase in proteinuria (from 265 ± 239 to 530.6 ± 416.7 mg/day and lipidemia (cholesterol from 4.71 ± 0.98 to 5.61 ± 1.6 mmol/L and triglycerides

500 French verbs for dummies

CERN Document Server

Erotopoulos

2013-01-01

Vexed by French verbs? Fear no more! In 500 French Verbs For Dummies, beginning French language learners can find a quick reference for verbs in the basic present tenses. More advanced French speakers can utilize this book to learn more complex verb tenses and conjugations as well as advanced verbs with irregular endings. One page for each of the 500 most commonly used verbs in the French language -alphabetically arranged and numbered for easy referenceSpecial designation of the 50 most essential French verbsA summary of basic French grammar that incl

29 CFR 500.143 - Civil money penalty assessment.

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2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Civil money penalty assessment. 500.143 Section 500.143... MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.143 Civil money penalty assessment. (a) A civil money penalty may be assessed for each violation of the Act or these regulations. (b) In...

Fortune 500 Corporate Headquarters

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Department of Homeland Security — Large Corporate Headquarters in the United States This database is composed of 'an annual list of the 500 largest industrial corporations in the U.S., published by...

78 FR 11089 - Special Conditions: Bombardier Aerospace, Model BD-500-1A10 and BD-500-1A11 Airplanes; Sidestick...

Science.gov (United States)

2013-02-15

...; Special Conditions No. 25-477-SC] Special Conditions: Bombardier Aerospace, Model BD-500-1A10 and BD-500... special conditions. SUMMARY: These special conditions are issued for the Bombardier Aerospace Model BD-500...: Background On December 10, 2009, Bombardier Aerospace applied for a type certificate for their new Model BD...

Behavior of methyl orange and orange 10 (orange G) in the presence of hydrotalcite type compounds of Mg/Al and Mg/Fe

International Nuclear Information System (INIS)

Cruz N, G.

2015-01-01

This work is focused on studying the sorption capacity of methyl orange dye (Nm) and orange 10 (N-10) in the presence of hydrotalcite type compounds of Mg/Al and Mg/Fe uncalcined and calcined previously at 500 degrees Celsius. Sorption isotherms were determined and the study of the kinetics of sorption was performed. The materials were characterized before and after sorption processes of these dyes by X-ray diffraction, scanning electron microscopy, the specific surface area determination by the Brunauer-Emmett-Teller method, thermogravimetry coupled to mass and infrared spectrometry. The hydrotalcite type compounds reported in this paper were prepared in the laboratory and their acronyms are: HTMgAlG1, HTMgAlMO, HTMgFeG1 and HTMgFeG2. Note that in this work the best conditions for preparing compounds of Mg/Fe were found. From patterns of X-ray diffraction was identified the typical crystal structure of the hydrotalcite type compounds. By scanning electron microscopy the morphology could be determined in the form of flakes characteristics of these compounds. Likewise with elemental analysis of energy dispersive X-ray spectroscopy the presence of Mg, Al, Fe and C, elements of interest for this study was determined. The compounds presented a specific surface area relatively high from 80 to 120 m 2 /g. Thermogravimetry results presented spectra of mass loss very characteristic associated to water losses, dehydroxylation and decarboxylation. The characteristic bands of water and carbonate were assigned by infrared spectroscopy and the bands corresponding to the dyes sulfonates were identified only for the calcined materials. The sorption capacities found of these compounds were as follows: for Nm in the compound HTMgAlG1 uncalcined was 17.82 mg/g for an initial concentration of 200 mg/L and for calcined (HTMgAlMOcal) of 99.8 mg/g with and initial concentration of 1000 mg/L. Moreover, the sorption capacity of the dye N-10 in this same material was 17.92 mg/g and 99.4 mg

500 Cities: City Boundaries

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U.S. Department of Health & Human Services — This city boundary shapefile was extracted from Esri Data and Maps for ArcGIS 2014 - U.S. Populated Place Areas. This shapefile can be joined to 500 Cities...

29 CFR 780.305 - 500 man-day provision.

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2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false 500 man-day provision. 780.305 Section 780.305 Labor...) Statutory Provisions § 780.305 500 man-day provision. (a) Section 3(u) of the Act defines man-day to mean “any day during which an employee performs agricultural labor for not less than 1 hour.” 500 man-days...

Catalytic Chemical Vapor Deposition of Methane to Carbon Nanotubes: Copper Promoted Effect of Ni/MgO Catalysts

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Wen Yang

2014-01-01

Full Text Available The Ni/MgO and Ni-Cu/MgO catalysts were prepared by sol-gel method and used as the catalysts for synthesis of carbon nanotubes by thermal chemical vapor deposition. The effect of Cu on the carbon yield and structure was investigated, and the effects of calcination temperature and reaction temperature were also investigated. The catalysts and synthesized carbon materials were characterized by temperature programmed reduction (TPR, thermogravimetric analysis (TGA, and scanning electron microscopy (SEM. Results showed that the addition of Cu promoted the reduction of nickel species, subsequently improving the growth and yield of CNTs. Meanwhile, CNTs were synthesized by the Ni/MgO and Ni-Cu/MgO catalysts with various calcination temperatures and reaction temperatures, and results suggested that the obtained CNTs on Ni-Cu/MgO catalyst with the calcination temperature of 500°C and the reaction temperature of 650°C were of the greatest yield and quantity of 927%.

31 CFR 500.572 - Humanitarian projects authorized.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Humanitarian projects authorized. 500.572 Section 500.572 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... from private sources, including but not limited to accredited degree-granting institutes of education...

13 CFR 146.500 - Secretary of Defense.

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2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Secretary of Defense. 146.500 Section 146.500 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW RESTRICTIONS ON LOBBYING..., a covered Federal action from the prohibition whenever the Secretary determines, in writing, that...

40 CFR 152.500 - Requirements for devices.

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2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Requirements for devices. 152.500 Section 152.500 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS... other than a bacterium, virus, or other microorganism on or in living man or living animals) but not...

A possible simplification for the estimation of area under the curve (AUC₀₋₁₂) of enteric-coated mycophenolate sodium in renal transplant patients receiving tacrolimus.

Science.gov (United States)

Fleming, Denise H; Mathew, Binu S; Prasanna, Samuel; Annapandian, Vellaichamy M; John, George T

2011-04-01

Enteric-coated mycophenolate sodium (EC-MPS) is widely used in renal transplantation. With a delayed absorption profile, it has not been possible to develop limited sampling strategies to estimate area under the curve (mycophenolic acid [MPA] AUC₀₋₁₂), which have limited time points and are completed in 2 hours. We developed and validated simplified strategies to estimate MPA AUC₀₋₁₂ in an Indian renal transplant population prescribed EC-MPS together with prednisolone and tacrolimus. Intensive pharmacokinetic sampling (17 samples each) was performed in 18 patients to measure MPA AUC₀₋₁₂. The profiles at 1 month were used to develop the simplified strategies and those at 5.5 months used for validation. We followed two approaches. In one, the AUC was calculated using the trapezoidal rule with fewer time points followed by an extrapolation. In the second approach, by stepwise multiple regression analysis, models with different time points were identified and linear regression analysis performed. Using the trapezoidal rule, two equations were developed with six time points and sampling to 6 or 8 hours (8hrAUC[₀₋₁₂exp]) after the EC-MPS dose. On validation, the 8hrAUC(₀₋₁₂exp) compared with total measured AUC₀₋₁₂ had a coefficient of correlation (r²) of 0.872 with a bias and precision (95% confidence interval) of 0.54% (-6.07-7.15) and 9.73% (5.37-14.09), respectively. Second, limited sampling strategies were developed with four, five, six, seven, and eight time points and completion within 2 hours, 4 hours, 6 hours, and 8 hours after the EC-MPS dose. On validation, six, seven, and eight time point equations, all with sampling to 8 hours, had an acceptable r with the total measured MPA AUC₀₋₁₂ (0.817-0.927). In the six, seven, and eight time points, the bias (95% confidence interval) was 3.00% (-4.59 to 10.59), 0.29% (-5.4 to 5.97), and -0.72% (-5.34 to 3.89) and the precision (95% confidence interval) was 10

24 CFR 954.500 - Repayment of investment.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Repayment of investment. 954.500... DEVELOPMENT INDIAN HOME PROGRAM Program Administration § 954.500 Repayment of investment. (a) HOME funds will be made available pursuant to a HOME Investment Partnership Agreement. The agreement ensures that...

31 CFR 500.325 - National securities exchange.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false National securities exchange. 500.325... Definitions § 500.325 National securities exchange. The term national securities exchange shall mean an exchange registered as a national securities exchange under section 6 of the Securities Exchange Act of...

Global Investigation of the Mg Atom and ion Layers using SCIAMACHY/Envisat Observations between 70 km and 150 km Altitude and WACCM-MG Model Results

Science.gov (United States)

Langowski, M.; vonSavigny, C.; Burrows, J. P.; Feng, W.; Plane, J. M. C.; Marsh, D. R.; Janches, Diego; Sinnhuber, M.; Aikin, A. C.

2014-01-01

Mg and Mg+ concentration fields in the upper mesosphere/lower thermosphere (UMLT) region are retrieved from SCIAMACHY/Envisat limb measurements of Mg and Mg+ dayglow emissions using a 2-D tomographic retrieval approach. The time series of monthly means of Mg and Mg+ for number density as well as vertical column density in different latitudinal regions are shown. Data from the limb mesosphere-thermosphere mode of SCIAMACHY/Envisat are used, which covers the 50 km to 150 km altitude region with a vertical sampling of 3.3 km and a highest latitude of 82 deg. The high latitudes are not covered in the winter months, because there is no dayglow emission during polar night. The measurements were performed every 14 days from mid-2008 until April 2012. Mg profiles show a peak at around 90 km altitude with a density between 750 cm(exp-3) and 2000 cm(exp-3). Mg does not show strong seasonal variation at mid-latitudes. The Mg+ peak occurs 5-15 km above the neutral Mg peak at 95-105 km. Furthermore, the ions show a significant seasonal cycle with a summer maximum in both hemispheres at mid- and high-latitudes. The strongest seasonal variations of the ions are observed at mid-latitudes between 20-40 deg and densities at the peak altitude range from 500 cm(exp-3) to 6000 cm(exp-3). The peak altitude of the ions shows a latitudinal dependence with a maximum at mid-latitudes that is up to 10 km higher than the peak altitude at the equator. The SCIAMACHY measurements are compared to other measurements and WACCM model results. In contrast to the SCIAMACHY results, the WACCM results show a strong seasonal variability for Mg with a winter maximum, which is not observable by SCIAMACHY, and globally higher peak densities. Although the peak densities do not agree the vertical column densities agree, since SCIAMACHY results show a wider vertical profile. The agreement of SCIAMACHY and WACCM results is much better for Mg+, showing the same seasonality and similar peak densities. However

Cryogenic milling for the fabrication of high J{sub c} MgB{sub 2} bulk superconductors

Energy Technology Data Exchange (ETDEWEB)

Kim, D. N.; Kang, M. O.; Park, H. W. [Korea University of Technology and Education, Cheonan (Korea, Republic of); Jun, B. H.; Kim, C. J. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2017-06-15

Cryogenic milling which is a combined process of low-temperature treatment and mechanical milling was applied to fabricate high critical current density (J{sub c}) MgB{sub 2} bulk superconductors. Liquid nitrogen was used as a coolant, and no solvent or lubricant was used. Spherical Mg (6-12 μm, 99.9 % purity) and plate-like B powder (⁓ 1 μm, 97 % purity) were milled simultaneously for various time periods (0, 2, 4, 6 h) at a rotating speed of 500 rpm using ZrO{sub 2} balls. The (Mg{sup +2B}) powders milled were pressed into pellets and heat-treated at 700°C for 1 h in flowing argon. The use of cryomilled powders as raw materials promoted the formation reaction of superconducting MgB{sub 2}, reduced the grain size of MgB{sub 2}, and suppressed the formation of impurity MgO. The superconducting critical temperature (T{sub c}) of MgB{sub 2} was not influenced as the milling time (t) increased up to 6 h. Meanwhile, the critical current density (J{sub c}) of MgB{sub 2} increased significantly when t increased to 4 h. When t increased further to 6 h, however, Jc decreased. The J{sub c} enhancement of MgB{sub 2} by cryogenic milling is attributed to the formation of the fine grain MgB{sub 2} and a suppression of the MgO formation.

13 CFR 500.100 - Purpose and scope.

Science.gov (United States)

2010-01-01

... Board's authorities and organizational structure, the means and rules by which the Board takes actions... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Purpose and scope. 500.100 Section 500.100 Business Credit and Assistance EMERGENCY OIL AND GAS GUARANTEED LOAN BOARD EMERGENCY OIL AND...

13 CFR 500.213 - Termination of obligations.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Termination of obligations. 500.213 Section 500.213 Business Credit and Assistance EMERGENCY OIL AND GAS GUARANTEED LOAN BOARD... the Application, the Guarantee or the Loan Documents; (5) A Lender fails to make a demand for payment...

49 CFR 179.500-10 - Protective housing.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Protective housing. 179.500-10 Section 179.500-10...-10 Protective housing. (a) Safety devices, and loading and unloading valves on tanks shall be protected from accidental damage by approved metal housing, arranged so it may be readily opened to permit...

TOP500 Supercomputers for November 2004

Energy Technology Data Exchange (ETDEWEB)

Strohmaier, Erich; Meuer, Hans W.; Dongarra, Jack; Simon, Horst D.

2004-11-08

24th Edition of TOP500 List of World's Fastest Supercomputers Released: DOE/IBM BlueGene/L and NASA/SGI's Columbia gain Top Positions MANNHEIM, Germany; KNOXVILLE, Tenn.; BERKELEY, Calif. In what has become a closely watched event in the world of high-performance computing, the 24th edition of the TOP500 list of the worlds fastest supercomputers was released today (November 8, 2004) at the SC2004 Conference in Pittsburgh, Pa.

TOP500 Supercomputers for June 2004

Energy Technology Data Exchange (ETDEWEB)

Strohmaier, Erich; Meuer, Hans W.; Dongarra, Jack; Simon, Horst D.

2004-06-23

23rd Edition of TOP500 List of World's Fastest Supercomputers Released: Japan's Earth Simulator Enters Third Year in Top Position MANNHEIM, Germany; KNOXVILLE, Tenn.;&BERKELEY, Calif. In what has become a closely watched event in the world of high-performance computing, the 23rd edition of the TOP500 list of the world's fastest supercomputers was released today (June 23, 2004) at the International Supercomputer Conference in Heidelberg, Germany.

TOP500 Supercomputers for June 2002

Energy Technology Data Exchange (ETDEWEB)

Strohmaier, Erich; Meuer, Hans W.; Dongarra, Jack; Simon, Horst D.

2002-06-20

19th Edition of TOP500 List of World's Fastest Supercomputers Released MANNHEIM, Germany; KNOXVILLE, Tenn.;&BERKELEY, Calif. In what has become a much-anticipated event in the world of high-performance computing, the 19th edition of the TOP500 list of the worlds fastest supercomputers was released today (June 20, 2002). The recently installed Earth Simulator supercomputer at the Earth Simulator Center in Yokohama, Japan, is as expected the clear new number 1. Its performance of 35.86 Tflop/s (trillions of calculations per second) running the Linpack benchmark is almost five times higher than the performance of the now No.2 IBM ASCI White system at Lawrence Livermore National Laboratory (7.2 Tflop/s). This powerful leap frogging to the top by a system so much faster than the previous top system is unparalleled in the history of the TOP500.

31 CFR 500.407 - Administration of blocked estates of decedents.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Administration of blocked estates of decedents. 500.407 Section 500.407 Money and Finance: Treasury Regulations Relating to Money and Finance... Interpretations § 500.407 Administration of blocked estates of decedents. Section 500.201 prohibits all...

31 CFR 500.511 - Transactions by certain business enterprises.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Transactions by certain business enterprises. 500.511 Section 500.511 Money and Finance: Treasury Regulations Relating to Money and Finance... Licenses, Authorizations and Statements of Licensing Policy § 500.511 Transactions by certain business...

Formation and characterization of the MgO protecting layer deposited by plasma-enhanced metal-organic chemical-vapor deposition

CERN Document Server

Kang, M S; Byun, J C; Kim, D S; Choi, C K; Lee, J Y; Kim, K H

1999-01-01

MgO films were prepared on Si(100) and soda-lime glass substrates by using plasma-enhanced metal-organic chemical-vapor deposition. Various ratios of the O sub 2 /CH sub 3 MgO sup t Bu gas mixture and various gas flow rates were tested for the film fabrications. Highly (100)-oriented MgO films with good crystallinity were obtained with a 10 sccm CH sub 3 MgO sup t Bu flow without an O sub 2 gas flow. About 5 % carbon was contained in all the MgO films. The refractive index and the secondary electron emission coefficient for the best quality film were 1.43 and 0.45, respectively. The sputtering rate was about 0.2 nm/min for 10 sup 1 sup 1 cm sup - sup 3 Ar sup + ion density. Annealing at 500 .deg. C in an Ar ambient promoted the grain size without inducing a phase transition.

49 CFR 179.500-6 - Heat treatment.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Heat treatment. 179.500-6 Section 179.500-6...-6 Heat treatment. (a) Each necked-down tank shall be uniformly heat treated. Heat treatment shall... treatment of alternate steels shall be approved. All scale shall be removed from outside of tank to an...

31 CFR 500.529 - Powers of attorney.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Powers of attorney. 500.529 Section 500.529 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... section does not authorize the creation of any power of attorney in favor of any person outside of the...

49 CFR 179.500-7 - Physical tests.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Physical tests. 179.500-7 Section 179.500-7...-7 Physical tests. (a) Physical tests shall be made on two test specimens 0.505 inch in diameter... tank. These test specimen ring sections or prolongations shall be heat treated, with the necked-down...

Career Development Programs in Fortune 500 Firms.

Science.gov (United States)

Keller, Jack; Piotrowski, Chris

Career development programs (CDPs) are a rather recent area of study in organizational and industrial psychology. The present study investigated the nature and evaluation of CDPs in Fortune 500 firms. Data were obtained by a mailed questionnaire completed by the firms' human resources directors. Of the 500 companies surveyed, only those 50 that…

Inferring seawater temperature over the past 2,500 years in the Southern California Bight on the basis of brachiopods

Science.gov (United States)

Tomašových, Adam; Müller, Tamás; Kidwell, Susan M.

2017-04-01

Use of calcite δ18O in brachiopod shells in assessing past variations in seawater temperature remains poorly constrained in the absence of other methods due to vital effects and unknown variations in seawater density, salinity. Here, in order to evaluate past changes in seawater temperature of mainland shelf habitats off the Southern California Bight over the past 2,500 years, we analyze δ18O and Mg/Ca ratio of dead shells of the terebratulid brachiopod Laqueus erythraeus collected at 60-80 m water depths and age-dated by radiocarbon-calibrated amino acid racemization. These dead Holocene shells show excellent preservation (Mn concentrations < 10 ppm and Sr concentrations above 800 ppm). Although historical changes in sea-surface temperature in the southern California Bight were inferred on the basis of alkenones and δ18O in of planktonic foraminifers, temperature history of deeper shelf below storm wave base in this region remains unclear. First, we investigate thermal sensitivity of Mg/Ca ratio (using Laser Ablation Inductively Coupled Plasma Mass Spectrometry and wavelength-dispersive spectrometry) in the terebratulid brachiopod Laqueus erythraeus (collected in 1994 at Santa Catalina Island at 116 m water depth). At this depth, annual temperature range is relatively small (between 9-11°C), although at times of El Nino events in 1982-1983, 1986-1987, and 1992-1993, monthly temperature attained 13 °C. We find that δ18O measured along a growth profile of a shell precipitated in oxygen isotopic equilibrium with ambient seawater, and maxima in Mg/Ca ratio coincide with minima in δ18O, suggesting that fluctuations in Mg/Ca ratio trace temperature fluctuations, as observed also in other brachiopod species. Second, preliminary observations of Holocene shells show that Mg/Ca ratios show centennial-scale fluctuations but on average remain remarkably constant, with minima and maxima staying within intra-shell seasonal variations captured by extant specimens

MAGIICAT I. THE Mg II ABSORBER-GALAXY CATALOG

Energy Technology Data Exchange (ETDEWEB)

Nielsen, Nikole M.; Churchill, Christopher W. [New Mexico State University, Las Cruces, NM 88003 (United States); Kacprzak, Glenn G.; Murphy, Michael T., E-mail: nnielsen@nmsu.edu [Swinburne University of Technology, Victoria 3122 (Australia)

2013-10-20

We describe the Mg II Absorber-Galaxy Catalog, MAGIICAT, a compilation of 182 spectroscopically identified intermediate redshift (0.07 ≤ z ≤ 1.1) galaxies with measurements of Mg II λλ2796, 2803 absorption from their circumgalactic medium within projected distances of 200 kpc from background quasars. In this work, we present 'isolated' galaxies, which are defined as having no spectroscopically identified galaxy within a projected distance of 100 kpc and a line of sight velocity separation of 500 km s{sup –1}. We standardized all galaxy properties to the ΛCDM cosmology and galaxy luminosities, absolute magnitudes, and rest-frame colors to the B- and K-band on the AB system. We present galaxy properties and rest-frame Mg II equivalent width, W{sub r} (2796), versus galaxy redshift. The well-known anti-correlation between W{sub r} (2796) and quasar-galaxy impact parameter, D, is significant to the 8σ level. The mean color of MAGIICAT galaxies is consistent with an Sbc galaxy for all redshifts. We also present B- and K-band luminosity functions for different W{sub r} (2796) and redshift subsamples: 'weak absorbing' [W{sub r} (2796) < 0.3 Å], 'strong absorbing' [W{sub r} (2796) ≥ 0.3 Å], low redshift (z < (z)), and high redshift (z ≥ (z)), where (z) = 0.359 is the median galaxy redshift. Rest-frame color B – K correlates with M{sub K} at the 8σ level for the whole sample but is driven by the strong absorbing, high-redshift subsample (6σ). Using M{sub K} as a proxy for stellar mass and examining the luminosity functions, we infer that in lower stellar mass galaxies, Mg II absorption is preferentially detected in blue galaxies and the absorption is more likely to be weak.

TOP500 Supercomputers for June 2005

Energy Technology Data Exchange (ETDEWEB)

Strohmaier, Erich; Meuer, Hans W.; Dongarra, Jack; Simon, Horst D.

2005-06-22

25th Edition of TOP500 List of World's Fastest Supercomputers Released: DOE/L LNL BlueGene/L and IBM gain Top Positions MANNHEIM, Germany; KNOXVILLE, Tenn.; BERKELEY, Calif. In what has become a closely watched event in the world of high-performance computing, the 25th edition of the TOP500 list of the world's fastest supercomputers was released today (June 22, 2005) at the 20th International Supercomputing Conference (ISC2005) in Heidelberg Germany.

Discharge behaviour of Mg-Al-Pb and Mg-Al-Pb-In alloys as anodes for Mg-air battery

International Nuclear Information System (INIS)

Wang, Naiguang; Wang, Richu; Peng, Chaoqun; Peng, Bing; Feng, Yan; Hu, Chengwang

2014-01-01

Highlights: • We investigate the effect of indium on the discharge behaviour of Mg-Al-Pb alloy. • We evaluate the performance of Mg-air batteries with Mg-Al-Pb and Mg-Al-Pb-In anodes. • We analyze the activation mechanism of Mg-Al-Pb-In alloy in the discharge process. - Abstract: The discharge behaviour of Mg-Al-Pb and Mg-Al-Pb-In alloys in 3.5 wt.% NaCl solution is investigated by electrochemical techniques, and compared with that of pure magnesium. The results show that Mg-Al-Pb-In alloy provides a more negative potential and exhibits a higher utilization efficiency in contrast with Mg-Al-Pb alloy and pure magnesium during the half-cell test at a large current density, and gives desirable discharge performance when used as anode for Mg- air battery. The peak power density of the Mg-air battery with Mg-Al-Pb-In anode is 94.5 mW cm −2 , which is comparable with those of Mg-H 2 O 2 semi-fuel batteries. Moreover, the activation mechanism of Mg-Al-Pb-In alloy during the discharge process is also analyzed

29 CFR 500.81 - Payment of wages when due.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Payment of wages when due. 500.81 Section 500.81 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Worker Protections Wages and Payroll Standards § 500.81 Payment of...

The effect of the MgO buffer layer thickness on magnetic anisotropy in MgO/Fe/Cr/MgO buffer/MgO(001)

Energy Technology Data Exchange (ETDEWEB)

Kozioł-Rachwał, Anna, E-mail: a.koziolrachwal@aist.go.jp [National Institute of Advanced Industrial Science and Technology, Spintronics Research Center, Tsukuba, Ibaraki 305-8568 (Japan); AGH University of Science and Technology, Faculty of Physics and Applied Computer Science, al. Mickiewicza 30, 30-059 Kraków (Poland); Nozaki, Takayuki; Zayets, Vadym; Kubota, Hitoshi; Fukushima, Akio; Yuasa, Shinji [National Institute of Advanced Industrial Science and Technology, Spintronics Research Center, Tsukuba, Ibaraki 305-8568 (Japan); Suzuki, Yoshishige [National Institute of Advanced Industrial Science and Technology, Spintronics Research Center, Tsukuba, Ibaraki 305-8568 (Japan); Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka 560-8531 (Japan)

2016-08-28

The relationship between the magnetic properties and MgO buffer layer thickness d was studied in epitaxial MgO/Fe(t)/Cr/MgO(d) layers grown on MgO(001) substrate in which the Fe thickness t ranged from 0.4 nm to 1.1 nm. For 0.4 nm ≤ t ≤ 0.7 nm, a non-monotonic coercivity dependence on the MgO buffer thickness was shown by perpendicular magneto-optic Kerr effect magnetometry. For thicker Fe films, an increase in the buffer layer thickness resulted in a spin reorientation transition from perpendicular to the in-plane magnetization direction. Possible origins of these unusual behaviors were discussed in terms of the suppression of carbon contamination at the Fe surface and changes in the magnetoelastic anisotropy in the system. These results illustrate a method to control magnetic anisotropy in MgO/Fe/Cr/MgO(d) via an appropriate choice of MgO buffer layer thickness d.

Mixed methanol/ethanol on transesterification of waste cooking oil using Mg/Al hydrotalcite catalyst

International Nuclear Information System (INIS)

Ma, Yingqun; Wang, Qunhui; Zheng, Lu; Gao, Zhen; Wang, Qiang; Ma, Yuhui

2016-01-01

Biodiesel production from waste cooking oil using calcined Mg/Al HT (hydrotalcite) as heterogeneous catalyst was investigated. This study describes the calcined Mg/Al HT prepared under optimal conditions to catalyse waste cooking oil for biodiesel preparation and proposes a plausible catalysis mechanism. The catalysts were characterised by Fourier Transform-Infrared, X-ray diffraction, Thermal Gravity Analysis-Differential thermal gravity and Brunner−Emmet−Teller measurements. Hydrotalcite with Mg/Al ratio of 3:1 showed a uniform mesoporous structure, excellent crystallinity, high surface area (270.5 m 2 /g) and good catalytic activity (at 500 °C calcination). The highest biodiesel yield obtained was 95.2% under optimised conditions of alcohol/oil molar ratio of 6:1, methanol/ethanol molar ratio of 4:2, catalyst content of 1.5%, reaction time of 2.5 h, reaction temperature of 80 °C. Mixed methanol/ethanol showed good synergistic effects as an ester exchange agent, and the catalyst was easily separated and recycled. Therefore, Mg/Al hydrotalcite can effectively catalyse waste cooking oil for biodiesel preparation with mixed methanol/ethanol. - Highlights: • Mg/Al hydrotalcite filtered and stirred with acetone has the better dispersion. • Mg/Al hydrotalcite used as catalyst to prepare biodiesel. • Catalytic mechanism of Mg/Al hydrotalcite was investigated. • Mixed Methanol/Ethanol used as transesterification agent to prepare biodiesel. • Regenerative catalyst was assessed to make catalyst reuse well.

Neuropsychiatric safety with liraglutide 3.0 mg for weight management

DEFF Research Database (Denmark)

O'Neil, Patrick M; Aroda, V R; Astrup, Arne

2017-01-01

with liraglutide 3.0 mg were evaluated post hoc. METHODS: Data from the liraglutide weight-management programme were pooled. Across trials, individuals with a body mass index ≥30 kg/m(2) or ≥27 kg/m(2) with weight-related comorbidities were randomized to once-daily subcutaneous liraglutide 3.0 mg (n = 3384......) or placebo (n = 1941), both with a 500 kcal/day deficit diet plus exercise. Adverse events related to neuropsychiatric safety were collected in all trials. Additionally, in the phase 3a trials, validated mental-health questionnaires were prospectively and systematically administered. RESULTS: In the pooled...... analysis of 5325 randomized and exposed individuals, rates of depression (2.1 versus 2.1 events/100 person-years) and anxiety (1.9 versus 1.7 events/100 person-years) through adverse event reporting were similarly low in the liraglutide group and the placebo group. Nine (0.3%) individuals on liraglutide...

Microstructural evolution in Mg-rich Mg-Zn-Y alloys

International Nuclear Information System (INIS)

Biswas, T.; Ranganathan, S.; Nair, S.; Bajargan, G.

2005-01-01

Mg-rich Mg-Zn-Y alloys with nominal compositions Mg 97 Zn 1 Y 2 , Mg 97 Zn 2 Y 1 , Mg 92 Zn 6.5 Y 1.5 and Mg 97-x Zn 1 Y 2 Zr x have been chosen for the present study. These alloys are prepared by using sand casting mold. The sand cast alloys are remelted and subjected to copper mold casting and melt spinning techniques. The effect of cooling rate on microstructures was studied. It is observed that the size of the precipitates decreases with an increase of cooling rate. The formation of nano precipitates results in higher strength of the alloy as compared to the conventional alloys. The microstructures of melt spun ribbons are compared with RS/PM (rapidly solidified power metallurgy) Mg 97 Zn 1 Y 2 alloy, obtained from a different source. (author)

42 CFR 456.500 - Purpose.

Science.gov (United States)

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals § 456.500 Purpose. For hospitals and mental hospitals, this subpart— (a...

Deposition of MgB2 Thin Films on Alumina-Buffered Si Substrates by using Hybrid Physical-Chemical Vapor Deposition Method

International Nuclear Information System (INIS)

Lee, T. G.; Park, S. W.; Seong, W. K.; Huh, J. Y.; Jung, S. G.; Kang, W. N.; Lee, B. K.; An, K. S.

2008-01-01

[ MgB 2 ] thin films were fabricated using hybrid physical-chemical vapor deposition (HPCVD) method on silicon substrates with buffers of alumina grown by using atomic layer deposition method. The growth war in a range of temperatures 500 - 600 degrees C and under the reactor pressures of 25 - 50 degrees C. There are some interfacial reactions in the as-grown films with impurities of mostly Mg 2 Si, MgAl 2 O 4 , and other phases. The T c 's of MgB 2 films were observed to be as high as 39 K, but the transition widths were increased with growth temperatures. The magnetization was measured as a function of temperature down to the temperature of 5 K, but the complete Meissner effect was not observed, which shows that the granular nature of weak links is prevailing. The formation of mostly Mg 2 Si impurity in HPCVD process is discussed, considering the diffusion and reaction of Mg vapor with silicon substrates.

Synthesis of carbon nanotubes from acetylene on the FeCoMgO catalytic system obtained by ball milling

Energy Technology Data Exchange (ETDEWEB)

Biris, A R; Simon, S; Lupu, D; Misan, I [National Institute for Research and Development of Isotopic and Molecular Technologies, 65-103 Donath, 400293 Cluj-Napoca (Romania); Biris, A S; Dervishi, E; Li, Z; Watanabe, F [UALR Nanotechnology Center, University of Arkansas, 2801 S University Ave, Little Rock, AR 72204 (United States); Lucaci, M, E-mail: alexandru.biris@itim-cj.r [National Institute for Research and Development in Electrical Engineering ICPE-CA 313 Splaiul Unirii, 030138 Bucharest (Romania)

2009-08-01

Highly crystalline multi wall carbon nanotubes have been synthesized by RF-CVD from acetylene at 850{sup 0}C over a Fe:Co:MgO catalyst. The catalytic system was obtained by mixing for 100 h Fe, Co and MgO powders in a ball milling device under petroleum ether environment, followed by oxidation in air at 500{sup 0}C for 24 h. Most of the nanotubes had external diameters in order of dozens of nm and lengths of microns, resulting in an aspect ration of over 1000. Their external to internal diameter ratio varied between 2.5 and 3.

25 CFR 11.500 - Law applicable to civil actions.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Law applicable to civil actions. 11.500 Section 11.500 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Civil Actions § 11.500 Law applicable to civil actions. (a) In all civil cases, the...

Selective recovery of uranium from Ca-Mg uranates by chlorination

Science.gov (United States)

Pomiro, Federico J.; Gaviría, Juan P.; Quinteros, Raúl D.; Bohé, Ana E.

2017-07-01

A chlorination process is proposed for the uranium extraction and separation using Calciumsbnd Magnesium uranates such as starting reactants which were obtained by precipitation from uranyl nitrate solutions with calcium hydroxide. The study is based on thermodynamic and reaction analysis using chlorine gas as chlorination agent. The results showed that the chlorination reaction of Ca uranate is more feasible to occur than the Mg uranate. The products obtained after chlorination reactions were washed with deionized water to remove the chlorides produced and analyzed. The XRD patterns of the washed products indicated that the chlorination between 400 and 500 °C result in a single phase of calcium uranate (CaUO4) as reaction product. The formation of U3O8 and MgU3O10 was observed at temperatures between 600 °C and 700 °C for 8 hs. The optimal conditions to recover uranium were 3 l h-1 of chlorine and 10 hs of reaction at 700 °C being U3O8 the single uranium product obtained.

Microstructure, biocorrosion and cytotoxicity evaluations of rapid solidified Mg-3Ca alloy ribbons as a biodegradable material

International Nuclear Information System (INIS)

Gu, X N; Zhou, W R; Zheng, Y F; Li, X L; Cheng, Y

2010-01-01

Rapidly solidified (RS) Mg-3Ca alloy ribbons were prepared by the melt-spinning technique at different wheel rotating speeds (15 m s -1 , 30 m s -1 and 45 m s -1 ) with the as-cast Mg-3Ca alloy ingot as a raw material. The RS45 Mg-3Ca alloy ribbon showed a much more fine grain size feature (approximately 200-500 nm) in comparison to the coarse grain size (50-100 μm) of the original as-cast Mg-3Ca alloy ingot. The corrosion electrochemical tests in simulated body fluid indicated that the corrosion rate of the as-cast Mg-3Ca alloy was strongly reduced by the RS procedure and tended to be further decreased with increasing wheel rotating speeds (1.43 mm yr -1 for RS15, 0.94 mm yr -1 for RS30 and 0.36 mm yr -1 for RS45). The RS Mg-3Ca alloy ribbons showed more uniform corrosion morphology compared with the as-cast Mg-3Ca alloy after polarization. The cytotoxicity evaluation revealed that the three experimental as-spun Mg-3Ca alloy ribbon extracts did not induce toxicity to the L-929 cells, whereas the as-cast Mg-3Ca alloy ingot extract did. The L-929 cells showed more improved adhesion on the surfaces of the three as-spun Mg-3Ca alloy ribbons than that of the as-cast Mg-3Ca alloy ingot.

The Influence of Aluminum on the Microstructure and Hardness of Mg-5Si-7Sn Alloy

Directory of Open Access Journals (Sweden)

Rzychoń T.

2016-03-01

Full Text Available Magnesium alloys due the low density and good mechanical properties are mainly used in the automotive and aerospace industry. In recent years, magnesium alloys are extensively developed for use in high temperatures (above 120°C. Among these alloys, magnesium alloys containing tin and silicon have large possibilities of application due to the formation of thermally stable intermetallic Mg2Sn and Mg2Si. In this paper the influence of aluminum and heat treatment on the on the microstructure and hardness of Mg-7Sn-5Si alloy is reported. It was found that the microstructure of Mg-7Sn-5Si alloy consist of α-Mg solid solution, Mg2Sn and Mg2Si compounds. Addition of 2 wt% of Al to Mg-7Sn-5Si alloy causes the formation of Al2Sn phase. Moreover, Al dissolves in the α-Mg solid solution. The solution heat-treatment of tested alloys at 500°C for 24 h causes the dissolve the Mg2Sn phase in the α-Mg matrix and spheroidization of Mg2Si compound. The Mg2Si primary crystals are stable at solution temperature. After ageing treatment the precipitation process of equilibrium Mg2Sn phase was found in both alloys. The addition of aluminum has a positive effect on the hardness of Mg-7Sn-5Si alloy. In case of Mg-5Si-7Sn-2Al alloy the highest hardness was obtained for sample aged for 148 h at 250°C (88 HV2, while in case of Al-free alloy the highest hardness is 70 HV for material aged for 148 h at 250°C.

Demonstration of the 500 kW stoker burning system; 500 kW stokeripolttojaerjestelmaen demonstrointi

Energy Technology Data Exchange (ETDEWEB)

Oravainen, H. [VTT Energy, Jyvaeskylae (Finland); Kantalainen, K. [Hoegfors Laempoe Oy, Saarijaervi (Finland)

1995-12-31

The objective of the project is to demonstrate the operation of a 500 kW stoker-burning system in practice. The project is continuation of the previous projects of the Bioenergy research programme, 303 - Development of automatic heating system for wood chips and sod peat, carried out by VTT Energy, and Y301 - Development of heating boiler for wood chips and sod peat, carried out by Hoegfors Laempoe Oy. A 500 kW (nominal power) stoker-burner was constructed on the basis of the results of these projects. The burner was mounted on ETNA 500 bioenergy boiler. Screw-feeders, constructed by Maamiehen Saehkoe Oy, were used as fuel feeding system. Maamiehen Saehkoe Oy delivered also the automation system for the combustion equipment. Combustion air pre-heater was mounted on the boiler for promotion of the combustion of moist fuel. Testing of the equipment was carried out at the laboratory of VTT Energy in Jyvaeskylae in October-November 1994. In December 1994 the equipment was transported to Jalasjaervi, to heating station of the farmer Juha Jyrae. The actual heat generation started in the beginning of February 1995, when the greenhouses started to require heating. Sod peat has been used as the fuel. VTT Energy has carried out the efficiency and emission measurements in the heating station with sod peat in March 1995, and with reed canary grass in autumn 1995. The energy generation and fuel consumption have been followed all the time

Demonstration of the 500 kW stoker burning system; 500 kW stokeripolttojaerjestelmaen demonstrointi

Energy Technology Data Exchange (ETDEWEB)

Oravainen, H [VTT Energy, Jyvaeskylae (Finland); Kantalainen, K [Hoegfors Laempoe Oy, Saarijaervi (Finland)

1996-12-31

The objective of the project is to demonstrate the operation of a 500 kW stoker-burning system in practice. The project is continuation of the previous projects of the Bioenergy research programme, 303 - Development of automatic heating system for wood chips and sod peat, carried out by VTT Energy, and Y301 - Development of heating boiler for wood chips and sod peat, carried out by Hoegfors Laempoe Oy. A 500 kW (nominal power) stoker-burner was constructed on the basis of the results of these projects. The burner was mounted on ETNA 500 bioenergy boiler. Screw-feeders, constructed by Maamiehen Saehkoe Oy, were used as fuel feeding system. Maamiehen Saehkoe Oy delivered also the automation system for the combustion equipment. Combustion air pre-heater was mounted on the boiler for promotion of the combustion of moist fuel. Testing of the equipment was carried out at the laboratory of VTT Energy in Jyvaeskylae in October-November 1994. In December 1994 the equipment was transported to Jalasjaervi, to heating station of the farmer Juha Jyrae. The actual heat generation started in the beginning of February 1995, when the greenhouses started to require heating. Sod peat has been used as the fuel. VTT Energy has carried out the efficiency and emission measurements in the heating station with sod peat in March 1995, and with reed canary grass in autumn 1995. The energy generation and fuel consumption have been followed all the time

Noteworthy: Fortune 500: Texas ties California for national lead

OpenAIRE

Michael Nicholson

2010-01-01

According to the 2010 Fortune 500, released in April, Texas hosts the headquarters of 57 of the nation's 500 largest companies, ranked by gross revenues. Texas secured its place as a Fortune 500 leader through its position as focal point of the domestic energy industry, its relatively strong economic growth over the past decade, and its relatively low tax rates and living costs.

Characterization of the Micro-Arc Coatings Containing β-Tricalcium Phosphate Particles on Mg-0.8Ca Alloy

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Mariya B. Sedelnikova

2018-04-01

Full Text Available The characterization of the microstructure, morphology, topography, composition, and physical and chemical properties of the coatings containing β-tricalcium phosphate (β-TCP particles deposited by the micro-arc oxidation (MAO method on biodegradable Mg-0.8Ca alloy has been performed. The electrolyte for the MAO process included the following components: Na2HPO4·12H2O, NaOH, NaF, and β-Ca3(PO42 (β-TCP. The coating morphology, microstructure, and compositions have been studied using scanning electron microscopy (SEM, transmission electron microscopy (TEM, energy-dispersive X-ray spectroscopy (EDX, and X-ray diffraction (XRD. With increasing of the MAO voltage from 350 to 500 V, the coating thickness and surface average roughness of the coatings increased linearly from 6 to 150 µm and from 2 to 8 µm, respectively. The coating deposited at 350 V had more homogeneous porous morphology with numerous pores similar by sizes (2–3 µm than the coatings formed at 450–500 V. The β-TCP isometric particles were included in the coating surface. The XRD recognized the amorphous-crystalline structure in the coatings with incorporation of the following phases: β-TCP, α-TCP, MgO (periclase and hydroxyapatite (HA. The corrosion experiments showed that the biodegradation rate of the Mg-0.8Ca alloy coated by calcium phosphates is almost 10 times less than that of uncoated alloy.

A new class of IMP dehydrogenase with a role in self-resistance of mycophenolic acid producing fungi

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Mortensen Uffe H

2011-09-01

Full Text Available Abstract Background Many secondary metabolites produced by filamentous fungi have potent biological activities, to which the producer organism must be resistant. An example of pharmaceutical interest is mycophenolic acid (MPA, an immunosuppressant molecule produced by several Penicillium species. The target of MPA is inosine-5'-monophosphate dehydrogenase (IMPDH, which catalyses the rate limiting step in the synthesis of guanine nucleotides. The recent discovery of the MPA biosynthetic gene cluster from Penicillium brevicompactum revealed an extra copy of the IMPDH-encoding gene (mpaF embedded within the cluster. This finding suggests that the key component of MPA self resistance is likely based on the IMPDH encoded by mpaF. Results In accordance with our hypothesis, heterologous expression of mpaF dramatically increased MPA resistance in a model fungus, Aspergillus nidulans, which does not produce MPA. The growth of an A. nidulans strain expressing mpaF was only marginally affected by MPA at concentrations as high as 200 μg/ml. To further substantiate the role of mpaF in MPA resistance, we searched for mpaF orthologs in six MPA producer/non-producer strains from Penicillium subgenus Penicillium. All six strains were found to hold two copies of IMPDH. A cladistic analysis based on the corresponding cDNA sequences revealed a novel group constituting mpaF homologs. Interestingly, a conserved tyrosine residue in the original class of IMPDHs is replaced by a phenylalanine residue in the new IMPDH class. Conclusions We identified a novel variant of the IMPDH-encoding gene in six different strains from Penicillium subgenus Penicillium. The novel IMPDH variant from MPA producer P. brevicompactum was shown to confer a high degree of MPA resistance when expressed in a non-producer fungus. Our study provides a basis for understanding the molecular mechanism of MPA resistance and has relevance for biotechnological and pharmaceutical applications.

On the lack of correlation between Mg II 2796, 2803 Å and Lyα emission in lensed star-forming galaxies

Energy Technology Data Exchange (ETDEWEB)

Rigby, J. R. [Astrophysics Science Division, Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, MD 20771 (United States); Bayliss, M. B. [Department of Physics, Harvard University, 17 Oxford Street, Cambridge, MA 02138 (United States); Gladders, M. D. [Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Avenue, Chicago, IL 60637 (United States); Sharon, K. [Department of Astronomy, University of Michigan, 500 Church Street, Ann Arbor, MI 48109 (United States); Wuyts, E. [Max Plank Institute for Extraterrestrial Physics, Giessenbachstrasse 1, D-85748 Garching (Germany); Dahle, H. [Institute of Theoretical Astrophysics, University of Oslo, P.O. Box 1029, Blindern, NO-0315 Oslo (Norway)

2014-07-20

We examine the Mg II 2796, 2803 Å, Lyα, and nebular line emission in five bright star-forming galaxies at 1.66 < z < 1.91 that have been gravitationally lensed by foreground galaxy clusters. All five galaxies show prominent Mg II emission and absorption in a P Cygni profile. We find no correlation between the equivalent widths of Mg II and Lyα emission. The Mg II emission has a broader range of velocities than do the nebular emission line profiles; the Mg II emission is redshifted with respect to systemic by 100-200 km s{sup –1}. When present, Lyα is even more redshifted. The reddest components of Mg II and Lyα emission have tails to 500-600 km s{sup –1}, implying a strong outflow. The lack of correlation in the Mg II and Lyα equivalent widths, the differing velocity profiles, and the high ratios of Mg II to nebular line fluxes together suggest that the bulk of Mg II emission does not ultimately arise as nebular line emission, but may instead be reprocessed stellar continuum emission.

17 CFR 201.500 - Expedited consideration of proceedings.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Expedited consideration of proceedings. 201.500 Section 201.500 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... Expedited consideration of proceedings. Consistent with the Commission's or the hearing officer's other...

XPS Study of Chemical Changes on the La/Ce Treated Surface of A361 Aluminium Alloy Exposed to Air at Temperatures up to 500∘C

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A. Pardo

2009-01-01

Full Text Available The chemical changes that take place on the rare earth treated surface of the A361 aluminium alloy exposed to air at temperatures between 100 and 500∘C have been examined using X-ray photoelectron spectroscopy (XPS. The most notable features discussed in this work are the disappearance of Mg and Si signals at the tested temperatures and disappearance of the Ce signal at temperatures of 400–500∘C. The biphasic microstructure of the A361 alloy, constituted by close to 12 wt% Si and the Al matrix, plays an important role in many of the results obtained. The notable growth of aluminium oxide across the conversion coating in the case of the Ce-treated surface is related to the structural transformation experienced by the cerium oxide coating at 400–500∘C.

12 CFR 500.10 - The OTS or The Office.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false The OTS or The Office. 500.10 Section 500.10 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY AGENCY ORGANIZATION AND FUNCTIONS General Organization § 500.10 The OTS or The Office. The Office of Thrift Supervision (referred to as “OTS” or “Office”) is an office of the...

Study on microstructure and properties of extruded Mg-2Nd-0.2Zn alloy as potential biodegradable implant material.

Science.gov (United States)

Li, Junlei; Tan, Lili; Wan, Peng; Yu, Xiaoming; Yang, Ke

2015-04-01

Mg-2Nd-0.2Zn (NZ20) alloy was prepared for the application as biodegradable implant material in this study. The effects of the extrusion process on microstructure, mechanical and corrosion properties of the alloy were investigated. The as-cast alloy was composed of α-Mg matrix and Mg12Nd eutectic compound. The solution treatment could lead to the Mg12Nd phase dissolution and the grain coarsening. The alloy (E1) preheated at 380°C for 1h and extruded at 390°C presents fine grains with amounts of tiny Mg12Nd particles uniformly dispersed throughout the boundaries and the interior of the grains. The alloy (E2) preheated at 480°C for 1h and extruded at 500°C exhibits relatively larger grains with few nano-scale Mg12Nd phase particles dispersed. The alloy of E1, compared with E2, showed relatively lower corrosion rate, higher yield strength and slightly lower elongation. Copyright © 2015 Elsevier B.V. All rights reserved.

Role of dopants in LiF:Mg,Cu, LiF:Mg,P and LiF:Mg,Cu,P detectors

International Nuclear Information System (INIS)

Mohammadi, Kh.; Moussavi Zarandi, A.; Afarideh, H.; Shahmaleki, S.

2013-01-01

In this study, electronic structure of LiF crystal doped with Mg,Cu,P impurities was studied with WIEN2k code on the basis of FPLAPW+lo method. Results show that in Mg-doped LiF composition, an electronic trap was created with impurity concentration of 1.56% and 3.125%. In this condition, the electronic trap with increasing the percentage of the impurities up to 4.687% is annihilated. It was found, that by doping of Mg and Cu or P simultaneously, a hole-trap is created in valence band. It was realized that in LiF:Mg,Cu, LiF:Mg,P and LiF:Mg,Cu,P, Cu impurity and Li atom, have a key role in creation of levels which lead to create electronic and hole traps. Mg impurity and F atom, only have a role in creation of electronic traps. In addition, P impurity has a main role in creation of the electronic and hole traps in LiF:Mg,Cu,P. The activation energy of electronic and hole trap in LiF:Mg,Cu, LiF:Mg,P and LiF:Mg,Cu,P crystalline lattice were obtained as 0.3 and 5.5 eV, 0.92 and 3.4 eV and 0.75 and 3.1 eV, respectively. - Graphical abstract: Figure (a) and (b) shows changes in electronic structure and band gap energy of LiF crystal due to presence of Mg and Cu, Mg and P ions respectively. - Highlights: • Electronic structure of LiF, LiF:Mg,Cu, LiF:Mg,P and LiF:Mg,Cu,P materials were studied with WIEN2K code. • In LiF:Mg,Cu and LiF:Mg,Cu,P, Li atom and Cu impurity have a key role in creation of levels. • F atom and Mg impurity only have a role in creation of electronic traps. • In LiF:Mg,Cu,P, P impurity has a main role in creation of electronic and hole traps

L10 ordered structures in Al-Cu-(Mg alloys at the early stages of elevated temperature aging

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Fuzhong, Xia

2016-09-01

Full Text Available This study concerns the precipitation structures of Al-3Cu and Al-3Cu-1.78Mg (wt. % alloys at the early stages of elevated temperature aging. The Al-3Cu and Al-3Cu-1.78 Mg alloys were solution treated at 540 °C and 500 °C for 2 h, respectively, and then aged at 190 °C for 2 min. The precipitation structures in aged Al-3Cu-(1.78Mg alloys were characterized by Transmission Electron Microscopy (TEM and High Resolution Transmission Electron Microscopy (HTREM. 001 zone axis Selected area electron diffraction patterns indicate that L10 ordered structures are formed in the two aged alloys. HRTEM experiments reveal the partial dislocations on the interfaces of L10 ordered structures. From comparing experimental results with that in the literature, it is concluded that the L10 ordered structures in aged Al-3Cu alloy consist of Al and Cu atoms, and they are comprised by Al, Cu and Mg atoms together in the aged Al-3Cu-1.78Mg alloy. On the basis of precipitate growing thermodynamics, it is thought the L10 ordered structures act as nuclei for GP zones in Al-Cu-(Mg alloys during aging.En este trabajo se estudian las estructuras de precipitación en Al-3Cu y Al-3Cu-1,78Mg (% en peso en los estados iniciales de envejecimiento a temperatura elevada. Las aleaciones Al-3Cu y Al-3Cu-1.78 Mg fueron sometidas a un tratamiento térmico de solución de 2 h a 540 °C y 500 °C, respectivamente, y posteriormente envejecidas 2 min a 190 °C. Las estructuras de precipitación en Al-3Cu-(1.78Mg envejecido fueron caracterizadas por microscopía electrónica de transmisión (TEM y por microscopía electrónica de transmisión de alta resolución (HTREM. Los diagramas de difracción de electrones de área seleccionada indican que se forman estructuras ordenadas L10 en las dos aleaciones envejecidas. Experimentos de HRTEM revelan la presencia de dislocaciones parciales en las intercaras de las estructuras L10 ordenadas. Comparando estos resultados experimentales con la

TOP500 Supercomputers for November 2003

Energy Technology Data Exchange (ETDEWEB)

Strohmaier, Erich; Meuer, Hans W.; Dongarra, Jack; Simon, Horst D.

2003-11-16

22nd Edition of TOP500 List of World s Fastest Supercomputers Released MANNHEIM, Germany; KNOXVILLE, Tenn.; BERKELEY, Calif. In what has become a much-anticipated event in the world of high-performance computing, the 22nd edition of the TOP500 list of the worlds fastest supercomputers was released today (November 16, 2003). The Earth Simulator supercomputer retains the number one position with its Linpack benchmark performance of 35.86 Tflop/s (''teraflops'' or trillions of calculations per second). It was built by NEC and installed last year at the Earth Simulator Center in Yokohama, Japan.

500 Cities: Census Tract Boundaries

Data.gov (United States)

U.S. Department of Health & Human Services — This census tract shapefile for the 500 Cities project was extracted from the Census 2010 Tiger/Line database and modified to remove portions of census tracts that...

Preparation and Hydrogen Storage Properties of Mg-Rich Mg-Ni Ultrafine Particles

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Jianxin Zou

2012-01-01

Full Text Available In the present work, Mg-rich Mg-Ni ultrafine powders were prepared through an arc plasma method. The phase components, microstructure, and hydrogen storage properties of the powders were carefully investigated. It is found that Mg2Ni and MgNi2 could be obtained directly from the vapor state reactions between Mg and Ni, depending on the local vapor content in the reaction chamber. A nanostructured MgH2 + Mg2NiH4 hydrogen storage composite could be generated after hydrogenation of the Mg-Ni ultrafine powders. After dehydrogenation, MgH2 and Mg2NiH4 decomposed into nanograined Mg and Mg2Ni, respectively. Thermogravimetry/differential scanning calorimetry (TG/DSC analyses showed that Mg2NiH4 phase may play a catalytic role in the dehydriding process of the hydrogenated Mg ultrafine particles.

29 CFR 36.500 - Employment.

Science.gov (United States)

2010-07-01

...) Application. The provisions of §§ 36.500 through 36.550 apply to: (1) Recruitment, advertising, and the..., leave for persons of either sex to care for children or dependents, or any other leave; (7) Fringe...

Mycophenolate

Science.gov (United States)

... your muscles; confusion or difficulty thinking clearly; unsteadiness; memory loss; difficulty speaking or understanding what others say; ... is important to keep all medication out of sight and reach of children as many containers (such ...

Self-healing of drying shrinkage cracks in cement-based materials incorporating reactive MgO

Science.gov (United States)

Qureshi, T. S.; Al-Tabbaa, A.

2016-08-01

Excessive drying shrinkage is one of the major issues of concern for longevity and reduced strength performance of concrete structures. It can cause the formation of cracks in the concrete. This research aims to improve the autogenous self-healing capacity of traditional Portland cement (PC) systems, adding expansive minerals such as reactive magnesium oxide (MgO) in terms of drying shrinkage crack healing. Two different reactive grades (high ‘N50’and moderately high ‘92-200’) of MgO were added with PC. Cracks were induced in the samples with restraining end prisms through natural drying shrinkage over 28 days after casting. Samples were then cured under water for 28 and 56 days, and self-healing capacity was investigated in terms of mechanical strength recovery, crack sealing efficiency and improvement in durability. Finally, microstructures of the healing materials were investigated using FT-IR, XRD, and SEM-EDX. Overall N50 mixes show higher expansion and drying shrinkage compared to 92-200 mixes. Autogenous self-healing performance of the MgO containing samples were much higher compared to control (only PC) mixes. Cracks up to 500 μm were sealed in most MgO containing samples after 28 days. In the microstructural investigations, highly expansive Mg-rich hydro-carbonate bridges were found along with traditional calcium-based, self-healing compounds (calcite, portlandite, calcium silicate hydrates and ettringite).

31 CFR 500.535 - Exchange of certain securities.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Exchange of certain securities. 500.535 Section 500.535 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... securities from blocked accounts: (1) Exchange of certificates necessitated by reason of changes in corporate...

Four-fold magnetic anisotropy in a Co film on MgO(0 0 1)

International Nuclear Information System (INIS)

Pires, M.J.M.; Cotta, A.A.C.; Martins, M.D.; Silva, A.M.A.; Macedo, W.A.A.

2011-01-01

The development of devices based on magnetic tunnel junctions has raised new interests on the structural and magnetic properties of the interface Co/MgO. In this context, we have grown ultrathin Co films (≤30 A) by molecular-beam epitaxy on MgO(0 0 1) substrates kept at different temperatures (T S ). Their structural and magnetic properties were correlated and discussed in the context of distinct magnetic anisotropies for Co phases reported in the literature. The sample characterization has been done by reflection high energy electron diffraction, magneto-optical Kerr effect and ferromagnetic resonance. The main focus of the work is on a sample deposited at T S =25 o C, as its particular way of growth has enabled a bct Co structure to settle on the substrate, where it is not normally obtained without specific seed layers. This sample presented the best crystallinity, softer magnetic properties and a four-fold in-plane magnetic anisotropy with Co easy directions. Concerning the samples prepared at T S =200 and 500 o C, they show fcc and polycrystalline structures, respectively and more intricate magnetic anisotropy patterns. - Research Highlights: →Results suggest the lattice is already after the Bain transformation for T S =25 o C, and the Co film has a bct structure instead of an fct one. →For deposition temperature of T S =25 o C, a four-fold in-plane magnetic anisotropy with Co easy directions has been obtained. →The growth mode of Co on MgO single crystals at different temperatures resulted in bct Co at T S =25 o C, fcc Co at T S =200 o C and polycrystalline Co at T S =500 o C.

Adverse Event Burden, Resource Use, and Costs Associated with Immunosuppressant Medications for the Treatment of Systemic Lupus Erythematosus: A Systematic Literature Review

Directory of Open Access Journals (Sweden)

A. Oglesby

2013-01-01

Full Text Available This paper assessed the burden of adverse events (AEs associated with azathioprine (AZA, cyclophosphamide (CYC, mycophenolate mofetil (MMF, methotrexate (MTX, and cyclosporine (CsA in patients with systemic lupus erythematosus (SLE. Thirty-eight publications were included. Incidence of AEs ranged from 42.8% to 97.3%. Common AEs included infections (2.4–77%, gastrointestinal AEs (3.2–66.7%, and amenorrhea and/or ovarian complications (0–71%. More hematological cytopenias were associated with AZA (14 episodes than MMF (2 episodes. CYC was associated with more infections than MMF (40–77% versus 12.5–32%, resp. or AZA (17–77% versus 11–29%, resp.. Rates of hospitalized infections were similar between MMF and AZA patients, but higher for those taking CYC. There were more gynecological toxicities with CYC than MMF (32–36% versus 3.6–6%, resp. or AZA (32–71% versus 8–18%, resp.. Discontinuation rates due to AEs were 0–44.4% across these medications. In summary, the incidence of AEs associated with SLE immunosuppressants was consistently high as reported in the literature; discontinuations due to these AEs were similar across treatments. Studies on the economic impact of these AEs were sparse and warrant further study. This paper highlights the need for more treatment options with better safety profiles.

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

Science.gov (United States)

Oray, Merih; Tuğal-Tutkun, İlknur

2016-04-01

Pediatric uveitis may be a serious health problem because of the lifetime burden of vision loss due to severe complications if the problem is not adequately treated. Juvenile idiopathic arthritis (JIA)-associated uveitis is characterized by insidious onset and potentially blinding chronic anterior uveitis. Periodic ophthalmologic screening is of utmost importance for early diagnosis of uveitis. Early diagnosis and proper immunomodulatory treatment are essential for good visual prognosis. The goal of treatment is to achieve enduring drug-free remission. The choice of therapeutic regimen needs to be tailored to each individual case. One must keep in mind that patients under immunomodulatory treatment should be monitored closely due to possible side effects. Local and systemic corticosteroids have long been the mainstay of therapy; however, long-term corticosteroid therapy should be avoided due to serious side effects. Steroid-sparing agents in the treatment of JIA-associated uveitis include antimetabolites and biologic agents in refractory cases. Among the various immunomodulatory agents, methotrexate is generally the first choice, as it has a well-established safety and efficacy profile in pediatric cases and does not appear to increase the risk of cancer. Other classic immunomodulators that may also be used in combination with methotrexate include azathioprine, mycophenolate mofetil, and cyclosporin A. Biologic agents, primarily tumor necrosis factor alpha inhibitors including infliximab or adalimumab, should be considered in cases of treatment failure with classic immunomodulatory agents.

Treatment of Intraepidermal Autoimmune Bullous Diseases Sürekli Eğitim

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Tamer İrfan Kaya

2011-06-01

Full Text Available Pemfigus is an autoimmune bullous skin disease, characterized by intraepidermal blisters. It is a severe and potentially life-threatening chronic disease with blisters and erosions on the mucosae and the skin. Treatment options do not differ for two most common types of pemphigus, pemphigus vulgaris and pemphigus foliaceus, except that the latter is usually less resistant to treatment and corticosteroids can often be started at lower doses. Systemic corticosteroids are still the most widely used drugs in the treatment of pemphigus and continue to be the mainstay of therapy for this disease. Adjuvant drugs are commonly used in combination with the aims of increasing efficacy and of having a steroid-sparing action, thereby allowing reduced corticosteroid side-effects. Mortality and complete remission rates have improved since the introduction of adjuvant drugs to pemphigus. Adjuvant drugs include immunoadsorbtion, corticosteroid pulse therapy, intravenous immunoglobulin (IVIG, immunosuppressive agents such as azathioprine, cyclophosphamide, mycophenolate mofetil and and anti-CD20 monoclonal antibody (rituximab. The lack of consensus in the published literature about the treatment of this disorder is responsible for different treatment strategies. Treatments need to be chosen after careful consideration of the potential benefits and side effects according to the patients’ medical condition. Here, both conventional therapies and novel treatment regimens for pemphigus are discussed. (Turkderm 2011; 45 Suppl 1: 44-53

Higher tacrolimus trough levels on days 2-5 post-renal transplant are associated with reduced rates of acute rejection.

LENUS (Irish Health Repository)

O'Seaghdha, C M

2011-04-06

We analyzed the association between whole-blood trough tacrolimus (TAC) levels in the first days post-kidney transplant and acute cellular rejection (ACR) rates. Four hundred and sixty-four consecutive, deceased-donor kidney transplant recipients were included. All were treated with a combination of TAC, mycophenolate mofetil and prednisolone. Patients were analyzed in four groups based on quartiles of the mean TAC on days 2 and 5 post-transplant: Group 1: median TAC 11 ng\\/mL (n = 122, range 2-13.5 ng\\/mL), Group 2: median 17 ng\\/mL (n = 123, range 14-20 ng\\/mL), Group 3: median 24 ng\\/mL (n = 108, range 20.5-27 ng\\/mL) and Group 4: median 33.5 ng\\/mL (n = 116, range 27.5-77.5 ng\\/mL). A graded reduction in the rates of ACR was observed for each incremental days 2-5 TAC. The one-yr ACR rate was 24.03% (95% CI 17.26-32.88), 22.20% (95% CI 15.78-30.70), 13.41% (95% CI 8.15-21.63) and 8.69% (95% CI 4.77-15.55) for Groups 1-4, respectively (p = 0.003). This study suggests that higher early TACs are associated with reduced rates of ACR at one yr.

Research priorities in pediatric rheumatology: The Childhood Arthritis and Rheumatology Research Alliance (CARRA consensus

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Mellins Elizabeth D

2008-04-01

Full Text Available Abstract Background North American pediatric rheumatologists have created an investigator-initiated research network (the Childhood Arthritis and Rheumatology Research Alliance – CARRA to facilitate multi-centre studies. One of the first projects undertaken by this network was to define, by consensus, research priorities for the group, and if possible a first group-sponsored clinical trial in which all members could participate. Methods We determined consensus using the Delphi approach. This approach has been used extensively in health research to reach consensus in large groups. It uses several successive iterations of surveys eliciting ideas and opinions from specialists in the field. Three surveys were designed based on this method and were distributed to members of CARRA to elicit and rank-order research priorities. Results A response rate of 87.6% was achieved in the final survey. The most highly ranked research suggestion was to study infliximab treatment of uveitis unresponsive to methotrexate. Other highly ranked suggestions were to study i the treatment of systemic arthritis with anakinra and ii the treatment of pediatric systemic lupus erythematosus with mycophenolate mofetil. Conclusion The Delphi approach was an effective and practical method to define research priorities in this group. Ongoing discussion and cooperation among pediatric rheumatologists in CARRA and others world-wide will help in developing further research priorities and to facilitate the execution of clinical trials in the future.

TREATMENT APPROACH FOR JUVENILE IDIOPATHIC ARTHRITIS-RELATED UVEITIS: 2012 UPDATE

Directory of Open Access Journals (Sweden)

Francesco Zulian

2012-01-01

Full Text Available Chronic anterior uveitis is the most common extra-articular complication of juvenile idiopathic arthritis. It is more frequent in the early onset forms with a higher prevalence in the oligoarticular (40% than in other juvenile idiopathic arthritis subtypes (5–14%. The risk for severe visual impairment is still high due to the development of sight-threatening complications (synechiae, band keratopathy, cataract, glaucoma, cystoid macular oedema. Treatment is not standardized and requires a complex decision-making process, involving a close collaboration between paediatric ophthalmologist and rheumatologist. Topical therapy alone is often inadequate to control ocular inflammation and bulbar injections are too invasive to perform in children therefore immunosuppressive treatment is often advocated. Low dose methotrexate is the second-line agent mostly used although no controlled studies comparing effects of early to late methotrexate treatment have been reported. Mycophenolate mofetil is effective in controlling inflammation in methotrexate -refractory patients. Its efficacy, however, seems to be more relevant in intermediate or posterior uveitis, than in juvenile idiopathic arthritis uveitis and scleritis. Anti-TNFα agents, namely infliximab and adalimimab showed effectiveness in open-label studies but no wide controlled trials have been reported so far. Adalimimab is as effective as infliximab but has an easier way of administration and a better drug tolerance. Abatacept should be used in anti-TNF refractory patients with juvenile idiopathic arthritis uveitis.

Pregnancy in renal transplant recipients.

Science.gov (United States)

Bouattar, T; Hakim, H; Rhou, H; Benamar, L; Bayahia, R; Ouzeddoun, N

2009-06-01

Renal transplantation with a well-functioning graft leads to a rapid restoration of endocrine and sexual functions. The aim of this study was to examine our experience with pregnancies among renal transplant patients, particularly with regard to their impact on graft function. We analyzed 10 pregnancies in 7 renal transplant recipients for long-term graft outcomes in terms of clinical and biological data. The mean patient age was 28.5 +/- 4 years. They all received a living donor kidney. The time between transplantation and the onset of pregnancy was 33.4 +/- 23.2 months. Regarding the immunosuppressive therapy, all patients received steroids and cyclosporine; 4 patients received in addition azathioprine and 2 received mycophenolate mofetil that was changed at 1 month before conception to azathioprine. There was no significant difference between the serum creatinine before and during pregnancy. We did not observe any acute rejection episode. Pregnancy complications were preclampsia in 1 case, hypertension in 1 case, urinary tract infection in 2 cases, and anemia in 80% of patients during the third trimester. Premature rupture of membranes occurred in 1 case and preterm delivery in 2 cases. Two cases of neonatal death were registered. Cesarean section was performed in 50% of cases. The follow-up revealed 2 cases of chronic rejection. A multidisciplinary approach is necessary for pregnancy which generally occurs at 2 years after kidney transplantation.

Incidence and Pattern of Graft-versus-Host Disease in Patients Undergoing Allogeneic Transplantation after Nonmyeloablative Conditioning with Total Lymphoid Irradiation and Antithymocyte Globulin

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Lauren Veltri

2013-01-01

Full Text Available Nonmyeloablative (NMA conditioning with total lymphoid irradiation and antithymocyte globulin (TLI/ATG has been shown to protect against acute graft-versus-host disease (GVHD. We report here our institutional experience with allogeneic transplantation following NMA conditioning with TLI/ATG (. GVHD prophylaxis consisted of a combination of a calcineurin inhibitor and mycophenolate mofetil. Median patient age was 59 years. The median followup of surviving patients is 545 days. One patient experienced primary graft rejection. The median time to neutrophil engraftment was 18 days and platelet engraftment was 9.5 days. The cumulative incidence (CI of grade II–IV acute GVHD at day +100 was 28.6% and 38.1% at day +180. The CI for grade III-IV acute GVHD was 28.6% at day +180. CI of chronic GVHD was 45.2% at 1 year. The CI of disease relapse was 9.5% at 1 year. The rate of nonrelapse mortality (NRM was 0% at day +100 and only 9.5% at 1 year. The overall and progression free survival at 1 year was 81% and 80.4%, respectively. Our limited, retrospective data show encouraging relapse and NRM rates with TLI/ATG-based NMA conditioning, but with higher than previously reported rates of acute and chronic GVHD, underscoring the need for novel strategies designed to effectively prevent GVHD.

Renal Infarction during Anticoagulant Therapy after Living Donor Liver Transplantation

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Shinji Onda

2018-04-01

Full Text Available Introduction: Liver transplant recipients are at risk for complications of vascular thrombosis. The reconstructed hepatic artery and portal vein thrombosis potentially result in hepatic failure and graft loss. Renal infarction is a rare clinical condition, but in severe cases, it may lead to renal failure. We herein report a case of renal infarction after living donor liver transplantation (LDLT during anticoagulant therapy. Case Presentation: A 60-year-old woman with end-stage liver disease due to primary biliary cholangitis underwent LDLT with splenectomy. Postoperatively, tacrolimus, mycophenolate mofetil, and steroid were used for initial immunosuppression therapy. On postoperative day (POD 5, enhanced computed tomography (CT revealed splenic vein thrombosis, and anticoagulant therapy with heparin followed by warfarin was given. Follow-up enhanced CT on POD 20 incidentally demonstrated right renal infarction. The patient’s renal function was unchanged and the arterial flow was good, and the splenic vein thrombosis resolved. At 4 months postoperatively, warfarin was discontinued, but she developed recurrent splenic vein thrombosis 11 months later, and warfarin was resumed. As of 40 months after transplantation, she discontinued warfarin and remains well without recurrence of splenic vein thrombosis or renal infarction. Conclusion: Renal infarction is a rare complication of LDLT. In this case, renal infarction was incidentally diagnosed during anticoagulant therapy and was successfully treated.

Anaemia and fever in Kidney transplant. The role of human parvovirus B19.

Science.gov (United States)

Parodis López, Yanet; Santana Estupiñán, Raquel; Marrero Robayna, Silvia; Gallego Samper, Roberto; Henríquez Palop, Fernando; Rivero Vera, José Carlos; Camacho Galán, Rafael; Pena López, María José; Sablón González, Nery; González Cabrera, Fayna; Oliva Dámaso, Elena; Vega Díaz, Nicanor; Rodríguez Pérez, José Carlos

Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections. Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognized by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow. We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Clinical features of neuromuscular disorders in patients with N-type voltage-gated calcium channel antibodies

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Andreas Totzeck

2016-09-01

Full Text Available Neuromuscular junction disorders affect the pre- or postsynaptic nerve to muscle transmission due to autoimmune antibodies. Members of the group like myasthenia gravis and Lambert-Eaton syndrome have pathophysiologically distinct characteristics. However, in practice, distinction may be difficult. We present a series of three patients with a myasthenic syndrome, dropped-head syndrome, bulbar and respiratory muscle weakness and positive testing for anti-N-type voltage-gated calcium channel antibodies. In two cases anti-acetylcholin receptor antibodies were elevated, anti-P/Q-type voltage-gated calcium channel antibodies were negative. All patients initially responded to pyridostigmine with a non-response in the course of the disease. While one patient recovered well after treatment with intravenous immunoglobulins, 3,4-diaminopyridine, steroids and later on immunosuppression with mycophenolate mofetil, a second died after restriction of treatment due to unfavorable cancer diagnosis, the third patient declined treatment. Although new antibodies causing neuromuscular disorders were discovered, clinical distinction has not yet been made. Our patients showed features of pre- and postsynaptic myasthenic syndrome as well as severe dropped-head syndrome and bulbar and axial muscle weakness, but only anti-N-type voltage-gated calcium channel antibodies were positive. When administered, one patient benefited from 3,4-diaminopyridine. We suggest that this overlap-syndrome should be considered especially in patients with assumed seronegative myasthenia gravis and lack of improvement under standard therapy.

Microstructure, biocorrosion and cytotoxicity evaluations of rapid solidified Mg-3Ca alloy ribbons as a biodegradable material

Energy Technology Data Exchange (ETDEWEB)

Gu, X N; Zhou, W R; Zheng, Y F [State Key Laboratory for Turbulence and Complex System and Department of Advanced Materials and Nanotechnology, College of Engineering, Peking University, Beijing 100871 (China); Li, X L [Center for Biomedical Materials and Engineering, Harbin Engineering University, Harbin 150001 (China); Cheng, Y, E-mail: yfzheng@pku.edu.c [Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871 (China)

2010-06-01

Rapidly solidified (RS) Mg-3Ca alloy ribbons were prepared by the melt-spinning technique at different wheel rotating speeds (15 m s{sup -1}, 30 m s{sup -1} and 45 m s{sup -1}) with the as-cast Mg-3Ca alloy ingot as a raw material. The RS45 Mg-3Ca alloy ribbon showed a much more fine grain size feature (approximately 200-500 nm) in comparison to the coarse grain size (50-100 {mu}m) of the original as-cast Mg-3Ca alloy ingot. The corrosion electrochemical tests in simulated body fluid indicated that the corrosion rate of the as-cast Mg-3Ca alloy was strongly reduced by the RS procedure and tended to be further decreased with increasing wheel rotating speeds (1.43 mm yr{sup -1} for RS15, 0.94 mm yr{sup -1} for RS30 and 0.36 mm yr{sup -1} for RS45). The RS Mg-3Ca alloy ribbons showed more uniform corrosion morphology compared with the as-cast Mg-3Ca alloy after polarization. The cytotoxicity evaluation revealed that the three experimental as-spun Mg-3Ca alloy ribbon extracts did not induce toxicity to the L-929 cells, whereas the as-cast Mg-3Ca alloy ingot extract did. The L-929 cells showed more improved adhesion on the surfaces of the three as-spun Mg-3Ca alloy ribbons than that of the as-cast Mg-3Ca alloy ingot.

12 CFR 500.30 - General statement concerning procedures and forms.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false General statement concerning procedures and forms. 500.30 Section 500.30 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY AGENCY ORGANIZATION AND FUNCTIONS Procedures § 500.30 General statement concerning procedures and forms...

Re-examining the 26Mg(α ,α')26Mg reaction: Probing astrophysically important states in 26Mg

Science.gov (United States)

Adsley, P.; Brümmer, J. W.; Li, K. C. W.; Marín-Lámbarri, D. J.; Kheswa, N. Y.; Donaldson, L. M.; Neveling, R.; Papka, P.; Pellegri, L.; Pesudo, V.; Pool, L. C.; Smit, F. D.; van Zyl, J. J.

2017-11-01

Background: The 22Ne(α ,n )25Mg reaction is one of the neutron sources for the s process in massive stars. The properties of levels in 26Mg above the α -particle threshold control the strengths of the 22Ne(α ,n )25Mg and 22Ne(α ,γ )26Mg reactions. The strengths of these reactions as functions of temperature are one of the major uncertainties in the s process. Purpose: Information on the existence, spin, and parity of levels in 26Mg can assist in constraining the strengths of the 22Ne(α ,γ )26Mg and 22Ne(α ,n )25Mg reactions, and therefore in constraining s -process abundances. Methods: Inelastically scattered α particles from a 26Mg target were momentum-analyzed in the K600 magnetic spectrometer at iThemba LABS, South Africa. The differential cross sections of states were deduced from the focal-plane trajectory of the scattered α particles. Based on the differential cross sections, spin and parity assignments to states are made. Results: A newly assigned 0+ state was observed in addition to a number of other states, some of which can be associated with states observed in other experiments. Some of the deduced Jπ values of the states observed in the present study show discrepancies with those assigned in a similar experiment performed at RCNP Osaka. The reassignments and additions of the various states can strongly affect the reaction rate at low temperatures. Conclusion: The number, location, and assignment of levels in 26Mg that may contribute to the 22Ne+α reactions are not clear. Future experimental investigations of 26Mg must have an extremely good energy resolution to separate the contributions from different levels. Coincidence experiments of 26Mg provide a possible route for future investigations.

The role of Mg in the crystallization of monohydrocalcite

Science.gov (United States)

Rodriguez-Blanco, Juan Diego; Shaw, Samuel; Bots, Pieter; Roncal-Herrero, Teresa; Benning, Liane G.

2014-02-01

Monohydrocalcite is a member of the carbonate family which forms in Mg-rich environments at a wide range of Mg/Ca ratios Mg2+aq/Ca2+aq≥0.17stock solutions. However, its crystallite and particle size are inversely proportional to these parameters. At high supersaturations (SIMHC = 3.89) nanometer-sized single crystals of monohydrocalcite form, while at low values (SIMHC = 2.43) the process leads to low-angle branching spherulites. Many carbonates produced during biomineralization form at similar conditions to most synthetic monohydrocalcites, and thus we hypothesize that some calcite or aragonite deposits found in the geologic record that have formed at high Mg/Ca ratios could be secondary in origin and may have originally formed via a metastable monohydrocalcite intermediate. High-Mg monohydrocalcite (χMgCO3 > 0.06) consists of individual nanometer-sized crystals (500 °C (Fig. 9b). Such high-Mg monohydrocalcites are uncommon in nature, but can be synthesized in the laboratory at high initial supersaturation levels (SI > 3.25). Low-Mg monohydrocalcite (χMgCO3 bonded to Mg, so it fully dehydrates at low temperatures (150-200 °C). They have the same composition as natural monohydrocalcites reported in the literature, and can be synthesized in the laboratory at lower supersaturation levels (SI relationships. Firstly, our on-line experiment shows an increase in nanocrystal sizes during the secondary crystallization of monohydrocalcite, which is coupled with a significant decrease in χMgCO3 (from ˜0.26 to ˜0.065). This corresponds to the transition from high- to low-Mg monohydrocalcite, suggesting that the former would be metastable and rapidly transforming to the latter, possibly triggered by the removal of Mg from aqueous solution. Secondly, Davis et al. (2000) determined that the solubility of Mg-calcite (Ca1-xMgxCO3; x = 0-0.20) varies by approximately half an order of magnitude depending on the Mg content of the solid (Ksp = 10-8.0-10-8.5). A similar

L10 ordered structures in Al-Cu-(Mg) alloys at the early stages of elevated temperature aging

Energy Technology Data Exchange (ETDEWEB)

Fuzhong, X.; Mingpu, W.

2016-07-01

This study concerns the precipitation structures of Al-3Cu and Al-3Cu-1.78Mg (wt. %) alloys at the early stages of elevated temperature aging. The Al-3Cu and Al-3Cu-1.78 Mg alloys were solution treated at 540 °C and 500 °C for 2 h, respectively, and then aged at 190 °C for 2 min. The precipitation structures in aged Al-3Cu-(1.78Mg) alloys were characterized by Transmission Electron Microscopy (TEM) and High Resolution Transmission Electron Microscopy (HTREM). 001 zone axis Selected area electron diffraction patterns indicate that L10 ordered structures are formed in the two aged alloys. HRTEM experiments reveal the partial dislocations on the interfaces of L10 ordered structures. From comparing experimental results with that in the literature, it is concluded that the L10 ordered structures in aged Al-3Cu alloy consist of Al and Cu atoms, and they are comprised by Al, Cu and Mg atoms together in the aged Al-3Cu-1.78Mg alloy. On the basis of precipitate growing thermodynamics, it is thought the L10 ordered structures act as nuclei for GP zones in Al-Cu-(Mg) alloys during aging. (Author)

Deuterium absorption in Mg70Al30 thin films with bilayer catalysts: A comparative neutron reflectometry study

International Nuclear Information System (INIS)

Poirier, Eric; Harrower, Chris T.; Kalisvaart, Peter; Bird, Adam; Teichert, Anke; Wallacher, Dirk; Grimm, Nico; Steitz, Roland; Mitlin, David; Fritzsche, Helmut

2011-01-01

Highlights: → Mg 70 Al 30 thin films studied for hydrogen absorption using in situ neutron reflectometry. → Films with Ta/Pd, Ti/Pd and Ni/Pd bilayer catalysts systematically compared. → Measurements reveals deuterium spillover from the catalysts to the MgAl phase. → The use of Ti-Pd bilayer offers best results in terms of amount absorbed and kinetics. → Key results cross-checked with X-ray reflectometry. - Abstract: We present a neutron reflectometry study of deuterium absorption in thin films of Al-containing Mg alloys capped with a Ta/Pd, Ni/Pd and Ti/Pd-catalyst bilayer. The measurements were performed at room temperature over the 0-1 bar pressure range under quasi-equilibrium conditions. The modeling of the measurements provided a nanoscale representation of the deuterium profile in the layers at different stages of the absorption process. The absorption mechanism observed was found to involve spillover of atomic deuterium from the catalyst layer to the Mg alloy phase, followed by the deuteration of the Mg alloy. Complete deuteration of the Mg alloy occurs in a pressure range between 100 and 500 mbar, dependent on the type of bilayer catalyst. The use of a Ti/Pd bilayer catalyst yielded the best results in terms of both storage density and kinetic properties.

L10 ordered structures in Al-Cu-(Mg) alloys at the early stages of elevated temperature aging

International Nuclear Information System (INIS)

Fuzhong, X.; Mingpu, W.

2016-01-01

This study concerns the precipitation structures of Al-3Cu and Al-3Cu-1.78Mg (wt. %) alloys at the early stages of elevated temperature aging. The Al-3Cu and Al-3Cu-1.78 Mg alloys were solution treated at 540 °C and 500 °C for 2 h, respectively, and then aged at 190 °C for 2 min. The precipitation structures in aged Al-3Cu-(1.78Mg) alloys were characterized by Transmission Electron Microscopy (TEM) and High Resolution Transmission Electron Microscopy (HTREM). 001 zone axis Selected area electron diffraction patterns indicate that L10 ordered structures are formed in the two aged alloys. HRTEM experiments reveal the partial dislocations on the interfaces of L10 ordered structures. From comparing experimental results with that in the literature, it is concluded that the L10 ordered structures in aged Al-3Cu alloy consist of Al and Cu atoms, and they are comprised by Al, Cu and Mg atoms together in the aged Al-3Cu-1.78Mg alloy. On the basis of precipitate growing thermodynamics, it is thought the L10 ordered structures act as nuclei for GP zones in Al-Cu-(Mg) alloys during aging. (Author)

29 CFR 500.269 - Stay pending decision of the Secretary.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Stay pending decision of the Secretary. 500.269 Section 500.269 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR... Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The...

41 CFR 101-27.500 - Scope and applicability of subpart.

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2010-07-01

... MANAGEMENT 27.5-Return of GSA Stock Items § 101-27.500 Scope and applicability of subpart. This subpart sets... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Scope and applicability of subpart. 101-27.500 Section 101-27.500 Public Contracts and Property Management Federal Property...

29 CFR 500.232 - Consent findings and order.

Science.gov (United States)

2010-07-01

... Administrative Law Judge; and (4) A waiver of any right to challenge or contest the validity of the findings and... 29 Labor 3 2010-07-01 2010-07-01 false Consent findings and order. 500.232 Section 500.232 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS MIGRANT AND...

BURNER RIG TESTING OF A500 C/SiC

Science.gov (United States)

2018-03-17

AFRL-RX-WP-TR-2018-0071 BURNER RIG TESTING OF A500® C /SiC Larry P. Zawada Universal Technology Corporation Jennifer Pierce UDRI...TITLE AND SUBTITLE BURNER RIG TESTING OF A500® C /SiC 5a. CONTRACT NUMBER In-House 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 62102F 6...test program characterized the durability behavior of A500® C /SiC ceramic matrix composite material at room and elevated temperature. Specimens were

23 CFR 500.106 - PMS.

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2010-04-01

... the “AASHTO Guidelines for Pavement Management Systems.” 1 1 AASHTO Guidelines for Pavement Management... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.106 PMS. An effective PMS for Federal-aid highways is a systematic...

23 CFR 500.101 - Purpose.

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2010-04-01

... HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.101 Purpose. The purpose of this part is to implement... highway pavement of Federal-aid highways (PMS), bridges on and off Federal-aid highways (BMS), highway...

In vitro cytotoxicity of fungi spoiling maize silage

DEFF Research Database (Denmark)

Rasmussen, Rie Romme; Rasmussen, Peter Have; Larsen, Thomas Ostenfeld

2011-01-01

Penicillium roqueforti, Penicillium paneum, Monascus ruber, Alternaria tenuissima, Fusarium graminearum, Fusarium avenaceum, Byssochlamys nivea and Aspergillus fumigatus have previously been identified as major fungal contaminants of Danish maize silage. In the present study their metabolite....... roqueforti metabolites roquefortine C (48μg/mL), andrastin A (>50μg/mL), mycophenolic acid (>100μg/mL) and 1-hydroxyeremophil-7(11),9(10)-dien-8-one (>280μg/mL) were high. Fractionating of agar extracts identified PR-toxin as an important cytotoxic P. roqueforti metabolite, also detectable in maize silage....... The strongly cytotoxic B. nivea and P. paneum agar extracts contained patulin above the IC50 of 0.6μg/mL, however inoculated onto maize silage B. nivea and P. paneum did not produce patulin (>371μg/kg). Still B. nivea infected maize silage containing mycophenolic acid (∼50mg/kg), byssochlamic acid and other...

Electronic Health Records Place 1st at Indy 500

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... Navigation Bar Home Current Issue Past Issues EHR Electronic Health Records Place 1st at Indy 500 Past ... last May's Indy 500 had thousands of personal Electronic Health Records on hand for those attending—and ...

Resistência de Haemonchus placei, Cooperia punctata e Oesophagostomum radiatum à ivermectina pour-on a 500mcgkg-1 em rebanhos bovinos no Brasil

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Welber Daniel Zanetti Lopes

2014-05-01

Full Text Available O amplo espectro de ação dos endectocidas e a praticidade de aplicação das suas formulações pour-on são fatores que têm estimulado uma maior frequência de utilização destes produtos na criação de bovinos. Neste estudo, avaliou-se a eficácia anti-helmíntica da ivermectina, administrada via pour-on, 500mcgkg-1, contra nematódeos de bovinos provenientes de diferentes rebanhos. Foram adquiridos 12 bezerros de cada um dos quatro rebanhos selecionados. Todos os 48 bezerros utilizados apresentavam médias de ovos por grama de fezes (OPG maiores que 500, considerando-se três contagens consecutivas. Na sequencia, os animais de cada rebanho foram divididos em dois grupos de seis bovinos cada, sendo um tratado com ivermectina 500mcgkg-1 via pour-on e outro mantido como controle. Quatorze dias depois do tratamento, os bovinos foram submetidos à eutanásia para contagem de endoparasitas. A ivermectina demonstrou resultados nulos de eficácia contra H. placei nos quatro rebanhos. Contra C. punctata, tal formulação teve eficácia nula nos rebanhos provenientes de Jaboticabal,SP, e de Formiga,MG, e eficácias de 75,8% e 58,4% nos rebanhos provenientes de São José do Rio Pardo,SP, e de São Sebastião do Paraíso,MG, respectivamente. Valores de eficácia de 94,2% (Jaboticabal, 0,0% (São José do Rio Pardo, 94,2% (Formiga e 39,2% (São Sebastião do Paraíso foram detectados contra O. radiatum. Com base nos resultados encontrados, pode-se concluir que as quatro populações de Haemonchus placei e de Cooperia punctata avaliadas foram resistentes à ivermectina, administrada via pour-on, 500mcgkg-1. Foram observadas cepas de Oesophagostomum radiatum resistentes à ivermectina em dois dos quatro rebanhos testados.

Optical absorption and thermoluminescence in Mg O, Mg O:Ni and Mg O:Li irradiated at room temperature; Absorcion optica y termoluminiscencia en MgO, MgO:Ni y MgO:Li irradiados a temperatura ambiente

Energy Technology Data Exchange (ETDEWEB)

Delgado, L

1984-07-01

Optical absorption and thermoluminescence (TL) studies in Mg O, Mg O:Ni and Mg O:Li irradiated at room temperature are presented. In pure Mg O the thermal annihilation of Fe3+ by recombination with thermally released electrons at {approx} 90 and 175 degree centigree and the V center annealing by hole release up to 100 degree centigree cause the observed glow peaks at these temperatures. The TL excitation spectrum shows two maxima at 245 nm (electron center) and 288 nm (Fe3+). In Mg O:Ni X irradiation induces Fe{sup 2}+ {yields}- Fe{sup 3}+ and Ni{sup 2}+ {yields} Ni{sup 3}+ oxidations. Two TL emission bands centered at 110 degree centigree (red) and 80 o{sup C} (green) are assigned to electron release and their recombination at Fe{sup 3}+ and Ni{sup 3}+ respectively. In Mg O:Li two TL emission bands, one blue (430 nm) and the other red (730 nm) with excitation maxima at 245 nm (electron center) and 200 nm (hole center) respectively are observed. No V-center formation was detected in both Ni and Li doped samples. (Author) 42 refs.

Differential proteome analysis of human embryonic kidney cell line (HEK-293 following mycophenolic acid treatment

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Rahman Hazir

2011-09-01

Full Text Available Abstract Background Mycophenolic acid (MPA is widely used as a post transplantation medicine to prevent acute organ rejection. In the present study we used proteomics approach to identify proteome alterations in human embryonic kidney cells (HEK-293 after treatment with therapeutic dose of MPA. Following 72 hours MPA treatment, total protein lysates were prepared, resolved by two dimensional gel electrophoresis and differentially expressed proteins were identified by QTOF-MS/MS analysis. Expressional regulations of selected proteins were further validated by real time PCR and Western blotting. Results The proliferation assay demonstrated that therapeutic MPA concentration causes a dose dependent inhibition of HEK-293 cell proliferation. A significant apoptosis was observed after MPA treatment, as revealed by caspase 3 activity. Proteome analysis showed a total of 12 protein spots exhibiting differential expression after incubation with MPA, of which 7 proteins (complement component 1 Q subcomponent-binding protein, electron transfer flavoprotein subunit beta, cytochrome b-c1 complex subunit, peroxiredoxin 1, thioredoxin domain-containing protein 12, myosin regulatory light chain 2, and profilin 1 showed significant increase in their expression. The expression of 5 proteins (protein SET, stathmin, 40S ribosomal protein S12, histone H2B type 1 A, and histone H2B type 1-C/E/F/G/I were down-regulated. MPA mainly altered the proteins associated with the cytoskeleton (26%, chromatin structure/dynamics (17% and energy production/conversion (17%. Both real time PCR and Western blotting confirmed the regulation of myosin regulatory light chain 2 and peroxiredoxin 1 by MPA treatment. Furthermore, HT-29 cells treated with MPA and total kidney cell lysate from MMF treated rats showed similar increased expression of myosin regulatory light chain 2. Conclusion The emerging use of MPA in diverse pathophysiological conditions demands in-depth studies to