-
1.
Effect of Different Modalities of Purgative Preparation on the Diagnostic Yield of Small Bowel Capsule for the Exploration of Suspected Small Bowel Bleeding: A Multicenter Randomized Controlled Trial.
Rahmi, G, Cholet, F, Gaudric, M, Filippi, J, Duburque, C, Bramli, S, Quentin, V, Alavi, Z, Nowak, E, Saurin, JC, et al
The American journal of gastroenterology. 2022;(2):327-335
Abstract
INTRODUCTION The aim of our study was to compare clear liquid diet with 2 different polyethylene glycol (PEG)-based bowel preparation methods regarding diagnostic yield of small bowel capsule endoscopy (SBCE) in patients with suspected small bowel bleeding (SBB). METHODS In this prospective multicenter randomized controlled trial, consecutive patients undergoing SBCE for suspected SBB between September 2010 and February 2016 were considered. Patients were randomly assigned to standard regimen, that is, clear fluids only (prep 1), standard regimen plus 500 mL PEG after SBCE ingestion (prep 2), or standard regimen plus 2 L PEG plus 500 mL PEG after SBCE ingestion (prep 3). The primary outcome was the detection of at least one clinically significant lesion in the small bowel. The quality of small bowel cleansing was assessed. A questionnaire on the clinical tolerance was filled by the patients. RESULTS We analyzed 834 patients. No significant difference was observed for detection of P1 or P2 small bowel lesions between prep1 group (40.5%), prep 2 group (40.2%), and prep 3 group (38.5%). Small bowel cleansing was improved in prep 2 and 3 groups compared with that in prep 1 group. Compliance to the preparation and tolerance was better in prep 2 group than in prep 3 group. DISCUSSION Small bowel purgative before SBCE allowed better quality of cleansing. However, it did not improve diagnostic yield of SBCE for suspected SBB.
-
2.
Pretreatment and Coadministration With Methotrexate Improved Durability of Pegloticase Response: An Observational, Proof-of-Concept Case Series.
Botson, JK, Peterson, J
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2022;(1):e129-e134
-
-
Free full text
-
Abstract
BACKGROUND/OBJECTIVE Pegloticase is used for treatment of refractory gout, which has failed maximal medical management, but only 42% of patients respond completely to treatment because of the presumed development of antidrug antibodies, which rapidly clear the pegloticase molecule. Immunomodulatory medications temper antidrug antibody development in other diseases. The aim of this case series was to investigate the utility of adding methotrexate to a pegloticase regimen to increase the response durability in a real-world practice setting. METHODS In this multicenter, proof-of-concept, observational case series, refractory tophaceous gouty arthropathy patients being started on pegloticase 8 mg every 2 weeks were identified. The patients began oral methotrexate 15 mg/wk and folic acid 1 mg/d, 1 month prior to the initial pegloticase administration, and continued throughout pegloticase treatment. Responders were defined by demonstrating ≥80% of preinfusion serum uric acid (sUA) levels <6.0 mg/dL between months 3 and 6. RESULTS Ten sequential patients, aged 35 to 80 years, identified between May 2017 and June 2018, from 3 separate infusion centers were followed for up to 10 months. All patients maintained methotrexate 15 mg/wk without dose adjustments. There were 143 total pegloticase infusions. All 10 patients completed a full course of pegloticase treatment with 100% response and no infusion reactions. No patients stopped pegloticase therapy because of increased sUA, loss of response, or gout flares. CONCLUSIONS Pretreatment and coadministration of methotrexate with pegloticase resulted in 100% maintenance of pegloticase sUA response with no infusion reactions. These data support the potential use of immunomodulation with methotrexate to improve durability of pegloticase response in the treatment of refractory gout.
-
3.
A Galvanizing Solution: Colonoscopy Bowel Preparation as a Trigger for Supraventricular Tachycardia.
Kajy, M, Ramappa, P
The Annals of pharmacotherapy. 2022;(3):297-302
Abstract
BACKGROUND Polyethylene glycol (PEG)-based solutions are among the most commonly used bowel preparation regimens for colonoscopy. Although these solutions are well tolerated, rare adverse cardiac events have been reported. OBJECTIVES We sought to identify the characteristics that may predispose patients to develop supraventricular tachycardia (SVT) after ingestion of GoLYTELY (PEG 3350 and electrolytes oral solution) in anticipation for their colonoscopy. METHODS We performed a retrospective observational cohort study of the electronic medical record of all patients who developed SVT after ingestion of GoLYTELY solution from April 2012 to March 2019 at the John D. Dingell VA Medical Center. Clinical data were obtained through review of medical records. RESULTS We identified 16 patients with new-onset SVT after ingestion of bowel preparation solution before undergoing the colonoscopy procedure. In all, 12 (75%) patients developed atrial fibrillation, 3 (18.8%) patients developed atrial tachycardia, and 1 patient (6.3%) developed atrial flutter. Most patients were male (93.8%), and the mean age was 69 ± 8.2 years. The commonly associated comorbidities were hypertension (87.5%), hyperlipidemia (56.3%), and diabetes (37.5%). Laboratory testing demonstrated a normal electrolyte panel and thyroid stimulating hormone level. A significant percentage of patients had dilated atria and left-ventricular hypertrophy on echocardiogram. CONCLUSION Our case series suggests that there may be certain individuals who are predisposed to development of atrial arrhythmias, more so than others, after ingestion of PEG based solution for colonoscopy. We hypothesize that the combination of atrial dilation, sympathovagal discharge, and transient electrolyte shifts at the cellular level led to the development of SVTs.
-
4.
Potential effective treatment of shortening continuous erythropoietin receptor activator treatment interval combined with iron supplementation in hemodialysis patients.
Kawai, Y, Toya, Y, Wakui, H, Fujikawa, T, Ueda, E, Azushima, K, Kinguchi, S, Mitsuhashi, H, Kawano, T, Kuji, T, et al
Journal of pharmacological sciences. 2021;(1):118-125
Abstract
Our previous randomized controlled trial comparing the total dose of weekly versus biweekly continuous erythropoietin receptor activator (CERA) therapy to maintain optimal hemoglobin (Hb) levels showed no significant differences between the two therapies. This post-hoc analysis assessed whether the total dose of weekly versus biweekly CERA therapy to maintain Hb levels among HD patients differed among groups with or without iron supplementation. Of 107 patients, 40 received intravenous iron supplementation due to iron deficiency (iron group) and 67 did not (non-iron group). In the iron group, the weekly therapy tended to require a lower total CERA dose compared with the biweekly therapy (274 ± 274 vs 381 ± 223 μg/12 weeks, P = 0.051). Changes in circulating hepcidin levels, a negative regulator of intestinal iron uptake, after 2 weeks of CERA treatment were significantly lower in the weekly therapy compared with the biweekly therapy (-4.2 ± 6.3 vs 11.1 ± 7.3 ng/mL, P = 0.015). In the non-iron group, there were no significant differences in total CERA dose or changes in hepcidin levels between the two therapies. Shortening the CERA treatment interval combined with iron supplementation may lead to the more efficient treatment of HD patients with iron deficiency.
-
5.
Electrospinning of Electroconductive Water-Resistant Nanofibers of PEDOT-PSS, Cellulose Nanofibrils and PEO: Fabrication, Characterization, and Cytocompatibility.
Latonen, RM, Cabrera, JAW, Lund, S, Kosourov, S, Vajravel, S, Boeva, Z, Wang, X, Xu, C, Allahverdiyeva, Y
ACS applied bio materials. 2021;(1):483-493
Abstract
Electrically conductive composite nanofibers were fabricated using poly(3,4-ethylenedioxythiophene) doped with poly(styrenesulfonate) (PEDOT-PSS) and cellulose nanofibrils (CNFs) via the electrospinning technique. Poly(ethylene oxide) (PEO) was used to assist the electrospinning process, and poly(ethylene glycol) diglycidyl ether was used to induce chemical cross-linking, enabling stability of the formed fibrous mats in water. The experimental parameters regarding the electrospinning polymer dispersion and electrospinning process were carefully studied to achieve a reproducible method to obtain bead-free nanofibrous mats with high stability after water contact, with an electrical conductivity of 13 ± 5 S m-1, thus making them suitable for bioelectrochemical applications. The morphology of the electrospun nanofibers was characterized by scanning electron microscopy, and the C/S ratio was determined with energy dispersive X-ray analysis. Cyclic voltammetric studies showed that the PEDOT-PSS/CNF/PEO composite fibers exhibited high electroactivity and high stability in water for at least two months. By infrared spectroscopy, the slightly modified fiber morphology after water contact was demonstrated to be due to dissolution of some part of the PEO in the fiber structure. The biocompatibility of the PEDOT-PSS/CNF/PEO composite fibers when used as an electroconductive substrate to immobilize microalgae and cyanobacteria in a photosynthetic bioelectrochemical cell was also demonstrated.
-
6.
Sodium picosulfate/magnesium citrate versus 4L split-dose polyethylene glycol for bowel cleansing prior to colonoscopy in high fibre diet African patients.
Ray-Offor, E, Opusunju, KA
The Pan African medical journal. 2021;:43
Abstract
INTRODUCTION an adequate bowel preparation is essential for good mucosal inspection during colonoscopy. This study aims to compare the efficacy of two validated oral lavage solutions for colonoscopy preparation in African patients. METHODS a prospective observational study of patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt, Nigeria, using sodium picosulfate magnesium citrate (SPMC) and 4L split-dose polyethylene glycol (PEG). Variables collated were sociodemographic, primary indication, comorbidities, Aronchick bowel preparation scale, polyp/adenoma detection, caecal intubation and outcome. Statistical analysis was performed using IBM SPSS version 20. RESULTS one hundred and twenty-four patients received PEG prior to colonoscopy and SPMC in 175 patients. The age range was from 22 to 92 years; mean age of 53.8 ± 14.2 years for PEG group and 55.3 ± 13.2 years for SPMC group (p=0.361). There were 215 males and 84 females. An excellent/good bowel preparation scale was recorded in 77 (62%) PEG group and 130 (74.3%) for SPMC group (p=0.592). PEG was predominantly used in the early years of endoscopists practice with the odds ratio (OR) of no polyp detection in the PEG vs SPMC groups as 1.64 (confidence interval CI 1.06-2.55) versus 0.76 (CI 0.62-0.92), respectively (p=0.016). For no adenoma detection, OR was 4.18 (CI 1.12-15.60) versus OR 0.63 (CI 0.52-0.75), respectively (p=0.012). CONCLUSION there is similar efficacy profile using either split volume PEG or SPMC prior to colonoscopy in these African patients. Polyp and adenoma detection rates are highly dependent on the expertise of the endoscopist.
-
7.
A Safety and Efficacy Comparison of a New Sulfate-Based Tablet Bowel Preparation Versus a PEG and Ascorbate Comparator in Adult Subjects Undergoing Colonoscopy.
Di Palma, JA, Bhandari, R, Cleveland, MV, Mishkin, DS, Tesoriero, J, Hall, S, McGowan, J
The American journal of gastroenterology. 2021;(2):319-328
-
-
Free full text
-
Abstract
INTRODUCTION A new tablet-based bowel prep for colonoscopy has been developed containing poorly absorbed sulfate salts which act to retain water within the intestinal lumen resulting in a copious diarrhea, thereby cleansing the bowel. This study evaluated the safety and efficacy of these oral sulfate tablets (OST) compared with a US FDA-approved bowel prep solution containing PEG3350, electrolytes, and ascorbate (polyethylene glycol and ascorbate [PEG-EA]). METHODS Five hundred fifteen adult patients (mean 57y) were enrolled in this single-blind, multicenter, noninferiority study. Subjects were assigned either PEG-EA or OST to be administered in a split-dose regimen starting the evening before colonoscopy. PEG-EA was taken according to its approved labeling (1 L of prep solution with 16 oz. of additional water) in the evening and again in the morning. OST patients took a total of 24 tablets. OST patients were administered 12 tablets in the evening, and the following morning. Patients consumed 16 ounces of water with each dose of 12 tablets and drank an additional 32 oz. of water with each dose. Colonoscopies were performed by blinded investigators. Cleansing efficacy was evaluated globally and segmentally using a 4-point scale (Excellent-no more than small bits of feces/fluid which can be suctioned easily; achieves clear visualization of the entire colonic mucosa. Good-feces and fluid requiring washing and suctioning, but still achieves clear visualization of the entire colonic mucosa. Fair-enough feces even after washing and suctioning to prevent clear visualization of the entire colonic mucosa. Poor-large amounts of fecal residue and additional bowel preparation required). Scores of Good or Excellent were considered to be a success. Safety was assessed by spontaneously reported adverse events, solicited ratings of expected prep symptoms, and laboratory testing. RESULTS A high rate of cleansing success was seen with OST (92%), which was noninferior to PEG-EA (89%). Only a small proportion of subjects rated their expected gastrointestinal symptoms as severe (<5% for both preps). No clinically significant differences were seen between preps for chemistry and hematology parameters. No serious adverse experiences were reported with OST. DISCUSSION Sulfate tablets achieved a high level of cleansing in the study, comparable with US FDA-approved preps. OST was noninferior to PEG-EA in this study and achieved significantly more Excellent preps overall and in the proximal colon. The OST prep was well-tolerated, with a similar rate of spontaneously reported adverse experiences to PEG-EA and a low rate of severe expected gastrointestinal symptoms.
-
8.
Enhanced filtration performance using feed-and-bleed configuration for purification of antibody precipitates.
Li, Z, Chen, TH, Andini, E, Coffman, JL, Przybycien, T, Zydney, AL
Biotechnology progress. 2021;(1):e3082
Abstract
Precipitation can be used for the initial purification of monoclonal antibodies (mAbs), with the soluble host cell proteins removed in the permeate by tangential flow microfiltration. The objective of this study was to examine the use of a feed-and-bleed configuration to increase the effective conversion (ratio of permeate to feed flow rates) in the hollow fiber module to enable more effective washing of the precipitate. Experiments were performed using human serum Immunoglobulin G (IgG) precipitates formed with 10 mM zinc chloride and 7 wt% polyethylene glycol. The critical flux was evaluated as a function of the shear rate and IgG concentration, with the resulting correlation used to predict conditions that can achieve 90% conversion in a single pass with minimal fouling. Experimental data for both the start-up and steady-state performance are in good agreement with model calculations. These results were used to analyze the performance of an enhanced continuous precipitation-microfiltration process using the feed-and-bleed configuration for the initial capture / purification of a mAb product.
-
9.
The Use of a PEG/Ascorbate Booster Following Standard Bowel Preparation Improves Visualization for Capsule Endoscopy in a Randomized, Controlled Study.
Mascarenhas-Saraiva, MJ, Oliveira, E, Mascarenhas-Saraiva, MN
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 2021;(5):437-442
Abstract
BACKGROUND/AIMS: The increasing use of capsule endoscopy (CE) to examine the gastrointestinal tract highlights the need to establish intestinal preparations that ensure optimal visualization while maximizing patient adherence. Thus, we assessed whether bowel preparation involving dietary restriction and a booster regimen produces adequate CE visualization in a real-world clinical setting. METHODS We conducted a randomized, double-blind, prospective study of CE procedures at 2 tertiary-care centers. Patients were allocated to 3 groups: group 1 followed a clear liquid diet and fasting-based bowel preparation for the exploration (n = 55); group 2 followed the same procedure as group 1 and then ingested 1 L of a polyethylene glycol (PEG)/ascorbic acid booster solution when the capsule reached the small intestine (n = 55); and group 3 followed the same procedure but ingesting only 0.5 L of the booster solution (n = 56). The quality of visualization and the average gastric, orocecal and small-bowel transit times were evaluated. RESULTS A total of 166 patients participated in the study. Significantly higher quality of visualization (Park score) was obtained in group 3 (2.28 ± 0.59) than in group 1 (1.84 ± 0.54, P < .001), while there were no significant differences in the average gastric (range: 36.58- 48.32 min, P = .277), orocecal (range: 322.58-289.45 min, P = .072), and small-bowel transit time (range: 280.71-249.95 min, P = .286) between the 3 groups. CONCLUSIONS Following a clear liquid diet and fasting-based bowel preparation for CE exploration, administering a booster solution of PEG/ascorbic acid after the capsule had reached the small intestine improves mucosal visualization and cleansing without affecting capsule transit times.
-
10.
Poly ethylene glycol (PEG)-Related controllable and sustainable antidiabetic drug delivery systems.
Fu, Y, Ding, Y, Zhang, L, Zhang, Y, Liu, J, Yu, P
European journal of medicinal chemistry. 2021;:113372
-
-
Free full text
-
Abstract
Diabetes mellitus is one of the most challenging threats to global public health. To improve the therapy efficacy of antidiabetic drugs, numerous drug delivery systems have been developed. Polyethylene glycol (PEG) is a polymeric family sharing the same skeleton but with different molecular weights which is considered as a promising material for drug delivery. In the delivery of antidiabetic drugs, PEG captures much attention in the designing and preparation of sustainable and controllable release systems due to its unique features including hydrophilicity, biocompatibility and biodegradability. Due to the unique architecture, PEG molecules are also able to shelter delivery systems to decrease their immunogenicity and avoid undesirable enzymolysis. PEG has been applied in plenty of delivery systems such as micelles, vesicles, nanoparticles and hydrogels. In this review, we summarized several commonly used PEG-contained antidiabetic drug delivery systems and emphasized the advantages of stimuli-responsive function in these sustainable and controllable formations.