Tolerability and pharmacokinetics of the nitrone NXY-059 in patients with acute stroke

BACKGROUND AND PURPOSE

Increased free radical formation contributes to the damage caused to the brain by acute ischemia. NXY-059 is a nitrone-based free radical trapping agent in development for acute stroke. NXY-059 has neuroprotective efficacy when given 5 hours after onset of transient focal ischemia in the rat.

METHODS

This was a randomized, double-blind, placebo-controlled, parallel group, multicenter study that evaluated the safety and tolerability of 2 NXY-059 dosing regimens compared with placebo within 24 hours of acute stroke. NXY-059 was administered as either 250 mg over 1 hour followed by 85 mg/h for 71 hours or 500 mg over 1 hour followed by 170 mg/h for 71 hours; plasma concentrations were monitored. Neurological and functional outcomes were recorded up to 30 days.

RESULTS

One hundred fifty patients were recruited, of whom 147 received study treatments and completed assessments (50 placebo, 48 lower-dose NXY-059, 49 higher-dose NXY-059). Mean (+/-SD) age was 68 (+/-10) years, and baseline National Institutes of Health Stroke Scale score was 7.9 (+/-6.2). Serious adverse events occurred in 16%, 23%, and 16% of patients, respectively, with deaths in 0%, 10%, and 4%, largely following the proportions with primary intracerebral hemorrhage (6%, 16%, and 8%). Hyperglycemia, headache, and fever were common but not related to treatment. The mean unbound steady state NXY-059 plasma concentrations were 25 and 45 micromol/L, respectively. Population pharmacokinetic analysis estimated clearance to be 4.6 L/h.

CONCLUSIONS

NXY-059 was well tolerated in patients with an acute stroke. The testing of higher doses in future trials may be justified.

Surgical emphysema--an unusual finding in spontaneous neonatal gastric perforation

A neonate presented with extensive surgical emphysema of the abdominal wall and a spontaneous gastric perforation. This clinical presentation is very rare. Early diagnosis and treatment improve the clinical outcome.

Alkyl ester prodrugs for improved topical delivery of ibuprofen

Topical delivery of ibuprofen directly to the site of inflammation can overcome gastrointestinal side effects associated with its long term oral administration. The set of physicochemical properties necessary for optimum topical delivery of ibuprofen can be imparted by formation of its ester prodrugs. Various alkyl ester prodrugs (methyl, ethyl, n-propyl, iso-propyl, n-butyl, iso-butyl, sec-butyl, tert-buty, n-pentyl, hexyl, heptyl, octyl, lauryl, cetyl and octadecyl esters) were synthesised and studied for their physicochemical properties and activity in the carrageenan induced rat paw oedema by topical route. Favourable shift in lipophilicity and self penetration enhancing effect of prodrugs responded in improved topical activity over the parent drug ibuprofen.

Experimental study of harmonic generation from solid surfaces irradiated by multipicosecond laser pulses

An experimental study is presented on harmonic generation from solid surfaces using 27 ps Nd:glass laser pulses (lambda=1053 nm) in the intensity range of 10(13)-10(15) W cm(-2). Second, third, and fourth harmonics emitted in the specular reflection direction showed intensity scaling exponents of 1.5, 1.8, and 3.8 for an obliquely incident p-polarized laser beam, providing a conversion efficiency of 2x10(-8), 10(-10), and 5x10(-12) at 10(15) W cm(-2), respectively. Second and third harmonic radiation generated using an s-polarized pump was about 10 and 100 times smaller, respectively, compared to that for the p-polarized laser radiation. Faraday rotation observed in the reflected fundamental radiation can explain the relative harmonic yields for the p and s polarizations of the pump beam.

The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Collaborative Stroke Audit and Research

OBJECTIVE

It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation.

DESIGN

A two-centre pilot study to assess the feasibility of performing a multicentre randomized controlled trial on this subject.

SETTING

Clatterbridge and Aintree Stroke Rehabilitation Units, Merseyside, UK.

SUBJECTS

Forty early stroke patients (mean age 67 years) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied.

INTERVENTION

A central randomization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient. They were allocated to either an 'encouraged to self-propel' or a 'discouraged from self-propulsion group'. OUTCOME MEASURES USED: Independent outcome assessment was performed by postal questionnaire and telephone interview using the Barthel ADL Scale, Nottingham Extended ADL Scales and the shortened General Health Questionnaire (GHQ-12) at 3 and 12 months. Patient's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital.

RESULTS

After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres. No major differences were found between the pilot groups for any of the outcome measures.

CONCLUSIONS

A multicentre randomized controlled trial to assess this question is feasible but further work is being conducted before proceeding, to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures.

Human CD34(+) stem cells express the hiwi gene, a human homologue of the Drosophila gene piwi

Hematopoietic stem cells (HSCs) are characterized by their dual abilities to undergo differentiation into multiple hematopoietic cell lineages or to undergo self-renewal. The molecular basis of these properties remains poorly understood. Recently the piwi gene was found in the embryonic germline stem cells (GSCs) of Drosophila melanogaster and has been shown to be important in GSC self-renewal. This study demonstrated that hiwi, a novel human homologue of piwi, is also present in human CD34(+) hematopoietic progenitor cells but not in more differentiated cell populations. Placing CD34(+) cells into culture conditions that supported differentiation and rapid exit from the stem cell compartment resulted in a loss of hiwi expression by day 5 of a 14-day culture period. Expression of the hiwi gene was detected in many developing fetal and adult tissues. By means of 5' RACE cloning methodology, a novel putative full-length hiwi complementary DNA was cloned from human CD34(+) marrow cells. At the amino acid level, the human HIWI protein was 52% homologous to the Drosophila protein. The transient expression of hiwi in the human leukemia cell line KG1 resulted in a dramatic reduction in cellular proliferation. Overexpression of hiwi led to programmed cell death of KG1 cells as demonstrated by the Annexin V assay system. These studies suggest that hiwi maybe an important negative developmental regulator, which, in part, underlies the unique biologic properties associated with hematopoietic stem and progenitor cells.

Activity profile of glycolamide ester prodrugs of ibuprofen

Glycolamide esters of ibuprofen (I), namely, unsubstituted (II), N,N dimethyl (III), and N,N diethyl (IV), were synthesized and studied for different physicochemical, pharmacological, and toxicological properties. They were comparable with I in respect of anti-inflammatory and analgesic activity but did not exhibit reduction in the ulcerogenicity on oral administration. However, all three exhibited significantly better topical activity in carrageenan-induced rat paw edema assay. In the same assay, they provided significant protection against inflammation when applied at a site remote to the inflammation site.

HARTMANN'S PROCEDURE REVISITED

Between July 1991 and June 1999 out of 176 patients undergoing colonic surgery (elective and emergency), Hartmann's procedure was performed in 63. There were 39 males and 24 females. Mean age was 43 years (range 12 to 81). To assess the utility of Hartmann's procedure the documents of all these 63 patients were retrospectively analysed. In 47 bowel continuity was reestablished. The over all mortality in first stage operation (Hartmann's procedure) was 12.7% and mortality in the second stage procedure (reestablishing bowel continuity) was nil. Complication rate was drastically less in second operation. The authors conclude that Hartmann's procedure is safe and effective while dealing with colorectal pathologies as resection and primary anastomosis is fraught with danger.

Colorectal cancer in children: case report and review of literature

Compared to adults, colorectal carcinoma is rare in children and has poorer prognosis, due to delay in diagnosis, advanced stage at presentation and aggressive natural history. We describe a case of mucinous adenocarcinoma of the rectum in a eleven year old boy and review the literature regarding colorectal cancer in children. A high index of suspicion and an early diagnosis may lead to an improvement in the dismal prognosis of this disease in children.

HIV/AIDS related knowledge, risk perception, attitude and sexual behavior of working women staying in hostels

HIV infection poses a formidable threat to women's health. Already, in India, women account for 21.3% of all AIDS cases. In metropolitan cities women living alone in hostels and having independent income, may have a liberal life style and chances of practising high risk sexual behaviour is greater. This study was conducted to assess the risks and risk perception of such women. Among eighty-nine hostel residents, AIDS awareness was 92.1%. Very few respondents had adequate knowledge about modes of transmission and methods of prevention. Risk perception was poor, however high risk behaviour was less commonly practised by this group.

Necrotising fasciitis of the breast

Necrotising fasciitis is a rare condition and to the best of our knowledge has never been reported in the breast. We report the first case in the literature of necrotising fasciitis involving the breast.

Analysis of the activity of promoters from two photosynthesis-related genes psaF and petH of spinach in a monocot plant, rice

The subunit III of photosystem I and ferredoxin-NADP(+)-oxidoreductase are encoded by nuclear genes, namely psaF and petH. The activity of their promoters from spinach has been evaluated in transgenic tobacco earlier. Evaluation of the activity of these Dicotyledoneae-specific promoters has been carried out in a monocot system (i.e. rice) by transient gene expression system, based on electroporation-mediated gene delivery into protoplasts from leaves and roots. It has been found that various promoter deletions show higher activity in leaf protoplasts and elements for quantitative response are widely distributed. Transgenic rice has also been produced with a petH promoter and gus reporter gene construct. Although petH promoter is a weak promoter in comparison to the 35S promoter, it expresses well in green tissues and could be useful for plant genetic engineering.

Case-control study of Meige's syndrome. Result of a pilot study

A pilot case-control study was conducted to identify possible risk factors for Meige's syndrome. Patients with Meige's syndrome and age- and sex-matched controls suffering from other neurological diseases were recruited from the Movement Disorders Clinic and Neurology Outpatient Department of the All India Insititute of Medical Sciences. All participants were interviewed and information regarding psychiatric and medical illnesses, use of medications, exposure to fumes, dust and pets, characteristics such as marital status, socio-economic status, alcohol, tea/coffee use, tobacco use, betel nut chewing and family history of neurodegenerative diseases among first-degree relatives was ascertained. We found that betel nut with tobacco chewing was a significant predictor for Meige's syndrome (adjusted odds ratio 7.4, 95% confidence interval = 1.0-59. 82). The role of local irritation or the effect of some chemicals in tobacco and betel nuts needs further evaluation of the pathogenesis of Meige's syndrome.

Effect of preservation techniques and food additives on staphylococcal thermonuclease

Staphylococcal TNase was found to retain its activity fully even after exposure to chilling and refrigeration temperatures for 24 h. It was not inhibited by p-hydroxy benzoic acid, sorbic acid, methylpropyl p-benzoic acid and sodium nitrite in the concentration range of 0.04 to 0.5%, whereas it was inhibited by 100 ppm of butylated hydroxy anisole (BHA), 200 ppm of butylated hydroxy toluene (BHT), and 300 ppm of propyl gallate. There was not complete inhibition of S. aureus and TNase by tocopherol (TP) and ascorbic acid (AA) even at concentration of 300 ppm. These results indicate that TNase can be used as an index of potentially enterotoxin producing S. aureus contamination in foods subjected to chilling, refrigeration as well as in foods containing common preservatives and antioxidants.

Pathological lesions in lambs fed raw or processed cottonseed meal

Thirty male lambs of 3-4 months of age, were assigned equally to five dietary treatments in a completely randomized design and fed isonitrogenous and isocaloric concentrate mixtures containing 30% de-oiled peanut meal (DPNM) or 40%, cottonseed meal, which was raw, cooked for 45 min or treated with either 1%, calcium hydroxide or iron (1:3, free gossypol: Fe). The mixtures containing raw or variously processed CSM replaced about 50% of the nitrogen of the reference concentrate mixture. These concentrate mixtures were fed to meet 80% of the animals' crude protein requirements along with ad libitum feeding of maize (Zea mays) hay for 180 days. The free gossypol content of the raw cottonseed meal (0.27%) was reduced to 0.16% 0.20% and 0.21% by the cooking, Ca(OH)2 and iron treatments, respectively. At the end of the experiment, the tissues of various organs were fixed in 10% formol saline. embedded in paraffin and sectioned at 4-5 microm thickness, and duplicate sections were stained with either haematoxylin and eosin or Perl's Prussian blue. The lambs fed diets incorporating raw, cooked, Ca(OH)2- or iron-treated cottonseed meal consumed respectively 302, 215, 250 and 222 mg free gossypol/day. No morbidity. mortality or gross lesions were observed in any organs and the histopathological lesions due to cottonseed meal were limited to the testes and epididymis. Spermatogonial cells were absent in the majority of the seminiferous tubules of testes from lambs fed raw cottonseed meal. Most seminiferous tubules were collapsed, with a reduced wall thickness, owing to there being fewer germ cell layers and vacuolation of the basal cells. The epithelium of the epididymal ductules was degenerated, desquamated to a variable degree with hyperplastic changes, and they were devoid of spermatozoa. Most lambs fed any of the processed cottonseed meals did not show any of these lesions, and such lesions as occurred in affected lambs in these groups were relatively mild. Iron pigments were deposited around the portal areas of the liver, the tip of intestinal villi and the spleen of lambs fed the iron-treated cottonseed meal diet. Cooking or treatment with 1%, Ca(OH)2 effectively minimized the toxic effects of free gossypol.

Need for bringing in a change in biochemistry curriculum to make it clinically oriented?

OBJECTIVES

This study was conducted to (a) assess the views of medical students and doctors regarding relevance of biochemistry training, (b) explore if they have any suggestion to bring in any improvement in contents of biochemistry curriculum and mode of teaching.

METHODS

In 1997-98, a structured questionnaire was filled up by 114 medical students and 118 doctors.

RESULTS

As many as 62/114 (55%) medical students and 40/118 (34%) doctors believed that it is not important to remember minute details of biochemical reactions (p value < 0.0001). Among medical students, 108/110 (98.2%) agree that a clinician should be invited to seminars for developing skills of interpretation of laboratory investigations; whilst 110/118 (93.2%) doctors expressed similar view, p value ns. Approximately 92% responders favored that departments biochemistry and physiology should co-ordinate on the topics of common interest in order to save time and effort. What is the most informative and effective way of teaching biochemistry?' in response to this question only 0.9% responders opted lecture as the best option. Seminars with active participation of medical students was preferred by 93.2% responders. About 6.9% responders reckoned that symposium prepared by a more than one teacher. In response to the question whether it is possible to cover pre-clinical subjects in 12 months so as to allow spiral mode of curriculum, 73% of all the responders agreed that it would be good idea, there was no difference of opinion among the doctors and medical students. On the other hand, 27% were strongly opposed to this suggestion.

CONCLUSIONS

We suggest that there is a need to modify the contents, methods of teaching, and curriculum organization of training in clinical biochemistry. How best the curriculum can be made problem oriented needs to be debated among medical educationists.

Reliability of measurements of muscle tone and muscle power in stroke patients

OBJECTIVES

to establish the reliability of the modified Ashworth scale for measuring muscle tone in a range of muscle groups (elbow, wrist, knee and ankle; flexors and extensors) and of the Medical Research Council scale for measuring muscle power in the same muscle groups and their direct antagonists.

DESIGN

a cross-sectional study involving repeated measures by two raters. We estimated reliability using the kappa statistic with quadratic weights (Kw).

SETTING

an acute stroke ward, a stroke rehabilitation unit and a continuing care facility.

SUBJECTS

people admitted to hospital with an acute stroke-35 patients, median age 73 (interquartile range 65-80), 20 men and 15 women.

RESULTS

inter- and intra-rater agreement for the measurement of power was good to very good for all tested muscle groups (Kw = 0.84-0.96, Kw = 0.70-0.96). Inter- and intra-rater agreement for the measurement of tone in the elbow, wrist and knee flexors was good to very good (Kw = 0.73-0.96, Kw = 0.77-0.94). Inter- and intra-rater agreement for the measurement of tone in the ankle plantarflexors was moderate to good (Kw = 0.45-0.51, Kw = 0.59-0.64).

CONCLUSIONS

the Medical Research Council scale was reliable in the tested muscle groups. The modified Ashworth scale demonstrated reliability in all tested muscle groups except the ankle plantarflexors. If reliable measurement of tone at the ankle is required for a specific purpose (e.g. to measure the effect of therapeutic intervention), further work will be necessary.