A novel consensus bacterial 6-phytase variant completely replaced inorganic phosphate in broiler diets, maintaining growth performance and bone quality: data from two independent trials

Total replacement of dietary inorganic phosphate (Pi) by a novel consensus bacterial 6-phytase variant (PhyG) in phytate-rich diets (>0.3% phytate-P) was investigated in 2 trials using growth performance and bone quality as outcome measures. Both trials utilized a completely randomized design with 5 dietary treatments across 4 phases: starter (0-10 d), grower (10-21 d), finisher 1 (21-35 d), and finisher 2 (35-42 d). Treatments comprised a nutritionally adequate positive control (PC) diet containing monocalcium phosphate and 4 experimental diets (IPF1, IPF2, IPF3, and IPF4), all containing no added Pi and reduced in Ca by 0.2 to 0.3% units vs. PC. IPF1contained PhyG at 1,000 FTU/kg (all phases); IPF2 contained PhyG at 1,000 FTU/kg (all phases) and was additionally reduced in digestible AA, ME, and sodium (-0.2 to -0.4% points, -74 kcal/kg, -0.04% points, respectively, vs. PC); IPF3 contained PhyG at 3,000 FTU/kg in starter, 2,000 FTU/kg in grower, and 1,000 FTU/kg in finisher phases; and IPF4 contained xylanase (2,000 U/kg) and PhyG (2,000 FTU/kg in starter, 1,500 FTU/kg in grower, and 1,000 FTU/kg in finisher phases) and was additionally reduced in ME (-71 kcal/kg vs. PC). Ross 308 broilers were used (trial 1: n = 1,200 mixed sex; 24 birds per pen × 10 replicates; trial 2: n = 1,300 males; 26 birds × 10 replicates). During all phases in both trials, all IPF treatments maintained or improved BW, ADG, ADFI, FCR and BW-corrected FCRc and bone quality parameters vs. PC. vs. PC, treatment IPF3 increased ADG during starter phase (+10.8%) and reduced overall FCRc (-12 points, P < 0.05) in Trial 1, and increased overall ADG (+4.4%), day 35 and day 42 BW (+3.5%, +4.9%), and reduced overall FCRc (-11 points) in Trial 2 (P < 0.05). IPF4 produced equivalent performance to IPF3 (both trials). These are the first data to demonstrate total replacement of Pi by microbial phytase during an entire growth cycle in broiler diets.

Kidney Transplantation in a Recipient with Positive RT-PCR for SARS-CoV-2

When it is safe to proceed with transplantation after coronavirus disease 2019 (COVID-19) infection is still unknown. We describe the clinical course and management of immunosuppression in a patient with positive real-time polymerase chain reaction (RT-PCR) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a nasopharyngeal swab at the time of kidney transplantation, and with positive antibodies for SARS-CoV-2. The patient had no complications and was discharged with a functioning graft.

Single-dose pharmacokinetics of BMS-986177/JNJ-70033093 in participants with mild or moderate hepatic impairment compared to healthy participants

Background

According to the scientific evidence accumulated to date (ie, genetic, epidemiological, preclinical, clinical), the modulation of Factor XI (FXI) function may provide a novel mechanism for systemic anticoagulation without increasing the risk of clinically significant bleeding in a variety of conditions predisposing patients to a high risk of thrombotic or bleeding events. BMS-986177/JNJ-70033093 (BMS-177/JNJ-3093) is a small molecule that inhibits the active form of FXI (FXIa) with high affinity and selectivity. Depending on the indication, BMS-177/JNJ-3093 may provide benefit to patients as add-on or potentially replacement therapy to the current standard of care antithrombotic agents. Patients with hepatic impairment may have an increased risk of bleeding when using existing antithrombotic agents and therefore may benefit from drugs with an improved safety profile.

Purpose

To assess the effect of mild or moderate hepatic impairment on the pharmacokinetic (PK) properties of BMS-177/JNJ-3093.

Methods

This was a multicenter, open-label, non-randomized, single-dose study. A single 60-mg oral dose of BMS-177/JNJ-3093 was administered to 9 participants with mild hepatic impairment (Child-Pugh class A), 8 participants with moderate hepatic impairment (Child-Pugh class B), and 9 healthy participants with normal hepatic function. Healthy participants were matched to participants with hepatic impairment in each Child-Pugh class with regard to body weight. To assess the effects of hepatic impairment on BMS-177/JNJ-3093 PK, an analysis of variance was performed on the natural log-transformed Cmax, AUC(INF), and AUC(0-T) with hepatic function group as a fixed effect.

Results

BMS-177/JNJ-3093 was well tolerated when administered as an oral dose of 60 mg in participants with mild or moderate hepatic impairment and healthy participants with normal hepatic function. There were no deaths, serious adverse events (AEs), severe AEs, bleeding AEs, or discontinuations due to an AE reported during the study. The geometric mean ratios (GMRs) (90% CI) comparing mild hepatic impairment to normal hepatic function were 1.180 (0.735, 1.895) and 1.168 (0.725, 1.882) for total BMS-177/JNJ-3093 maximum concentration (Cmax) and area under the curve from time 0 to infinity (AUC(INF)), respectively. The GMRs (90% CI) comparing moderate hepatic impairment to normal hepatic function were 1.140 (0.699, 1.857) and 0.996 (0.609, 1.628) for total BMS-177/JNJ-3093 Cmax and AUC(INF), respectively. Overall, levels of activated partial thromboplastin time (aPTT) increased in an exposure-related manner following single oral doses of 60 mg BMS-177/JNJ-3093 in all groups.

Conclusion

BMS-177/JNJ-3093 was well tolerated in the normal healthy participants and those with mild or moderate hepatic impairment. The observed changes indicate that a dose adjustment in these populations may not be necessary.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This work was sponsored by Bristol-Myers Squibb and Janssen Research & Development, LLC

Improvement in the performance and inflammatory reaction of Ross 708 broilers in response to the in ovo injection of 25-hydroxyvitamin D3

The effects of the in ovo administration of vitamin D₃ (D₃) and its metabolite, 25-hydroxyvitamin D₃ (25OHD₃)_, on the performance, breast meat yield, and inflammatory responses of broilers fed commercial diets were investigated. Live embryonated Ross 708 broiler hatching eggs were randomly assigned to one of the following 5 in ovo injection treatments at 18 d of incubation: 1) noninjected; 2) diluent; diluent containing 3) 2.4-μg D₃, 4) 2.4-μg 25OHD₃, or 5) 2.4-μg D₃ + 2.4-μg 25OHD₃. A 50-μL solution volume of each prespecified treatment was injected into each egg using an Inovoject multiegg injector. At hatch, 18 male chicks were randomly assigned to each of 30 floor pens. The BW, BW gain, feed intake, and feed conversion ratio of the birds were determined in each dietary phase. At 14, 28, and 39 d of posthatch age (doa), plasma α-1-acid glycoprotein (AGP) levels in 1 bird in each of 6 replicate pens per treatment were determined at 14 and 39 doa. The pectoralis major and minor weights of those same birds were also determined. The remaining birds were processed at 43 doa, and the weights of their processing parts were determined. At 39 doa, the in ovo injection of 25OHD₃ alone decreased plasma AGP concentrations in comparison with the noninjected, diluent, and D₃-alone treatment groups. In addition, birds that received 25OHD₃ alone had a greater BW at 42 doa than birds in the noninjected, diluent, and D₃-alone treatment groups. At 39 and 43 doa, breast meat yield was increased in response to the in ovo injection of 25OHD₃ alone in comparison to all other treatments. These results indicate that the in ovo injection of 2.4 μg of 25OHD₃ resulted in an improvement in the performance and inflammatory responses of broilers. A reduction in the inflammatory response subsequent to the in ovo injection of 2.4 μg of 25OHD₃ may have led to an increase in broiler performance.

Effects of dietary calcium and available phosphorus levels and phytase supplementation on performance, bone mineral density, and serum biochemical bone markers in aged white egg-laying hens

Exogenous phytase supplementation increases P and Ca availability to allow for the dietary reductions without negative consequences on productivity or skeletal health. Effects of a Buttiauxella sp. phytase (BSP) supplemented in available P (avP)-reduced and Ca-reduced diets on performance, BW, eggshell quality, serum biochemical bone markers, and bone densitometry were evaluated in egg-laying hens from 68 to 78 wk of age. One hundred hens were fed 1 of 5 diets (n = 20/treatment), including a positive control (PC) with 0.35% avP and 3.5% Ca, and the PC moderately reduced in avP and Ca levels by 0.187 and 0.159% of the diet (by 53 and 4.5%), respectively, (NC1) or severely reduced by 0.231 and 0.275% of the diet (by 66 and 7.9%), respectively, (NC2). Other diets were the NC1 or NC2 supplemented with BSP at 600 FTU/kg (NC1 + BSP or NC2 + BSP, respectively). Egg production and feed conversion ratio were maintained by NC1 but were 11.9% lower and 12.3% higher, respectively, with the NC2 than the PC, which was alleviated by supplemental BSP. Diet effects on FI and eggshell quality followed a similar pattern. Body weight was 2.9% lower for NC1, and 6.1% for NC2 than the PC; BSP alleviated the decreased BW. Serum pyridinoline (bone resorption marker) was 20 to 27% higher in NC2 hens than in the other groups, with no effects on other bone markers. Total and trabecular space bone mineral density in the proximal metaphysis were 8.4 and 15.2% lower for NC1, respectively, and 12.1 and 26.7% lower for NC2, respectively, than PC. Supplemental BSP completely alleviated the decreased bone densitometry measures in NC1, but only partially in NC2. The NC1 hens maintained performance but had decreased BW and bone quality; phytase supplementation restored productivity, BW, and bone quality. The Ca and avP deficiencies in the NC2 hens relative to other groups were partially alleviated by the 600 FTU/kg BSP.

Effects of source and level of in ovo-injected vitamin D3 on the hatchability and serum 25-hydroxycholecalciferol concentrations of Ross 708 broilers

Effects of the in ovo injection of vitamin D3 (D3) and 25-hydroxycholecalciferol (25OHD3) on broiler embryo serum 25OHD3 concentrations, hatchability, and hatchling somatic characteristics were determined. Eggs from a 35-wk-old commercial Ross 708 broiler breeder flock were set in a single-stage incubator with 11 treatments represented on each of 8 incubator tray levels (blocks). Each treatment group within a flat on each tray level contained 30 eggs. Control treatments were noninjected and diluent injected. Vitamin treatments were commercial diluent containing 0.6 μg D3, 0.6 μg 25OHD3, 0.6 μg D3 + 0.6 μg 25OHD3, 1.2 μg D3, 1.2 μg 25OHD3, 1.2 μg D3 + 1.2 μg 25OHD3, 2.4 μg D3, 2.4 μg 25OHD3, or 2.4 μg D3 + 2.4 μg 25OHD3. At 432 h of incubation (hoi), 50-μL solution volumes were injected. Blood samples were collected at 462 hoi for serum 25OHD3 analysis, and hatchability of injected live embryonated eggs (HI) was determined at 492 and 516 hoi. At 516 hoi, hatchling yolk-free BW and weights of the liver and yolk sac were determined. Percentage of yolk moisture and dry mater was calculated. At 492 and 516 hoi, HI did not differ between treatments. Embryos that received 1.2 μg or more of either vitamin D3 source alone or in combination had higher serum 25OHD3 concentrations than those that were injected with diluent alone or diluent containing 0.6 μg of D3. Hatchlings that received 1.2 or 2.4 μg of 25OHD3 had higher percentage of yolk dry matter or lower percentage of yolk moisture levels than noninjected controls and those that received D3 alone at any level. These results indicate that the in ovo injection of either vitamin D3 source at levels equal to or higher than 1.2 μg resulted in serum 25OHD3 concentrations that were higher than that of noninjected controls. In addition, the in ovo injection of 1.2 μg or higher of either vitamin D3 source did not negatively affect broiler HI or chick quality.

The efficacy of 2 phytases on inositol phosphate degradation in different segments of the gastrointestinal tract, calcium and phosphorus digestibility, and bone quality of broilers

The anti-nutritional effects of dietary inositol phosphates (IP6 through IP3) have been recognized in broiler chickens; however, inositol hexaphosphate (IP6) is more potent than the lower IP esters. The efficacies of 2 commercial phytases, a Buttiauxella sp. phytase (BSP) and a Citrobacter braakii phytase (CBP) at 500 and 1,000 FTU/kg, were studied on IP6-3 concentrations in the crop, proventriculus + gizzard, and distal ileum digesta, and ileal IP6 disappearance in broilers at day 22. Apparent ileal P and Ca digestibility, and bone quality at days 22 and 33 were also measured. Female Ross 308 broilers (n = 1,890; 30 birds × 7 diets × 9 replicates) were fed corn-soy-based crumbled diets. The 7 diets included a primary breeder recommendation-based positive control diet (PC); the PC marginally reduced in available P by 0.146% and Ca by 0.134% of the diet, (NC1) or moderately reduced by 0.174 and 0.159% of the diet, respectively (NC2). Other diets were the NC1 + BSP or CBP at 500 FTU/kg (NC1+500BSP and NC1+500CBP) and the NC2 + BSP or CBP at 1,000 FTU/kg (NC2+1,000BSP and NC2+1,000CBP). Each of the NC1 and NC2 had distal ileum IP6 disappearance similar to that of PC, but each had lower P digestibility and the majority of measured bone quality parameters than the PC. The ileal IP6 levels were decreased by 52.0 and 32.7% for NC1+500BSP and NC1+500CBP, respectively, relative to NC1 and by 73.6 and 50.9% for NC2+1,000BSP and NC2+1,000CBP, respectively, relative to NC2 (P < 0.001), with a similar effect for distal ileum IP6 disappearance. Overall, phytase in the NC diets increased P digestibility, and femur breaking strength and cortical bone mineral density at days 22 and 33. Overall, each of the phytases at each dose degraded IP6-3 across the gastrointestinal tract segments to increase P digestibility and the P and Ca utilization in bone. However, dietary BSP at 1,000 FTU/kg was most effective. Supplemental phytase degrades phytate to decrease the anti-nutritional effects in a dose- and phytase-dependent manner.

Long-term effects of Buttiauxella sp. phytase on performance, eggshell quality, apparent ileal Ca and P digestibility, and bone properties of white egg layers

Adequate dietary Ca and available phosphorus (avP) are essential to long-term egg production and bone health in laying hens. The effects of dietary Ca and avP levels and Buttiauxella sp. phytase (BSP) were studied in Lohmann LSL Lite hens from 30 to 70 wk of age (woa). Hens (n = 456; 4 per cage) were fed either a primary breeder recommendation-based diet (positive control; PC); the PC with avP and Ca levels reduced by 0.146 and 0.134% of the diet, respectively, without (NC) or with 300 FTU/kg BSP (NC+BSP). Egg production, BW, feed intake, FCR, and eggshell quality from 30 to 70 woa, and apparent ileal digestibility of P (AIDP) and Ca (AIDCa), and bone quality at 32, 48, and 70 woa were measured. The avP and Ca levels in the NC diet were not clinically deficient, as most parameters were unaffected by diet. Hen BW from 34 to 70 woa tended to be 2.9% greater (P = 0.076) for PC and NC+BSP compared to NC. Mid-diaphysis cortical bone mineral content (CBMC) tended to be 10% and 9% higher (P = 0.065) in the NC+BSP hens than in NC hens at 48 and 70 woa, respectively. AIDP of NC+BSP was 24% greater (P = 0.034) than of NC at 32 woa and tended to be 18% greater (P = 0.082) than AIDP of PC at 48 woa, and 25% lower than of NC and PC at 70 woa (P = 0.028). AIDCa was 25% lower for NC+BSP than PC at 48 woa only (P = 0.037). The avP and Ca sufficiency in the NC diet limited the opportunity to determine a phytase effect. Although the supplemental BSP tended to increase BW and 48 and 70 woa CBMC, and increased 32 woa AIDP, the efficacy of BSP could not be determined due to the lack of an NC effect on most parameters. Commercial laying hens can maintain health and productivity at lower than recommended levels of dietary Ca and avP; phytase supplementation may allow for even further reductions.

Model-based evaluation of the efficacy and safety of nivolumab once every 4 weeks across multiple tumor types

BACKGROUND

Nivolumab 480 mg every 4 weeks (Q4W) is approved in the European Union, United States, and several other markets across multiple tumor types. Its approval was supported by quantitative efficacy/safety analyses bridging to 3 mg/kg every 2 weeks (Q2W).

PATIENTS AND METHODS

The benefit-risk profile of nivolumab 480 mg Q4W relative to 3 mg/kg Q2W was evaluated using population pharmacokinetic modeling and exposure-response (E-R) analyses for safety and efficacy. Pharmacokinetic exposures were predicted for 3203 patients with melanoma, non-small-cell lung cancer (NSCLC), renal cell carcinoma (RCC), squamous cell carcinoma of the head and neck, urothelial carcinoma, or classical Hodgkin lymphoma. Quantitative models analyzed E-R to predict 480-mg Q4W safety across all indications and efficacy for melanoma, NSCLC, and RCC. Intratumoral receptor occupancy (RO) was predicted for parameters representing different tumor types.

RESULTS

Time-averaged concentrations for 480 mg Q4W versus 3 mg/kg Q2W were higher during the first 28 days (26.8%) and similar at steady state (5.2%). The maximum concentration (C_max) after the first dose was higher (110.4%), and the trough concentration at day 28 was lower (-22.1%) with 480 mg Q4W versus 3 mg/kg Q2W. The C_max achieved with 480 mg Q4W was lower than the previously established safe dose of 10 mg/kg Q2W. The probability of adverse events for key safety end points was similar for 480 mg Q4W and 3 mg/kg Q2W. The predicted overall survival and objective response rates with 480 mg Q4W were comparable to 3 mg/kg Q2W. The predicted high intratumoral RO provided additional evidence to support 480 mg Q4W across tumor types.

CONCLUSIONS

The benefit-risk profile for nivolumab 480 mg Q4W was predicted to be similar to that of 3 mg/kg Q2W across tumor types while providing a convenient and flexible option for patients and their caregivers.

Assessment of nivolumab exposure and clinical safety of 480 mg every 4 weeks flat-dosing schedule in patients with cancer

Background

A nivolumab monotherapy flat-dosing regimen of 480 mg every 4 weeks (Q4W) has been approved in several markets, including the United States, Canada, and European Union, as an alternative dosing regimen for several indications. Approvals of this Q4W regimen were based on population pharmacokinetic (PK) analyses, established flat exposure–response relationships, and clinical safety. The objective of this study was to compare the PK exposure of 480 mg Q4W with 3 mg/kg every 2 weeks (Q2W) and 240 mg Q2W using modeling and simulation, and to evaluate clinical safety of the Q4W regimen.

Patients and methods

Nivolumab PK exposure for the 480 mg Q4W schedule was simulated for 3817 patients across multiple tumor types and compared with those for the 3 mg/kg Q2W and 240 mg Q2W schedules. The safety profile of the Q4W schedule was assessed by analysis of clinical data from 61 patients who transitioned to nivolumab 480 mg Q4W from 3 mg/kg Q2W during four phase III clinical trials.

Results

Compared with 3 mg/kg Q2W, nivolumab 480 mg Q4W produced similar time-averaged concentration, approximately 16% lower trough concentration, and 45% higher peak concentration at steady state. The peak concentration for 480 mg Q4W was significantly lower than that of 10 mg/kg Q2W, a dose previously shown to have an acceptable tolerability and safety profile. Treatment-related adverse events (TRAEs) that started after transitioning from 3 mg/kg Q2W to 480 mg Q4W were reported in 14.8% of patients, with 1.6% of patients reporting grades 3–4 TRAEs. Pooled safety data for these patients are consistent with those for the 3 mg/kg Q2W schedules, and no new safety signals were identified.

Conclusions

The time-averaged steady-state exposure and safety profile of nivolumab 480 mg Q4W are consistent with that of 3 mg/kg Q2W across multiple tumor types. Nivolumab 480 mg Q4W represents a new dosing schedule option, and in addition to 240 mg Q2W, provides convenience and flexibility for patient care.

Clinical trial numbers

NCT01721772, NCT01668784, NCT01673867, NCT01642004

Green and scalable synthesis of 3D porous carbons microstructures as electrode materials for high rate capability supercapacitors

Porous carbon nanostructures have long been studied because of their importance in many natural phenomena and their use in numerous applications. A more recent development is the ability to produce porous carbon materials with tuneable properties for electrochemical applications, which has enabled new research directions towards the production of suitable carbon materials for energy storage applications. Thus, this work explores the activation of carbon from polyaniline (PANI) using a less-corrosive potassium carbonate (K₂CO₃) salt, with different mass ratios of PANI and the activating agent (K₂CO₃ as compared to commonly used KOH). The obtained activated carbon exhibits a specific surface area (SSA) of up to ∼1700 m² g^-1 for a carbon derived PANI : K₂CO₃ ratio of 1 : 6. Moreover, the prepared samples were tested as electrode materials for supercapacitors with the results showing excellent electrical double layer capacitor behavior. Charge storage was still excellent for scan rates of up to 2000 mV s^-1, and a capacitance retention of 70% at a very high specific current of 50 A g^-1 was observed. Furthermore, the fabricated device can deliver an energy density of 25 W h kg^-1 at a specific current of 0.625 A g^-1 and a power density of 260 W kg^-1 in 1-ethyl-3-methylimidazolium bistrifluorosulfonylimide (EMIM-TFSI) ionic liquid, with excellent rate capability after cycling for 16 000 cycles at 3.0 V with ∼98% efficiency. These results are promising and demonstrate the electrode's potential for energy storage, leading to the conclusion that K₂CO₃ is a very good alternative to corrosive activation agents such as KOH in order to achieve high electrochemical performance.

Effects of in ovo injection of different doses of coccidiosis vaccine and turn-out times on broiler performance,

Inovocox EM1 vaccine (EM1) is hatchery-applied via in ovo injection for the control of coccidiosis in broiler chickens. Effects of 3 in ovo injection treatments (INT) and 2 turn-out times (TOT) on the hatching chick quality variables and 35 d posthatch performance of Ross × Ross 708 broilers were investigated. In a single-stage incubator, 1,440 hatching eggs were randomly distributed among 3 INT groups on each of 8 tray levels. At 19 d of incubation (doi), embryonated eggs were subjected to one of the following INT by in ovo injection: noninjected control; 1 × dose of EM1; 10 × dose of EM1. On 21 doi, hatchability of injected eggs (HI), hatching body weight (HBW), and hatching chick quality variables were determined. Additionally, for the grow-out phase, birds belonging to each INT were randomly subjected to a 7 or 10 d TOT. Twenty chicks were initially placed in each of 48 floor pens (6 INT × TOT combination groups × 8 replications) for growth performance evaluation from 0 to 35 d posthatch. The main effect of INT on hatching chick quality variables, as well as the main and interactive effects of INT and TOT on various grow-out performance variables were determined. Although there was no significant INT effect on HI or HBW, significant INT effects on chick total BW, yolk-free BW, and yolk sac weight were observed. There were significant INT effects on BWG and FCR in the 21- to 28-d posthatch interval, as well as on BWG and FCR in the 0- to 35-d posthatch interval. There was no main effect of TOT or interactive effect of INT and TOT on BW and other performance variables from 0 to 35 d posthatch. There was a significant main effect of INT on relative intestine weight at 28 d posthatch. In conclusion, the injection of EM1 vaccine at a 10 × dose may affect hatching chick quality variables and growth performance up to 35 d posthatch.

Assessment of nivolumab benefit-risk profile of a 240-mg flat dose relative to a 3-mg/kg dosing regimen in patients with advanced tumors

Background

Nivolumab 3 mg/kg every 2 weeks (Q2W) has shown benefit versus the standard of care in melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). However, flat dosing is expected to shorten preparation time and improve ease of administration. With knowledge of nivolumab safety, efficacy, and pharmacokinetics across a wide dose range in body weight (BW) dosing, assessment of the benefit–risk profile of a 240-mg flat dose relative to the approved 3-mg/kg dose was approached by quantitative clinical pharmacology.

Patients and methods

A flat dose of 240 mg was selected based on its equivalence to the 3-mg/kg dose at the median BW of ∼80 kg in patients in the nivolumab program. The benefit–risk profile of nivolumab 240 mg was evaluated by comparing exposures at 3 mg/kg Q2W and 240 mg Q2W across BW and tumor types; clinical safety at 3 mg/kg Q2W by BW and exposure quartiles in melanoma, NSCLC, and RCC; and safety and efficacy at 240 mg Q2W relative to 3 mg/kg Q2W in melanoma, NSCLC, and RCC.

Results

The median nivolumab exposure and its distribution at 240 mg Q2W were similar to 3 mg/kg Q2W in the simulated population. Safety analyses did not demonstrate a clinically meaningful relationship between BW or nivolumab exposure quartiles and frequency or severity of adverse events. The predicted safety and efficacy were similar across nivolumab exposure ranges achieved with 3 mg/kg Q2W or 240 mg Q2W flat dose.

Conclusion

Based on population pharmacokinetic modeling, established flat exposure–response relationships for efficacy and safety, and clinical safety, the benefit–risk profile of nivolumab 240 mg Q2W was comparable to 3 mg/kg Q2W. The quantitative clinical pharmacology approach provided evidence for regulatory decision-making on dose modification, obviating the need for an independent clinical study.

Investigation into diseases in free-ranging ring-necked pheasants (Phasianus colchicus) in northwestern Germany during population decline with special reference to infectious pathogens

The population of ring-necked pheasants (Phasianus colchicus) is decreasing all over Germany since the years 2008/2009. Besides impacts of habitat changes caused by current rates of land conversion, climatic influences or predators, a contribution of infectious pathogens needs also to be considered. Infectious and non-infectious diseases in free-living populations of ring-necked pheasants have been scarcely investigated so far. In the present study, carcasses of 258 deceased free-ranging pheasants of different age groups, predominantly adult pheasants, collected over a period of 4 years in the states of Lower Saxony, North Rhine–Westphalia and Schleswig-Holstein, were examined pathomorphologically, parasitologically, virologically and bacteriologically, with a focus set on infectious pathogens. A periocular and perinasal dermatitis of unknown origin was present in 62.3% of the pheasants. Additional alterations included protozoal cysts in the skeletal musculature (19.0%), hepatitis (21.7%), enteritis (18.7%), gastritis (12.6%), and pneumonia (11.7%). In single cases, neoplasms (2.6%) and mycobacteriosis (1.7%) occurred. Further findings included identification of coronaviral DNA from trachea or caecal tonsils (16.8%), siadenoviral DNA (7.6%), avian metapneumoviral RNA (6.6%), and infectious bursal disease viral RNA (3.7%). Polymerase chain reaction (PCR) on herpesvirus, avian influenza virus (AIV), paramyxovirus type 1 (PMV-1), avian encephalomyelitis virus (AEV), and chlamydia were negative. Based on the present results, there is no indication of a specific pathogen as a sole cause for population decline in adult pheasants. However, an infectious disease can still not be completely excluded as it may only affect reproduction effectivity or a certain age group of pheasants (e.g., chicks) which were not presented in the study.

Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria

BACKGROUND

Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN.

PATIENTS AND METHODS

We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics.

RESULTS

A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully.

CONCLUSION

PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

Self-perceived seizure precipitants among patients with epilepsy in Middle-belt of Nigeria

AIM

Patient's perception of seizure precipitant is crucial in epilepsy management, but it is often overlooked by physicians. This may be due to neglect and underestimation of its importance. This study looked at frequency and nature of self-perceived seizure precipitants among patients with epilepsy.

MATERIALS AND METHODS

A close-ended questionnaire-based study. Patients with active epilepsy (≥2 attacks/year) were recruited from the neurology clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin.

RESULT

A total of 89 patients participated in the study and of these 41 (46.1%) were males. Their median age was 30 (21-52) years and median age at seizure onset was 22 (15-46) years. The median seizure duration was five (2-14) years. More patients (46.1%) had less than secondary school education and 12 (13.5) were uneducated. Generalized epilepsy was the predominant (68.6%) seizure type. A total of 33 (37.1%) subjects had ≥4 attacks/year, 29 (32.6%) had 5-12 attacks/year, and 27 (30.3%) >12 attacks/year. A total of 16 (18%) subjects did not mention any seizure precipitant, whereas 73 (82.2%) reported at least one specific seizure precipitant; of these, 62 (85%) patients reported ≥2 precipitants. Stress (41%), inadequate sleep (27%), and head trauma (26%) were the three leading seizure precipitants mentioned. Subject's age, sex, level of seizure control, and place of abode did not influence reported seizure precipitants. However, the more educated (>12 years education) patients significantly reported stress as seizure precipitant (P < 0.05). Most (80%) patients rightly indicated that antiepileptic drug was the best treatment for their seizure control.

CONCLUSION

The result of this study showed that the leading perceived seizure precipitants among epilepsy patients attending the neurology clinic of UITH were stress, inadequate sleep, head trauma, and demonic attacks and spells.