A randomised, double-blind, placebo-controlled phase 2 study of trebananib (AMG 386) in combination with FOLFIRI in patients with previously treated metastatic colorectal carcinoma

Background:

This phase 2 study evaluated trebananib (AMG 386), an investigational peptide-Fc fusion protein that neutralises the interaction between angiopoietins-1/2 and the Tie2 receptor, plus FOLFIRI as second-line treatment for patients with metastatic colorectal cancer.

Methods:

Patients had adenocarcinoma of the colon or rectum with progression within 6 months of receiving only one prior fluoropyrimidine/oxaliplatin-based chemotherapy regimen for metastatic disease. All patients received FOLFIRI and were randomised 2 : 1 to also receive intravenous trebananib 10 mg kg⁻¹ once weekly (QW) (Arm A) or placebo QW (Arm B). The primary end point was investigator-assessed progression-free survival (PFS).

Results:

One hundred and forty-four patients were randomised (Arms A/B, n=95/49). Median PFS in Arms A and B was 3.5 and 5.2 months (hazard ratio (HR) 1.23; 95% CI, 0.81–1.86; P=0.33) and median overall survival (OS) was 11.9 and 8.8 months, respectively (HR 0.90; 95% CI; 0.53–1.54; P=0.70). Objective response rate (ORR) was 14% and 0% in Arms A and B, respectively. Incidence of grade ⩾3 adverse events was similar between treatment arms (Arm A, 61% Arm B, 65%) and included pulmonary embolism (1%/4%), deep vein thrombosis (5%/2%), and hypertension (1%/0%).

Conclusion:

Administration of trebananib plus FOLFIRI did not prolong PFS compared with placebo plus FOLFIRI. Toxicities were manageable and consistent with those known for FOLFIRI and trebananib.

Measurement of the proton-air cross section at √s=57 TeV with the Pierre Auger Observatory

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505±22(stat)(-36)(+28)(syst)] mb is found.

Drug-induced sensorineural deafness caused by antithyroid drugs: a rare side effect

Acute ototoxicity is a rare but important complication of antithyroid drugs. Although previous cases have been reported in the medical literature, these cases occurred in younger patients with serological evidence of lupus-like syndrome with positive antidouble-stranded deoxyribonucleic acid and antineutrophil cytoplasmic antibodies. We describe the case of a 68-year-old Caucasian male who developed deafness and tinnitus one week after being prescribed carbimazole. The management options include stopping the culprit drug, treatment with immunosuppressive drugs and referring the patient for urgent thyroidectomy. Healthcare professionals who prescribe antithyroid drugs should be aware of this rare but potentially serious complication, so that early drug withdrawal and referral for surgery can be considered.

Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

Adult smoking intervention programmes in Massachusetts: a comprehensive approach with promising results

This paper provides a brief overview of the history of Massachusetts' opposition to smoking. It describes the current Massachusetts Tobacco Control Program and its smoking intervention programmes; changes in public opinion, perceptions and attitudes toward smoking; and programme impact. Massachusetts has been successful in developing a comprehensive intervention that has had encouraging results in changing public attitudes about smoking and in helping smokers to quit.

EEG P300 event-related markers of hypnosis

Barabasz, Barabasz, Jensen, Calvin, Trevisan, and Warner (1999) showed that, when subjects are stringently selected for hypnotizability and responses are time locked to events, robust markers of hypnotic responding emerge that reflect alterations in consciousness that correspond to subjects' subjective experiences of perceptual alteration. To further test the Barabasz et al. (1999) hypothesis, we obtained EEG visual P300 event-related potentials (ERPs) from 20 high- and low-hypnotizable subjects. The effects of positive obstructive and negative obliterating instructions were tested during waking and alert hypnotic conditions. High-hypnotizables showed greater ERP amplitudes in response to the negative hallucination condition and lower ERP amplitudes in response to the positive obstructive hallucination when compared to the low-hypnotizables. Contrary to socio-psychological or role play conceptualizations, the hypnotic induction resulted in specific psychophysiological responses which could not be produced by waking imagination or by the lows who were trying to mimic hypnotic responding.

Massive intraperitoneal hemorrhage from traumatic intrasplenic pseudoaneurysms: treatment using superselective embolotherapy

The importance of splenic preservation in the setting of penetrating and blunt trauma has led to the development of more sophisticated and noninvasive methods for controlling splenic hemorrhage. Although controversy exists, transcatheter embolotherapy has challenged the use of splenectomy in patients suffering from persistent bleeding after splenic trauma. We describe a case of a 41-year-old man with hepatitis C, ethanol-induced liver disease, and portal hypertension who presented with splenic rupture secondary to blunt trauma. Continued intra-abdominal hemorrhage was successfully controlled by superselective embolotherapy using microcoils and gelatin sponge pledgets.

Coagulation factor XIII and cardiovascular disease in UK Asian patients undergoing coronary angiography

Possession of the coagulation factor XIII Val34Leu (FXIIIVal34Leu) polymorphism is associated with protection against myocardial infarction (MI) in Caucasians, in the absence of features of insulin resistance. The role of this polymorphism in the UK Asian population, with its high prevalence of insulin resistance and ischaemic heart disease, is unknown. We investigated the frequency of genotypes at this polymorphism, and measures of circulating FXIII in a group of UK Asians attending for coronary angiography. Genotype at the FXIIIVal34Leu polymorphism was not associated with MI. FXIII B-subunit levels correlated with waist: hip ratio (r = 0.19, p <0.005), HbA1c (r = 0.18, p <0.05), fasting triglycerides (r = 0.21, p <0.005), total cholesterol (r = 0.29, p <0.0005) and PAI-1 antigen (r = 0.24, p <0.005). An association between FXIIIVal34Leu and FXIII cross-linking activity was confirmed in these subjects (one-way ANOVA p <0.0005). This evidence does not support the hypothesis that FXIIIVal34Leu is protective against MI in the UK Asian population. FXIII B-subunit levels are strongly linked to risk factors for cardiovascular disease, suggesting an underlying association with insulin resistance.

Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer

In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.

Development of a state wide tobacco treatment specialist training and certification programme for Massachusetts

OBJECTIVE

To describe the research conducted to structure and develop a statewide tobacco training and certification programme for tobacco treatment specialists (TTSs) in Massachusetts.

DESIGN

Qualitative research strategies were used to obtain information on certification development and opinions regarding TTS training and certification from key informants. A role definition and validation study was then conducted to determine the core competencies for TTSs. A comprehensive training programme was developed, piloted, and finalised, and a certification programme was initiated.

PARTICIPANTS

Key informants included: individuals involved in the development of their professional certification programmes; tobacco treatment providers from across Massachusetts; and national tobacco treatment experts.

MAIN OUTCOME MEASURES

Participants' opinions about the need for and structure of a training and certification programme for individuals specialising in the provision of moderate to intensive tobacco treatment; delineation of core competencies for TTSs, using the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) clinical practice guideline as a foundation for the development of evidence based standards of practice for the treatment of nicotine dependence.

RESULTS

The data support a comprehensive training and certification programme for TTSs in Massachusetts. Main concerns include the cost of obtaining certification, the potential to exclude uncertified healthcare professionals from delivering basic tobacco treatment, and the role of the TTS in the healthcare delivery system and the community. The training programme developed for Massachusetts was piloted, and the structure of a statewide training and certification programme for TTSs was finalised.

CONCLUSIONS

The research provides support for the need and acceptance of a training and certification programme for TTSs in Massachusetts, and presents the challenges to be addressed. We demonstrated the feasibility of developing and implementing an evidence based training programme, and of initiating a statewide certification programme in Massachusetts. This work will add to a national dialogue on the development of a training and certification programme for tobacco treatment providers and encourage further research into the potential impact of statewide and national certification.

Hypnosis and distraction differ in their effects on cold pressor pain

On the bases of Hilgard's neodissociation theory and Spano's (1982) sociocognitive theory, volunteers stringently selected for high (N = 10) and low (N = 10) hypnotizability were exposed to a cold pressor pain test during counterbalanced conditions of waking relaxation, distraction, and hypnosis. To better discriminate between hypnosis and distraction conditions, a new distraction procedure was developed involving the memorization of a sequence of colored lights. High hypnotizables showed significantly greater pain relief for hypnosis versus distraction or waking relaxation conditions. High hypnotizables also demonstrated significantly greater pain relief than low hypnotizables in response to hypnosis. Quantitative electroencephalographic (EEG) findings showed significantly greater high theta (5.5-7.5 Hz) activity for highs as compared to lows at parietal (P3) and occipital (01) sites during both hypnosis and waking relaxation conditions. The findings fail to support the socio-cognitive conceptualization of hypnotic behavior while providing additional evidence supporting the neo-dissociation theory and state based theories of hypnosis in general.

The thrombomodulin gene mutation G(127)-->A (Ala25Thr) and cerebrovascular disease

BACKGROUND AND PURPOSE

Thrombomodulin is an integral part of the protein C anticoagulation pathway, and polymorphisms of its gene have been implicated in thrombosis. The point mutation G(127)-->A has recently been found to be associated with myocardial infarction.

METHODS

We investigated this mutation in 465 patients with acute stroke and 353 control subjects. Genomic DNA containing the region of interest was amplified by PCR, and differing genotypes were identified by RFLP.

RESULTS

The A allele frequency was not statistically significantly different in the two groups, being 0.5% in the stroke group and 0.7% in the control group.

CONCLUSIONS

The point mutation G(127)-->A is an uncommon finding and, in this population, is unlikely to be a major risk factor for cerebrovascular disease.

Universal interfacing system for interactive technologies in telemedicine, disabilities, rehabilitation, and education

A modular hardware and software system for human-computer interaction is described that allows for flexible, affordable interfacing of people, computers, and instruments. The approach is illustrated with an application in the disabilities area. Other application areas are outlined.