Phase II study of avatrombopag in thrombocytopenic patients with cirrhosis undergoing an elective procedure

BACKGROUND & AIMS

This is a phase II multicentre study to investigate the efficacy and safety of avatrombopag (E5501), an investigational second-generation thrombopoietin receptor agonist, administered one week prior to elective procedures in patients with thrombocytopenia secondary to cirrhosis.

METHODS

Adults with cirrhosis and platelet counts ⩾10 to ⩽58×10(9)/L were randomized to placebo or avatrombopag in two sequential cohorts. Cohort A: placebo vs. one of 3 different doses (100mg loading dose followed by 20, 40, or 80 mg/day on days 2-7) of a first-generation avatrombopag formulation. Cohort B: placebo vs. one of 2 different doses (80 mg loading dose followed by 10 mg/day for days 2-7, or 20mg/day for days 2-4) of a second-generation avatrombopag formulation. Primary end point was achievement of a platelet increase of ⩾20×10(9)/L from baseline and >50×10(9)/L at least once during days 4-8.

RESULTS

A total of 130 patients were randomized: 93 patients (51, cohort A; 42, cohort B) to avatrombopag and 37 (16, cohort A; 21 cohort B) to placebo. The primary end point was achieved by 49.0% of treated patients in cohort A and 47.6% in cohort B compared to 6.3% and 9.5% of controls; a dose response was seen. Each avatrombopag regimen had a higher proportion of responders compared with their respective cohort placebo arms (p<0.01), except for the 100/40 mg group in cohort A (p=0.17). The most common adverse events were nausea, fatigue, and headache. One patient in the (100/80) avatrombopag group, without a Doppler assessment at screening was diagnosed with portal vein thrombosis during post-treatment follow-up.

CONCLUSIONS

In this study avatrombopag was generally well-tolerated and increased platelet counts in patients with cirrhosis undergoing elective invasive procedures.

CO2 laser photoacoustic detection of ammonia emitted by ceramic industries

A homemade photoacoustic spectrometer has been constructed for monitoring gas emission from several sources. Numerous air pollutant gases are emitted exhaust of industries, vehicles and power plants. The photoacoustic technique is extremely sensitive and selective in detecting various gases. This work focuses on the gas emitted by the ceramic industry in northern Rio de Janeiro State in Brazil, the ceramic industry plays a remarkable role in the economy activity of this region, in recent years, this region developed into a significant red ceramic complex. The potential impact on the atmospheric environment of the region due to gaseous pollutant emissions from these anthropogenic sources needs to be evaluated. In this work we identified NH3 present in the samples collected in the kiln of a ceramic plant, in the concentration range of 33-52 ppmV. The ammonia gas present in our collected samples might come from the excess nitrogen in the manure soil from where the ceramic material was extracted. This soil was used for the sugarcane culture which is another important economic activity of this region.

Classifier based on support vector machine for JET plasma configurations

The last flux surface can be used to identify the plasma configuration of discharges. For automated recognition of JET configurations, a learning system based on support vector machines has been developed. Each configuration is described by 12 geometrical parameters. A multiclass system has been developed by means of the one-versus-the-rest approach. Results with eight simultaneous classes (plasma configurations) show a success rate close to 100%.

Malignant hemangiopericytoma arising in neurofibromatosis: a case report with histological, immunohistochemical and ultrastructural studies

Subject. A 27-year-old Hispanic male with clinical manifestation of neurofibromatosis type 1 developed chronic constipation and urination difficulty along with recently increased abdominal bloating and anorexia. He also noted 40 lbs weight loss over period of 1 year. Physical and radiographic examinations revealed a large mass in the right pelvic fossa.

Results. The surgically removed tumor was demonstrated, histologically, immunohistochemically, and ultrastructurally, to be a malignant hemangiopericytoma.

Discussion.Although non-neurogenic tumors associated with neurofibromatosis have been reported in these patients, only one hemangiopericytoma case has been found in the English literature. We report here another case of this rare malignant hemangiopericytoma in a patient with neurofibromatosis.

Retransplantation for hepatitis C: results of a U.S. multicenter retransplant study

It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n = 43), group 2: non-HCV reTX (n = 73), and group 3: recurrent HCV but no reTX (n = 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of >30 in the non HCV group, survival was <50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was <50% in the non-HCV reTx group with MELD score of >30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

Discovery of Potent 3,5-Diphenyl-1,2,4-oxadiazole Sphingosine-1-phosphate-1 (S1P1) Receptor Agonists with Exceptional Selectivity against S1P2 and S1P3

A class of 3,5-diphenyl-1,2,4-oxadiazole based compounds have been identified as potent sphingosine-1-phosphate-1 (S1P1) receptor agonists with minimal affinity for the S1P2 and S1P3 receptor subtypes. Analogue 26 (S1P1 IC50 = 0.6 nM) has an excellent pharmacokinetics profile in the rat and dog and is efficacious in a rat skin transplant model, indicating that S1P3 receptor agonism is not a component of immunosuppressive efficacy.