Microfluidic Enabling Platform for Cell-based Assays

We have developed proprietary technologies for executing continuous flow assays in biochips which mimic human capillaries. Such technologies are integral to the rapidly growing laboratory instrumentation sector for applications in drug discovery, biotechnology, medical diagnostics and environmental studies. A common link between all sectors is the movement toward miniaturization to increase throughput, accuracy and efficiency in the development of new drugs. The miniaturization process itself leads to a demand for new instruments and tools capable of handling microlitre quantities of biological fluids and reagents, thus, we present an instrument which is capable of doing so in the form of a microfluidic enabling platform.

Ofatumumab maintenance versus observation in relapsed chronic lymphocytic leukaemia (PROLONG): an open-label, multicentre, randomised phase 3 study

BACKGROUND

Ofatumumab is a human anti-CD20 monoclonal antibody that has proven efficacy as monotherapy in refractory chronic lymphocytic leukaemia. We assessed the efficacy and safety of ofatumumab maintenance treatment versus observation for patients in remission after re-induction treatment for relapsed chronic lymphocytic leukaemia.

METHODS

This open-label, multicentre, randomised phase 3 study enrolled patients aged 18 years or older from 130 centres in 24 countries who had chronic lymphocytic leukaemia in complete or partial remission after second-line or third-line treatment. Eligible patients had a WHO performance status of 0-2, had a response assessment within the previous 3 months, did not have refractory disease, autoimmune haemolytic anaemia requiring treatment, chronic or active infection requiring treatment, and had not previously received maintenance treatment or autologous or allogeneic stem-cell transplant. Using a randomisation list generated by a central computerised system and an interactive voice recognition system, we randomly assigned (1:1) patients to receive ofatumumab (300 mg followed by 1000 mg 1 week later and every 8 weeks for up to 2 years) or undergo observation. Randomisation was stratified by number and type of previous treatment and remission status after induction treatment (block size of four). Treatment assignment was open label. The primary endpoint was investigator-assessed progression-free survival in the intention-to-treat population. We report the results of a prespecified interim analysis after two-thirds of the planned study events (disease progression or death) had happened. This trial is closed to accrual but follow-up is ongoing. This trial is registered with ClinicalTrials.gov, number NCT00802737.

FINDINGS

Between May 6, 2010, and June 19, 2014, we enrolled 474 patients: 238 patients were randomly assigned to receive ofatumumab maintenance treatment and 236 to undergo observation. One (<1%) patient in the ofatumumab group did not receive the allocated intervention (withdrawal of consent). The median follow-up was 19·1 months (IQR 10·3-28·8). Progression-free survival was improved in patients assigned to the ofatumumab group (29·4 months, 95% CI 26·2-34·2) compared with those assigned to observation (15·2 months, 11·8-18·8; hazard ratio 0·50, 95% CI 0·38-0·66; p<0·0001). The most common grade 3 or higher adverse events up to 60 days after last treatment were neutropenia (56 [24%] of 237 patients in the ofatumumab group vs 23 [10%] of 237 in the observation group) and infections (31 [13%] vs 20 [8%]). 20 (8%) of 237 patients in the ofatumumab group and three (1%) of 237 patients in the observation group had adverse events that led to permanent discontinuation of treatment. Up to 60 days after last treatment, two deaths related to adverse events occurred in the ofatumumab treatment group and five deaths related to adverse events occurred in the observation group; no deaths were attributed to the study drug.

INTERPRETATION

These data are important for the development of optimum maintenance strategies in patients with relapsed chronic lymphocytic leukaemia, notably in the present era of targeted drugs, many of which are to be used until progression.

Deletion of the gene for adiponectin accelerates diabetic nephropathy in the Ins2 (+/C96Y) mouse

AIMS/HYPOTHESIS

Diabetic nephropathy is one of the most common forms of chronic kidney disease. The role of adiponectin in the development of diabetic nephropathy has not been elucidated, and the aim of the present study was to investigate the hypothesis that deletion of the gene for adiponectin would accelerate diabetic nephropathy in the Akita mouse.

METHODS

We followed four groups of mice from 4 weeks to 16 weeks of age (n ≥ 10 in each group): wild-type (WT) (Ins2 (+/+) Adipoq(+/+)) mice; APN(-/-) (Ins2(+/+) Adipoq(-/-)) mice; Akita (Ins2(+/C96Y) Adipoq(+/+)) mice and Akita/APN(-/-) (Ins2(+/C96Y) Adipoq(-/-)) mice. The mice were then killed and diabetic kidney injury was assessed. In vitro experiments were performed in primary mesangial cells.

RESULTS

Mice from both diabetic groups exhibited increased glomerular adiponectin receptor 1 (adipoR1) expression, kidney hypertrophy, glomerular enlargement, increased albuminuria and tissue oxidative stress compared with the WT control. Deletion of the adiponectin gene had no effect on glycaemia. However, Akita/APN(-/-) mice exhibited a greater extent of renal hypertrophy. In vitro, adiponectin attenuated high-glucose-induced phosphorylation of mammalian target of rapamycin (mTOR) and ribosomal protein S6 kinase (S6K). A higher level of fibrosis was observed in the tubulointerstitial and glomerular compartments of the Akita/APN(-/-) mice and adiponectin was found to inhibit TGFβ-induced Smad2 and Smad3 phosphorylation in vitro. There was an exaggerated inflammatory response in the Akita/APN(-/-) mice. Adiponectin also inhibited high-glucose-induced activation of nuclear factor κB (NFκB) in mesangial cells.

CONCLUSIONS/INTERPRETATION

Our data suggest that adiponectin is an important determinant of the kidney response to high glucose in vivo and in vitro.

Characterization of the intrarenal renin-angiotensin system in experimental alport syndrome

Blockade of the renin-angiotensin system attenuates the progression of experimental and clinical Alport syndrome (AS); however, the underlying mechanism(s) remains largely unknown. We evaluated the renin-angiotensin system in 4- and 7-week-old homozygous for collagen, type IV, α3 gene (Col4A3(-/-)) and wild-type mice, a model of AS characterized by proteinuria and progressive renal injury. Renal angiotensin (Ang) II levels increased, whereas renal Ang-(1-7) levels decreased in 7-week-old Col4a3(-/-) mice compared with age-matched controls; these changes were partially reversed by recombinant angiotensin-converting enzyme 2 (ACE2) treatment. The expression of both the angiotensinogen and renin protein increased in Col4a3(-/-) compared with wild-type mice. Consistent with the Ang-(1-7) levels, the expression and activity of kidney ACE2 decreased in 7-week-old Col4a3(-/-) mice. The urinary excretion rate of ACE2 paralleled the decline in tissue expression. Expression of an Ang II-induced gene, heme oxygenase-1, was up-regulated in the kidneys of 7-week-old Col4a3(-/-) mice compared with wild-type mice by microarray analysis. Heme oxygenase-1 (HO-1) protein expression was increased in kidneys of Col4a3(-/-) mice and normalized by treatment with ACE inhibitor. Urinary HO-1 excretion paralleled renal HO-1 expression. In conclusion, progressive kidney injury in AS is associated with changes in expression of intrarenal renin Ang system components and Ang peptides. HO-1 and ACE2 may represent novel markers of AS-associated kidney injury, whereas administration of recombinant ACE2 and/or Ang-(1-7) may represent novel therapeutic approaches in AS.

Implications for women of Louisiana's law requiring abortion providers to have hospital admitting privileges

BACKGROUND

In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. This law is temporarily on hold while a court case challenging it continues. We aimed to describe the population who would be affected if the law goes into effect and how closures of between three and five Louisiana abortion facilities would affect the distance Louisiana women would need to travel for an abortion.

STUDY DESIGN

We abstracted patient data from three of the five Louisiana abortion care facilities in the year before the law was scheduled to take effect. We then estimated distance traveled and distances women would need to travel if clinics close.

FINDINGS

Half (53%) of women who had an abortion had no education beyond high school, most were black (62%) or white (30%), three fourths (73%) had a previous live birth, and most (89%) were having a first-trimester abortion. Seventy-nine percent resided in Louisiana and 15% in Texas. The parishes in which abortion patients resided had lower median income and higher percentage poverty than the Louisiana average. Abortion patients residing in Louisiana traveled a mean distance of 58 miles each way for an abortion. If all Louisiana facilities close, the mean distance women would need to travel would more than triple to 208 miles, and the proportion of Louisiana women of reproductive age who live more than 150 miles from an abortion facility would increase from 1% to 72%.

CONCLUSION

The admitting privileges law will likely significantly increase the distance Louisiana women need to travel for an abortion. This burden is likely to disproportionately affect Louisiana's more vulnerable residents.

IMPLICATIONS

If all Louisiana abortion facilities close due to Louisiana's hospital admitting privileges law, the mean distance women would need to travel for an abortion would more than triple from 58 to 208 miles. Louisiana's law would thus present a considerable burden on many Louisiana women, particularly those who are more vulnerable.

Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012

A national point-prevalence survey for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and for Clostridium difficile infection (CDI) was done in Canadian hospitals in 2010. A follow-up survey was done in November 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs). Associations between prevalence and infection prevention and control policies were evaluated in logistic regression models. A total of 143 (67% of eligible facilities) hospitals with 29 042 adult inpatients participated in the survey, with representation from all 10 provinces; 132 hospitals participated in 2010 and 2012. There were no significant changes in the median prevalence of MRSA in 2010 (4.3%) compared to 2012 (3.9%), or of CDI in 2010 (0.8%) compared to 2012 (0.9%). A higher median prevalence of VRE was identified in 2012 (1.3%) compared to 2010 (0.5%) (p 0.04), despite decreased VRE screening in 2012. The median prevalence of ESBLs was 0.7% and was 0 for CREs; CREs were reported from only 10 hospitals (7.0%). A policy of routinely caring for patients with MRSA or VRE in a private isolation room was associated with lower prevalence of these organisms. Targeted screening of high-risk patients at admission was associated with lower MRSA prevalence; better hand hygiene compliance was associated with lower VRE prevalence. These data provide national prevalence rates for antibiotic-resistant organisms among adults hospitalized in Canadian hospitals. Certain infection prevention and control policies were associated with prevalence.

EEG sensorimotor correlates of translating sounds into actions

Understanding the actions of others is a necessary foundational cornerstone for effective and affective social interactions. Such understanding may result from a mapping of observed actions as well as heard sounds onto one's own motor representations of those events. To examine the electrophysiological basis of action-related sounds, EEG data were collected in two studies from adults who were exposed to auditory events in one of three categories: action (either hand- or mouth-based sounds), non-action (environmental sounds), and control sounds (scrambled versions of action sounds). In both studies, triplets of sounds of the same category were typically presented, although occasionally, to ensure an attentive state, trials containing a sound from a different category were presented within the triplet and participants were asked to respond to this oddball event either covertly in one study or overtly in another. Additionally, participants in both studies were asked to mimic hand- and mouth-based motor actions associated with the sounds (motor task). Action sounds elicited larger EEG mu rhythm (8–13 Hz) suppression, relative to control sounds, primarily over left hemisphere, while non-action sounds showed larger mu suppression primarily over right hemisphere. Furthermore, hand-based sounds elicited greater mu suppression over the hand area in sensorimotor cortex compared to mouth-based sounds. These patterns of mu suppression across cortical regions to different categories of sounds and to effector-specific sounds suggest differential engagement of a mirroring system in the human brain when processing sounds.

The contribution of nurses to a multi-disciplinary approach to patient care in Tomsk, Russia

The Tomsk Oblast Tuberculosis (TB) services have accumulated unique experience in the area of TB detection, care and control through their collaboration with various international partners since 1994. Nurses account for about one half of all health care personnel in both in-patient and out-patient care sectors in Tomsk TB services, and they have been involved throughout in the planning and delivery of care. The authors believe that a holistic approach to service provision has led to positive results in TB programme outcomes, which are better than many in Russia, even with historically high rates of drug-resistant TB.