Association of baseline C-reactive protein and prior anti-tumor necrosis factor therapy with need for weekly dosing during maintenance therapy with adalimumab in patients with moderate to severe Crohn's disease

OBJECTIVE

A post hoc analysis of data from the adalimumab Crohn's disease (CD) maintenance trial (CHARM, NCT00077779), examining the relationship between adalimumab dosing and maintenance of remission and response in subgroups stratified by previous anti-TNF use and baseline CRP.

METHODS

All patients received open-label induction (adalimumab: 80 mg, week [wk] 0; 40 mg, wk 2). At wk 4, all patients were randomized to double-blind maintenance adalimumab (40 mg weekly or every other week [eow]) or placebo for 52 weeks. In this analysis, clinical remission (CDAI <150) and clinical response (CR-100) at wk 26 and wk 56 by baseline CRP (high: ≥ 10 mg/L, or low: <10 mg/L) and prior anti-TNF use were determined for patients with CR-70 at wk 4.

RESULTS

Of 498 patients in this analysis, 260 (52.2%) were anti-TNF-naïve. For anti-TNF-naïve patients, the wk 56 remission rates in the adalimumab groups were significantly greater than placebo (P < 0.05) for both high and low CRP cohorts, with no statistically significant differences between remission rates with eow and weekly dosing within each CRP cohort (high: 52.8% eow, 53.5% weekly; low: 34.7% eow, 41.9% weekly). For anti-TNF-exposed patients, wk 56 remission rates were higher than placebo with both eow and weekly dosing within each cohort; weekly dosing in the high CRP cohort and eow dosing in the low CRP cohort achieved statistical significance (P < 0.05). In the high CRP cohort, remission rate with weekly dosing (46.9%) was statistically significantly greater compared with eow dosing (22.5%). There were no significant differences between eow (23.1%) and weekly (37.0%) dosing in the low CRP group. For all subgroups, clinical remission (wk 26) and clinical response (wk 26 and wk 56) patterns were similar to those observed for wk 56 remission.

CONCLUSIONS

These subgroup analyses suggest that in patients with moderately to severely active CD, weekly dosing may be most effective in the anti-TNF-experienced patients with elevated CRP at baseline.

A multicenter, blinded, randomized, factorial controlled trial of doxycycline and rifampin for treatment of Alzheimer's disease: the DARAD trial

OBJECTIVES

Preliminary evidence suggested that doxycycline and rifampin might stop or slow the progression of Alzheimer's disease (AD). We carried out a randomized trial to confirm or refute these findings.

METHODS

A multicenter, blinded, randomized, 2 × 2 factorial controlled trial, set at 14 geriatric outpatient clinics in Canada. Four hundred and six patients with mild to moderate AD (standardized mini mental state examination (SMMSE) score 14-26) participated. The intervention was 12 months' treatment with doxycycline 100 mg twice daily + rifampin 300 mg daily or doxycycline 100 mg twice daily + placebo-rifampin daily or rifampin 300 mg daily + placebo-doxycycline twice daily or placebo-doxycycline twice daily + placebo-rifampin daily. Coprimary outcomes were the Standardized Alzheimer's Disease Assessment Scale-Cognitive Subscale (SADAS-cog) and the Clinical Dementia Rating Scale-Sum of the Boxes (CDR-SB). Secondary outcomes were the SMMSE, Quick mild cognitive impairment screen, Geriatric Depression Scale, Cornell Scale for Depression in Dementia, activities of daily living (Lawton Scale), and the Dysfunctional Behavior Rating Instrument frequency and reaction subscales.

RESULTS

There was a significant deterioration in SADAS-cog over time with both rifampin and doxycycline in comparison with placebo. When the two were used together, there was no statistically significant decline/deterioration in comparison with placebo (n = 305). For the CDR-SB, there were no significant effects of either rifampin or doxycycline. Secondary outcome results followed similar patterns.

CONCLUSION

Twelve months' treatment with doxycycline or rifampin, alone or in combination, has no beneficial effects on cognition or function in AD.

Therapeutic concerns when oral medications are administered nasogastrically

WHAT IS KNOWN AND OBJECTIVE

Administering oral medications to patients with nasogastric tube (NGT) is a challenging patient-care issue. Inappropriate prescribing behaviour and incorrect procedure for extemporaneous preparation of oral suspensions given via NGT may result in significant harm to patients. There are many drugs which have not been tested regarding oral absorption profile and bioavailability derived from NGT dosing. Although several studies and case-reports have been reported, there is no up-to-date review of drug administration via NGT. The aim of this review is to increase awareness of rational drug administration via NGT and to encourage relevant research in this area.

METHODS

Full prescribing information from each currently available oral medication was reviewed for any data indicating that the medication could not be crushed or opened. Literature was identified by searching PubMed (1988 to Aug 2012).

RESULTS AND DISCUSSION

There is evidence to show that NGT dosing of some medications may bring both benefits (e.g. cost saving) and disadvantages (e.g. decrease in efficacy and/or safety). For medications with package inserts that warn that they should not be crushed or opened, alternatives are usually recommended. However, in some cases, there is evidence to support NGT dosing. Sometimes special procedures are required to avoid problems such as instability, interaction with enteral nutrition, adsorption, tube obstruction and low recovery when preparing extemporaneous oral suspensions.

WHAT IS NEW AND CONCLUSION

Physicians, pharmacists and nurses should know the procedures for drug administration by NGT, as well as the latest evidence on such administrations. There may not be bioequivalence between oral and nasogastric administrations. Care must be taken to avoid compromising the physicochemical, biopharmaceutical and pharmacological properties of drugs given by NGT to ensure their safety and efficacy.

Neuregulin-1 protects against doxorubicin-induced apoptosis in cardiomyocytes through an Akt-dependent pathway

In previous studies, it has been shown that recombinant human neuregulin-1(rhNRG-1) is capable of improving the survival rate in animal models of doxorubicin (DOX)-induced cardiomyopathy; however, the underlying mechanism of this phenomenon remains unknown. In this study, the role of rhNRG-1 in attenuating doxorubicin-induce apoptosis is confirmed. Neonatal rat ventricular myocytes (NRVMs) were subjected to various treatments, in order to both induce apoptosis and determine the effects of rhNRG-1 on the process. Activation of apoptosis was determined by observing increases in the protein levels of classic apoptosis markers (including cleaved caspase-3, cytochrome c, Bcl-2, BAX and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) staining). The activation of Akt was detected by means of western blot analysis. The study results showed that doxorubicin increased the number of TUNEL positive cells, as well as the protein levels of cleaved caspase-3 and cytochrome c, and reduced the ratio of Bcl-2/Bax. However, all of these effects were markedly antagonized by pretreament with rhNRG-1. It was then further demonstrated that the effects of rhNRG-1 could be blocked by the phosphoinositole-3-kinase inhibitor LY294002, indicating the involvement of the Akt process in mediating the process. RhNRG-1 is a potent inhibitor of doxorubicin-induced apoptosis, which acts through the PI3K-Akt pathway. RhNRG-1 is a novel therapeutic drug which may be effective in preventing further damage from occurring in DOX-induced damaged myocardium.

Melatonin inhibits cell growth and migration, but promotes apoptosis in gastric cancer cell line, SGC7901

The pineal hormone, melatonin (MLT), has been shown to have therapeutic effects in patients with gastric cancer; however, the mechanisms for the anti-cancer effects are unknown. We investigated the effects of melatonin on cell proliferation, apoptosis, colony formation and cell migration in the gastric adenocarcinoma cell line, SGC7901, using MTT assay, Hoechst 33258 staining, flow cytometry, western blot, caspase-3 activity assay, soft agar colony formation assay, and scratch-wound assay. Our results showed that melatonin could inhibit cell proliferation, colony formation and migration efficiency, and it promoted apoptosis of SGC7901 cells. Our findings suggest that the anti-cancer effects of melatonin may be due to both inhibition of tumor cell proliferation and reduction of the metastatic potential of tumor cells.

Pleural mesothelial cells promote expansion of IL-17-producing CD8+ T cells in tuberculous pleural effusion

IL-17-producing CD8(+) T lymphocytes (Tc17 cells) have recently been detected in many cancers and autoimmune diseases. However, the possible implication of Tc17 cells in tuberculous pleural effusion remains unclarified. In this study, distribution and phenotypic features of Tc17 cells in both tuberculous pleural effusion (TPE) and peripheral blood from patients with tuberculosis were determined. The effects of proinflammatory cytokines and local accessory cells (pleural mesothelial cells) on Tc17 cell expansion were also explored. We found that TPE contained more Tc17 cells than the blood. Compared with IFN-γ-producing CD8(+) T cells, Tc17 cells displayed higher expression of chemokine receptors (CCRs) and lower expression of cytotoxic molecules. In particularly, Tc17 cells in TPE exhibited high expression levels of CCR6, which could migrate in response to CCL20. Furthermore, IL-1β, IL-6, IL-23, or their various combinations could promote Tc17 cell expansion from CD8(+) T cells, whereas the proliferative response of Tc17 cells to above cytokines was lower than that of Th17 cells. Pleural mesothelial cells (PMCs) were able to stimulate Tc17 cell expansion via cell contact in an IL-1β/IL-6/IL-23 independent fashion. Thus this study demonstrates that Tc17 cells marks a subset of non-cytotoxic, CCR6(+) CD8(+) T lymphocytes with low proliferative capacity. The overrepresentation of Tc17 cells in TPE may be due to Tc17 cell expansion stimulated by pleural proinflammatory cytokines and to recruitment of Tc17 cells from peripheral blood. Additionally, PMCs may promote the production of IL-17 by CD8(+) T cells at sites of TPE via cell-cell interactions.

[The relationship between histological classification of lung cancer and protein tyrosine phosphatase]

BACKGROUND

To investigate the relationship between histological classification of lung cancer and protein tyrosine phosphatase.

METHODS

The expression of protein tyrosine phosphatase in bronchial epithelia from 34 patients with benign pulmonary lesions and 121 patients with primary pulmonary carcinoma was examined by immunohistochemical staining method.

RESULTS

The positive rate of protein tyrosine phosphatase expression was 95.03%±2.10% in 34 patients with benign pulmonary lesions, 43.59%±14.41% in 121 patients with primary pulmonary carcinoma; 47.57%±16.26% in 46 patients with adenocarcinoma, 40.59%±14.04% in 48 patients with squamous cell carcinoma, 42.13%±9.84% in 27 patients with adenosquamous carcinoma; 31.63%±10.34% in 21 patients with poor differentiated squamous cell carcinoma, 41.39%±9.35% in 18 patients with intermediate differentiated squamous cell carcinoma, 59.90%±8.61% in 9 patients with well differentiated squamous cell carcinoma; 34.14%±12.53% in 16 patients with poor differentiated adenocarcinoma, 52.10%±12.19% in 26 patients with intermediate differentiated adenocarcinoma, and 63.05%±15.84% in 4 patients with well differentiated adenocarcinoma. A significant difference of protein tyrosine phosphatase positive expression was observed between benign pulmonary lesions and primary pulmonary carcinomas, and between poor differentiated primary pulmonary carcinomas and well differentiated primary pulmonary carcinomas (P<0.01 or P<0.05).

CONCLUSIONS

Detection of protein tyrosine phosphatase may be helpful to differentiate pulmonary lesions from lung cancer and be regarded as one of the indices in predicting the prognosis of patients with primary pulmonary carcinomas.

Verification of flood damage modelling using insurance data

This paper presents the results of an analysis using insurance data for damage description and risk model verification, based on data from a Danish case. The results show that simple, local statistics of rainfall are not able to describe the variation in individual cost per claim, but are, however, feasible for modelling the overall cost per day. The study also shows that in combining the insurance and regional data it is possible to establish clear relationships between occurrences of claims and hazard maps. In particular, the results indicate that with improvements to data collection and analysis, improved prediction of damage costs will be possible, for example based also on socioeconomic variables. Furthermore, the paper concludes that more collaboration between scientific research and insurance agencies is needed to improve inundation modelling and economic assessments for urban drainage designs.

Activated human hydroxy-carboxylic acid receptor-3 signals to MAP kinase cascades via the PLC-dependent PKC and MMP-mediated EGFR pathways

BACKGROUND AND PURPOSE 3-Hydroxy-octanoate, recently identified as a ligand for, the orphan GPCR, HCA(3), is of particular interest given its ability to treat lipid disorders and atherosclerosis. Here we demonstrate the pathway of HCA(3)-mediated activation of ERK1/2. EXPERIMENTAL APPROACH Using CHO-K1 cells stably expressing HCA(3) receptors and A431 cells, a human epidermoid cell line with high levels of endogenous expression of functional HCA(3) receptors, HCA(3)-mediated activation of ERK1/2 was measured by Western blot. KEY RESULTS HCA(3)-mediated activation of ERK1/2 was rapid, peaking at 5 min, and was Pertussis toxin sensitive. Our data, obtained by time course analyses in combination with different kinase inhibitors, demonstrated that on agonist stimulation, HCA(3) receptors evoked ERK1/2 activation via two distinct pathways, the PLC/PKC pathway at early time points (≤ 2 min) and the MMP/ epidermal growth factor receptor (EGFR) transactivation pathway with a maximum response at 5 min. Furthermore, our present results also indicated that the βγ-subunits of the G(i) protein play a critical role in HCA(3)-activated ERK1/2 phosphorylation, whereas β-arrestins and Src were not required for ERK1/2 activation. CONCLUSIONS AND IMPLICATIONS We have described the molecular mechanisms underlying the coupling of human HCA(3) receptors to the ERK1/2 MAP kinase pathway in CHO-K1 and A431 cells, which implicate the G(i) protein-initiated, PLC/PKC -and platelet-derived growth factor receptor/EGFR transactivation-dependent pathways. These observations may provide new insights into the pharmacological effects and the physiological functions modulated by the HCA(3)-mediated activation of ERK1/2.

Cellulose nanocrystals/polyurethane nanocomposites. Study from the viewpoint of microphase separated structure

Cellulose nanocrystals (CNC) successfully obtained from microcrystalline cellulose (MCC) were dispersed in a thermoplastic polyurethane as matrix. Nanocomposites containing 1.5, 5, 10 and 30 wt% CNC were prepared by solvent casting procedure and properties of the resulting films were evaluated from the viewpoint of polyurethane microphase separated structure, soft and hard domains. CNC were effectively dispersed in the segmented thermoplastic elastomeric polyurethane (STPUE) matrix due to the favorable matrix-nanocrystals interactions through hydrogen bonding. Cellulose nanocrystals interacted with both soft and hard segments, enhancing stiffness and stability versus temperature of the nanocomposites. Thermal and mechanical properties of STPUE/CNC nanocomposites have been associated to the generated morphologies investigated by AFM images.

[A randomized clinical trial of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III non-small cell lung cancer]

BACKGROUND

To explore the feasibility and toxicity of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III NSCLC and to evaluate its effects on tumor response, resection rate, tumor downstaging, and survival rate.

METHODS

From Jan. 1990 to Jan. 2001, 624 patients were randomly devided into group A ( preoperative neoadjuvant chemotherapy group) and group B ( control group, without neoadjuvant chemotherapy) . Group A had 314 patients and group B had 310 cases. The patients in group A were give 2 cycles of neoadjuvant chemotherapy, and operations were performed in 4 weeks after finishing the last chemotherapy. Twenty-one patients were given bronchial artery intervensional chemotherapy. The other 293 cases were given intravenous chemotherapy. The regimens included MVP in 68 cases, CAP in 36 cases, EP in 67 cases, VIP in 20 cases, Gem+ DDP in 30 cases, NVB+ DDP in 32 cases, Taxol+ NVB in 30 cases, and Taxol+ DDP in 10 cases. The patients in group B were firstly operated. Thoracic radiation therapy of 50-55 Gy was g iven in the patients with N1 and N2 disease both in group A and group B.

RESULTS

The tumor response to induction chemotherapy was 73. 57%( 231/ 314) in group A. The tumor downstaging was 43. 63%( 137/ 314) . The histological complete response was 15. 92%( 50/ 314) . The resection rate was 97. 69% in group A, and 91. 94% in group B. No significant differences of blood loss, operative complications and mortality were observed between the group A and group B. The 1-, 3-, 5- and 10-year survival rates were 89. 35%, 67. 46% , 34. 39% and 29. 34% in group A, and 87. 53%, 51. 54%, 24. 19% and 21. 64% in group B respectively. The long-term survival rate in group A was remarkably higher than that in group B ( P < 0. 01) .

CONCLUSIONS

The results demonstrate that the preoperative neoadjuvant chemotherapy is safe and effective. It is helpful to decrease the tumor staging , to increase the resection rate of the tumor, and to improve the long-term survival rate and life qualities of patients with stage III NSCLC.

[Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer]

BACKGROUND

To summarize the results of extended resection of the heart, great vessels, or both in the treatment of 349 patients with locally advanced lung cancer.

METHODS

From February , 1983 to December, 2000, lobectomy or pneumonectomy combined with extended resection of the heart, great vessels or both were carried out in 349 patients with locally advanced lung cancer. The operations included bronchoplastic procedures and pulmonary artery reconstruction in 205 cases, extended resection of left atrium in 75 cases, superior vena cava resection and reconstruction in 65 cases ( 3 patients had carina resection and reconstruction simultaneously) , and aorta resection and reconstruction in 4 cases respectively.

RESULTS

There were two operative death. The operative mortality was 0. 6% in the series. Fifty-three patients had operative complications. The 1, 3, 5 and 10-year survival rates were 79. 36%, 59. 93%, 33. 14% and 23. 56% respectively.

CONCLUSIONS

Extended resection of the heart, great vessels or both can remarkably increase the long-term survival and improve the prognosis in patients with locally advanced lung cancer. Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer.

RFLP analysis of the progeny from Oryza alta Swallen x Oryza sativa L

RFLP analyses were carried out in the progeny from a cross of two phylogenetically distant rice species, wild rice Oryza alta Swallen (CCDD, 2n = 48) and cultivated rice O. sativa L. (AA, 2n = 24). The sterile plants gave heterozygous RFLP patterns at most of the loci detected. They looked more like their wild rice parent, with 36 chromosomes in their root-tip cells and pollen mother cells. In two partially fertile plants, however, most of the markers that were used showed RFLP patterns similar to the cultivated parent, O. sativa. By cytological study, it was found that nearly one-third of the chromosomes had been eliminated in the partially fertile plants. Their seeds have short awns, which is a characteristic of their wild parent, O. alta. An introgression occurred in one of the partially fertile plants, which led to the discussion about a nonconventional mechanism in wide hybridization for transference of wild rice chromosome segments to cultivated rice chromosomes.

Experimental study of single-pin puncture asymmetrical hydroablation using a conformational radiofrequency ablation electrode in ex vivo ox liver

OBJECTIVE

The aim of this study was to evaluate the feasibility of single-pin puncture asymmetrical hydroablation in liver using the multipole cluster conformable radiofrequency ablation electrode.

METHODS

The conformable electrode used in this study consists of both a main electrode in a central cannula and a circle of subelectrodes comprising two groups of six subelectrodes located on opposite sides (A and B) of the circle. The two subelectrode groups can be extended to different lengths independently of one another, resulting in asymmetrical shapes. Ablation experiments were performed using ex vivo ox liver. The experiments included six groups based on six potential electrode deployments in which the subelectrodes on sides A and B were fully extended, half extended or fully retracted. After ablation, the transverse diameters of the resulting necrotic tissue from sides A and B were measured. The experiment was conducted in 12 separate sites for each group.

RESULTS

When the subelectrodes were arranged symmetrically (either fully extended or half extended on both sides), the mean transverse diameter of necrotic tissue was similar for both sides A and B. When the subelectrodes were arranged asymmetrically, the fully extended side showed a significantly greater mean transverse diameter of necrotic tissue than the half extended or fully retracted side.

CONCLUSION

In this study, the WHK 3-8-4 multipole cluster conformable radiofrequency ablation electrode was able to produce both symmetrical and asymmetrical necrotic tissue patterns in the liver.

ADVANCES IN KNOWLEDGE

The size and shape of the ablation can be altered by both withdrawing and extending the subelectrodes to different lengths.