Effectiveness and safety assessment of lamotrigine monotherapy for treatment of epilepsy

BACKGROUND

Epilepsy is a recurrent chronic nervous system disease. A correct choice of antiepileptic drug is the key to control seizures and improve patient's life quality.

AIM

To study the effectiveness and safety of lamotrigine monotherapy for treatment of epilepsy, systemic evaluation was carried out on published comparative trials between lamotrigine and carbamazepine.

METHODS

The retrieval method referred to the search strategy developed by Cochrane Epilepsy Group and software Rev.Man 5 was used for META analysis and forest plots. The Odds ratio (OR) was selected as the effect size and funnel plot was used to analyze the publication bias.

RESULTS

A total of 9 studies and 2269 cases of patients were included in the analysis. There was no significant difference between lamotrigine and carbamazepine for treatment of epilepsy as the OR was 1.17, 95% confidence interval (CI) [0.88, 1.54]. However, lamotrigine had advantages in the overall withdrawal rate and withdrawal rate due to side effects as the ORs were 0.57, 95% CI [0.47, 0.69] and 0.41, 95% CI [0.32, 0.52].

CONCLUSIONS

Lamotrigine has certain advantages over carbamazepine for treatment of epilepsy as it has less side effects and higher tolerability. In addition, the quality of such clinical trials should be further improved to have a more comprehensive understanding.

Meta-analysis demonstrates lack of association of the hOGG1 Ser326Cys polymorphism with bladder cancer risk

The functional polymorphism Ser326Cys (rs1052133) in the human 8-oxoguanine DNA glycosylase (hOGG1) gene has been implicated in bladder cancer risk. However, reports of this association between the Ser326Cys polymorphism and bladder cancer risk are conflicting. In order to help clarify this relationship, we made a meta-analysis of seven case-control studies, summing 2521 cases and 2408 controls. We used odds ratios (ORs) with 95% confidence intervals (95%CIs) to assess the strength of the association. Overall, no significant association between the hOGG1 Ser326Cys polymorphism and bladder cancer risk was found for Cys/Cys vs Ser/Ser (OR = 1.10, 95%CI = 0.74-1.65), Ser/Cys vs Ser/Ser (OR = 1.07, 95%CI = 0.81-1.42), Cys/Cys + Ser/Cys vs Ser/Ser (OR = 1.08, 95%CI = 0.87-1.33), and Cys/Cys vs Ser/Cys + Ser/Ser (OR = 1.04, 95%CI = 0.65-1.69). Even when stratified by ethnicity, no significant association was observed. We concluded that the hOGG1 Ser326Cys polymorphism does not contribute to susceptibility to bladder cancer.

Impact of dose hot spots on spinal cord tolerance following stereotactic body radiotherapy: a generalized biological effective dose analysis

The purpose of this study was to investigate the effects of high-dose inhomogeneous irradiation to small volumes of spinal cord with a new generalized biological effective dose (gBED) analysis for spine stereotactic body radiotherapy (SBRT). The gBED was applied to spinal cord dosimetric data (contoured per the thecal sac) at specified volumes for a cohort of five patients with radiation-induced myelopathy (RM) and compared to nineteen patients without RM post-SBRT. The spinal cord gBED was calculated and normalized to a conventional 2-Gy equivalent dose fraction scheme (α/β = 2 Gy for late toxicity). Differences between the conventional BED and those gBED calculations by accounting for small-volume dosing within the spinal cord was observed. Statistically significant differences in the mean gBED between the RM group and the non-RM group was observed both at the maximum point volume (gBED of 66 Gy vs. 37 Gy (p = 0.01), respectively) and at the 0.1 cm(3) volume (gBED of 53 Gy vs. 28 Gy (p = 0.01), respectively). No significant difference at the 0.1 cm(3) volume was observed based on the mean BED comparisons. No significant differences were observed at the larger 1 cm(3), 2 cm(3) or 5 cm(3) volumes for either BED or gBED comparisons. We conclude that differences in dose hot spots characteristics within small inhomogenously irradiated volumes of spinal cord can affect spinal cord tolerance following SBRT treatments.

Nitrogen and phosphorus use efficiencies and losses in the food chain in China at regional scales in 1980 and 2005

Crop and animal production in China has increased significantly during the last decades, but at the cost of large increases in nitrogen (N) and phosphorus (P) losses, which contribute to ecosystem degradation and human health effects. This information is largely based on scattered field experiments, surveys and national statistics. As a consequence, there is as yet no comprehensive understanding of the changes in N and P cycling and losses at regional and national scales. Here, we present the results of an integrated assessment of the N and P use efficiencies (NUE and PUE) and N and P losses in the chain of crop and animal production, food processing and retail, and food consumption at regional scale in 1980 and 2005, using a uniform approach and databases. Our results show that the N and P costs of food production-consumption almost doubled between 1980 and 2005, but with large regional variation. The NUE and PUE of crop production decreased dramatically, while NUE and PUE in animal production increased. Interestingly, NUE and PUE of the food processing sector decreased from about 75% to 50%. Intake of N and P per capita increased, but again with large regional variation. Losses of N and P from agriculture to atmosphere and water bodies increased in most regions, especially in the east and south of the country. Highest losses were estimated for the Beijing and Tianjin metropolitan regions (North China), Pearl River Delta (South China) and Yangzi River Delta (East China). In conclusion, the changes and regional variations in NUE and PUE in the food chain of China are large and complex. Changes occurred in the whole crop and animal production, food processing and consumption chain, and were largest in the most populous areas between 1980 and 2005.

Chemical composition tuning of the anomalous Hall effect in isoelectronic L10FePd(1-x)Pt(x) alloy films

The anomalous Hall effect (AHE) in L1(0)FePd(1-x)Pt(x) alloy films is studied both experimentally and theoretically. We find that the intrinsic contribution (σ(AH)(int)) to the AHE can be significantly increased, whereas the extrinsic side-jump contribution (σ(AH)(sj)) can be continuously reduced from being slightly larger than σ(AH)(int) in L1(0) FePd to being much smaller than σ(AH)(int) in L1(0) FePt, by increasing the Pt composition x. We show that this chemical composition tuning of the intrinsic contribution is afforded by the stronger spin-orbit coupling strength on the Pd/Pt site when the lighter Pd atoms are replaced by the heavier Pt atoms. Our results provide a means of manipulating the competing AHE mechanisms in ferromagnetic alloys for fully understanding the AHE and also for technological applications of ferromagnetic alloys.

Contrast-enhanced 3T high-resolution MR imaging in symptomatic atherosclerotic basilar artery stenosis

BACKGROUND AND PURPOSE

Contrast-enhanced 3T high-resolution MR imaging can be used to determine the wall enhancement pattern of the basilar artery in symptomatic atherosclerotic stenosis. We used this method to explore the relationship between wall enhancement and both recent infarction in the territory of the stenotic BA and subsequent ischemic events associated with the stenotic BA.

MATERIALS AND METHODS

Sixty patients with symptomatic atherosclerotic BA stenosis ≥70% were enrolled consecutively. HR-MRI of cross-sectional BAs was obtained before and after contrast media injection, and wall enhancement indices were calculated for sections proximal to, at, and distal to the site of maximal luminal narrowing. DWI of the brain was performed to determine the presence of recent infarction.

RESULTS

Images from 56 patients were suitable for analysis. Thirty-three patients underwent stent placement for the stenotic BA, and 23 patients underwent conservative medical treatment with antiplatelet agents and risk-factor control. All 23 patients with medical treatment had a 12-month follow-up. Greater wall enhancement was seen in the section proximal to the MLN section in both patients with recent infarction (74 ± 65% versus 44 ± 44%; P = .046) and in patients with subsequent ischemic events (100 ± 57% versus 44 ± 44%; P = .014).

CONCLUSIONS

Greater wall enhancement proximal to the MLN site correlates with recent infarction in the territory of the stenotic BA and subsequent ischemic events associated with the stenotic BA. Contrast-enhanced HR-MRI may serve as a noninvasive tool for risk stratification of BA atherosclerosis.

The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER)

BACKGROUND

While guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are widely available, clinical uptake of guidelines remains low. Our objective was to evaluate the effect of guideline-consistent CINV prophylaxis (GCCP) on patient outcomes.

PATIENTS AND METHODS

This prospective, observational multicenter study enrolled chemotherapy-naive adults initiating single-day highly or moderately emetogenic chemotherapy (HEC or MEC) for cancer. Patients completed 6-day daily diaries beginning with cycle 1 for up to three chemotherapy cycles. The primary study end point, complete response (no emesis and no use of rescue therapy) during 120 h after cycle 1 chemotherapy, was compared between GCCP and guideline-inconsistent CINV prophylaxis (GICP) cohorts using multivariate logistic regression, adjusting for potential confounding factors.

RESULTS

In cycle 1 (N=991), use of GCCP was 55% and 46% during acute and delayed phases, respectively, and 29 % for the overall study period (acute plus delayed phases). Complete response was recorded by 172/287 (59.9%) and 357/704 (50.7%) patients in GCCP and GICP cohorts, respectively (P=0.008). The adjusted odds ratio for complete response was 1.43 (95% confidence interval 1.04-1.97; P=0.027) for patients receiving GCCP versus GICP.

CONCLUSION

GCCP reduces the incidence of CINV after single-day HEC and MEC.

Polymorphisms in the IL-13 and IL-4R genes are associated with the development of renal cell carcinoma

BACKGROUND

Cytokines are the important modulators that bind to their relevant receptors in response to some stimuli to mediate the homeostasis. It has been suggested that the imbalance of immune system of the host might affect the generation of diseases, including cancers.

PATIENTS AND METHODS

We investigated the association between six functional polymorphisms of IL-4, IL-13, and IL-4R genes and susceptibility to renal cell cancer in a hospital-based study, including 620 renal cell carcinoma (RCC) patients and 623 controls. Logistic regression model was used to assess the genetic effects on the development of RCC.

RESULTS

Overall, individuals with IL-4R Ile50Val CT/TT genotypes had a 0.34-fold significantly decreased RCC risk (CT/TT versus CC), and the T variant allele was associated with a decreased risk of RCC in a dose-response manner (Ptrend=0.009). In addition, we also observed that IL-13 C-1055T and Arg130Gln polymorphisms could decrease the risk of RCC [TT versus

CC/CT

odds ratio=0.36, 95% confidence interval (CI)=0.16-0.78; AA versus GG/GA: 0.66, 0.44-0.97, respectively]. Furthermore, a multiplicative interaction association between the combined IL-4R Ile50Val and IL-13 C-1055T genotypes was observed to decrease the risk of RCC (P=0.036).

CONCLUSION

IL-13 and IL-4R may play an important role in the etiology of RCC.

A new solid oral tablet formulation of posaconazole: a randomized clinical trial to investigate rising single- and multiple-dose pharmacokinetics and safety in healthy volunteers

Objectives

Posaconazole is an extended-spectrum triazole with proven efficacy as antifungal treatment and prophylaxis. The marketed oral suspension should be taken with food to maximize systemic absorption. A new solid oral tablet has been developed with improved bioavailability that can be administered without regard to food. The aim of this study was to evaluate rising single- and multiple-dose pharmacokinetics, safety and tolerability of the new tablet.

Methods

This was a single-centre, randomized, placebo-controlled, Phase I, rising single- and multiple-dose study of healthy subjects aged 18–65 years who received a posaconazole tablet as 200 mg once daily, 200 mg twice daily or 400 mg once daily. The 24 subjects were studied in two cohorts of 12 subjects each (9 active and 3 placebo).

Results

After single or multiple oral dose administration of posaconazole tablets (200 and 400 mg), exposure increased in a dose-related manner. Peak posaconazole concentrations were attained at a median T_max of 4–5 h. Mean half-life was similar for 200 and 400 mg posaconazole doses (25 and 26 h). The accumulation ratio upon multiple doses over 8 days was ∼3 for 200 and 400 mg once daily and ∼5 for 200 mg twice daily. C_avg values exceeded 1300 ng/mL. The posaconazole oral tablet was safe and well tolerated, although mild, transient elevations in liver function were reported in some patients.

Conclusions

Posaconazole exposure increased in a dose-related manner. The pharmacokinetics of this new solid oral tablet of posaconazole supports the clinical evaluation of once-daily dosing regimens for fungal infections.

The effect of lubrication on the friction and wear of Biolox®delta

The performance of total hip-joint replacements depends strongly on the state of lubrication in vivo. In order to test candidate prosthetic materials, in vitro wear testing requires a lubricant that behaves in the same manner as synovial fluid. The current study investigated three lubricants and looked in detail at the lubrication conditions and the consequent effect on ball-on-flat reciprocating wear mechanisms of Biolox®delta against alumina. Biolox®delta, the latest commercial material for artificial hip-joint replacements, is an alumina-matrix composite with improved mechanical properties through the addition of zirconia and other mixed oxides. Three commonly used laboratory lubricants, ultra pure water, 25 vol.% new-born calf serum solution and 1 wt.% carboxymethyl cellulose sodium salt (CMC-Na) solution, were used for the investigation. The lubrication regimes were defined by constructing Stribeck curves. Full fluid-film lubrication was observed for the serum solution whereas full fluid-film and mixed lubrications were observed in both water and the CMC-Na solution. The wear rates in the CMC-Na and new-born calf serum were similar, but were an order of magnitude higher in water. The worn surfaces all exhibited pitting, which is consistent with the transition from mild wear to severe or "stripe" wear. The extent of pitting was greatest in the serum solution, but least in the water. On all worn surfaces, the zirconia appeared to have fully transformed from tetragonal to monoclinic symmetry. However, there was no evidence of microcracking associated with the transformed zirconia. Nevertheless, AFM indicated that zirconia was lost preferentially to the alumina grains during sliding. Thus, the current study has shown conclusively that the wear mechanisms for Biolox®delta clearly depend on the lubricant used, even where wear rates were similar.

SU-E-T-446: Effect of Dose Calculation Grid Size Variability on the Specification of Spinal Cord Dose Tolerance for Spinal Stereotactic Body Radiation Therapy

PURPOSE

To investigate the effect of the dose grid resolution variability on the spinal cord dose for spinal SBRT treatments.

METHOD

10 CyberKnife plans were selected for the proximity of the PTV to the spinal cord. All dose distributions were calculated with Monte Carlo using high spatial resolution and minimal relative uncertainty. The plans were renormalized to a 16 Gy prescription dose and to ensure a target coverage > 95% in order to compare the calculated dose distributions. Each dose matrix was resampled 12 times, covering a grid resolution range of 0.95 mm to 13.52 mm. The spinal cord DVHs were generated for each resampled dose grid. The variations of the maximum point dose (DmaxCord) and dose-coverage to partial volumes (D[V]) up to 5 cc were investigated against the grid resolution.

RESULTS

The mean variation of DmaxCord with grid resolution is characterized by an inverse power law, with a sharp initial decrease leading to potentially large underestimates of DmaxCord (24%, 40% and 55% at resolutions of 2 mm, 4 mm and 8 mm). The variability of mean D[V] values decreases from smaller to larger grid resolutions, however large disparities are observed between patient plans. We introduced the variability threshold volume (Vth) as a constraint to express the dose coverage independently from the grid resolution. For resolutions up to 8 mm, the mean Vth value is (0.96±0.10) cc with a corresponding dose coverage of (26± 12) % relative to the initial DmaxCord value.

CONCLUSIONS

Dose distributions calculated with grid resolutions larger than 2 mm could Result in significant underestimates of DmaxCord. Furthermore, the sensitivity of the dose coverage to grid resolution variability is patient dependent. Consequently, a specified cord dose tolerance should be quoted at a particular grid resolution uniformly adopted between institutions; 2 mm or less is an appropriate value.

Rational design of anti-microbial peptides with enhanced activity and low cytotoxicity based on the structure of the arginine/histidine-rich peptide, chensinin-1

AIMS

To understand the structure-activity relationship of chensinin-1, a anti-microbial peptide (AMP) with an unusual structure, and to develop novel AMPs as therapeutic agents.

METHODS AND RESULTS

A series of chensinin-1 analogues were designed and synthesized by one to three replacement of glycines with leucines at the hydrophilic face of chensinin-1 or rearrangement of some of the residues in its sequence. Circular dichroism spectroscopy showed that the analogues adopted α-helical-type conformations in 50% trifluoroethanol/water but adopted β-strand-type conformations in 30 mmol l(-1) sodium dodecyl sulphate. The anti-microbial activities of the peptides against Gram-positive bacteria increased 5- to 30-fold, and these increases paralleled the increases in the peptides' hydrophobicities. Their haemolytic activities also increased. Amphipathicities had little influence on the bactericidal activity of chensinin-1. All peptides caused leakage of calcein entrapped in negatively charged liposomes although with different efficiencies. The peptides did not induce leakage of calcein from uncharged liposomes.

CONCLUSIONS

Peptide adopted an aperiodic structure can improve the anti-microbial potency by increasing peptide hydrophobicity. Its target is bacteria plasma membrane.

SIGNIFICANCE AND IMPACT OF THE STUDY

Chensinin-1 can act as a new lead molecule for the study of AMPs with atypical structures.

Ghrelin contributes to derangements of glucose metabolism induced by rapamycin in mice

AIMS/HYPOTHESIS

Rapamycin impairs glucose tolerance and insulin sensitivity. Our previous study demonstrated that rapamycin significantly increases the production of gastric ghrelin, which is critical in the regulation of glucose metabolism. Here, we investigated whether ghrelin contributes to derangements of glucose metabolism induced by rapamycin.

METHODS

The effects of rapamycin on glucose metabolism were examined in mice receiving ghrelin receptor antagonist or with Ghsr1a gene knockout. Changes in GLUT4, c-Jun N-terminal kinase (JNK) and phosphorylated ribosomal protein S6 (pS6) were investigated by immunofluorescent staining or western blotting. Related hormones were detected by radioimmunoassay kits.

RESULTS

Rapamycin impaired glucose metabolism and insulin sensitivity not only in normal C57BL/6J mice but also in both obese mice induced by a high fat diet and db/db mice. This was accompanied by elevation of plasma acylated ghrelin. Rapamycin significantly increased the levels of plasma acylated ghrelin in normal C57BL/6J mice, high-fat-diet-induced obese mice and db/db mice. Elevation in plasma acylated ghrelin and derangements of glucose metabolism upon administration of rapamycin were significantly correlated. The deterioration in glucose homeostasis induced by rapamycin was blocked by D: -Lys3-GHRP-6, a ghrelin receptor antagonist, or by deletion of the Ghsr1a gene. Ghrelin receptor antagonism and Ghsr1a knockout blocked the upregulation of JNK activity and downregulation of GLUT4 levels and translocation in the gastrocnemius muscle induced by rapamycin.

CONCLUSIONS/INTERPRETATION

The current study demonstrates that ghrelin contributes to derangements of glucose metabolism induced by rapamycin via altering the content and translocation of GLUT4 in muscles.

SU-D-211-04: Sector Intensity Modulated (SIM) Gamma Knife Stereotactic Radiosurgery

PURPOSE

The latest Gamma Knife (GK) system, Perfexion, consists of 192 Co-60 sources divided into eight sectors. Treatment delivery includes multiple shots placed at different positions. For every shot, each sector can be either blocked or open with four different aperture sizes. However, the beam-on time is designed to be fixed. We proposed an innovative concept, Sector Intensity Modulated (SIM) Gamma Knife by dynamically varying the beam-on time for each individual sector to improve stereotactic radiosurgery planning quality.

METHODS

The anatomic structures and dose matrices from each sector for every shot were obtained from the GK workstation. The beam-on time for each sector was decomposed with various discrete levels and brute-force algorithm was used to get the optimal solution. The resulting SIM plan was then re-entered into the GK workstation. Six indices were used to benchmark the plan quality: Coverage, Conformality, Gradient, Maximum Dose(s) to critical structure(s), Volume receiving over 8 and 12 Gy. All the SIM plans in comparison with the original plans were further reviewed by an experienced oncologist.

RESULTS

The simulations were tested on various pituitary adenoma cases. Results consistently showed that SIM yielded better plans with all quantitative indices improved compared to original plan. It provides better conformality, quicker drop off of the isodose line outside the tumor, lower doses to the critical structures as optical- nerve/chiasm while maintaining at least 99% coverage of the tumor. Results were more favorable according to oncologist's view. In particular, up to 20% or 0.6 cc volume decrease in healthy tissue receiving 8 Gy was observed. This may translate into clinically observable reduction in acute/late toxicities.

CONCLUSIONS

Our preliminary results show that Sector Intensity Modulated Gamma Knife offers superior treatment plans compared to the originally delivered plans. Further works as adding dynamic shot location and dynamic shot shaping will be discussed.

Evaluation of the prognosis of fulminant viral hepatitis in late pregnancy by the MELD scoring system

The purpose of this paper was to analyze the prognosis of women with fulminant viral hepatitis in late pregnancy (FVHILP) by the Model for End-Stage Liver Disease (MELD) scoring system. A retrospective study involving patients admitted to two tertiary hospitals between January 1, 1994 and June 30, 2011 was undertaken. The relations between MELD scores and change of MELD score over time (ΔMELD) and prognosis during hospitalization were analyzed. Among the 54 patients with FVHILP, the MELD scores on admission were significantly higher in the non-survival group than those in the survival group (p < 0.05). Among the 26 FVHILP patients who underwent cesarean section, the MELD scores before and after cesarean section were both significantly higher in the non-survival group (p < 0.05). The ΔMELD scores (before operation and three days after operation) significantly increased in the non-survival group (p < 0.05). The concordance (c-statistic) values were all greater than 0.8. The MELD scoring system shows excellent short-term predictive value for the prognosis of FVHILP.