The effect of hierarchical micro/nanosurface titanium implant on osseointegration in ovariectomized sheep

Hydrofluoric etching and anodized hierarchical micro/nanotextured surface titanium implant was placed in mandibles of ovariectomized sheep for 12 weeks, and it showed improved osseointegration by resonance frequency analysis (RFA), microcomputed tomography (micro-CT) evaluation, histomorphometry, and biomechanical test.

INTRODUCTION

This study aimed to investigate the effects of micro/nanotextured titanium implant on osseointegration in ovariectomized (OVX) sheep.

METHODS

The hierarchical micro/nanotextured surface of titanium implant was fabricated by acid in 0.5% (w/v) hydrofluoric (HF) and anodized in HF acid electrolytes with a DC power of 20 V, and the machined surface implants with no treatment served as control group. The implants were placed in mandibles of OVX sheep, respectively. Twelve weeks after implantation, RFA, microcomputed tomography, histomorphometry, and biomechanical tests were applied to detect the osseointegration of the two groups.

RESULTS

The implant stability quotient (ISQ) values, the maximum pull-out forces, and the bone-implant contact (BIC) were 65.5 ± 6.3, 490.6 ± 72.7 N, and 58.31 ± 5.79% in the micro/nanogroup and 58.3 ± 8.9, 394.5 ± 54.5 N, and 46.85 ± 5.04% in the control group, respectively. There was no significant difference between the two groups in ISQ values (p > 0.05), but in the micro/nanogroup, the maximal pull-out force and the BIC were increased significantly (p < 0.05 or p < 0.01). Micro-CT analysis showed that the bone volume ratio and the trabecular number increased significantly (p < 0.01), and the trabecular separation decreased significantly (p < 0.05) in the micro/nanogroup.

CONCLUSION

Implant modification by HF acid etching and anodization to form a hierarchical micro/nanotextured surface could improve titanium implant osseointegration in OVX sheep 12 weeks after implantation.

Part 5. Public health and air pollution in Asia (PAPA): a combined analysis of four studies of air pollution and mortality

BACKGROUND

In recent years, Asia has experienced rapid economic growth and a deteriorating environment caused by the increasing use of fossil fuels. Although the deleterious effects of air pollution from fossil-fuel combustion have been demonstrated in many Western nations, few comparable studies have been conducted in Asia. Time-series studies of daily mortality in Asian cities can contribute important new information to the existing body of knowledge about air pollution and health. Not only can these studies verify important health effects of air pollution in local regions in Asia, they can also help determine the relevance of existing air pollution studies to mortality and morbidity for policymaking and environmental controls. In addition, the studies can help identify factors that might modify associations between air pollution and health effects in various populations and environmental conditions. Collaborative multicity studies in Asia-especially when designed, conducted, and analyzed using a common protocol-will provide more robust air pollution effect estimates for the region as well as relevant, supportable estimates of local adverse health effects needed by environmental and public-health policymakers.

SPECIFIC OBJECTIVES

The Public Health and Air Pollution in Asia (PAPA*) project, sponsored by the Health Effects Institute, consisted of four studies designed to assess the effects of air pollution on mortality in four large Asian cities, namely Bangkok, in Thailand, and Hong Kong, Shanghai, and Wuhan, in China. In the PAPA project, a Common Protocol was developed based on methods developed and tested in NMMAPS, APHEA, and time-series studies in the literature to help ensure that the four studies could be compared with each other and with previous studies by following an established protocol. The Common Protocol (found at the end of this volume) is a set of prescriptive instructions developed for the studies and used by the investigators in each city. It is flexible enough to allow for adjustments in methods to optimize the fit of health-effects models to each city's data set. It provides the basis for generating reproducible results in each city and for meta-estimates from combined data. By establishing a common methodology, factors that might influence the differences in results from previous studies can more easily be explored. Administrative support was provided to ensure that the highest quality data were used in the analysis. It is anticipated that the PAPA results will contribute to the international scientific discussion of how to conduct and interpret time-series studies of air pollution and will stimulate the development of high-quality routine systems for recording daily deaths and hospital admissions for time-series analysis.

METHODS

Mortality data were retrieved from routine databases with underlying causes of death coded using the World Health Organization (WHO) International Classification of Diseases, 9th revision or 10th revision (ICD-9, ICD-10). Air quality measurements included nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter with aerodynamic diameter < or = 10 microm (PM10), and ozone (O3) and were obtained from several fixed-site air monitoring stations that were located throughout the metropolitan areas of the four cities and that met the standards of procedures for quality assurance and quality control carried out by local government units in each city. Using the Common Protocol, an optimized core model was established for each city to assess the effects of each of the four air pollutants on daily mortality using generalized linear modeling with adjustments for time trend, seasonality, and other time-varying covariates by means of a natural-spline smoothing function. The models were adjusted to suit local situations by correcting for influenza activity, autocorrelation, and special weather conditions. Researchers in Hong Kong, for example, used influenza activity based on frequency of respiratory mortality; researchers in Hong Kong and Shanghai used autoregressive terms for daily outcomes at lag days; and researchers in Wuhan used additional smoothing for periods with extreme weather conditions.

RESULTS AND DISCUSSION

For mortality due to all natural (nonaccidental) causes at all ages, the effects of air pollutants per 10-microg/m3 increase in concentration was found to be higher in Bangkok than in the three Chinese cities, with the exception of the effect of NO2 in Wuhan. The magnitude of the effects for cardiovascular and respiratory mortality were generally higher than for all natural mortality at all ages. In addition, the effects associated with PM10 and O3 in all natural, cardiovascular; and respiratory mortality were found to be higher in Bangkok than in the three Chinese cities. The explanation for these three findings might be related to consistently higher daily mean temperatures in Bangkok, variations in average time spent outdoors by the susceptible populations, and the fact that less air conditioning is available and used in Bangkok than in the other cities. However, when pollutant concentrations were incorporated into the excess risk estimates through the use of interquartile range (IQR), the excess risk was more comparable across the four cities. We found that the increases in effects among older age groups were greater in Bangkok than in the other three cities. After excluding data on extremely high concentrations of PM10 in Bangkok, the effect estimate associated with PM10 concentrations decreased in Bangkok (suggesting a convex relationship between risk and PM10, where risk levels off at high concentrations) instead of increasing, as it did in the other cities. This leveling off of effect estimates at high concentrations might be related to differences in vulnerability and exposure of the population to air pollution as well as to the sources of the air pollutant. IMPLICATIONS OF THE STUDY: The PAPA project is the first coordinated Asian multicity air pollution study ever published; this signifies the beginning of an era of cooperation and collaboration in Asia, with the development of a common protocol for coordination, data management, and analysis. The results of the study demonstrated that air pollution in Asia is a significant public health burden, especially given the high concentrations of pollutants and high-density populations in major cities. When compared with the effect estimates reported in the research literature of North America and Western Europe, the study's effect estimates for PM10 were generally similar and the effect estimates for gaseous pollutants were relatively higher. In Bangkok, however, a tropical city where total exposures to outdoor pollution might be higher than in most other cities, the observed effects were greater than those reported in the previous (i.e., Western) studies. In general, the results suggested that, even though social and environmental conditions across Asia might vary, it is still generally appropriate to apply to Asia the effect estimates for other health outcomes from previous studies in the West. The results also strongly support the adoption of the global air quality guidelines recently announced by WHO.

Selection of the distraction implant length with improved biomechanical properties by three-dimensional finite element analysis

In this study, the distraction length of distraction implant was set as input variable which ranged from 2 to 10 mm. The effect of distraction length on the maximum Von Mises stress in the jaw bones and the implant were evaluated by a finite element method. The results showed that under axial load, the maximum equivalent stresses in cortical bone, cancellous bone, and distraction screw decreased by 5·8%, 8·6%, and 11·0%, respectively, with the changing of distraction length, and under buccolingual load those decreased by 0·3%, 18·0%, and 13·0%, respectively. The data indicate that cancellous bone is more sensitive to distraction length than the cortical bone. Under both loads, the central distraction screw was subjected to the stress concentration and more easily damaged by buccolingual force than by axial force. Distraction implant with distraction length exceeding 8 mm showed relatively better biomechanical behaviour.

Further evaluation of 11C-PD153035 as a molecular imaging probe for the assessment of the epidermal growth factor receptor status in non-small cell lung cancer patients

3590

Background: Epidermal growth factor receptor (EGFR) plays a key role in tumorgenosis and is therefore an important target for new therapeutic and prognostic strategies. Our pilot study has demonstrated that 11C-PD153035, a highly EGFR selective tracer for positron emission tomography (PET), accumulated in tumor mass of non-small cell lung cancer (NSCLC) and the tracer uptake correlated with EGFR expression. Here, we further evaluate correlation between the intensity of 11C-PD153035 uptake and EGFR protein expression level and gene mutation. Methods: Fourteen patients (45–71y, mean 59.2±9.2 y, Male: Female = 8:6, squamous carcinoma: adenocarcinoma = 9:5) with pathologically proved NSCLC were examined with PET using 11C-PD153035 one week before surgery. Radioactivity concentrations, derived from regions of interest (ROI), were analyzed mathematically to maximum standardized uptake value (SUVmax). The EGFR protein expression of surgical specimen was utilized by immunohistochemistry (IHC) with a three-tier system intensity scored and Western Blot assay. The EGFR genetic alterations in exon 19 and 21 were examined by direct sequencing of polymerase chain reaction (PCR) products. Results: 11C-PD153035 uptake was observed in 9 out of 14 NSCLC patients (mean SUV 3.94±1.06, range 0.8–5.9) and the biodistribution study further demonstrated accumulation of radioactivity in the tumor mass. The SUVmax of 11C-PD153035 molecular images did not correlate with tumor size and injection dose of the tracer. A closely correlation between SUVmax and EGFR protein expression as determined by IHC (r = 0.84, p = 0.005) was observed but not with the protein expression level of Western Blot analysis (r = 0.442, p = 0.114), as well as EGFR exon 19 (r = -0.078, p = 0.790) or exon 21 (r = 0.118, p = 0.689) gene mutation. With ROC analysis according to IHC intensity, the cut-off value of SUVmax was 2.45. Conclusions: PET with 11C-PD153035 might therefore be used to visualize EGFR pattern on tumor in NSCLC patients and for individualized planning of therapeutic strategies with EGFR targeted drugs, especially small-molecule TKIs (gefitinib and erlotinib) which targeting the intracellular EGFR tyrosine kinase domain as PD153035.

No significant financial relationships to disclose.

The role of whole body 18F-FDG PET/CT scan in patients with carcinoma of unknown primary

e22051

Background: Carcinoma of unknown primary (CUP) is a heterogeneous group of tumors and usually follows an aggressive biological and clinical behavior. Difficult challenges in oncology which the identification of the primary tumor and a complete disease staging could offer a more rational and efficient treatment in order to improve the survival time. Our aim was to evaluate the role of 18F-FDG PET/CT scan with two aspects: detection of the primary site, and estimation of tumor biological behavior which essential for the development of new, individual and targeted effective therapies. Methods: One hundred and seventeen patients presenting with histologically confirmed metastatic carcinoma (76 lymph nodes, 41 visceral biopsy proven) of unknown primary site were included in this retrospective study. The evaluations as follows had not revealed a primary site: detailed medical history, full physical and laboratory examinations, and diagnostic imaging methods. All patients underwent PET/CT. Results: In 42 (35.90%) patients, a primary tumor site which was confirmed by follow-up or surgery was showed by PET/CT. In 15 (12.82%) patients, the primary tumor site was suggested by PET/CT but not confirmed. In 60 (51.28%) patients, the primary tumor site was not localized modifying the stage of disease. In the other 17 (14.53%) patients, PET/CT scan identified further unexpected metastases. Overall, the following oncological treatment was influenced by the PET/CT scan, in a total of 38 (32.47%) patients. Between the adenocarcinoma and squamous cell carcinoma groups, no significant difference in SUVmax was found ( t=1.191, p = 0.244). A significantly higher SUVmax was found among patients with poorly or undifferentiated carcinoma compared with patients with well to moderately ( t=4.013, p<0.01) differentiation; In 42 patients with a confirmed primary tumor site, the SUVmax of Metastatic tumours have a closely relationship correlate with those of primary tumours, ( r=0.738, p<0.01). Furthermore, a significantly higher SUVmax was found among metastases compared with primary tumors ( t=3.470, p<0.01). Conclusions: Our data strongly support 18F-FDG PET/ CT imagings not only provide new insights in the diagnosis and staging of patients with CUP, but also evaluate biologic characters of tissue. 1

No significant financial relationships to disclose.

A comparative study of the skeletal morphology of the temporo-mandibular joint of children and adults

BACKGROUND

The skeletal morphology of the temporo-mandibular joint (TMJ) is constantly remodeled.

AIMS AND OBJECTIVES

A comparative study was undertaken to determine and characterize the differences in the skeletal morphology of TMJ of children and adults.

MATERIALS AND METHODS

The study was conducted on 30 children cadavers and 30 adult volunteers. Parameters that could reflect TMJ skeletal morphology were measured with a new technology combining helical computed tomography (CT) scan with multi-planar reformation (MPR) imaging.

RESULTS

Significant differences between children cadavers and adults were found in the following parameters (P<0.05): Condylar axis inclination, smallest area of condylar neck/largest area of condylar process, inclination of anterior slope in inner, middle, and outer one-third of condyle, anteroposterior/mediolateral dimension of condyle, length of anterior slope/posterior slope in inner and middle one-third of condyle, anteroposterior dimension of condyle/glenoid fossa, mediolateral dimension of condyle/glenoid fossa, inclination of anterior slope of glenoid fossa, depth of glenoid fossa, and anteroposterior/mediolateral dimension of glenoid fossa.

CONCLUSION

There are significant differences of TMJ skeletal morphology between children and adults.

Association analysis of TIM-1 -232G > A and 5383_5397 insertion/deletion polymorphisms with childhood asthma and total serum immunoglobulin E levels in middle China

BACKGROUND

One of the members of the T cell immunoglobulin (Ig) domain and mucin domain (TIM) gene family, TIM-1, located in the chromosome 5q31-33 region, has been associated with the development of T helper (T(H)) 2-biased immune responses and may be selectively expressed in T(H)2 cells. Previous studies have also shown an association between polymorphisms in the TIM-1 gene and asthma or asthma-related phenotypes.

OBJECTIVE

The aim of the present study was to analyze the association between the TIM-1 polymorphisms -232G > A and 5383_5397 insertion/deletion (ins/del) and susceptibility to asthma in a group of patients from middle China.

METHODS

Polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis and PCR-polyacrylamide gel electrophoresis were used to detect -232G > A and 5383_5397 ins/del genotypes in 302 asthmatic children and 206 controls. Serum total IgE was measured by chemiluminescence and specific IgE to common aeroallergens by immunoblot analysis.

RESULTS

We found no association between the -232G > A polymorphism and asthma or total serum IgE levels or statistically significant differences between asthma and control subjects in terms of genotype and allele frequency for the 5383_5397 ins/del polymorphism.We did, however, detect a difference in total serum IgE levels for 5383_5397 ins/ins genotypes in individuals with atopic asthma (P < .05) in that they had higher IgE levels than those with del/del and del/ins genotypes.

CONCLUSION

Our results suggest that the 5383_5397 ins/ins genotype in the TIM-1 gene is associated with elevated serum total IgE levels, particularly in individuals with atopic asthma. Further studies are needed to confirm such an association.

Inhibition of ADAMTS-7 and ADAMTS-12 degradation of cartilage oligomeric matrix protein by alpha-2-macroglobulin

OBJECTIVE

As we previously reported, ADAMTS-7 and ADAMTS-12, two members of ADAMTS (a disintegrin and metalloprotease with thrombospondin motifs) family, degrade cartilage oligomeric matrix protein (COMP) in vitro and are significantly induced in the cartilage and synovium of arthritic patients [Liu CJ, Kong W, Ilalov K, Yu S, Xu K, Prazak L, et al. ADAMTS-7: a metalloproteinase that directly binds to and degrades cartilage oligomeric matrix protein. FASEB J 2006;20(7):988-90; Liu CJ, Kong W, Xu K, Luan Y, Ilalov K, Sehgal B, et al. ADAMTS-12 associates with and degrades cartilage oligomeric matrix protein. J Biol Chem 2006;281(23):15800-8]. The purpose of this study was to determine (1) whether cleavage activity of ADAMTS-7 and ADAMTS-12 of COMP are associated with COMP degradation in osteoarthritis (OA); (2) whether alpha-2-macroglobulin (a(2)M) is a novel substrate for ADAMTS-7 and ADAMTS-12; and (3) whether a(2)M inhibits ADAMTS-7 or ADAMTS-12 cleavage of COMP.

METHODS

An in vitro digestion assay was used to examine the degradation of COMP by ADAMTS-7 and ADAMTS-12 in the cartilage of OA patients; in cartilage explants incubated with tumor necrosis factor-alpha (TNF-alpha) or interleukin-1-beta (IL-1beta) with or without blocking antibodies; and in human chondrocytes treated with specific small interfering RNA (siRNA) to knockdown ADAMTS-7 or/and ADAMTS-12. Digestion of a(2)M by ADAMTS-7 and ADAMTS-12 in vitro and the inhibition of ADAMTS-7 or ADAMTS-12-mediated digestion of COMP by a(2)M were also analyzed.

RESULTS

The molecular mass of the COMP fragments produced by either ADAMTS-7 or ADAMTS-12 were similar to those observed in OA patients. Specific blocking antibodies against ADAMTS-7 and ADAMTS-12 dramatically inhibited TNF-alpha- or IL-1beta-induced COMP degradation in the cultured cartilage explants. The suppression of ADAMTS-7 or ADAMTS-12 expression by siRNA silencing in the human chondrocytes also prevented TNF-alpha- or IL-1beta-induced COMP degradation. Both ADAMTS-7 and ADAMTS-12 were able to cleave a(2)M, giving rise to 180- and 105-kDa cleavage products, respectively. Furthermore, a(2)M inhibited both ADAMTS-7- and ADAMTS-12-mediated COMP degradation in a concentration (or dose)-dependent manner.

CONCLUSION

Our observations demonstrate the importance of COMP degradation by ADAMTS-7 and ADAMTS-12 in vivo. Furthermore, a(2)M is a novel substrate for ADAMTS-7 and ADAMTS-12. More significantly, a(2)M represents the first endogenous inhibitor of ADAMTS-7 and ADAMTS-12.

The role of dietary factors in chronic disease control in China

Using the dietary intake and chronic disease condition data of 39,843 adults aged over 18 years old from the 2002 National Nutrition and Health Survey in China (2002 CNHS) logistic regression analysis was applied to calculate the odd ratios (ORs) of hypertension, diabetes and dyslipidaemia for the various dietary patterns of the subjects. The higher percentage of energy intake from cereals was significantly associated with lower body mass index (BMI), lower total serum cholesterol (TC) and lower low density lipoprotein cholesterol (LDL-C), while it was significantly associated with lower risk of overweight/obesity, hypertension, high TC, high serum triglycerides (TG) and high LDL-C, but the prevalence of underweight was significantly higher in the cluster of subjects with cereal energy share more than 75%. The higher percentage of energy intake of fat was related to higher BMI, higher TC and higher LDL-C which were associated with a high risk of overweight/obesity, hypertension, TC and TG. The study confirmed the important role of dietary pattern in chronic disease control. In particular, an optimum energy contributed from cereals ranged from 55% to 65% of total dietary energy intake and dietary fat energy share no more than 30% which should be the focus of preventive measures.

Economic burden of obesity-related chronic diseases in Mainland China

The objectives of the present study are: (i) to estimate annual direct medical costs of chronic diseases attributable to overweight and obesity among adults in China and (ii) to predict the medical costs if the epidemic continues developing. Using 2002 National Nutrition and Health Survey (n = 39,834), the prevalence of overweight [24 > or = body mass index (BMI) < 28] and obesity (BMI > or = 28), and population attributable risks (PARs) for hypertension, type 2 diabetes, coronary heart disease and stroke were calculated. The 2003 third National Health Services Survey (n = 143,521) was used to derive direct medical costs including costs for outpatient visits, physician services, inpatient stays, rehabilitation services, nursing fees and medications. The medical costs attributable to overweight and obesity were estimated by multiplying the disease costs by PAR for each disease. The total medical cost attributable to overweight and obesity was estimated at 21.11 billion Yuan (RMB) (approximately $2.74 billion) accounting for 25.5% of the total medical costs for the four chronic diseases, or 3.7% of national total medical costs in 2003. The medical cost associated with overweight and obesity could increase to 37 billion Yuan (RMB) (approximately $4.8 billion), a 75% increase, if the epidemic developed speedily and the ratio of overweight to obesity approached 1.1:1. The high economic burden of overweight and obesity suggests an urgent need to develop effective interventions for controlling the obesity epidemic and consequently the prevention of chronic diseases.

Impact of famine during pregnancy and infancy on health in adulthood

The objectives of the present study are (i) To examine the association between fetal nutritional status and overweight and obesity in adulthood and (ii) to provide the evidence for formulating a strategy to prevent low birth weight. With data from the 2002 Nationwide Nutrition and Health Survey, the body mass indexes (BMIs) of rural residents born during the famine years of 1959, 1960, 1961 were compared with those born in 1964. The health consequence of famine on the adulthood BMI was evident in women; the mean BMIs of the women were significantly higher in the three famine groups than that in the control group born in 1964 (P < 0.01). After adjustment for regional differences within China, the prevalences of overweight in women were significantly higher in the three famine groups (P < 0.01) and of obesity in the 1959 and 1960 groups. (P < 0.01). Such differences were not found in men. The higher risks of overweight and obesity in women were caused by malnutrition in fetal life. A strategy for preventing low birth weight should be formulated by the government to prevent chronic disease in adulthood.

Prospective observational study of acute coronary syndromes in China: practice patterns and outcomes

OBJECTIVE

To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice.

DESIGN

A multicentre prospective survey of sociodemographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS.

SETTING

Large urban public hospitals.

PATIENTS

Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (MI) or unstable angina pectoris.

MAIN OUTCOME MEASURES

Myocardial infarction/re-infarction, heart failure, death.

RESULTS

Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres.

CONCLUSION

This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guidelines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways.

Pharmacokinetics of lenalidomide in subjects with various degrees of renal function

2520

Background: Lenalidomide is a novel oral immunomodulatory drug approved for treating myelodysplastic syndrome (MDS) and multiple myeloma (MM). As unchanged lenalidomide is eliminated predominantly by urinary excretion, the present study investigated the effect of renal impairment (RI) on pharmacokinetics (PK) of lenalidomide. Results were used to refine initial dosing recommendations based on a subject’s estimated creatinine clearance. Methods: The study was conducted at 3 clinical centers. Thirty male and female subjects aged 39–76 years were stratified into 5 groups based on their creatinine clearance (CLCr) values: normal renal function (NRF) (CLCr > 80 mL/min; N = 7), mild RI (50 = CLCr = 80 mL/min; N = 5), moderate RI (30 = CLCr < 50 mL/min; N = 6), severe RI (CLCr < 30 mL/min, but not on dialysis; N = 6), and end stage renal disease (ESRD, requiring dialysis; N = 6). Subjects with NRF, mild, moderate or severe RI received a single 25-mg oral dose of lenalidomide. Subjects with ESRD received 2 single 25 mg doses which were separated by 7–10 days: one dose on a non-dialysis day and the other dose 3 hours before a 4-hour haemodialysis. Assessments included PK and safety parameters. Results: All subjects completed the study. Total and renal clearance of lenalidomide were strongly correlated with CLCr (R > 0.9, p < 0.01). As a result, AUC8 increased with decreasing CLCr. The mean difference in AUC8 between NRF and mild RI was < 20%. Compared with the pooled data from NRF and mild RI groups, mean AUC8 increased approximately 140% in moderate RI, 240% in severe RI, and 360% in ESRD (off dialysis). There was no correlation between Cmax or Tmax and CLCr. Approximately 10% of the dose was recovered in the dialysate of subjects with ESRD. Protein binding of lenalidomide was not markedly affected by RI (∼35 - 44%). The drug was well tolerated. On the basis of these data, recommendations for initial starting doses were made ( Table below). Conclusions: Lenalidomide dosage adjustment should be considered for patients with CLCr < 50 mL/min.

[Table: see text]

No significant financial relationships to disclose.

Respiratory responses to diverse indoor combustion air pollution sources

Diverse indoor combustion sources contribute to the indoor air environment. To evaluate the effect of these sources on human respiratory health, we examined associations between respiratory conditions and household factors in the 2360 children's fathers (mean = 38.4 years old) and associations between lung function and household factors in 463 primary school children (mean = 8.3 years old) from Wuhan, China. Factor analysis developed new uncorrelated 'factor' variables. Unconditional logistic regression models or linear regression models, controlling for important covariates, estimated the respiratory health effects. Coal smoke derived from home heating ('heating coal smoke') was associated with high adult reporting of persistent cough, persistent phlegm, and wheeze. Cooking coal smoke was associated with physician-diagnosed adult asthma and decreased forced vital capacity (FVC), and forced expiratory volume at 1 s (FEV(1)) in children. The presence of any home cigarette smoker was associated with more reports of persistent cough, persistent phlegm, cough with phlegm, and bronchitis. Our study suggests that in Wuhan, there may be independent respiratory health effects of different indoor combustion sources and their exposure factors for these study populations.

PRACTICAL IMPLICATIONS

We conclude that multiple indoor air pollution sources could have adverse respiratory health effects on both children and middle-aged men in the city of Wuhan, China. These results may have implications for the Wuhan local government, the Chinese government, or other related organizations in efforts on protecting public health through regulation of indoor air pollution from indoor combustion sources.

Design of vaccine equivalence/non-inferiority trials with correlated multiple binomial endpoints

Immunogenicity trials that study the immune responses to vaccination are often used in the vaccine development process as alternatives to clinical efficacy trials. The comparisons of immune responses among various treatment groups are conducted in a non-inferiority or equivalence framework. When there exists a level of immune response that correlates with protection against disease, it is of interest to compare the proportion of responders as defined as response above a specific level or as a predefined increase in immune levels for post-vaccination levels above pre-vaccination levels. Since vaccines often contain several antigens, the correlations between the immune responses need to be taken into account in the analysis. In this paper, we describe appropriate testing methods for demonstrating the non-inferioritylequivalence of two treatments on each of the binomial endpoints. We conduct a comprehensive simulation study to shed light on how the Type I error and power are affected and to what extent when correlated multiple binomial endpoints are present in the vaccine trials. We also illustrate the computation of power for assessment of non-inferioritylequivalence in real studies.

Overexpression of phosphatase of regenerating liver-3 in breast cancer: association with a poor clinical outcome

BACKGROUND

Increasing evidence has suggested that phosphatase of regenerating liver-3 (PRL-3) plays an important role in cancer cell migration, invasion and metastasis. However, the correlation between the PRL-3 expression and clinical outcome in breast cancer has not been investigated.

PATIENTS AND METHODS

Using a PRL-3-specific monoclonal antibody 3B6, PRL-3 expression was assessed by immunohistochemistry in tumor tissues from 382 breast cancer patients with a median follow-up of 65 months.

RESULTS

We found that 34.8% patients expressed a high level of PRL-3 protein in their tumors. Patients with a high level of PRL-3 in the tumor had a worse disease-specific survival (DSS) rate than those with a low level of PRL-3 (74.0% versus 84.9%, P = 0.011), and PRL-3 remained an independent prognostic marker for DSS (HR 1.8, 95% CI 1.1-2.9, P = 0.019) in multivariate analysis. More importantly, in 219 node-negative patients, PRL-3 showed a significant correlation with DSS in univariate analysis (P = 0.014) and retained a borderline significance (HR 2.65, 95% CI 0.92-7.64, P = 0.071) in multivariate analysis.

CONCLUSIONS

Our results suggest that PRL-3 may serve as an unfavorable prognostic marker in breast cancer, especially for patients with node-negative diseases. Thus, our findings may provide useful information for individualized therapy in the clinical setting.