How are women with SUI-symptoms treated with duloxetine in real life practice? - preliminary results from a large observational study in Germany

BACKGROUND

Duloxetine was found safe and effective in the treatment of moderate to severe female stress urinary incontinence (SUI) in controlled clinical trials; complementary data from routine clinical practice are still wanted.

OBJECTIVES

To explore the use of various initial duloxetine doses by physicians in the treatment of female SUI in routine clinical practice and its implications on drug safety and patients' subjective impression of effectiveness.

METHODS

Adult women treated with duloxetine for SUI symptoms were documented as part of an ongoing large-scale observational study in Germany. Data collected at baseline, after 4 and 12 weeks, were evaluated by initial doses. Statistics were descriptive, 95% confidence intervals were calculated for adverse event (AE) rates.

RESULTS

A total of 7888 adult women were treated with duloxetine; their mean age was 61.4 years, body mass index 27 kg/m(2), incontinence episode frequency (IEF) 14.0 per week. Previous SUI treatments were observed in 52.2%, comorbidities in 60.4% of the patients. A total of 90.7% reported reduced frequency of SUI-episodes, 12.1% any AE; nausea (5.7%) and vertigo (1.6%) were reported most frequently. In all, 52.2% of patients were initiated on a duloxetine dose of 40 mg/day. Only minor differences in patient characteristics, effectiveness and tolerability were associated with varying initial duloxetine doses.

CONCLUSIONS

Many women received lower duloxetine doses than expected based on evidence-based dosing recommendations. Although SUI patients in this study had a higher health risk because of old age and multiple comorbidities than in previous controlled clinical trials, AE rates were lower, possibly because of the observational character of the study and/or the use of rather low doses. Similar AE rates for varying initial doses possibly reflect sensible dose-adjustment to individual needs.

Extending the search for neutrino point sources with IceCube above the horizon

Point source searches with the IceCube neutrino telescope have been restricted to one hemisphere, due to the exclusive selection of upward going events as a way of rejecting the atmospheric muon background. We show that the region above the horizon can be included by suppressing the background through energy-sensitive cuts. This improves the sensitivity above PeV energies, previously not accessible for declinations of more than a few degrees below the horizon due to the absorption of neutrinos in Earth. We present results based on data collected with 22 strings of IceCube, extending its field of view and energy reach for point source searches. No significant excess above the atmospheric background is observed in a sky scan and in tests of source candidates. Upper limits are reported, which for the first time cover point sources in the southern sky up to EeV energies.

OnEX: Exploring changes in life science ontologies

Background

Numerous ontologies have recently been developed in life sciences to support a consistent annotation of biological objects, such as genes or proteins. These ontologies underlie continuous changes which can impact existing annotations. Therefore, it is valuable for users of ontologies to study the stability of ontologies and to see how many and what kind of ontology changes occurred.

Results

We present OnEX (Ontology Evolution EXplorer) a system for exploring ontology changes. Currently, OnEX provides access to about 560 versions of 16 well-known life science ontologies. The system is based on a three-tier architecture including an ontology version repository, a middleware component and the OnEX web application. Interactive workflows allow a systematic and explorative change analysis of ontologies and their concepts as well as the semi-automatic migration of out-dated annotations to the current version of an ontology.

Conclusion

OnEX provides a user-friendly web interface to explore information about changes in current life science ontologies. It is available at .

Limits on a muon flux from neutralino annihilations in the sun with the IceCube 22-string detector

A search for muon neutrinos from neutralino annihilations in the Sun has been performed with the IceCube 22-string neutrino detector using data collected in 104.3 days of live time in 2007. No excess over the expected atmospheric background has been observed. Upper limits have been obtained on the annihilation rate of captured neutralinos in the Sun and converted to limits on the weakly interacting massive particle (WIMP) proton cross sections for WIMP masses in the range 250-5000 GeV. These results are the most stringent limits to date on neutralino annihilation in the Sun.

Quantum electron transport through ultrathin Si films: effects of interface passivation on Fermi-level pinning

We report first-principles calculations on electron transport through ultrathin silicon films between aluminum electrodes. The passivation of interface Si atoms at one side of the film with hydrogen makes the current-voltage characteristics asymmetric with quasirectifying properties. The low conductivity in this case can be explained by the weakened metal-induced gap states due to the passivation. We also demonstrate that the applied bias changes the strength of Fermi-level pinning for the passivated interface.

ENVIRO-HIRLAM: on-line coupled modelling of urban meteorology and air pollution

Abstract. The strategy of new generation integrated Meso-Meteorological (MetM) and Atmospheric Chemical Transport (ACT) models for predicting atmospheric composition, meteorology and climate change is discussed for the Enviro-HIRLAM (HIgh Resolution Limited Area Model) integrated system. Current progress in the Enviro-HIRLAM system development and its urban on-line coupled modelling applications is considered. Results of several sensitivity studies of the urban effects (urban albedo and roughness, anthropogenic heat flux, heat island, and urban aerosols) on meteorology and air pollution at different scales are presented. Several sensitivity tests of the off-line versus on-line coupling of MetM and ACT models in Enviro-HIRLAM as well as their verification versus the ETEX experiment are considered and results are discussed.

Assessment of extraction methods with fowl manure for the production of liquid organic fertilizers

Supplementary nitrogen (N) side-dressing via the irrigation system is needed in organic cropping. The aim here was to improve N-extraction efficiency, by testing five extraction protocols with guano, layer and broiler manures. The manure-N released by the different methods and manures was mainly in the form of ammonia and ranged from 50% to 85% with no differences among extraction methods. Volatilised ammonia from the extract solution was trapped. At the end of the extraction period, the pH of the extract solution was raised and the rest of the volatilised ammonia was trapped. In the case of guano, about 89% of the manure-N that was mineralised to the extract solution volatilised (after a pH increase), whereas in the layer and broiler manures, 59% and 54% were volatilised, respectively. Extraction of ammonia, its volatilisation and entrapment could provide a significantly more efficient N source than using the extract solution as currently recommended.

Small scale recirculating vertical flow constructed wetland (RVFCW) for the treatment and reuse of wastewater

The quantity of freshwater available worldwide is declining, revealing a pressing need for its more efficient use. Moreover, in many developing countries and lightly populated areas, raw wastewater is discarded into the environment posing serious ecological and health problems. Unfortunately, this situation will persist unless low-cost, effective and simple technologies are brought in. The aim of this study is to present such a treatment method, a novel setup which is termed recirculating vertical flow constructed wetland (RVFCW). The RVFCW is composed of two components: (i) a three-layer bed consisting of planted organic soil over an upper layer of filtering media (i.e. tuff or beads) and a lower layer of limestone pebbles, and (ii) a reservoir located beneath the bed. Wastewater flows directly into the plant root zone and trickles down through the three-layer bed into the reservoir, allowing passive aeration. From the reservoir the water is recirculated back to the bed, several times, until the desired purification is achieved. The results obtained show that the RVFCW is an effective and convenient strategy to treat (domestic, grey and agro) wastewater for re-use in irrigation. The system performance is expected to be further improved once current optimization experiments and mathematical modeling studies are concluded.

Energetics driving the short-range order in CuxPd1-x/Ru(0001) monolayer surface alloys

The energetics determining the distinct short-range order in two-dimensional (2D) monolayer Cu(x)Pd(1-x) surface alloys on a Ru(0001) substrate were investigated by Monte Carlo simulations and density functional theory calculations. Using a 2D lattice gas Hamiltonian based on effective pair interaction (EPI) parameters, the EPIs were derived for different Cu concentrations with Monte Carlo (MC) simulations by comparing with the atomic distributions obtained from atomic resolution STM images and the related Warren-Cowley short-range order parameters (Hoster et al., Phys. Rev. B, 2006, 73 165413). The ground state structures and mixing energies at 0 K derived from these EPIs agree well with mixing energies determined from DFT calculations of different ordered surface alloys. Additional MC simulations yield rather low transition temperatures which explain the absence of ordered 2D phases in the experiments. The consequences of our findings for the use of alloy surfaces and surface alloys as model systems for adsorption and catalytic reaction studies are discussed.

Medicinal and injection therapies for mechanical neck disorders

BACKGROUND

Controversy persists regarding medicinal therapies and injections.

OBJECTIVES

To determine the effects of medication and injections on primary outcomes (e.g. pain) for adults with mechanical neck disorders and whiplash.

SEARCH STRATEGY

We searched CENTRAL, MANTIS, CINAHL from their start to May 2006; MEDLINE and EMBASE to December 2006. We scrutinised reference lists for other trials.

SELECTION CRITERIA

We included randomised controlled trials with adults with neck disorders, with or without associated headache or radicular findings. We considered medicinal and injection therapies, regardless of route of administration.

DATA COLLECTION AND ANALYSIS

Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.

MAIN RESULTS

We found 36 trials that examined the effects of oral NSAIDs, psychotropic agents, steroid injections, and anaesthetic agents. Trials had a mean of 3.1 on the Jadad Scale for methodological quality; 70% were high quality. For acute whiplash, administering intravenous methylprednisolone within eight hours of injury reduced pain at one week (SMD -0.90, 95% CI -1.57 to -0.24), and sick leave but not pain at six months compared to placebo in one trial. For chronic neck disorders at short-term follow-up, intramuscular injection of lidocaine was superior to placebo (SMD -1.36, 95% CI -1.93 to -0.80); NNT 3, treatment advantage 45% and dry needling, but similar to ultrasound in one trial each. In chronic neck disorders with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function more than when given by intramuscular route at one-year follow-up, in one trial. In subacute and chronic neck disorders, muscle relaxants, analgesics and NSAIDs had limited evidence and unclear benefits. In participants with chronic neck disorders with or without radicular findings or headache, there was moderate evidence from five high quality trials that Botulinum toxin A intramuscular injections had similar effects to saline in improving pain (pooled SMD: -0.39, 95%CI -1.25 to 0.47), disability or global perceived effect.

AUTHORS' CONCLUSIONS

The major limitations are the lack of replication of the findings and sufficiently large trials. There is moderate evidence for the benefit of intravenous methylprednisolone given within eight hours of acute whiplash, from a single trial. Lidocaine injection into myofascial trigger points appears effective in two trials. There is moderate evidence that Botulinum toxin A is not superior to saline injection for chronic MND. Muscle relaxants, analgesics and NSAIDs had limited evidence and unclear benefits.

Nucleocytoplasmic shuttling of BID is involved in regulating its activities in the DNA-damage response

The BH3-only BID protein acts as a sentinel to interconnect specific death signals to the core apoptotic pathway. Our previous data demonstrated that BID is important for both S-phase arrest and cell death following DNA damage, and that the cell cycle arrest function is regulated by its phosphorylation by the ATM kinase. We also showed that a portion of cellular BID localizes to the nucleus. Here, we demonstrate that etoposide and ionizing radiation induce the exit of BID from the nucleus and that leptomycin B, a specific inhibitor of the nuclear export receptor CRM1, prevents the nuclear exit of BID. BID carries a nuclear export signal (NES) consensus motif; however, it does not seem to be functional. To examine the importance of BID nuclear export, we targeted BID to the nucleus by fusing it to a strong nuclear localization signal (NLS). NLS-BID is phosphorylated in a similar time course as wild-type BID, but does not exit the nucleus following etoposide treatment. Importantly, introducing NLS-BID into BID(-/-) cells failed to restore S-phase arrest and cell death in response to etoposide. These results implicate BID as a nuclear protein and raise the possibility that nucleocytoplasmic shuttling of BID is involved in regulating its activities in the DNA-damage response.