Predictors of antiviral treatment initiation in hepatitis C virus-infected patients: a Danish cohort study

Predictive factors for initiation of antiviral therapy in chronically infected hepatitis C virus (HCV) patients are not fully elucidated. The aim of this study was to determine predictive factors for initiation of treatment with standard or pegylated interferon either alone or combined with ribavirin. A Danish cohort of individuals chronically infected with HCV was used and observation time was calculated from the date of inclusion in the cohort to date of death, last clinical observation, 1 January 2007, or start of HCV antiviral treatment in treatment-naïve patients. Kaplan-Meier survival analysis was used to construct time to event curves. Cox regression was used to determine the incidence rate ratios as estimates of relative risk (RR) and 95% confidence intervals (CI). A total of 1780 patients were enrolled in the study. The cumulative chance of treatment initiation over 5 years was 33.0%. We found several strong predictors of treatment initiation: elevated alanine aminotransferase [>2 times upper limit (RR = 2.17, 95% CI 1.64-2.87), >3 times upper limit (RR = 3.64, 95% CI 2.75-4.81)], genotype 2 or 3 (RR = 1.86, 95% CI 1.49-2.31) and HIV co-infection (RR = 0.28, 95% CI 0.15-0.53). To our knowledge, this study is the first to estimate factors predicting initiation of antiviral treatment in patients with chronic HCV infection on a nationwide scale. We found that several of the factors predicting initiation of antiviral treatment correlate with factors known to predict a better response to treatment and factors known to increase the progression of liver disease.

Prevalence of Facial Pain in Migraine: A Population-Based Study

Unilateral head pain focused on frontal, orbital or parietal regions is a leading symptom of migraine attacks. Rarely, head pain in migraine can extend involving the maxillary or mandibular region of the face, sometimes isolated facial pain is the only and atypical presentation of migraine. The prevalence of these unusual symptoms in migraine is unknown. We aimed to estimate the true prevalence of facial pain in migraine in a population-based sample of 517 migraine patients in Germany. In 46 (8.9%) cases migraine pain involved the head and the lower half of the face. Patients with facial pain suffer more trigemino-autonomic symptoms than migraine patients (47.8% vs. 7.9%; α2 = 66.23, P < 0.001). In one case isolated facial pain without headache was the leading symptom of migraine. Our results demonstrate that facial pain is not unusual in migraine, whereas isolated facial migraine is extremely rare.

Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis

BACKGROUND

Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease.

OBJECTIVES

To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations.

METHODS

Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls.

RESULTS

Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD.

CONCLUSIONS

IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.

Combining reactive and configurational-bias Monte Carlo: confinement influence on the propene metathesis reaction system in various zeolites

In order to efficiently calculate chemical equilibria of large molecules in a confined environment the reactive Monte Carlo technique is combined with the configurational-bias Monte Carlo approach. To prove that detailed balance is fulfilled the acceptance rule for this combination of particular Monte Carlo techniques is derived in detail. Notably, by using this derivation all other acceptance rules of any Monte Carlo trial moves usually carried out in combination with the configurational-bias Monte Carlo approach can be deduced from it. As an application of the combination of reactive and configurational-bias Monte Carlo the influence of different zeolitic confinements (MFI, TON, LTL, and FER) on the reaction equilibrium and the selectivity of the propene metathesis reaction system was investigated. Compared to the bulk phase the conversion is increased significantly. The authors study this reaction system in the temperature range between 300 and 600 K, and the pressure range from 1 to 7 bars. In contrast to the bulk phase, pressure and temperature have a strong influence on the composition of the reaction mixture in confinement. At low pressures and temperatures both conversion and selectivity are highest. Furthermore, the equilibrium composition is strongly dependent on the type of zeolite. This demonstrates the important role of the host structure in catalytic systems.

Initial Steps of Aromatic Ring Formation in a Laminar Premixed Fuel-Rich Cyclopentene Flame†

A fuel-rich, nonsooting, premixed laminar cyclopentene flame (phi = 2.0) at 37.6 Torr (50 mbar) is investigated by flame-sampling photoionization molecular-beam mass spectrometry utilizing vacuum-ultraviolet synchrotron radiation. Mole fractions as a function of distance from the burner are measured for 49 intermediates with ion masses ranging from 2 (H2) to 106 (C8H10), providing a broad database for flame modeling studies. The isomeric composition is resolved for most species, and the identification of several C4Hx, C7H6, and C7H8 isomers is discussed in detail. The presence of C5H5CCH/C5H4CCH2 and cycloheptatriene is revealed by comparisons between flame-sampled photoionization efficiency data and theoretical simulations, based on calculated ionization energies and Franck-Condon factors. This insight suggests a new potential molecular- weight growth mechanism that is characterized by C5-C7 ring enlargement reactions.

Method of detection of local recurrence in patients following breast conserving surgery and its utility for surveillance

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Background: It is estimated that approximately 10% of all breast cancer patients will develop local recurrence (LR) at 10 years. Routine surveillance for detection of early breast cancer recurrence is widely performed despite lack of conclusive evidence for an improvement in patient quality of life or potential for cure. A number of historical studies evaluating the effectiveness of routine screening for LR following treatment for early-stage breast cancer have suggested that the diagnosis of LR is more frequent during a routine visit and occurring in asymptomatic patients. However, differentiating the method of detection is not often elucidated. In this study we evaluated the manner in which patients presented with an isolated LR in clinical practice. Methods: Our routine patient follow-up consists of physical exam and mammogram every 6 mos for the first 2 years following breast conserving surgery (BCS) and yearly thereafter. We queried our prospectively collected breast cancer database (1632 patients from July 1986 - July 2004) for patients with an isolated LR following BCS (n=59 (3.6%); two patients had bilateral LRs). Medical records were not available for three patients. Results: At a median follow-up of 45 mos (range: 5–122 mos) there were 58 evaluable LRs: 15 DCIS, 31 infiltrating ductal carcinoma (IDC), 6 infiltrating lobular (ILC), 2 mixed IDC/ILC, 3 invasive cancers NOS and 1 unknown. Patient presentation was as follows: 25 were diagnosed by self-exam, 28 on screening mammogram, 2 were diagnosed by physician (includes one referral), and 3 unknown. Mammogram detected recurrences were more frequent among patients with DCIS whereas self-detected recurrences were more common in patients with IDC (79% vs 33% and 21% vs 67%, respectively; P<0.2). Mean tumor size was larger in self-presentation (2.1 cm; range: 0.8–4.5 cm) than in mammogram detected group (1.6 cm; range 0.4–6 cm). Conclusions: These findings demonstrate the value of mammography as compared to patient detected LRs. Whether a survival advantage exists remains uncertain. Nevertheless routine physician examination in this setting is highly insensitive and its further utility must be considered when devising cost-effective strategies for surveillance of breast cancer patients.

No significant financial relationships to disclose.

A phase I study of the pan-Bcl2 family inhibitor GX15–070, administered as a 3-hour weekly infusion in patients with refractory solid tumors or lymphomas

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Background: GX15–070 is an antagonist of the BH3-binding groove of the bcl-2 family of anti apoptotic proteins. GX15–070 activates apoptosis in vitro and exhibits clinical activity in chronic lymphocytic leukemia (O’Brien et al, ASH 2005) with a recommended phase II dose of 28 mg/m2 every 3 weeks with DLT of grade 3 infusional CNS toxicities. Methods: In a standard titration design, 4 cohorts of 3 patients (pt) were treated with 5mg/m2 - 14 mg/m2 IV infused over 3 hours, weekly. Each cycle of therapy consisted of 4 weekly infusions. Pharmacokinetics (PK) and pharmacodynamic (PD) response based on plasma oligonucleosomal DNA levels were evaluated. Results: N=15 pts were treated. Median age was 58 (range 24–71). Median number of prior regimens was 4 (range 1–11). A total of 105 infusions (26 cycles) was administered. GX15–070 underwent first order elimination kinetics with a short initial distribution phase (α t1/2=0.6 h), followed by a longer elimination γphase (t1/2=43.8 h). At the 14 mg/m2 dose level, median C max and AUC values were 98 ng/ml and 276 ng.hr/ml, respectively. The coefficient of variation was low at 38%. Adverse events have mostly been observed during or shortly after the infusion and have been transient. The most common pertain to the central nervous and gastro-intestinal system (drowsiness, euphoria, ataxia, and abdominal pain). Most toxicities were mild to moderate, with the exception of grade 3 pain experienced by 2/2 pts with Hodgkin’s disease, that resolved rapidly but resulted in treatment discontinuation in 1 patient. One episode of Grade 3 infusional CNS toxicity was reported at 14 mg/m2 requiring the inclusion of 6 patients with no further DLT. No neutropenia, thrombocytopenia or lymphopenia have been reported. The MTD has not been reached. Mean increase in plasma oligonucleosomal DNA was 36 fold (range 0–182 fold) over baseline. Best response to treatment to date : SD ≥ 8 weeks (4); PD (5); too early (6). Conclusion: Weekly GX15–070 as been well tolerated at doses showing biological activity. Dose escalation will be pursued up to 28 mg/m2 weekly.

No significant financial relationships to disclose.

Photofragment translation spectroscopy of ClN3 at 248 nm: determination of the primary and secondary dissociation pathways

Photofragmentation translational spectroscopy was used to identify the primary and secondary reaction pathways in the KrF laser (248 nm) photodissociation of chlorine azide (ClN(3)) under collision-free conditions. Both the molecular channel producing NCl (X (3)Sigma,a (1)Delta) + N(2) and the radical channel producing Cl ((2)P(J)) + N(3) were analyzed in detail. Consistent with previously reported velocity map ion imaging experiments [N. Hansen and A. M. Wodtke, J. Phys. Chem. A 107, 10608 (2003)] a bimodal translational energy distribution is seen when Cl atoms are monitored at mz = 35(Cl(+)). Momentum-matched N(3) counterfragments can be seen at mz = 42(N(3) (+)). The characteristics of the observed radical-channel data reflect the formation of linear azide radical and another high-energy form of N(3) (HEF-N(3)) that exhibits many of the characteristics one would expect from cyclic N(3). HEF-N(3) can be directly detected by electron-impact ionization more than 100 mus after its formation. Products of the unimolecular dissociation of HEF-N(3) are observed in the mz = 14(N(+)) and mz = 28(N(2) (+)) data. Anisotropy parameters were determined for the primary channels to be beta = -0.3 for the NCl forming channel and beta = 1.7 and beta = 0.4 for the linear N(3) and HEF-N(3) forming channels, respectively. There is additional evidence for secondary photodissociation of N(3) and of NCl.