A phase II, open-label, multicenter study to evaluate the antitumor efficacy of CO-1.01 as second-line therapy for gemcitabine-refractory patients with stage IV pancreatic adenocarcinoma and negative tumor hENT1 expression

BACKGROUND

Nucleotide transporters such as human equilibrative nucleoside transporter-1 (hENT1) play a major role in transporting gemcitabine into cells. CO-1.01 (gemcitabine-5'-elaidate) is a novel cytotoxic agent consisting of a fatty acid derivative of gemcitabine, which is transported intracellularly independent of hENT1. CO-1.01 was postulated to have efficacy as a second-line treatment in gemcitabine-refractory pancreatic adenocarcinoma in patients with negative tumor hENT1 expression.

METHODS

Eligibility criteria included patients with either a newly procured or archival biopsy tumor confirming the absence of hENT1 and either gemcitabine-refractory metastatic pancreas adenocarcinoma or with progression of disease following resection during or within 3 months of adjuvant gemcitabine therapy. Patients were treated with intravenous infusion of CO-1.01 dosed at 1250 mg/m(2) on Days 1, 8, and 15 of a 4-week cycle. The primary end point was disease control rate (DCR).

RESULTS

Nineteen patients were enrolled of which 18 patients were evaluable for efficacy assessment. Thirteen patients (68%) had liver metastases, 6 (32%) had lymph node metastases, and 10 (53%) had lung metastases. Two of 18 patients (11%) achieved disease control. The median survival time was 4.3 (95% CI 2.1-8.1) months. All patients experienced at least one treatment-related adverse event with the majority of events being mild or moderate.

CONCLUSION

This study did not meet its primary endpoint and no efficacy signal was identified for CO-1.01 in treating progressive metastatic pancreas adenocarcinoma.

Treatment with tirofiban for acute coronary syndrome (ACS): a systematic review and network analysis

OBJECTIVE

To assess the efficacy of tirofiban in comparison to usual care or other GPIIb/IIIa antagonists (eptifibatide and abciximab). Results were analysed by drug administration with planned percutaneous coronary intervention (PCI) or as medical management without planned PCI, and separately for STEMI or NSTE ACS patients.

RESEARCH DESIGN AND METHODS

A systematic review was performed of randomized controlled trials of tirofiban, abciximab, eptifibatide or usual care given to patients with acute coronary syndrome. Nine databases were searched up to March 2010. Pair-wise meta-analysis was used to combine all available direct comparisons; indirect comparisons and network analysis were performed when this was not possible. The primary outcome was MACE (major adverse cardiac event).

RESULTS

The search yielded 8, 119 records and 50 trials were included (total number of patients = 52,958). Compared to usual care, high and medium-dose tirofiban (25 and 10 µg/kg/min) administered with planned PCI reduced MACE at 30 days for patients with STEMI (RR 0.67, 95% CI 0.45, 0.99; RR 0.28, 95% CI 0.10, 0.80), but was not effective as a medical management. Medium-dose tirofiban (10 µg/kg/min) administered with planned PCI or low dose (0.4 µg/kg/min) as medical management reduced the risk of MACE for patients with NSTE ACS (RR 0.39, 95% CI 0.21, 0.75; RR 0.58, 95% CI 0.41, 0.83) in comparison to usual care, but at the expense of increased thrombocytopenia (RR 3.26, 95% CI 1.31, 8.13). Evidence from RCTs and network analysis indicated tirofiban and abciximab were equally effective and safe. Comparing tirofiban and eptifibatide treatment by indirect and network analysis produced inconclusive results.

CONCLUSIONS

Tirofiban was more effective than usual care for STEMI and NSTE ACS patients receiving planned PCI, and NSTE ACS patients receiving medical management. Tirofiban and abciximab were equally effective. Comparisons of tirofiban and eptifibatide were inconclusive.

Fresh cow mastitis monitoring on day 3 postpartum and its relationship to subsequent milk production

The purpose was to determine the association of milk California Mastitis Test (CMT), somatic cell concentration (SCC), and milk differential cell count results on day 3 postcalving with subsequent lactation production and health events. On d 3 postcalving, the CMT was performed and quarter milk samples were collected from 130 dairy cows. Quarter SCC and milk differential cell counts were determined. Microbiology on duplicate quarter milk samples was used to determine the presence of intramammary infection by major or minor pathogens. Production measures obtained using Dairy Herd Improvement Association testing were 150-d standardized and summit milks. Milk culture results on a cow basis included 82 (63.1%) samples with no growth, 31 (23.9%) with major pathogens, and 17 (13.1%) with minor pathogens. Milk culture results comparing cows with no growth to those with any growth (major or minor pathogens) were not associated with statistically significant differences in milk production. Milk culture results comparing cows with major pathogens to those with no growth and minor pathogens combined were associated with statistically significant differences in 150 d milk. Milk production did not differ for cows with CMT results above and below a cut-off of trace, and for SCC results above and below cut-offs of 200,000, 300,000, and 400,000/mL, respectively. Statistically significant differences in milk production were found for cows above and below cut-offs for percentage neutrophils in milk and for absolute neutrophil counts. Associations were found for milk production and number of quarters (0, 1, 2, or 3 and 4 combined) above respective cut-offs for SCC, percentage neutrophils in milk, and absolute numbers of neutrophils in milk, but not for CMT. Milk production differed for cows experiencing any health event versus those with no health event. The most commonly recorded health event was clinical mastitis. Statistically significant associations were detected between health events and milk culture results, SCC, neutrophil percentage, and neutrophil absolute counts. Results of the present investigation indicate that milk monitoring on d 3 of lactation using milk neutrophil percentage or neutrophil absolute counts may be useful as an indication of subsequent milk production.

Blackawton bees

BACKGROUND

Real science has the potential to not only amaze, but also transform the way one thinks of the world and oneself. This is because the process of science is little different from the deeply resonant, natural processes of play. Play enables humans (and other mammals) to discover (and create) relationships and patterns. When one adds rules to play, a game is created.

THIS IS SCIENCE

the process of playing with rules that enables one to reveal previously unseen patterns of relationships that extend our collective understanding of nature and human nature. When thought of in this way, science education becomes a more enlightened and intuitive process of asking questions and devising games to address those questions. But, because the outcome of all game-playing is unpredictable, supporting this 'messyness', which is the engine of science, is critical to good science education (and indeed creative education generally). Indeed, we have learned that doing 'real' science in public spaces can stimulate tremendous interest in children and adults in understanding the processes by which we make sense of the world. The present study (on the vision of bumble-bees) goes even further, since it was not only performed outside my laboratory (in a Norman church in the southwest of England), but the 'games' were themselves devised in collaboration with 25 8- to 10-year-old children. They asked the questions, hypothesized the answers, designed the games (in other words, the experiments) to test these hypotheses and analysed the data. They also drew the figures (in coloured pencil) and wrote the paper. Their headteacher (Dave Strudwick) and I devised the educational programme (we call 'i,scientist'), and I trained the bees and transcribed the childrens' words into text (which was done with smaller groups of children at the school's local village pub). So what follows is a novel study (scientifically and conceptually) in 'kids speak' without references to past literature, which is a challenge. Although the historical context of any study is of course important, including references in this instance would be disingenuous for two reasons. First, given the way scientific data are naturally reported, the relevant information is simply inaccessible to the literate ability of 8- to 10-year-old children, and second, the true motivation for any scientific study (at least one of integrity) is one's own curiousity, which for the children was not inspired by the scientific literature, but their own observations of the world. This lack of historical, scientific context does not diminish the resulting data, scientific methodology or merit of the discovery for the scientific and 'non-scientific' audience. On the contrary, it reveals science in its truest (most naive) form, and in this way makes explicit the commonality between science, art and indeed all creative activities.

PRINCIPAL FINDING

'We discovered that bumble-bees can use a combination of colour and spatial relationships in deciding which colour of flower to forage from. We also discovered that science is cool and fun because you get to do stuff that no one has ever done before. (Children from Blackawton)'.

Noradrenergic function in pathological gambling: blunted growth hormone response to clonidine

The noradrenergic system has been linked to impulsive behaviour in animals and humans, yet little data on noradrenergic system exist in specific impulse control disorders. To explore the role of the noradrenergic system in pathological gamblers (PG), we assessed neuroendocrine growth hormone (GH) response to the alpha2-adrenergic receptor agonist clonidine and placebo in PG and controls. The net effects of clonidine are a decrease in neurotransmission by depressing locus coeruleus activity and stimulation of GH secretion through activation of post-synaptic alpha2-adrenergic receptors in the hypothalamus. Twenty-nine PG subjects, free of other comorbid conditions, and 27 healthy controls received a double-blinded, placebo-controlled, single dose of oral clonidine (0.15 mg/kg). Data observed included GH, clonidine levels and levels of the main noradrenergic metabolite, 3-methoxy-4-hydroxy-phenylglycol (MHPG). The area under the curve for GH response to clonidine was significantly lower (separate variance t with 44.3 df = 2.626, P = 0.012, d = 0.58) in the PG group (199.6) than in the control group (426.3). PG had significantly blunted GH responses compared with controls at 120 and 150 min post-clonidine. These results are consistent with the idea that the subsensitivity of post-synaptic alpha-2 receptors is possibly attributable to higher-than-normal noradrenergic secretion in PG. This peripheral noradrenergic dysfunction could be consistent with attenuated cortico-frontal noradrenergic function as shown in positron emission tomography (PET) studies of PG.

Mucus glycoprotein structure, gel formation and gastrointestinal mucus function

Gastrointestinal mucus occurs as a water-insoluble gel adherent to the mucosal surfaces and as a viscous, mobile solution in the lumen. The adherent gastroduodenal mucus gel is part of the mucosal defence against acid (with HCO3-), pepsin (diffusion barrier) and mechanical damage. Rheological studies show that gastrointestinal mucus is a weak, viscoelastic gel. The size and physical properties of the isolated component glycoproteins depend critically on the methods used to obtain them. A glycoprotein preparation of Mr approximately 2 X 10(6), which possesses the gel-forming properties of the native mucus, is considered to represent the secreted covalent entity in pig gastric and small intestinal mucus. These glycoproteins have a polymeric structure of subunits joined by disulphide bridges between non-glycosylated regions of their protein cores. Glycoprotein polymerization, essential for gel formation, is deficient in gastric mucus in peptic ulcer disease. In vivo, adherent mucus gel forms a thin but continuous cover of variable thickness (rat 5-500 microns) over the gastroduodenal mucosa. Luminal pepsin rapidly dissolves this mucus cover and its continuity is maintained by fresh mucus secretion. Bile, HCl, 2 M-NaCl and ethanol (less than 40%) do not destroy mucus gel structure. Prostaglandins and carbachol increase mucus thickness, affording better protection, but it is thought that continuity of the protective mucus cover is the critical factor in its protective functions.