Focal vibration in neurorehabilitation

During the last decade, many studies have been carried out to understand the effects of focal vibratory stimuli at various levels of the central nervous system and to study pathophysiological mechanisms of neurological disorders as well as the therapeutic effects of focal vibration in neurorehabilitation. This review aimed to describe the effects of focal vibratory stimuli in neurorehabilitation including the neurological diseases or disorders like stroke, spinal cord injury, multiple sclerosis, Parkinson's' disease and dystonia. In conclusion, focal vibration stimulation is well tolerated, effective and easy to use, and it could be used to reduce spasticity, to promote motor activity and motor learning within a functional activity, even in gait training, independent from etiology of neurological pathology. Further studies are needed in the future well-designed trials with bigger sample size to determine the most effective frequency, amplitude and duration of vibration application in the neurorehabilitation.

Real-world healthcare resource utilization in a European non-small cell lung cancer population: the EPICLIN-Lung study

BACKGROUND

There is a lack of data on health resource assessment in non-small cell lung cancer (NSCLC) to inform clinical decision-making. The Epidemiological Study to Describe NSCLC Clinical Management Pattern in Europe-Lung (EPICLIN-Lung) study provides information on healthcare resource utilization associated with different NSCLC treatment strategies in real-life clinical settings.

METHODS

This multinational, multicenter, non-interventional study (NCT00831909) was conducted in eight European countries in 2009-2010. Patients with confirmed NSCLC were enrolled and followed for 12 months or until death. Information was collected on patient and disease characteristics, diagnosis and treatment patterns. Healthcare resource utilization was described in relation to diagnostic patterns and treatment received.

RESULTS

Data were available for 3508 patients (median age=65.0 years, male=77.6%, Caucasian=98.4%, adenocarcinoma=43.8%, stage IV=48.6%, 10.8% never smoked). The overall mean number of hospitalization days was 16.4 (standard deviation (SD)=18.42). Patients were followed up for a mean of 245.8 (131.4) days. Most patients (96.0%) underwent imaging procedures, most commonly scanning (93.9%). Surgery was associated with a mean of 12.5 (9.33) hospitalization days, with lobectomy and extended procedures (20.3%) being the most common surgery types. Radiotherapy resulted in a mean of 11.6 (14.12) hospitalization days. The majority of radiotherapy was palliative (56.0%), which resulted in fewer (mean 9.5 [11.12]) hospitalization days. Administration of systemic treatment resulted in a mean of 6.5 (8.04) hospitalization days, 1.7 (3.59) visits for disease-related events, 2.3 (1.83) adverse events and 5.4 (5.86) blood-specific resources. The key limitations of this study are those inherent to its non-interventional nature and wide regional focus, and the lack of cost-effectiveness data.

CONCLUSIONS

EPICLIN-Lung provides important, Europe-wide information on drivers of healthcare resource use in different treatment strategies for NSCLC.

Clinical management patterns and treatment outcomes in patients with non-small cell lung cancer (NSCLC) across Europe: EPICLIN-Lung study

BACKGROUND

Throughout Europe, physicians face similar challenges in non-small cell lung cancer (NSCLC) management, but comprehensive international information on usual clinical practice is lacking so the burden of NSCLC is not fully understood.

METHODS

This multinational, multicentre, non-interventional study (NCT00831909) was conducted in eight European countries. Patients with confirmed NSCLC were consecutively enrolled from January to March 2009 and followed for 12 months or until death. Information was collected on patient and disease characteristics, diagnosis and treatment patterns, and clinical outcomes. Spontaneously reported adverse events (AEs) were also recorded.

RESULTS

Data were available for 3508 patients. Most patients (77.5%) were male, median (range) age was 65.0 years (21.6-90.7), the majority of patients had a World Health Organization performance status of ≤1 (74.7%), and 10.8% were never smokers. The most prevalent histologies were adenocarcinoma (43.8%) and squamous-cell carcinoma (29.4%). Most patients presented with advanced disease (11.6% with stage IIIA, 18.7% with stage IIIB, 48.6% with stage IV). In stage IV disease, median progression-free survival and overall survival (months) by first-line treatment cluster were platinum regimens: 6.5, 10.8; non-platinum regimens: 4.3, 8.5; regimens with bevacizumab 8.7, 12.9; investigational regimens: 5.6, 10.8; best supportive care: 5.4, 6.6. The most frequently reported severe (Common Terminology Criteria for Adverse Events v3.0>2) AEs were blood/bone marrow (16.0%) and pulmonary/upper respiratory (7.8%). Key limitations of this study related to its non-interventional nature and wide regional focus; for example, achieving a representative sample of the overall NSCLC population, variation in recruitment between countries, and data based on information from medical records derived from routine visits.

CONCLUSIONS

The Epidemiological Study to Describe NSCLC Clinical Management Pattern in Europe-Lung (EPICLIN-Lung) study provides new insights into the descriptive patterns and clinical management strategies for NSCLC across Europe, and how they affect patient outcomes.

Preclinical evaluation of AMG 925, a FLT3/CDK4 dual kinase inhibitor for treating acute myeloid leukemia

Acute myeloid leukemia (AML) remains a serious unmet medical need. Despite high remission rates with chemotherapy standard-of-care treatment, the disease eventually relapses in a major proportion of patients. Activating Fms-like tyrosine kinase 3 (FLT3) mutations are found in approximately 30% of patients with AML. Targeting FLT3 receptor tyrosine kinase has shown encouraging results in treating FLT3-mutated AML. Responses, however, are not sustained and acquired resistance has been a clinical challenge. Treatment options to overcome resistance are currently the focus of research. We report here the preclinical evaluation of AMG 925, a potent, selective, and bioavailable FLT3/cyclin-dependent kinase 4 (CDK4) dual kinase inhibitor. AMG 925 inhibited AML xenograft tumor growth by 96% to 99% without significant body weight loss. The antitumor activity of AMG 925 correlated with the inhibition of STAT5 and RB phosphorylation, the pharmacodynamic markers for inhibition of FLT3 and CDK4, respectively. In addition, AMG 925 was also found to inhibit FLT3 mutants (e.g., D835Y) that are resistant to the current FLT3 inhibitors (e.g., AC220 and sorafenib). CDK4 is a cyclin D-dependent kinase that plays an essential central role in regulating cell proliferation in response to external growth signals. A critical role of the CDK4-RB pathway in cancer development has been well established. CDK4-specific inhibitors are being developed for treating RB-positive cancer. AMG 925, which combines inhibition of two kinases essential for proliferation and survival of FLT3-mutated AML cells, may improve and prolong clinical responses.

Abstract A279: Preclinical evaluation of AMG 925, a FLT3/CDK4 dual kinase inhibitor

Acute myeloid leukemia (AML) remains a serious unmet medical need. Despite high remission rates with chemotherapy standard care treatment, the disease eventually relapses. Activating FLT3 mutations are found in approximately 30% of AML patients. Targeting FLT3 receptor tyrosine kinase has shown encouraging results in treating FLT3-mutated AML. Responses, however, are not sustained and acquired resistance has been a clinical challenge. Treatment options to overcome resistance are currently the focus of research. We report here preclinical evaluation of AMG 925, a potent, selective and bioavailable FLT3/CDK4 dual kinase inhibitor. The compound inhibited AML xenograft tumor growth by >99% without detectable body weight loss. AMG 925 was also found to inhibit FLT3 mutants (e.g, D835Y) that are resistant to the current FLT3 inhibitors (e.g., quizartinib/AC220, sorafenib). CDK4 is a cyclinD-dependent kinase that plays an essential central role in regulating cell proliferation in response to external growth signals. A critical role of the CDK4-Rb pathway in cancer development has been well established. CDK4 specific inhibitors are being developed for treating Rb positive cancer. AMG 925, which combines inhibition of two kinases essential for proliferation and survival of FLT3-mutated AML cells, may improve clinical response rates.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):A279.

Citation Format: Kang Dai, Kathleen Keegan, Zhihong Li, Ma Ji, Cong Li, John Eksterowicz, Coberly Suzanne, David Hollenback, Margret Weidner, Justin Huard, Lingming Liang, Grace Alba, Jessica Orf, Mei-Chu Lo, Sharon Zhao, Rachel Ngo, Ada Chen, Lily Liu, Timothy Carlson, Lawrence R. McGee, Julio Medina, Alexander Kamb, Dineli Wickramasinghe. Preclinical evaluation of AMG 925, a FLT3/CDK4 dual kinase inhibitor. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr A279.

Potent and Orally Bioavailable GPR142 Agonists as Novel Insulin Secretagogues for the Treatment of Type 2 Diabetes

GPR142 is a G protein-coupled receptor that is predominantly expressed in pancreatic β-cells. GPR142 agonists stimulate insulin secretion in the presence of high glucose concentration, so that they could be novel insulin secretagogues with reduced or no risk of hypoglycemia. We report here the optimization of HTS hit compound 1 toward a proof of concept compound 33, which showed potent glucose lowering effects during an oral glucose tolerance test in mice and monkeys.

Motor and gait improvement in patients with incomplete spinal cord injury induced by high-frequency repetitive transcranial magnetic stimulation

OBJECTIVE

To assess the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremities motor score (LEMS) and gait in patients with motor incomplete spinal cord injury (SCI).

METHOD

The prospective longitudinal randomized, double-blind study assessed 17 SCI patients ASIA D. We assessed LEMS, modified Ashworth Scale (MAS), 10-m walking test (10MWT), Walking Index for SCI (WISCI II) scale, step length, cadence, and Timed Up and Go (TUG) test at baseline, after the last of 15 daily sessions of rTMS and 2 weeks later. Patients were randomized to active rTMS or sham stimulation. Three patients from the initial group of 10 randomized to sham stimulation entered the active rTMS group after a 3-week washout period. Therefore a total of 10 patients completed each study condition. Both groups were homogeneous for age, gender, time since injury, etiology, and ASIA scale. Active rTMS consisted of 15 days of daily sessions of 20 trains of 40 pulses at 20 Hz and an intensity of 90% of resting motor threshold. rTMS was applied with a double cone coil to the leg motor area.

RESULTS

There was a significant improvement in LEMS in the active group (28.4 at baseline and 33.2 after stimulation; P = .004) but not in the sham group (29.6 at baseline, and 30.9 after stimulation; P = .6). The active group also showed significant improvements in the MAS, 10MWT, cadence, step length, and TUG, and these improvements were maintained 2 weeks later. Following sham stimulation, significant improvement was found only for step length and TUG. No significant changes were observed in the WISCI II scale in either group.

CONCLUSION

High-frequency rTMS over the leg motor area can improve LEMS, spasticity, and gait in patients with motor incomplete SCI.

Automedicación y factores relacionados en trabajadores de Salud que laboran en el Instituto Materno Perinatal de Lima 2011

Objetivos: Determinar la prevalencia de automedicación y sus principales características en trabajadores de Salud que laboran en el Instituto Nacional Materno Perinatal de Lima. Diseño: Estudio descriptivo transversal realizado Institución: Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Trabajadores de Salud, asistenciales y administrativos; no se incluyó médicos, enfermeras, obstetrices, odontólogos ni químicos farmacéuticos. Intervenciones: Entre julio y setiembre de 2011 se realizó entrevista a 226 trabajadores aplicando un cuestionario que fue validado mediante juicio de expertos y una prueba piloto; tipo de muestreo aleatorio simple; los cálculos fueron realizados con nivel de confianza de 95%. Principales medidas de resultados: Automedicación. Resultados: La prevalencia de automedicación fue 79%. El 63% refirió su uso por falta de tiempo para ir al médico y su uso favorable como antecedente. El 95% conocía que el uso de la automedicación es un riesgo para su salud. El 91% lo adquirió en farmacias y boticas, donde 92% refiere que no le solicitaron receta médica. Conclusiones: Existió una elevada prevalencia de automedicación en estos trabajadores, a pesar de encontrase en una institución de salud. La falta de tiempo, el antecedente de uso favorable y la fácil adquisición de medicamentos fueron las características más importantes de la automedicación.

Características laborales del médico joven egresado de la Facultad de Medicina San Fernando

Objetivo: Determinar las características laborales del médico joven egresado de la Facultad de Medicina San Fernando. Diseño: Estudio observacional, transversal. Lugar: Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos. Participantes: Médicos egresados de la Facultad de Medicina. Intervenciones: Se recolectó datos sociodemográficos, del desempeño laboral, grado profesional, nivel de satisfacción y desempeño extracurricular del pregrado, en 232 médicos egresados de la Facultad de Medicina San Fernando entre 1994 y 2003, elegidos al azar. La recolección se llevó a efecto mediante entrevista directa, telefónica o cuestionario vía correo electrónico. También se obtuvo las notas finales del pregrado de los sujetos. Principales medidas de resultados: Índice de empleo, tipo de labor, desempeño, especialización. Resultados: El 72,4% estuvo representado por varones, 73,2% radicaba en Lima, 19,3% en provincias y 7,5% en el extranjero; 97% tenía trabajo remunerado, 51,4% de ellos tenía 2 o más trabajos; 71% trabajaba en el sector público. El tipo de labor predominante fue el asistencial; 78,8% alcanzaba el desempeño laboral esperado; 64,9% era especialista o estaba en proceso de especialización; 15,4% tenía o estudiaba una maestría. No se encontró relación significativa entre factores del pregrado y las características laborales o profesionales. Conclusiones: El índice de empleo fue alto. El centralismo, trabajo médico múltiple, modelo centrohospitalario público asistencial y la tendencia a la especialización fueron predominantes.

[Self-medication behavior among pregnant women user of the Instituto Nacional Materno Perinatal, Peru 2011]

We aim to determine the prevalence of self prescribing behaviour during pregnancy and its characteristics. For this purpose, we designed a cross sectional study and interviewed 400 pregnant women who had their prenatal care at Instituto Nacional Materno Perinatal, Lima. We found that 10.5% of the patients (42 patients) had a self prescribing behavior during pregnancy, 64.5% think that self prescribing behavior can produce congenital malformations. The medications used were classified as type A and B according to the Food and Drug Administration (FDA). Paracetamol was used more frequently (47.6%) followed by amoxicillin (16.7%). All the women who self-prescribed have had this behavior before pregnancy. According to these results, we conclude there is a low prevalence of self-prescribing behavior during pregnancy compared to the international literature.

Abstract LB-249: Characterization of a novel potent and selective CDK4/6 inhibitor and a resistance mechanism

CDK4 and CDK6 are two highly related cyclin D-dependent cell cycle regulatory kinases. CDK4/6 activity promotes G1 to S phase transition by phosphorylating the retinoblastoma (Rb) tumor suppressor protein. Here, we report the characterization of a potent, selective and orally-available small molecule inhibitor of CDK4/6 for treating Rb-positive cancer. The inhibitor was over 1000-fold more potent in inhibiting CDK4 than CDK1. It also showed Rb-dependent anti-proliferative activity both in cancer cell lines and in xenograft tumor models. A greater degree of variation in sensitivity to the inhibitor was observed in colon cancer cell lines compared to the other cell lines tested. To understand this difference in sensitivity, we isolated CDK4/6 inhibitor-resistant colon cancer cells by growing sensitive cells in the presence of the inhibitor. Gene expression in the parental and the resistant cells was analyzed and compared. Cyclin E1, a CDK2 cyclin, was found to be the most significantly overexpressed gene in the resistant cells. Consistent with this, CDK2-associated cyclin E1 protein and CDK2 kinase activity were also significantly increased in the cells. These results suggest that high expression of cyclin E1 may make tumors less sensitive to CDK4/6 inhibition and could be a potential sensitivity marker for patient selection for treatment with a CDK4/6 inhibitor.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-249. doi:1538-7445.AM2012-LB-249