Chronic nitrate therapy in patients with angina with comorbidity

In a retrospective study from the Dutch Mononitrate Quality of Life (DUMQOL) Study Group, the authors found that patients with angina with concomitant diabetes or hypercholesterolemia derived more benefit from changing over to a once-daily nitrate treatment regimen than did patients without angina. The aim of this study was to assess this issue prospectively. In an open-label study, patients with stable angina pectoris from facilities in Germany, Portugal, and me Czech Republic were treated for 3 months with multiple daily doses and subsequently for 3 more months with once-daily isosorbide mononitrate/dinitrate. After the first and second 3-month periods, they were assessed by a validated QOL battery including domains for mobility, side effects, life satisfaction, anginal pain, and psychological distress. In the 1045 patients who participated in the study, the mean summary domain scores varied from 5 to 16 points and score improvements from 1.6 to 4.3 points. In the patients without concomitant hypertension and smokers, domain scores improved less than they did in the patients without, with differences in domain score improvements up to 1.0 points (P<0.001), which is substantial considering the range of improvement was between 1.6 and 4.3 points. In the patients with diabetes mellitus or hypercholesterolemia, a reverse pattern was observed with differences in domain score improvements up to 0.4 points (P<0.05). Patients with angina with diabetes or hypercholesterolemia derived more benefit from an asymmetric regimen of isosorbide mononitrate/dinitrate than did patients without. Patients with angina with hypertension and smokers benefited less. Differences in endothelial function may be involved.

Pharmacogenetic Screening of CYP3A and ABCB1 in Relation to Population Pharmacokinetics of Docetaxel

PURPOSE

Despite the extensive clinical experience with docetaxel, unpredictable interindividual variability in efficacy and toxicity remain important limitations associated with the use of this anticancer drug. Large interindividual pharmacokinetic variability has been associated with variation in toxicity profiles. Genetic polymorphisms in drug-metabolizing enzymes and drug transporters could possibly explain the observed pharmacokinetic variability. The aim of this study was therefore to investigate the influence of polymorphisms in the CYP3A and ABCB1 genes on the population pharmacokinetics of docetaxel.

EXPERIMENTAL DESIGN

Whole blood samples were obtained from patients with solid tumors and treated with docetaxel to quantify the exposure to docetaxel. DNA was collected to determine polymorphisms in the CYP3A and ABCB1 genes with DNA sequencing. A population pharmacokinetic analysis of docetaxel was done using nonlinear mixed-effect modeling.

RESULTS

In total, 92 patients were assessable for pharmacokinetic analysis of docetaxel. A three-compartmental model adequately described the pharmacokinetics of docetaxel. Several polymorphisms in the CYP3A and ABCB1 genes were found, with allele frequencies of 0.54% to 48.4%. The homozygous C1236T polymorphism in the ABCB1 gene (ABCB1*8) was significantly correlated with a decreased docetaxel clearance (-25%; P = 0.0039). No other relationships between polymorphisms and pharmacokinetic variables reached statistical significance. Furthermore, no relationship between haplotypes of CYP3A and ABCB1 and the pharmacokinetics could be identified.

CONCLUSIONS

The polymorphism C1236T in the ABCB1 gene was significantly related to docetaxel clearance. Our current finding may provide a meaningful tool to explain interindividual differences in docetaxel treatment in daily practice.

Pattern identification in biogeography

Identifying common patterns among area cladograms that arise in historical biogeography is an important tool for biogeographical inference. We develop the first rigorous formalization of these pattern-identification problems. We develop metrics to compare area cladograms. We define the maximum agreement area cladogram (MAAC) and we develop efficient algorithms for finding the MAAC of two area cladograms, while showing that it is NP-hard to find the MAAC of several binary area cladograms. We also describe a linear-time algorithm to identify if two area cladograms are identical.

Opposite spin asymmetry of elastic and inelastic scattering of nonequilibrium holes injected into a ferromagnet

The spin asymmetry of elastic and inelastic scattering of nonequilibrium holes injected into Co thin films is examined using a p-type magnetic tunnel transistor. Spin-dependent transmission yields a positive or negative magnetocurrent depending on Co thickness and hole energy. Up to a critical thickness of about 3 nm, (quasi)elastic scattering dominates with a short attenuation length (<1 nm) and preferential attenuation of holes in the majority spin bands, consistent with spin-wave emission. At a larger Co thickness, inelastic scattering dominates with a larger attenuation length ( approximately 4 nm) and opposite spin asymmetry.

Bioactive components of the traditionally used mushroom Podaxis pistillaris

In the course of an ethnobotanical study on fungi used in Yemeni ethnomedicine the fungus Podaxis pistillaris (Podaxales, Podaxaceae, Basidiomycetes) was found to exhibit antibacterial activity against Staphylococcus aureus, Micrococcus flavus, Bacillus subtilis, Proteus mirabilis, Serratia marcescens and Escherichia coli. In the culture medium of P. pistillaris three epidithiodiketopiperazines were identified by activity-guided isolation. Based on spectral data (NMR, ESI-MS and DCI-MS) their identity was established as epicorazine A (1), epicorazine B (2) and epicorazine C (3, antibiotic F 3822), which have not been reported as constituents of P. pistillaris previously. It is assumed that the identified compounds contribute to the antibacterial activity of the extract.

LC-MS/MS systematic toxicological analysis: Comparison of MS/MS spectra obtained with different instruments and settings

OBJECTIVES

To compare the mass spectra obtained using a linear-ion-trap (LIT) tandem mass spectrometer (QTRAP) operated in the "enhanced product ion scan" (EPI) mode with those obtained in the classical triple-quadrupole product ion scan (PIS) mode run on the same as well as on two other instruments (TSQ-Quantum and Quattro-Micro).

DESIGN AND METHODS

After tentative standardization of ion fragmentation and transmission in both polarities using a reference compound (glafenine) on the three instruments, eight test compounds detected in the positive mode and five in the negative mode were systematically infused in different ionization sources and spectral acquisition performed over approximately 5 s. The relative intensity of the ions present in the resulting spectra was quantitatively and statistically compared. Also, the intra-day and inter-day variabilities of these relative intensities, as well as the effect of increasing compound concentration, were studied using QTRAP operated in EPI mode.

RESULTS

The EPI and PIS modes operated on a single LIT MS/MS instrument resulted in significant differences in relative ion intensities in both polarities, and so did the other two instruments despite prior standardization with glafenine. Some fragments could be absent in certain spectra, but no unexpected or unique fragments showed up. Intra-day variability was smaller in the LIT EPI than in the regular PIS mode and in the positive than in the negative polarity. In EPI mode, both intra- and inter-day variabilities increased when the relative intensity decreased. The effect of increasing concentration on the relative intensity of major and minor ions was small but significant in both polarities. Finally, contamination and cleansing of the ionization source also had noticeable effects on MS/MS spectra, though the cause is unclear.

CONCLUSIONS

MS/MS spectra do not offer the expected inter-instrument reproducibility despite an attempt at standardizing the fragmentation conditions using a reference compound. However, although the inter-instrument differences in ion relative intensity were significant, the spectra obtained looked almost similar. This suggests that in library searching algorithms, higher weight should be assigned for the m/z ratios than for their relative intensity in the spectra.

Spin filtering of hot holes in a metallic ferromagnet

Spin-dependent transport of nonequilibrium holes in ferromagnetic thin films and trilayers is investigated using ballistic hole magnetic microscopy. For Co, the hole attenuation length is short and increases from 6 to 10 A in the energy range 0.8 to 2 eV. The hole transmission of a Ni(81)Fe(19)/Au/Co trilayer is clearly spin dependent, resulting in a surprisingly large current change by a factor of 2.3 in a magnetic field. The energy and spin dependence of the hole transmission cannot be explained by the phase space available for inelastic decay of the hot holes.

Rapid detection of chromosomal aneuploidies in uncultured amniocytes by multiplex ligation-dependent probe amplification (MLPA)

OBJECTIVE

To test whether multiplex ligation-dependent probe amplification (MLPA) can be used for the detection of aneuploidy of chromosomes 13, 18, 21, X, and Y in uncultured amniocytes.

METHODS

We performed a prospective study based on 527 amniotic fluid samples. Chromosome copy numbers were determined by analysing the relative amount of PCR product of chromosome-specific MLPA probes. Results were available within 48 h and were compared with those of karyotyping.

RESULTS

There were 517 conclusive MLPA tests. In 514 tests, results were concordant with those of karyotyping. There were two cases of 69,XXX triploidy that could not be detected by MLPA and there was one false-positive result. Here, MLPA indicated a 47,XXY fetus, whereas the karyotype was 46,XY. We correctly identified all 23 cases of autosomal trisomy and the single case of monosomy X in samples collected from 16 up to 36 weeks of gestation. In 10 cases (2%), the result was inconclusive owing to an insufficient amount of DNA.

CONCLUSION

Sensitivity, specificity, and failure rate of MLPA were comparable to those of FISH and QF-PCR. Aneuploidy screening in uncultured amniocytes by MLPA is feasible in a clinical diagnostic setting, yielding an informative and rapid result in 98% of cases.

Inhibition of a dual chamber pacemaker by oversensing of far-field atrial depolarisation in a patient after His-bundle ablation

After His-bundle ablation, a 54-year-old pacemaker-dependent patient suffered from severe presyncopal attacks one year after pacemaker replacement. The attacks were caused by ventricular inhibition due to atrial far-field sensing during paroxysmal atrial flutter.

[Cuff pressure monitoring and regulation in adults]

OBJECTIVES

In adults the use of cuffed endotracheal tubes is the standard technique. Nitrous oxide increases the cuff pressure secondary to diffusion through the cuff membrane. The aim of the study was to verify a newly designed cuff pressure regulating device and comparison of postoperative complications.

METHODS

In a prospective, randomized, open trial the cuff pressure and the incidence of postoperative complications (e.g., hoarseness, coughing and pain while swallowing) were measured using the newly designed automatic pressure monitoring and regulating device Cuff Pressure Control (Tracoe) and a conventional handheld manometer. A total of 40 patients were assigned to the automatic group with a goal of 25.5 cmH(2)O and 40 patients to the conventional group where the pressures were kept between 20 cmH(2)0 and 40 cmH(2)0 with intermittent measurements and manual pressure release.

RESULTS

The automatic device reliably maintained the pressure at the chosen constant level within +/-2 cmH(2)O. In the control group increases in cuff pressure to 40 cmH(2)O were common. The incidence of postoperative complications in both groups was not significantly different.

CONCLUSIONS

In conclusion our data demonstrate that the automatic cuff pressure and regulation device was useful and reliable in an adult population of intubated patients in the studied pressure range.

Phosphoramidate protides of 2',3'-dideoxy-3'-fluoroadenosine and related nucleosides with potent activity against HIV and HBV

Syntheses of phosphoramidate protides of several 2',3'-dideoxy-3'-fluoroadenosine derivatives by treatment of the nucleoside with phosphorochloridates in the presence of pyridine and t-BuMgCl is described. Several of these protides showed significantly improved antiviral potency over the parent nucleoside against HIV and HBV. Especially marked was the improvement in potency of phosphoramidate protides of 2',3'-dideoxy-3'-fluoroadenosine against both HIV and HBV.

Mechanism of protein binding to spherical polyelectrolyte brushes studied in situ using two-photon excitation fluorescence fluctuation spectroscopy

We used two-photon excitation fluorescence fluctuation spectroscopy with photon counting histogram (PCH) analysis as a new tool to study the binding of globular proteins to colloidal particles in situ. Whereas fluorescence fluctuations are traditionally evaluated by calculating the autocorrelation function (fluorescence correlation spectroscopy), a complementary PCH analysis has been performed in this study which is advantageous when particle concentrations of a multicomponent system are of interest and the particles can be distinguished through particle brightness differences. The binding of two proteins, staphylococcal nuclease (SNase) and bovine serum albumin (BSA), to spherical polyelectrolyte brushes (SPB) was measured as a function of protein concentration and ionic strength of the solution at pH-values where SNase and BSA are positively and negatively charged, respectively. It has been found that SNase and BSA strongly bind to the SPB regardless of the protein charge. When the ionic strength of the solution is raised to 100 mM, the SPB become resistant to both proteins. These findings provide further evidence for a binding mechanism where the proteins are mainly driven to the SPB by the "counterion evaporation" force, while Coulomb interactions play a minor role. The results of this study characterize the potential of SPB as a new class of carrier particles for proteins whose use in biotechnological applications appears to be rewarding.

172ELECTIVE SINGLE EMBRYO TRANSFER (ESET) IN HUMANS DOES NOT AFFECT THE CHANCES OF A SUCCESSFUL PREGNANCY

Improvements in human IVF have led to increased pregnancy rates but at the expense of increasing twinning rates. Twins are a bad outcome for the offspring, parents and the healthcare system. An obvious solution to this is to transfer only one embryo and freeze the rest for potential further treatment. This study looked at the effect of doing this on the cumulative live birth rate (when the cryopreserved embryos were thawed and transferred). Patients less than 38 years of age presenting for IVF treatment and with more than two embryos suitable for transfer were offered the chance of transferring only one embryo (elective single embryo transfer, eSET) and freezing the rest. Those patients declining a single embryo transfer had two transferred and served as the controls. Patients not achieving a pregnancy returned for a frozen embryo transfer but were not restricted on the number transferred (to a maximum of two). Cumulative live birth rates were recorded over the ensuing two years. Statistical comparisons were made using paired chi-square tests. The live birth rates from the initial fresh transfer was 41% for eSET (41/111) and significantly higher (53%, P&lt;0.05) for the two-embryo transfer group. These differences were eliminated when the frozen embryos were factored in, both groups rising to 61% of patients treated (68 and 172 live births, respectively). The twinning rate was significantly reduced (P&lt;0.01) from 33% in the two-embryo transfer group to 6% (arising from 4 sets of twins in the frozen embryo transfers) in the eSET group. eSET in the fresh embryo transfer cycle does not affect the chances of a live birth and reduces the twinning rate at least fivefold. Currently, 70% of patients under the age of 38 are electing to have eSET.

Single Embryo Transfer in IVF to Prevent Multiple Pregnancies

As the success rates of IVF clinics improve, one of the adverse consequences is the increased incidence of twins, due largely to the number of embryos transferred. Even if the number of embryos transferred is restricted to two, the twinning rate can exceed 40% of the pregnancies. An obvious way to reduce this high twin rate would be to transfer only one embryo. This would require that cryopreservation of the supernumerary embryos be efficacious enough so that the chance of achieving an ongoing pregnancy is not diminished by transferring a single embryo in the stimulated cycle. Previous studies utilising embryos on day 2 and 3 of development have shown that the pregnancy rates can be acceptable (about 40%) and that the cumulative rate can be up to 60%. Most of these studies, however, do not include a comparison with the cumulative pregnancy rate with two embryos transferred in the stimulated cycle. Therefore, the efficacy has not been proven. We present clinical data from the past few years to illustrate the increase in success rates and the concomitant increase in twinning rates. The increased success in the cryopreservation program has enabled us to trial a single embryo transfer program and compare the results to the transfer of two embryos. The results strongly suggest that the transfer of a single embryo is the better clinical option.

Quality of life with heart failure: psychosocial determinants to be considered by cardiologists

BACKGROUND

Independent determinants of QOL (quality of life) with heart disease have been recognised and include factors such as severity of medical condition, comorbidity, and concomitant medication. Psychosocial factors, as 'ability to cope with the unpleasantness of the medical condition', 'want of information', and 'social identification' have an important influence on self-perceived wellbeing, but their influence on health-related QOL domains and self-perceived QOL in patients with heart failure has not been systematically studied.

OBJECTIVE

To assess correlation between such psychosocial factors and QOL in patients with heart failure.

METHODS

Patients from the outpatient heart failure clinic of the Martini Hospital, a 1000-bed community hospital in the city of Groningen, the Netherlands, were included if their ejection fractions were <40% and their medical diagnosis according to their cardiologists was stable chronic congestive heart failure. The following QOL estimators were applied: Pearlin's Mastery Scale, Stewart's Short Form 36 Quality of Life Questionnaire, Dupuy's Index of Wellbeing, Cantrill's Self-perceived Quality of Life Scale, Mester's Want of Information Scale. Internal consistency of the multi-item scales was estimated by Cronbach's alphas. Linear and multiple linear regression analyses were performed of the data.

RESULTS

Sixty patients were enrolled, 41 males and 19 females, average age 68 years (range 51 to 84 years). 'Ability to cope with the unpleasantness of the medical condition' was not only an independent determinant of self-perceived and health-related QOL (both p<0.001), but also of each domain of health-related QOL separately (p<0.001 for each domain). Lack of 'adequate medical information' and 'negative social identification' (identification with fellow-sufferers who are doing worse) were negative predictors of 'ability to cope' (p<0.01 and <0.001 respectively). 'Negative social identification' was also an independent determinant of self-perceived QOL, both unadjusted and after adjustment for 'ability to cope' and 'adequate medical information'.

CONCLUSION

Relevant recommendations from this paper to be considered by cardiologists during everyday office hours could include: 1. Patients who express having difficulties in coping with the unpleasant aspects of their underlying heart condition have low health-related QOL as well as low self-perceived QOL. 2. Providing adequate medical information is a significant contributor to both better 'ability to cope' and better self-perceived QOL. 3. Avoiding identifying with fellow-sufferers who are doing worse and, instead, starting to identify with those who are doing better, are significant contributors to both better 'ability to cope' and better self-perceived QOL.

Immunotherapy with concurrent subcutaneous GM-CSF, low-dose IL-2 and IFN-alpha in patients with progressive metastatic renal cell carcinoma

The purpose of the study was to determine toxicity, efficacy and immunologic effects of concurrent subcutaneous injections of low-dose interleukin-2 (LD-IL-2), granulocyte-monocyte colony-stimulating factor (GM-CSF) and interferon-alpha 2b (IFNalpha) in progressive metastatic renal cell carcinoma. In a multicentre phase II study, 59 evaluable patients received two to six cycles of subcutaneous IL-2 (4 mIU m(-2)), GM-CSF (2.5 microg kg(-1)) and IFNalpha (5 mIU flat(-1)) for 12 days per 3 weeks with evaluation after every two cycles. Cycles were repeated in responding or stable patients. Data were analysed after a median of 30 months follow-up (range 16-48 months). In 42 patients, the immunologic response was studied and related to response and survival. The main toxicity were flu-like symptoms, malaise and transient liver enzyme elevations, necessitating IL-2 reduction to 2 mIU m(-2) in 29 patients, which should be considered the maximal tolerable dose. The response was 24% (eight out of 34, three complete response (CR), five partial response (PR)) in patients with metachronic metastases and 12% (three out of 25, 2CR, 1PR) in patients with synchronic metastases. Overall response was 19% (11 out of 59). Median survival was 9.5 months. All tested patients showed expansion and/or activation of lymphocytes, T cells and subsets, NK cells, eosinophils and monocytes. Pretreatment HLA-DR levels on monocytes and number of CD4(+)HLA-DR(+) cells correlated with response. Pretreatment number of CD4(+)HLA-DR(+) cells and postimmunotherapy levels of lymphocytes, CD3(+), CD4(+) and CD8(+) T cells, but not of NK or B cells, correlated with prolonged survival. Immunotherapy with concurrent subcutaneous GM-CSF, LD-IL-2 and IFNalpha has limited toxicity, can be given as outpatient treatment and can induce durable CR. Response and survival with this form of immunotherapy seem to be more dependent on expansion/activation of T cells than of NK cells.

Antiviral lanostanoid triterpenes from the fungus Ganoderma pfeifferi

Ganodermadiol, lucidadiol and applanoxidic acid G were isolated as first triterpenes from the European Basidiomycete Ganoderma pfeifferi. The compounds show antiviral activity against influenza virus type A and HSV type 1.

Non-myeloablative allogeneic stem cell transplantation in patients with solid tumours and patients with a haematological malignancy

Allogeneic stem cell transplantation (allo-SCT) is a treatment option for several haematological tumours, not only to regain haematopoiesis after myeloablative chemotherapy and/or radiotherapy, but also for its apparent antitumour effect. This so-called graft-versus-tumour effect might not only be effective against haematological tumours, where it has best been proven, but also against solid tumours. To reduce morbidity and treatment-related mortality of allo-SCT, efforts are being made to establish engraftment of allogeneic stem cells after a non-myeloablative conditioning regimen and create a 'mini transplantation'. Such a therapy relies more heavily on the graft-versus-malignancy effect than on the antitumour effect exerted by the chemotherapy/radiotherapy. Here, we report the outcomes of 15 patients with haematological disease or solid tumours who underwent an SCT in the University Hospital Maastricht after a non-myeloablative fludarabine/cyclophosphamide conditioning regimen. Although results are promising, adjustments will be needed to ensure long-term stable engraftment and optimise the antitumour effect.

Band structure and density of States effects in co-based magnetic tunnel junctions

Utilizing Co/Al(2)O(3)/Co magnetic tunnel junctions with Co electrodes of different crystalline phases, a clear relationship between electrode crystal structure and junction transport properties is presented. For junctions with one fcc(111) textured and one polycrystalline (polyphase and polydirectional) Co electrode, a strong asymmetry is observed in the magnetotransport properties, while when both electrodes are polycrystalline the magnetotransport is essentially symmetric. These observations are successfully explained within a model based on ballistic tunneling between the calculated band structures (density of states) of fcc-Co and hcp-Co.