Zn capped Al2O3 and TiO2 nanoporous arrays as pH sensitive drug delivery systems: a combined experimental and simulation study

pH sensitive nanotube arrays based on Zn capped Al₂O₃ and TiO₂ were reported for the release of vitamin C in an experimental/theoretical study using MD simulations.

Tramadol as a pain relieving and physical work performance enhancement medication

Purpose

The purpose of this paper is to assess participants’ perception that tramadol enhances physical work performance and acts as a pain relief.

Design/methodology/approach

The participants were 30 (18 male and 12 female) tramadol-using emerging adults, aged 16–27 years, selected through respondent-driven sampling. The majority of the participants were university students, whereas others had completed senior secondary education. The study adopted a qualitative design. Qualitative data were analysed using thematic analyses.

Findings

In general, respondents perceived and used tramadol for pain relief and physical work performance enhancement. The result showed that sex, employment status and daily dosage were not associated with respondents’ perception of tramadol as a pain-relieving medication. In contrast, sex and employment status were associated with participants’ perception of tramadol as a physical work performance enhancement medication, but daily dosage was not.

Research limitations/implications

Some users refused to participate because they were afraid of being exposed to law enforcement.

Practical implications

Male and female emerging adults are involved in non-medical use of tramadol. Prevention and intervention programs to reduce or stop this behaviour are needed, especially in the rural communities.

Social implications

The result showed that users were mostly from poor homes, whose parents could not afford university education and who were not qualified to get good government paying jobs. So, the use of tramadol became necessary for them to make more money from the kind of jobs they did. Reduction of the cost of university education and provision of regular jobs for this population are some of the measures recommended to counter non-medical use of tramadol by this population.

Originality/value

This is the first study in South-eastern Nigeria that focused on the non-medical use of tramadol among emerging adults, using a qualitative design.

P3349RHAPSODY: a pivotal phase 3 trial to assess efficacy and safety of rilonacept, an interleukin 1 alpha and beta blocker, in patients with recurrent pericarditis

Background

Recurrent pericarditis (RP) is managed with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), and colchicine; up to 15% of pericarditis patients experience multiple recurrences. Interleukin 1 (IL-1) is an important cytokine in the pathophysiology of RP. Rilonacept (KPL-914) is a recombinant fusion protein which binds IL-1α and IL-1β. An ongoing Phase 2 study of rilonacept demonstrated improvements in RP symptoms and inflammation.

Purpose

To evaluate the efficacy and safety of subcutaneous (SC) rilonacept in patients with RP in a Phase 3, randomized, placebo-controlled trial.

Methods

RHAPSODY is a double-blind, placebo-controlled, randomized-withdrawal trial; ∼50 patients will be enrolled (Figure). Patients (≥12 y) must present with at least a third pericarditis episode (all etiologies except infectious and malignant) characterized by a pain score ≥4 on the 11-point Numeric Rating Scale (NRS) and C-reactive protein (CRP) ≥1 mg/dL at screening. Patients may be receiving stable doses of analgesics, NSAIDs, colchicine, and/or CS. After a loading dose (320 mg SC in adults and 4.4 mg/kg SC in children), all patients will receive weekly rilonacept (160 mg SC in adults and 2.2 mg/kg SC in children) during the run-in period. Patients able to taper and discontinue concomitant pericarditis medications and achieve clinical response (mean daily NRS score ≤2.0 during the 7 days before randomization and CRP level ≤0.5 mg/dL) will be randomized 1:1 in a blinded fashion to continued rilonacept or matching placebo weekly SC injections. Investigators may choose different treatments for pericarditis recurrences based on patient clinical status, including bailout rilonacept, while maintaining the blind to prior treatment assignment. The primary efficacy endpoint is time to pericarditis recurrence (adjudicated by an independent committee) in the randomized-withdrawal portion of the study. Secondary efficacy endpoints are the proportion of patients maintaining a clinical response, percentage of days with NRS pain score ≤1, and percentage of patients with no-to-minimal pericarditis symptoms based on patient global assessment. Safety evaluations include adverse events monitoring, physical examinations, and laboratory tests.

Figure 1

Conclusions

RHAPSODY is a pivotal Phase 3 trial evaluating the efficacy and safety of rilonacept in patients with RP using a double-blind, placebo-controlled, randomized-withdrawal design. The results of this study may inform the management of RP.

Acknowledgement/Funding

This study is sponsored by Kiniksa Pharmaceuticals, Ltd.

Variation between hospitals in outcomes following cardiac surgery in the UK

INTRODUCTION

We examine the influence of variations in provision of cardiac surgery in the UK at hospital level on patient outcomes and also to assess whether there is an inequality of access and delivery of healthcare. Cardiothoracic surgery has pioneered the reporting of surgeon-specific outcomes, which other specialties have followed. We set out to identify factors other than the individual surgeon, which can affect outcomes and enable other surgical specialties to adopt a similar model.

MATERIALS AND METHODS

A retrospective analysis of prospectively collected data of patient and hospital level factors between 2013 and 2016 from 16 cardiac surgical units in the UK were analysed through the Society for Cardiothoracic Surgery of Great Britain and Ireland and the Royal College of Surgeons Research Collaborative. Patient demographic data, risks factors, postoperative complications and in-hospital mortality, as well as hospital-level factors such as number of beds and operating theatres, were collected. Correlation between outcome measures was assessed using Pearson's correlation coefficient. Associations between hospital-level factors and outcomes were assessed using univariable and multivariable regression models.

RESULTS

Of 50,871 patients (60.5% of UK caseload), 25% were older than 75 years and 29% were female. There was considerable variation between units in patient comorbidities, bed distribution and staffing. All hospitals had dedicated cardiothoracic intensive care beds and consultants. Median survival was 97.9% (range 96.3-98.6%). Postoperative complications included re-sternotomy for bleeding (median 4.8%; range 3.5-6.9%) and mediastinitis (0.4%; 0.1-1.0%), transient ischaemic attack/cerebrovascular accident (1.7%; range 0.3-3.0%), haemofiltration (3.7%; range 0.8-6.8%), intra-aortic balloon pump use (3.3%; range 0.4-7.4%), tracheostomy (1.6%; range 1.3-2.6%) and laparotomy (0.3%; range 0.2-0.6%). There was variation in outcomes between hospitals. Univariable analysis showed a small number of positive associations between hospital-level factors and outcomes but none remained significant in multivariable models.

CONCLUSIONS

Variations among hospital level factors exists in both delivery of, and outcomes, following cardiac surgery in the UK. However, there was no clear association between these factors and patient outcomes. This negative finding could be explained by differences in outcome definition, differences in risk factors between centres that are not captured by standard risk stratification scores or individual surgeon/team performance.

Tramadol: a valuable treatment for pain in Ghana and Nigeria

OBJECTIVE

Pain management is unsatisfactory worldwide, particularly in developing countries where access to opioids is restricted and cost is an issue. It is a major concern in West Africa and we therefore undertook a survey of pain experts to obtain a better understanding of the problems in the region.

METHODS

Medical practitioners involved in pain management, identified via professional networks, were interviewed to share their experience in treating moderate-to-severe pain in West Africa. The questionnaire was based on an existing version modified to meet African conditions. Additionally, informal focus group meetings with palliative care physicians and pharmacists were conducted.

RESULTS

A total of 11 questionnaires were returned. All respondents were physicians who reported availability of opioids in their clinics, but access to morphine was challenging and not possible in some rural settings. Obligatory maintenance of detailed records was considered a burden. The main concern raised was the risk of misuse/addiction. Seven of 11 respondents reported that they would use tramadol as an alternative to strong opioids if required and, interestingly, 9 of 11 considered it to be an essential medicine. Based on personal experience, the respondents noted that some properties of tramadol make it a key pain treatment option in West Africa (strong/fast-acting, better tolerated than NSAIDs, less addictive than other opioids and relatively inexpensive).

CONCLUSIONS

Most stakeholders who completed the survey indicated that tramadol was essential to provide optimal pain management in the absence of access to strong opioids.

Abstract OT2-06-01: Highly innovative personalized RNA-immunotherapy for patients with triple negative breast cancer

Background: The treatment of triple negative breast cancer (TNBC) is hampered by the lack of established therapeutic targets such as hormone receptors or HER-2. Chemotherapy and radiotherapy is the standard of care, yet survival rates in TNBC remain poor. Approaches tailored to the patient's individual tumor signature may lead to improved therapeutic outcome. We have set up a clinical workflow covering drug development (from target discovery to manufacturing) and drug release providing a custom-made investigational medicinal product (IMP) for each individual patient.

Trial Design: A phase I/II trial assesses the feasibility, safety and biological efficacy of this personalized immunotherapy in three clinical sites in Germany and Sweden. TNBC patients (pT1cN0M0 – TxNxM0) after completion of initial standard of care therapy will be allocated to one of two study arms. Patients in ARM1 receive 8 vaccination cycles with a personalized combination of shared tumor-associated antigens, selected based on each patient tumor's antigen-expression profile out of a WAREHOUSE of pre-manufactured mRNA vaccine. Patients in ARM2 receive the personalized mRNA WAREHOUSE vaccine followed by 8 vaccination cycles of an on-demand manufactured mRNA MUTANOME vaccine encoding up to twenty unique neo-epitopes of the individual patient identified by next generation sequencing. The mRNAs are administered intravenously as a nanoparticulate lipoplex formulation, which protects RNA from degradation, activates innate immunity, transfects APCs and consequently induces highly potent antigen-specific T-cell responses. The treatment of 12 patients in ARM1 is completed and enrolment of patients for ARM2 has started. Preliminary data show that the RNA-WAREHOUSE approach is feasible and can be applied safely. Biomarker analysis is ongoing. This approach is promising as it addresses the heterogeneity of TNBC.

The TNBC-MERIT trial was initially funded by the EU Commission's FP7 and led by BioNTech AG.

Citation Format: Schmidt M, Bolte S, Frenzel K, Heesen L, Derhovanessian E, Bukur V, Diken M, Gruetzner J, Kreiter S, Klein A, Kuhn A, Langer D, Loewer M, Lindman H, Schneeweiss A, Tuereci O, Sahin U. Highly innovative personalized RNA-immunotherapy for patients with triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-06-01.

Cycloaddition of CO2 with epoxides and esterification reactions using the porous redox catalyst Co-POM@MIL-101(Cr)

The catalytic activity of the Co-POM@MIL-101(Cr) composite in solvent-free cycloaddition of CO₂ to epoxides and esterification of acetic acid with alcohols is due to an outer-sphere electron transfer mechanism using the Co(iii)/Co(ii) redox pair.

Poly and Tricky Dick: The drug war origins of the term "polydrug use"

Polydrug use is presented as a particular drug-use phenomenon when the combination of substances is and always has been the practice. The origin of the term is found in the early years of the war on drugs under the Nixon administration in the US, when it was used to justify the intensification of repressive measures against drug users and to counter the growing accommodation and normalisation of cannabis. Only by presenting cannabis as the first step towards the use of harder drugs could the repression of this largely innocuous and widely used substance be justified. Drug users were presented as "polydrug users", which offered an explanation of problematic use as rooted in the drug user, the addict, who would switch substances in accordance with availability and price. Having become established for political reasons, the term has become entrenched because it resonates and vividly describes social practice. Yet it does not add to understanding of social reality but occludes and confuses because it presents "polydrug" as a particular and peculiar pattern of consumption and not as the norm.

Doltsinis N, Klein A. Reactions of the organoplatinum complex [Pt(cod) (neoSi)Cl] (neoSi = trimethylsilylmethyl) with the non-coordinating anions SbF6– and BPh4–

Reactions of the organoplatinum complex [Pt(cod)(neoSi)Cl] (neoSi = (trimethylsilylmethyl) with the Ag(I) salts of oxo or fluoride containing anions A– = NO3–, ClO4–, OTf – (trifluoromethanesulfonate) and SbF6– lead to the desired abstraction of the chlorido ligand and precipitation of AgCl. However, further reaction of the resulting Pt complexes [Pt(cod)(neoSi) (solvent)]+ with diverse N-heterocyclic ligands L such as pyridines, caffeine, and guanine did not yield the targeted complexes [Pt(cod)(neoSi)(L)](A) in most of the cases, but to extensive decomposition yielding [Pt(cod)(Me) (solvent)]+, thus transforming the neoSi into a methyl ligand. A detailed study on the reaction with SbF6– combining DFT calculations with NMR and MS revealed that Pt catalysed decomposition of SbF6‒ and fluorination of the neoSi silicon atom leading to FSiMe3. When reacting the parent complex with Ag(BPh4), the arylated derivative [Pt(cod)(neoSi)(Ph)] was obtained and characterised by multinuclear NMR, MS and single crystal XRD.

Adalimumab versus adalimumab and methotrexate for the treatment of juvenile idiopathic arthritis: long-term data from the German BIKER registry

OBJECTIVE

Adalimumab (ADA) has become a valuable treatment option for juvenile idiopathic arthritis (JIA). The importance of combination with methotrexate (MTX) is unclear.

METHOD

Data from the German Biologics in Paediatric Rheumatology (BIKER) registry are reported. Response to treatment was analysed using JIA American College of Rheumatology (ACR) scores, 10-joint Juvenile Arthritis Disease Activity Score (JADAS10), and improvement of functional status and ACR inactive disease criteria. Compa-risons between rates of adverse events (AEs) and serious adverse events (SAEs) provided data for the safety assessment.

RESULTS

Overall, 584 patients with non-systemic JIA started ADA therapy, 61% of whom received concomitant MTX treatment at baseline. The latter patients were younger (p < 0.001), with shorter disease duration (p = 0.001), more frequently had antinuclear antibodies (p = 0.04), and had higher baseline JADAS10 scores (p = 0.03). In patients with ADA monotherapy, enthesitis-related arthritis (p = 0.004) and presence of human leucocyte antigen-B27 (p = 0.008) were documented more often. Mean treatment duration in both cohorts was 15 months. Comparable last follow-up rates for JIA ACR 30/50/70/90% response, JADAS minimal disease activity, JADAS remission, and ACR inactive disease were, respectively, 75/72/64/49%, 66%, 46%, and 58% for ADA monotherapy, and 77/72/61/45%, 64%, 48%, and 55%, for ADA + MTX. During 1082 patient-years (PY) of ADA exposure, 725 AEs (67/100 PY), including 57 SAEs (5.3/100 PY), were reported. Serious infections were reported in 10 patients (0.9/100 PY) and 11 (1.0/100 PY) had varicella infections/zoster reactivation. Rates of AEs, SAEs, infectious events, and serious infections did not differ between the cohorts. Elevated transaminases (p = 0.005) and gastrointestinal events (p < 0.0001) were reported more often in the combination cohort. Two pregnancies and no deaths were reported.

CONCLUSION

ADA demonstrated an acceptable risk profile and high percentages of patients in both cohorts showed sufficient treatment response. No differences in treatment response or adherence to treatment were found.

Live-cell labeling of endogenous proteins with nanometer precision by transduced nanobodies

Accurate labeling of endogenous proteins for advanced light microscopy in living cells remains challenging. Nanobodies have been widely used for antigen labeling, visualization of subcellular protein localization and interactions. To facilitate an expanded application, we present a scalable and high-throughput strategy to simultaneously target multiple endogenous proteins in living cells with micro- to nanometer resolution. For intracellular protein labeling, we advanced nanobodies by site-specific and stoichiometric attachment of bright organic fluorophores. Their fast and fine-tuned intracellular transfer by microfluidic cell squeezing enabled high-throughput delivery with less than 10% dead cells. This strategy allowed for the dual-color imaging of distinct endogenous cellular structures, and culminated in super-resolution imaging of native protein networks in genetically non-modified living cells. The simultaneous delivery of multiple engineered nanobodies does not only offer exciting prospects for multiplexed imaging of endogenous protein, but also holds potential for visualizing native cellular structures with unprecedented accuracy.

Center of Mass Motion of Short-Range Correlated Nucleon Pairs studied via the A(e,e^{'}pp) Reaction

Short-range correlated (SRC) nucleon pairs are a vital part of the nucleus, accounting for almost all nucleons with momentum greater than the Fermi momentum (k_{F}). A fundamental characteristic of SRC pairs is having large relative momenta as compared to k_{F}, and smaller center of mass (c.m.) which indicates a small separation distance between the nucleons in the pair. Determining the c.m. momentum distribution of SRC pairs is essential for understanding their formation process. We report here on the extraction of the c.m. motion of proton-proton (pp) SRC pairs in carbon and, for the first time in heavier and ansymetric nuclei: aluminum, iron, and lead, from measurements of the A(e,e^{'}pp) reaction. We find that the pair c.m. motion for these nuclei can be described by a three-dimensional Gaussian with a narrow width ranging from 140 to 170  MeV/c, approximately consistent with the sum of two mean-field nucleon momenta. Comparison with calculations appears to show that the SRC pairs are formed from mean-field nucleons in specific quantum states.