Indacaterol provides sustained 24 h bronchodilation on once-daily dosing in asthma: a 7-day dose-ranging study

BACKGROUND

Indacaterol is a novel, once-daily beta(2)-agonist in development for the treatment of asthma and chronic obstructive pulmonary disease. Studies were required to determine optimal dose(s) for continuing investigation.

OBJECTIVE

A dose-ranging study was undertaken to evaluate efficacy and safety of indacaterol.

METHODS

A total of 436 patients with persistent asthma receiving inhaled corticosteroids were randomized to 7 days treatment with once-daily indacaterol 50, 100, 200, or 400 microg via multi-dose dry-powder inhaler (MDDPI; Certihaler), indacaterol 400 microg via single-dose dry-powder inhaler (SDDPI), or placebo. Serial 24-h spirometry was performed on days 1 and 7. Vital signs, laboratory evaluations, and adverse events were monitored.

RESULTS

All doses of indacaterol increased the mean time-standardized area under the curve of forced expiratory volume in 1 s (FEV(1)) from 22 to 24 h postdose (P <or= 0.001 vs placebo) on days 1 and 7, with clinically relevant treatment-placebo differences of 240, 260, 350, 300, and 380 ml on day 1 and 230, 220, 320, 250, and 270 ml on day 7 for indacaterol 50, 100, 200, and 400 microg via MDDPI and 400 microg via SDDPI, respectively. All doses increased mean FEV(1) (P < 0.05 vs placebo) from 5 min to 24 h postdose on days 1 and 7. All doses were well tolerated. Most adverse events were mild-to-moderate in severity: most frequently reported were respiratory, thoracic, and mediastinal disorders.

CONCLUSION

Once-daily dosing with indacaterol provided sustained 24-h bronchodilation in patients with moderate-to-severe asthma, with a satisfactory overall safety profile. Indacaterol 200 microg appears the optimum dose, offering the best efficacy/safety balance.

Ultrasound study of the asymptomatic shoulder in patients with a confirmed rotator cuff tear in the opposite shoulder

Objective. To document the incidence of asymptomatic rotator cuff tears in patients with a confirmed symptomatic tear in the opposite shoulder, and to identify ultrasound findings that may distinguish symptomatic from asymptomatic tears. Design. When patients are referred for an ultrasound examination for the confirmation of symptomatic rotator cuff tear the opposite shoulder is often used for comparison. However, patients often have a similar tear on the asymptomatic side. Fifty patients with a confirmed symptomatic rotator cuff tear and an asymptomatic shoulder on the opposite side were chosen for inclusion. The patients were examined using a Siemens Sonoline Elegra 7.5 MHz linear multi-frequency probe. The appearance of the rotator cuff, long head of the biceps and the subacromial-subdeltoid bursa (SASD bursa) were documented. The antero-posterior (AP) dimension of the supraspinatus muscle and fat between the trapezius and supraspinatus muscles were measured, which indicated if a tear was acute or chronic. The width and length of the rotator cuff tear were measured. Setting. Division of Sports Medicine, University of Pretoria. Results. Fifty-four per cent of the asymptomatic shoulders had tears. We found that the symptomatic tears were larger, appeared more chronic and had an associated biceps tendinopathy and glenohumeral joint effusion. Conclusion. As other authors have found, the high incidence of asymptomatic tears indicates that rotator cuff tears can be regarded as a natural correlate of aging and that bilateral tears are common. Initial treatment should be conservative, but larger tears may benefit from early surgery before becoming chronic and causing glenohumeral dysfunction. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 23-28

What percentages of patients are suitable for prehospital thrombolysis?

OBJECTIVE

To apply the Joint Royal College Ambulance Liaison Committee (JRCALC) checklist to patients who were deemed eligible for thrombolytic therapy on arrival in an Accident & Emergency Department (A&E) to determine the proportion suitable for prehospital thrombolysis.

DESIGN

Retrospective descriptive analysis.

METHODS

The clinical notes of all patients thrombolysed in an A&E department in a year were reviewed against the JRCALC guidelines for prehospital thrombolysis.

RESULTS

14.2% of patients eligible for thrombolysis in a district general hospital were deemed suitable for prehospital thrombolysis according to the JRCALC criteria. The most common exclusion criteria were hyper/hypotension (50%), onset of symptoms (pain) >6 h previously (41.7%), or age >75 years (37%). Two or more contraindications to prehospital thrombolysis were present in 63.9% of patients.

CONCLUSION

The JRCALC guidelines are an effective tool for identifying patients with potential contraindications to thrombolysis.

Why does Japan have a high incidence of gastric cancer? Comparison of gastritis between UK and Japanese patients

BACKGROUND AND AIMS

The incidence of gastric cancer in Japan is four times higher than in the UK. It usually arises in a stomach with corpus predominant or pangastritis that has undergone extensive atrophy and intestinal metaplasia. We hypothesised that a Japanese population would have a more severe gastritis with a corpus predominant or pangastritis pattern and a greater degree of atrophy and intestinal metaplasia than that found in the UK. To test this we designed a comparative trial.

METHODS

A total of 252 age matched consecutive patients were recruited from the endoscopy services in Leeds and Tokyo. In each centre, 21 patients were prospectively selected from each decennial, between the ages of 20-80 years. All had epigastric discomfort as their predominant symptom. Patients with peptic ulcer, cancer, and oesophagitis were excluded. Five gastric biopsies were examined by two histopathologists using the updated Sydney system. Helicobacter pylori infection was assessed by histology and culture of biopsies and enzyme linked immunosorbent assay and immunoblot of plasma.

RESULTS

Gastritis was found by both pathologists in 59 (47%) UK and 76 (60%) Japanese patients (chi(2) test, p = 0.04). In those patients with gastritis, corpus predominant or pangastritis was commoner in the Japanese (63% Japan v 36% in the UK (chi(2) test, p = 0.003) Atrophy and intestinal metaplasia were more extensive and severe (Mann-Whitney U test, p<0.001) and chronic inflammation and polymorph activity were also greater, especially in the corpus (Mann-Whitney U test, p<0.001). Fifty three of 59 UK gastritis patients (90%) and 67/76 (88%) (chi(2) test, p = 1) Japanese gastritis patients were positive for H pylori. Using a previously described "gastric cancer risk index" among H pylori positive patients, there were significantly more Japanese than UK subjects with a "high risk" score.

CONCLUSION

In Japanese as opposed to English patients, gastritis is more prevalent and severe with more corpus predominant atrophy and intestinal metaplasia. These differences may partially explain the higher incidence of gastric cancer in Japan.

Secondary polycythaemia associated with unilateral renal cystic disease

Unilateral renal cystic disease (URCD) is a rare condition, with pathological features indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). In contrast to this condition, however, URCD is not inherited, is not associated with progressive deterioration in renal function, and is unilateral. We present a case of URCD associated with polycythaemia, which showed resolution following nephrectomy. Secondary polycythaemia has not previously been reported in cases of URCD, but may be hypothesised to be a result of excess erythropoietin production.

Squamous cell carcinoma of the head and neck (SCCHN) in patients reporting human immunodeficiency virus (HIV) infection: A retrospective case series

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Background: Although Squamous Cell Carcinoma of the Head and Neck (SCCHN) is a non-AIDS defining malignancy, its risk is greater in HIV-positive populations for unclear reasons. Very limited data exist on the clinical presentation, treatment toxicities and outcomes of HIV infected pts with SCCHN, a population frequently excluded from participation in clinical trials. Methods: We present a large case series of HIV infected pts with SCCHN who were recently treated at a single institution. Retrospective chart reviews were performed by treating physicians. Results are reported with descriptive statistics. Results: Thirty individuals with SCCHN reporting HIV infection have been treated by the collaborating physicians from 1997–2005; all were smokers. The average age at diagnosis of SCCHN was 49.3 years (range 33–62), and interestingly, a relatively large number were female (13 of 30, 43%). The median CD4 count of pts was 374/μL, and most pts reported a history of antiretroviral therapy. The most frequent sites of primary disease were the larynx (13 pts, 43%, mostly supraglottic) and oropharynx (13 pts, 43%). Although most patients (87%) presented with advanced (stage III and IV) disease, a few (4 pts, 13%) had stage II disease. Although 12 pts underwent surgical resections for primary treatment, 16 pts underwent primary nonsurgical therapy, including 8 pts treated with chemoradiotherapy. Therapy related toxicities were expected and did not appear different from those observed in immunocompetent individuals. Eight pts had recurrence (7 locoregional/1 distant), and 5 pts died from recurrent/metastatic disease. Three pts had second primary cancers. Conclusions: HIV-infected individuals with SCCHN are generally young smokers, both male and female, receiving active treatment against HIV. The detection of a proportion of pts with early stage disease further supports the role for aggressive smoking cessation counseling and screening efforts for SCCHN in HIV infected populations. Additionally, HIV infection is not a contraindication to aggressive organ-preserving regimens for SCCHN pts with otherwise good functional status. A case-control clinical and pathologic study of SCCHN in HIV infection is planned.

No significant financial relationships to disclose.

Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution

Islet transplantation is being offered increasingly for selected patients with unstable type 1 diabetes. Percutaneous transhepatic portal access avoids a need for surgery, but is associated with potential risk of bleeding. Between 1999 and 2005, we performed 132 percutaneous transhepatic islet transplants in 67 patients. We encountered bleeding in 18/132 cases (13.6%). In univariate analysis, the risk of bleeding in the absence of effective track ablation was associated with an increasing number of procedures (2nd and 3rd procedures with an odds ratio (OR) of 9.5 and 20.9, respectively), platelets count <150,000 (OR 4.4), elevated portal pressure (OR 1.1 per mm Hg rise), heparin dose > or =45 U/kg (OR 9.8) and pre-transplant aspirin (81 mg per day) (OR 2.6, p = 0.05). A multivariate analysis further confirmed the cumulative transplant procedure number (p < 0.001) and heparin dose > or =45 U/kg (p = 0.02) as independent risk factors for bleeding. Effective mechanical sealing of the intrahepatic portal catheter tract with thrombostatic coils and tissue fibrin glue completely prevented bleeding in all subsequent procedures (n = 26, p = 0.02). We conclude that bleeding after percutaneous islet implantation is an avoidable complication provided the intraparenchymal liver tract is sealed effectively.

Genomic microarray analysis identifies candidate loci in patients with corpus callosum anomalies

Absence of the corpus callosum is often associated with cognitive deficits, autism, and epilepsy. Using a genomic microarray, the authors analyzed DNA from 25 patients with radiographically confirmed callosal anomalies and identified three patients with de novo copy number changes in chromosome regions 2q37, 6qter, and 8p. Chromosomal deletions and duplications may be a relatively common cause of cerebral malformations.

Imaging of human metaphase chromosomes by atomic force microscopy in liquid

Human metaphase chromosomes were observed using an intermittent contact mode of atomic force microscopy (AFM) in a phosphate-buffered saline solution to clarify their conformation close to that in the physiological state. In the AFM images in liquid, symmetric alternating ridges and grooves were evident on their surface of the paired sister chromatids. The number of the ridges and grooves were rather specific to the type of the chromosome. The structural changes of chromosomes caused by trypsin treatment were also directly observable using AFM in liquid. These results suggest that the intermittent contact mode AFM is useful not only for analyzing the structure of chromosomes in a liquid condition but also for studying the effect of chemical treatments on chromosomes in relation to their structural changes.

An investigation into the causes of low calving percentage in communally grazed cattle in Jericho, North West Province

The communal grazing system is generally understood to have a low input, low output type of management. However, the actual inputs and outputs of the farmers are not well known and the farmers are often unaware of their problems. Although the causes of low calving percentage are well understood in commercial beef farming enterprises in South Africa, the same is not true for communal farming systems. The aim of this study was to determine the reproductive performance of beef cattle on a communal farming system in Jericho, North West Province. Ten farmers from five villages with a total of 265 cows and 13 bulls were purposively selected. The selection criteria were that each farmer had to have a minimum of 10 breeding cows and a bull and be willing to participate in the study. This was followed by a 12-month longitudinal study with monthly herd visits where cows were examined rectally and bulls (n = 13) were subjected to a single breeding soundness evaluation. The calving percentage was found to be 37.7%. This is lower than the recorded percentages for commercial beef cattle on extensive grazing. The factors playing a role in low calving percentage were ranked using field data. From this it appeared that failure of cows to become pregnant was the main cause of poor calving percentage as opposed of loss of calves through abortion or resorption. Sub-fertility of the bulls was found to be of great significance and it is proposed that this be included in extension messages and that bulls be fertility tested routinely. Poor body condition score of cows, mainly caused by poor management, was also considered to play a major role in reducing pregnancy rates. Infectious diseases like trichomonosis, campylobacteriosis and brucellosis played a much leser role than anticipated.

Agricultural motorcycle injuries in WA adolescents

OBJECTIVE

To determine and compare the prevalence, nature and predictors of agricultural motorcycle injuries (2, 3 & 4 wheels) in a high-risk cohort of Western Australian adolescents.

METHODS

A cross-sectional survey of 326 students (Years 11 and 12) was drawn from the six designated agricultural colleges, in Western Australia. The survey instrument was assessed as reliable and measured riding exposure, vehicle type and maintenance, use of protective equipment, training and injury experience.

RESULTS

For those subjects with access to an agricultural motorcycle (n = 240), a total of 53% (n = 127) had incurred an injury. Of these, 73% (n = 92) resulted from two wheelers and 24% (n = 31) from ATVs, with 3% (n = 4) not specified. No significant differences in the nature of injury or body parts injured was observed. Approximately one-third of those injured required medical treatment. Predictors of injury were maximum travelling speed exceeding 101 km/hour (OR 4.53) and only sometimes wearing a helmet (OR 4.10).

CONCLUSIONS

Agricultural motorcycle injuries are a significant issue in rural areas, with potential intervention points relating to improving rider training and reducing specific risk-taking behaviours.

IMPLICATIONS

Further work to investigate the efficacy of rider training interventions for agricultural motorcycles are warranted.

Mutation screening of the Homer gene family and association analysis in schizophrenia

Homer proteins are a group of proteins that regulate group 1 metabotropic glutamate receptor function. As altered glutamate function has been implicated in many neuro psychiatric disorders, particularly schizophrenia, we have screened all three known Homer genes for sequence variation for use under the candidate gene association paradigm. We found seven SNPs, including three in exons. Of these, none was non-synonymous. Allele frequencies of all the detected SNPs were estimated in DNA pools of 368 schizophrenics and 368 controls. Only one (Homer 1 IVS4 + 18A > G) was associated with schizophrenia in this sample, a finding confirmed by individual genotyping (P = 0.01). However, in our extended sample of 680 cases and 671 controls, the evidence for association diminished (P = 0.05). Our results suggest it is unlikely that sequence variants in the Homer genes contribute to the aetiology of schizophrenia, but the variants we identified are plausible candidates for other neuropsychiatric phenotypes.