Efficacy and speed of onset of pain relief of fast-dissolving paracetamol on postsurgical dental pain: two randomized, single-dose, double-blind, placebo-controlled clinical studies

BACKGROUND

Paracetamol (APAP), also known as acetaminophen, is the most commonly used over-the-counter analgesic for the treatment of mild-to-moderate pain. However, the speed of onset of pain relief is limited mainly to the standard, immediate-release formulation. Efficacy and speed of onset of pain relief are critical in acute pain situations such as postsurgical dental pain, because reducing pain can improve clinical outcome and reduce the risk of transition from acute pain to more chronic pain. Efficacy and rapid onset also reduce the risk of excessive dosing with the analgesic.

OBJECTIVE

We sought to investigate the dose-response efficacy and speed of onset of pain relief of a fast-dissolving APAP formulation compared with lower doses of APAP and placebo in dental patients after impacted third molar extraction.

METHODS

Two single-center, single-dose, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies (Study I and Study II) were conducted to evaluate the efficacy and speed of onset of pain relief of different doses of a fast-dissolving APAP tablet (FD-APAP), standard APAP, and placebo in patients with postsurgical dental pain following third molar extraction. In Study I, a single dose of FD-APAP 1000 mg, FD-APAP 500 mg, or placebo was given to 300 patients; in Study II, a single dose of FD-APAP 1000 mg, standard APAP 650 mg, or placebo was given to 401 patients. All 701 patients from both studies were included in the analysis and safety assessment.

RESULTS

FD-APAP 1000 mg demonstrated significantly greater effect compared with FD-APAP 500 mg, APAP 650 mg, and placebo for all efficacy measurements, including sum of pain relief and pain intensity difference, total pain relief, sum of pain intensity difference, pain intensity difference, and pain relief score during 6 hours after the dose. Onset of confirmed first perceptible relief in subjects treated with FD-APAP 1000 mg was 15 minutes, which was 32% and 25% significantly shorter than onset of pain relief of FD-APAP 500 mg (22 minutes) and standard APAP 650 mg (20 minutes), respectively. FD-APAP 500 mg and APAP 650 mg demonstrated efficacy over placebo for most of the measurements; however, their effects were significantly lower and lasted for a shorter period of time than for FD-APAP 1000 mg. All study treatments were well tolerated.

CONCLUSIONS

FD-APAP 1000 mg tablets demonstrated efficacy over placebo. Also, FD-APAP 1000 mg had significantly superior effect, faster onset, and longer duration of pain relief compared with FD-APAP 500 mg and APAP 650 mg tablets.

Osteogenic differentiation of adipose-derived stem cells prompted by low-intensity pulsed ultrasound

OBJECTIVES

Based on in vivo studies, low-intensity pulsed ultrasound (LIPUS) stimulation has been widely used in the clinic for advancing bone growth during healing of non-union alignment, fractures and other osseous defects. In this study, we have investigated osteogenic differentiation of adipose stem cells (ASCs) regulated by LIPUS, and also in a preliminarily manner, we have discussed diverse effects of different duty ratio parameters.

MATERIALS AND METHODS

Mouse adipose stem cells were isolated and osteogenically induced. Then they were treated with LIPUS for 10 min/day for 3 days, 5 days and 7 days, respectively. Finally, effects of LIPUS on osteogenic differentiation of the ASCs were analysed by real-time PCR, western blotting and immunofluorescence.

RESULTS

Our data indicated that LIPUS promoted mRNA levels of runt-related transcription factor 2, osteopontin and osterix in the presence of osteo-induction medium; moreover, protein levels of runt-related transcription factor 2 and osteopontin were upregulated.

CONCLUSIONS

We successfully demonstrated that LIPUS enhanced osteogenesis of ASCs, specially at the duty ratio of 20%.

Low-intensity pulsed ultrasound induced enhanced adipogenesis of adipose-derived stem cells

OBJECTIVE

The aim of this study was to investigate effects of low-intensity pulsed ultrasound (LIPUS) on differentiation of adipose-derived stem cells (ASCs), in vitro.

MATERIALS AND METHODS

Murine ASCs were treated with LIPUS for either three or five days, immediately after adipogenic induction, or delayed for 2 days. Expression of adipogenic genes PPAR-γ1, and APN, was examined by real-time PCR. Immunofluorescence (IF) staining was performed to test for PPAR-γ at the protein level.

RESULTS

Our data revealed that specific patterns of LIPUS up-regulated levels of both PPAR-γ1 and APN mRNA, and PPAR-γ protein.

CONCLUSIONS

In culture medium containing adipogenic reagents, LIPUS enhanced ASC adipogenesis.

Abstract 817: Genomic evolution landscape of patient tumor derived xenograft of gastric cancer

Patient-derived xenograft (PDX) models have emerged as key model systems to understand the efficacy of anti-cancer agents. PDX systems have demonstrated superiority over cell lines with regards to higher histological resemblance to primary tumor, presence of stroma and also in mimicking response to therapeutic agents. However, the genomic evolution landscape of model establishment is not a well studied topic. In order to do that, we systematically collected materials from the first three passages of xenografts derived from eight gastric cancer patients from Seoul National University, Korea from 2008-2011. We subsequently generated comprehensive genomic profiles of the first three passages, parent primary tumor, and matched normal tissues for the eight patients. The genomic profiling data included whole-exome sequencing data (Agilent exome capture, paired-end sequencing on Illumina HiSeq 2000), mRNA expression (Affymetrix U133 Plus2.0), copy number data (Affymetrix SNP6), miRNA expression (Agilent miRNA array v16.0) and DNA methylation data (Illumina HumanMethylation27). The analysis is focused on two types of events: a) Cancer-related genomic changes derived from normal vs. tumor comparison, and their subsequent assessment in early passages; b) Passage-specific genomic changes derived from tumor vs. passages comparison. A further refinement of passage-specific genomic changes is done to differentiate ‘true’ passage-specific events from the ones that appear due to the difference in tumor purity that is lower in primary tumor due to the normal contamination. Overall, we describe the genomic landscape of evolution along xenograft establishment in gastric cancer and provide a comprehensive picture of genetic and genomic similarities (and differences) of xenografts to the primary tumor. This analysis will help us to better interpret the in vivo results emanating from experiments using xenografts and to translate the findings appropriately to the clinic.

Citation Format: Kun Yu, Swee Seong Wong, Jason C. Ting, Thompson N. Doman, Yong Yue, Amit aggarwal, Gregory P. Donoho, Rebekka Krumbach, Heiner H. Feibig, Seong-Ho kong, Woo-ho Kim, Han-kwang Yang, Christoph Reinhard. Genomic evolution landscape of patient tumor derived xenograft of gastric cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 817. doi:10.1158/1538-7445.AM2013-817

Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.

Surgical incision induces phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites and GluR1 trafficking in spinal cord dorsal horn via a protein kinase Cγ-dependent mechanism

Spinal α-amino-3-hydroxy-5-methy-4-isoxazole propionate (AMPA) receptor plays an important role in acute pain induced by surgical tissue injuries. Our previous study has shown that the enhanced phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites by protein kinase C (PKC) in the spinal cord dorsal horn is involved in post-surgical pain hypersensitivity. However, which isoforms of PKC are responsible for the phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites remains to be established. In the present study, using an animal model of postoperative pain, we found that surgical tissue injuries enhanced the membrane translocation level of PKCγ, but not PKCα, βI, and βII, and induced the trafficking of GluR1, but not GluR2 into neuronal plasma membrane. Intrathecal (i.t.) pretreatment of small interfering RNA targeting PKCγ to reduce the PKCγ expression in the spinal cord significantly attenuated the pain hypersensitivity and inhibited the phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites as well as GluR1 membrane trafficking. Our study indicates that the surgical incision-induced phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites and GluR1 trafficking are regulated by a PKCγ-dependent mechanism.

Nonedge-specific adaptive scheme for highly robust blind motion deblurring of natural imagess

Blind motion deblurring estimates a sharp image from a motion blurred image without the knowledge of the blur kernel. Although significant progress has been made on tackling this problem, existing methods, when applied to highly diverse natural images, are still far from stable. This paper focuses on the robustness of blind motion deblurring methods toward image diversity-a critical problem that has been previously neglected for years. We classify the existing methods into two schemes and analyze their robustness using an image set consisting of 1.2 million natural images. The first scheme is edge-specific, as it relies on the detection and prediction of large-scale step edges. This scheme is sensitive to the diversity of the image edges in natural images. The second scheme is nonedge-specific and explores various image statistics, such as the prior distributions. This scheme is sensitive to statistical variation over different images. Based on the analysis, we address the robustness by proposing a novel nonedge-specific adaptive scheme (NEAS), which features a new prior that is adaptive to the variety of textures in natural images. By comparing the performance of NEAS against the existing methods on a very large image set, we demonstrate its advance beyond the state-of-the-art.

Evaluation of 3D fluoroscopic image generation from a single planar treatment image on patient data with a modified XCAT phantom

Accurate understanding and modeling of respiration-induced uncertainties is essential in image-guided radiotherapy. Explicit modeling of the overall lung motion and interaction among different organs promises to be a useful approach. Recently, preliminary studies on 3D fluoroscopic treatment imaging and tumor localization based on principal component analysis motion models and cost function optimization have shown encouraging results. However, the performance of this technique for varying breathing parameters and under realistic conditions remains unclear and thus warrants further investigation. In this work, we present a systematic evaluation of a 3D fluoroscopic image generation algorithm via two different approaches. In the first approach, the model's accuracy is tested for changing parameters for sinusoidal breathing. These parameters include changing respiratory motion amplitude, period and baseline shift. The effects of setup error, imaging noise and different tumor sizes are also examined. In the second approach, we test the model for anthropomorphic images obtained from a modified XCAT phantom. This set of experiments is important as all the underlying breathing parameters are simultaneously tested, as in realistic clinical conditions. Based on our simulation results for more than 250 s of breathing data for eight different lung patients, the overall tumor localization accuracies of the model in left-right, anterior-posterior and superior-inferior directions are 0.1 ± 0.1, 0.5 ± 0.5 and 0.8 ± 0.8 mm, respectively. 3D tumor centroid localization accuracy is 1.0 ± 0.9 mm.

Two new stemona alkaloids from Stemona tuberosa Lour

Two new pyrrolo[1,2-α]azepine-type stemona alkaloids, named as tuberostemonoxirine (1) and 9α-epi-tuberospironine (2), were isolated from the roots of Stemona tuberosa. The structures and relative configurations of new compounds were established on the basis of extensive spectroscopic evidences, especially 1D and 2D NMR and HR-MS experiments.

Genome-wide screen for modulation of hepatic apolipoprotein A-I (ApoA-I) secretion

Control of plasma cholesterol levels is a major therapeutic strategy for management of coronary artery disease (CAD). Although reducing LDL cholesterol (LDL-c) levels decreases morbidity and mortality, this therapeutic intervention only translates into a 25-40% reduction in cardiovascular events. Epidemiological studies have shown that a high LDL-c level is not the only risk factor for CAD; low HDL cholesterol (HDL-c) is an independent risk factor for CAD. Apolipoprotein A-I (ApoA-I) is the major protein component of HDL-c that mediates reverse cholesterol transport from tissues to the liver for excretion. Therefore, increasing ApoA-I levels is an attractive strategy for HDL-c elevation. Using genome-wide siRNA screening, targets that regulate hepatocyte ApoA-I secretion were identified through transfection of 21,789 siRNAs into hepatocytes whereby cell supernatants were assayed for ApoA-I. Approximately 800 genes were identified and triaged using a convergence of information, including genetic associations with HDL-c levels, tissue-specific gene expression, druggability assessments, and pathway analysis. Fifty-nine genes were selected for reconfirmation; 40 genes were confirmed. Here we describe the siRNA screening strategy, assay implementation and validation, data triaging, and example genes of interest. The genes of interest include known and novel genes encoding secreted enzymes, proteases, G-protein-coupled receptors, metabolic enzymes, ion transporters, and proteins of unknown function. Repression of farnesyltransferase (FNTA) by siRNA and the enzyme inhibitor manumycin A caused elevation of ApoA-I secretion from hepatocytes and from transgenic mice expressing hApoA-I and cholesterol ester transfer protein transgenes. In total, this work underscores the power of functional genetic assessment to identify new therapeutic targets.

Current conduct of deep hypothermic circulatory arrest in China

INTRODUCTION

Deep hypothermic circulatory arrest for adult aortic arch repair is still associated with significant mortality and morbidity. Furthermore, there is still significant variation in the conduct of this complex perioperative technique. This variation in deep hypothermic circulatory arrest practice has not been adequately characterized and may offer multiple opportunities for outcome enhancement. The hypothesis of this study was that the current practice of adult deep hypothermic circulatory arrest in China has significant variations that might offer therapeutic opportunities for reduction of procedural risk.

METHODS

An adult deep hypothermic circulatory arrest questionnaire was developed and then administered at a thoracic aortic session at the International Cardiothoracic and Vascular Anesthesia Congress convened in Beijing during 2010. The data was abstracted and analyzed.

RESULTS

The majority of the 56 respondents were anesthesiologists based in China at low-volume deep hypothermic circulatory arrest centers. The typical aortic arch repair had a prolonged deep hypothermic circulatory arrest time at profound hypothermia. The target temperature for deep hypothermic circulatory arrest was frequently measured distal to the brain. The most common perfusion adjunct was antegrade cerebral perfusion, typically monitored with radial arterial pressure and cerebral venous oximetry. The preferred neuroprotective agents were steroids and propofol.

CONCLUSIONS

The identified opportunities for outcome improvement in this delineated deep hypothermic circulatory arrest model include nasal/tympanic temperature measurement and routine cerebral perfusion, preferably with unilateral antegrade cerebral perfusion monitored with radial artery pressure and cerebral oximetry. Development and dissemination of an evidence-based consensus would enhance these practice-improvement opportunities.

Effect of greyscale liquid crystal displays of different resolutions on observer performance during detection of small solitary pulmonary nodules

OBJECTIVE

The aim of this study was to evaluate the effect of monochrome liquid crystal displays (LCDs) with different resolutions on observer performance during detection of small solitary pulmonary nodules.

METHODS

Chest images of digital radiography were selected online from the hospital's picture archiving and communication system. Of the 164 images selected, small solitary non-calcified pulmonary nodules were present in 63 images and absent in 101 images. Observer performance was assessed among 3 extremely experienced, 3 very experienced and 3 moderately experienced radiologists, who independently interpreted these images on 2, 3 and 5 megapixel greyscale LCDs. A five-point confidence level rating scale was used to represent the presence of nodules: definite absence, probable absence, indetermination, probable presence and definite presence. The observers were requested to rank each image on the given display according to the presence of the pulmonary nodule. Observer performance was analysed in terms of receiver operating characteristics (ROCs).

RESULTS

The areas under the ROC curves which represented the observer performance for the 2, 3 and 5 megapixel LCDs were found to be 0.705, 0.722 and 0.764, respectively, for the extremely experienced radiologists; 0.687, 0.712 and 0.721, respectively, for the very experienced radiologists; and 0.689, 0.696 and 0.711, respectively, for the moderately experienced radiologists. These differences were not statistically significant.

CONCLUSION

The observer performances for detection of small solitary non-calcified pulmonary nodules by radiologists with varying degrees of experience were comparable between the 2, 3 and 5 megapixel monochrome LCDs.

WE-G-213CD-05: Beam's-Eye-View Prostate Motion Detection during Arc Radiotherapy

PURPOSE

To track prostate motion during clinical arc radiotherapy using a novel statistical motion tracking algorithm in both phantom and patient systems.

METHODS

For the phantom study, a dynamic phantom with a custom tumor model and radiopaque fiducials was used. For the patient study, the clinical data from two prostate patients were acquired during volumetric modulated arc therapy (VMAT). For each patient, two gold fiducials (X-Mark, 1cm and 2cm in length) were implanted in the prostate. A total of 35 fractions with 2-field full arcs were delivered. Beam's-eye- view (BEV) images were acquired in cine mode every five fractions at a frame rate of 2 fps.The prostate motion was measured by two sequential steps: fiducial detection and motion estimation. In the first step, a wavelet- based block matching filter was used to suppress the noise and enhance the fiducials in the BEV images. A trajectory of detected fiducials was generated along the projection angles. Sequentially, the prostate motion was tracked using a statistical maximum a posteriori (MAP) algorithm. The 3-D fiducial position was estimated by maximizing the probability of displacement of 2-D projections.

RESULTS

A total of 8,400 BEV images were processed for this study. The phantom experiments showed that the baseline accuracy of estimation is 0.69+/-0.56 mm. For patient 1, intra- fraction prostate motion was measured to be 0.98+/-0.51 mm for all fractions, and individual fraction motion less than 1 mm. For patient 2, intra- fraction motion was 1.12+/-0.65 mm for all fractions. However, an exceptionally large displacement was measured as 4.9+/-0.74mm in one of the fractions.

CONCLUSIONS

Prostate motion during arc-therapy can be rigorously tracked to an accuracy of one millimeter. This technique is well suited for in-treatment room target tracking and post-therapy evaluation. Varian Medical Systems Inc.