An open-label phase II study of first- and second-line treatment with brivanib in patients with hepatocellular carcinoma (HCC)

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Background: Brivanib is an orally available dual inhibitor of vascular endothelial growth factor and fibroblast growth factor (FGF) signaling. FGF pathway activation is of increasing importance in the setting of liver fibrosis and HCC. This phase II study aimed to assess the efficacy and safety of brivanib in patients (pts) with unresectable, locally advanced or metastatic HCC who had received either no prior systemic therapy (Cohort A) or one prior regimen of angiogenesis inhibitor (Cohort B). Methods: Eligible pts had biopsy-proven HCC or had radiological evidence of HCC and were serology positive for Hep B or C with alpha fetoprotein levels ≥ 400 μg/L. Pts received brivanib 800 mg qd. Efficacy endpoints included OS, PFS, TTP, ORR, and DCR. Safety was assessed throughout the study. Serum levels of a biomarker, Collagen IV (a component of the basement membrane of blood vessels), were measured on day 1, weeks 3 and 6, and at end of treatment. Results: Interim results are reported. From December 2006 to October 2008, 96 patients were enrolled (Cohort A: 55 pts; Cohort B: 41 pts). In Cohort B, 38 pts had failed sorafenib and 3 had failed thalidomide. In Cohort A, median OS (95% CI) was 10 (6.8,-) months. Most frequently reported grade 3/4 AEs were fatigue (16%), AST elevation (19%), and hyponatremia (41%) in Cohort A and hypertension (7.3%), diarrhea (4.9%), and headache (4.9%) in Cohort B. 24 pts died in Cohort A and 5 pts in Cohort B, none were considered treatment-related. Treatment-induced reductions in serum Collagen IV appear to correlate with long term outcome (PFS and OS). Conclusions: Brivanib has activity as both first-line and second-line post-sorafenib systemic treatment in HCC. Collagen IV, a novel serum angiogenic biomarker, appears to be associated with outcome.

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The near triad and associated visual problems

No abstract available

Novel low-risk commercial sex practices in the parks of Vietnam

This is a paper about a novel form of commercial sex practice recorded in Vietnam, and its implications for HIV/AIDS prevention strategies. Female commercial sex workers occupy urban parks in the evenings, offering on-site masturbation services to clients at cheap prices even by local standards. All sex acts are performed in public by workers who sit on benches, path edges or stools,often behind bicycles or open umbrellas in the quest for some semblance of privacy. Clients are local men, with only an occasional foreigner involved Many sex workers were involved, some having 15 to 20 or more clients a night. Sex workers and clients in Vietnam, a s elsewhere, operate at high risk of HIV/AIDS infection. As a service which minimizes risks, this form of commercial sex practice should perhaps be given serious consideration by policy makers and authorities for formal deployment in the fight against AIDS.

Clinical efficacy of aspirin and dextran for thromboprophylaxis in geriatric hip fracture patients

The clinical efficacy of thromboprophylaxis with aspirin and dextran 40 was compared in a prospective review of 530 geriatric hip fracture patients treated surgically. All patients were also treated with early mobilization with weight bearing as tolerated and above-knee elastic stockings. In addition to clinical efficacy in preventing thromboembolic complications [deep vein thrombosis (DVT), pulmonary embolism (PE)], safety and cost-effectiveness were also assessed. The overall incidence of clinical thromboembolic disease was 2.8% (DVT = 0.4%, PE = 2.4%). The incidence of DVT (0.5%) and PE (2.6%) in the aspirin group was essentially the same as the incidence of DVT (0.3%) and PE (2.4%) in the dextran group. The inhospital mortality rate (aspirin 4.6%, dextran 3.8%), wound drainage (aspirin 1.5%, dextran 0.9%), deep wound infection (aspirin 0.5%, dextran 0.3%), gastrointestinal bleeding (aspirin 2.1%, dextran 1.5%), and congestive heart failure (aspirin 2.6%, dextran 1.8%) did not differ significantly between the two groups. The intraoperative transfusion rate was similar in both groups (aspirin .65 units, dextran .55 units). However, postoperatively, the transfusion rate was significantly higher in the dextran group (aspirin .26 units, dextran .41 units, p < .05). The treatment of thromboembolic complications was the same for each group and therefore represents similar treatment costs. However, the cost of prophylaxis with dextran was $309 per patient and with aspirin was $1.79 per patient. Our findings suggest that, based on clinical diagnostic criteria, aspirin and dextran are equally effective thromboembolic prophylactic agents in geriatric hip fracture patients. The safety, cost, and ease of administration of aspirin may make its use more desirable.

A model of fulminant hepatic failure in the rabbit

A highly reproducible model of fulminant hepatic failure was developed by administering intravenously the selective hepatotoxin galactosamine hydrochloride (4.25 mmoles per kg) to genetically uniform rabbits. The great majority of rabbits died between 21 and 44 hr after injection following a period of coma which lasted 2.6 hr on average. Serum biochemical tests and liver histology reflected massive hepatic injury. Changes in plasma ammonia and amino acid concentrations, in coagulation parameters, and in the electroencephalogram were similar to those found in human fulminant hepatic failure. This model appears promising for future studies of the pathogenesis and treatment of fulminant hepatic failure.

The encephalopathic action of five-carbon-atom fatty acids in the rabbit

1. Five-carbon-atom organic acids (C-5 acids) have been administered intravenously to rabbits with ventriculocisternal perfusion and continuous electroencephalographic recording (EEG). The concentration of the acids in the cerebrospinal fluid (CSF) perfusate have been compared with changes in integrated low-frequency activity in the EEG. 2. The C-5 acids investigated were those accumulating in inborn errors of metabolism, i.e. isovaleric acid, beta-methylcrotonic acid, tiglic acid and alpha-keto- and alpha-hydroxy-isovaleric acid. There activity was compared with that of valeric acid. 3. Valeric acid and isovaleric acid produced coma and pronounced increase in slow-wave electrical activity and these changes paralleled the increase in concentration of the acids in the CSF perfusate. 4. The concentration of beta-methylcrotonic acid and tiglic acid in the CSF perfusate reached values comparable with valeric acid and isovaleric acid but showed less encephalopathic activity. An interaction between beta-methylcrotonic acid and isovaleric acid was observed. 5. Although the concentrations of alpha-ketoisovaleric acid and alpha-hydroxyisovaleric acid rose to the lesser extent in the CSF perfusate, changes in rousability of the animal and in the EEG recording were demonstrated. 6. It is concluded that all the C-5 acids tested have encephalopathic activity although this is lessened by the presence of either a double bond or an oxygenated functional group.