A phase I trial of andrographolide in HIV positive patients and normal volunteers

A phase I dose-escalating clinical trial of andrographolide from Andrographis paniculata was conducted in 13 HIV positive patients and five HIV uninfected, healthy volunteers. The objectives were primarily to assess safety and tolerability and secondarily to assess effects on plasma virion HIV-1 RNA levels and CD4(+) lymphocyte levels. No subjects used antiretroviral medications during the trial. Those with liver or renal abnormalities were excluded. The planned regimen was 5 mg/kg bodyweight for 3 weeks, escalating to 10 mg/kg bodyweight for 3 weeks, and to 20 mg/kg bodyweight for a final 3 weeks. The trial was interrupted at 6 weeks due to adverse events including an anaphylactic reaction in one patient. All adverse events had resolved by the end of observation. A significant rise in the mean CD4(+) lymphocyte level of HIV subjects occurred after administration of 10 mg/kg andrographolide (from a baseline of 405 cells/mm(3) to 501 cells/mm(3); p = 0.002). There were no statistically significant changes in mean plasma HIV-1 RNA levels throughout the trial. Andrographolide may inhibit HIV-induced cell cycle dysregulation, leading to a rise in CD4(+) lymphocyte levels in HIV-1 infected individuals.

Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Effects of delta9-tetrahydrocannabinol on social behaviour in mice: comparison between two vehicles

Two vehicles for the intraperitoneal administration of delta9-tetrahydrocannabinol (delta9-THC) were compared, using aspects of social behaviour in mice and 5 doses of delta9- THC, with vehicle alone and saline control groups. 10% propane-1,2-diol-1% Tween 80-saline (vehicle B) seemed to be more effective than 1% Tween 80-saline (vehicle A) since depressant effects of --1 delta9-THC on behaviour tended to occur at lower doses with this vehicle. Few differences in behaviour could be detected among the three control groups. In general the overall number of behavioural acts decreased with increasing doses of delta9-THC, but with vehicle B low doses selectively decreased the number of 'social' (including aggressive) as distinct from 'individual' acts. Low doses of the drug in vehicle A sometimes stimulated behaviour, whereas with vehicle B such doses mostly produced depression; however, 2.5 mg/kg delta9-THC, in either vehicle, markedly increased the percentage of animals which showed both aggression and flight acts--a rare combination among controls. Our findings are consistent with other evidence that propylene glycol is an effective vehicle for the i.p. administration of delta9-THC.

Introducing a new method to assess vision: Computer-adaptive contrast-sensitivity testing predicts visual functioning better than charts in multiple sclerosis patients

Background

Impaired low-contrast visual acuity (LCVA) is common in multiple sclerosis (MS) and other neurological diseases. Its assessment is often limited to selected contrasts, for example, 2.5% or 1.25%. Computerized adaptive testing with the quick contrast-sensitivity function (qCSF) method allows assessment across expanded contrast and spatial frequency ranges.

Objective

The objective of this article is to compare qCSF with high- and low-contrast charts and patient-reported visual function.

Methods

We enrolled 131 consecutive MS patients (mean age 39.6 years) to assess high-contrast visual acuity (HCVA) at 30 cm and 5 m, low-contrast vision with Sloan charts at 2.5% and 1.25%, qCSF and the National Eye Institute Visual Functioning Questionnaire (NEIVFQ). Associations between the different measures were estimated with linear regression models corrected for age, gender and multiple testing.

Results

The association between qCSF and Sloan charts (R²= 0.68) was higher than with HCVA (5 m: R²= 0.5; 30 cm: R²= 0.41). The highest association with NEIVFQ subscales was observed for qCSF (R² 0.20–0.57), while Sloan charts were not associated with any NEIVFQ subscale after correction for multiple testing.

Conclusion

The qCSF is a promising new outcome for low-contrast vision in MS and other neurological diseases. Here we show a closer link to patient-reported visual function than standard low- and high-contrast charts.

Collective multielectron tunneling ionization in strong fields

We investigate the quantum mechanical process of two-electron tunneling in strong external electric fields. Numerical solution of a two-electron s-wave model reveals the existence of collective tunneling ionization in a mode where both electrons stay at equal distance from the nucleus. Otherwise the lagging electron is immediately recaptured. The corresponding double ionization rate fails to explain nonsequential multiple ionization in strong-field laser experiments. However, an empirically modified version of the analytical one-electron tunneling rate of Ammosov, Delone, and Krainov agrees with the experiments to a surprising accuracy. The reason for this agreement is presently unknown.

Hospitalizations due to heart failure: major differences between East and West Germany even 30 years after reunification

Background

Heart failure (HF) is one of the most common diseases in the adult population with a prevalence of about 4% and a steady increase due to demographic and medical developments. In Germany, it is the most common primary diagnosis for inpatient treatment. Little was known so far about regional differences.

Methods

We retrospectively analyzed aggregated administrative data on the number and characteristics of in-patients in Germany for the period 2000 to 2017, obtained from the German Federal Health Monitoring, an annual complete census of in-patient routine data. The number and duration of hospitalizations as well as hospital mortality with the main diagnosis “I50” (HF) were analyzed over time with a special emphasis on regional differences between the federal states.

Results

The number of HF-related hospitalizations in Germany increased continuously: from 239,694 in 2000 to 464,724 cases in 2017 (+94%). This increase was more pronounced in East Germany than in West Germany (119% vs. 88%) [Figure 1]. The proportion of HF-related hospitalizations in relation to the total number of hospitalizations rose from 1.4% to 2.3% (relative increase +67%) in whole Germany. Accordingly, HF was the most frequent disease-related reason for hospitalizations in Germany in 2017, again with marked differences between East and West Germany (relative increase +96% vs. +61%). Similar differences were found after age-standardization: hospitalization rate due to HF in 2017 was higher in the East than in West Germany (609 vs. 490 cases per 100,000 population), reflecting a major increase compared to year 2000 (49% vs. 36%).

Despite a continuous decrease in the length of stay (from 14.3 to 10.2 days; –29%), the total number of HF-related hospital days in Germany increased by 38% (4.72 million hospital days in 2017). In East Germany, the number of hospital days increased by 51%, in West Germany by 35% [Figure 1].

The in-hospital mortality rate of HF patients remained unchanged between 2000 and 2017 at about 38,000 cases per year, corresponding to 8.2% in 2017 (East Germany 8.4%, West Germany 8.2%). With a contribution of 8.9% of all hospital deaths, HF constituted the leading cause in 2017. Again, this proportion was higher in East compared to West Germany throughout the entire observation period (2017 10.8% vs. 8.5%). The rate of HF-related in-hospital deaths was also higher in East than in West Germany (2017: 65 vs. 43 per 100,000 population) [Figure 1].

Conclusion

HF continues to be the most common cause of hospitalization and hospital deaths in Germany. HF-related morbidity and mortality parameters are higher in East than in West Germany. Possible explanations for this finding are differences in the prevalence of risk factors and the structure of patient care between these regions. A more detailed understanding of these striking discrepancies 30 years after the German reunification requires further investigations.

Figure 1

Funding Acknowledgement

Type of funding source: None

Single vocal cord irradiation for early-stage glottic cancer: Excellent local control and favorable toxicity profile

OBJECTIVE

To validate the earlier reported promising oncologic outcomes and favorable toxicity profile following single vocal cord irradiation (SVCI) in an expanded cohort of patients with early-stage glottic cancer treated at our institute with longer follow-up time.

MATERIALS AND METHODS

Between February 2011 and January 2020, 111 consecutive patients with early-stage glottic cancer were treated with SVCI to the whole involved vocal cord (58.08 Gy, given in 16 fractions of 3.63 Gy). Setup verification was done using cone-beam CT, prior to each fraction. The endpoints were local control (LC), overall survival (OS), grade ≥ 3 toxicity and voice quality assessment using voice-handicap index (VHI) questionnaires.

RESULTS

Median follow-up was 41 months (range; 8-84). Two patients developed in-field local failure (LF). The 3- and 5-year LC rates were 99.1% and 97.1%, respectively. As both patients with LF were successfully salvaged with total laryngectomy, the 5-year ultimate LC-rates was 99%. The 5-years OS was 80.6%. All patients finished treatment without any interruption. No patients developed acute grade ≥ 3 toxicity. Late grade 3 toxicity was reported in 7 patients (6.5%) out of 108 patients evaluable for late toxicity; 2 because of severe hoarseness and 5 because of laryngeal radionecrosis (4.5%). The 5-years laryngectomy-free survival was 98.1%. The VHI-scores improved over time, only 22% of patients had VHI > 30 at 3-years post-radiotherapy, compared to 38% at baseline.

CONCLUSIONS

Local control rate and laryngectomy-free survival of SVCI are excellent with favorable toxicity profile and good VHI-score. These results validate our early results.

Cardiorespiratory fitness but not physical activity are associated with pulse wave velocity and arterial stiffness in the general population

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BMBF

Background

Higher cardiorespiratory fitness (CRF) and physical activity (PA) are associated with lower cardiovascular morbidity and all-cause mortality. Pulse wave velocity (PWV) and augmentation index (AIx) are vascular parameters associated with aging and end-organ damage and provide reliable information about arterial stiffness. Therefore, PWV and AIx could represent attractive parameters for cardiovascular risk stratification.

Purpose

To improve our understanding of the relationship between CRF/PA and PWV and arterial stiffness, we associated CRF and PA with central and peripheral PWVs and AIx as outcomes using multivariable regression analysis using data from the population-based Study of Health in Pomerania (SHIP Trend 1).

Methods

CRF was assessed using cardiopulmonary exercise testing (CPET) on a bicycle ergometer. CRF was defined as peak oxygen uptake (VO2peak), VO2peak per kg fat free mass (VO2peak_ffm) and metabolic equivalent tasks (METs). PA was measured using the Baecke questionnaire. Aortic PWV (aoPWV), carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) in m/s were determined non-invasively using the Vascular Explorer. Aortic AIx (aoAIx), aortic AIx at a heart rate of 75 bpm (aoAIx@75) and brachial-ankle AIx (brAIx) were measured using the same device. We used linear regression models adjusted for age, sex, smoking status, mean arterial pressure, antihypertensive medication, diabetic medication, HbA1c, fat mass, fat-free-mass and height. Fat-free mass was not included when VO2peak_ffm was the exposure. Fat-free mass and fat mass were not used in models with METs.

Results

We analysed data of 1,677 individuals which included 840 men (median age 56 years; inter-quartile range [IQR] 47 to 65) and 837 women (median age 54 years; IQR 46 to 65). A one l/min greater VO2peak was related to lower aoPWV (β - 0.22; 95% confidence interval (CI) -0.37 to -0.06, p &lt; 0.01), cfPWV (β - 0.32; 95%CI -0.55 to -0.09; p &lt; 0.01), baPWV (β -0.02; 95%CI -0.03 to 0.00, p &lt; 0.05) and brAIx (β -3.49; 95%CI -6.95 to -0.03, p &lt; 0.01). VO2peak was not related to aoAIx and aoAIx@75. VO2peak_ffm was associated with lower aoPWV (β -0.01; 95%CI -0.02 to -0.00, p &lt; 0.05) and cfPWV (β -0.02; 95%CI -0.03 to -0.00, p &lt; 0.05). VO2peak_ffm was not associated with baPWV, aoAIx, aoAIx@75 or brAIx. METs were positively associated with aoAIx@75 (β 0.30; 95%CI 0.02 to 0.59, p &lt; 0.01). Sport and work related PA were not related to PWV or AIx. Sensitivity analysis with further adjustment for heart rate did not significantly change the results.

Conclusions

We found an association between CRF and central as well as peripheral PWV and AIx values in the adult general population. Interestingly, body composition had an impact on the relationship between CRF and peripheral but not central parameters. Further, PA was not related to these vascular markers which highlights the important difference between CRF and PA.