Sacubitril/valsartan and cardiovascular biomarkers among patients with recent COVID-19 infection: The PARACOR-19 randomized clinical trial

AIMS

The PARACOR-19 randomized controlled trial (RCT) was designed to examine the effects of sacubitril/valsartan on markers of cardiac injury, inflammation, structure, and function among patients who have recovered from acute coronavirus disease 2019 (COVID-19) infection.

METHODS AND RESULTS

PARACOR-19 was a single-centre, double-blind RCT of patients with cardiovascular risk factors and a history of COVID-19 infection 4-16 weeks prior to enrolment. Patients were randomized to sacubitril/valsartan (titrated to the maximum dose of 97/103 mg twice daily) versus matching placebo. Co-primary endpoints were change from baseline to 12 weeks in high-sensitivity cardiac troponin T (hs-cTnT) and soluble ST2 (sST2). Exploratory endpoints included change from baseline to 12 weeks in additional circulating biomarkers. Overall, 42 patients were randomized between August 2021 and March 2023 (n = 20 sacubitril/valsartan, n = 22 placebo). Median (25th-75th) time from COVID-19 diagnosis to enrolment was 67 (48-80) days. Median age was 67 (62-71) years, 48% were female, and 91% were White. Compared with placebo, sacubitril/valsartan did not have a significant effect on the co-primary endpoints of change from baseline in hs-TnT and sST2 (all p ≥ 0.29). In exploratory analyses, sacubitril/valsartan led to a 46% greater reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 51% greater reduction in C-terminal telopeptide of collagen type I (CITP). Permanent drug discontinuation occurred in four patients in the sacubitril/valsartan group and three patients in the placebo group. There were no deaths and one patient was hospitalized in each group.

CONCLUSION

In this pilot RCT of patients who recovered from acute COVID-19, sacubitril/valsartan did not lower hs-cTnT or sST2 compared with placebo. Exploratory analyses suggested potential benefits of sacubitril/valsartan on cardiac wall stress and collagen turnover as measured by NT-proBNP and CITP. Sacubitril/valsartan was well tolerated.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT04883528.

Self-reported mindfulness, cyclist anger and aggression

Anger is a common behaviour exhibited by road users when one's goals are perceived to have been blocked by another. Recent research has demonstrated that, generally, cyclists tend to deal with anger in constructive ways. However, when anger does manifest, it can result in behaviours that increase their crash risk. Amongst motor vehicle drivers, mindfulness levels have been associated with less anger and appear to mediate anger and associated aggression. The current study sought to understand whether mindfulness has similar associations with anger and aggression in a sample of cyclists. A total of 583 cyclists (males = 68 %) completed an online questionnaire that sought information on their levels of mindfulness, current mindfulness practices and tendencies for anger and aggression while cycling. The relationships between these were then examined using structural equation modelling. The results showed that cyclists with higher mindfulness levels tended to report less anger across a range of situations (e.g., interactions with pedestrians, cyclists, motor vehicle drivers and police). Both direct and indirect (through anger) relationships were found between mindfulness and aggression, again showing that more mindful cyclists tended to engage in less frequent aggression. These findings align with recent research investigating this relationship amongst motor vehicle drivers and suggest that mindfulness may be a promising strategy to reduce or avoid anger and aggression in cyclists.

Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy

BACKGROUND

Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments.

AIMS

The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning.

METHODS

An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants.

RESULTS

System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage.

CONCLUSION

MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.

Pan-European early switch/early discharge opportunities exist for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections

The objective of this study was to document pan-European real-world treatment patterns and healthcare resource use and estimate opportunities for early switch (ES) from intravenous (IV) to oral antibiotics and early discharge (ED) in hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (cSSTIs). This retrospective observational medical chart review study enrolled 342 physicians across 12 European countries who collected data from 1542 patients with documented MRSA cSSTI who were hospitalized (July 2010 to June 2011) and discharged alive (by July 2011). Data included clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and oral antibiotic use, and ES and ED eligibility according to literature-based and expert-validated criteria. The most frequent initial MRSA-active antibiotics were vancomycin (50.2%), linezolid (15.1%), clindamycin (10.8%), and teicoplanin (10.4%). Patients discharged with MRSA-active antibiotics (n = 480) were most frequently prescribed linezolid (42.1%) and clindamycin (19.8%). IV treatment duration (9.3 ± 6.5 vs. 14.6 ± 9.9 days; p <0.001) and hospital LOS (19.1 ± 12.9 vs. 21.0 ± 18.2 days; p 0.162) tended to be shorter for patients switched from IV to oral treatment than for patients who received IV treatment only. Of the patients, 33.6% met ES criteria and could have discontinued IV treatment 6.0 ± 5.5 days earlier, and 37.9% met ED criteria and could have been discharged 6.2 ± 8.2 days earlier. More than one-third of European patients hospitalized for MRSA cSSTI could be eligible for ES and ED, resulting in substantial reductions in IV days and bed-days, with potential savings of €2000 per ED-eligible patient.

Costs of adverse events among patients with HIV infection treated with nonnucleoside reverse transcriptase inhibitors

OBJECTIVES

The aim of the study was to assess the incidence and costs of adverse events (AEs) among patients with HIV infection treated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) from the health care system perspective.

METHODS

US medical and pharmacy claims during 2004-2009 were examined to select adult new NNRTI users with HIV infection. The incidence of selected AEs and time to occurrence were assessed during the first year. Episodes of care for each AE were identified using claims associated with AE management. For each AE, a propensity score model was used to match patients with an AE to those without (1:4) based on the propensity of having an AE. Mean total health care costs, AE-associated costs and incremental costs per episode, and annual total health care costs per patient were calculated.

RESULTS

Of the 2548 NNRTI-treated patients, 29.3% experienced AEs. The incidence ranged from 0.4 episodes/1000 person-years for suicide/self-injury to 14.9 episodes/1000 person-years for dizziness, 49.8 episodes/1000 person-years for depression and 150.3 episodes/1000 person-years for lipid disorder. The mean AE-associated cost (duration) per episode ranged from $586 (88 days) for lipid disorder to $975 (33 days) for rash, $2760 (73 days) for sleep-related symptoms and $4434 (41 days) for nausea/vomiting. The mean incremental cost per episode ranged from $1580 for rash to $2032 for lipid disorder, $8307 for sleep-related symptoms and $12 833 for nausea/vomiting. During the 12 months following NNRTI initiation, the mean annual total health care cost was $27 299 (efavirenz: $26 185; other NNRTIs: $34 993) and AE-associated costs were $608 (efavirenz: $554; other NNRTIs: $979) among all NNRTI users.

CONCLUSIONS

With treatment increasing patient survival, comparisons of therapeutic regimens should consider treatment-associated AEs. Findings from this study could be informative for clinicians and payers in managing HIV infection with NNRTIs.

Healthcare professionals' knowledge of calories

AIM

To determine healthcare professionals' knowledge of the calorie content of foods and the relationship to weight maintenance.

METHOD

A cross-sectional questionnaire was used to survey 179 clinical staff, non-clinical staff and life coaches working in health care.

RESULTS

The response rate is 81%. The majority of respondents identified the weight loss requirements necessary to achieve marked health benefits in obese patients. Estimation of calorie and salt contents of specified foods was generally inaccurate. The majority of healthcare professionals did not know the amount of exercise required to burn off the calories of commonly consumed foods.

CONCLUSION

Support and education are required for healthcare professionals to manage the challenges associated with obesity.

The surgical aspects of Role 2 Afloat

The current configuration of the surgical component of the Role 2 Afloat team is described, including an outline of the equipment available. The lessons learned from a recent exercise, where a Role 2 Afloat team was deployed on RFA CARDIGAN BAY are outlined and expanded, emphasising the difficulties of providing damage control surgery in the maritime environment.

INTRACELLULAR OXIDATION-REDUCTION STUDIES : I. REDUCTION POTENTIALS OF AMOEBA DUBIA BY MICRO INJECTION OF INDICATORS

Twenty-five oxidation-reduction indicators were injected in oxidized or reduced form into Amoeba dubia and Amœba proteus under controlled conditions of oxygen access. (1) Under anaerobiosis the ameba was able to reduce completely all the reversible oxidation-reduction indicators down to and including indigo disulfonate. (2) Under anaerobiosis the ameba was unable to reoxidize six of the most easily oxidizable indicators. (3) Under aerobiosis the ameba was able to reduce completely all the indicators down to and including 1-naphthol-2-sulfonate indo-2, 6-dichlorophenol. Toluylene blue, methylene blue and indigo tetrasulfonate were sometimes completely and sometimes only partly reduced, depending on the quantity of indicator injected and the duration of observation. (4) The time of reduction varied approximately with the size of the injection. Reduction was more rapid under anaerobiosis than under aerobiosis, more rapid in active than in sluggish cells and was retarded by toxic compounds. (5) Sulfonated compounds were somewhat toxic, as a rule. In interpreting reduction phenomena of micro injection, it is necessary to take into consideration the intensity, capacity and rate factors. It then becomes apparent that the ameba has a high reducing potential lying on the rH scale below the zone of indigo disulfonate. The reducing capacity of the ameba seems to be relatively great in the region of the simple indophenols and of a progressively diminishing magnitude as the zone of the indigos is approached. Material of high reduction potential appears to be generated within the ameba at a measurable rate. These phenomena, observed in the interior of the cell with the aid of indicators, parallel very closely those found in reduction electrode studies on bacterial cultures.

MICRURGICAL STUDIES IN CELL PHYSIOLOGY : III. THE ACTION OF CO(2)AND SOME SALTS OF NA, CA, AND K ON THE PROTOPLASM OF AMOEBA DUBIA

I. Plasmalemma. 1. Of the salts used in these experiments the anions have only a modifying effect on the cations. The dispersive action of Na and, to a lesser extent, of K, predominates. Borate increases the toxicity of Na and acetate decreases it. 2. CO₂ and carbonates dissolve the plasmalemma readily. 3. Na lactate tends to dissolve the surface especially when brought into contact with it from the interior by injection. Lactate antagonizes the stimulating effect of Ca on the plasmalemma. II. The Internal Protoplasm. 4. Acid phosphate of Na and K, when injected, causes a membrane to form around the granular endoplasm within the ameba. 5. Na borate increases the toxicity of Na inside the cell. 6. Bubbles of CO₂, injected into the cell, cause an increase of fluidity of the internal protoplasm. These bubbles shrink and disappear from the cell more readily than air bubbles. 7. The anions modify the typical cation effect. Carbonates accentuate the liquefying and solvent action of Na. Phosphates prevent a complete rounding of the ameba caused by Na. Lactate inhibits the solidification and pinching off effect caused by Ca. III. Physiological Significance of Salts. 8. The buffer salts can be injected in high concentrations without toxic effects but amebæ can be immersed in them only in very dilute solutions without injury. 9. The inhibiting action of lactate and the dispersive effect of CO₂, carbonates, and lactate on the plasma membrane, must be of importance in a consideration of the functions of the organism and perhaps in the production of pathological changes.

MICRURGICAL STUDIES IN CELL PHYSIOLOGY : I. THE ACTION OF THE CHLORIDES OF NA, K, CA, AND MG ON THE PROTOPLASM OF AMOEBA PROTEUS

By means of micro-dissection and injection Amoeba proteus was treated with the chlorides of Na, K, Ca, and Mg alone, in combination, and with variations of pH. I. The Plasmalemma. 1. NaCl weakens and disrupts the surface membrane of the ameba. Tearing the membrane accelerates the disruption which spreads rapidly from the site of the tear. KCl has no disruptive effect on the membrane but renders it adhesive. 2. MgCl(2) and CaCl(2) have no appreciable effect on the integrity of the surface membrane of the ameba when applied on the outside. No spread of disruption occurs when the membrane is torn in these salts. When these salts are introduced into the ameba they render the pellicle of the involved region rigid. II. The Internal Protoplasm. 3. Injected water either diffuses through the protoplasm or becomes localized in a hyaline blister. Large amounts when rapidly injected produce a "rushing effect". 4. HCl at pH 1.8 solidifies the internal protoplasm and at pH 2.2 causes solidification only after several successive injections. The effect of the subsequent injections may be due to the neutralization of the cell-buffers by the first injection. 5. NaCl and KCl increase the fluidity of the internal protoplasm and induce quiescence. 6. CaCl(2) and MgCl(2) to a lesser extent solidify the internal protoplasm. With CaCl(2) the solidification tends to be localized. With MgCl(2) it tends to spread. The injection of CaCl(2) accelerates movement in the regions not solidified whereas the injection of MgCl(2) induces quiescence. III. Pinching-Off Reaction. 7. A hyaline blister produced by the injection of water may be pinched off. The pinched-off blister is a liquid sphere surrounded by a pellicle. 8. Pinching off always takes place with injections of HCl when the injected region is solidified. 9. The injection of CaCl(2) usually results in the pinching off of the portion solidified. The rate of pinching off varies with the concentration of the salt. The injection of MgCl(2) does not cause pinching off. IV. Reparability of Torn Surfaces. 10. The repair of a torn surface takes place readily in distilled water. In the different salt solutions, reparability varies specifically with each salt, with the concentration of the salt, and with the extent of the tear. In NaCl and in KCl repair occurs less readily than in water. In MgCl(2) repair takes place with great difficulty. In CaCl(2) a proper estimate of the process of repair is complicated by the pinching-off phenomenon. However, CaCl(2) is the only salt found to increase the mobility of the plasmalemma, and this presumably enhances its reparability. 11. The repair of the surface is probably a function of the internal protoplasm and depends upon an interaction of the protoplasm with the surrounding medium. V. Permeability. 12. NaCl and KCl readily penetrate the ameba from the exterior. CaCl(2) and MgCl(2) do not. 13. All four salts when injected into an ameba readily diffuse through the internal protoplasm. In the case of CaCl(2) the diffusion may be arrested by the pinching-off process. VI. Toxicity. 14. NaCl and KCl are more toxic to the exterior of the cell than to the interior, and the reverse is true for CaCl(2) and MgCl(2). 15. The relative non-toxicity of injected NaCl to the interior of the ameba is not necessarily due to its diffusion outward from the cell. 16. HCl is much more toxic to the exterior of a cell than to the interior; at pH 5.5 it is toxic to the surface whereas at pH 2.5 it is not toxic to the interior. NaOH to pH 9.8 is not toxic either to the surface or to the interior. VII. Antagonism. 17. The toxic effects of NaCl and of KCl on the exterior of the cell can be antagonized by CaCl(2) and this antagonism occurs at the surface. Although the lethal effect of NaCl is thus antagonized, NaCl still penetrates but at a slower rate than if the ameba were immersed in a solution of this salt alone. 18. NaCl and HCl are mutually antagonistic in the interior of the ameba. No antagonism between the salts and HCl was found on the exterior of the ameba. No antagonism between the salts and NaOH was found on the interior or exterior of the ameba. 19. The pinching-off phenomenon can be antagonized by NaCl or by KCl, and the rate of the retardation of the pinching-off process varies with the concentration of the antagonizing salt. 20. The prevention of repair of a torn membrane by toxic solutions of NaCl or KCl can be antagonized by CaCl(2). These experiments show directly the marked difference between the interior and the exterior of the cell in their behavior toward the chlorides of Na, K, Ca, and Mg.

MICRURGICAL STUDIES IN CELL PHYSIOLOGY : IV. COLORIMETRIC DETERMINATION OF THE NUCLEAR AND CYTOPLASMIC pH IN THE STARFISH EGG

I. Cytoplasm. 1. The normal cytoplasmic pH, colorimetrically determined, of the starfish eggs in the unfertilized, fertilized, and first and second cleavage stages is 6.7 ± 0.1. 2. Cytolysis lowers the pH to a value 5.5 ± 0.1. 3. The cytolyzed material in time assumes the pH of its environing sea water. 4. The acid due to mechanical injury can also be detected in the environment of the egg. 5. Injury to the cytoplasm unaccompanied by visible disintegration causes an increase in acidity which is quickly neutralized. II. Germinal Vesicle. 6. The intranuclear pH, colorimetrically determined, of the immature Asterias egg is 7.5 ± 0.1. 7. Injury to the nucleus does not change its pH. 8. The spherical nuclear remnant which persists after injury gradually assumes the pH of its environment. III. Plasmalemma. 9. A dye to which the cell is normally impermeable can penetrate through a tear in the surface from an environment more acid than normal. This may be due to a difference in the formation of the plasmalemma in a normal and an acid medium.

A MICRO INJECTION STUDY ON THE PERMEABILITY OF THE STARFISH EGG

The experiments with the NH(4)Cl are similar to, and corroborate micro injection experiments performed in connection with some work on mustard gas in which the writer collaborated. Eggs immersed in sea water containing decomposed mustard gas, at a certain low concentration are not affected. If, however, the solution be injected, the egg quickly cytolyzes owing to the free HCl present. A similar impermeability of the protoplasmic surface film to certain substances was also encountered in injection work on Amoeba. Amoeboe immersed in an aqueous solution of eosin will not take the stain till after death. On the other hand, the eosin, when injected into the Amoeba, quickly permeates the protoplasm, to be arrested only at the surface. The semipermeability of a living cell appears primarily to be a function of its surface film. It is immaterial whether this film be that of the original cortex of the cell, a film newly formed over a cut surface, or a film that surrounds an artificially induced vacuole within the cell. As long as such a surface film exists neither the acid group of the NH(4)Cl nor the alkaline group of the NaHCO(3) can, within certain concentration limits, penetrate the protoplasm. These solutions, if injected beneath the surface film, however, will produce their characteristic effects upon the protoplasm.

CHANGES IN PROTOPLASMIC CONSISTENCY AND THEIR RELATION TO CELL DIVISION

1. The development of the amphiaster is associated with the formation of two semisolid masses within the more fluid egg substance. 2. The elongation of the egg during cleavage is possibly produced as a consequence of the mutual pressure of these two growing semisolid masses. 3. The division of the egg into two blastomeres consists essentially in a growth, within the egg, of two masses of material at the expense of the surrounding cytoplasm. When all the cytoplasm of the egg is incorporated in these two masses cleavage occurs. 4. After a certain period of time the semisolid masses revert to a more fluid state. In the eggs studied this normally occurs after the cleavage furrow has completed the separation of the two blastomeres. The formation of the furrow, however, may be prevented in various ways, upon which the egg reverts to a single spherical semifluid mass containing two nuclei. 5. An egg mutilated during its semisolid state (amphiaster stage) may or may not revert to a more fluid state. If the more solid state is maintained, the cleavage furrow persists and proceeds till cleavage is completed. If the mutilation causes the egg to revert to the more fluid state the furrow becomes obliterated and a new cleavage plane is subsequently adopted. 6. The nuclei of eggs in the semifluid state are able to alter their positions. In semifluid mutilated eggs the nuclei tend to move to positions which may assure symmetry in aster formation and cleavage.

Novel Objective Biomarkers of Alcohol Use: Potential Diagnostic and Treatment Management Tools in Dual Diagnosis Care

Alcohol use disorders are highly prevalent conditions that generate a large fraction of the total public health burden. These disorders are concentrated in mentally ill populations, in which reliability of self-reporting of alcohol consumption may be especially compromised. The application of objective biomarkers for alcohol use may therefore play an important role in these patients. This article provides a description and comparative overview of traditional versus novel biomarkers of alcohol consumption. Greater professional familiarity with and use of novel biomarkers as diagnostic and treatment management tools may enhance clinical standards and research on alcohol use in patients with a dual diagnosis.

Advantages of achiral h.p.l.c. as a preparative step for chiral analysis in biological samples and its use in toxicokinetic studies

1. Achiral reverse-phase h.p.l.c. with semi-automated post-column fraction collection and solid-phase sample reconcentration, has been applied as the purification procedure during the enantiomeric quantification of two widely differing experimental drugs; an HMG-CoA reductase inhibitor (I) and an alpha 2-adrenoceptor antagonist (II). 2. The robust and specific achiral methodologies were available prior to the need for chiral analyses and recovery of drug from the fractions provided clean samples from a variety of biological matrices, without the need to develop compatible achiral/chiral mobile phases. 3. Compared with direct chiral chromatography of plasma extracts, this approach decreased the potential for metabolites and endogenous components to interfere or impair the performance of the chiral stationary phase. 4. The availability of quantitative data from achiral analysis of samples negated the need for internal standardization of the chiral analyses, helped confirm assay specificity and provided potential to determine enantiomeric ratios where only one isomer could be accurately measured. 5. Routine enantiomeric analyses were successfully carried out on samples taken from animals dosed orally with the racemic drugs, providing important data on the possible levels of exposure to individual enantiomers during toxicity testing.

Development of the Diet Habits Questionnaire for Use in Cardiac Rehabilitation

The objective of this study is to design a tool that could be used in the cardiac rehabilitation setting to quickly assess dietary habits and identify individual participants? dietary education requirements. An initial study compared a research diet history of 4 0 participants against the results of the Diet Habits Questionnaire. Concurrent validity has been established as there was a significant difference between mean (95% CI) intake of 5 .7 (0.6 - 10.7) g saturated fat 6.8 (2.9 - 10.8) g fibre and 417 (5 - 838) mg sodium between participants requiring additional dietary advice and those who do not require additional intervention based on the DHQ score. The inter-rater reliability of the DHQ was high with strength of agreement rated as moderate for fat and substantial for fibre and sodium. The Diet Habits Questionnaire was found to be a valid and reliable screening tool for the assessment of dietary habits in cardiac rehabilitation programs. Further research may establish its usefulness not just in cardiac rehabilitation, but in other health centres such as general practice and community health settings.

Pregabalin in central neuropathic pain associated with spinal cord injury: A placebo-controlled trial

OBJECTIVE

To evaluate pregabalin in central neuropathic pain associated with spinal cord injury.

METHODS

A 12-week, multicenter study of patients randomized to either flexible-dose pregabalin 150 to 600 mg/day (n = 70) or placebo (n = 67), administered BID. Patients were allowed to remain on existing, stable pain therapy. The primary efficacy variable was the endpoint mean pain score, derived from patients' last 7 days daily pain diary entries. Key secondary endpoints included pain responder rates, the SF-MPQ, sleep interference, mood, and the patient global measure of change.

RESULTS

The mean baseline pain score was 6.54 in the pregabalin group and 6.73 in the placebo group. The mean endpoint pain score was lower in the pregabalin group (4.62) than the placebo group (6.27; p < 0.001), with efficacy observed as early as week 1 and maintained for the duration of the study. The average pregabalin dose after the 3-week stabilization phase was 460 mg/day. Pregabalin was significantly superior to placebo in endpoint assessments on the SF-MPQ. The > or =30% and > or =50% pain responder rates were higher with pregabalin than placebo (p < 0.05). Pregabalin was associated with improvements in disturbed sleep (p < 0.001) and anxiety (p < 0.05), and more patients reported global improvement at endpoint in the pregabalin group (p < 0.001). Mild or moderate, typically transient, somnolence and dizziness were the most common adverse events.

CONCLUSIONS

Pregabalin 150 to 600 mg/day was effective in relieving central neuropathic pain, improving sleep, anxiety, and overall patient status in patients with spinal cord injury.

Purification and characterization of the aromatic desulfinase, 2-(2'-hydroxyphenyl)benzenesulfinate desulfinase

2-(2(')-Hydroxyphenyl)benzenesulfinate desulfinase (HPBS desulfinase) catalyzes the cleavage of the carbon-sulfur bond of 2-(2(')-hydroxyphenyl)benzenesulfinate (HPBS) to form hydroxybiphenyl and sulfite. This is the final step in the desulfurization of dibenzothiophene, the organosulfur compound used to study biodesulfurization of petroleum middle distillate. HPBS desulfinase was purified 1600-fold from Rhodococcus IGTS8. The purification was monitored using a spectrofluorimetric assay and SDS-PAGE. The pI of HPBS desulfinase is 5.6, the temperature optimum is 35 degrees C, and the pH optimum is 7.0. HPBS desulfinase has a K(m) of 0.90+/-0.15 microM and a k(cat) of 1.3+/-0.07 min(-1). Several analogs were tested for their ability to act as substrates or inhibitors of HPBS desulfinase. No alternative substrates and very few inhibitors were identified. HPBS desulfinase activity decreases in the presence of Cu(2+) and Zn(2+), while no metals significantly enhance enzyme activity. HPBS desulfinase is susceptible to tyrosine, tryptophan, and cysteine specific modification agents.

The effect of education on patients' willingness to participate in a telemedicine study

We assessed the effect of previous education on patients' willingness to participate in a clinical study of telemedicine for hypertensive patients. The design was a cross-sectional study of adult patients arriving for appointments in a hypertension clinic. Of the 259 patients approached, 86% completed a baseline survey and were subsequently asked if they would be willing to participate in a one-year telemedicine study. One hundred and fifty patients (58%) agreed to participate. A stepwise logistic regression analysis was performed to assess the effect of level of education on willingness to participate, while controlling for potentially confounding variables. In the final model, only education remained significant. The odds ratio for non-participation of patients with high-school education or less was 3.6 (95% confidence interval 1.9-7.0). Educational status should be carefully considered when designing, implementing and interpreting telemedicine studies.