Effect of rosuvastatin on risk markers for venous thromboembolism in cancer

Essentials Statins lower venous thromboembolism risk in general but have not been studied in cancer patients. We completed a randomized trial of rosuvastatin vs. placebo among cancer patients on chemotherapy. Rosuvastatin did not significantly lower prothrombotic biomarkers including D-dimer. The role of statins in venous thrombosis prevention in cancer patients remains unknown.

SUMMARY

Background Statin therapy is associated with lower risk of venous thromboembolism (VTE) but has not been prospectively evaluated in patients with advanced cancer. Objectives We determined if statin administration in this high-risk population reduces the risk of VTE, based on established and emerging biomarkers. Patients/Methods This double-blind, crossover, randomized controlled trial among patients with advanced cancer receiving systemic therapy allocated participants to rosuvastatin 20 mg daily or placebo for 3-4 weeks prior to crossover to the alternative therapy, with a 3-5-week washout. D-dimer, C-reactive protein (CRP), soluble (s)P-selectin, factor VIII (FVIII), thrombin generation and exploratory biomarkers focusing on endogenous thrombin potential, including tissue factor (TF), activated factor IX (FIXa) and activated factor XI (FXIa), were measured at the start and end of both treatment periods. The primary outcome was change in D-dimer with rosuvastatin compared with placebo. Results Of 38 enrolled participants, 24 (63%) completed the study. Rosuvastatin did not cause statistically significant changes in D-dimer levels or any other biomarker. CRP levels decreased by 40%; 4.3 mg L-1 (95% confidence interval, -11.0 to +2.5 mg L-1 ) compared with placebo. In post-hoc analysis, participants who received rosuvastatin initially during their first line of treatment had a 13% decrease in D-dimer. Circulating TF, FIXa and FXIa were detected in 26%, 68% and 71% of cancer patients despite not being found in healthy individuals. Conclusions Rosuvastatin did not cause favorable changes in biomarkers of VTE risk in advanced cancer patients receiving chemotherapy. The role of statin therapy as thromboprophylaxis in the cancer population remains uncertain.

Large heterometallic coordination cages with gyrobifastigium-like geometry

Large coordination cages with unusual gyrobifastigium-like geometry were obtained by combining cis-blocked Pt^II or Pd^II complexes with clathrochelate-based metalloligands.

Risk factors for first trimester miscarriage--results from a UK-population-based case-control study

OBJECTIVE

The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage.

DESIGN

Population-based case-control study.

SETTING

Case-control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register.

POPULATION

Six hundred and three women aged 18-55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18-55 years whose most recent pregnancy had progressed beyond 12 weeks (controls).

METHODS

Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy.

MAIN OUTCOME MEASURE

First trimester miscarriage.

RESULTS

After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy.

CONCLUSIONS

The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations.

A randomised controlled trial of a double layer of Allevyn compared to Jellonet and proflavin as a tie-over dressing for small skin grafts

INTRODUCTION

The tie-over dressing is used to encourage skin graft take by minimising dead space, reducing seroma and haematoma formation and by graft immobilisation. Various materials have been proposed, however we have compared one of the most popular, Jellonet with a bolster of proflavin-soaked cotton wool, to a newer dressing, Allevyn foam.

PATIENTS AND METHODS

Sixty patients were recruited and randomised into either group. Any patient requiring surgery involving a split or full thickness graft due to be carried out in the outpatient department on any site was invited to participate. Outcome measures included percentage take, pain on dressing removal (visual analogue scale) and infection. Ethical approval was obtained from the North and Mid Essex Local Research Ethics Committee.

RESULTS

There was no statistical difference in graft take between the two groups at day 5 (P=0.963). The Allevyn dressing was statistically more comfortable (P=0.0182).

DISCUSSION

We propose that Allevyn foam provides an effective and comfortable method for securing small split and full thickness skin grafts. While offering equal levels of graft take, improved levels of comfort may lend itself to use in sensitive areas such as the nose, ear and around the eye.

The role of art-making in identity maintenance: case studies of people living with cancer

The aim of this qualitative research was to understand why some people with cancer take up art as a leisure activity, and how visual art-making in daily life might support identity maintenance/reconstruction. The study forms part of a larger project with people who view art-making as a resource for living with chronic illness. In order to provide a detailed, holistic analysis, the paper focuses on the accounts and artwork of three participants, two women (aged 47 and 59 years) each with breast cancer, and a man (aged 51 years) with stomach and lung cancer. The participants turned to art after a process of reflection but did not necessarily reject their pre-illness lifestyles or selves. Rather, art-making afforded many opportunities to retain familiar personal and social identities, and to resist being dominated by labels related to their illness. A practical implication is that people coping with cancer may need not only cognitive and emotional support, but opportunities to find meaningful activities. Such activities can be understood to have a powerful role in maintaining a familiar, positive identity in cancer, and providing a resource for coping.

The Middlesex University rehabilitation robot

This paper describes the development of an electrically powered wheelchair-mounted manipulator for use by severely disabled persons. A detailed review is given explaining the specification. It describes the construction of the device and its control architecture. The prototype robot used several gesture recognition and other input systems. The system has been tested on disabled and non-disabled users. They observed that it was easy to use but about 50% slower than comparable systems before design modifications were incorporated. The robot has a payload of greater than 1 kg with a maximum reach of 0.7-0.9 m.

Developments in reduction and replacement of in vivo toxicity and potency tests for pertussis vaccines

The regulatory control of pertussis vaccines, as for other biological products, requires that they conform to specified standards of safety and efficacy. The current potency test for whole cell vaccines, the intracerebral mouse protection test (AMPT) is still the only such assay that has shown a correlation with protection in children. An alternative in vivo assay based on non-lethal aerosol challenge of mice has been assessed as a replacement for the current AMPT. An in vitro assay based on determination of reactive nitrogen/oxygen intermediates produced as a result of macrophage activation has also been investigated as a potential replacement for the in vivo challenge test. On the other hand, for safety testing, an enzymatic-HPLC coupled assay using a fluorescein-labelled G alpha(i3)C20 peptide to measure the enzymatic ribosylation activity of active pertussis toxin was evaluated for its suitability as a replacement for the current histamine sensitisation test (HIST). An assay for adenylate cyclase toxin (ACT)-related toxicity, based on measuring the ACT-induced oxidative burst in macrophage-like cell cultures has also been investigated. Although some questions still need to be answered in relation to the development of suitable replacements for in vivo tests of pertussis vaccines, the prospects for further improvements are promising.

[Controlled liberation of active principles by means of new galenic formulations]

Drugs inside a conventional galenic form are distributed between specific biological targets and other anatomical tissues. With the aim to obtain a more rational and a better therapeutic, one of the most promising possibilities by using the concept of vectorization: association of an active principle to an appropriate vector with the object to increase its action efficiency and efficacy. By this means, they do not just increase the affinity of the drug to the target but also active principle gets protected from a potentially hostile environment (hydrolytic enzymes, acid pH, etc.). The success in the extension of the applications of the vectorización depends more and more of an appropriate design, for what the fundamental objective of this revision will be the one of presenting the general characteristics and some of the current applications in these new galenic forms.

Gentamicin encapsulation in PLA/PLGA microspheres in view of treating Brucella infections

In view of treating intracellular Brucella infections, microspheres made of poly(lactide) (PLA) and poly(lactide-co-glycolide) (PLGA) were developed as delivery system for the cationic and highly hydrophilic antibiotic gentamicin sulphate. Drug microencapsulation by spray drying yielded microspheres with regular morphology, an average particle size of approximately 3 micrometer and encapsulation efficiencies of up to 45%. Different copolymers of similar molecular weights gave varying encapsulation efficiencies and particle size distributions. The encapsulation efficiency generally increased with polymer hydrophilicity, except for the hydrophilic copolymer PLGA50:50H carrying carboxylic end groups. Encapsulation also depended on the pH value of the aqueous drug solution to be encapsulated. Moreover, increasing nominal gentamicin sulphate loading yielded lower efficiencies. For comparison, some formulations were also prepared by a (W(1)/O)W(2)-solvent evaporation method, which yielded lower encapsulation efficiencies, in the order of 13%. Finally, drug bioactivity was found to remain intact after microencapsulation, MS storage and MS incubation in aqueous medium. The results suggest that PLA/PLGA microspheres prepared by spray drying may be an appropriate delivery system for gentamicin sulphate to be used in the treatment of intracellular Brucella infections.

Norplant utilization in a Latina inner-city population

This study was a consecutive-case series of 138 Latinas (age 16 to 36) who received levonorgestrel implants (Norplant) in a community health center between September 1, 1992, and December 31, 1994, and were observed through September 30, 1997. Continuation rate at one year was 70 percent, and 43, 28, and 22 percent at two, three, and four years, respectively. Average observation time was 32 months. Most frequent reasons for removal were excessive bleeding (34 percent), weight gain (26 percent), hair loss (16 percent), amenorrhea (13 percent), desire for pregnancy (11 percent), and headaches (9 percent). Five women discontinued due to fear of ill effects, four to undergo sterilization. No pregnancies occurred while using the method. Norplant is an effective contraceptive for inner-city Latinas; removal rate was higher than in previous reports. Side effects or fear of side effects led to removal in more than half the patients by two years' use.

Influence of atmospheric CO2 enrichment, soil N, and water stress on needle surface wax formation in Pinus palustris (Pinaceae)

Interactive effects of increasing atmospheric CO2 with resource limitations on production of surface wax in plants have not been studied. Pinus palustris seedlings were grown for 1 yr at two levels of soil N (40 or 400 kg N_ha-1_yr-1) and water stress (-0.5 or -1.5 MPa xylem pressure potential) in open-top field chambers under two levels of CO2 (365 or 720 mumol/mol). Needle surface wax content was determined at 8 mo (fall) and 12 mo (spring) and epicuticular wax morphology was examined using scanning electron microscopy (SEM) at 12 mo. Wax content expressed on both a leaf area and dry mass basis was increased due to main effects of low N and water stress. No main effects of CO2 were observed; however, a CO2 x N interaction at 12 mo indicated that under low soil N the elevated CO2 treatment had less wax (surface area or dry mass basis) compared to its ambient counterpart. Morphologically, low N needle surfaces appeared rougher compared to those of high N needles due to more extensive wax ridges. Although the main effect of water treatment on wax density was not reflected by changes in wax morphology, the CO2 x N interaction was paralleled by alterations in wax appearance. Decreases in density and less prominent epicuticular wax ridges resulting from growth under elevated CO2 and limiting N suggest that dynamics of plant/atmosphere and plant/pathogen interactions may be altered.

Establishment of a cell line from a hepatocellular carcinoma from a patient with hemochromatosis

We describe the establishment and characterization of a novel hepatoma cell line. This cell line, designated RBHF-1, was established from a hepatocellular carcinoma of a 67-yr-old man with a history of genetic hemochromatosis. At this writing, the cells have been maintained in RPMI-1640 tissue-culture medium and fetal calf serum without any additional supplements for 30 mo. The cells form colonies on soft agar and are not tumorigenic in nude mice. The cell line is polymorphic and displays characteristics of mature hepatocytes by synthesizing albumin, alpha 2-macroglobulin, fibronectin and alpha-fetoprotein. Cytogenetic analysis shows multiple chromosomal aberrations, with a consistent deletion in the long arm and deletions or rearrangements in the short arm of chromosome 1. There is no evidence for hepatitis B or hepatitis C virus infection of the cell line. The cells contain no detectable intracellular iron after staining with Perls' stain. Unlike other hepatoma cell lines, there is no detectable binding of epidermal growth factor to RBHF-1 cells. This is the first cell line to be established from a patient with hemochromatosis, and it provides a potentially important model for the study of hepatocyte transformation in association with iron overload.

Infection of human bone marrow stromal cells by hepatitis B virus: implications for viral persistence and the suppression of hematopoiesis

Suspension cultures of bone marrow cells (BMC) were challenged with hepatitis B virus (HBV) to study interactions between the virus and the nonadherent and adherent BMC populations. Virus-challenged BMC developed an adherent stromal layer that differed in cellular composition from that of mock-infected cultures, showing a threefold increase in cells of the monocyte-macrophage lineage with an accompanying decrease in cells of the granulocytic lineage. Both viral envelope hepatitis B surface and core antigen expression was detected in adherent and nonadherent cell populations up to 10 days after virus challenge, which decreased thereafter. HBV DNA was still detectable in adherent cells 3 weeks after virus challenge, as shown by polymerase chain reaction analysis. These data indicate that HBV can infect not only bone marrow colony-forming cells but also the stromal cell populations involved with the regulation of hematopoiesis in vivo. Such virus-cell interactions could contribute to the immune dysfunction and bone marrow failure occasionally reported for patients with HBV infection as well as acting as an important site for HBV latency and persistence.

Is there a role for a twins clinic? An evaluation of parents' responses

To evaluate parental responses to the Twins Clinic, postal questionnaires were sent to the parents of 141 pairs of twins, born outside the maternity hospital who were referred to the clinic in the first three years. The main outcome measures were: the sources of, and reasons for, referral; previous attempts to find help; experiences at the clinic and outcome of the visit. One hundred and thirteen families (80%) replied, of whom 101 (89%) were self-referred. The most common problems for which twins were referred related to behaviour (34) and development (28). In 99 (88%) cases, parents had already sought assistance from other sources (39 from health professionals) but only 29 had found this helpful. In 95 (84%) cases, parents felt there had been a positive outcome from attending the clinic, in the form of reassurance (87), change of management (39), successful support for applications (19) or information (11). Parents' responses indicate that the Twins Clinic meets the needs of families with multiples who are inadequately served by existing sources of help. These will only be improved through education of health professionals (and of the community as a whole) so as to obviate the need for Twins Clinics.

Bionomics of Anopheles quadrimaculatus and Culex erraticus (Diptera: Culicidae) in the Falls Lake basin, North Carolina: seasonal changes in abundance and gonotrophic status, and host-feeding patterns

Larval and adult Anopheles quadrimaculatus Say (sensu lato) and Culex erraticus (Dyar & Knab) were collected at Falls of the Neuse Lake (Falls Lake) in North Carolina from May 1985 to December 1986. Adult mosquitoes were aspirated weekly from shelters in woodlands adjacent to larval sampling sites. An. quadrimaculatus and Cx. erraticus comprised > 95% of the total number of mosquitoes collected. An. quadrimaculatus adults exhibited vernal and autumnal peaks of abundance during both years. Cx. erraticus adults exhibited several peaks of abundance in summer and early fall of both years. An. quadrimaculatus initiated blood feeding in May and April 1985 and 1986, respectively. Only unfed females were found in late fall and winter. Cx. erraticus initiated blood feeding earlier than An. quadrimaculatus. In 1985, approximately 25% of the females in the first collection in May contained a blood meal, whereas in 1986, approximately 10% of the females in the first collection in April were blood fed. Females of both species ceased blood feeding in late fall. Larvae were sampled on a weekly basis from lake edge, flood plain, and creek edge habitats. Generally, An. quadrimaculatus larvae were most abundant in lake edge and flood plain habitats, whereas Cx. erraticus larvae were most abundant in the creek edge habitat. The population dynamics of An. quadrimaculatus were associated with seasonal changes in the level of Falls Lake. In 1985 and 1986, the level of Falls Lake gradually declined from May to mid-August until heavy rainfall caused a 1-m rise in lake level. Populations of An. quadrimaculatus larvae and adults increased significantly following the rise in the level of Falls Lake. In contrast, the abundance of larval and adult Cx. erraticus decreased with rising lake levels in late August. Water level management should be an effective method for controlling populations of An. quadrimaculatus but not for Cx. erraticus. Blood-fed mosquitoes were tested to identify bloodmeal hosts using both capillary precipitin and enzyme-linked immunosorbent assays. An. quadrimaculatus (n = 941) predominantly (99%) fed on mammals, principally white-tailed deer and horses. Cx. erraticus (n = 348) exhibited an opportunistic host-feeding pattern; blood meals were taken from mammalian (49%), reptile or amphibian (20%), and avian (31%) hosts.

Hepatitis B virus differentially suppresses myelopoiesis and displays tropism for immature hematopoietic cells

The hematopoietic cell lines HL-60 and THP-1 were challenged with hepatitis B virus (HBV) in vitro to study interactions between the virus and host cell. Exposure to HBV suppressed the ability of HL-60 cells to differentiate into granulocytes after treatment with retinoic acid (RA) or dimethyl sulfoxide (DMSO), and RA-induced activation of the monocytic cell line THP-1 was also suppressed. Terminal differentiation of both cell lines by phorbol 12-myristate 13-acetate (PMA) was not affected by HBV. The suppressive effect on RA- or DMSO-induced differentiation was unique to HBV, since cell exposure to human cytomegalovirus, another virus that inhibits hematopoiesis, failed to block cellular differentiation. At 5 days postinfection, extracellular viral DNA was detected in immature but not in differentiated cultures and higher levels of core antigen (HBcAg) and surface antigen (HBsAg) were seen in undifferentiated cells than in RA- or PMA-treated cells. In addition, release of HBsAg into the medium was 2 to 12 times greater in untreated cultures than for RA- or PMA-treated cells. Thus, HBV suppresses hematopoiesis by blocking the maturational development of progenitors and selectively infects immature myeloid cells compared with mature end-stage cells.