An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome

BACKGROUND

Tegaserod has been shown to be an effective therapy for the multiple symptoms of irritable bowel syndrome (IBS) in Western populations. However, little information is available regarding the use of tegaserod in the Asia-Pacific population.

AIMS

To evaluate the efficacy, safety, and tolerability of tegaserod versus placebo in patients with IBS from the Asia-Pacific region.

PATIENTS

A total of 520 patients from the Asia-Pacific region with IBS, excluding those with diarrhoea predominant IBS.

METHODS

Patients were randomised to receive either tegaserod 6 mg twice daily (n=259) or placebo (n=261) for a 12 week treatment period. The primary efficacy variable (over weeks 1-4) was the response to the question: "Over the past week do you consider that you have had satisfactory relief from your IBS symptoms?" Secondary efficacy variables assessed overall satisfactory relief over 12 weeks and individual symptoms of IBS.

RESULTS

The mean proportion of patients with overall satisfactory relief was greater in the tegaserod group than in the placebo group over weeks 1-4 (56% v 35%, respectively; p<0.0001) and weeks 1-12 (62% v 44%, respectively; p<0.0001). A clinically relevant effect was observed as early as week 1 and was maintained throughout the treatment period. Reductions in the number of days with at least moderate abdominal pain/discomfort, bloating, no bowel movements, and hard/lumpy stools were greater in the tegaserod group compared with the placebo group. Headache was the most commonly reported adverse event (12.0% tegaserod v 11.1% placebo). Diarrhoea led to discontinuation in 2.3% of tegaserod patients. Serious adverse events were infrequent (1.5% tegaserod v 3.4% placebo).

CONCLUSIONS

Tegaserod 6 mg twice daily is an effective, safe, and well tolerated treatment for patients in the Asia-Pacific region suffering from IBS and whose main bowel symptom is not diarrhoea.

The degree of depression in Hamilton rating scale is correlated with the density of presynaptic serotonin transporters in 23 patients with Wilson's disease

OBJECTIVE

One of the most frequent psychiatric symptoms in patients with Wilson's disease (WD) is depression. It has been suggested that depression is associated with deficits in serotonergic neurotransmission, but, hitherto, no measurements have been performed in WD.

METHODS

We prospectively examined 23 adult patients (12 women, 11 men, mean age 40 years) with WD for symptoms of depression using the Hamilton rating scale for depression (HAMD). We correlated the data with the presynaptic serotonin transporter density (SERT density) in the thalamus-hypothalamus and the midbrain-pons regions measured with high resolution single-photon emission computed tomography (SPECT) 24 hours after the application of 180 MBq 2beta-carbomethoxy-3beta-(4 [(123)I]iodophenyl)tropane ( [(123)I]b-CIT). The regions of interest were determined by coregistration with a standard MRI dataset.

RESULTS

A significant negative correlation was found between HAMD and SERT density in the thalamus-hypothalamus region (r = -0.49, p = 0.02), but not in the midbrain-pons (r = -0.31, p = 0.15).

CONCLUSIONS

We conclude that depression in patients with Wilson's disease is correlated with alterations of serotonergic neurotransmission in the thalamus-hypothalamus region.

Differential expression of IFN-alpha subtypes in human PBMC: evaluation of novel real-time PCR assays

Studies of the human IFN-alpha subtype system have been hampered by the lack of efficient procedures to quantify and differentiate the expression of the highly homologous IFN-alpha subtypes. Here we evaluate four novel real-time PCR assays for the specific detection and quantification of IFN-alpha mRNA for the subtypes alpha(2), alpha(6), alpha(8) and alpha(1/13) in a combined assay in human peripheral blood mononuclear cells (PBMC). This included (a) the selection of beta-glucuronidase (GUS) as a suitable housekeeping gene for relative quantification; (b) verification of the specificity by using human DNA of different IFN-alpha subtypes; and (c) comparison of the amplification efficiencies among the different assays. This highly sensitive method allows the detection of low-level, constitutive IFN-alpha mRNA and shows differences in the composition of constitutive IFN-alpha subtypes compared to other cell types (HeLa and HEp-2). The in vitro stimulation of PBMC with Newcastle disease virus (NDV), Respiratory syncytial virus (RSV) or an inactivated Herpes simplex (HSV) preparation leads to the transcriptional induction of all IFN-alpha subtypes investigated but to different expression levels. Among the subtypes detected, IFN-alpha(13/1) and alpha(2) are the major transcripts followed by alpha(8), and finally alpha(6) as a minor transcribed subtype. Time-kinetics of IFN-alpha transcriptional activation also revealed variations in the course of IFN-alpha transcription between NDV, RSV or HSV. The data obtained from the real-time PCR assays correlated well with IFN-alpha(2) protein release. In conclusion, we have demonstrated the suitability and reliability of new real-time PCR assays for the rapid and efficient analysis of IFN-alpha subtype expression.

Phase separation in binary fluid mixtures with continuously ramped temperature

We consider the demixing of a binary fluid mixture, under gravity, which is steadily driven into a two-phase region by slowly ramping the temperature. We assume, as a first approximation, that the system remains spatially isothermal, and we examine the interplay of two competing nonlinearities. One of these arises because the supersaturation is greatest far from the meniscus, creating inversions of the density which can lead to fluid motion; although isothermal, this is somewhat like the Bénard problem (a single-phase fluid heated from below). The other is the intrinsic diffusive instability which results either in nucleation or in spinodal decomposition at large supersaturations. Experimental results on a simple binary mixture show interesting oscillations in heat capacity and optical properties, for a wide range of ramp parameters. We argue that these oscillations arise under conditions where both nonlinearities are important.

The radial free forearm flap--prelaminated versus non-prelaminated: a comparison of two methods

In the present work two methods of harvesting the RFFF (radial free forearm flap) are compared: the prelaminated fasciomucosal and the non-prelaminated fasciocutaneous version. The flaps were employed for intraoral reconstruction after radical oncological surgery of the oral cavity. In most cases a squamous cell carcinoma was the present malignant tumour. A total of 32 patients were included in the study, 16 in each group. The design was retrospective. Data were obtained by clinical follow up, chart review and compiled database. Analysis included the amount of shrinkage of the flaps during the follow-up period, early postoperative complications, following function improving operations and early and late donor site difficulties. Prelaminated fasciomucosal flaps showed a higher shrinkage rate than fasciocutaneous non-prelaminated flaps. Due to this circumstance the number of following function improving operations was higher in the prelaminated flap group. Early wound healing difficulties were also seen more often in the prelaminated flap group, whereas donor site problems occurred more frequently in the non-prelaminated group. Mucosal prelamination of the RFFF is a promising method for a most physiological reconstruction of intraoral defects resulting from tumour surgery. Postoperative shrinkage is a problem in prelaminated RFFF. Our aim is to improve the prelamination technique in order to prevent shrinkage. The almost complete absence of donor site difficulties in prelaminated RFFF may represent a solution to this common and yet unsolved problem.

Prevalence and sociodemographic determinants of overweight in young French adolescents

BACKGROUND

The prevalence of overweight in adults and in children is increasing in most industrialised countries. Our purpose is to estimate the prevalence of overweight and obesity in a population of 12-year-old French adolescents and to analyse its association with different sociodemographic factors.

METHODS

A cross-sectional study was conducted in 2001 on a representative sample of sixth-grade adolescents (mean age 12.1 +/- 0.6 years) living in the Department of the Bas-Rhin (Eastern part of France). Height and weight were measured in 4326 adolescents. Overweight and obesity were defined as recommended by the International Obesity Task Force. Sociodemographic data were obtained for 3436 adolescents.

RESULTS

The prevalence of overweight was 22.7% (17.5% of moderate overweight and 5.2% of obesity) and it was not different by gender or by size of the commune of residence. Overweight was more frequent in low economic zones (p < 10(-4) in girls, p < 10(-2) in boys) and in public schools than in private schools (p < 10(-3) in girls). The prevalence of overweight was inversely associated with family income tax (p < 10(-3) in girls, p = 0.012 in boys), mother's (p = 10(-4) in girls, p = 10(-3) in boys) and father's (p = 0.001 in girls, p = 0.004 in boys) educational level. Multiple logistic regression analysis indicated an independent association of being overweight with low family income tax (p = 0.2195) and poor mother's educational level (p = 0.0193).

CONCLUSIONS

This study indicates that, as in other industrialised countries, much overweight and obesity are present in 12-year-old French adolescents. It suggests the existence of an influence of socio-economic factors with a predominant effect of the mother's educational level rather than the financial resources.

Investigation of fine-motor disturbances in Wilson's disease

Patients suffering from Wilson's disease (WD) can be divided into two main subgroups: neurologic and nonneurologic WD. We measured passive and active fine-motor abilities of 37 WD patients and 24 randomly selected volunteers. The measurement was based on a standardized test set in a defined environment for detection of disturbed finemotor control. The set contains 5 tests comprising rest tremor, postural tremor, target tapping, forefinger tapping and spiral painting, reflecting different aspects of movement disorders. The tests showed significant differences between neurologic WD and volunteers, especially for tasks defining active control. In neurologic WD we found no differences between subgroups whereas for non-neurologic WD we often detected slight movement disorders. The detected movement disorders cam be interpreted as persistent disorders after long-term therapy.

[Male breast cancer: 19 case reports]

Breast cancer is rarely encountered in men. In developed countries, it accounts for less than 1% of cancers in men, whereas in women it represents about 23% of all cancers. A retrospective review was performed on 19 cases of men who underwent surgery for breast carcinoma between 1989 and 2000. The aim of this work was to analyse epidemiological and etiological aspects, circumstances of discovery, pathological characteristics, therapy modalities as well as prognostic factors. The mean age was 65.3 years. A high incidence of overweight, diabetes, hypertension and hypercholesterolemia was found. The most frequent clinical presentation was a firm subareolar lump, at a low stage (stage I 23% and stage II 41%). The most common pathological type was an infiltrating ductal carcinoma (89%). Hormone receptors where most often positive (92% for oestrogen and 100% for progesterone receptors). 84% of patients underwent simple mastectomy and axillary dissection, 74% chest wall irradiation after surgery, 26% received chemotherapy and 42% hormonal therapy. Median follow-up was 52 months. The estimated 2-year overall survival (OS) and disease-free survival (DFS) was respectively 93% and 87.5% and the 5-year OS and DFS respectively 86% and 75%. The management of male and female breast carcinoma is identical, as well as their prognosis at equal stages. However male breast carcinoma is more often diagnosed at a more advanced stage, thus a breast screening in men would permit a sooner diagnosis and a better prognosis.

Early biochemical and histological changes during hyperbaric or normobaric reoxygenation after in vitro ischaemia in primary corticoencephalic cell cultures of rats

In a first series of experiments, the morphological changes of corticoencephalic cells by ischaemia were determined by staining with celestine blue-acid fuchsin in order to classify cells as intact, dark basophilic (supposedly reversibly injured) and preacidophilic or acidophilic (profoundly injured). Hypoxia and glucose-deprivation (in vitro ischaemia) markedly decreased the number of intact cells and correspondingly increased the number of both reversibly and profoundly damaged cells. The morphological characteristics indicated a partial recovery during reoxygenation either in the absence or presence of glucose and irrespective of whether normobaric or hyperbaric oxygen was used. In a second series of experiments, nucleoside triphosphate and diphosphate levels were determined in corticoencephalic cultures by high-performance liquid chromatography. Hypoxia in combination with glucose-deficiency markedly decreased the ATP:ADP, GTP:GDP and UTP:UDP ratios. A still larger fall of these ratios was observed both after normobaric and hyperbaric reoxygenation. In contrast, both normobaric and hyperbaric reoxygenation in the presence of glucose led to an almost complete recovery near the control normoxic values. In conclusion, the histological changes were not adequately reflected by changes in the nucleoside triphosphate:diphosphate ratios and, in addition, hyperbaric oxygen had neither favourable nor unfavourable effects on the early morphological and functional restitution of ischaemically damaged cells under the conditions of the present study.

Reproducability and transferability of topological properties; experimental charge density of the hexapeptide cyclo-(D,L-Pro)2-(L-Ala)4 monohydrate

The charge density of a hexapeptide was determined from high-resolution CCD area-detector experiments at 100 K. Two datasets, one from a rotating anode and a second one from synchrotron radiation, were measured and the results are compared. The data are interpreted in terms of the 'rigid pseudoatom' model. The topology of the experimental density is analyzed and compared with the topology of the constituting amino acids, and shows good agreement. All critical points of the electron density at the covalent and hydrogen bonds, as well as those of the Laplacian, were located. With respect to the transferability of electronic and bond topological properties the six peptide bonds were compared with values given in the literature.

[Physiology and pathophysiology of the vascular endothelin system: clinical implications]

The endothelium-derived 21 amino acid peptide endothelin-1 is one of the most potent vasoconstrictors. Endothelin-1 exerts its effects upon a variety of vascular and non-vascular cells through a direct interaction with specific receptors. Beyond its vasoconstrictive action on vascular smooth muscle cells endothelin-1 has mitogenic and pro-inflammatory properties. The present review deals with current experimental and clinical evidence for the involvement of endothelin-1 in several cardiovascular disorders with inflammatory components. We further discuss the potential clinical relevance of the endothelin system and therapeutical perspectives of anti-endothelin strategies in the treatment of cardiovascular disease.

Comparison of clinical types of Wilson's disease and glucose metabolism in extrapyramidal motor brain regions

In Wilson's disease a disturbed glucose metabolism especially in striatal and cerebellar areas has been reported. This is correlated with the severity of extrapyramidal motor symptoms (EPS). These findings are only based on a small number of patients. Up to now it is unknown whether EPS are caused by various patterns of disturbed basal ganglia glucose metabolism. We investigated 37 patients and 9 normal volunteers to characterize the disturbed glucose metabolism in Wilson's disease more precisely. The glucose metabolism was determined in 5 cerebellar and cerebral areas (putamen, caput nuclei caudati, cerebellum, midbrain and thalamic area) by using (18)F-Fluorodesoxyglucose-Positron-Emission-Tomography ( [(18)F]FDG-PET). The database was evaluated by a cluster analysis. Additionally, the severity extrapyramidal motor symptoms were judged by a clinical score system. Three characteristic patterns of glucose metabolism in basal ganglia were obtained. Two of them may be assigned to patients with neurological symptoms whereas the third cluster corresponds to most patients without EPS or normal volunteers. The clusters can be identified by characteristic consumption rates in this 5 brain areas. The severity of EPS can not clearly be assigned to one of the clusters with disturbed glucose metabolism. However, the most severe cases are characterized by the lowest consumption in the striatal area. When there is marked improvement of EPS impaired glucose consumption reveals a persistent brain lesion. Finally, the neurological symptoms in Wilson's disease are caused by (at least) two different patterns of disturbed glucose metabolism in basal ganglia and cerebellum. The severity of EPS seems to be determined by a disturbed consumption in the striatal area.

Quantitative analysis of factors affecting intraoperative precision and stability of optoelectronic and electromagnetic tracking systems

This study aims to provide a quantitative analysis of the factors affecting the actual precision and stability of optoelectronic and electromagnetic tracking systems in computer-aided surgery under real clinical/intraoperative conditions. A "phantom-skull" with five precisely determined reference distances between marker spheres is used for all measurements. Three optoelectronic and one electromagnetic tracking systems are included in this study. The experimental design is divided into three parts: (1) evaluation of serial- and multislice-CT (computed tomography) images of the phantom-skull for the precision of distance measurements by means of navigation software without a digitizer, (2) digitizer measurements under realistic intraoperative conditions with the factors OR-lamp (radiating into the field of view of the digitizer) or/and "handling with ferromagnetic surgical instruments" (in the field of view of the digitizer) and (3) "point-measurements" to analyze the influence of changes in the angle of inclination of the stylus axis. Deviations between reference distances and measured values are statistically investigated by means of analysis of variance. Computerized measurements of distances based on serial-CT data were more precise than based on multislice-CT data. All tracking systems included in this study proved to be considerably less precise under realistic OR conditions when compared to the technical specifications in the manuals of the systems. Changes in the angle of inclination of the stylus axis resulted in deviations of up to 3.40 mm (mean deviations for all systems ranging from 0.49 to 1.42 mm, variances ranging from 0.09 to 1.44 mm), indicating a strong need for improvements of stylus design. The electromagnetic tracking system investigated in this study was not significantly affected by small ferromagnetic surgical instruments.

Measurement of the beam-helicity asymmetry in the p((-->)e,e'p)pi(0) reaction at the energy of the Delta(1232) resonance

In a p((-->)e,e'p)pi(0) out-of-plane coincidence experiment at the three-spectrometer setup of the Mainz Microtron MAMI, the beam-helicity asymmetry has been precisely measured around the energy of the Delta(1232) resonance and Q(2) = 0.2(GeV/c)(2). The results are in disagreement with three up-to-date model calculations. This is interpreted as a lack of understanding of the nonresonant background, which in dynamical models is related to the pion cloud.

Intra- and intermolecular topological properties of amino acids: a comparative study of experimental and theoretical results

The charge densities rho(r) of the six amino acids L-Asn.H(2)O, DL-Glu.H(2)O, DL-Lys.HCl, DL-Pro.H(2)O, DL-Ser, and DL-Val were determined from high-resolution X-ray diffraction experiments at 100 K using synchrotron radiation and area detection (CCD) techniques. Bond topological parameters derived from these densities and from those of six additional amino acids published earlier are compared to each other and to the results of ab initio calculations. Experimental and theoretical properties for each chemically equivalent bond are in a fair agreement, and their variances are of similar magnitude. A noticeable outlier is the positive curvature of the density at the bond critical point, for which no correlation between the experimental and theoretical values can be established. The location of nonbonded valence shell charge concentrations derived from the crystalline densities scatter in a wider range than those obtained for the isolated molecules.