Long-term fracture rates seen with continued ibandronate treatment: pooled analysis of DIVA and MOBILE long-term extension studies

Ibandronate reduces the risk of vertebral and non-vertebral fractures versus placebo in postmenopausal women with osteoporosis. This analysis, in which fractures were reported as safety events, showed that long-term use of ibandronate was associated with low fracture rates over 5 years of treatment.

INTRODUCTION

A previous post-hoc meta-analysis of 2-3 year studies found that ibandronate regimens with annual cumulative exposure (ACE) of ≥10.8 mg reduced the risk of vertebral and nonvertebral fractures (NVFs) versus placebo in postmenopausal women. This post-hoc analysis used individual patient data from the 2-year monthly oral ibandronate in ladies (MOBILE) and dosing intravenous administration (DIVA) studies, including the 3-year long-term extensions (LTEs), to assess fracture risk in patients treated with ibandronate for 5 years.

METHODS

Patients treated for 2 years in MOBILE with monthly oral ibandronate 150 mg (n = 176) and in DIVA with IV ibandronate every 2 months 2 mg (n = 253) or quarterly 3 mg (n = 263) who continued on the same regimens for 3 additional years in the LTEs were included. Three-year placebo data (n = 1,924) were obtained from the ibandronate osteoporosis vertebral fracture trial in North America and Europe (BONE) and IV Fracture Prevention trials. The primary endpoint was clinical fracture rate; clinical fracture data were collected as adverse events. Time to fracture was analyzed using Kaplan-Meier and statistical analysis was conducted using the log-rank test. All clinical fractures included all NVFs and symptomatic vertebral fractures.

RESULTS

For ibandronate regimens with ACE ≥10.8 mg, time to fracture was significantly longer for all clinical fractures, NVFs, and clinical vertebral fractures versus placebo (P = 0.005). For all fracture types, the rate of fracture appeared stable during the 5-year treatment period.

CONCLUSION

In women with postmenopausal osteoporosis, continuous treatment with ibandronate over 5 years results in low sustained clinical fracture rate.

Cortical regulation of dopaminergic neurons: role of the midbrain superior colliculus

Dopaminergic (DA) neurons respond to stimuli in a wide range of modalities, although the origin of the afferent sensory signals has only recently begun to emerge. In the case of vision, an important source of short-latency sensory information seems to be the midbrain superior colliculus (SC). However, longer-latency responses have been identified that are less compatible with the primitive perceptual capacities of the colliculus. Rather, they seem more in keeping with the processing capabilities of the cortex. Given that there are robust projections from the cortex to the SC, we examined whether cortical information could reach DA neurons via a relay in the colliculus. The somatosensory barrel cortex was stimulated electrically in the anesthetized rat with either single pulses or pulse trains. Although single pulses produced small phasic activations in the colliculus, they did not elicit responses in the majority of DA neurons. However, after disinhibitory intracollicular injections of the GABA_A antagonist bicuculline, collicular responses were substantially enhanced and previously unresponsive DA neurons now exhibited phasic excitations or inhibitions. Pulse trains applied to the cortex led to phasic changes (excitations to inhibitions) in the activity of DA neurons at baseline. These were blocked or attenuated by intracollicular administration of the GABA_A agonist muscimol. Taken together, the results indicate that the cortex can communicate with DA neurons via a relay in the SC. As a consequence, DA neuronal activity reflecting the unexpected occurrence of salient events and that signaling more complex stimulus properties may have a common origin.

Insulin degludec: overview of a novel ultra long-acting basal insulin

All the basal insulin products currently available have suboptimal pharmacokinetic (PK) properties, with none reliably providing a reproducible and peakless pharmacodynamic (PD) effect that endures over 24 h from once-daily dosing. Insulin degludec is a novel acylated basal insulin with a unique mechanism of protracted absorption involving the formation of a depot of soluble multihexamer chains after subcutaneous injection. PK/PD studies show that insulin degludec has a very long duration of action, with a half-life exceeding 25 h. Once-daily dosing produces a steady-state profile characterized by a near-constant effect, which varies little from injection to injection in a given patient. Clinically, insulin degludec has been shown consistently to carry a lower risk of nocturnal hypoglycaemia than once-daily insulin glargine, in both basal+bolus and basal-only insulin regimens. The constancy of the steady-state profile of insulin degludec also means that day-to-day irregularities at the time of injection have relatively little PD influence, thereby offering the possibility of greater treatment flexibility for patients.

The effect of hospital effluent on antimicrobial resistant E. coli within a municipal wastewater system

There is a concern that hospital effluent potentially containing antimicrobial compounds, antimicrobial resistant (AMR) bacteria and genetic determinants of resistance may contribute to the emergence, dissemination and persistence of AMR bacteria in municipal wastewaters. Hence, it is of interest to investigate the effect, if any, hospital effluent has on the percentage of AMR bacteria within wastewater. Water from two wastewater treatment plants (WWTPs) (one receives and treats hospital effluent (WWTPhe) and the second does not (WWTPc)) were examined for E. coli expressing resistance to seven antimicrobials (ampicillin, streptomycin, cefoxitin, cefotaxime, tetracycline, sulphonamide and ciprofloxacin). A two-sample t-test showed that AMR E. coli are present in WWTP influent and effluent, irrespective of receiving hospital effluent, and are being released into the environment (no statistical difference in count between the two WWTPs). The effect of hospital effluent on resistance varies for each AMR bacteria. Excluding tetracycline, sulphonamide and ciprofloxacin, the results suggest that the release of hospital effluent does not significantly affect the frequency with which AMR E. coli are detected in effluent. For some hospital specific antimicrobial agents, such as ciprofloxacin, the release of hospital effluent is associated with an increased proportion of antimicrobial resistance. The results suggest resistance to AMR E. coli may already be well developed in the community, making the effect of hospital effluent on AMR E. coli indistinguishable. However, for hospital specific antimicrobials, there may be a selective effect and hence limiting the release of hospital effluent containing such antimicrobials may impact the proportion of antimicrobial resistance. This research has provided statistical evidence to support necessary mitigation and remediation of antimicrobial residue release and subsequent resistance in the environment.

Barium proctography vs magnetic resonance proctography for pelvic floor disorders: a comparative study

AIM

Accurate and reliable imaging of pelvic floor dynamics is important for tailoring treatment in pelvic floor disorders; however, two imaging modalities are available. Barium proctography (BaP) is widely used, but involves a significant radiation dose. Magnetic resonance (MR) proctography allows visualization of all pelvic midline structures but patients are supine. This project investigates whether there are measurable differences between BaP and MR proctography. Patient preference for the tests was also investigated.

METHODS

Consecutive patients referred for BaP were invited to participate (National Research Ethics Service approved). Participants underwent BaP in Poole and MR proctography in Dorchester. Proctograms were reported by a consultant radiologist with pelvic floor subspecialization.

RESULTS

A total of 71 patients were recruited. Both tests were carried out on 42 patients. Complete rectal emptying was observed in 29% (12/42) on BaP and in 2% (1/42) on MR proctography. Anismus was reported in 29% (12/42) on BaP and 43% (18/42) on MR proctography. MR proctography missed 31% (11/35) of rectal intussusception detected on BaP. In 10 of these cases no rectal evacuation was achieved during MR proctography. The measure of agreement between grade of rectal intussusception was fair (κ=0.260) although MR proctography tended to underestimate the grade. Rectoceles were extremely common but clinically relevant differences in size were evident. Patients reported that they found MR proctography less embarrassing but harder to empty their bowel.

CONCLUSIONS

The results demonstrate that MR proctography under-reports pelvic floor abnormalities especially where there has been poor rectal evacuation.

Sexual assault and coincident alcohol use in attendees at a genitourinary medicine clinic in the south of England

To investigate the relationship between alcohol consumption and the experience of sexual assault, either as victim or perpetrator, among genitourinary (GU) medicine department attendees in Portsmouth, UK, we carried out a cross-sectional survey of consecutive patients attending the walk-in service when a researcher was available. Self-completed questionnaires were used and anonymized data were collected from 1186 participants (response rate 34%). Responses showed that 15.6% of female and 3.7% of male participants had ever being sexually assaulted. Women who reported sexual assault drank more on a heavy night out than those who did not report sexual assault (mean 21.3 versus 17.0 units, P = 0.041). Over half of the victims had been drinking prior to the relevant assault. Twenty-seven participants (2.3%) admitted to having sex with a person who was not fully willing. Of these, 59% had been drinking prior to the assault, and the majority believed alcohol had contributed to the assault. Any strategies aiming to reduce the incidence of sexual assault must address hazardous drinking as a high priority.

Predicting oscillatory dynamics in the movement of territorial animals

Understanding ecological processes relies upon the knowledge of the dynamics of each individual component. In the context of animal population ecology, the way animals move and interact is of fundamental importance in explaining a variety of observed patterns. Here, we present a theoretical investigation on the movement dynamics of interacting scent-marking animals. We study how the movement statistics of territorial animals is responsible for the appearance of damped oscillations in the mean square displacement (MSD) of the animals. This non-monotonicity is shown to depend on one dimensionless parameter, given by the ratio of the correlation distance between successive steps to the size of the territory. As that parameter increases, the time dependence of the animal's MSD displays a transition from monotonic, characteristic of Brownian walks, to non-monotonic, characteristic of highly correlated walks. The results presented here represent a novel way of determining the degree of persistence in animal movement processes within confined regions.

Engagement with the National Healthy Schools Programme is associated with higher fruit and vegetable consumption in primary school children

BACKGROUND

  Improving children's diets is currently a government focus. However, fruit and vegetable consumption, a key target, is still far below the government guidelines of five portions per day. The present study aimed to assess the impact of engagement with the National Healthy Schools Programme (NHSP) on fruit and vegetable consumption in a sample of primary school children.

METHODS

  A sample of 511 children, aged 7-9 years, who were attending 10 randomly selected schools in Hampshire, completed the Day in the Life Questionnaire, a validated 24-h recall method of dietary assessment. Fruit and vegetable intake in pupils attending schools engaged with the NHSP was compared with that of pupils attending schools not engaged with the programme.

RESULTS

  Children attending schools engaged with the NHSP ate a median of two (interquartile range, 0-8.0) portions of fruit and vegetables, compared to one portion (interquartile range, 0-8.0) consumed by pupils attending a school not engaged with the programme (P=0.001). Gender was also a significant predictor of fruit and vegetable consumption, with girls being 1.68 times more likely to consume 2.5 or more portions of fruit and vegetables. After adjustment for free school meal eligibility (as a measure of socio-economic status) and gender, pupils attending schools engaged with NHSP were twice as likely to eat 2.5 portions of fruit and vegetables or more per day.

CONCLUSIONS

  Engagement with the NHSP may be an effective way of increasing fruit and vegetable consumption in primary school children. Further evaluation of the programme is recommended to determine which aspects of the NHSP are successful in achieving this.

Identification of markers of prostate cancer progression using candidate gene expression

BACKGROUND

Metastatic prostate cancer (PCa) has no curative treatment options. Some forms of PCa are indolent and slow growing, while others metastasise quickly and may prove fatal within a very short time. The basis of this variable prognosis is poorly understood, despite considerable research. The aim of this study was to identify markers associated with the progression of PCa.

METHODS

Artificial neuronal network analysis combined with data from literature and previous work produced a panel of putative PCa progression markers, which were used in a transcriptomic analysis of 29 radical prostatectomy samples and correlated with clinical outcome.

RESULTS

Statistical analysis yielded seven putative markers of PCa progression, ANPEP, ABL1, PSCA, EFNA1, HSPB1, INMT and TRIP13. Two data transformation methods were utilised with only markers that were significant in both selected for further analysis. ANPEP and EFNA1 were significantly correlated with Gleason score. Models of progression co-utilising markers ANPEP and ABL1 or ANPEP and PSCA had the ability to correctly predict indolent or aggressive disease, based on Gleason score, in 89.7% and 86.2% of cases, respectively. Another model of TRIP13 expression in combination with preoperative PSA level and Gleason score was able to correctly predict recurrence in 85.7% of cases.

CONCLUSION

This proof of principle study demonstrates a novel association of carcinogenic and tumourigenic gene expression with PCa stage and prognosis.

Spatial and behavioral changes by red foxes (Vulpes vulpes) in response to artificial territory intrusion

Urine marking is thought to play a pivotal role in territory demarcation by red foxes ( Vulpes vulpes (L., 1758)), but little is known about how individuals respond to alien scent marks, and whether there are sex-related differences in territorial defense. We radio-tracked dominant male and female urban foxes before and after synthetic fox urine was applied to approximately a third of their territories and compared spatial and behavioral reactions both before and after scent application and with foxes on territories where no urine was applied. Home-range boundaries of male foxes shifted towards the scent-marked area, but this change did not affect the total territory size. Larger males shifted their home ranges to a greater degree than small males. Scent application did not affect total activity, but males spent more time in the scent-marked area. Behaviors such as distance moved per night and speed of movement did not differ before and after application, but foxes searched a greater percentage of their home range each night following scent marking. Females showed no significant spatial or behavioral response to the synthetic scent marks. Overall, responses of foxes to synthetic scent marks were male-biased and related to changes in space use rather than movement behaviors.