Evidence of NI-0101 pharmacological activity, an anti-TLR4 antibody, in a randomized phase I dose escalation study in healthy volunteers receiving LPS

Toll-like receptor-4 (TLR4) pathways are major contributors to pathological inflammatory responses induced by tissue damage. NI-0101 is the first monoclonal antibody (mAb) blocking TLR4 signaling. This activity is independent of the ligand type and concentration, therefore, potentially blocking any TLR4 ligands. A phase I single ascending dose study was conducted in 73 healthy volunteers to evaluate NI-0101 tolerability, preliminary safety, pharmacokinetics (PKs), and pharmacodynamics (PDs), in absence and in presence of a systemic challenge with lipopolysaccharide (LPS), a TLR4 ligand. NI-0101 was well tolerated without safety concern. The PK profile was characterized by a half-life of ∼10 days at high concentrations and by a rapid elimination at low concentrations due to expected target-mediated drug disposition. NI-0101 prevented cytokine release following ex vivo and in vivo LPS administration and prevented the C-reactive protein (CRP) increase and the occurrence of flu-like symptoms expected following the in vivo administration of LPS.

Nonergodic subdiffusion from Brownian motion in an inhomogeneous medium

Nonergodicity observed in single-particle tracking experiments is usually modeled by transient trapping rather than spatial disorder. We introduce models of a particle diffusing in a medium consisting of regions with random sizes and random diffusivities. The particle is never trapped but rather performs continuous Brownian motion with the local diffusion constant. Under simple assumptions on the distribution of the sizes and diffusivities, we find that the mean squared displacement displays subdiffusion due to nonergodicity for both annealed and quenched disorder. The model is formulated as a walk continuous in both time and space, similar to the Lévy walk.

Distribution of entanglement in large-scale quantum networks

The concentration and distribution of quantum entanglement is an essential ingredient in emerging quantum information technologies. Much theoretical and experimental effort has been expended in understanding how to distribute entanglement in one-dimensional networks. However, as experimental techniques in quantum communication develop, protocols for multi-dimensional systems become essential. Here, we focus on recent theoretical developments in protocols for distributing entanglement in regular and complex networks, with particular attention to percolation theory and network-based error correction.

Comment on "Finding finite-time invariant manifolds in two-dimensional velocity fields" [Chaos 10, 99 (2000)]

This note serves as a commentary of the paper of Haller [Chaos 10, 99 (2000)] on techniques for detecting invariant manifolds. Here we show that the criterion of Haller can be improved in two ways. First, by using the strain basis reference frame, a more efficient version of theorem 1 of Haller (2000) allows to better detect the manifolds. Second, we emphasize the need to nondimensionalize the estimate of hyperbolic persistence. These statements are illustrated by the example of the Kida ellipse. (c) 2001 American Institute of Physics.

Photoelectron diffraction imaging for C2H2 and C2H4 chemisorbed on Si(100) reveals a new bonding configuration

A new adsorption site for adsorbed acetylene on Si(100) is observed by photoelectron imaging based on the holographic principle. The diffraction effects in the carbon 1s angle-resolved photoemission are inverted (including the small-cone method) to obtain an image of the atom's neighboring carbon. The chemisorbed acetylene molecule is bonded to four silicon surface atoms. In contrast to the C2H2 case, the image for adsorbed C2H4 shows it bonded to two Si surface atoms.

Coexisting left congenital diaphragmatic hernia and esophageal atresia with tracheoesophageal fistula: successful management in a premature neonate

The combination of left congenital diaphragmatic hernia (CDH) with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The authors describe a premature neonate with this association, who is alive at 6 1/2 years of age. Temporary banding of the gastroesophageal junction and gastrostomy was performed concurrently with hernia repair and prosthetic abdominoplasty to enlarge the abdominal cavity. A right thoracotomy for ligation of the fistula, using extracorporeal membrane oxygenation (ECMO), was performed 13 days later. Complete repair of the esophageal atresia was accomplished 7 weeks after birth. The methods that have been suggested in the literature are discussed. The institution of ECMO at birth could allow a primary complete surgical repair of EA and CDH. Nevertheless, surgical management with staged repair, as described herein, can be useful.

Pharmacodynamic effects of three doses of ORG 9426 used for endotracheal intubation in humans

STUDY OBJECTIVE

To determine the pharmacodynamic characteristics of three incremental doses of ORG 9426 used for endotracheal intubation in patients.

DESIGN

Double-blind, randomized administration of one of three doses of intravenous ORG 9426.

SETTING

Inpatients requiring surgery at Georgetown University Medical Center.

PATIENTS

Thirty-six patients, ages 18 to 65, ASA physical status I, II, and III, scheduled for general surgery.

INTERVENTIONS

After Georgetown University Institutional Review Board approval and patient consent, patients were premedicated with midazolam or droperidol. Anesthesia was induced with thiopental sodium and fentanyl. Anesthesia was maintained with 60% nitrous oxide in oxygen. The ulnar nerve was stimulated supramaximally with a 2 Hz train-of-four (TOF) every 20 seconds. Thumb contractions were measured with a force transducer. When TOF and anesthesia were stable, 2, 2.5, or 3 times the ED95 of ORG 9426 (570 micrograms/kg, 710 micrograms/kg, or 850 micrograms/kg) was administered randomly. Tracheal intubation was attempted at maximal depression of the first TOF response (T1).

MEASUREMENTS AND MAIN RESULTS

The following parameters were measured: time interval from the injection of ORG 9426 to 90% depression of T1 (T1 90% block), maximal T1 depression (onset time), intubating conditions, clinical duration (time for return of T1 to 25% of control), heart rate (HR), blood pressure (BP), and any adverse clinical experience. ORG 9426 provided adequate intubating conditions in all patients but two, independent of the dose used. Its onset time was rapid, but increasing the dose did not shorten the onset. T1 90% block was achieved rapidly (75 +/- 25 seconds to 78 +/- 18 seconds, means +/- SD). The clinical duration of ORG 9426 was relatively short and lengthened with increasing doses (from 36 +/- 18 minutes at 570 micrograms/kg to 42 +/- 10 minutes at 850 micrograms/kg. Spontaneous twitch recovery from 10% to 25% was similar in all dosage groups (5 +/- 1 minutes to 6 +/- 4 minutes). No clinically significant changes in HR and BP and no adverse clinical experiences were noted in any group.

CONCLUSION

These findings warrant further clinical evaluation of ORG 9426 for induction and maintenance of muscle relaxation in humans.

[Cardiovascular tolerance to tianeptine]

The cardiovascular effects of tianeptine were assessed by a specific placebo-controlled trial in healthy volunteers and by heart rate, blood pressure and electrocardiogram data analyses in five studies enrolling depressed patients. In two of these studies the effects of tianeptine were compared to those of amitriptyline. The three other studies were performed as open, long-term trials (up to one-year treatment) in large populations of patients (more than 3,300 patients). The findings show that tianeptine does not modify heart rate, blood pressure, conduction or ventricular function. Tianeptine was well tolerated in depressed patients and induced no significant changes at the current dosage in treatment periods from three-months to one-year even in elderly patients, patients with cardiovascular abnormalities or alcoholic patients. Fewer cases of orthostatic hypotension were observed than with other antidepressants. Suicide attempts with tianeptine overdosage did not lead to death due to cardiovascular complications.

[Early reocclusion after in situ coronary desobstruction either with streptokinase or angioplasty during the acute phase of myocardial infarction]

The aim of this study was to assess the incidence of early reocclusion after therapeutic reperfusion of coronary arteries in acute myocardial infarction. Seventy four patients underwent intracoronary thrombolysis and 133 patients had immediate coronary angioplasty. The success rates were 70 per cent and 86 per cent respectively (p less than 0.01) and the degree of residual stenosis was 77 +/- 13 percent and 25 +/- 15 per cent respectively (p less than 0.001). The patients in whom coronary reperfusion was successful, 52 after in situ thrombolysis, 48 after angioplasty alone, and 66 after combined angioplasty and intravenous thrombolysis, underwent coronary arteriography 24 to 36 hours later. Reocclusion was asymptomatic in 46 per cent of cases (13/28) and its prevalence was 16.9 per cent: 25.5 per cent for the right coronary compared with 12.8 per cent for the left anterior descending (p less than 0.05) and 11.7 per cent for the left circumflex artery; reocclusion occurred in 8.6 per cent of patients treated before the 3rd hour compared with 22.9 per cent of patients receiving treatment after the 3rd hour (p less than 0.05). The incidence of reocclusion was 17.3 per cent after intracoronary thrombolysis and 16.7 per cent after angioplasty (angioplasty alone 18.7 per cent; associated with thrombolysis 15.2%). The degree of residual stenosis was nil after intracoronary thrombolysis and 16.3 per cent after angioplasty when the stenosis was insignificant, and 20.5 per cent and 18.8 per cent respectively with stenotic lesions greater than 50 per cent.

[Contribution of perindopril to the treatment of chronic congestive cardiac insufficiency. Multicenter pilot double blind study versus placebo]

Cardiac decompensation occurred in three patients of the placebo group, but not in the perindopril group. The effectiveness of perindopril in heart failure was demonstrated by the improvement observed in exercise test and severity score and by the decrease of cardiothoracic ratio. Changes in SAP, and serum creatinine levels, in particular, showed that the drug was well tolerated.

Isoflurane attenuates baroreflex control of heart rate in human neonates

Clinical studies have suggested that baroreflex regulation of heart rate may be more affected by inhalational anesthetics in human neonates or young animals than in adults. To test this hypothesis, baroreceptor reflex control of heart rate was studied in eight neonates during administration of 1 MAC isoflurane. The neonates were hemodynamically stable and their lungs were mechanically ventilated. No other anesthetic was used. Mean (+/- SD) corrected gestational age was 39.4 +/- 2.0 weeks and mean weight was 2,710 +/- 430 g. The pressor response was tested with the use of phenylephrine and the depressor response with nitroglycerin. Changes in heart rate (R-R interval) were plotted against the changes in systolic arterial pressure, and the slope of the linear portion of this relationship was used to define the baroreflex response. Both baroresponses measured in awake neonates varied widely between patients. With administration of approximately 1 MAC isoflurane, the pretest mean systolic arterial pressure decreased by about 30% (P less than 0.001), whereas mean heart rate values remained unchanged compared with control awake values. During isoflurane administration, the mean (+/- SD) pressor response decreased to 23% of control awake values (11.2 +/- 7.7 ms/mmHg vs. 2.6 +/- 3.7 ms/mmHg; P less than 0.01) and the depressor response to 28% of control (4.3 +/- 3.2 ms/mmHg vs. 1.2 +/- 0.8 ms/mmHg; P less than 0.05). These changes can be attributed to a significant resetting of heart rate itself (calculated as the change in R-R interval at a constant pressure).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of the action kinetics of alcuronium and vecuronium by electromyographic monitoring]

Twenty-eight ASA I or ASA II adults undergoing microsurgery were anaesthetized according to a standard protocol using droperidol, phenoperidine and thiopentone followed by enflurane. The patients were randomly assigned to two homogeneous groups: the first group (n = 14) received 0.2 mg.kg-1 alcuronium, whereas the second group (n = 14) received 0.08 mg.kg-1 vecuronium. There was no reinjection of either drug and curarization tapered off spontaneously. Neuromuscular monitoring was begun once anaesthesia was stable and after intentional isovolaemic haemodilution. The type of stimulus used was the train-of-four, delivered by a Relaxograph monitor to the ulnar nerve. Muscle response was measured at the hypothenar eminence. The kinetic study considered the time interval required between the injection of the muscle relaxant and the appearance of the minimal value of the twitch (first response of the train-of-four = T1min). The times to recovery of the twitch height to 25, 75 and 100% of the reference value (T1/T0) and of the fourth response of the train-of-four to 25 and 75% of the ratio (T4/T1) were also recorded. Finally, the recovery indexes represented by the times required for T1/T0 and T4/T1 to rise from 25% to 75% respectively were studied. The maximal twitch height inhibition was significantly greater (p less than 0.001) in the vecuronium group (T1min = 0.36 +/- 1.33%) than in the alcuronium group (T1min = 4.36 +/- 5.08%); it occurred significantly more quickly (p less than 0.001) with vecuronium (139 +/- 48 s) than with alcuronium (316 +/- 133 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Thallium 201 muscle scintigraphy: application to the management of patients with arterial occlusive disease

Skull (S), thigh (T), and calf (C) scintigraphies were performed by using 2 mCi thallium 201 IV in 30 patients suffering from stages II, III, and IV arterial occlusive disease (Fontaine's classification). Two indexes were calculated: P = T/C-C/S (T/C and C/S were the absolute values of radioactivity ratios measured before medical treatment) and R = delta(C/S)-delta(T/C) (where delta expressed the relative variation of the ratios measured after treatment and compared with initial values). Angiography was performed on all patients prior to treatment, and the results were quantified as 1 in the case of obliteration and 0.5 in case of stenosis of major arterial axes. Clinical improvement was demonstrated by a 100% increase in walking distance for stage II disease, abolition of pain at rest for stage III disease, and reepithelialization of trophic lesions for stage IV disease. Paraclinical effectiveness was evaluated by measuring ankle systolic pressure (SP) and index (SI) before and after treatment. The correlation observed between the values of P and angiography results was p less than 0.025 (Student t-test). The mean of P (measured before treatment) was 1.75 for the improved patients and 0.56 for the others (p less than 0.005). After treatment, R was +58% for improved patients versus -13% in those in whom the treatment was inefficient (p less than 0.025). P expresses the microcirculatory effects of arterial lesions detected by angiography. It is a prognostic index: satisfactory proximal perfusion (high T/C), associated with lesions that are essentially peripheral (low C/S), predicting a positive effect of medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)