Genetic testing practices among specialist physicians who treat prostate cancer A Canadian, cross-sectional survey

INTRODUCTION

In patients with prostate cancer (PCa), the identification of an alteration in genes associated with homologous recombination repair (HRR) has implications for prognostication, optimization of therapy, and familial risk mitigation. The aim of this study was to assess the genomic testing landscape of PCa in Canada and to recommend an approach to offering germline and tumor testing for HRR-associated genes.

METHODS

The Canadian Genitourinary Research Consortium (GURC) administered a cross-sectional survey to a largely academic, multidisciplinary group of investigators across 22 GURC sites between January and June 2022.

RESULTS

Thirty-eight investigators from all 22 sites responded to the survey. Germline genetic testing was initiated by 34%, while 45% required a referral to a genetic specialist. Most investigators (82%) reported that both germline and tumor testing were needed, with 92% currently offering germline and 72% offering tissue testing to patients with advanced PCa. The most cited reasons for not offering testing were an access gap (50%), uncertainties around who to test and which genes to test, (33%) and interpreting results (17%). A majority reported that patients with advanced PCa (74-80%) should be tested, with few investigators testing patients with localized disease except when there is a family history of PCa (45-55%).

CONCLUSIONS

Canadian physicians with academic subspecialist backgrounds in genitourinary malignancies recognize the benefits of both germline and somatic testing in PCa; however, there are challenges in accessing testing across practices and specialties. An algorithm to reduce uncertainty for providers when ordering genetic testing for patients with PCa is proposed.

Characterization of chemical components of fresh and aged aerosol from vehicle exhaust emissions in Hong Kong

The chemical properties of fresh and aged aerosol emitted during controlled vehicular exhaust emissions were characterized in the analysis. Pyrene (10417.1 ± 534.9 ng kg^-1) is the most abundant of all analyzed compounds in total fresh emission and succinic acid (57359.8 ± 4000.3 ng kg^-1) is for the total aged emission. The fresh emission factors (EF_fresh) of all compounds in the n-alkanes group demonstrate higher average emissions for the two vehicles with EURO 3 standard compared to the other vehicles. The EF_fresh for benzo [a]pyrene is in descending order: G1 (183.1 ± 144.7 ng kg^-1) > G3 (103.4 ± 60.1 ng kg^-1) > G4 (91.2 ± 80.1 ng kg^-1) > G2 (88.6 ± 93.9 ng kg^-1). Aged/fresh (A/F) emission ratios (>20) confirmed that these diacid compounds are generated by the photooxidation of primary pollutants that emitted from gasoline combustions. High A/F ratios (>200) in phthalic acid, isophthalic acid and terephthalic acid under idling mode imply relatively more intense photochemical reactions for their productions compared with other chemical groups. Strong positive correlations (r > 0.6) were observed between the degradation of toluene and formations of pinonic acid, succinic acid, adipic acid, terephthalic acid, and glutaric acid after the aging process, suggesting possible photooxidation of toluene that can lead to secondary organic aerosol (SOA) formation in the urban atmosphere. The findings demonstrate that vehicle emission standards for pollution in relation to the change of particulate matter chemical compositions and SOA formations. The results warrant a need for regulated reformulation for such vehicles.

Health-related quality of life in patients with light chain amyloidosis treated with bortezomib, cyclophosphamide, and dexamethasone ± daratumumab: Results from the ANDROMEDA study

In the phase 3 ANDROMEDA trial, patients treated with daratumumab, bortezomib, cyclophosphamide, and dexamethasone (D-VCd) had significantly higher rates of organ and hematologic response compared with patients who received VCd alone. Here, we present patient-reported outcomes (PROs) from the ANDROMEDA trial. PROs were assessed through cycle 6 using three standardized questionnaires. Treatment effect through cycle 6 was measured by a repeated-measures, mixed-effects model. The magnitude of changes in PROs versus baseline was generally low, but between-group differences favored the D-VCd group. Results were generally consistent irrespective of hematologic, cardiac, or renal responses. More patients in the D-VCd group experienced meaningful improvements in PROs; median time to improvement was more rapid in the D-VCd group versus the VCd group. After cycle 6, patients in the D-VCd group received daratumumab monotherapy and their PRO assessments continued, with improvements in health-related quality of life (HRQoL) reported through cycle 19. PROs of subgroups with renal and cardiac involvement were consistent with those of the intent-to-treat population. These results demonstrate that the previously reported clinical benefits of D-VCd were achieved without decrement to patients' HRQoL and provide support of D-VCd in patients with AL amyloidosis.

The chemical composition and toxicological effects of fine particulate matter (PM2.5) emitted from different cooking styles

The mass, chemical composition and toxicological properties of fine particulates (PM_2.5) emitted from cooking activities in three Hong Kong based restaurants and two simulated cooking experiments were characterized. Extracts from the PM_2.5 samples elicited significant biological activities [cell viability, generation of reactive oxygen species (ROS), DNA damage and inflammation effect (TNF-α)] in a dose-dependent manner. The composition of PAHs, oxygenated PAHs (OPAHs) and azaarenes (AZAs) mixtures differed between samples. The concentration ranges of the Σ30PAHs, Σ17OPAHs and Σ4AZAs and Σ7Carbonyls in the samples were 9627-23,452 pg m^-3, 503-3700 pg m^-3, 33-263 pg m^-3 and 158 - 5328 ng m^-3, respectively. Cell viability caused by extracts from the samples was positively correlated to the concentration of benzo[a]anthracene, indeno[1,2,3-cd]pyrene and 1,4-naphthoquinone in the PM_2.5 extracts. Cellular ROS production (upon exposure to extracts) was positively correlated with the concentrations of PM_2.5, decaldehyde, acridine, Σ17OPAHs and 7 individual OPAHs. TNF-α showed significant positive correlations with the concentrations of most chemical species (elemental carbon, 16 individual PAHs including benzo[a]pyrene, Σ30PAHs, SO₄^2-, Ca²⁺, Ca, Na, K, Ti, Cr, Mn, Fe, Cu and Zn). The concentrations of Al, Ti, Mn, Σ30PAHs and 8 individual PAHs including benzo[a]pyrene in the samples were positively correlated with DNA damage caused by extracts from the samples. This study demonstrates that inhalation of PM_2.5 emitted from cooking could result in adverse human health effects.

Health-Related Quality of Life in Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma: Findings From the Phase III MAIA Trial

PURPOSE

To evaluate the effects of daratumumab, lenalidomide, and dexamethasone (D-Rd) versus lenalidomide and dexamethasone (Rd) on patient-reported outcomes (PROs) in the phase III MAIA study.

PATIENTS AND METHODS

PROs were assessed on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item and the EuroQol 5-dimensional descriptive system at baseline and every 3 months during treatment. By mixed-effects model, changes from baseline are presented as least squares means with 95% CIs.

RESULTS

A total of 737 transplant-ineligible (TIE) patients with newly diagnosed multiple myeloma were randomly assigned to D-Rd (n = 368) or Rd (n = 369). Compliance with PRO assessments was high at baseline (> 90%) through month 12 (> 78%) for both groups. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item global health status scores improved from baseline in both groups and were consistently greater with D-Rd at all time points. A global health status benefit was achieved with D-Rd, regardless of age (< 75 and ≥ 75 years), baseline Eastern Cooperative Oncology Group (ECOG) performance status score, or depth of response. D-Rd treatment resulted in significantly greater reduction in pain scores as early as cycle 3 (P = .0007 v Rd); the magnitude of change was sustained through cycle 12. Reductions in pain with D-Rd were clinically meaningful in patients regardless of age, ECOG status, or depth of response. Similarly, PRO improvements were observed with D-Rd and Rd on the EuroQol 5-dimensional descriptive system visual analog scale score.

CONCLUSION

D-Rd compared with Rd was associated with faster and sustained clinically meaningful improvements in PROs, including pain, in transplant-ineligible patients with newly diagnosed multiple myeloma regardless of age, baseline ECOG status, or depth of treatment response.

Metallic elements and Pb isotopes in PM2.5 in three Chinese typical megacities: spatial distribution and source apportionment

Heavy metal pollution in fine particulate matter (PM_2.5) is a serious environmental and health concern in China, particularly during winter. Here, we detected 40 elements in 24 h integrated daily PM_2.5 samples collected in January 2014 from three typical Chinese metropolises (Beijing, Changchun, and Chengdu) to reflect elemental spatial variations, local sources, and regional transport. The measured elemental concentrations in Changchun were 11.1% and 48.4% higher than those in Beijing and Chengdu, respectively. Thus, PM_2.5 from Changchun exhibited high levels and diversity in the elemental profile (characterized by high concentrations of industrial emission elemental markers). The results of elemental ratios and Pb isotopes proved that, except for a coal combustion source, vehicular emissions contributed more to PM_2.5 heavy metals in Beijing than in the other two cities; Changchun PM_2.5 elements received large contributions from industrial sources, including iron and steel manufacturing, and automobile industry. Moreover, crustal dust from long-range transport of regional air masses from the northwest regions of China played a crucial role in determining elemental levels in Beijing and Changchun, accounting for more than 50% of source intensity. However, a specific dominant source was not determined in Chengdu; the contribution of anthropogenic dust, mainly from construction activities, needs to be paid attention in Chengdu eastern area. This study contributed to enhancing our understanding of elemental spatial distribution characteristics and sources and to setting more judicious standards and strategies for PM_2.5 bound heavy metals in China.

Prediction model for air particulate matter levels in the households of elderly individuals in Hong Kong

Air pollution has shown to cause adverse health effects on mankind. Aging causes functional decline and leaves elderly people more susceptible to health threats associated with air pollution exposure. Elderly spend approximately 80% of their lifetime at home every day. To understand air pollution exposure, indoor air pollutants are the targets for consideration especially for the elderly population. However, indoor air monitoring for epidemiological studies requires a large population, is labor intensive and time consuming. As a result, a prediction model is necessary. For 3 consecutive days in summer and winter, 24-h average of mass concentrations of fine particulate matter (aerodynamic diameter <2.5 μm: PM_2.5) were measured in indoors for 116 households. A PM_2.5 prediction model for elderly households in Hong Kong has been developed by combining ambient PM_2.5 concentrations obtained from land use regression model and questionnaire-elicited information related to the indoor PM_2.5 sources. The fitted linear mixed-effects model is moderately predictive for the observed indoor PM_2.5, with R² = 0.67 (or R² = 0.61 by cross-validation). The model shows indoor PM_2.5 was positively influenced by outdoor PM_2.5 levels. Meteorological factors (e.g. temperature and relative humidity) were related to the indoor PM_2.5 in a relatively complex manner. Congested living areas, opening windows for extended periods for ventilation and use of liquefied petroleum gas for cooking were the factors determining the ultimate indoor air quality. This study aims to provide information about controlling household air quality and can be used for future epidemiological studies associated with indoor air pollution in large population.

The effects of particle-induced oxidative damage from exposure to airborne fine particulate matter components in the vicinity of landfill sites on Hong Kong

The physical, chemical and bioreactivity characteristics of fine particulate matter (PM_2.5) collected near (<1 km) two landfill sites and downwind urban sites were investigated. The PM_2.5 concentrations were significantly higher in winter than summer. Diurnal variations of PM_2.5 were recorded at both landfill sites. Soot aggregate particles were identified near the landfill sites, which indicated that combustion pollution due to landfill activities was a significant source. High correlation coefficients (r) implied several inorganic elements and water-soluble inorganic ions (vanadium (V), copper (Cu), chloride (Cl^-), nitrate (NO₃^-), sodium (Na) and potassium (K)) were positively associated with wind flow from the landfill sites. Nevertheless, no significant correlations were also identified between these components against DNA damage. Significant associations were observed between DNA damage and some heavy metals such as cadmium (Cd) and lead (Pb), and total Polycyclic Aromatic Hydrocarbons (PAHs) during the summer. The insignificant associations of DNA damage under increased wind frequency from landfills suggested that the PM_2.5 loading from sources such as regional sources was possibly an important contributing factor for DNA damage. This outcome warrants the further development of effective and source-specific landfill management regulations for particulate matter production control to the city.

Source contributions of surface ozone in China using an adjoint sensitivity analysis

Air pollution has become an adverse environmental problem in China, resulting in serious public health impacts. This study advanced and applied the CMAQ adjoint model to quantitatively assess the source-receptor relationships between surface ozone (O₃) changes over different receptor regions and precursor emissions across all locations in China. Five receptor regions were defined based on the administrative division, including northern China (NC), southern China (SC), Pearl River Delta region (PRD), Yangtz River Delta region (YRD), and Beijing-Tianjin-Hebei region (BTH). Our results identified the different influential pathways of atmospheric processes and emissions to O₃ pollution. We found that the atmospheric processes such as horizontal and vertical advection could offset the O₃ removal through chemical reactions in VOC-limited areas inside the receptor regions. In addition, O₃ pollution can be induced by transport of O₃ directly or its precursors. Our results of relative source contributions to O₃ show that transboundary O₃ pollution was significant in SC, NC and YRD, while the O₃ pollution in PRD and BTH were more contributed by local sources. Anhui, Hubei and Jiangsu provinces were the three largest source areas of NO_x and VOC emissions to O₃ in SC (>52%) and YRD (>69%). NO_x and VOC emissions from Tianjin and Beijing were the largest contributors to O₃ in NC (>34%) and BTH (>51%). PRD was the dominant source areas of NO_x (>89%) and VOC emissions (~98%) to its own regional O₃.

Relationship between patient-reported outcomes and clinical outcomes in metastatic castration-resistant prostate cancer: post hoc analysis of COU-AA-301 and COU-AA-302

Background

Patient-reported outcomes (PROs) are used to assess benefit-risk in drug development. The relationship between PROs and clinical outcomes is not well understood. We aim to elucidate the relationships between changes in PRO measures and clinical outcomes in metastatic castration-resistant prostate cancer (mCRPC).

Patients and methods

We investigated relationships between changes in self-reported fatigue, pain, functional well-being (FWB), physical well-being (PWB) and prostate cancer-specific symptoms with overall survival (OS) and radiographic progression-free survival (rPFS) after 6 and 12 months of treatment in COU-AA-301 (N = 1195) or COU-AA-302 (N = 1088). Eligible COU-AA-301 patients had progressed after docetaxel and had Eastern Cooperative Oncology Group performance status (ECOG PS) ≤ 2. Eligible COU-AA-302 patients had no prior chemotherapy and ECOG PS 0 or 1. Patients were treated with abiraterone acetate (1000 mg/day) plus prednisone (10 mg/day) or prednisone alone daily. Association between self-reported fatigue, pain and functional status, and OS and/or rPFS, using pooled data regardless of treatment, was assessed. Cox proportional hazard regression modeled time to death or radiographic progression.

Results

In COU-AA-301 patients, PRO improvements were associated with longer OS and longer time to radiographic progression versus worsening or stable PROs (P < 0.0001). In multivariate models, all except pain intensity remained associated with OS. Pain intensity, PWB and FWB improvements remained associated with rPFS. In COU-AA-302 patients, worsening PROs were associated with higher likelihood of radiographic progression (P ≤ 0.025) compared with improved or stable PROs. In multivariate models, worsening PWB remained associated with worse rPFS. The 12-month analysis confirmed the 6-month results.

Conclusions

PROs are significantly associated with clinically relevant time-to-event efficacy outcomes in clinical trials and may complement and help predict traditional clinical practice methods for monitoring patients for disease progression.

Clinical Validation of the Autism Behavior Inventory: Caregiver-Rated Assessment of Core and Associated Symptoms of Autism Spectrum Disorder

There is a need for measures to track symptom change in autism spectrum disorder (ASD). We conducted a validation study on a revised version of the Autism Behavior Inventory (ABI), and a short form (ABI-S). Caregivers of individuals (6–54 years) with confirmed diagnoses of ASD (N = 144) completed the ABI and other rating scales at 4 time points. Scale consistency for each domain, 3–5 day test–retest reliability, and construct validity, determined by comparison to pre-specified scales, were all good. Change in the ABI was congruent with changes in other instruments. Collectively, results suggest incipient suitability of the ABI as a measure of changes in core and associated symptoms of ASD.

Trial Registration NCT02299700.

Psychometric Validation of the Hepatitis C Symptom and Impact Questionnaire (HCV-SIQv4) in a Diverse Sample of Adults with Chronic Hepatitis C Virus Infection Treated with an Interferon-free Simeprevir-containing Regimen

BACKGROUND

Hepatitis C virus (HCV) infection and its treatments are associated with significant symptoms, side effects and impact on patients functioning. The Hepatitis C Symptom and Impact Questionnaire version 4 (HCV-SIQv4) was developed according to FDA Patient Reported Outcomes (PRO) Guidance, for evaluating chronic HCV infection and its treatment.

OBJECTIVES

This study evaluated the psychometric properties and clinically important change (CIC) thresholds of the measure.

METHODS

PRO data were pooled from three Phase IIb and III trials evaluating interferon-free simeprevir-containing regimens for treatment of chronic HCV infection. Scale range adequacy, reliability, validity, responsiveness and CIC thresholds were assessed incorporating knowledge of the appropriate measurement model.

RESULTS

Data from 437 patients were analyzed. Stage of liver disease was associated with symptom severity and functioning at baseline. Reliability was acceptable (test-retest ICC ≥0.7) for most scores except the Gastrointestinal and Integumentary domains. Convergent validity was observed between HCV-SIQv4 scores and concurrent measures of conceptual similarity. Greater symptom severity and worse impact scores were associated with liver cirrhosis, depression, severe fatigue and health limitations. Patients who achieved SVR12 had better outcomes than those failing to. HCV-SIQv4 symptom and domain scores were responsive to changes in health state (effect sizes ≥0.5). Exploratory thresholds for change in scores indicating a clinically important improvement and worsening were HCV-SIQv4 Overall Body System Score (BSS), 8 and 8; Constitutional BSS, 10 and 10; Gastrointestinal BSS, 5 and 5; Psychiatric BSS, 8 and 8; Neurocognitive BSS, 8 and 8; and Integumentary BSS, 5 and 5.

CONCLUSIONS

The HCV-SIQv4 offers reliable, responsive assessments within HCV clinical development. CIC thresholds are now available to aid score interpretation.

Epidemiology of lung cancer: A joinpoint analysis of temporal incidence and mortality trends in 38 countries

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Background: Lung cancer is the leading cause of cancer death worldwide. We examined the correlation between lung cancer incidence/mortality and country-specific socioeconomic development, and evaluated the most recent global patterns and trends of this cancer in 38 countries. Methods: We retrieved age-standardized incidence rates of lung cancer in 2012 from the GLOBOCAN database. Temporal patterns were assessed for all countries obtained from the Cancer Incidence in Five Continents volumes I-X and the WHO mortality database. Simple linear regression analysis was used to evaluate their correlations with Human Development Index (HDI) and Gross Domestic Product (GDP) per capita. The average annual percent change (AAPC) of the incidence and mortality trends in the most recent 10 years were evaluated from join-point regression analysis according to country and gender. The statistical significance of AAPC was ascertained comparing with zero, and all insignificant AAPCs were regarded as having “stable trends”. Results: The global incidence and mortality of lung cancer varied by 31-fold. Country-specific HDI was strongly correlated with age-standardized incidence (r = 0.70) and mortality (r = 0.67), and so was GDP per capita to a lesser extent (r = 0.24 to 0.55) (all p < 0.001). Among men, 22 and 30 (out of 38 and 36) countries showed declining incidence and mortality trends, respectively; whilst among women, 19 and 16 countries showed increasing incidence and mortality trends, respectively. The AAPCs ranged from -2.8 to -0.6 (incidence) and -3.6 to -1.1 (mortality) among countries with declining trend in men, whereas the AAPC range was 0.4 to 8.9 (incidence) and 1 to 4.4 (mortality) among countries with increasing trends in women. Among women, Brazil, Spain and Cyprus had the greatest incidence increase, and all countries in Western, Southern and Eastern Europe had increasing mortality. Conclusions: Countries with higher socioeconomic development had higher lung cancer incidence and mortality. The incidence and mortality rates of lung cancer were increasing in many countries among women but declining in most countries among men, highlighting the need for regular surveillance and global preventive measures.

Significant Improvement in Cognition in Mild to Moderately Severe Dementia Cases Treated with Transcranial Plus Intranasal Photobiomodulation: Case Series Report

Objective: This study investigated whether patients with mild to moderately severe dementia or possible Alzheimer's disease (AD) with Mini-Mental State Exam (MMSE) Baseline scores of 10–24 would improve when treated with near-infrared photobiomodulation (PBM) therapy. Background: Animal studies have presented the potential of PBM for AD. Dysregulation of the brain's default mode network (DMN) has been associated with AD, presenting the DMN as an identifiable target for PBM. Materials and methods: The study used 810 nm, 10 Hz pulsed, light-emitting diode devices combining transcranial plus intranasal PBM to treat the cortical nodes of the DMN (bilateral mesial prefrontal cortex, precuneus/posterior cingulate cortex, angular gyrus, and hippocampus). Five patients with mild to moderately severe cognitive impairment were entered into 12 weeks of active treatment as well as a follow-up no-treatment, 4-week period. Patients were assessed with the MMSE and Alzheimer's Disease Assessment Scale (ADAS-cog) tests. The protocol involved weekly, in-clinic use of a transcranial-intranasal PBM device; and daily at-home use of an intranasal-only device. Results: There was significant improvement after 12 weeks of PBM (MMSE, p < 0.003; ADAS-cog, p < 0.023). Increased function, better sleep, fewer angry outbursts, less anxiety, and wandering were reported post-PBM. There were no negative side effects. Precipitous declines were observed during the follow-up no-treatment, 4-week period. This is the first completed PBM case series to report significant, cognitive improvement in mild to moderately severe dementia and possible AD cases. Conclusions: Results suggest that larger, controlled studies are warranted. PBM shows potential for home treatment of patients with dementia and AD.

Cancer risk from polycyclic aromatic compounds in fine particulate matter generated from household coal combustion in Xuanwei, China

Polycyclic aromatic hydrocarbons (PAHs) and their polar derivatives (oxygenated PAHs: OPAHs and azaarenes: AZAs) were characterized in fine particulates (PM_2.5) emitted from indoor coal combustion. Samples were collected in Xuanwei (Yunnan Province), a region in China with a high rate of lung cancer. A sample from the community with the highest mortality contained the highest total concentration of PAHs, OPAHs and AZAs and posed the highest excess cancer risk from a lifetime of inhaling fine particulates. Positive correlations between total carbonyl-OPAHs, total AZAs and total PAHs implied that the emissions were dependent on similar factors, regardless of sample location and type. The calculated cancer risk ranged from 5.23-10.7 × 10^-3, which is higher than the national average. The risk in each sample was ∼1-2 orders of magnitude higher than that deemed high risk, suggesting that the safety of these households is in jeopardy. The lack of potency equivalency factors for the PAH derivatives could possibly have underestimated the overall cancer risk.

Evidence to Support Montgomery-Asberg Depression Rating Scale Administration Every 24 Hours to Assess Rapid Onset of Treatment Response

OBJECTIVE

This study investigated the suitability of the Montgomery-Asberg Depression Rating Scale (MADRS), with a 24-hour recall period (MADRS-24hr), to assess the rapid onset of the antidepressant effect of a treatment in patients with treatment-resistant depression (TRD). Psychometric properties of the MADRS-24hr were assessed together with qualitative assessment of content validity.

METHODS

Content validity was assessed using semistructured interviews conducted from November 2013 to December 2013 in patients (18-64 years old) with TRD who met DSM-IV diagnostic criteria and health care professionals (HCPs) experienced in treating major depressive disorder and familiar with using the MADRS. The psychometric properties of MADRS-24hr were evaluated using data from 2 randomized clinical studies involving patients with TRD.

RESULTS

A total of 23 patients (15 [65%] women) with TRD (mean age = 45 years) and 11 HCPs were interviewed. With the exception of reduced sleep, the majority of patients and HCPs reported that the items captured in the MADRS can fluctuate in a 24-hour period. The majority of participants also reported that a meaningful change in depression symptoms could be assessed in a 24-hour recall period, except for reduced sleep and appetite. Assessment of the psychometric properties of the MADRS-24hr showed that this instrument had high internal consistency reliability (Cronbach α of 0.84 and 0.91) and test-retest reliability (intraclass correlation coefficients of 0.96 and 0.91), had construct validity, and was responsive to change following an intervention.

CONCLUSIONS

Overall, results suggest that MADRS-24hr can be used to assess the rapid onset of antidepressant efficacy of a treatment in patients with TRD.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers: NCT01627782 and NCT01640080.

Patient-reported Outcomes for Multicentric Castleman's Disease in a Randomized, Placebo-controlled Study of Siltuximab

Background

Multicentric Castleman’s disease (MCD) is a rare lymphoproliferative disorder driven by dysregulated interleukin-6 production. MCD has a poor prognosis, and treatment is generally noncurative and aimed at symptom relief. Siltuximab is a novel, monoclonal interleukin-6 antibody recently shown to be effective in a registration clinical trial. MCD symptoms, such as fatigue, pain, and weakness, are most appropriately quantified using patient-reported outcome (PRO) measures. We assessed the effect of siltuximab on patient perception of symptoms, functional status, and wellbeing using PRO instruments.

Methods

We analyzed results of a randomized, double-blind trial comparing siltuximab 11 mg/kg every 3 weeks with placebo to treat MCD. Subjects (N = 79) completed the recently developed MCD–Symptom Scale (MCD–SS), the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT–Fatigue) scale, and the Short Form (SF)-36 at predetermined time points throughout the treatment period. Scores were compared at baseline and over time between the treatment arms and PRO instruments.

Results

At baseline, the mean number of symptoms reported was 9.2 (standard deviation 3.76) out of 16 total, as measured by the MCD–SS. Fatigue was a key symptom across all PRO instruments. Siltuximab-treated subjects reported early improvements in symptoms compared with subjects in the placebo arm on both the MCD–SS and FACIT–Fatigue scale. Statistically significant improvements in five SF-36 domains were observed in siltuximab-treated patients, namely role physical, role emotional, vitality, bodily pain, and mental health.

Conclusions

Patients with MCD commonly report impairments in functioning, wellbeing, and fatigue at baseline. Siltuximab-treated patients reported significant improvements in these outcomes after treatment.

Electronic supplementary material

The online version of this article (doi:10.1007/s40271-015-0120-5) contains supplementary material, which is available to authorized users.

Characterization of chemical components and bioreactivity of fine particulate matter (PM2.5) during incense burning

The chemical and bioreactivity properties of fine particulate matter (PM2.5) emitted during controlled burning of different brands of incense were characterized. Incenses marketed as being environmentally friendly emitted lower mass of PM2.5 particulates than did traditional incenses. However, the environmentally friendly incenses produced higher total concentrations of non-volatile polycyclic aromatic hydrocarbons (PAHs) and some oxygenated polycyclic aromatic hydrocarbons (OPAHs). Human alveolar epithelial A549 cells were exposed to the collected PM2.5, followed by determining oxidative stress and inflammation. There was moderate to strong positive correlation (R > 0.60, p < 0.05) between selected PAHs and OPAHs against oxidative-inflammatory responses. Strong positive correlation was observed between interleukin 6 (IL-6) and summation of total Group B2 PAHs/OPAHs (∑7PAHs/ΣOPAHs). The experimental data indicate that emissions from the environmentally friendly incenses contained higher concentrations of several PAH and OPAH compounds than did traditional incense. Moreover, these PAHs and OPAHs were strongly correlated with inflammatory responses. The findings suggest a need to revise existing regulation of such products.

Analysis of the temporal relationship between patient-reported outcomes (PROs) and overall survival (OS) and radiographic progression-free survival (rPFS) in metastatic castration-resistant prostate cancer (mCRPC) patients (pts)

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Background: PROs are used to measure therapeutic impact. The relationship between PROs and clinical outcomes is not well described. Methods: COU-AA-301 (301) and COU-AA-302 (302) were phase 3 trials of abiraterone acetate + prednisone (P) vs P in post-docetaxel and chemotherapy-naïve mCRPC pts, respectively. Using Cox regression models, we explored the association between self-reported fatigue, pain, physical well-being (PWB), functional well-being (FWB), and PC-specific (PCS) signs and symptoms, and OS and rPFS over the first 181 days, regardless of treatment, using data from 301 (N = 1195) and, separately, from 302 (N = 1088). Pts in 301 had more advanced disease and were more symptomatic at entry; pts in 302 were asymptomatic/mildly symptomatic. PRO improvements were assessed for 301 and worsening was assessed for 302. Results: In 301, pts with PRO improvements had reduced risk of death and radiographic progression (p < 0.0001) vs pts with worsening or stable PROs (Table). When all PROs were included in a multivariate (MV) model, all except pain intensity were significantly associated with OS; pain intensity, PWB, and FWB improvements were significantly associated with reduced radiographic progression. Pts in 302 with worsening PROs had greater risk of radiographic progression (p ≤ 0.02) vs pts with improved or stable PROs (Table). When all PRO end points were included in an MV model, worsening PWB remained significantly associated with worse rPFS. There were too few events at cutoff to explore the relationship between PROs and OS in 302. Conclusions: These results reinforce the clinical meaningfulness of self-reported symptoms and suggest that PROs can be used in combination with clinical measures in practice. Clinical trial information: NCT00887198; NCT00638690. [Table: see text]

Spatiotemporal distribution of carbonyl compounds in China

A sampling campaign was carried out at nine Chinese cities in 2010/2011. Fifteen monocarbonyls (C# = 1-9) were quantified. Temperature is the rate-determining factor of the summertime carbonyl levels. The carbonyl emissions in winter are mainly driven by the primary anthropogenic sources like automobile. A molar ratio of propionaldehyde to nonaldehyde is a barometer of the impact of atmospheric vegetation emission which suggesting that strong vegetation emissions exist in summer and high propionaldehyde abundance is caused by fossil fuel combustion in winter. Potential health risk assessment of formaldehyde and acetaldehyde was conducted and the highest cumulative risks were observed at Chengdu in summer and Wuhan in winter. Because of the strong photochemical reaction and large amount of anthropogenic emissions, high concentrations of carbonyl compounds were observed in Chengdu. The use of ethanol-blended gasoline in Wuhan is the key reason of acetaldehyde emission and action should be taken to avoid potential health risks.

Chemical and biological characterization of air particulate matter 2.5, collected from five cities in China

Fifteen polycyclic aromatic hydrocarbons (PAHs) in PM2.5 samples collected in five different cities (Hong Kong (HK), Guangzhou (GZ), Xiamen (XM), Xi'an (XA) and Beijing (BJ)) in China in the winter 2012-13 [corrected] were analyzed by gas chromatography-mass spectrometry. The biological effects of organic extracts were assayed using the human bronchial epithelial cells BEAS-2B. All sixteen priority PAHs can be found in the PM2.5 samples of XA and BJ, but not in HK, GZ and XM, demonstrating the differential spatial source and distribution of PAHs. Our results showed that the total PAHs ranged from 3.35 to 80.45 ng/m(3) air, leading by BJ, followed by XA, XM, GZ and HK. In the cell culture study, transcript levels of pro-inflammatory cytokine interleukin-6 (IL-6), CYP1A1 and CYP1B1 were found to be induced in the treatment. The cells exposed to extracts from XA and BJ demonstrated significant migratory activities, indicating a sign of increase of tumorigenicity.

Carotid dosimetry for T1 glottic cancer radiotherapy

OBJECTIVE

Radiotherapy for T1 glottic cancer is commonly delivered using a lateral parallel opposed pair of megavoltage photon fields. There is increasing reported evidence of cerebrovascular events due to radiation-induced carotid stenosis. An alternative field arrangement is to use an anterior oblique technique. This study compares the carotid dosimetry between the two techniques and reviews the evidence for the risk of radiation-induced vascular events.

METHODS

The radiotherapy plans of 10 patients with T1 glottic cancer treated with an anterior oblique technique were examined for carotid dose. Alternative plans were then created using a parallel opposed pair of fields and the dose to the carotids compared. All patients received 50 Gy in 16 fractions treating once daily, for 5 days in a week.

RESULTS

The average of the mean dose to the carotids with the anterior oblique technique was 21 Gy compared with 37 Gy using the lateral parallel opposed pair arrangement (p < 0.0001).

CONCLUSION

An anterior oblique field arrangement for the treatment of T1 glottic cancer results in a significantly lower radiation dose to the carotid arteries, which may be clinically important in terms of reducing the risk of cerebrovascular events in long-term survivors.

ADVANCES IN KNOWLEDGE

Although the anterior oblique technique for treating early glottic cancers is well described, and it is predictable that the dose received by the carotid arteries should be lower with this technique, to our knowledge this is the first study to quantify that reduction in dose with a series of patients.

Seasonal variations of monocarbonyl and dicarbonyl in urban and sub-urban sites of Xi'an, China

Seventeen airborne carbonyls including monocarbonyls and dicarbonyls were determined in urban and sub-urban sites of Xi'an, China in three seasons in 2010. In winter, acetone was the most abundant carbonyl in the urban site due to usage of organic solvents in constructions and laboratories and its slower atmospheric removal mechanisms by photolysis and reaction with hydroxyl radical than those of formaldehyde and acetaldehyde. In the sub-urban site, acetaldehyde was the most abundant carbonyl, followed by formaldehyde and acetone. During summer, however, formaldehyde was the most dominant carbonyl in both sites. The photooxidations of a wide range of volatile organic compounds (VOCs) yielded much more formaldehyde than other carbonyls under high solar radiation and temperature. In the urban site, the average concentrations of dicarbonyls (i.e., glyoxal and methyglyoxal) in spring and summer were higher than that in winter. Transformation of aromatic VOCs emitted from fuel evaporation leads to the formation of 1,2-dicarbonyls. A reverse trend was observed in sub-urban sites, as explained by the relatively low abundances and accumulations of VOC precursors in the rural atmosphere during warm seasons. Moreover, cumulative cancer risk based on measured outdoor carbonyls (formaldehyde and acetaldehyde) in Xi'an Jiaotong University and Heihe was estimated (8.82 × 10(-5) and 4.96 × 10(-5), respectively). This study provides a clear map on the abundances of carbonyls and their source interpretation in the largest and the most economic city in Northwestern China.

Composite measure to assess efficacy/gastrointestinal tolerability of tapentadol ER versus oxycodone CR for chronic pain: pooled analysis of randomized studies

OBJECTIVE

To evaluate a composite measure for chronic pain that balances pain relief with tolerability.

DESIGN

Post hoc meta-analysis of three randomized, multicenter, double-blind studies.

PARTICIPANTS

Subjects with moderate-to-severe chronic osteoarthritis knee pain or low back pain who had been randomized to receive active treatment with tapentadol extended release (ER; n = 978) or oxycodone controlled release (CR; n = 999). Twenty-two subjects were excluded, mainly because they did not receive treatment.

MAIN OUTCOME MEASURES

We defined the composite measure as ≥30 percent pain relief without nausea/vomiting/constipation and without discontinuations (≥30 percent PRT [pain relief/tolerability]). We also considered ≥50 percent PRT as well as ≥30 percent and ≥50 percent pain relief without any adverse events of any type. To further evaluate ≥30 percent PRT, we studied its relationship with four patient-reported outcomes: EQ-5D, Physical and Mental Component Summaries of SF-36, Patient Global Impression of Change, and Patient Assessment of Constipation Symptoms.

RESULTS

At week 12, tapentadol ER recipients were more likely to have ≥30 percent PRT than oxycodone CR recipients (OR, 3.15; 95% CI, 2.47, 4.00; p < 0.001). Significant differences were also observed with the other three composite measures (p < 0.001). At week 12, subjects with ≥30 percent PRT had more favorable changes in all patient-reported outcomes than those without and were more likely to have threshold changes in EQ-5D and SF-36 (all p < 0.001).

CONCLUSIONS

Tapentadol ER was associated with significantly better composite outcomes than oxycodone CR. Because both pain relief and gastrointestinal tolerability appeared to be related to outcomes, the composite measure may represent a useful tool for comparing opioids that merits further evaluation.

Estimation of exhaust emission from ocean-going vessels in Hong Kong

As one of the busiest port in the world, ship emissions have become of great concern in Hong Kong. In this study, a detailed maritime emission inventory for ocean-going vessels (OGVs) in Hong Kong with the base year of 2007 was developed. The high-resolution vessel speed profiles determined using the Automatic Identification System (AIS) during 2009 were adopted for the speed data in the estimation. It was obtained that the total ship emissions from 37,150 voyages of OGVs in 2007 were 17,097, 8190, and 1035 tonnes accounting for 17%, 11%, and 16% of the total emissions of NO(x), SO(2), and PM(10), respectively. The contribution of ship emissions during transiting was 60-68% for three pollutants while the emissions during hotelling were responsible for the remaining portions. From the emission spatial allocation, the shipping route along the East Lamma Channel and the berthing location of the Kwai Chung and Tsing Yi Container Port comprised the regions with the highest emissions. The OGV emissions in Hong Kong contributed 0.07% NO(x), 0.05% SO(2), and 0.06% PM(10) out of the global total shipping emissions in 2007.

Characteristics and source apportionment of PM1 emissions at a roadside station

The mass concentrations of PM(1) (particles less than 1.0 μm in aerodynamic diameter), organic carbon (OC), elemental carbon (EC), water-soluble ions, and up to 25 elements were reported for 24h aerosol samples collected every sixth day at a roadside sampling station in Hong Kong from October 2004 to September 2005. Annual average PM(1) mass concentration was 44.5 ± 19.5 μg m(-3). EC, OM (organic matter, OC × 1.2), and SO(4)(=) were the dominant components, accounting for ∼ 36%, ∼ 26%, and ∼ 24% of PM(1), respectively. Other components, i.e., NO(3)(-), NH(4)(+), geological material, trace elements and unidentified material, comprised the remaining ∼ 14%. Annual average OC/EC ratio (0.6 ± 0.3) was low, indicating that primary vehicle exhaust was the major source of carbonaceous aerosols. The seasonal variations of pollutants were due to gas-particle partitioning processes or a change in air mass rather than secondary aerosol produced locally. Vehicle exhaust, secondary aerosols, and waste incinerator/biomass burning were dominant air pollution sources, accounting for ∼ 38%, ∼ 22% and ∼ 16% of PM(1), respectively. Pollution episodes during summer (May-August) which were frequently accompanied by tropical storms or typhoons were dominated by vehicle emissions. During winter (November-February) pollution episodes coincided with northeasterly monsoons were characterized by secondary aerosols and incinerator/biomass burning emissions.

On the relationship between ozone and its precursors in the Pearl River Delta: application of an observation-based model (OBM)

BACKGROUND, AIM, AND SCOPE

Photochemical smog, characterized by high concentrations of O(3) and fine particles, is of great concern in the urban areas, in particular megacities and city clusters like the Pearl River Delta.

MATERIALS, METHODS, AND RESULTS

Ambient ozone (O(3)) and its precursors were simultaneously measured at two sites in the Pearl River Delta, namely, Wan Qing Sha (WQS) in Guangzhou and Tung Chung (TC) in Hong Kong, from 23 October to 01 December 2007 in order to explore their potential relationship. Eight high O(3) episode days were identified at WQS and two at TC during the sampling campaign, indicating a more serious O(3) pollution in Guangzhou than in Hong Kong. An observation-based model was employed to determine the ozone-precursor relationship. At both sites, O(3) production was found to be volatile organic compound (VOC)-limited, which is consistent with previous observations. Anthropogenic hydrocarbons played a key role in O(3) production, while reducing nitric oxide emissions aided the buildup of O(3) concentrations. Among VOC species, the summed relative incremental reactivity (RIR) of the top 12 compounds accounted for 89% and 85% of the total RIR at WQS and TC, respectively, indicating that local photochemical O(3) formation can be mainly attributed to a small number of VOC species.

DISCUSSION AND CONCLUSIONS

A large increment in both simulated HO(2) and O(3) concentrations was achieved with additional input of hourly carbonyl data. This suggested that apart from hydrocarbons, carbonyls might significantly contribute to the O(3) production in the Pearl River Delta.

Chemically-speciated on-road PM(2.5) motor vehicle emission factors in Hong Kong

PM(2.5) (particle with an aerodynamic diameter less than 2.5microm) was measured in different microenvironments of Hong Kong (including one urban tunnel, one Hong Kong/Mainland boundary roadside site, two urban roadside sites, and one urban ambient site) in 2003. The concentrations of organic carbon (OC), elemental carbon (EC), water-soluble ions, and up to 40 elements (Na to U) were determined. The average PM(2.5) mass concentrations were 229+/-90, 129+/-95, 69+/-12, 49+/-18microg m(-3) in the urban tunnel, cross boundary roadside, urban roadside, and urban ambient environments, respectively. Carbonaceous particles (sum of organic material [OM] and EC) were the dominant constituents, on average, accounting for approximately 82% of PM(2.5) emissions in the tunnel, approximately 70% at the three roadside sites, and approximately 48% at the ambient site, respectively. The OC/EC ratios were 0.6+/-0.2 and 0.8+/-0.1 at the tunnel and roadside sites, respectively, suggesting carbonaceous aerosols were mainly from vehicle exhausts. Higher OC/EC ratio (1.9+/-0.7) occurred at the ambient site, indicating contributions from secondary organic aerosols. The PM(2.5) emission factor for on-road diesel-fueled vehicles in the urban area of Hong Kong was 257+/-31mg veh(-1) km(-1), with a composition of approximately 51% EC, approximately 26% OC, and approximately 9% SO(4)(=). The other inorganic ions and elements made up approximately 11% of the total PM(2.5) emissions. OC composed the largest fraction (approximately 51%) in gasoline and liquid petroleum gas (LPG) emissions, followed by EC (approximately 19%). Diesel engines showed higher emission rates than did gasoline and LPG engines for most pollutants, except for V, Br, Sb, and Ba.

Predictions of gas-particle partitioning coefficients (K(P)) of polycyclic aromatic hydrocarbons at various occupational environments of Songkhla Province, Thailand

Ambient air samples were collected over periods of 24 hours and 3 hours using a Graseby-Anderson high volume air sampler with PM10 TE-6001 at 15 sampling sites, including an urban residential zone, rural area, industrial factories, waste incinerator, traffic areas and agricultural burning areas in Songkhla Province, Thailand. An analysis of organic carbon and elemental carbon was conducted to estimate the gas-particle partitioning of PAHs using a model proposed by Dachs-Eisenreich. The estimated LogK(P) of PAHs emphasized the risk for lung cancer among outdoor workers in waste incinerators, traffic intersections and bus terminals, suggesting the role of the carbonaceous fraction over the gas-particle partitioning of PAHs. Analysis of f(SC)K(SA)delta(OCT)/F(OM)K(OA) ratios revealed a significant role of adsorption and absorption in unusually high elemental carbon fractions (ie low OC/EC ratio) in fine particles collected at waste incinerators and the abnormally high organic carbon fractions (ie high OC/EC ratio) observed in those fine particles of an urban residential zone, respectively. The dual mode of ab/adsorption tended to dominate the gas-particle partitioning of LMW PAHs collected at the traffic intersections and bus terminal.

Developing a CTCAEs patient questionnaire for late toxicity after head and neck radiotherapy

PURPOSE

Patient-based reporting of symptoms is increasingly important in providing treatment toxicity information. However, observer-based scoring systems such as the CTCAEs which incorporate the LENT-SOMA scales are not adapted for patient-based reporting. We aim to (1) report the late toxicity in patients following head and neck radiotherapy using a LENT-SOMA patient-based questionnaire, (2) describe how the responses help to improve the questionnaire and (3) adapt the questionnaire for patient reporting using CTCAEs.

METHODS

A 31-item LENT-SOMA patient questionnaire was administered prospectively to 220 patients pre-treatment and at eight time periods post-radical head and neck radiotherapy over 3 years. Exploratory factor analysis was carried out and questionnaire reliability was evaluated using Cronbach's alpha coefficient.

RESULTS

At 3-years follow-up, grade 3/4 toxicity was recorded for xerostomia (44%), hoarseness (14.3%), altered taste (6.1%) and oropharyngeal pain (1.9%). Factor analysis indicated that questionnaire division according to anatomical sub-site was reasonable. Cronbach's alpha was 0.851 (95% CI: 0.820-0.883) indicating high reliability. Good compliance was obtained with all questions except for the 'weight loss' item. A satisfaction survey showed that the questionnaire was clear and concise. Teeth and mandible sections have been removed. Dietary change due to xerostomia has been incorporated in line with CTCAEs. LENT-SOMA scoring of analgesic needs and dysphagia not described in CTCAEs were found useful and have been retained.

CONCLUSIONS

The questionnaire has enabled reporting of late toxicity and the responses have enabled refinement of the questionnaire. It is reliable, feasible and has been validated for patient-based collection of CTCAEs late toxicity data.

The Premature Ejaculation Profile: validation of self-reported outcome measures for research and practice

OBJECTIVE

To evaluate the reliability and validity of the Premature Ejaculation Profile (PEP), a self-reported outcome instrument for evaluating domains of PE and its treatment, comprised of four single-item measures, a profile, and an index score.

SUBJECTS AND METHODS

Data were from men participating in observational studies in the USA (PE, 207 men; non-PE, 1380) and Europe (PE, 201; non-PE, 914) and from men with PE (1238) participating in a phase III randomized, placebo-controlled clinical trial of dapoxetine. The PEP contains four measures: perceived control over ejaculation, personal distress related to ejaculation, satisfaction with sexual intercourse, and interpersonal difficulty related to ejaculation, each assessed on five-point response scales. Test-retest reliability, known-groups validity, and ability to detect a patient-reported global impression of change (PGI) in condition were evaluated for the individual PEP measures and a PEP index score (the mean of all four measures). Profile analysis was conducted using multivariate analysis of variance.

RESULTS

All PEP measures showed acceptable reliability (intraclass correlation coefficients ranged from 0.66 to 0.83) and mean scores for all measures differed significantly between PE and non-PE groups (P < 0.001). Men who reported a reduction in PE with treatment in the phase III trial had significantly greater scores on each of the four measures. The PEP profiles of men with and without PE differed significantly (P < 0.001) in both observational studies; higher levels of PGI were associated with higher PEP profiles (P < 0.001). The PEP index score also showed acceptable reliability and was significantly different between the PE and non-PE groups (P < 0.001). Men who reported an improvement in PE with treatment in the phase III trial had significantly greater PEP index scores. In the phase III trial, nausea was the most common adverse event with dapoxetine.

CONCLUSION

The PEP provides a reliable, valid, and interpretable measure for use in monitoring outcomes of men with PE.

Characteristics of emissions of air pollutants from burning of incense in temples, Hong Kong

Field investigations of target air pollutants at two of the most famous temples in Hong Kong were conducted. The air pollution problems in these two temples during peak and non-peak periods were characterized. The target air pollutants included particulate matters (PM(10), PM(2.5)), volatile organic compounds (VOCs), carbonyl compounds, carbon monoxide (CO), nitrogen oxides (NO(x)), methane (CH(4)), non-methane hydrocarbons (NMHC), organic carbon (OC), elemental carbon (EC), and inorganic ions (Cl(-), NO(3)(-), SO(4)(2-), Na(+), NH(4)(+), and K(+)). The pollutant levels of the two temples during peak period were shown to be significantly higher than those during non-peak period. The highest average CO level was obtained at Temple 1 during peak period, which exceeded IAQO 8-h Good Class criteria. In general, the average PM(2.5)/PM(10) ratios were approximately 82%. The results revealed that the fine particulates (PM(2.5)) constituted the majority of suspended particulates at both temples. It was noted that formaldehyde was the most abundant carbonyl compounds, followed by acetaldehyde. At Temple 1 during peak period, the average benzene concentration exceeded almost 8 times more than Indoor Air Quality Objectives for Office Buildings and Public Places (IAQO) [HKEPD, 2003. Guidance notes for the management of indoor air quality in offices and public places. Indoor air quality management group, The Government of the Hong Kong Special Administrative Region.] Good Class criteria. The average OC/EC ratios ranged from 2.6 to 17 in PM(10) and from 4.2 to 18 in PM(2.5) at two temples, which suggested that OC measured in these two temple areas may be due to both direct emission from incense burning and secondary formation by chemical reactions. The total mass of inorganic ions, organic carbon, and elemental carbon accounted for about 71% in PM(2.5) and 72% in PM(10).

Source apportionment of PM2.5 in urban area of Hong Kong

A monitoring program for PM(2.5) had been performed at two urban monitoring stations in Hong Kong from November 2000 to February 2001 and June 2001 to August 2001. PM(2.5) samples were collected once every 6 days at PolyU and KT stations with the sampling duration of 24-h. A sum of 25 chemical species in PM(2.5) were determined and selected for receptor models. Enrichment factors relative to earth crust abundances were evaluated and it was noted that most crustal elements including Al, Ti, Mg, Ca and K have small enrichment factors. Correlation and multivariate analysis technique, such as principal components analysis (PCA)/absolute principal components analysis (APCA) and cluster analysis (CA) are used for source apportionment to identify the possible sources of PM(2.5) and to determine their contribution. Six factors at each site were isolated by using PCA/APCA and cluster analysis. Similar sources (crustal matter, automobile emission, diesel emission, secondary aerosols, tire wear, and non-ferrous smelter) are identified by the PCA/APCA and cluster analysis.

Low molecular weight dicarboxylic acids, ketoacids, and dicarbonyls in the fine particles from a roadway tunnel: possible secondary production from the precursors

Low molecular weight dicarboxylic acids (DCAs), ketoacids, and alpha-dicarbonyls have been determined for the PM2.5 samples in a Hong Kong roadway tunnel, using a water extraction followed by a butyl ester and/or dibutyl acetal derivatization technique. For the most wintertime sampling runs, outlet and inlet concentrations of the quantified compounds were found to be quite similar (ca. 10% differences), leading to the conclusion that direct emissions of the organic compounds are insignificant from vehicles in hot-stabilized operations although vehicular emissions can provide important precursors to them. In contrast, a significant concentration increase of most compounds was observed at the outlet station compared to the inlet station in the summertime runs, which might be explained by the secondary production of aerosols in the tunnel. The organic compounds studied comprised a small fraction (<1%) of aerosol organic carbon (OC). In winter, their abundances relative to that of OC in outlet samples were found to be significantly less than those in inlet samples. On the basis of the summer data, apparent secondary production factors of the compounds were calculated, which indicate that adipic and m-phthalic acids can be favorably formed in the tunnel. However, like other DCAs, direct emissions of adipic, m-phthalic, and p-phthalic acids from automobiles are suggested to be insignificant.

Carbonyl compounds in the roadside environment of Hong Kong

The levels of carbonyl compounds were determined at the roadside urban station at the Hong Kong Polytechnic University (HKPU) campus during January 2002 to February 2002. Nine carbonyl compounds were quantified in this study. Temperature and solar radiation were found to affect the photochemical reactions of the carbonyls. Formaldehyde/acetaldehyde ratio ranged from 1.27 to 1.35. Strong correlations between formaldehyde and acetaldehyde were found, in the time period 1800-2100, which indicated that they were originated from the same sources during this time period. Roadside carbonyl samples were also collected at four other roadside environments during 2001. Kwai Chung (KC) station showed the highest average formaldehyde and acetaldehyde concentrations due to its highest traffic flow, especially for diesel vehicles. High concentration of toluene emitted from gasoline-fueled vehicles was believed to be the cause of high benzaldehyde level at the Central (CT) station through the photochemical oxidation of toluene. The average concentrations of formaldehyde and acetaldehyde in Hong Kong are well within the ranges reported in roadside environments of other urban cities. However, Mexico City in Mexico and Cairo in Egypt had much higher concentration levels of formaldehyde and acetaldehyde than in Hong Kong roadside environment due to the incomplete combustion of different fuel compositions.

Seasonal variations and mass closure analysis of particulate matter in Hong Kong

The chemical characteristics of ambient particulate matters in urban and rural areas of Hong Kong were determined in this study. A monitoring program starting from November 2000 to February 2001 (winter) and June 2001 to August 2001 (summer) for PM10 and PM2.5 was performed at three monitoring stations in Hong Kong. Twenty-four-hour PM10 and PM2.5 samples were collected once every 6 days at two urban sites, PolyU and KT, and every 12 days at a background site, HT, with Hi-Vol samplers. High concentrations of OC, EC (except in PolyU), water-soluble ions and elements were observed in winter among the three sampling sites for PM10 and PM2.5 fractions. Seasonal variations were significant in background HT. Dilution effect due to the increase in mixing depth and precipitation in summer reduced the concentrations of particulate matters. Long-range transport could contribute to the higher concentrations of particulate matter in the winter. Chemical mass closure calculations were performed for PM10 and PM2.5 observed. Mass closure improved when separate factors (1.4 and 1.9 respectively) were used to convert water-soluble organic carbon (WSOC) and water-insoluble organic carbon (WINSOC) into corresponding organic masses. The urban sites showed high percentages of water-soluble ions in winter and high percentages of carbonaceous species in summer. Better results were obtained for the chemical mass closure analysis in winter than in summer. High temperature and solar radiation in summer increased the rate of the complex photochemical reaction in the atmosphere. Therefore the chemical mass closure analysis would underestimate the volatized species and secondary aerosols during summer.

Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials

Pathological complete response (pCR) has been used as a marker for the efficacy of pre-operative chemoradiotherapy (CRT) schedules in rectal cancer. To date there have been no randomized trials comparing CRT regimens in rectal cancer. Prospective phase II and CRT arms of randomized trials reported up to January 2004 were included, providing they defined the following minimum variables: drugs employed during CRT, radiotherapy dose and pCR rate. Multivariate analysis was used to examine the relationship of these variables on the pCR rate. In addition, the use of neoadjuvant chemotherapy, the type of publication (peer reviewed vs meeting abstract) and whether the tumours were stated to be unresectable/clinically fixed or to have threatened circumferential margins were investigated. The method of analysis was weighted linear modelling of the pCR rate which was normalized by the arcsine transformation. Phase II and phase III trials were identified including a total of 3157 patients. On multivariate analysis only the use of continuous infusion 5FU (p = 0.01), the use of a second drug (p = 0.001) and radiation dose (p = 0.02) were associated with higher rates of pCR. The use of a two drug regimen, the mode of delivery of 5FU and the radiation dose appear to be related to the incidence of pCR following CRT for rectal cancer. These results may generate hypotheses for future randomized trials. Important factors not considered in this analysis include the variability in pathological examination and in the time interval between CRT and surgery. In addition, the toxicity of the CRT regimens requires further investigation.

Indoor/outdoor relationships for PM2.5 and associated carbonaceous pollutants at residential homes in Hong Kong - case study

Six residences were selected (two roadside, two urban, and two rural) to evaluate the indoor-outdoor characteristics of PM(2.5) (aerodynamic diameter <2.5 microm) carbonaceous species in Hong Kong during March and April 2004. Twenty-minute-averaged indoor and outdoor PM(2.5) concentrations were recorded by DustTrak samplers simultaneously at each site for 3 days to examine diurnal variability of PM(2.5) mass concentrations and their indoor-to-outdoor (I/O) ratios. Daily (24-h average) indoor/outdoor PM(2.5) samples were collected on pre-fired quartz-fiber filters with battery-powered portable mini-volume samplers and analyzed for organic and elemental carbon (OC, EC) by thermal/optical reflectance (TOR) following the Interagency Monitoring of Protected Visual Environments (IMPROVE) protocol. The average indoor and outdoor concentrations of 24 h PM(2.5) were 56.7 and 43.8 microg/m(3), respectively. The short-term PM(2.5) profiles indicated that the penetration of outdoor particles was an important contributor to indoor PM(2.5), and a household survey indicated that daily activities were also sources of episodic peaks in indoor PM(2.5). The average indoor OC and EC concentrations of 17.1 and 2.8 microg/m(3), respectively, accounted for an average of 29.5 and 5.2%, respectively, of indoor PM(2.5) mass. The average indoor OC/EC ratios were 5.8, 9.1, and 5.0 in roadside, urban, and rural areas, respectively; while average outdoor OC/EC ratios were 4.0, 4.3, and 4.0, respectively. The average I/O ratios of 24 h PM(2.5), OC, and EC were 1.4, 1.8, and 1.2, respectively. High indoor-outdoor correlations (r(2)) were found for PM(2.5) EC (0.96) and mass (0.81), and low correlations were found for OC (0.55), indicative of different organic carbon sources indoors. A simple model implied that about two-thirds of carbonaceous particles in indoor air are originated from outdoor sources.

PRACTICAL IMPLICATIONS

Indoor particulate pollution has received more attentions in Asia. This study presents a case study regarding the fine particulate matter and its carbonaceous compositions at six residential homes in Hong Kong. The characteristics and relationship of atmospheric organic and elemental carbon were discussed indoors and outdoors. The distribution of eight carbon fractions was first reported in indoor samples to interpret potential sources of indoor carbonaceous particles. The data set can provide significant scientific basis for indoor air quality and epidemiology study in Hong Kong and China.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Premature Ejaculation: An Observational Study of Men and Their Partners

INTRODUCTION

Premature ejaculation (PE) is the most common male sexual dysfunction affecting men and their partners. Lack of community-based data describing this condition limits understanding of PE and its outcomes.

AIM

To characterize PE in a large population of men with and without PE using patient-reported outcome (PRO) measures elicited from men and their partners.

METHODS

4-week, multicenter, observational study of males (> or =18 years) and their female partners in monogamous relationships (> or =6 months). Screening, baseline, and follow-up visits scheduled at 2-week intervals. Clinicians diagnosed PE utilizing DSM-IV-TR criteria. Intravaginal ejaculatory latency time (IELT), measured by a stopwatch held by the partner, was recorded for each sexual intercourse experience. Subject and partner independently assessed PROs: control over ejaculation and satisfaction with sexual intercourse (0 = very poor to 4 = very good), personal distress and interpersonal difficulty (0 = not at all to 4 = extremely), and severity of PE (0 = none to 3 = severe). Results. Of the total study population (N = 1,587), 207 subjects were diagnosed with PE and 1,380 were assigned to the non-PE group. Median IELT (min) was 1.8 (range, 0-41) for PE and 7.3 (range, 0-53) for non-PE subjects (P < 0.0001). More PE vs. non-PE subjects gave ratings of "very poor" or "poor" for control over ejaculation (72% vs. 5%; P < 0.0001) and satisfaction with sexual intercourse (31% vs. 1%; P < 0.0001). More subjects in the PE vs. non-PE group gave ratings of "quite a bit" or "extremely" for personal distress (64% vs. 4%; P < 0.0001) and interpersonal difficulty (31% vs. 1%; P < 0.0001). Subject and partner assessments showed similar patterns and correlated moderately (0.36-0.57).

CONCLUSIONS

PE subjects reported significantly shorter IELT. Overlap in IELT distributions was observed between the PE and non-PE groups, indicating the need for additional PRO measures to characterize PE. Shorter IELT was significantly associated with reduced ejaculatory control and sexual satisfaction and increased distress and interpersonal difficulty.

Characterization of hydrocarbons, halocarbons and carbonyls in the atmosphere of Hong Kong

Ambient air quality measurements of 156 species including 39 alkanes, 32 alkenes, 2 alkynes, 24 aromatic hydrocarbons, 43 halocarbons and 16 carbonyls, were carried out for 120 air samples collected at two sampling stations (CW and TW) in 2001 throughout Hong Kong. Spatial variations of volatile organic compounds (VOCs) in the atmosphere were investigated. Levels of most alkanes and alkenes at TW site were higher than that at the CW site, while the BTEX concentrations at the two sites were close. The BTEX ratios at CW and TW were 1.6:10.1:1.0:1.6 and 2.1:10.8:1.0:2.0, respectively. For major halogenated hydrocarbons, the mean concentrations of chloromethane, CFCs 12 and 22 did not show spatial variations at the two sites. However, site-specific differences were observed for trichloroethene and tetrachloroethene. Furthermore, there were no significant differences for carbonyls such as formaldehyde, acetaldehyde and acetone between the two sites. The levels of selected hydrocarbons in winter were 1-5 times that in summer. There were no common seasonal trends for carbonyls in Hong Kong. The ambient level of formaldehyde, the most abundant carbonyl, was higher in summer. However, levels of acetaldehyde, acetone and benzaldehyde in winter were 1.6-3.8 times that in summer. The levels of CFCs 11 and 12, and chloromethane in summer were higher than that in winter. Strong correlation of most hydrocarbons with propene and n-butane suggested that the primary contributors of hydrocarbons were vehicular emissions in Hong Kong. In addition, gasoline evaporation, use of solvents, leakage of liquefied petroleum gas (LPG), natural gas leakage and other industrial emissions, and even biogenic emissions affected the ambient levels of hydrocarbons. The sources of halocarbons were mainly materials used in industrial processes and as solvents. Correlation analysis suggested that photochemical reactions made significant contributions to the ambient levels of carbonyls in summer whereas in winter motor vehicle emissions would be the major sources of the carbonyls. The photochemical reactivity of selected VOCs was estimated in this study. The largest contributors to ozone formation were formaldehyde, toluene, propene, m,p-xylene, acetaldehyde, 1-butene/i-butene, isoprene and n-butane, suggesting that motor vehicles, gasoline evaporation, use of solvents, leakage of LPG, photochemical processes and biogenic emission are sources in the production of ozone. On the other hand, VOCs from vehicles and gasoline evaporation were predominant with respect to reactions with OH radical.

A generalized plate method for estimating total aerobic microbial count

The plate method outlined in Chapter 61: Microbial Limit Tests of the U.S. Pharmacopeia (USP 61) provides very specific guidance for assessing total aerobic bioburden in pharmaceutical articles. This methodology, while comprehensive, lacks the flexibility to be useful in all situations. By studying the plate method as a special case within a more general family of assays, the effects of each parameter in the guidance can be understood. Using a mathematical model to describe the plate counting procedure, a statistical framework for making more definitive statements about total aerobic bioburden is developed. Such a framework allows the laboratory scientist to adjust the USP 61 methods to satisfy specific practical constraints. In particular, it is shown that the plate method can be conducted, albeit with stricter acceptance criteria, using a test specimen quantity that is smaller than the 10 g or 10 mL prescribed in the guidance. Finally, the interpretation of results proffered by the guidance is re-examined within this statistical framework and shown to be overly aggressive.

Seasonal and diurnal variations of volatile organic compounds (VOCs) in the atmosphere of Hong Kong

Ambient VOCs samples were collected at three locations (PolyU campus (PU), Kwun Tong (KT), Hok Tsui (HT)) in Hong Kong during the periods of November 2000-February 2001 and June 2001-August 2001. Also the concentrations of VOCs in Cross Harbor tunnel in Hong Kong were obtained in order to determine the vehicular sources of VOCs. Toluene was the most abundant VOC detected in Hong Kong. At the PU station, which is close to a main road, the concentrations of most VOCs were higher in summer than in winter. However, at the background location HT, the concentrations of all VOCs except tetrachloroethene were higher in winter than in summer. Regional physical dispersion/transportation and mixing depth may be the reasons for higher VOC concentrations in winter at HT. The BTEX (benzene:toluene:ethylbenzene:xylene) ratios of PU and KT during winter period were (1.9:10.1:1.0:1.8) and (1.9:10.4:1.0:1.5), and (0.9:8.3:1.0:2.2) and (0.8:29.6:1.0:1.8) for summer season, respectively. The xylene/ethylbenzene (X/E) ratio was used to assess the relative age of the air parcels in this study. The concentrations of VOCs in the atmosphere in Hong Kong were mainly affected by direct emissions from vehicles, evaporation of fuels, photochemical reactions and few industrial emissions. The BTEX ratio in the tunnel was 2:10.4:1:3.2. The BTEX ratios at PU and KT during the winter period were similar to that in tunnel (except for xylenes). The X/E ratio in the tunnel was higher than that in the ambient air. This indicated that the freshly emitted xylenes in the tunnel decayed at different rates from OH-oxidation in the atmosphere. Good BTEX correlations (r>0.8) were found at PU and KT in winter (**P<0.01). Vehicular exhaust was the dominant source at PU and KT stations, and less evaporation of fuel or additive occurred at low temperature in winter. Diurnal variations of mean BTEX concentrations at the roadside monitoring station (PU) showed two peaks associated with traffic density and vehicle type.

Characterization of ambient volatile organic compounds at a landfill site in Guangzhou, South China

Ambient air monitoring was conducted at Datianshan landfill, Guangzhou, South China in 1998 to investigate the seasonal and horizontal variations of trace volatile organic compounds (VOCs). Twelve sampling points over the Datianshan landfill were selected and samples were collected simultaneously using Carbontrap(TM) adsorption tubes. Thirty eight VOCs were detected in the winter, whereas 60 were detected in the summer. The VOC levels measured in summer were alkanes, 0.5-6.5 microg/m(3); aromatics, 2.3-1667 microg/m(3); chlorinated species, 0.2-31 microg/m(3); terpines, 0.1-34 microg/m(3); carbonyl species, 0.3-5.6 microg/m(3) and naphthalene and its derivatives, 0.4-27 microg/m(3). Compared to the summer samples the VOC levels in winter were much lower (mostly 1-2 orders of magnitude lower). The aromatics are dominant VOCs in landfill air both in winter and summer. High levels of alkylbenzene and terpines such as methyl-isopropylbenzene (max 1667 microg/m(3)) and limonene (max 162 microg/m(3)) cause undesirable odor. The similar correlation coefficients of BTEX in summer and winter suggest VOCs emissions were from landfill site sources. The variation of BTEX ratio at landfill site is different from that in the urban area of Guangzhou. It shows that the ambient VOCs at landfill site were different from the urban areas.