Satisfaction with the Injection Experience of a New, Citrate-Free Formulation of Ixekizumab

INTRODUCTION

A new, citrate-free ixekizumab formulation, which is bioequivalent to the original formulation, was associated with significant reduction in injection site pain. This study evaluates patient satisfaction with the first injection experience of citrate-free ixekizumab in a real-world setting.

METHODS

A non-interventional, observational, web-based survey of adults (≥ 18 years) with psoriasis, psoriatic arthritis, or axial spondyloarthritis was conducted between August 2022 and March 2023. Patients enrolled in the Taltz US Customer Support Program were identified as receiving either the original ixekizumab or initiating citrate-free ixekizumab. Patients receiving original ixekizumab completed one survey at baseline to assess satisfaction with the formulation and one survey after switching to assess satisfaction, willingness to continue using and recommending citrate-free ixekizumab, and formulation preference. Participants previously exposed to ixekizumab completed one survey to assess their satisfaction and willingness to continue using and recommending citrate-free ixekizumab. Descriptive and comparative statistics are reported for patients that switched from original to citrate-free ixekizumab (n = 361); and descriptive statistics are reported for patients not previously exposed to ixekizumab (n = 90).

RESULTS

A total of 451 patients were included in the analysis. Significantly more patients were satisfied with their first injection with citrate-free ixekizumab compared to original ixekizumab (83.9% vs. 71.7% respectively; p = 0.0001). Almost all patients who switched from original ixekizumab were definitely or mostly willing to continue using and recommending citrate-free ixekizumab (93.9% and 93.4%, respectively). Additionally, 94.2% of patients who switched from original to citrate-free ixekizumab preferred citrate-free ixekizumab or had no preference. Three-fourths of patients not previously exposed to ixekizumab were satisfied with their first injection with citrate-free ixekizumab and 94.5% were definitely or mostly willing to continue using citrate-free ixekizumab.

CONCLUSION

The citrate-free ixekizumab formulation was preferred and well accepted by most patients who switched from the original ixekizumab formulation. Similar findings were seen for those newly initiating citrate-free ixekizumab.

Time to solve the puzzle of heart failure with preserved ejection fraction by biomarkers, echocardiography and cardiac magnetic resonance

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): HEART PRESERVED

onbehalf

HEART PRESERVED

Background

Heart failure with preserved ejection fraction (HFpEF) is now recognized as a major and growing public health problem worldwide. Clinical trials investigating different treatment strategies had disappointing results. Several biomarkers of inflammation, endothelial dysfunction, and myocardial fibrosis appeared to be promising in understanding HFpEF pathophysiology.

Methods. We enrolled prospectively 94 patients with HFpEF in sinus rhythm  (according to 2019 scoring system) (67 ± 9 yrs, 33 men). We evaluated them by 2D and speckle tracking echocardiography (STE). 80 patients had also a cardiac magnetic resonance (CMR) 1.5T evaluation. We measured LV ejection fraction (LVEF), mean E’ (E’m), E/E’ ratio, sPAP, left atrial volume indexed (LAVi), and global longitudinal stain by STE (GLS).  By CMR we evaluated LVEFcmr, LV mass, T1 mapping with mean extracellular volume (ECVm), and pre-gadolinium mean times quantification (preGDT1m) as markers of myocardial fibrosis. All patients had NTproBNP and biomarkers for systemic inflammation (IL6, cystatin C, pentraxin-3, GDF15), endothelial dysfunction: soluble E -selectin, VCAM, von Willebrand factor (vWf), and myocardial fibrosis: Galectin-3.

Results. LVEF was 60.5 ± 6 % and LVEFcmr 61 ± 6.6%. All parameters from the scoring system were as we expected: E’m = 7.6 ± 1.8 cm/s, E/E’ ratio = 11 ± 3.4, sPAP = 34 ± 8 mmHg, LAVi = 47 ± 11 ml/m2, GLS=-18.3 ± 2.9, and NTproBNP of 282 ± 294 pg/ml. NTproBNP significantly correlated with sPAP, LAVi, preGDT1m, ECVm, galectin-3, GDF15, and pentraxin-3 (all r > 0.4, p < 0.05). The best predictor for NTproBNP level was GDF15 (r = 0.4, r2 = 0.25, p = 0.001). LAVi significantly corelated with E/E’ ratio, sPAP, NTproBNP, galectin-3 (r > 0.4, p < 0.05). GLS correlated with LVEFcmr, LV mass, ECVm, preGDT1m, LAVi, E/E’ ratio, NTproBNP, GDF15, vWf, Eselectin, VCAM (all r = 0.4, p < 0.05). The best predictor model for GLS was LV mass, NTproBNP, E-selectine, and vWf (r = 0.67, r2 = 0.45, P < 0.001). sPAP was best predicted by a model composed by IL6, VCAM, LAVi (r = 0.5, r2 = 0.25, p < 0.001). E’m significantly correlated with vWf, GHD15, VCAM, LV mass, and preGDT1 (all r > 0.4, p < 0.05), but the best predictor model included only LV mass and GDF15 (r = 0.57, r2 = 0.32, P < 0.001). Galectin-3 significantly correlated with LAVi, preGDT1m, and NTproBNP, but the only predictor for galectin-3 level was preGDT1 (r = 0.4, r2 = 0.2, p = 0.007).

Conclusions

In HFpEF NTproBNP is significantly correlated with markers of inflammatory status, endothelial dysfunction, and fibrosis, but the level is mainly determined by inflammation (GDF15). Diastolic dysfunction parameters are mainly correlated with inflammatory and endothelial dysfunction biomarkers . Only LAVi was correlated with myocardial fibrosis. Sub-clinical systolic dysfunction is mainly determined by proinflamatory status and endothelial dysfunction, but not by fibrosis.

Multimodality approach by cardiac magnetic resonance and biological markers in left ventricular non-compaction with heart failure with preserved ejection fraction - revealing the unknown

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PN-III-P1-1-TE-2016-0669, within PNCDI III

Background

Left ventricular non-compaction (LVNC) is associated with an increased risk of heart failure (HF). The presence of a real LVNC with HF with preserved ejection fraction (HFpEF), is still controverted.

Methods

We evaluated prospectively 42 patients with HFpEF, 21 with LVNC (61 ± 9 years) and 21 without LVNC (LVC), aged and risk factor matched, by cardiac magnetic resonance (CMR) 1.5T. LVNC diagnosis was confirmed by Petersen and Jacquier criteria (NC/C ratio and the percentage of NC myocardium). We performed myocardial T1 mapping (normal value of 950 ± 21ms). We calculated a mean value of all native T1 (T1mean), and also for apical (apicalT1) and basal segments (basalT1). We also calculated ECV mean, basal and apical. All patients had NTproBNP and biomarkers for systemic inflammation (hsCRP, IL6, cystatin C and sST2), endothelial dysfunction: VCAM, von Willebrand factor (vWf), vWF metalloproteinase-ADAMTS13, and myocardial fibrosis: vascular peroxidase (VPO), and Galectin-3.

Results

In the LVNC, mean NC/C ratio was 2.9 ± 0.5 mm and the percentage of NC myocardium was 24.41 ± 8.8%. LVNC patients had significantly higher T1apical, higher ECVmean, ECV basal and apical (Table) by comparison with LVC group, suggesting an extensive fibrosis in LVNC group with significantly higher apical fibrosis.  Inflammatory markers were similar between groups, LVNC patients had lower values of ADAMTS13, suggesting endothelial dysfunction, and higher values of Galectin-3, suggesting increased myocardial fibrosis (Table). Galectin-3 correlated positively only with apicalT1 (R = 0.49, p = 0.04). NTproBNP significantly correlated with VPO, a promotor of fibrosis (r = 0.61, p = 0.009) in LVNC group, whereas in LVC group correlated with cystatin C (r = 0.62, p = 0003) and VCAM (r = 0.4, p = 0.05). Native apical T1 cut off >1021 ms provided the highest sensibility and specificity to differentiate segments with and without NC in HFpEF (p = 0.002) (Figure).

Conclusion

 HFpEF patients with LVNC have significant higher NTproBNP, higher fibrosis than patients without LVNC, more extensive in non-compacted apical segments. Galectin-3 level correlates only with apical fibrosis on CMR, expressed by apicalT1 time. Moreover, endothelial dysfunction seems to play an important role in HFpEF generation in LVNC. All findings suggests that LVNC is a stand alone condition, not an adaptive hyper-trabeculation in HFpEF.

Table.Comparison between groups NTproBNP (pg/ml) Galectin3 (ng/ml) ADAMTS13 (ng/ml) T1mean (ms) basalT1 (ms) apicalT1 (ms) ECV mean (%) ECV basal (%) ECV apical (%) LVNC 294 ± 282 8.44 ± 3.45 767.35 ± 335.56 1013.8 ± 31.8 1002.8 ± 27.2 1059 ± 73 27.2 ± 2.9 26.2 ± 2.9 29.6 ± 3.9 LVC 163 ± 71 6.67 ± 2.88 962.33 ± 253.78 1003.2 ± 28.1 1004.3 ± 29.5 1007 ± 40 24.3 ± 2.5 24.2 ± 2.7 25.2 ± 2.8 P value 0.031 0.048 0.049 0.26 0.865 0.007 0.002 0.033 <0.001 Abstract Figure

Anticandidal and synergistic effect of essential oil fractions from three aromatic plants used in Cameroon

Despite the use of conventional antifungal drugs, Candida spp resistance, especially mediated by biofilms formation remains recurrent. Therefore, new drugs to treat fungal infections are urgently needed. In this line, our study aimed to determine the anticandidal activity and the synergistic effect of essential oil fractions from Syzygium aromaticum, Cymbopogon citratus and Aeollanthus heliotropioides harvested in Cameroon using a combination approach. Essential oils have been obtained by hydrodistillation and their chemical composition was analysed by GC/MS. Antifungal activity was evaluated by the determination of minimum inhibitory concentration (MIC) using a micro-dilution method. The sorbitol and ergosterol binding ability and anti-biofilm activity were also assessed in order to evaluate the mode of action. The crude essential oils showed a good anticandidal activity, most probably due to the eugenol, linalool and citral content. The combination of two fractions F7 and F10 showed an improved growth inhibition of Candida spp compared to the crude essential oils. The inhibitory effect could be related with the presence of γ-dodecalactone and citronellol as main compounds. The best synergistic combination F7F10 inhibited biofilm formation at ten time reduced combination MIC. The active fractions targeted different fungal cell structures, including cell wall and membrane. Our study showed that the combination of selected essential oils fractions exhibited an increased antifungal activity against Candida spp compared to the crude essential oils. The combination approach of inner compound groups may be used as a promising strategy for the development of efficient recombined micro-essential oils as antifungal agents to face Candida resistance.

Synthetic flavonoids with antimicrobial activity: a review

The emergence of drug-resistant microbes left us with a great need for new antimicrobial agents. Flavonoids, with their wide range of biological activities, are good candidates in this respect. Although naturally occurring flavonoids are the most studied ones, semi-synthetic or synthetic flavonoids have proven to have great potential, inhibiting and even killing microbes at concentrations below 1 μg ml^-1 . The substitution pattern of these flavonoids often includes hydroxy groups, halogens or other heteroatomic rings, such as pyridine, piperidine or 1,3-dithiolium cations. However, the great variety in substituents makes it difficult to draw any definitive conclusion regarding their structure-activity relationship.

Abstract S1-08: Prognostic associations of tumor-infiltrating lymphocytes (TIL) in metastatic HER2-positive breast cancer (BC) treated with trastuzumab and pertuzumab: A secondary analysis of the CLEOPATRA study

Background

The presence of stromal TILs (sTILs) is associated with a better prognosis with anti-HER2 therapy in primary HER2-positive BC. The prognostic value of TILs in the advanced setting with pertuzumab-based therapy is unknown.

Methods

The CLEOPATRA trial randomly assigned 808 patients with metastatic HER2-positive BC to receive pertuzumab or placebo in combination with trastuzumab and docetaxel. We evaluated %TILs using our previously described method. For concordance evaluation, 40 slides from metastatic samples were independently analysed by two pathologists. TILs were examined for associations with clinicopathological factors, progression-free survival (PFS), overall survival (OS), and treatment interactions using Cox regression models fitting sTILs as a continuous variable (per 10%) adjusting for treatment arm, age, estrogen receptor (ER) status, PIK3CA genotype, and visceral vs. non-visceral disease at screening.

Results

Tumour samples from 678 (84%) participants were available. 519 (76.5%) were archival and 155 (22.9%) were obtained fresh, ≤45 days prior to study treatment start. Median follow-up for OS was 50 months, with 519 PFS events and 358 deaths. 54% of patients were treatment naïve i.e. had not received prior chemotherapy nor trastuzumab. The median sTIL level was 10% (1-95%). sTIL evaluation was highly concordant between pathologists (R=0.93). Fresh vs. archival samples had significantly lower sTILs (10% vs 15%, p=0.0004). sTIL levels significantly differed by ethnicity (15% Asians, 10% white, 5% African-Americans, p=0.0007), but not age (p=0.26). Higher sTILs were observed in ER-negative vs. ER-positive tumors (15% vs 10%, p<0.001).

In the whole cohort for PFS, higher sTIL levels trended towards a better outcome independent of treatment (adjusted HR:0.95, 95%CI:0.90-1.00, p=0.06). For OS, the prognostic effect of sTILs reached statistical significance, with each 10% increase in sTILs associated with an 11% reduction in the risk of death (adjusted HR:0.89, 95%CI:0.83-0.96, p=0.001). The prognostic effect was observed independent of treatment arm, ER status, PIK3CA genotype, prior treatment or presence of visceral disease at screening, and in both fresh and archival tissue samples.

There was no significant interaction (int) between pertuzumab and sTILs for PFS (Pint=0.4) nor OS (Pint=0.6). There were no significant interactions between pertuzumab and sTILs for OS in subgroups of PIK3CA mutated (Pint=0.2) or PIK3CA WT (Pin=0.2), nor treatment naive (Pint=0.3) vs prior treatment (Pint=0.5).

The 5-year estimates of OS according to median ≤10% vs >10% sTILs in the placebo arm were 26% (95%CI:19-37) vs. 39% (95%CI:32-48), while in the pertuzumab arm 42% (95%CI:33-53) vs. 56% (95%CI:47-66) respectively.

Conclusion

In advanced HER2-positive disease, sTILs are still evident, though at lower levels, but are nevertheless significantly associated with prognosis, with effects stronger for OS than PFS. This suggests that the influence of anti-tumour immunity persists in the advanced first line setting and that enhancement by immunotherapeutic approaches could potentially further improve survival.

Citation Format: Luen S, Salgado R, Stephen F, Peter S, Jennifer E-W, Emma C, Astrid K, Sandra SM, Jose B, Stefan M, Sherene L. Prognostic associations of tumor-infiltrating lymphocytes (TIL) in metastatic HER2-positive breast cancer (BC) treated with trastuzumab and pertuzumab: A secondary analysis of the CLEOPATRA study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S1-08.

UV/H2O2 oxidation of arsenic and terbuthylazine in drinking water

Arsenic is a widespread contaminant in the environment. The intake of water containing high concentrations of arsenic could have serious impact on human health, such as skin and lung cancer. In the European Union, thus, also in Italy, the arsenic limit in drinking water is 10 μg L(-1). Several water remediation treatment technologies are available for arsenic removal. For some processes, the removal efficiencies can be improved after an oxidation step. Most full-scale applications are based on conventional oxidation processes for chemical micropollutant removal. However, if water contains arsenic and refractory organic contaminants, the advanced oxidation processes could be considered. The aim of this work was to investigate the effectiveness of ultraviolet (UV) radiation alone and in combination with hydrogen peroxide for the oxidation of arsenic and terbuthylazine (TBA). The experimental tests were performed in groundwater at the laboratory scale (0.1 mg L(-1) As(III) and 10 μg L(-1) TBA). Hydrogen peroxide alone (15 mg L(-1)) was ineffective on both arsenic and TBA oxidation; the 253.7-nm radiation alone did not oxidize arsenic(III), but photolyzed efficiently TBA (52 % removal yield at a UV dose of 1,200 mJ cm(-2)). The UV/H2O2 advanced oxidation (UV dose 600-2,000 mJ cm(-2), 5-15 mg L(-1) H2O2) was the most effective process for the oxidation of both arsenic and TBA, with observed oxidation efficiencies of 85 and 94 %, respectively, with 5 mg L(-1) H2O2 and a UV dose of 2,000 mJ cm(-2).

Local structure at Mn2+ ions in vacuum annealed small cubic ZnS nanocrystals self-assembled into a mesoporous structure

A mesoporous structure of self-assembled nanocrystals of cubic ZnS doped with Mn2+ ions with a homogeneous distribution of pores of similar size was synthesized at room temperature by a surfactant-assisted liquid-liquid reaction. The component nanocrystals exhibit a high crystallinity and a tight size distribution centered at 2 nm, as well as the narrowest Electron Paramagnetic Resonance (EPR) spectra linewidth and the best resolution reported so-far, effects attributed to self-assembling. The observed EPR spectra consist of lines from the substitutional Mn2+(I) and surface Mn2+(II) and Mn2+(III) centers. Here we show that, in contrast with previous reports, our EPR spectra are highly sensitive to structural changes during pulse annealing in vacuum up to 500 degrees C. The changes are related to the transformation of the surface Mn2+ centers in new Mn2+ centers, attributed to an oxidation process in which the thermal decomposition of the Tween 20 additive, also observed by EPR, seems to be involved. We have also been able to observe, for the first time by EPR spectroscopy, the formation of the ZnO phase and the nanocrystals size increase, which occur during annealing up to 500 degrees C, structural changes confirmed by XRD and TEM observations on the samples previously investigated by EPR.

Accurate determination of the spin Hamiltonian parameters for Mn2+ ions in cubic ZnS nanocrystals by multifrequency EPR spectra analysis

Accurate determination of the spin Hamiltonian (SH) parameters, describing the electron paramagnetic resonance (EPR) spectra of paramagnetic impurity ions in wide band gap semiconductor nanocrystals, is essential for determining their localization and quantum properties. Here we present a procedure, based on publicly available software, for determining with higher accuracy the SH parameters of isolated Mn(2+) impurity ions in small cubic ZnS nanocrystals. The procedure, which can be applied to other cubic II-VI semiconductor nanocrystals as well, is based on the analysis of both low and high frequency EPR spectra with line shape simulation and fitting computing programs, which include the hyperfine forbidden transitions and line broadening effects. The difficulties, limitations and errors which can affect the accuracy in determining some of the SH parameters are also discussed.

Localization of Mn2+ ions in mesoporous NnS

Nanocrystalline cubic ZnS doped with 0.2% mol manganese, exhibiting a stable mesoporous structure, was synthesized at room temperature by a non toxic surfactant-assisted liquid-liquid reaction. The X-ray diffraction measurements demonstrate the formation of a sponge-like mesoporous material built from cubic ZnS nanocrystals of 1.8 nm average sizes, with a tight distribution of pores of 1.8 nm mean diameter. The transmission electron microscopy images confirm the formation of the mesoporous structure with walls of 3.1 nm mean thickness built from cubic ZnS nanocrystallites of 2.1 nm average size. The resulting tight distribution of crystallites and pores yields a well resolved Electron Paramagnetic Resonance spectrum, with the narrowest reported component lines attributed to three types of isolated Mn2+ centers, called Mn2+(I), Mn2+(II) and Mn2+(III). From the analysis of the spin Hamiltonian parameters it is shown that in the Mn2+(I) centers the paramagnetic ion is situated at substitutional Zn sites in the ZnS nanocrystals, being also subjected to a small axial distortion. The relative concentration changes under thermal treatment experiments strongly suggest that in both Mn2+(II) and Mn2+(III) centers the Mn2+ ion is localized on the surface of the ZnS nanocrystallites, being bond to an oxygen ion in the first case and to an additional water molecule in the second case.

Arsenic oxidation by UV radiation combined with hydrogen peroxide

Arsenic is a widespread contaminant in the environment around the world. The most abundant species of arsenic in groundwater are arsenite [As(III)] and arsenate [As(V)]. Several arsenic removal processes can reach good removal yields only if arsenic is present as As(V). For this reason it is often necessary to proceed with a preliminary oxidation of As(III) to As(V) prior to the removal technology. Several studies have focused on arsenic oxidation with conventional reagents and advanced oxidation processes. In the present study the arsenic oxidation was evaluated using hydrogen peroxide, UV radiation and their combination in distilled and in real groundwater samples. Hydrogen peroxide and UV radiation alone are not effective at the arsenic oxidation. Good arsenic oxidation yields can be reached in presence of hydrogen peroxide combined with a high UV radiation dose (2,000 mJ/cm(2)). The quantum efficiencies for As(III) oxidation were calculated for both the UV photolysis and the UV/H(2)O(2) processes.

Study of the ground multiplet of Kramers rare earth ions in solid matrices by multifrequency electron paramagnetic resonance spectroscopy: Nd3+ in PbWO4 single-crystals

A multifrequency electron paramagnetic resonance (EPR) investigation of Nd(3+) impurities in PbWO(4) single-crystals at the conventional microwave frequency (MF) 9.43 GHz, and at the 95, 190, and 285 GHz high frequencies was carried out. The resulting spectra are well described at all frequencies by an axial spin-Hamiltonian corresponding to an effective electron spin of one-half and to a tetragonal symmetry. For the magnetic field along the tetragonal axis, the g(parallel)-factor and the hyperfine constant A(parallel) of the lowest doublet of the ground multiplet decreases with frequency increase. For the magnetic field perpendicular to the tetragonal axis, the g(perpendicular)-factor exhibits a small azimuthal angular dependence that increases with increasing the frequency due to the S(4) site symmetry. The azimuthal angular dependence allows to clearly distinguish between different local axial symmetries. These properties are interpreted as high field/frequency (HF) effects associated with the mixing by the large Zeeman interaction of some of the upper-lying doublets of the ground multiplet into the lowest-lying doublet states. We show that from the combined analysis of the multifrequency MF- and HF-EPR spectra and of the optical data, an accurate description of the ground multiplet of the Kramers rare earth ions in solid matrices can be derived.

In-depth investigation of EPR spectra of Mn(2+) ions in ZnS single crystals with pure cubic structure

The X (9.8 GHz)-band electron paramagnetic resonance (EPR) properties of substitutional Mn(2+) ions in high quality cubic ZnS single crystals grown from PbCl(2) flux have been thoroughly investigated. Accurate spin Hamiltonian (SH) parameters: g = 2.002 25 ± 0.000 06; a = (7.987 ± 0.008) × 10(-4) cm(-1) and A = -(63.88 ± 0.02) × 10(-4) cm(-1) were obtained by simulation and fitting to the experimentally allowed transitions recorded for the magnetic field aligned within ± 0.25° along the main crystal axes. The normally forbidden hyperfine [Formula: see text], Δm = ± 1 transitions were also observed. Their position was found to be in agreement, within the experimental accuracy of ΔH = ± 0.01 mT, with calculations using the same SH parameters. The angular variation of the ratios of the intensities of the central forbidden to the allowed transitions could be accounted for only by including an additional constant contribution. The observed line broadening of the [Formula: see text] and [Formula: see text] fine structure transitions and their line width variation in a (110) plane have been quantitatively described by considering a random distribution of lattice strains at the Mn(2+) impurity ions. The influence of the forbidden transitions and line broadening on the EPR spectra line shape of the Mn(2+) ions in cubic ZnS crystalline powders is also examined.

Hormonal and metabolic defects in a prader-willi syndrome mouse model with neonatal failure to thrive

Prader-Willi syndrome (PWS) has a biphasic clinical phenotype with failure to thrive in the neonatal period followed by hyperphagia and severe obesity commencing in childhood among other endocrinological and neurobehavioral abnormalities. The syndrome results from loss of function of several clustered, paternally expressed genes in chromosome 15q11-q13. PWS is assumed to result from a hypothalamic defect, but the pathophysiological basis of the disorder is unknown. We hypothesize that a fetal developmental abnormality in PWS leads to the neonatal phenotype, whereas the adult phenotype results from a failure in compensatory mechanisms. To address this hypothesis and better characterize the neonatal failure to thrive phenotype during postnatal life, we studied a transgenic deletion PWS (TgPWS) mouse model that shares similarities with the first stage of the human syndrome. TgPWS mice have fetal and neonatal growth retardation associated with profoundly reduced insulin and glucagon levels. Consistent with growth retardation, TgPWS mice have deregulated liver expression of IGF system components, as revealed by quantitative gene expression studies. Lethality in TgPWS mice appears to result from severe hypoglycemia after postnatal d 2 after depletion of liver glycogen stores. Consistent with hypoglycemia, TgPWS mice appear to have increased fat oxidation. Ghrelin levels increase in TgPWS reciprocally with the falling glucose levels, suggesting that the rise in ghrelin reported in PWS patients may be secondary to a perceived energy deficiency. Together, the data reveal defects in endocrine pancreatic function as well as glucose and hepatic energy metabolism that may underlie the neonatal phenotype of PWS.

[Diclofenac 75mg. and 30 mg. orfenadine (Neodolpasse) versus placebo and piroxicam in postoperative analgesia after arthroscopy]

PURPOSE OF THE STUDY

Arthroscopy is often performed in an out-patient department or as one-day surgery. Opioids often used as postoperative analgesics may have unwanted side effects that may postpone the patient's discharge from hospital. This study was designed to evaluate a substitute for the most frequently used opioid pethidine. For pain relief, non-steroid anti-inflammatory drugs are recommended, but they offer a limited choice for parenteral administration. We used a new agent (Neodolpasse) based on diclophenac and orphenadine, and compared its efficacy with piroxicam and placebo.

METHODS

A total of 119 patients scheduled for knee joint arthroscopy were included in this prospective study. In a randomized, double-blind manner, they received piroxicam (P), Neodolpasse (combining 75 mg diclophenac and 30 mg orphenadine; N) or placebo (C). The number of patients in groups P, N and C were 44, 35 and 40, respectively. The effect of therapy was evaluated on the basis of the following criteria: duration of post-operative analgesia until a request for another analgesic, pain intensity (0-10 VAS), side effects and the patient's satisfaction with analgesia. The efficacy was evaluated for 24 hours after arthroscopy; premedication and analgesia induction and administration followed the same anesthetic protocol in all groups. The ethic committee approved the study and patients gave their informed consent. The results were statistically evaluated using the ANOVA analysis of variance completed by a multiple comparison of levels of significance according to Bonferroni. The presence of side and unwanted effects was analyzed by the chi-square of Fisher's exact test. A p value les than 0.05 was regarded as statistically significant.

RESULTS

There were significant differences in the number of patients not requiring further analgesic medication after arthroscopy (P 52.3% vs. C (11.7%) p < 0.05, N (68.6%) vs. C p < 0.001), lower average postoperative pain (0 to 10-point scale, P 2.4 vs. C 2.9 p < 0.05, N 1.5 vs. C p < 0.05) and fewer side effects (N vs. both P and C, p < 0.05).

DISCUSSION

The combination of diclophenac with orphenadine for intravenous application has only recently been available in the Czech Republic. The addition of a central muscle relaxant to a peripheral analgesic has a better effect than diclophenac alone. This may also account for a longer duration of analgesia in comparison with piroxicam reported to have significantly longer analgesic effects. The new medication also had fewer side effects. It was interesting to record that even the patients who had more pain and shorter postoperative analgesia were satisfied with the therapy provided.

CONCLUSIONS

The main result of this study is the finding that Neodolpasse significantly reduces the intensity of postoperative pain and increases the duration of postoperative analgesia after knee joint arthroscopy.

A multistep process for the dispersal of a Y chromosomal lineage in the Mediterranean area

In this work we focus on a microsatellite-defined Y-chromosomal lineage (network 1.2) identified by us and reported in previous studies, whose geographic distribution and antiquity appear to be compatible with the Neolithic spread of farmers. Here, we set network 1.2 in the Y-chromosomal phylogenetic tree, date it with respect to other lineages associated with the same movements by other authors, examine its diversity by means of tri- and tetranucleotide loci and discuss the implications in reconstructing the spread of this group of chromosomes in the Mediterranean area. Our results define a tripartite phylogeny within HG 9 (Rosser et al. 2000), with the deepest branching defined by alleles T (Haplogroup Eu10) or G (Haplogroup Eu9) at M172 (Semino et al. 2000), and a subsequent branching within Eu9 defined by network 1.2. Population distributions of HG 9 and network 1.2 show that their occurrence in the surveyed area is not due to the spread of people from a single parental population but, rather, to a process punctuated by at least two phases. Our data identify the wide area of the Balkans, Aegean and Anatolia as the possible homeland harbouring the largest variation within network 1.2. The use of recently proposed tests based on the stepwise mutation model suggests that its spread was associated to a population expansion, with a high rate of male gene flow in the Turkish-Greek area.

Src homology 2-containing inositol 5-phosphatase 1 binds to the multifunctional docking site of c-Met and potentiates hepatocyte growth factor-induced branching tubulogenesis

Hepatocyte growth factor (HGF)/scatter factor is a multifunctional cytokine that induces mitogenesis, motility, and morphogenesis in epithelial, endothelial, and neuronal cells. The receptor for HGF/scatter factor was identified as c-Met tyrosine kinase, and activation of the receptor induces multiple signaling cascades. To gain further insight into c-Met-mediated multiple events at a molecular level, we isolated several signaling molecules including a novel binding partner of c-Met, SH2 domain-containing inositol 5-phosphatase 1 (SHIP-1). Western blot analysis revealed that SHIP-1 is expressed in the epithelial cell line, Madin-Darby canine kidney (MDCK) cells. SHIP-1 binds at phosphotyrosine 1356 at the multifunctional docking site. Because a number of signaling molecules such as Grb2, phosphatidylinositol 3-kinase, and Gab1 bind to the multifunctional docking site, we further performed an in vitro competition study using glutathione S-transferase- or His-tagged signaling molecules with c-Met tyrosine kinase. Our binding study revealed that SHIP-1, Grb2, and Gab1 bound preferentially over phosphatidylinositol 3-kinase. Surprisingly, MDCK cells that overexpress SHIP-1 demonstrated branching tubulogenesis within 2 days after HGF treatment, whereas wild-type MDCK cells showed tubulogenesis only after 6 days following treatment without altering cell scattering or cell growth potency. Furthermore, overexpression of a mutant SHIP-1 lacking catalytic activity impaired HGF-mediated branching tubulogenesis.

Y chromosome analysis reveals a sharp genetic boundary in the Carpathian region

Nine single nucleotide (SNP) or indel binary polymorphisms were used to determine the frequencies and phylogenetic relationships of 12 Y chromosomal haplogroups in 289 males from Romania and the Republic of Moldova. Our data indicated a low but not null rate of the homoplasic appearance of the DYZ3 (-) allelic state. All other markers confirmed the previously proposed phylogeny. Based on the affinities between populations in terms of haplogroup frequencies, this work identified the geographical region of the Carpathians as a break point in the gene geography of Eastern Central Europe, providing a finer definition of one of the possible sharp genetic changes between Western and Eastern Europe.

Interferometric sensor for detection of surface-bound bioreactions

An integrated optical interferometer for direct detection of affinity reactions is presented. A modern version of a Young's interferometer is built with a waveguide structure as beam splitter and as sensing element. Resistive waveguides were produced by plasma-enhanced chemical vapor deposition of silicon oxinitride. At the output of this device a fringe pattern is detected by a CCD line camera. The adsorption of molecules on top of the waveguides is observed with a detection limit of 750 fg/mm(2). The resolvable variation of effective refractive index is 9 x 10(-8).

The direct association of the multiple PDZ domain containing proteins (MUPP-1) with the human c-Kit C-terminus is regulated by tyrosine kinase activity

We have identified the multiple PDZ domain containing protein (MUPP-1 or MPDZ) as a novel binding partner of the human c-Kit. c-Kit binds specifically to the 10th PDZ domain of MUPP-1 via its C-terminal sequence. Furthermore, a kinase negative-mutant receptor interacted more strongly with MUPP-1 than the wild-type c-Kit. Strikingly, a constitutively activated c-Kit (D816V-Kit) did not bind to MUPP-1, although this oncogenic form retains the PDZ binding motif 'HDDV' at the C-terminal end. Deletion of V967 of c-Kit abolished binding to MUPP-1 and drastically reduced its tyrosine kinase activity, suggesting that the structure of the C-terminal tail of c-Kit influences its enzymatic activity.

Patterns of male-specific inter-population divergence in Europe, West Asia and North Africa

We typed 1801 males from 55 locations for the Y-specific binary markers YAP, DYZ3, SRY10831 and the (CA)n microsatellites YCAII and DYS413. Phylogenetic relationships of chromosomes with the same binary haplotype were condensed in seven large one-step networks, which accounted for 95% of all chromosomes. Their coalescence ages were estimated based on microsatellite diversity. The three largest and oldest networks undergo sharp frequency changes in three areas. The more recent network 3.1A clearly discriminates between Western and Eastern European populations. Pairwise Fst showed an overall increment with increasing geographic distance but with a slope greatly reduced when compared to previous reports. By sectioning the entire data set according to geographic and linguistic criteria, we found higher Fst-on-distance slopes within Europe than in West Asia or across the two continents.

Direct interaction of nerve growth factor receptor, TrkA, with non-receptor tyrosine kinase, c-Abl, through the activation loop

The nerve growth factor receptor, TrkA, is essential for the survival and differentiation of neurons in the central and peripheral nervous systems. To understand the molecular principles underlying this differentiation step, we employed a yeast two-hybrid screening protocol using human TrkA as bait. We isolated c-Abl as a TrkA-interacting protein, in addition to known proteins such as phospholipase Cgamma and SH2-B. This interaction was confirmed by an in vitro binding assay using glutathione S-tranferase-Abl fusion protein. Furthermore, we show here that c-Abl binds to phosphotyrosine residue(s) in the kinase activation loop of TrkA.

The binding of Violamycin BI to poly-C

The binding constant Kst of Violamycin BI (VBI) to poly-C at small and medium values of the concentration ratio p (0-12) is determined using the procedure of Schwarz under two different conditions: at constant C(VBIo) and variable C(po), and at p = C(po)/C(VBIo) = const. The average value obtained for Kst is 3.3 +/- 0.1 x 10(4) M-1, whereas the cooperativity parameter q of 13 characterizes a moderate cooperative interaction between adjacent bound ligands. In contrast, at large values of p (12-355) the formation of isolated bound dimers on the poly-C chain is observed. At pH 7, VBI dimerizes in solution with a dimerization constant strongly dependent on ionic strength: Kd = 732 +/- 20 M-1 and (9.3 +/- 0.2) x 10(3) M-1 at I = 0.02 M and 0.2 M respectively. The lower and upper boundaries for the binding constant of the dimer to the polynucleotide at large values of p are 1.0 x 10(-5) M-1 and 6.25 x 10(-6) M-1 respectively.

Biochemical and cytogenetical study of the mycoplasmal antigen and of the cyclophosphamide action in mammalians, in vivo. The action of some immunomodulatory antioxidants

It was proved spectrophotometrically that Mycoplasma agalactiae antigen inoculated in vivo in sheep modifies the corresponding erythrocyte lysates reactivity toward methylene blue and neutral red and induces several types of chromosomal rearrangements. The treatment in vivo of sheep with an original preparation obtained from the Phaseolus vulgaris pods restores the erythrocyte lysates reactivity toward the two redox dyes and reduces the chromosomal abnormalities frequency induced by the mycoplasmal antigen. It was also demonstrated by optical and electronical microscopy that the Smise line mouse meiocytes exhibit chromosomal abnormalities induced by the cyclophosphamide treatment in vivo. In the case of concomitant treatment with the cyclophosphamide and C vitamin the same frequency of abnormalities was recorded as in the simple treatment with the drug.

Pedal polydactyly: an overview with case report

Polydactyly is a fairly common congenital condition of the foot, and is characterized by supernumerary digits and/or metatarsals. It may be an isolated condition or part of a congenital syndrome. Polydactyly is generally classified into three major groups: medial ray (preaxial), central ray, and lateral ray (postaxial). A review of polydactyly and an unusual case report of central ray involvement and its surgical correction are presented.

Proliferating trichilemmal cyst. Report of four cases, two with nondiploid DNA content and increased proliferation index

Proliferating trichilemmal cyst (PTC) is an uncommon tumor that usually arises on the scalp of elderly women. Its biologic nature is that of a benign lesion with occasional local recurrences. PTC can be confused both grossly and microscopically with squamous cell carcinoma and malignant PTC. Distinction between these lesions has historically been made on a histologic basis. We present four cases of PTC. Histologically, the lesions consisted of lobules of basaloid cells admixed with larger pale-staining cells with abrupt trichilemmal type of keratinization and peripheral palisading embedded in a fibrous stroma. Flow cytometry performed on nuclear extracts of the lesions revealed two of the four lesions to have nondiploid DNA content. Proliferation index, measured by immunohistochemical staining with Ki-67 monoclonal antibody along with mitotic rate count, was higher in the two nondiploid lesions as compared with their diploid counterparts. The results raise the question of the significance of aneuploidy and increased proliferation indices in otherwise benign PTC.

[Verification of the usefulness of Estrophan inj. Spofa in the control of reproductive parameters in sows after weaning of piglets]

Cloprostenol, a prostaglandin F2-alpha analogue, used in the Czechoslovak preparation Oestrophan ing. Spofa was tested by a new nontraditional use. The effect of cloprostenol use on reproductive parameters of sows after piglet weaning was followed in a set of 456 experimental and 434 control sows. The effect of single intramuscular instillation of cloprostenol was tested in five partial observations: to multiparous sows at a dose of 175 micrograms on the day of weaning (experimental group no. 1), on day 1 after weaning (group no. 2), 500 micrograms on day 1 after weaning (group no.3), to primiparous sows at a dose of 500 microgram on day 1 after weaning (group no. 4). The treatment used in group no. 4 was also applied to 42 primiparous sows kept on a farm with regular occurrence of post-weaning anoestria of sows (experimental group no. 5). These parameters were evaluated: dynamics of oestrus onset within five, and/or ten, days after weaning, average length of the weaning--first insemination interval, conception rate after the first insemination in dependence on terminated deliveries and parameters of piglet litter. Cloprostenol application did not have a statistically significant effect on the evaluated reproductive parameters. The percentage of multiparous, and/or primiparous, sows in which the oestrus onset was not detected by the 10th day after weaning, did not show any large differences in the various experimental and control groups (17.09 vs. 16.55%, 23.53 vs. 32.56%, 13.66 vs. 18.13%, 29.54 vs. 30.30%; P > 0.05). On the farm with regular occurrence of post-weaning anoestria there were 73.81% of primiparous sows with oestrus onset after cloprostenol instillation and 71.43% primiparous sows without treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fertilizing capability of breeding boars by evaluation of the early pregnancy factor in test sows]

The fertilizing ability of breeding boars was evaluated on the basis of an early pregnancy factor (EPF) determined in the blood serum of test sows by the method of rosette inhibition. The fertilizing ability was tested in ten boars on an insemination farm: the fertilizing potency of 41 ejaculates was evaluated from the percent conception of 105 test sows. The percent conception of test sows was evaluated from the EPF positive findings in the blood serum of these sows in the average range of 8.02 +/- 1.70 days (the range of 2 to 11 days) after insemination and from the recorded deliveries. The evaluation of the fertilizing of boars on the basis of EPF in test sows revealed in most cases the higher fertilization rate than could be found on the basis of the recorded deliveries of test sows. There was an exception to this trend: one breeding boar with a paradoxical finding of the somewhat higher percentage of deliveries recorder in test sows, in comparison with the fertilization ability according to the results of EPF. Identical results of the two criteria of fertilizing ability were recorder in another boar with a small number of tested ejaculates and test sows. The average fertilization of the whole set of the breeding boars, expressed by the average percent conception of all test sows, reached 86.67% on the basis of the EPF positive findings in 2 to 11 days after insemination, and 67.31% on the basis of recorded deliveries. These differences in fertilization are likely to be related to the share of dams and can be ascribed to embryonic mortality.

Use of vein-patch angioplasty in microvascular tissue transfers

Vein-patch angioplasty is a well-established technique in vascular surgery to reduce the critical narrowing of the arteriotomy site. In microsurgical end-to-side anastomosis, although the arteriotomy is not closed, it is not known if anastomosis through a sclerotic segment contributes to narrowing at the anastomotic site. It is certainly technically difficult to perform a microanastomosis with fine sutures through a sclerotic segment. Two cases are illustrated in which vein-patch angioplasties were successfully used for microsurgical anastomoses.

Painless myocardial ischemia and atherosclerous valvulopathies--their great statistical prevalence

3384 patients over 40 years old referred to our Cardiovascular Laboratory for overt cardiovascular complaints were examined by usual non-invasive investigations. Painless myocardial ischemia (PMI) prevalence was 17.49% and degenerative aortic and mitral valvulopathies incidence was 15.60%. PMI predominate in women especially in the group 50-59 years of age in which painful forms of ischemic heart disease have the highest prevalence in men. Although more affected by painless myocardial ischemia, women show a more favourable outcome than men. Ischemic heart disease was frequently associated with isolated mitral regurgitation. In the elderly patients mitral valvulopathy was associated with calcific aortic stenosis. No significant difference was noted between mitral and aortic valvulopathies prevalence.

[Effect of exogenous administration of steroids during the 1st month of pregnancy in sows and gilts on certain characteristics of the litter]

Four trials were performed to evaluate the influence of i. m. application of progesterone and estrogens to 444 experimental and control sows and gilts, kept mostly under large-scale production conditions, during the first month of pregnancy, as exerted on the number of born piglets, live born piglets and on the average birth weight of the live born piglet in litter. In the first trial the experimental sows and gilts on the 16th and 17th days of gravidity were applied 25 mg of progesterone (P4) and 12.5 micrograms of estrone (E1), in the second trial in the same phase of gravidity 25 mg of P4 with 1.25 micrograms of estradiol-17 beta (E2) and in the third trial in the identical gestation phase only 12.5 micrograms of E2 per head/day. In the fourth trial, experimental animals were given 0.55 mg of P4 with 0.275 micrograms of E1 per one kg of live weight, for six subsequent days between the 25th and 30th day of gravidity. In all trials the control animals were administered, under the same conditions, only the vehicle. None of the performed trials proved a significant difference in the studied parameters of litters of experimental and control animals (P greater than 0.05). The application of 25 mg of P4 with 1.25 micrograms of E2 on the 16th and 17th days of gravidity per sow/day under the conditions of small-scale production with the extension of the evaluated criteria of litter quality had no significant influence (P greater than 0.5) on the above-mentioned indicators, nor on the average birth weight of the whole litter and on the average number and weight of piglets of experimental sows at weaning. These results document that the verified application of hormonal substances in the above-mentioned phases of the first month of sow and gilt gravidity do not represent, in view of the intensive reproduction of pigs, a suitable procedure.