Double-blind, randomized and controlled trial of EPI-743 in Friedreich's ataxia

Aim: To evaluate the safety and clinical effects of EPI-743 in Friedreich's ataxia patients. EPI-743 is a compound that targets oxidoreductase enzymes essential for redox control of metabolism. Methods: We conducted a multicenter trial that evaluated EPI-743 during a 6-month placebo-controlled phase, followed by an 18-month open-label phase. End points included low-contrast visual acuity and the Friedreich's Ataxia Rating Scale. Results/conclusion: EPI-743 was demonstrated to be safe and well tolerated. There were no significant improvements in key end points during the placebo phase. However, at 24 months, EPI-743 treatment was associated with a statistically significant improvement in neurological function and disease progression relative to a natural history cohort (p < 0.001).

Comprehensive systematic review summary: Treatment of cerebellar motor dysfunction and ataxia: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

OBJECTIVE

To systematically review evidence regarding ataxia treatment.

METHODS

A comprehensive systematic review was performed according to American Academy of Neurology methodology.

CONCLUSIONS

For patients with episodic ataxia type 2, 4-aminopyridine 15 mg/d probably reduces ataxia attack frequency over 3 months (1 Class I study). For patients with ataxia of mixed etiology, riluzole probably improves ataxia signs at 8 weeks (1 Class I study). For patients with Friedreich ataxia or spinocerebellar ataxia (SCA), riluzole probably improves ataxia signs at 12 months (1 Class I study). For patients with SCA type 3, valproic acid 1,200 mg/d possibly improves ataxia at 12 weeks. For patients with spinocerebellar degeneration, thyrotropin-releasing hormone possibly improves some ataxia signs over 10 to 14 days (1 Class II study). For patients with SCA type 3 who are ambulatory, lithium probably does not improve signs of ataxia over 48 weeks (1 Class I study). For patients with Friedreich ataxia, deferiprone possibly worsens ataxia signs over 6 months (1 Class II study). Data are insufficient to support or refute the use of numerous agents. For nonpharmacologic options, in patients with degenerative ataxias, 4-week inpatient rehabilitation probably improves ataxia and function (1 Class I study); transcranial magnetic stimulation possibly improves cerebellar motor signs at 21 days (1 Class II study). For patients with multiple sclerosis-associated ataxia, the addition of pressure splints possibly has no additional benefit compared with neuromuscular rehabilitation alone (1 Class II study). Data are insufficient to support or refute use of stochastic whole-body vibration therapy (1 Class III study).

Emerging therapies in Friedreich's ataxia

Friedreich's ataxia (FRDA) is an inherited, progressive neurodegenerative disease that typically affects teenagers and young adults. Therapeutic strategies and disease insight have expanded rapidly over recent years, leading to hope for the FRDA population. There is currently no US FDA-approved treatment for FRDA, but advances in research of its pathogenesis have led to clinical trials of potential treatments. This article reviews emerging therapies and discusses future perspectives, including the need for more precise measures for detecting changes in neurologic symptoms as well as a disease-modifying agent.

Critical appraisal of rotigotine transdermal system in management of Parkinson's disease and restless legs syndrome - patient considerations

Rotigotine (RTG) is a dopamine agonist that is used as mono and adjunct therapy to treat Parkinson’s disease, and as therapy for moderate-to-severe restless legs syndrome. RTG is the only dopamine agonist currently available as a 24-hour/day transdermal system, providing once-a-day dosing. As a transdermal patch, RTG bypasses the gastrointestinal tract, making it a treatment option for patients with dysphagia. The use of RTG also avoids the need to schedule administration of medication around meals. This review provides a critical appraisal of RTG as treatment of Parkinson’s disease and RLS.

Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson's disease

OBJECTIVE

To evaluate the efficacy of solifenacin succinate in Parkinson's disease (PD) patients suffering from overactive bladder (OAB).

BACKGROUND

Urinary dysfunction is a commonly encountered non-motor feature in PD that significantly impacts patient quality of life.

DESIGN/METHODS

This was a double-blind, randomized, placebo-controlled, 3-site study with an open label extension phase to determine the efficacy of solifenacin succinate in idiopathic PD patients with OAB. Patients were randomized to receive solifenacin succinate 5-10 mg daily or placebo for 12 weeks followed by an 8-week open label extension. The primary outcome measure was the change in the mean number of micturitions per 24 h period. Secondary outcome measures included the change in the mean number of urinary incontinence episodes and the mean number of nocturia episodes.

RESULTS

Twenty-three patients were randomized in the study. There was no significant improvement in the primary outcome measure in the double-blind phase, but there was an improvement in the number of micturitions per 24 h period in the solifenacin succinate group compared to placebo at a mean dose of 6 mg/day (p = 0.01). In the open label phase, the mean number of urinary incontinence episodes per 24 h period decreased (p = 0.03), as did the number of nocturia episodes per 24 h period (p = 0.01). Adverse events included constipation and xerostomia, which resolved after treatment was discontinued.

CONCLUSIONS

In this pilot trial, solifenacin succinate treatment led to an improvement in urinary incontinence, despite persistence in other OAB symptoms.

Treatment of cerebellar ataxia

SUMMARY 

Symptoms of cerebellar degeneration include ataxia or wide-based gait, visual and speech dysfunction, dysmetria, and dyscoordination. The etiology of cerebellar degeneration is vast and often complex, and requires neuroimaging, lab assessments, and a thorough family history to delineate its cause. There is currently no accepted treatment of hereditary cerebellar degeneration, although several pharmaceutical agents have shown potential promise.

Pilot program to improve self-management of patients with heart failure by redesigning care coordination

Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

Fluorescent labeling of yeast

This unit describes the use of several different fluorescence methods for labeling yeast cells. It includes methods to label the vacuole, the actin cytoskeleton, and chitin deposits on cell walls (bud scars), as well as methods for visualizing specific proteins in live cells with GFP chimeras and in fixed cells by immunofluorescence.

Yeast as a model system for studying endocytosis

Endocytosis is the membrane trafficking process by which plasma membrane components and extracellular material are internalized into cytoplasmic vesicles and delivered to early and late endosomes, eventually either recycling back to the plasma membrane or arriving at the lysosome/vacuole. The budding yeast Saccharomyces cerevisiae has proven to be an invaluable system for identifying proteins involved in endocytosis and elucidating the mechanisms underlying internalization and postinternalization events. Through genetic studies in yeast and biochemical studies in mammalian cells, it has become apparent that multiple cellular processes are linked to endocytosis, including actin cytoskeletal dynamics, ubiquitylation, lipid modification, and signal transduction. In this review, we will highlight the most exciting recent findings in the field of yeast endocytosis. Specifically, we will address the involvement of the actin cytoskeleton in internalization, the role of ubiquitylation as a regulator of multiple steps of endocytosis in yeast, and the sorting of endocytosed proteins into the recycling and vacuolar pathways.

Personality moderators of the relationship between abusive supervision and subordinates' resistance

Results of a study using data collected at 2 points in time, separated by 6 months, suggested that subordinates resisted their supervisors' downward influence tactics with greater frequency when their supervisors were more abusive and that subordinates' personality moderated the effects of abusive supervision. The relationship between abusive supervision and subordinates' dysfunctional resistance was stronger among subordinates who were lower in conscientiousness than among subordinates who were higher in conscientiousness, but this effect emerged only for subordinates who were also lower in agreeableness. The relationship between abusive supervision and subordinates' constructive resistance was stronger among subordinates who were higher in conscientiousness than among subordinates who were lower in conscientiousness. The study's implications for theory and research are discussed.

Positive affectivity and negative outcomes: the role of tenure and job satisfaction

In this study, the authors proposed and tested a 3-way interaction among positive affectivity (PA), job satisfaction, and tenure in predicting negative employee outcomes. Specifically, the authors predicted that the relationship between job satisfaction and negative outcomes would be stronger for high PAs and that this relationship would be more pronounced for longer tenured employees. Results support this 3-way interaction in predicting job search behavior, physical health complaints, and counterproductive employee behavior. In particular, the relationship between job satisfaction and negative outcomes was most strongly negative for high-PA individuals with longer tenure. The authors discuss the implications of these results and some directions for future research.

A retrospective analysis of the results of 218 consecutive rhinoplasties

In a 7-year period, 218 consecutive rhinoplasties were performed within a joint rhinoplasty service comprising a plastic surgeon and an otorhinolaryngologist. Retrospective analysis of these procedures revealed a minor surgical complication rate of 5%, no major complications and requests for revisional surgery in 10% of patients after primary rhinoplasty by the service. However when patients had not had their first operation by our joint service, the revisional operation rate after our first operation was 19%. These results are discussed in relation to other published series. The data generated should enable more precise preoperative patient counselling and act as a useful baseline for subsequent audit of performance. Specifically, patients should know that after rhinoplasty 1 in 10 patients may request revisional surgery. All trainers and trainees should be aware of such data on their own patients in order that standards be set and enhanced with time.

Kikuchi's necrotising lymphadenitis

Three cases of Kikuchi's necrotizing lymphadenitis without granulocytic infiltration presented to the ENT department as cervical lymphadenopathy with neutropaenia. Differential diagnosis from malignant lymphoma was difficult both clinically and histopathologically. Two recovered spontaneously without treatment within three months, one improved initially but was lost to follow-up after one month.

Shapes of benz[a]anthracenes: the crystal and molecular structure of 6-methylbenz[a]anthracene

The crystal structure of 6-methylbenz[a]anthracene (6-MBA), a more potent carcinogen than the other K-region monomethyl-substituted benz[a]anthracene (5-MBA), has been determined by application of direct methods to single-crystal X-ray diffractometric data and refined by least squares to R = 0.047 (Rw = 0.053). Deviations of the carbon atoms from planarity are very small with even the methyl carbon displaced by only 0.05 A from the mean molecular plane. The benzo-ring A is inclined at only about 1 1/2 degrees to each of the three rings in the anthracene moiety, i.e. 6-MBA is one of the most nearly planar benz[a]anthracenes. The K-region bond C(5)-C(6) = 1.328(6) A and two other short bonds are C(8)-C(9) = 1.341(7) and C(10)-C(11) = 1.361(7) A in the anthracene D ring.

Steric strain and tumorigenicity: the molecular structure of 3,6-dimethylcholanthrene

The crystal structure of 3,6-dimethylcholanthrene, a highly tumorogenic polycyclic aromatic hydrocarbon, has been solved and refined, from X-ray diffractometric data collected at room temperature, to an R index 0.050 over 1684 independent reflections. The steric strain arising from the presence of the bay-methyl substituent distorts the molecule almost as much as in the moderately carcinogenic 1- and 12-methylbenz[a]anthracenes, with the benzo A ring inclined at approximately 16 degrees to the furthest C and D rings. The 6-methyl carbon atom is displaced 0.7 A from the molecular plane and the beach bond length of the bay region is 1.480(6) A, with beach C-C-C angles of 124.1 and 123.5 degrees. The shortest carbon-carbon bond is C(5)-C(6) = 1.331(7) A at the K region, with the next shortest C(8)-C(9) = 1.362(7), C(10)-C(11) = 1.366(7), and C(3)-C(4) = 1.369(8) A.

Rhabdomyosarcoma of the nasopharynx a case with recurrence of tumour after 20 years

A case of embryonal (botryoid) rhabdomyosarcoma of the nasopharynx originally occurring in a two year old male, with late recurrence in the neck 20 years after treatment by combined surgery and radiotherapy is presented. The histological diagnosis of rhabdomyosarcoma, and the significance of late recurrence are discussed.

X-ray refinement of the crystal and molecular structure of 1,12-dimethylbenz[a]anthracene

The molecular and crystal structure of 1,12-dimethylbenz[a]anthracene, one of the least carcinogenic of the benz[a]anthracenes, has been refined, from new X-ray diffractometric data collected at room temperature, to an R index 0.047 over 1217 independent reflections. Improved determination of molecular geometry shows that steric strain arising from the presence of two bay-methyl substituents causes even greater molecular distortion than in the highly carcinogenic 7,12-dimethylbenz[a]anthracene, with the benzo A ring inclined at about 29 degrees to the furthest C and D rings. Methyl carbon atoms are displaced 1.0 and 1.3 A on opposite sides of the mean molecular plane and the beach bond of the bay region is 1.480(4) A long, flanked by C-C-C angles of 124.3 and 125.0 degrees. The shortest carbon-carbon bond is C5-C6 = 1.327(5) A at the K region, with the next shortest C8-C9 = 1.346(6) A. Close intramolecular approaches of methyl hydrogens across the bay and to nearest aromatic hydrogens are 2.3-2.6 A.