Donepezil and memantine for moderate-to-severe Alzheimer's disease

Background: Clinical trials have shown the benefits of cholinesterase inhibitors for the treatment of mild-to-moderate Alzheimer's disease. It is not known whether treatment benefits continue after the progression to moderate-to-severe disease. Methods: We assigned 295 community-dwelling patients who had been treated with donepezil for at least 3 months and who had moderate or severe Alzheimer's disease (a score of 5 to 13 on the Standardized Mini-Mental State Examination [SMMSE, on which scores range from 0 to 30, with higher scores indicating better cognitive function]) to continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine. Patients received the study treatment for 52 weeks. The coprimary outcomes were scores on the SMMSE and on the Bristol Activities of Daily Living Scale (BADLS, on which scores range from 0 to 60, with higher scores indicating greater impairment). The minimum clinically important differences were 1.4 points on the SMMSE and 3.5 points on the BADLS.
Results: Patients assigned to continue donepezil, as compared with those assigned to discontinue donepezil, had a score on the SMMSE that was higher by an average of 1.9 points (95% confidence interval [CI], 1.3 to 2.5) and a score on the BADLS that was lower (indicating less impairment) by 3.0 points (95% CI, 1.8 to 4.3) (P<0.001 for both comparisons). Patients assigned to receive memantine, as compared with those assigned to receive memantine placebo, had a score on the SMMSE that was an average of 1.2 points higher (95% CI, 0.6 to 1.8; P<0.001) and a score on the BADLS that was 1.5 points lower (95% CI, 0.3 to 2.8; P = 0.02). The efficacy of donepezil and of memantine did not differ significantly in the presence or absence of the other. There were no significant benefits of the combination of donepezil and memantine over donepezil alone.
Conclusions: In patients with moderate or severe Alzheimer's disease, continued treatment with donepezil was associated with cognitive benefits that exceeded the minimum clinically important difference and with significant functional benefits over the course of 12 months. (Funded by the U.K. Medical Research Council and the U.K. Alzheimer's Society; Current Controlled Trials number, ISRCTN49545035).

Use of arc-length method for capturing mode jumping in postbuckling aerostructures

The arc-length method has become a widely established solution technique for studying nonlinear structural behavior. By augmenting the set of nonlinear equilibrium equations with a constraint equation, which is a function of both the displacements and load increment, it is capable of traversing limit points. Numerous investigations have shown that highly nonlinear behavior such as sharp "snap-backs" can still lead to numerical difficulties. Two practical examples are presented to assess the effectiveness of this solution technique in capturing secondary instabilities in postbuckling structures, which present themselves as abrupt mode jumps. Although the first example poses no special difficulties, in the second case the nonlinear procedure fails to converge. An improvement to the method's formulation is suggested, which accounts for the residual forces that are usually neglected, when proceeding to the next increment once convergence is reached on the current increment. The choice of a correct load increment at the first iteration, within a predictor-corrector scheme, is central to the method's effectiveness. Current strategies for a choice of this load increment are discussed and are shown to be no longer consistent with the modified formulation; therefore, a new approach is proposed.

Perimetric progression in open angle glaucoma and the Visual Field Index (VFI)

PURPOSE: To evaluate the changes in the Visual Field Index (VFI) in eyes with perimetric glaucomatous progression, and to compare these against stable glaucoma patients.

PATIENTS AND METHODS: Consecutive patients with open angle glaucoma with a minimum of 6 reliable visual fields and 2 years of follow-up were identified. Perimetric progression was assessed by 4 masked glaucoma experts from different units, and classified into 3 categories: "definite progression," "suspected progression," or "no progression." This was compared with the Glaucoma Progression Analysis (GPA) II and VFI linear regression analysis, where progression was defined as a negative slope with significance of <5%.

RESULTS: Three hundred ninety-seven visual fields from 51 eyes of 39 patients were assessed. The mean number of visual fields was 7.8 (SD 1.1) per eye, and the mean follow-up duration was 63.7 (SD 13.4) months. The mean VFI linear regression slope showed an overall statistically significant difference (P<0.001, analysis of variance) for each category of progression. Using expert consensus opinion as the reference standard, both VFI analysis and GPA II had high specificity (0.93 and 0.90, respectively), but relatively low sensitivity (0.45 and 0.41, respectively).

CONCLUSIONS: The mean VFI regression slope in our cohort of eyes without perimetric progression showed a statistically significant difference compared with those with suspected and definite progression. VFI analysis and GPA II both had similarly high specificity but low sensitivity when compared with expert consensus opinion.

Acidic properties of nanolayered ZSM-5 zeolites

The acidic properties of nanolayered ZSM-5 zeolites synthesized with the aid of multiquaternary ammonium surfactants were investigated in detail. A substantial fraction of Al is present in highly dispersed form at extraframework positions indicative of the defective nature of the calcined nanolayered zeolites. Acidity characterization reveals that the Brønsted acid sites are similar in strength to those in bulk HZSM-5. Nanolayered zeolites contain a higher amount of Brønsted acid sites (BAS) at their external (mesopore) surface. Unilamellar zeolites have a higher concentration of external BA and silanol sites than multilamellar ones. The number of BAS in the nanolayered zeolites is considerably lower than the tetrahedral Al content, the difference increasing with nanolayer thickness. Except for one particular sample (nanolayered ZSM-5 synthesized from COH template), the total turnover of methanol normalized per BAS trends inversely with the concentration of BAS. There is no correlation with the concentration of external BAS. Catalyst deactivation due to coke mainly depends on the BAS concentration. A unilamellar ZSM-5 zeolite prepared using COH displayed substantially improved performance in terms of a much lower rate of coke deactivation in line with earlier data Choi et al. [10]. Since the acidic and textural properties of this zeolite did not differ significantly from the others, it remains to be determined why this zeolite performs so much better. © 2013 Elsevier Ltd. All rights reserved.

Susceptibility to Invasive Meningococcal Disease: Polymorphism of Complement System Genes and Neisseria meningitidis Factor H Binding Protein

BACKGROUND: Neisseria meningitidis can cause severe infection in humans. Polymorphism of Complement Factor H (CFH) is associated with altered risk of invasive meningococcal disease (IMD). We aimed to find whether polymorphism of other complement genes altered risk and whether variation of N. meningitidis factor H binding protein (fHBP) affected the risk association.

METHODS: We undertook a case-control study with 309 European cases and 5,200 1958 Birth Cohort and National Blood Service cohort controls. We used additive model logistic regression, accepting P<0.05 as significant after correction for multiple testing. The effects of fHBP subfamily on the age at infection and severity of disease was tested using the independent samples median test and Student's T test. The effect of CFH polymorphism on the N. meningitidis fHBP subfamily was investigated by logistic regression and Chi squared test.

RESULTS: Rs12085435 A in C8B was associated with odds ratio (OR) of IMD (0.35 [95% CI 0.19-0.67]; P = 0.03 after correction). A CFH haplotype tagged by rs3753396 G was associated with IMD (OR 0.56 [95% CI 0.42-0.76], P = 1.6x10-4). There was no bacterial load (CtrA cycle threshold) difference associated with carriage of this haplotype. Host CFH haplotype and meningococcal fHBP subfamily were not associated. Individuals infected with meningococci expressing subfamily A fHBP were younger than those with subfamily B fHBP meningococci (median 1 vs 2 years; P = 0.025).

DISCUSSION: The protective CFH haplotype alters odds of IMD without affecting bacterial load for affected heterozygotes. CFH haplotype did not affect the likelihood of infecting meningococci having either fHBP subfamily. The association between C8B rs12085435 and IMD requires independent replication. The CFH association is of interest because it is independent of known functional polymorphisms in CFH. As fHBP-containing vaccines are now in use, relationships between CFH polymorphism and vaccine effectiveness and side-effects may become important.

Dust-acoustic shocks in strongly coupled dusty plasmas

Electrostatic dust-acoustic shock waves are investigated in a viscous, complex plasma consisting of dust particles, electrons, and ions. The system is modelled using the generalized hydrodynamic equations, with strong coupling between the dust particles being accounted for by employing the effective electrostatic temperature approach. Using a reductive perturbation method, it is demonstrated that this model predicts the existence of weakly nonlinear dust-acoustic shock waves, arising as solutions to Burgers's equation, in which the nonlinear forces are balanced by dissipative forces, in this case, associated with viscosity. The evolution and stability of dust-acoustic shocks is investigated via a series of numerical simulations, which confirms our analytical predictions on the shock characteristics.

EFFECT OF EXERCISE ON THE NASAL TRANSMUCOSAL POTENTIAL DIFFERENCE IN PATIENTS WITH CYSTIC-FIBROSIS AND NORMAL SUBJECTS

Background - Normal subjects have a negative nasal transmucosal potential difference (TPD) at rest which becomes more negative with exercise. Patients with cystic fibrosis have a more negative resting nasal TPD than controls. The present study was designed to determine the effects of exercise on the TPD of patients with cystic fibrosis.