Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial

BACKGROUND: Bone metastases frequently cause skeletal events in patients with metastatic castration-resistant prostate cancer. Radium-223 dichloride (radium-223) selectively targets bone metastases with high-energy, short-range α-particles. We assessed the effect of radium-223 compared with placebo in patients with castration-resistant prostate cancer and bone metastases.

METHODS: In this phase 3, double-blind, randomised ALSYMPCA trial, we enrolled patients who had symptomatic castration-resistant prostate cancer with two or more bone metastases and no known visceral metastases, who were receiving best standard of care, and had previously either received or were unsuitable for docetaxel. Patients were stratified by previous docetaxel use, baseline total alkaline phosphatase level, and current bisphosphonate use, then randomly assigned (2:1) to receive either six intravenous injections of radium-223 (50 kBq/kg) or matching placebo; one injection was given every 4 weeks. Randomisation was done with an interactive voice response system, taking into account trial stratification factors. Participants and investigators were masked to treatment assignment. The primary endpoint was overall survival, which has been reported previously. Here we report on time to first symptomatic skeletal event, defined as the use of external beam radiation to relieve bone pain, or occurrence of a new symptomatic pathological fracture (vertebral or non-verterbal), or occurence of spinal cord compression, or tumour-related orthopeadic surgical intervention. All events were required to be clinically apparent and were not assessed by periodic radiological review. Statistical analyses of symptomatic skeletal events were based on the intention-to-treat population. The study has been completed and is registered with ClinicalTrials.gov, number NCT00699751.

FINDINGS: Between June 12, 2008, and Feb 1, 2011, 921 patients were enrolled, of whom 614 (67%) were randomly assigned to receive radium-223 and 307 (33%) placebo. Symptomatic skeletal events occurred in 202 (33%) of 614 patients in the radium-223 group and 116 (38%) of 307 patients in the placebo group. Time to first symptomatic skeletal event was longer with radium-223 than with placebo (median 15·6 months [95% CI 13·5-18·0] vs 9·8 months [7·3-23·7]; hazard ratio [HR]=0·66, 95% CI 0·52-0·83; p=0·00037). The risks of external beam radiation therapy for bone pain (HR 0·67, 95% CI 0·53-0·85) and spinal cord compression (HR=0·52, 95% CI 0·29-0·93) were reduced with radium-233 compared with placebo. Radium-223 treatment did not seem to significantly reduce the risk of symptomatic pathological bone fracture (HR 0·62, 95% CI 0·35-1·09), or the need for tumour-related orthopaedic surgical intervention (HR 0·72, 95% CI 0·28-1·82).

INTERPRETATION: Radium-223 should be considered as a treatment option for patients with castration-resistant prostate cancer and symptomatic bone metastases.

FUNDING: Algeta and Bayer HealthCare Pharmaceuticals.

Numerical analysis of impact events in a centrifugal impact pin mill

Milling is an important operation in many industries, such as mining and pharmaceutical. Although the comminution process during milling has been extensively studied, the material fragmentation mechanisms in a mill are still not well understood partly because of the lack of an understanding on the local stressing and dynamic information under operational conditions in mills. This paper presents a DEM simulation of particle dynamics and impact events in a centrifugal impact pin mill. The main focus is the statistical characteristics of the dominant stressing modes during the milling process. The frequency, velocity and force of the different impact events between particles and mill components, or between particles, are analysed. © 2013 AIP Publishing LLC.

Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

AIMS: To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes.

METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years.

RESULTS: Alanine aminotransferase level had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase value (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P=0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P=0.001). No relationship was found for gamma-glutamyltransferase.

CONCLUSIONS: The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health. This article is protected by copyright. All rights reserved.

A role for local mechanisms in perceived duration of brief visual events

Background: Spatially localized duration compression of a briefly presented moving stimulus following adaptation in the same location is taken as evidence for modality-specific neural timing mechanisms.

Aims: The present study used random dot motion stimuli to investigate where these mechanisms may be located.

Method: Experiment 1 measured duration compression of the test stimulus as a function of adaptor speed and revealed that duration compression is speed tuned. These data were then used to make predictions of duration compression responses for various models which were tested in experiment 2. Here a mixed-speed adaptor stimulus was used with duration compression being measured as a function of the adaptor’s ‘speed notch’ (the removal of a central band from the speed range).

Results: The results were consistent with a local-mean model.

Conclusions: Local-motion mechanisms are involved in duration perception of brief events.

Easily Accessible Rare-Earth-Containing Phosphonium Room-Temperature Ionic Liquids: EXAFS, Luminescence and Magnetic Properties

A range of liquid rare-earth chlorometallate complexes with alkyl-phosphonium cations, [P666 14]+, has been synthesised and characterised. EXAFS confirmed the predominant liquid-state speciation of the [LnCl6]3- of the series with Ln = Nd, Eu, Dy. The crystal structure of the shorter-alkyl-chain cation analogue [P4444]+ has been determined and exhibits a very large unit cell. The luminescence properties, with visible light emissions of the liquid Tb, Eu, Pr and Sm and the NIR emissions for the Nd and Er compounds were determined. The effective magnetic moments were measured and fitted for the Nd, Tb, Ho, Dy, Gd and Er samples.

Reigning Supreme: Events at the UK Supreme Court in 2015

This short article provides statistics on the number of decisions issued by the UK Supreme Court during 2015 and highlights some of the most interesting of them.

RAIN EVENTS INFLUENCE SHORT-TERM FEEDING PREFERENCES IN THE SNAIL CEPAEA NEMORALIS

Terrestrial gastropods are both herbivores and detritivores, but the ratio between these two modes of feeding can be highly variable over time. While previous studies have examined long-term seasonal patterns in the consumption of fresh material, mechanisms explaining short-term variation in dietary preferences have not been explored. We used faecal analysis to determine how short-term variation in weather affects the ratio of herbivory to detritivory in the land snail Cepaea nemoralis. Averaged across sampling dates, c. 9% of the faeces were composed of fresh plant material, with the remainder consisting of plant litter and soil. Temperature, relative humidity and soil moisture did not affect the proportional consumption of fresh material; however, snails consumed more soil with increasing temperature. If there had not been a recent precipitation event, the mean proportion of fresh material in the faeces more than doubled on average; however, this increase only occurred in areas of low herbaceous cover. Our results suggest that an increased proportion of snails consume fresh material during dry periods to compensate for water losses. Moreover, our study highlights that studies of dietary composition in the field need to account for short-term variation in feeding
preferences caused by weather.

Between-taxon matching of common and rare species richness patterns

Aim: Our primary aim is to understand how assemblages of rare (restricted range) and common (widespread) species are correlated with each other among different taxa. We tested the proposition that marine species richness patterns of rare and common species differ, both within a taxon in their contribution to the richness pattern of the full assemblage and among taxa in the strength of their correlations with each other. Location The UK intertidal zone. Methods: We used high-resolution marine datasets for UK intertidal macroalgae, molluscs and crustaceans each with more than 400 species. We estimated the relative contribution of rare and common species, treating rarity and commonness as a continuous spectrum, to spatial patterns in richness using spatial crosscorrelations. Correlation strength and significance was estimated both within and between taxa. Results: Common species drove richness patterns within taxa, but rare species contributed more when species were placed on an equal footing via scaling by binomial variance. Between taxa, relatively small sub-assemblages (fewer than 60 species) of common species produced the maximum correlation with each other, regardless of taxon pairing. Cross-correlations between rare species were generally weak, with maximum correlation occurring between small sub-assemblages in only one case. Cross-correlations between common and rare species of different taxa were consistently weak or absent. Main conclusions: Common species in the three marine assemblages were congruent in their richness patterns, but rare species were generally not. The contrast between the stronger correlations among common species and the weak or absent correlations among rare species indicates a decoupling of the processes driving common and rare species richness patterns. The internal structure of richness patterns of these marine taxa is similar to that observed for terrestrial taxa.