Clinical trials profile: Professionals and sites

Clinical trial is considered a breakthrough method in medicine and essential to the development of new drugs. Clinical trials that comply with international and national regulations require an appropriate infrastructure and team qualification. The goal of this study was to evaluate clinical trial groups in Brazil: professional qualification, site structure regulatory knowledge and Good Clinical Practice (GCP) adherence. This is a transversal study with investigators (PI) and sub investigator (SI). PI and SI data were initially identified from Curriculum Lattes from National Advice of Scientific and Technological Development. The study participants were submitted to a questionnaire, which was composed of qualitative and quantitative questions. A hundred PI and SI were interviewed. The most representative Brazilian regions were Southeast (68%) and South (18%). The main institutions involved were HCFMUSP complex and UNIFESP among others institutions. Academic graduation is observed in 86% of them and the higher degree is Doctorate (62%). 91% had GCP knowledge although only 74% had formal training. About the team, all of them are multidisciplinary with majority of nurses and pharmaceuticals. 88% had GCP knowledge although only 77% had formal training. 36%, 60% and 44% of clinical trials were in phase II,III and IV. In conclusion, researchers have appropriate skills and knowledge to perform clinical studies however there is still a need for training. The centers where the researchers work, have trained staff and adequate infrastructure for conducting clinical trials phase II,III and IV. (C) 2010 Elsevier Inc. All rights reserved.

Marijuana Smoking and the Risk of Head and Neck Cancer: Pooled Analysis in the INHANCE Consortium

Background: Marijuana contains carcinogens similar to tobacco smoke and has been suggested by relatively small studies to increase the risk of head and neck cancer (HNC). Because tobacco is a major risk factor for HNC, large studies with substantial numbers of never tobacco users could help to clarify whether marijuana smoking is independently associated with HNC risk. Methods: We pooled self-reported interview data on marijuana smoking and known HNC risk factors on 4,029 HNC cases and 5,015 controls from five case-control studies within the INHANCE Consortium. Subanalyses were conducted among never tobacco users (493 cases and 1,813 controls) and among individuals who did not consume alcohol or smoke tobacco (237 cases and 887 controls). Results: The risk of HNC was not elevated by ever marijuana smoking [odds ratio (OR), 0.88; 95% confidence intervals (95% Cl), 0.67-1.16], and there was no increasing risk associated with increasing frequency, duration, or cumulative consumption of marijuana smoking. An increased risk of HNC associated with marijuana use was not detected among never tobacco users (OR, 0.93; 95% Cl, 0.63-1.37; three studies) nor among individuals who did not drink alcohol and smoke tobacco (OR, 1.06; 95% Cl, 0.47-2.38; two studies). Conclusion: Our results are consistent with the notion that infrequent marijuana smoking does not confer a risk of these malignancies. Nonetheless, because the prevalence of frequent marijuana smoking was low in most of the contributing studies, we could not rule out a moderately increased risk, particularly among subgroups without exposure to tobacco and alcohol. (Cancer Epidemiol Biomarkers Prev 2009;18(5):1544-51)

Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: The relevance of the placebo effect and psychological symptoms

Background: Little is known about the treatment of depression in older patients with heart failure. This Study was developed to investigate the effectiveness of antidepressant treatment for major depressive disorder (MDD) in the elderly with heart failure. Methods: We enrolled 72 older outpatients with ejection fraction < 50 and diagnosed with MDD by the structured clinical interview for DSM-IV. Thirty-seven patients, 19 on citalopram and 18 on placebo, initiated an 8-week double-blind treatment phase. Measurements were performed with the 31-item Hamilton Rating Scale for Depression (Ham-D-31), the Montgomery-Asberg rating scale (MADRS) and the Systematic Assessment for Treatment Emergent Effects (SAFTEE). A psychiatrist followed up the patients weekly, performing a consultation for about 20 min to field complaints after the measurements. Results: A trend toward superiority of citalopram over placebo in reducing depression was observed in MADRS scores (15.05 + 9.74 vs 9.44 + 9.25, P = .082) but not on HAM-D scores. The depressive symptomatology significantly decreased in both groups (P < .001). The high rate of placebo response during the double-blind phase (56.3%) led us to conclude the study at the interim analysis with 37 patients. Conclusion: Citalopram treatment of MDD in older patients with heart failure is well-tolerated with low rates of side effects, but was not significantly more effective than placebo in the treatment of depression. Weekly psychiatric follow-up including counseling may contribute to the improvement of depression in this population. Scales weighted on psychological symptoms such as the MADRS are possibly better suited to measure depression severity and improvement in patients with heart failure. (C) 2009 Elsevier Inc. All rights reserved.

Leuprolide acetate reduces both in vivo and in vitro ovarian steroidogenesis in infertile women undergoing assisted reproduction

Despite the probable inhibitory effects of GnRH analogues on ovarian steroidogenesis in vitro, their association with assisted reproduction protocols shows favorable results. This suggests that there are important differences in the behaviors of these drugs when administered in vivo versus in vitro. To clarify these differences, this study was designed to analyze the effect of leuprolide acetate (LA) on ovarian steroidogenesis in women undergoing In Vitro Fertilization (IVF). A prospective, randomized open label study was conducted on 14 women (26-35 years): seven receiving only gonadotrophins (Group 1) and seven receiving gonadotrophin plus LA at 1mg/day (Group 2). The LA in vivo effect was determined with serum and follicular fluid (FF) samples and via luteinized granulosa cell cultivation (GCC), where cells were obtained during oocyte retrieval after ovarian hyperstimulation. In vitro analysis was performed via addition of LA to GCC only for Group 1 (without LA) at progressively higher concentrations (0, 10(-12), 10(-9) and 10(-6) M). In vivo, the main observation was a reduction in androgen production in Group 2, represented by lower androstenedione production in FF (G1 = 6479 +/- 3458; G2 = 3021 +/- 1119 ng/ml; p = 0.04) and a lower testosterone peak in GC at 96 h (G1 = 0.64 +/- 0.12 ng/ml; G2 = 0.50 +/- 0.19ng/ml; P = 0.02), but a higher fertilization rate (G1 = 67%; G2 = 83%; p = 0.009). in vitro, testosterone, estradiol and progesterone were also reduced by LA, even though this reduction occurred for progesterone only at the highest LA dosage (10(-6) M; 606.0 +/- 114.3 ng/ml versus 1524.0 +/- 246.5 ng/ml; p=0.02). Results show that LA reduces ovarian steroidogenesis in vivo by essentially inhibiting androgen synthesis; whereas, in vitro, ovarian steroidogenesis is reduced overall. (C) 2008 Elsevier Inc. All rights reserved.

Inhibition of COX 1 and 2 prior to Renal Ischemia/Reperfusion Injury Decreases the Development of Fibrosis

Ischemia and reperfusion injury (IRI) contributes to the development of chronic interstitial fibrosis/tubular atrophy in renal allograft patients, Cyclooxygenase (COX) 1 and 2 actively participate in acute ischemic injury by activating endothelial cells and inducing oxidative stress. Furthermore, blockade of COX I and 2 has been associated with organ improvement after ischemic damage. The aim of this study was to evaluate the role of COX I and 2 in the development of fibrosis by performing a COX I and 2 blockade immediately before IRI We subjected C57BI/6 male mice to 60 min of unilateral renal pedicle occlusion, Prior to surgery mice were either treated with indomethacin (IMT) at days -1 and 0 or were untreated. Blood and kidney samples were collected 6 wks after IRI. Kidney samples were analyzed by real-time reverse transcription-poly me rase chain reaction for expression of transforming growth factor beta (TGF-beta), monocyte chemoattractant protein 1 (MCP-1), osteopontin (OPN), tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1 beta, IL-10, heme oxygenose 1 (HO-1), vimentin, connective-tissue growth factor (CTGF), collagen 1, and bone morphogenic protein 7 (BMP-7), To assess tissue fibrosis we performed morphometric analyses and Sirius red staining. We also performed immunohistochemical analysis of anti-actin smooth muscle, Renal function did not significantly differ between groups. Animals pretreated with IMT showed significantly less interstitial fibrosis than nontreated animals. Gene transcript analyses showed decreased expression of TGF-beta, MCP-1,TNF-alpha, IL-1-beta, vimentin, collagen 1, CTGF and IL-10 mRNA (all P < 0.05), Moreover, HO-I mRNA was increased in animals pretreated with IMT (P < 0.05) Conversely, IMT treatment decreased osteopontin expression and enhanced BMP-7 expression, although these levels did rot reach statistical significance when compared with control expression levels, I he blockade of COX 1 and 2 resulted in less tissue fibrosis, which was associated with a decrease in proinflammatory cytokines and enhancement of the protective cellular response.

The Potential Role of Suppressors of Cytokine Signaling in the Attenuation of Inflammatory Reaction and Alveolar Bone Loss Associated with Apical Periodontitis

Inflammatory cytokines contribute to periapical tissue destruction. Their activity is potentially regulated by suppressors of cytokine signaling (SOCS), which down-regulate signal transduction as part of an inhibitory feedback loop. We investigated the expression of the cytokines tumor necrosis factor alpha (TNF-alpha); interleukin (IL)-10 and RANKL; and SOCS-1, -2, and -3 by real-time polymerase chain reaction in 57 periapical granulomas and 38 healthy periapical tissues. Periapical granulomas exhibited significantly higher SOCS-1, -2, and -3, TNF-alpha, IL-10, and RANKL messenger RNA levels when compared with healthy controls. Significant positive correlations were found between SOCS1 and IL-10 and between SOCS3 and IL-10. Significant inverse correlations were observed between SOCS1 and TNF-alpha, SOCS1 and RANKL, and SOCS3 and TNF-alpha. Increased SOCS-1, -2, and -3 messenger RNA levels in periapical granulomas may be related to the downregulation of inflammatory cytokines in these lesions; therefore, SOCS molecules may play a role in the dynamics of periapical granulomas development. (J Endod 2008;34:1480-1484)

Mobius Sequence in a Girl and Arthrogryposis in her Half-Brother: Distinct Phenotypes Caused By Prenatal Injuries

Mobius sequence is a congenital facial and abducens nerve palsy, frequently associated to abnormalities of extremities. Arthrogryposis multiplex congenital is defined as a congenital fixation of multiple joints seldom of neurogenic origin. Both sequences must have a genetic origin, but usually are sporadic cases related to environmental factors such as drugs exposition and maternal trauma. A 5-year-old girl and a 1-year-old boy were born with Mobius sequence and arthrogryposis multiplex congenital, respectively. During pregnancies, the mother had vaginal bleeding at 7 weeks and used crack (free-based cocaine) in the first trimester, respectively. The girl also has equinovarus talipes and autistic behavior. The boy has arthrogryposis with flexion contractures of the feet and knees. A vascular disruption, due to hemorrhage and cocaine exposure, causing a transient ischemic insult to embryos in a critical period of development may be responsible for distinct phenotypes in these cases.

Crucial cytokine interactions in nitric oxide production induced by Mycoplasma arthritidis superantigen

Mycoplasma arthritidis causes autoimmune arthritis in rodents. It produces a superantigen (MAM) that simultaneously activates antigen presenting cells and T cells inducing nitric oxide and cytokine release. Nitric oxide is a key inducer and regulator of the immune system activation. Here, we investigated nitric oxide and cytokine production and interactions of these molecules in MAM-stimulated co-cultures of macrophages (J774A.1 cell line) with spleen lymphocytes. We found that: a) MAM-induced nitric oxide, interferon-gamma, membrane-associated tumor necrosis factor and interleukin-2 production in co-cultures of macrophages with lymphocytes from BALB/c and C3H/HePas but not from C57B1/6 mice; b) production of nitric oxide was dependent on interferon-gamma whereas that of interferon-gamma was dependent on interleukin-2 and membrane-associated tumor necrosis factor; c) these cytokines up regulated MAM-induced nitric oxide production. Unraveling the mechanisms of cell activation induced by MAM might be helpful to design strategies to prevent immune system activation by superantigens and therefore in seeking amelioration of associated immunopathologies. (C) 2008 Elsevier Masson SAS. All rights reserved.

Watch-and-Comment as a Paradigm toward Ubiquitous Interactive Video Editing

The literature reports research efforts allowing the editing of interactive TV multimedia documents by end-users. In this article we propose complementary contributions relative to end-user generated interactive video, video tagging, and collaboration. In earlier work we proposed the watch-and-comment (WaC) paradigm as the seamless capture of an individual`s comments so that corresponding annotated interactive videos be automatically generated. As a proof of concept, we implemented a prototype application, the WACTOOL, that supports the capture of digital ink and voice comments over individual frames and segments of the video, producing a declarative document that specifies both: different media stream structure and synchronization. In this article, we extend the WaC paradigm in two ways. First, user-video interactions are associated with edit commands and digital ink operations. Second, focusing on collaboration and distribution issues, we employ annotations as simple containers for context information by using them as tags in order to organize, store and distribute information in a P2P-based multimedia capture platform. We highlight the design principles of the watch-and-comment paradigm, and demonstrate related results including the current version of the WACTOOL and its architecture. We also illustrate how an interactive video produced by the WACTOOL can be rendered in an interactive video environment, the Ginga-NCL player, and include results from a preliminary evaluation.

Nanograined Ferroelectric Ceramics Prepared by High-Pressure Densification Technique

For the first time, nanograined Pb(1-1.5x)La(x)TiO(3) ferroelectric ceramics, with x=0.2, were produced by a process based on a high-pressure densification technique (HPD) that eliminates the need of high-temperature sintering. Our results showed the production of workable dense ceramics with average grain size around 100 nm and free from secondary phase. Regarding the dielectric measurements, the samples showed satisfactory dielectric losses as well as remarkable diffusivity in the dielectric curves. Moreover, ferroelectric hysteresis measurements showed that samples produced by the HPD technique can stand high electric fields necessary to switch the polarization and thus to induce piezoelectric activity. Our results demonstrated clearly the viability of the proposed method to produce nanograined ferroelectric bulk ceramics, then opening the possibility of developing new technologies.

Internal Residual Stress Measurements in a Bioactive Glass-Ceramic Using Vickers Indentation

The residual stress distribution that arises in the glass matrix during cooling of a partially crystallized 17.2Na(2)O-32.1CaO-48.1SiO(2)-2.5P(2)O(5) (mol%) bioactive glass-ceramic was measured using the Vickers indentation method proposed by Zeng and Rowcliffe (ZR). The magnitude of the determined residual stress at the crystal/glass boundary was 1/4-1/3 of the values measured using X-ray diffraction (within the crystals) and calculated using Selsing`s model. A correction for the crack geometry factor, assuming a semi-elliptical shape, is proposed and then good agreement between experimental and theoretical values is found. Thus, if the actual crack geometry is taken into account, the indentation technique of ZR can be successfully used. In addition, a numerical model for the calculation of residual stresses that takes into account the hemispherical shape of the crystalline precipitates at a free surface was developed. The result is that near the sample surface, the radial component of the residual stress is increased by 70% in comparison with the residual stress calculated by Selsing`s model.

Effect of Lithium Nitrate on the Alkali-Silica Reaction Gel

Lithium nitrate has been used to prevent and to mediate the expansion caused by alkali-silica reaction (ASR). However, there is limited information on how it affects the existing reaction products caused by ASR. The aim of the present work is to determine the modifications caused by the LiNO3 treatment on the structure of the gel produced by ASR. ASR gel samples obtained from a concrete dam were exposed to an aqueous solution of lithium nitrate and sodium hydroxide with molar LiNO3/NaOH = 0.74, and the resulting products were analyzed by X-ray diffraction, infrared spectroscopy, and solid-state nuclear magnetic resonance of Si-29, Na-23, and Li-7. The treatment of the gel samples produces significant structural modifications in ASR products. A new amorphous silicate compound incorporating Li+ ions is formed, with an average silicate network that can be described as linear in contrast with the layered structure of the original gel. This elimination of the layered structure after the Li-based treatments may be related to the reduction of the tendency of the gel to expand. Also, several crystalline compounds containing potassium indicate the release of this species from the original ASR gel.

Erbium and Ytterbium Codoped Titanoniobophosphate Glasses for Ion-Exchange-Based Planar Waveguides

This work presents the optical properties of erbium-doped and erbium/ytterbium codoped Na(2)O-Al(2)O(3)-TiO(2)-Nb(2)O(5)-P(2)O(5) glass systems and also the characterization of planar waveguides obtained by typical thermally assisted Ag+<-> Na+ ion-exchange process. The glass systems allow the preparation of single mode and multimode planar waveguides presenting a strong and relatively broad emission at 1536 nm. The emission signal in the infrared region is intensified for silver-containing samples when compared with free-silver samples. The emission signal intensification may be attributed to a nonplasmonic energy transfer from silver species to Er3+ ions as no bands related to surface plasmon resonance (SPR) of silver nanoparticles were observed.

Luminescence characteristics of YAP:Ce scintillator powders and composites

Cerium doped yttrium aluminate perovskite YAlO(3) (YAP) powders are pursued as interesting alternatives to bulk crystals for application in scintillating devices. The emissions of these materials in the near-UV and visible spectral regions originate from electric dipole transitions between 4f and 5d energy levels of Ce(3+) and largely depend on the environment occupied by the ion. In search for improved synthesis conditions that can lead to phase pure powders with optimized structural and spectroscopic characteristics, in this work we have employed the polymeric precursor (Pechini) method to prepare crystalline and amorphous YAP:Ce powders doped with 1-10 mol% Ce(3+). Interesting composite materials were also obtained by dispersing some of the YAP:Ce powders in silica xerogels. A comparative structural and spectroscopic study of all the samples was done by XRD, FT-IR, emission, excitation and excited state lifetime measurements. In agreement with previous reports, excitation at 296 nm results in intense emission in the range 315-425 nm with an average decay time of 30 ns. (c) 2010 Elsevier B.V. All rights reserved.