Efficacy and safety of ivacaftor in patients with cystic fibrosis who have an Arg117His-CFTR mutation: a double-blind, randomised controlled trial

BACKGROUND: Ivacaftor has been previously assessed in patients with cystic fibrosis with Gly551Asp-CFTR or other gating mutations. We assessed ivacaftor in patients with Arg117His-CFTR, a residual function mutation.

METHODS: We did a 24-week, placebo-controlled, double-blind, randomised clinical trial, which enrolled 69 patients with cystic fibrosis aged 6 years and older with Arg117His-CFTR and percentage of predicted forced expiratory volume in 1 s (% predicted FEV1) of at least 40. We randomly assigned eligible patients (1:1) to receive placebo or ivacaftor 150 mg every 12 h for 24 weeks. Randomisation was stratified by age (6-11, 12-17, and ≥18 years) and % predicted FEV1 (<70, ≥70 to ≤90, and >90). The primary outcome was the absolute change from baseline in % predicted FEV1 through week 24. Secondary outcomes included safety and changes in sweat chloride concentrations and Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory domain scores. An open-label extension enrolled 65 of the patients after washout; after 12 weeks, we did an interim analysis.

FINDINGS: After 24 weeks, the treatment difference in mean absolute change in % predicted FEV1 between ivacaftor (n=34) and placebo (n=35) was 2·1 percentage points (95% CI -1·13 to 5·35; p=0·20). Ivacaftor treatment resulted in significant treatment differences in sweat chloride (-24·0 mmol/L, 95% CI -28·01 to -19·93; p<0·0001) and CFQ-R respiratory domain (8·4, 2·17 to 14·61; p=0·009). In prespecified subgroup analyses, % predicted FEV1 significantly improved with ivacaftor in patients aged 18 years or older (treatment difference vs placebo: 5·0 percentage points, 95% CI 1·15 to 8·78; p=0·01), but not in patients aged 6-11 years (-6·3 percentage points, -11·96 to -0·71; p=0·03). In the extension study, both placebo-to-ivacaftor and ivacaftor-to-ivacaftor groups showed % predicted FEV1 improvement (absolute change from post-washout baseline at week 12: placebo-to-ivacaftor, 5·0 percentage points [p=0·0005]; ivacaftor-to-ivacaftor, 6·0 percentage points [p=0·006]). We did not identify any new safety concerns. The studies are registered with ClinicalTrials.gov (the randomised, placebo-controlled study, number NCT01614457; the open-label extension study, number NCT01707290).

INTERPRETATION: Although this study did not show a significant improvement in % predicted FEV1, ivacaftor did significantly improve sweat chloride and CFQ-R respiratory domain scores and lung function in adult patients with Arg117His-CFTR, indicating that ivacaftor might benefit patients with Arg117His-CFTR who have established disease.

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.

Effects of Prochlorperazine on Normal Vestibular Ocular and Perceptual Responses: A Randomised, Double-Blind, Crossover, Placebo-Controlled Study

Background: The present study investigated whether prochlorperazine affects vestibular-ocular reflex (VOR) and vestibulo-perceptual function. Methods: We studied 12 healthy naïve subjects 3 hours after a single dose of oral prochlorperazine 5mg in a randomised, placebo-controlled, double-blind, cross-over study in healthy young subjects. Two rotational tests in yaw were used: 1) a Threshold task investigating perceptual motion detection and nystagmic thresholds (acceleration steps of 0.5deg/s/s) and 2) Suprathreshold responses to velocity steps of 90deg/s in which vestibulo-ocular (VO) and vestibulo-perceptual (VP) time constants of decay, as well as VOR gain, were measured. Results: Prochlorperazine had no effect upon any measure of nystagmic or perceptual vestibular function compared to placebo. This lack of effects on vestibular-mediated motion perception suggests that the drug is likely to act more as an antiemetic than as an anti-vertiginous agent.

A vision system for detecting paths and moving obstacles for the blind

In this paper we present a monocular vision system for a navigation aid. The system assists blind persons in following paths and sidewalks, and it alerts the user to moving obstacles which may be on collision course. Path borders and the vanishing point are de-tected by edges and an adapted Hough transform. Opti-cal flow is detected by using a hierarchical, multi-scale tree structure with annotated keypoints. The tree struc-ture also allows to segregate moving objects, indicating where on the path the objects are. Moreover, the centre of the object relative to the vanishing point indicates whether an object is approaching or not.

The SmartVision navigation prototype for the blind

The goal of the project "SmartVision: active vision for the blind" is to develop a small and portable but intelligent and reliable system for assisting the blind and visually impaired while navigating autonomously, both outdoor and indoor. In this paper we present an overview of the prototype, design issues, and its different modules which integrate a GIS with GPS, Wi-Fi, RFID tags and computer vision. The prototype addresses global navigation by following known landmarks, local navigation with path tracking and obstacle avoidance, and object recognition. The system does not replace the white cane, but extends it beyond its reach. The user-friendly interface consists of a 4-button hand-held box, a vibration actuator in the handle of the cane, and speech synthesis. A future version may also employ active RFID tags for marking navigation landmarks, and speech recognition may complement speech synthesis.

Blavigator: a navigation aid for blind persons

Blavigator (blind navigator) is a vision aid for blind and visuaIIy impaired persons. It supports local navigation by detecting waIkable paths in the immediate vicinity of the user. It guides the user for centering on the path.

A time frequency approach to blind deconvolution in multipath underwater channels

Blind deconvolution is studied in the underwater acoustic channel context, by time-frequency (TF) processing. The acoustic propagation environment is modelled by ray tracing and mathematically described by a multipath propagation channel. Representation of the received signal by means of a signal-dependent TF distribution (radially Gaussian kernel distribution) allowed to visualize the resolved replicas of the emitted signal, while signi cantly attenuating the inherent interferences of classic quadratic TF distributions. The source signal instantaneous frequency estimation was the starting point for both source and channel estimation. Source signature estimation was performed by either TF inversion, based on the Wigner-Ville distribution of the received signal, or a subspace- -based method. The channel estimate was obtained either via a TF formulation of the conventional matched- lter, or via matched- - ltering with the previously obtained source estimate. A shallow water realistic scenario is considered, comprising a 135-m depth water column and an acoustic source located at 90-m depth and 5.6-km range from the receiver. For the corresponding noiseless simulated data, the quality of the best estimates was 0.856 for the source signal, and 0.9664 and 0.9996 for the amplitudes and time-delays of the impulse response, respectively. Application of the proposed deconvolution method to real data of the INTIMATE '96 sea trial conduced to source and channel estimates with the quality of 0.530 and 0.843, respectively. TF processing has proved to remove the typical ill-conditioning of single sensor deterministic deconvolution techniques.

The smart vision local navigation aid for blind and visually impaired persons

The SmartVision prototype is a small, cheap and easily wearable navigation aid for blind and visually impaired persons. Its functionality addresses global navigation for guiding the user to some destiny, and local navigation for negotiating paths, sidewalks and corridors, with avoidance of static as well as moving obstacles. Local navigation applies to both in- and outdoor situations. In this article we focus on local navigation: the detection of path borders and obstacles in front of the user and just beyond the reach of the white cane, such that the user can be assisted in centering on the path and alerted to looming hazards. Using a stereo camera worn at chest height, a portable computer in a shoulder-strapped pouch or pocket and only one earphone or small speaker, the system is inconspicuous, it is no hindrence while walking with the cane, and it does not block normal surround sounds. The vision algorithms are optimised such that the system can work at a few frames per second.

On the performance of a blind source separation based I/Q-corrector

I and Q Channel phase and gain mismatches are of great concern in communications receiver design. In this paper we carry out a detailed performance analysis of the Blind-Source Seperation (BSS) based imbalance compensation structure. The results indicate that the BSS structure can offer adequate performance for most communication systems. Since the compensation is carried out before any modulation specific processing, the proposed compensation method works with all standard modulation formats.

On the structure and performance of a novel blind source separation based carrier phase synchronization error compensator

In this paper we carry out a detailed performance analysis of a novel blind-source-seperation (BSS) based DSP algorithm that tackles the carrier phase synchronization error problem. The results indicate that the mismatch can be effectively compensated during the normal operation as well as in the rapidly changing environments. Since the compensation is carried out before any modulation specific processing, the proposed method works with all standard modulation formats and lends itself to efficient real-time custom integrated hardware or software implementations.