Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial

Background: Ataluren was developed to restore functional protein production in genetic disorders caused by nonsense mutations, which are the cause of cystic fibrosis in 10% of patients. This trial was designed to assess the efficacy and safety of ataluren in patients with nonsense-mutation cystic fibrosis. 

Methods: This randomised, double-blind, placebo-controlled, phase 3 study enrolled patients from 36 sites in 11 countries in North America and Europe. Eligible patients with nonsense-mutation cystic fibrosis (aged ≥6 years; abnormal nasal potential difference; sweat chloride >40 mmol/L; forced expiratory volume in 1 s [FEV₁] ≥40% and ≤90%) were randomly assigned by interactive response technology to receive oral ataluren (10 mg/kg in morning, 10 mg/kg midday, and 20 mg/kg in evening) or matching placebo for 48 weeks. Randomisation used a block size of four, stratified by age, chronic inhaled antibiotic use, and percent-predicted FEV₁. The primary endpoint was relative change in percent-predicted FEV₁ from baseline to week 48, analysed in all patients with a post-baseline spirometry measurement. This study is registered with ClinicalTrials.gov, number NCT00803205. 

Findings: Between Sept 8, 2009, and Nov 30, 2010, 238 patients were randomly assigned, of whom 116 in each treatment group had a valid post-baseline spirometry measurement. Relative change from baseline in percent-predicted FEV₁ did not differ significantly between ataluren and placebo at week 48 (-2·5% vs -5·5%; difference 3·0% [95% CI -0·8 to 6·3]; p=0·12). The number of pulmonary exacerbations did not differ significantly between treatment groups (rate ratio 0·77 [95% CI 0·57-1·05]; p=0·0992). However, post-hoc analysis of the subgroup of patients not using chronic inhaled tobramycin showed a 5·7% difference (95% CI 1·5-10·1) in relative change from baseline in percent-predicted FEV₁ between the ataluren and placebo groups at week 48 (-0·7% [-4·0 to 2·1] vs -6·4% [-9·8 to -3·7]; nominal p=0·0082), and fewer pulmonary exacerbations in the ataluern group (1·42 events [0·9-1·9] vs 2·18 events [1·6-2·7]; rate ratio 0·60 [0·42-0·86]; nominal p=0·0061). Safety profiles were generally similar for ataluren and placebo, except for the occurrence of increased creatinine concentrations (ie, acute kidney injury), which occurred in 18 (15%) of 118 patients in the ataluren group compared with one (<1%) of 120 patients in the placebo group. No life-threatening adverse events or deaths were reported in either group. I

nterpretation: Although ataluren did not improve lung function in the overall population of nonsense-mutation cystic fibrosis patients who received this treatment, it might be beneficial for patients not taking chronic inhaled tobramycin. 

Funding: PTC Therapeutics, Cystic Fibrosis Foundation, US Food and Drug Administration's Office of Orphan Products Development, and the National Institutes of Health. 

DEX: self-healing expanders

The Early Effects of Rapid Androgen Deprivation on Human Prostate Cancer

The androgen receptor (AR) is the dominant growth factor in prostate cancer (PCa). Therefore, understanding how ARs regulate the human transcriptome is of paramount importance. The early effects of castration on human PCa have not previously been studied 27 patients medically castrated with degarelix 7 d before radical prostatectomy. We used mass spectrometry, immunohistochemistry, and gene expression array (validated by reverse transcription-polymerase chain reaction) to compare resected tumour with matched, controlled, untreated PCa tissue. All patients had levels of serum androgen, with reduced levels of intraprostatic androgen at prostatectomy. We observed differential expression of known androgen-regulated genes (TMPRSS2, KLK3, CAMKK2, FKBP5). We identified 749 genes downregulated and 908 genes upregulated following castration. AR regulation of α-methylacyl-CoA racemase expression and three other genes (FAM129A, RAB27A, and KIAA0101) was confirmed. Upregulation of oestrogen receptor 1 (ESR1) expression was observed in malignant epithelia and was associated with differential expression of ESR1-regulated genes and correlated with proliferation (Ki-67 expression).

PATIENT SUMMARY: This first-in-man study defines the rapid gene expression changes taking place in prostate cancer (PCa) following castration. Expression levels of the genes that the androgen receptor regulates are predictive of treatment outcome. Upregulation of oestrogen receptor 1 is a mechanism by which PCa cells may survive despite castration.

Modelling the fresh properties of self-compacting concrete using support vector machine approach

The main objective of the study presented in this paper was to investigate the feasibility using support vector machines (SVM) for the prediction of the fresh properties of self-compacting concrete. The radial basis function (RBF) and polynomial kernels were used to predict these properties as a function of the content of mix components. The fresh properties were assessed with the slump flow, T50, T60, V-funnel time, Orimet time, and blocking ratio (L-box). The retention of these tests was also measured at 30 and 60 min after adding the first water. The water dosage varied from 188 to 208 L/m3, the dosage of superplasticiser (SP) from 3.8 to 5.8 kg/m3, and the volume of coarse aggregates from 220 to 360 L/m3. In total, twenty mixes were used to measure the fresh state properties with different mixture compositions. RBF kernel was more accurate compared to polynomial kernel based support vector machines with a root mean square error (RMSE) of 26.9 (correlation coefficient of R2 = 0.974) for slump flow prediction, a RMSE of 0.55 (R2 = 0.910) for T50 (s) prediction, a RMSE of 1.71 (R2 = 0.812) for T60 (s) prediction, a RMSE of 0.1517 (R2 = 0.990) for V-funnel time prediction, a RMSE of 3.99 (R2 = 0.976) for Orimet time prediction, and a RMSE of 0.042 (R2 = 0.988) for L-box ratio prediction, respectively. A sensitivity analysis was performed to evaluate the effects of the dosage of cement and limestone powder, the water content, the volumes of coarse aggregate and sand, the dosage of SP and the testing time on the predicted test responses. The analysis indicates that the proposed SVM RBF model can gain a high precision, which provides an alternative method for predicting the fresh properties of SCC.

Stochastic ground motion simulation with geological site effects in damage asessment

Damage assessment of structures with a mechanical non linear model demands the representation of seismic action in terms of an accelerogram (dynamic analysis) or a response spectrum (pushover analysis). Stochastic ground motion simulation is largely used in regions where seismic strong-motion records are available in insufficient number. In this work we present a variation of the stochastic finite-fault method with dynamic corner frequency that includes the geological site effects. The method was implemented in a computer program named SIMULSIS that generate time series (accelerograms) and response spectra. The program was tested with the MW= 7.3 Landers earthquake (June 28, 1992) and managed to reproduce its effects. In the present work we used it to reproduce the effects of the 1980’s Azores earthquake (January 1, 1980) in several islands, with different possible local site conditions. In those places, the response spectra are presented and compared with the buildings damage observed.

Aplicação de técnicas de optimização na utilização de acelerogramas registados

Actualmente, existe uma grande difusão de aparelhos digitais do tipo “strong-motion”, por todo mundo, que permitem registar movimentos sísmicos intensos. Também começa a ser frequente esses registos estarem disponíveis, na Internet, para acesso livre. O Eurocódigo 8 (EN 1998-1:2004) permite a representação da acção sísmica, no domínio do tempo, por intermédio de um número, não inferior a três, de acelerogramas registados. No entanto, a escolha desses acelerogramas, de forma a cumprir as regras impostas pelo EC8, reveste-se de alguma complexidade. Neste trabalho, apresentamos uma metodologia para selecção dos acelerogramas a utilizar nas análises sísmicas de estruturas. O que propomos é a escolha de um conjunto de factores multiplicadores dos acelerogramas, que ajustam os valores dos respectivos espectros de resposta às regras impostas pelo EC8. Recorre-se a técnicas de optimização numérica, por forma a quantificar os valores desses factores. Eles são determinados de modo a minimizarem a soma dos desvios em relação ao espectro de resposta objectivo, para o tipo de terreno em causa. A mesma técnica pode ser utilizada na determinação dos valores de TB, TC e TD dos espectros do EC8, depois de normalizados os espectros de resposta dos acelerogramas registados. São apresentados exemplos de aplicação das metodologias propostas a alguns casos de estudo.

Parâmetros que condicionam os valores da casualidade sísmica

As dispersões nos resultados das análises da casualidade sísmica têm originado alguma prudência na sua utilização em aplicações práticas de minimização de risco sísmico. Este trabalho visa a verificação, de forma sistemática e crítica, da influência de alguns parâmetros da análise, na credibilidade dos resultados, nomeadamente, o tipo de modelo probabilista adoptado, a delimitação das zonas geradoras de eventos sísmicos, a definição das leis de atenuação e a respectiva adequação à sismicidade verificada e às evidências sismotectónicas, no contexto da cidade de Lisboa.

Análise comparativa da casualidade sísmica do Algarve

In this paper we compared the seismic hazard of Algarve obtained with two different models: a point-source model (proposed by McGuire) and a fault-rupture model (proposed by Der Kiureghian and Ang).

Caracterização dinâmica das bancadas principais do Estádio Algarve

No presente artigo apresenta-se o estudo de revisão do Projecto de Estabilidade e Fundações das Bancadas Nascente e Poente do Estádio Algarve. Dá-se relevo ao comportamento dinâmico da estrutura da Bancada Poente, com a descrição das respostas da mesma perante a acção sísmica e a acção das multidões.

Contribuição para a avaliação do risco sísmico: aplicação à cidade de Faro

O programa SRAPOR permite a realização de rápidas avaliações de risco sísmico de aglomerados habitacionais. A presente versão é constituída por uma base de dados de sismos, por um sistema simplificado de informação geográfica e por um módulo de avaliação da casualidade sísmica. A aplicação do programa é ilustrada com a análise da casualidade sísmica da cidade de Faro.

Estudo da viabilidade da construção em alvenaria confinada no Algarve

Os sismos ocorridos nos últimos anos têm demonstrado um comportamento aceitável dos edifícios de pequeno porte, de alvenaria resistente confinada, que diversos estudos experimentais têm vindo a corroborar. No Algarve existe um tipo próprio de construção de pequeno porte, que embora constituindo uma profunda adulteração à construção vernacular, e tendo sido imposto por um impulso turístico pouco sustentado, se encontra abundantemente disseminado e que, por isso mesmo, constitui um conjunto suficientemente homogéneo para justificar uma análise de viabilidade de um processo construtivo. Neste trabalho, apresenta-se um estudo sobre a segurança estrutural de pequenas construções de alvenaria confinada, no enquadramento da referida tipologia e em conformidade com os materiais existentes na região. Procede-se a uma resumida caracterização tipológica dessas construções correntes e apresentam-se os resultados de alguns ensaios experimentais de alvenarias. Com base na tipologia construtiva e nos resultados experimentais, realizaram-se análises sísmicas (numéricas) de uma construção, tendo em vista a verificação da segurança no contexto dos Eurocódigos 6 e 8. Comparam-se, ainda, os resultados obtidos com alvenaria confinada (com elementos confinantes de betão armado), com os de estrutura reticulada em betão armado de baixa ductilidade (com alvenaria de preenchimento não resistente), para a mesma acção. Como consequência, alvitram-se algumas recomendações, visando a optimização dos processos construtivos, de que, eventualmente, as empresas regionais poderão usufruir, aquando da próxima entrada em vigor dos Eurocódigos Estruturais.

Exercise training reduces fatty acid availability and improves the insulin sensitivity of glucose metabolism

Aims/hypothesis - It is not known whether the beneficial effects of exercise training on insulin sensitivity are due to changes in hepatic and peripheral insulin sensitivity or whether the changes in insulin sensitivity can be explained by adaptive changes in fatty acid metabolism, changes in visceral fat or changes in liver and muscle triacylglycerol content. We investigated the effects of 6 weeks of supervised exercise in sedentary men on these variables. Subjects and methods - We randomised 17 sedentary overweight male subjects (age 50 ± 2.6 years, BMI 27.6 ± 0.5 kg/m2) to a 6-week exercise programme (n = 10) or control group (n = 7). The insulin sensitivity of palmitic acid production rate (Ra), glycerol Ra, endogenous glucose Ra (EGP), glucose uptake and glucose metabolic clearance rate were measured at 0 and 6 weeks with a two-step hyperinsulinaemic–euglycaemic clamp [step 1, 0.3 (low dose); step 2, 1.5 (high dose) mU kg−1 min−1]. In the exercise group subjects were studied >72 h after the last training session. Liver and skeletal muscle triacylglycerol content was measured by magnetic resonance spectroscopy and visceral adipose tissue by cross-sectional computer tomography scanning. Results - After 6 weeks, fasting glycerol, palmitic acid Ra (p = 0.003, p = 0.042) and NEFA concentration (p = 0.005) were decreased in the exercise group with no change in the control group. The effects of low-dose insulin on EGP and of high-dose insulin on glucose uptake and metabolic clearance rate were enhanced in the exercise group but not in the control group (p = 0.026; p = 0.007 and p = 0.04). There was no change in muscle triacylglycerol and liver fat in either group. Conclusions/interpretation - Decreased availability of circulating NEFA may contribute to the observed improvement in the insulin sensitivity of EGP and glucose uptake following 6 weeks of moderate exercise.

Detailed phenotypic and genotypic characterization of bietti crystalline dystrophy

OBJECTIVE: To provide a detailed phenotype/genotype characterization of Bietti crystalline dystrophy (BCD). DESIGN: Observational case series. PARTICIPANTS: Twenty patients from 17 families recruited from a multiethnic British population. METHODS: Patients underwent color fundus photography, near-infrared (NIR) imaging, fundus autofluorescence (FAF) imaging, spectral domain optical coherence tomography (SD-OCT), and electroretinogram (ERG) assessment. The gene CYP4V2 was sequenced. MAIN OUTCOME MEASURES: Clinical, imaging, electrophysiologic, and molecular genetics findings. RESULTS: Patients ranged in age from 19 to 72 years (median, 40 years), with a visual acuity of 6/5 to perception of light (median, 6/12). There was wide intrafamilial and interfamilial variability in clinical severity. The FAF imaging showed well-defined areas of retinal pigment epithelium (RPE) loss that corresponded on SD-OCT to well-demarcated areas of outer retinal atrophy. Retinal crystals were not evident on FAF imaging and were best visualized with NIR imaging. Spectral domain OCT showed them to be principally located on or in the RPE/Bruch's membrane complex. Disappearance of the crystals, revealed by serial recording, was associated with severe disruption and thinning of the RPE/Bruch's membrane complex. Cases with extensive RPE degeneration (N = 5) had ERGs consistent with generalized rod and cone dysfunction, but those with more focal RPE atrophy showed amplitude reduction without delay (N = 3), consistent with restricted loss of function, or that was normal (N = 2). Likely disease-causing variants were identified in 34 chromosomes from 17 families. Seven were novel, including p.Met66Arg, found in all 11 patients from 8 families of South Asian descent. This mutation appears to be associated with earlier onset (median age, 30 years) compared with other substitutions (median age, 41 years). Deletions of exon 7 were associated with more severe disease. CONCLUSIONS: The phenotype is highly variable. Several novel variants are reported, including a highly prevalent substitution in patients of South Asian descent that is associated with earlier-onset disease. Autofluorescence showed sharply demarcated areas of RPE loss that coincided with abrupt edges of outer retinal atrophy on SD-OCT; crystals were generally situated on or in the RPE/Bruch's complex but could disappear over time with associated RPE disruption. These results support a role for the RPE in disease pathogenesis.

O uso do smartphone na avaliação da dorsiflexão da tibiotársica, do passo rápido anterior/lateral/posterior e da marcha em idosos

Introdução: A correta avaliação das capacidades do idoso será fundamental na diminuição do risco de queda inerente ao envelhecimento. Os Smartphones são uma boa ferramenta para a avaliação das capacidades em idosos. Objetivo: Verificar se o smartphone é uma ferramenta de avaliação do ângulo de dorsiflexão ativa da tibiotársica (Dors. TT) e em diferentes parâmetros relacionados com a marcha. ; Métodos: Estudo transversal correlacional, com amostra composta por 27 indivíduos com mais de 60 anos. Procedeu-se à recolha de dados através de um sistema de análise cinemática em 3D com conexão a uma plataforma de forças e de uma aplicação para Smartphone (Fraunhofer®, Porto, Portugal), de forma a verificar a funcionalidade desta última. As variáveis medidas foram a Dors. TT; e todas a variáveis relacionadas com a marcha. Resultados: A dors. TT apresentou uma correlação forte positiva (rs=0,8; p<0,001) entre os dados dos dois instrumentos, assim como no balanço pélvico (rp=0,8; p<0,001), na velocidade na marcha (rp=0,7; p<0,001) e no nº de passos posteriores (rs=0,8; p<0,001). Observou-se uma correlação moderada positiva na duração do passo direito, na duração do passo, na duração da passada, na cadência, no comprimento do passo esq., no comprimento do passo e no deslocamento lateral da pélvis (rp=0,6; p≤0.008). Na percentagem da fase de apoio (%FA) (rs =-0.6; p= 0.007) e na medição da cadência lateral (rs =-0.4; p= 0.042) observou-se uma correlação moderada negativa e na cad. post. (rs=-0,7; p<0,001) uma correlação forte negativa. Conclusão: A aplicação para Smartphone parece ser uma ferramenta útil para avaliar corretamente o ângulo de dorsiflexão da tibiotársica, a contagem do número de passos no sentido posterior, o balanço pélvico e a velocidade. Contudo, necessita ser reajustada para as outras variáveis.