Intravenous immunoglobulin for treatment of mild-to-moderate Alzheimer's disease: a phase 2, randomised, double-blind, placebo-controlled, dose-finding trial.

BACKGROUND: Three small trials suggest that intravenous immunoglobulin can affect biomarkers and symptoms of mild-to-moderate Alzheimer's disease. We tested the safety, effective dose, and infusion interval of intravenous immunoglobulin in such patients. METHODS: We did a multicentre, placebo-controlled phase 2 trial at seven sites in the USA and five in Germany. Participants with probable Alzheimer's disease aged 50-85 years were randomly assigned (by a computer-generated randomisation sequence, with block sizes of eight) to infusions every 4 weeks (0·2, 0·5, or 0·8 g intravenous immunoglobulin per kg bodyweight, or placebo) or infusions every 2 weeks (0·1, 0·25, or 0·4 g/kg, or placebo). Patients, caregivers, investigators assessing outcomes, and staff at imaging facilities and the clinical research organisation were masked to treatment allocation, but dispensing pharmacists, the statistician, and the person responsible for final PET analyses were not. Treatment was masked with opaque pouches and infusion lines. The primary endpoint was median area under the curve (AUC) of plasma amyloid β (Aβ)(1-40) between the last infusion and the final visit (2 weeks or 4 weeks depending on infusion interval) in the intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT00812565) and controlled-trials.com (ISRCTN64846759). FINDINGS: 89 patients were assessed for eligibility, of whom 58 were enrolled and 55 included in the primary analysis. Median AUC of plasma Aβ(1-40) was not significantly different for intravenous immunoglobulin compared with placebo for five of the six intervention groups (-18·0 [range -1347·0 to 1068·5] for 0·2 g/kg, -364·3 [-5834·5 to 1953·5] for 0·5 g/kg, and -351·8 [-1084·0 to 936·5] for 0·8 g/kg every 4 weeks vs -116·3 [-1379·0 to 5266·0] for placebo; and -13·8 [-1729·0 to 307·0] for 0·1 g/kg, and -32·5 [-1102·5 to 451·5] for 0·25 g/kg every 2 weeks vs 159·5 [51·5 to 303·0] for placebo; p>0·05 for all). The difference in median AUC of plasma Aβ(1-40) between the 0·4 g/kg every 2 weeks group (47·0 [range -341·0 to 72·5]) and the placebo group was significant (p=0·0216). 25 of 42 (60%) patients in the intervention group versus nine of 14 (64%) receiving placebo had an adverse event. Four of 42 (10%) patients in the intravenous immunoglobulin group versus four of 14 (29%) receiving placebo had a serious adverse event, including one stroke in the intervention group. INTERPRETATION: Intravenous immunoglobulin may have an acceptable safety profile. Our results did not accord with those from previous studies. Longer trials with greater power are needed to assess the cognitive and functional effects of intravenous immunoglobulin in patients with Alzheimer's disease.

Extração e quantificação de alumínio trocável em Organossolos

O objetivo deste trabalho foi avaliar diferentes métodos de extração e quantificação de alumínio trocável em Organossolos. As amostras foram coletadas em três perfis de turfeira e, então, secas ao ar e passadas em peneira de malha de 2 mm. Foram feitas extrações com KCl 1 mol L-1 , Ca(OAc2) 1 mol L-1 e CuCl20,5 mol L-1 . Em seguida, os extratos obtidos por KCl e Ca(OAc2) foram analisados por titulação com NaOH 0,025 mol L-1 e por espectrômetro de absorção atômica com forno de grafite (GF-AAE). Os extratos obtidos por CuCl2 foram analisados por GF-AAE. Na quantificação por GF-AAE, os extratores KCl e Ca(OAc2) tiveram capacidade semelhante de extrair alumínio trocável, enquanto o CuCl2 foi capaz de extrair também o Al reativo. Os elevados teores de alumínio trocável observados na titulação após extração com KCl podem estar relacionados aos elevados teores do íon H+ presente nas amostras. O método indicado para determinação do teor de alumínio trocável em Organossolos é a extração com KCl ou com Ca(OAc2) e, para quantificação, a espectrofotometria de absorção atômica com forno de grafite.

Seletividade de agrotóxicos indicados na produção integrada de pêssego a Trichogramma pretiosum Riley, 1879 (Hymenoptera: trichogrammatidae)

A seletividade de agrotóxicos indicados nas Normas Técnicas Específicas da Produção Integrada de Pêssego (NTE-PIP) foi avaliada sobre Trichogramma pretiosum Riley, utilizando-se da metodologia padronizada internacionalmente pela International Organization for Biological and Integrated Control of Noxious Animals and Plants (IOBC). Os agrotóxicos (% ingrediente ativo na calda) Orthocide 500 (0,120) e Persist SC (0,160) foram classificados como inócuos; Hokko Cihexatim 500 (0,025) e Roundup WG (1,387) foram levemente nocivos; Assist (1,512) foi moderadamente nocivo; Sevin 480 SC (0,173), Tiomet 400 CE (0,048), Dipterex 500 (0,150) e Kumulus DF (0,480) foram nocivos a adultos de T. pretiosum no teste de toxicidade inicial em laboratório.

Alimentación, mortalidad y desarrollo de Cydia pomonella (L.) y de Cacoecimorpha pronubana (Hübner) sobre dieta con extracto de neem incorporado

Se han estudiado los efectos de 4 extractos del neem (Sukrina New ®, Rakshak ®, Margosan-O® y Azatin®) incorporados en la dieta larvaria sobre la alimentación, la mortalidad y el desarrollo de larvas de Cydia pomonella (L.) y de un extracto (Sukrina New ®) sobre Cacoecimorpha pronubana (Hübner) (ambos Lepidoptera, Tortricidae). C. pomonella fue más sensible a la acción de Sukrina New® que C. pronubana. Sobre esta última especie, no se detectaron cambios en el comportamiento de alimentación ni efectos sobre la mortalidad o la duración del desarrollo. Todos los extractos ensayados alteraron el comportamiento de alimentación de C. pomonella, cuyas larvas no penetraron en la dieta , pero sólo Azatin® mostró un efecto repelente o antiapetitivo. Margosan-O® y Rakshak® fueron los extractos más activos sobre C. pomonella, provocando un 100% de mortalidad a las concentraciones de 0,0625% y 0,025%, respectivamente. La mayoría de las larvas muertas presentaron síntomas asociados al proceso de la muda. Los individuos de C. pomonella alimentados con extracto de neem tuvieron un menor tamaño y una duración del desarrollo mayor que los de los testigos.

Uusien energianormien vaikutus pientalojen rakenteisiin ympäristön kannalta

Tehokkaimpia keinoja vähentää rakennusten lämmitysenergian kulutusta ja lämmityksen aiheuttavia hiilidioksidi- ja happamoitavia päästöjä on tiukentaa rakentamismääräysten lämmöneristysvaatimuksia. Hyvin lämmöneristetyissä, tiiveissä ja ilmanvaihdoltaan optimoiduissa taloissa on pienet lämpöhäviöt. Näin ympäristöä kuormittava vaikutus saadaan paljon vähemmäksi kuin nykynormien mukaisissa asuinrakennuksissa. Johtumislämpöhäviö pienenee suoraan eristekerroksia paksuntamalla ja siihen on helpointa vaikuttaa. Mitä suurempiin eristepaksuuksiin mennään sen suuremmaksi tulee konvektion osuus kokonaislämpöhäviöstä. Tulevaisuudessa parempia ratkaisuja haetaan erityisesti konvektiosta ja säteilystä aiheutuvien lämpöhäviöiden pienentämiseksi. Eristeen osastointi ilmanpitävillä, vesihöyryä diffuusisesti läpäisevillä pystysuuntaisilla konvektiokatkoilla vähentää tehokkaasti paksun seinäeristeen kuljettumis-ilmavirtauksia. Katkoina käytetään erilaisia kalvoja ja rakennuspapereita, joilla on pieni emissiviteetti. Katkojen merkitys kasvaa, kun mennään uusien normien mukaisiin eristepaksuuksiin. Lämmöneriste voidaan toteuttaa myös kokoamalla ohuita kalvoja paketiksi, jotka jakavat ilmatilan ja siis eristeelle varatun paksuuden suljettuihin ilmaväleihin. Kun kalvoiksi valitaan pieniemissiviteettisiä pintoja, saadaan säteilylämmönsiirto lähes eliminoiduksi. Tällaisen ilmatilan lämmönjohtumisluku lähestyy paikallaan pysyvän ilman lämmönjohtumislukua, l = 0,025 W/Km, eli tällä rakennesysteemillä on mahdollista toteuttaa ohuempia rakenteita kuin perinteisillä eristeillä. Hygroskooppisen massan käyttö sisäilman kosteutta tasaavana rakenteena voi olla tulevaisuutta. Kehitystyö tuottaa uusia, kosteusteknisesti toimivia sovelluksia. Toisaalta palomääräykset tulevat kehitystyötä vastaan. Hygroskooppinen pintamateriaali on kevyt (pieni tiheys) ja paloteknisesti arka. Suoraa sähkölämmitystä ei voida pitää ympäristöystävällisenä. Sen jalostusketju on pitkä ja monivaiheinen. Millä peruspolttoaineella sähköä tuotetaan, vaikuttaa asiaan luonnollisestikin. Suoraa sähkölämmitystä voidaan suositella vain yksinäisen ihmisen taloudessa lämmitysmuotona taloudellisista syistä. Halvan polttoaineen säästöllä ei voida maksaa suuria laiteinvestointeja. Aurinkoenergian hyvä hyödyntäminen edellyttää hyvää säätöä, joka kytkee lämmityksen pois päältä silloin, kun aurinko lämmittää. Auringon hetkelliset säteilytehot ovat suuria verrattuna rakenteen lämpöhäviöihin ja huonetilojen lämmöntarpeeseen. Ratkaisu aurinkoenergian hetkellisyyteen ja paikallisuuteen on energian siirtäminen lämmöntarpeen mukaan rakennuksen eri osiin ja sen varastoiminen päivätasolla. Kun varastoivasta massasta ei ole suoraa yhteyttä ulos, voidaan kerääjäeristeeltä saatu lämpö käyttää häviöttömästi huonetilojen lämmittämiseen. Vaikka lämmitysenergian käytössä päästään 30 % vähennyksiin uudisrakennusten osalta, ei kokonaisenergian käyttö merkittävästi pienene, jos taloussähkön kulutus pysyy vakiona. Sama pätee myös CO2 -päästöihin. Saavutettava etu lämmitys-energian kulutuksessa voidaan hukata yhä suurenevaksi taloussähkön käytöksi, mikä olisi erityisen huono asia ympäristön kannalta.

Efficacy and safety of once-daily aclidinium in chronic obstructive pulmonary disease

Background: The long-term efficacy and safety of aclidinium bromide, a novel, long-acting muscarinic antagonist, were investigated in patients with moderate to severe chronic obstructive pulmonary disease (COPD). Methods: In two double-blind, 52-week studies, ACCLAIM/COPD I (n = 843) and II (n = 804), patients were randomised to inhaled aclidinium 200 μg or placebo once-daily. Patients were required to have a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio of ≤70% and FEV1 <80% of the predicted value. The primary endpoint was trough FEV1 at 12 and 28 weeks. Secondary endpoints were health status measured by St George"s Respiratory Questionnaire (SGRQ) and time to first moderate or severe COPD exacerbation. Results: At 12 and 28 weeks, aclidinium improved trough FEV1 versus placebo in ACCLAIM/COPD I (by 61 and 67 mL; both p < 0.001) and ACCLAIM/COPD II (by 63 and 59 mL; both p < 0.001). More patients had a SGRQ improvement ≥4 units at 52 weeks with aclidinium versus placebo in ACCLAIM/COPD I (48.1% versus 39.5%; p = 0.025) and ACCLAIM/COPD II (39.0% versus 32.8%; p = 0.074). The time to first exacerbation was significantly delayed by aclidinium in ACCLAIM/COPD II (hazard ratio [HR] 0.7; 95% confidence interval [CI] 0.55 to 0.92; p = 0.01), but not ACCLAIM/COPD I (HR 1.0; 95% CI 0.72 to 1.33; p = 0.9). Adverse events were minor in both studies. Conclusion: Aclidinium is effective and well tolerated in patients with moderate to severe COPD. Trial registration: ClinicalTrials.gov: NCT00363896 ACCLAIM/COPD I) and NCT00358436 (ACCLAIM/COPD II).

Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients.

BACKGROUND: Studies that systematically assess change in ulcerative colitis (UC) extent over time in adult patients are scarce. AIM: To assess changes in disease extent over time and to evaluate clinical parameters associated with this change. METHODS: Data from the Swiss IBD cohort study were analysed. We used logistic regression modelling to identify factors associated with a change in disease extent. RESULTS: A total of 918 UC patients (45.3% females) were included. At diagnosis, UC patients presented with the following disease extent: proctitis [199 patients (21.7%)], left-sided colitis [338 patients (36.8%)] and extensive colitis/pancolitis [381 (41.5%)]. During a median disease duration of 9 [4-16] years, progression and regression was documented in 145 patients (15.8%) and 149 patients (16.2%) respectively. In addition, 624 patients (68.0%) had a stable disease extent. The following factors were identified to be associated with disease progression: treatment with systemic glucocorticoids [odds ratio (OR) 1.704, P = 0.025] and calcineurin inhibitors (OR: 2.716, P = 0.005). No specific factors were found to be associated with disease regression. CONCLUSIONS: Over a median disease duration of 9 [4-16] years, about two-thirds of UC patients maintained the initial disease extent; the remaining one-third had experienced either progression or regression of the disease extent.

SOIL ATTRIBUTES THREE YEARS AFTER MAKING RIDGES AND OR DRAINS FOR PLANTING GRAPEVINE ROOTSTOCK

RESUMO Os atributos do solo estão relacionados com o desenvolvimento e a produção das culturas, tanto anuais como perenes. O presente trabalho teve como objetivo determinar os atributos químicos e físicos do solo três anos após a aplicação de sistemas de manejo para implantação de porta-enxertos de videira, em um Nitossolo Vermelho com textura muito argilosa. Os sistemas de manejo consistiram na confecção ou não de camalhões e/ou de drenos antes da implantação das mudas de porta-enxertos Dog Ridge. Os atributos químicos (pH em água e teores de matéria orgânica e de macronutrientes) foram determinados em amostras coletadas na linha da cultura, nas camadas de 0-0,1; 0,1-0,2; 0,2-0,3 e 0,3-0,4 m de profundidade. Os atributos físicos do solo (teor de argila, densidade, porosidade, resistência à penetração e estabilidade dos agregados) foram determinados em amostras coletadas com estrutura preservada nas camadas de 0,025-0,075; 0,125-0,175; 0,225-0,275 e 0,325-0,375 m de profundidade. Também foram determinadas a massa seca de raízes do portaenxerto nas camadas de 0-0,2 e 0,2-0,4 m de profundidade e suas correlações com os atributos do solo. A confecção de camalhões alterou significativamente a maioria dos atributos químicos do solo e proporcionou maior uniformidade nos valores em profundidade, criando condições mais favoráveis ao crescimento radicular nas camadas mais profundas. Os atributos físicos foram menos afetados do que os químicos pela confecção de camalhões ou drenos, e não foram observados valores restritivos ao crescimento radicular nas camadas amostradas após quatro anos da aplicação dos sistemas de manejo do solo. A confecção de drenos alterou menos os atributos químicos e físicos do solo do que a confecção de camalhões.

Prevalence of Ischemic Heart Disease and Management of Coronary Risk in Daily Clinical Practice: Results from a Mediterranean Cohort of HIV-Infected Patients

There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) inHIV-infected patients. Methods.We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results.We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus).OtherCVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol ( � = 0.025) and LDLcholesterol ( � = 0.004) was observed. However, the percentage of patients whomaintained LDL-cholesterol > 100mg/dL remained stable (from 46% to 41%, � = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time ( � = 0.028). Conclusions.The prevalence of coronary events in our cohort is low. CVRF prevalence is high and theirmanagement is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.

Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients.

BACKGROUND: Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients. METHOD: Two hundred and twenty-five patients aged 18-35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up. RESULTS: There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not. CONCLUSION: Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

Thromboxane prostaglandin receptor antagonist and carotid atherosclerosis progression in patients with cerebrovascular disease of ischemic origin: a randomized controlled trial.

BACKGROUND AND PURPOSE: Thromboxane prostaglandin receptors have been implicated to be involved in the atherosclerotic process. We assessed whether Terutroban, a thromboxane prostaglandin receptor antagonist, affects the progression of atherosclerosis, as measured by common carotid intima-media thickness and carotid plaques. METHODS: A substudy was performed among 1141 participants of the aspirin-controlled Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin with Terutroban in Patients with a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM) trial. Common carotid intima-media thickness and carotid plaque occurrence was measured during a 3-year period. RESULTS: Baseline characteristics did not differ between Terutroban (n=592) and aspirin (n=549) treated patients and were similar as in the main study. Mean study and treatment duration were similar (28 and 25 months, respectively). In the Terutroban group, the annualized rate of change in common carotid intima-media thickness was 0.006 mm per year (95% confidence interval, -0.004 to 0.016) and -0.005 mm per year (95% confidence interval, -0.015 to 0.005) in the aspirin group. There was no statistically significant difference between the groups in the annualized rate of change of common carotid intima-media thickness (0.011 mm per year; 95% confidence interval, -0.003 to 0.025). At 12 months of follow-up, 66% of Terutroban patients had no emergent plaques, 31% had 1 to 2 emergent plaques, and 3% had ≥3 emergent plaques. In the aspirin group, the corresponding percentages were 64%, 32%, and 4%. Over time, there was no statistically significant difference in the number of emergent carotid plaques between treatment modalities (rate ratio, 0.91; 95% confidence interval, 0.77-1.07). CONCLUSIONS: Compared with aspirin, Terutroban did not beneficially affect progression of carotid atherosclerosis among well-treated patients with a history of ischemic stroke or transient ischemic attacks with an internal carotid stenosis <70%. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN66157730.

Characteristics of non-responders to self-reported questionnaires in a large inflammatory bowel disease cohort study.

BACKGROUND: A major threat to the validity of longitudinal cohort studies is non-response to follow-up, which can lead to erroneous conclusions. The objective of this study was to evaluate the profile of non-responders to self-reported questionnaires in the Swiss inflammatory bowel disease (IBD) Cohort. METHODS: We used data from adult patients enrolled between November 2006 and June 2011. Responders versus non-responders were compared according to socio-demographic, clinical and psychosocial characteristics. Odds ratio for non-response to initial patient questionnaire (IPQ) compared to 1-year follow-up questionnaire (FPQ) were calculated. RESULTS: A total of 1943 patients received IPQ, in which 331 (17%) did not respond. Factors inversely associated with non-response to IPQ were age >50 and female gender (OR = 0.37; p < 0.001 respectively OR = 0.63; p = 0.003) among Crohn's disease (CD) patients, and disease duration >16 years (OR = 0.48; p = 0.025) among patients with ulcerative colitis (UC). FPQ was sent to 1586 patients who had completed the IPQ; 263 (17%) did not respond. Risk factors of non-response to FPQ were mild depression (OR = 2.17; p = 0.003) for CD, and mild anxiety (OR = 1.83; p = 0.024) for UC. Factors inversely associated with non-response to FPQ were: age >30 years, colonic only disease location, higher education and higher IBD-related quality of life for CD, and age >50 years or having a positive social support for UC. CONCLUSIONS: Characteristics of non-responders differed between UC and CD. The risk of non-response to repetitive solicitations (longitudinal versus transversal study) seemed to decrease with age. Assessing non-respondents' characteristics is important to document potential bias in longitudinal studies.