Association of urethral toxicity with dose exposure in combined high-dose-rate brachytherapy and intensity-modulated radiation therapy in intermediate- and high-risk prostate cancer.

INTRODUCTION: To report acute and late toxicities in patients with intermediate- and high-risk prostate cancer treated with combined high-dose-rate brachytherapy (HDR-B) and intensity-modulated radiation therapy (IMRT). MATERIALS AND METHODS: From March 2003 to September 2005, 64 men were treated with a single implant HDR-B with 21 Gy given in three fractions, followed by 50 Gy IMRT along with organ tracking. Median age was 66.1 years, and risk of recurrence was intermediate in 47% of the patients or high in 53% of the patients. Androgen deprivation therapy was received by 69% of the patients. Toxicity was scored according to the CTCAE version 3.0. Median follow-up was 3.1 years. RESULTS: Acute grade 3 genitourinary (GU) toxicity was observed in 7.8% of the patients, and late grades 3 and 4 GU toxicity was observed in 10.9% and 1.6% of the patients. Acute grade 3 gastrointestinal (GI) toxicity was experienced by 1.6% of the patients, and late grade 3 GI toxicity was absent. The urethral V(120) (urethral volume receiving > or =120% of the prescribed HDR-B dose) was associated with acute (P=.047) and late > or = grade 2 GU toxicities (P=.049). CONCLUSIONS: Late grades 3 and 4GU toxicity occurred in 10.9% and 1.6% of the patients after HDR-B followed by IMRT in association with the irradiated urethral volume. The impact of V(120) on GU toxicity should be validated in further studies.

Constrained peptidomimetics reveal detailed geometric requirements of covalent prolyl oligopeptidase inhibitors.

Prolyl oligopeptidases cleave peptides on the carboxy side of internal proline residues and their inhibition has potential in the treatment of human brain disorders. Using our docking program fitted, we have designed a series of constrained covalent inhibitors, built from a series of bicyclic scaffolds, to study the optimal shape required for these small molecules. These structures bear nitrile functional groups that we predicted to covalently bind to the catalytic serine of the enzyme. Synthesis and biological assays using human brain-derived astrocytic cells and endothelial cells and human fibroblasts revealed that these compounds act as selective inhibitors of prolyl oligopeptidase activity compared to prolyl-dipeptidyl-aminopeptidase activity, are able to penetrate the cells and inhibit intracellular activities in intact living cells. This integrated computational and experimental study shed light on the binding mode of inhibitors in the enzyme active site and will guide the design of future drug-like molecules.

Étude des biais sur la dose parentérale d'un nouveau médicament lors d'un essai clinique avec profil cinétique

Introduction et objectif: Lors d'essais cliniques, le pharmacien est responsable de la préparation et de la dispensation des médicaments à évaluer. Un article récent a toutefois montré que les aspects pharmaceutiques liés au contrôle de la dose administrée in fine étaient souvent mal contrôlés. Il peut exister une différence entre la dose nominale fournie par le certificat d'analyse du fabricant et la dose réellement administrée au sujet, biais qui se reporte en cascade sur l'estimation des paramètres pharmacocinétiques (PK), comme la clairance ou le volume de distribution. Ce travail visait à évaluer les biais entachant la quantité de médicament réellement injectée (iv/sc) aux volontaires d'un essai clinique étudiant la PK et la relation dose-réponse d'un nouveau produit biotechnologique. Méthode: La dose de médicament administrée lors de l'essai clinique (D) a été calculée de la manière suivante: D = C * V - pertes. La concentration du produit (C; titre nominal du fabricant) a été vérifiée par immuno-essai. Le volume de médicament injecté (V) a été déterminé pour chaque injection par pesée (n=72), en utilisant la masse de la seringue avant et après injection et la densité du produit. Enfin, une analyse in vitro a permis d'évaluer les pertes liées à l'adsorption du produit dans les lignes de perfusion et de choisir le dispositif adéquat in vivo. Résultats: La concentration du médicament s'est révélée proche du titre nominal (96 ± 7%), et a été utilisée comme référence. Le volume injecté était quant à lui entaché d'un biais systématique par rapport à la valeur théorique correspondant à 0.03 mL pour la dose minimale (i.e. 75% du volume à injecter à cette dose). Une analyse complémentaire a montré que cela s'expliquait par une réaspiration partielle de la solution médica-menteuse avant le retrait de la seringue après injection sc, due à l'élasticité du piston. En iv, le biais était par contre provoqué par une réaspiration du soluté de perfusion co-administré. Enfin, la mesure des quantités de médicament récupérées après injection dans le dispositif de perfusion a démontré des pertes minimales par adsorption. Discussion-conclusion: Cette étude confirme l'existence de biais inversement corrélés au volume et à la concentration du médicament administré, pouvant provoquer des erreurs importantes sur les paramètres PK. Ce problème est négligé ou insuffisamment considéré dans les protocoles de Phase I et nécessiterait une planification rigoureuse. Les procédures opératoires devraient attirer l'attention sur ce point crucial.

Installation Information requirements in the GPLv3 and LGPLv3

One of the major changes introduced in the GPLv3 and LGPLv3 is the clause preventing "tivoisation". Richard Stallman defines Tivoisation as "the practice of designing hardware so that a modified version cannot function properly". In this presentation we will go through the reasons of why the information installation requirement was introduced, how you can comply with this requirement and why you may want to think about it now rather than later.

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.

Pollination requirements of seeded and seedless mini watermelon varieties cultivated under protected environment

The objective of this work was to evaluate the floral biology and pollination requirements of seeded and seedless mini watermelon varieties, and to determine the best varieties to cultivate under protected environment. Three seedless (HA-5106, HA-5158, and HA-5161) and two seeded (Minipol and Polimore) genotypes were tested. Flowers were monitored from the pre-anthesis stage to senescence, and fruit quality was also evaluated. The evaluated treatments were hand-geitonogamous pollination (MG), cross-pollination with pollen from the Polimore variety (MCP), cross-pollination with pollen from the Minipol variety (MCM), and restricted pollination. All varieties had monoecious plants with diclinous flowers, and the stigmas remained receptive throughout anthesis. Fruit set rates of 84.62% (MG), 61.54% (MCP), 48% (MCM), and 0% (restricted) were obtained for seeded varieties, but of 0% (MG), 76.36% (MCP), 82.69% (MCM), and 0% (restricted) for seedless varieties. Fruits did not differ in quality among treatments within each genotype. Therefore, all the studied varieties require a pollination agent and diploid pollen for fruit set to occur, regardless of the donor variety; and Minipol or Polimore with HA-5106 or HA-5158 are the varieties recommended for cultivation in protected environment.

Effect of Tocopherol Extract, Staphylococcus carnosus Culture, and Celery Concentrate Addition on Quality Parameters of Organic and Conventional Dry-Cured Sausages

The effects of the addition to sausage mix of tocopherols (200 mg/kg), a conventional starter culture with or without Staphylococcus carnosus, celery concentrate (CP) (0.23% and 0.46%), and two doses of nitrate (70 and 140 mg/kg expressed as NaNO(3)) on residual nitrate and nitrite amounts, instrumental CIE Lab color, tocol content, oxidative stability, and overall acceptability were studied in fermented dry-cured sausages after ripening and after storage. Nitrate doses were provided by nitrate-rich CP or a chemical grade source. The lower dose complies with the EU requirements governing the maximum for ingoing amounts in organic meat products. Tocopherol addition protected against oxidation, whereas the nitrate dose, nitrate source, or starter culture had little influence on secondary oxidation values. The residual nitrate and nitrite amounts found in the sausages with the lower nitrate dose were within EU-permitted limits for organic meat products and residual nitrate can be further reduced by the presence of the S. carnosus culture. Color measurements were not affected by the CP dose. Product consumer acceptability was not affected negatively by any of the factors studied. As the two nitrate sources behaved similarly for the parameters studied, CP is a useful alternative to chemical ingredients for organic dry-cured sausage production.

Canakinumab Relieves Symptoms of Acute Flares and Improves Health-Related Quality Of Life (HRQoL) in Difficult-To-Treat Gouty Arthritis Patients by Suppressing Inflammation: Results of a Randomized, Dose-Ranging Study

RATIONALE:We investigated the impact of canakinumab, a fully human anti-interleukin-1b monoclonal antibody on inflammation and HRQoL in gouty arthritis patients.METHODS: In this 8-week, single-blind, dose-ranging study, patients with acute gouty arthritis flares, unresponsive/intolerant or contraindicated to NSAIDs and/or colchicine were randomized to single subcutaneous canakinumab (10, 25, 50, 90, or 150mg, N5143) or single intramuscular triamcinolone acetonide (TA, 40mg, N557). Patients assessed pain (Likert scale), physicians assessed clinical signs of joint inflammation, and HRQoL was recorded using SF-36.RESULTS: At baseline, 98% patients had moderate-to-extreme pain, 85% had moderate/severe joint swelling, 64-79% had elevated inflammatory markers and HRQoL scores indicated impaired physical function. Percentage of patients with no/mild pain was numerically greater in most canakinumab groups vs. TA, 24-72h post-dose; difference significant for 150mg group at these time-points (P<0.05). Canakinumab 150mg was associated with significantly lower Likert scores for tenderness [OR, 3.2; 95% CI, 1.27-7.89; P50.014] and swelling (OR, 2.7; 95% CI, 1.09-6.50, P50.032) at 72h vs. TA; erythema was not different. Median CRP and SAA levels normalized by 7 days post-dose in most canakinumab groups, but remained elevated in TA. Physical function improved at 7 days postdose in all groups, highest improvement for canakinumab 150mg. SF-36 scores for physical functioning and bodily pain with canakinumab 150mg approached US general population scores by 7 days post-dose and exceeded normal values by 8 weeks post-dose.CONCLUSION: Canakinumab 150mg produced significantly greater and rapid pain-relief and improvements in HRQoL vs. TAin acute gouty arthritis patients.

Oral rivaroxaban for symptomatic venous thromboembolism.

BACKGROUND: Rivaroxaban, an oral factor Xa inhibitor, may provide a simple, fixed-dose regimen for treating acute deep-vein thrombosis (DVT) and for continued treatment, without the need for laboratory monitoring. METHODS: We conducted an open-label, randomized, event-driven, noninferiority study that compared oral rivaroxaban alone (15 mg twice daily for 3 weeks, followed by 20 mg once daily) with subcutaneous enoxaparin followed by a vitamin K antagonist (either warfarin or acenocoumarol) for 3, 6, or 12 months in patients with acute, symptomatic DVT. In parallel, we carried out a double-blind, randomized, event-driven superiority study that compared rivaroxaban alone (20 mg once daily) with placebo for an additional 6 or 12 months in patients who had completed 6 to 12 months of treatment for venous thromboembolism. The primary efficacy outcome for both studies was recurrent venous thromboembolism. The principal safety outcome was major bleeding or clinically relevant nonmajor bleeding in the initial-treatment study and major bleeding in the continued-treatment study. RESULTS: The study of rivaroxaban for acute DVT included 3449 patients: 1731 given rivaroxaban and 1718 given enoxaparin plus a vitamin K antagonist. Rivaroxaban had noninferior efficacy with respect to the primary outcome (36 events [2.1%], vs. 51 events with enoxaparin-vitamin K antagonist [3.0%]; hazard ratio, 0.68; 95% confidence interval [CI], 0.44 to 1.04; P<0.001). The principal safety outcome occurred in 8.1% of the patients in each group. In the continued-treatment study, which included 602 patients in the rivaroxaban group and 594 in the placebo group, rivaroxaban had superior efficacy (8 events [1.3%], vs. 42 with placebo [7.1%]; hazard ratio, 0.18; 95% CI, 0.09 to 0.39; P<0.001). Four patients in the rivaroxaban group had nonfatal major bleeding (0.7%), versus none in the placebo group (P=0.11). CONCLUSIONS: Rivaroxaban offers a simple, single-drug approach to the short-term and continued treatment of venous thrombosis that may improve the benefit-to-risk profile of anticoagulation. (Funded by Bayer Schering Pharma and Ortho-McNeil; ClinicalTrials.gov numbers, NCT00440193 and NCT00439725.).

Green Field fluteboard factory infrastructure requirements in Russia

Russian corrugated board market is rapidly developing. Owing to that Russia becomes more and more attractive to the companies ¿ world leaders in corrugated board production. Thus, in order to strengthen or even to maintain its market position the firm should uninterruptedly develop improving volume and quality of the products. At the same time operations in the Russian market are commonlyassociated with various types of risks which should be avoided. Unfortunately, the information of the Russian corrugated board market is not systematized yet there is almost no theoretical background in this areaand, therefore, the thesis is mainly based on the practical experience of the managers of Stora Enso. The goal of the paper is to define and describe the main particularities of Russian corrugated board market which are lying in different areas and to concentrate on the difficultieswith which a corrugated board factory may face while functioning in the Russian market. The contribution of the thesis consists of forming general requirements and principles while establishing a corrugated boardproduction facility and maintaining its operations in order to avoid risks, to save time and financial resources and as a result to operate in the Russian market obtaining higher profits.

Early high-dose treatment: SCT results from the European High Risk Neuroblastoma Study

Aims: The HR-NBL1 Study of the European SIOP Neuroblastoma Group (SIOPEN) randomised two high dose regimens to learn about potential superiority and toxicity profiles.Patients and Methods: At interim analysis 1483 high risk neuroblastoma patients (893 males) were included since 2002 with either INSS stage 4 disease (1383 pts) above 1 year, or as infants (59 pts) and stage 2&3 of any age (145 pts) with MYCN amplification. The median age at diagnosis was 2.9 years (1 month-19.9 years) with a median follow up of 3 years. Response eligibility criteria prior randomisation after Rapid Cojec Induction (J Clin Oncol, 2010) ± 2 courses of TVD (Cancer, 2003) included complete bone marrow remission and at least partial response at skeletal sites with no more than 3, but improved mIBG positive spots and a PBSC harvest of at least 3x10E6 CD34/kgBW. The randomised regimens were BuMel [busulfan oral till 2006, 4x150mg/m² in 4 ED; or intravenous use according to body weight as licenced thereafter; melphalan 140mg/m²/day) and CEM [carboplatinum ctn. infusion (4x AUC 4.1mg/ml.min/day, etoposid ctn. infusion (4x 338mg/m²/day or [4x 200mg/m²/day]*, melphalan (3x70mg/m²/day; 3x60mg/m²/day*;*reduced dosis if GFR< 100ml/min/1.73m²). Supportive care followed institutional guidelines. VOD prophylaxis included ursadiol, but randomised patients were not eligible for the prophylactic defibrotide trial. Local control included surgery and radiotherapy of 21Gy.Results: Of 1483 patients, 584 were being randomised for the high dose question at data lock. A significant difference in event free survival (3-year EFS 49% vs. 33%, p<0.001) and overall survival (3-year OS 61% vs. 48%, p=0.003) favouring the BuMel regimen over the CEM regimen was demonstrated. The relapse/progression rate was significantly higher after CEM (0.60±0.03) than after BuMel (0.48±0.03)(p<0.001). Toxicity data had reached 80% completeness at last analysis. The severe toxicity rate up to day 100 (ICU and toxic deaths) was below 10%, but was significantly higher for CEM (p= 0.014). The acute toxic death rate was 3% for BuMel and 5% for CEM (NS). The acute HDT toxicity profile favours the BuMel regimen in spite of a total VOD incidence of 18% (grade 3:5%).Conclusions: The Peto rule of P<0.001 at interim analysis on the primary endpoint, EFS was met. Hence randomization was stopped with BuMel as recommended standard treatment in the HR-NBl1/SIOPEN trial which is still accruing for the randomised immunotherapy question.

Yeast vacuoles fragment in an asymmetrical two-phase process with distinct protein requirements.

Yeast vacuoles fragment and fuse in response to environmental conditions, such as changes in osmotic conditions or nutrient availability. Here we analyze osmotically induced vacuole fragmentation by time-lapse microscopy. Small fragmentation products originate directly from the large central vacuole. This happens by asymmetrical scission rather than by consecutive equal divisions. Fragmentation occurs in two distinct phases. Initially, vacuoles shrink and generate deep invaginations that leave behind tubular structures in their vicinity. Already this invagination requires the dynamin-like GTPase Vps1p and the vacuolar proton gradient. Invaginations are stabilized by phosphatidylinositol 3-phosphate (PI(3)P) produced by the phosphoinositide 3-kinase complex II. Subsequently, vesicles pinch off from the tips of the tubular structures in a polarized manner, directly generating fragmentation products of the final size. This phase depends on the production of phosphatidylinositol-3,5-bisphosphate and the Fab1 complex. It is accelerated by the PI(3)P- and phosphatidylinositol 3,5-bisphosphate-binding protein Atg18p. Thus vacuoles fragment in two steps with distinct protein and lipid requirements.