The need for combination antihypertensive therapy to reach target blood pressures: what has been learned from clinical practice and morbidity-mortality trials?

Pharmacological treatment of hypertension represents a cost-effective way for preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment blood pressure (BP) should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Most of the time such targets cannot be reached using monotherapies. This is especially true in patients who exhibit a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases BP control. Such preparations are not only efficacious, but also well tolerated, and some fixed low-dose combinations have a tolerability profile similar to placebo. This is for instance the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has recently been shown in controlled interventional trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving macrovascular stiffness. Fixed-dose combinations are becoming more and more popular and are even proposed by current hypertension guidelines as a first-line option to treat hypertensive patients.

Treatment of brain metastases from non-small cell lung cancer with whole-brain radiotherapy (wbrt) in combination with gefitinib (gft) or temozolomide (tmz): a randomized multicenter phase ii trial of the swiss group of clinical cancer research (sakk #70/03)

BACKGROUND: Patients with BM rarely survive .6 months and are commonly excluded from clinical trials. We aimed at improving outcome by exploring 2 combined modality regimens with at the time novel agents for which single-agent activity had been shown. METHODS: NSCLC patients with multiple BM were randomized to WBRT (10 × 3 Gy) and either GFT 250 mg p.o. daily or TMZ 75 mg/m2 p.o. daily ×21/28 days, starting on Day 1 of RT and to be continued until PD. Primary endpoint was overall survival, a Simon's optimal 2-stage design was based on assumptions for the 3-month survival rate. Cognitive functioning and quality of life were also evaluated. RESULTS: Fifty-nine patients (36 M, 23 F; 9 after prior chemo) were included. Median age was 61 years (range 46-82), WHO PS was 0 in 18 patients, 1 in 31 patients, and 2 in 10 patients. All but 1 patients had extracranial disease; 33 of 43 (TMZ) and 15 of 16 (GFT) had adenocarcinoma histology. GFT arm was closed early after stage 1 analysis when the prespecified 3-mo survival rate threshold (66%) was not reached, causes of death were not GFT related. Main causes of death were PD in the CNS 24%, systemic 41%, both 8%, and toxicity 10% [intestinal perforation (2 patients), pneumonia (2), pulmonary emboli (1), pneumonitis NOS (1), seizure (1)]. We summarize here other patients' characteristics for the 2 trial arms: TMZ (n ¼ 43)/GFT (n ¼ 16); median treatment duration: 1.6 /1.8 mo; Grade 3-4 toxicity: lymphopenia 5 patients (12%)/0; fatigue 8 patients (19%)/2 patients (13%). Survival data for TMZ/GFT arms: 3-month survival rate: 58.1% (95% CI 42.1-73)/62.5% (95% CI 35- 85); median OS: 4.9 months (95% CI 2.5-5.6)/6.3 months (95% CI 2.2- 14.6); median PFS: 1.8 months (95% CI 1.5-1.8)/1.8 (95% CI 1.1-3.9); median time to neurol. progr.: 8.0 months (95% CI 2.2-X)/4.8 (95% CI 3.9-10.5). In a model to predict survival time including the variables' age, PS, number of BM, global QL, total MMSE score, and subjective cognitive function, none of the variables accounted for a significant improvement in survival time. CONCLUSIONS: The combinations of WBRT with GFT or TMZ were feasible. However, in this unselected patient population, survival remains poor and a high rate of complication was observed. Four patients died as a result of high-dose corticosteroids. Preliminary evaluation of cognitive function andQL failed to show significant improvement. Indications and patient selection for palliative treatment should be revisited and careful monitoring and supportive care is required. Research and progress for this frequent clinical situation is urgently needed. Trial partly supported by AstraZeneca (Switzerland), Essex Chemie (Switzerland) and Swiss Federal Government.

Effects of preset sequential administrations of sunitinib and everolimus on tumour differentiation in Caki-1 renal cell carcinoma.

BACKGROUND: Sunitinib (VEGFR/PDGFR inhibitor) and everolimus (mTOR inhibitor) are both approved for advanced renal cell carcinoma (RCC) as first-line and second-line therapy, respectively. In the clinics, sunitinib treatment is limited by the emergence of acquired resistance, leading to a switch to second-line treatment at progression, often based on everolimus. No data have been yet generated on programmed alternating sequential strategies combining alternative use of sunitinib and everolimus before progression. Such strategy is expected to delay the emergence of acquired resistance and improve tumour control. The aim of our study was to assess the changes in tumours induced by three different sequences administration of sunitinib and everolimus. METHODS: In human Caki-1 RCC xenograft model, sunitinib was alternated with everolimus every week, every 2 weeks, or every 3 weeks. Effects on necrosis, hypoxia, angiogenesis, and EMT status were assessed by immunohisochemistry and immunofluorescence. RESULTS: Sunitinib and everolimus programmed sequential regimens before progression yielded longer median time to tumour progression than sunitinib and everolimus monotherapies. In each group of treatment, tumour growth control was associated with inhibition of mTOR pathway and changes from a mesenchymal towards an epithelial phenotype, with a decrease in vimentin and an increase in E-cadherin expression. The sequential combinations of these two agents in a RCC mouse clinical trial induced antiangiogenic effects, leading to tumour necrosis. CONCLUSIONS: In summary, our study showed that alternate sequence of sunitinib and everolimus mitigated the development of mesenchymal phenotype compared with sunitinib as single agent.

Fuzzy Principal Components Analysis

Due to the large number of characteristics, there is a need to extract the most relevant characteristicsfrom the input data, so that the amount of information lost in this way is minimal, and the classification realized with the projected data set is relevant with respect to the original data. In order to achieve this feature extraction, different statistical techniques, as well as the principal components analysis (PCA) may be used. This thesis describes an extension of principal components analysis (PCA) allowing the extraction ofa finite number of relevant features from high-dimensional fuzzy data and noisy data. PCA finds linear combinations of the original measurement variables that describe the significant variation in the data. The comparisonof the two proposed methods was produced by using postoperative patient data. Experiment results demonstrate the ability of using the proposed two methods in complex data. Fuzzy PCA was used in the classificationproblem. The classification was applied by using the similarity classifier algorithm where total similarity measures weights are optimized with differential evolution algorithm. This thesis presents the comparison of the classification results based on the obtained data from the fuzzy PCA.

Evaluation of existing technologies in manufacturing of decorative solutions

Matkapuhelinvalmistajien välinen kilpailu kiristyy jatkuvasti. Tuotteiden ollessa teknisiltä ominaisuuksiltaan lähes samanvertaisia, asiakkaat alkavat kiinnittää huomiota myös puhelimen muihin ominaisuuksiin.Puhelimen koristeellisuudesta ja mandollisuudesta personoida matkapuhelin, on muodostumassa entistä tärkeämpiä tekijöitä puhelinvalmistajien välisessä kilpailussa. Asiakas ei myöskään ole valmis odottamaan puhelintaan, vaan haluaa puhelimensa nopesti. Lyhyt läpimenoaika on puhelinvalmistajille elintärkeä kilpailutekijä. Tämän työn tehtävänä on tutkija puhelinvalmistajien alihankkijan teknologisiamandollisuuksia laajentaa tuotevalikoimaansa vastaamaan tämän päivän tarpeita koristella matkaviestimiä. Teknologioioden sovellukset, Tuotantokustannukset, läpimenoajat ja teknologoiden riskit ovat tutkimuksen pääkohteet. Tavoitteena on saavuttaa käsitys kohdeyrityksen mandollisuuksista vastata asiakkaansa tarpeisiin olemassa olevilla teknologioilla ja niiden kombinaatioililla.

Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion

Previous studies have examined the experience of owning a virtual surrogate body or body part through specific combinations of cross-modal multisensory stimulation. Both visuomotor (VM) and visuotactile (VT) synchronous stimulation have been shown to be important for inducing a body ownership illusion, each tested separately or both in combination. In this study we compared the relative importance of these two cross-modal correlations, when both are provided in the same immersive virtual reality setup and the same experiment. We systematically manipulated VT and VM contingencies in order to assess their relative role and mutual interaction. Moreover, we present a new method for measuring the induced body ownership illusion through time, by recording reports of breaks in the illusion of ownership ("breaks") throughout the experimental phase. The balance of the evidence, from both questionnaires and analysis of the breaks, suggests that while VM synchronous stimulation contributes the greatest to the attainment of the illusion, a disruption of either (through asynchronous stimulation) contributes equally to the probability of a break in the illusion.

Hitsaussuojakaasujen tehokas ja taloudellinen käyttö

Suojakaasun päätehtävänä on suojata hitsaustapahtumaa ympäröivän ilman vaikutukselta. Päätehtävän lisäksi suojakaasullavoidaan vaikuttaa suoraan tai välillisesti lähes kaikkiin hitsauksen asioihin, joista laatu, tehokkuus ja taloudellisuus muodostuvat. Suojakaasuja tarvitsevat hitsausmenetelmät ovat: kaasukaarihitsausprosessit (MIG/MAG-, TIG- ja plasmahitsaus), laserhitsaus sekä näiden yhdistelmät eli hybridihitsausmenetelmät sekä MIG-juotto. Hitsaussuojakaasujen peruskaasu tänä päivänä on argon, johon hitsausprosessista tai materiaalistariippuen sekoitetaan hiilidioksidia, heliumia, vetyä tai happea. Pääsääntöisesti hitsaussuojakaasut ovat kahden komponentin kaasuja, mutta 3-komponenttikaasut ovat yleistymässä. Sopivalla suojakaasuseostuksella saadaan erittäin merkittävä hyöty tuottavuuden lisääntyessä ja laadun parantuessa. Suojakaasujen oikealla toimitusmuodolla on merkittävä vaikutus kokonaiskustannuksiin. Uudet, kehittyneet sekoitinlaitteet mahdollistavat tarkat osakomponenttien sekoittamiset hitsauspaikalla. Seokset ovat jatkuvasti analysoitavissa ja jäljitettävissä. Suojakaasujen kierrätys on erityisesti kalliiden kaasujen, kuten helium ja argon, kohdalta tulevaisuuden haaste ja mahdollisuus. Suojakaasulla on suuri merkitys hitsauksen tuottavuuteen, taloudellisuuteen ja myös hitsausympäristöön ja työturvallisuuteen. Robottihitsauksen lisääntyminen asettaa vaatimuksia, joihinoikein valitulla suojakaasulla voidaan myönteisesti vaikuttaa. Tehokashitsaus on valmistusprosessin tärkeä osa, jossa oikein valituilla suojakaasuilla saavutetaan merkittävä tuottavuuden lisäys vaikuttamalla kaariominaisuuksiin, tunkeumaan, roiskeisiin, nopeuteen, hitsimetallurgiaan, lämmöntuontiin ja hitsausympäristöön. Diplomityössä tutkittiin casena Peikko Finland Oy:n suojakaasujärjestelmät, niiden tehokkuus, toimivuus ja sopivuus konepajan tuotantoon ja erityisesti robottihitsaukseen.

Tolerance to preharvest sprouting and yield of wheat genotypes from different breeding programs

Abstract:The objective of this work was to characterize the performance of elite wheat genotypes from different Brazilian breeding programs for traits associated with grain yield and preharvest sprouting. The study was conducted in 2010 and 2011 in the municipality of Capão do Leão, in the state of Rio Grande do Sul, Brazil, in a randomized complete block design with three replicates. Thirty-three wheat genotypes were evaluated for traits related to preharvest sprouting and grain yield. The estimate of genetic distance was used to predict potential combinations for selection of plants with high grain yield and tolerance to preharvest sprouting. The combined analysis of sprouted grains and falling number shows that the TBIO Alvorada, TBIO Mestre, Frontana, Fundacep Raízes, Fundacep Cristalino, and BRS Guamirim genotypes are tolerant to preharvest sprouting. Combinations of TBIO Alvorada and TBIO Mestre with Fundacep Cristalino show high potential for recovering superior genotypes for high grain yield and tolerance to preharvest sprouting.

Language variation in source texts and their translations: the case of L3 in film translation

In addition to the two languages essentially involved in translation, that of the source text (L1) and that of the target text (L2), we propose a third language (L3) to refer to any other language(s) found in the text. L3 may appear in the source text (ST) or the target text (TT), actually appearing more frequently inSTs in our case studies. We present a range of combinations for the convergence and divergence of L1, L2 and L3, for the case of feature films and their translations using examples from dubbed and subtitled versions of films, but we are hopeful that our tentative conclusions may be relevant to other modalities of translation, audiovisual and otherwise. When L3 appears in an audiovisual ST,we find a variety of solutions whereby L3 is deleted from or adapted to the TT.In the latter case, L3 might be rendered in a number of ways, depending on factors such as the audience’s familiarity with L3, and the possibility that L3 inthe ST is an invented language.

Antipsychotic polypharmacy in a regional health service: a population-based study

Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine. Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.

Tietokantakäyttäjän autentikoinnin ja auktorisoinnin hallinnointi Active Directory -ympäristössä

Usean nykypäivän yrityksen tietojärjestelmäinfrastruktuuri on muotoutunut heterogeeniseksi ympäristöksi, jossa eri käyttöjärjestelmä- ja laitealustoilla toimii usean eri valmistajan toimittamia järjestelmiä. Heterogeenisen ympäristön hallitsemiseksi yritykseltä vaaditaan keskitettyä tietovarastoa, johon on tallennettu tietoa käytetystä järjestelmäympäristöstä sekä sen komponenteista. Tähän tarkoitukseen Microsoft toi markkinoille vuonna 1999 Active Directory 2000 -hakemistopalvelun. Heterogeenisessa ympäristössä käyttäjien autentikointi ja auktorisointi on erittäin vaativaa. Pahimmassa tapauksessa käyttäjällä voi olla kymmeniä käyttäjätunnus-salasana-yhdistelmiä yrityksen eri tietojärjestelmiin. Lisäksi jokaisessa tietojärjestelmässäon ylläpidettävä käyttäjäkohtaisia toimintavaltuuksia. Niin käyttäjän kuin ylläpitäjänkin näkökulmasta tällainen skenaario on painajainen. Tässä diplomityössä kartoitetaan mahdollisuuksia Oracle-tietokantojen käyttäjien autentikoinnin sekä auktorisoinnin keskittämiseksi Active Directory -hakemistopalveluun. Työssä tarkastellaan tarkoitukseen soveltuvia valmiita kaupallisia ratkaisuja sekä tutkitaan mahdollisuuksia oman ratkaisumallin toteuttamiseksi umpäristöstä löytyvien ohjelmointirajapintojen avulla.

Puukuitulujitteiset muovikomposiitit puunjalostusteollisuudessa

Puukuitulujitteisten muovikomposiittien käyttömäärät ovat maailmanlaajuisesti kasvaneet jatkuvasti viimeisen 15 vuoden aikana.Kasvun on ennustettu jatkuvan voimakkaana myös tulevaisuudessa. Diplomityön tavoitteena oli selvittää puukuitulujitteisten muovikomposiittimateriaalien soveltuvuus erääseen, mahdollisesti rakennusteollisuuden käyttöön tulevaan, tuotteeseen. Tutkittaviksi materiaaliyhdistelmiksi valittiin sekä kerta- että kestomuovin ja puu- jauhon seos. Puujauho oli koivupuista sahaus- ja hiontajätettä. Molemmissa tapauksissa puun osuus komposiitissa oli 30 p-%. Koekappaleiden valmistuksessakäytettiin koivupuisia muotteja, joihin materiaali annosteltiin. Kertamuovin japuujauhon seos kovettui huoneenlämmössä. Kestomuovin ja puujauhon seoksen sulatukseen käytettiin lämmitettävillä puristinlevyillä varustettua aihiopuristinta. Koekappaleille määritettiin taivutuslujuudet taivutuskokeen avulla. Koekappaleiden taivutuslujuuksia verrattiin mm. lattialastulevyn ja koivuliimalevyn arvoihin. Liimalevyn taivutuslujuus muihin verrattuna oli huomattavasti suurempi. Komposiittimateriaalista valmistettujen koekappaleiden taivutuslujuus oli lähellä lattia-lastulevyn tasoa, osittain jonkin verran parempikin. Diplomityössä saatujen tulosten perusteella voidaan todeta puukuitulujitteisilla muovikomposiiteilla olevan kehityspotentiaalia myös tutkimuskohteen tyyppisissä ratkaisuissa. Jatkotutkimusta tulisi kohdistaa ennen kaikkea kestomuovipohjaisen komposiittimateriaalinsuuntaan.

Optimization of the procedure for removing iron deposits on ceramic filter media

In this thesis, cleaning of ceramic filter media was studied. Mechanisms of fouling and dissolution of iron compounds, as well as methods for cleaning ceramic membranes fouled by iron deposits were studied in the literature part. Cleaning agents and different methods were closer examined in the experimental part of the thesis. Pyrite is found in the geologic strata. It is oxidized to form ferrous ions Fe(II) and ferric ions Fe(III). Fe(III) is further oxidized in the hydrolysis to form ferric hydroxide. Hematite and goethite, for instance, are naturally occurring iron oxidesand hydroxides. In contact with filter media, they can cause severe fouling, which common cleaning techniques competent enough to remove. Mechanisms for the dissolution of iron oxides include the ligand-promoted pathway and the proton-promoted pathway. The dissolution can also be reductive or non-reductive. The most efficient mechanism is the ligand-promoted reductive mechanism that comprises two stages: the induction period and the autocatalytic dissolution.Reducing agents(such as hydroquinone and hydroxylamine hydrochloride), chelating agents (such as EDTA) and organic acids are used for the removal of iron compounds. Oxalic acid is the most effective known cleaning agent for iron deposits. Since formulations are often more effective than organic acids, reducing agents or chelating agents alone, the citrate¿bicarbonate¿dithionite system among others is well studied in the literature. The cleaning is also enhanced with ultrasound and backpulsing.In the experimental part, oxalic acid and nitric acid were studied alone andin combinations. Also citric acid and ascorbic acid among other chemicals were tested. Soaking experiments, experiments with ultrasound and experiments for alternative methods to apply the cleaning solution on the filter samples were carried out. Permeability and ISO Brightness measurements were performed to examine the influence of the cleaning methods on the samples. Inductively coupled plasma optical emission spectroscopy (ICP-OES) analysis of the solutions was carried out to determine the dissolved metals.

Chemical chaperones regulate molecular chaperones in vitro and in cells under combined salt and heat stresses.

Salt and heat stresses, which are often combined in nature, induce complementing defense mechanisms. Organisms adapt to high external salinity by accumulating small organic compounds known as osmolytes, which equilibrate cellular osmotic pressure. Osmolytes can also act as "chemical chaperones" by increasing the stability of native proteins and assisting refolding of unfolded polypeptides. Adaptation to heat stress depends on the expression of heat-shock proteins, many of which are molecular chaperones, that prevent protein aggregation, disassemble protein aggregates, and assist protein refolding. We show here that Escherichia coli cells preadapted to high salinity contain increased levels of glycine betaine that prevent protein aggregation under thermal stress. After heat shock, the aggregated proteins, which escaped protection, were disaggregated in salt-adapted cells as efficiently as in low salt. Here we address the effects of four common osmolytes on chaperone activity in vitro. Systematic dose responses of glycine betaine, glycerol, proline, and trehalose revealed a regulatory effect on the folding activities of individual and combinations of chaperones GroEL, DnaK, and ClpB. With the exception of trehalose, low physiological concentrations of proline, glycerol, and especially glycine betaine activated the molecular chaperones, likely by assisting local folding in chaperone-bound polypeptides and stabilizing the native end product of the reaction. High osmolyte concentrations, especially trehalose, strongly inhibited DnaK-dependent chaperone networks, such as DnaK+GroEL and DnaK+ClpB, likely because high viscosity affects dynamic interactions between chaperones and folding substrates and stabilizes protein aggregates. Thus, during combined salt and heat stresses, cells can specifically control protein stability and chaperone-mediated disaggregation and refolding by modulating the intracellular levels of different osmolytes.

Comparaison de stratégies thérapeutiques dans la prise en charge de l'hypertension artérielle [Comparison of therapeutic strategies in the management of hypertension]

Guidelines for the treatment of hypertension recommend reducing blood pressure to below 140/90 mmHg. However, there is little to guide the clinician on which pharmacological strategy to pursue: monotherapy with stepped-care, sequential monotherapy, or the initial use of combination therapy. The STRATHE study was designed to clarify this issue by comparing the three strategies. A low-dose combination of perindopril/indapamide was significantly superior to either stepped-care or sequential monotherapy in terms of reducing systolic blood pressure and in the percentage of patients achieving normalisation without adverse effects. Pulse pressure showed a trend to greater reductions with the low-dose combination. Although there must be caution about extrapolating these results to other combinations, which may not have the same pharmacological properties, the STRATHE study has shown that initiating antihypertensive therapy with a low-dose combination has advantages over the two other classical therapeutic strategies.