Mycophenolate mofetil vs. sirolimus in kidney transplant recipients receiving tacrolimus-based immunosuppressive regimen

Abstract:  Mycophenolate mofetil (MMF) and sirolimus (SRL) are effective immunosuppressive drugs with distinct safety profile.
Methods:  Kidney transplant recipients receiving tacrolimus (TAC)-based immunosuppressive regimen were randomized to receive fixed daily doses of MMF (2 g/d, n = 50) or SRL (one loading dose of 15 mg, 5 mg/d till day 7 and 2 mg/d thereafter, n = 50) without induction therapy.
Results:  No differences were observed in the incidence of the composite (biopsy-confirmed acute rejection, graft loss or death) end-point (18% vs. 16%, p = 1.000), biopsy confirmed acute rejection (12% vs. 14%, p = 1.000), one-yr patient (94% vs. 98%, p = 0.308), graft (92% vs. 98%, p = 0.168), and death-censored graft survival (98% vs. 100%, p = 0.317) comparing patients receiving MMF or SRL respectively. Patients receiving SRL showed worse safety outcomes, higher mean creatinine (1.6 ± 0.5 mg/dL vs. 1.4 ± 0.3 mg/dL, p = 0.007), higher proportion of patients with proteinuria (52.0% vs. 10.7%, p = 0.041), higher mean urinary protein concentrations (0.3 ± 0.5 g/L vs. 0.1 ± 0.2 g/L, p = 0.012), higher mean cholesterol concentration (217 mg/dL vs. 190 mg/dL, p = 0.030), and higher proportion of patients prematurely discontinued from randomized therapy (26% vs. 8%, p = 0.031).
Conclusion:  In patients receiving TAC, MMF produced similar efficacy but superior safety profile compared with SRL.     

The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay

Background: Aging of the population represents one of the main challenges for health systems because of the increase in the demand for hospital services. To be able to count on tools that allow an objective evaluation of hospital‐resource use becomes indispensable for health systems. Objective: To evaluate the reliability and validity of the Appropriateness Evaluation Protocol (AEP) regarding the appropriateness of admissions and hospital stays in elderly patients. In a scenario of scarce resources, to have a valid instrument will make it possible to evaluate the process of care in our growing elderly population in a standardized way. Methods: We carried out a retrospective study of 144 randomly chosen elderly patients admitted to the hospital with 394 even‐numbered hospital‐stay days. For the reliability analysis between the pair of nurses with the AEP and the pair of specialists, the details of the hospital admissions and the stay days were obtained from the clinical files. Criteria validity was conducted by pairs of physicians, including two internists, two general surgeons and two geriatricians. Only the agreements were compared with agreements of the AEP‐trained nurses. Disagreements were excluded from the final analysis. Results: Inter‐rater (inter‐reviewer) agreement of hospital admissions and days spent by the patient presented a kappa coefficient of >0.70, while these admissions and hospital‐stay days was >0.70. Sensitivity and positive predictor value to detect inappropriate admissions were not calculated because no agreement existed on inappropriate admissions. Specificity and negative predictive value to detect appropriate admission was >94.0% and >98.0%. Sensitivity and positive predictor value to detect inappropriate hospital‐stay days was >44.0% and >10.0%, while specificity and negative predictor value for detecting appropriate hospital‐stay days was >79.0% and >88.0%. Conclusions: AEP’s high‐reliability and moderate‐validity results with regard to clinical judgement positions it as a useful instrument for appropriate hospitalization screening in elderly patients.     

Lipoperoxidation and cyclooxygenase enzyme inhibitory piperidine alkaloids from Cassia spectabilis green fruits

Phytochemical work in the search for bioactive metabolites from the methanolic extract of Senna spectabilis green fruits led to the isolation of a new piperidine alkaloid, (+)-3- O-feruloylcassine ( 1), in addition to the known (-)-spectaline ( 2) and (-)-3- O-acetylspectaline ( 3). The isolates were submitted to in vitro evaluation of lipoperoxidation (LPO) and cyclooxygenase enzymes (COX-1 and -2) inhibitory properties and showed moderate antioxidant activities (40-70%) at 100 ppm when compared to commercial standards BHT and vitamin E and moderate inhibition of COX-1 (ca . 40%) and marginal inhibition of COX-2 enzymes (<10%) at 100 ppm when compared to nonsteroidal anti-inflammatory drugs (NSAIDs) aspirin, rofecoxib, and celecoxib, respectively.     

Isolation and characterization of piscine osteonectin and downregulation of its expression by PTH-related protein.

The skeleton is the main source of osteonectin mRNA in adults of the seawater teleost sea bream Sparus auratus. It is expressed by cells forming the basement membrane of calcifying tissue indicating that, as in mammals, it may play a role in osteoblast differentiation. PTHrP induced downregulation of osteonectin mRNA in vitro in scales, a mineralizing tissue with bone-like metabolism. This indicates a means to redirect calcium to activities such as vitellogenesis when this ion is in high demand. INTRODUCTION: Osteonectin is a unique matricellular calcium-binding glycoprotein and a major noncollagenous constituent of higher eukaryote bone. In terrestrial vertebrates, it has been associated with development, remodeling, cell turnover, and tissue repair, all processes involving substantial changes in extracellular matrix (ECM) structure. In skeleton biology, osteonectin has been described as a positive factor in the mineralization process as well as in osteoblastic cell lineage differentiation and is downregulated by the hypercalcemic hormone PTH. In this study, we report the cloning and characterization of bream S. auratus osteonectin cDNA and its tissue and cellular distribution. Its high expression by fish scales provides a unique in vitro bioassay with which to study regulation of osteonectin gene expression by the recently isolated piscine PTH-related peptide (PTHrP). MATERIALS AND METHODS: An intervertebral tissue cDNA library from S. auratus was the source of the full-length cDNA clone for osteonectin. Expression studies were performed by semiquantitative RT-PCR, Northern blot, and in situ hybridization analysis. Moreover, an in vitro bioassay with S. auratus scales was specifically developed for measuring the effect of PTHrP on osteonectin expression. RESULTS AND CONCLUSIONS: Phylogenetic analysis showed that S. auratus osteonectin is highly homologous with previously reported osteonectins, supporting the idea of a conserved function for this protein in the ECM. Its expression pattern in adult tissues from S. auratus was markedly biased toward skeletal structures of both dermal or endochondral origin. More specifically, the localization of the osteonectin mRNA in the basement membrane that separates the epithelia from the underlying mineralized connective tissue supports a role for this protein in calcified matrix turnover. Furthermore, the recently identified piscine hypercalcemic factor PTHrP downregulates osteonectin expression in scales, suggesting a catabolic action for this hormone on these structures.     

Comparison of intramuscular and venous blood pH, PCO(2) and PO(2) during rhythmic handgrip exercise

Oxygen and acid-base status during exercise is well established for the lungs, large arteries and veins. However, values for these parameters in exercising muscle are less frequently reported. In this study we examined the relationship between intramuscular PO(2), pH, PCO(2) and the comparable venous values during rhythmic isometric handgrip exercise at target levels of 15%, 30% and 45% of maximum voluntary contraction (MVC). A small fiber optic sensor was inserted into the flexor digitorum profundus (FDP) muscle for continuous measurement of intramuscular (IM) PO(2), pH and PCO(2). Venous blood samples were taken from the forearm every minute during each exercise bout. IM pH and PCO(2) were similar to their venous counterparts at baseline, but the difference between IM and venous values increased when exercise exceeded 30% MVC. During exercise at 15% MVC and greater, venous PO(2) declined from 40 to 21 Torr (approximately 5.3 to 2.8 kPa). IM PO(2) declined from 24 to 8 Torr with 15% MVC, and approached 0 Torr at 30% MVC and 45% MVC. IM pH declined rapidly when IM PO(2) reached 10 Torr and continued to decrease with increasing exertion, despite an IM PO(2) near 0 Torr.     

The Food and Drug Administration Office of Women's Health: impact of science on regulatory policy

In 1994, the Food and Drug Administration Office of Women's Health (FDA-OWH) was created to provide leadership and policy direction for the Agency regarding issues of women's health. Within its first year, the FDA-OWH established a science program for women's health research, promoting the development of sound policy and regulation. In a little over a decade, the program has provided approximately 14 million dollars to fund more than 100 women's health research studies covering a broad range of health topics affecting women across their lifespan. Some studies, such as those elucidating drug effects on QT prolongation in women and drug-dietary supplement interaction, have had significant influence on regulatory decisions. Other studies have provided sound scientific data on sex and gender differences supporting FDA guidelines to protect women's health. This paper describes the science program at the FDA-OWH, providing examples of how funded research impacts regulatory policy.     

Isopropyl quinoxaline-7-carboxylate 1,4-di-N-oxide derivatives induce regulated necrosis-like cell death on Leishmania (Leishmania) mexicana

Parasitology Research - Leishmaniasis is a neglected tropical disease caused by the parasite of the genus Leishmania. About 13 million people are infected worldwide, and it is estimated that 350...     

Use of an olmesartan medoxomil-based treatment algorithm for hypertension control

Hypertension guidelines recommend a steppedcare approach that starts with titration of the initial agent followed by the addition of other agents, as necessary, to achieve goal blood pressure. This study assessed the effectiveness of an antihypertensive treatment algorithm with olmesartan medoxomil as the initial agent. This was a 24-week, open-label trial in patients (N=201) with mean seated diastolic blood pressure of 90–109 mm Hg. Following placebo run-in, all patients received olmesartan medoxomil 20 mg/d for 4 weeks. At subsequent 4-week intervals, the regimen was modified in patients with blood pressure >130/85 mm Hg: up-titration of olmesartan medoxomil to 40 mg/d; addition of hydrochlo-rothiazide 12.5 mg/d; up-titration of hydrochlo-rothiazide to 25 mg/d; addition of amlodipine besylate 5 mg/d; and up-titration of amlodipine besylate to 10 mg/d. Patients who achieved blood pressure ≤130/85 mm Hg at any point exited the study with no further follow-up. At Week 24, reductions in blood pressure from baseline were 33.7/18.2 mm Hg. Altogether, 87.7% of patients reached the goal blood pressure of ≤130/85 mm Hg and 93.3% achieved a blood pressure of ≤140/90 mm Hg. Thus, an antihypertensive algorithm with olmesartan medoxomil as the initial agent controlled blood pressure in the majority of patients, but with >60% of patients also requiring the use of a thiazide diuretic or a thiazide and a calcium channel blocker.