Overview of costs of stroke from published, incidence-based studies spanning 16 industrialized countries

OBJECTIVE: The aim of this review is to summarize published data (based on a search of Medline sources, 1993-October 2003) from the last 10 years on the costs of stroke. With the recent encouraging evidence of interventions that reduce the incidence of stroke, the primary focus is on incidence-based cost of stroke studies to identify important factors for future cost-effectiveness analyses on stroke interventions. FINDINGS: Lifetime costs per patient were in the range USD 11 787 for 'unclassified' stroke in Australia to USD 3035671 in stroke patients with untreated non-rheumatic atrial fibrillation in a UK setting (costs inflated to 2003 values). For the lifetime costs of ischemic stroke only, the range narrowed to USD 41257 in Australia and USD 104629 in the UK. These data confirm that stroke management is associated with a vast economic burden. No correlation of lifetime cost of stroke with specific cost components or time horizon was identified. The cost of stroke is influenced by severity (more severe strokes cost more due to extended hospitalization), age (costs were greater in younger stroke patients) and gender (direct costs were greater for women, but indirect costs were greater in men). CONCLUSION: Conducting research according to methodological consensus would markedly improve the quality of data from future studies of stroke and support identification of the main cost drivers in different country-specific settings.     

A study of interlaboratory influence on column evaluation

A liquid chromatography method for the characterization of base deactivated columns was investigated in a collaborative study involving six laboratories. This work was carried out on two chromatographic supports (Xterra RP 18 and Symmetry Shield). Different cooling systems, namely water bath and air oven, were tested and it was shown that column thermoregulation did not significantly influence chromatographic data. In order to control the mobile phase composition, the latter was prepared by weight rather than volume. Thanks to the injection of a set of selected neutral compounds, extra-column effects were evaluated in each of the participating laboratories. The results showed that chromatographic supports tested in different laboratories and following the same test protocol could be effectively compared.     

LEA3D: a computer-aided ligand design for structure-based drug design

We present an improved version of the program LEA developed to design organic molecules. Rational drug design involves finding solutions to large combinatorial problems for which an exhaustive search is impractical. Genetic algorithms provide a tool for the investigation of such problems. New software, called LEA3D, is now able to conceive organic molecules by combining 3D fragments. Fragments were extracted from both biological compounds and known drugs. A fitness function guides the search process in optimizing the molecules toward an optimal value of the properties. The fitness function is build up by combining several independent property evaluations, including the score provided by the FlexX docking program. One application in de novo drug design is described. The example makes use of the structure of Mycobacterium tuberculosis thymidine monophosphate kinase to generate analogues of one of its natural substrates. Among 22 tested compounds, 17 show inhibitory activity in the micromolar range.     

Effects of the Herbicide Isoproturon on Metallothioneins,Growth, and Antioxidative Defenses in the Aquatic Worm <Emphasis Type="Italic">Tubifex tubifex</Emphasis> (Oligochaeta,Tubificidae)

Metallothioneins (MTs) are low molecular weight proteins, mainly implicated in metal ion detoxification. Increase in MT contents is considered to be a specific biomarker of metal exposure. Recently it has been demonstrated that MTs participate in several cellular functions such as regulation of growth, and antioxidative defenses. Therefore, the induction of MTs as biomarkers of exposure to the pesticide isoproturon has been investigated in the aquatic worms Tubifex tubifex. MT levels in exposed worms increased significantly (p < 0.05) after 2, 4, and 7 days of exposure to different concentrations of isoproturon (maximum increase compared to unexposed controls: +148.56% for 10 mg l⁻¹ after 4 days of exposure). In response to isoproturon, the activity of glutathione-S-transferase (max. +52%), glutathione-reductase (max. +100%), and catalase (max. +117%) increased, demonstrating the occurrence of an oxidative stress response to the herbicide. Thus, the increase in MT contents caused by isoproturon was interpreted as a defense response towards increased oxidative stress generated by the herbicide. Residues of isoproturon and its metabolites, 1-(4-isopropylphenyl)-3-methylurea, 1-(4-isopropylphenyl) urea, and 4-isopropylanilin were detected in the worm growth medium. Half-life of the herbicide was shorter at a low (0.1 mg l⁻¹) initial concentration. The herbicide accumulated in T. tubifex but no metabolite could be detected.     

Survival after gamma interferon intratumoral injections in a model of hepatocarcinoma

BACKGROUND/AIMS: Short-term efficacy of local gamma interferon delivered via a single injection of an adenovirus-gamma interferon vector has been reported in immunocompetent animals which develop spontaneous liver cancer. However the long-term outcome was not examined. The aim of this randomized trial was to assess in an immunodeficient mouse ectopic model the benefit, if any, of the long-term efficacy of intratumoral injections of gamma interferon itself. METHODOLOGY: 77 mice were randomly assigned to 4 groups. Gamma interferon treated groups received a dose of 5000, 10000 or 20000 IU per animal versus phosphate-buffered saline. The follow-up lasted 46 days. RESULTS: Significant differences were noted in mice receiving 20000 IU compared to controls: increase in survival (p=0.0485), slowing down of tumor growth in large tumors (p=0.009), increase in necrosis (p=0.004). The preferential staining in necrotic areas with anti-Class II antibody and the accumulation of nuclear debris indicated that neutrophils were involved. CONCLUSIONS: Gamma interferon could accentuate the migration of non-specific immune cells to necrotic areas which occur spontaneously in large tumors. These results in animals bearing large tumor suggest that it may be worthwhile to explore local gamma interferon delivery to patients with extensive hepatocarcinoma.     

Decreased Specificity of an Assay for Recent Infection in HIV-1-Infected Patients on Highly Active Antiretroviral Treatment: Implications for Incidence Estimates

The aim of this study was to estimate the rate of misclassification in treated HIV patients who initiated treatment at the chronic stage of HIV infection using an enzyme immunoassay (EIA) that discriminates between recent infection (RI; within 6 months) and established infection. The performance of EIA-RI was evaluated in 96 HIV-1 chronically infected patients on highly active antiretroviral therapy (HAART) with an undetectable viral load (VL) for at least 3 years. Demographic data, HIV-1 viral load, CD4(+) T-cell count, viral subtype, and treatment duration were collected. The subset of misclassified patients was further analyzed using samples collected annually. The impact on incidence estimates was evaluated by simulation. The specificity in treated patients was significantly lower (70.8 to 77.1%) than that observed in untreated patients (93.3 to 99.3%, P < 0.001). Patients falsely classified as recently infected had been treated for a longer period and had longer-term viral suppression than those correctly classified. The loss of specificity of the test due to treatment may have a dramatic impact on the accuracy of the incidence estimates, with a major impact when HIV prevalence is high. The cross-sectional studies intended to derive HIV incidence must collect information on treatment or, alternatively, should include detection of antiretroviral drugs in blood specimens to rule out treated patients from the calculations.     

Humanized mice: current states and perspectives

The development of chimeric mice bearing the components of a human immune system to serve as animal models for "human" diseases has been the goal of many years of research. In this review we will discuss the latest advances in this field, their remaining shortcomings and challenges to the generation of new models of mouse/human chimeras.