One year open-label safety and efficacy trial with rotigotine transdermal patch in moderate to severe idiopathic restless legs syndrome

BackgroundLong-term efficacy and tolerability data are not yet available for patch formulations of dopamine agonists in restless legs syndrome.MethodsEfficacy and safety of rotigotine (0.5–4 mg/24 h), formulated as a once-daily transdermal system (patch), were investigated in an open extension (SP710) of a preceding 6-week placebo-controlled trial (SP709, 341 randomized patients) in patients with idiopathic restless legs syndrome. For efficacy assessment the international RLS severity scale (IRLS), the RLS-6 scales, the clinical global impressions (CGI) and the QoL-RLS questionnaire were administered. In addition, long-term tolerability and safety were assessed.ResultsOf 310 patients who finished the controlled trial, 295 (mean age 58 ± 10 years, 66% females) with a mean IRLS score of 27.8 ± 5.9 at baseline of SP709 were included. We report results after one year of this ongoing long-term trial. Two hundred twenty patients (retention rate = 74.6%) completed the 12-month follow-up period. The mean daily dose was 2.8 ± 1.2 mg/24 h with 4 mg/24 h (40.6%) being the most frequently applied dose; 14.8% were sufficiently treated with 0.5 or 1.0 mg/24 h. The IRLS total score improved by −17.4 ± 9.9 points between baseline and end of Year 1 (p < 0.001). The other measures of severity, sleep satisfaction and quality of life supported the efficacy of rotigotine (p < 0.001 for pre-post-comparisons of all efficacy variables). The tolerability was described as “good” or “very good” by 80.3% of all patients. The most common adverse events were application site reactions (40.0%), which led to withdrawal in 13.2%. Further relatively frequent adverse events were nausea (9.5%) and fatigue (6.4%). Two drug-related serious adverse events, nausea and syncope, required hospitalization. Symptoms of augmentation were not reported by the patients.ConclusionRotigotine provided a stable, clinically relevant improvement in all efficacy measures throughout one year of maintenance therapy. The transdermal patch was safe and generally well tolerated by the majority of patients. Comparable to any transdermal therapy, application site reactions were the main treatment complication.     

Distribution of in vivo and in vitro range of motion following 1-level arthroplasty with the CHARITE artificial disc compared with fusion

OBJECT: One of the goals of lumbar arthroplasty is to restore and maintain range of motion (ROM) and to protect adjacent levels from abnormal motion, which may be a factor in transition syndrome following arthrodesis. In this study, in vitro ROM results were compared with in vivo, 2-year postoperative radiographic ROM evaluations. METHODS: Radiographs of patients enrolled in the CHARITE investigational device exemption study were analyzed at baseline and at 2 years postoperatively. The ROM in flexion/extension at the implanted and adjacent levels was measured, normalized, and compared with ROM results obtained using cadaver (in vitro) evaluations. RESULTS: Preoperative ROM distributions in patients enrolled for arthroplasty or fusion at the L4-5 level was as follows: 28% motion was observed at L3-4, 35% at L4-5 and 37% at L5-S1. Following a one-level arthroplasty at L4-5, the in vivo ROM distribution from L-3 to S-1 at the 2-year time point was 36% at L3-4, 30% at L4-5 and 35% at L5-S1. Following a one-level fusion with BAK and pedicle screws at L4-5, the in vivo ROM distribution from L-3 to S-1 at the 2-year time point was 45% at L3-4, 9% at L4-5 and 46% at L5-S1. CONCLUSIONS: The baseline as well as the 2-year in vivo data confirmed previously published in vitro data. One-level arthroplasty was shown herein to replicate the normal distribution of motion of the intact spine.     

Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix

Adenosarcomas are rare cervical tumors with unknown optimal treatment, which often affects young women. A 23-year-old woman was found to have a stage IB1 adenosarcoma of the cervix. She underwent a robotically assisted total laparoscopic radical trachelectomy with the placement of abdominal cerclage for the sparing of fertility.     

A new technique for simultaneously recording EMG and movements in experimental animals

In this protocol a new system is presented for recording EMG signals from leg and trunk muscles along with video-recording of leg and trunk movements. The system comprises a front-end amplifier consisting of a reference amplifier, a differential amplifier with a filter combination and an analog to digital converter (ADC). A fiber optic transmitter connects the front end amplifier via a fiber cable to a receiver board placed in a personal computer (PC). A dedicated software programme (POLY) was written to process the physiological signals on the PC. The physiological recordings can be synchronized to video-recordings and the principles of this technique are given. The system allows to record artifact-free physiological signals and also to link activation patterns in muscles with kinematic aspects of movements.     

Differential projections from subfields in the lateral preoptic area to the lateral habenular complex of the rat

The lateral habenular complex (LHb) constitutes an important link in the dorsal diencephalic conduction system conveying information from limbic forebrain structures to regulatory midbrain nuclei. In line with the considerable number of biological functions in which the habenula is thought to be involved, a complex subnuclear organization of the LHb has been suggested. However, the precise connectivity of habenular subnuclei remains to be identified. We hypothesize that axons from the lateral preoptic area (LPOA) project to distinct subnuclei of the LHb. As a result of an unexpected heterogeneity within the LPOA, we first examined its subregional morphology. Based on the analysis of several coronal series of sections, seven subfields were identified within the LPOA. Retrograde tracing experiments revealed that neurons projecting to the LHb were concentrated in the dorsal, ventral, and ventromedial subfields of the rostral LPOA and in the caudal LPOA. Anterograde tracing experiments confirmed that all LPOA subfields containing retrogradely labelled cells project to the LHb. Neurons in rostral subfields of the LPOA target predominantly the lateral area of the LHb, whereas caudal LPOA fibers innervate the medial LHb. Afferent labelling is most prominent within the magnocellular subnucleus in the LHbM, and only few fibers can be observed in the parvocellular subnucleus of the LHbM. The superior subnucleus of the LHbM and the oval subnucleus of the LHbL do not receive any fibers from the LPOA at all. This is the first comprehensive study so far to show that projections from LPOA subfields individually target subnuclei in the lateral habenular complex.     

Influence of neoadjuvant anastrozole (Arimidex) on intratumoral estrogen levels and proliferation markers in patients with locally advanced breast cancer.

Anastrozole (Arimidex) is a novel, selective, and potent aromatase inhibitor used for the treatment of postmenopausal breast cancer. The drug has been shown to inhibit in vivo aromatization by 96--97% and to suppress plasma estrogen levels by 84--94%. However, the effects of anastrozole on intratumoral estrogen levels have not been studied. Here we report the effects of neoadjuvant treatment with anastrozole on intratumoral levels of estrone (E(1)), estradiol (E(2)), and estrone sulfate (E(1)S), measured by a highly sensitive RIA following a multistep purification procedure involving high-pressure liquid chromatography. Tumor tissue was obtained prior to treatment and after 15 weeks on therapy with anastrozole (1 mg once daily) from 12 postmenopausal women with locally advanced breast cancer (T(3)--T(4) and/or N(2)). Pretreatment tissue levels of E(2), E(1), and E(1)S were 217.9 (69.8--679.9), 173.6 (83.9--358.9), and 80.7 (31.4--207.3) fmol/g tissue (geometric mean values with 95% confidence interval, respectively). Treatment with anastrozole suppressed tissue E(2), E(1), and E(1)S levels by 89.0% (73.2--95.5%), 83.4% (63.2--92.5%), and 72.9% (47.3--86.1%), respectively, compared with baseline levels, with no significant difference between responders and nonresponders. Plasma levels of E(2), E(1), and E(1)S were suppressed by 86.1, 83.9, and 94.2%, respectively. Anastrozole caused a decrease in the immunoexpression of the proliferation markers Ki67 and pS2 in all of the patients, with a trend for a more profound suppression in those achieving an objective response. The mean percentage of apoptotic cells was found to be decreased in responders and increased in nonresponders after 15 weeks of anastrozole therapy. Our results reveal anastrozole to cause a significant suppression of tissue estrogen levels and to influence the biology of primary estrogen receptor-positive breast cancers in postmenopausal women.     

GSTM1, GSTT1, and the risk of squamous cell carcinoma of the head and neck: a mini-HuGE review.

Squamous cell carcinoma of the head and neck (SCCHN) is a group of cancers of epithelial origin that may provide an ideal model for the study of gene-environment interaction. SCCHN includes squamous cell carcinomas of the oral cavity, pharynx, and larynx. Approximately 90% of the attributable risk for oral cancer and 80% of the attributable risk for larynx cancer results from tobacco use. Tobacco smoking has been demonstrated to increase the risk of SCCHN in a dose-response fashion. Polymorphisms of carcinogen-metabolizing enzymes, known to be involved in metabolism of carcinogens found in tobacco smoke, are relatively common in most populations. This paper provides a concise review of the 24 published studies that evaluated the risk of SCCHN in relation to two deletion polymorphisms of the glutathione S-transferase family: GSTM1 and GSTT1. Patterns of risk based on the site of the tumor and on nationality are presented, as are some methodological weaknesses of the studies. The results of these studies are inconsistent, with some reporting weak-to-moderate associations and others finding no elevation in risk for the main effect of the gene. Few studies have directly evaluated the interaction with tobacco. Well-designed, population-based studies of adequate size are needed.     

The relative contributions of pre-neural and neural factors to areal summation in the fovea

In order to determine the relative contributions of pre-neural and neural factors to areal summation in the fovea, measurements of Ricco's area were made. These were compared to the results of an ideal-observer analysis which incorporated only pre-neural factors, up to the level of the photoreceptor. The comparison indicated that Ricco's area in the fovea is largely (if not completely) accounted for by pre-neural factors. Thus, our results, in agreement with the recent analysis of contrast sensitivity by Banks, Geisler and Bennett (1987; Vision Research, 27, 1915-1924), are consistent with the hypothesis that a neural pathway exists which consists of units whose center mechanisms sum over only a single cone or a single row of cones. Our results also imply that the quantum efficiency for detection is constant for test areas up to 256 min2, once the effects of the optics and receptor aperture are factored out.     

GM1 gangliosides in the treatment of spinal cord injury: report of preliminary data analysis

A prospective, randomized, placebo-controlled, double-blinded spinal cord injury GM1 ganglioside drug trial was completed. Of the 37 patients entered over a 16 month period, 34 patients (23 cervical and 11 thoracic injuries) received the test drug protocol and completed the one year follow up period. The neurologic recovery was quantified by serial measurement of the ASIA motor score throughout the acute hospital course and one year long follow up period. The primary variable used to assess neurologic recovery was the difference in the ASIA motor score from the admission value to the value at one year. The GM1 group had an average motor recovery of 36.9 points whereas the placebo group had an average change of 21.6 points (t-test difference, p = 0.088). Analysis of the secondary variable, the area under the ASIA motor score versus the logarithm of time, and the use of rank order nonparametric statistic on both the primary and secondary variables to sort neurologic recovery obtained similar statistical differences between the GM1 and placebo treatment groups. Randomization imbalances in baseline severity of injury and division of cervical and thoracic injury occurred in the trial. Because of this fact and the small sample size of the study verification of these results by a larger study is required.