Development of a Population Pharmacokinetic Model for Taranabant, a Cannibinoid-1 Receptor Inverse Agonist

Taranabant is a cannabinoid-1 receptor inverse agonist developed for the treatment of obesity. A population model was constructed to facilitate the estimation of pharmacokinetic parameters and to identify the influence of selected covariates. Data from 12 phase 1 studies and one phase 2 study were pooled from subjects administered single and multiple oral doses of taranabant ranging from 0.5 to 8 mg. A total of 6,834 taranabant plasma concentrations from 187 healthy and 385 obese subjects were used to develop the population model in NONMEM. A standard covariate analysis using forward selection (α = 0.05) and backward elimination (α = 0.001) was conducted. A three-compartment model with first-order absorption and elimination adequately described plasma taranabant concentrations. The population mean estimates for apparent clearance and apparent steady-state volume of distribution were 25.4 L/h and 2,578 L, respectively. Statistically significant covariate effects were modest in magnitude and not considered clinically relevant (the effects of body mass index (BMI) and creatinine clearance (CrCL) on apparent clearance; BMI, age, CrCL, and gender on apparent volume of the peripheral compartment and age on apparent intercompartmental clearance). The pharmacokinetic profile of taranabant can adequately be described by a three-compartment model with first-order absorption and elimination. Clinical dose adjustment based on covariates effects is not warranted.Key words: NONMEM, obesity, pharmacokinetics, population, taranabant     

CRP, interleukin-6, secretory phospholipase A2 group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up

OBJECTIVES: The objectives of this study were to examine the time course of the inflammatory response in acute coronary syndromes (ACS) and to assess the markers of inflammation and their relation to disease severity. METHODS: We prospectively studied 134 patients with ACS who survived for at least 30 months. The patients were divided into four groups: acute myocardial infarction (MI) with (n=54) or without (n=46) ST-segment elevation and unstable angina with (n=14) or without (n=20) increased risk. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A2 group IIA (sPLA2-IIA), and intercellular adhesion molecule-1 (ICAM-1) were measured on days 1 and 4 and after 3 and 30 months. RESULTS: The highest levels of CRP and sPLA2-IIA were seen on day 4 but for IL-6 on day 1. These three markers, but not ICAM-1, were significantly related to disease severity, CKMB, and ejection fraction. Patients in Killip class II-IV had higher levels than those in Killip class I. The individual acute-phase responses correlated with marker levels at 3 and 30 months. ICAM-1 correlated with the development of congestive heart failure. CONCLUSIONS: In ACS there seems to be an individual predisposition to inflammatory response. Plasma IL-6 is the first marker to rise, while sPLA2-IIA and CRP peak later. All three markers, especially CRP, may discriminate between MI and non-MI. ICAM-1 seems to reflect other aspects of the inflammatory processes than the other markers. The results emphasize the complexity of the inflammatory response in ACS and stress the need for further studies involving multiple markers.     

Noncemented Cathcart elliptical head endoprosthesis for displaced femoral neck fractures

A total of 93 patients (95 hips) undergoing unipolar noncemented elliptical head endoprosthetic replacement for an acute displaced femoral neck fracture were reviewed clinically and radiographically at an average follow-up of 28 months. The 12-month mortality rate was 22%. The medical complication rate was 15%, and the surgical complication rate was 19%. At most recent follow-up, 66% of patients used an assist device for ambulation or were nonambulatory. Of patients, 64% required full-time nursing care. Radiographically, subsidence of the component was identified in 66% of the hips and acetabular erosion in 29%. More than half of these patients had complaints of either thigh or groin pain. Hips with evidence of subsidence had a statistically significant greater length of follow-up (36 months) compared with hips that did not show subsidence (18 months; P = .014). Noncemented unipolar replacement for displaced femoral neck fractures is an accepted form of treatment. In this group of predominantly male patients, noncemented elliptical head unipolar replacement was associated with a high medical and surgical complication rate as well as poor clinical and radiographic results.     

对配偶婚外情的决定宽恕和情感宽恕与心理健康的关系

目的:考察因配偶婚外情而求助热线的个案决定宽恕与情感宽恕与心理健康状况的关系。方法:采用问卷调查法对82名热线求助个案进行测查。结果:①求助个案自尊和生活满意度处于中等水平,而抑郁和沉思处于较高水平;②决定宽恕显著正向预测生活满意度,情感宽恕显著负向预测抑郁心境和沉思;③高决定宽恕低情感宽恕组的生活满意度显著高于低决定宽恕低情感宽恕组;高决定宽恕高情感宽恕组的沉思显著低于另外两组。结论:决定宽恕和情感宽恕对个体心理健康有积极影响,婚姻家庭治疗师或其他专业人士应关注两者在婚外恋创伤心理治疗中的重要意义。     

Comparison of antegonial index,mental index,panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis

Objective

The aim of the study was to compare the values of the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI) in the panoramic radiographs of normal males and male patients with osteoporosis.

Methods

In panoramic radiographs obtained from 40 male individuals (20 normal and 20 with osteoporosis), the mean was calculated for MI, AI, PMI and MCI index values measured in the right and left mandibles. The MI, AI and PMI index values were evaluated using the paired t-test, and MCI values were analysed using the χ² test.

Results

MI (P < 0.001), AI (P < 0.01) and PMI (P < 0.05) values were significantly smaller in the group with osteoporosis; however, MCI (P > 0.05) was not significantly different.

Conclusion

MI, PMI and AI values, as radiomorphometric indices, were found to be smaller among male patients with osteoporosis, compared with normal patients in this study. It is suggested that these indices, used as an ancillary method in the diagnosis of osteoporosis in women, could also be useful for male patients. Further studies, of larger groups are needed on this subject, including of the MCI, which in this study showed no significant difference.