Pharmacokinetics, safety and tolerability of an oral suspension of fexofenadine for children with allergic rhinitis

Allergic rhinitis (AR) is a common chronic condition in children and may impact a child's quality of life. Increasing treatment compliance may improve quality of life. An oral suspension of fexofenadine hydrochloride (HCl) has been developed to ease administration to children and may, therefore, improve treatment compliance. The purpose of this study was to assess the pharmacokinetic behavior, safety, and tolerability of a single dose of fexofenadine HCl oral suspension administered to children aged 2-5 years with allergic rhinitis. Children (aged 2-5 years) with AR were recruited in a multicenter, open-label, single-dose study. Fexofenadine HCl (30 mg) was administered as a 6-mg/mL suspension (5 mL). Plasma samples were collected up to 24 hours postdose. Adverse events (AEs); electrocardiograms (ECGs); vital signs; and clinical laboratory tests for hematology, blood chemistry, and urinalysis were analyzed to evaluate safety and tolerability. Fifty subjects completed the study. Mean maximum plasma concentration of fexofenadine was 224 ng/mL, and mean area under the plasma concentration curve was 898 ng . hour/mL. Treatment-emergent AEs were mild in intensity and reported in a total of seven subjects. No trends or clinically meaningful changes in mean ECG, vital sign, or clinical laboratory test data occurred during the study. In children aged 2-5 years, the exposure after a 30-mg dose of fexofenadine HCl suspension was similar to the exposures previously seen after a 30- and 60-mg dose of fexofenadine HCl in children aged 6-11 years and in adults, respectively. The suspension was also well tolerated.     

Localization of brain stem motoneurons innervating the laryngeal muscles in the rufous horseshoe bat,rhinolophus rouxi

The motoneurons innervating the laryngeal muscles were localized in the rufous horseshoe bat,Rhinolophus rouxi, using the HRP method. HRP was applied to the cricothyroid muscle and to the cut end of the recurrent laryngeal nerve. Labeled motoneurons were found in two completely separated regions of the nucleus ambiguus. The motoneurons innervating the cricothyroid muscle via the superior laryngeal nerve (SLN) are located withinn the ventrolateral portion of the nucleus reaching the caudal pole of the motor nucleus of the facial nerve. The motoneurons innervating the other intrinsic laryngeal muscles via the recurrent laryngeal nerve (RLN) are situated in the caudal half of the nucleus ambiguus. The innervation is strictly homolateral.     

Treatment with allogeneic interleukin-2 secreting fibroblasts protects against the development of malignant brain tumors

We have reported that mice with an intracerebral (i.c.) malignant glioma or breast cancer treated with i.c. injection of allogeneic fibroblasts genetically engineered to secrete interleukin-2 (IL-2) survived longer than mice in various control groups. The goal of the present study was to determine the effectiveness of utilizing IL-2 secreting allogeneic fibroblasts as a protective treatment to prevent the development of an i.c. glioma or breast carcinoma. Using an intracranial microcannula system that we developed, the animals received weekly injections of the cellular vaccine prior to the introduction of tumor cells via the cannula. The results demonstrate a significant delay (P < 0.005) in the development of glioma in the animals pre-treated with either allogeneic non-secreting or IL-2-secreting fibroblasts prior to introduction of tumor cells. In addition, 50% of the animals pre-treated with IL-2 secreting allogeneic fibroblasts injected subsequently with G1261 glioma cells did not develop a tumor, while all of the animals injected with glioma cells alone and 92% of those treated with non-secreting fibroblasts eventually died. The long-term survivors from the pre-treatment group were subsequently re-challenged with tumor and compared to naive controls. There was evidence that long-term immunity was established in the pre-treated animals, since there was a significant prolongation of survival (P < 0.01). In similar experiments using breast cancer cells, 62% of the animals pre-treated with non-secreting allogeneic fibroblasts and 75% of the animals pre-treated with allogeneic IL-2 secreting fibroblasts subsequently injected with SB-5b breast carcinoma cells did not develop tumors and had a significant prolongation of survival. These data suggest that i.c. injection of allogeneic IL-2 secreting fibroblasts are effective as a protective treatment in the prevention of the development of a brain tumor when the fibroblasts are introduced into the same site where the tumor is subsequently injected.     

Reference values for dynamic and static pulmonary compliance in men

The aim of the present study was to determine new reference values and predictive variables for dynamic and static pulmonary compliance in men. The investigation was conducted as a prospective study in healthy, non-smoking men with normal pulmonary function parameters including spirometry, bodyplethysmography and CO diffusing capacity. The esophageal pressure method was used to measure dynamic compliance (Cdyn), specific dynamic compliance (Cdyn/ITGV), static compliance (Cstat) and specific static compliance (Cstat/ITGV). Lung recoil pressures were recorded at different levels of total lung capacity (TLC). A total of 208 men aged 20-69 years were included in the study. The mean values for the compliance parameters were: Cdyn: 2.91+/-1.08 L/kPa; Cdyn/ITGV: 0.71 +/- 0.30 kPa (-1); Cstat: 3.34 +/- 1.04 L/kPa; Cstat/ITGV: 0.82 +/- 0.31 kPa (-1). Cdyn, Cdyn/ITGV and Cstat/ITGV were significantly correlated with age and Cstat was related to height, but in multiple regression analyses the predictability for compliance parameters was very low. Lung recoil pressures at all TLC levels significantly decreased with ageing. In conclusion, we demonstrated that the contribution of anthropometric variables to the regression equations of pulmonary compliance was low. With ageing the static pressure-volume curve of the lung shifted to the left without substantial alteration of the slope.     

Efficacy and safety of beclomethasone dipropionate extrafine aerosol in childhood asthma: a 12-week,randomized, double-blind,placebo-controlled study

BACKGROUND: Beclomethasone dipropionate (BDP) has been formulated as an extrafine aerosol (hydrofluoroalkane-134a [HFA]-BDP) [QVAR; 3M Pharmaceuticals; St Paul, MN], which gives improved lung deposition compared with chlorofluorocarbon (CFC)-BDP. The clinical efficacy of HFA-BDP has been established in adult asthma at a required dose below that of CFC-BDP, but has not been evaluated in children. OBJECTIVE: To examine the efficacy and safety of HFA-BDP in childhood asthma. DESIGN: A 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study involving 353 children aged 5 to 12 years with moderate, symptomatic asthma. After a 2-week run-in period, patients were randomized to HFA-BDP, 80 micro g/d (n = 120); HFA-BDP, 160 micro g/d (n = 117); or HFA-placebo (n = 116) administered twice daily. SETTING: Hospital outpatient. RESULTS: HFA-BDP, 80 micro g/d and 160 micro g/d, produced a significant, dose-related increase from baseline in FEV(1) percent predicted compared with placebo. At week 12, mean changes from baseline in FEV(1) percent predicted were 9.2% (p < or = 0.01 vs placebo), 10% (p < or = 0.01 vs placebo), and 3.9% for the HFA-BDP 80 micro g/d, HFA-BDP 160 micro g/d, and placebo groups, respectively. There was also a significant decrease in daily beta-agonist use, improvement in peak expiratory flow, and increase [correction] in the percentage of days free from asthma symptoms (p < or = 0.05 for HFA-BDP, 160 micro g/d, vs placebo at weeks 11 to 12). HFA-BDP was well tolerated, with no significant differences in the incidence or nature of adverse events between HFA-BDP and placebo groups. Neither were there significant differences between groups in mean percentage change from baseline in the morning plasma cortisol level at week 12 or in the percentage of patients with morning plasma cortisol levels below the reference range at baseline and week 12. In a subgroup tested, the percentage of patients with an abnormal response to low-dose adrenocorticotropic hormone stimulation at week 12 was low and similar among all groups. CONCLUSIONS: HFA-BDP, 80 to 160 micro g/d, is effective and safe in childhood asthma.     

Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine

Introduction

Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, CK, and ECG abnormalities in patients with septic shock and compared the effect of vasopressin (VP) versus norepinephrine (NE) on troponin, CK, and ECGs.

Methods

This was a prospective substudy of a randomized trial. Adults with septic shock randomly received, blinded, a low-dose infusion of VP (0.01 to 0.03 U/min) or NE (5 to 15 μg/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65 to 75 mm Hg. Troponin I/T, CK, and CK-MB were measured, and 12-lead ECGs were recorded before study drug, and 6 hours, 2 days, and 4 days after study-drug initiation. Two physician readers, blinded to patient data and drug, independently interpreted ECGs.

Results

We enrolled 121 patients (median age, 63.9 years (interquartile range (IQR), 51.1 to 75.3), mean APACHE II 28.6 (SD 7.7)): 65 in the VP group and 56 in the NE group. At the four time points, 26%, 36%, 32%, and 21% of patients had troponin elevations, respectively. Baseline characteristics and outcomes were similar between patients with positive versus negative troponin levels. Troponin and CK levels and rates of ischemic ECG changes were similar in the VP and the NE groups. In multivariable analysis, only APACHE II was associated with 28-day mortality (OR, 1.07; 95% CI, 1.01 to 1.14; P = 0.033).

Conclusions

Troponin elevation is common in adults with septic shock. We observed no significant differences in troponin, CK, and ECGs in patients treated with vasopressin and norepinephrine. Troponin elevation was not an independent predictor of mortality.

Trial registration

Controlled-trials.com ISRCTN94845869     

The Cryo-Needle: A New Tool for Histological Biopsies. A Feasibility Study

Purpose

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for intrathoracic lymph node biopsies. The newly developed cryo-needle operates in a similar way to the EBUS-TBNA but is able to obtain specimens for histological evaluation. The purpose of this animal study was to evaluate the feasibility, effect, and safety of the cryo-needle biopsies.

Methods

Four EBUS-guided cryo-needle biopsies were obtained from a mediastinal lymph node of a healthy pig. In an open surgery approach, cryo-needle biopsies using activation times of 1, 2, and 3 s (A1/A2/A3) and needle biopsies using a 21-gauge EBUS-TBNA needle were obtained from mesenteric lymph nodes. Cryo-needle biopsies A2 were performed with (A2+) and without (A2?) an oversheath. The size, weight, percentage of lymphatic tissue and artefact-free area of each cryobiopsy were evaluated. Smears were made with the TBNA-needle aspirates to determine the number of lymphocytes per high-power field (HPF). The bleeding duration was measured.

Results

We successfully obtained EBUS-guided cryo-needle biopsies. The area and weight of the biopsies A3 and A2+ were significantly larger compared with A1 (1.7 ± 0.8 and 1.4 ± 0.3 vs. 0.9 ± 0.4 mm²; 5.2 ± 2.4 and 3.4 ± 1.8 vs. 1.5 ± 0.7 mg). The percentage of lymphatic tissue of the cryobiopsies was 90 ± 25 and 98 % of samples were artefact-free. The number of lymphocytes/HPF of TBNA-needle smears was 128 ± 54.3. There was no difference in bleeding duration between the techniques.

Conclusions

The cryo-needle yields large histological specimens of high quality.     

Effects of intensive outpatient training on the adherence of CPAP therapy for patients with OSA

Background

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA). Long-term adherence is still an unsolved problem in this treatment, although different technical modifications for pressure application have been introduced. The only proven intervention to increase therapy adherence is an intensive training programme [1].

Subjects and methods

Eighty-four patients with the first diagnosis of OSA completed an intensive CPAP education programme during an in-hospital sleep laboratory stay. In this randomised prospective study the patients were treated as usual (control group) or enrolled in an outpatient training programme consisting of additional weekly telephone calls and an outpatient follow-up appointment with personal and technical support after 6?weeks. The mean daily use of CPAP was determined by reading off the internal clock of the devices, and daytime sleepiness was characterised using the Epworth Sleepiness Scale (ESS).

Results

In all, 22% of the patients rejected the therapy (mean use of less than 1?h per night). For the rest, the mean use of CPAP was 4.6±?2.7?h in the control group and 4.3±?1.8?h in the intervention group (no statistically significant difference).

Conclusion

After an intensive introduction to CPAP therapy in an inpatient environment, no increase in therapy adherence could be achieved via weekly telephone calls and a follow-up appointment.