229 research outputs found

    Efficacy and safety of once-monthly pasireotide in Cushing's disease: A 12 month clinical trial

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    © 2017 Elsevier Ltd. Background: Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. We report results of the first phase 3 trial assessing long-acting intramuscular pasireotide in patients with Cushing's disease. Methods: In this phase 3 clinical trial we recruited patients aged 18 years or older with persistent, recurrent, or de-novo (non-surgical candidates) Cushing's disease who had a mean urinary free cortisol (mUFC) concentration (from three 24 h samples) of 1·5-5·0 times the upper limit of normal (ULN), a normal or greater than normal morning plasma adrenocorticotropic hormone concentration, and a pituitary source of Cushing's syndrome, from 57 sites across 19 countries. Exclusion criteria included previous pasireotide treatment, mitotane therapy within 6 months, and pituitary irradiation within 10 years. We randomly allocated patients 1:1 (block size of four) using an interactive-response-technology system to intramuscular pasireotide 10 mg or 30 mg every 4 weeks for 12 months (in the core phase). We stratified randomisation by screening mUFC concentration (1·5 to < 2·0 × ULN and 2·0-5·0 × ULN). The dose could be uptitrated (from 10 mg to 30 mg or from 30 mg to 40 mg) at month 4 if the mUFC concentration was greater than 1·5 × ULN, and at month 7, month 9, or month 12 if the mUFC concentration was greater than 1·0 × ULN. Investigators, patients, site personnel, and those assessing outcomes were masked to dose group allocation. The primary endpoint was the proportion of patients in each group with an mUFC concentration of less than or equal to the ULN at month 7. Efficacy analyses were based on intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01374906. Findings: Between Dec 28, 2011, and Dec 9, 2014, we randomly allocated 150 patients to receive pasireotide 10 mg (74 [49%] patients) or 30 mg (76 [51%] patients). The primary efficacy endpoint was met by 31 (41·9% [95% CI 30·5-53·9]) of 74 patients in the 10 mg group and 31 (40·8% [29·7-52·7] ) of 76 in the 30 mg group. The most common adverse events were hyperglycaemia (36 [49%] in the 10 mg group and 36 [47%] in the 30 mg group), diarrhoea (26 [35%] and 33 [43%] ), cholelithiasis (15 [20%] and 34 [45%] ), diabetes mellitus (14 [19%] and 18 [24%] ), and nausea (15 [20%] and 16 [21%] ). Serious adverse events suspected to be study drug related were reported in eight (11%) patients in the 10 mg group and four (5%) in the 30 mg group. Two (3%) patients in the 30 mg group died during the study (pulmonary artery thrombosis and cardiorespiratory failure); neither death was judged to be related to the study drug. Interpretation: Long-acting pasireotide normalised mUFC concentration in about 40% of patients with Cushing's disease at month 7 and had a similar safety profile to that of twice-daily subcutaneous pasireotide. Long-acting pasireotide is an efficacious treatment option for some patients with Cushing's disease who have persistent or recurrent disease after initial surgery or are not surgical candidates, and provides a convenient monthly administration schedule. Funding: Novartis Pharma AG

    Rapid and low temperature processing of mesoporous TiO\u3csub\u3e2\u3c/sub\u3e for perovskite solar cells on flexible and rigid substrates

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    \u3cp\u3ePerovskite solar cells (PSCs) have recently attracted the attention of the scientific community because of the rapid advances in their development. Most of the state-of-the-art devices contain mesoporous titanium dioxide (TiO\u3csub\u3e2\u3c/sub\u3e) as an electron transport layer. The drawback of such TiO\u3csub\u3e2\u3c/sub\u3e layers is that it often needs high temperature sintering at 450–500 °C for 30 min, which slows down the fabrication process and is clearly not compatible with future roll-to-roll (R2R) manufacturing. The aim of this study was to develop low temperature and rapid curing techniques for mesoporous TiO\u3csub\u3e2\u3c/sub\u3e thin films, which are compatible with R2R processing and heat-sensitive plastic substrates for PSCs. Several alternative annealing techniques were tested on rigid and flexible substrates, such as UV-ozone (UV/O\u3csub\u3e3\u3c/sub\u3e) treatment, oxygen plasma treatment (O\u3csub\u3e2\u3c/sub\u3e plasma) and Intense Pulsed Light (IPL) sintering and compared to conventional thermal annealing. After each treatment, the mesoporous layers were characterized using Raman spectroscopy, UV–vis spectroscopy, thermogravimetric analysis and scanning electron microscopy. Low temperature sintering techniques were specifically optimized for the mesoporous TiO\u3csub\u3e2\u3c/sub\u3e layers and were adapted for the fabrication of PSCs. Sintering process and solar cells manufacturing were optimized for two different device architectures on glass as well as on polyethylene naphthalate (PEN) substrates. Moreover, the maximum temperature of the mesoporous TiO\u3csub\u3e2\u3c/sub\u3e layer during the IPL curing process was simulated to better understand the curing process. By employing IPL curing, the processing time for the mesoporous TiO\u3csub\u3e2\u3c/sub\u3e layer can be reduced from 30 min to a few seconds without significant loss in the device performance. In particular stabilized PCE of 16% and 12% were obtained using IPL on glass and PEN substrates respectively. This processing route paves the way for future low temperature R2R processing of mesoscopic PSC on plastic substrates.\u3c/p\u3

    Reducing the size of the human physiological blind spot through training

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    The physiological blind spot refers to a zone of functional blindness all normally sighted people have in each eye, due to an absence of photoreceptors where the optic nerve passes through the surface of the retina. Here we report that the functional size of the physiological blind spot can be shrunk through training to distinguish direction signals at the blind spot periphery. Training on twenty successive weekdays improved sensitivity to both direction and colour, suggesting a generalizable benefit. Training on one blind spot, however, did not transfer to the blind spot in the untrained eye, ruling out mediation via a generic practice effect; nor could training benefits be attributed to eye movements, which were monitored to ensure stable fixation. These data suggest that training enhances the response gains of neurons with receptive fields that partially overlap, or abut, the physiological blind spot, thereby enhancing sensitivity to weak signals originating primarily from within the functionally-defined region of blindness 1, 2 and 3. Our results have important implications for situations where localised blindness has been acquired through damage to components of the visual system 4 and 5, and support proposals that these situations might be improved through perceptual training 5, 6 and 7

    Divergence between growth hormone and insulin-like growth factor-i concentrations in the follow-up of acromegaly.

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    CONTEXT: Divergence between GH and IGF-I values is regularly observed in treated acromegalic patients, and its significance is unclear. OBJECTIVES: The objective of the study was to explore the frequency and identify potential determinants of discordant serum GH and IGF-I concentrations in noncured acromegalic patients. PATIENTS: Two hundred twenty-nine noncured acromegalic patients of the Belgian acromegaly registry (AcroBel) were grouped according to their mean GH level ( 2 microg/liter) and IGF-I z-score ( 2). Clinical and metabolic parameters were compared between groups with active disease (high GH and IGF-I; n=81),high GH (with normal IGF-I; n=25), high IGF-I (with normal GH; n=55), and controlled disease (GH and IGF-I normal; n=68). RESULTS: Compared with the high IGF-I group, the high GH group was characterized by younger age (52 vs. 58 yr, P < 0.05), female predominance (72 vs. 36%, P < 0.01), and lower body mass index (25 vs. 31 kg/m(2); P < 0.001), fasting glucose (91 vs. 99 mg/dl; P < 0.05), and glycated hemoglobin levels (5.7 vs. 6.1%; P < 0.01). There was no difference among the groups regarding baseline characteristics of pituitary adenoma, current medical treatment, or symptom score. CONCLUSIONS: Thirty-five percent of noncured acromegalic patients exhibit a discordant GH and IGF-I pattern. The high GH phenotype was found predominantly in younger estrogen-sufficient females, implying a possible role for age, gender, and estrogens in this biochemical divergence. The high IGF-I phenotype was associated with a worse metabolic profile, suggesting that high IGF-I, rather than high GH, is indicative of persistently active disease

    Sustainable approach to produce 3D-printed continuous carbon fiber composites: "a comparison of virgin and recycled PETG"

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    The use of recycled polymers in 3D printing technologies has recently become a promising research topic because of the global concerns on plastic waste pollution and an increase in awareness of sustainability and circularity. In order to unlock the potentials of 3D printing beyond prototyping purposes, continuous fiber-embedded fused filament fabrication (FFF) as a process for composite production has gained importance. This study focuses on the potential use of recycled, glycol-modified poly(ethylene terephthalate) (rPETG) as a matrix material in continuous fiber additive manufacturing of composites. First, the characteristics of rPETG were compared with those of non-recycled PETG in terms of molecular weight as well as rheological, thermal, and mechanical properties. Then, rPETG and PETG composites containing 25% continuous carbon filament (CCF) fibers (CCFs) were printed using a co-extrusion-type FFF printer. Their tensile and flexural properties were characterized. It was found that the tensile properties of rPETG-based composites were lower than those of PET-based composites, but their flexural properties were nearly the same. The thermodynamic work of adhesion approach was applied to understand the interfacial interactions between the matrix and CFF. It was found that the thermodynamic adhesion between rPETG/CFF was higher than that of PETG/CFF. Additionally, SEM-SE images obtained from the fracture surfaces of the samples supported the findings by showing that the adhesion between rPETG and CF was superior to that between PETG and CF. Thus, this study demonstrated that recycled PETG can be used as a possible matrix material for 3D-printed CCF composites, thus highlighting the ability of recycled plastics to be converted into circular products with high added value

    Sustainable approach to produce 3D

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    The use of recycled polymers in 3D printing technologies has recently become a promising research topic because of the global concerns on plastic waste pollution and an increase in awareness of sustainability and circularity. In order to unlock the potentials of 3D printing beyond prototyping purposes, continuous fiber-embedded fused filament fabrication (FFF) as a process for composite production has gained importance. This study focuses on the potential use of recycled, glycol-modified poly(ethylene terephthalate) (rPETG) as a matrix material in continuous fiber additive manufacturing of composites. First, the characteristics of rPETG were compared with those of non-recycled PETG in terms of molecular weight as well as rheological, thermal, and mechanical properties. Then, rPETG and PETG composites containing 25% continuous carbon filament (CCF) fibers (CCFs) were printed using a co-extrusion-type FFF printer. Their tensile and flexural properties were characterized. It was found that the tensile properties of rPETG-based composites were lower than those of PET-based composites, but their flexural properties were nearly the same. The thermodynamic work of adhesion approach was applied to understand the interfacial interactions between the matrix and CFF. It was found that the thermodynamic adhesion between rPETG/CFF was higher than that of PETG/CFF. Additionally, SEM-SE images obtained from the fracture surfaces of the samples supported the findings by showing that the adhesion between rPETG and CF was superior to that between PETG and CF. Thus, this study demonstrated that recycled PETG can be used as a possible matrix material for 3D-printed CCF composites, thus highlighting the ability of recycled plastics to be converted into circular products with high added value

    Efficacité et sécurité du mitotane dans le traitement de l'adénocarcinome corticosurrénalien: une étude rétrospective chez 34 patients belges

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    Objectives Evaluation of patient characteristics and mitotane use in the treatment of adrenocortical carcinoma (ACC) over a 4-year period in Belgium. Material and methods This was a multicentre retrospective review of the outcome of 34 patients treated with mitotane for ACC during the period [01/2008–12/2011] (12 diagnosed before and 22 diagnosed during the study period) and evaluated up to 06/2013. Results Patient and tumour characteristics were consistent with those generally described for ACC. Mean age at diagnosis was 46.5 years, most patients were female (62%), had functioning ACC (65%) and advanced tumours (ENSAT stages III or IV: 82%). Therapeutic mitotane plasma levels (14–20 mg/L) were achieved at least once in 70% of the cohort, after a median of 4 months, and were maintained for more than 2 months in 61% of evaluable patients. Mitotane-related adverse effects were observed in 66% of patients, were never serious, and included gastrointestinal, neurological, neuropsychological, hormonal, dermatologic and metabolic effects. Most patients (88%) discontinued mitotane, mainly due to tumour progression. Multivariate analysis showed that ENSAT stage was a prognostic factor for overall (OS) and disease-free survival (DFS); OS was also influenced independently by achievement of therapeutic mitotane plasma levels for at least two consecutive months. Conclusion Patient and tumour characteristics were consistent with previously published data. OS and DFS were mostly influenced by ENSAT stage at diagnosis. Achieving therapeutic levels of mitotane for at least two consecutive months seemed to positively influence OS, but such levels were not reached or sustained in some patients.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
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