OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field

T lymphocyte insensitivity to corticosteroids in chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>There are increased numbers of activated lymphocytes in the lungs of chronic obstructive pulmonary disease (COPD) patients. The clinical benefits of corticosteroids in COPD patients are limited. Our hypothesis is that lymphocytes play a role in this corticosteroid insensitivity.</p> <p>Objectives</p> <p>To investigate the effects of the corticosteroid dexamethasone on lung lymphocyte cytokine production from patients with COPD compared to controls.</p> <p>Methods</p> <p>Cultured airway lymphocytes obtained by bronchoscopy from healthy non-smokers (HNS), smokers (S) and COPD patients were stimulated with phytohaemagglutinin (PHA) & phorbol myristate acetate (PMA), +/- dexamethasone. Supernatants were assayed for interleukin (IL)-2 and interferon (IFN)γ. Immunofluoresence was used to analyse changes in CD8 glucocorticoid receptor (GRα and GRβ) expression.</p> <p>Results</p> <p>The inhibition of PHA/PMA stimulated IFNγ production by dexamethasone was reduced in COPD patients compared to HNS (<it>p </it>< 0.05 at concentrations from 0.1-1 μM). There was also a significant reduction (<it>p </it>< 0.05) in the mean inhibitory effect at 1 μM in COPD patients (54.1%) compared to smokers (72.1%), and in smokers compared to HNS (85.5%). There was a numerically reduced effect of dexamethasone on IL-2 production that did not reach statistical significance. There was no difference in GRα and GRβ expression in follicular CD8 cells between COPD patients (50.9% and 30.4% respectively) and smokers (52.9% and 29.7% respectively).</p> <p>Conclusions</p> <p>IFNγ production from COPD airway lymphocytes is corticosteroid insensitive. This phenomenon may be important in the poor clinical response often observed with corticosteroids.</p

Calcitonin gene related peptide in migraine: current therapeutics, future implications and potential off-target effects

Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Despite the global burden of migraine, few classes of therapeutics have been specifically developed to combat migraine. After 30 years of translational research, calcitonin gene-related peptide (CGRP) inhibitors have emerged as a promising new tool in the prevention of migraine. Like all new therapeutics; however, we have limited real-world experience and CGRP has several known systemic actions that warrant consideration. This article provides a narrative review of the evidence for CGRP antagonists and summarises the known and potential side effects that should be considered

Quantification of the SF₆ lifetime based on mesospheric loss measured in the stratospheric polar vortex

Sulfur hexafluoride (SF₆) is a greenhouse gas with one of the highest radiative efficiencies in the atmosphere as well as an important indicator of transport time scales in the stratosphere. The current widely used estimate of the atmospheric lifetime of SF₆ is 3200 years. In this study we use in situ measurements in the 2000 Arctic polar vortex that sampled air with up to 50% SF₆ loss to calculate an SF₆ lifetime. Comparison of these measurements with output from the Whole Atmosphere Community Climate Model (WACCM) shows that WACCM transport into the vortex is accurate and that an important SF₆ loss mechanism, believed to be electron attachment, is missing in the model. Based on the measurements and estimates of the size of the vortex, we calculate an SF₆ lifetime of 850 years with an uncertainty range of 580–1400 years. The amount of SF₆ loss is shown to be consistent with that of HFC‐227ea, which has a lifetime of 670–780 years, adding independent support to our new SF₆ lifetime estimate. Based on the revised lifetime the global warming potential of SF₆ will decrease only slightly for short time horizons (<100 years) but will decrease substantially for time horizons longer than 2000 years. Also, the use of SF6 measurements as an indicator of transport time scales in the stratosphere clearly must account for potential influence from polar vortex air

Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease

OBJECTIVE: In statin-treated patients with stable coronary artery disease (CAD), residual risk of cardiovascular events is partly explained by plasma levels of low-density lipoprotein cholesterol (LDL-C). This study aimed to estimate individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in CAD patients already treated with high-dose statin. METHODS: Individual lifetime benefit was estimated in months gain free of stroke or myocardial infarction (MI) until age 80 years. Predictions were based on two competing risk models developed in data from 4853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets (TNT) trial. The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials. We accounted for individual LDL-C levels, assuming 50% LDL-C reduction by PCSK9 inhibition and 21% cardiovascular risk reduction per mmol/L (39 mg/dL) LDL-C lowering. RESULTS: Estimated individual gain was 1.8 mmol/L (>70 mg/dL). Estimated benefit was lowest (≤5 months) in older patients (≥70 years), in particular if LDL-C and other risk factors levels were low. CONCLUSION: The individual estimated lifetime benefit from PCSK9 inhibition in patients with stable CAD on high-dose statin varied from <6 to ≥12 months free of stroke or MI. Highest benefit is expected in younger patients (age 40-60 years) with high risk factor burden and relatively high LDL-C levels. TRIAL REGISTRATION NUMBER: NCT00327691; Post-results

Electronic properties of a-CNx thin films: An x-ray-absorption and photoemission spectroscopy study

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Mitochondrial phylogeography and demographic history of the Vicuña: implications for conservation

The vicuña (Vicugna vicugna; Miller, 1924) is a conservation success story, having recovered from near extinction in the 1960s to current population levels estimated at 275 000. However, lack of information about its demographic history and genetic diversity has limited both our understanding of its recovery and the development of science-based conservation measures. To examine the evolution and recent demographic history of the vicuña across its current range and to assess its genetic variation and population structure, we sequenced mitochondrial DNA from the control region (CR) for 261 individuals from 29 populations across Peru, Chile and Argentina. Our results suggest that populations currently designated as Vicugna vicugna vicugna and Vicugna vicugna mensalis comprise separate mitochondrial lineages. The current population distribution appears to be the result of a recent demographic expansion associated with the last major glacial event of the Pleistocene in the northern (18 to 22°S) dry Andes 14–12 000 years ago and the establishment of an extremely arid belt known as the 'Dry Diagonal' to 29°S. Within the Dry Diagonal, small populations of V. v. vicugna appear to have survived showing the genetic signature of demographic isolation, whereas to the north V. v. mensalis populations underwent a rapid demographic expansion before recent anthropogenic impacts

Inflammatory complications of CGRP monoclonal antibodies: a case series

BACKGROUND: Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. CASES: We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. CONCLUSION: This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward

Electronic structure and bonding properties of Si-doped hydrogenated amorphous carbon films

[[abstract]]This work investigates the C K-edge x-ray absorption near-edge structure (XANES), valence-band photoelectron spectroscopy (PES), and Fourier transform infrared (FTIR) spectra of Si-doped hydrogenated amorphous carbon films. The C K-edge XANES and valence-band PES spectra indicate that the sp2/sp3 population ratio decreases as the amount of tetramethylsilane vapor precursor increases during deposition, which suggest that Si doping% enhances sp3 and reduces sp2-bonding configurations. FTIR spectra show the formation of a polymeric sp3 C–Hn structure and Si–Hn bonds, which causes the Young’s modulus and hardness of the films to decrease with the increase of the Si content.[[incitationindex]]SCI[[booktype]]紙