Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

The metals in the soils of the Włochy district in Warsaw

Chemical investigations of metals content in the soils (0.0–0.3 m) from the Włochy district in Warsaw were conducted in Autumn 2012. Sixty-one samples were collected in sites earlier indicated, with particular reagard to post-industrial areas and productive plants as sources of contamination. The content of arsenic, barium, chromium, cadmium, cobalt, copper, molybdenum, nickel, lead, tin, zinc and mercury was determined after digestion of samples in aqua regia. Additionally, the acidity and grain-size analyses of soil samples were carried out. The results of chemical and grain-size analyses are presented in a series of maps. An estimation of the degree of soil contamination by metals was carried out based on permissible limit values specified in Rozporządzenie…., 2002. Over most of the district area the soils are included into groups A and B (80.3% of the samples) and they are mostly used according to the recommendation of Rozporządzenie…, 2002, as the residential or agricultural areas. The soils classified into group C (including the industrial and communication areas) occur in post-industrial areas, where productive and service plants are currently located, and along the communication routes. In the contaminated areas, migration of the metals is limited by soil alkalinity

Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study

Background Worldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic.Objective To conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era.Methods This mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians).Findings In the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician.Conclusion and relevance There were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry.Clinical implications All stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry

Results about imaging with silicon strips for angiography and mammography

We present results obtained with a single photon counting system consisting of 384 silicon microstrips of 100 micron pitch equipped with 6 RX64 ASICs. The ASIC includes a charge preamplifier, a shaper, a discriminator and a 20‐bit counter for each of its 64 channels. The energy resolution of the system has been measured in the range from 8 keV to 32 keV using fluorescence X‐ray lines from several targets, using either an Am‐241 source or an X‐ray tube. Then, the efficiency of the system has been determined using the specially developed quasi‐monochromatic X‐ray beams in the energy range 18–36 KeV. Good efficiency has been obtained in the edge‐on configuration, which is more suitable for the intended applications. The spatial resolution of the system has been verified using a special microfocus X‐ray tube equipped with capillaries. Finally, images of angiographic and mammographic test objects have been obtained with dual energy X‐ray beams and have then been processed with the dual energy subtraction technique. In particular, the contrast for the angiographic test object has been evaluated for different concentrations of an iodate solution injected into 1 mm and 2 mm diameter vessels. Further developments, including a double threshold version of the ASIC, are also discussed

Organic micropollutants on river sediments from Rio de Janeiro State, Southeast Brazil Micro-poluentes orgânicos em sedimentos fluviais no Estado do Rio de Janeiro, Sudeste do Brasil

The paper is a contribution for the knowledge upon concentrations and fate of different kinds of organic micropollutants in Tropical River system from a very industrialized region in Brazil. The presented data was obtained during three years of an International Research Project between Brazilian and Dutch institutions. The sediments were sampled at the Paraiba do Sul-Guandu river watershed, the most important watercourse of Rio de Janeiro state, where up 90 % of the population depends on its water for domestic uses. After extraction with non-polar solvents in a hot sohxlet device and clean up using chromatographic columns, three classes of organic micropollutants were analyzed: organochlorine insecticides (OCs), polychlorinated biphenyls (PCBs) and polynuclear aromatic hydrocarbons (PAHs). The organochlorines, including the PCBs were scarcely present in the collected samples probably reflecting the restrictions of use of this class of compounds in the Brazilian market. However, the PAHs levels were high at the vicinity of a huge steelworks located in the city of Volta Redonda. This contamination is probably due to the massive use of coal in the above-cited metallurgical plant.<br>Este artigo pretende contribuir para o conhecimento sobre a concentração e destino de diferentes tipos de micro-poluentes num sistema fluvial tropical de uma região brasileira altamente industrializada. Os dados apresentados foram obtidos ao longo de três anos, como parte de um projeto de pesquisa internacional envolvendo instituições brasileiras e holandesas. As amostras de sedimentos foram obtidas da bacia hidrográfica Paraíba do Sul/Guandu, a mais importante hidrovia no Estado do Rio de Janeiro, onde 90% da população depende dessa água para uso doméstico. Após extração com solventes não-polares num dispositivo sohxlet quente, e limpeza utilizando colunas cromatográficas, foram analisadas três classes de micro-poluentes orgânicos: inseticidas organoclorados (OCs), bifenis policlorados (PCBs) e outros hidrocarbonetos polinucleares (PAHs). Os organoclorados, inclusive os PCBs, estavam presentes em quantidades muito reduzidas nas amostras, provavelmente refletindo as restrições contra o uso dessa classe de compostos no mercado brasileiro. Entretanto, os PAHs mostravam níveis elevados ao redor de uma grande indústria siderúrgica na cidade de Volta Redonda. Tal contaminação deve-se, provavelmente, ao uso maciço de carvão nesta fábrica