Assessing the Impact of Tiotropium on Lung Function and Physical Activity in GOLD Stage II COPD Patients who are Naïve to Maintenance Respiratory Therapy: A Study Protocol

Physical activity status is increasingly recognized as a reliable predictor of mortality and hospitalization in patients with chronic obstructive pulmonary disease (COPD). The reduction in physical activity occurs earlier in the clinical course of COPD than previously appreciated, possibly arising from breathlessness, reduced exercise tolerance, and adoption of a more sedentary lifestyle. To date, no clinical trial has evaluated the impact of pharmacotherapy on both lung function and physical activity. We recently designed a study that evaluates the impact of tiotropium (a once-daily inhaled anticholinergic) on lung function and physical activity in a maintenance/treatment-naïve Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage II COPD cohort. Previous studies have demonstrated that tiotropium improves lung function and exercise tolerance; whether these benefits translate into improvements in physical activity is the focus of the current work. Here we describe the rationale and challenges in developing and implementing this study and review its unique features and novel design, including: utility of direct activity monitoring in multicenter clinical trials; importance of behavioral-modification techniques (including motivational interviewing to improve patient self-efficacy and adherence for a healthy, more active lifestyle); utility of individualized activity plans that provide an integrated approach with pharmacotherapy and behavioral modification to help patients achieve a more active lifestyle

Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes

Context: Hypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY. Methods: ACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality. Results: The tota

CaFe2O4 sensitized hierarchical TiO2 photo composite for hydrogen production under solar light irradiation

Hierarchical spheres of self organized nanosheets of TiO2 are prepared by solvothermal method. The spheres comprising nanosheets are expected to exhibit high conducting properties. The present work is an attempt to explore the conducting properties of these spheres of TiO2 nanosheets that facilitate charge transfer and charge mobility. And at the same time to extend the absorption of TiO2 to visible light, it is combined with a low bandgap semiconductor CaFe2O4. In this perspective, CaFe2O4/TiO2 composite photocatalyst consisting of CaFe2O4 and TiO2 hierarchical spheres of nanosheets is prepared by solid state dispersion (SSD) method. The photocatalysts are characterized by thermo gravimetric analysis (TGA), X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), N2 adsorption desorption, photoluminescence (PL) and UV-Vis diffuse reflectance spectra (DRS). SEM and TEM images show TiO2 spheres and the mesoporous structure is substantiated by the N2 adsorption desorption studies. UV-Vis DRS of the composites show visible light absorption confirming the sensitization of TiO2 by CaFe2O4. XRD shows the crystallinity of the prepared composites is anatase and SEM confirms that the TiO2 spheres are intact at 400??C calcination temperature. However, deformation of spheres is seen at higher temperatures. Photocatalytic activity of the composites is studied using methanol water mixtures and optimum conditions for hydrogen production are established. By comparing the activity of CaFe2O4/TiO2 composite under visible and solar light irradiation, the possible charge transfer processes that are responsible for the synergistic activity are visualized. Based on the results, a mechanism highlighting the structure activity correlation has been proposed.close0

One-pot Lewis acid assisted synthesis of indole-3-sulfonamide and imidazo[1,2-a]pyridine-3-sulfonamide using Burgess reagent in a microwave reactor

Indole-3-sulfonamides and imidazo[1,2-a]pyridine-3-sulfonamides have served as useful derivatives for development of useful therapeutics and agrochemicals. An efficient one-pot yet two step synthesis of these key derivatives was developed using a modified Burgess reagent and Lewis acids under microwave reaction conditions. A systematic study to optimize the synthetic yield of indole-3-sulfonamide, and subsequent application of the developed reaction condition for the synthesis of imidazo[1,2-a]pyridine derivatives is reported in this paper

Patient-reported outcomes in patients with acromegaly treated with pegvisomant in the ACROSTUDY extension: A real-world experience

International audiencePurpose: To report the effects of pegvisomant (PEGV) treatment on patient-reported outcomes in acromegaly patients.Methods: We conducted an extension study of an open-label, multinational, non-interventional study (ACROSTUDY) evaluating the long-term safety and efficacy of PEGV for acromegaly in routine clinical practice. Enrolled patients were rollover patients from ACROSTUDY, or treatment naïve/semi-naïve (NSN; no PEGV within 6 months of enrollment). Exploratory efficacy endpoints were changes in symptoms with the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) and quality of life with the Acromegaly Quality of Life questionnaire (AcroQoL) analyzed by controlled or uncontrolled IGF-I levels. Results were analyzed in all patients, in NSN patient subgroup, and by diabetes status.Results: A total of 544 patients with acromegaly were enrolled, including 434 rollover subjects from ACROSTUDY and 110 NSN patients. Mean PEGV treatment duration was 7.8 years (range, 0-19.6 years). Overall, the majority of PASQ scores improved over time, but there was no significant difference between IGF-I controlled or uncontrolled groups. In the NSN subgroup, most PASQ and AcroQoL scores remained similar to baseline up to 1 year, regardless of IGF-I control. Patients with diabetes reported better PASQ scores over time with PEGV treatment, regardless of IGF-I control. IGF-I normalization increased from 10% of patients at baseline to more than 78% at year 10, with a mean daily PEGV dose of 18.7 mg.Conclusions: Overall, patients treated with PEGV had small improvements in PASQ. While IGF-I normalization increased with PEGV treatment, IGF-I control had no effects on PASQ and AcroQoL scores

Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality : Global ACROSTUDY Outcomes

Hypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY. ACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality. The total cohort included 2,090 patients with acromegaly treated with PEGV who were followed for a median of 6.8 years (range up to 12.1 years). In ACROSTUDY there were 1,344 patients with hypertension (52.3% males). This subgroup was older, had a higher BMI, and higher prevalence of diabetes, hyperlipidemia, and cardiovascular disease (CVD) when compared to patients without hypertension. During ACROSTUDY, 68 deaths were reported in the hypertension cohort, vs 10 in the cohort without hypertension. Both CVD (p<0.0001) and anterior pituitary deficiencies (p=0.0105) at study entry independently predicted mortality in patients with acromegaly and hypertension; Kaplan-Meier analysis confirmed that CVD significantly impairs survival. Hypertension is common in patients with acromegaly and significantly increases mortality, especially when there is concomitant CVD. These data suggest that treatment goals should extend beyond IGF-I normalization, and include optimisation of substitution of pituitary deficiencies and scrutinous screening and treatment of CVD