58 research outputs found

    Safety and efficacy of GABAA α5 antagonist S44819 in patients with ischaemic stroke: a multicentre, double-blind, randomised, placebo-controlled trial

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    Background: S44819, a selective GABAA α5 receptor antagonist, reduces tonic post-ischaemic inhibition of the peri-infarct cortex. S44819 improved stroke recovery in rodents and increased cortical excitability in a transcranial magnetic stimulation study in healthy volunteers. The Randomized Efficacy and Safety Trial of Oral GABAA α5 antagonist S44819 after Recent ischemic Event (RESTORE BRAIN) aimed to evaluate the safety and efficacy of S44819 for enhancing clinical recovery of patients with ischaemic stroke. Methods: RESTORE BRAIN was an international, randomised, double-blind, parallel-group, placebo-controlled, multicentre phase 2 trial that evaluated the safety and efficacy of oral S44189 in patients with recent ischaemic stroke. The study was done in specialised stroke units in 92 actively recruiting centres in 14 countries: ten were European countries (Belgium, Czech Republic, France, Germany, Hungary, Italy, Netherlands, Poland, Spain, and the UK) and four were non-European countries (Australia, Brazil, Canada, and South Korea). Patients aged 18–85 years with acute ischaemic stroke involving cerebral cortex (National Institute of Health Stroke Scale [NIHSS] score 7–20) without previous disability were eligible for inclusion. Participants were randomly assigned to receive 150 mg S44819 twice a day, 300 mg S44819 twice a day, or placebo twice a day by a balanced, non-adaptive randomisation method with a 1:1:1 ratio. Treatment randomisation and allocation were centralised via the interactive web response system using computer-generated random sequences with a block size of 3. Blinding of treatment was achieved by identical appearance and taste of all sachets. Patients, investigators and individuals involved in the analysis of the trial were masked to group assignment. The primary endpoint was the modified Rankin Scale (mRS) score 90 days from onset of treatment, evaluated by shift analysis (predefined main analysis) or by dichotomised analyses using 0–1 versus 2–6 and 0–2 versus 3–6 cutoffs (predefined secondary analysis). Secondary endpoints were the effects of S44819 on the NIHSS and Montreal Cognitive Assessment (MoCA) scores, time needed to complete parts A and B of the Trail Making Test, and the Barthel index. Efficacy analyses were done on all patients who received at least one dose of treatment and had at least one mRS score taken after day 5 (specifically, on or after day 30). Safety was compared across treatment groups for all patients who received at least one dose of treatment. The study was registered at ClinicalTrials.gov, NCT02877615. Findings: Between Dec 19, 2016, and Nov 16, 2018, 585 patients were enrolled in the study. Of these, 197 (34%) were randomly assigned to receive 150 mg S44819 twice a day, 195 (33%) to receive 300 mg S44819 twice a day, and 193 (33%) to receive placebo twice a day. 189 (96%) of 197 patients in the 150 mg S44819 group, 188 (96%) of 195 patients in the 300 mg S44819 group, and 191 (99%) patients in the placebo group received at least one dose of treatment and had at least one mRS score taken after day 5, and were included in efficacy analyses. 195 (99%) of 197 patients in the 150 mg S44819 group, 194 (99%) of 195 patients in the 300 mg S44819 group, and 193 (100%) patients in the placebo group received at least one dose of treatment, and were included in safety analyses. The primary endpoint of mRS at day 90 did not differ between each of the two S44819 groups and the placebo group (OR 0·91 [95% CI 0·64–1·31]; p=0·80 for 150 mg S44819 compared with placebo and OR 1·17 [95% CI 0·81–1·67]; p=0·80 for 300 mg S44819 compared with placebo). Likewise, dichotomised mRS scores at day 90 (mRS 0–2 vs 3–6 or mRS 0–1 vs 2–6) did not differ between groups. Secondary endpoints did not reveal any significant group differences. The median NIHSS score at day 90 did not differ between groups (4 [IQR 2–8] in 150 mg S44819 group, 4 [2–7] in 300 mg S44819 group, and 4 [2–6] in placebo group), nor did the number of patients at day 90 with an NIHSS score of up to 5 (95 [61%] of 156 in 150 mg S44819 group, 106 [66%] of 161 in 300 mg S44819 group, and 104 [66%] of 157 in placebo group) versus more than 5 (61 [39%] in 150 mg S44819 group, 55 [34%] in 300 mg S44819 group, and 53 [34%] in placebo group). Likewise, the median MoCA score (22·0 [IQR 17·0–26·0] in 150 mg S44819 group, 23·0 [19·0–26·5] in 300 mg S44819 group, and 22·0 [17·0–26·0] in placebo group), time needed to complete parts A (50 s [IQR 42–68] in 150 mg S44819 group, 49 s [36–63] in 300 mg S44819 group, and 50 s [38–68] in placebo group) and B (107 s [81–144] in 150 mg S44819 group, 121 s [76–159] in 300 mg S44819 group, and 130 s [86–175] in placebo group) of the Trail Making Test, and the Barthel index (90 [IQR 60–100] in 150 mg S44819 group, 90 [70–100] in 300 mg S44819 group, and 90 [70–100] in placebo group) were similar in all groups. Number and type of adverse events were similar between the three groups. There were no drug-related adverse events and no drug-related deaths. Interpretation: There was no evidence that S44819 improved clinical outcome in patients after ischaemic stroke, and thus S44819 cannot be recommended for stroke therapy. The concept of tonic inhibition after stroke should be re-evaluated in humans. Funding: Servier

    Maternal overnutrition programs epigenetic changes in the regulatory regions of hypothalamic Pomc in the offspring of rats.

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    Maternal overnutrition has been implicated in affecting the offspring by programming metabolic disorders such as obesity and diabetes, by mechanisms that are not clearly understood. This study aimed to determine the long-term impact of maternal high-fat (HF) diet feeding on epigenetic changes in the offspring's hypothalamic Pomc gene, coding a key factor in the control of energy balance. Further, it aimed to study the additional effects of postnatal overnutrition on epigenetic programming by maternal nutrition.Eight-week-old female Sprague-Dawley rats were fed HF diet or low-fat (LF) diet for 6 weeks before mating, and throughout gestation and lactation. At postnatal day 21, samples were collected from a third offspring and the remainder were weaned onto LF diet for 5 weeks, after which they were either fed LF or HF diet for 12 weeks, resulting in four groups of offspring differing by their maternal and postweaning diet.With maternal HF diet, offspring at weaning had rapid early weight gain, increased adiposity, and hyperleptinemia. The programmed adult offspring, subsequently fed LF diet, retained the increased body weight. Maternal HF diet combined with offspring HF diet caused more pronounced hyperphagia, fat mass, and insulin resistance. The ARC Pomc gene from programmed offspring at weaning showed hypermethylation in the enhancer (nPE1 and nPE2) regions and in the promoter sequence mediating leptin effects. Interestingly, hypermethylation at the Pomc promoter but not at the enhancer region persisted long term into adulthood in the programmed offspring. However, there were no additive effects on methylation levels in the regulatory regions of Pomc in programmed offspring fed a HF diet.Maternal overnutrition programs long-term epigenetic alterations in the offspring's hypothalamic Pomc promoter. This predisposes the offspring to metabolic disorders later in life

    EXISTE-T-IL UN \uab PROTO-CIMENT \ubb AU COURS DE LA PR\uc9HISTOIRE R\uc9CENTE EN EUROPE OCCIDENTALE ? L\u2019EXEMPLE DU SITE DE L\u2019\uc2GE DU BRONZE MOYEN DE \uab SOLAROLO-VIA ORDIERE \ubb (RAVENNE, ITALIE)

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    A large quantity of very hard earthen fragments with a flat smoothed surface has been unearthed during the excavation of the Bronze Age site of \u201cSolarolo\u201d (Ravenna, Italy). Most of them seem to originate from dismantled constructed floors. A technological analysis of them was conducted at different observation scales. Their hardness appears to result from complex cementation and thermal alteration processes.Dans le cadre de la fouille du site de l\u2019\ue2ge du Bronze moyen de \uab Solarolo \ubb (Ravenne, Italie), les fragments en terre crue caract\ue9ris\ue9s par une seule surface plane et une tr\ue8s forte coh\ue9sion sont r\ue9guli\ue8rement mis au jour. Ils semblent provenir de sols construits d\ue9mantel\ue9s. Ces restes ont fait l\u2019objet d\u2019une analyse technologique conduite \ue0 diff\ue9rentes \ue9chelles d\u2019observation. La coh\ue9sion du mat\ue9riau de terre semble \ueatre le r\ue9sultat de processus complexes de cimentation et d\u2019alt\ue9ration thermique

    Integrating technical performances within design exploration: The case of an innovative Trombe wall

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    The Double Face 2.0 research project aims at developing a novel type of an adaptive translucent Trombe wall. The novelty of the proposed system is based on the integration of new lightweight and translucent materials, used both forlatent heat storage and insulation, advanced computational design processes, used to identify the relationship between variations in geometry and their effect in terms of overall performance, as well as proposed fabrication methods basedon Fused Deposition Modelling. Various concepts and geometric configurations are explored and improved via a computational design workflow. The exploration is deeply rooted in performance simulations manufacturing constraints and measurements of prototypes. The paper presents the workflow of the overall on-going research project, with specific emphasis on the incorporation of a omputational assessment and optimization process. Moreover, it presents the preliminary set of measurements and simulations for thermal performances, their results and related conclusions.Design InformaticsBuilding Physic

    Temperature Control in (Translucent) Phase Change Materials Applied in Facades: A Numerical Study

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    Phase change materials (PCMs) are materials that can store large amounts of heat during their phase transition from solid to liquid without a significant increase in temperature. While going from liquid to solid this heat is again released. As such, these materials can play an important role in future energy-efficient buildings. If applied in facades as part of a thermal buffer strategy, e.g., capturing and temporarily storing solar energy in so-called Trombe walls, the PCMs are exposed to high solar radiation intensities, which may easily lead to issues of overheating. This paper therefore investigates the melting process of PCM and arrives at potential solutions for countering this overheating phenomenon. This study uses the simulation program Comsol to investigate the heat transfer through, melting of and fluid flow inside a block of PCM (3 × 20 cm2) with a melting temperature of around 25 °C. The density, specific heat and dynamic viscosity of the PCM are modeled as a temperature dependent variable. The latent heat of the PCM is modeled as part of the specific heat. One side of the block of PCM is exposed to a heat flux of 300 W/m2. The simulations show that once part of the PCM has melted convection arises transporting heat from the bottom of the block to its top. As a result, the top heats up faster than the bottom speeding up the melting process there. Furthermore, in high columns of PCM a large temperature gradient may arise due to this phenomenon. Segmenting a large volume of PCM into smaller volumes in height limits this convection thereby reducing the temperature gradient along the height of the block. Moreover, using PCMs with different melting temperature along the height of a block of PCM allows for controlling the speed with which a certain part of the PCM block starts melting. Segmenting the block of PCM using PCMs with different melting temperature along its height was found to give the most promising results for minimizing this overheating effect. Selecting the optimal phase change temperatures however is critical in that case.Building PhysicsDesign InformaticsTeachers of Practice / AE+
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