Underrepresentation of Elderly People in Randomised Controlled Trials. The Example of Trials of 4 Widely Prescribed Drugs

BACKGROUND: We aimed to determine the representation of elderly people in published reports of randomized controlled trials (RCTs). We focused on trials of 4 medications--pioglitazone, rosuvastatin, risedronate, and valsartan-frequently used by elderly patients with chronic medical conditions. METHODS AND FINDINGS: We selected all reports of RCTs indexed in PubMed from 1966 to April 2008 evaluating one of the 4 medications of interest. Estimates of the community-based "on-treatment" population were from a national health insurance database (SNIIR-AM) covering approximately 86% of the population in France. From this database, we evaluated data claims from January 2006 to December 2007 for 1,958,716 patients who received one of the medications of interest for more than 6 months. Of the 155 RCT reports selected, only 3 studies were exclusively of elderly patients (2 assessing valsartan; 1 risedronate). In only 4 of 37 reports (10.8%) for pioglitazone, 4 of 22 (18.2%) for risedronate, 3 of 29 (10.3%) for rosuvastatine and 9 of 67 (13.4%) for valsartan, the proportion of patients aged 65 or older was within or above that treated in clinical practice. In 62.2% of the reports for pioglitazone, 40.9% for risedronate, 37.9% for rosuvastatine, and 70.2% for valsartan, the proportion of patients aged 65 or older was lower than half that in the treated population. The representation of elderly people did not differ by publication date or sample size. CONCLUSIONS: Elderly patients are poorly represented in RCTs of drugs they are likely to receive

New records of lichen - forming fungi from Fiji

Sixty-six species are recorded for the first time from the Fijian archipelago. Diagnostic features and distribution areas are given for each species reported here. The genera Bactrospora, Badimia, Baeomyces, Calenia, Coccotrema, Dibaeis, Gyalectidium, Gyalideopsis, Lecanora, Lepraria, Leucodecton, Megalospora, Melanotopelia, Pannaria, Peltigera, Pyxine, strigula, Thalloloma, and Thelotrema are reported here from Fiji for the first time. The majority of new records belong to pan- or palaeo-tropical species, in addition to cosmopolitan, Australasian and Indo-Pacific elements

New Liverwort (Marchantiophyra) records for the Fiji Islands

Forty-eight species of liverworts (Marchantiophyta) are reported as new to the Fiji Islands. These records increase the number of Fijian liverworts by over 20%. Extension of range within Fiji are reported for an additional 39 taxa already known to occur within the Fijian archipelago. These records indicate that the Fijian flora is understudied and many localities in Fiji, including entire islands, remain under-collected for bryophytes. Metalejeunea crassitexta (J.B.Jack et Steph.) Pocs is proposed as a new combination, and Lejeunea microstipula Steph. is reduced to a synonym of Lejeunea exilis (Reinw., Blume et Nees) Grolle

A brief history of the cryptogams of Fiji and prospects for the future

A brief history of Fijian cryptogams, including bryophytes, ferns and lycophytes, and lichenised fungi is provided. Brief comments on the future prospects for the systematic and conservation of these groups of organisms are provided. An overview of the six Fijian contributions is also provided. In contrast to many other biodiversity hotspots, the current study highlights our limited floristic knowledge of the Fijian cryptogams

Molecular basis of F-actin regulation and sarcomere assembly via myotilin.

Sarcomeres, the basic contractile units of striated muscle cells, contain arrays of thin (actin) and thick (myosin) filaments that slide past each other during contraction. The Ig-like domain-containing protein myotilin provides structural integrity to Z-discs-the boundaries between adjacent sarcomeres. Myotilin binds to Z-disc components, including F-actin and α-actinin-2, but the molecular mechanism of binding and implications of these interactions on Z-disc integrity are still elusive. To illuminate them, we used a combination of small-angle X-ray scattering, cross-linking mass spectrometry, and biochemical and molecular biophysics approaches. We discovered that myotilin displays conformational ensembles in solution. We generated a structural model of the F-actin:myotilin complex that revealed how myotilin interacts with and stabilizes F-actin via its Ig-like domains and flanking regions. Mutant myotilin designed with impaired F-actin binding showed increased dynamics in cells. Structural analyses and competition assays uncovered that myotilin displaces tropomyosin from F-actin. Our findings suggest a novel role of myotilin as a co-organizer of Z-disc assembly and advance our mechanistic understanding of myotilin's structural role in Z-discs