Harbour porpoises (Phocoena phocoena) and minke whales (Balaenoptera acutorostrata) observed during land-based surveys in The Minch, north-west Scotland

Peer reviewedPublisher PD

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Aldo-keto reductases are biomarkers of NRF2 activity and are co-ordinately overexpressed in non-small cell lung cancer

BACKGROUND: Although the nuclear factor-erythroid 2-related factor 2 (NRF2) pathway is one of the most frequently dysregulated in cancer, it is not clear whether mutational status is a good predictor of NRF2 activity. Here we utilise four members of the aldo-keto reductase (AKR) superfamily as biomarkers to address this question. METHODS: Twenty-three cell lines of diverse origin and NRF2-pathway mutational status were used to determine the relationship between AKR expression and NRF2 activity. AKR expression was evaluated in lung cancer biopsies and Cancer Genome Atlas (TCGA) and Oncomine data sets. RESULTS: AKRs were expressed at a high basal level in cell lines carrying mutations in the NRF2 pathway. In non-mutant cell lines, co-ordinate induction of AKRs was consistently observed following activation of NRF2. Immunohistochemical analysis of lung tumour biopsies and interrogation of TCGA data revealed that AKRs are enriched in both squamous cell carcinomas (SCCs) and adenocarcinomas that contain somatic alterations in the NRF2 pathway but, in the case of SCC, AKRs were also enriched in most other tumours. CONCLUSIONS: An AKR biomarker panel can be used to determine NRF2 status in tumours. Hyperactivation of the NRF2 pathway is far more prevalent in lung SCC than previously predicted by genomic analyses

Book Reviews

PRACTICAL STUDENT OBSTETRICS Bende, S & Tindall, VR Heinemann, 1980 pp; 435. £12.50ESSENTIALS OF DERMATOLOGY J.L. Burton, Churchill Livingstone. 1980. pp. 196. £3.95ESSENTIAL PAEDIATRICS Hull, D. & Johnston, D.l. Churchill Livingstone, 1981 pp.305. £10.00PRACTICAL PROCEDURES IN CLINIC AL MEDICINE Michael J. Ford and John F. Munro Churchill Livingstone 1980 pp. 128. £4.25LECTUR E NOTES ON CLINICAL ONCOLOGY: Hancock, B.W. & Bradshaw, J.D.Blackwell, 1981.pp. 176. £5.50INTRODUCING ANATOMY J.D. Lever London: William Heinemann Medical Books Ltd. 1980.pp. 288. £7.95

The impact of opiate substitution treatment on mortality risk in drug addicts: a natural experiment study

Background Opiate substitution treatment (OST) is the main treatment for people addicted to heroin and other opioid drugs. However, there is limited information on how the delivery of this treatment affects mortality risk.Objectives To investigate the associations of mortality risk with periods during treatment and following cessation of treatment, medication type, co-prescription of other medication and dosing regimens during titration and detoxification. The trends with time of prescribed medication, dose and treatment duration were also explored.Design Prospective longitudinal observational study.Setting UK primary care between 1998 and 2014.Participants A total of 12,780 patients receiving methadone, buprenorphine or dihydrocodeine.Main outcome measures All-cause mortality relating to 657 deaths and drug-related poisoning relating to 113 deaths.Data sources Clinical Practice Research Datalink with linked information on cause of death from the Office for National Statistics.Results For both outcomes, the lowest mortality risk was observed after 4 weeks of treatment and the highest risk was observed in the first 4 weeks following cessation of treatment [e.g. for drug-related poisoning, incidence rate ratio (IRR) 8.15, 95% confidence interval (CI) 5.45 to 12.19]. There was evidence that the treatment period risks varied with OST medication. The largest difference in risk was for the first 4 weeks of treatment for both outcomes, with patients on buprenorphine being at lower risk than those on methadone (e.g. for drug-related poisoning, IRR 0.08, 95% CI 0.01 to 0.48). The co-prescription of benzodiazepines was associated with linearly increasing the risk of drug-related deaths by dose (IRR 2.02, 95% CI 1.66 to 2.47), whereas z-drugs (zolpidem, zopiclone and zaleplon) were associated with increased risk of both all-cause (IRR 1.83, 95% CI 1.59 to 2.12) and drug-related (IRR 3.31, 95% CI 2.45 to 4.47) mortality. There was weak evidence that higher initial and final doses were associated with increased all-cause mortality risk. In the first 4 weeks of treatment, the risk increased by 4% for each 5-mg increment in methadone dose (1-mg increase in buprenorphine) (hazard ratio 1.04, 95% CI 1.00 to 1.09). In the first 4 weeks after treatment ceased, a similar increment in final dose increased the risk by 3% (hazard ratio 1.03, 95% CI 0.99 to 1.07). There were too few deaths to evaluate the effects on drug-related poisoning. The proportion of OST patients receiving buprenorphine increased between 1998 and 2006. Median treatment duration was consistently shorter for buprenorphine than for methadone for each year studied (overall median duration of 48 and 106 days, respectively).Limitations As this was an observational study, the possibility remains of bias from unmeasured factors, which covariate adjustment and inverse probability weighting can eliminate only partially.Conclusions Using buprenorphine as an alternative to methadone may not reduce mortality overall despite resulting in lower IRRs from shorter treatment duration. Clinical guidance needs to consider strengthening warnings about the co-prescription of a range of drugs for OST patients.Future work Our analyses need to be replicated using other clinical data sets in the UK and in other countries. New interventions and trials are required to investigate improving the retention of OST patients in primary care.Funding The National Institute for Health Research Health Services and Delivery Research programme

Recallable but not recognizable: The influence of semantic priming in recall paradigms

When people can successfully recall a studied word, they should be able to recognize it as having been studied. In cued-recall paradigms, however, participants sometimes correctly recall words in the presence of strong semantic cues but then fail to recognize those words as actually having been studied. Although the conditions necessary to produce this unusual effect are known, the underlying neural correlates have not been investigated. Across five experiments, involving both behavioral and electrophysiological methods (EEG), we investigated the cognitive and neural processes that underlie recognition failures. Experiments 1 and 2 showed behaviorally that assuming that recalled items can be recognized in cued-recall paradigms is a flawed assumption, because recognition failures occur in the presence of cues, regardless of whether those failures are measured. With event-related potentials (ERPs), Experiments 3 and 4 revealed that successfully recalled words that are recognized are driven by recollection at recall and then by a combination of recollection and familiarity at ensuing recognition. In contrast, recognition failures did not show that memory signature and may instead be driven by semantic priming at recall and followed at recognition stages by negative-going ERP effects consistent with implicit processes, such as repetition fluency. These results demonstrate that recall - long-characterized as predominantly reflecting recollection-based processing in episodic memory - may at times also be served by a confluence of implicit cognitive processes

Effectiveness of attentional bias modification training as add-on to regular treatment in alcohol and cannabis use disorder:A multicenter randomized control trial

BACKGROUND: Attentional bias for substance-relevant cues has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, increase positive treatment outcome and reduce relapse rates. The current study investigated the effectiveness of a newly developed home-delivered, multi-session, internet-based ABM intervention, the Bouncing Image Training Task (BITT), as an add-on to treatment as usual (TAU). METHODS: Participants (N = 169), diagnosed with alcohol or cannabis use disorder, were randomly assigned to one of two conditions: the experimental ABM group (50%; TAU+ABM); or the control group (50%; split in two subgroups the TAU+placebo group and TAU-only group, 25% each). Participants completed baseline, post-test, and 6 and 12 months follow-up measures of substance use and craving allowing to assess long-term treatment success and relapse rates. In addition, attentional bias (both engagement and disengagement), as well as secondary physical and psychological complaints (depression, anxiety, and stress) were assessed. RESULTS: No significant differences were found between conditions with regard to substance use, craving, relapse rates, attentional bias, or physical and psychological complaints. CONCLUSIONS: The findings may reflect unsuccessful modification of attentional bias, the BITT not targeting the relevant process (engagement vs. disengagement bias), or may relate to the diverse treatment goals of the current sample (i.e., moderation or abstinence). The current findings provide no support for the efficacy of this ABM approach as an add-on to TAU in alcohol or cannabis use disorder. Future studies need to delineate the role of engagement and disengagement bias in the persistence of addiction, and the role of treatment goal in the effectiveness of ABM interventions

Application of a mouse model humanized for cytochrome P450–mediated drug metabolism to predict drug-drug interactions between a peptide and small molecule drugs

Conventional preclinical in vitro approaches inaccurately predicted clinical trial outcomes of drug-drug interactions involving the peptide NN1177, a glucagon and glucagon-like peptide 1 receptor coagonist. To further study the mechanisms behind this discrepancy, we have exploited a mouse model (8HUM) humanized for the major cytochrome P450 (P450) enzymes involved in drug disposition in humans. We show that NN1177 administration to 8HUM mice suppressed hepatic in vivo expression of CYP3A4 (82% compared to vehicle) and CYP1A2 (58% compared to vehicle). This was consistent with in vitro sandwich culture hepatocyte data reported previously. However, reduction in CYP3A4 and CYP1A2 levels in vivo appeared to resolve over time, despite daily NN1177 administration. These findings suggest an adaptive response to the metabolic effects of NN1177. In vivo pharmacokinetic studies in 8HUM closely matched the findings observed in the clinical trial, because there was no relevant increase in the exposure of the CYP3A4 and CYP1A2 probe drugs. Furthermore, no suppression effects were observed when the mice had been pretreated with the inducing agents, St. John’s wort or phenobarbital, respectively, suggesting that the mechanism of P450 reduction does not involve the transcription factors constitutive androgen receptor or pregnane X receptor. These data highlight the complexities associated with therapeutic peptide drug-drug interactions and the remaining challenges for accurate predictions of P450 suppression and potential clinical implications. The humanized 8HUM model provides a promising and informative preclinical tool that can add high value during drug development by providing further insights into the effects on P450 expression, together with the subsequent impact of coadministered probe drugs in an in vivo model. Significance Statement: The current work describes the application of a humanized cytochrome P450 mouse model that provides further insight into the potential mechanisms and outperforms conventional in vitro approaches for preclinical predictions of peptide drug-drug interaction risk. The results showed no significant effects on the Cooperstown 5 + 1 cocktail, in line with clinical findings, and thereby represent an exciting model to further explore future therapeutic peptide projects during drug development.</p

Antibiotic susceptibilities of Pseudomonas aeruginosa isolates derived from patients with cystic fibrosis under aerobic, anaerobic, and biofilm conditions

Recent studies have determined that Pseudomonas aeruginosa can live in a biofilm mode within hypoxic mucus in the airways of patients with cystic fibrosis (CF). P. aeruginosa grown under anaerobic and biofilm conditions may better approximate in vivo growth conditions in the CF airways, and combination antibiotic susceptibility testing of anaerobically and biofilm-grown isolates may be more relevant than traditional susceptibility testing under planktonic aerobic conditions. We tested 16 multidrug-resistant isolates of P. aeruginosa derived from CF patients using multiple combination bactericidal testing to compare the efficacies of double and triple antibiotic combinations against the isolates grown under traditional aerobic planktonic conditions, in planktonic anaerobic conditions, and in biofilm mode. Both anaerobically grown and biofilm-grown bacteria were significantly less susceptible (P < 0.01) to single and combination antibiotics than corresponding aerobic planktonically grown isolates. Furthermore, the antibiotic combinations that were bactericidal under anaerobic conditions were often different from those that were bactericidal against the same organisms grown as biofilms. The most effective combinations under all conditions were colistin (tested at concentrations suitable for nebulization) either alone or in combination with tobramycin (10 mu g ml(-1)), followed by meropenem combined with tobramycin or ciprofloxacin. The findings of this study illustrate that antibiotic sensitivities are dependent on culture conditions and highlight the complexities of choosing appropriate combination therapy for multidrug-resistant P. aeruginosa in the CF lung