Treatment With Mycophenolate and Cyclophosphamide Leads to Clinically Meaningful Improvements in Patient-Reported Outcomes in Scleroderma Lung Disease: Results of Scleroderma Lung Study II.

OBJECTIVE: Our objective was to determine if treatment with cyclophosphamide (CYC) and mycophenolate mofetil (MMF) improves patient-reported outcomes (PROs) among patients with systemic sclerosis-related interstitial lung disease (SSc-ILD). METHODS: This study examined PROs in patients with SSc-ILD (N = 142) who participated in the Scleroderma Lung Study II, a randomized controlled trial comparing MMF for 2 years with oral CYC for 1 year followed by 1 year of a placebo. Joint models were created to evaluate the course of PROs over 2 years. The difference in PRO scores from baseline to 24 months was measured, and the percentage of patients meeting the minimum clinically important difference (MCID) was calculated. Correlations between PROs and SSc-ILD disease severity measures were also examined. RESULTS: Treatment with CYC and MMF led to improvements in several PROs with no between-treatment differences. Scores for the Transitional Dyspnea Index (TDI) and St. George's Respiratory Questionnaire (SGRQ) improved significantly over 2 years, and 29%/24% and 28%/25% of participants in the CYC/MMF groups met or exceeded the MCID estimates for TDI and SGRQ, respectively. At baseline, the forced vital capacity (FVC) percentage predicted (FVC%-predicted) did not correlate with the Baseline Dyspnea Index or SGRQ. However, improvements in the FVC%-predicted were weakly associated with improvements in dyspnea (assessed by the TDI) and SGRQ scores. CONCLUSION: Treatment with CYC and MMF improved overall health-related quality of life in patients with SSc-ILD. The relationship between PRO measures and the FVC was relatively weak, suggesting that PROs provide complementary information about treatment efficacy not captured by changes in the FVC alone in this patient population.

Developmental trajectories of cerebral blood flow and oxidative metabolism at baseline and during working memory tasks.

The neurobiological interpretation of developmental BOLD fMRI findings remains difficult due to the confounding issues of potentially varied baseline of brain function and varied strength of neurovascular coupling across age groups. The central theme of the present research is to study the development of brain function and neuronal activity through in vivo assessments of cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) both at baseline and during the performance of a working memory task in a cohort of typically developing children aged 7 to 18years. Using a suite of 4 emerging MRI technologies including MR blood oximetry, phase-contrast MRI, pseudo-continuous arterial spin labeling (pCASL) perfusion MRI and concurrent CBF/BOLD fMRI, we found: 1) At baseline, both global CBF and CMRO2 showed an age related decline while global OEF was stable across the age group; 2) During the working memory task, neither BOLD nor CBF responses showed significant variations with age in the activated fronto-parietal brain regions. Nevertheless, detailed voxel-wise analyses revealed sub-regions within the activated fronto-parietal regions that show significant decline of fractional CMRO2 responses with age. These findings suggest that the brain may become more "energy efficient" with age during development.

A survey of background levels of explosives and related compounds in the environment.

In this paper, swabbings from various public areas in 28 different cities throughout the United States were collected. A wide variety of objects were tested, ranging from park benches and telephones to sign posts and mailboxes. Inorganic anions and cations common in low explosives were detected simultaneously using capillary zone electrophoresis. Organic high explosives including nitroaromatics, nitramines, and nitrate esters were detected using gas chromatography with a pulsed-discharge electron capture detector. Confirmation of selected results was performed by ion chromatography and negative ion chemical ionization GC/MS. In general the results provide two major conclusions: (i) with the exception of nitrate, most low explosive oxidizers are rare in the environment; (ii) no organic explosives or significant interferences to these explosives were detected.

A novel method for analysis of explosives residue by simultaneous detection of anions and cations via capillary zone electrophoresis.

A novel electrolyte has been developed for the simultaneous separation of cations and anions in low explosive residue by capillary electrophoresis. This electrolyte contains 15mM alpha-hydroxyisobutyric acid (HIBA) as the buffer, 6mM imidazole as the cation chromophore, 3mM 1,3,6-naphthalenetrisulfonic acid (NTS) as the anion chromophore, 4mM 18-crown-6 ether as a cation selectivity modifier, and 5% (v/v) acetonitrile as an organic modifier. The pH was adjusted to 6.5 using tetramethylammonium hydroxide (TMAOH), an electroosmotic flow modifier. The method was optimized by varying the concentrations of alpha-HIBA, imidazole, and 1,3,6-NTS at three different pH values. The results provided a simultaneous indirect photometric analysis of both anions and cations with detection limits ranging from 0.5 to 5ppm for anions and from 10 to 15ppm for cations with a total run time of under 7min. The method was then applied to the analysis of Pyrodex((R)) RS and black powder, as well as several smokeless powders. The results obtained were consistent with previously reported results for separate anion and cation analysis and provide a faster, more complete analysis of each sample in a single chromatographic run.