Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study.

Background and aims: Cardiovascular mortality is high in Germany. For patients with high or very high cardiovascular risk, the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT). This study aimed to assess dyslipidaemia management and achievement of the ESC/EAS guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals. Methods: This European 18-country, cross-sectional, observational DA VINCI study (EUPAS22075) collected data during a single visit between June 2017 and November 2018 and included LLT in the preceding 12 months and the patients' most recent LDL-C measurement. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL-C goals while receiving stabilized LLT was assessed. Data from the German cohort are presented here. Results: Seven German sites enrolled a total of 421 primary and secondary prevention patients, 327 were receiving stabilized LLT at the time of LDL-C measurement, i.e. statin monotherapy of high (16%; n = 53), moderate (49%; n = 160) or low (7%; n = 24) intensity, ezetimibe combination (18%; n = 58), proprotein convertase subtilisin/kexin type 9 antibody combination (3%; n = 9), and other LLT (7%; n = 23). The 2016 and 2019 risk-based LDL-C goals were attained by 46% (n = 149) and 28% (n = 92) of patients, respectively. Conclusions: There is a large gap between ESC/EAS recommendations and LDL-C goal achievement in routine clinical practice in high and very high-risk patients in Germany. Low-to-moderate-intensity statin monotherapy was the most frequently used LLT; use of high-intensity statins and combination therapy was limited. In addition to optimizing statin intensity, combination with non-statin LLT may be needed in most of these patients.

Configurationally flexible zinc complexes as catalysts for rac-lactide polymerisation.

Zn(N(SiMe3)2)2 was reacted with pyridinemethanol and R,R-N,N'-di(methylbenzyl)-2,5-diiminopyrrole (L1H) to afford the dimeric complex (L1)2Zn2(µ-OR)2. The complex showed moderate activity in rac-lactide polymerization to heterotactic polymer (Pr = 0.75). 2,4-Di-tert-butyl-6-aminomethyl-phenol ligands with amino = N,N,N',N'-tetramethyldiethylenetriamine (L2H) or di-(2-picoly)amine (L3H) were reacted with ZnEt2 to form (L2)ZnEt and with Zn(N(SiMe3)2)2 to form the respective amide complexes. All complexes, including (L1)2Zn2(µ-OR)2 were characterised by X-ray diffraction studies. (L2)ZnEt was unreactive toward ethanol, but the amide complexes afforded (L2)ZnOEt and (L3)ZnOEt upon reaction with ethanol, which were used in rac-lactide polymerization without isolation. All complexes racemise readily at room temperature and show apparent Cs-symmetry in their NMR spectra. The ethoxide complexes were highly active in lactide polymerization, with (L3)ZnOEt reaching full conversion in 15 min at 0.5 mM catalyst concentration at room temperature. In both cases, introduction of a second donor arm on the central nitrogen introduced a slight bias for isotactic monomer enchainment (Pm = 0.55-0.60), which for (L3)ZnOEt was dependent on catalyst concentration.

Dinuclear iminophenoxide copper complexes in rac-lactide polymerisation.

Dinuclear bis(R'-(R''-iminomethyl)phenoxide) copper complexes L2Cu2(µ-OR)2 were prepared from the reaction of copper methoxide with ROH and LH (ROH = dimethylaminoethanol or pyridylmethanol, R' = H, 4,6-tBu, 1,3-Cl, R'' = benzyl, cyclohexyl, diphenylmethyl and 2,6-dimethylphenyl). Preparation was complicated by formation of homoleptic L2Cu and only 9 of the 24 possible combinations could be prepared. All complexes were characterized by single crystal X-ray diffraction studies and crystallized as dinuclear penta-coordinated complexes. Homoleptic complexes L2Cu were inactive in lactide polymerization at room temperature. Most heteroleptic complexes showed modest to good activities with full conversion in less than 6 h at room temperature. Complexes with R' = H showed poor molecular weight control, complexes with R' = Cl were inactive in polymerization. In pyridylmethoxide-containing complexes, only one alkoxide initiated chain growth. All complexes produced atactic polymer.

Exploring the reactivity of manganese(III) complexes with diphenolate-diamino ligands in rac-lactide polymerization.

Manganese(III) complexes of tetradentate diphenolate-diamino (NNOO(2-)) ligands were prepared from aerobic reaction of MnCl2 with the respective ligands in basic methanolic solution. Methoxide complexes (NNOO)Mn(OMe)(MeOH)0-1 were obtained for three ligands, while others only provided the respective chloride complexes (NNOO)Mn(Cl)(MeOH). Complexes were analyzed by X-ray diffraction studies and octahedral complexes showed evidence of Jahn-Teller distortions. Magnetic moments determined in MeOD were indicative of high-spin Mn(III)-d(4) complexes (µeff = 4.2-4.6µB). Methoxide complexes were active in the coordination-insertion polymerization of rac-lactide (130 °C, 0.33-1.0 mol% catalyst loading) to yield atactic polylactic acid with moderate molecular weight control. Polymerization activity was reduced, but not suppressed by the presence of protic impurities. Chloride complexes showed less activity and only in the presence of external alcohol, indicative of an activated-monomer mechanism.

Isotactic rac-Lactide Polymerization with Copper Complexes: The Influence of Complex Nuclearity.

Diiminopyrrolide copper alkoxide complexes, LCuOR (OR(1)=N,N-dimethylamino ethoxide, OR(2)=2-pyridyl methoxide), are active for the polymerization of rac-lactide at ambient temperature in benzene to yield polymers with M(w)/M(n)=1.0-1.2. X-ray diffraction studies showed bridged dinuclear complexes in the solid state for both complexes. While LCuOR(1) provided only atactic polylactide, LCuOR(2) produced partially isotactic polylactide (P(m)=0.7). The difference in stereocontrol is attributed to a dinuclear active species for LCuOR(2) in contrast to a mononuclear species for LCuOR(1).

Parallel screening for ALK, MET and ROS1 alterations in non-small cell lung cancer with implications for daily routine testing.

OBJECTIVES: ALK, MET and ROS1 are prognostic and predictive markers in NSCLC, which need to be implemented in daily routine. To evaluate different detection approaches and scoring systems for optimal stratification of patients eligible for mutation testing in the future, we screened a large and unselected cohort of NSCLCs for all three alterations. MATERIAL AND METHODS: Using tissue microarrays, 473 surgically resected NSCLCs were tested for ALK and MET expression by IHC and genomic alterations in the ALK, MET and ROS1 gene by FISH. For MET IHC, two different criteria (MetMAb and H-score), for MET FISH, three different scoring systems (UCCC, Cappuzzo, PathVysion) were investigated. RESULTS: ALK and ROS1 positivity was seen in 2.6% and 1.3% of all ADCs, respectively, but not in pure SCCs. One ROS1 translocated tumor showed additional ROS1 amplification. MET IHC+/FISH+ cases were found in both histological subtypes (8.6% in all NSCLCs; 10.6% in ADCs; 5.0% in SCCs) and were associated with pleural invasion, lymphatic vessel invasion and lymph node metastasis. MET altered ADCs more frequently showed a papillary growth pattern. Whereas ALK testing revealed homogenous results in IHC and FISH, we saw discordant results for MET in about 10% of cases. Both METIHC scoring systems revealed almost identical results. We did not encounter any combined FISH positivity for ALK, MET or ROS1. However, three ALK positive cases harbored MET overexpression. CONCLUSION: In daily routine, IHC could support FISH in the identification of ALK altered NSCLCs. Further research is needed to assess the role of discordant MET results by means of IHC and FISH as well as the relevance of tumors with an increased ROS1 gene copy number.

Multicenter immunohistochemical ALK-testing of non-small-cell lung cancer shows high concordance after harmonization of techniques and interpretation criteria.

INTRODUCTION: Detection of anaplastic lymphoma kinase (ALK)-gene rearrangements in non-small-cell lung cancer (NSCLC) is mainly performed by fluorescence in-situ hybridization (FISH). The question was raised if FISH might be replaced by immunohistochemistry (IHC) in a reliable and reproducible manner across different laboratories. METHODS: After calibration of the staining instruments and training of the observers to binary interpretation (positive versus negative), 15 NSCLC were independently tested for ALK protein expression by IHC only in a multicenter setting (16 institutes). Each laboratory utilized the VENTANA ALK-D5F3 IHC assay. As demonstrated by FISH the samples displayed unequivocal ALK break-positivity (6×) and negativity (7×), as well as ALK positive-"borderline" character (2×), which is challenging for FISH diagnosis and thus was RT-PCR-confirmed. RESULTS: All seven ALK FISH-negative cases were homogenously scored as ALK-IHC negative. All 16 participants scored the two ALK positive-"borderline" samples as unequivocally positive according to their protein expression. Concordant IHC interpretation was also noticed in four of six unequivocal ALK break positive cases. In two of six some observers described a weak/heterogeneous ALK-IHC staining. This would have resulted in a subsequent ALK-testing (FISH/PCR) in a routine diagnostic setting. CONCLUSIONS: This so-called "ALK-Harmonization-Study" shows for the first time that predictive semiquantitative IHC reveals reliable and reproducible results across several labs when methodology and interpretation are strictly defined and the pathologists are uniquely trained. The application of validated ALK IHC assays and its comparison to ALK-FISH is highly needed in future clinical trials. This might answer the question if ALK-IHC cannot only serve as a prescreening tool, but as a stand-alone test at least in cases displaying an unequivocally staining pattern as well as an alternative predictive test in samples with reduced FISH interpretability.

Lactide polymerization catalyzed by Mg and Zn diketiminate complexes with flexible ligand frameworks.

Diketimine ligands bearing N-benzyl, N-9-anthrylmethyl and N-mesitylmethyl substituents (nacnac(Bn)H, nacnac(An)H, and nacnac(Mes)H) were prepared from condensation of the amine with either acetyl acetone or its ethylene glycol monoketal. Chlorination with N-chlorosuccinimide in the 3-position yielded Clnacnac(Bn)H and Clnacnac(An)H. The ligands were reacted with Zn(TMSA)2 (TMSA = N(SiMe3)2) to yield nacnac(An)Zn(TMSA) and Clnacnac(Bn)Zn(TMSA). Protonation with isopropanol afforded nacnac(An)ZnOiPr and Clnacnac(Bn)ZnOiPr. Reaction of the diketimines with Mg(TMSA)2 afforded nacnac(An)Mg(TMSA), nacnac(Mes)Mg(TMSA), Clnacnac(Bn)Mg(TMSA) and Clnacnac(An)Mg(TMSA). Subsequent protonation with tert-butanol produced nacnac(Mes)MgOtBu and Clnacnac(Bn)MgOtBu, but only decomposition was observed with N-anthrylmethyl substituents. Most complexes were characterized by X-ray diffraction studies. TMSA complexes were monomeric and alkoxide complexes dimeric in the solid state. All alkoxide complexes, as well as nacnac(An)Mg(TMSA)/BnOH and Clnacnac(An)Mg(TMSA)/BnOH were moderately to highly active in rac-lactide polymerization (90% conversion in 30 s to 3 h). nacnac(An)ZnOiPr produced highly heterotactic polymers (P(r) = 0.90), Clnacnac(Bn)MgOtBu/BnOH produced slightly isotactic polymers at -30 °C (P(r) = 0.43), and all other catalysts produced atactic polymers with a slight heterotactic bias.

Role of diuretics, ß blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: reanalysis of data from the NAVIGATOR study.

OBJECTIVE: To examine the degree to which use of ß blockers, statins, and diuretics in patients with impaired glucose tolerance and other cardiovascular risk factors is associated with new onset diabetes. DESIGN: Reanalysis of data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. SETTING: NAVIGATOR trial. PARTICIPANTS: Patients who at baseline (enrolment) were treatment naïve to ß blockers (n=5640), diuretics (n=6346), statins (n=6146), and calcium channel blockers (n=6294). Use of calcium channel blocker was used as a metabolically neutral control. MAIN OUTCOME MEASURES: Development of new onset diabetes diagnosed by standard plasma glucose level in all participants and confirmed with glucose tolerance testing within 12 weeks after the increased glucose value was recorded. The relation between each treatment and new onset diabetes was evaluated using marginal structural models for causal inference, to account for time dependent confounding in treatment assignment. RESULTS: During the median five years of follow-up, ß blockers were started in 915 (16.2%) patients, diuretics in 1316 (20.7%), statins in 1353 (22.0%), and calcium channel blockers in 1171 (18.6%). After adjusting for baseline characteristics and time varying confounders, diuretics and statins were both associated with an increased risk of new onset diabetes (hazard ratio 1.23, 95% confidence interval 1.06 to 1.44, and 1.32, 1.14 to 1.48, respectively), whereas ß blockers and calcium channel blockers were not associated with new onset diabetes (1.10, 0.92 to 1.31, and 0.95, 0.79 to 1.13, respectively). CONCLUSIONS: Among people with impaired glucose tolerance and other cardiovascular risk factors and with serial glucose measurements, diuretics and statins were associated with an increased risk of new onset diabetes, whereas the effect of ß blockers was non-significant. TRIAL REGISTRATION: ClinicalTrials.gov NCT00097786.

Physical activity is strongly inversely related to post-challenge plasma glucose and glycemic spikes in a risk population for type 2 diabetes.

AIM: To examine the relationship between physical activity (PA) and various cardiometabolic risk factors during an oral glucose tolerance test (OGTT), including glycemic spikes (PGS) in individuals at risk for type 2 diabetes. SUBJECTS AND METHODS: A total of 949 middle-aged subjects from the Risk factors in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) trial aged 40-70 years were included in the present cross-sectional analysis. Standard 75 g OGTT was performed and blood was collected every 30 min for 2 hours for measurements of plasma glucose (PG) and other cardiometabolic risk factors. PA was assessed using interviewer-administered questionnaire. RESULTS: Post-challenge PGS and maximal PG (PGmax) during OGTT were significantly lower in individuals with high PA vs. individuals with low PA even after body mass index (BMI) adjustment (p = 0.026 and p = 0.035, respectively). In univariate analysis post-challenge PG 30, 60, 90, and 120 minutes, PGS and PGmax during OGTT were significantly inversely correlated to PA. This correlation was attenuated but remained significant after adjustment for BMI. Fasting PG and glycosylated hemoglobin were not correlated to PA. Significantly higher fasting and post-challenge insulin levels were found among subjects with low vs. subjects with medium (p < 0.05) and high PA (p < 0.05). Post-challenge C-peptide and proinsulin levels were significantly lower in participants with high vs. participants with low PA (p < 0.05 for all). The relationship between 2-h PG and PA was observed also in lean subjects and in subjects with normal fasting glucose. In multivariate analysis PA was a significant independent determinant of 2-h PG. CONCLUSION: We found a strong inverse relationship between PA and various post-challenge cardiometabolic parameters during OGTT, including glycemic spikes, in a population at risk for diabetes. This relationship was only partially dependent on BMI.

Square-planar Cu(II) diketiminate complexes in lactide polymerization.

Cu(OiPr)2 was reacted with several ß-diketimine ligands, nacnac(R)H. Sterically undemanding ligands with N-benzyl substituents afforded the dimeric heteroleptic complexes [nacnac(Bn)Cu(µ-OiPr)]2 and [3-Cl-nacnac(Bn)Cu(µ-OiPr)]2 (Bn = benzyl). With sterically more demanding amines, dimerization was not possible, and the putative nacnacCuOiPr intermediate underwent ligand exchange to the homoleptic bisdiketiminate complexes Cu(nacnac(ipp))2 and Cu(nacnac(Naph))2 (ipp = 2-isopropylphenyl, Naph = 1-napthyl). Homoleptic complexes were also prepared with N-benzyl ligands to yield Cu(nacnac(Bn))2 and Cu(3-succinimido-nacnac(Bn))2. All complexes were characterized by single-crystal X-ray diffraction. Even bulkier ligands with N-anthrylmethyl, N-mesitylmethyl, or N-methylbenzyl substituents failed to react with Cu(OiPr)2. In the case of nacnac(dipp)CuOiPr, putative nacnac(dipp)CuOiPr decomposed by ß-hydride elimination. Heteroleptic complexes [nacnac(Bn)Cu(µ-OiPr)]2 and [3-Cl-nacnac(Bn)Cu(µ-OiPr)]2 are very highly active rac-lactide polymerization catalysts, with complete monomer conversion at ambient temperature in solution in 0.5-5 min. In the presence of free alcohol, the homoleptic complexes seem to be in equilibrium with small amounts of the respective heteroleptic complex, which are sufficient to complete polymerization in less than 60 min at room temperature. All catalysts show high control of the polymerization with polydispersities of 1.1 and below. The obtained polymers were essentially atactic, with a slight heterotactic bias at ambient temperature and at -17 °C.

Potential association of paraoxonase-1, type 2 diabetes mellitus, and periodontitis.

BACKGROUND: The association between periodontitis and systemic diseases, including cardiovascular diseases and diabetes mellitus (DM), has been recognized repeatedly. Paraoxonase-1 (PON-1) is involved in the prevention of atherosclerosis, and decreased enzyme activity in patients with DM has been shown. The aim of this study is to investigate a possible correlation between decreased PON-1 activity and the association between impaired glucose metabolism or DM and periodontitis. METHODS: PON-1 phenotype distribution and enzyme activities were characterized by measuring the hydrolysis of phenylacetate and paraoxon in serum samples of 87 patients with type 2 DM and 46 patients with pre-DM showing impaired fasting plasma glucose and/or impaired oral glucose tolerance. The control group comprised 64 individuals with normal fasting plasma glucose and normal glucose tolerance. Altogether, 154 study participants were available for complete clinical periodontal examination. RESULTS: No difference in periodontitis prevalence existed between the study groups. However, patients with DM had an increased risk of suffering from generalized periodontitis (adjusted odds ratio = 4.05; 95% confidence interval = 1.24 to 13.18; P = 0.02), and their PON-1 activity was reduced compared to controls. In contrast, patients with pre-DM showed neither an increased periodontitis risk nor an impaired paraoxonase status. PON-1 was not associated directly with periodontitis. Nevertheless, concerning patients with DM, poor oral hygiene, male sex, and PON-1 phenotype were found to be significant predictors for periodontitis extent. CONCLUSIONS: Type 2 DM, but not a prediabetic state, increases the risk of generalized periodontitis. PON-1 status in patients with type 2 DM may contribute to this association.

Exceptionally high lactide polymerization activity of zirconium complexes with bridged diketiminate ligands.

A cyclohexanediyl-bridged, bis(N-xylyl) diketiminate ligand, (±)-C6H10(nacnac(Xyl)H)2, LH2 (Xyl = 2,6-dimethylphenyl), was obtained from the reaction of [(2,6-dimethylphenyl)amino]-pent-3-en-2-one first with Meerwein's salt, then with (±)-cyclohexanediamine. The reaction of the ligand with Zr(NMe2)4 yielded LZr(NMe2)2. Protonation of the remaining diamide ligands with EtOH or [H2NMe2]Cl yielded LZr(OEt)2 and LZrCl2, respectively. The latter complex was also obtained by the reaction of LH2 first with nBuLi and then with ZrCl4(THF)2. The dichloride complex yielded LZr(OEt)2 and LZrMe2 upon reaction with NaOEt or MeLi/AlMe3, respectively. X-ray diffraction studies showed a trans-configuration of the ancillary ligands in LZrCl2 and LZrMe2, and a cis-configuration in LZr(NMe2)2 and LZr(OEt)2. LZr(OEt)2 was tested as a catalyst for the polymerization of rac-lactide. Kinetic investigations yielded a rate law first order in catalyst and monomer and a rate constant k = 14(1) L mol(-1) s(-1), the latter being orders of magnitude higher than typical activities for group 4 complexes in lactide polymerization. Analyses of the obtained polymer revealed an atactic polymer and broad polymer molecular weight distributions with sizeable fractions of cyclic oligomers. The influence of contaminants on the polymerization activity was examined: while lactic acid deactivates the catalyst, addition of up to 1 equiv. of water or para-toluenesulfonic acid revitalized catalysts not showing maximum activity.

Association of physical activity with insulin resistance, subclinical inflammation, coagulation, and fibrinolytic biomarkers among population at high risk for type 2 diabetes.

OBJECTIVE: TO investigate the association of physical activity with insulin resistance and biomarkers of inflammation, coagulation, and fibrinolysis in a population at high risk for type 2 diabetes. PATIENTS AND METHODS: A total of 778 subjects from the Risk factors in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) study aged 40-70 years were included in the present cross-sectional analysis. RESULTS: Participants classified as having low physical activity (PA) were more insulin resistant in comparison to participants with medium (P = 0.042) and high PA (P = 0.015). Individuals with high physical activity had a significantly lower leucocytes count than individuals with low PA (P = 0.027) and significantly lower hs-CRP and fibrinogen concentrations than individuals with medium (P = 0.011 and P = 0.021) and low physical activity (P = 0.04 and P = 0.007). Although a trend towards a decrease in plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA) levels with increasing physical activity was present, significant differences were observed only between subjects with high and medium physical activity (P = 0.045 and P = 0.033). In multivariate regression analyses physical activity was an independent determinant of insulin resistance, leucocytes count, hs-CRP, and fibrinogen concentrations. CONCLUSIONS: Physical activity was independently associated with insulin resistance and biomarkers of inflammation, whereas only a tendency towards decreased concentrations of coagulation and fibrinolytic biomarkers with increasing physical activity was observed.

Nacnac(Bn)CuOiPr: a strained geometry resulting in very high lactide polymerization activity.

N,N'-Dibenzyl diketiminate copper isopropanolate, (nacnac(Bn)CuOiPr)(2), polymerizes rac- and S,S-lactide in the presence or absence of isopropanol as a chain-transfer reagent with very high activity (k(2) = 32 M(-1) s(-1)), narrow polydispersities and without evidence of side reactions such as transesterification, epimerization or catalyst decomposition.

Formation and reactivity of 3-diazopyridinium cations and influence on their reductive electrografting on glassy carbon.

The in situ generation of 3-diazonium cations from 3-aminopyridine and their subsequent stability under experimental conditions used for electrografting of pyridine groups were investigated by spectroscopy and electrochemistry. UV spectroscopy revealed the rapid kinetics for the reaction of 3-aminopyridine with sodium nitrite in HCl to form the 3-diazopyridinium cation with a second-order rate constant of 550 ± 20 L mol(-1) s(-1) at 22 °C. UV spectroscopy showed that the 3-diazopyridinium ion was relatively unstable and its transformation into 3-hydroxypyridine was proven by (1)H NMR. Its hydrolytic decomposition was investigated by NMR and followed first-order kinetics with a rate constant of (53 ± 5) × 10(-3) s(-1) at 22 °C. These results enable us to establish the appropriate conditions for the electrografting of pyridine from the corresponding diazonium cations generated in situ. The electrochemical modification of glassy carbon electrodes with pyridine was characterized by cyclic voltammetry and the resulting grafted layer by electrochemical impedance spectroscopy in the presence of Fe(CN)(6)(3-/4-) as redox probes. The effect of diazotization time before electrochemical reduction on the blocking effect of the grafted layer was investigated and showed that an increase of the diazotization time led to less efficient grafting. The presence of immobilized pyridine on the electrode surface was demonstrated by X-ray photoelectron spectroscopy measurements, and a surface coverage of 8.8 × 10(-10) mol cm(-2) was estimated for the grafted pyridine groups. The significance of these results for researchers using the in situ generation approach for electrochemical and chemical grafting is discussed.

A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study.

BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. CONCLUSION: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000417482.

'Gotta be sit down and worked out together': views of Aboriginal caregivers and service providers on ways to improve dementia care for Aboriginal Australians.

INTRODUCTION: Dementia is five-fold more prevalent among Aboriginal than non-Aboriginal Australians. Despite this, the quality of care available to people living with dementia in remote Aboriginal communities is poor. The objective of this study was to determine ways to overcome factors affecting the successful delivery of services to Aboriginal people with dementia living in remote communities, and to their families and communities. METHODS: This qualitative research took place in the Kimberley Region of Western Australia. Data collection occurred in three stages: (1) interviews with service providers to identify the services available; (2) interviews with the caregivers of Aboriginal people living with dementia and community-based care workers; and (3) focus groups with community representatives and community care staff. Each stage was concluded when no new themes emerged. At each stage the transcribed information was analysed and joint interpretation identified common themes. RESULTS: In total, 42 service providers, 31 caregivers and community-based care workers were interviewed and 3 focus groups were conducted. Obstacles to accessing quality care were mentioned and recommendations on ways to improve care were made. The key themes that emerged were caregiver role, perspectives of dementia, community and culturally-appropriate care, workforce, education and training, issues affecting remote communities and service issues. Detailed information on how each theme affects the successful delivery of dementia care is provided. CONCLUSIONS: These research findings indicate that people living with dementia and their caregivers in remote Aboriginal communities are struggling to cope. They are requesting and require better community care. Implementing a culturally safe model of dementia care for remote Aboriginal communities that encompasses the recommendations made and builds on the strengths of the communities could potentially deliver the required improvements to dementia care for this population.

Correlation of SHOX2 gene amplification and DNA methylation in lung cancer tumors.

BACKGROUND: DNA methylation in the SHOX2 locus was previously used to reliably detect lung cancer in a group of critical controls, including 'cytologically negative' samples with no visible tumor cell content, at a high specificity based on the analysis of bronchial lavage samples. This study aimed to investigate, if the methylation correlates with SHOX2 gene expression and/or copy number alterations. An amplification of the SHOX2 gene locus together with the observed tumor-specific hypermethylation might explain the good performance of this marker in bronchial lavage samples. METHODS: SHOX2 expression, gene copy number and DNA methylation were determined in lung tumor tissues and matched morphologically normal adjacent tissues (NAT) from 55 lung cancer patients. Quantitative HeavyMethyl (HM) real-time PCR was used to detect SHOX2 DNA methylation levels. SHOX2 expression was assayed with quantitative real-time PCR, and copy numbers alterations were measured with conventional real-time PCR and array CGH. RESULTS: A hypermethylation of the SHOX2 locus in tumor tissue as compared to the matched NAT from the same patient was detected in 96% of tumors from a group of 55 lung cancer patients. This correlated highly significantly with the frequent occurrence of copy number amplification (p < 0.0001), while the expression of the SHOX2 gene showed no difference. CONCLUSIONS: Frequent gene amplification correlated with hypermethylation of the SHOX2 gene locus. This concerted effect qualifies SHOX2 DNA methylation as a biomarker for lung cancer diagnosis, especially when sensitive detection is needed, i.e. in bronchial lavage or blood samples.

Nacnac(Bn)MgOtBu: a diketiminate-based catalyst for the polymerisation of rac-lactide with slight isotactic preference.

The reaction of N,N'-dibenzyl-2-amino-4-imino-pent-2-ene, nacnac(Bn)H, with 1 or 2 equiv. of MgnBu2 afforded the homoleptic complex nacnac(Bn)2Mg. The reaction of nacnac(Bn)H with Mg(N(SiMe3)2)2 yielded nacnac(Bn)MgN(SiMe3)2, which reacted with tert-butanol to form nacnac(Bn)MgOtBu. The latter complex crystallizes as an alkoxide bridge dimer and is active in the ring-opening polymerisation of rac-lactide. Polymerisations at room temperature afforded atactic polylactide, while polymerisations at -17 and -26 °C afforded polylactide with a small isotactic bias (P(m) = 0.52, and 0.55, respectively).