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1.
J Pharm Sci ; 112(7): 1749-1762, 2023 07.
Article in English | MEDLINE | ID: mdl-37142122

ABSTRACT

The workshop "Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS) Based Biowaivers" was held virtually on December 6, 2021, organized by the University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI), and the Food and Drug Administration (FDA). The workshop focused on the industrial, academic, and regulatory experiences in generating and evaluating permeability data, with the aim to further facilitate implementation of the BCS and efficient development of high-quality drug products globally. As the first international permeability workshop since the BCS based biowaivers was finalized as the ICH M9 guideline, the workshop included lectures, panel discussions, and breakout sessions. Lecture and panel discussion topics covered case studies at IND, NDA, and ANDA stages, typical deficiencies relating to permeability assessment supporting BCS biowaiver, types of evidence that are available to demonstrate high permeability, method suitability of a permeability assay, impact of excipients, importance of global acceptance of permeability methods, opportunities to expand the use of biowaivers (e.g. non-Caco-2 cell lines, totality-of-evidence approach to demonstrate high permeability) and future of permeability testing. Breakout sessions focused on 1) in vitro and in silico intestinal permeability methods; 2) potential excipient effects on permeability and; 3) use of label and literature data to designate permeability class.


Subject(s)
Biopharmaceutics , Research Report , Pharmaceutical Preparations , Biopharmaceutics/methods , Therapeutic Equivalency , Excipients , Permeability , Solubility
2.
Sci Rep ; 11(1): 3662, 2021 Feb 11.
Article in English | MEDLINE | ID: mdl-33574460

ABSTRACT

Experimental observations assisted by 2-D imaging diagnostics on the KSTAR tokamak show that a solitary perturbation (SP) emerges prior to a boundary burst of magnetized toroidal plasmas, which puts forward SP as a potential candidate for the burst trigger. We have constructed a machine learning (ML) model based on a convolutional deep neural network architecture for a statistical study to identify the SP as a boundary burst trigger. The ML model takes sequential signals detected from 19 toroidal Mirnov coils as input and predicts whether each temporal frame corresponds to an SP. We trained the network in a supervised manner on a training set consisting of real signals with manually annotated SP locations and synthetic burst signals. The trained model achieves high performances in various metrics on a test data set. We also demonstrated the reliability of the model by visualizing the discriminative parts of the input signals that the model recognizes. Finally, we applied the trained model to new data from KSTAR experiments, which were never seen during training, and confirmed that the large burst at the plasma boundary that can fatally damage the fusion device always involves the emergence of SP. This result suggests that the SP is a key to understanding and controlling of the boundary burst in magnetized toroidal plasmas.

3.
Clin Exp Immunol ; 188(1): 174-181, 2017 04.
Article in English | MEDLINE | ID: mdl-28076879

ABSTRACT

Anti-neutrophil cytoplasmic antibodies (ANCA) appear to play an important role in the pathogenesis of ANCA-associated vasculitis (AAV). However, ANCA alone are not sufficient to generate disease, and some evidence suggests that infectious triggers may serve as inciting events for AAV disease activity. Antibodies of the immunoglobulin (Ig)M isotype often serve as markers of recent infection, and IgM ANCA have been identified previously in patients with AAV, although the frequency and clinical relevance of IgM ANCA is not well established. We sought to characterize IgM ANCA more clearly by creating a novel enzyme-linked immunosorbent assay (ELISA) for IgM antibodies to proteinase 3 [IgM proteinase 3 (PR3)-ANCA], which we applied to two large, clinically well-characterized trial cohorts of patients with granulomatosis with polyangiitis and microscopic polyangiitis. In the first cohort, IgM PR3-ANCA occurred with a frequency of 15·0%, and were associated with a higher degree of disease severity and a trend towards a higher rate of alveolar haemorrhage (29·6 versus 15·7%, P = 0·10). Analysis of follow-up samples in this cohort showed that the presence of IgM PR3-ANCA was transient, but could recur. In the second cohort, IgM PR3-ANCA occurred with a frequency of 41·1%, and were also associated with a higher degree of disease severity. A higher rate of alveolar haemorrhage was observed among those with IgM PR3-ANCA (45·3 versus 15·8%; P < 0·001). The association of transient IgM PR3-ANCA with an acute respiratory manifestation of AAV suggests a possible link between an infectious trigger and AAV disease activity.


Subject(s)
Autoantibodies/immunology , Granulomatosis with Polyangiitis/immunology , Immunoglobulin M/immunology , Microscopic Polyangiitis/immunology , Myeloblastin/immunology , Adult , Aged , Antibodies, Antineutrophil Cytoplasmic/immunology , Biomarkers , Female , Granulomatosis with Polyangiitis/diagnosis , Humans , Immunoglobulin G/immunology , Male , Microscopic Polyangiitis/diagnosis , Middle Aged , Severity of Illness Index
4.
Clin Exp Rheumatol ; 33(2 Suppl 89): S-77-83, 2015.
Article in English | MEDLINE | ID: mdl-26016754

ABSTRACT

OBJECTIVES: To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. METHODS: The main characteristics and outcomes of patients with generalised and/or severe GPA or MPA with a five-factor score ≥ 1 enrolled in the French Vasculitis Study Group (FVSG) or the US-Canadian-based Vasculitis Clinical Research Consortium cohorts were compared to those enrolled in one of 2 FVSG clinical RCTs (WEG91, WEGENT) or 3 European Vasculitis Society clinical trials (CYCLOPS, CYCAZAREM, IMPROVE). RESULTS: 657 patients (65.3% with GPA) in RCTs were compared to 437 in cohorts (90.6% with GPA). RCT patients were older at diagnosis than the cohort patients (56.6 ± 13.9 vs. 46.8 ± 17.3 years), had higher Birmingham vasculitis activity score (19.5 ± 9.1 vs. 16.9 ± 7.4), and more frequent kidney disease (84.0% vs. 54.9%) but fewer ear, nose, and throat symptoms (56.8% vs. 72.2%). At 56 months post-diagnosis, mortality and relapse rates, adjusted for age and renal function, were higher for patients with GPA in RCTs vs. cohorts (10.7% vs. 2.5% [p=0.001] and 22.5% vs. 15.6% [p=0.03], respectively) but similar for patients with MPA (6.2% vs. 6.6% [p=0.92] and 16.6% vs. 10.1% [p=0.39], respectively). CONCLUSIONS: Patients with GPA or MPA in RCTs and those in observational cohorts show important differences that should be remembered when interpreting results based on these study populations.


Subject(s)
Granulomatosis with Polyangiitis/epidemiology , Microscopic Polyangiitis/epidemiology , Observational Studies as Topic , Randomized Controlled Trials as Topic , Adult , Age Distribution , Aged , Antibodies, Antineutrophil Cytoplasmic/immunology , Cohort Studies , Female , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/immunology , Humans , Kidney Diseases/etiology , Male , Microscopic Polyangiitis/complications , Microscopic Polyangiitis/immunology , Middle Aged , Myeloblastin/immunology , Otorhinolaryngologic Diseases/etiology , Patient Selection , Peroxidase/immunology , Severity of Illness Index
5.
Semin Arthritis Rheum ; 45(1): 67-9, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25796088

ABSTRACT

OBJECTIVES: Advancing age is a risk factor for treatment-related side effects and mortality in AAV patients treated with cyclophosphamide (CYC) and glucocorticoids (GC) for remission induction. The efficacy and safety of rituximab (RTX) in elderly AAV patients has not been well described. METHODS: We performed a single center retrospective review of 31 consecutive AAV patients aged 60 or more at the time of RTX use for remission induction. All patients received RTX with GC for remission induction. Four patients received concomitant CYC for a mean duration of 52 days. We evaluated clinical and laboratory variables at diagnosis, rates of complete remission defined as Birmingham Vasculitis Activity Score/Wegener's Granulomatosis (BVAS/WG) = 0 and patient survival, renal survival, infections requiring hospitalization, and vasculitis relapse 24 months following RTX use. RESULTS: Of the 31 patients, 77% were Caucasian, 68% female, mean age was 71 ± 6 years, 58% were MPO ANCA positive, and 42% had relapsing disease. The mean BVAS/WG score entry was 4.4 ± 1.5, 71% had glomerulonephritis (GN) and 10% had alveolar hemorrhage. The mean baseline e-GFR was 40 ± 28ml/min/1.73m(2). Thirty patients achieved remission with a mean time to remission of 57 ± 27 days. The single patient with refractory vasculitis responded to CYC. The mean prednisone dose at 6 months was 5.6 ± 4mg. Remission maintenance therapy was started within 12 months of RTX induction in 6 patients (4 with RTX, 1 with azathioprine, and 1 with mycophenolate mofetil). One patient suffered a limited relapse 10 months post RTX use. Among the 22 patients with GN at baseline, 1 developed ESRD. One-year patient survival among 25 patients with at least 1 year of follow-up was 100%. There were no episodes of infusion reaction or leukopenia. There were 3 episodes of bacterial pneumonia, 1 episode of candida pneumonia, and 1 episode of disseminated cutaneous zoster. CONCLUSIONS: This study demonstrates that rituximab is effective for remission induction in elderly patients with AAV. Furthermore, we observed a high incidence of infectious complications. Our experience was limited by its retrospective design, and further studies are needed to evaluate the efficacy and safety of RTX in elderly AAV patients.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Immunologic Factors/therapeutic use , Rituximab/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Remission Induction , Retrospective Studies , Treatment Outcome
6.
Arthritis Rheumatol ; 67(6): 1629-36, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25776953

ABSTRACT

OBJECTIVE: Nonsevere relapses are more common than severe relapses in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but their clinical course and treatment outcomes remain largely unexamined. We undertook this study to analyze the outcomes of patients with nonsevere relapses in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial who were treated with prednisone according to a prespecified protocol. METHODS: RAVE was a randomized, double-blind, placebo-controlled trial comparing rituximab (RTX) to cyclophosphamide (CYC) followed by azathioprine (AZA) for induction of remission. Patients who experienced nonsevere relapses between months 1 and 18 were treated with a prednisone increase without a concomitant change in their nonglucocorticoid immunosuppressants, followed by a taper. RESULTS: Forty-four patients with a first nonsevere relapse were analyzed. In comparison to the 71 patients who maintained relapse-free remission over 18 months, these patients were more likely to have proteinase 3-ANCAs, diagnoses of granulomatosis with polyangiitis (Wegener's), and a history of relapsing disease at baseline. A prednisone increase led to remission in 35 patients (80%). However, only 13 patients (30%) were able to maintain second remissions through the followup period (mean 12.5 months); 31 patients (70%) had a second disease relapse, 14 of them with severe disease. The mean time to second relapse was 9.4 months (4.7 months in the group treated with RTX versus 13.7 months in the group treated with CYC/AZA; P < 0.01). Patients who experienced nonsevere relapses received more glucocorticoids than those who maintained remission (6.7 grams versus 3.8 grams; P < 0.01). CONCLUSION: Treatment of nonsevere relapses in AAV with an increase in glucocorticoids is effective in restoring temporary remission in the majority of patients, but recurrent relapses within a relatively short interval remain common. Alternative treatment approaches are needed for this important subset of patients.


Subject(s)
Glucocorticoids/therapeutic use , Granulomatosis with Polyangiitis/drug therapy , Microscopic Polyangiitis/drug therapy , Prednisone/therapeutic use , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Autoantibodies/immunology , Azathioprine/therapeutic use , Cyclophosphamide/therapeutic use , Double-Blind Method , Female , Granulomatosis with Polyangiitis/immunology , Humans , Immunosuppressive Agents/therapeutic use , Maintenance Chemotherapy , Male , Microscopic Polyangiitis/immunology , Myeloblastin/immunology , Peroxidase/immunology , Recurrence , Remission Induction , Rituximab , Severity of Illness Index , Treatment Outcome
7.
Arthritis Rheumatol ; 66(11): 3151-9, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25047592

ABSTRACT

OBJECTIVE: Disease relapses are frequent in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study was undertaken to evaluate outcomes in patients with AAV who are re-treated with rituximab (RTX) and prednisone for severe disease relapses. METHODS: The Rituximab in AAV trial was a randomized, double-blind, placebo-controlled trial comparing the rates of remission induction among patients treated with RTX (n = 99) and patients treated with cyclophosphamide (CYC) followed by azathioprine (AZA) (n = 98). Prednisone was tapered to discontinuation after 5.5 months. After remission was achieved, patients who experienced a severe disease relapse between months 6 and 18 were eligible to receive RTX and prednisone on an open-label basis according to a prespecified protocol. Investigators remained blinded with regard to the original treatment assignment. RESULTS: Twenty-six patients received RTX for disease relapse after remission had initially been achieved with their originally assigned treatment. Fifteen of these patients were initially randomized to receive RTX and 11 to receive CYC/AZA. Thirteen (87%) of the patients originally assigned to receive RTX and 10 (91%) originally assigned to receive CYC/AZA achieved remission again with open-label RTX (an overall percentage of 88%). In half of the patients treated with open-label RTX, prednisone could be discontinued entirely. Patients in this cohort experienced fewer adverse events compared to the overall study population (4.7 adverse events per patient-year versus 11.8 adverse events per patient-year). CONCLUSION: Re-treatment of AAV relapses with RTX and glucocorticoids appears to be a safe and effective strategy, regardless of previous treatment.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/prevention & control , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antirheumatic Agents/therapeutic use , Secondary Prevention/methods , Azathioprine/therapeutic use , Cyclophosphamide/therapeutic use , Double-Blind Method , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Prednisone/therapeutic use , Prospective Studies , Recurrence , Remission Induction/methods , Rituximab , Time Factors , Treatment Outcome
8.
Am J Nephrol ; 39(1): 20-6, 2014.
Article in English | MEDLINE | ID: mdl-24401699

ABSTRACT

BACKGROUND: BK virus (BKV) is an important cause of renal dysfunction in kidney transplant (KTX) recipients. Immunosuppression intensity is a major risk factor for BKV replication in these patients. The prevalence of BKV replication in immunosuppressed patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) without transplant is not known. METHODS: Consecutive patients (n = 37) with a diagnosis of GPA (n = 25) or MPA (n = 12) without history of KTX were evaluated for plasma BKV replication by quantitative PCR (group A). Descriptive data were collected. BKV replication in this nontransplant immunosuppressed vasculitis cohort was compared with a historical cohort of vasculitis KTX recipients (group B). RESULTS: Group A patients had mean disease duration of 75 months. Mean age was 57 years and 54% were female. Mean time from vasculitis onset to BKV testing was 36 months, and 19/37 patients were tested within 24 months of induction therapy. At the time of BKV testing, 73% were on prednisone (P) with azathioprine, mycophenolate mofetil (MMF), methotrexate or leflunomide. None of the nontransplanted vasculitis patients had detectable plasma BKV. Among 35 patients in group B, 16 were tested for BKV; 5/16 (31%) had detectable virus in plasma at a mean of 6 months after TX (p = 0.002). Most (94%) were on maintenance therapy with MMF, P and tacrolimus. CONCLUSION: Immunosuppressed patients with GPA/MPA without KTX had no evidence of plasma BKV. However, BKV was common in GPA/MPA patients after KTX, suggesting that replication may be related to differences in immunosuppression, alloimmune activation or differences in host defense mechanisms.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/virology , BK Virus/physiology , Polyomavirus Infections/diagnosis , Adult , Aged , Cohort Studies , Cross-Sectional Studies , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Polymerase Chain Reaction , Retrospective Studies , Risk Factors , Virus Replication
9.
Arthritis Rheum ; 65(9): 2441-9, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23754238

ABSTRACT

OBJECTIVE: To evaluate the reasons that complete remission is not achieved or maintained with original treatment in some patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) treated with rituximab (RTX) or with cyclophosphamide/azathioprine (CYC/AZA). METHODS: The Rituximab in AAV trial was a randomized, double-blind, placebo-controlled trial comparing the rate of remission induction among patients treated with RTX (n = 99) and patients treated with CYC followed by AZA (n = 98). Glucocorticoids were tapered over a period of 5 months. The primary outcome measure was lack of disease activity without glucocorticoid treatment at 6 months. To determine the most important reason for failure to achieve the primary outcome, 7 hierarchical categories of reasons were defined retrospectively (uncontrolled disease, adverse event leading to therapy discontinuation, severe flare, limited flare, Birmingham Vasculitis Activity Score for Wegener's Granulomatosis >0, prednisone treatment at any dosage, and other). RESULTS: Although remission (lack of disease activity) was achieved in 170 of the 197 patients (86%) in the first 6 months, the primary outcome measure was not achieved in 42%. There were 3 deaths. Twenty-four percent of the patients failed to achieve the primary end point due to active disease: 10 (5%) experienced uncontrolled disease in the first month and 37 (19%) experienced flares after initial improvement. In the majority of such patients, treatment with blinded crossover or according to best medical judgment led to disease control. Ninety-one percent of patients who had uncontrolled disease or experienced a severe flare had proteinase 3 (PR3)-ANCA. When patients with uncontrolled disease were excluded from analysis, those who were PR3-ANCA positive were found to experience fewer flares when treated with RTX compared to CYC/AZA (8 of 59 [14%] versus 20 of 62 [32%]; P = 0.02). Neither ANCA titers nor B cell counts predicted disease flare. CONCLUSION: Current treatment regimens are largely successful in controlling AAV, but in approximately one-fourth of patients, active disease persists or recurs in the first 6 months despite treatment. PR3-ANCA positivity is a risk factor for recurrence or persistence of severe disease. ANCA titers and B cell detectability are poor predictors of both disease relapse and disease quiescence in the first 6 months.


Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Granulomatosis with Polyangiitis/drug therapy , Immunosuppressive Agents/therapeutic use , Microscopic Polyangiitis/drug therapy , Remission Induction/methods , Adult , Antibodies, Monoclonal, Murine-Derived/administration & dosage , Azathioprine/administration & dosage , Azathioprine/therapeutic use , Cross-Over Studies , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Double-Blind Method , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Immunosuppressive Agents/administration & dosage , Male , Rituximab , Treatment Outcome
10.
Breast Cancer Res Treat ; 132(1): 215-23, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22138748

ABSTRACT

NOV-002 (a formulation of disodium glutathione disulfide) modulates signaling pathways involved in tumor cell proliferation and metastasis and enhances anti-tumor immune responsiveness in tumor models. The addition of NOV-002 to chemotherapy has been shown to increase anti-tumor efficacy in animal models and some early phase oncology trials. We evaluated the clinical effects of NOV-002 in primary breast cancer, whether adding NOV-002 to standard preoperative chemotherapy increased pathologic complete response rates (pCR) at surgery, and determined whether NOV-002 mitigated hematologic toxicities of chemotherapy and whether levels of myeloid derived suppressor cells (MDSC) were predictive of response. Forty-one women with newly diagnosed stages II-IIIc HER-2 negative breast cancer received doxorubicin-cyclophosphamide followed by docetaxel (AC â†’ T) every 3 weeks and concurrent daily NOV-002 injections. The trial was powered to detect a doubling of pCR rate from 16 to 32% with NOV-002 plus AC â†’ T (α = 0.05, ß = 80%). Weekly complete blood counts were obtained as well as circulating MDSC levels on day 1 of each cycle were quantified. Of 39 patients with 40 evaluable tumors, 15 achieved a pCR (38%), meeting the primary endpoint of the trial. Concurrent NOV-002 resulted in pCR rates for AC â†’ T chemotherapy higher than previously reported. Patients with lower levels of circulating MDSCs at baseline and on the last cycle of chemotherapy had significantly higher probability of a pCR (P = 0.02). Further evaluation of NOV-002 in a randomized study is warranted.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Receptor, ErbB-2/metabolism , Adolescent , Adult , Aged , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Cisplatin/administration & dosage , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Disease-Free Survival , Docetaxel , Doxorubicin/administration & dosage , Drug Combinations , Female , Glutathione Disulfide/administration & dosage , Humans , Immunity, Cellular/drug effects , Kaplan-Meier Estimate , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Invasiveness , Neoplasm Staging , Taxoids/administration & dosage , Treatment Outcome , Young Adult
11.
Arthritis Rheum ; 58(6): 1849-53, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18512818

ABSTRACT

OBJECTIVE: Giant cell arteritis (GCA) is the most common type of primary vasculitis. Matrix metalloproteinase 9 (MMP-9) is present in arterial lesions of GCA and may be involved in its pathogenesis. We investigated whether certain genotypes of 4 single-nucleotide polymorphisms (SNPs) of MMP-9 are overrepresented in patients with histologically confirmed GCA. METHODS: Four SNPs of MMP-9, rs3918242 in the promoter region and 3 nonsynonymous coding SNPs (rs3918252, rs17576, and rs2250889) were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis in 58 white patients for whom there was a clinical suspicion of GCA. Thirty of these patients had histologically confirmed GCA (group 1), and 28 patients had negative results of a temporal artery biopsy for GCA (group 2). Estimates of the genotype distributions of each of these SNPs in a white population were determined using publicly available genotype data for a panel of 23 individuals (group 3). RESULTS: Although 1 SNP was monomorphic in all 3 groups, we observed statistically significant differences in the genotype distributions for rs2250889 between group 1 and group 2 (P = 0.005) and between group 1 and group 3 (P = 0.009), but not between groups 2 and 3 (P = 0.965). CONCLUSION: These data derived from a sample of patients with GCA suggest that the G allele of MMP-9 polymorphism rs2250889 is overrepresented in patients with histologically confirmed GCA. Clearly, larger sample sizes will be necessary to confirm this suggestive association and better characterize a possible linkage disequilibrium structure among polymorphisms.


Subject(s)
Genetic Predisposition to Disease/genetics , Giant Cell Arteritis/enzymology , Matrix Metalloproteinase 9/genetics , Polymorphism, Single Nucleotide/genetics , Aged , Aged, 80 and over , Case-Control Studies , Female , Giant Cell Arteritis/genetics , Giant Cell Arteritis/pathology , Humans , Male , Temporal Arteries/pathology
12.
Rev Sci Instrum ; 79(3): 031301, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18376990

ABSTRACT

We describe the design, construction, and performance of three generations of superconducting Ioffe magnetic traps. The first two are low current traps, built from four racetrack shaped quadrupole coils and two solenoid assemblies. Coils are wet wound with multifilament NbTi superconducting wires embedded in epoxy matrices. The magnet bore diameters are 51 and 105 mm with identical trap depths of 1.0 T at their operating currents and at 4.2 K. A third trap uses a high current accelerator-type quadrupole magnet and two low current solenoids. This trap has a bore diameter of 140 mm and tested trap depth of 2.8 T. Both low current traps show signs of excessive training. The high current hybrid trap, on the other hand, exhibits good training behavior and is amenable to quench protection.

13.
Postgrad Med J ; 84(989): 143-52, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18372486

ABSTRACT

The systemic vasculitides are multisystem disorders with considerable mortality and morbidity and frequent relapses. In the absence of reliable serological markers, accurate clinical tools are required to assess disease activity and damage for treatment decisions, and for the performance of clinical trials. This article reviews and summarises the development and use of disease assessment tools for determining activity and damage in systemic vasculitis and reports ongoing initiatives for further development of disease assessment tools. A literature search was conducted using PubMed and reference lists for vasculitis, assessment, clinical trials, outcome and prognosis. The findings indicate that comprehensive disease assessment in vasculitis requires documentation of disease activity, chronic irreversible damage and impairment of function.


Subject(s)
Vasculitis/diagnosis , Clinical Trials as Topic , Cost of Illness , Decision Support Systems, Clinical , Forecasting , Humans , Quality of Life , Risk Assessment/methods , Surveys and Questionnaires
14.
Am J Transplant ; 7(12): 2657-62, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17908271

ABSTRACT

Despite advances in the diagnosis and treatment of the antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitides, renal morbidity is common. End-stage renal disease occurs in up to 20% of patients with these diagnoses, which include Wegener's granulomatosis and microscopic polyangiitis. As the mortality of patients with ANCA-associated vasculitis continues to improve, our ability to address the consequences of renal failure in this patient population becomes paramount. Renal transplantation is an important therapeutic option for these patients. Graft and patient survival rates among patients with ANCA-associated vasculitis are comparable to those observed in nondiabetic patients. This review summarizes our current knowledge of indications and contraindications for renal transplantation in these patients, the recurrence of vasculitis after transplantation and the impact of posttransplant immunosuppression on the clinical course of these patients.


Subject(s)
Antibodies, Antineutrophil Cytoplasmic/immunology , Kidney Transplantation/immunology , Vasculitis/immunology , Humans , Kidney Failure, Chronic/therapy , Recurrence , Renal Dialysis , Treatment Outcome , Vasculitis/etiology , Vasculitis/therapy
15.
Am J Transplant ; 7(12): 2821-5, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17908274

ABSTRACT

Kidney transplantation should be considered the treatment of choice for patients with end-stage renal disease due to antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). However, relapses of AAV have been reported to occur in 9-40% of cases following kidney transplantation and may adversely affect allograft outcome. These relapses are usually treated with cyclophosphamide (CYC) and glucocorticoids, but the repeated use of CYC carries a risk of substantial toxicity that may limit or prohibit its use in some patients. B lymphocytes have been implicated in the pathogenesis of AAV, and their depletion has been effective as salvage therapy for refractory disease in the nontransplant setting. We report the successful induction of remission using rituximab in two patients who suffered relapse of AAV post-kidney transplant. Given the substantial morbidity and adverse effects of CYC, rituximab appears to be a suitable alternative agent to treat relapses of AAV posttransplantation.


Subject(s)
Antibodies, Antineutrophil Cytoplasmic/immunology , Antibodies, Monoclonal/therapeutic use , Immunologic Factors/therapeutic use , Kidney Transplantation/immunology , Vasculitis/drug therapy , Vasculitis/immunology , Adult , Antibodies, Monoclonal, Murine-Derived , Contraindications , Cyclophosphamide , Female , Humans , Immunosuppressive Agents , Kidney Transplantation/adverse effects , Kidney Transplantation/pathology , Male , Recurrence , Remission Induction , Rituximab
16.
J Res Natl Inst Stand Technol ; 110(3): 195-203, 2005.
Article in English | MEDLINE | ID: mdl-27308121

ABSTRACT

The NPDGamma experiment will measure the parity-violating directional gamma ray asymmetry A γ in the reaction [Formula: see text]. Ultimately, this will constitute the first measurement in the neutron-proton system that is sensitive enough to challenge modern theories of nuclear parity violation, providing a theoretically clean determination of the weak pion-nucleon coupling. A new beam-line at the Los Alamos Neutron Science Center (LANSCE) delivers pulsed cold neutrons to the apparatus, where they are polarized by transmission through a large volume polarized (3)He spin filter and captured in a liquid para-hydrogen target. The 2.2 MeV gamma rays from the capture reaction are detected in an array of CsI(Tl) scintillators read out by vacuum photodiodes operated in current mode. We will complete commissioning of the apparatus and carry out a first measurement at LANSCE in 2004-05, which would provide a statistics-limited result for A γ accurate to a standard uncertainty of ±5 × 10(-8) level or better, improving on existing measurements in the neutron-proton system by a factor of 4. Plans to move the experiment to a reactor facility, where the greater flux would enable us to make a measurement with a standard uncertainty of ±1 × 10(-8), are actively being pursued for the longer term.

17.
J Res Natl Inst Stand Technol ; 110(3): 215-9, 2005.
Article in English | MEDLINE | ID: mdl-27308124

ABSTRACT

The NPDGamma γ-ray detector has been built to measure, with high accuracy, the size of the small parity-violating asymmetry in the angular distribution of gamma rays from the capture of polarized cold neutrons by protons. The high cold neutron flux at the Los Alamos Neutron Scattering Center (LANSCE) spallation neutron source and control of systematic errors require the use of current mode detection with vacuum photodiodes and low-noise solid-state preamplifiers. We show that the detector array operates at counting statistics and that the asymmetries due to B4C and (27)Al are zero to with- in 2 × 10(-6) and 7 × 10(-7), respectively. Boron and aluminum are used throughout the experiment. The results presented here are preliminary.

18.
J Res Natl Inst Stand Technol ; 110(3): 145-8, 2005.
Article in English | MEDLINE | ID: mdl-27308111

ABSTRACT

The NPDGamma collaboration has completed the construction of a pulsed cold neutron beam line on flight path12 at the Los Alamos Neutron Science Center (LANSCE). We describe the new beam line and characteristics of the beam. We report results of the moderator brightness and the guide performance measurements. FP12 has the highest pulsed cold neutron intensity for nuclear physics in the world.

19.
J Res Natl Inst Stand Technol ; 110(4): 389-93, 2005.
Article in English | MEDLINE | ID: mdl-27308155

ABSTRACT

We are developing an experiment to measure the correlations a, A, and B, and the Fierz interference term b in neutron decay, with a precision of approximately 10(-4). The experiment uses an electromagnetic spectrometer in combination with two large-area segmented silicon detectors to detect the proton and electron from the decay in coincidence, with 4π acceptance for both particles. For the neutron-polarization-dependent observables A and B, precision neutron polarimetry is achieved through the combination of a pulsed neutron beam, under construction at the SNS, and a polarized (3)He neutron polarizer. Measuring a and A in the same apparatus provides a redundant determination of λ = gA/gV . Uncertainty in λ dominates the uncertainty of CKM unitarity tests.

20.
J Res Natl Inst Stand Technol ; 110(4): 427-9, 2005.
Article in English | MEDLINE | ID: mdl-27308162

ABSTRACT

We have developed a new type of field-expansion spectrometer to measure the neutron beta decay correlations (a, b, B, and A). A precision measurement of these correlations places stringent requirements on charged particle detectors. The design employs large area segmented silicon detectors to detect both protons and electrons in coincidence. Other requirements include good energy resolution (< 5 keV), a thin dead layer to allow observation of 30-keV protons, fast timing resolution (~1 ns) to reconstruct electron-backscattering events, and nearly unity efficiency. We report results of testing commercially available surface-barrier silicon detectors for energy resolution and timing performance, and measurement of the dead-layer thickness of ion-implanted silicon detectors with a 3.2 MeV alpha source.

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