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Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34–68 Early Treatment Diabetic Retinopathy Study letters (20/200–20/50 Snellen equivalent), and central retinal thickness (CRT) ≥300 μm measured by time-domain optical coherence tomography. Patients were randomized to 1 of 2 doses of DEX (0.7 mg or 0.35 mg), or to sham procedure, with retreatment no more than every 6 months. The primary endpoint was ≥15-letter gain in BCVA at study end. Average change in BCVA and CRT from baseline during the study (area-under-the-curve approach) and adverse events were also evaluated. The present subgroup analysis evaluated outcomes in patients randomized to DEX 0.7 (marketed dose) or sham based on prior treatment for DME at study entry. Baseline characteristics of previously treated DEX 0.7 (n = 247) and sham (n = 261) patients were similar. In the previously treated subgroup, mean number of treatments over 3 years was 4.1 for DEX 0.7 and 3.2 for sham, 21.5 % of DEX 0.7 patients versus 11.1 % of sham had ≥15-letter BCVA gain from baseline at study end (P = 0.002), mean average BCVA change from baseline was +3.2 letters with DEX 0.7 versus +1.5 letters with sham (P = 0.024), and mean average CRT change from baseline was −126.1 μm with DEX 0.7 versus −39.0 μm with sham (P

Background Recurrent vascular events remain a major source of morbidity and mortality after stroke or transient ischemic attack (TIA). The IRIS Trial is evaluating an approach to secondary prevention based on the established association between insulin resistance and increased risk for ischemic vascular events. Specifically, IRIS will test the effectiveness of pioglitazone, an insulin-sensitizing drug of the thiazolidinedione class, for reducing the risk for stroke and myocardial infarction (MI) among insulin resistant, nondiabetic patients with a recent ischemic stroke or TIA. Design Eligible patients for IRIS must have had insulin resistance defined by a Homeostasis Model Assessment–Insulin Resistance >3.0 without meeting criteria for diabetes. Within 6 months of the index stroke or TIA, patients were randomly assigned to pioglitazone (titrated from 15 to 45 mg/d) or matching placebo and followed for up to 5 years. The primary outcome is time to stroke or MI. Secondary outcomes include time to stroke alone, acute coronary syndrome, diabetes, cognitive decline, and all-cause mortality. Enrollment of 3,876 participants from 179 sites in 7 countries was completed in January 2013. Participant follow-up will continue until July 2015. Summary The IRIS Trial will determine whether treatment with pioglitazone improves cardiovascular outcomes of nondiabetic, insulin-resistant patients with stroke or TIA. Results are expected in early 2016.

International audience; We have developed a new laboratory nucleation setup to study binary homogeneous nucleation (BHN) of sulphuric acid and water (H2SO4/H2O). Here we provide a detailed evaluation of this new experimental setup and also discuss our preliminary results by comparing with other laboratory studies. H2SO4 is produced from the SO2+OH ?HSO3 reaction and OH radicals are produced from water vapor UV absorption. The residual H2SO4 concentrations ([H2SO4]) are measured at the end of the fast flow nucleation reactor with a chemical ionization mass spectrometer. The measured BHN rates (J) ranged from 0.02 and 550 cm?3 s?1 at the residual [H2SO4] from 108 to 1010 cm?3, a temperature of 288 K and relative humidity (RH) from 6 to 23%; J increased with increasing [H2SO4] and RH. J also showed a power dependence on [H2SO4] with the exponential power of 3 to 8. These results are consistent with other laboratory studies under similar [H2SO4] and RH, but different from atmospheric field observations which showed that particle number concentrations are often linearly dependent on [H2SO4]. Both particle sizes and number concentrations increased with increasing [H2SO4], RH, and nucleation time, consistent with the predictions from nucleation theories. Particle growth rates were estimated between 28 to 127 nm h?1, much higher than those seen from atmospheric field observations, because of the higher [H2SO4] used in our study. While these experimental results demonstrate a validation of our laboratory setup, there are also technical difficulties associated with nucleation studies, including wall loss and H2SO4 measurements.

International audience; Recent aircraft studies showed that new particle formation is very active in the free troposphere and lower stratosphere. And, these observations lead to a new question: when does new particle formation not occur? Here, we provide case studies to show how convection and surface area affect new particle formation in the upper troposphere, using the measured aerosol size distributions during the NSF/NCAR GV Progressive Science Missions in December 2005. There were ten research flights, including three days of nighttime experiments, at latitudes from 18 to 52° N and altitudes up to 14 km. About 78% of the total samples showed the new particle formation feature with number concentrations of particles with diameters from 4 to 9 nm, 670±1270 cm?3, and the total particle number concentrations with diameters from 4 to 2000 nm, 920±1470 cm?3. Our case studies show that new particle formation was closely associated with convection and low surface areas of preexisting aerosol particles (?3). On the other hand, for the cases where no new particle formation events were observed, air masses usually did not experience a vertical motion and air often originated from either the upper troposphere or lower stratosphere where precursor concentrations are relatively low; in addition, it was also a general trend that non-event cases also had higher surface areas (~16 ?m² cm?3). These observations are consistent with other observations during the Progressive Science Missions (Young et al., 2007). Because of the lower temperatures in this region (T

To understand the role of cytolytic lymphocytes in the pathogenesis of rheumatoid arthritis, we investigated the expression of lymphocyte cytotoxicity mediators, perforin, and serine esterases, in lymphocytes derived from the synovial fluid of 15 patients with rheumatoid arthritis. Previous work has shown that CD8+ lymphocytes that possess markers of activation appear to be present in rheumatoid arthritis (RA). By means of in situ hybridization techniques and immunohistochemical analysis, the authors show that perforin and two serine esterases (serine esterase 1/Hanukah factor/granzyme A, and serine esterase 2/granzyme B) are expressed by subpopulations of CD8+ and CD56+ lymphocytes obtained from synovial fluid. The presence of these cytotoxic mediators suggests a possible mechanism for tissue damage, and provides evidence implicating cytolytic lymphocytes in the pathogenesis of RA.

Binary homogeneous nucleation (BHN) of sulphuric acid and water (H2SO4/H2O) is one of the most important atmospheric nucleation processes, but laboratory observations of this nucleation process are very limited and there are also large discrepancies between different laboratory studies. The difficulties associated with these experiments include wall loss of H2SO4 and uncertainties in estimation of H2SO4 concentration ([H2SO4]) involved in nucleation. We have developed a new laboratory nucleation setup to study H2SO4/H2O BHN kinetics and provide relatively constrained [H2SO4] needed for nucleation. H2SO4 is produced from the SO2+OH→HSO3 reaction and OH radicals are produced from water vapor UV absorption. The residual [H2SO4] were measured at the end of the nucleation reactor with a chemical ionization mass spectrometer (CIMS). Wall loss factors (WLFs) of H2SO4 were estimated by assuming that wall loss is diffusion limited and these calculated WLFs were in good agreement with simultaneous measurements of the initial and residual [H2SO4] with two CIMSs. The nucleation zone was estimated from numerical simulations based on the measured aerosol sizes (particle diameter, Dp) and [H2SO4]. The measured BHN rates (J) ranged from 0.01–220 cm−3 s−1 at the initial and residual [H2SO4] from 108−1010 cm−3, a temperature of 288 K and relative humidity (RH) from 11–23%; J increased with increasing [H2SO4] and RH. J also showed a power dependence on [H2SO4] with the exponential power of 3–8. These power dependences are consistent with other laboratory studies under similar [H2SO4] and RH, but different from atmospheric field observations which showed that particle number concentrations are often linearly dependent on [H2SO4]. These results, together with a higher [H2SO4] threshold (108–109 cm−3) needed to produce the unit J measured from the laboratory studies compared to the atmospheric conditions (106–107 cm−3), imply that H2SO4/H2O BHN alone is insufficient to explain atmospheric aerosol formation and growth. Particle growth rates estimated from the measured aerosol size distributions, residence times (tr), and [H2SO4] were 100–500 nm h−1, much higher than those seen from atmospheric field observations, because of the higher [H2SO4] used in our study.