• Research dataclose
• Open Access close
• Clinical Trial close
• Dataset close
• OpenTrials close

In high-income societies the use of health care and medication is steadily increasing. Children have high morbidity, many visits at the general practitioner, an increasing number of hospitalisations, and an increasing use of medication. And, when children are ill, someone has to stay home to care for them. An un-explained global increase in the incidence of the allergic diseases eczema, wheezing, asthma and allergies means that 25% of high-income populations are affected. Cheap preventive measures are highly warranted. Recent studies have shown a positive, non-specific effect of early Bacille Calmette Guérin (BCG) immunisation on neonatal mortality in low-income countries and suggested a positive, non-specific effect on allergic disease in high-income countries. "Non-specific" means that the vaccine effect goes beyond prevention of the targeted disease, i.e. the BCG vaccine benefits the health status of the immunised individual in ways unrelated to protection against tuberculosis (TB). For instance, in a recent randomised trial in West Africa the investigators showed that the BCG vaccine at birth was safe in low birth weight (LBW) infants and significantly reduced neonatal mortality in these children, with a significant long-lasting effect on infant mortality in the smallest newborns with a birth weight <1.5 kg. There is an urgent need to explore the huge potential of the BCG's beneficial immune-stimulatory effects among children in high-income populations. Therefore, the investigators will carry out a large prospective randomised clinical trial in Denmark primarily designed to test the hypothesis that infants who get the BCG vaccine at birth experience 20% fewer hospitalisations during early childhood. Secondary outcomes 1. To test the hypothesis that infants who get the BCG vaccine at birth are prescribed less antibiotics during early childhood than non-BCG-immunised infants. 2. To test the hypothesis that Danish infants who get the BCG vaccine at birth develop less eczema, asthmatic bronchitis/wheeze and food allergy at 3 and 12 months of age: self-reported, diagnosed by a physician, or found at clinical examination; and are prescribed less anti-eczema/asthma/allergy medication during early childhood than non-BCG-immunised infants. 3. To test the hypothesis that infants who receive the BCG at birth respond in paraclinical measures: Specific IgE, thymic gland size, leucocyte count and differentiation, monocyte memory, cytokine profiles, and antibody titres following immunisation against diphtheria, tetanus, pertussis, pneumococcus, hemophilus. 4. To test the hypothesis that infants who get the BCG vaccine at birth respond in growth measures: weight, length and head circumference. 5. To test the hypothesis that infants who get the BCG vaccine at birth respond with decreased morbidity: common cold, pneumonia, febrile episodes, diarrhoea and vomiting, acute otitis media, febrile convulsions. 6. To test the hypothesis that premature infants with gestational age less than 37 weeks who get the BCG vaccine at birth have unaffected psychomotor development measures: Ages and Stages scores. 7. To test the hypothesis that infants who get the BCG vaccine at birth has unaffected coverage with the subsequent vaccinations in the Child Vaccination Programme. 8. To test the above mentioned hypotheses specifically in the strata of premature and low-birth-weight Danish infants.

Background: Pelvic Organ Prolapse represents a significant problem worldwide and may have a significant negative impact on a woman's quality of life. The uterus, rectum and the bladder are held in their normal positions just above the inner end of the vagina by a "hammock" made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the uterus, the bladder, the bowels, the vaginal vault or the rectum to sag through the muscle and ligament layers. When this occurs, the rectum, uterus, bowels or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging rectum, uterus, bowels or bladder to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening. Pelvic Organ Prolapse causes significant discomfort to the patients being associated with urinary incontinence, voiding difficulty culminating with urinary retention, constipation, pain during sexual intercourse, local discomfort, etc. Treatment Options When symptoms occur, many patients initially opt for conservative treatment. Pelvic exercises and vaginal support are the current mainstays of non surgical management. In addition, patients who are poor surgical candidates or are strongly disinclined to surgery can be offered vaginal support (pessaries) for symptom relief. Topical estrogen is an important adjunct in the conservative management of patients with Pelvic Organ Prolapse. However, the primary management strategy for severe Pelvic Organ Prolapse is surgical. The exact treatment choice will depend on the severity of the prolapse and whether there are any related pelvic floor defects. Endogun Medical Systems Ltd. has developed an innovative, minimally-invasive system for repair of Pelvic Floor Prolapse. The EndoFast Reliant™ system is a new concept of reinforcing the vaginal wall with a proprietary system comprised of a mesh and soft tissue fasteners in a minimally-invasive way. The fasteners can be deployed easily and swiftly in narrow spaces into soft tissue and can support substantially more weight than needed for Pelvic Organ Prolapse repair. Following many pre-clinical tests, the EndoFast Reliant™ system is now available for clinical evaluation. The objective of this study is to evaluate the safety and performance of the EndoFast Reliant™ system for treatment of Pelvic Organ Prolapse. In particular: - The study's primary goal is to clinically assess the safety of the EndoFast Reliant™ as a minimally-invasive procedure for vaginal wall reinforcement. - The study's secondary goal is to clinically evaluate the performance of the EndoFast Reliant™ system as a minimally-invasive procedure for vaginal wall reinforcement by evaluating the improvement in Pelvic Organ Prolapse using the POPQ grading system. Study Procedures and Follow up: Pre-treatment tests and inspection will be performed within 4 months prior to surgery. Approximately two weeks, three months and six months after the surgery the patient will be invited for physician examination and laboratory tests. Additional Study Measures: In addition to the endpoint parameters, the following study measures will be collected: - Symptoms relief and Quality of Life (QOL) considerations. - Sexual Function considerations, as documented using the Female Sexual Function (FSFI) questionnaire; - Assessment of the physician's satisfaction. The purpose of this study is to clinically assess the safety and performance of the EndoFast Reliant™ system as a less invasive treatment for Pelvic Organ Prolapse.

The study will be a randomised, single-blinded study comparing oxygen with air in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing Pulmonary Rehabilitation (PR). The study subjects will be patients with a confirmed diagnosis of COPD who have been accepted for PR and who are not hypoxemic at rest, but have exercise-induced desaturation (defined as a fall in oxygen saturations (SaO2) ≥4% to at least <90%, or any fall to a SaO2 <90%) and demonstrate positive improvement with use of ambulatory oxygen as per the British Thoracic Society 2015 Oxygen guidelines. It is standard practice for patients to have this assessment prior to commencing PR and as part of the assessment the flow rate required to increase the SaO2 to ≥90% during exercise will be determined. Patients will be recruited from PR programs at imperial college health care trust hospitals. The subjects will be randomised to receive either oxygen at the flow rate determined at the initial assessment to a maximum flow rate of 6 litres per minute, or room air. The subjects will then undergo a standard program of PR over 6 - 8 weeks and then undergo reassessment. 20 patients are required in each group to detect a 30% effect size on the 6 minute walk test (6MWT) with 80% power at the 5% significance level and 29 patients in each group to detect a 25% effect with 80% power. Therefore a minimum of 20 patients per group will be included. Baseline assessments prior to commencing PR will include symptom and quality of life assessments including Borg scale for assessment of breathlessness, Chronic Respiratory Questionnaire (CRQ), COPD Assessment Tool (CAT) and the Hospital Anxiety and Depression score (HAD). A 6 minute walk test (6MWT) will be carried out as this is a widely used and well validated tool to measure exercise capacity. A handheld dynamometer will be used to obtain more detailed measures of quadriceps muscle strength. In addition we will measure activity at home during and after PR using pedometers as this has never been investigated previously.These are simple devices that can be attached to patients and count the numbers of steps during a day and therefore provide an estimate of activity in the home environment. A yamax Digi-walker SW-200 pedometer will be used to count the number of steps taken per day. Patients will be instructed to wear the device on left side of the body all the time, except when sleeping or showering. Pedometer placement was standardised by placing it on the belt or waistband, in the midline of the thigh, consistent with the manufacturers recommendation and with other studies conducted previously. Patients will be record daily step counts on daily diary cards until their final follow up. The measures of exercise capacity at the follow up assessment will be carried out off oxygen and will be carried out by an observer blinded as to whether they received oxygen or not during PR. All patients will be provided with ambulatory oxygen for domiciliary use after completing PR. All patients will have repeat assessments at 8 and 12 weeks after completion of PR. At these visits data will also be collected on activity, number of exacerbations and hospitalisations and ongoing usage of ambulatory oxygen. The hypothesis is that use of oxygen in selected patients improves exercise capacity during PR. The measurable aims will be exercise capacity and on-going usage of oxygen in this patient group. Primary Objective Assess the effects of ambulatory oxygen on outcomes from Pulmonary Rehabilitation Secondary Objectives 1. Assess the proportion of patients that wish to continue to use ambulatory oxygen. 2. Assess the usage of ambulatory oxygen following completion of Pulmonary Rehabilitation 3. Assess whether initiation of ambulatory oxygen before or after PR has any influence on adherence to usage at 8 and 12 weeks. Pulmonary rehabilitation (PR) is an exercise program tailored for patients with chronic lung disease that is a core part of the management of patients with Chronic Obstructive Pulmonary Disease (COPD). Many COPD patients develop low oxygen levels (desaturation) during exercise and this is often discovered when they are being evaluated for PR. Current practice is to administer oxygen to COPD patients with exercise-induced desaturation, but this is based on very limited evidence. This limited evidence relates to a short-term increase in exercise capacity and it is not known if this translates into longer term increases in activity or whether providing these patients with oxygen improves outcomes after PR. In addition it is not known if patients given ambulatory oxygen continue to use it after completing PR. Evidence for a beneficial effect of oxygen would provide a more solid evidence base for its use. Conversely demonstration of no effect would allow reassessment of the use of oxygen and whether the costs are justified. Therefore the aims of this study are to assess the effects of oxygen on outcomes from PR and assess the usage of ambulatory oxygen following completion of PR.

Allogeneic blood stem cell transplant remains the only potential curative treatment for myelodysplastic syndromes (MDS) to date. Pre-transplant induction chemotherapy with leukemia-type regimens is associated with significant toxicity and even death. The hypomethylating agents decitabine and 5-azacytidine have been shown in studies to cause improved hematologic parameters and partial or complete responses in patients with high risk MDS compared to standard therapy. In contrast to leukemia-type chemotherapy, decitabine is associated with a relatively low risk of toxicity. We therefore propose to treat transplant-eligible MDS patients with Decitabine as induction therapy and a bridge to transplant. Hypothesis: 1. Decitabine is able to reduce disease burden as measured by blood and marrow blast counts prior to allogeneic hematopoietic stem cell transplant to below 5%. 2. Decitabine is well-tolerated by patients with high-risk MDS and will be a safe induction agent and bridge prior to allogeneic transplant in transplant-eligible patients. Primary endpoint: 1. safety and tolerability of Decitabine prior to transplant (assessed by occurence of non-hematologic toxicities of grade 3 or more as defined by CTC grading) 2. reduction in pre-transplant disease burden ability to achieve blast <5% in the bone marrow and peripheral blood Secondary endpoints: 1. Proportion of patients with suitable donor able to proceed to an allogeneic hematopoietic cell transplant. 2. Non-relapse mortality 3. time to neutrophil engraftment 4. Overall survival and disease-free survival. Patients will receive Decitabine until blast <5% is achieved, suitable HLA-matched donor or umbilical cord blood is available up to a maximum of 6 cycles. Patient who progress on therapy or are unable to find a donor by 6 cycles will be removed from protocol. The method, conditioning regimen and choice of donor will be determined based on patient's age and functional status, and transplant physician's discretion. The available regimens are standardized within the center

A phase I trial to evaluate the safety and tolerability of ALS-357 when administered for four weeks as a topical ointment, in escalating doses, to patients with cutaneous metastatic melanoma and to evaluate the effect of escalating doses of topically applied ALS-357 on histological remission of cutaneous metastatic melanoma and induction of apoptotic biomarkers.

The goal of this study is to compare the LMA Supreme and i-gel in children having surgery. The investigators hypothesize that airway leak pressures with the i-gel will not be significantly different clinically (higher) when compared with the LMA Supreme. Airway leak pressures will be measured by recording the circuit pressure at which equilibrium is reached. The ease of placement, fiberoptic grade of laryngeal view, feasibility of use during positive pressure ventilation, ease of gastric tube placement, and complications (airway related, gastric insufflation, and trauma) will also be assessed. The aim of this randomized prospective study is to compare two single-use laryngeal mask airways with a provision of a gastric drain tube allowing for evacuation of gastric contents, the i-gel and the LMA Supreme, in pediatric patients undergoing positive pressure ventilation. The investigators hypothesize that airway leak pressures with the i-gel will not be significantly different clinically (higher) when compared with the LMA Supreme.

PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of twice weekly 17-allylamino-17-demethoxygeldanamycin (17-AAG) in combination with weekly rituximab in patients with relapsed chronic lymphocytic leukemia (CLL). II. To examine the pharmacology of twice weekly 17-AAG in combination with weekly rituximab in patients with relapsed CLL. SECONDARY OBJECTIVES: I. To evaluate toxicity (using NCI CTCAE v3.0 criteria) and preliminary efficacy of twice weekly 17-AAG when used in combination with weekly rituximab in this patient population. II. To examine the kinetics of depletion of PDK1/AKT-related proteins, mutant p53 and up-regulation of alternative targets that mediate resistance to therapy following treatment with twice weekly 17-AAG; and the relationship of this to spontaneous and drug-induced apoptosis in patients with relapsed CLL. III. To examine the immunologic effects of twice weekly 17-AAG, in conjunction with weekly rituximab, in patients with relapsed CLL. IV. To evaluate toxicity and preliminary efficacy of twice weekly 17-AAG as a single agent in this patient population. OUTLINE: This is a multicenter, dose-escalation study of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG). Patients receive 17-AAG intravenously (IV) over 2 hours on days 1, 4, 8, 11, 15 and 18 (course 1). Patients achieving ≥ 25% reduction in measurable disease after course 1 receive an additional course of single-agent 17-AAG approximately 10 days later in the absence of disease progression or unacceptable toxicity and provided absolute lymphocyte count continues to decrease. Patients failing to achieve a 25% reduction in measurable disease after course 1 OR with disease progression after courses 1 or 2 of single-agent 17-AAG proceed to combination therapy comprising 17-AAG IV over 2 hours on days 1, 4, 8, 11, 15, 18, and 22; and rituximab IV over 4 hours on days 1 and 2 and over 1 hour on days 4, 8, 15, and 22 in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of 17-AAG as a single agent or in combination with rituximab until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients are followed up at 2 months and then every 3 months for 2 years. This phase I trial is studying the side effects and best dose of 17-N-allylamino-17-demethoxygeldanamycin when given with or without rituximab in treating patients with relapsed B-cell chronic lymphocytic leukemia or prolymphocytic leukemia. Drugs used in chemotherapy, such as 17-N-allylamino-17-demethoxygeldanamycin, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some find cancer cells and kill them or carry cancer-killing substances to them. Others interfere with the ability of cancer cells to grow and spread. Monoclonal antibodies may kill cancer cells that are left after chemotherapy. Giving 17-N-allylamino-17-demethoxygeldanamycin with or without rituximab may kill more cancer cells.

BACKGROUND: Low blood antioxidant concentrations are associated with several major degenerative diseases including cardiovascular disease and cancer. Animal, cellular and chemical experiments have elucidated biologic mechanisms consistent with antioxidant protection against several disease processes. Determinants of blood antioxidant concentrations are not well understood in young adults. The main scientific outcome of this research will be information on distribution and correlates of blood antioxidant concentrations, useful for formulating public health messages concerning maintenance of adequate levels of alpha tocopherol, selenium, ascorbic acid and the carotenoids. DESIGN NARRATIVE: An analysis was conducted using serum stored at 70 degrees Celsius, collected in 1985-86 (n=5115) and 1992-93 (n=4086). These analytes were stable in serum samples collected, handled and stored under conditions used in this study. Integrity of the chemical analysis throughout the study was maintained by proven laboratory quality control procedures. Monitoring analyte concentrations in serum from collections seven years apart allowed analysis of age and time dependent changes in serum antioxidants. These data were linked with extensive pre-existing sociodemographic, dietary, other behavioral and physiologic data for the cohort. Statistical analyses provided information on the population's serum antioxidant distribution, tracking, change and major determinants in diverse young adults. In addition, these data established baseline and 7-year change concentration values for followup of this large CARDIA cohort, though the relationship of these serum antioxidants to disease endpoints was not itself part of the work scope. Study of plasma ascorbic acid, which is not stable under our storage conditions, was initiated using fresh samples to be collected in 1995-96 (n=4000). The Young Adult Longitudinal Study of Antioxidants (YALTA), ancillary to CARDIA study, was renewed in fiscal year 2000 to obtain additional blood and urine samples in the year 15 exam of the CARDIA participants. New measures of circulating lipid, protein, and DNA oxidation products (F2-isoprostanes, advanced glycosylation end-products [AGE], chlorinated and nitrosylated tyrosine, platelet aggregating factor (PAF) acetylhydrolase, paroxonase), urinary DNA damage, soluble intercellular adhesion molecule (ICAM), soluble P-selectin, and relevant genetic polymorphisms. The specific endpoints at the 15 year exam were coronary artery calcification as measured by computed tomography and microalbuminuria. The study was renewed in 2004 through 2008. Blood and urine was collected from subjects at the CARDIA year 20 exam to remeasure blood F2 isoprostanes, phospholipase A2, superoxide dismutase and carotenoids and tocopherols. Oxidized low density lipoprotein (LDL) and myeloperoxidase was also measured and analysis conducted of the association of antioxidant and oxidative damage levels and the development of subclinical macrovascular disease in this still-young group. The study renewed for a fourth time in 2010 through 2015, and a renewal application for a fifth renewal period was submitted in summer, 2014. It continues to write reports about different feature of oxidative stress and related phenomena as the CARDIA subjects age. To measure serum concentrations of alpha tocopherol, selenium and all major carotenoids (alpha- and beta- carotene, lutein, (beta-cryptoxanthin and lycopene) in Black and white, male and female, high and low education individuals aged 18-30 in 1985-86. In subsequent renewals additional markers of oxidative stress and endothelial dysfunction have been measured in blood collected 7 to 30 years after baseline.

Background: Insulin resistant subjects and type 2 diabetic patients are characterized by a decreased metabolic flexibility: a reduced capability to switch from fat oxidation in the basal state to carbohydrate oxidation in the insulin-stimulated state. This metabolic inflexibility is an early hallmark in the development of diabetes. Recent evidence suggests that low carnitine availability may limit acetylcarnitine formation, thereby reducing metabolic flexibility. Objectives: We will investigate whether subjects with impaired glucose tolerance (IGT) show a diminished capacity to form acetylcarnitine in the face of high substrate availability. Therefore, we will use a novel non-invasive 1H-Magnetic Resonance Spectroscopy (1H-MRS) protocol to determine in vivo, and in time, the formation of acetylcarnitine in skeletal muscle. Additionally, we will examine whether carnitine supplementation increases the capacity to form acetylcarnitine and improves metabolic flexibility and insulin sensitivity in IGT subjects. Study design: 12 subjects with IGT will be included and will be subjected to either placebo- or carnitine treatment (daily capsules with 2g of L-carnitine or placebo) in a randomized, placebo-controlled, double blind crossover design. After both interventions, acetylcarnitine formation after a mixed meal will be determined by 1H-MRS and meal-induced changes in fat and glucose oxidation by indirect calorimetry. The maximal acetylcarnitine formation will be measured after a cycling test via 1H-MRS. A hyperinsulinemic-euglycemic clamp will be performed to determine insulin sensitivity. Biopsies will be taken to measure free carnitine and carnitine acetyltransferase (CrAT) activity. To investigate whether differences in acetylcarnitine formation may be involved in variations in glucose tolerance, twelve control subjects, matched for BMI and age but glucose tolerant (based on oral glucose tolerance test, according to WHO criteria) will also be included and will undergo all measurements once without any intervention. Insulin resistant subjects and type 2 diabetic patients are characterized by a decreased metabolic flexibility: a reduced capability to switch from fat oxidation in the basal state to carbohydrate oxidation in the insulin-stimulated state. This metabolic inflexibility is an early hallmark in the development of diabetes. Recent evidence suggests that a low carnitine availability may limit acetylcarnitine formation, thereby reducing metabolic flexibility. We propose to test the hypothesis that metabolic inflexibility in pre-diabetic subjects and diabetic patients is due to a reduced capacity to form acetylcarnitines.

The study is carried out in order to determine the relationship between the dose of AZD6280 and the blood concentration of AZD6280, and to investigate to which extent AZD6280 binds to GABAA receptors