Riviste scientifiche

UK civil servants use Slack to chat about games, drinking and romance

New Scientist - %age fa
A freedom of information request has revealed how UK civil servants use Slack, a popular chat service, to talk about everything from Pokémon Go to polyamory

A man with paralysis can walk again thanks to a nerve-boosting implant

New Scientist - %age fa
Advances in implants that read signals from the brain and spine are helping people with paralysis to regain the use of their limbs

Nilvadipine in mild to moderate Alzheimer disease: A randomised controlled trial

PLoS Medicine - Lu, 24/09/2018 - 23:00

by Brian Lawlor, Ricardo Segurado, Sean Kennelly, Marcel G. M. Olde Rikkert, Robert Howard, Florence Pasquier, Anne Börjesson-Hanson, Magda Tsolaki, Ugo Lucca, D. William Molloy, Robert Coen, Matthias W. Riepe, János Kálmán, Rose Anne Kenny, Fiona Cregg, Sarah O'Dwyer, Cathal Walsh, Jessica Adams, Rita Banzi, Laetitia Breuilh, Leslie Daly, Suzanne Hendrix, Paul Aisen, Siobhan Gaynor, Ali Sheikhi, Diana G. Taekema, Frans R. Verhey, Raffaello Nemni, Flavio Nobili, Massimo Franceschi, Giovanni Frisoni, Orazio Zanetti, Anastasia Konsta, Orologas Anastasios, Styliani Nenopoulou, Fani Tsolaki-Tagaraki, Magdolna Pakaski, Olivier Dereeper, Vincent de la Sayette, Olivier Sénéchal, Isabelle Lavenu, Agnès Devendeville, Gauthier Calais, Fiona Crawford, Michael Mullan, for the NILVAD Study Group

Background

This study reports the findings of the first large-scale Phase III investigator-driven clinical trial to slow the rate of cognitive decline in Alzheimer disease with a dihydropyridine (DHP) calcium channel blocker, nilvadipine. Nilvadipine, licensed to treat hypertension, reduces amyloid production, increases regional cerebral blood flow, and has demonstrated anti-inflammatory and anti-tau activity in preclinical studies, properties that could have disease-modifying effects for Alzheimer disease. We aimed to determine if nilvadipine was effective in slowing cognitive decline in subjects with mild to moderate Alzheimer disease.

Methods and findings

NILVAD was an 18-month, randomised, placebo-controlled, double-blind trial that randomised participants between 15 May 2013 and 13 April 2015. The study was conducted at 23 academic centres in nine European countries. Of 577 participants screened, 511 were eligible and were randomised (258 to placebo, 253 to nilvadipine). Participants took a trial treatment capsule once a day after breakfast for 78 weeks. Participants were aged >50 years, meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer’s disease Criteria (NINCDS-ADRDA) for diagnosis of probable Alzheimer disease, with a Standardised Mini-Mental State Examination (SMMSE) score of ≥12 and <27. Participants were randomly assigned to 8 mg sustained-release nilvadipine or matched placebo. The a priori defined primary outcome was progression on the Alzheimer's Disease Assessment Scale Cognitive Subscale-12 (ADAS-Cog 12) in the modified intention-to-treat (mITT) population (n = 498), with the Clinical Dementia Rating Scale sum of boxes (CDR-sb) as a gated co-primary outcome, eligible to be promoted to primary end point conditional on a significant effect on the ADAS-Cog 12. The analysis set had a mean age of 73 years and was 62% female. Baseline demographic and Alzheimer disease–specific characteristics were similar between treatment groups, with reported mean of 1.7 years since diagnosis and mean SMMSE of 20.4. The prespecified primary analyses failed to show any treatment benefit for nilvadipine on the co-primary outcome (p = 0.465). Decline from baseline in ADAS-Cog 12 on placebo was 0.79 (95% CI, −0.07–1.64) at 13 weeks, 6.41 (5.33–7.49) at 52 weeks, and 9.63 (8.33–10.93) at 78 weeks and on nilvadipine was 0.88 (0.02–1.74) at 13 weeks, 5.75 (4.66–6.85) at 52 weeks, and 9.41 (8.09–10.73) at 78 weeks. Exploratory analyses of the planned secondary outcomes showed no substantial effects, including on the CDR-sb or the Disability Assessment for Dementia. Nilvadipine appeared to be safe and well tolerated. Mortality was similar between groups (3 on nilvadipine, 4 on placebo); higher counts of adverse events (AEs) on nilvadipine (1,129 versus 1,030), and serious adverse events (SAEs; 146 versus 101), were observed. There were 14 withdrawals because of AEs. Major limitations of this study were that subjects had established dementia and the likelihood that non-Alzheimer subjects were included because of the lack of biomarker confirmation of the presence of brain amyloid.

Conclusions

The results do not suggest benefit of nilvadipine as a treatment in a population spanning mild to moderate Alzheimer disease.

Trial registration

Clinicaltrials.gov NCT02017340, EudraCT number 2012-002764-27.

Genetic tool that wipes out malaria could save 500,000 lives each year

New Scientist - Lu, 24/09/2018 - 17:00
Malaria could be eliminated by a CRISPR 'gene drive' that wipes out the mosquitoes that spread it, transforming the lives of hundreds of millions of people for the better

People are more clued up about science than you might think

New Scientist - Lu, 24/09/2018 - 12:00
Fake news isn't making us wilfully ignorant. Our survey suggests that people are better informed and more discerning than we give them credit for

Japanese space hoppers reveal glorious sci-fi vision of asteroid Ryugu

New Scientist - Lu, 24/09/2018 - 09:41
Japan's Hayabusa 2 spacecraft has released its two small MINERVA-II rovers on to the surface of the asteroid Ryugu, and the pair have sent back some amazing images

Riemann hypothesis likely remains unsolved despite claimed proof

New Scientist - Lu, 24/09/2018 - 09:30
Mathematician Michael Atiyah has presented his claimed proof of one of the most famous unsolved problems in maths, but others remain cautiously sceptical

Divers are attempting to regrow Great Barrier Reef with electricity

New Scientist - Sa, 22/09/2018 - 21:00
It may be possible to restore damaged parts of the Great Barrier Reef by electrically stimulating coral fragments grown on underwater metal frames

[Editorial] GLOBOCAN 2018: counting the toll of cancer

The Lancet - Sa, 22/09/2018 - 00:00
On Sept 12, the International Agency for Research on Cancer published the GLOBOCAN 2018 estimates of worldwide incidence and mortality for 36 cancers and cancer overall. Behind the data, gathered from local registries representing 185 countries, are the stories of 18·1 million people diagnosed with cancer in 2018 and the sorrow of 9·6 million deaths.

[Editorial] NCD Countdown 2030: strengthening accountability

The Lancet - Sa, 22/09/2018 - 00:00
One of the most powerful forces to emerge from the MDG era has been the idea of accountability. At its most elementary level, accountability means holding those with responsibility for health accountable for their commitments. It is a controversial concept. Few governments wish to be judged by their actions. Global health is replete with pledges, agreements, and declarations guaranteeing outcomes. A Marshall Plan for west Africa after Ebola? Financial assistance to deliver universal health coverage? Scaling up human resources for health? Empty promises.

[Editorial] Monkeypox contacts: a puzzling problem

The Lancet - Sa, 22/09/2018 - 00:00
When it emerged that two people infected with monkeypox had travelled by plane through one of the world's busiest airports, a media storm arose, with irresponsible headlines and exaggerations of risks for others in the UK and across the globe.

[Comment] Partnerships with the alcohol industry at the expense of public health

The Lancet - Sa, 22/09/2018 - 00:00
Public Health England (PHE) and Drinkaware launched the Drink Free Days campaign on Sept 10, 2018.1 PHE's partnership with the alcohol industry-funded body Drinkaware attracted widespread criticism before the launch when 46 public health professionals called for it to be halted.2 When this call was ignored, PHE's alcohol adviser, Sir Ian Gilmore, resigned from this role. In his capacity as chair of the Alcohol Health Alliance, Gilmore said that the partnership was “more likely to improve the reputation of global alcohol corporations than improve the health of the nation”.

[Comment] The Lancet Commission on public policy and health in the Trump era

The Lancet - Sa, 22/09/2018 - 00:00
Amid the raging US Civil War, Abraham Lincoln, the nation's 16th President, vowed that America's “government of the people, by the people, for the people, shall not perish from the earth”. At a time of deep ideological and political schism, it was a notion of government predicated on promoting the welfare—and wellbeing—of its citizens. With the 45th presidency of Donald Trump, that foundational vision has come under siege and the US Government and its commitments are at risk of capture by a privileged few for private gain.

[Comment] Offline: The death and rebirth of globalism

The Lancet - Sa, 22/09/2018 - 00:00
In a restaurant in Beijing, opposite a doctor unusually forthcoming, the conversation turned to the war—the trade war—between America and China. My companion jabbed his finger at me. “Would you really want less America in the world? Tell me from your heart!”, he asked. “Would you really want to live in a Communist country? Tell me from your heart!” His questions were not intended to be politically provocative. He was making a simple point: that the war between China and America was not about trade.

[World Report] India launches Ayushman Bharat's secondary care component

The Lancet - Sa, 22/09/2018 - 00:00
With one of the two crucial components of the Ayushman Bharat nearing a formal launch, can the health reforms transform India's health-care system? Patralekha Chatterjee reports.

[World Report] Forum on China-Africa Cooperation: what it means for health

The Lancet - Sa, 22/09/2018 - 00:00
Investment in health is an essential component of the FOCAC. Whereas some laud China's investment strategy, others deplore that gains to health are hard to track. Andrew Green reports.

[World Report] Increase of West Nile virus cases in Europe for 2018

The Lancet - Sa, 22/09/2018 - 00:00
Hundreds more cases of West Nile virus have been recorded in Europe this year compared with the 2017 season, which experts think might be a consequence of the hot summer. Talha Burki reports.

[Perspectives] Natasha Azzopardi-Muscat: promoting public health in Malta

The Lancet - Sa, 22/09/2018 - 00:00
Promoting public health in a small island nation such as Malta can be extremely challenging, but it is the career that Natasha Azzopardi-Muscat, President of the European Public Health Association and a senior lecturer on health services management at the University of Malta, has negotiated in the past 20 years, working to transform the country's health system to be fit for the 21st century.

[Perspectives] Women in medicine: deeds not words

The Lancet - Sa, 22/09/2018 - 00:00
As a neurology registrar, I worked in a department that ran social events that were exclusively for men. Male doctors were invited to golf outings, while female doctors stayed at work. Somebody had to hold the fort, after all. Cricket matches were more inclusive. Women could attend, but only to make the tea, not to play. This took place in 2003 in one of the UK's foremost centres for neuroscience. I think of it any time I am faced with claims that women have equal opportunities to men in medicine and that any failure to achieve senior positions is out of a lifestyle choice.

[Perspectives] The Royal College of Physicians at 500 years: changing roles and challenges

The Lancet - Sa, 22/09/2018 - 00:00
The Royal College of Physicians (RCP) celebrates its 500th anniversary on Sept 23, 2018. Few organisations have been in continual existence for longer in the field of medicine and to be able to celebrate a quincentenary is a remarkable achievement. Over 500 years, the RCP has assumed different functions as a consequence of the many changes in British sociopolitical history and British medicine. Here, we reflect on some of these changing roles and challenges to the current roles of the College.
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