Functional evidence supports adaptive plant chemical defense along a geographical cline.

Environmental clines in organismal defensive traits are usually attributed to stronger selection by enemies at lower latitudes or near the host's range center. Nonetheless, little functional evidence has supported this hypothesis, especially for coevolving plants and herbivores. We quantified cardenolide toxins in seeds of 24 populations of common milkweed (Asclepias syriaca) across 13 degrees of latitude, revealing a pattern of increasing cardenolide concentrations toward the host's range center. The unusual nitrogen-containing cardenolide labriformin was an exception and peaked at higher latitudes. Milkweed seeds are eaten by specialist lygaeid bugs that are even more tolerant of cardenolides than the monarch butterfly, concentrating most cardenolides (but not labriformin) from seeds into their bodies. Accordingly, whether cardenolides defend seeds against these specialist bugs is unclear. We demonstrate that Oncopeltus fasciatus (Lygaeidae) metabolized two major compounds (glycosylated aspecioside and labriformin) into distinct products that were sequestered without impairing growth. We next tested several isolated cardenolides in vitro on the physiological target of cardenolides (Na+/K+-ATPase); there was little variation among compounds in inhibition of an unadapted Na+/K+-ATPase, but tremendous variation in impacts on that of monarchs and Oncopeltus. Labriformin was the most inhibitive compound tested for both insects, but Oncopeltus had the greater advantage over monarchs in tolerating labriformin compared to other compounds. Three metabolized (and stored) cardenolides were less toxic than their parent compounds found in seeds. Our results suggest that a potent plant defense is evolving by natural selection along a geographical cline and targets specialist herbivores, but is met by insect tolerance, detoxification, and sequestration.

Cardenolides, toxicity, and the costs of sequestration in the coevolutionary interaction between monarchs and milkweeds.

For highly specialized insect herbivores, plant chemical defenses are often co-opted as cues for oviposition and sequestration. In such interactions, can plants evolve novel defenses, pushing herbivores to trade off benefits of specialization with costs of coping with toxins? We tested how variation in milkweed toxins (cardenolides) impacted monarch butterfly (Danaus plexippus) growth, sequestration, and oviposition when consuming tropical milkweed (Asclepias curassavica), one of two critical host plants worldwide. The most abundant leaf toxin, highly apolar and thiazolidine ring-containing voruscharin, accounted for 40% of leaf cardenolides, negatively predicted caterpillar growth, and was not sequestered. Using whole plants and purified voruscharin, we show that monarch caterpillars convert voruscharin to calotropin and calactin in vivo, imposing a burden on growth. As shown by in vitro experiments, this conversion is facilitated by temperature and alkaline pH. We next employed toxin-target site experiments with isolated cardenolides and the monarch's neural Na+/K+-ATPase, revealing that voruscharin is highly inhibitory compared with several standards and sequestered cardenolides. The monarch's typical >50-fold enhanced resistance to cardenolides compared with sensitive animals was absent for voruscharin, suggesting highly specific plant defense. Finally, oviposition was greatest on intermediate cardenolide plants, supporting the notion of a trade-off between benefits and costs of sequestration for this highly specialized herbivore. There is apparently ample opportunity for continued coevolution between monarchs and milkweeds, although the diffuse nature of the interaction, due to migration and interaction with multiple milkweeds, may limit the ability of monarchs to counteradapt.

Why Volume and Dynamics Decouple in Nanocomposite Matrices: Space that Cannot Be Accessed is Not Free.

Polymer nanocomposites have important material applications and are an ongoing focus of many molecular level investigations, however, puzzling experimental results exist. For example, specific volumes for some polymer nanocomposite matrices are 2% to 4% higher than for the neat polymer; in a pure polymer melt this would correspond to a pressure change of 40 to 100 MPa, and a decrease in isothermal segmental relaxation times of 3 to 5 orders of magnitude. However, the nanocomposite segmental dynamics do not show any speed up. We can explain this apparent uncoupling of dynamics from specific volume, and the key is to consider the system expansivity, i.e., the temperature dependence of the volumetric data, together with the concept of limiting volume at close liquid packing. Using pressure, volume, temperature data as a path to both, we are able to predict the effect of nanoadditives on the accessible, i.e., free, space in the material, which is critical for facilitating molecular rearrangements in dense systems. Our analysis explains why an increase in specific volume in a material may not always lead to faster segmental dynamics.

Spectroscopic ellipsometry as a route to thermodynamic characterization.

Strategies for synthesizing molecularly designed materials are expanding, but methods for their thermodynamic characterization are not. This shortfall presents a challenge to the goal of connecting local molecular structure with material properties and response. Fundamental thermodynamic quantities, including the thermal expansion coefficient, α, can serve as powerful inputs to models, yielding insight and predictive power for phenomena ranging from miscibility to dynamic relaxation. However, the usual routes for thermodynamic characterization often require a significant sample size (e.g. one gram), or challenging experimental set-ups (e.g. mercury as a confining fluid), or both. Here, we apply spectroscopic ellipsometry, which is an optical technique for thin film analysis, to obtain thermodynamic data. We clarify issues in the scientific literature concerning the connection between ellipsometric and volumetric thermal expansion coefficients for substances in both the glass and melt states. We analyze temperature-dependent data derived using both ellipsometry and macro-scale dilatometric techniques for ten different polymers. We find superb correlation between the α values obtained via the two techniques, after considering the effects of mechanical confinement by the substrate for a glassy thin film. We show how the ellipsometric α can serve as input to the locally correlated lattice theory to yield predictions for the percent free volume in each polymer as a function of temperature. We find that the ellipsometric α at the glass transition temperature, Tg, is not only material dependent, but it is linearly correlated with Tg itself. Spectroscopic ellipsometry, which requires only very small quantities of sample and is straightforward to perform, will significantly expand the range of systems for which thermodynamic properties can be characterized. It will thus advance our ability to use theory and modeling to predict the miscibility and dynamic relaxation of new materials. As such, ellipsometry will be able to underpin materials synthesis and property design.

Electron and Positron Scattering Cross Sections from CO2: A Comparative Study over a Broad Energy Range (0.1-5000 eV).

In this Review, we present a comparative study between electron and positron scattering cross sections from CO2 molecules over a broad impact energy range (0.1-5000 eV). For electron scattering, new total electron scattering cross sections (e-TCS) have been measured with a high resolution magnetically confined electron beam transmission system from 1 to 200 eV. Dissociative electron attachment processes for electron energies from 3 to 52 eV have been analyzed by measuring the relative O- anion production yield. In addition, elastic, inelastic, and total scattering cross section calculations have been carried out in the framework of the Independent Atom Model by using the Screening Corrected Additive Rule, including interference effects (IAM-SCARI). Based on the previous cross section compilation from Itikawa ( J. Phys. Chem. Ref. Data, 2002, 31, 749-767) and the present measurements and calculations, an updated recommended e-TCS data set has been used as reference values to obtain a self-consistent integral cross section data set for the elastic and inelastic (vibrational excitation, electronic excitation, and ionization) scattering channels. A similar calculation has been carried out for positrons, which shows important differences between the electron scattering behavior: e.g., more relevance of the target polarization at the lower energies, more efficient excitation of the target at intermediate energies, but a lower total scattering cross section for increasing energies, even at 5000 eV. This result does not agree with the charge independence of the scattering cross section predicted by the first Born approximation (FBA). However, we have shown that the inelastic channels follow the FBA's predictions for energies above 500 eV while the elastic part, due to the different signs of the scattering potential constituent terms, remains lower for positrons even at the maximum impact energy considered here (5000 eV). As in the case of electrons, a self-consistent set of integral positron scattering cross sections, including elastic and inelastic (vibrational excitation, electronic excitation, positronium formation, and ionization) channels is provided. Again, to derive these data, positron scattering total cross sections based on a previous compilation from Brunger et al. ( J. Phys. Chem. Ref. Data, 2017, 46, 023102) and the present calculation have been used as reference values. Data for the main inelastic channels, i.e. direct ionization and positronium formation, derived with this procedure, show excellent agreement with the experimental results available in the literature. Inconsistencies found between different model potential calculations, both for the elastic and inelastic collision processes, suggest that new calculations using more sophisticated methods are required.

Understanding the performance differences between solution and vacuum deposited OLEDs: A computational approach.

Solution-processing of organic light-emitting diode films has potential advantages in terms of cost and scalability over vacuum-deposition for large area applications. However, solution processed small molecule films can have lower overall device performance. Here, novel molecular dynamics techniques are developed to enable faster simulation of solvent evaporation that occurs during solution processing and give films of thicknesses relevant to real devices. All-atom molecular dynamics simulations are then used in combination with kinetic Monte Carlo transport modeling to examine how differences in morphology stemming from solution or vacuum film deposition affect charge transport and exciton dynamics in films consisting of light-emitting bis(2-phenylpyridine)(acetylacetonate)iridium(III) [Ir(ppy)2(acac)] guest molecules in a 4,4'-bis(N-carbazolyl)biphenyl host. While the structures of the films deposited from vacuum and solution were found to differ, critically, only minor variations in the transport properties were predicted by the simulations even if trapped solvent was present.

Simulating the Feasibility of Using Liquid Micro-Jets for Determining Electron-Liquid Scattering Cross-Sections.

The extraction of electron-liquid phase cross-sections (surface and bulk) is proposed through the measurement of (differential) energy loss spectra for electrons scattered from a liquid micro-jet. The signature physical elements of the scattering processes on the energy loss spectra are highlighted using a Monte Carlo simulation technique, originally developed for simulating electron transport in liquids. Machine learning techniques are applied to the simulated electron energy loss spectra, to invert the data and extract the cross-sections. The extraction of the elastic cross-section for neon was determined within 9% accuracy over the energy range 1-100 eV. The extension toward the simultaneous determination of elastic and ionisation cross-sections resulted in a decrease in accuracy, now to within 18% accuracy for elastic scattering and 1% for ionisation. Additional methods are explored to enhance the accuracy of the simultaneous extraction of liquid phase cross-sections.

The dynamics of freestanding films: predictions for poly(2-chlorostyrene) based on bulk pressure dependence and thoughtful sample averaging.

In this paper we model the segmental relaxation in poly(2-chlorostyrene) 18 nm freestanding films, using only data on bulk samples to characterize the system, and predict film relaxation times (τ) as a function of temperature that are in semi-quantitative agreement with film data. The ability to translate bulk characterization into film predictions is a direct result of our previous work connecting the effects of free surfaces in films with those of changing pressure in the bulk. Our approach combines the Locally Correlated Lattice (LCL) equation of state for prediction of free volume values (Vfree) at any given density (ρ), which are then used in the Cooperative Free Volume (CFV) rate model to predict τ(T, Vfree). A key feature of this work is that we calculate the locally averaged density profile as a function of distance from the surface, ρav(z), using the CFV-predicted lengthscale, Lcoop(z), over which rearranging molecular segments cooperate. As we have shown in the past, ρav(z) is significantly broader than the localized profile, ρ(z), which translates into a relaxation profile, τ(z), exhibiting a breadth that mirrors experimental and simulated results. In addition, we discuss the importance of averaging the log of position dependent relaxation times across a film sample (〈log τ(z)〉), as opposed to averaging the relaxation times, themselves, in order to best approximate a whole sample-averaged value that can be directly compared to experiment.

Unraveling exciton processes in Ir(ppy)3:CBP OLED films upon photoexcitation.

Emissive layers in phosphorescent organic light-emitting diodes commonly make use of guest-host blends such as Ir(ppy)3:CBP to achieve high external quantum efficiencies. However, while the Ir(ppy)3:CBP blend has been studied experimentally, crucial questions remain regarding how exciton diffusion is dependent on the distribution of the guest in the host, which can currently only be addressed at the atomic level via computational modeling. In this work, kinetic Monte Carlo simulations are utilized to gain insight into exciton diffusion in Ir(ppy)3:CBP blend films. The effects of both guest concentration and exciton density on various system properties are analyzed, including the probability of singlet excitons being converted to triplets, and the probability of those triplets decaying radiatively. Significantly, these simulations suggest that triplet diffusion occurs almost exclusively via guest-guest Dexter transfer and that concentration quenching of triplets induced by guest-guest intermolecular dipole-dipole interactions has a negligible effect at high exciton densities due to the prevalence of triplet-triplet annihilation. Furthermore, results for vacuum deposited morphologies derived from molecular dynamics simulations are compared to the results obtained using a simple cubic lattice approximation with randomly distributed guest molecules. We show that while differences in host-based processes such as singlet diffusion are observed, overall, the results on the fate of the excitons are in good agreement for the two morphology types, particularly for guest-based processes at low guest concentrations where guest clustering is limited.

To Understand Film Dynamics Look to the Bulk.

We show that shifts in dynamics of confined systems relative to that of the bulk material originate in the properties of bulk alone, and exhibit the same form of behavior as when different bulk isobars are compared. For bulk material, pressure-dependent structural relaxation times follow τ(T,V)∝exp[f(T)×g(V)]. When two states (isobars) of the material, "1" and "2", are compared at the same temperature this leads to a form τ_{2}∝τ_{1}^{c}, where c=g[V_{2}(T)]/g[V_{1}(T)]. Using equation of state analysis and two models for P-dependent dynamics, we show that c is approximately T independent, and that it can be very simply expressed in terms of either the (free) volume above the close packed state (V_{free}) or the activation energy for cooperative motion. The effect of changing state through a shift in pressure (P_{1} to P_{2}) is thus mechanistically traceable to cooperativity changing with density, through V_{free}. The connection with confined dynamics follows when 1 and 2 are taken as bulk and film at ambient P, differing in density only due to the film surface. The general form for τ(T,V) also illuminates why samples in different states (film vs bulk, high P vs low) trend toward the same relaxation behavior at high T.

Substrate Roughness Speeds Up Segmental Dynamics of Thin Polymer Films.

We show that the segmental mobility of thin films of poly(4-chlorostyrene) prepared under nonequilibrium conditions gets enhanced in the proximity of rough substrates. This trend is in contrast to existing treatments of roughness which conclude it is a source of slower dynamics, and to measurements of thin films of poly(2-vinylpiridine), whose dynamics is roughness invariant. Our experimental evidence indicates the faster interfacial dynamics originate from a reduction in interfacial density, due to the noncomplete filling of substrate asperities. Importantly, our results agree with the same scaling that describes the density dependence of bulk materials, correlating segmental mobility to a term exponential in the specific volume, and with empirical relations linking an increase in glass transition temperature to larger interfacial energy.

A Complete Cross Section Data Set for Electron Scattering by Pyridine: Modelling Electron Transport in the Energy Range 0-100 eV.

Electron scattering cross sections for pyridine in the energy range 0-100 eV, which we previously measured or calculated, have been critically compiled and complemented here with new measurements of electron energy loss spectra and double differential ionization cross sections. Experimental techniques employed in this study include a linear transmission apparatus and a reaction microscope system. To fulfill the transport model requirements, theoretical data have been recalculated within our independent atom model with screening corrected additivity rule and interference effects (IAM-SCAR) method for energies above 10 eV. In addition, results from the R-matrix and Schwinger multichannel with pseudopotential methods, for energies below 15 eV and 20 eV, respectively, are presented here. The reliability of this complete data set has been evaluated by comparing the simulated energy distribution of electrons transmitted through pyridine, with that observed in an electron-gas transmission experiment under magnetic confinement conditions. In addition, our representation of the angular distribution of the inelastically scattered electrons is discussed on the basis of the present double differential cross section experimental results.

The cooperative free volume rate model for segmental dynamics: Application to glass-forming liquids and connections with the density scaling approach⋆.

In this paper, we apply the cooperative free volume (CFV) rate model for pressure-dependent dynamics of glass-forming liquids and polymer melts. We analyze segmental relaxation times, [Formula: see text] , as a function of temperature (T and free volume ( [Formula: see text] , and make substantive comparisons with the density scaling approach. [Formula: see text] , the difference between the total volume (V and the volume at close-packing, is predicted independently of the dynamics for any temperature and pressure using the locally correlated lattice (LCL) equation-of-state (EOS) analysis of characteristic thermodynamic data. We discuss the underlying physical motivation in the CFV and density scaling models, and show that their key, respective, material parameters are connected, where the CFV b parameter and the density scaling [Formula: see text] parameter each characterize the relative sensitivity of dynamics to changes in T , vs. changes in V . We find [Formula: see text] , where [Formula: see text] is the value predicted by the LCL EOS at the ambient [Formula: see text] . In comparing the predictive power of the two models we highlight the CFV advantage in yielding a universal linear collapse of relaxation data using a minimal set of parameters, compared to the same parameter space yielding a changing functional form in the density scaling approach. Further, we demonstrate that in the low data limit, where there is not enough data to characterize the density scaling model, the CFV model may still be successfully applied, and we even use it to predict the correct [Formula: see text] parameter.

Understanding charge transport in Ir(ppy)3:CBP OLED films.

Ir(ppy)3:CBP blends have been widely studied as the emissive layer in organic light emitting diodes (OLEDs), yet crucial questions about charge transport within the layer remain unaddressed. Recent molecular dynamics simulations show that the Ir(ppy)3 molecules are not isolated from each other, but at concentrations of as low as 5 wt. % can be part of connected pathways. Such connectivity raises the question of how the iridium(iii) complexes contribute to long-range charge transport in the blend. We implement a kinetic Monte Carlo transport model to probe the guest concentration dependence of charge mobility and show that distinct minima appear at approximately 10 wt. % Ir(ppy)3 due to an increased number of trap states that can include interconnected complexes within the blend film. The depth of the minima is shown to be dependent on the electric field and to vary between electrons and holes due to their different trapping depths arising from the different ionization potentials and electron affinities of the guest and host molecules. Typical guest-host OLEDs use a guest concentration below 10 wt. % to avoid triplet-triplet annihilation, so these results suggest that optimal device performance is achieved when there is significant charge trapping on the iridium(iii) complex guest molecules and minimum interactions of the emissive chromophores that can lead to triplet-triplet annihilation.

The application of FT-NIRS for the detection of bruises and the prediction of rot susceptibility of 'Hass' avocado fruit.

BACKGROUND: A rapid non-destructive in-line grading system that can rapidly and accurately assess individual avocado fruit for internal quality attributes, including bruises and rots, would allow the avocado industry to provide a more consistent fruit quality to the consumer, optimise market distribution and ensure maximum yield for the producer and retailer. Fourier transform-near-infrared (FT-NIR) spectroscopy was investigated to detect bruises and rot susceptibility as an indication of shelf-life in avocado fruit at both the sprung stage of ripeness and eating ripe fruit. RESULTS: The classification models (principal component linear discriminant analysis, partial least squares discriminant analysis and support vector machine) for each of three growing seasons found hard green fruit that were deliberately bruised could be correctly detected with 70-78% accuracy after 2-5 h following impact damage and with 83-89% accuracy after 24 h. For eating ripe fruit, the accuracy was 60-100% after 2-5 h following impact damage and 66-100% after 24 h. The ability of the classification models to accurately predict rot development into two classes, ≤10% and >10% of flesh affected, ranged from 65% to 84% over the three growing seasons. When the rot classes were defined as ≤30% and >30% the accuracy was 69-77%. CONCLUSIONS: The results of the study highlight the potential of FT-NIR reflectance spectroscopy for application in a commercial, in-line setting for the non-destructive evaluation of impact damage and rot susceptibility of whole avocado fruit. The study indicates that fruit should be held for approximately 24 h prior to scanning to allow bruise development to occur, particularly in hard fruit (i.e., stage 2) prior to bruise assessment. © 2018 Society of Chemical Industry.

Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: With facet interventions under scrutiny, the authors' objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes. METHODS: A total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average reduction in numerical rating scale pain score 1 month after the facet or saline blocks, and average numerical rating scale pain score 3 months after ablation. RESULTS: Mean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005). CONCLUSIONS: This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.

Explaining the T,V-dependent dynamics of glass forming liquids: The cooperative free volume model tested against new simulation results.

In this article, we derive a rate model, the "cooperative free volume" (CFV) model, to explain relaxation dynamics in terms of a system's free volume, Vfree, and its temperature, T, over widely varied pressure dependent conditions. In the CFV model, the rate a molecule moves a distance on the order of its own size is dependent on the cooperation of surrounding molecules to open up enough free space. To test CFV, we have generated extensive T,V dependent simulation data for structural relaxation times, τ, on a Kob and Andersen type Lennard-Jones (KA-LJ) fluid. The Vfree = V - Vhc values are obtained by estimating the limiting hard core volume, Vhc, through analysis of the KA-LJ PVT data. We provide the first simulation evidence that shows ln τ to be linearly proportional to 1/Vfree on isotherms, with T-dependent slopes, thus confirming our recent analysis of experimental systems. The linear relationship exhibited by the simulation data is further shown to occur at temperatures both above and below the transition to Arrhenius behavior. We also show that the gas kinetic T-dependent contribution is important in simulation results and that there can be a significant entropic contribution from lingering molecular hard-cores at high T. A key result is that non-Arrhenius relaxation behavior is always exhibited on isobars of the KA-LJ fluid, even at high T. The CFV model predicts all of this behavior over a surprisingly wide range of the KA-LJ T,V space, fitting it with just a single set of three parameters. The CFV approach leads to a framework wherein the number of cooperating particles, and thus, the process free energy of activation, is inversely proportional to Vfree, and this is the foundation for the form of the model's volume contribution, a form that we find to hold for all systems and at all temperatures.

Advancing Risk Analysis for Nanoscale Materials: Report from an International Workshop on the Role of Alternative Testing Strategies for Advancement.

The Society for Risk Analysis (SRA) has a history of bringing thought leadership to topics of emerging risk. In September 2014, the SRA Emerging Nanoscale Materials Specialty Group convened an international workshop to examine the use of alternative testing strategies (ATS) for manufactured nanomaterials (NM) from a risk analysis perspective. Experts in NM environmental health and safety, human health, ecotoxicology, regulatory compliance, risk analysis, and ATS evaluated and discussed the state of the science for in vitro and other alternatives to traditional toxicology testing for NM. Based on this review, experts recommended immediate and near-term actions that would advance ATS use in NM risk assessment. Three focal areas-human health, ecological health, and exposure considerations-shaped deliberations about information needs, priorities, and the next steps required to increase confidence in and use of ATS in NM risk assessment. The deliberations revealed that ATS are now being used for screening, and that, in the near term, ATS could be developed for use in read-across or categorization decision making within certain regulatory frameworks. Participants recognized that leadership is required from within the scientific community to address basic challenges, including standardizing materials, protocols, techniques and reporting, and designing experiments relevant to real-world conditions, as well as coordination and sharing of large-scale collaborations and data. Experts agreed that it will be critical to include experimental parameters that can support the development of adverse outcome pathways. Numerous other insightful ideas for investment in ATS emerged throughout the discussions and are further highlighted in this article.

BMS-871: a novel orally active pan-Notch inhibitor as an anticancer agent.

This Letter describes synthesis, SAR, and biological activity of (2-oxo-1,4-benzodiazepin-3-yl)-succinamides as inhibitors of γ-secretase mediated signaling of Notch receptors. Optimization of this series led to the identification of BMS-871 (compound 30) which displayed robust in vivo efficacy in Notch-dependent leukemia and solid tumor xenograft models.

Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: a multicenter, randomized, comparative-effectiveness study.

BACKGROUND: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy. METHODS: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month. RESULTS: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006). CONCLUSIONS: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.