Effects of balance-focused interactive games compared to therapeutic balance classes for older women.

OBJECTIVE: The prospective pre-post control study was designed to evaluate the effect of introducing balance-focused interactive virtual-reality games to community-dwelling older women to improve their agility, balance and functional mobility. METHOD: The study was set in a senior citizens' club in Cheras, Kuala Lumpur, Malaysia. The participants were 36 community-dwelling older women. Participants were randomly divided into either a group undertaking balance-focused virtual-reality games or a group doing therapeutic balance exercises. The program lasted 6 weeks and was conducted twice a week for 40 min during each session. As the main outcome measures, the results of the Ten Step Test (TST), postural sway (overall performance index, OPI) and the Timed Up and Go test (TUG) were measured pre- and post-intervention to evaluate agility, balance and functional mobility, respectively. RESULTS: Although both groups improved in OPI (F = 4.63, p < 0.001), TST (F = 46.15, p < 0.001) and TUG (F = 52.57, p = 0.03), combined time and group interaction only improved in the TUG (F = 4.54, p < 0.05). No significant differences between the two groups were found in terms of TST (F = 0.02, p = 0.86), OPI (F = 0.66, p = 0.42), and TUG (F = 0.11, p = 0.74). CONCLUSION: Older people could improve their agility, balance and functional mobility by complementing therapeutic balance exercises with active participation in interactive virtual-reality games at home or in the community.

Degradation pathways of a corticotropin-releasing factor antagonist in solution and solid states.

Stability of the 1,3,5-triazine derivative (1), a corticotropin-releasing factor inhibitor, was studied in acidic solutions and in solid formulations. Degradant structures were elucidated using liquid chromatography/mass spectrometry (LC/MS) and nuclear magnetic resonance (NMR). Compound 1 was found to undergo hydrolysis via two pathways. Pathway 1 involves three hydrolysis steps of the triazine ring. Pathway 2 proceeds through hydroxy substitution of the amino group on the triazine ring followed by its hydrolysis, eventually resulting in the formation of the same degradant as pathway 1. Stability of 1 in the tablets was dependent on the manufacturing process and degradation appeared to proceed more rapidly in amorphous regions created during processing. Pathways 1 and 2 were observed in the tablets and degradation rate was enhanced at high humidity condition. In addition to pathways 1 and 2, degradation in the tablet formulations was found to proceed through a third pathway involving nucleophilic displacement of the ether methoxy group by the triazine N-3. The resulting imidazolidinium intermediate was found to undergo a series of hydrolytic steps finally leading to the same end degradant as pathways 1 and 2. This intermediate was observed at a lower concentration in the tablet at the high humidity conditions and at very low concentrations in acidic solutions.

Loxapine for schizophrenia.

BACKGROUND: Some authors have suggested that loxapine is more effective than typical antipsychotics in reducing the negative symptoms of schizophrenia, that extrapyramidal adverse effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as atypical. OBJECTIVES: To determine the effects of loxapine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: For this 2007 update, we searched the Cochrane Schizophrenia Group's Register (January 2007). SELECTION CRITERIA: We included all randomised controlled clinical trials relevant to the care of schizophrenia that compared loxapine to other treatments. DATA COLLECTION AND ANALYSIS: We independently inspected abstracts ordered papers, re-inspected and quality assessed these. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. MAIN RESULTS: We were able to include 41 studies in this review. Compared with placebo, loxapine has an antipsychotic effect (Global effect - not improved at six weeks: n=78, 2 RCTs, RR 0.30 CI 0.1 to 0.6 NNT 3 CI 3 to 5). It is as effective as typical drugs in the short term (4 -12 weeks) (Global effect: n=580, 13 RCTs, RR 0.86 CI 0.7 to 1.1; mental state: n=915, 6 RCTs, RR 0.89 CI 0.8 to 1.1). Very limited heterogeneous data suggest that, given intramuscularly (IM), loxapine may be at least as sedating as IM haloperidol and thiothixene. Loxapine is also as effective as atypicals (risperidone, quetiapine) (n=468, 6 RCTs, RR mental state not improved 1.07 CI 0.8 to 1.5). Adverse effect profile is similar to typicals but loxapine may cause more extrapyramidal adverse effects when compared with atypicals (n=340, 4 RCTs, RR 2.18 CI 1.6 to 3.1). AUTHORS' CONCLUSIONS: Loxapine is an antipsychotic which is not clearly distinct from typical or atypical drugs in terms of its effects on global or mental state. Loxapines profile of adverse effects is similar to that of the older generation of antipsychotic drugs.

Characterization of CAF4 and CAF16 reveals a functional connection between the CCR4-NOT complex and a subset of SRB proteins of the RNA polymerase II holoenzyme.

The CCR4-NOT transcriptional regulatory complex affects transcription both positively and negatively and consists of the following two complexes: a core 1 x 10(6) dalton (1 MDa) complex consisting of CCR4, CAF1, and the five NOT proteins and a larger, less defined 1.9-MDa complex. We report here the identification of two new factors that associate with the CCR4-NOT proteins as follows: CAF4, a WD40-containing protein, and CAF16, a putative ABC ATPase. Whereas neither CAF4 nor CAF16 was part of the core CCR4-NOT complex, both CAF16 and CAF4 appeared to be present in the 1.9-MDa complex. CAF4 also displayed physical interactions with multiple CCR4-NOT components and with DBF2, a likely component of the 1.9-MDa complex. In addition, both CAF4 and CAF16 were found to interact in a CCR4-dependent manner with SRB9, a component of the SRB complex that is part of the yeast RNA polymerase II holoenzyme. The three related SRB proteins, SRB9, SRB10, and SRB11, were found to interact with and to coimmunoprecipitate DBF2, CAF4, CCR4, NOT2, and NOT1. Defects in SRB9 and SRB10 also affected processes at the ADH2 locus known to be controlled by components of the CCR4-NOT complex; an srb9 mutation was shown to reduce ADH2 derepression and either an srb9 or srb10 allele suppressed spt10-enhanced expression of ADH2. In addition, srb9 and srb10 alleles increased ADR1(c)-dependent ADH2 expression; not4 and not5 deletions are the only other known defects that elicit this phenotype. These results suggest a close physical and functional association between components of the CCR4-NOT complexes and the SRB9, -10, and -11 components of the holoenzyme.

A reinvestigation of the D-homoannular rearrangement and subsequent degradation pathways of (11 beta,16 alpha)-9-fluoro-11,16,17,21- tetrahydroxypregna-1,4-diene-3,20-dione (triamcinolone).

The commercial anti-inflammatory drug triamcinolone has been shown to rearrange by similar, but distinct pathways when exposed to certain trace metal ions or to dilute aqueous base. In the presence of aqueous base, the 16-hydroxy-20-keto system undergoes reverse aldol cleavage of the 16,17-bond, followed by aldol cyclization linking C-16 to C-20. This base-catalyzed rearrangement gives a 16 beta,17 alpha-dihydroxy product and a corresponding 16 alpha,17 alpha-dihydroxy product in roughly 4 to 1 ratio. Metal-catalyzed rearrangement provides the 16 alpha,17 alpha-dihydroxy product with extremely high stereoselectivity. Mechanistic models are proposed that help explain the ratio of products isolated from each route. The studies presented suggest that similar forms of rearrangement could be of preparative value in syntheses requiring specific stereochemistry of appropriately substituted bicyclic alpha,beta-dihydroxyketones. Under more vigorous conditions of aqueous base treatment these rearrangement products undergo further decomposition with loss of formaldehyde from the hydroxymethyl group, followed by beta-elimination of water. Reaction of the beta-elimination product with formaldehyde results in the formation of a dimeric species linked by a methylene group.