Detonation Performance of Insensitive Nitrogen-Rich Nitroenamine Energetic Materials Predicted from First-Principles Reactive Molecular Dynamics Simulations.

Because of the excellent combination of high detonation and low sensitivity properties of the 1,1-diamino-2,2-dinitroethylene (FOX-7) energetic material (EM), it is useful to explore new energetic derivatives that start with the FOX-7 structure. However, most such derivatives are highly sensitive, making them unsuitable for EM applications. An exception is the new nitroenamine EM, 1,1-diamino-2-tetrazole-2-nitroethene (FOX-7-T) (synthesized by replacing a nitro group with a tetrazole ring), which exhibits good stability. Unfortunately, FOX-7-T shows an unexpected much lower detonation performance than FOX-7, despite its higher nitrogen content. To achieve an atomistic understanding of the insensitivity and detonation performance of FOX-7 and FOX-7-T, we carried out reactive molecular dynamics (RxMD) using the ReaxFF reactive force field and combined quantum mechanics MD (QM-MD). We found that the functional group plays a significant role in the initial decomposition reaction. For FOX-7, the initial decomposition involves only simple hydrogen transfer reactions at high temperature, whereas for FOX-7-T, the initial reaction begins at much lower temperature with a tetrazole ring breaking to form N2, followed by many subsequent reactions. Our first-principles-based simulations predicted that FOX-7-T has 34% lower CJ pressure, 15% lower detonation velocity, and 45% lower CJ temperature than FOX-7. This is partly because a larger portion of the FOX-7-T mass gets trapped into condensed phase carbon clusters at the CJ point, suppressing generation of gaseous CO2 and N2 final products, leading to reduced energy delivery. Our findings suggest that the oxygen balance is an important factor to be considered in the design of the next generation of high-nitrogen-containing EMs.

Serum Folate and Vitamin B12 Modify the Associations of N6AMT1 Genetic Variants with Gestational Diabetes Mellitus: A Cross-Sectional Study in Chinese Pregnant Women.

Purpose: This study aimed to explore the association between N-6 adenine-specific DNA methyltransferase 1 (N6AMT1) single nucleotide polymorphisms (SNPs) and gestational diabetes mellitus (GDM) and the modification of the relationship by folate and vitamin B12. Methods: A cross-sectional study involving 1303 pregnant women (262 GDM and 1041 non-GDM) was performed in Tianjin, China. Nine SNPs in N6AMT1 were genotyped, and serum folate, vitamin B12, and homocysteine (Hcy) levels were measured. The logistic regression models determined the odds ratios (ORs) for SNPs in N6AMT1 and the gene-nutrition interactions on GDM. Results: N6AMT1 rs7282280, rs1048546, and rs1997605 were related to GDM under the dominant model after adjusting for multiple covariates. Individuals carrying the N6AMT1 rs7282280 TC/TT genotypes had a lower risk of developing GDM, regardless of serum folate and vitamin B12 levels. However, rs1048546 TG/GG genotypes were associated with lower GDM risk when serum folate ≥ 6.0 ng/mL. Pregnancies with the risk genotypes in N6AMT1 and higher serum folate or lower vitamin B12 are more prone to GDM. The study also showed a statistically significant additive interaction between N6AMT1 rs1997605 GG genotypes and lower vitamin B12 (RERI: 2.54; 95% CI: 0.17, 4.92). Conclusion: SNPs in N6AMT1 were found to be associated with GDM, and serum folate and vitamin B12 levels can modify their associations.

The Effect of BI 730357 (Retinoic Acid-Related Orphan Receptor Gamma t Antagonist, Bevurogant) on the Pharmacokinetics of a Transporter Probe Cocktail, Including Digoxin, Furosemide, Metformin, and Rosuvastatin: An Open-Label, Non-randomized, 2-Period Fixed-Sequence Trial in Healthy Subjects.

Evaluating Drug-Drug Interactions (DDIs) for new investigational compounds requires several trials evaluating different drugs with different transporter specificities. By using a cocktail of drugs with different transporter specificities, a single trial could evaluate the pharmacokinetics (PKs) of each cocktail drug simultaneously, reducing the number of clinical DDI trials required for clinical development. We aimed to investigate the effect of steady-state Boehringer Ingelheim (BI) 730357 (bevurogant) on the PKs of a validated and optimized 4-component transporter cocktail. This open-label, non-randomized, 2-period fixed-sequence phase I trial compared transporter cocktail (0.25 mg digoxin/1 mg furosemide/10 mg metformin hydrochloride/10 mg rosuvastatin) with and without BI 730357 in healthy subjects aged 18-55 years with body mass index 18.5-29.9 kg/m2 . During reference treatment/period 1, transporter cocktail was administered 90 minutes after breakfast. After a washout period, during test treatment/period 2, BI 730357 was dosed twice daily for 13 days, with transporter cocktail administered on day 1. The primary endpoints were the area under the concentration-time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity (AUC0-∞ ) and the maximum measured concentration of the analyte in plasma (Cmax ), and the secondary endpoint was the area under the concentration-time curve of the analyte in plasma over the time interval from 0 to the last quantifiable data point (AUC0-tz ). Steady-state BI 730357 increased digoxin (+48% to +94%), minimally affected metformin (-2% to -9%), furosemide (+12% to +18%), and rosuvastatin (+19% to +39%) exposure. Therefore, no clinically relevant inhibition of transporters OCT2/MATE-1/MATE-2K, OAT1/OAT3, OATP1B1/OATP1B3 was observed. Potential inhibition of breast cancer resistance protein noted as PK parameters of coproporphyrin I/III (OATP1B1/OATP1B3 biomarkers) remained within bioequivalence boundaries while rosuvastatin PK parameters (AUC0-∞ /Cmax /AUC0-tz ) exceeded the bioequivalence boundary. BI 730357 was safe and well tolerated. This trial confirms the usefulness and tolerability of the transporter cocktail consisting of digoxin, furosemide, metformin, and rosuvastatin in assessing drug-transporter interactions in vivo.

A semi-empirical formula based on a modified general penetration resistance for predicting the motion of the rigid projectile.

The semi-empirical formula is an effective method for predicting the motion of rigid projectiles in practical applications due to the simplicity of its theory and the convenience of parameter calibration. The commonly used semi-empirical formula is Forrestal's form, combining several specific experimental cases that have been published, we find it exists deficiencies in predicting deceleration histories and the penetration depths of high velocities. To solve this problem, the general penetration resistance is employed to formulate the semi-empirical formula due to the 'general' characteristic of the general penetration resistance, and also make an assessment of this semi-empirical through experimental data. The results show that this semi-empirical method, like Forrestal's form, is not good at predicting high-velocity penetration depth. Thus, it propels us to develop a new semi-empirical formula. To this end, the general penetration resistance is modified with the assumption that the additional mass should be increased with the penetrating velocity and the projectile mass, based on which a new semi-empirical formula is developed. Then, the proposed semi-empirical formula is employed in individual published experimental data of different projectiles and striking velocities as well as different targets. The predictions of the proposed semi-empirical formula show good agreement with the experimental data both in penetration depths and deceleration histories, which also demonstrate the reasonableness of the assumption that the additional mass of rigid projectile increases with penetrating velocity and the projectile mass.

Can Mechanistic Static Models for Drug-Drug Interactions Support Regulatory Filing for Study Waivers and Label Recommendations?

BACKGROUND AND OBJECTIVE: Mechanistic static and dynamic physiologically based pharmacokinetic models are used in clinical drug development to assess the risk of drug-drug interactions (DDIs). Currently, the use of mechanistic static models is restricted to screening DDI risk for an investigational drug, while dynamic physiologically based pharmacokinetic models are used for quantitative predictions of DDIs to support regulatory filing. As physiologically based pharmacokinetic model development by sponsors as well as a review of models by regulators require considerable resources, we explored the possibility of using mechanistic static models to support regulatory filing, using representative cases of successful physiologically based pharmacokinetic submissions to the US Food and Drug Administration under different classes of applications. METHODS: Drug-drug interaction predictions with mechanistic static models were done for representative cases in the different classes of applications using the same data and modelling workflow as described in the Food and Drug Administration clinical pharmacology reviews. We investigated the hypothesis that the use of unbound average steady-state concentrations of modulators as driver concentrations in the mechanistic static models should lead to the same conclusions as those from physiologically based pharmacokinetic modelling for non-dynamic measures of DDI risk assessment such as the area under the plasma concentration-time curve ratio, provided the same input data are employed for the interacting drugs. RESULTS: Drug-drug interaction predictions of area under the plasma concentration-time curve ratios using mechanistic static models were mostly comparable to those reported in the Food and Drug Administration reviews using physiologically based pharmacokinetic models for all representative cases in the different classes of applications. CONCLUSIONS: The results reported in this study should encourage the use of models that best fit an intended purpose, limiting the use of physiologically based pharmacokinetic models to those applications that leverage its unique strengths, such as what-if scenario testing to understand the effect of dose staggering, evaluating the role of uptake and efflux transporters, extrapolating DDI effects from studied to unstudied populations, or assessing the impact of DDIs on the exposure of a victim drug with concurrent mechanisms. With this first step, we hope to trigger a scientific discussion on the value of a routine comparison of the two methods for regulatory submissions to potentially create a best practice that could help identify examples where the use of dynamic changes in modulator concentrations could make a difference to DDI risk assessment.

Anticoagulant Effects of Dabigatran on Coagulation Laboratory Parameters in Pediatric Patients: Combined Data from Five Pediatric Clinical Trials.

BACKGROUND: Dabigatran etexilate, a direct oral thrombin inhibitor, is approved to treat venous thromboembolism (VTE) in both adults and children. OBJECTIVES: This population analysis characterized relationships between dabigatran total plasma concentrations and coagulation laboratory parameters (activated partial thromboplastin time [aPTT]; diluted thrombin time [dTT]; ecarin clotting time [ECT]). METHODS: Data from three phase 2a and one single-arm and one randomized, comparative phase 2b/3 pediatric studies (measurements: aPTT 2,925 [N = 358]; dTT 2,348 [N = 324]; ECT 2,929 [N = 357]) were compared with adult data (5,740 aPTT, 3,472 dTT, 3,817 ECT measurements; N = 1,978). Population models were fitted using nonlinear mixed-effects modeling. Covariates (e.g., sex, age) were assessed on baseline and drug-effect parameters, using a stepwise covariate model-building procedure. RESULTS: Overall, relationships between dabigatran, aPTT, dTT, and ECT were similar in children and adults. For children aged <6 months, a higher proportion of baseline samples were outside or close to the upper aPTT and ECT adult ranges. No age-related differences were detected for dTT. With increasing dabigatran concentration, aPTT rose nonlinearly (half the maximum effect at 368 ng/mL dabigatran) while dTT and ECT increased linearly (0.37 and 0.73% change per ng/mL dabigatran, respectively). Mean baseline aPTT (45 vs. 36 seconds) and ECT (40 vs. 36 seconds) were slightly increased for those aged <6 months versus older children. CONCLUSION: The similar relationships of laboratory parameters observed across pediatric age groups suggests that developmental changes in the hemostatic system may have little effect on response to dabigatran.

Efficacy and Safety Differences between Domestic Paclitaxel Drug-Coated Balloons and Metal Bare Stents in the Treatment of ASO of Femoral-Popliteal Arteries Type IIA-C.

The aim in this study was to investigate the efficacy and safety of domestic paclitaxel-coated balloon (DCB) and bare metal stent (BMS) in the treatment of Transatlantic Cooperative Organization Consensus II (ASC II) types A-C femoral-popliteal arteriosclerosis obliterans (ASO). A total of 103 patients with ASC II A-C femoropopliteal ASO, who received treatment in our hospital from March 2020 to March 2021, were retrospectively selected and divided into the DCB group (n = 56) and BMS group (n = 47), according to treatment methods. The general clinical data and surgical results were compared between the two groups. The patients were followed up, and the primary patency rate, restenosis rate, freedom from target lesion revascularization (f-TLR), and limb preservation rate were recorded. The liver and kidney functions before and after operation and the occurrence of major postoperative adverse events were recorded. The operation was successful in both groups. The minimum diameter of the DCB group was smaller than that of the BMS group after treatment (P < 0.05). At 6 and 12 months after operation, the Rutherford classification decreased and ABI index increased in both groups (P < 0.05), but there was no significant difference (P > 0.05). At 6 and 12 months after surgery, f-TLR was significantly higher in the DCB group than in the BMS group (P < 0.05); at 12 months after surgery, the restenosis rate was lower in the DCB group than in the BMS group (P < 0.05). There was no significant difference in the primary patency rate and limb preservation rate at 6 and 12 months after operation between the two groups (P > 0.05). Before and after operation, there was no significant difference in liver and kidney function between the two groups (P > 0.05). Within 12 months after surgery, 1 patient in the DCB group developed puncture site hematoma 3 days after surgery, and 1 patient in the BMS group developed acute thrombosis 1 day after surgery, and no intervention-related deaths occurred. Domestic paclitaxel DCB can achieve better f-TLR and lower restenosis rate than BMS in the treatment of type II A-C femoral-popliteal artery ASO. Short-term and medium-term efficacy and safety are comparable to BMS.

Study on the Polycrystalline Mechanism of Polycrystalline Diamond Synthesized from Graphite by Direct Detonation Method.

In this paper, a polycrystalline diamond was synthesized by the direct detonation method using graphite as the carbon source. By comparing the numbers of the obtained diamond particles and the original graphite particles, it was found that when the graphite phase transformed into the polycrystalline diamond during the detonation process, a single graphite particle would form multiple diamond nuclei, and the nuclei would grow simultaneously to form polycrystals. Accordingly, a validation experiment was designed, which added different ratios of inert additives while keeping the ratio of graphite to hexogen (RDX) unchanged. It was found that increasing the ratio of inert additives within a certain range could increase the grain size of a polycrystalline diamond, which is consistent with the obtained polycrystalline mechanism.

Study on Intrinsic Influence Law of Specimen Size and Loading Speed on Charpy Impact Test.

Charpy impact energy/impact toughness is closely related to external factors such as specimen size. However, when the sample size is small, the linear conversion relationship between the Charpy impact energy of the sub-size and full-size Charpy specimens does not hold; the Charpy impact toughness varies with the size of the specimen and other factors. This indicates that studying the internal influence of external factors on impact energy or impact toughness is the key to accurately understanding and evaluating the toughness and brittleness of materials. In this paper, the effects of strain rate on the flow behavior and the effects of stress triaxiality on the fracture behavior of 30CrMnSiNi2A high-strength steel were investigated using quasi-static smooth bar and notched bar uniaxial tensile tests and Split Hopkinson Tensile Bar (SHTP). Based on the flow behavior and strain rate dependences of the yield behavior, a modified JC model was established to describe the flow behavior and strain rate behavior. Charpy impact tests were simulated using the modified JC model and JC failure model with the determined parameters. Reasonable agreements between the simulation and experimental results have been achieved, and the validity of the model was proved. According to the simulation results, the impact energy was divided into crack initiation energy, crack stability propagation energy and crack instability propagation energy. On this basis, the effects of striker velocity and specimen width on the energy and characteristic load of each part were studied. The results show that each part of the impact energy has a negligible dependence on the hammer velocity, but there is a significantly different positive linear relationship with the width of the sample. The energy increment of each part also showed an inverse correlation with the increase in the sample width. The findings reveal that the internal mechanism of Charpy impact toughness decreases with the increase in sample width; to a certain extent, it also reveals the internal reason why the linear transformation relationship of Charpy impact energy between sub-size specimens and standard specimens is not established when the specimens are small. The analytical method and results presented in this paper can provide a reference for the study of the dynamic behavior of high-strength steel, the relationship between material properties and sample size, and the elastic-plastic impact dynamic design.

Ballistic Performance of Polyurea-Reinforced Ceramic/Metal Armor Subjected to Projectile Impact.

Although polyurea has attracted extensive attention in impact mitigation due to its protective characteristics during intensive loading, the ballistic performance of polyurea-reinforced ceramic/metal armor remains unclear. In the present study, polyurea-reinforced ceramic/metal armor with different structures was designed, including three types of coating positions of the polyurea. The ballistic tests were conducted with a ballistic gun; the samples were subjected to a tungsten projectile formed into a cylinder 8 mm in diameter and 30 mm in length, and the deformation process of the tested targets was recorded with a high-speed camera. The ballistic performance of the polyurea-reinforced ceramic/metal armor was evaluated according to mass efficiency. The damaged targets were investigated in order to determine the failure patterns and the mechanisms of interaction between the projectile and the target. A scanning electron microscope (SEM) was used to observe the microstructure of polyurea and to understand its failure mechanisms. The results showed that the mass efficiency of the polyurea-coated armor was 89% higher than that of ceramic/metal armor, which implies that polyurea-coated ceramic armor achieved higher ballistic performance with lighter mass quality than that of ceramic/metal armor. The improvement of ballistic performance was due to the energy absorbed by polyurea during glass transition. These results are promising regarding further applications of polyurea-reinforced ceramic/metal armor.

Dynamic Mechanical Properties of TC11 Titanium Alloys Fabricated by Wire Arc Additive Manufacturing.

To study the compressive mechanical properties and failure modes of TC11 titanium alloy fabricated by wire arc additive manufacturing (WAAM) technology in a large strain rate range at room temperature, the quasi-static and dynamic compression tests were carried out. In addition, optical microscopy (OM) and scanning electron microscopy (SEM) were employed to observe the metallographic structure and fracture morphology, respectively. The stress-strain curves in the range of 0.001 s-1-4000 s-1, original and post-deformation microstructures, macroscopic damage patterns, and microscopic fracture morphology were obtained at two different loading directions, including the scanning and deposition directions, respectively. In uniaxial compression experiments, the material showed little difference in mechanical properties between the scanning and deposition directions, exhibiting a strain rate strengthening effect. However, the strain rate sensitivity of the material under quasi-static loading conditions is much less than that under dynamic loading conditions. In addition, combining the stress-strain curve with the fracture morphology analysis, the plasticity in the scanning direction is better than in the deposition direction. Based on the experimental results, a modified Johnson-Cook (JC) constitutive model considering strain rate sensitivity and the effect of strain rate on strain hardening was proposed, and the parameters were determined using a Multiple Population Genetic Algorithm (MPGA). The obtained constitutive model is in good agreement with the experimental data, which can provide a reference for the engineering numerical calculation of TC11 titanium alloy for WAAM. This study also provides a fundamental databank for the application and design of WAAM TC11 alloy in the manufacturing of large and complex structural parts.

Pharmacokinetic modeling and simulation support for age- and weight-adjusted dosing of dabigatran etexilate in children with venous thromboembolism.

BACKGROUND: Dabigatran etexilate (DE), a direct oral thrombin inhibitor, has been evaluated in children with venous thromboembolism (VTE) using oral solution, pellets, or capsules. OBJECTIVES: This study evaluated DE pharmacokinetics (PK) in children with VTE and the appropriateness of a DE pediatric age- and weight-based dosing algorithm. PATIENTS/METHODS: A population PK model was fitted to data from four single-arm and one randomized, comparative pediatric VTE studies (358 children aged birth to <18 years; 2748 PK observations) and one healthy-adult study (32 males aged <40 years; 1523 PK observations) using nonlinear mixed-effects modeling. A stepwise, covariate, model-building procedure evaluated the influence of covariates (e.g., age, body weight, body surface area [BSA]-normalized renal function, and sex). The final model was used to evaluate the pediatric dosing algorithm, with simulations comparing pediatric trough exposure with reference exposure defined for the pediatric studies. RESULTS: The population PK of dabigatran was adequately described by a two-compartment model with first-order elimination and absorption. Age, weight, BSA-normalized renal function, and sex were statistically significant covariates (all P < .05). Apparent clearance increased with age (independently of body weight), diminished with decreasing BSA-normalized renal function, and was lower in females than males. All disposition parameters increased with body weight escalation (allometric scaling). Simulations confirmed that for all DE formulations, the final pediatric dosing algorithms achieved reference exposure without dose adjustment. CONCLUSIONS: Using a population PK model of DE for children with VTE, simulations showed that the final dosing algorithms were appropriate for all DE formulations; no dose titration was needed.

Safety, pharmacokinetics and pharmacodynamics of BI 655064 in phase 1 clinical trials in healthy Chinese and Japanese subjects.

AIMS: To evaluate the safety, pharmacokinetics and pharmacodynamics of BI 655064 in healthy Chinese and Japanese subjects after administration of single doses of 80-240 mg and multiple dosing of 240 mg once weekly over 4 weeks. METHODS: Two phase 1, double-blind, placebo-controlled studies were conducted (single-rising doses of BI 655064 in Chinese/Japanese male subjects [n = 12 per BI 655064 dose group] or repeated 240 mg BI 655064 in Chinese male subjects [n = 9]). Plasma samples were collected to investigate BI 655064 pharmacokinetics, pharmacodynamics (CD40 receptor occupancy [RO]) and immunogenicity, along with the safety and tolerability of BI 655064. RESULTS: BI 655064 showed good overall tolerability following single-dose administration of 80-240 mg and repeated administration of 240 mg BI 655064 over 4 weeks. More Chinese subjects reported adverse events compared with Japanese subjects following single-dose administration (59.4% vs 3.1%). BI 655064 exhibited nonlinear, saturable kinetics, with higher doses resulting in slower apparent clearance (0.514-0.713 mL min-1 ), and disproportionately higher total exposure (AUC0-inf ; 5610-7780 µg·h mL-1 ) and maximum plasma concentration (15 700-21 300 ng mL-1 ) with 240 mg BI 655064. Ninety percent inhibition of CD40 RO was achieved with doses ≥120 mg, and a direct relationship between BI 655064 plasma concentration and inhibition of CD40 RO was observed. Most subjects had a positive treatment-emergent antidrug antibody response. CONCLUSIONS: BI 655064 pharmacokinetic and safety profiles in East Asian male subjects were consistent with those observed in a Western population. No adjustments in the BI 655064 dosing recommendations are warranted for future clinical trials.

Dabigatran etexilate for the treatment of acute venous thromboembolism in children (DIVERSITY): a randomised, controlled, open-label, phase 2b/3, non-inferiority trial.

BACKGROUND: Dabigatran etexilate is a direct oral anticoagulant with potential to overcome the limitations of standard of care in children with venous thromboembolism. The aims of this clinical trial were to study the appropriateness of a paediatric dabigatran dosing algorithm, and the efficacy and safety of dabigatran dosed according to that algorithm versus standard of care in treating children with venous thromboembolism. METHODS: DIVERSITY is a randomised, controlled, open-label, parallel-group, phase 2b/3 non-inferiority trial done in 65 centres in 26 countries. Standard of care (low-molecular-weight heparins, unfractionated heparin, vitamin K antagonists or fondaparinux) was compared with a paediatric oral dabigatran dosing regimen (an age-adjusted and weight-adjusted nomogram) in children younger than 18 years with acute venous thromboembolism initially treated (5-21 days) with parenteral anticoagulation, requiring anticoagulation therapy for at least 3 months. Patients were randomised 1:2 (standard of care:dabigatran) and stratified by age (12 to <18 years, 2 to <12 years, and birth to <2 years) via interactive response technology. The primary composite efficacy endpoint (intention-to-treat analysis) was the proportion of children with complete thrombus resolution, and freedom from recurrent venous thromboembolism and venous thromboembolism-related death. A non-inferiority margin of absolute differences of 20% was used. Secondary endpoints included safety (determined by major bleeding events [time-to-event analysis on the treated set]), and pharmacokinetic-pharmacodynamic relationships (descriptive analyses). This trial is registered with ClinicalTrials.gov, NCT01895777 and is completed. FINDINGS: 328 children were enrolled between Feb 18, 2014, and Nov 14, 2019. 267 were randomly assigned (90 [34%] to standard of care and 177 [66%] to dabigatran) and included in the analyses. Median exposure to standard of care was 85·0 days (IQR 80·0-90·0) and to dabigatran was 84·5 days (78·0-89·0). Similar proportions of children treated with standard of care and dabigatran met the composite efficacy endpoint (38 [42%] of 90 vs 81 [46%] of 177; Mantel-Haenszel weighted difference, -0·04; 90% CI -0·14 to 0·07; p<0·0001 for non-inferiority). On-treatment bleeding events were reported in 22 (24%) of 90 children receiving standard of care and 38 (22%) of 176 children receiving dabigatran (hazard ratio [HR] 1·15, 95% CI 0·68 to 1·94; p=0·61); major bleeding events were similar between the groups (two [2%] of 90 and four [2%] of 176; HR 0·94, 95% CI 0·17 to 5·16; p=0·95). Pharmacokinetic-pharmacodynamic curves showed a linear relationship between total dabigatran plasma concentration and diluted thrombin time and ecarin clotting time, and a non-linear relationship with activated partial thromboplastin time; curves were similar to those for adults. Serious adverse events were reported for 18 (20%) of 90 children receiving standard of care and 22 (13%) of 176 children receiving dabigatran. The most common severe adverse events were vascular disorders (standard of care three [3%] of 90, dabigatran two [1%] of 176), and gastrointestinal disorders (standard of care two [2%] of 90 and dabigatran five [3%] of 176). One on-treatment death occurred in the standard of care group (retroperitoneal bleeding, not considered treatment related by the study investigators). INTERPRETATION: An age-adjusted and weight-adjusted dabigatran dosing algorithm was appropriate in children aged birth to less than 18 years with venous thromboembolism. Dabigatran was non-inferior to standard of care in terms of efficacy, with similar pharmacokinetic-pharmacodynamic relationships as those seen in adults, and might be a suitable alternative to standard of care. FUNDING: Boehringer Ingelheim.

Safety of dabigatran etexilate for the secondary prevention of venous thromboembolism in children.

This open-label, single-arm, prospective cohort trial is the first phase 3 safety study to describe outcomes in children treated with dabigatran etexilate for secondary venous thromboembolism (VTE) prevention. Eligible children aged 12 to <18 years (age stratum 1), 2 to <12 years (stratum 2), and >3 months to <2 years (stratum 3) had an objectively confirmed diagnosis of VTE treated with standard of care (SOC) for ≥3 months, or had completed dabigatran or SOC treatment in the DIVERSITY trial (NCT01895777) and had an unresolved clinical thrombosis risk factor requiring further anticoagulation. Children received dabigatran for up to 12 months, or less if the identified VTE clinical risk factor resolved. Primary end points included VTE recurrence, bleeding events, and mortality at 6 and 12 months. Overall, 203 children received dabigatran, with median exposure being 36.3 weeks (range, 0-57 weeks); 171 of 203 (84.2%) and 32 of 203 (15.8%) took capsules and pellets, respectively. Overall, 2 of 203 children (1.0%) experienced on-treatment VTE recurrence, and 3 of 203 (1.5%) experienced major bleeding events, with 2 (1.0%) reporting clinically relevant nonmajor bleeding events, and 37 (18.2%) minor bleeding events. There were no on-treatment deaths. On-treatment postthrombotic syndrome was reported for 2 of 162 children (1.2%) who had deep vein thrombosis or central-line thrombosis as their most recent VTE. Pharmacokinetic/pharmacodynamic relationships of dabigatran were similar to those in adult VTE patients. In summary, dabigatran showed a favorable safety profile for secondary VTE prevention in children aged from >3 months to <18 years with persistent VTE risk factor(s). This trial was registered at www.clinicaltrials.gov as #NCT02197416.

The Ubiquitiformal Characterization of the Mesostructures of Polymer-Bonded Explosives.

A nesting ubiquitiform (NU) approach was developed to characterize the mesostructural features of polymer-bonded explosives (PBXs), and then used to predicate some equivalent physical properties of PBXs, which can also be expected to be extended to other composites with complicated internal mesostructures. To verify the availability, two NU models for two kinds of PBX with different compositions are presented, which are PBX 9501 and LX-17, based on which, the equivalent thermal conductivities were calculated. Particularly, it is so encouraging that an analytical expression of the equivalent thermal conductivity was obtained only under a simply assumption of homogeneity. Moreover, it was found that the numerical results calculated by both the recursive algorithm and the analytical expression were in good agreement with the experimental data. In addition, it is also shown that such a physical property as the equivalent thermal conductivity is indeed independent of the meso-configuration of the location distribution of the explosive particles and the voids inside the PBX, which seems consistent with the common expectations and lays the foundations for the application of ubiquitiform to investigating some equivalent properties of composites.

Shock initiation of multi-component insensitive PBX explosives: Experiments and MC-DZK mesoscopic reaction rate model.

To facilitate the pre-estimation and optimization of the prescription design of a multi-component polymer bonded explosive (PBX), a multicomponent mesoscopic reaction rate model (MC-DZK model) is developed to predicate preferably the influence of both the explosive components and the particle size of on the shock initiation. All the parameters in the model are determined directly by the parameters in the DZK model for each explosive component. Furthermore, for the multicomponent insensitive explosive PBXC10 (70% TATB, 25% HMX, and 5% Kel-F800 by weight) with different explosive particle sizes, both shock initiation experiments and corresponding numerical simulations are performed, and there is satisfactory agreement between the numerical results and the available experimental data. It is found that the pressure histories present as a shape of step increase during the whole shock initiation process, which is resulted mainly from the rapid chemical reaction rate just behind the precursory shock wave front. It is also found that the smaller the size of the explosive particulates, the faster the pressure grows on the precursory shock wave front, the shorter the run distance to detonation, and the higher the chemical reaction rate just behind the precursory shock wave front.

Computational analysis of mesoscale thermomechanical ignition behavior of impacted LLM-105 based explosives.

LLM-105 (2,6-diamino-3,5-dinitropyrazine-1-oxide) is an insensitive high explosive crystal which has performance between that of HMX and TATB. An elastoviscoplastic dislocation model is developed for LLM-105 crystal, which accounts for the dislocation evolutions at the crystal interior and crystal wall and strain-rate dependent work hardening. Three different crystal morphology (cubic, icosahedral, rodlike) of LLM-105 based explosive computational models were constructed and subjected to an impact velocity of 200 m s-1 and 500 m s-1. Effects of crystal morphology and initial dislocation density on thermomechanical ignition behavior of LLM-105 based explosives were analyzed. Dislocation density of both crystal interiors and crystal walls in the rodlike LLM-105 based explosive increases slower than that in the cubic and icosahedral explosives. Both the volume averaged and localized stress and dislocation density are the lowest for the rodlike explosive. At the impact velocity of 500 m s-1, a temperature rise due to volumetric work, plasticity work and chemical reaction is sufficiently high to lead to the ignition of the cubic explosive, which shows that the rodlike explosive is the least sensitive among the three explosives. Moreover, with the increase of initial dislocation density, the corresponding volume averaged and localized stress and temperature increase as well. Results presented bridge the macroscale thermomechanical ignition response with the mesoscale deformation mechanisms, which is essential for better understanding the ignition mechanisms and guiding the design of LLM-105 based formulations.

Investigation of the agglomeration reduction mechanism of the aluminized HTPB propellant containing ferric perfluorooctanoate [Fe(PFO)3].

In this study, ferric perfluorooctanoate [Fe(PFO)3] was used in the aluminized HTPB propellant to reduce Al agglomeration during solid propellant combustion, and the agglomeration reduction mechanism was experimentally demonstrated via the burning rate measurement, heat of explosion and Al agglomeration analysis. The behavior of the burning particles on the burning surface as well as the morphology and composition of the quenched burning particles were characterized by microscopic high-speed photography and X-ray photoelectron spectroscopy, respectively; the thermal decomposition properties and gaseous decomposition products of Fe(PFO)3 were investigated by thermal gravimetry-differential scanning calorimetry joint analysis (TG-DSC), Fourier transform infrared spectroscopy (FTIR) and mass spectrometry (MS). The results show that Fe(PFO)3 can significantly increase the burning rate of the aluminized HTPB propellant and reduce Al agglomeration. The aluminized HTPB propellant containing Fe(PFO)3 exhibited a more efficient aluminum combustion process and smaller solid combustion product generation; the agglomeration reduction mechanism was revealed by the comprehensive effects of Fe(PFO)3 on the thermal decomposition of AP and promotion of the thermite reaction with aluminum. It led to the special "immediate detachment upon ignition" phenomenon of Al particles in the propellant and caused the generation of smaller detached burning Al particles. The highly reactive gaseous decomposition products of Fe(PFO)3 could reduce the accumulation of the generated Al2O3 on the burning Al particles.

Anticoagulant Effects of Dabigatran in Paediatric Patients Compared with Adults: Combined Data from Three Paediatric Clinical Trials.

BACKGROUND: Physiological age-related changes in the haemostatic and coagulation systems result in differing anticoagulant assay responses to standard anticoagulants. Therefore, we investigated the response of anticoagulant assays to dabigatran etexilate (DE) in children compared with adults. OBJECTIVE: This article assesses the relationship between plasma dabigatran concentration and coagulation assay results across age groups in children and adults. PATIENTS AND METHODS: Data from three clinical trials in which children received DE following standard of care for venous thromboembolism were compared with data from adult clinical trials. The effects of dabigatran concentration on diluted thrombin time (dTT), ecarin clotting time (ECT) and activated partial thromboplastin time (aPTT) were analysed graphically and with modelling. RESULTS: The concentration-dTT relationships were consistent in children across all ages and adults in the graphical analysis. For ECT and aPTT, relationships based on ratios over baseline were similar across all ages; absolute clotting times showed that the same exposure resulted in longer clotting times in some of the children aged < 1 year versus adults. Modelling showed concentration-clotting time relationships for all three assays were largely comparable between adults and children, except in those aged < 2 months, in whom there was a slight upward shift in ECT and aPTT relative to adults. CONCLUSION: Results suggest that developmental haemostatic changes will have little impact on response to DE. However, further paediatric clinical trials assessing the relationship between coagulation assay responses and clinical outcomes will be needed to confirm this finding.