Secukinumab in psoriasis: randomized, controlled phase 3 trial results assessing the potential to improve treatment response in partial responders (STATURE).

BACKGROUND: Secukinumab, an anti-interleukin-17A monoclonal antibody, has demonstrated rapid and sustained efficacy in phase 3 psoriasis trials. OBJECTIVES: To examine whether partial responders could achieve improved responses with intravenous (IV) secukinumab vs. the same or a higher subcutaneous (SC) dose. METHODS: Forty-three participants with moderate-to-severe psoriasis and partial response [Psoriasis Area and Severity Index (PASI) score improvement of ≥ 50% but < 75%] after 12 weeks of 300 or 150 mg SC secukinumab therapy were randomized 1 : 1 to secukinumab 10 mg kg(-1) IV (baseline, weeks 2 and 4, respectively) or secukinumab 300 mg SC (baseline, week 4). All participants subsequently received secukinumab 300 mg SC every 4 weeks (weeks 8-36). Co-primary end points were PASI 75 and Investigator's Global Assessment [2011 modified version (IGA mod 2011)] 0/1 response rates at week 8 (IV vs. SC). RESULTS: Higher IGA mod 2011 0/1 response rates (66.7% vs. 33.3%; P = 0.03) and a trend towards higher PASI 75 response rates (90.5% vs. 66.7%; P = 0.06) were observed with secukinumab IV vs. SC at week 8. The primary objective was not met, as the difference was not significant for both co-primary end points. Improved responses in both groups were maintained at week 40 in most participants. Safety profiles for IV and SC secukinumab were similar. The trial was underpowered owing to its small sample size. CONCLUSIONS: Improved response may be attained in patients with psoriasis achieving partial response after 12 weeks of SC secukinumab treatment by continued dosing with 300 mg SC or treatment with higher doses.

Randomized clinical study comparing Compeed cold sore patch to acyclovir cream 5% in the treatment of herpes simplex labialis.

BACKGROUND: Hydrocolloid technology has been proven effective in treating dermal wounds. A previous study showed that a newly developed thin hydrocolloid patch [Compeed cold sore patch (CSP)] provided multiple wound-healing benefits across all stages of a herpes simplex labialis (HSL) outbreak. METHODS: An assessment of CSP efficacy and safety was conducted in an international, multicentre, assessor-blinded study, which enrolled 728 subjects with a history of recurrent HSL. Of these, 351 experienced an HSL outbreak and were randomized to use CSP (n = 179) or acyclovir cream 5% (n = 172) at the onset of symptoms until the lesion healed, for a maximum of 10 days. The primary end point was the subject's global assessment of therapy (SGAT; 0-10 scale; 0 = no response, 10 = excellent response). Multiple secondary end points included clinician-assessed healing time and subject assessment of lesion protection, noticeability and social embarrassment. RESULTS: CSP and acyclovir were highly effective (mean SGAT = 7.89 and 8.00, respectively), with no significant difference observed (P = 0.65). The difference in healing times between products was not significant (median, 7.57 days with CSP vs. 7.03 days with acyclovir, P = 0.37). Both treatments were well tolerated. CONCLUSION: CSP using hydrocolloid technology provides an efficacious and safe alternative to topical antivirals in treating HSL as a wound while affording additional immediate benefits of wound protection, discretion and relief of social embarrassment.

Penciclovir cream for the treatment of sunlight-induced herpes simplex labialis: a randomized, double-blind, placebo-controlled trial. Penciclovir Cream Herpes Labialis Study Group.

OBJECTIVE: The purpose of this study was to further define the therapeutic value of penciclovir cream in the treatment of sunlight-induced herpes labialis by comparing its efficacy and tolerability with those of an inactive control (purified water). METHODS: In this randomized, double-blind, placebo-controlled, parallel-group clinical trial, lesions were induced by exposure to sunlight. Treatment was self-initiated within 1 hour of development of the signs or symptoms of a recurrence. RESULTS: Healthy male and female patients (mean age, 38.3 years; range, 18 to 81 years) who had a history of sunlight-induced herpes labialis (mean of 6 recurrences in previous 12 months) applied either penciclovir cream (n = 266) or purified water (n = 275). Penciclovir cream significantly decreased the time to lesion healing (P < 0.001), with a reduction in median time of up to 2 days. The efficacy of penciclovir cream was further supported by a significant reduction in maximum lesion area (P = 0.008), a faster loss of lesion-associated symptoms (P = 0.026), and significant reductions in daily assessments of pain (P < or = 0.040), itching (P < or = 0.032), burning (P < or = 0.028), and tenderness (P < or = 0.026) as moderate or severe. These effects were reinforced by the results of the daily self-assessment of lesion attributes, with significantly fewer severe/extreme assessments of lesion size (P < or = 0.003), noticeability (P < or = 0.003), amount of scab/crust (P < or = 0.003), raised/ swollen area (P < or = 0.040), soreness/tenderness (P < or = 0.043), and overall severity (P < or = 0.001) throughout the study period. CONCLUSIONS: Penciclovir cream has demonstrated efficacy for a broad range of clinically important outcomes. Significant effects on lesion area, lesion symptoms, and other lesion attributes extend the clinical efficacy of penciclovir cream beyond lesion healing.

Social turn-taking of children with neuropsychiatric impairments and their parents.

Social interactional theory posits that child behavior and parent behavior are inter-dependent. Interactions that encourage reciprocity and balanced turn-taking are considered most conducive to child communication development. Children who have impaired communication development often exhibit frustration and a variety of aberrant behaviors. These behaviors may be, at least in part, because of a breakdown or imbalance in parent-child turn-taking, a form of social reciprocity. Parent-child turn-taking was examined in children exhibiting a variety of neuropsychiatric symptoms, including developmental delays and behavioral problems. Preadmission videotapes of 43 children and their parents (43 mothers and 21 fathers) were coded with respect to initiating and responding behaviors. Twenty-seven of the children were prelinguistic, and 16 were linguistic. An imbalance in parent-child reciprocity and turn-taking was noted in this sample: Parents initiated more frequently than children, and children responded to approximately half of parent initiations. There was a greater imbalance in prelinguistic children, evidenced by a significantly higher rate of mother initiating (p < .01) and responding behaviors (p < .08) as well as a significantly lower rate of child initiating behaviors (p < .02). Implications for interventions focusing on the parent-child dyad and including fathers are discussed, as well as directions for further research.

Hepatitis C virus in alcoholic patients with and without clinically apparent liver disease.

A high prevalence of antibodies to the hepatitis C virus (anti-HCV) has been demonstrated among patients with alcoholic liver disease, whereas the prevalence of HCV viremia in these patients remains uncertain. The aims of this study were to determine the prevalence of anti-HCV in alcoholic patients both with and without clinically apparent liver disease and to determine the presence of HCV RNA in those patients who tested positive for anti-HCV by RIBA II (Chiron Corporation, Emeryville, CA). One hundred male patients consecutively admitted to an alcoholic rehabilitation program were included. Group 1 was comprised of 40 patients with clinically apparent liver disease. Group 2 was comprised of 60 patients without clinically apparent liver disease. Anti-HCV was performed by a second-generation ELISA assay and confirmed by RIBA II. HCV RNA was performed by Quantiplex assay (Chiron Corporation) and a nested reverse transcriptase-polymerase chain reaction. No significant differences were found between the two groups with regards to age, quantity and duration of alcohol intake, or accepted risk factors for HCV. The overall prevalence of anti-HCV in our patients was 23%, with 43% of these in group 1 and 10% in group 2. HCV RNA tested positive in 94% of the anti-HCV-positive patients in group 1 and in 67% of the anti-HCV-positive patients in group 2. These data suggest that HCV infection is an important cofactor in the pathogenesis of liver disease among alcoholic patients.

Martinomycin, a new polyether antibiotic produced by Streptomyces salvialis. I. Taxonomy, fermentation and biological activity.

Actinomycete culture LL-D37187 has been found to produce the new polyether antibiotic martinomycin. Taxonomic studies, including morphological, physiological, and cell wall chemistry analyses, revealed that culture LL-D37187 is a novel streptomycete species, and the proposed name is Streptomyces salvialis. Martinomycin exhibits activity against the Southern Army Worm (Spodoptera eridania) and Gram-positive bacteria.

Comparative efficacy of sunscreen reapplication regimens in children exposed to ambient sunlight.

Undercompliance with sunscreen reapplication recommendations is a probable factor in suboptimal childhood ultraviolet radiation (UVR) protection. However, improving on the ability of sunscreens to absorb UVR without requiring frequent reapplication is difficult because the models most frequently used to develop and evaluate photoprotectants have only a limited ability to incorporate behavioral and environmental variables that are primarily responsible for loss of sunscreen efficacy. Hence, the objective of the present work was to develop a method to evaluate the efficacy of various regimens of sunscreen reapplication in children, under conditions of unrestricted behavior and exposure to ambient sunlight. Ninety-eight children, ages 7-12, Fitzpatrick skin types I-III, were divided between two study groups. The majority were types I-II, and all types were approximately equally represented between the groups. The children received single or multiple applications of a sun protection factor 25 sunscreen to preassigned lateral halves of the body and engaged in unrestricted activities throughout a 6- (group I) or 8-h (group II) period of sun exposure at a seaside location. The end measurement for these studies was incidence and severity of erythema 18 to 22 h after peak UV exposure. The results obtained showed that 1 or 4 sunscreen applications yielded comparable erythema protection after a 6-hour sun exposure, totaling 13 minimal erythema doses (MED). However, after an 8-h, 21 MED exposure, incidence and severity of erythema was greater at body sites treated with 1 compared with 5 sunscreen applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Application of fast-Fourier-transform techniques to the discrete-dipole approximation.

We show how fast-Fourier-transform methods can be used to accelerate computations of scattering and absorption by particles of arbitrary shape using the discrete-dipole approximation.

Biosynthetic origin of the carbon skeleton and oxygen atoms of the LL-F28249 alpha, a potent antiparasitic macrolide.

The biosynthesis of LL-F28249 alpha in a culture of Streptomyces cyaneogriseus has been studied using 13C, 14C and 18O labeled precursors. A complete 13C NMR spectrum of F28249 alpha has been assigned. Incorporation studies using 13C labeled precursors indicate that the carbon skeleton of F28249 alpha is derived from seven acetate, six propionate and one 2-methylpropionate units. The origin of the oxygen atoms of F28249 alpha has been examined by feeding [1-13C,18O2]acetate, [1-13C,18O2]propionate, [2-13C]acetate/18O2 and 18O2 separately to the fermentation culture and analyzing the resulting labeled LL-F28249 alpha samples by 13C NMR, electron impact MS and chemical ionization MS. Out of a total of eight oxygen atoms in LL-F28249 alpha, four oxygen atoms are derived from acetate, three from propionate and one from molecular oxygen.

Human safety study of body lotion containing Kathon CG.

The safety of Kathon CG biocide as a preservative in leave-on body lotions was assessed by 2 double-blind studies, using similar protocols. A total of 209 healthy male and female subjects aged 18 to 65 years, 100 in California (72 test subjects, 28 controls) and 109 in Florida (88 test subjects, 21 controls) completed the studies which included pre- and post-use phase diagnostic patch testing with Kathon CG 100 ppm active ingredient, and 13 weeks daily applications of either a test lotion containing Kathon CG 15 ppm active ingredient or a control lotion without Kathon CG. No evidence of irritation or sensitization attributable to use of the biocide was found during regular dermatological examinations during the use phase. Post-use phase patch testing produced negative results in all subjects with the exception of 1 control subject in Florida who had positive readings at the 2- and 4-week post-use phase patch testing. Overall, these studies show there is minimal, if any, risk of adverse effects associated with the use of Kathon CG 15 ppm active ingredient in a leave-on application.

The relationship of the intrauterine device, actinomycosis infection, and bowel abscesses.

PIP: A case study of the injurious effect of an IUD as a contributing factor to the development of an actinomycotic infection in the female genitalia and associated abdominal viscera is reviewed. A 38-year-old white woman presented with a 2-month history of pelvic cramps, menorrhagia, and "weakness." She also complained of occasional night sweats, a 6-pound weight loss, vaginal discharge, and a low-grade fever for 6 weeks prior to admission. The patient had no significant medical history except for a calcified pelvic mass (fibroid uterus); she had had a Dalkon Shield IUD in place for several years. The patient was admitted to the hospital gynecological service for removal of the IUD, dilatation and curettage, and probable hysterectomy. Cultures were taken of the IUD and the curettings. The mass involving the rectosigmoid as well as the enlarged fibroid uterus were confirmed on pelvic examinations. The histologic diagnosis of modern squamous metaplasia was made on microscopic examination. Fungal colonies in the detritus were noted on the IUD and curettings. The pelvic mass that was palpable on examination and associated with the fibroid uterus was found to be an abscess in juxtaposition to the sigmoid colon. The operative procedure included lysis of multiple adhesions, a subtotal hysterectomy and bilateral salpingo-oophorectomy, omentectomy with a transverse colon resection leaving a proximal colostomy and a distal mucous fistula. Microscopic examination of the abscesses was diagnostic for actinomycosis. Intravenous penicillin and clindamycin were used for treatment of the actinomycosis and bacteroids that were cultured from the abscesses. The IUD, colonic abscess, fallopian tubes, uterus, transverse colon and ovaries had microscopic evidence of actinomycotic infection. Review of the world literature reveals that the papers of Barth and Tietze are the 1st to indict the IUD as an etiologic factor for actinomycosis of the female genital organs.^ieng

Glycocinnamoylspermidines, a new class of antibiotics. I. Description and fermentation of the organism producing the LL-BM123 antibiotics.

The producing organism for the new broad spectrum glycocinnamoylspermidine antibiotics designated LL-BM123beta, gamma1 and gamma2 was characterized as a Nocardia sp. by chemical analysis of the cell wall, growth requirements, morphology and physiological reactions. Fermentation conditions to elaborate and analytical methods to characterize these antibiotics in fermentation filtrates are described.