Preparation of nano-sized multi-vesicular vesicles (MVVs) and its application in co-delivery of doxorubicin and curcumin.

Multi-vesicular vesicles (MVVs) offer structural advantages in terms of drug encapsulation and physiological stability. In this study, we address the challenge of preparing small-sized MVVs for drug delivery. The nano-sized MVVs (∼120 nm) loaded with doxorubicin (DOX) and curcumin (CUR) (DOX/CUR@MVVs) were successfully prepared using a glass bead combined with a thin film dispersion method. Transmission electron microscopy (TEM) and dynamic light scattering (DLS) analysis confirmed the independent non-homocentric vesicle structures of DOX/CUR@MVVs with homogeneous particle sizes. The experimental results showed high encapsulation rates of DOX and CUR in DOX/CUR@MVVs, reaching 82.5 ± 0.75 % and 85.9 ± 0.69 %, respectively. Moreover, the MVVs exhibited good biosafety and sustained release properties. Notably, the bioavailability of DOX and CUR in DOX/CUR@MVVs was enhanced compared to free DOX and CUR, with increases of 4.2 and 2.1 times, respectively. And the half-life of DOX and CUR was extended by 10 times in DOX/CUR@MVVs. In vivo antitumor experiments demonstrated that nano-sized DOX/CUR@MVVs significantly improved the antitumor activity while reducing the toxic side effects of DOX. Overall, the successful preparation of nano-sized DOX/CUR@MVVs and their potent and low-toxic antitumor effects provide a critical experimental reference for the combined antitumor therapy of MVVs and liposomes.

Efficacy and Safety of the TYK2/JAK1 Inhibitor Brepocitinib for Active Psoriatic Arthritis: A Phase IIb Randomized Controlled Trial.

OBJECTIVE: Brepocitinib is a TYK2/JAK1 inhibitor in development for the treatment of several immunologic diseases. The efficacy and safety of oral brepocitinib were assessed in participants with moderately-to-severely active psoriatic arthritis (PsA) for up to 52 weeks. METHODS: In this placebo-controlled, dose-ranging, phase IIb study, participants were randomized to receive 10 mg, 30 mg, or 60 mg of brepocitinib once daily or placebo, advancing to 30 mg or 60 mg of brepocitinib once daily at week 16. The primary endpoint was the response rate according to the American College of Rheumatology criteria for 20% improvement (ACR20) in disease activity at week 16. Secondary endpoints included response rates according to the ACR50/ACR70 response criteria, 75% and 90% improvement in the Psoriasis Area and Severity Index (PASI75/PASI90) score, and minimal disease activity (MDA) at weeks 16 and 52. Adverse events were monitored throughout the study. RESULTS: Overall, 218 participants were randomized and treated. At week 16, the brepocitinib 30 mg and 60 mg once daily groups had significantly greater ACR20 response rates (66.7% [P = 0.0197] and 74.6% [P = 0.0006], respectively), versus the placebo group (43.3%), and significantly higher ACR50/ACR70, PASI75/PASI90, and MDA response rates. Response rates were maintained or improved through week 52. Adverse events were mostly mild/moderate; serious adverse events (15) in 12 participants (5.5%) included infections in 6 participants (2.8%) in the brepocitinib 30 mg and 60 mg once daily groups. No major adverse cardiovascular events or deaths occurred. CONCLUSION: Treatment with brepocitinib at dosages of 30 mg and 60 mg once daily was superior to placebo at reducing signs and symptoms of PsA. Brepocitinib was generally well tolerated throughout the 52-week study, with a safety profile consistent with those found in other brepocitinib clinical trials.

An Acid-Sensitive Nanofiber Conjugate Based on a Short Aromatic Peptide for Targeted Delivery of Doxorubicin in Liver Cancer.

Purpose: This study aimed to construct a DOX conjugate with liver tumor targeting and acid sensitivity based on a short aromatic peptide FFYEE, which could amplify the tumor inhibition efficacy of DOX and alleviate tissue toxicity. Methods: A novel DOX-peptide conjugate, D-gal-FFYEE-hyd-DOX, was constructed by linking DOX to the side chain of FFYEE with acid-sensitive hydrazone bond and by modifying the C-terminal of peptide with α-D-galactosamine (D-gal) as targeting ligand. The structure of D-gal-FFYEE-hyd-DOX was characterized by mass spectrometry, infrared spectroscopy (IR), and UV-Vis spectroscopy (UV-Vis). The assembly characteristics of pentapeptide FFYEE and D-gal-FFYEE-hyd-DOX were observed by transmission electron microscope (TEM). In vitro drug release, cytotoxicity, endocytosis, in vivo antitumor experiment and histopathology analysis were investigated. Results: Peptide FFYEE endowed the D-gal-FFYEE-hyd-DOX with self-assembly performance and improved biocompatibility. D-gal-FFYEE-hyd-DOX can self-assemble into nanofibers with a diameter of ~ 40 nm in neutral aqueous solution and significantly reduced the cytotoxicity of free DOX to L02 cells. In vitro drug release results showed that D-gal-FFYEE-hyd-DOX had acid sensitivity and controlled release characteristics. The cytotoxicity and endocytosis investigations confirmed that D-gal-FFYEE-hyd-DOX enhanced the cellular uptake of DOX and inhibition effect on HepG2 cells. In vivo antitumor experiment indicated that D-gal-FFYEE-hyd-DOX could significantly inhibit the growth of liver tumor in mice and reduce the side effects of DOX. Conclusion: The conjugate D-gal-FFYEE-hyd-DOX with liver tumor targeting and acid sensitivity has the characteristics of strong tumor inhibition and low toxicity, hinting the great clinical application potential for targeted delivery of DOX in cancer treatment.

Glass Refraction Distortion Object Detection via Abstract Features.

Glass reflection and refraction lead to missing and distorted object feature data, affecting the accuracy of object detection. In order to solve the above problems, this paper proposed a glass refraction distortion object detection via abstract features. The number of parameters of the algorithm is reduced by introducing skip connections and expansion modules with different expansion rates. The abstract feature information of the object is extracted by binary cross-entropy loss. Meanwhile, the abstract feature distance between the object domain and source domain is reduced by a loss function, which improves the accuracy of object detection under glass interference. To verify the effectiveness of the algorithm in this paper, the GRI dataset is produced and made public on GitHub. The algorithm of this paper is compared with the current state-of-the-art Deep Face, VGG Face, TBE-CNN, DA-GAN, PEN-3D, LMZMPM, and the average detection accuracy of our algorithm is 92.57% at the highest, and the number of parameters is only 5.13 M.

Measuring the Influence of Legally Recognized Partnerships on the Health and Well-Being of Same-Sex Couples: Utility of the California Health Interview Survey.

PURPOSE: This study explored the utility of the California Health Interview Survey (CHIS) to compare health-related outcomes among gay men, lesbians, and heterosexuals who reported being in a legally recognized partnership. METHODS: We regressed sexual identity and marriage/legally recognized partnership status on seven different outcomes related to health insurance coverage, medical services access and use, and general health and well-being using CHIS data collected between 2009 and 2013. RESULTS: There were 1432 respondents who identified as gay, lesbian, or homosexual, and 67,746 who identified as heterosexual. The percentage of participants who reported being married/legally partnered was 54.06% for heterosexual women, 52.93% for heterosexual men, 38.83% for lesbians, and 23.56% for gay men. Legally partnered/married gay and lesbian respondents were more likely to have health insurance and use healthcare than their counterparts not in such partnerships; few trends were statistically significant. Gay men in legally recognized partnerships were more likely than their heterosexual counterparts to report continuous health insurance coverage, a usual medical care source, and at least one provider visit within the past 12 months. We found statistically significant poorer health status outcomes among lesbians in legally recognized partnerships compared to married heterosexual women. CONCLUSIONS: Lesbians in legally recognized partnerships did not fare as well as married heterosexual women. Gay men in legally recognized partnerships fared better than married heterosexual men on some measures. CHIS questionnaire structures limited our sample and analyses. We recommend that CHIS and other researchers ask partnered status-, marriage-, and sexual identity-related questions en bloc to ensure more robust representation, analyses, recommendations, and policy resolutions.

Quality of well-being outcomes in the National Emphysema Treatment Trial.

BACKGROUND: Surgical and medical treatments for emphysema may affect both quality and quantity of life. The purpose of this article is to report outcomes from the National Emphysema Treatment Trial (NETT) using an index that combines quality and quantity of life. METHODS: This was a prospective randomized clinical trial. Following pulmonary rehabilitation, 1,218 patients with severe emphysema were randomly assigned to maximal medical therapy or to lung volume reduction surgery (LVRS). A generic quality-of-life measure, known as the Quality of Well-being Scale (QWB), was administered at baseline and again at 6, 12, 24, 36, 48, 60, and 72 months following treatment assignment. RESULTS: At baseline, QWB scores were comparable for the Medical and LVRS groups. For both groups, scores significantly improved following the rehabilitation program. The QWB scores before death for patients in the LVRS group improved up to the year 2 visit, whereas scores for the Medical group dropped significantly following the baseline visit. Imputing zeros (0) for death, QWB scores decreased significantly for both groups. With or without scoring death as 0, the LVRS group achieved better outcomes, and the significant differences were maintained until the sixth year. Over 6 years of follow-up, LVRS produced an average of 0.30 quality-adjusted life years (QALYs), or the equivalent of about 3.6 months of well life. CONCLUSIONS: Compared with maximal medical therapy alone, patients undergoing maximal medical therapy plus LVRS experienced improved health-related quality of life and gained more QALYs. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00000606; URL: www.clinicaltrials.gov.

Long-term follow-up of high-risk patients in the National Emphysema Treatment Trial.

BACKGROUND: The National Emphysema Treatment Trial (NETT) was a randomized clinical trial designed to compare lung volume reduction surgery (LVRS) with maximal medical care for patients with severe emphysema. The trial was halted early for a subgroup of patients with severe lung disease. We report longer term follow-up for this high-risk subgroup. METHODS: In a randomized clinical trial, patients with moderate to severe emphysema were assigned to LVRS plus maximal medical care or to maximal medical care alone and followed prospectively for vital status over 15 years. We focus on 140 high-risk patients. Quality of life data were available through 6 years of follow-up and were assessed using the University of California, San Diego Shortness of Breath Questionnaire and the Self-Administered Quality of Well-Being Scale. RESULTS: Through the first 3 years of follow-up, surgical patients in the high-risk subgroup had a significantly higher probability of death. However, the mortality curves crossed and there was a trend favoring surgical treatment through the remainder of the follow-up. The log-rank test suggested that the 2 groups were not significantly different (p=0.95) in survival. Quality of life data suggested an advantage of LVRS through the first 5 years of follow-up (p<0.01). The combined quality-adjusted survival model favored the medical group for the first few years of follow-up and favored the LVRS group after 4 years. CONCLUSIONS: The NETT was stopped early for high-risk patients with severe lung disease. Longer term follow-up suggests that surgical patients in this high-risk subgroup ultimately achieved comparable outcomes. The high risk of death within 30 days of the surgery may discourage use of the procedure for high-risk patients despite the potential for better long-term outcomes.

A latent model to detect multiple clusters of varying sizes.

This article develops a latent model and likelihood-based inference to detect temporal clustering of events. The model mimics typical processes generating the observed data. We apply model selection techniques to determine the number of clusters, and develop likelihood inference and a Monte Carlo expectation-maximization algorithm to estimate model parameters, detect clusters, and identify cluster locations. Our method differs from the classical scan statistic in that we can simultaneously detect multiple clusters of varying sizes. We illustrate the methodology with two real data applications and evaluate its efficiency through simulation studies. For the typical data-generating process, our methodology is more efficient than a competing procedure that relies on least squares.

Impact of baseline ECG collection on the planning, analysis and interpretation of 'thorough' QT trials.

The current guidelines, ICH E14, for the evaluation of non-antiarrhythmic compounds require a 'thorough' QT study (TQT) conducted during clinical development (ICH Guidance for Industry E14, 2005). Owing to the regulatory choice of margin (10 ms), the TQT studies must be conducted to rigorous standards to ensure that variability is minimized. Some of the key sources of variation can be controlled by use of randomization, crossover design, standardization of electrocardiogram (ECG) recording conditions and collection of replicate ECGs at each time point. However, one of the key factors in these studies is the baseline measurement, which if not controlled and consistent across studies could lead to significant misinterpretation. In this article, we examine three types of baseline methods widely used in the TQT studies to derive a change from baseline in QTc (time-matched, time-averaged and pre-dose-averaged baseline). We discuss the impact of the baseline values on the guidance-recommended 'largest time-matched' analyses. Using simulation we have shown the impact of these baseline approaches on the type I error and power for both crossover and parallel group designs. In this article, we show that the power of study decreases as the number of time points tested in TQT study increases. A time-matched baseline method is recommended by several authors (Drug Saf. 2005; 28(2):115-125, Health Canada guidance document: guide for the analysis and review of QT/QTc interval data, 2006) due to the existence of the circadian rhythm in QT. However, the impact of the time-matched baseline method on statistical inference and sample size should be considered carefully during the design of TQT study. The time-averaged baseline had the highest power in comparison with other baseline approaches.

Comparisons between ITT and treatment emergent adverse event analyses.

Different from the use of intention-to-treat (ITT) analysis for efficacy evaluation, many pharmaceutical companies currently use treatment emergent (TE) analysis for adverse event (AE) safety analysis. In the TE analysis, study period and AEs occurring after a pre-specified post-treatment window will not be included. One consideration for using the TE AE analysis is that including substantial off-drug period and events in the analysis may dilute the power for detecting safety signals especially if after discontinuation residual treatment effect diminishes quickly. We perform quantitative analyses to compare the unbiasedness and power of the ITT and TE AE analyses under several different settings and metrics (difference in rates and relative risk). Results show that unbiasedness and power are not always in the same direction. The choice of an approach for a particular trial should depend on the focus of the analysis. A data example is used to illustrate these points.