Improvement in treatment adherence with a 3-day course of fluocinonide cream 0.1% for atopic dermatitis

Variations in adherence may cause variations in treatment outcomes with topical corticosteroid therapy for atopic dermatitis. An intensive short course of outpatient treatment may promote good adherence and provide a high level of efficacy. The purpose of this study was to assess the efficacy, tolerability, and adherence to short-term treatment with fluocinonide cream 0.1% in the treatment of atopic dermatitis. Twenty participants with mild to severe atopic dermatitis were instructed to use fluocinonide cream 0.1% twice daily for 3 consecutive days for a total of 6 doses. Disease severity was assessed at baseline, day 3, day 7, and day 14. Electronic monitoring was used to measure adherence to treatment. Median adherence to treatment over the 3-day period was 100%. By day 14, the median visual analog scale (VAS) of pruritus and eczema area and severity index (EASI) scores improved from baseline by 79% and 76%, respectively. By the end of the study period, 11 participants had investigator global assessment (IGA) scores of clear or almost clear. The absolute degree of improvement was proportional to baseline disease severity. Short-term treatment with fluocinonide cream 0.1% for atopic dermatitis was well-tolerated and resulted in significant disease improvement (P < .001). Participants were highly adherent to the 3-day treatment regimen. Efforts to improve adherence may be valuable approaches for treating recalcitrant atopic dermatitis.

Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial

New combination topical formulations for the treatment of acne may improve outcomes by increasing adherence. We assessed adherence to and efficacy of a combination topical medication for acne applied once daily compared with daily applications of 2 separate generic subcomponents. Twenty-six participants with mild to moderate acne vulgaris were randomized to 12 weeks of once daily application of clindamycin phosphate 7.2%-tretinoin 0.025% gel (CTG) combination product or separate daily applications of clindamycin phosphate gel 1% and tretinoin cream 0.025% (C gel + T cream) for a total of 2 applications daily. Disease severity was measured at baseline and weeks 4, 8, and 12. Adherence was monitored using electronic monitoring caps on the medication tubes. Of the 26 participants enrolled, 21 completed the 12-week study. Median adherence in the CTG group was 88% compared with 61% in the C gel + T cream group. There was a 51% mean reduction in total lesions for the CTG group versus a 32% mean reduction for the C gel + T cream group by the end of the study. Both CTG and separate applications of C gel + T cream improved mild to moderate acne. The use of a once daily combination product has the advantage of promoting better adherence and clinical outcomes.

ON THE MODE OF ACTION OF SULFANILAMIDE IN EXPERIMENTAL STREPTOCOCCUS EMPYEMA

Sulfanilamide prevents the evolution of an invariably fatal streptococcus empyema in rabbits when it is given repeatedly and in sufficient doses subcutaneously. Complete sterilization of the inoculated cavity occurs on approximately the 2nd day. The serum, defibrinated blood and artificial pleural exudate of similarly treated animals inhibits the growth of the same streptococcus in the test tube but even repeated doses of such treated blood serum fail to sterilize the culture. The coccal chains grown in such drugged serum are elongated and present pleomorphic and metachromatic organisms and may give rise to colonies that are at first less predominantly mucoid in appearance. Such organisms have, however, lost little if any of their virulence. Cooperation on the part of locally derived clasmatocytes is apparently required in complete sterilization of the animal body. This conclusion is reached not only by a process of exclusion from comparison with the test tube results, but through the direct histological demonstration of a precocious and increasing mobilization of clasmatocytes in the parietal and visceral pleura of treated animals. In other words, sulfanilamide apparently produces a bacteriostasis sufficiently marked to protect the accumulated leucocytes and to allow the natural defense macrophages to accumulate. There is direct evidence that the drug does not in itself stimulate the mobilization of the macrophages. There is no evidence that the cell reaction which finally accounts for disposal of the organisms is other than local.

Contribution of serial and parallel microperfusion to spatial variability in pulmonary inter- and intra-acinar blood flow

This study presents a theoretical model of combined series and parallel perfusion in the human pulmonary acinus that maintains computational simplicity while capturing some important features of acinar structure. The model provides a transition between existing models of perfusion in the large pulmonary blood vessels and the pulmonary microcirculation. Arterioles and venules are represented as distinct elastic vessels that follow the branching structure of the acinar airways. These vessels are assumed to be joined at each generation by capillary sheets that cover the alveoli present at that generation, forming a "ladderlike" structure. Compared with a model structure in which capillary beds connect only the most distal blood vessels in the acinus, the model with combined serial and parallel perfusion provides greater capacity for increased blood flow in the lung via capillary recruitment when the blood pressure is elevated. Stratification of acinar perfusion emerges in the model, with red blood cell transit time significantly larger in the distal portion of the acinus compared with the proximal portion. This proximal-to-distal pattern of perfusion may act in concert with diffusional screening to optimize the potential for gas exchange.

Good adherence and early efficacy using desonide hydrogel for atopic dermatitis: results from a program addressing patient compliance

BACKGROUND

Patients with atopic dermatitis (AD) may have poor adherence for several reasons, including fear of side effects or dislike of messy topical therapies.

PURPOSE

To assess adherence to and efficacy of a multifaceted program for atopic dermatitis using a lightweight, easy-to-apply medication and more frequent return visits.

METHODS

Forty-one subjects with mild-to-moderate atopic dermatitis were instructed to use desonide hydrogel 0.05% twice daily. Disease severity was measured at baseline and weeks 1, 2 and 4. Subjects also received a follow-up phone call on day 3. Adherence was assessed using electronic monitors. At the end of the study, subjects sampled and rated the vehicle attributes of six different topical corticosteroid formulations.

RESULTS

Mean adherence to twice-daily application slowly declined over time, from 81% on day 1 to 50% by day 27. An improvement in pruritus was observed as early as day 3, and by week 4, mean pruritus and EASI scores improved from baseline by 60% and 61%, respectively. Mean SGA scores also improved to marked improvement/almost clear by week 4. In vehicle attribute surveys, the hydrogel was consistently rated higher than the other vehicles in all categories.

CONCLUSION

Subjects responded very well to treatment, and adherence to desonide hydrogel 0.05% was much better than previously reported with ointments. The early efficacy, favorable attributes of the hydrogel vehicle and judicious follow up likely increased adherence to topical therapy. The use of ointments or more potent topical steroids as a first choice may be counterproductive in the treatment of atopic dermatitis.

Dual-specificity phosphatase 1: a critical regulator of innate immune responses

Innate immune responses are critically dependent on MAPK (mitogen-activated protein kinase) signalling pathways, in particular JNK (c-Jun N-terminal kinase) and p38 MAPK. Both of these kinases are negatively regulated via their dephosphorylation by DUSP1 (dual­-specificity phosphatase 1). Several pro- and anti-inflammatory stimuli converge to regulate the DUSP1 gene and to modulate the time course of its expression. In turn, the pattern of expression of DUSP1 dictates the kinetics of activation of JNK and p38 MAPK, and this influences the expression of several mediators of innate immunity. DUSP1 is therefore a central regulator of innate immunity, and its expression can profoundly affect the outcome of inflammatory challenges. We discuss possible implications for immune-mediated inflammatory diseases and their treatment.

Mathematical modelling of oxygen concentration in bovine and murine cumulus–oocyte complexes

Immature oocytes benefit from nutrient modification of the follicular environment by the surrounding cumulus mass. However, the oxygen concentration that the oocyte may be exposed to could be lower than the antral follicular concentration due to the metabolism of surrounding cumulus cells. Using metabolic data previously determined, we have developed a mathematical model of O2diffusion across the bovine and murine cumulus–oocyte complex. From this we have determined that across a physiological range of external pO2, less than 0.25% and 0.5% O2is removed by cumulus cells within the bovine and murine cumulus–oocyte complex respectively. Our model differs from others as it: incorporates a term that allows for nonlinear variation of the oxygen consumption rate with oxygen concentration; considers two regions (oocyte and cumulus) sharing a common boundary, both of which consume oxygen at different non linear rates. Cumulus cells therefore remove little O2, thus sparing this essential gas for the oocyte, which is dependent on ATP generation via oxidative phosphorylation.

Measurement of dijet azimuthal decorrelations at central rapidities in pp collisions at sqrt s =1.96 TeV

Correlations in the azimuthal angle between the two largest transverse momentum jets have been measured using the D0 detector in p (-)p collisions at a center-of-mass energy sqrt[s]=1.96 TeV. The analysis is based on an inclusive dijet event sample in the central rapidity region corresponding to an integrated luminosity of 150 pb(-1). Azimuthal correlations are stronger at larger transverse momenta. These are well described in perturbative QCD at next-to-leading order in the strong coupling constant, except at large azimuthal differences where contributions with low transverse momentum are significant.

Search for supersymmetry with gauge-mediated breaking in diphoton events at D0

We report the results of a search for supersymmetry (SUSY) with gauge-mediated breaking in the missing transverse energy distribution of inclusive diphoton events using 263 pb(-1) of data collected by the D0 experiment at the Fermilab Tevatron Collider in 2002-2004. No excess is observed above the background expected from standard model processes, and lower limits on the masses of the lightest neutralino and chargino of about 108 and 195 GeV, respectively, are set at the 95% confidence level. These are the most stringent limits to date for models with gauge-mediated SUSY breaking with a short-lived neutralino as the next-to-lightest SUSY particle.

Measurement of the B0s lifetime in the exclusive decay channel B0s-->J/psiphi

Using the exclusive decay B0s-->J/psi(mu+mu-)phi(K+K-), we report the most precise single measurement of the B0s lifetime. The data sample corresponds to an integrated luminosity of approximately 220 pb(-1) collected with the D0 detector at the Fermilab Tevatron Collider in 2002-2004. We reconstruct 337 signal candidates, from which we extract the B0s lifetime, tau(B0s)=1.444(+0.098)(-0.090)(stat)+/-0.020(sys) ps. We also report a measurement for the lifetime of the B0 meson using the exclusive decay B0-->J/psi(mu+mu-)K*0(892)(K+pi-). We reconstruct 1370 signal candidates, obtaining tau(B0)=1.473(+0.052)(-0.050)(stat)+/-0.023(sys) ps, and the ratio of lifetimes, tau(B0s)/tau(B0)=0.980(+0.076)(-0.071)(stat)+/-0.003(sys).

Observation and properties of the X(3872) decaying to J/psipi(+)pi(-) in pp collisions at sqrt[s]=1.96 TeV

We report the observation of the X(3872) in the J/psipi(+)pi(-) channel, with J/psi decaying to mu(+)mu(-), in pp collisions at sqrt[s]=1.96 TeV. Using approximately 230 pb(-1) of data collected with the Run II D0 detector, we observe 522+/-100 X(3872) candidates. The mass difference between the X(3872) state and the J/psi is measured to be 774.9+/-3.1(stat)+/-3.0(syst) MeV/c(2). We have investigated the production and decay characteristics of the X(3872) and find them to be similar to those of the psi(2S) state.

Search for doubly charged higgs boson pair production in the decay to mu(+)mu(+)mu(-)mu(-) in pp collisions at sqrt[s]=1.96 TeV

A search for pair production of doubly charged Higgs bosons in the process pp -->H(++)H(--) -->mu(+)mu(+)mu(-)mu(-) is performed with the D0 run II detector at the Fermilab Tevatron. The analysis is based on a sample of inclusive dimuon data collected at an energy of sqrt[s]=1.96 TeV, corresponding to an integrated luminosity of 113 pb(-1). In the absence of a signal, 95% confidence level mass limits of M(H(+/-+/-)(L))>118.4 GeV/c(2) and M(H(+/-+/-)(R))>98.2 GeV/c(2) are set for left-handed and right-handed doubly charged Higgs bosons, respectively, assuming 100% branching into muon pairs.

A precision measurement of the mass of the top quark

The standard model of particle physics contains parameters--such as particle masses--whose origins are still unknown and which cannot be predicted, but whose values are constrained through their interactions. In particular, the masses of the top quark (M(t)) and W boson (M(W)) constrain the mass of the long-hypothesized, but thus far not observed, Higgs boson. A precise measurement of M(t) can therefore indicate where to look for the Higgs, and indeed whether the hypothesis of a standard model Higgs is consistent with experimental data. As top quarks are produced in pairs and decay in only about 10(-24) s into various final states, reconstructing their masses from their decay products is very challenging. Here we report a technique that extracts more information from each top-quark event and yields a greatly improved precision (of +/- 5.3 GeV/c2) when compared to previous measurements. When our new result is combined with our published measurement in a complementary decay mode and with the only other measurements available, the new world average for M(t) becomes 178.0 +/- 4.3 GeV/c2. As a result, the most likely Higgs mass increases from the experimentally excluded value of 96 to 117 GeV/c2, which is beyond current experimental sensitivity. The upper limit on the Higgs mass at the 95% confidence level is raised from 219 to 251 GeV/c2.

Search for narrow tt resonances in pp collisions at square root of (s)=1.8 TeV

A search for narrow resonances that decay into tt pairs has been performed using 130 pb(-1) of data in the lepton + jets channel collected by the Dphi detector in pp collisions at square root of (s)=1.8 TeV. There is no significant deviation observed from the standard-model predictions at a top-quark mass of 175 GeV/c2. We therefore present upper limits at the 95% confidence level on the product of the production cross section and branching fraction to tt for narrow resonances as a function of the resonance mass MX. These limits are used to exclude the existence of a leptophobic top-color particle with mass MX<560 GeV/c2, using a theoretical cross section for a width GammaX=0.012MX.

MAP kinase phosphatase 1: a novel mediator of biological effects of glucocorticoids?

Synthetic glucocorticoids (GCs) potently inhibit the expression of pro-inflammatory genes and are widely used in the treatment of inflammatory diseases. However, some patients are resistant to the therapeutic effects of GCs, and many suffer deleterious side effects from these drugs. Furthermore, the precise mechanisms by which GCs inhibit pro-inflammatory gene expression remain unclear. A number of recent papers report that GCs induce the sustained expression of MAP kinase (MAPK) phosphatase 1 (MKP-1), a negative regulator of MAPK signal transduction pathways. The potential relevance of MKP-1 to some of the biological effects of GCs is discussed.

Search for large extra dimensions in the monojet+E(T) channel with the DØ detector

We present a search for large extra dimensions (ED) in pp collisions at a center-of-mass energy of 1.8 TeV using data collected by the DØ detector at the Fermilab Tevatron in 1994-1996. Data corresponding to 78.8+/-3.9 pb(-1) are examined for events with large missing transverse energy, one high-p(T) jet, and no isolated muons. There is no excess observed beyond expectation from the standard model, and we place lower limits on the fundamental Planck scale of 1.0 and 0.6 TeV for 2 and 7 ED, respectively.

Search for the production of single sleptons through R-parity violation in pp; collisions at square root (s) =1.8 TeV

We report the first search for supersymmetric particles via s-channel production and decay of smuons or muon sneutrinos at hadronic colliders. The data for the two-muon and two-jets final states were collected by the D0 experiment and correspond to an integrated luminosity of 94+/-5 pb(-1). Assuming that R parity is violated via the single coupling lambda'211, the number of candidate events is in agreement with expectation from the standard model. Exclusion contours are given in the (m(0),m(1/2)) and (m(x),m(v)) planes for lambda(')(211)=0.09, 0.08, and 0.07.